bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARISON OF PROGRESSIVE MUSCULAR RELAXATION (PMR) AND MUSIC THERAPY (MT) IN REDUCING THE ANXIETY, DEPRESSION AND STRESS SYMPTOMS AMONG NURSES
Authors: Mustafa Nazia , Farzeen Midhat , Kiani Shoaib , Khan Sana , Ain Noor Ul , Mumtaz Jaweria 
Published: January 2022

Objective: To compare the progressive muscular relaxation and music therapy in reducing the anxiety, depression and stress symptoms among nurses.
Study Design: Quasi-experimental Study.
Place and Duration of Study: Various hospitals in Rawalpindi, from Mar 2018 to Mar 2019.
Methodology: Sample of study was 20 female nurses. They were assessed by using depression, anxiety and stress scale (DASS21), Urdu version. Study participants were randomized into two groups, group 1= who received the music therapy (n=10); group 2=who receive progressive muscular relaxation (n=10). Both the groups were provided with 4 sessions of both interventions for one month. After completion of intervention, post assessment was carried immediately and analysis was carried out.
Results: Mean age of nurses was 31 ± 7.42 years (range from 19-45 years). Significant difference was found which showed that progressive muscular relaxation was more effective in reducing the symptoms of depression and stress as compared to music therapy. Whereas, no significant difference (p>0.05) was found on anxiety (both the treatments equally reduced the anxiety).
Conclusion: Progressive muscular relaxation was found to be more effective in reducing stress and depression in nurses than music therapy. The use of such techniques can serve as an additional therapy in the treatment of stress, anxiety and depression and can be used to reduce the need for pharmacological therapy.
RIFAXIMIN EFFECTIVENESS IN PREVENTING THE RECURRENCE OF HEPATIC ENCEPHALOPATHY AMONG PATIENTS WITH LIVER CIRRHOSIS
Authors: Saleem Muhammad Zulqurnain , Saleem Muhammad Hasan , Saleem Husnain , Aasil Muhammad Ali 
Published: January 2022

Objective: To determine the effectiveness of rifaximin in reducing the frequency of recurrence of hepatic encephalopathy among patients with liver cirrhosis.
Study Design: Descriptive case series.
Place and Duration of Study: Outpatient department of Combined Military Hospital Peshawar from Jan to Jun 2017.
Methodology: We included one hundred patients of either gender having liver cirrhosis with child Pugh B or C class with at least two previous episodes of hepatic encephalopathy. Patients were followed for six months to have any recurrence of hepatic encephalopathy. Conventional group was defined as having standard regimen including lactulose. Rifaximin treatment was defined as a 550mg BD daily dosing along with standard prescription.
Results: Fifty patients were on conventional treatment to prevent recurrence of hepatic encephalopathy while 50 patients were using rifaximin in addition to standard prescription. The average age of 54.8 ± 6.1 years with 58% male patients and 48% in child-pugh B class. Thirty (30%) patients developed hepatic encephalopathy among the study population. 14 patients with recurrence belong to rifaximin group while 16 were on conventional treatment (p-value >0.05) showing a non-significant difference. Post stratification revealed only age as a significant predictor of recurrence of hepatic encephalopathy in our study population (p<0.05).
Conclusion: Frequency of hepatic encephalopathy is similar in conventional treatment with Lactulose over six months of follow up as compared with rifaximin.
ERECTILE DYSFUNCTION AND ASSOCIATED SOCIO-DEMOGRAPHIC FACTORS AMONG PATIENTS SUFFERING FROM ASTHMA
Authors: Sultan Omer , Khalid Muhammad , Athar Muhammad Hammad 
Published: January 2022

Objective: To determine the frequency of erectile dysfunction among the patients of asthma and analyze the associated socio demographic factors.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi, from Oct to Dec 2018.
Methodology: One hundred and fifty seven patients of asthma diagnosed for more than one year by a consultant medical specialist or pulmonologist were included in the study. Erectile dysfunction was assessed by using the International Index of Erectile Function-5 (IIEF-5).
Results: Out of 157 patients of asthma, 74 (47.1%) had no erectile dysfunction, 50 (31.8%) had mild, 17 (10.8%) had mild to moderate, 11 (7.1%) had moderate and 5 (3.2%) had severe erectile dysfunction. Mean age of the study participants was 41.74 ± 3.16. Mean duration of asthma among the patients in this study was 5.98 ± 4.38 years. Poly-pharmacy and long duration of illness had significant association with erectile dysfunction (p-value<0.05).
Conclusion: There is a high frequency of erectile dysfunction among the patients suffering from asthma. Chronic illness when not under adequate control for a long time or is under control with poly pharmacy might give rise to problems which may be more troublesome than the primary illness.
PREDICTORS OF MORTALITY WITHIN 8 WEEKS AFTER ENDOSCOPIC TREATMENT OF GASTRIC VARICEAL BLEED WITH N-BUTYL 2-CYANOACRYLATE IN CIRRHOTIC PATIENTS
Authors: Ahmad Mahmood , Mahmud Yasir , Rasheed Sidra , Muaaz Muhammad , Afzal Muhammad Naeem , Nadeem Muhammad Arif 
Published: January 2022

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2- cyanoacrylate treatment.
Study Design: Prospective comparative study.
Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019.
Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted.
Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005).
Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks.
GONIAL ANGLE DETERMINATION; A COMPARISON BETWEEN LATERAL CEPHALOGRAM AND BOTH HEMISPHERES OF ORTHOPANTOMOGRAM
Authors: Khan Mehwish , Akhtar Faheem Nake , Jan Abdullah , Hamid Fatima , Tariq Sana 
Published: January 2022

Objective: To evaluate the mean values of Genial angle measured by Lateral cephalogram and Orthopantomogram.
Study Design: comparative cross sectional study.
Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Aug 2018 to Feb 2019.
Methodology: Patients irrespective of gender between the ages of 13-20 who reported for the treatment of class I malocclusion with complete anterior dentition were included. Orthopantomogram and lateral cephalogram were drawn by the same person. Gonial angle on orthopantomogram was measured by drawing tangents on posterior border of ramus and lower border of mandible on both halves of orthopantomogram. On lateral cephalogram the angle was measured between ramus and mandible. Gonial angle measured from lateral cephalogram and orthopantomogram were compared. T-test was applied.
Results: Mean age of the individuals was 18.33 ± 3.97 years. The mean gonial angle measured on lateral cephalogram was 122.66 ± 1.64 degrees while the mean gonial angle measured on right and left side of orthopantomogram was 122.41 ± 1.56 degrees and 122.33 ± 1.55 degrees respectively.
Conclusion: Orthopantomogram can also be used to measure gonial angle as accurately as a lateral cephalogram with the advantage that there are no superimpositions and both the gonial angles can be measured simultaneously on orthopantomogram.
PERCEPTIONS OF CONTINUING MEDICAL EDUCATION PARTICIPANTS REGARDING IMPROVEMENT OF PATIENT CARE THROUGH CONTINUING MEDICAL EDUCATION ACTIVITIES IN LAHORE DISTRICT
Authors: Tufail Shazia , Khan Junaid Sarfraz , Baqai Shehla , Mustafa Nilofar 
Published: January 2022

Objective: To explore the perceptions of Continuing Medical Education participants about the improvement of patient care through Continuing Medical Education activities and to explore the factors hampering or favouring improvement of patient care through Continuing Medical Education activities.
Study Design: Qualitative phenomenological study.
Place and Duration of Study: University of Health Sciences, Lahore, from Dec 2016 to May 2017.
Methodology: In qualitative phenomenological study conducted at University of Health Sciences, Lahore from Dec 2016 to May 2017, semi structured in-depth interviews were conducted individually from 10 General Practitioners which were audiorecorded and transcribed. Code labels were assigned manually and grouped together into broader themes. Interpretation ofthemes was done after thematic analysis.
Results: Two participants were female and ten were male with experience ranging between 20-38 years. Three main themes with sub-themes were identified: (1) positive talk (Affirming the link between Continuing Medical Education and improved patient care), (2) negative talk (perceived hindrances in gaining full benefit from Continuing Medical Education activities), (3) concerns regarding current Continuing Medical Education activities.
Conclusion: Participants were found inclined towards Continuing Medical Education activities and felt more confident and comfortable in managing their patients. However, they felt that physicians working in rural areas were dealing directly with all sorts of patients and were more in need of targeted and tailored Continuing Medical Education activities.
PRE-EMPTIVE EFFECT OF INTRAVENOUS PARACETAMOL VERSUS INTRAVENOUS KETOROLAC ON POST-OPERATIVE PAIN AND SHIVERING AFTER SEPTOPLASTY UNDER GENERAL ANESTHESIA: A COMPARATIVE STUDY
Authors: Kashif Sanum , Kundi M Nasir , Khan Taimur Azam 
Published: January 2022

Objective: To observe the pre-emptive effect of intravenous paracetamol versus intravenous ketorolac in preventing postoperative shivering and pain after septoplasty in postoperative care unit.
Study Design: Prospective comparative study.
Place and Duration of Study: Main Operation Theatre of Frontier Corps Hospital Quetta, from Sep to Dec 2019.
Methodology: After ethical committee approval, 90 American Society of Anaesthesiologist (ASA-I patients, aged between 18-45 years, scheduled for septoplasty, were recruited and divided into three equal groups, Paracetamol (PA), Ketorolac (KE) and Placebo (PL) as per computer generated table. The paracetamol (PA) group (n=30) received 1gm intravenous paracetamol, ketorolac (KE) group (n=30) received 30mg intravenous ketorolac and group placebo (PL) received 100ml normal saline, 20 minutes before completion of surgery. Postoperative shivering and pain was assessed via four-point scale and visual analogue scale (VAS) respectively, in post-anesthesia care unit at 10 and 30 minutes post-extubation.
Results: Mean visual analog scale (VAS) score in paracetamol group was 2.7 ± 1.41, ketorolac group was 2.3 ± 1.24 and in placebo group was 3.6 ± 1.44, with a p-value of 0.002. Mean four point shivering score in paracetamol group was 0.3 ± 0.55, ketorolac was 0.7 ± 0.78 and placebo group was 1.4 ± 1.00, with a p-value of <0.001.
Conclusion: The effect of paracetamol is better than ketorolac in preventing pain and shivering after septoplasty under general anesthesia.
EVALUATION OF IMPROVEMENT IN RENAL FUNCTION AFTER FIRST-LINE CHEMOTHERAPY IN MULTIPLE MYELOMA PATIENTS PRESENTING WITH RENAL IMPAIRMENT
Authors: Hamdani Syed Abdul Mannan , Wahab Abdul , Azhar Musa , Iftikhar Faiza , Ahsan Bushra , Ahmad Usman 
Published: January 2022

Objective: To evaluate the effect of response to first-line chemotherapy on renal functions in multiple myeloma (MM) patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore, from Jan 2013 to Dec 2017.
Methodology: Multiple myeloma patients with renal impairment (RI) at baseline were included. Data was collected from the hospital registry.The variables assessed pre and post first-line chemotherapywere age, gender, initial estimated glomerular filteration rate and serum creatinine levels. Progression-free survivaland overall survival (OS) was calculated for both groups of patients i.e those who had improvement in renal funtions and those who did not show improvement. Kaplan-Meier curves were drawn, and SPSS-20 was used for data analysis.
Results: Mean age was 48 ± 7 years. Out of 139 myeloma patients, 35 (25.1%) had RI at baseline. Males were 23 (65.7%), while females were 12 (34.3%). Cyclophosphamide, thalidomide and deamethsone (CTD)were used in the majority 30 (85.7%) followed by boretzomib, thalidomide and dexamethasone (VTD) in 2 (5.7%) patients. Boretezomib and dexamethasone (BorDex), lenalidomide and dexamethasone (Len Dex), lenalidomde, cyclophosphamide and dexamethasone (LCD) were given to 1 (2.8%) patient each. Serum creatinine levels normalized in 19 (54.3%). Dialysis was required in 11 (31.4%) patients out of which 3 (8.6%) got dialysis-independent while 8 (22.9%) patients remained dialysis-dependent. The medianoverall survival in whomcreatinine levels normalized was 35 months while it was 15 months in those in whom it did not normalize.
Conclusion: Prompt administration of chemotherapy regimens can lead to an improvement in renal function....................
EFFICACY OF TWO APPROACHES OF TRANSFORAMINAL EPIDURAL INJECTIONS IN PATIENTS OF LUMBAR RADICULOPATHY
Authors: Ali Moazzam , Iqbal Rashid , Waseem Majid , Ali Liaquat , Talib Tahseen , Khawar Maliha 
Published: January 2022

Objective: To determine the efficacy of transforaminal epidural steroid injection (TFESI) using conventional versus Kambin’s triangle approaches in patients of lumbar radiculopathy.
Study Design: Quasi experimental study.
Place and Duration of Study: Department of Pain Medicine, Combined Military Hospital Rawalpindi Pakistan, from Oct 2019 to Apr 2020.
Methodology: Eighty patients suffering from lumbar radiculopathy fulfilling the inclusion criteria were included in this study and were randomly assigned to undergo transforaminal epidural steroid injection using either conventional approach (group C) or the Kambin’s triangle (group K) approach. Pain scores and patient satisfaction levels were recorded at 4 and 8 weeks after the procedure.
Results: In both groups, the pain score (group C pre-procedure NRS =7.28 ± 1.26 vs post-procedure NRS = 2.14 ± 0.81, group K pre-procedure NRS = 7.33 ± 1.16 vs post-procedure NRS=2.70 ± 0.94) and patient satisfaction improved 4 and 8 weeks after the procedure. The pain score (p-value=0.21) and patient satisfaction score (p-value=0.88) however were not significantly different between groups.
Conclusion: This study demonstrated that using conventional or Kambin’s approach exhibits no difference in decreasing pain score or patient satisfaction level.
USE OF 20 MINUTE WHOLE BLOOD CLOTTING TIME IN PATIENTS OF SNAKEBITE; AN EXPERIENCE FROM KOHAT, KHYBER PAKHTUNKHAH
Authors: Javed Hammad , Bashir Tariq , Rauf Atif , Murtaza Syed , Jibran Raja 
Published: January 2022

Objective: To study the diagnostic accuracy of 20-minute whole blood clotting time in hemotoxic snakebite.
Study Design: Cross sectional validation study.
Place and Duration of Study: Combined Military Hospital Kohat Pakistan, from Jul 2015 to Jun 2017.
Methodology: Study included 52 patients who presented with the complaint of a snakebite. The data was recorded on predesigned proforma including clinical, laboratory features. All the patients were kept indoor for observation for a minimum of 72 hours from the time of presentation.
Results: The study showed that males were more affected with age group between 20-50 years. Most common presenting features were local swelling 33 (71%) and pain and most common snakebite type was hemotoxic 33 (71%). The 20-minute whole blood clotting time was found to have low sensitivity (61%) and specificity (58%). A significant association was found between the dose of anti-snake venom and severity of coagulopathy (p<0.001), respiratory failure (p<0.001) and development of side effects due to anti snake venom (p<0.001). The mortality rate was 6.5% and was significantly related to age of the victims (p=0.003). The diagnostic accuracy of 20-minute whole blood clotting time was 60.25%.
Conclusion: The use of 20-minute whole blood clotting time can not only be misleading but also a source of delay in administering anti snake venom given the low sensitivity and specificity and high false negative rate.
IDENTIFICATION OF TORCH PATHOGENS IN CONGENITAL CATARACT PATIENTS VISITING ARMED FORCES INSTITUTE OF OPHTHALMOLOGY
Authors: Javaid Mamoona , Masud Hannan , Sajjad Rathore Hassan , Ali Dilshad , Javaid Haroon 
Published: January 2022

Objective: To assess the rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex (TORCH) pathogens in patients suffering from congenital cataract in Pakistan.
Study Design: Cross sectional comparative study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2017 to Mar 2018.
Methodology: Cataract group included sixty children already diagnosed with congenital cataract and control group included 60 children not suffering from congenital cataract. Serum samples of all children were collected to test against IgG and IgM antibodies of Toxoplasma gondii, Rubella, Cytomegalo, Herpes simplex pathogens using enzyme linked immune essay (ELISA) technique. Data were analyzed observe in difference between unilateral and bilateral cataract and between cataract and control group.
Results: Out of 60 children in cataract group, 29 were tested positive for Toxoplasma gondii, Rubella, Cytomegalo (CMV), Herpes simplex infections. CMV IgG antibodies were identified in 21 (35%) children followed by Rubella IgG 13 (21.7%), Toxoplasmosis IgG 8 (13.3%), CMV IgM 7 (11.7%), HSV I IgG 5 (8.3%), HSV II IgG 2 (3.3%) and HSV I IgM 1 (1.7%) antibodies. None of the children was positive for Toxoplasmosis, Rubella and HSV II IgM antibodies. There was no statistical difference in rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens between unilateral and bilateral cataract and between cataract and control group.
Conclusion: Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens are an important cause of congenital cataract with Cytomegalovirus and Rubella virus being most common respectively. In order to prevent paediatric complications, we need........
FREQUENCY OF SYMPTOMATIC SPONTANEOUS BACTERIAL PERITONITIS AND ASSOCIATED CLINICAL PARAMETERS IN PATIENTS WITH LIVER CIRRHOSIS
Authors: Gilani Syed Fayyaz Mehmood , Hassan Fayyaz , Siddiqui Fuad Ahmad , Gardezi Syed Anees Ahmed 
Published: January 2022

Objective: To study association between spontaneous bacterial peritonitis and clinical symptoms in liver cirrhosis.
Study Design: cross-sectional study.
Place and Duration of Study: Combined Military Hospital Kharian, from Jul 2019 to Apr 2020.
Methodology: A total of 122 patients of liver cirrhosis (irrespective of aetiology), presented with various clinical symptoms such as fever, pain abdomen and hepatic encephalopathy were randomly selected. Patients between 18-80 years of age, were included in the study. Asymptomatic patients, with ascites other than liver cirrhosis were excluded. Spontaneous Bacterial Peritonitis was defined as positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥250 cells/mm3 in ascitic fluid.
Results: Of the 122 randomly selected patients, the mean age was 56.5 ± 20.2 years. Forty-Five (46.8%) were male and 67 (54.2%) patients were female. Chronic Hepatitis C was the commonest cause of liver cirrhosis (92%). The frequency of spontaneous bacterial peritonitis was 37.7%. Majority, (83%) of the culture positive ascitic isolate was Gram negative bacilli and E.coli (72%) being the commonest organism isolated. Severe ascites, high International Normalized Ratio (INR), hepatic encephalopathy, fever, low ascetic fluid protein count, high serum bilirubin and creatinine were considered to be independent predictor of Spontaneous Bacterial Peritonitis.
Conclusion: Clinical symptoms of fever, hepatic encephalopathy, severe ascites, International Normalized ratio high and deranged renal profile was highly suggestive of Spontaneous Bacterial Peritonitis in cirrhotic patients.
ASSOCIATION OF PERCEIVED STRESS AND COPING STRATEGIES WITH DEPRESSIVE SYMPTOMS IN STUDENTS AT A PRIVATE MEDICAL COLLEGE IN ISLAMABAD
Authors: Mansoor Sawera , Azad Nadia , Zubair Usama Bin , Khan Khalid Hayat 
Published: January 2022

Objective: To determine the association of perceived stress and coping strategies with depressive symptoms in students at a private medical college in Islamabad.
Study Design: Correlational study.
Place and Duration of Study: Foundation University Medical College, Islamabad, from Jun to Dec 2019.
Methodology: Fourth and Final year medical students of Foundation university medical college were enrolled in the study. Beck’s Depression Inventory was used to assess the depressive symptoms, perceived stress scale (PSS) was the tool used to look for the perceived stress and the coping strategies were assessed using the Brief Coping Orientation to Problems experienced (Brief COPE) Inventory. The association of perceived stress and coping strategies with depressive symptoms and other sociodemographic factors was established with the help of the chi-square test.
Results: Out of 262 medical students included in the study, 211 (80.5%) had none or mild depressive symptoms while 51 (19.5%) had moderate to severe depressive symptoms. Sixty-six (25.2%) had low stress, 127 (48.4%) had moderate stress while 69 (26.3%) reported high stress levels. Pearson chi-square test revealed that perceived stress and the coping strategies used including self-distraction, active coping, denial, substance use, behavioural disengagement, positive reframing, acceptance, religion/spirituality and self-blaming had a statistically significant relationship with the presence of depressive symptoms among the target population.
Conclusion: Considerable number of medical students had the presence of moderate to severe depressive symptoms in our study. Perceived stress and some specific kinds of coping strategies had a significant association with the presence of depressive symptoms among the target.......