bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Physician Burnout and its Association with Musculoskeletal Disorder
Authors: Saleem Saad , Khaliq Taqdees , Adil Mohammad Hammas , Hashmi Fasih 
Published: December 2022

Objective: To assess burnout among doctors and to determine its association with a musculoskeletal disorder.
Study Design: Cross sectional study.
Place and Duration of Study: Government and Private Hospitals of Islamabad and Rawalpindi Pakistan, from Jun to Aug 2020.
Methodology: Two hundred and forty doctors were included through two-stage cluster sampling from different departments of the selected hospitals. Maslach Burnout Inventory (MBI) was used to assess burnout. Second, Nordic Musculoskeletal Questionnaire (NMQ) was used to assess the musculoskeletal disorder.
Results: There were one hundred thirty-five males and one hundred and five females participants with an average age of 31.64±6.21 years. There was an association between burnout, and Musculoskeletal Disorder (MSD) assessed through "Depersonalization" and "Personal Achievement" components with p-values of 0.005 and 0.017. In contrast, burnout assessed through the Emotional Exhaustion (EE) component was not associated with Musculoskeletal Disorder (MSD) and had a pvalue of 0.817. The logistic regression analysis showed that marital status, age and burnout assessment through depersonalization were significant confounders for musculoskeletal disorders.
Conclusion: Musculoskeletal disorder is related to the presence of burnout assessed through depersonalization. Nearly half of the doctors had at least one component of burnout.
The Immune Response after Double Dose Hepatitis B Vaccination in Hemodialysis Patients: Influence of Age and Hepatitis C Virus
Authors: Asghar Muhammad Rashid , Abbasi Tanzeel , Bashir Khurram , Hashmi Nauman , Anwar Shumaila 
Published: December 2022

Objective: To determine the efficacy of Hepatitis B vaccination among the candidates of maintenance hemodialysis due to chronic kidney disease and to measure the impact of ageing and Hepatitis C infection upon immune seroconversion.
Study Design: Cross-sectional study.
Place and Duration of Study: Nephrology Department, Multan Institute of Kidney Diseases (MIKD), Multan Pakistan from Jan to Jun 2020.
Methodology: Two hundred male and female patients diagnosed with end-stage kidney disease on maintenance dialysis (more than three months) with the range of age, 15 to 70 years, were selected by non-probability consecutive sampling. Already treated patients of HB virus and those with HB virus detectable by ELISA were excluded from the study. Data was accessed through hospital management software records. Three months after the three or four completed doses, antiHBs titer was assessed by ELISA. Cut off the value of anti-Hbs titer was 10U/L to differentiate between responders and non-responders of HBV.
Results: Among the 117 responders, 109 (93%) cases received four double doses of the vaccine, while only 8 (7%) were those who received three double doses. Among 83 non-responders, 52 (63%) were above age 40 years, while 31 (37%) were of age 40 years or below. In addition, among the non-responders, 63 (76%) were Hep C positive, while 20 (24%) were Hep C negative patients.
Conclusions: Four double-dose vaccines have been effective for haemodialysis patients with end-stage kidney disease. Vaccine response is inversely correlated with age and Hepatitis C virus.
Accuracy of Rapid Antigen Detection Test Device (COVID-19 Ag Rapid Test Device) in Diagnosis of Acute COVID-19 Infections
Authors: Shakoor Noman , Ghani Eijaz , Niazi Saifullah Khan , Noor Misbah , Ahmed Faraz , Hussain Hammad 
Published: December 2022

Objective: To evaluate the accuracy of the COVID-19 Ag Rapid test device for detection of SARS-CoV-2 with Reverse Transcriptase Polymerase Chain Reaction as the gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Virology, Armed Forces Institute of Pathology, Rawalpindi, in the month of Sept 2020.
Methodology: A total of 106 patients suspected of COVID-19 were tested, including 63 patients admitted to the COVID-19 ward of Pak Emirates Military Hospital and 43 from the emergency department of Combined Military Hospital, Rawalpindi Pakistan respectively. The samples were transported to the Virology department and subjected to Polymerase Chain Reaction and Antigen testing. In addition, the diagnostic accuracy of the COVID-19 Ag Rapid test device was compared to Reverse Transcriptase Polymerase Chain Reaction for detection of SARS-CoV-2 infection.
Results: Out of 106 nasopharyngeal swab samples tested, 48 (45.2%) samples were positive by Rapid test device and Reversed Transcriptase Polymerase Chain Reaction, and 52 (49.0%) samples tested negative by both methods. Inconsistent results (False Negative) were obtained in 6 (5.6%) samples. COVID-19 Ag Rapid test device has detected the maximum number of cases, 41 (85.4%), during the first week of illness. Its sensitivity decreases as the duration of infection progress.
Conclusion: The overall sensitivity of the Rapid test device is much less than the Polymerase chain reaction due to potential false negative results. However, it can be helpful in the early isolation of cases in an outbreak in a closed community and for case management in peripheral setups....
Association of Serum Ammonia Levels with Severity of Grades of Hepatic Encephalopathy in Patients Presenting to er of a Tertiary Care Hospital
Authors: Dawood Muhammad , Ashraf Muhammad Nadeem , Madad Sonia , Khan Andaleeb , Butt Kamil Rehman , Rehman Shahana 
Published: December 2022

Objective: To determine the association of serum Ammonia levels with severity of grades of hepatic encephalopathy in patients presenting to the department.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Emergency Department, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021.
Methodology: This study was conducted on 100 patients presenting with hepatic encephalopathy at the emergency department of our hospital. Based on clinical findings and relevant investigations, a consultant gastroenterologist or emergency medicine physician diagnosed hepatic encephalopathy or the underlying cause. In addition, serum Ammonia levels were done on all the patients at the time of presentation and associated with grades of hepatic encephalopathy and other factors.
Results: Out of 100 patients included in the final analysis, 67 were males, and 33 were females. Infection (29%) was the commonest aetiology of hepatic encephalopathy, followed by Constipation (23%). In addition, 59% had normal serum ammonia levels, while 41% had raised ammonia levels in their serum. High grade of hepatic encephalopathy and raised Child-Turcotte-Pugh score were statistically significantly associated with raised ammonia levels in our study participants.
Conclusion: Raised serum ammonia levels were a common finding among patients with hepatic encephalopathy. Therefore, patients with a high grade of hepatic encephalopathy and a high Child-Turcotte-Pugh score at the time of presentation should be considered at a higher risk of having hyperammonemia.
Appraisal of the Effect of Norepinephrine Versus Phenylephrine on Blood Pressure and Heart Rate During Spinal Anaesthesia for a Caesarean Section; A Quasi-Experimental Study
Authors: Iftikhar Hina , Hassan Ali , Rehman Habib Ur , Ayaz Saeed Bin , Ali Zulfiqar , Majeed Kaukab 
Published: December 2022

Objectives: To compare the effects of Norepinephrine and Phenylephrine on blood pressure and heart rate during spinal anaesthesia for caesarean section.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Anaesthesia Combined Military Hospital, Multan Pakistan, from May to Nov 2019.
Methodology: Women (age: 18 to 45 years) with singleton pregnancy planned for caesarean section in spinal anaesthesia were included. Women with pregnancy-induced hypertension, placenta previa, placenta accreta, diabetes mellitus, and any other cardiovascular disease were excluded. After distribution into groups, Group-A was given a 20μg Norepinephrine bolus, and Group-B was given a 50μg bolus of Phenylephrine just after spinal anaesthesia. At five time points, systolic, diastolic, and mean blood pressures and heart rate were measured: baseline, block of the highest sensory level, oxytocin injection, delivery, and operation completion. If hypotension developed, the same rescue drug was repeated. Bradycardia was countered by 0.5 mg of Atropine.
Results: The frequency of hypotension in the Norepinephrine group was 5 (16.67%), and in the Phenylephrine Group, it was 19 (63.33%) (p=0.0001). The frequency of bradycardia in the Norepinephrine Group was 6 (20%), and in the Phenylephrine Group, it was 17 (56.67%) (p=0.003).
Conclusion: The frequency of hypotension and bradycardia is less after prophylactic 20 μg of Norepinephrine during spinal anaesthesia for a caesarean section than 50 μg of Phenylephrine.
The Biochemical Pattern of Liver Function Tests in Adult Patients of Diabetes and the Association with Hypoglycemic Medications
Authors: Nageen Ayesha 
Published: December 2022

Objective: To study the biochemical pattern of liver function tests in adult patients of diabetes and the association with hypoglycemic medications.
Study Design: Cross-sectional study.
Place and Duration of Study: Creek General Hospital, Karachi Pakistan, from Jun 2021 to Sep 2021.
Methodology: Two sixty patients were enrolled through consecutive non-probability sampling. Adult patients with diagnosed Type 2 diabetes mellitus were included in the study. While Type 1 diabetes patients, pregnant subjects, and people with diabetes with any other systemic disease or on any other non-diabetic medications or any history of drug abuse were excluded from the study.
Results: Raised Alanine transaminase levels were seen in 193 (74%) patients, a high Alkaline Phosphatase in 208 (80%) and a high Aspartate Aminotransferase in 202 (77%) patients. Liver markers were higher in the middle age group, females, hypertensive, and with abdominal obesity. There was no association between glycemic control and the duration of diabetes. The number of subjects having raised ALT and ALP was higher in those taking oral hypoglycemic and lower in those with insulin.
Conclusion: The liver markers are raised in patients with diabetes and can be the predictors of future hepatotoxicity.
Apoptosis in Human Papillomavirus-Induced Cervical Cancer Cells By Higher Doses of Ascorbic Acid
Authors: Baig Zunaira Ali , Rashid Amir , Gul Ambreen , Raza Imran , Majeed Asifa 
Published: December 2022

Objective: To assess the anti-cancer role of ascorbic acid using high doses against the cervical cancer cell line and to establish a cell culture facility in the laboratory.
Study Design: In Vitro Study.
Place and Duration of Study: Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi Pakistan, from Aug 2014 to Jul 2015.
Methodology: HeLa cells were grown in Dulbecco’s modified eagle medium, and upon reaching confluency, cells were challenged with different doses of ascorbic acid. The MTT assay was employed to study the cytotoxic effects of increased doses of ascorbic acid on HeLa cells.
Results: An increasing dose of ascorbic acid was found to be cytotoxic toward HeLa cells, and its EC50 was found to be between 5-6µM. A high dose of ascorbic acid is selectively cytotoxic to HeLa cell lines of cervical cancer, which may imply the treatment of cervical cancer patients. NF- kB inducing kinase is a salient protein in TNFα-induced NF-kB activation. Ascorbate has been reported to inhibit that activation which has anti-apoptotic roles in tumour progression. CB-Dock was employed to propose the binding sites for NIK-Ascorbate interaction, which might be a therapeutic target for cancer cells.
Conclusion: The study concludes that high dose ascorbic acid is cytotoxic to cervical cancer cells HeLa and may have important implications in treating cervical cancer patients. Therapeutic intervention of this vitamin may contribute to suppressing cancer development.
Immune Status Against Hepatitis B Infection in Children with Thalassemia Major in Pakistan: A Single-Centre Study
Authors: Fakih Misbah , Basheer Faisal , Khan Qamar uz Zaman , Hashmi Fasih , Asad Hafsa 
Published: December 2022

Objectives: To assess the immunogenicity of the Hepatitis B Vaccine in children with thalassemia.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Aug 2018 to Jan 2019.
Methodology: After ethical approval and informed consent, 150 diagnosed patients with thalassemia were selected from the Thalassemia centre at Pak Emirates Military Hospital Rawalpindi. The patients’ transfusion, vaccination history and clinical data were obtained. The patient's sera were tested for Anti-Hepatitis B surface antibodies (anti-HBs) by ELISA. The patients who showed seroprotection (anti-HBs titer>10 IU/L) were taken as a case group.
Results: Out of 150 patients, only 22% (33 patients) showed seroprotection (anti-Hbs titer>10 IU/L). Children younger than four years had significantly positive anti-HBs (p-value=0.067) at a 5% significance level. Time since the last vaccination was also a significant factor, with the 3.76±3.072 years range exhibiting better protection (p=0.002).
Conclusion: Protective Anti-HBs titer was reduced after the age of 4 years in our patients, so we recommend screening patients with thalassemia after four years to assess the need for a booster dose.
Correlation of Mean pH, HCO3 and CO2 Between Arterial Blood Gases and Venous Blood Gases in Critically Ill Patients
Authors: Haneef Sanam , Jaffer Raza , Ijaz Aamir , Ain Qurrat-ul , Aman Saba , Ansari Uzma 
Published: December 2022

Objective: To determine the correlation of mean pH, HCO3 and CO2 between arterial and venous blood specimens in critically ill patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Apr to Oct 2015.
Methodology: Forty critically ill patients admitted to the Intensive Care Unit were selected. Analysis of arterial blood gases followed by venous blood gases of the same patient was carried out after collection in lithium heparin tubes. Specimens were analyzed on COBAS 221 fully automated ABGs and an electrolyte analyzer.
Results: Out of 40 patients, 30 (75%) were males. The average age was 57.78±7.64 years. The p-value of pH and HCO3 was 0.259 and 0.921, respectively. The CO2 in VBGs was 58.10±11.35 mm Hg versus 36.32±6.69 mm Hg in ABG, with a p-value of 0.001, which was statistically significant.
Conclusion: In critically ill patients, pH and HCO3 levels of venous blood gases were comparable with ABG. VBG CO2 was significantly higher than ABGs.
The Patterns of Clinical Presentation in Patients with Unsafe Miscarriage
Authors: Khanum Faiza , Tariq Amera , Waseem Syed Majid , Mahmood Tariq 
Published: December 2022

Objective: To study the pattern of clinical presentation in patients with unsafe miscarriages.
Study Design: Case series study.
Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2016 to Mar 2017.
Methodology: Thirty patients were included in this study after approval of the Ethical Committee. Detailed clinical assessment and clinical presentations of the cases were noted. Methods of miscarriage and associated complications were also noted. All cases were unbooked and referred cases.
Results: In this study, 30 patients with unsafe miscarriages were studied. The mean ages of the patients were 27.4±7.1 years. Most of the patients were married (93.3%, n=28,) multigravida (73.3%, n=22,) and in 1st trimester (76%, n=23). The method of the abortions was by instrumentations in 90%, (n=27) cases and vaginal tablets in only 10%(n=03) of the cases. The mean hospital delay was of 8.5±10.1 days. Abdominal pain was the commonest presentation in 90% of the patients (n=27). Acute abdomen with abdominal distension and constipation was seen in 53.3%(n=16) cases. There was a history of vaginal bleeding in 43.3%(n=13) cases, and 6.7% (n=2) of patients presented in shock. Mean vitals on admission were as pulse 108.7±13.4 per minute, temperature 99.4+2°F, respiratory rate 24.3±4 per minute, systolic and diastolic blood pressure were 103.5.5±14 mmHg and 68.6±10.4 mmHg respectively.
Conclusion: Illegally induced abortion remains a prominent cause of maternal morbidity in our society. However, high-quality post-abortion care will help a long way in saving many lives.
Anesthetic Efficacy of Intraligamentary Injection Techniques on Mandibular Posterior Teeth Diagnosed with Asymptomatic Irreversible Pulpitis
Authors: . Avinash , Sheikh Abu Bakar , Rashid Saqib , Ali Muhammad , Siddiqui Kishwer Naz , Mujeeb Fauzia 
Published: December 2022

Objective: To compare the effectiveness of Intraligamentary Injection with the IANB injection technique for root canal treatment of mandibular molars and premolars in patients with asymptomatic irreversible pulpitis undergoing access opening.
Study Design: Quasi-experimental study.
Place and Duration of Study: Operative Dentistry Department, Fatima Jinnah Dental College Karachi Pakistan, from Nov 2018 to Apr 2019.
Methodology: The study was conducted on 80 patients. Visual analogue scale was used to determine the level of pain. Three groups were made depending on the effectiveness of anaesthesia at 2-sites (Group-A), 4-site (Group-B) and failure of Intraligamentary injection (Group-C). Anaesthesia was successful when the patient revealed no pain symptoms during access opening.
Results: A total of 80 cases were evaluated, out of which 47 were males (58.70%), and 33 were females (41.30%). The most common age groups recorded in our study were 18 – 25 years (33.75%) and 36- 45 years (33.75%). According to our results, the Intra-ligamentary technique was successful in 23(28.75%) cases. The remaining 57(71.25%) cases which received anaesthesia via IANB showed a 100.00% success rate with profound anaesthesia.
Conclusion: Inferior alveolar nerve block was more successful compared to Intraligamentary injections for providing profound anaesthesia to mandibular posterior teeth previously diagnosed with asymptomatic irreversible pulpitis and under-going the procedure of access opening.
Effect of Role-Modeling (Modelling) Clinical Skills and Professional Behavior on the Learning of Medical Students as Measured through Pre and Post-test Assessment
Authors: Khan Niazi Fuad Ahmad , Khaliq Tanwir 
Published: December 2022

Objectives: To examine the effect of role-modelling (modelling) clinical skills and professional behaviour on the learning of fourth-year medical students through pre and post-test.
Study Design: Quasi-experimental study.
Place and Duration of Study: Ophthalmology Department, Rawalpindi Medical University, Pakistan, from Jan to Feb 2019.
Methodology: Two Groups were formed, the Study and Control-Group, with 30 students from 4th-year MBBS. The Study- Group was exposed to role-modelling intervention accompanied by the verbal narration of steps after being given a pre-test and retested with a post-test after two weeks. The Control-Group was also given pre and post-tests with a verbal description of steps without modelling the drill. Each test was observed by three different observers.
Results: Total mean score given by observers in the Study- Group was 71.53±12.38 in the pre-test, which was statistically significantly improved to 92.07±13.12 in the post-test (p-value 0.0001), an improvement of 28.71% after modelling intervention. All observers in the Control-Group gave a total mean score was 74.93±12.90 in the pre-test and 74.53±12.83 in the post-test (p-value 0.634). After applying ANOVA on inter-observer difference, there was no statistically significant difference in the mean score given by observers (p>0.05).
Conclusion: Role-modelling or modelling as a means of demonstrating clinical skills and behaviour is effective teaching or instructional strategy measured through pre and post-test.
Associative Factors Involved in Avoidance of Exclusive and Non-Exclusive Breastfeeding after C-section
Authors: Rahman Asbah , Malik Qudrat Ullah , Shafiq Muhammad Faisal , Mumtaz Shaista , Babar Muhammad Waleed , Akram Saira 
Published: December 2022

Objective: To look for the associative factors in avoidance of exclusive and non-exclusive breastfeeding among mothers after lower segment Caesarean section.
Study Design: Cross-sectional study.
Place and Duration of Study: Paediatrics department, Pak Emirates Military Hospital, Rawalpindi Pakistan from Oct to Mar 2020.
Methodology: Mothers bringing their infants for vaccination at six weeks of age with babies born with lower segment caesarean section were included in the study. They were asked simple questions regarding exclusive or non-exclusive breastfeeding. Relevant socio-demographic factors were also recorded and compared among mothers breastfeeding their babies and those avoiding it.
Results: A total of 500 mothers were included in the study. The mean age of the study participants was 33.576±9.174 years. 336(67.2%) women were primiparous, while 164(32.8%) were multiparous. 208(41.6%) women were actively breastfeeding their child, while 292(58.4%) avoided breastfeeding their babies. 150(72.1%) women were non-exclusively breastfeeding, while 58(27.9%) showed an exclusive breastfeeding pattern. Pearson chi-square test revealed that low education and working outside the home had a statistically significant association with the avoidance of breastfeeding the babies among our target population (p-value <0.05).
Conclusion: Avoidance of breastfeeding was a common finding after six weeks of birth among women who delivered the babies via lower segment caesarean section. Mothers with low education and duties to work outside the home were more at risk of avoiding this highly beneficial practice for the baby.
Assessment of Pattern of Drug Abuse from Different Clinical Settings in a Reference Laboratory of Pakistan During the COVID-19 Pandemic
Authors: Younas Alveena , Aamir Muhammad , Kirmani Sobia Irum , Haroon Zujaja Hina , Bibi Afshan , Munir Muhammad Usman 
Published: December 2022

Objective: To determine the pattern of drug abuse from different clinical settings in a reference laboratory of Pakistan during the COVID-19 pandemic and assess any change from the previous trend.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan from Mar to Dec 2020.Methodology: Out of 6902 subjects tested for drug abuse, 672 subjects with positive results were included in the study. The study population was divided into three main Groups. i.e., Psychiatry, ITC/Emergency and Workplace testing. A pattern of drug abuse was compared in the pre (Mar-Dec 2019) and post-COVID (Mar-Dec 2020) periods.
Results: Out of 672 study subjects, 338(50%) were psychiatry patients. Around 629(94%) subjects were males. Mainly young individuals (306, 46%) were affected. Cannabis was the most frequent drug of abuse detected (357, 53%), followed by Benzodiazepines (BZD) (236, 35%) individuals and Opiates (47, 7%). Compared with pre-COVID data, an overall increase of 3% in the total frequency of drug abuse from 392(7%) to 672(10%) was found in 2020. About 14% decrease, from the frequency of 81(21%) to 47(7%) in Opiates usage, while 8% increase in frequency, from 106(27%) to 236(35%) in Benzodiazepines, was observed. There was significant mean difference (p<0.001) between Psychiatric and ITC patients.
Conclusion: Most frequent drug abuse in our settings is Cannabis, followed by Benzodiazepines and Opiates. An overall increase in drug abuse frequency while a decrease in the frequency of...........Keywords: COVID-19 pandemic, Pakistan, Substance abuse pattern.