Journal of Fatima Jinnah Medical University

Prevalence of Indices of Stress with Degree of Insomnia and Academic Performance in Undergraduate Medical Students

Thu, 15 Jun 2023 00:00:00 +0000

Background: Studying medicine is quite challenging as medical students have to work hours and hours which leads to continuous psychological stress and as a result decrease in sleep duration and quality. This study aims to determine the prevalence as well as the relationship of academic stress and pattern of sleeping problems among medical students.

Subjects and Methods: In this cross-sectional study,128 non-obese medical students (18 -23 years old, BMI=18.5-24.9) are included and they are divided into 2 groups as non-stressed (K10≤19) and stressed (K10>19) medical students. We have used Kessler Psychological Distress Scale(K10), Pittsburgh Sleep Quality Index Scale (PSQI) and percentage of Professional Examination Result to assess stress, sleep quality and academic performance, respectively.

Results: PSQI scores were less in the stressed[8.5(3─17)] as compared to non-stressed [6(1─17)] subjects (p=0.000) while academic score (percentage) in stressed [70.9(59─77)] was lesser than that of non-stressed[76.7(57─86)] subjects (p=0.000).Within the non-stressed subjects,K10 scores were positively correlated to PSQI scores (rho=0.294, p=0.018) and negatively correlated to academic score (rho= -0.319, p=0.010).Similarly in the stressed subjects there was a positive correlation between K10 and PSQI scores (rho=0.435, p=0.000) and a negative correlation between K10 and academic scores( rho= -0.251, p=0.045)

Conclusion: This study suggests that both sleep quality and academic performance reduces with increase in stress among non-obese medical students.

Keywords: stress, non-obese, medical students, sleep quality, academic performance.

Communities of Practice: Redressal of Medical Education Leadership Challenges through a Workplace-Based Learning Approach

Syeda Amina Ahmad — Thu, 15 Jun 2023 00:00:00 +0000

Background: There is a realization that learning leadership skills is beyond classroom teaching and requires leaders to participate in communities of practice (CoP) that enables them to learn from the wisdom of seasoned leader because such leaders don’t ask budding leaders to follow their instructions, they rather set examples of best practices in medical education. However, dearth of published evidence both locally and internationally suggests that there is a need to investigate how have communicates of practice impacted leadership skills of physicians as medical education leaders.

Participants and Methods: A transcendental phenomenological study was conducted, involving seven physician leaders working as medical teachers from both basic and clinical sciences, heading the medical college and/or their departments as professors in a medical college on the basis of convenience sampling and their experiences as medical education leaders who had presumably experienced the phenomenon of ‘learning leadership skills’. The researcher conducted hour-long one-on-one interviews with participants at their workplace offices and one interview was conducted at the researcher’s home office. One of the participants was interviewed twice as additional gaps were identified from the initial analysis. Interviews conducted in the surgeon’s office were interrupted many a times by theatre assistants, but the continuity was resumed successfully. The qualitative data was analyzed manually by using the Stevick-Colaizzi-Keen method.

Results: One major theme namely ‘communities of practice impacting leadership skills’ emerged from the transcripts whereas, two subthemes namely ‘gaining wisdom’ and ‘uplifting emotional wellbeing’ were identified as main aspects that had a major influence on leadership skills of physicians in the medical education milieu.

Conclusion: CoP has a positive impact on leadership skills. It enables leaders in medical education to learn wisdom to solve difficult leadership problems. Evidence supports that CoP also uplifts emotional wellbeing of leaders by preventing their burn out.

Health Consequences of Smokeless Tobacco Substance Abuse among High School Adolescents

Fahad Ali Mangiro, Shafqat Ali Mangrio; Musarat Fatima — Thu, 15 Jun 2023 00:00:00 +0000

Background: People currently reside in a smokeless tobacco -oriented society, and the threat of illicit substances is visible in every part of the world, including Pakistan. Moreover, Substance abuse has become a big problem in our society now days, therefore current study conducted on health consequences and prevalence of smokeless tobacco substance abuse among high school adolescents at taluka Qasimabad, Hyderabad, Sindh, Pakistan.

Methodology: A cross sectional study conducted through predesigned survey form, in which 308 respondents were selected at random level from the full targeted sample of ninth and tenth grade pupils..

Results: the researcher revealed 22.9% of smokeless tobacco abuse among high school adolescents, in which male participants showed high prevalence as compare female. Furthermore, Areca nuts (57.1%), Safina sachet smokeless tobacco (19.2%), betel (14.6%), and Tara chewing smokeless tobacco (13.3%) had the highest percentage of smokeless tobacco used. In addition, data showed significant 0.05 association with smokeless tobacco abuse with health-related problem, i.e., throat pain, cough, mouth ulcer and headache, abdominal pain, loss of appetite and sleeping pattern disturb problem.

Conclusion: It is revealed that High school adolescents abused smokeless tobacco substances and suffered worst health consequences.

The Recovery of Left Ventricular Function in Cases of Primary Angioplasty for Acute Myocardial Infarction

Thu, 15 Jun 2023 00:00:00 +0000

Background: This study is to investigate the recovery in left ventricular ejection fraction in the first 3 months after acute myocardial infarction treated with primary angioplasty. Left ventricular function (LVF) is the main predictor of long term prognosis in cases of survival after acute myocardial infarction. Study aims to investigate successful improvement in left ventricular ejection fraction after primary angioplasty.

Methodology: A cross sectional study was conducted at Chaudhary Pervaiz Ellahi Institute of Cardiology, Multan from 1^stSeptember 2019 to 30^thSeptember 2020. Left ventricular ejection fraction was evaluated in 100 patients treated with primary angioplasty. Primary angioplasty is a very 1^st treatment to re-open the locked artery after acute myocardial infarction. Ejection fraction was measured with Echocardiography Simpson’s biplane method at 3^rd day and 3 months after angioplasty. Collected data was analyzed by using SPSS version 23. Chi square test was applied to see association among variables.

Results: One hundred patients were included this study. The mean age and BMI of the patients was 59.45±6.01 years and 24.76±8.02 kg/m², respectively. Male 70 (70%) and female 30 (30%) ratio was 7:3. LVEF at 3rd month was observed in ≤40% in 223 (23.0%) patients and >40% in 77 (77%) patients. Male patients were greater in number that’s why LVEF is also observed in greater in male gender (p<0.001). Increase in age also have no impact on procedure success (p>0.050).

Conclusion: Results of this study reveal that primary angioplasty is successful treatment plan in patients with acute myocardial infarction. A significant recovery of left ventricular function during 3 months after primary angioplasty in acute Myocardial infarction (MI) patients was observed.

Persistently Elevated Parathyroid Hormone Level after Curative Parathyroidectomy in Patients with Primary Hyperparathyroidism

Thu, 15 Jun 2023 00:00:00 +0000

Background: Persistent elevation of parathyroid hormone (PPTH) levels following curative parathyroidectomy is a dynamic & multifactorial process. This study was designed to study the frequency of persistent hyperparathyroidism in our patients and to identify the potential causal factors for persistent PTH elevation following parathyroidectomy.

Methodology: The study included prospectively collected data on post-operative patients of primary hyperparathyroidism who underwent parathyroidectomy from 2004-2018. Data was analyzed by SPSS version-21. For descriptive statistics, frequency and percentages were calculated, while mean ±standard deviation were calculated for age, duration of disease, pre-operative and post-operative biochemical parameters, like serum PTH, calcium and vitamin D levels.

Results: A total of 11 (39.3%) patients, were diagnosed as persistent hyperparathyroidism, out of the 30 patients, who underwent parathyroidectomy. All patients were female with a mean age of 45.27+17.2 years and a mean duration of symptoms of 21.3 months. The mean post-operative PTH level, vitamin D and calcium were 154.04±78.64 pg/ml, 22.28±13.79 ng/ml 9.46±0.79 mg/dl, respectively. Fluctuation of PTH hormone in relation to erratic vitamin D intake was reported in 8 patients, and recurrent parathyroid adenoma was reported in three patients, which was subsequently re-operated.

Conclusion: Adequate vitamin D supplementation is essential in the pre and post-operative period to prevent persistent parathyroid stimulation and possible dysregulation. Surveillance for recurrence of hyperparathyroidism should be maintained long term.

Psychological Behavior and Compliance of the General Population with Facemasks during the COVID-19 Pandemic: Implications for the Future

Samreen Misbah, Shiza Maheen, Memoona Mumtaz, Yumna Rubab — Thu, 15 Jun 2023 00:00:00 +0000

Background: Globally people have succumbed to viral infections that posed a stupendous threat. Community wearing of facemask helped lowering the incidence of COVID-19. The objective was to determine the public opinion regarding prolonged mask-wearing practice, and to find out the behavioral differences as pertinent compensations for not wearing that may help combat pandemics because of emerging infections.

Methodology: This cross-sectional study carried out in the outpatient departments of Military Hospital (MH) Rawalpindi, Pakistan from January to June 2021 after ethical approval. Participants selected by non-probability convenience sampling technique of different residential, economic and educational backgrounds, above 16 years of age, from both genders to give their opinion on a validated questionnaire, “Multidimensional face mask perceptions scale” with eight domains.

Results: Among 175 participants, almost 81.7% participants were of the view that when they do not wear mask it is because facemasks get overheated and disrupt the breathing, 60.6% adopted compensation ways by avoiding people and 45.7% considered its wearing a hassle. Female participants felt more uncomfortable by disrupted breathing (p =0.029), male participants reflected about value of independence (p<0.001), and participants from rural area thought a difficult access to get facemasks (p =0.003).

Conclusion: The most likely reason for not wearing mask among participants was uncomfortable breathing. The other reasons includes adopting social distancing guidelines as a compensatory measure, finding facemask wearing practice a hassle, interference with freedom and access issues by rural population. Designing and implementing awareness sessions may halt such spread of pandemics because of emerging infections.

Level of Adherence to the Gold Strategy Document for the Management of Patients with Acute Exacerbation of COPD in Sahiwal

Thu, 15 Jun 2023 00:00:00 +0000

Background: Chronic Obstructive Pulmonary Disease (COPD) and its exacerbation are a major cause of pulmonology OPD and emergency visits in Pakistan. The objective of this study was to measure the level of adherence to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy document in the management of patients with acute exacerbation of COPD, in Sahiwal Punjab Pakistan.

Methodology: This retrospective cross-sectional study comprised 480 patients with acute exacerbation of COPD. It was conducted in the Pulmonology Department DHQ Teaching Hospital, Sahiwal. The treatment given to these patients was compared to treatment guidelines mentioned in the GOLD strategy document for management of acute exacerbation of COPD.

Results: Out of total 480 patients, 408 (85%) were males. 312 (65%) patients belonged to age group 50-70 years. 100% Gold strategy treatment standards were not followed in any patient. Five out of ten management steps were followed in all cases. While remaining five steps were followed variably.

Conclusion: Overall adherence to the AECOPD management standards set by GOLD strategy document was not good. Improved physician’s awareness of guidelines and better adherence to treatment standards can improve patient care and outcome.

Chest Radiograph appearance of SARS-Cov-2 Infection: A Prospective Observational Study of Ambulatory Patients from a Field Hospital in a Middle-Income Country

Thu, 15 Jun 2023 00:00:00 +0000

Background: The ongoing COVID-19 pandemic has had a profound impact on both individuals and society, resulting in widespread illness and death, as well as a global economic downturn. In order to examine chest X-rays (CXRs) of ambulatory patients diagnosed with COVID-19 in a field isolation center, our aim is to determine the proportion of patients with normal versus abnormal chest radiographs. Moreover, in cases where abnormal findings are present on the CXR, our goal is to document the distribution and patterns of these abnormalities.

Method: This prospective observational study was conducted on a cohort of 510 consecutive COVID-19 patients who tested positive for the virus and presented at the field isolation center between March 15^th and May 15^th, 2020. The study encompassed patients of all ages and both genders, with the exclusion criteria being patients requiring intensive care and those with unreadable CXRs due to technical limitations. The review of CXRs was performed by two certified radiologists, ensuring reliable and accurate assessments. Age, gender, and X-ray findings were noted.

Results: Among the total of 510 patients included in the study, 463 (90.8%) were male, while 47 (9.2%) were female. The age range of the study population spanned from 12 to 64 years, with the majority falling within the 23-33 year age group. During the review of CXRs, 433 (84.90%) were classified as normal, while 77 (15.10%) were deemed abnormal. The most frequently observed abnormal pattern was ground glass opacification, accounting for 54.5% of the cases, followed by the reticular pattern at 45.5%.

Conclusion: CXRs obtained from confirmed COVID-19 patients were normal in 85% of the patients. The most common abnormality seen in our study population was involvement of the lower lobes with patchy peripheral ground glass opacities or reticular shadowing, which was focal or multifocal in location.

Correlation in Academic Performance, Purpose in Life and Hopelessness among Final year Medical Students

Ammara Butt, Marryam Iftikhar, Zainab Mahmood — Thu, 15 Jun 2023 00:00:00 +0000

Background: Student’s academic performance is the major concern for the educational sector because students are the future practitioners who will serve the society. The academic performance of students is a key feature in teaching. The present study aims to determine the relationship between academic performance, purpose in life and hopelessness among final year MBBS students, by taking hopelessness as predicting variable.

Methodology: A Correlational study was conduct at Fatima Jinnah Medical University, Lahore Pakistan. A total no. of 240 final year medical students were included by using convenient sampling technique and they were administered Purpose in Life (PIL) Scale and Beck’s Hopelessness Scale (BHS) along with demographic details. The academic performance of students was measured through 4^th year academic scores. Hopelessness was taken as independent variable (IV), while, academic performance and purpose in life served as dependent variables (DVs).

Results: The mean age of students was 22.5 years. Results found negative correlation between hopelessness and academic performance (p<0.01), as well as a negative correlation between hopelessness and purpose in life (p <0.01). Hopelessness negatively predicted academic performance (β= -.19, p<.01) and purpose in life (β= -.72, p<.001) among students. Total 25% students were in the normal range of hopelessness, 45.4% students scored in mild range, 23.8% students were in the moderate category, while 5.8% students were found in the severely hopeless category.

Conclusion: The study concluded that hopelessness does not only predict purpose in life negatively among students but also affect their academic performance. A wide range of students were found hopeless therefore, various interventions for the prediction of hopelessness in various academic institutes should be made by involving appropriate educational and administrative measures.

Letter to Editor "Barret’s Esophagus Screening: An Inevitable Urge For Gastroenterologists"

Jibran Umar Ayub Khan, Azhar Zahir Shah, Ayesha Qaisar, Ayesha Gul — Tue, 14 Mar 2023 06:09:24 +0000

The presence of benign esophageal diseases including gastroesophageal reflux disease, barrets esophagus,hiatal hernia and achalasia have been arousing the curiosity of young clinicians , scientists and researchers for decades and years to follow.¹ Dyspepsia is one of the most common symptoms experienced by the patients and witnessed by the doctors during routine clinical consultations. This does accompany regurgitation of food, bad taste in mouth early morning, chest pain and sometimes alarm symptoms including hematemesis, malena, unintentional weight loss and dysphagia.That is the point where one has to rethink and diagnosis treatment strategies and review patients accordingly.²

Barrett’s oesophagus is defined as ‘an oesophagus in which any portion of the normal squamous lining has been replaced by metaplastic columnar epithelium. Barrets esophagus is a benign condition with a potential to transform to oesophageal carcinoma.³ There is a long history gastroesopheal reflux disease symptoms. In our country there is a trend of self medicating oneself before coming to any physician in the general practice who also treats the patients for years before referral to gastroenterologist who can think out of the box and do invasive investigations like endoscopy, CT chest and non invasive one like barium swallow. Most of the people ponder over when is right moment for screening the patients for Barrets esophagus and Esophageal Cancer Screening. A lot depends on the biopsy report and its findings in terms of having low grade, indefinite for dysplasia and high grade dysplasia.⁴

Low grade dysplasia in terms of surveillance carries less significance in which the guidelines suggest the time interval can be enhanced to 2-3 years in case of permanent regression with proton pump inhibitors given for 8 weeks The high grade dysplasia is an alarm finding for any gastroenterologist requirement more aggressive screening and management as there is a 30-40% risk of oesophageal carcinoma.⁵ This will need discussion by multidisciplinary teams including gastroenterologists, oncologists and pathologists as well.⁵

There is usage of proton pump inhibitors for years by the patients that is itself a risk factor for complications such as atrophic gastritis, pernicious anaemia, osteoporosis and even cancer.⁶ The resistance of symptoms to standard and even high doses of proton pump inhibitors is an indication for endoscopy as well. The role of PPI in asymptomatic patients is not substantiated by enough evidence in the literature However, in clinical practice, most patients are advised long term PPI based on the premise that chronic acid exposure may contribute towards Barrett’s Esophagus.⁶ So the bottom line is that there should be no hesitation in expediting the referral of such patients for urgent gastroenterology consultation who may do subsequent endoscopy after thorough examination of the patients.

American Gastroenterological Association has strong recommendations for screening for Barrett oesophagus in patients older than 50 years with symptomatic GERD and at least one additional risk factor for oesophageal adenocarcinoma.⁷ Almost similar guidelines have been formulated by other reputed societies as well including British Society Of Gastroenterology. There is a phobia of endoscopies in general public and they are reluctant to do them. But once the indication is clear then the patient should be counselled thorough as in case of oesophageal cancer for which a Barrets Oesophagus is a risk factor, early diagnosis is the key as surgery is curative. Indeed it is and should be irresistible urge for gastroenterologists to screen such patients.⁷

Frequency of the multi and extensively drug-resistant Salmonella Typhi in a health care facility

Tue, 14 Mar 2023 05:49:58 +0000

Background: Antibiotic resistance is increasing against Salmonella Typhi (S. Typhi), causative agent of enteric fever, at a very high pace in Pakistan. The objective of this study was to evaluate the emergence of multi and extensively drug resistant Salmonella Typhi among suspected patients in a public health care facility in Lahore.

Patients and methods: 5cc blood samples from the patients with high grade fever (>38°C), vomiting and bradycardia (heart rate 84 bpm) were collected from laboratory of Arif Memorial Teaching Hospital, Lahore over six months (August 2020-January 2021), After informed consent, questionnaire were filled and total 97 samples were taken from suspected patients and screened for Salmonella Typhi by using Typhidot IgG/IgM by ELISA kit (one step typhoid fever) for S. Typhi. Gram staining, culture and biochemical testing was performed for confirmation. Antibiotic susceptibility testing was used to evaluate the emergence of antibiotic resistance. Statistical analysis was performed by using SPSS 20.0, software. Chi square test was used,

Results: Total 55 (56.7%) samples out of 97 (100%) were reported positive for Salmonella Typhi. Antimicrobial susceptibility testing results indicated that 6 samples were resistant to more than one antibiotic commonly called as multidrug resistant, 44 samples were extensively drug resistant and 5 samples were nonresistant/sensitive to selected antibiotics. Highest resistance was reported against Ampicillin (51 samples (92.7%) and Co-trimoxazole (50 samples (90%)). Resistance against Moxifloxacin and Tobramycin, Ciprofloxacin, Ceftriaxone Cefuroxime and Cefotoxime, Cefxime, Levofloxacin, Salbactum, Imepenum and Amikain was 47 (85.4%), 46 (83.6%), 45 (81.81%), 44 (80%), 37 (67.2%), 32 (58.18%), 14 (45%) and 9 (16.3%) respectively. Lowest resistance was reported against Meropenum 5 (9%) and Azithromycin 1 (1%).

Conclusion: It is concluded that the monitoring of MDR and XDR must be performed by all clinical microbiology/pathology laboratories to implement effective measures to reduce the emergence of antimicrobial resistance.

A study of morphological variations of fissures and lobes of formalin fixed cadaveric lungs

Farhana Jafri, Aliya Zahid, Javeria Ali — Tue, 14 Mar 2023 05:25:08 +0000

Background: Variation of morphology of lung fissures and lobes affects the interpretation of results of radiological examination as well as line of action in cardiothoracic surgical procedures. A research was done to find out the incidence of variations of fissures and lobes in embalmed cadaveric lungs.

Materials and methods: This is a cross sectional study. All the formalin fixed lung specimens present in dissection halls and museums of the Anatomy Departments were observed for any abnormal fissures that are adding accessory lobes to lungs. Data was entered and analyzed by using SPSS 22.0. Descriptive analysis was applied by using frequencies and percentages for qualitative variables.

Results: Total 80 formalin-fixed specimens of lungs were examined and a total of 29 (36.25%) (%) were found to have incomplete fissures. It was observed that 14 (17.5 %) out of 80 lungs had incomplete oblique fissures, and out of these 6 (17.65%) were found in right lungs and 08 (19.05%) were present in left lungs, whereas 15 (39.47%) right lungs showed incomplete horizontal fissure. Among 80 lungs, 6 (7.5%) presented unusual accessory fissures and lobes, whereas 5 (14.7%) showed absent horizontal fissure reducing the number of lobes to two in right lung specimen.

Conclusion: There is a prevalent incidence of incomplete horizontal fissure that must be kept in mind when investigating and treating any lung pathology.

Delayed speech in children of working and non-working mothers in Lahore, Pakistan: Prevalence and associated factors

Tue, 14 Mar 2023 05:20:31 +0000

Background: Before going to school 2-3% of children have language problems and 3-6% have speech delays. This study was carried out to determine the prevalence of delayed speech in children of working and non-working mothers and to determine if speech and language development in children are affected by the working status of the mothers.

Subjects and methods: This cross-sectional study was conducted at Mayo Hospital, Services Hospital, Sheikh Zaid Hospital, Lahore College for Women University, and the University of Lahore, Pakistan. A total of 288 mothers were recruited. Among them, 144 were working women (aged 25-40, working hours 6-8 for at least 5 days a week), including all professionals, teachers, doctors, and job holders. The other group included 144 non-working women (aged 25-40 years) having both male and female children from 2 to 5 years of age (with normal developmental milestones mean age of 3.5 years). Data were analyzed using SPSS.

Results: The results showed that 44 (30.6%) children of working women and 40 (27.8%) children of non-working women had delayed speech. The overall prevalence of delayed speech in children was 29.1%. No significant relationship was found between the working status of mothers with speech delay. The socioeconomic parameter (Kuppuswami scale) of the study revealed that 29% of delayed speech children (late talkers) belonged to the upper class, while 65.5% belonged to the middle class. Of delayed speech children 41.7% lived in a nuclear family and 58.3% in a joint family system. A significant relationship between delayed speech was seen with gender, birth order, social class, and the schooling status of the child.

Conclusions: Delayed speech is significantly related to gender, birth order, and schooling status. The working status of mothers plays no significant role in the language and speech development of children in the current study.

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Zainab Fatima, Asmi Shaheen, Waqar Ahsan, Muhammad Illyas — Tue, 14 Mar 2023 00:00:00 +0000

Background: Different behavioral therapies are used to reduce pain severity in patients undergoing separator placement apart from pharmacological treatments. However, there is limited local data.This study aimed to determine the frequency of high and low levels of activity in adult patients who needed separator placement and compared the mean pain scores with respect to baseline physical activity level following the intervention.

Subjects and methods: It was a descriptive case series carried out at the Orthodontics Department, De’Montmorency College of Dentistry, Lahore, for a period of 3 months from 15.7. 2022 to 15.9.2022. Total 120 patients aged 18 to 40 years of both genders, who needed separator placement were included in the study. Patients were excluded if they had medical conditions or systemic diseases that was a contraindication for usage of fixed orthodontic appliances, had chronic pain or pain in the orofacial or dental region, had maxillary or mandibular fracture and who had previous history of mandibular or maxillary surgery. Baseline physical activity level was noted down as per clinical history. Patients then underwent separator placement.

Results: Mean age of the patients was 28.67±6.312 years. There were 62 (51.7%) males and 58 (48.3%) females. Baseline low physical activity was found in 77 (64.2%) patients while high activity was found in 43 (35.8%) patients. Mean pain scores in the low physical activity group were 3.9±2.056 and in the high physical activity group were 2.26±2.094 and the difference was statistically significant i.e. p=0.001 as assessed by independent t-test.

Conclusion: Frequency of low physical activity level was higher in patients and it was found to be associated with higher mean pain scores compared to patients who had high baseline level of physical activity.

Evaluation of right liver lobe size to serum albumin concentration ratio in predicting the presence of esophageal varices in cirrhotic patients taking endoscopy as gold standard

Tue, 14 Mar 2023 00:00:00 +0000

Background: Cirrhosis with its complication is a major health concern in Pakistan. Endoscopy is an invasive and expensive modality for screening for esophageal varices which is one of the most common complication of liver cirrhosis. Research is being conducted to explore non-invasive markers that can replace this invasive technique. We aimed to evaluate the predictive value of the ratio of the size of the right lobe of liver to serum albumin concentration in prediction of the presence of esophageal varices.

Methods: It was a cross-sectional study conducted at the Medicine Department, Ghurki Trust Teaching Hospital, Lahore from January 4 till July 31. The study included 297 patients of all the genders, aged 20-70 years, diagnosed cases of liver cirrhosis for at least 6 months and having suspected esophageal varices on right liver lobe size to serum albumin ratio >4.1. All the patients were subjected to upper GI endoscopy to confirm predicted varices. Data was analyzed using SPSS 23.0. PPV of the ratio was calculated. Post-stratification chi square was used to find association (p value <0.05 as significant).

Results: The patients had a mean age of 51.5 ± 9.2 years with 180 (60.6%) male and 117 (39.4%) female patients. Diagnosis of esophageal varices was confirmed in 225 (75.8%) patients on endoscopy. There were 225 true positive and 72 false positive cases. Positive predictive value was 75.8%.

Conclusion: The positive predictive value of the ratio of the size of the right liver lobe to serum albumin was statistically significant in predicting the presence of esophageal varices on upper GI endoscopy. These findings were not dependent on the patient's age, BMI, gender, duration of disease or serum bilirubin level.

Cirrhosis, Esophageal Varices, Right Liver Lobe Diameter to Serum Albumin Ratio

Role of neutrophils to lymphocytes ratio in identification of bacterial infection in adult population

Sat, 11 Mar 2023 00:00:00 +0000

Background: Bacterial infection are difficult to distinguish from viral infection. Neutrophils are the first cells mobilize to infectious site caused by bacteria and also apoptosis of lymphocytes in response to cell mediated immunity hence raised in neutrophils and decrease in lymphocyte count. The goal of this study is to determine the neutrophil to lymphocyte ratio in patient with positive blood culture for bacteria in patients admitted in hospital.

Patients and methods: This cross-sectional study was conducted at Department of Pathology, Hamdard University Karachi, Pakistan from 1st January to 31st June 2022. Total 123 adult patients with positive blood cultures admitted in ward or ICU were enrolled in the study. CBC Samples were collected from patients admitted in ward or ICU and blood culture were already sent due to clinical condition, the organism isolated in blood culture were recorded As blood culture is a gold standard investigation to detect bacterial infection .In this study we will record neutrophil to lymphocyte ratio in patients admitted with positive blood culture for bacteria. Age less than 15 years, pregnant female, OPD patients, negative blood cultures and patients on antibiotic therapy were excluded. Complete blood count (CBC) was performed in Beckman coulter model DxH 520 made by Germany. Age and ward of patient, organism isolated from blood culture, CRP.

Results: A total of 123 patients with positive blood culture were enrolled in the study. Out of 123 patients 61.8% (n=76) were male and 38.2% (n=47) were female. Mean NLR was 5.9± 13.1. Total 45.5% patients presented with high NLR. Mean CRP was 58.5± 68.7.

Conclusion: High NLR was seen in 45.5% which shows NLR is an important indicator of bacterial infection. More studies are needed to define true significance of NLR in all ages and negative blood cultures.

Comparison of dermatosis acne vulgaris in obese and non-obese patients

Sat, 11 Mar 2023 00:00:00 +0000

Background: Obesity is a disorder characterized by increase fat deposition in human body. Acne vulgaris is a common skin disease, affecting approximately 9.4% of the world’s population, with considerable effect on the quality of life. According to a previously conducted study, the prevalence rate of acne in Pakistan was found to be 5%. Obesity is increasing rapidly in developed and developing world. Acne vulgaris is commonly associated with obesity. The objective of this study is to compare the acne vulgaris in obese and non-obese patients.

Patients and methods: It was a cross-sectional descriptive survey in which 300 obese and 300 non-obese patients were included respectively. Dermatosis, acne vulgaris was observed in the patients selected through inclusion criteria. This study was conducted in The University of Lahore Pakistan. Data was collected from outdoor Patients of skin Department of The University of Lahore Hospital during April 2020 to October 2020, by using questionnaire. Consent was taken before data collection. Data was analyzed through SPSS version 20.

Results: Mean age of obese group was 37.4±13.0 years and non obese group was 30.9±15.6 years. In obese group 161(53.7%) were females, while 139(46.3%) were males respectively. In non-obese patients 193(64.3%) were males and 107(35.7%) were females respectively. In obese group, 115 (38.3%) had acne vulgaris, while in non-obese group 41 (13.7%) were affected with acne (P value ˂ 0.05).

Conclusion: It is concluded that dermatosis acne vulgaris is significantly greater in obese patients as compared to non-obese patients. Obese persons should be given special consideration in terms of proper referral and management.

Knowledge, attitude and issues in practicing kangaroo mother care at home after discharge from a kangaroo mother care ward of a tertiary care hospital in central Lahore

Sat, 11 Mar 2023 00:00:00 +0000

Background: Kangaroo mother care (KMC) is well known intervention in preterm care. Mothers gets training from health professionals to provide skin to skin care, breast feeding which helps in infections prevention and early discharge. It is required to inquire the mothers experience during home environment to promote this technique after discharge from hospital. This study focused on gaining the knowledge, attitude of unsupervised mothers practicing KMC at home and determine the most common issues faced by them.

Subjects and methods: A cross-sectional study, conducted at KMC ward of the Department of Pediatrics, Unit-1, Services Institute of Medical Sciences (SIMS), Lahore from March 2020 to April 2021 after ethical approval. Hospitalized mothers of stable pre-term infants were taught KMC techniques by trained health care provider. After two weeks of discharge from hospital mothers were interviewed according to structured questionnaire by the trained doctor about their KMC knowledge, experience and issues faced at home.

Results: Out of 156 mothers 145 (92.9%) conducted KMC at home and 93 (59.6%) performed intermittent KMC during nighttime (p=0.001). 152 (97.4%) mothers felt good, 133 ( 85.3%) were comfortable and 122 (78.2% ) deemed the process safe for their babies. 82 (52.6%) felt ease with provided kits (p=0.032).120 (76,9%) husbands felt KMC was essential for their babies. 102 (65.4%) mothers were allowed by their husbands to do KMC at home (p=0.000) and 68 (43.6%) fathers sometimes performed KMC themselves (p=0.001). Family and friends were also supportive in 104 (66.7%) cases while 112 (71.8%) mothers felt the positive attitude of the community (p=0.000). 127 (81.4%) mothers were willing to recommend KMC to new mothers (p=0.019).

Conclusion: Most of the mothers performed intermittent KMC at home. They were assisted by husband and family members to carryout KMC at home. They are willing to recommend it to new mothers.

Effect of caffeine consumption on sleep quality of undergraduate medical students of Multan

Sat, 11 Mar 2023 00:00:00 +0000

Background: Caffeine is extensively utilized as a stimulant of the central nervous system by more than 80% of the world’s population. About 94% of medical students are reported using caffeine which is likely to have a detrimental impact on sleep quality. The purpose of the study was to evaluate the relationship between caffeine consumption and sleep quality among non-obese. undergraduate medical students

Subjects and methods: An Observational cross-sectional comparative study was carried out at Nishtar Medical University, Multan during the months of November and December 2022.Total 83, both male and female, non-obese undergraduate medical students (18-23 years old, BMI=18.5-24.9) selected by simple random sampling were included in this study, and they were divided into 3 groups on the basis of low (58 ± 29 mg/day), moderate (143±25 mg/day) or high (351±139 mg/day) caffeine consumption daily. Caffeine Consumption Questionnaire (CCQ) and Pittsburgh Sleep Quality Index Scale (PSQI) were used to assess the daily caffeine consumption (mg/day) and sleep quality, respectively. IBM SPSS-26 was used for data analysis. Mann-Whitney U test and Spearsman’s rho correlation were applied.

Results: PSQI scores were high [11(8─16)] in highly caffeinated participants, moderate [7(5─9)] in moderately caffeinated participants, and low [3(1─6)] in low caffeinated [3(1─6)] participants (p=0.000). Low-caffeinated subjects had lower PSQI scores compared to moderately and highly caffeinated subjects (p=0.000 and p=0.000, respectively). PSQI scores in moderately caffeinated were also less as compared to highly caffeinated (p=0.000). Within the low caffeinated, moderately caffeinated, and highly caffeinated subjects caffeine consumption was positively correlated to PSQI scores (r=0.529, p=0.004), (r=0.579, p=0.002), (r=0.592, p=0.001) respectively.

Conclusion: Increase in Caffeine consumption reduces sleep quality, implying that caffeine consumption and sleep quality are inversely related to each other.

Immunohistochemical expression of HER2 and MUC1 in breast carcinoma and its correlation with histological grades

Sidra Ghazanfer, Rozina Jaffar, Hasan Osman Mahmood — Thu, 16 Feb 2023 17:56:36 +0000

Background: Mucin 1 (MUC1) is overexpressed in almost 90% of CA breast cases and is usually associated with poor prognosis. On the other hand, HER2 is profoundly expressed in breast carcinoma and is also linked with increased disease recurrence, tumor invasion and poor prognosis. Thus, this study was designed to assess the expression of MUC1 and HER2 against the histological grades of breast carcinoma in our population.

Materials and methods: It was a cross sectional analytical study conducted at Post Graduate Medical Institute/General Surgery Departments of Lahore General Hospital (LGH), Lahore. Duration of study was 12 month from 27-3-2018 to 30-3-2019. Total 60 newly diagnosed cases of CA breast were included in the study. Immunohistochemistry technique was used and MUC1 and HER2 markers were applied to check the probable association between the two markers and the histological grades of cancer.

Results: A total of 60 cases were included in the study, out of which 96.7% (n=58) were invasive ductal carcinoma, while 3.3% (n=2) were Invasive lobular carcinoma. Among the total, 60% (n=36) were found positive for MUC1 (moderate/strong) and 40% (n=24) were found negative (negative/weak). Regarding HER2, 26.7% (n=16) were strong positive, 20% (n=12) were at the borderline/equivocal and 53.3% (n=32) were found negative for HER 2.

Conclusion: Statistically significant association was found between MUC1 and HER2 against the histological grades of breast cancer patients (p <0.05).

Short term outcome of treatment with percutaneous cross Kirschner wires in paediatric distal humeral metaphyseal diaphyseal junction fractures

Thu, 16 Feb 2023 17:49:58 +0000

Background: Soft tissue sarcomas (STS) are malignant tumours arising from mesenchymal tissue, comprising <1% of all the tumours of the human body and represent the second most common type of solid tumours in children and adolescents. Surgical resection is considered the mainstay of treatment, supported by multimodal therapies including chemotherapy and radiotherapy. Resource-limited countries, like Pakistan, face additional challenges due to inadequate resources. This study presents the experience of management of soft tissue sarcomas presenting to a tertiary care hospital in Central Lahore.

Patients and Methods: This was an observational study conducted in Surgical Unit I of Sir Ganga Ram Hospital Lahore from January 2017 till June 2022. American Joint Committee on Cancer (AJCC) staging system and Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) resection classification was applied. Surgical treatment including R0, R1 and R2 resections were carried out. SPSS 23 version was used for statistical analysis of collected data.

Results: A total of 36 patients; 24 male (66.7%) and 12 females (33.3%) were included. Anatomical site involvement was observed as 23 (63.8%) limb sarcomas and 13 (36.1%) trunk sarcomas. Out of 36 patients, 20 (55.6%) patients were staged as stage II, 11 (30.5%) patients as stage III and 5 (13.9%) as stage I. Total 17 (47.2%) patients underwent wide excision, 13 (36.1%) patients underwent limited excision, 4 (11.1%) patients underwent compartmental excision and 2 (5.6%) patients underwent palliative excision.

Keywords: Soft Tissue Sarcoma, Presentation, Resection, Histology, Outcome

Spectrum of soft tissue sarcomas: Experience of surgery at a tertiary care referral hospital in Central Lahore

Absar Nazir, Muhammad Rashid Naveed, Ghazala Bano, Azka Sohail — Thu, 16 Feb 2023 17:45:35 +0000

Patients and methods: This was an observational study conducted in Surgical Unit I of Sir Ganga Ram Hospital Lahore from January 2017 till June 2022. American Joint Committee on Cancer (AJCC) staging system and Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) resection classification was applied. Surgical treatment including R0, R1 and R2 resections were carried out. SPSS 23 version was used for statistical analysis of collected data.

Conclusion: Thigh was the commonest site of involvement in extremity sarcomas. Retroperitoneal sarcomas were most frequent among trunk tumours. Leiomyosarcoma was the most common histopathological diagnosis followed by malignant peripheral nerve sheath tumours. Most of the patients presented with stage II disease. Resectional surgery, whether curative or palliative, was found to be the management modality of choice. Rhabdomyosarcoma most frequently recurred within 6 months of potentially curative surgery (R1), most likely due to compromised initial resection.

Does Covid-19 vaccination affect menstruation pattern?

Sadia Anwar, DR, Sajjad Ahmad, Hamzullah Khan, Kausar Inayatullah — Thu, 16 Feb 2023 17:39:21 +0000

Background: As Millions of people are receiving COVID-19 vaccine around the world, a number of side effects are being reported. Menstrual cycle disturbance is also a side effect reported by hundreds of women on social media. The objective of this study was to assess the association of menstrual abnormalities with COVID-19 vaccination.

Subjects and methods: This descriptive cross sectional study was conducted in Obstetrics and Gynecology OPD of Mufti Mehmood Hospital D.I. Khan from March 2021 to June 2021. The health care workers who received Sinopharm COVID-19 vaccine and consented were included. Data was collected about change in menstrual cycle pattern after COVID-19 vaccination.

Results: A total of 80 subjects were included in the study with mean age of 32.6 +7.89 years. There were 36 (45.0%) doctors, 33 nurses (41.25%), 6 (7.5%) paramedics and 5 (6.25%) medical students. According to their marital status, 51 (63.75%) were married and 29 (36.25%) were unmarried. Out of 80 subjects, 16 (20%) reported disturbance in menstrual cycle pattern, 13 (81.2%) after first dose and 3 (18.75%) after both first and second dose. Among these 9 (56.25%) reported heavy menstrual bleeding, 4 (25%) had prolonged bleeding days while 3 (18.75%) had irregular bleeding pattern.

Conclusion: Menstrual cycle disturbance is a reported side effect of COVID-19 vaccination. It is more commonly reported after first dose and heavy menstrual bleedings is the most common pattern followed by prolonged/irregular bleeding.

Demographic features and outcomes in critically ill mechanically ventilated COVID-19 patients with respiratory failure in a resource limited ICU setting – Report from a tertiary care center in Karachi

Thu, 16 Feb 2023 17:37:14 +0000

Background: Studies done on severe COVID-19 have revealed a wide heterogeneity in intensive care clinical outcomes across various countries. We aimed to identify the demographic features and outcomes of mechanically ventilated COVID-19 patients with respiratory failure in Pakistan in resource limited settings.

Methods: This was a cross-sectional study conducted at the COVID-19 Intensive care unit (ICU) of Jinnah postgraduate medical center in Karachi, Pakistan. 86 patients who received mechanical ventilation in a period of five months from 1/2/2021 till 30/6/2021 were included in the study. Patient demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, laboratory values at the time of presentation (hemoglobin, Neutrophil lymphocyte ratio, platelets, glomerular filtration rate, C-reactive protein, D-dimers, Ferritin, liver function tests and electrolytes) and mode and duration of ventilation, final outcome (survivor vs. non-survivor) and cause of death in non-survivors were recorded.

Results: 86 patients, who required mechanical ventilation because of severe respiratory distress not alleviated by non-invasive methods of ventilation, were included in the study. 66.3% (n=57) were males and 33.7% (n=29) were females. Mean age was 59 (SD 12). The most common comorbidities were diabetes mellitus and hypertension 44.2% (n=38) each. Only 3 (3.4%) of mechanically ventilated patients were extubated and 1 patient was eventually discharged home on room air. The mortality rate was 98.8% and only one patient survived. The most common causes of death were respiratory failure (86%, n=74), renal failure (48.8%, n=42) and sepsis (18.6%, n=16).

Conclusion: Mortality in COVID-19 patients who require mechanical ventilation is very high in resource limited settings because of the lack of essential medications, specialized teams and established protocols of ICU management and is not related to the demographic characteristics and comorbidities of patients and severity of disease at presentation.

Keywords:

COVID-19, Intensive Care Unit, Mechanical Ventilation, Mortality

Comparison of effect of prophylactic administration of ondansetron and placebo on prevention of post induction hypotension in elderly patients undergoing surgery in general anesthesia

Thu, 16 Feb 2023 17:35:23 +0000

Background: Post-induction hypotension is a frequently encountered complication seen particularly in elderly population. Hypotension, by impairing vital organ perfusion, increases the morbidity and mortality of the patients. prophylactic use of ondansetron in preventing hypotension after induction of general anaesthesia in elderly patients , hence getting the benefit of preventing both hypotension and postoperative nausea and vomiting by the use of a single drug.

Subjects and method: This randomized controlled clinical trial was carried out in the operation theaters of general surgery, Mayo Hospital, Lahore, from 09-09-2017 to 09-09-2018. A total of 80 patients who were to undergo general anaesthesia for elective general surgical procedures were recruited for this study. After taking informed consent, the patients were randomly divided into two groups. Patients in group A received ondansetron and those in group B received placebo prior to the induction of anaesthesia. Efficacy was labeled in terms of absence of hypotension i.e. a drop in mean arterial pressure of no more than 25% of baseline at 1, 3, 5, 9 and 11 minutes after induction of anaesthesia. The data was recorded on a predesigned proforma. Statistical analysis was done using SPSS version 21.

Results: Both groups were comparable in terms of age, gender, ASA status, BMI and weight. Efficacy was seen in 19 (47.50%) cases managed by ondansetron vs. 10 (25%) in placebo group (p = 0.03). There was significant difference of efficacy in patients with age between 60 to 70 years where 63.63% patients in the Group A effectively maintained their blood pressure (p=0.02). Patients having age 70 years or above did not show statistically significant difference. History of hypertension made no impact on the efficacy of ondansetron for maintaining blood pressure after induction (p=0.53)

Keywords:

Ondansetron, Efficacy, Hypotension

Poliomyelitis in Pakistan: Evolving challenges and way forward

Taskeen Zahra — Thu, 16 Feb 2023 17:32:47 +0000

Poliomyelitis, an acute paralytic illness, affects children under the age of five. It is brought on by the Polio Virus (PV), a single-stranded RNA virus that comes in three serotypes (type 1, 2, and 3) which is transmitted by feco-oral route.^1,2Since 1988, there has been a 99.9% decrease in polio cases worldwide because of the World Health Organization's Global Polio Eradication initiative.¹ This initiative has played a vital role in eradication of the disease. Pakistan is one of the 2 nations where polio remains as an endemic disease even at the end of 2022, the other being Afghanistan.²

In 2021, Pakistan reported just 1 case of polio linked to the Wild Poliovirus type 1 (WPV1) against 14 cases from April 1 through July 31, 2022.² Eleven instances of polio have been reported in the Northwestern Waziristan in 2022, clearly illustrating the loopholes in national policies to completely eradicate the disease despite its goal to immunize 12.6 million children by 2022.² The goal of the Global Polio Eradication Initiative's (GPEI) current 5-year strategic plan is to interrupt WPV1 transmission by 2023.³

According to WHO and UNICEF estimates, in Pakistan approximately 83% of infants received three doses of the Oral Poliovirus Vaccine (OPV) and one dose of Inactivated Poliovirus Vaccine (IPV) in 2021. While none of the districts in Baluchistan, Khyber Pakhtunkhwa, and Sindh attained 80% vaccine coverage, 86% districts in Punjab province had >3 dose OPV coverage.⁴

Diagnostic accuracy of Non-ECG Gated Chest CT (NEGCT) for cardiac chambers’ dimensions in comparison with echocardiography

Mahnoor Hafeez, Amjad Sattar — Thu, 16 Feb 2023 17:22:51 +0000

Objective: To analyze the accuracy of Non-ECG Gated Chest CT (NEGCT) for cardiac chambers’ dimensions, keeping Echocardiography as the gold standard.

Methods: After IRB approval, all patients that underwent concurrent contrast chest CT/CTPA and transthoracic 2D echocardiography exam at our institute within 1 month interval comprised the study population. Data was archived from HMIS PACS Database. The sizes of right ventricle (RV), left ventricle (LV) and left atrium (LA) was recorded in shot axis at axial CT sections and at echocardiography. RV and LV-transverse diameter was measured at basal third of the heart, from the inner to inner myocardium perpendicular to the inter-ventricular septum and LA-max. Anterior-posterior dimension was measured at the level of the aortic root.

Results: Total 213 subjects were studied, with average age of 52.1±15.8 years. The CT-Echocardiography measurement concordance rates were significantly high for LA, LV and RV measuring 93.8%, 96.7% and 69.01% respectively. Using CT threshold for LA, LV, RV enlargement > or equal to 45, 55, 35mm, the AUC via ROC curve analysis was estimated to be 0.912, 0.992, 0.650 respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NEGCT was found to be 66.67%, 95.10%, 37.5%, 98.5% and 93.90% for LA; 100%, 96.67%, 30.0%, 100%, 96.7% for LV and 33.33%, 74.86%, 17.86% 87.26% and 69.01% for RV respectively.

Conclusion: Overall, the accuracy of chamber dimensions at NEGCT was excellent with high CT-Echocardiography concordance, making it an alternative modality for examining chamber sizes, in the absence of cardiac MRI. Through it, a radiologist can also add more value to CT reporting.

Keywords:

Echocardiography, NEGCT, Dimensional Measurement

Determinants of child health in a rural Karakoram village

Thu, 16 Feb 2023 00:00:00 +0000

Background: Mountain communities have unique issues, being generally geographically remote, and politically and socially neglected. The objective was to evaluate the health and healthcare access of children in Tissar, a mountain village in Gilgit-Baltistan.

Subjects and methods: This was a cross-sectional study conducted in August 2021, in Tissar, Gilgit-Baltistan (GB), in Northern Pakistan. Interviews were conducted of adults over the age of 18 years, who had at least one child of age12 years and below, using a convenience sampling method. Descriptive summary statistics were computed using statistical software R version 4.1.2. Poisson regression was used to find potential risk factors associated with diarrhea and pneumonia.

Results: Semi-structured interviews were conducted on 400 participants. Although 363 (90.8%) people grew their own food; 203 (50.7%) still needed to purchase food with only 213 (53.2%) receiving up to three meals a day. Access to healthcare was perceived as inadequate, with only 42 (10.5%) satisfied with the healthcare their children were receiving. Up to 268 (67%) needed to borrow money or could not afford healthcare. Annual occurrence of diarrhea and pneumonia was reported in 100% households, most reporting repeated episodes in one year per child. On Poisson Regression, number of meals per day was negatively associated with diarrhea (rate ratio=0.646, 95%CI=0.591-0.706, p<0.001), adjusted for weaning. Number of meals per day was also negatively associated with pneumonia (rate ratio 0.529, 95%CI=0.487-0.574, p<0.001), adjusting for education and number of children in the family (>6 versus <6).

Conclusion: Health of Children needs to be addressed in mountain communities in Pakistan.

The hyperglycemic and dyslipidemic effects of L-arginine in streptozotocin-induced diabetic rats

Thu, 16 Feb 2023 00:00:00 +0000

Background: Diabetes is a serious disease which is posing a great risk to the overall health care all around the globe. Major factor in its systemic adverse effects is the enhancement of lipolysis by prolonged hyperglycaemia ultimately leading to dyslipidemia. This dyslipidemia is a big risk feature for all cardiovascular diseases related to most of the diabetic patients. L arginine blessed with antioxidant properties can play a substantial role in the prevention, and management of diabetes and related complications. The study was aimed at finding the novel uses of L-Arginine in diabetes.

Subject and method: 15 adult Sprague Dawley rats , only female (to avoid pregnancy) weighing 250+ 50 g were used in this study which were divided equally (five rats each) into three groups randomly after ensuring that their lipid profiles and blood sugar were normal. After keeping one group as Normal Control Group (NC), the remaining two groups were made quasi-analogue Type II diabetic model through administration of Streptozotocin (35 mg/kg) in a single dose intra-peritoneal (IP). After lapse of 48 hours, all the rats of two groups had shown blood sugar levels over 300 mg/dl and therefore were taken as diabetic. One of the two diabetic groups was taken as “Positive Control” with DM rats (DM), while the other was taken as treatment group DM+L-ARG Group”.

Results: With regards to fasting blood sugar (BSF), total cholesterol (T-Chol), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL), Group III (DM+L-ARG) showed significant improvement with the p-value of less than 0.001.

Conclusion: After conducting this experimental animal work, we are able to conclude that in Streptozotocin induced diabetic model, the novel use of antioxidant L-Arginine with good safety profile and minimal adverse effects also has significant anti-hyperglycemic and anti-lipidemic activity.

Effect of Torilis leptophylla on blood total leukocyte count and differential leukocyte count in asthmatic mice

Mon, 19 Dec 2022 10:04:10 +0000

Background: Chronic inflammation, mucus hypersecretion and airway blockage are the characteristics of asthma. Current treatments of asthma are effective but cause adverse effects on their long term use. This research was designed to explore anti-inflammatory effect of Torilis leptophylla (T. leptophylla) on allergic inflammation of airways by estimation of blood total leukocyte count (TLC) and differential leukocyte count (DLC) to compare its effect with a standard drug in an animal model.

Materials and methods: This experimental study was carried out in Pharmacology Department, University of Health Sciences, Lahore. A total of 48 healthy, adult, male BALB/c mice were randomly divided into six groups. Group I (control), group II (diseased); groups III, IV and V were given 100, 200, 400 mg/kg T. leptophylla methanolic extract (TLM) respectively, and Group VI treated with standard drug monteleukast. Airway inflammation was induced in all groups with ovalbumin except control group. On day 28, cardiac puncture was done to collect the blood and TLC and DLC (lymphocytes, neutrophils, eosinophils and monocytes) were measured in blood. All the data was interpreted as mean ± SD. SPSS 20 was used to carry out statistical analysis.

Results: T. leptophylla extract resulted in significant (p-value ≤ 0.05) decrease of TLC and DLC in blood. T. leptophylla cause 59-67% decrease in TLC, 67-80% decrease in lymphocytes, 69 - 72% decrease in neutrophils, and 45-51.7% decrease in eosinophils

Conclusion: In current study T. leptophylla successfully treated inflammation in asthmatic mice by reducing proportion of inflammatory cells.

Investigative analysis of extended-spectrum beta-lactamase (ESBL) producing Pseudomonas aeruginosa isolated from hospitals of Islamabad-Rawalpindi

Muhammad Bhader Sher, Laiba ., Warda Fatima, Hasnain Javed — Mon, 19 Dec 2022 09:59:01 +0000

Background: Pseudomonas aeruginosa (P. aeruginosa) is a ubiquitous gram-negative rod shaped bacteria and a significant nosocomial opportunistic pathogen. Current study aimed at the investigation and determination of extended-spectrum beta-lactamase (ESBL) positive P. aeruginosa from clinical samples.

Materials and methods: A total of 150 catheter tubes, pus, blood, and sputum samples were collected from three different hospitals in the twin cities of Rawalpindi and Islamabad. The isolates were identified by using standard microbiology procedures. Antibiotic susceptibility of the isolates was done through the disc diffusion method as per the protocol given by CLSI guidelines. Phenotypic characterization of ESBL producers was performed by combination disc test (CDT), double disc synergy test (DDST) and through PCR.

Results: A total of 77/218 isolates were identified as P. aeruginosa. Among them 47 were resistant to different drugs, while 28 were identified as multidrug resistant. They were resistant to 9 different drugs including Cefotaxime (49%), Cefipime (41%), Cephradine (32%), Cefotetan (62%), Azetronam (50%), Cofaclor (42%), Ticarcillin (57%), Ciproflaxacin (45%), and Imipenem (36%). CDT and DDST showed that 7/29 isolates produce ESBL. One isolate was positive for VEB and 3 were positive for SHV ESBL genotype.

Conclusion: The phenomenon of ESBL production does not only remain in Klebsiella pneumonia and Escherichia coli but could also be found in P. aeruginosa. Moreover, SHV genotype is prevalent in local isolates of P. aeruginosa.

Paraphenylene diamine (Kala Pathar) poisoning in children of Bahawalpur and surrounding areas

Mon, 19 Dec 2022 09:37:43 +0000

Background: Paraphenylene diamine (commonly known as Kala Pathar in Pakistan) poisoning is a common presentation in adults as well as pediatric patients in Southern Punjab. The study was carried out to assess paraphenylene diamine poisoning in pediatric cases.

Patients and methods: The cross-sectional study was carried out at Bahawal Victoria Hospital Bahawalpur. All the pediatric cases (<15 years age) of paraphenylene diamine poisoning reported during April 2021 to April 2022. Data was entered and analyzed in SPSS.

Results: Total 84 children presented at pediatric department of the hospital. Out of these, 43 (51.2%) were males and 41 (48.8%) were females. Age range was between 02 months and 15 years, mean age being 9.4 + 4.49 years. Majority of cases (46.6%) ingested paraphenylene diamine accidentally, followed by suicidal intention (29.8%), homicidal intent (21.4%) and unknown motive in 2.4% cases. Of all, 49 (58.3%) died of poisoning and 35 (41.7%) survived. Of all the cases, 44 (52.4%) underwent emergency tracheostomy.

Conclusions: Paraphenylene diamine poisoning in children is an alarming trend. Although majority of the cases ingested it accidently but intake due to suicidal or homicidal reason were also high. Positive outcome was associated with higher age, carrying out early tracheostomy and mode of poisoning (homicidal cases had poorest outcome whereas accidental and suicidal pediatric cases had more chances of survival).

Financial burden on the parents of children infected with extensively drug resistant Salmonella infection

Mon, 19 Dec 2022 09:33:27 +0000

Background: Typhoid illness is a significant cause of morbidity in Pakistan. This study aimed to determine the financial burden on parents of children infected with extensively drug-resistant (XDR) salmonella infection.

Patients and methods: This observational study included 159 patients aged 6 months to 13 years admitted through OPD/ER of Karachi Adventist Hospital with the diagnosis of enteric fever and intravenous antibiotics started as per local antibiogram. To remove recall bias antibiotic cost before hospitalization was not included. All those patients who were culture positive for XDR salmonella, either continued or shifted to newer antibiotics as per susceptibility pattern were included. Depending upon the type and duration of antibiotic therapy cost was calculated in Pakistani rupee (1 USD = ~225 PKR).

Results: Total 60.4% of patients aged less than 7.5 years; 62.3% were male, 41.5% from urban areas, 15.1% had graduated mothers, 27% had graduated fathers, 5.7% uses boiled water, and 1.9% typhoid vaccination. In 54.1% of patients antibiotic cost reached >40k PKR. Patients with urban dwelling were 0.29 times less likely for higher cost, increase in duration of fever (>7 days) at admission increased the cost 5.73 times, XDR samples found 13.5 time more likely for higher cost, and TLC between 4000 – 11000/mm³ gave negative association with higher cost.

Conclusion: The burden of XDR salmonella infection is heavy and is related to urban residence, duration of fever at admission, and length of hospital stay.

Fungal osteomylitus in diabetic patients and COVID-19

Mon, 19 Dec 2022 09:14:39 +0000

Background: COVID-19 pandemic has become a big medical problem worldwide. In this era, COVID-19 patients’ along with diabetes mellitus are at an increased risk of developing opportunistic infections. This study demonstrate association of COVID-19 infection in patients having uncontrolled diabetes with the fungal osteomyelitis.

Subjects and methods: This prospective cross-sectional study was done at a Nishter Institute of Dentistry, Multan. Patients diagnosed with fungal osteomyelitis of jaw bones presented during April to December 2021 were included in this study. Data was collected from the patients regarding history of the disease, clinical diagnosis, imaging findings by plain radiographs and CT scans, histopathology. Association of disease process with diabetes and COVID-19 was analyzed in SPSS.

Results: Between the period April 2021 to December 2021, 23 cases presented in Nishter Institute of Dentistry Multan with fungal osteomylitus were diagnosed clinically and fungal organism was identified by immunohistochemical studies by PAS and GMA stains. 22/23 (95.6%) patients were with uncontrolled diabetes mellitus and 18/23(78.2%) gave the history of Covid 19 infection 2 to 3 months before with moderate to severe symptoms.11/23 (47.8%) gave the history of treatment with systemic steroid. Age range was 38-72 years of age with mean age 53.26. 12/23(52.1%) were males and 11/23 (47.8%) were females. 17/23 (73.9%) patients presented with pain in jaws with exposed bone and 6/23(23%) complained of pain and loose teeth in arch. In 22/23 (95.6%) involved jaw was maxilla. In one patient associated medical condition was hepatitis C virus infection also with diabetes. 2 patients were cardiac and 3 were hypertensive along with diabetes. One patient was previously treated with radiotherapy of mandible due to alveolar cancer. Only one (0.04%) patient was non diabetic.

Conclusion: There is increased incidence of fungal osteomyelitis of jaws mostly maxilla in diabetic and COVID-19 infected patients.

The role of bone marrow biopsy in patients with pyrexia of unknown origin

Mon, 19 Dec 2022 09:10:40 +0000

Background: Pyrexia of unknown origin (PUO) is a major complication which remains undiagnosed. Different diagnostic test were used to arrive at final investigation. Bone marrow biopsy (BMB) plays a vital role in diagnosis of PUO. The objective of current study was to determine the role of bone biopsy in diagnosing various types of causes of pyrexia of unknown origin.

Patients and methods: A prospective cross-sectional study was conducted from 1^st September 2018 to 28^th February 2019 at Department of Hematology, Combined Military Hospital Lahore, Pakistan. The data of 120 patients who were remained undiagnosed for at least 1 week were enrolled. Standard procedures were used to obtain the biopsy specimens and bone marrow aspiration was sent for microbiological examination. All the demographic information was kept on a structured self-designed proforma. Data was entered and analyzed using SPSS v.24.

Results: Out of 120 patients recruited in the study there were 67 (55.8%) were from age group 16 to 35 years, were males (65.8%) and 65.0% patients were suffering from fever for more than 3 days. The majority of the participants (30%) were diagnosed with infections, fever due to reactive changes (10.0%), acute leukemia (14.2%), lymphoma (11.7%), chronic leukemia (10.0%), aplastic anemia (4.2%), multiple myeloma (2.5%) and 11.7% patients were undiagnosed

Conclusion: In the diagnosis of pyrexia of unknown origin, morphological and histological investigation of bone marrow plays a vital role. However, if it is combined with other diagnostic modalities such as radiological, microbiological, and serological examinations, the efficiency of diagnosis can be improved.

Evaluation of amnion versus calcium alginate as split-thickness skin graft donor site dressing: A randomised controlled trial

Mon, 19 Dec 2022 08:05:53 +0000

Background: Split-thickness skin graft (STSG) covers patient’s primary wound, but, at the expense of a donor-wound which heals by secondary intention. This study evaluated the efficacy of amnion and calcium alginate dressings at STSG donor sites in terms of healing duration, patient comfort and incidence of infection.

Patients and methods: An open label randomised control trial was conducted during October 2018 to May 2019. Total 60 patients, aged 20-45 years, were randomly allocated to two equal groups. Amnion was applied to 30 donor sites in Group A and calcium alginate in 30 donor sites in Group B. Patients were phone-called on 1^st, 3^rd and 7^th post-operative days and donor site pain scored using numerical rating scale. Donor site was opened on 10^th postoperative day and signs of infection assessed. Lastly, the day on which donor site healed, revealing an epithelialized wound, was noted.

Results: Group A included 30 patients (11 females, 19 males) having mean age of 31.23 years and Group B included 30 patients (12 females, 11 males) having mean age of 31.30 years. Average pain scores on 1^st, 3^rd and 7^th post-operative days were 7.6, 6.6 and 4.4 in Group A and it was 8.2, 6.5 and 4.4 in Group B. Two cases of amnion, 4 of calcium alginate got infected. Average healing duration was 11 days in Group A; and it was 14 days in Group B (p-value = 0.000).

Conclusion: Amnion shows quicker healing and better pain control than calcium alginate.

Assessment of knowledge and behavior regarding cardiovascular diseases and their risk factors among medical students of a private medical college in Lahore

Mon, 19 Dec 2022 07:58:10 +0000

Background: Cardiovascular diseases (CVD) are a major cause of premature deaths globally. The gap between knowledge and behavior regarding modifiable risk factors related to these diseases has been noticed in medical students and is associated with a high number of morbidity and mortality. The aim of this study was to assess knowledge and behavior regarding cardiovascular diseases risk factors among newly enrolled MBBS students.

Subjects and methods: This cross-sectional study was conducted from May to September 2021. A total of 140 first-year MBBS students participated including 80 females and 60 males. Data were collected through a self-administered questionnaire having 17 questions and two sections, one for knowledge assessment and the other for the behavior of participants regarding CVD risk factors.

Results: Major risk factors for heart disease identified by students included obesity (99.3%), high cholesterol (98.6%), hypertension (97.9%), lack of physical activity (95.7%), smoking (82.1%), older age (89.3%), family history of heart disease (73.6%) and diabetes (78.6%). Pertaining to personal history, 10% were smokers, 32.1% regularly consumed soft drinks and 79.3% reported having any physical activities. Significant differences were found between male and female students regarding knowledge of CVD risk factors such as smoking (p-value = 0.003). Similarly, significant differences were observed between male and female students heart health behavior such as cholesterol checkup (31.7% vs. 16.2%, p-value = 0.032), use of soft drinks (48.3% vs 20%, p-value = 0.001) and physical activity (90% vs. 71.2%, p-value = 0.007).

Conclusion: First-year medical students have good knowledge of CVD risk factors but the behavior, regarding practice to avoid these risk factors, needs improvement. It was also observed by comparison that male students have more knowledge of heart disease risk factors as compared to female students.

Androgen receptor (AR) expression in different Gleason scores of prostatic adenocarcinoma by immunohistochemistry

Ghazia Fatima, Abeer ., Kanwal Babar, Muhammad Imran, Junaid Iqbal, Tuba Tariq — Mon, 19 Dec 2022 00:00:00 +0000

Background: Prostatic cancer is highly ominous in men and survives hormonal insufficiency. We studied Androgen Receptor (AR) expression in various Gleason scores (GS) of prostatic adenocarcinoma by using immunohistochemistry.

Materials and methods: This descriptive analytical study was carried out at King Edward Medical University/Mayo Hospital, Lahore in 2016. Slides were prepared from 60 paraffin blocks of prostatic adenocarcinoma and stained for evaluation of different parameters like Gleason score (GS), histopathological grades (well differentiated, intermediate or high grade) and AR immunohistochemistry score. Data entry and analysis was carried out using SPSS version 22. The relationship between different parameters was determined by Pearson chi-square test. A p-value of < 0.05 was considered statistically significant.

Results: Out of 60 cases, 15 (25%) had intermediate and 45 (75%) had high grade tumors. AR was positive in 59 (98.33%) cases. Among the positive cases, 5 (8.33%) had +1 score, 25 (41.67%) has +2 and 29 (48.33%) had +3 score. A significant association of AR expression with GS and histological grades was found.

Conclusion: AR positivity is significantly associated with Gleason Score and histological grading of prostate adenocarcinoma, hence it may prove a useful diagnostic and prognostic marker for carcinoma prostate.

Factors associated with low birthweight among newborns delivered at term in a tertiary care hospital in Lahore

Mon, 19 Dec 2022 00:00:00 +0000

Background: Low birth weight (LBW) is an important risk factor that contributes to mortality of 15-20% of newborn globally. This case-control study was conducted to determine factors associated with low birth weight among new-born delivered at term in obstetrical and gynecological wards of the hospital.

Patients and methods: Mothers of 150 low birth weight babies born at term were taken as cases and 150 normal weight babies born at same day, were taken as controls. Mothers were interviewed on using a semi-structured and pretested questionnaire. The data was analyzed on SPSS Version 22.0. A p-value <0.05 was considered statistically significant.

Results: Illiterate mothers had 2.332 odds of having low birth weight babies (0.03, 95% CI = 1.3317 to 4.152). Mothers from low socio-economic status had 3.54 odds of delivering LBW (p-value = 0.000, 95% CI = 2.184 to 5.94). The odds of having low birth weight babies was 4.004 times high in the mothers exposed to passive smoking (p-value = 0.000, 95% CI = 2.477 to 6.474). Hemoglobin value less than 10 gm/dl was found to be significantly associated with odd of having LBW 3.003 in anemic mothers versus non anemic mothers (p-value = 0.0027, 95% CI = 1.279 to 3.227). Mother with parity <3 had 0.0933 odds of having low birth weight babies. Mothers having adequate antenatal care had 0.394 odds of having low birth weight babies.

Conclusion: Illiteracy, low socio-economic status, employment, anemia, tobacco smoke exposure and inadequate antenatal care were significantly associated with LBW.

Insulin deficient type 2 diabetics: Urgent need for enhanced research in Pakistan

Muhammad Naeem Afzal — Wed, 14 Dec 2022 04:35:16 +0000

Type 2 diabetes is classically associated with insulin resistance stemming from obesity along with relative pancreatic dysfunction to sustain this resistance.¹ In the recent past, Scandinavian researchers highlighted that a considerable proportion of type 2 diabetics are actually insulin deficient out of proportion to their insulin resistance.² These patients were younger, had low BMI, and more deranged glycemic control. Based on sophisticated tests measuring insulin secretion and resistance, high glycemia in this group was attributed more towards decreased insulin secretion instead of insulin resistance. This was described Cluster 2 or severe insulin deficiency diabetes (SIDD) in ANDIS data.² This data changed the perception about solitary attribute of insulin resistance in pathophysiology of type 2 diabetes, and the way we treat them on ameliorating insulin resistance predominantly.

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Laparoscopic management of hydatid cyst of liver

Thu, 07 Apr 2022 05:31:12 +0000

Background: Hydatic disease is caused by a parasite named Ecchinococcus granulosus. This disease is endemic in Pakistan. The disease mostly affects liver forming cysts. The treatment is mainly surgical which can be performed laparoscopically. This study was thus designed to assess the outcomes of the laparoscopic treatment of hydatid cyst of liver in terms of recovery of patient, complications and recurrence.
Subjects and methods: This case series was conducted from March 2015 to December 2020 in Surgical Department of Services Institute of Medical Sciences Lahore. Patients who were planned for laparoscopic surgery for hepatic hydatid cysts (CE2, CE3) were included in the study. Patients who have past history of hepatobiliary surgery, with multiple small cysts or those who has refused for laparoscopic surgery were excluded from study. Demographic data, presenting symptoms, clinicopatholigical findings, duration of surgery, hospital stay and complications were recorded on pre-designed Performa.
Results: Total of 42 patients were managed laparoscopically for hydatid liver cyst. The mean age of the patients was 39.42 + 12.04 years. There were 20 (47.62%) male and 22 (52.38%) female patients. Thirty patients (71.43%) were from rural areas. Twenty patients (47.62%) had history of close contacts with dogs or domestic animals. Patients mostly presented with symptoms of pain in right hypochondrium and abdominal mass. Majority of the patients had single hydatid cyst in the liver. Right lobe of the liver was more frequently involved than left lobe. Both lobes were involved in 2 (4.8%) patients. The mean duration of surgery was 76 minutes. No patient developed intra or postoperative anaphylactic shock. Biliary leakage was seen in 4 (9.5%), port site infection in 2 (4.8%) patients and conversion to laparotomy was done in 2 patients (4.8%). The mean hospital stay of patients was 3.41+ 2.82 days. There was no mortality of the patients or recurrence of cyst on 12 week follow up.
Conclusion: Laparoscopic surgery for hepatic hydatid cyst is safe and effectual treatment in carefully selected patients. It is a simple technique with lesser postoperative morbidity and potentially decreased risk of complications especially recurrence of disease.

The role of ocular coherence tomography angiography in the diagnosis of diabetic retinopathy and a comparison with the current gold standard fundus fluorescein angiography

Thu, 07 Apr 2022 05:26:54 +0000

Background: Diabetic retinopathy is a leading cause of preventable blindness in the world. Efficient and effective diagnosis and surveillance of diabetic retinopathy is of crucial importance to preserve the vision of patients. The FAZ (Foveal Avascular Zone) area is enlarged in patients of diabetic retinopathy. The purpose of this study was to evaluate the accuracy of OCT-A (Optical Coherence Tomography-Angiography) in delineating the FAZ area in cases of diabetic retinopathy and make a comparison with the findings of FFA (fundus fluorescein angiography) - the current gold standard.
Subjects and methods: This was a comparative analytical study carried out at a tertiary care hospital in Lahore, Pakistan. A series of 50 patients, 30 males and 20 females with a mean age of 40 years were selected from the hospital outpatient department with history of five years of diabetic retinopathy. They were classified according to the ETDRS classification system into NPDR and PDR groups. The patients were booked for OCT-A, the scans were then observed for findings with a specific focus on the area of the FAZ at the level of the superficial capillary plexus. The patients then underwent same day FFA the current gold standard modality for diabetic retinopathy, thereafter a comparison between the mean area of the FAZ in both the modalities was made & documented. Data was analyzed using SPSS version 25.0.
Results: The FAZ was easily distinguished by both FFA and OCT-A. The mean FAZ area was 0.62 mm²on FFA and 0.69 mm²on OCT-A. There was a statistically significant difference between the two means (p=0.002). Both the modalities had a Sensitivity of 100% at 0.44 and 0.48 cut-offs. OCT-A had a specificity of 91.9% and FFA had a Specificity of 89.2%.
Conclusions: OCT-A proved to be an effective and accurate modality in delineating the FAZ area and detecting macular ischemia in patients of diabetic retinopathy in comparison to the current Gold-Standard FFA.

Comparison of efficacy of electrocautery vs. cryotherapy in the treatment viral warts

Ahsan Anwar, Zahid Rafiq, Sana us Salam — Thu, 07 Apr 2022 05:17:53 +0000

Background: Warts are common cutaneous viral infections due to human papilloma virus (HPV) mostly affecting school age children and adults.¹Various therapeutic modalities are available including topical, physical, and systemic therapies. Physical therapies are considered to be effective in the management of viral warts. This study aims to compare the efficacy of electrocautery with cryotherapy in the treatment of viral warts.
Patients and methods: This randomized trial was conducted in Dermatology Department of GHAQ / DHQ Teaching Hospital/SLMC, Sahiwal from October 2020 to March 2021.A total of 50 patients with clinical diagnosis of warts either sex with age ranging from 5-60 years were enrolled in the study and were divided into two equal groups. Patients excluded were those with evidence of any superadded infection and number of warts >6, having documented hypersensitivity to lignocaine or taking any treatment for warts in last month. After obtaining an informed written consent group A was treated with electrocautery and group B with liquid nitrogen cryotherapy. The patients were treated until the complete clearance of warts or maximum of eight sessions on weekly basis. Demographic and clinical data as efficacy (cleared if not palpable or visible to naked eye) was recorded on predesigned proforma and was analyzed by using chi-square test through SPSS version 25.
Results: Out of total 50 patients, there were 27 (54%) male and 23 (46%) female patients, with an overall male to female ratio was 1:0.7. Most commonly observed clinical type of wart were plantar warts in 28 (56%) followed by palmar in 6 (12%). Electrocautery was found to be effective therapy in treatment of wart as indicated by complete clearance noticed in 19 (76%) patients as compared to cryotherapy in 11 (44%) participants.
Conclusion: Electrocautery is more effective as compared to cryotherapy in the treatment of warts especially plantar and deep-seated. However, promising effects of cryotherapy is seen in common and multiple warts as compared to electrocautery.

Correlation of inflammatory biomarkers with disease severity in hospitalised patients of COVID-19 at presentation

Thu, 07 Apr 2022 05:05:37 +0000

Background: The course of COVID-19 ranges from asymptomatic infection to life threatening critical illness. Inflammatory biomarkers have vital role in predicting outcome, disease severity and disease prognosis in COVID-19 cases. This study aims to observe the correlation of these biomarkers with disease severity in COVID-19.
Patients and methods: This cross-sectional study was conducted in Chughtai Institute of Pathology from February 2021 to May 2021. Blood was collected from 1300 hospitalized adult PCR confirmed COVID-19 patients categorized in mild to critical disease classes. Asymptomatic cases, patients having coagulopathies and those who received plasma infusion were excluded from the study. Blood was analyzed for serum Interleukin-6 (IL-6), Ferritin, C-reactive protein (CRP), procalcitonin and D Dimers. Data was analyzed using SPSS 23.0.
Results: From the study patients, 65.3% (n=849) were male and 34.7% (n=451) were female. Majority of the cases (43.5%, N=565) belonged to moderate group whereas only 0.6% (N=8) were in critical group. Study population had a mean age of 56 (+13.98) years. Serum IL-6 was taken as marker of disease severity, showed significant positive correlation with CRP (r =0.52), ferritin (r =0.33), D-dimers (r =0.32) but no correlation with procalcitonin (r =0.17) using spearmen correlation coefficient. All patients with critical disease had IL-6 levels above 1000pg/ml.
Conclusion: The inclusion of inflammatory biomarkers in routine panel of COVID-19 patients can allow risk stratification of COVID-19 patients in different disease severity groups as cases with critical disease had higher levels.

Short term outcome of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction

Thu, 07 Apr 2022 04:54:51 +0000

Background: Percutaneous Coronary intervention (PCI) is a routinely performed procedure in coronary care units. The aim of our study was to investigate the frequency of major adverse cardiac events (MACEs) after percutaneous coronary angiography in acute ST-elevation myocardial infarction (STEMI) patients in our institution. The objective of the study is to determine the frequency of MACEs after Percutaneous Coronary Intervention (PCI) in patients with acute myocardial infarction.
Patients & Methods: This prospective observational study was carried out at Punjab Institute of Cardiology, Lahore from May 2017 to June 2017. A total 35 patients with STEMI who underwent Primary PCI were enrolled by consecutive sampling technique. An inclusion criterion was chest pain of 30 minutes to 12 hours duration with ECG showing ≥ 0.1mm ST-elevation in at least two contiguous leads. An exclusion criterion was thrombolysis within last 24 hours, malignancy, stroke and Left Main or equivalent disease on coronary Angiogram. Patients were followed after 2 weeks till 1 month for any MACES. (Including re-admission, need for repeat revascularization, stent thrombosis, recurrent acute MI, angina, stroke, and mortality). Frequency and percentages were calculated for MACEs by using SPSS 23.0.
Results: Out of 35 cases, 34 (97.1%) were male and 1 (2.9%) were female. Mean age was 47.11±10.59 years, 14 (40%) patients had hypertension, 10 (28.6%) were diabetics and 12(34.3%) were current smokers while 4 (11.4%) were ex-smokers, 10 (28.6%) had family history of CAD, and 3 (8.6%) had hyperlipidemia. Successful revascularization with TIMI-III flow was attained in 34(97.1%) cases. 33minutes was mean door to balloon time. At one month follow-up, out of 35 patients, angina was reported only in 1 (2.9%) patient. There was no readmission, repeat revascularization, stent thrombosis, myocardial infarction, stroke and death reported in study subjects.
Conclusion: Successful revascularization by Primary PCI was associated with very few early MACEs. For the treatment of coronary artery disease, PCI is an effective option. It has a few early MACEs and uses less contrast and has fewer distal complications than conventional angioplasty and invasive procedures.

Complications affecting outcome in COVID 19 patients admitted in high dependency unit Sir Ganga Ram Hospital, Lahore

Shazia Siddique, Muhammad Anwar, Asma Kamal, Khadija Muneer, Zia Ul Haq — Thu, 07 Apr 2022 04:51:31 +0000

Background: Covid 19 is a highly contagious viral infection resulting in severe acute respiratory syndrome Coronavirus (SARS-CoV-2). The objective of this study was to determine the potential complications affecting the outcome of moderate to severe COVID 19 patients admitted in HDU of Sir Ganga Ram Hospital, Lahore.
Subjects and methods: It was a prospective cohort study. The study was conducted on 108 patients admitted in the COVID HDU of Sir Ganga Ram Hospital, Lahore with positive PCR for COVID-19 having moderate to severe disease. After written consent, all the demographic data and complications like ARDS, respiratory failure, cardiac injury and liver dysfunction, acute kidney injury and sepsis/DIC were obtained through specially designed proformas data was collected through specially designed proformas and data was analysed through SPSS version 22. During hospital stay, we observed the patients for the development of complications as mentioned above. All Patients were followed up till discharge and outcome were noted in terms of discharge or death.
Results: Out of 108 admitted patients in COVID HDU, 68 were discharged, 26 were died and14 got left against medical advice. The mean age was 53.6 + 15.94 years with 53.7% males (n=58), the most common complication during hospital stay was sepsis (31 affected with 16 deaths, 14 survived and p-value=0.000), acute kidney injury (27 affected, 13 died, 13 survived, p-value=0.002), ARDS (seen in 19 patients with 16 deaths, 3 survived and acute cardiac injury (17 affected, 9 died, 8 survived, p-value=0.005).
Conclusion: The complications like adult respiratory distress syndrome, respiratory failure, acute cardiac injury, acute kidney injury, and secondary infection had poor outcomes. This study could help clinicians to take early measures to prevent the development of complications in patients admitted in HDU.

Gender differences in the health status of the imprisoned population in Kot Lakhpat Jail in Pakistan

Thu, 07 Apr 2022 04:28:17 +0000

Background: The prison population of any country is a high-risk population because of a lack of access to regular health care facilities. This research was planned to assess the gender differences in the health status of the imprisoned population of Lahore.
Patients and methods: An analytical cross-sectional study was conducted in Kot Lakhpat Jail in the province of Punjab, near Lahore, from January to August 2019. After getting permission from Inspector General, Police of Punjab, a sample of 320 inmates of Kot Lakhpat Jail was collected through a simple random sampling technique. Data was collected on a structured questionnaire based on history and examination. Data was entered in SPSS version 23, and the chi-square test was applied to assess the gender differences in health status, p-value ≤ 0.05 was taken as significant.
Results: General examination revealed that 143 (44.7%) had refractory errors, and 34 (10.6%) had mild deafness. Common infection in males were scabies (p = 0.002), Sore throat (p =0.015) and urinary tract infections (p=0.015). Hepatitis C was present in high frequency (9.1%). Assessment of sexually transmitted diseases showed discharge in 10.6%, vesicular herpetic eruptions in 8.8%, and ulcers in private parts in 3.8% of the sample. Males showed a significantly high frequency of hypertension (p =0.052) and arthritis (p=0.024). Evaluation of mental health status revealed significant high rates of depression in females (p =0.000) and a high frequency of insomnia (p=0.000). Social health problems revealed a high frequency of smoking in males (p=0.000) and feeling of stigmatization in females (p=0.000).
Conclusion: Male jail inmates showed high frequencies of scabies, sore throat and urinary tract infection, and hypertension. Females showed higher rates of depression, insomnia, and feeling of stigmatization.

Comparison of efficacy of single dose versus split dose prednisolone therapy in achieving remission in patients with nephrotic syndrome in children

Imran Qaisar, Abid Ali Anjum, Abdul Rehman — Thu, 07 Apr 2022 00:00:00 +0000

Background: Nephrotic syndrome is a medical problem clinically characterized by proteinuria, generalized body edema and hypercholesterolemia. We did this study to compare the effectiveness of single dose versus split dose prednisolone in achieving remission in patients with nephrotic syndrome in children.
Patients and methods: This open-ended randomized control trial was done in pediatric unit of tertiary care hospital from January to December 2019.We included one hundred Patients of nephrotic syndrome in the study who met the inclusion criteria. We divided total Patients into 2 groups (group A & B) 50 patients in each group. Group A was given single dose prednisolone, while group B was given split dose prednisolone therapy. Both groups were compared with respect of achievement of remission.
Results: Out of 50 patients of group A who were given single dose prednisolone 37 (74%) were male, while in group B who were given split dose prednisolone 22 (44%) were male (p-value=0.137). Mean age of patients of study group A and B was 4.5 ±1.67 years and 4.9 ±1.49 years respectively (p-value=0.1876). Mean serum creatinine level in study group A and B was 0.744±0.189 and 0.736±0.167 (p-value=0.823). Similarly mean serum albumin level in study group A and B was 2.34±0.358 and 2.39±0.33 (p-value=0.473). When both groups were compared with regard to response to treatment, in group A mean remission duration was 16.48 ±3.69. In group B mean remission duration was 19.42 ±3.11 days (p-value<0.05).
Conclusion: From our study we concluded that single dose prednisolone is more effective in achieving remission in steroid sensitive nephrotic syndrome as compared to split dose prednisolone.

Protective role of omega 3 on histological status of liver of albino rats affected by energy drinks

Imtiaz Aslam, Ammara Rasheed, Farhana Jafri, Raafea Tafweez, Mahjabeen Munira — Thu, 07 Apr 2022 00:00:00 +0000

Background: This study was planned to see the toxic effects of energy drinks on the liver. The study was done for a period of one month in the animal house of the postgraduate medical institute, Lahore, on albino rats. Omega 3 was selected as a protective agent against the toxicity of energy drinks on liver parenchyma. The purpose of this study was to evaluate the protective role of omega 3 on the histology of liver parenchyma damaged by an energy drink.
Subjects and methods: A total of 30 male adult albino rats were used in this experimental study. They were divided into three groups with 10 animals in each: Group 1 was treated with distilled water at the dose of 0.5ml/100g of body weight, Group 2 was given an energy drink at the dose of 1.5ml/100g of body weight and Group 3 at the dose of 0.04-0.05ml/100g of omega 3 and 1.5ml/100g of body weight of energy drink. All doses were given for 4 weeks, orally once daily.
Results: Hepatotoxicity was produced by the energy drink, as histological parameters deranged in experimental group 2, which was treated with the energy drink alone. While group 3, which was treated with omega 3 along with energy drink showed the protection of hepatic architecture to some extent by reducing inflammation and nuclear changes to prove the protective role of omega 3.
Conclusion: Energy drink when given at dose of dose was 1.5ml/100gram/body wt.1.8ml was average dose adjusted on average base for a period of one month causes hepatotoxicity in albino rats. Omega 3 was given as at dose of 0.04-0.05ml/100 gm of body weight/day for a period of one month. It is concluded that 0.04-0.05ml/100mg of b.w/day of Omega 3 offered partial protection to liver against damage by energy drinks.
Conclusion: It is concluded that 0.04-0.05ml/100mg of b.w/day of Omega 3 offered partial protection to the liver against damage by energy drinks.

Evolution of telehealth and its future in Pakistan

Iram Manzoor — Thu, 07 Apr 2022 00:00:00 +0000

Provision of health information, prevention, health care services, and monitoring of the patient by the health care provider through a technology-based virtual platform at the doorstep of the patient is termed as telehealth.¹ In 1959, the first telepsychiatry consultations were made between the Nebraska Psychiatric Institute in Omaha and the state mental hospitals.² Boom to this concept was observed with the emergence of internet access and digital devices. However, the worldwide development in telehealth has been steady and gradual in the last two decades, owing to the lack of sustainable health system models. The telehealth revolution was set in motion by the COVID-19 pandemic. The quarantine of patients required access to medical care, made possible by the virtual health care system, which eased the burden of disease on organizations and hospitals, as well as permitted health care providers with COVID-19 to stay at home and contribute to patients’ care when possible.³ With the provision of telehealth services in a local tertiary health care facility in Virginia, a greater than 5000% rise in virtual health services was observed within a fortnight of the epidemic ⁴. This clearly depicts the twofold advantage of dealing with the epidemic while preserving the capacity of the healthcare system.
Telemedicine can be valuable to patients in inaccessible localities; this, in turn, reduces outpatient visits and benefit those with disabilities. It allows the health personals to witness evidence-based practices and deal with health data under the supervision of experts ⁵. Yet, the full incorporation of telehealth into best practice has evident risks and obstacles. Physical examinations, diagnostic procedures, rehabilitation, and certain mental health treatments cannot be replaced by virtual health services ⁶. Telehealth permits well-timed and adaptable care to patients anywhere they may be; though this is helpful for the patients yet, privacy, safety, and medical reimbursement are jeopardized. In a virtual meeting, it is difficult to ascertain the laws applicable in that context ⁷. The cost of telecommunication services, data management equipment and technical training for medical personnel in these services are major hurdles in the implementation of telehealth services in large areas. In Pakistan, equitability is another issue as many individuals and communities lack not only access to the internet but also the knowledge to operate electronic devices and, in many instances, the electronic gadget itself.
In Pakistan, the disproportionate delivery of healthcare personnel combined with the rapid increase in population has led to a persistent shortage of doctors. Health care service provision indicators show the availability of 0.8 doctors per 1000 residents.⁸ This shows poor access to health care providers. The position gets worse with areas distant from the large cities. There is a dire need to develop a system of telehealth in Pakistan in order to promote the international slogan of health coverage for all. This will also help Pakistan to comply with principles of equity and equality in health care coverage too. With the emerging need to develop telehealth services in Pakistan, initiatives are taken at governmental and non-governmental levels. The development of the whole telehealth department in KEMU is one of the great examples of this initiative. But, according to WHO, Pakistan has no laws and regulations in place for telehealth services.⁸ Need of the hour indicates that such laws and regulations should be made in lieu of the development of telehealth services too for effective implementation. India, Bangladesh, Kenya, and Uganda are examples of developing countries that have implemented telehealth services through various electronic applications for maternal and child care. Aga Khan University Hospital (AKUH) in Karachi has implemented Information technologies (IT) and mobile health (mHealth) services in a video‐based educational intervention in post‐stroke patients with great success. ^9,10 Another example of implementation of mHealth in rural areas is a mobile-based audiovisual application, employed by lady health workers to supervise the Feeding program for children under two years of age for their mothers, which is another successful intervention.¹¹ Regardless of technical advances, the major obstacle hindering the progress and feasibility of telehealth is a deficiency of physical contact with patients and the inability to perform clinical examinations.¹² Pakistan has recently opened a pathway for telehealth service provision. These services are introduced at a very primitive level and lack accessibility. Areas to be focused on a wider range of population due to lack of awareness. ¹³ Although COVID-19 has boosted the telehealth system in Pakistan, there is a lack of a patient-centered, preventive, collaborative, and cost-effective model of care. A well‐informed policy catering to both public and private health care systems, in collaboration with stakeholders, is vital to revive the outdated and over-burdened health sector in Pakistan.³ Moreover, there is a dire need to establish training facilities for health care providers engaged in the provision of telehealth services.¹⁴ Such initiatives will enhance the progress of telehealth and promote the health care delivery system of Pakistan.

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Mahdi SS, Allana R, Battineni G, Khalid T, Agha D, Khawaja M, et al. The promise of telemedicine in Pakistan: A systematic review. Health Science Reports. 2022 Mar; 5(1):e438.
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Iftikhar S, Saqib A, Sarwar MR, Sarfraz M, Arafat M, Shoaib QU. Capacity and willingness to use information technology for managing chronic diseases among patients: A cross-sectional study in Lahore, Pakistan. PloS One. 2019 Jan 10; 14(1):e0209654.
Kamal A, Khoja A, Usmani B, Magsi S, Malani A, Peera Z, et al. Effect of 5-minute movies shown via a mobile phone app on risk factors and mortality after stroke in a low-To middle-income country: Randomized controlled trial for the stroke caregiver dyad education intervention (MovIes4Stroke). JMIR mHealth and uHealth. 2020 Jan 28; 8(1):e12113.
Akber S, Mahmood H, Fatima R, Wali A, Alam A, Sheraz SY, et al. Effectiveness of a mobile health intervention on infant and young child feeding among children≤ 24 months of age in rural Islamabad over six months duration. F1000Research. 2019; 8.
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Late sequelae of COVID-19 and its effect on the quality of life

Mon, 04 Apr 2022 06:32:19 +0000

Background: COVID pneumonitis presents with symptoms of fever, cough, fatigue, myalgia, inability to smell and shortness of breath. However, certain symptoms have been reported to be persistent in some people or novel post-recovery symptoms have developed. Due to the day today rise in the number of covid-19 cases in Pakistan, it is the need of the hour to determine the long-term consequences associated with this disease, to educate the general population and to establish the long-term management of the patients.
Patients and methods: This cross-sectional study was conducted using non-probability purposive sampling, in which a total of 75 patients who had recovered from Covid-19 infection in the past 2-10 months visiting tertiary care hospitals in Lahore for follow up were recruited and filled survey forms bearing different questions regarding their disease, post-recovery symptoms and quality of life. Data collected was then analyzed by SPSS-26.
Results: The most common symptoms were fatigue (66.7%), dry cough (46.7%), headache (44%) and joint pains (41.3%), followed by other general, neurological, pulmonary and psychological symptoms. The quality of life was analyzed in different domains exhibiting an average range of 60-68% which shows that covid-19 has significantly affected the quality of life of its victims.
Conclusion: Various post disease recovery symptoms have been seen in the covid-19 victims and their quality of life has been deteriorated in physical, psychological, environmental and social domains; therefore, we need a multi-disciplinary team comprising of physicians, nurses, psychologists, social and occupational health workers who should work in liaison to tackle with these issues.

Effect of video game addiction on the physical and mental wellbeing of adolescents of Karachi

Ferhana Shabih, Awais Gohar, Farah Ahmed, Hasan Danish — Mon, 04 Apr 2022 06:18:31 +0000

Background: The current study aimed to determine the effect of video games among the Non-Video-Game Addicted (NVGA) and Video Game Addicted (VGA) in terms of mental health and physical activity among adolescents from Karachi.
Subjects and methods: A cross-sectional study was conducted at public sector schools and colleges of different socioeconomic status of Karachi, Pakistan, from Jan-March 2020. Total of 321 students, adolescents, aged from 15-19 years, from both genders and who used to play video games but were considered as non-video game adictors (using less than four hours per day on video games) and video game adictors (using more than 5 hours per day). Questionnaires were used to collect data based on DSM-5 to find gaming addiction in adolescents with 21 questions. "General Health Questionnaire (GHQ)," with 14 questions on mental health. "International Physical Activity Questionnaire," for physical activity status. Students were divided into two groups: non-video game addicted (NVGA) and video game addicted (VGA).
Results: Out of 321, 233 (72.6%) were VGA, and 88 (27.4%) were NVGA students. There were 184 (57.3%) males and 137 (42.7%) females. The mean addiction score was 2.221+0.49 and 3.34+0.35 in the VGA group and NVGA group, respectively. 19.0% of males and 8.4% of females were VGA. Variables used for video game addiction in the study were salience, tolerance to play the game, mood modification, relapse, withdrawal, conflict, and problems (such as sleep deprivation, etc.). The mean score for all these variables was higher in the VGA group (p<0.001). The mean score of MHQ responses was significantly higher in the VGA group, indicating the high intensity of distress.
Conclusion: It has been concluded from the study that a very high frequency of video game addiction in adolescents (VGA group) caused mental and physical health problems in the study population.

Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy?

Muhammad Irfan, Abdul Rasheed Qureshi, Muhammad Sajid, Zeeshan Ashraf — Mon, 04 Apr 2022 06:16:46 +0000

Background: Pulmonary tuberculosis is a tremendous public health problem, increasing significantly, especially in developing countries. Getting a TB-free globe appears to be not more than a dream. Mycobacterial culturing is the gold standard for precise diagnosis but requires six-week time, in the meantime, patients remain a source of inadvertent disease dissemination in the community. The unavailability of sputum also poses a challenge several times. As adenosine deaminase level measurement is easy, rapid and independent of a sputum sample, this study was conducted to determine the diagnostic efficacy of adenosine deaminase activity for pulmonary tuberculosis.
Patients and methods: This prospective study was conducted at Pulmonology-OPD, Gulab Devi Chest Hospital, Lahore, from 01-01-2019 to 30-06-2019. A total of 300 sputum smear-positive patients with clinical and radiological evidence consistent with diagnosis of pulmonary tuberculosis and 30 normal participants without any clinical, radiological or haematological evidence of tuberculosis were included. While, smear-negative patients and those having any evidence of hepatic disease, hematopoietic malignancy, infectious mononucleosis, typhoid or pregnancy were excluded. The serum ADA level of each participant was determined. All patients were subjected to AFB culture. Diagnostic accuracy was determined by considering sputum culture as a gold standard.
Results: At cut-off value of >15 IU/L, a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 98.30%, 100.00%, 100.00%, 85.71%, 98.46% respectively were defined.
Conclusion: Serum ADA level, having excellent sensitivity and specificity, can diagnose pulmonary tuberculosis even if sputum sample is not available.

Pattern of dermatophytes among skin, hair, and nail specimens in a tertiary care hospital of Lahore

Mon, 04 Apr 2022 06:12:46 +0000

Background: Dermatophytes are considered to be the most common cause fungal of infections globally. The geographical distribution of these fungi varies from region to region. The aim of this study was to isolate and determine the frequency and variety of various dermatophytes from clinically suspected cases of dermatophytoses.
Patients and methods: This was a descriptive study carried out at the Department of Microbiology, Post graduate Medical Institute, Lahore over a period of nine months from July 2013 till March 2014. Nonprobability convenient sampling was used. One hundred clinically suspected cases of dermatophytosis were selected for this study. Specimen of skin, hair and nail were taken from patients and were evaluated by both microscopic examination and culture. Dermatophytes were identified based on the colony morphology as well as microscopic arrangement of macroconidia and microconidia. Data was collected and entered in Statistical Package for the Social Sciences (SPSS) version 20.0.
Results: Out of a total of 100 patients, 48 were male and 52 were female. The majority of cases were from the age group of 31-40 (25%) followed by less than 10 years (18%). Out of hundred patients, 59 (59%) were positive on direct microscopy with KOH wet mount. Fungal culture was positive in 56 (56%) cases. Out of these 56 positive cultures, twenty-three were identified as dermatophyte species. Trichophyton rubrum was the commonest isolate. Other dermatophyte species isolated were Trichophyton mentagrophytes, Trichophyton verrocosum, Microsporum canis, Trichophyton tonsurans, and Microsporum audonii.
Conclusion: Studying the pattern of dermatophyte species is necessary as it helps in the early diagnosis and treatment of dermatomycoses. This study identified Trichophyton rubrum as the commonest etiological agent of dermatophytoses.

Effectiveness of trans-scleral cyclophotocoagulation for refractory paediatric glaucoma

Fiza Azhar, Sema Qayyum, Asma Mushtaq, Ahmed Raza, Asad Zaman — Mon, 04 Apr 2022 05:53:12 +0000

Background: The aim of this study was to find out the effectiveness of trans-scleral cyclophotocoagulation in lowering intraocular pressure in the paediatric population.
Patients and methods: This quasi-experimental study was conducted between July 2020 and January 2021 in Department of Ophthalmology, The Children’s Hospital, Lahore. Total 45 eyes of 42 children of age 1-14 years, both genders, with glaucoma were enrolled in this study. Diode cyclophotocoagulation unit and probe of make Quantel Medical was used for cycloablation under general anesthesia. Postoperative intraocular pressure was noted by using handheld Perkins applanation tonometer Mk2 after every 3 weeks for 12 weeks. If an IOP of ≤21mmHg was achieved, then efficacy or success was labeled. Patients with an IOP of >21mmHg after 12 weeks were selected for repeat cycloablation treatment. Failure was labeled to an IOP of >21mmHg even after a repeat session. Data analysis was done using SPSS 24.
Results: In this study, 45 eyes were included with a mean age of 4.49 ± 3.12 years. There were 21 (46.7%) males and 24 (53.3%) females. At the time of presentation, the most common diagnosis was primary congenital glaucoma [28 (62.2%)], followed by aphakic glaucoma [10 (22%)], Anterior segment dysgenesis [2 (4.4%)], Pseudophakic glaucoma [2 (4.4%)], Sturge weber syndrome [2 (4.4%)] and Post-traumatic [1 (2.2%)]. The mean IOP at baseline was 26.67±3.66 mmHg, which was reduced to 19.60±6.33 mmHg with mean change in IOP of 7.07±4.56 mmHg (p<0.05). The mean anti-glaucoma drugs used at baseline was 2.91±0.42, which was reduced to 0.93±1.2 with mean change in use of anti-glaucoma drugs of 1.98±1.06 (p<0.05). Success was achieved in 34 (75.56%) eyes, while 11 (24.44%) needed second session. After repeat session 2 (4.4%) eyes went into treatment failure.
Conclusion: Diode cyclophotocoagulation is a useful therapy for the management of glaucoma in children.

Outcome of pars plana vitrectomy with pre-operative intra vitreal bevacizumab in diabetic patients with vitreous haemorrhage

Mon, 04 Apr 2022 05:45:45 +0000

Background: Intravitreal bevacizumab causes regression of retinal neo vessels in proliferative diabetic retinopathy as it is anti-vascular endothelial growth factor (anti VEGF). So this study was done to observe the effect of pre-operative intravitreal bevacizumab on intra operative outcome when administered in patients with vitreous hemorrhage undergoing pars-plana vitrectomy (PPV).
Patients and methods: This quasi-experimental trial was carried out in the Department of Ophthalmology Services Hospital Lahore from June 2020 to December 2020. Fifty seven diabetic patients with vitreous hemorrhage were selected who were eligible for PPV. Patients with recurrent hemorrhage were not included. Demographics were recorded and all patients were given intravitreal bevacizumab (1.25 mg/0.05 ml) one week prior to vitrectomy and intra-operative bleeding was noted. Intra-operative bleeding was graded as No, Mild and Severe bleeding.
Results: The mean age of patients undergoing PPV was 55.36 ± 4.62 years. There were 35 (61%) males and 22 (39%) females. The mean duration of diabetes was 10.35±1.92 years. Out of 57 eyes, 36 (63.15%) had no bleeding, 11 (19.29%) had mild and 10 (17.54%) had severe intra-operative bleeding.
Conclusion: Intravitreal bevacizumab prior to PPV is quite effective in reducing the risk of intra-operative bleeding in patients with vitreous hemorrhage.

Prospective analysis of factors affecting the surgical outcomes of pediatric depressed skull fractures

Mon, 04 Apr 2022 05:30:55 +0000

Background: Around 42% of the pediatric patients present with skull fractures and the prognosis depends on several factors including type and location of fracture along with severity of associated brain trauma. The objective of this study was to find the factors affecting the outcome in childhood depressed skull fractures.
Patients and methods: This prospective observational study included 68 patients with depressed fractures presenting in the neurosurgery emergency department of Children Hospital Lahore. After detailed history and routine investigations, patients underwent the standard surgical procedure and were closely observed during the hospital stay. All were followed up for one month after being discharged from the hospital.
Results: The mean age of the children was 7.72±3.80 years. The male-to-female ratio was 1.42:1. Most of the patients had a history of fall (N=39, 57.4%). Twenty-nine (42.6%) had simple and 39 (57.4%) had complex fractures. Mostly presented with injuries at parietal (25%) and frontal (20.6%) region. Forty-seven (69.1%) were having GCS in between 13-15 (mild), 12 (17.6%) in between 9-12 (moderate) and 09 (13.2%) of the children were having GCS ≤8 (severe) at the time of presentation. Regarding outcome, good recovery was noticed in 49 (72.1%) children, moderate disability in 8 (11.8%), severe disability in 4 (5.9%), the vegetative state in 3 (4.4%), and death in 4 (5.9%) of the patients. A strong association was found between the GCS category and outcome of the surgery (p<0.001). No significant association was found between outcome and mode of injury (p=0.45), site (p=0.553), and type of fracture (p=0.66).
Conclusion: Children with depressed fractures and a history of trauma normally present with minor brain injury and have a good post-surgical outcome.

Quantitative MRI T2 relaxometry of knee joint in early detection of osteoarthritis

. Aneeta, Shaista Shoukat, Ameet Kumar, Rubnawaz Baloch, Vinod Kumar — Mon, 04 Apr 2022 00:00:00 +0000

Background: Magnetic resonance imaging (MRI) T2 is an advance modality for the early diagnosis of osteoarthritis. This study was performed to determine the MRI T2 relaxometry value of knee joint in early detection of osteoarthritis among suspected cases.
Patients and methods: This observational study was conducted at Department of Radiology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from 20^th September 2020 to 28^th February 2021. All patients aged 20-60 years of either gender suspected of knee osteoarthritis were consecutively enrolled. Osteoarthritis was confirmed based on Kellgren & Lawrence (KL) radiographic grading of 2-5. MRI T2 relaxometry was performed in all patients.
Results: Of 102 patients, there were 67 (65.7%) males and 35 (34.3%) females. Mean age was 43.72 ±14.01 years. KL grading showed that KL grade 0 observed in 29 (28.4%), grade I in 13 (12.7%), grade II in 25 (24.5%), grade III in 30 (29.4%), and grade IV in 5 (4.9%) patients. The frequency of osteoarthritis was found in 60 (58.8%) patients. Mean MRI T2 value was found to be 94.12 ±16.32. Mean MRI T2 value was found significantly higher in patients with KL grade IV (109.89 ±5.38) followed by KL grade III (107.35 ±3.24), KL grade II (97.72 ±14.65), KL grade I (89.54 ±13.69), and KL grade 0 (76.65 ±10.56). (p-value<0.001) The findings of ROC curve showed that AUC was found to be 0.911 (0.85-0.97) (p-value<0.001).
Conclusion: MRI T2 relaxometry is highly recommended for the prediction of osteoarthritis in suspected cases.

Treatment response in prostatic neoplastic lesions using CyberKnife (stereotactic body radiation therapy)

Nimrah Sultana, Bakhtawar Memon, Shazia Kadri — Mon, 04 Apr 2022 00:00:00 +0000

Objective: To evaluate the treatment response of CyberKnife stereotactic radiotherapy in patients with prostatic neoplastic lesions.
Patients and methods: This prospective observational study was conducted at Radiology and Cyberknife Robotic Radiosurgery Department of Jinnah Post Graduate Medical Centre (JPMC), Karachi from 22nd June 2019 to 21st June 2020. Males with biopsy-proven prostatic adenocarcinoma with age 55 years or more having Gleason's score of 6 to 8, clinical stage of T1 to T2C, and prostate-specific antigen (PSA) of ≤30 ng/ml were consecutively enrolled. Detailed information regarding PSA concentration, Gleason score, T stage, risk group and ADT (Androgen Deprivation Therapy) usage were noted which were given to high risk patients only for 9 months. Drop in the PSA (biochemical marker) was assessed at baseline, at 3 months and 6 months follow-up.
Results: The median age of the patients was 65 years. The overall median PSA level was 2.7 (0.86-7.3) ng/ml. Majority 49 (90.7%) patients presented with T2 N0 M0 TNM status while only 5 (9.3%) patients presented with T1 N0 M0 TNM status. There were 5 (9.3%) patients with high risk, 26 (48.1%) with intermediate risk, and 23 (42.6%) with low risk. ADT was received by 5 (9.3%) patients. The median PSA at baseline was 10.1 (6.9-18.1) ng/ml which significantly drops to 1.6 (0.8-3.6) ng/ml at 3rd months, and 0.4 (0.2-1.2) at 6th months (p-value <0.01).
Conclusion: The findings showed an adequate treatment response of CyberKnife stereotactic radiotherapy of patients with prostatic neoplastic lesions.

Impact of duration of occupational exposure on physical and mental health of construction workers in Lahore, Pakistan

Mon, 04 Apr 2022 00:00:00 +0000

Background: Construction industry is one of the most hazardous and accident prone occupation causing around 270 million accidents and 2 million deaths annually. In Pakistan reporting of incidence of occupational injuries and accidents is low. The present study aimed to determine the physical and mental health profile of construction workers in Lahore, Pakistan.

Subjects and methods: An analytical cross-sectional study was conducted among construction workers in Lahore from January 2020 to September 2020. The study included 181 participants by using non-probability convenience sampling technique. Data was collected by using a self-structured, pre-tested questionnaire. Data was analyzed using SPSS version 23. Chi-square test was applied and p-value <0.05 was taken as significant to find out association with duration of occupational exposure.

Results: Maximum number of the participants 55 (30.4%).was between age group 26-35 years and 97 (53.6%) were illiterate. Among 181 participants, 112 (61.87%) were found to be hypertensive, 98 (54.1%) were drug abusers. The total duration of hours spent on work per day was reported more than 10 hours in 50 (27.6%) of the participants. A significant association was observed between duration of occupational exposure and presence of chronic illnesses (p value=0.028) and mental health issues (p=0.041). A significant association (p-value= 0.026) was also found with duration of exposure with drug abuse. Bad effect of health on job performance was reported by 97 (53.6%) of the workers and 71(39.2%) of the workers reported restricted movements after injury during occupational exposure.

Conclusion: In this study, a relatively higher prevalence of chronic diseases, injuries and stress has been reported by construction workers, negatively affecting their occupation. Significant associations are seen with duration of exposure and its impact on physical and mental health.

Chikungunya virus: An emerging public health challenge for Pakistan

Faiz Ahmed Raza — Sun, 20 Mar 2022 00:00:00 +0000

Chikungunya is a viral illness caused by the Chikungunya virus (CHIKV), an enveloped single-stranded linear RNA alphavirus belonging to the family Togaviridae. The CHIKV is transmitted by the same Aedes mosquito (Ae. aegypti and Ae. albopictus) responsible for transmitting the dengue and Zika viruses to humans.¹These viruses can co-circulate in an area and concurrent infections are possible in the same person.¹

CHIKV infections are mostly symptomatic (~80%), and the symptoms are similar to dengue virus infection, with fever and polyarthralgia being the commonest. The Chikungunya fever can be divided into three stages: acute (1-21 days), post-acute (22 to 90 days), and chronic stages (>90 days).² However, post-acute and chronic stages are not observed in all patients.³ The acute stage starts after a very brief incubation period (average 3 days, range 1-12 days) with typical symptoms including high-grade fever (>38.5^oC), arthralgia, arthritis with edema and pain, myalgia, headache, a maculopapular rash with cutaneous pruritus (soles and palms), facial edema, and lymphadenopathy. The infection is associated with mild thrombocytopenia, increased levels of liver enzymes, increased C-reactive protein (~50–60 mg/L), and lymphopenia (<1000 cells/mm³) being the main findings. Anorexia and asthenia are commonly observed after the subsiding of fever.³^{, 4} However, the disease may present atypically (like severe pain even after intake of pain relievers, thrombosis, bleeding, dehydration, decompensation of chronic disease, organ failure) in 0.5% of vulnerable patients (elderly, young children, patients with chronic diseases, pregnant females, etc.).³

Rare complications of Chikungunya fever may include myocarditis, retinitis, uveitis, hemorrhages, Guillain-Barré syndrome, nephritis, hepatitis, bullous skin lesions, meningoencephalitis and cranial nerve palsies.⁵ One-time infections with CHIKV usually provide lifelong immunity against re-infection.^3-5

Differential diagnosis of Chikungunya fever from dengue fever is challenging due to similar clinical features. But usually CHIKV infection result in high fever, severe joint pain, rash, arthritis, and lymphopenia in contrast to dengue infection which results in neutropenia, thrombocytopenia, hemorrhage, shock and death.⁵ Laboratory confirmation of the CHIKV infection is carried out through viral cultures or viral nucleic acid detection in human serum/plasma by reverse-transcriptase polymerase chain reaction (RT- PCR) from day 1 to 5 of onset of symptoms. Serum IgM antibodies can be detected after five days of fever (and even earlier) and remain detectable for many months post-infection. A four-fold rise in the titer of CHIKV IgG antibodies in paired sera can be carried out to diagnose current infection.³

There is no definite treatment available at the moment to treat Chikungunya fever. Symptomatic treatment is provided to patients to prevent fever, relieve pain, avoid dehydration and organs damage. Among analgesics, acetaminophen is recommended; however, nonsteroidal anti-inflammatory drugs and salicylates are not recommended within two weeks of the disease onset due to the risk of bleeding and Reye's syndrome.³ Currently, no vaccine is approved to prevent CHIKV infections, but many potential vaccine preparations are being evaluated. More promising results have been shown by live attenuated, single-dose vaccine prepared by Valneva/Karolinska Institute in Phase-III clinical trials. The vaccine was effective in 98.5% of participants, and only mild or moderate adverse events were recorded.⁶ It could be assumed that a safe and effective vaccine will soon be available against CHIKV infections.

A seroepidemiological study conducted in Pakistan in the 1980s detected CHIKV antibodies in humans and rodents.⁷ Although in this study, CHIKV antibodies were detected in only one participant, the first report indicated co-circulation of CHIKV and other arboviruses locally. However, no outbreaks were recorded during the last three decades until 2016, when cases of a "mysterious" disease started to emerge in Karachi, which was later identified as CHIKV infections.⁸ The disease rapidly spread to other provinces and was also detected in the federal capital Islamabad by mid-2017.⁹ Another seroepidemiological study detected the co-circulation of CHIKV and DENV in Lahore, Rawalpindi, and Peshawar.¹⁰ More recently, in November 2021, several local newspapers reported prevalence of another "mysterious disease" affecting a large number of people along with the ongoing dengue epidemic in Lahore and Karachi.^11-13 The mystery disease had dengue-like symptoms but tested negative for it. Many medical practitioners suspected it as Chikungunya fever; however, the exact diagnosis was not made due to lack of expertise, unavailability of diagnostic facilities, and lack of interest and cooperation by the medical fraternity with the researchers interested in deciphering the mystery.

The co-circulation of multiple arboviruses in Pakistan is a worrisome situation as it will inflict a burden on the already fragile health system. There is an urgent need to develop diagnostic facilities and strengthen vector control and surveillance activities to prevent any future epidemics. To control CHIKV infection, developing an efficacious and affordable vaccine and treatment guidelines are need of time.

REFERENCES

Le Coupanec A, Tchankouo-Nguetcheu S, Roux P, Khun H, Huerre M, Morales-Vargas R, et al. Co-infection of mosquitoes with chikungunya and dengue viruses reveals modulation of the replication of both viruses in midguts and salivary glands of Aedes aegypti Int J Mol Sci. 2017;18(8):1708.
Simon F, Javelle E, Oliver M, Leparc-Goffart I, Marimoutou C. Chikungunya virus infection. Curr Infect Dis Rep. 2011;13(3):218-28.
Chikungunya virus: advances in biology, pathogenesis, and treatment. Okeoma CM, editor. Switzerland: Springer International Publishing; 2016.
Thiberville S-D, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, et al. Chikungunya fever: epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res. 2013;99(3):345-70.
Chikungunya virus USA: U.S. Department of Health & Human Services; 2022 [cited 2022 Feb 18]. Available from: https://www.cdc.gov/chikungunya/symptoms/index.html.
Begley A. Chikungunya vaccine effective in 98.5 percent of participants 2021 [cited 2022]. Available from: https://www.europeanpharmaceuticalreview.com/news/159755/chikungunya-vaccine-effective-in-98-5-percent-of-participants/.
Darwish MA, Hoogstraal H, Roberts TJ, Ahmed IP, Omar F. A sero-epidemiological survey for certain arboviruses (Togaviridae) in Pakistan. Trans R Soc Trop Med Hyg. 1983;77(4):442-5.
Mysterious disease affects 30,000 people in Karachi. Dunya News. Retrieved 22 August, 2019. Accessed from: http://dunyanews.tv/en/Pakistan/366034-Mysterious-disease-affects-30000-people-in-Karach
Harb H, Mansour D, Abouahmed Y. Intravaginal isosorbide mononitrate in addition to misoprostol versus misoprostol only for induction of labor: a randomized controlled trial. QJM. 2020;113(Supplement_1):hcaa056. 13.
Raza FA, Javed H, Khan MM, Ullah O, Fatima A, Zaheer M, et al. Dengue and Chikungunya virus co-infection in major metropolitan cities of provinces of Punjab and Khyber Pakhtunkhwa: A multi-center study. PLoS Neg Trop Dis. 2021;15(9):e0009802.
Bhatti MW. Mysterious virus spreading in Karachi causing dengue-like symptoms: experts. The News International. 2021 November 12, 2021
Asghar RJ. A mysterious disease in Karachi? The Express Tribune. 2021 20 November 2021.
Ilyas F. Suspected new variant of dengue under analysis in Karachi Dawn. 2021 November 19, 2021

Culture and sensitivity patterns of bacteriological agents in children admitted to a tertiary care hospital

Tue, 07 Dec 2021 04:21:59 +0000

Background: Culture from various infected body fluids is one of the commonly used investigations to establish the etiology of infections and helps clinicians to select appropriate antimicrobial therapy. This study is aimed to determine the culture and sensitivity patterns of bacteriological agents grown in children admitted to a tertiary care center.

Patients and methods: This descriptive cross-sectional study was conducted at the Department of Pediatric Medicine, The Children’s Hospital and the Institute of Child Health, Lahore from April 2019 to December 2019. All admitted children of age £ 15 years who fulfilled the criteria of systemic inflammatory response syndrome and sepsis were enrolled in the study. Blood and other body fluids were cultured in appropriate medium as indicated. Profile of microorganisms grown and their sensitivity patterns were noted and recorded on a predesigned data sheet. Statistical analysis was performed by SPSS v.22.

Results: A total of 500 patients were enrolled in the study. Eighty-three of them (16.6%) had growth of different microorganisms on culture and were further analyzed. Total 58 of these 83 (69.87%) were <5 years of age, Male to female ratio was 1.2:1. Blood culture was positive in 36 patients (43.37%). Cultures from throat swabs, sputum and tracheal secretions showed growth of organisms in 15 (18.10%), while cerebrospinal fluid culture was positive in 14 (16.87%) and urine culture in 11 (13.25%). Microorganism isolated were: Klebsiella spp. (15.66%), Salmonella spp. (14.45%), Escherichia coli (13.25%), Staphylococcus aureus (12.04%), Acinetobacter (12.04%), Streptococcus pyogenes (10.84%), Pseudomonas aeruginosa (10.84%), Enterobacter spp. (7.23%) and Stenotrophomonas maltophilia (3.61%). Klebsiella spp. and E. coli showed resistant to various antibiotics including penicillin, co-amoxiclav, cephalosporin, fluoroquinolones and nalidixic acid. Salmonella spp. was mostly sensitive to meropenem and azithromycin. Staphylococcus aureus was sensitive to cephalosporin, amikacin, vancomycin and linezolid.

Conclusion: Commonest micro-organism isolated were Klebsiella spp., Salmonella spp., Escherichia coli, Staphylococcus aureus and Streptococcus pyogenes. Resistance to commonly used antibiotics was observed in most cultures, which is a whistle blower against inappropriate use of these drugs.

Diagnostic accuracy of toluidine blue in early detection of oral squamous cell carcinoma

Muhammad Salman Chishty, Malik Ali Hassan Sajid, Shoaib - Younus, Usman Ul Haq — Tue, 07 Dec 2021 04:17:45 +0000

Background: Indian sub-continent (India, Pakistan, and Bangladesh) is one of the high-risk populations for oral cancer cases. Intraoral screening is critical to diagnosis and treating oral cancer at an early stage for a better prognosis. Among the diagnostic adjuncts, toluidine blue staining is considered a simplistic, cost-effective, and highly sensitive method. The objective of the current study was to find out the diagnostic accuracy of toluidine blue in the early detection of oral squamous cell carcinoma.

Patients and methods: This prospective observational study was undertaken at the Department of Oral and Maxillofacial Surgery, Institute of Dentistry, CMH Lahore Medical College from15-09-2019 to 15-03-2020 after getting approval from IRB. Based on inclusion criteria, a sample size of 100 was calculated and enrolled in the study. Non-probability convenient sampling technique was utilized. Oral staining of 100 patients was done with 1% toluidine blue on an OPD basis, and incisional biopsies were then performed. Staining pattern and histopathology reports of patients were evaluated to assess the diagnostic accuracy

Results: The study results revealed the sensitivity of Toluidine Blue as 89.87%, and specificity of toluidine blue was found as 76.19%. Positive and negative predictive values of Toluidine Blue remained 93.42% and 66.67%, respectively.

Conclusion: Toluidine blue has good diagnostic accuracy for early detection of oral squamous cell carcinoma (SCC).

Frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction: A single-center experience at a large tertiary care center in Lahore, Pakistan

Tue, 07 Dec 2021 04:09:50 +0000

Background: Thrombolytic therapy with streptokinase is the mainstay of pharmacological treatment in acute myocardial infarction in Pakistan. Retinal hemorrhage is a common complication of streptokinase-induced thrombolysis and is often overlooked which can lead to permanent vision loss. Therefore, this study was carried out to determine the frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction (STEMI).

Patients and methods: It was an observational, cross-sectional study conducted at the Emergency Department of Mayo Hospital Lahore from 11-08-2015 to 10-02-2016. The patients underwent injection of streptokinase (1.5 million U) intravenously over 60 min and intravenous heparin 5,000 U bolus followed by 1,000 U/hour. Then patients were followed up for 24 hours followed by the ophthalmoscopy to confirm the presence of retinal hemorrhage. The data were entered and analyzed using SPSS version 20.

Results: A total of 130 patients were included in this study. The mean age of patients was 62±9.86 years. The male to female ratio was 1.6:1. The retinal hemorrhage was present in 17 (13.08%) patients. About 80 (61.5%) were diabetics and 96 (73.8%) were hypertensive. Stratified variables like age, gender, hypertension, and diabetes were not found associated with retinal hemorrhage (p-value ≥0.05).

Conclusion: Retinal hemorrhage was found in 13.08% after streptokinase injection in patients presenting with STEMI. Although the association was statistically insignificant but still the proportion of retinal hemorrhage was substantially high in these patients. This higher percentage demands vigilant monitoring with the drug for timely diagnosis of this ignored complication which latter can be proved hazardous to the vision.

Spectrum of biopsied oral and maxillofacial lesions in a tertiary care hospital of Karachi, Pakistan

Syeda Hala Raza, Sufyan Ahmed, Maryam Zafar — Tue, 07 Dec 2021 04:05:32 +0000

Objectives: The burden of benign and malignant maxillofacial lesions in developing countries has increased rapidly over the years. Objective of this study was to provide a spectrum of oral and maxillofacial lesions biopsied in a tertiary care hospital of Karachi, Pakistan and to contribute in baseline data of target population.

Patients and methods: This descriptive cross sectional study was made of biopsies performed in patients presenting to OPD of Oral and Maxillofacial Surgery Department, Abbasi Shaheed Hospital Karachi, Pakistan, between July 2018 till June 2020. A total of 652 patients belonging to either gender, 18-75 years of age, incisional or excisional biopsy were included. Recurrent or previously diagnosed lesions and patients not willing to give informed consent were excluded. Data including age, gender, site and histopathological diagnosis was recorded on a performa. Descriptive statistical analysis was done using SPSS version 26.

Result: Out of 652 biopsies performed, (82.9%, n=541) belonged to soft tissues and (17.1%, n=111) were hard tissue lesions. The mean age of patients was 41.82 years, with a male to female ratio of 2.9:1. The most frequent sites biopsied were buccal mucosa (50.9%, n=332) and posterior mandible (10.6%, n=69). Oral squamous cell carcinoma (OSCC) (55.1%, n=359) was the most commonly reported soft tissue lesion with major involved sites buccal mucosa (74.4%, n=267), dentoalveolar mucosa (8%, n=29) and lateral border of tongue (7.2%, n=26) and for hard tissue the most common lesion was ameloblastoma of posterior mandible (3.5%, n=23).

Conclusion: This study provides useful information about distribution of oral and maxillofacial lesions and highlights OSCC as the single most frequent diagnosis involving a much younger male population.

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Tue, 07 Dec 2021 04:00:00 +0000

Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement.

Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1^st, 2018 to October 30^th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant.

Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001).

Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

Awareness of parents of hearing-impaired children about the importance of speech-language therapeutic interventions

Tue, 07 Dec 2021 00:00:00 +0000

Background: The importance of parental involvement of hearing-impaired children in their child's speech therapy cannot be denied. The current study aimed to determine parental awareness and involvement in the Speech-language therapeutic interventions of hearing-impaired children.

Subjects and methods: This was a cross-sectional study design, and a purposive sampling technique was used. Data were collected from 45 parents (male=32, female=13) of hearing-impaired children whose children received speech therapy from special education centers and schools of Gujranwala. The duration of the study was nine months, from June 2019 to February 2020. A related questionnaire was developed with the literature, and expert opinions (Cronbach's α=0.894) were used to assess parental awareness and involvement in speech therapeutic interventions. Data entered and analyzed by SPSS version 23. Descriptive statistics were used to describe demographic variables (age, gender) of the participants. Frequency and percentage were used to access the awareness and involvement of the parents of hearing-impaired children.

Results: Parental awareness survey showed that a total of 15 (33.3%) parents, both mother, and father, strongly agreed, and 24 (53.3%) agreed that speech therapy would be beneficial for their child. And results related to parents' involvement showed that 21 (46.7%) parents, both mother, and father, agreed, and 15 (33.3%) strongly agreed on their child's active involvement in speech therapy plans.

Conclusions: The study concluded that most parents understand the importance of parental awareness and involvement in the therapeutic intervention of hearing-impaired children.

Inappropriate antibiotic use for respiratory infections in outpatient settings

Tue, 07 Dec 2021 00:00:00 +0000

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir.

Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data.

Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names.

Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.

Frequency of Anxiety and Depression in Dissociative Trance (Possession) Disorder

Tue, 07 Dec 2021 00:00:00 +0000

ABSTRACT

Background: The possession of a person by God or spirit is an age old one. The ICD-10 has recorded the presence of a possession and trance disorder before formal featuring it in 10th edition as category of dissociative (conversion) disorders. The current study sought to determines the frequency of anxiety and depression among the patients presented in tertiary care hospital with dissociative trance (possession) disorder, along with gender differences.

Patients and Methods: This cross-sectional study was conducted at Department of Psychiatry, Sir Ganga Ram Hospital Lahore over the period of one year: December 2019 till December 2020. A sample of 350 patients, who met the ICD-10 criteria of dissociative trance (Possession) disorder, was recruited in the study through purposive sampling technique. Demographic information sheet and Urdu version of Hospital Anxiety and Depression (HAD) rating scale were used as assessment measures. The data was stored and analyzed in SPSS version 20. Descriptive analysis i.e., means, standard deviations, percentages and frequencies, and inferential statistics i.e., independent sample t-test, were performed in order to explore objectives.

Results: The results indicate that 13.2 % of patients with dissociative trance disorder scored in normal range of depression, 20.7% fall in borderline depression while abnormal case of depression was found in 66.1% of patients. For anxiety, results demonstrates that 28.2% of patients fall in the category of normal anxiety, 3 31.5% in borderline anxiety and 40.3% fall in the case of abnormal anxiety. Differences for gender of patients in depression and anxiety scores were evaluated by independent sample t-test and significant differences were found in depression and anxiety scores of male and female patients with dissociative trance disorder (p<0.05). Female patients scored high on depression (19.84±6.68) and anxiety (16.02±5.54) scale than male patients’ scores for depression (27.47±5.06) and anxiety (19.35±4.95).

Conclusion: There is a definite frequency of depression and anxiety among patients with, dissociative trance disorder while females are high in the scores. This can help to decrease the comorbidity associated with dissociative trance disorder, reduce the disease burden and ensure a better outcome of treatment

Parental compliance for speech therapy of their hearing-impaired children using cochlear implants

Mon, 06 Dec 2021 00:00:00 +0000

Background: Cochlear implant is a miraculous surgery to improve hearing in profound hearing-impaired children who derive no benefit from hearing aids and consequently present with speech and language disability. This study aims to explore the parental perspective regarding compliance to speech therapy and its potential benefit in hearing-impaired children with cochlear implantation. This will help understand parental concerns and plan recommendations for providing appropriate speech therapy sessions after cochlear implantation.

Subjects and methods: This cross-sectional study using purposive sampling recruited 217 parents of hearing impaired cochlear implanted children of both genders, aged 1 to 15 years. Sample was collected from Audiology Department of Riphah International University, Combined Military Hospital, Bahria Town Hospital and Alam Audiology Clinic, Lahore, Pakistan over a period of 6 months. Basic demographic sheet and self-structured questionnaire was used for data collection. SPSS Version 22 was used for data analysis.

Results: Results revealed that both parents of 120 (55.3%) male and 97 (44.7%) female cochlear implanted children entered the study. A poor compliance was noted with only 88(40.55%) parents got their children consulted with a speech therapist for post implant needs and of these only 75 (84.23%) received regular speech therapy. There was significant association of those who received hearing aid trial and consultation to speech therapist (p=0.01) and length of speech therapy with regular therapy sessions (p=0.03), speech language improvement with the thought that regular speech therapy was important (p=0.04)

Conclusion: By and large parents are not very compliant to speech therapy needs of their implanted children with only 40.55% consulted speech language therapists and remaining remained indifferent. Of the 40.55% who consulted speech language therapists 84.23% followed speech therapy for their children. Study also revealed a significant relationship between regular speech therapy sessions and early speech and language development.

Evaluating the causative factors that lead to rejection of hearing aids among young adults having moderate to severe degree sensorineural hearing loss

Hafiz Muhammad Usama Basheer, Atia Ur Rehman, Humaira Waseem, Wajeeha Zaib — Mon, 06 Dec 2021 00:00:00 +0000

Background: Hearing loss in young adulthood causes real stigma and a state of denial. The crucial clinical management to sustain the hearing loss is hearing aid fitting, but most adult people reject it or do not use it. Many factors, including social, personal, and device problems, lessen the usage of hearing aid. The objective of this study was to evaluate the causative factors which can lead to the rejection of hearing aids.

Patients and methods: This was a cross-sectional survey carried out in 9 cities of Punjab, Pakistan, using a convenient sampling technique during summer 2018. A total of 171 participants were included who were young adults ranging from 19-40 years. A questionnaire with 11 factors and a further 35 sub-reasons was given to the participants. Questions were close-ended in yes or no. Data were analyzed through frequency and percentages tabulation with SPSS software.

Results: Results showed that hearing aid value/speech clarity was the most problematic reason for patients to reject hearing aid. The given factor had four sub-reasons ('noisy situation,' 'poor benefit,' 'poor sound quality, and 'not suitable for the type of hearing loss). A total number n=154 (90.05%) marked yes for facing poor sound quality followed by poor benefit n=141 (82.45%), not suitable for the type of hearing loss n=121 (70.76%) and noisy situation n=118 (69.00%), thus making hearing aid value the leading cause of rejection. The second leading cause was financial factors followed by situational factors, appearance, fit and comfort, device factors, psychosocial factors, ear infections, care and maintenance, attitude, and family pressure to use a hearing aid.

Conclusion: Most prevalent cause of not taking up a hearing aid is the hearing aid value followed by financial factors, situational factors, appearance, fit, and comfort.

Traumatic brain injury of childhood

Abdul Hameed — Mon, 06 Dec 2021 00:00:00 +0000

It is a common observation, and very unfortunate one, that only the driver wears or “bears” helmets on motorbikes. None of the other passengers, especially children, are supposed to be protected against head injury. The same callous attitude is observed in cars where children are sometimes sitting in the lap of the front seater without tightening with the seat belt. Kids are thrown in the air to recatch them for pleasure or shaken severely. At times intentionally or unintentionally abused and hit or slapped on head or face without understanding how much harm is posed to them psychologically and physically. “Children are not mini-adults.” Their unique unprotected anatomy and premature physiology make them vulnerable to catastrophic permanent damage and even death.

Traumatic brain injury (TBI) frequently occurs in young people. It remains the most common cause of disability and death between the ages 1 and 45.¹ TBI cases are increasing rapidly in Pakistan with the increase in population and poor domestic, road, and sports safety considerations.^1,2 Falls from height remain on top while reviewing the modes of injury followed by road traffic accidents. Child abuse is increasingly observed important reason for a head injury, especially in infants and young children, as they are more vulnerable and dependent on adults.² Abusive head trauma (AHT) is unfortunately common in children up to two years. These children may appear with drowsiness, delayed milestones, seizures, and intracranial traumas of different stages of healing. Other associated injuries may be retinal bleeds, multiple rib fractures, and long bone fractures of different stages of recovery. Child abuse should be promptly identified and appropriately reported.

Children are different from adults and more vulnerable to traumatic brain injuries because of their proportionately larger head, low blood circulating volume, and thin osteo-fibrous non-rigid skull. More watery and less myelinated brain, non-aerated paranasal sinuses, and less CSF cushion to protect shaking and damage. Children are also vulnerable to TBI during the birth process. During normal delivery and especially difficult instrument-assisted births neonates are left with various types of intracranial hemorrhages. Cephalic and subgaleal hematomas are not uncommonly seen. This is due to increased flexibility or decreased rigidity of the neonatal skull. This increased elasticity of premature skull caused some degree of skull deformation in small children when they are shacked. The irregular base of the skull, especially in the anterior and middle cranial fossa, and the absence of adequate CSF cushion and watery consistency of the brain make it vulnerable to “shaken baby syndrome.” When a child is severely shacked, stretching and shearing forces may tear vessels and cause contusions in brain parenchyma. It may end up in subdural hematomas and intraparenchymal contusions.

Head size in the pediatric age group is proportionately larger than the body, making the head a bigger target for trauma. A thin neck also accompanies this with weak neck muscles, and it increases the chances of neck trauma and cervical spinal cord injury in children. It is mandatory to inspect and rule out any spinal injury with head trauma. Children have not yet developed paranasal air sinuses that could absorb force of direct impact on the skull and hence the brain. It makes the brain less protected from trauma. Children also have less circulating volume, so lacerating scalp wounds, contrary to adults, may be cause of hypovolemic shock and death in children.

Skull fractures and the resulting severity of TBI in children are similar to in adults.^1-3 Child may come with huge linear fractures spanning over parietal, occipital, temporal, and frontal bones. These may or may not be associated with dural tears and CSF leaks. Most fractures may not need surgical treatment. There are two types of fractures specific for the early age group. A greenstick ping pong ball fracture occurs when a parietal eminence strikes over or is hit upon. It usually is associated with falls from the bed over a hard surface. Spontaneous resolution is observed in early neonates, but in toddlers, it may need surgical elevation if untreated is a potential cause of seizure activity of the brain in the future. Growing skull fracture of neonates and children younger than two years is earlier a linear fracture that grows due to pulsatile leptomeningeal or brain herniation through free edges of fracture and separating these edges apart. It should be treated surgically. Epidural hematomas in children are primarily venous sinus hemorrhages when fracture line runs over and tears the venous sinuses. Arterial causes of epidural hematoma are also possible. Indications for surgery in symptomatic patients are the same as in adults. Most non-symptomatic hematomas may resolve spontaneously by seepage through overlying skull fractures and absorption in subgaleal space.³

Goals and means of treatment of traumatic brain injury are similar in children as in adults.^3,4 Primary goal of treatment is to identify primary brain insults and prevent their conversion into secondary brain injure. Secondary brain injury is a result of an ongoing increase in brain oedema and reduction in cerebral perfusion. Resulting brain ischemia may cause death or irreversible mental damage. This can be achieved, stepwise, by elevation of the head by 30 degrees to facilitate CSF and venous drainage out of intracranial compartment while keeping airway patent, oxygenation, use of osmotic diuretics, external ventricular drainage of CSF, evacuation of intracranial hematomas, elective ventilation and barbiturate coma, hyperventilation with targets of CO₂between 30 and 35, decompressive craniotomies and hypothermia as a last resort. The goal of all these measures is to decrease intracranial pressure and increase cerebral perfusion. Patients with a low Glasgow Coma Scale at arrival, like 3 or 4, have very few chances of surviving one year after trauma. General school-going toddlers with mild traumatic brain injury have good outcomes. These children may need prolonged psychological assistance to transition from preschool to school life.^1-4

Particular attention should be given to children who tolerate abusive head trauma. These children are under constant torture from their caregivers. So prompt identification and reporting to the concerned government department is the health caregiver's moral and legal obligation. Transport rules should be made and implemented for safety measures in motorbikes and an unrestrained car traveling.

Prevalence of insomnia and anxiety in university students during the COVID-19 lockdown: A cross-sectional study

Wed, 11 Aug 2021 01:52:54 +0000

Background: The world is facing COVID-19 pandemic and almost 70% of the world had gone under Lockdown. People are facing stress, insomnia and anxiety. The lack of basic awareness and spread of fake news are common causes of all these issues. This study was done to determine the prevalence of insomnia and anxiety in medical and non-medical students.

Subjects and methods: Subjects were approached through friends in universities using WhatsApp. People having insomnia and anxiety before quarantine were excluded from this study. People using anti-depressants and anti-psychotics before quarantine were also excluded from this study. A descriptive cross-sectional study was conducted among 965 students of medical and non-medical universities in the cities of Lahore, Rawalpindi and Islamabad. Consent was taken for using the Hamilton Anxiety Rating Scale and Insomnia Severity Index for scoring of anxiety and insomnia respectively. An online questionnaire made in Google forms was used for data collection. Independent t-tests, Pearson Correlation and Regression analysis were performed using SPSS v25.

Results: Increased prevalence of anxiety and insomnia in non-medical students as compared to the medical students was observed. There was statistically significant strong correlation between anxiety and insomnia of the enrolled subjects (r=0.742, p<0.001). A linear regression equation was formulated. Increased prevalence of anxiety and insomnia in females was also determined.

Conclusion: Non-medical students, compared to medical students, among which, females, compared to males, were more likely to suffer from anxiety and insomnia during lockdown.

COVID-19 and Dengue: A potentially emerging healthcare challenge for Pakistan

Faiz Ahmed Raza — Mon, 15 Mar 2021 00:00:00 +0000

Pakistan is facing the third wave of the SARS-CoV-2 pandemic and could head towards the fourth one. Although the burden of COVID-19 remained significantly low in the country as compared to its neighboring countries despite similar gene pool, health system, and climatic conditions, still Pakistan has dealt with the disease with relative effectiveness. The pandemic imposed immense pressure on the public health systems due to increased demand for specialized isolation wards and intensive care units and disease-related morbidity and mortality. Many of the tertiary care hospitals in the major pandemic-stricken districts have been transformed into specialized centers dedicated to the treatment of COVID-19. This resulted in diverting major hospital resources and manpower to deal with the pandemic at the cost of other medical and surgical conditions. A recent pulse survey conducted by World Health Organization (WHO) in 135 countries demonstrated that the SARS-CoV-2 pandemic severely affected the global health services, while services for endemic tropical diseases (like dengue) were affected in 44% of countries, especially in resource-limited countries. Moreover, large-scale community-based interventions including vector surveillance and control were disrupted in 60% of the countries.¹ Another survey by WHO on malaria control in sub-Saharan Africa demonstrated a >20% increase in malaria cases and a doubling of malaria-associated deaths due to a decline in malaria control activities during the pandemic. It is expected that the future catastrophe due to malaria might be much greater than the COVID-19 in endemic regions. Therefore, WHO recommends continuous monitoring, surveillance, and treatment to control the spread of malaria.²

Assessment of risk factors associated with pre-term labour in Tertiary care Hospitals, Lahore

Tanzeela Zafar, Iram Manzoor, Fariha Farooq — Mon, 15 Mar 2021 00:00:00 +0000

Background: Pakistan has one of the highest rates of preterm births, nearly 16 for every 100 babies born. Around 4% of these premature babies, are at highest likelihood of death. The objective of this study was to assess association of multiple risk factors with preterm birth in Pakistani women.

Patients and methods: An analytical cross-sectional study was carried out in Obstetrics and Gynecology Department of Akhtar Saeed Trust Hospital and Farooq Hospital, West Wood Branch, Lahore from October 2018 to December 2019. Total 116 pregnant females who gave birth to preterm babies with gestational age between 20-37 weeks were included. Data about patients’ socio-demographic profile, previous obstetric history and current gestational profile was collected using closed ended structured questionnaire. Variables were presented in the form of frequency tables. Chi-square and Fisher exact test were applied to establish association of various risk factors and preterm presentation of patients’ in hospital. A p-value ≤ 0.05 was taken as significant.

Results: Out of 116 participants, 49 (42.2%) were aged between 20-25 years, 47 (40.5%) were illiterate. Of the total sample 60 (51.7 %) participants were obese (BMI >30). Eighty-two (70.7%) patients were multigravida and 65 (56.1%) gave the history of previous cesarean section. Significant association was found between preterm birth and multi-parity (p=0.001), previous history of abortion (p=0.000), intrauterine death (p=0.001), infertility (p=0.04), cesarean-section (p=0.000), and inter-pregnancy interval of less than 24 months (p=0.007). Other significant factors associated with preterm labour were urinary tract infections (p=0.001), documented fever more than 101^oF (p=0.000), anemia (p=0.000), singleton pregnancy (p=0.000) and cephalic fetal presentation (p=0.002), during current pregnancy.

Conclusion: Multi-gravidity, history of abortion, intrauterine death, previous infertility, cesarean-section, inter-pregnancy interval of less than 24 months, UTI, genital tract infection, anemia, singleton pregnancy and cephalic fetal presentation during current pregnancy were observed to be significantly associated with preterm births.

Hemispheric encephalitis secondary to HAV

Aijaz Ahmed, Muhammad Ashfaq, Bader -U- Nisa, Hira Waseem — Mon, 15 Mar 2021 00:00:00 +0000

A 2-year male child, presented to National Institute of Child Health (NICH), with acute onset high grade fever and focal left sided seizures for 1 day, followed by left hemiparesis and encephalopathy. Developmental and family history was unremarkable. On physical examination, patient’s body temperature rose up to 38.7 °C. Though he had pallor along with hepatomegaly, there were no signs of jaundice or ascites. Central nervous system examination showed encephalopathy as well as positive neck stiffness. Motor system examination revealed generalized decrease in bulk of upper and lower limbs, but rest of the findings were localized to left side of the body, showing hypertonia, decreased power, brisk muscle stretch reflex, and positive ankle clonus and left Babinski sign.

Blood investigations showed anemia (hemoglobin 9.1g/dl), leukocytosis (white blood cells 22.1 cells/μL) and raised aspartate aminotransferase (AST) levels (826 IU/L). Total bilirubin and direct bilirubin levels were normal (0.3 mg/dL and 0.1 mg/dL, respectively). Serum ammonia (64 μg/dL) and lactic acid (1.6 μg/dL) levels were also within normal ranges. The cerebrospinal fluid (CSF) was also clear, with 0 leukocytes/μL, protein levels of 25 mg/dL, and normal glucose levels (82 mg/dL), no organism was seen on gram stain. Hepatitis A Ig M antibody came out to be reactive.

Brain computed tomography showed large hypo density along with effacement of sylvian fissure, sulci, gyri on right side involving frontal, parietal, and temporal and occipital lobe on ipsilateral side. On post contrast, there was remarkable meningeal enhancement on right side. MRI brain revealed cortical and subcortical large area of abnormal signal intensity seen in fronto-parietal and occipital cortex on the right side along with laminar necrosis.

Seizures were controlled by given intravenous injection phenytoin and leviteracetam in bolus and then maintenance doses. Intravenous acyclovir was started

due to clinical suspicion of herpes encephalitis but was stopped after observing clinical improvement and identification of Ig M antibody of HAV. Patient conscious level improved after 2 weeks. AST levels also decreased to 20 IU/L and he was discharged with advice to follow up after 14 days

Maternal and fetal factors contributing to neonatal outcome in Al-Tibri Medical College and Hospital

Erum Saboohi, Nighat Seema, Abdulah Hadi Hassan — Mon, 15 Mar 2021 00:00:00 +0000

Background: The study was done to identify the maternal and fetal factors contributing to neonatal outcome and to evaluate the correlation between risk factors and adverse neonatal outcome.

Subjects and methods: This prospective observational study was conducted on 126 mothers and their neonates fulfilling the selection criteria at Al-Tibri Medical College and Hospital. A self-designed Performa was used to enter data of subjects. Sick neonates were referred to neonatal intensive care unit for admission and management. The results were analyzed by using SPSS version 22. A p-values <0.05 was considered as significant.

Results: Out of 126 enrolled subjects, 81% mothers were multigravidas, 31% were unbooked, 13.5% had gestational comorbidities, 15% were drug addict, 2% were Hepatitis B positive. 22.2% underwent emergency LSCS while 31.7% delivered babies by elective LSCS. Regarding fetal factors contributing to sick babies, IUGR (20%), twin fetuses (15.4%), prematurity (47.7%) were significant. 65 were sick babies. Adverse neonatal outcomes observed were prematurity in 25.4%, IUGR in 11.1%, NICU admission in 33.3%, and neonatal death in 2%. Risk factors associated with adverse neonatal outcomes were positive maternal drug addiction (p-value = 0.028), preterm delivery (p-value<0.001), NICU admission (p-value<0.001) and low birth weight (p-value <0.001).

Conclusion: Compromised maternal antenatal care has profound deleterious effect on fetus and neonate. Obstetricians, perinatologists and neonatologists need to work in concord to improve maternal antenatal care hence improving neonatal outcome. In our study adverse neonatal outcome was associated with unbooked cases, delivery by EmLSCS, addicted mother, preterm delivery, LBW and neonates requiring NICU admission.

Neonatal outcomes of birth asphyxia in tertiary care hospital of low-income country

Muhammad Asif Siddiqui, Sehrish Masood, Tayyaba Khawar Butt, Shahla Tariq — Mon, 15 Mar 2021 00:00:00 +0000

Background: Pakistan has highest neonatal mortality in the region and birth asphyxia is one of the main preventable contributors to this. Objective of this study is to determine the frequency of different neonatal outcomes in neonates with birth asphyxia.

Subjects & Methods: It was descriptive case series study conducted in Department of Pediatrics Medicine, Services Hospital, Lahore in 6 months period during 6^th Dec 2016 to 5^th June 2017. 150 cases were included using non probability, consecutive sampling with 95% confidence level, 6% margin of error taking an expected percentage of neonate mortality as 15%. Data was analyzed with SPSS version 23. Categorical variables i.e., gender and neonatal outcomes in terms of neonatal mortality, discharge and neurological complications were expressed by frequency and percentage. Post stratification chi square test was applied. A p-value of <0.05 was taken as significant.

Results: The mean age of neonates was 3.09±0.8 hours. Outcomes of these neonates was seen in terms of mortality, discharge and neurological problems. Out of total 150 patients, 51 (34%) neonates expired and 99 (66%) neonates were survived. And neonates 69 (46%) neonates were diagnosed with neurological complications.

Conclusion: We found, birth asphyxia has significant association with neonatal mortality and neurological complications. Prevention of birth asphyxia with appropriate resuscitation at birth may be helpful in reduction of morbidity and mortality due to birth asphyxia.Neonates

Effect of anti-tuberculosis treatment on weight of tuberculous patients following up in Gulab Devi Hospital, Lahore

Mon, 15 Mar 2021 00:00:00 +0000

Background: Tuberculosis is the most prevalent disease in Pakistan. Multiple studies have been conducted on disease pattern and anti-tuberculosis therapy however; there is sparse literature of anti-tuberculosis therapy on weight gain of patients. The objective of this study was to measure the effect of anti-tuberculosis treatment on weight of the patient.

Subjects and methods: It was a cross sectional study conducted for a period of 1 year at Pulmonology and Surgical OPD of Gulab Devi Chest Hospital Lahore. Interview of 400 patients were recorded and there record of weight and height was collected at start of the treatment, at 02 months and at 6 months of treatment.

Results: Mean weight change in 400 patients were 3.06 ± 3.97 Kg. Out of 400 patients 310 had weight gain, 50 patients had weight loss and in 40 patients weight remain unchanged. Mean weight gain in 310 patients was 4.53 ± 2.95 kg with maximum weight gain of 16 Kg. Mean weight loss in 50 patients was 3.67 ± 2.63 Kg with maximum weight loss of 14 Kg.

Conclusion: A significant weight gain was seen in patients undergoing anti tuberculosis treatment. Younger age group, treatment completion and drug compliance had positive association with weight gain of the patient. Diabetes mellitus was the only co morbidity found to have negative association with weight gain of the patient.

Association of anti dsDNA antibodies titer with non-renal manifestations of Systemic Lupus Erythematosus and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)

Mon, 15 Mar 2021 00:00:00 +0000

Background: Early diagnosis and effective treatment in systemic lupus erythematosus (SLE) has very crucial role. Anti dsDNA is very important diagnostic tool and activity marker in SLE. This study aimed to determine the association of anti dsDNA antibodies titer with non-renal manifestations of systemic lupus erythematosus and systemic lupus erythematosus disease activity index (SLEDAI).

Patients and methods: It was a cross-sectional study and was carried out at Department of Rheumatology and Immunology, Tertiary Care Hospital, Lahore from Feb 2021 to May 2021. The study involved 69 male and female patients satisfying the systemic lupus international collaborating clinics (SLICC) classification criteria. Questions regarding different symptoms were asked and disease activity parameters were noted excluding renal parameters. Anti-dsDNA titers were measured from standard laboratory using immunofluorescence technique and were correlated with SLEDAI score. A written informed consent was obtained from every patient.

Results: The mean age of the patients was 30.7±10.2 years while the mean duration of disease 1.94±2.65 years. We observed a female predominance among these patients with male to female ratio of 1:7.6. There were fifty-four (78.3%) patients with active disease. The mean anti-dsDNA levels were significantly higher in patients with active disease (315.73±481.68 vs. 78.46±113.64 IU/mL; p-value=0.003). There was a significantly strong positive correlation between anti-dsDNA levels and SLEDAI score (r=0.358; p-value=0.006). When compared, significant difference was observed in mean anti-dsDNA titers in patients with chronic cutaneous manifestations (p-value=0.040), lymphopenia (p-value= 0.012), pleurisy/pericarditis (p-value= 0.024) and leukopenia <3000/mm³(p-value= 0.001).

Conclusion: Anti-dsDNA antibodies titers are remarkably increased in patients with non-renal manifestations of systemic lupus erythematosus particularly with chronic cutaneous manifestations and leukopenia and positively correlate with disease activity status and SLEDAI score.

Effect of Furosemide and Spironolactone on urinary zinc excretion in rats

Mon, 15 Mar 2021 00:00:00 +0000

Background: Zinc deficiency is associated with numerous diseases including hypertension, diabetes, obesity, immune dysregulation, cancer, depression and congenital anomalies. There are many reasons of zinc deficiency including some medications. If zinc supplementation is used with these medicines than many diseases can be prevented.

Subjects and methods: This experimental study was planned to observe the effect of single diuretic dose of furosemide and spironolactone on zinc urinary excretion and blood levels in normal rats. Eighteen adult healthy male Sprague Dawley rats were randomly divided into three groups. After saline load rats were given distilled water, furosemide (10 mg/kg) and spironolactone (20 mg/kg) as single oral dose. Blood and urine samples were collected after five hours and analysed for zinc concentration by flame atomic absorption spectrophotometer.

Results: Single oral dose of furosemide and spironolactone highly significantly increased urinary zinc excretion (p-value <0.001 vs normal control), and increased blood zinc level (p-value <0.001 vs. normal control). Value of both variables were significantly higher in furosemide-treated group (p-value <0.001 vs. furosemide-treated).

Conclusion: Results of this research conclude that furosemide and spironolactone increase urinary zinc excretion when used for short period. It is also postulated that blood zinc concentration is not reliable measure to assess the zinc status of the body because its level shows compensatory rise during deficiency states.

Hepatotoxic effects of Diclofenac and Febuxostat combination on mice liver function tests after oral administration

Mon, 15 Mar 2021 00:00:00 +0000

Background: The liver is a major organ and involved in metabolizing various toxins, including chemicals, drugs, and natural substances.¹ Diclofenac is a commonly used non-steroidal anti-inflammatory drug. Febuxostat is a novel non-purine xanthine oxidase inhibitor prescribed in various hyperuricemic states. Rise in liver enzymes with diclofenac use is a well-established fact. When both drugs are used in combination, these may lead to profound hepatotoxicity. To find out these facts this study was planned.

Subjects and methods: An experimental study on mice was planned to explore these facts in University of Health sciences, Lahore. Animals were divided into 6 groups having 10 animals in each group. The animals were given drugs for 7 days. One served as control. 2^nd group was given Diclofenac alone (100mg/kg), 3^rd group was given Febuxostat (50mg/kg) alone while rest of three groups were administered drugs combination (Diclofenac + Febuxostat). Dose of Diclofenac (100mg/kg) kept constant while dose of Febuxostat increased in each group (5mg/kg, 10mg/kg and 50mg/kg). All drugs administered orally by gavage. After 7 days, the serum levels of liver enzymes assessed. Statistical analysis was performed using SPSS 20. One way ANOVA and Post hoc Tukey tests were applied. A p-value of ≤0.05 was considered statistically significant.

Results: The results showed that Diclofenac and Febuxostat caused liver damage when used separately but hepatotoxicity was much significant (p-value <0.001) when drugs were used in combination.

Conclusion: Both drugs Diclofenac and Febuxostat when administered in combination, causes more liver profound liver damage. That is why their use in combination should be avoided in clinical settings.

Assessment of knowledge related to COVID-19 among professionals and students: A cross-sectional study from Punjab, Pakistan

Mon, 15 Mar 2021 00:00:00 +0000

Background: COVID-19 outbreak posed a serious threat to public health and greatly impacted the life of professionals and students. Hence, this study aimed to evaluate the knowledge related to COVID-19 during a lockdown in Punjab, Pakistan.

Subjects and methods: This cross-sectional online study recruited 833 participants (males=417, females=416) from major cities (Lahore, Islamabad, Rawalpindi, Gujranwala, Bahawalpur, Faisalabad, and Sialkot) in Punjab, Pakistan, during the months of March and April 2020. A pre-designed questionnaire was shared, among professionals (including pharmacists, paramedical staff, lawyers, businessmen, teachers) and students (including medical undergraduate and postgraduate students, and non-medical students), containing 12 questions regarding their knowledge of COVID-19. Data were collected using convenient sampling technique. Chi-square test and logistic regression model were applied for analysis using Statistical Package for Social Sciences (SPSS) software.

Results: The mean age of the participants was 23 years ranged from 15-68 years. Of the 833 participants, 365 (43.8%) were well aware, 405 (48.6%) were aware and only 63 (7.6%) were not aware of COVID-19. Most of the participants (69.4%) did not know about coronaviruses (Severe Acute Respiratory Syndrome Coronavirus and Middle East respiratory syndrome-related coronavirus) before this pandemic. Using logistic regression analysis, age above 24 years, being a student (vs. being a professional) and a prior knowledge about coronavirus resulted in having higher odds of knowledge about COVID-19 with a significant p-value (<0.05).

Conclusion: This study identifies that the majority of the participants had necessary knowledge about transmission, preventive measures and basic hygiene about COVID-19. However, there is a need to improve knowledge among the younger population and professionals.

Screening of thyroid disorders in age and gender groups in a teaching hospital of Nowshera

Hamzullah Khan, Fawad khan, Zahid khan, Naseer Ahmed, Waseemyar khan — Mon, 15 Mar 2021 00:00:00 +0000

Background: In Pakistan 28.7% of the population had some degree of goiter. Out of those 40% of the nodules behaved hyperthyroidism based on the lower-than-normal values of thyroid stimulating hormones (TSH). Present study was designed as to determine the screening of thyroid disorders on the basis Thyroid Stimulating Hormone (TSH) in age and gender groups in a hospital-based study.

Patients and methods: This cross-sectional study was conducted in Qazi Hussain Ahmed Medical Complex Nowshera from March 2019 to Jan 2020. Total 392 cases, 167 (42.6%) males and 225 (57.4%) females were included. All patients referred to pathology laboratory for measurement of TSH levels irrespective of age and gender were included to measure incidence of hyper, hypo or euthyroid status. Exclusion criteria were patients taking medications or iodine supplementation. Numerical variables like age and TSH values were presented with Mean with SD, Median and range. Inferential statistics and correlation statistics (chi-Square, ANOVA, Mann-Whitney U test and Spearman correlation) were used to determine the difference of TSH values in gender and age groups.

Results: Mean age of the patients was 31+8.1 years. Mean TSH was 5.22+16.5 ng/ml. The difference of TSH values in the age categories using one way ANOVA statistics was insignificant (p = 0.15). Mann Whitney U Test confirmed that the distribution of TSH is the same across the categories of gender (p=0.001). Total 55 (14%) patients were hyperthyroid, and 23 (5.9%) mild hypothyroid and 30 (7.7%) hypothyroid. Chi square test showed the relation of gender with hypo and hyperthyroidism as statistically isignificant ( p= 0.18, p=0.8) respectively. Spearman ranked correlation test showed a mild to moderate inverse correlation of hypothyroidism with increase in age categories (p=0.88, r=-0.47) and a moderate uphill correlation of hyperthyroidism with increase in age categories, again statistically insignificant (p= 0.31, r=0.51).

Conclusion: We observed a skewed distribution of TSH in our population. On the basis of the TSH values the thyroid disorders were categorized in hyper and hypothyroidism. There was a negative correlation of Hypothyroidsim (TSH<0.4) with age. While a positive correlation of age was noted with hyperthyroidism. While no significant relationship of hyper or hypothyroidism was noted in gender groups.

Comparison of prevalence of various ENT diseases and hearing impairment among children of government schools versus private schools of Mardan

Wed, 24 Feb 2021 15:38:06 +0000

Background: School children are frequently afflicted with ENT diseases. The diseases and their associated complications, especially hearing impairment, can be devastating to the children and families alike. Socioeconomic status of children can have strong effect on frequency of various ENT diseases. The objective of this study is to compare the frequency of various ENT diseases among children studying in government schools versus those in private schools of district Mardan.

Subjects and methods: A cross-sectional descriptive study was carried out at Mardan from July to December 2019. The researchers visited four schools (two government and two private schools) in Mardan district. Relevant history was obtained and physical examination was done to find out the frequency of various ENT diseases. The data variables (age, gender, ENT diseases, hearing impairment) were noted in research Performa and data was entered and analysed in SPSS 21 software. Frequencies were determine for age, gender and ENT diseases. Independent t-test was used to analyze quantitative variables, while Chi-square was used to analyze qualitative variables. A p-value less than 0.05 was taken as significant.

Results: Total 2986 children were examined in 4 schools. The mean age of the children was 11 years. There were 56% boys and 44% girls. Total 2106 children were examined in two government schools and 880 children were examined in two private schools. The frequency of impacted cerumen was 18.4% (21.2% of government school children versus 11.4% of private school children; p<0.05). Frequency of allergic rhinitis was 9.7% (9.5% of government school children versus 10.1% of private school children; p=0.635). The frequency of chronic suppurative otitis media (CSOM) in government school children was 4.9% versus 2.5% among those in private schools (p<0.05). In this study cumulative prevalence of hearing impairment was 26.8%, where prevalence in government school children was 30.9% versus 17.2% in private schools (p-value<0.001). The causes of hearing impairment were impacted ear cerumen (68.3%), CSOM (15.7%), otitis externa (6.2%), OME (4.1%), otitis media (2.8%), congenital ear deformities (1.6%) and foreign bodies in ear (1.2%). The main causes of hearing impairment in majority of children were impacted cerumen and CSOM in 84% children.

Conclusion: Various ENT diseases like impacted cerumen, rhinosinusitis, allergic rhinitis, pharyngitis, tonsillitis and CSOM are common in school going children. Impacted cerumen and CSOM are significantly more prevalent in government school children as compared to private schools which are primary cause of hearing impairment in children leading to significantly high prevalence of hearing impairment in government school children

Prevalence of vitamin D deficiency in type 2 diabetics and its association with glycemic control

Wed, 24 Feb 2021 15:26:45 +0000

Background: Optimal glycaemic control in type 2 diabetics is of utmost importance in preventing the complications of diabetes which lead to increased morbidity and mortality related to the disease. Some studies have shown that vitamin D deficiency was prevalent in type 2 diabetic patients and was associated with poor glycaemic control. This study aimed to determine the vitamin D3 levels in type 2 diabetic patients and its association with glycaemic control.

Patients and methods: This cross sectional study was carried out in the outdoor department of Medical Unit II of Sir Ganga Ram Hospital/Fatima Jinnah Medical University Lahore from Feb 10, 2019 to May 9, 2019. A total of 45 cases of type 2 diabetes mellitus were enrolled in this study after taking informed consent from them. Demographic details (name, age, gender, including duration of diabetes) were obtained and blood sample were taken for HbA1c and 25-OH vitamin D3 levels. Vitamin D deficiency was diagnosed by taking serum level <20 ng/mL as cut off. The data analysis was carried out in SPSS version 20. Quantitative variables like age and duration of diabetics were taken as mean and standard deviation. Qualitative variables, gender and vitamin D3 levels and HbA1c levels were taken as percentage. Post stratification chi-square test was applied taking p-value <0.05 as significant.

Results: Out of 45 patients, 17 (37.78%) were male and 28 (62.2%) were female. Mean age was 49.56 ± 10.77 years. Mean duration of diabetes was 5.91 ± 3.74 years. Mean vitamin D levels were 36.36±17.9 ng/ml. Out of 45 patients, 7 (15.6%) were found deficient, 10 (22.2%) insufficient, 27 (60%) sufficient and 1 (2.2%) had vitamin D toxicity. Among the patients with sufficient vitamin D levels, 12 (44.4%) were male and 15 (55.5%) were female. Two (16.6%) male patients with sufficient vitamin D levels had good glycemic control as compared to none of the female patients. Two (16.6%) male and 2 (13.3%) female patients with sufficient vitamin D had fair HbA1c. Most of the patients had poor control of HbA1c despite sufficient vitamin D levels including 8 (66.6%) males and 13 (86.6%) females. Mean HbA1c concentration was 9.3±1.66%. Out of 45 patients, 2 (4.4%) had good glycaemic control, 5 (11.11%) had fair and 38 (84.4%) had poor control. It was seen that out of 7 vitamin D deficient, 6 (85.7%) had poor glycemic control, 1 (14.3%) had fair and none had good glycaemic control. The post stratification chi-square test was applied to determine the significant association between vitamin D levels and HbA1c and showed a p-value of 0.196 which is statistically insignificant. The Pearson correlation revealed a value of -0.012 which shows a negative correlation between vitamin D and HbA1c levels.

Conclusions: No statistical significance could be established between vitamin D deficiency and poor glycemic control. There is a weak negative correlation between vitamin D and HbA1c levels showing that low Vitamin D levels are associated with higher HbA1c concentration.

Risk factors for development of dementia in Parkinson’s disease: Effect of family history

Wed, 24 Feb 2021 15:22:27 +0000

Background: Parkinson’s disease is one of the most common neurodegenerative disease characterized by tremors at rest, rigidity and akinesia. Despite being one of the common neurodegenerative diseases etiology and progression of PD is complex and poorly understood and has proposed to be a combination of genetic and environmental factors. Nearly 80% of the patients of Parkinson’s disease go on to develop dementia. However, there are considerable variations in disease course and some patients develop dementia quite early in the disease course. The genetic factors and association of family history for early development of dementia is still something that is controversial and under study. This study is an attempt to understand the significance of family history in development of dementia in Parkinson’s disease.

Patients and methods: This cross-sectional comparative study was conducted in Sheikh Zayed Postgraduate Medical Institute Lahore in which participants were assessed for dementia through Mini mental state examination. The subjects were divided in three groups of 30 each - Parkinson’s disease with dementia group, Parkinson’s disease without dementia group and a healthy control group and a potential association between family history of dementia and development of dementia in Parkinson’s disease was studied.

Results: Out of total 90 patients, 23 (25.6%) had a family history of Parkinson’s disease in Group A (Parkinson’s disease with dementia), 9 (30.0%) patients in Group B (Parkinson’s disease without dementia) whereas in healthy controls only 5 (16.7%) patients had family history of Parkinson’s disease. Chi-square test revealed that the difference in the proportion of family history of Parkinson’s disease among the groups was insignificant (p-value = 0.393).

Conclusion: No associations between dementia in PD and familial occurrence of dementia could be established. A longitudinal cohort study performing cross sections at intervals would be valuable to further study the effect of family history and early signs of dementia in patients of Parkinson’s disease.

Comparison of visual acuity and post-operative inflammation in phacoemulsification and removal of silicone oil with and without injection of Enoxaparin Sodium (40mg/0.04ml)

Wed, 24 Feb 2021 15:17:17 +0000

Background: Phacoemulsification and removal of silicone oil (ROSO) is a combined, frequently done procedure in retina theatre. A common problem in this procedure is the post inflammation that affects the recovery of the patients. Thus to counter this post-operative inflammation, the study has used Enoxaparin Sodium (an anti-inflammatory enoxaparin) to counter the post-operative inflammation in phacoemulsification and ROSO.

Patients and methods: Prospective interventional study done at Ophthalmology Department, Lahore General Hospital, included 60 patients which were operated and observed for results over a period of 3 months. Total 60 patients were randomly allocated in two groups, Group A and B. Both groups underwent phacoemulsification and ROSO. Group A had Enoxaparin Sodium, admixed in infusion bottles with a dosage of 40mg/0.04ml while Group B was operated without Enoxaparin Sodium. Patients were examined on slit lamp on the 1st day after the surgery then on the 7^th day and every month for 3 months for post-operative inflammation and visual recovery. The effectiveness of the procedure was defined by the comparison of post-operative inflammation as well as speedy recovery of sight.

Results: Total 60 patients were randomly allocated in two groups. Group A had 30 patients, 23 males and 7 females, with mean age of 49.43 years. Group B included 30 patients, 19 males and 11 females, with mean age of 47.73 years. Post-operative BCVA in Group A was above vision 6/60 (Snellen’s Chart) in 90% of cases while it improved to vision 6/36 and better in 93% of cases at 7^th day while 93% of cases crossed recovery of Vision 6/18 by 3^rd Month. While in Group B, Vision 6/60 was observed in 70% of cases while it improved to vision 6/36 and better in 67% of cases at 7^th day while 53% of cases crossed recovery of vision 6/18 by 3^rd Month. Post-operative results for inflammation of Group B showed grade 3 reaction on first day (94%) while it reduced to grade 2 reaction on 7^th day in 97% of the cases. While Group A was observed with occasional activity in 25 out of 30 cases (84%) on the first day and grade 2 reaction in 5 (16%) cases. 100% cases of Group A showed occasional activity on 7^th day with better visual recovery.

Conclusion: Intraoperative use of Enoxaparin Sodium helped in reducing post-operative inflammation as well as aided in better visual acuity after phacoemulsification and ROSO thus proving to be a viable enoxaparin agent to reduce post-operative reactions in these surgeries.

The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

Ali Hassan Sajid — Wed, 24 Feb 2021 14:52:02 +0000

Background: Periapical and Orthopantomogram (OPG) are the most commonly used radiographs for assessment of the relationship of lower 3^rd molar roots with the inferior alveolar canal. Panoramic radiographs provide inadequate information of the buccolingual relationship between the roots of the 3^rd molar & mandibular canal being two-dimensional (2D) in nature. To verify the relationship in three (3D) dimensions and to make a predictable treatment plan, traditional investigations may be supplemented by using CBCT. Cone-beam computerized tomography (CBCT) is an office-based radiography technique used to assess the three-dimensional relationship of lower 3^rd molar roots with inferior alveolar nerve.

Patients and methods: This comparative-cross sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital (FMH), Lahore from 1^st January 2019 till 30^th June 2019. A total of 124 patients requiring removal of lower wisdom tooth were enrolled and then divided into two groups (62 in each) randomly. OPG was used for diagnosis of impacted lower 3^rd molars in Group A patients while CBCT for diagnosis in Group B patients. A self-designed Performa was used to collect the data and final information was collected after 3 months of follow-up. Data analysis was performed using SPSS 20. A chi-square test was used to compare the postoperative paraesthesia between the OPG group and CBCT group patients. A p-value <0.05 was taken as significant.

Results: The occurrence of postoperative paresthesia between the two groups is significantly different; being a low percentage in the CBCT group at 2^nd, 7^th day and after 3 months follow-up visits with a p-value of 0.019, 0.019, and 0.005 respectively. On 3 months follow up, the distribution of paraesthesia between the two groups is significantly different; 20 patients (32.25%) in OPG group A and those of 7 (11.29%) in CBCT group B experienced paresthesia with a p-value of 0.005.

Conclusion: It is better to use CBCT to improve the postoperative paraesthesia for lower third molar surgical extraction.

Prevalence of celiac disease in irritable bowel syndrome patients: A single centre experience from a large teaching hospital of Lahore, Pakistan

Wed, 24 Feb 2021 14:43:11 +0000

Background: Many studies have been conducted worldwide to evaluate the proportion of patients with Celiac disease (CD) in persons presenting with Irritable Bowel Syndrome (IBS), showing a positive association between the two diseases. However, reports from Pakistan remain scanty. This study aims to find out the prevalence of CD in patients presenting with IBS and to establish the correlation of both diseases.

Patients and methods: It was a descriptive cross-sectional study conducted at Combined Military Hospital, Lahore (CMHL) from January 2018 till March 2019. Consecutive, nonprobability sampling was used to include 210 patients of both genders with the age range of 15-65 years fulfilling ROME IV criteria and were not previously diagnosed as CD or CKD or CLD. Demographic data was noted. Serum Anti tTG levels and Duodenal Biopsy from the second part was assessed to diagnose CD. CD was labeled if the disease was present on both serological and Histopathological reports. Data were analyzed by using SPSS version 20. Descriptive statistics were calculated and a Chi-square test was used to compare the outcome variables with P-value < 0.05 as significant.

Results: Of 210 enrolled patients, 113 (53, 8%) were male and 97 (46.2%) were female. The mean age of the patients was 28.40 ± 5.06 years. Eight patients (3.8%) were positive for Anti tTg and on histopathological findings suggestive of CD. Seven of 8 were less than 35 years old. Out of 8 positive patients, 6 (75%) were females. However, the p-value was found to be insignificant for age (0.549) and gender (0.096). On stratification with respect to duration of IBS, all 8 patients diagnosed with celiac disease were having symptoms of IBS for less than 12 months (100%) which was significant statistically (7.1% vs 0.0%; p=0.007).

Conclusion: The frequency of CD was 3.8% among IBS patients. Considering this percentage of CD in IBS patients s, a high index of suspicion for CD in IBS patients is required,