Journal of Fatima Jinnah Medical University https://www.jfjmu.com/index.php/ojs <p>Journal of Fatima Jinnah Medical University is open access, peer-reviewed journal published regularly on a quarterly basis since the year 2000. The journal is recognized by the Higher Education Commission of Pakistan and the College of Physicians and Surgeons of Pakistan. The articles published in the journal are of interest to researchers in health professions, medical and biomedical sciences, and health professional education. Journal accepts original articles, review articles, and case reports in health sciences. The journal follows a double-blind peer-review system for all submissions and all the manuscripts are peer-reviewed by at least two subject experts. The Journal of Fatima Jinnah Medical University uses Open Journal System (OJS), an online open source journal management system, which allows authors to submit and track their submissions online in a real-time manner. The journal follows a strictly anti-plagiarism policy according to HEC guidelines. In this direction, all the manuscripts are screened for similarity index with Turnitin<sup>®</sup> software before forwarding them to the reviewers and before final acceptance for publication.</p> Fatima Jinnah Medical University en-US Journal of Fatima Jinnah Medical University 2616-6461 <p>The Journal of Fatima Jinnah Medical University follows the Attribution Creative Commons-Non commercial (CC BY-NC) license which allows the users to copy and redistribute the material in any medium or format, remix, transform and build upon the material. The users must give credit to the source and indicate, provide a link to the license, and indicate if changes were made. However, the CC By-NC license restricts the use of material for commercial purposes. For further details about the license please check the Creative Commons <a title="CC BY-NC" href="https://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noopener">website.</a> The editorial board of JFJMU strives hard for the authenticity and accuracy of the material published in the journal. However, findings and statements are views of the authors and do not necessarily represent views of the Editorial Board. </p> <p>&nbsp;</p> Laparoscopic management of hydatid cyst of liver https://www.jfjmu.com/index.php/ojs/article/view/893 <p><strong>Background:</strong> Hydatic disease is caused by a parasite named <em>Ecchinococcus granulosus</em>. 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.<br><strong>Subjects and methods:</strong> 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. <br><strong>Results:</strong> 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.<br><strong>Conclusion: </strong>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.</p> Shabbar Hussain Changazi Javaid ur Rehman Syed Muhammad Bilal Muhammad Imran Qamar Ashfaq Ahmad Muhammad Waris Farooka ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 189 192 10.37018/RBFV7354 The role of ocular coherence tomography angiography in the diagnosis of diabetic retinopathy and a comparison with the current gold standard fundus fluorescein angiography https://www.jfjmu.com/index.php/ojs/article/view/917 <p><strong>Background:</strong> 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.<br><strong>Subjects and methods</strong>: 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 &amp; documented. Data was analyzed using SPSS version 25.0. <br><strong>Results</strong>: The FAZ was easily distinguished by both FFA and OCT-A. The mean FAZ area was 0.62 mm<sup>2 </sup>on FFA and 0.69 mm<sup>2 </sup>on 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%.<br><strong>Conclusions:</strong> 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.</p> Rayyan Zakir Kashif Iqbal Ammar Afzal Tarar Zeeshan Azhar Muhammad Hassaan Ali Nauman Hashmani Mohammad Zakir ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 184 188 10.37018/IOOX6573 Comparison of efficacy of electrocautery vs. cryotherapy in the treatment viral warts https://www.jfjmu.com/index.php/ojs/article/view/875 <p><strong>Background: </strong>Warts are common cutaneous viral infections due to human papilloma virus (HPV) mostly affecting school age children and adults.<sup>1 </sup>Various 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.<br><strong>Patients and methods:</strong> 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 &gt;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.<strong>&nbsp; <br></strong><strong>Results:</strong> 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.<br><strong>Conclusion:</strong> 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.</p> Ahsan Anwar Zahid Rafiq Sana us Salam ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 177 180 10.37018/PZCW5103 Correlation of inflammatory biomarkers with disease severity in hospitalised patients of COVID-19 at presentation https://www.jfjmu.com/index.php/ojs/article/view/866 <p><strong>Background:</strong> 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.<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> 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 (<u>+</u>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.<br><strong>Conclusion:</strong> 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.</p> Hijab Batool M Dilawar Khan Omar Rasheed Chughtai Akhtar Sohail Chughtai Shakeel Ashraf Sana Amir ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 171 176 10.37018/SELQ5005 Short term outcome of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction https://www.jfjmu.com/index.php/ojs/article/view/896 <p><strong>Background:</strong> 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.<br><strong>Patients &amp; Methods:</strong> 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.&nbsp; 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.&nbsp; 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.<br><strong>Results:</strong> 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.<br><strong>Conclusion:</strong> Successful revascularization by Primary PCI was associated with very few early MACEs. For the treatment of coronary artery disease, PCI&nbsp;is an&nbsp;effective option. It has a few&nbsp;early&nbsp;MACEs&nbsp;and uses less contrast and has fewer distal complications than conventional angioplasty and invasive procedures.</p> Muhammad Kashif Zafar Asim Iqbal Ahmed Noeman Nida Tasneem Akber Sohail Yousuf Muhammad Faisal ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 166 170 10.37018/HLQB4294 Complications affecting outcome in COVID 19 patients admitted in high dependency unit Sir Ganga Ram Hospital, Lahore https://www.jfjmu.com/index.php/ojs/article/view/938 <p><strong>Background</strong>: 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.<br><strong>Subjects and methods:</strong> 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.<br><strong>Results:</strong> 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 <u>+</u> 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).<br><strong>Conclusion:</strong> 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.</p> Shazia Siddique Muhammad Anwar Asma Kamal Khadija Muneer Zia Ul Haq ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 161 165 10.37018/JTEG8507 Gender differences in the health status of the imprisoned population in Kot Lakhpat Jail in Pakistan https://www.jfjmu.com/index.php/ojs/article/view/883 <p><strong>Background:</strong> 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.<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> 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).<br><strong>Conclusion:</strong> 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.</p> Iram Manzoor Qurat- ul Ain Zulfi Nashmia Zahid Muhammad Asad Muhammad Babar Ahmed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 150 155 10.37018/CSYS3378 Protective role of omega 3 on histological status of liver of albino rats affected by energy drinks https://www.jfjmu.com/index.php/ojs/article/view/882 <p><strong>Background:</strong> 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.<br><strong>Subjects and methods:</strong> 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.<br><strong>Results:</strong> 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.<br>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.<br><strong>Conclusion:</strong> 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.</p> Imtiaz Aslam Ammara Rasheed Farhana Jafri Raafea Tafweez Mahjabeen Munira ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 156 160 10.37018/FFYZ6574 Comparison of efficacy of single dose versus split dose prednisolone therapy in achieving remission in patients with nephrotic syndrome in children https://www.jfjmu.com/index.php/ojs/article/view/809 <p><strong>Background</strong>: 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.<br><strong>Patients and methods</strong>: 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 &amp; 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.<br><strong>Results</strong>: 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&lt;0.05).<br><strong>Conclusion</strong>: 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.</p> Imran Qaisar Abid Ali Anjum Abdul Rehman Iftikhar Ahmed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 181 183 10.37018/EWSH7228 Evolution of telehealth and its future in Pakistan https://www.jfjmu.com/index.php/ojs/article/view/941 <p>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.<sup>1</sup> In 1959, the first telepsychiatry consultations were made between the Nebraska Psychiatric Institute in Omaha and the state mental hospitals.<sup>2</sup> 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.<sup> 3</sup> 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 <sup>4</sup>. This clearly depicts the twofold advantage of dealing with the epidemic while preserving the capacity of the healthcare system.<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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 <sup>5</sup>. 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 <sup>6</sup>. 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 <sup>7</sup>. 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. &nbsp;<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.<sup>8</sup> 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.<sup>8</sup> 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. <sup>9,10</sup> 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.<sup>11</sup> 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.<sup>12<br></sup>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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. <sup>13</sup> 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.<strong><sup>3</sup></strong> Moreover, there is a dire need to establish training facilities for health care providers engaged in the provision of telehealth services.<sup>14</sup> Such initiatives will enhance the progress of telehealth and promote the health care delivery system of Pakistan.</p> <p>&nbsp;<strong>REFERENCES</strong></p> <ol> <li>Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. New England Journal of Medicine. 2017 Oct 19;377(16):1585-92.</li> <li>Mahdi SS, Amenta F. Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance. International Maritime Health. 2016;67(4):187-95.</li> <li>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.</li> <li>Barsom E, Feenstra T, Bemelman W, Bonjer J, Schijven M. Coping with COVID-19: Scaling up virtual care to standard practice. Nature Medicine. 2020; 26(5):632-634.</li> <li>Keck C, Doarn C. Telehealth technology applications in speech-language pathology. Telemedicine and e-Health. 2014; 20(7):653-659.</li> <li>Dorsey ER, Topol EJ. State of telehealth. New England Journal of Medicine. 2016 Jul 14;375(2):154-61.</li> <li>Mirmoeini SM, Marashi Shooshtari SS, Battineni G, Amenta F, Tayebati SK. Policies and challenges on the distribution of specialists and subspecialists in rural areas of Iran. Medicina. 2019 Dec; 55(12):783.</li> <li>Ahmed A, Ahmed M. The Telemedicine Landscape in Pakistan-Why are we falling behind. Journal of Pakistan Medical Association. 2018 Dec 1; 68(12):1820-2.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>Bradford N, Caffery L, Smith A. Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability. Rural Remote Health. 2016 Oct-Dec; 16 (4): 4268. RRH4268. 2016.</li> <li>Ashfaq A, Memon SF, Zehra A, Barry S, Jawed H, Akhtar M, Kirmani W, Malik F, Khawaja AW, Barry H, Saiyid H. Knowledge and attitude regarding telemedicine among doctors in Karachi. Cureus. 2020 Feb 9; 12(2).</li> <li>Ahmed W. Telehealth: Trend in Pakistan. Journal of the College of Physicians and Surgeons Pakistan. 2017 Oct 1;27(10):663-5.</li> </ol> Iram Manzoor ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-07 2022-04-07 15 4 148 149 Late sequelae of COVID-19 and its effect on the quality of life https://www.jfjmu.com/index.php/ojs/article/view/865 <p><strong>Background: </strong>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.<br><strong>Patients and methods</strong>: 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.<br><strong>Results:</strong> 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.<br><strong>Conclusion:</strong> 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.</p> Ayesha Irshad Hussain Hira Iftikhar Uzma Malik Irshad Hussain Qureshi Muhammad Awais Abid Hafsa Farooq ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 112 117 10.37018/ALCB4676 Effect of video game addiction on the physical and mental wellbeing of adolescents of Karachi https://www.jfjmu.com/index.php/ojs/article/view/872 <p><strong>Background:</strong>&nbsp;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.<br><strong>Subjects and methods:</strong> 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).&nbsp;<br><strong>Results:</strong> 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.&nbsp; The mean addiction score was 2.221<u>+</u>0.49 and 3.34<u>+</u>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&lt;0.001). The mean score of MHQ responses was significantly higher in the VGA group, indicating the high intensity of distress.<br><strong>Conclusion:</strong> 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.</p> Ferhana Shabih Awais Gohar Farah Ahmed Hasan Danish ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 106 111 10.37018/BIYK3428 Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy? https://www.jfjmu.com/index.php/ojs/article/view/777 <p><strong>Background:</strong> 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.<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> At cut-off value of &gt;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. &nbsp;<br><strong>Conclusion: </strong>Serum ADA level, having excellent sensitivity and specificity, can diagnose pulmonary tuberculosis even if sputum sample is not available.</p> Muhammad Irfan Abdul Rasheed Qureshi Muhammad Sajid Zeeshan Ashraf ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 143 147 10.37018/CIBO4525 Pattern of dermatophytes among skin, hair, and nail specimens in a tertiary care hospital of Lahore https://www.jfjmu.com/index.php/ojs/article/view/833 <p><strong>Background: </strong>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.<br><strong>Patients and methods</strong>: 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.<br><strong>Results</strong>: 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. <em>Trichophyton rubrum</em> was the commonest isolate. Other dermatophyte species isolated were <em>Trichophyton mentagrophytes</em>, <em>Trichophyton verrocosum</em>, <em>Microsporum canis</em>, <em>Trichophyton tonsurans</em>, and <em>Microsporum audonii</em>.<br><strong>Conclusion</strong>: 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.</p> Majid Rauf Ahmad Iffat Javed Sohaila Mushtaq Saeed Anwar Kanwal Hassan Cheema ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 140 142 10.37018/RKBW7418 Effectiveness of trans-scleral cyclophotocoagulation for refractory paediatric glaucoma https://www.jfjmu.com/index.php/ojs/article/view/832 <p><strong>Background:</strong>&nbsp;The aim of this study was to find out the effectiveness of trans-scleral cyclophotocoagulation in lowering intraocular pressure in the paediatric population.<br><strong>Patients and methods:</strong> 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 &gt;21mmHg after 12 weeks were selected for repeat cycloablation treatment. Failure was labeled to an IOP of &gt;21mmHg even after a repeat session. Data analysis was done using SPSS 24.&nbsp;<br><strong>Results:</strong> 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&lt;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&lt;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.<br><strong>Conclusion:</strong> Diode cyclophotocoagulation is a useful therapy for the management of glaucoma in children.</p> Fiza Azhar Sema Qayyum Asma Mushtaq Ahmed Raza Asad Zaman ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 136 139 10.37018/DOTE2300 Outcome of pars plana vitrectomy with pre-operative intra vitreal bevacizumab in diabetic patients with vitreous haemorrhage https://www.jfjmu.com/index.php/ojs/article/view/818 <p><strong>Background:</strong> 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).<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> 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.<br><strong>Conclusion:</strong> Intravitreal bevacizumab prior to PPV is quite effective in reducing the risk of intra-operative bleeding in patients with vitreous hemorrhage.</p> Alina Mustafa Saqib Siddiq Maha Shahbaz Khawaja Mohsin Ihsan Syed Raza Ali Shah Khalid Waheed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 132 135 10.37018/XATM1361 Prospective analysis of factors affecting the surgical outcomes of pediatric depressed skull fractures https://www.jfjmu.com/index.php/ojs/article/view/873 <p><strong>Background:</strong> 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.<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> 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&lt;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).<br><strong>Conclusion:</strong> Children with depressed fractures and a history of trauma normally present with minor brain injury and have a good post-surgical outcome.</p> Hassaan Zahid Lubna Ijaz Anila Jamil Laeeq ur Rehman Shahid Iqbal Malik Muhammad Nadeem ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 118 121 10.37018/SLGB1653 Impact of duration of occupational exposure on physical and mental health of construction workers in Lahore, Pakistan https://www.jfjmu.com/index.php/ojs/article/view/871 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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 <u>&lt;</u>0.05 was taken as significant to find out association with duration of occupational exposure.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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.</p> Irum Qureshi Iram Manzoor Laiba Razaq Muhammad Ali Mavra Shahid Mamoona Majeed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 102 105 10.37018/SWLM6913 Treatment response in prostatic neoplastic lesions using CyberKnife (stereotactic body radiation therapy) https://www.jfjmu.com/index.php/ojs/article/view/838 <p><strong>Objective:</strong> To evaluate the treatment response of CyberKnife stereotactic radiotherapy in patients with prostatic neoplastic lesions.<br><strong>Patients and methods:</strong> 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.<br><strong>Results:</strong> 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 &lt;0.01).<br><strong>Conclusion:</strong> The findings showed an adequate treatment response of CyberKnife stereotactic radiotherapy of patients with prostatic neoplastic lesions.</p> Nimrah Sultana Shaista Shoukat Bakhtawar Memon Shazia Kadri Kamran Saeed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 122 126 10.37018/EAJY5783 Quantitative MRI T2 relaxometry of knee joint in early detection of osteoarthritis https://www.jfjmu.com/index.php/ojs/article/view/840 <p><strong>Background: </strong>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.<br><strong>Patients and methods: </strong>This observational study was conducted at Department of Radiology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from 20<sup>th</sup> September 2020 to 28<sup>th</sup> February 2021. All patients aged 20-60 years of either gender suspected of knee osteoarthritis were consecutively enrolled. Osteoarthritis was confirmed based on Kellgren &amp; Lawrence (KL) radiographic grading of 2-5. MRI T2 relaxometry was performed in all patients.<br><strong>Results: </strong>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&lt;0.001) The findings of ROC curve showed that AUC was found to be 0.911 (0.85-0.97) (p-value&lt;0.001).<br><strong>Conclusion: </strong>MRI T2 relaxometry is highly recommended for the prediction of osteoarthritis in suspected cases.</p> . Aneeta Shaista Shoukat Ameet Kumar Rubnawaz Baloch Vinod Kumar ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-04-04 2022-04-04 15 4 127 131 10.37018/BGCG4108 Chikungunya virus: An emerging public health challenge for Pakistan https://www.jfjmu.com/index.php/ojs/article/view/937 <p>Chikungunya is a viral illness caused by the Chikungunya virus (CHIKV), an enveloped single-stranded linear RNA alphavirus belonging to the family <em>Togaviridae</em>. The CHIKV is transmitted by the same Aedes mosquito (<em>Ae. aegypti</em> and <em>Ae. albopictus</em>) responsible for transmitting the dengue and Zika viruses to humans.<strong><sup>1 </sup></strong>These viruses can co-circulate in an area and concurrent infections are possible in the same person.<strong><sup>1</sup></strong></p> <p>Chikungunya is a viral illness caused by the Chikungunya virus (CHIKV), an enveloped single-stranded linear RNA alphavirus belonging to the family <em>Togaviridae</em>. The CHIKV is transmitted by the same Aedes mosquito (<em>Ae. aegypti</em> and <em>Ae. albopictus</em>) responsible for transmitting the dengue and Zika viruses to humans.<strong><sup>1 </sup></strong>These viruses can co-circulate in an area and concurrent infections are possible in the same person.<strong><sup>1</sup></strong></p> <p>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 (&gt;90 days).<strong><sup>2</sup></strong> However, post-acute and chronic stages are not observed in all patients.<strong><sup>3</sup></strong> The acute stage starts after a very brief incubation period (average 3 days, range 1-12 days) with typical symptoms including high-grade fever (&gt;38.5<sup>o</sup>C), 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 (&lt;1000 cells/mm<sup>3</sup>) being the main findings. Anorexia and asthenia are commonly observed after the subsiding of fever.<sup>3</sup><sup>, 4</sup> 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.).<strong><sup>3</sup></strong></p> <p>Rare complications of Chikungunya fever may include myocarditis, retinitis, uveitis, hemorrhages, Guillain-Barré syndrome, nephritis, hepatitis, bullous skin lesions, meningoencephalitis and cranial nerve palsies.<strong><sup>5</sup></strong> One-time infections with CHIKV usually provide lifelong immunity against re-infection.<strong><sup>3-5</sup></strong>&nbsp;</p> <p>Differential diagnosis of Chikungunya fever from dengue fever is challenging due to similar clinical features. But usually CHIKV infection result in high&nbsp;fever, severe joint pain, rash, arthritis, and lymphopenia in contrast to dengue infection which results in neutropenia, thrombocytopenia, hemorrhage, shock and death.<strong><sup>5</sup></strong> 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.<strong><sup>3</sup></strong>&nbsp;</p> <p>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.<strong><sup>3</sup></strong> 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.<strong><sup>6</sup></strong> It could be assumed that a safe and effective vaccine will soon be available against CHIKV infections.</p> <p>A seroepidemiological study conducted in Pakistan in the 1980s detected CHIKV antibodies in humans and rodents.<strong><sup>7</sup></strong> 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.<strong><sup>8</sup></strong> The disease rapidly spread to other provinces and was also detected in the federal capital Islamabad by mid-2017.<strong><sup>9</sup></strong> Another seroepidemiological study detected the co-circulation of CHIKV and DENV in Lahore, Rawalpindi, and Peshawar.<strong><sup>10</sup></strong> 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.<strong><sup>11-13</sup></strong> 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.</p> <p>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.</p> <p><strong>REFERENCES</strong></p> <ol> <li>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 <em>Aedes aegypti</em> Int J Mol Sci. 2017;18(8):1708.</li> <li>Simon F, Javelle E, Oliver M, Leparc-Goffart I, Marimoutou C. Chikungunya virus infection. Curr Infect Dis Rep. 2011;13(3):218-28.</li> <li>Chikungunya virus: advances in biology, pathogenesis, and treatment. Okeoma CM, editor. Switzerland: Springer International Publishing; 2016.</li> <li>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.</li> <li>Chikungunya virus USA: U.S. Department of Health &amp; Human Services; 2022 [cited 2022 Feb 18]. Available from: https://www.cdc.gov/chikungunya/symptoms/index.html.</li> <li>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/.</li> <li>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.</li> <li>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</li> <li>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.</li> <li>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.</li> <li>Bhatti MW. Mysterious virus spreading in Karachi causing dengue-like symptoms: experts. The News International. 2021 November 12, 2021</li> <li>Asghar RJ. A mysterious disease in Karachi? The Express Tribune. 2021 20 November 2021.</li> <li>Ilyas F. Suspected new variant of dengue under analysis in Karachi Dawn. 2021 November 19, 2021</li> </ol> Faiz Ahmed Raza ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2022-03-20 2022-03-20 15 4 100 101 10.37018/YCUK8608 Culture and sensitivity patterns of bacteriological agents in children admitted to a tertiary care hospital https://www.jfjmu.com/index.php/ojs/article/view/753 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods:</strong> 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.</p> <p><strong>Results:</strong> 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 &lt;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: <em>Klebsiella spp.</em> (15.66%), <em>Salmonella spp.</em> (14.45%), <em>Escherichia coli</em> (13.25%), <em>Staphylococcus aureus </em>(12.04%),&nbsp;Acinetobacter (12.04%), <em>Streptococcus pyogenes</em> (10.84%), <em>Pseudomonas aeruginosa</em> (10.84%), <em>Enterobacter spp.</em> (7.23%) and&nbsp;<em>Stenotrophomonas maltophilia</em> (3.61%). <em>Klebsiella spp.</em> and <em>E. coli</em> showed resistant to various antibiotics including penicillin, co-amoxiclav, cephalosporin, fluoroquinolones and nalidixic acid. <em>Salmonella spp.</em> was mostly sensitive to meropenem and azithromycin. <em>Staphylococcus aureus </em>was sensitive to cephalosporin, amikacin, vancomycin and linezolid.</p> <p><strong>Conclusion:</strong> Commonest micro-organism isolated were <em>Klebsiella spp.</em>, <em>Salmonella spp.</em>, <em>Escherichia coli</em>, <em>Staphylococcus aureus </em>and <em>Streptococcus pyogenes</em>. Resistance to commonly used antibiotics was observed in most cultures, which is a whistle blower against inappropriate use of these drugs.</p> Samia Naz Asma Mushtaq Sobia Qamar Nazeela Zia Aisha Iftikhar Fazaila Jabeen ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 95 99 10.37018/GXEW6797 Diagnostic accuracy of toluidine blue in early detection of oral squamous cell carcinoma https://www.jfjmu.com/index.php/ojs/article/view/850 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods:</strong> 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. &nbsp;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</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> Toluidine blue has good diagnostic accuracy for early detection of oral squamous cell carcinoma (SCC).</p> Muhammad Salman Chishty Malik Ali Hassan Sajid Shoaib - Younus Usman Ul Haq ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 91 94 10.37018/LXYE5273 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 https://www.jfjmu.com/index.php/ojs/article/view/851 <p><strong>Background:</strong> 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).</p> <p><strong>Patients and methods:</strong> 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.</p> <p><strong>Results:</strong> 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). &nbsp;</p> <p><strong>Conclusion:</strong> 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. &nbsp;</p> Sarmad Zahoor Hafiz Mudabbar Mahboob Hafiz Muhammad Sajid Jehangir Bilal Mehmood Aleena Khan Usama Iqbal ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 87 90 10.37018/BXOS4371 Spectrum of biopsied oral and maxillofacial lesions in a tertiary care hospital of Karachi, Pakistan https://www.jfjmu.com/index.php/ojs/article/view/758 <p><strong>Objectives:</strong> 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.</p> <p><strong>Patients and methods:</strong> 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.</p> <p><strong>Result:</strong> 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<strong>.</strong> 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).</p> <p><strong>Conclusion:</strong> 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.</p> Syeda Hala Raza Sufyan Ahmed Maryam Zafar ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 81 86 10.37018/MTRK5234 Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement https://www.jfjmu.com/index.php/ojs/article/view/819 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods</strong><strong>:</strong> 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<sup>st,</sup> 2018 to October 30<sup>th,</sup> 2019. A total of number 71 patients, aged 35 to 75 years,&nbsp;who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. &nbsp;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&nbsp;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.</p> <p><strong>Results:</strong> 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<u>+</u>1.2 and 13.8<u>+</u>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).</p> <p><strong>Conclusion:</strong> 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.</p> Mumraiz Naqshaband Muhammd Taqi Sohail Ashraf Faisal Masood Muhammad Akhtar Muhammad Jazib Nadeem Javaid Hassan Raza Rana Dilawaz Nadeem ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 76 80 10.37018/EXBO5236 Awareness of parents of hearing-impaired children about the importance of speech-language therapeutic interventions https://www.jfjmu.com/index.php/ojs/article/view/766 <p><strong>Background:</strong> The importance of parental involvement of hearing-impaired children in their child's speech therapy cannot be denied.&nbsp; The current study aimed to determine parental awareness and involvement in the Speech-language therapeutic interventions of hearing-impaired children.</p> <p><strong>Subjects and methods</strong>: 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.</p> <p><strong>Results: </strong>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.</p> <p><strong>Conclusions:</strong> The study concluded that most parents understand the importance of parental awareness and involvement in the therapeutic intervention of hearing-impaired children.</p> Nazia Sheikh Bareera Saeed Atia ur Rehman Sikander Ghayas Khan Maddhia Tufail ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 63 66 10.37018/VAUO4413 Inappropriate antibiotic use for respiratory infections in outpatient settings https://www.jfjmu.com/index.php/ojs/article/view/829 <p><strong>Background: </strong>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.</p> <p><strong>Patients and methods</strong>: 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.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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.</p> Saman Omer Bushra Tayyaba Khan Omer Jalil Muhammad Waqar Aslam Khan Quratulain Mehdi Mahjabeen Sharif ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 67 71 10.37018/DQUY6587 Frequency of Anxiety and Depression in Dissociative Trance (Possession) Disorder https://www.jfjmu.com/index.php/ojs/article/view/757 <p><strong>ABSTRACT</strong></p> <p><strong>Background:</strong> 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.</p> <p><strong>Patients and Methods:</strong> 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.</p> <p><strong>Results:</strong> 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&nbsp; and significant differences were found in depression and anxiety scores of male and female patients with dissociative trance disorder (p&lt;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).</p> <p><strong>Conclusion:</strong> 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</p> Ammara Butt Azmat Ahad Beig Farast Ali Dogar Junaid ul Islam Syed Kumail Abdi ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-07 2021-12-07 15 4 72 75 10.37018/AUMO3440 Evaluating the causative factors that lead to rejection of hearing aids among young adults having moderate to severe degree sensorineural hearing loss https://www.jfjmu.com/index.php/ojs/article/view/639 <p><strong>Background:</strong> 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.&nbsp;The objective of this study was to evaluate the causative factors which can lead to the rejection of hearing aids.&nbsp;</p> <p><strong>Patients and methods: </strong>This was a cross-sectional survey carried out in 9 cities of Punjab, Pakistan, using a convenient sampling technique during summer 2018.&nbsp;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.</p> <p><strong>Results</strong>: 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.&nbsp;</p> <p><strong>Conclusion: </strong>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.</p> Hafiz Muhammad Usama Basheer Atia Ur Rehman Humaira Waseem Wajeeha Zaib ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-06 2021-12-06 15 4 54 57 10.37018/MYWB9397 Parental compliance for speech therapy of their hearing-impaired children using cochlear implants https://www.jfjmu.com/index.php/ojs/article/view/806 <h5>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.</h5> <p><strong>Subjects and methods:</strong> 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.</p> <p><strong>Results:</strong> 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)</p> <p><strong>Conclusion:</strong> 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.</p> Amna Asghar Tayyaba Dawood Ghulam Saulain Aqsa Irum Rabia Zaman Khan Hina Saeed Ch Noreen Anwar ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-06 2021-12-06 15 4 58 62 10.37018/HKZN3939 Traumatic brain injury of childhood https://www.jfjmu.com/index.php/ojs/article/view/907 <p>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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.<strong><sup>1</sup></strong> TBI cases are increasing rapidly in Pakistan with the increase in population and poor domestic, road, and sports safety considerations.<strong><sup>1,2</sup></strong> 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.<strong><sup>2</sup></strong> 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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Skull fractures and the resulting severity of TBI in children are similar to in adults.<strong><sup>1-3</sup></strong> 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.<strong><sup>3</sup></strong></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Goals and means of treatment of traumatic brain injury are similar in children as in adults.<strong><sup>3,4</sup></strong> 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 CO<sub>2&nbsp;</sub>between 30 and 35, decompressive craniotomies and hypothermia as a last resort.&nbsp; 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.<strong><sup>1-4</sup></strong></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.</p> Abdul Hameed ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-12-06 2021-12-06 15 4 52 53 10.37018/ZNCR2683 Prevalence of insomnia and anxiety in university students during the COVID-19 lockdown: A cross-sectional study https://www.jfjmu.com/index.php/ojs/article/view/760 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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.</p> <p><strong>Results:</strong> 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&lt;0.001). A linear regression equation was formulated. Increased prevalence of anxiety and insomnia in females was also determined.</p> <p><strong>Conclusion:</strong> Non-medical students, compared to medical students, among which, females, compared to males, were more likely to suffer from anxiety and insomnia&nbsp;during lockdown.</p> Ameer Hamza Mahmood-ul-Hassan Abdul Sannan Nehala Nooz Ansa Ramay Muhammad Huzaifa Syed Muhammad Jawad Zaidi Ayesha Mahmood-ul-Hassan ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-08-11 2021-08-11 15 4 9 12 10.37018/raux7717 Assessment of risk factors associated with pre-term labour in Tertiary care Hospitals, Lahore https://www.jfjmu.com/index.php/ojs/article/view/796 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods:</strong><strong>&nbsp; </strong>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.</p> <p><strong>Results:</strong> 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 &gt;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<sup>o</sup>F (p=0.000), anemia (p=0.000), singleton pregnancy (p=0.000) and cephalic fetal presentation (p=0.002), during current pregnancy.</p> <p><strong>Conclusion:</strong> 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.</p> Tanzeela Zafar Iram Manzoor Fariha Farooq ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 13 17 10.37018/pobp2666 Maternal and fetal factors contributing to neonatal outcome in Al-Tibri Medical College and Hospital https://www.jfjmu.com/index.php/ojs/article/view/695 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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 <u>&lt;</u>0.05 was considered as significant.</p> <p><strong>Results:</strong> 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&lt;0.001), NICU admission (p-value&lt;0.001) and low birth weight (p-value &lt;0.001).</p> <p><strong>Conclusion:</strong> 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.</p> Erum Saboohi Nighat Seema Abdulah Hadi Hassan ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 18 22 10.37018/qbhp7754 Neonatal outcomes of birth asphyxia in tertiary care hospital of low-income country https://www.jfjmu.com/index.php/ojs/article/view/811 <p><strong>Background: </strong>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.</p> <p><strong>Subjects &amp; Methods:</strong> It was descriptive case series study conducted in Department of Pediatrics Medicine, Services Hospital, Lahore in 6 months period during 6<sup>th</sup> Dec 2016 to 5<sup>th</sup> 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 <u>&lt;</u>0.05 was taken as significant.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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</p> Muhammad Asif Siddiqui Sehrish Masood Tayyaba Khawar Butt Shahla Tariq ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 23 26 10.37018/unkh2664 Screening of thyroid disorders in age and gender groups in a teaching hospital of Nowshera https://www.jfjmu.com/index.php/ojs/article/view/722 <p>&nbsp;<strong>Background</strong>: 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.</p> <p><strong>Patients and methods:</strong> 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.</p> <p><strong>Results:</strong> Mean age of the patients was 31<u>+</u>8.1 years. Mean TSH was 5.22<u>+</u>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).</p> <p><strong>Conclusion:</strong> 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&lt;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.</p> Hamzullah Khan Fawad khan Zahid khan Naseer Ahmed Waseemyar khan ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 27 30 10.37018/bhob1556 Effect of anti-tuberculosis treatment on weight of tuberculous patients following up in Gulab Devi Hospital, Lahore https://www.jfjmu.com/index.php/ojs/article/view/793 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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.</p> Usman Ali Rahman Anjum Razzaq Muhammad Adil Iftikhar Shabbar Hussain Changazi Samiullah Bhatti Qamar Ashfaq Ahmad ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 31 34 10.37018/przi9094 Association of anti dsDNA antibodies titer with non-renal manifestations of Systemic Lupus Erythematosus and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) https://www.jfjmu.com/index.php/ojs/article/view/858 <p><strong>Background:</strong> 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).</p> <p><strong>Patients and methods:</strong> 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.</p> <p><strong>Results:</strong> 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 &lt;3000/mm<sup>3 </sup>(p-value= 0.001).</p> <p><strong>Conclusion:</strong> 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.</p> Sadaf Andleeb Tafazzul-E-Haque Mahmud Aflak Rasheed Muhammad Shahid Mehmood Iram Gull Maira Ahmad Mufazzal-E-Haque Mahmud ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 35 39 10.37018/gpgq6331 Effect of Furosemide and Spironolactone on urinary zinc excretion in rats https://www.jfjmu.com/index.php/ojs/article/view/740 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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&nbsp;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.</p> <p><strong>Results:</strong> Single oral dose of furosemide and spironolactone highly significantly increased urinary zinc excretion&nbsp;(p-value &lt;0.001 vs normal control), and increased blood zinc level (p-value &lt;0.001 <em>vs.</em> normal control). Value of both variables were significantly higher in furosemide-treated group (p-value &lt;0.001 <em>vs</em>. furosemide-treated).</p> <p><strong>Conclusion:</strong> 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.</p> Rabab Miraj Muhammad Jahangir Akfish Zaheer Nada Azam Amer Hassan Siddiqui Sadia Chiradh ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 40 44 10.37018/hpgq6331 Hepatotoxic effects of Diclofenac and Febuxostat combination on mice liver function tests after oral administration https://www.jfjmu.com/index.php/ojs/article/view/779 <p><strong>Background</strong><strong>:</strong> The liver is a major organ and involved in metabolizing various toxins, including chemicals, drugs, and natural substances.<sup>1</sup> 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.</p> <p><strong>Subjects and methods:</strong> 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<sup>nd</sup> group was given Diclofenac alone (100mg/kg), 3<sup>rd</sup> 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.</p> <p><strong>Results:</strong> The results showed that Diclofenac and Febuxostat caused liver damage when used separately but hepatotoxicity was much significant (p-value &lt;0.001) when drugs were used in combination.</p> <p><strong>Conclusion:</strong> 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.<a href="#_ednref1" name="_edn1"></a></p> Saima Naureen Rizwan Waseem Javaria Fatima Azher Abbas Shah Huma Manzor Bushra Shaheen ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 45 49 10.37018/sxaw2460 Assessment of knowledge related to COVID-19 among professionals and students: A cross-sectional study from Punjab, Pakistan https://www.jfjmu.com/index.php/ojs/article/view/761 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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.&nbsp; 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.</p> <p><strong>Results:</strong> 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 (<em>vs.</em> being a professional) and a prior knowledge about coronavirus resulted in having higher odds of knowledge about COVID-19 with a significant p-value (&lt;0.05).</p> <p><strong>Conclusion:</strong> 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.</p> Ali Hashim Zubair Abubakar Shah Muhammad Junaid Tahir Muna Malik Muhammad Irfan Malik Ayesha Sajjad Sardar Muhammad AL Fareed Zafar ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 3 8 10.37018/2478 COVID-19 and Dengue: A potentially emerging healthcare challenge for Pakistan https://www.jfjmu.com/index.php/ojs/article/view/885 <p>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.<strong><sup>1</sup></strong> Another survey by WHO on malaria control in sub-Saharan Africa demonstrated a &gt;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.<strong><sup>2</sup></strong></p> Faiz Ahmed Raza ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 1 2 10.37018/feog2563 Hemispheric encephalitis secondary to HAV https://www.jfjmu.com/index.php/ojs/article/view/623 <p>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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Seizures were controlled by given intravenous injection phenytoin and leviteracetam in bolus and then maintenance doses. Intravenous acyclovir was started</p> <p>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</p> Aijaz Ahmed Muhammad Ashfaq Bader -U- Nisa Hira Waseem ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2021-03-15 2021-03-15 15 4 50 51 10.37018/cmer2954 Comparison of prevalence of various ENT diseases and hearing impairment among children of government schools versus private schools of Mardan https://www.jfjmu.com/index.php/ojs/article/view/702 <p><strong>Background:</strong> 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.</p> <p><strong>Subjects and methods:</strong> 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.</p> <p><strong>Results:</strong> 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&lt;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&lt;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&lt;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.</p> <p><strong>Conclusion: </strong>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</p> Sumera Akram Muhammad Ahmed Khan Abdul Rehman Kamran Zamurrad Malik Jehangir Ahmed Afridi Sumera Akram ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 170 175 10.37018/pjdw8445 Prevalence of vitamin D deficiency in type 2 diabetics and its association with glycemic control https://www.jfjmu.com/index.php/ojs/article/view/715 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods:</strong> 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 &lt;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 &lt;0.05 as significant.</p> <p><strong>Results:</strong> 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&nbsp;(15.6%) were found deficient, 10&nbsp;(22.2%) insufficient, 27&nbsp;(60%) sufficient and 1&nbsp;(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&nbsp;(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.</p> <p><strong>Conclusions:</strong> 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.&nbsp;</p> Khadija Muneer Naheed Hashmat Muhammad Adnan Hasham Bushra Asif Sheikh Noma Sarwar Nouman Zafar ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 195 199 10.37018/wego2897 Risk factors for development of dementia in Parkinson’s disease: Effect of family history https://www.jfjmu.com/index.php/ojs/article/view/653 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods:</strong> 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&nbsp; - 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.</p> <p><strong>Results:</strong> 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).</p> <p><strong>Conclusion:</strong> 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.</p> Tabinda Kazmi Ameena Nasir Maria Anwar Qanita Mahmud Wardah Anwar Maryam Rao ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 191 194 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) https://www.jfjmu.com/index.php/ojs/article/view/801 <p><strong>Background</strong>: 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.</p> <p><strong>Patients and methods</strong>: 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<sup>th</sup> 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.</p> <p><strong>Results</strong>: 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<sup>th</sup> day while 93% of cases crossed recovery of Vision 6/18 by 3<sup>rd</sup> 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<sup>th</sup> day while 53% of cases crossed recovery of vision 6/18 by 3<sup>rd</sup> 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<sup>th</sup> 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<sup>th</sup> day with better visual recovery.</p> <p><strong>Conclusion</strong>: 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.</p> Hasnain Muhammad Buksh Hussain Ahmad Khaqan Usman Imtiaz Ateeq ur Rehman Mehreen Afzal Raheela Naz ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 185 190 10.37018/xmpi6453 The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT https://www.jfjmu.com/index.php/ojs/article/view/765 <p><strong>Background:</strong> Periapical and Orthopantomogram (OPG) are the most commonly used radiographs for assessment of the relationship of lower 3<sup>rd</sup> molar roots with the inferior alveolar canal. Panoramic radiographs provide inadequate information of the buccolingual relationship between the roots of the 3<sup>rd</sup> molar &amp; 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<sup>rd</sup> molar roots with inferior alveolar nerve.</p> <p><strong>Patients and methods:</strong> This comparative-cross sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital (FMH), Lahore from 1<sup>st</sup> January 2019 till 30<sup>th</sup> 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<sup>rd</sup> 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 <u>&lt;</u>0.05 was taken as significant.</p> <p><strong>Results:</strong> The occurrence of postoperative paresthesia between the two groups is significantly different; being a low percentage in the CBCT group at 2<sup>nd</sup>, 7<sup>th</sup> 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.</p> <p><strong>Conclusion:</strong> It is better to use CBCT to improve the postoperative paraesthesia for lower third molar surgical extraction.</p> Ali Hassan Sajid ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 180 184 10.37018/uiae7852 Prevalence of celiac disease in irritable bowel syndrome patients: A single centre experience from a large teaching hospital of Lahore, Pakistan https://www.jfjmu.com/index.php/ojs/article/view/745 <p><strong>Background:</strong> 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.</p> <p><strong>Patients and methods</strong>: 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 <u>&lt;</u> 0.05 as significant.</p> <p><strong>Results:</strong> 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).</p> <p><strong>Conclusion: </strong>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,</p> Mohammad Ahmed Saifullah Amer Ahmad Khan Sarmad Zahoor Sidra Saif Javed Sajjad Hashmi Wajeeha Amer ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 176 179 10.37018/cndo3595 Frequency of different histopathological types of esophageal cancer patients at oncology department of a tertiary care hospital in Karachi https://www.jfjmu.com/index.php/ojs/article/view/645 <p><strong>Background:</strong> Around the globe, carcinoma of the esophagus is the eighth most prevalent cancer with an incidence of 456,000 cases per year and is the sixth cause of cancer mortality. There are two major histological subtypes of carcinoma of the esophagus, esophageal squamous cell carcinoma and adenocarcinoma. The aim of the current study is to evaluate the frequency of different histopathological types of esophageal cancer in patients presenting at the tertiary care hospital of Karachi.</p> <p><strong>Patients and methods:</strong> It was a cross-sectional study conducted at the Department of Clinical Oncology, Jinnah Postgraduate Medical Center, Karachi from March 2017 till March 2019. Two hundred and one histologically proven cases of esophageal cancer of in patients of either gender and between 15-80 years of age were included. Patients were interviewed and data regarding age, gender, education, marital status, employment status, addictions like cigarette or huqqa smoking, consumption of pan, betel nut, naswar, or gutka were recorded. Endoscopy and histology and <em>computed tomography</em> scan were performed. Stage, site, grade and type of tumor were noted. SPSS version 23 was used to analyze data. Mean and SD were calculated for quantitative variables. Frequency and percentage were calculated for qualitative variables. A Chi-square test was used to assess the significance between age and gender with type of EC. A p-value≤0.05 was taken as significant.</p> <p><strong>Results:</strong> Mean age of the patients was 47.84. The majority of the patients had stage 2 of cancer (42.8%) and lower tumor site (62.2%) Squamous cell carcinoma was the most common histopathological type in 137 patients out of 201 (68%). The age, gender, smoking, consumption of pan, grade, site, and stage of the tumor showed a statistically significant difference when compared with esophageal squamous cell carcinoma and esophageal adenocarcinoma.</p> <p><strong>Conclusion: </strong>The burden of esophageal squamous cell carcinoma is dramatically increasing in the Pakistani population and squamous cell carcinoma was the most common histopathological type.</p> Zoya Sheikh Ghulam Haider Khalil Ahmed Dr. Bhunisha ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 161 165 10.37018/uqiz9862 Difference in mean weight gain and hospital stay in preterm babies receiving complete or partial kangaroo mother care compared to no kangaroo mother care: Experience from a tertiary care hospital https://www.jfjmu.com/index.php/ojs/article/view/770 <p><strong>Background:</strong> Pakistan is a resource limited country with one of the highest neonatal mortality rate (NMR) in the world. Kangaroo Mother Care (KMC) helps in reducing the mortality and improving the care of preterm babies. The objective of this study was to identify the benefits of KMC in hospitalized newborns in terms of better weight gain and early discharge from hospital.</p> <p><strong>Subjects and methods:</strong> A retrospective case-control study was conducted in the Neonatal Department of Services Hospital from 01.02.2019 to 31.01.2020. A total of 144 case notes, who met inclusion criteria were included. Subjects were divided in 2 Groups of 77 each. Group 1 did not receive KMC and Group 2 received KMC (partial or complete). Admission weight, gestational age at birth, duration of hospital stay and the average weight gain was noted for subjects in both groups. SPSS version 23 was used to analyze data. Independent samples t-test was applied. A p-value of <u>˂</u>0.05 is taken as significant.</p> <p><strong>Results:</strong> Mean weight gain in Group 1 was 5.521 g/kg/day (±6.664), whereas in Group 2 was 15.635 g/kg/day (±9.268). Mean hospital stay in Group 1 was 12.558 days (±10.856) and in Group 2 it was 8.208 days (±6.473). Weight gain and duration of hospital stay was significantly better in KMC Group with a p-value ˂0.05. This benefit was observed both for partial and complete KMC.</p> <p><strong>Conclusion:</strong> KMC (partial or complete) leads to better weight gain and reduces the duration of hospital stay.</p> Muhammad Asif Siddiqui Tayyaba Khawar Butt Muhammad Azhar Farooq Muhammad Tauseef Omer Farhan Zahoor Komal Khadam Hussain ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 152 155 10.37018/qymd3680 Perception about central induction policy among postgraduate trainees of Punjab - a mixed method qualitative study https://www.jfjmu.com/index.php/ojs/article/view/680 <p><strong>Background:</strong> Central induction policy is recently implemented for induction of doctors for post-graduation training based on their performance in MBBS, post-graduation entrance exam, house job, studying in public institute, work in periphery and research. Despite controversies this policy was implemented in May 2016 and no feedback was taken by the stakeholders. This discrepancy aroused the need for data collection to determine effectiveness of CIP in terms of PG perceptions.</p> <p><strong>Subjects and methods:</strong> An interview based qualitative study was conducted in four Tertiary care hospitals from 05 June 2018 to 30 November 2018. Request forms were randomly sent to 75 residents inducted through and before CIP. Total 39 residents participated in the study after giving consent. Interview questions were selected by the authors after detailed discussion. Each interview was heard thrice, manuscripts were prepared in the same words used by the participant. Manuscripts were discussed among the team members to identify themes. Depending upon themes questionnaire was designed and quantitative data was collected.</p> <p><strong>Results:</strong> Qualitative evaluation identified following major themes including policy being merit based allowing every candidate to get a fair chance of induction; financial security on all the slots and provision of qualified doctors at primary health care centers for the induction policy whereas issues with choice of specialty and place of work, delay in start of training due to various factors and discrepancy in special cases like wedlock, FMGs, authenticity of research papers were identified as demerits.</p> <p><strong>Conclusion:</strong> CIP is a good initiative and is acceptable due to its merit based policy and financial security however there is need to improve the standard and evaluation method of research and option for change of specialty.</p> Maliha Nadeem Hafsa Khalid Anam Nazir Hassan Nawaz Yaqoob Ghulam Abbas Kalyar Ain ul Momina Ahmad Uzair Qureshi ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 145 151 10.37018/bzkw5932 Diagnostic accuracy of PET/CT scan in evaluation of clinically suspected recurrent ovarian cancer https://www.jfjmu.com/index.php/ojs/article/view/789 <p><strong>Background:</strong> Accurate evaluation of ovarian carcinoma is utmost important for effective management. PET/CT is reported to be effective in evaluation of suspected recurrence of ovarian carcinoma. This study aims to assess the accuracy of PET/CT in evaluation of recurrent ovarian cancer among clinically suspected cases with rising tumor marker or suspicious clinic-radiological findings.</p> <p><strong>Patients and methods:</strong> This prospective cross-sectional study was conducted at Radiology department of Jinnah Postgraduate Medical Centre Karachi from 22<sup>nd</sup> April 2019 to 21<sup>st</sup> April 2020. Patients having age of 40 to 60 years and referred for PET scan with suspected recurrence of ovarian carcinoma were consecutively enrolled. Patients were suspected due to relevant history, clinical findings and initial imaging investigations with elevated CA-125 level. Results of 18FDG PET/CT scan was correlated with the raised tumor findings. The PET/CT scan showing abnormally elevated FDG take-up and higher SUV values than the background activity considered recurrence. Diagnostic accuracy of PET/CT was calculated taking raised tumor level as reference category.</p> <p><strong>Results:</strong> Of 65 patients, median age was 50 (43-56) years. The findings showed positive cases in 57 (87.7%) while negative in 8 (12.3%) patients, whereas the findings of tumor marker showed raised tumor marker in 61 (93.8%) patients. Diagnostic accuracy of PET/CT showed sensitivity, specificity, positive predicted value, negative predated value, and overall diagnostic accuracy as 93.44%, 100%, 100%, 50%, and 93.85% respectively.</p> <p><strong>Conclusion:</strong> A higher accuracy of PET/CT was observed in the diagnosis of recurrent ovarian cancer among clinically suspected cases, thus helping in devising an appropriate management plan by the treating physician.</p> Nimrah Sultana Shaista Shoukat Sadaf Nausheen Bakhtawar Memon ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 156 160 10.37018/txti8122 Burden of febrile neutropenia in paediatric oncology: Experience from Children’s Hospital Lahore Pakistan https://www.jfjmu.com/index.php/ojs/article/view/727 <p><strong>Background</strong>: Infection is the major cause of morbidity and mortality in children with cancer. Chemotherapy induced febrile neutropenia-associated mortality is much higher in low-middle-income countries than in high-income countries, emphasizing the need of prevention, early identification and timely management of infection related complications in these children. Objective of this prospective study was to analyze the burden of chemotherapy induced febrile neutropenia and to assess the leading risk factors.</p> <p><strong>Patients and methods:</strong> Prospective cohort study was done in 100 patients with febrile neutropenia (fever of 38.3℃ and ANC &lt;500) admitted in the Haematology/Oncology Department of Children’s Hospital Lahore (CHL) from July to August 2016. All the children on curative chemotherapy were included in this study and children with relapse and on palliation were excluded from this study. Risk factors including knowledge of parents and caregivers about febrile neutropenia, travel time from home to hospital and duration of symptoms at home before seeking treatment and reasons for delayed response in these children’s febrile illness, were analyzed for duration of hospital stay considered as a burden on the Haematology/Oncology Department. Data regarding their age, sex, and clinical features, baseline CBC, course of therapy, hospital stay and understanding of caregivers regarding febrile neutropenia was analyzed. The first line therapy was IV Piperacillin-Tazobactam and IV Amikacin. SPSS-16 software was used to analyze the data and a p-value of <u>&lt;</u>0.05 was considered as statistically significant.</p> <p><strong>Results:</strong> Total 100 patients with age ranging from &lt;1 to 15 years were included.<strong>&nbsp;</strong>Male to female ratio was 1.7:1, 72% of the cases had Acute Lymphoblastic Leukaemia and 28% with solid tumors. About, 28% had last chemotherapy received in 72 hours, 30% in last week and rest in more than a week time 36% had&nbsp;upper respiratory tract infections, 18% gastrointestinal infections, 20% mucositis, 10% no focus found and rest 16% had other manifestations. Only 2 % presented in less than one hour of start of symptoms, 27% &lt;24 hours, 61% in &lt;5 days and 10% &gt;5 days duration of symptoms. 45% had&nbsp;Hb&nbsp;&lt;8 gm/dL, 33% had&nbsp;platelets &lt;50,000 mm<sup>3</sup>, and 54% had&nbsp;WBC&nbsp;&lt;1000 and 63% had&nbsp;ANC &lt;100. 29% presented with the first episode while 51% had 3 or more febrile neutropenia episodes. 28% cases stayed 1 hour distance from CHL while&nbsp;72% had to travel &gt;1-5 hours&nbsp;to reach the primary treatment center. 66% received paracetamol at home, 17 had oral antibiotics while 17% had no treatment before reaching hospital. Only 19% caregivers had&nbsp;adequate awareness regarding adequate management of febrile neutropenia, 72% had some understanding while 9% had no knowledge about febrile neutropenia. 46% had financial issues, 41% were unaware while, 13% showed negligence in seeking treatment. Only 2 patients stayed for a day, 46% stayed for 5 days and 48% for more than 5 days.</p> <p><strong>Conclusion:</strong> Febrile neutropenia episodes accounted for 25% of monthly admissions of the Haematology/Oncology Department of Children’s Hospital Lahore. Majority of these caregivers had inadequate basic knowledge of standard management of febrile neutropenia aggravated by increased travel time from their homes to the hospital.</p> Alia Ahmad Fauzia Shafi Khan Wasila Shamim Aman Salman Ahmad ##submission.copyrightStatement## 2021-02-24 2021-02-24 15 4 166 169 10.37018/zptb7901 Use of preoperative tranexamic acid in tonsillectomy with or without adenoidectomy to reduce primary haemorrhage https://www.jfjmu.com/index.php/ojs/article/view/643 <p><strong>Background:</strong> Haemorrhage during adenotonsillectomy is a common and potentially grave complication especially in children due to less physiological compensation of total blood volume. Tranexamic acid being synthetic antifibrinolytic drug has been widely used in surgical procedures to reduce bleeding. Few researches have done to see its effectiveness during adenotonsillectomy. The objective of current study is to evaluate the use of preoperative tranexamic acid to reduce primary haemorrhage in children who undergo elective tonsillectomy with or without adenoidectomy.</p> <p><strong>Subjects and methods:</strong> It was a It was a quantitative, randomized control study and conducted at Pakistan Railway hospital from June 2015 to September 2016.The current study included 80 children randomized into two groups. Children between the ages of 5 to 15 years had been operated for tonsillectomy with or without adenoidectomy. Group 1 (experimental group) was given tranexamic acid at a dose of 10mg/kg of body weight intravenously, 30 minutes before induction of anaesthesia while the other arm (control arm) did not receive injection tranexamic acid. All children underwent dissection and snare method under general anaesthesia. P-value were obtained by applying independent sample t-test and considered statistically significant at 0.05 in reduction of primary haemorrhage during the procedure.</p> <p><strong>Results:</strong> In study group mean amount of primary haemorrhage was 64.56 (<u>+</u>40.85) ml and in control group was 98.34 (<u>+</u>62.57) ml. The comparison of Boezzart blood grading scale was also significantly different between both groups.</p> <p><strong>Conclusion:</strong> Preoperative tranexamic acid when used intravenously is effective in reducing primary haemorrhage during tonsillectomy with or without adenoidectomy.</p> Nighat Arif Sadaf Raffat Mustafa Usman Aslam Aysha Nauman Sadia Chaudhary Shuman Roy ##submission.copyrightStatement## 2020-12-26 2020-12-26 15 4 125 128 10.37018/jfjmu.v13i3.643 Cesarean scar endometriosis - a case report https://www.jfjmu.com/index.php/ojs/article/view/784 <p>Scar site endometriosis is a rare event. It mostly occurs after obstetrics and gynaecological related surgeries. Classical presentation is cyclical pain and swelling at or near scar in relation to menstrual cycle. A case of scar site endometriosis in a 25-year-old female is presented. Patient developed characteristic clinical features 3 years after cesarean section. Clinical diagnosis was supported by ultrasonography. A wide excision with clear margins was curative. High index of clinical suspicion and wide excision remain the keys to successful management.</p> Nayyer Sultana Mariam Malik Ameelia Saddaqat ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 140 141- 10.37018/dvsk5506 Efficacy of 4% chlorhexidine in preventing neonatal umbilical cord infection https://www.jfjmu.com/index.php/ojs/article/view/756 <p><strong>Background:</strong> Umbilical cord stump is a budding point for bacterial colonization subsequently leading to sepsis that contributes to high neonatal morbidity and mortality, if not properly managed. Antiseptic care can significantly reduce omphalitis and ultimately improve newborn survival. Objective of this study was to see the efficacy of 4% chlorhexidine use to prevent umbilical cord infection in neonates.<br><strong>Subjects and methods:</strong> It was a comparative analytical study conducted in Neonatal unit, Sir Ganga Ram Hospital (SGRH) Lahore from July, 2016 till January, 2017. One hundred neonates were enrolled and randomized into two equal group by simple random method (50 each). In one group, nothing was applied to cord while in chlorhexidine group, 4% chlorhexidine gel was applied on umbilicus and around it, once daily for 7 days or till cord detached whichever came early. First application was done by a nurse followed by duly trained mother/caregiver. The signs of omphalitis (redness, pus or localized oedema) were observed and recorded for each neonate in both groups. Chi square test was used to see the difference in omphalitis in these groups with p˂ 0.05 considered as statistically significant result.<br><strong>Results:</strong> Out of 100 neonates, 29 (58%) and 23 (46%) males while 21 (42%) and 27 (54%) females neonates belonged to dry care and chlorhexidine group respectively. Nineteen (38%) neonates with dry cord had omphalitis compared to only 5 (10%) in chlorhexidine group (p 0.001). Neonates with chlorhexidine application showed prolonged mean cord separation time (7.9±1.5 days) compared to dry care (6.1±1.8 days). <br><strong>Conclusion:</strong> The use of 4% Chlorhexidine was effective to lower omphalitis compared to neonates with dry cord care. </p> Fouzia Ishaq Anila Jamil Muhammad Sajjad Maria Iftikhar Muhammad Adnan Zafar Asma Anwar ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 136 139 10.37018/ilil1903 Serum free testosterone levels in polycystic ovarian syndrome patients and its correlation with clinical hyperandrogenism in Pakistan https://www.jfjmu.com/index.php/ojs/article/view/716 <p><strong>Background<em>:</em></strong> Polycystic ovary syndrome (PCOS) is the most frequent pathology among women of reproductive age characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries on ultrasound. Evidence suggests that high androgen levels are the fundamental factor in the pathogenesis of PCOS. The objectives of the present study was to determine serum free testosterone levels in polycystic ovarian syndrome patients, and observe its correlation with clinical hyperandrogenism.</p> <p><strong>Patients and methods</strong>: This cross-sectional study was conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology Lahore, Pakistan from 15<sup>th</sup> May 2019 to 15<sup>th</sup> November 2019. The study included 140 patients of PCOS diagnosed as per Rotterdam criteria. Serum testosterone levels were determined in these patients by ELISA method. Ferriman-Gallwey (FG) score was used to assess severity of clinical hyperandrogenism in the form of hirsutism. Patients were categorized into three groups, mild (FG score 8-15), moderate (FG score 15-25) and severe (FG score &gt;25). Correlation between clinical (hirsutism) and biochemical hyperandrogenism (serum free testosterone levels) was assessed using Fisher exact test. Data was analyzed using SPSS version 25.</p> <p><strong>Results:</strong> Biochemical hyperandrogenism in the form of raised free testosterone levels was present in 46 (32.9%) PCOS patients. Out of 12 patients having Ferriman Gallwey score &gt;25, 10 (83.3%) had biochemical hyperandrogenism. Out of 70 patients having Ferriman Gallwey score 15-25, 22 (31.4%) had biochemical hyperandrogenism whereas out of 58 patients having Ferriman Gallwey score 8-15, only 14 (24.1%) patients had biochemical hyperandrogenism.</p> <p><strong>Conclusion:</strong> Prevalence of biochemical hyperandrogenism in PCOS patients in our studied population was significantly low when compared to the population studied worldwide making it less reliable as diagnostic tool in this part of the world. Also there was significant positive correlation between free testosterone levels and degree of hirsutism which means that diagnostic accuracy of free testosterone in PCOS patients is considerably high in those having clinical hyperandrogenism.</p> Tahir Ullah Khan Naseer Nazeer Memon Amna Riaz Zohaib Ahmed Khan Sundus Mariyum Haroon Khurshid Ahmed Khan ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 132 135 10.37018/fjfl1810 Screening the adequacy of hydroxychloroquine prescription and monitoring of ocular toxicity in patients with rheumatic disease https://www.jfjmu.com/index.php/ojs/article/view/604 <p><strong>Background</strong>: Hydroxychloroquine (HCQ) an anti-inflammatory drug used in treatment of rheumatic diseases causes retinal toxicity in a minority of patients which are both time and dose dependent. The aim of this study was to assess the compliance &nbsp;with guidelines &nbsp;of American Association of Ophthalmology for screening and dosage of this drug.</p> <p><strong>Patients and methods</strong>: In this cross-sectional analysis, the medical records of patients who were on HCQ, attending Rheumatology Outpatient Department of Fatima Memorial Hospital Shadman, Lahore from 25-05-2019 to 30-05-2019 were reviewed. The dosage and, duration of HCQ were collected, files were reviewed for physician recommendation of screening tests for retinal toxicity. HCQ dose of 5mg/kg/day was labeled as adequate dose; dose below 4.5mg/kg/day under dosed, while dose of 6mg/kg/day and above was considered overdose.</p> <p><strong>Results:</strong> Data was collected from 81 patients during the study period, 74 (91.4%) of them being female, with mean age 35.15 ± 12.6 years. Based on total body weight, 23 patients (28.4%) were receiving the correct dosage of the drug around 5mg/kg/day whereas 39 (48.1%) patients were under-dosed below 4.5mg/kg/day, and 19 patients (23.5%) were over dosed, out of which 5 (6.17%) were receiving doses above 6.5mg/kg. Baseline eye screening examination by ophthalmologist was performed within 1 year of commencing treatment in 54 (66%) patients. Of the 27 patients receiving HCQ more than 5 years, 6 patients underwent Spectral coherence Ocular CT scan (SD-OCT) evaluation at 5 years. There was minimal compliance (less than 70% of Patients) to optimum drug dosage, partial compliance (70-89% patients) to preventing over-dosage of the drug, and full compliance (more than 90% patients) was achieved in baseline screening exam recommendation. Follow-up screening documentation and 5-years screening examination had minimal compliance.</p> <p><strong>Conclusion:</strong> A significant proportion of patients are underdosed, especially the obese population where the recommended dosage is not prescribed.</p> Saira Elaine Anwer Khan Muhammad Zeeshan Aslam Asadullah Khan Zia ud Din Farhan Bashir Hajra Khan ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 128 131 10.37018/zbsl5515 Ameliorative effects of Spinacia oleracea on sperm morphology, count, and motility by normalizing the obesity-induced oxidative stress in Sprague Dawley rats https://www.jfjmu.com/index.php/ojs/article/view/683 <p><strong>Background:</strong> Obesity is a prevailing metabolic disorder that affects the functioning of the male reproductive system. Excessive adipose tissue enhances reactive oxygen species generation and is linked with male infertility. Spinach has demonstrated antioxidant effects. The present study was conducted to determine the antioxidant effects of spinach on sperm parameters in obese Sprague Dawley rats.</p> <p><strong>Subjects and methods:</strong> This randomized control study was conducted at the animal house of the National Institute of Health Islamabad, Islamic International Medical College, Cosmesurge International Hospital, Rawalpindi, and Apollo lab, Islamabad, Pakistan from April 2016 to March 2017. Forty male Sprague Dawley rats having an age of 8 weeks and weight 160-200g were tagged from number 1 to 40. Every third rat was randomly allocated to control Group A (<em>n</em>=13) and remaining into the Experimental group (<em>n</em>=27). Rats of control Group A was given a standard diet while a high-fat diet was given to Experimental group rats to induce obesity for the duration of six weeks. Weight (g) was measured weekly and obesity was confirmed when rats attain more than 20% weight when compared with that of rats of control Group A. Then, after obesity induction, the experimental group was alienated into the obesity control group (Group B) and spinach treated group (Group C). For sample, rats of Group A and Group B were sacrificed, and the cauda epididymis of each rat was placed in a Petri dish containing normal saline and cut into pieces to allow the release of sperm and then sperm parameters (sperms concentration, motility, and morphology) were recorded under the microscope. Then, spinach (5% hot water extract) along with the persistence of fat diet was administered to Group C for 4 weeks and finally, sperm parameters were measured in this group.</p> <p><strong>Results:</strong> Sperm concentration/ml, motility (%), and normal morphology (%) of Group B rats were significantly decreased as compared to Group A rats. However, sperm concentration/ml, motility (%), and normal morphology (%) of Group C (spinach treated group) rats was significantly increased (p&lt;0.001) as compared to Group B (obesity control group) rats after administering spinach.</p> <p><strong>Conclusion:</strong> The addition of Spinach in a normal diet regimen restores normal sperm morphology, improves sperm motility and concentration.</p> Somia Iqbal Noman Sadiq Saad Siddiqui Hira Iqbal ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 124 127 10.37018/jspf4712 The Role of MDCT and 3D computed tomography in the assessment of maxillofacial fractures and their types: a tertiary care hospital experience https://www.jfjmu.com/index.php/ojs/article/view/691 <p><strong>Background:</strong> Maxillofacial region is a complex anatomical region that is commonly injured due to trauma and Multidetector Computed Tomography and Three-Dimensional Computed Tomography are used for accurate assessment of fractures and associated soft tissue injuries for correct clinical management. The objective of this study was to determine the frequency, various types of maxillofacial fractures and associated injuries using MDCT and 3D computed tomography (3D CT) at Sharif Medical City Hospital, Lahore.</p> <p><strong>Patients and methods:</strong> This was a cross-sectional study, carried out in the Department of Diagnostic Radiology, Sharif Medical City hospital, Lahore from December 2018 to November 2019. 3D reconstructed CT images were obtained in 70 patients with maxillofacial injuries referred to the Radiology Department of Sharif Medical City Hospital, using 16 slices Toshiba<sup>®</sup> Aquillion Multidetector Computed Tomography scanner. CT images were evaluated by consultant radiologists and data was collected.</p> <p><strong>Results:</strong> The maxillofacial fractures were significantly higher in the male population 61 (87%) than the female population 9 (13%). Road traffic accidents were the most common cause of injury and the mean age was 30±12 years with the most common age group were 21-30 years (32.8%). Maxilla and maxillary sinus wall fracture were commonest fracture 23 (33%) followed by orbital 20 (28%) bone fractures. Hemosinus 22 (31.4%) was the commonest associated injury.</p> <p><strong>Conclusion</strong>: The complex anatomy of the facial bones requires MDCT and 3D CT which offers excellent spatial resolution, and helpful in the accurate diagnosis of the maxillofacial fractures their exact site, number, and associated injuries, and surgical planning.</p> Asma Iqbal Abeer Yasin Mahwish Javeed Tashhir Rana Basma Khan Ariba Yasin ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 119 123 10.37018/dvdu4414 Pathological response rate in patients who achieve clinical response after neoadjuvant concurrent chemoradiotherapy in localized esophageal cancer https://www.jfjmu.com/index.php/ojs/article/view/754 <p><strong>Background:</strong> The incidence of esophagus carcinoma is raising and it is the 6<sup>th</sup> leading cause of mortality. The objective of this study is to determine pathological response rate in patients who achieve clinical response after neo-adjuvant concurrent chemoradiotherapy in locally advanced esophageal cancer presented at a single tertiary care centre in Karachi.</p> <p><strong>Patients and methods:</strong> It was a longitudinal study conducted at the Department of Oncology of Jinnah Postgraduate Medical College from May 2017 to July 2018. Thirty five patients with locally advanced carcinoma involving lower and middle esophagus had concurrent chemoradiotherapy. Induction of concurrent chemoradiotherapy with radiations in which carboplatin and paclitaxel was given weekly. After 6 weeks at the end of irradiation, the clinical response was assessed on CT scan. All patients who had achieved stable, partial and complete clinical response after completion of concurrent chemoradiotherapy (CCRT) underwent surgery within 6-8 weeks. After surgery, pathologist evaluated resected specimen and staging was done on the basis of residual tumor. To grade the response to therapy, the degree of histomorphologic regression classified into four categories as Pathological complete response (pCR), pathological partial response, stable disease as no pathological response and progression of disease. Statistical analysis was performed using SPSS version 23. Chi-square test was applied to assess association between effect modifiers and complete pathological response.&nbsp;</p> <p><strong>Results:</strong> Total of 35 patients were included in the study. Mean age of the patients was 42.42±14.16 years. There was female preponderance (57.4%) with male to female ratio of 17:18. Eleven patients (31%) achieved complete clinical response and 2 patients (6%) had stable disease. After surgery, complete pathological response was observed in 21 (60%) patients. However, 10 (28.6%) patients achieved partial pathological response, 1 (2.9%) patient had stable disease and 3 (8.6%) patients showed progression of disease.</p> <p><strong>Conclusion:</strong> The achievement of complete pathological response was comparatively higher than partial response among locally advanced EC patients who had neoadjuvant CCRT followed by surgery.</p> Ravisha Bai Ghulam Haider Kanwal Satyawan Ammara Manzoor Shahid Hussain Muhammad Hayat Sasoli ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 114 118 10.37018/qsqy1921 The outcome of the Trendelenburg procedure with stripping vs. no stripping in the management of varicose veins https://www.jfjmu.com/index.php/ojs/article/view/720 <p><strong>Background:</strong> Varicose veins is a common problem in Pakistan with multiple treatment options. One of its recommended and commonly performed surgical treatment includes the flush ligation of Saphenofemoral junction (Trendelenburg procedure) with stripping of great saphenous vein and avulsion of varicosities which is a cumbersome process. This study aims to evaluate the effect of stripping of great saphenous vein on the recurrence rate.</p> <p><strong>Patients and methods:</strong> A randomized controlled trial was conducted in the Surgical Unit I, Services Hospital, Lahore over a period of 22 months from 20-09-2016 to 20-07-2018. Seventy patients were divided equally into two groups of 35 patients each i.e. Trendelenbrug procedure and avulsion of varicosities with stripping down to the knee, (Group A) versus Trendelenbrug procedure and avulsion of varicosities without stripping (Group B). Recurrence at 12 weeks was noted. SPSS version 17.0 was used to analyze data. Comparison of recurrence and stratified confounding factors such as age, gender, and BMI were assessed by the chi-square test (significant p-valve ≤0.05).</p> <p><strong>Results:</strong> In group A, 32 out of 35 patients were male (91.43%) and 3 (8.57%) were female. While in group B, 31 out of 35 patients were male (88.87%) and 4 (11.43%) were female. Four out of 35 (11.43%) patients in group A whereas 6 (17.14%) group B patients (p-value=0.494) had a recurrence in the perforators below the knee at 12 weeks. Stratification (p-values) of recurrence rate with respect to age (&lt;40 years: 0.41 versus ≥ 40 years:0.905), gender (female: p-value not applicable versus male: 0.96) and BMI was done (&lt;25 kg/m<sup>2</sup>: 0.36 versus ≥ 25 kg/m<sup>2</sup>: 0.901)</p> <p><strong>Conclusions:</strong> Stripping does not significantly affect the outcome of varicose vein surgery in relation to the recurrence rate at 12 weeks and recurrence was independent of age, gender, and BMI of patients.</p> Jibran Mohsin Muhammad Haris Janjua Jumana Fatima Muhammad Usman siddique Muhammad Yasir Naseem Imdad Ahmad Zahid ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 110 113 10.37018/wdid8444 Barriers to the access of oral health care facilities among adults: an exploratory study from Lahore https://www.jfjmu.com/index.php/ojs/article/view/750 <p><strong>Background:</strong> Oral health is one of the key indicators of the quality of life, overall health and well‑being of the general population. Globally, the high prevalence of the periodontal disease, excessive tooth loss, dental caries experiences, oral cancers and xerostomia are the major issues reported among adult populations. Timely access to oral healthcare facilities preserves the function, morbidity and mortality. The best possible health outcomes are only possible if the personal health care services are accessible timely. So, the primary objective of this study was to explore the barriers to the access of oral health care facilities among adults. In addition, the study also determined the association between adult’s demographic factors and their visits to dental clinics.&nbsp;</p> <p><strong>Subjects and methods:</strong> This exploratory study was conducted for two months between November 2019 and January 2020. The study recruited 400 adults including 200 males and 200 females visiting outpatient department (OPD) of public hospital i.e. Jinnah Hospital, Lahore. Participants were included in this study if they were 18 years of age or older and had provided written informed consent before data collection. Data were collected using a structured questionnaire whereas barriers to access the oral healthcare facilities was confirmed by asking an open-ended question. Statistical Package for Social Sciences (SPSS) software was used to calculate descriptive statistics (i.e., mean, standard deviation, percentages). The study also determined the association between sociodemographic factors of adults and their tendency to visit dental clinics just for routine checkups using the chi-square test.</p> <p><strong>Results:</strong> The average age of the participants was 36.81±9.29 years ranged from 18 – 63 years. Of the 400 participants, 259 (64.75%) reported costly treatment as a barrier affecting access to oral healthcare facilities followed by difficulty in access to dental clinics (27.75%) and fear of the pain of dental procedures (20.25%). Only 52 (13%) adults were regularly visiting dental clinics for routine check-ups whereas 21 (5.25%) respondents never had been to the dentist throughout their life. Nearly, half of the respondents i.e. 189 (47.25%) stated that dental care expenditures were borne by them and none of them was health insured. Statistically, a significant association was found between demographics (i.e. education, rural background and income) and the tendency to visit the dental clinics (p&lt;0.05).</p> <p><strong>Conclusion: </strong>Expensive treatment, difficulty in accessing dental facilities and fear from dental procedures are the major barriers to the utilization of dental services. Access to dental clinics for routine check-ups is significantly influenced by sociodemographic factors.</p> Shehla J. Akram Raheela Yasmin Saira Atif Asadullah Rathore Omair Anjum Muhammad Bilal Arshad Imran Hameed Khaliq ##submission.copyrightStatement## 2020-12-15 2020-12-15 15 4 105 109 10.37018/iyvh7026 Role of sleep deprived EEG in undiagnosed epileptic patients with negative standard EEG https://www.jfjmu.com/index.php/ojs/article/view/678 <p><strong>Background:</strong> Epilepsy is a common illness and most of the times it is diagnosed with standard electroencephalography (EEG). However, this is not positive in all the patients. Among these patients sleep deprived EEG is recommended by many authors but this is not routinely used. This study was conducted to evaluate that how commonly sleep deprived EEG will show positive results among patients with unspecified seizures having negative standard EEG.</p> <p><strong>Patients and methods:</strong> This was a cross sectional survey that included 100 patients with unspecified seizure having negative standard EEG. All the patients had sleep deprived EEG. The frequency of patients positive for epilepsy on sleep deprived EEG was calculated.</p> <p><strong>Results:</strong> Forty one (41%) patients were found positive for epilepsy on sleep derived EEG, while rest of 59 (59%) patients were negative.</p> <p><strong>Conclusions:</strong> it is recommended that all the patients with unspecified seizures having negative standard EEG should have sleep deprived EEG in our clinical setup.</p> Zia ul Haq Tahira Liaquat Tahir Bashir Muhammad Anas Bashir Anam Khan Shazia Siddique Seemeen Hussain ##submission.copyrightStatement## 2020-07-27 2020-07-27 15 4 107 109 Hypomagnesemia in hemodialysis patients taking proton pump inhibitors https://www.jfjmu.com/index.php/ojs/article/view/681 <p><strong>Background:</strong> Proton pump inhibitors (PPIs) are in routine widely prescribed to hemodialysis patients. Recent studies have reported the association of PPIs use with hypomagnesemia in patients with long term hemodialysis. This study aims to determine the frequency of hypomagnesemia in patients of hemodialysis taking proton pump inhibitors.</p> <p><strong>Patients and methods:</strong> This cross-sectional study was conducted in the Department of Nephrology of Sandman Provincial Hospital Quetta from 01-6-2019 till 01-9-2019. A total of 120 patients (52 PPI users and 68 non-PPI users) who were on HD for more than 06 months were included. Data regarding age, gender, duration of hemodialysis and taking PPIs were collected. Determination of serum magnesium was made by taking 3 different samples at 2 weeks’ interval and the mean value of serum magnesium was calculated. Serum Mg<sup>2+ </sup>levels &lt;2.0 mg/dL was taken as hypomagnesemia. A Chi-square test was applied to determine the association of PPI use with hypomagnesemia.</p> <p><strong>Results:</strong> Demographic variables such as age and gender were not significantly different between the groups. There was female dominance in both groups (73% in PPI groups and 66.1% in the non-PPI group (p-value 0.65). The mean duration of dialysis was 45.3±13.8 months in PPI users versus 48.9±12.9 months in non-PPI users (p-value 0.14). There was a significantly higher frequency of hypomagnesemia in PPI users; 36 (69.3%) versus 27 (39.7%) in non-PPI users (p-value 0.001).</p> <p><strong>Conclusion:</strong> The use of PPI is associated with a significant reduction in serum magnesium levels. So serum magnesium levels should be advised as routine monitoring in patients of hemodialysis taking PPIs.</p> Abdul Malik Syed Mohkumuddin Humaira Rahim Shamima hanif ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 55 58 10.37018/dezk2659 Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study https://www.jfjmu.com/index.php/ojs/article/view/751 <p><strong>Background:</strong> Renal stones represent a common urological pathology where standard treatment advised is ESWL in current practice. However, NCCT based determination of stone fragility may help to predict the outcome of ESWL treatment, hence optimizing its clinical use. Therefore, this study evaluated the role of NCCT determined urinary stone fragility in predicting the outcome of ESWL treatment in local clinical settings.</p> <p><strong>Patients and methods:</strong> One hundred patients with single renal calculus of 0.6-2 cm in size were included. NCCT based determination of stone fragility in HU units was done for all patients. Patients were then subjected to ESWL, with a maximum of 3000 shock waves given per ESWL session. Plain film and/or ultrasonography was used to monitor ESWL treatment progress with a final NCCT evaluation at 12 weeks to determine the clearance of the calculi for each patient. Association of NCCT based stone fragility and outcome of ESWL was statistically analyzed using Fisher exact test.</p> <p><strong>Results:</strong> The mean age of the patients was 37.7 ± 10.9 years with 54% being male. Decreasing stone fragility on NCCT (high = &lt;500HU, moderate = 500-1000HU, and high = 1000HU) required more number and intensity of ESWL sessions (1-2 visits and 3000-6000 shock waves for high stone fragility group, 3-5 visits and 7000-18000 shock waves for the moderate group, and 6 visits and &gt;18000 shock waves for low fragility group, respectively) necessary for clearance of urinary stones (p&lt;0.001). In 98% of patients, the clearance of urinary stones was excellent.</p> <p><strong>Conclusion:</strong> Renal stone patients with NCCT determined high and moderate stone fragility show an optimal response after ESWL treatment, whereas, for low fragility renal stones attenuative treatment like percutaneous nephrolithotomy and/or ureteroscopy should be considered instead of ESWL. This approach can enable patient stratification before ESWL therapy ensuring better clinical management of the renal stone disease.</p> Athar Hameed Khazir Hayyat Gondal, ` ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 59 63 10.37018/xivf1000 Patterns of serum CEA levels in different clinico-pathological variables of colorectal cancer https://www.jfjmu.com/index.php/ojs/article/view/668 <p><strong>Background:</strong> Globally, colorectal malignancy is the 3<sup>rd</sup> most frequent cancer and the 2<sup>nd</sup> major cause of mortality. Serum carcinoembryonic antigen (CEA) is a simple tumor marker for the diagnosis, predicting response to therapy and survival and identifying the recurrence of colorectal cancer. Therefore, the aim was to evaluate the pattern of serum CEA levels in patients with colorectal cancer presenting at a tertiary care hospital in Karachi</p> <p><strong>Patients and methods:</strong> It was a cross-sectional study conducted at the Department of Medical Oncology of Jinnah Postgraduate Medical Center, Karachi from January till August 2019. One ninety-nine patients of 12-80 years age and either gender diagnosed with colorectal cancer (biopsy-proven) were included. Data on demographics, clinical and pathological findings were recorded in the pre-designed proforma. The serum CEA levels in colorectal cancer patients were assessed using an ELISA kit. CEA levels higher than 5.0 ng/mL were deemed as elevated CEA levels in colorectal patients. Data were analyzed using SPSS version 23.</p> <p><strong>Results:</strong> A total of 191 colorectal cancer patients were included. The mean age of the patients was 42.81±15.22 years. Most of the patients (61.3%) were male. Out of 191 colorectal cancer patients, 60 (31.4%) had CEA level 0-0.3 ng/ml, whereas 79 (41.4%) had elevated serum CEA level (&gt;10 ng/ml). The CEA levels were stratified with respect to effect modifiers. The size of the tumor, TNM staging and localization and metastasis of cancer showed a statistically significant difference between levels of CEA (p&lt;0.05).</p> <p><strong>Conclusion:</strong> The raised CEA levels are associated with clinically progressive or presence of residual and recurrent disease. For patients with progressive tumors, particularly colorectal carcinoma, CEA assays are an important guide to assess the burden of the tumor, hence clinicians and surgeons ought to monitor antigen levels. It is recommended to enhance the clinical efficacy of the CEA levels.</p> Muhammad Hayat Ghulam Haider Shahid Hussain Perwasha Kerio Ravisha Bai Shakeel Akbar Saima Zahoor ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 68 71 10.37018/mmtu5850 Gender difference in risk factors associated with ischemic heart disease in Lahore https://www.jfjmu.com/index.php/ojs/article/view/723 <p><strong>Background:</strong> Ischemic heart disease (IHD) is one of the leading causes of mortality in Pakistan. With advancement in research, multiple causes have contributed in development of web of causation of this public health issue. The objective of this study was to assess gender differences in risk factors associated with ischemic heart disease in patients presenting at the biggest cardiology hospital of Lahore.</p> <p><strong>Patients and methods:</strong> A comparative cross-sectional study was carried out in Punjab Institute of Cardiology, Lahore from January to August, 2018 on a sample of 296 diagnosed patients of IHD, through non-probability consecutive sampling technique. Data was collected on pretested questionnaire. The data was analyzed using SPSS version 22. Chi-Square test of significance was applied and a p-value ≤0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The mean age of participants was 45±12 years with predominance of male patients (71.3%). Frequency of risk factors for IHD included increase body mass index (83.8%), hypertension (61%), insufficient physical activity (43%), diabetes (38.5%) and smoking (23%). Increase serum cholesterol was reported in 95% and triglycerides in 99% of the participants. Gender difference was significant with females residing in urban population (p=0.054) and exercise routine (p=0.034). Males showed high tendency of IHD with smoking pattern (p&lt;0.001) contrary to presence of diabetes in females (p=0.05), hypertension (p=0.054), BMI (p=0.0379) and stressful event in life (p=0.002). Males showed regular intake of medicines (p =0.045) after diagnosis as compared to female population.</p> <p><strong>Conclusion:</strong> There is more frequency of ischemic heart disease in males as compared to females. Significant association was observed with residence in urban area, presence of diabetes, hypertension, high BMI and stressful event in life in occurrence of ischemic heart disease in female population.</p> Muhammad Salman Tariq Iram Manzoor Qurat ul Ain Zulfi Naeem Hussain Nimra Saleem Murtaza Shabbir ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 72 77 10.37018/hjie6482 Role of intravitreal ranibizumab for rapid recovery of central serous chorioretinopathy https://www.jfjmu.com/index.php/ojs/article/view/749 <p><strong>Background:</strong> Central serous chorioretinopathy (CSCR) is an idiopathic disorder in which there is leakage of fluid from hyper permeable choriocapillaris and the collection of fluid between neurosensory and neuropigmentry retina in the macular area that is responsible for decrease visual acuity. CSCR may be acute or chronic. Various treatment options include simple observation, argon laser photocoagulation of the leaking spot, photodynamic therapy (PDT), oral ketoconazole and oral rifampicin are available. Ranibizumab is a monoclonal antibody fragment that act as vascular endothelial growth factor inhibitor, stabilize blood retinal barrier and decrease leakage from choriocapillaris. This study aims to evaluate the role of intravitreal ranibizumab for rapid recovery in central serous chorioretinopathy.</p> <p><strong>Patients and methods:</strong> This descriptive case series was carried out at Department of Ophthalmology, Nishtar Medical University Multan, Pakistan from 01-10-2019 till 30-04-2020. The study included twelve eyes of twelve patients suffering from acute CSCR. All patients were given a single injection of intravitreal ranibizumab (0.5mg/0.05ml) as a primary treatment and followed for two months after injection at one week, one month and two months interval to document efficacy of intravitreal ranibizumab. At each baseline and follow up visits, dilated fundus examination was carried out, ending up with patients’ best corrected visual acuity. Central retinal thickness (CRT) was also recorded and results were compared with prior visit results of patients. Major outcomes were the improvement in visual acuity and decrease in CRT. Baseline CRT values were also compared with post injection CRT values at one week, one month and two months intervals using paired sample t-test and best corrected visual acuity (BCVA) was compared using chi–square test.</p> <p><strong>Results:</strong> Mean age of the patients was 39.6 years with a male to female ratio of 9:1. Best corrected visual acuity was 6/60 on Snellen chart at baseline. All patients exhibited mean improvement of best corrected visual acuity of three Snellen lines after one week. Eleven patients were back to best corrected visual acuity of 6/6 after one month. Remaining one patient gained best corrected visual acuity of 6/6 after two months of post injection. The mean CRT at presentation was 500 ± 80U (range; 386–580) which reduced significantly to 272 ± 52 U (range 220–338) from baseline after one month showing significant reduction (p&lt;0.001). At the last follow-up visit, the CRT was measured 230 ± 20 U (range 220—250) which shows complete resolution of sub-retinal fluid.</p> <p><strong>Conclusion:</strong> Intravitreal ranibizumab can be used for rapid absorption of sub-retinal fluid in acute CSCR and significant reduction in CRT along with improvement in BCVA indicate that it may be safely employed in CSCR to achieve better clinical outcomes.</p> Kamran Shahzad Syed Ahmer Hussain Muhammad Zafarullah Nausherwan Adil ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 78 82 10.37018/ykjf3651 Evaluation of Chicago sky blue stain against Potassium Hydroxide-Dimethyl Sulfoxide wet mount in the identification of dermatophytes https://www.jfjmu.com/index.php/ojs/article/view/728 <p><strong>Background:</strong> Dermatophytoses infections are widespread in the developing world. The laboratory diagnosis of dermatophytes has been a challenge as it involves microscopy and trained personnel. Potassium hydroxide wet mount with dimethyl sulfoxide added is routinely used in direct microscopy. But it lacks color contrast and the hyphae may be missed on routine microscopy. The study aimed to evaluate the effectiveness of the Chicago sky blue stain against routine potassium hydroxide-dimethyl sulfoxide (KOH/DMSO) wet mount in direct microscopy.</p> <p><strong>Patients and methods</strong>: The study was carried out at the Department of Microbiology, Postgraduate Medical Institute, Lahore over a period of nine months from July 2013 till March 2014. Patients of either gender regardless of age, clinically diagnosed as having dermatophytoses by dermatologists were selected for this study. Specimens from 100 patients were collected from the dermatology outdoor of a tertiary care hospital for this study. They were evaluated microscopically with routine potassium hydroxide-dimethyl sulfoxide (KOH-DMSO) wet mount and Chicago sky blue (CSB) stain. Data were collected and entered in Statistical Package for the Social Sciences (SPSS) version 20.0.</p> <p><strong>Results</strong>: Out of a total of 100 samples collected from skin, hair and nails, 59% were positive on direct microscopy with KOH/DMSO wet mount. Whereas direct microscopy using CSB stain revealed dermatophytes in 62% of cases.</p> <p><strong>Conclusion</strong>: Chicago sky blue staining is a better technique for the detection of dermatophytes as compared to potassium hydroxide wet mount examination. It is simple, rapid, and easy to interpret. We recommend the use of this technique to improve the detection of dermatophytes without awaiting the results of the culture.</p> Majid Rauf Ahmad Iffat Javed Suhaila Mushtaq ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 83 86 10.37018/ybro2935 Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore https://www.jfjmu.com/index.php/ojs/article/view/692 <p><strong>Background:</strong> Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated.</p> <p><strong>Patients and methods:</strong> 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks.</p> <p><strong>Results:</strong> The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12<sup>th</sup> week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile.</p> <p><strong>Conclusion:</strong> Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.</p> Sadaf Amin Chaudhry Nadia Ali Zafar Rabia Hayat Ayesha Noreen Gulnaz Ali Zain Ali Raza Muhammad Nadeem ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 87 90 10.37018/xqbw1463 Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion https://www.jfjmu.com/index.php/ojs/article/view/738 <p><strong>Background:</strong> Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography.</p> <p><strong>Patients and methods:</strong> From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs.</p> <p><strong>Results:</strong> Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria.</p> <p><strong>Conclusion:</strong> Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.</p> Khalid Rehman `Yousaf Shahzad Saeed Saman Chaudhry Rabia Bashrat Abadullah Khalid Usman Baig Maria Haq Talal Azhar Moeez Zafar ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 97 102 10.37018/kori7947 Posterior and lateral ponticles of atlas: An osteological study at Fatima Jinnah Medical University, Lahore https://www.jfjmu.com/index.php/ojs/article/view/742 <p><strong>Background:</strong> Among the cervical vertebrae, atlas is known to have many variations, posterior ponticle being the commonest. It may completely or incompletely covers the groove of vertebral artery leading to ischemia of posterior circulation. Therefore, vertebral artery is at greater risk of injury during neurological and spinal surgeries. Prevalence of posterior ponticles varies widely among different populations, for instance in Turkish population it was 10.8%, in American 22.1%, Kenyan 14.7%, Brazilian and Indian 16.7%. The prevalence of lateral ponticle in Kenyan population was reported to be 3.9% and in Indians it was 2%. However, the data regarding the prevalence of these ponticles is largely lacking in Pakistan. Therefore, this research was designed to determine the prevalence of posterior and lateral ponticle in atlas vertebrae of Pakistani population.</p> <p><strong>Materials and methods:</strong> A total of 47 human atlas vertebrae of unknown age and gender from bone bank of Department of Anatomy Fatima Jinnah Medical University, Lahore were studied for the presence of complete and incomplete posterior and lateral ponticles. The bones studied were completely intact and did not have any pathology.</p> <p><strong>Results:</strong> Total incidence of ponticles was 38 % in this study, of which 36% were posterior ponticles and 2% were lateral ponticles. Bilateral incomplete posterior ponticles/were found in 8 (17%) atlas vertebrae whereas bilateral complete posterior ponticles/foramen arcuale were found in only 1 (2%) atlas vertebrae. Unilateral incomplete posterior ponticle was identified on right side in 5 (11%) and left side in 2 (4%) atlas vertebrae. Unilateral complete posterior ponticle was found in only 1 (2%) atlas on the left side whereas no such finding was identified on right side in any vertebra. Unilateral complete lateral ponticle was found in only 1 (2%) atlas on the right side but not on left side. No bilateral complete lateral ponticle and incomplete unilateral or bilateral lateral ponticles were identified in this study.</p> <p><strong>Conclusion: </strong>Presence of posterior and lateral ponticles pose a risk of vertebrobasilar vascular insufficiency and may cause variety of symptoms. Vertebral artery may be at risk during neurosurgical procedures when having a foramen arculae and may give a false impression of much wider posterior arch of atlas. Knowing the prevalence of this can help neurosurgeons, general surgeons, radiologists, and chiropractors in management of the patients.</p> Saira Munawar Farhana Jafri Ahmad Farzad Qureshi Darab Fatima Aliya Zahid ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 91 96 10.37018/NQOV7890 Internal limiting membrane peel with or without finesse flex loop assistance https://www.jfjmu.com/index.php/ojs/article/view/656 <p><strong>Background:</strong> Internal Limiting Membrane (ILM) peeling, currently, due to more successful hole closure rate and prevention of postoperative reopening, has been accepted globally but it may leads to other trivial complications like subretinal and retinal hemorrhage, vitreous hemorrhage and retinal edema etc., which may be avoided by using adjuvant instruments, like Finesse flex Loop. The aim of this study was to compare complications after ILM peel, with and without finesse loop.</p> <p><strong>Patients and methods:</strong> In this comparative cross-sectional study conducted in Ophthalmology Department of Lahore General Hospital, Lahore from February 2018 to January 2019, the data of thirty (30) patients was compared after taking informed consent through self-made pro-forma. Data analysis was done on SPSS-21. Frequency / percentage table of qualitative variables like retinal hemorrhage, retinal tear, retinal detachment and surface irregularities were designed by using excel-16. Fischer’s exact test was applied to compare complications after ILM peeling with and without using Finesse loop. Confidence interval of 0.95 with α of 0.05 was taken as significant.</p> <p><strong>Results:</strong> This study included thirty (30) patients (female: 13; male: 17) with mean age of 56 years and 8 months. Comparison between outcomes of ILM peeling with and without using Finesse™ Flex Loop showed that there is statistically non-significant difference in occurrence of retinal hemorrhage (p=0.245), retinal tear (p=0.224), retinal detachment (p=1.00) and surface irregularities (p=0.39). However, the prevalence of complications like surface irregularities, retinal tear, retinal hemorrhage and retinal detachment with finesse loop were less as compared to without finesse loop.</p> <p><strong>Conclusion:</strong> The prevalence of complications during ILM peel with finesse loop in a macular hole surgery, were less than that in ILM peel with ILM forceps alone.</p> Faisal Mehmood Abdullah Irfan, PGR Ophthalmology Awais Afzal, PGR Ophthalmology Muhammad Moin Muhammad Muneeb, PGR Ophthalmology ##submission.copyrightStatement## 2020-07-15 2020-07-15 15 4 64 67 10.37018/tqqv9443 Microbial contamination in a pediatric surgery operation theatre https://www.jfjmu.com/index.php/ojs/article/view/679 <p><strong>Background:</strong> In surgical patients, 38% of nosocomial/ health care associated infections are surgical site infections (SSI). The exogenous causes of SSI include microbial contamination of operation theatre environment, equipment, and personnel. The objective of this study was to generate local data involving microbial contamination of operation theatre environment, equipment, and personnel.</p> <p><strong>Methods:</strong> This cross sectional survey was conducted in Pediatric Surgery Operation Theatre, Mayo Hospital, Lahore from August 2018 to September 2018. Samples for bacterial culture were taken by theatre sister and list in charge using cotton swabs moistened in normal saline. After informed consent, 53 samples were taken from the dominant hand and anterior nares of theatre staff (surgeons, nurses, theatre assistants and anesthetists), and 33 samples from operation theatre equipment and environment (laryngoscope, anesthesia machine, operation table, wall and floor of the theatre, dirty area, and store.). Air samples were collected by night staff using settle plate method on blood agar. After collection, all samples were transported to laboratory within 15 minutes, where pathologist performed antimicrobial susceptibility testing for all bacterial isolates using the Kirby-Bauer disc diffusion method.</p> <p><strong>Results:</strong> This study had 24 (45%) of the samples from anterior nares, and 29 (55%) samples from dominant hand, while 33 samples were taken from theatre environment and equipment. Positive bacterial growth from theatre staff was seen in 9 (17%) out of 53 collected samples. <em>Staphylococcus aureus</em> was present in 5 (55.6%) of these 9 samples, while <em>Staphylococcus epidermidis</em> was present in 3 (33.3%), and 1 (11.1%) sample revealed <em>Escherichia coli</em>. In samples from operation theatre environment and equipment, 11 samples (33.3%) out of 33 samples had bacterial growth. Most common growth obtained was bacillus species (90.9%) either alone or as mixed growth, while 1 (9.1%) was <em>Staphylococcus aureus</em>.</p> <p><strong>Conclusion</strong><strong>: </strong>Despite observing standard protocols of theatre sterilization, microbial contamination was noted in 33.3% of samples collected from theatre and 17% from personnel. The main microorganism isolated from theatre environment and equipment’ samples was Bacillus (90.9%), and <em>Staphylococcus aureus</em> (55.6%) from theatre personnel.</p> Fatima Naumeri Bilal Qayyum Sushil Rijal Sohail Jamil ##submission.copyrightStatement## 2020-07-13 2020-07-13 15 4 49 52 10.37018/ZDZE280 Predictive value of CA 19-9 in patients with pancreatic tumours https://www.jfjmu.com/index.php/ojs/article/view/633 <p><strong>Background:</strong> Pancreatic carcinoma is a disease with high modality and has a high incidence of recurrence after surgical resection. The prognosis depends on early diagnosis and treatment. Numerous international studies have reported use of CA 19-9 in diagnosis of pancreatic cancer. We planned this study to validate role of CA 19-9 in our local population. The objective of this study is to correlate raised serum CA 19-9 levels in patients with pancreatic tumours to distinguish between benign and malignant pancreatic disease.</p> <p><strong>Subjects and methods: </strong>The present study is a validation study. Thirty-five patients with diagnosis of pancreatic tumor on radiological imaging were included after their informed consent. Data collection forms were filled, blood samples were taken and serum CA 19-9 was estimated by ELISA in Biochemistry department, SIMS. Histopathology samples were collected at time of surgical resection, sent to pathology departments of respective hospitals and histopathological reports collected. All data was collected and analysed by using descriptive method. The study was conducted in Biochemistry department of PGMI and SIMS, Lahore from May 2015 till June 2016.</p> <p><strong>Results:</strong> Out of 35 patients, nineteen (54.3%) were female and sixteen (45.7%) were male. Thirty [85.7%] patients were between third to seventh decades of their life. The mean age range around 47.28. Thirty-four patients had malignant tumor and 1 benign on histopathology. CA 19-9 was raised (&gt;37 U/ml) in 33 out of 34 patients with malignant pathology. The patient with benign pathology had CA 19-9 level &lt;37U/ml (the cut off value). Head of pancreas was the commonest site in 32 patients (65%) for tumour occurrence. Total 28 (82%) patients had adenocarcinoma as the histological type of pancreatic tumour. Cholangiocarcinoma in Periampullary region of pancreas was second in frequency, 4 patients (12%). CA 19-9 shows sensitivity of 97% and specificity of 100% to diagnose carcinoma of pancreas in patients with pancreatic tumour. CA 19-9 has 100% positive predictive value to diagnose benign tumour and 50% negative predictive value to diagnose malignant tumours.</p> <p><strong>Conclusion: </strong>Raised levels of CA 19-9 has an important role in diagnosis of patients with pancreatic tumour to differentiate between benign and malignant pathology.</p> Faiza Abrar Adnan Riaz Kaukab Sultana Tariq Feroz Khawaja ##submission.copyrightStatement## 2020-07-13 2020-07-13 15 4 45 48 10.37018/UBUG4188 Sofosbuvir plus Daclatasvir without Ribavirin for the Treatment of Chronic Hepatitis C in Patients with Decompensated Liver Disease https://www.jfjmu.com/index.php/ojs/article/view/603 <p><strong>ABSTRACT</strong></p> <p><strong>Background: </strong>In chronic hepatitis C infection, hepatic decompensation remained a contraindication to treatment for many years. The direct acting antiviral drugs have shown high treatment success even in decompensated liver disease. This study aims to assess the response and safety profile of Sofosbuvir and Daclatasvir in patients of decompensated cirrhosis with chronic hepatitis C.</p> <p><strong>Patients and </strong><strong>Methods:</strong> It was a prospective observational study conducted at Gastroenterology Department of Gujranwala Medical College/ DHQ teaching Hospital, Gujranwala from February 2016 to December 2017.Consecutive patients of hepatitis C with decompensated cirrhosis were enrolled in the study. Sofosbuvir 400mg and Daclatasvir 60mg was given to all patients without ribavirin for a period of 24 weeks. Sustained virologic was taken as primary end point.</p> <p><strong>Results:</strong> A total of 140 patients were included in our study, 122 patients (87%) completed the study, 08 patients (5.7%) were lost to follow up, treatment discontinuation was seen in 06 patients (4.2%) &amp; 04 patients (2.8%) died during the study. 110 patients (90.2%) achieved end treatment response (ETR), 12 patients (9.8%) remained treatment non-responder, 100 patients (82%) achieved sustained virological response (SVR<sup>12</sup>) and 10 patients (8%) had a relapse of HCV infection.</p> <p><strong>Conclusion:</strong> Once daily oral Sofosbuvir plus Daclatasvir without Ribavirin achieved overall high rates of sustained virologic response in patients with chronic HCV having decompensated liver disease.</p> Mahmood Ahmad Muhammad Ayub Fawad Iqbal Janjua Abdul Moiz Bhatti Nooman Gilani ##submission.copyrightStatement## 2020-07-13 2020-07-13 15 4 41 44 10.37018/WOXS1774 Comparison of health-related quality of life in children with normal hearing and those with cochlear implant at age of 4-6 years https://www.jfjmu.com/index.php/ojs/article/view/673 <p><strong>ABSTRACT</strong></p> <p><strong>Background:</strong> Hearing impairment during early life years have profound negative consequences on linguistic output, educational, psychosocial and physical functioning. Auditory perception plays a key role in the development of child. Severely hearing-impaired children receiving cochlear implant (CI) before the age of speech and language acquisition may enjoy their quality of life similar to their normally hearing peers. Considering the beneficial effects of CI on quality of life of hearing-impaired child, it is evident to properly investigate the similarity in life quality of children with CI and their normal hearing mates of same age group.</p> <p><strong>Patients and Method:</strong> This comparative cross-sectional study was conducted on parents of 50 children, who were allocated in two equal groups by purposive sampling. The questionnaire was administered by interviewing the parent participants using a validated quality of life questionnaire of Children for Parents and findings were compared with the responses from parents of normal hearing children. Responses from both the groups were analyzed by independent sample t-test.</p> <p><strong>Results:</strong> Parents of Cochlear Implanted children rated their children’s Health Related Quality of Life positively. All the sub domains showed the similar results except self-esteem. Findings suggest that normally hearing children had better self-esteem than CI children. No significant difference was found between overall Health Related Quality of Life of Cochlear Implanted children and their normally hearing peers.</p> <p><strong>Conclusion:</strong> Overall health related quality of life of children with cochlear implant is similar to that of normal hearing peers of same chronological age.</p> Noreen Anwar Tayyaba Dawood Munaza Hayyat Atia ur Rehman Muhammad Adnan Waris Ali ##submission.copyrightStatement## 2020-04-16 2020-04-16 15 4 175 179 10.37018/jfjmu.673 Effectiveness of crystal violet stain for localization of mitotic activity in oral squamous cell carcinoma https://www.jfjmu.com/index.php/ojs/article/view/671 <p><strong>Background:</strong> Mitotic figure counting is simplest and oldest method for determining proliferative activity of cell. It is considered as one of the important diagnostic aid in cancer pathology. Though advanced methods to evaluate dysplastic features are more precise and definite but expense and time makes them less practicable for routine use. Therefore an effort was made to use economical as well as simple approach involving crystal violet stain (1%) to study the mitotic figures in oral squamous cell carcinoma.</p> <p><strong>Materials and Methods:</strong> This descriptive research included samples, consisting of thirty three cases of the oral squamous cell carcinoma (OSCC). Representative sections were stained with H&amp;E stain and 1% crystal violet stain respectively. The stained sections were viewed under optical microscope to count mitotic figures for evaluating the effectiveness of 1% crystal violet stain. Data obtained was statistically analyzed by using sample t-test.</p> <p><strong>Results:</strong> There was noteworthy increase in the mean mitotic count among the crystal violet stained sections of OSCC in contrast to the OSCC sections stained with H&amp;E (P = 0.00).</p> <p><strong>Conclusion:</strong>1% Crystal violet stain can be considered as one of the optimum stains to observe the mitotic figure. Practice of staining with 1% crystal violet during routine histopathological procedures will be cost effective and may be used as a selective stain.</p> Aneequa Sajjad Muhammad Qasim Raza Syeda Zaira Sajjad Ihtesham-ud-Din Qureshi Syed Sajjad Sarwar Sadia Minhas ##submission.copyrightStatement## 2020-04-16 2020-04-16 15 4 166 169 10.37018/jfjmu.671 Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder https://www.jfjmu.com/index.php/ojs/article/view/664 <p><strong>Background:</strong> Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results.</p> <p><strong>Patients and Methods:</strong> In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1<sup>st</sup>, 2<sup>nd</sup> and 3<sup>rd</sup> week follow up.</p> <p><strong>Results:</strong> Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3<sup>rd</sup> week postoperative follow up. There were no procedure-related complications.</p> <p><strong>Conclusion:</strong> Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.</p> Yasir Arfat Muhammad Umer Anwer Maria Imdad Faheem Ahmad Usmani Sana Imdad Shazia Rizwan Zahid Shafiq ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 34 40 10.37018/KRCW7511 Evaluation of anti-arthritic effect of Torilis leptophylla and its comparison with indomethacin https://www.jfjmu.com/index.php/ojs/article/view/654 <p><strong>Background:</strong> Rheumatoid arthritis is an autoimmune debilitating disease involving multiple joints and organs. Many treatment options are available but all are associated with frequent side effects. Phytochemical screening of <em>Torilis leptophylla</em> has shown the presence of anti-inflammatory compounds like flavonoids, phenols and anthraquinones. This study was designed to evaluate its effect on joints inflammation (rheumatoid arthritis). Indomethacin is one of the oldest and most commonly used drugs for arthritis. It was used as a standard drug to compare with indomethacin.</p> <p><strong>Methods:</strong> This experimental study was carried out in Pharmacology Department, University of Health Sciences, Lahore. Thirty six male albino Wistar rats were randomly divided into six groups (group I-control, group II-positive control, group III-10 mg indomethacin, group IV,V,VI--100mg, 200mg, 300mg <em>Torilis leptophylla</em> extract (TLE) administered (orally) respectively). Arthritis was induced by sub plantar injection of 0.1 ml Freund’s complete adjuvant (FCA) to all groups except the control group. Body weight (weekly) and ankle joint diameter (every 4<sup>th</sup> day) were measured. At day 29 blood was collected and all animals were killed by overdose of ether. Acid phosphatase and alkaline phosphatase levels were determined by chemistry analyzer (RX MONZA, RANDOX, Republic of Ireland). 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.</p> <p><strong>Results:</strong> Treatment with indomethacin caused significant (p≤0.001) reduction in all the inflammatory parameters. <em>Torilis leptophylla</em> extract also significantly (p≤0.05) reduced all the inflammatory parameters. Anti-inflammatory effect was comparable to indomethacin.</p> <p><strong>Conclusion: </strong><em>Torilis leptophylla</em> has significant anti-arthritic activity as it modified the parameters of joint inflammation and destruction.</p> Javaria Fatima Bushra Shaheen Saba Batool Tooba Malik Sheikh Maria Qammar Saima Naureen ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 25 29 10.37018/XELK8039 Assessment of health status of traffic constables: An occupationally exposed group in Pakistan https://www.jfjmu.com/index.php/ojs/article/view/725 <p><strong>Background:</strong> Traffic constables are exposed to various occupational health hazards worldwide. This study is planned to assess occupational health hazards in traffic constables in Punjab, Pakistan.</p> <p><strong>Subjects and Methods:</strong> A descriptive cross-sectional study was conducted in different cities of Punjab including Lahore, Gujranwala, Bahawalpur, Bahawalnagar, Sialkot and Islamabad from March till August 2018. A sample of 384 traffic personals were selected by using non-probability convenient sampling technique. Retired traffic constables and those with work experience less than a year were excluded. A pretested questionnaire was used to conduct the interviews after taking informed consent. Data was collected and analyzed using SPSS version 22 and presented in frequency tables and charts.</p> <p><strong>Results</strong>: Maximum number of constables belonged to 31-40 years of age group. Among them 98.7% were male, 25% were having education level above graduation. Results of physical health hazards showed that 53% of warden were smoker, 16.14% were known diabetics and 19.53% were found to be hypertensive. Other physical ailments included respiratory problems (23.4%), hearing impairment or loss (15.88%) and various eye ailments (13.28%). Additionally, 9.1% of participants had evidence of lead poisoning, 33.84% complaints of tightness in muscles and 13.72% of headache, whereas 35.7% had met an accident in the last year. Prevalence of stress and anxiety were 30% and 33.33%. Regarding social health issues 36.7% reported that they were unable to give family time and 42.48% felt lack of independence due to their occupation. Job satisfaction was reported by 50%.</p> <p><strong>Conclusion:</strong> The traffic constables in Punjab suffer from a large number of physical, mental and social health issues. Their perception about their occupational health hazards is low and needs improvement through imparting health education.</p> Mahnoor Taheer Butt Iram Manzoor Muhammad Ahmad Muhammad Abbas Shah ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 19 24 10.37018/VEIG5252 Role of behavioral sciences in development of professionalism among MBBS students https://www.jfjmu.com/index.php/ojs/article/view/693 <p><strong>Background:</strong> Professionalism is a global quality expected in medical students’ along with clinical skills. Behavioral sciences have been included in 3rd year MBBS curriculum since 2014 at FJMU. The purpose of this change is to enhance Professionalism formally in addition to other areas of the subject. This study aims to determine effectiveness of studying behavioral sciences as a subject in enhancing elements of Professionalism.</p> <p><strong>Subjects and Methods:</strong> The mixed-methods study was used and a sample of 240 3<sup>rd</sup> year medical students was taken by convenient sampling. In the first (quantitative) phase of the study, Penn State College of Medicine Professionalism Questionnaire (PSCOM-PQ) was administered before and after studying behavioral sciences as a subject, to collect pre and post statistical results about students’ attitudes towards professionalism. The results were analyzed by paired sample t-test. In the second (qualitative) phase, Focus Group Discussion (FGD) was conducted to reveal the reasons for professionalism development and role of Behavioral Sciences in its development. 8 students were selected by purposeful homogeneous sampling technique. FGD session was audio-taped and transcribed, finally thematic analysis was done.</p> <p><strong>Results:</strong> The results showed highly significant increase (p-value= 0.00,<strong> t= -74.39,</strong> mean= -72, SD= 14.99)<em> in</em> the scores of Professionalism after studying behavioral sciences as a subject. The broad themes identified by FGD were “Professionalism Related Skills Learned through Behavioral Sciences” and “Modes of Information Transfers’ Role in Professionalism Understanding”. The professional skills conceptualized by the students included emotional stability, empathy, psychoeducation, confidentiality, competency and sense of responsibility. The participants felt that professionalism develops by the means of lectures, workshops, role plays, modeling and formal assessment sessions.</p> <p><strong>Conclusion:</strong> Study of behavioral science has significant effect in the development of professionalism among MBBS students and is well received by third year MBBS students.</p> Ammara butt Abid Ashar ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 3 9 10.37018/TWMG3311 Insight into strategies adopted by the residents who passed exit fellowship examination in first few attempts https://www.jfjmu.com/index.php/ojs/article/view/676 <p><strong>Background:</strong> The residents who pass exit fellowship examination in few attempts adopt certain strategies for early success. The lived experiences of residents passing FCPS final examination in few attempts, barriers to success and strategies to overcome those barriers were studied.</p> <p><strong>Participants and methodology:</strong> This phenomenological research study was conducted at Services Hospital, Lahore, Pakistan from June 2015 to May 2017. Purposeful snowball sampling was done. Eleven residents who passed their Final FCPS examination in few attempts, in the last 15 years were included in the study. Semi-structured open-ended interview of the residents was audio-recorded and transcribed. Three themes of helpful factors, barriers encountered and suggestions to overcome those barriers to get through the final FCPS examination and the emerging sub-themes were analyzed and textural and structural description were assigned.</p> <p><strong>Results:</strong> Three themes were based on the aim of study and their related emerging sub-themes were found. The helpful factors included self-directed learning, peer assisted learning, interactive educational environment, rehearsal and self-determination. Barriers encountered were related to learning difficulties, competing responsibilities and physical and emotional burnout. Lastly, suggestions to overcome the barriers were use of multiple technology based learning strategies, developing self-confidence and self-efficacy together with prioritization of emotional and physical wellbeing.</p> <p><strong>Conclusions:</strong> This study found that self-regulation and internal motivation were important strategies for success in the FCPS exit examination. Barriers can be overcome through technology based learning and increased self-efficacy and prioritizing physical and emotional wellbeing.</p> Humera Zafar Ali Khan Amina Ahmad Abid Ashar Hamid Mahmood ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 10 15 10.37018/QASN5232 Effectiveness of the social communication emotional regulation and transactional support (SCERTS) model based intervention in language development and fostering social communication in children with autism spectrum disorder https://www.jfjmu.com/index.php/ojs/article/view/675 <p><strong>Background:</strong> Social Communication Emotional Regulation Transactional Support (SCERTS) model is based on studies and has manuals for assessing children and designing individual treatment plans. However, limited research has been done to evaluate the efficacy of this model. This study attempts to evaluate the impact of SCERTS model-based intervention on children with Autism Spectrum Disorder (ASD) in Lahore with the objective to determine the usefulness of SCERTS in promoting language development and improvement in social skills in children with ASD.</p> <p><strong>Patients and methods</strong><strong>:</strong> This quasi experimental study was conducted at Roots and Wings autism center, located in Bahria Town Lahore, for the duration of nine months. Children with formal diagnosis of Autism Spectrum Disorder, with age range of 3 years to 6 years old. Prior to intervention and subsequently after that, the children were evaluated with the portage checklist in the domain of language and socialization skills.</p> <p><strong>Results:</strong> Participating children demonstrated improvement in their language and social skills after the intervention, as assessed by portage.</p> <p><strong>Conclusion:</strong> SCERTS based intervention can facilitate children with autism spectrum disorder to improve their language and social communication skills.</p> Hafsa Fiaz Atia Ur Rehman ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 16 18 10.37018/IENH3595 Risk factors associated with early variceal rebleed after endoscopic variceal band ligation in cirrhotic Hepatitis B and C patients with variceal bleed https://www.jfjmu.com/index.php/ojs/article/view/591 <p><strong>Background:</strong> Chronic liver disease is endemic in Pakistan with esophageal variceal bleeding as one of the important complications and is treated with EVBL. The early esophageal variceal rebleeding is one of the ignored factors which carries the high mortality and morbidity.</p> <p><strong>Patients and methods:</strong> This case-control study was conducted in the Gastroenterology Department at Jinnah Hospital, Lahore, from February 2016 to February 2017. The Study included total 100 patients and out of these 50 were rebleeding cases while 50 were controls (without esophageal rebleed). Cases and control were matched for age, sex, Presence of hepatitis B and C and cirrhosis. The endoscopic findings of any active bleed and white nipple sign was recorded.</p> <p><strong>Results:</strong> In this study, association of risk factors for prediction of early variceal rebleed after banding in cirrhotic hepatitis b and c patients with variceal bleed was recorded as 58%(n=29) in cases and 12%(n=6) for active bleeding, O.R was 10.12, 68%(n=34) in cases and 14%(n=7) in controls had nipple sign, O.R was 13.05, Hb level &lt;9 g/dl was recorded in 88%(n=44) in cases and 40%(n=20) in controls, O.R 11.00, PT&gt;18 sec was recorded in 96%(n=48) in cases and 4%(n=2) in controls, O.R was 576.00.</p> <p><strong>Conclusion:</strong> Active bleeding and nipple sign, Hb level &lt; 9 g/dl and PT &gt; 18 sec are found to have strong association for prediction of early variceal rebleed after EVBL in cirrhotic hepatitis B and C patients.</p> Atif Nasrullah Muhammad Kashif Haris Nasrullah Arif Mahmood Saddiqiui ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 30 33 10.37018/PENC3048 Pakistan and the COVID-19 challenges https://www.jfjmu.com/index.php/ojs/article/view/746 <p>not applicable</p> Iram Manzoor ##submission.copyrightStatement## 2020-03-14 2020-03-14 15 4 1 2 10.37018/DSMY7203 Medial transport of the fibula using the Ilizarov device for reconstruction of a large defect of the tibia https://www.jfjmu.com/index.php/ojs/article/view/701 <p>Background: Large tibial defects are always a challenging to treat, especially those associated with soft tissue compromise and infection. There are different treatment options available for bridging such gaps. Therefore, current study undertakes to test Ilizarov technique for transport of fibula to establish its usefulness in bridging large tibial defects.<br>Patients and Methods: This prospective case series was carried out from April 2013 to December 2016 at Orthopedic ward Lahore General Hospital in which 11 patients with large tibial defects having associated compromised soft tissue were treated by medial transport of fibula using Ilizarov external fixator.<br>Results: Among total 11 patients, 63.6% were male while 36.4% were female. The mean age of the patients was 31.6 years. There were 45.5% patients reported with right side while 6 (54.5%) were reported with left side tibia with bone defect. Most of the patients (54.5%) had open fracture with bone loss while 45.5% patients had chronic osteomyelitis. Average time to union was 5.2 months. Average tibial defect size was 10.7 cm. Among them 72.7% patients regained normal walk. All patients had multiple previous surgeries on their limbs.<br>Conclusion: Use of Ilizarov for medial transport of fibula is an effective procedure for reconstruction of large tibial defects especially in those patients who underwent multiple previous surgeries and with compromised soft tissue.</p> Adnan Latif Malik Muhammad Hanif ##submission.copyrightStatement## 2020-03-02 2020-03-02 15 4 2 5