Journal of Fatima Jinnah Medical University <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> en-US <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="" 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> (Professor. Dr. Kamran Khalid) (Rana Muhammad Rizwan) Mon, 19 Dec 2022 10:07:46 +0000 OJS 60 Effect of Torilis leptophylla on blood total leukocyte count and differential leukocyte count in asthmatic mice <p><strong>Background:</strong> Chronic inflammation, mucus hypersecretion and airway blockage are the characteristics of asthma. Current treatments of asthma are effective but cause adverse effects on their long term use. This research was designed to explore anti-inflammatory effect of <em>Torilis leptophylla (T. leptophylla) </em>on allergic inflammation of airways by estimation of blood total leukocyte count (TLC) and differential leukocyte count (DLC) to compare its effect with a standard drug in an animal model.</p> <p><strong>Materials and methods:</strong> This experimental study was carried out in Pharmacology Department, University of Health Sciences, Lahore. A total of 48 healthy, adult, male BALB/c mice were randomly divided into six groups. Group I (control), group II (diseased); groups III, IV and V were given 100, 200, 400 mg/kg <em>T. leptophylla</em> methanolic extract (TLM) respectively, and Group VI treated with standard drug monteleukast. Airway inflammation was induced in all groups with ovalbumin except control group. On day 28, cardiac puncture was done to collect the blood and TLC and DLC (lymphocytes, neutrophils, eosinophils and monocytes) were measured in blood. All the data was interpreted as mean ± SD. SPSS 20 was used to carry out statistical analysis.</p> <p><strong>Results:</strong> <em>T. leptophylla </em>extract resulted in significant (p-value ≤ 0.05) decrease of TLC and DLC in blood. <em>T. leptophylla</em> cause 59-67% decrease in TLC, 67-80% decrease in lymphocytes, 69 - 72% decrease in neutrophils, and 45-51.7% decrease in eosinophils</p> <p><strong>Conclusion:</strong> In current study <em>T. leptophylla</em> successfully treated inflammation in asthmatic mice by reducing proportion of inflammatory cells.</p> Sheikh Maria Qammar, Saba Batool, Muhammad Umair Samee, Iram Imran, Bushra Shaheen, Javeria Fatima ##submission.copyrightStatement## Mon, 19 Dec 2022 10:04:10 +0000 Investigative analysis of extended-spectrum beta-lactamase (ESBL) producing Pseudomonas aeruginosa isolated from hospitals of Islamabad-Rawalpindi <p><strong>Background:</strong> <em>Pseudomonas aeruginosa </em>(<em>P. aeruginosa</em>) is a ubiquitous gram-negative rod shaped bacteria and a significant nosocomial opportunistic pathogen. Current study aimed at the investigation and determination of extended-spectrum beta-lactamase (ESBL) positive <em>P. aeruginosa</em> from clinical samples.</p> <p><strong>Materials and methods:</strong> A total of 150 catheter tubes, pus, blood, and sputum samples were collected from three different hospitals in the twin cities of Rawalpindi and Islamabad. The isolates were identified by using standard microbiology procedures. Antibiotic susceptibility of the isolates was done through the disc diffusion method as per the protocol given by CLSI guidelines. Phenotypic characterization of ESBL producers was performed by combination disc test (CDT), double disc synergy test (DDST) and through PCR.</p> <p><strong>Results: </strong>A total of 77/218 isolates were identified as <em>P. aeruginosa.</em> Among them 47 were resistant to different drugs, while 28 were identified as multidrug resistant. They were resistant to 9 different drugs including Cefotaxime (49%), Cefipime (41%), Cephradine (32%), Cefotetan (62%), Azetronam (50%), Cofaclor (42%), Ticarcillin (57%), Ciproflaxacin (45%), and Imipenem (36%). CDT and DDST showed that 7/29 isolates produce ESBL. One isolate was positive for VEB and 3 were positive for SHV ESBL genotype.</p> <p><strong>Conclusion:</strong> The phenomenon of ESBL production does not only remain in <em>Klebsiella </em><em>pneumonia </em>and <em>Escherichia coli </em>but could also be found in <em>P. aeruginosa</em>. Moreover, SHV genotype is prevalent in local isolates of <em>P. aeruginosa</em>.</p> Muhammad Bhader Sher, Laiba ., Warda Fatima, Hasnain Javed ##submission.copyrightStatement## Mon, 19 Dec 2022 09:59:01 +0000 Paraphenylene diamine (Kala Pathar) poisoning in children of Bahawalpur and surrounding areas <p><strong>Background: </strong>Paraphenylene diamine (commonly known as Kala Pathar in Pakistan) poisoning is a common presentation in adults as well as pediatric patients in Southern Punjab. The study was carried out to assess paraphenylene diamine poisoning in pediatric cases.</p> <p><strong>Patients and methods: </strong>The cross-sectional study was carried out at Bahawal Victoria Hospital Bahawalpur. All the pediatric cases (&lt;15 years age) of paraphenylene diamine poisoning reported during April 2021 to April 2022. Data was entered and analyzed in SPSS.</p> <p><strong>Results: </strong>Total 84 children presented at pediatric department of the hospital. Out of these, 43 (51.2%) were males and 41 (48.8%) were females. Age range was between 02 months and 15 years, mean age being 9.4 <u>+</u> 4.49 years. Majority of cases (46.6%) ingested paraphenylene diamine accidentally, followed by suicidal intention (29.8%), homicidal intent (21.4%) and unknown motive in 2.4% cases. Of all, 49 (58.3%) died of poisoning and 35 (41.7%) survived. Of all the cases, 44 (52.4%) underwent emergency tracheostomy.</p> <p><strong>Conclusions: </strong>Paraphenylene diamine poisoning in children is an alarming trend. Although majority of the cases ingested it accidently but intake due to suicidal or homicidal reason were also high. Positive outcome was associated with higher age, carrying out early tracheostomy and mode of poisoning (homicidal cases had poorest outcome whereas accidental and suicidal pediatric cases had more chances of survival).</p> Sumera Akram, Muhammad Ahmed Khan, Imran Qaisar, Abdul Rehman, Wasif Ijaz, shafaq Khalid ##submission.copyrightStatement## Mon, 19 Dec 2022 09:37:43 +0000 Financial burden on the parents of children infected with extensively drug resistant Salmonella infection <p><strong>Background:</strong> Typhoid illness is a significant cause of morbidity in Pakistan. This study aimed to determine the financial burden on parents of children infected with extensively drug-resistant (XDR) salmonella infection.</p> <p><strong>Patients and methods:</strong> This observational study included 159 patients aged 6 months to 13 years admitted through OPD/ER of Karachi Adventist Hospital with the diagnosis of enteric fever and intravenous antibiotics started as per local antibiogram. To remove recall bias antibiotic cost before hospitalization was not included. All those patients who were culture positive for XDR salmonella, either continued or shifted to newer antibiotics as per susceptibility pattern were included. Depending upon the type and duration of antibiotic therapy cost was calculated in Pakistani rupee (1 USD = ~225 PKR).</p> <p><strong>Results</strong><strong>:</strong> Total 60.4% of patients aged less than 7.5 years; 62.3% were male, 41.5% from urban areas, 15.1% had graduated mothers, 27% had graduated fathers, 5.7% uses boiled water, and 1.9% typhoid vaccination. In 54.1% of patients antibiotic cost reached &gt;40k PKR. Patients with urban dwelling were 0.29 times less likely for higher cost, increase in duration of fever (&gt;7 days) at admission increased the cost 5.73 times, XDR samples found 13.5 time more likely for higher cost, and TLC between 4000 – 11000/mm<sup>3</sup> gave negative association with higher cost.</p> <p><strong>Conclusion:</strong> The burden of XDR salmonella infection is heavy and is related to urban residence, duration of fever at admission, and length of hospital stay.</p> M. Hanif Memon, Shahina Hanif, Farhan Saeed, Erum Saboohi, Muhammad Daniyal Zafar Malick, Abdul Hadi Hassan Mallick ##submission.copyrightStatement## Mon, 19 Dec 2022 09:33:27 +0000 Fungal osteomylitus in diabetic patients and COVID-19 <p><strong>Background: </strong>COVID-19 pandemic has become a big medical problem worldwide. In this era, COVID-19 patients’ along with diabetes mellitus are at an increased risk of developing opportunistic infections. This study demonstrate association of COVID-19 infection in patients having uncontrolled diabetes with the fungal osteomyelitis.</p> <p><strong>Subjects and methods:</strong> This prospective cross-sectional study was done at a Nishter Institute of Dentistry, Multan. Patients diagnosed with fungal osteomyelitis of jaw bones presented during April to December 2021 were included in this study. Data was collected from the patients regarding history of the disease, clinical diagnosis, imaging findings by plain radiographs and CT scans, histopathology. Association of disease process with diabetes and COVID-19 was analyzed in SPSS.</p> <p><strong>Results:</strong> Between the period April 2021 to December 2021, 23 cases presented in Nishter Institute of Dentistry Multan with fungal osteomylitus were diagnosed clinically and fungal organism was identified by immunohistochemical studies by PAS and GMA stains. 22/23 (95.6%) patients were with uncontrolled diabetes mellitus and 18/23(78.2%) gave the history of Covid 19 infection 2 to 3 months before with moderate to severe symptoms.11/23 (47.8%) gave the history of treatment with systemic steroid. Age range was 38-72 years of age with mean age 53.26. 12/23(52.1%) were males and 11/23 (47.8%) were females. 17/23 (73.9%) patients presented with pain in jaws with exposed bone and 6/23(23%) complained of pain and loose teeth in arch. In 22/23 (95.6%) involved jaw was maxilla. In one patient associated medical condition was hepatitis C virus infection also with diabetes. 2 patients were cardiac and 3 were hypertensive along with diabetes. One patient was previously treated with radiotherapy of mandible due to alveolar cancer. Only one (0.04%) patient was non diabetic.</p> <p><strong>Conclusion:</strong> There is increased incidence of fungal osteomyelitis of jaws mostly maxilla in diabetic and COVID-19 infected patients.</p> Shaheen Anjum, Noreen Rashid, Amjad Bari, Atif Zulfiqar, Mazhar Rasool, Shabana Asif ##submission.copyrightStatement## Mon, 19 Dec 2022 09:14:39 +0000 The role of bone marrow biopsy in patients with pyrexia of unknown origin <p><strong>Background: </strong>Pyrexia of unknown origin (PUO) is a major complication which remains undiagnosed. Different diagnostic test were used to arrive at final investigation. Bone marrow biopsy (BMB) plays a vital role in diagnosis of PUO. The objective of current study was to determine the role of bone biopsy in diagnosing various types of causes of pyrexia of unknown origin.</p> <p><strong>Patients and methods: </strong>A prospective cross-sectional study was conducted from 1<sup>st</sup> September 2018 to 28<sup>th</sup> February 2019 at Department of Hematology, Combined Military Hospital Lahore, Pakistan. The data of 120 patients who were remained undiagnosed for at least 1 week were enrolled. Standard procedures were used to obtain the biopsy specimens and bone marrow aspiration was sent for microbiological examination. All the demographic information was kept on a structured self-designed proforma. Data was entered and analyzed using SPSS v.24.</p> <p><strong>Results</strong>: Out of 120 patients recruited in the study there were 67 (55.8%) were from age group 16 to 35 years, were males (65.8%) and 65.0% patients were suffering from fever for more than 3 days. The majority of the participants (30%) were diagnosed with infections, fever due to reactive changes (10.0%), acute leukemia (14.2%), lymphoma (11.7%), chronic leukemia (10.0%), aplastic anemia (4.2%), multiple myeloma (2.5%) and 11.7% patients were undiagnosed</p> <p><strong>Conclusion:</strong> In the diagnosis of pyrexia of unknown origin, morphological and histological investigation of bone marrow plays a vital role. However, if it is combined with other diagnostic modalities such as radiological, microbiological, and serological examinations, the efficiency of diagnosis can be improved.</p> Shehneela Jabeen, Muhammad Farooq, Samina Naeem, Sadia Khan, Maria Farid, Asma Tasneem, Sahar Rabbani, Amara Hafeez ##submission.copyrightStatement## Mon, 19 Dec 2022 09:10:40 +0000 Evaluation of amnion versus calcium alginate as split-thickness skin graft donor site dressing: A randomised controlled trial <p><strong>Background:</strong> Split-thickness skin graft (STSG) covers patient’s primary wound, but, at the expense of a donor-wound which heals by secondary intention. This study evaluated the efficacy of amnion and calcium alginate dressings at STSG donor sites in terms of healing duration, patient comfort and incidence of infection.</p> <p><strong>Patients and methods:</strong> An open label randomised control trial was conducted during October 2018 to May 2019. Total 60 patients, aged 20-45 years, were randomly allocated to two equal groups. Amnion was applied to 30 donor sites in Group A and calcium alginate in 30 donor sites in Group B. Patients were phone-called on 1<sup>st</sup>, 3<sup>rd</sup> and 7<sup>th</sup> post-operative days and donor site pain scored using numerical rating scale. Donor site was opened on 10<sup>th</sup> postoperative day and signs of infection assessed. Lastly, the day on which donor site healed, revealing an epithelialized wound, was noted.</p> <p><strong>Results:</strong> Group A included 30 patients (11 females, 19 males) having mean age of 31.23 years and Group B included 30 patients (12 females, 11 males) having mean age of 31.30 years. Average pain scores on 1<sup>st</sup>, 3<sup>rd</sup> and 7<sup>th</sup> post-operative days were 7.6, 6.6 and 4.4 in Group A and it was 8.2, 6.5 and 4.4 in Group B. Two cases of amnion, 4 of calcium alginate got infected. Average healing duration was 11 days in Group A; and it was 14 days in Group B (p-value = 0.000).</p> <p><strong>Conclusion:</strong> Amnion shows quicker healing and better pain control than calcium alginate.</p> Roeya -E-Rasul, Bushra Akram, Zain Ul Abidin, Farrukh Aslam Khalid, Sheraz Raza, Kamran Khalid ##submission.copyrightStatement## Mon, 19 Dec 2022 08:05:53 +0000 Assessment of knowledge and behavior regarding cardiovascular diseases and their risk factors among medical students of a private medical college in Lahore <p><strong>Background:</strong> Cardiovascular diseases (CVD) are a major cause of premature deaths globally. The gap between knowledge and behavior regarding modifiable risk factors related to these diseases has been noticed in medical students and is associated with a high number of morbidity and mortality. The aim of this study was to assess knowledge and behavior regarding cardiovascular diseases risk factors among newly enrolled MBBS students.</p> <p><strong>Subjects and methods:</strong> This cross-sectional study was conducted from May to September 2021. A total of 140 first-year MBBS students participated including 80 females and 60 males. Data were collected through a self-administered questionnaire having 17 questions and two sections, one for knowledge assessment and the other for the behavior of participants regarding CVD risk factors.</p> <p><strong>Results:</strong> Major risk factors for heart disease identified by students included obesity (99.3%), high cholesterol (98.6%), hypertension (97.9%), lack of physical activity (95.7%), smoking (82.1%), older age (89.3%), family history of heart disease (73.6%) and diabetes (78.6%). Pertaining to personal history, 10% were smokers, 32.1% regularly consumed soft drinks and 79.3% reported having any physical activities. Significant differences were found between male and female students regarding knowledge of CVD risk factors such as smoking (p-value = 0.003). Similarly, significant differences were observed between male and female students heart health behavior such as cholesterol checkup (31.7% vs. 16.2%, p-value = 0.032), use of soft drinks (48.3% vs 20%, p-value = 0.001) and physical activity (90% vs. 71.2%, p-value = 0.007).</p> <p><strong>Conclusion:</strong> First-year medical students have good knowledge of CVD risk factors but the behavior, regarding practice to avoid these risk factors, needs improvement. It was also observed by comparison that male students have more knowledge of heart disease risk factors as compared to female students.&nbsp;</p> Muhammad Ashraf Choudhry, Hafiza Asma Riasat Ali, Bushra Amin, Tahira Ahsan, Nadir Abbas, Mujadad Ahmad Khan ##submission.copyrightStatement## Mon, 19 Dec 2022 07:58:10 +0000 Factors associated with low birthweight among newborns delivered at term in a tertiary care hospital in Lahore <p><strong>Background:</strong> Low birth weight (LBW) is an important risk factor that contributes to mortality of 15-20% of newborn globally. This case-control study was conducted to determine factors associated with low birth weight among new-born delivered at term in obstetrical and gynecological wards of the hospital.</p> <p><strong>Patients and methods</strong>: Mothers of 150 low birth weight babies born at term were taken as cases and 150 normal weight babies born at same day, were taken as controls. Mothers were interviewed on using a semi-structured and pretested questionnaire. The data was analyzed on SPSS Version 22.0. A p-value <u>&lt;</u>0.05 was considered statistically significant.</p> <p><strong>Results:</strong> Illiterate mothers had 2.332 odds of having low birth weight babies (0.03, 95% CI = 1.3317 to 4.152). Mothers from low socio-economic status had 3.54 odds of delivering LBW (p-value = 0.000, 95% CI = 2.184 to 5.94). The odds of having low birth weight babies was 4.004 times high in the mothers exposed to passive smoking (p-value = 0.000, 95% CI = 2.477 to 6.474). Hemoglobin value less than 10 gm/dl was found to be significantly associated with odd of having LBW 3.003 in anemic mothers versus non anemic mothers (p-value = 0.0027, 95% CI = 1.279 to 3.227). Mother with parity &lt;3 had 0.0933 odds of having low birth weight babies. Mothers having adequate antenatal care had 0.394 odds of having low birth weight babies.</p> <p><strong>Conclusion:</strong> Illiteracy, low socio-economic status, employment, anemia, tobacco smoke exposure and inadequate antenatal care were significantly associated with LBW.</p> Taskeen Zahra, Uzair Mumtaz, Nayyer Riffat, Faisal Mushtaq, Muhammad Hussain Cheema, Tahir Mahmud ##submission.copyrightStatement## Mon, 19 Dec 2022 00:00:00 +0000 Insulin deficient type 2 diabetics: Urgent need for enhanced research in Pakistan <p>Type 2 diabetes is classically associated with insulin resistance stemming from obesity along with relative pancreatic dysfunction to sustain this resistance.<strong><sup>1</sup></strong> In the recent past, Scandinavian researchers highlighted that a considerable proportion of type 2 diabetics are actually insulin deficient out of proportion to their insulin resistance.<strong><sup>2</sup></strong> These patients were younger, had low BMI, and more deranged glycemic control. Based on sophisticated tests measuring insulin secretion and resistance, high glycemia in this group was attributed more towards decreased insulin secretion instead of insulin resistance. This was described Cluster 2 or severe insulin deficiency diabetes (SIDD) in ANDIS data.<strong><sup>2</sup></strong> This data changed the perception about solitary attribute of insulin resistance in pathophysiology of type 2 diabetes, and the way we treat them on ameliorating insulin resistance predominantly.</p> <p>(continue reading on PDF file....)</p> Muhammad Naeem Afzal ##submission.copyrightStatement## Wed, 14 Dec 2022 04:35:16 +0000 Laparoscopic management of hydatid cyst of liver <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## Thu, 07 Apr 2022 05:31:12 +0000 The role of ocular coherence tomography angiography in the diagnosis of diabetic retinopathy and a comparison with the current gold standard fundus fluorescein angiography <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## Thu, 07 Apr 2022 05:26:54 +0000 Comparison of efficacy of electrocautery vs. cryotherapy in the treatment viral warts <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## Thu, 07 Apr 2022 05:17:53 +0000 Correlation of inflammatory biomarkers with disease severity in hospitalised patients of COVID-19 at presentation <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## Thu, 07 Apr 2022 05:05:37 +0000 Short term outcome of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction <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## Thu, 07 Apr 2022 04:54:51 +0000 Complications affecting outcome in COVID 19 patients admitted in high dependency unit Sir Ganga Ram Hospital, Lahore <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## Thu, 07 Apr 2022 04:51:31 +0000 Gender differences in the health status of the imprisoned population in Kot Lakhpat Jail in Pakistan <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## Thu, 07 Apr 2022 04:28:17 +0000 Protective role of omega 3 on histological status of liver of albino rats affected by energy drinks <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## Thu, 07 Apr 2022 00:00:00 +0000 Comparison of efficacy of single dose versus split dose prednisolone therapy in achieving remission in patients with nephrotic syndrome in children <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 ##submission.copyrightStatement## Thu, 07 Apr 2022 00:00:00 +0000 Evolution of telehealth and its future in Pakistan <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## Thu, 07 Apr 2022 00:00:00 +0000 Late sequelae of COVID-19 and its effect on the quality of life <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## Mon, 04 Apr 2022 06:32:19 +0000 Effect of video game addiction on the physical and mental wellbeing of adolescents of Karachi <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## Mon, 04 Apr 2022 06:18:31 +0000 Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy? <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## Mon, 04 Apr 2022 06:16:46 +0000 Pattern of dermatophytes among skin, hair, and nail specimens in a tertiary care hospital of Lahore <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## Mon, 04 Apr 2022 06:12:46 +0000 Effectiveness of trans-scleral cyclophotocoagulation for refractory paediatric glaucoma <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## Mon, 04 Apr 2022 05:53:12 +0000 Outcome of pars plana vitrectomy with pre-operative intra vitreal bevacizumab in diabetic patients with vitreous haemorrhage <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## Mon, 04 Apr 2022 05:45:45 +0000 Prospective analysis of factors affecting the surgical outcomes of pediatric depressed skull fractures <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## Mon, 04 Apr 2022 05:30:55 +0000 Impact of duration of occupational exposure on physical and mental health of construction workers in Lahore, Pakistan <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## Mon, 04 Apr 2022 00:00:00 +0000 Treatment response in prostatic neoplastic lesions using CyberKnife (stereotactic body radiation therapy) <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, Bakhtawar Memon, Shazia Kadri ##submission.copyrightStatement## Mon, 04 Apr 2022 00:00:00 +0000 Quantitative MRI T2 relaxometry of knee joint in early detection of osteoarthritis <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## Mon, 04 Apr 2022 00:00:00 +0000 Chikungunya virus: An emerging public health challenge for Pakistan <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:</li> <li>Begley A. Chikungunya vaccine effective in 98.5 percent of participants 2021 [cited 2022]. Available from:</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:</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## Sun, 20 Mar 2022 00:00:00 +0000 Culture and sensitivity patterns of bacteriological agents in children admitted to a tertiary care hospital <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## Tue, 07 Dec 2021 04:21:59 +0000 Diagnostic accuracy of toluidine blue in early detection of oral squamous cell carcinoma <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## Tue, 07 Dec 2021 04:17:45 +0000 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 <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## Tue, 07 Dec 2021 04:09:50 +0000 Spectrum of biopsied oral and maxillofacial lesions in a tertiary care hospital of Karachi, Pakistan <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## Tue, 07 Dec 2021 04:05:32 +0000 Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement <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## Tue, 07 Dec 2021 04:00:00 +0000 Awareness of parents of hearing-impaired children about the importance of speech-language therapeutic interventions <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## Tue, 07 Dec 2021 00:00:00 +0000 Inappropriate antibiotic use for respiratory infections in outpatient settings <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## Tue, 07 Dec 2021 00:00:00 +0000 Frequency of Anxiety and Depression in Dissociative Trance (Possession) Disorder <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## Tue, 07 Dec 2021 00:00:00 +0000 Evaluating the causative factors that lead to rejection of hearing aids among young adults having moderate to severe degree sensorineural hearing loss <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## Mon, 06 Dec 2021 00:00:00 +0000 Parental compliance for speech therapy of their hearing-impaired children using cochlear implants <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## Mon, 06 Dec 2021 00:00:00 +0000 Traumatic brain injury of childhood <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## Mon, 06 Dec 2021 00:00:00 +0000 Prevalence of insomnia and anxiety in university students during the COVID-19 lockdown: A cross-sectional study <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## Wed, 11 Aug 2021 01:52:54 +0000 Assessment of risk factors associated with pre-term labour in Tertiary care Hospitals, Lahore <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## Mon, 15 Mar 2021 00:00:00 +0000 Maternal and fetal factors contributing to neonatal outcome in Al-Tibri Medical College and Hospital <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## Mon, 15 Mar 2021 00:00:00 +0000 Neonatal outcomes of birth asphyxia in tertiary care hospital of low-income country <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## Mon, 15 Mar 2021 00:00:00 +0000 Screening of thyroid disorders in age and gender groups in a teaching hospital of Nowshera <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## Mon, 15 Mar 2021 00:00:00 +0000 Effect of anti-tuberculosis treatment on weight of tuberculous patients following up in Gulab Devi Hospital, Lahore <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## Mon, 15 Mar 2021 00:00:00 +0000 Association of anti dsDNA antibodies titer with non-renal manifestations of Systemic Lupus Erythematosus and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) <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## Mon, 15 Mar 2021 00:00:00 +0000 Effect of Furosemide and Spironolactone on urinary zinc excretion in rats <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## Mon, 15 Mar 2021 00:00:00 +0000 Hepatotoxic effects of Diclofenac and Febuxostat combination on mice liver function tests after oral administration <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## Mon, 15 Mar 2021 00:00:00 +0000 Assessment of knowledge related to COVID-19 among professionals and students: A cross-sectional study from Punjab, Pakistan <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## Mon, 15 Mar 2021 00:00:00 +0000 COVID-19 and Dengue: A potentially emerging healthcare challenge for Pakistan <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## Mon, 15 Mar 2021 00:00:00 +0000 Hemispheric encephalitis secondary to HAV <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## Mon, 15 Mar 2021 00:00:00 +0000 Comparison of prevalence of various ENT diseases and hearing impairment among children of government schools versus private schools of Mardan <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## Wed, 24 Feb 2021 15:38:06 +0000 Prevalence of vitamin D deficiency in type 2 diabetics and its association with glycemic control <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## Wed, 24 Feb 2021 15:26:45 +0000 Risk factors for development of dementia in Parkinson’s disease: Effect of family history <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## Wed, 24 Feb 2021 15:22:27 +0000 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) <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## Wed, 24 Feb 2021 15:17:17 +0000 The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT <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## Wed, 24 Feb 2021 14:52:02 +0000 Prevalence of celiac disease in irritable bowel syndrome patients: A single centre experience from a large teaching hospital of Lahore, Pakistan <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## Wed, 24 Feb 2021 14:43:11 +0000 Frequency of different histopathological types of esophageal cancer patients at oncology department of a tertiary care hospital in Karachi <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, Dr. Bhunisha ##submission.copyrightStatement## Wed, 24 Feb 2021 14:31:08 +0000 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 <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## Wed, 24 Feb 2021 13:53:15 +0000 Perception about central induction policy among postgraduate trainees of Punjab - a mixed method qualitative study <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## Wed, 24 Feb 2021 13:45:21 +0000 Diagnostic accuracy of PET/CT scan in evaluation of clinically suspected recurrent ovarian cancer <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## Wed, 24 Feb 2021 00:00:00 +0000 Burden of febrile neutropenia in paediatric oncology: Experience from Children’s Hospital Lahore Pakistan <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## Wed, 24 Feb 2021 00:00:00 +0000 Use of preoperative tranexamic acid in tonsillectomy with or without adenoidectomy to reduce primary haemorrhage <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## Sat, 26 Dec 2020 00:00:00 +0000 Cesarean scar endometriosis - a case report <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## Tue, 15 Dec 2020 10:58:35 +0000 Efficacy of 4% chlorhexidine in preventing neonatal umbilical cord infection <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## Tue, 15 Dec 2020 10:53:22 +0000 Serum free testosterone levels in polycystic ovarian syndrome patients and its correlation with clinical hyperandrogenism in Pakistan <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## Tue, 15 Dec 2020 10:46:10 +0000 Screening the adequacy of hydroxychloroquine prescription and monitoring of ocular toxicity in patients with rheumatic disease <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## Tue, 15 Dec 2020 09:12:49 +0000 Ameliorative effects of Spinacia oleracea on sperm morphology, count, and motility by normalizing the obesity-induced oxidative stress in Sprague Dawley rats <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## Tue, 15 Dec 2020 09:07:43 +0000 The Role of MDCT and 3D computed tomography in the assessment of maxillofacial fractures and their types: a tertiary care hospital experience <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## Tue, 15 Dec 2020 09:04:37 +0000 Pathological response rate in patients who achieve clinical response after neoadjuvant concurrent chemoradiotherapy in localized esophageal cancer <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## Tue, 15 Dec 2020 09:01:03 +0000 The outcome of the Trendelenburg procedure with stripping vs. no stripping in the management of varicose veins <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## Tue, 15 Dec 2020 08:54:14 +0000 Barriers to the access of oral health care facilities among adults: an exploratory study from Lahore <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## Tue, 15 Dec 2020 08:47:07 +0000 Role of sleep deprived EEG in undiagnosed epileptic patients with negative standard EEG <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## Mon, 27 Jul 2020 00:53:35 +0000 Hypomagnesemia in hemodialysis patients taking proton pump inhibitors <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## Wed, 15 Jul 2020 00:00:00 +0000 Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study <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## Wed, 15 Jul 2020 00:00:00 +0000 Patterns of serum CEA levels in different clinico-pathological variables of colorectal cancer <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## Wed, 15 Jul 2020 00:00:00 +0000 Gender difference in risk factors associated with ischemic heart disease in Lahore <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## Wed, 15 Jul 2020 00:00:00 +0000 Role of intravitreal ranibizumab for rapid recovery of central serous chorioretinopathy <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## Wed, 15 Jul 2020 00:00:00 +0000 Evaluation of Chicago sky blue stain against Potassium Hydroxide-Dimethyl Sulfoxide wet mount in the identification of dermatophytes <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## Wed, 15 Jul 2020 00:00:00 +0000 Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore <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## Wed, 15 Jul 2020 00:00:00 +0000 Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion <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## Wed, 15 Jul 2020 00:00:00 +0000 Posterior and lateral ponticles of atlas: An osteological study at Fatima Jinnah Medical University, Lahore <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## Wed, 15 Jul 2020 00:00:00 +0000 Internal limiting membrane peel with or without finesse flex loop assistance <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## Wed, 15 Jul 2020 00:00:00 +0000 Microbial contamination in a pediatric surgery operation theatre <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## Mon, 13 Jul 2020 01:36:58 +0000 Predictive value of CA 19-9 in patients with pancreatic tumours <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## Mon, 13 Jul 2020 01:24:43 +0000 Sofosbuvir plus Daclatasvir without Ribavirin for the Treatment of Chronic Hepatitis C in Patients with Decompensated Liver Disease <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## Mon, 13 Jul 2020 00:00:00 +0000 Comparison of health-related quality of life in children with normal hearing and those with cochlear implant at age of 4-6 years <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## Thu, 16 Apr 2020 16:24:56 +0000