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Objective: To evaluate and compare the efficacy of Electroconvulsive therapy (ECT) and Ketamine infusions in hospitalized patients suffering from major depressive disorder (MDD). Study Design: Comparative cross-sectional study. Place and duration of study: Armed Forces Institute of Mental Health, Rawalpindi Pakistan, from Feb to Apr 2021. Methodology: Forty in-patients diagnosed as having MDD were randomly allocated ECT/Ketamine intervention as per international standards. Either group of patients acted as a control for the other. Their Beck Depressive Inventory (BDI) scores before and after the completion of treatment cycles were assessed to determine their response to treatment. Results: The Ketamine-Group showed fewer depressive symptoms than the ECT Group. The depressive symptoms were reduced in 16(80.78%) patients after Ketamine infusions, while 15(77.78%) patients showed improvement after ECT sessions.In addition, the response to Ketamine was quicker. Conclusion: This study has reported that low dose Ketamine has a more rapid impact than Electroconvulsive therapy in improving symptoms of depression in major depressive disorder patients.

Objectives: To compare with and without flap removal of partially impacted mandibular third molars in terms of mean pain and mean swelling on the second post-operative day. Study Design: Quasi-experimental study. Place and duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from May to Nov 2021. Methodology: Sixty cases (30 in each Group) with partially impacted mandibular third molar with mesioangular impaction aged 18-45 years were included. Random allocation of patients was done to the removal with flap (Group-A) and without flap (Group-B). On the second post-operative day, the outcome of pain and swelling in patients was measured based on the Visual Analogue Scale (VAS between 0 to 10 cm points for pain and swelling on a scale of 0 to 3). Results: The mean pain score was 5.67±1.30 in Group-A (with flap) versus 2.97±1.25 in Group-B (without flap) (p-value

Objective: To evaluate changes in corneal endothelium in patients with anterior uveitis by using specular microscopy and compare it with the corneal endothelium of healthy subjects. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun 2018 to Jun 2019. Methodology: This study included 65 eyes of 65 patients with anterior uveitis and 65 eyes of healthy subjects. Corneal endothelium was assessed in all participants of both Groups by using Specular microscopy. Corneal endothelial markers like central corneal thickness (CCT), cell density (CD), cell minimum area, cell maximum area, the average of cell size, percent of hexagonality (HEX%), coefficient of variation (CV) were compared in both Groups. The Uveitis Group was further subdivided into active and inactive Uveitis Subgroups, and corneal endothelium markers were also compared in these Subgroups. Results: The mean endothelial cell density was 2626.0±413.0 cells/mm² in patients with uveitis, whereas cell density was 2766.0±327.0 cells/mm² in healthy subjects. The difference in endothelial cell density was statistically significant between the Groups (p=0.03). The difference between central corneal thickness, maximum cell area, average cell size and hexagonality values between Groups was also statistically significant, whereas there was no difference in terms of cell minimum area between these Groups. There was no statistically significant difference between inactive and active uveitis when corneal endothelial markers were compared between them (p>0.05). Conclusion: There was an effect of uveitis on central corneal thickness, endothelial cell density, cell size, and morphology compared to healthy subjects,......

Objectives: To evaluate the success rate of probing and syringing for congenital nasolacrimal duct obstruction in children under local anaesthesia. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Niazi Medical Dental College, Sargodha Pakistan, from Jul 2018 to Dec 2019 Methodology: Forty-five children were included in the study, of which five had bilateral epiphora. Children of 8-12 months of age were included in this study. Probing and syringing were done under topical local anaesthesia. In this study, special modified straight 25D lacrimal probe cannula was used. Post-operative steroids and antibiotics were given to all the children for two weeks. Results: Forty Children (45 Eyes) of 8-12 months of age (less than one year) were included in this study. Single successful probing was achieved in 40 eyes (88.88%). Probing was repeated in five cases. Repeated successful probing was achieved in 3 eyes (60%) as the remaining two eyes (40%) where success was not achieved had a bone abnormality which needed an ENT examination and further intervention like Dacryocystorhinostomy (DCR) with close intubation. Conclusion: Topical local anaesthesia is a good alternative to general anaesthesia as it is not available, particularly in remote areas of Pakistan. It saves the children from the hazards of general anaesthesia and is a good choice for children who are not fit for general anaesthesia.

Objective: To compare the respiratory complications of COVID-19 among patients with rheumatological conditions taking bDMARDs and csDMARDs at Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative prospective study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Mar to May 2020. Methodology: Patients diagnosed with COVID-19 on polymerase chain reaction having previously rheumatological conditions managed either with bDMARD or cs DMARD were included in the study. They were followed up for three weeks after the positive polymerase chain reaction. Complications leading to the use of oxygen or ICU support or death were compared in both groups of patients. Results: A total of 82 patients with any rheumatological condition managed either with bDMARD or csDMARD tested positive for covid-19 on polymerase chain reaction and were included in the final analysis. 30 (36.6%) patients were taking bDMARDs while 52 (63.4%) were taking csDMARD. In addition, 4 (4.8%) low dose oxygen therapy, 5 (6.1%) required moderate dose oxygen therapy, while 5 (6.1%) required severe dose oxygen therapy or intensive care unit support. 2 (2.4%) patients died within the three weeks. The requirement of moderate or severe dose oxygen and intensive care unit support was found statistically significantly more in the group taking csDMARDS. Conclusion: The presence of complications of COVID -19 and the requirement of oxygen and intensive care unit support were present in some of the patients taking DMARDs. Among the DMARDs, bDMARDs were less linked with complications, but large studies with better design required better results.

Objective: To gauge the frequency of iron deficiency anaemia among chronic renal disease patients and factors related to the presence of anaemia at our hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, Nine months, Sep 2019 to May 2020. Methodology: Three hundred patients suffering from the chronic renal disease were included in the study. Iron deficiency anaemia was diagnosed based on haemoglobin and ferritin levels. In addition, the relationship between age, gender, duration of chronic kidney disease and stage of chronic kidney disease was assessed with the presence of iron deficiency anaemia among the patients suffering from chronic kidney disease. Results: Out of three hundred patients studied, 139 were males, and 161 were females. Out of 300 patients with chronic kidney disease included in our study, 159 (53.0%) showed the presence of iron deficiency anaemia, while 141 (47.0%) had no anaemia. Chi-square analysis showed that female gender, long duration of illness and more severe illness had a significant association with iron deficiency anaemia among the patients with chronic kidney disease. Conclusion: High frequency of iron deficiency anaemia among the patients of chronic kidney disease in a tertiary care hospital of Pakistan. Routine screening for anaemia should be done, especially on female patients and patients with more severe and long-standing illnesses.

Objective: To see the clinical and immunological profile of systemic lupus erythematosus (SLE) patients and their correlation with the central nervous system and renal involvement. Study Design: Cross-sectional study. Place and Duration of Study: Fauji Foundation Hospital Rawalpindi from Sep 2019 to Sep 2020. Methodology: One hundred forty patients were selected according to SLE ACR (American College of Rheumatology) criteria. Detailed history and examination, including dermatological examination, were done, and blood samples were taken for baseline investigations and SLE-related autoimmune profile. Statistical analysis was done using SPSS 23 to determine the correlation between skin, central nervous system and renal involvement. Results: In our study, among the lupus-specific lesions, photosensitivity was most frequent 119 (85%) finding followed by oral ulcers 114 (81.4%), alopecia 112 (80%) and malar rash 81 (57.9%). Among the immunological profile, antinuclear antibody (ANA) was the most frequent 116 (82.9%) finding, followed by anti-double stranded antibody 71 (51.7%). Hypocomplementemia and anti-Sm antibody was significantly associated with lupus nephritis (p-value

Objective: To ascertain the diagnostic accuracy of raised neck circumference to thyromental distance ratio (NC/TMD) for difficulty in intubation among patients with obesity keeping grades III and IV of Cormack and Lehane's score as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Rawalpindi, from Jul to Dec 2017. Methodology: One hundred and thirty obese patients who had to undergo surgery under general anaesthesia were included in the study. All the patients underwent measurement of neck circumference to thyromental distance ratio, and raised neck circumference to thyromental distance ratio was noted. Difficult intubation was labelled according to the grades III and IV of Cormack and Lehane's score. Results: In this study, 130 cases were included. Fifty-eight patients were males, and 72 were females. Diagnostic accuracy of raised neck circumference to thyromental distance ratio for difficulty in intubation among patients who were obese, was recorded where sensitivity was 83.87%, and specificity was found to be 91.92%, positive predictive value as 76.47%, negative predictive value as 94.79%, the accuracy rate was calculated as 90%. Conclusion: Our study showed that difficulty in intubation is more frequent in patients who are obese and the neck circumference to thyromental distance ratio is a reliable method for foreseeing difficult intubation compared to other established predictors with cut off value of 5.0.

Objective: To determine the lactic acid and lactate dehydrogenase levels in synovial fluid and differentiate between inflammatory and non-inflammatory arthritis. Study Design: Cross-sectional study. Place and Duration of Study: Department of Rheumatology, Liaquat National Hospital, Karachi, from Feb to May 2019. Methodology: All patients of age >18 years, of either gender, who presented with knee joint effusion were enrolled in the study. Synovial fluid aspiration for the analysis of lactate and lactate dehydrogenase (LDH) was done for all patients. Results: Seventy-seven patients were enrolled, of which 75 were included in the analysis. Two patients were excluded as one had lymphoma and the other had recent joint trauma. 31 (41.3 %) patients had non-inflammatory, or osteoarthritis, and 44 (58.7 %) had inflammatory arthritis. The mean value of synovial LDH in inflammatory and non-inflammatory arthritis was 737.38 ± 102.76 mmol/L and 265.5 ± 17.43 mmol/L, respectively, (p0.05). The plasma lactate in inflammatory arthritis and noninflammatory arthritis was 12.84 ± 0.59 mg/dl and 12.97 ± 0.78 mg/dl, respectively (p>0.05). Conclusion: Synovial fluid lactic acid and synovial LDH can serve as rapid diagnostic and cost-effective tests to differentiate between non-inflammatory and inflammatory arthritis.

Objective: To compare the effect of Dexmedetomidine and Nalbuphine premedication on changes in hemodynamics and neuroendocrine stress response under general anaesthesia by analyzing the variation of perioperative serial blood glucose levels. Study Design: Prospective comparative study. Place and Duration of Study: Services Hospital, Lahore Pakistan, from Oct to Dec 2020. Methodology: Total 90 patients aged between 30-and 65 years were allocated randomly into three groups. Group-D patients (n=30) were administered Dexmedetomidine 0.5 μg/kg in 100 ml normal saline, group-N (n=30) were given Nalbuphine 0.1 mg/kg in 100ml saline, and group-S received saline (100ml) throughout 15 minutes before induction of anaesthesia for laparoscopic cholecystectomy. General Anaesthesia was administered. Intra-abdominal pressure was maintained after abdominal insufflation with carbon dioxide between 12-15 mmHg. Blood glucose levels were analyzed preoperatively, 30 minutes after the beginning of surgery, at extubation and 2.5 hours postoperatively. Hemodynamic changes were recorded after premedication, 15 and 30 minutes after pneumoperitoneum and extubation. Results: Random mean blood sugar levels were 135.23 mg/dl with Dexmedetomidine and 123.33 mg/dl with Nalbuphine and 122.53 mg/dl in saline group (p

Objective: To evaluate the effectiveness of using anesthesia at 42°C (107.6°F) for the insight of pain as dental sedative in contrast to its administration at room temperature 21°C throughout the procedure of maxillary infiltration. Study Design: Double-blind, Split-Mouth randomized clinical trial (Clinical trial number: ISRCTN79560957) Place and Duration of Study: Department of Armed Forces Institute of Dentistry, Rawalpindi, from Jan to Jun 2021. Methodology: A total of 38 patients were examined, undergoing maxillary premolar extractions for orthodontic purposes. Group- A received local anesthesia injection with the anesthesia warmed to 42°C (107.6°F) and group- B patients receiving local anesthesia injection with anesthesia at room temperature. The injection point was placed in the mucobuccal fold apically in the middle of maxillary premolars using a 27G short needle and injecting 0.9 mL of the anesthetics at the speed of 0.15 mL/second. Patients were instructed to grade intensity of pain on Visual analogue scale. Results: According to the Visual analogue scale score, the level of pain perceived with the anesthesia at 42°C (107.6°F) in group-1 was 3.81 ± 1.48 and the level of pain perceived with the anesthesia at temperature 21°C in group-2 was 5.57 ± 1.50 with statistically significant result (p=0.001). Conclusion: The use of anesthesia at 42°C (107.6°F) significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections.

Objective: To assess the clinical spectrum and various etiological factors of idiopathic intracranial hypertension in Pakistani patients. Study Design: Cross-sectional study. Place and Duration: Neuro-Ophthalmology Clinic, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2017 to Jul 2018. Methodology: A total of 64 individuals with intracranial hypertension (IH) were screened. On the basis of inclusion criteria 32 patients were selected for the study. The demographics, clinical features and etiologies were recorded for each patient. Results: High frequency was noted among females, affecting 26 (84.37%) as compared to males who were 6 (18.75%) in number. Half of the patients had body weight lying in range of overweight, 16 (50%), however, only 5 (15.6%) patients fell into the category of obesity. Among clinical features, headache was the most prominent symptom seen in 17 (53.12%) patients and severe disc swelling seen in 19 (59.3%) was the most common sign. Most prevalent systematic association was anemia, 11 (34.3%), and the most prominent etiology was idiopathic intracranial hypertension, being 26 (81.25%). Conclusion: There was high frequency of intracranial hypertension in the females with obesity, pregnancy and in the age group of 20-30 years.

Objective: To assess and compare the effect of Salbutamol and Furosemide therapy in the management of transient tachypnea of newborn. Study Design: Randomized controlled trial (Registered with Clinical Trials.gov: NCT03208894). Place and Duration of Study: Neonatal Intensive Care Unit of Pakistan Emirates Military Hospital Rawalpindi from Oct 2019 to May 2020. Methodology: A total of 100 newborns were included in the study. They were divided into 4 groups. Group-A received nebulized 0.1ml Salbutamol. Group-B was given single intravenous dose of injection Furosemide at the dose of 2mg per kg. Group-C received both IV Furosemide and nebulized Salbutamol. Control group-D received only supportive care. Results: There were 48 male babies and 52 female babies. The average gestational age was 38.8 ± 6.2 weeks and the average birth weight was 2558 ± 620 grams. Administration of both Salbutamol and IV Furosemide together (group-C) showed significant reduction in the mean duration of oxygen dependency compared to control-group (13.40 ± 3.342 vs 83.64 ± 68.546 hours respectively (p

Objective: To determine the frequency of diastasis recti abdominis and its associated risk factors in postpartum women. Study Design: Cross-sectional study. Place and Duration of Study: Omar Medical Center Lahore, Yaseen Medical Center Lahore and Social Security Hospital Lahore, from Sep 2019 to Dec 2019. Methodology: This study included 128 participants fulfilling the eligibility criteria. The assessment of diastasis recti abdominis was done manually by a female physiotherapist using single finger, double finger and three finger methods on abdomen at three levels: at the umbilicus, 4.5 cm below and above the umbilicus. Results: The frequency of diastasis recti abdominis out of 128 participants was 97 (75.8%). Out of 128 participants about 38 (29.7%) were primigravida and 90 (70.3%) multigravida. Statistical significance (p=0.015) was found between presence of diastasis recti abdominis and number of pregnancies (gravidity). No association was present between diastasis recti abdominis and delivery method (p=0.09). The p-value (0.56) showed no significant association of diastasis recti abdominis with pelvis floor dysfunction and urinary incontinence. Conclusion: The findings of this study concluded high frequency of diastasis recti abdominis in postpartum women. As the number of pregnancies increased, it decreased the integrity of linea alba and caused the separation of rectus abdominis muscle.

Objective: To highlight Pakistani Students anxieties and their attitude towards the circumstances created by the COVID-19 pandemic and to bring forth this data for better policy revisions in the country. Study Design: Cross-sectional study. Place and Duration of Study: Different cities of Pakistan, from May to May 2020. Methodology: A structured self-administered questionnaire was prepared, based on other surveys conducted in the past. Questionnaire was made available online and shared across social media sites with students. All students of Colleges and Universities who had access to internet were included in the study. Results: Total study population was 731 students. We found that around 320 (44%) of students felt anxious daily due to COVID-19 while 438 (60%) of them were not content with the current measures to stop the spread of the virus. 636 (87%) of the students feared for the health of their family members while 584 (80%) felt anxious for their academic future due to the unprecedent circumstances created by the disease. 387 (53%) had decided not to go to hospitals in case of any illness other than COVID-19. Approximately 400 (55%) believed that the situation was worse than actually being portrayed. Females generally were found to be more anxious than males regarding their health and health of their family members (p-value 0.001 and 0.003 respectively). Conclusion: There is a dire need of establishing mental health services in educational institutions. Despite the students’ generally correct approach towards curbing the spread of COVID-19, they are still much apprehensive regarding the situation surrounding the pandemic due to the disturbance of their academic and everyday life.

Bilateral Acute Iris Transillumination is a rare entity characterized by pigment dispersion, raised intraocular pressure and sluggish pupils. It usually follows systemic infections. A mid aged female presented with photophobia, visual blurring and ocular pain. Bilateral ocular examination revealed patchy loss of iris pigment epithelium, pupillary atrophy, and persistent mydriasis and raised intra ocular pressure. She had history of acute respiratory infection treated with oral moxifloxacin one month before onset of her ocular discomfort. Her ocular symptoms were managed with topical pressure lowering drugs and steroids which improved over a period of 6 to 9 weeks, however, pupils remained slightly dilated.

Objective: To explore professional dilemmas and ethically difficult situations faced by maxillofacial surgeons in conservative society of Pakistan. Study Design: Qualitative narrative analytical study. Place and Duration of Study: December 2015 to May 2016 was carried out including faculty from public, private and Armed Forces Hospitals in Pakistan. Material and Methods: A narrative inquiry approach was used with in-depth interviews of nine maxillofacial surgeons involved in teaching and clinical work in tertiary care hospitals of public, private and armed forces hospitals. The interviews were transcribed verbatim and data cleansing was done. Qualitative narrative analysis of interviews was done manually. Results: Thirty-five different situations were shared by the participants. The dilemmas were categorized according to the roles and identity of participants as clinicians, educator and assessor. The majority of dilemmas were related to clinical role (16) with the descending order in educator (12), multiple roles (4) and assessor (3) related dilemmas. Conclusion: All participants faced dilemma situation in their professional life. They responded to those situations according to their own way not following any specific guidelines. The situations narrated by participants were not very different from those reported by general surgeons, physicians and nurses. The situation related to identity was peculiar to maxillofacial surgeon and might be due to emerging speciality in the region.

Objective: To determine and compare serum homocysteine (Hcy) levels in primigravidas in second and third trimesters of normal pregnancy and preeclampsia. Study Design: Cross-sectional comparative study. Place and Duration of Study: Study was conducted at department of Gynecology and Obstetrics, Lahore General Hospital, from June 2013 to May 2014. Material and Methods: One hundred primigravida patients of normal pregnancy and preeclampsia of second and third trimester were evaluated in terms of parameters including blood pressure and Hcy. The subjects were further subdivided into four groups. Age of patients was ranging from 18 to 40 years. Results: The age of selected hundred subjects ranged from 18 to 40 years, while the mean ± SD age was 25.92 ± 5.56 years. Systolic blood pressure ranged from 100 to 210 mmHg, (mean ± SD 136.3 ± 24.623 mmHg). The recorded diastolic blood pressure ranged from 70 to 130 mmHg, (mean ± SD 87.8 ± 15.736 mmHg). There was a significant difference in Hcy amongst pre-eclamptics and controls of 2nd and 3rd trimesters and also between controls of 2nd and 3rd trimesters and cases of both 2nd and 3rd trimesters (p

Objective: To analyze the position of the mental foramen in relation to gender and side using Cone-beam Computed Tomography (CBCT) images for providing the grounds for a better understanding of the anatomy of the region leading to better treatment planning and outcome. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Department of Oral & Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi from Dec 2014 to May 2015. Material and Methods: The study included CBCT images of 64 patients (32 male & 32 females) above the age of 18 years obtained from the main departmental data. Position of the MF was analyzed using the 3D reconstruction of the images in relation to the long axis of associated teeth in mandibular arch. In addition, pattern of emergence of the foramen (using axial section) and presence of accessory mental foramen was also noted. Results: In our study group the most common position of the MF associated with second premolar (54.7%) on right side and 67.2% on left side. Straight pattern of E was found most commonly both on right (62.5%) and left (47.5%) sides. AMF was found in total 4 cases on right side (6.3%) and in one case on left side (1.6%). Conclusion: Although the MF is most commonly associated with second premolar however variation in anatomy and presence of AMF should always be kept in mind while performing surgery in the area to avoid the neurosensory disturbance.

Objective: To determine the frequency of awareness in mothers about the risk factors of asthma in children aged 1-12 years, attending pediatric department, Combined Military Hospital, Quetta. Study Design: Descriptive, cross sectional study. Place and Duration of Study: The study was conducted at department of Pediatrics, Combined Military Hospital Quetta. Duration of the study was six months from Oct 2011 to Apr 2012. Material and Methods: All the mothers of children with asthma were selected for this study. Informed consent was taken from all the patient’s parents participated in the study. Every patient was assigned a serial number. Detailed history about risk factors was taken by the researcher and all the information entered in the proforma and collected data was analyzed by SPSS version 22. Results: Total 150 mothers were included in study. There were 9 (6.0%) mothers who had awareness of any relation between breast feed and the risk of asthma in children, 15 (10%) mother had awareness of relation between pet animals / birds and the risk of asthma in children, 3 (2%) mothers had awareness of relation between carpets at home and the risk of asthma, 24 (16%) mothers had awareness of relation between cigarette smoke and the risk of asthma in children. There were 15 (10%) mothers who had awareness about relation between food and the risk of asthma, 3 (2%) mother had awareness of relation between repeated use of medicines in children under six months of age and the risk of asthma, 5 (3.3%) mothers had awareness of relation between the use of pillows and the risk of asthma, 3 (2%) mothers had awareness of relation between the presence of cockroaches in child’s bedroom and the risk of asthma in children. Conclusion: In Quetta region, mothers had lower frequency of awareness among mothers regarding pediatric (112 years) asthma development and its associated risk factors.