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Objective: To evaluate the incisor mandibular plane angle (IMPA) among the Pakistani population. Study Design: Cross-sectional Learning. Period: 1st January 2019 till 30th June 2019. Setting: Department of Orthodontics, University College of Dentistry The University Lahore. Material & Methods: 100 participants were incorporated in the learning by following inclusive standards. Demographic history i.e. name, age, gender, contact, and outcome variable i.e. IMPA value was recorded in a pre-designed proforma. Tracing of lateral cephalogram diagnosed as Class II Division I malocclusion was done by placing the Matte Acetate tracing paper over the radiograph. IMPA was used to assess the lower incisor inclination parameter Data were analyzed by using SPSS-20. Post-stratification students’ t-test was smeared with p-value ≤ 0.05 as significant. Results: Out of 100 subjects, 44 subjects were males while the 56 subjects were females. The mean IMPA among all the patients were found to be 107.71°±3.89°. Whereas, the mean IMPA in male and female subjects was 106.91°±3.62° and 108.34°±4.01°, respectively. Similarly, the mean IMPA in non-obese subjects was 107.81°±3.81° and in obese subjects was 107.13°±4.41°, respectively. However, a non-significant relationship was found between both factors. Conclusion: The mean IMPA in patients with “Class II Division I malocclusion” is 107.71°±3.89° with a minimum and maximum value of 100° and 117° which may be incorporated for the treatment plan among Pakistani population. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between type 1 diabetes mellitus development, breastfeeding and early cereal introduction in Pakistani children. Study Design: Case-control study. Setting: Allied Hospital in Faisalabad, Pakistan. Period: November 2023 to February 2024. Methods: Involving 220 children ranged from 2 to 10 years were selected for case (diagnosed with type 1 diabetes) and Control group (without diagnosed with type 1 diabetes). Researchers developed a questionnaire based on information about breastfeeding, cereal introduction and other factors associated with type 1 diabetes. Parents were requested to complete the questionnaire regarding their child, mother, and family. Results: The mean ages of children were slightly higher in the control group (6.2±5.5 years) compared to the case group (5.67±7.4 years). This research determined that a one-month cumulative increase in exclusive breastfeeding for the duration of the breastfeeding period decreased the individual risk by 47.8% to 13.9% less probability in type 1 DM case. Among cases, 47.8% of the children were exclusively breastfed for less than one month, which was very low, while in the control group, this proportion was lower at 30. 6%. Furthermore, more cases (22.6%) were exclusively breastfed for 6 months compared to controls (13.9%). Among cases, 45.5% of children did not consume formula, whereas in the control group, this percentage was lower at 54.2%. Additionally, a higher proportion of controls (39.8%) were introduced to the formula before 6 months compared to cases (30.0%). Cereals were introduced to 5.55% of cases and 3.12% of controls prior to six months of age. Conclusion: Children who were breastfed for a longer period of time had a lower chance of type 1 diabetes, while children who were introduced to cereal and other food at an early age had a higher risk of the disease. Extended breastfeeding lowers the risk of diabetes by offering important protective effects from birth. [ABSTRACT FROM AUTHOR]

Ageing is exactly the organic process of growing older and showing the effects of increasing age. The state of Pakistan is caught in the complicated web of various socioeconomic and political problems. In such scenario, efforts to voice the rights of elderly seem a bit surprising and out-of-priority box. Objective: The paper attempts to serve as an eyeopener for the policy makers both in public and private sectors to interrelate the factors deemed imperative for taking concrete steps to redress the menace arising out of ignoring ageing and dropping it from the national development agenda. Materials and Methods: Structured interview schedule was developed to collect information on Older Persons' health, economic and psychological status. In this regard, an extensive questionnaire was designed and pretested vigorously. Study Design: This paper is extracted out of the base-line exploratory study. Setting: Rawalpindi city. Period: Oct 2013 to Dec 2013. Results: 69.3% OPs reported various diseases, 19.7% respondents never visited the doctor. 25.1% respondents' last visit to the doctor was between six months to more than a year. 15.3% visited the doctor for a medical treatment. Older persons with no permanent income made them more vulnerable to suffer various illnesses. Conclusions: Pakistan is not an aged-friendly country that even lacks a policy at national level for the welfare rights of older persons. [ABSTRACT FROM AUTHOR]

Research training at higher education level for clinical and teaching staff is important and there are methods to introduce research culture in employees at clinical and teaching departmental level. Objectives: To recognize and quantify the research productivity status of teaching and clinical faculty of (DUHS) Dow University of Health Sciences Karachi before and after its establishment in 2003. Design: Non experimental cross sectional study. Period: 1st October 2012 to 1st February 2013. Setting: Medical college Karachi. Subjects and method: Students of third semester were applied to sort out the ten years record from 1998 to 2008 of all researches conducted by faculty of Dow University of Health Sciences, published in international and national journals by using different online search engines. Research Output was measured in terms of the increase in the number of publications and quality of publications before and after the launch of Dow University. Data was entered in Microsoft office excel version 2007 and analyzed it in statistical package for social sciences (SPSS) version 17; Pearson chisquare was applied to test the statistical significance at 95% confidence interval. Results: Data of total 594 researches was found out between the years 1998 to 2008, 175(29.5%) researches were published before the foundation of Dow university of Health sciences Karachi (2003) while 419(70.5) researches were produced after 173(45.6%) research papers were published in indexed journals before, "whereas" 206(54.4%) were published in indexed journal after 2003. Original research articles were 152 (31%) before 2003, which rose to 339 (69%). Publications of article types such as case reports, case series, and short communication, editorials and review articles also increased to 80 from 23 after establishment of Dow University. Conclusions: From a total of 594 faculty researches o published in indexed and non indexed journals between the years 1998 and 2008; there was a significant increase in production after establishment of Dow university of Health Sciences Hence it is confidently reported that due to establishment of research committees after the founding, there is a promotion and facilitation of research activities among faculty members. [ABSTRACT FROM AUTHOR]

Objective: To study the mandibular changes in the β-thalassemia major patient. Study Design: Cross sectional study. Setting: Husaini Blood Bank and Institute of Hematological Diseases Karachi, Department of Oral and Maxillofacial Surgery, and Department of Orthodontics, Baqai Dental College Baqai Medical University, Karachi. Period: January 2023-December 2023. Methods: 50 Orthopanthogram (OPG) radiographs of beta-thalassemia major patient were taken, analyzed and compared to check any variation from normal. Fifty diagnosed β-thalassemia major patients were voluntarily selected through convenience sampling. The study was carried out in collaboration of Husaini Institute of Blood Diseases Karachi, National institute of Oral Diseases Karachi Pakistan and, Department of Oral and Maxillofacial Surgery and department of orthodontics Baqai Dental College Baqai Medical University. Results: 18 (36%) patient's alteration of trabecular pattern are present and in 32 (64%) patient alteration of trabecular pattern absent. Similarly, in 16 (32%) patients have short spiky roots are present and 34 (68%) patients short spiky roots absent. Conclusion: Effect of anemia is not so profound in mandible of thalassemia patients from population of Karachi. [ABSTRACT FROM AUTHOR]

Objective: To assess for any peculiar lip prints in relation to the lip shapes of individual, and determine the most common lip print type among the members of biological families. Study Design: Descriptive study. Setting: Department of Forensic Medicine & Toxicology, Women Medical & Dental College, Abbottabad. Period: January 2018 to June 2018. Material & Methods: A total of 216 individuals (father, mother, both children's), who underwent descriptive study of lip impression collection without any anesthesia or drug, were enrolled into the present study. Father, mother and two babies of each family were selected. Lip prints of Father, mother and both babies of each family were recorded. Each lip of 54 offspring's was compared with the corresponding lip of his/her father mother and other baby. The segments of each lip of the offspring's that matched/ resembled with either of father mother and biological babies were recorded. Results: Out of 54-total families, biological babies of 19(35.18%) families observed resemblance with father, whereas biological babies of 35(64.81%) families observed resemblance with mother. There was no definite identical lip print observed in any of the children. Furthermore, the prevalence of Type II lip prints was higher type present in males and in females. We observed that lip shape 7 was the most frequent lip shape type in most of individuals. Conclusion: Lip prints of study participants did not clearly match with each other, evenly distributed in both genders and distinctive similar to finger prints. The data did not show any specific association of the lip print type with lip shape. It is considered feasible to apply lip prints features in personal identification. [ABSTRACT FROM AUTHOR]

Health care is the crucial and fundamental right of every human being. Quality health care is the strong desire of every human being. Quality is considered as one of the prime pillar of differentiation in services. Service quality is lifeline of organizational success. This paper throws a public eye on patient's expectations and the satisfaction level pertaining to quality of service provided by public hospitals. Objectives: (1) To dig out the quality of service in public teaching hospitals of Lahore, Pakistan by using SERVQUAL model. Study Design: Quantitative Study. Period: Sep 2014 to Oct 2014. Setting: Five Teaching Hospital, Jinnah Hospital, Mayo Hospital, Services Hospital, General Hospital, Sir Ganga Ram Hospital, Lahore which are the Medical Giants of Pakistan. Material & Methods: The research is carried out on primary data, recording 250 responses from target audience by using structure questionnaire. Regression and correlation analysis were performed to confirm a relationship between Service Quality dimensions and patient satisfaction. Results: Study shows that empathy is the most important factor that brings happiness and satisfaction to the patients. Conclusions: Research findings are fruitful for health department and hospital administration to plan strategies in order to improve service quality and become benchmark for others in industry. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate the efficacy of EMDR in complex multiple psychological trauma after failed drug treatment from selective serotonin reuptake inhibitor (SSRI) in a diagnosed case of post-traumatic stress disorder (PTSD). Method: Single participant of this case study, a sitting session judge of judicial governmental scaffold reported to this mental health tertiary care facility at his own accord with features of intense anxiety, depression, maladjustment issues and post- traumatic stress for a duration of several months. As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address his symptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low self-esteem, inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal and inability to perform as a judicial head in active war stricken area of northern Pakistan. Complete psychiatric evaluation was carried out and after the discontinuation of SSRIs he was scored on Impact of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by the English version of the PTSD module of the Structured Clinical Interview for DSM-IV administered once before commencement of EMDR. Safe place of the client was established and 8 staged protocol of EMDR was started with him. Multiple EMDR sessions were conducted. Result: The case presented in this paper had multiple psychological trauma forms and failed drug treatment and yet it was observed that EMDR provided marked improvement in all the domains of his deficits and this was at a prompt speed as compared to cognitive behavioural therapy (CBT) which usually takes longer duration of therapy to achieve similar results. Conclusions: EMDR provides marked improvement in all domains of complex mental trauma and traumatic memories. Improvement attained was prompt and enduring as compared to other forms of established therapies and drug treatment indicating permanent changes happening at neurobiological levels of brain. [ABSTRACT FROM AUTHOR]

Neonates born to diabetic mothers are more prone to develop congenital anomalies and defects. Overall risk of development of congenital malformations increases by 2-12% compared to normal neonates. In Pakistan, the true prevalence of CHD is unknown. Objectives: To determine the frequency of congenital heart diseases in infants born to diabetic mothers (IDM). Study Design: Cross Sectional Study. Setting: Department of Pediatrics, Allied Hospital, Faisalabad. Period: Six month, August 16, 2017 to February 16, 2018. Material & Methods: Total 295 neonates born to diabetic mothers diagnosed presenting in neonatal unit were enrolled in study. Chest X-ray, electrocardiography (ECG) and echocardiography were done to identify CHDs. Results: Total 292 infants born to diabetic mother were selected. Mean age of the patients was 10.1±5.9 days. Of total, 189 (64.7%) were males and 103 (35.3%) were females. Out of 292 infants of diabetic mothers, 138(47.3%) were having various (CHD) and remaining 48(47.5%) were found normal after echocardiography. Conclusion: The cardiovascular system along with other systems of the body of neonates is affected in about 50% of the neonates born to diabetic mothers. Early diagnosis of CHD using a screening echocardiography is recommended to morbidity and mortality. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are a major burden to the health care as it is estimated that around 150 million UTIs occur yearly worldwide. Enterobacteriaceae are the most common agent causing serious urinary tract infections; and multi drug resistent (MDR) cases are increasing day by day. Objectives: To determine the frequency and patient demographics of multidrug resistant urinary tract isolates of Escherichia Coli in a Tertiary Care Hospital. Study Design: Retrospective cross sectional study. Setting: Department of Medicine, Madinah Teaching Hospital / The University of Faisalabad, Faisalabad. Period: May 2016 to Sep 2018. Material & Methods: 187 patients of age 15 to 90 years with positive E. coli on urine culture and sensitivity were included in this retrospective cross sectional study. All those patients with history of dysuria (pain during urination) or frequent urination (more than 7 times per day) were advised urine complete analysis and those with >5 WBCs or pus cells /HPF or having positive for leukocyte esterase and/or nitrite, were advised urine culture and sensitivity. Main outcome variable was the frequency of MDR cases among the culture positive E. coli UTI patients. Results: Among all the cases of E. coli UTI, frequency of MDRE UTI was 66.8% (n=125) and rest 33.2% (n= 62) cases were not MDR UTI. 97.3% patients were resistant to lactam antibiotics, 95.7% were resistant to quinolones and 68.4% were resistant to aminoglycosides. Conclusion: With the rise in the microbe’s resistance to multiple drugs, new therapeutic strategies are to be designed after analyzing our population’s susceptibility pattern. It is not less than a challenge for physicians of a developing nation like Pakistan to treat MDR E.coli UTI cases while taking care of the cost of treatment and controlling the disease burden at the same time. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Red blood cell distribution width (RDW) in people with type 2 diabetes and its relationship with glycemic control. Study Design: Retrospective study. Setting: Baqai Institute of Diabetology and Endocrinology, Baqai Medical University. Demographic, Clinical and Biochemical Data were retrieved from hospital management system of BIDE. Period: September 2018 to April 2019. Methods: Ethical approval was obtained from the Institutional Review Board of BIDE. Based on the HbA1c values, patients were divided into two groups, HbA1c < 7.0% and HbA1c ≥ 7.0%. RDW calculated from RBC histogram in Nihon Kohden fully automated analyzer. Results: RDW found 13.9±1.88 and 13.57±1.64 (p-value 0.018) in good and poorly controlled glycemic groups respectively. Poor glycemic group had higher levels of white cell count (9.58±4.34) and Triglycerides (170.12±129.13) (p-value <0.05), whereas controlled glycemic group demonstrated higher levels of BMI (29.03±6.01), MCV (84.36±7.81) and HDL (33.75±12.31). RDW was directly correlated with gender (p-value <0.0001) and duration of diabetes (p-value 0.01), and showed significant and inverse correlation with HbA1c. Age, blood pressure, duration of diabetes, serum LDL cholesterol, and the CBC values demonstrated no significant differences between the both groups. Conclusion: We found significant correlation between RDW and glycemic control. [ABSTRACT FROM AUTHOR]

Objectives: To present our experience of distraction osteogenesis in Metacarpal and Phalangeal lengthening of the hand and analyze the factors which influence the period of healing. Design: Experimental study. Period: December 2008 to April 2011. Setting: Department of Plastic and Reconstructive Surgery, Khyber Teaching Hospital, Peshawar. The patients were admitted through out-patient department and detailed history, clinical examination and necessary investigations were carried out. Informed consent was taken. Distraction has been performed in six metacarpal bones and four phalangeal bones in nine patients. The age ranged from 3 to 59 years. All the digits had traumatic amputations. The injury was in the right hand (dominant) in 6 patients and in the left hand in 3 patients. An isolated injury to the thumb was seen in 4 patients, while in the remaining patients other fingers had been injured. All patients were operated by the same surgeon using similar lengthening technique. Patients were followed regularly and assessed for bone lengthening by clinical and radiological methods. Results: The achieved elongation of the metacarpal bones varied from 26 mm to 30 mm (average 27.66 mm), and of the digital phalanges from 10 mm to 17 mm (average 13.5 mm). Average healing time was 2.05 months (range from 1.8 - 2.5). Average healing index was 0.75 month/cm (range from 0.65 - 0.88). Complications observed were pin tract infection (3 cases), necrosis of free grafted skin (2 cases), delayed spontaneous bone union (2 cases) and volar angulation (1 case). Webplasty was performed in all cases. Strength of pinch improved by an average of 37% and that of grasp by 48% compared to the preoperative values. All patients were able to pick up a paper and a cup of water. Conclusions: Distraction osteogenesis is a successful and reliable method for the lengthening of short metacarpals and phalanges. However, severe complications such as stiffness, angulation, subluxation of the MCP joint and delayed union or non-union are associated with this procedure. To avoid these complications, we suggest protection of the periosteum, refraining from distraction rates of more than 2×0.25 mm/day and, if possible, avoid lengthening a bone by more than 40% or not more than 20 mm of the preoperative bone length. [ABSTRACT FROM AUTHOR]

Personal identity is an attribute of a mankind which makes him or her unique. Cheiloscopy is one of the sciences which is used to study and examine the lip prints pattern in order to establish the personal identity in Forensic Medicine. Objective: To categorize lip patterns in female population of different divisions of Punjab, Pakistan according to Suzuki and Tsuchihashi's classification. Study Design: Descriptive, Cross-sectional study. Setting: The present study was conducted on 357 female medical students of 1st, 2nd and 3rd year of University Medical and Dental College, Faisalabad in the department of Forensic Medicine and Toxicology. Period: March-June, 2018. Materials and Methods: After obtaining informed consent students were asked to stand erect and their lip prints were taken on the glass slide. Next carbon black powder was dispensed on the slide and the latent lip print pattern was obtained. The slide was preserved by using cellophane tape and lip print patterns were scanned. These patterns were then categorized according to Suzuki and Tsuchihashi's classification by using Software Adobe Photoshop version 6.0. Results: The results showed that most participants were from central Punjab (70%) followed by Southern Punjab (19%), Western Punjab (9.6%) and Northern Punjab (1.4%). The most common lip print pattern was Type I (66%), second was Type II (17.3%), then Type IV (7.1%), after that Type III (5.1%), Type I'(2.5%) & last was Type V (1.7%). Conclusion: The most common lip print pattern in females of Punjab, Pakistan is Type I while the least common is Type V. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of long-term supplemental dose of Folic acid on the oestrous cycle of female Sprague Dawley rats. Study Design: Laboratory-based Experimental study. Setting: Department of Anatomy, CMH Multan Institute of Medical Sciences in Pakistan conducted this research. Period: September 2020 to September 2021. Material & Methods: In this study, 60 female Sprague Dawley rats were used and divided into two groups. The animals of control group A were given distilled water (1ml/100g) by oral gavage daily for four weeks. Folic acid was administered orally to the experimental group B once per day at a dosage of 0.2mg/kg of body weight, diluted in 100 grams of pure distilled water. A vaginal smear was taken every day between 11 am and 12 pm daily for four weeks and the slides were stained with Papanicolaou’s stain. SPSS version 26 was used for data entry and analysis. Results: In experimental group B, the animals had an abnormal oestrus cycle. A statistically significant p-value of 0.000 was obtained after comparison between the groups. Conclusion: The current study showed that long-term supplemental dose of Folic Acid leads to prolongation of oestrous cycle of Sprague Dawley rats. [ABSTRACT FROM AUTHOR]

Objective: To investigate the viability of utilizing preoperative serum vitamin D levels as a predictor of postoperative transient hypocalcemia in patients who were undergoing total thyroidectomy in our population. Study Design: Prospective Observational study. Setting: Shifa International Hospital Islamabad, Pakistan. Period: 1st July 2020 to 30th June 2022. Material & Methods: All the data was collected prospectively. Patients are divided into two groups depending on the pre- operative vitamin D levels. The preoperative vitamin D levels are checked on the day of admission before the surgery. After the surgery, their post-operative serum calcium levels are checked at 6 hours, 24 hours and 48 hours. Intact PTH levels are also checked after the surgery and correlation of transient hypocalcemia with intact PTH levels is also checked. Results: Our results strongly predict that serum Vitamin D levels and intact parathyroid hormone (PTH) levels are diagnostic indicators of transient hypocalcemia in post thyroidectomy patients. Conclusion: Our study shows: Pre-operative vitamin D is an early indicator of hypocalcemia in post-thyroidectomy patients. Serum intact parathyroid hormone levels is an early indicator of hypocalcemia in post-thyroidectomy patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of Orthopaedic virtual journal club started during COVID-19 pandemic. Study Design: Descriptive Cross sectional. Setting: Orthopaedic & Traumatology Division Lady Reading Hospital Peshawar, Pakistan. Period: 6th February 2021 to 6th June 2023. Material & Methods: We selected one original article which was published in Journal of Pakistan Orthopaedic Association (JPOA). The author of that article would present it in synchronous virtual journal club (VJC) on Zoom. Orthopaedic residents from all over Pakistan attended the VJC. All the residents provided feedback (on 5 point Likert scale) by answering 11 questions related to various aspects of their learning experiences which were analyzed to measure the effectiveness of VJC. Results: We conducted 12 VJC on various topics. The total number of post graduate residence who attended these VJC were 380. Final year residents were more likely to attend VJC than first year residents (p=0.02). After 12 VJC the mean resident participation was 42±1.2. We received the feedback forms of 344(90.52%) residents. The VJC was extremely convenient to vast majority (86.62%, n=298) of residents. The VJC was perceived very effective and extremely valuable by 90.11% (n=310) and 84.59% (n=291) residents respectively. Majority (90.11%, n=310) of our residents strongly agreed that VJC provided them more understanding of writing an original article. Conclusion: Our transition from physical to virtual journal club was very fruitful. Virtual Journal club was an extremely convenient, very effective and extremely valuable form of distant learning. Knowledge, attitude and skills of the residents were improved which support them in their delivery of patient care and improved patient clinical outcome. The VJC provided the residents more understanding of writing an original article. [ABSTRACT FROM AUTHOR]

Objective: To assess relationship between clopidogrel resistance and different ethnicities in Pakistan. Study Design: Cross-sectional study. Setting: Army Medical College, National University of Medical Sciences (NUMS), Pakistan. Period: 2015 to 2019. Material & Methods: Included 390 ischemic heart disease (IHD) patients on clopidogrel therapy belonging to different ethnicities in Pakistan. Their platelet aggregation was assessed through light transmission aggregometry and the patients were divided into clopidogrel responder and clopidogrel resistant groups. Chi square analysis was done to assess difference in clopidogrel resistance among different ethnicities. One-way ANOVA was applied to assess difference in mean platelet aggregation among different ethnic groups. Results: This study has demonstrated that there was no significant difference in clopidogrel resistance among ischemic heart disease patients belonging to different ethnic groups of Pakistan, p = 0.566. Mean platelet aggregation of all the ethnic groups was also similar, p = 0.330. Conclusion: There is no association of clopidogrel resistance with ethnicity in Pakistan. [ABSTRACT FROM AUTHOR]

Objective: to determine how frequently children in developing countries like Pakistan with urolithiasis have metabolic abnormalities alongwith clinical features. Study Design: Descriptive Cross Sectional study. Setting: Department of Paediatric, National Institute of Child Health, Karachi. Period: January 2021 to February 2022. Material & Methods: To determine how frequently local children with urolithiasis have metabolic problems. A total of 80 children who were aged 4 to 14 years and who had renal stones were included, while those suffering from chronic kidney diseases, liver and biliary tract diseases and children, receiving vitamin D supplementation are excluded. Urine samples were analyzed urinary uric acid, calcium, Demographics and metabolic abnormalities--hypercalciuria, hyperuricosuria analyzed. Results: The study analysis included 80 patients. Seventy one patients (88.8%) had metabolic abnormalities. Most frequent metabolic abnormality was hypercalciuria 60(75%) followed by hyperuricosuria in 52(65%) of participants. There was no significant association observed between metabolic abnormalities and age, gender and BMI classification. Conclusion: Metabolic abnormalities were found 88.8% of children presenting with urinary lithiasis. The most frequent abnormality observed was hypercalciuria followed by hyperuricosuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potent role of oxidative stress in thyroid disease development and progression in young pregnant females during 1st and second trimesters compared with matched healthy pregnant females of the same gestational age. Study Design: Cross-sectional Comparative study. Setting: Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Pakistan. Samples were collected at the Punjab Institute of Nuclear Medicine (PINUM), Faisalabad, and the Department of Obstetrics at DHQ Hospital, Chiniot. Period: July 2019 to July 2021. Material & Methods: Thyroid disease-comorbid pregnant women and euthyroid pregnant women were compared for serum levels of oxidative stress markers and antioxidants. The markers were evaluated between 68 healthy subjects in Group A and 43 subjects in Group B known for having thyroid diseases. Blood samples were taken under highly sterile conditions after gaining written consent from all subjects and stored at -8°c to -30°c. A spectrophotometer at 532nm was used to measure serum concentrations of oxidative stress markers. ELISA kits were used to determine serum levels of triiodothyronine, thyroxin, and thyroid-stimulating hormone. Data was analyzed using independent student t-test, multiple logistic regression, and receiver operating characteristic curve (ROC) analysis using SPSS version 25. Results: Group A and Group B had a mean age of 26.07±4.88 and 29.19±4.17 years, respectively. Pregnant women having thyroid dysfunction had decreased superoxide dismutase levels (0.05±0.01 nmol/ml) than group A (0.06±0.01). Other indicators of lipid peroxidation showed a non-significant mean difference compared between both groups (p>0.05). Multiple linear regression studies revealed healthy pregnant women with a positive thyroid medication history had higher SOD levels among group B than those without antithyroid medicine, with a Beta coefficient of +0.26 and p=0.04. According to ROC curve analysis, the Superoxide Dismutase biomarker area under ROC was 67.25% at p=0.002. Thus, it may be used as a diagnostic and predictive biomarker. A cutoff value of 51.5pg/ml was proposed, at which sensitivity is 79% and specificity is 69%. It can be a diagnostic and predictive biomarker. Conclusion: The results of the current study concluded that oxidative stress can be considered a potent risk factor for the development and progression of thyroid disease in young pregnant females. [ABSTRACT FROM AUTHOR]

Objective: To determine the hemostatic abnormalities in iron overloaded frequently transfused thalassemia patients. Study Design: Cross Sectional study. Setting: Departments of Pathology and Paediatrics, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan. Period: October 2022 to April 2023. Material & Methods: Was conducted on 112 patients using convenient sampling technique. The collected data was analyzed using SPSS version 23. Results: Total 112 thalassemia patients were included in the study, 62 were males and 50 of them were females. A normal PT value was recorded in 107 (95.5%), while 5 (4.5%) had prolonged PT, a normal APTT value was recorded in 98 (87.5%), while 14 (12.5%) patients had prolonged APTT, a normal BT value was recorded in 89 (79.5%), while 23 (20.5%) patients had prolonged BT, and a normal platelet count was recorded in 86 (76.7%), while 26 (23.2%) patients had thrombocytopenia. The mean level of serum ferritin was (4169.08±2193.49) and the mean age of total study subjects was (11.7 ± 3.39). Conclusion: It was concluded that high serum ferritin levels resulted in disturbance of hemostatic profile in thalassemia patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of complications of central venous line insertion among children admitted in Pediatric Intensive Care Unit (PICU). Study Design: Cross-sectional study. Setting: PICU of Shifa International Hospital, Islamabad, Pakistan. Period: March 2022 to February 2023. Material & Methods: Children of either gender aged between 2 months to 16 years admitted in PICU during study period and underwent central venous catheterization(CVC) during admission were analysed. The patients were observed for immediate and late complications of CVC. Results: In a total of 160 children, 89 (55.6%) were boys. The mean age at the time of admission was 6.00±4.87 years. Immediate complications occurred among 9 (5.6%) children including catheter malposition, pneumothorax, hematoma, and arterial puncture observed in 4 (2.5%), 2 (1.3%), 2 (1.3%) and 1 (0.6%) children respectively. The CLABSI rate was 16.8 per 1,000 catheter days. The most common micro-organisms causing CLABSI were Methicillin Resistant Staph Epidermidis (MRSE), and Klebsiella, reported in 3 (21.4%) cases each. Younger age (p<0.001), relatively low body weight (p<0.001), and increased duration of central venous line placed (p<0.001) were found to be significantly associated with CLABSI. Conclusion: In this study, CLABSI rate was found to be 16.8 per 1,000 catheter days which is comparable to the regional data. Common immediate complications of CVC were catheter malposition, pneumothorax, hematoma, and arterial puncture. Younger age and increased duration of CVC were associated with CLABSI. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency and associated factors of impaired IADLs (instrumental activities of daily living) among the geriatric population of Pakistan. Study Design: Cross-sectional study. Setting: Department of Family Medicine and Outreach Centres, Liaquat National Hospital, Karachi. Period: Dec 2020 to Dec 2021. Material & Methods: A total of 200 participants of either gender aged above 60 years were included. At the time of data collection, demographic information was noted along with impairment in specific IADLs and associated factors. Results: Total 200 participants were included in the study. Median age and BMI was 70 (IQR= 65-73) years and 24.8 (IQR= 21.8-27.8) Kg/m2. Majority of study participants considered their health status as better (n=92, 46%) whereas some considered it not as good as their peers (n=33, 16.5%) and good (n=55, 27.5%). Few had no idea about their health status (n=20, 10%). The enrolled participants had comorbidity of hypertension (n=78, 39%), diabetes (n=53, 26.5%), ischemic heart diseases (n=10, 5%) and hypothyroidism (n=15, 7.5%). Overall 85 (42.5%) study participants were found to be dependent with median IADL score of 6 (IQR= 4-7). Conclusion: Quite a significant proportion of the study participants were found to be dependent. Advancing age, gender predisposition, perceived weight loss and psychological distress were found to be associated with impairment in instrumental activities of daily living. [ABSTRACT FROM AUTHOR]

Objective: To note the factors linked with delayed diagnosis of congenital heart diseases (CHDs) among children. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: September 2022 to February 2023. Material & Methods: We analyzed children aged up to 15 years who presented for the first time with echocardiographic evidence for the diagnosis of CHDs. Socio-demographic data along with clinical information like gender, age, residential status, maternal education status, history of maternal fetal echocardiography and the frequency of delayed diagnosis of CHDs were noted on a specially made proforma. Parent or guardians were asked for possible reasons of delayed diagnosis for CHDs. Results: In a total of 250 children, the mean age was 2.33±3.81 years while 162 (64.8%) children were aged below 2 years. There were 138 (55.2%) boys. Residential status of 159 (63.6%) children was rural while maternal educational status of 99 (39.6%) was illiterate. There were 164 (65.6%) children who were diagnosed to have cyanotic CHDs while 86 (34.4%) had acyanotic CHDs. Frequency of delayed diagnosis was noted among 182 (72.8%) children. In these 182 cases, delayed first consultation was the commonest factor behind delayed diagnosis noted in 78 (42.9%) children while missed diagnosis by the pediatrician was the 2nd most common factors linked with the delayed diagnosis of CHDs as described by 62 (34.1%) parents. Conclusion: Almost 3/4th of the studied children had delayed diagnosis of CHDs while cyanotic CHDs were the most common CHD types. Delayed first consultant and missed diagnosis by the pediatrician were the most common factors linked with delayed diagnosis of CHDs. [ABSTRACT FROM AUTHOR]

Objective: To present our experience of modified del Nido Cardioplegia for chemical arrest and myocardial protection during congenital heart defect repair pediatric cardiac surgeries. Study Design: Retrospective Cross Sectional. Setting: Department of Cardiac Surgery, PAQSJIMS, Gambat, Khairpur. Period: 15th March, 2021 to 10th October, 2022. Material & Methods: del Nido solution is generally constituted in plasma lyte A solution, not available in Pakistan; therefore, we constituted del Nido solution in ringer lactate solution. We had collected our data retrospectively for our study to assess the safety and efficacy of modified del Nido cardioplegic arrest during the open heart surgeries for congenital heart defects. We report clinical outcomes of our patients that include spontaneous rhythm, ionotropic score and duration of mechanical ventilation in patients underwent open heart surgeries. Results: During the study period we had performed 102 surgeries for correction or palliation of congenital heart defects. We have included 54 patients in our study with 28 (52%) male and 26 female (48%) patients; had a mean age 8.9 (±3.7) years and mean weight 22.4 (±12.7) kg. Majority of patients 29 (54%) belonged to Category 2 on RACHS-1 scale. Our average cross clamp time was 39.7min, and 37(68%) patients required a single dose of cardioplegia. Spontaneous sinus rhythm was established in 48(89%) patients; average ionotropic score of patients at the time of PICU arrival was 8.6 (±5.6) with 31(57%) have score of less than 10, while 2(4%) patients were received without the ionotrope. All the patients were shifted on mechanical ventilators with average time of 253.6 (±219.6) min of mechanical ventilation. Conclusion: Our results show modified del Nido solution is safe, with added benefits of fewer interruption in surgery, greater magnitude of spontaneous sinus rhythm and fewer ionotropic requirements. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of tracheostomy on COVID positive patients and the risk included in the procedure for the patient and health care workers. Study Design: Retrospective Observational Study. Setting: Shifa International Hospital Islamabad, Pakistan. Period: 30th May 2020 to 15th February 2022. Material & Methods: The tracheostomies were performed in COVID ICU at bed side by ENT team. This is a study of 22 patients mostly with multiple comorbidities who presented to the hospital with symptoms of SARS-COVID-19. The changes in their ventilation were recorded before and after the tracheostomy. The health care workers included in the study were also kept under observation for any possible cross infection. Results: Eight out of twenty two patients were weaned off from ventilator. There was decrease in partial pressure of oxygen after the procedure but the mortality rate was high. None of the members of operating team, ICU team, anaesthesia team was infected with the virus. Conclusion: Our study shows that although tracheostomy helps in weaning off from ventilator, it has no role in weaning off COVID patients. There is no benefit of tracheostomy for a COVID positive patients. Furthermore, if adequate personal protective equipment's are used, there is no risk of spread of infection from patient during the procedure of tracheostomy. [ABSTRACT FROM AUTHOR]

Objective: To find out the types and outcome of respiratory illnesses at a tertiary healthcare facility. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: January 2022 to July 2022. Material & Methods: Admitted children of both genders aged between 1 month to 12 years were analyzed. At the time of admission, characteristics like gender, age, body weight, vaccination status and types of respiratory illness were noted. Duration of hospitalization along with outcome was recorded. Results: During the study period, a total 851 children were admitted. Out of these 851 children, 266 (31.3%) children had some kinds of respiratory illnesses and were further analyzed. There were 148 (55.6%) male children while overall mean age was 3.9±2.6 years. Pneumonia was the commonest respiratory illness noted in 92 (34.5%) children while bronchiolitis was the 2nd most common respiratory illness observed in 56 (21.1%). A total of 241 (90.6%) children were discharged, 11 (4.1%) referred to other departments, 7 (2.6%) LAMA while deaths were noted in 7 (2.6%). Vaccination status was found to have significant association with the outcome (n=0.0096). Conclusion: Respiratory illnesses contribute significantly to children admitted to resource limited healthcare facilities. Poor immunization status has significant association with mortality among children with respiratory illnesses. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical profile of children presenting with acute rheumatic fever (ARF) at a tertiary care healthcare facility. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: January 2021 to December 2022. Material & Methods: We analyzed children of both genders aged between 1 month to 18 years and presenting with ARF. At the time of enrollment, medical history was obtained and physical as well as clinical examinations were performed. The demographical and clinical information were recorded. ARF was labeled as per “Modified Jones Criteria”. A special proforma was formed to record study data. Results: In a total of 154 children, 96 (62.3%) were female while the mean age was 9.3±4.6 years. Forty four (28.6%) patients were having first episode of ARF while 110 (71.4%) had recurrence of ARF. Fever was noted to be the most common presentation noted in 121 (78.6%) patients of ARF. Arthritis was significantly more common among patients with first episode of ARF when compared to recurrence of ARF (70.5% vs. 29.1%, p<0.0001). Degree of carditis was significantly more severe among patients with recurrence of ARF (p<0.0001). Conclusion: Majority of the acute rheumatic fever patients present with recurrence of acute rheumatic fever. Fever was the commonest clinical presentation while arthritis was significantly more prevalent among patients with first episode of acute rheumatic fever. [ABSTRACT FROM AUTHOR]

Objective: To assess level of patient satisfaction in inpatient department of Ayub teaching hospital Abbottabad. Study Design: Cross-sectional Observational study. Setting: Different Wards of Ayub Teaching Hospital (ATH) Abbottabad. Period: July 2022 to September 2022. Material & Methods: Three hundred five sample size was calculated by WHO sample size calculator. Data was collected through a self-administered questionnaire by convenient sampling technique. Six parameters were marked on a Likert scale from 0-4 and total score were categorized into high satisfaction, mediocre satisfaction and low satisfaction. Data was analyzed on SPSS Version 23. Results: 240(78.69%) patients were highly satisfied, 38(12.46%) were mediocrely satisfied, while 27(8.85%) had low satisfaction with registration process. 252(82.62%) patients were highly satisfied, (10.49%) were mediocrely satisfied while 21(6.89%) patients had low satisfaction with the courtesy received from the staff. 158(51.80%) patients were highly satisfied, 86(28.2%) were mediocrely satisfied while 61(20%) had low satisfaction from hygiene of hospital. Similarly patient satisfaction during hospital stay, technical and professional expertise of hospital staff and affordability of medical treatment was also measured. Overall patients satisfaction with all six parameters combined was: 177(58.03%) patients were highly satisfied, 100(32.79%) were mediocrely satisfied and 28(9.18%) patients had low satisfaction. Conclusion: The results of this study confirm that patient satisfaction was high in the setup studied. However this study was conducted in one hospital to make it generalize there is a need of more studies at larger scale involving more hospitals. [ABSTRACT FROM AUTHOR]

Objective: To determine the core risk factors of Ear, Nose and Throat (ENT) diseases at D. G. Khan and Rajanpur districts of Punjab, Pakistan. Study Design: Cross Sectional Case Control study. Setting: A sample of 1553 individuals including two categories, ENT Diseased (Case) and ENT diseased free (Control) respondents including both males and females was collected from different hospitals of D. G Khan and Rajanpur Districts. Period: June 2021 to June 2022. Material & Methods: Data for this study have been collected by formulating a questionnaire. That questionnaire was then completed by face to face interviewing. Chi-squared test is used to check the association between the assumed risk factors and ENT diseases. Odds ratios are calculated to measure the strength of association between assumed risk factors and ENT diseases. Looking at the dichotomous nature of the response variable, a binary logistic regression model is also applied to assess the overall influence of potential risk factors on developing the ENT diseases. Results: In our sample of 1553 respondents, 41.47% are females and 58.53% are males. The percentage of clinically diagnosed ENT diseased patients is 54.92% and those of controlled ones is 45.08%. Among the diseased respondents, 57% have ear disease, 19.2% have nose disease and 23.8% have throat disease. Age, education, family status, family system, marital status, slow physical activity, smoking, Naswar, Paan, family history, occupation, work place, water, ventilation, nutrition and tea are found to be the most significant risk factors of developing the ENT diseases. Conclusions: The occurrence of ENT diseases can be reduced by giving the awareness to the people about its risk factors. [ABSTRACT FROM AUTHOR]

Objective To evaluate factors associated with rising trends of intentional ingestion of caustic agents for suicidal attempts in Pakistan. Study Design: Cross Sectional, Observational study. Setting: Tertiary Health Care Center of Islamabad. Period: January 2019 to December 2020. Material & Methods: One hundred subjects with intentional ingestion of caustic ingestion were interviewed on a written questioner after informed consent. Non-probability purposive was sampling method used. Results: Out of 100 patients 63% were female, mean age was 28.81 years and 58% had suicidal intension. Disturbed marital/family life was main factor behind suicidal attempts. (P= 0.025). Conclusion: factors like female gender, younger age, poor socioeconomic status and disturbed marital/family life in study group had statistically significant association with suicidal intentions. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of two canals in mandibular central incisors using a radiographic technique in a sample representing Karachi Pakistan. Study Design: Cross-sectional in Vitro study. Setting: Hamdard University Dental Hospital. Period: January, 2022 to July, 2022. Material & Methods: According to inclusion criteria 187 extracted mandibular central incisors were collected, flushed under running tap water. 10% formalin was used as storage media afterwards. The attached periodontal tissues and calculus remaining after extraction were removed using a 1/2 Gracey Curette. Number 2 round bur was used in a high speed hand piece to initiate access chamber opening of the pulp chamber. Irrigation was done with 2.5% sodium hypochlorite to make the pulp chamber clearly visible. Detection and negotiation of second canal were performed by using Dental Operating Microscope. No. 15 K-files were introduced into the main canals. Two peri-apical radiographs were exposed at different angulations using DIGORA OPTIME for confirmation. Data was analyzed by using SPSS version 23. Results: Mean age of the patients included in the study were 37.12±12.81 years. According to gender distribution there were 101 (54%) males and 86 (46%) females. Outcome concludes that in mandibular central incisors frequency of two canals was 28.3 %. Conclusion: Presence of two canals in mandibular central incisors among Pakistani population in our study was 28.3%. When endodontic therapy is commenced on these teeth, dentist must consider the possibility of existence of second canal and exercise caution. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of vitamin D deficiency (VDD) in healthy children. Study Design: Crosssectional study. Setting: Department of Pediatric Medicine, Sahiwal Teaching Hospital, Sahiwal. Period: July 2022 to December 2022. Material & Methods: A total of 80 healthy children of either gender aged 6 to 36 months visiting outpatients department of pediatrics during the study period adopting convenient sampling technique were included. At the time of enrollment, demographic information was recorded and blood sample was obtained and sent for vitamin D analysis. The frequency of VDD was noted. Results: In a total of 80 children, 48 (60.0%) were boys and 32 (40.0%) girls. The mean age was of 14.4±6.2 months. Residential status of 47 (58.3%) children was rural. Evaluation of vitamin D status revealed that 16 (20.0%) children had sufficient levels while deficiency and severe deficiency were noted in 44 (55.0%) and 20 (25.0%) children respectively. Younger age group was having significant linkage with VDD (p=0.0135). Conclusion: The frequency of vitamin D deficiency was very high among healthy children visiting a tertiary care health facility of Punjab, Pakistan. Younger age groups had significant association with the occurrence of vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy and safety of corticosteroids and combined therapy with corticosteroids and vigabatrin in infantile spasm. Study Design: Randomized Controlled Trial. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health Multan, Pakistan. Period: November 2020 to November 2022. Material & Methods: A total of 320 children of either gender aged 1-24 month with clinical diagnosis of infantile spasm were included. Infants were randomized into either receiving prednisolone (Group-A) or vigabatrin plus prednisolone (Group-B). Demographical information along with treatment outcomes and adverse effects were noted. Final outcomes were labeled at day-180. Results: In a total of 320 children, 170 (53.1%) were male. Overall, the mean age was 1.3±0.5 years while 166 (51.9%) children were aged between 1 to 2 years. A total of 166 (51.9%) children responded to allocated treatment. The response rate was significantly better in Group-B (n=118, 73.8%) versus Group-A (n=48, 30.0%), p<0.0001. Significantly more children in Group-A missed follow-ups in comparison to those in Group-B (11.8% vs. 1.9%, p=0.0006). Mortality was statistically similar in both study groups (2.5% vs. 1.9%, p=0.7023). The most treatment related adverse effect was noted to be increased appetite and/or weight, gastrointestinal symptoms and sleep disturbance in 253 (79.1%), 121 (37.8%) and 117 (36.6%) respectively. Increased appetite and/or weight gain was significantly more in Group-A (p<0.0001). Conclusion: The findings of this study are in support of using combination therapy of prednisolone and vigabatrin instead of monotherapy for patients with infantile spasm as reflected by higher number of responders to therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of meningitis in children 6-18 months of age presenting with 1st episode of febrile seizure (FS). Study Design: Cross-sectional. Setting: Department of Pediatric Medicine, Sahiwal Teaching Hospital, Sahiwal. Period: October 2021 to April 2022. Material & Methods: Children with 1st simple FS of age 6 months to 18 months of either gender were included. After taking informed written consent from the child’s parents, lumbar puncture was done in each patient and cerebrospinal fluid (CSF) analysis and blood sample were sent to the institutional pathology laboratory for presence or absence of meningitis. Results: In a total of 156 children, mean age was 11.24±2.86 months while 94 (60.3%) children were between 6-12 months of age. There were 100 (64.1%) male and 56 (35.9%) female children. The frequency of meningitis was found in 16 (10.3%) patients. Conclusion: The frequency of meningitis in children with 1st episode of febrile seizure was high (10.3%). [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and distribution by gender of Transfusion transmissible infections (TTIs) in blood donors. Study Design: Cross-sectional study Setting: Department of Community Medicine, GMC. Period: July 18, 2022 to November 18, 2022. Material & Methods: The data collecting tool was a structured proforma. A sample of 3329 was calculated with a 0.71% margin of error, a 95% confidence level, and an expected prevalence of TTIs of 4.61%. Consecutive non probability sampling technique used. Nominal variables were gender, type of donors, presence of TTIs and types of TTIs. Counts and percentages with 95% confidence intervals were used to describe the prevalence and distribution. Chi-square goodness of fit was used to compare expected values with observed values. SPSS version 21 was used for data analysis. Results: Out of sample of 3329, TTIs positive cases were 174 (5.22%) with 95% CI of 4.51- 5.93%. All the positive cases were males. The prevalence for Hepatitis B, Hepatitis C, HIV, Syphilis, and Malaria was 2.2%, 0.9%, 0.3%, 1.9%, and 0.1% respectively. Our observed values for Hepatitis B&C, HIV and malaria were not statistically significantly different from expected values except for syphilis. Conclusion: Prevalence of TTIs was 5.22% with significantly higher prevalence of syphilis as compared to expected prevalence. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein's anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein's anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein's anomaly case. Almost 3/4th of the patients had late diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the antibiotic resistance in enteric fever in our population. Study Design: Observation study. Setting: OPD and indoor patients in three tertiary care hospitals of Lahore. Period: May 2018 to September 2018. Material & Methods: We selected patients with symptoms and signs of enteric fever randomly in our out door and ER departments. Blood cultures were sent before start of any antibiotic. Patients with Positive culture were enrolled for this study. Results: We enrolled 180 patients, including 123 (68.3%) male patients and 57 (31.7%) were female patients. We divided these patients in three groups, below 25 years 38(21.1%) patients, from 26 to 50 years 98(54.4%), and above 50 years 44(24.4%) patients. Out of 180 patients 138(76.7%) patients took antibiotic before coming to us, 42 (23.3%) were naïve patients. We found 108 (60%) patient having quinolone resistance and 72 (40%) were sensitive to floroquinolones, 88 (48.9%) patients were cephalosporin resistant and 12 (6.7%) were macrolide resistant. We did not check the sensitivity of chloramphenicol, ampicillin and nalidixic acid as it is already proven resistance of these antibiotics. Among all patients quinolones resistance was much higher and resistance against cephalosporin is also increasing and few cases were found to be resistant to even macrolides, although resistance against macrolides is low up to now. Conclusion: Antibiotic resistance is gradually increasing rapidly even against those drugs which were proven very effective against salmonella typhi and paratyphi infections. Younger population (26-50years) had much more resistance than below 25 and above 50 years patients. Due to such prevalence of antibiotic resistance, few antibiotics are left for the treatment of enteric fever, which lead not only to high morbidity and mortality in these patients but a great financial burden for developing countries like Pakistan. Patients with positive blood culture of salmonella were included in this study. Patients with other causes of fever, malaria, Tb, respiratory infections, and with negative blood culture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of thyroid hormones as well as the effect of treatment choice on the quality of life of patients visiting/admitted in tertiary healthcare centers in Karachi, Sindh Pakistan. Study Design: Cross-sectional study. Setting: Rafae Aam General Hospital Federal Area Karachi, Sindh, Pakistan. Period: March 2022 to June 2022. Material & Methods: Patient's data related to their socio-demographic and clinical details was collected by using a pre-tested written questionnaire. Brazilian version of 36-Item Short Form Health Survey questionnaire was completed by all the study participants. Results: Total 337 participants were included in the study. Mean age of the study participants was 34.03 ± 10.06. Majority of them were females while most of them belonged to the age group of 18-29 years. Most of our study participants were urban residents, married, having no any formal education and suffering from comorbidities. Based on clinical examination, 272 (80.7%) patients were found euthyroidism while 65 (19.3%) were hyperthyroid. Thus, hyperthyroid patients displayed a greater toll on the quality of life, particularly in areas of physical (59.62 vs. 82.81; p<0.05) as well as emotional (61.54 vs. 82.81; p<0.05) functioning. Conclusion: This study concludes that hyperthyroid patients have a significant quality of life impairment, particularly in the physical and emotional domains. Moreover, regardless of the findings of the serum thyroid hormone levels, quality of life of hyperthyroid patients is compromised. [ABSTRACT FROM AUTHOR]

Objectives: To find out the correlation between inter commissural width and maxillary inter canine width. Study Design: Cross-sectional Research. Setting: Department of Prosthodontics Dental OPD LUHMS Jamshoro. Period: June to December 2021. Material & Methods: A total of 100 patients with maxillary impressions of patient were taken in metal perforated stock trays with irreversible Hydrocolloid impored immediately with dental stone type IV for making the study cast. Questionnaire mode of research instrument was used for the data acquisition during patient treatment. In parallel with maxillary anterior teeth selection and inter-commissural width determination by using Vernier calliper, the intercanine distance was also assessed. Results: About 100 patients were assessed maxillary anterior teeth selection, and inter-commissural width. The mean age of the study participants was recorded as 21.52±2.83 years. Whereas 63% patients were male. The overall statistical calculations showed a significant positive correlation (r=0.73; p=0.0005) between and the inter-commissural width and maxillary inter-canine teeth. Conclusion: Based on the findings, the study concludes that there is a significant correlation between inter-commissural width and maxillary inter-canine teeth among the south-west population in Sindh. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of our institutional experience with anaesthetic management of renal transplant data in terms of demographics, preoperative status, anaesthesia management, and postoperative care. Study Design: Descriptive study. Setting: Pakistan Kidney and Liver Institute and Research Center, Lahore. Period: January 2022 to June 2022. Material & Methods: This descriptive study included 203 cases of renal transplant. We reviewed the medical records of these patients for demographics, preoperative anaesthetic assessment, intraoperative anaesthesia records, and postoperative care unit notes. Data was analyzed using SPSS Version 25. Results: The mean age of the patients was 35.75 + 10.1 years, and most of the patients had co-morbidities. The preoperative echocardiographic findings were significant in 52.7% of the patients, and 87.2% were on dialysis preoperatively. General anaesthesia was used in 99.5% of cases. Mean volume of intravenous fluid was 5.8 L, and 9.35% required ionotropic support, 9.9% received transfusion intraoperatively while 3.9% required postoperative mechanical ventilation. Conclusions: Renal transplant recipients have significant comorbidities and require a meticulous approach for successful perioperative anaesthetic management. [ABSTRACT FROM AUTHOR]

Objective: To identify how students with the preferred learning styles rate the academic environment of the Medical College. Study Design: Cross-sectional study. Setting: Shifa College of Medicine, Shifa Tameer-e-Millat University. Period: April 2022 to September 2022. Material & Methods: After taking ethical approval from the ethical review board of the institute, a two hours slot was designated in the schedule of students of five years in the private medical college. Students were given two questionnaire, Honey & Mumford LSQ and DREEM. Students were requested to leave the demographic part in order to maintain confidentiality of data. Data analysis was done and the preferred learning style of the cohort was found. DREEM questionnaires of these students were also analyzed in order to find their ratings of the environment. Results: Preferred learning style of the cohort was Reflectors (58.4%). Reflectors marked domains of DREEM as, A more Positive Approach, Moving in the right Direction, Feeling More on the Positive Side, A more Positive Atmosphere and Not too bad. Conclusion: Environment of the medical college seemed fit for the students with preferred learning style (Reflector). Further studies are indicated to rate the environment from students with other learning styles. [ABSTRACT FROM AUTHOR]

Objective: To identify the fears and concerns regarding HCV amongst people presenting to a free screening camp and to identify the barriers preventing patients from linkage to care (seeking medical care for HCV). Study Design: Cross Sectional study. Setting: Gajrakh District, Gujranwala. Period: 15th February to 14th March 2019. Material & Methods: Questionnaire was filled by all the participants attending free screening and treatment camp. Questionnaire explored sociodemographic features, financial status, knowledge regarding awareness of disease e.g. risk factors for transmission of disease, possible complications of disease, fears regarding diagnosis & treatment of HCV and possible concerns of female population. Results: This study included 100 participants, 58% were females and 42% were males with a mean age of 46.23±12.36. Fifty seven percent of the participants were laborer, 15 were salary based, 6 were shopkeepers and 7 were housewives. Majority of participants have a sound knowledge about transmission of HCV i.e 95% said yes to the question about spread via ear/nose piercing by unsterilized needles, however, 49% and 61% think that hugging the patient and eating and drinking with patient also caused viral spread respectively. Most important factors contributing to inability to start treatment were inability to bear cost, missing of daily wages, lack of transport, fear of side effects and fear of being outcast in 75, 66, 41, 26 and 25% respectively. Conclusion: Socioeconomic factors like costly treatment, missing of daily wages, lack of transport, fear of side effects and being outcast are real hindrance in getting HCV treatment. [ABSTRACT FROM AUTHOR]

Objective: To check the Bacterial Co-infections and Susceptibility patterns among admitted COVID-19 patients during 3rd wave of pandemic. Study Design: Descriptive Cross Sectional study. Setting: Department of Microbiology, Combined Military Hospital Lahore Pakistan. Period: May 2021 to August 2021. Material & Methods: Six hundred and twelve COVID-19 positive patients having positive bacterial cultures were processed, Antibiotic susceptibility testing was done by Kirby-Bauer diffusion technique, all antibiotics were reported using breakpoints recommended in clinical and laboratory standards institute (CLSI 2021). Results: Out of 612 patients, 348 (56.9%) were male and 264 (43.2%) were female. Mean age of the patients was 57.2 ± 14.4 years with a range of 22 to 89 years. Bacterial coinfection was present in 70.4% of the patients. Gram negative bacteria (94.4%) were more prevalent in COVID-19 patients as compared to gram positive isolates (5.6%). Antibiotic sensitivity pattern of Staphylococcus aureus showed a high resistance against penicillin, ampicillin, tetracycline and doxycycline. Conclusion: Our study reported a high prevalence of bacterial coinfections in COVID-19 patients infected during the third wave of pandemic. A high percentage of gram negative species were identified in our study population, this could be due to the suppression in the immunity of individuals due to severity of COVID-19 infection and already present Antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Objective: To establish the occurrence of Scianna blood group alleles via genotyping in Pakistani blood donors. Study Design: Cross-sectional Analytical study. Setting: Department of Hematology, Army Medical College (AMC) in association with the Armed Forces Institute of Transfusion (AFIT) Rawalpindi. Period: January 2019 to January 2020. Material & Methods: In this study 300 blood donors were incorporated after taking informed consent; DNA was extracted from their EDTA anticoagulated blood samples and tested for SC*01 and SC*02 alleles by Sequence-Specific Primer Polymerase Chain Reaction (PCR-SSP), which was ensued by gel electrophoresis. The allele frequencies were established and Hardy Weinberg equilibrium was determined. Chi-square test was applied to compare the observed and expected genotype frequencies as well as for comparison with published allele frequencies of other populations. We used SPSS version 22 for the analysis of study data. Results: All donors were homozygous for SC*01, demonstrating allele frequency for SC*01 nearly 1.00. Genotype frequencies were congruent with the Hardy Weinberg equilibrium. The difference between the allele frequencies of SC*01 and SC*02 alleles of population of Pakistan was not statistically significant when compared to those of other populations. Conclusion: This maiden research illustrates Scianna blood group distribution in Pakistani community by PCR-SSP. This method is cheap and proficient and can be applied in developing nations. The findings of this study can aid in the production of local red cell panels, detection of uncommon blood types, and setting up of a domestic rare blood donor platform. [ABSTRACT FROM AUTHOR]

Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of microalbuminuria and relative determination of glycated hemoglobin (HBA1C) in Type II diabetes mellitus patients. Study Design: Descriptive Cross Sectional. Study Setting: Three Different Hospitals Based in Sindh Pakistan. Study Period: March-August 2021. Material & Methods: After selection through nonprobability purposive sample technique, demographic details of all patients were noted in a written questionnaire. All the confirmed patients of type-II diabetes mellitus were then tested for microalbuminuria and glycated hemoglobin in parallel with the disease progression. All the collected information was analyzed in SPSS ver. 22. Results: Among 165 enrolled cases, 89 (54%) type II diabetic patients were normoalbuminuric, 53 (32 %) Microalbuminuria and 14 % macroalbuminuria. Males were at greater risk (65%) of developing type II diabetes mellitus in comparison to females (35%). In total 46 type II diabetes mellitus cases with microalbuminuria represent raised HBA1C levels AT95% CI. Conclusion: Prevalence of microalbuminuria among type II diabetic patients visiting the tertiary care hospital is 32.1%. Patients with higher HbA1c or poor glycemic control are present with microalbuminuria. [ABSTRACT FROM AUTHOR]

Duplex collecting system is commonly associated with ectopic ureter in females. A 17 years old girl presented with continuous urinary dribbling since birth in our OPD and she also had urge to void. This is a rare case with double ureteral ectopia and this case report enlightens the suffering of rare diseased in terms of diagnosis and treatment. She had been frequently treated for urinary tract infections. The surgical treatment is the main stay which comprises the en bloc reimplantation of ectopic ureter via open surgical or laparoscopic approach. To our knowledge yet, laparoscopic reimplantation for ectopic ureter has not been reported in Pakistan. We did ureteral reimplantation of ectopic ureter laparoscopically. [ABSTRACT FROM AUTHOR]

Objective: To find out fetal and maternal factors linked with thrombocytopenia (TCP) among neonates admitted in neonatal intensive care unit (NICU) of a tertiary care hospital of South Punjab, Pakistan. Study Design: Cross-sectional study. Setting: The NICU of Sadiq Abbasi Hospital, Bahawalpur. Period: May 2022 to August 2022. Material & Methods: A total of 146 neonates of both genders admitted to NICU having TCP were analyzed. Neonatal TCP was categorized as mild (>100,000/ul to < 150,000/ul), moderate (>50,000/ul to 100,000/ul) and severe (<50,000/ul). Associations of baseline characteristics, fetal factors and maternal factors with categories of TCP were checked applying chi-square test considering p-value ≤0.05 as significant. Results: In a total of 147 neonates with TCP, 84 (57.5%) were male. Mean age was calculated to be 3.9±3.6 days while 109 (74.7%) neonates were aged between 1 to 3 days. Distribution of TCP categories showed that 78 (53.4%) neonates were having mild TCP, 43 (29.5%) moderate TCP whereas remaining 25 (17.1%) neonates were having severe TCP. Stratification of TCP with respect study variables showed that maternal anemia (p=0.0467), pre-term birth (0.0001) and sepsis (p<0.0001) among neonates were significantly linked with severity of TCP. Conclusion: Most neonates admitted to NICU were having mild to moderate degree of thrombocytopenia. Severe degree of thrombocytopenia was found among neonates with history of maternal anemia, pre-term birth and sepsis. [ABSTRACT FROM AUTHOR]

Objective: To establish demographics of OSCC patients presenting to a major tertiary care hospital and identify different potential risk factors. Study Design: Descriptive Cross Sectional study. Setting: Department of Oral and Maxillofacial Surgery Mayo Hospital Lahore. Period: July 2021 to July 2022. Material & Methods: A total of 86 patients were included in the study. The diagnosis of OSCC was histo-pathologically confirmed. Patients of both gender and all ages were included in the study and a standard questionnaire was developed to collect data including bio-data, demographics and history of illicit habits. Results: Out of 86 patients 75.58% (n=65) were males and 24.41% (n=21) patients were females. The mean age of the patients was 47.02 years. Male to female ratio was 3.6:1. Well differentiated squamous cell carcinoma was most common (53.48%), Majority presented with stage 4 disease. Highest proportion of the patients (29.6%) was having no obvious predisposing factor. Most commonly involved site was tongue followed by buccal mucosa. Conclusion: The disease trends are changing in our population, as the disease is increasingly affecting younger age group, tongue is now increasing being involved more commonly as in majority of the previous studies the incidence of OSCC of buccal mucosa was much higher, the incidence of OSCC without any obvious risk factor is increasing which needs further investigation. [ABSTRACT FROM AUTHOR]