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Objective: To determine the effectiveness of axillary exclusion technique versus no axillary exclusion in Modified Radical Mastectomy in terms of mean drain output. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital Faisalabad Pakistan. Period: 8th August, 2018 to 8th February, 2019. Methods: A request for authorization was made to the Hospital Ethical Review Committee. The research had 60 individuals in all who were admitted. General Surgery Department from outside the Allied Hospital in Faisalabad. For the sixty patients receiving modified radical mastectomy, written informed consent was obtained. A computer-generated database of random numbers was used to split them into two equal groups of thirty patients each at random. Following a modified radical mastectomy, group A received axillary exclusion, but group B did not. Total volume of accumulated fluid) following a modified radical mastectomy. After surgery, until the drain was removed, the total quantity of fluid collection in the drainage bag was recorded and compared across groups. Data was input into a template form. Results: In our study, the mean + SD was determined as 43.73+5.64 years in Group B. Of the two groups, 63.33% (n=19) in Group A and 70% (n=21) in Group B were between 41 and 70 years old, while 36.67% (n=11) in Group A and 30% (n=9) in Group B were between 20 and 40 years old. (First Table-I). Following a modified radical mastectomy with drainage, axillary exclusion procedures were compared with no exclusion, and the results indicated that the mean total drainage output (+SD) in Group B was 642.1 ml (+117.06). (Table-II). The total volume of seroma fluid drained between the two groups was significantly lower, as indicated by the p value of ˂0.001. Conclusion: In comparison to individuals who do not undergo axillary exclusion, we find that axillary exclusion procedures considerably reduce drainage expense in patients undergoing modified radical mastectomy. [ABSTRACT FROM AUTHOR]

Objective: To study the recent trends and patterns of antibiotic sensitivity and resistance in infected wounds of burns patients. Study Design: Cross sectional study. Setting: Burns and Plastic Surgery Canter, Peshawar, Pakistan. Period: July 30th to January 30th, 2023. Methods: In this cross sectional study we adopted convenience sampling technique. A total of 75 samples collected from patients fitted to our infected patients criteria and culture and sensitivity tests were performed using standard microbiological techniques. Results: Among the positive infected wound samples, Klebsiella Species were found in 23 (30.7%), Pseudomonas Aeruginosa in 16 (21.3%), Acinetobacter Species in 14(18.7%), Proteus Species in 8(10.7%), Citrobacter species in 5(6.6%), Staph. Aureus in 5(6.6%), Enterobacter species in 3(4%) and E.coli in 1(1.4%) of the positive cultures. Each pathogen showed varying degree of sensitivity and resistance patterns to different antibiotics tested. Conclusion: Klebsiella Species was the most common pathogen in patients with infected burns wounds. Meropenem, imipenem, Doripenem, Piperacillin/Tazobactum, Colistin, and Tigecyclin were found to be effective against the majority of the bacteria. Conversely, most of the bacterial strains exhibited resistance to commonly prescribed antibiotics such as co-amoxiclave, ampicillin, ceftriaxone, ciprofloxacin, cefotaxime and co-trimoxazole. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of thyroid dysfunction among patients with chronic kidney disease (CKD). Study Design: Cross-sectional study. Setting: Department of Medicine, Ayub Teaching Hospital’s. Period: September 2019 to August 2020. Methods: The study included adult patients with CKD who were at least 18 years old, regardless of gender. Patients with acute kidney injury, pregnant and lactating females, patients with history of goiter, thyroid surgery or radioactive iodine treatment, familial diseases of thyroid disorders, history of medication for thyroid disorders, and known cases of thyroid disorders were not included. Likewise, patients who were on concurrent medications which could affect thyroid function like amiodarone, lithium, iodine, glucocorticoids and interferon were also excluded. Results: A total of 165 patients of CKD were enrolled. The mean age of the patients was 38 ± 14 years, there were 71 (43%) males and 94 (57%) females. The mean TSH, T3 and free T4 were 3.73257 ± 16.52632 mIU/L, 1.5869 ± 0.76796nmol/L, and 1.4480 ± 0.57540 ng/L respectively. Thirty-nine (23.6%) patients had thyroid dysfunction while 126 (76.4%) were euthyroid. Regarding thyroid status of the patients, twenty-two (13.3%) patients of CKD had subclinical hypothyroidism, eight (4.8%) had hypothyroidism, six (3.6%) had subclinical hyperthyroidism, three (1.8%) had hyperthyroidism 126 (76.4%) were euthyroid. Conclusion: Thyroid dysfunction is common among patients with CKD. Subclinical hypothyroidism is the most prevalent anomaly, followed by hypothyroidism. In view of the increased CVD and mortality in these patients, it is imperative to regularly screen CKD patients for thyroid dysfunction and to appropriately treat them. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of types of bacterial pathogens involved in urinary tract infections and antibiotic sensitivity patterns among diabetic patients in the medical units of Khyber Teaching Hospital Peshawar. Study Design: Cross-sectional study. Setting: Department of Medicine, Khyber Teaching Hospital, Peshawar. Period: November 9, 2022 until May 8, 2023. Methods: The study was conducted after the approval of the hospital’s ethical committee and the written informed consent of patients. Data was entered and analyzed using SPSS. Patients aged 16 to 80 years of both genders admitted to medical units with diabetes and diagnosed with urinary tract infection were enrolled using a nonprobability consecutive sampling technique. Results: In our study, a total of 184 patients were enrolled, with a mean age of 52.08±18.4 years. There were 42.4% male and 57.6% female patients. The most common organism isolated was E. coli in 37% of patients, followed by Klebsiella in 23.9% of patients, Pseudomonas in 6.3%, Enterococcus in 12%, and Proteus mirabilis in 10.9% of patients. The most sensitive drug was Fosfomycin in 89.1% of patients, followed by nitrofurantoin in 81.5%, imipenem in 77.1%, amikacin in 73.3%, Piperacillin/tazobactam in 69%, gentamycin in 67.9%, Trimethoprimsulfamethoxazole in 66.8%, Amoxicillin-clavulanic acid in 59.7%, ciprofloxacin in 54.3%, ceftriaxone in 51%, and cefixime in 46.1% of patients. Conclusion: E. coli is the most common organism isolated in urinary tract infection in diabetics and Fosfomycin is the most sensitive drug for treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of clinico-hematological features and JAK 2 status of young adults presenting with Polycythemia Vera at the department of hematology. Study Design: Cross-sectional study. Setting: Department of Hematology, RMI Hospital, Peshawar. Period: 25th November 2023 to 25th May 2024. Methods: A total of 190 patients aging between 18-45 years and presented as suffering from Polycythemia Vera as per diagnosis of consultant hematopathologists, were included in this study. Samples with clear evidence of hemolysis, coagulation, or clots were excluded. Patient's demographics, details of physical appearance, clinical findings and history of adverse events were recorded. Hematological and pathological investigations were done and analysis of JAK2 V617F mutation was conducted using polymerase chain reaction from the diagnostic lab of the institute. The primary outcome of the study was to determine the frequency of clinicohematological features and JAK 2 status. Results: The Mean±SD of age in our study was 36.81±6.11 years with an age range of 21-45 years. Out of total patients, 49 (25.79%) patients were asymptomatic. The major symptoms affecting the daily life activities were headache 65 (34.21), abdominal discomfort 41 (21.58%), blurred vision 27 (14.21%) and fatigue 27 (14.21%). These patients had plethoric face 61 (32.11%), splenomegaly 64 (33.68%) and budd-chiari syndrome 8 (4.21%). The results of hematopathological findings showed abnormal hemoglobin (17±3.92 gm/dL), hematocrit (52.94±4.8 g %), platelet (579.63±227.68 103/μL) and leukocyte (10.32±2.6, 10³/μL) levels while 177 (93.16 %) patients had mutated JAK2 levels. Conclusion: Plethoric face and splenomegaly are the commonly found clinical findings in patients with Polycythemia Vera while these patients also have abnormal levels of hemoglobin, hematocrit, platelet and leukocyte. JAK 2 status serves conclusive role in the diagnosis of Polycythemia Vera. [ABSTRACT FROM AUTHOR]

Objective: To evaluate dexamethasone's effect on serum glucose concentration in diabetic versus nondiabetics patients undergone laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesiology, Lady Reading Hospital, Peshawar. Period: January 2022 to December 2022. Methods: One hundred and eight patients presenting for laparoscopic cholecystectomy were included. Patients were divided in two groups, fifty four patients in diabetic group and fifty four in non-diabetic group. Dexamethasone was administered in both groups prior the anesthesia induction. Blood glucose levels were recorded at baseline, at 6th and 12th hours in both groups. Results: Total 108 patients divided in two groups, 54 in diabetic group, and 54 in non-diabetic group. Patient's mean age was 38.67±13.66 years in diabetic group while 42.31±12.58 years in non-diabetic group. Mean BMI was 25.27±2.34 kg/m2 in diabetic group while 24.96±2.20 kg/m2 in non-diabetic group. The gender distribution of the patients in both groups is presented in Figure-1. No noteworthy significance in the rise of blood glucose levels was discerned between the two groups from baseline to the 6th hour. However, a substantial increase in blood glucose levels at the 12th hour was evident in the non-diabetic group (P = 0.0001). Conclusion: We conclude that 8 mg dexamethasone triggers a significantly elevated hyperglycemic surge in nondiabetic patients as compared to diabetics. [ABSTRACT FROM AUTHOR]

Objective: To determine the short term outcome of intra-articular corticosteroid injection the treatment of chronic shoulder pain. Study Design: Descriptive Study. Setting: Mardan Medical Complex, MTI. Period: 12th August 2023 to 15th December 2023. Methods: All patients of chronic shoulder pain fulfilling inclusion criteria were administered intraarticular corticosteroid injection. Pre intervention demographic and visual analogue scale (VAS) score and DASH (Disabilities of the Arm, Shoulder and Hand) scores were noted. All patients underwent through intraarticular corticosteroid injection procedure. VAS score and DASH score was calculated again on four week follow up visit. Both scores were compared by paired t test using SPSS version 23. The pre and post injection VAS and DASH scores were compared and p value calculated using paired t test. P value <0.05 was considered significant. Results: Total of 50 patients were included in the study. The mean age of patients was 50.08+6.43yrs and mean duration of symptoms was 5.7+1.6 months. 64% (n=32) of the patients were male, while 36% (n=18) were female about a total of 64% (n=32) of the patients were diabetic. Majority (56%, n=28) of patients exhibited left-side involvement, while 44% (22) presented with right-side involvement. The mean pre intervention VAS score was 79.86 + 6.32 and DASH score was 59.98+8.44. The mean post intervention VAS score was 15.7+4.1and DASH score was 49.78+6.33. After applying paired t-test on pre and post intervention scores, both VAS and DASH score was statistically significant with p value of <0.001. Conclusion: Intra-articular corticosteroid injection significantly relieved shoulder pain and improved functional outcome in short term follow up in patients with chronic shoulder pain. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequencies of liver cirrhosis-associated complications in patients with HCV+ diabetic patients and its association with HbA1C. Study Design: Observational Cross-sectional study. Setting: Medical Wards of Khyber Teaching Hospital. Period: October 2019 to November 2020. Methods: After approval from the hospital ethical committee, all HCV positive diabetic patients were enrolled in the study. Informed consent was obtained and relevant examination was performed. Hematemesis was diagnosed clinically, while venous blood was sent for all routine and relevant specialized investigations. Twenty-four-hour urinary output was calculated. Abdominal ultrasounds and Triphasic CT abdomen were done where required. Data were collected on structurally designed proforma. All data were entered into SPSS version 22. Results: A total of 62 patients were enrolled. The mean age was 49. 23 years ± 11.72 SD. Twenty-three patients (37.1%) were males, while 39 patients (62.9%) were females. Forty-nine patients (79%) were PCR-positive for HCV. Most patients (58.1%) had less than five years duration of HCV. Frequency of SBP was 16.1%, hepatic encephalopathy was 22.6%, ascites was 40.3%, hematemesis was 11.3%, portal vein hypertension was 45.2%, and HCC 3.2%. On poststratification, significant associations emerged with age, where SBP (p <0.01), hepatic encephalopathy (p<0.001), and ascites (p<0.0001), increased with advancing age, while hematemesis (p<0.04) and portal vein hypertension (p<0.04) were more pronounced in younger patients. Conclusion: In conclusion, individuals with both chronic HCV and diabetes mellitus exhibit an increased risk of cirrhosis-related complications. The most common complication was portal vein hypertension followed by ascites and hepatic encephalopathy. The complications like SBP, Hepatic encephalopathy and ascites associated with increasing age. [ABSTRACT FROM AUTHOR]

Objective: Sphingosine 1 Phosphate (S1P) is a key regulator of inflammation, angiogenesis, vessel permeability, and immune processes, acting through S1P receptors. Fingolimod (FTY720), an S1P receptor analog Fingolimod, was initially approved for multiple sclerosis treatment and has shown potential for application in infectious and inflammatory disorders, including COVID-19. Study Design: Comprehensive Literature Review. Setting: Northwest School of Medicine. Period: 1st March 2023 to 3rd July 2023. Methods: Examining S1P pathways, S1P receptor analogs, and their potential in treating inflammatory and infectious disorders, particularly COVID-19, utilizing Fingolimod. Results: S1P analogs have demonstrated therapeutic benefits in autoimmune diseases. In COVID-19, these analogs modulate the inflammatory response, reduce tissue damage, and promote viral clearance. Fingolimod, in particular, affects S1PR1, S1PR4, and S1PR5, blunting the inflammatory response and mitigating lung tissue injury. Early administration may prevent excessive inflammation without interfering with viral clearance. Potential risks include disturbance of cytokine homeostasis and delayed administration. Limited human studies and concerns about off-target effects need addressing. Conclusion: Fingolimod shows promise in treating COVID-19 by reducing inflammation and lung damage. Further research is needed to address limitations and ensure safety for clinical application. Sphingosine 1 Phosphate (S1P) plays a key role in regulating inflammation and immune responses, with Fingolimod being a potential treatment option. [ABSTRACT FROM AUTHOR]

Objective: To study the re-admission rate after coronary artery bypass grafting performed through a median sternotomy. Study Design: Retrospective study. Setting: Punjab Institute of Cardiology, Lahore. Period: January 2018 and December 2022. Methods: Patients above the age of 18 who underwent first time CABG were included in the study. Patients with additional procedures like valve surgery were excluded. Re-admission was defined as unplanned re-hospitalization within 30 days after discharge. Data was collected on Excel sheets from the available electronic medical record system of the hospital. The data was then transported to and analyzed using IBM SPSS software (version 23, SPSS Inc., Chicago, IL, USA). Patients were divided into re-admission group and no re-admission group and various perioperative variables were compared between the two groups. Results: After applying the exclusion criteria, the final analysis included 503 patients. Of the cohort, 29 (5.77%) were re-admitted. Mean age of the patients in readmission group was 54.3 ± 10 years while that in the no-readmission group 52 ± 8.3 years (p=0.144). The main reasons for readmissions were superficial chest wound infection (24.14%), pericardial effusion (24.14%) and deep sternal wound infection (10.34%). Conclusion: Coronary artery bypass grafting is associated with re-admissions after planned discharge of the patients. Wound infections are the commonest cause of re-admission. Large scale multi center studies are needed to study the rate as well as financial impact of re-admissions after CABG. [ABSTRACT FROM AUTHOR]

Objective: To determine adverse effects of Human Milk Fortifier on Preterm neonates in a Neonatal Intensive Care Unit. Study Design: Descriptive study. Setting: Indus Hospital NICU in Karachi. Period: Mar 2022 to September 2023. Methods: Aimed to investigate the adverse effects of HMF on 139 preterm neonates. The study excluded infants with congenital anomalies. Adverse effects, including Necrotizing Enterocolitis (NEC), metabolic acidosis, feeding intolerance, and other complications, were monitored. Results: The findings revealed that feeding intolerance was the most common adverse effect of HMF. Mild metabolic acidosis and NEC were also observed. These results are consistent with previous studies and may be attributed to the high osmolality of feeds following fortification with HMF. Despite the well-established role of HMF in promoting weight gain in preterm infants, the study underscores the importance of closely monitoring its use. Conclusion: Careful consideration of the potential risks and benefits of HMF is essential before prescribing it to preterm neonates. Future research with larger sample sizes and controlled designs is needed to validate these findings and explore strategies to mitigate the adverse effects of HMF in NICU settings. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and factors associated with self-medication among students with medical and non-medical backgrounds in Peshawar, Khyber Pakhtunkhwa. Study Design: Cross-sectional study. Setting: Medical and Non-medical Universities of Peshawar. Period: May to October 2022. Methods: For this comparative analysis, sample size was calculated based on the formula of Cochran, taking a 95% confidence level with 5% precision. The sampling was conducted using a non-probability convenience approach. Data was collected using a structured questionnaire and analyzed with the help of SPSS v.25. Results: A study sample of 427 participants with a 95% response yielded 212 medical students and 215 non-medical students. The prevalence of self-medication among medical and non-medical students was 35.36% and 39.35%, respectively. The occurrence of self-medication was reported as 7% daily, 11% weekly, 11% fortnightly, and 71% monthly. Among the reasons for self-medication, headache was the most common (49.65%), followed by cough/sore throat/cold (31.85%), fever (26.46%), generalized body aches (17.56%), heartburn/indigestion (14.75%), nausea/vomiting (9.36%), constipation (4.91%), anxiety/depression (4.68%), and insomnia (3.51%), while 8.89% constitutes other factors like allergies, skin rashes, and weight loss. The main reason for self-medication was the mild nature of the illness, which accounted for 31.85% of cases. Conclusion: The study indicated a considerable number of student population involved in self-medication practices. The prevalence of this behavior was slightly more common among non-medical students than medical students. Various factors contributed to self-medication ranging from physical symptoms to mental health issues. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of bile duct variant using magnetic resonance cholangiopancreatography (MRCP) on a magnetic field strength of 3.0 Tesla in liver donors. Study Design: Descriptive Cross-sectional study. Setting: Department of Radiology, Armed Forces Institute of Radiology and Imaging, Military Hospital Rawalpindi. Period: May 2019 to November 2019. Methods: The research comprised people who went to the hospital for magnetic resonance cholangiopancreatography. 85 liver transplant recipients between the ages of 20 and 70 were chosen for the research. According to Yoshida categorization, bile duct variation was noted. The MRCP methodology includes multiplanar imaging, maximum intensity projection pictures, thin slab axial HASTE, thick slab coronal HASTE, and T2 3D sequence. The Siemens Avanto 3 Tesla machine was used for the study. Results: The study’s participants ranged in age from 20 to 70, with a mean age of 41.73 ± 10.03 years. The majority of the 54 patients (63.53 percent) were aged 20 to 45. The male to female ratio was 1:1 among the 85 patients, with 43 (50.59 percent) men and 42 (49.41 percent) women. In my research of liver donors, 57 (67.05 percent) showed normal biliary tree structure and 28 (32.95 percent) exhibited abnormalities. Conclusion: This study concluded that normal biliary tree anatomy was seen in 67.05% and 32.95% had variations in biliary anatomy on MRCP on 3.0T in liver donors. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of De Quervain's tensosynovitis among smart phone users caused by excessive text messaging in undergraduate students of Gujranwala. Study Design: Cross Sectional study. Setting: Data was collected from different Institutes of Gujranwala City in the Institutes i.e. Elite College Gujranwala, Gujranwala Institute of Medical Sciences, Gujranwala Medical College, and Degree College Gujranwala. Period: 01-01-2022 to 30-06-2022. Methods: Institutes were selected by convenience sampling technique. 8 male and 12 female institutes were selected. The sample size at the time of study were 300. In this investigation, non-probability convenience sampling technique was used. Results: Results show that youngsters using smartphone frequently showed more positive result for Dequervain tenosynovitis (Finkelstein test p-value < 0.05). Conclusion: De Quervain's tenosynovitis is most prevalent among females. People with the age group of 20-21 are most effected as compared to the other age groups. Because of their repetitive usage of smartphone experiencing ache and weakness over the base of pollex or wrist. There seems to be a direct link among heavy text communications on a smartphone and prevalence of Dequervain tenosynovitis. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics and outcomes of congenital nephrotic syndrome (CNS) and infantile nephrotic syndrome (INS). Study Design: Cross-sectional study. Setting: Department of Pediatric Nephrology, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to January 2024. Methods: All cases of CNS or INS visiting the outpatient, emergency department, or admitted in Nephrology ward were analyzed. Data including demographic characteristic and anthropometric measurements, clinical history and presentation were noted. Short-term outcomes in terms of cases who were discharged from hospital or those who died were recorded. Results: In a total of 33 infants, 17 (51.5%) were male. The mean age was 5.8±3.2 months. The mean days from onset of edema to the time of enrollment was 33.27±22.63 days. The most common presenting features were ascites noted in 4 (12.1%). Associated infections were reported in 21 (63.6%) infants. INS and CNS were noted in 25 (75.8%) and 8 (24.2%) infants respectively. Mortality was reported in 11 (33.3%) infants. Conclusion: Infections were the most common associated conditions in congenital and infantile nephrotic syndrome. Short term outcomes exhibiting high mortality rates warrants early identification and treatment of congenital and infantile nephrotic syndrome. [ABSTRACT FROM AUTHOR]

Objective: The present study will help us in establishing local statistics in our population. Study Design: Descriptive study. Setting: Department of Orthopedic Surgery at Khyber Teaching Hospital in Peshawar. Period: June 2023 to December 2023. Methods: Seventy MRI of knee were collected. Knee MR images sagittal and coronal plane (T2-Weighted Images) were reviewed by radiologist and only knees with an intact cruciate ligament were included in the study. All the measurement (length and width) were made with electronic caliper. Results: Regarding radiological length of ACL on sagittal view on MRI, the minimum length was 28mm and maximum was 46mm and mean length was 34mm and standard deviation of 4.49, Regarding width of ACL on sagittal view it was found that the minimum length was 8mm and maximum was 16mm and its mean length was 10.4mm with standard deviation of 2.02. While the width of ACL on coronal plane was such that the minimum length was 6mm maximum was 16mm its mean was 11.34 and standard deviation of 2.48. By applying one sample T-Test and compare with Kowen parameter the p value was 0.00 for both length and width showing statistically highly significant. Conclusion: In conclusion in our population ACL is shorter and thicker then westerns population. Further studies should be done arthroscopically and on cadaveric to establish our local statistics of anthropometric measurements of anterior cruciate ligament. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the functional outcomes following surgical intervention for distal femur fractures using femoral locking compression plates. Study Design: Descriptive study an Observational study. Setting: Department of Orthopedics, MTI Mardan Medical Complex in Mardan. Period: January 2023 to December 2023. Methods: Was conducted on 86 patients with distal femur fractures treated with femoral locking compression plates at the Orthopedic Ward. The sampling method employed was non-probability consecutive sampling. All surgeries were performed using a standardized technique by an experienced surgeon. Functional outcomes were assessed using the Oxford Society score six weeks postprocedure. Data analysis was conducted using SPSS 23, with significance set at p ≤ 0.05. Results: Of total 86 patients, n=57(66.3%) were male while n=29(33.7%) were female. Mean age was 35.43±10.49. Overall, 39 patients (45.3%) had excellent functional outcomes, 22 patients (25.6%) had good functional outcomes, 13 patients (15.1%) had fair functional outcomes, and 12 patients (14.0%) had poor functional outcomes. After cross tabulation with functional outcomes, gender and BMI were found insignificant with p value of 0.584 and 0.399 respectively. While diabetes, hypertension and age was found to be significantly associated with functional outcomes with p value of <0.001,0.005 and <0.001 respectively. Conclusion: The use of locking compression plates for distal femur fractures resulted in predominantly favorable functional outcomes with minority of patients experiencing poor outcomes. Additionally, diabetes, hypertension, and age emerged as significant predictors of functional outcome. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of ventilator-associated pneumonia among mechanically ventilated patients with four hourly chlorhexidine mouthwash vs six hourly chlorhexidine mouthwash. Study Design: Randomized Controlled Trial. Setting: Surgical Intensive Care Unit of the Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan. Period: January 2020 to June 2020. Methods: Eighty patients admitted to ICU and mechanically ventilated for at least 48 hrs were randomly allocated, and 40 patients were treated with chlorhexidine mouthwash four-hourly per day group1, and 40 received chlorhexidine mouthwash six-hourly group2. The primary researcher followed patients for up to 7 days. Lower respiratory tract specimens were obtained on admission, and after 48 hrs of intubation, findings were entered in proforma. Results: The average age of the patients in group 1 was 37.55±10.16 years and in group 2 was a 38.65±9.25 year. There were 38(47.5%) male and 42(52.5%) female. The frequency of VAP was not significant between groups (11.25% vs 6.25%, p=.23). It was observed that the rate of VAP was not significant between groups in all age stratification. Gender stratification was performed and observed that no difference was found between groups. The frequency of VAP in females in group 1 was 7 (35%) and 4 (18.2%) in group 2, with p-value=0.21 and Chi-square=1.53. The frequency of ventilatorassociated pneumonia differed between groups for males in group 1 (35%) and 1 (5.6%) in group 2, with p-value=0.61 and Chi-square=0.25. Conclusion: Our study concludes that oral hygiene care incorporating chlorhexidine mouthwash effectively reduces the development of VAP in adults in ICU. We found no difference between the efficacy of four hourly and six-hourly chlorhexidine mouth wash in VAP frequency. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of surgical site infections in patients undergoing laparoscopic cholecystectomy with or without prior ERCP. Study Design: Prospective Comparative study. Setting: Surgical Unit-I of Holy Family Hospital, Rawalpindi. Period: December 2021 to May 2022. Methods: Total 140 patients were included. Group A had ERCP before their laparoscopic cholecystectomy. Those, who had laparoscopic cholecystectomy without first undergoing ERCP included in Group B. For this study, we used SPSS to analyze the data we gathered (version 23.0). Two groups were compared for surgical site infection using the Chi-square test. The level of significance was set at P 0.05. Results: Total 140 patients with biliary tract disease (choledocholithiasis, cholangitis and cholelithiasis) were enrolled in this study. In group-A, there were 16(22.9%) males and 54(77.1%) females, while in Group-B, there were 14(20.0%) males and 56(80.0%) females. In patients with prior ERCP group, 28(40.0%) developed surgical site infections, while in patients without ERCP group, 13(18.6%) developed surgical site infections with a p-value of 0.005, which is statistically significant. Conclusion: An increase in the incidence of SSI following laparoscopic cholecystectomy by two- fold is connected with pre-operative (ERCP) so we plan to assess if this technique is linked to a higher risk of wound infection after surgery. we suggest that long term use of antibiotics can reduce the rate of SSI and longer stay of patients in hospital. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of mirabegron in treating overactive bladder by assessing its impact on urodynamic detrusor overactivity (DO). Study Design: Cross-sectional study. Setting: Center for Urology and Transplantation in Sindh. Period: April 6, 2022, to October 4, 2022. Methods: Sixty-four individuals presenting OAB symptoms and without prior OAB medication use were included after obtaining informed consent and conducting relevant medical evaluations. Patients demonstrating signs of detrusor overactivity were evaluated through urodynamic assessments. Collected data, including patient history and study outcomes, were recorded using a standardized Proforma (Annexure I). Patient demographics, age, and gender distribution were documented. Patients with urodynamic detrusor overactivity were administered 50.0 mg mirabegron tablets once daily for a period of 13 weeks. A noteworthy percentage of patients reported substantial success after three months of treatment. Results: The average age of study participants was 50 years. The mean duration of OAB symptoms was 20.22 ± 15.38 months. Of the total 64 patients, 41 were female (64.06%) and 23 were male (34.94%). Notably, successful treatment outcomes were observed in 49 cases (76.56%). Conclusion: Mirabegron emerges as a valuable therapeutic option for individuals dealing with overactive bladder. This study underscores its efficacy in managing OAB sympt0oms, with a notable success rate of 76.6%. These findings contribute to the growing body of evidence supporting mirabegron as an effective treatment for overactive bladder syndrome. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of fistula in patients undergoing primary cleft palate repair. Study Design: Descriptive Case Series study. Setting: Burns and Plastic Surgery Center, HMC, Peshawar. Period: February 2023 to December 2023. Methods: Patient of both genders males and females undergoing primary cleft palate repair were included in the study with age ranging from 9 to 18 months age excluding patients with comorbids and syndromic patients. Non-probability consecutive sampling was adopted. The data was acquired from patients and hospital record and analyzed with statistical package for social sciences (SPSS). Results: Our study shows that among 169 patients, mean age was 10 months with SD ± 5.11. 100(59%) patients were male and 69(41%) patients were female. More over 3(2%) patients had fistula while 166(98%) patients didn't had fistula. Conclusion: In this study we observed an internationally acceptable frequency of post-palatal repair fistula for primary cleft palate in our study population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the significance of high signals in STIR sequences in MRI in patients presenting with non-traumatic knee pain. Study Design: Cross-sectional study. Setting: Department of Radiology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2023 to August 2023. Methods: The patients presented for MRI of knee joint for knee pain unrelated to trauma were analyzed. Data were collected through a proforma based on 9 questions that included demographic data and questions related to the cause of pain. The total calculated sample size was 86 patients Data was analyzed through SPSS. Descriptive statistics were calculated. Association was determined using chi-square test considering p-value =0.05 as significant. Results: Our study showed no statistical correlation between knee pain and high STIR signals seen in pre-patellar bursa with 90.9% showing high signals with pain, while 85.3% showed high signals without pain. In our study this signal was found in about 20-30% that were mostly female household help and carpet layers. Conclusion: There is no statistical correlation between knee pain and high STIR signals seen in pre-patellar bursa. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of chronic kidney disease (CKD) among children of school-going age. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: A total of 130 children of both genders, aged between 5-15 years, visiting outpatient department of pediatric medicine were analyzed. Demographic and clinical information were noted. Laboratory investigations like urinalysis and serum creatinine were performed. CKD was diagnosed on the basis of "Kidney Disease Outcomes Quality Initiative (KDOQI)" guidelines. Results: In a total of 130 children, 67 (51.5%) children were male. Overall, the mean age was 8.43±2.45 years. Hypertension was diagnosed in 10 (7.7%) children. Anemia was present in 103 (79.2%) patients. The mean hemoglobin, serum creatinine, and blood urea nitrogen were 9.41±1.98 g/dl, 0.48±0.37 mg/dl, and 34.20±33.18 mg/dl, respectively. CKD was diagnosed in 10 (7.7%) children. Among these 10 children diagnosed with CKD, 7 were having CKD stage-1 whereas CKD stage-2 was noted in 3 children. Presence of hypertension (p=0.006), and albuminuria (p<0.001) were associated with CKD. Conclusion: The prevalence of CKD in school going age children was 7.7%. Presence of hypertension, and albuminuria were linked with CKD. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of intra-articular PRP injections in patients with knee osteoarthritis. Study Design: Cross Sectional. Setting: Orthopedic Department of Mardan Medical Complex. Period: 13th August to 14th December 2023. Methods: Involving 50 diagnosed osteoarthritis patients at demographic data, grades of osteoarthritis, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded pre-treatment. Patients received PRP injections at three intervals, and post-treatment WOMAC scores were assessed. Statistical analysis included mean, standard deviations, and a paired t-test. Results: The study comprised 66% female patients, with a mean age of 50.08±5.82 and mean BMI of 27.16±3.53. Regarding grades of osteoarthritis, grade 1, grade 2 and grade 3 comprised of n=14(28%), 19(38%), 17(34%) respectively PRP treatment significantly reduced WOMAC scores from a pre-treatment mean of 56.62±5.70 to 27.54±4.79 (p < 0.001). Conclusion: The significant reduction in WOMAC scores post-treatment suggests that intra-articular PRP injections may serve as a valuable intervention in the short term management of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequent site of squamous cell carcinoma of oral cavity and pattern of neck node involvement in cross sectional population. Study Design: Prospective Study. Setting: Department of Otorhinolaryngology Head and Neck Surgery, Abbasi Shaheed Hospital Karachi and Karachi Medical and Dental College. Period: 01-06-2023 to 31-12-2023. Methods: Patients who biopsy proven squamous cell carcinoma of oral cavity visited ENT department Abbasi Shaheed Hospital were include in this study. Proforma was made in which detail history and examination were noted. Oral cavity examined to see the size and site of tumor. Neck was palpated to see palpable cervical lymph node. CT scan head and neck with contrast was done. Those patients who fulfilled the inclusion and exclusion criteria included in this. Result: 56 patients were selected in this study who fulfill the inclusion criteria. Male were 37 (66%). Maximum number of patients were between the 41-50 years of age, 24 patients (42.8%). Most common site of carcinoma was buccal mucosa 27 (48.2%). Highest number of patients presented with T3 stage 22 patients (39.2%). The frequency of lymph node involvement noted in 35 (62.5%) patients while 21 (37.5%) came with no lymph node. Level I was the most frequent level involved, it was involved in 28 patients (50%). Conclusion: Oral squamous cell carcinoma usually reported late. Early referral to otorhinolaryngologist and educate patient to consult Otorhinolaryngologist as earliest for early diagnosis and appropriate treatment plan. [ABSTRACT FROM AUTHOR]

Objective: To compare the serum selenium levels in anemic and non-anemic Pakistani children. Study Design: Case-control Prospective study. Setting: PAEC General Hospital, Islamabad, Pakistan. Period: 1st March 2022 to 31st August 2022. Methods: A case control study was conducted wherein comparison of Selenium levels in anemic and non anaemic Pakistani children was investigated. Age, serum selenium level and haemoglobin were the quantitative variables of this study and were subjected to median and standard deviation. Severity of anemia, mean being qualitative (ordinal) variables were expressed in terms of percentages. Bar graph and tables were used to display results. Chi square test was applied to compare both the groups. Odd ratios were also calculated. A total of 60 samples from anemic and control population were selected using consecutive non-probability sampling method. Selenium levels of the serum were determined using atomic absorption spectrometry. SPSS 19 version software was used for data analysis. Results: The findings in this study indicated that 33% of cases were Selenium deficient, while 27% among controls had low Selenium levels. (p=0.57). Conclusion: This study showed no association of selenium deficiency with anaemia. [ABSTRACT FROM AUTHOR]

Objective: To study the optimal timing of Coronary artery bypass grafting (CABG) after acute myocardial infarction (MI). Study Design: Retrospective Cross-sectional study. Setting: Punjab Institute of Cardiology, Lahore. Period: January 2019 to January 2023. Methods: Patients who underwent on pump CABG grafting after MI were included in the study and divided into those who had surgery within 7 days (early surgery group) and those who had surgery after 7 days (late surgery group). Those with additional cardiac procedures, operated in emergency and those who underwent redo procedures were excluded from the study. Patients were followed for 30 days. Data was collected on pre-formed proformas and analyzed using IBM SPSS software (version 23, SPSS Inc., Chicago, IL, USA). Results: A total of 475 patients ((early surgery group, 224), (late surgery group, 251) were included in the study. Mean age was 52.75 ± 7.7 years. NSTEMI was significantly more in patients with early surgery (161) (71.9%) compared to 99 (39.3%) in the late group (p= 0.01). Intraoperatively, cross clamp time and bypass time was similar in both the groups (p=0.81 and 0.15 respectively). Mortality was (1.3%) in the early surgery group and 3 (1.2%) in the late operation group. Conclusion: Patients who suffered from myocardial infarction can undergo surgery after the acute phase with acceptable mortality and morbidity compared to those operated late. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern and outcome of burns in epileptic patients. Study Design: Retrospective study. Setting: Plastic and Burn Unit, Lady Reading Hospital, Peshawar. Period: January 2021 to Decmber 2022. Material & Methods: The research was conducted at the Plastic surgery and burn unit of Lady Reading Hospital Peshawar. Digital records of 35 epileptic patients admitted in the last five years were extracted. The demographics, burn pattern, total body surface area, level of burn, surgical outcome, complications, and length of hospital stay of epileptic patients were extracted from the electronic record. IBM-SPSS version 20 was used to analyze the data. Results: Over the last five years, 35 epileptic patients have been admitted to our unit. Males made up 28.6% of our patients, while females were 71.4%. The patient's average age was 24.14 years ±16. 28 SD. The most common pattern in our patients was fire burn (62.9%), followed by scald (25.7%), and the least common pattern was 11.4%. 10 to 20% of body surface area burns were seen in 51.4% of patients, less than 10% in 20% of patients, and >20% burns in 28.6% of patients. The majority of the patients (37.1%) had a fullthickness burn, followed by mixed burns (31.4%), deep partial-thickness burns (20%), and superficial partial-thickness burns (11.4%). Twenty-eight patients stayed in the hospital for 1 to 14 days, 04 patients for 15 to 30 days, and 03 patients for 31 to 45 days. Conclusion: Epilepsy-related burns are a serious public health concern in developing nations, putting a significant burden on burn units due to the severity of the burns and the duration of hospital admissions. [ABSTRACT FROM AUTHOR]

Objective: To document the frequency of various classes of Angle’s malocclusion and its treatment need among children of both gender between 13-17 years age attending government high schools in Peshawar District. Study Design: Cross sectional study. Setting: Khyber Medical University Institute of Dentistry. Period: Jan 2020 to Nov 2021. Material & Methods: 900 patients of both genders between the ages of 13 and 17 were used in the current investigation. A performa was used to record malocclusions e.g. Angle’s classification, overjet, overbite, open bite and cross bite. For various malocclusions, the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) index was reported. Results: We looked at 900 students between the ages of 13 and 17 whose guardians had signed a written consent form. Among the 900 students who were examined, 60% (540) were males, and 40% (360) were females. 175 individuals had normal dental health, 420 had class 1 malocclusions, 265 had class 2s, and 40 had class 3s. Overjet was excessive in 210 cases and reduced in 53. Overbite was excessive in 201 cases and reduced in 34. In 185, there was an open bite. The difference was significant (P < 0.05). In 489 cases, DHC grade I and II, 310 cases, grade III, and 101 cases, grade IV, and grade V. The difference was significant (P< 0.05). Conclusion: The most frequent malocclusion is class 1. DHC grades I and II were more frequently observed in patients. Malocclusion can be identified using the Dental Health Components (DHC) of the Index of Orthodontic Treatment Need (IOTN). [ABSTRACT FROM AUTHOR]

Objective: To assessed upper airway differences between individuals with and without obstructive sleep apnea (OSA). The study Investigated upper airway differences in OSA. Study Design: Comparative cross sectional study. Setting: Hayatabad Medical Complex, Khyber Girls Medical College. Period: January, 2022 to October, 2022. Material & Methods: 68 participants examined with results: “Anterior-posterior (AP) respiratory tract dimension” consistent across groups. Mandible rami dimension uniform, indicating no bony contribution to lateral narrowing. OSA patients displayed narrower lateral respiratory tracts due to enlarged lateral pharyngeal walls. OSA patients didn’t exhibit larger fat pads in the minimal respiratory tract compared to healthy individuals. Results: Our findings reveal that the upper airways of apneic patients exhibit distinct characteristics compared to those of individuals without apnea. Specifically, these differences manifest in the lateral and narrow constriction of the apneic airway. The study’s results underscore the significance of examining delicate tissue elements surrounding the upper respiratory tract to comprehend these variations in apneic respiratory tract dimensions. Conclusion: This study highlights OSA-related upper airway differences, primarily attributed to enlarged lateral pharyngeal walls. Understanding these distinctions may aid OSA diagnosis and management. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of moringa oleifera on lipid parameters of rabbits. Study Design: Experimental Trial. Setting: was carried out on healthy animal models using adult male rabbits in indoor Patient Ward of Pakistan Veterinary Clinic and Pet Centre Nawabshah. Period: January 2023 to June 2023. Methods: Thirty adult male rabbits age ranging from 16 to 24 months having weight between 2 to 3 kg were selected and randomly divided in to three groups comprising 10 rabbits in each group. Data was analyzed by using SPSS version 25.0. Results: The mean Cholesterol, LDL, HDL and Triglycerides level of the rabbits were compared between Group A (Control), Group B (250 mg/Kg MO) and Group C (500 mg/Kg MO) and data was collected on four scheduled days (Day 0, 15, 30 and 45). Statistical significant test repeated measure ANOVA was applied and there was statistically significant difference among means Cholesterol level in each time period in both Group B and C with P-value 0.002 on groups, mean LDL level with P-value 0.014 and 0.000 on both groups and mean HDL level with P-value 0.000 and 0.015on both groups. There were no statistically significant differences between means in Serum Triglyceride level in both groups with P-value 0.063 and 0.149. Conclusion: It was concluded in our study that Moringa Olifera has potential role in lowering serum Cholesterol, LDL and HDL level with regular use. But we cannot find any significant difference in lowering triglyceride level. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiology and outcomes of pleural effusions in children. Study Design: Crosssectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: June 2022 to October 2023. Methods: A total of 60 admitted children of either gender, aged 1-12 years, and having pleural effusion were analyzed. Relevant laboratory and radiological studies including complete blood count, complete urinalysis, ultrasonography, chest X-ray, sputum for acid fast bacilli (AFB) smear, and gene x-pert were performed. Pleural tap was done and fluid was sent to institutional laboratory for biochemical analysis, microbiological testing, and cytology testing to rule out infections. Results: In a total of 60 children, 34 (56.7%) were male. The mean age was 5.4±3.5 years. Cough and fever were the most reported symptoms among the patients, with 18 (30.0%) having a cough, and 17 (28.3%) having fever. The sputum test was positive in 7 (11.7%) of children. The cause of pleural effusion in 44 (73.3%) of patients was pneumonia, 12 (20.0%) tuberculosis, and 4 (5.7%) had congestive heart failure (CHF). Conclusion: The cause of pleural effusion in the pediatric age group is commonly infection. Taking preventive measures, diagnosing and managing pleural effusion promptly as a multidisciplinary approach can decrease the morbidity and mortality rate. [ABSTRACT FROM AUTHOR]

Objective: To determine the correlation of hepatic steatosis and fibrosis with body anthropometry among Nonalcoholic fatty liver disease (NAFLD) patients presenting in outpatients Gastroenterology clinics in a tertiary care hospital in Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: October 2022 to March 2023. Methods: Body anthropometric measures and demographic data of patients were recorded when presenting to outpatient clinics with NAFLD. The controlled attenuation parameter (CAP) was obtained by FibroScan using an M or XL probe considering CAP value = 248 dB/m as hepatic steatosis. Liver fibrosis was defined as a liver stiffness (LS) value =8 kPa. Results: In a total of 300 patients, the mean age was 51.4±8.4 years. The median CAP was 251 (IQR=219-342). Steatosis was present among 233 (77.7%) patients. Fibrosis was present among 229 (76.3%) patients. Steatosis was found to have significant correlation with age, waist circumference, neck circumference, hip circumference, triglycerides, creatinine, low density lipoprotein, alinine transaminase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, srum cholesterol and, high density lipoprotein. Fibrosis was significantly correlated with age, waist circumference, neck circumference, hip circumference, triglycerides, low density lipoprotein, total bilirubin, alanine tansaminase, alkaline phosphatase, gamma-glutamyl transferase, serum cholesterol, high density lipoprotein. Conclusion: Considerable interplay of metabolic factors, and anthropometric measures exist with NAFLD. It is important to monitor visceral fat measurements among NAFLD patients with anthropometric and biochemical abnormalities. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of functional outcome after conservative treatment in patients with distal radius fractures presenting to Hayatabad Medical Complex, Peshawar. Study Design: Descriptive Case Series. Setting: Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Period: 1st January 2022 to 30th June 2022. Methods: A total of 137 patients of both gender with distal radius fracture were included in the study. A Basic demographics (age, gender, duration of fracture and weight on weighing scale) were recorded. At the end of 6 weeks, the plaster cast was removed and functional outcome examinations was made. Functional outcome was noted using demerit point system of Gartland and Werley. Results: Age range in this study was from 18 to 70 years with mean age of 44.153±8.19 years, mean duration of complain 26.708±4.18 hours and mean weight was 80.343±7.05 Kg. Male patients were 70.8% and females were 29.2%. Excellent functional outcome was seen in 33.6% patients, good 14.6%, fair 34.3% and poor was 17.5%. Conclusion: Our study concluded that conservative management of the distal radius fractures in plaster cast is an effective treatment modality achieving satisfactory results. [ABSTRACT FROM AUTHOR]

Objective: To compare the technique of total laparoscopic hysterectomy (TLH) and laparoscopic assisted vaginal hysterectomy (LAVH) in order to identify the procedure with better outcome. Study Design: Prospective Comparative study. Setting: Northwest General Hospital and Research Center and Lady Reading Hospital, Peshawar. Period: 1st Jan, 2018 till 31st Dec, 2022. Methods: All the patient presenting in out-patient department needing hysterectomy with benign pathologies, perimenopausal age group, size of the uterus =12 weeks and with no previous history of abdominal surgery were placed alternatively in to two groups. Group A included patients who were supposed to undergo Total Laparoscopic Hysterectomy, where uterus was supposed to be delivered vaginally and vault was to be repaired via intracorporeal sutures over uterine manipulator. While group B included patients who were to be operated by Hybrid laparoscopic/vaginal technique and vault was to be repaired vaginally after delivering the uterus vaginally. Data was collected, placed on SPSSR version 16.0 and data was analyzed. Results: 62 patients were included in this study and were placed alternatively in to each group. The demographic values of both groups showed no significant differences for age, BMI and preoperative hemoglobin levels. The higher age group presenting with dysfunctional uterine bleeding was insignificantly more common in Group A whereas fibroids were more common in group B, yet a non-significantly higher age was recorded in group B. Conclusion: Both Laparoscopic assisted Vaginal hysterectomy (LAVH) and Total Laparoscopic hysterectomy (TLH) are feasible options for benign uterine pathology with lesser operative time in hysterectomy performed by the TLH method. The Total laparoscopic Hysterectomy (TLH) results in lower per-operative and post-operative blood loss as compared to the Laparoscopic assisted vaginal technique (LVAH). [ABSTRACT FROM AUTHOR]

Objective: To Compare the learning approaches of medical students at the exit and entry of their medical school, to evaluate the influence of gender and to look for factors leading students towards a change in their learning approach, if any, through interviews. Study Design: Concurrent Mixed Method study. Setting: Ameer-ud-deen Medical College, Lahore. Period: March 2021 to March 2022. Methods: Sequential mixed method 100 first year and 100 Final year MBBS students were included in the study for quantitative analysis. ASSIST Questionnaire is used for identifying student's approach to studying as either deep, surface or strategic and the correlation of gender with preference of study approach. Descriptive statistics wer'e performed. Student's t-test was used for statistical comparisons. Qualitative data was collected through in depth semi structured interviews of final year students. Thematic analysis was done to interpret the data and triangulation method was used for validation. Results: There is an over-all predominance of deep approach in the both first and final year MBBS students. The number of first-year students employing a strategic approach were significantly in majority as compared to final year students doing the same. No significant difference is seen in the learning approaches of male and female students. Interviews indicated reasons of shifting away from strategic learning approach in the final year medical students. No significant difference was seen in the selection of approach between female and male students of both groups. Conclusion: Study suggests that there is a predominance of deep approach in the medical students both at exit and entry points. This is due to their clinical exposure and environment, assessment methodologies, curriculum planning, seniors and peer pressure and most importantly their immediate teachers. The more we understand these learning styles, the better we can guide our future generations towards deep learning and improve their attitude and professional skills. [ABSTRACT FROM AUTHOR]

Objective: To find out the spectrum of respiratory distress and outcome in neonates admitted to Neonatal Intensive care unit (NICU) of National Institute of Child Health (NICH), Karachi, Pakistan. Study Design: Cross-sectional study. Setting: NICU of NICH, Karachi, Pakistan. Period: June 2022 to May 2023. Methods: We analyzed 148 neonates of either gender presenting with respiratory distress. At the time of enrollment, demographic and clinical information was noted in all neonates along with detailed maternal history. Relevant laboratory and radiological studies were performed. Final outcomes were recorded in terms of discharged, expired or referred. Results: In a total of 148 neonates, 96 (64.9%) were boys. The mean age was 4.04±5.65 days. Tachypnea, nasal flaring, intercostal recession, subcostal recession, grunting, and cyanosis 148 (100%), 146 (98.6%), 138 (93.2%), 133 (89.9%), 97 (65.5%), and 83 (56.1%) were the most frequent clinical presentations among neonates with respiratory distress. The most frequent causes behind respiratory distress were noted to be respiratory distress syndrome, sepsis, and meconium staining of labour in 31 (20.9%), 25 (16.9%), and 24 (16.2%) neonates. Mortality was observed in 21 (14.2%) neonates. Significant association of neonates presenting with congenital pneumonia (p=0.048), or congenital anomalies (p<0.001) were found to with poor outcomes. Mechanical ventilation was found to have significant relationship with poor outcomes (p<0.001). Conclusion: Tachypnea, Nasal flaring, intercostal and subcostal recessions, grunting, and cyanosis were the primary clinical presentations among the neonates with respiratory distress. Congenital pneumonia, and congenital anomalies emerged as key predictors of poor outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine sleep quality among functional dyspepsia (FD) patients presenting to gastroenterology out-patient clinic in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2022 to December 2023. Methods: FD diagnosis was established in view of ROME-IV criteria. Sleep quality was evaluated using Pittsburgh Sleep Quality Index PSQI scoring tool. A global score of 5 or more indicates poor sleep quality. Binary logistic regression was applied and odds ratio with 95% confidence level were figured out to assess relationship of patients' profile with FD. Results: In a total of 240 patients, the mean age was 37.3±6.5 years. There were 122 (50.8%) male patients. The most common dyspeptic feature was postprandial fullness (60.4%) followed by early satiety epigastric pain (50%) and epigastric burning (39.6%). Mean PSQI score was 14.7±3.5. Frequency of poor sleep quality among FD patients was 79.2%. None of the parameter was significantly associated with sleep quality except urban residence (p=0.005). Conclusion: Very high burden of poor sleep quality was found among FD patients. While most dyspeptic symptoms did not show a significant association with sleep quality, urban residence emerged as a notable factor. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the literature regarding the practices to manage the hidden curriculum for the best use of mobile devices in clinical practice. Study Design: Systematic Review. Setting: Articles selected for review from Canada, United Kingdom, Japan, Ireland and Saudi Arabia. Period: July to Dec 2023. Methods: Following databases were searched: PubMed (12,579), the Cochrane Library (348), scopus (84), PsycInfo (21), CINAHL (220), Google Scholar (1,414). Primary variable (Evaluation of the development of clinical skills made possible by mobile devices) and secondary variable (to determine how satisfied students are with their mobile learning experience). The quality of study was critically appraised according the Critical Appraisal Skills Programme (CASP) scale. Results: The research findings indicate that using mobile devices into medical education has a variety of effects. Positive instructor perspectives, more student involvement, and higher learning outcomes were frequently reported by participants. Medical students' growth of technological competency and readiness for the changing healthcare landscape have been found to be accelerated by mobile devices. The integration of virtual simulations and applications that are interactive has had a positive impact on the development of clinical abilities. Positive effects included themes of individualization, collaborative learning communities, and a better understanding of patient-centered care. On the other hand, issues including the digital divide, diversions, and security threats were recognized as obstacles that called for a careful strategy to reduce any negative effects. When everything is considered, the findings confirm the revolutionary potential of mobile device incorporation in medical education and highlight how it helps to create a dynamic, technologically advanced learning environment for prospective medical professionals. Conclusion: This study provides insight on how adding mobile devices into medical education has a revolutionary effect. The research indicates enhanced learning outcomes, increased student involvement, and altering faculty perspectives through insightful stories and compelling arguments. [ABSTRACT FROM AUTHOR]

Objective: To assess the pulpal calcification that was presented on radiographs after the completion of orthodontic treatment. Study Design: Retrospective Observational study. Setting: Department of Orthodontic, Ayub Medical College Abbottabad. Period: October 2023 to November 2023. Methods: Following the inclusion and exclusion criteria, the current study was carried out on patients who had reported and registered for orthodontic intervention within the previous five years and had case records from the orthodontics department available. A total of 670 case records were assessed for selecting 191 cases as per sample size. Results: Among 191 patients, 30.4% were male and 69.6% were female. The highest percentage belonged to the 14-16 age group (32%), followed by 20-22 (28.3%), 17-19 (26.2%), and 23-25 (12.6%) age groups. Pre-treatment calcification was 17.8% (n=34), rising to 28.3% (n=54) post-treatment. Pulp calcification significantly increased after orthodontic treatment (p<0.05). No significant differences were found between gender and age groups regarding pulp calcification (p>0.05). However, a significant association existed between pulp calcification and treatment duration (p<0.05). The 25-30 months treatment duration had the highest occurrence (n=27), followed by 31-36 months (n=19). Mandibular teeth had a higher prevalence of pulp calcification (53.7%) than maxillary teeth (46.3%), with tooth number 36 having the highest prevalence (25.9%). A significant relationship was observed between the left and right sides of the dental arches, with the left side exhibiting greater tooth calcification (68.5%) than the right side (31.5%). Conclusions: The present study concluded that there was an increase in the frequency of pulpal calcifications in the observed posterior teeth after orthodontic treatment. Pulpal calcifications were significantly more prevalent in the posterior teeth of the mandibular arch compared to the maxillary arch. Moreover, the likelihood of pulpal calcification increased over the duration of orthodontic treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic accuracy of high resolution computed tomography (HRCT) of chest in diagnosing sputum smear positive and negative pulmonary tuberculosis (PTB). Study Design: Cross-sectional study. Setting: Tertiary Care Hospital, Kharian Cantt. Period: Oct 2021 to April 2022. Methods: The retrospective reviews of medical records of patients undergone HRCT chest and sputum for AFB smear and culture due to pulmonary tuberculosis (PTB) suspicion were included. The HRCT and AFB findings for sample size of 220 was compared. SPSS was used to stratify outcomes on basis of sputum smear results. Diagnostic accuracy of HRCT chest was calculated by taking AFB as gold standard. The AFB findings and HRCT outcomes were compared through correlation analysis and paired t-test with p value < 0.05 considered as significant. Results: The sensitivity was found to be 86.23% with specificity of 86.48%, positive predictive value of 86.23%, negative predictive value of 86.48% and diagnostic accuracy of 86.36% for HRCT for diagnosing pulmonary tuberculosis (PTB). Conclusion: HRCT chest affirms high diagnostic potential for pulmonary tuberculosis (PTB) and should be used as a routine diagnostic tool for the disease. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of tooth wear with freeway space among different age groups in patients with generalized tooth wear reporting to Khyber College of Dentistry, Peshawar. Study Design: Descriptive, Crosssectional study. Setting: Department of Prosthodontics, Khyber College of Dentistry, Peshawar. Period: 3rd May 2020 to 29th January 2021. Methods: For this study, a total of 180 subjects were observed to identify the occurrence of tooth wear within the age group of 25-34 years, considering a prevalence rate of 3%. The sample size was determined with a 95% confidence level and a margin of error of 3%. Moreover, a non-probability consecutive sampling technique was used for data collection. Results: Data from 180 subjects were collected within a study duration of 7 months. The mean age of the subjects was 40.36±9.048 (SD) yrs. The chi-square test determined the association between tooth wear and freeway space, revealing a statistically insignificant (p-value of 0.16) relationship between the two variables. Conclusion: Freeway space was found to be statistically insignificant to the rate and degree of tooth wear. [ABSTRACT FROM AUTHOR]

Objective: To investigate the reliability of a short scale i.e: PHQ-2 in medical students. Study Design: Crosssectional Descriptive. Setting: Quaid-e-Azam Medical College, Bahawalpur. Period: 25-10-23 to 25-11-23. Methods: 159 Pakistani medical college students were selected through convenience sampling technique. Participants completed two scales, namely the Patient Health Questionnaire-2 (PHQ-2) and the Beck Suicide Ideation Scale (BSSI). The collected data from both scales were analyzed using SPSS version 21. The analysis included assessing the Cronbach's alpha coefficient for the Patient Health Questionnaire-2 (PHQ-2) scores and its items in comparison with the Beck Suicide Ideation Scale (BSSI). Results: The average PHQ-2 score observed was (2.14 ± 1.69 standard deviation). The Cronbach's alpha coefficient was (a = 0.72), indicating a high level of PHQ-2 internal items consistency. PHQ-2 showed a significant correlation with the Beck Suicide Ideation (BSSI) at (r=.48), indicating good construct reliability. Conclusion: The PHQ-2 scale appeared as a reliable scale for screening depression and it can be used for assessing depression and suicidal ideations in academic settings of Pakistan. However, its complementation with PHQ-9 is recommended for clinical use. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of anemia in carriers of Beta thalassemia Study Design: Retrospective Observational study. Setting: PAEC General Hospital, Islamabad, Pakistan. Period: 1st January 2022 to 30th June 2022. Methods: In this descriptive study, 131 carriers of Beta-thalassemia trait, diagnosed by hemoglobin electrophoresis on cellulose acetate membrane at alkaline pH, of any age and both genders were included. Complete blood counts were performed by hematology analyzer of Sysmex XN-1000 to determine hemoglobin level and red blood cell indices i.e. mean corpuscular volume. The studied parameters included hemoglobin and mean corpuscular volume as quantitative variables. Severity and type of anemia were the qualitative variables of this study and were expressed in terms of frequency and percentages. SPSS 19 version software was used for data analysis. Results: 131 carriers of Beta-thalassemia traits were included in study. 58 (44.27%) were males while 73 (55.73%) were females, male to female ratio being 1: 1.3. Of 131 beta thalassemia traits 67 (51.15%) were found to be anemic while 64 (48.85%) had normal hemoglobin for given age and gender. The mean corpuscular volume of anemic and non-anemics was 59.54+5.82 fl and 63.70+6.95 fl respectively. Mean hemoglobin level of anemic Beta-thalassemia traits was 9.42+1.05 g/dl while non-anemic patients was 12.12+1.39 g/dl. Conclusion: Burden of anemia among carriers of Beta-thalassemia traits is high. Understanding the prevalence of anemia in individuals with the trait is crucial for optimizing healthcare interventions and improving the quality of life for affected individuals. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of carvedilol and propranolol for prophylaxis of variceal bleeding in cirrhotic patients. Study Design: Randomized Controlled Trial. Setting: Department of Gastroenterology and Hepatology, PIMS, Islamabad. Period: 1st January 2022 to 31st of December 2022. Material & Methods: A total of 260 patients reporting at the department suffering from liver cirrhosis with medium or large esophageal varices and had never reported for variceal bleeding previously. The patients were randomized in to 2 equal groups of 130 each through computer generated randomization. Patients in Group-A were started on dose of carvedilol 6.25mg once daily initially for 1 week, subsequently titrated to twice daily 6.25mg and titrated up if needed to maximum of 25mg twice daily. Patients in Group-B received a dosage of propranolol 20 mg BID which then escalated weekly in 20 mg steps if needed and doses were adjusted as per targeted heart rate and systolic BP. Patients were followed up over 1 year for any event of variceal bleeding. Results: Mean overall age in this study was 42.13±10 years. The ratio of male patients was higher than female patients (60% VS 40%). Carvedilol prevented variceal bleeding in 86.15% of the patients while propranolol was effective in preventing variceal bleeding in 75.38% of the patients. Hence carvedilol was significantly more effective than propranolol in preventing variceal bleeding (p=0.02). Conclusion: Carvedilol is significantly more effective in prophylaxis of variceal bleeding than propranolol in patients with medium or large esophageal varices. [ABSTRACT FROM AUTHOR]

Objective: To make aware that the healthcare professionals should diagnose GUTB as early as possible to avoid the grave side effects of untreated cases as it can lead to the gross structural abnormalities in the Genito urinary system. Study Design: Single Center Observational study. Setting: Tertiary Care Medicine Unit in Baluchistan, in BMCH Teaching Hospital. Period: 1st January 2012 to 31st Dec 2022. Methods: Total 118 patients were enrolled in the research and patients were taken a detailed history, they went through physical examination, then they went they underwent through different diagnostic modalities as per the availability in indications. The diagnosed cases were treated and the follow up was done the mean duration for the follow up was around two years. Results: All individuals received interventions primarily involving anti-tuberculosis medications. Three patients had bilateral fallopian tubes obstruction who went under laparoscopy and later on 1 couple opted for IVF, for infertility. Anti-TB drug therapy resulted in severe adverse reactions in 8 individuals. Among them, two female patients experienced the formation of a thimble bladder accompanied by incapacitating storage symptoms. Additionally, at the time of diagnosis, 4 patients exhibited impaired renal functions, which, fortunately, remained unaltered following the completion of the prescribed treatment. None of our patients went into ESRD, and no death during study was reported due to GUTB. Conclusion: It was concluded in our study that Genito urinary tuberculosis being the second commonest type of extrapulmonary tuberculosis is also common in Baluchistan and it needs to be treated and diagnosed and treated as soon as possible, we also suggest that if the expert diagnostic modalities for the diagnosis of GUTB are not available even the clinical suspicion can be used to diagnose the case and start the treatment. [ABSTRACT FROM AUTHOR]

Objective: To access the prevalence of undiagnosed type 2 Diabetes Mellitus in patients with Acute Coronary Syndrome. Study Design: Cross-sectional study. Setting: Department of Medicine, of Tertiary Care Hospital of Islamabad. Period: 17th July 2023 to 17th October 2023. Methods: WHO calculator was used to calculate the sample size and 100 subjects were selected fulfilling the inclusion criteria (Both male and female of age 18 to 65 years retained in ER or admitted with the diagnosis of ACS). Blood samples were obtained for baseline investigations including blood sugar and HBA1C. Results were entered on EXCEL Sheets and analyzed using SPSS V.20. Results: The data showed 47% males, 70% of the participants belonging to the age group 41-65 years ACS presenting with STEMI in 37%, 40% patients with NSTEMI and unstable angina was found in 23%. The Mean BMI was 27±3.2SD mean HBA1C level was 4.3±1.7SD and the mean FBG was 129±17.9SD. Among all the male patients, there were (27.65%) patients with undiagnosed T2DM while among all the female patients, (18.8%) were reported with undiagnosed T2DM. Conclusion: A high prevalence of undiagnosed DM was observed in ACS patients admitted to tertiary care hospital. Research work done in developing countries showed data which was consistent with our study, however, research data from developed world was in contrast to our study. [ABSTRACT FROM AUTHOR]

Objective: To investigate the TIMI (Thrombolysis in Myocardial Infarction) score as a predictive tool for assessing the severity of coronary artery disease in patients presenting with ST-segment elevation myocardial infarction (STEMI). Study Design: Prospective, Observational Cohort study. Setting: Hayatabad Medical Complex Peshawar. Period: January 2021 to June 2022. Methods: Consecutive patients presenting with STEMI to the emergency department of the participating hospital was considered for inclusion. Inclusion criteria were including patients aged 21 years or older, with symptoms consistent with STEMI and ST-segment elevation of at least 1 mm in two or more contiguous leads on the electrocardiogram (ECG). Patients with a known history of coronary artery disease or previous myocardial infarction were excluded from the study. Results: The age of the patients ranged widely, with a mean±SD age of 60.18±15.38 years. Gender distribution showed a predominance of males, constituting 67.79% of the sample, while females accounted for 32.20%. In terms of comorbidities, 22.03% of patients were obese, 52.54% had diabetes mellitus, 18.64% had hypertension, 25.42% had hyperlipidemia, 11.86% had a family history of myocardial infarction, and 47.45% were smokers. Moderate risk group shows a lower incidence at 71.11%, and the High risk group has the lowest incidence at 50%. The p-value for this comparison is highly significant at 0.0001, indicating that there is a substantial difference in the occurrence of LV dysfunction among these risk groups. Conclusion: Our study demonstrates a strong association between TIMI risk groups and the occurrence of post-myocardial infarction complications, including LV dysfunction, arrhythmias, cardiogenic shock, and death. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic accuracy of diffusion weighted imaging on MRI in patients of ovarian cancer with histopathology considered as gold standard. Study Design: Cross-sectional study. Setting: Department of Radiology, Tertiary Care Hospital Kharian. Period: February 2022 to August 2022. Methods: Non-probability, consecutive sampling was performed from 60 patients. After receiving informed consents, the suspected female patients with age 15 to 65 years went under MRI. The results were compared with histopathological findings and diagnostic potential of MRI was calculated by 2x2 table. The findings of both the modalities were compared by correlation analysis with p<0.05 considered as significant. Results: The sensitivity and specificity of MRI were estimated to be 92.68% and 73.68%. The positive predictive value and negative predictive value were estimated to be 88.37% and 82.35%. The diagnostic accuracy was found to be 86.66%. The findings of MRI and histopathology were significantly (p<0.05) correlated with a value of 0.685. Conclusion: The use of MRI is highly recommended in diagnosis of ovarian cancer. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of surgical site wound infection and factors responsible for it following emergency Caesarean section performed in, PNS Shifa Hospital Karachi. Study Design: Cross Sectional study. Setting: Department of Obstetrics and Gynecology, PNS Shifa Hospital Karachi. Period: 4th July 2021 to 4th January 2022. Methods: Three hundred eleven women with term pregnancy undergoing emergency Caesarean section for maternal or foetal indications were included in this study. Wound inspection for signs of infection was done every day. Factors responsible of causing wound infection were noted from the discharge card. All the information was recorded on a preformed questionnaire. Results: 62(19.94%) of 311 women experienced surgical site wound infections in which prolonged duration of rupture of membranes was the commonest factors i.e. 51.6% (32/62), prolong duration of labor before operation 29%(18/62) and excessive volume of intra operative blood loss 29% (18/62). Conclusion: It is concluded there is a need to adopt specific preventative measures to decrease the frequency of identified factors so that the frequency of wound infection after the emergency caesarean section can be controlled with decreasing maternal morbidity and reduce hospital stays and thus, reducing the cost of treatment. [ABSTRACT FROM AUTHOR]