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Objective: To evaluate risk factors that predict Insulin requirements and outcomes in women with gestational diabetes in a resource-limited country. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital, Mangla Pakistan, from Jan to Dec 2019. Methodology: Our study included 100 pregnant women with gestational diabetes over a period of one year. The primary outcome was to calculate the frequency of gestational diabetes and the correlation between maternal age and parity with subdermal Insulin therapy in a peripheral (Class C) hospital. The secondary outcomes of this study included mode of delivery and neonatal birth weight. Results: Out of 1509 deliveries, our study included 100 pregnant women (6.62%). Sixty-two (62%) required Insulin to control hyperglycemia in addition to oral Metformin; 36% required oral Metformin alone. Maternal age (p=0.078), presence of comorbidity (p=0.260), and parity (p=0.242) did not predict Insulin requirement. A caesarean section (69%) was the most common mode of delivery. Insulin requirements to control hyperglycemia didn't correlate with mode of delivery (p=0.825). The neonatal birth weight was 3.30±0.33 kg in patients requiring Insulin versus 3.26±0.25 kg in other treatments (p=0.86). There was one intrauterine death. Conclusion: The frequency of gestational diabetes was 6.62%. Maternal age, parity, and the presence of maternal comorbidities did not predict Insulin requirements. There was no correlation between Insulin therapy, mode of delivery, or neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: This study assesses first-aid facilities within school premises and assessment of teachers on first aid training. The objective was to assess and compare the first aid knowledge, attitude and practice among teachers from both public and private sector of some schools in Karachi. Methods: The study was cross-sectional and was conducted from March 2018 to September 2019. All participants were included after the informed consent and all of them were full-time teachers from both public and private sector schools. All of them were below 70 years and had minimum one year experience at least. Data was collected through the questionnaire method. Results: Total 384 teachers were included, out of which, 106 were from the public sector and 278 from the private sector. Also, 53% of public and 54% of private-sector teachers had performed first aid in their professional life. Only 27% of public and 40% private teachers think that they are able to handle emergency situations and have enough first aid knowledge. Out of all the teachers participated in, only 27% of public sector teachers think that they have sufficient knowledge regarding first aid, that they can handle emergency situation on their own. On the other hand, 40% of private-sector teachers have enough first aid knowledge to handle emergency cases on their own in schools. Conclusion: Knowledge and attitude regarding first aid training and management is unsatisfactory among the teachers at schools in Karachi. Public sector school teachers have a poor understanding of knowledge and practice of first aid as compared to the private sector. Although not enough but private sector schools do recognize the importance of first aid training more than public sector schools. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of spontaneous labour in the swept and non-swept groups. Study Design: Quasi-experimental study. Study and Duration of Study: Department of Gynaecology and Obstetrics, Sheikh Khalifa bin Zayed Hospital, SKBZ Hosp/AK CMH Muzaffarabad, from Nov 2019 to Apr 2020. Methodology: Patients were randomly divided into two groups (with lottery method). Group-A underwent a sweeping membrane while group-B was the control group. Spontaneous labour and other outcomes were observed in both groups. Results: A total of 250 women were included in the study. There were 125 women in each group. The mean age of women was 23.4 ± 1.3 years in swept-group and 24.5 ± 1.7years in the non-swept group. The swept-group showed a high frequency of spontaneous labour compared to the non-swept group (24.8% vs 15.2%, p=0.01). Swept-group showed less postpartum haemorrhage (p=0.001), pain (p=0.001), pre-labour membrane rupture (p=0.03) and admission to neonatal intensive care unit (p=0.01). Conclusion: Sweeping of the membrane is a safe and beneficial procedure for labour induction among low-risk term pregnant women. It is an effective procedure preventing women from reducing the incidence of post-term pregnancy with minimum complications. [ABSTRACT FROM AUTHOR]

Objective: To assess the anti-cancer role of ascorbic acid using high doses against the cervical cancer cell line and to establish a cell culture facility in the laboratory. Study Design: In vitro study. Place and Duration of Study: Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi Pakistan, from Aug 2014 to Jul 2015. Methodology: HeLa cells were grown in Dulbecco's modified eagle medium, and upon reaching confluency, cells were challenged with different doses of ascorbic acid. The MTT assay was employed to study the cytotoxic effects of increased doses of ascorbic acid on HeLa cells. Results: An increasing dose of ascorbic acid was found to be cytotoxic toward HeLa cells, and its EC50 was found to be between 5-6gM. A high dose of ascorbic acid is selectively cytotoxic to HeLa cell lines of cervical cancer, which may imply the treatment of cervical cancer patients. NF-kB inducing kinase is a salient protein in TNFa-induced NF-kB activation. Ascorbate has been reported to inhibit that activation which has anti-apoptotic roles in tumour progression. CB-Dock was employed to propose the binding sites for NIK-Ascorbate interaction, which might be a therapeutic target for cancer cells. Conclusion: The study concludes that high dose ascorbic acid is cytotoxic to cervical cancer cells HeLa and may have important implications in treating cervical cancer patients. Therapeutic intervention of this vitamin may contribute to suppressing cancer development. [ABSTRACT FROM AUTHOR]

Objective: To determine the practice of waterfall life cycle functions in the health profession department of medical institutes by keeping in view the demographic factors of health professions managers. Study Design: Cross-sectional survey. Place and Duration of Study: Medical Institutes of Rawalpindi and Islamabad Pakistan, from Feb to Jul 2021. Methodology: 46 managers were taken as a sample through a systematic random sampling technique. A self-developed questionnaire was used, and it contained 21 items. Mean and standard deviation were used to measure the practices of waterfall agile management, and t-test and ANOVA were used to test the effect of gender and experiences. Results: Managers were not fully confident about the practices of water fall life cycle functions in their respective organization (Mean=3.08 ± 1.19). Gender has no significant effect on required analysis (p=0.861); design stage (p=0.625); test (p=0.222); deployment (p=0.718) and development (p=0.432) while monitoring and evaluation had significant effect (p=0.042). Similarly, managers' experience has significant effect on required analysis (p=0.013); test (p=0.001); deployment (p=0.001) and development (p=0.002) while it has no significant effect on design stage (p=0.062) and monitoring and evaluation (p=0.060) in medical institutes. Conclusion: Health profession managers were neutral about the practices of the waterfall life cycle of agile management in their respective medical institutes. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of various tongue lesions diagnosed during dental examination in a Pakistani population and to assess their association with blood groups. Study Design: Cross-sectional study. Place and Duration of the Study: Outpatient Department, Dental College Hospital of Heavy Industries Taxila Educational City Institute of Medical Sciences and Dental OPD, Heavy Industries Taxila Hospital, Taxila Pakistan, from Oct 2022 to Sep 2023. Methodology: The study included five hundred patients. It excluded pregnant women and participants with a diagnosed malignant condition. Those who gave consent were examined for the absence or presence of tongue lesions like Aphthous ulcer, Fissured tongue, coated tongue, geographic tongue and median rhomboid glossitis on the basis history and clinical presentation. Results: The study included five hundred patients. It was discovered that 19(3.80%) of the participants had aphthous ulcers, 17(3.40%) of the participants had fissured tongues, 24(4.80%) had geographic tongue, 146(29.20%) had coated tongue, and 19(3.80) had median rhomboid glossitis. Aphthous ulcers were more common in the O+ blood group, the A+ blood group had more cases of Fissure tongue, the O+ blood group had more cases of Coated tongue, and the O-blood group had more cases of Geographic tongue. Conclusion: Different tongue lesions had varying frequency in our population, with coated tongue being the most prevalent. However, there were no statistically significant differences in the distribution of tongue lesions among various blood groups. [ABSTRACT FROM AUTHOR]

Objective: To calculate the Maternal Near Miss Mortality Ratio and Mortality Index at a tertiary care hospital in a developing country with limited healthcare resources. Study Design: Retrospective analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Shaikh Khalifa Bin Zayed Al Nahyan Hospital Azad Kashmir and Combined Military Hospital, Muzaffarabad Pakistan, from Jan 2015 to Dec 2018. Methodology: Four hundred and forty-nine severe maternal outcome cases admitted in Intensive Care Unit were included in our study. Maternal Near Miss Mortality Ratio and Mortality Index were calculated. SPSS version 23.00 used for statistical analysis. Results: The maternal near missed mortality ratio was 11:1, mortality index 8.68%, severe maternal outcome 1.58% with 39 maternal deaths. Most common causes of maternal morbidity were hemorrhage (56.1%); hypertensive disorders (24%); sepsis (3.5%) and cardiovascular diseases (1.8%). Hypertensive disorders of pregnancy (30.7%), hemorrhage (25.6%) and sepsis (25.6%) were the common causes of maternal deaths. The total ICU time in patient with near-miss was 1.9±1.7 days versus 2.6±3.14 days in deaths, p<0.001. Operative delivery was statistically significantly (p value <0.001) more common mode of delivery in severe maternal outcomes (66.6%) and maternal deaths (33.3%). Conclusion: Our study has shown 1.58% severe maternal outcomes amongst admitted pregnant, maternal near missed mortality ratio being 11:1, mortality index being 8.68%. Eclampsia, hemorrhage and sepsis are major cause of maternal death. [ABSTRACT FROM AUTHOR]

Objectives: To assess the epidemiological data and potential connection between different endocrine chemical disruptors and thyroid hormone abnormalities. Study Design: The 2020 PRISMA standards were followed when conducting the systematic review. Ten research studies were found and examined after an in-depth review of the scientific literature. Methodology: The systematic review was aimed to gather all pertinent information, including observational studies (prospective or retrospective cohorts) that address the relationship between exposure to endocrine disruptors and thyroid hormone imbalance. Results: Ten studies were found, and they demonstrated that these substances, especially in adulthood, impact the level of thyroid hormone and the incidence of thyroid nodules. Conclusions: Endocrine disruptive chemicals can compromise thyroid function by affecting hormone transporters, gene expression, and the hypothalamic-pituitary-thyroid axis. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to investigate the relationship of these factors and major depressive disorder in a sample of patients presenting to the psychiatry department of the teaching hospital of a private medical college in Islamabad, Pakistan. Methods: Using convenience sampling a total of 50 participants were included in the study which comprised of 25 patients with major depressive disorder (MDD) and 25 matched healthy controls (HC). The severity of depression was determined with the help of Hamilton Rating Scale for Depression (HRSD) while the demographic details of the participants were collected with the help of a proforma. The pro-inflammatory markers (CRP, IL-6 and IL-1â) were measured in the serum by taking peripheral venous samples from both cases and controls. Statistical analysis was performed by using SPSS, version 22. Results: Patients with MDD had significantly higher levels of the proinflammatory factors as compared to healthy controls. In HC the levels of proinflammatory cytokines were not raised to any significant degree, while these were consistently higher in MDD patients with acute depressive episodes (two sample t test 2-tailed significance d" 0.01). Conclusion: This study showed that sensitive indicators of inflammation were higher in the local patients with MDD. Our study lends support to the inflammatory hypothesis of major depression, so that there is a further need to investigate this avenue. In this manner it would be possible to discover much needed biomarkers, while opening new paths to more effective therapeutics of this recalcitrant disorder. [ABSTRACT FROM AUTHOR]

20 honey samples from district, Balochistan (Pakistan) were studied for their physiochemical, biochemical and antioxidant potential. During the study, pH, ash content, moisture, total fat, sugar content, reducing and non-reducing sugars, vitamin C, Vitamin A, flavonoids, polyphenols and % DPPH scavenging activity were monitored. The pH of the samples was between4.0 - 5.0, having mean±SD values of 4.5 ± 0.1. The moisture and ash content had an average value of 17.4 ± 0.7 g/100g and 0.142 ± 0.0 g/100g respectively. The fat content had range of values from minimum to maximum 0.12 - 0.49 g/100g with mean±SD of 0.297 ± 0.11. Total sugar content varied between 66.2 - 71.8 g/100g with mean and S.D 68.88 ± 1.7. The sucrose content ranged between 0.60 - 4.28 g/100g with mean±SD 1.93 ± 0.8 while average value of fructose and glucose values were 36.84g/100g ± 0.9 and 30.41g/100g ± 3.00 respectively. All the tested samples showed very low content of Vitamin A while Vitamin C and flavonoids showed the average values of 112.45 ± 9.8 mg/kg and 43.0 ± 2.0 mg CE/kg respectively and polyphenols showed the average value of 748.76 ± 31.6 mg GAE/kg with 6057.5 - 887.2 mg GAE/kg min to max values. The % DPPH scavenging at 40mg/ml showed the values 61.8 - 75.7 min to max with the average of 70.3 ± 0.9. All the tested samples lie within the limits of international standard but Sample P4 showed the best results among all the 20 honey samples. [ABSTRACT FROM AUTHOR]

Objective: To determine the molecular diversification and frequency of mecA Gene in MRSA infections of hospitalised patients at Islamabad, Pakistan. Study design: Cross-sectional study. Place and Duration: Pakistan Institute of Medical Science, Islamabad, Pakistan, from Sep 2017 to Sep 2018. Methodology: To explore the occurrence of pathogenic S. aureus in the hospitalised patients of Islamabad, 500 samples were collected. All the isolates were further characterised by gram staining, catalase test and DNAse media analysis validating the presence of S.aureus. The overall frequency of S.aureus was 19.5% in all the isolates. Six highly distinguished colonies were further evaluated through colony PCR by 16S r RNA analysis, and results revealed 99.9% homology of isolates with S.aureus. The degree of resistance was further evaluated for 12 isolates based on the previous MRSA resistance pattern. The extraction and concentration of DNA were done by the CTAB and Nanodrop methods. Then primers were designed for the presence of the mecA gene of S. aureus. Results: Results showed 51 (52.7%) MSSA and 45 (47.4%) MRSA among all the isolates. Colony PCR by 16S r RNA analysis results revealed 97 (99.9%) homology of isolates with S.aureus. PCR of all the twelve extracted DNAs of isolates showed the frequency of the mecA gene in all the isolates. Conclusion: The study is the first report the presence of resistance mecA gene in the hospitalised patients of Islamabad. It has depicted a resistant gene's presence and showed the rising trend of resistance in pathogenic S. aureus. [ABSTRACT FROM AUTHOR]

Objective: To determine extended-spectrum beta-lactamase (ESBL) producing, multidrug-resistant (MDR) uropathogens and their antimicrobial susceptibility profile in various age groups and gender. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital Abbottabad, from Jan to Dec 2018. Methodology: A total of 727 urine samples were collected and inoculated on cysteine lactose electrolyte deficient (CLED) agar plates (Oxoid). Plates were incubated for 24-48 hours at 37°C ±2 aerobically. Growth was identified by standard techniques. Antimicrobial susceptibility was determined. Results: The rate of positive culture was 19%. Uropathogens spectrum showed that there were Escherichia coli 82 (59.85%), Klebsiella pneumoniae 37 (27.01%), Serratia spp. 4 (2.92%), Enterobacter spp. 4 (2.92%), Citrobacter spp. 3 (2.19%), Pseudomonas aeruginosa 2 (1.46%), Staphylococcus saprophyticus 3 (2.19%) and Enterococcus spp. 2 (1.46%). Susceptibility was as follows: Ampicillin (2.92%), Co-amoxiclav (26.28%), Ceftriaxone (64.69%), Cefepime (58.39%), Tazobactum-piperacillin (63.50%), Imipenem (82 %), Ciprofloxacin (27.01%), Co-trimoxazole (29.93%), Amikacin (74.45%), Nitrofurantoin (81.75%) and Sulbactum-Cefoperazone (54.48%). Among 130 Gram negative bacilli (GNB) from urinary isolates 71(54.6%) were ESBL producer and 59 (44.3%) were non-ESBL producers. No isolate of Serratia spp, Enterobacter spp. and Citrobacter spp. Were producing ESBL. Out of 130, Gram negative bacilli 92 (70.8%) were MDR and 38 (29.2%) were non-MDR. Conclusion: Extended-spectrum beta-lactamase production and MDR is significantly high in uropathogens. Empirical treatment followed by a de-escalation of antimicrobial is suggested after culture report in order to combat the problem of emerging antibiotic resistance. [ABSTRACT FROM AUTHOR]

Objective: To find out the histopathological findings in appendectomy specimens, negative appendectomy rate (NAR) and the association of gender and age groups which underwent negative appendectomies in our set up. Study Design: Cross sectional study. Place and Duration of Study: POF Hospital, Wah Cantt, from Jan to Aug 2017. Methodology: The records of 1050 patients were assessed for the relevant clinical history, age, gender and date of their presentation in hospital. The appendectomy specimens were classified as positive specimens which contained fecoliths, worms, granulomatous inflammation, foreign body reaction, mucocele, or appendiceal tumors. All the data were entered and analyzed in SPSS-21. Results: Among the 1050 patients with suspicion of acute appendicitis, 458 (43.6%) were cases of acute appendicitis followed by acute suppurative appendicitis 100 (9.5%) and fecolith 79 (7.5%) in appendiceal lumen. The negative appendectomy rate was calculated as 248 (23.6%). A significant association of normal appendices was found with female gender (p=0.002) and young age group (p=0.02). Conclusion: Acute appendicitis was the most frequent histopathological finding in our study. The negative appendectomy rate was significantly associated with the females of young age. [ABSTRACT FROM AUTHOR]

Objective: To predict the tertiary structure of human interferon alpha/beta receptor 2 protein. Study Design: Structure prediction by using bio informatics tools. Place and Duration of Study: Department of Biochemistry, Swat Medical College (STMC), Saidu Shareef, Swat, Pakistan, from Aug 2019 to Dec 2019. Methodology: All protein sequences of human interferon alpha/beta receptor 2 (isoforma, b and c) (IFNAR-2) were retrieved through the BLAST search (The Basic Local Alignment Search Tool) from available databases ‘NCBI’ (National Centre for Biotechnology Information) and ‘Uni Prot KB’ (The Universal Protein Resource). Sequence alignment was conducted by using Clustal Omega, to get the consensus sequence for IFNAR-2 protein. Consensus protein sequence of human IFNAR-2 was used for the prediction of the three-dimensional structure by employing Swiss-Model Server. Moreover, subcellular localization analysis was also performed by using CELLO2GO program. Results: Structural model of human IFNAR-2 protein was predicted and evaluated by Ramachandran dimension. Cellular localization of tertiary topological domains of the predicted models were revealed probability of localization of IFNAR-2 protein (isoform a, b & c) is highest in the plasma membrane due to the presence of the transmembrane alpha helical regions. Conclusion: This study predicted the tertiary structural dimensions of human IFNAR-2 protein, including the specific topological domains that contribute towards the subcellular compartmentalization and functional characteristics. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the physical activities and dietary habits and to determine the concept of healthy eating among university students of Pakistan. Study Design: Cross sectional survey. Place and Duration of Study: Three well reputed educational institutes of Lahore Pakistan, from Jul 2019 to May 2020. Methodology: A questionnaire was used for data collection and validated scientifically as well as linguistically by experts. The questionnaire consists of 4 parts demographic and basic profile of participants i.e., body mass index, age, gender. The rest of parts used to evaluate dietary patterns, physical activities and participant’s concept for healthy eating. A total of 324 participants were included in the study and sample size was calculated by using Raosoft sample size calculator by keeping the population size as 200000. The data was collected through online protocols such as by sharing in social media groups of relevant universities. All the collected data was entered and analyzed by using SPSS-21. Results: Out of 324 participants, there was a major cohort of female participants 202 (62.3%) as well as 209 (64.5%) participants were day scholars. The key findings of current study were observed that the students have satisfactory eating habits and 103 (31.8%) have an active lifestyle; 130 (40.1%) have a normal body mass index; only 142 (43.8%) have quite good nutritional knowledge. Conclusion: The results specified detrimental behaviors influencing student’s dietary habits and they must be considered inevitable for interventions to be made and refining student’s responsiveness for acquiring a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of using a 3D atlas on academic performance and compare it with the use of power point presentations during online lectures for gross anatomy of the head. Study Design: Comparative prospective study. Place and Duration of Study: Department of Anatomy, Dental College, Heavy Industries Taxila Education City Institute of Medical Sciences, Taxila Pakistan, from Jun to Jul 2020. Methodology: Forty-nine students from first year BDS were selected through nonprobability convenience sampling. They were assigned to two groups, A and B comprising of 25 and 24 students respectively. Group A was taught gross anatomy of head region via Zoom lectures employing a digital three-dimensional anatomy atlas application (Visual body, 2019). Group B was exposed to only two-dimensional pictures through presentations during their lectures. Ten teaching sessions were conducted with post session MCQ based assessments. One comprehensive assessment was conducted at the completion of the region. Results were compared for both groups. Results: The mean scores for three of the post session assessment tests were higher for group A (15.72 ± 2.03, 15.28 ± 2.79, 16.92 ± 2.13) as compared to that of group B (14.64 ± 3.42, 13.66 ± 3.00, 15.04 ± 3.01) (p<0.05). Similarly, the mean score for comprehensive assessment for group A (35.36 ± 6.02) was also more than that of group B (31.41 ± 6.88) (p<0.05). Conclusion: Three-dimensional viewing of structures led to better academic performance as compared to that of presentations with two dimensional pictures. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of noise stress on Thyroid Stimulating Hormone in adult rats. Study Design: Laboratory-based experimental study. Place and Duration of Study: Department of Anatomy Army Medical College, Rawalpindi in collaboration with National Institute of Health, Islamabad, from Jan to Dec 2020. Methodology: A total of 30 adult Sprague Dawley rats were distributed into three groups as ten rats/group. Group A served as the control group, rats in group B were exposed to 100 dB noise for continuous 4 hours/day for four months, and the rats in group C were exposed to 100 dB noise for continuous 6 hours/day for four months. At the end of the study, serum samples were collected from the rats' tail veins. Thyroid-stimulating hormone levels were compared among the groups. Results: At the start of the study, mean serum thyroid stimulating hormone level of control group A rats was 0.34 ± 0.15 μIU/ml. Mean serum thyroid stimulating hormone level of experimental groups B and C rats at the start of the study was 0.46 ± 0.18 μIU/ml and 0.41 ± 0.14 μIU/ml, respectively Mean serum thyroid stimulating hormone of rats did not differ statistically significantly between the group p=0.26, By the end of study mean serum thyroid stimulating hormone level of control group A rats was 0.6 ± 0.2 μIU/ml. Mean serum thyroid stimulating hormone levels of experimental groups B and C rats at the end of the study were 1.32 ± 0.35 μIU/ml and 1.86 ± 0.67 μIU/ml, respectively, Mean serum thyroid stimulating hormone of rats differed significantly between the groups p<0.001. Conclusion: Loud noise exposure can lead to an increased level of mean serum thyroid stimulating hormone levels in adult rats. [ABSTRACT FROM AUTHOR]

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018. Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit. Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively. Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found. [ABSTRACT FROM AUTHOR]

Objective: To find out low molecular weight heparin (LMWH) efficacy inlate second trimester oligohydramnios cases. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Malir, from Jan to Jun 2017. Methodology: A total of 30 patients having amniotic fluid index (AFI) <8 on ultrasound scan during their late second trimester phase were enrolled in the study after informed consent. Exclusion criteria included congenital anomalies on U/S, PPROM, and drug-induced oligohydramnios. Personal, medical and obstetric history was obtained for age, parity and co-morbids like hypertension, antiphospholipid syndrome, and previous oligohydramnios. Low molecular weight heparin was started at dose of 0.5mg/kg of body weight subcutaneously for 8-12 weeks and stopped 24 hours prior to delivery. Rescan for amniotic fluid index and fetal bio-metry assessment done every 2 weeks till date of delivery. Fetal outcome in terms of maturity, mode of delivery, birth weight, APGAR score and need for NICU admission were measured. Results: There were 28 live births and two intrauterine deaths. Twelve patients were delivered normally and 18 had elective LSCS. Of twenty eight cases, eight were premature low birth weight (LBW) babies. Twenty six patients showed significant improvement in amniotic fluid index. Average birth weight was 2.5kg. Neonates showed an average APGAR score of 7. Eight neonates admitted in NICU (for prematurity and/or low birth weight) and discharged within a week. Conclusion: Low molecular weight heparin plays significant role in treating oligohydramnios in cases with or without risk factors. However further studies with large sample size including a control sample are recommended to validate the results. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of S. aureus in hospitalized patients of Islamabad. Study Design: Cross-sectional study. Study Duration: Pakistan Institute of Medical Science, Applied Microbiology and Biotechnology Lab, COMSATS Institute of Information Technology, Islamabad, from Sep 2017 to Sep 2018. Methodology: A total of 500 samples were collected. The isolates were divided into four study groups according to their source of origin i.e. group 1 (dermal group), group 2 (nasal group), group 3 (blood group) and group 4 (urine group). Gram staining, catalase test and DNA se media analysis were done for validation of S. aureus. Disc diffusion test (for antibiotic susceptibility), Oxacillin disc test (to differentiate between methicillin-resistant Staphylococcus aureus and methicillin-susceptible staphylococcus aureus) and minimal inhibitory concentration (for susceptibility to vancomycin), were performed. Results: Degree of the prevalence of staphylococcus aureus was 21%, 17%, 9% and 8% in group 1, 2, 3 & 4 respectively. The overall prevalence of staphylococcus aureus was 19.5% in all isolates. The disc diffusion test showed the descending resistance pattern of isolates i.e. 100, 94, 94, 76, 58, 55, 47, 43, 40 and 37% for penicillin, ciprofloxacin, Kanamycin, erythromycin, tetracycline, oxazolidinone, sulfamethoxazole, doxycycline, clindamycin, and cipoxin respectively. Minimal inhibitory concentration found only one sample resistant at 2ug/l concentration of Vancomycin. Moreover, Oxacillin disc test showed 52% methicillin-susceptible Staphylococcus aureus while 48.2% methicillin-resistant staphylococcus aureus among all isolates. Conclusion: There is an increase in the frequency of methicillin-resistant staphylococcus aureus. Single vancomycin resistant staphylococcus aureus strain was also isolated. [ABSTRACT FROM AUTHOR]

Objective: To determine association of ABO and Rh blood groups with COVID-19 RT-PCR positive status. Study Design: Case control study. Place and Duration of the Study: Department of Pathology, Margalla Hospital Taxila, from Apr 2020 to Dec 2020. Methodology: The sample comprised of 436 cases and 500 controls. Out of 3936 RT-PCR done during the study duration, 436 RT-PCR positives were enrolled in study as cases. 500 age and gender matched controls were selected from same population. Study variables (age, gender, blood groups, RT-PCR result) were obtained from Hospital data (HIMS). Data was analyzed using SPSS version 25. Mean and SD was calculated for age. Frequencies were calculated for categorical variables. p-value calculated applying chi square test. Odds ratios calculated to determine association. Results: The mean age of cases was 37.3 ± 16.3. Statistically significant association was observed between age, gender and COVID-19 RT-PCR positive status. B+ blood group was most frequent both among cases (35.4%) and controls (36.2%), followed by O+ and A+. However, no significant association was observed between blood groups and COVID-19 RTPCR positivity. Odds ratios calculated for blood group O and non - O (OR=0.95), A antigen (OR=0.97) and Rh factor (OR 0.93) among cases and controls showed week negative association. Whereas a weak positive association of B antigen + and B antigen - with PCR positivity (1.07) was observed between cases and controls. Conclusion: Susceptibility to acquire COVID-19 infection is not associated with ABO and Rh blood groups according to this study. [ABSTRACT FROM AUTHOR]

Objective: To identify the sources of learning gaps in biochemistry teaching and learning and explore new teaching and learning strategies, considering the students' perceptions and felt needs. Study Design: Exploratory qualitative study (Social-constructivist philosophical worldview). Place and Duration of Study: Public Sector Medical College, Pakistan, from Jul 2020 to Jul 2021. Methodology: Students from all five years of medical college were recruited voluntarily after their written consent. Ten focus group discussions were conducted, each consisting of approximately 8 to 12 participants. Each session was recorded and then later transcribed verbatim. Verbatim FGDs were reviewed, and codes were given as the concept became recognizable. A code structure was developed via an inductive approach, and then sub-themes and themes were generated. Results: Ten major themes were generated from the FGDs. These themes were teaching, students' motivation, clinical irrelevance, educational needs, transition difficulty, attitudes, student support, senior peers, curriculum coherence, and assessment. These themes were further elucidated to explain the causes of the learning gaps and provide suggestions. Conclusion: This study concludes that teaching, students' motivation, clinical irrelevance, educational needs, difficulty in transition, student attitude, student support, senior peers, curriculum coherence, and assessment are the potential sources of the learning gap to achieve intended learning outcomes of biochemistry for medical students. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the sensitivity and specificity of serum lactate dehydrogenase as an indicator for maternal and neonatal outcomes in hypertensive disorders of pregnancy. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital, Okara Cantt Pakistan, from Apr to Sep 2018. Methodology: Eighty-six pregnant women with pregnancy-induced hypertension were included in our study. Group-A included pregnant women with raised serum LDH, and Group-B included pregnant women with normal LDH levels. The patients were followed up until delivery and hospital discharge. Maternal and neonatal outcomes were studied. Results: The progression to hemolysis elevated liver enzyme low platelet (HELLP) syndrome was 4(4.8%) in Group-A versus zero in Group-B, p=0.022. The two groups did not vary in mode of delivery (cesarean section in 28 vs. 33); preterm delivery (22 versus 15); intrauterine growth retardation (8 vs. 6); intrauterine demise (9 vs 5); low APGAR at birth (13 vs. 7); eclampsia (3 vs. 3) which were comparable between the two groups, p-value>0.05. For overall maternal outcomes, the sensitivity for raised LDH was 57.1% and specificity 53.3%. The sensitivity was 51.2%, and the specificity was 54.7% for overall neonatal outcomes. Conclusion: Elevated serum LDH alone in pregnancy-induced hypertension cannot considered as a prognostic indicator for maternal and neonatal adverse outcomes, except HELLP syndrome. [ABSTRACT FROM AUTHOR]

The ostrich meat is considered healthy as it contains low cholesterol and fat levels. Foodborne diseases caused by the bacterium Salmonellaare a significant public health concern. The study was conducted to determine the prevalence, the risk factors involved, and antimicrobial susceptibility patterns of Salmonella isolates recovered from captive ostrich feces in the district of Lahore, Pakistan. There is not a single research on this issue in Pakistan up to date in ostrich. A total of 100 ostrich fecal samples were collected-and specifically cultured on Salmonella Shigella agar. The antimicrobial susceptibility was checked for different antibiotics throughthe Kirby-Bauer disc diffusion method. The 21% fecal samples were found positive for Salmonella. The disease was found to besignificantly(p<0.05) associated with risk factors; water type(p=0.027), bird's capacity(p=0.042), cage hygiene(p=0.024), age of bird(p=0.041) andother bird species around (p=0.031) while enclosure size and diet were found non-significant. The bacterium was found highly susceptible to Amoxicillin followed by Chloramphenicol, Gentamicin, Cefotaxime, andEnrofloxacin respectively.Further Salmonella species-level diagnostic studies along with susceptibility checks of more therapeutic agents are suggested to future researchers. [ABSTRACT FROM AUTHOR]

Objective: To identify effect of pre-analytical variables on serum thyroid stimulating hormone. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology (AFIP) Rawalpindi, Department of Chemical Pathology & Endocrinology, from Mar 2018 to Aug 2018. Methodology: Hundred subjects with ages ranging from 18 to 34 years, irrespective of gender, were randomly selected for this study. Five milliliters venous blood sample was collected from each subject in a serum separator and divided into two aliquots. First aliquot was centrifuged and analyzed immediately for TSH, while second aliquot was stored for 24 hours and was then analyzed. TSH was measured by third generation assay using chemiluminescence technique on ADVIA Centaur® XP. Serum TSH levels were also analyzed twice daily; in the morning (0800 to 0900 hours) and afternoon (1400 to 1600 hours). Data was analyzed using SPSS version 24. Frequency and percentages were calculated for qualitative variables like gender and pre-analytical variables. Test of significance Mann-Whitney U-test was applied and p-value <0.05 was taken as significant. Results: Mean age of subjects was 23 ± 3.4 years. Change in circadian rhythm was observed in 17 (28%) males and 14 (36%) females. Statistically significant association was found between morning and evening TSH levels, while no change was observed in TSH level by early and late centrifugation of samples. Conclusion: TSH levels vary significantly between blood samples collected at different timings of the day from the same person. TSH is resistant to degradation, immunologically stable, and reasonably insensitive to potential problems associated with routine specimen handling, when measured by immunoassay technique. Therefore, it is helpful in large epidemiological studies and small size laboratory, which require long transportation time and storage. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of magnetic resonance imaging in diagnosing bone tumors keeping histopathological as correlation gold standard. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Departments of Radiology, Orthopedics and Pathology of Pakistan Institute of Medical Sciences, Islamabad, from Jan 2018 to Jan 2019. Methodology: All the patients who had complain of bone deformity or pain with high suspicion of neoplastic pathology involving bone and soft tissue on radiograph were included in study. Patients were first diagnosed on conventional radiography followed by magnetic resonance imaging. Magnetic resonance imaging with contrast was done on Phillips 1.5 tesla machine. T1W, T2W, STIR images, Fat suppressed, PD spair and post contrast T1W images were obtained. Positive magnetic resonance imaging findings which were noted were; marrow involvement, cortical break, soft tissue involvement, joint involvement, neurovascular bundle involvement and post contrast enhancement on T1W imaging. Then bone biopsy was performed. The removed bone was sent for histopathological examination in all cases. The histopathological reports were collected. The results were entered in structured proformas. Data was collected after the informed consent. All the data was entered and analyzed using SPSS version-23. Results: Fifty patients of both genders were recruited during our study duration. 32 (64.0%) were male while 18 (36.0%) were female patients. Mean age of the patient was 54.5 ± 14.3 years with range 18 to 80 years. Among the benign tumors vertebral hemangiomas were most commonly found 5 (10.0%) followed by osteochondroma which was 4 (8.0%), while among malignant tumors metastatic deposits/secondaries were most commonly found 11 (22.0%), followed by multiple myeloma 6 (12.0%) then Ewing Sarcoma and Osteosarcomas. Study showed sensitivity, specificity and accuracy in differentiating benign from malignant of 94.12%, 90% and 92.59%. Conclusion: In evaluating bone tumors, magnetic resonance imaging plays an important role. Whenever a bony pathology is detected that cannot be characterized and shows features of aggressive pathology magnetic resonance imaging is indicated. Magnetic resonance imaging is superior in detecting osseous lesions with marrow invasion and soft tissue component. It is helps to locally stage the disease, and by identifying the perilesional invasion and extension it helps the surgeon to plan the surgery. It is also used to assess the response of neoadjuvant therapy followed by restaging. It can further be used for follow up assessment of patient after completion of treatment. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk factors with estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status of breast cancer patients. Study Design: Cross sectional comparative study. Place and Duration of Study: This study was carried out in Multidisciplinary Lab-1 of Army Medical College, National University of Medical Sciences, Rawalpindi, in collaboration with Department of Pathology of Army Medical College, NUMS Rawalpindi, from Jan 2019 to Jan 2020. Methodology: A total of 50 individuals including radiologically diagnosed cases of breast cancer with different stages and 10 healthy controls without cancer. Patients with any co-morbidity were excluded. Participant's sample was collected and subjected to ER, PR and HER2 estimation. Other factors i.e. age, gender, marital status, breast feeding, menopause status, side of the breast affected were all taken into consideration. Results: Patients characteristics showed that the mean age, marital and menopause status were linked with breast cancer. The data showed that hormone receptors i.e., ER (p=0.0001), PR (p=0.0002) and HER2 (p=0.0001) were positive among most of the cancer patients as compared to the healthy subjects without cancer. There were no association found between age and hormone receptors. Marital status, breast feeding, menopause and side of breasts involved also had no association with hormone receptors. Conclusion: No significant association found between risk factors and hormone recpetors status of breast cancer patients in our population. [ABSTRACT FROM AUTHOR]

Objective: To identify the risk factors for the development of stress fractures in this sub population in our country. Study Design: Comparative cross sectional study. Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, from Jan 2015 to Aug 2017. Methodology: This study was conducted to identify different variables as risk factors for stress fractures in training cadets. We analyzed age, gender, running and sports prior to joining training, duration of marching, daily milk and carbonated drinks consumption, cigarette smoking, serum albumin, calcium and vitamin D levels, calf muscle diameter, leg length discrepancy and tibiofemoral angles. Results: A total of 275 participant included in this study, 140 cases, 51% and 135 controls, 49%. Mean age was 20 years. Two hundred and sixty eight (97%) were males and 7 (3%) were females. Grade-2 stress fracture was the commonest with 63 (45%) cases. Regular daily running prior to joining training p<0.006, regular milk intake p<0.005 were found to have a protective effect while subnormal serum calcium level p<0.001, serum vitamin D insufficiency p<0.009, thinner calf diameter p<0.001, heavy daily march p<0.039, leg length discrepancy p<0.025 were significant risk factors. Fourteen percent needed operative treatment. Conclusion: Regular daily running prior to joining training, regular milk intake, thicker calf diameter has a protective effect, while subnormal serum calcium and serum vitamin D levels, daily heavy march, leg length discrepancy are significant risk factors. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of micronized per rectal progesterone (cyclogest pessary) and placebo in prevention of preterm birth in tertiary care hospital. Study Design: Randomized controlled trial (RCT). Place and Duration of Study: Study was conducted at department of gynecology and Obstetrics, Combined Military Hospital Nowshera, Khyber Pakhtunkhwa, from Jan 2018 to Jun 2018. Methodology: A sample size of 140 patients was calculated using WHO calculator. Non probability consecutive sampling was used for recruitment of participants. Ethics approval and consent forms were taken. Women were divided into two groups randomly. Group A was given micronized progesterone (cyclogest pessary) per rectal usage and group B was given placebo. Patients were followed for maternal and neonatal outcomes. Data was analyzed using SPSS version 23. Independent t-test was applied. p-value ≤0.05 was considered significant. Results: Total 140 patients were included in study. Mean age of women was 29.4 years ± 4.6SD. Patients in micronized progesterone (cyclogest pessary) was more effective in increasing birth weight (p=0.00), Apgar score maintenance at 1st (p=0.00) and 5th minute (p=0.000) and reduction in length of hospital stay (p=0.000) as compared to placebo. Patients were more satisfied with micronized progesterone (cyclogest pessary) per rectal as compared to placebo (p=0.00). Conclusion: Preterm birth is remained as significant issue in health care system of Pakistan. However, micronized progesterone (cyclogest pessary) per rectal usage had positive impact in improving maternal and neonatal health outcomes. Effective strategies for prevention of preterm birth in Pakistan are required. [ABSTRACT FROM AUTHOR]

Objective: To assess the medical students’ awareness regarding self-care and its significance. It was also intended to assess what methods/strategies they adopt for self-care and which one they expect to be part of their official curriculum. Study Design: Qualitative (phenomenology) study. Place and Duration of Study: The study was carried out at Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from Jun 2018 to Jan 2019. Methodology: Non-probability purposive sampling technique was used for participants’ recruitment. By using semi-structured interview protocol, to the point of data saturation, 13 medical-students were interviewed. For data analysis, thematic analysis was carried out manually. Results: We have found three superordinate themes, the first superordinate theme was about the nature of problems and issues that have been faced by medical students i.e. academic and hostel issues, the second super ordinate theme was coping strategies and it is related to managing ways that medical students used to deal with stresses, the third one was suggestions for official improvements which was related to recommendation for official personals to bring a change in curriculum in order to overcome stress in medical students. Conclusion: The medical students used different strategies for self-care and gave recommendations for inclusion of different strategies in official course curriculum in reference to their self-care perception. So, it may be helpful in addressing issue of increasing burnout among medical students and help increasing resilience. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency, associated risk factors and intraoperative reasons for conversion of Laparoscopic Cholecystectomy to open Cholecystectomy. Study Design: Case series study. Place and Duration of Study: This study was conducted in department of Surgery, Combined Military Hosptial Rawalpindi, from May to Oct, 2018. Methodology: Patients admitted for laparoscopic cholecystectomy were included in the study. Demographic information, ASA Score of physical health, Ultrasonogram Abdomen findings and presence of pericholecystic fluid were documented. The reasons for conversion from laparoscopic cholecystectomy (LC) to open Cholecystectomy (OC) for example excessive haemorrhage, visceral injury, equipment failure, injury to Common bile duct were also noted. Results: In this study 15 (8.77%) patients were converted from laparoscopic cholecystectomy to open cholecystectomy. The most common reason 6 (40%) of conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. In patients who converted most 10 (66.7%) were 41-60 years old and in patients who had successful laparoscopic cholecystectomy majority 70 (44.9%) patients belonged to age group 21-40 years. The male gender had significantly (p-value <0.05) higher rate of conversion (53.3% vs. 46.7%). There was significant (p-value <0.05) association of ASA score and presence of pericholecystic fluid with rate of conversion. Conclusion: Male gender, higher ASA score, and presence of pericholecystic fluid are significant contributors for conversion of laparoscopic cholecystectomy to open cholecystectomy. The most common reason for conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. [ABSTRACT FROM AUTHOR]

Pandemic of COVID-19 is globally on the rise. Routes of transmission include human to human contact. Dentists are at highest risk of coronavirus infection contraction and dissemination. Due to recent outbreak of this disease, definitive guidelines on this subject are not sufficient for various procedures. Awareness of protective measures for dental practices may reduce the number of new cases within the country. The aim of this study was to evaluate the awareness of cross infection control measures during stage I of pandemic of COVID-19 within dental practices of Pakistan. A cross sectional study based on evidence provided by The School and Hospital of Wuhan University9was conducted during the stage I of spread of coronavirus amongst general dental practitioners of Pakistan. A questionnaire comprising of 10 questions pertinent to the cross-infection protocol for COVID-19 in a dental setting was constructed. Sample size was calculated for registered general dental practitioners of Pakistan. The form was communicated to 200 general dental practitioners all over Pakistan. Out of these, 143 (71.5%) responded. Majority participants showed adequate level of awareness (more than 66%), for protection measures against corona virus COVID-19 in a dental practice. However, few aspects need more emphasis. such as during initial patient interview, temperature evaluation, radiographic records, pre-operative rinses, nature of permissible procedures, surface disinfection, irrigation and drainage methods, to control the chain the infection transmission. Earlier awareness of COVID-19 specific protection measures to health professionals may reduce the number of new diseased cases. Strict adherence to social distancing generally and COVID-19 specific cross infection control measures in a dental setting might help in timely control of this potentially deadly disease. [ABSTRACT FROM AUTHOR]

Objective: To assess the awareness of personal protective equipment usage, among health care providers. Study Design: Cross sectional survey. Place and Duration of Study: Tertiary care hospitals across Pakistan, from 1st May 2020 to 25th May 2020 by convenient sampling method. Methodology: A total of 74 responders from different health care setups completed a questionnaire-based survey on the knowledge and practice regarding personal protective equipment usage among healthcare providers. The questionnaire was designed by the help of central disease control (CDC) guidelines and its reliability and validity check by SPSS. Convenient sampling was used for data collection and frequencies and percentages were used to present distribution of responses. WHO sample size calculator (2.2a for population proportions) was used for sample size calculation from previous study23. Data was tabulated in excel and SPSS 17 was used for Descriptive Statistics. Results: The overall awareness among healthcare providers about personal protective equipment use in COVID19 was not satisfactory with 40.5% reported correct answers. About 54 (75%) of responders had been in contact with confirmed or suspected COVID-19 patients. Regarding kind of personal protective equipment use, 41 (58.6%) knew the correct sequence of donning as per central disease control guidelines and only 21(30%) knew the correct sequence of doffing. Conclusion: The current survey concluded that although majority of responders had fair knowledge regarding COVID-19, yet many knowledge gaps were there, regarding proper donning and doffing technique of personal protective equipment. Therefore continuous health education and training programs according to the recent guidelines by CDC and WHO, at all health care levels, regarding judicious use of personal protective equipment in COVID-19 is required. [ABSTRACT FROM AUTHOR]

Objective: To determine whether fast food addiction correlate with body esteem and psychological well-being among university students. Study Design: Cross sectional analytical study. Place and Duration of Study: University of Lahore, Superior University and Comsats University of Lahore, from Jan to May 2019. Methodology: Two hundred students of BS and M.Sc were included through purposive sampling. Only those students were included who were using fast food on regular basis (1 to 3 times per day). Participants diagnosed or under treatment of any clinical problem were not included in the study. Sample size was calculated by the software G-Power (version 3.1.9.2). Food addiction was assessed using Yale Food Addiction Scale. Body esteem was measured using Franzoi Body Esteem Questionnaire and psychological well-being was assessed using Ryff Psychological Well-being Scale. Results: There were more participants who were using fast food one time (per day) 35 (17.5%), two times 84 (42%) and three times 81 (40.5%). Students who were using fast food addiction had low level of psychological well being and low level of body esteem. However, Body esteem and psychological well-being were significantly positively correlated. Fast food addicted girls had significant lower level of body esteem and psychological well being than fast food addicted boys. Conclusion: The use of food addiction resulted in low level of body esteem and low psychological well being. A definitive negative correlation was found in fast food addiction with body-esteem and psychological well-being among university students. [ABSTRACT FROM AUTHOR]

Objective: To determine the factors of obesity and role of personality traits in prevalence of obesity among middle-aged women. Study Design: Cross sectional analytical research design. Place and Duration of Study: Three universities (Lahore College for Women University, Riphah International University, University of Central Punjab) and three hospitals (Services Hospital, Jinnah Hospital and Shalimar Hospital) of Lahore City, from Feb 2019 to Jul 2019. Methodology: Four hundred clinically diagnosed obese women were collected using Purposive Sampling. The age range of participants was 25-50 years. Women diagnosed with any other clinical problem were excluded from the study. Factors of obesity were assessed using Factors for Obesity Scale. To measure the relationship of personality traits with obesity Neo Personality Trait Scale was used. The data was analyzed using Pearson correlation, simple regression analysis and independent sample t-test using SPSS version 22. Results: There was strong positive correlation of psychological, emotional and cognitive factors with obesity. Neuroticism trait was significant positive (β=0.25, p<0.01) and conscientiousness trait of personality was significant negative predictor of (β=-0.43, p<0.01) obesity. Latter middle-aged women were more obese as compared to women in age of early middle aged-women. Conclusion: Psychological, emotional and cognitive factors play important role in the pervasiveness of obesity. A definitive positive correlation was found in these factors and obesity. Neuroticism trait personality strongly predicts obesity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of ultrasound in acute appendicitis in comparison with Alvarado score keeping histopathological correlation as gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Radiology, Surgery and Pathology of PIMS Hospital, Islamabad, from Jan 2018 to Oct 2018. Methodology: Patients that were Alvarado positive or either ultrasound positive were included in the study followed by appendectomy. Removed appendix was sent for histopathological examination. The results were entered in structured proformas. Results: Out of 200 patients, 117 (58.5%) were male patients while 83 (41.55%) were females. Mean age of the patients was 22.6 ± 3.1 year with range 9 to 55 years. Mean Alvarado score of patients was found to be 9.1 with maximum score 10 and minimum score of 7. Among ultrasound findings, 192 (96%) patients had appendix with diameter >6mm. Ninety two (46%) patients had free fluid, 186 (93%) patients had peri-appendicular fat and 40(20.0%) patients had appendicolith. Sensitivity of ultrasonography was 80%, sensitivity of Alvarado was 94.1%. Specificity of ultrasound was 60%, specificity of Alvarado was 33.3%. Diagnostic accuracy of ultrasonography was 77.5%, Alvarado score was 85%. Conclusion: Alvarado score has higher sensitivity as compared to ultrasound, while ultrasound has a higher specificity. Neither tool is superior to the other. Both need to be used together to reduce the negative appendectomy rates. [ABSTRACT FROM AUTHOR]

Objective: To find out the magnitude of hepatitis B and hepatitis C seropositivity during antenatal screening of pregnant women aged 20 years and above. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Hyderabad, Sindh Pakistan, from Jan 2014 to Dec 2014. Methodology: This study was conducted on 1769 admitted pregnant females 20 years age and above which were selected by non-probability consecutive sampling technique. For sample collection 3ml of blood was taken in clot activated bottle. Quantitative detection of HbsAg and Hepatitis B from serum of patients were done by rapid chromatographic immunoassay (ICT kit used for HbsAg and Anti Hepatitis B by Healgen Scientific, London). Seropositivity for HbsAg and anti-hepatitis C virus among selected pregnant patients was also checked. Results: Out of 1769 pregnant females mean age 22 ± 2.23 years screened for hepatitis B and C seropositivity, 129 (7.299%) females were found to be positive for serum antibodies for hepatitis B and C. Out of 129 seropositive females 99 (76.7%) were anti-hepatitis C virus (HCV) positive and 30 (23.3%) were HbsAg positive. Out of 129 seropositive females 80 (62%) patients delivered by caesarean section and 23 (38%) had normal vaginal delivery. Multiparas patients were 110 (85.3%) more than prim gravidas 19 (2%). Conclusion: Magnitude of hepatitis B and C virus is alarming among pregnant women. This study shows high frequency of Anti-hepatitis C than HbsAg which is alarming due to non-availability of prophylactic vaccine against the disease. [ABSTRACT FROM AUTHOR]

Objective: To study the functional and molecular interactions of IFNAR-2 within biological networks Study Design: Computational analysis: STRING software Place and Duration of Study: Department of Biochemistry, HITEC-Institute of Medical Sciences, Taxila Cantt, Pakistan, from Dec 2017 to Jun 2018. Methodology: Protein sequence of IFNAR-2 protein was obtained from 'National Centre for Biotechnology Information (NCBI)' database and STRING analysis conducted by applying specific parameters including (1) Text mining (2) Experiments (3) Databases (4) Co-expression (5) Neighborhood (6) Gene fusion and (7) Co-occurrence for identifying protein-protein interactions and molecular associations. Maximum number of interactors was set at 20 and highest confidence level was set at 0.900. Results: Protein-protein interaction analysis translate that human IFNAR-2 protein has high level of interactions with a set of proteins of similar size, drawn from the genome. This set represents a partial biologically connected group of proteins. This information has a potential to set the basis for further experimental investigations in more integrated and biologically linked pathway-oriented perspective that results in more targeted outcomes. Conclusion: Functional and molecular enrichment through STRING analysis revealed that IFNAR-2 protein has strong associations and serves as a key player in antiviral response of immune system. [ABSTRACT FROM AUTHOR]

Objective: To determine correlation of Chronic Obstructive Pulmonary disease Assessment Test score with Body mass index, airflow Obstruction, Dyspnea and Exercise index in patients with stage II and III chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi, Pakistan from Jul, 2017 to Dec 2017. Methodology: This study was conducted on Stage II and III chronic obstructive pulmonary disease patients. We analyzed demographic variables; Body mass index (BMI), 6-min walktest, modified Medical Research Council dyspnea scale to calculate Body mass index, airflow Obstruction, Dyspnea and Exercise index score. Spirometry was performed on each patient. The chronic obstructive pulmonary disease Assessment Test was used to assess symptoms of these subjects. Results: A total of 80 subjects participated in the study with mean age of 58.5 ± 8.0 years. The mean chronic obstructive pulmonary disease Assessment Test and Body mass index, airflow Obstruction, Dyspnea and Exercise scores were 25.5 ± 7.7 and 5.14 ± 2.0 respectively. Pearson's correlation showed positive correlation between chronic obstructive pulmonary disease Assessment Test score and Body mass index, airflow Obstruction, Dyspnea and Exercise score (r²=0.810, p=0.0001). A positive correlation coefficient was obtained between chronic obstructive pulmonary disease Assessment Test score and Body mass index, airflow Obstruction, Dyspnea and Exercise class (r²=0.784, p=0.00012). Conclusion: Chronic obstructive pulmonary disease Assessment Test score correlated positively with Body mass index, airflow Obstruction, Dyspnea and Exercise index score in stage II and stage III chronic obstructive pulmonary disease patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the teaching qualities of supervisors in post graduate residency training. Study Design: Cross sectional study. Place and Duration of Study: This multicenter study was conducted at four medical colleges and six affiliated postgraduate training institutions of Rawalpindi/Islamabad, from Feb to May 2017. Methodology: Total 242 post graduate trainees evaluated teaching qualities of their supervisors on a five point likert scale of SETQ tool. Trainees having experience of more than six months enrolled in all post graduate courses like MCPS, FCPS, MS/MD and M.Phil were included in this study from basic, preclinical and clinical specialties. Data was analyzed by using SPSS version 21. Frequencies were calculated for computed scores categories of individual domain as well as for total SETQ computed scores. Chi square test was applied to find out association between SETQ computed scores and age, gender, specialty, qualification and duration of experience of supervisors as well as for different variables related to trainees. Results: Cronbach’s α value of tool was 0.73. Overall teaching practices were categorized as “Good” by 220 (90.9%) trainees. More than 85% trainees evaluated their supervisors as “Good” regarding each of individual domains (Professional attitude, learning climate and evaluation) of SETQ except for communication of goals and feedback domain. Lowest evaluation scores (79.3%) were observed for “Feedback” domain. Statistically significant association was found between SETQ score and qualification of supervisors (p=0.04). Conclusion: Despite of work load and patient care responsibilities, the supervisors are evaluated to have good teaching qualities and practices by postgraduate trainees. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between hospital environment, mental health and turnover intention among doctors. Study Design: Cross-sectional analytical study. Place and Duration of Study: Mayo Hospital Lahore and Jinnah Hospital, Lahore Pakistan, from Feb to July 2019. Methodology: Using convenient sampling, a sample of 100 doctors (males=50 and females=50) was recruited. This study did not include participants with less than one year of work experience. The hospital environment was examined using the Organizational Environment Scale. The mental health of doctors was assessed using the Mental Wellbeing Scale, and their turnover was measured through the Turnover Intention Scale. Results: Hospital environment and doctors' mental health positively correlated (p<0.001). Doctors who perceived the hospital environment as good had good mental health and less intention to turnover their jobs (p<0.001). Furthermore, female doctors had poorer health and higher turnover intention than male doctors (p<0.001). Conclusion: The hospital environment affects doctors' mental health. A good hospital environment significantly positively predicted good mental health. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of e-Health in imparting continuing medical education to general practitioners of rural areas of Sindh. Study Design: Prospective comparative study Place and Duration of study: Department of Path, Indus Medical College, Tando Muhammad Khan, Pakistan from Feb to Jul 2021. Methodology: General Practitioners of any age group gender and working experience, presently practising in rural areas of Sindh, attended all five e-Health Continuing Medical Education sessions organized by the Department of Pathology. Before each online session, pre-tests and post-tests were conducted on completing each of the five online sessions. Scores of all pre-and post-session tests were calculated for analysis for each participant. Results: One hundred participants were included in the study, of which the majority (73%) were male compared to their counterparts. There was a statistically significant difference (p<0.05) between the pre and post-test scores of all study participants (24.92±6.98 and 30.91±6.19), respectively. While a statistically significant difference (p<0.05) between pre and post-test scores of male and female participants (24.47±6.43 and 26.11±8.31) and (30.64±5.62 and 31.62±7.59) respectively. Conclusion: Continuing e-Health medical education sessions revealed a significant improvement in general practitioners' medical knowledge and professional competency, as reflected in the testing score. [ABSTRACT FROM AUTHOR]

Objective: To study the relationship between Life Orientation (optimism/pessimism) and Mental Health. Study Design: Cross-sectional study design. Place and Duration of Study: The clinical sample was taken from Armed Forces Institute of Mental Health, Rawalpindi and Fauji Foundation Hospital, Rawalpindi. The sample of non-clinical individuals was selected from the areas of Rawalpindi and Islamabad, from Jan 2016 to Sep 2016. Methodology: The researcher used translated versions of the two instruments, Life Orientation Test (LOT), and Mental Health Inventory (MHI). Sample comprised of 90 adults (n=45 for both men and women) ranging from 18-50 years of age. Sample was further divided into clinical (n=45) and normal population (n=45). The clinical population comprised of patients with the diagnosis of mood (n=22) and anxiety disorders (n=23). Results: The results revealed that life orientation and mental health were significantly correlated to each' other (r=0.78). For confirming the relationship of life orientation with mental health further covariance of age, gender and education was controlled through Analysis of Covariance (ANCOVA). Results revealed that life orientation explained 97% of the variance in mental health initially but after partialling out the covariance of demographic variables, life orientation still significantly accounted for 55% of variance in mental health scores. Conclusion: The manner through which one orients his or her life optimistically or pessimistically can have deterministic effects on one's mental health. [ABSTRACT FROM AUTHOR]

Objective: To identify the role of supervisors as mentor in the academic performance of post graduate doctors in a public sector hospital of Karachi. Study Design: Post positivist quantitative quasi experimental study. Place and Duration of Study: PNS Shifa Hospital Karachi, from Aug 2017 to Jan 2018. Material and Methods: In this study pre-test scores of mentees and non mentored trainees (control group) were compared with the post-test scores. A total of 91 post graduate trainees and their supervisors was enrolled in this study. The trainees were randomly assigned to 2 group labeled as A and B. Group A was given mentoring sessions on fortnightly basis for three months. Group B was not given any mentoring during the initial 3 months. For data analysis the statistical software SPSS version 20.0 was used. Results: A total of 91 post graduate trainees participated in this study. There were 21 male participants and 70 female participants with male to female ratio of 1:3.3. The ages of the trainees ranged from 26 to 43 years. While comparing the pre-test and post-test scores between groups A and B, it was seen that both the post-test scores, at 3 months and at 6 months, were significantly different among both groups (p<0.05). While the post-test scores with mentoring, i.e. of group A at 3 months and of group B at 6 months, were higher than post-test scores without mentoring. Conclusion: On the basis of this study it was concluded that mentoring by supervisors has a significant impact on the academic performance of the post graduate trainees in our set up. [ABSTRACT FROM AUTHOR]

Objective: To find out the perceptions of postgraduate students regarding inclusion of clinical audit in the training programme. Study Design: Mixed method sequential study. Place and Duration of Study: Combined Military Hospital Lahore, from Apr to Nov 2018. Material and Methods: In the first phase, quantitative research question addressed the perceptions of postgraduate students regarding inclusion of clinical audit in the training programme through a questionnaire. A total of fifty postgraduate students participated in the study. In the second phase, focus group discussions (FGD) were carried out from thirty-five students divided into five equal groups across different disciplines to explore these perceptions in depth. Results: The quantitative analysis of results revealed that significantly large percentage of students considered clinical audit, audit project and relevant clinical governance domains to be of high relevance to the postgraduate training programmes. The key themes emerging from clinical audit focus group discussions FGD were better clinical care, patient safety, lack of institutional support, lack of understanding about audit on part of the students and faculty and improper implementation mechanisms. Conclusion: Clinical audit promotes safe, quality and evidence-based care for the patients and minimizes the cases of clinical negligence in clinical practice. Clinical audit needs to be incorporated as an integral component in the postgraduate curricula. The medical educators and curriculum committees need to focus on the benefits of clinical audits, clinical governance, effective learning strategies and relevant support system to help students in achieving the desired goals in clinical audit practice and quality assurance measures. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the relationship between parenting styles and aggression in adolescents studying in various schools of Lahore, Pakistan. METHODS: This cross-sectional study was conducted on 200 adolescents (100 male & 100 females). Parenting Style Questionnaire and Aggression scale were used to collect the data. Sample was selected from 3 schools of Lahore (King Way High School, Shaheen High School and Lahore Garrison School) using purposive sampling strategy. The age range of sample was 14 to 18 years. In the present study we hypothesized; adolescents with authoritarian parents will have high level of aggression as compared to the adolescents of authoritative parents. We used Pearson Correlation and Multiple Regression techniques to find out the results from collected data. RESULTS: Mean age of participants was 13.09±0.86 years. Significant positive association was found between authoritarian parenting style and aggression (P<0.01) and significant inverse relationship between authoritative style of parenting and aggression (P<0.05) in adolescents. So, parents with authoritarian parenting style had higher level of aggression. Authoritarian parenting significantly predicted (19%) aggression in adolescents, while authoritative parenting style was not a significant predictor of aggression in adolescents. CONCLUSION: In our study, there is significant effect of authoritative and authoritarian parenting style on aggression and most of the children from authoritarian parents have high level of aggression as compared to authoritative parents. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and pattern of lipid abnormalities in diagnosed female patients of coronary artery disease in a tertiary care hospital of Karachi. Methods: This cross-sectional study was conducted from January 2016 to August 2016. A total of 300 female patients of Coronary Artery Disease (CAD), diagnosed on the basis of angiography were included in the study. For detection of lipid profile abnormalities five ml of fasting venous sample of 10-12 hours was obtained from the left median cubital vein under aseptic conditions. The blood was centrifuged for 5 minutes. Automated chemistry analyzer was used for lipid profile measurement via kits of the CYPRESS Laboratory (Langdorp, Belgium). Statistical analysis was done via SPSS version 17 and results were expressed as percentage and mean ± standard deviation. Results: Mean age of recruited females was 51.36 ± 13.71 years. About 81.39% of patients were found with abnormal lipid profile. The frequency of low high-density lipoprotein cholesterol in studied population was 61.66%, high triglycerides 19.33% whereas; high low-density lipoprotein cholesterol was 17.33% respectively. Combined two parameter dyslipidaemia patterns was found in 41.32% followed by mixed dyslipidaemia in 19.33%, while isolated high-density lipoprotein hypocholesteraemia in 12.00% of study population. Conclusion: We conclude that low levels of high-density lipoprotein cholesterol and hypertriglyceridemia, in both combined and isolated pattern, are more prevalent in Pakistani females with CAD.The data from the current study may increase the knowledge of the guidelines for lipid lowering need in females. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate a new high-performance liquid chromatography (HPLC) based method for Voriconazole (VRC) analysis in blood. Study Design: Cross sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology Armed Forces Institute of Pathology (AFIP), Rawalpindi, from May 2017 to Oct 2017. Material and Methods: Trough venous blood samples of twenty-five patients on VRC therapy were collected, after five days of starting VRC. Samples were centrifuged. About 100 µl of Lorazepam as internal standard (5.0 µg/ml), was added to 0.5ml of each sample. Then extraction was done with 4.0 ml of mixture of hexane and ethyl acetate. Centrifugation was again done and supernatant layer was collected and dried under nitrogen. It was reconstituted with 200µl of deionized water and acetonitrile. Samples were analyzed on HPLC. Results: Method was validated in terms of linearity, limit of detection, limit of quantification, precision, accuracy, recovery, analytical specificity and stability. Linearity calibration curve plot for assay obtained was linear over analytical measurement range of 1.0 to 8.0µg/ml and correlation coefficient was 0.99. Mean intra-assay accuracy for 1.0, 5.0 and 8.0 µg/ml was 96%, 98.6%, 99.5% respectively, and percentage Relative Standard Deviation (RSD) was 5.9%, 1.15%, 1.44% respectively. Mean inter-assay accuracy for 1.0, 5.0 and 8.0 µg/ml was 95%, 98.6%, 99.5% respectively, and % RSD was 5.68%, 1.03% and 1.01% respectively. Limit of Detection (LOD) was 0.25 µg/mL and Limit of Quantitation (LOQ) was 1.0 µg/ml. Conclusion: HPLC based method for VRC determination is accurate and specific with good clinical correlation. This method may be used in routine for Therapeutic Drug Monitoring (TDM) of VRC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the burden of carbapenemases producers among carbapenem-resistant isolates. Study Design: Cross-sectional study. Place and Duration of Study: This cross-sectional study was conducted at microbiology lab, Pathology department, Allama Iqbal Medical College Lahore, from Jul 2016 to Apr 2017. Material and Methods: A total of 12126 clinical specimens were enrolled through a non-probability/consecutive sampling technique, every sample was processed for bacterial culture, identification was done on the basis of colonial morphology, Gram stain, and biochemical profile. All those isolates that were Gram-negative rods, were processed for carbapenemases detection by Modified Hodge test (MHT) in accordance with CLSI 2016. Results: Out of total n=12126 samples, culture positive were 35.9% (n=4361) of which 40.5% (n=1770) were Gram-negative rods, among these 9.6% (n=170) were carbapenem-resistant isolates of which 50% (n=85) were carbapanamases producers (MHT positive). Organisms wise carbapenem resistance was detected in Acineto- bacter species 44.%, Pseudomonas species 34%, E.coli 7%, Klebsiella species 8%, Proteus species 3%, Citrobacter species 1%, Enterobacter species 0.7% Among these isolates MHT positivity was as followed Acinetobacter species were 53%, Pseudomonas species 51%, E.coli 36%, Klebsiella species 50%, Proteus species 20%, Citrobacter species 66%, Enterobacter species 50%, department wise distribution of carbapenemases producer showed that among total sample received from surgical units 51.4%, ICU 65.3% medical units 43.5%, pediatric ward 71.4%, orthopedic 11.1% neurosurgery 20%, other wards 55.1% were MHT positive. The almost similar resistant pattern was observed in MHT positive and negative isolates. Conclusion: Emergence of carbapenem resistance is an alarming situation in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To determine the learning approaches of medical students in their pre-clinical years in a case based learning curriculum. Study Design: Descriptive (Quantitative) study. Place and Duration of Study: Army Medical College Rawalpindi Pakistan, from Jan 2017 to Jul 2017. Materials and Methods: Two hundred students from 2nd year MBBS participated in the study by filling a 52 items questionnaire-Approach and study skills inventory for students. Students' scores were measured separately for surface, deep and strategic approaches. Gender difference regarding the preferred approach of students was also found out. Analysis was carried out by using student t-test on Microsoft Excel Sheet. Results: There is a significant difference (p-value <0.05) between the number of surface learners when compared with number of deep and strategic learners. A preference for the deep or strategic approaches has been noticed in both female and male students. Conclusion: The study provided evidence that even in very initial years of medical studies where case based learning has been introduced as a student-centered strategy, it is promoting a deep or strategic learning approach in medical students. These approaches have been considered helpful in making students lifelong learners. It also helps in identifying the surface learners at the same time. Their identification will help and guide teaching faculty and the curriculum planners about the scope of different teaching modalities to be used in the best interest of the students. [ABSTRACT FROM AUTHOR]