Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University

Geographic Accessibility of Burn Care Centres; A Battle of Life in Pakistan

Muhammad Rehan, Tariq Iqbal, Esha Kamran — Thu, 07 Sep 2023 00:00:00 +0300

Socio-Demographic and Clinical Factors Associated with Poor Glycemic Control among Patients of Type-2 Diabetes Mellitus Presenting at a Tertiary Healthcare Facility

Shafat Khatoon, Hareem Bin Saleem, Shajee Ahmed Siddique — Thu, 07 Sep 2023 00:00:00 +0300

Objective: To identify socio-demographic and clinical factors associated with poor glycemic control in type-2 diabetes mellitus patients at a tertiary healthcare facility.

Methodology: This cross-sectional study was conducted at Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from February 2022 to July 2022, included 246 known type-2 diabetes patients of both genders, aged 18 to 75, with at least three consecutive days of fasting blood glucose (FBG) measurements. We assessed socio-demographic and clinical characteristics and classified glycemic control according to ADA guidelines: FBG between 80-130 mg/dl as good control and FBG above 130 mg/dl as poor control. We recorded the prevalence of good and poor glycemic control and compared them based on various socio-demographic and clinical factors.

Results: Among 246 patients, 152 (61.8%) were male, with a mean age of 46.47±11.55 years and a mean BMI of 23.13±5.01 kg/m². The mean diabetes duration was 9.18±7.50 years, and 132 (53.7%) patients had a disease duration > 5 years. Diabetes-related complications were present in 156 (63.4%) patients. Poor glycemic control was found in 137 (55.7%) patients. Significant associations with poor glycemic control were observed for age (p<0.001), educational status (p<0.001), BMI (p=0.002), residential status (p=0.013), family history of diabetes (p<0.001), diabetes duration (p<0.001), and current diabetes medications (p=0.001).

Conclusion: A majority (55.7%) of type-2 diabetes patients in our study had poor glycemic control. Factors such as increasing age, BMI, education level, residential status, family history of diabetes, longer disease duration, and current diabetes medications were significantly associated with poor glycemic control.

Comparison of Bubble CPAP versus conventional ventilation in Neonates having Respiratory Distress

Thu, 07 Sep 2023 00:00:00 +0300

Objective: The purpose of this study was to compare the outcome of bubble CPAP against ventilatory CPAP in neonates having respiratory distress.

Study design: Randomized controlled trial study.

Place and duration of study: Department of Neonatology, Children Hospital, Pakistan Institute of Medical Sciences (PIMS) Islamabad for six months from 01-03-21 to 31-08-21.

Patients and method: It is a randomized controlled trial study conducted at the Department of Neonatology, Children Hospital, PIMS Islamabad for six months from 01-03-21 to 31-08-21. The study included a total of 150 neonates of either gender presenting with respiratory distress delivered at >32 weeks and weighing >1500 grams. Demographic details (name, age, gender, gestational age at delivery, birth weight, and Silverman Score) were noted. Then neonates were divided into two groups by using the lottery method. Treatment failure was defined as the neonate failing to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of >7cm of water and a FiO2 greater than 0.6, or necessitating mechanical ventilation.

Results: In our study, we included a total of 150 neonates, 75 in each group. Total males were 82 (54.7%) and females 68 (45.3%) with a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 and 35.52±1.36 weeks in bubble continues positive airway pressure (B-CPAP), and ventilator continuous positive airway pressure (V-CPAP) groups. The mean birth weight was 2381±506.4 grams and 2187.3±427.49 grams in B-CPAP and V-CPAP groups, respectively. Ten (13.3%) patients out of 75 in B-CPAP and 19 (25.3%) in the V-CPAP group were labeled as treatment failure as per operational definition. Although the failure rate was slightly higher in patients having Ventilatory CPAP as a resuscitation for respiratory distress, these results were statistically not significant (p-value= 0.052).

Conclusion: In the treatment of respiratory distress, there is no difference in the failure rate of bubble CPAP and ventilatory CPAP. Regardless of the patient's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered a primary mode of respiratory support in neonates with respiratory distress.

Keywords: Bubble continuous positive airway pressure, Mechanical ventilation, Neonate, Respiratory distress syndrome, respiratory failure, ventilator continuous positive airway pressure.

INFILTRATION OF ROUND BLUE CELL TUMORS IN BONE MARROW

Thu, 07 Sep 2023 00:00:00 +0300

ABSTRACT:

Objective: To identify the different types of Round Blue cell tumors on bone marrow biopsy and their pattern of marrow infiltration.

Methodology: This Cross-sectional descriptive study was conducted at the Department of Hematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from July 2021 to December 2021. A total of 60 diagnosed cases of round blue cell tumors were included in this study. Patients with acute lymphoblastic leukemia (ALL) and patients of round blue cell tumors on treatment were not included in this study.Bone marrow aspiration and biopsy were performed. Peripheral film results, clinical observations, and patterns of marrow infiltration of Round Blue cell malignancies were reported on Statistical Package for the Social Sciences (SPSS) version 23 was used for data analysis.

Results:Our investigation revealed a male to female ratio of 2:1, with 40 (66.6%) males and 20 (33.3%) females. The overall average age was 5.695.0years. Ewing sarcoma and Rhabdomyosarcoma patients did not exhibit infiltration, however three instances of retinal blastoma (9.37%) and two cases of Neuroblastoma (10.52%) did. IHC results for Synaptophysin and Chromgranin indicated positive results for Retinoblastoma and Neuroblastoma, while S100 results were positive for Neuroblastoma infiltration and negative for Retinoblastoma.Both Retinoblastoma and Neuroblastoma showed diffuse, focal and interstitial pattern of infiltration on trephine biopsy.

Conclusion:Small round blue cell tumors were noted in bone marrow infiltration 5 (8.33%) cases. Early detection of malignant cancers necessitates appropriate medical care and in more severe cases need of neoadjuvant chemotherapy.

Key words: Small round blue cell tumors, Neuroblastoma, Retinoblastoma.

Assessment of uterine scar thickness by ultrasonography in women with previous cesarean scar

Thu, 07 Sep 2023 00:00:00 +0300

Background: Radiological evaluation of a scar from a previous cesarean section is not commonly used as a primary criterion for mode of delivery. However, no radiological standard criteria for evaluation of scars are widely established.

Objectives: To assess the uterine scar thickness by transabdominal ultrasonography among term pregnant women with previous cesarean scar.

Methods: A descriptive cross-sectional study was done in the department of Obstetrics and Gynecology, Benazir Bhutto Hospital, Rawalpindi between June and November 2022. A total of 130 women who have previously given one birth by caesarean section between 25 to 40 years of age were included. Clinical pelvimetry and sonographic assessment of the scar was done between 37-40 weeks. The lower uterine segment thickness was measured by partial filling of the bladder to avoid interobserver variability. Measurements were taken at several points (3-4) on lower uterine, and the thinnest part was measured as scar. The complete examination of lower uterine in multiple planes was performed to find symptomless uterine dehiscence. Women underwent trial of labour was monitored by pulse, fetal heart rate via cardiotocography with progress of labour. If they had lower segment cesarean section, the status of scar noted and findings correlated with scar thickness.

Results: The patients mean age was 28.31±4.34 years. Gestational age mean was 38.57±0.96 weeks. Mean interpregnancy interval was 23.34±11.21 months. The mean uterine scar thickness was 3.68±1.47 mm. Frequency of scar dehiscence among women was found 13.1%. Frequency of dehiscence among women was found 41.5% with ≤ 2.5 mm and no woman was reported with ≥ 2.5 mm scar thickness.

Conclusion: The study concluded that the uterine scare thickness less than 2.5 mm during the labour is associated with uterine defect during a labour trial.

Effectiveness of scalp nerves block in reducing the immediate postoperative pain in patients undergoing craniotomy in elective neurosurgical procedures.

Thu, 07 Sep 2023 00:00:00 +0300

Objective: To determine the usefulness of regional scalp block in controlling pain after craniotomy.

Methodology: This prospective, randomized, double-blind, placebo-controlled study was conducted at the Pakistan Institute of Health Sciences, Islamabad from November 2021 to April 2022. Adult patients aged 18 to 65 years, scheduled for elective craniotomy for neurosurgical procedures with an American Society of Anesthesiologists (ASA) physical status of I or II, of either gender, were included. Patients underwent craniotomy for their respective lesions. Patients were randomized into two groups: one receiving a regional scalp nerve block of 0.5% bupivacaine with 1:100,000 epinephrine after general anesthesia, and the other undergoing general anesthesia as a placebo. Pain intensity was assessed using the Visual Analog Scale (VAS) pain score at baseline (preoperatively), at 1 hour postoperatively, and at 6 hours postoperatively.

Results: The mean age of patients in the treatment group was 43.14 years, while in the control group, it was 42.55 years. The treatment group had 26 males (54.2%) and 22 females (45.8%), while the control group had 25 males (52.1%) and 23 females (47.9%). There was no significant difference in the VAS score preoperatively (p > 0.05). Patients undergoing surgeries lasting less than 3 hours showed that the treatment group had a significantly lower mean VAS score of 3.08 at 1 hour compared to the control group's score of 5.11 (p = 0.027), while at the 6-hour post-surgery it was insignificant (p = 0.844). For surgeries lasting more than 3 hours, the treatment group had a significantly lower mean VAS score at 1 hour and at 6 hours post-surgery compared to the control group (p < 0.05). There were no overall complications associated with the subcutaneous injection of epinephrine and bupivacaine in blocking the scalp nerves.

Conclusion: The administration of scalp nerve blocks using bupivacaine and epinephrine prior to surgical incisions has demonstrated notable advantages in terms of postoperative pain management. Such nerve blocks can offer superior postoperative analgesia compared to the control group.

Relationship between mode of delivery and rate of birth asphyxia in a Tertiary Care Hospital, Rawalpindi: A case-control study

Thu, 07 Sep 2023 00:00:00 +0300

Abstract:

Objective: To assess the relationship between mode of delivery and rate of birth asphyxia in a Tertiary care Hospital, Rawalpindi.

Methodology: This prospective case control study was conducted in Holyfamily Hospital,Rawalpindi from August 2021 to December 2021.One hundred and seventy two newborns were enrolled after assessing the inclusion criteria and divided equally into cases(neonates with birth asphyxia) and controls(neonates without birth asphyxia).A structured performa was designed to take detailed history of mode of delivery and severity of birth asphyxia by using APGAR score. Data analysis was done using SPSS 24.00.

Results: One hundred and seventy two neonates were included in the study. 110 were males (63.9%) and 62 were females (36%). Term infants were more affected with birth asphyxia rather than preterm infants(53.6%). Meconium stained liquor(61.9%) and non-booked cases(55.1%) were seen more in case group.Spontaneous vaginal delivery was the common mode among all in our study population(91%). Emergency caesarean sections have higher frequency of birth asphyxia as compared to elective caesarean sections (39.3%) but no statistically significant difference found in frequency of birth asphyxia between case and control groups with regards to mode of delivery (p value=0.620) but significant in terms of neonatal mortality(p value=0.000).

Conclusion:

Birth asphyxia is a common contributor to neonatal mortality and improving perinatal care can help in reducing neonatal morbidity and mortality in developing countries.

Determination of monocyte to high density lipoprotein ratio as an inflammatory marker in schizophrenia

Ather Muneer, Hina Saghir, Ambreen Zahoor, Mariam Tariq, Hafiz ud din — Thu, 07 Sep 2023 00:00:00 +0300

Abstract:

Aim:

Monocyte to high density lipoprotein ratio (MHR) is an innovative parameter which indicates low-grade systemic inflammation and risk of coronary artery disease. Mounting evidence shows that inflammation plays a part in the pathophysiology of schizophrenia. The aim of this study was to explore the potential relationship between MHR and schizophrenia.

Methods:

The participants of this cross sectional study comprised of 60 patients out of which 30 were schizophrenics and 30 were healthy controls. The Positive and Negative Syndrome Scale was employed for the collection of data from the patient group. The parameters of Complete blood count and lipid profile were recorded and analyzed in all the study subjects.

Results:

The result showed that the patients with schizophrenia had higher MHR values (15.25±3.16 in schizophrenia patients and 11.50±2.65in controls; P = 0.001). Monocyte counts and MHR of the schizophrenia patients were significantly higher than the control group. There was a significant and positive correlation between age, body mass index, severity of disease and MHR.

Conclusion:

This study demonstrated that there was an association between the inflammatory marker, MHR and schizophrenia. In the patients both monocyte counts and MHR were elevated, such that this could be an easily obtainable and valuable inflammatory marker, and it adds to our understanding that inflammation plays a role in pathophysiology of schizophrenia and cardiovascular risk factor, so it might be helpful in the management of schizophrenia by protecting patients against cardiovascular diseases and early deaths due to cardiac causes.

To compare the effectiveness of Chlorhexidine and Povidine iodine in preventing surgical site infections (SSIs) in C-section deliveries

Habiba Sharaf Ali , Shaheena Ishtiaq , Summiya Yayia — Thu, 07 Sep 2023 00:00:00 +0300

Background: Surgical site infections (SSIs) are a significant concern in healthcare settings,

leading to increased morbidity, mortality, and financial burden. Effective skin preparation

using suitable antiseptic agents is crucial for preventing SSIs.

Objective: This study aimed to compare the effectiveness of Chlorhexidine and Povidine iodine in preventing SSIs in C-section deliveries.

Methods: The study was conducted at a medical university and hospital in Karachi, Pakistan, over a six-month period. A sample size of 35 participants was calculated, and a non-probability consecutive sampling technique was used to select participants. Two groups were randomly assigned, with Group 1 receiving Chlorhexidine gluconate and Group 2 receiving Povidone-Iodine for skin preparation. Data on various factors were recorded, and the occurrence of SSIs within ten days of cesarean delivery was assessed.

Results: The study included women aged 18 to 45 years. The efficacy of Chlorhexidine and Povidine iodine in preventing SSIs was evaluated. The results showed that Chlorhexidine was effective in preventing SSIs in 94.3% of cases, while Povidine iodine was effective in 91.4% of cases. However, no significant difference was observed between the two groups.The study results were consistent with previous research showing a reduction in SSI rates with the use of Chlorhexidine or Povidine iodine. However, other studies have reported conflicting

findings. The overall rate of SSI was lower in the Chlorhexidine group, but contextual factors and adherence to infection control practices may influence outcomes..

Conclusion: This study contributes to the existing body of knowledge on preventing SSIs in C-section deliveries. While Chlorhexidine and Povidine iodine showed comparable efficacy, Chlorhexidine appeared to be slightly more effective in reducing SSIs. However, the limitations of the study and the need for further research in different healthcare settings should be considered.

Single Versus Multiple Sittings Endodontic Treatment Using Rotary Nickle Titanium Instruments

Thu, 07 Sep 2023 00:00:00 +0300

Objective: To access if there is considerable difference in an incidence & severity of the post obturation pain afterwards the single and multiple-visit RCT.

Methodology: Study was directed at operative dentistry department, Rawal dental hospital, Islamabad. Sample size was calculated using WHO calculator. 156 patients were randomly allocated into 2 groups, 78 each. Before treatment all partakers were said to put mark on a horizontal scale to indicate pain intensity. After treatment participants are inquired about pain after twenty-four hours of treatment via graded using Visual-analogue scale.

Results: Males were 93 (59.6%) while females were 63 (40%). Anterior teeth were 80 (51%) while posterior teeth were 76 (48 %). Mean VAS & S.D of Group 1 was 9.12 & 1.98, while for Group 2 was 8.76 & 1.03 pre-operatively. When talking about 24 hours post-operatively, Mean VAS & S.D of Group 1 was 5.58 & 1.92, while for Group 2 was 4.86 & 1.18 respectively. Independent sample t-test exposed statistically in-significant variation in a pre and post-operative pain levels in both groups

Conclusion: Pain incidence was less in multi-visit group than a single-visit, which was not significant statistically.

Keywords: Endodontic treatment, RCT, Single visit, Visual-analogue scale.

Correlation of Smart Phone Addiction with Poor Sleep Quality and Low Academic Score in Medical Students of Nishtar Medical University, South Punjab

Thu, 07 Sep 2023 00:00:00 +0300

Background: Smart phone addiction can disturb sleep quality in medical students by upsetting internal biological clock (SCN) and melatonin level which in turn adversely affects academic performance of medical students.

Objectives: To correlate smart phone addiction (SPA), poor sleep quality and low academic score in medical students and its association with gender.

Methodology: A Cross- sectional descriptive study was conducted on medical students of 4th and final year MBBS (who were mobile phone addict for more than one year). The percentage of last professional exam was taken as academic score. A proposed SPA diagnostic criterion was used to diagnose smart phone addict students. For SPA severity and sleep quality assessment Problematic Mobile Phone Use Questionnaire (PMPU-Q) and Pittsburgh Sleep Quality Index (PSQI) were used.

Results: A total of 74 subjects having mean (SD) age of 22.24 (1.929) years presented with negative correlation between academic score and PSQI (p< 0.05) were included in the study. There was no significant association between academic score and smart phone addiction. The male students had worse score in dependency and dangerous use on PMUQ scale. The female students were worse in dangerous and problematic use of smart phone on PMUQ scale.

Conclusion: The SP dependency and poor subjective sleep quality of male students were negatively associated with their academic score. The female students with low academic score were worse at PSQI score, their academic score was not significantly correlated with their smart phone addiction.

Keywords: Smartphone addiction, Sleep Quality, Academic Score

Barriers to uptake of postpartum Long Acting Reversible Contraception: A cross sectional study

Thu, 07 Sep 2023 00:00:00 +0300

OBJECTIVE: The present research aimed to investigate factors limiting postpartum long-acting reversible contraception from being used in our system.

SETTING AND DURATION: This cross sectional study was carried out in the department of Obstetrics and Gynecology, Nishtar Medical University, Multan, from September 2022 to April 2023.

METHODS: A cross-sectional analysis of institutions was carried out. The study population consisted of all women who gave birth at this hospital during the study period. Data were gathered using a structured questionnaire that had been pretested. The survey asks questions about sociodemographics, reproductive health, healthcare, knowledge and attitudes about LARC, and family planning use. At discharge, a skilled nurse conducted a face-to-face interview with the patient in a quiet private room to gather the data.

RESULTS: In our study most (56.04%) of the women were between age of 26-35 years and (69.97%) belonged to urban area. Main bulk (47.68%) of the women had parity of 3-4 and majority (44.58%) of the women in sample had 0-2 alive children and (21.05%) women presented with history of previous abortion. Most (74.61%) of the women had spontaneous vaginal delivery. The rate of use of LARCs was 69 (21.36%) in our study sample. The comparison of rate of use of LARC’s was found to be significantly (P-value < 0.05) associated with increasing age, increasing women education, occupation and job status. Family income, number of alive children and duration for plan to have next pregnancy were also significant (P-value < 0.05) contributors for uptake of LARCs.

CONCLUSION: The rate of used of postpartum LARC was low (21.36%) in the studied population. Postpartum women from of higher age, having higher education, with formal employment, having higher level of family income, and with higher duration for plan to have next pregnancy were more likely to use LARC.

KEY WORD: Postpartum Family Planning, Postpartum Long Acting Reversible Contraception, Uptake of LARCs,

Comparison of Catheter Related Blood Stream Infections in Hemodialysis Patients Treated With Trisodium Citrate as Catheter Locking Solution vs Heparin as Conventional Locking Method

Thu, 07 Sep 2023 00:00:00 +0300

Objective: To compare the frequency of temporary catheter related blood stream infections using sodium citrate as catheter locking solution with heparin as standard in hemodialysis patients.

Methods: A comparative randomized control trial was conducted at hemodialysis unit of nephrology department, Pakistan Institute of Medical Sciences (PIMS) Islamabad between August 2022 and February 2023. Total 110 patients included consecutively with end stage renal disease, aged above 18 years undergone hemodialysis using temporary central venous catheter as vascular access irrespective of etiology of renal failure. Patients were divided into two groups: Group-I (Trisodium citrate) was administrated with lock solution of trisodium citrate 46.7%, whereas Group-II (Heparin) was administrated with lock solution of heparin 2000 U/ml (as control). The primary endpoint of this study is catheter-related bloodstream infection (CRBSI), measured as the number of observed episodes per 1000 catheter days between the two groups. Secondary endpoints were the number of catheters with thrombosis, catheter infection, and bleeding episodes.

Results: The average age of patients in both groups was 51.98±13.57 years. The average duration of dialysis in both groups was 4.01±3.1 months and mean catheter time in group-I was 13.65±8.29 days and in group-II was 13.40±8.33 days with statistically insignificant (p ≥ 0.05). The rate of CRBSI per 1000 catheter days was 3.12 days for group I and 5.14 days for group II (p = 0.001). The cumulative mean infection-free catheter survival in the trisodium citrate group was lower than the heparin group (log rank = 2.31, p = 0.128). Cox regression survival analysis between two groups; the difference in group I & II was insignificant (HR = 1.6, CI = 0.49–1.17, p = 0.201).

Practical implication: is that the determination of catheter related blood stream infections and comparing two methods i.e., trisodium citrate and heparin in hemodialysis patients.

Conclusion: There is insignificant difference between trisodium citrate 46.7% and heparin as a catheter lock solution in the survival rate of tunneled hemodialysis catheters in end-stage renal disease.

Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears

Fri, 08 Sep 2023 00:00:00 +0300

Objective: To compare the efficacy in absorbed continuous vs interrupted suture material for repair the episiotomy and 2nd degree perineal tears in terms of time required for repair, number of suture material used and pain relief following childbirth.

Methods: A comparative randomized controlled trial was performed in Gynae & Obstetrics department of Akbar Niazi Teaching Hospital, Islamabad between May and October 2022. Total 300 patients of term delivered by spontaneous vaginal birth with episiotomy or 2nd degree perineal tear through non probability consecutive sampling were included. In group-A perineal tear was repaired with continuous non locking sutures and in group-B continuous locking sutures was done. Duration of procedures and number of suture material used was noted. Patients were followed for 24 hours for pain.

Results: The patients mean age was 24.85±3.98 years. The gestational mean age at time of delivery of all the cases was 38.79±0.84 weeks. Type of perineal trauma among all the cases was observed as 84 (28.0%) cases had 2nd degree perineal tear while 216 (72.0%) had episiotomy. Mean time required for suture repair in group-A was 9.0±0.86 sec, while in group-B, the mean time required for suture repair was 15.02±2.06 sec (p-value = 0.001). Mean suture material required for suture repair in group-A was 108.38±9.70 cm, while in group-B, the mean suture material required for suture repair was 114.01±7.17 cm (p-value = 0.001). The mean pain score in group-A was calculated as 3.64±0.94 on VAS, while in group-B mean pain was 5.46+0.75 on VAS (p-value = 0.001).

Conclusion: Through this study, it was proved that episiotomy and repair of perineal tears with continuous suture is faster, and uses less suture material without increasing complexity compared to interrupted suture. The continuous suture method of perineal repair is associated with less pain than the interrupted method.

Effectiveness of cataract uncomplicated surgery on retina thickness

Fri, 08 Sep 2023 00:00:00 +0300

Background: The most common preventable cause is cataract for the loss of vision, and pseudophakic cystoid macular edema, also called Irvine-Gass syndrome, is a well-known complication after cataract surgery.

Objective: To determine changes in total retinal thickness after cataract uncomplicated surgery.

Methods: A prospective quasi experimental study was done at the department of Ophthalmology of Combined Military Hospital (CMH), Rawalakot AJK between September and December 2022. Total 28 patients (28 eyes) who underwent phacoemulsification uncomplicated surgery and grafting of intraocular lens in unilateral eye were included. The effective phacoemulsification time and total energy used during phacoemulsification cataract surgery was noted. The optical coherence tomography (OCT) scan was performed to analyze the retina thickness. Data were collected preoperatively, which serves as a baseline measurement. This baseline measurement was used to compare with measurements taken at postoperative day 1, end of week 1, end of month 1, and follow-up period month 3 to assess changes in various parameters such as total retinal thickness.

Results: The patient’s mean age comprising of 20 (71.4%) males and 8 (28.6%) females was 54.73±7.6 years. Typically, there is a transient decrease in retinal thickness, immediately after surgery (day 1), followed by a gradual increase in thickness over the weeks (first week) and months (1st & 3rd month) following surgery. Overall, a positive correlation was seen between phacoemulsification time, total energy, and changes in the retinal thickness (1mm & 1-3mm grids) (p ≤ 0.05).

Conclusion. The study concluded that a follow-up period of at least 3 months is generally recommended after surgery of cataract to assess the whether preoperative levels return of total retina.

EFFECT OF CONTINUOUS ULTRASONIC IRRIGATION ON POSTOPERATIVE PAIN IN CASES IN SYMPTOMATIC APICAL PERIODONTITIS AFTER SINGLE VISIT ENDODONTIC TREATMENT.

Bharat Kumar, Feroze Ali, Pooja Kumari, Imran Ali, Rajesh Kumar, Sarang Suresh — Thu, 07 Sep 2023 00:00:00 +0300

Background & Objective

Root canal therapy is a vital dental procedure that helps save damaged or infected teeth and maintain overall oral health. Efficient pain management after root canal therapy is crucial to ensure patient satisfaction and encourage proactive dental care. This study aims to investigate the effectiveness of Continuous Ultrasonic Irrigation (CUI) versus Syringe Irrigation (SI) in reducing postoperative pain, ultimately improving patient comfort and treatment success.

Methodology

This study compares the efficacy of continuous ultrasonic irrigation (CUI) and syringe irrigation (SI) in reducing postoperative pain after single-visit root canal therapy. With a sample size of 90 patients, the study examines pain levels 24 hours and seven days postoperatively using the Heft Parker Visual-Analogue Scale.

Results

The study found that continuous ultrasonic irrigation (Group A) was more effective in reducing postoperative pain at 24 hours compared to syringe irrigation (Group B), with a significant difference in pain reduction (P-value: 0.001). However, syringe irrigation was more effective in reducing postoperative pain at the 7th day (P-value: 0.010). The results also indicated significant differences in pain severity between the two groups at 24 hours and the 7th day, with gender-specific differences in pain levels as well.

Conclusion

Continuous ultrasonic irrigation was more effective in reducing postoperative pain at 24 hours, while syringe irrigation showed greater effectiveness at the 7th day postoperative.

Do Respiratory Maneuvers Affect Rght Hepatic Vein Waveform and Maximum Velocity in Post LDLT Recipients?

Wed, 20 Sep 2023 00:00:00 +0300

AIM: To evaluate the effect of respiratory maneuvers on right hepatic vein (RHV) Doppler waveform and its maximum velocity in Living donor liver transplant (LDLT) recipients.

METHODS: This was a prospective cross-sectional study performed at Pakistan Kidney and Liver Institute and Research Centre (PKLI& RC), Lahore Radiology department. The sample size of the study, calculated according to WHO sample size calculator, was 30 patients after applying the inclusion and exclusion criteria. Most of these patients were analyzed during their first post-operative week while staying in the surgical intensive care unit (SICU). The Doppler waveform and maximum velocity of RHV were recorded during normal gentle breathing, following breath-hold after deep inspiration and then after quiet expiration. The waveforms that were recorded were triphasic, biphasic, or monophasic in the pattern. To assess the RHV flow quantitatively, the Damping Index was also calculated during all these three respiratory maneuvers as follows (DI=Minimum velocity/maximum velocity)

RESULTS: The maximum velocities during normal respiration, after quiet expiration and after breath-holding following deep inspiration were 125 cm/sec, 105 cm/sec and 94 cm/sec. The waveforms observed during gentle breathing were triphasic in 77%, biphasic in 10%, and monophasic in 13% of the patients. After quiet expiration, these were triphasic in 80%, biphasic in 6%, and monophasic in 13% of patients. However, after breath-hold following deep inspiration, the waveforms observed were triphasic in 42%, biphasic in 13%, and monophasic in 45% of the patients. (P <0.008)

CONCLUSION: The study showed that not only did the RHV waveforms show significant change from triphasic pattern to monophasic pattern, but also the peak velocities were lower following expiration. Therefore, during the Doppler ultrasound assessment of post-LDLT recipient patients, respiratory variations must be taken into consideration.

An Assessment of the Current Trends of Antibiotic Resistance of Salmonella typhi against 1st Line Antimicrobial Agents in Metropolitan City of Karachi: An Observational, Cross Sectional Descriptive Study

Wasim Ahmad — Thu, 07 Sep 2023 00:00:00 +0300

Objectives: The objective of this study was to assess current trends of antibiotic resistance against S. typhi in Pakistani population.

Methodology: This was a cross-sectional, observational descriptive research conducted in various diagnostic facilities in Karachi-Pakistan from January 2019 to November 2020.

The study was approved by the IRB through letter no. JUW/IERB/035/2021. A data of 1223 patients, who were reported positive for typhoid fever, was collected from various diagnostic facilities with in the area. Clinical isolates were examined for culture sensitivity by using BACTEC™ and Versa TREK™. Isolates of the Salmonella typhi and para typhi were recovered from blood of the patients. The collected data was analyzed using SPSS version 22.0.

Results: Among all isolates, 92.7% (n=1134) isolates were identified as S. typhi and the remaining 7.3% (n=89) as S. paratyphi. Study population suffering from typhoid fever were 58.5% (n=716) male trailed by 41.5% (n=507) female. Similarly, among 1223 clinical isolates, 14.2% (n=174) were non-resistant, 5.4% (n=66) were multi-drug resistant (MDR), 56.4% (n=690) were extensive drug resistant (XDR), 12.7% (n=155) were moving towards multi-drug resistant species trend and 5.7% (n=70) were heading towards XDR. A further 5.6% (n=68) were moving towards ESBL positive typhoid fever. Moreover, 49.1% of the S. typhi isolates were found to be resistant to all the first line antibiotics agents (ampicillin, chloramphenicol and co-trimoxazole) with only 15.2% found to be sensitive to all first line antibiotics drugs. 22% were resistant to either two 1st line drugs whereas 10.6%, 1.9% and 1.6% were found to be resistant to ampicillin, co-trimoxazole and chloramphenicol alone therapies respectively. XDR cases with resistance to even 3^rd-line drugs for typhoid fever have documented.

Conclusion: Strains of Salmonella typhi in Karachi are resistant to most of the drugs recommended by local infectious disease society for treatment of typhoid. This is alarming for healthcare policy makers because of lack of newer drugs discovered for treatment of typhoid fever and pathogens isolated for this highly infectious disease being resistant to most of the recommended anti-microbial agents.

Keywords: Typhoid fever, Drug resistance, XDR, Salmonella typhi

Diagnostic accuracy of transcutaneous bilirubinometry versus serum bilirubin level

KINZA IMRAN — Thu, 07 Sep 2023 00:00:00 +0300

Objective: To assess the diagnostic accuracy of transcutaneous bilirubinometry over serum bilirubin level in newborns with hyperbilirubinemia.

Study design: Cross-sectional study.

Place and duration of study: Department of Neonatology, Children Hospital, PIMS Islamabad for six months from 01-09-20 to 28-02-21.

Patients and method: Total 150 Neonates of either gender having clinical jaundice were included in the study. Neonates who took treatment for Hyperbilirubinemia, gestational age of < 33 weeks, birth weight < 1500 gm, having major congenital malformations, and neonates of a jaundiced mother were excluded from the study. MBJ-20 transcutaneous bilirubinometer was used for transcutaneous bilirubinometry. The first of three measurements with the MBJ-20 was taken, and the average mean was taken as the final reading. Readings were compared with serum bilirubin levels at the same time.

Results: There were 80 (53.3%) males and 60 (46.6%) females. The mean gestational age was 37±3.4 weeks. The postnatal age at the time of presentation was 52 (34.7%) patients within three days, 80 (53.3%) patients within 4-7 days, and 18 (12%) presented after the first week.. There were 32 newborns (21.3%) weighing less than 2.5 kg and 118 neonates weighing more than 2.5 kg. Forty-five (30%) patients had a transcutaneous bilirubin level of less than 10mg/dl, 77 (51.3%) patients had between 11-15 mg/dl, and 28 (18.7%) patients had a level of more than 16 mg/dl. There were 52 (34.7%) patients with a serum bilirubin level less than 10 mg/dl, 73 (48.7%) patients with a level between 11 and 15 mg/dl, and 25 (16.6%) patients with a level greater than 16 mg/dl. Serum bilirubin levels varied from 2-21.7 mg/dL, whereas transcutaneous bilirubin levels ranged from 1.4 to 22.1 mg/dL. Transcutaneous bilirubin and serum bilirubin had a Pearson Correlation coefficient (r) of 0.776 (p-value < 0.0001). The calculated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.59%, 78.57%, 97.74%, 64.71%, and 94.00%, respectively.

Conclusion:

Transcutaneous bilirubinometry is a low-cost, noninvasive, and accurate screening test for hyperbilirubinemia with a high sensitivity specificity and positive predictive value (PPV).

Intra Ocular Pressure Change After Low Energy And High Energy Nd:Yag Laer Posterior Capsulotomy

Fri, 08 Sep 2023 00:00:00 +0300

OBJECTIVE

To determine the frequency of change in Intraocular Pressure (IOP) among patients undergoing YAG Laser Posterior Capsulotomy and to compare IOP change based on the level of YAG laser energy and number of shots applied.

METHODOLOGY

A descriptive cross-sectional study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital Rawalpindi, from December 2021 to November 2022. A total of 200 pseudophakic eyes with posterior capsular opacification were included in the study. Preliminary baseline intra-ocular pressure (IOP) was measured by Goldman Applanation Tonometry (GAT). Patients were divided into groups according to the laser energy utilized and the number of shots. IOP was measured after 1 and 4 hours post-procedure and results compared.

RESULTS

In the low energy group (mean energy 2.73 mJ), average IOP calculated was 14.86 and 12.97 mmHg after 1 and 4 hours of procedure respectively. While in the high energy group (mean energy 4.11mJ), it was 19.42 and 17.51 mmHg respectively. In group 1 (less than 20 shots), mean IOP 1 and 4 hours procedure was 13.88 and 12.97 mmHg respectively. In group 2 (greater than 20 shots) the mean IOP was 21.63 and 18.31 mmHg respectively. The rise in IOP was significantly higher for the higher laser energy and in the group with greater number of shots at both 1 and 4 hours (p=0.000).

CONCLUSION

In conclusion, we found that significant rise of IOP is noted when more energy and greater number of shots are utilized in YAG laser capsulotomy.

A cephalometric study of pharyngeal dimensions following Twin block treatment

Asma Najibullah Khan, Omar Arshad, Amra Minhas Abid, Shahzonia Tariq — Thu, 07 Sep 2023 00:00:00 +0300

Objective: The purpose of this prospective study, using lateral cephalograms, was to measure and compare pre and post-treatment
linear changes of the pharyngeal airway widths (PAW) in patients treated with a removable twin block appliance.
Methodology: Lateral cephalogram records taken before (T 0 ) and after (T 1 ) treatment of 50 Class II subjects (ANB>4 0 ; 28 males;
22 females; mean age 12.6 years) treated with removable twin block appliance. Airway volumes of upper airway width (UAW),
middle airway width (MAW) and lower airway width (LAW) were compared between T 0 and T 1 . The data was analyzed by SPSS
statistical software through paired t-test. A p value of ≤0.05 was considered statistically significant.
Results: A total of 50 patients were included in the study and analyzed for airway change at two different times prospectively (T 0
and T 1 ). The male to female ratio was 1:0.8 (44% females/56 %males). Mean upper airway width (UAW) at T 0 and T 1 was 14.04
mm and 15.3mm respectively, mean middle airway width (MAW) at T 0 and T 1 was 8.8mm and 11.8mm respectively, while mean
lower airway width (LAW) at T 0 and T 1 was 7.5mm and 10.2mm respectively. Mean age was 12.6 years. Mean BMI was 21.
Mean SN-Md angle was 31.8 degrees. At T 1 , significant airway volume increase in upper airway width (UAW), middle airway
width (MAW) and lower airway width (LAW) was recorded. (P=0.000).
Conclusion: Twin Block Appliance treatment, in growing subjects, increased the overall posterior pharyngeal airways volumes.
Keywords: Removable twin block, retrognathic mandible, airway volume, PAW

Invisible Hazards: Tackling the Menace of Passive Smoking and Lung Cancer in Pakistan - Urgent Steps for Awareness and Change

berkharani — Tue, 19 Sep 2023 00:00:00 +0300

its an editoriallun

Psychological Problems among School Going Children- A Systematic Review

Asima Mehaboob Khan, Rizwan Taj, Aamir Naveed, Aamir Naveed — Thu, 07 Sep 2023 00:00:00 +0300

Background: The childhood psychological problems are the life impairing psychological indicator of an individual. The adolescent age is the most prominent age for acquiring the diversified psychological adaptation.

Objective: The current research study is systematically analyzing the psychological problem of school going children. The aim of this study was to assess the consensus and differentiation of the spectrum of psychological problems among school going children and their associated factors in previously published literature.

Methodology: The adopted method of this research study because PRISMA diagram. EndNote Version X9's PubMed collection was searched for publications using the particular keywords (psychological issues and school-age children). The papers were filtered by year of publication, and any content that had been published before 2019 was purged from the electronic PubMed collection.

Data Analysis: out of total 1564, 10 articles were included in systematic analysis. The included articles were international research study from China, Europe, Turkey, Netherlands, Denmark, the USA and Canada. The research studies were of cross sectional correlational research design, longitudinal research studies, quantitative cross sectional studies.

Conclusion: The qualitative analysis has shown the spectrum of psychological physical problems of school going children i.e. the behavioral changes, ignorance, arrogance, irritation, social withdrawal, social isolation, lack of confidence and low self-esteem, anxiety, depression, stress, post-traumatic stress disorder. These psychological issues are deeply associated with mobile phone addiction, social media addiction, parental psychological disorders and child sexual abuse, school bullying and criticism. The moderate to vigorous physical activates are suggested ad non pharmacological treatment of these psychological problems.