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Objective: To evaluate the health professional's knowledge, atitude, and practices towards the COVID-19 pandemic in Karachi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Karachi Pakistan, from Mar to Jul 2020. Methodology: A total of 228 healthcare professionals, i.e. specialists, physicians, nurses, and technicians working in the district East of Karachi were included. Independent sample t test and ANOVA were used for inferential statistics. Results: Our findings showed that 95% study participants had a good knowledge regarding the infection and 81.8% showed a positive atitude towards the infection with over 98% reporting good professional practices regarding COVID-19 infection control. Conclusion: These findings underscore the effectiveness of ongoing education and training initiatives among health professionals in Karachi, contributing to their preparedness and ability to effectively respond to the chalenges posed by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: To compare the nebulized salbutamol alone with combination of nebulized salbutamol and ipratropium for acute exacerbation of chronic obstructive pulmonary disease in terms of mean length of stay. Study Design: Quasi-experimental study Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi Pakistan. Study was carried out over a period of six months from May to Nov 2017. Methodology: A total of 300 patients of chronic obstructive pulmonary disease (150 in each group) were recruited in the study. Group A received nebulized salbutamol (5mg) alone and Group B received a combination of nebulized salbutamol (5mg) and ipratropium bromide (0.5mg). Results: Mean age of the patients was 66.4±6.4 years and 65.7±6.8 years in Group-A and B, respectively. In Group-A, there were 136(90.7%) and in Group-B 134(89.3%) were males while 14(9.3%) and 16(10.7%) were females in Group-A and B, respectively. Mean duration of disease in Group-A was 5.2±2.4 years and in group-B 6.0±1.6 years. Comparison of mean length of stay (days) revealed in hospital between nebulized Salbutamol alone 5.0±0.5 days with combination of nebulized Salbutamol and Ipratropium 4.3±0.6 days with p-value <0.001. Conclusion: In conclusion, the routine addition of nebulized ipratropium bromide to salbutamol appears to be of benefit in the treatment of acute exacerbations of chronic obstructive pulmonary disease and in terms of mean length of hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of the international organization for standardization (ISO), the challenges faced in its implementation and the implications of the process on patient care in the long-term accreditation in a tertiary care hospital in Kharian. Study Design: Cross-Sectional Study Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Jan to Dec 2019. Methodology: Patient satisfaction questionnaires were given to 1600 patients presenting to the Indoor, Outdoor, Accidents & Emergency, Pharmacy, Radiology Department and Laboratory of Combined Military Hospital, Kharian Pakistan, as a part of a routine ISO audit annually for 2019. Responses were analyzed and tabulated. Results: The upward trend in patient satisfaction was attributed to administrative intervention policies based on patient complaints and suggestions incorporated into the questionnaires' comment boxes. There was a significant difference between the response rates of patients in departments (p=0.016). It indicates that the satisfaction rate was higher among different departments. Conclusion: Patient satisfaction is directly proportional to interventional measures based on patient feedback. When utilised positively, these feedback loops can lead to an increase in the hospital's overall efficiency index and the standard of care. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiological pattern, clinical presentation and outcome of patients with proptosis in a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Khyber Teaching Hospital, Peshawar Pakistan, from Jan 2019 to Jun 2020. Methodology: This study was conducted on 60 patients having proptosis. Patients were treated either medically, surgically or both. The demographic profile included age, gender and type of proptosis. The outcome included recovery, re-treatment, referral to the relevant speciality and loss to follow-up, were measured. Results: Out of 60 patients with proptosis, 39 were males, and 21 were female. Fifty-two patients had unilateral, and 8 had bilateral proptosis, with the majority suffering from non-axial proptosis. On aetiology exhibited tumours (45%), infectious (25%), inflammatory (16.6%), vascular (6.66%) and injury (6.66%). The surgical procedure was indicated in 27(45%) patients, while medical treatment was given in 28(46.6%) patients. Five patients (8.4%) received both surgical and medical treatment. Out of 60 patients, 26 patients (46.33%) fully recovered and 11 patients (18.33%) did not recover, 17(28.33%) patients were referred to other specialities for management, and 5(8.3%) patients lost to follow-up. Conclusion: In our study, tumours were the main cause of proptosis, followed by infective and inflammatory causes, with the paediatric age group (<18 years) at more risk. [ABSTRACT FROM AUTHOR]

Objective: To study the severity of noise-induced hearing loss and noise levels in the environment in occupationally exposed individuals. Study Design: Prospective longitiginal study. Place and Duration of Study: Tertiary care hospital, Lahore Pakistan, from Dec 2019 to Jun 2020. Methodology: The noise levels and duration of exposure to loud noise were measured at various exposure points to define ways and means for future prevention. Results: Out of 3000 patients reporting to the ENT outpatient department for various problems, 33.3% had ear problems. Out of 1000, 750 had hearing loss with normal tympanic membranes. Among 750, 200 (26.6%) had conductive hearing loss, while 550 (73.3%) had sensorineural hearing loss. Out of 550, 70 (12.72%) were related to occupational exposure in service and 480 (87.2%) were due to various causes. Most patients reported from the security wing (40, 57.14%) being exposed to the loud noise as a pulsed exposure, followed by patients in the telecommunication field (20, 28.57%) being exposed to persistent noise. Conclusion: Occupational exposure to loud noise in the workplace poses significant health issues, including an economic burden on an individual. NIHL related to occupational exposure to loud sounds is frequently reported worldwide. Education and prevention are two vital steps which can reduce the number of such cases significantly, thus preventing this lifelong disability, ensuring health and reducing the economic burden. [ABSTRACT FROM AUTHOR]

Objective: To compare the short-term outcomes of patients with Occlusive Myocardial Infarction and Non-occlusive Myocardial Infarction in the context of non-ST Elevation Myocardial Infarction. Study Design: Analytical cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan; from Jul to Nov 2023. Methodology: One hundred and ninety four patients aged 20 to 75 years with NSTEMI were consecutively enrolled. Patients were classified into OMI and NOMI groups using angiographic, laboratory tests and electrocardiographic findings. Short-term outcomes such as stroke, heart failure, recurrent myocardial infarction, and mortality were recorded. The comparative analysis assessed differences in baseline characteristics and clinical endpoints between Occlusive Myocardial Infarction and Non-occlusive Myocardial Infarction patients. Chi square test was applied to compare the categorical variables among study groups and p-value <0.05 was considered as statistically significant. Results: Among 194 patients, there were 71(36.6%) patients with Occlusive Myocardial Infarction and 123(63.4%) with Non-occlusive Myocardial Infarction and mean age was 60.68 ±12.97 years. Majority of the patients presented with Triple Vessel Coronary Artery Disease 89(45.9%), followed by Single and Double Vessel Coronary Artery Disease [60(30.9%); 45(23.2%)] respectively. Short-term outcomes included heart failure 50(25.8%), stroke 4(2.1%), recurrent MI 8(4.1%), and death 7(3.6%). However, the difference was not significant among study groups (p>0.05). In OMI group, diabetes mellitus, hypertension, hyperlipidemia and Coronary Artery Disease were found significantly associated with morbidity and mortality (p<0.05), while none of the variables were significantly associated with morbidity and mortality in NOMI group (p>0.05). Conclusion: The study emphasizes tailored management strategies for NSTEMI patients, specifically, the disconnect between baseline risk of the two groups and the timely utility of invasive strategy can help improve prognosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of thrombocytopenia (mild, moderate & severe) with pregnancy-related disorders. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology of Pakistan Railway Hospital, Rawalpindi Pakistan, in collaboration with the Departments of Obstetrics and Gynecology of Pak Emirates Military Hospital and Fuji Foundation Hospital, Rawalpindi Pakistan, from Oct 2018 to Oct 2019. Methodology: Seventy-five pregnant females with platelet count <150x109/l were included. Blood samples were taken and analyzed for complete blood count, peripheral blood smear, manual count by Neubauer chamber, uric acid, urinary proteins, liver function tests (bilirubin & aspartate aminotransferase), lactate dehydrogenase, coagulation profile and viral serology (Hepatitis B & C). Results: Out of a total of 75 thrombocytopenic pregnant females, gestational thrombocytopenia was most common (74.7%), followed by preeclampsia (17.3%), HELLP syndrome (4%), immune thrombocytopenic purpura (4%) respectively. Mild thrombocytopenia was frequently observed in patients of G. T. (62.5%), while moderate thrombocytopenia (84.6%) was generally detected in preeclampsia patients. Severe thrombocytopenia was mostly identified in patients with HELLP syndrome (66.7%) and immune thrombocytopenic purpura (66.7%). Conclusion: Mild thrombocytopenia is mostly presented in gestational thrombocytopenia. Moderate thrombocytopenia was frequent in patients with preeclampsia, and severe thrombocytopenia was usually diagnosed in patients with HELLP syndrome and immune thrombocytopenic purpura, which require apposite and judicious management for the safety of mother and fetus. [ABSTRACT FROM AUTHOR]

Objective: To evaluate total mechanical gastroesophageal anastomosis in patients with carcinoma of esophagus. Study Design: Cross sectional study. Place and Duration of Study: Department of Surgery, Bolan Medical University, from Jan 2020 to Jun 2021. Methodology: Total of 75 patients were included consecutively in this observational cross sectional study involving patients diagnosed with esophageal cancer and awaiting to undergo esophagiectomy with mechanical anastomosis in-between 18 to 60 years and were ASA I and II were included. Patients that were ASA III or IV and having any systemic disorder and those that refused to participate were excluded. SPSS version 23.0 was used for data analysis keeping p-value <0.05 as significant. Results: Mean age of patients was 58.31 ± 6.2 years wherein 42(56%) males and 33(44%) females. 29 (38.7%) of patients were ASA I while 46 (61.3%) were ASA II. Mean operative time of patients was 240 ± 65.2 minutes while mean blood loss was 205 ± 32.3 ml. Regarding anastomotic leakage, minor (type I) leakage was observed in 05(6.7%) of patients while major (type II or III) leakage was seen in 03(4%) of patients. Anastomotic dilatation, stricture formation and death were reported in 01(1.33%) patient each. Conclusion: Total mechanical gastro-esophageal anastomosis was found to have safe, less time consuming and with minimal post-operative anastomotic leakage or stricture formation and morbidity. [ABSTRACT FROM AUTHOR]

Objective: To determine the contraceptive awareness and practices in patients with rheumatic diseases using disease modifying anti-rheumatic drugs. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient of Rheumatology, Department at Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Apr 2021. Methodology: Patients with any rheumatic disease and taking teratogenic disease modifying anti-rheumatic drugs were included in the study. Patients were asked about if they were counseled regarding the risk of teratogenicity with the antirheumatic drugs and when to stop the drug before pregnancy. Results: Out of total 150 patients, 87 (58.0%) female patients had Rheumatoid arthritis and 26 (17.3%) had Systemic lupus erythematosus. The majority of female patients (104, 69.3%) were using Methotrexate and 21 (14.0%) females were using Leflunomide. Only 53 (35.3%) females were counseled about drug teratogenicity. Most of the female patients (102, 68.0%) were never counseled about the use of contraception while taking anti-rheumatic drugs. The rate of use of contraceptives was even worse and merely 15 (10.0%) females were using contraceptives. Conclusion: Majority of the patients with rheumatic diseases being treated with teratogenic disease modifying anti-rheumatic drugs, were not using any form of contraception. The rate of contraceptive use and counseling regarding contraceptives was noted to be very low. [ABSTRACT FROM AUTHOR]

Objective: To determine the characteristics and outcome of acute-on-chronic liver failure patients being managed at Pak-Emirates Military Hospital Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gastroenterology at Pak-Emirates Military Hospital, Rawalpindi, from Sep 2018 to Jan 2021. Methodology: In this study, 1559 patients diagnosed with cirrhosis were studied. Patients with pre-existing chronic kidney disease, chronic obstructive pulmonary disease, cardiac failure, dementia, and stroke were excluded. All the relevant features of each case were recorded in the proforma. Results: Out of 1559 patients, 67 had Acute-on-chronic liver failure. The majority of patients who presented with acute-onchronic liver failure were in grade Ib (55%), followed by grade II (30%). Hepatitis C virus related liver cirrhosis was the commonest underlying liver disease (78.4%). Drugs were the commonest triggering factor (33%), followed by acute viral hepatitis (27%). However, a large number of patients had no identifiable cause (25.4%). Conclusion: Acute-chronic-liver failure is common in patients presenting with acute decompensation of liver cirrhosis. Patients undergoing liver transplantation in the correct window period, have good prognosis. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean time of first rescue analgesia with Nalbuphine versus Tramadol as an adjuvant to Bupivacaine given for caudal block in children. Study Design: Quasi-experimental study Place and Duration of Study: Anesthesiology Department, Bolan Medical Complex Hospital, Quetta Pakistan, from Feb to Aug 2019. Methodology: The study included 60 patients, of either gender, aged 3-12 years. Group-A included patients who received 0.125% Bupivacaine 1ml/kg with Tramadol 2mg/kg body weight caudally. Group-B included patients who received 0.125% Bupivacaine with Nalbuphine 0.1mg/kg body weight caudally. The time required for the first rescue analgesia call was noted in all patients. Paracetamol 10 mg/kg intravenous was given as a rescue analgesic in all patients. Results: The mean age of patients was 8.30±3.03 years, and mean weight of patients was 23.33±6.92 Kg. There were 26(43.33%) female and 34(56.67%) male patients. The mean pain score was 3.53±1.43 in the Tramadol-Group and 1.86±1.25 in the Nalbuphine-Group (p-value<0.001). The mean time of first rescue analgesia showed significant prolongation in the Nalbuphine-Group compared to the Tramadol-Group. Conclusion: A single dose of Nalbuphine as an adjunct to Bupivacaine is superior to Tramadol in reducing post-operative pain when given caudally in paediatric patients. It also significantly prolongs the duration of analgesia in children. [ABSTRACT FROM AUTHOR]

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation. Study Design; Quasi experimental study. Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020. Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting & synechie/adhesions. All the data was entered on SPSS-17 and analyzed. Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting & 3 synechie/adhesions in endoscopic partial turbinectomy group. Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy. [ABSTRACT FROM AUTHOR]

Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin. [ABSTRACT FROM AUTHOR]

Objective: To determine the mean change in central macular thickness after cataract surgery and to compare the mean change in central macular thickness after cataract surgery in patients with diabetes and without diabetes. Study Design: Cross sectional comparative study. Place and Duration of Study: Ophthalmology Department, Pakistan Ordinance Factory Hospital, Wah, from Apr to Sep 2019. Methodology: Patients were divided into two groups; Group A (patients with diabetes) and group B (patients without diabetes). All the patients underwent phacoemulsification and observed after 4 weeks for macular thickness measurement using optical coherence tomography before and after surgery. Results: Total 60 patients were included. Mean age of patients was 65.31 ± 7.63 years. There were 35 (58.3%) males and 25 (41.7%) female patients in the study. We found a significant increase in central macular thickness in Group A and Group B [(223.10 ± 15.86 μm vs 227.26 ± 17.90 μm, p<0.001) and (221.20 ± 12.16 μm vs 226.28 ± 16.78 μm, p=0.001)] before and after phacoemulsification in Group A and Group B respectively. However, no significant difference was found between the groups (p=0.486). Conclusion: There is no significant difference in central macular thickness after uncomplicated phacoemulsification in both groups. [ABSTRACT FROM AUTHOR]

Objective: To assess the cross-reactivity of COVID-19 IgG assay with known immune-mediated and infectious disorders and evaluate for any false-positive reactions to determine the specificity of the serological assay. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore Pakistan, from Sep to Oct 2020. Methodology: A total of 116 samples were included in the study of both males and females. Diagnosed cases of typhoid fever, viral hepatitis, systemic lupus erythematosus (SLE), syphilis, multiple connective tissue disorders (MCTD), varicella-zoster infection, rabies, toxoplasmosis, epstein-barr virus (EBV) infection, rubella, rheumatoid arthritis, AIDS, cytomegalovirus (CMV) infection and dengue fever were included in the study. Three samples of multiparous women aged more than 40 years were also included in the study. IgG antibody levels were measured against SARS-CoV-2 with a cut-off index of 1.4. Results: Out of 116, only 3 (2%) samples were reactive for IgG against SARS-CoV-2. The categories showing cross-reactivity were typhoid, hepatitis C, and CMV. All specimens showing cross-reactivity were of females. Assay under consideration showed a specificity of 97.4%. Conclusion: Cross-reactivity was seen in pre-pandemic cases of infectious diseases with COVID-19 IgG antibody assay. Medical lab professionals must verify the serological assays before use in the clinical laboratory to avoid false-positive results. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of total laryngeal anesthesia and simple local anesthesia during awake fiberoptic bronchoscopy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pulmonology, Combined Military Hospital Lahore, from Jan to Jul 2020. Methodology: A total of 70 patients, who were undergoing fiberoptic bronchoscopy were divided into two groups. Group-I patients were given topical anesthesia with 2% Lignocaine while group-II patients, in addition to topical Lignocaine, had 2% Lignocaine injected into bilateral internal laryngeal nerves for total laryngeal anesthesia. Assessment of efficacy of anesthesia was evaluated by Reasoner scale. Results: In group-I, 26 (74.28%) patients showed mild or moderate cough and gagging during stage-1. Fifteen (42.85%) patients showed moderate cough and gagging that interfered with the procedure during stage-2 and 19 (54.28%) patients showed mild cough or gagging that did not interfere with the procedure in stage-3. In group-II, 17 (48.57%) patients exhibited mild cough or gagging during stage-1. Sixteen (45.71%) exhibited mild cough or gagging that did not interfere with the procedure during stage-2 with all the patients showing either no cough or mild cough and gagging that did not interfere with the procedure during stage-3. More patients of group-II 32 (91.42%) agreed to a repeat test if required medically as compared to group-I 28 (80%). Conclusion: Patients undergoing fiberoptic bronchoscopy who underwent total laryngeal anesthesia and sedation, in addition to topical anesthesia experienced less cough and gagging than those receiving only local anesthesia. [ABSTRACT FROM AUTHOR]

Objective: To compare the negative appendectomy in the females of reproductive and non-reproductive age groups. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan, from January 2018 to December 2019. Methodology: A total of 1126 appendectomy specimens were enrolled irrespective of age and gender. The biodata of patients was retrieved from the database. Statistical analysis was done using SPSS version 22. Results: Out of total 1126 reported cases, 787 (69.9%) were males and 339 (30.1%) were females. The mean age was calculated to be 24.43 ± 12.42 years ranging from 2-94 years. Histopathological examination revealed cases of acute appendicitis 374 (33.2%), acute appendicitis with peri-appendicitis 478 (42.5%), fibrous obliteration 28 (2.5%) and parasitic infestation 7 (0.6%). Overall negative appendectomies were 219 (19.4%) and were prominent in females 100 (29.5%) than males 119 (15.1%). Also it was higher in females of reproductive age group 77 (30.4%) than in non-reproductive age group 23 (27.9%). Conclusion: In our study negative appendectomy in females of reproductive age groups was found to be higher than expected. Clinical scoring systems, biochemical markers, imaging modalities, and second opinion from other specialties like internal medicine, gynae and obstetric have been introduced to substantiate the diagnosis of acute appendicitis and thereby decreases the negative appendectomy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the complexity and diversity of type, surgical management and complications in adult choledochal cysts presenting to a Hepatobiliary unit of a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2019. Methodology: All the patients diagnosed with choledochal cyst and underwent surgical procedure between Jan 2017 to June 2019 were analyzed. The clinical features, types, operative procedure and outcomes of the patients in terms of post-operative morbidity and mortality were assessed. Calvin Dindo classification was used to assess complications. Results: A total of 17 patients were studied, out of which, 13 were females (76.5%) and 4 were males (23.5%) with mean age of 37.41 ± 16.96 years. There were 13 type I (76.5%), 2 type IVa (11.8%) and 1 type II (5.9%) choledochal cysts according to Todani’s classification. Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on all 17 patients. There was no mortality in the series. Post-operative complications occurred in 4 (23.5%) patients, 2 were grade II, 1 was grade I and 1 grade III according to Clavin Dindo scale. Long-term follow up revealed recurrent cholangitis in 3 (17.6%) patients which settled on antibiotic regime. The median follow up time was 1.5 years. Conclusion: The total extra-hepatic excision with Roux-en-Y hepaticojejunostomy is the treatment of choice for adult choledochal cyst. The procedure has low morbidity and very low mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine the in-hospital outcomes of primary percutaneous coronary intervention approach in a tertiary care cardiac center. Study Design: Retrospective observational descriptive study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan 2018 to Dec 2019. Methodology: A total of 143 consecutive ST-elevation myocardial infarction patients presented to the ER within 24 hours of the onset of chest pain were included in this study. We included patients of both genders, aged >20 years and met the diagnostic criteria of ST-elevation myocardial infarction. Patients with cardiogenic shock, puncture site infection were excluded from the study. Results: Average age of patients was 54.2 ± 12.7 years (min-max age=24-92 years). Majority 130 (90.9%) of cases were males, while 55 (38.5%) patients had diabetes, 52 (36.4%) were hypertensive, 38 (26.6%) were smokers, family history of CAD was found in 10 (7%) cases and 8 (5.6%) cases had prior percutaneous coronary intervention or coronary artery bypass graft. Mostly 64.3% procedures were performed by trans-radial approach. Mean ± SD door-to-balloon time was 60.31 ± 29.8 minutes. About 72% patients received primary percutaneous coronary intervention within ≤60 min and 40 (28%) cases received primary percutaneous coronary intervention with door-to-balloon time >60 min. This study shown 100% success rate with zero mortality only one patient developed arrhythmia during procedure. Conclusion: Primary percutaneous coronary intervention through trans-radial approach was safe option with excellent success rates in terms of both morbidity & mortality rates. [ABSTRACT FROM AUTHOR]

Objective: To describe the demographic, clinical, serological and radiological scores in patients with rheumatoid arthritis (RA) presenting in a tertiary hospital in Pakistan. Study Design: Cross sectional study. Place and Duration of Study: Department of Rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi, from Sep 2018 to Feb 2019. Methodology: The study included 52 female patients with RA between the ages of 18 and 80 years. Data were obtained from FFH Rawalpindi's outpatient department. Demographic details, reference data, and serological status were recorded. The joints involved in the onset of the disease, joint deformities, clinical disease activity index (CDAI) and overall functional status were evaluated. Extra-articular manifestations of rheumatoid arthritis have also been examined during a detailed physical examination. The patient's bone mineral density was calculated by the use of dual energy absorptiometry (DEXA scan). Radiological scores were evaluated using modified sharp score. Results: Mean age of the patient was 55.08 ± 8.79 and mean duration of disease 9.73 ± 7.54. The most common co-morbidity in rheumatoid arthritis patients was hypertension 20 (38.5%). Twenty four (11.7%) patients had osteoporosis. Wrist was the first joint involved in 17 (32.7%) patients. Ulnar deviation was the most common deformity in 12 (23.1%) patients. Sharp score for joint space narrowing was 61.09 ± 36.90 and sharp score joint erosions were 36.90 ± 42.41. Most common extra articular manifestation was anemia. Conclusion: Rheumatoid arthritis as a variable spectrum of disease with different manifestations. Patients had radiological damage as demonstrated by high sharp score even before starting the appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate written prescriptions according to a checklist based on WHO guidelines (prescription audit). To compare prescriptions of senior and junior physicians and to provide data and recommendations. Study Design: Cross-sectional, analytic study. Place and Duration of Study: Pak Emirates Military Hospital, and Combined Military Hospital, Rawalpindi Pakistan, from March to Aug 2018. Methodology: A total of 205 prescriptions using convenient sampling technique were analyzed according to a checklist based on WHO guidelines for standard prescription writing. Data was analyzed using SPSS-22. Results: Out of total 205 prescriptions, 83 (40%) prescriptions belong to senior and 122 (60%) to junior physicians. 50 (25%) prescriptions lacked patient name, 49 (24%) lacked age. Gender was mentioned in only 117 (57%) prescriptions. Date, diagnosis and dosage of drug were written in 170 (83%), 172 (84%) and 177 (86%) respectively while dosage form and route of administration were mentioned in 144 (70%) and 102 (50%) respectively. Generic name was written in only 75 (37%) prescriptions. Name and stamp of the doctor were available on 135 (66%) and 125 (61%) prescriptions respectively. A statistically significant association was observed between senior and junior physicians in terms of error in name of patient and dosage form (p=0.002 & 0.005 respectively). Conclusions: Prescriptions were mainly deficient in the generic names of drugs. Route of administration was missing in half of the prescriptions. None of the parameters was totally accurate. Prescriptions from junior physicians had more errors. [ABSTRACT FROM AUTHOR]

Objective: To assess the reasons of conflicts in tertiary care hospital Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Tertiary care hospital Rawalpindi, from Aug 2008 to Jul 2009. Methodology: Hospital staff comprising of health administrators, clinicians, nurses and paramedics working in tertiary care hospital Rawalpindi were included in the study. Results: These questions were asked to assess the general understanding of the respondents regarding the subject of conflicts to deduct their possible response in conflict situations. As per "Traditional" view conflict was considered as dysfunctional, destructive and irrational. The "Human relations view" describes conflict as natural, suggests tolerating it whereas the latest "inter-actionist view" defines conflict as a means for keeping us viable and creative, and suggests encouraging it. Average 44% of the respondents, mainly administrators and clinicians have fair idea regarding current concept of conflict. Conclusion: Clinical and administrative staffs of hospitals are like parts of a train track. The irrational relationship between them will result in distortion and lower quality of services. Therefore, effective strategies to decrease staffs" experience of conflict need to be developed. This might create a healthier and more productive work environment which positively affects the care quality. [ABSTRACT FROM AUTHOR]

Objective: To establish efficacy of malaria prevention programs by screening troops returning from United Nations peace-keeping services in high risk areas in Africa for malarial parasites. Study Design: Quantitative analysis. Place of Study of Study: Combined Military Hospital, Kharian, from Jan 2017 to Jan 2019. Methodology: In this cross sectional study, individuals of regiments returning to Pakistan from high risk areas in Africa were screened for malarial parasites. A total of 1632 samples were analyzed during this time frame. Informed consent was taken at the individual and institutional level. Blood samples obtained from each participant were tested by both immuno-chromatographic techniques and peripheral blood films. Results: Total 1632 individuals were screened for malarial parasites. Peripheral blood slides were negative in all individuals except one. Immuno-chromatographic techniques for detection of malarial parasites were positive in 17 individuals for Plasmodium falciparum antigen. Only one individual had both Plasmodium vivax and Plasmodium falciparum positivity via both methods. All of them were asymptomatic at the time of screening, had a past history of high grade fever treated with anti-malarial drugs and were admitted for observation and follow up. Conclusion: Despite the high prevalence of malaria in Africa, the current prevention protocols prove to be highly efficacious in protecting United Nations peace-keeping forces from infection and lowering mortality rates. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of Tranexamic acid on intraoperative blood loss. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Oct 2021. Methodology: A total of 96 patients from both genders undergoing elective open abdominal aortic aneurysm surgery under general anaesthesia enrolled in the study after random distribution to Drug and Control Groups. The primary determinant was intraoperative blood loss. Additionally, determining variables were intraoperative and postoperative blood transfusions, thromboembolic episodes, and postoperative mortality rate. Results: A total of 96 patients enrolled in the study, out of which 90(93%) were males, whereas 6(7%) were females, with a mean age of 65.37±7.01 (55-75 years). Of 96 participants, 52(54%) patients were from ASA Class II and 44(46%) were from ASA Class III. There was no significant correlation between surgical time (p-value 0.45), clamping time (p-value 0.34), and intraoperative and postoperative transfusions (p-value 0.56 and 0.28, respectively). However, a statistically significant reduction in intraoperative and postoperative blood loss was recorded (p-value <0.001). Conclusion: Tranexamic acid significantly impacts the reduction of intraoperative and postoperative bleeding in elective open abdominal aortic aneurysm surgeries under general anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of Coronary Artery Disease in patients presenting with Non ST-Elevation Acute Coronary Syndrome(NSTE-ACS) with a normal Electrocardiogram (ECG) and to assess the frequency of left circumflex artery as a culprit artery. Study Design: Analytical Cross-sectional Study. Place and Duration of Study: In Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, Pakistan, from Aug 2022 to Jan 2023. Methodology: A total of n=118 patients with NSTE-ACS, presenting within 24-hours of symptoms onset, with a normal ECG reports, were recruited using non-probability consecutive sampling. Demographics, Ejection fraction, and Coronary angiography findings were noted. Coronary Angiography was done as per standard protocol. The number of diseased vessels was recorded. Data management and analysis were done on SPSS version-26;00. Mean±SD along with frequencies and percentages were used to express quantitative and qualitative variables respectively. Chi square and Student t-test were applied and p-value <0.05 was taken as statistically significant. Results: Out of the 118 patients, 86(72.0%) were males. Mean age of the patients was 60.26±9.67 years. The coronary angiography showed Triple Vessel Coronary Artery Disease (TVCAD) in 50(42.4%) patients, double and single vessel coronary artery disease in 22(18.6%) and 43(36.4%) patients, respectively. The culprit artery was found to be Left circumflex artery in 77(65.3%), left anterior descending in 69(58.5%) and Right coronary artery in 49(39.0%) of the patients. Conclusion: Majority of the patients with normal ECG and NSTE-ACS had TVCAD and the Left Circumflex artery was the most common Culprit in such patients. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting (CABG) has long been regarded as the treatment of choice for unprotected left main coronary artery (LMCA) disease. Left main stem stenting remains a dilemma despite the latest developments in percutaneous coronary stenting. Percutaneous coronary intervention can be a safe and effective method for revascularization in this subset of patients however it has typically been reserved for poor surgical candidates. Recently some randomized data has emerged comparing unprotected left main stem stenting to CABG. We wanted to share our experience regarding left main stem stenting as Army Cardiac Centre is a high-volume Centre, has skilled operators and cardiac surgical backup. Objective: To share experience of Left main stem stenting from Army Cardiac Centre Lahore and determining that left main stem stenting is a suitable alternative to coronary artery bypass grafting in selected patients. Study Design: A observational study. Place and Duration of Study: Army Cardiac Centre Lahore during the period 1st January 2013 to 26 May 2018. Material and Methods: Fifty Six patients who underwent left main stenting at Army Cardiac Centre Lahore during the period 1st January 2013 to 26 May 2018 were included in the study. A list of variables was devised to be included in the study. All patients underwent provisional left main stem stenting. Results: Out of 56 patients 14 had ostial and midshaft disease while rest had distal left main stem disease. A provisional stenting approach was taken in all of the patients. Single stent was used in 50 patients while 6 patients went under bifurcation stenting. All patients had TIMI III flow in both Left Anterior Descending (LAD) and Left Circumflex (LCx) arteries after stenting. Conclusion: Left main stenting is a safe procedure in selected patients however technique, operator skill and cardiac surgical backup play a vital role in the success of this procedure. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of risk factors in patients undergoing coronary angiography at Army Cardiac Centre Lahore. Study Design: Descriptive cross sectional study. Place and Duration of Study: Army Cardiac Centre Lahore, from May 2018 to Jul 2018. Material and Methods: One hundred and ninety six patients were enrolled in the study through purposive convenience sampling. All the patients undergoing coronary angiography were included in the study after informed consent and the data was collected using a structured questionnaire regarding risk profile. Results: Out of 196 patients enrolled, frequencies of male and female genders were 150 (76.53%) and 46 (23.46%) respectively. The age varied from 24 years to 90 years with a mean age of 57.14 ± 10.6. Maximum number of patients i.e. 67 (34.18%) were within 60-70 years. Increased BMI (overweight) was the most common risk factor with 105 (53.57%) patients having BMI between ≥ 25 and <30kg/m². Hypertension was the second most common risk factor with frequency 74 (37.75%) and Diabetes Mellitus was the third in line having 70 (35.71%) patients. Frequencies of other risk factors were Dyslipidemia 36 (18.36%), Smokers 34 (17.34%) and Family History 1 (0.51%). Conclusion: Our findings highlighted the major contribution of modifiable risk factors in prevalence of Ischemic Heart Disease which can be controlled by adopting healthy lifestyle behaviors. [ABSTRACT FROM AUTHOR]

Objective: To determine the development of dyslipidemia in type 2 diabetics with and without periodontal diseases. Study Design: Comparative cross-sectional study. Place and Duration of Study: Fauji Foundation Hospital and Pak Emirates Military Hospital, Rawalpindi, Pakistan, from Jan 2018 to Jan 2019. Methodology: Total number of participated subjects (males and females) was 75, with age ranging from 23 to 72 years. Their tests included blood sugar, lipid profile, HbA1c and hepatitis screening. Oral health parameters were divided into two categories; type 2 diabetes mellitus with and without periodontitis. Results: Out of 75 patients, males and females were 19 (25.3%) and 56 (74.7%). Females with periodontitis 20 (74.1%) and without periodontitis 36 (75%) possessed larger numbers. Mean ages [56.33 ± 10.88 years] had a higher incline, along with significantly altered total cholesterol [5.41 ± 1.70 mmol/l], triglycerides [2.55 ± 1.46 mmol/l], low and high density lipoproteins [3.01 ± 1.22 mmol/l, 0.97 ± 0.48 mmol/l] in type 2 diabetes mellitus with periodontitis. Patients of diabetes without periodontitis showed mild derangements for triglycerides [1.88 ± 1.22 mmol/l]. Patients of diabetes with dyslipidemia and periodontitis 16 (59.3%) were documented highest in number, compared to other type 2 diabetes mellitus groups. Conclusion: There was an overall significant association between type 2 diabetes mellitus related dyslipidemia and periodontitis. Also, significant difference in age and gender of study subjects was noted that affected middle aged females more often than middle to late aged males. [ABSTRACT FROM AUTHOR]

Objective: To determine the correlation between symptoms and objective wheeze in asthmatics. Study Design: A cross sectional study. Place and Duration of Study: Medicine department, Combined Military Hospital Lahore, from Jul to Dec 2019. Methodology: Two hundred patients of asthma were selected reporting in Medicine department, CMH Lahore. Patients were interviewed regarding their primary chest symptom and it was correlated with the clinical examination for wheeze to find which particular symptom correlated most with the presence of wheeze. The 130 symptomatic cases were subjected to spirometry to assess their lung functions tests. Results: Two hundreds patients of asthma were interviewed of whom 130 patients were symptomatic. Out of 130 patients, 59 (45.3%) complained of difficulty in breathing, 40 (30.7%) complained of shortness of breath, 20 (15.3%) had wheezing, 7 (5.3%) had cough and 4 (3%) had chest pain. Eighty five (65.3%) patients when examined had wheeze. The distribution of objective wheezing in the above cases were 100% for wheezing patient, 66.1% for difficulty in breathing, 57.5% for shortness of breath 28.5% for cough and 25% for chest pain. The FEV1/FVC ratio was lowest for wheezing patients at 0.55 and highest for cough at 0.70. Conclusion: Difficulty in breathing was the commonest symptom in symptomatic asthmatics being present in 66.1% of patients. The symptom which correlated best with the presence of wheeze was wheezy chest and difficulty in breathing and was also associated with lowest FEV1/FVC ratio. [ABSTRACT FROM AUTHOR]

Objective: To assess the notion that milk can cause or aggravate asthma and break this myth. Study Design: A cross sectional study. Place and Duration of Study: Medicine department, Combined Military Hospital Lahore, from Jan 2019 to Dec 2020. Methodology: A survey was conducted whereby known asthmatics were questioned about their opinion weather milk aggravates their asthma. Those who confirmed their positive response were exposed to milk and some liquid resembling milk, and their Lung functions were tested after each drink. The 42 patients who considered milk as the primary aggravator were called for the study for spirometry Results: A total of 600 people from the general population were surveyed. Two hundred and six (34.3%) of them were illiterate, 394 (65.6%) were educated from middle to graduates. In the first milk/milk encounter, the combined dyspnea scale showed increase of 50.3% and improvement of 0.008% in FEVI/FVC. In the second substitute /milk encounter, the dyspnea score showed an increase of 61.8% and an increase of 0.90% in FEVI/FVC. In the third milk/substitute encounter the dyspnea score showed a decrease of 22.9% and the FEVI/FVC decreases by 5.5%. In the 4th substitute/substitute encounter, dyspnea scores decreased by 8.4% while the pre and postencounter FEVI/ FVC scores were 2726 and 2711 with 0.55% decrease with insignificant p-value >0.05. Conclusion: Drinking milk or milk substitute has negligible effect on the spirometric parameters. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of vitamin D3 supplementation on HbA1c in individuals with pre-diabetes Study Design: Quasi experimental study. Place and Duration of Study: Study was executed in department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi in collaboration with Chemical Pathology department, Army Medical College and Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: One hundred and forty individuals with pre-diabetes and co-existing hypovitaminosis D3 were selected, with serum 25(OH) D (<50 nmol/L) and elevated glycosylated hemoglobin (HbA1c) (5.7-6.4%). Individuals were randomly assigned to receive 2000000 IU of vitamin D3 (Vit D3; n=70) or placebo (n=70) one stat at the beginning of study and one after one month. The primary outcome was amelioration of HbA1c. Results of HbA1c and vitamin D3 were compared after completion of study with the initial values. Results: A considerable inverse association was found between vitamin D3 and HbA1c in individuals with prediabetes. Median with inter-quartile range of baseline serum 25(OH) D3 was 43 and 41 nmol/L in the Vitamin D3 and placebo group, respectively. Post treatment serum 25(OH) D3 was significantly increased to 54nmol/L (p<0.0001) in the Vitamin D3 group. HbA1c level was decreased in the vitamin D3 group. Conclusion: This study evaluated the correlation between vitamin D3 in individuals with pre-diabetes. A statistically significant improvement in Glycosylated hemoglobin (HbA1c) was observed in the patients selected in the pre-diabetic range. [ABSTRACT FROM AUTHOR]

Objective: To make an estimate of magnitude of cerebrospinal fluid rhinorrhea patients presenting in Otorhinolaryngology department of CMH Lahore and further elaboration of our experience of different techniques of endonasal endoscopic repair of cerebrospinal fluid leak. Study Design: Cross-sectional analytical study. Place and Duration of Study: Combined Military Hospital Lahore, from Jan 2017 to Dec 2017. Methodology: For this analytical study last one year’s data of cerebrospinal fluid rhinorrhea patients as well as all endoscopic surgeries was collected retrospectively from ENT department registers. Both male and female patients of all ages undergoing functional endoscopic sinus surgery were included in study to calculate the magnitude of cerebrospinal fluid rhinorrhea. Results: During the last one year, 832 ENT surgeries were performed out of which 234 (28%) were functional endoscopic sinus surgeries. Total 10 cerebrospinal fluid rhinorrhea patients presented in ENT department of CMH Lahore in the last one year and all these underwent endonasal endoscopic repair surgery in operation theatre. Out of these 3 were males and 7 females. Age range was 43 to 67 years (average age was 53.2 years). Out of 10 cases of cerebrospinal fluid rhinorrhea treated endoscopically, 4 (40%) were iatrogenic, 3 (30%) were traumatic and 3 (30%) had spontaneous cerebrospinal fluid leakage. Conclusion: Cerebrospinal fluid leakage is quite rare happening and its surgical management is also difficult to master. In our study use of facialata (alone or with septal cartilage) to endoscopically repair the leak has proved to be successful in 90% of cases. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the usefulness of residual cholesteatoma wall as a lining of mastoid cavity in achieving a dry mastoid cavity after a canal wall down (CWD) mastoidectomy. Study Design: Experimental study. Place and Duration of Study: Combined Military Hospital Lahore, from May 2015 to Oct 2016. Methodology: Both adults and children (58 cases) undergoing canal wall down mastoidectomies were included in the study. While removing the cholesteatoma, medial wall of fundus was left intact and wide opening was ensured to leave it saucer shaped. Post operatively all patients were observed to see that when their mastoid cavities become dry and asymptomatic. Results: Out of total 58 patients operated 11 were children and 47 adults. Age range was 11 to 67 years. Thirty patients were males and 28 were females. Following Canal Wall Down mastoidectomies all the mastoid cavities were managed regularly and at the end of four months 27 (47%) cavities became dry. At six months 49 (84%) became dry and one was still wet after one year of surgery. Conclusion: At 12 month follow up, 98% percent of mastoid cavities were dry and asymptomatic with our technique of leaving part of cholesteatoma wall. However longer follow-up and larger sample is required for better outcome assessment. [ABSTRACT FROM AUTHOR]

Objective: To see the effect of refractive error correction on visual acuity and to observe the various causes of blindness in visually impaired children. Study Design: Quasi experimental study. Place and Duration of study: The study was carried out at Combined Military Hospital (CMH)/CMH Institute of Medical Sciences (CIMS) Multan, from Jun 2017 to Jun 2018. Methodology: The administration authorities of Al-Noor Special education School, Multan were approached regarding establishment of free eye screening camps biannually. Parents of all the students were informed and consent was taken regarding this study. A total of 124 visually impaired children were included in the study. Children were examined by a consultant ophthalmologist and optometrist. Demographic details and related family history was noted. Visual acuity was assessed by Snellen chart and refractive error was assessed after achieving cycloplegia with 0.5% cyclopentolate eye drops. Detailed slit lamp examination of anterior and posterior segments was carried out by consultant ophthalmologist and the main cause of visual impairment was noted. Results: A total of 124 students were assessed in this study. The age of students varied from 6 to 16 years with a mean of 9.48 ± 2.92 years. Out of total 79 (63.7%) were male while 45 (36.3%) were female students. Visual acuity of all the students was worse than 6/60. Considering the cause of blindness in children, retina was the most commonly affected organ contributing 62.9% of the cases. The leading retinal pathology appeared to be Leber’s congenital Amaurosis and pigmentry retinopathies. Conclusion: Retinal disorders appeared to be the most common cause of childhood blindness in our study, however detailed community based visual screening surveys need to be carried out for more comprehensive results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the ulceroprotective effects of Verapamil on aspirin-induced gastropathy in rabbits. Study Design: Laboratory based, quasi-experimental study. Place and Duration of Study: The study was conducted at the department of Pharmacology and Therapeutics in collaboration with Clinico-Pathologic Laboratory, Army Medical College, Rawalpindi, from Apr to Jun 2016. Methodology: Eighteen rabbits were split into three groups, each consisting of six rabbits. Weight of rabbits was measured and dose was calculated accordingly. The first group was given single ulcer producing dose of aspirin 150mg/kg body weight orally, after an overnight fast. The protective group was administered oral Verapamil 08mg/kg of body weight. Rabbits were sacrificed 01 hour after ulcerogenic dose of aspirin. Stomachs were recovered for ulcer index, pH and were referred for histopathology. Statistical analysis was carried out by using Microsoft Office Excel 2013 and SPSS version 22. One-way ANOVA, followed by 'Post Hoc Tukey' test was used for biochemical parameters. Results: Significant gastropathy was seen in toxic groups, with substantial elevation in ulcer index (p=0.001) and distinctly low pH (p=0.001). Ulcer protection was moderate with verapamil groups (percentage protection calculated for Verapamil was 15.18%). Conclusion: The ulcerogenic activity of Ca2+ influx (connected to peptic acid and gastrin secretion) was found to be ameliorated by antagonistic action of verapamil. [ABSTRACT FROM AUTHOR]

Objective: To assess the gastroprotective effect of montelukast on aspirin induced gastric mucosal ulceration in rabbits. Study Design: Laboratory based quasi experimental study. Place and Duration of Study: National Institute of Health Islamabad and department of Pharmacology and Therapeutics in collaboration with Histopathology department at Army Medical College Rawalpindi from March to May 2018. Methodology: Twenty eight New Zealand white rabbits were randomly divided into four groups as follows: Group 1 was normal control group, group 2 received aspirin as a single dose of 300mg/kg orally on day 6 of the study, group 3 and 4 received omeprazole and montelukast respectively on a similar dosing schedule: where a total of 10mg/kg/day of each respective drug was administered orally for 6 consecutive days followed by a single oral dose of 300 mg/kg of aspirin after 1 hour of the last dose. All animals were sacrificed 5 hours after aspirin administration. The abdomens were dissected and the gastric tissues were excised for macroscopic, ulcer index and pH evaluation and were sent for histopathology for microscopic assessment. Results: Moderate to severe gastric mucosal damage (grade II-III) was seen in the aspirin treated toxic group, with considerable increase in ulcer index and decrease in pH (p<0.001). Montelukast significantly ameliorated the gastric mucosal ulceration as evident by substantial decrease in ulcer index (UI), increase in pH, gross and histoarchitecture findings with preventive index of 51.36% closed to the percentage protection of standard antiulcer drug omeprazole. Conclusions: Montelukast has anti-ulcerogenic gastroprotective effect on microscopic, macroscopic and biochemical level. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of various ear, nose and throat diseases in Shangla valley. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Study was carried out in shangla. Duration of study was 3 months, from Jun 2014 to Aug 2014. Material and Methods: All the patients of any age group and both genders who reported with any ENT disorder and emergency were included in this study. Frequency and percentage of various ENT diseases among patients and emergency procedures performed were found. Results: A total of 2725 patients were included. The most common ENT disorder encountered was rhinosinusitis which was seen in 14.2% cases, followed by ear wax (impacted cerumen) in 13.4% and pharyngitis in 12.5% cases. Allergic rhinitis was seen in 10.4% cases, epistaxis in 7.4% and chronic suppurative otitis media in 6.4% cases. Among the emergency ENT procedures performed, anterior nasal packing was the commonest (done in 55 cases) followed by stitching of lacerations and foreign body removal from ear and nose. Conclusion: Ear, nose and throat diseases are very common in Shangla and their spectrum range from rhinosinusitis, impacted cerumen (ear wax) and pharyngitis to less common but potentially dangerous conditions like foreign body impaction in ear and nose. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of chemical cautery with silver nitrate along with fucidin ointment versus topical vasoconstrictor spray (xylometazoline 0.05%) and fucidin ointment application in idiopathic pediatric anterior epistaxis. Study Design: Randomized controlled trial. Place and Duration of Study: Study was carried out at Combined Military Hospital (CMH) Bahawalpur from Jan 2016 to Dec 2016. Material and Methods: Total 112 patients fulfilling the inclusion criteria were selected from Ear Nose Throat (ENT) outpatient department at CMH Bahawalpur. They were randomly divided into two groups of 56 cases in each group. Group A individuals were treated by cauterization with 75% silver nitrate followed by fucidic acid ointment. Group-B individuals were treated with topical vasoconstrictor spray (xylometazoline 0.05% twice a day for one week) along with fucidic acid ointment. Efficacy was determined in terms of control of epistaxis, whether the procedure was effective in controlling epistaxis or otherwise i.e. patient again developed bleeding from same side of nose and needed further treatment to control epistaxis. All the cases were followed up for two months after procedure to check their efficacy. Results: There were total 61 (54.46%) males and 51 (45.54%) females among the cases. Mean age of patients was 8.27 (± 2.34) years. Both the groups were comparable as regards the gender (p=0.817) and age (p=0.749). Group-A were treated with silver nitrate cauterization followed by fucidic acid ointmnet application and group-B were treated by vasoconstrictor nasal spray along with fucidic acid ointment. In group A (silver nitrate cautery), 87.5% cases had no rebleed during two months follow up and in group-B, 67.8% children had no rebleed during two months follow up period (p=0.022). Conclusion: Chemical cauterization with silver nitrate along with fucidic acid ointment application was found to be more effective as compared to xylometazoline nasal spray and fucidic Acid ointment application in treating idiopathic pediatric epistaxis. [ABSTRACT FROM AUTHOR]

Objective: To highlight the significance of histopathological examination of gallbladder and to evaluate incidental gallbladder cancer in post-menopausal females. Study Design: Cross-sectional Study. Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad Pakistan, from Jan 2020 to Dec 2021. Methodology: Two thousand nine hundred fifty-nine (n=2959) gallbladder specimens with a clinical diagnosis of cholelithiasis and cholecystitis were analyzed. The clinical history of patients was taken from computer storage data. Results: Out of the total 2959 cases, on histopathological examination, chronic cholecystitis was the commonest finding (1990, 67.25%), followed by acute cholecystitis 410(13.85%) cholesterolosis (396,13.38%) and gallbladder carcinoma 42(1.42%). Out of 42 cases of gallbladder carcinoma, 34(80.95%) were female and 8(19%) were male. Most cases were post-menopausal age group 21(61.76%) compared to premenopausal 13(38.23%). Conclusion: In our study, Incidental gallbladder carcinoma in post-menopausal women was higher than expected. [ABSTRACT FROM AUTHOR]

Objective: To assess the accuracy of portal vein pulsatility (VPI) for non-invasive diagnosis of high-risk non-alcoholic fatty liver disease (NAFLD). Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Institute of Medical Science, Islamabad Pakistan, from Jan to May 2022. Methodology: Duplex Doppler ultrasound was used to examine the main portal vein in patients with a biopsy-proven Nonalcoholic fatty liver disease (NAFLD) diagnosis. Patients were evaluated by Doppler ultrasonography after fasting for four hours in accordance with standard methodology. The maximum (Vmax) and minimum (Vmin) blood velocities in the portal veins were measured using the spectral waveform. Results: Out of 240 NAFLD patients, 102(42.50%) were males, and 138(57.50 %) were females. According to the Non-alcoholic Steatohepatitis clinical research network (NASH CRN) scoring system, 95(39.58%) patients had F0 disease, 80(33.33%) had F1, 30(12.5%) patients F2, 24(10%) patients had F3 and 11(4.58%) had F4. 50(53.76%) patients in the low-risk group and 43(46.24%) patients in the high-risk group had diabetes. Of 102 males, 73(71.56%) had low risk, and 29(28.44%) had high risk. While out of 138 females, 79(57.24%) females had low risk, and 59(42.76%) females had a high risk of NAFLD. Venous pulsatility index, NAFLD fibrosis score, FIB-4, BARD score, and APRL had statistically significant differences (p<0.05). Conclusion: Venous pulsatility index is a reliable marker for detecting high-risk NAFLD. It is a readily available non-invasive investigation and can be reliably used as a screening tool for detecting NAFLD in high-risk patients, avoiding invasive investigation. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of Pitavastatin on Insulin Resistance in patients with type 2 diabetes mellitus with hypercholesterolemia who were previously being treated with Atorvastatin. Study Design: Prospective, comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital Sialkot, from Sep 2018 to Dec 2018. Methodology: Our study was a prospective, comparative cross-sectional study, formulated to evaluate the effects of statins on Insulin resistance. A total of 52 patients of Diabetes Mellitus and Hypercholesterolemia who were previously treated with Atorvastatin for at least 12 weeks were enrolled for the study carried out for 3 months. Serum lipid profiles and blood samples were obtained after overnight fast. Insulin resistance was calculated at the start of study for atorvastatin and after 3 months of shifting to Pitavastatin. Results: At initiation of the study no statistically significant differences were found in the baseline BMI, HDL-C, triglycerides or HbA1c. Homeostatic Model Assessment of Insulin Resistance (HOMA_IR) was employed to calculate Insulin resistance at the start of study and after 3 months of shifting to Pitavastatin. There was a significant reduction in Insulin resistance (p=0.031) after three months of shifting the patient from Atorvastatin to Pitavastatin. Conclusion: Pitavastatin treatment in comparison to Atorvastatin had statistically significant reduction in Insulin resistance in patients with type 2 Diabetes Mellitus. [ABSTRACT FROM AUTHOR]

Objective: To determine and compare the safety and outcomes of same day discharge patients with over-night stay patients after elective percutaneous coronary interventions with stable coronary artery disease. Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted at Army Cardiac Center, Lahore from, Jun 2017 to Jul 2018. Methodology: Hundred patients with stable CAD were recruited after their informed consent. Patients were randomized through lottery method using list of patients. Fifty patients were discharged on the same day of PCI while 50 patients stayed over-night. Inclusion Criteria was patients of either gender with age <75 years undergoing elective PCI with no acute decompensated CHF or shock, LVEF > 30%, Serum creatinine <1.5 mg/dl and no contrast allergy. While those excluded were with multi vessel disease, bifurcation disease or left main disease, saphenous vein graft or internal mammary disease, recent ACS, ≥3 stents or Femoral access. Immediate adverse cardiac and cerebral events were noted in the first 24 hours. The procedural result followed by a 6-hours observation period allowed adequate triage of patients to same-day discharge or to extended clinical observation. The one month clinical follow up was also done. Data was analyzed using SPSS 23. Confidentiality of data was maintained. Results: Mean age of the patients was 54 ± 3.8 years, 81 male patients while 19 female patients. Most common comorbidity was hypertension in 62 patients followed by diabetes in 43, dyslipidemia in 39 patients and current smokers 20 (20%). Haematoma formation [3 (6.0% vs 4 (8.0%); p=0.04], allergic reaction [5 (10.0% vs 6 (12.0%); p=0.50] and re- hospitalization for chest pain [5 (10.0% vs 2 (4.0%); p=0.50] were almost the same. No cardiac death, MI, Repeat PCI, urgent CABG, stroke, re-hospitalization for bleeding or non-cardiac death were observed in both groups. When patients were asked about their preference of discharge, 47 (47.0%) patients preferred for same day discharge, 22 (22.0%) for over-night stay while 31 (31.0%) preferred whatever their doctor considered best for them. Conclusion: Our study results yielded that same day discharge after elective PCI is a safe practice. Postprocedural outcomes are the same in same day group and over-night stay group. Same day discharge strategy is a cost effective approach and should be considered for the future. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of hypertension in our younger population according to new guidelines released by American College of Cardiology in 2017. Study Design: Descriptive cross sectional study. Place and Duration of Study: Army Cardiac Centre Lahore, from Feb 2019 to Apr 2019. Methodology: One hundred and ninety seven people were enrolled in the study as per inclusive criteria. Two blood pressure measurements were taken 5 minutes apart using proper technique as described in ACC/AHA guidelines and then average blood pressure of the recorded readings was used to calculate the results. Results: Out of 197 patients enrolled in the study, 103 (52.28%) were females and 94 (47.71%) were males. Age varied from 18 to 60 years with a mean age of 30.87 ± 5.76. Maximum number of individuals i.e. 109 (55.32%) were within 21-30 years. Out of 197, 105 (53.3%) were having normal blood pressure i.e. <120/<80 mmHG, 23 (11.67%) were having elevated systolic blood pressure i.e. 120-129/<80 mmHG, 53 (26.9%) were having blood pressure measurement in range of stage 1 hypertension i.e. systolic blood pressure between 130-139mmHg or diastolic blood pressure between 80-89 mmHG while 16 (8.12%) were having blood pressure in range of stage 2 hypertension i.e. systolic blood pressure >140mmHG or diastolic blood pressure >90 mmHG. Conclusion: Our findings highlighted the prevalence of silent hypertension in apparently normal individuals and the necessity to overcome this increasing disease burden. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and effectiveness of the dTRA from both the right and left arm. Study Design: Prospective longitudinal study. Place and Duration of Study: The study was conducted in Army Cardiac Centre, Lahore Pakistan, from Nov 2018 to Dec 2018. Methodology: Forty-five consecutive patients who were undergoing coronary angiography/angioplasty were included regardless of indication. Right dTRA was used in 22 patients and left dTRA was used in 20 patients. Procedural success was defined as ability to complete the procedure without conversion to different access site due to failure of coronary artery cannulation. Radial artery patency was checked with doppler ultrasonography both at forearm and snuff box 24 h after successful hemostasis by manual method. We monitored for bleeding and ischemic complications and failure of hemostasis while hospitalization. Results: Procedure was successful in 42 cases (93.3%), 22 (52.3%) diagnostic and 20 (47.6%) coronary intervenetional procedures, 22 (52.3%) cases from right dTRA and 20 (47.6%) cases from left dTRA. 3 (6.6%) cases were unsuccessful because of weak pulse/hypoplastic distal radial artery or vessel spasm. Manual hemostasis was applied in all cases. There were no ischemic or bleeding complications. No distal or forearm radial artery occlusion (RAO) was observed on doppler ultrasonography 24 h after successful hemostasis. Conclusion: dTRA is a safe and feasible radial arterial access which is comfortable for both operator and patient and especially left dTRA provides improved operator ergonomics. Also despite longer time to access distal radial artery and a steeper learning curve, dTRA is a reproducible procedure for coronary interventions in a radial experienced catheterization lab. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Coronary artery anomalies using coronary CT angiography. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD), from Aug 2014 to Apr 2015. Methodology: After fulfilling ethical criteria, all consecutive patients of either gender who were referred for CCTA were included. CCTA was carried out using a 64-MSCT scanner after IV injection of non-ionic contrast mediums. The scan field was extended from the proximal aorta to the cardiac apex. Retrospective ECG-gated images were obtained. Both coronary arteries were evaluated at different phases of cardiac cycle. Results: Our data shows that mean age as 51.19 ± 12.47 years, 982 (80.89%) male and 232 (19.11%) females, frequency of coronary anomalies were 89 (7.33%). Muscle bridging in mid-course and distal segment of LAD were the most common type. Conclusion: The frequency of Coronary artery anomalies is higher in patients undergoing CTCA for any indication. However, it is required that every patient undergoing CTCA should also be screened for coronary artery anomaly. Some other studies in local population are also required to validate our findings. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of cisplatin administration on oxidative stress induced hepatotoxicity in male Sprague Dawley rats. Study Design: Randomized controlled trial. Place and Duration of Study: Study was conducted at department of Physiology, Army Medical College, Rawalpindi. Duration of study was 18 months from Oct 2014 to Apr 2016. Material and Methods: The trial was performed on sixty male Sprague Dawley rats which were distributed randomly into two groups of 30 rats each. Group I received placebo whereas group II received intraperitoneal cisplatin 2mg/kg body weight two times a week for the period of 4 weeks. After successful treatment, animals were sacrificed and terminal blood sample was collected and used for estimation of serum AST, ALT, albumin and 8-isoprostane. Dissection of rats were done and liver tissue sampled. Tissue homogenate was prepared from liver sample which was used for estimation of total glutathione levels. Results: In group I, 8-isoprostane was 18.31 ± 3.35 pg/ml, total glutathione was 4.29 ± 0.42 µmol/L, ALT was 36.93 ± 4.72 IU/L, AST was 124.2 ± 12.75 IU/L and Albumin was 4.11 ± 0.26 g/dl whereas in group II, 8-isoprostane was 67.9 ± 8.14 pg/ml, total glutathione was 1.92 ± 0.28 µmol/L, ALT was 87.17 ± 6.47 IU/L, AST was 357.7 ± 19.37 IU/L and Albumin was 2.12 ± 0.25 g/dl. Levels of serum 8-isoprostane, ALT and AST were significantly raised (p<0.001) whereas serum albumin and total glutathione in liver tissue were found significantly low (p<0.001) in group II as compared to group I. Conclusion: Cisplatin treatment causes hepatotoxicity by increased production of reactive oxygen species in male Sprague Dawley rats. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of the unmet need for contraception in terms of spacing birth for a sample of married women of reproductive age (15-49 years) working in tertiary care and Identify underlying factors of unmet need for contraception in same age group. Study Design: Descriptive cross sectional study. Place and Duration of Study: Armed forces postgraduate medical institute (AFPGMI), from Apr 2018 to Jan 2019. Methodology: This study was conducted in tertiary care hospital after taking ethical approval from institutional ethical review board. With anticipated Prevalence of unmet need for contraception of 25%, 95% level of confidence and margin of error 0.05, sample size calculated for the study by using Epi info was 317 married women of reproductive age. Two class “A” Military hospitals out of total ten were selected by convenient method. From the selected hospitals, 317 women of reproductive age, sample size collected by non-probability consecutive method. The data was collected through a preformed questionnaire. Data was entered and analyzed through SPSS version 22. Frequency of women with unmet need for contraception was calculated. Mean and Standard deviations were calculated for numerical data like age. Frequencies and percentages for qualitative variables. Chi square test was applied to find out significant difference if existed. A p-value less than 0.05 were taken as significant. Results: Total 317 women were included in the study having mean age of 26.48 ± 6.25 years. The prevalence of unmet need of contraception for spacing among health care providers in tertiary care hospital was 7.2%. More than half of the respondents (55.8%) in the study had 1-2 alive male issues. Husband or in laws opposition was significantly associated with unmet need of contraception in terms of spacing childbirth (p≤0.001). Men's awareness raising techniques by reproductive health care providers are likely to improve in existing conditions. In our study the desire for male child was also significantly associated with unmet need for spacing child birth (p≤0.001). Perception of respondents regarding acceptance of spacing child birth in religion is significantly related with the unmet need for contraception in terms of spacing (p≤0.001). Conclusion: The study concluded that the factors associated with unmet of contraception were husband or in laws opposition, non-acceptance of contraceptive use in religion and desire for male child. [ABSTRACT FROM AUTHOR]

Objective: To compare single versus double band ligation in the office based management of non-prolapsed internal hemorrhoids. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient department of Surgery, CMH Rawalpindi, from Jan 2015 to Dec 2016. Material and Methods: All patients (216 patients, 108 in each group) presenting with bleeding, non-prolapsed internal hemorrhoids were included in the study after approval from hospital ethical committee. Patients with bleeding disorders and other ano-rectal conditions causing bleeding per rectum were excluded. Lignocaine gel (2%), disposable proctoscope, Barron’s ligator with grasper & black silicon bands (Germany) of 2mm diameter were used. The follow up regimen inclusive of Polycarbophil (Fibercon) sachet, Micro Purified Flavonoid Fraction (MPFF) (Daflon 500mg) and warm water sitz bath was same for both the groups of our study. Results: A total of 216 patients meeting the inclusion and exclusion criteria were selected and divided into two equal groups. In group A of double band ligation, mean age was 39.3 ± 1.7 years and mean time for fall of band was 6.6 ± 1.3 days (p=0.000). While in group B of single band ligation, mean age was 41.2 ± 2.1 years & mean time for fall of band was 7.2 ± 1.5 days (p=0.03) while the mean time of fall between the two groups was insignificant (p=0.251). Conclusion: Double band ligation for non-prolapsed bleeding hemorrhoids was found more simple, accessible, cost effective and more reliable than the single band ligation. Frequent visits of the patient can be minimized. The complications in both groups are same. It has reasonable early recovery, but equivocal recurrence [ABSTRACT FROM AUTHOR]

Objective: To find out the stability of the quality of motivation of first year dental students in the first 6 months at the dental college and to identify the key factors that influence students‟ motivation during their stay at college. Study Design: Pre-post comparative design. Place and Duration of Study: Liaquat College of Medicine and Dentistry and Dr Ishratulibad Dental College from December 2016 to May 2017. Materials and Methods: Two questionnaires for identifying motivation were sent to 130 dental students of 1st year of both colleges. The first questionnaire was administered in the first month of 1st year dental education and the second questionnaire was administered after 6 months of 1st year dental education to the same students. Results: Out of 130 dental students only 106 participated in the study. The response rate of the students was 81.5% (106/130), which included 40.5% (43/106) males and 59.4% (63/106) females. There was 40% drop in overall motivation of dental students within 6 months of their dental education. There was 46.9% and 32.1% decline in intrinsic and extrinsic motivation. Motivation of students was increased to 78.5%. Quality of teaching (79.1%), teaching methodology (68.1%) and contents (49.5%) were rated most important factors for students‟ motivation but were considered only 14.3%, 13.2% and 12.1% respectively at their dental college. Conclusion: Quality of Teachers, Teaching Methodology and Content which are rated as most important factors by students, turned out to be core reasons for their decline in motivation as per this study. [ABSTRACT FROM AUTHOR]