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Objective: To identify the relationship between injection needle threat as a mode of disciplining children and acquired dental phobia in pediatric patients. Methods: This cross-sectional study was conducted at University College of Dentistry, Lahore, Pakistan between December 2021 and November 2022. The study included individuals under the age of 18 years who were presented during the survey and scheduled for pulpotomy or pulpectomy treatment. The study assessed two primary outcomes: dental anxiety and childhood needle threat. Dental anxiety was evaluated using the Modified Children's Dental Anxiety Scale, while childhood needle threat was measured by observing the child's responses to scenarios involving needles. Results: Of total 200 pediatric patients, the mean age was 12.04 ±2.34 years. Mild dental anxiety level was observed in 56 (28.0%) patients, moderate in 122 (61.0%) patients and severe in 22 (11.0%) patients. Childhood needle threat was observed in 94 (47.0%) patients. Patients with mild dental anxiety were 0.86 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.14, 95% CI 0.04 to 0.48, p-value 0.002). Similarly, patients with moderate dental anxiety were 0.83 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.17, 95% CI 0.05 to 0.55, p-value 0.003). Conclusion: The study revealed that most children exhibited moderate dental anxiety, with a notable incidence of dental phobia. Those with higher anxiety levels felt more threatened by needles, underscoring the need to avoid using needles as a mode of discipline.

Objective: To compare the efficacy and accuracy of the Fibrosis-4 (FIB-4) index with FibroScan in assessing liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods: This cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan, from October 2023 to April 2024. All known cases of NAFLD or non-alcoholic steatohepatitis (NASH) aged ≥18 years, regardless of gender, were included. FIB-4 scores were measured using age, platelet level, aspartate transaminase (AST), and alanine transaminase (ALT). FibroScan categorized liver fibrosis into stages F0 to F4 with specific stiffness ranges: F0 (1-6 kPa), F1 (6.1-7 kPa), F2 (7.1-9 kPa), F3 (9.1-10.3 kPa), and F4 (≥10.4 kPa). Results: Of the 146 patients, the median age was 52.00 (IQR: 47.00-54.00) years. Based on FibroScan results, 61 (41.8%) patients were classified as F1, 35 (24.0%) as F2, 30 (20.5%) as F3, and 20 (13.7%) as F4. The diagnostic performance of FIB-4 showed an area under the curve of 0.83 (95% CI: 0.76-0.90). The optimal cut-off for FIB-4 was 1.28 with sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of 98.0%, 65.6%, 59.7%, 98.4%, and 76.7%, respectively. Spearman's correlation test (ρ) was applied and a significantly moderate correlation was found between FibroScan and FIB-4 (ρ = 0.50, p < 0.001). Conclusion: FIB-4 demonstrated higher accuracy and diagnostic performance in determining liver fibrosis in NAFLD patients compared to FibroScan. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate of common bile duct stones extraction on first endoscopic retrograde cholangiopancreatography (ERCP) attempt among patients with suspected choledocholithiasis. Methods: This retrospective study was performed from January 2012 till December 2015. All patients diagnosed with choledocholithiasis on the basis of sonographic or other radiological evidence of Common Bile Duct stones or patients who had cholestatic liver functions on the background of gallstones were included. Data were retrieved from the endoscopic database. Results: Out of 612 patients with suspected choledocholithiasis, stones were found on ERCP in 592 patients (96.75%). During the first attempt at ERCP, 480 patients out of 592 had complete duct clearance (81.08%). The percentage of stones cleared via balloon was 434 (90.42%) and via basket was 46 (9.58%). The plastic stent was placed in remaining 112 patients (18.30%) that were kept on the list for follow up ERCP. A total of 44 patients out of 592 underwent sphincteroplasty (7.4%), in which 32 patients had complete duct clearance (72.72%), whereas 12 patients have stent placement (27.27%). Complete duct clearance on first ERCP attempt was found significantly associated with age (p-value 0.011) and stone diameter (p-value

Background: Infection with hepatitis C virus is reported to have infected almost 71 million people worldwide. This study was done to assess the frequency and associated factors leading to oesophageal varices in patients presenting with hepatitis C related liver cirrhosis. Methods: A cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan from 9th May to 5th October 2019. Patients of either gender having age >20 years presenting with HCV related liver cirrhosis, and Child Pugh class A, B and C were consecutively enrolled in the study. Data on variables like: age, gender, Childs Pugh Score (A/B/C), smoking status, laboratory characteristics like hemoglobulin (Hb), TLC, platelets, serum albumin level, cholesterol, alkaline phosphate (ALK), alkaline transaminase (ALT), ascites and presence of oesophageal varices was recorded and analysed using SPSS-21.0. Results: Out of 167 patients, mean age was 44.86±14.74 years. Eight-nine (53.3%) of the patients were males. The mean duration of cirrhosis was 5.78±1.10 months. Thrombocytopenia was observed in majority (n=130, 77.8%) of the patients. There were 33 (19.8%) patients with Child Pugh score A while Child-Pugh score B and C was found in 67 (40.1%) each. The frequency of oesophageal varices was 141 (84.4%). A significantly higher proportion of oesophageal varices were found among thrombocytopenic patients (p<0.001), ascites (p-0.024), and having “C” Child-Pugh score (p-0.012). Conclusion: Oesophageal varices were found in a considerable proportion. Thrombocytopenia, ascites and Child-Pugh class C were found as leading contributing factors to oesophageal varices [ABSTRACT FROM AUTHOR]

Background: Pleural effusion is a common diagnostic problem. Successful treatment of these cases depends upon establishing the exact etiology. The objective of this study was to determine the frequency of clinical features and frequency of various diseases in patients presenting with pleural effusion. Material & Methods: It was a cross sectional study carried out at the Department of Medicine, Civil Hospital Karachi, from to July 2011 to March 2012. Inclusion criteria were all patients above 15 years of age with clinical and radiological evidence of pleural effusion. Patients with history of chest injury or surgical procedures involving pleural cavity were excluded. The demographic variables were gender, age in years and age group. The research variables were breathlessness, fever, cough, chest pain, dependent edema, weight loss, haemoptysis and confusion and cause of pleural effusion. There were four age groups as: 16-30 years, 31-45 years, 46-60 years and more than 60 years. Nominal data was analyzed for frequency and (%) and the numeric data was analyzes by mean, SD and range. Results: Tuberculosis was the most common cause 40(53.33%) of exudative pleural effusions, followed by parapneumonic/empyema 13(17.33%) and malignant effusions 9(12%). Congestive cardiac failure 9(36%) and liver cirrhosis 6(24%) were the commonest causes of transudative pleural effusions. Nephrotic syndrome 4(16%), renal failure 3(12%), systemic lupus erythmatosus 1(1.33%) were other causes of pleural effusion in this study. Conclusion: Due to high incidence of infectious causes, especially tuberculosis, pleural fluid examination should be a routine evaluation in each case of pleural effusion.

Objective: To study the frequency of resistant hypertension in chronic kidney disease patients in our population and to analyse associated risk factors contributing to this problem. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Multan Pakistan from Jun to Dec 2022. Methodology: The study included all patients older than 19 who were already diagnosed with hypertension and CKD and were visiting for the usual routine check-up in the Medical/Nephrology OPD. Results: A total of 325 patients suffering from CKD were included in the study, including 226(69.5%) males and 99(30.5%) females. The mean age of study participants was 56.54±7.15 years. Mean systolic blood pressure was 140.9±19.5 mmHg, whereas mean diastolic blood pressure was 85.12±9.1 mmHg. The average BMI of the participants was measured to be 24.96±4.2 m2/kg. The average/mean eGFR of the case-study participants was calculated to be 47.80±11.6 ml/min. Out of the 325 patients, 141(43.4%) were suffering from resistant hypertension. Conclusion: The frequency of resistant hypertension in CKD patients who have a positive genealogy of hypertension and associated risk factors of diabetes mellitus and hyperlipidaemia is considerable. Worsening of CKD also increases the proportion of treatment-resistant hypertension in hypertensive patients. [ABSTRACT FROM AUTHOR]

Objective: To study clinical symptoms and chest X-ray findings for evaluation of chest X-ray in management of confirmed cases of COVID-19 and predicting the clinical outcome. Study Design: Cross sectional study. Place and Duration of Study: The departments of Radiology & Medicine of Combined Military Hospital Malir, from Mar to May 2020. Methodology: The sample used in this study consists of 73 patients. All the standard frontal projections of chest X-ray of PCR confirmed COVID-19 patients were studied on computer and findings were noted Results: At the aggregate, the study indicates that there is no Significant Connection in between the clinical symptoms, their severity and chest X-ray findings. Conclusion: There is no significant connection found between the severity of clinical symptoms and chest X-rays suggesting that chest X-Ray cannot be a reliable indicator to predict the clinical outcome of the patient and has limited role in management of patient. Clinical assessment is still the main stay of the patient management. [ABSTRACT FROM AUTHOR]

Objective: To determine various factors associated with poor dialysis compliance as evident by early signoff and no shows. Study Design: Descriptive study. Place and Duration of Study: Nephrology department at Pak Emirates Military Hospital Rawalpindi, from Feb 2012 to Jan 2013. Material and Methods: A standardized proforma was formulated which was to be filled by dialysis staff each time a patient refused dialysis, absented "No show" or had premature termination of dialysis session against the medical advice, "early sign off" due to any cause. This data was compiled centrally on monthly basis and patients were counseled by doctors to evaluate the cause and various factors for early sign off and no shows. Using Non probability convenience sampling 364 dialysis sessions were included in our study. Data was analysed using SPSS version 20 and frequencies were calculated for various factors associated with early termination or absence altogether from dialysis. Results: A total of 11232 dialysis sessions were followed during study period. Amongst total of 364, 320 (88%) dialysis were terminated prematurely (Early sign off) while 44 (12%) dialysis sessions were missed out completely (no shows). Febrile reaction was most frequent factor causing early sign off n=97 (27%). Cramps were second most common factor for early sign offs n=70 (19%). Other factors like Symptomatic arrhythmias, nonspecific body aches, AV access site pain and socio economic issues also had contributions but less than 10% each. Conclusion: Poor hemodialysis compliance indicated by early sign offs and no show is fairly common problem in our community. Febrile reactions, cramps, poor education and hemodynamic instability are major contributory factors. These issues need to be addressed urgently to save a large population from life threatening complications and poor dialysis compliance. Identifying these complications and addressing them can ensure better compliance and likely will contribute to long term survival benefit. [ABSTRACT FROM AUTHOR]

Objective: To document quality of life in haemodialysis patients and to determine predictive factors. Study Design: Cross sectional study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi, from Oct to Nov 2016. Material and Methods: Patients undergoing maintenance haemodialysis were selected by convenience sampling. Patients with acute kidney injury, those on infrequent HD, those on dialysis for less than three months and unwilling patients were excluded. Kidney Disease Quality of Life Short Form Version 1.3 was administered in direct face-to-face interviews. The effects of age, gender, level of education, duration on haemodialysis, smoking, marital status, frequency of dialysis per week, body mass index, presence of comorbid conditions, residence, availability of attendant, type of vascular access and household income on quality of life indices was studied. Results: There were a total of 109 patients, having a mean age of 50.22 ± 13.73 years. Out of these, 86 (78.90%) were males. Mean physical composite score, mental composite score and kidney disease component summary score were 33.41 ± 6.85, 46.10 ± 5.89 and 65.00 ± 6.11 respectively. Adequate physical composite score, mental composite score and kidney disease component summary score were attained by 8.26%, 22.94% and 49.54% patients respectively. A higher level of education predicted a higher mental composite score and a younger age predicted a better kidney disease component summary score. None of the factors studied could predict higher physical composite score. Conclusion: Haemodialysis patients had a poor quality of life. Older age and a lower level of education were best predictive factors in our patients. [ABSTRACT FROM AUTHOR]

Though risk of venous thromboembolism in increased at high altitude, involvement of renal veins is rare. A 27-year-old soldier was evacuated from a height of 18000 feet after developing flank pain and haematuria. Ultrasound showed an enlarged left kidney and lack of flow in proximal renal vein. CT scan confirmed the presence of renal vein thrombus. Serum IgM Anti β-2 Glycoprotein I antibodies, IgG Anti β-2 Glycoprotein I antibodies and IgM anticardiolipin antibodies were detectable and the former two were present after three months also. Secondary causes of antiphospholipid syndrome were excluded. He was started on low molecular weight heparin and is now on lifelong oral anticoagulation with warfarin. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate of common bile duct stones extraction on first endoscopic retrograde cholangiopancreatography (ERCP) attempt among patients with suspected choledocholithiasis. Methods: This retrospective study was performed from January 2012 till December 2015. All patients diagnosed with choledocholithiasis on the basis of sonographic or other radiological evidence of Common Bile Duct stones or patients who had cholestatic liver functions on the background of gallstones were included. Data were retrieved from the endoscopic database. Results: Out of 612 patients with suspected choledocholithiasis, stones were found on ERCP in 592 patients (96.75%). During the first attempt at ERCP, 480 patients out of 592 had complete duct clearance (81.08%). The percentage of stones cleared via balloon was 434 (90.42%) and via basket was 46 (9.58%). The plastic stent was placed in remaining 112 patients (18.30%) that were kept on the list for follow up ERCP. A total of 44 patients out of 592 underwent sphincteroplasty (7.4%), in which 32 patients had complete duct clearance (72.72%), whereas 12 patients have stent placement (27.27%).Complete duct clearance on first ERCP attempt was found significantly associated with age (p-value 0.011) and stone diameter (p-value <0.001). Conclusion: In our experience, at first ERCP attempt, the stone extraction rate is around 81.08%. This relates to the expertise in doing ERCP. The size and shape of stone and size of Bile duct are the predominant reason behind the failure of stone extraction on first ERCP attempt. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of chronic kidney disease and its associated risk factors in patients with type 2 Diabetes Mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Malir Cantt, Karachi, from Jan to Jun 2019. Methodology: A total of 203 adult patients with Type 2 Diabetes Mellitus were included in the study after taking informed consent on the justification of inclusion/exclusion criteria. The estimated Glomerular filtration rate was calculated for each patient using Creatinine based chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Chronic kidney disease was defined as decreased glomerular filtration rate of <60 mL/min per 1.73m2. In addition, risk factors for developing chronic kidney disease, including Body Mass Index and blood pressure, were clinically determined. Results: Out of 203 patients with type 2 diabetes mellitus, 65(32%) had Chronic kidney disease. Most of them, 34(52.30%), were in Chronic kidney disease stage 3, while 21(32.30%) were in stages 4 and 10(15.40%) were having stage 5. Increasing age, smoking, female gender and higher body mass index were positively correlated with the development of chronic kidney disease in diabetes patients. Conclusion: Chronic kidney disease is a frequently observed complication in diabetes patients. Early detection and appropriate treatment can help in retarding progression to advanced stages of chronic kidney disease. Regular screening of diabetes patients for chronic kidney disease and associated risk factors is therefore recommended. [ABSTRACT FROM AUTHOR]

Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Nephrology Military Hospital (MH) Rawalpindi, from Jan 2016 till Mar 2016. Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19. Results: Out of the 150 enrolled patients, males were 125 (83.33%) and females were 25 (16.67%). A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 (12.62%) dialysis sessions, followed by hypertension in 208 (8.25%) and fever in 193 (7.66%) sessions. Other complications were muscle cramps in 116 (4.60%), shivering in 94 (3.73%), headache in 70 (2.78%), nausea/ vomiting 60 (2.38%), itching 41 (1.62%), chest pain 37 (1.47%), hypoglycaemia 31 (1.23%), seizures 23 (0.91%) and arrhythmias in 13 (0.52%) dialysis sessions. Conclusion: Haemodialysis, one of the renal replacement therapies, is a life-saving treatment modality but it is not without complications despite the advances in technology. However frequency with which they occur is low and majority are not life threatening. [ABSTRACT FROM AUTHOR]