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Background: Spine tuberculosis is common in Pakistan and this needs expert treatment to decrease morbidity. The objective of this study was to compare Modified Kalafong (MKF) and Modified Hong Kong (MHK) operations for spinal TB patients regarding neurological recovery and deformity correction. Material and Methods: This cross sectional study was conducted at Combined Military Hospital (CMH), Rawalpindi, Pakistan, on data from February 2012 to November 2020. According to the selection criteria and availability of data, 70 patients out of 90 consecutive patients handled surgically by MKF or MHK Operations were chosen for this research. Frankel grade system, Cobb’s technique and Bridwell’s criteria were used for assessment of results. Results: There were thirty-one cases of MHK and thirty-nine cases of MKF patients. Age, Neurological recovery, and Numbers of Vertebrae involved with TB were comparable across the two groups. In the MHK, the mean operating time was 6.12 hours, whereas in the MKF, it was 5.37 hours. When compared to the MKF, where the mean blood loss was 0.921 L, the MHK had a greater mean blood loss of 1.139 L. Deformity correction with MHK was 79.467 % against 58.40% via MKF, which was statistically significant (P 0.001). The MHK group had a much shorter mean time to fusion (4.56 months) than the MKF group (6.74 months), which is significant (P 0.05) statistically. Conclusion: Our study revealed significant differences between MHK and MKF spinal tuberculosis surgeries in terms of fusion time, blood loss and deformity correction. [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 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 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 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 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]

Objectives  This study aims to determine microbial patterns and antibiotic susceptibility to alert clinicians to the emerging pathogens that may pose a threat to the community, especially children. Materials and Methods  This retrospective cross-sectional study was conducted in the Department of Pathology, Holy Family Hospital, Rawalpindi, Pakistan, from July 2019 to December 2019. Two samples were taken from two different sites of each patient at the time of fever (> 100° F) to avoid chances of contamination. A blood sample of 5 to 10 mL was drawn from each site. In a 50 mL brain heart infusion broth (BHIB), 5 to 10% blood was injected in two different bottles and incubated for 48 hours at 37°C. After 48 hours, subculture was done by streaking the drops of blood samples taken from BHIB on blood and MacConkey agar. Cultures were incubated in aerobic conditions at 37°C for 24 to 48 hours. For testing antibiotic susceptibility, criteria defined by the Clinical and Laboratory Standards Institute (CLSI) were followed. Microbes were identified under a microscope by observing their morphological characteristics after gram staining and applying biochemical tests. Antibiotic sensitivity test was performed using standard aseptic methods. Statistical Analysis  Bacterial isolates and their susceptibility patterns were represented using frequencies and percentage charts. Results  Out of 423 blood cultures, growth was recorded in 92 (21.75%) of the cultures with female to male ratio 2.1:1. The gram-positive bacteria accounted for 43.48% (n = 40), whereas gram-negative bacteria covered the majority 54.36% (n = 50). Among isolates, Staphylococcus aureus (42.39%) was the most common, followed by Acinetobacter spp. (17.39%) and Pseudomonas aeruginosa (14.13%). Acinetobacter spp. showed 0% susceptibility to amikacin and cefotaxime. All the isolates were 100% resistant to amoxicillin-clavulanic acid. S. aureus showed lower sensitivity for ceftazidime (0%), clindamycin (66.67%), ciprofloxacin (0%), clarithromycin (11.76%), and ceftriaxone (0%). Tigecycline showed 100% sensitivity for all isolates tested. Conclusion  Gram-negative bacteria form the majority of isolates in our setup, with Acinetobacter as the most common species among them. The resistance against cephalosporins, penicillin, and fluoroquinolones shown by Acinetobacter , Pseudomonas , Salmonella, and Klebsiella is of grave concern. Among gram-positive bacteria, S. aureus has established resistance against multiple drugs. Limited and objective use of antibiotic therapy is a much-needed strategy under new guidelines. [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 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 determine the prevalence of depression amongst the transgender community and assess the relationship of socio-demographic features with depression. Study design: Cross-sectional study. Place and Study duration: Rawalpindi/Islamabad, Pakistan. Oct to Dec 2016 Materials and Methods: The studied population accounted for one hundred and forty-two transgender persons. The psychometric assessment was done with Beck depressive inventory II (BDI-II) to evaluate depressive symptoms. The sample was categorized as having no, mild, moderate, and severe depressive symptoms. The presence of depressive symptoms was also studied for its relationship with the age of the persons, smoking habits, financial status, illicit substances use, and educational history in the transgender community of Islamabad/Rawalpindi, Pakistan. Results: Among the 142 studied participants mean age was found 39.55 ± 6.18. Among them 45.1% didn't have symptomatology suggestive of Depression, However, 31.7% had mild symptoms, 12.7% had moderate and 10.6% were having severe symptoms suggestive of depression. Using Binary logistic regression, it was concluded that the presence of symptoms suggesting depression was having a significant association with the use of illicit substances. Conclusion: The study revealed a high prevalence of depressive symptoms in the transgender of Rawalpindi/Islamabad. The use of Illicit substances like tobacco, cannabis, opiates, and alcohol should be prohibited and those using these should be routinely screened for the presence of other mental health issues to timely diagnose and treat them. [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 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 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 explore whether the performance of a 2nd year MBBS student in subject of physiology by continuous assessment method as determined by internal assessment correlates to the final summative evaluation in 2nd professional examination. Study Design: Cross sectional analytical study. Place and Duration of Study: Army Medical College, Rawalpindi, from Jan to May 2017. Material and Methods: Data pertaining to the result of 2nd Professional MBBS examination and internal assessment in the subject of Physiology of the whole 2nd year MBBS class was used making a total sample size of 173. Sample size was calculated using the software G Power version 3.1.9.2. Data were analyzed using SPSS version 23. Mean and standard deviation were calculated for numerical variables. Correlation between marks of 2nd Professional examination and internal assessment was calculated using Pearson Correlation. Association between internal assessment and the result of 2nd Professional examination was computed using Chi Square test and Odds ratio. Alpha value was kept at 0.05. Results: There were 101 (52.4%) male and 72 (41.6%) female students out of total 173 with a mean age of 20.01 ± 0.69 years. Total marks of 2nd professional examination and internal assessment were normally distributed with mean values of 126.43 ± 17.56 and 36.79 ± 5.9 respectively. Results of the present study reflect significant correlation of 2nd year MBBS professional result with the internal assessment. Conclusion: A definitive correlation is found between the internal assessment performance and the summative final profession result in 2nd year MBBS students. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effect of use of VERION image guided system on surgically induced astigmatism (SIA) in patients undergoing cataract surgery Study Design: Randomized controlled trial. Place and Duration of Study: The study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Aug 2016 to Dec 2016. Material and Methods: Sixty eyes undergoing cataract surgery with already existing corneal astigmatism of at least 0.5 diopter (D) were included in the study. Cases with already existing ocular pathology or any per operative complication were excluded. Non-probability (purposive) sampling technique was used. Patients were randomly grouped into two groups 1 and 2. Group-1 underwent normal conventional phacoemulsification with no specific predetermined incision site. Group-2 underwent keratometric assessment using VERION image guided system and data was transferred to operating microscope. Steep and flat meridian were displayed on screen and incision were made on steep axis. Pre and 2 week post op keratometric readings were noted on a workup performa for both the groups and compared. All the surgeries were done by the same surgeon. Statistical program for social sciences (SPSS) version 23.0 was used for statistical analysis. Results: Sixty eyes (29 male, 31 female) with mean age of 57.65 ± 7.41 years were studied. Group-1 included 30 eyes with mean age of 56.73 ± 9.16 years. Group-2 also included 30 eyes with mean age of 58.56 ± 5.10 years. Mean pre op astigmatism was 0.93 ± 0.45D and 0.88 ± 0.47 D in group 1 and 2 respectively. Mean post op astigmatism was 0.95 ± 0.43 and 0.50 ± 0.39 in group 1 and 2 respectively Mean SIA in group-1 was 0.54 ± 0.43. Diopters while that in group 2 was 0.55 ± 0.36 diopters. Mean residual astigmatism -0.016 ± 0.43 and 0.37 ± 0.24 D in groups 1 and 2 respectively showing a 42% reduction in astigmatism in group 2 as compared with 1.7% increase in group 1. Conclusion: There is no significant difference between the SIA between two groups however there was a significantly less residual astigmatism in VERION group (group 2). Verion assisted incision along the steep axis is helpful in achieving a better refractive outcome in patients undergoing cataract surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of general anaesthesia versus combined epidural and general anaesthesia on postoperative complications in elective abdominal aortic aneurysm surgeries. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Sep 2020. Methodology: A total of 100 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 in equal proportions. The primary determinants were postoperative complications. Additionally, it determined the impact on postoperative mortality rate. Results: Of 100 participants, 54% of patients were from ASA status II, and 46% were from ASA status III. Among postoperative complications, bowel ischemia was recorded in 16% and 2% among Group-A and Group-B, respectively (pvalue 0.01). Postoperative dialysis was required in 18% of patients in Group-A, whereas among Group-B, only 4%went through it (p-value 0.02). Pulmonary complications variation was not statistically different between the two groups, with 54% and 46% (p-value 0.42) frequencies in Group-A and Group-B, respectively. However, surgical reintervention within 30 days was notable, 36% in Group-A and 14% in Group-B (p-value 0.01). Conclusion: Combined general and epidural anaesthesia, when compared with general anaesthesia alone, significantly impacts the reduction of postoperative complications after elective open abdominal aortic aneurysm surgeries without increasing morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the frequency of myocarditis in patients recovered from COVID-19 infection. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Cardiac Magnetic Resonance Imaging Department, Armed Forces Institute of Cardiology/ National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from Jul 2020 till Apr 2022. Methodology: All patients who underwent Cardiac Magnetic Resonance Imaging after recovery from COVID-19 were enrolled. Non-probability consecutive sampling technique was used for sample selection and was calculated on the basis of G-power. Data of patients fulfilling the inclusion criteria was selected. All PCR positive cases of COVID-19 who recovered from COVID-19 and completed their 12 days of isolation not exceeding 60 days of 1st Polymerase chain reaction positive, and who have any symptoms of shortness of breath, fatigue and chest pain with reduced left ventricular ejection fraction (LVEF) on 2D-echocardiogram were included in the study. Data was recorded, stored, and analyzed by using SPSS version-21. Quantitative data was reported as Mean±SD. Categorical variables were reported as frequency and percentage. To determine the association between different variables Chi square test was used. Results: A total 83 patients were included in this study who recovered from COVID-19 and underwent Cardiovascular magnetic resonance. Mean age of the patients was 39.17±12.9 years. 67(80.72%) were male while 16(19.28%) were females. 50(60%) had myocarditis after recovery from COVID-19. This study showed statistically significant association of all the Cardiovascular magnetic resonance imaging findings with Myocarditis (p<0.05) at 95% confidence interval and 5% margin of error. Conclusion: Early detection of COVID-19 related myocarditis will help in better management of patient. In such patients, cardiac Magnetic Resonance Imaging is the modality of choice, since it allows for noninvasive assessment of myocardial edema and fibrosis, as well as therapeutic guidance and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To find out association of speciality and working hours with compassion fatigue. Study Design: Cross sectional comparative study. Place and Duration of Study: Military Hospital and Combined Military Hospital Rawalpindi, Combined Military Hospital Sialkot, from December 2013 to July 2014. Material and Methods: Fifty four doctors from departments of Medicine, Surgery, Anesthesia and Gynaecology participated in the study. Other health care related personnel, not directly related to patient care, were excluded from the study. The data collection tool was a questionnaire "Professional Quality of Life Measure version 5". Data was analysed by SPSS version 22. Chi Square test for goodness of fit was used to determine difference in the frequency distribution of various categories of a single variable whereas Chi square test for independence was used to find association between two categorical variables. The p-value was kept at < 0.05 for significance. Results: Results showed 11 females and 43 males with mean age of 37.69 ± 9.72 years. Cronbach's alpha was 0.81. Eleven participants (20.4%) showed low compassion fatigue, 37 (68.5%) showed average whereas only 6 participants (11.1%) showed high compassion fatigue scores and the difference was significant (p-value < 0.001). Working hours were associated with compassion fatigue (p-value = 0.03) but speciality was not (p-value = 0.41). Conclusion: Chances of suffering from compassion fatigue are significantly higher if working hours are 12 or more, however the disorder is not associated with speciality. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the correlation between baseline C-reactive protein (Hs-CRP) levels and severity of coronary artery disease (CAD), measured in terms of Syntax Score (SScore), among patients presenting with acute coronary syndromes (ACS). Methodology: This cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from April 2022 to October 2022. Baseline Hs-CRP levels were obtained for all the patients. Patients were divided into three groups as per the SScore as low (= 22), intermediate (= 23), and high (= 33) burden of CAD. Results: Out of the 200 patients studied, 82.5% (165) were males, and mean age was 60.16±10.66 years. Diabetics were 50% (100) of the sample, 48.5% (97) were hypertensive, and smokers were 17.5% (35). Median Hs-CRP was 4.0 mg/L [2.0-12.5 mg/L], and median left ventricular ejection fraction (LVEF) was 45% [40-55%]. Median SScore was 23.5 [14.5-30.0], with 44.5% (89) categorized as low, 36.5% (73) as intermediate, and 19% (38) as high burden of CAD. The correlation between Hs-CRP and SScore was 0.236 (p=0.001) and -0.229 (p=0.001) with LVEF. A significant increase in Hs-CRP was observed in relation to the burden of CAD (p<0.001) with median of 2.0 mg/L [1.0-4.2 mg/L], 6.0 mg/L [3.1-15.7 mg/L], and 12.5 mg/L [5.8-20.7 mg/L] for low, intermediate, high burden of CAD, respectively. Conclusion: Admission Hs-CRP was found to be positively correlated with the burden of CAD and negatively correlated with LVEF in patients with ACS. [ABSTRACT FROM AUTHOR]

The article focuses on the survey on archaeological sites and historic monuments in the district of Rawalpindi and Islamabad, Pakistan. It notes that the two regions played a vital role in the human history. It presents the objectives of the survey which include the recovery of archaeological material and art specimens, publication of the survey results, and choose sites for potential future archaeological excavations. Moreover, it details the archaeological sites and historic monuments in Tehsil Kallar Sayedan, Tehsil Gujar Khan, and Rawalpindi.

Objective: To compare the respiratory complications of COVID-19 among patients with rheumatological conditions taking bDMARDs and csDMARDs at Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative prospective study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Mar to May 2020. Methodology: Patients diagnosed with COVID-19 on polymerase chain reaction having previously rheumatological conditions managed either with bDMARD or cs DMARD were included in the study. They were followed up for three weeks after the positive polymerase chain reaction. Complications leading to the use of oxygen or ICU support or death were compared in both groups of patients. Results: A total of 82 patients with any rheumatological condition managed either with bDMARD or csDMARD tested positive for covid-19 on polymerase chain reaction and were included in the final analysis. 30 (36.6%) patients were taking bDMARDs while 52 (63.4%) were taking csDMARD. In addition, 4 (4.8%) low dose oxygen therapy, 5 (6.1%) required moderate dose oxygen therapy, while 5 (6.1%) required severe dose oxygen therapy or intensive care unit support. 2 (2.4%) patients died within the three weeks. The requirement of moderate or severe dose oxygen and intensive care unit support was found statistically significantly more in the group taking csDMARDS. Conclusion: The presence of complications of COVID -19 and the requirement of oxygen and intensive care unit support were present in some of the patients taking DMARDs. Among the DMARDs, bDMARDs were less linked with complications, but large studies with better design required better results. [ABSTRACT FROM AUTHOR]

Bovine ephemeral fever (BEF) is a vector-borne viral disease caused by the RNA virus which belongs to the genus Ephemerovirus and the family Rhabdoviridae. To evaluate the effect of the risk factors like the breed of cattle and buffaloes, age, sex, lactation, housing and region on the bovine ephemeral fever virus (BEFV) prevalence, ELISA and virus neutralisation (VN) tests (n = 600) were performed for the BEFV prevalence. The seroprevalence in cattle was 45.6% and 42% by ELISA and VN, respectively (P = 0.001). The breed-wise seropositive ratio was (55-64%) in cattle and (22.5-18.3%) in buffaloes by VN and ELISA. The sex-wise prevalence was (40-49.4%) in females and (35.8-46%) in males by VN and ELISA in cattle and a similar prevalence was reported in buffaloes. The age-wise prevalence in bovines by ELISA was 5.33, 22.66 and 17.66% in the age group < 1 year, 1-3 years and > 3 years, respectively. The disease prevalence was higher in the age group of 1-3 years. The prevalence was higher during the 3rd lactation in bovines. The region-wise prevalence was higher in the 07 districts while lower (18-21%) in Rawalpindi District by VN and ELISA, respectively (P = 0.001). Commercial dairy farms of cattle showed a higher disease prevalence (52% and 44%) than non-commercial farms (38% and 36%) by ELISA and VN, respectively (P = 0.227). Exotic cows showed higher disease prevalence (76.67% and 70%) by ELISA and VN. The mortality in bovines was 5% (7.7% and 2.3%) in the cattle and buffaloes. The case fatality of BEFV in bovines was 12.25%. There was a significant effect of the risk factors like the breed, age, sex, lactation, housing and region on the BEFV prevalence. This is the first comprehensive study of BEFV in Pakistan. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons are among persistent organic pollutants and incomplete combustion of hydrocarbons during petroleum processing activities may cause polycyclic aromatic hydrocarbons contamination in the surrounding area. For the first time in Morgah, Rawalpindi, Pakistan, three targeted polycyclic aromatic hydrocarbons i.e. naphthalene, phenanthrene, and pyrene were estimated from surroundings of an oil refinery. Samples were collected simultaneously in soil, water, and leaves of Melia azedarach L., a widely grown tree species in the sampling area, along different selected sites of main drainage coming out of the refinery. Among three polycyclic aromatic hydrocarbons, pyrene was observed in maximum concentration (24.31 mg/kg in soil) among all selected environmental media and studied compounds showed a dynamic behavior in context of accumulation at different sampling points. There was a significant effect of distance, from petroleum refining area on polycyclic aromatic hydrocarbons levels in soil, water and plant leaves. Our findings provide conclusive evidence that location of an oil refinery has attributed to high polycyclic aromatic hydrocarbons contamination in selected study area which can pose significant risk to general environment and to the public. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019. Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (8) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis. Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of <0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of <0.001. Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology. [ABSTRACT FROM AUTHOR]

Dengue has become endemic in Pakistan with annual recurrence. A sudden increase in the dengue cases was reported from Rawalpindi in 2016, while an outbreak occurred for the first time in Peshawar in 2017. Therefore, a multi-center study was carried out to determine the circulating dengue virus (DENV) serotypes and Chikungunya virus (CHIKV) co-infection in Lahore, Rawalpindi, and Peshawar cities in 2016–18. A hospital-based cross-sectional study was carried out in Lahore and Rawalpindi in 2016–18, while a community-based study was carried out in Peshawar in 2017. The study participants were tested for dengue NS1 antigen using an immunochromatographic device while anti-dengue IgM/IgG antibodies were detected by indirect ELISA. All NS1 positive samples were used for DENV serotyping using multiplex real-time PCR assay. Additionally, dengue samples were tested for CHIKV co-infection using IgM/IgG ELISA. A total of 6291 samples were collected among which 8.11% were NS1 positive while 2.5% were PCR positive. DENV-2 was the most common serotype (75.5%) detected, followed by DENV-1 in 16.1%, DENV-3 in 3.9% and DENV-4 in 0.7% while DENV-1 and DENV-4 concurrent infections were detected in 3.9% samples. DENV-1 was the predominant serotype (62.5%) detected from Lahore and Rawalpindi, while DENV-2 was the only serotype detected from Peshawar. Comorbidities resulted in a significant increase (p-value<0.001) in the duration of hospital stay of the patients. Type 2 diabetes mellitus substantially (p-value = 0.004) contributed to the severity of the disease. Among a total of 590 dengue positive samples, 11.8% were also positive for CHIKV co-infection. Co-circulation of multiple DENV serotypes and CHIKV infection in Pakistan is a worrisome situation demanding the urgent attention of the public health experts to strengthen vector surveillance. Author summary: Mosquitoes are responsible for the transmission of many different types of infectious pathogens and parasites to humans. Some of these pathogens include viruses like dengue and chikungunya viruses which cause diseases in humans. Dengue virus has four different types (1, 2, 3, and 4) present in nature. In this study, we detected all four dengue virus types in hospitalized patients in Lahore and Rawalpindi. While only dengue virus type-2 was detected from Peshawar city. The secondary infections with different dengue virus types than the previous one might result in a more severe form of the disease. Therefore, the population of Peshawar is at risk of developing a severe form of dengue fever in the future in case of infection from another dengue virus type. The data of hospitalized patients showed that other diseases in addition to dengue fever result in an increased hospital stay. Comorbidities like diabetes also increase the risk of developing a more severe form of dengue fever. Combined infections of both dengue and chikungunya viruses were detected from Lahore, Rawalpindi, and Peshawar. The transmission of dengue and chikungunya viruses and the co-circulation of multiple dengue virus types not only impose public health burden but also result in economic losses. [ABSTRACT FROM AUTHOR]

Objective: To compare the early morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG) with and without coronary endarterectomy CE) in our hospital settings. Study Design: Comparative prospective study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi Pakistan, from Jan 2019 to Jan 2021. Methodology: Consecutive 1820 patients who fulfilled the inclusion criteria and underwent conventional coronary artery bypass grafting (were included in group "A", while 130 patients who underwent coronary endarterectomy during coronary grafting were included in group "B". We identified and compared the preoperative risk factors, early mortality and perioperative complications in our study. Results: In our study the early mortality between both the groups i.e. conventional coronary artery bypass grafting (group A) and coronary artery bypass grafting with coronary endarterectomy (group B) was 3.1% and 5% (p=0.07). Amongst the perioperative and postoperative characteristics of patients in both the groups; CPB time, aortic X-clamp time, ICU stay, postoperative Max CKMB, inotropic requirement, hemodynamic instability requiring IABP, dysrhythmias, significant bleeding and LIMA as conduit were significant with the p-value<0.05. However, ventilation time, requirement of products (FFP, Platelets) and pleural effusion were non-significant. Conclusion: Although early mortality in coronary artery bypass grafting with coronary endarterectomy is higher than the conventional coronary artery bypass grafting, but this difference is statistically insignificant. However, there is an evidence of higher perioperative complications in coronary endarterectomy group in comparison to conventional CABG. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety, efficacy and cost effectiveness of ultrasound-guided foam sclerotherapy in superficial venous reflux in Clinical, Etiological, Anatomical and Pathological (CEAP) classification grade 2-6 disease. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2018 to Feb 2020. Methodology: One thousand and sixty-seven patients (1312 legs) with varicose veins were treated by ultrasound-guided foam sclerotherapy using 3% sodium tetradecyl sulphate for truncal veins and 1% for smaller veins in 1:4 ratio with air. After 7 days, leg was assessed clinically and radiologically with Duplex ultrasound for occlusion of veins and complications. Second, third and fourth sclerotherapy sessions were performed for residual/recurrence/new varicosities. Compression bandage was used for at least 3 months after treatment. Results: The overall eradication of superficial venous reflux and healing of ulcers, was seen in 92.1% (1208 legs). It was 83.5% (1095 legs) after 1st session of UGFS. Second, 3rd and 4th session of UGFS further increases this percentage of benefitted patients Deep vein thrombosis developed post procedure in 2 (0.18%) patients and pulmonary embolus in one patient. Three (0.28%) patients had transient visual disturbances within half an hour of treatment. Retreatment was required due to formation of new superficial venous reflux in 39 (2.9%) legs and recurrence in 93 (7.1%) legs. Conclusion: Ultrasound guided foam sclerotherapy is a better option of treatment in varicose veins in terms of safety, efficacy and cost effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To determine the gender and age-based disparities in side effects among healthcare workers in response to COVID-19 (Sinopharm) vaccination. Materials and Methods: A total of 216 healthcare workers were vaccinated against COVID-19 by administering Sinopharm vaccine during February and March 2021 at the Infectious Diseases Department of Holy Family Hospital, Rawalpindi. They were enrolled in the study through consecutive sampling. Data for this cross-sectional descriptive study was gathered pertinent to age, gender, and side effects of Sinopharm vaccination. The information regarding vaccination side effects was inquired through telephonic calls. Statistical analysis of data was done by SPSS version 25.0. Gender-based differences in post-vaccination side effects with a first and second dose of vaccine were statistically confirmed by the application of the chi-square test. P-value < 0.05 was taken as significant. Results: Mean age of healthcare workers in our study was 35.7 ± 9.5 years. Most (54.6%) of them were females and 79.2% of health professionals were 21-40 years old. Side effects after the first dose of Sinopharm vaccine were experienced by 46.3% males and 42.4% females. About 45.2% and 42.3% of males and females respectively overlooked the second jab adversity. A greater proportion (43.6%) complained of vaccine-related side effects after the second dose than 37.5% of subjects who noted side effects after the first dose of vaccine. Body aches, injection site pain, headache, and fever were established as the commonest post-vaccination side effects. Gender-based variations between post-vaccination side effects were statistically insignificant both with the first dose (P>0.1) and second dose (P>0.2) of the Sinopharm vaccine. Conclusion: Side effects resulting from the Sinopharm vaccine among our healthcare personnel were minimal. Fortunately, none of them complained of serious aftereffects. Despite the COVID vaccination, our healthcare workers should strictly adhere to COVID SOPs amidst pandemics in order to avoid catastrophe in the future. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of usage of topical autologous platelet rich fibrin (PRF) in improving outcomes of myringoplasty regarding graft uptake and hearing improvement. Methods: This study was conducted in the ENT department of Holy Family Hospital, Rawalpindi, over a period of six months from August 2019 to January 2020. It was designed as a prospective single blinded randomized controlled trial. The study involved a total of 50 participants in whom myringoplasty was done through post auricular approach using underlay technique. In 25 patients topical drops of PRF were used. Outcomes were compared after three months with the control group (n=25), who underwent myringoplasty without PRF. Results: After three months follow-up, graft uptake was reported 78% and 52% in cases and controls, respectively (P=0.070). Mean hearing improvement was 18 dB and 6 dB in cases and controls, respectively (P=0.014). Postoperative infection occurred in 8% of the cases, and in 32% controls (P=0.037). Conclusion: Topical use of Platelet-Rich Fibrin during myringoplasty results in improved graft uptake. Hence, resulting in much improved hearing, significant reduction in infection rates and decrease in perforation sizes. [ABSTRACT FROM AUTHOR]

Objective: To determine patient’s level of satisfaction and factors leading to dissatisfaction in selected patients group with health care delivery in outpatients department of CMH Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Out Patients Department of Combined Military Hospital Rawalpindi, from Sep 2013 to Aug 2015. Methodology: Before data collection, written informed consent was taken from all the participants. The study population comprised of armed forces personnel and their families. Patients, including both, males and females, coming to the outpatient department of Combined Military Hospital Rawalpindi were included in the study through consecutive sampling. Results: Results revealed that only 30% were satisfied. 67% patients were satisfied with the facilities in reception and 70% were satisfied with cleanliness in waiting area. A relatively low level of satisfaction with dealing of nursing assistant was recorded while very high percentage of satisfaction with performance of doctor i.e. 91%, examination done by doctor 91% and information provided by doctor 93% was recorded.90% patients reported high level of satisfaction with medicines provided.95.33% patients were satisfied with lab tests being done in hospital. Conclusion: Assessing satisfaction of patients is a simple and cost effective way for assessment of hospital services. Most of the patients were contented with services delivered in OPD and showed their trust in doctors, medicines provided and lab facilities offered. Majority were willing to revisit the hospital if required. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of single agent methotrexate in locally advanced and metastatic head and neck cancer. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oncology, Combined Military Hospital (CMH), Rawalpindi from Jan 2017 to Jul 2017. Methodology: Fifty patients were enrolled with locally advanced or metastatic head and neck cancers, which were unfit for further treatment with curative radical surgery, radiotherapy and/or double agent chemotherapy. All the patients were treated with metronomic chemotherapy methotrexate 50mg weekly intravenously and the dose was escalated as tolerated up to a maximum of 200mg/week. Patients were followed up fortnightly for clinical response using Response Evaluation Criteria in Solid Tumors (RECIST). Imaging was performed on suspicion of progression. Results: Out of 50 patients, two (4%) patients have shown complete clinical response, 16 (32%) patient with partial response and 19 (38%) patients with stable disease. Disease progression was observed in 13 (26%) patients. Subset analyses revealed thirty-two (64%) patients with improvement in quality of life in terms of symptomatic control. Only 9 (18%) patients were observed with Grade 2 neutropenia, 4 (8%) patients with grade 2 anemia. Conclusion: Single agent methotrexate was an effective alternative regimen for patients with locally advanced or metastatic head and neck cancers. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of emotional intelligence with academic performance of medical student of Army Medical College, Rawalpindi. Study Design: Cross sectional study analytical study. Place and Duration of study: Army Medical College, Rawalpindi from Jan to Mar 2018. Patients and Methods: Three hundred and forty-seven students of 2nd and 3rd year MBBS were included through convenience sampling. All those students who were under the treatment of psychiatrist or had any psychological problems were excluded from the study. Emotional Intelligence was measured using 'The Quick Emotional Intelligence Self-Assessment Questionnaire' adapted for the San Diego City College MESA Program from a model by Paul Mohapel. Academic performance of the students was measured by determining the marks in the last professional examination. Results: Out of 347, thirty-one (8.9%) students were in low category of emotional intelligence, 241 (69.5%) were in moderate whereas 75 (21.6%) were in high emotional intelligence category. Predictive effect of emotional intelligence on academic performance was assessed by regression analysis which showed Unstandardized coefficient (B) as 0.07 with 95% confidence interval of 0.03-0.11 and p-value of 0.001. Academic performance was positively correlated with total emotional intelligence score (r=0.12, p=0.001), emotional awareness (r=0.16, p=0.002), emotional management (r=0.12, p=0.02) and social emotional awareness (r=0.20, p<0.001). However, the correlation was not significant with relationship management (r=0.07, p=0.16). There was no significant difference between the academic scores of students with moderate and high emotional categories (67.90 ± 6.33 vs. 68.10 ± 7.63, p=0.98). However, the scores were significantly lower in low category as compared to moderate and high categories. (61.49 ± 7.95 vs. 67.90 ± 6.33 and 68.10 ± 7.63, p=0.001 and <0.001 respectively). Conclusion: Emotional intelligence is directly correlated with academic performance. Students with high emotional intelligence may outperform those with low intelligence. [ABSTRACT FROM AUTHOR]

Objective: To explore the extent of bleeding among three different groups of patients based on their blood platelet count and identify the frequency of specific types of bleeding manifestations among the study groups. Study Design: Comparative prospective study. Place and Duration of Study: Pak-Emirates Military Hospital, (PEMH) Rawalpindi Pakistan, from Jul to Dec 2019. Methodology: One hundred patients hospitalized with dengue fever and platelet count of less than 100,000 per microliter of blood were enrolled in the study. They were divided into three groups based on platelet count, i.e., <20,000 (Group-1), 20,00050,000 (Group-2), and >50,000 (Group-3) per microliter of blood and observed for different types of bleeds and were also categorized as no bleed, single-site bleed and multiple-site bleed. Results: Group comparisons revealed that no patient from Group-1 versus 3(10.3%), patients from Group-2 whereas 11(19.3%) patients from Group-3 experienced single site bleed (p=0.05). In addition, patients belonging to Group-1 significantly more petechiae as compared to Groups 2 and 3 (92.8% vs 65.5% vs 19.2%, p<0.001). Similarly, gum bleeding and purpura were more commonly observed in Group-1 than in two other groups (50% vs 44.8% vs 14.0%, p 0.001; 85.7% vs 44.8% vs 3.5%, p<0.001, respectively). Conclusion: Bleeding complications among dengue patients has a positive relationship with platelet count, but some specific bleeds, e.g., melena, hematemesis, hemoptysis and per vaginal bleed, cannot be directly correlated with the number of platelets circulating in the blood. [ABSTRACT FROM AUTHOR]

Objective: To assess the aetiology and outcome of patients admitted with acute kidney injury at the Nephrology Unit of Pak Emirates Military Hospital (PEMH). Study Design: Cross-sectional analytical study. Place and Duration of Study: Nephrology Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to Jun 2020. Methodology: Patients admitted with AKI were included in the study. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines were used to diagnose acute renal injury based on creatinine level or urine output. Results: A total of 300 patients were admitted to the Nephrology Unit with AKI during the study period. Sepsis was the commonest aetiology for acute kidney injury among the target population, followed by injury. 155(51.4%) patients were discharged, 53(17.7%) were stable in the ward, 70(23.4%) patients were shifted to the Critical Care Unit, and 22(7.3%) died. Long duration of hospital stay and the presence of multiorgan failure had a statistically significant relationship with poor outcomes in our study. Conclusion: This study gives an insight into the aetiology and outcome of acute kidney injury among acute kidney injury patients admitted to the nephrology ward. Sepsis and injury were the commonest causes affecting renal function. Most of the patients had a good outcome. Patients with long hospital stays and multiorgan failure should be given special attention as they were more at risk of poor outcomes in our study. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of lifestyle on the optimization of blood pressure in adult hypertensive patients Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, Aug 2019 to Jan 2020 Methodology: The study population comprised of 200 hypertension patients reporting for routine follow-up. Patients were divided into two groups. Group-A (controls) had the patients with the continuation of the routine anti-hypertensive medication. At the same time, Group-B (cases) received lifestyle modifications (salt restriction, quitting smoking and daily step count by using a pedometer) in addition to the routine anti-hypertension medication. Control of blood pressure among the groups was compared three months after the start of the study. Results: Mean age of the patients was 46.50±3.56 years. The mean duration of hypertension in the study participants was 5.12±3.24 years. Optimal blood pressure was achieved in 103(51.5%), while this was not achieved in 97(48.5%). With the help of binary logistic regression analysis, we found a statistically significant difference in achieving optimal blood pressure control among the cases and controls. Gender was also statistically significant in achieving control of blood pressure (p- value<0.001). Conclusion: This study showed a significant difference in optimizing the blood pressure of patients who received lifestyle modification in addition to conventional biological treatment than those who only received the routine anti-hypertensive medication. Females also had better control as compared to males. [ABSTRACT FROM AUTHOR]

Objective: To find out the effectiveness of short message service (SMS) on glycaemic control among patients with diabetes at a tertiary care hospital in Rawalpindi. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020. Methodology: A total of 218 patients with diabetes were included in the study. Patients were randomized into two groups by lottery method. Group-A received a tailored SMS package daily for six months along with printed dietary instructions, while Group-B was given only printed dietary instructions. After six months, HbA1c levels and other sociodemographic factors were compared among the two Groups A and B. Results: In Group-A (SMS-Group) mean HbA1c levels reduced from 9.3±2.0 to 7.0±0.4 compared to Group-B (non-SMS-Group) with mean HbA1c levels from 9.7±1.8 to 8.8 ±1.4. Before SMS intervention, all variables, including HbA1c levels between the two groups, were insignificant. However, the use of structured SMS-based intervention in Group-A showed a statistically significant reduction in HbA1c levels compared to Group-B (p-value <0.05). The mean difference was 1.77(95% CI: -2.44 to -1.10). Conclusion: This study showed Short Message Service (SMS) effectiveness by significantly reducing glycaemic levels (HbA1c) among people with diabetes compared to conventional methods of diabetic education for glycaemic control. [ABSTRACT FROM AUTHOR]

Background: To assess vitamin - D deficiency in Northern Pakistan in order to provide inputs towards developing effective preventive and remedial strategies. Methods:A total of five thousand six hundred and ninety three (n=5693) adult patients of both genders were screened for serum Vitamin D-3 levels over the period of six years. Results:Mean serum Vitamin D3 levels among males and females were in insufficient range and showed no significant difference (P>0.05). In study population 56.5% (n=3216) of patients were Vitamin D-3 deficient (<20 ng/ml), 18.2% (n=1037) showed insufficient levels (20-30 ng/ml) and 25.3% showed sufficient levels (>30 ng/ml). Significant difference was observed on gender stratification with female population showed higher percentage of deficient levels (79.7%) versus males (20.3%) (p<0.05). Age based stratification also showed significant difference with age groups younger than 50 years showed higher percentage of deficient levels than in patients older than 50 years (P<0.05). Conclusion: There is a high prevalence of vitamin D deficiency in population of Rawalpindi and Islamabad regions. [ABSTRACT FROM AUTHOR]

Background: To determine the frequency of different genotypes in HCV positive cases in the population of Rawalpindi/Islamabad over the period of five years. Methods: Data of total of three thousand eight hundred and eighteen (n=3818) HCV positive adult of both genders screened for genotype testing over the period of six years were analyzed. Results: Most frequent genotype identified in our study was genotype 3, accounting for 95.8%. The second most common genotype was Type 1 (2.9%). Other genotypes were Type 2 (0.3%)and Type 4 (0.1%). Mixed genotype (Type 1 and 3) were detected in 1 %. Genotype 5 and 6 was not detected in any case. No significant difference was observed among males and females in genotype distribution (p>0.05). Conclusion: Most common genotype among HCV patients was genotype 3, followed by genotype 1. [ABSTRACT FROM AUTHOR]

Objective: To gauge the frequency of iron deficiency anaemia among chronic renal disease patients and factors related to the presence of anaemia at our hospital. Study Design: Cross-sectional study. Setting and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, Nine months, Sep 2019 to May 2020. Methodology: Three hundred patients suffering from the chronic renal disease were included in the study. Iron deficiency anaemia was diagnosed based on haemoglobin and ferritin levels. In addition, the relationship between age, gender, duration of chronic kidney disease and stage of chronic kidney disease was assessed with the presence of iron deficiency anaemia among the patients suffering from chronic kidney disease. Results: Out of three hundred patients studied, 139 were males, and 161 were females. Out of 300 patients with chronic kidney disease included in our study, 159 (53.0%) showed the presence of iron deficiency anaemia, while 141 (47.0%) had no anaemia. Chi-square analysis showed that female gender, long duration of illness and more severe illness had a significant association with iron deficiency anaemia among the patients with chronic kidney disease. Conclusion: High frequency of iron deficiency anaemia among the patients of chronic kidney disease in a tertiary care hospital of Pakistan. Routine screening for anaemia should be done, especially on female patients and patients with more severe and long-standing illnesses. [ABSTRACT FROM AUTHOR]

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021. Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done. Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73±8.36 years in Group-A and 43.48±8.98 years in Group-B. Mean duration of complaints was 8.72±4.32 months in Group-A and 10.89±3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant. Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments. [ABSTRACT FROM AUTHOR]

Objective: To compare the respiratory complications of COVID-19 among patients with rheumatological conditions taking bDMARDs and csDMARDs at Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative prospective study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Mar to May 2020. Methodology: Patients diagnosed with COVID-19 on polymerase chain reaction having previously rheumatological conditions managed either with bDMARD or cs DMARD were included in the study. They were followed up for three weeks after the positive polymerase chain reaction. Complications leading to the use of oxygen or ICU support or death were compared in both groups of patients. Results: A total of 82 patients with any rheumatological condition managed either with bDMARD or csDMARD tested positive for covid-19 on polymerase chain reaction and were included in the final analysis. 30 (36.6%) patients were taking bDMARDs while 52 (63.4%) were taking csDMARD. In addition, 4 (4.8%) low dose oxygen therapy, 5 (6.1%) required moderate dose oxygen therapy, while 5 (6.1%) required severe dose oxygen therapy or intensive care unit support. 2 (2.4%) patients died within the three weeks. The requirement of moderate or severe dose oxygen and intensive care unit support was found statistically significantly more in the group taking csDMARDS. Conclusion: The presence of complications of COVID-19 and the requirement of oxygen and intensive care unit support were present in some of the patients taking DMARDs. Among the DMARDs, bDMARDs were less linked with complications, but large studies with better design required better results. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of electrolyte imbalance and associated etiological factors among the unconscious patients hospitalized at Pak Emirates Military Hospital. Study Design: Cross-sectional study Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020 Methodology: A total of 240 cases were included in this study in liaison with other departments where the admitted patients became unconscious. Patients with a Glasgow coma scale score <10 were included in the study. Serum electrolytes, including Sodium, Potassium, Magnesium and Chloride, were measured in the study participants. Results: Mean age of study participants was 49.10±7.55 years. One hundred and 62(67.5%) patients were from Medicine-Allied Wards while 78(32.5%) patients were from Surgical-Allied Wards. Thirty-eight patients were from the Critical Care Unit. Mean serum sodium was 139.10±11.52 meq/L, while potassium was 4.60±1.06 meq/L. Mean chloride was 809.4±53.55 meq/L, and Magnesium was 1.40±1.05) meq/L. Our analysis revealed that advanced age, underlying medical illness and duration of hospitalization were strongly linked with electrolyte imbalance among the unconscious patients. Conclusion: Electrolyte imbalance emerged as a common finding in the unconscious patients hospitalized in our tertiary care unit. Patients with advancing age, medical illnesses and long hospitalization should be screened for electrolyte wasting a priority to prevent them from going unconscious. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is a serious global public health, social and economical problem that affects millions of people particularly in low income countries. The aim of this study was to see the loss to follow up pattern in Tuberculosis patients in district Rawalpindi, Pakistan. Materials and method: A cross-sectional study was conducted in district Rawalpindi between August and October 2010. All sputum smear positive Tuberculosis patients diagnosed and treated in public sector, urban and rural diagnostic centers of the district Rawalpindi during the year 2008 were included in the study. All cases other (smear negative pulmonary and extra-pulmonary) than sputum smear positive and all private hospitals were excluded. Results: A total of 451 patients were enrolled in the study. Majority of the patients (89.6%) were provided with the treatment support. Geographically dropout rate was observed higher in urban patients than in rural 18.7% vs. 10.5%. On the other hand by patient gender, drop out was seen more in male patients than in females 16.5% vs. 13.1%. By patients age groups, interestingly patients under the childhood age group all the patients completed the treatment while drop out was observed more in older age group. Conclusions: Loss to follow up pattern was seen more in urban patients, by gender more in male patients and by age groups observed more in older patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the relation between days on ventilatory support and overall mortality to total days of pre-ventilator illness in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from Mar to Aug 2020. Methodology: A total of 140 admitted patients within the prescribed time frame were observed in the established COVIDIntensive Care Units of Pak Emirates Military Hospital, Rawalpindi. The criteria for inclusion in the study were patients of any age and gender on ventilatory support with a confirmatory diagnosis of SARS-CoV-2 both by RT-PCR, and radiological evidence on HRCT Chest. Results: The mean age of patients was 59.39 ± 13.517 years. Patients who presented with a confirmed diagnosis of COVID-19 and more than ten days of illness with respiratory compromise had a higher occurrence to be placed on mechanical ventilation. There was a strong linear and positive correlation between the total days of illness on presentation and the total days on ventilatory support (p-value <0.01). This linear relationship consequently translated into overall mortality of 78.6% with a 21.4% survival rate. Conclusion: To conclude, the total days of illness in critical COVID-19 patients had a linear relationship to days on ventilatory support and overall mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of real-time Shear Wave Elastography (SWE) in detecting liver cirrhosis among patients suffering from diseases predisposing to it, keeping histopathology as the reference standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Jul 2018. Methodology: A total of 114 patients were recruited, and relevant history taken from patientsreal-time shear wave elastography (SWE) of the liver was performed, followed by USG guided liver biopsy. Patients having clinically suspected diseases predisposing to hepatic fibrosis were sent to the Radiology department for ultrasound or ultrasound-guided liver biopsy. Elasticity values using sheer waves of 14.9 kPa (2.23m/s) or more was taken as suggestive of cirrhosis. Elastography findings were compared with histopathology findings. Results: Real-time SWE showed high diagnostic accuracy for detecting liver cirrhosis with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 92.86%, 89.66%, 89.66%, 92.86% and 91.23%, respectively. Conclusion: This study concluded that the diagnostic accuracy of RTSW elastography in detecting liver cirrhosis is relatively high. [ABSTRACT FROM AUTHOR]

Objective: To establish the role of determining increased amniotic fluid index (AFI) and large for gestational age (LGA) fetus on ultrasound for the screening of gestational diabetes mellitus (GDM). Study Design: Descriptive Observational study. Place and Duration: Department of Gynaecology and Obstetrics, Pakistan Railway Hospital, Rawalpindi from 1st September 2021 till 28th February 2022. Methodology: The pregnant women, between 20-30 weeks of gestation, suspected of having excessive AFI or LGA fetuses on routine clinical examination, were advised to have an obstetric ultrasound scan. AFI > 20 cm or LGA on ultrasound (>90th percentile for that gestation) were considered abnormal. These participants were then subjected to 75-gram Oral Glucose Tolerance test (OGTT). Based on OGTT, the sample population was divided into two groups at the post-stratification stage: with and without Gestational Diabetes Mellitus (GDM). Chi-square test was applied to compare the frequency of increased AFI and LGA between patients having GDM or not having GDM. Results: The study population (n=75) showed the frequency of LGA as 37.3 % and increased AFI as 65.3%. Women with increased AFI were at a significantly greater risk of GDM (65%), as compared to those with normal AFI (27%) with p-value of 0.002. Also, patients having LGA fetuses (60.7%) were at a greater risk of having GDM, as compared to those with normal weight fetuses (34%) with pvalue of 0.024. Conclusion: Women with Increased AFI and LGA fetuses between 20-30 weeks of gestation are at a greater risk to develop GDM. Hence these ultrasound parameters can be used as reliable screening tools for the detection of GDM. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of serum cholesterol and body mass index with body composition in the healthy Pakistani adults. Study Design: Cross sectional study. Place and Duration of Study: Physiology Department, Army Medical College Rawalpindi/National University of Medical Sciences (NUMS), in collaboration with Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi and Clinical Pathology Laboratory (CPL), Pak-Emirates Military Hospital, Rawalpindi. (Duration to be asked form the authors). Methodology: The total study sample of 100 participants was taken, that comprised of two groups. Group-1 included male participants (n=50) while group-2 included female participants (n=50). The participants were healthy adults of ages 18-60 years having same physical activity background. Body composition of the participants was evaluated by bioelectric impedance analysis machine. Measurement of serum cholesterol was carried out by the Bosh Diagnostic Kit. Body Mass Index (BMI) was determined by the formula. Results: Serum cholesterol was found to be significantly correlated with body fat mass and percent body fat in males (r-value = 0.90 and 0.82, p-value <0.001 and 0.002 respectively) and in females there was significantly positive correlation with the body fat mass (r-value=0.51, p-value 0.007), skeletal muscle mass (r-value = 0.59, p-value 0.005), total body water (r-value=0.67, pvalue 0.006) and fat free mass (r-value=0.47, p-value 0.008). Conclusion: Serum cholesterol and BMI were associated with the body composition in females but with only fat parameters in the males. [ABSTRACT FROM AUTHOR]

Objective: To assess the association of fatty liver with type 2 diabetes and other socio-demographic factors among the patients at Pak Emirates military hospital Rawalpindi. Study Design: Cross-sectional analytical Study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Aug 2019 to Jan 2020. Methodology: This study was conducted on 300 patients of type 2 diabetes mellitus reporting for a routine checkup at the medical Outpatient department. Fatty liver was diagnosed on ultrasound by a consultant radiologist. Results: Out of three hundred patients with diabetes mellitus included in the final analysis, 225(75.0%) were males, and 75(25.0%) were females. 176(58.6%) had fatty liver on ultrasound, while 124(41.4%) had no fatty liver on ultrasound examination at the time of the study. we found that increasing age, long duration of diabetes and poor control of illness had a statistically significant relationship with the presence of fatty liver among the target population (p<0.05). Conclusion: Patients with type 2 diabetes had a high frequency of fatty liver on routine ultrasound examinations. In addition, patients with more age, long duration of diabetes mellitus and poor control of illness were at a high risk of developing fatty liver among the study participants. [ABSTRACT FROM AUTHOR]