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Objective: Any component of the urinary system can get infected with bacteria, which is known as a urinary tract infection (UTI). It is one of the most common bacterial diseases in children. The study's objectives included identifying the clinical symptoms of UTI in children between the ages of one month and fifteen, as well as the bacteria responsible for the illness and their sensitivity to various medicines. Methods: This cross-sectional study was conducted at the CMH Rawalpindi, Pakistan from January to June of 2022. Our analysis comprised 137 strongly suspected instances of UTI in children (1 month to 15 years old). Results: A total of 137 urine samples from paediatric patients suspected of having UTI were obtained in which the 93 samples (67.88%) generated significant bacteria. The two most common clinical symptoms of UTI patients in our research were fever and dysuria. E. coli was the most prevalent isolate in cases with paediatric UTI. Ampicillin, Ciprofloxacin, and cotrimoxazole were the medications that were most effective against E. coli and Klebsiella, respectively. Conclusions: This study highlights the importance of identifying the clinical symptoms, bacteria causing urinary tract infections (UTIs), and their drug sensitivity patterns in children. The findings emphasize the need for early detection through urine culture sensitivity tests and provide valuable insights for clinicians to effectively manage UTI cases in children, including selecting appropriate empirical antibiotic treatment. [ABSTRACT FROM AUTHOR]

Objective: To discern the relationship of height and weight with body composition in healthy attendants of cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct to Dec 2022. Methodology: A total of 226 healthy adults aged 19-47 years having similar daily physical activity levels were included. The body composition of study participants was evaluated using a bioelectric impedance analysis (BIA) machine. The weight of all participants was recorded with the help of a weighing machine. The participants' height was measured using a Harp enden Stadiometer and recorded. Results: Our study showed that weight had a significant positive correlation with body fat mass (rs value=0.83), skeletal muscle mass (rs value=0.763), total body water (rs value=0.704), fat-free mass (rs value=0.75) and per cent body fat (rs value 0.716). On the other hand, height had a negative but non-significant association with fat mass (rs value= 0.025) and a negative significant association with per cent body fat (rs value=-0.16). Height had a positive and significant association with fat-free mass (rs value=0.553), total body water (rs value=0.501) and skeletal muscle mass (rs value=0.505). Conclusion: Weight, if used alone, is not a good indicator of obesity or emaciation, and height has a negative association with fat mass. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile. Study Design: Quasi-experimental study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016. Patients and Methods: Forty patients (n=40) having histopathologically confirmed (urothelial) urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group (ECOG) performance status ≤2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour (TURBT), they received 4 courses of chemotherapy with mitomycin and 5 fluorouracil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria. Results: Efficacy; defined in terms of complete and partial response, was observed in 85% (n=34) of patients. Treatment efficacy was better in males as compared to females (90.6% vs. 62.55: p<0.05). Patients with better ECOG-PS (0-1) and early stage (2) responded well to treatment while response was almost same in different age groups, (p>0.05 in all cases). Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia. Conclusion: Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy. [ABSTRACT FROM AUTHOR]

Three cereals viz. oats (Avena sativa L.), barley (Hordeum vulgare) and wheat (Triticum aestivum) were evaluated in pure stands as well as in mixtures of 50: 50 ratios with common vetch (Vicia sativa L.) under rainfed conditions of Pothowar to address the problem of nutritious green fodder for livestock. The experiment was sown during second week of October, 2007 in a randomized complete block design at Koont Research Farm, Pir Mehr Ali Shah-Arid Agriculture University, Rawalpindi, Pakistan. The results revealed that oatsvetch mixture performed better at all growth stages under rainfed conditions of Pothowar in terms of green and dry matter yields. By this mixture, 35.06 tons per hectare green fodder and 9.29 ton per hectare dry matter yield was obtained which was 17 and 19 percent higher than oats pure stand, respectively. Similarly, it was calculated that overall oats-vetch mixture yielded 63 and 78 percent higher dry matter than barley-vetch and wheat-vetch, respectively. So oats-vetch mixture can be recommended for higher biomass under rainfed conditions of Pothowar. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [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 determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin was subjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of PTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. PTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8-8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in PTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2-78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of PTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability. [ABSTRACT FROM AUTHOR]

Background: Cancer is the second leading cause of death, responsible for 1 in 6 deaths globally and Caregivers play a major role in cancer patients' care and rehabilitation. They may face several psychological issues like depression along with physical and emotional disadvantages, and significant financial consequences. The objective of this study is to find out the associations of Depression with demographic variables among family caregivers of cancer patients in combined Military Hospital, Rawalpindi. Methods: This was a cross-sectional study conducted in the OPD and IPD of the Oncology department of CMH, Rawalpindi between February and July 2020. The 384 adult cancer patient's caregivers visiting oncology department were assessed to find out level of depression after getting informed consent. Data was collected by Demographic questionnaire and Beck Depression Inventory (BDI) tool. Chi-square test and Likelihood ratio chi-square test used to find association. Results: Out of all 384 caregivers 181 (47.1 %) were males and 203 (52.9 %) were females. 267 (69.5 %) were diagnosed as non-depressive while 117 (30.5 %) were diagnosed as Depressive. A considerable association has been found between Depression and Age of caregivers (p= 0.006), Gender of caregivers (p <0.05), employment status of caregivers (0.02) and relationship to a cancer patient (p = 0.003). Conclusion: A high prevalence of depression is found in cancer patient's caregivers and Depression is significantly associated with Age of caregivers, Gender of caregivers, employment status of caregivers, and the relationship to cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To compare oral Montelukast with oral Doxycycline in the treatment of moderate Acne Vulgaris in terms of mean change in acne severity index. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi, from Mar 2016 to Aug 2016. Methodology: A total of 84 patients were included in the study. They were randomly assigned to group A and B by consecutive non probability sampling technique. Group A was given 100mg Doxycycline with topical 10% benzoyl peroxide and group B was given 5mg Montelukast with topical 10% benzoyl peroxide. Acne severity index (ASI) was calculated at base line and after one month. Mean change in acne severity index was observed for both the groups. Results: Independent sample t-test was used to compare the means. Mean post treatment change in acne severity index of group A was 5.45 ± 1.29 and group B was 1.80 ± .59 respectively (p-value <0.001). On post stratification analysis for age and gender results were consistent. Conclusion: Efficacy of Doxycycline is significantly better in terms of mean change in Acne Severity Index, as compared to Montelukast. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To analyze the factors associated with adverse effects in elderly women receiving chemotherapy for breast cancer. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Dec 2020 to Nov 2021. Methodology: This study was conducted on 145 female patients (>65 years) with breast cancer who were taking chemotherapy of any type and had undergone one cycle. All the study participants underwent detailed clinical evaluation by a consultant oncologist to assess the presence of various adverse effects of chemotherapy. In addition, the association of Anthracycline use, >3 months of treatment, low haemoglobin at baseline and abnormal liver functions at baseline were studied with adverse effects in the study participants. Results: The final analysis included one hundred fortyfive elderly female patients with breast cancer receiving chemotherapy. The mean age of the patients was 69.731±8.794 years. 89(61.4%) patients had no adverse effects, while 56(38.6%) had one or more adverse effects during chemotherapy. Anaemia 26(17.9%) was the commonest adverse effect, followed by fatigue 18(12.4%) and abnormal liver function tests 18(12.4%). It was revealed that the use of Anthracyclinebased chemotherapy and long duration of chemotherapy were statistically significantly associated with adverse effects (p-value<0.05) in our study participants. Conclusion: Considerable number of elderly patients with breast cancer undergoing chemotherapy showed the presence of adverse effects. In addition, patients using Anthracyclinebased chemotherapy and taking chemotherapy for more than three months were more at risk of developing adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [ABSTRACT FROM AUTHOR]

Purpose: To assess the adherence of cardiologists to JNC7 and the impact of pharmacists in reducing clinical inertia by managing high blood pressure in the cardiology out-patient department of the Armed Forces Institute of Cardiology, Rawalpindi, Pakistan. Methods: This was a pre- and post-interventional prospective study in which data was abstracted from patients’ history notes or prescription of selected patients at baseline and follow-up visits by applying a reliable tool. The data were abstracted again from the same patients to evaluate the cardiologists’ adherence with the same parameters after 2,4 and 6 months. The sample size for this study was 116 patients and descriptive statistics were used for categorical variables. For the comparison of cardiologist’s adherence to JNC7, means and paired ‘t’ test were used at the level of 0.05 significance. Results: At baseline, the mean overall percentage of cardiologists’ adherence to JNC7 was 46.7 ± 18.9 %. This significantly improved to 98.8 ± 6.0 % after 2 months of the pharmacist intervening by way of discussions with cardiologists. The cardiologists’ adherence was further improved to 100 % after 4 and 6 months. Conclusion: Improvement in cardiologists’ adherence to JNC 7 guidelines and involvement of the pharmacist enhance the documentation of BP goal, lifestyle modifications and uncontrolled BP. All these helps to overcome clinical inertia that ultimately leads to better BP control and rational use of medicines. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship of baseline quantitative BCR ABL1 gene percentage and therapeutic response i.e. Early Molecular Response (EMR) at 3 months with first generation Tyrosine kinase inhibitors (Imatinib) in patients with Chronic Myeloid Leukemia (CML) in chronic phase (CP) Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital, Rawalpindi, Pakistan, and Armed Forces Institute of Pathology Rawalpindi, Pakistan from Oct 2017 to Oct 2019. Methodology: One hundred and seventy patients, 18 years of age or older with newly diagnosed Chronic Myeloid Leukemia (CML) in chronic phase (CP) with quantitative baseline BCR-ABL (IS) transcript were included in the study. All enrolled patients were placed on Imatinib therapy (400 mg/day) and Reverse transcription polymerase chain reaction (RT-PCR) for BCR ABL transcript was repeated at 3 months to document EMR (BCR-ABL (IS) <10%). Patients who were in accelerated/blast phase, or already taking any Tyrosine Kinase Inhibitors (TKI) or chemotherapy were excluded from the study Results: In our study 101 (59.4%) patients achieved early molecular response. Out of these 80 (70.8%) patients with BCR-ABL<50% at baseline value showed early molecular response. However, only 21 (36.8%) with BCRABL >50% at baseline achieved early molecular response (p-value <0.001). Conclusion: A significant number of patients achieved early molecular response with Imatinib therapy that had BCR ABL below 50%, however those with baseline BCR ABL >50%, the rate of EMR was comparatively lower. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the clinical characteristics of COVID-19 Virus disease in the pediatric population in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2020 to Jan 2021. Methodology: All children presenting to the department with symptoms consistent with COVID-19 disease were tested for the virus. Patients who tested positive on the PCR were included in the study. Patients with nonconsistent symptoms of COVID-19 and those who tested negative on the PCR were excluded from the study. All clinical data, including the age of the child, the onset of symptoms, the gap between the onset of symptoms and presentation as well as clinical symptoms, were documented on a predefined proforma. Results: A total of 106 patients were enrolled on the study. The mean age of patients was 5.6±2.5 years. The most frequent symptoms were fever (63, 59.6%) and cough (49, 46.2%). There were 3(2.9%) cases with severe or critical illness. The most frequent abnormal laboratory findings were leukopenia (29, 27.4%) and increased creatine kinase (38, 36.0%). Groundglass opacities were observed in the HRCT chest of 17(65.3%) cases, out of 26 children diagnosed with pneumonia. The majority (70, 66%), had a positive exposure history. 88(83%) cases did not abide by the precautionary measures against the COVID-19 disease. Conclusions: The current study indicates that children usually present with mild symptoms but can present as severe diseases, as observed in this study. [ABSTRACT FROM AUTHOR]