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Objective: To compare the ease of placement of arterial catheters using palpation versus ultrasound guidance under aseptic measures. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2022. Methodology: Patients of either gender, aged 18 to 90 years presenting to a paranesthesia clinic that required intra-arterial blood pressure monitoring were included in the study. After induction, under General Anaesthesia, arterial lines were placed following an aseptic technique using ultrasound or palpatory method; in Group-U (ultrasound) or Group-P (Palpation), respectively. Demographic variables of the patient along with hemodynamic readings and success rate at first or multiple attempts, along with the total time of cannulation, were recorded. Results: Out of the total 74 patients, 59(79.7%) patients belonged to ASA-1 Grade, and 15(20.3%) patients in ASA-2 Grade. The mean age of the patients was 48.3±16.3, while mean BMI was 25.42±2.8kg/m2. In Group-P, the first-pass success was achieved in 19(51.4%) patients as compared to 32(86.5%) in Group-U when ultrasound was used (p<0.05). Conclusion: The success rate in placing an arterial line using ultrasound was significantly greater than the conventional palpatory method. Therefore, ultrasound should be a preferred modality during intra-arterial line placement. [ABSTRACT FROM AUTHOR]

Objective: To associate the SYNTAX score, residual SYNTAX score and in-hospital outcomes in patients who underwent multivessel Percutaneous Coronary Intervention. Study Design: Analytical, cross-sectional Study. Place and Duration of Study: Cardiac Cath Lab, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan, from Jul to Oct 2023. Methodology: Total three hundred and sixty-six patients who underwent multivessel coronary intervention were included using non-probability consecutive sampling. Patients with history of CABG and complex coronary artery disease were excluded. SYNTAX score and residual SYNTAX score were calculated. Chi-square test and Wilcoxon Signed Rank test were applied to find associations. p<0.05 was considered as statistically significant. Results: In a study of 366 participants, 292(79.8%) were males and 74(20.2%) were females whose mean age was 62.01±8.67 years, 136(37.2%) had diabetes, 177(48.4%) were hypertensive, and 153(41.8%) were smokers. NSTEMI was present in 173(47.2%) patients, and 43(11.7%) had LMS disease. In-hospital outcomes included 5(1.4%) repeat revascularization cases, 3(0.8%) Myocardial Infarction cases and 2(0.5%) death cases. SYNTAX Score had insignificant association with mortality (p=0.05), while residual SYNTAX score was significantly associated with repeat revascularization, MI, and mortality (p<0.01). Pre and post-procedural SYNTAX score were also different significantly (p<0.001). Conclusion: Our study underscored the predictive importance of SYNTAX Score and residual SYNTAX Score in guiding optimal treatment decisions for improved outcomes in multivessel coronary intervention. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intravenous phenylephrine infusion versus boluses for blood pressure management in elective caesarean sections. Study Design: Quasi-experimental study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2022. Methodology: Three hundred ninety patients requiring elective caesarean section were divided into an Infusion Group (n=195) and a Bolus Group (n=195). The Infusion Group received phenylephrine with 100 mcg/ml titration immediately after spinal anaesthesia as per weight and height at a 1 ml/minute rate and continued for 5 minutes. Infusion stopped if MAP at 5 minutes was above baseline and restarted if dropped below baseline in subsequent readings. In the case of bradycardia, 600mcg of Glycopyrrolate was administered. Parameters recorded at 1, 5, 10 and 15-minute intervals. In the bolus group, total numbers of 100mcg boluses at the end of fifteen minutes were recorded. Protocol for bradycardia and data record intervals was the same. The primary variables were mean arterial pressure (MAP), heart rate(HR), the total dose of phenylephrine used, and nausea and vomiting. Results: Primary outcome variables showed consistent improvement in maintaining MAP in the Infusion Group versus the Bolus Group (p<0.05). A similar trend was seen with heart rate between both groups (p<0.05). However, the infusion group had an average fall in heart rate compared to the bolus group at all-time intervals. Conclusion: Phenylephrine infusion offers better hemodynamic stability, requiring less ephedrine support than when given in boluses. [ABSTRACT FROM AUTHOR]

Objective: To compare the ease of intubation using glide scope video laryngoscope versus direct laryngoscopy for nasotracheal intubation. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, Aug 2022 to Feb 2023. Methodology: Patients of either gender with age greater than 18 years with American Society of Anesthesiologists (ASA) Grade I or Grade II planned for elective dental or maxillofacial procedures requiring nasotracheal intubation were included. A total of 60 patients were included, with 30 patients in each group. Recorded variables were time to intubate, glottic grade, use of Magill forceps, first attempt success, failure to intubate and postoperative sore throat. Results: With 60 patients after randomised allocation, 30 were allocated to Group-DL (Direct laryngoscopy) and Group-VL(Video laryngoscopy). The success rate in the first attempt was 27(90%) in Group-DL vs 30 (100%) in Group-VL, and the number of patients who could not be intubated was 1(3.3%) vs 0(0%) in both groups. The glottic grade recorded by the operator under vision, time to intubation, use of Magill forceps and post-operative sore throat in both groups was significant with a p-value of <0.05. Conclusion: Glide scope video laryngoscopy provides a better view of the vocal cords with less time to intubation, greater chances of successful intubation, and fewer post-operative chances of sore throat than direct laryngoscopy. [ABSTRACT FROM AUTHOR]

Antibiotic resistance is a health challenge worldwide. Carbapenem resistance in Gram-negative bacteria is a major problem since treatment options are very limited. Tigecycline and colistin are drugs of choice in this case, but resistance to these drugs is also high. The aim of this study was to describe the diversity of resistance mechanisms in carbapenem-resistant clinical Gram-negative bacteria from Pakistan. Carbapenem-hydrolyzing enzyme-encoding genes were detected using PCR and DNA sequencing and clonal types determined by multilocus sequence typing (MLST). Forty-four carbapenem-resistant isolates were collected from the microbiology laboratory of Fauji Foundation Hospital and Al-Syed Hospital, Rawalpindi, Pakistan, including Klebsiella spp., Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, and Achromobacter xylosoxidans. blaNDM-1, blaNDM-4, blaNDM-5, blaNDM-7, blaOXA-48, and blaOXA-181 were detected in Enterobacteriaceae; blaOXA-23, blaOXA-72, and blaNDM-1 in A. baumannii, and blaVIM-6 and blaVIM-11 in P. aeruginosa. MLST analysis revealed several predominant clonal types: ST167 in E. coli, ST147 in Klebsiella pneumoniae, ST2 in Acinetobacter, and ST664 in P. aeruginosa. In Acinetobacter, a new clonal type was observed for the first time. To the best of our knowledge, this is the first study describing the clonality and resistance mechanisms of carbapenem-resistant Gram-negative bacteria in Pakistan. [ABSTRACT FROM AUTHOR]

Objective: To compare the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block with intravenous Nalbuphine in patients with breast cancer planned for modified radical mastectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of 106 patients diagnosed with breast cancer Stage I and II requiring modified radical mastectomy were included. Comparison of the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block and intravenous Nalbuphine were noted. Results: One hundred six patients were included in the study, and divided into the Nalbuphine Group (n=53) and the Paravertebral Block (PVB) Group (n=53). The per-operative Nalbuphine requirement was significantly reduced in the PVB-Group, 2.28±0.37 mg versus 5.30±0.24 mg in the Nalbuphine-Group (p<0.001). Similarly, the time to the first dose of rescue analgesia was significantly prolonged in the PVB Group at 238.32±5.22 minutes versus 37.71±1.72 minutes in the Nalbuphine Group. The mean satisfaction score between both Groups was 4.33±0.64 in the Nalbuphine was 5.69±0.66 and in the PVB Group (p<0.001). Conclusion: We conclude that paravertebral block is superior to intravenous opioids in decreasing the per-operative and post-operative dose of intravenous opioids with a more favourable profile and a decreased incidence of adverse events. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of multivitamin supplement use among prescribed and non-prescribed population of Rawalpindi and Islamabad Pakistan. Study Design: It was a Quantitative analytical cross-sectional study. Place and Duration of Study: The study was carried out among general population of Rawalpindi and Islamabad Pakistan, from Jan till Apr 2022. Methodology: Nonprobability convenient sampling technique was used. The sample size was 385. The data was gathered through an online survey and was analyzed using IBM SPSS statistics version 25. Chi-square test was applied on qualitative variables with p-value significant at <0.05. Results: Only 41% of people were prescribed multivitamins by their doctors while 59% were self-medicated. An overall prevalence of multivitamin supplementation among the population was 66.9%. About 48.3% of people are aware of their harmful effects. Majority (88.1%) of population consider vitamins good for their health. 70% of people buy supplements via pharmacist and almost half of the people do not read the leaflets that come with supplements. Male gender was statistically significantly associated with awareness of vitamin supplement use and encouraging its use to others (p≤0.05). Conclusion: There exists a high prevalence of multivitamins use amongst the twin cities of Rawalpindi/Islamabad. Although most of the population had an awareness of what multivitamins are essentially, half the population do not know about the harmful effects of vitamins. Males had more awareness of multivitamins supplement use as compared to females. [ABSTRACT FROM AUTHOR]

Education is life blood for development of country. This paper explores the impact of various factors on student performance. Data was collected from ten (10) Govt. & Private schools in Rawalpindi. Out of 1100 hundred responded 600 hundred responses inducted in this study. Simple regression employed in this study to test the hypothesis. The result concluded that both factor have significant negative relationship with student performance. In future, the difference of performance level among male and female may be explored in term of pick & drop facility, university distance from home and other responsibility due on male student as they grow. [ABSTRACT FROM AUTHOR]

objective: To compare the frequency of inflamed appendix in suspected patients of acute appendicitis having Modified Alvarado Score (MAS) of 7 or more with patients having MAS of 6 or below. Design: Comparative cross sectional study. Place and duration of study: The study was carried out at Surgical Departments of Combined Military Hospital (CMH) and Military Hospital (MH) Rawalpindi from April 2006 to April 2007. Material and Methods: This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated and the patients were divided in two groups. Group-I had MAS of 7 or more while Group-II had MAS of 6 or below. Postoperatively appendices of all the patients were sent for histopathological examination and its result regarding presence or absence of acute appendicitis was then compared with MAS of respective group. Results: (a) Group-I:- A total of 72 patients with 64(88.9%) positive inflamed appendices on histology. Negative appendicectomy rate 8(11.1%), (b) Group-II:- A total of 28 patients with 8(28.6) positive inflamed appendices. Negative appendicectomy rate 20(71.4%). There is statistical significant difference of positive appendicectomy rate between two groups with (p-value<0.001). Conclusion: Frequency of inflamed appendix is more in patients having MAS of seven or above. The number of negative appendicectomies can be reduced by using MAS in clinical practice. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is an important healthcare-associated bacterium that causes a multitude of infections in humans such as superficial skin and soft tissue infections, necrotizing pneumonia, foodborne illnesses and postsurgical infections. Treatment of S. aureus infections has become more complicated due to the emergence of Methicillin-Resistant Staphylococcus aureus (MRSA), some of which are multidrug resistant. The present study aimed to characterize S. aureus isolates from a tertiary care hospital in the Rawalpindi district of Pakistan. Staphylococci were isolated from 300 clinical samples collected from January 2018 to January 2019 and S. aureus isolates were tested for antimicrobial susceptibility and analyzed using Pulsed-Field Gel Electrophoresis (PFGE), Multi-Locus Sequence Typing (MLST), staphylococcal cassette chromosome mec (SCCmec) and spa typing. Approximately 25.3% (76/300) of the clinical samples were positive for S. aureus; of those, 88.2% (67/76) were mecA+ (MRSA). In addition to the β-lactam antibiotics, high levels of resistance were also found to the fluoroquinolones (ciprofloxacin, gatifloxacin and levofloxacin (73.7% each)). Of the 23 different spa types identified, the majority of isolates belonged to spa type t632 and t657 (9/66; 13.6% each spa type). ST772-t657 (Bengal Bay clone) was the most commonly identified clone in this study although other clones circulating around different regions of the world were also found indicating the diversity in MRSA isolates from this area of Pakistan. This study emphasizes the need to monitor MRSA in the clinical setting for improved infection control and treatment options. [ABSTRACT FROM AUTHOR]

Aim of the study was to find out the frequency of screw loosening in self tapping IMF screws during the treatment of mandibular fractures. It was descriptive case series. It was carried out of oral and maxillofacial surgery, Armed Forces Institute Of Dentistry, Rawalpindi, from Oct 2012 to Jun 2013. Patients were treated for IMF with 4 screws and were advised follow up for 4 weeks. At each follow up visit screw loosening was assessed, and the observations were recorded along with age, gender, frequency and percentage. A total of 80 patients were selected and 320 self tapping IMF screws were used to achieve intermaxillary (IMF) fixation. Maximum number of screw loosening in any one case was one. Male patients constituted 60% while female were 40%. The mean age was 31.20 years which ranged from 18 to 47 years. Screw loosening was observed in 33.8% patients. The number of loose screws were related to the fracture pattern and distribution. Total number of IMF screws used were 320 with a maximum of 4 screws in each patient out of which 8.73% screws became loose. It was concluded that IMF screws can be used as an alternative method for obtaining quick and safe MMF in mandibular fracture with simple and undisplaced fracture patterns. [ABSTRACT FROM AUTHOR]

Introduction: Two patients with jaundice reported to the National Institute of Health (NIH), Islamabad from Shakrial, Rawalpindi in April 2017. An outbreak investigation team was formulated to assess the disease magnitude, risk factors and control measures. Methodology: A case-control study was conducted in 360 houses in May 2017. The case definition was: onset of acute jaundice with any symptom including fever, right upper-quadrant pain, loss of appetite, dark urine, nausea and vomiting among Shakrial residents from March 10 - May 19, 2017. Four age and gender matched controls were selected for each case. Blood samples were sent to the NIH for laboratory confirmation. Frequencies, attack rates (AR), odd ratios, and logistic regression were computed at 95% confidence interval and p < 0.05. Results: A total of 25 cases (23 new) were identified with mean age 8 years and male to female ratio 1.5:1. Overall AR was 1.39% and the most severely affected age-group was 5-10 years (AR of 3.92%). Multivariate analysis revealed that raw vegetable consumption, lack of awareness and poor handwashing practices had significant association with disease spread. All blood samples were positive for hepatitis A, and no resident was previously vaccinated. Lack of awareness of disease spread among the community was the most probable reason for the outbreak. There were no new cases during follow up until May 30, 2017. Conclusions: Healthcare departments should implement public policies towards the management of hepatitis A in Pakistan. Health awareness sessions and vaccination for children = 16 years age is recommended. [ABSTRACT FROM AUTHOR]