The Professional Medical Journal

Quadratus lumborum block in laparoscopic inguinal hernia repair: A single center study.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To evaluate the efficacy of QL block in patients undergoing laparoscopic TEP inguinal hernia repair. Study Design: Randomized Clinical Trial. Setting: Kalsoom International Hospital, Islamabad. Period: Dec 2022 to June 2023. Methods: In this, all patients between the ages of 18 and 70 who were scheduled for laparoscopic TEP inguinal hernia repair to repair a one-sided inguinal hernia and did not have any complications related to the hernia. In one group, the patients received general anesthesia and in the other group, the patients were given sedation along with a technique called QL block. Age, gender, pain score on VAS at 1 hours, 6 hour and 12 hours after procedure was noted. Comparison of pain according to the VAS by type of anesthesia was done between the two groups and independent sample t-test was applied to see the statistical significant. Results: The patients' mean age was 43 + 9.09 years. Around 70% of the patients were males, while 30% were females, indicating a male predominance. The study's outcome was the mean pain score after 1 hour, 6 hours, and 12 hours. The two techniques of anesthesia utilized in the two groups were compared in terms of pain. The mean VAS at 1 hour after the initiation of anesthesia was not significantly different between the two groups, but it was statistically significant at 6 and 12 hours (p value of 0.001). Conclusion: QL block is a safe and effective alternative for patients undergoing TEP inguinal repair because to the observed reduction in early postoperative pain, shorter hospitalization, and cheaper anesthetic and hospital costs. Although our research showed that pain was significantly reduced for up to 12 hours after the operation, more information is needed before we can confidently endorse it for widespread use.

Comparison of non-mesh vs mesh technique for inguinal hernias. A randomized clinical study.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To assess the efficacy of mesh with non-mesh techniques in the management of primary inguinal hernias. Study Design: Randomized Clinical Trail. Setting: Teaching Hospital Peshawar. Period: March 2022 till January 2023. Methods: This RCT study was conducted 166 on individuals with primary, reducible inguinal or inguino-scrotal hernias based on predetermined inclusion criteria. For the purpose of hernia repair, they were split into two groups: non-mesh and mesh repair. Computer-generated random numbers were contained in sealed opaque envelopes. Acute groin discomfort, the amount of time needed to return to duty, and sequelae were evaluated as clinical outcomes. SPSS version 23 was used to enter and analyzed the data. Results: Age range for mesh group was 33-65 while for non-mesh 34-65. Observed Male to female ratio was 9:1. In both groups, there was no discernible difference in pain. There were notable variations in the amount of time needed to resume work. Conclusion: Both repairs techniques are effective to treat hernias but mesh repair has superior results.

Adenoma detection rate as a quality indicator for colonoscopy.

Naik Muhammad, Mansoor-Ul-Haq, Tauqeer Shaikh, Atif Ali Hashmi — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the quality of colonoscopy in terms of adenoma detection rate in the existing local settings. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: February 2022 to August 2022. Methods: We analyzed patients having age 18 years or older, of any gender, and who had colonoscopy indications and were required to have a screening colonoscopy for diagnostic purposes. The number of procedures with at least one polyp or adenoma was classified as the polyp detection rate (PDR) and adenoma detection rate (ADR). Result: Total 210 patients were enrolled into the study with median age of 41.5 (29.8-56.3) years and majority were males (n=46, 69.5%). The most frequent indication for colonoscopy was constipation (n=72, 34.3%) followed by bleeding (n=78, 37.1%), chronic diarrhea (n=36, 17.1%), both constipation and diarrhea (n=21, 10%) and altered bowel habits (n=3, 1.4%). PDR and ADR were 16.2% (n=34) and 10% (n=21) respectively. Age was significantly higher among patients who were found to have polyp (p<0.001) and adenomas (p<0.001). Frequency of polyps (p=0.010) and adenomas (p=0.007) were significantly higher in male patients. Conclusion: The current research discovered a low rate of adenoma detection in people receiving colorectal cancer screening, and it did not meet the quality benchmarks that have been associated with higher rates of early diagnosis and cancer prevention.

Frequency of unplanned re-admissions after coronary artery bypass grafting. Experience at a tertiary care hospital.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To study the re-admission rate after coronary artery bypass grafting performed through a median sternotomy. Study Design: Retrospective study. Setting: Punjab Institute of Cardiology, Lahore. Period: January 2018 and December 2022. Methods: Patients above the age of 18 who underwent first time CABG were included in the study. Patients with additional procedures like valve surgery were excluded. Re-admission was defined as unplanned re-hospitalization within 30 days after discharge. Data was collected on Excel sheets from the available electronic medical record system of the hospital. The data was then transported to and analyzed using IBM SPSS software (version 23, SPSS Inc., Chicago, IL, USA). Patients were divided into re-admission group and no re-admission group and various perioperative variables were compared between the two groups. Results: After applying the exclusion criteria, the final analysis included 503 patients. Of the cohort, 29 (5.77%) were re-admitted. Mean age of the patients in readmission group was 54.3 ± 10 years while that in the no-readmission group 52 ± 8.3 years (p=0.144). The main reasons for readmissions were superficial chest wound infection (24.14%), pericardial effusion (24.14%) and deep sternal wound infection (10.34%). Conclusion: Coronary artery bypass grafting is associated with re-admissions after planned discharge of the patients. Wound infections are the commonest cause of re-admission. Large scale multi center studies are needed to study the rate as well as financial impact of re-admissions after CABG.

Frequency and risk factors for inadequate preparation on boston bowel scale during colonoscopic examination.

Mashal Bai, Shahid Karim, Rajesh Kumar, Afsheen Faryal, Sindhu Rani — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency and risk factors for inadequate bowel preparation using Boston Bowel Preparation Scale. Study Design: Cross-sectional study. Setting: Gastroenterology Department, Liaquat National Hospital, Karachi, Pakistan. Period: September 2022 to June 2023. Methods: The study comprised of patients between 18 to 70 years undergoing colonoscopy. Boston bowel preparation score (BBPS) was used to evaluate the quality of bowel preparation before washing or suctioning. Total score was calculated taking sum of scores in all three segments. Adequate preparation was defined as all 3 BBPS segment scores ≥ 2. Results: In a total of 136 patients, the mean age was 55.8±14.1 years. The mean BBPS score was 5.7±3.5. Based on the criteria of overall adequate rate, inadequate preparation was seen among 44 (32.4%) patients. Lower risk of inadequate preparation was significantly associated with outpatient patients, patients consuming more water and patients with liquid stool consistency whereas odds were significantly higher among patients with age 50 years and above, males, diabetic patients, patients receiving movcal sachet and dulcolex for preparation, patients with lower number of stools (2-4 stools per day) and, patients receiving insulin. Conclusion: The risk of inadequate preparation was higher among older age patients, male gender, diabetic patients, and patients with less number of stools with semi solid consistency.

Treatment of chronic sacroiliac joint pain using Conventional Radiofrequency (CRF) and Pulsed Radiofrequency (PRF): A randomized control study.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the effectiveness of conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) in treatment of chronic sacroiliac joint pain. Study Design: Randomized Controlled Trial. Setting: Shaikh Zayed Hospital, Lahore. Period: 2^nd August 2022 to 10^th February 2023. Methods: A total sample of 60 patients with SIJ pain was screened for this study. This sample was divided equally but randomly into both study groups; conventional radiofrequency (CRF) and pulsed radiofrequency (PRF). Pre-procedure general information on Visual analogue score (VAS) and revised Oswestry Disability Index (ODI) were used to measure the main outcome variables; pain score and physical disability index. Post-procedure information on these two outcome variables was also recorded after 1, 3 and 6 months duration. Paired samples t-test and independent samples t-test was used to assess the effectiveness of these two treatment methods for SIJ pain treatment. Results: The mean pain score in the conventional radiofrequency (CRF) group was reduced to 3.02 ± 0.9 from 8.02 ± 1.13 which is more substantial and statistically significant than pulsed radiofrequency where it was 4.2± 1.31 from 7.98 ± 1.20. Similarly, the conventional radiofrequency (CRF) group showed better performance on average scores of the ODI index (20.2± 6.9) as compared to pulsed radiofrequency (31.2± 8.9) in reducing physical disability in SIJ patients. Conclusion: This study concludes that the existing conventional radiofrequency (CRF) method of treatment can be effectively used in treatment of SIJ with its slight complications.

Clinical correlation of Magnetic Resonance Imaging (MRI) with symptom complex in prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To assess the clinical correlation of MRI with the symptoms of prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian. Study Design: Cross Sectional study. Setting: Tertiary Care Hospital, Kharian. Period: February 2022 to August 2022. Methods: The patients with age range 18 to 50 years, visiting hospital with complaint of low back pain and radicular pain were included in this study. Physical and neurological examination was conducted followed by MRI. The symptoms were correlated with MRI findings through correlation analysis with p<0.05 as significant. Results: The mean age was 38.09 ± 8.4 years with majority (54.6%) of patients in age range 41 to 50 years. The male patients (69.3%) and hard labor workers (59.3%) were more effected. Protrusion was the most prevalent type (60%). SLR was significantly associated with disc bulge and protrusion (p<0.001). The loss of power (56.6%) had significant correlation with disc protrusion (p < 0.001). Majority (55.3%) of the cases comprised of nerve root compression with more (47.3%) and significant prevalence in protrusion (p < 0.001). The multiple nerve root involvement had significant association with disc extrusion (p<0.001). Conclusion: MRI is a good means of indicating disease level in prolapsed intervertebral disc disease. However, some of the clinical symptoms show high association with the radiological findings, whereas, some are not good indicators.

Frequency of hospital acquired malnutrition at a tertiary care pediatric hospital.

Hina Rajani, Misbah Anjum — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of hospital acquired malnutrition in hospitalized pediatric population. Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: January 2023 to June 2023. Methods: The inclusion criteria were children (irrespective of gender) aged between 1 and 12 years who were admitted for at least 48 hours. Weight of the children was measured daily from the time of admission to discharge. The hospital-acquired malnutrition rate was determined by dividing the patients with decreased weight-for-height (WFH) or body mass index (BMI) z-scores by total samples, then multiplying by 100. Results: In a total of 367 children, the mean age was 6.4±2.8 years whereas 203 (55.4%) children were boys. Hospital stays ranged from 2 to 19 days, with a mean of 18±6.9 days. At the time of discharge, the mean weight to be 17.6±6.53 kg, indicating a mean weight drop of 1.3±1.14 kg from admission to discharge. Weight reduction during hospitalization was observed in all age groups, with the highest percentage observed in children aged 2 to 5 years (77.7%) and the lowest in those aged 1 to 2 years (38.9%). Significant changes were observed in both WFH z-scores (mean difference -1.06, ± 1.69, p<0.001) for children under 60 months and BMI z-scores (mean difference -1.07, ± 4.63, p=0.023) for children over 60 months from admission to discharge. Conclusion: Hospital acquired malnutrition is common among pediatric patients and deteriorates when a child is hospitalized without attention to adequate nutritional support. Weight loss shows direct correlation with duration of hospitalization.

Frequency of major congenital malformations in neonates born in three tertiary care hospitals of Pakistan.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To assess the frequency of major congenital anomalies in newborns delivered in three different hospitals of Pakistan. Study Design: Cross Sectional study. Setting: Department of Pediatrics Hameed Latif Teaching Hospital, Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Period: Jan 2023 to November 2023. Methods: 205 neonates who met the inclusion criteria were included in the study from labour room of Hameed Latif Teaching Hospital Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Informed consent was obtained from parents. Demographic variables (name of mother, gender, birthweight and gestational age at birth) were recorded. Then neonates were admitted in NICU and evaluated for presence of congenital malformations including cardiovascular system defects, limbs anomalies, genitourinary system, central nervous system and chromosomal anomalies. All data was entered in specially designed performa. Results: We found that overall gestational age was greater than 32 weeks with mean age of 37.190±2.00 weeks. Mean birth weight was 2.938±0.31 Kg. Frequency and %age of patients according to gender was 60% males and 40% females. Major congenital malformation was seen in 2.9% patients. Among infants with major congenital malformations, cardiovascular system defects were seen in 33.3% infants, limb anomalies 16.7%, genitourinary system 16.7% and central nervous system defects were 33.3%. Parents of 67.7% of cases were cousins. It was observed that only 32.3% of the mothers had taken the recommended daily dose of folic acid in antenatal period. Conclusion: Central nervous system and cardiovascular system defects were the most prominent anomalies detected. Prenatal diagnosis may be helpful in decreasing mortality by offering early termination.

Frequency of tracheal intubation associated adverse events and contributing factors in the Pediatric Intensive Care Unit (PICU).

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of adverse events associated with immediate tracheal intubation in children (1-18 years) from Pediatric Intensive Care Unit of Tertiary Care Hospital of Karachi, Pakistan. Study Design: Observational study. Setting: PICU of the Aga Khan University Hospital Karachi. Period: September 2020 to August 2021. Methods: A total of 183 intubations occurred during the study period. Data was extracted using the pre-designed peri-intubation proforma, data recorded on the checklist by the observer (Staff) who was fully trained by the Physician, later on compared by the researcher using the video recorded laryngoscopy used during the intubation procedure. Results: There were 183 intubations occurred during study period. Maximum intubations were in age group of 1-5 years (27.3%) and among total intubations, there were 11(6%) intubation related complications occurred. 6 (3.3%) cases have hypoxia, 3 (1.6%) bradycardia and 2 (1.1%) others (hypotension and esophageal intubation). Majority of the complications were observed during morning hours with statistically significant association. 63.60% TI related cases survived whereas 36.40% of them expired, 54.5% stayed in PICU for 0-10 days. Conclusion: Tracheal intubation related adverse events were 6% and majority of them lead to hypoxia. Physiological and mechanical complications with the procedure do occur inspite of our best efforts. Recognizing the complications associated with tracheal intubation can help physicians better care for patients requiring intubation.

Colour blindness prevalence and its awareness in primary school children of Karachi.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To Assess and compare different types of color blindness in primary school children also to appraise the self-awareness levels regarding this ailment amongst them. Study Design: Cross Sectional study. Setting: Different Primary Schools of Karachi in Collaboration with Department of Physiology, Jinnah Medical and Dental College Karachi. Period: 1^st October 2020 to 1^st December 2020. Methods: 146 primary school children of both genders aged between 5 to 12 years were assessed by prescribed questionnaire and Ishahara Chart for color blindness. Result: Out of the 148 students who underwent screening, only 16 were diagnosed with color blindness, indicating a prevalence of 10.8% among primary school children in Karachi. Of these 16 students, males exhibited a higher incidence of color blindness (56.25%) than females (47.35%). Conclusion: The incidence of color blindness is higher in males than females with significant association with family history and night blindness. Colour blindness unawareness also significantly found in this study. It is recommended to have an eye checkup at the start of school and to have regular eye examination to avoid any hindrances and get the right help.

Breastfeeding practices among infants at Madina Teaching Hospital in Faisalabad: A comprehensive analysis.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To gain insight into the breastfeeding practices of new mothers within a tertiary care facility. Study Design: Descriptive, Cross-sectional Approach. Setting: Department of Pediatric Medicine, Madina Teaching Hospital in Faisalabad. Period: Jan 2023 to June 2023. Methods: The study included 350 infants, of both genders, aged between 6 months and 1 year, who were attending the outpatient department for a routine checkup. Infants with congenital respiratory or cardiac conditions, as well as congenital anomalies such as cleft lip, diaphragmatic hernia, tracheoesophageal fistula, and congenital pneumonia at birth were excluded from the study. The researcher in training meticulously recorded data in the structured study Performa, utilizing this instrument to gather information on breastfeeding practices. Results: Findings revealed that 34.57% of mothers initiated breastfeeding within an hour after childbirth, while 53.43% did so between one and twenty-four hours later. Additionally, 30.57% of mothers chose not to provide their newborns with colostrum, whereas 69.43% did. Only 32.86% of women exclusively breastfed their infants. Furthermore, 35.71% of mothers fed their babies honey, 33.71% used ghutti, 17.14% opted for top feed, and 1.43% provided water. A backache hindered 32% of women from breastfeeding, while weakness affected 40.57%. Additionally, nostalgia, experienced by 13.43% of mothers, and depression experienced by 11.71%, also posed obstacles to breastfeeding. Conclusion: The study indicated that while the majority of mothers possessed knowledge about breastfeeding, there was a noticeable gap between knowledge and its application in practice. Surprisingly, a relatively small percentage of women engaged in exclusive breastfeeding.

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To assess the prevalence and underlying causes of thrombocytosis among patients seeking medical attention at a prominent tertiary care facility located in Lahore. Thrombocytosis, characterized by an elevated platelet count, can signify an array of underlying health conditions, and this research seeks to unravel the frequency of these causes within the study population. Study Design: Cross-sectional. Setting: Department of Pathology, Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to May 2020. Methods: A total of 150 patients were carefully selected from diverse medical specialties, including but not limited to medical, surgical, gynecological, obstetric, gastroenterological, nephrological, and intensive care units. The diagnostic criteria for thrombocytosis were aligned with the operational definition provided by the World Health Organization (platelet count exceeding >450 x 10^9/L) during the stipulated study period. Statistical analysis of gathered data was performed using SPSS version 17.0. Results: The findings of the study showcased that infections and iron deficiency emerged as the predominant contributors to thrombocytosis among the adult patient cohort. These factors were trailed by conditions like chronic infections, trauma accompanied by blood loss, and instances of splenectomy. Interestingly, instances of primary thrombocytosis, notably essential thrombocythemia, constituted a mere 2% of the overall sample size, signifying its rarity within this adult population. Conclusion: In the realm of thrombocytosis, the research highlights a notable prevalence of secondary thrombocytosis, while primary thrombocytosis remains a considerably infrequent occurrence among adults. The study emphasizes the significance of infections and iron deficiency anemia as the leading triggers for secondary thrombocytosis. Such insights contribute to an improved understanding of the spectrum of conditions associated with elevated platelet counts and may aid clinicians in effectively diagnosing and managing these underlying causes.

Confirmation of correct placement of nasogastric / orogastric tube on Point of Care Ultrasound (POCUS) in pediatric critical care unit patients.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine frequency of correct placement of nasogastric /orogastric tube on POCUS in pediatric critical care unit patients. Study Design: Descriptive cross-sectional. Setting: High Dependency Unit and Pediatric Intensive Care Unit, Indus Hospital Health Network, Karachi, Pakistan. Period: November 2022 to April 2023. Methods: Patients of age 1 months to 15 years of age requiring NGT placement were enrolled into the study. Patients with nasal surgery, fracture of skull base/ face, bleeding, coagulopathy, esophageal varices, stricture, upper gastrointestinal surgery were excluded from this study. NG tube was passed by principal investigator after evaluating correct size and length measurement. After passing the NG tube, gastric aspiration and gastric auscultation were also performed by principal investigator. Results: In this study we enrolled 147children with median age of patient was 3 (IQR=0.75-07) years. Majority of patient in our study were male (63.9%). Gastric aspiration and gastric auscultation was seen in all of the study patients. Based on POCUS, frequency of correct placement of nasogastric tube in children admitted in PICU was 83%. Sensitivity of POCUS against gastric aspiration and gastric auscultation was 82.5% with 100% positive predictive value (PPV). Specificity was unable compute as there was no negative finding in reference standard and hence there was also no false positive case. Conclusion: POCUS seems to be helpful and could help with the placement of NGT in paediatric clinical settings. Nevertheless, NGT envision in the stomach was difficult, and if the operator is not skilled or there is abdominal distention, it may go unnoticed.

Frequency of anemia in individuals with beta-thalassemia trait.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of anemia in carriers of Beta thalassemia Study Design: Retrospective Observational study. Setting: PAEC General Hospital, Islamabad, Pakistan. Period: 1^st January 2022 to 30^th June 2022. Methods: In this descriptive study, 131 carriers of Beta-thalassemia trait, diagnosed by hemoglobin electrophoresis on cellulose acetate membrane at alkaline pH, of any age and both genders were included. Complete blood counts were performed by hematology analyzer of Sysmex XN-1000 to determine hemoglobin level and red blood cell indices i.e. mean corpuscular volume. The studied parameters included hemoglobin and mean corpuscular volume as quantitative variables. Severity and type of anemia were the qualitative variables of this study and were expressed in terms of frequency and percentages. SPSS 19 version software was used for data analysis. Results: 131 carriers of Beta-thalassemia traits were included in study. 58 (44.27%) were males while 73 (55.73%) were females, male to female ratio being 1: 1.3. Of 131 beta thalassemia traits 67 (51.15%) were found to be anemic while 64 (48.85%) had normal hemoglobin for given age and gender. The mean corpuscular volume of anemic and non-anemics was 59.54+5.82 fl and 63.70+6.95 fl respectively. Mean hemoglobin level of anemic Beta-thalassemia traits was 9.42+1.05 g/dl while non-anemic patients was 12.12+1.39 g/dl. Conclusion: Burden of anemia among carriers of Beta-thalassemia traits is high. Understanding the prevalence of anemia in individuals with the trait is crucial for optimizing healthcare interventions and improving the quality of life for affected individuals.

Frequency of incidental findings of COVID 19 pneumonia on CT scan chest in patients undergoing CT imaging for some other indications.

Bushra Ujala, Istikhar Ali Sajjad, Nida Pervaiz — Mon, 01 Apr 2024 00:00:00 -0700

Objectives: To determine the frequency of incidental findings of COVID 19 pneumonia on CT scan chest in patients undergoing CT imaging for some other indications. Study Design: Descriptive, Cross sectional study. Setting: Department of Radiology, Allied Hospital, Faisalabad. Period: 4^th August 2021 to 3^rd February 2022. Methods: A total of 100 patients referred to radiology department for CT scan chest, individuals ranging from 15 to 65 years old, encompassing both male and female genders were included. Individuals with symptoms of COVID-19 and CRF were excluded. After taking informed consent, demographic features like age, gender, BMI, smoking (yes/no) were noted. Subsequently, all patients underwent a chest CT scan, revealing the inadvertent discovery of COVID-19 pneumonia. Results: In my study, frequency of incidental findings of COVID-19 pneumonia on chest CT scans among individuals undergoing CT imaging were consolidation (55.0%), ground glass opacities (80.0%), reticular pattern (47.0%) and air bronchograms (41.0%). Conclusion: This study concluded that ground glass opacities and consolidation are the commonest incidental observations of COVID-19 pneumonia on chest CT scans.

Epiretinal membrane formation after rhegmatogenous retinal detachment repair (RRD): A single center study.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of patients developing ERM (epiretinal membrane) after surgical procedure for RRD. Study Design: Retrospective study. Setting: Department of Ophthalmology, Madina Teaching Hospital Faisalabad. Period: November 2021 to October 2022. Methods: Involving patients of primary RRD; 160 patients enrolled before the operation, each patient had both of their eyes assessed, and then again after one month, and then three months after the procedure. These assessments comprised a comprehensive ophthalmological evaluation, which consisted of slit-lamp biomicroscopy, OCT scans. On the basis of ERM formation, the participants were divided into two distinct groups. Age, gender, length of retinal detachment in days, existence of PVD, type of surgery done for RRD, and presence or absence of postoperative ERM were some of the demographic and clinical data that were obtained. Results: A total of 160 patients' data was evaluated, and 47 (29.4%) of them had ERM formation following RRD repair. No factor such as age, gender, side of the eye involved and type of surgery has any influence on the outcome of ERM as the p value <0.05. Conclusion: According to the results it can be concluded that ERM is a prevalent complication after SB and PPV surgery dome for RRD but no associations were seen with age, gender, side of the eye involved and type of surgery has any influence on the outcome of ERM.

Efficacy of topical cyclosporine 0.5% in vernal keratoconjuctivitis.

Amber Khalid, Kanwal Zehra Rizvi, Quratulain, Aveen Fatima — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To evaluate the effectiveness of Topical cyclosporine 0.05% in comparison to topical artificial tear formulation (Tear Natural II) in the treatment of severe VKC. Study Design: Randomized Controlled Trial. Setting: Ziauddin University Hospital. Period: July 1 2022, to June 30, 2023. Methods: A group of individuals presented at the eye outpatient ophthalmology department (OPD) with complaints of redness, itching and watery discharges underwent clinical examination and were diagnosed with VKC based on inclusion criteria. Data was collected and analyzed using SPSS 23, with the Chi square test employed for variable comparisons. Result: In this study of 92 diagnosed VKC cases, participants were divided into two groups: Group 1 (interventional) and Group 2 (control), consisting of 47 and 38 individuals, respectively, with an average age of 9.6±2.3 years. Among them, 64 were boys (75.3%), and 21 were girls (24.7%). Group 1 showed improvement with a majority experiencing mild or quiescent symptoms, while Group 2 demonstrated worsening conditions, with a substantial portion reaching severe or very severe stages during the final follow-up assessment after six months. Conclusion: In conclusion, our research highlights the effectiveness of the topical cyclosporine o.o5% in significantly improving the condition of VKC patients over a six-month period.

Frequency of asymptomatic bacteriuria, causative pathogens and antibiotic sensitivity pattern in antenatal women.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of asymptomatic bacteriuria (ASB), causative pathogens and antibiotic sensitivity pattern in antenatal women. Study Design: Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, Nishtar Hospital, Multan, Pakistan. Period: February 2022 to July 2023. Methods: A total of 110 women with singleton pregnancy with gestational age 13-42 weeks, and aged 18 to 40 years were included. Once the patients were enrolled, demographic characteristics (age, gestational age, parity (primiparous or multiparous), body mass index (BMI), place of living (rural or urban), gestational diabetes mellitus (yes or no), educational status (illiterate, primary, middle, matric, or graduate)) were noted. Presence or absence of asymptomatic bacteriuria was noted. Results: In a total of 110 pregnant females, the mean age and gestational age were 28.7±3.9 years and 29.4±4.0 weeks, respectively. The frequency of ASB among pregnant women was found in 19 (17.3%) patients. The frequency of causative pathogens showed that E. coli was the most frequent isolates noted among 7 (36.8%) women while staphylococcus aureus, Klebsiella, pseudomonas spp, and Proteus spp were identified in 5 (26.3%), 4 (21.0%), 2 (10.5%), and 1 (5.26%) respectively. Antibiotic susceptibility patterns revealed that Amikacin, Nitrofurantoin, cephalexin, and Ciprofloxacin were the most sensitive antibiotics noted in 18 (94.7%), 17 (89.5%), 15 (79.0%) and 14 (73.7%) samples respectively. Conclusion: The frequency of asymptomatic bacteriuria in pregnant women is high with E. coli as the most common causative organism. Antibiotic susceptibility patterns revealed that Amikacin, Nitrofurantoin, cephalexin, and Ciprofloxacin to have good sensitivities.

Frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Outpatients Obstetrics & Gynaecology, Ward 8, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: July 30, 2021 to January 29, 2022. Methods: All patients who met the inclusion criteria and visited JPMC, Karachi were enrolled in the study. After providing a thorough explanation of the procedure, risks, and benefits of the study, informed consent was obtained. The study involved conducting detailed history and examination, as well as recommending relevant laboratory investigations such as thyroid and ultrasound pelvic/TVS profiles. Results: 150 women of thyroid disorders in patients with menstrual irregularities were included with mean age was 33.72±7.62 years, mean height was 1.69±0.07 meter, mean weight was 76.60±12.70 kg, mean BMI was 26.78±4.13 kg/m2, mean parity was 2.84±2.05 and mean duration of menstrual irregularity was 0.82±0.07 days. Positive family history of thyroid disorder was found to be in 15 (10.0%). Positive history of thyroid surgery was noted in 26 (17.3%) patients. Thyroid disorder was noted in 57 (38.0%) cases. In distribution for type of thyroid disorder, subclinical hypothyroidism was noted in 37 (64.9%), 9 (15.8%) overt hypothyroidism, 11 (19.3%) subclinical hyperthyroidism while overt hyperthyroidism was noted in 0 (0.0%). In distribution of menstrual complain, amenorrhea was noted in 3 (5.3%), 3 (5.3%) oligomenorrhea, 7 (12.3%) metrorrhagia, 32 (56.1%) menorrhagia while polymenorrhea were noted in 12 (21.1%) cases. Conclusion: It is to be concluded that thyroid disorder is frequently observed in patients experiencing menstrual irregularities, as indicated by the study. However, further research is required to validate these finding.

Association of tooth wear with freeway space among different age groups in patients with generalized tooth wear.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the association of tooth wear with freeway space among different age groups in patients with generalized tooth wear reporting to Khyber College of Dentistry, Peshawar. Study Design: Descriptive, Cross-sectional study. Setting: Department of Prosthodontics, Khyber College of Dentistry, Peshawar. Period: 3^rd May 2020 to 29^th January 2021. Methods: For this study, a total of 180 subjects were observed to identify the occurrence of tooth wear within the age group of 25-34 years, considering a prevalence rate of 3%. The sample size was determined with a 95% confidence level and a margin of error of 3%. Moreover, a non-probability consecutive sampling technique was used for data collection. Results: Data from 180 subjects were collected within a study duration of 7 months. The mean age of the subjects was 40.36±9.048 (SD) yrs. The chi-square test determined the association between tooth wear and freeway space, revealing a statistically insignificant (p-value of 0.16) relationship between the two variables. Conclusion: Freeway space was found to be statistically insignificant to the rate and degree of tooth wear.

Comparison between mini-plate and reconstruction plate osteosynthesis in the treatment of the comminuted mandibular fracture.

Bisma Iftikhar, Gulraiz Zulfiqar, Asad Mehmood — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To compare the treatment outcome for reconstruction plates and mini plates in treating comminuted mandibular fracture. Study Design: Randomized Controlled Trial. Setting: Department of Oral and Maxillofacial Surgery, Allama Iqbal Medical College/Jinnah Hospital, Lahore. Period: October 2021 to April 2023. Methods: All subjects presented for treatment of comminuted fractures of the mandible fulfilling the inclusion criteria at Jinnah Hospital Lahore Maxillofacial surgery department were included in the study, and were randomly allocated into group A and group B. The mini-plate osteosynthesis technique was used on Group A and Group B was treated by fixation with reconstruction plate. Results: A total of (n=30) patients were included in this study. Fifteen of these patients received mini-plate fixation (group A) and the remaining fifteen were treated with reconstruction plates (group B). The mean age was 29.4± 10.5 years. 80% of study subjects were male n=24. All patients of (group A) were treated via an intraoral approach. However, n=10 (66.6%) patients were treated by intraoral approach in (group B). Whereas the rest of the subjects (n=4) were treated with extra oral approach and (n=1) through combined intraoral and extra oral approach.100% stability at the fracture site was observed in both groups. Comparative occlusion status showed a nonsignificant p-value (p=1.000). Pearson chi-square value=0.0000a for plate exposure between both groups also shows a non-significant difference. The contour of the mandible was improved in 38.89% of (group A) population and 61.11% of group B patients. Conclusion: Mini-plate and reconstruction plate osteosynthesis are equally effective for the fixation of comminuted fractures of the mandible, considering postoperative occlusion status, stability of the fracture segment, and the possibility of plate exposure.

Epidemiology of suicide: Autopsy audit of five years in an industrial city of Punjab.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To determine the epidemiological pattern of suicidal deaths in an industrial city of Punjab Province over a period of five years as well as to determine the gender and age group mostly affected. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Forensic Medicine and Toxicology, Punjab Medical College, Faisalabad. Period: 1^st January 2019 to 31^st December 2023. Methods: Subjects of the study were victims of suicidal death in areas covered by Police stations where the postmortem was performed in the Mortuary of Punjab Medical College / Faisalabad Medical University. Data was collected from respective official Police records, FIRs and Postmortem reports and recorded on pre-structured proformas. It was categorized on the basis of manner of death, type of weapon, gender and age groups involved. Results: A total of 1329 autopsies were conducted during the Five-year time period from 2019 to 2023 in which 82 cases (6.17%) were labelled as Suicide on Autopsy and Police inquest. The highest percentage of suicides was recorded in year 2020 with 19 out of 254 cases (7.48%). Among the suicidal cases, 81.7% were males predominantly in the age group 20-29 years. It was found that 57.3% cases were reported from the rural areas. Hanging accounted for 65.8% of suicidal deaths making it the major method employed to commit suicide. Conclusion: Our study concluded that 6.71% cases of suicide were reported among all autopsy cases during the five-year time period of 2019-2023. Among these, young males in age group 20-29 years from rural areas were in majority and hanging was the most common method of suicide employed.

The reliability of a short scale PHQ-2 for screening depression among Pakistani medical students.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To investigate the reliability of a short scale i.e: PHQ-2 in medical students. Study Design: Cross-sectional Descriptive. Setting: Quaid-e-Azam Medical College, Bahawalpur. Period: 25-10-23 to 25-11-23. Methods: 159 Pakistani medical college students were selected through convenience sampling technique. Participants completed two scales, namely the Patient Health Questionnaire-2 (PHQ-2) and the Beck Suicide Ideation Scale (BSSI). The collected data from both scales were analyzed using SPSS version 21. The analysis included assessing the Cronbach’s alpha coefficient for the Patient Health Questionnaire-2 (PHQ-2) scores and its items in comparison with the Beck Suicide Ideation Scale (BSSI). Results: The average PHQ-2 score observed was (2.14 ± 1.69 standard deviation). The Cronbach’s alpha coefficient was (α = 0.72), indicating a high level of PHQ-2 internal items consistency. PHQ-2 showed a significant correlation with the Beck Suicide Ideation (BSSI) at (r=.48), indicating good construct reliability. Conclusion: The PHQ-2 scale appeared as a reliable scale for screening depression and it can be used for assessing depression and suicidal ideations in academic settings of Pakistan. However, its complementation with PHQ-9 is recommended for clinical use.

Compare the surgical outcome of Fistulectomy and Mucoal advancement flap in perianal fistula.

Mudassar Jabeen, Shahbaz Ahmed, Nida Firdous, Samia Rasool — Mon, 01 Apr 2024 00:00:00 -0700

Objective: To compare the fistulectomy with mucosal advancement flap in treatment of perianal fistula in terms of mean hospital stay, frequency of anal incontinence and wound healing time. Study Design: Randomized Control Trial. Setting: Surgical OPD, DHQ and Allied Hospital, Faisalabad. Period: 1^st March 2019 to 28 February 2020. Methods: Conducted on 120 (60 in each group) patients with fistula in ano presenting. Sampling technique was Non probability consecutive sampling. All the Patient age ranges from 20-55 years of either gender having perianal fistula which are low lying fistulas and with single external opening are included in study. Patients having perianal abscess, pilonidal sinus, Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis) or with history of tuberculosis, HIV disease, Complex high lying fistulas with multiple external openings are excluded. Results: In our study, group A underwent fistulectomy while on group B we perform mucosal advancement flap. About 56.67%(n=34) in Group A and 50%(n=30) in Group B were between 20-40 years of age while 43.33%(n=26) in Group A and 50%(n=30) in Group B were between 41-55 years of age, mean+SD was calculated as 38.78+9.07 years and 40.12+8.89 years respectively. According to gender division 86.67%(n=52) in Group A and 78.33%(n=47) in Group B were male while 13.33%(n=8) in Group A and 21.67%(n=13) in Group B were females, mean hospital stay was calculated as 93.93+4.56 hours in Group A and 107.95+4.66 hours in Group B, p value was calculated as 0.0001 showing a significant difference between the two groups. Comparison of anal incontinence in both groups was done showing that 13.33% (n=8) in Group A and 23.33%(n=14) in Group B had anal incontinence, p value was calculated as 0.15. At one month postoperative follow-up only 4 patient (6.7%) in group A showed complete wound healing while in group B 28 patients out of 60(46.6%)showed complete wound healing, P value was calculated as 0.00167 showing a significant difference while there is no significant difference in incidence of early post-operative complications. Conclusion: We concluded that hospital stay was significantly decreased in cases with fistulectomy when compared with MAF while there was no significant difference regarding anal incontinence in both groups.

A comparative study on intraoperative complication with posterior vitrectorhexis versus forcepsorhexis before implantation of intraocular lens in children.

Mon, 01 Apr 2024 00:00:00 -0700

Objective: To compare intraoperative complications in manual posterior capsulorhexis (forcepsorhexis) and posterior vitrectorhexis, before implantation of the IOL in patients of paediatric cataract surgery. Study Design: Observational study. Setting: Department of Ophthalmology, Shaheed Mohtarma Banazir Bhutto Medical University Larkana. Period: July 2021 to June 2022. Methods: Our study included patients within the age range of 1-12 years who were diagnosed with congenital cataract and did not exhibit any other abnormalities in the anterior or posterior segments. A comprehensive ophthalmic and systemic examination was conducted, and the patients were categorized into two groups: Group A for Forceps Capsulorhexis and Group B for Posterior Vitrectorhexis. Results: There were a total of 154 cases of paediatric cataracts that underwent surgical procedures known as Posterior capsulorhexis (forcepsorhexis) and posterior vitrectorhexis. Both groups had participants with ages ranging from 1 year to 12 years, with a minimum age of 1 year. The mean age for the Forceps Capsulorhexis group was 6.1+1.8 years, while the mean age for the Posterior Vitrectorhexis group was 6.9+1.3 years. The outcomes during surgery showed that in the Forceps Capsulorhexis group, 60 patients (77.92%) had organization of the capsular bag, while in the Posterior Vitrectorhexis group, 49 patients (63.63%) had organization of the capsular bag. Additionally, 55 patients (71.42%) in the Forceps Capsulorhexis group experienced vitreous thrust into the anterior chamber, compared to 66 patients (85.71%) in the Posterior Vitrectorhexis group. Conclusion: The safety and effectiveness of Forceps capsulorhexis as a treatment for paediatric cataract surpasses that of the posterior vitrectorhexis procedure, as concluded by our study.