The Professional Medical Journal

Commentary: Transforming Mental Health Care in Pakistan through Telemedicine.

Khadeeja Ishtiaq — 2024-12-01

This commentary explores the transformative potential of telemedicine in addressing mental health care challenges in Pakistan, particularly in the context of the COVID-19 pandemic. With approximately 34% of the population suffering from various mental disorders and significant barriers to treatment—such as social stigma, poverty, and limited access to resources—telemedicine offers a critical solution for delivering care, especially in underserved rural areas where traditional services are lacking. The article discusses the benefits of remote consultations, including increased accessibility, flexible scheduling, and reduced stigma, particularly for vulnerable populations like women who face additional societal barriers. However, it also highlights key challenges, such as the digital divide, with approximately 45% of the population lacking reliable internet access, and the urgent need for training among mental health professionals to effectively utilize telehealth platforms. The commentary advocates for a comprehensive approach that includes improving technological infrastructure, enhancing digital literacy, and community education to fully harness telemedicine's potential. Future research is essential to evaluate its long-term efficacy and inform policy decisions. Ultimately, telemedicine could play a vital role in reshaping mental health care delivery in Pakistan, fostering greater access and engagement in a post-pandemic world.

Frequency and outcomes of acute kidney injury in pediatric intensive care unit.

Yummnah Lone — 2024-12-01

Objective: The objective of this study is to ascertain the prevalence of acute kidney damage (AKI) in pediatric patients who are hospitalized to the critical care unit at Fatima Memorial Hospital in Lahore. Study Design: Cross-sectional Descriptive study. Setting: Pediatric Intensive Care Unit, Fatima Memorial Hospital, Lahore. Period: Jan 10, 2023 to July 10, 2023. Methods: 100 PICU children had urine output and serum creatinine measured. Patients received the proper pRIFLE categorization (Table II). Duration and mortality in the PICU were recorded. Results: For this research, we included 100 children from the Pediatric Intensive Care Unit (PICU) with an average age of 8.17 ± 3.81 years. There were an equal number of men and females, with each gender comprising 50% of the total population. The male-to-female ratio was 1:1. Upon admission, the average creatinine level was 1.04 ± 0.39 mg/dl, however it considerably rose to 1.44 ± 0.81 mg/dl throughout the patient's stay (p<0.05). The RIFLE criteria revealed that 50% of the children were at risk, 14% had injury, 8% had failure, 16% suffered loss, and 12% reached the end-stage. AKI was seen in 36% of the children. Conclusion: The risk of AKI is high in children admitted to PICU.

Frequency of Vitamin D deficiency in children under five years of age in a tertiary care hospital of Pakistan.

Sonia Saleem — 2024-12-01

Objective: To determine the frequency of vitamin-D deficiency in children under five years of age. Study Design: Cross-sectional-survey. Setting: Department of Pediatrics, Gulab Devi Hospital, Lahore. Period: 01-6-2022 to 1-12-2022. Methods: This cross-sectional survey was done in the Department of Pediatrics, Gula Devi Hospital, Lahore. One hundred children, with fever, flu cough or presented for vaccination or routine check-up were included via Non-probability consecutive sampling. Children were assessed for vitamin D level. Data analysis was done in SPSS v. 25.0. Results: In this study, there were 100 children included with mean age of 3.8 ± 1.1 years. There were 25 (25%) male children and 75 (75%) female children. The mean duration of sun exposure per 24 hours was 1.8 ± 0.6 hours, and previous history of vitamin-D deficiency was noted in 3 (3.0%) cases. Mean vitamin-D level was calculated as 24.75 ± 9.90 ng/ml in all the children. Out of 100 children, 62 (62.0%) children had vitamin-D deficiency. Conclusion: According to this data, “the chances of vitamin D deficiency are higher in children less than 5 years of age belong to local community.”

Comparison of short-term outcomes between Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation in preterm neonates with respiratory distress syndrome.

Syed Hassan Ahmed — 2024-12-01

Objective: To compare the safety and effectiveness of nasal continuous positive airway pressure (NCPAP) versus nasal intermittent positive pressure ventilation (NIPPV) as initial respiratory therapy among preterm neonates with respiratory distress syndrome (RDS). Study Design: Randomized Controlled Trial. Setting: The Neonatal Intensive Care Unit (NICU) of Indus Hospital and Health Network, Muzaffargarh, Pakistan. Period: January 2024 to June 2024. Methods: A total of 118 preterm neonates with 26-34 weeks gestation and admitted to NICU with RDS were randomly allocated to either NCPAP or NIPPV. Success respiratory support, along with complications, and mortality were noted. Results: In a total of 118 newborns, 64 (54.2%) were girls. The mean gestational age, and birth weight were 30.94±1.43 weeks, and 1479.07±310.69 grams. In NIPPV group, 49 (83.1%) babies showed successful outcome versus 29 (49.2%) in NCPAP group (p<0.001). Necessitation of intubation within 7 days (40.7% vs. 22.0%, p=0.029). Surfactant requirement (37.3% vs. 16.9%, p=0.013), and bronco pulmonary dysplasia (BDP) (11.9% vs. 0%, p=0.006) were significantly more in NCPAP group. Pneumothorax was significantly more prevalent in NIPPV group (18.6% vs. 3.4%, p=0.008). Duration of non-invasive support was significantly more in NCPAP group (10.58±6.07 vs. 8.15±3.58 days, p=0.009). Conclusion: NIPPV significantly outperformed NCPAP in terms of successful outcomes, as measured by reduced rates of intubation, surfactant requirement, and the incidence of BPD.

Neonatal sepsis – etiological study at the Central Park teaching Hospital, Lahore.

Mohsan Nadeem Sheikh — 2024-12-01

Objective: To identify the causative bacteria responsible for early and late onset neonatal sepsis and to determine their antibiotic susceptibilities at Central Park Teaching Hospital. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Central Park Teaching Hospital, Lahore. Study Period: Jan to June 2024. Methods: Neonates up to 28 days old with clinical features of sepsis were randomly sampled and included in the study. Key maternal and neonatal risk factors were evaluated. Blood cultures were analyzed to identify microbial isolates and assess resistance patterns. Demographic data, clinical features, and blood culture results were collected and analyzed using SPSS version 26.0. Results: Out of the cases studied, 55% were male. Early onset sepsis was slightly more prevalent at 51.5%. Significant maternal risk factors for early sepsis included maternal fever, offensive liquor, and prolonged second stage of labor. Blood cultures were positive in 18.8% of cases, with early onset sepsis accounting for 44.7% of positives and late onset sepsis for 55.3%. Gram-positive bacteria were more common in early sepsis (48.1%), with Acinetobacter baumannii and Candida blankii being notable isolates, while Gram-negative bacteria were more prevalent in late sepsis (63.6%), with Bacillus spp. and Burkholderia cenoc as key pathogens. Coagulase-negative Staphylococcus was the most frequently isolated pathogen in both early and late sepsis. Conclusion: The study underscores the importance of developing tailored antimicrobial strategies based on the timing of sepsis onset to improve neonatal outcomes. Significant differences in microbial distribution between early and late neonatal sepsis were observed (p < 0.001).

Reproducibility of spirometry in asthmatic children between 5-12 years of age.

Mehwish Afzal — 2024-12-01

Objective: To investigate how consistently children (aged 5-12) attending the asthma clinic at Abbasi Shaheed Hospital could perform forced expiratory maneuvers during standard spirometric evaluation. Study Design: Cross-sectional. Setting: Department of Paediatric, Abbasi Shaheed Hospital, Karachi. Period: October, 2021 till April, 2022. Methods: Prospective data collection was conducted on 128 suspected asthmatic patients following verbal consent. Simple descriptive statistics, including mean and standard deviation, were used to summarize quantitative data, while qualitative variables were reported as frequencies and percentages. Stratification was used to manage effect modifiers and evaluate their influence on the outcome variable. A post-stratification chi-square test was employed, with a significance level set at p ≤ 0.5. Results: A total of 128 suspected asthmatic patients were included in this study. Mean age in our study was 9.14±2.09 years. 58 (45.3%) were male and 70 (54.7%) were female. Out of 128 suspected asthmatic patients, 95 (74.2%) and 33 (25.8%) had and did not have reproducibility. Conclusion: In a busy clinical environment, a significant number of school-aged children demonstrate the ability to perform technically acceptable and repeatable spirometry. This indicates that spirometry could serve as an effective screening tool for identifying abnormal lung function, such as asthma, in this age group.

Effects of four cycles of anthracycline based chemotherapy on cardiac ejection fraction in breast cancer patients.

Faiza Mahar — 2024-12-01

Objective: To assess the impact of four cycles of anthracycline chemotherapy on left ventricle ejection fraction in breast cancer patients. Study Design: Analytical Observational, Cohort study. Setting: Department of Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: July 2023 to August 2024. Methods: A total of 56 patients with histologically confirmed BC cases of any age group were analyzed. A sample size of 56 was determined using OPENEPI, with a 95% confidence interval and 80% power. Data were collected through a predefined proforma, covering demographic information, breast cancer details, echocardiography findings (specifically left ventricular ejection fraction [LVEF]), and doxorubicin side effects. Treatment involved use of doxorubicin with LVEF measured at baseline and after four cycles of drug. Results: In a total of 56 patients, the mean age was 47.07±11.69 years. The baseline LVEF was 62.86±2.77%, which decreased to 60.50±5.32% after four treatment cycles. Comorbid conditions like hypertension, and a combination of hypertension and diabetes were noted in 32.1%, and 10.7% patients, respectively. All four drug cycles were administered to 92.9% of patients, with 14.3% requiring treatment discontinuation due to adverse events. Conclusion: Patients with elevated baseline LVEF levels tend to sustain higher LVEF levels after undergoing chemotherapy. These results emphasize the significance of vigilant LVEF monitoring in breast cancer patients treated with anthracycline chemotherapy, to enhance the management of potential cardiotoxicity.

The 30-Days readmission among hepatic encephalopathy patients and the associated factors: An experience of a tertiary care hospital in Karachi Pakistan.

Narjis Raza — 2024-12-01

Objective: To determine the 30-days readmission rate among hepatic encephalopathy patients and its associated factors among patients admitted in a tertiary care hospital. Study Design: Prospective Cohort study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: July 2023 to June 2024. Methods: Patients of cirrhosis with hepatic encephalopathy discharged from hospital were followed up in out-patient and inpatient department as per the hospital protocol. Data were entered into SPSS version 26 to perform statistical analysis. Results: Total 215 patients were included into the study. Mean age of patients was 55.40 ± 11.05 years and most of the patients were males (59.3%). Incidence of 30 day readmission was 15.3%. Causes of readmission were constipation (51.5%), infection (30.3%), electrolyte imbalance (12.1%) and renal failure (6.1%). Presence of hypertension and diabetes was associated with increased risk of readmission. Increasing potassium levels at the time of discharge were also found to be associated with increased readmission rate. Conclusion: The present study analyzed that main cause of 30 days readmissions were incidence of constipation and infection after discharge. Moreover, the study also showed that patients with comorbidity of hypertension and diabetes were likely to readmit.

Efficacy of Vitamin E Versus Pioglitazone in Treating Non-Alcoholic Fatty Liver Disease (NAFLD) without Diabetes “Decoding the Exodus of Liver Health”.

Muhammad Owais Fazal — 2024-12-01

Objective: To compare the effectiveness of vitamin E in comparison with Pioglitazone in the management of NAFLD without Diabetes. Study Design: Randomized Control Trial. Setting: Outpatient Department of Allied Hospital, Faisalabad. Period: Dec 2023 to May 2024. Methods: The Ethics Review Committee of Faisalabad Medical University was taken on board and patients having the characteristics of the set Inclusion Criteria were enrolled as allowed. Selected individuals were counseled regarding the study and their consent was sought. Using a computer-generated random number table, two main groups were formed out of the participants, Group A and Group B. Group A was given 800IU of Vitamin E daily. Group B received Pioglitazone 30mg daily. Patients were monitored for efficacy over three months by tracking ALT levels as specified in the operational definition. Follow-up was ensured through contact numbers. Results: In our study of 722 cases (361 in each group), the mean age was 41.25±6.41 years in Group A and 41.23±6.56 years in Group B. Males comprised 60.11% (n=217) of Group A and 59.56% (n=215) of the Group B, while females accounted for 39.89% (n=144) out of Group A and 40.44% (n=146) of the Group B. Efficacy comparison showed that 49.72% (n=147) in Group A and 31.30% (n=113) in Group B achieved efficacy, with a p-value of 0.008, pointing out a considerable difference. Conclusion: Our study succeeded in establishing the better efficacy of Vitamin E in treating NAFLD compared to Pioglitazone.

Comparison study of genexpert MTB / RIF assay versus sputum smear microscopy results in presumptive tuberculosis cases in district Ghotki, Sindh.

Rao Aftab Ahmed — 2024-12-01

Objective: To evaluate the performance of GeneXpert MTB/RIF assay by comparing its results with sputum smear microscopy. Study Design: Comparative Cross-Sectional Study. Setting: Department of Outpatient (OPD), Taluka and District Head Quarter Hospitals of District Ghotki Sindh. Period: October 2022 to 2023. Methods: In this study 350 Participants were included and all sputum specimens were tested for both above mentioned diagnostic tools that are sputum smear microscopy and GeneXpert MTB/RIF assay during the period October 2022 to April 2023. All details regarding the study such as Demographic details, sputum smear microscopy results, and GeneXpert MTB/RIF assay test results of patients were collected. A case of pulmonary tuberculosis (PTB) was considered to be a patient having mycobacterium tuberculosis detected in sputum by GeneXpert MTB/RIF assay. Results: In this study, 61 cases (17.4%) out of 350 participants, were detected in GeneXpert MTB/ RIF assay and 35 cases (10%) out of 350 participants were positive in sputum smear microscopy. Male ratio is slightly higher than female among GeneXpert positive cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy sputum smear microscopy were 57%, 100%, 100%, 91.7%, and 92.5%, respectively, when GeneXpert test is taken as reference test. Conclusion: Sputum smear microscopy is as specific as GeneXpert but less sensitive test for the diagnosis of pulmonary tuberculosis than GeneXpert MTB/RIF assay.

Dietary habits in patients presenting with chronic constipation at Tertiary Care Hospital, Karachi.

Moneeba Siddiqui — 2024-12-01

Objective: To determine dietary habits in patients presenting with chronic constipation (CC) at tertiary care hospital in Karachi. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital. Period: June 2022 to December 2022. Methods: Patients of age 18 years and above of either gender, presenting with history of CC were enrolled. Dietary fiber intake was determined on the basis of self-reported history. Dietary fiber intake was categorized as higher fiber intake, medium fiber intake and low fiber intake. Data was entered in SPSS version 26 to perform statistical analysis. Results: Total 190 patients were enrolled with median age and disease duration of 40 (IQR=29-55) years and 16 (IQR=9-24) months respectively. Majority of the patients were males (n=121, 63.7%). Around three-fourth people had low fiber intake (72.6%), nearly quarter had medium level of fiber intake (26.3%) and very few had high intake (1.1%). Fiber intake was significantly higher among those with low literacy. Less fiber intake was significantly seen with patients having dyslipidemia and weight loss. Water glass consumption per day was significantly higher among those with medium to high fiber intake. Conclusion: The present study analyzed that fiber intake was quite low among CC patients. General public should be educated regarding importance of dietary fiber for disease cure and better gut health particularly those who are lower educated patients and those with dyslipidemia.

Validation of Gall bladder wall thickness as a non-invasive marker for the prediction of esophageal varices in cirrhotic patients with portal hypertension.

Ameet Kumar — 2024-12-01

Objective: To validate the gall bladder wall thickness as a non-invasive marker for the prediction of esophageal varices (EV) in cirrhotic patients with portal hypertension. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January 2024 to June 2024. Methods: Patients of age 18 years, of any gender diagnosed with cirrhosis and were endoscopy naïve with no previous history of intervention for varices were included. After an overnight fast, the gall bladder (GB) thickness was measured twice at two distinct places, and an average value was determined. Results: Total 210 patients were enrolled into the study with mean age of 56.3 ± 11.8 years. Majority were males (57.1%). Patients had comorbidity of hypertension (17.1%) and diabetes (16.2%). Median gall bladder thick was 2.3 (IQR=1.2-2.9) cm. AUC for GB to predict EV was found to be 0.983 (95% CI: 0.96-1, p<0.001) which shows excellent predictive ability of GB thickness. The optimal cut-off value of GB thickness was found to be ≥1.95 cm. On multivariable regression analysis, increasing gall bladder thickness was found to be associated with higher odds of esophageal varices. Conclusion: The present demonstrated that GB thickness is a promising parameter with excellent predictive ability for prediction of EV among cirrhotic patients with portal hypertension, which should be included in part of routine evaluation in such cohort of patients for timely detection of EV.

Correlation between abnormal lipid profile and semen parameters in infertile males: Experience at a Tertiary care hospital.

Syed Atif Hussain — 2024-12-01

Objective: To determine the correlation between abnormal lipid profile and semen parameters in infertile males. Study Design: Observational Cross-sectional Study. Setting: Department of Urology and Pathology, Sheikh Zayed Hospital (SZH), Rahim Yar Khan. Period: January 2022 and December 2023. Methods: Infertile males between 18 to 45 years of age visiting the outdoor clinic subjected to semen analysis as work up of infertility. Infertile males with high BMI (>25kg/m2), family history of dyslipidemia and family history of high BMI were subjected to the estimation of lipid profile. A total of 127 infertile males with abnormal lipid profile were included. Serum total cholesterol >200 mg/dl, serum triglycerides >150 mg/dl, serum LDL >50 mg/dl, and serum HDL <40 mg/dl were the markers for an abnormal lipid profile. The study examined the correlation between aberrant lipid profile and characteristics related to semen, including sperm concentration (millions/ml), total sperm quantity (millions/ejaculate), morphology (percentage of normal forms), motility (percentage of progressive motility), and vitality (percentage of live). P-value less than 0.05 was deemed significant. Results: Mean age of the total 127 study subjects was 33±5.414years. Positive correlation of serum cholesterol has been found with respect to total sperm number (r=1.040), morphology (r=1.622), motility (r=0.832) and vitality(r=1.471). Positive correlation of triglyceride was found with respect to age (r=1.280) and sperm concentration (r=1.729). Positive correlation of HDL-c found with respect to sperm concentration (r=1.116). LDL-c shows positive correlation with respect to age (r=1.342), sperm concentration(r=0.856), total sperm number (r=1.757) and vitality(r=1.347). Statistically significant difference of serum cholesterol with respect to vitality (p value: 0.004), HDL-c with respect to sperm concentration (p value: 0.024), LDL-c with respect to age (p value: 0.037) and total sperm number (p value: 0.049) has been found. Conclusion: On the basis of our study, it has been concluded that abnormal lipid profile is positively correlated with semen parameters with significant correlation of LDL-c with total sperm number. Infertile males should have their lipid profile assessed to determine whether it adversely affects the characteristics of their semen parameters.

Efficacy of low-dose metronomic chemotherapy with 2 drugs versus 3 drugs oral regimen in metastatic breast cancer patients.

Rana Atique Anwer — 2024-12-01

Objective: To investigate the effectiveness of two LDMC drugs (cyclophosphamide and methotrexate) compared to three drugs (cyclophosphamide, methotrexate, and capecitabine) in treating MBC. Study Design: Retrospective study. Period: September 21, 2021, and December 31, 2022. Setting: Oncology Unit, Nishtar Hospital Multan. Methods: This study involved 80 female patients with metastatic breast cancer (MBC) who were selected consecutively. The participants were divided into groups A and B, consisting of 40 patients. Group A received two oral LDMC medications, cyclophosphamide and methotrexate. In comparison, group B received three medications: cyclophosphamide, methotrexate, and capecitabine. Results: In the study, it was observed that 27.5% of participants in group A exhibited disease control rate, whereas 60% of patients in group B showed disease control rate (p=0.014). The mean progression free survival was 10.5 weeks in group A and 19.7 weeks in group B (p=0.039). The mean duration of response was 27.4 weeks in group A and 35.5 weeks in group B (p=0.412). Conclusion: This retrospective research has demonstrated that using the low-dose metronomic chemotherapy (LDMC) treatment with a three-medicine combination regimen significantly improved outcomes in patients with metastatic breast cancer (MBC). The observed disease control rate (DCR) was considerably higher.

Comparison of frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing transurethral resection of prostate with and without postoperative catheter traction.

Hafeez Sohaib Ahmad Warraich — 2024-12-01

Objective: To determine and to compare the frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing TURP with and without postoperative catheter traction. Study Design: Analytical Cross Sectional Study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Dec 2023 to March 2024. Methods: After ERC approval & informed consent a total of 48 patients with comparable baseline characteristics such as age and preoperative prostate size who underwent TURP and were having significant postoperative hematuria (≥ grade 2 on a standardized hematuria colorimetric card) were enrolled in the study & were divided into two groups i.e. group A and group B, each having 24 patients. Group A patients were subjected to postoperative catheter traction with thigh using an adhesive band that was maintained over the night, while group B patients were not subjected to this postoperative intervention. Patients of both the groups received a single shot of IM diclofenac sodium 75mg in the recovery room and later on oral diclofenac sodium 50mg was given twice a day. All Patients were presented with a visual analogue scale (VAS) every 6 hourly during the first 24 hours postoperatively and were given additional IM diclofenac sodium 75mg if the reported pain was of moderate-severe intensity as indicated by the VAS score and an entry was made on the pro forma. Also, at the time of discharge total days spent in the hospital by patients of both the groups after undergoing TURP and any postoperative complications were noted. Results: 79.16% of group A patients required additional postoperative analgesia as compared to a value of 29.16% of group B patients (p= 0.0001). The mean hospital stay of group A and group B was 4.04 ± 0.65 days and 3.25 ± 0.65 days respectively (p=0.0001).

Comparison of outcome of lambda plate versus double plate fixation in AO Type C fractures of distal humerus in adults.

Azlan Bashir — 2024-12-01

Objective: To compare the outcome of lambda plate versus double plate fixation in AO Type C fractures of the distal humerus in adults regarding bone union, range of motion and MEP score. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 1-01-2020 to 31-12-2020. Methods: After fitting in the inclusion criteria, 50 patients were signed up, 25 in each group. In group A, patients underwent surgery by using a lambda plate. In group B, patients underwent surgery by using a double plate. All this procedure was done by a researcher under the supervision of a supervisor. On follow up on each visit, patients were re-evaluated for MEP score. If MEP scores>75, then excellent to the good outcome was noted. Meanwhile, range of motion and bone union on x-rays was also evaluated. Results: In this study, the average age of the patients was 37.46±11.34 years; 32(64%). patients were male, while 18(36%). patients were females. After the 6th month, the excellent to good MEP score was noted in 23 patients (92%) of the double plate group versus the excellent to good MEP was found in 24 patients (96%) of lambda plate group, p-value=>0.999. After the sixth month, in the double plate group, the delayed union was noted in two patients (8%) of double plate group while in one patient (4%) of lambda plate group, p-value=0.261. Conclusion: This study concluded that in the management of fractures of distal humerus in adults, both lambda plate and double plate fixation are equally effective.

To evaluate the outcome of intramedullary nailing in femoral shaft fractures in children.

Malik Muhammad Abbas — 2024-12-01

Objective: To determine the frequency of outcome of intramedullary nailing in femoral shaft fractures in children. Study Design: Case series study. Setting: Department of Orthopedics, ATH, Abbotabad. Period: 27^th February 2020 to 26^th August 2020. Methods: We included 85 patients with femoral shaft fractures, and age 5 to 10 years of both genders, meeting the criteria and consent was taken. Each patient was followed fortnightly for assessment 2 of outcome (excellent/satisfactory/poor) after 3months post-operative. Results: In our study age ranges from 5 to 10 years with mean age of 7.14 ± 0.90 years. Majority of the patients 60 (70.59%) were between 5 to 7 years of age. We had 64 (75.29%) males and 21 (24.71%) were females. Mean weight was 24.35 ± 4.66 kg. Mean duration of symptoms was 6.48 ± 2.45 days. In this study, the excellent outcome was seen in 70 (82.35%) patients, satisfactory in 10 (11.77%) and poor outcome in 05 (5.88%) patients. Conclusion: This study concluded that intramedullary nail is simple, effective, minimally invasive procedure for treating femoral shaft fractures in children with excellent outcome.

Determination of 99th percentile upper reference limit of cardiac troponin I in healthy population of Rahim Yar Khan.

Anber Rahim — 2024-12-01

Objective: To determine the 99th percentile upper reference limit (URL) of cardiac troponin I (cTnI) in healthy population of Rahim Yar Khan. Study Design: Cross-sectional study. Setting: Department of Chemical Pathology, Sheikh Zayed Hospital, Rahim Yar Khan. Period: February 2023 to November 2023. Methods: A total of 262 healthy individuals aged between 20-76 years without any known cardiac diseases were included and selection was performed on the basis of a designed questionnaire. Serum hs-cTnI was measured using a chemiluminescent technique on ACCESS II, Beckman Coulter. A non-parametric statistical technique was used to establish the 99th percentile upper reference limit (URL) of hs-cTnI in accordance with CLSI Document C28-A3c. Mann Whitney U test was applied between two subgroups taking p value <0.05 as significant. Results: In this study, 136 (51.9%) were males and 126 (48.1%) were females. Of the total 262 study subjects, 180(68.7%) had values greater than Limit of detection (LoD) 2.3 ng/L while 82(31.3%) had values less than LOD. Overall, Male and Female 99^th percentile URL of hs-cTnI in population of Rahim Yar Khan was found to be 10.8, 13.1 and 8.3 ng/ml respectively before removing any outliers. After removing outliers by Dixon/Reed method, the 99^th percentile URL found to be 8.4, 9.0 and 6.3 ng/L for overall, males and females respectively. The distribution troponin I with respect to age and gender was statistically significant with p value <0.05. Conclusion: On the basis of our study, it was concluded that the study population's overall high-sensitive cardiac troponin I 99th percentile URL was found to be significantly lower than both manufacturer-quoted values and results published in prior publications. High-sensitive troponin assay allows precise quantification of very low cardiac troponin concentration that helps in rapid exclusion of myocardial infarction.

Surgical repair of post infarct ventricular septal rupture in Peshawar Institute of cardiology: Experience in a newly established tertiary care hospital.

Waqar Masud Malik — 2024-12-01

Objective: To share our experience of post infarct closure of ventricular septal rupture in newly established cardiac center. Study Design: Retrospective study. Setting: Department of Cardiac Surgery, Peshawar Institute of Cardiology, Peshawar. Period: Jan 2021 to August 2024. Methods: All VSR repair cases done during this period were included which were 10. Results: A total of 10 cases of surgical repair of VSR were included in the study. 50 % were males. Mean age was 65 years (IQR 14.7). 40 % were diabetic while 80% were hypertensive. 20% patients had thrombolysis while 60% had PPCI. 50 % patients presented with NYHA IV symptoms. 10% patients were in pre operative AKI. 40% were in cardiogenic shock. 10 % had pre operative IABP passed while 50 % were stabilized with preoperative ionotropic support. 90% of VSR were anterior while 10% posterior. Median VSR size was 13.5 mm (IQR 12.2mm). 20 % VSR were multiple. Median time from onset of symptoms to VSR was 4 days (IQR 2.5). Median time from hospital presentation to VSR repair was 15 days (IQR 20.7). Concomitant CABG was performed in 90% cases. Post operative median ICU stay was 4 days (IQR 4.7) while hospital stay was 7 days (IQR 7.2). Residual VSR, pleural effusion, reopening, post Operative AKI, stroke and heart failure each were present in 10% cases. In hospital mortality was 10%. Conclusion: Optimal timing of surgery and preoperative status of patients are important determinant to decrease postoperative complications and mortality.

Prevalence of anxiety among medical students of D.G. Khan Medical College: A cross-sectional study.

Areeba Rashid — 2024-12-01

Objective: To evaluate anxiety levels among medical students of a public medical college by using a self-administered anxiety questionnaire. Study Design: Cross-sectional study. Setting: Study was conducted on the MBBS students of D.G. Khan Medical College. Period: December 2022 to June 2023. Methods: A validated questionnaire comprised on Beck Anxiety Inventory (BAI) scale was provided to all MBBS students at D. G. Khan medical college. Sociodemographic variables like; gender, age, locality, and current residential status were included in the questionnaire. The data was transferred to SPSS V-23 to analyze the variance of Anxiety Levels and MBBS study years among both genders. The p-value (p ≤ 0.05) was used to decide significance of the results. Results: The number of respondents was 523 (93.6%) out of 559 enrolled students at the time of the survey. Using the BAI scale, the overall anxiety estimated in MBBS students was 96.4% including male (95.5%) and female (97.0%). However, the prevalence of severe anxiety observed in female (22.2%) students was slightly higher than male (21.9%) students. Moreover, the highest level of severe anxiety (37.1%) was detected in 3^rd year students whereas, the peak value of overall anxiety (23.1%) was detected in 2^nd year students. The gender comparison test (p = 0.006) revealed that females exhibit more anxiety than males. Conclusion: The higher levels of anxiety were consistently observed among female students. The severe anxiety was observed among 3^rd year students, likely due to their transition into the clinical year facing additional c hallenges beyond academics.

Invivo and ex-vivo evaluation and characterization of wound healing effect of topical calendulaofficinalis and turmeric cream in diabetic rats.

Komal Arshad — 2024-12-01

Objective: To evaluate wound healing by topically administration of calendulaofficinalis and tumeric cream to diabetic rats. Study Design: Observational Cross-sectional study Setting: Department of Pharmaceutics, Faculty of Pharmacy, BahaUddin Zakariya University, Multan, Pakistan Period: October 2020-march 2021. Method: Different batches of hydrophilic cream bases (C1-C6) were developed and characterized. The optimized base composition (C6) was loaded with calendula Officinal is extract and turmeric powder as an active ingredient (C7) and evaluated the rate at which wounds heal in diabetic rats. Calendula officinal is and turmeric were combined in a cream, as different stability parameters of the creams were analysed at different temperature. Microbiological action of the cream was also examined. Results: The formulation was homogenous, stable with pH 6.29±0.03, viscosity 381± 6.96 Cps and the microbiological quality met the requirements of European pharmacopeia. The total flavonoid content was less than 1. The formulation showed accelerated wound healing with more than 95% wound contraction after tenth day. Conclusion: The result were favorable and suggested that topical administration of Calendula officinal is and turmeric powder combination would enhance wound healing in diabetic rats with potential for diabetic foot ulcer treatment. Moreover, the designed formulation poses good quality emulsion system stabilizing the active ingredient as well as appropriate release of medicinal agents.

Surgical site infection in clean cases with or without antibiotics.

Muhammad Abu Talha Dar — 2024-12-01

Objective: To assess the rate of infection in clean cases with antibiotics or without antibiotics. Study Design: Observational Prospective study. Setting: Surgical Unit 1, Independent University Hospital, Faisalabad. Period: Oct 2022 to February 2023. Methods: All patients were selected from surgical wards and OPD. Patients of any age group undergoing clean surgeries were included in this study. The demographic details such as age, gender and type of surgery were recorded for statistical analysis. Patients with Diabetes mellitus, hypertension and immune-compromised patients were excluded from these studies. All patients were kept under observation for 30 days to look any evidence of SSI. Results: One group is given antibiotics and the other does not. But No significant difference between the infection rate in both group. Conclusion: It was concluded that there is no role of antibiotics in infection control in clean cases.

Aspiration of an unusual Foreign Body: A case report.

Syed Mohsin Raza Bukhari — 2024-12-01

Foreign body aspiration is an important cause of death in children, having a spectrum of presentations. Date seed aspiration is an unusual event and here we present a case of a 4-year-old child who was referred to our hospital after aspirating a date seed. 12 days prior to referral, the child aspirated the seed and had breathing difficulty and cough. The parents took the child to a hospital for examination and CT Virtual Bronchoscopy was done revealing FB in the right main bronchus at which point the child was referred to our hospital where bronchoscopy was done and the child recovered without any complication.