Pakistan Journal of Health Sciences (Lahore)

Impact of Human Immunological Responses and Viral Genetic Diversity on Outbreak of Human Monkeypox Virus. A Comprehensive Literature Review Study

Irsa Shabbir — 2024-09-30

Monkeypox was caused by Monkeypox Virus (MPXV) and can infect both humans and animals. An understanding of the interplay between host immunity and genetic diversity was necessary to understand the etiology and epidemiology of monkeypox disease. Objective: To clarify how genetic differences and host immune responses interact when a moneypox infection occurs. Furthermore, we also aim to provide insights into individual variability in illness outcomes and possible treatment targets by investigating how distinct genetic profiles affect immune system activation and efficacy. Methods: Recent research on monkeypox, concentrating on the immune response mechanisms of the host and genetic variables linked to virus vulnerability have thoroughly analyzed. For this purpose, the data were searched from various research engines such as google scholar, pubmed, medline etc., by using different key words i.e., monkeypox and host immunity, monkeypox and antibodies interactions, monkeypox outbreak, mnkeypox strains. Conclusions: The way a monkeypox infection progresses and turns out was greatly influenced by the interplay between host genetic differences and immunological responses. Public health initiatives and the creation of tailored treatment plans can both benefit from the identification of genetic markers linked to immunological response profiles and vulnerability.

Chronic Respiratory Diseases: Innovations in Treatment and Management

Sami Ullah Mumtaz — 2024-09-30

Chronic Respiratory Diseases (CRDs) include diseases of the airways and the lung and are among the major causes of morbidity and mortality worldwide. The major CRDs include asthma, chronic obstructive pulmonary disease (COPD), pulmonary sarcoidosis, pneumoconiosis and interstitial lung diseases (ILDs). The common symptoms of CRDs include wheezing, chest tightness, shortness of breath and cough [1]. These diseases affect millions of people across the globe and have significant impacts on patients’ quality of life and healthcare.

Over the past few decades, however, improvement in the pharmacotherapy has provided a considerable progress. For example, biologics have given a new insight in the management of severe asthma by modulating certain inflammatory processes. Medications like omalizumab, dupilumab, and Mepolizumab are aimed at adjusting the immune response and significantly decrease the frequency of exacerbations and increase overall lung function.

In addition, innovations in the field of stem cell therapy and tissue engineering are targeted to repair or replace diseased lung tissue, thus, being aimed at treating the origin of the diseases rather than simply alleviating the symptoms. Furthermore, Nanoparticles can be orally given, intravenously injected or inhaled using nanoparticle aerosols. Nanoparticles can also be used in the molecular imaging of chronic lung diseases such as COPD.

Advanced inhalers, developed with sensors, can monitor the usage of medication and provide feedback in real-time to ensure compliance to prescriptions and other salient treatment plans. COPD pulmonary rehabilitation programs of exercise and education together with psychological support for individuals have been documented to enhance quality of life. The use of AI and a machine learning system has now moved to the ability to forecast disease exacerbations and provide individualized recommendations for treatment of CRDs.

As a result, people with COPD receive care through various healthcare professions like doctors, nurses, and physiotherapists, which may have diverse roles, such as prescribing medications, supporting their self‐management or patient education, or delivering exercise training. The aim of an Integrated Disease Management (IDM) programme is that various aspects of care through which healthcare providers are working in coordination to deliver improved and optimum care to patients.

Similarly Advancements in the treatment of ILD are being conducted, and recently, some new FDA-approved drugs have been advised for the management of patients. Among these are Nintedanib is a tyrosine kinase inhibitor, Pirfenidone an anti-fibrotic and anti-thrombotic agent and Treprostinil is an analogue of prostacyclin. These drugs have opened a new path for the treatment of ILD and have improved the recovery outcomes of patients [2]. Rituximab has also been found to be effective in more than half of patients treated in a small prospective open-label trial of refractory pulmonary disease in sarcoidosis[3].

Overall, there is a renewed emphasis on CRD management as a burgeoning field. With the advancement in the research in the personalized, proactive and integrative strategy the efforts made will lay down new avenues of better health outcomes for millions of people suffering from the CRDs. The future of respiratory health is bright as it is a growing field that has no sign of discontinuing its steady development and pushing for the comforts and breakthroughs for many patients across the globe.

Assessment of Pain and Functional Outcomes in Individuals with Patellofemoral Pain Syndrome

Abdul Hannan — 2024-09-30

Patellofemoral pain syndrome is a pathological condition of the patellofemoral joint characterized by knee pain in the peripatellar, anterior, and even retro patellar regions. Between 15% and 45% of persons in their 20s to 40s experience patellofemoral pain. Objective: To assess pain and functional outcomes in individuals with patellofemoral pain syndrome. Methods: At Mayo Hospital and the University of Lahore Teaching Hospital, 87 people enrolled in this cross-sectional study using a non-probability convenience sampling technique during the period of 20^th January 2024 to 20^thJuly 2024. Both male and female patients between ages of 20 to 40 years with a positive patellar grind test were included. The numeric pain rating scale and Kujala score were used for data collection to assess pain and functional outcomes respectively. Data were analyzed using IBM SPSS Statistics 25.0. All qualitative variables were shown as frequency and percentages; all quantitative data were provided as Mean ± S.D. Results: Mean age of participants was 30.68 ± 5.62 years. Out of 87 participants, there were 41 (47.1%) females and 46 (52.9%) males. The mean score of the Numeric Pain Rating Scale was 6.31 ± 1.56 and the Kujala score was 46.37 ± 10.36. Out of 87 participants, 6 (6.9%) had mild pain, 62 (71.3%) had moderate pain and 19 (21.8%) had severe pain. The NPRS and Kujala Score have a very weak correlation of 0.049 with a p-value of 0.655. Conclusion: It was concluded that this study had a significant impact of patellofemoral pain syndrome on pain and functional outcomes in affected individuals.

Comparing Absolute Eosinophil and Monocyte Counts in Critical and Non-Critical COVID-19 Patients

Yasir Ishaq — 2024-09-30

Emerging evidence suggests that variations in immune cell counts, particularly absolute eosinophil and monocyte counts may be important in predicting the clinical course and severity of the disease in COVID-19 patients. Objective: To compare the absolute eosinophil and monocyte counts ‘between critical and non-critical COVID-19 patients to elucidate potential associations with disease severity and prognosis. Methods: Between March 19th and June 6th, 2021, peripheral blood samples were taken from 26 ‘critical COVID-19 patients and 26 non-critical COVID-19 patients. Standard laboratory procedures were used to determine the immunological and haematological parameters for every participant. Whole blood samples were taken in ethylenediaminetetraacetic acid (EDTA) tubes and processed per the manufacturer's instructions using an automated haematology analyser (XN-1000, Sysmex, Japan). Results: Critical patients of COVID-19 exhibited significantly reduced absolute eosinophil, absolute monocyte, and lymphocyte count compared to non-critical patients. Additionally, critical patients were significantly older. However, there is no significant differences in the two groups' basophil counts, neutrophil counts, WBC counts, RBC counts, HCT percentage, HGB levels, MCH levels, MCV, MCHC levels, and MPV or platelet counts. Conclusions: Critical patients exhibited significantly reduced absolute eosinophil and monocyte counts suggesting a potentially weaker immune response in these subgroups. The significance of immune cell counts in assessing the severity of COVID-19 is highlighted by these results which may aid in developing targeted therapeutic interventions and prognostic indicators. Validating these results and clarifying their therapeutic significance will require more investigation.

Demographic and Clinical Features of Allergic Rhinitis Presenting at a Postgraduate Teaching Hospital

Tahir Hussain Khan — 2024-09-30

Allergic rhinitis is a common disorder that affects millions worldwide and it represents a global concern. Objective: To determine the frequency of clinical variables, and demographic pattern of the allergic rhinitis patients in the otorhinolaryngology outpatient department in a Teaching Hospital. Methods: This cross-sectional study was conducted at the Department of Ear, Nose, and Throat of Kulsumbai Valik Site Postgraduate Teaching Hospital Karachi from 1^st July 2022 to 31^st December 2023. The study comprised allergic rhinitis patients. A total of 750 patients were included in this study after diagnosing allergic Rhinitis mentioned on their prescription. Data were collected properly on a predesigned questionnaire. Variables included age, gender, socioeconomic status, residence, sneezing, itching in the eye and nose, rhinorrhea, nasal discharge, bluish pale nasal mucosa (Nasal Congestion), edematous turbinate, and headache. Data were entered in SPSS software version 23.0 and analyzed. Results: The mean age of patients were 39 ± 13 years. Male were reported 447 (59.6%) and female patients were 303 (40.4%). 390 (52%) patients have resided in Industrial areas while 360 (48%) patients were in city areas. The most common symptom was nasal itching 522 (69.6%) followed by rhinorrhea 492 (65%) and nasal discharge 465(62%). Conclusions: It was concluded that allergic rhinitis patients presenting at the ENT outpatient department showed that males were commonly affected with the productive age group 59% of males suffered from Allergic Rhinitis. The most frequent and common symptom was nasal itching (69.6%) followed by rhinorrhea (65%) and nasal discharge (62%).

Association Between Acute Ischemic Stroke and Raised Serum Gamma Glutamyl Transferase

Sibgha Kanwal — 2024-09-30

The serum gamma-glutamyl transferase level predicts the development of cardiovascular illnesses. Serum gamma-glutamyl transferase levels have been linked to atherosclerosis in several investigations, indicating that gamma-glutamyl transferase may be utilized as an early indicator of atherosclerosis. Objective: To determine the association between acute ischemic stroke and raised serum gamma-glutamyl transferase. Methods: After obtaining ethical approval, in this case-control study, 310 patients fulfilling the selection criteria were included from the Medical Emergency Department of, KEMU/ Affiliated hospital, Lahore from August 2022 to February 2023. Informed consent was obtained. After matching for age (40-80 years) and gender (both male and female), 155 controls enrolled preferably the accompanying healthy attendants of the patients and 155 cases i.e. ischemic stroke patients. Venous blood samples were obtained from cases at the time of presentation in the Emergency Department for serum gamma-glutamyl transferase (GGT). Data was collected in structured proforma. Data scrutiny was done using SPSS version 26.0. Mean and standard deviation were used for quantitative variables and frequency for qualitative data. Data were stratified for effect modifiers, and p≤0.05 was taken as significant. Results: In the current study, the frequency of raised GGT was found more among cases as compared to controls i.e. 74% vs 20%, p<0.00001 and OR calculated was 11.5. Conclusions: It was concluded that a considerable percentage of patients had raised gamma-glutamyl transferase at the time of presentation with acute ischemic stroke. These results emphasize the need to keep an eye on GGT levels in ischemic stroke patients as a possible stroke marker.

Antibiotic Resistance Patterns of Pseudomonas aeruginosa Bacterial Species Isolated from Various Clinical Samples

Qandeel Abbass Soomro — 2024-09-30

Pseudomonas aeruginosa infections have become a real burden in healthcare settings, contributing substantially to nosocomial infections. The emergence of several drug-resistant strains was the major issue causing massive mortality. Multiple-drug resistant Pseudomonas aeruginosa isolates containing beta-lactamase were becoming more prevalent. Objective: To investigate and characterize the antibiotic resistance patterns of Pseudomonas aeruginosa isolated from different clinical samples. Methods: A total of 618 different clinical samples including blood, pus and urine samples were collected from the patients visiting Indus Medical College Hospital Tando Muhammad Khan, Sindh, Pakistan. All the clinical samples were processed for the isolation of bacterial species using specific culture media. The identification of Pseudomonas aeruginosa strains was achieved based on Gram’s staining and certain biochemical tests including Cetrimide test. Moreover, antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion method. Results: A total of 452 bacterial strains were isolated and pure cultured from different clinical samples. Among these, 60.62% were Gram-negative and 25% of the total isolates were found to be Pseudomonas aeruginosa strains. Antibiotic sensitivity testing results revealed the highest resistance ratio of Pseudomonas aeruginosa strains against Ticarcillin (46.02%), while Colistin showed the lowest resistance (3.54%). Overall, 14.15% of the isolates of Pseudomonas aeruginosa strains were found to be multi-drug-resistant bacteria. Conclusion: The results of the present study reveal an increased ratio of antibiotic resistance particularly of Ticarcillin, piperacillin and imipenem in Pseudomonas aeruginosa isolated from various clinical samples.

Comparative Efficacy of Single-Dose versus Multiple-Dose Antibiotic Prophylaxis in Reducing Postoperative Infections in Elective Cesarean Deliveries

. Arifa — 2024-09-30

Cesarean Sections (CS) were common surgeries that may lead to complications like endometritis and Surgical Site Infections (SSIs). While prophylactic antibiotics reduce these risks, the ideal dosing regimen remains debated. Objective: To evaluates whether a single or multiple-dose antibiotic regimen offers better protection against infections in patients undergoing planned cesarean sections. Methods: A six-month quasi-experimental study was conducted from October 1, 2020, to March 30, 2021, at Lady Reading Hospital in Peshawar. Eighty-two women scheduled for elective CS were assigned into two groups: one received a single 1g dose of intravenous cefazolin before surgery, and the other received the same initial dose followed by two additional doses every eight hours. Primary outcomes assessed were the incidence of endometritis and SSIs within 30 days post-surgery. Results: Postpartum infections were significantly lower in the multiple-dose group (4.9%) compared to the single-dose group (19.5%, p = 0.039). The multiple-dose group also had fewer SSIs (4.9% vs. 14.6%, p = 0.140) and no cases of endometritis (0% vs. 4.9%, p = 0.154), though these differences were not statistically significant. There were no significant differences in adverse drug reactions, hospital stay duration, or antibiotic resistance development between the groups. Conclusions: Multiple-dose antibiotic regimens may reduce infection rates in planned CS without increasing adverse effects or antibiotic resistance. Further studies were needed to confirm these findings and optimize prophylactic strategies.

Paced QRS Duration as the Major Determinant of Pacing Induced Cardiomyopathy in Complete AV Block

Roomana Khawajakhail — 2024-09-30

Patients with complete heart block often develop pacing-induced cardiomyopathy (PICM) after placement of a permanent pacemaker. Objective: To establish paced QRS duration as determinant of pacing induced cardiomyopathy in complete Atrioventricular (AV) block. Methods: This descriptive study included 115 male and female patients that had a permanent pacemaker implanted for complete AV block, at the department of Cardiology, Hayatabad Medical Complex, Peshawar, during the period 1^st November 2023 till 30^th June 2024. Patients were evaluated for the presence of PICM and subsequently grouped as PICM and non-PICM. Paced QRS duration in both groups was compared. Results: PICM was confirmed in 63 patients (54.8%) and 52 (45.2%) were non-PICM. Mean age in PICM group was 71.2 ± 8.7 years and 66.8 ± 9.5 years in non-PICM group. The mean paced QRS duration in PICM group was 200.5 ± 22.3 milliseconds and 168.3 ± 15.7milliseconds in non-PICM group (p value <0.001). Conclusion: Prolonged paced QRS duration was found as key indicator for predicting pacing induced cardiomyopathy in patients with permanent pacing for complete AV block.

Analyzing the Role of Mechanical Bowel Preparation on Surgical Outcomes in Colorectal Surgery

Muhammad Uzair — 2024-09-30

Despite improved postoperative recovery from the use of minimally invasive procedures and enhanced recovery after surgery protocols in recent decades, colectomy is still associated with morbidity. Surgical site infections range from trivial wound infections to potentially deadly colonic anastomotic leaks. Objectives: To compare the outcome results regarding postoperative complications of Mechanical Bowel Preparation and Non-Medical Bowel Preparation groups in elective colorectal surgery at a Tertiary Care Hospital in Peshawar, Pakistan. Methods: The research was a quasi-experimental study. In this study, 210 patients were included; they were divided into 2 groups: Mechanical Bowel Preparation Group and the Non-Mechanical Bowel Preparation Group. Data were collected through electronic health records. The data were analysed using SPSS software version 26.0. Descriptive statistics, such as the Chi-Square test, were applied to the results. Results: There was no statistically significant difference regarding the surgical outcomes and the demographics between the Mechanical Bowel Preparation and Mechanical Bowel Preparation groups. The escalation of the surgical site infection looked lower when the Mechanical Bowel Preparation was not in use i.e 20 (19.05%) in the Mechanical Bowel Preparation group and 14 (13.33%) in the Non-Mechanical Bowel Preparation group, but it did not seem to be, statistically significant; p-value=0.261014. The anastomotic leak rates and intra-abdominal collection rates do not differ significantly between the two groups; p>0.05. Conclusions: It was concluded that there was no statistical significance between the groups of mechanical bowel preparation and non-mechanical bowel preparation concerning surgical site infections, anastomotic leakages, and other colorectal surgery complications.

Cardiovascular Risk Factors Associated with Mitral Annular Calcification in a Non-Rheumatic Population

Mahboob ur Rehman — 2024-09-30

Mitral Annular Calcification (MAC), cardiovascular disease marker was common in non-rheumatic populations but was frequently disregarded in clinical evaluations. Objective: To MAC and to assess effect of these factors on cardiac function in non-rheumatic adult population. Methods: From September 2022 to August 2023, we conducted this cross-sectional study at Cardiac Center, Pakistan institute of medical sciences Islamabad that included 182 adults aged 50 years and older. We evaluated the patient's clinical history, demographic data and echocardiographic and laboratory results. The association between the presence of MAC and cardiovascular risk factors (age, hypertension, diabetes, dyslipidemia, smoking, obesity and chronic renal disease) was analyzed using logistic regression. Echocardiographic data were used to provide insight into cardiac function. Results: The prevalence of MAC was substantially correlated with hypertension (OR = 2.30), diabetes (OR = 2.00), dyslipidemia (OR = 1.75) and obesity (OR = 1.07). Also, smoking demonstrated a significant correlation with MAC. In comparison to those without MAC, individuals with MAC exhibited substantially lower ejection fractions, increased left atrial diameters and impaired diastolic function, as indicated by cardiac function assessments. Conclusion: In non-rheumatic population, MAC was significantly associated with conventional cardiovascular risk factors, particularly hypertension and diabetes.

The New Spectrum of Plasmodium Vivax Malaria Severity: A Single-Center Experience

Naveed Iqbal — 2024-09-30

Plasmodium vivax malaria, once considered a benign and self-limiting disease, has emerged as a significant public health concern, with increasing reports of severe and even fatal cases. Objective: To evaluate the clinical severity and complications associated with Plasmodium vivax malaria in patients in Peshawar. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar, for about two months. A total of 160 patients diagnosed with Plasmodium vivax malaria were enrolled. Participants were divided into two groups based on platelet count. Laboratory tests, including complete blood count, liver function tests, and Renal Function Tests were performed. Data were analyzed using SPSS version 20.0 , An Independent sample t-test was used to assess the significant difference between the two groups with statistical significance set at p<0.05. Results: A total of 165 patients were included in the study. In the severe thrombocytopenia group (<100,000/µL), there were 23 cases of anemia, jaundice (n=25), acute renal failure (n=7), cerebral malaria (n=2), seizures (n=1) and hypoglycemia (n=1). In the less severe thrombocytopenia group (>100,000/µL), there were 14 cases of anemia, jaundice (n=17), and acute renal failure (n=2). The blood glucose level (p=0.37), systolic blood pressure (p=0.18) and pulse rate (p=0.21) revealed no significant differences between the two groups. Conclusions: It was concluded that severe thrombocytopenia in P. vivax malaria was associated with more severe clinical manifestations, with a few cases requiring transfusions. Patients with less severe thrombocytopenia had fewer complications

Attitudes Towards Learning Communication Skills Among University Nursing Students

Amjad Ali — 2024-09-30

A major skill of nurses for achieving high-quality care is their ability to communicate effectively with patients, and this has been considered very valuable in the patient healing process. Objectives: To assess the learning attitudes of university nursing students towards communication skills and to find out the association of demographic characteristics of students with their attitude level. Methods: This cross-sectional analytical study design was conducted on 230 student nurses studying in a four-year Bachelor of Science in Nursing program. Permissions were obtained from the Ethical Review Committee and the Head of the Department for data collection. Data were collected via non-probability purposive sampling. Communication Skills Attitudes Scale was used to assess the attitude of university nursing students. Student's t-test and One-way analysis of variation were used to identify the differences in Positive Attitude Scores and Negative Attitude Scores between demographic variables. Results: Most of the study participants (77.4%) were male and 94% belonged to the age group 18-25 years. There was a significant difference in the Positive Attitude Score between gender and education of the students with p-values of 0.009 and 0.015 respectively. Furthermore, education level is the only variable that shows a significant association with a Negative Attitude Score with a p-value<0.0001. Conclusions: It was concluded that female students had more positive attitudes compared to their counterparts. Third-year students had a more positive attitude compared to other study years.

Impact of Lifestyle and Demographic Factors on Diabetes-Associated Complications; A Cross-Sectional Study

Maira Maqsood Alam — 2024-09-30

Globally, the prevalence of Diabetes Mellitus (DM), a leading cause of death and morbidity, is rising, adults with DM have the highest prevalence of chronic illness. This study pursuits to assess and evaluate the impact of life style and demographic factors that aggravates the diabetic complications. Methods: A cross-sectional study design was carried out in adult diabetic patients. The study was a nationally based study in Lahore, Pakistan, target population was Medical OPDs and Diabetic Care centers. Participants includes both gender with age 20 year to 70 years who’s diagnosed with type 2 Diabetes Mellitus. The study variables include the demographic information, patient assessment, regarding the life style, face to face interview through self-structured questionnaire and anthropometric measurement were taken from every participant (weight, height). SPSS version 20.0 was used for data analysis. Results: The sample of this study consisted of 189 (51.1%) females and 181(48.9%) male respondents (N=370). The descriptive Statistics of gender of respondents giving standard deviation of 0.501 and variance of 0.251. As all the respondents are diabetic patients so while cross tabulating the gender with Obese scale 167 of the total population fall in normal weight scale, 110 are categorized as overweight and 33 as obese. The people with good knowledge about their life style impact on Diabetes complications were relatively less affected. Conclusions: The findings alert the medical practitioner informed the patients about the significance of impact of sedentary lifestyle on diabetic’s complications. Regular screening for diabetic patient is necessary for the early detection of complications by skilled health professionals.

Frequency of Dry Socket among Patients Undergoing Dental Extractions Presenting to A Teaching Hospital, Rawalpindi

Nauman Bari Khan — 2024-09-30

A dry socket, a painful post-extraction complication, occurs when the blood clot at the extraction site is dislodged or fails to form. Understanding its prevalence is crucial for improving outcomes in dental practices. Objective: To determine the frequency of dry sockets in patients undergoing dental extraction. Methods: A cross-sectional descriptive study was carried out and two customized questionnaires were filled out over three months. One questionnaire was for patients undergoing extractions and the other was filled for patients returning with dry sockets. The study included Pakistani individuals with permanent dentition while excluding non-Pakistani individuals, children with deciduous/mixed dentition, and severely immunocompromised patients. Chi-square and Fischer's exact tests were used to compare the frequency of dry sockets between gender and age groups. p-value of less than or equal to 0.05 was considered statistically significant. Results: Out of the 188 patients, 85 (45.2%) were males and 103 (54.8%) were females. Medically compromised patients comprised 24.5% of the study population. The overall incidence of dry sockets was 9.0%, with a slightly higher occurrence in females (9.7%), though the difference was not statistically significant (p-value=0.802). Smokers demonstrated a higher incidence of dry sockets (23.1%), which was also not statistically significant (p-value=0.099). Medically compromised patients experienced dry sockets at 17.4%, compared to 6.3% in healthy patients, suggesting a trend that did not reach statistical significance (p-value=0.363). Conclusions: It was concluded that identifying high-risk groups and promoting effective prevention and management techniques can reduce the incidence of dry sockets, leading to better outcomes and overall oral health

Electric Pulp Test Threshold Responses in Healthy Mature Permanent Teeth

Razia Noor — 2024-09-30

Electric pulp testers assess only the neural component of pulp sensibility in dental practice, while vascular status is evaluated with laser Doppler flowmeters and pulp oximeters, which are more reliable for determining vitality in traumatic teeth. Objective: To determine the accuracy of the electric pulp test in healthy mature permanent teeth. Methods: This cross-sectional study was conducted at the Liaquat University of Medical and Health Sciences Jamshoro by consecutive sampling on 220 participants aged 18-35, who had healthy, mature permanent central incisors, canines, first premolars, and first molars, with no history of cardiac pacemakers and metallic restorations. Teeth were isolated, dried, and tested with a COXO C-Pulse electric pulp tester using toothpaste as a conducting medium. Threshold responses were recorded at increasing currents, with each tooth tested twice to determine the mean value. Accuracy was assessed using additional metrics post-therapy. Chi-square tests were employed to compare accuracy across gender and age groups, with significance set at p<0.05. Results: The mean age of the patients was 25.55 ± 5.41 years. 132 (60%) subjects were female, 88 (40%) subjects were male in this study. Accuracy of the electric pulp test in healthy mature permanent teeth was detected in 181 (82.3%) subjects in this study. Conclusion: It was concluded that the electric pulp tester method seems to be a reliable way to evaluate how sensitive the live nerve tissue inside a tooth is for healthy permanent teeth that have fully formed.

Significance of Modified Hodge Test in Carbapenemase Detection: A Brief Insight

Romah Ishfaq — 2024-09-30

Neonatal sepsis is one of the leading causes of neonatal deaths. A. baumannii-calcoaceticus is the most notorious bacterial agent. Carbapenems are the most important antibiotics and modified Hodge Test is considered as important phenotypic method for observing Carbapenemase production. Objective: To evaluate the efficacy rate of Modified Hodge Test, for detection of Carbapenem resistance. Methods: A cross sectional study was conducted at department of pathology, Nishtar Medical University, Multan from August 2023 to September 2023. The blood samples of suspected cases of sepsis were collected and after isolation of Acinetobacter baumannii sensitivity of multiple antibiotics were checked by disc diffusion method. Carbapenem resistance was re-evaluated by Modified Hodge Test using Meropenem disc (10 µg). All data were entered and analyzed by SPSS version 23.0. Results: Total samples of neonatal sepsis were 182. 83 (45.6%) were culture positive for bacterial growth. Among the positive samples 26 (31.3%) were isolated as Acinetobacter baumannii. Kirby-Bauer disc diffusion method was used to check sensitivity of multiple antibiotics including Carbapenems. Out of 26 Acinetobacter isolated samples, 16 were found to be Carbapenem resistant by this method. Modified Hodge test was used to re-confirm Carbapenem resistance. Out of 16 Meropenem resistant cases this phenotypic test only detected 5 cases (31.25%). Conclusions: Staphylococcus aureus followed by Acinetobacter baumannii were isolated predominantly and Carbapenem resistance has markedly increased. In contrast to a study conducted in 2010 in Pakistan on MHT effectiveness where effectiveness of MHT for Carbapenemase detection was satisfactory, our results reveled that some other techniques should be introduced for Carbapenemase detection as Modified Hodge test did not give satisfactory results

Comparing the Student Learning Outcomes and Teaching Satisfaction of Conventional Lecture and Team-Based Learning Methods

Marium Shoukat — 2024-09-30

Students hesitate to pursue subjects like biochemistry and manifest a lack of participation and motivation during conventional lectures. However, team-based learning facilitates interactive learning through discussion and improves learning outcomes. Objective: To compare the student learning outcomes and teaching satisfaction from team-based learning and conventional learning among medical students. Methods: A prospective study was conducted in Rahbar Medical College from December 2023 to May 2024. A total of 100 undergraduate students aged from 19 to 22 years studying biochemistry course were selected for the study. A total of 16 classes were conducted for teaching biochemistry among which 8 were taught by conventional lecture method and the rest 8 were taught by team-based learning. Students were instructed to fill out a student satisfaction scale questionnaire consisting of 20 questions at the end of the last TBL session. Results: The mean score of conventional lectures was 11.85 ± 1.54 with a maximum score of 15.5 and minimum score of 10 out of 20. The highest score was obtained by group assessment readiness test i.e. 16.25 ± 1.05. The mean score of conventional and TBL methods was 14.10 ± 1.12, with a minimum score of 12.20, and a maximum score of 15.95 out of 20 (P=0.016). Overall satisfaction scores in females were higher than in males (p<0.001). The mean student satisfaction score was 81.27 ± 9.18. Conclusion: Team-based learning yields better learning outcomes and teaching satisfaction in medical students as compared to conventional lecture methods. These results were also improved in female students than in males.

Prevalence and Patterns of Electrolyte Imbalance in Children Diagnosed with Acute Severe Malnutrition at a Nutritional Stabilization Center

. Azizullah — 2024-09-30

Malnutrition accounts for around 35% of all fatalities in Pakistan among children under five, making it the primary cause of childhood mortality in that country. The most severe type of malnutrition, known as severe acute malnutrition (SAM), was frequently linked to electrolyte abnormalities. The purpose of this study was to ascertain how frequently electrolyte imbalance occurred in children with SAM who were admitted to a tertiary care facility. Objective: To Determine the Prevalence and Patterns of Electrolyte Imbalance in Children Diagnosed with Acute Severe Malnutrition at a Nutritional Stabilization Center”. Methods: A cross-sectional study was carried out in Nawabshah at the Department of Pediatrics, Peoples University of Medical and Health Sciences, from May 16 to August 15, 2024. This study comprised 92 patients with severe acute malnutrition, ranging in age from 2 to 60 months. Non purposive sampling technique was used for data collection. Children with secondary causes of wasting were excluded, including those with congenital heart disease, chronic renal or liver illness, TB, cancer, and hemolytic anaemia. Weight-for-height was calculated using measurements of weight, length, and height. When the weight-for-height ratio fell below the -3 standard deviation (SD), children were diagnosed with SAM. The lab received blood samples that were taken for serum electrolytes. The chi-square test was used for stratification, and descriptive statistics were computed. Results: Participants' average ages ranged from 23.63± 12.71 months. A total of 85 (93.4%) of the 92 SAM patients had an electrolyte imbalance. The prevalence of hypokalemia (70.08%), hypocalcemia (56.52%), hyponatremia (32.60%), and hypomagnesemia (28.26%), respectively. Conclusions: Children with SAM experience dyselectrolytemia both with and without problems. In all cases of SAM, serum electrolyte levels may need to be assessed in order to identify hyponatremia and hypokalemia in the absence of symptoms. This will facilitate the inpatient treatment triage process for patients with asymptomatic hyponatremia and hypokalemia.

Radio-Histopathological Spectrum of Ovarian Specimens Following Cystectomy

Nagina Khaliq — 2024-09-30

Ovarian cysts can be benign or malignant and requires accurate diagnosis for efficient treatment. Objective: To characterize the radiological and histopathological spectrum of ovarian specimens following cystectomy. Methods: This retrospective study was conducted at Pakistan Atomic Energy Commission General Hospital, Islamabad from 1^st April 2022 to 31^st December 2022.Eighty patient’s samples from cystectomy patients who were suffering from ovarian cysts were included. Each patient underwent radiological examination before ovarian cystectomy through laparoscopic surgery except two cases of urgent laparotomy. Gross histopathological specimen examination was conducted. The data were analysed using SPSS version 26.0, wherein p value <. 0.05 was considered as significant. Results: The mean age of the patients enrolled in this study was 35.5±5.9 years. Hemorrhagic cysts were having a reticular pattern of internal echoes with soli appearing area with concave margins and no internal flow, while endometrioma cysts were having homogenous low level internal echoes with non-solid component and tiny echogenic foci in the walls. While within the neoplastic cysts 4/8 werehaving cystic external surface and 1/8 presented with ovarian mass.The surface epithelial tumor presented of 2 cases with carcinoma detection on histopathology slides while in the germ cell tumor 1 cases each of strumaovarii, dysgerminoma and mixed germ cell tumor was observed. Conclusions: Surface epithelial tumors were the most common category of ovarian tumors and majority of the cysts were benign cystadenomas. Radiological imaging provides a precise non-invasive tool for categorizing various ovarian cysts and histopathological findings further confirms the exact category of tumors.

An Exploratory Study on Integrative Management of Irritable Bowel Syndrome with Constipation (IBS-C)

Izrum Shafi Rajput — 2024-09-30

Irritable Bowel Syndrome (IBS) was complicated disorder that results in pain and change in bowel habits. The major contributing factors to the onset and detoriation include stress and gastrointestinal problem. The women between 20 to 40 years were most commonly involved. The prevalence varies among countries that was affected by diet and diagnostic criteria. Objective: Compairing the efficacy of Mebeverine, Polyethylene Glycol with the combination therapy of Mebeverine and Polyethylene Glycol in Irritable Bowel Syndrome associated with Constipation. Methods: The comparative analytical study was conducted at the National Medical Centre, Karachi, and approved by the Ethical Review Committee of Bahria University Health Science Campus. Participants aged 15-50 with IBS were selected to reflect the target population. Observational data were collected based on the treatments they naturally received: Mebeverine, Polyethylene glycol, or a combination. Pain and constipation status were recorded at baseline (day 0) and after 24 days, analyzing the effectiveness of the treatments as they were administered in routine care settings. Results: The demographic data mentioned comparable age, weight, height, and gender distribution across the three groups. Constipation and pain status before and after varied considerably across the investigation time. There was substantial improvements by day 24 from the baseline in the combination therapy. Conclusions: The combination of Mebeverine and Polyethylene glycol reveals in managing IBS, with prominent improvements in constipation severity over the research duration. This highlights the importance of multimodal treatment methods in addressing the varied symptoms of IBS and enhancing the quality of life.

The Impact of Endometriosis Diagnosis on Women's Mental Health-A Cross-Sectional Study

Sajid Hameed — 2024-09-30

Endometriosis is a chronic condition where tissue similar to endometrium grows outside the uterus. It affects the social and psychological life of women. Objective: To evaluate the impact of endometriosis diagnosis on women's mental health. Methods: In this cross-sectional study basal data, Endometriosis Health Profile (EHP-30) statuses, and Hospital Anxiety and Depression scale scores were collected from 200 sub-fertile women who were sampled using a non-probability sampling technique. Frequency distribution and chi-square (X²) analysis were performed using IBM SPSS^® version 26.0. Results: Out of 200 sub-fertile women 28 (14%) had endometriosis. Positive endometriosis significantly correlated with age (0.09<0.1). The endometriosis-related health statuses significantly correlated with anxiety and depression with two-sided asymptomatic significances of 0.007 (<0.05) and 0.000 (< 0.05) respectively. The highest prevalence of severe anxiety and depression was present in women with bad possible health profiles related to endometriosis. Conclusions: It was concluded that endometriosis aggravates with age and its positive diagnosis has a strong negative impact on the social and psychological health of the patients.

Perceptions for Utilization of Artificial Intelligence among Early Pediatric Rehabilitation Practitioners: A Survey in Pakistan

Samreen Sadiq — 2024-09-30

Integration of Artificial Intelligence in clinical medicine is rapidly expanding, driven by advancements in computing and extensive datasets. Artificial Intelligence is primarily utilized to design diagnostic tools for numerous medical conditions. Objective: To assess perceptions of using Artificial Intelligence among early pediatric rehabilitation practitioners in Pakistan. Methods: A cross-sectional online survey was conducted from November 2023 to April 2024, targeting young Masters students of Physical Therapy specializing in Pediatric Care and early pediatric therapists across Pakistan. Nonprobability convenience sampling was utilized. Participants were recruited through mailing lists and social media platforms. The anonymous survey collected demographic data and explored participants' knowledge, expected benefits, fears, and practices regarding Artificial Intelligence using a structured questionnaire. Descriptive statistics were employed for data analysis. Results: A total of 120 participants, with a mean age of 26 years and 70% female representation, completed the survey. Approximately 39.1% had received Artificial Intelligence training during their medical education, and 48.3% had utilized Artificial Intelligence tools during their learning. Key findings included 93.3% believing that Artificial Intelligence will enhance medical training and 60.8% agreeing that Artificial Intelligence will improve healthcare access. Despite positive attitudes towards AI, 54.1% had not utilized AI in their practice, indicating a need for further professional education. Conclusion: It was concluded that the study highlights a generally positive perception of Artificial Intelligence among novice pediatric rehabilitation practitioners in Pakistan but underscores the need for comprehensive AI education and training.

Management of Symptomatic Gallstones in Pregnancy

Zahoor Hussain — 2024-09-30

Gallstones, also known as cholelithiasis, are crystalline forms that occur in the gallbladder or biliary tract. Pregnancy causes various physiological changes that raise the chance of gallstone formation, which can lead to difficulties for both the mother and the fetus. Objective: To examine the safety and outcomes of conventional and interventional treatment in pregnant women with symptomatic gallstones. Methods: The study was longitudinal study. This study was conducted in Khairpur Medical College Civil Hospital Khairpur Mirs. The duration of this study was one Year, from Jan 2023 to Dec 2023. A total number of participant was (N=250) in this study. The age of participants was 18-35 years. There were included two treatment conventional and interventional. Results: The mean age of patients was 35.5 years. This study included 250 patients, had experienced gallstone symptoms. The intervention treatment group had the most participants (76%), followed by the conservative treatment group (24%). The cholecystitis participants had conservative treatment (76.3%), followed by laparoscopic treatment (53.3%). The majority participants was (66.6%) got laparoscopic therapy in the second trimester and indicate significant outcomes as compared to third trimester. The pregnant women was experienced no mortality, miscarriage during intervention therapy. Conclusions: This study supported prior findings that laparoscopic cholecystectomy can be performed safely during pregnancy, particularly in the second trimester. However, the third trimester brings additional obstacles, as seen by the higher prevalence of open cholecystectomy.

Correlation Between Complexity of Coronary Lesions and Delta High-sensitivity Troponin (hs-cTn) I Levels in Patients of Non-ST Elevation Myocardial Infarction

Muhammad Hammad Azam — 2024-09-30

Non-ST Elevation Myocardial Infarction is a critical condition where early identification of myocardial injury is essential for risk stratification and treatment. High-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for detecting myocardial damage. Objectives: To assess the association between Syntax scores and initial significant delta hs-cTnI in patients who had been hospitalized with Non-ST Elevation Myocardial Infarction. Methods: Observational cohort study from January 2022 to December 2022 involving a total of one hundred and fifty patients admitted at Hayatabad Medical Complex Peshawar. hs-cTnI on admission and at 1, 2 hours and between (6h-12 h) post-admission daily was measured. Coronary lesion complexity was assessed with Syntax scores according to the results of coronary angiography. Statistical Analysis of data was performed using Pearson correlation to analyze the association between syntax scores delta hs-cTnI levels. Results: SYNTAX scores were correlated with Δhs-cTnI levels at all-time points, and the strongest correlation was found 6-12 hours post-admission (r=0.78). The syntax score had a mean value of 24.11 ± 14.74, and hs-cTnI levels increased over time to reflect the extent of myocardial injury. Conclusions: It was concluded that in Non-ST Elevation Myocardial Infarction patients, Syntax scores demonstrating more complex coronary lesions are related to higher delta hs-cTnI levels. This value highlights the use of hs-cTnI as a biomarker to evaluate the severity of myocardial injury and direct clinical decision-making in Non-ST Elevation Myocardial Infarction. Delta hs-cTnI measurements in diagnostic and risk stratification algorithms may lead to enhanced early identification of disease with improved outcomes.

Association of Shock Index and Modified Shock Index with Mortality Rate in Emergency Department Trauma Patient

Areej Zehra — 2024-09-30

At the emergency room, triage was used to determine which patients were more seriously injured and in need of urgent care. Trauma remains one of the primary causes of morbidity and death even with the use of modern triage techniques. Objective: To find out the relationship between trauma patients' 48-hour mortality and the shock index and modified shock index at Emergency Departments (EDs). Methods: A study was conducted in the Emergency Ward of Ziauddin University Hospital, focusing on patients aged 18-65 who sustained trauma. The study involved 50 trauma patients admitted to a Level I trauma center. Data were collected on heart rate, blood pressure, and shock indices at the time of admission. A shock index cut-off value of 0.9 was used to determine its association with patient outcomes. Data collection involved patients visiting the emergency department, with informed consent obtained. SPSS version 21.0 was used for analysis. Results: The study involved 50 patients, with 25 in each exposed and unexposed group. Exposed patients had a higher average age, higher heart rates, and lower blood pressure. Road traffic accidents were the leading trauma mechanism in both groups. Open wounds were more common in exposed patients. Most exposed patients received intravenous fluids and inotropic support. Patients with a Shock Index ≥ 1 and a Modified Shock Index ≥ 1.3 had higher mortality rates. Conclusion: The study revealed a significant link between medical mortality in older adults and bruises in emergency departments, indicating that SI and Modified SI were effective markers for severity assessment.

Unveiling the Impact of Enhanced Recovery After Surgery Programs on Post-Operative Morbidity and Mortality

Asad Sami — 2024-09-30

Enhanced recovery after surgery is an evidence-based and holistic perioperative care approach and a real revolution in surgical settings. Initially, this concept referred to as “fast-track surgery’’ has evolved to enhanced recovery after surgery and acquired remarkable attention for its potential to improve patient recovery and surgical adverse outcomes, reduce the length of hospital stay, and yield beneficial impact on post-surgical mortality and morbidity. Objective: To evaluate the impact of enhanced recovery after surgery programs on Post-Operative Morbidity and Mortality. Methods: A comprehensive overview was provided based on several studies' data on the impact of enhanced recovery after surgery programs on postoperative mortality and morbidity. Nine years of epidemiological studies published between 2014-2023 were included based on the presence of qualitative and quantitative data. Results: Enhanced recovery after surgery significantly reduces the overall morbidity, surgical site infections, and complications associated with different surgeries, and shortens the length of stay at the hospital without escalating the readmission and mortality rate. However, only one study reported a significant difference in mortality rate between enhanced recovery after surgery and the control group. Conclusions: It was concluded that enhanced recovery after surgery protocols have increasingly been recognized as pivotal tools in reducing postsurgical mortality and morbidity, highlighting their efficacy in optimizing surgical consequences. By synthesizing core insights this review emphasizes the concrete advantage of enhanced recovery after surgery programs inpatient rehabilitation mobilization, encompassing faster recovery, and reducing surgical-related adverse effects.

Clinicopathological Insights to the Nerve Growth Factor NGF Associated Stress Response in Pregnancy and Therapeutic Potential in Fetal Neurodevelopment

Tayyaba Siddique — 2024-09-30

The nerve growth factor has a significant role in fetal neurogenesis and sustaining pregnancy. Objectives: To investigate the effects of nerve growth factor in stress response during pregnancy on developing fetus to bring clinicopathological correlation on the role of nerve growth factor in maternal stress markers (cortisol levels, glucocorticoids, depression, anxiety, and brain-derived neurotrophic factor levels) and fetal brain development. Methods: Following PRISMA guidelines, this study was extracted from PubMed, ScienceDirect, Nature, and Google Scholar articles from January 2014 to April 2024. The examination of pregnant women in published research gave a possibility to understand the application of nerve growth factor as a suitable biomarker for brain stress and fetal neuronal development. To exclude studies with lower ranks, each of the selected studies was assessed for adherence to evidence-based research methodology. The studies were taken from China, Europe, America and South Asia (including Pakistan). Results: Increased nerve growth factor levels were associated with maternal stress reactions which caused changes in cortisol levels and the amygdaloidal complex area. However, the increased nerve growth factor level was linked to changes in the fetal brain such as the weight of the fetal brain and stress biomarkers in the amniotic fluid sample inferring a critical role in the modulation of maternal stress on the fetal neurodevelopmental spheres. Conclusions: It was concluded that it is important to note how stress and nerve growth factors interact during pregnancy to create effective interventions to reduce stress dependence for the better health of both the mother and child.

Interlinking Human-Derived Leukemia Cells with Clinicopathological Therapeutics: Exploring Capsaicin's Anti-Cancer Mechanisms/potential for Leukemia Patients

Maryam Mastoor — 2024-09-30

Capsaicin, a bioactive compound isolated from chilli peppers, comes out as a potential agent for its anti-proliferation role in leukemia patients’ therapy. Objectives: This systematic review describes the Clinicopathological therapeutic potential of capsaicin against leukemia emphasizing the mechanism by which it inhibits growth through apoptosis, the cell cycle, and regulation of oncogenic signalling pathways in human-derived leukemia cell lines. Methods: According to PRISMA guidelines, the 75 studies were obtained from the various databases January 2013 and April 2024; Semantic Scholar, Google Scholar, PubMed as well as Frontiers and Link Springer. 50% (38) of the articles were taken from Semantic Scholar, 30% (22) from Google Scholar and 20% (15) from other search engines including PubMed and Link Springer. The papers included the inclusion criteria of PRISMA based on demographics, key outcomes and Anti-Cancer mechanisms majorly. Results: Capsaicin research published in America, Europe, Asia and Africa proves that it regulates vital processes at the cellular level including production of ROS, inhibition of NF-κB, STAT3, MAPK and cellular apoptosis. As human-derived cell lines are playing a pivotal role in cancer therapy, silicon methodologies along with in-vitro and in-vivo verification also shed more light on the improvement by capsaicin of the effectiveness of standard chemotherapeutic agents in combination with preferential killing of leukemic cells. Conclusions: Significantly, there were low levels of cytotoxicity of capsaicin to normal peripheral blood hematopoietic cells indicating that the compound is safe to use inhibiting the key oncogenic pathways and enhancing the efficacy of existing chemotherapeutic agents makes it a promising candidate for future therapeutic development.