Pakistan Journal of Health Sciences

Strengthening Primary Healthcare in Pakistan: A Foundation for Sustainable Health Reform

Sami Ullah Mumtaz — 2024-11-30

The firsthand health care services and a set of health-improving strategies or interventions, underline the concept of public health care. These are for meeting the health needs of economically compromised groups of people fairly. This concept has been polished since 1978. Public health care does not only comprise the implementation of comprehensive healthcare approaches but also rising economic, environmental, and social concerns that can be useful in optimizing healthcare strategies. According to the Alma-Ata Declaration, PHC underscores the importance of focusing on all the health-improving aspects such as taking precautions for preventing illness to offering treatments, reducing morbidity rates, and improving survival rates [1]. Different regions of the world have different primary health care approaches which are being implemented strategically for the well-being of humankind. There are several challenges faced by the healthcare system in Pakistan such as insufficient funding, low healthcare workforce, and inadequate infrastructure.

According to the World Health Organization (WHO), the health indicators of Pakistan are behind other countries in the continent, and the difference in the healthcare systems in the rural and urban areas is significant. A considerable portion of the population relies on the public sector for health facilities, as the private sector is way too expensive for an average person to afford.

The core issue of the poor health care system in Pakistan is the financing so to strengthen it this must be addressed first. An increase in the spending in this department is imperative, especially in the rural and unprivileged areas where healthcare is not easily accessible.

The difference between the healthcare systems in urban and rural areas can be decreased if there is an equitable distribution of resources. Moreover, training and retaining a skilled healthcare workforce could help resolve this issue. Programs such as Pakistan’s Lady Health Worker (LHW) have shown an increase in coverage but all these efforts can be supported by adequate resources and training.

Health equity and primary health care go side by side. PHC ensures that healthcare is accessible not only to the privileged segment of society but also to marginalized populations, women, and children. By providing communities with these facilities Pakistan can take a great step towards achieving health coverage and improving the health of its population.

In conclusion, strengthening PHC is not just an option it’s a demand and must be done. It’s the base for the achievement of sustainable health reforms. It should be prioritized by the policymakers, ensuring all Pakistanis get quality access to healthcare regardless of economic and geographic differences.

Occurrence of Hyperkalemia in Patients with Chronic Kidney and Liver Diseases

Farzana Adnan Sheikh — 2024-11-30

Hyperkalemia is a common and potentially life-threatening electrolyte imbalance in patients with Chronic Kidney Disease (CKD) and Chronic Liver Disease (CLD), often exacerbated by comorbid conditions such as hypertension and diabetes. Objective: To assess the frequency and risk factors associated with hyperkalemia in patients with Chronic Kidney Disease (CKD) and Chronic Liver Disease (CLD) at a tertiary care hospital in Karachi, Pakistan. Methods: This cross-sectional study was carried out from March 2024 to May 2024, including 120 adult patients diagnosed with CKD (stage 3 or above) or CLD. Data on demographics, disease duration, comorbidities, previous hyperkalemia episodes, and medication compliance were collected. Serum potassium levels were measured, with hyperkalemia severity classified as mild (K+ 5.0–5.5 mEq/L), moderate (K+ 5.5–6.0 mEq/L), or severe (K+ >6.0 mEq/L). Statistical analysis was performed using SPSS version 24.0, with Spearman correlation and Chi-square tests applied. Results: The average age of the patients was 53.33 years, with 55% being male. The mean serum potassium level was 5.42±0.92 mEq/L. Medication compliance was high in 74.2% of patients. Hyperkalemia was present in 70.8% of patients, with 22.5% exhibiting severe hyperkalemia. Significant association was found between severity of hyperkalemia and age (p<0.01). Hypertension (p=0.001) and diabetes mellitus (p=0.001) were significantly associated with severity of potassium levels. Conclusion: The study highlighted a high prevalence of hyperkalemia in CKD and CLD patients, significantly associated with age, hypertension, and diabetes mellitus.

Perception of Undergraduate Physiotherapy Students Regarding Clinical Instructors’ Behaviour During Clinical Training; A Descriptive Cross-Sectional Study

Abeera Ajmal — 2024-11-30

Professional therapists must be prepared through clinical training, which forms the foundation of physiotherapy education. The effectiveness of the interactions between students and clinical instructors can help students learn more in the clinical setting. Objective: To find out the undergraduate physiotherapy students’ perceptions regarding the clinical instructors’ behaviours during clinical training. Methods: A descriptive cross-sectional study was conducted on 260 undergraduates of Doctor of Physical Therapy from different institutes of Faisalabad and Sialkot after ethical approval from September 2021 to March 2022. Students in 3rd year or 5th semester and above were included. A clinical instructor behaviour instrument was utilized to get the responses and SPSS version 21.0 to extract the results. Mean and standard deviations were computed for individual subsets of the instrument to find the perception. Results: Mean age ± standard deviation was 22.79 ± 15.75 years ranging from 21 to 25 years. Among the participants, 226 (86.92%) were female and 34 (13.07%) were male. A total score of all five categories of the clinical instructor behaviour instrument was found 116.17 out of a maximum possible score of 150. Conclusion: It was concluded that the perception of students regarding the clinical instructors’ behaviours during clinical training was found positive.

Prevalence and Histopathological Findings of Endometrioid Carcinoma and Associated Risk Factors: A Cross-Sectional Study

Shagufta Nasir Pervez — 2024-11-30

Ovarian cancer ranks as the seventh most frequently diagnosed malignancy among women worldwide. Endometrioid carcinoma, a type of proliferative endometrial tumor, accounts for approximately 15% of epithelial ovarian cancers, making it the third most common subtype. Objective: To investigate the relationship between Endometrioid Carcinoma and potential risk factors, including demographic, reproductive, and lifestyle factors. Methods: A cross-sectional study was conducted at Hayatabad Medical Complex's Department of Pathology from January 1 to December 31, 2023. The study analyzed 139 ovarian tumor specimens confirmed through histopathology. Statistical analysis using SPSS version 26 identified significant associations between variables using Chi-square tests and logistic regression, with a significance level of p < 0.05. Results: A total of 139 ovarian specimens with the patient's mean age (45.34 years) with the highest prevalence of endometrioid carcinoma observed in women aged 40-49 and 60 years and above. The prevalence of endometrioid carcinoma was about 14.4% (n=20). A significant association was identified between parity and endometrioid carcinoma (p-value = <0.001). Menopausal status also showed a significant association, with postmenopausal women having a higher prevalence of endometrioid carcinoma. Logistic regression analysis indicated that age was a significant predictor of endometrioid carcinoma (p-value = 0.028). Conclusions: Significant association between nullipara and premenopausal women with endometrioid carcinoma, emphasizing the importance of considering parity and menopausal status as a risk factor for endometrioid carcinoma.

Evaluation of Platelet Indices and Sepsis Markers in Neonates with Different Types of Sepsis

Hira Arshad — 2024-11-30

Sepsis in neonates was the main reason for morbidity and mortality globally, primarily in developing countries. The World Health Organization (WHO) approximates that sepsis affects approximately 3 million neonates annually, causing about 750,000 deaths. Platelet indices such as Platelet Crit distribution width (PCT), Platelet Width Volume (PWV), and Mean Platelet Distribution (MPD) were considered major biomarkers for diagnosis. Objective: To evaluate the alterations in platelet indices and septic markers (CRP) in neonates with sepsis as compared to established reference values. Methods: This cross-sectional study was conducted at the Department of Hematology and Transfusion Medicine in the Children's Hospital and University of Child Health Sciences, Lahore, from November 2023 to February 2024. 57 neonates of the Neonatal Intensive Care Unit (ICU) were sampled. Platelet indices, including PCT, PDW, MPV, and C-reactive protein (CRP), were measured using automated hematology analyzers. Data were analyzed by using SPSS V-23.0. One sample T-test was used to compare the means with the reference value. Results: The mean platelet count was significantly lower. MPV and PDW were significantly elevated in neonates with sepsis compared to the reference value, while PCT was considerably lower. CRP levels were significantly elevated in neonates with sepsis. Conclusions: This study concluded that platelet indices and CRP levels were valued biomarkers for diagnosing and treating neonatal sepsis. These well-established inflammatory markers suggest a strong systemic inflammatory response typically associated with sepsis.

Types of Inherited Hemoglobin Disorders among the Patients Attending a Tertiary Care Hospital

Rehan Anwar — 2024-12-01

The genetic conditions known as hemoglobinopathies, which include thalassemia impact the synthesis and structure of Hemoglobin, the red blood cell protein that carries oxygen. Objectives: To investigate the prevalence of different types of thalassemia associated with age, gender and Hematological parameters. Methods: The total number of participants was n=139. The cross-sectional study was conducted at Rai Medical College Sargodha. The study was conducted for six months, from July 2023 to Dec 2023. Biochemical parameters investigated such as Hemoglobin, mean corpuscular hemoglobin MCH, reticulocyte and ferritin were done in the Hematology lab. Collected data were analyzed by SPSS version 25.0. Results: The gender distribution among the participants included male 50.3% and female 49.6%. The mean age of the patients was approximately 34.8 years. This study of 139 participants found Hb-E Beta Thalassemia (25.4%) to be the most common type, especially among those with a history of cousin marriage. Severe forms like Hb-E Beta Thalassemia and Beta Thalassemia Major had low hemoglobin and MCH levels, indicating severe anemia, while milder forms showed near-normal levels. In mean corpuscular Hemoglobin E Beta Thalassemia (29.7 ± 4.1), p=0.001, mean corpuscular Hemoglobin A levels are considerably lower than Beta Thalassemia Trait. There was no association with age and gender, p>0.005. Conclusions: It was concluded that our investigation offered important insights into the biochemical profiles linked to various thalassemia types, even though it did not identify any appreciable variations in thalassemia prevalence by age or gender.

Fetuin-A as A Marker of Vascular Calcification in Chronic Kidney Disease

Raisa Shaikh — 2024-11-30

Multiple factors contribute to vascular calcification in chronic kidney disease. Fetuin-A is known for its potent inhibitory effects on ectopic calcification Objectives: To determine the association between fetuin-A levels and vascular calcification in chronic kidney disease patients. Methods: 90 samples were collected from patients admitted to the Nephrology ward of Shahida Islam Medical Complex, Lodhran due to renal disease, and 90 samples were collected from normal healthy subjects. Patients with congestive heart failure, use of hormonal contraceptives or hormone replacement therapy, malignancy, pregnancy and with a history of trauma or surgery within a month were excluded. Mann-Whitney was applied to test Serum Fetuin A between cases and controls keeping p<0.05 as statistically significant. Results: Of 90 cases and 90 controls, 63 male (70%) and 27 female (30%) were in cases and 45 (50%) male and female were in the control group. the cases exhibited lower levels of Fetuin-A (0.4416 ± 0.17 g/L) compared to the controls (0.752 ± 0.176 g/L). The clustering revealed a possible association between the severity of chronic kidney disease and decreased Fetuin-A levels. The values ranged from as low as 0.034 to a peak at 2.132 g/L, with several outliers distributed across the chronic kidney disease stage. Conclusions: It was concluded that comparing fetuin-A levels in chronic kidney disease patients to controls revealed a significant correlation. Patients had lower levels of fetuin-A compared to controls.

Fetomaternal Outcomes of Obstructed Labour in Tertiary Care Hospital Dera Ismail Khan

Najma Bibi — 2024-11-30

Strong contractions that prevent the fetus from moving through the birth canal, known as obstructed labour, were often due to a mismatch between the size of the fetal head and the pelvis. Despite being preventable, this condition significantly contributes to maternal and neonatal morbidity and mortality and is a leading cause of hospitalization. Objective: To assess the frequency and types of adverse maternal and fetal outcomes associated with obstructed labour in Tertiary Care Hospital, Dera Ismail Khan. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Gomal Medical College, Dera Ismail Khan, from December 1, 2021 to June 1, 2022. The sample size was 193 calculated using WHO sample size software by convenient sampling technique. Adverse fetomaternal outcomes such as bladder trauma, uterine rupture, hysterectomy, sepsis, Postpartum Hemorrhage (PPH), birth asphyxia, and stillbirth were the outcomes of the study. All the data were entered on a pre-designed proforma and analyzed by SPSS version 25.0. Results: The age range for pregnant women was Participants between 18 to 40 years with a mean age of 28.689±3.05 years, the average gestational age was 37.492±2.24 weeks and the average parity was 1.507±1.51. Bladder trauma was observed in 8.3% of patients, ruptured uterus 15.5%, hysterectomy 7.8%, sepsis 19.2%, PPH 6.2%, birth asphyxia 56.5%, and stillbirth was 33.2%. Conclusions: This obstetrical emergency affects relatively younger women with a mean age of 28.69 years, with a mean gestational age of 37.49 weeks. Birth asphyxia and stillbirth were the common outcomes while maternal bladder trauma uterine rupture, hysterectomy sepsis, and postpartum hemorrhage were significant.

Role of Uroflowmetry in Patients of Benign Prostatic Hyperplasia Presenting with Lower Urinary Tract Symptoms

Aijaz Hussain Memon — 2024-11-30

Benign Prostatic Hyperplasia (BPH) is prevalent among aging men, causing Lower Urinary Tract Symptoms (LUTS) that can impact quality of life. Objective: To assess the role of uroflowmetry in determining Lower Urinary Tract Symptom (LUTS) severity in Benign Prostatic Hyperplasia (BPH) patients by examining correlations between symptom scores and uroflowmetric parameters (Qmax, Qavg, PVR, and voiding time). Methods: This cross-sectional study was conducted on sixty BPH male patients presenting with a spectrum of symptom scores based on IPSS. With a standard uroflowmeter, uroflowmetric parameters were determined and correlation coefficients and t-tests between parameters about most severe complaints yielded statistical analyses. Results: Uroflowmetric parameters were significantly different among severity groups of symptoms. Mean Qmax values decreased successively from 12.5 mL/s in mild to severe symptoms of 6.5 mL/s (p < 0.001). The same results were evident for average flow rates, as mean flows at mild were 8.0 mL/s vs severe of 4.0 mL/s (p < 0.001) Residual urine increased from 25 mL to 110 mL (p <0.001 and voiding times from 15 seconds up to 40 seconds (p <0.001). Correlation analysis revealed moderate positive and negative correlations between residual urine and IPSS (r = 0.60), Qmax (r = -0.54), and Qavg (r = -0.50) with IPSS scores (p < 0.001). Conclusion: The importance of uroflowmetry in clinical assessments and management methods was shown by the substantial correlation found between uroflowmetric parameters and the severity of BPH symptoms.

Immuno-Histochemical Analysis of PDGFRβ in OSCC: Clinical Significance and Prospects for Targeted Therapy

Sarah Rabbani — 2024-11-30

The most prominent and key cells in cancer development are fibroblasts, known as cancer-associated fibroblasts. Limited data available on Head and Neck Cancer showed the presence of platelet-derived growth factor receptor beta as the most prevalent marker. Furthermore, therapies can be targeted against this receptor for the treatment of cancer. Objectives: To evaluate the expression of Platelet-derived growth factor receptor beta as a specific marker of cancer-associated fibroblasts in different grades of oral squamous cell carcinoma through immunohistochemistry. Methods: This descriptive study included 51 cases of squamous cell carcinoma of the head and neck region. Platelet-derived growth factor receptor beta expression was assessed based on the extent and intensity of immune-labelling in a tumor. SPSS was used to determine the association between the grade of tumor and Platelet-derived growth factor receptor beta expression. Results: Mean age was found as 53.65 + 17.15 years and there were 30 (58.8%) male and 21 (41.2%) female. The most commonly affected sites were glottis and supra-glottis areas accounting for 18.9% of total cases followed by the tongue which accounts for 13.2% of cases. The majority of the patients 34 (66.7%) patients had an intermediate grade of squamous cell carcinoma. In most cases, the degree of staining was strongest, with intermediate-grade tumors exhibiting the highest platelet-derived growth factor receptor beta staining. Conclusions: It was concluded that platelet-derived growth factor receptor beta emerges as a promising tumor marker in head and

Frequency of Abnormal Electroencephalography in Cases with Ischemic Stroke

Ammar Yasir — 2024-11-30

Stroke was a common global condition, with low-income countries bearing the highest burden. It leads to reduced cerebral blood flow, limiting oxygen and glucose, and causing cerebral infarction. Electroencephalography has been used as a biomarker to predict outcomes in ischemic stroke during its acute and subacute phases. Objective: To determine the frequency of abnormal EEG in cases with ischemic stroke. Methods: After obtaining approval from the CPSP research evaluation unit, this cross-sectional study was conducted at the Department of Neurology, Punjab Institute of Neurosciences, Lahore, from January 2019 to June 2019 on 96 ischemic stroke patients. Written informed consent was taken from patients/attendants, and demographic details were noted. Using a CT scan, all cases were diagnosed as ischemic stroke. The EEG was done in all cases within 24 hours of admission. All data were entered and analyzed using SPSS version 26.0. Results: In the current study, 57.3% of patients with ischemic stroke were found to have abnormal EEG. Data stratification was found to be significant concerning gender and duration of stroke, p- value = 0.01 and 0.000, respectively. However, abnormal EEG frequency was noted more among 45-60-year-old male patients of normal weight and those who presented within 1-2 days of stroke. Conclusions: According to current study findings, more than half of the ischemic stroke cohort was found to have abnormal EEG. The high frequency of aberrant EEG results highlights the importance of EEG as a useful diagnostic tool when evaluating individuals who have had acute ischemic stroke.

Efficacy of Artesunate versus a Combination of Artesunate and Quinine Di-Hydrochloride Given Intravenously for the Treatment of Malaria; A Comparative Study

Asma Akbar — 2024-11-30

In developing countries, malaria is still one of the leading causes of morbidity and mortality. Objectives: To evaluate the efficacy of intravenous artesunate alone versus intravenous combination of artesunate and quinine. Methods: This randomized control trial was conducted in the Pediatric Medicine Unit-2, Allama Iqbal Teaching Hospital, Dera Ghazi Khan, Pakistan. The inclusion criteria were children of either gender, aged 2-14 years and admitted to the emergency department with the diagnosis of severe malaria. Children were randomly allocated to two treatment groups of equal size. The intravenous artesunate group received artesunate administered intravenously for a maximum of 7 days. The intravenous combination of artesunate and quinine group received artesunate intravenously combined with quinine di-hydrochloride intravenously for a maximum of 7 days. they were employing the lottery method. The outcome was measured as the number of hours elapsed for an individual to become fever-free (temperature below 36.8°C). Results: In a total of 104 children with severe malaria. the mean duration required to become fever-free was 28.3 ± 5.4 hours in intravenous artesunate alone versus 26.5 ± 6.4 hours in intravenous combination of artesunate and quinine groups (p=0.1242). The most frequent treatment-related side effects were nausea, loss of appetite, hypoglycemia, diarrhea, and rash, noted in 21 (20.2%), 13 (12.5%), 11 (10.6%), 5 (4.8%), and 2 (1.9%) patients, respectively. Conclusions: It was concluded that intravenous artesunate and quinine together did not provide any additional benefit or synergistic effect over intravenous artesunate alone in treating severe malaria in children.

Compliance and Barriers among Nurses Regarding Surgical Site Infection Prevention Guidelines at Public Tertiary Care Hospitals of Islamabad

Rubina Afsar — 2024-11-30

Surgical Site Infections (SSI) are a common healthcare-related issue, occurring within 30 days to a year after surgery or prosthesis implantation. Objective: To assess nurses' compliance and identify barriers related to SSI prevention guidelines. Methods: A cross-sectional study conducted from February to July 2024 involved 270 participants from four hospitals in Islamabad, using convenience sampling. A validated questionnaire, based on WHO guidelines (2016), was adopted, comprising three sections: demographic information, compliance (before surgery, during surgery, and after surgery), and barriers to compliance. Results: The study revealed that while most participants had over five years of experience, only 43.7% adhered to SSI prevention standards. Significant barriers included insufficient surgical supplies, lack of formal training, limited hospital oversight, and poor communication within healthcare teams. Conclusions: Nurses exhibited limited awareness and adherence to SSI prevention guidelines, with key barriers hindering effective prevention. Addressing these challenges is essential to improving SSI control and patient outcomes

ABO and Rh Blood Group Distribution and Its Association with Hemoglobin Levels in Pregnant Women: A Study from Peshawar District

Nadra Jamil — 2024-11-30

Anemia was a significant global health issue, leading to preterm birth, low weight at birth, and fetal malformations in pregnancy. Determination of blood group distribution and their relationship with anemia was essential for improving anemia management in pregnancy. Objective: To assess the distribution of the ABO blood group and Rh type of pregnant women and its relationship with the concentration of hemoglobin. Methods: A descriptive cross-sectional design study was conducted at a primary healthcare center in Peshawar from 1^st January 2023 to 31^st December 2023, enrolling 1049 pregnant women attending antenatal care. ABO and Rh typing were determined, and Hb levels were assayed to assess the presence of anemia in the participants. The data were analyzed using SPSS version 26.0. To examine the relationship between various blood group types and anemia, ANOVA and correlation analysis were employed. Results: B-type was the most prevalent blood group among the participants, about 358 (34.1%), followed by O 295 (28.1%), A 279 (26.6%), and AB about 117 (11.2%). The majority of participants, 972 (92.7%), were Rh-positive. Anemia was prevalent in 878 (83.7%) of participants, with 639 (60.9%) having mild anemia. Linear regression analysis indicated no significant impact of ABO blood group or Rh factor on hemoglobin levels (p > 0.05). Conclusions: In the current study, B-type was the most prevalent blood group among pregnant women, differing from previous reports of blood group O. However, no significant association was observed between blood group types and anemia, suggesting that other factors might play a more significant role in the prevalence of anemia.

Clinical and Demographic Factors Associated with Preterm Labor in Twin Pregnancies at Mardan Medical Complex

. Sumaira — 2024-11-30

Twin pregnancies (TP) were often associated with preterm labor due to excessive dilation of the endometrium. Most twin pregnancies result in delivery before 37 weeks of gestation. In this study, which did not focus on cervical selection, the average pregnancy duration was 35.83 ± 8.7 weeks, with 50% of the babies delivered before 37 weeks. Objective: To figure out how frequently twin pregnancies that present at Mardan Medical Complex, Mardan, result in preterm labor. Methods: This descriptive case series was conducted over six months, from January 1^st, 2022, to June 30^th, 2022, in the Obstetrics and Gynaecology Department of Mardan Medical Complex. The study included 98 women pregnant with twins, and each was followed up until 36 weeks of pregnancy. Data analysis was performed using SPSS version 23.0. Results: There was a significant association between preterm labor and maternal weight. Women weighing 70 kg or less had a higher rate of preterm labor (55.7%) compared to those weighing more than 70 kg (35.1%) with a p-value of 0.048. Preterm labor occurred in 49.2% of women aged 18-30 years and 45.5% of those over 30 years (p=0.724). Conclusions: Maternal weight appears to be a key factor in the risk of preterm labor. Future studies should investigate the impact of weight on preterm labor and explore weight management interventions as part of antenatal care.

The Association Between High Cholesterol Levels and Severity of Periodontitis

Rashid Javaid — 2024-11-30

Periodontitis is a common inflammatory condition affecting tooth-supporting structures, leading to tooth loss and is linked to systemic diseases, including cardiovascular disease. Objectives: To examine the association between high cholesterol levels and periodontitis severity in a sample from Lahore, Pakistan. Methods: A cross-sectional study was conducted at De' Montmorency College of Dentistry, Lahore, over six months. A total of 154 participants aged ≥40 years with periodontitis symptoms and without any systemic diseases were included. Participants were grouped based on the severity of periodontal disease status into no periodontitis group, mild disease group, moderate disease group, and severe periodontitis. Blood samples were collected and analyzed for lipid profile parameters. Multivariable regression analyses were performed, adjusting for age, gender, BMI, smoking, alcohol use, and exercise, to evaluate associations between lipid levels and periodontitis severity. Results: Severe periodontitis was found in 58 participants (37.7%). Multivariable regression indicated an inversely associated link between high-density lipoprotein cholesterol in blood and disease severity (p<0.05). Lower total cholesterol and higher triglyceride levels were associated with severe periodontitis (p<0.05). Logistic regression showed that participants with severe periodontitis had significantly higher values of the odds ratio of decreased high-density lipoprotein cholesterol (OR 1.34, 95% CI 1.05–1.72), total cholesterol (OR 1.26, 95% CI 1.02–1.55), and triglyceride levels (OR 1.48, 95% CI 1.12–1.96). Conclusions: It was concluded that severe periodontitis is greatly linked with lower high-density lipoprotein cholesterol and elevated triglyceride and total cholesterol levels, suggesting that periodontal health may influence lipid profile and increase cardiovascular disease risk.

Frequency of Malignancy in Retrosternal Multinodular Goiter

Faridullah Khan Ismail — 2024-11-30

Retrosternal Multinodular Goiter (MNG) was a condition often associated with benign thyroid disease, but it may harbor undetected malignancies. Accurate diagnosis was essential to avoid complications during and after surgery. Objective: To determine the frequency of malignancy in patients undergoing total thyroidectomy for retrosternal multinodular goiter. Methods: This retrospective observational study included data of 80 patients, aged 40 years or more who underwent total thyroidectomy for retrosternal multinodular goiter. Data of patients with smoking history, recurrent goiter, previous neck surgeries, solitary nodules, metastatic lymphadenopathy, Graves’ disease, known carcinoma thyroid, or associated carcinoma of other organs were excluded. Thyroidectomy was performed via cervical incision, with or without sternotomy. Histopathological examination of the excised thyroid tissue was conducted. Data were analyzed using SPSS version 25.0. The quantitative variables were shown in tables as mean ± standard error, and qualitative data as frequency (percentage); N (%). Results: According to the results, 14 (17.5%) patients were aged 40-50 years, 47 (58.75%) were aged 51-60 years, and 19 (23.75%) were aged 61-70 years. Histopathological examination revealed thyroid malignancy in 10% of the cases. Conclusion: A notable percentage of patients with retrosternal multinodular goiter were found to have malignancy that was not detected in preoperative investigations.

Comparative Evaluation of Lipid Profile and C-Reactive Protein in Chronic Periodontitis and Coronary Heart Disease

Afsheen Zehra — 2024-11-30

Epidemiological studies suggest local infections may elevate systemic inflammatory mediators and lipid levels, potentially promoting atherosclerosis. Objective: To investigate the correlation between Chronic Periodontitis (CP) and Coronary Heart Disease (CHD), assessing C-Reactive Protein (CRP) and lipid profile alterations in affected patients. Methods: This case-control study included 88 participants, divided into four groups: 22 with Chronic Periodontitis (CP), 22 with Coronary Heart Disease (CHD), 22 with both CP and CHD and 22 systemically healthy controls, aged 30-60 years, selected through consecutive sampling. Conducted at Bahria University Health Sciences and PNS Shifa Hospital from December 2022 to May 2023, the study assessed clinical and periodontal parameters, including probing depth and clinical attachment level. Fasting blood samples were analyzed for lipid profiles and C-Reactive Protein Levels. Statistical analysis included the Pearson Chi-square test for baseline demographics, the Kruskal-Wallis test for comparing biochemical and periodontal parameters, and the Spearman Rank Correlation. Results: Serum HsCRP levels were twice higher in participants with CP and CHD than in healthy individuals and three times higher in subjects with combined disorder (CP + CHD). Patients with both CP and CHD (CP + CHD) have the highest median CRP levels. C-reactive protein was negatively correlated with TC, LDL-C, HDL-C, and number of teeth, while positive correlations were demonstrated with PD, CAL, BoP%, and PI scores. Conclusion: Coronary heart disease and other inflammation driven atherosclerotic processes may be exacerbated by chronic infections, such as periodontitis, which can alter systemic levels of TC, HDL, LDL, and CRP.

Medicinal Plants Used by Nursing Mothers for the Treatment of Children Diseases (Diarrhea and Malaria) in Bichi Northern Nigeria

Shehu Usman Adamu — 2024-11-30

Medicinal plants as means of complementary and alternative medical practices. This study examines the use of plant materials as a means of complementary and alternative medicine in treating children's diseases (Diarrhea and Malaria) by nursing mothers in Bichi LGA. Objective: To evaluate the use of plant materials by nursing mothers in treating diarrheal and Malaria disease in Bichi LGA, to assess the percentage of nursing mothers that prefer using traditional medicine alone and those that use traditional medicine with orthodox paediatric drugs, to determine common plants in use and their sources used in the treatment of paediatric condition like malaria and diarrhea. Methods: Three research questions were formulated and data was collected using both focused group discussion and structured questionnaires. Based on the analysis of the data, the following findings were discovered. Results: Ninety-eight (98%) of Bichi’s nursing mothers know Medicinal Plants. 74% of which utilize medicinal plants and 47% use medicinal plants exclusively, while 26% use it in addition to orthodox medication. The primary causes of this high medicinal plant use among these women were: socioeconomic status (45%) of Nursing mothers were unemployed 30% of them lack a formal education) the beliefs that medicinal plants were more effective than orthodox medicine and the availability or easy accessibility of these plants. Conclusion: The sources of the plants used by these women were 100% natural and organic from their farmland

Frequency of Neonatal Respiratory Distress among Newborns of Mothers with Preterm Premature Rupture of Membranes in Tertiary Care Hospital

Maryam Nazir — 2024-11-30

Respiratory distress leads to neonatal morbidity and mortality. The premature rupture of membranes before labor at less than 37 weeks. Objectives: To determine the frequency of neonatal respiratory distress in newborns delivered with preterm premature rupture of membranes. Methods: Cross-sectional study conducted in the Gynecology unit at Ayub Teaching Hospital Abbottabad from 1-4-2018 to 1-9-2018. Sample size 244 was calculated using WHO software by non-probability consecutive sampling using a convenience sampling technique. Pregnant women with singleton pregnancy, gestation 34-36 weeks, parity 0-4 with preterm rupture of membranes were included. After birth, an examination of the newborn for features of respiratory distress was done by a neonatologist. Data were analyzed with SPSS version 22.0. Mean ± SD was presented for quantitative variables and frequency percentage was computed for qualitative variables like respiratory distress. Results: The mean age was 28.733 ± 2.71, the mean gestational age was 34.750 ± 0.65 and the mean parity was 1.028 ± 1.11. Respiratory distress was observed in 40.2% of newborns. Stratification of Respiratory Distress concerning maternal age, parity, and gestation done. This was 87.9 % in newborns of women aged 18-27 and 25.3% in women aged 28-35 years. 43% of newborns developed respiratory distress at gestation less than 35 weeks and 20% at gestation more than 35 weeks. Conclusions: It was concluded that the frequency of neonatal respiratory depression was 40% in newborns with premature rupture of membranes. It was more common in younger ages and at less than 35 weeks of gestation.

Markers of Systemic Inflammation in Smoker and Non-Smoker Chronic Obstructive Pulmonary Diseases

Snehanshu Debabrata Malla — 2024-11-30

Non-smoker and tobacco smoker also have different inflammatory and proteolytic effects in the lung in experimental studies. Objectives: To compare the clinical, investigational profile and inflammatory markers e.g. ESR, CRP, Fibrinogen, IL-5 and IL-6 between smoker and non-smoker COPD patients.2. To compare the CAT score, mMRC score and various spirometry parameters between smoker and non-smoker COPD patients3. To calculate the diagnostic performance, sensitivity and specificity of inflammatory markers e.g. ESR, CRP, Fibrinogen, IL-5 and IL-6 between smoker and non-smoker COPD patients. Methods: In this cross-sectional study 80 subjects between age group of 40 to 65 years participated. This study included category A, B and C patients of COPD included and category D of COPD patients were excluded and those who were exposed to occupational exposure to smoke. Serum levels of inflammatory markers including ESR, CRP, IL-5, IL-6, and Fibrinogen measured. Results: This study showed that there was statistically significant difference in ESR, CRP and fibrinogen levels between smoker and non-smoker COPD. There was also significant statistical difference between smoker and non-smoker COPD with respect to gender, old TB, haemoglobin, and the spirometry parameters. Conclusions: Therefore, this phenotypical categorization of patients with COPD may result in better understanding of the varied pathophysiology and help as screening tool for diagnosis of non-smoker COPD patients. ESR, CRP and fibrinogen may be used as a screening tool between smoker and non-smoker COPD patients, for a focused approach to treatment.

Knowledge and Preparedness Regarding Chemical, Biological, Radiological and Nuclear (CBRN) Warfare among Doctors and Medical Students at Combined Military Hospital (CMH) Lahore Medical College

Fariha Rahman — 2024-11-30

Chemical, biological, radiological and nuclear-related disasters have become increasingly common all around the world. Objectives: To assess the knowledge and preparedness regarding chemical, biological, radiological and nuclear Warfare among Doctors and Medical students at Combined Military Hospital Lahore Medical College. Methods: In this descriptive cross-sectional study, 311 respondents participated from November 2022 to May 2023. Non-probability convenience sampling technique was used. Data were analyzed on SPSS version 26.0. Results: The study revealed a significant knowledge gap regarding chemical, biological, radiological and nuclear warfare. Almost 290 participants had never encountered the term 'chemical, biological, radiological and nuclear' signifying a substantial lack of awareness. Furthermore, a slightly higher knowledge gap was observed among female participants, although this difference did not reach statistical significance (p-value=0.07). Additionally, students in their 3rd, 4th, and final years of medical college demonstrated a more comprehensive understanding of chemical, biological, radiological and nuclear compared to those in their initial years of study (p-value=0.008). Conclusions: It was concluded that there is a significant knowledge gap about chemical, biological, radiological and nuclear Warfare and its management among medical professionals. A very low percentage of professionals were properly trained in chemical, biological, radiological and nuclear emergency management. Respondents stressed the inclusion of chemical, biological, radiological and nuclear emergency management training in the curriculum. These findings suggest that proper provision of knowledge, and training related to these disasters is inevitable for timely management and future risk reduction from such events.

Frequency of Respiratory Symptoms among Marble Workers in Cutting and Grinding sections of Marble Factories, Lahore

Imran Maqsood Butt — 2024-11-30

Occupational exposure to dust particles was a public health problem in developing countries. One of the main dust which is responsible for higher prevalence of obstructive lung diseases is silica dust present in marble factories. Objective: To compare the frequency of respiratory symptoms among individuals working in cutting and grinding sections of marble factories, Lahore. Methods: A cross sectional study was conducted in marble factories situated in Ichra market, Ferozepur Road Lahore, during April to September 2022. Forty-one marble employees each from wet cutting and dry grinding sections were selected after obtaining written consent from the respondents. Data were collected in a pretested standardized questionnaire regarding socio demographic and respiratory symptoms. The data were analyzed by SPSS version 24.0. Results: The mean age of workers was 29.93 ± 6.18 years while mean years of work experience was11.19 ± 5.66 years. 20 (48.78%) workers of dry cutting had cough as compared to 14 (34.14%) workers of wet cutting section. Similarly, 11 (26.8%) workers of grinding section had experienced phlegm whereas 6 (14.63%) from wet cutting workers complained of this symptom. Similarly, breathlessness and chest tightness were more prevalent among grinding workers as compared to marble cutting workers showing statistically significant association (p-value < 0.005). Greater than 15 years of work exposure, respiratory symptoms were significantly (p-value < 0.001) more common in grinding workers than in cutting workers. Conclusion: Respiratory symptoms were more marked among grinding workers than among wet cuttings workers.

The Impact of Lifestyle Factors on the Development of Kidney Stones

Nisar Ahmad — 2024-11-30

Kidney stones are a common urological condition affecting millions worldwide, and lifestyle factors significantly influence their risk. Objectives: To assess the correlation between the risk of kidney stones and dietary habits, physical activity levels, hydration status, and body mass index in a cohort of 220 participants at Gomal Medical College, Dera Ismail Khan. Methods: A cross-sectional study was executed, with 220 adults stratified into two groups based on presence (n=111) or absence (n=109) of kidney stones. Validated structured questionnaires assessing hydration level, physical activity, body mass index, socioeconomic level, and dietary intake; animal protein, oxalates, and sodium were used to compile data. Chi-square testing and logistic regression allowed one to compute the odds ratios for kidney stone risk. Results: Significant risk factors for kidney stones were shown by high intake of animal protein (OR=3.88, p<0.001), high sodium intake (OR=1.98, p<0.05), and high oxalate intake (OR=1.65, p<0.05). High physical activity and adequate hydration were protective against kidney stones. A greater body mass index (OR=2.33, p<0.01) was linked to a higher risk. Socioeconomic level and stone frequency showed an association; the lower status was linked to a higher prevalence of stones (OR=1.75, p<0.05). Conclusions: It was concluded that the study underlined the strong relationships between particular lifestyle choices and kidney stone development probability. Good preventive measures are keeping an active lifestyle, making sure one is hydrated enough, and controlling their food. These findings highlight the importance of including lifestyle modifications in the clinical management of kidney stones.

Evaluation of Nurses' Knowledge and Performance Related to Patient Safety Following Cardiac Catheterization

Zahid Ali Korejo — 2024-11-30

Cardiac catheterization is a crucial medical procedure that requires adherence to standardized care protocols and the proficiency of trained, competent healthcare professionals to achieve optimal outcomes. Objectives: To evaluate nurses' knowledge and performance regarding patient safety following cardiac catheterization. Methods: A cross-sectional analytical study design was used among staff nurses who are working in the Cath-Lab and coronary care unit of four tertiary care hospitals from October 2022 to May 2023. A non-probability purposive sampling technique on a sample of n=90 participants was employed in this study. The Institutional Review Board granted approval and consent was obtained from all relevant study sites. The data were analyzed using both descriptive and inferential statistical methods, with a p-value of ≤0.05 regarded as statistically significant. Results: Outcomes of the current study represent that most of the nurses, 62 (68.9%), possessed an inadequate level of knowledge, while 28 (31.1%) displayed an adequate level. Furthermore, 81 (90%) of the nurses were noted to perform unsatisfactory levels of practice. Whereas, only 9 (10%) nurses were observed to carry out a satisfactory level of practice and there was a significant but weak correlation found between the total score of knowledge and performance with (p<0.05). Conclusions: It was concluded that the study participants displayed, an inadequate level of knowledge and unsatisfactory level of practice concerning patient safety after cardiac catheterization in caring for such patients.

Prevalence of Allergic Indicators in Patients with Chronic Otitis Media: A Case-Control Study

Ashfaq Hussain — 2024-11-30

Chronic Otitis Media (COM) was a persistent inflammation of the middle ear that often leads to prolonged effusion and hearing loss. It was a significant health concern, particularly in children, due to its impact on speech development and academic performance. Objective: To investigate the association between allergies and Chronic Otitis Media (COM) by assessing allergy positivity, blood eosinophil levels, and skin prick test results in patients with COM compared to healthy controls. Methods: It was a cross-sectional, case-control study conducted at Shahida Islam Medical Complex from August 2023 to January 2024. 112 patients suffering from COM in case groups and 112 participants were taken as healthy control were selected. The positivity of allergy, increase in blood eosinophils and, skin prick test was assessed. The data analysis was conducted using the SPSS version 24.00. The p-value of less than 0.05 was considered significant. Results: The mean age of participants in the case group was 37.4 years ± 12.6 and control groups was 38.9 years ± 10.9. The prevalence of positive skin prick tests in the case group at 56.25%, compared to 36.61% in the control group (p = 0.01). Blood eosinophil counts were significantly higher in the case group (0.39 ± 0.15 cells x 10^-3 µl) than in the control group (0.23 ± 0.11 cells x 10^-3 µl) (p = 0.031). The positivity rate for allergies, based on clinical assessment, was significantly higher among patients in the case group (63.39%) compared to those in the control group (24.11%) (p = 0.04). Conclusion: Findings of this suggests that there was strong association between allergies and chronic otitis media in patients

Frequency and Risk of Preeclampsia in Women with Gestational Diabetes Mellitus

Aliya Dar Khan — 2024-11-30

Preeclampsia is a serious hypertensive disorder of pregnancy that affects 5-8% of pregnancies and is a major cause of maternal and neonatal morbidity and mortality. Gestational diabetes mellitus is another significant pregnancy complication that increases the risk of adverse maternal and fetal outcomes, including preeclampsia. Objectives: To determine the frequency and assess the risk of preeclampsia in pregnant women diagnosed with gestational diabetes mellitus as an independent risk factor. Methods: This descriptive cross-sectional study was carried out from October 2020 to April 2021 within the Department of Obstetrics and Gynecology, Medical Teaching Institution-Hayatabad Medical Complex Peshawar and included patients having regular monitoring for blood pressure using a mercury sphygmomanometer and proteinuria by urine dipstick. Results: A total of 133 pregnant women were diagnosed with gestational diabetes mellitus in the study. Of these, 10 women (7.5%) developed preeclampsia, indicating a significant association between gestational diabetes mellitus and preeclampsia. Participants were aged between 18 and 45 years, with the majority (75%) falling within the 18-30-year age group. Results showed that gestational diabetes mellitus was associated with an increased risk of preeclampsia, particularly in this younger age group. Conclusions: It was concluded that gestational diabetes mellitus is associated with a higher risk of preeclampsia and requires intensive clinical follow-up and intervention measures for maternal and fetal health protection.

Ankle-Brachial Index as a Predictor of Peripheral Arterial Disease in Newly Diagnosed Hypertensive Patients

Safdar Ali Pervez — 2024-11-30

Hypertension was a major risk factor for cardiovascular disorder including Peripheral Arterial Disease (PAD). Objective: To evaluate the risk of Peripheral Arterial Disease (PAD) in newly diagnosed hypertensive patients using Ankle-Brachial Index (ABI) measurements and to determine its potential role as a predictor of cardiovascular risks in this population. Methods: The study was an observational, cross-sectional study. This study was conducted in Khairpur Medical College Civil Hospital Khairpur Mirs. The duration of this study was six months, from November 2023 to April 2024This study include n= 246 newly diagnosed hypertension. Three levels of ABI had been identified through determining the ABI in both legs: low ABI (<0.9), normal ABI (0.9-1.4), and high ABI (>1.4). Student’s t-test. Pearson correlation test have been utilized when assessing the significance of the association between ABI levels and blood pressure values. Results: ABI was normal in 60% of the 246 participants, low in 20% and high in 20% of them. In comparison to those who had normal and high ABI, participants who had low ABI showed considerably higher SBP in both lower limbs (p < 0.001). Furthermore, there was additionally a significant distinction (p < 0.001) in the SBP and DBP among people who had high ABI. Participants with average ABI had higher SBP in their right upper limb than those who suffered from elevated ABI (p < 0.001). Conclusion: This study showed that in individuals who have recently identified high blood pressure, there was a significant relationship among ABI levels and arterial pressure levels.

Sweetened Beverages Consumption and Self-Reported Oral Health among Young Adults: A Cross-Sectional Study in Peshawar

Aiman Niaz — 2024-11-30

Sweetened beverage consumption has become a growing concern due to its potential negative effects on oral health, particularly among young adults. Objectives: To assess the consumption patterns and self-reported oral health of sweetened beverages among young adults in Peshawar. To evaluate the association of self-reported oral health and sweetened beverage consumption among young adults. Methods: A cross-sectional study was conducted among 163 young adults in Peshawar. An online questionnaire was sent to study participants via convenience sampling. A structured questionnaire was used to collect data. Data were entered and analyzed using SPSS 26. The chi-square test was employed to assess the association between different categorical variables and p<0.05 was considered significant. Results: The mean age of the participants was 19.37 + 1.57 years. Soda was the most frequently consumed beverage (33.1%), followed by energy drinks (11.7%), favored tea (9.8%), packed juices (11.7%), and other beverages (14.8%). Around 41.7% of the participants experienced tooth sensitivity, 41.1% had dental caries and 37.4% had gum problems. Significantly more female than male consumed sweetened beverages daily. Conclusions: A positive link between increased intake of sugary drinks and poor oral health. To tackle this issue, it is crucial to implement public health initiatives, school-based programs, and policy reforms aimed at reducing sugary drink consumption and enhancing oral health.

Evaluation of Maternal Near Miss (MNM) Events and Maternal Mortality at Tertiary Care Hospital

Hina Murtaza — 2024-11-30

Maternal Near-Miss events are critical indicators of the quality of maternal healthcare, representing instances where women survive severe obstetric complications that could have resulted in death. Objectives: To find out the characteristics and causes of maternal near-miss events and maternal mortality at Liaquat University Hospital Hyderabad/Jamshoro. Methods: This cross-sectional study was conducted on 233 pregnant and postpartum women of were within 42 days of childbirth, who presented with severe morbidity or early maternal mortality. The duration of the study was from January 1 2021 to June 30 2021. Women undergoing uncomplicated cesarean sections or normal vaginal deliveries, as well as cases of mild anemia, mild-to-moderate hypertension, and Class I and II hemorrhages (less than 30% blood loss), were excluded. Data were collected on demographic characteristics and clinical details such as the mode of delivery, timing of near-miss events concerning admission, patient presentation, surgical interventions performed to save the mother's life, and obstetric complications. Results: The mean age of maternal near-miss cases was 25.5 ± 5.5 years. Most maternal near-miss cases occurred among multiparous, rural, un-booked women aged 26–30 years. The leading causes of maternal near-miss were hemorrhage (44.2%), hypertensive disorders (35.1%), and dystocia (12%), followed by sepsis and severe anemia (4.2% each). A significant proportion, 176 cases (75.5%), required intensive care unit admission, with a mean hospital stay of 14.5 days. Conclusions: It was concluded that hemorrhage and hypertensive disorder were found to be the most common causes of maternal near-miss cases.

Forensic Analysis of Injury Patterns among Occupants in Fatal Motor Vehicle Accidents in Karachi, Pakistan

Abdul Waheed — 2024-11-30

Drivers and passengers in Motor Vehicle Accidents (MVAs) may sustain a wide range of injuries. Objective: To investigate the patterns of injuries and factors responsible for differences between drivers and passengers in fatal motor vehicle accidents in Karachi, Sindh. Methods: Retrospective study was conducted carried out from 2^nd July 2022 to 30^th June 2024 by Department of Forensic medicine and Toxicology, Karachi Institute of Medical Sciences, Karachi. All victims involving drivers and passenger’s road traffic accidents fatalities, belongs to either gender, of any age from three major tertiary care hospitals in Karachi, Sindh were investigated and evaluated. Incomplete information, those of other fatalities and pedestrian related data were excluded. Results: Most (70.8%) were drivers, 20.0% were front-seat passengers, and 9.2% were rear-seat passengers. Over two-third, 80.5% died within one hour after the crash whereas, majority, 67.3% of the deaths occurred in front crashes, 13.7% in near edge hits, 13.5% in rollovers, and 5.5% in other accidents. Fatal injuries to the abdomen, thorax, head, and neck in 63.6%, 10.7%, 61.6%, and 27.4% of cases, respectively. Compared to drivers, those in the front seats experienced less heart and spleen traumas. In comparison to drivers, passengers in the front and back seats experienced a higher frequency of seat belt abrasions and a lower frequency of fractures to the extremities. Conclusion: The findings revealed significant differences in the types and frequency of injuries between drivers and passengers, highlighting the greater vulnerability of drivers to severe abdominal and head injuries.

Comparison of Efficacy of Tofacitinib versus Betamethasone Pulse Therapy in the Treatment of Vitiligo

Hira Shafquat — 2024-11-30

Vitiligo is a chronic autoimmune skin disorder characterized by depigmentation due to melanocyte destruction, significantly impacting patients' quality of life. Emerging treatments, including Janus kinase inhibitors like tofacitinib, offer promising alternatives to conventional therapies such as corticosteroids. Objective: To compare the efficacy of tofacitinib with betamethasone pulse therapy in achieving re-pigmentation in vitiligo patients. Methods: This quasi experimental study was conducted on 42 patients of vitiligo of either gender with ages between 12 and 65 years and had a history of vitiligo for over one year with a body surface area affected by vitiligo exceeding 5%, and a vitiligo area scoring index score of more than 10 were included in the study. Patients were divided into 2 equal groups using alternate assignments. Group A were treated with betamethasone pulseerapy of 4mg twice a week. Group B were treated with tofacitinib at a dose of 5 mg twice a day. Results: Optimal recovery (vitiligo area scoring index decrease ≥20% from baseline) was observed in 14 (66.7%) of the tofacitinib group compared to 6 (28.6%) in the betamethasone group, highlighting tofacitinib’s superior efficacy in achieving significant vitiligo area scoring index reduction. Over three months, the BSA affected by vitiligo decreased in both groups, with a significantly greater reduction in Group B (tofacitinib) compared to Group A (betamethasone). Conclusions: It was concluded that tofacitinib may be more effective than betamethasone pulse therapy in reducing both the extent and severity of vitiligo.

Analysis of Current Knowledge and Social Implications of Minimal Intervention Prosthodontics

Uzma Khalil — 2024-11-30

Minimal Intervention Prosthodontics (MIP) focuses on preserving healthy tooth structure while providing functional and aesthetic restorations. Objective: To evaluate the knowledge and social implications of Minimal Intervention Prosthodontics (MIP) among patients at Rehman College of Dentistry, Peshawar, Pakistan. Methods: A cross-sectional survey was conducted on 173 patients aged 35 years and above. Data were collected through a structured questionnaire that assessed patients' understanding of MIP principles, clinical applications, and perceived social impacts. Statistical analysis was performed to determine associations between knowledge of MIP and demographic factors, such as age, gender, and educational level. Results: Among the respondents, 74% had some awareness of MIP, with higher knowledge levels observed in individuals with advanced education. However, only 41% were familiar with the specific procedures involved in MIP, such as adhesive restorations, sealants and Atraumatic Restorative Treatment (ART). The majority of participants (68%) perceived MIP as beneficial for patient comfort and reducing healthcare costs, though 56% recognized the increased time and expertise required for its application. Additionally, 62% of respondents acknowledged the social benefits of MIP, including preserving natural dentition and improving overall quality of life. Conclusions: The study revealed a moderate level of awareness and understanding of MIP among patients, with educational level significantly influencing knowledge. Despite recognizing its advantages, there was a need for improved patient education to enhance the acceptance and implementation of MIP in dental care

Association of Bacterial Vaginosis with Preterm Labour in Pregnant Women

Ayesha Qamar — 2024-11-30

Bacterial Vaginosis (BV) was a common vaginal infection associated with adverse pregnancy outcomes, including premature birth. Objective: To evaluate the association between the BV and the risk of preterm Labor in pregnant women and to assess whether BV prevalence differs based on obstetric history, including parity and prior delivery outcomes. Methods: This case-control study was conducted in the Obstetrics and Gynecology Department at PAF Hospital Mushaf, Sargodha, from July 2022 to January 2023. A total of 130 participants were included in the study. BV was diagnosed using laboratory and diagnostic methods. Participants were enrolled using non-probability consecutive sampling. Data were analyzed using SPSS version 21.0. Chi-square tests and odds ratios were employed to assess the association between bacterial vaginosis and variables such as age, gravida, and history of preterm delivery, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age of the participants was 25.32±6.8 years. Parity also had a notable impact, with multiparous women showing a significantly higher prevalence of BV (46.2%) compared to controls (18.2%), with an OR of 3.86; P=0.006. However, the difference among primiparous women was insignificant (P=0.477, OR=1.56). Women with no prior delivery history had a higher BV prevalence in the case group, 41.5%, compared to the control group, 20.0%, with an OR of 2.83; P=0.130. Conclusions: Bacterial vaginosis was significantly associated with older maternal age and multiparity, but no strong correlation was found with previous preterm delivery. Timely diagnosis and management of BV may help reduce the risk of preterm labor.

Comparative Efficacy of Intravenous Ciprofloxacin against Ceftriaxone in Spontaneous Bacterial Peritonitis Patients

Muhammad Imran Sheikh — 2024-11-30

Cirrhotic individuals with spontaneous bacterial peritonitis were treated empirically with ciprofloxacin or ceftriaxone. Objective: To compare the effectiveness of intravenous ciprofloxacin against ceftriaxone in cirrhotic patients who developed spontaneous bacterial peritonitis. Methods: This prospective interventional analysis was conducted at the Department of Medicine GHURKI Trust and Teaching Hospital, Lahore from Aug 2018 to 2023, and comprised 356 patients of spontaneous bacterial peritonitis. After getting informed written consent patients with ages 35-70 years were included. Equally divided cases into two groups, 178 patients in group I received intravenously ciprofloxacin 200mg and 178 patients in group II received intravenously ceftriaxone 1g for 6 days after every 12 hours. Post-treatment efficacy of both drugs was compared. Results: Patients under study had a mean age of 53.15 ± 11.67 years and had a body mass index of 24.8 ± 6.20 kg/m². In group I efficacy was found in 142 (79.8%) and in group II effectiveness was found in 160 (89.9%) with p-value=0.002. We found a reduction in ascetic fluid polymorph nuclear count in both groups after 6 days with p<0.003. The frequency of complications in group II was higher found in 16 (8.9%) cases and in group I found in only 5 (2.8%) cases. 4 cases in group I and 2 cases in group II left against medical advice. The mortality rate was also non-significant among both groups. Conclusion: It was concluded that intravenous ciprofloxacin is equally efficacious as ceftriaxone in treating spontaneous bacterial peritonitis in cirrhotic individuals.

Association between Clinical Manifestations and Candida Carriage in Patients with Oral Sub-Mucous Fibrosis

Muhammad Zain-Ul Abedeen — 2024-11-30

A chronic, progressive disorder known as oral sub-mucous fibrosis causes the oral mucosa to become inflamed and fibrotic, which limits mouth opening, causes a burning sensation, and reduces salivary flow. Objectives: To assess the relationship between candida carriage in oral sub-mucous fibrosis patients and demographic traits, tobacco use, and clinical parameters such as burning sensation, salivary flow rate, and mouth opening. Methods: A comparative cross-sectional study was conducted from May 2024 to Oct 2024. This study was conducted in Multan Medical and Dental College. The total number of patients was 384 divided into 192 with oral sub-mucous fibrosis and 192 control participants split into groups with and without risk exposure. Clinical characteristics such as mouth opening, salivary flow rate, and burning sensation (measured using a visual analogue scale) were evaluated. Data were analyzed with descriptive, mean, Post Hoc analysis, and Chi‑square tests. Results: Comparing the oral sub-mucous fibrosis positive group (93%) to the negative group (7%), the oral sub-mucous fibrosis group had a considerably greater prevalence of candida carriage. Reduced salivary flow rate (≤0.2 ml/min), restricted mouth opening (≤20 mm), and severe burning sensation (3-5 (Visual Analogue Scale)) were shown to be strongly correlated with candida positivity (p<0.001). A greater prevalence of candida colonization was also seen in patients who used tobacco more frequently (p<0.001). Conclusions: It was concluded that comprehensive treatment methods should include patient education on oral hygiene and quitting smoking, given the major impact that these behaviours play in candida's carriage.

The Prevalence and Distribution of Beta Thalassemia Trait among Outpatient Individuals in A Tertiary Care Hospital of Lodhran, Pakistan

Farhan Ali Khanzada — 2024-11-30

Thalassemia is an autosomal recessive genetic disorder characterized by impaired synthesis of hemoglobin due to mutations affecting the production of alpha (α) or beta (β) globin chains. This imbalance causes ineffective erythropoiesis, microcytic anemia, and hematological abnormalities. Objectives: To assess the prevalence and distribution of β-thalassemia carriers for implementing targeted screening and preventive strategies. Methods: This retrospective observational study analyzed 108 samples from patients who were suspected of a complete blood count parameter; which included Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, and total red blood cell count. After that analysis of the suspected patients’ blood for Hb A2 through Hb Electrophoresis for the screening of the thalassemia trait was carried out. The data were sourced from Shahida Islam Medical College Hospital, reflecting the carrier status of the participants. Results: The findings of the study are distributed between 62 male and 46 female and demonstrated the presence of β-thalassemia trait across various age groups (mean age 25) and found typically higher (52.8%) in the age of 21 to 30 years. Specifically, 68 out of the 108 patients tested positive for the β-thalassemia trait having raised Hb A2 level on the Hb electrophoresis. Conclusions: It was concluded that the β-thalassemia trait is widespread across diverse ethnic groups. It highlights the necessity for standardized blood testing protocols for β-thalassemia screening. Implementing comprehensive screening programs, coupled with enhanced public awareness and educational campaigns, is crucial to mitigate the incidence of thalassemia major. These measures are essential for populations to prevent the transmission of this genetic abnormality.

Prevalence of Hyperprolactinemia in Patients Undergoing Long-Term Proton Pump Inhibitor Therapy

Muhammad Zubair — 2024-11-30

Proton pump inhibitors used to treat gastrointestinal disorders cause various threatening effects and lead to an increase in serum prolactin levels. Objectives: To evaluate serum prolactin and macroprolactin levels in long-term proton pump inhibitor therapy patients. Method: An observational cross-sectional study was done between February 2023 and June 2024, at Niazi Welfare Foundation Teaching Hospital, Sargodha after approval from the institutional review board. Patients of either gender using proton pump inhibitors for ≥3 months, alone or in combination with histamine 2 receptor antagonists or pro-kinetics were included to measure serum prolactin levels. A duration of >3 months was taken as long-term therapy to see the impact on prolactin levels. The data were analyzed using SPSS version 25.0. Results: Out of the 166 patients, 102 (61.4%) were female, and 64 (38.6%) were male. The patient's mean age was 42.6 ± 14.3 years, and serum prolactin level was 23.2ng/mL. Among the participants, 97 (58.4%) had normoprolactinemia, while 69 (41.6%) had hyperprolactinemia. A significant increase in hyperprolactinemia with longer proton pump inhibitor treatment duration was revealed. Conclusions: It was concluded that prolonged use of proton pump inhibitors has the potential to raise serum prolactin levels, highlighting the importance of thorough evaluation for optimal clinical management.

Evaluating Patient Experiences and Perceptions in the Diagnosis and Management of Dentine Hypersensitivity: A Cross-Sectional Study

Tayyaba Nayab — 2024-11-30

Dentine Hypersensitivity (DH), or sensitive teeth, was a dental pain caused by exposure of dentinal tubules. Understanding patients' experiences and perceptions was crucial for developing effective diagnostic and treatment plans. Objective: To investigate the patients' experiences, perceptions, and diagnostic techniques for DH. The research also addresses the therapy approaches to limit dentine hypersensitivity for the better quality of life in patients. Methods: A non-probability convenience sampling technique was used to conduct the study for three months, from April 2024 to June 2024, in the University of Lahore's dental hospital and private dental clinics in Lahore. A close-ended questionnaire consisting of 20 items was used for data collection. The relationship between DH, gender, and other variables was examined using a chi-square test; P-value < 0.05 was considered statistically significant. Results: The study with 1105 participants found a slightly higher representation of females (51%) than males (49%), with both genders reporting similar rates of tooth pain during food consumption. DH was most prevalent in the 41-60 age group (33.8%), with 74% experiencing pain with certain foods, 88% not receiving professional treatment, and 99% acknowledging DH's significant impact on their quality of life. Conclusions: This study highlighted the significant prevalence of DH among adults, substantially impacting their quality of life. The findings emphasize the need for increased awareness, better diagnostic strategies, and patient-centred treatments to manage this condition effectively.

Umbilical Cord Coiling Index as A Marker of Perinatal Outcome

Sadiq Jan — 2024-11-30

Umbilical cord coiling patterns have a considerable effect on both pregnancy outcomes and fetal health. Objectives: To assess the postnatal umbilical coiling index and investigate its association with normal coiling, hypo-coiling, and hyper-coiling patterns about maternal and perinatal outcomes. Methods: This cross-sectional study was conducted at the Obstetrics and Gynecology Department of Pakistan Aeronautical Complex Hospital Kamra from January 2024 to June 2024. The patterns of umbilical cord coiling were analyzed in 200 Livebirths. This study utilized convenience sampling to select a sample of live births for assessing the relationship between the umbilical cord coiling index and perinatal outcomes. Data were collected on maternal factors and neonatal outcomes, including Apgar scores. Statistical analysis was conducted using SPSS version 26.0, with descriptive statistics to summarize the data and inferential tests (e.g., chi-square test, t-test, regression analysis) to evaluate associations between umbilical cord coiling patterns and perinatal outcomes. Results: The study revealed that hypo-coiled cords were linked to older maternal age (≥35 years) and higher gestational diabetes rates. Hypo-coiled infants had a low birth weight incidence of 28.6%, significantly lower coiling index (0.07 ± 0.02), and lower Apgar scores at one minute (6.8 ± 1.2) and five minutes (8.2 ± 0.9). These results suggest umbilical cord coiling patterns are crucial indicators of maternal health and neonatal outcomes, highlighting the need for careful monitoring in at-risk pregnancies. Conclusions: It was concluded that there is a correlation between neonatal outcomes and factors such as maternal age, gestational diabetes, and abnormal umbilical cord coiling patterns.

Association of Emotional Intelligence and Aggression with Physical Activity Among Undergraduate Medical Students

Muhammad Umair Chishti — 2024-11-30

tendencies may interfere with a student’s potential to acquire knowledge and become a good professional later on. Objectives: To determine the association of emotional intelligence and aggression with physical activity among undergraduate medical students. Methods: The analytical cross-sectional study was conducted on a sample of 267 students from five private medical colleges and universities offering allied health sciences courses after ethical approval in four months using Non-Probability Convenience sampling. Emotional intelligence, aggression and physical activity were measured using the Emotional Intelligence Questionnaire, Buss Perry aggression Questionnaire and short form of the International Physical Activity Questionnaire respectively. Correlation tests were applied to find the association (p≤0.05 as significant). Results: A positive association between Physical Activity Questionnaire and Aggression was found in male with (p=0.020) and a negative association in female with (p=0.894). Emotional intelligence had a negative association in both male and female undergraduate medical students except motivating oneself in males which had a positive association in males (p=0.019). Conclusions: It was concluded that the study highlights the strong relationship between emotional intelligence, physical activity and aggression among undergraduate medical students. Male exhibit aggressive behaviour more often than female do. Male showed a positive relation between emotional intelligence and physical activity.

Predictive Factors of the Persistence and Remission of Irritable Bowel Syndrome at Tertiary Care Hospital

Khadim Hussain Samejo — 2024-11-30

Irritable Bowel Syndrome is a functional gastrointestinal disorder that affects millions of people worldwide, characterized by chronic or recurrent abdominal pain associated with altered bowel habits in the absence of detectable structural or biochemical abnormalities. Objectives: To examine the clinical and demographic predictors of irritable bowel syndrome outcomes in a tertiary care hospital in Sindh, Pakistan Methods: A prospective study was conducted at the Department of Medicine and Gastroenterology of Liaquat University of Medical and Health Sciences, Jamshoro, from December 2022-July 2023. The study included 240 patients diagnosed with irritable bowel syndrome of all genders and ages of 18 to 60 years. Irritable bowel syndrome was diagnosed via Rome IV Criteria. Patients with clinical evidence of organic or metabolic diseases that may affect the bowel transit or cause abdominal pain along with the patients who were taking the medications for irritable bowel syndrome at the time of enrollment were excluded from the study. Results: Over six months, 167 (69.6%) participants showed symptom persistence, while 73 (30.4%) achieved remission. Irritable bowel syndrome D-subtype (p=0.03) and symptom duration under three years (54.8%; p=0.04) were significantly linked to outcomes. Psychological distress, especially stress, and non-digestive symptoms like backache and fatigue predicted persistence. Conclusions: The study concluded that a shorter symptom duration of less than 3 years along with irritable bowel syndrome D as a predictor of improved remission rates. Psychological distress, particularly high stress levels, along with non-digestive symptoms such as backache and fatigue, are significant predictors of symptom persistence.

Metabolic Syndrome in Obese and Non-Obese Individuals Presented at A Tertiary Care Hospital of Hyderabad, Pakistan

Javeria Tariq — 2024-11-30

Metabolic Syndrome (MetS) has proved to be of enormous negative impact on health of humans, even in case of non-obese people. Objective: To determine the frequency of metabolic syndrome in obese and non-obese individuals at Liaquat University Hospital Hyderabad/Jamshoro. Methods: This Cross sectional comparative study was conducted on 122 persons, 61 obese and 61 non-obese persons, chosen through Non probability consecutive sampling technique. Patients of either gender, aged between 30 to 60 years, visited the OPD or hospitalized were selected. The patients with acute or chronic Ischemic heart disease or stroke, liver, lung or kidney or thyroid diseases or suffering from malignancy along with Pregnant ladies and lactating mothers were excluded. MetS was diagnosed via IDF and AHA classification. Results: Metabolic Syndrome (MetS) was significantly more prevalent in obese individuals (70.5%) than in non-obese individuals (19.7%) (p = 0.001). Obese participants had a higher BMI (29.24 kg/m² versus 20.70 kg/m², p = 0.001), greater prevalence of dyslipidemia (63.9% versus 16.4%, p = 0.001), and uncontrolled diabetes (41.0% versus 13.1%, p = 0.001). Blood pressure was significantly elevated in the obese group, with mean systolic and diastolic pressures of 143.52 mmHg and 93.11 mmHg, respectively (p = 0.001). Conclusion: MetS was present in 45.1% of the participant and was found to be strongly consistent with obesity although it was also detected in noteworthy portion of non-obese persons.

Decoding Demise: A Comprehensive Analysis of Unnatural Deaths in Rahim Yar Khan

Qurrat-ul-Ain Kamran — 2024-11-30

A medico-legal autopsy is a systematic examination of a deceased body conducted under the law of the state to determine the cause, and manner of death and to verify or dismiss any potential involvement of foul play related to the deceased. Objective: To assess the spectrum of unnatural deaths in the district of Rahim Yar Khan. Methods: This retrospective descriptive study was done at the Department of Forensic Medicine and Toxicology, Sheikh Zayed Medical College, Rahim Yar Khan from 1^st January 2021 to 31^st December 2023. Variables were age, gender, cause and manner of death, weapon, and residence. All autopsies referred by police were included except hospital, police torture and custodial deaths, and putrefied or exhumed bodies. Data from police, hospital records, and autopsy reports were recorded on a pre-designed form. Results: There was male preponderance of 72.57% to female with 27.43%. In general, 78% of all deaths were homicidal, compared to 12% suicidal, 9% accidental and 1% remained undetermined. The 21-30-year age range is the most often afflicted group. Firearms as the leading cause of death followed by blunt objects, asphyxia and sharp weapons accounted for the majority of fatalities respectively. The instances involved 44.25 % urban inhabitants as compared to 55.75% peri-urban ones. Conclusions: It was concluded that men accounted for the majority of unnatural deaths. The most common cause of death was murder. Guns and blunt weapons were the leading causes of death. Compared to the surrounding area, the city had a higher number of unnatural fatalities.

Atrial Fibrillation in Patients with Acute ST Elevation Myocardial Infarction

Zakir Ullah — 2024-11-30

Atrial fibrillation (AF) can lead to complications such as stroke and heart failure. The prevalence of AF in patients with MI has garnered increasing attention due to its significant impact on clinical outcomes. Understanding its prevalence and associations with various risk factors is crucial for improving patient management and outcomes. Objective: To determine the frequency of atrial fibrillation in acute ST elevation myocardial infarction. Methods: Descriptive cross-sectional study, conducted at Department of Cardiology, Mardan Medical Complex, Mardan from September 2023 to August, 2024. About 118 patients, already diagnosed cases of acute ST segment elevation myocardial infarction, were enrolled in the study. Atrial fibrillation was considered positive on the absence of P waves and irregularly irregular QRS complexes on surface electrocardiography. Data were collected under the supervision of expert consultant and analyzed using SPSS version 20. Results: Atrial fibrillation was observed in 14% (n=17) of the patients with STEMI. The mean age of the cohort was 55 years (SD±9.29). The study population was predominantly male (66%) with a high prevalence of diabetes (71%) and hypertension (78%). Despite these factors, no significant correlation was found between atrial fibrillation and diabetes, smoking status, BMI, or hypertension (p>0.05). Conclusions: Our study concludes that the frequency of atrial fibrillation was found to be 14% in the participants presenting with acute STEMI. Identifying no significant associations between AF and the common risk factors analyzed, these findings underscore the necessity for more research to investigate additional factors and mechanisms that connect AF with STEMI.

Unveiling Parental Knowledge, Attitudes, and Practices on Intestinal Parasitic Infections in Lahore, Pakistan

Kanwal Zia — 2024-11-30

Intestinal Parasitic Infections are intestinal infections, especially in toddlers, caused by parasites such as worms. Objectives: To explore Knowledge, Attitudes, and Practices of Intestinal Parasitic Infections in Pakistan, emphasizing their interlinkage with other socio-demographic factors. Methods: This cross-sectional study was conducted in Pak town, Lahore, on 348 parents. A questionnaire was developed to record demographic data, five Knowledge items, seven Attitudes, and 12 Practice questions. IBM SPSS version 27 was used for all the analyses. Descriptive, chi-square and binary logistic regression analyses were applied. Results: The majority of participants were housewives (50.9%). The levels of Knowledge, Attitude, and Practices were poor in 56%, 60.9%, and 51.7% of the parents, respectively. There was a greater likelihood of good attitude in parents with good knowledge (adjusted OR=5.3; 95% CI=0.3-96.4) compared with poor knowledge. Male were less likely (adjusted OR=0.3; 95% CI=0.1-0.7) to present good attitudes than female. Parents with education level of Intermediate (adjusted OR=2.6; 95% CI=1.2-5.7), Graduate (adjusted OR=3.5; 95% CI=1.6-7.6), and Masters (adjusted OR=60.8; 95% CI=3.8-974.3) showed better attitudes than those with secondary education. Good practices were associated with the presence of good attitudes rather than poor attitudes (adjusted OR=0.6; 95% CI=0.4-0.9). Conclusions: It was concluded that there was a poor prevalence of Knowledge, Attitudes, and Practices in Punjab. Good knowledge determines good attitudes that control good practices; hence, a focus on augmenting Practices of Intestinal Parasitic knowledge among parents should be the top priority of healthcare, especially among mothers.

Comparison of Fetomaternal Outcomes in Nifedipine Combined with Sildenafil Citrate Versus Nifedipine Alone for the Management of Threatened Preterm Labour

Humna Mian Faiz Rasul — 2024-11-30

Sildenafil, a smooth muscle relaxant, has been explored as an adjuvant to delay the onset of preterm labor. By inhibiting uterine contractions, it helps prolong pregnancy and improve fetal outcomes. Objectives: To evaluate the effects of Nifedipine on the mother and fetus during impending preterm labour, alone or with sildenafil citrate. Methods: The quasi-experimental trial was conducted at Sir Ganga Ram Hospital Lahore. Patients were randomly assigned to receive either 20 mg Nifedipine orally (stat dose) followed by 10 mg every 8 hours with 25 mg sildenafil citrate orally at 8-hour intervals or 20 mg without sildenafil citrate. The medication therapy lasted 72 hours. Chi-square and independent sample t-tests were used to compare groups in SPSS version 26.0. Results: Baseline age, gestational age and parity were similar in both groups (p>0.05). With mean gestational age at delivery 34.47 ± 2.18 weeks, the frequencies of term, preterm and very preterm were 15.0%, 77.5% and 7.5%, respectively. Nifedipine with Sildenafil citrate group had significantly higher term deliveries (30.0% vs. 0.0%; p-value=0.002) and normal weight births (35.0% vs. 5.0%; p=0.005) compared to Nifedipine alone group; however maternal readmission and neonatal intensive care unit admission rates were not statistically different between groups (p>0.05). There was no mortality feto-maternal observed. Conclusions: It was concluded that oral sildenafil citrate combined with Nifedipine is an effective option as tocolytic therapy for threatened preterm labour. The prolongation of pregnancy will improve fetal weight, and reduce neonatal intensive care unit admissions and preterm deliveries with minimum maternal and fetal side effects.

The Role of Nanomaterials in Preventive Dentistry: Antimicrobial Coatings for Dental Restorations

Shahneela Sohail — 2024-11-30

The applicability of antimicrobial nanomaterial coatings in preventive dentistry such as dental restoration practice in combating dental caries while embracing biocompatibility, and long-lasting and low bacterial adhesion properties has been the main area of research for many decades. Objective: To review the role of different types of nanomaterials in the field of preventive dentistry by focussing on anti-microbial coatings for dental restorations. Methods: The articles were taken from PubMed, Science Direct, and Google Scholar within the years 2018-2024 following PISMA 2020 guidelines. The effectiveness of nanomaterials included in dental coatings in terms of antimicrobial properties, biocompatibility, and durability in clinical applications was observed. Bacterial adhesion, caries prevention, material nanotechnology, and patient satisfaction were assessed. The antimicrobial efficiency and restorative outcomes of different nanomaterials: via silver, zinc oxide and titanium dioxide; were evaluated. Initially, 109 articles were retrieved, which were then screened based on predefined inclusion and exclusion, resulting in 16 studies for detailed analysis. The regions of study conduction were North America, Europe and Asia. Results: The antimicrobial efficacy of nano-coatings in dental restorations was seen via reduced bacterial adhesion and biofilm. The link between nanomaterials like silver nanoparticles and titanium dioxide enhanced secondary caries prevention and improved the long-term stability of restorative materials. Biocompatibility studies demonstrated that these coatings are biocompatible; however, more work is required. The application of antimicrobial nano-coatings gives adaptive and therapeutic characteristics. Conclusions: It was concluded that nanotechnology should lead to better durability and performance of dental restorations thus better oral health and less caries

Neuropharmacology of Fisetin as a Senotherapeutic Agent: Investigating Its Role in Neurodegeneration and Brain Aging

Sidra Javaid — 2024-11-30

Fisetin, a flavonoid in various fruits and vegetables, has emerged as a promising chemotherapeutic agent with potential neuroprotective effects, particularly in neurodegeneration and brain aging. Objective: To explore the role of fisetin in mitigating age-related neuronal damage by targeting oxidative stress, inflammation, and cellular senescence, common contributors to neurodegenerative diseases such as Alzheimer's and Parkinson's. Methods: Following PRISMA guidelines, relevant studies were sourced from ScienceDirect, Google Scholar, and PubMed, spanning publications between April 2014 and August 2024. One website was also used to retrieve studies, i.e., Frontiers. Fisetin's mechanism of action includes modulating key pathways, such as the inhibition of inflammatory markers, reduction of Reactive Oxygen Species (ROS), and protection against neuronal apoptosis. Results: Studies conducted on various animal models and human-derived neurodegenerative cell lines reveal its potential to improve cognitive function and reduce the progression of age-related brain disorders. Conclusions: Fisetin's ability to selectively target senescent cells, reduce neuroinflammation, and enhance synaptic function positions it as a potential therapeutic for brain aging. Future research focusing on clinical trials and dosing optimization was crucial to establishing fisetin as a viable treatment for neurodegenerative conditions and cognitive decline associated with aging.

Clinicopathological Role of Adiponectin in Preeclampsia: Linkage with Placental Function and Maternal Health

Mohammedelfateh Adam — 2024-11-30

Preeclampsia is a hypertensive, multisystem disease in pregnancy, associated with dysfunction of the placenta. Emerging studies point toward the possibility that adiponectin, a hormone with anti-inflammatory and vasodilator properties, may contribute to the development of preeclampsia. Objectives: To systematically review the role of adiponectin in the pathophysiology of preeclampsia with limited evidence on the role of placental gene expression, providing clinicopathological insights into its role in maternal and fetal health. Methods: A comprehensive literature search was conducted across PubMed, Science Direct, and Google Scholar for articles published between 2017 and 2024. Included studies explored the relationship between Adiponectin levels and preeclampsia in relevance to placental pathology, and hormonal levels. Studies analyzed adiponectin's role in modulating insulin resistance, hypertension, placental growth, and vascular health in preeclampsia. Data from multiple regions, including Asia, Europe, and America, provided global perspectives. Results: An association between reduced adiponectin levels and increased severity of preeclampsia and its potential role in impaired placental physiology and adverse pregnancy outcomes were reviewed. Conclusions: It was concluded that adiponectin plays a crucial role in the pathophysiology of preeclampsia, affecting both maternal health and placental function. Understanding these mechanisms may offer insights for therapeutic interventions in managing preeclampsia and improving fetal outcomes.

Effectiveness of Ultrasound-Guided Regional Anaesthesia in Paediatric Patients Undergoing Urological Surgeries: A Systematic Review

Shabir Ahmad — 2024-11-30

Recent research in anatomy and ultrasound has highlighted the importance of a technique named ultrasound-guided regional anaesthesia in pediatric anaesthesia, due to its approach to enhancing nerve visualization and targeted nerve blockade which improves patients’ safety and pain relief during surgical procedures. Objectives: To evaluate the outcomes of pediatric patients who received ultrasound-guided regional anaesthesia during urological surgeries and compare its effectiveness in pain control, anaesthetic quality, and post-surgery results. Methods: A search was conducted according to PRISMA guidelines using PubMed, Google Scholar, Springer Link, and Science Direct. A total of 96 studies were included after applying the inclusion criteria to articles published between January 2013 and April 2024. Out of these, only 15 were used in the study table to highlight the effectiveness of ultrasound-guided regional anaesthesia in pediatric urological surgeries. Results: Consistently, the alignment with the ultrasound-guided regional anaesthesia revealed significantly greater analgesic efficacy, least opioid usage as well and lesser rates of anaesthesia-related adverse events in pediatric subjects mainly neurodevelopmental concerns and opioid dependency. Other papers also revealed better hemodynamic control and the duration of time needed to feel fully recovered postoperatively, and thus, ultrasound-guided regional anesthesia may enhance perioperative outcomes and ambience in children undergoing different urological procedures. Conclusions: It was concluded that ultrasound-guided regional anaesthesia appears to be applicable for pediatric urological surgery, providing better analgesia, fewer side effects, and reduced demand for systemic anaesthesia. Future studies should establish the long-term results of the method and make comparisons to the other procedures

A Biomarker-Centric Diagnostic Approach based on Neutrophil Percentage to Albumin Ratio (NPAR) for Diabetic UTIs

Abdul Samad — 2024-11-30

The Neutrophil Percentage to Albumin Ratio (NPAR) was identified as a promising biomarker for identifying inflammation and renal complications in diabetic Urinary Tract Infections (UTIs). Objective: To evaluate the diagnostic potential of NPAR as a novel biomarker for the diagnosis and prognosis of diabetic UTIs. Methods: The current study was carried out according to PRISMA criteria to determine the prognostic value of the Neutrophil Percentage to Albumin Ratio (NPAR) in diabetic UTIs. The study (April 2024 to June 2024) was made on Google Scholar, Science Direct, PubMed with a date ranging from 2014 to 2024. Articles comparing NPAR effect on non-diabetic and diabetic UTI-related inflammation, immune cells suppression, comparison of NPAR to classic biomarkers with comorbidities and renal damage were taken for the review. Information was available from different world areas, such as the Asia Pacific, Europe, and the America’s for breadth. The first search found 162 papers, but 134 remained after duplicates were deleted, and these were screened and reviewed, resulting in the inclusion of 15 studies in the systematic review. Results: The findings of the study demonstrated that NPAR has higher reliability in diagnosing inflammation and prognosis than traditional biomarkers, especially in septic patients with hypoalbuminemia. Conclusions: Due to the reliability, sensitivity and specificity of NPAR, it was a potential biomarker for evaluating inflammation and prognosis of patients with diabetic UTI. Its implementation as part of clinical practice could extend understanding on disorder and early identification.

Exploring the Effectiveness of Guided Tissue Regeneration Techniques in Periodontal Disease Treatment and Its Long-Term Effects on Patients

Ayesha Imtiaz — 2024-11-30

Periodontal disease is a bacterial infection that affects gums, alveolar bone and periodontal ligaments. An innovative approach to treat such infections is guided tissue regeneration which helps in the regeneration of tissues which are lost by this disease. Objectives: To assess the appropriateness of guided tissue regeneration procedures in periodontal management and evaluate the clinical benefits for patients. Methods: An intensive review of literature was made using PubMed, Science Direct and Google Scholar, by considering articles published between 2020-2024. Some of the analysed works investigated the effectiveness of guided tissue regeneration techniques as compared to other traditional methods of periodontal treatment. The parameters that have been evaluated include tissue repair, decrease in periodontal pocketing, gain in clinical attachment, and the aesthetic crown height index. The studies have been sourced from America, Europe and Asia. Results: Results from the studies highlight the efficacy of guided tissue regeneration techniques in the tissue repair process. It significantly highlights the improvements in dental attachment levels, long-term periodontal health and pocket reduction. However, variation in patients and their specified underlying conditions remain. Conclusions: It was concluded that guided tissue regeneration appears to provide an effective line of treatment for periodontal disease with the prediction of long-term therapeutic outcomes. Further studies should be carried out to enhance the properties of guided tissue regeneration materials and application methods to obtain more consistent results.

Managing Clinical Trials Amid Healthcare Policy Reforms: Challenges and Opportunities

Babar Hayat — 2024-11-30

Clinical trial management is becoming more influenced by policies in healthcare reform, especially if those reforms are actively affecting regulations, access to healthcare, and compliance. Objectives: To find out the implications of healthcare reforms for the administration, supervision and outcomes of the clinical trials. Methods: This study was carried out according to the PRISMA guidelines. Eight scholarly databases of peer-reviewed research articles were used including PubMed, ScienceDirect, and Google Scholar. For this review, articles published from January 2016 to April 2024 were collected. This paper reviewed articles centred on the impact of healthcare reform policies on clinical trials, especially in chronic diseases and novel therapies in North America, Europe, and Asia. Through screening, 96 articles were taken for initial screening. 16 articles were fully reviewed based on challenges and prospects of clinical trial management in the course of changes in healthcare system reforms. Results: Healthcare policy reforms face obstacles like regulatory challenges, added bureaucracy, and highly volatile patient care accessibility. But there are also some benefits like optimized approval of trials-based procedures, better patient engagement, and increased trial effectiveness. Conclusions: It was concluded that clinical research can be more effective and scalable if proactive adaptive strategies are integrated and trial protocols are aligned with evolving policy changes. Adapting proven trial management practices in healthcare settings has the potential to enhance patient outcomes and promote operational efficiency in clinical research around the world.

Sound Induced Dental Sensitivity

Mohammad Aizaz Khan — 2024-11-30

Tooth sensitivity is a common complaint of patients [1], which can be defined as an exaggerated response to a stimulus such as thermal, chemical, tactile, osmotic, or air-current that usually causes no response in a normal, healthy tooth [2-4] but have you ever winced when hearing the screech of nails on a chalkboard or felt sharp discomfort in your teeth at the sharp sounds, such as the sound of metal scraping against metal? These reactions are common among people, as most of us feel during our lifetime. The scientific community has yet to fully explain why certain sounds cause physical discomfort in teeth. Most of the dental and facial pain had a psychological or behavioural impact. Thus, dental and facial pain is a relevant problem that is mostly associated with tooth sensitivity [5]. Direct research on the phenomenon of sound-induced teeth sensitivity is almost nil which is a void to be filled by scientists. Deep studies on misophonia, auditory-tactile synesthesia, polyvagal theory, cross-modal sensory processing, and teeth conduction provide reasonable insights that can help us understand this phenomenon. Analyzing opinion-based clues from different studies, we can explain how sharp sounds such as metal scratching can induce sensitivity in our teeth. Misophonia means "hatred or dislike of sound." It is a neurobehavioral syndrome phenotypically characterized by heightened autonomic nervous system arousal and negative emotional reactivity (e.g. irritation, anger, anxiety) in response to a decreased tolerance for specific sounds [6-8]. It is characterized by a negative reaction to a sound with a specific pattern and meaning to a given individual. Trigger sounds include food chewing, sniffling, persistent coughing, knuckle cracking, metal scratching, and nail scratching [9, 10]. The phenomenon of tooth sensitivity can be explained by misophonia in certain ways in light of different research and theories. No direct link has been explained by the researchers to teeth sensitivity, but as professionals, we have selected the lines that reflect the concept of sound-induced teeth sensitivity. The concept we extract from the condition of misophonia is that teeth sensitivity is the negative response of the body to the triggering misophonic sounds like screeching of metal. Another study suggests that individuals with misophonia exhibit stronger activation in the orofacial motor area in response to trigger sounds, indicating a motor response to misophonia [11]. Dr. Stephen Porges devised the polyvagal hypothesis, which explains how the neurological system reacts to safety or danger by concentrating on the vagus nerve, which connects the brain to the face, neck, and internal organs. Sensations of security and calm are brought on by healthy vagus nerve activity. On the other hand, when it malfunctions, dangerous reactions might occur even in the absence of real dangers. This idea links the body's stress response to sound-induced oral sensitivity. The autonomic nervous system, in particular the vagus nerve, is responsible for inducing a "fight, flight, or freeze" reaction in response to perceived dangers, such as specific noises, according to the polyvagal theory [12-15]. Certain noises may cause an unconscious stress reaction in those who have sound-induced dental sensitivity, which makes them more sensitive to oral stimuli. This response is like how people have misophonia, and strongly react to specific noises. Essentially, the nervous system may interpret sound as a threat, causing unpleasant sensations. There could be a neural connection between hearing and touch, according to a study by Oxford University Press, which indicates that the auditory and somatosensory systems are well related. An anatomical basis for multisensory interactions is provided, explaining why some unpleasant sounds irritate. Within this framework, the correlation between metallic scraping noises and tooth sensitivity can be twigged as cross-modal perception, which can be elucidated in two ways: (1) Sensory Association: The brain interprets unpleasant sounds with high pitch as physical sensations, causing tooth pain. (2) Neural Overlap: When certain noises are heard, the activation of neural circuits linked to tooth pain may result from the overlap of auditory and somatosensory regions [16]. Auditory-Tactile Synesthesia: This condition involves sounds evoking tactile sensations due to cross-modal processing and hyper-connectivity in the brain. Different sounds can induce various tactile sensations such as vibrations, warmth, and tingling, varying among individuals [17]. In the context of this study, we can suppose that certain sounds can induce painful tactile sensations in the teeth in the form of sensitivity. This study suggests that specific sounds can trigger painful tactile sensations in teeth, manifesting as sensitivity. Both teeth and bones serve as sound conductors. High-frequency sounds, like metal scratching, are conducted through the skull's bone to the teeth or directly by the teeth, causing sensitivity. These sounds disturb dental tubular fluid, which stimulates baroreceptors and leads to teeth sensitivity according to the concept of hydrodynamic theory [18, 19]. Despite, various plausible reasons discovered by linking several studies, further study is needed to recognize the exact source of sound-induced oral sensitivity. Researchers must also determine the prevalence of this condition, whether it is general or affects only a small percentage of the population. Future studies may focus on neuroimaging studies to detect brain activity in people who experience this phenomenon, or it could look into whether there is a genetic predisposition that renders certain people more prone to this form of multimodal pain. The phenomenon known as sound-induced dental sensitivity is a fascinating nexus between the fields of neuroscience, psychology, otolaryngology, and dentistry to investigate the relationship between pain in the teeth and the other systems. The interdisciplinary approach involving neurology, otolaryngology, and psychology can help the researchers understand the idea of sound-induced tooth sensitivity, which will ultimately help those who are affected by it. Identifying the gap could help dentists improve their dental practices by enabling them to investigate sound-induced dental discomfort and provide specialized, comfortable, anxiety-free, high-quality services. The results could also help develop customized treatment plans that take into account a patient's sensitivity to particular sounds or discover and use cutting-edge technical solutions like sound-mitigating devices during dental procedures. Additionally, the introduction of innovative dental materials that reduce sound vibration transmission might be considered.