Pakistan Journal of Health Sciences

Desmoid Tumor of the Left Abdominal Wall: A Rare Case Report

Muhammad Haider Ali — 2023-02-28

Desmoid tumors are the type of tumors that are infrequent. However, Desmoid tumors can invade in nearby areas and can re-appear even after excision. They can reach the abdominal areas and can result in pain and swelling. The author presents a case of Desmoid tumors in a 24 years old female involving the rectus sheath. Case Summary: We present a case of 24-year-old woman initially diagnosed with fibroadenoma of the right breast. After a month of the procedure, the patient complained of nausea, pain and cramping in the left abdominal area. She was referred to us for further evaluation of the growing mass in the left abdominal area. A Trucut Biopsy revealed an abdominal mass in the left upper quadrant about 5x5cm hard in consistency. A desmoid tumor was revealed in the diagnosis. She underwent wide local excision. Conclusions: Desmoid tumors are a rare type of tumor. These types of tumors arise most commonly in the upper limb, lower limb and in the popliteal region. Our case presents a representation of the tumor in the abdominal region particularly rectus sheet. MRI and CT scan can be helpful in diagnosis of these tumors but histological findings are necessary. Our case outlines the importance of identification of desmoid tumors in a timely manner and also the symptoms that it presents with. These tumors are to be treated with surgical excision with follow up every two to four weeks.

The Use of Complementary and Alternative Medicine in Health Care

Riffat Mehboob — 2023-02-28

It's kind of mysterious how complementary and alternative medicine (CAM) is being used more and more in developed, "established" Western countries. There hasn't been much study or good understanding about it. The National Center for Complementary and Alternative Medicine (NCCAM) defines "complementary and alternative medicine" (CAM) as a collection of various medical and health systems, procedures, and objects that are not currently regarded as corresponding to traditional medicine. Over the past 15 years or so, CAM use has grown significantly, and it is without a dispute significant from a medical, economic, and sociological perspective. Even though there are literally hundreds of therapies that fall under the broad definition of CAM, only about 15-20 have definitive proof of their efficacy and safety to be taken seriously (Tiran, 2001). The NCCAM divides complementary and alternative medicine (CAM) into five primary categories: whole medical systems, mind-body healthcare, physiologically based, manipulative and body-based therapies, and energy fields [1].

CAM is frequently used to supplement conventional treatment. Back issues, melancholy, sleeplessness, intense headaches or migraines, stomach or intestinal diseases, and back problems were the most frequent symptoms linked with CAM, according to a review of the worldwide CAM literature by Frass et al. [2]. A few earlier studies looked into the use of CAM for particular diseases or health issues, like cancer and multiple sclerosis.

According to Menniti-Ippolito et al., herbal medicine was more frequently used to enhance life expectancy while acupuncture and manipulative treatments were mainly used to treat pain in Italy. Homeopathy, in comparison, was not linked to any particular health issues [3]. Other common reasons people turn to complementary and alternative medicine (CAM) are dissatisfaction with biomedicine, frustration with the doctor-patient relationship, relaxation, enhancements in subjective wellbeing, preventative medicine, a preference for natural care over biomedical medicine, and an eagerness for more individualized and holistic care.

People in Pakistan who believe in quacks, pastors, hakeems, homoeopaths, or other psychic healers have used alternative treatments. For issues like infertility, seizures, psychosomatic issues, melancholy, and many other illnesses, these are the first line of defense. The proximity, reasonable cost, accessibility, family obligation, and the positive perception of the community are the primary justifications for visiting a CAM healer. Pakistan has a long history of using medicinal herbs to cure a variety of illnesses. The people's health-seeking behavior, particularly in emerging nations, necessitates integrating all CAM healers into society by giving them access to appropriate training, tools, and referral support.

Nutritional Potential of Citrus Sinensis and its Pharmacological Action: A Concise Review

Madiha Khan Niazi — 2023-02-28

Currently, the pharmaceutical industry is becoming increasingly interested in the quest for novel medications derived from natural resources. Since ancient times, new pharmaceuticals have been created using natural ingredients. Secondary metabolites that have been discovered to have advantageous qualities are abundant in plants. This review highlights the medicinal potential of C. sinensis as a source of natural chemicals with significant health-promoting properties that could be exploited to create novel medications.

Use of Ketamine, Propofol and Their Combination (KETOFOL) For Procedural Sedation in Emergency Department: A Review

Huma Nasir — 2023-02-28

For Procedural Sedation, sedative and Analgesic agents are frequently used in Emergency Department but titration of anesthetic doses should be performed with care, and patients should be continuously monitored. The use of Ketamine, Propofol and their combination (Ketofol) is in common practice, but there is currently no intravenous anesthetic agent that is ideal. Therefore, this review was conducted to analyze the efficacy as well as the potential side effects of these anesthetic agents during procedural sedation. Method: For this purpose, Medline, EMBASE, CCRCT and CINAHL were searched and systematically analyzed and the meta-analysis included all English-language randomized control trials (RCTs) comparing K-P vs propofol for procedural sedation in ED. The study included the data of ED patients who received procedural sedation for non-elective unpleasant procedures. Results: As a result of the removal of duplicate citations and studies that did not fulfill eligibility requirements, a total of 06 RCTs involving 932 patients (412 in the propofol group and 520 in the K-P group). Very high levels of inter-rater reliability (j = 0.88; 95% CI = 0.68 to 1.0) were found in the final selection of included trials, with 95.2% agreement. Conclusion: Data revealed that the combination of Ketamine with propofol was the most effective anesthetic combination in the larger randomized, prospective studies carried out in the ED that had sufficient power to use the maintenance of vital signs and the success of the procedure as endpoints are still required

Knowledge, Attitude, and Practices Regarding Menopause Among Elderly Women Attending Tertiary Health Care Centers in Lahore, Pakistan

Muaaz Bin Waqar — 2023-02-28

Menopause is a stage in life in which female periods are stopped, as it is a normal part of ending of your fertile, reproductive years. Objective: To assess the knowledge, attitude and practices regarding menopause among elderly women of Lahore. Methods: A cross sectional study was conducted in the Tertiary Health Care Centers in Lahore, Pakistan. Data were collected by non-probability convenient sampling technique. Inclusion criteria includes all females age between 45 to 60 and above. Whereas the exclusion criteria include non-cooperative individuals, women on any drug therapy. After taking informed written consent, data were collected by using self-structured questionnaire. Results: According to the study, 70% women had prior knowledge of menopause. 60% believe menopause is life-altering. Additionally, 67% believe menopause causes weight gain, 67% believe that food changes assist manage menopause. In addition, 65% practice the lifestyle changes help managing menopause. 44% had mild hot flashes and sweating episodes, 23% had severe symptoms, 45% of women had mild sleep issues. 36% were suffering from mild depression, and 30% had no symptoms. In 29% women had osteoporosis, 46% women have joint pain 25% of women made dietary modification for menopause. Conclusions: The majority of women were aware of menopause and its symptoms because they were educated, but they did not live a healthy lifestyle that included dietary practices and physical activities such as yoga and exercise. Providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women

Frequency of Successful Extubation in Patients with Rapid Shallow Breathing Maximum (RSBImax)

Bushra Rabbani — 2023-02-28

Prolonged mechanical ventilation and premature removal from mechanical ventilation (MV) are independent risk factors for morbidity and mortality. Weaning and liberation from MV remain critical stages of a patient's ICU stay. To date, no weaning predictive index has proven to be ideal. Objectives: To determine the frequency of successful extubation in patients on mechanical ventilation after 2 hour of spontaneous breathing trial (SBT). Methods: A total of 100 consecutive patients admitted in Medical ICU, meeting the inclusion criteria was enrolled. Non probability purposive sampling was employed. Patients of both gender and age >18 years, on mechanical ventilator for more than 48hrs were included. Two hours of SBT was performed in a semi seated position. RSBI were measured at 1 min after extubation. Patient who have not developed any feature of SBT intolerance, was continued on SBT up to 120 min. All collected data was entered into Statistical Package for Social Sciences (SPSS) version 24.0 for analysis. Results: Successful extubation was found to be (86%). in patients with RSBI_max <105. Among 43 patients with successful extubation, 60.5% were male and 39.5% were female. The average age was 53+ 14.6 yrs and the average days of MV were 7+ 2.3 days. Rate of successful extubation was high with the age < 60 yrs, in male gender and with duration of MV <7 days. Conclusion: It is concluded from the above study that patients with RSBI_max <105 were found to have successful extubation

Frequency of Hyperuricemia In Patients Presenting with Acute Ischaemic Stroke

Amjad Iqbal — 2023-02-28

Hyperuricemia refers to elevated serum uric acid concentration above the upper limit of normal. Objective: To determine hyperuricemia in patients presenting with acute ischemic stroke to the Neurology ward of Lady Reading Hospital, Peshawar. Methods: A total of 153 patients were observed to the frequency of hyperuricemia in patients presenting with acute ischemic stroke. Study design was cross sectional study which was conducted for the period of 6 months. The total Sample size was calculated by using WHO sample size calculator. It was calculated using the World Health Organization software. Results: A total of 153 patients were observed to the frequency of hyperuricemia in patients presenting with acute ischemic stroke. Mean age of study participants was 52.45±1.14 years. Distribution of hyperuricemia was 114(74.5%). Mean serum uric acid level among cases of acute ischemic stroke was 06.15 ± 01.91 mg/dl while the mean serum uric acid level among control group was 05.1 ± 01.4 mg/dl. The results were highly significant p-value < 0.0001. Conclusions: Serum uric acid levels can be used to predict stroke risk. Moreover, serum uric acid can be utilized to stratify risk following a stroke. Long-term prospective research is needed to determine the involvement of serum uric acid in ischemic stroke. A trial of serum uric acid reducing medications in stroke patients as well as those at high risk of stroke may also be worthwhile.

The Ultrasonographic Findings of Ventriculomegaly in 2nd And 3rd Trimester with Fetal Outcomes

Saba Feroz — 2023-02-28

In the second trimester, fetal ventriculomegaly is a typical finding on obstetrical ultrasonography. It is clinically relevant since it can be caused by a variety of disorders that cause brain, motor, and/or cognitive impairment. Many cases are associated with other abnormalities, but in other cases, ventriculomegaly is the only abnormality. Objective: To evaluate the incidence of ventriculomegaly in 2^nd and 3^rd trimester with fetal outcomes. Methods: A descriptive study was conducted at of University of Lahore Ultrasound Clinic Greentown for duration of 4 months. Total 774 females were presented at hospital for in 2^nd and 3^rd trimester. All participants underwent transabdominal ultrasound using 3-5 MHz curvilinear probe. Written informed consent was obtained from all participants. Results: Total 774 women in 2^nd and 3^rd trimester of their pregnancy were included in our study. Out of 774 patients 700 were with cephalic presentation and 74 were with breech presentation. Variables including Spinal defect types, ventriculomegaly and ventricular involvement were noted. Out of 774 patients, 22 patients had fetal ventriculomegaly, 2 patients were with meningocele, 3 were with myelomeningocele and 16 patients were with spina bifida occluta. Ventricular involvement was as follow: In 5 fetuses, fourth ventricle was involved, in 15 fetuses lateral ventricles were involved and in 2 fetuses third ventricle was involved. Conclusion: Findings from this study concluded that Severity of ventriculomegaly is highly associated with fetal spinal defects.

Prevalence of Sleep Disturbance Among DPT Students

Iqra Nadeem — 2023-02-28

Sleeping is essential for student physical as well as mental health. Sleep disturbance is distressing state that affect quality of work. Objective: To determine the sleep disturbance in DPT students. Methods: This observational study recruited 884 participants out of which 800 filled the questionnaire with mean age 21.54 ±1.76 from different medical universities and medical colleges of Punjab. Non probability convenient sampling technique was used. Both male and female students of all the years of DPT were included. Students with psychiatric illness, chronic medical illness, smoking and taking drugs excluded from the study. The effects of insomnia were checked by Athens Insomnia Scale (AIS) questionnaire. For data analysis SPSS version 26 was used. Results: Mean age of the physical therapy students was 21.54 ±1.76. Out of 800, 61.75% students were insomniac. Most of the students had unsatisfactory sleep quality (55.87%), awakening at the night time (62%), and day time sleepiness (76.25%). Conclusion: According to present study prevalence of sleep disturbance was very high among physical therapy students

Multi-Slice Computed Angiography for The Evaluation of Stent Patency After Left Main Coronary Artery Stenting

Muhammad Alam Khan — 2023-02-28

Due to the high frequency of in-stent restenosis, repeat coronary angiography and left main percutaneous coronary intervention is recommended. But Computed Tomography Angiography is a noninvasive procedure for evaluating coronary arteries. Objectives: To assess the proportion of InStent restenosis in left main per-Cutaneous coronary intervention and to evaluate diagnostic efficacy of Computed Tomography Angiography in detecting In stent Restenosis. Methods: We assessed 263 consecutive LM PCI patients; 130 patients were chosen for this study procedure as they meet our criteria. CTA was conducted three months following the LM PCI. Results: The vast majority of patients (73.8 %) had PCI from LM to LAD and 16.2 % from LM to LCX. Only 10% of patients had bifurcation PCI, and all patients had DES (100%). The average period for ISR development was 125 months, with ISR rates of 32.2 % in the LM to LAD cohort and 38 % in the LM to LCX cohort. The median time between PCI and CTA was 194 days, with a mean basal heart rate of 69 ± 12 beats per minute. CTA exhibited a positive predictive value of 84.7%. Conclusion: CTA enables an accurate noninvasive assessment of selected patients following LM PCI. And CTA can be used as a first-line treatment instead of coronary angiography.

Comparison of Outcome of Traditional Radial Artery versus Distal Artery Approach in Patients undergoing Coronary Intervention

Naeem Tariq — 2023-02-28

Although most interventional cardiologists favor radial artery (RA) access because to its ergonomic practicality, data on distal artery (DRA) access with relation to RA patency has not been compared in major trials. Objective: To compare the access feasibility of distal radial artery vs Forearm radial artery for cardiac catheterization operations. Methods: A cross sectional study of total of 198 patients undergoing radial coronary operations were monitored for radial artery occlusion (RAO) and other local problems with DRA and FRA access. Purposive sampling was performed. The inclusion criteria include all participants who had a palpable distal or proximal radial pulse. The patient was free to choose between the two approaches. Patients having an inappropriate radial pulse were eliminated. Results: The main objective was fulfilled by 11.7% in the FRA and 10.4% in the DRA group (p-value=0.24). Cannulation time was greater in the DRA group compared to the FRA group; however, this had no effect on hemostasis time (254 20 vs. 254 17; p-value=0.72). Hematoma (26.4% vs. 12.5%; OR (95% CI): 3.18 (1.09–5.63); p-value 0.001) was more prevalent with FRA, while radial artery spasm (18.6 % vs. 22.9 %; OR (95 % CI): 0.53 (0.03 – 0.95); p-value=0.01). Conclusions: When compared to Forearm Radial Artery access, Distal Radial Artery access is linked with poorer cannulation success rates and greater RAO rates. It is, however, linked to the production of lower hematomas

Experiences of Post Esophagectomy Patients Admitted in Lady Reading Hospital Peshawar Pakistan

Ishrat Shaheen — 2023-02-28

Patients having esophageal cancer can experience psychological, emotional, physical, social, financial and spiritual changes following surgery. Exploration of such challenges, particularly from the Patient’s perspective has been limited in Pakistan. Objective: To explore the experiences of post-esophagectomy patients admitted in Lady Reading Hospital Peshawar Pakistan. Methods: A qualitative phenomenological study was conducted on ten patients having esophagectomy admitted at Lady Reading Hospital Peshawar. Participants were selected through None Probability purposive sampling technique. Permission was taken from concerned departments as well as from participants before data collection. An interview topic guide was used for Face-to-face individual, in-depth interviews. Audio recorded, transcribed, and analyzed through thematic analysis. Results: Five major themes were constructed i.e., Physical changes, psychological effects, social issues and support, financial issues, acceptance, and adjustment to a new changed way of life. Conclusions: Post-esophagectomy patients need full support in adjustment to their physical, psychological, emotional, social, financial, and spiritual aspects of life. Family, friends, and society could be an effective channel in this regard. Government should provide medical and financial support to such patients for their treatment as well as for their rehabilitation.

Frequency of Benign Lesions in Radiologically Presumed Renal Cell Carcinoma Taking Histopathology as Gold Standard

Ayesha Khan — 2023-02-28

Renal cell carcinoma (RCC) comprises for between 90-95% of renal neoplasms in adults and about 3% of all malignancies overall. Objective: To ascertain the prevalence of benign lesions in radiologically presumed renal cell carcinoma ≤ 7 cm, using histology as the gold standard Methods: A prospective cross-sectional study was undertaken at the department of urology. A total number of 131 patients who were diagnosed possibly as RCC on CT scan. Demographic characteristics (age and gender), size of renal mass both pre-operatively and per-operatively were noted. After nephrectomy, the specimen was sent to histopathology laboratory for confirmation of diagnosis. Histopathology reports were analyzed post operatively and frequency of benign lesions in radiologically presumed RCC was determined. Results: Mean age of patients included in this study was 52.02±13.18 years. Mean size of mass pre-operatively was 4.89±1.47 cm. Mean size of mass per-operatively was 5.07±1.44 cm. There were 87 (66.41%) male and 44 (33.59%) female patients. Incidental diagnosis was made in 25 (19.08%) patients. Symptomatic predisposition was found in 107 (81.68%) patients. Partial nephrectomy was performed in 59 (45.04%) and radical nephrectomy was performed in 72 (54.96%) patients. Malignancy was diagnosed in 109 (83.21%) patients and benign lesions were diagnosed in 22 (16.79%) patients on histopathology reporting. Conclusion: The frequency of benign lesions in radiologically presumed renal cell masses in our study is 16.8%. The findings of this study may assist urologist in advising patients who have small renal masses and choosing the best course of action

Medical and Dental Faculty’s Attitude towards E-Learning as the Mode of Teaching during Covid-19 Pandemic

Mahvish Wahad Khan — 2023-02-28

The use of modern technology infrastructure is regarded as critical for the successful adoption of innovative teaching approaches. Objective: To determine the attitudes and concerns of medical and dental faculty about the use of E-learning as a medium of instruction during the Covid-19 outbreak. Methods: This cross-sectional study included 368 faculty members from Medical and Dental Colleges of Punjab province was conducted utilizing a questionnaire developed following a thorough literature review and analysis of questionnaires from previous studies. A 5-point Likert scale was used to record knowledge, attitude, and practice, and the questionnaires were graded. SPSS version 22 was used to enter the data. The mean and SD of quantitative variables such as age and total score for knowledge, attitude, and practice score was calculated. Gender, education level, knowledge, attitude, and practice were all represented as frequency (%). Results: Zoom was shown to be the most commonly utilized software (69.0%). E-learning was deemed a beneficial tool in medical education by 56% of the respondents. An equal percentage of individuals (35%) agreed and disapproved the use of E-learning approaches over traditional ones. Only 30% participants resisted the change from traditional educational methods. Technological infrastructure was considered crucial for successful implementation of E-learning by 46% of the participants. Conclusion: Faculty members are using the available infrastructure to implement E-learning teaching modalities to the best of their knowledge and abilities.

Effectiveness of Intravenous Magnesium Sulfate in Children Presenting to the Emergency Department with Acute Exacerbation of Asthma

Shaista Ehsan — 2023-02-28

Asthma is a serious medical condition in the pediatric age group and can have a high mortality, therefore it should be managed effectively. Patients not responding adequately to first line therapy need additional treatment. A few research studies have evaluated the use of intravenous magnesium sulfate in improving respiratory scores in severe acute pediatric asthma but the results have been conflicting. Objectives: To determine the benefit of intravenous magnesium sulfate in treating children presenting with worsening of asthma symptoms. Methods: A cross-sectional prospective study carried out at the Pediatrics Unit of Zia Uddin University Hospital, Karachi from 1^st March 2021 to 1^st March 2022. On the whole, 280 children in the age group 2-12 years with acute worsening of asthma of were selected by non-probability purposive sampling technique, however, children in need of invasive ventilation and those having asthma related complications on radiological investigations were omitted. Chi-square was applied for categorical variables and a p-value <0.05 was considered statistically significant. Results: Out of 280 patients who came to the Pediatric Emergency Department with acute severe asthma, 236 (84.3%) patients responded to a single dose of intravenous magnesium sulfate manifested by an improvement in clinical asthma score, while 44 patients (15.7%) did not show improvement. The admission rate to the pediatric intensive care unit was only 12.8%. Conclusion: Magnesium sulfate infusion helps improve respiratory symptoms in acute worsening of pediatric asthma.

Frequency of Ventricular Tachycardia in First 48 Hours of ST-Elevation Myocardial Infarction

Zahoor Ahmad Khan — 2023-02-28

ST-elevation myocardial infarction (STEMI) has a poor long-term prognosis associated with early ventricular tachycardia (VT). Objective: To find out the frequency of ventricular tachycardia in the first 48 hours of ST-elevation myocardial infarction. Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1^st October 2020 to 31^st March 2021. All the patients having new onset ST-elevation Myocardial infarction as per Operational definition, both genders, aged between 40 and 75 years and who have given consent were included in the study. Non-probability consecutive sampling technique is being used for the sampling. Results: Standard deviation was ±1.357 years, while the average age was 51.56. Gender-wise distribution among patients male was 89(53.6%) and female was 77(46.4%). Distribution of duration of disease among patients 12-24 hours 80(48.2%) and more than 24 hours 86(51.8%) was 100(52.4%). Family History of coronary artery disease (CAD) 84(50.6%), diabetes mellitus 93(56.0%), hypertension 110(66.3%) and smoking status was 118(71.1%). Distribution of ventricular tachycardia was present among 103(62.0%) patients and was absent in 63(38.0%) patients. Conclusions: Ventricular tachycardia is the most common tachycardia occurring in patients in the first 48 hours who sustained myocardial infarction. It was shown that bradyarrhythmia was more common in patients with inferior wall myocardial infarction while ventricular tachycardia was found to be more in patients with anterior wall myocardial infarction.

Exploring Status of Oral Submucous Fibrosis and its Association with C-Reactive Protein at a Public Sector Medical University

. kiran — 2023-02-28

Oral submucous fibrosis (OSMF) is a well-established precancerous condition affecting the oral mucosa. Objective: To explore serum C- reactive protein levels in healthy patients and their comparison with diagnosed patients having oral submucous fibrosis. Methods: Eighty-two patients of all age groups, irrespective of gender and clinically diagnosed with oral submucous fibrosis, without any other systemic problem were included in the study. Patients were divided into two groups i.e., Group A = normal healthy patients and Group B = clinically diagnosed oral submucous fibrosis patients. After taking detailed history of patients of both groups, blood samples were collected from all patients for C- reactive protein levels. Results: Out of 82 patients, male were 30 (73.2%) and 34 (82.9%) and female were 11 (26.8%) and 7 (17.1%) with mean age of 41.0 ± 6.6 years and 42.6 ± 7.4 years in group I (normal healthy patients) and group II (oral submucous fibrosis patients) respectively. All patients were long-term consumers of betel quid with or without tobacco [13 (31.7%) and 28 (68.3%)], whereas no healthy patient was using betel quid. CRP level was significantly high 3.62 ±1.02 mg/dl in OSMF patients as compared to normal healthy patients 0.40 ± 0.21mg/dl. Similarly, CRP level was significantly abnormal (raised) in all OSMF patients as compared to normal healthy patients where only 7 (17.1%) were reported with abnormal (raised) CRP levels. Conclusions: Serum C- reactive protein levels in oral submucous fibrosis patients were significantly high as compared to normal healthy patients.

Effects of Parental Oral Health knowledge on Early Childhood Caries and Oral Health Status of Children 3-5 Years of Age in Abbottabad

Arooj Irfan — 2023-02-28

Dental caries can spread rapidly in children and was given the term "Early Childhood Caries" (ECC) that was coined to describe "one or more carious, non-cavitated or cavitated tooth surfaces that are missing or filled due to caries on a deciduous tooth" in a child of 5 years and 9 months of age or younger. Early childhood caries (ECC) is a “complicated condition affecting the maxillary primary incisors which quickly propagate to other primary teeth about a month of eruption”. It is a serious issue of socio-behavior or dental health which strikes pre-schoolers across the globe. Objective: To determine effects of parental knowledge on their children's oral health practices and status. Methods: A cross-sectional study was carried out, with a total of 384 kids from Government and Private Schools of Abbottabad City. Oral hygiene of the children was assessed through dmft scores upon the request of school administration and parents. Structured oral health questionnaires were distributed by the instructors among the parents during parent-teacher conferences/ meetings that were held after every three months in a fiscal year of the school. Results: A total of 372 of the youngsters in the study have all their primary teeth erupted (98.7%). Three-year-olds make up 35.7% of the overall sample, while four-year-olds make up 23%, and five-year-olds make up 0.5% of the sample. One or more of the sample's 245 decaying teeth affects 40.5% of the total. Conclusions: Parental knowledge and practise of oral hygiene were found to be linked to their children's oral health in this study.

Association of Musculoskeletal Disorders and Job Satisfaction Among Nurses Working in Hospitals of Lahore

Intsam Aslam — 2023-02-28

Musculoskeletal disorders are the most common work-related problems reported till today worldwide. This might be because nurses are engaged in activities that require continuous physical efforts and interaction with patients. Job satisfaction can be defined as how the employees feel about job and its attributes. Job satisfaction is one of the most important and common variables in work environment. Objective: To evaluate the association between musculoskeletal disorders and job satisfaction among nurses working in the hospitals of Lahore. Methods: This analytical cross-sectional study was conducted in Lahore. 194 subjects were enrolled. Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal disorders. The Nursing Workplace Satisfaction Questionnaire was used to assess job satisfaction. The Data were analyzed using SPSS v20. Mean ± SD was calculated for numeric variables while chi square test was used find the association between musculoskeletal disorders and job satisfaction. Cut off value was used to make categories of satisfaction. Results: Chi- square test of independence showed no association among neck (0.475), shoulder (0.698), elbow (0.066), wrist/hand (0.857), upper back (0.076) and Low back pain (0.358), Knee pain (0.61), ankle/foot pain (0.329) and job satisfaction as p-value of each was > 0.05 but there was found to be slight positive association among hip/thigh pain and job satisfaction as P-value was 0.43 which is statistically significant. Conclusions: There was no association between musculoskeletal disorders and job satisfaction because there were some other factors that determined the job satisfaction. These factors may include low salary, work environment etc

Incidence of Hepatitis B Due to Multiple Transfusions in Patients of β-Thalassemia Major

Rida Naz — 2023-02-28

β-Thalassemia is one of the most prevalent childhood hemolytic disorders. Multiple blood transfusions of unscreened blood can result in infection transmission. After many transfusions, Hepatitis B infection in thalassemia patients was reported. Objective: To determine the incidence of Hepatitis B in β-thalassemia major patients, associated with multiple blood transfusion strategies. Methods: This cross-sectional study was executed in Pediatric department of DHQ teaching hospital Dera Ismail khan with the collaboration of the Regional Blood center, and comprised 360 patients, diagnosed with β-Thalassemia Major and maintained on multiple transfusions. Results: The average weight of the subjects was 43.50+18.76 Kg and their mean age was 13.10+2.1 years. The significantly high population of the patients (p<0.05) was not immunized against Hepatitis B (73.88%), while only 26.66% (94/360) were immunized. The patients having less than 10, 11-20 and more than 20 transfusions per annum comprised 72 (20%), 157 (43.61%) and 131 (36.38%) patients, respectively. The affected patients had significantly altered hematological parameters (p<0.05). The highest number of β-Thalassemia Major patients affected with Hepatitis B belonged to the Group having more than 25 transfusions of blood annually, with an incidence rate of 11.53. Conclusions: The greatest risk factor for Hepatitis B infection in β-thalassemia major patients is concluded to be multiple blood transfusions. It was also found that a huge population of Thalassemia patients was not immunized against HBV despite the severe risk. Therefore, health education and awareness campaigns are needed for the significance of Hepatitis B immunization and transfusion of screened blood.

Causes of Mortality in Hospitalized, PCR Positive Patients of Covid-19 At Tertiary Care Hospital of Sindh Pakistan

Mona Humaira — 2023-02-28

In Pakistan, over 10,000 deaths have been reported due to COVID-19 while the exact course of illness and significant causes of mortality has not been found out. Objective: To enumerate the causes of death in hospitalized SARS CoV2 PCR positive patients and also to assess the relationship between COVID mortality and comorbidities. Methods: The cross-sectional study was conducted at Liaquat University Hospital after taken permission from the ethical review committee. Study included SARS CoV2 PCR positive patients, admitted at Liaquat university hospital and expired during hospitalization, aged greater than 15 year and belonged from either gender. Operated and RTA patients were excluded from study. Results: Patient’s age ranged from 18 to 90 year. Mean age was 59.6-year, Male were 79% and female were 21%. Triad of fever, cough and SOB present in 48% of patients. Respiratory failure (54%) and respiratory failure with sepsis (38%) were the leading cause of fatality. Anova Test showed statistically significant correlation between causes of death and comorbidities with p-value 0.015. Both Diabetes and Hypertension were present in 25% of patients. Conclusions: The study concluded that male gender was the dominant sufferer of COVID-19 and in contrast to normal perception, younger age is not an exception for mortality due to COVID-19. Fever, cough and SOB were the most frequent complain. Respiratory failure alone and with sepsis, was found to be the leading reason for mortality. Causes of death were strongly linked with presence of comorbidities in covid 19 patients.

Prevalence of HCV Infection in End Stage Renal Disease (ESRD) Patients on Maintenance Hemodialysis

Kishor Kumar — 2023-02-28

Hepatitis C virus (HCV) is a significant cause of morbidity and mortality in haemodialysis patients. Patients on haemodialysis are at high risk for HCV, with frequency of infection several times higher than that in non-hemodialysis patients. Objective: To determine the frequency of HCV infection in End Stage Renal Disease (ESRD) patients on maintenance hemodialysis. Methods: The Descriptive Cross-sectional study was conducted at Department of Nephrology, Liaquat University of Medical and Health Sciences Jamshoro. All patients above 18 years of age and below 60 years of age of both gender having end stage renal disease on maintenance hemodialysis with 3 months or more of maintenance hemodialysis were consecutively enrolled. Post hemodialysis patient’s serum was checked for anti HCV antibody by enzyme linked immune-sorbent assay (ELISA). Presence of anti HCV antibodies in serum detected by ELISA was labeled as HCV positive. Results: Of 90 patients, the mean age of the patients was 46.85 ±8.21 years. There were 54 (60%) males and 36 (40%) females. The mean duration of hemodialysis was 10.39 ±3.31 months. The frequency of HCV was found to be 21 (23.3%). A significant association of HCV was found with gender (p-value 0.006) whereas age (p-value 0.597) and duration of hemodialysis (p-value 0.715) was found to be insignificant. Conclusion: The frequency of HCV infection was found to be 23% in ESRD patients on maintenance hemodialysis. Early recognition and treatment of which improves the patient outcome.

Frequency of Liver Fibrosis by Non Invasive Marker in Patients with Non-Alcohol Fatty Liver Diseases

Ghulam Fatima — 2023-02-28

Nonalcoholic fatty liver disease (NAFLD) is one of the most important causes of liver disease. NAFLD is commonly associated with obesity, insulin resistance and other metabolic abnormalities such as hypertriglyceridemia and hyperuricemia. Patients with NAFLD can be properly rationalized and with early exploration and management of fatty liver the progression and complications of NAFLD in relation to liver fibrosis can be reduced on priority basis because the APRI is noninvasive and a simple calculation of two laboratorial variables. Objective: To determine the frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease. Methods: This cross-sectional descriptive study was conducted upon 164 patients with NAFLD, presented at Department of Medicine, Liaquat University Hospital, Hyderabad. All the patients with NAFLD were evaluated and explored for liver fibrosis through APRI by taking 2cc venous blood sample in a sterilized syringe by principal investigator and send to laboratory for analysis to get the AST and platelet count. An APRI score greater than 0.7 was set cut off for significant hepatic fibrosis. The data were collected on pre-designed proforma. The study lasted 6 months from 26^th February 2020 to 31^st August 2020. Results: The mean age of the patients was 48.15±11.13 years. Frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease was 10.98% (18/164). The mean APRI score was found to be 1.8±0.6. Conclusions: It was concluded that APRI is noninvasive and a simple calculation of two laboratory variables and can easily be used at the bedside or in an outpatient setting to assess the liver fibrosis. In this way, the management of NAFLD can be improved.

The Knowledge, Attitude, and Practices of Soft Drinks and its association with gender among Nursing Students, Karachi, Pakistan

. Badil — 2023-02-28

It has been recognized that soft drinks have become the third most consumed beverage worldwide. In contrast, it has a detirmental effect on health. Objective: To assess the knowledge, attitude, and practices of soft drink consumption and determine its association with gender among nursing students in Karachi, Pakistan. Methods: This cross-sectional study was accomplished at three nursing institutions in Karachi from 1^st January 2018 to 30^th June 2018. In this study, there was a total of 369 students of male and female gender were enrolled for the study. Subjects were approached by a non-probability convenient sampling method. Self-structured and pretested questionnaire was used for the collection of data. Results: Among 369 subjects, the majority of 261 (70.7%) were male, and 315 (85.4%) were single. 310 (84%) participants knew the deleterious effects of soft drinks. More than 85% admitted that soft drinks are bad for health. Two knowledge questions heard about soft drinks and the idea of the bad effects of soft drinks showed statistically significant associations with gender variables (p-values < 0.05). Whereas only attitude questions regarding the amount of drink students prefer and one practice question related to favorite drink were found to be significantly associated with gender variable (p-values < 0.05). Conclusion: Most nursing students had a fair knowledge of soft drink and their hazardous effects on their health. Despite knowing the harmful consequences, nursing students consume soft drinks.

Psychological Effects of Covid-19 Care; A Qualitative Study of Health Care Workers in Punjab Pakistan

Afsheen Talat — 2023-02-28

The pandemic has caused severe psychological distress among Healthcare Workers. They were readily exposed to extreme workloads and physical and emotional turbulence throughout the pandemic which impacted them on both professional and personal fronts. Objectives: To explore the adverse impacts of Covid-19 on the mental health of the Healthcare Workers while delving into the relationship between occupational stress, communal norms, and mental health outcomes. Methods: It utilizes content gathered through observation and in-depth interviews of the frontline Healthcare Workers (n=32) that included doctors (n=14), nurses (n=12), and domestic staff (n=6) working in three COVID-19 treatment centers made in three major cities of Punjab, Pakistan, (Lahore, Faisalabad, and Sialkot) during Covid-19. Results: The results were divided into two themes followed by their sub-themes based on the results gathered through data collection tools. The themes were analyzed using the transactional model of stress and coping. The results reveal that the psychological distress faced by HCWs is directly related to occupational stress such as extreme workload/demand, while other challenges include fighting the community-imposed stigmas against the pandemic and social isolation. Conclusions: Psychological distress is a raising concern; current evidence reveals that low- and moderate-income communities, particularly in South Asian nations, have little or no understanding of workplace stress and its repercussions. Therefore, this study investigated Healthcare Workers’ perspectives on mental health concerning the pandemic.

Exploring The Experience of Mothers of Premature Babies: A Phenomenological Study

Sobia Gulshan — 2023-02-28

Premature birth of babies is a one of the major public health problems all around the world. Objective: To explore the experience of mothers of preterm babies when their baby is admitted in a tertiary care hospital of Lahore. Methods: This study was conducted in the Neonatology department of Children’s Hospital, Lahore, Tertiary Care Hospital, Pakistan from June 2022 to December 2022. Semi structured face-to-face individual interview was used to obtain data from the 12 participants who were purposively selected for the study. The audio recorded data collected was translated into English and transcribed verbatim. Analysis was done with the help of computer assisted software called NVIVO-12. By using the Coliazzi’s method of phenomenological analysis the codes generated from NVIVO-12 were organized into sub-categories, categories, sub-themes and themes. Results: Three themes emerged with sixteen subthemes. The themes are: Mixed emotional feelings of the mothers; Mother’s satisfaction about care and support from Health Care Professionals; Mother-baby interaction in NICU. Mothers were worried due to unexpected emergency premature delivery and baby’s status and had uncertainty related to delivery outcome and the baby’s life. Participants have good interaction babies while the Kangaroo Mother Care and Breast Feeding and they applaud HCPs. Conclusions: Mothers were concerned about the survival of premature babies admitted to the NICU. They showed different emotions like fear, anger, sadness, worry, tension, lack of confidence, hope, gratefulness, courage and spiritual faith in Allah. They expressed the feelings of satisfaction about care, treatment counseling and teaching by HCPs.

Experiences Of Nurses Attended Covid-19 Pandemic Patients During 2020, In Public Tertiary Care Hospitals

Faiz Muhammad — 2023-02-28

Hospitals are often the epicenter of newly circulating infections, consequently health workers are at high risk to obtain irresistible infections. Nurses are viewed as among the first to contact patients with arising diseases. Nurses with no prior experience with such contagious diseases were recruited who provided care to patients with COVID 19 in this pandemic. Objective: To investigate the experiences of nurses who have attended covid 19 pandemic patients during 2020. Methods: A qualitative study with thematic analysis was conducted, using a phenomenological approach. A total of 12 nurses have joined in-depth, semi-structured interviews, from three COVID-19-designated hospitals in the capital city of Khyber Pakhtunkhwa province of Pakistan, using purposive sampling technique. Face to face interviews were conducted and their observations were recorded. Interviews were transcribed verbatim and thematically analyzed. Results: Five major themes emerged from data analysis that included Nosophobia, Scarcity of Resources, First Line Warriors, Environmental/Physical Problems and Perceived super spreaders. Nurses identified many sources of social support during pandemic situation. Participants expressed and considered high work load, anxiety and fear and concern for patients and family members as negative emotions in early stage of pandemic crises. Conclusions: The exhaustive work drained nurses physically and emotionally. Nurses should be given a comprehensive assistance and support in protecting themselves while they have showed their strength and spirit of professional dedication to defeat hurdles and challenges, they have faced. Consistent training for nurses is important to advance preparedness and viability in future crisis management.

Hypokalemia Among Children Having Acute Malnutrition with Diarrhea

Sardar Ali — 2023-02-28

Diarrhea is one the most common symptoms encountered in emergency department in children specially and needs prompt management. There are many disastrous complications and hypokalemia is one and most important of them. Hypokalemia warrants urgent diagnosis and expert management. Objective: To determine the frequency of hypokalemia among children having acute malnutrition with diarrhea. Methods: This cross-sectional study was done in Department of Pediatrics, Khairpur Medical College from 1^st November 2021 to 30^th April 2022. A total of 134 patients fulfilling the inclusion criteria were included. Informed consent was taken from attendants. The data were collected on prepared proforma. Results: There were 134 patients in this study with The mean age of the cases was 2.4 ± 3.13 years. Male children 84 (62.6%) and were in majority while females comprising of 50(37.3%). Frequency of hypokalemia was 57 (42.5%). Conclusions: Our results showed that children with acute diarrhea and dehydration have an increased risk of developing hypernatremia and hypokalemia. Significant correlations were found between electrolyte imbalance and mortality.

Comparison of Outcome in Immediate Vs Delayed Management in Patients with Gunshot Injuries to Face, A Prospective Study

Hafiz Waqas Ahmed — 2023-02-28

Facial injuries due to gunshot often comprise on bone and tissue destruction. The destruction or injury to facial muscle and bone depend on the category of weapon used. Surgical intervention must be done, but the timing for the surgical procedure delayed verses immediate closure surgeries are controversial. Objective: To compare the outcome of immediate and delayed closure of the facial injuries by a gunshot. Methods: A descriptive cross-sectional study consisting of 60 patients getting their treatment in Department of Oral and Maxillofacial Surgery, Mayo hospital, Lahore. Data were analyzed by SPSS version 20.0. Chi-square test was used to compare the results with p-value ≤ 0.05 as significant. Results: Age group on average was 21 to 60 years. Out of these 60 gunshot facial injury patients, 52 (86.7%) were males and 8 (13.3%) were females. Among these, patients managed with immediate closure after gunshot injuries were 44 (73.3%) and 16 (26.7%) were managed with delayed closure. Wound infection and wound dehiscence were compared in both groups. The mean wound defect size was found among patients 3.98 ± 1.30cm. On comparison, statistically significant difference was observed for wound infection and wound dehiscence among both immediate versus delayed groups (p-value < 0.05). Conclusions: In this study, we found that early management is better in terms of lower percentage of wound infection and dehiscence.

Effect of Age on Survival in Patients with Cervical Cancer

Hatim M. Al-Jifree — 2023-02-28

Cervical cancer survival rates depend on several factors, such as the stage of the cancer, age of the patient, and overall health status. However, early detection through regular screening and prompt treatment can significantly increase the chances of survival. Objectives: To determine the effects of age and other prognostic factors on survival in patients with cervical cancer. Methods: The medical records of 142 patients with cervical cancer were retrospectively reviewed. All patients were diagnosed by biopsy between January 2000 and December 2012 at the Princess Norah Oncology Center of King Abdul Aziz Medical City (Jeddah, Saudi Arabia). Kaplan-Meier survival curves and log-rank tests were used to compare groups. Results: The mean age at diagnosis was 51.77 ± 13.36 years (range, 28–96 years). The 1-year survival rates for each age group were as follows: < 30 years, 100%; 30–54 years, 83.9%; 55–65 years, 72.2%; and > 65 years, 73.3%. By contrast, the 5-year survival rates (0%, 38.5%, 30.8%, and 33%, respectively) were much lower. No significant differences in survival outcomes were identified among the age groups. Low mean hemoglobin levels during treatment were associated with poor survival rates. The mean hemoglobin level for all patients was 14.22 ± 16.28 mg/dL. Conclusions: Survival outcomes in patients with cervical cancer were not influenced by age at diagnosis. It will be necessary to perform systematic reviews of multiple studies on this topic to come to a more definitive conclusion.

Knowledge, Perceptions and Use of Electronic Cigarettes Among Health Professionals

Ferheen Shahbaz — 2023-02-28

In the developing era we are facing increasing prevalence of tobacco use and rapid increase of e-cigarette. Health professional are no longer found to abstain from e-cigarettes. The growing interest of vaping in our society leads to us a debate that e-cigarette are the tools to refrain from smoking or these are provoking people towards more smoking. Objectives: to evaluate the knowledge and concepts of e-cigarettes. And how the health professional perceive the use of vaping over smoking tobacco? What are the attitudes of vaping in health care professional? Methods: A descriptive cross-sectional study based on questionnaire filling survey, filled by 350 health professionals working in Jinnah hospital Lahore. The questionnaire compromises on four parts; demographic data, knowledge and attitudes toward vaping behavior, interest and trend of e-cigarettes, and perception of harms and health related risks. Results: data collected from 350 individuals. Average age of health professionals included in study was 30.6(2.60). A large percentage was found for former smokers 22% and current smokers 39%. Vape users also found in increasing percentages.so far the mass media roles were evaluated in smoking cessations. A cumulative percentage of 42%, electronic cigarettes were supported by the health professionals. Despite of good knowledge most of the professional had opinion in support of e-cigarettes upto 64% and the results were significantly proven by p-value 0.03. the knowledge and attitudes that e-cigarettes is less harmful than combustible tobacco smoking with and cumulative percent of 76% . Conclusion: health care professionals working in Jinnah hospital Lahore have favorable attitudes towards vaping or e-cigarettes perceived thought of vaping is less harmful than tobacco smoking is also highlighted. The need of the hour is to highlight the health related problems by e-cigarettes in our society to control the behaviors of population towards e-cigarettes.

Incidence of the Atrial Fibrillation in Patients with Chronic Obstructive Pulmonary Disease (COPD) in Sindh, Pakistan

Arshad Hussain Laghari — 2023-02-28

Chronic obstructive pulmonary disease (COPD) is a major public health problem and leading cause of death globally. COPD fails to receive adequate attention from the health care community and government officials, with these concerns in mind we designed our study. Objective: To find out the incidence of atrial fibrillation in patients with COPD. Methods: A cross-sectional study was conducted from 12^th February 2019 to August, 2020 at the Department of Pulmonology, Ghulam Muhammad Maher Medical College teaching Hospital, Sukkur. N=150 patients with chronic obstructive lung disease were involved in this study. The Criterion for the selection of patients for the study was those patients who was a diagnosed case of COPD. The exclusion criteria were known asthmatic patients and the case of restrictive lung diseases; history of ischemic heart disease, already on cardiac medication, patients with hyperthyroidism whereas the percentages, mean and Standard deviation were computed for study variables. Results: During One year and six months phase, patients who had COPD for > 3-Year duration were explored and study. The mean, SD for age (years) of citizens of Sindh Rural and Urban was 59.52 ± 7.81. Regarding gender, male 64 % and female 36 % individuals whereas the Atrial Fibrillation (AF) was identified in 62 % patients of COPD. Conclusions: High risk of AF has been identified among the COPD patients in Pakistani Populace. Hypertension and CHF among the COPD patients were notable as self-sufficient hazard features for new beginning of AF.

The Risk Factors of Intestinal Perforation Associated with Peritonitis

Imran Younas — 2023-02-28

Perforation is known as an abnormal opening in an empty organ. It is copied from the Latin word perforatus, meaning “to bore through.” In western world the estimated frequency of intestinal perforation ranges from 0.6% to 4.9%. Objective: To find out the risk factors of intestinal perforation associated with peritonitis. Methods: It was a cross-sectional study and data was collected from February 2022 to July 2022. Data was collected from, DHQ Teaching Hospital Gujranwala and Social Security Hospital Multan chungi Lahore. Calculated sample size was 50 based on prevalence (0.68%) of intestinal perforation through an online sample size calculator (CI 95% and margin of error=0.09%). Patients of both genders with age limit of 10-60 years and patients presenting with perforation peritonitis were included in this study. Patients with Post-operative peritonitis and Immuno-compromised patients were excluded from study. Patient demographic information was collected. For demographic variables and risk factors of intestinal perforation descriptive analysis was used. Ethical approval has been obtained from concerned department and statistical analysis was done using SPSS version 24. Results: Out of 50 patients 38% were female and 62% were male. Major risk factors for intestinal perforation were Appendicitis (32%), Trauma (26%), Abdominal distension (24%) and Intestinal obstruction (20%). Conclusion: This study concludes that intestinal perforation is commonly seen between the age group of 21-30 years. Common risk factors of intestinal perforation are fever, appendicitis, trauma, abdominal distension, followed by intestinal obstruction, ascites and infection. The most commonly found perforation is duodenal perforation.

Contributing Factors Towards Low Back Pain Among Front Line Health Care Workers in Lahore, Pakistan

Razia Sultana — 2023-02-28

For nurses’ low back pain is a serious health issue. Objective: To determine the contributing factors towards low back pain among front line health care workers in Lahore, Pakistan. Method: The design of this study was cross-sectional, descriptive, and quantitative. 191 nurses were selected for this study through non-probability purposive sampling. Data were collected by adopted Performa by Prof. Cilliers. Results: This study encompassed 191 nurses working in the four public hospitals of Lahore. The response rate was 100%. The regular prevalence of low back pain was 41.4%. The highest ratio of contributing factors towards low back pain was physical, (poor posture 36.6%), while in the psychological factors fatigue 52.4%, whereas in the social factors age 35.6%, similarly in patient care Lifting a heavy Patient 23.6%, and work environment workload 36.6%. Conclusion: Low back pain was moderately prevalent among front-line health care workers. A physical, psychological, social, patient care, and work environment are all contributing factors towards low back pain.