Pakistan Journal of Health Sciences

Effects of Rhythmic Stabilization and Mckenzie Techniques on Pain and Function in Patients with Non-Specific Chronic Low Back Pain

Arzoo Nawaz, Sana Hafeez, Usama Ahmad Khan, Muhammad Usama — Fri, 31 May 2024 00:00:00 +0000

Non-specific chronic low back pain affects 90% of people around the world, resulting in impairment. Their quality of life can be enhanced by exercising. However, due to the complexity of non-specific chronic low back pain (NSCLBP) the most effective type of exercise as a rehabilitation technique is unknown, and more research is required. Objective: To assess the effects of rhythmic stabilization and McKenzie techniques on pain and function in patients with NSCLBP. Methods: A total of 36 NSCLBP patients were randomly assigned to the McKenzie group and the rhythmic stabilization group. Over a four weeks’ period, both groups received 12 sessions. Numeric pain rating scale (NPRS), modified oswestry low back pain (MODI), and bubble inclinometer were used to measure outcomes at baseline of 2^nd, and 4^th week. Results: Across the group, both rhythmic stabilization and McKenzie's results were significant. McKenzie had more significant results within the group than rhythmic stabilization (p<0.05). Conclusion: It was concluded that both rhythmic stabilization and McKenzie were helpful in improving pain, functional status, and mobility, with significant changes in NPRS, MODI score, and ranges. In CNSLBP patients, however, McKenzie's technique was demonstrated to be more effective in alleviating pain and impairment, as well as improving mobility, when compared to the technique of rhythmic stabilization

Frequency of Fetomaternal Outcomes in Severe Preeclampsia

Aroosa Usman Khattak, Saima Khattak — Fri, 31 May 2024 00:00:00 +0000

Preeclampsia, severe preeclampsia, and eclampsia are hypertension illnesses that occur during pregnancy. The severe spectrum that includes organ failure, unconsciousness, and, sadly, maternal, and fetal deaths, is known as preeclampsia and eclampsia. Objective: To investigate the prevalence of fetomaternal outcomes in severe preeclampsia. Methods: This descriptive cross-sectional study was conducted from February 1st to August 1st, 2021, a descriptive case series was carried out at the Obstetrics and Gynecology Department at Lady Reading Hospital (LRH), Peshawar. A total of 232 pregnant women with severe preeclampsia were included in the research. Several unfavorable fetomaternal outcomes, such as caesarean section, mortality, low birth weight, fetal death, poor Apgar score, preterm birth, and birth asphyxia, were recorded along their course till delivery. Results: The study encompassed women aged 18 to 40, with mean values of 28.14 ± 2.72 years for age, 1.24 ± 1.23 for parity, 36.37 ± 2.17 weeks for gestational age, and 25.86 ± 1.39 kg/m² for BMI. Among the observed outcomes, cesarean section was noted in 56% of patients, mortality occurred in 8.6% cases, low birth weight in 17.2%, fetal death in 11.2%, low Apgar score in 19%, preterm birth in 8.6%, and birth asphyxia in 7.8%. Conclusions: The results highlight a significant rate of morbidity and death among mothers and perinatals linked to severe preeclampsia. Better prenatal care may be able to delay the onset of severe preeclampsia and eclampsia, which might significantly reduce the risk of negative outcomes.

Pathological Pulmonary Manifestations in Chronic Kidney Disease Patients Undergoing Hemodialysis

Henna Khalid, Mariam Riaz, Saba Shafiq, Sara Ali, Anwar Shahzad, Raheela Bano — Fri, 31 May 2024 00:00:00 +0000

Provenance of chronic kidney diseases is much more common in these days especially in patients suffering from secondary causes like diabetes mellitus and hypertension. Objective: To study the prevalence of pathological pulmonary manifestations in chronic kidney diseases patients. Methods: A descriptive cross-sectional study was done to examine the spectrum of pulmonary manifestations and any significant correlation with raised serum urea and creatinine level in patients on hemodialysis at various dialyzing units in Abbottabad for chronic kidney diseases. 200 patients with end-stage renal diseases were selected with convenience sampling for study with complaints of breathlessness, cough or chest discomfort. Evidence of pulmonary manifestations was gathered from histopathological and radiological reports records. Results: The most common findings in the acute phase of the patients were pneumonia 30% and 14% in males and females respectively. Pleural effusion was 20% prevalent in males while 6% in females. Empyema was 7% in males and 2% in females. Lung abscess and fibrosis was less common in patients suffering from chronic kidney disease. Spearmen rho results showed significant two tailed correlations between pulmonary manifestations and raised level of serum urea and creatinine levels. In most patients, co-morbidities such as diabetes mellitus and chronic hypertension, urolithiasis were evident as co-factors with significant raised urea and creatinine levels responsible for chronic kidney diseases. Conclusions: Pulmonary manifestations are common in patients on hemodialysis due to chronic kidney disease and strong correlation exists between raised serum urea and creatinine markers with pulmonary manifestations.

Patient Satisfaction with Quality of Dentures at Teaching Hospital of Lahore

Fri, 31 May 2024 00:00:00 +0000

Complete dentures are fabricated to restore functional and esthetic needs of edentulous patients. Poor psychomotor abilities undermine their satisfaction level with well fabricated dentures and prosthodontic treatment becomes unsuccessful. Objective: To evaluate the patient’s satisfaction level with newly inserted complete dentures fabricated by final year students and senior prosthodontists. Methods: The cross-sectional observational study population comprised of completely edentulous patients. The study conducted at Prosthodontic department of Lahore Medical and Dental College Lahore; from 8^th June till 8^th December 2023.A questionnaire was designed to assess parameters. Likert scale was used to answer; ranging from 1 to 5 where 1 is the poorest and 5 is the best value. Dentist, gender and previous experience were compared with patient satisfaction parameters. Results: Out of 62 complete denture patients; 72.6% had no denture wearing experience. 43.5% tooth loss was due to caries followed by periodontitis. Tooth loss in past 5 years’ time was 61.3%. Denture aesthetics was rated as good 46.8%. Patient satisfaction parameters with age group and doctor group showed significant association. Correlation of patient satisfaction parameters with doctor group was statistically significant for mandibular denture speech, mandibular function and operator service p-value <0.05. Conclusions: Patient satisfaction with removable prosthesis determines the success of the prosthodontics intervention. Evaluation of patients’ satisfaction level should be carried out routinely after the completion of the treatment as will help in the improvement of the work quality of a dental practitioner.

Photographic Analysis of Facial Soft Tissue by Angular and Proportional Measurements in Adult Pakistani Population

Fri, 31 May 2024 00:00:00 +0000

An important requisite of orthodontic treatment is achieving well balanced, pleasant face. Precise diagnosis and treatment planning, on facial hard and soft tissue norms basis, is fundamental for that purpose. Objective: To use photogrammetry technique on standardized photographs, and determination of mean angular and proportional parameters defining characteristics of facial soft tissue, on an adult Pakistani population. Methods: A cross sectional study, on 78 subjects from OPD and students of FMH College of Medicine and Dentistry, were selected. Data were entered and SPSS 2.0 was used for analysis. Mean and standard deviations were used for the quantitate variables used in the study. To control confounders with respect to age and gender, stratification was done and independent t-test was used, taking statistically significant p-value at ≤ 0.05. Results: All parameters were statistically insignificant on the basis of gender and age. The average values of nasolabial angle, angle of facial convexity and facial height proportion were greater in males than in females. The mean values of mentolabial angle, lower face to total face height and facial index were found to be greater in females as compared to males. Conclusions: This study concluded that gender and age based average values for angular and proportional parameters should be used while planning cases for Pakistani population for orthodontic treatment.

The Knowledge, Attitude and Practice of Nurses, Technicians and Sanitary Workers Regarding Biomedical Waste Management at Healthcare Establishments of Dera Ismail Khan, Pakistan

Fri, 31 May 2024 00:00:00 +0000

Risk waste generated in hospitals can cause some serious health and environment related problems, if not disposed properly. Objective: To assess the knowledge, attitude and practice of healthcare workers regarding Biomedical Waste (BMW) management and to find out any significant difference across different sociodemographic variables. Methods: This was a cross sectional study conducted from 20^th February to 20^th August 2023. Sampling technique was consecutive non probability with a sample size of 287. Research variables were knowledge, attitude and practice. T-test and One-way ANOVA test were used to show statistically significant difference between research variables across demographic variables at p-value of ≤ 0.05. Results: 287 health care workers participated in this study. Around 84% nurses, 78% technicians and 64% sanitary worker have good knowledge about BMW management. Remaining participants had fair knowledge and none of the health care workers in any category had poor knowledge about BMW. 83% of the total participants from all three categories of workers had a good attitude regarding BMW management whereas around 16.7% participants had a fair attitude while 0.3% had a poor attitude. However, only 1% had good practices while 62% had poor practice and the remaining 37% participants had fair practice. It was found there was a statistically significant association of the category of workers with knowledge. Conclusions: The healthcare workers have good knowledge and attitude regarding BMW disposal but the practice was either fair or poor.

The Role of Lipid Peroxidation Products in the Development of Oral Sub Mucous Fibrosis- A Cross-Sectional Survey

Fri, 31 May 2024 00:00:00 +0000

Oral sub mucous fibrosis (OSMF) is a premalignant condition. Factors that cause OSMF are areca nut, nutritional deficiency and genetics. These factors produce free radicals which generate oxidative stress by damaging DNA, lipids and proteins. Levels of 4 hydroxynonenal (4HNE), 8-hydroxy-2-deoxy guanosine (8-OHdG), C reactive protein (CRP), and malondialdehyde (MDA) were raised due to oxidative DNA damage and lipid damage. Objective: To determine the levels of lipid peroxidation by-products such as MDA, 4HNE, 8-OHdG, and CRP in patients with OSMF. Methods: A cross-sectional comparative study was conducted at The University of Lahore from January 2020 to August 2021. Fifty OMSF cases and fifty healthy controls were recruited by using non-probability convenient sampling technique. Serum of participants was analyzed for lipid peroxidation byproducts by using ELISA kits. The results were analyzed by applying independent t-test in SPSS version 21.0. Results: The mean MDA levels in OSMF patients were (3.22 ± 1.265nmol/ml) as compared to those of control group (1.26 ± 0.568nmol/ml). Serum CRP levels were significantly raised (1.23 ± 0.124mg/l) in patients of OSMF as compared to those of control group (1.04 ± 0.0324mg/l). The levels of 4-HNE, 8-OHdG were recorded as significantly increased in OSMF (1.5 ± 0.965pg/ml and 1.9 ± 0.265pg/ml) as compared to the those of control group (0.72 ± 0.065pg/ml and 0.09564 ± 0.00058pg/ml). Conclusions: It was concluded that the levels of MDA, 4HNE, 8-OHdG, and CRP were increased significantly in patients with OSMF compared to healthy controls.

Seasonal and Time-Series Analysis of Alcohol Intoxication-Related Cases in Hyderabad, Pakistan

Fri, 31 May 2024 00:00:00 +0000

Cases related to alcohol intoxication are important because they can help raise awareness about the dangers of excessive alcohol consumption and the need for responsible alcohol use. The present research studied the seasonal trend of alcohol intoxication-related cases in Hyderabad, Pakistan. Objective: To conduct seasonal and time series analysis of alcohol intoxication cases. Methods: Prospective study was conducted at Casualty Department, Liaquat University Hospital Hyderabad from January 2020 to December 2022. One hundred and eighty nine cases of alcohol intoxication-related cases were enrolled. Data was presented as frequency and averages of month-wise cases. Different plots i.e, seasonal index plot and time series plot were created to demonstrate the seasonal trend. Results: The largest number of cases were observed in April and December (n ≥ 25). The second most frequent cases occurred in months of June and November with 18 to 20 frequencies. The seasonal pattern was further illustrated by time-series analysis which showed that April and December had higher numbers of cases compared to other months. Conclusions: The study suggested a little decline in alcohol intoxication-related sufferer. These findings may highlight the importance to developed public awareness about the responsible use of alcohol.

Unraveling the Mind-Gut Connection: Investigating Anxiety and Depression in Functional Dyspepsia

Fri, 31 May 2024 00:00:00 +0000

Psychological association with functional dyspepsia underscores the importance of a holistic approach to its management, addressing both physical and psychological aspects of the condition. Objective: To determine the relationship of anxiety and depression with severity of dyspepsia. Methods: A prospective cross sectional study was carried out in the Endoscopy Unit, Department of Gastroenterology, Baqai Medical Institute. All patients fulfilling the Rome III criteria for functional dyspepsia with normal endoscopy findings were included in the study, Pregnant females, patients with known diabetes, chronic kidney disease, chronic liver disease and known psychiatric illness, history of peptic ulcer disease and use of NSAIDs, steroids or alternative medicine were excluded. Severity of dyspepsia was assessed by Short Form Leeds Dyspepsia Questionnaire (SF-LDQ). Whereas hospital anxiety and depression scale (HADS) was used to assess the psychological factors. Results: A total of 223 participants were included in the study. Out of 223 participants, majority 55.6% (124) had moderate dyspepsia, followed by severe dyspepsia 26.9% (60), mild dyspepsia 12.6% (28) and very mild dyspepsia 4.9% (11). Using Hospital Anxiety And Depression Scale (HAD-S), we found that out of 223 participants, 56.5% (126) had moderate to severe anxiety and depression while 29.1% (65) had mild anxiety and depression. Conclusions: It was concluded that functional dyspepsia is clearly associated with common psychological disorders like depression and anxiety. Early recognition and timely linkage to care in such cases can considerably improve the health-related quality of life and hence decrease the global burden of this common disorder.

Frequency of Anemia among Patients of Rheumatoid Arthritis: Cross Sectional Study

Fri, 31 May 2024 00:00:00 +0000

Anemia of inflammation is the common manifestation of chronic inflammatory diseases like rheumatoid arthritis. There is a lack of local data regarding this heath issue so we conducted this study order to assess the frequency of anemia among RA patients. Our results will help clinicians to manage anemia actively with chronic inflammatory disorders in our clinical setups. Objective: To evaluate the frequency of anemia of inflammation in rheumatoid arthritis patients. Methods: Both male and female patients having age 40-70 years with confirmed rheumatoid arthritis were enrolled. Patients with history of any previous blood loss or any co-morbidities like CLD, CRF and thalassemia were ruled out. Blood sample drawn from each patient was sent for laboratory measurement of hemoglobin levels thus indicating the presence or absence of anemia. Results: Mean age was 50.85 ± 9.07 years. Out of the 79 patients, 63 (79.75%) were female and 16 (20.25%) were females. Frequency of anemia in rheumatoid arthritis was found in 64 (81.01%) patients, whereas there was no anemia in 15 (18.99%) patients. Conclusions: It was concluded that anemia is a common disorder and its frequency is very high among patients of rheumatoid arthritis.

Evaluation of Risk Factors Associated with Severe Suicide Attempts among Individuals Presenting at the Emergency Department

Fri, 31 May 2024 00:00:00 +0000

Severe suicide attempts represent critical incidents characterized by high lethality or medical acuity, posing significant risks of morbidity and mortality. Objective: To assess the risk factors linked to severe suicide attempts among those presenting in the Emergency Department. Methods: The cross-sectional study took place at the Department of Forensic Medicine, Makran Medical College, Turbat, Pakistan covering the period from 21 December 2023 to 21 March 2024. The study included 90 patients aged 18 years or older who were admitted to the ED with a documented suicide attempt. Variables related to demographic characteristics, clinical presentations, substance use history, and details of the suicide attempt. Collected data were processed and analyzed using IBM SPSS, version 27.0. Results: The majority of participants were female (56.7%), with a mean age of 31.01 ± 12.42 years. Major depressive disorder was the most prevalent (33.3%), followed by anxiety disorder (18.9%). Other conditions included abuse of narcotics (6.7%), schizophrenia (4.4%), and a history of previous suicide attempts (1.1%). The most frequently cited reasons were psychiatric illnesses (n=28, 31.1%) and family problems (n=26, 28.9%), followed by financial problems (13.3%) and romantic relationship issues (6.7%). In the study cases, suicide attempts mostly occurred between 6 am to 12 pm (38.9%) and 12 pm to 6 pm (34.4%). The majority of patients were hospitalized (61.1%). Conclusions: It was concluded that the urgent need for targeted suicide prevention initiatives, with major depressive disorder identified in 33.3% and drug poisoning as prevalent in 40.0% of suicide attempts.

Iron Deficiency Anemia in Patients with Chronic Renal Insufficiency at Tertiary Care Hospital in Northern Punjab

Fri, 31 May 2024 00:00:00 +0000

Anemia is a frequently encountered complication of chronic kidney disease (CKD) leading to worse outcomes in terms of quality of life and premature death. However, the current prevalence of iron deficiency anemia (IDA) in CKD is understudied in Pakistan. Objective: To assess the frequency of IDA in patients with CKD at Bewal International Hospital, Gujar Khan, Pakistan. Methods: A cross-sectional was executed at the Department of Nephrology, Bewal International Hospital, Pakistan from January 1, 2022, to June 30, 2022. The study comprised 97 patients aged >13 years of either gender having CKD (GFR <60 ml/min/1.73m²) for at least 90 days. All patients were tested for serum creatinine, ferritin, and hemoglobin levels. IDA was considered if hemoglobin was ≤12 mg/dL in women and ≤13 mg/dL in men. Results: Among 97 patients, there were 57(58.7%) males and 40(41.3%) females. The mean age was 51.23 ± 12.99 years while the mean disease duration was 6.01 ± 1.610 years. 57(58.7%) patients had IDA. IDA was more frequent in women with CKD (67.5%), compared to men (52.64%). However, this association was statically insignificant (p>0.05). When data was stratified, a substantial association was found between IDA and the stage of CKD (p=0.007). There was no significant association between IDA and disease duration (p>0.05). Conclusions: It was concluded that anemia is common in CKD patients, with a high prevalence in females. Stage 3–5 CKD is significantly associated with developing iron deficiency anemia. Early identification and timely management can avoid unfavorable outcomes in these patients.

Tracing the Connection of Iron and Copper in Chronic Telogen Effluvium

Fri, 31 May 2024 00:00:00 +0000

Chronic Telogen Effluvium (CTE) is a common non- scarring, diffuse type of hair loss, affecting a significant proportion of population. The purpose of the current study is to assess the relationship between CTE and trace metal levels, specifically copper and iron. Objective: To collect hair and serum samples from both control group and patients with CTE and to analyze the association between hair copper and iron content and serum copper and iron levels in both groups. Methods: The Dow University Hospital (DUHS) in Karachi, Sindh, Pakistan, served as the site of this case control research. The duration of study was one year. The study population encompassed hundred individuals, categorized into 50 cases with CTE and 50 healthy controls. Using non probability sampling technique (convenient sampling), the sample size was determined. Diagnostic criteria a positive hair pull test. Hair and serum samples were collected from both groups for trace metal analysis. Analysis was carried out using ab Atomic Absorption Spectrophotometer (Perkin Elmer Analyst 800, located in Waltham, MA, USA). Data analysis was carried out using SPSS® software for Windows® version 16.0. Results: Results showed that hair samples from patients had considerably lower iron levels than those from controls (p<0.001), while there was no significant difference in copper levels (p=0.713). Additionally, the CTE group showed noticeably greater copper levels (p<0.001) and significantly lower serum iron levels (p<0.001). Conclusions: The study identified a positive association between iron deficiency and hair loss.

Comparative Sero-Analysis between Copper Levels and the Risk of Acute Myocardial Infarction in District Nowshera

Fri, 31 May 2024 00:00:00 +0000

There is an increasing evidence pointing to a possible correlation between AMI and copper levels. Serum copper levels serve as a valuable biomarker for assessing the body's copper status. Objective: To find the changes in serum copper level in patients with Acute Myocardial Infarction (AMI). Methods: This observational study was conducted in District Headquarter Hospital, Nowshera in duration of two years. A total of 240 patients were recruited in this study. Upon admission, demographic information, medical history, and clinical characteristics were collected. Blood samples were obtained for measurement of serum copper levels using established laboratory methods. All data were analyzed through SPSS version 29.0. Results: Among total, 65% males and 35% females and the prevalence of cardiovascular risk factors was notable, with 70% of patients having hypertension, 40% with diabetes mellitus, 60% with dyslipidemia, and 45% identified as smokers. Baseline serum copper levels averaged 110 ± 5.2 µg/dL, within 24 hours of admission, the peak serum copper level significantly increased to 125 ± 18.6 µg/dL. Subsequently, levels decreased gradually over the following days, with mean values of 120 ± 17.1 µg/dL on Day 2, 115 ± 16.4 µg/dL on Day 3, 112 ± 15.9 µg/dL on Day 4, and returning to baseline levels by Day 5, 110 ± 15.2 µg/dL. Conclusions: Serum copper levels exhibit significant changes during the acute phase of AMI, with a peak observed within 24 hours of admission. While patients with anterior infractions showed higher peak copper levels, no significant associations were found between copper levels and traditional cardiovascular risk factors or inflammatory markers

Assessment of Workplace Difficulties Faced by Nurses Working in Public Sector Hospitals of Lahore

Naveeda Aslam, Madiha Mukhtar, Sarfaraz Masih — Fri, 31 May 2024 00:00:00 +0000

Nursing is recognized as a stressful profession, with adverse effects on both personal health and professional performance. However, there is a scarcity of data on stress prevalence among nurses in developing countries like Pakistan. Objective: To assess stress prevalence and contributing factors among nurses in government hospitals, informing interventions to improve their work environment and well-being. Methods: This descriptive cross-sectional survey collected data from Mayo Hospital, Lady Atchison Hospital, and Said Mitha Hospital in Lahore. A structured questionnaire assessed demographic information and perceptions across four domains: Occupational Stress, Job Satisfaction, Workplace Violence, and Workplace Harassment. Likert scale items were analyzed using SPSS version 26.0, with logistic regression examining factors associated with job satisfaction. Results: Findings reveal significant concerns regarding occupational stress, job satisfaction, workplace violence, and harassment among nurses. While nurses express satisfaction with certain aspects of their job, including opportunities to utilize their abilities and relations between management and staff, concerns arise regarding workload, recognition, pay rates, and workplace violence and harassment. Logistic regression analysis indicates that age, educational qualifications, marital status, experience duration, and department insignificantly influence job satisfaction among nurses in public sector hospitals. Conclusions: These findings emphasize the urgent need to address the challenges faced by nurses to enhance their well-being and maintain a positive work environment conducive to high-quality patient care.

Zinc Deficiency in Type II Diabetes Mellitus

Fri, 31 May 2024 00:00:00 +0000

Zinc (Zn) is an essential trace element for various biochemical, physiological and immunological functions in the human body. Zn deficiency affects up to 25% of the population in poor countries and up to 15% in industrialized countries. Diabetes Mellitus (DM) refers to impaired glucose metabolism, which leads to a constellation of disorders and is marked by poor immunity in the diseased subject. Zn deficiency has an inverse relationship with glycemic control. Objective: To assess the serum Zn level in diabetic patients in comparison with healthy subjects. Method: A cross sectional study was conducted at Department of Biochemistry, Niazi Welfare Foundation Teaching Hospital, Sargodha, Pakistan from 1^st June, 2023 to 31^st December, 2023. Data were collected after institutional review board (IRB) approval (NM&DC-IRB-53; Dated 1^st Dec, 2022) and informed consent was taken from all the participants. A total of 150 participants were equally divided into two groups based on glycemic control. Serum Zn levels of all participants were estimated via atomic absorption spectrophotometry. Descriptive statistic was used to calculate mean and standard deviation on SPSS version 23.0. Results: The mean value of serum Zn level was significantly lower (8.83 ± 1.64 µmol/L) in diabetic subjects as compared to healthy participants (18.63 ± 6.13 µmol/L). Conclusions: Deficiency of serum Zn level has a negative relationship with the body’s glycemic control.

Comparison of Misoprostol and Manual Vacuum Aspirator for Managing Early Pregnancy Miscarriage

Fri, 31 May 2024 00:00:00 +0000

Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Objective: To compare efficacy, safety and acceptability of misoprostol and manual vacuum aspirator in management of early pregnancy miscarriage Methods: Prospective quasi experimental study Department of gynecology and obstetrics, Sheikh Khalifa Bin Zayed Al Nahyan (CMH).Muzaffar Abad. Study duration was 6 months. A sample of 90 women was calculated using WHO calculator. Patients were approached through non probability consecutive sampling. After following inclusion and exclusion criteria, Patients were randomly divide into two groups; Group A was given misoprostol while group B was patients underwent manual vacuum aspiration. Data were analyzed with SPSS version 25.0. Chi-square and fissure exact test was applied. Results: Total 90 patients were included in study. Mean age of patients was 35.4 ± 3.2SD. Treatment failure/incomplete uterine evacuation was significantly lower in manual vacuum aspiration group as compared to misoprostol group (45.6% vs 36.7%, p=0.05). Misoprostol showed less adverse events (p=0.03) and high satisfaction rate (p=0.00) as compared to manual vacuum aspirator. Conclusions: Manual vacuum aspirator is more effective in complete uterine evacuation as compared to misoprostol. However, misoprostol is found as more safe with limited side effects and highly acceptable drug as compared to manual vacuum aspirator. It is recommended to use misoprostol as a better choice for management of early pregnancy loss in resource limited areas

Comparing the efficacy of Chlorhexidine Mouthwash and Natural Honey in Reducing Plaque and Improving Gingival Health. A Randomized Controlled Trial

Fri, 31 May 2024 00:00:00 +0000

Plaque control is essential for maintaining gingival health, if left untreated can lead to conditions like gingivitis and progress to periodontitis. Natural honey has been historically utilized for its antibacterial properties, while Chlorhexidine (CHX) is used as synthetic antimicrobial agent in oral care. Objective: The objective was to assess and compare the effectiveness of natural honey-based mouthwash and chlorhexidine in preventing dental plaque formation and improving gingival health. Methods: An open-label, randomized controlled trial was conducted with 60 participants aged 18 to 25. The study compared the effects of natural honey and chlorhexidine mouthwashes on dental plaque levels, employing the Silness and Loe index for plaque assessment. Participants were randomly assigned to either Group A (Chlorhexidine Mouthwash) or Group B (Natural Honey Mouthwash). Both groups followed a prescribed oral hygiene regimen, and plaque levels were measured at baseline and after two weeks. Results: Demographic characteristics of both groups were documented, including age, gender distribution, and level of education. Plaque and gingival indices were measured at baseline and after 21 days. Both groups showed a significant decrease in plaque and gingival indices after 21 days (p=<0.001). The honey mouthwash demonstrated a more pronounced reduction in the plaque (p=<0.001) and ginigival index (p=0.001) on Day 21, with a notable and statistically significant difference between the two groups. Conclusions: The study concludes that both natural honey and chlorhexidine mouthwashes effectively reduce plaque and improve gingival health. However, honey mouthwash exhibits superior efficacy, suggesting it as a promising alternative for oral hygiene maintenance

Nurses Knowledge of Post Needle Stick Injury Prophylaxis at a Public Sector Hospital Karachi

Fri, 31 May 2024 00:00:00 +0000

Post Needle Stick Injury Prophylaxis (PNSIP) is a stepwise medical management to prevent nurses from blood borne pathogens such as hepatitis B, hepatitis C, and AIDS after Needle Stick Injuries (NSI). Objective: To assess the knowledge of nurses regarding PNSIP at a public sector hospital in Karachi, Pakistan. Methods: A descriptive cross-sectional study was conducted at a public sector hospital, Karachi, Pakistan, among 109 staff nurses. Sample size was calculated with the help of openepi.com, data were collected through conveniences sampling technique from september to december 2023, by an adopted questionnaire which was distributed in the wards in hard copy among nurses. Data were entered and analysed in Statistical Package for Social Sciences software (version-26). Results: The result revealed that majority of the participants 58.7% were male and were in 25-30 years age group, 53.2% were diploma holders and 46.8% were graduate, half of them had less than 5 years of service in the hospital and 39.4% had 5-9 years of service, majority of them 33.9% had worked in emergengy ward, 33% in critical area and 15.6% in operation room. 26.6% of the participants did not know about the antiretroviral drugs used in PNSIP. Knowledge results revealed that nurses have a good knowledge level 78% regarding PNSIP. Conclusions: Results showed that although nurses have a good knowledge level regarding PNSIP, however, there is still some percentage of nurses who need education to enhance their knowledge regarding PNSIP.

Pattern of Diseases Presenting in ENT Outpatient Department in a Postgraduate Teaching Hospital in S.I.T.E. Area Karachi

Fri, 31 May 2024 00:00:00 +0000

Ear, Nose and Throat (ENT) diseases are one of the public health problems and affect a huge number of the patient around the globe. Objective: To determine the pattern of ENT disorders or diseases in those patients who were attended outpatient department of ORL in a postgraduate teaching hospital of Karachi. Methods: Patients presenting at ENT OPD were selected randomly for the study. Data about ENT problems and information were collected through well structured questionnaire. After data collection, it was entered and analyzes by using software SPSS-23. Variables were age, sex, residence, socioeconomic status and different ENT diseases including wax, otitis media, allergic rhinitis, pharyngitis, tonsillitis, Deviated Nasal Septum (DNS) etc. Results: Male patients were 585 (46.8%) while female patients were 665 (53.2%) out of 1250 patients. Most of the patients were from industrial areas 775 (62%) and 475 (38%) were from city areas. 355 (28%) were suffering from wax followed by acute otitis media 300 (24%), acute tonsillitis and deviated nasal septum each in 225 (18%), otitis externa 150 (12%) and acute pharyngitis 145 (11%). In our study, a huge number of 72% of cases had ear disorders. 43.2% of patients had nasal issues, while 45.2% were related to laryngopharyngeal issues. Conclusions: Majority of the patients attending outpatient ENT department were related to ear wax followed by acute otitis media, acute tonsillitis, DNS, otitis externa, acute pharyngitis and many patients have multiple diseases.

Evaluation of Mean Apical Sealing Ability of Bio Ceramic and AH Plus (Dentsply Sirona) Sealer in Single Rooted Teeth: An In Vitro Study

Fri, 31 May 2024 00:00:00 +0000

A good seal is essential to prevent bacteria from re-entering the canal. Sealers can significantly impact the success of the treatment. Understanding which sealant works better can help dentists improve the outcome of root canal treatments. Objective: To compare mean apical sealing ability of bioceramic sealer and AH plus sealer in single rooted tooth. Methods: Extracted single-rooted teeth were divided into two groups and sealed with either bioceramic or AH plus sealer. After soaking in dye solution, the depth of dye penetration was measured to assess leakage. Results: Bioceramic sealer showed significantly better apical sealing ability (mean 5.43 mm) compared to AH plus (mean 8.55 mm), suggesting it may be a more effective choice for preventing future problems after root canal treatment. Conclusions: The study concluded that bioceramic sealer is superior to AH plus in sealing the tips of single-rooted teeth. This finding can help dentists choose the most effective sealant for their patients, potentially reducing the chance of treatment failure.

Evaluation of Dyslipidaemia in Patients with Chronic Viral Hepatitis in a Lower Socio-Economic Country

Fri, 31 May 2024 00:00:00 +0000

Patients having chronic viral hepatitis do have disturbances in their serum lipid profiles, still the monitoring of dyslipidemia is not a routine part of management in low socio economic countries. Objective: To investigate the status of lipid profile among patients with chronic hepatitis and compare them with non-infected individuals. Methods: A cross-sectional study was done in a Tertiary Care Hospital of Karachi, from 5^th September 2022 to 31^st May 2023. Patients with chronic hepatitis B and C, diagnosed within two years with a body mass index (BMI) of 25-29.9 kg/m² were included. Their comparison was done with non-infected individuals of the same BMI. All patients were evaluated with different parameters of lipid profile along with haemoglobin, alanine aminotransferase, albumin and international normalized ratio. Results: Among 521 participants of the study, the grouping was almost equal. The age range was 12-75 years, with an increased number of females in each group. In comparing the different statuses of lipid profile, each parameter including cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, all were significantly much less in patients with chronic viral hepatitis as compared to controls with a p-value of 0.000 in all. Conclusions: It was concluded that Dyslipidaemia is not common among chronic viral hepatitis patients’ despite being overweight, particularly among patients with child’s class A.

Seasonal and Time-Series Analysis of Road Traffic Accidents

Fri, 31 May 2024 00:00:00 +0000

Road Traffic Accidents (RTAs) contribute a significant and escalating rate in harm, hospitalization, and mortality. This study assesses the seasonal trend and time series analysis of RTAs cases brought to casualty department of Liaquat University Hospital, Hyderabad, Pakistan. Objective: To conduct seasonal and time series analysis of RTA cases at Casualty Department of Liaquat University Hospital Hyderabad. Methods: Nine hundred and sixty-six road traffic accidents-related cases were examined through prospective study at casualty department, Liaquat University Hospital, Hyderabad, Pakistan from January 2020 to December 2022. The seasonal trend was demonstrated by drawing seasonal index plot and time series plot. Results: The largest occurrences of RTA-related cases were reported in the month of December, having 103 total cases with a mean of 34.33 ± 18.92. July had the second highest frequency of RTAs-related cases, with a total of 94 cases having a mean of 31 ± 5.43 cases. The second-highest number of cases was observed in July and November with approximately equal mean number of RTAs. The time series analysis demonstrated an increasing trend of RTAs-related cases in the last three months of the year. Conclusions: The number of cases connected to RTAs increased during seasons of extreme weather, such as the summer and winter, and it also showed an increasing tendency in the last quarter of 2022.

Risk Factors and Prevalence of Hepatitis B and C in Badin City, Pakistan

Fri, 31 May 2024 00:00:00 +0000

Hepatitis is a global health concern, and its ever increasing prevalence in Pakistan has highlighted the need to study its epidemiology and develop preventative strategies. Objective: To determine the frequency and identify the risk factors associated with hepatitis virus infections B and C among the population of Badin city. Methods: Seven hundred sixty-seven people were tested for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) using immunochromatographic methods. Additional testing was performed on blood samples from individuals who tested positive for hepatitis, and quantitative Polymerase Chain Reaction (PCR) was used to determine the viral load. Results: A total of 767 individuals had hepatitis. Among these, the research found that HCV was more common than HBV. However, men were more affected than women. Data on the exposure to risk factors for hepatitis B and C among the patients in our study are presented in Table 2 Of the 767 respondents, 473 (61.7%) were shaved from a barber/beauty parlour. Approximately 358 (46.7%) patients with hepatitis reused syringes. Drug addiction was observed in 66 (8.6%) patients. A history of blood transfusion was observed in 73 patients (9.5 %). Obstetrical procedures, ear pricks, and nose piercings were reported in 195 (68.1%), 245 (85.7%) and 240 (83.9%) female patients with hepatitis, respectively. Conclusions: Barbers, blood transfusions, and intravenous drug use are the most common risk factors for the spread of HBV and HCV are barbers, blood transfusions, and Intravenous Drug Use (IDUs), although newer variables, including piercings of the nose and ears and IDPs, also contribute

Periodontal Health and Its Association with Age and Trimester in Pregnant Women Visiting Hospitals of Prime Foundation

Fri, 31 May 2024 00:00:00 +0000

Immune system and trimester-specific hormonal changes that affect the mother and baby during pregnancy raise the hazards to dental health. Objective: To use the Community Periodontal Index of Treatment Needs (CPITN) Index to evaluate expectant mothers' periodontal health and its association with age and trimester. Methods: The research used a descriptive cross-sectional survey in a number of healthcare settings, including outpatient departments for gynecology and dentistry at many hospitals were conducted from January 2022 to December 2022. 384 pregnant patients were evaluated utilizing a specially created questionnaire and the CPITN Index by non-probability sequential sampling. IBM-SPSS Statistics 23.0 was used for statistical analysis, whereby associations between age, trimester, and CPITN scores (p-value < 0.05) were investigated using chi-square tests. Results: The groups with the largest representation in the third trimester (68.8%) and 18–22 (33.6%) were found to be the majority in the age distribution. The majority (59.9%) had a CPITN score of 0, age and trimester has significant association with CPITN scores (p-value<0.05). Conclusions: The study among pregnant women visiting hospitals of Prime Foundation highlights significant associations between periodontal health and trimester, with younger age groups and the third trimester predominantly represented. Most participants exhibited normal gum health, while notable proportions showed calculus and pocket depth issues, underscoring the relevance of these factors in periodontal health during pregnancy.

Spectrum of Clinical Manifestations among Paediatrics and Adult Patients of Idiopathic Thrombocytopenic Purpura Presenting to Tertiary Care Hospital

Fri, 31 May 2024 00:00:00 +0000

Idiopathic Thrombocytopenia Purpura (ITP), an autoimmune bleeding disorder, affects both children and adults, categorized into acute, persistent or chronic types based on symptom duration. Clinical presentations vary widely, ranging from minor bleeds to severe systemic hemorrhages involving CNS, GIT and genitourinary tract. Objective: To assess clinical manifestations in ITP patients at a Lahore tertiary care Hematology department. Methods: This retrospective cross-sectional study included data from 660 diagnosed ITP patients from January 2020 to December 2022 using consecutive sampling technique at Allama Iqbal Medical College. Data were recorded after taking consent from patients. Results: Mean age was 31.8 ± 12.8 SD, with 10.3% children and 89.7% adults. Patients were categorized based on platelet counts into mild, moderate, and severe groups. Most children (47%) and adults (59.9%) had moderate thrombocytopenia. Common features included bruising in children (67.6%), gum bleeding (77%) in adults of both sexes and menorrhagia (67.9%) in females. Conclusions: ITP affects all ages but predominantly females. Clinical presentation varies, with most cases showing superficial bleeding like bruising, epistaxis, gum bleeding, or menorrhagia in females.

Comparison of Conjunctival Autograft Using Autologous Serum Versus Suturing Technique in Primary Pterygium

Fri, 31 May 2024 00:00:00 +0000

Pterygium is characterized by degeneration of the subconjunctival tissue, which proliferates as vascularized granulation tissue that invades the cornea, particularly affecting the superficial layers of the stroma and bowman's membrane. Objective: To compare the conjunctival autografts using autologous serum versus suturing techniques in primary pterygium. Methods: This randomized controlled study was conducted at the ophthalmology department of Bahawal Victoria Hospital, Bahawalpur, Pakistan, from September 2023 to February 2024. Patients of either gender aged between 18-70 years with primary pterygium (either nasal or temporal) were included. Patients in Suturing group (n=16) consisted of patients receiving the traditional suturing technique, while in autologous serum group (n=16) had surgeries performed using autologous serum as tissue adhesive. Results: In a total of 32 patients, there were 25 (78.1%) males while overall mean age was 45.4 ± 12.6 year. The mean duration of surgery was 35.6 ± 4.8 minutes in suturing group versus 26.4 ± 2.9 minutes in autologous group (p<0.000). Evaluation of post-surgery ocular discomfort showed that significantly better results were obtained among patients of autologous serum group (p=0.024). Significantly better satisfaction scores were recorded among patients of autologous serum group when compared to patients undergoing suturing technique (p=0.001). Post-surgery complications were assessed in both study groups and no statistically significant differences were observed among patients of both study groups (p>0.05). Conclusions: When considering efficacy, both techniques demonstrated comparable outcomes. In terms of postoperative discomfort and surgical duration, the autologous serum method showed significant advantages by presenting reduced discomfort and shorter surgical times.

Comparative Analysis of Tinted X-Chrome Contact Lenses And Red Filters On Color Vision Impairment

Fri, 31 May 2024 00:00:00 +0000

Accurate color vision is necessary for doing daily tasks efficiently. Even so, numerous individuals experience color vision impairment. Objective: To evaluate and compare the effect of x-chrome contact lenses (CLs) and red filters on color vision deficient. Methods: Cross-sectional study was conducted at Madinah Teaching Hospital, Faisalabad. Data were collected by non-probability purposive sampling technique. Congenital color blindness, 15-35 years, red-green deficient were included. Acquired color blindness, active ocular diseases, systemic diseases were excluded. 30 red-green color vision deficient, divided in 2 groups, 15 used CLs and 15 used RF. Visual acuity, contrast sensitivity, stereopsis and color vision were recorded at baseline and after wearing lenses. Data were analyzed by using SPSS version 23.0. Results: Mean age was 24.53 ± 6.68. After using x-chrome CL, mean number of correctly read plates increased to 22.55 ± 1.27 from the baseline evaluation of 1 ± 1.679 (p=0.00). Comparably, baseline performance was 1 ± 1.89 plates successfully read; using red filters, that number increased to 22.89 ± 1.03 (p =0.00). With red filters, the mean contrast sensitivity decreased from 1.35 ± 0.32 to 1.31 ± 0.56 (p = 0.004), and with x-chrome lenses, it decreased from 1.34 ± 0.45 to 1.32 ± 0.97 (p = 0.02). Mean stereopsis value was 55.33 ± 13.02 prior to x-chrome contact lens insertion; this value decreases to 67.33 ± 12.47 (p = 0.00). Likewise, mean stereopsis value was 54.02 ± 11.05 before to applying red filters, it decreases significantly to 66.89 ± 11.98 (p = 0.00). Conclusions: X-Chrome CLs and red filter has significantly improved color vision. Visual acuity remains unchanged. Contrast sensitivity and stereopsis showed slight reduction in both groups.

Medical Student’s Attitudes towards Implementation of National Licensing Exam (NLE) – A Qualitative Exploratory Study

Saima Bashir, Rehan Ahmed Khan — Fri, 31 May 2024 00:00:00 +0000

The introduction of the post-qualification National Licensing Examination (NLE) in Pakistan has been met with resistance from the medical students. They are the main stakeholders of medical colleges. Objective: To explore the opinions of medical students regarding the feasibility of NLE. Methods: An exploratory, qualitative study was conducted at Riphah International University, Islamic international medical college, Rawalpindi and Gomal Medical College, D.I. Khan, KP using in-depth interviews. A sample of 12 medical students from different medical colleges in Pakistan was included. The recorded interviews transcribed verbatim. Thematic analysis was then conducted using NVivo V2 and coded into nodes and daughter nodes, of which 5 themes and 17 subthemes emerged. Results: A total of five themes and 17 themes were created. NLE was deemed as a good standardization tool for assessing the competence of medical graduates. Students believed that current MBBS assessment lacks in clinical skills assessment and did not prepare to treat patients upon graduation. However, they did not want to take another exam after the professional exams especially when no incentives are offered to graduates upon clearing. They suggested NLE should be used as a means of constructive feedback for institutions and students to allow them to work on weak areas. Conclusions: There were mixed opinions regarding the acceptance of the exam. If medical institutions across the country focus their curricula on developing clinical skills and incentives are provided to the doctors upon clearing, the students would readily accept the exam

High Doses of Dexamethasone Improved Hemoglobin Levels Lowered by Corona Virus in COVID-19 Infected Patients

Fri, 31 May 2024 00:00:00 +0000

Corona virus an infectious disease caused by SARS–CoV-2 virus that lower hemoglobin level leading to worsening of the conditions. The respiratory symptoms are treated by steroids and patients are rapidly recovered. Objective: To study the effect of high and low doses of dexamethasone on hemoglobin level in COVID-19 infected patients. Methods: This experimental study was carried out in Rawal Institute of Health Sciences, Islamabad and Pakistan Institute of Medical Sciences, Islamabad between May 2021 to Sep 2021 on 100 adult male and female of COVID-19 patients having blood hemoglobin level < 10 g/dl. For different doses of dexamethasone patients were divided into two groups of 50 patients in each group. Blood samples were taken on day 01 and day 15 for hemoglobin analysis. Mean and standard deviation of both groups was calculated and p-value of < 0.05 was considered significant. Results: At the time of admission 74% of the patients had a cough, 89% of the patients presented with fever, 98% had increased heart rate whereas 100% of the patients presented with the complaint of fatigue. Mean Hemoglobin (Hb) levels of both groups were compared on day 01 and day 15 respectively. The comparison of Hb levels showed a significant difference on day 15, there was a marked increase in Hb levels in the group which was taking 12mg/day of dexamethasone as compared to the group which was taking 6mg/day of dexamethasone (P-value <0.05). Conclusions: Administration of high doses of Dexamethasone caused a pronounced increase in hemoglobin levels in COVID-19 patients

Pattern Of Temporomandibular Joint Disorders And Associated Intra-Oral Findings Among Patients Reporting To Oral and Maxillofacial Surgery OPD, With History Of Psychiatric Illness In A Tertiary Care Hospital Of Taxila Cantt

Fri, 31 May 2024 00:00:00 +0000

Temporomandibular joint illness impairs normal existence. Many disagree on this condition's cause. To comprehend this illness, know the signs. Understanding the prevalence of temporomandibular disorder will help people prevent them and schedule regular temporomandibular joint exams. Objective: To observe the pattern of temporomandibular joint disorders and associated intra-oral signs and symptoms among patients who are being treated for psychiatric illnesses and mental health issues. Methods: This prospective, cross-sectional study was conducted at the dental college HITEC-IMS Taxila Cantt from 1^st September 2022 to 31^st December 2023 and comprised of 181 patients. A detailed history of para-functional habits, headache, otalgia, smoking and stress was acquired along with a clinical examination of joint clicking, and occlusal variation. Fisher's exact test and pearson's chi-square found factor connections. Results: There were 112 (61.9%) females and 69 (38.1%) males in all patients. The patients mean age was 33.7 ± 10.47 years and had a mean BMI 24.12 ± 6.26 kg/m². Among the symptoms that patients experienced, 125 (69.1%) heard noises in their joints, while 116 (64.1%) of the total reported feelings of emotional stress or strain. Most symptoms were more common in women. Men showed a substantial connection (p<0.005) between para-functional habits and stress/tension. Age also correlated with occlusal variation, joint sound, missing teeth, mastication side, parafunctional behaviors, tension, and stress. Conclusions: The study indicated that temporomandibular disorders were more common in women. Psychiatric patients most often complained of headache, clicking, and limited mouth opening.

Next-Generation Sequencing (NGS) in Hematologic Diagnostics

Riffat Mehboob — Fri, 31 May 2024 00:00:00 +0000

Next-Generation Sequencing (NGS) has played a vital role in eld of medical diagnostics by providing insights into the genetic
causes of various disorders. NGS enables the study of multiple genes linked to hematologic diseases simultaneously and is
especially helpful in the diagnosis of complicated diseases such as lymphomas, leukemias and myelodysplastic syndromes
[1]. NGS helps classify subtypes by detecting particular genetic changes, which is important for implementing the best
treatment plans.
NGS integration into hematologic diagnostics improves patient care by using high-resolution data and increasing diagnosis
accuracy. This is especially crucial for conditions where the clinical symptoms are similar. NGS-based genetic pro ling aids
in the prediction of patient outcomes and the course of disease, enabling more informed clinical decisions. Targeted therapy
development is made possible by NGS, which also minimizes side effects and maximizes therapeutic e cacy. Despite its
potential, the adoption of NGS faces several challenges including cost and accessibility, technical expertise and regulatory
and ethical considerations.
These di culties do, however, also provide opportunities: a broader use of NGS might greatly enhance diagnostic capacities
and raise the standard of healthcare provided worldwide. International research projects that concentrate on the genetic
components of hematologic illnesses can advance medical understanding worldwide and lead to novel therapeutic
approaches. Global rates of morbidity and death can be decreased by better managing hematologic illnesses by early and
precise diagnosis made possible by NGS.
Globally, next-generation sequencing has great potential to improve hematopoietic diagnosis and patient care. Unlocking
this technology's full potential will require addressing its cost, accessibility, and technical expertise limitations. Integrating
NGS into routine diagnostics could revolutionize the treatment of hematologic illnesses and improve patient outcomes and
prospects globally as the world's healthcare infrastructure develops

Pakistan Society of Hepatology Guidelines on the Management of Hepatic Encephalopathy

Fri, 31 May 2024 00:00:00 +0000

Hepatic Encephalopathy (HE) is one of the major complications in patients with liver cirrhosis. Cirrhosis is a significant health burden worldwide, and due to the increasing population and aging, the burden has increased since 1990. The pathogenesis of HE has been explained by different hypotheses, like astrocyte dysfunction, the ammonia hypothesis, and the GABA hypothesis. Hyperammonemia is the most likely cause of MHE. The breakdown of amines, amino acids, and purines by bacteria in the gastrointestinal tract leads to the production of ammonia. Ammonia is converted to urea in the liver by the Krebs-Henseleit cycle. Guidelines are made to help physicians and gastroenterologists diagnose patients at an early stage of hepatic encephalopathy, and a prompt diagnosis can prevent overt hepatic encephalopathy. Since no previous national guidelines regarding PSE are available, the aim here is to create a unifying guideline regarding the treatment of both overt and covert encephalopathy in a cost-effective manner. The management plan given in these guidelines is flexible and can be changed with more authentic data. We recommended that these guidelines provide a valuable source of information regarding HE in the Pakistani population, its current diagnosis, and its treatment. There is a high cost of treatment for liver diseases, and according to the current available data, we must follow the guidelines of PSH.