1 Post-Acute Covid-19 Syndrome Post-Acute Covid-19 Syndrome ,   Syed Zulfiquar Ali Shah, Ikram Din Ujjan, Naveed Aslam Lashari  
The coronaviruses (CoVs) belongs to the subgroup Orthocoronavirinae in the family Coronaviridae, Order Nidovirales.1 During 2002, the China reports first outbreak of SARS quickly spread worldwide, leads to approximately 11% fatality rate while during 2012;2 Middle East Respiratory Syndrome (MERS) originates in Saudi Arabia followed by its spread worldwide with 37% mortality.3 During December 2019, an pneumonia of unknown etiology has been detected in vast majority of patients resides in Wuhan City, Central China and Hubei Province.4 The Genomic research has been identified that this pneumonia considered as coronavirus disease 2019 caused by novel corona virus (CoV) labeled as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), formerly called as 2019-novel coronavirus (2019-nCoV).5 The screening and management strategies are not sufficient to end the battled against COVID-19.6 The survivors face various long terms symptoms produced by COVID-19 which are still the matter of debate.7 The literature reported 50-90% individuals have persistent symptoms and considered as long-haulers but due to confounders as gender, age, race, duration and severity of infection, short term study period and follow ups the results are hampered and limited.8
2 Patients with Severe Asthma: Analysis of Future Risks       Patients with Severe Asthma: Analysis of Future Risks   Sajida Parveen, Ghufran Zafar, Rukhshanda Nosheen       , Sajida Parveen, Ghufran Zafar, Rukhshanda Nosheen
  The upcoming severe health problems can be due to the asthmatic burdens. Severe asthma can lead to dangerous exacerbation and damage of pulmonary function. It can also affect medication-related problems for example steroids. In routine practice, the risk of asthma is not easily detectable. The present tools for the measurement and diagnosis of asthma and asthma-related morbidity cannot surely predict the upcoming risks of morbidity due to medication. The article reviews the existing evidence of upcoming danger in people with asthma. This review is pivoted on the danger in people with “controlled” acute asthma. It is obvious from some studies that long-term use of corticosteroids cannot stop the progression of asthma and lung damage. The other results show that the adverse effect of the drugs increases even with the lesser dose of oral corticosteroids. So, there is a need for new therapies for the reduction of upcoming risks due to asthma. Keywords: Asthma, Risk, Severity.
3 Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus , Tooba Saeed, Saadia Firdous, Shahzad Iqbal Malik, Muhammad Aamir, Yasir Ishaq, Nabeela Riaz  
Background: Oral Lichen Planus (OLP) is a relatively common chronic inflammatory mucocutaneous disorder. WHO considers OLP a premalignant lesion. This makes management of OLP important to avoid its malignant transformation. Corticosteroids are considered as the first-line of treatment. Different other treatment modalities are also in use for OLP. But there is no statistically significant data available for a particular therapy. The recent evidences suggest methotrexate may effectively be used in low dose in the treatment of OLP. Aim: To compare the frequency of complete resolution of mucosal lesions of oral lichen planus with low dose oral methotrexate versus systemic corticosteroids. Methods: It was a randomized control trial conducted at Oral & Maxillofacial Surgery Department, King Edward Medical University/Mayo Hospital Lahore in six months. A sample of 60 patients was divided into two sub groups namely Group -A (methotrexate) and Group - B (corticosteroid) using lottery method. More than 75% resolution of mucosal lesions clinically was considered as complete resolution at the end of 8th week. Results: The mean age of the patients was 44.55±12.38 years. On 8th week, frequency of complete resolution of mucosal lesions was 73.3% in Group A and 60% in Group B with an insignificant difference (p-value<0.05). Conclusion: Methotrexate group A showed more complete resolution of mucosal lesions than corticosteroid group B with insignificant statistical difference. Keywords: Oral Lichen Planus, Mucosal lesions, Malignant transformation, Methotrexate, Corticosteroids
4 Prevalence, Attitude and Knowledge of Self Medication during Covid-19 Disease Pandemic , Hamna Azhar, Ambreen Tauseef, Tahir Usman, Yousra Azhar, Momna Ahmed, Khadija Umer, M. Shoaib  
Aim: To determine the prevalence, attitude, and knowledge of self-medication of general population for the prevention of coronavirus during the COVID 19 pandemic. Place and duration of the study: Major studies of Punjab during 2020. Methodology: A self-generated questionnaire was distributed online amongst the general population of Punjab excluding the people using medication for any other chronic medical disorder. The study included the general public including the age group from 16-60 years. Results: Among 290 participants, 33.7% were males and 66.3% were female. Based on the data obtained 53% used medication without a doctor’s prescription (self- medication) while 46.7% took the medication with a doctor’s prescription. Those with the habit of self-medication relied on both allopathic and herbal medications due to various reasons, the most frequent reason found was unavailability of doctors (27.8%). The most frequently used self-medicated drugs were pain killers, Hydroxychloroquinone, Azithromycin and Ivermectin to prevent from this deadly virus (p-value=0.000).Adverse effects reported after self-medications are statistically non-significant. Conclusion It is concluded that majority of the general population of Punjab are in the habit of self-medicating themselves because of difficulty in approaching physicians and the most commonly self-medicated drug with or without symptoms was found to be tablet Azithromycin as a preventive measure during this pandemic. Keywords: COVID-19, self-medication, adverse effects
5 Infection and Expulsion Rate of Intrauterine Contraceptive Device After Post Caesarean Vs Interval Insertion , Zille Hyder Syed, Maryam Matloob, Rubina Qasim, Wafa Najeeb  
Aim: To compare the frequency of infection and expulsion following insertion of IUCD immediate post casarean to that of interval insertion in parturient undergoing elective caesarean section Method: This Randomized controlled trial was conducted from 21 February to 20th August 2010. Results: It was observed that in immediate post cesarean group(Group A) expulsion rate was 8.1% and infection rate 7.2% where as in interval insertion group(Group B) expulsion rate was 10.9%and infection rate was 9.0%. The difference of expulsion rate was statistically significant in two groups (p value 0.491) i.e expulsion rate was proven to be significantly higher in interval insertion group than immediate trans cesarean insertion group. The difference of infection rate was not statistically significant between two groups (p value 0.623) although infection rate was found to be higher in interval insertion group but not clinically significant difference was found. Conclusion: Null hypothesis was rejected for expulsion rate of IUCD and a statistically significant increased expulsion rate was found in interval insertion group as compared to immediate post cesarean insertion group. Null hypothesis was accepted for infection rate after IUCD placement in two groups as no statistically significant increased infection rate was found between immediate post cesarean and interval insertion groups Keywords: Expulsion rate, infection rate,immediate post cesarean insertion,interval insertion.
6 Frequency of Vocal Cord Paralysis in Thyroidectomy , Waqas Javaid, Mirza Muhammad Sarwar, Muhammad Usman Khalid Amin, Wajiha Khizer, Maryam Fatima  
Back ground: Recurrent laryngeal nerves being adjacent to the thyroid glands are prone to surgical trauma by thyroid surgery done for thyroid disease leading to vocal cord paralysis. Aim: To determine frequency of vocal cord paralysis in thyroidectomy Methodology: This is a descriptive cases series was completed in 6 months [December 4, 2019 till June 4, 2020] at Department ENT, Sir Ganga Ram hospital Lahore. The sample technique used is non-probability consecutive sampling .All 170 patients meeting inclusion criteria were inducted in the study from ENT SGR hospital, Lahore. Results: The mean age of all patients was 39.52±11.30 years with minimum and maximum age as 20 and 60 years. There were 91(53.5%) cases that were 20-40 years old and 79(46.5%) cases were 41-60 years old. There were 62(36.5%) male and 108(63.5%) female cases with higher female to male ratio. In 96(56.5%) cases left side and in 74(43.5%) cases right side was involved. There were 37(21.8%) who had vocal cord paralysis while 133(78.2%) cases did not have vocal cord paralysis. Conclusion: It is concluded that high number of patients i.e. 21.8% had vocal cord paralysis, so in future ENT surgeons should adopt safety measures for prevention of VCP such anatomical considerations of the sensitive area Keywords: ENT, thyroidectomy, complications, vocal cord paralysis
7 Comparison of Misoprostol With Tranexamic Acid in Preventing Post-Partum Hemorrhage   , Maryam Matloob, Zille Hyder Syed, Rubina Qasim, Wafa Najeeb
Aim: To compare the amount of average blood loss in transamine and misoprostol groups in patients undergoing spontaneous vaginal delivery in third stage of labour. Method: We conducted the randomized controlled trial from July 26th 2016 to 25th of January 2017. Results: In my study the mean age of the patients undergoing normal vaginal delivery was 28.47 years, parity wise, 31%, 33%, 24% and 11% of participants were para 1, para 2, para 3 and para 4 respectively. Mean blood loss in group A was 224.08 +/- 20.81mls and in group B 331 +/- 398 mls. Conclusion: This study has demonstrated that the blood loss in transamine group (group A) is less than the mean blood loss in misoprostol group (group B). Keywords: Transamine, misoprostol, normal vaginal delivery
8 Attitudes and Reactions of Medical Students to the Dissection Room , R. Khurshid, Sadia Majeed, Lubna Amer, Shazana Rana, Sadia Ikram, Sadaf Saleem Upal
Background: Students get their first experiences of dissecting human cadavers in the practical classes of anatomy. These experiences may help in their profession, but may also create some problems for students Aims: To find out the attitudes and reactions of medical students to the dissection room. Methods: A longitudinal study was conducted on 309 first year MBBS students at the local college of Lahore with no previous experience of cadaver dissection. Students were filled a questionnaire. The questionnaire designedwas based to identify the feelings and problems faced by the students in their first exposure to the human cadaver. Results: Almost 25% students experience no symptom on first entry into the dissecting room. The commonest symptoms of 75% students were insomnia, dizziness, sweating, loss of appetite and palpitation. Other symptoms reported were breathlessness, skin irritation, irritation of the eye, etc. Focusing on task was the main coping strategy used by majority of students. Conclusion: The majority of the students initially experience nausea and fear that may reduce with time while excitement and interest had increased on ensuing exposure to dissection.Study concluded that the negative effect of dissection room on students is less than the benefits of dissection of cadaver. Anticipation felt by the students to learn dissecting the cadaver was relatively high. Keywords: Cadaver, Dissection room, Medical students
9 A Comparative Study of Frequency of Atrial Fibrillation (AF) in Patients Diagnosed With Ischemic Stroke , Muzammil Khalid, M. Asif Naseer
Aim: To find frequency of atrial fibrillation (AF) in patients diagnosed with ischemic stroke. Study design: A Cross sectional descriptive study. Place and duration of study: Department of Medicine, PAF Hospital Mushaf, Sargodha from July 4, 2019 to Jan 4, 2020. Methods: In this study a total of 260 patients were taken after taking informed consent meeting inclusion criteria from Department of Medicine, PAF Hospital Mushaf, Sargodha. The informed consent was taken from patients or attendants. Basic information like, age, gender and contact details were taken of all selected subjects. After basic clinical investigation, ECG was done for all patients with 24 hours of Ischemic stroke who presented to the selected setting. Atrial fibrillation was as per operational definition. On pre designed proforma, data was collected from all patients. Results: The mean age of patients was 57.34±12.82 years with minimum and maximum age as 20 and 80 years. There were 150(57.7%) males. According to operational definition 91 (35%) cases had atrial fibrillation while other 169(65%) cases did not have atrial fibrillation. The frequency of atrial fibrillation was statistically same when stratified for age), gender, smoking, obesity, hypertension, diabetes mellitus. Conclusion: The frequency of atrial fibrillation was seen in 35% of the cases having ischemic stroke. Hence if atrial fibrillation is diagnosed early then ischemic stroke can be prevented. Keywords: Stroke, risk factors, complications, echocardiography, atrial fibrillation.
10 Prevalence and Interrelationship of Obesity in Hypertension , Arif Gulzar, Riasat Ali, Muhammad Aleem ud Din, Aqeel Ahmad, M. Faheem Siddiqui, Zoya Arif
Aim: To evaluate recognized parameters as obese or central obese and divided into groups. Methods: The study has been conducted in OPD of Medical Department of Pak Red Crescent Medical & Dental college and hospital which is located in rural area of Punjab Pakistan. Young patients in age group of 18-40 years with hypertension were selected. Fifty three patients without any known complication of hypertension were selected .The patients groups were made and obese patients were separated from non-obese in the form of tables and the results are noted. Results: Obesity was found in large proportion of observed groups of hypertension and it was noted in 60% of cases.The obese patients were with higher BMIrange in males and females. Conclusions: The obesity with hypertension in young our rural population is an alarming situation and the international and nationalevidences showing the interrelationship of the two conditions by certain mechanisms make it a matter of national health consideration. Keywords: Obesity, hypertension, rural area
11 A Study of thrombocytopenia in cases of Hepatitis C infection presenting at tertiary care hospital , Muhammad Abdul Raziq, Bushra Hussain, Wahhaj Munir, Fahad Qaisar
Aim: To determine the frequency of thrombocytopenia in hepatitis c patients presenting at tertiary care hospital. Methods: This cross sectional study was conducted at Department of Physiology in collaboration with Department of Medicine, Bahawal Victoria Hospital, Bahawalpur from March 2020 to September 2020 over the period of 6 months. Total 150 of hepatitis C, either male or female having age 20-60 years were included. Thrombocytopenia was assessed in selected patients. Results: In this study mean age of the patients was 44±12.38 years. Out of 150 patients of hepatitis C, thrombocytopenia was present in 48(32%) patients. In age group 20-40 years, thrombocytopenia was found in 14(26.92%) patients while in age group 41-60 years, thrombocytopenia was seen in 34(34.69%) patients. No statistically significant association of thrombocytopenia with age group was detected with p value 0.332. Male patients were 93(62%) and female patients were 57(38%). Thrombocytopenia was found in 30(32.26%) male patients and in 18(31.58%) female patients. Association of thrombocytopenia with gender was not statistically significant with p value 0.931. Conclusion: Results of present study revealed that higher proportion of hepatitis C patients found with thrombocytopenia. Most of the patients belonged to 4th and 5th decade. Higher number of male patients were victim of hepatitis C infection as compared to female patients. Most of the patients were obese. Higher number of patients were normotensive and non-diabetics. Keywords: Hepatitis C, thrombocytopenia, cirrhosis, hepatocellular carcinoma
12 Frequency of Color Blindness in Driving License Candidates Presenting in Allied Hospital, Faisalabad , Iftikhar Ahmad, Muhammad Nawaz, Huzaifa Akhlaq, Muhammad Ahsen, Nida Haider, Sarfraz Anwar Hussain
Background: Color vision is an integral part of visual functions. Defective color vision may leadto difficulties in daily activities and even choosing and continuing in a certain profession. Colorvision deficiency or blindness may be congenital or acquired due to retinal or optic nerve disorders Aim: To investigate the frequency of color blindness or weakness in driving license candidates presenting for medical exam, for the year 2019. Methodology: The study design was descriptive cross sectional and the sampling technique wasnon probability convenient sampling. The place of study was eye outdoor of Allied Hospital,Faisalabad. The sample size was 13,637 based on inclusion criteria. The subjects ranged in agefrom 18 years onwards to a maximum presentation of 76 years with mean age as 30.728 ±10.131.Both genders were included in the study. Visual acuity was tested on Snellen’s Chart andrefraction, if needed, was performed to obtain best corrected acuity. Results: The results of the study showed that most of the subjects had 6/6 vision as 96.6% in righteye and 96.5% in left eye, 6/9 as 2.8% and 2.9% and 6/12 as 0.3% and 0.4% respectively for rightand left eye. The frequency of normal color vision was 94%, 4.9% for red green deficiency and 1.1% for color blindness. Conclusion: A frequency of 4.9% and 1.1% for color deficiency and color blindness respectively, in drivers, indicates that color vision must be tested to avoid any possible accidents related todeficient color perception. Keywords: Driving license, colorblindness
13 Quality of life and Social Support Among Diagnose Bipolar Patients , M Adnan, T Khan, B Razzaq, R Ghaffar, S Batool, I Shehzadi, M Qayum, A B Mustafa, F Hussain, B J Makhdoom
Aim: To ascertain the relationship between quality of life and social support in bipolar patients who have been diagnosed. STUDY DESIGN: cross-sectional research design Place and duration of the study: The research was performed impatiently on the Sheikh Zayed Medical College, Rahim Yar Khan at the Department of Psychiatry and Behavioral Sciences, which ran from January 2018 to July of 2019. Method: Data was retrieved from 100 patients, with diagnosed patients of bipolar affective disorder. Quality of life and social support were assessed by quality of life scale (QOLS) developed by Burckhardt and Berline social support scale (BSSS) developed by Berline. Results: Research claims a close relationship between the presence of such things as quality of life and social help for people with Bipolar Disorder. Conclusion: Bipolar is linked to inadequate health and quality of life and social isolation, mostly due to ineffective social skills. Social support is critical to emotional stability and quality of life. It may help patients deal with difficulties and reduce depression and help in both the recovery phase and positive results of psychiatric treatment. What is currently being sought to be learned is how social care has an impact on the level of well-being for bipolar patients. Keywords: Quality of life, bipolar, validation, generalization
14 Non-variceal Upper Gastro-intestinal Bleeding in Patients of Liver Cirrhosis , M Shahid Nawaz Khan, Hafiz Yasir Qamar, M Farooq Khan, Abeera Abdul Ghaffar, Farah Sattar
Aim: To determine the frequency of non-variceal upper gastro-intestinal bleeding (NVUGIB) in patients of liver cirrhosis. Methods: A total number of 136 patients of liver cirrhosis having upper GI bleeding who presented in medical emergency of Nishtar Hospital Multan were included in this cross-sectional analysis. Gastric Endoscopy was done all patients to determine the presence of NVUGIB in all patients. Data regarding patient’s age, Body mass index (BMI), gender and duration of upper GI bleed was also collected. Results: Mean age was 47.23±9.45 years. Mean body mass index (BMI) was 24.94±3.35 kg/m2. Mean duration of upper UGIB was 3.45±3.03 months. There were 94(69.12%) male and 42(30.88%) female patients. NVUGIB was found in 76(55.88%). There was a significant association of age with NVUGIB. In patients of age 20-49 years, NVUGIB was found in 47(62.7%) patients. In having age 49-65 years, NVUGIB was found in 29(47.5%) patients. Conclusion: NVUGIB in patients with liver cirrhosis is very common and it is more common in younger age patients. So diagnostic endoscopy should be done in liver cirrhosis patients presenting with upper GI bleeding in emergency departments. This will aid in proper diagnosis and in deciding the appropriate treatment in these patients. Keywords: Non-variceal upper gastro-intestinal bleeding, liver cirrhosis, Hepatitis.
15 The feelings & perceptions of a Medical doctor after recovery from Corona infection ,   Sidrah Riaz, Sabrina Tariq, Umair Tariq Mirza, Muhammad Tariq Khan, Shabana Chaudhary, Muhammad Arshad
Aim: To know the core feelings and perception of a medical doctor after recovery from corona infection Study Design: A descriptive cross-sectional qualitative survey Place and duration of study: Akhter Saeed medical and dental college Lahore. Duration of study was two months from 1stJanuary 2021 to 31st March 2021. Methods: A survey questionnaire is formed and sent to different doctors of different specialties both in the public and private sectors. Non-probability conventional sampling technique was used. Qualitative data was analyzed by the SPSS 20. Results: The online survey was sent to three hundred and fifty (350) doctors who were fellows, consultants, assistant consultants and professors. The voluntary response is submitted by 26doctors who suffered and recovered from corona infection. Conclusion: Coronapandemic has physical, psychological, social and economic effects. Everyone who suffered from it has his own insight about disease but unlike other infections, anxiety and uncertainty about future were major psychological effects which added to physical suffering of patients. All recovered patients strongly recommended following of SOPs. Vaccinationwith following SOPs is unanimously only optimistic approachagainst corona to decrease incidence and severity of infection. There is a need for doctor counselling sessions to cope with stress and anxiety issues. Keywords: Corona infection, anxiety, consultant
16 Subinguinal Cremasteric Disruption and Venous Ligation for Varicocele Repair , Syed Tahir Mohammad Shah, Mohammad Farooq, Nadia Akbar, Majid Bahir Mughal
Aim: To evaluate the outcome of subinguinal cremasteric disruption and venous ligation for the treatment of varicocele with regard to improvement in semen parameters, recurrence hydrocele formation and testicular atrophy. Methods: The clinical study was carried out from July 2016 to June 2019. Fifty-nine patients were included in the study. Varicocele repair was done as a day case surgery under local anesthesia using cremasteric disruption and venous ligation technique. The treatment outcomes studied were improvement in semen parameters and complications like recurrence, hydrocele formation and testicular atrophy. Results: Seventy-four varicocelectomies were done in fifty-nine patients. Semen parameters improved in those nineteen patients who had abnormal semen parameters before surgery and nine out of these nineteen (47.36%) got their semen count normal after varicocele repair. There were five recurrences (6.75%). No hydrocele formation or testicular atrophy occurred during one year of follow up. Conclusion: Day case varicocelectomy by subinguinal cremasteric disruption and venous ligation is a simple, economical choice with minimal morbidity and comparable outcomes. Keywords: Varicocele, Subinguinal cremasteric disruption and venous ligation, complication
17 Women in Punjab are in Dire Need of Awareness Initiatives Related to Cervical Cancer and its Screening Tests , Zertaj Kashif, Aman ur Rehman, Sonia Zafar Warriach, Muhammad Bilal Pasha, Zoya Khan, Sehar Bashir
Cervical cancer is the third most common cancer and the fourth dominant cause of cancer related death in women throughout the globe. Eighty percent of cases occur in the developing nations1,2. The extent of this cancer is tough to be evaluated in Pakistanbecause of differing insufficient epidemiological figures obtainable in small scale studies, dealing only reported limited number of cases which are not representative of its true burden3,4,5. As stated by World Health Organization, in 2002, the pervasiveness of cervical cancer in Pakistan was 9 in 100,000; in 2008 it jumped up to 19.5/100,000. Claimed by various studies, this cancer is among the list of first ten frequent cancers in Pakistan6,7,8,9. It is one of the most avoidable cancers nowadays and we have all the tools to eradicate it, still the number of lives lost due to cervical cancer is very high in Pakistan as it is an ignored ailment here in terms of screening, prevention and vaccination9. Economically developed countries who invested capitals for organized screening projects have made notable progress in reducing both occurrence and mortality due to this specific cancer10. The out of proportion load of cervical cancer in developing countries is largely attributable to scarcity of functional screening projects11. In our over 500 bedded teaching hospital with a well running gynecology outdoor, we do receive cervical biopsies positive for invasive malignancies but hardly receive any Pap smear tests in laboratory that prompted us to check for cervical cancer screening especially Pap smear test related awareness among our non-medical ladies.As the foundation of cervical cancer eradication is screening and prevention, each country and its regions must device an elimination plan that fits into its own culture and geographic landscape. Keywords: perception and understanding of existing screening tests, preventive measures, cervical cancer
18 Comparison of contrast sensitivity in myopic patients using spectacle and contact lens correction , Sadaf Qayyum, Zubair Wahab, Rabia Saeed, Anbar Zulfiqar, Ayisha Shakeel, Iqra Iqbal
Aim: To compare the contrast sensitivity in different categories of myopia using two different optical correction spectacles and contact lens correction. Methods: This cross-sectional study in design was conducted from August 2018 to May 2019 at the Ophthalmology Department of Madinah Teaching Hospital Faisalabad.45 subjects corrected with spectacles lenses and contact lenses all had corrected visual acuity of 6/9 or better were studied.The extent of myopia determined the three groups. All individuals were subjected to spectacles and Contact lens correction using slitlamp for anterior eye examination and for the fundus examination. The assessment of visual acuity was carried out by the Snellen vision Chart at 6m distance and contrastssensitivity was tested by Pelli- Robson chart. Results: Results showed a significant relationship between contrast sensitivity and type of optical correction. There were significant results of the independent t-test for spectacle and contact lenses 0.00 (p<0.005). However, the mean contrast sensitivity was better for all the three groupswith contact lens correction as compared to spectacle lens correction.Contact lenses provide better contrast sensitivity than spectacle lenses. Conclusion: Comparison between contact lens and spectacle correction was done and better quality contact lenses reduce optical defocus and give better results of contrast sensitivity. Results also concluded that loss of contrast sensitivity will be interpreted as early loss of retinal functions in severe myopes. Keywords: Myopia, Contrast sensitivity, Spectacle lens, Contact lens
19 A Bird’s Eye View on Firearm Injuries Lady Reading Hospital MTI, Peshawar , Almas Afridi, Hamid Shahzad, S H Shirin, M Nouman, J Akhtar, T Hayat, J Bahadur, S Fareed, Z Jaffar
Background There is a concern that firearm injuries are very common reported at lady Reading hospital Peshawar MTI, but the there are no contemporary studies. Gunshot wound are persistent burden on community as well as on hospitals Aim: To evaluate trends of firearm injuries reporting to LRH their anatomical distributions and their outcomes. Methods: This prospective randomized study (a pilot project for public health alert) was conducted in Accident & Emergency Department of Lady Reading hospital MTI, Peshawar KPK, from 1st May, 2020 to 1st October, 2020. Hundred patients with firearm injuries to different region shot were included in this study. Data collected on predesigned proforma and entries in HMIS used after stabilizing the patient. A prospective pilot study done over a period of six months from 1st May, 2020 to 1st October, 2020 in trauma section of Accident Emergency department of Lady Reading hospital MTI Peshawar. Results: Patients of all age groups with firearm injuries were included in this study from May 2020 to October 2020. Data was collected on predesigned proforma as well as HMIS (health management information system) of ED department. A total of 100 patients presented to LRH with firearm injuries during six months. Males outnumbered female by 6:1 accounting for 100(85%) of injured. : Domestic violence was found to be the most common reason for the firearm use 44(44%), Don’t know or refuse to share was 29(29%), rivalry 12(12%), land and property conflict 9(9%), street fight 3(3%) accidental gunshots 2%, (n=25) and robbery 1.1% (n=1).The most common firearm used for inflicting injury was pistol (70%), shot gun (2.2%), curiously 16% were either reluctant or were never knowing about the weapon Conclusion: Firearm injuries are common public health problem globally, in our set up situation is more grievous and less highlighted, the most common cause being domestic violence, lack of education, easy availability of arms, illegal or legal weapon ownership making situation worst in the form of premature deaths and disability. Understanding the nature of problem can prevent this violence Keywords: Firearms, violence, gunshot wounds, homicides, suicides
20 Frequency of Pre-Extensively Drug Resistant Tuberculosis and Extensively Drug Resistant Tuberculosis , Bashir Ullah, Rukhsana Saboor, Muhammad Zahid Iqbal, Atiq Ahmad Bhatti, Abad-Ur-Rehman, Muhammad Akram
Aim: To determine the frequency of pre-extensively drug resistant tuberculosis, extensively drug resistant tuberculosis in patients with multi-drug resistant tuberculosis. Study design: Retrospective/observational Place and duration of study: Department of Medicine, Bolan Medical College Quetta from 1st July 2019 to 31st December 2020. Methodology: One hundred and eighty patients of both genders presented with multi drug resistant tuberculosis were enrolled in this study. Patient’s detailed information including age between 20-70 years, sex, body mass index were recorded. Sputum samples were taken from all the patients and then drug sensitivity testing (DST) for 1st and 2ndline drugs. Frequency of pre-XDR TB and XDR tuberculosis were recorded. Results: There were 100 (55.56%) males and 80 (44.44%) patients were females and mean age was 37.38±10.75 years. Mean body mass index was 24.18±2.41 kg/m2. Among all the multi-drug resistant tuberculosis patients, pre extensively drug resistant tuberculosis was found in 62(34.44%) patients and extensively drug resistant tuberculosis was found in 8(4.44%) patients. All 62(100%) patients of pre-XDR tuberculosis were resistant to fluoroquinolone while among XDR tuberculosis patients 4 were resisted to amikacin, 2 were resisted to kanamycin and fluoroquinolone, 1 patient was resisted to amikacin and kanamycin. Conclusion: Frequency of pre-extensively tuberculosis among multi drug resistant tuberculosis was high while only 4% patients had extensively drug resistant tuberculosis. Keywords: Tuberculosis, Multi-drug resistant, Pre-extensively drug resistant, Extensively drug resistant
21 Premedication with Dexamethasone and Propofol to Control Fentanyl-Induced Cough , Muhammad Faisal Farooq, Haider Ali Khan, Vijai Kumar3, Arsalan Jamil, Shakil Malik, Naila Zahoor
Background: Fentanyl-induced cough is a common difficulty encountered at induction of anesthesia. Various interventions both pharmacological and non-pharmacological have been used to prevent this side effect including dexamethasone and propofol. Aim: To compare the effectiveness of dexamethasone and propofol to prevent fentanyl-induced cough at the induction of general anesthesia. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesiology, Surgical ICU & Pain Management, Dow University of Health Sciences and Civil Hospital Karachi from 16th September 2011 to 15th March, 2012. Methodology: One hundred patients who underwent elective surgical procedure were selected. Patients were randomized in two groups of 50 patients each; Group D was given intravenous dexamethasone; whereas patients of group P received intravenous propofol as the premedication before induction. The main outcome measure was effectiveness of both drugs to prevent fentanyl-induced cough. Results: Majority of patients (40%) were between 20-30 years of age group with mean age was 35.80±10.14 years. Males were more than females. Intravenous dexamethasone was significantly effective (90%) than intravenous propofol (70%) [p=0.012]. Conclusion: Intravenous dexamethasone is effective in reducing fentanyl-induced cough in comparison to propofol. Keywords: Dexamethasone, Propofol, Fentanyl-induced cough (FIC)
22 Relation of Parents Economical, Educational and Awareness on Immunization Status of Children , Lubna Riaz, Waqas Ali Khan, Shamayal Mandokhel, Asfand Tariq, Neelam Faryad, Shazia Irum
Aim: To determine the immunization status of children 0 to 2 years and factors leading to low vaccination status in children visiting tertiary care center. Study design: Cross-sectional study Place and duration of study: Department of Paediatrics Shaikh Zayed Hospital Lahore from 1st November 2019 to 31st April 2020. Methodology: Five hundred children age between 0-2 years were enrolled after fulfilling inclusion and exclusion criteria. Results: The mean age was 9.9±6.1 months, with mean weight of 7.4±3.4 kg and 200 (40%) were male and 300 (60%) were female patients. Sixty (12%) were not vaccinated, 145 (29%) partially vaccinated and 295 (59%) fully vaccinated. In the distribution by income level 255 (51%),180 (36%) and 65 (13%) parents were having low, middle and high income respectively; By education level,155 (31%) with no education, 140 (28%) some education and 205 (41%) with high education, regarding knowledge of immunization, 50 (10%) had no knowledge, 215 (43% )had wrong perception of immunization and 235 (47%) were fully aware.295 (59%) had up-to-date immunization Conclusion: More than half of the study populations were upto date about immunization status. It is also concluded that majority of parents of low-income level and uneducated were unknown about immunization status and majority of middle and high-income level and educated people were partial known or up-to-date about immunization status Keywords: Economical level, Educational level, Awareness level, Immunization status
23 Use of Tropical Vancomycin in Decreasing the Incidence of Surgical Site Infection in Open Heart Surgery , Muhammad Mohsin Mahmood, Aqeel Ahmad, Waseem Rehman
  Aim: To study the effect of vancomycin tropically in decreasing the incidence of sternal wound infection in patients undergoing open cardiac surgery. Study design: Randomized controlled trial Place and duration: Department of Cardiovascular & Thoracic Surgery Sheikh Zayed Hospital Lahore from 1st January 2019 to 31st July 2020. Methods: A total of 180 male and female planned for elective open heart surgery is selected for this research work. All patients age is between 40 and 70 years and these patients are bifurcated in two groups. In Group I there are 90 patients in which vancomycin is used on the sternal edges, while in Group II there are 90 patients in which only normal saline wash is used at the time of sternal approximation. At the end incidence of sternal wound infection is monitored to establish the benefits of tropical vancomycin. Results: One hundred and thirty three (73.89%) were males and 47 (26.11%) were females. Topical vancomycin group has decreased rate of superficial and deep sternal wound infections as compared to the patients in which topical vancomycin is not applied (2.22% vs 6.67%) and (1.11% vs 4.4%). Conclusion: Application of vancomycin tropically at surgical site at the time of closure of sternum in conjunction with prophylactic use of antibiotics reduces wound infection in open heart surgery.   Keywords: Open heart surgery, Vancomycin, Sternal wound infection
24 Comparison of Various Progesterone Drugs in Reducing Miscarriages , Hina Zubair, Lubna Riaz, Fartash Zahra, Sara Saeed Malik, Rabail Javed
Background: Threatened abortion is a common complication of pregnancy. In order to prevent miscarriage progesterone in various forms is administered in patients. This is done to allow pregnancy to proceed further beyond twenty week of gestation. Aim: To compare gravibinan (injected) with utrogestan/cyclogest (intra vaginal administration) in reduction of miscarriages. Study design: Case control study Place and duration of study: Department of Obstetrics & Gynecologiy, Mohtrama Benzair Bhutto Shaheed Medical College Mirpur and Department of Pediatric, Shaikh Zayed Hospital Lahore from 1st April 2020 to 30th September 2020. Methodology: Pregnant women, who had vaginal bleeding until 20 weeks of their pregnancy, were assessed for inclusion. Participants were divided into three groups. Group A was given gravibinan, Group B was given utrogestan and Group C was given cyclogest. Results: Women infested with gravibinan had 20% those who still had miscarriage while the number of miscarriages significantly decreased to 14.2% in utrogestan group and 13.63% in cyclogest group (p<0.005). Conclusion: Cyclogest proved a better drug of choice for reducing miscarriages. Keywords: Miscarriages, progesterone, pregnancy
25 Maternal Outcome among Women Having Cardiac Disease at Tertiary Care Hospital , Shazia Awan, Saira Dars, Shazia Rani, Raheel Sikandar
Aim: To determine the maternal outcome among women presented with cardiac disease at tertiary care hospital. Study design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Liaquat University of Medical and Health Science Jamshoro from 1st April 2019 to 31st March 2020. Methodology: Fifty-seven women after 24 weeks of alive pregnancy and having cardiac diseases were included. The subjects were seen in the Gynaecology OPD every two weeks till 34-36 weeks, as per institutional protocols and after that every week by obstetrician. Cardiologists saw subjects in each trimester and delivery schedule were developed and medications were adapted with collaboration. The anaesthetic scheme of the subject was also reviewed with the cardiac anaesthetist. All the maternal outcome data was recorded. Results: Most of the patients 89.5% had age group of 25-32 years. Multiparous women were commonest 43.3% and 53.7% patients underwent normal vaginal delivery. 35.8% patients had congenital heart disease, 32.8% had cardiomyopathy and 16.4% had Rheumatic heart disease. According to the maternal outcome anemia was most common among 85.1%, pre-eclampsia 41.8%, pulmonary edema 35.8%, IUGR 20.9%, birth asphyxia 26.9%, preterm 38.8% and maternal mortality 14.9%. Abruption placenta and preterm birth were significantly associated with congenital heart disease and cardiomyopathy p=0.047 and p=0.002 respectively. Pulmonary edema was higher among patients of cardiomyopathy (p=0.027). Birth asphyxia was higher among patients of rheumatic heart disease. While anemia, IUGR and maternal mortality were equally found among cardiac diseases, p-values were quit insignificant. Conclusion: Cardiac disease showed adverse maternal outcome during pregnancy with mortality rate of 14.9%. Keywords: Pregnancy cardiac disease, Maternal outcome, Mortality rate
26 Effect of Thrombocytopenia on Age and Method of Delivery among Pregnant Women in Late Trimester , Shazia Awan, Shazia Rani, Saira Dars, Madiha Abbassi, Naheed Parveen, Raheel Sikandar
Aim: To evaluate the effect of thrombocytopenia in pregnant women. Study design: Descriptive cross-sectional hospital based study Place and duration of study: Department of Obstetrics & Gynaecology, Liaquat University of Medical and Health Science Jamshoro from 1st June 2018 to 31st June 2019. Methodology: One hundred and seventy-six patients were observed. Women with pre-eclampsia, platelets less than 50X1010, singleton pregnancy and pregnancy greater than 32 weeks were included. Results: Most of the participants 91(51.9%) were 26 to 30 years with mean age was 30.71±4.45 years. Gestational duration in last trimester was 50(28.4%), 98(55.7%) and 28 (15.9%) of 28 to 32 Weeks, 32 to 36 Weeks and greater than 36 weeks respectively. Mean gestational duration was 35.11±2.3 Weeks. Seventy-one were falling in range of platelets of 30x1010 to 40x1010 (40.3%). Others were 46 (26.1%) of >40x1010, 43(24.4%) of 20x10-30x1010 and 16(9.1%) of 10x10-20x1010. One hundred and 41(80.1%) had vaginal deliveries and 35(19.9%) had lower segment caesarean section deliveries. Conclusion: The young participants of thrombocytopenia were more prevalent than old age participants. Keywords: Gestational thrombocytopenia, Platelet count, Pregnancy
27 Maternal Near-Miss Obstetric Events and Maternal Mortality , Shehla Channa, Hina Akmal Memon, Nayab Qasim, Abdul Rauf Memon, Ikram Ahmed Tunio, Nand Lal Seerani
Aim: To know about the prevalence, characteristic and nature of near miss events and to relate the nature of near miss events with that of maternal mortality. Study design: Descriptive cross sectional study Place and duration of study: Department of Obstetrics & Gynecology Unit IV, LUMHS Jamshoro from 1st January 2020 to 31st December 2020 Methodology: Pregnancy outcomes segregated into maternal death, near-miss event, or live birth categories. Age, level of education, religion, and residence were socio demographic variables. Obstetrics characteristics and nature of maternal near-miss events also studied. Result: The prevalence of maternal near-miss event was 5.6%, and the maternal near-miss events were seen more in multigravida, pregnant women with the lack of antenatal care in referral cases. Live birth as fetal outcome was 75%. The maternal death to near-miss ratio in this study was 1:5. 44 (42.3%) postpartum haemorrhage and 28 (26.9%), hypertensive disorders cases were leading cause of maternal near-miss events. Conclusion: Every fifth women who survived life-threatening complications, one died. Maternal near-miss should be adopted as an indicator for evaluating maternal health services. Keywords: Maternal near-miss (MNM), Maternal mortality, Life-threatening complication
28 Hemodynamic Responses during Insertion of Laryngeal Mask Airway versus Conventional Intubation , Vijai Kumar, Muhammad Faisal Farooq, Shakil Malik, Zamir Ahmed, Muhammad Nadeem Muneer
Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity,
29 Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty , Zamir Hussain Tunioi, Rizwan Ali Jhatiyal, M Azeem Akhund, M Kashif Abbasi, L Das Maheshwari5, A R Memon
Aim: To evaluate the functional outcome of bipolar hemiarthroplasty in intracapsular fracture neck of femur. Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopaedic Surgery & Traumatology, Peoples Medical University Hospital, Shaheed Benazir Abad from 1st December 2017 to 31st December 2020. Methodology: Sixty six cases of intracapsular femoral neck fractures with age ranging from 50 year to 75 year of either gender who were ambulatory before injury were included; while basicervical, younger than 50 years, with neuromuscular disorder, unfit for surgery, open fracture, bilateral injuries, osteoarthritis of hip, Rheumatoid, Gouty, pathological fractures, bedridden & who did not give consent for study, were excluded from the study. Functional outcome assessed by Harris hip score & data analyzed by SPSS version 23. Results: Twenty six (59.09%) were male and 40 (40.91%) were female with mean age of 64.3±7.77 year. Average time from injury to hospital arrival was 14.7±6.8 hours. Average time from hospitalization to surgery was 4.67±2.23 days. Average time of surgery was 55.67±9.9 minutes. Average hospital stay was 9.7±4.3 days. The average time of follow-up was 18.45±7.63 months. Conclusion: Bipolar implant is safe, effective, reliable, stable and cost effective implant for intracpsular fracture of femoral neck in elderly populace. The 66.66% of patients have satisfactory Harris hip score in follow up duration of 18.45±7.63 months. Keywords: Functional, Outcome, Femoral neck fractures, FNF, Bipolar, Hemiarthroplasty, HHS
30 Frequency of Undiagnosed Hypoxia in Patients , Muhammad Imran Aslam, Nayyar Manzoor Elahi, W Ahmad Khan, M Saqib Musharaf, Shamshad Ali, M Abdal
  Aim: To determine frequency of undiagnosed hypoxia in pts which was medically sick admitted in chest wards. Study design: Cross-sectional. Place and duration of study: Department of Medicine, Social Security Hospital, Multan Road Lahore from 1st January 2020 to 30th June 2020. Methodology: Two hundred and ninety patients were included in this study. Patients detailed demographics age, sex, and body mass index were recorded after taking written consent and admitted in chest wards. Presented patients were aged between 20-70 years. Pulse oximeter was used to measure the oxygen saturation levels. Mean time of hospitalization was also measured. Results: There were 170(60%) males and 120(40%) females with mean age of the patients were 40.78±18.64 years. Mean BMI was 27.78±12.64 kg/m2. Majority of the patients 160(55.17%) were from the age group 35-70 years. Calculated oxygen saturation rate was 91.98±9.42% in which minimum rate was 80% and the maximum rate was 105%. Mean heart rate was 92.96±19.20 per minute. Patients were admitted due to tuberculosis were 102(35.17%), patients with chronic pulmonary disease were 70 (24.17%), patients with pleural effusion were 30(10.34%) and the patients of asthma were 20(6.9%). In this study hypoxia was observed in 44 (15.17%) patients and was absent in 246 (84.83%) patients. Conclusion: The frequency of hypoxia was most prevalent in male patients with increasing age as compared to females and in chronic obstructive pulmonary disease patients, it was observed more commonly.   Keywords: Pulse oximeter, Oxygen saturation, Undiagnosed hypoxia
31 Frequency of Undiagnosed Hypoxia in Patients , Muhammad Imran Aslam, Nayyar Manzoor Elahi, W Ahmad Khan, M Saqib Musharaf, Shamshad Ali, M Abdal
  Aim: To determine frequency of undiagnosed hypoxia in pts which was medically sick admitted in chest wards. Study design: Cross-sectional. Place and duration of study: Department of Medicine, Social Security Hospital, Multan Road Lahore from 1st January 2020 to 30th June 2020. Methodology: Two hundred and ninety patients were included in this study. Patients detailed demographics age, sex, and body mass index were recorded after taking written consent and admitted in chest wards. Presented patients were aged between 20-70 years. Pulse oximeter was used to measure the oxygen saturation levels. Mean time of hospitalization was also measured. Results: There were 170(60%) males and 120(40%) females with mean age of the patients were 40.78±18.64 years. Mean BMI was 27.78±12.64 kg/m2. Majority of the patients 160(55.17%) were from the age group 35-70 years. Calculated oxygen saturation rate was 91.98±9.42% in which minimum rate was 80% and the maximum rate was 105%. Mean heart rate was 92.96±19.20 per minute. Patients were admitted due to tuberculosis were 102(35.17%), patients with chronic pulmonary disease were 70 (24.17%), patients with pleural effusion were 30(10.34%) and the patients of asthma were 20(6.9%). In this study hypoxia was observed in 44 (15.17%) patients and was absent in 246 (84.83%) patients. Conclusion: The frequency of hypoxia was most prevalent in male patients with increasing age as compared to females and in chronic obstructive pulmonary disease patients, it was observed more commonly.   Keywords: Pulse oximeter, Oxygen saturation, Undiagnosed hypoxia
32 Indications of Colonoscopy and Their Diagnostic Yield , M Naveed Anwar, Humaira Achakzai, Fahimullah, Wajeeha Qayyum, Zaland Ahmed Yousfzai, Mawara Iftikhar
  Aims: To look for common indications and gastrointestinal pathologies observed on colonoscopy and to assess its diagnostic yield with respect to different clinical indications. Study design: Observational cross-sectional study Place and duration of study: Department of Medicine, Rehman Medical Institute from 1st January 2018 to 31st March 2019 Methodology: Five hundred and seventy three patients referred for colonoscopy were included. The demographic profile, indication of colonoscopy and colonoscopy findings were noted. Results: There were 231 (40.3%) males and 342 (59.7%) females with mean age 42.32±17.51 years. Bleed per rectum was most common indication noted in 284 (49.6%) followed by altered bowel habits 125 (21.8%) cases. Two hundred and fifty two (44%) colonoscopies were normal. One hundred and seventy three (30.2%) revealed significant lesions and 148 (25.8%) lesions were insignificant. Internal hemorrhoids were observed in 130 (22.7%) followed by colitis in 54 (9.4%). Abnormal computerized tomography abdomen revealed significant lesions in 62.2% of patients. Chronic diarrhea followed by constipation, altered bowel habits and iron deficiency anemia (IDA) showed 34.5%, 25.7%, 17.6% and <10% significant lesions respectively. Conclusion: Rectal bleed was the most common indication followed by altered bowel habits. Most common colonoscopy findings were hemorrhoids followed by colitis and abnormal growth. Abnormal computerized tomography abdomen gave the best diagnostic yield for colonoscopy.   Keywords: Colonoscopy, Indications, Diagnostic yield
33 Ivermectin may Not be a Miraculous Drug to Improve PF Ratio and Virus Clearance in COVID-19 Patient , Abid Mushtaq, Saba Zartash, Muhammad Javed, M Asim Rana, M A Qayyum, T Bibi, M M Ullah Saif, M M Hafeez
  Aim: To evaluate the effectiveness of Ivermectin in COVID 19 infection in terms of virus clearance and symptomatic improvement. Study design: Prospective Quasi experimental study Place and duration of study: Study was carried out in COVID treatment units of Services Institute of Medical Sciences and Bahria International Hospital COVID treatment centre from April 15, 2020 to November 30, 2020 Methodology: One hundred COVID19 confirmed patients for this study and divided into 2 groups. Both groups were given standard treatment including Oxygen, therapeutic anticoagulation and hydroxychloroquine therapies. Group-1 was given Ivermectin for 6 days and group 2 didn’t receive Ivermectin.   Results: The significance value represented as p value (p=.825) was greater than the table value at 0.05 in all aspects, which shows that Ivermectin has no effect in improving PF ratio in COVID19 patients. Out of 50 only 4 patients who received Ivermectin got COVID19 PCR negative after 6 days but on the other hand 3 patients who did not receive Ivermectin also got their PCR negative after 6 days of treatment. Conclusion: Ivermectin does not seem to be effective in improvement of PF ratio and virus clearance in COVID19 patients. Keywords: SARS-CoV-2, COVID-19, PF ratio, Ivermectin, Virus clearance, Anti-viral treatment, Viral clearance
34 Comparative Assessment of Drug Drug Interactions Among Public and Private Sector Hospitals , Hammad Ahmed Butt, M Zeeshan Anwar, Akram Shahzad, Ammara Khan, Hina Aslam, Anum Ashraf, Talha Laique
Background: Drug-drug interactions (DDIs), being one of the most preventable drug related hazards having serious life threatening adverse consequences or at least results in therapeutic failure. Aim: To confirm the drug-drug interactions among medical patients at private and public sector hospitals of Jhelum and Kharian. Study design: Comparative study. Methodology: The collected data was analyzed for drug interactions. Patients who were being prescribed less than two drugs along with topical drugs (ointments, creams, ear drops and eye drops) were excluded. Information on prescriptions was retrieved from the hospital prescription.  SPSS for windows version 20.0 was used to analyze the data. Results were presented as frequency and percentage. Results: The results showed that the public sector showed 1640 drug interactions, that is 75%; on the other hand, the private sector showed 260 drug interactions, that is 41%.  Conclusions: We concluded that frequency of drug interactions were more in public sector hospitals. Hence, a possible reason for such a result could be the greater patient load on public sector hospitals and less number of appointed doctors in such facilities. Keywords: Adverse Drug Interaction, Drug-Related Problems and Drug-Drug Interaction. 
35 Perceptions of Female Medical Students about Practicing in Rural Areas , Iffat Naiyar, Iffat Noor, A F Anjum, A Chughtai, M S Abdullah, M Z Anwar, S Shoaib, M R I Hashmi, S N Hashmi, TL  
  Background: Effective management of human resources for health-care services in rural areas are dependent on high salary packages. Aim: To explore whether security provided to female doctors in rural areas is sufficient as well as to determine if female doctors prefer to work in rural areas after specialization in Pakistan. Study Design: Cross-sectional study. Methodology: This study with enrolled female students (n=300) was carried out after ethical review committee’s (ERC) approval at CMH Kharian Medical College (CKMC), Community-Medicine Department, Kharian-Pakistan. A structured close ended questionnaire was designed. Data was analyzed by SPSS software, version 17. Analyzed data presented as percentage. Results: Results showed that 22% were satisfied whereas 78% subjects were unsatisfied. Regarding security satisfaction, 15% were satisfied whereas 85% were not. Similarly, staff available in RHC is sufficient according to 17% subjects while majority (83%) had opposite idea. Conclusion: We concluded that majority of the subjects did not want to perform their duties at RHCs rather 78% of them were unsatisfied with facilities provided to them at RHCs. Other reasons for unwillingness included lack of security, medical staff, low salary packages and plus they are not trained to work there. Keywords: Medical students, Rural Area and Security Concerns.
36 N-Acetyl Cysteine Ameliorates Hepatotoxicity Associated with the Use of Methotrexate in Mice , Aamna Khokhar, Iram Kehkashan Khurshid, Sadia Lodhi, Alia Sarfaraz, Muhammad Arif, Amtul Hafeez, Talha Laique
  Background: Liver is not only involved in maintaining homeostasis but also exhibits significant role in metabolism and detoxification of various drugs and toxins. Aim: To explore the hepato-protective role of N-acetylcysteine against methotrexate induced hepato-toxicity. Study design: Randomized controlled trial. Methodology: This study having mice (n=18) was carried out after ethical review committee’s (ERC) approval at Foundation university medical college in collaboration of National institute of health, Islamabad in 2017. Single intraperitoneal injection (20mg/kg) of methotrexate induced hepato-toxicity. Hepatoprotective effect was assessed by oral administration N-acetylcysteine (50mg/kg) alone with methotrexate. The extent of liver damage and effect of protective agents were determined by measuring serum ALT, AST, ALP after 24 hours of respective treatment. Liver samples were taken for histological analysis. One way ANOVA followed by Post Hoc Tukey test was applied for multiple comparisons of biochemical markers between the groups. Histopathological findings were analyzed by Chi Square test. p < 0.05 was considered significant. Results: Significant (p < 0.05) hepatotoxicity was seen with substantial elevation in serum ALT, AST and ALP with methotrexate. N-acetylcysteine attenuated the methotrexate induced hepatotoxicity significantly (p < 0.05). The histopathological examination showed mild steatosis along with focal pleomorphism in the liver of mice that received methotrexate in comparison to group treated with N-acetylcysteine and methotrexate though minimal inflammation was seen. Conclusion: We concluded that N-acetylcysteine ameliorates the methotrexate induced hepatotoxicity on when used concomitantly.   Keywords: Hepatotoxicity, N-acetylcysteine and Methotrexate
37 Frequency of Accelerated Bacillus Calmette-Guerin Response in Bacillus Calmette-Guerin Vaccinated Children , Muhammad Irfan, Syed Usama Masood, Talha Laique
Background: BCG is a vaccine obtained by attenuating Mycobacterium bovis. It is a fairly safe vaccine with no associated complications. Aim: To determine the frequency of accelerated BCG response in BCG vaccinated children. Study design: Descriptive case series. Methodology: A total of 124 already BCG vaccinated patients, having age in the range of 6 months to 10 years of either gender were included in the study. Patients with known case of TB and any other systemic disease were excluded. After this, BCG vaccination was given by the researcher himself who noted the in-duration after 72 hrs of BCG vaccination accelerated response of BCG. Chi square test was applied with P-value <0.05 as significant. Results: Mean age was 6.02±2.22 years. Out of the 124 patients, 63(50.81%) were male and 61(49.19%) were females. Mean duration of previous BCG was 4.75±2.41 years. Frequency of accelerated BCG response in BCG vaccinated children was found in 76(61.29%) patients. Conclusion: This study concluded that the frequency of accelerated BCG response in BCG vaccinated children was 61.29%. So, we suggested that public awareness programs should be arranged to educate people for compulsory BCG vaccination of their children. Keywords: Bacillus Calmette-Guerin (BCG) Vaccine, Accelerated BCG Response and Tuberculosis
38 The Impact of Covid-19 Lockdown on Metamemory among Medical Students , A FAnjum, G Jawwad, I Naiyar, R Masud, A Khokhar, H Ayaz, Y Atique, M Riaz, MAH Attique, MRIHashmi, SNH, TL
  Background: The lockdown due to Covid-19 has impacted certain aspects of cognition among medical students. Aim: To explore the impact of the Covid-19 lockdown on metamemory among medical students studying in a private medical college in Pakistan. Study design: Experimental study. Methodology: This study with enrolled students (n=233) was carried out after ethical review committee’s (ERC) approval at CMH Kharian Medical College (CKMC), Physiology Department, Kharian-Pakistan. Both male and female medical students were enrolled. In phase 1, the students reported to the Physiology laboratory where age and gender were recorded. Metamemory was measured using the Multi-factorial Memory Questionnaire (MMQ)-Satisfaction scale using the Baycrest Centre protocols for its administration and scoring. Data was analyzed by SPSS software, version 21. MMQ-Satisfaction score was presented as mean±SD. Statistical significance was taken at p value <0.05. Results: Among males mean±SD for Pre Covid-19 MMQ was 43.24±9.58 while mean±SD for Post Covid-19 MMQ males was 55.32±6.01. Significant difference was seen between Pre & Post Covid-19 MMQ scores with p-value of <0.000. Conclusion: We concluded that significant difference was seen between Pre & Post Covid-19 MMQ scores with p-value of <0.000. However, means among all age groups were significantly equal with the others in Pre & Post COVID-19 MMQ. Similarly, means were significantly equal among both genders for Pre & Post COVID-19 MMQ.   Keywords: Covid-19 lockdown, Medical students, Metamemory, Age and Gender.
39 Generalized Anxiety Disorders Among Cases With Diabetes Mellitis , Saif-Ul-Islam, Syed Arsalan Haider, Athar Iqbal, Muhammad Naeem Akhtar, Munazza Javed, Nadir Hussain
  Background: Diabetes mellitus is one of the highly prevalent chronic diseases that can impact the life greatly, not only by its own disease process, but also due to wide range of other social and psychological effects on one’s life. Generalized anxiety disorder is one of these complications, but is highly under rated. Aim: To determine the frequency of generalized anxiety disorder (GAD) among cases with Diabetes Mellitus presenting to out-patient Diabetes clinic of Lahore General Hospital, Lahore. Place and duration of study: This study was carried out in the Department of Medicine, Lahore General Hospital, Lahore from 10-06-18 to 10-06-19. Methodology: This was a cross sectional study. The cases with both gender and age range of 30 to 60 years with known history of DM for at least one year were included. Anxiety was labelled on the basis of GAD scale and score of 5 or more was labelled as yes. Results: In this study there were total 192 cases of DM and out of them 98 (51.04%) were males. The mean age of the subjects was 51.20±8.16 years and mean HbA1c level was 8.78±2.34. There were 127 (66.15%) cases with type II DM, and only 28(14.58%) had controlled DM. Generalized anxiety disorder was seen in 72 (37.50%) of cases. GAD was significantly high in females affecting 44 out of 94 cases with p= 0.03. The cases with duration of DM of 5 or more years had GAD significantly high (64 out of 120) cases with p= 0.01. The cases who were un-employed had significantly higher number of cases suffering from GAD; affecting 58 out of 106 with p= 0.01. Conclusion: GAD is common and seen in almost more than every 3rd case suffering from DM and those with DM for 5 years or more, un-employed or those who were widow or divorced had it significantly high.   Keywords: DM, GAD, HbA1c
40 Sonographic Association of Ventriculomegaly and Neural Tube Anomalies , Shamshad Yousaf, Syeda Khadija, Naveed Asad, Mehreen Fatima, Syed Amir Gilani, Talha Laique
  Background: Ventriculomegaly is most common indicator of many of neural tube anomalies of intrauterine fetus. Presence of which has alarming sign for sonologist to have careful evaluation of fetus for other cranial and extra cranial anomalies. Aim: To evaluate the sonographic difference of fetal ventricle dilatation and neural tube anomalies. Study design: Cross Sectional study. Methodology: Female patients (n=1492) were enrolled in present study held at University Ultrasound Clinic, Green Town, University of Lahore as a reference placement for 6 months. Informed consent was taken from all of them. In this study, pregnant women who underwent ultrasound scanning between 18 and 40 weeks of gestational age were reviewed according to normal size of ventricles and dilatation of ventricles by per abdominal ultrasound having convex transducer with 3.5MHZ frequency. Results: A total of 1492 cases of pregnant women between gestational ages of 18-40 weeks were examined. Normal cases were 1485/1492(99.5%).Total 7-cases were found to have ventricle dilatation. Fetus with mild ventricular dilatation 1/7, with moderate ventricle dilatation were 4/7, 2/4 having moderate ventricle dilatation were associated with neural tube anomalies, severe ventricle dilatation was noted in 2/7, both these fetuses had neural tube anomalies. Conclusion: This study concluded that level of degree of dilatation increases the chances of abnormalities. Early detection provide better counseling opportunity for family to make decisions regarding their fetuses.   Keywords: Neural tube defects, Ventriculomegaly, Gestation age and Ultrasonography.
41 Comparison of Recovery Time of Propofol and Midazolam with Propofol Alone for Sedation in Endoscopic Retrograde Cholangiopancreatography , Asma Samreen, Aamir Waseem, Muhammad Azam, Itrat Hussain Kazmi, Aamir Bashir, Sarmad Masud
  Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP.   Keywords: Propofol, midazolam, sedation outside operation theatre
42 Comparison of Subacromial Ketorolac Inj Vs Subacromial Steroid Inj in Shoulder Impingement Syndrome , Tariq Siddique, Haider Ayyaz Harl, Syed Faraz Ul Hassan Shah Gillani, Sadia Asif, Mian Muhammad Hanif
  Aim: To compare the outcome of subacromial ketorolac injection versus subacromial steroid injection in Shoulder Impingement Syndrome. Methodology: This randomized controlled trial was done at the Department of Orthopedics Unit II, Mayo Hospital, Lahore from 26th April 2018 to 25th October 2018. The sample size was 218patients 15 to 60 years of age with shoulder impingement syndrome, were included and patients with a fracture or rotator cuff tear who presented with weakness and muscle wasting, taking regular systemic NSAIDs or steroids, history ofgastrointestinal (GI) ulcers and bleeding disorderswereexcluded. Randomization was done by lottery method.Group A (ketorolac group) was given a single injection of 60 mg ketorolac mixed with 1 ml 2% lidocaine and Group B (steroid group) was given 40 mg methylprednisolone mixed with 1ml 2% lidocaine. All patients were followed up on 4th weeks. Results: Out of 218 patients, 117(53.67%) were males and 101(46.33%) were females with a male to female ratio of 1.2:1.The mean age of patients in group A was 39.09±9.90years and in group, B was 38.08±8.61years. The mean post-injection VAS score in group A was 2.80±0.94 and in a group, B was 4.20 ± 0.98 with a p-value of <0.001. The mean post-injection constant score in group A was 31.59±6.86 and in group, B was 41.31±4.56 with a p-value of <0.001. Conclusion: Sub-acromial ketorolac injection showeda better mean pain score and constant score than subacromial steroid injection in patients with shoulder impingement syndrome.   Keywords: Shoulder Impingement Syndrome, subacromial ketorolac injection, subacromial steroid injection,
43 Early Complications of Arteriovenous Fistula in patients on maintenance Hemodialysis , M Asif, F Siddique, Anum Awais, Usman Siddique, AUHassan Pirzada, Rabia Saeed, H Alam, A Nazir Ahmed
  Background: Repeated access to circulation is essential to conduct the adequate maintenance hemodialysis. The efficiency of arteriovenous fistula, being permanent source of access to vascular system in hemodialysis, is severely hampered by its complications Aim: To determine the frequency of most common early complications of arteriovenous fistula in patients on maintenance hemodialysis. Methods: This cross sectional study was conducted over a period of five years. Total 450 patients of hemodialysis were included. Informed consent was taken and demographics were noted. Early postoperative complications of AV fistula were recorded. Results: Average age of the patients was 39.61±8.17 years. There were 255 (56.7%) males and 195 (43.3%) females. Radiocephalic fistula was constructed in 198 (44%) cases while brachiocephalic fistula in 252 (56%) cases. Among early complications, 19 (4.2%) cases had wound infection, 27 (6%) had thrombosed AV accesses and 12 (2.6%) had bleeding. Conclusion: Early complications of AVF may compromise its efficacy as source of vascular access for maintenance hemodialysis. Timey detection and management improves patient morbidity.   Keywords: Maintenance Hemodialysis, Arteriovenous fistula, Infection, Thrombosis, Bleeding.
44 Comparison of Tramadol Versus Tramadol and Paracetamol in Postop Pain Management after C-Section , Usman Salamat, M.Baqir Ali Khan, Liaqat Ali, Tahir Nazeer, Amna Tahir, Maimoona Zahid, Muhammad Shoaib
  Background: Multimodal technique of pain control is better than unimodal technique in perioperative time. Both tramadol and paracetamol are commonly used for pain control. Aim: To compare the tramadol alone versus tramadol with paracetamol in pain management after C- section. Method: 150 patients with ASA class P1&P2 undergoing elective cesarean section under general anesthesia were included in this study and were divided into group A & B by random number table. In both group tramadol 1mg/kg body weight intravenous was given after delivery of baby and in group B intravenous paracetamol 15 mg/kg body weight was given additionally and same doses were given in postop after 8 hours for 24 hs of post-surgery. Result: Mean age in group A was 31.04±5.35 years and in group B it was 29.64±5.92. Mean pain score in group A was 1.19±0.81 and in group B it was 0.60±0.75. The degree of pain was low in group B and patients were more comfortable as compared to group A patients. Conclusion: Tramadol plus paracetamol has better pain control as compared to tramadol alone.   Keywords: Tramadol, Paracetamol, Cesarean Section, VAS.
45 Frequency of Gall?Bladder Wall Thickness in Patients Suffering from Liver Cirrhosis , Muhammad Azam, Amir Hamza, Maqbool Ahmed, Aftab Ahmed, Samina, Allah Bakhsh
  Aim: To evaluate the frequency of gall bladder wall thickness in patients suffering from liver cirrhosis. Study design: Cross-sectional study Place and duration of study: Department of Internal Medicine, Bolan Medical Complex Hospital, Quetta from 01-01-2020 to 31-012-2020. Methodology: Sixty eight diagnosed patients of liver cirrhosis, age ranging between 20 to 60 years, were randomly selected from indoor patient department and they were further evaluated for gall bladder wall thickness.The diagnosis of liver cirrhosis and portal venous hypertension was made by ultrasonography of abdomen, especially hepatobiliary system. The gall bladder wall thickness is also evaluated by ultrasonography. Results: Mean age of the patients was 41.22±8.93 years. There were 35(51.5%) males while female patients were 33(48.5%). The mean duration of symptoms was 6.32±0.57 weeks. The duration of symptoms was ≤6 weeks in 45(66.2%) of patients, while 23(33.8%) of patients were having duration of symptoms >6 weeks. Twenty 20(29.4%) cases of liver cirrhosis patients were presented with gall bladder wall thickness, while rest 48(70.6%) were presented with normal gall bladder wall thickness on USG.   Conclusion: The gall?bladder wall thickness is very common finding associated with liver cirrhosis. It requires no surgical intervention or any other specific medical therapy. Keywords: Gall?bladder wall thickness; liver cirrhosis; portal venous hypertension; hypoalbuminemia
46 Frequency of Hepatitis C Virus in Diagnosed Tuberculosis Cases , Muhammad Farooq Baig, Geeta Kumari, Amir Bux Detho, Abdul Saleem Qadeer, Ball Chand, Javeria Farooq
  Background: The frequency of hepatitis C virus infection along with tuberculosis has not been widely investigated and very low statistics on rates of hepatitis C virus co-infection in tuberculosis patients. Hepatotoxicity is the major side effect of anti-tuberculosis therapy hepatitis HCVliver disease elevates the chances of hepatotoxicity up-to five folds. Aim: To see the frequency of Hepatitis Cvirus infection amongst people with diagnosed Tuberculosis using gene X-pert technique. To evaluate the factors associated with HCVinfection in patients with MTBtuberculosis and to determine sensitivity and specificity of the tests. Study design: Comparative analytical study. Place and duration of study: Pathology Department, Civil Hospital Mirpur Khas Sindh from 1stJanuary 2017 to 31st December 2018. Methodology: Three hundred and thirteen patients of tuberculosis diagnosed by Genexpert included while testing hepatitis C virus using immunochromotography rapid test technique, enzyme linked immunosorbent assay method and polymerase chain reaction test for confirmation. Results:Higher frequency of tuberculosis infection in males 57.8%, 42.5% between 20-39 years and 22% of hepatitis C virus infection in tuberculosis patients.Sensitivity of rapid test and enzyme-linked immunosorbent assay was 79% and 96% respectively while the specificity of rapid test and enzyme-linked immunosorbent assay was 91% and 99% respectively. Conclusion: The high frequency of hepatitis C virus co-infection was found among tuberculosis cases in Mirpur Khas Division Sindh. Enzyme-linked immunosorbent assay method is more accurate, reliable as compared to rapid immunochromatographytest for hepatitis C virus and polymerase chain reaction is still gold standard.   Keywords: TB, Hepatitis C virus, Mycobacterium tuberculosis,, PCR, Genexpert, Rapid test
47 Mean Change in Intra-Ocular Pressure in patients undergoing Trabeculectomy with Mitomycin C , Munib Ur Rehman, Shahid Mahmood Dayal, Ali Zain Ul Abidin
  Aim: To examine the outcomes of trabeculectomy followed by mitomycin C in term of mean change in intra-ocular pressure in patients presented with primary congenital glaucoma. Study design: Cross-sectional/observational Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot from 7th July 2020 to 6thJanuary 2021. Methods: Fortypatients of both genders with ages up to 5 years presented with primary congenital glaucoma were enrolled in this study. Patients demographics were recorded after taking written consent from parents/guardians. All the patients were receivedtrabeculectomy with 0.4mg/ml Mitomycin C was applied below the flap for 2 to 3 minutes. Intraocular pressure was examined preoperatively and at 12th day after surgery. Results:Twenty-four (60%) were males while 16 (40%) were females. 30 (75%) patients were ages <2yearsand 10 (25%) patients had ages >2 years. A significant difference was observed regarding mean change in intra-ocular pressure (pre-operatively 30.48±3.62 versus post-operatively 16.35±2.86) with p-value <0.001. Conclusion: Trabeculectomy with Mitomycin C is very effective for reducing intraocular pressure. A significant decrease in intra-ocular pressure was observed post-operatively.   Keywords: Primary congenital glaucoma, Intra-ocular pressure, Trabeculectomy, Mitomycin C
48 Paradigm Shifting From Bio-Medical to Bio-Psycho-Social and Role of Medical Social Work , Ibadullah Sajid, Uzma Ashiq, Raja Imran Sajid
  The health miseries emerged after the horrific incident of Second World War challenged the bio-medical model dominating the healthcare perceptions during the 19th century. The healthcare interventions in post war years have had to change toward a new idea, the social perspective of health. In 1977, Engel introduced a new approach “bio-psycho-social” (BPS) which emphasized that merely bio-medical intervention by ignoring the psycho-social determinants cannot be helpful in achieving absolute recovery. Although this paradigm shift in healthcare was widely acknowledged but the application of the approach is limited. In the context, the role of Medical Social Work, a profession focused on the reduction of the psycho-social and environmental determinants of health for absolute recovery, is considerable. This review study concludes that the interventions of Social work profession with its unique attributes such as breadth, holistic care and believe in absolute rehabilitation, can make the health system more responsive.   Keywords: Healthcare, determinants, Medical Social Work, Social, Psychological
49 Outcome and Complications of Phacoemulsification Combined with Pars Plana Vitrectomy , Ali Zain Ul Abidin, Munib Ur Rehman, Shahid Mahmood Dayal
  Aim: To determine the outcomes of phacoemulsification also examine the complications associated to phacoemulsification combined with pars plana vitrectomy. Study design: Observational study Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot, from 15th July 2020 to 14thJanuary 2021. Methodology: Twenty patients of both genders whom had undergoing phacovitrectomy were included. Patient’s ages were ranging from 20 to 80 years. Patient’s detailed medical histories were examined after taking informed consent. Patient’s retinal diagnosis, intraocular pressure, visual acuity, intra and post-operative complications were recorded. All the patients had received clear corneal phacoemulsification and 23-guage pars plana vitrectomy. Results: There were 15(75%) male patients while 5(25%) female patients with mean age was 54.52±12.45 years. Five patients (25%) had vitreos hemorrhage, 7(35%) patients had rhegmatogenous retinal detachment, 3(15%) patients had intraocular foreign body, 2(10%) had epiretinal membrane, 2(10%) had macular hole and 1(5%) had tractional retinal detachment. Miosis and rupture of posterior capsule were the most common intraoperative complications found in 85% and 10%. Fibrin was found in 3 (15%) cases, posterior synechia was found in 2 (10%) cases. Conclusion: The phacoemulsification with pars plana vitrectomy is safe and effective treatment modalities in patients with cataract coexist with vitreoretinal disease.   Keywords: Phacoemulsification, Pars plana vitrectomy, Cataract, Complications, Outcomes
50 Overview of Langerhans Cell Histiocytosis among Children , Alia Ahmad, Mahvish Hussain, Shazia Yaseen, Asma Mushtaq, Ayesha Bibi, Iqbal Hussain Dogar, Fauzia Shafi Khan
  Aim: To analyze clinical manifestations, course and outcome of Langerhans Cell Histiocytosis in children in resource limited settings lacking salvage therapy. Study design: Observational retrospective study Place and duration of study: Department of Haematology/Oncology, The Children’s Hospital, Lahore Pakistan from 1st January 2011 to 31st December 2018. Methodology: Sixty-five patients with age range from<1 to 8 years included analysing their age, gender, clinical classification, course of therapy and outcome. The major treatment was composed of either prednisolone and vinblastine or cytarabine pulses. Results: There were 59% males and 41% females. Forty-seven (72%) patients presented with multi system-LCH with 49% Risk Organ involvement. Most of them 42 (65%) had bone lesions while 15patients (23%) presented with central nervous system involvement. Forty patients (61%) have completed treatment, 11(17%) left against medical advice and 12(18%)patients expired due to progressive disease and worsening infection. Only 2 patients were put on palliation with progressive brain parenchyma disease. 22 patients (34%) had reactivations of disease requiring therapy for more than one-year (p-value=0.06), while 15 (23%) patients received two cycles of initiation therapy before continuation therapy started. The treatment initiated >6 months after the onset of symptoms in 48 (74%) patients. Conclusion: Early diagnosis and timely initiation of therapy are of utmost importance to reduce mortality and morbidity. There is a dire need of social support to reduce treatment abandonment in low-middle-income countries LMIC.   Keywords: Paediatric Langerhans cell histiocytosis, Resource-limited settings, Delayed diagnosis, Abandonment
51 Prevalence of Tuberculosis in Diabetic Patients , Shamshad Ali, M Imran Aslam, Nayyar M Elahi, Waseem A Khan, M Saqib Musharaf, Yousma Javed
  Aim: To determine the frequency of tuberculosis in the patients of diabetes. Study design: Cross-Sectional Place and duration of study: Department of Pulmonology, Avicenna Medical College, Lahore from 1st March 2020 to 31st August 2020. Methodology: Two hundred patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking proper consent. Patients admitted in outpatient department with diabetic duration greater than 5years. The different variants of pulmonary and extra pulmonary tuberculosis were measured. Results: There were 120(60%) males and 80(40%) were females with mean age was 51.8±18.22 years. The mean duration of diabetes was 11.5±9.19 years. 60% patients were addicted to gutka and smoking. Active tuberculosis was only found in 30(15%) cases. Pulmonary tuberculosis were 17(56.7%) and the rest 13(43.3%) were extra pulmonary tuberculosis. Eighteen (60%) patients had smear positive and 12(40%) had smear -ve TB. Conclusion: The frequency of tuberculosis in the diabetic patients was high as compared to other population. It can be cure by early diagnosed of disease otherwise multidrug-resistant tuberculosis can become serious health problem among public.   Key words: Prevalence, Tuberculosis, Diabetic patient, Multidrug-resistant tuberculosis
52 Role of Labetalol in Control of Hypertension during Pregnancy , Farzana Ramzan, Sara Qadir, Sardar Gul Zarin, Fatima Tahir, Sajid Malik
  Aim: To valuate the effectiveness of labetalol in controlling hypertension during pregnancy. Study design: Descriptive case series Place and duration of study: Department of Obstetrics & Gynaecology, Allama Iqbal Medical College/Jinnah Hospital Lahore from 1st September 2018 to 31st March 2019. Methodology: Sixty four patients were enrolled. All the patients were started with lowest effective dose of100mg orally three times daily and if required after 72 hours, the escalation dose up to 200mg every 8hours. When adequate reduction in blood pressure was obtained it was labelled as achievement of primary end point. Results: The age range between 18-35 years with mean age 25.8±5.0 years. There were 12 primigravida (18.8%) and multigravida 52(81.2%). Reduction in blood pressure was observed in56 cases (87.5%). Conclusion: The labetalol appears to be an effective agent in controlling hypertension during pregnancy with possible advantages and no apparent disadvantage during its use.   Keywords: Pregnancy-induced hypertension; Labetalol, Control of hypertension
53 Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients , M Asim Rana, M Ahad Qayyum, Amer Latif, M Afzal Bhatti, Syed Arsalan Khalid, Muhammad Saleem, Irtiqa Rehan
  Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center.   Keywords: Incidence, Outcome, COVID-19, Infection
54 Single Centre Experience of Slow Versus Fast Rate ESWL in Urolithiasis , Jmail Rahim, Jamshed Rahim, Ghazi Khan, Saad Ali Khan, Athar Mahmood, Tariq Mahmood
  Aim: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in the treatment of urolithiasis. Study design: Randomized controlled trial Place & duration of study: Department of Urology, Shaikh Zayed Hospital, Lahore from 1st October 2010 to 30th April 2011. Methodology: One hundredpatients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: The success rate of slow rate extracorporeal shock wave lithotripsy was 76 % and that of fast rate extracorporeal shock wave lithotripsy was 48% (p-<0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis.   Keywords: Extracorporeal shock wave lithotripsy; slow rate ESWL; fast rate ESWL
55 Workplace Bullying and Harassment among Health Care Professionals , Shehla Channa, Sarosh Khan, Zamir Hussain Tunio, Rizwan Ali Jhatiyal, Ikram Ahmed Tunio, Khanwad Bux Umrani
  Aim: To determine prevalence of workplace bullying and its effects on doctors at LUMHS Jamshoro. Study design: Cross sectional survey. Place and duration of study: Liaquat University of Medical & Health Sciences Jamshoro from 1stJanuary 2021 to 31stMarch. Methodology:Seventy five postgraduate residents, house officers and medical officers were selected randomly, all were interviewed by questionnaire. Questions were asked regarding any incident of bullying, aggression, violence, and harassment during hospital duty hours. Which behavior they faced and what was the reason of that behavior; asked from participants. The data was entered and analyzed using the SPSS 22. Results: Seventy four (98.66%) were females and 1(1.33%) was male with mean age of 27.3±4.7 years. 51 [68%] have been subjected to being bullied. Main source of harassing was by administration in 12%, faculty in 34.66%, senior colleagues in 42.66% colleagues 16%, paramedics15%, and patient’s attendants in 13%. Effects noticed on personality/ behavior were sadness in 41.33%, aggression 32%, confrontation change in sleep 12%, health complaints in headache/ palpitations 34.66%, loss of interest in activities 41.33%, poor performance at work 18.66%, lack of confidence 46.66%, fear to go to work place 20% and avoiding bullier in 29.33%. Conclusion: Prevalence of bullying was 68% among health care professionals interviewed in this study. Violence towards medical caretakers is expanding day by day.Serving in safe and healthy surroundings is the basic right of every health care worker to take healthy decisions to give quality patient care.   Keywords: Bullying, harassment, Violence, Doctors, Heath care worker
56 Gram negative organisms isolated from Blood Cultures and their Susceptibility Pattern , Sadaf Munir, Saima Inam, Aqsa Aslam, Maria Aslam, Usman Nasir, Maria Muddassir , Faheem Hadi, Tahir Maqbool
  Background: Bloodstream infections (BSIs) are an important frequent health problem in terms of their high incidence and lethal outcomes. The bacteria that frequently cause bacteremia are Staphylococcus, Streptococcus, Enterococcus, Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Neisseria and Haemophilus. Gram negative rods constitute a significant bulk in BSIs. The bloodstream infections due to multidrug resistant pathogens are on the rise globally making treatment more challenging. Aim: To identify the gram negative organisms causing blood stream infections and assess their susceptibility pattern so as to provide guidance for the empirical treatment hoping for better clinical outcome. Methodology: A retrospective, cross-sectional descriptive study carried out in Pathology Laboratory of Sharif City Hospital, Lahore. All the blood culture samples received in Microbiology laboratory between June 2017 to June 2019 were included in the study by non-probability consecutive sampling. Blood cultures were proceeded by subculturing on 1st and 5th day on MacConkey and Blood agar. The colonies obtained were identified through gram staining and biochemical profile. API20E was used for Enterobacteriaceae. Antibiotic susceptibility testing of the pathogens was by Kirby Bauer disc diffusion method. Results: In the current study 663 blood cultures were analyzed. Only 11.9% exhibited positive microbial growth. 55.7% of the positive cultures revealed gram negative bacteria. Among the pathogens isolated, E.coli was found to be responsible for BSIs in 22.7% cases, followed by Salmonella Typhi 20.4% and Klebsiella pneumoniae 18.1%.The gram negative rods exhibited a very high resistance for penicillins, cephalosporins and fluoroquinolones. The efficacy of aminoglycosides and results for carbapenems susceptibility were hopeful. Conclusion: The study shows that the Gram negative bacteria causing BSIs have shown unsatisfactory susceptibility to most of the commonly prescribed antimicrobials. The rising drug resistance has a major impact on the selection and prescription of antibiotics and calls for judicious use of antibiotics.   Keywords: Gram Negative Organisms, Blood Culture, Antimicrobial Susceptibility Pattern
57 Isolation of Multi Drug Resistant Escherichia coli from drinking water of Lahore City, Pakistan , Nazia Mir, Sidrah Saleem, Muhammad Imran, Ayesha Ghazal, Muhammad Usman
  Background: The major faecal coliform is Escherichia coli which contaminates the drinking water from human and animal faecal waste. In developing regions drinking water is a vital source of microbiological pathogens. Multi-drug resistant (MDR) is defined as resistance to one or more antibiotic groups. An E. coli count greater than 4/dl in municipal drinking water is indicative of unacceptable fecal contamination. Aim: To find out the frequency of MDR E. coli in water system of Lahore, Pakistan. Methodology: Drinking water was collected from different towns of Lahore. The samples were processed using Membrane Filtration Technique. In the present study, Multidrug Resistant E.coli was isolated and antibiotic resistant pattern was seen against 16 most commonly antimicrobials, using Kirby Bauer disc diffusion method. Results: Total 100 water samples were collected, frequency of Escherichia coliisolated was 27% and frequency of MDR E.coli was 19%. The highest resistance showed by the organism towards Ampicillin (AMP) 21(81.48%), Augmentin (AMC), and Ceftazidime (CAZ) 14(51.85%) respectively. In this study also frequency of Extended Spectrum β-Lactamases were seen. Most common organisms isolated were E. coli 7% and Klebsiella 5%. Frequency of other coliforms isolated from drinking water other than E. coli was Klebsiella species 26%, Pseudomonas species 27%, Enterobacter 7%, Citrobacter species 8% and Acinetobacter species 5%. Conclusion: This study revealed that drinking water of Lahore city is heavilycontaminated with pathogenic microorganisms. A high proportion of antibiotic resistant is due to overuse of antibiotics, in patients with mild infections and secretion of these resistant bacteria from patients to environment. One of the reasons could be the mixing of sewage lines with drinking water supply. So, there is solely requirement for further studies for the identification of the sources for these contaminants.   Keywords: Isolates, E. coli, Klebsiella, Multi-drug resistant (MDR)
58 Investigation of HRCT Chest Severity in Patients with COVID-19: A Study of Tertiary Care Hospital in Pakistan , Saulat Sarfraz, Kh. Bilal Waheed, Masood Akhtar, Sarfraz Latif, Muhammad Asif, Abdus Sami Malik
  Background: High-resolution computed tomography (HRCT) chest has a key role in diagnosis COVID-19, as it provides specific imaging features, i.e., bilateral, peripheral and sub-pleural, ground-glass opacity (GGO), consolidation and many associated findings. Aim: To provide the detailed chest HRCT findings along with clinical information in patients with COVID-19. Methods: A cross-sectional study was conducted in the Department of Radiology SZPGMI, Lahore. Information on clinical data, chest radiography appearance and comorbidities were recorded ona designed proforma. HRCT chest findings were recorded in terms of pattern, distribution, laterality, and other findings. HRCT chest severity was calculated using a 25 point CT severity score. Kendall’s Tau test applied to investigate the correlation between the severity of HRCT chest with clinical severity levels of COVID-19. Results: Fever (74%) was the most reported presenting symptom, followed by dry cough (70%). The majority of patients had abnormal chest X-ray (57%) as well as abnormal HRCT chest (90%). The majority of patients were in mild clinical scoring levels of disease (61%) and mild category (49%) of HRCT chest severity. In majority of the patients (46%), all five pulmonary lobes were involved, whereas the right lower lobe was most frequently affected. The pattern of ground-glass opacity (GGO) was found in 82% of patients. Most common distribution was ‘peripheral’, reported in 90% patients. Multiple lobe involvement was found in 82% of patients. The unilateral pulmonary involvement was observed in 12% of patients, whereas, bilateral was found in 78% of patients. Reticulations were reported in 22% followed by atelectasis in 18% patients. Conclusion: COVID-19 patients usually present with abnormal HRCT chest, mostly with a benign course. Multiple pulmonary lobes are commonly involved, especially basal lobes with ground glass opacities. Clinical severity of the disease is reflected in HRCT findings.   Keywords: COVID-19 Pandemic, HRCT Chest Findings, Ground Glass Opacity (GGO), Consolidation
59 Ludwig’s Angina: Management of 32 Cases at Tertiary Care Hospital , Masood Akhtar, Nasir Wakeel, Muhammad Asim Shafique, Saulat Sarfraz, M Younas Varachue, Fouzia Qayyum
Background: Ludwig’s angina is a rapidly expanding cellulitis involving the floor of mouth and sub mandibular space predominantly due to dental / periodontal infections. Aim: To determine the management outcomes in the patients of Ludwig’s Angina. Place and duration of study: Department of Otorhinolaryngology Bahawal Victoria Hospital Bahawalpur. Duration was two years from August 2018 to July 2020. Study design: Hospital based cross sectional descriptive type of study Methodology: Patients of any age and gender who were clinically diagnosed as Ludwig angina and required hospitalization during the study duration were included in the study. Data regarding age, gender underlying cause, mode of presentation, treatment and complications were collected and analyzed. Patients with mild infection who did not require hospital admission were excluded from the study. Results: Out of total 32 cases, 20(62.5%) were males and 12(37.5%) were females. Age range was 10 to 70 years. In 28 (87.5%) cases, the cause was dental infection. All patients presented with pain and swelling of sub mandibular region. Four (12.5%) patients were improved with conservative treatment while 28(87.5%) underwent incision and drainage. Two (6.25%) patients needed tracheostomy. One (3.1%) patient developed complication (mediastinitis) and could not revive. Conclusion: Ludwig's angina is a disease of any age and gender commonly seen among the patients of preexisting dental infection. It can be life threatening if presented late with complication. Early diagnosis and aggressive treatment decrease morbidity and mortality. Key words: Angina, Ludwing, Cellulitis, Submandibular region.
60 Clinical Evaluation of Children with Arthrogryposis Multiplex Congenital in Pakistani Population , Mumtaz Hussain, Shahzad Anver Qureshi, Khandah Fishan Mumtaz, Qamar Uz Zaman Shahzad  
  Background: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. The number of studies which have been previously done on Pakistani population to investigate patients with arthrogryposis is limited. Aim: This study presents our experience with evaluation and management of children with AMC at The Children Hospital & the Institute of Child Health, Lahore. Method: During the period from January 2018 to December 2018, we evaluated 25 children with AMC. The mean age at the time of evaluation was 20.56 months (range, 5 days to 9 years). All of the included patients were evaluated in terms of their clinical state according to selected subjective and objective criteria. Result: Our results indicate that shoulders were internally rotated (20%), the elbows were extended (36%), and the wrists (76%) and digits (56%) were flexed. Thumb was adducted (36%), hands were clawed (52%) and palmar crease was absent (28%). Hips were found to be dislocated (16%) and adducted (16%). Knees having extension contracture (32%); feet were in equinocavovarus (72%). Calf muscles were atrophic (56%). Conclusion: Our experience shows that the clinical findings are highly variable between families and also within families with AMC. Joint manipulation and casting during the first few months of life may produce considerable improvement. Orthotics may help. Surgery may be needed later, but mobility is rarely enhanced. Muscle transfers may improve function. Many children do remarkably well; two thirds are ambulatory after treatment. A multidisciplinary team evaluation of the child with AMC is recommended for specific diagnosis and planning of treatment.   Keywords: Arthrogryposis multiplex congenita (AMC), clinical evaluation
61 Prognosis of Anosmia in Patients of COVID-19 , Najaf Abbas, Maria Mahmood, Kamran Chaudhry, Hassan Majid Bhatti, Rehana, Sajid Ali
  Background: The novel Corona virus (SARS COV-2) causes respiratory tract infection that has been labeled as Covid-19. It was declared a pandemic by WHO on 30th of January 2020. So far, COVID-19 has involved 218 countries and territories with 135,338,376 total cases and 2,929,315 total deaths. This virus causes severe respiratory distress syndrome and usually present with dry cough, fever, respiratory distress, and myalgia. Interestingly, patients have shown various nonspecific presentations and Anosmia is also a prominent nonspecific feature. Aim: To find out the overall progress, duration and recovery of Covid-19 related loss of smell (anosmia). Methods: This is a retrospective online study in which 45 patients were included. Data was collected by using ‘Google survey form’. Only those patients, who were confirmed cases of Covid-19 (diagnosed by PCR) and who lost their smell at least 3 month earlier, were included in this study. The Statistical analysis of collected data was then carried out by using SPSS software. Results: Out of 45 patients 17(37.8%) were male and 28(62.2%) were female (male to female ratio of 1:1.6). 71.2% of the respondents were up to 40years of age. 12(26.7%) patients were between 41 to 50 years, while only one patient (2.2%) was between 51 to 60 years. In 43 patients (95.6%) the anosmia was reversible. In two of our respondents (4.4%), the smell sensation didn’t return even after 3 months. Conclusion: The anosmia in Covid-19 is mostly reversible and in most of the patients its duration is less than 2 weeks.   Keywords: Anosmia, Covid-19, SARS COV-2
62 Ovarian risk factors of female infertility by transvaginal ultrasonography , Syeda Khadija- Tul-Sughra, Syed Amir Gilani, Asif Hanif,, Sabar Butt, Zain-Ul-Hasan, Waheeda Awais
  Aim: To determine the Ovarian risk factors of female infertility by transvaginal ultrasonography Study design: Cross sectional validation study Methods: The study comprised women visiting the department with unexplained infertility for treatment during the period of 2018 to 2020. A total of 550 cycles were inducted primarily referred for ovarian assessment by ultrasound with patent tubes and normal utero-ovarian morphology. All those women having no conception with normal semen analysis of their husbands. Male factor infertility was also excluded. Baseline transvaginal sonography (TVS) was performed at proliferative phase, of the cycle. Mature follicles were studied by TVS. On an individual basis, the following parameters, that is, follicle size, ovarian volume and ovarian artery Doppler PI, RI were studied. Follicle size and ovarian artery Doppler flow were highly significant for a pregnancy. Results: In this research two types of infertility was compared with normal group as for as the primary infertile females were 99 (18.00%) and secondary infertile females were 144 (26.18%) and normal were 307 (55.82%). Out of 550 patients 243 (44.18%) patients were infertile and 307 (55.82%) were normal. Discussed in this research. Conclusions: Ovarian ultrasound assessment proved to be a simple, noninvasive and authentic to predict the ovarian environment and thereby helping in the prediction of the outcome in infertility.   Keywords: Infertility, Doppler ultrasonography, Transvaginal ultrasonography, Resistive index, Pulsatility index
63 Lifetime Risk of Radiation Induced Severe Hereditary Stochastic (SHS) Effects in Medical Radiation Personnel , Saman Shahid, Asma Majeed, Rana Aatif Siddique, Khalid Masood, Shahid Ali
  Background: Hereditary risk assessments in medical radiation workers must be accentuated as a precaution against genetic diseases. Ionizing radiations can induce hereditary or genetic radiation effects. Aim: To evaluate the lifetime risk of severe hereditary stochastic (SHS) effects in INMOL’s medical radiation personnel. Methods: The determination of the ‘whole-body’ effective doses was performed by ‘dose assessment algorithm’. We adopted the procedure described by ICRP for the assessment of lifetime severe hereditary annual risks by using ‘nominal probability coefficient’. Results: The AAEDs were between 1.41-1.79 mSv (in NM), 1.07-1.43 mSv (in RT) and 1.21-1.70 mSv (in RD) during 2014-2018. A declining trend is observed in AAED values in five consecutive years, due to improvements in radiation protection and safety measures. The risks of severe hereditary effects were also decreased from 2014-2018. The SHS risk was decreased from 5.012×10-4 to 3.948 ×10-4 in NM, 4.004×10-4 to 2.996×10-4 in RT and 4.76×10-4 to 3.388×10-4 in DR department. Conclusion: This study is emphasizing towards evaluating risks of hereditary effects from chronic exposure of radiations in occupational workers to avoid further late genetic complications. Such quantitative indicators would be useful in comparing other lifetime death risks from other harmful substances.   Keywords: Hereditary Stochastic Effects; Annual Average Effective Doses; Nominal Probability Coefficient; Medical Radiation; Occupational Radiation Risk Assessments
64 Adaptation of Hoarding Rating Scale Interview in Urdu for Use in Pakistan , Fauzia Malik, Anila Kamal
  Background: Hoarding Rating Scale Interview (HRS-I) is a brief five item instrument to assess symptoms of hoarding in both clinical and non-clinical population. Aim: To adapt and validate HRS-I in Urdu language for its convenient use in Pakistan. Methods: Sample consisted of 112 adults from both clinical and a control group. The scale was translated in Urdu following standard translation procedure and data was collected to determine the psychometric properties of translated version. Reliability and validity estimates were established using different statistical analysis. Results: Cronbach alpha value (.82) suggested an acceptable level of internal consistency. Factor structure was found to be consistent with original English version of HRS-I and correlations were found to be high for like subscales than other subscales except for a positive but non-significant correlation between acquisition item of HRS-I and acquisition subscale of SI-R. Though it significantly correlated with total scale score on HRS-I. Conclusion: The results of the study provide evidence for preliminary acceptable psychometric properties of Urdu version of Hoarding Rating Scale-Interview and proves it to be a time efficient and promising tool to assess hoarding in cultural context of Pakistan.   MeSH words: HRS-I, Validation study, Assessment of Hoarding, Cultural adaptation.
65 Correlation of intercanthal and interalar distance to intercanine distance for selection of maxillary ant. teeth   , Muhammad Shoaib Ayyub Qazi, Naveed Inayat, Afsheen Ahmad, Nadia Munir, M. Muddassar, Mirza Abdul Rauf  
  Background: Maxillofacial region’s reference points like interpupillary distance, intercanthal distance, interalar distance and bizygomatic width can significantly contribute toward reconstruction of two-dimensional (2D) facial profiles. Aim: To find correlation between intercanthal to intercanine and interalar to intercanine distance for maxillary anterior teeth selection. Methodology: This study was conducted at de’ Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from 29-08-2013 to 28-04-2014. Sampling technique was non-probability purposive. 200 subjects are estimated for correlation of intercanthal distance to intercanine distance and correlation of interalar distance to intercanine distance as r=0.302. Results: Out of 200 cases, 102(51%) were 20-40 years of age while 98(49%) were ranging between 41-60 years of age, mean±SD was calculated as 41.01±11.90 years, 135(67.5%) were male and 65(32.5%) were females, correlation among maxillary intercanine distance with other facial land marks shows the distance of intercanine was 37.26±3.91, it was 41.26±4.57 for interalar and 34.50+2.51 was recorded for intercanthal, the value of R2, the coefficient of determination, is 0.0893 for intercanine to intercanthal and 0.0018 for intercanine to interalar. Conclusion: We concluded that intercanthal distance to intercanine distance is more correlated as compared to interalar distance to intercanine distance in Pakistani population.   Keywords: Maxillary anterior teeth, intercanthal distance, intercanine distance, interalar distance, correlation
66 Feedback on Teaching and Assessment Methodologies, being practiced in Islam Dental College , Naveed Inayat, Nadia Munir, Mehvish Sajjad, Muhammad Usman Muneer, Muhammad Muddassar, Mirza Abdul Rauf  
  Background: The students are in the best position to judge the effectiveness of any teaching system. They may comment logically to assess the teaching and evaluation methods. Aim: To analyze the student's feedback on teaching methodologies and effectiveness of methods being practiced in department of Prosthodontics in Islam Dental College Sialkot. Methods: The cross sectional study was conducted in Islam Dental College Sialkot with a specially designed questionnaire. The study subjects were 100 students, 50 each from 3rd year and final year BDS. The questionnaire was based on methods of teaching and assessments, in terms of content, time and relevance. Results: Majority (85%) agreed on the reliability of multimedia and digital methods of teaching .A huge number (73%) were also satisfied with delivery and content of the lectures.80% students were satisfied with teaching in lecture halls. 30% and 40% were not satisfied with teaching in clinics and OPDs respectively. Multiple Choice questions were the most favored type of assessment methods with 45% agreement. Conclusion: Students were satisfaction with the teaching methods being practice in Islam dental College. MCQs were considered preferred assessment tools. There is a dire need to innovate Clinical and OPD Teaching regime in the dental colleges. As the lapse has a significant impact on knowledge and skill of the students.   Keywords: Blended Learning, Assessment tools, Feedback, teaching methods
67 The Effect of Oral and Nasal Breathing on Pain Perception during Inferior Alveolar Nerve Block , Usman Sana, Shakeel Ahmad, Iffat Umair Niazi, Naveed Inayat, Muhammad Muddassar, Mirza Abdul Rauf
  Background: Dental pain and anxiety is challenging problem during procedures. Breathing pattern has strong correlation with pain perception. Nasal breather patients have less pain perception than oral breather. Aim: To assess the role of breathing pattern and its impact on pain perception during painful dental procedures like dental local anaesthesia injections. Methods: 300 patients were randomly selected from dental departments of Islam dental college during 1st Jan 2020 till 31 Dec 2020 period. Verbal pain intensity scale was used among oral and nasal breather cases. Data was collected in proforma. Results were analysed statistically by SPSS version 23. Results: Among 300 cases, 150 cases had mild pain, 89 cases had moderate pain and 61 cases had severe pain. Among 150 mild pain cases, 120 mild pain cases were nasal breather while89 oral breather cases had moderate pain and 61 oral breather cases had severe pain. Nasal breather patient had mild pain perception than oral breather. Conclusions: Nasal breather has mild pain perception during dental anaesthesia than oral breather. Education and training of patient to practice nasal breathing can be recommended for oral breathers to become nasal breather preoperatively, this will help to reduce anxiety and pain perception during dental local anaesthesia injections.   Keyword: Oral and nasal breather, pain perception, local anaesthesia
68 Association between Sucrose Intake in Coke and Root or Coronal Caries among Teenagers , Syed Ammar Haider, Mohammad Irfan, Amina Rashid, Anooshay Ejaz, Afra Arslan, Muhammad Hassan, Amina Tariq
Aim: To examine the associations between sucrose intake in coke and the prevalence of root or coronal caries in teenagers. Methods: Crossectional survey design was used to achieve the aim of the study. Participants with the age ranging from 13 to 19 years were recruited using consecutive sampling technique. 60 participants were recruited in the study who take coke as carbonated drink regularly. Results: The results revealed that there was a significant difference in the prevalence of teeth with root caries or restoration in terms of levels of intake of sucrose in coke (X2=6.205, P=.045). Teeth with root caries or restoration were found higher among participants with medium sucrose intake in the form of coke (58.33%). Teeth with coronal caries or restoration were found higher among participants with high sucrose intake in the form of coke (66.66%). Conclusion: A significant positive relationship was observed between sucrose intake in coke and the number of coronal or root caries lesions in teenagers Keywords: Root caries, Coronal caries, Sucrose intake, Coke
69 Vitamin B3 (Niacin) in Diet Act as Protective Negotiator for Development of Myocardial Infarction , A. R. Memon, M. Akram, U. Bhatti, A. S. Khan, K. Rani, H. Riaz
Stage 5 covid-19 case with ground glass effect of lungs is considered as fatal/end stage.  An Indian medicine (Ayurvedicherbal) made of the dermis of the indo native Punica Granatum (dalim) was given. Named AVIR (anti virus india research).  Contains ellagic aacid & ellagitannins (e.acid {gallagic group} being the principal therapeutic moiety.  X-Ray & HRCT were availed pre to treatment.  X-Ray only post recovery. Resulted in eventless smooth swift recovery. The results are presented & discussed. Posits as a possible for home remedy. Rapid Brief Communication.  Keywords : Covid-19 stage 5 case;  Punica Granatum; Ellagic acid; ellagitanins; Ground glass effect.
70 Comparison of Transversus Abdominis Plane Block versus Local Wound Infiltration in Reducing Postoperative Pain in Patients Undergoing Infraumblical Hernia Repair , A. Jamil, Z. Ahmad, F. Farooq, H. A. Khan, R. Ansari, N. Zahoor
Background: Vitamin B3 (Niacin) is known to decrease LDL?cholesterol, and triglycerides, and increase HDL?cholesterol levels. The evidence of benefits with niacin monotherapy or add?on to statin?based therapy is controversial. Aim: To determine the effects of vitamin B3 with statins on lipid profile of patients of angina pectoris with dyslpidemia. Study Design: Randomized control trial study. Place and Duration of Study: Department of Biochemistry, Shaikha Fatima Institute of Nursing & Health Sciences (SFINHS), Lahore with collaboration of Cardiology OPD of Shaikh Zayed Hospital Lahore from 1st November 2019 to 31st January 2020. Methodology: Seventy four diagnosed cases of angina pectoris with dyslipidemia were recruited with age range from 30 to 50 years. They were divided into two groups; Group I contained 36 patients as controlled group which was given treatment of angina with Tab. Rovista (statin) 10mg at dinner for treatment of dyslipidemia and Group II contained 38 patients as case study group which was given treatment of angina with Tab. Rovista (statin) 10 mg at dinner and tablet Vitamin B3 500 mg with single OD dose at day time for treatment of dyslipidemia for 8 weeks. Results: The mean serum cholesterol levels at zero level (before the start of treatment) of group I was 244 mg/dl and group II was 246 mg/dl, LDL of group I was 169 mg/dl while group II was 170 mg/dl and HDL of group I was 20 mg/dl while group II was 19 mg/dl . After the treatment group I which taken only statins for treatment of dyslipidemia the mean serum cholesterol levels was 210 mg/dl, LDL was 144 mg/dl and HDL was 26 mg/dl while the mean values of group II (taken statin as well as vitamin B3) serum cholesterol level was 192 mg/dl, LDL was 122 mg/dl and HDL was 44 mg/dl. The results shown there were significant effects of statin therapy along with vitamin B3 on serum LDL and serum HDL levels. Conclusion: There were significant effects of statin therapy along with vitamin B3 on serum LDL and Serum HDL levels. Key Words: Vitamin B3, Serum Cholesterol, Serum LDL &HDL
71 Association of Adverse Outcomes in Patients with Cirrhosis Presented with COVID-19 , M. A. Chhutto, A. H. Mugheri, A. H. Phulpoto, I. A. Ansari, A. Shaikh, B. A. Shaikh
Objective: To compare the outcomes of TAP block versus local wound infiltration in reducing postoperative pain in patients undergoing infra-umbilical hernia repair. Study design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesiology, Surgical Intensive Care Unit & Pain Management, Dow Medical College & Civil Hospital Karachi from 1st August 2020 to 31st January 2021. Methodology: One hundred patients with undergoing infra-umbilical hernia mesh repair were randomly allocated into two groups. Fifty patients in group A were treated with transversus abdominis plane block and 50 were in group B for local infiltration. Anaesthetic technique was standardized. The drug was administered according to the weight of the patient. Visual analogue score (VAS), graduated from 0-10 was recorded. Results: The mean age was 41.08±10.36 years. There were 61% males and 39% females. Mean time of analgesia was significantly high in group A than groups B [413.2±63.83 vs 274.16±41.28; p=0.0005]. Mean VAS pain score at rest and movement was also significantly low in group A than group B. Conclusion: Transversus abdominis plane block seemed preferable to local anesthetic wound infiltration in postoperative analgesia. Current evidence is insufficient to suggest that the transversus abdominis plane block will minimize post-operative morphine requirements and associated side effects in comparison with local anesthetic infiltration. Key Words: Hernia repair, Transversus abdominis plane (TAP) block, Local wound infiltration, Postoperative morphine
72 Pyrazinamide Induced Hyperuricemia in the Induction Phase of Anti-Tuberculosis Therapy , N. Muhammad, S. Mehboob, M. Abbas
Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis presented with coronavirus disease. Study Design: Retrospective/observational study Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana from 1st March 2019 to 31st December 2020. Methodology: Two hundred and twenty covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (with cirrhosis 60 patients) and group B (without cirrhosis 60 patients). Outcomes in term of mortality between both groups were examined. Results: There were 38 (63.33%) males and 22 (36.67%) were females with mean age 46.14±8.44 years in group A while in group B, 40 (66.67%) and 20 (33.33%) patients were males and females with mean age 45.26±9.34 years. Patients with cirrhosis had high mortality rate as compared to patients without cirrhosis (33.33% Vs 13.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients with coronavirus disease. Keywords: Chronic Liver Disease, Corvid-19, Mortality
73 Effectiveness of Preload Verses Coload of Crystalloid during Spinal Anesthesia for Cesarean Delivery , R. Ansari, A. Jamil, H. A. Khan, N. Zahoor, Z. Ahmad, F. Farooq
Objective: To compare the effectiveness of preload verses coload of crystalloid during spinal anesthesia for cesarean delivery Study design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Civil Hospital Karachi from 1st November 2017 to 30th April 2018. Methodology: Sixty patients with age in between 18 to 35 years irrespective of parity having ASA physical status I and II and gestational age 37 completed weeks underwent cesarean section under spinal anesthesia were enrolled. Patients were randomized into one of two groups (P or C). A decrease of systolic blood pressure by 20% or more from the baseline value was taken as hypotension. Results: The mean age, weight, height, BMI and gestational age of the patients was 29.5±4.83 years, 60.16±5.17 kg, 1.54±0.60 m, 27.04±5.07 kg/m2 and 38.13±1.07 weeks respectively. Efficacy was significantly higher 25 (83.3%) among patients in preload group as compared to coload group 17 (56.7%) [P=0.024]. Conclusion: Effectiveness of preload was found to be less than coload of crystalloid during spinal anesthesia for cesarean delivery Keywords: Crystalloid, Preload, Coload, Spinal anesthesia, Cesarean delivery
74 Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release , S. Aziz, S. Ahmed, S. A. Mahar, S. Ali, J. Kumar
Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss
75 Outcome of Extra-Articular Fractures of Distal Femur: Less Invasive Stabilization on System (LISS) Plating versus Closed Retrograde Intramedullary Interlocking Nail , S. A. Mahar, S. Aziz, S. Ahmed, J. Kumar, S. Ali
Objective: To evaluate the functional outcome of extra-articular fracture of distal femur, LISS plating versus retrograde intramedullary interlocking nailing. Study Design: Prospective/Randomized control trial Place and Duration of Study: Department of Orthopaedic Surgery, Ghulam Muhammad Mahar Medical College Sukkur from 1st July 2019 to 31st December 2020. Methodology: One hundred patients of both genders with ages 20 to 60 years presented with fractures of distal femur were included in this study. Patients were equally divided into two groups I and II. Group I contained 50 patients and received LISS plating and Group II contained 50 patients and received closed retrograde intramedullary interlocking nail, Pre and post-operative assessment was done. Post-operative complications were noted at 12th day. Functional outcomes were examined after 6 months by the NEERs criteria. Results: Sixty five (65%) patients were males (35 in group I and 30 in group II) and 35 (35%) patients were females (15 in group I and 20 in group II). Road traffic accident was the most common mode of injury in 62 (62%) patients. Most of the fractures were on right side 66 (66%). According to the NEER criteria, 80% patients shows excellent, 20% patients shows satisfactory with no poor results in Group I and in Group II 30% patients shows excellent, 66% patients shows satisfactory results and 4% shows unsatisfactory results. Conclusion: The LISS plating and closed retrograde intramedullary interlocking nail was safe and effective methods for extra-articular fractures of distal femur but there were less complications found in LISS plating. Keywords: Fracture of distal femur, LISS plating, Interlocking nail
76 Delay in Appendicectomy due to Pre-operative Imaging Results in Increased Complication Rate , A. R. Nsar, A. A. Lashari, D. Kumar, T. Rasheed
Objectives: To determine the frequency of delay in case of suspected acute appendicitis and to determine the frequency of complications in patients of acute appendicitis having delay secondary to pre-operative imaging. Study Design: Descriptive study Place and Duration of Study: Department of General Surgery Unit-2, University of Lahore Teaching Hospital, Lahore 1st January 2020 to 31st March 2021. Methodology: Three hundred and eighty five patients, between 18-40 years of age of both genders presenting with clinically appendicitis were included. All the patients were operated under general anesthesia by a consultant surgeon having minimum of 5 years of experience. Results: The mean age was 28.746±5.25 years. Majority of the patients were between 26-30 years (42.6%). Body mass index of the patients were ?25kg/m2 in 57.7%. Delay was seen in 155 (40.03%) cases, peri-appendiceal abscess was seen in 10 (2.6%) and peritonitis was seen in 13. Complications due to delay was pri-appendiceal abscess 8 and peritonitis 13 with p value ?0.05. Conclusion: Delay in the appendectomy due to pre operative imaging has shown significant impact on complications rate and therefore suggests that delaying appendectomy is unsafe. Keywords: Appendectomy, Peri-appendiceal abscess, Peritonitis
77 Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery , I. Abbas, A. M. Ahmed, S. M. Dayal, G. A. Sirhindi
Aim: To determine the frequency of pseudophakic glaucoma in patients who underwent cataract surgery. Study Design: Cross-sectional Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: Ninety five patients of both genders with cataract surgery were enrolled and ages between 45 to 75 years. After taking written consent detailed demographics including age, sex, body mass index, intraocular pressure, and mode of surgery were recorded. Pseudophakic glaucoma was labelled in case of cataract surgery with intraocular lens implantation and intraocular pressure >21 mmHg or more in one eye along with glaucomatous optic disc or retinal nerve fiber layer defect on optical coherence tomography (OCT). Results: There were 58 (61.05%) males and 37 (38.95%) patients were females. Mean ages of patients were 62.36±9.44 years. Sixty two (65.26%) patients had extracapsular cataract extraction and 33 (34.74%) patients had phacoemulsification. Mean intraocular pressure was 19.33±8.56 mmHg. Pseudophakic glaucoma was found in 32 (33.68%) patients. Conclusion: The frequency of pseudophakic glaucoma was high in patients with extracapsular cataract surgery. Keywords: Cataract surgery, Pseudophakic glaucoma, Intraocular pressure (IOP)
78 Effectiveness of Neonatal Resuscitation Educational Intervention among undergraduate students: A systematic review , M. Liaqat, M. Hussain, M. Afzal
Globally 2.7 million neonatal deaths are reported annually and among these 25% instigated by birth asphyxia. A substantial proportion of these deaths can be prevented through simple resuscitation efforts, in which education plays an integral role. Hence, it is important to assess if neonatal resuscitation educational interventions (NREI) integrating with varying instructional methods improve educational outcomes among undergraduates. We searched PubMed, Medline, Embase, Science Direct, Google Scholar, Cochrane. We selected randomized controlled trials (RCT), Non-randomized and cohort design had an education and comparing two educational interventions, describing at least one of our definite outcomes. A total of 13 manuscripts were relevant to the review, in which 7 papers comprises (level I), 5 (level II), and 2 (level III) were included. We found strong evidence on NREI for imparting knowledge and skills among undergraduates, nevertheless, little evidence exists for the long-term sustainability effect. Keywords: Neonatal, Resuscitation, Students, Knowledge, Skills
79 Primary Anastamosis Versus Colostomy in Patients with Penetrating Colonic Injuries , Bayazeed, Sarzamin, A. Shafi, W. Ahmad, D. Waheed, T. Ahmad
Objective: The aim of this study is to determine the outcomes among primary anastomosis versus colostomy in patients with penetrating colonic injuries. Study Design: Comparative Study Place and Duration: Study was conducted at surgical department of Mardan Medical complex, Mardan and Bakhtawar Amin Medical & Dental College, Multan for duration of one year from January, 2020 to January 2021 Methods: 70 patients were presented in this study. Patients were aged between 18-75 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients penetrating colonic injuries were admitted in emergency ward. Patients were equally (n=35) divided into 2-groups, A and B. For abdominal surgery, group A received primary anastomosis and group B received colostomy. Post-operatively outcomes and complications among both groups were identified. SPSS 22.0 version was used to analyze the data. Results: Mean age of the patients was 29.48 ± 16.4 years with mean BMI 23.16 ± 08.13 kg/m2. Total 50 (71.43%) were males and 20 (28.57%) were females. Fire arm injured 55 (78.6%) was the most common cause of colonic injury followed by stab wound 10 (14.3%) among both groups. Small gut 28 (40%) was the most common organ injured followed by liver 13 (18.6%). Mean hospital stay in primary group was 7.45 ± 7.6 days while in colostomy group hospital stay was 9.54 ± 5.9 days. Postoperatively complications were lower in group A, wound infection found in 9 (25.71%) patients while in group B it was 11 (31.43%). Rate of mortality in primary group was 2 (5.71%) while in colostomy group was 4 (11.43%). Conclusion: We concluded in this study that primary anastomosis was effective because of less hospital stay and less post-operatively complications as compared to colostomy. Mortality rate was higher observed in colostomy group as compared to primary. Keywords: Colostomy, Primary anastomy, Colonic Injuries
80 Cardio Vascular Autonomic Dysfunction in Type 2 Diabetes Patients with Microalbuminuria , K. A. Samin, A. Gardazi, H. Alina, S. Malik, M. Najam ul Saqib Fayyaz, T. Rasheeq
Objective: Main objective of this study is to determine the prevalence of cardiovascular autonomic dysfunction in type-2 diabetes patients with microalbuminuria. Study Design: Descriptive/ observational study Place and Duration: Study was conducted at Diabetes Hospital Hayatabad Peshawar and Mukhtar A Sheikh Hospital Multan for duration of six months from September, 2019 to February, 2020. Methods: Total 70 patients of both genders diagnosed diabetes 2 mellitus were presented in this study. Patients were aged between 20-80 years. Patients’ details demographics were recorded after taking written consent. Prevalence of cardiovascular autonomic dysfunction with microalbuminuria was assessed by statistical analysis. Microalbuminuria was diagnosed among patients if urinary albumin excretion was >30-300mg/g and graded into mild, moderate and severe according to value of urinary albumin excretion was (20–50 mg/24 hr, 50–100 mg/24 hr, 100–300 mg/24 hr). Complete data was analyzed by SPSS 20.0 version. Results: Out of 70, 38 (54.3%) were males and 32 (45.7%) were females. Mean age of the patients were 49.71±17.8 years with mean BMI 28.41±9.42 kg/m2. Mean ACR of microalbuminuria was 166.7±47.8 mg/gm. Among 70 cases, mild microalbuminuria was found in 28 (40%) cases, moderate microalbuminuria was among 31 (44.3%) and 11 (15.7%) was severe microalbuminuria. Lethargy was the most common symptom found in 25 (35.7%) followed by anorexia 20 (28.6%). Frequency of Cardiac autonomic neuropathy was 58 (82.86%), Parasympathetic dysfunction found in 59 (84.3%) and sympathetic dysfunction was among 62 (88.6%). Conclusion: We concluded in this study that the cardiovascular autonomic dysfunction in type-2 diabetes patients highly associated with microalbuminuria with increased systolic diastolic pressure and heart rate. Keywords: Microalbuminuria, Type 2 Diabetes, Cardio autonomic dysfunction
81 Association of Cardiovascular Disease with Micro Albuminuria in Type 2 Diabetes Mellitus , W. Gul, W. Iqbal, M. R. Baig, M. Ejaz, A. Gardazi, K. A. Samin
Objective: The aim of this study is to determine the prevalence of cardiovascular disease with micro albuminuria in type 2 diabetes mellitus. Study Design: Observational study Place and Duration: Study was carried out in medicine department of DHQ category A hospital Batkhela and Combined Military Hospital, Multan for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders diagnosed diabetes 2 mellitus were presented in this study. Patients were aged between 20-80 years. Patients’ details demographics were recorded after taking written consent. Prevalence of cardiovascular disease with microalbuminuria was assessed by statistical analysis. Microalbuminuria was diagnosed among patients if urinary albumin excretion was >30mg/g and in normal albuminuria urinary albumin excretion was <30mg/g. Complete data was analyzed by SPSS 20.0 version. Results: Out of 120, 66 (55%) were males and 54 (45%) were females. Mean age of the patients were 45.71±16.9 years with mean BMI 26.14±9.22 kg/m2. Cardiovascular disease found in 90 (75%) cases. We found that 80 (66.7%) patients had microalbuminuria with mean ACR 160.4±74.6 mg/gm while rest of the patients 40 (33.3%) had normal albuminuria 19.14±5.4 mg/gm. Among 90 cases of cardiovascular disease frequency of microalbuminuria was 65 (72.22%) and among 30 diabetes patients of non- cardiovascular disease frequency of microalbuminuria were 15 (50%). Microalbuminuria was found significantly higher in patients of cardio vascular disease and increased systolic and diastolic blood pressure compared to normoalbuminuric patients. In patients with microalbuminuria, blood glucose and glycosylated hemoglobin have increased dramatically. Conclusion: We concluded in this study that the prevalence of cardiovascular disease with micro albuminuria in type 2 diabetes mellitus was significantly high <0.05 with increased systolic diastolic pressure and fasting blood glucose as compared to normal albuminuria. Keywords: Microalbuminuria, Normal albuminuria, Type 2 Diabetes, Cardio vascular disease
82 Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital , R. Farrukh, S. Masood, I. Shakoor, A. Naseer, S. Sultana, F. Nasir
Background: Magnesium deficiency is common in serious diseases and is often associated with mechanical ventilation, mortality, and long-term intensive care. Awareness of hypomagnesaemia is essential because little data is available and may have prognostic and therapeutic implications. Aim: This study was conducted to calculate the incidence of hypomagnesaemia at PICU admission and to relate it to length of PICU stay, duration of mechanical ventilation, and outcome of hospital stay or discharge. Place and Duration: In the Pediatric Intensive Care Unit (PICU), Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. Methods: This is a prospective observational study involving 200 children aged 1 month to 12 years admitted to the PICU. All qualified children underwent an interview and clinical examination. Blood was collected during admission to calculate serum magnesium level. The patients were grouped into three groups: normomagnesemia, hypomagnesaemia and hypermagnesemia, and the data were analyzed. Results: 200 children were included in the inclusion study. Males constituted 57.0%and females 43.0%. The ratio of men to women was 1.2: 1. Most of the respondents were 5 years old. Most of the respondents were in the ICU with neurological symptoms (36.5%), followed by respiratory diseases (27%). Of the 200 patients, 138 (69%) had a mean magnesium level of 1.9 mg / dL. 51(25.5%) patients had hypomagnesaemia. The average magnesium level was 1.3 mg / dL. 11 (5.5%) patients had hypermagnesemia with a mean magnesium content of 2.7 mg / dl. The lowest measured magnesium level was 1 mg / dl and the highest was 4.2 mg / dl. There was no statistically significant association between hypomagnesaemia and gender, age, disease acceptance category, and sepsis. ≤ 27.4% of children under 5 years of age had severe acute malnutrition in the hypomagnesaemia group. Among those with normal magnesium levels, 24% had severe acute malnutrition and 27.3% had severe acute malnutrition among those with hypermagnesemia. In the study, overall mortality was 25% (50 out of 200). Mortality among people with hypomagnesaemia was 29.40%. Among those with normal magnesium levels, 21.2% died and 18.2% in the hypermagnesemia group. Conclusion: Patients with hypomagnesaemia have prolonged PICU stay, other related electrolyte disturbances and increased mortality. Therefore, in severe ill patients, magnesium levels are monitored. Keywords: Children, Hypomagnesaemia, Intensive Care Unit, Mortality, Outcome, ICU
83 Effectiveness and Safety of Hyaluronic Acid for Chronic Shoulder Pain , S. A. Zeb, Y. M. Khan, M. A. Khanzada, S. Ismat
Objective: To elucidate the functional outcomes of Hyaluronic acid for chronic painful shoulder with improvement of pain and functional scores Study Design: Descriptive study Place and Duration: Study was conducted in Dr.Sulaimanal HabibHospital, Riyadh, KSAfor period of one year June, 2019 to June, 2020. Methodology: Ninety patients with Tendinitis and Rotator cuff syndrome were included in this study. Patients demographics including age, sex, body mass index and complete medical profile were recorded after taking written consent. Injection was given in an aseptic technique in subacromial space in controlled setting with 1 ml of lignocaine 1 percent, 2 ml 0.5 percentmarcaine and 4 ml of hyaluronic acid. The functional outcomes were assessed by Constant Murley scoring. Follow-up was taken at 6 weeks and at 12 weeks and patients satisfaction was recorded. Results: Out of 90 patients 54 (60%) were males while 40% were females with mean age 49.8±10.283 years. Constant Murley score at baseline was 55.18±9.70 and at 6 weeks it was increased to 63.48±7.86 and at final follow-up it was 81.9±12.46. A significant improvement was found at 6 and 12 weeks with p-value <0.05. 5 (5.56%) patients showed complications. None of the patients had severe complication. 75 (83.33%) patients were satisfied. Conclusion: It is concluded that Hyaluronic acid action replaces the traditional form of corticosteroid treatment of chronic shoulders pain associated with Rotator cuff tear and tendinitis. Keyword: Tendinitis, Rotator cuff syndrome, Hyaluronic acid, Range of motion
84 De Novo Urinary Symptoms after Pelvic Organ Prolapse Repair Surgery: A Cross Sectional Study at AKU Hospital , S. Ilyas, S. Najmusahar, D. Rehmani, S. Agha, N. Mushtaq
Objective: To determine the frequency of new onset urinary symptoms after surgery for pelvic organ prolapse repair. Study Design: Descriptive Cross-Sectional Study. Place and Duration: This study was conducted at Outpatient Gynecological Clinics, Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 19, 2018 to July 18, 2018. Materials and Methods: Eighty one women were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. Women who underwent POP repair surgery in the past 6 weeks were recruited. They were asked to complete the proforma including personal information and details of all urinary symptoms like frequency, urgency and incontinence etc. provided by residents after informed consent through validated questionnaire UDI SF6. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: Mean ± SD of age was 52.75±9.71 years. Out of 81 patients, 47 (58%) women were menopause. In frequency of new onset of urinary symptoms De novo urinary incontinence was noted in 12 (14.8%) women, 20 (24.6%) had De novo urges urinary incontinence, while 15 (18.5%), 28 (34.5%) and 20 (24.6%) women had De novo stress urinary incontinence, De novo urinary frequency and De novo urinary urgency respectively. Conclusion: It is to be concluded that De novo urinary frequency was found to be the most common new onset urinary symptoms followed by De novo urinary Urgency and De novo Urge Urinary Incontinence. Keywords: De novo urinary symptoms, Pelvic Organ Prolapse (POP), Post- Operative Stress Urinary Incontinence (SUI), Quality of Life (QoL), Urinary Incontinence (UI)
85 Determine the Outcome of Newborn in Post-Term Pregnancy , A. S. Rizwan, A. Fatima, M. Gul, S. Anwar, A. Jadaan, N. Mushtaq
Objective: The objective of this study was to assess the outcome of newborn among pregnant females who deliver after prolonged pregnancy. Study Design: Descriptive study Place and Duration: Obstetrics & Gynaecology department of Shahida Islam Teaching Hospital, Lodhran for duration of six months from September 2020 to February 2021. Materials and Methods: 100 patients with pregnancy of >40 weeks were included in study. The patients were not included in this study with medical disorders, intrauterine demise or pregnancy complications. Identification of parameters regarding poor neonatal outcome was done. Variable e.g. gestational age, parity, fetal movement, age, mode of delivery, ultrasound, admission cardiotocogram (CTG) and past prolonged pregnancy were studied. Results: Most of the patients i.e. 39 (39%) were between twenty to twenty five years of age. In this study group multigravida were found in 60 (60%). Emergency caesarean section 65 (65%). Most of babies 64% were admitted to neonatal intensive care unit (ICU). Meconium aspiration syndrome was most general among complications which were found in 67 (67%). No fetal mortality was observed. Conclusion: Pregnancy should be managed before 42 weeks of gestation and should not allow to go post-term due to high rate of neonatal mortality and morbidity. Key words: Neonate, Post-term Pregnancy, Gestational Age, Meconium Aspiration, NICU, Mortality
86 Determine the Outcome of Newborn in Post-Term Pregnancy , A. S. Rizwan, A. Fatima, M. Gul, S. Anwar, A. Jadaan, N. Mushtaq
Objective: The objective of this study was to assess the outcome of newborn among pregnant females who deliver after prolonged pregnancy. Study Design: Descriptive study Place and Duration: Obstetrics & Gynaecology department of Shahida Islam Teaching Hospital, Lodhran for duration of six months from September 2020 to February 2021. Materials and Methods: 100 patients with pregnancy of >40 weeks were included in study. The patients were not included in this study with medical disorders, intrauterine demise or pregnancy complications. Identification of parameters regarding poor neonatal outcome was done. Variable e.g. gestational age, parity, fetal movement, age, mode of delivery, ultrasound, admission cardiotocogram (CTG) and past prolonged pregnancy were studied. Results: Most of the patients i.e. 39 (39%) were between twenty to twenty five years of age. In this study group multigravida were found in 60 (60%). Emergency caesarean section 65 (65%). Most of babies 64% were admitted to neonatal intensive care unit (ICU). Meconium aspiration syndrome was most general among complications which were found in 67 (67%). No fetal mortality was observed. Conclusion: Pregnancy should be managed before 42 weeks of gestation and should not allow to go post-term due to high rate of neonatal mortality and morbidity. Key words: Neonate, Post-term Pregnancy, Gestational Age, Meconium Aspiration, NICU, Mortality
87 Awareness of House Surgeons regarding Denture Adhesives in Dental Colleges of Islamabad and Rawalpindi , M. S. A. Khawaja, A. Masood, T. Ahmed, P. Anwar, R. Saad Bin Sohail, F. Javed
Study Design and Setting A cross-sectional, questionnaire-based research was carried out. The questionnaires were filled by a total of 350 dental house surgeons who were working in various dental colleges of Islamabad and Rawalpindi in Pakistan. Objectives The objective was to assess the knowledge and mentality of dental house surgeons regarding the proper use, application and limitations of denture adhesives. Methodology A survey questionnaire was distributed among the dental house surgeons (n = 350). Cross tabulations were done and the Pearson’s Chi?square test was used to compare the variables using the Statistical Package for Social Sciences (P ≤ 0.05). Results Approximately, 85.5% of house surgeons who answered the questionnaire had learnt some of the basics about adhesives as part of their undergraduate studies. 73% agreed that Adhesives can be useful in aiding the stabilization and retention of dentures, and 95% agreed that dentists should inform denture patients about the proper use. However only a relatively small percentage (38%) routinely informed patients about the potential misuse of adhesives as part of their instructions. Conclusion Majority of the house surgeons had sound knowledge about DAs and agreed for the need to increase patient awareness towards these products. Sufficient dentist and patient knowledge towards denture adhesives is paramount in establishing patient satisfaction and knowledge towards dentures usage. Key words Denture adhesives, Awareness, Knowledge, Questionnaire
88 Frequency of Different Pattern of Hair Loss in Pakistani Men Using BASP Classification , S. Nasreen, T. Malik, H. S. Memon, M. Izhar, S. M. S. Shah, S. Ali
Objective: To determine the frequency of different hair loss using BASP classification in Pakistani men. Study Design: Cross-Sectional Study. Setting: Study was conducted at Department of Dermatology, Abbasi Shaheed Hospital, Karachi. Duration: Six months starting 6th August 2019 till 5th January 2020 Material and Methods: Total 157 diagnosed patients with hair loss who met the diagnostic criteria were included. Brief history was taken and demographic information was recorded after taking written informed consent. Male pattern of hair loss (MPHL) was checked and categorized using BASP classification. Data was analyzed by SPSS 24.0. Results: In this study out of 157 patients, mean and standard deviation of age and duration of hair loss were 33.14±12.49 years and 1.89± 0.44 years, respectively. The Pattern of hair loss distribution showed that 34 (21.7%) were L type, 66 (42%) were M type, 35 (22.3%) were C type, and 22 (14%) were U type patterned hair loss. Conclusion: Assessment of male pattern hair loss using BASP classification found that M type hair loss was more prevalent. Currently, there are effective medical and surgical treatments available for men. However, the knowledge of pattern of hair loss in our population would help in choosing suitable treatment plans. Keywords: Male Pattern hair loss, Androgenic alopecia and BASP classification
89 Supracondylar Fracture of Humerus in Children Treated with Closed Reduction and Percutaneous Cross Pinning VS Lateral Pinning , M. S. Zardad, S. A. Shah, M. Younas, M. Ullah, I. Muhammad, K. Asghar  
Objective: The aim of this study is to determine the outcomes between percutaneous cross pinning vs two lateral pinning in treatment of closed reduction supracondylar fracture of humerus in children. Study Design: Prospective study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan during from October 2019 to May 2020 (09 months duration). Methods: Total 60 patients of both genders were presented in this study. Baseline demographically details of patients age, sex and body mass index were recorded after taking consent. Patients were aged between 2-14 years were included. Children who had supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 30 patients and received percutaneous cross pinning technique and group II had 35 patients underwent for lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups, frequency of complications was also observed. Complete date was analyzed by SPSS 22.0 version. Results: Total 36 (60%) were males (18 in each group) and 24 (40%) were females (12 in each group. Mean age of the patients in group I was 6.14±3.12 years and in group II mean age was 5.66±5.28 years. Sports 45 (75%) was the most common cause of fracture followed by traffic accidents 10 (16.67%) and the rest were 5 (8.33%) fall from the height. Mean surgical time in group I was 31.24±2.16 minutes while in group II mean time was 33.42±1.61 minutes. Mean radiation time in group I was 2.01±1.1 sec and in group II radiation time was 1.34±1.1 sec. According flynn’s criteria excellent results were found in 20 (66.7%) cases, good results in 8 (26.7%) and fair results found in 2 (6.7%) while in group II excellent results were found in 19 (63.33%), good results in 9 (30%) and fair results in 2 (6.7%). Significantly no any difference in outcomes was observed among both groups. Conclusion: We concluded in this study that the both techniques are safe and effective for the treatment of closed reduction supracondylar fracture of humerus in children but less operative and high radiation time was observed in percutaneous cross pinning as compared to two lateral pinning. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture, Children
90 Management of Closed Tibal Shaft Fractures with Reamed Interlocking Nail , S. A. Shah, M. S. Zardad, A. Saboor, I. Muhammad, M. Ullah
Objective: The aim of this study is to determine the effectiveness of reamed interlocking nail in the management of closed tibal shaft fractures. Study Design: Descriptive/ Observational study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan for nine months duration from January 2019 to September 2019. Methods: Total 80 patients of both genders were presented in this study. Age ranges of enrolled cases were 20-70 years. Demographically details of enrolled cases were recorded after taking written consent. Patients who had tibial shaft fractures were admitted in emergency ward and underwent for reamed interlocking nail. Postoperatively union time and rate of complications were assessed. Complete follow up of the patients were take place in duration of 14-months. Data was analyzed by SPSS 20.0 version. Results: Mean age of the patients was 28.65±8.77 years with mean BMI 24.16±6.23 kg/m2. Out of 80 patients, 47 (58.6%) were males and 33 (41.4%) were females. Traffic accident was the most common cause of fracture found in 60 (75%) cases, followed by fall from the height 15 (18.75%) and the rest were others 5 (6.25%). Mean united time of simple fractures were 13.14±4.14 weeks while among segmental fractures union time observed 18.13±6.17 weeks. Frequency of union fractures was 62 (77.5%), delayed unions were 13 (16.25%) and non-unions were 5 (6.25%). Satisfaction rate was 72 (90%) among all cases. Conclusion: We concluded in this study that reamed interlocking nail was an effective and safest method for the management of closed tibal shaft fractures. Overall union rate in this study was 93.75% and showed less morbidity among cases. Keywords: Interlocking nail, Tibial shaft fractures, Union
91 Chest X-Rays Findings in Patients Positive for COVID 19 at Sheikh Zayed Hospital Lahore , A. Z. Sheikh, Z. Tariq, S. Noor, A. Ambreen, S. Awan, M. Amjad
Aim: To assess the results of chest x ray radiographs of patients positive for Covid-19, presented at the tertiary care hospital according to the classification by the British Society of Thoracic Imaging (BSTI. Place and Duration: In COVID-19 Ward (Department of Medicine) Sheikh Zayed Hospital, Lahore for three months duration from January 2021 to March 2021. Methods: A total of 96 patients were selected. In this observational study, positive COVID-19 patient determined by the reverse transcriptase polymerase chain reaction (RT-PCR) were enrolled for this study above the age of 14 years. CXR results were classified conferring to BSTI documentation and classification in terms of percentage and frequency. Results: Chest rays of 96 patients who tested positive for Covid-19 by RT-PCR over the age of 14 years were examined. Chest X-rays are classified according to the BSTI Covid-19 X-ray classification. Out of 96 patients, 10 patients (10.41%) had normal chest x-rays, 19 (19.80%) patients had classic bilateral, peripheral and basal consolidation / ground glass opacity (GMO), 60 (62.5%) had unspecified group,7(7.29%) patients have poor quality X-ray film. The unilateral involvement was noticed in 15 and bilateral in 49 patients, 12 of the patients had diffuse involvement on chest radiograph and peripheral involvement in 39 patients. According to regional dominance, 41 of the unspecified (42.70%) had middle and lower lung involvement, 7 (7.29%) had only the middle zone, and 8 (8.33%) had involvement of lower zone. Conclusions: In this study, Covid-19 chest X-rays are usually presented as ground glass opacity, mixed consolidation with GGOs in the middle and lower peripheral areas of the bilateral lung. Chest X-ray BSTI classification is used to classify Covid-19 severity in our patients, thus differentiating in the classic Covid-19 of the middle zone versus low zone involvement. Keywords: Consolidation, Covid, Ground Glass Opacity, Chest Image
92 Influence of COVID-19 on the Mental Health of Nurses dealing with COVID-19 Patients (A Study on Nurses within Karachi) , U. Amen, Z. Rajwani, U. Sumayya, R. Haroon, N. Mushtaq, S. Sharif
Background: Globally Corona virus (COVID-19) has become a huge challenge for all of the population. In South Asia, country Pakistan city Karachi the 1st case of this breakdown was identified on 26th February 2020 (Waris et al., 2020). This disease has developed psychological distress among all the population. COVID virus is one of the leading threats to all the healthcare organizations and due to increase rate of patients day by day, it has given enormous burden to all healthcare workers especially nurses the front line fighters who are always ready to give care towards the patient whom they encountered so it’s very crucial part to assess the impact of COVID -19 on the mental health of the nurses. Objective: The objective of the study is to identify the frequency level of stress, anxiety and depression among nurses while dealing with those patients who were admitted in various hospitals in Karachi for treatment of COVID-19. Method: A cross-sectional study was conducted from 20th November to 31st December 2020 from different hospitals in Karachi, Pakistan. Those Registered nurses who were assigned in isolation ward of Covid-19 were the part of the study. For data collection survey form was designed based on Depression Anxiety Stress scale (DASS-21) scale (Lovibond & Lovibond 1995). Results: The total mean score of depression among nurses was 50 (68%), Anxiety was 32 (43%) and stress was 34 (46%). 50 nurses suffered from moderate depression, 24 nurses reported from extremely severe anxiety and 50 nurses suffered from moderate stress level. From 74 participants 41(55.4%) were females and 33 (44.6%) were males. Furthermore, it shows that 25 (76%) males and 25 (61%) females suffered from moderate depression, 32 nurses 14 (42%) male and 18(43.90%) females reported from extremely severe anxiety. Conclusion: This pandemic is highly complex, contagious and vulnerable. The study results portrait that nurses working with COVID-19 patients have affected a lot of various psychological distress such as anxiety, stress, and depression. It is very vital for higher management to take major steps and take preventive intervention which would be beneficial towards their mental health in decreasing negative psychological outcomes, because they all are working under pressure environment. Key Words: Stress, Anxiety, Depression, Pandemic, Registered Nurse
93 Effectiveness of Sofosbuvir and Velpatasvir Combination in Chronic Hepatitis C with Hemodialysis Patients , R. A. Khan, A. Ali, S. Munib, I. Muhammad, N., Amjad Ali
Objective: The aim of this study is to determine the response of sofosbuvir and velpatasvir combination in chronic hepatitis C with hemodialysis patients. Study Design: Prospective/observational study Place and Duration: The study was conducted at department of Nephrology Nawaz Sharif Kidney Hospital, Swat for duration of six months from 1st July to 31st December, 2020. Methods: Total 27 patients of both genders were presented in this study. Patients were aged between 18-85 years. Patients details demographics age, sex and body mass index were recorded after taking written consent. Patients diagnosis hepatitis C with recognized genotypes were presented. Enrolled patients received combination of sofosbuvir and velpatasvir regime (SOF/VLP) for 14 weeks and follow up was taken. Effectiveness and safety among HCV patients on hemodialysis were observed. Complete data was analyzed by SPSS 22.0 version. Results: Out of 27 patients 17 (62.96%) were males 10 (37.04%) were females. Mean age of the patients was 35.14±5.18 years with mean BMI 24.41±6.25 kg/m2. Hypertension was the most common comorbidity found in 15 (55.55%) patients followed by obesity 8 (29.63%) and diabetes found in 3 (14.81%). Among 27 cases 20 (74.04%) were naïve and 7 (25.96%) were treatment experienced. Sustained virological response was found in 26 (96.3%) and 1(3.7%) patients were lost at follow up. Significantly improvement was found in hemoglobin level 12.11 ± 5.24, alanine aminotransferase (ALT) 28.51 ± 9.62 and aspartate aminotransferase (AST) 35.24 ± 7.08 after treatment. Headache, fatigue and nausea were the most common adverse outcomes. Conclusion: We concluded in this study that the use of sofosbuvir and velpatasvir was effective safe and well tolerated in the treatment of hepatitis C patients with hemodialysis. Keywords: Hemodialysis, Hepatitis C, Sofosbuvir, Velpatasvir, Complications
94 Prevalence of Hepatitis ‘B’ and ‘C’ in Orthopaedics Patients Admitted In Khyber Pakhtunkhwa Hospitals , A. Khan, M. S. Zardad, Abdus Saboor Awan, M. Tahir, M. A. E. Bhattani, S. A. Shah
Background and Aim: Hepatitis B and C are widespread global health issues that are rapidly spreading in developing countries due to ineffective preventive measures.Undiagnosed hepatitis B (HBV) and hepatitis C (HCV) viral infections in hospitalized patients and outdoor attendees must be addressed in order to obtain a more accurate picture of HBV and HCV prevalence.The purpose of this study was to determine the prevalence of HBV and HCV in patients admitted to the orthopedic department. Materials and Methods: This is a descriptive cross-sectional study of 1080 patients admitted to the department of orthopedics at Ayub Medical Teaching Institute Abbottabad and Orthopaedics department of DHQ Hospital Thimergara Dir lower for duration of six months fromSeptember 2019 to February 2020.The study included patients of both sex and all ages who were undergoing surgery. Venous blood was drawn from 1080 people and tested for infection using ELISA.All patients were screened for Hepatitis B and C, and positive patients were confirmed using the Elisa method. Results:Out of 1080 patients, 756 (70%) were male and 324 (30%) were female. Hepatitis B and C were found in 86 (8%) of the patients. Out of 86 infected patients, 49 (4.53 %t) had hepatitis C and 37 (3.42 %) had hepatitis B. The prevalence of both hepatitis B and C infections were 4 (0.37 %) of the patients. Of the 49 hepatitis C patients, 32 (65.3%) were male and 17 (34.7%) were female. Thirty-one (83.8 %) of the 37 hepatitis B patients were male, while six (16.21 %) were female.The prevalence of risk factors were history of blood transfusion 14 (16.27 %) patients, Previous history of surgery 17 (19.8 %), dental procedure 6 (7.00 %), and abroad visit in 5 (5.81 %) patients. Conclusion:Hepatitis B and C are common in orthopedic patients, with the following risk factors: prior history of surgery or blood transfusion. To prevent the transmission of HBV and HCV to others, a routinely screened procedure should be followed on a regular basis. Keywords:Prevalence, Hepatitis B, Hepatitis C, Orthopedic patients.
95 Frequency of Burnout Syndrome among Health Care Providers and its Association with Gender and Work setup , Wajeeha, A. Javed, U. J. Iqbal, O. Arshad, R. J. Iqbal, M. I. Baig, A. Iqbal
Objective: To find out the frequency of burnout syndrome among health care providers and its association with gender and work setup Methodology: It was a cross sectional studyinvolving 272 health care providersby convenient sampling, working in government hospitals and private hospitals. Level of Burnout was assessed by Maslach Burnout inventory (MBI). Data was analyzed by SPSS v.25. p-value ≤ 0.05 was considered as significant Results: The mean score of emotional exhaustion, cynicism and professional proficiency were 17.85±7.2, 19.32± 9.3 and 28.39±9.8 respectively. Males had more emotional exhaustion and cynicism burnout as compared to females but the results were insignificant. Professional proficiency burnout was significantly higher in females. In type of work setup, results were statistically significant for emotional exhaustion and professional proficiency. There was more burnout among health care providers working in private work setup. Conclusion: According to levels of burnout high level of cynicism and professional proficiency, and moderate level emotional exhaustion burnout were present among health care providers. Professional proficiency was significantly associated with gender and work setup while emotional exhaustion was significantly associated with work setup. Key words: Mental health, Occupational Health, Professional burnout, Stress
96 Comparison of Partial and Complete Caries Excavation in Permanent Teeth: An 18 Months Follow-up , M. R. Ahmed, S. Aaslam, J. H. Bukhari
Objective: To compare performance and survival of composite restorations in primary teeth using partial caries removal (PCR) versus complete caries removal (CCR). Methodology: In this trial, 70 permanent molars having deep caries lesions were selected and divided equally into CCR and PCR groups. The study duration was Jan-2018 to Jan-2020. In CCR group, complete dentin removal was done and confirmed by applying dentin detector dye for 10 seconds. In PCR group, visual & tactile criteria were followed for dentin removal. After dentin removal all cavities were filled using RMGIC cement resin. Follow-up was done at 06, 12 and 18 months. Results: Mean age in CCR group was 23.4+5.5 years and 25.6+4.9 years in PCR group. Male patients were 19 and 17 in CCR and PCR groups respectively (p= 0.59). Regarding lesion type, 25 patients in CCR were having occlusal and 5 having Occluso-proximal lesion. In PCR group, 27 teeth were diagnosed with occlusal lesion and 3 with occluso-proximal lesion (p=0.44). At 18 months’ follow-up, success rate was 100% in CCR group and 93.3% in PCR group (p=0.49). Pulp exposure occurred in 23.3% procedures in CCR group and none in PCR group. Conclusion: Partial caries removal has nearly similar success rates as that of complete caries removal and is associated with significantly less pulp exposure rate as compared to CCR. Keywords: Deep carious lesions, Partial caries removal, Complete caries removal, Randomized clinical trial
97 The Role of High Resolution Computed Tomography in the Diagnosis of Suspected Sputum Smear Negative Active Pulmonary TB , G. Hikmatyar, S. Lal, B. Kumar, M. Ali, R. Gul, K. Khurshid
Objective: To evaluate the diagnostic accuracy of high resolution CT (HrCT) for confirmatory evaluation of patients having active pulmonary TB (PTB) taking Acid-fast bacillus (AFB) culture reporting as standard parameter. Methods: In this cross-sectional (validation) analysis we included 200 patients having chest X-rays and clinical evidence of active TB and sputum smear (SS) –ve results. These patients were recruited from March-2019 to December-2019. Data of patients regarding baseline hematology investigations, sputum smear findings, and presenting symptoms was obtained. Sputum samples were obtained again for each patients, and sent for AFB culture reporting. The HrCT was performed in the radiology unit using a 64 slices CT machine. Results: The mean age of included patients was 53.61 ± 11.96 years. There 81 (40.5%) female and 119 (59.5%) male patients. The proportion of true positive (TP) cases was 79 (39.5%), true negative cases was 96 (48.0%), false positive (FP) cases 11 (5.5%) and false negative (FN) was 14 (7.0%). The HrCT was found to have sensitivity of 84.9%, specificity 89.7%, PPV 87.8% and NPV 87.3%. Conclusion: HrCT is a reliable imaging method for accurately diagnosis the active Pul. TB with a good sensitivity and specificity. In our view, HrCT can be used as a firstline imaging evaluation test for diagnosing pul. TB in suspected patients. Keywords: Pulmonary TB, Microbial culture, high resolution CT.
98 A Retrospective study on the advantage of Fine Needle Aspiration Cytology (FNAC) as Walk- in Diagnostic Test in Patients with Cervical Lymphadenopathy , A. Samad, A. Fayyaz, N. Fayyaz, N. Akhtar, S. Shafique, K. Sajjid
Objective: To determine the etiologic spectrum of cervical lymphadenopathy using fine-needle aspiration cytology (FNAC) in a tertiary care setting. Methods: In the present retrospective study, we presented the data of 1773 patients who presented in Multan Medical and Dental College within 11 years from Jan-2007 to Dec-2018. In all patients, FNAC was performed using a 22-23-gauge needle by using a 10 ml syringe. After collection specimens were sent to the hospital laboratory, the collected samples were stained using Papanicolaou stain, the Field’sbstain, and ZiehlaNeelsen (ZN) stain and acid-fast bacilli (AFB) for determination of the pattern of cervical lymphadenopathy. Specimen analysis was done in a private diagnostic center. Results: Mean age of study participants was 37.8±9.7 years. There were 1012 (57.07%) male patients and 761 (42.93%) female patients. Tuberculosis was diagnosed in 655 (36.9%) patients, metastasis in 349 (19.6%), reactive hyperplasia in 267 (15.0%), acute lymphadenitis in 193 (10.9%), lympho-proliferative lesions in 96 (5.4%), non-hodgkin lymphoma in 30 (1.69%), chronic infections in 18 (1.0%) and Hodgkin lymphoma in 11 (0.62%) patients. Conclusion: In the present study, cervical tuberculosis was the most common diagnosis found in 36.9% of cases, which present that tuberculosis is very common in our population. FNAC is easy and can be performed as a bedside procedure for the diagnosis of cervical lymphadenopathy. Keywords: Cervical lymphadenopathy, Fine needle aspiration cytology.
99 Axillary Ultrasound as Preoperative Staging in Clinical Negative Axillary Lymph Node Breast Cancer Patient , M. S. Javid, M. Barry
Objective: To determine the diagnostic accuracy of axillary US as a preoperative investigation by comparing it with the histology outcome of nodal status. Methods: This validation analysis was conducted in Mater Misericordia university hospital, Dublin Ireland form Feb 2007 to Feb 2015. All female patients with impalpable axillary lymph node and histology proven unifocal breast cancer between ages 18 to 75 years were included. Patients with the diagnosis of breast cancer were followed with Ultrasound imaging and results in Picture Archiving and communication system (PACS) and histology was confirmed using the patient center data base in both preoperative and postoperative course of breast cancer, including both sentinel lymph nodes and axillary lymph nodes. Results: A total of 625 patients had axillary ultrasound (US) to assess the preoperative axillary nodal status with mean age of 56±12 years. cN0 was diagnosed in 469 (75%) cases, cN1 in 136 (21.8%) cases and cN2 in 20 (3.2%) cases. After negative axillary ultrasound cN0 pathology shows positive pN2 and pN3 disease in 14 (2.9%) cases with the NPV of 97.01%. Axillary ultrasound had shown cN1 disease in 136 cases with the pathology outcome of pN2 and pN3 in 41 (30.14%) cases with the negative predictive value (NPV) of 69.85%. The overall sensitivity and specificity of the axillary US in detection of the positive node was 51.6% and 92.8% with PPV of 82.69% and NPV of 74.2%. Conclusion: Axillary US is a useful modality for screening of breast cancer patients. The negative US findings exclude the presence of advanced nodal disease. However, it cannot accurate distinguish between pN1 and pN2 or pN3 nodal disease. Keywords: Axillary ultrasound, Axillary lymph nodes, Breast cancer.
100 Requirements for paying attention and effectiveness to foreign criminal laws and sentences in the national territory: Developments, obstacles and solutions , M. B. Ghazani
The comprehensive application of the principle of sovereignty of territories in the territory by the instrument of criminal jurisdiction, despite the justifications for it, has changed, so that the effectiveness of foreign laws and rulings in recent years in the light of human rights concepts and fair trial standards have been adjusted. Many countries have relinquished their sovereignty by anticipating examples of foreign law enforcement and have preferred the interests of the accused. The impact of our country's criminal law on this process has gone through various stages, from absolute silence to It has a logical effectiveness and absolute denial and finally a slow move towards international standards in its record. The conditions of the appointed judge, the rule of denying the mustache and some unreasonable precautions of the legislator in this regard can be seen as an obstacle to the evolution of our country's criminal law to expand the spatial context. Keyword: Foreign Judgments, Effectiveness, Foreign Criminal Law
101 Phage therapy is an important replacement for the antibiotic resistance , P. Farmehr
Antibiotic resistance has become a significant and growing threat to public and environmental health. The emergence of multiple drug-resistant bacteria has prompted interest in alternatives to conventional antimicrobial. One of the possible replacement options for antibiotics is the use of bacteriophages as antimicrobial. We were forced to look for a new approach in treatment. Phage therapy is an important alternative antibiotic in the current of drug-resistance pathogens. In this way, poisoning bacteria bacteriophage bacteria infect and replicate in bacteria, in this therapy, identify the type of virus per person and can be targeted manipulation of harmful bacteria and then returned the person and invented phage therapy. We discuss the advantages and disadvantages of bacteriophages as therapeutic agents in this regard. And so describe a brief history of bacteriophages and clinical studies on their use in bacterial disease. Much hope is placed in genetic modifications of bacteriophages prevents the development of phage-resistant bacteria. Keywords: antibiotic resistance‚ bacteriophage, phage therapy
102 Exploring the experience of medical faculty members about the challenges of academic faculty promotion system in the Iranian context: a qualitative study , H. Didehban, A. Mirzazadeh, H. R. Khankeh
Background: Faculties' academic promotion process plays a significant role in career development and organizational change. Studies have indicated that this process is stressful and tense in the Iranian context. This study aimed to identify factors affecting medical faculty academic promotion at Tehran University of Medical Science. Methods: In this qualitative content analysis, 15 faculties at Tehran University of Medical Sciences were studied during 2016-2018. Purpose full sampling used for selecting participants. Data collection was performed using semi-structured interviews and demographic information. The collected data were analyzed through constant comparison analysis using grounded theory data analysis being recommended by Corbin and Strauss 2008. Results: Based on the experiences of participants, the factor affecting medical faculties academic promotion fit in two themes: problems in evaluation process and structural problems in promotion process. The first main theme consists of four main categories, i.e. “quantitative evaluation and objectivity "-'' necessity of differential evaluation "-'' lack of attention to the consequence" and other problems of evaluation area”. The other theme has the following main categories: “high research orientation in regulation "-" necessity of re-defining the promotion indicators"-"mandatory in promotion process" and " lack of attention to occupational problems of faculties”. Each category will have its subcategories. Conclusion: The results indicated that faculties are facing many problems in the field of academic promotion and need to improve the laws, evaluate qualitatively, pay more attention to education criteria, and redefine cultural and executive criteria. Keywords: Academic promotion, medical faculty, medical university, content analysis, challenge
103 Exploring the experience of medical faculty members about the challenges of academic faculty promotion system in the Iranian context: a qualitative study , H. Didehban, A. Mirzazadeh, H. R. Khankeh
Background: Faculties' academic promotion process plays a significant role in career development and organizational change. Studies have indicated that this process is stressful and tense in the Iranian context. This study aimed to identify factors affecting medical faculty academic promotion at Tehran University of Medical Science. Methods: In this qualitative content analysis, 15 faculties at Tehran University of Medical Sciences were studied during 2016-2018. Purpose full sampling used for selecting participants. Data collection was performed using semi-structured interviews and demographic information. The collected data were analyzed through constant comparison analysis using grounded theory data analysis being recommended by Corbin and Strauss 2008. Results: Based on the experiences of participants, the factor affecting medical faculties academic promotion fit in two themes: problems in evaluation process and structural problems in promotion process. The first main theme consists of four main categories, i.e. “quantitative evaluation and objectivity "-'' necessity of differential evaluation "-'' lack of attention to the consequence" and other problems of evaluation area”. The other theme has the following main categories: “high research orientation in regulation "-" necessity of re-defining the promotion indicators"-"mandatory in promotion process" and " lack of attention to occupational problems of faculties”. Each category will have its subcategories. Conclusion: The results indicated that faculties are facing many problems in the field of academic promotion and need to improve the laws, evaluate qualitatively, pay more attention to education criteria, and redefine cultural and executive criteria. Keywords: Academic promotion, medical faculty, medical university, content analysis, challenge
104 Challenges of the Relative Value Unit Experience in Iran: A Qualitative Study , S. Forootan, S. Hajebrahimi, B. Najafi, A. Janati
Background: The Relative Value Unit (RVU) is a value scale and plays a key role in the physician reimbursement system. The health sector has faced challenges such as providers’ dissatisfaction, income disparities, and reduced service quality which is said to be due to improper RVUs. Always there are debates about it. This study aims to identify the challenges of the RVU experience in Iran from the perspective of the service providers, payers and, policymakers. Methods: This qualitative study was conducted in 2020. Data were collected from November 2019 to February 2020. Thirty experts participated in the study and were categorized into four groups: insurance organizations’ managers, surgeons, health economists, and health policymakers. Focus Group Discussions and semi-structured interviews were held to collect data. Content analysis was conducted to analyze data. Results: According to the expert, the challenges of RVU in Iran are classified into five scopes. Financial, payment, macro-organization, regulation, and persuasion scope. Each scope’s result was categorized into main themes and relevant sub-themes. Conclusions: The RVU has an important impact on the health system, provider behavior, and even patients. Paying attention to required infrastructures, decision- makers’ conflict of interests, decrease the Ministry of Health and Medical Education’s authority, and expanding the active role of involved organizations to increase their commitment to the successful implantation of RVU is necessary. Keywords: Relative Value Unit, Challenge, Expert opinion, Qualitative study, Iran
105 Parenting of Children with Autism: An Evolutionary Concept Analysis , Forough Rafii, Hamideh Elahi Asgarabad
Background: Caring for a child with autism as a "developmental disorder of a lifelong nature" is associated with many challenges and has different definitions in the literature. The purpose of this study was to clarify the concept of parenting of the children with autism and its changes over time. Method: In this study, Rodgers' Evolutionary concept analysis approach has been used. Published articles were reviewed in valid scientific databases without regard to time limit and with the keywords of Autism, children, parenting, parenting children with autism, child parents, and caregiver. Articles were assessed in nursing sciences, psychology, social sciences, and medicine, and was limited to full-text and English-language. A total of 65 articles were selected; then the data were collected and analyzed using thematic analysis. Findings: The concept of parenting of children with autism is a concept with a process nature which has four attributes including: "demanding and challenging", "unique and multifaceted (guidance, education and socialization of children)", "dynamic interaction between parents and child"; "Personality growth and spiritual journey." Conclusion: This concept analysis could be a basis for further research to explain the meaning of parenting in a particular group of children for programs of parenting of children with autism. Keywords: Autism, children, parenting, concept, caregiver
106 Prescribing Pattern of Drugs in Department of Obstetrics and Gynecology at A Tertiary Care Teaching Hospital, Bangalore, India , F. Makiabadi, Rajeswari R., Jayashree AK
Objective: To assess the drug prescription pattern in the department of obstetrics and gynecology At A Tertiary Care Teaching Hospital, Bangalore, India. Methodology: A prospective observational study on Drug Utilization pattern was done in the department of Obstetrics and Gynecology of a 950 bedded tertiary care teaching hospital in Bangalore for 6 months. All patients were admitted to the Department of Obstetrics and Gynecology. Patients satisfying Inclusion criteria were enrolled after obtaining Informed Consent. Patient data entered into Case Report Form (CRF). Medication orders were observed for Prescription patterns. WHO Prescription indicators will be used to study the number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic, percentage of encounters with an injection, percentage of drugs prescribed. Result: A total of 120 cases were collected. A total of 1004 drugs were prescribed which included 244 (24.30%) minerals and vitamin supplements, 219 (21.81%) Antibiotics, 146 (14.55%) Gastric acid Secretion Inhibitors, 108(10.75%) Analgesics, 35 (3.49%) Antihypertensive drugs, 22 (2.19%)Antifungal drugs, 32 (3.19%) Anti-diabetic drugs, 32 (3.19%) Anti-spasmodic, 41 (4.08%) Antiemetic drugs, 12 (1.19%) Corticosteroids, 16 (1.59%) Anticonvulsant drugs, 97 (9.66%) in the category of “Others”: Anti sceptics, Topical agents, Oxytocic, Antihyperlipidemic drugs, Oral contraceptives, etc. Percentage of Drugs used in different categories were, In our study majority of drugs from Category A (45.405), Category B (35.63%), Category C (16.67%), Category D (2.30%). the average number of drugs per prescription in this study (8.36) is higher than the standard set by WHO (1.6-1.8), percentage of patients prescribed with Injectables is 39.70% this is also high when compared with the range of the standard set by WHO. Conclusion: The results of our study highlight several areas that need improvement, most importantly there is Polypharmacy was practiced as the average number of drugs (8.36) per prescription when compared with a standard set by WHO. Another area that is Percentage of drugs prescribed by Generic name is also low which also need to improve. Iron, Calcium, and Folic acid were the most frequently prescribed drugs. Overall drug use pattern is rational with few exceptions which were mentioned above. The majority of the drugs were prescribed from the Essential Medicine List and the majority of drugs were prescribed as per FDA Category A the Safest Category during pregnancy. Keywords: prescription pattern, Obstetrics, Gynecology
107 Medication Safety in Obstetrics and Gynecology Ward in Jayanagar General Hospital, Bangalore, India , S. Ferdousmakan, Namitha K.B, M. Etesami
Objective: The present study is aimed at Medication Safety in Obstetrics and Gynecology Ward in Jayanagar General Hospital, Bangalore, India Methodology: It is a prospective observational study, conducted in the inpatient obstetrics and gynecology ward in Jayanagar General Hospital. The study was conducted for 6 months. CRF (Case record form) was designed to record the clinical profile and treatment pattern which contains patient demography, family history, past medication history, obstetric history and follow up and further medication safety was assessed in the patient according to WHO and US-FDA guidelines. The patient demographics and all medically relevant information were noted in a predefined data collection form. Alternatively, these case charts were reviewed for prescription legibility and completeness, unaccepted abbreviations, the capture of relevant information in case sheets, contraindication, drug interactions, and adverse drug events. Result: The data of 150 pregnant women admitted to obstetrics and gynecology ward for delivery related care during the period October 2018 to April 2019 were analyzed. It was observed that 20.67% had Hypertension, 14.67% had Gestational diabetes mellitus, and 8.67% had urinary tract infections as major comorbidities. Among the study population most of them 20.67% had oligohydramnios as a major pregnancy risk factor followed by 12% of preeclampsia and 3.33% of small for gestational age. A total of 1950 drugs were prescribed, and thus the average number of drugs per patient was 13.28. Iron, folic acid, calcium, and vitamins were the most frequently used drugs during the pregnancy. Category A drug constituted 623(54.50%) followed by category B drug 398(34.82%) out of 1950 drugs used in pregnant subjects. Another category C, D and X were 6.99%, 3.5% and 0.1% respectively. The most common drug interaction was found to be between Metronidazole and ondansetron, which may be due to high usage of tramadol and metoclopramide in pregnancy. Conclusion: Among the study patients most them 75.33% were in the age group of 21-30 years. Most of the 20.67% and 14.67% had hypertension and gestational diabetes mellitus as co- morbidities. On the review of 150 prescriptions, the average number of drugs prescribed was found to be 7.62. Iron, folic acid, calcium, and vitamins were the most frequently used drugs during the pregnancy. Most of the used drugs were from Category A (54.50%). Only 0.1% of the drug were from Category X. There were 183 possible risks of major potential drug interactions. The most common interaction was between Metronidazole and ondansetron. The majority of the drugs were prescribed as per FDA category A, the safest category during pregnancy. Keywords: Medication Safety, Obstetrics, Gynecology, pregnancy
108 Evaluation of Cervical Cancer Screening Tools; INNO-LiPA® HPV Genotyping Extra-II Assay versus E7/E6 oncoproteins, How is reliable and practical? , R. Bahramabadi, M. K. Arababadi, M. Iranpour, E. Mohebbi, Z. Honarvar, M. F. S. Abadi, S. A. Rostami, M. Salajegheh, F. Khajepour, F. Hashemi, S. R. Nejad, S. Dabiri
Background: High-Risk Human papillomavirus (HR-HPV) has been well established as the cervical cancer (CC) risk factor. In recent years, various diagnostic methods of human papillomaviruses (HPV) have been developed to promote sensitivity and specificity of CC screening which leads to a low mortality rate. This study aimed to compare diagnostic test metrics of two HPV diagnostic techniques, including Western blot and INNO-LiPA HPV Genotyping Extra II assay methods in asymptomatic or subclinical patients, among the South-Eastern Iranian women. Methods: 323 women were referred to the Pathology and Stem Cell Research Center, from February 2018 to January 2020. HPV-DNA with the INNO-LiPA HPV Genotyping Extra-II Assay kit and the western blot assays for HPV E7 and E6 assessment were employed. Results: Overall, 163 (50.4%) samples were dysplastic pap smear, the specificity of the HPV DNA test by INNO-LiPA HPV Genotyping Extra-II Assay test was significantly higher than the E7/E6 oncoproteins finding (67.3 vs. 49.9%), and the sensitivity was lower (96.6 vs. 74.8%), respectively. Conclusions: HR-HPV E7/E6 oncoproteins expression was evaluated as a possible novel biomarker for CC screening in pap smear as the preliminary test with satisfactory diagnostic values for HR-HPV types 16 and 18. The corresponding diagnostic values may be further improved by combining HPV DNA tests with the INNO-LiPA HPV Genotyping Extra-II test. Also, they may prove helpful for HR-HPV infection diagnosis in cases that the patients are asymptomatic or subclinical. Keywords: Cervical Cancer; Human Papillomavirus (HPV); Diagnostic Screening Programs; Oncogene Proteins
109 Changes in Lung Cancer Cell Line Affected by Cytotoxicity of Lagenaria Siceraria Plant Extract , Moein Shaneh
Chemotherapy is a type of cancer treatment in which the lack of selective cytotoxicity often leads to intolerable side effects. Today, the use of medicinal plants is essential in treating cancer due to their fewer side effects. Lagenaria siceraria Standl is critical for cytotoxicity studies due to its polyphenolic, cucurbitacins, pectin, flavonoids, and saponin compounds. In this study, the cytotoxic effects of plant fruit extract were investigated on lung cancer cell lines. To this end, the hydroalcoholic extract of the plant fruit was initially prepared by the percolation method. Then, the effects of solutions containing samples with different concentrations (5000, 500, 1000, 100, 100, 250, 10, 1, 0.1μg.ml-1) were investigated by MTT assay on lung cancer cell line (A549). Cisplatin was considered as a positive control. Statistical calculations were carried out using Prism V.3 software to compare IC50, and the data were analyzed by analysis of variance (ANOVA) and t-test. The results indicated that the IC50 level of cisplatin anti-cancer drug, as a common drug in the market, is significantly lower than Lagenaria siceraria extract. However, the extract of this plant revealed a significant growth inhibitory effect on lung cancer cells. The results also showed that Lagenaria siceraria extract is an effective cytotoxic compound on lung cancer cells. More extensive studies are needed to find effective plant extracts compounds to find and design new and effective cancer treatment drugs. Keywords: Lagenaria siceraria, Cell line, Lung cancer, IC50, MTTassay.
110 Study on Utilization Pattern of Pulmonary Inhalers in Inpatient at Tertiary Care Teaching Hospital, Coimbatore, India , Askari Mirzaei, Chitra Bhojan
Objective: Aim of the study was to assess medication adherence to understand various determinants of medication non-adherence in inpatients at a tertiary care hospital, Coimbatore, India. Methodology: It is a prospective observational study conducted in the inpatient department at a Tertiary Care Teaching Hospital. Asthma or COPD patients were randomly recruited over six months from the ward's clinics. The inhalation technique was assed utilizing the questionnaires there were 11 steps for MDI and 12 steps for MDI + spacer each correct technique conveyed a score of 1 and the wrong technic conveyed 0. The adherence to the inhaler technique was assessed utilizing the recipe correct dose/incorrect dose*100 and the purposes behind nonadherence were additionally noted. Result: In our study out of 120 patients 53.3% were diagnosed with COPD and 46.7% were asthmatic, and 10.8% asthmatics and 20% COPD patients were endorsed with budesonide MDI. About 10% of asthmatics and 9.1 COPD patients have endorsed with budesonide MDI+ spacer. About 4.1% asthmatics and 2.5% COPD patients were endorsed with salbutamol MDI. About 17% asthmatics and 10% COPD patients were endorsed with MDI ipratropium and 8% asthmatics and 12.5% COPD patients were recommended with ipratropium MDI+ spacer. At the point when the knowledge concerning the use of inhalers was surveyed utilizing standard questionnaire, which had 11 steps for MDI and 12 steps for MDI+ spacer every questionnaire had scoring of 0 addressing not playing out the progression, 1 addressing following the progression the scores were high after pharmacist intervention when contrasted with before pharmacist intervention Conclusion: The current outcomes feature the requirement for pharmacist interventions pointed toward improving adherence to inhalers in COPD and asthmatic patients. Keywords: adherence, chronic obstructive pulmonary disease, Inhalers, Asthma
111 Prescribing Pattern and Pharmacist Intervention in Anticoagulation at A Tertiary Care Teaching Hospital, Coimbatore, India , S. Kanafileskookalayeh, C. Bhojan
Objective: To assess the prescribing pattern and pharmacist intervention in anti-coagulation at a tertiary care teaching hospital, Coimbatore, India Methodology: Data was gathered utilizing a well-structured data collection structure which includes patient's demographics, clinical data which includes (indication for anticoagulation therapy, wanted INR range, anticipated length of therapy, anticoagulation therapy got), social propensities, past medical history, current prescriptions and the prescribed oral anticoagulant (Warfarin/Acitrom). INR values were observed for the patients remembered for the investigation and dosage adjustment was finished by standard convention dependent on the INR value. The patients were also provided with effective counseling regarding the therapy and dietary modifications. All the patients were monitored for any adverse drug events/effects or any possible drug and food interactions during the study period. In case of any reported adverse events/drug associations in the anticoagulation facility, the legitimate intervention was finished by the clinical pharmacist in relationship with a physician to accomplish objective drug therapy. Result: During our study period, 86 patients were forwarded by the physicians to the clinical pharmacist managing the oral anticoagulation clinic. Only 70 patients could complete the study, where 4 patients did not visit the clinic, other 12 patients did not meet the inclusion criteria and hence they are excluded. The data were collected using data collection form for the study sample. After the interventional study, there was a significant improvement in patients maintaining % of INRs which were in target therapeutic range, % of TTR along with decreased adverse effects. It was also found that the patient’s awareness of the target INR values is correlated with the improved accuracy of anticoagulation control. Hence, our study results reflect the need for a clinical pharmacist in oral anticoagulation management and the necessity of implementing anticoagulation services in various hospital settings. Conclusion: the clinical pharmacist managing anticoagulation service was able to achieve the INRs of the patient in to target therapeutic range by proper and timely dose adjustments based on the INR value, to identify adverse drug reactions/ adverse events, drug-drug interactions, and drug-food interactions and bring about proper interventions by working in association with physicians. Keywords: anticoagulant, Clinical pharmacist intervention, INR results, Physician intervention,
112 The Correlation Between Health Promotion, Health Education and Health Quality , A. Murwani, Santosa, E. Lestari, E. Sutisna
Background: The health quality of the elderly is characterized by their ability to do their physical activity even though their family or others help them, join the social activity in their living area even though it is minimal, visit elderly health unit even though it is irregularly or not once a month. Aim: This research investigates the correlation between health promotion, health education, and health quality. Method: The study employed a quantitative design with a cross-sectional approach. The sampling technique was purposive sampling technique, with the sample's number as many as 200 respondents. The research was conducted in Sleman Regency in the Special Region of Yogyakarta in March. This type of research was designed using the survey method. It was processed with path analysis with the help of the STATA 13 program. Result: The result shows that there was a correlation between health promotion and health education with a chi-square value of 0.000, there was a correlation between health promotion and health quality with a chi-square value of 0.034, and there was a correlation between health education and health quality with chi-square value of 0.028. Conclusion: There is a correlation between health promotion, health education, and health quality. Keywords: Health promotion, health education, health quality
113 The Impact of Internet Media on Knowledge of Reproductive Health , W. Dwi Puspita, Ernaningsih, J. Nugrahaningtyas
Background: Time spent on social media users every day to encourage people always to know the development of information and make it part of their daily lives. Increased social activity in youth kalngan no accompaniment with increased knowledge about sexual health HIV / AIDS, sexually transmitted diseases (STDs), and contraception. Aim: This study aims to determine the long-standing relationship with the Internet usage rate of reproductive health knowledge. Methods: This study used a descriptive-analytic cohort study. Results: The results of the research in this study are no long relationship with the Internet usage rate of reproductive health knowledge where the p-value 0.534> 0.05 Conclusion: There was no relationship between Internet usage duration with the level of knowledge of reproductive health. Keyword: internet use, knowledge, reproductive health
114 Evaluation of The Counseling on Breast and Cervical Cancers Screening Among Women in Their Reproductive Age , I. Utami, Y. Yulianti
Background: Breast and cervical cancers are one of the leading causes of women's mortality. About 87% of cases of cervical cancer occur in developing countries. Breast cancer has the most increasing number amongst other cancers. Moreover, most of the cases of breast cancer are diagnosed in the late stadium. The late diagnosis of cancer cases is most probably due to a lack of screening at the beginning. Aim: The research aimed to discover the evaluation of breast cancer counseling and cervical cancer screening amongst women of their reproductive age. Methods: This research employed a survey method with a cross-sectional approach. The population and 63 samples were respondents taken using total sampling. The instruments were questionnaires. Results: The results showed that 37 respondents (58.7%) showed fair rates on breast cancer counseling, while 36 respondents (57.1%) gave a fair rating on cervical cancer counseling. Conclusion: This research has proven that women in this study gave fair ratings towards the counseling conducted. It is expected for midwives and health promotion teams to improve the promotional and preventive efforts, especially regarding breast and cervical cancer screening. Besides, women should be active in exploring more information and participating in every activity related to reproductive health, especially breast and cervical cancer screening. Keywords: Counseling Evaluation, Breast Cancer, Cervical Cance
115 Nursing Intervention in Decrease of Blood Cholesterol and Blood Pressure in The Lansia Group Provided Cupping Therapy in The Village of Wedomartani Sleman , Suwarsi
Background: Much alternative therapy such as cupping therapy in the community as one of the cheap treatment efforts without side effects makes the challenge and the goal for nursing staff improve nursing services. The unfinished scientific verification of cupping therapy's alternative therapy makes nurses need to prove decreased blood pressure and cholesterol levels in the elderly. Objective: Scientific proof of cholesterol and blood pressure decrease after Cupping Therapy in an elderly group in Wedomartani Village, Sleman Yogyakarta Indonesia. Method: quantitative type with pseudo experimental research design. Pre-test and Post-test nonequivalent control group. The treatment group was given wet cupping therapy, while the control group was given dry cupping. Respondents were selected using a purposive sampling technique. Blood pressure measurement uses a digital tensimeter and cholesterol measurement using a digital blood cholesterol level measuring device. Results: The elderly blood cholesterol levels after the average therapy decreased 42.89 mg/dl, whereas blood cholesterol levels in the control group decreased an average of 20.95 mg/dl. The blood pressure of the elderly systole in the intervention group after the average therapy decreased 10.74 mmHg, whereas the control group's systole blood pressure decreased an average of 1.58 mmHg. Diastole blood pressure in the treatment group decreased 3,48 mmHg, in the diastole blood pressure control group increased 5,26 mmHg. Conclusions: Wet and dry cupping are both significantly associated with decreased blood cholesterol and blood pressure levels, but wet cupping lowers blood cholesterol levels by a mean difference of 21.95 mg/dl and mean systole blood pressure of 3.74 mmHg and pressure diastole blood difference of mean 9.1 mmHg. Keyword: Blood Pressure. Cupping Therapy, Cholesterol, Elderly
116 Nutrition Education and Antioxidant Adequacy for People with HIV/ AIDS in Sardjito Hospital , N. E. Noviani
Background: Micronutrient is very important as an antioxidant for people with HIV/AIDS. It supports the immune system. Vitamin A, Vitamin C, and Zinc are micronutrients that work as antioxidants. People’s knowledge about nutrition influences the adequacy of antioxidant sources like vitamins and minerals. Objective: The research aims to define the correlation between nutrition education and antioxidant adequacies like zinc, vitamin A and vitamin C of people with HIV/AIDS in Sardjito Hospital. Method: This was an observational study with a cross-sectional design. Samples were HIV/AIDS outpatients registered in Polyclinic Edelweis in Sardjito Hospital in early 2011. The number of samples was 72 respondents selected purposively. A questionnaire about a balanced diet measured nutrition education. Antioxidant adequacy consisted of Zinc, Vitamin A, and vitamin C and was calculated by Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Spearman correlation was used to analyze the connection between nutrition knowledge and nutrition adequacy. A focused group discussion (FGD) was used to complete nutrition knowledge and food habit in two groups (males and females) to support the data. Result: There was no connection among sex, age, education, occupation, marital status, and opportunistic infection with vitamin A, vitamin C, and zinc adequacy (p>0,05). Only one-quarter of the total respondents had good nutrition education in a balanced diet. 62,5% of respondents were fulfilled with vitamin A, but almost 70% of the respondents did not meet vitamin C, and 86,1% had low adequacy in Zinc. Based on Spearman correlation, there was no correlation between nutrition education and antioxidant adequacy. Conclusion: Nutrition knowledge has no relationship with antioxidant adequacy. Different individual nutrition knowledge was possibly influenced by dietary practice and nutrition adequacy. Keywords: antioxidant, vitamin A, Vitamin C, Zinc, nutrition education
117 The Effectiveness of Young Coconut Water and Watermelon Juice in Reducing Blood Pressure , S. Fadlilah, A. Sucipto
Background: Blood pressure is influenced by psychosocial (stress), genetic, age, gender, nutritional status, and lifestyle (diet, lack of fiber consumption, smoking, lack of physical activity). 30 ml of young coconut water contains 61 mg of potassium, 5.45 mg of sodium, and 1.3 mg of sugar, affecting blood pressure changes. Coconut water contains K minerals and is useful for lowering blood pressure. Whereaswatermelon contains anti-hypertensive content, namely sodium, beta carotene, and potassium. Watermelon is rich in water, amino acids, L-arginine, which can maintain healthy blood pressure. Aim: This study aims to determine the effect of young coconut water and watermelon juice on blood pressure in the 2013 nursing students of Respati University Yogyakarta. Methods: This type of research is a quasi-experimental design with a nonequivalent control group pre and post-test. The sample was taken by simple random sampling, namely the control group (18 respondents), the young coconut water group (18 respondents), and papaya juice (18 respondents). Data pre-posttest of each group was tested using Paired T-test. The comparison control-treatment group was tested using an independent-test. Results: The mean differences of systole and diastole pre-posttest blood pressure in the control group were -1.8 mmHg and -1.0 mmHg. The mean difference in systole blood pressure and the pre-posttest diastole of young coconut water groups were -3.1mmHg and -2.4 mmHg. The mean systole and diastole blood pressure in the pre-posttest watermelon juice group were -2.9 mmHg and -1.5 mmHg. The pre-posttest results of systole and diastole blood pressure analysis in the p-value control group were 0.100 and 0.450. The pre-post test results of systole and diastole blood pressure analysis of young coconut water groups gained p-value of 0.030 and 0.194. The pre-post test results of the juice watermelon group's systole and diastole blood pressure analysis gained p-value of 0.032 and 0.181. The posttest results of systole and diastole blood pressure analysis in the control group and young coconut water gained p-value of 0.014 and 0.157. The post-test results of the systole and diastole blood pressure analysis control group and juice watermelon gained p-value of 0.013 and 0.420. Conclusion: Consumption of young coconut water and watermelon juice affects systole blood pressure, but it does not affect diastole blood pressure in nursing students in 2013 in Respati University Yogyakarta. Keyword: Blood pressure, Coconut Water, Watermelon Juice
118 Contributing Factors of Prenatal Visit K4 Donomulyo Public Health center in 2013 , Y. Salindri, A. Pradita
Background: In East Lampung, the rate of K4 in Several Primary Health Cares has exceeded 90% of National targetsDonomulyo; while in Primary Health Care, the rate of K4 achieved only 71.2%, with an increase dropped out the rate from 18.19% in 2010 to 21.69% in 2011. Aim: The study's objective was to determine K4 antenatal care is contributing factor in Donomulyo Primary Health Center in 2013. Method: The study was analytical cross-sectional research. The study's population was all third-trimester pregnant women in Donomulyo Primary Health Care's working area during July 2013, 76. The sampling technique in this study was total sampling, in which there were 48 samples, including full inclusion and exclusion criteria of the study. The Data was analyzed using frequentation distribution, chi-square, and double logistics regression. Result: 45% mother did not fully fill K4 antenatal visit, 33.3% of respondents were in risky age, the parity risky was 45.8%, 54.2% of respondents had low social status, 43.8% of respondents could not easily access health facilities, 41.7% of the respondents had low knowledge and 45.8% of the respondents thought that health worker's attitude was negative. The research found a significant correlation among maternal age (p value = 0.010 and OR = 6,600), parity (p value = 0.047 and OR = 3.938), economic status (p value = 0.001, OR = 10.125), access to health facilities (p value = 0.024, OR = 4.750), knowledge (p value = 0.011 and OR = 5,833), and health worker's attitude (p value = 0.047 and OR 3.938). Conclusion and Suggestion: Health providers must increase patient's knowledge by giving comprehensive counseling about the benefits of K4 antenatal visits and improving the quality of care to attract women to do antenatal visits, especially for high-risk women. Keywords: pregnancy, antenatal visits, K4
119 The Correlation Between Coping Mechanisms and Stress Levels in Childbearing Women with Infertility , S. W. Putri, L. K. Dwihestie
Background: In Indonesia, in 2012, there were 39.8 million fertile age couples, 10-15% of whom were declared infertile. Infertility often develops into a social problem because the wife is considered to be the cause. Coping mechanisms are used in dealing with stress infertility. Aim: This study aims to determine the relationship between coping mechanisms and stress levels in childbearing women with infertility at PKU Muhammadiyah Yogyakarta Hospital. Method: Research design using cross-sectional. The sampling technique with total sampling found 38 female respondents of childbearing age with infertility—data collection with DASS 42 instrument and Brief Cope 28. Data analysis used Kendall's tau. Results: The results showed that the p-value was 0.002 <0.005, and the Correlation Coefficient value was 0.516. Conclusion: There is a relationship between coping mechanisms and stress levels in childbearing women with infertility at PKU Muhammadiyah Yogyakarta Hospital with moderate closeness. Keywords: coping mechanisms, infertility, stress level
120 The Correlation of Pregnant Women's Knowledge Regarding Cosmetics and the Use of Face Cream , T. Yubiah, N. Sulami, Nurhaedah
Background: The knowledge of pregnant women about cosmetics' dangers is still shallow; this is because pregnant women mostly have never consulted a dermatologist regarding the cosmetic products they use. Aim: This study aimed to determine the relationship between pregnant women's knowledge about cosmetics and the use of facial cream. Method: This research applied an analytical survey with a cross-sectional approach. The study samples were 40 pregnant women taken from a population of 44 pregnant women who used facial cream with Slovin formula and a purposive sampling technique that met the inclusion criteria. The instrument used questionnaires. Results: Data analyzed by the Chi-Square test showed bivariate results (ρ = 0.001) <0.05 indicating that there were relationships between 2 variables. Conclusion: In conclusion, there was a relationship between maternal knowledge about cosmetics and the use of facial cream in the Bre Village of Palibelo Primary Health Center in 2017. Keywords: Knowledge, Pregnant women, Cosmetics
121 The Depiction of Sexual Function during Third Trimester of Pregnancy , R. Ratnasari, N. P. V. Putri
Background: Pregnant women often ask about sexual activity during pregnancy and the consequences curred during sexual activity. Sexual activity can occur during pregnancy, but the frequency is very varied, decreasing along with increasing gestational age. Aim: This study aims to know third-trimester pregnant woman's sexual function. This study was performed in“Siti Fauziah” Midwifery Health Care. Method: The study design used descriptive analysis in which researchers were eager to describe the sexual function of third-trimester pregnant women. Results: Results obtained 12 respondents (46.15%) in the category of low sexual function, nine respondents (34.61%) in the category of moderate sexual function, and five respondents (19.23%) had a useful sexual function. keywords: Function of Sexual activity, Pregnancy
122 Short Term Effectiveness of Intraarticular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in A Tertiary Care Hospital , M. S. Zardad, A. S. Awan, A. Khan, M. A. E. Bhattani, S. A. Shah, A. Hussain
Objective: To determine the effectiveness of intraarticular injection of methylprednisolone acetate in subacromial impingement syndrome. Study Design: Descriptive Case Series Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and MTI, Hayatabad Medical Complex Peshawar for one year duration from February 2020 to February 2021. Methods: Total 100 patients of newly diagnosed subacromial impingement syndrome were enrolled in this study. Patients were aged between 20-60 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients did not receive any treatment before were included. Effectiveness of intraarticular injection of methyl prednisolone acetate was measured by using visual analogue scale (VAS) for pain intensity from 0 to 10 by VAS score after 4 weeks.Completedata was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 38.14±7.44 years with mean BMI 25.64±18.9kg/m2. Among 100 cases, 75 (75%) patients were males and 25 (25%) were females. Diabetic patients were 25 (25%) and 14 (14%) patients were gout among all cases. Mean VAS score before treatment was 6.14±4.84 and after treatment VAS score was reduced to 4.41± 3.64. After follow up of 4 weeks VAS score was decreased to 1.11±3.65. Satisfaction among patients were 90 (90%). Conclusion: We concluded in this study that for the treatment of subacromial impingement syndrome, intraarticularinjection of methylprednisolone acetate was effective and useful. It was also observed that VAS score among patients were reduced significantly with should pain. Keywords: Intra articular methylprednisolone injection, Subacromial impingement syndrome, Effectiveness, Visual analogue scale
123 Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing , M. S. Zardad, M. Younas, S. A. Shah, I. Muhammad, M. Ullah, A. Hussain
Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail
124 Maternofetal Outcomes of Acute Hepatitis E in Pregnancy; A Cross Sectional Study , S. Hafeez, Z. Hafeez, S. Hafeez, S. Riaz, R. R. Khan, A. Yousaf
Objective: To identify the maternofetal outcomes of Acute Hepatitis E in Pregnancy Methods: A cross-sectional study was conducted at the Obstetrics and Gynecology Department of Services Institute of Medical Sciences, Lahore. It included 41 women with gestational age >32 weeks, singleton pregnancy, presenting with Hepatitis E infection. Their demographic and pregnancy-related characteristics were included. Maternal and fetal outcomes were assessed. Data was entered and analyzed using SPSS v.25. Results: Mean age of the participatns was 27.12 ± 3.85 years; the mean gestational age was 31.00 ± 6.15 weeks. Thirty one patients (75.6%) were admitted through the emergency. Twenty four (58.5%) needed packed cell transfusion and 32 (78%) needed fresh frozen plasma transfusion. Eleven patients (26.8%) developed hepatic encephalopathy and all of them required intensive care admission. The maternal mortality rate was 4 (9.8%). Thirty eight (92.1%) pregnancies were viable at the time of arrival. The fetal mortality rate was 7 (17.1%). Conclusion: HEV infections significantly contribute to materno-fetal morbidity and mortality. Screening for and monitoring HEV infection earlier during the pregnancy should be of primary public health importance. Improving awareness in women of childbearing age regarding HEV transmission and its adverse fetal effects should be prioritized. Key words: Hepatitis E virus, Maternofetal Outcomes, pregnancy, Childbearing age
125 Hematuria in Children with Spinal Injury , A. A. Rasheed, A. A. Sulaiman, M. S. M. Albayati
The presence of red blood cells (RBCs) in urine is hematuria, even in microscopic amounts alarms the patient and parents of the patient, and often prompts physician for many laboratory investigations. Hematuria can be red, dark or cola-colored, or brown known as macroscopic hematuria, and when it is not visible to the unaided eye, it is known as microscopic hematuria. RBCs in urine is one of the most important signs of genitourinary tract disease; however, it is almost never a cause of anemia, since few drops (1 mL) of blood can turn 1 L of urine into red-colored urine. Overall the physician should be alert enough not to overlook serious conditions like neoplasms and underlying bleeding disorder, to avoid unnecessary and often expensive laboratory studies. This article provides an approach to the evaluation and management of hematuria in children, and the detection of preventable and treatable conditions at the earliest to limit the disease progression, and an overall reduction in cost, energy, and anxiety. The patients are spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of postvoid residual urine, uroflowmetry, and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy, and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life. Keywords: Children; Kidneys, bladder, neurogenic, injuries, spinal cord, spinal cord disorders, ; RBC cast; Red blood cells; Urine, ASIA (American Spinal Injury Association)
126 Neurogenic Bladder in Patients with Mylomeningocele in Pediatric Age , M. S. M. Albayati, A. A. Rasheed, A. A. Sulaiman
Myelomeningocele (MMC) is congenital nervous system malformation caused by neurulation process failure during pregnancy. The prevalence varies by the continent, region, race, ethnicity and the time when assessed and patients present abnormalities of different organs. One of the most severe complications is renal failure. Aim: Clinical evaluation of patients with MMC in Iraq and answering the question whether our treatment methods lead to renal function preservation. Material and methods: Medical records of 28 patients in the period 2014.2019were evaluated retrospectively. The data included: age, sex, BMI Z-score WHO, place of residence, perinatal history, social situation, physical activity, urodynamic diagnosis, renal function, hydrocephalus diagnosis, and functioning of shunting procedures. Results: They were no statistically significant differences in most studied parameters between boys and girls. Keywords: Meningomyelocele, Epidemiological study, Neurogenic bladder, Renal function
127 Recurrent UTI in Ventriculoperitoneal Shunted Children's , A. A. Sulaiman, M. S. M. Albayati, A. A. Rasheed
Objective: To determine the rate and the type of recurrent UTI in ventriculoperitoneal shunted children's admitted to Azady Teaching Hospital, Kirkuk.. Methods: From mid 2015 to end of 2020; UTI in ventriculoperitoneal shunted children's . Once infection was suspected , CSF (from shunt reservoir or from ventricular tapping), blood, and urine samples, analysis, and culture taken and empirical antibiotics were recommended. Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. E.coli represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis. Conclusions: There is a high incidence of recurrent UTI in ventriculoperitoneal shunted children's in Azady Teaching Hospital, Kirkuk. when compared withother international centres. Gram negative organisms are the most common cause of the infection. Keywords: Urinary tract infection= UTI ,Renal scar.,BBD = Bladder Bowel Dysfunction; DMSA = dimercaptosuccinic acid; IV
128 Relationship between Job Stress and Job Performance among Nurses Facing Covid-19 Virus in Zahedan Teaching Hospitals In 2021 , S. Sheikh, Z. Poudineh, Z. Poudineh, A. Sshahbazi, Z. Abdi
Introduction: Coronavirus is an infection disease with respiratory symptoms and it is a virus that can be transmitted between humans as a mutated virus. Coronavirus-19 disease can lead to stress and anxiety among hospital staff. At present, one of the most important factors affected the occupational performance of the treatment staff and their ability to perform the overshadowed tasks effectively is Covid-19 disease. Therefore, this study was conducted to investigate the relationship between job stress and job performance of nurses in the covid-19 epidemic from the perspective of nurses in Zahedan teaching hospitals in 2021. Materials and Methods: This descriptive-analytical study was performed by available sampling method. Data were obtained using forms collected during three months in the inpatient ward of covid-19 in Zahedan teaching hospitals. The research samples were 235 nurses working in different wards of the hospital participated in this study and answered the three-part questionnaire containing demographic and job information, stress resulted by covid-19 and job performance. The collected data were statistically analyzed using SPSS software, version 20. There were used the descriptive and analytical statistics including frequency, mean, standard deviation and t test. Results: Most of the participants in this study were women (68%) under the age of 30 (59.4%). There is a significant relationship between the effect of Covid-19 on job stress and job performance. Thus, the effect of Covid-19 on job stress is direct, i.e. with the greater effect of Covid-19, the amount of stress increases by 39% ) p = 0.00, r = 0.39(. The effect of Covid-19 on the job performance was inversely so that with increasing the effect of Covid-19, job performance decreased by -20% (-r= 0.20, p=0.01). The findings showed there is a significant relationship between stress resulted by Covid-19 and the job performance. Discussion: The level of stress in nurses working in Covid-19-related wards in Zahedan teaching hospitals is moderate. It seems that paying attention to nurses' education to deal with critical situations similar to Covid-19 and increasing personal protective equipment can be effective in preventing nurses from developing stress and anxiety, and then their job performance will be improved. Keywords: Nurses, Covid-19, Job stress, Job performance
129 Investigating relationship between stress, anxiety and depression with birth growth indexes in pregnant women with COVID-19 , N. Dastyar , M. Ahmadi, N. Salari , A. Arbabisarjou
Background: Pregnancy can be affected by various psychological factors. These factors have adverse effects on the woman, her fetus. While COVID-19 is a new threatening subjects with less information yet. Therefore, This study conducted to determine the relationship between stress, anxiety and depression with birth indices in pregnant women admitted to the coronary care unit of hospitals in Kerman province in 2020. Methods: This is a descriptive analytical and across-sectional study carried out in Kerman, Iran in 2020. The research samples were 315 mothers affected with Covid-19 who have hospitalized in Covid-19 critical care wards in hospitals. The subjects entered in study by convenience method. The gathering tool was a questionnaire with two parts included demographic data and DASS-21 questioner. Collected data was analysed by SPSS version 18.0 .The Significance level considered 0.05. Results: The results showed that in terms of depression, 23.5% of subjects were in severe status, in terms of anxiety 47.6% were in very severe status and finally 29.2% were in severe stress. The results showed that the variables of stress, anxiety and depression were statistically inversely related to weight and height at birth (P< 0.05), but other indicators were not significantly related(P>0.05). Conclusions: Regard to the adverse effects of stress, depression and anxiety on neonatal outcomes in patients with Covid-19 critical care wards . It is recommended to be consider to such as mental health screening programs and strategies to reduce depression and anxiety in these mothers, To be considered by the health-treatment officials of the country. Key-words: Coronavirus-Stress-Anxiety-Depression-Pregnancy-Birth Index, DASS-21.
130 A Cross Sectional Survey on Musculoskeletal Pain Among Postmenopausal Women with Overall and Central Obesity , Q. Kiran, S. Riaz, Z. Hashmi, R. R. Khan, Z. R. Athar, T. Aamir
Objective: To find out the frequency of Musculoskeletal Pain among Postmenopausal women with Overall and Central Obesity. Methods: A Cross-Sectional study was carried out at Jinnah Hospital, Lahore, for six months. A sample size of 250 patients with generalized obesity and central obesity was taken. Non-Probability, Convenience Sampling technique was used. The Nordic questionnaire was used as a data collection tool. Data was analyzed on SPSS version 21. Results: Results showed that majority respondents were in the age group of 51-60 i.e. 43.6% (N=109), respondents with BMI >30 were 50.8% (N=127), waist/height ratio 99.2% (N=248) were > 0.5, waist/hip ratio 86.8% (N=217) were >0.85, 90% (N=225) were present with waist circumference >88cm. Conclusion: This study concludes that musculoskeletal pain is high in postmenopausal women with overall obesity and has shown more pain in the neck, back, shoulder and lower extremities, while postmenopausal women with central obesity have suffered more with back pain. Keywords: Body Mass Index, Obesity, Post menopause, Musculoskeletal pain
131 Misconceptions About Blood Donation Among CMH Kharain Medical College Employees , A. Chughtai, M. S. Abdullah, I. Naiyar, A. F. Anjum, M. Z. Anwar, I. Noor, S. Shoaib, M. R. Ul I. Hashmi, S. N. Hashmi, T. Laique
Blood donation acts as a life saving measure and steps are required to remove misunderstanding about current issues. Blood donation is required every second in life globally. Purpose: To determine and evaluate an attitude and knowledge of people regarding blood donation. Study Design: Descriptive cross sectional study. Methodology: Present study was conducted among the employees of CMH Kharian Medical College over a time period of 3 months. Data was collected by self structured questionnaire through convenient sampling. Data analysis was done by SPSS 20. Results: Out of 180 participants, 87% had donated blood in the past, 81.66% were willing to accept blood donation. Most of the participants were unafraid of donating blood (83.34%). Only 35% thought that they will catch infection while 71.67% believed that they will become obese, unconscious and anemic. Conclusion: We concluded that there was a positive attitude among the respondents towards blood donation. However, survey showed that blood donation (voluntarily & regularly) was low in actual practice according to WHO standards. Most likely reasons included misconception related to it. Hence, government should plan a strategy to educate common people regarding this health issue. Key word: Blood Donation, Attitude, Health Issue and Employees.
132 Menstrual Patterns and Common Menstrual Problems Among Doctor of Physical Therapy Students , S. Waris, S. Riaz, M. A. Javed, R. R. Khan, T. Aamir, M. Sulman
Objective: To observe the patterns and disorders of menstruation among physiotherapy undergraduates in Lahore city. Methods: A cross sectional survey was conducted at Riphah International University, Lahore from January 2020 to June 2020 after obtaining ethical approval. The data was collected through convenience sampling technique from two hundred physiotherapy undergraduate students by using anonymous questionnaire containing questions related to menstrual pattern, associated symptoms and heaviness of day wise bleeding. Informed consent was taken from all participants before data collection. Data was entered and analyzed on SPSS 21. Results: Menarche was found among 60% of undergraduates between the age of 13 and 14 and 24% of undergraduates between the ages of 15 and 17. A total of 71% of undergraduates had a regular menstruation cycle while 23% had irregular periods. 71% of undergraduates had a menstrual cycle of range between 21-28 days, 17% had irregular cycles, and 14% did not know how to go their menstrual duration. Most undergraduates have Bleeding for up to 1 week, with standard, medium, and restrained Bleeding. In 72% of undergraduates exploiting contains lumps, though 28.5% undergraduates do not experience exploiting. Because of their menses, 29% of undergraduates were incompetent to join university. 24% of undergraduates take leave from university because of painful menstruation whereas 9% take leave from university because of extreme blood flow. Dysmenorrhea signs were prevalent. Menses had a massive influence on societal lives and performances primarily on undergraduates. Conclusion: Dysmenorrhea and regular indiscretions were communal and mostly undergraduate’s responsiveness to menstruation signs was scarce. In its outcomes, there is entail for a teaching based program on menarche and menstrual issues. Keywords: Menarche, Dysmenorrhea, Undergraduates
133 Histomorphological Effects of Sodium Arsenite on Cervix of Rats: Experimental Study , A. Mir, H. A. Butt, M. Yasmeen, U. Z. Mir, W. A. Butt, S. Abbasi, T. Laique
Arsenic contamination among heavy metals in ground water is a health hazard due to its toxicological concern, affecting millions of humans globally. Purpose: To observe and analyze the histomorphological effects of sodium arsenite on cervix of rat. Study Design: Laboratory based experimental study. Methodology: Present study held at department of anatomy, College of Physician and Surgeon Pakistan, Regional Centre Islamabad, in two principal groups, group A (control) and group B (experimental). The animals of B were administered sodium arsenite by oral gavage daily for 14 days while group A were administered only distilled water daily for 14 days. The animals of both groups were sacrificed after day 14th of drug administration. The cervix was processed for paraffin embedding and stained with Haematoxylin and Eosin (H&E). Statistical analysis: Data analyzed by SPSS 22.0v. Student’s t-test was applied to determine the significance. P-value ≤ 0.05 was considered significant. Results: The histological evaluation of experimental group animals showed decrease in cervical canal’s luminal area, hyperplasia of cervical epithelium and decrease thickness of cervical muscles. Conclusion: The nature of histomorphological effects observed in cervix showed that these changes may be due to oxidative stress produced by the formation of free radicals, decrease levels of serum estradiol, progesterone and by the denaturation of proteins. Key Words: Arsenic, Cervix, Free Radicals, Hyperplasia and Oxidative stress
134 Investigating the classroom management styles and undesirable educational behaviors in students of Medical Sciences: Cross-sectional study , F. Z. Ghassemi, R. Sargazifar, Z. Khammar, N. Akbari, A. Arbabisarjou
Background and Aim: Classroom management has a significant impact on controlling and managing student behavior. The management of the classroom is an art and a science. The present study set to investigate the status of classroom management styles and types of undesirable educational behaviors among students of Zahedan University of Medical Sciences. Methods and Materials: In this descriptive study, 300 students were selected by stratified random sampling to study a variety of undesirable behaviors in an academic setting. Also, 100 faculty members from Zahedan University of Medical Sciences participated in the study to explore classroom management styles. Classroom management style inventory designed by Amini et al. (2014) were used. The self-administered questionnaire about undesirable educational behaviors was used to gather data. The validity and reliability of both instruments have confirmed .The data were analyzed in SPSS software version 16. Results: The findings showed that the faculty members’ average score of class management is 45.16 out of 100 , which indicates that the faculty members of this university have an interactive style. Also, the average score of undesirable educational behaviors was obtained 71.21. out of 135. Conclusion: Based on the findings of research on the use of interactive styles by faculty members, it is recommended to prepare training workshops for university professors. In order to reduce the undesirable educational behaviors of students at the beginning of the semester and upon entering the university, justification classes should be hold to control various educational behaviors and misbehaviors and management classes should be hold by cultural and social officials of university and oblige students to participate in such classes. Keywords: classroom management style, undesirable educational behaviors
135 Practice of Nurses Regarding Prevention from Needle Stick Injuries in Tertiary Care Hospital Lahore Pakistan , Zarnigar, R. Elahi, T. Zia, T. Sagir, W. Latif, T. Laique
Needle sticks injury considerably affects nurse’s wellbeing while performing routine patient’s care. Thus, nurses are at risk of exposure to various kinds of infectious diseases. Objectives: To analyze the practice of nurses regarding prevention from needle stick injury in Tertiary Care Hospitals of Lahore. Study Design: Cross-sectional study. Methodology: Study setting was tertiary care hospitals of Lahore, Pakistan after ethical review committee’s (ERC) approval. Data was collected from nurses by using tool used in this study was check list for observation of Nurses practice related to sharps and needles. This check list contains fourteen criteria for observation of Nurses’ practice. Whether they were doing; yes or no. sel. convenient sampling technique was used, and sample size was 93. Statistical analysis: SPSS 21 was utilized for the data analysis. Results: It was observed that 03(3%) Nurses were performing Safe Needle Handling Technique in procedure room while 90(97%) Nurses were not performing it. It was observed that 91(98%) Staff Nurses wash hands before and after use of syringes while only 02(2%) Nurses were not performing it. Conclusion: We concluded that nurses have ignorance of the protocols become the reason of such incidents even now. It is the need of time to implement appropriate strategies for precaution and intervention through hospital administration to avoid the needle stick injuries. Key Words: Needle Stick Injury, Re-capping of needles and Knowledge
136 Clinical and Functional Features of Chronic Obstructive Pulmonary Disease in Russian Primary Health Care , A. Nizov, A. Ermachkova, M. Dzhurdzhevich, I. Ponomareva, S. Glotov, A. Shakhanov
Aim: To reveal the clinical and functional features in patients with COPD in Russian primary health care. Methods: At stage 1, COPD risk factors were assessed among persons with respiratory symptoms (n=525). Stage 2 included screening spirometry. At stage 3, patients with COPD were examined to determine clinical and functional features. The COPD group included 150 patients in age from 45 to 81 years (56.1±2.3 years). According to the GOLD classification, patients were divided into the following groups: group A – 59 patients (39.3%), group B – 30(20%), group C – 29(19%) and group D – 32(21.7%). Results: Mild to moderate COPD was registered in 62% of cases. 88(58.7%) had few symptoms of the disease (mMRC-0-1, CAT <10 points), 62(41.3%) had many symptoms (mMRC-0-1, CAT ≥10 points). There is a correlation between the rate of exacerbations and severity of COPD (r=0,56, p<0,05 ). Most of the patients without exacerbations belonged to group A (45.4%). There were no significant demographic differences between the groups in terms of age, gender, and smoking status (p>0.05). 58.3% of COPD patients had a 1point mMRC score and 41.7% of patients had a score of more than 2. Conclusion: The study revealed a high prevalence of COPD between adults with mild to moderate severity. Keywords: COPD, spirometry, mMRC, CAT
137 Behaviors and Attitude towards COVID19 Disease among the Saudi Population Based on Sociodemographic characters , H. H. Abusalih, A. Aalghamdi, M. Malhawsawi
Aim: To investigate the attitude and associated sociodemographic characteristics of KSA residents toward COVID-19 during the peak of the pandemic. Methods: A descriptive cross-section study was conducted during the lockdown period among 465 Saudi Arabia residentsenrolled by using a snowball sampling technique. Data was collected through an online questionnaire contained Likert scale questions regarding assessing attitudes of the population towards COVID preventative measures. The statistical analysiswas doneusingSPSS version 22, t-test, analysis of variance (ANOVA),and regression tests were used to evaluate the relationship between the variables. Results: The mean score for perception towards COVID 19 was25.93± 2.217.Most of the items got more than 90% highest agreement was for dealing with diseases should be based on medical advice (97.63%) followed adhering to preventive procedure decrease disease infectionof the population(59.96%). The lowest score was for havingdirect contact witha COVID patient even when committing to preventive measures.There is nostatistical association betweenage and genderwith behavior.ANOVA test showed gender issignificantly associated with agreeing that following preventive measuresreduces the possibility of disease infection while the profession is significantly associated with being in contact with aCOVID patient while committing to preventive measures. Conclusion: This study showed a positive attitude towards COVID-19 among the Saudi population, which could play an important role in following the preventive measures and thus reduce the spread of the disease. Keywords: Behaviour, Attitude,COVID-19, Saudi Arabia
138 Varicose Veins Among Different Occupational Background in City of Mosul-Iraq , H. J. Mahmood, R. H. Ibrahim, M. F. Abdulghani, Z. F. Al-Zaidy
Background and aim: The Objectives of the present study to determine the VV among people with different background occupations in the City of Mosul, Iraq. Materials and method: A cross-sectional study was performed at Mosul Teaching Hospital between November 2019 and February 2020. Two hundred people who were physically examined represented different jobs in Iraqi society (Nurses, address, Policemen, and teachers). A physical examination was conducted of all participants who agreed to engage in this study. Results: The overall prevalence rate of VV among different occupational backgrounds in the City of Mosul is 19.5%. The study found that the percentage of men (50.5%) and women (49.5%). Most of the patient was beyond to age group (41-45) years and the mean age of the participants was (39.1+3.1). According to the BMI, the results indicated that most subjects belong to a class<30 (77%). Conclusions: The nurses will seek to prevent excessive extended occupational standing and using sitting or walking when appropriate. As a result, an improvement in clinical practice may reduce the incidence of vascular disease. Keywords: Varicose, Veins, Occupational
139 Quality of life, disability level and nutritional status among Multiple sclerosis patients , H. J. Mahmood, R. H. Ibrahim, M. F. Abdulghani, N. Khalaf
Background: The most severe form of nervous dysfunction among young individuals is Multiple sclerosis (MS). Symptoms usually appear at (15–40) years of age.MS is identified as an affective disorder in patients for a long time, characterized by current nervous system (NS) injury structure and rising accumulative damage.Recent years have seen a rise in the number of MS. This affects more than two million individuals every year in the world. Methods: Ethical approval for this study was granted by the Ethics Committee for the Medical Research/University of Mosul. This was a retrospective and a hospital-based study performed. In the latter, MS patients' medical records fulfilling the McDonald diagnostic criteria were analyzed, and both demographics and clinical characteristics were reviewed. We did exclude patients with neuromyelitis optica and isolated transverse myelitis. A retrospective study design was applied in Ibn-Sina Teaching Hospital, City of Mosul, Iraq. Results:This section summarizes the main findings of this research. Identified 500 patients who fulfilled our criteria for having MS. The crude estimated Prevalence of MS in the Mosul population was thus 50/100,000. The research population's demographic and clinical characteristics were identified and found a positive first or second-degree family history of MS at least 11.4% of Mosul patients. Conclusion:Based on the assumptions and previous studies that patients with multiple sclerosis in Mosul suffer from milder disease severity than those in western countries, it was surprising that half of the patients suffer from gait disability.
140 The effect of antifungal and Ago and Zno nanoparticles on Trichophyton mentagrophytes , H. Y. Khalaf, H. A. Awadh, H. M. Younis, N. A. Jasim, and K. S. Abass
This study aimed to determine the main species of dermatophytes which caused skin infection and effect of antifungal and Ago and Zno nanoparticles on them. The result of this study showed that out of 80 sample, 54 sample were positive to fungal isolation with ratio 67.5%. and according to culture and PCR results %8383 of isolated type belong to Trichophyton mentagrophytes. Trichophyton mentagrophytes resistant to Nystatin and Fluconazole while sensitive to Griesofulvin, Clotrimazole and Flucytosin. MIC of Ago and Zno nanoparticle against Trichophyton mentagrophytes were 250 and 275 μg /ml while MFC were 275 and 300 μg /ml respectively. Results of RAPD PCR showed that both Ago and Zno nanoparticle effect in genetic material of Trichophyton mentagrophytes Key words: Trichophyton mentagrophytes, nanoparticle, RAPD PCR
141 Sexual and Reproductive Health Challenges of female-headed Households, a Qualitative Study in Iran , Taghizadeh Z, Khoshnam Rad M
Background: Female-headed households are families in which the female is the main provider in the household. The reproductive and sexual health needs of women heads of households have been marginalized due to the high pressures that they endure. Aim: To investigate the Iranian female-supported households' sexual life challenges. Materials: This study was a qualitative study with the content analysis approach that was done amongst women head of household in Alborz, Iran. Sixteen married females participated and were interviewed deeply in a 7 months period in 2020. All interviews were tape-recorded and transcribed in verbatim. Data were collected and recorded and were encoded, then transcript and analyzed. Result: Females recruited in this study were of different socioeconomic levels. On average they have been lived 5 years with their husbands. Five key themes were extracted including unmet sexual needs, role conflict, concern about sexually transmitted diseases, unrestrained sexual activity due to irresponsibility of husbands, and sexual abuse from others under the guise of support. Conclusion: From the results, it could be concluded that not only the reproductive health needs of these women not met, but also these women's sexual life are associated with worry, threats, and discrimination. This requires serious measures to be taken by the authorities and policymakers. Keywords: Female-headed households, Challenges, Reproductive health, Qualitative study.
142 Factors associated with the academic use of smartphones in medical students. Based on 40 universities in Latin America , M. J. Valladares-Garrido, T. R. Aveiro-Róbalo, C. Pulido-Medina, J. A. Herrera, R. Aguilar, L. R. Barría, J. R. Antunez, D. V. Garrido, C. R. Mejia
Objective: to identify the factors associated with the academic use of smartphones in medical students from 40 faculties in Latin America. Material and Methods: A cross-sectional study was conducted in medical students from 40 faculties in Latin America. A questionnaire was used to measure the academic use of Smartphone, and its association with socio-academic variables, training in scientific databases and appreciation of technologies provided by the university. Multilevel random effects models were used to estimate prevalence ratios. The contribution of each co-variable was evaluated using nested models using the log-likelihood ratio test. Results: We surveyed 11587 participants. 40.9% belonged to academic groups. 68.2% reported using a Smartphone for academic purposes. A positive association was found between academic use of Smartphone and female sex (PR: 1.16, 95% CI: 1.06-1.26, p = 0.001), from Paraguay (PR: 1.44, 95% CI: 1.33-1.55, p < 0.001), carry out clinical cycles (PR: 1.12, IC95%: 1.03-1.23, p = 0.012), training in SCOPUS (PR: 1.26, IC95%: 1.17-1.35, p <0.001) and belonging to research groups (PR : 1.23, 95% CI: 1.13-1.34, p <0.001). In multiple regression, students affiliated with academic groups had 18% less prevalence of Smartphone academic use (PR: 0.82, 95% CI: 0.75-0.89, p <0.001). Discussion: Most students used Smartphone for academic purposes. The affiliation to academic groups seems to reduce the prevalence of its use. More evidence is needed on the factors related to the use of information technologies such as the Smartphone, particularly in the student-physician population. Keywords: Smartphone, information and communication technologies, medical student, medical education.
143 Effectiveness of Instruction Program on Nurses' Knowledgeabout Clinical Devices Alarm in Intensive Care Unit , A. S. Obeid, MSCN, Hudabakerhassan
The clinical alarms are used to enhance safety by alerting care provider to any deviations from normal status. The alarms alert care provider when there is deterioration in patient’s condition and there is a need for intervention, or when a device is not working as it should (1). Objectives:The aims of present study is to find out the effectiveness of instruction program on nurses knowledge about the clinical devices alarm, and to find out the relationship between the effectiveness of program and nurses level of education, year of experiences in nursing, and year of experiences in intensive care units. Methodology: a quasi-experimental study wascarried out on 80 nurses is divided to two groups (Experimental group who exposed on program, and control group to compare with experimental group) two group of nurse is workingin Al-Imam Al-Hussein Medical City, in holy Kerbala’a City, Iraq. The study started at 3rd of May, 2020 to 25th of May, 2021.The instrument consist of two part; part one deals the characteristics of the sample which of age, gender, level of education, year of experiences in nursing, year of experiences in intensive care units, and specific training course. Part two deals the nurses knowledge related to clinical devices alarm which of 30 items, the validity of instrument and program was obtained from 12 expert in specialty, the reliability was =1.81, the data analysis was done by uses SPSS program version 23, the statistical methods which used in present study is descriptive and inferential statistics. Results: the findings of present study revealed that the correct answer for experimental group at pretest was 42.44% then at post test was 99.87%, and correct answer for control group was 31.71 at pretest and 35.69% at post test., and there were statistical differences between experimental and control group at post test at P≤0.05 Conclusions:the study concluded that the instruction program on nurses knowledge was effective on experimental group through improving their knowledge Recommendations:The researchers recommend that the current program should be applied to all nurses in critical units because of its utmost importance in monitoring and patient safety. Keywords:Effectiveness, InstructionsProgram,Nurses, Knowledge, Clinical, Monitoring, Devices, Alarms, Intensive Care Unit
144 Assessment of Spinal Cord Injured Patients' Adherence toward Clean Intermittent Self-Catheterization in Baghdad City , M. A Hussein, W. Mohammed
Background: Patients with spinal cord injuries should adhere to the practice of self-intermittent catheterization, in order to reduce their urinary tract problems such as bladder stones or urinary tract infection and others. Aim: To evaluate the spinal cord injured patients' adherence toward clean intermittent self-catheterization. Methodology: A descriptive analytic study design was carried out to assess the spinal cord injured patients' adherence toward clean intermittent self-catheterization in Baghdad city. A non-probability (purposive) sample of (26) spinal cord injured patients with paraplegia. The study instrument was composed of two parts which: Socio-demographic characteristic and the patients' compliance with clean intermittent catheterization measured by Intermittent Catheterization Adherence Scale (ICAS). Results: The majority of the samples (73%) were (18-32) years old, (58%) were single, (42%) were primary graduate, and (50) of those in median level of economic status. The results demonstrated a strong adherence of the patients to the self-intermittent catheterization. Conclusion: The study indicated that the participants have a high adhere to the application of the clean intermittent catheterization. Keywords: Assessment; Spinal Cord Injury; Adherence; Clean Intermittent Self-Catheterization.
145 Acute Diarrhea in Exclusively Breast Fed Infants in relation to Zinc Level , Rian Mahmood Ibrahim1, Nashwan Mustafa Al Hafidh
Background: Zinc deficiency is associated with alteration in gastrointestinal tract structure, function, and impaired immune function. Aim: To analyze the effects of zinc deficiency on the occurrence of acute diarrhea in exclusively breast-fed infants. Methods: In a case-control study, including a total of 72 exclusively breast-fed infants aged ≤ 6 months, 34 of them with acute diarrhea were in the study group and 38 infants as the healthy control group. Demographic characteristics of all infants and their parents were studied. Serum Zinc level was measured for all participants. Results: Zinc level had significant (p-value =0.000) differences between infants with acute diarrhea and the healthy control group. The mean serum zinc value ± SEM in children with acute diarrhea was 63.11 ± 1.7 which was significantly (p = 0.000) different from the mean serum zinc value ± SEM (78.6 ± 1.6) in healthy infants. A cut-off value 60.6μg/dl of total serum zinc level was significantly (p = 0.000) associated with a sensitivity of 100 % with the occurrence of acute diarrhea among exclusively breast-fed infants. Conclusions: Low serum zinc level is associated with the occurrence of acute diarrhea in exclusively breast-fed infants. A cutoff serum zinc value of 60.6 μg/dl has 100% sensitivity with the occurrence of acute diarrhea among breast-fed infants. Keywords: Zinc deficiency, diarrhea, infants, breastfeeding.
146 Effectiveness of Spinal Mobilization with Leg Movement Versus McKenzie Back Extension Exercises in Lumbar Radiculopathy , B. Ashraf, S. Ahmad, K. Ashraf, S. Kanwal, S. Ashraf, N. Khan, M. Nouman, S. Shafique
Background: Lumbar Radiculopathy is characterized as radiating pain along with some sensory and motor deficits in lower back and hip into the leg. Manual therapy techniques like Spinal mobilization with leg movement and McKenzie Extension exercise seems to be effective in treating and managing the symptoms associated with Radiculopathy. Aim: To make comparison between effects of Spinal mobilization with leg Movement versus McKenzie Extension exercise to manage the Lumbar Radiculopathy. Methods: The present Randomized Control Trial included 60 patients of age 28-50 years with Lumbar radiculopathy were grouped into two by sealed envelope method; the first group (A) was Experimental Group, while the other group (B) was the control Group and were selected from City hospital Multan from February 2018 to June 2018. The study participants were requested to complete the protocol for 4 weeks (3 days per week, 30 repetitions in one session). All the subjects were examined before and after the tests, for pain intensity (NPRS), functional Mobility measured by MODI and range of motion by goniometry. Results: Results of the study showed significant decrease in pain intensity on NPRS (P< 0.05) and MODI Scoring (P<0.05) with noticeable improvement in Functions and range of motion measured by Goniometry. (Readings were taken at 1st session and at the end of the completion of the session). Pain was equally reduced in both groups while improvement in MODI scoring and Range of motion was more significant in experimental group (A) with respect to the control group (B). Conclusion: Study showed that both techniques SMWLW and McKenzie Extension Exercises were effective in improving the pain, decreasing the severity and MODI Scoring while SMWLM is more effective in improving range of motion. Keywords: Lumbar Radiculopathy, Spinal mobilization with leg movement, McKenzie Extension Exercises
147 Awareness of COVID-19 among dental practitioners of Multan , M. Ahmad, U. Hussain, A. Elahi, A. Nazir, Jawadtareen, F. A. Chaudhary
Background: Corona Virus Disease 2019 (COVID-19) is a global pandemic still at large whose vaccination is in a trial phase. Dental practitioners are at high risk of exposure to this deadly epidemic. Therefore, the purpose of this study is to assess the knowledge and practice of dentists in the city of Multan, Pakistan. Method: This cross-sectional study was carried out in Multan, Pakistan from January to March 2021. A 30 items valid and reliable self-administrative questionnaire was used to assess the knowledge, practice, and source of information regarding the COVID-19 pandemic from dentists. Result: The results showed that the majority of dentists practicing in Multan had good knowledge (97.8%) and more than half of the respondents had good practice (65.6%). The most common source of their knowledge was WHO and Television. Almost half of the respondents showed fear of this virus in their practices. Conclusion: Dental practitioners of Multan revealed good knowledge regarding COVID-19. However, some key points were lacking in their knowledge and practice. Our findings have important implications for developing strategies that will improve the knowledge and practices of dentists in this region and also in whole country. Keywords: COVID-19, Coronavirus, Knowledge, Awareness, Dentists, Multan.
148 The Effect of Hypothyroidism on the Development and course of Heart Failure , R. E. Tokmachev, A. V. Budnevsky, A. Y. Kravchenko, Y. S. Shkatova, T. A. Chernik, Y. A. Krasnikova
Thyroid gland dysfunction is a risk factor for development of cardiovascular diseases. From all types of thyroid gland dysfunction hypothyroidism is the most common. Increasing of thyroid-stimulating hormone level can influence the clinical course of chronic heart failure (CHF) because of its extrathyroid effects - namely - influence on lipide metabolism, endothelial function of vessels and blood pressure. Also CHF itself can make negative impact on a thyroid gland functioning, therefore pathophysiological "vicious circle" is formed. Manifest hypothyroidism is associated with an increased risk of general and cardiovascular mortality and frequency of hospitalizations of CHF patients. Association between subclinical hypothyroidism and heart failure is less studied. Figuring out the mechanisms of influence of thyroid gland hypofunction on systolic and diastolic function of myocardium may be important for effective treatment of heart failure and improvement of clinical outcomes. MeSH words: heart failure; hypothyroidism; thyroid-stimulating hormone (TSH); review.
149 The Effects of Alkaline Ionized Water Administration to the Total Cholesterol Levels in Patients with Type 2 Diabetes Mellitus Accompanied by Dyslipidemia , A. Ramadhan, S. A. Wicaksono, T. E. Nugroho, S. B. Utami
Background: Total cholesterol is a measure of the total amount of cholesterol components including LDL (low-density lipoprotein), HDL (high-density lipoprotein), and VLDL (very low-density lipoprotein). Alkaline ionized water (AIW) is an electrolyzed water with a hydrogen-rich molecule and an alkaline pH. It has a negative oxidation-reduction potential (ORP) and reactive oxygen species (ROS)-scavenging activity, which shows an antioxidant and has beneficial effects on reducing total cholesterol level, but the results still vary. This study was to investigate the effect of AIW to total cholesterol and other lipid profiles level in patients with type-2 diabetes mellitus (T2DM) accompanied by dyslipidemia. Methods: This was a randomized double blind controlled trial performed in December 2017–December 2018. Thirty patients that had been diagnosed with T2DM accompanied by dyslipidemia in Diponegoro National Hospital Semarang and met the inclussion criteria were determined by consecutive sampling. Subjects were randomly divided into two groups: AIW group (n=15) and control group (mineral water, MW) (pH 7) (n=15). Both were administered orally 1 liter per day for 12 days; total cholesterol level and other lipid profiles were measured before and after 12 days treatment. The statistical analysis was using independent t-test, paired t-test, and non-parametric Mann-Whitney test. Result: There were no differences between AIW group and mineral water group in all lipid profiles at before and after treatment, including total cholesterol (pre-treatment: 290.2 ± 41.45 mg/dL vs 282.2 ± 15.81 mg/dL, p=0.575, and post-treatment: 249.8 ± 41.17 vs 268.5 ± 16.73 mg/dL, p=0.097), LDLc (pre-treatment: 167.0 ± 9.17 mg/dL vs 162.2 ± 4.75 mg/dL, p=0.227, and post-treatment: 157.2 ± 8.88 mg/dL vs 157.6 ± 5.39 mg/dL, p=0.518), HDLc (pre-treatment: 43.8 ± 4.16 mg/dL vs 42.8 ± 4.45 mg/dL, p=0.136 and post-treatment: 47.1 ± 3.24 mg/dL vs 45.2 ± 1.98 mg/dL, p=0.142), and triglyceride (pre-treatment: 351.0 ± 119.36 mg/dL vs 381.3 ± 59.38 mg/dL, p=0.934 and post-treatment: 266.4 ± 115.63 mg/dL vs 317.6 ± 70.50 mg/dL, p=0.154), respectively. There was a wider differences between post- and pre-treatment of total cholesterol (Δtotal cholesterol) (40.4 ± 31.57 vs 13.7 ± 10.65, p=0.002), LDLc (ΔLDLc) (9.8 ± 4.29 vs 4.6 ± 1.54, p=0.000), and HDLc (ΔHDLc) (4.3 ± 1.87 vs 3.4 ± 3.11, p=0.031) in AIW group compared to mineral water group. Conclusion: Alkaline ionized water (AIW) decreased total cholesterol and improved other lipid profiles level in patients with T2DM accompanied by dyslipidemia. These findings might have important implications for the management of T2DM accompanied by dyslipidemia. Keywords : alkaline ionized water, total cholesterol level, type 2 diabetes mellitus, T2DM
150 A Prospective Study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India , Z. Khoshdel, S. Tomas
Aim: A prospective study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India Methodology: the prospective observational study was conducted for 6 months from September 2016_Febrry to 2017. All inpatients women who are pregnant and anemic. The patient data collection was used to collect all the details like inpatient number, age, sex, social history, history, laboratory data, diagnosis, therapeutic management. All inpatients diagnosed anemia in pregnancy and pregnant women without anemia. Fulfilling the inclusion criteria will be enrolled into the study and their prescriptions will be analyzed on daily basis. The prescription guidelines, Micromedex, interaction checker, drug interaction database, and Stockley's drug interaction book 8 edition. The drug interaction in prescription was collected and then compare with guidelines. When the analysis of prescription was completed then all data entered into the appropriate software and the results were gained. Results: The present study was focused to find out the presence of anemia in 110 pregnant women who were admitted to gynecology and OBG wards of BBH (Bangalore Baptist Hospital). Presence study showed that anemia was Confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20 (18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. The result of this study showed that LBW is higher in anemic women 19(25%) compared to non-anemic 17(21%). Conclusion: The present study showed from a total of 110 patients were included in this study, anemia was confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20(18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. More low-birth-weight (LBW) babies were born to anemic mothers. Anemia in pregnancy may be reduced by proper Iron and folic acid supplementation which can be improved through providing proper ANC services. Has also a recognizable association with fetal outcome. Keywords: Anemia, Iron, anemia, iron supplementation, pregnancy, low birth weight.
151 Evaluating the Accuracy of the Risk Assessment Tools in Predicting CVD Events in Tertiary Care Hospital, Bangalore, India , Elnaz Golabgir, Raju Koneri
Aim: To evaluate the accuracy of the risk assessment tools in predicting CVD events in tertiary care hospital, Bangalore, India. Methodology: A Prospective observational study conducted in medicine wards of a tertiary-care hospital for eight months. We collected all the details like inpatient number, age, sex, social status, laboratory data, weight, height, Blood Pressure (BP), family history, and therapeutic management. Then introduced the data to FRS and ASCVD risk score calculators and determined the risk for development of CVD in each patient and observed risk score for each risk factor in the study sample. Results: FRS and ASCVD predicted the risk factor for developing CHD; BMI values, tobacco use, alcohol consumption, diabetes, Total Cholesterol. FRS and ASCVD risk scores were used to classify individuals according to Low, Moderate and High-risk factor, the percentage was respectively (70%, 22%, 8%) for ASCVD and (61%,21%, 18%) for FRS. Using FRS and ASCVD, we observed that patients with high BMI values, smokers, alcoholics, diabetics, and patients with high TC, LDL, and TG levels with Low HDL levels were more likely to have a high risk of developing CVDs. Conclusion: The Risk Scores helped in investigating the status of cardiovascular patients and predicting the incidence of CVD events by determining risk factors. This study emphasizes the importance of good planning and predicting of CVDs in advance as a way to prevent the disease or lower its risk in individuals by studying the risk factors and calculating the risk using Framingham Risk Score and AHA/ACC risk score (ASCVD). Keywords: Atherosclerosis Cardiovascular Disease (ASCVD), Risk Factors, cardiovascular disease
152 Orthodontists’ Attitude and Practice in the Provision of Orthodontic Treatment for Patients with Visual and Hearing Impairments , R. Bilal, R. Alsuhaibani
Aim: To determine the behavior and attitudes of orthodontists toward providing orthodontic care for patients with visual impairment (VI) and hearing impairment (HI). Method: This cross-sectional study utilized a self-administered questionnaire that was completed by forty orthodontists. The questionnaire consisted of closed questions about past educational lectures and training in the field of special needs, as well as orthodontist’s enthusiasm, confidence, and experience in the provision of treatment for patients with special needs. A five point’s Likert scale was developed and used to determine the attitude of orthodontists towards providing orthodontic treatment for patients with visual impairment (VI Scale) and hearing impairment (HI Scale). Results: There was no statistically significant difference in the orthodontist’s degrees and their country of postgraduate study in determining their general foundation and attitude towards special needs care. Furthermore, the total years of experience was found to be irrelevant. Orthodontists tended to have a more favorable attitude toward patients with HI than toward patients with VI. (P=0.007) Conclusion: People with sensory impairments cannot be considered a homogeneous group. Insight into the treatment needs for different groups of persons with disabilities is required in order to enhance treatment planning and the quality of life of these patients. Keywords: orthodontist; orthodontic treatment, behavior; attitude; patients; visual and hearing impairments.
153 Mental Health and Obesity: A Narrative Review , M. M. Sopian, S. Abbas, S. H. Teoh, E. Khan, R. Hami, S. A. T. Din
Both mental health issues and obesity are widespread problems with major public health implications. Because of their increasing prevalence and the fact that they carry an increased risk for cardiovascular disease, a potential association between depression, anxiety, and stress and obesity has been presumed and repeatedly examined. As various studies concerning overweight and obesity have been published, the objective of this review is to appraise critically the literatureto clarify the association between mental health andobesity.More extensive research in this field is needed to improve management and minimize the chance of potential complications. Keywords: mental health, depression, anxiety, stress, obesity
154 A Comparative Study of in hospital Complications among Diabetic Hypertensive Patients and Normal Blood Pressure Diabetic Patients Presented with Acute Myocardial Infarction , B. Akhtar, H. Ishaq, M. T. Raza, M. Ismail, I. E. Soomro, R. Khan
Aim: To compare the incidence of in-hospital complications between diabetic normotensive and hypertensive diabetic patients presenting with acute myocardial infarction (MI) Methodology: This observational cohort study was conducted at National Institute of Cardiovascular Diseases Karachi from May 2019 to April 2020. We examined 220 diabetics with acute MI were included. 50% of the patients had high blood pressure and the rest had normal blood pressure. After enrollment in the study, selectees were observed for acute myocardial infarction complications in the hospital. Results: Most of the baseline characteristics were similar in both groups of patients. However, the hypertensive patients in the diabetes group had diabetes, high heart rate, and high blood pressure at reporting. The complication rates did not differ statistically between the two groups. The rates of complications occurred between diabetes and normotensive hypertension; Atrial fibrillation (AF) 15.5% vs 12.7% p = 0.194, respectively, ventricular tachycardia (LH) 14.5% vs 13.6%, AV block type-1 8.2% vs 7.3% p = 0.296, type2 AV block 2.7% vs 1.8% p = 0.352, complete heart block 11.8% vs 10% p = 0.313, acute congestive heart failure (CHF) 13.6% VS% 9.1 p = 0.137, left ventricular failure (LVF)19.1% vs 16.4% p = 0.259, cardiogenic shock (CS) 14.5% vs 10.9% p = 0.184, recurrent IM (Re-MI) 14.5% 10.9% p = 0.184 and mortality 14.5% vs 12.7 and% p = 0.326, respectively. Conclusion:It is concluded that diabetic patients with hypertensionhave not elevated risk of complications in the hospital after acute myocardial infarction. Key words: diabetes, hypertension, hospital complications, acute myocardial infarction
155 Knowledge of Nurses Regarding Prevention From Needle Stick Injuries in Tertiary Care Hopital Lahore Pakistan , Zarnigar, R. Elahi, T. Sagir, T. Zia, W. Latif, T. Laique
Nurses got exposed to various blood borne infections due to injury from different types of sharp instruments like needles, lancets, scissors etc. Such injuries ultimately became the reasons of blood borne diseases. Objectives: To analyze the knowledge and attitude of nurses about prevention from needle stick injury and the magnitude of such incidents in Tertiary Care Hospitals of Lahore. Study Design: Cross-sectional study. Methodology: Study setting was tertiary care hospitals of Lahore-Pakistan after ethical review committee’s (ERC) approval. Data was collected from nurses by using self-administered questionnaire from different department of tertiary care hospitals, Lahore. Convenient sampling technique was used, and sample size was 93. Statistical analysis: SPSS 21 was utilized for the data analysis. The tests of frequencies, percentages and graphs were applied. Results: Needle stick injuries association was measured with working experience among nurses. There was statistically significant difference found between the NSIs among (59%) nurses, who were having more working experience (22-24) about handling of needle during any procedure as compared to the nurses who lack in experience. The study results showed that majority of nurses have enough knowledge concerning to NSIs. Conclusion: We concluded that nurses have knowledge regarding the needle stick injury due to the training classes, however, ignorance of the protocols becomes the reason of such incidents even now. It is the need of time to implement appropriate strategies for precaution and intervention through hospital administration to avoid the needle stick injuries. Key Words: Needle Stick Injury, Re-capping of needles, Attitude and Knowledge
156 The Influence of Covid-19 Lockdown on Body Mass Index, Depression, Anxiety and Stress among Medical Students , R. Masud, A. F. Anjum, A. Khokhar, I. Naiyar, H. Ayaz, R. Azhar, M. Azeem, R. Irfan, S. Azam, S. Shoaib, S. N. Hashmi, T. Laique
The Covid-19 pandemic has wreaked havoc throughout the world, with 150 million cases to date and over 3 million lives claimed worldwide. Objectives: To explore the impact of the Covid-19 lockdown on psychological health parameters i.e. depression, anxiety and stress as well as on body mass index among medical students studying in a private medical college in Pakistan. Study Design: Experimental study. Methodology: This study with enrolled students (n=233) was carried out after ethical review committee’s (ERC) approval at CMH Kharian Medical College (CKMC), Physiology Department, Kharian-Pakistan. Both male and female medical students were enrolled. In phase 1, the students reported to the Physiology laboratory where age and gender were recorded. The pre-lockdown readings of BMI and DASS-21(Depression, Anxiety, Stress) scale were taken. In phase-2, the post-lockdown readings of BMI and DASS-21 scale were taken once the students returned to campus. Statistical analysis: Data was analyzed by SPSS software, version 21. BMI and DASS-21 score were presented as mean + SD. Statistical significance was taken at p value <0.05. Results: In present study, results showed that there was a decrease in level of depression post-Covid-19-lockdown among enrolled subjects with significant p-values (0.019*) in the pre and post covid-19-lockdown comparison. Conclusion: We concluded that significant difference was seen between Pre & Post Covid-19-lockdown depression with p-value of <0.019. However, insignificant difference was seen between Pre & Post Covid-19-lockdown anxiety and stress with p-value of >0.05. Key Words: Covid-19 lockdown, Medical students, Depression, BMI and Anxiety.
157 Correlation between atopy and Covid-19: A cross sectional study , M. Z. Anwar, A. F. Anjum, M. Ur Rehman, S. A. A. Gardezi, I. Rafique, A. Asad, M. R. Ul I. Hashmi, S. Shoaib, S. N. Hashmi, T. Laique
The whole world is facing one of the biggest health related disasters of the century. As a novel disease, Covid-19 has so many parameters yet to explore. Objectives: To explore any correlation between atopy and Covid-19 among residents of Gujrat and Kharian, Punjab, Pakistan. Study Design: Cross-sectional study. Methodology: This study with enrolled subjects (n=206) was carried out after ethical review committee’s (ERC) approval at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan. Both male and female medical subjects were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like gender, allergy and treatment taken were presented as frequency and percentage. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, only 13 patients had allergy from different allergens. Only 2 patients required hospitalization and injectable treatment. Conclusion: We concluded that there is strong affiliation between atopy and Covid-19 presentations. Key Words: Covid-19, Atopy, Treatment and Gender
158 Factors Contributing to Delayed Diagnosis of Congenital Heart Disease in Pediatric Population , S. Iqbal, S. Saidullah, R. I. Ahmed, M. A. A. Khan, N. Ahmed, M. F. Khan
Objective: To analyze various factors contributing to delayed diagnosis of congenital heart disease (CHD) in pediatric population. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawalakot from January to December 2020. Material and Methods: A total of 265 children of both genders aged up to 15 years and presenting for the 1st time with the echocardiography confirmed diagnosis of CHD were enrolled. A special proforma was designed and questions were asked from parents/guardians of all study participants. Socio-demographic profile along with improper referral status and inadequate health facilities were noted. SPSS version 26.0 was used for statistical analysis. Qualitative variables like gender, area of residence, literacy status, socio-economic status, types of CHDs, delayed diagnosis (yes/no) and reasons for delayed diagnosis were represented as frequency and percentages. Results: In a total of 265 children included in the study, there were 156 (58.9%) male. Majority of the children, 184 (69.4%) were less than 2 years of age. Body weight below 3rd centile was noted in 164 (61.9%) children. Maternal fetal echocardiography was done in 13 (4.9%). Acyanotic CHD was noted in 180 (67.9%) children while remaining had cyanotic CHD 85 (32.1%). Delayed diagnosis of CHD was noticed in 211 (79.6%) children. Most common factor contributing to delayed diagnosis of CHD was found to be delayed 1st consultation in 85 (40.3%). Delayed or missed diagnosis by the doctor was the 2nd most frequent factor contributing to delayed diagnosis of CHD noted in 52 (24.6%) children. Delayed referrals were observed in 42 (19.9%) children. Conclusion: Delayed diagnosis of CHD was noted among 79.6% cases. Acyanotic CHD was the commonest type of CHD in the present study. Most common factors contributing to delayed diagnosis of CHD were delayed 1st consultation, delayed diagnosis by the doctor and delayed referrals. Keywords: Congenital heart disease, fetal echocardiography, delayed referrals.
159 Awareness and Practice of Oral Hygiene Measures amongst College Students of Lahore , M. S. Sadiq, Z. B. Sohail, F. Riaz, M. S. Chishty, M. Munawar, S. Sabir
Objective: To evaluate awareness and practice of oral hygiene measures amongst college students of Lahore. To assess awareness and practice of oral hygiene measures amongst students of CMH LMC, LUMS, UET, FAST, Punjab College & Lahore Garrison University Materials and Methods: A survey was conducted among non-dental students using a questionnaire. Results: Most frequently used oral hygiene measure was toothbrush (81.3%). Most frequently used interdental aid was toothpick. (53.8%). 68% of the participants were aware about oral hygiene and most common mode of awareness was by dental fraternity 34.6%. 51% of the participants were using interdental aids. 49% of the participants were not using oral hygiene adjuncts and the most common reason was not knowing how to use it. (28.8%) Conclusions:68% of the participants were aware about oral hygiene measures but only half of the participants in this study engaged in regular oral hygiene measures and lack of knowledge was the dominant reason for not doing so. Key words: oral health, periodontal disease, interdental areas, interdental cleansing, interdental aids.
160 Medicolegal Autopsy: Histopathological Examination of Medicolegal Autopsy Cases and Its Correlation with Causes of Death , S. S. A. Naqvi, Gulshad, K. Sheikh, I. Wagan, A. Maher, S. A. A. Naqvi
Objective: The aim of this study is to determine the histopathological examination of medicolegal autopsy cases and its correlation with causes of death. Study Design: Retrospective/observational Place and Duration: This study was conducted at department of Pathology, Khairpur Medical College Khairpur Mir's for duration of eight months from 15thMay, 2020 to 15thJanuary, 2021. Methods: Hundred cases of both genders were presented in this study. Cases were aged between 15-75 years. Cases detailed demographics age, sex and body mass index were calculated after taking informed written consent from authorities. Autopsy laboratory was used to take medicolegal autopsies of enrolled cases. 10% formalin solution was used for histopathological examination of all the specimens. In the course of the post-mortem investigation we examined the histopathology results for five major organs, such as the brain, heart, lung, liver and kidneys and compared them with gross anatomical results. Complete data was analyzed by SPSS 24.0 version. Results: 62 (62%) cases were males and 38 (38%) patients were females. Mean age of the participants were 30.52±13.17 years with mean BMI 24.52±16.21kg/m2. Most of the participants 40 (40%) were aged between 25-35 years of age followed by 27 (27%) were aged between 36-45 years. Most of the participants 70 (70%) were from urban area and the rest were 30 (30%) from rural area. Instant death was the most common cause found in 35 (35%) cases, followed by traffic accidents 24 (24%) cases. Most frequent effected organs were lung 29%, heart 26%, liver 21% and brain 18%. In lungs pneumonia was the most common effected pathology among 20 (68.97%) and in heart atherosclerosis was the most common effected pathology among 21 (80.77%). Conclusion: In medicolegal autopsy cases, histopathological analysis may be regarded as a useful method. The most common organ in these cases were the heart, liver and lungs. In certain cases, the histopathological exam of these bodies has been useful in identifying the cause of death. Often pathological results included pneumonia, atherosclerosis and congestion. Keywords: Histopathology, Medicolegal, Cause of death, Autopsy
161 To Compare the Dissection of Gallbladder by Ultrasonic Harmonic Scalpel Versus Electrocautery in Laparoscopic Cholecystectomy , H. B. Burki, Ghansham, W. Afridi, V. Kumar, A. Hassan, S. Muhammad
Objectives: To assess the dissection of gallbladder by ultrasonic harmonic scalpel in comparison to electrocautery in laparoscopic cholecystectomy. Study Design: A randomized control trial Study Setting and Duration: Department of Surgery Ward-02 Jinnah Postgraduate Medical Centre, Karachi between June 2018 and February 2019. Methodology: A total of 110 patients diagnosed with cholelithiasis were included in the study. The participants were randomly allocated into two groups i.e., harmonic scalpel group and electrocautery group. Patients were followed postoperatively in the ward and the outcome was measured at the end of two days after surgery. Results: The average age of the patients was 44.56 ± 12.19 years. Out of 110 patients, 30 (27.3%) were male and 80 (72.7%) were female. It was found that the mean operative time (44.4 ± 3.64 min vs. 53.31 ± 8.09 min; p=0.0005), blood loss (10.27 ± 8.35ml vs. 4.00 ± 3.65ml; p=0.0005), post-operative pain (6.87 ± 1.04 vs. 4.29 ± 1.01 p=0.0005), and hospital stay (31.09 ± 10.58 vs. 24.11 ± 0.81; p=0.0005) were significantly lower in harmonic scalpel group than the electrocautery group. Conclusion: Dissection of gall bladder with harmonic scalpel is safe and easy method and superior then electrocautery and can routinely be used if available. Keywords: Laparoscopic cholecystectomy, Harmonic scalpel, Electrocautery
162 Determine Theadverse Effects of Formula Milk on Infants , K. Sheikh, Gulshad, S. S. A. Naqvi, I. Wagan, A. Maher, S. A. Naqvi
Objective: To determine the adverse effects of formula milk in infants presented to our institution. Study Design: Retrospective/observational Place and Duration:The study was conducted at Paediatric Department of Liaquat University Medical Hospital Jamshoro and Civil Hospital Khairpur Mir's. Methodology: Total 85 formula-fed infants of both genders with ages upto 2 years were included in this study. Detailed demographics including age, sex, weight, residence and socio-economic status were recorded after taking informed written consent from guardians/parents. Adverse effects such as iron deficiency, low weight, gastroenteritis, type I diabetes mellitus and autoimmune disease were examined. Data was analyzed by SPSS 24.0. Results: There were 45 (52.94%) females whiles 40 (47.06%) were males. Mean age was 1.86±1.02 years. 52 (61.18%) patients had urban residence and majority 50 (58.82%) had high socio-economic status. Iron deficiency was found in 38 (44.71%) infants, 32 (37.65%) infants had abnormal low weight, 24 (28.24%) had gastroenteritis/diarrhea, 18 (21.18%) infants had type I diabetes and 14 (16.47%) infants had autoimmune disease. Conclusion: It is concluded that formula milk was associated with many of adverse effects, the most common was iron deficiency and low weight. Mothers should be aware of these adverse effects of formula fed. Keywords: Formula Milk, Infants, Iron Deficiency, Low Weight, Infection, Type I Diabetes.
163 Frequency and Causes of Pericardial Effusion in Patients Presenting to Emergency Department with Dyspnea , A. Abrar, F. Faisal, M. U. Rehman, A. A. Shah, M. Shoaib, M. A. Raza
Objective: To determine the frequency and causes of pericardial effusion in patients presenting to emergency department with dyspnea. Study Design: Prospective/Observational study Place & Duration:Cardiac Centre, Pakistan Institute of Medical Sciences (PIMS),Islamabad for duration of one year from January 2019 to Dec 2019. Methods: A total 220 patients of both genders with ages above 20 years presented with dyspnea were enrolled in this study. Patients detailed medical history was recorded after taking informed consent. All patients had received echocardiography to examine the incidence of pericardial effusion. Causes of pericardial effusion were recorded. Data was analyzed by SPSS 24.0. Results: Out of 220 patients 38 (17.27%) patients had pericardial effusion. Among these 26 (68.42%) were males while rest 31.58% patients were females. 5 (13.16%) patients had ages <40 years while 33 (86.84%) patients had ages >40 years. 20 (52.63%) patients had small size effusion, 15 (39.47%) patients had moderate size and 3 (7.89%) patients had large size effusion. Neoplastic diseases were the commonest cause of pericardial effusion found in 15 (39.47%) patients followed by idiopathic in 10 (26.32%), uremia in 6 (15.79%) patients, 3 (7.89%) patients had bacterial infections, 3 (7.89%) had HIV positive and 1 (2.63%) patient had other. Conclusion: It is concluded that incidence of pericardial effusion is high in patients with unexplained dyspnea. Neoplastic was the commonest cause of pericardial effusion. Keywords: Pericardial Effusion, Frequency, Causes, Dyspnea. Electrocardiogram
164 Frequency of Obesity among Gastroesophageal Reflux Disease Patients , K. H. Samejo, S. K. Kumar, G. Lail, A. B. Langove, S. Ahsam, A. Devi, R. Mandhwani, N. H. Luck
Objective: Gastroesophageal reflux disease (GERD) prevalence ranges from 24% to 35% in Pakistani population. Studies have demonstrated GERD frequency is directly proportional to increasing weight. Thus, the frequency of obesity among gastro esophageal reflux disease patients was determined. Methodology: This cross-sectional study was conducted on outpatients with GERD visiting Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi; from December 2017 to June 2018. Clinical and demographic parameters of study population were recorded. Body mass index (BMI) more than 27 was labeled as obese. Patients with history of ischemic heart disease, pregnancy, ascites and/or Patients on NSAIDS, bisphosphonates or steroids were excluded. Results: One hundred and fifty patients with mean age of 43.3±11.5 years were included in study. Eighty-seven patients (63.3%) had age more than 40 years. Majority of study population were males 95 (63.3%). Mean height and weight of study population were 163.09±9.56 cm and 72.92±15.13 kg, respectively. Mean BMI were 27.55±6.02 in which 71 (47.3%) were obese i.e., BMI >27. Majority were Urdu speaking i.e., 57 (38%) followed by Sindhi 31 (20%) Diabetes mellitus was documented in 22 (14.7%) and hypertension in 16 (10.7%) patients. Statistically significant association of GERD was seen in obese females (p-value: 0.018) Conclusion: Increase frequency of obesity is significantly associated with GERD. More proportion of obese females has GERD. Keywords: Gastro esophageal reflux disease; Body mass index; Weight; height
165 The Incidence of Peripheral Artery Disease in Patients with Rheumatoid Arthritis , M. A. Anjum, M. J. Iqbal, I. Joher, M. Usman, A. Hussain, A. Rabbani
Objectives: The basic aim of this study was to find the expression of PAD in a group of Rheumatoid arthritis participants but with no record of any cardiovascular diseases. Methods: On Ninety subjects with no record of considerable CVD but with RA a prospective observational non-experimental studywas performed. Doppler spectral waveform analysis and Ankle Brachial Pressure Index for vascular judgment was performed. Place and Duration: In the Medicine Department of Aziz Fatima Medical and Dental College Faisalabad for one-year duration from April 2020 to April 2021. Results: In this study total 90 of participants were selected out of which 18 were males and 72 were females. The mean age for this study and time period of RA was 62 ±9.01 and 11.8±11.2 years respectively. It was noticed that seventy five percent of the subjects had triphasic waveforms in the Right foot while sixty percent had in the Left foot when examined the posterior tibial or PT artery. In sixty-eight percent of the total participants triphasic waveforms of the Dorsalis Pedis Arteries were found. Biphasic right was present in thirty percent subjects while biphasic left was present in thirty five percent subjects. Biphasic Dorsalis Pedis was found in forty percent participants of both feet. Only one subject was found with discontinuous monophasic PT of both feet. Conclusions: Results show that ABPI index was discovered normal in majority of patients but waveform analysis was found suboptimal or biphasic in total of one-third of the participants. These results indicatethat to find patients with early PAD the judgment of peripheral arterial perfusion should use both modes. Keywords: Rheumatoid arthritis, ankle brachial pressure value, CVD risks hazards, screening.
166 Coeliac Disease and the Liver: Spectrum of Liver Serology, Histology and Response of Treatment with Gluten-Free Diet , M. J. Iqbal, M. A. Anjum, I. Joher, M. Usman, A. Rabbani, A. Hussain
Aim: To evaluate the histological spectrum of "celiac hepatitis" and the likelihood that these features will return after GFD. Methods: The laboratory tests, Clinical profile, liver and duodenal biopsy were studied with the patients with hepatic derangement and CD among 35 patients. Whenever possible, a histological comparison of before and after GFD treatmenton liver and duodenal biopsies were performed. Results: In the records of the pathology and gastroenterology departments of our institute, CD and ECM were found in 35 patients. There were twenty-four men and 11 women with a mean age of 24.3 (10-50 range). Twenty-four patients were primarily identified with celiac disease and later diagnosed with CLD. At diagnosis, this feature was currently associated with small bowel diarrhea in 13 (65%) and CD without diarrhea in the remaining seven patients (35%). 10 of these 20 patients had anemia. Antibodies to TTG were positive in 21 patients (87.5%), AGA in 17 patients (70.8%), and EMA in 4 patients. Severe villous abnormality (Marsh-Oberhuber type 3C) in eleven patients (45.8.3%) on duodenal biopsy, moderate villous abnormality (type 3B) in seven patients (29.2%), 5 patients (20.8%) have mild abnormality of the villi (type 3A). The clinical topographies indicating the progress of liver ailment in these 24 cases are as follows: 8 have ascites (33.3%), 6(25%) patients have jaundice, hepatomegaly in 5 (20.8%) and 5(20.8%) Patients have splenomegaly. Conclusion: There has been a problematic case of coeliac disease that has undergone an unnoticed distinction. This is one of the few researches that shows the full range of Coeliac Disease liver histopathology, from non-invasive to invasive hepatitis’. Experiment of a GFD may outcome in clinicopathological enhancement of ’coeliac hepatitis’. Keywords: Gluten-free diet, coeliac disease, duodenal biopsies, hepatomegaly.
167 Effect of Metformin Therapy on Clinical and Hormonal Indices of Patients with Polycystic Ovary Syndrome , S. Inayat, H. F. Khattak, M. G. Muhammad, K. Robeen, A. Inayat, Fatima
Objective: The main objective of this study is to determine the efficacy of metformin therapy on clinical and hormonal indices of patients with polycystic ovary syndrome. Study Design: Randomized control trial Place and Duration: Study was conducted at Obstetrics & Gynaecology department of Northwest General Hospital and Research Center, Peshawar and Mian Rashid Hussain Shaheed Memorial Hospital, Pabbi for duration of nine months from March 2020 to November 2020. Methods: Total 100 patients of polycystic ovary syndrome were presented in this study. Patients were aged between 18 to 45years. Patients detailed demographics including age, body mass index and socio-economicstatus were recorded after taking informed written consent. Patients were divided into 2-groups, group I had 50 patients and received metformin (500 mg) three times a day and group II had 50 patients and received pioglitazone (30 mg) three times a day for 3months.Clinical (body weight, blood pressure (BP), and body mass index) and indices fasting blood sugar (FBS), serum triglyceride (TG), cholesterol, low-density lipoprotein, high-density lipoprotein, insulin, testosterone, and dehydroepiandrosterone (DHEA) were measured before and after therapy. Complete data was analyzed by SPSS 22.0 version. Results: Mean age of the patients in group I was 29.18 ± 2.25 years with mean BMI 26.14 ± 8.86 kg/m2 and in group II mean age was 29.8 ± 2.52 years with mean BMI 27.64 ± 7.68 kg/m2.Significantly decrease in blood pressure (systolic 105.41±8.57, diastolic 67.19±8.9), hair loss 20 (40%),oligomenorrhea 23 (46%), body weight 74.45±9.72, waist circumference and dehydroepiandrosterone (DHEA) 2.35±0.67 and as compared to group II. Only triglycerides gave results of reduction in group II 115.39±64.11. Among both groups serum insulin, acne, menstrual disturbance and fasting blood sugar were controlled after treatment. Conclusion: We concluded in this study that use of metformin in patients with polycystic ovary syndrome resulted in to decrease clinical body weight, blood pressure (BP), body mass index and hormonal indices with reduction of serum insulin, acne, menstrual disturbance and fasting blood sugar but pioglitazone was an alternative effective and reliable method in PCOS patients. Keywords: Polycystic ovary syndrome, Insulin resistance, Metformin, Pioglitazone
168 Complications Associated to High TIMI Score in Patients with Acute ST Elevation Myocardial Infarction , M. U. Rehman, F. Faisal, A. Abrar, A. A. Shah, M. Shoaib, M. A. Raza
Objective: To determine the complications associated to High TIMI risk score among patients presented with acute ST elevation myocardial infarction. Study Design: Cross sectional Place & Duration: Study was conducted at Cardiac Centre of Pakistan Institute of Medical Sciences (PIMS), Islamabadfor duration of 6 months from January to June, 2020. Methods: Total 290 patients of both genders with ages 35 to 80 years presented with acute myocardial infarction were included in this study. Patients detailed medical history including age, sex and residence were recorded. Thrombolysis in Myocardial Infarction (TIMI) risk score was calculated for each patient. Follow up was taken during the hospital stay and after discharge. Complications were recorded on follow-up. Data was analyzed by SPSS 21.0. Results: From all the patients high TIMI score was found in 34.48% patients. Out of 100 patients 70% were male and 30% were females with mean age 54.25+12.65 years. According to the high TIMI score 100 (34.48%) patients had score above 8 and 190 (65.52%) had score less than 8. Complications were recorded ad Ventricular fibrillation, VT, AF, Heart block, cardiogenic shock and pulmonary edema in 17%, 13%, 2%, 7%, 24% and 24% patients respectively.15% patients were died during hospital stay. 28% patients had post infarct angina, 9% patients had stroke and 28% patients treated revascularization. Conclusion: We concluded from this study that frequency of high TIMI score is high in our setting and we patients with increase score had high risk of complications and mortality. Keywords: High Thrombolysis in Myocardial Infarction, Acute ST Elevation Myocardial Infarction, Frequency, Complications, Mortality.
169 Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast , M. S. Abdulqader, L. J. Khorsheed, Hwaizi
Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.
170 Exosomes derived from chronic myeloid leukemia cells: roles in disease progression, survival, and treatment , S. Parkhideh, M. Mehdizadeh, A. Hajifathali, H. G. Nazari, E. Roshandel, R. Mirfakhraie
Exosomes, biologically active extracellular vesicles, are derived from normal and neoplastic cells. Emerging evidence revealed that exosomes modulate cell-cell communication and involve in hemostatic and pathologic processes. Recent studies have shown that exosomes released from cancer cells such as chronic myeloid leukemia cells could act as a key mediator in tumor induction and progression. Myeloid cells-derived exosomes affect different processes including angiogenesis, neoplastic proliferation, tumor cell survival, and imatinib resistance. These exosomes induce angiogenesis and tumor progression by IL-8 overexpression in both leukemic and bone marrow stromal cells. Exosomes cargo could alter the expression of different adhesion molecules, anti-and pro-apoptotic molecules, cytokines, and chemokines such as VCAM-1, ICAM-1, BCL, BAD, BAX, TGF-β, TNF-α, CXCL12 which affect tumor migration, homing, survival, and growth. CML-derived exosomes can also regulate signal transduction pathways, such as ERK/MAPK, ERK/Akt, EGFR/Ras, and Wnt. Furthermore, they can be applied as a vehicle for drug delivery or sensitization of drug-resistant cells. Here, we reviewed the role of chronic myeloid cell-derived exosomes in tumor growth, survival, and resistance to treatment. Keywords: Chronic myeloid leukemia, Exosome, Angiogenesis, Tyrosine kinase inhibitor, Drug resistance.
171 The effects of selenium in the prevention and treatment of Coronavirus disease 2019: A Review , Y. Hekmatnia, M. Naghdipour, P. Valiollahi, F. Ebrahimzadeh
The coronavirus disease 2019 (COVID-19), is an ongoing global pandemic and caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is transmitted between people through respiratory droplets. Because of antiviral drug resistance and virus mutation, the treatment of covid-19 disease is facing a new challenge. Therefore, have been proposed that micronutrients can be used for strengthen the immune system as new antiviral strategies. Selenium plays an important role in immune function through its incorporation in antioxidant and anti-inflammatory activity. There is a very strong evidence that is link between selenium status and susceptibility of humans to a viral infection. Recently published studies demonstrates that serum level of selenium was lower in patients with SARS-CoV-2 infection compared to in healthy individuals. Also, the results of these study demonstrated that the serum selenium level deficiency increased the mortality rate of COVID-19. Thus, selenium supplementation can possibly be used for the prevention or treatment of patients infected with SARS-CoV-2 in selenium-deficient status. Key words: COVID-19, SARS-CoV-2, Selenium, Selenium-deficient, Mortality rate
172 Factors Associated with Moral Distress and Caring Behavior of Nurses Working in Emergency Departments of Mazandaran University of Medical Sciences During COVID-19 Pandemic , F. Talebian, T. Yaghoubi, R. Marzband
Introduction: Moral distress is one of the prevalent problems of nursing which causes stress, that leads to nurses being unable to show a proper moral function in the critical situations. Moreover, due to the stressful conditions in emergency department, caring behaviors of nurses is of great importance. This study aimed to determine the factors associated with moral distress and caring behaviors of nurses working in emergency departments in educational-medical centers of Mazandaran University of Medical Sciences during COVID-19 pandemic. Methodology: This study was descriptive-analytical which was conducted through stratified and convenience sampling, and by participation of 188 nurses working in emergency departments in 5 educational-medical centers of Mazandaran University of Medical Sciences in 2020. Data was collected through standard three-section questionnaire of demographic information, Corley moral distress and Wolf caring behaviors of nurses, and its validity and reliability was confirmed. Data was analyzed by using descriptive (mean and standard deviation, frequency and percentage) and analytical statistics (Mann–Whitney, Kruskal-Wallis, and Spearman correlation coefficient). Finding: Moral distress mean score of nurses working in emergency was 20/97±101/60 and they had 92/4% of average moral distress. Caring behavior of nurses was 8/62±101/60. Gender and marital status variables had a significant relation with caring behavior, in a way that male nurses and married nurses had a lower score (p<0.05). the relation between moral distress and caring behavior was NOT statistically significant. Final conclusion: Nursing staff must have a good command of their caring behavior so that caring will be presented in high quality, and patients and help-seekers’ satisfaction who come to the emergency, especially in COVID-19 pandemic, will be met. Thus, it is necessary that health and medical system managers provide educational programs to draw nurses’ attention to their caring behavior dimensions, especially in emergency departments. Key words: moral distress, caring behavior, emergency department nurse, COVID-19 pandemic
173 A Comparison of Thioredoxin 1 Gene Expression in Schizophrenia Patients before and after Treatment with Risperidone , E. Azizi, M. Hosseinzadeh, P. Vahdatian, A. Adibi, A. Azizifar, H. Sayyadi, O. Davarinejad, H. Seidkhani, K. Haghani
Background: Schizophrenia is a mental disorder characterized by distortions in thinking, perception, emotions, language, self-sense, and behavior. Recent research suggests that Reactive Oxygen Species (ROS) are involved in the pathophysiology of schizophrenia. Studies have also shown the increased plasma and serum levels of the Trx1 molecule in schizophrenia patients. In the present study, the researchers compared the expression levels of Trx1 mRNA in peripheral blood leukocytes of Iranian schizophrenia patients compared to healthy controls. Methods: First-episode patients (n=35) who met DSM-IV criteria for schizophrenia were recruited from patients referred to psychiatrists in the city of Ilam and Farabi Hospital in Kermanshah. Healthy people were also selected by recruiting people who, according to a psychiatrist, did not have any mental illness. Diagnoses were made for each patient by two independent experienced psychiatrists and confirmed by the Structured Clinical Interview for DSM-IV (SCID). Patients were treated with risperidone for three months and then compared with thirty- five healthy volunteers. Patients were sampled before and after treatment and then by RNA Extraction and DNA synthesis, Trx1 gene expression was performed by real-time PCR method. Results: Comparison of Trx1 gene expression in PBMCs of schizophrenic patients before and after treatment with the control group showed that the expression of Trx1 gene of the “before” treatment group was significantly increased compared with that of the control group (P= 0.0007). Also, Trx1 gene expression in PBMCs of “before” and “after “groups showed that Trx1 gene expression of “after” group was significantly decreased compared to the “before” group (P= 0.014). These results showed that the mean of positive, negative, and general psychopathology was reduced significantly in schizophrenic patients before and after treatment in all three cases (P <0.001). Conclusion: the expression of TRX in PBMCs of schizophrenic patients decreased after risperidone treatment. This reduction of expression was statistically significant and indicates the possible effect of risperidone on the expression of the TRX gene in PBMCs of these patients and decreased gene expression is associated with reduced symptoms. Confirmation of the achievement of this study requires further research. Key words: Schizophrenia, Thioredoxin, Risperidone
174 The relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in Sulaimani , S. A. Ezzaddin
Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score
175 A Comprehensive Review on Trichogram and Trichoscopy in Dermatology , F. Moodi, E. Behrangi, M. Roohaninasab, A. S. Bazargan, S. Khosravi, A. Goodarzi
Background: We reviewed the literatures focusing on trichogram and comparing it with other newly introduced trichologic diagnostic methods (to be specific trichoscopy). Methods: This is a narrative review. We searched PubMed, Scopus, EMBASE and the Web of Science for most relevant and English publications using the terms ‘trichogram’ or ‘phototrichogram’ or ‘trichoscan’ or ‘unit area trichogram’ or ‘trichoscopy’.The results were then screened by two independent reviewers and discrepancies was reviewed by another author. The text and data related to these terms were then selected out of each included study and discussed with all authors for inclusion in this study. Results: There are many hair disorders with diagnostic clues of trichogram such as Alopecia areata, Androgenic alopecia, Anagen effluvium, Telogen effluvium, Trichotillomania, Pemghigus, Psoriasis, and Loose anagen syndrome. Trichoscopy have become a widely used non-invasive practical diagnostic tool for evaluation of many immune-mediated or non-immune mediated dermatologic disorders with involvement of hair. Trichoscopy is also commonly used for following up and evaluating the therapeutic responses in affected hair-bearing area. Conclusion: Trichogram is a valuable diagnostic method for complicated hair disorders butthe trend is toward less aggressive and more sensitive informative methods like trichoscopy and trichoscan. Key words: Trichogram, Trichoscopy, Phototrichogram, Trichoscan, Unit Area Trichogram, Dermatoscopy, Dermoscopy, Hair, Alopecia, Scalp, Diagnoses
176 Chronic graft-versus-host disease: focusing on the B cells , S. Parkhideh, A. Hajifathali, E. Roshandel, Bentolhoda, K. Dehaghi, M. Soleimani
Graft-versus-host disease (GVHD) has posed many challenges in allogeneic HSCT. Thanks to the development of immunomodulating approaches, the mortality of acute GVHD (aGVHD) is drastically decreased. Nevertheless, chronic GVHD (cGVHD) is became the leading causes of death in patients who survived of aGVHD. Various studies have demonstrated the essential role of B cells in the development of cGVHD. B cells are directly involved in allogeneic reactions through a variety of mechanisms such as alloantibody production, triggering complement system, promoting antibody-dependent cellular cytotoxicity (ADCC), and cross-presentation of immune complexes. It has been known that the pathways involved in the B-cell homeostasis and survival, such as BAFF, BCR, and Notch2 signaling pathways are abnormal in cGVHD. Post-HSCT lymphopenia triggers the continuous release of BAFF, leading to abnormalities in B cell homeostasis, and increasing the survival of alloreactive/autoreactive B cells, leading to production of allo/auto-antibodies. On the other hand, reduction of regulatory B cells following HSCT, causes loss of T cell peripheral tolerance, leading to cGVHD incidence. Therefore, B cells deserve special consideration in allogeneic HSCT, and targeting alloreactive B cells might be a promising approach in cGVHD management. In this article, we discussed the role of B cells in pathophysiology of cGVHD. Keywords: Chronic graft-versus-host disease, Hematopoietic stem cell transplantation, B cell, BAFF
177 A review of available herbal medicine options for the treatment of chronic insomnia , Z. Poursaleh, M. Khodadoost, E. Vahedi, M. M. A. Attari, M. Jafari, E. Poursaleh
Background: Insomnia is a universal health problem that affects the health and quality of life of people worldwide. During the last decade treatment of insomnia with herbal has been introduced to be effective but unfortunately, the safety and efficacy of these medicines are currently uncertain. However, the administration of various herbal medicines for insomnia is increasing mainly due to the diversity of various adverse effects of western medication. Objective: The present study is aimed to investigate available herbal medicine options for the treatment of chronic insomnia. Method: All demanded data were retrieved from electronic databases, Natural Medicines, TCMID, Natural Medicines Comprehensive Database, MedlinePlus, PubMed, EMBASE, and Google Scholar. Among them, randomized clinical trials were chosen precisely to be investigated more for seeking any additional information related to the treatment of chronic insomnia. All related papers in English and Persian languages included in the study criteria. At first, 162 articles were chosen to be investigated, then after screening all articles based on the PRISMA method, 83 qualified articles remained to be investigated carefully. Results: Herbal plants with medical properties as sedative agents are obtaining more and more attention because they contain various types of natural bioactive metabolites with the lowest rate of adverse effects. Moreover, these novel medicines are highly economic, with high efficacy while could be available easily. Conclusion: The data from this study demonstrated that medical plants could yield sedative activity and some of them are effective for insomnia, but we must not forget that further clinical trials are demanded to approve this. Keywords: Sleep disorders, Chronic insomnia, Herbal medicine, Alternative medication, Treatment.
178 Inclusive Design: An Approach to Adapt Homes for the Elderly , Hossein Fallah, Jalil Nazari, Alireza Choobineh, Mohammad Ali Morowatisharifabad, Mohamad Asghari Jafarabadi
The aging trend of the world population has increased the number of elderly people. Older people prefer to spend most of their time at home. The problem is that today's homes are often unsuitable for the elderly and the disabled. Thus, problems of the current design approaches, which are based on percentiles as well as the tendency to involve the elderly and disabled people in society, have put the concept of inclusive design into consideration. Application of new design approaches, such as inclusive design allows designers to design products and services to meet the needs of a larger group of users regardless of their age and ability. Given the rapid aging of the world population, more research is needed to design specific products and environments for elderly people. Keywords: Home design, Aging, Ergonomics, Adaptation
179 The Impact of Implementing Steps of Empowerment Model on Decisional Conflict for Re-Pregnancy for Women with Failed Pregnancies: A Randomized Controlled Trial , Mozhgan Zareyee Salehabadi, Masoomeh Kheirkhah, Nazanin Esmaeeli, Shima Haghani
Background: Failed pregnancy is known as a common and destructive experience. It has physical and psychological effects on both women and their families. Due to this experience, they may become reluctant to be pregnant again. In this regard, providing the coping strategies can help in being adapted to failed pregnancies, and making informed decisions on future pregnancies. So, this study was designed and then performed to determine the effect of implementing steps of empowerment model on decision conflict for re-pregnancy for women with failed pregnancies Method: This interventional research was a randomized controlled trial with a control group conducted in Iran from January 2020 to May 2020. Participants were 80 women who had been hospitalized in a referral center during the past 3-6 weeks due to failed pregnancies. Afterward, the eligible women were divided into the two groups of intervention (n=40) and control (n=40) with random allocation of sealed envelope site and a separate code was then determined for each person. The intervention was performed in four sessions lasted for 90-minute based on the model steps (threat perception, problem solving, educational participation, and evaluation) for intervention group. O'Connor's decisional conflict scale was completed in both groups once before and once six weeks after intervention. The obtained data were analyzed using SPSS edition 16 with the independent T-test, Fisher, and chi-squared tests. Results The scores of decisional conflict and its subscales had no differences between the two groups before the intervention (P = 0.65). However, by passing six weeks from the intervention, the decisional conflict and all its subscales have reduced in the intervention group. (P < 0.001). Conclusion: Empowerment education in women with failed pregnancies improved their decision conflict in immune re-pregnancy, so empowerment education along with health care services is recommended for women with failed pregnancies. Trial registration: This randomized control trial was registered on the TCTR site with the code TCTR20191226001. Registered on 26 December 2019. https://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=5336 Keywords: Empowerment, Conflict, Decision Making, Failed Pregnancy
180 Evolution the effectiveness of cognitive-behavioral therapy and compassion therapy in resilience and emotional schemas of diabetic patients , Fatemeh Jalayer, Mohammad Hatami, Hadi Hashemirazini, Ritaliyaghat
Introduction: Nowadays, comparing the effectiveness of treatment methods to reduce the psychological problems of patients with diabetes is considered by various psychologists. The aim of this study was to compare the effectiveness of compassion therapy and cognitive-behavioral therapy in emotional schemas and resilience in patients with diabetes Type 2 Materials and Methods: The research method is applied in terms of purpose, in terms of implementation of an all-experimental experiment with pre-test, post-test and follow-up design. The statistical population of this study included all diabetic patients referred to Pasteur Hospital in Bam in the second half of 2018 who met the inclusion criteria with a total of 152 people. Sampling method was available. From the statistical population, 45 people were selected and randomly divided into three groups (15 people in cognitive-behavioral therapy group, 15 people in compassion therapy and 15 people in control group). Subjects answered Connor and Davidson Resilience Questionnaires and Leahy Emotional Schemas before and after training. Data were analyzed using covariance .... multivariate method and Tukey's follow-up test. Results: Findings showed that compassion therapy and cognitive-behavioral therapy improve emotional schemas and increase resilience. The effect of compassion therapy was greater than cognitive-behavioral therapy and maintained its effect over time. Conclusion: The results showed that compassion therapy had a greater effect on improving emotional schemas and increasing resilience in patients with type 2 diabetes. Keywords: Cognitive-behavioral therapy, compassion therapy, emotional schemas, resilience
181 Performance Evaluation of Nursing Students in the Clinical Area , Roghayeh Esmaeili, Mehrdad Esmaeili
Performance evaluation is vital in the nursing field due to the large numbers of nursing students, and the necessity of skill training as an internship in the field under the supervision of the nurses. Accordingly, this study is aimed at determining the current situation and clinical performance evaluation of nursing students. This is descriptive-analytical research. The study sample contains all nursing students of 7th and 8th semesters with an internship in the field (n=145), who participated in the study by personal consent. Nursing Clinical Performance Evaluation Checklist made by Esmaeili et al. (2013) was used as a research instrument. The questionnaire contains 28 items in 3 domains of the nursing process (12 items), professionalism (9 items), and ethical principles (7 items). The face and content validity of the instrument was confirmed, and the reliability was measured using internal consistency by Cronbach's Alpha (0.92). For the data analysis, SPSS-20 was used. Descriptive statistics were used to describe the data. The results showed that the mean value and standard deviation of performance evaluation of students of 7th and 8th semesters of nursing are obtained at 5±2.03, which is in average level. The highest mean value of performance evaluation was associated with the ethical principles of students (6±2.3), and the lowest mean value was associated with the range of the nursing process (5±2). The mean value of professionalism was 6±2.1. The results obtained from the study showed that the 7th and 8th-semester nursing students were at an average level in terms of performance evaluation. Keywords: evaluation, clinical performance evaluation, nursing students, clinical area
182 Evaluating Soft Tissue Thickness in Different Anterior-Posterior Skeletal Classifications Informative , Saba Safarzadeh, Mohammad Monirifard, Farinaz Shirban
Background: The soft tissue thickness is affected by anterior posterior skeletal relationship. This study has been designed to evaluate the soft tissue thickness among different anterior posterior skeletal classifications. Material and Methods: In this cross-sectional study, 206 digital lateral cephalometric radiographs from patients undergoing treatment at several orthodontic clinics were evaluated. The skeletal group was determined by the ANB angle. The planned points were determined on digital radiographs using the Digimizer.V4.1.1.0 and then the measurements were done. Data were analyzed by Kruskal-Wallis, Mann-Whitney, Pearson Correlation and Spearman tests. Results: Significant difference showed between soft tissue thickness at Subnasale between class I and II, at Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius between class I and III and at Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius, between class II and III. Among the women, soft tissue thickness at subnasale were higher in class I group compared to class II, Subnasale, Labrale Superius, Stomion Superius, Stomion Inferius were higher in class III compared to class I and at Labrale Inferius was higher in class II compared to class III. Among the men, soft tissue thickness at Stomion Superius, Stomion Inferius and Labrale Superius were higher in class III group compared to class I and II. Conclusion: We established that soft tissue thickness in some landmarks were significantly different between skeletal groups and gender. There is a correlation in soft tissue thickness and skeletal relationship at Stomion Inferius, Subnasale, Labrale Superius, Stomion Superius. Keywords: Soft Tissue, Skeletal Classification, Cephalometry
183 Effects of Clinical Symptoms and Laboratory Values of COVID- 19 Patients' Tests at the Time of Hospitalization on Their Clinical Outcomes , Toomaj Shahverdi, Mahdi Nikoo Hemmat, Mohammad Islamy
Introduction: At the end of 2019, a new coronavirus caused pneumonia in Wuhan, China. Several studies have described the clinical features and immune manifestations in COVID-19 patients with moderate to severe symptoms, while their clinical relevance is less clear. This study investigates the effects of clinical symptoms and laboratory values of COVID-19 patients' tests at the time of hospitalization on their clinical outcomes. Methodology: This descriptive cross-sectional study was performed on COVID-19 patients hospitalized in Arak hospitals from April 2020 to March 2020. Medical records of all the hospitalized patients were retrieved. Trained personnel extracted general information (age and gender) and clinical profiles (the complete blood count and other required tests). Findings: Analyzing the laboratory indices of the blood count and LDH and CPK levels revealed a positive relationship between the patients' serum CPK levels, and the mortality rate (P = 0.001) and length of hospitalization (P = 0.015). Conclusion: The patients' serum LDH levels and fever were also associated with the mortality rate, and the need for mechanical ventilation, respectively. We hope this information helps physicians treat COVID-19 patients. Keywords: COVID-19, clinical symptoms, laboratory tests
184 Determining the incidence and risk factors of congenital hypothyroidism based on the specifications of infants in Shadegan city in the period of 2006-2014: a case-control study , Ehsan Keshavarzian, Yousef Khalifpour, Narges Biranvand
Introduction: Congenital Hypothyroidism (CHT) is a condition in which the thyroid stimulating hormone (TSH) is equal to or more than 10 MU/L and the thyroxine hormone (T4) is less than 6.5 M/L. CHT is one of the most important preventable causes of mental retardation in infants. The present study aimed to determine the incidence of CHT and the associated factors. Method: At first, a descriptive research was done to examine the incidence of CHT in the period of 2006-2014 in Shadegan city, Khuzestan province. Then, a case-reference and a case-control study was done to investigate the relationship between CHT and demographic characteristics, environmental factors and medical factors. The cases in this study were neonates with CHT (transient and permanent). The results showed that the venous TSH score for these neonates was equal to or higher than 10 MU/L and their T4 level was lower than 6.5 MU/L. The subjects in the control group were infants that did not suffer from CHT whose venous TSH and T4 scores were lower than 10 MU/L and higher than 6.5 MU/L, respectively. The relationship between the aforementioned factors with the illness was determined using multiple logistic regression statistical model. The SPSS 18 software was used to analyze the findings of this research. Findings: In this study, the incidences of neonatal CHT in Shadegan were 17, 21.5 and 12.59 per thousand newborn infants in 2012, 2013 and 2014, respectively. Conclusion: The parents' record of consanguineous marriage increases the likelihood of developing CHT; therefore, couples that wish to marry have to be educated and made aware in marriage counseling centers, both in the field of consanguineous marriage and CHT. Keywords: incidence, screening, transient, permanent, congenital hypothyroidism
185 Determination of the Efficacy of the Cold Atmospheric Plasma with Nano Tio2 Covered in Cathode Towards Enveloped Viruses such as Covid 19 and Influenza in Room Air , Mehrdad Fojlaley, Berat Guvenc Aslan
In this research, Medwave air and surface disinfection system (model:Klin20)selected to investigation effect , towards aerosolised enveloped viruses in room air. Phi6Pseudomonas syringae phage, a surrogate for coronavirus and influenza, was used in the trials Viral suspensions of Phi6 were aerosolised within the ukas accreditation Campden BRI aerobiology laboratory to achieve initial levels of ~106PFU/m3, representing very heavily contaminated air . Air samples were taken at 15 minute intervals and analysed to determine levels of Phi6 in the room air over a total test period of 135 minutes. On 3 separate days, paired trials were carried out with the Medwave switched onand with the units witched off as a control to determine baseline levels of virus in the air overtime. Trials carried out on the first two test days showed no reduction in viral titre compared with the control. Further investigation revealed that a wiring loom within the test unit had become disconnected during transport and the instrument was therefore not functioning correctly. Results from the trial showed that the level of Phi6 in the room air decreased rapidly from an initial titre of 6.12 log PFU/m3to undetectable levels (<1.78 log PFU/m3) after 45 minutes of operation, representing a log reduction of ≥4.00 logs compared with the control run with the unit switched off. Log reductions of 2.21, 3.30and ≥4.00 logs were observed after 15, 30 and 45 minutes respective to the log PFU/m3countsin the control run Keywords: Bioaerosols nano-titanium atmospheric cold plasma, covid19.
186 Comparison of the diagnostic accuracy of Ultrasonography and CBCT for detection of mandibular condyle erosion (an in-vitro study) , Yasaman Kheirandish, Mehrdad Panjnoush, Shabnam Mohammed Charlie, Elham Romoozi
Temporomandibular joint (TMJ) is one of the most important, unique and structurally has the highest complex synovial system in the body (1, 2). TMJ, encompassing the temporal bone, mandibular condyle and articular disc, is a diarthrodial joint. As a collective form, Temporomandibular Joint Disorders (TMD) is often with multifactorial etiologies, and these diseases can more commonly affect the soft-tissue components of the TMJ including the articular disc and posterior attachment, the osseous components of the TMJ and also the related muscles (3, 4). The most common cause of the regional orofacial pain of non-dental origin is a result of TMD. Additional symptoms may include TMJ sounds such as clicking, pumping, limited or asymmetric mandibular movement (5). As TMJ is covered by a layer of fibrocartilage, unlike other joints in the human body, the mandibular condyles can be damaged due to cartilage degeneration. In addition, arthritis can also be initiated because of the particular dynamics in the maxillofacial area (6). TMD's are frequently associated with degenerative bone changes which can involve the bone structures of the TMJ such as erosion, flattening, osteophytes, subchondral bone sclerosis and pseudocysts (7). To correctly diagnose the dysfunctions associated with the disease and for adequate treatment planning Knowledge about these bone changes is fundamental (8).
187 Beneath the Waves: Experiences of Beginner SCUBA Divers and Sensorium , Yalin Aygün, Göktu? Norman
Background: The experience of Recreational SCUBA Diving (RSD) is unique and exciting because participants can feel innermost and special sensations. Aim: By exploring the role of the senses in RSD This paper seeks to illustrate the complex, kaleidoscopic and inter-relational connections beginner SCUBA divers make with aquatic environment within the sensorium experience for the first time. Methods: The present research draws upon the qualitative inquiry away from the positivist approaches to capture insider views, meanings, and interpretations. Audio-recorded semi-structured interviews with a convenience sample of 12 undergraduate students who had experienced a first-time SCUBA diving through Discover SCUBA Diving (DSD) Program were transcribed and thematically analyzed. A thematic analysis was performed with the Nvivo 11 Plus software package program. Results: Analysis illustrated that both positive and negative emotions are experienced due to (a) Diver Dimension of Marine Wildlife Touching, (b) Diver Dimension of Marine Wildlife Viewing, and (c) Diver Dimension of Marine Wildlife Hearing. Conclusion: The opportunity to experience aquatic environment for the first time during active leisure reflects participants’ ability, which offers encouragement, enthusiasm, well-being, and satisfaction. In unravelling the negative diving experience, as experienced by divers, we argue some physical and psychological distress and difficulty arise due to chemical and physical properties of aquatic environment, however. Keywords: Active Leisure, Aquatic, Sensorium, SCUBA Diving, Well-being
188 The Relationsh?p Between Injury Anxiety and Forgiveness Flex?bility: A Research for Elite Field Hockey Athletes   , Kür?ad Hazar
Purpose: This study aims to examine the relationship between injury anxiety and forgiveness flexibility levels of elite field hockey players. Injury anxiety and forgiveness flexibility levels were compared in terms of gender, the status of being a national athlete, injury history, and frequency of training. Method: In line with the purpose of the research, it is descriptive research in which the relational survey model, one of the quantitative research methods, is used. With this method, it is used to grasp and explain the relationship between various variables without any attempt to change the current situation. In this framework, a research model was created that aims to determine the existence of covariance between two or more variables. The research population consists of field hockey players. The population of the study is elite field hockey players who participated in national or international field hockey tournaments. The research sample consists of 161 participants (66 Female, 41%; 95% Male, 59%) selected by convenience sampling method, which is one of the non-random sampling methods. The “Sports Injury Anxiety” scale was used to determine the injury anxiety levels of field hockey players who participated in the study voluntarily. The “Forgiveness Flexibility Scale” was used to determine the levels of forgiveness flexibility, and the “Personal Information Form” prepared by the researchers was used to collect information about demographic characteristics (gender, status of being a national athlete, injury history, training frequency). Conclusion: It was determined that there was a significant difference in injury anxiety and forgiveness flexibility scores of elite field hockey players according to gender and training frequency variables. On the other hand, while there was a significant difference in injury anxiety scores according to the status of being a national athlete and having an injury, no significant difference was found in the mean scores of forgiveness flexibility. As a result of the analysis performed to determine the relationship between injury anxiety and forgiveness flexibility, a positive and significant relationship was determined between the injury anxiety and forgiveness flexibility levels of the athletes. Finally, it was concluded that training frequency is an important predictor of injury anxiety, and as the training frequency increases, the athlete's injury anxiety level decreases. Keywords: Field hockey, injury anxiety, forgiveness flexibility
189 The Effect of Psychological Well-being on Athletic Performance of Professional Athletes , Tayebeh Baniasadi, Mir Hamid Salehian
The purpose of research was to study the effect of psychological well-being on the athletic performance of professional athletes. The present research was a descriptive of causal-comparative type. The statistical population consisted of professional skill level with an experience of 10 years (n=100) were randomly selected. Data collection tools consisted of three questionnaires: Charbonneau exercise performance questionnaire (2001), Reif's psychological well-being questionnaire (1989). To test the hypotheses, multiple regression analysis was used. The findings showed that sporting performance of professional athletes with predictive psychological well-being is predictable. The effect of psychological well-being on the performance of athletes' professional sport is not significant. Keywords: Psychological well-being, Professional athletes
190 The Reasons for National Athletes with Undergraduate Education to Leave Sports , Nuran Kandaz Gelen
Background: There are studies in the literature scrutinising the reasons for dropping out of sports in terms of physiological, psychosocial, and surrounding factors. In addition to these, it is a fact that there are athletes who end their sports life immediately after beginning their undergraduate education. At this point, the reasons for students to leave sports during their undergraduate education remains a matter to be discovered. Aim: To this end, this study aims to reveal the factors that cause these persons to leave sports. Methods: This research was conducted through the qualitative research method, utilising the phenomenology design. The participants of the study were eleven former national athletes who left sports after beginning their undergraduate education. The participants were selected by criterion sampling method from purposive sampling methods. The data were obtained through face-to-face interviews composed of semi-structured questions. The data acquired were analyzed by the content analysis method. Results: Five main themes were composed in the study: training, social life, health, psychology, and school. It was observed that the participants failed to balance their school and sports life due to heavy and intense training, socialisation needs, unexpected injuries, nutritional problems, psychological fear of failure, and inability to achieve the success they desire. Conclusion: The study results revealed that the participants decided to leave sports not for a single reason, but as a result of a process during which multiple reasons accumulated. In this context, measures can be taken to facilitate their academic and sports life in order to prevent national athletes from leaving sports. These measures may include enabling them to continue to school where they do sports, providing them with distance education and exam opportunities, and enabling them to better integrate into campus life. In order to prevent early specialisation, long-term athlete development models may also be implemented. Keywords: National athlete, undergraduate students, dropping out of sports
191 Analysing the Correlations between Sports Provincial Representatives’ Levels of Organisational Commitment and Job Satisfaction , Nahit Özdayi
Aim: This study aims to analyse the correlations between sports provincial representatives’ organisational commitment and job satisfaction. Methods: The study, which was conducted by using Minnesota job satisfaction scale, reached 84 volunteering athletes who were the provincial representatives in Çanakkale and Bal?kesir and 19 of whom were female and 65 of whom were male. The data collected were analysed on the SPSS programme. Descriptive statistics were used for the demographic variables. The validity and reliability tests were done for the scales used. The kurtosis and skewness values were tested in analysing the distribution of the data and the data were regarded to have normal distribution. Results: It was found on comparing the Çanakkale and Bal?kesir provincial sports representatives’ average scores for organisational commitment and job satisfaction that there were statistically significant differences between the athletes in the external satisfaction sub-factor of job satisfaction and in the attendance commitment sub-factor of organisational commitment. Accordingly, the sports provincial representatives in Çanakkale were found to have higher score averages than the ones in Bal?kesir. An examination of the participants in terms of their work experience, on the other hand, demonstrated that the representatives with 10 year or more experience had higher internal satisfaction and emotional commitment score averages than the ones with 7–9-year experience. Conclusion: It may be concluded that sports provincial representatives’ organisational commitment and job satisfaction increase in parallel to the increase in their work experience. Key words: Job satisfaction, commitment, organisational commitment
192 Investigation of Social Appearance Anxiety in University Students , Semra Çetin, Cuma Ece  
The aim of this study is to investigate Social Appearance Anxiety in university students according to gender, type of faculty, grade level, body weight and height. The present study was conducted on students of Sakarya University who were between the ages of 17 and 25. 247 of the participants were female and 256 were male. The social appearance anxiety scale filled in by 503 students was evaluated. T-test, one-way analysis of variance and LSD tests were used in statistical operations. In this study, the Social appearance anxiety scale score was found to be slightly lower in women than in men in the comparison made by gender. This difference did not show a statistically significant difference according to gender (p>0.05). The social appearance anxiety score differs statistically significantly according to the type of education and training faculties (p<0.001). Social appearance anxiety changes significantly according to education level (p<0.001). It was found that the students who were satisfied with their body weight and height had lower social appearance anxiety than the students who were not satisfied. Social appearance anxiety varies according to height and body weight category (p<0.001). In conclusion, social appearance anxiety was found to be similar according to gender in this study. It differed according to the field of study of the students. The social appearance anxiety levels of the students receiving sports education are the lowest. Anxiety levels of students who receive art education are higher than those who receive sports education. The social appearance anxiety of the students who did not receive sports and art education is the highest. In order to reduce social appearance anxiety, students should be supported in sports and art education and practice. Keywords: University student, Social Appearance Anxiety, Sports, Education, Age and Height
193 Investigation of Some Performance Parameters of Professional Football Players According to Game Regions , Hüseyin Özkamçi, Raif Zileli, Gürkan Diker, Mehmet Söyler, Serdar Bayrakdaroglu
Background and Study Aim: The aim of this study is to evaluate the Anaerobic Speed Reserve (ASR), Maximal Sprint Speed (MSS) and Maximal Aerobic Running Speed (MAS) parameters in terms of the players' playing positions on the field. Material and Methods: In this study, a total of 89 players consisting of 20 stoppers, 15 backs, 25 centre midfielders, 17 wingers and 12 strikers from 4 different 3rd league teams in Turkey with the average height of 1.82±7.20 cm and the average body weight of 75±5.20 participated as volunteers. Players were applied 10-30 meters speed test and Yo-Yo Intermittent Recovery Level 1 Test. Results In the MSH parameter, a statistically significant difference was found between the players playing in the stopper area (28.42±2.08) and the players playing in the wing area (30.40±1.94) (p <0.05). However, there was no statistically significant difference between the game positions in ASR parameter (p> 0.05). While a very high positive significant correlation was detected between MSS and ASR (r = 0.95, p < 0.001), a moderate but negative significant correlation was found between MAS and ASR (r = -0.59, p < 0.001). The findings revealed that wingers stand out in terms of MSS while centre midfielders are ahead of the other regions in terms of MAS. Conclusions: Regarding these findings, sports science experts and especially trainers should consider these differences when programming their training. In addition, the present study has indicated that further research is required to better understand the ASR parameter in football. Keywords: anaerobic speed reserve, maximal aerobic running speed, maximal sprint speed, football players
194 Examination of Phys?cal Educat?on Teacher's Opinions on Effective Class Management , Ahmet Yikilmaz, Fikret Alincak
Background: In order for education and training to be successful, various factors in the educational environment must be known, regulated and well managed. Classroom management enables teachers to carry out their teaching tasks effectively. In order to manage the classroom, teachers must have classroom management skills. A teacher who does not have classroom management skills will have difficulty in classroom management and failure in education is inevitable. Aims: The aim of this study is to reveal the views of physical education teacher candidates on effective classroom management. The research is a qualitative study. The research group consists of 10 physical education teacher candidates and this study group was determined by the maximum diversity sampling method. Place & duration of study: In the research, face-to-face interview technique was used in accordance with the voluntary basis and studying at I?d?r University School of Physical Education and Sports. Method: In the research, using the interview method, which is one of the qualitative research methods, the data obtained were analyzed by the content analysis method. Results: As a result of the research, physical education teacher candidates stated that for an effective classroom management, teachers should be competent in their field and love their profession. The physical education teacher candidates participating in the research came to the forefront by endearing the lesson and the teacher. In addition, the research group; They stated that they would motivate students in classroom management by giving responsibility to the student, determining the classroom rules together with the student, and applying different teaching methods. In addition, in order for the student-teacher communication of the research group to be effective; They expressed their opinion that a democratic environment should be created and cooperation between the parties should be ensured. Conclusion: In addition, in terms of improving the classroom management skills of the research group; In addition to gaining professional skills and practice skills, while managing unwanted student behaviors in the classroom; They stated that it is necessary to give responsibility to the student and to plan the lesson together with the student. At the same time, for an effective classroom management; It has been concluded that an effective classroom management can be done by knowing the student well and establishing healthy communication with the student. Keywords: Physical Education, Teacher Candidate, Classroom Management.
195 Examination of the Communication Skills of Students who Education in the Faculty of Sports Sciences in Terms of Different Variables , Comparing Efficacy of Intradermal Tranexamic Acid (TA) Verses Fluocinolone-Based Triple Combination (Hydroquinone 4%, Tretinoin 0.05%, Fluocinolone Acetonide 0.01%) Therapy in the Treatment of Melasma
Muhammad Khurram Shahzad, Raheel Tahir, Saba Amin, Tahir Hassan, Farah Sattar, Madiha Anwar  
196 Acute Kidney Injury is A Risk Factor among Type 2 Diabetic Patients after UTI due to Extended-Spectrum Beta-Lactamase Producing Organisms , Kashif Ali Samin, Sara Malik, Sidra Sadiq, Talha Rasheeq, Nisar Khan Sajid, Waheed Iqbal
Background: Communication is one of the most important and indispensable tools we use at every stage of our lives. It is seen that the existence of communication in human life is based on very old processes. It is the process of transferring the feelings, thoughts and information we have to the people in front of us. It is very important to make sense of the communication process on a regular basis. Aims: This study is a descriptive study to examine the communication skills of students studying at the faculty of sports sciences in terms of different variables. Place & duration of study: The universe of the study consists of students studying in sports sciences faculties of different universities. There were 226 (male 124, female 102) students in the sample group. The Communication Skills Scale developed by Korkut (1996) was used to obtain the research data. Method: One-way analysis of variance (ANOVA), independent sample t-test and descriptive statistical analysis were used in the analysis of the data. Results: As a result, in the study conducted to examine the communication skills of the students studying at the faculty of sports sciences in terms of different variables, it was determined that there were significant differences in terms of gender. Conclusion: It has been observed that the students studying in the physical education teaching department have higher communication skills than the students studying in the coaching education and sports management departments. It was concluded that there was no significant difference in terms of age variable. Keywords: Faculty of Sport Sciences, Student, Communication Skills.
197 Levels of Serum Magnesium among Recently Diagnosed Glucose Intolerance Patients and its Comparison with Serum Magnesium Level of Sex and Age Controlled Healthy Subjects , Kashif Ali Samin, Muhammad Mujtaba Hashir, Shaheera Batool, Jazib Andleeb, Nisar Khan Sajid, M. Iqbal Qasim
Background: Hypomagnesaemia is related with diabetes mellitus (DM) and its complications and insulin resistance. On the other hand, the patients of Diabetes mellitus have decreased levels of magnesium. This analysis was planned to assess levels of serum magnesium in patients with newly diagnosedimpaired glucose intolerance and the severity of intolerance e.g., DM or impaired glucose tolerance, impaired fasting glucoseand compare the serum levels of magnesiumwith sex and age matched healthy individuals. Methods: This case-control study was carried out in the Outpatient department of Diabetes Hospital Peshawar and CMH Multan Institute of Medical Science Multanfor six months duration from February 2020 to July 2020. New patients of glucose intolerance (IGT 2, DM 54) were matched with same number of sex and age matched healthy subjects (n=56). All participants in the study done with the level of serum magnesium and comparisons were made between the case and the healthy subjects. Results: This study evaluated 56 patients (studied group) and 56 healthy volunteers of similar gender and age (control group) with glucose intolerance.There was no substantial difference between the control group in terms of sex, body mass index (p = 0.39) and age (p = 0.88). The level of serum magnesium was according to standard in 30 patients and 39 healthy subjects, and decrease in 26 patients and 17 normal subjects. The mean concentration of serum magnesium was lower in the experimental group (0.69±0.16m. Mol / L) than in the control group (0.84±0.17 m. Mol / L), though the variance was not substantial (p = 0.37). Conclusions: The levels of Serum magnesium were lesser in individuals with IGT and DM compared to healthy volunteers of the same sex and age and levels of serum magnesium were related to blood glucose levels. Key words: Serum magnesium, Diabetes mellitus, Glucose intolerance, Impaired glucose tolerance, Impaired fasting glucose.
198 Comparision of Infection Frequency in 1-Day Vs 5-Days Post Operative Antibiotic Regimen in Open Treated Facial Fractures , Syed Tahir Husain, Ahsan Ullah Khan Sherani, Suneel Kumar Punjabi, Monis M. Ali, Shahzaman Memon, Rabia Anis  
Objective: To compare the frequency of surgical site infection by using postoperative prophylactic antibiotics (1day vs. > 5 days) in patients following open surgical reduction of facial fractures. Design: Randomized Controlled Trial Setting: Department of Dental &Maxillofacial Surgery, Liaquat National Hospital, Institute of Postgraduate Medical Studies & Health Sciences, Karachi. Duration: 06months from 23 December 2016 to 22 June 2017. Subject and Methods: A total of 368 cases according to inclusion and exclusion criteria were included in this study. Patients were randomly divided into two groups. Antibiotic (Inj. Augmentin 1.2g) was given to group A from admission to 24 hours postoperatively and in Group B antibiotic was continue up to 05 days postoperatively. A surgeon evaluated participants of both groups at 1, 2, 3 and 4 weeks postoperatively for infection according to criteria of surgical site infection published by CDC. All information was noted in the proforma. Results: - The average age of the patients was 31.10±7.39 years. Rate of surgical site infection was not significant between groups (4.9% vs. 7.1%; p=0.379). Conclusion: In this study 1-day course of antibiotics postoperatively in facial fractures is as effective in preventing infective complications as a 5-day regimen. The use of prolonged postoperative antibiotics in uncomplicated facial fractures had no significant benefit in reducing the incidence of infections. Key Words: Maxillofacial Surgeons, Surgical site infection, Prophylactic antibiotics
199 Iron Deficiency Association as A Possible Cause of First Febrile Seizure , Zarmast Khan, Zabit Khan Naibzai, M. Adnan Ahmed Sethi, Shahid Ghaffar, Sumera Makhdoom, Asadullah Khan
Aim: A controlled clinical study was conducted to investigate the relationship between iron deficiency and first episode of febrile seizure in children 6-60 months of age. Place and Duration:In the Pediatric Medicine department of ShifaInternationalHospital Islamabadforsix months duration from 15thMay 2020 to 30thNovember 2020. Methods:Hematological parameters for iron levels, including HB, MCV, MCHC and plasma ferritin, were determined in 75 patients who experienced a first febrile episode. 75 children without febrile seizures were taken as controls and the same markers were compared in both groups. Results: The most important factors influencing the first attack of febrile seizure were HB, MCV, and serum ferritin levels. Conclusion: Iron deficiency is significantly associated with the occurrence of the first febrile episode in children. Key words:Iron deficiency anemia, Iron deficiency, Febrile convulsions, Febrile attacks.
200 Requirement of Intravenous Fluid and Insulin in the Management of Diabetic Ketoacidosis to Overcome the Crisis , Muhammad Iqbal Qasim, M. Mujtaba Hashir, Shaheera Batool, Nisar Khan Sajid, Waheed Iqbal, M. Shahbaz Ashraf
Objective: The aim of this study is to determine the requirement of intravenous fluid and insulin in the treatment of diabetic ketoacidosis to overcome the crisis. Study Design: Cross-sectional Place and Duration:Study was conducted at Medicine department of King Abdullah Teaching Hospital Mansehra and Nishtar Medical University Hospital Multan for six months duration from15thDecember, 2020 to 15thJune, 2020. Methods: Total seventy patients of both genders were presented in this study. Patients were aged between 18-65 years. Patients details demographics age, sex and body mass index were recorded after taking written consent. Patients had diabetic ketoacidosis were presented in this study. Frequency of intravenous fluid and insulin were assessed to overcome the crisis of diabetic ketoacidosis by using portland protocol. Complete data was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 30.51±7.41 years with mean BMI 25.18±3.48 kg/m2. 38(54.3%) cases were females and 32 (45.7%) patients were males. 42 (60%) cases had previous history of diabetes and the rest28 (40%) were newly diagnosed.Prevalence of DKA was more common in low socio-economic status found in 39 (55.7%) cases. Vomiting was the most common symptom found in 35 (50%) cases, followed by infection of insulin doses 18 (25.7%) cases, abdominal pain found in 15 (21.43%) patients. 32 (45.7%) patients who had increased diuresis received 11L of fluid in the treatment of DKA, 91-100 units of insulin were given to 18 (25.71%) cases, and for management of acidosis 24 (34.3%) patients took 2-days. There was no any mortality found in this study. Conclusion:We concluded in this study that early diagnosed of diabetic ketoacidosis is necessary for treatment. Removal of adequate fluid was necessary to avoid mortality. Keywords:Intravenous fluid, Insulin, Diabetic ketoacidosis, Diabetes
201 Parent's satisfaction with the observance of “Patient Rights Charter” for children admitted to hospitals in Golestan province during 2018 , Atefeh Haghparast, Elham Khaloobagheri, Rahele Yousefzadeh, Malihe Kabus, Raziye Mazroei
Background: Patient rights are the duties that medical staffs are required to perform for patients from the time of admission. The increasing attention of organizations to this issue has led to the creation of a charter called the “Charter of Patient Rights”. Also, since children are a vulnerable group in society, these rights are more important to them. Therefore, this study was conducted to investigate the parents' satisfaction with the observance of patient rights charter for children admitted to children hospitals in Golestan province during 2018. Methods: This cross-sectional and descriptive study was performed on 350 children admitted to hospitals of Golestan province. Sampling was done by convenience method. The data collection tool was the questionnaire of patient rights charter for hospitalized children. Data were analyzed by SPSS-18 statistical software using descriptive (frequency, mean and standard deviation) and inferential statistics (independent t-test and analysis of variance). Results: The results showed that, the highest percentage of samples 73.4% (259 people) had moderate satisfaction and 26% of them (91 people) had high satisfaction with the observance of patient rights charter for children. The highest dissatisfaction was related to the laboratory tests and diagnostic procedures, so that only 68.3% of the samples (239 people) were satisfied with the response of staff and physicians and 11.1% of them (39 people) were dissatisfied with it. The highest level of satisfaction was related to the access to nurses during hospitalization, so that 86.9% of the samples (306 people) were satisfied and only 2.3% (8 people) were dissatisfied with it. Conclusion: The results showed that a large number of parents were moderately satisfied with the observance of patient rights charter for children by staff. Since the observance of “Patient Rights Charter”, in addition to the patient's satisfaction, shows the professionalism of medical staff, this charter must be implemented in the best way at all levels of health care and treatment. Key words: Parental Satisfaction, Patient Rights Charter
202 Investigating Practitioners’ Approach in Traditional Persian Medicine on Matching of Psoriasis , Farshad Mohammadian Rasanan, Ali Jabbari Sabbagh, Hoorieh Mohammadi Kenari, Ali Ghobadi, Mohammadreza Ghassemi, Farhad Jafari
One of the most common problems for the Traditional Persian Medicine and Modern medicine is to compare the illness which has been described in the past with its new definition. This difference causes many problems both in finding the cure for the illness and detecting its cases. The present study is aimed at comparing one of the ancient subjects in Persian Medicine named “Ghooba” with modern illness (i.e. Psoriasis). In order to gain the ideal results, a qualitative phenomenological design was performed based on Graneheim and Lundman method. In this regard, 9 experts who had extensive experience in the field were interviewed. The interviews were based on six basic questions and each interviewee explained his/her view freely about the subject. Next, all interviews were recorded, coded, and analyzed thoroughly. We hope the results of this study help to clarify the name of the illness and be useful in finding a more effective treatment with fewer side effects for the disease. Key Words: Psoriasis, Ghooba, Traditional Persian Medicine, Modern medicine, qualitative study.
203 The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator , Asadullah Makhdoom, Raheel Akbar Baloch, Tahir Ahmed, Jahazaib Hassan, Muhammad Faraz Jokhio, Lachman Das Maheshwari, Moiz Ahmed
Objective: To compare the efficacy of Chlorhexidine in the prevention of pin tract infection as compared to Povidone-iodine antiseptic. Study Design: Prospective, single blinded randomized trial. Study Setting and Duration: Liaquat University of Health Science (LUMHS), Jamshoro between July 2018 to November 2020. Methodology:  All patients who underwent Ilizarov external fixation as per indications were eligible for the study. Individuals with a previous history of osteomyelitis were excluded from the study. Pin sites were cleansed with normal saline using clean applicators. In the group chlorhexidine, the antiseptic was applied on the pin skin interphases (1% chlorhexidine). Similarly, 10% povidone iodine was applied to patients in group C. The control group was cleansed with normal saline. Pin sites were either dressed daily or weekly. The primary outcome was the rate of pin site infection days. Results: Chlorhexidine group had significantly lesser pin-site infections as compared to the povidone-iodine group with a frequency of 13 (39.39%) and 19 (63.33%), p=0.04, respectively. The mean pin tract infection rate days ± SD were significantly lower in the chlorhexidine group as compared to the povidone-iodine group (1.35 ± 2.26 vs 3.54 ± 4.30, p=0.041). Similarly, the mean duration to onset of pin site infection was also significantly higher in the chlorhexidine group compared to povidone-iodine and control groups. Conclusion: Patients who used Chlorhexidine as the cleansing agent had significantly fewer pin-site infections as compared to the povidone-iodine group. Keywords: Chlorhexidine, Ilizarov fixator, fracture, Povidone-iodine
204 The relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in Sulaimani , Shahow Abdulrehman Ezzaddin
Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score
205 The Relationship between believing in resurrection and attitudes toward death among elderly people , Hadise Sadat Tabatabaei, Mehrangiz Ghabimi, Faezeh Khajehmirzaei, Haniye Asadinejad, Hamid Hojjati
Background: Since believing in resurrection and life after death exists in all religions, strengthening this belief leads to positive emotional states, increases adaptation to adverse life events, reduces the fear of death and gives a meaning to life. This study was conducted in 2017 to investigate the relationship between believing in resurrection and attitude towards death among the elderly population of Golestan province. Methods: This descriptive-correlational study was conducted on 230 elderly people over 60 years old in Golestan province, Iran. The data collection tool was the standard questionnaire of resurrection belief and attitude towards death. Data were collected by self-reporting method, and then were analyzed by descriptive statistics (mean and standard deviation) and inferential statistics (Spearman and Kruskal-Wallis correlation coefficient). Results: The score of believing in resurrection was 70.62 + 8.41 and the score of attitude towards death was 128.08 + 16.58 among the samples. Pearson correlation test did not show a significant relationship between believing in resurrection and attitude towards death (r = 0.01, p = 0.9). Conclusion: The results of this study showed no significant relationship between believing in resurrection and attitude towards death among the elderly people. However, since almost everyone believes in resurrection and afterlife, spiritual tendencies become more pronounced in old age. By understanding and strengthening the spiritual needs of elderlies, health care providers can promote mental health, gives a meaning to life and reduce the fear of death in the elderly population. Key words: Believing in resurrection, Attitude towards death, Elderly
206 Bailout Thrombectomy: Its Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention , Mahboob ur Rehman, Farhan Faisal, Amjad Abrar, Amjad Ali Shah, Muhammad Shoaib, Malik Ali Raza
Aim: To determine the clinical outcomes of patients who received bailout thrombectomy for primary percutaneous coronary intervention. Study Design: Cross-sectional/observational Place & Duration: Study was conducted at Cardiac Centre, Cardiology Department, Pakistan Institute of Medical Sciences (PIMS) Islamabad from January 2020 to December 2020 (for one year). Methods: 200 hundred patients of both genders undergoing primary percutaneous coronary intervention(PPCI)for ST elevation myocardial infarction(STEMI) were analyzed in this study. All patients were divided into two groups. Group A contains 100 patients and received PPCI with bailout thrombectomy and Group B contains 100 patients and received PPCI alone. Informed written consent was taken. Outcomes such as mortality, re-infarction, heart failure, cardiogenic shock, renal impairment, excess bleeding, post procedure stroke and hospital stay were examined and compare between both groups. Results: In Group A there were 53% males and 47% females with mean age 56.45+10.88 years. In Group B 55% were males and 45% were females with mean age 58.35+9.23 years. In Groups A there were more diabetic patients 45% than Group B 32% (p-value 0.005), Group B had more smokers 60%. There was a significant difference between group A and B regarding family history of coronary artery disease 35% vs 20% (p=0.003). In Group A 3% patients were died and in Group B 2% patients were died with no significant difference. Group A patients had more renal impairment 9% vs 5% and stroke 3% vs 1% than Group B. Hospital stay was high in Group A patients 7.12+2.05 vs 5.34+1.02 days of Group B. Conclusion: It is concluded that patients received bailout thrombectomy for percutaneous coronary intervention (PCI) had high rate of comorbidities. There was no significant difference in term of mortality between both groups. However, patients with bailout thrombectomy had more renal impairment and post-procedure stroke. Keywords: ST-segment elevated myocardial infarction, bailout thrombectomy, PPCI, Outcomes
207 Association of Adverse Effects of Red Meat Consumption with Liver Cirrhosis , Gulshad Wagan, Abdullah Khilji, Kaleem Sheikh, Syed Sohail Abbas Naqvi, Imtiaz Wagan, Syeda Abiya Amber Naqvi
Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis and red meat consumption. Study Design: Cross-sectional Place and Duration: Medicine Department of Liaquat University Medical Hospital Jamshoro and Civil Hospital Khairpur Mir's for six months duration from December 2019 to November 2020. Methodology: Total 120 patients of both genders with chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (red meat consumption >60 gm/day) and group B (red meat consumption <60gm/day). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 27.0. Results: There were 36 (60%) males and 24 (40%) were females with mean age 48.14±7.58 years in group A while in group B 39 (65%) and 21 (35%) patients were males and females with mean age 49.08±8.33 years. Cirrhotic patients with red meat consumption >60 gm/day had high mortality rate as compared to patients with red meat consumption <60 gm/day (10% Vs 3.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients and red meat consumption. Keywords: Chronic Liver Disease, Red Meat Consumption, Mortality
208 Recent Infection With Black Fungus Associated With COVID-19: A Review , Ashwak Jasim Kzar, Tunjai Namiq Faiq, Ozdan Akram Ghareeb
Recently, an emergency health problem erupted that worried the world, which is the black fungus infection associated with Covid-19, especially in India and some regions of the Middle East. The members of genus Rhizopus or Mucor resulted the common mucormycosis. Humans become infected by inhaling and depositing the spores of fungi in the tissues of the body. Rhinocerebral is the site most susceptible to infection . Several factors may have contributed to an increase in the incidence of mucormycosis in patients with COVID-19, including hypoxia, steroid-induced elevated blood glucose levels, and diminished phagocytic action of leukocytes due to immunosuppression, and non-sterile medical supplies. In addition, there is an unsanitary phenomenon resorting to some people in India, it is smearing the body with cow dung and urine, which may have a role in the spread of the black fungus infection. Proper use of both the dose and duration of steroids is essential to avoid an increase in cases of mucormycosis, especially when caring for critically ill COVID-19 patients. Keywords : Black fungus, infection, health problem.
209 The effect of ear acupressure medicine at the “Shen Men” point on the nausea and vomiting during pregnancy , Sanaz Nehbandani, Hajar Salehi, Khadije Rezaie Keikhaie, Hossein Rashki Ghalenow, Fatemeh Mirzaie, Mahin Badakhsh
Introduction & Objective: Nausea and vomiting during pregnancy is one of the most common gastrointestinal disorders that more than 85% of pregnant women experience. However, controlling and treating this complication is still one of the most important issues in antenatal care. Therefore, the aim of this study was to investigate the effect of ear acupressure at Shen Men point on relieving nausea, vomiting and retching during pregnancy. Materials and Methods: In this quasi-experimental study, 100 pregnant women with a gestational age of less than 16 weeks attending the health clinics of Zabol city during 2019-2020 were studied in two control and intervention groups (n = 50 in each group). The samples in the intervention group were trained to apply pressure on their ears’ Shen Men point with the thumb for three minutes three times a day (morning, noon, and night), for a duration of one month. At the end of second and fourth weeks, the data were collected using the Rhodes index form and then, were analyzed by SPSS software version 22. Results: According to the results, there was no significant difference between the two groups in terms of age, gestational age, occupation and education. The difference in the mean scores of nausea, vomiting and retching was not statistically significant between the control and intervention groups before the study. But four weeks after the study, a significant difference was observed in the mean scores of vomiting, nausea and retching between the two groups, so that the mean scores of vomiting, nausea and retching were significantly lower in the intervention group than in the control group. Conclusion: The ear acupressure medicine at the Shen men point can be used as a non-invasive, safe and inexpensive method to relieve nausea, vomiting and retching during pregnancy. Keywords: Acupressure medicine, Shen Men, Vomiting, Pregnancy, Nausea, Retching, Rhodosis
210 An Investigation of the Effect of Retraining Courses on the Knowledge, Attitude, and Performance of Health Workers in the Field of Malaria , Roghaye Ershad Sarabi, Rafigh Dehvari Mohammadi, Aziollah Arbabisarjou
Introduction and Objective: Malaria is considered one of the most important parasitic diseases in Iran. With regard to malaria, Sistan and Baluchestan province ranks first among the country's provinces. This study set out in 2017 to investigate the impact of education on malaria knowledge, attitude and behavior among health workers working in Saravan city health center. Materials and Methods: The present study is a semi-experimental study of before and after clinical trial type that was performed on 73 health workers in Saravan city. A researcher-made questionnaire was used to collect the required data. It consisted of two parts: the first part was dedicated to demographic data and the second part was about the knowledge, attitude and performance of health workers regarding malaria. The face and content validity of the questionnaire was confirmed by an expert panel. The reliability of the questionnaire was calculated using Cronbach's alpha coefficient (α=0.85). Before the start of the training, the questionnaires were given to the health workers. The trainings were presented in 49 one-hour sessions by the experts of the headquarters of Saravan Health Center in Behvarzi Center using lectures and pamphlets. One month after the training, the same questionnaires were filled in by health workers. The difference between the variables of knowledge, attitude and performance in the two groups before and after the intervention was performed using a one-sample and paired sample t-test or their non-parametric equivalent i.e. Binominal and Wilcoxon tests in the SPSS software (version 18). A significance level of 0.5 was taken into consideration. Results: The results showed that the mean scores of health workers in the areas of knowledge, attitude and performance increased significantly after the workshop (p=0.001) so that the participants' knowledge score increased from 26.06 to 56.7. In terms of attitude, their score increased from 7.2 to 17.7, and in terms of performance, participants' score increased from 13 to 32. Discussion and Conclusions: The findings revealed that the implementation of educational programs in the field of malaria can increase the level of knowledge, attitude and performance of the community regarding the preventive behaviors of malaria. Therefore, health system officials are recommended to work toward the amelioration of the knowledge, attitude and performance of the health workers. Keywords: knowledge, attitude, performance, health workers, malaria, retrainin
211 Effect of vestibular rehabilitation therapy on visual and motor functions in children with dyspraxia , Maha Abd Ellatif, Kamal E. Shoukry, Gehan M. Abd El Maksoud, Ahmed E. Chedid, Ahmed F. Genedy
Purpose: To investigate the effect of vestibular rehabilitation therapy program on the visual and motor functions in children with dyspraxia. Method: Twelve children with dyspraxia from both genders, aged from 4 to 12 years, are included in this study. All of them had movement dyspraxia affecting their ability to stand and walk alone according to chick list of developmental dyspraxia. Also, they had level 2 or 3 of visual function level. They received vestibular rehabilitation therapy program in addition to traditional physical therapy program, for three times/ week, for three months. Visual and gross motor functions were assessed before and after three months of treatment using Hoyt's levels of visual function and Peabody Developmental Motor Scale (PDMS- 2) respectively. Results: Results showed highly significant improvement in visual function level and gross motor functions for the study group when comparing it's results before and after three months of treatment (P ≤ 0.05) Conclusion: Vestibular rehabilitation therapy program is an effective modality for improving visual and motor functions in children with dyspraxia.   Key words: Dyspraxia, motor functions, Vestibular Rehabilitation Therapy program, visual functions.  
212 COVID-19- HAB scale: Validation of a scale of perception of habits shifting during the COVID-19 pandemic , Christian R. Mejia, J. Franco Rodriguez-Alarcon, Dayana Ticona, Maria F. Fernandez, Renzo Felipe Carranza-Esteban, Oscar Mamani-Benito
Introduction: The COVID-19 pandemic has made the daily life difficult for thousands of people around the world. The measurements taken by many governments have reduced personal liberties and obligated many to change their habits and lifestyles. Objective: To validate a scale that measures the perception of habits shifting during the COVID-19 pandemic. Methods: This was an instrumental, analytical, and cross-sectional study with a pilot sample of 417 respondents. A form validation was carried out with the participation of 10 experts who evaluated the scale. Their assessments were used to calculate Aiken coefficient. The explorative factor analysis was carried out using KMO and Bartlett test. Finally, Cronbach’s alpha was calculated to get internal consistency. Results: The KMO measure was 0.92 and the Bartlett test was significative. With these results, factor determination was performed resulting in a 1-factor model which contains 71.45% of the total variance and with factorial charges between 0.46-0.88. Then, Cronbach’s coefficient was 0.89, assuring good reliability to the scale. Conclusion: The COVID-19-HAB scale is a validated scale and it could be applied to measure the habits acquired by the general population during health emergencies such as the COVID-19 pandemic. Key words: Validation study; Habits; Pandemics; COVID-19.
213 COVID-19: The Novel and Lethal Culprit- The Extrapulmonary Manifestations of SARS-CoV-2 (COVID-19) , S. Z. A. Shah, B. R. Devrajani, N. A. Lashari
During December 2019 at Wuhan the SARS-CoV-2 epidemic emerged and rapidly occupies the entire world, present as pandemic responsible for pulmonary dysfunction like acute respiratory distress syndrome and pneumonia but with time clinicians and researchers have been found some extrapulmonary features of COVID-19 which may reflect either replication or dissemination of SARS-CoV-2 infection as widespread immunopathological sequelae1. The knowledge regarding extrapulmonary complexities in the hospitalized COVID-19 patients should be addressed to prevent and decrease the coincidental exposure2. The spike protein and ACE2 receptors through S protein and MPRSS2 play role in pathogenesis of SARS-CoV-2 infection3. ACE2 receptors are situated in heart, GI epithelium, alveolar II cells, vessels, renal and smooth muscles of entire body responsible for COVID-19 induced injury4,5. SARS-COV-2 actuates T lymphocytes via cytokines: interleukin (IL-1 and 6), GM-CSF, and interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) known as cytokine storm bringing about tissue injury6.
214 Current Treatments for Obesity: An Update , Z. Safdar, R. Fatima, A. Bajwa
Obesity is one of the biggest health problems in the world. It is not only a key developer of various dangerous diseases like coronary heart disease, type 2 diabetes mellitus, and sleep apnoea, but is also associated with high mortality and morbidity rate. In recent years, doctors have shifted their attention towards the prevention and treatment of obesity rather than letting the person move towards different diseases and then curing those multiple disorders. One of those strategies for obesity treatment includes bariatric surgery. This review paper encapsulates multiple other strategies like dietary, pharmaceutical, and surgical options available at present for the treatment of obesity. Keywords: Obesity, weight, diabetes, heart disease.
215 Ultrasound Measurement of Endometrial Thickness for Detecting Endometrial Malignancy , A. Iqbal, S. K S Murrium, M. Yaseen, K. Shakeel, M. Z Iqbal
Background: Post-menopausal Bleeding is extremely doubtful of existence a mark intended for incidence of EC as well as around 5% to 12% of post-menopausal bleeding consequences commencing endometrial cancer. EC is greatest communal Gynecologic Malignancy into established countries. Thin endometrium (≤4 mm) devours precise high NPV (99%). Thickened Endometrium has been considered by way of sign intended for an offensive assessment. Aim: To determine the ET measurement for detecting endometrial malignancy with uterine bleeding in post-menopausal females. Methods: The search was led according to Systematic Reviews Ethics. Searched databases were: Google scholar and Web Research from January 2014 and November 2020. Around nine studies were designated for this Systemic Review. We mined subsequent facts: Design of study, mean age and range, menopause duration, range and mean, BMI range and mean, as well as ET range and mean. Conclusion: From beyond examination this review concluded that, the Endometrial Thickness among the suggested alteration in cut off 3-5 mm within repetitive ultrasound practice must be ended in elevation threat females identify for malignancy before in Postmenopausal females as well as ultrasound is attested chosen a convenient implement to diagnose. Keywords: Post-menopausal Bleeding, Endometrial Thickness, Endometrial Cancer.
216 Comparison of High Resolution Computed Tomography Features in Covid-19 and Other Viral Pneumonia- , S. Nisar, F. Farooq, Rabia, M. N. Anjum, M. Fatima, Z. Manzoor, H. S Ramzan
Aim: To compare the high resolution computed tomography features in Covid and other viral pneumonia presented in recent literature. Methodology: For this study, total 25 studies were included which follow the Preferred Reporting Items guideline for conducting this systematic review analysis (PRISMA). Electronic articles of Covid from January 2020 to April 2020 were searched on PUB Med, online Willey library, and Science Direct site by using keywords related to CT imaging and Corona virus. For pneumonia related studies articles from year 2010 to year 2017 were included for better comparison. Results: After pooling data, it was observed that bilateral involvement was found in 76.8% of studies, 68.4% GGO, and 62.2% ratio was occupied by peripheral distribution in different studies. Total 48.7% of studies were concerned about the ground glass opacity (GGO) consolidation, 33.2% observed consolidation, 27.7% look for crazy paving pattern, and 25% of studies observed mixed central and peripheral distribution. Conclusion: Study concludes that the chest CT finding results of selected studies for Covid and pneumonia cases were overlapping. Only high prevalence related to upper and lower lobe involvement and peripheral distribution was relatively high in Covid studies. Keywords: Computed tomography, pneumonia viral disease, Sars Covid-19
217 Sonographic Correlation between Endometrial Thickness and Infertility - A systematic review , Z. Siddique, S. K. T. S. Murrium, S. Sana, R. Bacha, S. Sana, I. Rahim
Background: Infertility is defined as not conceiving after one year of unprotected sex. Apart from age, physical and hormonal misbalance, and lifestyle or environmental factors for infertility; Endometrial thickness has an important role in conception. Females with the 8-12mm endometrial thickness in the late proliferative phase had great chances to get conceive. Aim: To determine the sonographic diagnostic features of the endometriumthickness with Transvaginal high-resolution ultrasound are predictive of infertility. Methods: An electronic database search was performed (Google Scholar, Science Direct, and PubMed) with the data range from 1988 to 2020.All studies, fully-available in English, assessing the endometrial thickness in the gray-scale image on TAS/TVs. Results: Thirty-three articles were found, we evaluated the performance of ultrasound diagnostic techniques, for the measurement of endometrial thickness, our results showed that ultrasound had a high level of diagnostic capability for measuring endometrial thickness. If endometrial thickness is more than 14mm or less than 7mm then chances of pregnancy were zero, so high chances of pregnancy when the endometrial thickness is 8mm to 11mm. Conclusion: We concluded that when the endometrial thickness was increased from 8 mm to 11 mm the chances of pregnancy were maximum, and when the thickness of endometrium was more than 14 mm or, less than 7 mm the pregnancy ratio was almost zero. Transvaginal ultrasound is an excellent imaging modality and its sensitivity is high for the measurement of endometrial thickness Keyword: Transvaginal sonography, endometrial thickness, Infertility
218 To Evaluate the Toxic Effects of Lithium Carbonate on Granule Cells Count of Rat Cerebellum , T. Kohari, Z. Malik, A. Ahmed, F. Irshad, A. Rasheed, R. M. Zeshaan
Aim: To study the damaging effect of chronic ingestion of 20 mg/kg body weight/OD of lithium carbonate on cerebellargranule cells. Methods: However, there is scanty documented information about the cerebellar toxicities of lithium carbonate on granule neurons. Therefore the present study is designed to observe the microscopic changes of granule neurons in rat cerebellum. For this experimental study 20 animals were used, they were divided into two groups, each comprising of 10 animals. Results: Group-A received normal lab diet and water ad libitum while group B received lithium carbonate 20 mg/kg/OD for 2 weeks and 6 weeks respectively. Micrometry was done on granule cells count. Conclusion: Highly significant changes of granule cells count were observed even at therapeutic doses. Lithium carbonate causes oxidant injury to granule neuronal cells in rat cerebellum. Keywords: Oxidant injury, Cerebellar degeneration, Incoordination,
219 Self-reported Oral Health Knowledge, DMFT status and Oral Hygiene Practices among University students , M. A. Abdulsalam, N A Alsewaiq, S. A. Hamza, A.U. Y. Syed, M. A. Ahmed, R. Jouhar, S. A. H. Bokhar
Aim: To assess dental caries knowledge, DMFT status and oral hygiene practices among Science and Non-science University students. Methods: A cross-sectional survey was conducted through a questionnaire that contained sociodemographic information, questions about oral health knowledge (OHK) assessed on Likert scale (strongly agree, agree, disagree, strongly disagree). Questions about dental caries, teeth extracted due to caries, and filled teeth while the fourth section questions were about oral hygiene practices (OHP). Data were processed using SPSS (version 21) with significance level of p≤0.050. Results: Four hundred (400) students participated in current study in which 190 students were from science (medicine and pharmacy) and 210 from non-science (education and arts) colleges. Male and female ratio were 185(46.3%) and 215(53.8%) respectively. Overall, oral health knowledge status was demonstrated as non-significant by both science and non-science students except for question regarding transmission of dental caries. A significant difference was observed between gender (p=0.016) for all questions except question 2 (bacteria is the cause of tooth decay). In addition, a significant difference were observed between urban and rural students (p=0.037) for question 2. No significant difference were observed for decayed, extracted teeth and oral hygiene practices between science and non-science students.. Conclusion: Statistically no significant difference in status of knowledge, decayed and missing teeth and oral hygiene practices was observed between science and non-science students, except for filled teeth. However differences among genders and urban/rural was noted. Keywords: Dental caries, Oral health practice, Science, Non-science, University students
220 Evaluation of Salivary Interleukin-1ß Levels and Oral Health in Pakistani Male Smokers , S. A. Hamza, S. Asif, S. A. H. Bokhari
Aim: Smoking induces changes in salivary inflammatory biomarker levels associated with oral diseases. This study status and explored association among salivary Interleukin-1β, oral diseases and smoking. Methods: Data of male smokers of a private institute recruited for a randomized clinical trial is analyzed for this paper. Demographic and systemic information were collected. Oral disease status was examined and saliva sample collected for IL-1β levels. IL-1β levels and other study variables were analyzed with respect to smoking status categorized into smoking years and cigarettes per day. The student's t-test and one-way ANOVA were used for statistical analysis using SPSS version 22) with significance level of p≤0.050. Results: Analysis of baseline data of seventy-eight smokers showed elevated levels of IL-1β with increasing smoking, higher BMI. Smoking was higher among aged, married and low-income individuals. Pearson partial correlation analysis, after controlling age, marital status, education, income, and BMI, demonstrated a positive significant relationship of smoking per day with smoking years; dental caries with missing teeth and calculus; gingivitis with missing teeth and calculus; periodontitis with dental caries, calculus and gingivitis. Conclusion: This analysis demonstrates that levels of IL-1β were raised in smokers, however; there was no association with oral disease parameters. Large studies may be conducted to observe status and association of smoking, oral disease and salivary biomarkers. Keywords: Smoking, Oral Health, IL-1β, Males
221 Determining the Receptor Proteins AdipoR1, Leptin and Lipid Status in Serum; Mitigating its impact on Obese and Healthy Individuals , M. A. Talat, I. Liaqat, T. Usman, M. K. Ashraf, A.malik, A. Talat
Aim: To investigate role of AdipoR1 concentrations and leptin levels in obese and healthy subjects along with their lipid status Methods: This cross sectional study was conducted in residents of Sialkot city and included 132 subjects. Each group had 66 participants. Mean age was 39.6±0.97 years. Mean BMI for obese subjects was 31.55±0.6 while healthy group BMI was 20.5±0.2. Individuals with known history of diabetes, hypertension, chronic kidney disease, any malignancy and history of lipid lowering, antihypertensive, antipsychotics and antiepileptic were excluded. Fasting blood samples were taken after informed and written consent. Samples were centrifuged to extract serum and stored for analysis by ELISA method for AdiopR1 and leptin while lipid profile was determined by kits by Randox Diagnostics using micro lab. Data was analyzed by SPSS v. 26. Comparison between groups was carried out by Mann-Whitney U test. Results: Our study revealed higher levels of serum AdipoR1 (28.9±22.86 ng/mL), leptin (320.7±59.38 pg/mL), cholesterol (216±5.31 mg/dl), triglyceride (177.8±4.93 mg/dl) and LDL (139.3±4.56 mg/dl) in obese when compared with healthy individuals, AdiopoR1 (17.8±1.96ng/mL), leptin (219±20.76 pg/mL), cholesterol (179.8±3.25 mg/dl), triglyceride (149.8±3.17mg/dl), LDL (108.5±25.7 mg/dl) respectively. No statistical difference was found for HDL between groups. Conclusion: Our Study concludes that rising levels of AdipoR1 and leptin in addition to lipid profile are associated with obesity. Keywords: Obesity, Receptor Proteins AdipoR1, Leptin, lipid status, adipose tissue
222 Frequency Of Diastolic Dysfunction In Preeclamptic Women Visiting Obs. & Gynaecology at LUMHS Jamshoro , H. A. Memon, F. Parveen, H. Najam
Aim: To determine the frequency of diastolic dysfunction in preeclamptic women visiting Obstetrics and Gynaecology department at LUMHS Jamshoro. Methods: This cross-sectional survey was conducted at department of Obstetrics and Gynecology of Liaquat University Hospital, Hyderabad, during the time period of January 2020 to December 2020. All diagnosed preeclamptic at gestational age of > 24 weeks, primigravida with singleton pregnancy between age 20 to 35 years was included in study. Confidentiality was maintained and preclamptic women were referred for echocardiography. The patient with diagnosed gestational hypertension and known cases of eclampsia, diabetes mellitus, any diagnosed renal and heart diseases, patients above 35 years and patients who are not willing to participate in the study were excluded from this study. Analysis was performed by SPSS version 21. Results: 145 diagnosed preeclamptic pregnant women average age was 26.42±4.14 years. Mostly patients were multiparity in 115(79.31%) cases and belongs to urban areas 76(52.41%) cases. 48(33.10%) were smoker and 35(24.14%) were used tobacco. Frequency of diastolic dysfunction in preeclamptic women was observed in 39.31% (57/145), while in multiparity women 41(28.27%) cases. Diastolic dysfunction was high in rural area 33(22.75%) cases as compare to urban 24(16.55%). It was also high in smoker (p=0.005) as shown in while it was not significant with tobacco users. Rate of diastolic dysfunction in preeclamptic women was high in those women whose family history of disease was observed 37(25.51%) cases. Conclusion: Preeclampsia still contributes to a predominance concerning maternal mortality and morbidity. Study indicates that in preeclamptic women the frequency of diastolic dysfunction is significant. Keywords: Diastolic dysfunction, Preeclampsia, Cardiovascular risk.
223 Comparison of Radiologic Diagnosis with surgical findings in 900 pts of acute appendicitis at AIMH, Sialkot , S. Ahmed, S. Ansar, M. Ansar, A. Latif, I. Ahmad, M. Q. Butt, M. Talat
Aim: To compare the radiological diagnosis with surgical findings of acute appendicitis Methods: This study included patients presenting with the complaint of pain in the right iliac fossa suggestive of acute appendicitis. The criteria for inclusion; twelve to sixty-five years of age, the existence of pain in the abdomen especially right iliac fossa or lower quadrant. Patients who presented with shock were excluded. Subjects suspected of acute appendicitis were referred for ultrasonography, which was carried out by a senior radiologist. A linear and convex probe was used for ultrasonography. Patients with insignificant findings on ultrasonography were evaluated for pain in the lower right quadrant. Those with ultra-sonographic findings strongly suggestive of acute appendicitis underwent a further evaluation to rule out complications. Results: Our study is based on 900 patients who fulfilled criteria of inclusion, age ranged from 6-55 years (mean 35±6.9 years) male to female ratio (2.22:1), 1036 ultrasonographic scans were done in these patients, 964 urine routine examination. The radiological confirmation of acute appendicitis 723, while clinical diagnosis of 900 patients leading to operative intervention. Laparoscopic appendectomy was done in 288 patients while open surgery in 612 patients. Histopathology of specimen of all the patients were obtained. In sonographic findings, appendix was visualized in 723 (80.33%) patients, uncompressible tubular structure in 723(80.33%), fluid in right iliac region 118(13.11%), mesenteric node enlargement in 103(11.44%), high up subhepatic appendix in 23(2.55%), and mass formation in 24(2.66%) patients. The surgical operative findings in the patients are as: hyperemic swollen appendix 648(72%), Blackened/ gangrenous appendix 84(9.33%), Appendix with pus in surrounding area 57(6.33%), appendix swollen with enlarged mesenteric lymph nodes 210(23.33%), Perforated appendix 58(6.44%), Early mass formation 35(3.88%) and Subhepatic appendix 23(2.55%). Conclusion: Ultrasonography being non invasive investigation is advised to diagnosis appendicitis. It has optimal sensitivity and for its diagnosis and suitable diagnostic method for assessing complications of appendicitis. The false negative diagnosis at ultrasonography for acute appendicitis is quantified as 14.44% with accuracy or sensitivity of 85.46%. Keywords: Appendicitis, incompressible, tubular structure, clinical diagnosis.
224 Acute Respiratory Distress Syndrome in Confirmed and Suspected Cases of Covid-19:A Cross Sectional Study , F. Sadiq, K. Ayoub, F. Riaz, S. Razzaq, A. Farooq, M. Khalid
Aim: To observe the frequency, severity and susceptibility to develop the severe symptoms of acute respiratory distress syndrome in confirmed and suspected cases of COVID-19. Study design: Cross sectional observational study. Place and duration of study: Lahore General Hospital, Lahore. Methodology: After Ethical Committee approval in 164 patients of confirmed or suspected COVID-19 who underwent the complication of ARDS were enrolled, admitted in department of Medicine and Intensive Care Unit at Lahore General Hospital, Lahore. After taking consent we studied different features in these patients like age, gender, comorbidities, symptoms, their radiological findings, SATS, PO2/FIO2 ratio, serum ferritin, CRP, LDH and d-dimer levels, and results were analyzed. Result: Out of 164 patients, 103 were COVID-19 positive. Mostly middle aged to old males developed the complications of ARDS. The most common symptoms observed were fever, cough and shortness of breath. Most common comorbidities present in the patients were diabetes and hypertension. HRCT was done in severe cases and 25 out of 35 patients had either unilateral or bilateral lung opacities. On chest X-ray 76% patients had bilateral lung infiltrates and 12% patients were having unilateral infiltrates. Inflammatory markers such as CRP, serum LDH, serum Ferritin, D-dimers were raised in most of the patients who developed moderate to severe ARDS. Conclusion: We concluded that the middle aged to old males with comorbidities like diabetes and hypertension are more likely to undergo ARDS. They can present with shortness of breath alone or in combination with fever and cough. Their X-ray usually showed bilateral patchy infiltrates and their ferritin, CRP, LDH and d- dimer levels are usually high. Keywords: ARDS, COVID-19, Inflammatory Markers
225 Covid-19 lockdown Impact on the Adult Pakistani Population , K. Shahzadi, B. Liaqat,, A. Shahbaz, H. U. Farooq
Background: COVID-19 pandemic started from Wuhan Hubei Area, China in December 2019 and by April 25th, 2020 had infected almost 2,858,000 people in 185 countries, resulting in more than 200,000 deaths. Pakistan first reported two cases was on 26th February, 2020. Aim: To illustrate the impact of lock down during Covid-19 on adult Pakistani population. Method: A cross sectional study was carried out from 1st June to 30th July, 2020. An online questionnaire was administered via social media and e-mailing channels, randomly dispersed to adult Pakistani population from 1st June 2020 until 30th July 2020. A self-prepared systematic questionnaire was utilized to record the responses of member. This survey included questions to check the impact of lockdown on Pakistani population behavior, health effect, income, daily routines and jobs status, demographic data, before and after lockdown (sleeping time, use of social networking and exercise time). Data analysis was performed using SPSS 24. Results: This data exhibit lockdown impacts the day-by-day schedules and habits of individuals. Periods of rest, eating propensities and internet users have found critical contrasts. The larger part of members acknowledged the urge influenced by lockdown in their schedules and propensities. Conclusion: Covid -19 lockdown has deistically affected all responses of life and people faced social isolation. Keywords: Covid-19, lockdown Impact, income status, sleeping time, work from home, use of internet.
226 Prevalence of Anemia and Use of Iron Supplements in MBBS Students of CMH Lahore Medical College , S. Zaffar, Q. U. Khan, H. Tanveer, I. R. Chattha, N. Rashid, R. Kamran, A. Masood  
Background: Iron deficiency anemia afflicts masses of all ages, worldwide. The disease tends to be prominent in the adolescence, students being more vulnerable due to their dynamic lifestyle, dietary habits and demanding growth spurt. Use of iron supplements can greatly reduce the burden of disease and associated morbidity. The objective of this study was to estimate the prevalence of anemia and use of iron supplements in MBBS students of CMH Medical College, Lahore. Methods: A cross sectional study was conducted in CMH Medical College, Lahore. A predesigned questionnaire was used to obtain information regarding use of iron supplements. Afterwards, hemoglobin level was measured using conventional Sahli’s method. The collected data was analyzed with SPSS 25 software. Results with p value < 0.05 were taken as significant. Results: Mean hemoglobin level was found to be 14.3±1.3 g/dL in males and 11.6±1.4 g/dL in females. Prevalence of anemia was found to be 38.7%. Anemia was found to be more prevalent in female students (57.8%) as compared to the male students (14.9%). Difference between prevalence of anemia in hostellites and day scholars was not found to be statistically significant (p = 0.17). Frequency of anemia was observed to be significantly higher in students who did not use oral iron supplements (p=0.03). Conclusion: Iron deficiency anemia is more common in female students than male students, of CMH Medical College Lahore. Majority of the anemic students do not take oral iron supplements. There is no difference in the prevalence of anemia among hostellites and day scholars. MeSH words: anemia, hemoglobin, iron supplements
227 Isolation of Multi Drug Resistant Escherichia coli from drinking water of Lahore City, Pakistan , N. Mir, S. Saleem, M. Imran, A. Ghazal, M. Usman
Background: The major faecal coliform is Escherichia coli which contaminates the drinking water from human and animal faecal waste. In developing regions drinking water is a vital source of microbiological pathogens. Multi-drug resistant (MDR) is defined as resistance to one or more antibiotic groups. An E. coli count greater than 4/dl in municipal drinking water is indicative of unacceptable fecal contamination. Aim: To find out the frequency of MDR E. coli in water system of Lahore, Pakistan. Methodology: Drinking water was collected from different towns of Lahore. The samples were processed using Membrane Filtration Technique. In the present study, Multidrug Resistant E.coli was isolated and antibiotic resistant pattern was seen against 16 most commonly antimicrobials, using Kirby Bauer disc diffusion method. Results: Total 100 water samples were collected, frequency of Escherichia coliisolated was 27% and frequency of MDR E.coli was 19%. The highest resistance showed by the organism towards Ampicillin (AMP) 21(81.48%), Augmentin (AMC), and Ceftazidime (CAZ) 14(51.85%) respectively. In this study also frequency of Extended Spectrum β-Lactamases were seen. Most common organisms isolated were E. coli 7% and Klebsiella 5%. Frequency of other coliforms isolated from drinking water other than E. coli was Klebsiella species 26%, Pseudomonas species 27%, Enterobacter 7%, Citrobacter species 8% and Acinetobacter species 5%. Conclusion: This study revealed that drinking water of Lahore city is heavilycontaminated with pathogenic microorganisms. A high proportion of antibiotic resistant is due to overuse of antibiotics, in patients with mild infections and secretion of these resistant bacteria from patients to environment. One of the reasons could be the mixing of sewage lines with drinking water supply. So, there is solely requirement for further studies for the identification of the sources for these contaminants. Keywords: Isolates, E. coli, Klebsiella, Multi-drug resistant (MDR)
228 Prevalence of Iron Deficiency Anemia in Hemodialysis patients at NIKD , A. Amjad, S. Usmani, H. H. Pasha, W. A. Khan, M. A. Qamar, Z. U Mustafa, U. Ather, S. Zulfiqar, S. Habib
Background: Iron deficiency is a cause of anemia in many hemodialysis patients. It remains under diagnosed in patients with kidney diseas and it leads to inappropriate response to erythropoietin. Early diagnosis of this anemia before usage of erythropoietin is important, to prevent prescription of expensive erythropoietin and unnecessary costs to the patient and the health care system. This study was conducted to determine prevalence of iron deficiency anemia in hemodialysis patients. Methods: This study was cross-sectional comparative study and was conducted at National Institute of Kidney Disease. Sheikh Zayed hospital nephrology department after taking permission from concerned department. Informed consent was taken from patients also. We measured serum ferritin, serum iron, Total iron binding capacity, complete blood count, hemoglobin in 140 hemodialysis patients. Serum samples were taken, processed and assessed for ferritin levels using commercially available ELISA kits. P value less than ≤ 0.05 was considered statistically significant. Results: Out of 140 hemodialysis patients, 34 had Iron deficiency anemia . (IDA). Conclusion: Iron deficiency anemia was observed in 24.2 % of hemodialysis patients.
229 To Determine the Efficacy and Safety of Narrow Band UVB (NB-UVB) in Chronic Hand Eczema (CHE) , S. Ali, S. Mohsin, Zeb, B. Ashraf, M. Nadeem
Aim: To d etermin e the safety and efficacy of narrow band ultravoilet B radiations in chronic hand eczema. Methods: 62 patients were enrolled from OPD of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore. They were given phototherapy treatment through NB UVB local chamber, t hrice weekly (on fixed days) for a total of 12 weeks or until clearance. Patients were followed up fortnightly for further 1 month and final assessment was done at the end of one month. Physician’s Global Assessment (PGA) Score was used to assess the sever ity of eczema affecting the hands. Results The data was collected from 62 patients with 0% dropout. There was only one patient who had improvement <25%, 4(6.45%) had improvement 25 50%, 8(12.90%) had 51 75% improvement and 49(79.03%) cases had improvem ent >75%. Minimal side effects were seen which included erythema, photosensitivity, itching and pain. Conclusion : NB UBV is a safe as well as effective treatment option for chronic eczema of hands. Keywords : Chronic Hand Eczema, Narrow Band UVB, Physician’s Global Assessment Score.
230 Knowledge and Practice of Health-care Workers regarding Hand Hygiene during Third Wave of COVID-19 , M.l Fatima, M. Waqar, H. Qamar, M. Akram, F. Zia, R. Hussain
Background: Iatrogenic and nosocomial infections are a serious threat to a healthcare setting especially during a pandemic. Hand hygiene among the health-care workers stands out to be a pivotal preventive measure. Practical application of hand hygiene measures during third wave of COVID-19 pandemic primarily depend upon the current knowledge among the health care workers. Methods: A cross-sectional study design based on validated WHO questionnaire for hand hygiene among the health care workers was conducted during March till May2021 in the settings of Shalamar and Central Park hospital and medical colleges. Results: The sample consisted of 271 participants with 110 males and 161 females, with the mean age of 24.72+ 4.174 years. The sample consisted of 36.2% of medical students, 49.1% of doctors and 14.8% of paramedical staff. Nearly 50.6% of the individuals claim to receive formal training. 47.6% believe that “Health-care workers’ hands when not clean” are the main route of cross-transmission. Nearly 57.2% believed that the hospital environment (surfaces)the most frequent source of germs. Comparison of hand-rubbing and washing revealed that major percentage believe hand rub to be rapid however less effective causing dryness. A majority believe that hand hygiene before touching the patient, immediately after exposure to body fluids or immediate surroundings of patients prevents transmission of germs to the patient and vice versa afterwards prevents transmission to HCW. Conclusion: A large proportion of the sample has considerable knowledge regarding essential hand hygiene in a health care setting. However more frequent training sessions should be conducted to improve it further. Key words: Hand hygiene, Health-care workers, Knowledge
231 Serum Interleukin-6 and Lipid Atherogenic Index Risk Ratios as Interpreters of Cardiac Disease in Obese and Non Obese Male Patients of Coronary Artery Disease , S. Naz, M. Raza, A. Akbar, A. N. Zaidi, S. Khaliq, T Ikram
Aim: To evaluate serum Interleukin-6, and lipids as predictors of cardiovascular diseases (CVD) in obese and non obese male patients of coronary artery disease (CAD). Methodology: It was cross-sectional comparative study. Serum Interleukin-6 and lipid profile was determined in non diabetic, non smoker and non hypertensive age matched obese and non obese male patients of CAD and healthy subjects. Sixty male subjects were divided equally into groups. Group 1, healthy controls (n=20), group 2, non obese male patients with CAD (n=20) and group 3 included Obese male patients with CAD (n=20). The serum was assayed for lipid profile and interleukin-6 . Results: Age matched healthy and patients were non diabetics, non hypertensive and non smoker with altered lipid profile in obese and non obese male patients with coronary artery disease. Patients have high serum cholesterol, low density cholesterol(LDL-C), Triglyceride(TG,) very low density lipoprotein(VLDL) and interleukin-6. The High density lipoprotein was lowered in both obese and non obese male patients with CAD. Significant positive correlation was observed in CAD group of IL-6 with TC (rho= 0.405, p= 0.009*) , with TG (rho= 0.639, p= 0.000*) ,with LDL (rho= 0.398, p= 0.002*), with VLDL (rho= 0.315, p= 0.014*). Significant negative correlation was observed in CAD group of IL-6 with HDL (rho= -0.565, p= 0.000*) Significant positive correlation was observed in CAD group of IL-6 .Significant positive correlation of IL-6 was observed with AI (rho= 0.602, p= 0.000*). Conclusion: Dyslipidemia, Raised interleukin-6 and strong positive correlation of Atherogenic index with IL-6 are independent risk factors for CVD; using Atherogenic risk ratios as a screening tool for the estimation of CVD risk is useful in patients with CAD. Keywords: Lipid profile, serum interleukin-6,Atherogenic index,coronary artery disease.
232 Comparison of rotary NiTi reciprocating file systems using Cone Beam CT in root canal transportation , N. Zahid, S. A. Khan, A. Saqib, A. Tariq
Aim: T assess the root canal transportation caused by these rotary NiTi reciprocating file systems using 3D cone beam computed tomography Method: This experimental study was conducted on 60 samples of rotary NiTi reciprocating file systems using CBCT. The extent of canal transportation and the centering ratio was analyzed using independent sample t test. The significance level was set at 95%. Results: Mean apical canal transportation was lower in wave one Gold groups as compare to Reciproc (0.8724±0.04SD vs 0.9463±0.02SD, p=0.000). Mean apical canal transportation at 5 mm was lower in wave one gold group as compare to reciproc blue group (0.5610±0.02SD vs 0.7253±0.06SD, p=0.000). Mean apical canal transportation at 8mm was lower in wave one group as compare to reciproc blue (0.358±0.03SD vs 0.5766±0.10SD, p=0.000). Conclusion: Wave one Gold had high centering ability and lower canal transportation as compare to Reciproc Blue single file system. CBCT is an efficient method of understanding Canal transportation Keywords: CBCT, NiTi wire, Root canal transportation, Reciproc blue
233 Relationship between Tobacco Smoking And Dental Fear Among Adolescents of 15-18 Year Age in Pakistan , G. Amin, M. S. Nawaz, A. M. Ikram, G. M. Shaikh, J. I. Afridi, A. Ehsan, A. Tariq
Aim: To assess the relationship between dental fear and smoking among adolescents of 15-18 year of age in Pakistan Method: This study was a prospective crossectional survey design which was conducted in Lahore. After taking permission from the school’s head, data was collected from the male students of grade 9th, 10th, 11th and 12th using questionnaire and later on one of their parents was approached to fill the questionnaire. For this purpose, only one school was targeted. Sample size was of 200 participants whereas parents of all the student participants participated in the study. Results: The results of chi-square revealed that dental fear was quite high among male students, occasional use of tobacco, and use of mouthwash minimum thrice a day. It was also found that students of those parents whose occupational level was low reported higher dental fear. Conclusion: It was found that adolescent male students were found to have more dental fear who smoke tobacco as compared to those who do not smoke. It is important to ask about smoking habits as well as dental fear when examining oral health maintenance of adolescents. Keywords: Smoking, Tobacco, Adolescents, Dental fear
234 Management of Acute Dental Pain during Pregnancy - A knowledge assessment of Dentists at University Hospital , Z. Iqbal, A. Hanif, S. A. Khan, A. Rashid, A. U. Hassan, S. Rana, A. Tariq
Aim: The purpose of the study was to explore the knowledge of the dentists regarding effective acute dental pain management among pregnant women. Methodology: Descriptive cross-sectional study design was conducted in the Operative Department, Dental Hospital at The University of Lahore. Sample size was 378 as in a Pakistani study. Non-probability convenient sampling technique was used to collect data. As descriptive statistics and data was analysed Results: Among 378 dentists, 122 (32.3%) had excellent knowledge and 143(37.8%) had good knowledge while 113 (29.9%) dentists had poor knowledge regarding management of acute dental pain during pregnancy Conclusion: Majority of the dentists reported good knowledge to deal pregnant patients with regards to procedure preferences. Keywords: Pregnant patients, Text books, Trimester, Dental pain management
235 Incidence and Clinical Implications of Postoperative Atrial Fibrillation in patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Grafting , U. Ullah, A. Ahmad, M. A. R. Mirza, W. Rehman, M. Mehmood
Aim: Post-operative incidence and clinical implications of atrial fibrillation in patients having on-pump and off-pump CABG. Place of Study: Department of Cardiovascular & Thoracic Surgery, Shaikh Zayed Hospital, Lahore. Study Duration: 1 year Design of Study: Quasi-experimental study Methodology: 140 cases were selected. Non-probability purposive sampling technique was used. Grouping: Group A (Off-pump) and Group B (On-pump). Results: In group A, cases showed atrial fibrillation and in group B 23(32.9%) cases were noted. The incidence of postoperative atrial fibrillation was low in off-pump CABG as compare to on pump CABG.Clinical implications of postoperative AF such as, length of ICU & hospital stay, cerebrovascular events, wound infections and mortality of the cases are significantly reduced by using off-pump CABG. Conclusion: Incidence of P/O atrial fibrillation is low in off-pump CABG as compare to on pump CABG Keywords: Coronary Artery Bypass Graft (CABG), Atrial Fibrillation, on pump CABG.
236 Prevalence of dental caries among 3 to 11 years old children in Lahore , A. I. Rana, S. Rana, A. U. Hassan, F. Ahmad , A. Anwaar, M. Riaz, A. Tariq
Aim: To determine frequency of dental caries in mal-occluded teeth among children 3-11 years of age and compare dental caries in children with mal-occluded teeth Methodology: This cross sectional analytical study using purposive sampling technique was carried out at Dental hospital of Institute of dentistry, CMH Lahore Medical College, Lahore for 09 months After permission from institute of dentistry, CMH Lahore medical college and informed consent form participants or their parents/ guardian, they were included as male and female children aged 3-11 years that attended dental hospital of Institute of dentistry, CMH Lahore Medical College for dental treatment and had mal-occluded teeth. Children with mental, physical disabilities and whose parents/ guardian refused to take part were excluded. Dental caries in mal-occluded teeth of children was examined to report the frequency of dental caries. SPSS version 23 was used for analysis data. Results: Among the total of 330 patients included in the study, dental caries was observed in 260 (78.8%) of patients. Conclusion(s): Significant associations of dental caries were observed in terms of gender and age, monthly income, interventional urgency, and occupation and education status. Higher frequency of dental caries was observed in the upper middle and lower middle class groups. Keywords: Dental caries, Mal-occlusion, Pre-school children, Dental treatment
237 To Compare Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Needles for S/A , M. S. Mehmood, T. Iqbal, R. Farooqi, Z. Y. Bhatti, F. Liaquat
Aim: Frequency of post dural puncture headache with Quincke 25G and 27G needles for spinal anesthesia Design of study: Control randomized study Setting: Anesthesiology/ deptt. / ICU, Shaikh Zayed Hospital Lahore Duration: 29-08-2013 to 01-03-2014 for 6 months Methodology: This was a prospective study of 100 patients undergoing surgery under spinal anesthesia. The subjects were divided in two groups. In group I, the anesthesia was applied with 25G quincke needle and in group II, the anesthesia was applied with 27G quincke needle. The patients were evaluated for post dural puncture headache till 72 hours postoperatively. Chi-square test was applied. P <0.05 was taken as significant. Results: PDPH was seen in 14 (28%) subjects in group I and in 4 (8%) subjects in group II. Conclusion: 27G needle should be preferred over 25G needle for application of spinal anesthesia due to decreased PDPH Keywords: Post dural puncture headache; spinal anesthesia; quincke needle
238 Comparison of Postoperative Mean Morphine Consumption in patients given Preoperative Gabapentin and Placebo undergoing Major Laparotomies for Lower Abdomen and Pelvis , T. Iqbal, R. Farooqi, M. S. Mehmood, Z. Y. Bhatti, F. Liaquat
Aim: Comparison of postoperative mean morphine consumption in patients given preoperative gabapentin and placebo undergoing major laparotomies for lower abdomen and pelvis. Study design: Randomized controlled trial Setting: Anaesthesia department, Hameed Latif hospital, Lahore Duration: Six months i.e. 20-04-2008 to 21-10-2008 Methods: 150 patients having major laparotomies were divided in group I i.e. 75 subjects with multivitamins as control and group II i.e.75 patients with Gabapentin. The two groups were compared for the consumption dose of opioid analgesia, postoperatively. Student’s t test was applied and p<0.05 was taken as significant. Results: The mean dose of tramadol consumed by the patients in group I was 43.6±18.9 mg and in group II was 14.7±5.7 mg. Conclusions: Preoperative use of Gabapentin before laparotomies reduces the morphine usage postoperatively. Keywords: Gabapentin; postoperative analgesia; morphine consumption:
239 Psychological Sequelae of Covid 19 Calamity on Medical Personnel in Pakistan , T. Iqbal, F. Naseem, A. A. Baig, F. Liaquat
Aim: To gauge the physiological sequelae of covid-19 pandemic on medical personnel in Pakistan. Place & duration: An online cross sectional study was conducted from May, 2020 to August, 2020 in Lahore. Methodology: 17 score PTSD check list civilian version was used to assess the symptoms of post-traumatic stress disorder in medical personnel. Results: Mean post-traumatic stress score (PTSS) was 39±15 with a range of 18-89. 66% (n=240) of the participants experienced moderate to extreme stress level. Chi Square test was used to determine an association between higher stress level and age, gender and staff category. Higher stress scores were associated with females (p<0.01). Conclusion: Rewarding the health personnel with gratitude, acknowledgement, financial compensations and provision of personal protective equipments (PPEs) can halt the psychological sequelae and is a promise to win this battle. Keywords: SARS coV2, Covid 19, PTSD, Health personnel
240 To Compare Frequency of Sore Throat in Early Postop period in General Anesthesia and Endotracheal Intubation for Abdominal Surgeries who are given Dexamethasone and Normal Saline , R. Farooqi, T. Iqbal, M. S. Mehmood, Z. Y. Bhatti, F. Liaquat
Aim: To Compare frequency of sore throat in early post operative period among patients undergoing general anaesthesia and endotracheal intubation for abdominal surgeries who are given dexamethasone and normal saline. Study Design: Randomized controlled study Setting: Department of Anesthesia/ ICU, Sheikh Zayed Hospital, Lahore Duration of study: Six months i.e. 25-09-2009 to 25-03-2010. Methodology: 120 patients undergoing elective general surgery on abdomen were selected. They were divided into two groups. Group I received dexamethasone 8mg (2ml) I/V pre-operatively and group II received 2ml normal saline I/V pre-operatively. Chi square test was used. Visual analogue (VAS) scale was used for recording sore throat. The VAS score ≤4 was considered as no sore throat and VAS scores>4 were considered as the sore throat. Results: Frequency of post-operative sore throat after the first 24 hours following GA and endotracheal intubation was lower in group (I) as compared to the control group (II). Eleven (20%) patients with dexamethasone had post-operative sore throat compared to thirty one (56.3%) patients in control group. (p<0.01). Conclusion: Pre-operative use of dexamethasone was associated with decreased incidence of post-operative sore throat. Keywords: Visual analogue scale (VAS), Post-operative sore throat, general anesthesia
241 Role of Transvaginal Ultrasonography in Diagnosing Endometrial Hyperplasia in Postmenopausal Women with Abnormal Uterine bleeding taking Histopathology as Gold Standard , S. Bilal, M. Gulshan, M. Tahir
Aim: Diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopausal women with abnormal uterine bleeding taking histopathology as gold standard. Settings & duration: Department of Radiology, CMH, Rawalpindi from 25-08-17 to 24-02-18 Methodology: A total of 203 post-menopausal females having AUB were included. Patients who had cervical and vaginal pathologies other than EH were excluded. The ultrasound was done with Endovaginal probe of Toshiba aplio 500. On ultrasound, endometrial thickness was taken. Endometrial biopsy was carried out using hysteroscopy. Final diagnosis was based upon histopathology report. Results: In TVS positive patients, 103 were True Positive and 12 were False Positive. Among 88 TVS negative patients, 04 were False Negative whereas 84 were True Negative (p=0.01). Overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopause women with abnormal uterine bleeding taking histopathology as gold standard was 96.3%, 87.5%, 89.6%, 95.5% and 92.1% respectively. Conclusion: Diagnostic accuracy of TVS in diagnosing endometrial hyperplasia in post-menopause women with AUB is high, so TVS should be the first line investigation in diagnosis of endometrial hyperplasia. Keywords: Abnormal uterine bleeding, TVS, endometrial hyperplasia
242 Role of Vitamin D in the Management of COVID-19 Patients Regarding Morbidity and Mortality , A. W. Khan, H. T. Hussain, Z.U. Mustafa, M. A. Qamar, M. A. Din, .U. Riaz
Aim: To determine the role of vitamin D in the management of COVID-19 patients regarding morbidity and mortality. Study Design: Prospective/Observational Place and Duration: Departments of Medicine & Pulmonology, Allama Iqbal Memorial Teaching Hospital, Sialkot and Department of Medicine, Sughra Shafi Medical Complex Narowal from 1st November 2020 to 30th April 2020. Methodology: One hundred and sixty patients of both genders diagnosed to have COVID-19, were enrolled. Patient’s ages were ranging from 17 to 70 years. The detailed demographics such as age, sex, and body mass index were recorded. 5 ml blood samples were taken from all the patients to check their vitamin D levels. Severe Vitamin D deficiency was defined as 25(OH)D <25 nmol/L (10 ng/dl). Association between mortality and morbidity was examined. Results: Ninety (56.25%) were males while 70 (43.75%) were females with mean age 40.15±17.37 years. Mean body mass index of patients was 24.16±7.26 kg/m2. Severe vitamin D deficiency was observed in 80 (50%) patients. Mortality found in 30 (18.75%) patients. Frequency of morbidity was among 66 (41.25%) patients. Patients with severe vitamin D deficiency had high rate of mortality 20 (25%) and morbidity 50 (62.5%) as compared to patients with no vitamin D deficiency had 10 (8%) mortality and 16 (20%) morbidity. A significant association was observed between severe vitamin D deficiency regarding morbidity and mortality among patients with covid-19 disease with p-value <0.05. Conclusion: The vitamin-D has strongest relationship among patients with covid-19 disease to reduce mortality and morbidity. Keywords: Morbidity, COVID-19, Vitamin D, Mortality
243 Socio-Economic Challenges in Childhood Cancer Care in a Low-Middle-Income Country , A. Ahmad, .A. Anjum, M. Hussain, A. A. Rasul, A. Mushtaq, A. S. Ahmad
Background: Each year, it is estimated that over 200 000 children and adolescents are diagnosed with cancer, and 80% of these reside in low-middle-income countries, with 90% mortality. There are enormous psychosocial needs of these patients, families, and care-givers, which are primarily affected by the communities' social, economic, cultural, and religious factors. Aim: To elucidate the significant psychosocial and socio-economic issues faced by the caregivers of children suffering from different types of cancer at the Children's Hospital Lahore. Study design: Prospective cohort study Place and duration of study: Department of Paediatric Hematology and Oncology, Children's Hospital Lahore Pakistan from 1st January 2018 to 30th June 2018 Methodology: Two hundred family members/caregivers of the patients were enrolled with ages ranging from <1 to 15 years (43% <5 years and 57% >5years old). Results: Male to female ratio was 1.2:1. 52% belonged to hematological malignancies and 48% from solid tumor groups. Most of these children had malnutrition with anemia (81% with Hb <10g%) and small weight forage in 63% cases at presentation. 80% of families had more than three children, with the youngest child being less than five years in 75%. 95% of families relied on public transport, with 65% of them traveling 100-500Km with 2-10 hours duration to reach the primary treatment center. 80% had a monthly income of less than USD150. 68% of these families had to borrow money for trip to hospital (p-Value=0.003), and 58% took a loan for treatment course. Conclusion: The significant socio-economic challenges faced by these families and caregivers included large family size with low incomes increasing their financial difficulties, logistic burden like traveling long distances to access health care, and parental employment and family dynamics disruptions. Keywords: Socioeconomic Challenges, Childhood Cancer, Low-Middle-Income Countries
244 Accuracy of Ultrasound for Determination of Fetal Gender , A. Ammar, M. A. Z. Husnain, M. Arshad, T. M. Mirza, Z. Arshad, T. Arshad, D. Arshad, M. Amjad
Aim: To evaluate the accuracy of ultrasound in determining the phenotypic foetal gender in all three trimesters. Study design: Cross sectional study. Place and duration of study: Department of Diagnostic Radiology Combined Military Hospital Lahore from 1st January 2020 to 30th April 2020. Methodology: Three hundred and seventy two patients in the inclusion criteria were selected. Ages of patients, gestational ages of foetuses and their genders were determined according to the ultrasonographic signs using ultrasound examination. Patients were contacted 3 weeks after the estimated date of delivery and phenotypic sex recorded. Results: Mean age was 34 years. Median gestational age was 21 weeks 3 days. Accuracy of gender determination by ultrasound in 1st, 2nd and 3rd trimesters was 62%, 97% and 95% respectively. Sensitivity and specificity of ultrasound in 1st trimester for males are 66% and 72%; and for females are 72% and 66% respectively. Positive and negative predictive values for male are 69% and 71%; and for female are 71% and 69% respectively. Sensitivity and specificity of ultrasound in 2nd trimester for males are 95% and 100%; and for females are 100% and 95% respectively. Positive and negative predictive values for male are 100% and 94%; and for female are 94% and 100% respectively. Sensitivity and specificity of ultrasound in 3rd trimester for males are 94% and 96%; and for females are 96% and 94% respectively. Positive and negative predictive values for male are 97% and 93%; and for female are 93% and 97% respectively. Conclusion: There is a high accuracy of ultrasound in determination of fetal gender in second and third trimesters. Keywords: Ultrasound, Gender, Trimester, Sensitivity, Specificity, Predictive Value
245 Depression in Primary Caregivers of Patients of Psychoactive Substance Use , A. A. Mufti, Z. Khan, M.U. Marri, A. Kamal, E. Gul, Z. Tareen
Aim: To determine the depression in primary caregivers of patients of psychoactive substance use. Study design: Descriptive cross-sectional Place and duration of study: Department of Psychiatry, Jinnah Medical College Hospital Peshawar from 1st June 2020 to 31st December 2020. Methodology: One hundred and twenty patients of both genders were enrolled. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. Patients were aged between 18-70 years of age. Depression and anxiety were calculated in primary caregivers of patients of psychoactive substance use. Results: Seventy (58.3%) patients were males and 50 (41.7%) patients were females. Mean age of the patients were 33.12±7.15 years with mean body mass index 25.08 ± 16.5 kg/m2. Psychoactive substance use resulted high level of depression and anxiety among the patients. 15 (12.5%) patients had mild, 30 (25%) showed moderate and 75 (62.5%) patients showed severe depression. Anxiety among patients was 12 (10%) mild, 26 (21.7%) moderate and 82 (68.3%) patients had severe. 30(25%) were illiterate and 90 (75%) were literate. Conclusion: The caregivers of patients of psychoactive substance use had severity of depression with negative intimation among the cases. In patients with substance use disorders, depression and anxiety are usually found. The development of anxiety and depression on the one hand is obviously associated with the seriousness of medication-related issues on the other side. Keywords: Anxiety, Depression, Substance use, Caregivers.
246 Frequency of Metabolic Abnormalities of Vesical Calculus in Children Younger than 10 Yrs of Age , H.U Rahman, S. F. Shah, A. J. Sheikh, I. U. Memon, W. S. Bhatti, N. U. K. Bhatti
Aim: To assess the metabolic abnormalities in children younger than 10 years of age with vesical calculus. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Hospital, Khairpur from 1st October 2014 to 30th September 2016. Methodology: Two hundred and six children age <10 years of age and either gender presented with vesical calculus were enrolled. Demographic information like age, gender, residence, serum electrolytes, calcium, magnesium, phosphate, uric acid, blood, and urine pH were recorded for the purpose of metabolic workup. Results: The mean age was 4.76±1.22 years and 157 (76.2%) were males and 49 (23.8%) were females. The frequency of metabolic abnormalities was observed in 153 (74.3%) of the patients. A significantly higher prevalence of metabolic abnormalities was observed with male gender (p-value 0.006), dark colored urine as presenting symptoms (p-value 0.022), frequent urination (p-value 0.045), and hematuria (p-value 0.016). Of 153 patients with metabolic abnormalities, hypercalciuria was observed in 45 (29.4%), hypocitraturia in 73 (47.7%), hyperoxaluria in 21 (13.7%), and hyperuricosuria in 14 (9.2%) patients. Conclusion: The frequency of metabolic abnormalities was high among children with vesical calculus. Moreover, hypocitraturia in these children was observed in majority followed by hypercalciuria, hyperoxaluria, and hyperuricosuria. Keywords: Metabolic abnormalities, Children, Vesical calculus
247 Evaluation of Shear Bond Strength of Prepared Samples of Silorane Composite Repaired with Silorane , H. Asghar, M. Rasheed, H. Khawaja, H. N. Naseem, Z. Arooj, F. Fayyaz
Aim: To evaluate shear bond strength of silorane based composite samples repaired with silorane composite with application of silane coupling agent and adhesive bond of silorane before and after thermal cycling. Study design: Experimental study Place and duration of study: Science of Dental Materials Department, de’Montmorency College of Dentistry Lahore from 1st January 2014 to 31st October 2014. Methodology: Sixty composite specimens equally divided into control and experimental groups. Control group was further prepared for repair procedure after polymerization without thermal cycling while experimental group was given with 5000 thermal cycles between temperature range of 5-55oC, dwell time of 20 seconds) before testing, all samples were surface roughened with 400 grit silicon carbide strip, followed by application of silorane coupling agent and adhesive bond of silorane over the substrate and cured for 20 seconds. Repair silane based composite was applied on all substrate silorane composite samples and polymerized, before testing samples were left in distilled water (24 hour at 37oC) and tested with universal testing machine (crosshead speed 0.5 mm/min) until fracture. Results: There is 12 (20%) adhesive, mixed 2 (3.3%) and cohesive is 46 (76.7%). The thermal cycling has no effect on bonding interface in experimental group on strength at bonding interface. Conclusion: Silorane based composite as repair composite gave better strength with silorane based composite and can be used for repair options. Keywords: Shear bond strength, Silorane based composite, Silorane adhesive bond
248 Bacterial Vaginosis and its Relation with Sociodemographic Determinants in married reproductive age females , R. Mukhtar, A. U.-Rehman, A. Ilyas, M. J. Khan, R. Liaqat, G. A. Khan
Aim: To determine the frequency of Bacterial vaginosis by pap smear cytology and find its association with its sociodemographic determinants. Study design: Cross sectional analytical study Place and duration of study: Department of Histopathology, Shaikh Zayed Hospital, Lahore from 1st January 2016 to 31st October 2016. Methodology: Two hundred and sixty pap smears of married women of reproductive age group with vaginal discharge who attended Gynecology OPD were included. Proper history regarding age, socioeconomic status, age of marriage, literacy level, smoking, and nutritional status was taken. Results: Disease prevalence was found to be 19.2%(50)in this sample of 260 while 9.1% had Candidiasis, 47%, 17.2% ,3.7%, 4.1% had Mild nonspecific inflammation, Moderate nonspecific inflammation, Moderate to severe nonspecific inflammation, and negative smears respectively. Bacterial vaginosis was associated with age, monthly income, illiteracy, early age at marriage, history of abortion and nutritional status with significant p-value ≤ 0.05. However no association was found between the disease and marital status, smoking and pallor. Conclusion: Low socioeconomic status, literacy, age >35, nutritional status is strongly related to occurrence of bacterial vaginosis in women of reproductive age group with vaginal discharge. Key Words: Bacterial vaginosis, Pap smear, Sociodemographic determinants
249 Comparison of Clomiphene Citrate Plus N-Acetyl Cysteine and Clomiphene Citrate Alone for Induction of Ovulation in Polycystic Ovary Syndrome , S. Waseem, S. Gohar, M. Afzal, Z. Wali
Aim: To compare the frequency of ovulation with clomiphene citrate plus N-acetyl cysteine versus clomiphene citrate alone in married females presenting with polycystic ovarian syndrome. Study design: Randomized clinical trial Place and duration of study: Department of Obstetrics and Gynaecology, Unit-3 Jinnah Hospital, Lahore from 1st September 2018 to 28th February 2019. Methodology: A total of 60 patients (30 in each group) were enrolled. In group A, females were prescribed clomiphene citrate 50-mg tablets twice daily with N-acetyl cysteine 1200 mg/day orally for 5 days starting on day 3 of the menstrual cycle and in group B, females were prescribed clomiphene citrate 50-mg tablets twice daily. Results: Patients ranged between 18-35 years of age. Mean age of the patients was 28.5±3.3 and 28.1±3.1 years in group A and B, respectively. Mean duration of marriage in group A was 3.4±0.9 and in group B 3.5±0.9 year. Mean BMI in group-A was 3.4±0.9 while in group-B 3.5±0.9 (kg/m2). Ovulation was observed at 1st month in group A was 12 (40%) and in group B 9 (30%). Ovulation was observed at 2nd month in group A was 16 (53.3%) and in group B 13 (43.3%). In 3rd months ovulation was seen in 19 patients (63.3%) of group A and 18 patients (60%) of group B. Stratification for age and BMI was also carried out. Conclusion: This study could not find any clinical superiority for clomiphene citrate plus N-acetyl cysteine versus clomiphene citrate alone in term of ovulation rate. Keywords: N-acetyl cysteine, Polycystic ovary syndrome, Ovulation induction
250 Impact of Proning in COVID-19 Patients Admitted in Allama Iqbal Memorial Teaching Hospital Sialkot , H. T. Hussain, A. W. Khan, Z. U. Mustafa, M. A. Qamar, M. A. U. Din
Aim: To determine the effects of prone position in patients with COVID-19. Study design: Retrospective/observational study Place and duration of study: Department of Medicine Allama Iqbal Memorial Teaching Hospital, Sialkot and its related ICU from 1st November 2020 to 30th April 2021 Methodology: Fifty patients of respiratory failure admitted to ICU were included in this study. Patient’s details demographics age, sex and body mass index were recorded after taking informed written consent. Patients were aged between 25-80years.Patients were divided in to two groups I and II. Group I had 25 COVID-19 patients underwent prone position and group II with 25 patients taken as control. Chest x-ray of both groups was taken. Patients of group I were kept in prone position while group II received invasive ventilation and follow up was taken in duration of 15-days. Results: There were majority of males, 40 (80%) and rest females 10 (20%). Mean age of the patients in prone positioning group was 50.3±18.22 years with mean BMI 26.14±7.13 kg/m2 and in control group it was 51.5±18.22 years with mean BMI 26.41±7.13 kg/m2.Thirty (60%) patients had moderate and 20 (40%) had severe covid-19 disease. Mean duration of prone position was 5.14±6.31 hours. Most of the patients 42 (84%) had bilateral lung involvement, interstitial infiltrates 55 (90%). Fever, cough and dyspnea were the most common symptom found in both groups. Mean PF ratio was increases in prone group as compared to controlled group. Mean hospital stay in group I was 6.9±18.8 days and in group II mean hospital stay was 9.7±13.2 days. Conclusion: The use of prone position among patients of COVID-19 was effective and safe method to reduce intubation, mortality and hospital stay. There was no any complication were found after this treatment. Keywords: Prone Position, Covid-19, Respiratory Failure, Mortality
251 Association between Achilles and Plantar Calcaneal Spur in Pakistani Population Presenting with Pain , Z. Arshad, A. Ammar, M. Arshad,T. M. Mirza, T. Arshad, D. Arshad, M. Amjad
Aim: To evaluate the prevalence and associationbetween Achilles and plantar calcaneal spurs in Pakistani population. Study design: Cross sectional study. Place and duration of study: The study was conducted in the radiology department Combined Military Hospital Lahore from October 2020 to December 2020. Methodology: Three hundred and thirty five patients were enrolled. The age and sex of the patients were recorded. Lateral foot and/ or ankle radiographs were evaluated for presence of calcaneal spurs. Results:Mean age 38 years.There were 268 (80%) males and 67 (20%) females. 30.7% patients had a calcaneal spur in our population irrespective of age and gender. 13% patients had both posterior and inferior calcaneal spurs. There was higher prevalence of inferior calcaneal spur irrespective of age and gender.Posterior calcaneal spur was seen in 20% of males and in 15% of females. A total of 44 (68%) patients with posterior plantar spur were found to have a concomitant inferior calcaneal spur.Inferior calcaneal spur was seen in 25% of males and in 28% of females and positive correlation between posterior and inferior calcaneal spurs. Conclusion: There is a high prevalence of calcaneal spurs, which increases with advances of age. Inferior calcaneal spurs tend to be more prevalent in females. Furthermore, there is a significant association between the presence of posterior calcaneal spurs and the concomitant inferior calcaneal spurs. Key words: Achilles, Plantar, Calcaneal, Spur
252 Midfacial Degloving Approach Facilitated with Endoscope for Nasal, Paranasal & Nasopharyngeal Pathologies , T. Rashid, A. Ayoub, M. Ahmed, S. Qadir, M. Jan, A. Ghafoor
Background: Endoscopic sinus surgery is mostly conducted for the removal of the inflammatory as well as infectious diseases of sinus and malignant or benign nasal, paranasal & nasopharyngeal pathologies. The various surgical approaches that have been used range from transpalatine to a lateral rhinotomy and to mid-facial degloving. Aim: To determine the outcome of mid-facial degloving approach facilitated with endoscope for nasal, paranasal and nasopharyngeal pathologies. Methods: Forty five patients that fulfilled the inclusion criteria were enrolled in the study. All the patients were then underwent surgery by the researcher along with a surgical team under general anesthesia by using Mid-facial degloving approach. The patients were followed - up on 3 & 6 months after the surgery and underwent clinical examination and endoscopic nasal examination to assess the complications, cosmetic outcome and recurrence after the procedure during the follow-up period. Data was entered & analyzed using SPSS v. 23. Results: Mean age of the patients in the sample was 25.47±10.52 years. There were 39(86.7%) male patients and 6(13.3%) female patients. Cosmetic outcome was excellent in 31(68.9%) cases, satisfactory in 12(26.7%) while 2(4.4%) variable comments about the cosmetic effects of the procedure. Bleeding was most common complication 3(6.7%), however recurrence occurred in 3(6.7%) cases. Conclusion: It is concluded that mid-facial degloving approach is a highly successful method for removal of nasal, paranasal or nasopharyngeal pathologies. Key words: Mid-facial degloving, endoscope, nasal, paranasal, nasopharyngeal, pathologies
253 Varied Clinical Presentations of COVID-19 in Pregnant Women in Tertiary Care Hospital of Lahore-Pakistan , S. Aslam, M. Gondal, T. Tahira, Zille Huma, M. Mumtaz, M. Zahir, T. Laique  
Background: The whole world is facing one of the biggest health related disasters of the century. As a novel disease, Covid-19 has so many parameters yet to explore. Aim: To explore varied pattern of clinical presentation of COVID-19 in obstetric population in tertiary care hospital. Study design: Cross-sectional study. Methodology: This study with enrolled pregnant females (n=36) was carried out after ethical review committee’s (ERC) approval at Department of Gynecology & Obstetrics, Sir Ganga Ram Hospital, Lahore-Pakistan over a period of 3 months in 2020. Data was analyzed by SPSS software, version-20. Presenting symptoms of subjects were presented as frequency and percentage. Results: Total 36 patients were selected. Twenty four (66.66%) patients were symptomatic while the rest 12 (33.33%) patients were asymptomatic. Conclusion: We concluded that clinical presentation of COVID-19 pregnant patients is similar as in rest of the world and it is also same as in general population. Keywords: Covid-19, Pregnant Patients and Clinical Presentation.
254 Assessment and comparative analysis of glycemic and satiety indices of locally available biscuits , B. Liaqat, K. Shahzadi, M. T. Abbas, A. R. Faisal, H. U. Farooq  
Background: Glycemic index is a relative ranking that tells how fast or slow carbohydrates alter your blood sugar level, While Satiety index is a ranking that describe the feeling of fullness after eating specific food. Aim: To determine GI & SI of different biscuits (chocolate chip, chocolato and candy). Methods: The GI and SI of 25 people were tested by giving them 3 types of different local biscuits. Their blood glucose level was monitored for 3 hours. Same way their Satiety level was observed for 3 hours. For satiety level, 5 people were given white bread as standard value. Results: Results showed that glycemic indices are 116.34±3.164, 108.93±3.874 and 110.99±7.18 of candy biscuit, chocolato biscuit and chocolate chip biscuit respectively. While their satiety indices are 52.66±6.38, 42.89±3.23 and 47.45±3.29 of candy biscuit, chocolato biscuit and chocolate chip biscuit respectively. Conclusion: From experiments it is concluded that Glycemic indices of biscuits are 110.99±7.18, 108.93±3.874 and 116.34±3.164 of chocolate chip, chocolato and candy biscuit respectively. Keywords: Glycemic indices, satiety indices, chocolate chip, candy
255 Proportion of Nonalcoholic Steatohepatitis in Patients with Chronic Liver Disease , H.A. Abro, B. A. Shaikh, A. H. Mugheri, I. A. Ansari, Z. A. Shaikh, A. Kumar
Aim: To determine the frequency of nonalcoholic steatohepatitis in patients with liver cirrhosis. Study Design: Retrospective/observational Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana from 1st July 2020 to 31st March 2021. Methodology: One hundred and twenty patients of both genders presented with liver cirrhosis were enrolled in this study. Patient’s detailed demographics including age, sex, body mass index, smoking status, alcohol consumption and family history of liver disease were recorded after taking written informed consent. Laboratory examination was done to examine the proportion of hepatitis B virus, hepatitis C virus and nonalcoholic steatohepatitis. Results: There were 68 (56.67%) males and 52 (43.33%) were females with mean age 45.74±10.54 years. Among all the patients hepatitis C virus was found in 62 (51.67%) patients, 15 (12.5%) had hepatitis B virus, 17 (14.17%) had hepatitis B virus + hepatitis C virus and nonalcoholic steatohepatitis was found in 26 (21.67%) patients. Conclusion: Nonalcoholic steatohepatitis was the major cause of liver cirrhosis in Pakistani population. The proportion of NASH in liver cirrhosis patients was 21.67%. Keywords: Nonalcoholic steatohepatitis (NASH), Liver Cirrhosis, Hepatitis B virus, Hepatitis C virus
256 COVID-19 Pandemic: Challenges, Impacts and Dilemmas in Surgical Oncology (Descriptive Longitudinal Study) , A. Waheed, H. J. Majid, M. I. Anwar
Background: The oncologic surgery patients constitute a highly susceptible group during COVID-19 pandemic. Aim: To determine how the COVID-19 pandemic affected the cases of surgical oncology, their frequency with reference to the pre-pandemic era and the challenges faced in general and in their management during the pandemic. Methodology: we conducted a descriptive longitudinal study, using consecutive non-probability sampling technique, estimating the number of cancer cases in our center, their management protocols keeping in view the local and international guidelines, resource availability and how the pandemic affected the dynamics of cancer surgery. Results: we received a total of 63 cancer cases from 1st march-31st august 2020, between age groups 29-70 years. 40 patients out of those 63 presented with complications and received early definitive surgery, where surgery could not be deferred due to the course of disease or complications. Rest of the 20 patients received either neoadjuvant chemotherapy, a palliative procedure or chemoradiotherapy, 2 patients tested COVID-19 positive, 1 non-cancer related mortality. We received 63 patients during our 6 months study time, compared with a total of 156 cancer cases received during the pre-pandemic 6 months period, showing significant decrease in frequency of cancer cases. Conclusion: Cancer cases with a chance of upgradation of disease stage due to delay or those complicated with obstruction or bleeding could not be deferred. Mandatory PCR COVID-19 testing of every admitted patient with a repeat test 48-72 hours before surgery. Early referral to corona care center if patient tests positive. Discussion of every case in MDM prior to decision making. Operating every case with complete SOPs. Keywords: COVID-19, surgical oncology, pandemic
257   Age and Gender-Based Differences in Covid-19 Clinical Features and Management: A cross sectional study , R. Masud, M. Z. Anwar, S.A. A. Gardezi, M. Rehman, I. Rafique, A. Asad, M.R.I. Hashmi, S. Shoaib, S. N. Hashmi, T. Laique
Background: The whole world is facing one of the biggest health related disaster (COVID-19) of the century. Aim: To identify age and gender-based differences in Covid-19 clinical features and its management among patients at government hospitals, Pakistan. Study design: Cross-sectional study. Methodology: This study with enrolled subjects (n=206) was carried out after ethical review committee’s (ERC) approval at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan. Both male and female medical subjects were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of age and gender with COVID-19 symptoms having P-value greater than 0.05. There was a significant association between treatments given was significantly related with age having P-value (0.006*). Conclusion: We concluded that there was no strong association between age and gender-based differences in Covid-19 clinical features; this could be due to small sample size. Keywords: Covid-19, Age, Treatment and Gender.
258 Student’ Knowledge and Attitude towards Infection Control at Prince Sultan Military College of Health Sciences , M. J. A .Zahrani, S. H. Qahtani, W. A. Baig, F. S. Alasmari
Background: Awareness and knowledge about prevention of infections are important to prevent transmission of diseases from healthcare workers to patients. Aim: To evaluate the students’ attitude towards infection control at Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia. Study Design: Cross sectional study. Methodology: Present study enrolled 415 participants involving both genders from different allied health specialties at PSMCHS. A standardized, anonymous online questionnaire was utilized to gather the data necessary to assess students’ attitudes through answering seven statements. Informed written consent was taken. Unwilling participants were excluded. All collected information was kept confidential. Data analyzed by SPSS 25.0. Frequency and percentage were given for gender distribution and knowledge assessment through questionnaire. Moreover, F- test was applied by keeping CI (95%) with p-value of ≤ 0.05 taken as significant. Results: There was a significant difference between female and male students regarding the positive attitude towards infection control. Dental and Oral Health students scored the highest degree of agreement using Analysis of Variance (F-test). This high score was obtained because dedicates an entire course infection control while it was embedded in the other departments’ courses. Conclusion: This study concluded that a dedicated course on infection control was an effective tool in instilling positive attitude towards infection control among PSMCHS students from different specialties. Keywords: Attitude, Awareness, Infection control and Students.
259 Assessment of Violence as Cause of Death Affecting Both Genders: Hidden View , F. Tariq, S. Sarwar, S. Sadia, K. Mukhtar, S. Nadeem, H. Rehman, T. Laique  
Background: Autopsy can lead to the cause of death most accurately in both natural as well as unnatural deaths. Aim: To determine the correlation between gender and different parameters like cause of death, region involved and manner of death seen on autopsies in government hospitals of Pakistan. Study design: Retrospective study. Methodology: Patients (n=186) were enrolled in present study held at Forensic department, Sheikh Zaid Hospital, Rahim-yar Khan-Pakistan. Cases were included irrespective of gender in present study. Data analyzed by SPSS 22.0v. Results: Males were 67.9% while females were 32.1% in present study. Among these 186 cases of autopsy, manner of death was homicidal in 83(44.6%) autopsies, accidental in 49(26.3%) and suicidal deaths was in 54(29%). There was no correlation between gender & cause of death by weapon. There was correlation between gender & manner of death. There was correlation between area & cause of death by weapon. Conclusion: This study concluded that mostly males of our population were involved in medico-legal cases and criminal activities. Major cause of death remained to be firearms. Gender was correlated with manner of death but not related with cause of death by weapon. However, government needs to play its due role in-order to stop criminal acts through law enforcement. Keywords: Autopsy, Audit, Manner of Death and Cause of Death.
260 Awareness of Nurses Regarding Culturally Competent Care in Hospitals of Punjab: Cross Sectional Study , T. Perveen, S. Shahnaz, Zarniga, N. .B. Anwar, T. Zia, W. Latif, T. Laique
Background: Nursing profession is one of the professions which is continuously developing and uniformly acclimatizing to not only new medical treatments and expansions but also adapting the socio-cultural norms and expectations. Aim: To analyze the level of nurses’ awareness regarding culturally competent care in three selected hospitals of Punjab. Study design: Cross-sectional study. Methodology: Study setting was public hospitals of Punjab-Pakistan after ethical review committee’s (ERC) approval. Data was collected from nurses (n=133) by using self-administered questionnaire that was adapted from cultural awareness assessment tool. They were selected from three hospitals through non-probability convenient sampling technique. Statistical analysis: Data was analyzed by using SPSS version-20. To summarize the results, mean ± SD, frequencies, percentages and graphs were used. Results: Overall average score of cultural competence was 24.31 ± 3.457 which was on the lower side. Scores of Muzaffar Garh nurses was statistically significantly higher than both hospitals (p-value <0.001). This variation is due to years of experience (4-6 years) of nurses in Muzaffar Garh. Perhaps, comparatively long period of experience made them aware of the cultural practices of the people. Conclusion: We concluded that frequent and long-term interaction of nurses with patient which may help nurses in developing understanding of client’s culture because novice nurses are not able to understand point of view of the patients with diverse culture as they are not prepared to deal with the problems of cultural diversity. Keywords: Nursing Profession, Cultural Norms, Trans-cultural Nursing Care and Awareness
261 An Audit Of Wheat Pill Poisoning In A Tertiary Care Hospital: A Retroscpective Study , S. Sadia, K. Naheed, F. Tariq, M. I. Ghani, P. Zarif, A Rafiq, T Laique
Background: Wheatpill is a commonly used suicide drug in developing countries. Due to the easy availability, this drug has played a great role for those people who commit suicide due to various reasons. Aim: To investigate different features such as (Age, Gender, Education, Marital status, Treatment, Location) of all those people who deliberately self-harm by using aluminium phosphide. Study design: Retrospective study. Methodology: Patients (n=83) were enrolled at Teaching Medical Unit, DHQ Teaching Hospital, Sargodha, Pakistan from January 2019 to December 2019 in present study and study tools were age, gender, marital status, educational status, time of arrival, number of days stayed in a hospital, treatment and outcome. Cases were included irrespective of gender. Data analyzed by SPSS 22.0v. Results: Among them 42 are men and 41 were women. 77% of the patients were under 40 years of age and despite taking advantage of all available treatment options, the mortality rate was up to 83% which indicates severe consequences after taking Aluminium Phosphide. Conclusion: This study concluded that this particular aspect of pesticide poisoning was almost exclusively a concern of the developing world where aluminum phosphide was a commonly used and easily available rodenticide. Agricultural activities were undertaken in remote rural areas, which most often lack health-care facilities. Death resulted from cardiogenic shock and hypotension. Keywords: Gender, educational status, time of arrival and treatment efficacy.
262 Association Of Acne Vulgaris With Polycystic Ovarian Syndrome In Patients Visiting UOL Teaching Hospital , A. Malik, S. A H. Kazmi
Background: Polycystic syndrome (PCOS) is the most common endocrine disorder in the world affecting 8% of women. The main characters of PCOS are enlarged ovaries, chronic ovulation, menstrual cycles disturbance, androgen overdose, and insulin resistance leading to acne, hirsutism, and reproductive problems. Acne is a quite common dermatological condition in daily practice. Aim: To determine the association of acne vulgaris with polycystic ovarian syndrome in patients visiting the University of Lahore Teaching Hospital. Study design: Descriptive cross-sectional study. Place and duration of study: Dermatology Outpatient Department, University of Lahore Teaching Hospital Lahore from March 2019 to March 2020. Methodology: It was a descriptive cross-sectional study from March 2019 to March 2020 conducted at the Dermatology Out-patient Department, University of Lahore Teaching Hospital. All patients between the ages of 18 and 40, with acne vulgaris were included in the study. After obtaining informed consent, 101 women with acne vulgaris in I-IV (Indian stages), between the ages of 18-40 years, presented in the Department of Dermatology, University of Lahore Teaching Hospital, from March 2019 to March 2020, were selected for the study. Pregnant females, lactating mothers, and women on hormonal treatment (oral contraceptives or injections) were excluded from the study. A history of acne, oligomenorrhea, hirsutism, seborrhea, alopecia, acanthosis nigricans infertility, obesity and amenorrhea were taken. Weight and height were measured to calculate BMI. Data were collected in a special statistically tool and analyzed using SPSS-25. Results: A total of 101 women were examined having acne vulgaris issue. A total of 101 female were assessed and having history of acne vulgaris. Out of this, 33 were 18–23 years old, while 24 (23.4%) have ages 24–28 years. There were 18 (17.8%) patients who have 29–33 years old. while 38–40 years were 10 (9.9%) years old. Irregular menstrualcycle was reported 34.6% of the study population. As Perth WHO criteria, only 17% of the participants had BMI in normal weight range. The proportion of women, who were overweight and obese were 50.4% and 32.6% in the study population. Conclusion: Acne vulgaris has been identified as a serious skin disease found in all age groups. PCOS is more common among women with acne and obesity is a major risk factor for PCOS. Keywords: PCOS, Acne
263 To Study the Frequency of Albuminuria in Diabetics Brought in with Stroke: A survey at Tertiary Care Hospital , A. Malik, A. Akhtar, F. F Jang, M. Uthman
Background: Albuminuria is thought to be a separate risk factor for stroke. A strong association between diabetes related albuminuria and stroke has been published in the international literature. Albuminuria being a sign of endothelial dysfunction, atherosclerosis is a strong predictor of strokes. Aim: To investigate the albuminuria as a predictor of stroke in diabetics in our population. Study design: Observational study. Place and duration of study: This study was done in the Department of Neurology, Sharif Medical & Dental College/Hospital, Lahore from January to August 2019. Methodology: One hundred and fifty diabetic patients having ages 25 to 75 years presented with stroke were enrolled in this study. Demographics (age, sex, residence and socio-economic status) of the included population and types of stroke were recorded on study proforma after getting brain CT of each patient. Urine for albuminuria was examined under microscope. Results: In this study (63%) were males and 37% were females with M:F ratio 2.54:1. Major portion of the patients (43%) were ages between 25-45 years mean±SD 51.62±8.45. Ischemic stroke was found in 114 (76%) hemorrhagic in 24(16%) and undetermined in 12(8%) patients respectively. Albuminuria was found in 72(48%) patients, Group A 40(69%) had ischemic stroke, 10(17%) had hemorrhagic and 8(14%) had undetermined stroke. Conclusion: It is concluded that is strong relation between microvascular complications with macrovascular complication of diabetes (i.e. albuminuria with stroke). The stoke patients with diabetes has more frequency of albuminuria as compared to non diabetics. Keywords: Albuminuria, T2DM, Stroke, Hemorrhagic.
264 Frequency of Postherpetic Neuralgia In Herpes Zoster Patients , A. Malik, F. F Jang, M. Moosa, A. Iqbal, S. A. A. Hassan, A. Malik
Aim: To estimate the incidence ofpostherpetic neuralgia after being infected by herpes zoster virus. Place and duration of study: This study was conducted in Sharif Medical & Dental College, Lahore from August 2019 to August 2020. Methodology: A number of 126 patients was included in this research who had history of herpes zoster. Demographic information, medical diagnosis, treatment and symptoms were included in the data collected. Patients with unclear diagnosis regarding herpes zoster were not included in this study. From patient’s history, we comprehended the number of patients who developed postherpetic neuralgia after herpes zoster. Severity of pain was judged by the medications prescribed to the patients. Risk factors like age, gender, co-morbidity and localization were also analyzed. We used multivariate logistic regression to analyze potential risk factors. Risk factors were analyzed in order to determine the frequency of postherpetic neuralgia in herpes zoster patients extensively. This gave us a better idea about postherpetic neuralgia occurrence. Results: Percentage of patients developing postherpetic neuralgia after one month of herpes zoster was 12.7% for age group 50-60. For age group 75-85, this percentage increased up to 26.8%. Neuralgia with severe pain persisted from 9 to 12 months. Mostly patients suffered mild to moderate pain up till 8 months. Patients with ophthalmic localization had 7.6% more chance of developing postherpetic neuralgia than the patients with no localization, after one month of herpes zoster. So, did the patients with co-morbidity. Conclusion: As the results show, postherpetic neuralgia in herpes zoster patients is a frequently occurring condition. The incidence of postherpetic neuralgia increases with age. As the age increases, so does the chance of postherpetic neuralgia in herpes zoster patients. Ophthalmic localization and co-morbidity, i.e. diabetes mellitus and rheumatoid arthritis, are also related to high prevalence of postherpetic neuralgia. Female population also tend to get more postherpetic neuralgia than male population does. Keywords: Postherpetic Neuralgia, Herpes Zoster, Incidence, Risk Factors.
265 Psychological and Social Impact of Lockdown due to Covid-19 , N. ibad, A. A.. Beig, F. Bukharie, I. iftikhar, J. Rasool, A. Shakoor
Aim: To determine the psychological and social impact of lockdown due to COVID-19 and to determine the associated factors like anxiety, depression and psycho social stressors. Methodology: It was a cross-sectional online survey conducted by Department of Psychiatry, Shaikh Zayed Hospital, Lahore, 500 random participants were enrolled. A pretested questionnaire was used and information was collected from a sample of 500 clients, selected via Google Class Room, Social Media (WhatsApp and Facebook). Results: The mean age of the participant’s was 24.83±5.245. Depression and anxiety scores on HADS were 6.88±2.791 and 8.42±4.09. As many as 22.2% individuals were affected financially by lockdown and 10.2% were affected badly. Due to lockdown, the bonding of individuals with their partners was affected positively in 22.2% cases and negatively in 18%. Bonding with the parents/children was affected positively in 23.8% cases and negatively, in 61.8%. Depression was reported by 43.6% individuals and anxiety was reported by 55.3% individuals. Conclusion: Significant psychosocial issues have emerged as a result of lockdown imposed because of Covid-19 pandemic in Pakistan. The high rates of psychosocial issues have been found to be associated with depression and anxiety. Keywords: Covid-19 pandemic, Lockdown, Depression, Anxiety, Psychosocial effects
266 Root. Canal. Morphology. of Mandibular. First. Permanent. Molars. in a Pakistani. Sub-population , U. Sana, I. U. Niazi, R. S. Din, M. Rasheed, I. Haider, O. Yousaf
Aim : To investigate the number and. patterns of. root canals. of mandibular. first. molars.. Methods.: Descriptive observational study to investigate the canal morphology using clearing technique. The duration of the study was one year from 1st February 2020 to 1st February 2021.Non purposive sampling technique was used and 200 mandibular first molar were collected. Data collected was analysed using the SPSS Vr 10. Study variables include Number and pattern of the roots in mandibular teeth. Descriptive statistics were used; frequencies of the root canals and their canal pattern were calculated. Results: In the mesial root, 14 teeth had a one root canal,186 possessed double root canals were observed. Distal root of 160 teeth possessed one canal, 40 teeth possessed two root canals with type 1 pattern mostly observed. Conclusion: Like other populations Pakistani population may have a diverse root canal system in the mandibular molars that ultimately affect endodontic therapy. Keywords: Roots, canals, anatomy, tooth clearing technique, demineralization
267 Perception of Students and House Officers for Restoration of Endodonticaly Treated Anterior Teeth , R. Sartaj, N. Khan, A. Mahmood, A. Noor, M. Sajid, Jamil
Background: Teeth in the oral cavity are affected by caries, trauma or fracture which causes pulpal diseases in the teeth. Dentists performed root canal treatment to treat these diseases. Caries fracture or trauma along with root canal treatment can weaken the tooth structure. Tooth structure is lost in root canal treatment. Dehydration after pulpectomy can effect on survival of the tooth. That is why an important intention should be paid to restore endodonticaly treated tooth. Study was performed in Multan Dental College Multan. Methods: Study design was cross sectional survey. The questionnaire was prepared for final year BDS students and house surgeons of Multan Dental College with the three conditions of anterior tooth structure; Condition A= Minimal tooth structure missing(less than 50%), Condition B=50% tooth structure missing, Condition C=maximum tooth structure lost (more than 50%). Data was collected randomly and analyzed and tabulated. Results: In condition A maximum participants (47.5%) preferred tooth colored restoration only. In condition B maximum participants (33%) choose tooth colored crown. In condition C maximum participants (67.5%) choose endopost and tooth colored crown. Conclusion: of study is that choice of material and technique of restoration is important for good results. Different dentists prefer different materials and techniques for restoration. Keywords: Endodonticaly treated tooth (ETT), Composite, Amalgam, Endopost
268 Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones , I. Sadiq, A. Malik, J. K. Lodhi, S. T. Bukhari, R. Maqbool, M. Zubair
Background: Conventionally, common bile duct stones (CBDS) are removed with help of ERCP. However, if CBDS are larger than 10 mm, then the ERCP failure rate to retrieve CBDS becomes high. In that case, open or laparoscopic common bile duct exploration (LCBDE) is other alternative. In this era of minimally invasive surgery, laparoscopic CBD exploration (LCBDE) seems to be a better option than open approach, but in our set up the safety of LCBDE is questioned. Aim: To see the conversion rate as well as complications associated with LCBDE. Material & Methods: Methods: This is a retrospective analysis of data of patients who underwent Laparoscopic Common Bile Duct Exploration (LCBDE) for large CBD stones at Fatima Memorial Hospital Lahore. Results: Since 2012, 29 patients of large (≥10 mm) CBD stones were included in this study. Among them 20(69.9%) were females and 9(31.01%) were males. The mean CBD stone size was 13 mm. Stones were extracted transcystically in 4 case and Transcholedochal stone extraction was done in 25 cases. The average duration of surgery was 130 minutes, but all cases were completed successfully without converting to open approach. There was minor bile leak in 3 patients which was managed successfully without any further intervention. No other complication was observed with LCBDE and even no retained stone was reported. Conclusion: Laparoscopic CBD exploration is safe and effective method of dealing CBD stones especially of large size when the chances of ERCP failure to retrieve stones are high. Keywords: Laparoscopy, ERCP, common bile duct,
269 Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy , P. Lal, B. Shaikh, S. Athar, I. Baloch, A. A. Shah, M. Asif, C. Rani, N. Azhar, M. Shoaib
Aim: To evaluate the factors for prediction of difficult laparoscopic cholecystectomy preoperatively. Methods: A Prospective Observational Study conducted at Surgical Unit II, Ghulam Muhammad Mahar Medical College Hospital Sukkur, from February 2020 to January 2021. Data was collected for 580 patients. All the patients fulfilling inclusion criteria were evaluated with following factors: age, gender, BMI, h/o previous GB disease, comorbids, h/o previous abdominal surgery, tender RHC, palpable gallbladder, ultrasonographic findings of gall bladder wall thickness, pericholecystic fluid collection & stone impaction at neck of gall bladder. Patients were assumed to be difficult on presence of one or more of above mentioned risk factors .laparoscopic cholecystectomy was performed by an experienced laparocopic surgeon. Peroperative findings and operative time was noted. Cases were considered difficult if operative time was >60 minutes or if the case was converted to open. All the information was recorded on predesigned proforma. Results: Age ranged from 23 to 70 years (mean age = 46.37 years). 456 patients were female while 124 patients were male. Majority of patients in our study (n=390) had normal BMI(BMI=18.5-24.9)and next majority (n=132) belonged to overweight group(BMI=25-29.9) . On inquiry, 93 patients had history of previous gall bladder disease in form of cholecystitis. Out of 580 patients, 161 patients had one or more comorbids. 39 out of 580 patients had history of previous abdominal surgery. 78 patients had tender right hypochonrium. 62 patients had palpable gall bladder. On ultrasound 73 patients had gall bladder wall thickness >4mm. In 39 patients pericholecystic fluid collection was found. In 33 patients, stone was impacted at the neck of gall bladder. 161 patients were preoperatively labeled as difficult. All the patients underwent laparoscopic cholecystectomy. Mean operative time was 42.56 minutes. 512 patients underwent uneventful laparoscopic cholecystectomy, in 68 patients difficulty was encountered 11 patients were converted to open procedure. Conclusion: We conclude that a careful insight in certain factors can predict the difficult laparoscopic cholecystectomy preoperatively. It acts as an important eye opener for surgeons to get an idea of the potential difficulty to be faced in that particular patient. Keywords: Laparoscopic cholecystectomy, Preoperative, Gall stones, Difficulty
270 Permanent Cure of Allergic Rhinitis , R. A. Akbar, M. M. Ali, U. Aslam, Z. Iqbal, S. Q. A. Jafri, R. A. Bajwa
Background: The allergic rhinitis is one of the most miserable disease and most of the sufferers waste a lot of time in place of earning and at home. The main treatment of this disease is avoidance of allergen. There are many different ways to avoid allergens but it is not acceptable for many patients in the long term. These are use of nasal filter and face mask, change of job, change of city etc. Aim: To assess the effectiveness of air purifier in the management of allergic rhinitis. Methods: As this is not possible in many cases, doctors prescribe different medical treatments. Systemic therapy includes different types of antihistamines, immunotherapy and steroids such as nasal sprays and topical decongestants. Every treatment modality has its own complications like topical decongestants cause rhinitis medicamentosa which is very difficult to manage. Steroids are prescribed in oral or injectable form. It causes hypertension, gastritis and peptic ulcers, re-distribution of body fat, Cushing’s syndrome and hirsuitism. Moreover patient has lack of concentration, sleepiness and dryness of nose. In long term follow up these medical interventions are not effective as many patients are non compliant due to side effects of these treatment modalities. Now in this new era it is possible to clean our room air from allergens and other agents by different methods, which can prevent the allergic rhinitis. Results: We are dealing with only nasal allergies and not vasomotor rhinitis, which is a completely different disease as it involves autonomic nervous system. We advised patient to purchase and use air purifier at home and during duty in the office. Patient may use special mask containing HEPA (High Frequency Particulate Air Filter) filter when they are working outside Conclusion: Air purifier machine contains HEPA filter, which sucks the air of room and remove the particles of size up to, even viruses and bacteria are also removed. Now patients feel comfortable in this healthy environment and sleep without any symptoms like itching, rhinorrhoea, blocked nose and eye problems resulting in improved quality of life. Keywords: Allergic rhinitis, Particulate matter, Air purifier
271 Frequency of Different Types of Arthritis in patients of Psoriasis , A. Ashraf, M. S. Aman, A. Z. K. Chachar, M. A. Bukhari, U. Sarwar, H. B. A. Kalhoro
Background: Psoriatic arthritis (PsA) is type of inflammatory arthritis associated with psoriasis. There are multiple patterns of joint involvement in patients with psoriasis Aim: To determine the frequency of arthritis and its different types in patients of psoriasis presenting at a tertiary care hospital in Lahore Methods: This cross Sectional study was conducted in Dermatology Department of Services Hospital, Lahore from 11th April, 2017 to 10th October, 2017. Two hundred and sixty patients having psoriasis were enrolled in the study, Patients’ detailed history about psoriasis, duration of psoriasis and joint pain or stiffness was taken. After written and informed consent Physical examination was done to determine the type of psoriasis and nail involvement. All the joints were examined for tenderness and deformities to assess the evidence of arthritis and its different types according to the site of involved joints. Results: Total numbers of patients included in the study was 260; in which 176 (67.7%) patients were males and 84 (32.3%) were females with the total mean age of 38 ±13.22 years. Out of 260 patients, 62(23.8%) patients had psoriatic arthritis (PsA), Out of these 62 patients having PsA, 23(37.1%) patients had Oligoarthritis, followed by Symmetric arthritis 19(30.6%) patients, Distal interphalangeal arthritis (DIP) in 15 (24.2 %). Conclusion: Our study concluded that almost one fourth of psoriasis patients had arthritis, asymmetrical oligoarthritis/monoarthritis came out to be the most common type in our study followed by symmetric polyarthritis, distal interphalangeal arthritis (DIP), Arthritis mutilans and axial arthritis Keywords: Psoriasis, types of psoriasis, arthritis, psoriatic arthropathy
272 Frequency of Hypoalbuminemia in Acute Ischemic Stroke patients Based on Stroke Severity , E. U Haq, A. Qayyum, H. A. Qayyum, M. Anam, A. R. Khan, K. Ahmed, F.Shafiq
Background: Stroke is a serious public health issue and third leading cause of death worldwide. Hypoalbuminemia is commonly found factor in patients of stroke and is also associated with severe disease as well as pro inflammatory patterns of serum protein electrophoresis. Therefore, further research for understanding the role of Hypoalbuminemia in stroke is important to devise strategies for better management of stroke. Aim : To determine the frequency of hypoalbuminemia in acute ischemic stroke patients based on stroke severity. Methods: This descriptive cross- sectional study was conducted in Shifa International hospital stroke unit for 6 months from May 15, 2018 till Nov 15, 2018. Data was collected from 100 patients using purposive sampling. After taking consent from patient or attendant, the demographic data was collected on a structured proforma. Baseline serum albumin and stroke severity using the NIHSS score was also assessed. All data was entered and analysed using SPSS 21. After descriptive analysis, post stratified Chi Square test was applied for gender and age categories. Results: The mean age of patients was 63.60 ± 11.87 years with 57(57%) male and 43(43%) female cases. The mean serum albumin level was 4.03 ± 0.94 with minimum and maximum values as 1.50 and 5.5. Among cases with minor, moderately severe and with severe stroke, 6(37.5%) cases, 18(25.7%) cases and 6(42.9%) cases had Hypoalbuminemia. The frequency of hypoalbuminemia was statistically same with respect to severity of stroke, p-value > 0.05. Conclusion: This study concludes that the frequency of hypoalbuminemia in acute ischemic stroke patients was diagnosed in almost one third cases, however, no statistical association could be found. Hence, screening for hypoalbuminemia should be done for better management of stroke patients. Keywords: Storke, NIHSS score, serum albumin, hypoalbuminemia, mortality
273 Comparison of Sub-Types and Severity of Ischemic Stroke among Both Genders , Q. Yusaf, A. Qayyum, E. U. Haq, Javaria, A. Yasir, H. A. Qayyum
Background: It has been noted that there is an increased prevalence and serious clinical implications of stroke in women. However, local studies focused on stroke among female gender are still scarce. Aim: To find frequency of female patients with ischemic stroke and to compare the sub-types of ischemic stroke, mean NIHSS score and mean MRS scores among both genders. Methodology: This descriptive case series was conducted in indoor and outdoor department of Neurology at Mayo Hospital, Lahore for six months [Feb 6, 2018 till August 6, 2018]. After taking demographics and clinical characteristics of patients, the severity of stroke was taken using National Institute of Health Stroke Scale (NIHSS) at admission in hospital. The functional outcome was measured using Modified Rankin Scale (MRS). Subtype of acute ischemic stroke was assigned using Oxfordshire classification for acute ischemic stroke. All data was taken on a structured proforma and was entered and analyzed using SPSS version 21. Results: The mean age of cases was 53.58 ± 9.42 years with 73(60.83%) male and 47(39.17%) female cases. Among TACS, there were 15(50%) female cases whereas 9(34.6%) female case were found in PACS and 10(33.3%) female cases were found in LACS. The frequency of gender in all subtypes was statistically same in both groups, p-value > 0.05. The mean modified Rankin scale in male and female cases was 2.93 ± 1.58 and 4.30 ±1.50 respectively with significantly higher mean MMR score in females than male cases, p-value < 0.05. Conclusion: This study concludes that females make up a considerable percentage of patients with ischemic stroke. Though, no statistically significant difference could be found in terms of subtypes of ischemic stroke, the mean NIHSS score and mean MRS were statistically higher among females compared to male cases. Keywords: Stroke, subtypes, severity, ischemia, gender difference, NIHSS, MRS
274 Infection Control Practices in Orthodontics during COVID-19 , Z. Ejaz, M. Azeem, F. Bukhari, M. U. Ghani, .A Rashid, A. A. Shah
Aim: To find out infection control practices among orthodontists in Punjab, Pakistan during COVID-19 pandemic. Methods: This cross sectional study was conceived from 1.6.2020 to 1.1.2021. A pre-designed proforma was used to find out the infection control practices in orthodontics. Each pre-designed proforma consisted of 10 questions about infection control. The pre-designed proforma was distributed among 50 orthodontists. The response rate was 100%. Results: The results showed that most of the orthodontists were up-dated and in practice of using proper infection control measures while COVID-19. Gloves, PPE, Protective eye wears and face shields were worn by most of the respondents. Most of them were using proper disinfection and sterilization measures. Conclusion: The knowledge and practices of infection control in orthodontics was appropriate and up to standards during COVID-19. Key words: Infection Control; Orthodontics.
275 Music for Pain Control Following Orthodontic Initial Archwire Placement , M. Azeem, Z. Ejaz, A. Ashraf, F. Bukhari, M. M. Ali, A. Rashid
Background: Pain control is very important aspect of orthodontic practice. Aim: To compare the efficacy of music therapy for pain control following initial archwire placement in orthodontics. Methods: This randomized control trial was conducted at orthodontics department. The study consisted of 50 orthodontic subjects from 1.1.2019 to 1.30.2020. Purposive sampling technique was used. 25 were in control group while other 25 were randomly allocated to music group. The pain was recorded using VAS scale at multiple points of time following archwire placement. T-test was used for the statistical analysis. Results: The study found that there was insignificant difference in mean pain scores between the two groups with less pain scores in music group. Conclusion: Music can play an effective role in pain control following orthodontic initial bonding. Keywords: Music; Orthodontics.
276 Health Related Quality Of Life among Individuals with Left Ventricular Diastolic Dysfunction Post Six Months , I. Zia, S. Waqas, H. M. Asim, M. Tariq, A. Shahzad
Aim: To describe health related quality of life using Minnesota Living with Heart Failure Questionnaire (MLWHFQ) in individuals of LVDD post six months. Methods: Descriptive cross sectional survey on 72 individuals of LVDD post six months was conducted. Sample was calculated by WHO sample size calculator keeping μ as 0.49, margin of error as 5% and confidence interval as 95%. Data was collected by MLWHFQ via interview method with Non probability convenience sampling technique from Punjab Institute of Cardiology Lahore and Sheikh Zayed Hospital Lahore during August 2018 to January 2019. Stable individuals both male and female were recruited who aged between 50-71 years old. The baseline characteristic taken in account was NYHA of Heart Failure greater than 2, 50% or more Ejection Fraction, Diastolic Dysfunction (grade ≥1) and at least one of the positive cardiovascular risk factor. Results: Out of a total 72 subjects 41 were males and 31 were females with scores on MLWHFQ showed that out of a total 72 LVDD, HRQOL of 3(4.2%) patients were not affected, 3(4.2%) were very little effected, 7(9.7%) were little effected, 4(5.7%) was moderately effected, 34(47.2%) were much effected and 21(29.2%) were very much effected. Conclusion: The study concluded that health related quality of life using was found out to be much effected in subjects of Left Ventricular diastolic Dysfunction. Keywords: Quality of life, Left Ventricular diastolic dysfunction, Cardiac Disease
277 Evaluation of Success of Pulpotomy in Mature Permanent Teeth with Carious exposure using Mineral Trioxide , N. Shafi, M. B. Munir, M. Virda, M. Anwar, M. Ali, M. S. Rashid
Aim: To evaluate the radiographical success of pulpotomy in cariously exposed mature permanent teeth using mineral trioxide aggregate. Methods:This Descriptive case series was conducted at the Department of Operative Dentistry, de’Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from December 2015 to December 2016.A total of 75 cases were included using non-probability consecutive sampling..Patients of both genders with age range from 15 to 26 years were considered. Performance of procedure and evaluation of success was done in terms of absence of periapical radiolucency on periapical radiographs.Data was entered and analyzed with IBM SPSS 20. Level of significance was kept at p-value ≤ 0.05 Results: Out of 75 patients, 41 were females and 34 were males.Mean age of patients included in this study was 20.5 ±3.60. Follow up at 6 months showed 92% success, with 69 cases showed absence of periapical radiolucency on periapical radiograph. There was no significant relation of success with age and gender of patient with p- value greater that 0.05. Conclusion: It is concluded from current study that the protocol of pulpotomy using Mineral trioxide Aggregate (MTA) in mature permanent teeth with carious exposure of pulp is encouraging and can be recommended for the treatment of mature permanent teeth with carious exposures. Keywords: Pulpotomy, Mineral trioxide aggregate, periapical radiolucency
278 Evaluation of the Prevalence of Childhood Autism Awareness amongst Medical Professionals in Pakistan , N. Noor, M. Talha, S. A. Ahmad,, M. Mohydin, S. S A. Shah, S. Mohydin, F. Faheem
Aim: To evaluate the level of awareness regarding childhood autism among medical professionals of Pakistan. Methodology: A cross-sectional descriptive survey was conducted among 105 medical students and health-care professionals to estimate their knowledge regarding Autism in Pakistan. By random sampling method, questionnaires were distributed during the month of April 2020. IRB approval was obtained. Results: The results have highlighted that medical students have significant knowledge of Autism Spectrum Disorder while Post Graduate trainees and House Officers have moderate knowledge. However, it is alarming to see that there is lack of knowledge among Medical Officers and Consultants. Due to this deficient knowledge gap, medical practitioners are unaware of the severity of this disorder in the region. The results emphasize that there is either initial lack of medical school curriculum or over time knowledge of medical professionals decreases due to which they are unable to identify the prevalent disorders. Conclusion: ASD is a pertinent regional health concern. Lack of clinical knowledge of this disorder amongst healthcare professionals, needs to be addressed by application of awareness systems. This will improve diagnosis and redesign treatment modalities alongside strategize preventive measures. Keywords: Autism Spectrum Disorder, Medical, Student, Child Development Disorders
279 A rare Case of Cesarean Section Scar Ectopic Pregnancy Managed by Laparotomy , M. U Nisa, N. Ayub, M. Gut, Nudrat
Cesarean section scar ectopic pregnancy (CSEP) is defined as a pregnancy in which blastocyst is implanted within the scar of previous cesarean section. It is a rare form of ectopic but its frequency is increasing due to increasing rate of cesarean section. In this case, a 36 years old G3P2A0, married for 10 years, previous II C/Sections, LCB 7 years back, presented with ultrasound report of the viable pregnancy at 11+1 weeks with gestational sac incorporating into previous scar of cesarean section. She was otherwise asymptomatic and stable. Serum Beta hCG was 73664.78 IU/L. Laparotomy was done as an elective procedure. Dense adhesions were noted on opening the abdomen between anterior abdominal wall, uterus, bladder and gut. Scar ectopic pregnancy was excised after dissecting the adhesions. Her Serum Beta hCG 48 hour post-operatively was 1397.0 IU/L.Patient was discharged home on 2nd post-operative day in good condition. She was counselled about risk of a recurrent scar ectopic and rupture of uterus in next pregnancy. Her serum Beta hCG declined to normal by 4 weeks post operatively. Keywords: Cesarean section, scar ectopic, laparotomy
280 Potential Physical Health Changes during the Covid-19 Confinement in Pakistan , A. Mohsin, J. Riaz, S. A. Ahmad
Background: The Coronavirus outbreak was declared a pandemic by the WHO in March 2020 and entire population was asked to self-isolate and live in home-confinement for several weeks to months. This has had collateral effects on many parameters of the isolatedindividuals health. A short term sedentary lifestyle is sufficient to induce insulin resistance and fat deposition which in turn increases the risk of multiple metabolic disorders. Aim: To investigate the potential physical health changes that occurred during the CoVID-19 quarantine/isolation period in Pakistan. Methods:A descriptive cross-sectional study was conducted during social isolation, from 27th May to 1st July, 2020. The study was initiated after approval from the institutional ethical review committee of Health Research Solutions. Stratified sampling technique was used to collect the data from the census organisation committee in Pakistan. Results: The sample of respondents in the data analysis included : N=553 (63.5% women 36.5% men). The findings explore the health impacts of several weeks of a reduction in physical activity and daily step-count combined with altered eating habits and sleep hygiene. Conclusion: The findings of the current study may contribute to a better understanding of the novel coronavirus effects on lifestyle especially physical activities and sedentary behaviour. It concludes that certain health aspects that have been explored in this research can be improved through methods developed to increase participation in activities during current and future pandemics. Keywords: CoVID-19 Coronavirus, WHO
281 Effect of Basil Seed and Chia SeedExtracts on Blood Lipid Profile , S. Munir, S. Khurshid, Q. J. Iqbal, N. Iqbal, Z. Masood
Background: Basil and Chia seeds contain higher nutritive values like vitamin, carbohydrates, Omega-3 oil and other dietary fibers. With all these rich dietary benefits these seeds regulate necessary health conditions and maintain body weight. Ocimumbasilicum (Basil) plant have been known to contain properties of weight loss, better digestion and other health benefits. Aim: To check the Basil seed against hyperlipidemia in mice with Chia seeds. Methodology: In this research, the effect of both seeds extract on body weight and plasma lipid profile were estimated in Albino mice after raising their cholesterol levels by high fatty diet. The experiments were performed in different groups like normal control, standard control, hyperlipidemia group and four groups of diet supplemented chia or basil seeds with two different doses. Results: The biochemical analysis revealed that the supplementation of Basil seeds (400mg/kg/day) significantly lowered the levels of total plasma cholesterol, lipoproteins and triacylglycerol. Moreover, histopathological analysis of vital organs like kidneys, heart reported no toxicity. Conclusion: Extracts of Chia and Basil seeds have shown controlling effects over the given parameters in the blood and weights of the animals and these may have potential to control high fat diet-induced hyperlipidemia when taken as dietary supplements. Keywords: Cholesterol, Hyperlipidemia, Ocimumbasilicum, Salvia hispanica
282 Comparing the Effectiveness of Oral Formulation of Tranexamic Acid in Treating Melasma versus Topical Treatmentlike Kojic Acid , M. Sheikh, R. Majeed, W. Iqbal
Aim: To compare the efficacy and safety of oral tranexamic acid with topical kojic acid in treatment of melasma. Method: This study was an interventional, randomized control trial done in Department of Dermatology Akhtar Saeed Trust Hospital Lahore from January 2020 till June 2020. 40 patients with moderate to severe melasma were enrolled for this study. These were divided into two groups A and B. In group A 20 patients were given oral tranexamic acid along with topical treatment and in group B, 20 patients were treated only with topical treatment. Oral tranexamic acid was given in dosage of 250 mg twice a day for 3 months and then follow-up was done at 8th and 12th wks. The evaluation of effectiveness of treatment was done with MASI(Melasma Area Severity Index). Comparison was done in the mean of the MASI scores obtained in both groups. Result: In both groups female patients were more in number. The mean age of patients in group A was 29.75 years & in group B it was 32.55 years. MASI scoring was done in both groups at baseline and at 8th& 12th wks. There was a significant decrease in this score in group A patients with oral tranexamic acid (12.08±2.8 vs 9.1±2.2 at 8th wk. andvs 8.2±2.0 at 12thwk.; P <0.05for both). Whereas in group B patients the decrease in mean MASI score was significant at 8thwk.& insignificant at 12th wk. (12.6±2.9 vs 10.9±2.4at 8th wk. and vs 10.3±2.4at 12th wk.; p<0.05 for former but p>0.05 for later). Conclusion: Oral tranexamic acid is a safe and effective treatment modality for treating moderate to severe melasma. Keywords: Melasma, oral tranexamic acid
283 Tuberculous Mastitis: A 7 year Experience in Sir Ganga Ram Hospital; Lahore. , H. Khan, M. A. Javed, L. A. Bhatti, K.. J. Khan
Background: Tuberculous mastitis is a rare clinical entity and it often resembles breast malignancy and pyogenic breast abscess both radiologically and clinically. It usually affects females from the Africa and Indian sub-continent. Aim: To find out the clinical feature, diagnostic criteria and need for surgical intervention in tuberculous mastitis. Methods: Patients with clinical suspicion of breast tuberculosis were subjected to a set of investigations for confirmation and were included in the study. The main diagnostic measures were thorough history and examination. All were subjected to complete blood examination, ESR, Monteux test, ultrasound (for patients aged<40 years), mammogram (for patients aged>40 years), fine needle aspiration cytology andAFB staining. Abscesses were aspirated, lumps greater than 2cm were subjected to true cut biopsy and less than 2cm were excised and histopathology performed on the specimen. Data was recorded in a predesigned proforma and parameters like age, site, size, mode of presentation etc., were recorded along with need of surgical intervention. Results: 264 patients were included with mean age of 31.4.23 patients had bilateral disease. Primary disease was found in 162 patients and secondary in 102. Multifocal disease was found in 45. Mode of presentation was discharging sinus in 115, lump in 61, cold abscess in 60 and non- healing ulcer in 28 cases. Cytology and AFB staining had diagnostic value in 60 cases. Wall biopsy after drainage of abscess 43, true cut biopsy47 and wide local excision biopsy confirmed the diagnosis in 68 patients after the specimen were subjected to histopathology. Even after anti-tuberculous therapy, surgical intervention wasrequired for 171 patients. Conclusion: Tuberculous mastitis may masquerade malignant lesion of breast and poses diagnostic difficulties without histopathological examination. Surgical intervention may be required. Keywords: Tuberculous mastitis; discharging sinus; granulomatous mastitis.
284 Stigmatization of Healthcare Workers during the COVID-19 Pandemic , M. F. Khalid, M. Alam, F. Rehman, R. Sarfaraz
Aim: To study stigmatization of healthcare workers due to COVID-19 pandemic Methodology: Using a cross-sectional study, a total of 134 healthcare workers were approached at Mayo Hospital, Lahore. An interview based, pre-tested, semi-constructed questionnaire consisting of both open and close ended questions were used for data collection. Data was analyzed using SPSS version 26. Results: Out of 134 healthcare workers, 40.3% were male and 59.7% were female. Distribution among doctors and nurses was 60.4% and 39.6% respectively. 51.5% of healthcare workers felt stigmatized due to working in the COVID-19 pandemic. 69.4% of healthcare workers knew of other people who faced similar stigmatization due to their exposure to COVID-19. Almost each age group and specialty faced such stigmatization. Conclusion: This study helped in understanding the stigma healthcare workers had to face during COVID-19 Pandemic which lead to significant distress and suffering for the healthcare workers. Keywords: COVID-19, pandemic, stigmatization, healthcare workers
285 Frequency of efficacy of topical cyclosporine 0.05% eye drops in the management of dry eyes , M. Khalid, M. Rizwan, S. Khurshid
Aim: To determine the efficacy of cyclosporine 0.05% for the management of patients of dry-eye disease presenting at tertiary care hospital. Methods: This cross sectional study was conducted at Department of Ophthalmology, Sahiwal Medical College, Sahiwal from March 2020 to September 2020 over the period of 6 months.Total 310 patients of dry eye were included in this study after scrutinized by inclusion criteria. All the selected patients were managed with cyclosporine 0.05% and efficacy of the drug was assessed. Results: Total 310 patients of dry eye disease were recruited. Mean age was 47.15 ± 3.61 years and mean duration of dry eye disease was 11.10 ± 1.75 months. Out of 310 patients, treatment was found effective in 225 (73%) patients. Efficacy of treatment was noted in 172(96.63%) male patients and in 53(40.15%) female patients. Significantly higher rate of efficacy was noted in male patients as compared to female patients with p value 0.000. Conclusion: Results of present study showed higher improvement rate of dry eye symptoms in cases of dry eye managed with cyclosporine 0.05%. Male patients were more victim of dry eye as compared to female patients and statistically significant association of efficacy with gender was observed. No association of efficacy of treatment with age group and duration of disease was observed. Keywords: Dry eye, cyclosporine, inflammation, immunomodulator agents.
286 Frequency of Hydrocephalus in Cases of Tuberculous Meningitis , M. U. Waheed, M. Abubakar, M. A. Malik, J. Mustafa, F. Ali, A. Hussain
Aim: To determine the frequency of hydrocephalus in cases of Tuberculous meningitis Methods: This was a cross sectional study conducted during 01-07-16 to 31-12-2017 at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. The cases of tuberculosis meningitis of age range of 15 to 50 years of either gender with tuberculous meningitis were included in this study. The diagnosis of TBM was made on the basis of combination of clinical symptoms and laboratory data. The symptoms were fever, weight loss and neck rigidity with or without fits. These cases then underwent CSF analysis under aseptic measures. The findings to label TBM on CSF were low glucose (< 40 mg/dl), increased protein content (> 100 mg/dl) and high WBC count with predominance of lymphocytes. The cases of TBM were divided according to standard BMRC scale into three stages. The cases with bacterial meningitis, having any SOL in brain and those with any previous history of neurosurgery were excluded from this study. Then these cases underwent CT brain in the same institute and diagnosis of Hydrocephalus was made when any of the ventricle is dilated more than 25% of the baseline. Results: In this study there were total 93 cases of TBM with mean age of 37.11±08.67years. There were 54(58.06%) males and 39(41.94%) females. Maximum cases were seen in stage II of TBM which affected 65 (69.89%) cases. Hydrocephalus was seen in 61(65.59%) of the cases as shown in figure 01. Hydrocephalus was significantly high in male gender as compared to females where it affected 39(72.22%) of cases with p value of 0.03. It was also more common in cases that had age group 15-29 years affecting 40(67.79%) of cases with p= 0.86. Hydrocephalus was also significantly high in cases with stage II and III of TB affecting 66.15% and 77.27% of cases respectively with p= 0.01. Conclusion: Hydrocephalus is very common in cases of TBM and it is significantly high in male gender and stage II and III of TBM. Key words: TBM, Hydrocephalus
287 To Study the Association between Weather and Frequency of Cataract Surgeries Performed Over Three Years in four different hospitals of Lahore, Punjab , S. Riaz, Q. Lateef, M. T. Khan, M. Moin, K. Iqbal, S. Tariq
Aim: To study the association between weather and frequency of cataract surgeries performed over the year in four different hospitals of Lahore, Punjab. Place and duration of study: The data of 8375 patients who underwent cataract surgeries over last three years 2017, 2018 and 2019 from four different hospitals, Medicare Eye hospital, Jinnah Hospital, Akhtar Saeed Trust Hospital and Lahore General Hospital, was collected. Study design: It was a cross sectional survey. Non-probability conventional sample was used. The data was analyzed by SPSS-20 and presented in forms of bar charts and line graphs. Methods: Total 8375 patients were selected from previous records for our study from four different centers. The hospitals were Akhtar Saeed trust hospital, Jinnah hospital,Lahore general hospital and Lahore Medicare Eye center. Lahore General hospital (LGH) and Jinnah Hospital are from government sector. Akhtar Saeed Hospital is a trust hospital and Lahore Medicare is a private Hospital.All patients with unilateral or bilateral cataract with age above 40 years were included where as patients under 40 years, cataract planned under general anesthesia and patients who had cataract associated with retinal attachment were excluded. Results: Total patients included in our study were 8375.There were 4439 (53%) men and 3936 (47%) women. Out of these 3721 (44.43%) from Jinnah hospital, 2498 (29.83%) were from Lahore General Hospital, 1676 (20.01%) from Medicare and 480 (5.73%) from trust Hospital. In Jinnah hospital, the highest number of cataract surgeries were observed in months of March 500 (13.44%), October 375 (10.08%) and February 341 (9.16%) and months with a smaller number of cataract surgeries were July 201 (5.40%), June 185 (4.9%) and August 170(4.57%).In LGH three months showing maximum number of patients were October313(12.53%), November 285(11.41%) and April 281(11.25%) and minimal in July 158(6.33%), August 128 (5.12%) and June 99(3.96%). Conclusion: It was clear from results of our study that higher number of cases were seen in months of March, April and October and the lowest number of surgeries were observed in months of June, July and August on an average. A definite seasonal variation was observed in number of cataract surgeries performed over the year, in different eye hospitals of Lahore (Punjab) Pakistan. Keywords: Cataract, Surgery, Seasonal variation
288 Post-operative Complications of Patients Underwent Mastoidectomy at Tertiary Care Hospital , M. W. Saleem, S. Ali, L. Wajid
Aim: To analyze the post mastoidectomy complications in patients presenting at tertiary care hospital. Methods: This case series study was conducted at Department of ENT, DG Khan Hospital, DG Khan from March 2020 to September 2020 over the period of 6 months. Total 65 patients came for open cavity mastoidectomy either male or female having age between 20-60 years were selected for this study. Results: In present study 65 patients had undergone open cavity mastoidectomy. Mean age of the patients was 39.95 ± 12.57 years. Out of 65 patients, cavity complications was found in 20 (31%) patients. Among the 20 patients who had cavity problems, the most common problem was prolonged discharge found in 19 (95%) patients followed by accumulation of wax in the cavity was found in 5 (25%) patients, Vertigo persisting beyond the immediate postoperative period was found in 3 (15%) patients, perichondritis of pinna was seen in 1 (5%) patients, development of facial palsy was found in 5 (50%) patients, recurrent cholesteatoma was found in 3 (15%) patients and wound infection was found in 2 (10%) patients. Conclusion: Results of present study showed higher rate of post operative complications after mastoidectomy. Sclerotic mastoid was most common. Higher rate of complications was seen after 40th decade of life. Most of the patients were male as compared to female. Prolonged discharge was the most common problem. Keywords: Mastoidectomy, Cavity, Meatoplasty, Pneumatisation, Cholesteatoma
289 The Histopathological Analysis of 122 Cases of Ovarian Lesions , Z. Kashif, S. Z. Warriach, M. B. Pasha, S. S. Ali, A. U Rehman, A. Kashif
Aim: To outline various histopathological types of ovarian cysts received in our teaching hospital along with their prevalence and mode of presentation and to assess the proportion of physiologic versus pathological cysts and benign versus malignant ovarian cysts. Duration of study: From Jan 2019 to March 2021. Methods: Histopathology Department of Bakhtawar Amin Medical & Dental College & Hospital, Multan. A retrospective review of 122 ovarian lesions including physiological/functional cysts, pathological non neoplastic cysts as well as benign, borderline and malignant neoplasm. Histopathology reports of all ovarian specimens were reviewed and counted. Details like age, marital status, parity, presenting complaints, procedure opted, laterality, size, gross and microscopic details and final histological diagnosis etc were recorded. H&E stained slides of all cases were reviewed. In difficult suspicious cases, immunohistochemistry was also carried out. Percentage and proportions were calculated for all the variables. Relevant tables and charts were computed. Results: A total of 122 ovarian specimens with some lesion were segregated in histopathology department of Bakhtawar Amin Hospital from 117 patients with 5 patients having bilateral lesions. The mean age was 33.2 years (ranging from 13-71 years). Most ladies presented between 25-45 years of age. Out of these 117 patients, 18 ladies were unmarried. Out of the 99 married, 12 were nulliparous. Sixty four ladies (54.7%) found to have cysts/neoplasm in right sided ovary, forty eight (41%) presented with left sided ovarian involvement and 5 (4.3 %) presented with bilateral ovarian lesions. Conclusion: Non neoplastic ovarian cysts are more frequent as compared to neoplastic masses. Histopathological diagnosis is mandatory for final confirmatory diagnosis. Keywords: Ovarian lesions, reproductive cells, cyst
290 Weaning Practices in Mothers of Infants age 6 to 12 months visiting Sandeman Provincial Hospital, Quetta , S. A.l Qadir, M. Umar, A. Rehman, H. U Nisa, Z. Fatima, F. Rehman
Background: Weaning can be described as gradually increasing the amount of foods other than breast 's milk in the infant's diet. Breast feeding for the first four to six months is recommended by the WHO for a full-term healthy child by a healthy mother. Aim: To find weaning-related factors that contribute, strengthen, and enable mothers of infants under the age of 12 months to obey or not obey guidance for proper infant feeding by World Health Organization's (WHO-2009) Methods: The current research was a cross-sectional descriptive study. From March 2020 to January 2021, pre design performa was used to collect data from 100 mothers of infants under the age of 12 months who lived in Quetta City and visited at OPD department of Sandeman Provincial Hospital in Quetta. .The multiple rounds of data collection were done. The data was analyzed by SPSS 20. Statistical test like chi- square test was applied to obtain the required results. Results: Total 100 babies consist of 41(41%) male and 59(59%) femaleenrolled. The mothers in the sample were on average 27.2 ± 4.2 years old with the age range of 20-40 years. Results showed that mothers of 6-8 months’ kids 18(45%) fully aware about the importance of weaning and feed their children with different soft food along with breast feeding which increased at the age of 8-12 month as 22(73.33%).Majority of mothers, i.e63% were housewives. The social status showed lower middle income 34% and 41% of research participants belonged to the middle income group.The findings showed that 61% mothers had inadequate knowledge about proper child feeding and weaning practice compare with other group as 39% with p-value 0.01. Conclusion: Mothers should be well informed about the benefits and importance of weaning, as well as the age in which weaning should begin and the different forms of weaning diets available. This target can be met with the assistance of LHWs and LHVs, as well as the use of social media. It is important to stress the importance of continuing to breastfeed after weaning. Key words: Mothers; Practices; Infants: Weaning
291 Cytological versus Histopathological Examination in Lesions of Cervix, taking histopathology as a Gold Standard , A. Ilyas, A. U. Rehman, M. Ikram, G. A. Khan, M. J. Khan, Zaib
Background: Malignancy of cervix is the major health burden in South Asia including Pakistan. PAP smear is the screening test for its early detection. To find out the specificity and sensitivity of the system called as Bethesda system, the correlation of cytological findings with histopathology,with histopathological examination as the golden standard. Aim: To find out the cytological utility in diagnosing different pathologies of cervix, to assess and infer the epithelial lesions cases and to correlate cytology findings with its consequent follow-up biopsies. Methods: This study was carried out taking 150 PAP smears of women coming to gynecological OPD ofShaikh Zayed Hospital Lahore from September 2020 to February 2021. There correlation with subsequent follow-up histology sections by using 2001 revised Bethesda System.Different factors analysis which were causing inconsistencies was done. Results:The overall sensitivity of PAP smear is 86.94%, specificity 57.14%, positive predictive value 86.94 %, negative predictive value 57.14 % and accuracy 80% in detecting low/high grade lesions and malignancy. Keywords: Bethesda system,Cervix cytology findings; Histopathological findings.
292 Frequency of depression in patients of Chronic Hepatitis C who had not yet received treatment , A. Adam, A. Z. K. Chachar, M. Haider, N. Yaqoob, M. Asif, M. Ali
Background: Chronic hepatitis C is a common entity which is frequently associated with depression. Aim: To determine the frequency of depression in patients of chronic hepatitis C who had not yet received treatment. Settings: Department of Gastroenterology and Medicine at Fatima Memorial Hospital Lahore, Pakistan. Study design: Cross sectional Descriptive study Methods: Total 217 patients were enrolled. Each patient was interviewed and then marked down by the doctor himself. Patient Health Questionnaire (PHQ 9) (annexure 2 attached) was applied to determine the presence of depression. Depression was managed as per hospital protocol. The study was conducted from 10th April, 2018 to 9th October, 2018 Results: In this study mean age was 45 years with standard deviation ± 11.33. 62% patients were male, 38% patients were female. More over 57% patients had depression while 43% patients didn’t have depression. Conclusion: Our study concluded that there was a significant association between depression and chronic hepatitis C patients before they have started their treatment, in tertiary care hospital. Keywords: Depression, chronic, hepatitis C
293 Frequency of Helicobacter pylori infection in patients of acne vulgaris , Z. Khalid, H. B. A. Kalhoro, .A. Ashraf, H. Mughal, K. Bukhsh, A. Z. K. Chachar
Background: Acne vulgaris is a common complaint throughout the world, contributing to both morbidity and healthcare costs. Helicobacter pylori (HP) infection is also a world heath problem, and recent evidence suggests that two conditions may be related. However, there is insignificant evidence to support a casual association of HP infection and acne vulgaris. Aim: To determine the frequency of helicobacter pylori infection in patients of acne vulgaris Study design: Descriptive, cross-sectional study. Settings and duration: Dermatology Department, Liaquat University of medical and health Sciences (LUMHS), Civil Hospital, Hyderabad from 22nd August 2017 to 21st February 2018 Methods: A total of 135 patients, 13 to 30 years of age of both genders with acne vulgaris were included in this study. Patients with H Pylori infection positive without acne vulgaris, family history helicobacter pylori infection, chronic smoker or alcoholics were excluded. Patients were subjected to relevant investigations i.e. HP antibody titer, for that blood sample of each patient was sent to institutional pathology laboratory for measuring of serum levels of anti H. Pylori IgG antibodies where each report was prepared by consultant pathologist. Results: Mean age was 23.33 ± 4.14 years. Out of these 135 patients, 48 (35.56%) were females and 87 (64.44%) were males with female to male ratio of 1:1.8. Frequency of helicobacter pylori infection in patients of acne vulgaris was seen in 107 (79.26%) patients. Conclusion: This study concluded that frequency of helicobacter pylori infection in patients of acne vulgaris is very high and these patients should be screened for helicobacter pylori infection Keywords: Acne, helicobacter pylori, association
294 A study of Ascitic Fluid of Cirrhotic patients with Spontaneous Bacterial Peritonitis; common microorganisms and their antibiotic Senstivity , A. Z. K. Chachar, M. Haider, S. Ali, N. Yaqoob, N. A. Lashari, H. B. Ahmed
Background: Spontaneous bacterial peritonitis (SBP) is an acute infection of otherwise sterile ascitic fluid in patients with decompensated liver cirrhosis. Gram negative bacteria are considered the main causative microorganisms of SBP. However, widespread use of antibiotics in cirrhotic patients has changed the microbial spectrum and the sensitivity patterns. Aim: To determine the frequency of different microorganisms and their sensitivity patterns in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis and to see the impact of age, gender and duration of SBP on these patterns. Study design and duration: It was a prospective observational study conducted at Fatima Memorial Hospital, Lahore from December 2015 to December 2016. Methods: A total of 200 patients with clinical suspicion of SBP were enrolled in the study. Ascitic fluid sample was obtained within 6 hours of hospitalization and was sent to hospital laboratory. Culture reports were reviewed to determine the frequency of different microorganism as well as their sensitivity patterns to different antibiotics. Results: Out of 200 patients, the culture was positive in 113(56.53%) patients. Escherichia coli was seen in 35 (31.2%) patients, Acinobacter Spp was present in 18 (15.3%), Streptococcus in 15 (13.4%), Enterococcus in 14 (12.1%), Staphylococcus aureus in 13 (11.4%), MRSA in 12 (10.8%), and K. Pneumonia in 6 (5.7%) patients. Ceftazidime was sensitive in 73 (64.9%) cases, Cefotaxime was sensitive in 55 (49%), Ceftriaxone was sensitive in 50 (43.9%), Ciprofloxacin was sensitive in 49 (43.3%), Amikacin was sensitive in 36 (31.8%) Conclusion: The most frequent organism in ascitic fluid of SBP patients was E Coli, and the most sensitive antibiotic was ceftazidime. Keywords: Microbial Spectrum, Sensitivity Pattern,Spontaneous Bacterial Peritonitis (SBP), Ascitic Fluid
295 A 4 year ERCP Profile of Tertiary Care Hospital: Indications and Diagnosis , A. H. Alvi, A. Z. K. Chachar, R. Parvaiz
Aims: To find the indications and diagnosed conditions in the cases reported in Fatima Memorial Hospital Lahore. Also, the prevalence of this procedure amongst the genders in our setting. To establish statistical association between indications and diagnosis. Methodology: All the ERCP procedures done in 4 years from January, 2011 to January 2014 were compiled. The data was gathered using a simple form after the intervention. A total of 554 patients’ data was available, all participants were above the age of 18 years. A response rate 93% was recorded for who consented and allowed to share their information anonymously in the study. Chi square was used to find statistical association, with p-value <0.005 was taken as significant. IBM SPSS 22 was used for data input and evaluation. Results: In our study 35% of the participants were males and 65% were females. 58.33% of the patients underwent sphincterotomy. The highest number of patient’s indicated of undergoing ERCP was 58.33% because of obstructive jaundice without any cause on further investigations. Choledocholithiasis was the commonest diagnosis with 36.6%. A strong association between the indications and the final diagnosis was also found with p-value of 0.000. The success rate of the intervention was 79% making it a safer procedure to be applied. Conclusion: More females have undergone this procedure. Obstructive jaundice was declared as major indication with choledocholithiasis as the commonest condition diagnosed. It was a successful procedure in our setting. Keywords: ERCP, Gastroenterology, Intervention
296 Different Management Strategies for Term Newborns Delivered with Premature rupture of membranes , J. Zain, M. Asim, K. Firdos, T. Laique
Background: Premature rupture of membranes (PROM) is a leading cause of neonatal morbidity and mortality. Aim: To compare the outcomes of prophylactic versus selective antibiotics in term newborns born after PROM > 18 hours in terms of neonatal sepsis and resistance of neonatal. Study design: Randomized controlled trial. Methodology: This study enrolled (n=120) asymptomatic term (37+ weeks) babies of either gender with PROM > 18 hours after ethical review committee’s (ERC) approval. This study held at DHQ Hospital, Rawalpindi-Pakistan in 2019. Data was collected through a structured proforma with informed consent. Data was analyzed by SPSS, v-20. The study outcomes were neonatal sepsis and resistant neonatal flora. Chi-square test was applied with p≤0.05 taken as significant. Results: The neonatal sepsis was diagnosed in 8 (13.3%) and 9(15%) babies in the prophylactic treatment group and the selective treatment group, respectively having statistically insignificant difference (p>0.05). Likewise, resistant neonatal flora between both groups showed statistically insignificant difference (p>0.05). Conclusion: We concluded that there was insignificant difference in terms of rates of neonatal sepsis and resistant neonatal flora between two treatment groups. However, there is a need to conduct large sample size, multicentre studies to validate these results before making recommendations for routine treatment of full term babies with PROM >18 hours in our clinical settings. Keywords: Neonates, Premature Rupture Of Membranes, Full Term, Neonatal Sepsis and Resistant Neonatal Flora
297 Frequency of Incus Bone Erosion on Mastoid Exploration in Chronic Suppurative Otitis Media with Middle Ear Cholesteotoma , W. Javaid, A. Rashid, M. U. K. Amin, T. Khan, M. Fatima
Background: Cholesteotoma is a benign but destructive lesion leading to ossicular necrosis. Objective: To see the frequency of incus bone erosion on mastoid exploration in chronic suppurative otitis media with middle ear cholesteotoma. Study Design: Cross-sectional descriptive study. Setting: This study was carried out in the Department of ENT Unit-2, Sir Ganga Ram Hospital, Lahore. Duration of Study: Fifteen months months (10th April, 2019 to 9th July, 2020) Sample technique: Non- probability purposive sampling Methods: One hundred and twenty patients were admitted through outpatient department of ENT Unit-2, Sir Ganga Ram Hospital Lahore. Patients were included after fulfilling the inclusion criteria and information was collected on a prescribed proforma. Finally during surgery under general anesthesia, the operative findings were noted to know the incus bone erosion after middle ear cholesteatoma formation in chronic suppurative otitis media. Results: A total number of one hundred and twenty patients of chronic suppurative otitis media with middle ear cholesteatoma were included. Out of which 80 (66.7%) were males and 40 (33.3%) were females(Table 1).The patients shown in table 2 were divided in six age groups (Table 2).Table 3 shows that the procedure of mastoidectomy was performed in 112 patients (93.3%) and modified radial mastoidectomy was performed in 8 patients (6.7%).Incus bone erosion in chronic suppurative otitis media with middle ear cholesteatoma in 102 patients (85%) and 18 patients (15%) have no incus bone erosion (Table 4). Conclusion: Ear discharge was the most common presenting characteristic of chronic suppurative otitis media with cholesteatoma. The majority of the cases had ossicular erosion, with the incus being the most common site of involvement. Males are more likely than females to develop cholesteatoma. Keywords: erosion of incus bone, Mastoid exploration, Chronic suppurative otitis media, Cholesteatoma
298 Accuracy of High-Resolution Computed Tomography Chest in Diagnosing Pulmonary Tuberculosis by taking AFB culture findings as Gold Standard , M. Amin, M. Javed, A. Noreen, M. Mehboob, N. Pasha, U. Majeed
Aim: To determine the accuracy of high resolution CT Chest (HRCT) for diagnosis of pulmonary tuberculosis (PTB) by taking AFB culture findings as gold standard. Methods: This validation study was conducted in patients referred for HRCT Chest for diagnosis of pulmonary tuberculosis in OPD/ Radiology unit of CH & ICH within duration of 6 months from September-2020 to February -2021. Patients with suspicion of PTB were included. In all patients, sputum samples were obtained and the AFB test was performed for diagnosis of PTB. After that high resolution CT Chest (HRCT) was performed for diagnosis of PTB. Results: Mean age was 54.67 ± 12.36 years. Male population 54% and female was 46%. AFB culture results for pulmonary. TB was positive in 44 patients and was negative in 56 patients. HRCT findings were positive for pulmonary TB in 46 patients and were negative in 54 patients (Table 1). The sensitivity of HRCT was 81.8%, specificity of HRCT was 82.1%, PPV was 78.3% and NPV was 85.2% (Table 2). Conclusion: HRCT Chest has a sufficient accuracy for PTB diagnosis taking AFB culture results as gold standard. So HRCT Chest can be opted as imaging modality of choice in patients having mixed plain radiographs findings. This will aid in early identification and starting treatment of PTB. Keywords: Accuracy, high resolution computed tomography, pulmonary tuberculosis
299 Rational for Maxillofacial Fracture Plate Removal , S. Ali, M. A. Khan, S. Khan, A. U. Rahim, U. Hussain, M. Nauman, Z. Iqbal
Aim: To estimate indications and frequency of plate removal in patient treated for maxillofacial fractures. Method; In this retrospective study, records were reviewed from March 2015 to March 2018, over a period of 3 years. 139 Maxillofacial trauma patients treated with Open reduction and Internal Fixation with 202 plate, Result; In 139 patients, 202 plates were implanted for bone fractures. In total, 128(92%) were male and 11(8%) were female, 32(23.02%) had revisited with complaint and subsequently 47(23.26%) plates were removed. Mandible was commonest location where majority of the plates32(68.08%) were removed. Most common reason for plates removal was infection 20(42%). Minimum time for plate in situ was 3 months. Conclusion; the reason for plate removal is multifactorial. Establishing measures to minimize plate related complication and avoid patients from further invasive procedures. Keywords: Facial Bone Fracture, Osteosynthesis Plate, Plate Removal Trauma
300 To Compare the Frequency of Chlamydial Infection in Infertile Women Compared to Normal Women , S. Jabeen, S. Yasmin, S. Riaz, A. Nazeer
Background: A better understanding of the role of persistent C. trachomatis infections in tubal factor subfertility may be useful in optimizing the fertility work-up by incorporating screening tests for persistent C. trachomatis infections. The aim is to accurately estimate the risk of persistence and identify those women who are at highest risk of tubal pathology. Aim: To compare the frequency of chlamydial infection in infertile women compared to normal women. Study Design: Case control study. Settings: Department of Obstetrics & Gynecology, Hospital, Bahawalpur. Study duration: 1st October 2019 to 31st March 2020. Methods: A total of 88 women (44 infertile and 44 normal), having normal semen analysis report, of age ranging from 18 to 40 years were included. Patients with polycystic ovarian disease, hyperprolactinemia, & hypothyroidism were excluded. Blood sample of all women in both groups was sent to the institutional pathology laboratory for presence or absence of chlamydial infection. Results: The mean age of women in case group was 27.80 ± 3.60 years and in control group was 28.05 ± 3.69 years. The mean duration of marriage in case group was 4.93 ± 1.66 years and in control group was 4.95 ± 1.68 years. The mean BMI in case group was 29.36 ± 2.52 kg/m2 and in control group was 29.50 ± 2.51 kg/m2. My study reveals the frequency of chlamydial infection in infertile women was seen in 15 (34.09%) women as compared to 05 (9.09%) in normal women which has shown p-value of 0.007 and odds ratio of 5.17 which is significant. Conclusion: This study concluded that frequency of chlamydial infection in infertile women is higher compared to normal women. Keywords: Infertility, chlamydial infection, tubal factor, sexually transmitted diseases
301 Prevalence of Hair Loss among Men and its Association with Smoking and Stress: A Case Study in the City of Lahore, Pakistan , R. Z. Abbas, J. Saleem, U. J. Iqbal, Z. Saqlain, M. Ishaq, A. Raza
Aim: To explore the prevalence of hair loss and its relation to men’s stress and smoking, Methodology: A cross sectional study attempts to explore the prevalence of baldness among the male residents of Lahore. For this purpose, a randomized sample of the male population was taken into consideration. The socio-demographic details, along with the smoking status of the sample were determined. Moreover, the body mass index (BMI) was also determined by referring to a prefixed formula. Baldness and stress levels were also quantified by taking into account the Norwood Hamilton categorical scale, and the perceived stress scale, respectively. A total of 250 male members were invited to participate in the research. Results: The study results showed that 51.2%, 41.2% and 7.6%of male experienced moderate, high and low level of stress respectively. When taking the Norwood Hamilton categorical scale into account, the results revealed that most prevalent type of baldness was Type II, which is the fronto-temporal hairline recession, with 19.2% of the individuals experiencing it. Age was significantly associated with baldness. Similarly a higher frequency of baldness was recorded in those men who lived in a nuclear family arrangement. Conclusion: No association was found between the type of baldness, stress level and smoking status. Keyword: Alopecia, Baldness, Norwood Hamilton categorical scale, Perceived stress scale, smoking
302 Frequency of Anatomical Variants of Paranasal Sinuses (PNS) on Computed Tomography (CT) , M. A. Siddiqui, M. Amin, A. Firdous, H. A. Saqib, S. Nighat, Z. U. Islam, M. M. Khan
Background: The para nasal sinuses be collection of air filled spaces adjoining the nasal cavity. Para nasal sinuses build up as of the primitive choana at 25–28 weeks of gestation. Three projections ascend from the lateral wall of the nose and work as the commencement of the growth of the para nasal sinuses. The Frequency of Anatomical Variants of Para nasal Sinuses (PNS) may be illustrated on Computed Tomography (CT) by using double slice CT machine. Aim: To reveal the anatomy of the para nasal sinuses as shown on the CT along with point out the variants lead to chronic sinusitis and escort obstacles in sino nasal operations. Methodology: This study was conducted in Ibnae-e Sieena Hospital and MMDC Multan during September 2019 to December 2019. In 50 patients without para nasal sinus diseases symptoms, head computed tomography studies were carried out after having consent from them and IRB. Para nasal sinuses coronal sections were taken. The CT studies were performed by using Dual Source multi slice CT Scanner. Results: 50 participants included in the study, 25 men with 25 women. Out of them, 22 having anatomical variants were noticed. Most common anatomical variants found were pneumatisation of center nasal turbinates (30%) then agger nasi cells 25%, Haller’s cells 20%, along with septal deviation 13% and sphenoid sinus septation (12%). Conclusion: This study shows that nasal cavity and para nasal sinuses anatomical variations are common. For the radiologic analysis of the para nasal sinuses, as of diagnosis of the pre and post -surgical evaluation and sino-nasal lesions, CT is the gold standard procedure. It can outline and explain the anatomical variants in para nasal sinuses. CT not only detect the lesion to vital constitutions which lined the para nasal sinuses but also repeated lesions that extra mural cells. CT of the para nasal sinuses has vital importance and should be passably analyze before FESS. Keywords: Para nasal sinuses, Computed tomography, Nasal turbinate, Ostiomeatal complex
303 Effect of Abdominal Physiotherapy in Reduction of Inter Recti Distance in Postpartum Females , K. Kazmi, G. M. Hashmi, M. Bilal, N. Iqbal, Wajeeha, A. Ilyas, A. Asif, J. Shafiq
Aim: To see the effect of abdominal exercises in the recovery of diastasis recti in post natal females. Methodology: A Quasi Experimental study design was used to enroll 40 participants from OPD of Gynecology and Obstetrics from a Tertiary Care Hospital Lahore between ages ranged from 18 to 30 years. Using purposive sampling all postpartum females having diastasis of rectus abdominis muscles with inter recti distance more than 2 fingers width were enrolled. All the study participants received abdominal muscle exercises program for 30 min a day in 8 week program. inter recti distance was measured by using two finger palpation method. All the pre intervention and post intervention data were recorded into a short structured proforma.Results were considered significant for p value ≤ 0.05. Results: 40 participants were selected in this study with an age from 18- 30 years. The inter recti distance was significantly reduced as p value was ≤ 0.05 for both (above umbilicus and below umbilicus) groups. Conclusion: It was observed that abdominal exercises helped in the recovery of diastasis and reduced the separation between the muscles in postpartum women. It also enlightens the importance of the prescription of physiotherapy in reduction of post partum complications. Keywords: Abdominal Exercises, Diastasis Recti, Pregnancy, Postnatal period,
304 Comparison of Frequency of Surgical Site Infection with or without Bile Spillage during Laparoscopic Cholecystectomy , M. Asif, L. A. Deokah, R. N. Malik
Aim: To compare the frequency of surgical site infection with or without bile spillage during Laparoscopic Cholecystectomy. Methods: This randomized controlled trial was conducted at Department of Surgery, M. Islam Medical and Dental College Gujranwala from March 2020 to September 2020 over the period of 6 months. Total 68 pppatients of acute cholecystitis (as per operational definition) undergoing laparoscopic cholecystectomy either male or female having age from 20 60 years with duration of gal stone (single or multiple) ≥ 6 months were selected. After 2 weeks follow-up, surgical site infection was assed. Results: Mean age of the patients was 39.90 ± 12.04, mean age of patients of study group A was and B was 38.88 ± 13.01 and 40.91 ± 11.08 years respectively. Comparison of frequency of surgical site infection was done between both groups. In study group A (spillage group), SSI was found in 12 (35.29%) patients while in study group B (without spillage group), SSI was noted in 4 (11.76%) patients. Difference of frequency of SSI between the study group A and B was statistically significant (P = 0.022). Conclusion: Results of present study showed that surgical site infection is mostly occurred in patients with spillage of bile during Laparoscopic Cholecystectomy. Most of the patients were belonged to 3rd and 4th decade of life. Significantly higher rate of surgical site infection was noted in female patients of spillage of bile group. Keywords: Bile spillage, Laparoscopic Cholecystectomy, gall bladder, surgical site infection
305 Primary causes of In-Hospital Mortality in Pediatric Cardiac Surgery Population , T. Waqar, M. Z. A. Ansari
Objective: To present primary causes of in-hospital mortality in large surgical population who underwent surgical correction for CHDs for the period of a decade at our institute. Methods: Retrospective analysis of pediatric cardiac surgery database along with decision of morbidity and mor-tality meeting at Department of Cardiac Surgery at CPE Institute of Cardiology from January 2009 to April 2021. Results: An overall 3705 patient underwent surgery for CHDs. The in-hospital mortality for CHDs surgery is 2.37% with RV dysfunction, Residual cardiac defect with valve dysfunction (TR/PR), pulmonary hypertensive complication, mediastinal bleeding, cardiac tamponade, respiratory complication, MODs, heart block as major primary cause of in-hospital mortality with frequency of 15.91%, 18.18%, 18.18%,18.18%,9.09%,10.23%, 4.54% and 4.54% respectively. Conclusion: in our population of 3705 congenital cardiac surgery patients, incidence of overall in-hospital mortali-ty is promising for wide range of CHDs. RV dysfunction, residual RV defects with vale regurgitation, pulmonary hypertension, bleeding complications and respiratory failure are major primary causes of in-hospital mortality. Keywords: In-hospital Mortality, Atrial septal defect (ASD), Tetralogy of Fallot (TOF), Ventricular septal defect
306 Prevalence of Left main coronary artery disease with diabetes and hypertension in STEMI patients , F. Ali, Q. A. Saboor, T. Mahmud, F. Ali, H. Bashir, A. Ahmed, W. Rehman, A. Hilal, A. Muhammad
Aim: To determine the association of left main stem disease with diabetes and hypertension in STEMI patients underwent coronary angiography Methodology: This study was conducted at Department of Cardiology, Sheikh Zayed Hospital, Lahore during January to June 2019 where 220 patients with age ranging from 40-70 years whether male or female, presenting with STEMI, In Exposed Group: Patients presenting with STEMI having diabetes and hypertension and Unexposed Group: Patients of STEMI without diabetes and hypertension. We excluded all cases with recurrent MI or undergoing recurrent PCI (on medical record), valvular heart disease, and cardiogenic shock. Then two groups were formed i.e. exposed group with diabetes and hypertension and unexposed group without diabetes and hypertension. All patients underwent angiography by a senior consultant cardiologist with assistance of researcher. On angiography, presence of LMS disease was ≥50% occlusion (stenosis) in LMS artery. Angiography reports were assessed and LMS disease was noted labeled. Patients with LMS disease was managed as per hospital protocol. Results: In this study risk of LMS was higher among exposed group as compared to un exposed group. i.e. exposed: 19.1% & Unexposed: 5.5%, RR=3.50 The risk of LMS among exposed group was higher for patients in the age group 51-60 years (RR=8.00), for male patients (RR=5.76) risk for LMS was higher as compared to female patients in exposed group, patients with normal BMI (RR:2.20) and patients with shorter duration of STEMI in exposed group had higher risk for LMS (1-4 weeks: RR=7.54). Conclusion: Results of this study showed that hypertensive and diabetic patients presenting with STEMI had higher risk for LMS disease. Keywords: Left main stem, Diabetes, Hypertension, Coronary, Angiography
307 Severity of Alveolar Bone Loss in Control and Uncontrolled Type II Diabetics , A. Farooq, M. Riasat, H. K. N. Baloch, S. G. S. Shah, S. Shehzad, S. Z. E. H. S. Shah
Objective: To assess the association between the controlled and uncontrolled type-2 diabetic patients to the severity of Alveolar bone loss Study Designed: Cross-sectional analytical study. Place and Duration of Study: Department of Radiology, Sardar Begum Dental College and Khyber College of Dentistry Peshawar KPK from 1st October 2020 to 31st March 2021. Methodology: One hundred and seventy patients were included. Daniel formula (1999) was used for the patient to check the alveolar bone loss and questionnaire was filled by the researcher and examination was done on the dental unit using examination instruments. Results: The mean age was 39.41±6.92. The oral hygiene status in patients visiting the radiology department using toothpaste twice a day was 50.58% while bone loss among patient using toothpaste and brushing their teeth twice a day was 21.51%. The patient with a controlled glucose level was 41.28% while a patient with an uncontrolled glucose level was 58.72%. The bone loss in a patient with controlled HbA1c the bone loss in normal to moderate 38.38%while severe bone loss was 2.90% which is less as compared to the controlled group. The bone loss was reported higher in males (51.16%)as in females were 48.84%, but there was a severe bone loss in females 31,40% as compared to males 17.44%. Conclusion: There is a strong association between alveolar bone loss with the increased level of HbA1c. When the levels of HbA1c level increased the bone loss in both male and female was reported high. Type 2 diabetic patients having increased HbA1c levels cause severe bone loss. Keywords: Diabetes mellitus, Out-patient department, Hemoglobin A1c
308 Determine the Clinical Presentation and Outcomes of Thoracostomy in Children with Complicated Pneumonia , S. U. Rehman, S. Khan, M. Anwar, A. Rafique, Z. I. Bhatti, S. Siddique
Objective: To examine the clinical presentation and outcomes of thoracostomy in patients presented with complicated pneumonia. Study Design: Descriptive/Observational Place and Duration of Study: Department of Paediatric Surgery, DHQ Teaching Hospital Sahiwal from 1st January 2019 to 31st December 2020. Methodology: Fifty patients of both genders with ages 0 to 12 years presented with complicated pneumonia were included. All the patients received chest tube intubation. Outcomes of thoracostomy were examined. Radiological examination was done. Results: Thirty eight (76%) patients were males while 24% were females. Majority of patients 64% were ages less than 5 years. Fever, cough, shortness of breath and chest pain were the common symptoms. Staphylococcus aureus was the most common causative factor found in 56% cases followed by streptococcus in 24% cases. 84% cases were successfully removed chest tube. Recollection found in 8% cases, pneumothorax found in 4% patients and 4% patients had pneumatocele. Conclusion: Chest tube intubation was the safe and effective treatment modality for complicated pneumonia with fewer rates of complications. Keywords: Complicated pneumonia, Thoracostomy, Empyema, Pneumothorax, Outcomes
309 Diaphyseal Humeral Fractures Treated by Bracing versus Dynamic Compression Plate , B. Kumar, A. Kumar, L. D. Mheshwari, Z. H. Tunio, R. A. Jhatiyal, K. B. Umrani
Objective: To compare the results of humerus shaft fractures treated by functional bracing and dynamic compression plate. Study Design: Cross sectional comparative study. Place and Duration of Study: Department of Orthopaedic Surgery & Traumatology, Liaquat University Hospital Hyderabad/Jamshoro from 1st June 2015 to 31st May 2016. Methodology: Eighty cases selected from accident emergency department and outpatient departments. Cases were divided in two groups; group A (dynamic compression plate) and group B (functional bracing). Patients of either gender with age range 18-50 years with an isolated closed fracture of the humeral shaft, of duration within 2 weeks and who were willing to participate in the study were included in the study while open fractures, bilateral injuries, poly-trauma, pathological fracture, smoker, alcoholic, immune compromised, and history of poor compliance, psychiatric disease were excluded. Results: In conservative group, 32 (80%) were males and 8 (20%) females while in dynamic compression plate group, 30 (75 %) were males and 10 (25%) females with mean age was 35.75±9.083 year. There were 46 (57.5%) patients who sustained fractures following road traffic accidents 16 (20%) cases had fall from height and 18 (22.5 %) cases had after assault. Fracture location was middle third in most of cases in both groups. Mean time for union was 15.45±2.864 and 14.325±3.033 weeks and mean time of follow-up was 48.35±6.436 & 42.52±9.33 weeks in dynamic compression plate and functional bracing groups respectively Conclusion: Plating of humeral shaft fracture was found to be satisfactory method of treatment with high fracture union rates, better functional outcome [DASH Score] and low complication rate as compared to functional bracing group. Keywords: Humeus shaft, Fracture, Dynamic compression plate, DASH score, Conservative, Functional bracing
310 Compare the Outcomes of Mini-Plate versus K-Wire Fixation in Patients with Shaft of Metacarpal Fractures , F. Noor, H. M. Nasir, F. Zahra, J. Kumar, S. Ali
Objective: To compare the functional outcomes of K-wire versus mini plate fixation for the treatment of fractures shaft of metacarpal. Study Design: Randomized controlled trial Place and Duration of Study: Department of Orthopaedic, Sahara Medical College, Narowal from 1st August 2020 to 31st January 2021. Methodology: Fifty six patients of both genders presented with fractures shaft of metacarpal were included. Patient’s ages were ranging between 15 to 60 years. Radiographic assessment was done to all the patients. Patients were categorized in to two equal groups. 28 patients treated with mini plates (group A) and 28 patients treated with K-wire fixation (group B). Post-operative complications were examined and compare between both groups. DASH scoring system was used for analyzing functional outcomes. Results: Mean age in group A was 34.57±7.84 years and in group B it was 34.95±7.76 years. Majority of patients 18 (64.29%) and 17 (60.71%) were males in group A and B. Mean time of union in group A was 9.58±2.24 weeks while in group B it was 12.33±2.85 weeks, the difference was statistically significant (p-value <0.05). As per DASH criteria, 15 (57.14%), 11 (39.29%) and 2 (7.14%) patients had excellent, good and fair functional outcomes who treated with mini plates internal fixation, while in group B 12 (42.86%), 13 (46.43%), 2 (7.14%) and 1 (3.57%) patients had excellent, good, fair and poor functional outcomes. Postoperative complications were more in group B as compared to group A but the difference was not statistically significant (p-value >0.05). Conclusion: Both procedures mini-plate internal fixation and K-wire fixation are effective for fractures shaft of metacarpal. However, mini-plates showed better functional outcomes with fewer rate of postoperative complications and earlier union as compared to K-wire internal fixation. Keywords: Shaft of metacarpal fracture, Internal fixation, Mini-plate, K-wire, DASH scoring system
311 Application and Experience of Various Reconstructive Procedures in Scalp Defects , K. Q. Shaikh, A. Q. Shaikh, Z. H. Tunio, R. A. Jhatiyal, M. K. Mugria, M. K. Abbasi
Aim: To evaluate the outcome of various reconstructive procedures in scalp defects. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Plastic/Reconstructive Surgery & Burns, LUMHS Jamshoro from 1st January 2018 to 31st December 2020. Methodology: Thirty patients of scalp wounds were admitted through outpatient and casualty departments. The patients were diagnosed by pre-operative workup and on clinical parameters were included. The patients unfit for general anaesthesia, patients having associated skin pathology, patients with history of allergic reactions and patients having any poorly controlled systemic co-morbidity like diabetes and hypertension were excluded. Results: Twenty two (73.33%) were males and 8 (26.66%) were females with mean age of 38.98±8.25 years. Scalp defect was due to trauma in46.66%, electric injury 23.33%, benign lesions 16.66%, malignant tumour 3.33%, Infection 3.33%, haemangioma and pigmented nevus 3.33%. Follow up duration was 42.34±7.83 weeks. Conclusion: Primary closure remained the mainstay of our treatments hence proved that simplest reconstruction should be used whenever possible to provide the most functional and aesthetic scalp reconstruction, with the least amount of complexity. Key Words: Scalp, Reconstructive surgical procedure, Graft, Flap
312 Outcome of Midvastus versus Subvastus Approach in Single Stage Bilateral Total Knee Arthroplasty , K. Siddiq, W. Ali, M. I. Haider, M. H. Hameed, M. Iqbal, M. S. Riaz
Objective: To compare midvastus and subvastus approach regarding operative parameters(lateral retinacular release, operative time, neurovascular injury) and outcome (Knee Society Score, Straight Leg Raise) at 12 weeks in single stage bilateral total knee arthroplasty. Study Design: Randomized clinical trial study Place and Duration of Study: Institute of Orthopaedic Surgery and South City Hospital Karachi from 1st January 2016 to 31st December 2018. Methodology: Fifty two patients of both genders ofmore than 50 years with osteoarthritis grade III or IV and bony changes confirmed by AP and lateral radiographs of knee were included. Patients with previous knee surgeries including high tibial osteotomy, deformities >20°(on mechanical axis), any neuromuscular problem and BMI ≥30 were excluded. Final assessment was done at 12 weeks. Isometric quadriceps strength was assessed by holding of contraction in seconds during the lifting (10cm above the plinth) phase of SLR (patient lying supine).Knee score (preoperative and final follow-up) was performed by Knee Society Score. Results: Thirty five were females and 21 males with mean age 65.3 years (50-78 years). Mean body mass index was 27.8 Kg/m2 (26.4-29.9). In midvastus TKR, the mean operative time was 61.7 minutes (range 52-70) whereas the same was 68.3 minutes (range 58-74) in subvastus TKR with p value 0.002. Rate of lateral retinacular release (LLR) was significantly (p=0.011) different between the midvastus TKR 5 (8.9%) and subvastus TKR 11 (19.6%). Neither group had neurovascular injury or early infection of the knee. Active SLR in subvastus group was achieved in shorter time (mean 3.1 days) as compared to midvastus group (mean 4.7 days). There was no difference (p=0.173) in isometric quadriceps strength at 12 weeks between subvastus TKR (mean 18 seconds) and midvastus TKR (mean 17 seconds). Knee society pain and functional scores were comparable between the two approaches at final follow up. Conclusion: Subvastus exposure has advantage of achieving active straight leg raise earlier while midvastus has lower frequency of lateral retinacular release. No difference in hospital stay and postoperative pain scores. Both subvastus and midvastus approaches are safe and offer comparable Knee Society Score outcomes. Keywords: Midvastus, Subvastus, Total knee arthroplasty, Knee Society Score, Straight leg raise
313 Determine the Frequency of Sensorineural Deafness in Children with Cerebral Palsy , A. G. Magsi, M. U. Rehman, F. A. Soomro, Z. Ahmed, A. Q. Memon
Aim: To determine the frequency of sensorineural deafness in child with cerebral palsy. Study Design: Descriptive/cross-sectional Place and Duration of Study: Department of Neurology, Chandka Medical College Hospital, Larkana from 1st October 2020 to 31st March 2021. Methodology: One hundred and seventy patients of both genders age between 1-14 years were enrolled. Children diagnosed as having cerebral palsy and fulfilling the inclusion criteria was included. Hearing assessment was done with audiometry and degree of hearing loss was recorded in both ears in the form of mild, moderate, severe and profound degree of hearing loss. Results: Most of the patients 90 (52.94%) were between 1-5 years old followed by 51(30%) patients between 5-10 years with mean age of 4.8±7.8 years. 115 (67.65%) cases were males and 55 (32.35%) females. 54 (31.8%) cases had microcephaly and116 (68.2) cases had normal head circumference. Among 170 cases of cerebral palsy 48 (28.23%) cases had hearing loss and 122 (71.77%) of patients of CP had no hearing deficit. Among 48 cases of CP with hearing loss 15 (31.25%) cases had mild, 14 (29.17) cases had moderate, 10 (20.83%) had severe and 11 (22.92%) cases had profound hearing loss. Conclusion: The frequency of sensorineural deficit is high and significantly associated with cerebral palsy patients. Keywords: Degree of hearing loss, Sensorineural hearing loss, Cerebral palsy
314 Frequency of Fine Needle Aspiration Cytological Category C5 in Breast Lesions among Females of Various Age Groups , S. Yaseen, M. Ali, F. Mahmood, S. Mudassar, U. Nisar
Background: Benign as well as malignant neoplasm of breast still appears to be the prime tumour among females and the prevalence of the disease is increasing all over the countries. The likelihood of emergence of breast neoplasm is linked to a number of factors i.e. reproductive life events and the factor of lifestyle that modify levels of endogenous sex hormones. One of most important risk factors is growing old age. Fine needle aspiration cytology (FNAC) is a least traumatic, reliable simple, complication free technique and economical for the diagnosis of mass lesions. It can be easily repeated if an adequate aspirate is not obtained. Aim: To determine the frequency of cytological category of FNAC C5 of breast lesion among different age groups. Study Design: Cross sectional comparative research study Place and Duration of Study: Department of Histopathology, Shaikh Zayed Hospital, Lahore from 21st January 2016 to 22nd September 2016. Methodology: One hundred and twenty female patients selected who presented with complain of palpable lesion in breast and was correlated with physical examination recording the size and consistency of mass. The procedure was performed on patients with complete clinical and radiological work up. After preparation of direct smear, slides were processed according to routine processing and then stained with H&E and Giemsa. Results: Thirty (25.80%) were between 18-30 age group while 42(35.00%), 47(39.20%) were between 31-45 and 46-60 age groups respectively. Though majority of FNAC cases were found in age group 31–45 but there was no significant difference among three groups by age. Conclusion: Malignancy in palpable breast masses can surely be diagnosed by a combination of clinical examination of breast and FNAC which when performed by a dedicated cytopathologist should be an integral part of a breast screening service. Middle age group had highest frequency but difference was insignificant. Keywords: Fine needle aspiration cytology, Palpable breast lesions, Age groups
315 Management of Depressed Skull Fractures: Selective Conservative Management of Non Missile Injuries , S. H. Arain, M. A. Shaikh, M. A. Narejo, N. S. Ansari, A. R. Mari
Objective: To determine the outcomes of management of depressed skull fractures. Study Design: Descriptive Study Place and Duration of Study: Department of Neurosurgeries, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat and Chandka Medical College Hospital, Larkana from 1st March 2020 to 28th February 2021. Methodology: Eighty patients of both sexes were enrolled in this study. Patients were aged between 12-70 years of age. Patient’s detailed demographics age, sex and body mass index were recorded. Diagnosis of skull fractures from closed head injury patients were undergone for CT scan Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. Patients were followed for 4-months. Outcomes were assessed by Glasgow Coma Scale (GCS). Results: Fifty five (68.8%) patients were males and thirty five (31.2%) were females with mean age was 18.21±7.32 years and mean body mass index was 20.04±3.14 kg/m2. Road traffic accident (56.25%) was the most common cause of the injury followed by fall from the height 25 (31.25%). The compound fractures have 48 (60%) and simple fractures were 32 (40%). Surgery was done among 70 (87.5%) cases and 10 (12.5%) patients were conservatively treated. Among these 50 (62.5%) patients were completely recovered. Cerebrospinal fluid leak was the most common complication and was found in 13 (16.25%) cases. Conclusion: The use of antibiotics and anticonvulsants had effective results during peri-operative periods to avoid infection and epilepsy. The initial stage of operation is particularly necessary when the fracture is larger than 5mm. Cerebrospinal fluid leaks occur after surgery as the most common complication. Keywords: Depressed skull fracture, Non-missile injuries, Cerebrospinal fluid
316 Medical Students and Patients Perspectives on Bedside Teaching , M. S. H. Ansari, M. Z. Anjum, N. Haider, S. Mustafa, A. Nawaz, M. A. Qureshi
Objective: To evaluate perspectives of medical students and patients on bedside teaching. Study Design: Cross-section survey Place and Duration of Study: Department of General Surgery/Pediatric Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st April 2019 to 30th June 2019. Methods: Two hundred students from 4th year and final year MBBS class were included and 100 patients from general surgery and general medical wards who stayed for at least 48 hours and had at least 2 case presentations and 2 consecutive morning rounds were enrolled in the study. Their perspectives about bedside teaching were assessed with two separate questionnaires. Results: The mean age of medical students was 23 years (20-26) and 35% were male and 65% were female. The mean age calculated for patients was 55.5 years (18-75). Fifty two percent were females and 48% were males. Fifty eight percent of medical students stated that the time of bedside teaching is not enough and it should be increased. Majority of patients were satisfied with the bedside teaching techniques and 82% of patients believed that through bedside teaching. No significant difference of responses among students and patients was observed. Conclusion: Teaching on the bedside provides unique opportunities to incorporate the learning skills for direct benefit of the patients. It provides a unique learning triad consisting of patients, students, and teachers and creates clinical simulation as a learning tool. Key words: Bedside teaching, undergraduate, medical students.
317 Association between Periodontal Status Sociodemographic Profile and Different Level of Oral Hygiene Status among Smokers , S. G. S. Shah, H. K. N. Baloch, S. U. Haq, A. Farooq, S. S. Shah, F. J. Shah
Aim: Association between smoking and periodontal disease with sociodemographic profile and different levels of oral hygiene status. Study Design: Case control study. Place and Duration of Study: Khyber College of Dentistry and Sardar Begum Dental College and Hospital Peshawar KPK from 1st July 2020 to 31st December 2020. Methodology: The were 300 patient from 20-50 years of age were enrolled in the study. The sample was stratified into two groups, cases and controls150 patients in each group. Patients were clinically evaluated by measuring the PDI scores and oral hygiene index. Results: There were (43.3%) smokers and (56.6%) were non-smokers. There were 57.3% smokers and 42.6% were non-smokers with periodontal disease the result was significant (p=0.0001), while 29.3% smokers and 70.6% were non-smokers and did not have periodontal disease. The oral hygiene status was poor among smokers it was 23.1% while 2.9% among non-smokers, with significant result p-value was =0.0001. There was an association between periodontal disease with different levels of smoking the result was significant (p=0.0001). Conclusions: There was an association between smoking, sociodemographic profile with periodontal disease and oral hygiene status. Keywords: Periodontal disease, Smokers, Non-smokers, Periodontal disease index, Oral hygiene index
318 Comparison of Myoinositol versus Combination of Metformin and Myoinositol in Ovulation Induction in Polycystic Ovarian Syndrome , T. Akhtar, F. Shaikh, Basma, W. U. N. Ahmed, S. Lashari, N. Bhatti
Objective: To compare the efficacy of insulin sensitizer myoinositol versus a combination of myoinositol plus metformin for ovulation induction in polycystic ovarian syndrome. Study Design: Prospective, randomize control trail. Place & Duration of Study: Department of Obstetrics & Gynaecology, Sheikh Zayed Women Hospital Larkana from 1st January 2017 to 31st December 2017. Methodology: Sixty patients were recruited. The proper clinical history, demographic and physical examinations were recorded. Sixty patient divided in two groups A and B, each group receive 30 patients. Group A received myoinositol 1 gm twice daily plus ovulation (letrozole +gonadotrophin) and Group B received two insulin sensitizer myoinositol and metformin plus ovulation induction protocol(from 2-6 days and 7-9 days. Transvaginal ultrasound performed on day 12 of all patients to see the follicular size. Results: Mean age of participants was 26.4±4.4 years and LH/FSH ratio was >1.5. Oligomenorrhea, infertility, hirsutism, and overweight were the major clinical manifestation of women with PCOs. Twenty nine women with PCOs of group A (metformin plus myoinositol) were increased number of follicles as compared to women of group B (myoinositol alone), the difference was statistically significant (p<0.05). Conclusion: The combination of these two drugs ‘Metformin and Myoinositol’, work synergistically that gives more metabolic and reproductive benefits as compared to single drug work alone. Keywords: Polycystic ovarian syndrome, Ovulation, Metformin, Myoinositol, Insulin sensitivity
319 A Critical Analysis of Vitamin D and Calcium in Women during Pregnancy , M. Abbas, S. Azhar, A. Fawwad, H. Abbas, H. Jabeen, F. Kamal, M. Sohail
Aim: To find out the frequency of vitamin D and calcium in pregnant women and their effects on fetus as well as mothers. Study Design: Retrospective study. Place and Duration of Study: Darul Shifa Clinic & Maternity Home Karachi Pakistan from 1st July 2020 to 31st December 2020. Methodology: One hundred and twenty patients with proper evidence of pregnancy were enrolled. All patients from age 18 years to age 35 years with no other disease were included and those women who have some other diseases or age outliers were excluded. Results: There is a significance difference in the vitamin D and calcium during the period of pregnancy. In the group A (18 years to 25 years) the significance difference of vitamin D was (P=0.000) while the calcium was (P=0.200). In the group B (26 years to 30 years) the significance difference of vitamin D was (P=0.000) while the Calcium was (P=0.071) and in the group C (30 years to 35 years) there was no significant change of vitamin D and calcium (P=0.000). The result of group C is different from the results of the above two groups, because in this age majority of the women were living in a congested houses as well as were spending a depressive life due to home problems, husband wife compromise problems, children problems, financial problems etc. and all such problems have a direct impact on their pregnancy Conclusion: It was statistically found that the Vitamin D and calcium values show significances changes during pregnancy in contrast to the normal women. Key words: Vitamin D, Calcium, Pregnant women
320 Chylolymphatic Cysts in Children: A Rare Condition , M. Z. Anjum, M. S. H. Ansari, S. Mustafa, T. M. Butt, M. A. Qureshi
Objective: To find out the clinical findings, anatomical types and preferred operative treatment for paediatric chylolymphatic cysts. Study Design: Prospective study Place and Duration of Study: Department of Pediatric Surgery/General Surgery Bahawal Victoria Hospital, Bahawalpur and Department of Pediatric Surgery/General Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st January 2018 to 31st December 2020 Methodology: Fifteen patients of either gender with age from 18 months to 8 years (96 months) enrolled. Clinical data of all the patients diagnosed as chylolymphatic cyst on exploration was recorded. Results: There were 8 (53.3%) females and 7 (46.7%) males with mean age was 49.80±27.07 (months). Four patients (26.66%) presented with abdominal mass, 5 patients (33.33%) presented with abdominal pain, 1 patient (6.66%) with abdominal mass and pain while 5 patients (33.33%) presented with signs of intestinal obstruction. Three (20%) had cysts at multiple sites, i.e., mesentery of jejunum, ileum and mesentery of sigmoid colon, 5 (33.33%) patients had cysts in jejunal mesentery while 9 (53.33%) patients’ cyst was found in ileal mesentery and 1 (6.66%) had cyst in mesentery of cecum. Fourteen underwent exploratory laparotomy and 1 was managed laparoscopically. Post-operative recovery in 14 patients was uneventful and 1 patient managed by open surgery underwent respiratory complications and later expired. No recurrence was noted during follow up period up to 6 months. Conclusion: Surgical exploration and surgical excision and sometimes resection anastomosis of gut is mainstay of treatment with excellent results. Key words: Paediatric mass abdomen, Mesenteric cysts, Chylolymphatic cyst, Paediatric surgery
321 The Impact of Malnutrition on the Increasing Risk of Bronchopneumonia Among Under Five-Year children , Intan Mutiara Putri, Ade Nopriyanti
Background: Bronchopneumoniabecomes, one of the infectious diseases, is causing mortality in under five-year children. One of the risk factors of pneumonia in under five-year children is nutritional status. One of the types of pneumonia is the inflammation occurred on the tip of the bronchioles. Aim: This research aimed to observe the relation of nutritional status and bronchopneumonia among under five-year children. Method: This research had been approved by the Research Ethics Committee in Universitas ‘Aisyiyah Yogyakarta. This control case research was conducted in the Public Regional Hospital of Panembahan Senopati, Bantul Yogyakarta. The study used 86 respondents (under five-year children) aged 12 to 60 months suffering from bronchopneumonia and 86 respondents (under five-year children) with pneumonia with the same ages as the previous one. The respondents were found using the random sampling technique listed in this research. The data were collected from the secondary data from the medical record. Results: The chi-square statistical test result showed that the under five-year children with the malnutrition had three times higher risk of suffering bronchopneumonia than those with good nutritional status (p-value: 0.001 and 95% CI: 1611-5.578). Keywords: Nutritional Status, Bronchopneumonia, Under Five-Year Children
322 The Correlation Between Marital Age and The Incidence of Cervical Cancer , Dwi Margareta Andini, Dessy Lutfiasari
Background: Cervical cancer (neck of the womb) is a malignant tumor that grows in the cervix (the lowest part of the uterus attached to the top of the vagina). Aim: This study aims to investigate the correlation between marital age and the incidence of cervical cancer. Methods: This research was correlation analytic with a cross-sectional approach. This study's population was all patients in Gambiran Hospital in obstetric and gynecology poly, and the sample size was 34 people chosen by simple random sampling technique. The research instrument used the medical record. The bivariate analysis used the Spearman rank test. Results: The analysis shows that there were two independent and dependent variables, namely marital age and the incidence of cervical cancer, with ρ value = 0001< α = 0.05 indicating that there was a correlation between marital age and the incidence of cervical cancer with a value of r = 0.549 showed that there is a relationship between the age of marriage with cervical cancer incidence. Conclusion: This research is expected to be an input to make people more healthy and open to receive health information, especially if a family has a child of early marriage age. Keywords: Cervical Cancer, Marital Age.
323 The Correlation Between Parity and Premature Rupture of Membrane (PROM) Incidence , Estiyani Wulandari, Lenna Maydianasari, Eva Yusnidhar
Aim: This research aims to identify the correlation between parity and premature rupture of membrane (PROM) incidence at KIA Sadewa Hospital in 2013. Methods: The research was observational analytic research with a cross-sectional design. The sampling employed total sampling. This research population was all women giving birth at KIA Sadewa Hospital from January to December 2013 who had complete data as many as 2,645 women. The samples used in this study were 2388 women with expected delivery and 257 women who experienced the PROM. The data were secondary data obtained from medical records and then analyzed in univariate and bivariate analysis using a chi-square test with p-value = 0.005. Results: Women giving birth at KIA Sadewa Hospital in 2013 were mostly multipara. The incidence of premature rupture of membrane at KIA Sadewa Hospital in 2013 indicated 9.7% of them experiencing the PROM and 90.3% not experiencing the PROM. Conclusion. There was a correlation between parity and the incidence of premature rupture of membrane at KIA Sadewa Hospital in 2013. There is a correlation between parity with the incidence of premature rupture of membrane at KIA Sadewa Hospital in 2013. Keywords: Parity, Premature Rupture of Membrane
324 The Identification of Maternal Characteristics and The Incidence of Anemia in Pregnant Women , Enny Fitriahadi, Desi Ayuningtyas
Aim: The research aims to identify maternal characteristics and anemia in third trimester pregnant women at Mantrijeron Primary Health Center of Yogyakarta. Methods: The study employed a correlation design and cross-sectional approach. The sampling technique in this study used the purposive sampling method with the number of samples was 69 people—the data analysis used using chi-square analysis. Results: This study shows correlations between education level, parity, maternal age, and the frequency of ANC visits as indicated by p-value (<0.05) and the incidence of anemia in the third trimester of pregnant women Mantrijeron Primary Health Center of Yogyakarta. Meanwhile, those with no correlation were nutritional status as indicated by p-value (0.389> 0.05). Conclusion: Pregnant women are suggested to have pregnancy checks regularly at least four times during pregnancy so that complications, such as anemia, can be indicated earlier and can be minimized. Keywords: Characteristics; anemia in pregnant women
325 E-learning Development Strategy through Massive Open Online Course (MOOC) In Clinical Rotation Nursing Education , Totok Harjanto, Dimas S.E.W. Sumunar, Oktavin, Rosiana Nur Imallah, Sri Suning Kusumawardani
Background: E-learning as a new learning method influences process of transforming conventional education into a digital basis. Massive Open Online Course (MOOC) is used as an e-learning management system that disseminates nursing institution partners' knowledge. An E-learning system provides highly configurable and integrated features in electronic books, journals, and web services. This system quickly, effectively, and economically distributes educational content toward students without any time or learning space limitation. E-learning has been implemented in various learning subjects, including nursing, but remains limited in clinical rotation nursing education. It has not been implemented widely, even though it is proven to support the learning process. Aim: The study aims to describe the process of developing an E-learning system in clinical rotation nursing education. Methods: The course subject was nursing management by involving two education institution partners. School of Nursing, Faculty of Medicine, Public Health, and Nursing (FKKMK) UniversitasGadjahMada (UGM) designed clinical learning innovation for clinical rotation nursing students in blended learning. It involved the institution’s partner students as the learning participants. Results: The process of developing E-learning in the clinical rotation nursing was by building partnership with education institutions passed through several phases: curriculum development, instructional design, and teaching media development, program evaluation methods, utilization of Learning Management System (LMS) as well as student learning outcomes evaluation. System design and development followed student needs resulting in the high score of participants' learning outcomes in clinical rotation nursing education. Conclusion: Appropriate E-learning system development strategy benefits student learning processes during nursing management practice in clinical rotation nursing education program. Keywords: Clinical Rotation Nursing Education, Education Institutions Partners, E-learning, Management Nursing Practice MOOC
326 Anxiety Level of Pregnant Mother in Facing Childbirth , Indra Iswari Ningsih, Rosmita Nuzuliana  
Background: Pregnancy is a dramatic episode of biological conditions, psychological changes, and adaptation for any woman experiencing it. Aim: Some women may assume that pregnancy is an inevitable nature to pass, while others deem it a determining event between life and death event for a new chapter of life. Some researches reveal the increasing level of anxiety shared by pregnant women at the time of delivery. Methods: This study used an observational analytical method with a cross-sectional approach. The samples were 74 respondents taken using quota sampling. It applied the standard questionnaire for data collection, the HARS questionnaire. The data were then analyzed with bivariate data of Chi-Square. It is revealed that 55.4% of respondents experienced anxiety, which was triggered by several factors, including employment factors (ρ = 0.001), parity (ρ = 0.001), and maternal age factors (0.021). Results: Women facing childbirth in Gamping II Primary Health Center mostly experienced anxiety due to risky age with ρ = 0.002, primigravida with ρ = 0.001. In contrast, the mothers with low education experienced anxiety with ρ = 0.080, and pregnant women with low education experienced ρ = 0.001. Keywords: Anxiety, pregnant women, childbirth
327 The Effect of Giving Pre-birth Counseling to the Anxiety Level of Third-trimester-Pregnant Mother , Yuslia Puspitasari, Suyani
Aim: This research aims to determine the effect of pre-birth counseling on women’s anxiety during the third trimester of pregnancy at Umbulharjo I Primary Health Center. Methods: This quantitative type of research used the pre-experiment method within Group Pretest-Posttest Design. Twenty people were used as a sample in this study, and they were the respondents who met the inclusion and exclusion criteria. The Accidental Sampling technique was used to take the sample. Results: This study found that 80% of the third-trimester-pregnant women experienced anxiety before the intervention, and there was a decrease in the anxiety of 25% after being given intervention. It was proven by the results of the p-value 0.011<0.05, meaning there is a positive effect of giving pre-birth counseling to lower the anxiety level of third-trimester-pregnant women. Thus, midwives are suggested to provide pre-birth counseling for pregnant women in Antenatal Care services. Keywords: third-trimester pregnancy, Anxiety
328 The Effect of Speos Method on the Quality of Postpartum Mother life at Mertoyudan I and Mertoyudan 2 Primary Health Center in 2018 , Risky Puji Wulandari, Mufdillah
Background: Postpartum mothers are potentially susceptible to postpartum care complications, such as postpartum blues and depression. SPEOS is a combination of endorphin massage techniques, oxytocin massage, and positive suggestions to improve life quality after childbirth. Aim: This study aimed to prove the SPEOS method's effectiveness on postpartum mothers' quality of life. Methods: This research was a quasi-experiment with a pretest-posttest control group design. The research was conducted in Mertoyudan I Primary Health Center and Mertoyudan II Health Center. The research subjects were 22 postpartum mothers taken using a simple random sampling technique. The independent variable in this study was the SPEOS method, and the dependent variable was the quality of life. The instrument used was the PQOL questionnaire. The data were analyzed using Wilcoxon and Mann-Whitney tests. Results: The quality of postpartum mothers life scores increased (mean = 177.55 to 182.45, CI = 95%, p = 0.000), SPEOS method was more effective in improving the quality of life of post partum mothers (mean difference = 4.9, CI = 95%, p = 0,000). Conclusion: The SPEOS method affects improving the quality of life of Postpartum mothers. Keywords: SPEOS, quality of life, postpartum, breastfeeding mothers
329 The Use of Application Based on Cellular as an Information Media in Pregnancy , Anisya Selvia, Dwi Ernawati
Background: The maternal mortality rate is still very high. This also happens in other countries in the world. This situation causes anxiety for each country. One of the causes of death in pregnant women is maternal knowledge about health information during pregnancy. The use of cellular-based applications is currently the leading choice in finding information, and the same thing also happens in pregnant women. Pregnant women currently use many cellular-based applications to access information about pregnancy. Aim: To find out how pregnant women use cellular-based applications as a medium of information in pregnancy. Method: Five review stages are used in this review. The five stages include: identifying research questions, identifying relevant studies, choosing studies, mapping data, compiling, summarizing, and reporting the results. Result: A total of 23 publications were included. Thematic analysis is used to identify key concepts. We classify these critical concepts into three themes: Health information in pregnancy based on text messages, the benefits of searching for information using cell phones in pregnancy, and the use of technology as an effort to improve maternal and child health. Keyword: Mobile Health, Antenatal Care, Pregnancy
330 Failure of Lactational Amenorrhea Method (LAM) in Yogyakarta , Reza Bintang Dari Johan, Mufdlilah
Background: The lactational amenorrhea method (LAM) is modern contraceptives that rely on exclusive breastfeeding for six months without additional food or beverage. The mother is in a state of amenorrhea and delays arranging birth to a quality family. Aim: The study aimed to determine the cause of the failure of LAM. Method: Study design with the cross-sectional analytic survey, conducted on mothers who have babies 6-24 months of age as 79 respondents. The sampling technique using purposive sampling, data analysis chi-square, and logistic regression. Result: This study showed parity (OR = 4.861; 95% CI = 0.991 - 23.852), education (OR = 0.525; 95% CI 0.073 - 3.758), work (OR = 2.087; 95% CI = 0.241 - 18.064), knowledge (OR = 20.481; 95% CI = 2.459 – 170.608), additional contraception other than LAM (OR = 2.894; 95% CI = 0.365 – 22.965), menstruation before six months (OR = 10.265; 95% CI = 1.283 – 82.150), breast pump ( OR = 1.843; 95% CI = 0.189 – 17.990) and socio-economic (OR = 9.843; 95% CI = 1.029 – 94.134). Conclusion: In conclusion, all variables influenced LAM's failure, but the most influential was knowledge, menstruation before six months, and social-economic. Keyword: LAM, breastfeeding, failure
331 The Relationship Between Parents and Children In Influencing Adolescents’ Sexual Behavior , Sarwinanti, Inesty Chandra
Background: The survey result ofSDKI (Basic Survey of Indonesian Demography and Health) in 2012 on KRR (Adolescents’ reproductive health) shows that approximately 9.3% or 3.7 million adolescents have had sexual intercourse, while the result of SKRRI (Survey of Adolescents’ Reproductive Health) shows that approximately 7% or 3 million adolescents have had sexual intercourse. One of the environmental factors on adolescents’ reproductive behavior is the family factor. Adolescents who have had premarital sexual intercourse mostly come from broken homes, which has many conflicts and problems. Aim: The study investigates the correlation between parents and children relationship and adolescents’ sexual behavior at Bantul. Method: The study used a cross-sectional approach and analytical correlation. The total sampling technique was used to draw 81 respondents as the samples. The data were analyzed using Chi-square statistical test. Result: The chi-square statistical test result showed that 34 respondents had a good relationship with their parents (42), and 16 respondents had a lack of relationship with their parents. Forty-seven respondents (58%) showed negative sexual behavior. P-value was 0.015 (p<0,05), meaning a correlation between parents’ close relationship and adolescents’ sexual behavior at senior high school in Bantul. Conclusion: There is a correlation between parents and children relationship and adolescents’ sexual behavior at senior highs schools in Bantul. Adolescents and parents should be more open to each other in discussing their problems, especially their reproductive health because it is one of the ways to build a good relationship between parents and adolescents Keywords: relationship, adolescents’ sexual behavior, parents and children
332 Mental Health Literacy in Iranian Adolescents , Arezoo, Behbood, Alireza, Salehi, Hossein, Molavi Vardanjani
Background: Mental health literacy (MHL) is a relatively ignored determinant of community mental health in Iran, in which its level and determinants should be addressed. Aim: To investigate MHL and its components among Iranian adolescents. Methods: A cross-sectional study was conducted. After multistage cluster random sampling, 500 high school students were enrolled. Previously validated Persian version of theMHL Scale (MHLS) was used for data collection. In addition, data on socio-demographic variables were also collected. Adolescents with an MHL score of less than 60% of the achievable score were considered as at-risk of mental health illiteracy. Relevant statistical analyses were used to determine the MHL level and its association with sociodemographic variables. Results: Overall prevalence of being at-risk of mental health illiteracy was estimated at 71.5 % (95% CI: 67.1, 75.6). Prevalence of being at-risk of stigmatization, inadequate self-help knowledge, and information seeking was 91.2 (95% CI: 88.3, 93.7), 60.3 (95% CI: 59.8, 60.8), and 36.6 (95% CI: 36.1, 37.1), respectively. Having religious beliefs was associated with the stigmatization component (adjusted OR= 2.66, 95% CI: 1.27-5.59). Conclusions: Prevalence of being at-risk of mental health illiteracy is high among Iranian adolescents. Mental disorders are highly stigmatized in Iran. Keywords: Mental Health Literacy, Health Literacy, Adolescent, Iran, Mental Disorder
333 University Students and Recreation in the Covid-19 Process: Metaphor Analysis , Aytekin Hamdi Ba?kan, Asiye Hande Ba?kan
Background: Covid-19 pandemic disease, which affects the world, causes serious mortality rates. In addition to medical studies worldwide, various restriction rules have also been developed by countries in order to slow the pace of the pandemic and achieve normal living conditions. In order to reduce the sorrowful consequences of the pandemic process, home quarantines were decided and although social distance rules were applied in outdoor environments, hygiene conditions were tried to be increased at the maximum level and education was suspended for an indefinite period. A total of 39 students participated in this study, which aims to examine the recreation perceptions of sports science students in the Covid-19 process through metaphors. Aim: To analyze the situation of recreation activities in the covid-19 process through literature review, data analysis, and observations. Methods: Qualitative research method was used in this study. In this regard, our study was conducted using a (phenomenological) pattern, which is one of the qualitative research methods. Results: When Table 1 is examined, it is seen that the participants of the study consisted of 9 (23.1%) female students and 30 (76.9%) male students. The majority are around 21 (38.5%) and 22 (35.9) years old, the mean age of the total participant is 21. Only 1 (2.6%) person was infected with the Covid-19 virus, and the rest of 38 (97.4%) people were not infected. 2 (5.1%) of the participants reside in the village, 13 (33.3) in the district, and 24 (61.5) in the province. The situation of doing sports actively, on the other hand, 24 (61.5) people are doing sports actively, 15 (38.5) people are not doing sports actively. Conclusion: When the research results were examined, it was concluded that the participant students were exposed to various negative psychological situations such as their anxiety and stress levels increased, they became intolerant of uncertainty as their recreational activities stopped during the Covid-19 period. Keywords: Covid-19, recreation, metaphor
334 The Relationship of Knowledge Level of Installation and Maintenance with the Successful Use of Soft Contact Lens in Myopia patients , Didik Wahyudi, J Dahjono, Untung Suparman
Background: Refractive errors have occurred in many parts of the world, including in Indonesia, with different types of abnormalities, one of which is myopia which can be corrected with glasses and spherical contact lenses. Aim: To determine the relationship between the level of knowledge of the installation and care of soft contact lenses in myopic patients. Methods: This research method is Cross Sectional at Optik Metro, the number of samples is the total population, the research instrument is a questionnaire, the independent variable of this research is the level of knowledge while the dependent variable is the attitude and behavior of Care and Installation with Successful Use of Contact Lenses. This research has been approved by the Widya Husada STIKES Ethics Commission. Results: The results of the study based on the number of sufferers and the distribution of refractive errors at Optik Metro from March 15-20, 2021, showed that the number of myopia patients who came was 13.0% with the type of treatment using soft contact lenses as much as 2.2%. There is a relationship between knowledge and attitudes of respondents with maintenance and installation behavior with successful use of LK with a significance value of 0.000 (p < 0.05). Conclusion: It was concluded that the toric soft contact lens installation procedure was carried out in the right way by taking into account a good fitting assessment. It is necessary to provide education to increase knowledge and education on Care and Installation of Contact Lenses for all customers. Keywords: Knowledge, Attitude, Soft LK, Myopia
335 Effect of Discharge Plan on Quality of Life among Elderly Women Undergoing Uterine Prolapse Surgery , Amal I. Fouad, Ebtesam Mo’awad El-Sayed Ebied
Background: Uterine prolapse is a highly prevalent disorder affecting as many as 50% of women above 60 years. Aim: To evaluate the effect of discharge plan on quality of life among elderly women undergoing uterine prolapse surgery. Methodology: one group pre-posttest quasi experimental design. Setting: gynecological outpatients' clinics. Sampling: A purposive sample of 105 elderly women undergoing uterine prolapse surgery. Tools: 1. structured questionnaire of personal and medical data. 2. A questionnaire to assess knowledge about uterine prolapse surgery. 3. Who Quality Of Life-bref to assess bio-psychosocial and environmental quality of life domains. Results: Showed statistically significant differences between pre & post- test regarding knowledge as well as quality of life domains scores. Conclusion: implementation of the discharge plan resulted in improvement in many quality of life domains. Conclusion: implementing discharge plans for elderly women undergoing uterine prolapse surgery. Keywords: Quality of life, elderly women, prolapsed uterus
336 Quantitative Evaluation of Diabetic Foot Wound Healing Using Hydrogel Nanosilver Based Dressing Vs. Traditional Dressing: A Prospective Randomized Control Study , Ehsan A. Yahia, Ayman E. El-Sharkawey, Magda M. Bayoumi
Background: The wound dressings perform a crucial role in cutaneous wounds management due to their ability to protect wounds and promote dermal and epidermal tissue regeneration. Aim:To evaluate the effectiveness of using hydrogel/nanosilver-based dressing vs. traditional dressing on diabetic foot wound healing. Methods:Sixty patients with type-2 diabetes hospitalized for diabetic foot wound treatment were recruited from selected Surgical departments. A prospective randomized control study was carried Results: The results showed that the percentage of a reduction rate of the ulcer by the third week of the treatment as in the hydrogel/nanosilver-based dressing group was higher (15.11%) than traditional wound dressing group (33.44%). Moreover, the mean ulcers size "sq mm" in the hydrogel/nanosilver-based dressing group recognized a faster healing rate (15.11±7.89), and considerably lesser in comparison to the traditional in the third week (21.65±8.4). Conclusion: The hydrogel/nanosilver-based dressing showed better results than traditional dressing in managing diabetic ulcer foot. Keywords: Diabetes, Wound Care, Diabetic Foot, Wound dressing, Hydrogel Nanosilver.
337 The Effect of Online Learning Policy toward Indonesian Students’ Mental Health during Covid-19 Pandemic , Megawati Purnama Sari Wijaya, Yoannes Romando Sipayung, Kadek Cahya Susila Wibawa, Wahyu Satria Wijaya
Background: The determination of a health emergency has implications for an online learning policy enactment in Indonesia. After one year of implementing the online learning policy, it has broughtproblems for Indonesian students, especially mental health issued. Aim: This research aimed to further analyze the relationship between the implementation of online learning policies and the mental health of Indonesian students after one year of Covid-19 pandemic. Method: This research used non-doctrinal legal research methods with a qualitative approach. Conclusion: The implementation of online learning policies has an indirect effect on mental health for students aged 7-18 years. Stressful conditions, lack of interaction, potential to become introverted are problems after one year of the implementation of the online learning policy. However, this condition is different from students in higher education who are more ready and comfortable with online learning patterns. Keywords: Policy; online learning; mental health; Covid-19.
338 The Womens’ Attitude and Practice towrads Childbearing , Hassan Robabi, Nazanin Yousefian Miandoab, Seydamalek Dadkhah, Fatemeh Azarkish
Background: Fertility is one of the main components of population growth. Knowing the fertility level of any society is important in assessing the economic and social conditions. Aim: To determine the attitude and practice of Zahedan women towards childbearing. Methods: This descriptive-analytical study was performed on 400 Iranian married women aged 15-38 years in Zahedan. Data were analyzed by SPSS 11.5 software. Descriptive statistics methods and analytical statistics methods were used. Results: The mean and standard deviation of the current number of the research units’ children was 2.54 ± 1.54 children. Regarding the tendency to increase the number of children, 65.8% of women and 66% of their spouses tended to have another child and the average number of their preferred children was 3.49 ± 1.44. Other results showed that the majority of the subjects (72.50%) had a moderate attitude towards childbearing. Conclusion: Considering that more than half of women wanted to have another child and the majority of them had a moderate attitude towards childbearing, this shows a positive attitude toward childbearing. On the other hand, it should be noted that government interventions alone can not be a solution to prevent declining population growth, and in this regard, public acceptance and cooperation can also play an important role. Keywords: Attitude, Performance, Childbearing, Women
339 Comparing the Effect of Hand and Foot Reflexology Massages on the Severity of Nausea, Vomiting and Ileus in patients after Abdominal Surgery , Elham Shahraki Moghadam ?Zahrasadat Manzari ?Hossein Rashki Ghalenow ?Hajar Noori Sanchooli
Background: Common clinical problems after surgery include nausea, vomiting and ileus that many patients complain of after their surgery. These complications can delay the patient's discharge from hospital. Nowadays, to reduce drug side effects, the use of complementary medicine, including reflexology, has received a great deal of attention. Aim: To compare the effect of hand and foot reflexology massages on the severity of nausea, vomiting and ileus in patients after abdominal surgery. Methods: This is a clinical trial study that was conducted between 2013 and 2015 in the emergency surgical departments of Imam Reza (AS) and Ghaem (AS) hospitals in Mashhad. The samples of this study included 90 women with cholecystitis and appendicitis who met the inclusion criteria. In this study, patients were randomly divided into 3 groups of hand reflexology massage, foot reflexology massage and control. To check the digestive status, gastrointestinal sounds were checked every hour using a clinical stethoscope. Also, information on gas and feces elimination was collected and recorded every hour. The intervention was performed 1 and 12 hours after the surgery. In both groups of hands and foot reflexology massages, after general massage of the hands and feet, the areas related to the abdominal distension and removal of the ileus were pressed. It should be noted that, the duration of massage for each person was 10 minutes (20 minutes in total). Data were analyzed by SPSS software version 16 using Chi-square, Fisher’s exact test, two-way ANOVA, Kruskal-Wallis test and repeated measures ANOVA. Results: There was no statistically significant difference in the mean score of severity of nausea before the intervention between the three groups (p = 0.90), but after the intervention a significant difference was observed in the mean score of severity of nausea between the three groups (p=0.002). Also, the result of ANOVA test with repeated measure showed a statistically significant difference in the mean score of nausea by group and stage (p<0.001). There was also no statistically significant difference in the frequency of vomiting severity between the three groups after the intervention. However, at 4 and 24 hours after the intervention, a statistically significant difference was observed between the three groups in that regard. Conclusion: The results showed that both types of hand and foot reflexology massage has positive effects on nausea and return of gastrointestinal movements, so nurses can use reflexology as a non-pharmacological and complementary method to reduce the severity of nausea and return gastrointestinal movements in postoperative patients. Since the reflexology had little or no effect on the severity of vomiting and the acceleration of gastrointestinal movements in patients, further studies in this area are recommended. Keywords: Reflexology, Pain, Nausea and vomiting, Ileus, Surgery
340 Development of learning professionalism assessment battery for medical residents , Seyed Kamran Soltani Arabshahi, Maryam Akbarilakeh, Hoorieh Mohammadi Kenari, Mohamed Elhassan Abdalla
Background: Professionalism is an exit learning outcome of health professions’ curricula. Much work has focused on professionalism teaching and little on the ways assessing it. The main goal was to develop composite assessment instrument as a battery accurately measured several aspects of learning professionalism in medical residents. Methods: The first step in battery development was to decide on the domains to be addressed. Based on the comprehensive review of the literature, a list of domains to assess was developed and identified specific assessment instruments for each domain. Based on the instrument selection criteria, forty one Assessment instruments were selected and developed to comprise the assessment battery. Results: The results are presented in 6 Section tests: duration, cost of each section, administration instruction, and scoring. The time required to complete the entire assessment battery was 100 minutes on average. Conclusions: The resulting battery was developed by selecting a set of validated assessment instruments and combining them into a battery. The assessment battery is easy to administer, easy for residents to complete, and provides a comprehensive assessment of a residents’ learning professionalism for teachers. Keywords: professionalism, learning, assessment, battery, residents
341 An Investigation of the Effect of Retraining Courses on the Knowledge, Attitude and Performance of Health Workers in the Field of Malaria , Roghaye Ershad Sarabi, Rafigh Dehvari Mohammadi, Aziollah Arbabisarjou
Background: Malaria is considered one of the most important parasitic diseases in Iran. With regard to malaria, Sistan and Baluchestan province ranks first among the country's provinces. Aim: To investigate the impact of education on malaria knowledge, attitude and behavior among health workers working in Saravan city health center. Methods: The present study is a semi-experimental study of before and after clinical trial type that was performed on 73 health workers in Saravan city. A researcher-made questionnaire was used to collect the required data. It consisted of two parts: the first part was dedicated to demographic data and the second part was about the knowledge, attitude and performance of health workers regarding malaria. The face and content validity of the questionnaire was confirmed by an expert panel. The reliability of the questionnaire was calculated using Cronbach's alpha coefficient (α=0.85). Before the start of the training, the questionnaires were given to the health workers. The trainings were presented in 49 one-hour sessions by the experts of the headquarters of Saravan Health Center in Behvarzi Center using lectures and pamphlets. One month after the training, the same questionnaires were filled in by health workers. Results: The results showed that the mean scores of health workers in the areas of knowledge, attitude and performance increased significantly after the workshop (p=0.001) so that the participants' knowledge score increased from 26.06 to 56.7. In terms of attitude, their score increased from 7.2 to 17.7, and in terms of performance, participants' score increased from 13 to 32. Conclusions: The findings revealed that the implementation of educational programs in the field of malaria can increase the level of knowledge, attitude and performance of the community regarding the preventive behaviors of malaria. Therefore, health system officials are recommended to work toward the amelioration of the knowledge, attitude and performance of the health workers. Keywords: knowledge, attitude, performance, health workers, malaria, retrainin
342 The effect of ear acupressure medicine at the “Shen Men” point on the nausea and vomiting during pregnancy , Sanaz Nehbandani, Hajar Salehi, Khadijerezaie Keikhaie, Hossein Rashki Ghalenow, Fatemeh Mirzaie, Mahin Badakhsh
Background: Nausea and vomiting during pregnancy is one of the most common gastrointestinal disorders that more than 85% of pregnant women experience. However, controlling and treating this complication is still one of the most important issues in antenatal care. Aim: To investigate the effect of ear acupressure at Shen Men point on relieving nausea, vomiting and retchingduring pregnancy. Methods: In this quasi-experimental study, 100 pregnant women with a gestational age of less than 16 weeks attending the health clinics ofZabol city during 2019-2020 were studied in two control and intervention groups (n = 50 in each group). The samples in the intervention group weretrained to apply pressure ontheirears’Shen Men point with the thumb for three minutes three times a day (morning, noon, and night), for a duration of one month. At the end of second and fourth weeks, the data were collected using the Rhodes index form and then, were analyzed by SPSS software version 22. Results: According to the results, there was no significant difference between the two groups in terms of age, gestational age, occupation and education. The difference in the mean scores of nausea, vomiting and retching was not statistically significant between the control and intervention groups before the study. But four weeks after the study, a significant difference was observed in the mean scores of vomiting, nausea and retching between the two groups, so that the mean scores of vomiting, nausea and retching were significantly lower in the intervention group than in the control group. Conclusion: The ear acupressure medicine at the Shen men point can be used as a non-invasive, safe and inexpensive method to relieve nausea, vomiting and retching during pregnancy. Keywords :Acupressure medicine, Shen Men, Vomiting, Pregnancy, Nausea, Retching, Rhodosis
343 The Prevalence of Violence against Healthcare Workers in Turkey and Employee Job Satisfaction , Salih Dursun, Sevinc Serpil Aytac
Aim: To reveal the different dimensions of workplace violence that healthcare workers are exposed to, and to evaluate the impact of exposure to violence on the job satisfaction of healthcare workers. Methods: The study sample comprises 169 people working in different positions in the hospital (doctor, nurse, secretary, assistant staff, etc.). The Workplace Violence Questionnaire and Job Satisfaction Scale were used to collect the study data. The questionnaire forms were distributed in closed envelopes according to the random sampling method, and were filled out by the volunteer participants themselves. Descriptive statistics and t-test were used to analyze the study data. Results: The results of the study show that more than half of the hospital staff (57.5%) had been exposed to violence in the last year; 54.8% of participants were exposed to verbal violence, 26% were exposed to physical violence, and 5.4% were exposed to sexual harassment. In addition, it was found that the job satisfaction levels of those individuals who were exposed to violence (16.71) were lower than the job satisfaction level of those who were not exposed to violence (18.59) (t = -2.793, p-value = 0.006). Conclusion: The study results show that healthcare workers are at serious risk of violence in the workplace. In addition, it is observed that exposure to violence negatively affects job satisfaction, which is important in regarding workplace attitude. Keywords: Health Workers, Workplace Violence, Job Satisfaction
344 The Perception towards Ketogenic Diet among General Population in Rawalpindi , Ubaidullah, Huma Tahir, Zarak Khan, Muhammad Tahir
Objective: The aim of study is to determine the knowledge and perception towards ketogenic diet among general population, as a weight lowering technique for a shorter period of time. Study Design: Cross sectional study Place and Duration: The study was conducted on general public of Rawalpindi and the duration of study was of six months i.e from 15thJan 2020 to 14thJuly 2020. Methods: Data was collected through questionnaires and each question measured with the help of five Likert Scale (Strongly disagree, Disagree, Neutral, Agree, strongly agree). More than 10 questions were asked from the general public in Rawalpindi of all age groups and analyzed through Microsoft Excel. The questionnaire was distributed via internet-based google form. The respondents actively and willingly participated in the survey. Keeping in mind the current pandemic situation, it was difficult to reach out the people in person, so we used simple convenient sampling technique. Some of the data was collected by using snowball sampling technique.The respondents from Rawalpindi region were included in the study whereas all from other cities were excluded. Results: There were68 (81%) females and 16 (19%) males in this study. Most of the patients 36 (42.9%) were from <25 years of age, 29 (34.5%) patients were between age group 26-35, 18 (21.4%) were between 36-45 years of age and the rest were >46 years of age. Findings show that ketogenic diet is the most popular weight losing technique these days. While 47% of the people believe that the diet shall be followed under the supervision of a physician keeping in mind the risks associated with it. Conclusion: Ketogenic diet is a popular weight loss diet these days. The general population somehow have the knowledge about the pros and cons of the diet. But still there is a dire need of health promotion and education regarding intake of ketogenic diet. The results are insignificant due to limited time and pandemic situation, so we are unable to gather significant amount of sample to know the actual reason behind younger population’s inclination towards ketogenic diet. Key Words: Keto-diet, Ketogenic, Perception and Knowledge
345 Moderating Effect of Physical Activity in Prevention of Colorectal and Breast Cancer by Mediterranean Diet in Females of Pakistan , Ubaidullah, Huma Tahir, Liaqat Ali, Muhammad Tahir, Zarak Khan
Objective: The aim and purpose of the study are to determine how cancer can be prevented by maintaining a good dietary plan and physical activity. To discuss the relationship between diet and cancer prevention, guidelines, and evidence-based strategies to reduce the cancer risk (Jennifer, Karen and Wendy 2016). Cancer prevention food plan should consist of all the right amounts of macronutrients and micronutrients. Dietary guidelines can be adapted to promote health and preventing diet-related chronic diseases—a population that hasa good dietary plan, less prone to the risk of cancer. Study Design:. A cross-sectional study Place and Duration:This study was conducted at Holy Family Hospital and Wapda Hospital of Rawalpindi for duration of six months i.e from June 2020 to December 2020. Methods: Research was conducted on a sample of 58 females. Patients were aged between 18-75 years. Patients’ detailed demographics age,residency and body mass index were recorded after taking informed written consent. Previous history of breast and colorectal cancer were recorded among patients. Consumption and awareness of mediterranean diet among females were assessed. Effectiveness and recommendation of this diet were also observed. Complete data was analyzed by SPSS 24.0 version. Results:Most of the patients 35 (60.34%) were aged between 18-24 years, 12 (20.7%) were between 25-34 years of age and the rest were 11 (18.97%) >35 years of age. Mean age of the patients were 28.74±10.54 years with mean BMI 24.08±9.45 kg/m2. 41(70.7%) was not aware from mediterranean diet and regular take of this diet was found in 15 (25.9%) cases. Physical activities were found among 47 (63.%) cases. Previous history of colorectal cancer was found in 4 (6.9%) cases and breast cancer was found in 26 (44.8%) cases. 42 (72.41%) patients were agree to recommend this diet after read this useful benefits. Conclusion:We concludedin this study that the use of mediterranean diet in daily routine was useful and effective in prevention of breast and colorectal cancer. It can also be prevented by physical activities in daily work. Keywords: Colorectal cancer, breast cancer, physical activity, Mediterranean diet
346 Determine the Frequency of Portal Vein Thrombosis in Patients with Liver Cirrhosis , Talal Safdar, Muhammad Nazir, Shahid Iqbal, Muhammad Ikram, Nisar Khan Sajid, Muazzam Fuaad
Objective: The aim of this study is to determine the frequency of portal vein thrombosis in patients with liver cirrhosis. Study Design: Retrospective/Case-control Place and Duration: Medicine and Gastroenterology department of Peshawar Institute of Medical Sciences, Peshawar and DHQ Teaching Hospital, Charsadda for six months duration from August 2020 to January 2021. Methods: Total 100 patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking written consent, Patients were aged between 20-75 years. Patients who had liver cirrhosis were included in this study. Complete patients were undergone for Doppler ultrasonography for observation of portal vein thrombosis. Complete data was analyzed by SPSS 24.0 version. Results: Out of 100 patients, 60 (60%) were males and 40 (40%) patients were females. Mean age of the patients were 47.08±7.42 years with mean BMI 28.22±9.61kg/m2. We found that 60 (60%) patients had hepatitis C, 29 (29%) patients had hepatitis B, 7 (7%) had chronic liver disease, 3 (3%) patients had autoimmune hepatitis and 1 (1%) patient had other disease (Wilson’s). Among hundred patients frequency of portal vein thrombosis (PVT) was 15 (15%) and majority of them were males 12 (80%). Conclusion: We concluded that the frequency of portal vein thrombosis was high among patients of liver cirrhosis and mostly patients of hepatitis C were affected. Keywords: Liver cirrhosis, Portal vein, Thrombosis
347 Determine the Prevalence of cagA and Baba of Helicobacter Pylori Isolated from Gastric Atrophic Patients , Muhammad Nazir, Talal Safdar, Mushtaq Ahmad, Muhammad Ikram, Nisar Khan Sajid, Muazzam Fuaad  
Objective: The aim of this study is to determine the prevalence of cagA and babA of helicobacter pylori isolated from gastric atrophic patients. Study Design: Descriptive/Analytical Place and Duration: The study was conducted at Medicine/Gastroenterology department of Khyber Teaching Hospital and Peshawar Institute of Medical Sciences, Peshawar for six months duration from March 2020 to August 2020. Methods: Total one hundred and twenty patients of both genders were presented in this study. Patients were aged between 20-80 years of age. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. All patients of gastroduodenal disorders were undergone for isolation of bacteria by using standard techniques. Complete data was analyzed by SPSS 22.0 version. Results: Total 50 (41.7%) patients were males and 70 (58.3%) patients were females. Mean age of the patients were 41.96 ± 16 years with mean BMI 25.24 ± 4.8 kg/m2. Frequency of H pylori was isolated in 30 (25%) patients in which 13 patients had atrophic gastritis, 9 patients had gastric ulcer and 8 patients had acute gastritis. Prevalence of cagA gene was 16 (53.33%) and babA was 10 (33.33%) in H. pylori isolated patients. Significantly difference with p value <0.05 was observed between cagA positive strains and patients of gastric atrophic. The involvement of gastric atrophic patients was not correlated to the babA gene. Conclusion: We concluded in this study that different cagA positive H. pylori can be retrieved from gastric atrophy patients. Keywords: Gastric atrophy, Gastric cancer, cagA, babA, Helicobacter pylori
348 Frequency of Early Post-Operative Complications following Modified Radical Mastectomy (MRM) in patients with Breast Carcinoma , Sadia Shah, Rahmat Ullah Shah, Adnan Badar, Monawar Shah, Shabir Ahmad, Haroon Muhammad
Objective: Breast carcinoma is the commonest cancer affecting female gender and is the second major cause of mortality in females globally. Among different surgical options, modified radical mastectomy (MRM) with or without neoadjuvant therapy is the most frequent surgery carried out globally for breast carcinoma. In this study we aimed to determine the frequency of early post-operative complications following modified radical mastectomy (MRM) in patients with breast carcinoma. Material and methods: This dual setting retrospective descriptive study was conducted at General surgery departments of Kuwait Teaching Hospital and MTI-Lady Reading Hospital Peshawar between January, 2018 and June, 2019. A total of 60 patients aged >18 years with biopsy proven stage-I to stage-III breast carcinoma who underwent modified radical mastectomy were included.All patients were followed on weekly basis for six weeks at the out-patient department (OPD) and evaluated for the development of early complications such as seroma/hematoma, flap necrosis and wound infections. Results: Seroma formation found in 9 patients (15%) and wound infection seen in 5 patients (8.3%) were the commonest complications. Conclusion: In our study seroma formation was the most common complication followed by wound infection. Skin flap necrosis, wound dehiscence, hematoma formation and development of early lymphoedema were less common. None of our patients presented with muscle paralysis secondary to nerves injury. Keywords: Breast carcinoma, modified radical mastectomy, complications, seroma, wound infection.
349 Comparison of the Outcomes of Laparoscopic Approach with Open Method for Primary Ventral Hernia Repair , Rahmat Ullah Shah, Sadia Shah, Gul Sharif, Adnan Badar, Sheikh Muhammad Ibqar Azeem, Aftab Hussain
Aim: To compare the outcomes of laparoscopic approach with open method in patients undergoing primary ventral hernia repair. Study Design: Randomized control trial Place and Duration: This study was conducted at Kuwait Teaching Hospital and Lady Reading Hospital Peshawar during the period of January 2017 to December 2019. Methods: One hundred and ninety patients of both genders with ages ≥18 years were included. All the patients were divided in to two groups, i.e’ Group A consists of 95 patients received open procedure and Group B with 95 patients received laparoscopic approach for primary ventral hernia repair. Outcomes in term of complications, hospital stay and recurrence rate were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. Results: There were 65 (68.4%) females and 30 (31.6%) males in Group A and in Group B 35 (36.8%) males and 60 (63.2%) females. Mean age of patients in Group A was 40.14±3.31 years and in Group B it was 42.94±8.55 years. In Group B hospital stay was shorter than Group A (3.11±1.20 days Vs 5.9±3.9 days). According to the wound infection we found significant difference between Group A and Group B (12.6% and 4.2%);[p-value <0.05]. In Group A 5.3% patients had developed wound dehiscence while in Group B none of patient found to have wound dehiscence (p-value <0.05). Recurrence rate was also high in Group A 7.4% vs 2.1% in Group B (p=<0.05). Conclusion: It is concluded that laparoscopic repair of primary ventral hernia is safe and effective with lesser complications as compared to open method. Keywords: Ventral Hernia, Laparoscopic, Open Procedure, Wound Infection, Wound Dehiscence, Recurrence.
350 Epidemiological Study of Henoch-Schonlein Purpura and its Characteristics in Infected Children During 2009-2016 , Sadegh Dehghanmehr, Reza Naghdi, Farahnaz Irandegani, Hamed Taheri, Omar Pourbalouch, Ferdows Bamari
Introduction: Due to the different complications caused by Henoch-Schonlein purpura and in order to prevent additional treatment costs for patients, we decided to investigate the clinical features of cases of Henoch-Schonlein purpura. Materials and Methods: In this descriptive cross-sectional study, 52 children in whom the diagnosis of Henoch-Schonlein purpura was confirmed were enrolled in the study from 2009 to 2016. The instruments of this research include a researcher-made questionnaire with two parts. The first part is related to demographic characteristics including age, sex and season of referral and the second part was related to morbidity such as various symptoms. Data were collected from patients’ records and interviews with families and were analyzed using SPSS V.22. Results: Out of 52 patients, 30 (57.7%) were boys and 22 (43.3%) were girls. The mean age of patients was 3.02 to 6.58 years. Autumn and winter had the most clients of Henoch-Schonlein purpura. One of the most common manifestations seen in most patients was cutaneous manifestations. There was no significant relationship between gender and clinical manifestations and seasons of the year with these manifestations (p> 0.05). The results showed that age was significantly associated with renal manifestations (P <0.05). Conclusion: The results of this study showed that the prevalence of Henoch-Schonlein purpura disease is higher in boys. Cutaneous manifestations were seen in most patients and in patients with renal manifestations, the mean age was higher and significant. Keywords: Henoch-Schonlein purpura, clinical manifestations, complications, gender, age
351 Relationship of Spiritual well-being and emotional intelligence among Iranian' nursing students , Javad Jafari, Asra Nassehi, Mohammadali Zaare, Seydamalek Dadkhah, Najmeh Saberi, Mojtaba Jafari
Background: Among all aspects of nursing care, the spiritual one is the issue that has received little attention. Having spiritual wellbeing (SWB) is a necessity to provide appropriate spiritual care. In addition to, the Emotional intelligence (EI) is one of the most important factors in social and professional success and is essential for effective nursing practice. Therefore, aim of study was evaluating the Relationship between SWB and EI among nursing students. Methods: The sample of this descriptive-analytic study consisted of 136 nursing students studying at Bam University of Medical Sciences selected by convenience sampling method. The Bradberry and Greaves 28-item EI scale, Palutzian and Ellison SWB Scale were used to assess the total score of EI and SWB. Collected data were analyzed using descriptive statistics (mean and standard deviation), Pearson correlation coefficient, independent t-test and one-way ANOVA with SPSS v18. Results: The mean score of SWB and EI were 97.1±11.56 and 123.4 + 123.6, respectively. The mean score dimensions of SWB include (religious wellbeing 47.9±6.6, existential wellbeing 49.1±5.7) and dimensions EI: self-awareness, self-management, social awareness, and relationship management were 27.2 3 3.2, 36.2 2 5.4, 25.1 + 3.5 and 35.1 + 4.5, respectively. The majority of students have reported moderate level SWB and high level of emotional intelligence. The factors influencing their level of SWB were academic semester and age (p<0.05). Conclusion: Although the level of students' EI and SWB were at a desirable level in this study, due to the nature of nursing and the interaction between nurses and patients, providing a suitable learning environment for the development of EI is essential. Therefore, it is suggested that nursing policymakers should develop appropriate educational programs for nurses and provide curriculum for students to promote their knowledge and skills. Keywords: spiritual, religious, wellbeing, existential, nursing, emotional intelligence
352 The relationship between intelligence (logic-mathematics) and media literacy , Hanieh Shaygan Yekta, Marzieh Ramezani, Abdolhassan Farhang
Background: Intelligence is one of the categories that has long been considered by human beings and is one of the most important factors that lead to individual differences. One of the differences between individuals that leads to the emergence of unique characteristics in them. The research was to find relationship between intelligence (logic-mathematics) and media literacy among high school females. Materials and Methods: In terms of objective, this research is an applied one and, in terms of method, it is a correlation research. So 357 female students at seventh grade at high schools in Tehran's district 4 education organization were selected by Morgan table among 4959 by cluster randomly sampling method. The research tools involved Gardner's Multiple Intelligences with a reliability value of 0.92, media literacy questionnaire (Hasankhani, 2018) with a reliability value of 0.86. Results: The relationship between intelligence (logic-mathematics) and media literacy was analyzed using Pearson correlation coefficient by SPSS21. It was revealed that the positive and significant relationship between intelligence (logic-mathematics) and media literacy among high school females. Conclusion: Possessing media literacy and mastering various softwares, especially in the field of methodology and statistics, will play an important role in shaping the structure of knowledge in individuals. Keywords: logic-mathematics Intelligences, Media literacy
353 The Relationship between the Aesthetic Dimension of Media Literacy and Academic Performance , Maryam Dezfooli, Marzieh Ramezani, Fatemeh Ahmad Beigi
With the advent of the technological revolution in the 1980s, the world entered a new phase in which the media, while evolving and diversifying, has become a key component of human societies, so that in order to be able to have an audience against the various media available, they can In addition to consciously and actively using these media, they must protect themselves against the challenges and their destructive consequences.1 The history of media literacy dates back to 1965. Marshall McLuhan first used the term in his book "Understanding the Media, Expanding the Dimensions of Human Existence" and wrote: When the global village is realized, human beings need literacy. Achieve a new one called media literacy.2 Media literacy is a set of perspectives on dealing with the media and interpreting the concepts we receive from the messages we receive.3 Media literacy seeks to enhance consumer perception so that the audience recognizes what they should use or what information or data they should not be exposed to, and the user should consider the needs of their time and the content of the information. And adjust the fit to your needs.3
354 Examination of Mental Training and Mental Toughness in Elite Boxers , Volkan Sural, Hasan Güler, Bekir Çar
Background: Mental training and toughness play an important role as well as physical training and toughness in increasing the performance of an athlete. Aim: This study aimed to i) evaluate the mental training and mental toughness levels of elite boxers in terms of various variables, ii) examine the relationship between mental training and mental toughness levels, and iii) investigate the predictive level of mental toughness levels of mental training levels. Methods: The sample of the study consisted of 191 elite boxers. The data of the study were collected with the online questionnaire method using the Mental Training Inventory in Sports and the Mental Toughness Inventory in Sports. SPSS package program was preferred for data analysis and independent samples t-test was used for pairwise comparisons and one-way analysis of variance was used for multiple comparisons. Pearson Product Moments Correlation Coefficient (r) was used to test the relationship between mental training and mental toughness in elite boxers, and linear regression analysis was used to determine the ratio of mental training to predict mental toughness level. Results: While the digital game playing level of secondary school students was low, their level of loneliness was found to be moderate, and it was determined that there was a significant and negative difference between digital game addiction and loneliness. A statistically significant difference was found between the levels of Digital Game Addiction (DGA7) and the variable of gender, presence of digital devices, and daily digital game playing status. However, it was concluded that there was a statistically significant difference between the perceived loneliness levels of the participants and their gender, age, income status, and availability of digital devices. Conclusion: As a result, while the mental training levels of elite boxers differed significantly according to age and being national athlete status, there was no difference according to gender. Mental toughness levels differed significantly according to age categories, but there was no difference according to gender and being national athletic status. There was a positive and significant relationship between the mental training levels of elite boxers and their mental toughness levels. Moreover, it was concluded that the mental training levels of elite boxers were a significant predictor of their mental toughness levels (34%). This result showed that the athletes who want to increase their mental toughness levels should do mental training. Keywords: Mental Training, Mental Toughness, Elite Boxers.
355 The impact of imagery on the performance and cognitive ability in the elderly , Amir Dana, Mir Hamid Salehian, Tayebeh Bani Asadi, Parinaz Ghanati
Background: In the future, aging becomes one of the problems of society and the problems of the country's health care system and brings many costs in the health care sector. Purpose: This study examines the effect of imagery on performance and cognitive ability in the elderly. The research method is quasi-experimental with a pretest-posttest design. 40 older adults were selected and divided into experimental and control groups. The subjects in the experimental group performed imagery for four weeks following the pretest. Methods: Data were analyzed using the analysis of covariance. Results: Findings showed that imagery improves the performance and cognitive ability in the elderly. Conclusion: In general, imagery may improve performance and cognitive abilities in the elderly. Keywords: Imagery, Performance, Cognitive Ability, Aging
356 Fear of Covid-19: Associations with Trait Anxiety and Life Satisfaction , Utku Isik, Neslisah Aktas Ustun, Pelin Tastan, Umit Dogan Ustun
Aim: Present study aimed to analyze perceived fear of COVID-19 among Turkish people and investigate its associations with trait anxiety and life satisfaction. Methods: The online snowball research sampling method was used to collect data, and 1129 subjects participated in the study. As data collection tools, the Fear of COVID-19 scale, Trait Anxiety Scale, and Satisfaction with Life Scale were used. In the adaptation and validation process of the Fear of COVID-19 Scale, confirmatory factor analysis was applied. Convergent validity of the model resulting from CFA was evaluated with Average Variance Extracted (AVE) and Composite Reliability (CR) based on the factor load values. The reliability of the scale was assessed with Cronbach's alpha method. Independent samples t-test and Two-Way ANOVA analysis were used to compare the differences in the perception of fear of COVID-19, trait anxiety and life satisfaction. Multiple regression was applied to predict anxiety based on fear of COVID-19 and life satisfaction. Results: Analyze results confirmed the unidimensionality of the 7-item scale on a Turkish sample, and the results indicated satisfactory reliability coefficients. According to independent t-test and Two Way Anova results, females, non-athletes, participants with the worry of gaining weight, who did not care about their nutrition, and who followed media news more often scored higher fear of COVID-19 and anxiety. Multiple regression analysis identified a negative correlation between fear of COVID-19 and life satisfaction and a positive correlation with anxiety. Conclusion: Although the present study revealed the associations of the fear of Covid-19 with life satisfaction and anxiety, further research is still recommended to explore these associations in more depth. Keywords: COVID-19; Fear; Anxiety; Satisfaction with Life; Athlete; Exercise; Adaptation
357 The Relationship between Motor Self-Motivation and Symptoms of Attention-Deficit Hyperactivity in Adhd Children , Amir Dana, Mir Hamid Salehian, Tayebeh Bani Asadi, Parinaz Ghanati
Background: The growth and development of the child are essential and inevitable, and the growth of every child requires motor development. Purpose: This study examines the relationship between motor self-motivation and attention-deficit hyperactivity disorder's symptoms in children with attention-deficit hyperactivity disorder. 40 people were selected by the convenience sampling method from the psychology centers of the province. The research method was descriptive-correlational. A questionnaire was used to collect data. Data were analyzed using Pearson correlation and linear regression. Results: The results showed that there is a significant negative relationship between motor self-motivation and symptoms of attention-deficit hyperactivity disorder. The results of regression analysis also showed that motor self-motivation is able to predict the symptoms of attention-deficit hyperactivity disorder in children. Conclusion: In general, the more children's motor motivation, the more minor attention-deficit hyperactivity disorder's symptoms. Keywords: Hyperactivity, motor self-motivation, motor development, preschool
358 Comparison of Internet Addiction Level of Sports Science Faculty Students in Accordance with Some Variables , Mustafa Deniz Dindar, Mustafa Can Koç
Background: Internet addiction, which has become a global social issue, can be broadly conceptualized as an inability to control one’s use of the Inter-net which leads to negative consequences in daily life. Aim: The purpose of this study was to compare internet addiction levels of sports science faculty students in Çanakkale 18 Mart University according to some variables. Methods: 205 voluntary students that are currently receiving education who were between 19-25 age participated in this research. Internet Addiction Scale developed by ?ahin and Korkmaz was used as a data collection tool. SPSS package was used in data analysis. For determining whether the data had a normal distribution or not, ‘’Kolmogorov-Smirnov’ test were used and ‘’Anova-Homogenety of variance’’ test were used for the homogeneity of data and as a result of these tests the data were determined to have a normal distribution and a homogeneity. Descriptive statistics, Independent Sample t-test and One-Way variance analysis were conducted in data analysis. Results: As a result of statistics, in scale size comparison according to gender variable, significant differences were determined in negativity in social relationship dimension and there were no significant differences in control loss and desire for staying online more. According to departments of students, there were no statistically significant differences determined in desire for staying online more and negativity in social relationships. Conclusion: In conclusion, there were similarities and differences determined between internet addiction levels of students according to departments which they received education and gender variable of students in Sports Science Faculty. These differences may be due to intentions of internet use, increasing need for internet use, and varying education styles that students receive from different departments. Keywords: Internet Addiction, University, Sports Science, Student, Athlete.
359 Stressors in Electronic Exams in Covid-19 Pandemic , Leila Safabakhsh, Azizollah Arbabisarjou
Since emerging Covid-19 on March 11,2010, universities have suspended or canceled their activities in their campus for example classroom learning, workshops, congress and examinations. Policy Makers in Higher Education and Faculty members transitioned their learning , assessment and evaluations to electronic learning and exams. Stress due to Covid 19 spreading and Stress due to exams have challenged higher education. Students my experience double stress through this situation. Background: The pandemic of coronavirus is named COVID-19, has challenged the world during the past several months. Coronavirus is transmitted through direct contact with the patient (coughing, sneezing, respiratory droplets,). Respiratory droplets spread through close contact from a person to others (hugging, kissing, and patient care) can transmit coronavirus The COVID-19 has affected all aspects of human life, specially education and learning ( 1).
360 A Comparision of QT Interval Prolongation in Covid 19 Patients Treated with Hydroxycholoquin Alone and in Combination with Azithromycin , Gauhar Rahman, Mohammad Yaqoob Khan, Zahabia Manzoor, Imrana Nawaz, Gul Mehnaz, Kashif Ali Samin
Objective: The aim of this study is to compare the incidence of increase QT interval among COVID 19 patients treated with hydroxychloroquin alone and combination with azithromycin. Study Design: Retrospective Cohort Study Place and Duration: It is a multicenter study and conducted in cardiology departments of Farooq Hospital, Lahore, Govt Zakir Khan Shaheed Hospital Matta Swat and Category A Hospital, Batkhela Malakand for duration from March 2020 to February 2021. Methods: Total 100 Covid-19 patients of both genders were enrolled in this study. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients were divided into two groups. Group I had 50 patients and received hydroxychloroquin and group II (50 patients) received hydroxychloroquin with azithromycin. Outcomes among both groups were assessed in terms of increase QT interval. Complete data was analyzed by SPSS 24.0 version. Results: There were 32 (64%) males and 18 (36%) females in group I while in group II 30 (60%) males and 20 (40%) females. Mean age in group I was 57.65±9.87 years with mean BMI 28.18±4.23 kg/m2 and in group II mean age was 61.09±6.26 years with mean BMI 29.18±6.53 kg/m2. Hypertension was the most common co-morbidity found in 60%and 56% in group I and II followed by diabetes 26% and 28% among both groups. Prolong QTc was found among 10 (20%) cases in group I and in Group II 15 (30%) patients. Significantly QTc was increase in group II from 443.18±26.23 to 475.13±29.36 while in group I QTc increases from 442.37±33.25 to 468.09±26.37 ms. Among 15 cases in combination group 9 patients had change QTc of >500 milliseconds and 2 cases had QTc of > delta 60 ms while in monotherapy group 4 cases had change QTc of 500 milliseconds and 1 had > delta 60 milliseconds. Conclusion: We concluded in this study that prolonged QTc and change of QTc was significantly higher in COVID 19 patients who received treatment with combination of hydroxychloroquin and azithromycin as compared to the patients who received hydroxychloroquin only.   Keywords: COVID 19, QTc interval, Hydroxychloroquin, Azithromycin  
361 Diagnostic Accuracy of HRCT Chest in Detection of Covid-19 Infection Taking PCR as Gold Standard , Afaque Ali, Majid Shaikh, Ahsanullah, Adeel Ahmed, Abid Ali Sahito, Sharni Kumari
Objective: To determine the diagnostic accuracy of High-resolution computed tomography (HRCT) chest in detection of covid-19 infection taking PCR as gold standard. Study Design: Cross-sectional study Setting: Radiology department of Tabba Hospital, Karachi. Duration: From March 2019 to September 2020 Material and Methods: All the clinically suspected patients of covid-19, of any age, both genders and those referred to radiology for High-resolution computed tomography (HRCT) chest to detect the covid-19 infection were included. After two days, patients’ PCR reports were collected from the ward, after taking informed consent and permission from head of department. The diagnostic accuracy of HRCT was established with respect to sensitivity, PPV, NPV, and specificity by taking PCR as gold standard. All the information was collected via study proforma. Results: Total 70 patients suspected for COVID-19 were studied, and the patients’ mean age was 58.23±9.52 years. Males were in majority 54(77.1%). As per HRCT findings, COVID-19 infection was positive in 46 patients, however, 48 patients were detected positive for COVID-19 infection as per PCR findings. In the detection of COVID-19 infection, HRCT chest showed sensitivity of 91%, specificity of 90%, PPV of 83%, NPV of 84% and diagnostic accuracy of 94%; by taking PCR as gold standard. Conclusion: High-resolution computed tomography (HRCT) is a reliable diagnostic approach in promptly detecting the COVID-19; with 91% sensitivity, 90% specificity, 83% positive predictive value, 84% negative predictive value and 94% diagnostic accuracy. Keywords: Accuracy, HRCT, COVID-19
362 Uterine Leiomyoma and Pregnancy Outcome: An Experience at Tertiary Care Setup , Farha Naz Chohan, Shaista Memon, Sabreena Abbas, Syeda Hira Ali Shah, Aliya Shamim, Afroz
Objective: To determine the impact of leiomyoma in pregnant women a tertiary care set up in Hyderabad. Methods: This prospective observational study conducted at OPD of Gynecology unit-III, Liaquat University of Medical and Health Science Hyderabad, from June 2018 to December 2018. A total of 18,402 pregnant women of age 20-45 years were attended, out of which 195 had leiomyoma and they were asked to take part in study. Data regarding demographic characteristics including complications during pregnancy, and indications of caesarean section was collected via study proforma. Results: Total 186 out of 195 females were studied, their mean age was 31.23+3.12 years, average gestational age was 33.12+3.15 weeks and average size of Leiomyoma was 3.12+2.15cm. The most common complications were PPH among 28.49% of cases, blood transfusion was required in 39.25% of the cases, miscarriage occurred in 6.45% of the cases, cord prolapse was seen in 24.3% cases, placental abruption in 5.91% cases, placenta previa in 11.32% cases and retained placenta was observed among 1.61% of the cases. Preterm labour occurred in 5.38% of the cases and IUGR was seen in 10.22% of the cases. Out of all cases, 10 females underwent preterm delivery, while 12 underwent fetus delivery before 24 weeks (miscarriage). Among all term pregnancies, 78.66% underwent C-Section due to failure in progress, cord prolapsed, fibroid in lower segment, breech presentation and low-lying placenta. Conclusion: Fibroid complicates pregnancy itself and also the outcome. Rural area dwelling women are at more risk, which include increase in caesarean section and a multifold increased risk of PPH and associated hysterectomy in these cases. Keywords: Leiomyoma, Uterine Fibroids, Pregnancy, complications.
363 Frequency of Neonatal Hypoglycemia Among Women Diagnosed with Maternal Hyperglycemia , Humaira Ashraf, Mehreen Yousaf Rana, Afra Rehman, Anila Mahmood
Objective: To determine frequency of neonatal hypoglycemia, in maternal hyperglycemia Subject and Method: This cross-sectional study was conducted at department of Pathology with collaboration of gynae and OBS department of PNS SHIFA Karachi. Study duration was six months from March 2015 to August 2015. All pregnant women who reported at antenatal clinics of PNS SHIFA Hospital and diagnosed as the cases of hyperglycinemia were included in the study. Maternal blood glucose testing was done according to WHO guidelines i.e. fasting sample, ingestion of 75 g glucose, 01 h and 02 h sample for plasma glucose estimation. Neonatal blood glucose was checked immediately after birth by glucometer. All the data was collected via study proforma. Results: A total of 157 pregnant women were studied their average age was 28.20±4.67 years. Caesarean section was done in 62.4% cases and 58.6% babies were males. Neonatal hypoglycemia was observed among 24.8% of the cases. Neonatal hypoglycemia was statistically significant according to gestational age (p- 0.012), while statistically insignificant according to parity (p-0.184). Conclusion: As per study conclusion, the neonatal hypoglycemia was observed to be highly prevalent among neonates of diabetic mothers as 24.8%. It was found to be statistically significant according to gestational age. Keywords: Gestational diabetes mellitus, Neonates, Hypoglycemia
364 Localized Prostate Cancer, Retropubic Radical Prostatectomy: Surgical Complications, Single Centre Study. , Muhammad Ali Sohail, Gulshan Ali Memon, Shahida Baloch, Mumtaz Ali Chandio, Zameer Hussain Laghari
Background: For organ-confined disease in carcinoma of prostate the primary curative procedure that is well identified is the retro pubic radical prostatectomy. Objective: To assess the complications related to surgery of prostate after open retro pubic radical prostatectomy. Materials and Methods: Retropubic radical prostatectomy was performed in 75 subjects suffering from localized cancer of prostate in last 05 years, at the urology department. Open retropubic radical prostatectomy procedure represented by Walsh as a classic method was adapted. Disease progression and caliber of life indices like potency and urinary continence were noted during the follow up. Result: There were total 75 patients in current study. Mean age of patients was 63.3 years. Out of 75 patients, 70 were married and 05 patients were unmarried, 25 were from urban areas, while 50 were from rural area, 35 were educated and 45 were uneducated, 05 patients had positive family history for prostatic malignancy, while 70 patients had no family history of prostatic carcinoma. Out of 75 patients, 63, 65 and 69 patients were continent, at 10, 06 and 12 months; however, 05, 04 and 04 had stress incontinence at 10, 06 and 12 months; and 07, 03 and 01 had mixed incontinence urge and stress at 06 and 12 months; 05, 03 and 01 had total incontinence at 06 and 12 months. Subjects with incontinence are trained exercises concerned with pelvic floor. Conclusion: The retro-pubic thorough prostatectomy is the typical management of early cancer of prostate and a number of complications are associated with this technique of surgery. It had a vertical knowledge curl. Large figure of patients and improvement in techniques are needed to attain the perfect outcomes. Keywords: Carcinoma, prostate, radical, prostatectomy.
365 Frequency of Helicobacter Pylori Infection in the Local Population Presenting with Dyspeptic Symptom , Muhammad Zarrar, Shahzad Memon, Kashif Ali, Arsalan Badar, Yar Muhammad, Rozina Mujeeb Sahito
Objectives: To determine the frequency of Helicobacter pylori infection in the local population presenting with dyspeptic symptom report to a tertiary care hospital of Nawabshah. Methodology: This cross-sectional study took place at department of medicine, Peoples Medical College and Hospital Nawabshah; during six months, form August 2015 to February 2016. A total of 115 patients with dyspeptic symptoms with upper abdominal disorders such as discomfort and pain, nausea, fullness, bloating, heartburn, anorexia, belching and regurgitation were included. After conducting detailed clinical examination and history, patients were subjected to relevant examinations, i.e. Blood antibody test (IgA antibody test), for H. pylori and venous blood was drawn. All the information was collected in the proforma. Results: The patients’ average age was 30.92±6.10 years. There were 66(57.4%) male cases and 49(42.6%) female cases. Helicobacter pylori (H. pylori) infection was observed to be frequent (60% cases) among both genders. Conclusion: In conclusion, the present results confirm that the frequency of patients suffering from helicobacter pylori infection was quite high in local population at tertiary care hospital, Nawabshah. Strategies could be developed at an earlier stage and prompt treatment may reduce the morbidity. Key Words: Dyspepsia, Helicobacter pylori, IgA antibody test
366 The Effect of an Educational Program on Fatigue Level Among Multiple Sclerosis Patients , Dalia Ibrahem Mustafa Abdel-Azem, Nawal Abdel Monem Fouad, Afaf Ibrahim
Background: Multiple sclerosis is a chronic disease that affect all aspects of the patients’ life causing multiple progressive symptoms; most common fatigue which leads to dependency of patients on their family for carrying out their daily routine activities. Aim: The present study aims at evaluating the effect of an educational program on fatigue level among multiple sclerosis patients. Design: A quasi-experimental one-group pretest-posttest was used. Setting: the study was conducted in multiple sclerosis outpatient clinic in El-Kasr El-Eini University Hospital. Sample: A convenient sample of (250) multiple sclerosis patients. Tools: Two tools were used: first tool was Structured MS patient dietary knowledge questionnaire, second tool was The Arabic Version of Modified Fatigue Impact Scale. Results: Showed a highly statistical negative correlation between dietary knowledge and cognitive, psychosocial fatigue among MS patients in pre, post and 3 months after implementation of the program. Conclusions: The results of this study indicated that MS patients' dietary knowledge improved after application of the educational program as well as there was a decline in MS patients' fatigue level with statically significance differences between pre, post and 3 months after application of the program. Recommendation: Dissemination of dietary knowledge program among other multiple sclerosis patients. Keywords: Multiple sclerosis patients, dietary knowledge, fatigue.
367 The Effect of an Educational Program on Fatigue Level Among Multiple Sclerosis Patients , Dalia Ibrahem Mustafa Abdel-Azem, Nawal Abdel Monem Fouad, Afaf Ibrahim
Background: Multiple sclerosis is a chronic disease that affect all aspects of the patients’ life causing multiple progressive symptoms; most common fatigue which leads to dependency of patients on their family for carrying out their daily routine activities. Aim: The present study aims at evaluating the effect of an educational program on fatigue level among multiple sclerosis patients. Design: A quasi-experimental one-group pretest-posttest was used. Setting: the study was conducted in multiple sclerosis outpatient clinic in El-Kasr El-Eini University Hospital. Sample: A convenient sample of (250) multiple sclerosis patients. Tools: Two tools were used: first tool was Structured MS patient dietary knowledge questionnaire, second tool was The Arabic Version of Modified Fatigue Impact Scale. Results: Showed a highly statistical negative correlation between dietary knowledge and cognitive, psychosocial fatigue among MS patients in pre, post and 3 months after implementation of the program. Conclusions: The results of this study indicated that MS patients' dietary knowledge improved after application of the educational program as well as there was a decline in MS patients' fatigue level with statically significance differences between pre, post and 3 months after application of the program. Recommendation: Dissemination of dietary knowledge program among other multiple sclerosis patients. Keywords: Multiple sclerosis patients, dietary knowledge, fatigue.
368 Effect of Training Program about Extravastion Injuries on Nurses’ Performance , Manal Yahia Ibrahem, Hanan Mohamad Rashad & Mohga Abd Elaziz Selim
Intravenous extravasation is a significant problem and one of the most commonly seen morbidity in infants admitted to the neonatal intensive care unit. Nurses play a key role in preventing extravasation injuries. The study aimed to evaluate the effect of a training program about extravasation injuries on knowledge and practice of neonatal nurses. One-group pre-posttest quasi-experimental design was used. A convenient sample of 45 nurses was recruited from two different NICUs at Kafrelsheikh General Hospital Governorate and Health Insurance Hospital (El Ebour Hospital) at Kafrelsheikh city. Tools: Structured questionnaire interview and observational checklist were used. Results revealed that minority of nurses had satisfactory level of knowledge and performance in pre-program compared to all nurses in post- program. A significant differences for nurses total mean knowledge and performance scores between pre and posttest (P =0.00) was evident. In conclusion, knowledge and performance of nurses were significantly increased after receiving the training program suggesting its effectiveness. The study recommended that nurses who working in NICUs especially newly hired should be equipped with updated information about extravasation injuries through continuous educational programs. As well, an emphasis should be done regarding their practices and periodic checkup for their knowledge. Keywords: Preterm, NICU, Extravasation injuries, Nurses’ performance, Training program
369 Evaluation of the effectiveness of low-frequency magnetotherapy in the rehabilitation of patients with pneumonia caused by the SARS-CoV-2 virus (the causative agent of COVID-19) , Nikolay Larinskiy, Irina Larinskaya, Yuriy Byalovskiy, Sergey Glotov, Anton Shakhanov
The study aimed to evaluate the effectiveness of the low-frequency magnetic therapy with a "running" magnetic field in medical rehabilitation after COVID-19 pneumonia. Materials and research methods: The study included 42 patients (24 men and 18 women) aged 40 to 65 years, who had pneumonia (J16.8) caused by the new coronavirus SARS-CoV-2. The first group included 22 patients who received standard drug therapy and starting from the 20th day after discharge from the hospital, this group of patients received low-frequency magnetotherapy with a “running” pulsed magnetic field of the ALMAG-02 apparatus. The second group included 20 patients who received the same treatment, except for magnetotherapy. Results: The course of rehabilitation measures carried out led to an increase in the functional capabilities of the cardio-respiratory system in patients of both groups, an increase in chest excursions, an increase in the vital capacity of the lungs, the normalization of the act of breathing and ventilation of the lungs, and an improvement in the psychosomatic status of patients. In the main group, these changes are more pronounced than in the control group, which is associated with the inclusion in the complex treatment of low-frequency magnetotherapy with a “running” pulsed magnetic field. Conclusion: The use of low-frequency magnetic therapy with a "running" pulsed magnetic field in the complex of rehabilitation measures for patients who have suffered from COVID-19 pneumonia significantly improves the somatic status of patients, increases exercise tolerance, and optimizes the function of external respiration. Keywords: magnetotherapy, COVID-19, pneumonia
370 Correlation between selective motor control and upper extremity function in children with hemiparesis , Radwa Gomaa Abd El-Aziz Said, Amira M. Abd-Elmonem, Maya G. Aly
Background: Impairedselective motor control is a common problem in children with hemiparesis; it interferes with upper extremity function and grip strength of the affected side. Aim: To study the relationship between selective motor control and upper extremity function in children with hemiparesis. Methods: This study included a convenient sample of 48 children with hemiparesis (age; four to eight years). The test of arm selective control, quality of upper extremity skill test, and hand held dynamometers were used to assess the selective motor control, upper extremityfunction and hand grip strength respectively. Results: The results showed positive significant correlation (p> 0.05) between test of arm selective control with upper extremityfunction (r=0.85) and hand grip strength (r=0.77). Moreover, there was positive significant correlation between upper extremityfunction and hand grip strength (r=0.72). Conclusion: Selective motor control is positively correlated with upper extremityfunction and hand grip strength in children with hemiparesis. The results help in the development of appropriate treatment programs for the rehabilitation of children with hemiplegia. Keywords: Cerebral palsy; Hand grip strength; Selective motor control; Unilateral cerebral palsy; Upper extremity function
371 A comparative study on the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing brain tumor surgery in Al-Zahra Hospital in 2017 , Seyed Taghi Hashemi, Mehrdad Masoudifar, Zohreh Rahimi  
Background: Considering the importance of maintaining hemodynamic stability in the patient undergoing brain tumor surgery, this study aimed to compare the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing brain tumor surgery. Methods: In a clinical trial study, 70 patients undergoing brain surgery were distributed in two groups of 35. The first group received 5 mg / kg fentanyl, and the second group received 1 mg / kg dexmedetomidine immediately after induction of anesthesia. During the operation, the patients were evaluated for hemodynamic parameters, blood gas levels and coagulation profile during operation and recovery and compared between the two groups. Findings: The mean changes of hemodynamic parameters was not differ between the two groups. Among blood gases HCO3had a higher level of in the dexmedotomidine group before, during and after surgery, and its changes during the study period were significant between the two groups (P <0.001). Also, PT level was higher in the dexmedmotidine group before surgery (P = 0.007), but its change was not significantly different during the study period (P = 0.14). Discussion: Our findings showed that the use of dexmeditomidine with more favorable hemodynamic stability, shorter hemodynamic presentation, and shorter duration of stay of patients undergoing cerebral surgery. Considering the serious side effects of doxedetomidine administration, it seems that the use of Dexmedetomidine is preferred in patients undergoing brain surgery than fentanyl. Keywords: Brain tumor, Dexmedmotidine, Fentanyl, Hemodynamic
372 A comparative study on the effect of infusion of 0.3 and 0.6 μg / kg dexmedetomidine during surgery on changes in hemodynamic parameters and pain in patients undergoing spinal surgery under general anesthesia: A 3-blind clinical trial , Mehrdad Masoudifar, Seyed Taghi Hashemi, Mahshad Rahimian
Introduction: Dexmedetomidine is a drug used widely in recent years to reduce complications during and after surgery, but there is a disagreement about the optimal dose of this drug. The aim of present study was to compare the effects of infusion of two doses of 0.3 and 0.6 μg / kg dexmedetomidine during surgery on changes in hemodynamic parameters and pain in patients undergoing spinal surgery under general anesthesia. Methods: In a clinical trial study, 81 patients, who were candidates for spinal surgery, were randomly assigned to three groups (27 patients in each group). The first group received 0.3 μg / kg dexmedetomidine and the second group received 0.6 μg / kg dexmedetomidine intravenously and the third group (control) received normal saline. Hemodynamic parameters during surgery and recovery and postoperative stage complications such as pain severity and the first time of receiving opioids were evaluated and compared in three groups. Results: Patients who received 0.6 μg / kg dexmedetomidine had lower blood pressure, lower heart rate and lower oxygen saturation during surgery. Also, the severity of postoperative pain was lower in this group. However, the first time of receiving opioid, received drug, length of stay in recovery and extubation time were not significantly different among the three groups. Conclusion: The use of 6 μg / kg dexmedetomidine intravenously is associated with reduced postoperative pain and appropriate hemodynamic stability during surgery. Therefore, it seems that this dose of drug to be effective in preventing acute postoperative pain. Keywords: Postoperative pain, Hemodynamics, Dexmedetomidine
373 Evaluation of nutritional risk according to screening (NRS.2002) in multiple trauma patients admitted to ICU of Alzahra Hospital in Isfahan in 2018 , Seyed Taghi Hashemi, Babak Ali Kiaii, Sara Mousavi
Introduction: Undernutrition of patients is one of the most important and effective issues in response to treatment and mortality rate. The prevalence of undernutrition in hospitalized patients is 22 to 50%. Little attention has been paid to this issue due to lack of a proper nutritional screening system. Nutrition of the patients admitted to ICU and maintaining their homeostasis requires proper and scientific management. Early nutritional support reduces the severity of disease, complications, and length of hospital stay in the intensive care unit. The aim of present study was to use the Nutritional Screening System (NRS 2002) in multiple trauma patients admitted to ICU. Methods: The present study was conducted on 100 multiple trauma patients admitted to the ICU of Al-Zahra Hospital in Isfahan in 2018. The required information form was completed for each patient. In this nutritional system, the severity of disease and level of undernutrition of patients are divided into three categories: mild, moderate and severe. In the NRS 2002 system, the final score varies from 0 to 7. The nutrition care program starts with a final score of ≥ 3. Results: In the present study, the results showed that weight loss in the last three months was 32%, and the level of nutrients received during the last week was 30%. Also, 42% of patients were severely ill and 45% needed nutritional support. Also, 68% of patients did not have undernutrition problems. Based on the independent t-test, weight loss during the last three months, reduction of calorie intake and severity of previous disease were effective in the type of treatment. Conclusion: The NRS 2002 method is very valuable and reliable due to the rapid and easy identification of undernutrition patients based on items that are readily available and its applicability if the reporter is not a nutritionist. Keywords: Nutritional Screening, Nutrition Risk, Intensive Care Unit, Multiple Trauma
374 Examining the relationship between the NUTRIC 2002 score and the complications and mortality up to 48 hours after the discharge of multiple trauma patients admitted to the ICU of Alzahra Hospital in Isfahan (2018-2019) , Babak Ali Kiaii, Seyed Taghi Hashemi, Sara Mousavi, Nafiseh Safian
Introduction: Eating disorders are among the most common problems in patients suffering from multiple trauma admitted to the ICU. They have a considerable impact on the increase of mortality risk. The present study aimed to determine the relationship between the Nutrition Risk in Critically ill (NUTRIC) score and the complications and mortality up to 48 hours after the discharge of multiple trauma patients admitted to the ICU of Alzahra Hospital in Isfahan between 2018 and 2019. Methodology: This study was descriptive-analytical research on 68 multiple trauma patients admitted to the ICU of Alzahra Hospital. The NUTRIC 2002 scores of the said patients were calculated by evaluating the parameters of age, APACHE II, SOFA Score, days in the hospital to ICU admission, and the number of comorbidities. Two different study groups were compared in terms of the said parameters, one composed of living and the other of deceased subjects. Findings: The mean NUTRIC 2002 Score was 3.5±0.03 in all studied patients. Out of the said patients, 67.6% and 32.4% of them were exposed to a low-risk eating disorder and a high-risk eating disorder, respectively. The mean of NUTRIC Scores in living and deceased patients were 2.82±3 and 1.19±5.83, respectively; which indicated that the deceased subjects had a higher NUTRIC Score (p<0.001). Conclusion: The 2002 NUTRIC Score was higher in the deceased subjects than in the living patients. Thus, this score seems to be a valuable and usable criterion for determining the eating disorder and the risk of mortality in multi-trauma patients admitted to the ICU. Keywords: NUTRIC, Multiple Trauma, Intensive Care, Death
375 The effect of music therapy on children with autism as a therapeutic intervention , Atiyeh Sadat Hasani Helm, Mahdi Ramezani
Objective: The global incidence of autism has rised up. It can appear the importance of interventions and family struggles, because music is attractive for children we can use it as an effective intervention. The goal of this article is a review of the ASD children problems and interventions and the music effects for treating children with Autism Spectrum Disorder (ASD). Finally, since music is always accessible and the human body utilizes it on a daily basis, we can use music as a complementary method in occupational therapy. Materials & Methods: Comprehensive electronic search of keywords "music therapy", "autism interventions" and "vagus nerve stimulation" was done in international electronic databases such as PubMed, Scopus, Google Scholar and Google Books between 2000 and 2021. In the first part of the search, based on the considered keywords, 30,446 articles were obtained. After reviewing the abstracts of articles, 30,405 articles were discarded due to lack of entry criteria, and finally 41 articles were selected. Among these, 30 articles focused on autism and its interventions and another 11 articles focused on the vagus nerve. Results: children with autism have lots of problems in different aspects and communicate with them is not like normal children. One best way to break this barrier is music. According to Physics, music is placed in energy spectrum as one part of sounds and volumes, which can affect on our body energy. On the other side the rhythmical and compositionality feature of music reinforce this consequence. Due to these features, music is more popular and we can utilize it for children with autism, who don't have enough eye contact and communication. We often use music in our daily lives, for example, from ringing the doorbell to using the phone or waiting in the elevator to reach the desired floor and etc. it is one common and available supplementary way that we can use it for treating beside the other methods. The music plays an important role in activation of Parasympathetic Nervous System via the vagus nerve stimulation. The vagus nerve is a tenth nerve of twelve pairs cerebral nerves. The tenth nerve is one of the most important nerves which originates from the brain and is responsible for innervating face, thorax, abdomen and etc. It is a motor sensory nerve. The vagus nerve is also involved in the Parasympathetic Nervous System. The parasympathetic nerves have a great effect on the relaxation of the body. Vagus nerve has two sensory ganglia that transmits sensory impulses: the superior and the inferior ganglia, by which we can affect on parasympathetic nerves for improvement. Generally these ganglions innervates different part of body such as: ear (where the most stimulations happen in this place) , larynx, heart, pulmonary system, abdomen and abdominal viscera. Because of this innervation vagus nerve stimulation can change the activity of pulmonary system, heart, abdomen, intestine and etc. and contributes to relaxation. The music stimulates the vagus receptors of the ear. Conclusion: Since music is an accessible and attractive resource, it can be used as a complementary method along with medication and other methods, due to which the connection with the child with autism is established and under the shadow of relaxation, learning and more concentration is provided. Keywords: Music Therapy, autism interventions, Vagus Nerve Stimulation
376 Control of trunk muscles activity while manual material handling symmetrically and asymmetrically, Based on Motor control strategy , Masoud Ghofrani, Manijeh Soleimanifar, Saeed Talebian
[Purpose] Although lifting tasks has been recognized as a primary risk factor in low back pain, the concept of lifting asymmetry is relatively new subject. To address trunk function, biomechanical studies generally measure trunk muscle activity using surface electromyography (EMG). But so far, magnitude and similarity index (SI) obtained from EMG have not been studied as indicators of the motor control during lifting task. So, the purpose of this study is to compare the trunk muscles magnitude and SI during symmetric and asymmetric lifting. [Subjects and Methods] A total of 20 healthy male with no history of lumbar spine disorders participated. Surface electromyography data were recorded from the 7 trunk muscles while the participants performed symmetric and asymmetric lifting and lowering different loads. [Results] According to Multivariate ANOVAs the phase of motion (lifting, lowering) and condition (symmetry, asymmetry) have a significant effect on SI and magnitude (p≤0.05). Load changes have no effect on SI (p=0.969) but have a significant effect on magnitude (p≤0.05). The magnitude and SI value is higher in asymmetrical lifting and lowering compare to symmetrical condition. [Conclusion] The findings reveal the SI value is higher in asymmetric conditions. This means that the amount of muscles co-contracture increased during asymmetrical conditions. Increased muscles co-contracture reinforces the hypothesis of exerting more compression on the spine in asymmetrical movement. Keywords: Asymmetrical lifting, Motor control, Electromyography
377 Antibiotic Prescribing in Outpatient Before and After Implementation of the Urban Family Physician and Referral System , Ehsan Nabovati, Hamed Mahmoudi, Reza Abbasi, Saeed Barzegari, Hossein Akbari, Mehrdad Farzandipour
Background The Family Physician and Referral System was piloted in Mazandaran and Fars provinces, Iran in 2012. The goal of this program was to improve the provision of health services including medication prescription. Objective This study aimed to determine the trends in antibiotic prescribing in outpatient before and after implementation of the Family Physician and Referral System in Babol, Iran from 2010 to 2018. Methods In this retrospective study, all prescriptions of urban family physicians in Babol, which were registered in the database of the Health Services Insurance Organization of Mazandaran province, were included. The trends of average number of items per prescription, percentage of antibiotics per prescription, frequency of antibiotic groups, and cost of antibiotics were calculated using SQL Server and IBM SPSS version 22. Results The average number of items per prescription was found to be 3.4±1.82, and 2.8±1.60, and percentage of antibiotics per prescription was 49% and 32% in 2010 and 2018, respectively. The most prescribed antibiotic groups were penicillin (54.8%) and cephalosporin (39.9%). Amoxicillin 500mg capsules (13.1%), metronidazole 250 mg (10.2%), and ciprofloxacin 500 mg (8.2%) were the most prescribed antibiotics. Also, the mean cost of prescriptions containing antibiotics compared to the total prescriptions had decreased from 22% in 2010 to 5.5% in 2018. Conclusion The pattern of medication prescription especially antibiotics, improved after the implementation of the Family Physician and Referral System. Due to the positive impact of the Family Physician and Referral System on medication prescription by physicians, we recommend the implementation of this program in low and middle-income countries. Keywords: Antibiotic, medication prescribing, Health system reform plan, Family physician, Trend
378 Associations Between Family Communication, Perceived Stress and Resilience with Life Satisfaction Among UPM Pre-University Students , Manoochehr Taghi Pour, Asmah Ismail, Wan Marzuki Wan Jaafar, Gholamreza Rajabi
Background: Alfred W. Adler (1870-1937), psychotherapist and founder of the school of individual psychology, believed that education, marriage, and job play important role in human development. Higher learning is a demanding and challenging period for students that can result in high rates of psychological distress affecting their life satisfaction. Aim: The research is to study the links between family communications, perceived stress and resilience with life satisfaction among pre-university students in UPM. Method: A cross-sectional study was conducted among a sample of 310 (females 158 and 152 males) pre-university students from a public university in Malaysia. Four instruments were used in this research namely the Family Communication Scale (FCS, Olson et al., 2004), Perceived Stress Scale (PSS, Cohen et al., 1983) Resilience Scale (CD-RISC, Connor-Davidson, 2003) & The Satisfaction with Life Scale (Diener et al. 1985). The data were analyzed using independent t-test, Pearson correlation coefficients and multiple regressions. Results: The finding of this study revealed that there are simple and multiple relationships between family communications, perceived stress and resilience with life satisfaction among pre-university students. Conclusion: The research may guide university counselors to view adolescents’ life satisfaction holistically and assist them in developing preventive and intervention plans for the university new enrolled students. Also, the results will provide students with some knowledge on their life satisfaction and its effects on their future accomplishments. Keyword: Family Communication; Perceived Stress; Resilience; Life Satisfaction; Pre-University Students
379 Effect of universal adhesive on shear bond strength of metal bracket to enamel and dental amalgam , Shiva Alavi, Fateme Gharibpour
Background: the bond strength of bracket to the tooth substrate is a critical matter. The different surface treatments are introduced to achieve an appropriate bond strength. We aimed to investigate the shear bond strength(SBS) of metal brackets to amalgam surfaces with universal adhesive and compared the results with the enamel group. Material and methods: in this in-vitro study, eighty specimens of amalgam in four groups and sixty specimens of the enamel in three groups were prepared. In amalgam groups, the control group was sandblasted and treated with transbond Xt whilst the other three groups prepared in the following order, group 2 sandblasted and treated with All Bond Universal(ABU), group 3 using diamond bur and ABU, and group 4 using self-etch mode of ABU. In enamel groups, control group was acid-etched and using transbond XT as a primer; in other two groups, the ABU was used as a primer in etched and self-etched mode. The specimens thermocycled and prepared for the SBS test. SEM analysis and ARI index were performed. pvalue≤ was considered significantly. Results: SBS of enamel was significantly higher than amalgam. Within enamel groups, etched with ABU showed the highest SBS. In amalgam group, the highest SBS was related to surface treated with ABU only, and the lowest SBS was related to diamond bur group. Conclusion: The etched surface of enamel showed the appropriate bond strength to bracket, and in the amalgam group, using mechanical preparation can decrease the oxide layer and compromise amalgam SBS. Keywords: Dental amalgam, Enamel, shear strength, Adhesive
380 Evaluation the effect of progressive muscle relaxation technique on fatigue and daily living activities in patients with Multiple Sclerosis , Tayebeh Javdan, Elham Imani, Ahmad Agha Negahi
Aim: This is a Quasi-experimental study wich was carried out in order to determine the effects of applying progressive muscle relaxation on fatigue and daily living activity of MS patients. Background: Fatigue is one of the most common symptoms in people with multiple sclerosis (MS) and adversely affects their daily living activities. Methods: 80 MS Patients were selected then conducted in two group (40 experiments and 40 contorol). Data collector tools included: demographic questionnaire, fatigue severity scale and activity of daily living questionnaire which completed four times by two group (before? Third week, sixth and ninth after study), self-report checklists which completed only by experimental group. PMRT performed once a day for 8 week by experimental group. During study no intervention was done for control group. Results: repeated measures ANOVA showed that there is significant difference in mean score of fatigue between two group in 4 times (P<0/05). Also, the results showed that with progressive muscle relaxation at 4 times, daily activities in ADL and IADL sections were significantly increased (P<0/05) but there was no significant difference between the two groups (P>0/05). however, clinically significant differences were observed. Conclusions: Acording to these findings? applying PMRT decreased patient´s fatigue and improve independence in daily living activities. This study supports the effect of PMRT on fatigue and activities of daily living in patients with MS, and it is recommended that further studies be conducted on this subject in the future. Keywords: daily living activity, fatigue, progressive muscle relaxation technique, multiple sclerosis.
381 Studying the induction effect of different mouse neck scaffolds on the behavior of Mouse Bone marrow-derived mesenchymal stem cell , Mohamadkazem Ganjavi, Mohamadreza Baghaban Eslaminejad, Nasser Mahdavi-Shahri
Objective: Studying the behavior of mesenchymal stem cells is important for understanding some physiological and pathological processes as well as long-term preservation of these cells in vitro. The neck area of mouse contains a wide variety of different organs and tissues and extracellular matrices. In the present study, the interaction of mouse bone marrow derived mesenchymal stem cells (BM-MSCs) with mouse neck scaffolds was performed in order to have a better understanding of the behavior of mesenchymal stem cells. Materials and methods: The neck areas of 9 two-week-old Syrian mice were cut into pieces with 4 mm thickness. Decellularization process was carried through snap freeze-thaw cycles followed by sodium dodecyl sulfate (SDS) treatments. After confirmation of acellularization through histological studies and DNA extraction process, scaffolds were co-cultured with mouse (BM-MSCs) up to 21 days, in vitro. Results: As indicated by histological studies and scanning of electron microscopy, stem cells migrate into the cartilage scaffold on third, seventh and fourteenth days of culture. Stem cells were divided on these days. On the fourteenth day of culture, migration to epidermal and blood vascular scaffolds was also observed. On the twenty-first day of culture, cells were observed only in the cartilage scaffold, while showing morphological differentiation. Conclusion: As indicated by the results of the present study, mouse neck scaffold, due to its diverse extracellular matrices, is a suitable structure for studying some cellular behaviors such as migration, cell division and cell differentiation. However, more molecular studies are needed to determine the extent of this differentiation. Keywords: Natural scaffold, Cell behaviors, Cell-matrix interaction, Experimental model scaffolding, mouse neck area
382 Panretinal photocoagulation laser in diabetic retinopathy patients , Farshad Ostadian, Fereydoun Farrahi, Bahman Cheraghian
Background: It was reported that corneal endothelial cell depletion is a complication of the retinal laser. In this study, the effect of panretinal laser on corneal endothelium was investigated. Method: A group consisting of 47 eyes of 47 Diabetic patients who need a panretinal photocoagulation laser was compared with another group of 47 diabetic patients who did not require a laser. The patient's age was chosen in the range of 50-70 and the tools included Ellex double frequency LASER, Specular microscopy, Pachymetry, and Condense Lens 90. Time course of coefficient of variation, endothelial cell density, hexagonal cells and central corneal thickness were evaluated. ANOVA, Dennett's, and Mann-Whitney test was used to compare the data. P-value of <0.05 was considered statistically significant. Results: We found no significant differences in age, gender between the two groups. There was no significant differences in hexagonal cells, coefficient of variation, endothelial cell density and central corneal thickness between the two groups at any time points. Conclusion: This study suggests that the "panretinal photocoagulation laser" conserves corneal endothelial cells of subsequent damage in diabetic retinopathy patients Keywords: photocoagulation laser, corneal, endothelial cell, argon laser, double frequency laser.
383 Investigating the cytotoxicity of four types of freshly prepared root canal sealers using human gingival fibroblasts , Ehsan Mostajeran, Shirin Asgarani, Hamid Razavian  
Introduction: One of the most important characteristics of endodontic treatment seals is their biocompatibility. The aim of present study was to investigate the cytotoxicity of four types of freshly prepared root canal sealers using human gingival fibroblasts. Materials and Methods: In this experimental laboratory study, freshly prepared sealers were investigated. To investigate the cytotoxicity, each sample was extracted separately in RPMI-1640 (Sigma Aldrich-USA). Then, the resulting extracts were exposed to C165 fibroblast cells in culture medium for 1, 3 and 7 days. Then, the level of cytotoxicity was assessed by MTT colorimetric method based on the level of light absorption. In the present study, multivariate analysis of variance was used to analyze the data. Results: The results showed that the cytotoxicity of AH 26 and tgsealer sealers decreased and MTA Fillapex sealer increased over time. Also, Adseal sealer did not follow a logical trend but, in general, its cytotoxicity increased over time. In addition, based on mean of all data obtained from each sealer, MTA Fillapex had the lowest cytotoxicity and Adseal had the highest cytotoxicity, and AH 26 cytotoxicity was higher than that of tgsealer. Conclusion: According to the results of the present study, the MTA-based sealer of MTA Fillapex has the lowest cytotoxicity. Keywords: Root canal sealers, fibroblasts, freshly prepared roots
384 Psychotic experiences in patients with obsessive compulsive disorder. A cross sectional clinical study , Mohammad Ali Ghoreishizadeh, Sepideh Herizchi, Sara Farhang
Background: Obsessive-compulsive disorder (OCD) is associated with heterogeneous and diverse symptoms. A diagnosis is challenging when patients experience psychotic symptoms. This study aimed to evaluate the pattern of psychotic symptoms in patients with OCD. Methods: Using semi-structured clinical interviews, 185 patients meeting the DSM-IV diagnostic criteria for OCD were selected. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Scale for the Assessment of Positive/Negative Symptoms (SAPS/SANS) were used to measure the OCD severity and insight levels and the pattern of psychotic symptoms, respectively. Characteristics of patients with and without psychotic experiences were compared. Results: A total of 38 patients (20.5%) displayed psychotic symptoms. Delusions were observed in 63.2% of these patients, while in 13.2% of them, delusions were accompanied with negative symptoms. Men, those aged between 18 and 34 years, less educated, and singles displayed significantly higher rates of psychotic symptoms. The mean Y-BOCS score (26.42±5.07) was significantly higher in patients with psychotic symptoms than in those without (24.97±6.38). Conclusion: The results showed that in OCD patients, psychotic symptoms are more common in young (<30 years), single, less educated, and those with severe OCD. Keywords: obsessive-compulsive disorder; psychosis; insight.
385 Evaluation of the consistency of RT-PCR test results in nasopharyngeal and fecal specimens in patients with Covid-19 disease with gastrointestinal symptoms , Mohammad Ebrahim Ghamarchehreh, Mohammad Mehdi Jahani, Zahra Nourollahzadeh
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Addition to respiratory manifestations, gastrointestinal symptoms have been observed in some patients with COVID-19. The aim of the present study was to investigate the simultaneous diagnosis of SARS-CoV-2 RNA by RT-PCR in nasopharyngeal and fecal specimens of patients with covid-19 with gastrointestinal symptoms. In the present study, 100 patients with COVID-19 disease with gastrointestinal symptoms were included. Isolation of viral RNA in nasopharyngeal and fecal samples performed using specific laboratory kits. Detection of COVID-19 in clinical samples conducted using TaqMan-probe Real Time PCR method with specific primers and probes (Pishtaz Teb RT-PCR kit, Iran). PCR test results showed that in 21% of patients with positive nasopharyngeal test, SARS ? CoV ? 2 RNA was detected. As a result, the compatibility of PCR test in the diagnosis of Covid-19 virus between nasopharyngeal and fecal results was 21%. Keywords: Covid-19, nasopharyngeal, fecal specimens, RT-PCR
386 An investigation on the frequency of thoughts, readiness and suicide attempt in individuals with thalassemia , Sahar Attar, Nour Mohammad Bakhshani, Qasem Miri Aliabad  
Background and Aim: Thalassemia major is one of the most common chronic genetic diseases in the world and in Iran that can impose many adverse effects on the self and society. Psychologically, patients with thalassemia are under stress. According to the World Health Organization (WHO), suicide is one of the leading causes of death worldwide. It is important to identify the people who have the highest risk factors for suicide. The present research investigates the frequency of thoughts, readiness and suicide attempts in people with thalassemia. Methods: This was a cross-sectional study. Its sample was 150 patients with thalassemia in the age range of 10 to 46 years whom we selected through census by sampling at convenience. We gave to patients a standardized Beck Suicide Thought Assessment Questionnaire. We analyzed the research data using descriptive and inferential statistical tests. Results: From among 150 patients with thalassemia in this study, 57.3% of the respondents were male and 42.7% were female. The results showed that there was a negative and significant relationship between suicide thoughts and attempts and age (-0.234) (P <0.05). The mean prevalence of suicide in men (1.89) was significantly higher compared to women (0.79) (P <0.05). We did not observe significant difference in prevalence of suicide thoughts and attempts between married and single groups with a mean difference (0.69) (P <0.05) and, in different educational groups, no significant difference was reported (P> 0.05). Conclusion: The findings of this research showed that among patients with thalassemia, the prevalence of suicidal ideation has a significant percentage. Since suicidal ideation provides a platform for preparation and attempt to commit suicide, so by providing mental health services and regular screening, we can take an effective step to prevent this problem among patients with thalassemia. Keywords: Thalassemia, Suicidal ideation, Suicide
387 The effect of music and vagus nerve to improve various Diseases , Atiyeh Sadat Hasani Helm, Mahdi Ramezani
Human body has energy which determines you are sick, tired, bored, excited and angry or not. According to Physics music is placed in energy spectrum as one part of sounds and volumes, which can affect our body energy. On the other side the rhythmical and compositionality feature of music reinforces this consequence, due to these features, music is more populare than the other hobbies. We often use music in our daily lives, for example, from ringing the doorbell to using the phone or waiting in the elevator to reach the desired floor and etc. it is one common and available supplementary that human can use it for treating different diseases. The music plays an important role in activation of parasympathetic part via the vagus nerve stimulation. The vagus nerve is a tenth nerve of twelve cerebral nerves. The tenth nerve is one of the most important nerves which originates from the brain and is responsible for innervating face, thorax, abdomen and etc. It is a motor sensory nerve. The vagus nerve is also involved in the parasympathetic system. This nerve has two sensory ganglia that transmit sensory impulses: the superior and the inferior ganglia, by which we can affect parasympathetic Nervous System for improvement. Generally these ganglions innervates different part of body such as: ear (where the most stimulations happen in this place), larynx, heart, pulmonary system, abdomen and abdominal viscera. Because of this innervation vagus nerve stimulation can change the activity of pulmonary system, heart, abdomen, intestine and etc. The music stimulates the vagus receptors of the ear. The goal of this article is review the music effects on vagus nerve for treating some diseases such as gut problems, mental health disorders, heart problems, epilepsy, seizures and etc. Finally, since music is always accessible and the human body utilizes it on a daily basis, we can use music as a complementary method in occupational therapy. Keywords: Music therapy, Vagus nerve stimulation, Occupational therapy, complementary therapy
388 The Mother’s Role in Improving the Oral and Dental Health of their Children: Application of Planned Behavior Theory , Bahareh Kabiri, Ali Reza Hidarnia, Mehdi Mirzaei Alavijeh
Introduction: It is necessary to identify the factors affecting the behaviors of the parents, especially mothers, in improving children's oral and dental health according to the theories of behavior change. This research aimed at determining the role of mothers in improving the oral and dental health of the children on the basis of the planned behavior theory. Materials & Methods: This was a descriptive-analytical, cross-sectional study. The research population included 240 subjects selected through the stratified random sampling from the mothers in the city of Ilam, Iran. The data collection tool was a questionnaire, which consisted of two sections: seven demographic and background questions, five items about attitude, four items about subjective norms, and five items concerning behavioral intention, which were completed as self-report. The collected data were analyzed using SPSS-21 software through descriptive and analytical tests such as independent t-test, linear regression, and Pearson correlation coefficient that were examined and had a significant level of 0.05. Findings: The participants’ age ranged from 20 to 44 (mean=5.67±31.8). The linear regression test indicated the structure of attitude (B=0.135, P<0.001), perceived behavioral control (B= 0.398, P<0.001), subjective norms (B= 0.236, P<0.001), and explained the 46% of the behavioral intention variance. Conclusion: Taking into account the impact of the attitude structure on the behavioral intention predicting, therefore, this structure should be employed in designing the preventive training programs in the framework of the theory of the planned behavior. Keywords: Attitude, Theory of Planned Behavior, Mothers, Dental Health
389 Non-fatal firearm injuries, Incidence and Circumstances: Presenting in DHQ Hospital Rawalpindi , Tasneem Murad, Sheeba Shabir, Khurram Saleem, Yasir Shehzad, Noor ul Ain, Sadaf Zahra
Objective: To describe the incidence and manner of nonfatal firearm injuries in Rawalpindi District Study design: Observational retrospective study Place and Duration: District Head Quarters Hospital Rawalpindi. Duration of 6 months, from July 2020 to Dec 2020. Methodology: Total 82 patients with nonfatal firearm injuries were included. After approval from ERC committee of DHQ Hospital Rawalpindi, data was obtained from the duplicate copies of medicoleagal reports kept at the Forensic Medicine department t of IIMCT. These reports were carried out by cross ponding author and the demonstrators of Forensic Medicine department of IIMCT. The data was entered on a pre-designed Performa having variables such as demographics, time & place of death, region of body involved, weapon used & month of the year. Results: A total of 82 nonfatal firearm injuries were reported during these 6 months. 87% of the victims of were males encountering injuries 1 to 11 in number with an average of 3 injuries per person. 3o% of these injuries were received on the upper trunk, 32% on the lower trunk, 16% the lower limbs, 13% the upper limb, 3% the head and neck and 6% on the other regions. 68% of the injuries were lacerations, an exit wound was detected in 19% of cases and in 13% only entry wounds were found. Tattooing and burning of the adjacent skin were common in wounds on the upper and lower trunk while comminuted intra articular and shaft fractures were important varieties in the limbs. 86% of the victims were vitally stable, others being critically unstable with GCS ranging till 6/15. Conclusion: The public health issue of firearm-related injuries continues to be a concern. The necessity for a district-based, nationwide reporting system for fatal and nonfatal firearm-related injuries is critical. In Pakistan, these data could be used in the design, implementation, and assessment of preventative programs. Key words: Non fatal, Firearm injuries, Regional injuries
390 Diagnostic Accuracy of a New Sonographic Classification System in Diagnosing Malignant Thyroid Nodules , Muhammad Amin, Mahwish Zahra, Mustafa Ali Siddiqui, Riffat Kamal, Sahar Javed, Amena Maqsood, M. Mohsin Khan
Objective: To evaluate the validity of new ultrasound classification in diagnosing malignant thyroid nodule keeping fine needle aspiration cytology (FNAC) as gold standard. Materials and Methods: This validation study was carried out at hospital from September 06-2020 to March-2021 in Children Hospital and Institute of Child Health Multan .A total number of 114 patients who presented with inflamed thyroid nodules were included. General information regarding patient like name, age and gender was documented for data collection. Ultrasonography was done using Linear 7.5 MHz and curvilear 3.5 MHz transducer all patient in supine position and comfortable setting. Features of ultrasound were recorded. Patients having U4-U5 score were labelled as having malignant lesions. All cases were followed up by fine needle aspiration and corresponding histopathology report. Results: Mean age of patients was 46.06±10.34 years. Out of 114 patients, 83 (72.81%) patients were female and only 31 (27.19%) were male. On ultrasonography, malignancy was diagnosed in only 24 (21.05%) patients, and remaining 90 (78.95%) were diagnosed of having benign lesions. On histopathology, malignancy was diagnosed in 25 (21.93%) lesions, while remaining 89 (78.07%) patients were diagnosed of having benign lesions. Sensitivity of ultrasound U-score in diagnosing malignant thyroid nodules was 88%, specificity was 97.8%, PPV was 91.7% and NPV was 96.7%. Conclusion: New sonographic classification system has a reliable accuracy for differentiating malignant from benign solid thyroid nodules. So it can be used as preferred radiological scoring system for initial investigation for solid thyroid nodules. Keywords: Thyroid nodules, ultrasound U-Score, Histopathology, Malignancy, Diagnostic accuracy.
391 A Study on Frequency of Development of Polycystic Ovarian Syndrome Among Undergraduate Doctor of Physical Therapy Students , Saima Riaz, Anfal Zahra, Zeest Hashmi, Sajid Rashid, Rehan Ramzan Khan, Amber Shabbir
Objective: To find out the frequency of development of polycystic ovarian syndrome among undergraduate Doctor of Physical Therapy students. Methodos: It was a cross-sectional study. Data was collected from Riphah International University, Lahore. The study was conducted on 350 undergraduate doctor of physical therapy students. Non-probability convenience sampling technique was used. Sample collection was done based on pre defined inclusion and exclusion criteria. Polycystic ovarian syndrome self-assessment form based on WHO guidelines was used. Collected data was entered and analyzed on SPSS version 21. Results: The target population of research comprises of 350 participants. The mean age of students was 21.28 +2.35. Out of which 35.71% were hostilities and 64.29% were day scholars. Among hostellites 49.6% (n=62) were at risk of unpredictable PCOS, 39.2% (n=49) were at chance of getting PCOS and 11.2% (n=14) were at high risk to get PCOS. In day scholars 52.9% (n=119) were at risk of unpredictable PCOS, 39.6% (n=89) were at chance of getting PCOS and 7.6% (n=17) were at high risk of PCOS Conclusion: The current study concludes that polycystic ovarian syndrome (PCOS) is more prevalent among female adolescents which may cause obstacles in their lifestyle ultimately leading to infertility. This negative effect is due to the unhealthy stressful lifestyle of teenager female adolescents. The unpredictable polycystic ovarian syndrome is more frequent in day scholars than hostilities among Doctor of Physical Therapy Students. Keywords: Polycystic ovary syndrome, Hyperinsulinism, Hirsutism
392 Effectiveness of Ponseti Versus Kite Method for the Management of Club Foot- A Quasi Experimental Trial , Shabana Sharif, Rehan Ramzan Khan, Saima Riaz, Sajid Rashid, Zaigham Rasool Athar, Tausif Aamir, M. M. Khan
Objective: To determine the effectiveness of ponseti versus kite method for the management of club foot among children. Methods: A quasi experimental trial was conducted to determine the most effective conservative method for managing idiopathic club foot. This study was carried out in District Head Quarter Hospital, Layyah. A total of 46 children (60 Feet) aged less than six months of both genders were included in this study using convenience sampling technique. The study sample was divided into Group A (Ponseti) and Group B (Kite). Each treatment group comprises of 30 feet. Patients were called for weekly follow up till ten weeks consecutively. At every follow-up visit, patients were assessed to check the improvement of deformity with the help of the Pirani scoring system for the foot. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. A greater negative value signified better correction. SPSS 23 was used for data entry and analysis. Results: Children's mean age in both treatment groups (A and B) was 10.83±4.59 and 10.20±4.75 weeks. At presentation mean Pirani score in both treatment groups (A and B) was 5.85±0.67 and 5.86±0.45, respectively, while at 10th follow up it was 1.42±0.39 and 2.35±0.54 for group A and group B, respectively. Conclusion: This study demonstrates that the Ponseti technique significantly improved the management of club foot as that of the Kites method. Ponseti's method is more effective in terms of rapid improvement in the involved group. Key words: Non operative Management, Idiopathic Club foot, Kites method, Ponseti method.
393 Teaching Professionalism in undergraduate Medical Education , Amjad Ali, Asim Shafi, Arif Siddiq, Muhammed Salman Siddiq, Rab Nawaz Malik, Kanwal Khalid
For the last many years, there have been speedy and far-reaching changes in health teaching. [1] Numerous innovative approaches of teaching professionalism have been established and executed since 1950’s and engrossed on medical expertise. In this paper, we will observe teaching professionalism in health teaching, detailing the usages and tasks associated with diverse methods. The developments in bio medical technologies and skills have been primed to advance of teaching professionalism tools that expand the assessment of expertise. Objective: To observe the Teaching Professionalism in undergraduate medical education in BADMC Multan Methodology: A cross sectional survey was conducted at BAMDC Multan from January 2020 to June 2020 after obtaining ethical approval from ECB. The data was collected through convenience sampling technique from 50 health educators teaching anatomy, medicine, Surgery and Gyane & Obs. to undergraduate students by using unidentified questionnaire. Consent was taken from all participants before data collection. Data was entered and analyzed by using SPSS 21. Results: Of the 50 health educators, 46 (92%) reacted to the main phase of the overview, 48 (96%) of medical educators have sound mentalities about their jobs and responsibilities, 42 (84 %) having disintegration of clinical polished methodology, 44 (80 %) have clinical instructors ethicists- subjecting one's personal responsibility to the interest of patients, 50 (100 %) sticking to high moral and good guidelines, 40 (80 %)responding to cultural necessities, 48 (96%) displaying center humanistic qualities (e.g., compassion, uprightness, benevolence, dependability), 50 (100%) can design demonstrable, 46 (92 %) have duplicates of educational plan materials utilized in courses identified with polished skill, 48 (96 %) use Simulations ,22 (44 %) can use Computer-based simulation, 40 (80 %) can create case generation techniques. Conclusion & Recommendations: From this study, it is concluded that only 22 health educators (44 %) can use Computer-based simulation, 40 (80 %) can create case generation techniques, 40 (80 %) responding to cultural necessities, 42 (84 %) having disintegration of clinical polished methodology that is very low bench mark in teaching professionalism. Extra exploration is needed, mainly if the teaching professionalism is used to make high stick verdicts (e.g., elevation and authorization). Key Words: Health Educators, Ethical Committee Board, Bakhtawar Amin Medical & Dental College, Multan
394 Effects of Structured Resisted Exercises on Cognition Level Among Patients with Mild Cognitive Impairment , Muhammad Hassan, Sajid Rashid, Rehan Ramzan Khan, Muhammad Usman Khalid, Haroon Mansha, Hayatullah Khalid
Objective: To evaluate the effects of structured resistance exercises on cognition level among patients with mild cognitive impairment. Methods: A quasi experimental trial was conducted on thirty patients with mild cognitive impairment (MCI) from September 2020 to February 2021 at Ibn e Siena hospital, Multan. The total sample was randomly divided into two equal groups containing fifteen patients each; Group-A (Conventional pharmacological treatment) and Group-B (Resisted exercises). Group-A participants were treated with conventional pharmacological treatment cholinesterase inhibitors along with regular physical exercise while Group-B participants were treated with resistance exercises along with conventional pharmacological treatment. The standardized tools were used for data collection including Standardized mini mental state examination (SMMSE), Montreal cognitive assessment (MOCA), Trial making test A (TMT-A) and Trial making test B (TMT-B). Data was entered and analyzed by using SPSS 21. Results: Independent samples T-test showed statistically significant difference after intervention for measures of cognitive performance. There was significant difference (p<0.01) between pre and post intervention score of SMMSE (20.60 ± 1.75 and 23.20 ± 1.69) and MOCA (17.60 ± 1.35 and 21.93 ± 1.57). There was also significant difference between (p<0.01) pre and post intervention score of TMT-A (1.47 ± 0.34 & 1.23 ± 0.04) and TMT-B (2.51 ± 0.04 and 2.08 ± 0.04). Conclusion: Resistance exercises increases the cognitive levels of Mild Cognitive impairment patients. Key Words: Cognitive dysfunction, Exercises, Dementia.
395 Serum Zinc Levels in Children with Upper Respiratory Tract Infection in the Age of 2-12 Years in Pakistan , Madeeha Rehman, Lubna Aman, Muhammad Shahid Ghaffar, Muqadar Shah, Zarmast Khan, Sajid Shamim
Objective: The aim of this study is to determine the zinc levels in children with upper respiratory tract infection in the age of 2-12 years in Pakistan. Study Design: A prospective observational Place and Duration: Conducted at department of Paediatrics Hamdard University hospital, Karachi and PIMS Children Hospital, Islamabad for four months duration from October, 2020 to January, 2021. Methods: Total 90 children of both genders were presented in this study. Patients’ detailed demographics including age, sex, socio-economic class and maternal education were recorded after taking informed written consent from the authorities. Patients with upper respiratory tract infection were included. Mean serum zinc among children was calculated as 55.14±17.68 μg/dl. Outcomes were measured in terms of risk factors associated with URT and lower level of serum zinc among patients. Complete data was analyzed by SPSS 24.0 version. Results: There were 60 (66.7%) males and 30 (33.3%) were females. Mean age of the cases were 08.44±7.65 years. 62 (68.9%) patients were from lower socio economic status and literacy rate of mothers were 35 (38.9%).Symptoms of URTI were cough, sore throat, runny nose and headache. Previous family history of URTI found in 55 (61.1%) cases. Rhinovirus was the most common cause of URTI found in 70(77.8%) cases. Severity of cold was found among 18 (20%) children. Meanserum zinc was38.76±6.88 μg/dl and found among 87 (96%) cases. Conclusion: We concluded in this study that the zinc level was significantly lower among children who had rhinovirus due to severe cold. Keywords: Serum Zinc Level, Children, Upper Respiratory Tract Infection
396 Prevalence of Pneumonia Associated with Measles among Infants and Children , Asadullah Khan, Abdul Moeed Khan, Ali Akbar, Muhammad Akram, Farhana Ahmad, Allah Nawaz Sultan
Objective: The aim of this study is to determine the prevalence of pneumonia associated with measles among children and infants. Study Design: Cross-sectional Place and Duration: Pediatrics department of Lady Reading Hospital, Peshawar and Sharif Medical and Dental College, Lahore for six months duration from February 2020 to July 2020. Methods: Total 150 patients i.e children and infants of both genders were included in this study. Children were aged <5years of age. Patients’ detailed demographics height and weight were recorded after taking informed written consent from the authorities. Patients’ diagnosed measles were presented. Symptoms and frequency of pneumonia among all patients were assessed. Complete data was analyzed by SPSS 22.0 version. Results: There were 90 (60%) children and 60 (40%) infants. Among 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. 70 (46.7%) cases had birth weight > 3kg. 30 (20%) patients had high socioeconomic status, 50 (33.3%) had middle and 70 (46.6%) cases had poor. 85 (56.7%) patients had rural residency. According to severity of measles, 35 (23.3%) had mild,45 (30%) cases had moderate and severity was among 70 (46.7%) patients. Prevalence of pneumonia was found among 95 (63.3%) cases. 40 (26.75) cases had measles vaccination. Conclusion: We concluded in this study that prevalence of pneumonia among children of measles were significantly high. It was due to less number of vaccination status with poor socio economic status among patients. It can be controlled by providing awareness of vaccination to the parents of children. Keywords: Pneumonia, Measles, Children, Infants, Prevalence
397 Frequency of Urinary Tract Infection in Children with Diarrhea , Ali Akbar, Abdul Moeed Khan, Asadullah Khan, Farhana Ahmad, Muhammad Akram, Allah Nawaz Sultan
Aim: To determine the frequency of UTI in children presented with diarrhea. Study Design: Cross-sectional Place and Duration: Pediatrics department of Alkhidmat Hospital, Peshawar and Sharif Medical and Dental College, Lahore for six months duration from October 2020 to March 2021. Methodology: Total 120 patients of both gender with ages 2 months to 5 years were enrolled in this study. After taking written consent from parents/guardians, detailed demographics including age, sex, residence, severity and complete medical history were examined and recorded. Urine samples were obtained for examination of urine culture. Data was analyzed by SPSS 24.0. Results: There were 78 (65%) males while 42 (35%) patients were females. 58 (48.33%) patients were ages <1 years, 45 (37.5%) had ages between 1 to 3 years and 17 (14.17%) were ages of >3 years. 36 (30%) patients had mild, 50 (41.67%) had moderate and 34 (28.33%) had severe diarrhea. UTI was found in 40 (33.33%) patients. E.coli was the commonest organism found in 28 (70%) patients followed by K. pneumonia in 12 (30%) patients. Conclusion: Frequency of urinary tract infection was high among children with diarrhea. E.coli was the commonest organism associated with UTI. Keywords: Urinary Tract Infection, Diarrhea, Children
398 The Association between Obesity and Prostate Volume in Patients with Benign Prostatic Hyperplasia , Ijaz ur Rehman, Syed Atif Hussain, Humayun Khan, Bilal Habib, Raheel Sheikh
Background and Aim:Prostate histological enlargement known as Benign Prostatic Hyperplasia (BPH) is the major challenge for aging men with substantial burden on the health care system. It is associated with incomplete emptying sensations and impedance in flow due to symptoms of the lower urinary tract. Patient of higher body mass index (BMI) or obese have larger prostate volume (PV) and increase in lower urinary tract symptoms (LUTS) compared to normal BMI patient as reported by many researchers. The current study aim was to correlate the association between obesity and prostate volume in BPH patients. Materials and Methods: This cross-sectional was conducted on 140 BPH patients with 45 years to 75 years age range admitted in the department of Urology, DHQ Teaching Hospital, Dera Ismail Khan for six months duration from July 2020 to December 2020. BMI of each individual was calculated using height and weight measurements. Measuring tape was used to measure waist circumference (WC) while Prostate volume (PV) was measured with Transrectal Ultrasound (TRUS). Demographic and clinical parameters such as diabetes, smoking, prostate specific antigen (PSA) and hypertension were recorded on pre-designed proforma. Outcome variables were BMI and prostate volume. Results:Patients were divided into three categories based on BMI namely Obese, overweight and normal. Mean value for age and BMI was 61.34±5.324 and 26.89±4.13 respectively. Mean PV of Obese, overweight and normal BMI were 61.34±7.5, 59±3.10 and 50.91±8.5 cm3 respectively. The PV average score was 58.42±6.53 cm3. The mean value for waist circumference (WC) and PSA were 97.20 and 5.10±3.23 with 1.2-5.9 range respectively. The correlation between PV and BMI as well as between WC and PV, diabetes, smoking and hypertension shown no significance (p value=0.195). However, PSA and PV correlation give significant (p value 0.001-0.009) correlation. Conclusion:Central obesity plays a key role in developing and promoting BPH. The highest prevalence of BPH was found in patients with BMI >30kg/m2 while lowest in men of BMI <23 kg/m2. The current study found higher frequency of BPH among patients with WC >90 cm and lowest in men of WC <90 cm. A positive correlation was found between WC, BMI and PV. Individual quality of life affected by LUTS caused by severe risk of BPH due to increase in obesity. Balance diet and physical exercise help in maintaining the healthier BMI among obese and aged men. Keywords: Benign prostate hypertrophy, Bladder outlet obstruction, Prostate volume
399 Comparison of MRI and CT for Detection of Acute Cerebral Haemorrahge , Memona Nazir, Tahir Baig, Atif Hussain, Muhammad Tahir, Haider Ali, Muhammad Nauman Akram
Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy
400 Mean Changes in Sperm Count in Adult Males after Varicocelectomy , Mohib Ullah, Ibrahim Ahmed, Sana Ullah, Sami ur Rehman, Asif Khan, Muhammad Ali Shah
Background: Varicocele, a bilateral vascular condition in which hypoxia can induce ischemic damage to both testes due to hydrostatic pressures in the venous drainage system, is a prominent cause of male infertility with a complex pathogenesis. varicocele make up 35% of primary infertility and 81% of secondary fertility. Methodology: A quasi-experimental study was conducted from January 2018 to September 2018 at urology department of Nawaz Sharif Kidney Hospital and Saidu Group of Teaching Hospitals, Swat. Sample size was 261. The study included all males between the ages of 20 and 60 who had clinically evident varicocele. Result: Results of our study P-value for pre-operative and post-operative sperm count was 0.00001 so statistically significant. According to the age distribution, 93 patients were in the age group 20-30 (35.63%), 70 patients in age group 31-40 years (27.01%), 60 patients aged 41-50 (22.98%), 38 patients aged 51 to 60 (14.26) %) are shown in Table 2. All cases had varicocele on the left side. Conclusion: After inguinal varicocelectomy, sperm count increases in adult patients with clinically palpable varicocele. Keywords: Adult male, Sperm count, Varicocele, Varicocelectomy.
401 Magnetic Resonance Imaging and Computed Tomography in Emergency Assessment of Patients with Suspected Acute Stroke: A Prospective Comparison , Adnan Ahmed, Memona Nazir, Ajmaal Jami, Muhammad Tahir, Mahnoor Khalil, Tahir Baig
Background: Timely diagnosis has become important because the safety and efficacy of acute cerebral ischemia depend on rapid and accurate assessment and treatment within a few hours of the onset of symptoms.The overall incidence of stroke is about 2.4 per thousand people, with a small geographical difference. Studies have shown that the echo MRI gradient is as accurate as CT within 6 hours of the onset of symptoms in patients with acute stroke. Methodology: This study is a one-time prospective comparison of CT and MRI in acute stroke assessment. The study was conducted from April 2020 to September 2020at the Hayatabad Medical Complex in Peshawar, with the ethical approval of the hospital ethical review committee. Regardless of the onset date, the severity of symptoms, or final clinical diagnosis, a series of patients suspected of further referral to a stroke staff at the hospital are eligible. Results: Results showed that out of 178 patients referred for clinical suspicion of stroke, acute stroke corresponds to almost two-thirds of the final clinical diagnosis. MRI found 92 out of 178 acute strokes and 29 out of 178 CT. According to study results, the MRI has a higher frequency for detecting any acute stroke (ischemic or hemorrhagic) compared with CT (p <0.0001). All four readers agreed that 143 patients with MRI and 103 patients with CT respectively, 143 patients (80%, 76–84%) had an acute stroke. Conclusion: MRI is better for detecting acute ischemia than CT and can detect both acute and chronic bleeding. This should therefore be the preferred test method for accurate diagnosis of patients with suspected acute stroke. Samples of patients cover a variety of diseases that may arise in an emergency with a suspected stroke so that the results can be applied immediately in the clinic. Keywords: Magnetic Resonance Imaging, Computed tomography, Acutestroke.
402 Fetomaternal Outcome of Pregnancy with COVID-19: An Observational Study in Tertiary Care Hospitals of Pakistan , Nabila Khan, Zahra Wasim, Aesha Sadaf Rizwan, Afshan Ahmad, Muhammad Tahir, Irum Batool Hashmi
Background: The new corona virus first appeared in Wuhan, China in December 2019 and has since spread around the world to other countries. The World Health Organization believes that this new CoV-19 epidemic is a public health emergency of international concern (PHEIC) on January 30, 2020Worldwide.The mortality rate of this viral infection ranges from 2% in Pakistan to 14.4% in Italy. Lympopenia, elevated transminase, proteinuria, increased LDH, and C-reactive protein levels are all common laboratory findings in the early stages of the disease. Covid patients have experienced a variety of complications, including extreme pneumonia, ARDS, heart defects, sepsis and septic shock, and respiratory tract super infection. Methodology: This retrospective observational research study was carried out at the Gynecology Unit of MardanMedical Complex, Mardan and Combined Military Hospital, Risalpur for 06 months duration from April 2020 to September 2020. In a pre-constructed data collection form, biochemical and radiological parameters of medical history, test results, symptoms, pregnancy, and neonatal outcomes were noted. Patients treated in an outpatient setting were not included in the study. Results: There were 121 patients in total, with mean age of 27 having standard deviation ± 5, having range 19-40 years. 48.3% pregnant women reported their first pregnancy(primigravida). 51.3% of SARS-Cov-2 were in their 3rd trimester while 34.7% were in their 35-40 weeks of gestational age. Common complications are gestational hypertension (PIH) (16 cases), hypothyroidism (14 cases) and gestational diabetes (GDM) 9 cases. More than half (53%) of patients are asymptomatic. Common symptoms are cough (22%) and fever (11%). The incidence of multiple organ failure was 2% as shown in table 01. Lymphopenia was common (84%). A CT scan of 24 patients showed bilateral invasion. Conclusion: COVID-19 has a negative impact on the foetus, according to our results. Although pregnant women do not seem to be more vulnerable to COVID-19 complications than non-pregnant adults, previous research has suggested that pregnant women could be at higher risk for negative pregnancy outcomes such as preterm birth, foetal pain and respiration, symptoms, and LBW in a newborn baby. Keywords: Corona virus, COVID-19, Pregnancy, Outcome.
403 Comparison of Human Thymus Gland between Young and Old Age , Faiza Mehboob, Ponum Mirani, M. Kamran Ameer, Khurram Shabeer, Muhammad Ali Qamar, Mah Noor Arshad
Aim: Study was conducted to examine the different parameters of human thymus glands of young and old patients and compare the findings between both age groups. Study Design: Comparative/observational study Place and Study: Study was conducted at Anatomy department of Nishtar Medical University Hospital, Multan for duration of six months from 15th January 2020 to 15th July 2020. Methods: Total 54 specimens of human thymus of 54 patients were enrolled in this study. All specimens were divided in to two groups I and II, Group I contains 27 patients with ages <30 years and group II with 27 patients having ages 45 to 60 years. All specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Compare the different parameters such as thickness of interlobular connective tissue and thymic capsule, length and number of Hassal’s corpuscles between both groups. Data was analyzed by SPSS 24.0. Results: In group I 12 (44.44%) patients were ages <15 years and 15 (55.56%) patients were ages >15 years. In group 13 (48.15%) and 14 (51.85%) patients were ages <50 years and >50 years. There was a significant difference observed between both groups regarding thickness of interlobular connective tissue and thymic capsule, quantity and length of Hassal’s corpuscles with p-value <0.05. Conclusion: It is to be concluded that patients with young age had significantly less thickness of thymic capsule and interlobular connective tissue with more in number and decreasing size of Hassal’s corpuscles as compared to old age patients. Keywords: Human Thymus Glands, Young Age, Old Age
404 Multi Drug Resistance (MDR) Urinary Tract Infection: An Evidence Based Study , Nasir Orakzai, Liaqat Ali, Majid Khan Kakakhel, Arshad, Faiza Hayat, Ihsanullah Khan
Background: Urinary tract infections are the most frequently reported infections that drive the use of antibiotics around the world. UTI is the 4th most common healthcare-associated infection. Multidrug-resistant (MDR) organisms are predominantly bacteria that are resistant to one or more classes of antimicrobials. The increasing rise in the incidence of MDR-UTI has resulted in increased morbidity, mortality, and treatment cost of the patients. Thus, it is important to highlight the magnitude of the problem, identify the risk factors that result in MDR-UTI, and to take appropriate measures to control its occurrence. Objective: To determine the magnitude of the multidrug-resistant bacteria, their antibiotic-resistant profile, andtheir effect on the treatment cost of the patients Methods: It is a descriptive study conducted in the Department of Urology at the Institute of Kidney Diseases (IKD) from Jan 2019 till 30th March 2020. A total of 54 patients with multi-drug resistant UTI were included in the study irrespective of age and gender. All the data was recorded on a structured pro-forma and was analyzed on SPSS. Results: A total of 3190 patients were operated on from Jan 2019 till 30th March 2020. Out of which 54 patients (1.6 %) developed MDR-UTI. Among them,38 were male and 16 females. The mean age of the patients was 41 ± 18.4. Urolithiasis with infections was found most frequent, in 32 (59.3%) patients. All patients were on broad-spectrum oral antibiotics and had a history of urethral catheterization before the development of MDR-UTI. The most common procedure was Emergency cystoscopy and DJ stent 15 (27.8%). Followed by Percutaneous nephrostomy in 8 (14.8%). Regarding co-morbidities, 38(68.5%) patients had none, 3 patients had diabetes and 6 patients were having Diabetes and Hypertension. Pseudomonas aeruginosa was found most frequent microorganisms in 34 (63%) patients while E.coli in 10 (18.5%) and Klebsiella in 5 (9.3%) patients. Colistin was found sensitive in 36 patients (66.7%). The mean hospital stay in MDR-UTI is 9.28± 5.17 days as compared to 2.1 days in routine cases. Approximately a 4-fold increase was observed in medicines alone in the management of MDR UTI. We recorded 1 mortality (1.9%), case of MDR urosepsis. Linear regression revealed previous use of antibiotics; catheterization, old age, and endo-urological procedures in an emergency as independent risk factors for MDR-UTI. Conclusion: MDR-uti is an emerging local problem. pseudomonas aeruginosa is the most frequently found microorganism in the present setup. it is associated with significant morbidity and very high treatment cost. Keywords: Urinary Tract Infection, Multidrug Resistance, Micro-Organism, Urology, Antimicrobials
405 Frequency of Bacteriological Organism in Patients with Thoracic Empyema , Muhammad Umer Salim, Syed Mohammad Umair Dilawar, Syed Tabish Rehman
Objective: To examine the frequency of bacteriological organism present in pleural fluid, in patients positive with thoracic empyema, assessed on the basis of pus culture test. Study Design: Cross-sectional study Place and Duration: Inpatient Department, Chest Medicine Ward 12, JPMC, Karachi, Pakistan for six months duration from 11 February 2019 to 10 August 2019. Methodology: One hundred and thirty nine patients diagnosed with Thoracic Empyema were included in this study. All patients included in the study shall undergo Pus Culture Test prior to identify the presence or absence of bacterial organism. Those with positive bacterial findings (mainly Staph Aureus and gram negative organisms) were further assessed for stratification with reference to their possible variable affecters. Results: There were 107 males and 32 females (%M: F ratio 77:23), with Empyema Thoracic, aged between 25-55 years and having a mean age of 36.28 year (± SD 8.206), were studied. The Pus Culture Test rate was 100% whereas duration of empyema was of average 18.38 days (± S.D 11.16). One hundred and four patients (74.82%) were carrying investigated bacteria which were staph. Aureus in 17 (12.50%) patients. GRAM NEGATIVE ORGANISMS in 87 (62.58%) patients. Echerea Coli in 12 (8.3%) patients, Pseudomonas. Aeruginosa in 46 (33.33%) patients, Klebseilla in 17(12.50%) patients, Enterococcus Species in 12 (8.3%) patients. While remaining thirty five patients (25.17%) were found to have other bacteria, including Streptococcus, Proteus Mirabillis and Acinobacter, responsible for Empyema. Conclusion: It is concluded that 74.82% patients had bacteria and among them 62.58% patients had gram negative organism. Pseudomonas Aeruginosa was the most common organism followed by Klebseilla and staph. Aureus. Keywords: Empyema, Thoracic, Pleural Effusion, Thoracentesis, Thoracostomy
406 Mortality Rate and Causing Factors in Ventilator Associated Pneumonia in Children , Riffat Farrukh, Amber Naseer, Shaheen Masood, Ibrahim Shakoor, Farhina Nasir, Sarwat Sultana
Aim: To estimate the incidence of ventilator-associated pneumonia (VAP) and to identify causing microbiological organismsand VAP related mortality rate in children admitted to the ICU. Study design: This was a Cross-sectional and an observational study. Study place and duration: In the Pediatric department of Abbasi Shaheed Hospital, Karachi, for one-year duration from May 2020 to May 2021. Methodology: All admitted children to the pediatric ICU (PICU) and ventilated were selected and observed for any features suggestive of VAP. All suspected children have Partial septic signs. A VAP will be categorized ifchild remains on ventilator for more than 48 hours and when a patient had 2 of these signs of nosocomial infection - TLC <4,000 or> 15,000 mm3 , fever> 101 ° F, CRP> 48 mg / L, neutrophils> 85% or a new chest X-rayexhibited pneumonia withradiological sign of progressive, persistent or new infiltrates. The chi-square test was used for comparison of percentages with a value of Less than 0.05 p. Results: Of all the cases admitted, the average length of ICU stay was 8.65 ± 6.45 per day. Children who needed VAP required 14.2 ±9.5 days of ventilation and 7.5± 5.2 days for children who have not VAP progression. Of 100 cohort of children necessitating ventilation, 22 died and 2 were left without advice or serious illness, with a total mortality of 22%. Conclusion: The VAP incidence in this study was 22%. Features related with a higher incidence of ventilator-associated pneumonia include age <1-year, continuous intravenous sedation and unplanned intubation in emergency situation. Features suggestive of underlying VAP encompassed, CRP> 48 mg / L, purulent tracheal secretions, positive tracheal culture of aspirate and positive X-ray results. Key words: Ventilator-associated pneumonia (VAP), Nosocomial infections,PICU and Children
407 Comparison of Slow Rate versus Fast Rate Extracorporeal Shock Wave Lithotripsy in Patients with Urolithiasis , Muhammad Musa Kakar, Asadullah, Masha Khan, Ijaz Ur Rehman
Objectives: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in patients undergoing treatment of urolithiasis. Study design: Randomized controlled trial Place & Duration of Study: This study was conducted in Urology Department of Sandeman Civil Hospital, Quetta for one year duration from 1stApril 2020 to 30thMarch 2021. Methods: Total ninety patients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: There were 32 (71.1%) male patients and 13 (28.9%) female patients in group A. In group B, there were 28 (62.2%) male patients and 17 (37.8%) female patients. Mean age in group A was 35.61+4.19 years while in group B, the mean age was 34.11+69.32 years. The success rate of slow rate extracorporeal shock wave lithotripsy was 36 (80%) and that of fast rate extracorporeal shock wave lithotripsy was 21 (46.7%) (p-<0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis. Keywords: Extracorporeal shock wave lithotripsy, Slow rate ESWL, Fast rate ESWLObjectives: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in patients undergoing treatment of urolithiasis. Study design: Randomized controlled trial Place & Duration of Study: This study was conducted in Urology Department of Sandeman Civil Hospital, Quetta for one year duration from 1stApril 2020 to 30thMarch 2021. Methods: Total ninety patients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: There were 32 (71.1%) male patients and 13 (28.9%) female patients in group A. In group B, there were 28 (62.2%) male patients and 17 (37.8%) female patients. Mean age in group A was 35.61+4.19 years while in group B, the mean age was 34.11+69.32 years. The success rate of slow rate extracorporeal shock wave lithotripsy was 36 (80%) and that of fast rate extracorporeal shock wave lithotripsy was 21 (46.7%) (p-<0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis. Keywords: Extracorporeal shock wave lithotripsy, Slow rate ESWL, Fast rate ESWL
408 Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites , Salman Khan, Ihsan Ullah, Moeen ul Haq, Umar Badshah, Maryam Nazir
Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)
409 Association between Trigeminal Neuralgia and Multiple Sclerosis: Role of Magnetic Resonance Imaging , Tahir Baig, Adnan Ahmed, Atif Hussain, Rabia Shah, Muhammad Tahir, Rashid Mehmood
Background: Trigeminal neuralgia (TN) is a severe neuropathic unilateral facial pain affecting about 30% percent of the world population. Neuropathic pains are considered to be associated with multiple sclerosis (MS).Multiple sclerosis is a chronic inflammatory condition causing demyelination and degeneration of axons in central nervous system. Objective: The objective of the study is to determine role of Magnetic Resonance Imaging to find association between trigeminal neuralgia and multiple sclerosis. Methods: The prospective cohort study was conducted for six months in Radiology Department of Hayatabad Medical Complex, Peshawar from September 2020 to February 2021. Initially 250 patients were screened for multiple sclerosis. The study recruited a total of 35 patients of MS visited neuroradiology department, out of which 26 patients were enrolled in the study. The participants with age of 18 years and onward of both genders with definitive symptoms of TN with MS that is having unilateral TN pain (that is sharp shooting electric pulse like) lasting for up-to 2minutes precipitated with an environmental stimulus were included in the study. The patients (n=6) with bilateral MS with TN and cognitive disturbances (n=3) were excluded from the study. Results: The study recruited a total of 26 participants with MS related TN. The clinical examination didn’t show any difference between the three groups with the p-value less than 0.001. Age at the onset of MS was younger in patients with MS related sensory disturbances compared to other two groups, with p-value less than 0.05. The frequency of the affected side was different in all three groups with the p-value less than 0.05 as tested by Fischer exact test. Trigeminal reflex tests done for different components such as R1 and SP1 showed longer latency periods for the affected side after stimulation and unaffected side after stimulation with the mean of 14.2± 4.4 and 15.3±3.2, 16.3±4.2 and 17.4±5.2ms and p-value less than 0.001 as shown by Wilcoxon test. Conclusion: The study showed significant association between trigeminal neuralgia and multiple sclerosis with the greater efficacy of using MRI as imaging technique to find this association. Keywords: Multiple sclerosis, Magnetic Resonance Imaging, Trigeminal neuralgia
410 Incidence and Risk factors of Uterine Scar Dehiscence after Previous Caesarean Section , Rizwana Naz, Maryam Shoaib, Sakina Naeem, Samia Saifullah, Safia Ewaz Ali
Objectives: To assess the incidence and risk factors of scar dehiscence. Methodology: This was a prospective observational study where a total of 210 patients were involved over a period of six months (May 2020 to November 2020) who came to Sandeman Provincial Hospital, BUMHS gynaecology unit 1. The parturient were above the age of 18 and had previous uncomplicated lower segment caesarean sections. Patients with previous classical caesarean section and ruptured uterus diagnosed pre or intra-operatively were excluded from the study. Sampling technique: Non-probability convenience sampling technique will be used. Results: In this study, the mean age of the patients was 31.57 ± 4.26 years, the mean gestational age was 34.43± 4.45 weeks. The incidence of scar dehiscence was observed in 47 patients. Conclusion: Uterine Scar Dehiscence is one of the factors that increases fetal and maternal morbidity and mortality rate. Its incidence is found to be related with C-sections, inadequately short intra-pregnancy time interval, preterm delivery, VBAC and trial labour. In this study, the incidence of scar dehiscence was 22.38%. Keywords: Previous one caesarean section, scar dehiscence, scar tenderness.
411 Efficacy of Preoperative Misoprostal in Reducing Hemorrhage during Abdominal Myomectomy , Irum Batool Hashmi, Asim Shafi, Ayesha Choudhary, Wasim Ahmad, Muhammad Hamayun Khan, Moniza Imran  
Objective: The aim of this study is to determine the efficacy of preoperative misoprostal in reducing hemorrhage during abdominal myomectomy. Study Design: Prospective comparative randomized double blinded Place and Duration: Conducted at DHQ Zanana hospital Dera Ismail Khan for one year duration from January 2019 to December 2019. Methods: Total 100 patients underwent abdominal myomectomy were presented in this study. Patients were aged between 18-45 years of age. Patients’ detailed demographics including age, body mass index and parity were recorded after taking informed written consent. Patients were categorized equally into two groups, I and II. Group I had 50 patients and received single dose 400 micrograms of misoprostol transrectally one hour preoperatively and group II had 50 patients and received 2-tablets of placebo preoperatively. Outcomes intraoperative blood loss, blood transfusion, hysterectomy and complications among both groups were assessed. Complete data was analyzed by SPSS 23.0 version. Results: Mean age of the patients was 32.16±9.44 with mean BMI 26.07±10.44 kg/m2. There were no significantly difference among age and body mass among both groups. 60 Patients had 0 parity, 30 patients had parity 1 and the rest were had parity 2. Mean pre-operative hemoglobin in group I was 13.64±8.55 and post-operative was 9.88±8.55 and in group II mean pre-operative hemoglobin was 13.55±8.55 and post-operative was 9.12±5.55. Mean intraoperative blood loss in group I was 388.17±37.18 ml and in group II was 501.16±17.64 ml. Post-operatively blood transfusion in group I was among 2(4%) cases and 3 (6%) in group II. Mean hospital stay in group II was greater as compared to group I. Nausea, vomiting and shivering were the complications found in this study. Conclusion: We concluded in this study that the use ofmisoprostol preoperatively during abdominal myomectomy was effective safe and useful in reduction of intraoperative blood loss and post-operatively blood transfusion among patients. Keywords: Abdominal myomectomy, Misoprostol, Placebo, Intraoperative, Blood loss
412 Frequency of Patients with Coronary Artery Disease Achieving Optimal Glycemic Control at Tertiary Care Hospital, Karachi , Sharafuddin, Javed Khurshed S., M. Hashim Kalwar, M. Hassan Butt, Sarfraz Hussain Sahito5, M. Rafique Kanhar
Objective: To determine frequency of glycemic control in patients with coronary artery disease (CAD) visiting to National Institute of Cardiovascular Diseases, Karachi. Study Design: Descriptive Cross-Sectional study Place and Duration: This study was conducted at Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan for six months duration from 12th October 2019 to 11th April 2020. Methodology: One hundred and ten patients of both gender with coronary artery disease were enrolled in this study. Informed consent was taken after explaining the procedure, risks and benefits of the study. In our study, all the included patients were given the emergency treatment and their blood samples were sent to laboratory to assess the outcome variable i.e. glycemic control. All the data was analyzed by SPSS 24.0. Results: Mean ± SD of age was 62.5±8.4 years. Out of 110 patients, 65 (59.1%) were male while 45 (40.9%) were female. Obesity was found in 41 (37.3%) patients. Glycemic control was noted in 20 (18.2%) patients. Conclusion: It is to be concluded that less glycemic control was noted among coronary artery disease (CAD) patients with increasing prevalence of diabetes. Indicators of quality care (HbA1c & other complications) should be assessed regularly for better diabetes management. Keywords: Glycemic Control, Coronary Artery Disease, Type 2 Diabetes, Risk Factors
413 Determine the Prevalence of Migraine in Pregnant Women Presented with Severe Headache , Jawad Hussain, Muhammad Saqib, Nadia Khan, Sohail Khan, Fawad Jan, Muhammad Shahid Iqbal
Objective: The main objective of this study is to determine the prevalence of migraine in pregnant women presented with severe headache. Study Design: Retrospective study Place and Duration: Study was conducted at department of Neurology Ayub Teaching Hospital, Abbottabad for duration of eighteen months(from August 2019 to February 2021). Methods: 120 pregnant women with ages 18-45 years were presented in this study. Patients’ detailed demographics including age, body mass index and gestational age was recorded after taking informed written consent. Patients with severe headache were enrolled and International Classification of Headache Disorders-II criteria were used for diagnosis of migraine. Trimester of pregnancy were assessed in terms of 1st, second and third. Complete date was analyzed by SPSS 20.version. Results: Mean age of the patients was 32.16±6.44 years with mean BMI 25.07±2.44 kg/m2. Most of the patients 70 (58.3%) were from third trimester. Gestational age of the pregnant women was 22.64±11.03 weeks. 75 (62.5%) were from urban areas and mostly had low socio-economic status 80 (66.7%). 45 (37.5%) women were educated. 50 (41.7%) cases diagnosed migraine, 35 (29.17%) cases had tension type headache (TTH) while the rest were showed only severe headache among pregnant women. Most common symptom was nausea 24 (48%), followed by vomiting 16 (32%) and sensitivity to light was found in 10 (20%) women. Conclusion: In this study, we concluded with the prevalent condition for pregnant women of migraine and headache-related impairment. Migraine and headache during pregnancy are critical for diagnosis and treatment. Keywords: Headache, Pregnancy, Migraine, Prevalence
414 Maternal Education and Acute Diarrhea Among Children Aged 2-5 Years In Pakistan: Cross Sectional Study , Fatima Ehsan, Ayesha Ehsan, Wajahat Ullah Khan, Rizwan Masud, Hamad Hanif, Abeerah Zainub, Talha Laique
Childhood diarrheal disease is the second leading cause of death globally. All over the world, children below five years of age experience, on average, 3.2 episodes of diarrhea per year. Objectives: To explore an association of maternal education with childhood diarrhea in Pakistan. Study Design: Cross sectional study. Methodology: This study was conducted from Aug 2016 to Jan 2017 in Combined Military Hospital (CMH), Peshawar following approval from ethical review board. Total children under study were 363 aged 2 to 5 years, amid whom 121 were acute diarrhea cases and 242 were healthy controls leading to cases control ratio as 1:2. Data collection was done through semi structured questionnaire asked from mothers. Statistical analysis: Data was analyzed by SPSS software, version 22. To compare the association of maternal education with acute diarrhea, chi square test was applied at 5% level of significance. Statistical significance was taken at p value <0.05. Results: In present study, there was significant association between formal education of mothers and acute diarrhea with a highly statistically significant association (p < 0.001) observed showing increased proportion of childhood diarrhea, with increasing levels of education in mothers. Conclusion: We concluded that a significant increase in childhood diarrhea with higher levels of maternal education refutes the commonly observed finding. We need to further probe the underlying causes to minimize this high observed morbidity. Key Words: Maternal Education, Child Health and Safety and Acute Childhood Diarrhea
415 Impact of BMI on Covid-19 Clinical Features and its Management: A Cross Sectional Study , M. Zeeshan Anwar, Rizwan Masud, Iffat Rafique, Syed Anees Ahmad Gardezi, Matloob ur Rehman, Hira Ayaz, M. Razi ul Islam Hashmi, Shaiza Shoaib, Shoaib Naiyar Hashmi, Talha Laique
The whole world is suffering from COVID-19 pandemic. This disease has halted life and has a negative impact on physical and mental health of all individuals. Objectives: To identify impact of BMI on Covid-19 clinical features and its management in terms of relationship among patients at government hospitals, Pakistan. Study Design: Cross-sectional study. Methodology: This study enrolled 206 patients having both genders and was carried at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan following ethical review committee’s (ERC) approval. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of BMI with COVID-19 symptoms having P-value greater than 0.05. There was an association of BMI with gender as P-value (0.000*). There was an association of BMI with age having P-value (0.000*). Conclusion: From present study, we concluded that there was a correlation between BMI and individuals with higher BMI as they developed more serious symptoms and required active management strategies in comparison to individuals who were either underweight or normal weight. Key Words: Covid-19, BMI, Treatment and Gender.
416 Comparing Diameter of Hepatic Portion of Inferior Vena Cava During Normal Breathing in Normal Individuals Versus Cirrhotic Patients: Case Control Study   , Afshan Israr, Sehrish Shamrez Khan, Sadia Azmat, Talha Laique
A non invasive ultrasound technique has been proposed as a mean of detection of early fibrosis by measuring changes in the diameter of the hepatic inferior vena cava (IVC). Objectives: To determine the mean diameter of hepatic portion of inferior vena cava and mean reduction in its diameter by inspiration in normal and cirrhotic patients using USG. Study Design: Case control study. Methodology: This study (n=60) was conducted after ethical review committee’s (ERC) approval from April-October 2018 at Department of Radiology, Military Hospital Rawalpindi. Patients with stage 5 and 6 of cirrhosis were taken as cases. Controls had sonographically normal livers. The maximal diameter of IVC was measured during normal breathing first followed by a deep breath. Statistical analysis: Data was analyzed by SPSS, v-20. Parameters were measured by applying t-test with p≤0.05 as significant. Results: The IVC diameter during deep inspiration was 1.217±0.168 cm and 1.711±0.422 cm among controls and cirrhotic cases respectively (p= 0.00). The mean IVC diameter decrease was 1.02±0.25 cm and 0.03±0.02 cm by inspiration among controls and cases respectively having statistically significant p-value (<0.05). Conclusion: We concluded that stiffness of the hepatic parenchyma have caused the physiological changes in the diameter of IVC enhanced by deep respiration. Thus, it can be used as a tool for evaluation of cirrhotic patients. Key Words: Cirrhosis, Hepatic Portion of Inferior Vena Cava, Liver and Sonography.
417 Assessment of Self-Medication and Their Associated Risks in Medical and Non-Medical People of Sialkot: Cross-Sectional Study , Yasir Sadiq, Kanwal Khalid, Amtul Hafeez, Mirza Muhammad Abdullah, Mudassar Nazar, Aisha Hadayat, Talha Laique
Self-medication is an important health issues among patients’ behavior in reaction to their ailment. Objectives: To assess self-medication practices and their associated risks in medical & non-medical people of Sialkot, Pakistan. Study Design: Cross sectional study. Methodology: Present study enrolled 250 subjects from Sialkot between October-November 2020 through self-administered web-based questionnaire. It assessed demographic details, prevalence and practice of self-medication along-with the attitude of respondents towards self-medication and associated side effects. Statistical analysis: Data was analyzed by SPSS, v-24. Results: Among enrolled subjects, mean age was 21 ± 1.8 years. Female: Male percentages were (59.4%: 40.2%). Self-medication was common among 85% subjects. The most common reason for self-medication in medical people was to need a quick relief (42.9%) and in non-medical people were previous experience with symptoms (35.2%). Conclusion: We concluded that habit of self-medication is a common practice among educated generation knowing the fact that it harms their lives. Hence, need of hour is to educate them in-order to ensure safe practices. Key Words: Self Medication, Prevalence and Risk Factors.
418 Analysis of all Forensic Autopies at Sheikh Zaid Hospital from 2016 to 2020: A Retroscpective Study , Fariha Tariq, Sumaira Sarwar, Khalid Mukhtar, Summyia Sadia, Shahid Nadeem, Humera Rehman, Talha Laique
Autopsy can lead to the cause of death most accurately in both natural as well as unnatural deaths. Purpose: To determine the pattern of deaths seen on autopsy in a tertiary care hospital and to determine the cause of deaths and manners of deaths with special focus of homicidal cases, seen on autopsies in the past few years. Study Design: Retrospective study. Methodology: Patients (n=186) were enrolled in present study held at Forensic department, Sheikh Zaid Hospital, Lahore-Pakistan. Data of 186 autopsy cases of 5 years from 2016 to 2020 was entered and analyzed. All the forensic autopsies done at the forensic department, irrespective of the age and gender were included in the study. Statistical analysis: Data analyzed by SPSS 22.0v. Results: Most of the patients were of age group 20 to 30 years. Males were 67% while females were 20% in present study. Among these 186 cases of autopsy, manner of death was homicidal in 43% (n=80) autopsies, accidental in 10% (n=19) and suicidal deaths was in 1.6% (n=3) while in 34% (n=64) autopsy cases cause of death cannot be determined. Conclusion: This study concluded that the cause of death couldn’t be determined in around 1/3rd autopsies; showing that steps should be taken to improve performance of forensic departments. As young males are mostly involved in criminal acts, illegal activities should be controlled with education and law enforcement. Key Words: Autopsy, Audit, Manner of Death and Cause of Death.
419 Prevalence of Mechanical Neck Pain among University Students: An Observational Study , Maham Gull, Wajid Khalil, Muneeb Jaffar, Jahan Ara, Alishba Mustansar, Talha Laique
Mechanical neck pain influences forty five - fifty four % of the all general community eventually during their lives and can come about extreme inability. It is an immense medical issue among undergraduate students because of poor postural habits. Sitting for delayed periods with forward head act, such as reading books and utilizing PCs, work stations and the phone will cause pressure in muscles and compressive power in the cervical spine results in mechanical neck ache. Objectives: To determine the prevalence of mechanical neck pain among university students. Study Design: An observational study. Methodology: In present study, a sample size of 143 was used by using a convenient sampling technique. Subjects were enrolled according to inclusion and exclusion criteria. Data was collected by circulating Oswestry Neck Disability Index (ODI), Northwick Park Neck Pain Questionnaire and Visual Analogue Scale. The research was conducted in public sector universities of Faisalabad. Statistical analysis: Data was analyzed by SPSS, v-24. Results: Study results showed that 36.4% had mild, 37.1% had moderate and 26.6% had severe mechanical neck pain. Conclusion: We concluded that university students were at greater risk of mechanical neck pain. Key Words: Neck pain, Students and Oswestry neck Disability index (ODI)
420 Hepato curative effects of Silymarin and Cymbopogoncitratus stem infusion: RCT , Sidra Mumal, Abdul Azeem, Talal Zafar, Hina Aslam, Tasneem Murad, Aamna Khokhar, Talha Laique
People all around the world suffer from liver diseases, which is a serious health problem. Purpose: To observe the synergistic effects of Silymarin and Cymbopogoncitratus stem infusion on liver in acetaminophen induced hepatotoxicity in rats. Study Design: Laboratory-Based Randomized Control Trial. Methodology: Total forty adult rats were divided into four groups (10 each). Group 1 was taken as control group. After initial sampling at day 0, Acetaminophen (300 mg/kg) was injected to 30 rats via intra-peritoneal route. At day 8, rats were further divided into three groups. Group 2 was a disease control group. Group 3 was given Silymarin (100 mg/kg) and group 4 was treated with Silymarin (100 mg/kg) plus Cymbopogoncitratus stem infusion (130 mg/kg) through gavage method for fourteen days. At day 21, rats were sacrificed for histological examination after terminal sampling. Statistical Analysis: Mean± SEM was calculated and analyzed through SPSS 20. P-value less than 0.05 was considered statistically significant. Results: Rats from group 2 showed marked elevation (p<0.05) in serum markers. There was marked sinusoidal dilatation and necrosis present in group 2 rats.Silymarinin group 3 and Silymarin plus Cymbopogoncitratus stem infusion in group 4 significantly lowered the biochemical enzymes as well as considerably reversed the histological changes in comparison to group 2 rats. Conclusion: We concluded in present study that synergism was observed in group 4 rats. There was more reversal of hepatic injury in group 4 rats. Key words: Cymbopogoncitratus, Silymarin and Synergism.
421 Common mucocutaneous manifestations of patients with End Stage Renal Disease: A comprehensive review study , Seyed-Mohamad-Sadegh Mirahmadi, Kimia Saleh Anaraki, Azadeh Goodarzi
One of the notable points in ESRD patients is the multiplicity of skin manifestations which can include a wide range. It can also affect the living standards of patients due to its many types and severity. Careful study, as well as intense follow-up of these manifestations, can help physicians in timely diagnosis and their control or treatment. In this study, we tried to study the common mucocutaneous manifestations that occur in these patients. All references can be searched from PubMed. Sources of this study have been studied for clinical manifestations, pathophysiology, and treatment of skin manifestations in ESRD patients. In this study, xerosis, pruritus, pigmentation disorders, half and half nails, perforating disorder, and skin infections as well as appendageal disorders (hair and nail) in ESRD patients have been studied. These can be associated with other diseases and increase by disease severity. For better results and more help to patients with this disease, it seems that more and more comprehensive studies are needed. Key words: End stage renal disease, ESRD, mucucutaneous, skin, dermatology, xerosis, pigmentation disorders, infection, perforating disorder, half and half nails
422 Lamivudine associated hair repigmentation and a comprehensive review on reversal canities , Mohammadreza Ghassemi, Elham Behrangi, Masoumeh Roohaninasab, Afsaneh Sadeghzadeh-B., Niloufar Najar N., Habib Hasannejad, Azadeh Goodarzi
Background and Objective: Hair whitening is among important cosmetic problems in both genders but more annoying between women which necessitates more research about hair repigmenting methods or probable therapeutic drugs. The objective of this research was to review the mechanisms of hair pigmentation as well as the drug-related hair repigmentation. Methods: In this review article, we searched PubMed, Medline and Google scholar databases and reviewed all related articles in this area (hair repigmentation) since the reversal of canities has been an important cosmetic concern many years ago. Results: No reports of changes of hair color have been identified with lamivudine in the present research. Herein can be reported as the first case of hair repigmentation following the use of lamivudine. Conclusion: We reported a case of hair pigmentation with lamivudine for the first time that could be a desirable drug-induced side effect, also review all related articles about hair repigmention or reversal of canities. By research on probable mechanisms of drug-induced hair repigmentation, we may achieve a therapeutic strategy of hair graying as an important and highly prevalent cosmetic concern. Keywords: Lamivudine; hair repigmentation; reversal canities; drug-induced, review
423 Psychiatric Disorders in New Cancer Patients in Semnan , Nilufar Safaie, Hadi Zeinali, Nazila Ghahramanfard, Majid Mir Mohammad Khani, Mohammadreza Moonesan
Introduction & Objective: Definitive diagnosis of cancer in patients, the duration of treatment, and grueling treatment methods can provide a basis for psychiatric disorders such as depression and anxiety in patients; accordingly, this study was conducted to evaluate the factors affecting these disorders in patients who were newly diagnosed with cancer. Materials and Methods: This descriptive-analytical study was performed on 122 cancer patients in 1397 in Semnan, Iran. Data were collected using the HADS questionnaire. In order to compare the subgroups in terms of frequencies, Chi-square test and, if necessary, more accurate Fisher test were used. Numerical variables were compared using T-test or Mann Whitney U test. Results: In the present study, the mean of total anxiety was about 28.6% and the mean of total depression among patients was 26.2%. 80% of women and 74.3% of people without income had anxiety and there was a significant relationship between gender and income with anxiety in cancer patients (p <0/05). The variables of age, sex, income level, education level were not significantly associated with depression (P> 0.05). Conclusion: Considering the levels of psychiatric disorders, especially anxiety and depression in cancer patients, to control this issue, providing psychiatric interventions in the treatment program of these patients can be effective. Key words: Cancer, Anxiety, Depression, Psychiatric disorders
424 Correlation Between Point Shear Wave Elastography and Liver Function Tests as A Predictor of Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease , Shahla Mohammed Saeed Rasul, Ali Khalaf Salim, Hiwa Abubakr Hussein
Aim: of this study is to correlate between point shear wave elastography(pSWE) and liver function tests (LFTs) to predict liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Materials and methods: this study is a cross sectional study conducted in Ultrasound Clinic in Suleymaniya city. The duration of the study was through the period from 1st of November, 2018 to 30th of June, 2019 on 50 NAFLD patients. After confirming NAFLD diagnosis, the patients were referred to Ultrasound Clinic to complete Point Shear Wave Elastography (PSWE). Results: showed a mean PSWE of NAFLD patient was 4.12±0.87 Kpa; 18% of them had high PSWE (> 4.6). Elastography fibrosis score was distributed to F0 (82%), F1 (6%), F2 (8%) and F3 (4%). The Aspartate Aminotransferase Platelet Ratio Index (APRI) fibrosis scores were distributed to F0 (48%), F1-3 (48%) and F4 (4%), There was a highly significant association between elastography fibrosis score and APRI fibrosis score of NAFLD patients (p<0.001), There was no significant association between elastography fibrosis score and Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) values of NAFLD patients (p=0.5). Conclusion: this study showed that the point shear wave elastography is a valuable noninvasive diagnostic technique for predicting significant liver fibrosis among patients with non-alcoholic liver fatty diseases and there is significant correlation between APRI score and pSWE score. The current gold standard in the diagnosis and staging of liver fibrosis is liver biopsy. Point shear wave elastography is among the noninvasive procedures to assess liver fibrosis. Keywords: Non-alcoholic fatty liver disease, Point shears wave elastography, Liver fibrosis.
425 A Retrospective Large Original Study of Cutaneous Melanoma , Hojat Eftekhari, Shabnam Fahim, Zeinab Aryanian, Azadeh Goodarzi, Ali Sadeghinia, Pedram Nourmohammadpour, Monireh Mazandarani, Ali Pourali, Sepehr Khosravi, Zohre Khodashenas, Maisa Nouralinejad  
Background: The incidence of cutaneous malignant melanoma (CMM) has increased continuously during recent decades among many populations of the world. Cutaneous Malignant Melanoma is a malignancy with a demographic and ethnic disparity located in the skin and mucous membranous. The objective of this study is to determine Cutaneous Melanoma (CM) characteristics in Iran. Methods: This is a retrospective cross sectional study. We used data from Razi Hospital, Tehran University Melanoma Cancer Registry. The cases included in this study met the following criteria: primary CM, in situ or invasive, diagnosed in the recent past ten years. We have evaluated prognostic factors in addition to basic demographic data. Result: A total of 193 melanomas (99 males (51.3%) and 94 females (48.7%)) were included. The mean age was 58.3±15.8years. The most frequent location for melanoma was lower extremity (75 patients, 38.9%). The most frequent subtype for melanoma based on histopathology was the Acral Lentiginous Melanoma (ALM) (74 patients, 38.3%). There was statistically significant difference between histological subtypes of melanoma and Breslow thickness (p? 0.00 1). Conclusion: Present study showed risk factors such as age and pre-existing nevus are important factors in CMM incidence in Iran. Early detection of melanoma is a key factor in improving patients’ survival. Keywords: Cutaneous Melanoma, Malignant Melanoma, Cancer, Epidemiology, Histopathology, Immunohistochemistry, Histology, IHC, Original study, Skin cancer
426 Evaluation of Frailty Elderly Syndrome, General Health and Cognitive Disorders in the Elderly and Their Relationship with Demographic Factors and Underlying Diseases   , Hamid Taghinejad, Sattar Kikhavani, Sara Mohammad Nejad, Nafiseh Sohrabi
Introduction: Due to the vulnerability of the elderly in the community and the increase in their population and the problems occurring due to aging in the elderly, the present study aimed to investigate the frailty elderly syndrome, general health and cognitive disorders in the elderly in Ilam in 2020. Materials and Methods: This cross-sectional study was performed on 267 elderly referring to teaching hospitals in Ilam. Data collection tools were GHQ-28, MMSE and Edmonton questionnaires. Data were analyzed using SPSS v.24 statistical software using independent t-test, chi-square, Fisher’s exact test, one-way and two-way analysis of variance, Mann-Whitney, Kruskal-Wallis and linear regression. Results: The mean ± standard deviation of the overall score of general health, frailty elderly syndrome and cognitive disorders in the studied elderly were 44.38±13.43, 9.29±2.98 and 23.40±6.49, respectively. There was a statistically significant relationship between cognitive disorders with age, marital status, education and underlying diseases and also between frailty elderly syndrome with age, marital status, place of residence, gender, education, type of insurance and some underlying diseases (P <0.001). There was a significant relationship between general health of the elderly and pulmonary disease (P = 0.03). Conclusion: The general health of the elderly was low so that most of the elderly suffered from mild symptoms, the greatest effect was related to depression and then anxiety (psychological dimension). Regarding cognitive disorders, a large number of patients did not have any pathological disorders. The rate of frailty elderly syndrome was high in the study population. Keywords: frailty elderly syndrome, Cognitive disorders, General health
427 The comparison of on-demand caffeine consumption with squeezing technique on treating patients with premature ejaculation; a randomized clinical trial , Seyyed Hassan Saadat, Khodabakhsh Ahmadi
Background: The present study was aimed at evaluating the effect of on-demand caffeine consumption on treating patients with premature ejaculation (PE compared to squeezing technique. Methods: In this non-blind RCT, 42 otherwise healthy individuals with PE were divided into 2 groups of caffeine and squeezing technique group. The former received 100 mg of encapsulated caffeine for 3 weeks, 2 hours prior to each intercourse. Intra-vaginal ejaculation latency time and index of sexual satisfaction were calculated before and after treatment in both groups. Results: Mean age of the participants was 39.48±7.62 years. Despite the fact that there was no significant difference between pre-treatment and post-treatment values of both IELT and ISS between our 2 groups, significant difference was seen in both groups between pre-treatment and post-treatment values. Furthermore, no strong correlation was seen in pre-treatment IELT and ISS; however, statistically significant correlation was found in post-treatment values. Conclusion: Regarding the fact that caffeine is a well-known and widely-used drug in common disease, the use of this compound is highly unlikely to bear any stigma. Our study demonstrates that 100 mg of on-demand caffeine can equally increase both IELT and ISS significantly as squeezing technique. Further investigations are needed. Keywords: caffeine, premature ejaculation, squeezing technique, intra-vaginal ejaculation latency time, index of sexual satisfaction,
428 Effect of chamomile on chemotherapy-induced neutropenia: a pilot open-label controlled trial , Mahdi Shahriari, Mohammad Azadbakht, Maryam Roohparvar, Babak Daneshfard, Majid Nimrouzi
Neutropenia is a common complication of chemotherapy in leukemic patients. An herbal formulation of chamomile was hypothesized to be effective on neutropenia. A group of healthy volunteers and two groups of patients received chamomile oral drop to be compared with a control group of neutropenic patients. Results showed an increase of white blood cells and resolution of neutropenia in all groups except for the control group. In conclusion, chamomile could be used as an effective complementary medicine for increasing the immunity of neutropenic patients (in addition to healthy individuals). Keywords: Chamomile; Leukemia; Chemotherapy; Neutropenia; Integrative Medicine; Persian Medicine
429 Investigation of The Nutritional Approaches of Student Athletes During The Covid-19 Epidemic , Sevcan Altun, Aykut Aksu, Osman Imamoglu, Murat Erdogdu, Kursat Karacabey
The aim of this study is to investigate the nutritional approaches of student athletes studying at the university during the coronavirus outbreak period. Participants consisted of students studying and doing sports at the University. 446 students, 246 males and 200 females, participated in the study. Besides the personal form, students were filled the questionnaire testing questionnaire. Students voluntarily participated. The surveys were done on social media. Nutritional habits questionnaire consists of 12 questions. In the preparation of the survey questions, the questions proved validity of the researches which have been done on the subject before have been used. SPSS 23.00 package program was used in statistical analyses. Kolmogorov-Smirnov test was performed to test whether the data was normally distributed and it was determined that the data showed normal distribution. Independent t-test, paired t-test, unidirectional variance analysis and LSD tests were used in statistical operations. There was no significant difference in students' nutrition approaches by gender, both in the pre-outbreak period and in the outbreak period points (p> 0.05). Nutrition scores were significantly increased during the outbreak period (p <0.001). A significant difference was found between the students who felt bad before the epidemic and those who felt well before the epidemic and their nutritional scores according to the levels they felt (p <0.05). A significant difference was found between the pre-outbreak period and post-epidemic nutrition scores of the sports faculty students (p <0.05). During the coronavirus epidemic, university student athletes have either increased their nutritional opportunities or have changed their eating habits positively to keep their immune systems strong or both. The fact that sports faculty students have better nutrition compared to other faculty students can be attributed to their taking courses in nutrition, health and similar. It is recommended to give lectures or seminars on nutrition to athlete students. Keywords: Student, Nutrition, Sports Nutrition, Nutritional Approach, Covid-19
430 Presentation of varicella zoster virus infection with bladder mass and gross hematuria , Mosa Asadi, Mohammad Reza Fattahi
Varicella zoster virus reactivation can cause painful and vesicular rashes with involving some dermatomes, defined as herpes zoster. we reported a 68 years old man who had come to the clinic with a complaint of hematuria.in examination, varicella-zoster lesions were visible on the left buttock. After beginning of valacyclovir for patient, due to existing of polipoid mass in sonography, cystoscopy was done for patient. red patches, fragile and bleeding places on the left bladder wall with no evidence of any mass was seen in the cystoscopy. This patient was managed conservatively. One week after the first ultrasonography, new sonography by the same radiologist show no evidence of bladder mass. Keywords: Herpes Zoster; Hematuria, Bladder mass
431 Persistent Mullerian Duct Syndrome in a Man with Unilateral Cryptorchidism : A Case Report , Azarabadi M, Heydari S, Rouhani S ,Ghane Ezabadi M
Introduction: Persistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well asgenotypically, normal man; only a few cases have been reported in the worldwide literature. A greatvariety of organs have been found in indirect inguinal hernial sacs. Case presentation: We report a case of 28 year old man, father of 2 children with unilateral cryptorchidism on the left side and testis and painful left groin mass. we found uterine tissue extending through the inguinal canal. Conclusions : PMDS is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well as genotypically, normal man. Hernia uteri inguinalis is type I of the male form of PMDS, characterized by one descended testis and the herniation of the ipsilateral corner of the uterus and fallopian tube into the inguinal canal. Keywords: mullerian duct syndrome, cryptorchidism
432 An Investigation of the Effect of Retraining Courses on the Knowledge, Attitude, and Performance of Health Workers in the Field of Malaria , Roghaye Ershad Sarabi, Rafigh Dehvari Mohammadi, Aziollah Arbabisarjou
Introduction and Objective: Malaria is considered one of the most important parasitic diseases in Iran. With regard to malaria, Sistan and Baluchestan province ranks first among the country's provinces. This study set out in 2017 to investigate the impact of education on malaria knowledge, attitude and behavior among health workers working in Saravan city health center. Materials and Methods: The present study is a semi-experimental study of before and after clinical trial type that was performed on 73 health workers in Saravan city. A researcher-made questionnaire was used to collect the required data. It consisted of two parts: the first part was dedicated to demographic data and the second part was about the knowledge, attitude and performance of health workers regarding malaria. The face and content validity of the questionnaire was confirmed by an expert panel. The reliability of the questionnaire was calculated using Cronbach's alpha coefficient (α=0.85). Before the start of the training, the questionnaires were given to the health workers. The trainings were presented in 49 one-hour sessions by the experts of the headquarters of Saravan Health Center in Behvarzi Center using lectures and pamphlets. One month after the training, the same questionnaires were filled in by health workers. The difference between the variables of knowledge, attitude and performance in the two groups before and after the intervention was performed using a one-sample and paired sample t-test or their non-parametric equivalent i.e. Binominal and Wilcoxon tests in the SPSS software (version 18). A significance level of 0.5 was taken into consideration. Results: The results showed that the mean scores of health workers in the areas of knowledge, attitude and performance increased significantly after the workshop (p=0.001) so that the participants' knowledge score increased from 26.06 to 56.7. In terms of attitude, their score increased from 7.2 to 17.7, and in terms of performance, participants' score increased from 13 to 32. Discussion and Conclusions: The findings revealed that the implementation of educational programs in the field of malaria can increase the level of knowledge, attitude and performance of the community regarding the preventive behaviors of malaria. Therefore, health system officials are recommended to work toward the amelioration of the knowledge, attitude and performance of the health workers. Keywords: knowledge, attitude, performance, health workers, malaria, retrainin
433 Quantitative Evaluation of Diabetic Foot Wound Healing Using Hydrogel Composite Nanosilver (AgNPs) - Based Dressing Vs. Traditional Dressing: A Prospective Randomized Control Study , Ehsan A. Yahia, Ayman E. El-Sharkawey, Magda M. Bayoumi
Background: The wound dressings perform a crucial role in cutaneous wounds management due to their ability to protect wounds and promote dermal and epidermal tissue regeneration. Aim: the aim was to evaluate the effectiveness of using hydrogel/nano silver-based dressing vs. traditional dressing on diabetic foot wound healing. Methods: Sixty patients with type-2 diabetes hospitalized for diabetic foot wound treatment were recruited from selected Surgical departments. A prospective randomized control study was carried, and the results showed that the percentage of a reduction rate of the ulcer by the third week of the treatment as in the hydrogel/nano silver-based dressing group was higher (15.11%) than traditional wound dressing group (33.44%). Moreover, the mean ulcers size "sq mm" in the hydrogel/nano silver-based dressing group recognized a faster healing rate (15.11 ± 7.89), and considerably lesser in comparison to the traditional by the third week (21.65 ± 8.4). Conclusion: The hydrogel/nanosilver-based dressing showed better results than traditional dressing in managing diabetic ulcer foot. Keywords: Diabetes, Wound, Diabetic ulcer, Wound dressing, Nanomedicine, Nano-silver
434 Molecular Detection of Chlamydia Trachomatis Associated with Ocular Infection among Children in Gadarif State-Sudan , Nuha Abas Abdulwhab, Wafa Ibrahim Elhag  
Background: Trachoma is the leading cause of infectious blindness worldwide. Trachoma is endemic in parts of Africa, the middle east, and India. The disease is particularly problematic in particular Ethiopia and Sudan regions. Objectives :To detect Chlamydia trachomatis among active trachoma children using molecular technique in -Gadarif State- Sudan Methodology: A population-based prevalence study was conducted during the period from Nov 2016 to Nov 2017. A total of 318 children were surveyed; their ages range between 1 to 9 years old. The children's eyes were examined for trachoma follicles and trachoma inflammatory intense (TF, and TI). Samples were collected on Swabs from children clinically diagnosed as active trachoma for the DNA analysis, and collection was done from the tarsal conjunctival surface with a dacron polyester swab and with UTM media, DNA was extracted and amplified by molecular technique with Touchdown protocol and primers for C. trachomatis outer membrane protein complex B ( omcB). Data was collected by direct interviewing questionnaire; ethical approval was obtained from Ethical Research Committee -Al Neelain University Result: Out of the total 318 children, 83(26.1%) children were positive for the C trachomatis omc B gene; Sequencing was performed for both strands of omc B genes, found that the circulating strain in Sudan Gdarif state is similar genetically to the classical one registered in NCBI Conclusion: Chlamydia trachomatis is one of the causative agents of trachoma in Sudan, the circulating strain in Sudan Gdarif state is similar genetically to the classical one registered in NCBI Keywords: Chlamydia trachomatis- omc B genes- PCR- Trachoma- Sudan
435 Diagnostic Accuracy of 128-Slice Dual Source CT Coronary Angiography with Invasive Catheter Coronary Angiography in a Tertiary Care Teaching Hospital , Vishram Singh, Suresh Babu Kottapalli, Rakesh Gupta, Nitin Agarwal, Yogesh Yadav
Background: Coronary artery disease (CAD) morbidity and mortality increasing day by day in India as well as worldwide. Coronary arteries visualization by using invasive catheterization angiography is still using as a front-line diagnostic tool to evaluate the patients with CAD. 128 slice dual source CT improves the cardiac imaging such as high scanning speed, good temporal resolution and low radiation dose. Objective: To assess the diagnostic accuracy of 128-slice dual source CT cardiac angiography with conventional catheter angiography to find common arteries involved in CAD. Methods: This is a prospective, comparative, cross sectional study conducted at cardiology OPD. Patients with complaint of chest pain and suspected CAD were evaluated by CT and conventional coronary angiography and results were compared. Serum creatinine and ECG status were analyzed before the angiography. SIEMENS 128-slice Dual Source Flash Definition CT Scanner was used as a CT coronary angiography. Severity distribution of coronary artery disease, artery wise distribution of non-significant, significant lesions and coronary artery dominance pattern were analyzed and compared. Results: A total of 70 suspected CAD patients were selected and analyzed. American Heart Association (AHA) model of 17-segment was used to assess the coronary arteries. Normal angiograms reported in 15.71% patients and 58.57% had significant disease. A total of 356 lesions were identified from 690 out of 720 segments. Right coronary artery (RCA) is the most common location of significant lesions which contributes 33.5% (n=55/164). Coronary circulation of right-sided dominance was most commonly reported (70.0%). CT angiography showed 96.13% of an overall sensitivity, 96.28% specificity, 89.72% positive predictive value and 98.49% negative predictive value. Conclusion: 128-slice dual source CT scanner has showed high accuracy and act as non-invasive assessment of coronary arteries in patients with CAD Keywords: Cardiac angiography, Catheter coronary angiography, CT coronary angiography, 128-slice MDCT, Conventional angiography
436 Below Knee Angioplasty Results in Diabetic aAnd Non-Diabetic Patients , Afghani Reza, Cheraghali Roozbeh
Ten to 25 % of all diabetic patients will develop a lower limb ulcer in their lifetime. Ankle-brachial index is not accurate in diabetic patients .The resting systolic toe pressure (TP) may be a measure of small arterial function within the periphery. Objective: The purpose of this article is to consider the effect of below-knee angioplasty on systolic toe pressure changes in diabetic patients with critical limb ischemia. Methods/Materials: In this prospective study 114 patients, were included who satisfied the inclusion criteria: patients with critical limb ischemia in the form of tissue loss(ulcer or gangrene) or rest pain, presence of below-knee vessel lesion, and absence of proximal vessels lesion or stenosis. We evaluated the effect of angioplasty on toe pressure of diabetic patients and compared them to non-diabetics. Results: Among 114 patients, 78(68/4%) were men and 36(31/6%) were women. Diabetic patients were 96(84/2%) and non-diabetics were 18 (15.8%). In Paired T-Test analysis we compared toe pressure values of each patient before and after angioplasty and it was a significant difference in both Diabetic and non-diabetic groups.(0.00 and 0.008 respectively). The mean of systolic toe pressure before angioplasty had no difference between the 2 groups (PValue: 0.13). The mean of toe pressure in non-diabetic patients was 42±31.9 and in diabetics was 25.6 and after angioplasty, the mean of toe pressure raised 44.3 in non-diabetics and 19.4 in diabetics. Conclusions: Systolic toe pressure is a valuable tool to evaluate and predict angioplasty effect on below-knee ulcers especially in diabetic patients. Keywords: Below knee Angioplasty, Systolic toe pressure, Diabetes
437 The Influence of speed-power abilities on the intellectual abilities of school children with different strength of the nervous system , Polevoy G.G
The aim is to determine the effect of speed and strength training on the intellectual abilities of children aged 13-14 years, taking into account the strength of their nervous system. Methods: the pedagogical experiment took place in a school (Kirov, Russia) and lasted for 3 months. The study involved 40 children aged 13-14 years, who studied in the 7th grade. Children from the control group were engaged in the usual physical education program at school. Children from the experimental group were engaged in the usual program, but additionally performed exercises to develop speed and strength abilities. The load was differentiated taking into account the strength of the schoolchildren nervous system. The tapping test determined the strength of the schoolchildren nervous system. "Choose unnecessary" determined the indicators of intellectual abilities of schoolchildren. Results: after the study, the indicators in all subgroups improved, but in different ways. In schoolchildren with a strong nervous system in CG, the indicators of intellectual abilities improved from 7.1±1.1 to 7.5±1.0, the increase in indicators was only 6%. In children with a weak nervous system, the indicators improved from 7.5±1.0 to 8.1±1.0, and the increase in intellectual abilities was 8%. At the same time, the results in the EG in both subgroups were much more significant. Thus, in children with a strong nervous system, the indicators improved from 7.4±0.7 to 8.5±0.8, an increase of 17%. And in children with a strong nervous system, the indicators improved from 7.7±1.2 to 9.2±1.4, an increase of 20%. Conclusion: the indicators of intellectual abilities of schoolchildren aged 13-14 years will improve if they perform physical exercises aimed at developing speed and strength abilities at each physical culture lesson at school. At the same time, the physical activity for children with a strong and weak nervous system should be differentiated according to the process of arousal. Keywords: health, speed abilities, schoolchildren, physical development
438 A study on awareness and practices of bio-medical waste management in tertiary care hospital , Mohammad Shakil Ahmad
Introduction: Bio-Medical Waste (BMW) consists of solids, liquids, sharps and laboratory waste that are potentially infectious and dangerous. In India, lack of knowledge and practice in relation to availability of resources and processes in place has been reported in many studies. Hence, the present study has been carried out with an objective of assessing awareness and practices of healthcare providers regarding BMW. Materials and methods: This cross-sectional study was conducted in tertiary care hospital with 300 beds in Karnataka over a period of one month using preformed, pre-structured proforma. Results: Almost all health personnel were aware about BMW guidelines; adequate segregation of BMW was noticed in only 4 sites (11.8%). Conclusion: The awareness about BMW management among healthcare providers in our study was found to be adequate but with low segregation practices. The staffs are well aware to manage the spills and will use if all the sites are provided with spill kits. Key words: Biomedical waste, color coding, India, tertiary hospital, waste segregation
439 Prescribing Pattern of Asthma Therapy among Children with Asthma at Qassim Region, Saudi Arabia , Abdullah Mohammad Hamad Alolayan
Background: Asthma is a chronic inflammatory condition affecting millions of children across the globe and requires long-term pharmacotherapy. This study was carried out with the objective to assess the prescription pattern in asthmatic children in Qassim region, Saudi Arabia. Methods: A cross-sectional hospital-based-retrospective study was performed, which included out-patients children aged less than 14 years attending Al-Habib Hospital (HMG), Qassim region, Saudi Arabia, between 2010-2019 after obtaining Ethical Approval from the research unit. Results: The most visited physicians was the pediatricians, who counted 53.84% of the total visits. Pediatricians prescribed more oral medications in comparison to Pediatric ER physicians, while Pediatric ER physicians tended to prescribe more antibiotics than pediatricians. In regard to prescribed suppository medication, the most commonly prescribed drug was paracetamol. There was no association between the specialty and prescribing patterns. Regarding prescribed IV medication, no association was found between the specialty and prescribing patterns. The most commonly IV medication was ceftriaxone, followed by salbutamol. In regard to nebulizers, and inhalers no association was found between the specialty and prescribing patterns. Conclusion: The study effectively established the relationship between the prevalence and incidence of asthma. In order to properly manage asthmatic patients, it is necessary to develop asthma treatment recommendations and assess physician adherence to treatment guidelines. Keywords: Asthma, Qassim, ISAAC, Therapy, Survey, Children
440 Evaluation of Oral Health Literacy among Adults in Sari - Iran , Maryam Zamanzadeh, Elham Mahmoodnia, Mahmood Moosazadeh, Anahita Ghorbani
Background and aim: It is generally accepted that oral health literacy is one of the important determinants of oral health. The aim of this study was to evaluated oral health literacy in Sari City -Northern Iran. Methods: This cross-sectional study was carried out on 855 adult citizens of Sari by random sampling. The data was collected using a standard questionnaire including 17 questions regarding oral health literacy in four sections: content comprehension, number comprehension, listening and decision making; three questions about oral health behaviors and some questions about self-assessment of oral health status, age, gender and education. Citizens were divided into three groups in terms of oral health literacy: inadequate (0-9), marginal (10-11), and adequate (12-17). The data was analyzed using descriptive and analytical statistics including chi-square, t-test, ANOVA and correlation coefficient in SPSS ver. 20 software. Results: 43.3% of the Sari city citizens had adequate oral health literacy. The mean score of oral health literacy was 10.02 ± 3.4 out of 17. Oral health literacy was higher among educated and employed people, as well as those with smaller households. Those who reported better oral health behaviors had higher oral health literacy than others (P-value <0.001). Also, those who had poor oral health status in compare with two other groups had lower oral health literacy (P-value <0.001). Conclusion: The oral health literacy of Sari city citizens was marginal. Oral health care providers need to devise the necessary plans to improve the oral health of the community Key words: Health Literacy, Oral Health Literacy, Oral Health.
441 Correlation of Sleep Quality in Spondyloarthritis Patients and its Association with Disease Activitiy Parameters , Mohamed K Bedaiwi, Abdulaziz Alkhalaf, Ibrahim A Almaghlouth, Eman M Alqurtas, Saad ‎Almutairi1, Faris Almutairi1, Turki Alqahtani, Majed Alasbali, Mohamed A. Omair  
Background: Patients with chronic medical disorders are substantially more likely to have sleep related issues. Previously, various authors have reported sleep disruptions to be common in rheumatic diseases, although such sleep related issues in the spondyloarthropathies have not received much attention.. Aim: The present study was aimed to assess the effect of spondyloarthropathies on sleep quality and to see whether this effect is associated with disease activity. Material and Methods: This cross-sectional study was conducted in the rheumatology clinic, King Khalid University Hospital, during the duration of two months. A total of 85 diagnosed cases of spondyloarthritis were included. All participants were interviewed regarding their Demographic details, disease duration, medications, treatment regimens and physical examination. Sleep disturbance was measured using Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the Ankylosing Spondylitis Quality of Life scale. The intensity of disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and patient’s functional status was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Blood inflammatory markers like ESR levels and CRP levels were also calculated for each patient. Results: Among the total 79 cases included, mean age of patients was 41.06±11.78 years, 40 (50.6%) were females, mean disease duration was 5 years. Diagnoses included Ankylosing spondylitis (48.10%), Psoriatic arthritis (43.04%), Undifferentiated spondyloarthopathy (6.33%) and IBD-related arthropathy (2.53%). Spondyloarthritis was observed to be associated with considerable impaired sleep quality on (PSQI) questionnaire. Six out of seven studied components came out to be worse and the only component which remained unaffected was “use of sleep Medication”. A significant correlation was observed between disease severity and patients ESR and CRP levels, and a significant correlation was observed between BASDAI score and all seven sleep quality parameters and overall PSQI scores. Both BASDAI score and BASFI scores correlated significantly with each other and a significant correlation was observed between the functional status (BASFI score) and Six sleep quality parameters except for use of sleep medication. Conclusion: We conclude that the sleep related problems were significantly higher in patients with spondyloarthritis and patients during active phase of disease had decreased sleep quality. Keywords: spondyloarthropathies, sleep quality, disease activity, PSQI scores.
442 The Effect of Nursing Protocol in Insertion and Care of Vascular Access Devices in Oncology Pediatric Patients , Hanan Marzouk, Iman Ibrahim Abdel-Moneim, Hyam Refaat Tantawi
Arrangement of a focal line consistently conveys likely dangers for the patient, with significant contrasts in the sort and seriousness of entanglement, contingent upon which vein, which strategy and which gadget have been picked. Aim: The current study aimed to study the effect of nursing protocol in insertion and care of Vascular Access Devices (VAD) in oncology pediatric patients Design: A quasi experimental design was used. Setting: This study was conducted at the oncology department Unit, affiliated to Ain Shams University Hospital and police hospital at El-Agoza. Sample: A purposive example of (50) nurses were working at Ain Shams and (20) at ElAgoza. I. Predesigned Questionnaire Format, Assessment tool for the studied children , Questionnaire tool for nurses to assess nurse's knowledge, Observational checklists used to assess the nurses' practices regarding nursing protocols for care and insertion of VAD Results: there was positive correlation between knowledge of the studied nurses and their total practices and regarding vascular access devices (Port-A-Cath, Hickman, and CVC) throughout intervention with statically significant differences (p<0.05). Conclusion: Implementation of the nursing protocol has statistically significant positive effect in insertion and care of VAD on oncology pediatric patients Recommendation: the nursing protocol should be applied for all nurses who deal with pediatric devices. Keywords: Nursing Protocol, Vascular Access Devices, Oncology, Pediatric Patients
443 Histopathologic interpersonal overview of generalized pustular cutaneous reaction to Hydroxychloroquine (HCQ): New challenging clinical manifestation   , Alireza Ghanadan, Zahra Naraghi, Kambiz Kamyab-Hesari, Azita Nikoo, Zahra Halaji, Maryam Ghiasi, Robabeh Abedini, Monireh Mazandarani, Ali Pourali, Sepehr Khosravi, Azadeh Goodarzi
Background: Pathologic examination of Acute Generalized Exanthematous Pustulosis (AGEP) and Pustular Psoriasis (PP) are similar. We encountered many patients with PP or AGEP who cannot be distinguished clinically, pathologically and based on disease course from each so we designed a comprehensive interpersonal histopathologic overview of these patients' samples. Method: Histopathological data of 16 patients over 3.5 years were analyzed. Four pathologists separately reviewed specimens based on eighteen criteria (9 Epidermal and 9 Dermal). Severity score for each criterion was considered as to be (0 to 3+). We compared the final pathologic diagnosis with primary one. Results: Neutrophilic and lymphocytic infiltration in dermis were seen in all cases of AGEP while intraepithelial pustules. Subcorneal and intraepithelial pustules, spongiosis, neutrophilic exocytosis, neutrophilic and lymphocytic infiltration in dermis were observed in all cases of PP. The most severe neutrophilic inflammation; acanthosis and neutrophilic or lymphocytic infiltration were seen in PP. The authors of this study have been reported generalized pustular clinical presentations of patients have been taken HCQ, and in the recent pandemic it is also one of the concerns that many studies have been focused (....). Conclusion: When primary histopathologic report is AGEP/PP overlap, clinical judgment is the best way to manage and it is more probable that the final diagnosis being PP. When only AGEP or PP is histopathologic diagnostic report, it is usually enough to make final diagnosis and appropriate management. Key words: hydroxychloroquine, HCQ, generalized pustular cutaneous eruption, Pustular Psoriasis (PP), Acute Generalized Exanthematous Pustulosism, AGEP, Histopathological overview, pathology, review
444 Benign Paroxysmal Positional Vertigo (BPPV) in Adult Patients between 15-40 years of age: A study on Treatment Outcome in Teaching Hospitals , Zafar Iqbal, Rehan Saleem, Muhammad Tayyab Rasheed, Mohammed Habib, Naseem ul Haq, Sakhawat Khan
Objectives: To study treatment outcome of positional vertigo in adult patients of 15-40 years of age. Place and duration of study: This study was conducted at ENT department of Chaudhary Muhammad Akram Teaching & Research Hospital, Lahore and Kuwait Teaching Hospital, Peshawar from June 2019 to June 2020. Material and Methods: 50 patients with diagnosis of benign positional vertigo were included in the study. Patients were treated and their outcomes were analyzed. Results: 50 patients of age between 15-40 years were included in the study. The analysis of treatment outcome showed that 35 patients (70%) showed maximum improvement in vertigo with medical treatment, 10 patients (20%) showed improvement in their symptoms with positional exercises and 5 patients (10%) showed improvement by combined treatment. Conclusion: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and presents as brief, episodic, positional provoked vertigo. The diagnosis can be made through clinical history along with diagnostic maneuvers and it can have a considerable impact on the quality of life. The medical treatment with vestibular dilators and vestibular suppressant is best option, with particle repositioning maneuver (Epley maneuver) for resistant and recurrent patients. Key words: Vestibular exercises, Dizziness, Positional vertigo, Dis equilibrium.
445 Evaluation of Mean Platelet Volume (MPV) in Pre-Eclamptic and Normotensive Women in 3rd Trimester of Gestation , Salza Zainab, Armish Saeed, Shazia Awan, Sehrish Raja, Faiza Khanum, Erum Pervaiz  
Objective: To determine the mean platelet volume (MPV) in pre-eclamptic and normotensive women presenting in 3rd trimester of pregnancy. Study Design: Descriptive Cross-sectional study. Place and Duration: Department of Obstetrics & Gynecology, Multan Medical and Dental College/Ibn-e-Sina Hospital, Multan during from 29-May-2019 to 28-Nov-2019. Methodology: 246 pregnant females were included in this study. Patients were assessed for pre-eclampsia those who were history of blood pressure >140 mmHg and 90 mmHg diastolic as seen on examination on three consecutive readings. Data of maternal hemogram taken at presentation was recording using an automated hematology analyzer. mean platelet volume (MPV) was recorded at completion of 36th week of gestation. Results: Mean age of patients included in this study was 34.22±5.02 years. Mean body mass index (BMI) of patients was 24.58±4.65 kg/m2. Mean parity was 2.63±0.78. Mean blood pressure of patients was 128.37±15.06 mmHg. The mean platelet volume in patients with normotensive pregnancy was 9.27±1.31 fL versus 12.49±1.51 fL in patients pre-eclampsia. This difference was statistically significant with p-value of <0.0001. Conclusion: As a biomarker for preeclampsia severity, MPV is a valuable tool. In a clinical context, MPV is regularly acquired during a complete blood count, making it a potentially cost-effective prediction tool for evaluating pre-eclampsia Keywords: Pregnancy, Pre-eclampsia, Mean Platelet Volume (MPV)
446 Dental Anxiety, Smoking and Snuff Use among Dental Patients , Muhammad Nauman, Rabia Mehboob, Komal Sikandar, Areeba Ishtiaq Ahmed, Mahrukh Afzal, Zain Akram
Background and Aims: Dental anxiety often causes psychological problems including the fear that have a negative impact on dental treatment. Periodontal health and dental deteriorating might be caused by the patient’s interference with dental fear. The current study aims to evaluate dental anxiety, smoking and snuff use in dental patients. Methods:One hundred eighty consecutive dental patients with meanage ±SD 31.45±13.75 were investigated for dental anxiety, smoking, and snuff use.The evaluation of dental anxiety was measured with the specific question “Do youfeel any type of anxiety while visiting the dentist?” and their answers were givenas follows: “Absolutely not”, “Somehow” and “Extreme fear”. Tobacco use wasinvestigated with the question “Do you smoke or take snuff?” with the alternatereplies “Absolutely not”, “regularly on a daily basis” and “occasionally. Chi-squaretest and multiple regression analysis were carried out in statistical analysisusing SPSS version 20. Results:Among one hundred eighty dental patients, higher dental anxiety was reported in 32 (17.8%) being common among women (71.9%) than men (28.1%). General mood and social situation was reported negative in 9 and 36 patients respectively. It was observed that tobacco use on routine a basis was more common among men (8.5%) than women (1.5%). Age played key a role in dental fears among patients. Patients of young age feel more anxious than mature or older aged patients. Higher dental anxiety and fear was observed in those dental patients who used snuff on a regular basis compared to occasional and no users at all while controlling for age, social status, and general mood. It was observed that chain smokers feel more anxious compared to occasional or no smoking at all, when smoking was added to the model and asked the participants about their visits to the dentists. Conclusion: Our study findings were common vulnerability factors among dental patients related to dental anxiety or fear, smoking, and snuff use. The reason for patients' anxiety was found to be the fear of pain which was more common among women compared to men. Also, Regular tobacco users felt more anxious than occasional or no users at all. Hence, dentists should focus on anxiety alleviation among patients while treatment and follow-up call for maintenance. Keywords: Dental anxiety, Tobacco use, Dental fear
447 Facilitators and Barriers for Using Outcome Measuring Tools in Physical Therapy Practice , Rahat Ayub, Somia Sabeeh Awan, Muhamamd Rizwan, Rabia Majeed, Rabia Jawa, Tamknat Ilyas  
Objective: The study was conducted toascertain the percentage of physiotherapist who were utilizing the outcome measures during the treatment of patients and to find the factors which were potentiating the physiotherapists in implementing the outcome measuring tools in the treatment of their patients. On the other hand, such factors were also looked into which were considered as obstacles by the physiotherapists in the use of the tools. Methodology: The estimated study population size was 242. Data was collected through e-mail as well as through one-on-one meeting with the physiotherapists by using a standard questionnaire (appendix I) and was analyzed through SPSS version 20. Results: It was found that 78 percent of the study participants were using the outcome measures in the assessments of the patients and for finding the progression in their condition. The feeling of the patient about the keen involvement of the physiotherapist in his treatment, enhanced communication between two of them and increased efficiency of examination were the major facilitators which urged the physiotherapists to use outcome measures in their practice. The most frequent barriers seen were the duration required by physiotherapist to analyze the score and duration of patient to complete it. Conclusion: The main facilitators are increased communication between physiotherapist and patient and enhanced the efficacy of assessment. Alternatively, the main barriers restricting the usage of outcome measures are reported to be the inability to complete the various assessment tools due to the lack of time on the part of the patient as well as the physical therapist. Key words: Outcome measures, Outcomes measuring tools, Facilitators, Barriers, Physical therapist, Physiotherapist
448 Anesthetist Perception of Anesthetist-Surgeon Conflicts in Operation Theater , Arshi Naz, Vijai Kumar, Mirza Shahzad Baig, Sidra Javed, Samita S Khan, Basma Salman
Objective: The aim of this study is to determine the anesthetist perception of anesthetist-surgeon conflicts in Operation Theater. Study Design: Cross-sectional Place and Duration: Study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 1st July 2020 to 1st June 2021. Methods: Total 50 anesthesiologists of both genders were presented in this study. Participants were aged between 25-55 years. Details demographics including age, sex, working experience and marital status were recorded after taking informed consent. Reasons of conflicts (lack of team work) among surgeons and anesthetics were observed due to this patients work affected. Complete data was analyzed by SPSS 20.0 version. Results: Mean age of anesthesiologists was 37.68±6.81 years. 30 (60%) were males among and 20 (40%) were females. 40 (80%) anesthetics were married. Working relationships disturbed in anesthetics were 35 (70%). Patient pressure on surgeons, lack of consideration of anesthesiologist instructions, patient ignorance of anesthesiologists' roles, lack of information about the patients' needs, decisions regarding the urgency of operations, the lack of coordination in departments regarding operational priorities, the lack of an out-patient anesthesia clinic and finally shortage of work facilities were the predictors of conflicts among anesthesiologist. Conclusion: We have found a number of reasons that participants believe to trigger conflict. Attention to these questions may assist harmonize surgeons' workplace with anesthesiologists. Keywords: Anesthesiologist, Conflicts, Operating room
449 Knowledge, Attitude, Risk Factors & Screening Practices Regarding Breast Cancer among Women in Islamabad , Nida Khaliq, Zille Huma Mustehsan, Hania Rashid, Shafaq Khadija, Nazeeha Waseem, Hafsa Waseem
Introduction: Cancer of breast tissue is a commonly recognized cancer among females and is the fifthmain reason of cancer associated deaths in the world. It is important and beneficial for the females at risk to understand breast cancer as this may assist in timely detection and management of this deadly disease. Objectives: To assess understanding about breast cancer, knowledge and attitude, risk factors and screening practices among female in Islamabad. Methodology: The study is across-sectional survey which was conducted from October 2020 till March 2021. A self-administered questionnaire, using Google forms, was distributed among women residing in Islamabad, consisting of questions regarding knowledge about breast cancer symptoms, risk factors and screening methods. A total of 320 participants completed and submitted the questionnaire. Results: The participants of the present study were familiar with the term “breast cancer”; however, their attitude towards breast cancer prevention was recorded as unsatisfactory because they lacked knowledge about the screening practices of breast cancer. Conclusion: Women residing in Islamabad seem to have limited understanding about breast cancer, its symptoms and associated risk factors which is somewhat similar to other developing countries. Very few women in the study population practice “BSE” and have undergone “CBE” and “mammography”. They also have limited information about other screening practices of breast cancer. Keywords: “Breast cancer”, “Breast Self-Examination”, “Clinical Breast Examination”, “Mammography”, Screening
450 Contamination of Mobile Phones of Health Care Workers of PIMS Hospital Islamabad , Nida Khaliq, Zille Huma Mustehsan, Hania Rashid, Shafaq Khadija, Nazeeha Waseem, Hafsa Waseem
Introduction: Mobile phones are one of the most vital telecommunication devices and are used to stay in touch with both the social and professional aspects of our lives. They have also become an important tool for the rapid delivery of information in healthcare institutions, such as hospitals. However, with many benefits of mobile phone usage, also comes the drawbacks of hospital-associated pathogens surviving on these mobile phone screens. Objectives: To determine the frequency of contamination of healthcare worker’s mobile phones by different types of microorganisms. Methodology: A cross-sectional study was conducted from June 2020 till December 2020 at PIMS Hospital, a tertiary care hospital located in Islamabad, Pakistan. A total of 121 individual mobile phones were randomly sampled. A simple random sampling method was used. Informed consent was taken before taking a sample and a questionnaire was also utilized. Results: Among 121 samples collected from different department health workers mobile phone surfaces, 112 showed significant differences (92.56%) which were positively contaminated with microorganisms. Conclusion: To conclude, a high contamination rate of mobile phones was found with microorganisms. This could lead to serious nosocomial infections. Therefore, a standard guideline on the use of electronic devices and mobile phones should be implemented in hospitals and healthcare centres. Enforce the hygiene practices such as washing hands and cleaning mobile phones a few times a day. Keywords: Healthcare Worker, Mobile Phone, Microorganism, Contamination, Disinfectant
451 Outcome of Distal Femoral Fracture Treated with Locking Plate , Muhammad Shoaib Zardad, Abdus S. Awan, Muhammad Younas, Shahkeel A. Shah, S. Sohail Akhtar, Matiullah Shah
Objective: The aim of this study is to determine the outcome of distal femoral fracture treated with locking plate. Study Design:Prospective study Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute, Abbottabad for one year duration from 1stJanuary 2020 to 31st December 2020. Methods: Total 90 patients of both genders were presented in this study.Patients were aged between 18-80 years of age. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. All the patients had distal femoral fracture treated with locking plate. Radiological assessment was done. Mean union time and complications associated to procedure were examined.Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 6 months postoperatively. Complete data was analyzed by SPSS 24.0 version. Results:There were 58 (64.4%) patients were males and 32 (35.6%) were females. Mean age of the patients were 42.61±12.88 years with mean BMI 27.65±9.56 kg/m2. According AO/OTA classification 55 (61.1%) had A1, A2 fracture was among 18 (20%) cases and the rest were 17 (18.9%) had A3. 62 (68.9%) fractures were caused due road traffic accidents, falling from height were among 17 (18.9%) cases and 11 (12.2%) cases were due to sports. Right side fracture was the most common side of fracture among 54 (60%). Mean union time among patients was 5.16±1.27 months.According to Flyn’s criteria, 38 (42.2%) cases had excellent results, 32 (35.6%) patients had good, fair results were among 16 (17.8%) cases and poor results were among 4 (4.4%) cases. Complications were delayed union, stiffness, varus deformityand non union observed among all cases. Conclusion: We concluded in this study that the locking plate for the treatment of distal femoral fractures was effective in terms of good results with fewer complications. Keywords:Distal femoral fracture, Locking plate, RTA, Complications
452 Comparison of Retrograde Femoral Interlocking Nail Versus Dynamic Condylar Screw in Distal Femoral Shaft Fractures , Muhammad Kamran Shafi, Fraz Noor, Syed Alam Zeb, Muhammad Ishfaq, Yousaf Bin Tahir, Tauqeer Nawaz Khan
Objective: The aim of this study is to compare the effectiveness of retrograde femoral interlocking nail versus dynamic condylar screw in distal femoral shaft fractures. Study Design: Prospective/Randomized comprehensive Place and Duration: Department of Orthopaedic Surgery Bahawal Victoria Hospital (BVH) / QAMC, Bahawalpur for duration of eight months i.e July 2020 to February 2021. Methods: Total 65 patients of both genders were presented in this study with age ranges between 20-40 years. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Patients were divided into 2- groups, I and II Group I had 32 patients and underwent for retrograde femoral interlocking nail and group II had 33 patients and received dynamic condylar screw. Mean operative time, mean union time of bones and complications were calculated. Effectiveness among both groups was calculated by HSS score. Complete data was analyzed by SPSS 22.0 version. Results: Most of the patients were males 40 (61.54%) and 25 (38.46%) were females. Mean age of the patients in group I was 26.46±4.28 years and in group II mean age was 30.78±8.22 years. Mean operative time in group I was 82.8±7.14 minutes while in group II it was 90.6±8.19 minutes. Mean union time in group I was 22.7±2.5 weeks and in group II was 26.21±5.3 weeks. According to HSS score in group I 16 (50%) results were excellent, 11 (34.38%) was good, 3 (9.8%) showed moderate and 2 (6.25%) was poor, while in group II excellent results were 15 (45.45%), 10 (30.30%) was good, 5 (15.15%) showed moderate and 3 (9.09%) showed poor results. Complications were observed joint stiffness, delayed union, non union and varus deformity were significantly lower in group I as compared to group II. Conclusion: We concluded in this comparison of study that bothretrograde femoral interlocking nail and dynamic condylar screw was useful and effective methods for trauma in distal femoral shaft fractures. But less union time and good outcomes were observed in interlocking nail as compared to dynamic condylar screw. Keywords: Distal femoral shaft fractures, Trauma, Dynamic condylar, Interlocking nail
453 Assessing Responsiveness of Elevated Serum Ferritin for Treatment in Chronic Hepatitis C Infected Patients , Waheed Iqbal, Mirza Rehan Baig, Mudassar Ali, Muhammad Zaid Iqbal, Ajmaal Jami, Tarik Alam Solangi
Background: Hepatitis C virus (HCV) infection is a foremost community health issue globally. There is anoptimisticrelationamid iron accumulation in hepatocytes and high serum markers counting transferrin and ferritin. The purpose of this analysis was to examine the responsiveness of the treatment with elevated serum ferritin in patients with hepatitis C infection. Methods: The study included 200 HCV-infected patients from the department of Medicine, Divisional Headquarters teaching hospital, Mirpurand Isra Medical University, Karachi for six months duration from 16thJune 2020 to 15thDecember 2020. The clinical feature assesses HCV exposure in all patients, biochemical data, and iron status parameters. The results were quantified using Microsoft Excel 2013. Results: The obtained outcomes indicate that antiviral treatment significantly interferes the iron accumulation in hepatocytes in HCV positive patients. All positive iron values were calculated as 19.93 mol / L; and for all negative PCR, the value was calculated at 24.61 μmol / L prior to drug started. Our patients’ levels of iron were 62.77 μmol / L in patients whose PCR is positive for HCV which is within the normal range. Reduced ferritin levels have negative effects after drug administration. The increase in ALT was observed in 37.62% of cases. Conclusions: Patients with chronic HCV have strong association with serum iron concentration. Keywords: Ferritin levels, Drugs, Iron load, Hepatitis C Virus Infection, Serum and Liver Cells
454 Compare the Analgesic Efficacy of Dexmedetomidineand Fentanyl as an Adjuvant to Bupivacaine for Lower Limb Surgery , Arshi Naz, Mirza Shahzad Baig, Vijai Kumar, Samita S Khan, Sidra Javed, Basma Salman
Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-Value <0.05 was significantly considered. Results: Mean age of group A was 40.52±12.28 years and in group B it was 40.14±13.34 years. There were 18 (69.23%) male patients and 8 (30.77%) females in group A while in Group B 19 (73.08%) patients were male and 7 (26.92%) were females. No significant difference was observed between both groups regarding time to T10 blockade with p-value >0.05. A significant difference was found regarding time to rescue analgesia, in Group A it was 426.58±92.44 minutes and in Group B, it was 206.44±48.47 minutes (p-value <0.0001). Patients’ satisfaction was high in dexemedetomidine group as compared to fentanyl group. Conclusion: Dexmedetomidine 10 μg with 0.5% bupvicaine showed better effectiveness regarding time to first rescue analgesia as compared to fentanyl. No significant difference was observed regarding time to sensory blockade between both medications. Keywords: Dexmedetomidine, Fentanyl, Spinal Anaesthesia, Lower Limb Surgery, Sensory Block, Analgesia.
455 Comparison of glucose lowering ability of Pioglitazone and Glimepiride in Steptozotocin induced type 2 diabetes mellitus male mice model , Hina Aslam, Saima Rafique, Sidra Mumal, Furqan Ali Shah, Abeerah Zainub, Aamna Khokhar
Introduction: Diabetes mellitus type 2 is a global health problem expanding at an alarming rate and putting individuals at high risk of microvascular and macrovascular complications. Life style modification and drugs intervention can help achieve normal glucose levels. Aim &Objective: To compare the hypoglycemic activity of glimepiride and pioglitazone in a type 2 diabetes mellitus induced male mice model. Place & Duration of study: This study was carried out in the animal house of National Institute of Health (NIH), Islamabad from 7th November 2013 till 21st January 2014. Materials & Methods: Forty albino Balb/C male mice were divided randomly into groups I-IV (n=10). Group I served as normal control group. In rest of mice from group II-IV, type 2 diabetes mellitus was induced by administration of high fat diet (HFD) for two weeks followed by low dose (40 mg/kg) intra-peritoneal streptozotocin (STZ) injections for four consecutive days. Group II served as the disease control group. Group III received Glimepiride in a dose of 2mg/kg body wt. while group IV was administered Pioglitazone in a dose of 30mg/kg body wt. Both the drugs were given orally once a day. Samples were taken at the end of ten weeks. Results: The blood samples estimated for fasting blood glucose (FBG) & glycosylated hemoglobin (HbA1c %) levels showed that both glimepiride and pioglitazone equally lowered the FBG and HbA1c% levels. However, pioglitazone lowered the FBG and HbA1c levels slightly more than Glimepride. Conclusion: Glimepiride and pioglitazone lowered the FBG and HbA1c levels in type 2 diabetes induced male mice with the later having slightly more reduction than Glimepride. Key words: Glimepiride, Pioglitazone, Streptozotocin, type 2 Diabetes Mellitus.
456 Assessment of Anti-Anemic Effects of Saccharum Munja Roxb Roots Extract , Shaawana Aslam, Komal Najam, Lubna Shakir, Zaka ur Rehman, Nasira S., Tayyaba N., Anum N., Arshia B. Khanum
Anticancer agents often cause bone marrow suppression resulting in progressive anemia which may influence the therapeutic effects of different cancer treatment. Objective: The objective of this study was to evaluate, effects of ethanolic extract of Saccharum munja roxb (Kaana or Sirkanda) on hemoglobin and red blood cells counts suppressed by carboplatin. Methodology: Anemia was induced in mice with a single iv dose of 50 mg/kg carboplatin. Hematological responses including, RBC and Hb was measured at 3rd, 5thand 8th day. Saccharum munja roxbethanolicextract with dose of 25mg/kg, 50mg/kg and 100mg/kg were given to different treatment groups. Results: In the low dose (R. ext 25mg/kg) group hemoglobin level was found to be 11g/dl on 8thday. However (R.ext 50mg/kg) showed more improvement in hemoglobin levels i.e11.5 g/dl at 8th day. The mice treated with higher doses of extract (R.ext100mg/kg) showed major improvement in hemoglobin levels at 8th day which was 12.6g/dl.RBC count increased after oral administration of Saccharummunja extract (R.ext 25mg/kg) to 6.4 ×106cells /mm3 on 8thday. However, in (R.ext 50mg/kg) extract treated group RBC count was found to be 6.9 × 106cells /mm3 on 8thday. In (R.ext 100mg/kg) treated group the RBC count was 7.4 × 106 /mm3 on 8thday. Conclusion: Thus, the results suggested that ethanolic-extract ofSaccharum munja roxb at different dosesshow beneficial effects in improving different parameters of blood.This study also appropriately described the time course of hematological changes after carboplatin induced anemia in mice. Therefore, this study method can be useful tool to explore potential strategies for the management of anemia caused by chemotherapeutic agents. Keywords: Carboplatin, heamoglobin, Saccharummunja
457 Toxicity of AgNPs upon Liver Function and Positive Role of Tinospora Cordifolia: In Vivo , Samed Abdul Jabbar Ramadhan, Ozdan Akram Ghareeb  
This experiment was premeditated to probe the toxic impact of Silver Nanoparticles (AgNPs) upon liver function parameters in male rats, as well as to demonstrate the protective effect of Tinospora cordifolia (T.C) against liver function disorders caused by AgNPs. Twenty-four rats were classified into four packs, six ones for every pack. Rats were included by control animals without treatment, while the AgNPs group included rats treated with 50μl/kg / day AgNPs. In the AgNPs + T.C group, rats were co-administered of AgNPs at a dose of 50μl/kg with T.C at a dose of 400 mg/kg. Whereas, animals of the T.C pack were treated with 400 mg/kg of T.C. The duration of the experiment was 28 days. After blood samples were taken at the conclusion of the experiment. The levels of biochemical parameters (liver enzymes) such as alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were evaluated to detect liver function abnormalities. Thwe Pw A t e dewoe t ste user e dnoAiwoe se dsnd disnte dnirease in the activity of serum liver enzymes in comparison to the control group (p < 0.05).While T. cordifolia co-treatment significantly reduced the levels of activities of those enzymes. Therefore, it can be considered that T. cordifolia effectively contributes to the protection against liver dysfunction caused by AgNPs in rats. Keywords : Silver Nanoparticles, liver dysfunction, biochemical parameters.
458 Relationships Between Emotional Intelligence, Mental Skills and Techniques: A Research on Professional Athletes , Temel Çakiro?lu
The purpose of this research is to examine the relationships between the levels of mental skills and techniques of university students, who continue their sports life as licensed in different sports branches, and the emotional intelligence in sports. A total of 169 athletes, 91 male (53.8%) (Mage=25.36±6.06) and 78 female (46.2%) (Mage=23.03±4.98), who continue their professional sports life in different sports branches, voluntarily participated in the research. The research was designed in relational screening model. Personal Information Form, Mental Training Inventory in Sport, and Emotional Intelligence Inventory in Sport, which were created by the researchers, were used as data collection tools within the scope of the research. In the analysis of the data, firstly, the skewness and kurtosis values were checked for the normality assumptions and it was determined that the distribution was normal. In this direction, t-test was used to compare two independent groups, Pearson correlation analysis was used to determine the relationships between the variables, and multiple linear regression analysis was used to determine the power of the independent variables in predicting the dependent variable. When the findings obtained within the scope of the research were examined, it was determined that the emotional intelligence sub-dimensions significantly predicted the components of mental training skills and techniques. In this context, a result was obtained that as the level of emotional intelligence increases, the levels of mental training skills and techniques will also increase. However, when the analyzes for demographic variables were examined within the scope of the research, it was determined that there was a significant difference within the groups. As a result, it is recommended to include programs on emotional intelligence and mental training skills and techniques in the training of athletes in order to achieve the optimal range of sportive performance. Keywords: Emotional Intelligence, Mental Training, Sports
459 A Rare Case of Pseudotumoral Ureteric Tuberculosis Causing Forniceal Rupture , M. Hajri, W. Ferjaoui,S. Baccouche, L. Gharbi, H. Mestiri, R. Bayar, Dhouhabacha, S.Ben Slama, A. Lahmer
A 55-year-old woman, with no medical history, presented with acute right flank pain. She had no history of other urinary complaints. On physical examination, the patient was tachycardic (pulse rate: 100bpm) and tachypneic (respiratory rate: 24 breaths/min), blood pressure was11/6 and temperature was 37.4°. The abdominal examination showed severe tenderness in the right flank and the right iliac fossa. All blood reports were normal, including C-reactive protein, cell blood count and serum creatinine. Computed Tomography of the abdomen revealed a right hydronephrosis with delayed phase contrast leak and a retroperitoneal mass of 48x36mm of unknown nature, enhanced after contrast injection, which seemed to compress the right ureter causing the forniceal rupture. A double J ureteral stent was insterted into the right renal cavities with favorable evolution and immediate resolution of pain. Surgical management of the mass was scheduled one month later after the inflammatory phase and resorption of the urinoma. The patient underwent an exploratory laparotomy. Intraoperatively, a tissular retroperitoneal mass of 4 cm was discovered which invadedthe right proximal ureter as well asthe duodenum and the ileocecal pedicle (Figure 1). Resection of the tumor was performed as well as a segmental ureterectomy, right colectomy, and resection of a small portion of the duodenum. Both ureteric and colic anastomosis were then performed along with duodenal suture. The post operative course was uneventful.
460 Comparison of Mammography and Ultrasonography for Early Detection of Breast Cancer , Samina Mahmood, M Nawaz Anjum, Faiza Farooq, S.Amir Gilani, Mehreen Fatima, Shakila Andlib, H. Sobia Ramzan
Aim: This systematic review is specifically aimed to compare mammography and ultrasonography in early detection of breast cancer. For this systematic review, major purpose is to compare both screening methods and also analyze the performance of supplemental ultrasonography for early detection of breast cancer. Methodology: For this systematic review, total 23 studies are included which follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic articles from year 2007 to from year 2017 on PUB Med, online Willey library, and Science Direct site were searched by using keywords related to sonographic and mammography imaging for breast cancer. Results: Out of 23 studies, 12 studies are conducted on women with dense breasts. Twenty studies performed their imaging with hand held ultrasound (HHUS). Out of twenty-three studies, sixteen studies followed BI-RADS procedures. In eleven studies that used joint methods, it was observed that mammography (MAM) has 65% whereas ultrasound (US) has 68% efficiency for early detection of breast cancer. 88% area under a cover (AUCs) among MAM and 98% among US imaging was observed. No major difference was found in sensitivity and specificity of both techniques. Conclusion: Study concludes that Ultrasound is more efficient to diagnose factors suggestive of breast cancer that cannot be detected on mammography. It also has the potential to evaluate cancer among dense breast women but unfortunately in some cases, it may cause a high recall rate. Keywords: Breast, Cancer, Mammography, Ultrasonography, Screening.
461 Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses , Furozan Baig, Sayyeda khadija, Nimra Afzal, Irum Raheem
Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,
462 Ultrasound Measurement of Endometrial Thickness for Detecting Endometrial Malignancy with Uterine Bleeding in Postmenopausal Women- A Systematic Review , Alia Iqbal, Syeda Khadija-Tul-Sughra Murrium, Maria Yaseen, Kiran Shakeel, Muhammad Zafar Iqbal
Background: Post-menopausal Bleeding is extremely doubtful of existence a mark intended for incidence of EC as well as around 5% to 12% of post-menopausal bleeding consequences commencing endometrial cancer. EC is greatest communal Gynecologic Malignancy into established countries. Thin endometrium (≤4 mm) devours precise high NPV (99%). Thickened Endometrium has been considered by way of sign intended for an offensive assessment. Aim: To determine the ET measurement for detecting endometrial malignancy with uterine bleeding in post-menopausal females. Methods: The search was led according to Systematic Reviews Ethics. Searched databases were: Google scholar and Web Research from January 2014 and November 2020. Around nine studies were designated for this Systemic Review. We mined subsequent facts: Design of study, mean age and range, menopause duration, range and mean, BMI range and mean, as well as ET range and mean. Conclusion: From beyond examination this review concluded that, the Endometrial Thickness among the suggested alteration in cut off 3-5 mm within repetitive ultrasound practice must be ended in elevation threat females identify for malignancy before in Postmenopausal females as well as ultrasound is attested chosen a convenient implement to diagnose. Keywords: Post-menopausal Bleeding, Endometrial Thickness, Endometrial Cancer.
463 Recurrence Rate of Carcinoma Breast patients Undergoing Mastectomy at Gulab Devi Hospital Lahore , Muhammad Adil Iftikhar, Khalil Ahmed, Usman Ali Rahman, Malihajavaid Butt, Iftikhar Ahmed, M. Kaleem Akhtar
Aim: To determine recurrence rate of carcinoma breast after mastectomy in our population and to determine various risk factors associated with local recurrence which would help in management of new carcinoma breast patients in future. Methods: It was a descriptive study conducted on patients of carcinoma breast with stage II and III undergoing modified radical mastectomy with negative resection margins at Gulab Devi Hospital, Lahore. Total of 59 patients were recruited in study using purposive sampling technique. Results: Mean age was 51.61±11.52 years with range from 26 to 78 year. Female 58(98.31%) predominated over the 1(1.69%) male. Recurrence rate was seen only in 5 (8.47%) female patients Conclusion: Proper surgical technique results in less chances of carcinoma breast recurrence. Menopause, positive axillary lymphnodes, lymphovascular invasion and necrosis on histology are associated factors of recurrence. MeSH: Carcinoma breast, recurrence, Nottingham Prognostic Index (NPI)
464 Cell-phone Addiction Amongst Medical students: A cross-sectional study , Faiza Javaid Tariq, Abdur Rahman Bin Irfan, Seema Daud  
Background: Cellular phone has become an integral part of our daily lives. Almost all medical students use it to perform various functions, from networking to use of different application. Aim: To observe the ill effects of problematic cell phone use amongst medical students. Method: A descriptive cross-sectional study was conducted on 4th year MBBS at Lahore medical and dental college during January to April 2019. A questionnaire was used having a 7 scale Likert and frequencies of result were given in form of pie chart, bar chart and a table. Results: It was seen that almost half of the class have some tendency towards developing cell phone addiction. 47.2% were males and 52.8% were females who participated in this study. More than half i.e. 51.4% and 59% agreed to have urge to use phone and to frequently check their phone, respectively. A collective 54.9% showed distraction from their studies while being constantly using phone. Conclusion: Cellphone addiction among medical student is rising, some patterns of this problematic use still needs to be explored further and guidelines need to be provided so as to improve the overall wellbeing of students from the ill effects of their phone use. And developing habits which would improve their lifestyle and do not add to their stresses. Keywords: Cellphone, Medical students, Addiction
465 Diagnostic Accuracy of MDCT (Multidetector Computed Tomography) for Staging of Renal Cell Carcinoma , Sadaf Gill, Sarah Nisar, Lubna Sarfraz, Khaula Sidra, Arshad Faheem, Naima Mujahid
Background: The advancement in technology has introduced multi-detector CT scanners and achievement of better spatial resolution with faster acquisition has become a possibility. The three-dimensional reformatted images along with multiplanar reconstructions upgrade the staging capabilities for RCC. Aim: To check accuracy of MDCT (Multi-detector Computed tomography) in staging renal cell carcinoma with histopathology taken as the gold standard. Study design: The study is a descriptive cross sectional study. Settings: Radiology Department, Bahawal Victoria Hospital, Bahawalpur Study duration: 16"' January 2019 to 15"' July 2019. Methods 157 patients (including both genders) were included with age range of 25-60 years, showing features of renal cell carcinoma on ultrasonography. Those Patients with renal mass other than renal cell carcinoma, solitary functioning kidney and pregnant females were eliminated from the study. All the selected patients had Multi-detector CT scan abdomen performed. Results: Mean age was 44.66+9.3 I years. Out of these 157 patients, there were 90(57.32) male patients and 67 (42.68°/c) females with ratio of I.3: I. All the patients had CT scan of abdomen and pelvis. The results showed that 8I of the patients were True Positive and only 08 were False Positive. Out of 68 CT negative patients, 07 (False Negative) showed renal cell carcinoma on histopathology while 6 I True Negative patients had no evidence of RCC on histopathology (p=0.0001). Conclusion: Multi-detector CT scan is a very sensitive yet accurate non - invasive method for staging renal cell ca. Keywords: Renal cell carcinoma, multidetector CT scan, imaging, sensitivity
466 Comparison of efficacy & safety of Blue Light vs topical application of 1% Clindamycin solution in the treatment of mild to moderate inflammatory Acne Vulgaris , Saira Mohsin, Muhammad Nadeem, Shahbaz Aman, Zaib, Shehbaz Ali
Aim: To compare the efficacy & safety of blue light vs topical application of 1% clindamycin solution in the treatment of mild to moderate inflammatory acne vulgaris. Study Design: Comparative interventional study done in Dermatology Outpatient Department Unit-II, KEMU/ Mayo Hospital, Lahore six months i.e. 1-06-2014 – 30-11-2014 Methodology: After an informed and written consent, 130 patients fulfilling the selection criteria were enrolled in the study and divided in two study groups A & B by balloting method. At first visit, a detailed history and clinical examination was recorded on a specially designed proforma. The acne was graded according to the acne grading scale of American Academy of Dermatology.4,13 Group A was exposed to blue light for twenty minutes twice weekly for eight weeks. Group B was given 1% clindamycin to apply twice daily for a period of eight weeks. Post- treatment follow up was done for next four weeks. Patients were assessed at 2nd, 4th, 6th, 8th, 10th, and 12th week. All findings and side effects were recorded on a predesigned proforma. To determine the efficacy of treatment, Acne Severity Index (ASI) was used.5 Result: Efficacy of treatment [≥ 50% improvement in ASI score] was seen in 39(60%) patients in blue light group while in clindamycin group it was achieved in 8 (12.3%) patients only. Blue light group had significantly less number of side effects observed in 35 (37.23%) patients while clindamycin group had a higher number of side effects observed in 59 (62.77%) patients, p-value= 0.013. Conclusion: Blue light is more efficacious and safer than topical 1% clindamycin in the treatment of mild to moderate inflammatory acne vulgaris. Keywords: Blue light, 1% Clindamycin, Acne vulgaris
467 Enhanced learning through Natural Model training: Case for application in pediatric dentistry , Muhammad Farooq, Saqib Ghafoor Kayani, Wajeeha Jabeen, Waleed Javaid Toosy
Background: In field of pediatric dentistry, proper diagnosis and teaching is very important in analysis of resorbed root radio graphically in deciduous teeth for pulpectomy. Aim: To present a new method that improves root canals quality by Undergraduate who was learners. Methods: The oral medicine department selects study cases from OPD. The deciduous teeth were extracted and molded in the transparent epoxy resin similar as their position in human jawbone. Then, their own pre-extraction radiographs were pasted along with them. There was selection of about forty dental Undergraduate in conventional group and experimental Group A. Data from all the participants was carefully analyzed. There was allocation of a questionnaire to each participating Undergraduate that consisted of answer choice in Lickert scale in order to measure aptitude of Undergraduate to this new method and then data obtained was an analyzed statistically. Results: when the mean degree of learning aptitude was compared between experimental Group A group and conventional group then experimental Group A group showed significant results 8.9 than conventional group 6.1, whereas p= 0.03 <0.05. Conclusion: By using the natural models in radiography training, we can make undergraduate to learn better educational diagnosis pediatric dentistry as well as make them compatible to face upcoming challenges in periodic field of dentistry. Keywords: Pediatric Dentistry; Radiology; Pulpectomy; Medial Education, Undergraduate
468 Use of Antibiotics in Cleft Palate Post Operative Patients , Mufassar Nishat, Muhammad Ansar Aslam, Abid Hussain, Najaf Abbas, Usman Ul Haq, Muhammad Nadeem
Background: Cleft palate surgeries are one of the most common surgeries done by Plastic surgeons. Aim: To determine the role of postoperative antibiotics in terms of incidence of complications in cleft palate surgery. Study Design: Prospective randomized control trial. Place and duration of study: Department of Plastic Surgery, Bashir Hospital, Sialkot from May 2016 to January 2019 Methodology:. Patients were randomly divided into two groups. Both groups received a single dose of injection Ceftriaxone (50mg/kg) about 30 minutes before incision. Group A (n=25) received a 5-day regimen of oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) post operatively. Group B (n=25) received 5-day regimen of oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) plus oral Metronidazole (7.5mg/kg/dose in three divided doses) for 5 days postoperatively. Patients were followed up postoperatively at 2 weeks, 1month and 2 months for complication such as infection and wound dehiscence. Result. .Candidates belonging to Group A, (Amoxicillin + Clavulanic acid group) were reported to have Infection 6 (24%) (P 0.005) and delay oral intake. Candidates who were administered oral Amoxicillin + Clavulanic acid (15mg/kg/dose in three divided doses per day) plus oral Metronidazole (7.5mg/kg/dose in three divided doses) 2 patients (8%) had infection in group B which was settled with improvement in oral hygiene. Conclusion: whose candidates who were admitted or stayed for longer duration of time in hospital had insufficient and poor dietary intake. One of the candidates was again admitted due to being dehydrated along with rotavirus whereas group A 24% patients got infected on the other end group B only 8% patients got infected.In net shell, this study revealed that use of postoperative antibiotics (Amoxicillin + Clavulanic acid and metronidazole) can reduce the incidence of infection and results in better surgical outcome of cleft palate surgery Keywords: cleft palate repair, Amoxicillin, Clavulanic acid, Metronidazole, Prophylactic Antibiotics
469 Psychiatric symptoms in students of medical colleges in Punjab , Muhammad Imran Ashraf, Bushra Suhail, Usman Saeed, Muhammad Arshad, Muhammad Imtiaz, Ali Zulqernain
Background: In Punjab, after medical college entrance exam, 3405 candidates got seats in 19 medical colleges (public sector) from 80 thousand participants. In Pakistan, after UHS induction, enrollment of 4300 candidates was made in 43 private medical colleges per year. MBBS, In Pakistan, consist of five academic years along with one year of House job. MBBS is regarded as one of toughest studies that not only effect student health physically but also mentally. Aim: To find out the incidence of stress, depression and anxiety, and stress experienced by medical candidates, and its link with different variables. Duration and study design: September 2018 to December 2019, Cross-sectional study Methods: From September 2018 to 2019 December, this case research was carried out in candidates of private as well as public Medical Colleges. The case research consists of sampling of 270 candidates. The data was collected via questionnaire.. The data was analyzed using social sciences .The statistical analysis of different variables and anxiety stress and depression was carried out. Results: It was reported that the incidence of stress depression and anxiety, and between medical candidates were respectively, 41.1%, 60.1% and 62.2%. Female candidates were found to be more relaxed and stress free as compared to male candidates. Male students were found to be more depressed than female students (29.4% vs 52.2%) along with a statistically significant (P<0.001). Gender is free from association with stress and Anxiety. Candidates from urban areas were more stress free (41.4%) as compared to candidates from village sides (59.2%) with a statistically significant (P=0.021). Conclusion: The incidence of stress anxiety and depression was found more significant in case of male candidates as compared to female candidates. Male candidates and candidates from rural sides were more prone to stress and anxiety. Keywords: Medical Education, Depression, Anxiety, Stress, Medical students.
470 Viral origin of wheeze in the under-five population in Pakistan , Muhammad Arshad, Usman Saeed, M. Imran Ashraf, Shoaib Ahmed, Roman Abbas, Sana Mushtaq, Safdar Ali, H. Mahmood Makhdoom, Asif Shahzad, Amal Shaukat
Background: One of the most common issues arising these days is wheezing that is observed in kids below five year of age accompanied with acute respiratory infections (ARIs). The main etiological causes of ARIs are viruses. Aim: To investigate the viral cause of wheezing in kids below five years of age who were hospitalized in hospital located in Pakistan. Methods: Forty candidates under 5 years of age were admitted complaining wheezing, in this case research. Nasal and throat swaps were taken. For screening purpose, real-time, polymerase chain reaction (PCR) assay was employed in order to rule out rhinovirus, influenza 1 and 2, respiratory para influenza virus (PIV) 1, 2, 3 and 4, syncytial virus (RSV), human meta-pneumovirus, bocavirus (HBoV), Enterovirus Coronavirus, Parechovirus and adenovirus. Results: 30% was regarded as total viral detection rate. Candidates detected with pheumonina viral RNA markers were found from their samples (6 cases), episodic wheeze (1 cases) bronchiolitis (7 cases) and multitrigger wheeze (8 cases). It was discovered that RSV was the most common virus found (30%) which is then followed by PIV1, 2 and 3(18%), HBoV (8%) and rhinovirus (4%). Whereas mixed infection was found in case of in 32 per cent. Conclusions: According to the case research, respiratory viral agents was found to be the culprit in 30 per cent of kids suffering from wheezing; the most common RSV and PIV were responsible for 50 per cent of the total number of cases involved. In case of 30% of cases mixed infections were reported. There was also noteworthy Seasonal variation was noted. Moreover, Further research required to accomplished with a large samples and long duration follow up span in order to clarify results of research. Keywords: Asthma - bronchiolitis - child - incidence - PCR
471 Metabolic Abnormalities in Hypertensive patients and their Risk Factors , M. Imran Ashraf, Shazana Rana, M. Salee Makhtar, Adnan Afzal, Bushra Suhail, Sara Mukhtar, Javaria Fatima, Asif Shahzad, Amal Shaukat
Background: Metabolic syndrome is a disorder which is categorized by the presence of various features like hypertension, obesity, insulin resistance and dyslipidemia. One of the basic features of this syndrome is hypertension that may lead to increased incidence of cardiovascular incidents. Aim: To determine the gender based comparison of metabolic syndrome among the hypertensive patients who reported in the outpatient department. Study Time: The present study was conducted from January 2019 to June 2019 over a period of six months. Methods: Known hypertensive patients aged between 20 to 50 years who fulfilled the selection criteria were included in this study. After informed written consent, the physical examination and required laboratory investigation were done. The data was entered and analysed by using SPSS version 23 Mean±standard deviation was recorded for the quantitative variables while frequency was utilized for the qualitative variable. The p-value of ≤0.05 was taken as significant. Results: A total of 85 known patients of hypertension were included in the study comprising (70.12%) males and (35.40%) females. They were evaluated for the metabolic syndrome using the Adult Treatment Panel III- A (ATP –III A) criteria. Their blood pressure was recorded and fasting blood sample were taken to determine the levels of serum glucose, HDL-cholesterol and triglyceride. Conclusion: Metabolic syndrome is more prevalent in the hypertensive patients Keywords: Metabolic syndrome, Hypertension, Dyslipidemia
472 Effect on lipid profile due to prolong Valproic acid intake , Rao. S Aziz, Usman Saeed, Liaqat Ali, Muhammad Arshad, Roman Abbas, Sana Mushtaq, Asif Shahzad, A Shaukat
Background: Valproic acid (VA) serve as the antimigraine , anti-mental disturbances agent and antiepileptic medicine. After using va, metabolic rearrangements seen in patients that include alteration in lipoproteins levels; Aim: To discuss the effects of VA after using for long duration on total levels of cholesterol in adult. Methods: About Eighty candidates participated and they were divided into two groups namely, case group (40 candidates) and control groups (40 candidates). All the candidates were asked for collection of venous blood sample in order to determine total cholesterol serum level among them via aid of enzymatic cholesterol oxidase phenol 4-aminoantipyrine peroxidase. Results: By the aid of the logistic regression analysis, the relationship of the long-term VA treatment and the level of total cholesterol was obtained. With respect to our analysis, there is a co relation between total levels of cholestrol and long term usage of VA (P=0.003). Conclusions: In a net shell, by using VA for long duration, the total level of cholesterol in adults reduces. Keywords: Lipid profile, side effects, total cholesterol, valproic acid
473 Topical Tacrolimus vs Topical Triamcinolone equally effective in the Treatment of Oral Lichen Planus , Saman Malik, Faiqa Hassan, Usman Ul Haq, Wajeeha Jabeen, Farooq, Saqib Ghafoor Kayani
Background: Lichen planus is a disease that can involve either skin, mucosa or both. Although there is no definite treatment but many medications are available for the relieving the symptoms of this autoimmune disease and recent literature has brought into light the use of an immunosuppressant such as Tacrolimus that may be effectively used as topical application in treatment of Oral Lichen Planus (OLP). Methods: We conducted a study on 80 patients to determine the use of results of topical Tacrolimus (0.1%) versus Triamcinolone acetonide (0.1%) ointment for the treatment of Oral Lichen Planus over a period of six months at Oral & Maxillofacial Surgery Department, HITEC Dental College Taxila. Results: Outcome of the study was determined in terms of ‘Improvement in pain’. Conclusion: This study showed an insignificant difference in improvement in pain of patients of lichen planus treated with tacrolimus and triamcinolone. Keywords: Oral lichenplanus, treatment outcome, symptomatic management, improvement in pain,
474 Effect of Green Tea and Black Tea Aqueous Extract on Histomorphology of Precentral Gyrus of Cerebral Cortex of Albino Rats , Warisha Iftikhar, Syeda Shabeeh Rubab, Raafea Tafweez Kuraishi, Saira Salman, Muhammad Ghazi Zafar
Aim: To compare the histomorphological changes in the precentral gyrus of cerebral cortex of albino rats by taking green tea and black tea aqueous extract. Study design: Experimental Study Duration of study: 30 days study conducted in Animal Experimental Research Laboratory of PGMI and Department of Anatomy, King Edward Medical University, Lahore. Methodology: 90 albino rats were divided into three groups of 30 animals each. Rats in the group I were given distilled water, while group II and group III received green tea and black tea aqueous extract respectively. At the end of 30 days of experiment, brains were removed and studied for histological changes. Results: When comparison among all the three groups was made at 30 days time, p-value was significant for gliosis i.e. p<0.01. However, experimental group III revealed more gliosis among all the three groups. Necrosis was absent in all the groups and was not statistically analyzed. Conclusion: Gliosis caused by black tea is highly significant as compared to green tea. Key words: Cerebral Cortex, Green tea, Black tea, Gliosis, Necrosis
475 Placental Elasticity (KPA) Assessment by Shearwave Elastography in early detection of hypotrophic fetuses. , Sabar Butt, Syed Amir Gilani, Asif Hanif, Syeda Khadija-Tul-Sughra Murrium, Aima Gilani,Raham Bacha, Amjad Iqbal
Aim: To see the predictability of the shear wave elastography assessment of placental elasticity (kpa) for early detection of hypotrophic fetuses Design: Cross sectional comparative.300 single tone pregnancies previously diagnosed as normal and hypotrophic fetuses were included, the placental elasicity assessed by shear wave elastography of both groups and compared. Methods: We took biometric measurements and Doppler indicis of the uterine, umbilical, and middle cerebral arteries in both groups and screened them for grayscale and colour doppler ultrasonography. The placental elasticity was measured by Shear wave elastography in these groups .The comparison of strain ratios between these groups were done. Statistical analysis was carried out using the Mann-Whitney test. By plotting ROC curves, cut-off values for elasticity were analysed. On Shear wave elastography measurements, the sensitivity and specificity and diagnostic accuracy of hypotrophic fetuses were planned and developed. Results: The mean placental elasticity in hypotrophic fetuses and normal group was 28.71 ± 7.28 and 5.64 ± 1.53 respectively while the median placental elasticity in IUGR group was 27 ± 7 and 5.50 ± 2 with statistically higher median in hypotrophic groups, p-value < 0.001. Conclusion: In hypotrophic fetuses, as placental stiffness values are much higher, therefore for early detection of compromised hypotrophic fetuses , as a non-invasive, supplementary tool to gray-scale and Doppler, the Shear-wave elastography can be used. Keywords: Hypotrophic fetuses, Shear-wave elastography, Placental Elasticity (kpa), IUGR, Uterine artery, Umbilical artery, Middle cerebral artery, resistive index, pulsatility index,
476 Frequency of True and False Umbilical Cord Knots and their Relation Maternal Age and Parity , Sabahat Gul, Sumaira Hassan, Urooj Fatima
Background: Umbilical Cord Knots both true and false are common abnormalities whichobstruct the blood flow and oxygen supply to the fetus and are frequently associated with advanced age and high parity of the mother. Aim: To find the frequency of true and falseumbilical cord knots in 100 samples of placentae (with attached umbilical cords ) and their relation to maternal age and parity. Study design: Descriptive cross sectional study. Place of study: Anatomy Department of (BMSI) Basic Medical Science Institute, JPMC Karachi. Methodology: 100 normal vaginally delivered full term placentae with attached umbilical cords were studied with direct Visual examination of the cords. The study included frequency, type and location of the knots and their relation with maternal age and parity. Data collected was analyzed by SPSS version 23 and presented in the form of tables and figures, cross tabulations of umbilical cord knots with age of mother and parity was done. Chi square test was used as test of significance asvariablesunder study are qualitative in nature. Results: This study showed that frequency of umbilical cord knots in 100 samples of placentae was 14% out of which 10(72%) were false knot and 4(28%) were true knot. Bothtrue and false knots were more frequent in male babies. There was statistically significant relation of knots with advanced maternal age (>30) and high parity (>5). Conclusion: Frequency of true umbilical cord knots is 4%. Most of knots are found in male babies and there is statistically significant relation of umbilical cord knots with advanced maternal age and high parity. Keywords: Umbilical cord, true knots, false knots, fetus.
477 Demographic Characteristics with Osteoporosis in Post Menopausal Women Referred for Osteoporosis Screening by Dual Energy X Ray Absorptiometry , Shandana Khan, Rabia Akhtar, Tahir Malik, Hadia Abid, Ummara Siddique Umer, Sana Iqbal
Aim: Association of various demographic characteristics with osteoporosis in post menopausal women. Study design: Descriptive study. Place and duration of study: Radiology Department North West General Hospital and Research Centre, Peshawar, from 15th August 2013 to 14th August 2014. Methodology: Post menopausal women referred for osteoporosis screening were scanned for bone mineral density (BMD) of the left hip by Dual-energy X-ray absorptiometry (DEXA) technique. Patients who were using any drugs or had any known disease affecting bone metabolism and patients already diagnosed as osteoporotic were excluded. Mean±SD were calculated for numerical data using SPSS version 16. Chi-Square test was applied. Results: Among the 318 post menopausal women, the mean age was 62.51±9.15 and menopausal duration 15.19±8.27 years. Mean BMI was 29.2±6.47Kg/m2. Parity ranged from 0 to 14 children, with mean of 6±. Overall observed frequency of osteoporosis was 38.1%. Osteoporosis was significantly associated with older age groups (p<0.05). Majority of patients beyond the age of 70 years (58.3%) and with menopausal duration of ≥21 years (52.8%) had osteoporosis. Low BMI, defined as BMI<18.5Kg/m2, was associated with lower BMD (p<0.01). No significant association was established between early and late onset menopause and osteoporosis, as well as high parity and osteoporosis in our study. Conclusion: Increasing age, longer duration of menopause, low BMI, and physical inactivity were significantly associated with the presence of osteoporosis. Keywords: Osteoporosis, Menopause, Bone Mineral Density (BMD), Dual-Energy X ray Absorptiometry (DEXA)
478 Frequency of Pneumonia in Children Less Than two years of age Presenting with Measles , Hanif Ullah, Syed Sajid Munir, Maimoona Saeed
Aim: Frequency of pneumonia in children < 2 years of age presenting with measles. Settings: Pediatric Department, Khyber Teaching Hospital, Peshawar. Study design: Cross sectional study. Study duration: 6 months from 24/7/2018 to 24/1/2019. Methodology: In this study, a total of 131 patients observed. Children with clinical suspicion of measles were undergone a complete blood count and X-ray chest. Results: In this study, mean age was 12 years with SD ± 2.16. Fifty five percent children were male while 45% children were female. 70% children had pneumonia and difference was statistically significant. Conclusion: Frequency of pneumonia was 70% in children <2 years of age presenting with measles. Keywords: Pneumonia, children, measles
479 Role of Interleukin- 34 together with Receptor Activator of Nuclear Factor kB ligand and Osteoprotegrin levels in Periodontal Disease , Noor Ul Amin, I. Saleem Qureshi, Sana Naeem, S. Hassan Jan, Kamal Khan, Riaz Khan, Sadia Amin, Tahira Sahar
Aim: To compare the levels and relative ratios of Interleukin-34, osteoprotegrin, and factor kB ligand in the crevicular fluid of individuals with periodontal disease. Study design & setting: Randomized Clinical Trial, Frontier Medical And Dental College, Abbotabad Methodology: We enrolled 15 healthy subjects (Group I), 15 patients with chronic periodontal disease (Group II) and 15 patients with aggressive periodontal disease (Group III). At baseline and six weeks after NSPT, crevicular fluid and clinical measures were made. The GCF IL-34, factor kB ligand, and osteoprotegrin levels were measured by using ELISA and their relative ratios were computed. Result: Group II and III had significantly higher crevicular fluid IL-34 and factor kB ligand levels than the Control group (I), although crevicular fluid with osteoprotegrin levels was significantly decreased (P<0.05). GCF, IL-34, and RANKL levels reduced in Groups II and III six weeks after NSPT, although OPG concentrations increased statistically (P<0.05). Significantly positive association was observed between IL-34 and factor kB ligand, clinical attachment level, and gingival index, but not with osteoprotegrin. Conclusion: Gingival crevicular fluid IL-34 levels were elevated in individuals with periodontal disease and lowered during non surgical intervention, and its levels correlated positively with the factor kB ligand and osteoprotegrin ratios, clinical attachment level, and gingival index. Keywords: Periodontitis, IL-34, osteoprotegrin
480 Gross Anatomical Variations of Cystic Duct: A Cadaveric Study , Syeda Shabeeh Rubab, Warisha Iftikhar, Raafea Tafweez Kuraishi, Saira Salman
Aim: To determine the frequency of anatomical variations of cystic duct. Study design: Descriptive Case Study Place and duration of study: Anatomy Department of King Edward Medical University Lahore and duration of study was from August 2018 to December 2019. Methodology: The dissection of 43 cadavers was done and extra hepatic biliary tract was explored. The length of cystic duct and site of insertion of cystic duct in common hepatic duct was noted. The length of cystic duct <1 cm was taken as short cystic duct and >4cm as long cystic duct. The insertion of cystic duct near porta hepatis is high insertion and near duodenum is low insertion. Results: The mean length of cystic duct was 2.67±0.71 cm. Out of 43 cadavers 2(4.7%) of cadavers had short cystic duct. 41(95.3%) of cadavers had normal length of cystic duct. There was no cadaver observed with long cystic duct. Out of 43 cadavers 39(90.7%) of cadavers had mid insertion of cystic duct, 4(9.3%) of cadavers with high insertion of cystic duct and no cadaver with low insertion. Conclusion: The most common anatomical variation of cystic duct is high insertion of cystic duct 9.3%. Keywords: Anatomical variations, cystic duct, cholecystectomy
481 Surgical Management of Traumatic Epidural Hematomas , Naeem Ul Haq, Adnan Ahmed, Mukhtiyar Ali, Muhammad Ishaq, Sana Ullah, Waqas Mehdi, Mehtaabudin
Aim: To find out predictive significance and impact on neurosurgical treatment in EDH patients Setting & duration of study: Neurosurgery unit, Mardan Medical Complex, Mardan, from Dec, 2017 to Dec, 2019 Sample size: 120 individuals with traumatic epidural hematoma were treated through surgical intervention. Result: Out of 120 cases, 74% were male, while 26% were female. Motor vehicle accidents caused 86% of the injuries, while falls and heavy hits caused 14% of the injuries. On well defined tomography imaging of the brain, 14% individuals exhibited the swirl sign. The epidural hematoma had a strong association with preoperative Glasgow score, preoperative mydriasis, time from injury to CT scan, and intraoperative hematoma volume. Conclusion: Epidural hematoma has an excellent outcome, if managed on time. The epidural hematoma may be linked with a cataclysmic result, with comparatively high rates of mortality and morbidity. Keywords: Epidural hematoma, Glasgow Outcome Scale
482 Socrative.Com; An Innovative Tool to Enhance Performance of Undergraduate Students in Histology Practicals , Tayyaba Mahmud, Uzma Akhtar, Natasha Nadeem, Bakhtawar  
Background: Undergraduate medical students require a strong foundation in histology which is an important part of curriculum in basic sciences years. Histology is considered to be a difficult subject by the students. Aim: To facilitate student learning, Socrative was introduced into histology practicals. Methods: This was a comparative cross-sectional study conducted among second year MBBS students (n=146) in histology. Socrative based activity, Space race, was introduced into histology practicals for the entire duration of module-III (10 weeks). This activity was done by the students in addition to demonstration and slide viewing under microscope. Performance of the students was assessed in histology Objective Structured Practical Examination (OSPE) and viva during module examinations. Score sheets of module-I were compared to those of module-III to assess the impact of using Socrative on academic performance. The study was approved by institutional Ethical Review Committee. Results: The results were analyzed using Wilcoxon Signed Rank test which showed statistically significant improvement in the performance of students (P value= 0.0001) in module-III. Moreover, 81.5% students showed improvement in academic performance after using Socrative. Conclusion: These results show that use of Socrative assessment method as part of teaching method, improved academic performance of undergraduate medical students in histology. Keywords: Socrative, histology, formative assessment, academic performance (MeSH words required)
483 Depression and Conventional Risk Factors of Coronary Artery Disease , Ayesha Khalil, Muhammad Asif Iqbal, Saad Subhan, Marina Khan, Malik Faisal Iftikhar
Aim: To compare the conventional risk factors of coronary artery disease in depressed versus non-depressed groups. Study Design: Cross sectional, comparative study Place and duration of study: Department of Cardiology, Lady Reading Hospital, Peshawar from 1st October 2018 to 31st October 2019 Methodology: One thousand and twenty eight patients of age 18 years and above and both genders were enrolled. They were divided into group A (depressed) having 634 patients and group B (non-depressed group) 394 patients. Both groups were assessed for the presence of modifiable cardiovascular risk factors. Results: There were 368 (61.5%) males and 266 (38.5%) were females with mean age was 55.88±11.37 years. In depressed group, 557 (87.8%) patients were living in sedentary life style while in non-depressed group, 327(82.9%) patients were living sedentary life style (p<0.05). Hypertension was present in 69.5% patients in depressed group and 60.1% in non-depressed group (P=0.005). Diabetes (36.7% vs 35.5% P=0.79), smoking (17.5 vs 20.5 P=0.19 and hypercholesterolemia (202.76±58.12 vs 196.51±52.4, P=0.311) were present in depressed versus non depressed patients respectively. Conclusion: Cardiovascular risk factors including hypertension, physical inactivity and obesity are more common in patients with depression as compared to non-depressed patients while smoking, diabetes and cholesterol are not different between depressed and non-depressed patients Keywords: Coronary artery disease (CAD), Depression, Risk factors
484 Characteristics and Outcome of Adult Patients with Community Acquired Pneumonia , Muhammad Farooq  
Aim: To evaluate the characteristics and outcome of patients with community acquired pneumonia admitted to a tertiary care hospital of Pakistan. Study design: Retrospective observational study Place and duration of study: Department of Pulmonology, Bolan Medical College Quetta from 1st January 2017 to 31st December 2018. Methodology: Two hundred and ninety three patients were enrolled. Baseline demographics and characteristics, clinical features, complications and mortality were recorded for each patient at a tertiary care hospital of Quetta. Results: There were 170 (58%) male patients with mean age 61.74±16.15 years. The average length of hospital stay was 4.88±4.0 days. Fifty nine (20.2%) had COPD, 65 (22.2%) were active smokers and 54 (18.4%) were ex smokers. The parapneumonic effusion during the course of the disease was found to be 49 (16.7%). Fourteen (5.8%) of the patients had empyema. Forty eight (16.4%) patients among the study population died during their hospital stay. Conclusion: The community acquired pneumonia has high mortality rate and high frequency of complications like parapneumonic effusion and empyema among the patients admitted to a tertiary care hospital of Pakistan. Keywords: Community acquired pneumonia. Parapneumonic effusion, Empyema
485 Experience of Management of Vesicovaginal Fistula in Khairpur Medical College Hospital Khairpur , Hameed-Ur-Rahman Bozdar, Sabahat Fatima, I. Ullah Memon, W. Sarwar Bhatti, N.Karim Bhatti, Imran Khan Memon
Aim: To report the experience of vesicovaginal fistula repair among patients attending Khairpur Medical College. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Khairpur Mir’s and Department of Obstetrics & Gynaecology, GMMC, Sukkur from 1st February 2018 to 20th November 2020. Methodology: Thirty five known case of vesicovaginal fistula presenting with continuous leakage of urine were consecutively included. Patients with failed previous repair were also included. After pre-operative work-up, fistula repair was done either through abdominal or vaginal route in two layers tension free and watertight with absorbable suture. All patients were called for follow-up visits at two weeks initially and then depending on the presence of symptoms later on. Results: Transabdominal repair was observed in 18 (51.4%) patients whereas transvaginal vesicovaginal repair in 17 (48.6%) patients. The mean operative time was significantly higher among patients with transabdominal repair than transvaginal repair (p<0.001). Similarly, mean estimated blood loss was significantly higher in transabdominal repair than transvaginal repair (p<0.001). Success was found in majority of the patients 30 (85.7%). Success was found significantly higher among patients with transabdominal repair as compared to transvaginal repair, 18(100%) vs 12(70.6%) (p=0.013). Conclusion: Success rate of vesicovaginal repair was reported in majority of the patients. Though, success rate was remarkably higher in transabdominal repair, less estimated blood loss and operative time was reported in transvaginal repair. Keywords: Vesicovaginal repair, Success rate, Transabdominal repair, Estimated Blood Loss, operative time,
486 Educational Efficacy of Diverse Strategies on Knowledge and Skill of Nursing Regarding Neonatal Resuscitation , Mishal Liaqat, Muhammad Hussain, Muhammad Afzal
Background: The educational efficacy in resuscitation could be improved by enhancing instructional design through different innovative approaches especially in resource-limited settings. Aim: To determine the educational efficacy of diverse strategies on knowledge and skill of nursing students regarding neonatal resuscitation. Study design: Quasi-experimental study. Place and duration of study: School of Nursing, Allama Iqbal Medical College, Lahore from 1st November 2020 to 30th April 2021. Methodology: Sixty-five nursing students of 1st and 2nd professionals were selected. The education on neonatal resuscitation consists of diverse educational strategies including didactic lecture, video, simulation, and self-practice sessions in the simulation laboratory of a public school of nursing in Lahore, Pakistan. The data on knowledge and skill was assessed two times before and after the intervention. Results: The study showed a significant (p<0.001) change in knowledge and skill after education. Nearly, all students had poor knowledge and skill before education. The knowledge had been improved as 40.0%of students achieved good, and 53.3% achieved fair knowledge level. Conclusion: The diverse educational strategies in neonatal resuscitation significantly improve nursing students' knowledge and skill. Keywords: Neonatal resuscitation, Education, Nursing students, Knowledge, Skill
487 Outcome of Sellar and Suprasellar Brain Tumors with Retractorless Modified Subfrontal Approach , Abdul Rauf, Hameed Ullah Khan, Mubarak Hussain
Aim: To determine the outcome of sellar and suprasellar brain tumors with retractorless modified subfrontal approach. Study design: Descriptive/observational study Place and duration of study: Department of Neurosurgery, Liaquat University Hospital Hyderabad/Jamshoro from 1st March 2020 to 28th February 2021. Methodology: Fifty patients of sellar and suprasellar brain tumors age between 15-70 years were enrolled. Patients details demographics age, sex and body mass index were recorded after taking written consent. The inter-hemispheric front-basal technique was used for all patients and the average follow-up time was 6 months. Postoperatively, magnetic resonance imaging (MRI) and computerized tomography (CT) scans in all patients were performed. After 12 hours, the postoperative CT scan was performed to monitor for persistent tumor and hemorrhage cerebral edema following an operation. Results: There were 30 (60%) male patients and 20 (40%) female patients. Mean age of the patients were 28.36±14.88 years with mean BMI 23.16±7.54 kg/m2. Most of the patients 20(40%) were from age group 15-30 years, followed by 31-40 years in 12 (24%) patients. Frequency of pituitary adenoma was found in 22 (44%) cases, craniopharyngioma found in 19 (38.7%) cases, arachnoid cyst found in 4 (8%), keratin flakes in 2 (4%) cases, benign giant cell tumor found in 2 (4%)olfactory groove meningioma in 1 (2%) and epidermoid in 1 (2%) cases. Post operatively 35 (70%) patients were completely recovered, complications found in 13 (26%) patients who were recovered later and frequency of not recovered patients was 2 (4%). According to Karnofsky performance, 16 (32%) patients had scale 30, scale 60 was in 2 (4%) cases, scale 70 in 4 (8%) patients, scale 80 in 19 (38%) and scale 90 in 9 (18%). Conclusion: This retractorless method is very effective and safe in the sellar and suprasellar region for excision of big tumors. This method allows the huge tumor to be removed without serious complication. Keywords: Sub-frontal approach, Sellar, Suprasellar, Brain tumor, Retractorless method
488 A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh , Sabahat Fatima, A. G.ul Shaikh, Tahmina Mahar, Hameed-Ur-Rehman Bozdar, Sameena Memon, Mahjabeen Khokhar
Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous
489 Cerebrospinal Fluid Sterilization with Intrathecal Polymyxin in Addition to Parenteral Polymyxin in Nosocomial Acinetobacter Meningitis , Sadia Ishaque, Ehsan Bari, Muhammad Shahzad Shamim, Syed Faisal Mahmood
Background: For the last few decades there has been a substantial concern regarding the increasing prevalence of multidrug resistant (MDR) Acinetobacter species in hospitals. Aim: To determine the outcomes with intrathecal polymyxins therapy in patients with multidrug resistant Acinetobacter species nosocomial meningitis. Place and duration of study: This Retrospective study was conducted in the Department of Infectious Diseases, Aga Khan University Hospital, Karachi Pakistan between 2010 and 2014. Methodology: Twenty six patients who developed post neurosurgical MDR Acinetobacter nosocomial meningitis age above 18 were included, while those with polymicrobial meningitis, and those patients who only received intravenous polymyxins were excluded. The primary outcome is ability and time to sterilize the cerebrospinal fluid Results: The mean age was 42.9±11.5 years. Cerebrospinal fluid sterilization was observed in 24 patients in a median of 4 days. One patient made complete recovery, 16 patients recovered with neurological deficits and five patients expired. A trend of early cerebrospinal fluid sterilization was observed in patients with continuous intrathecal therapy. The time to cerebrospinal fluid sterilization is similar with intrathecal colistin or polymyxin. Conclusion: Intrathecal polymyxins are safe and efficacious in the treatment of multidrug resistant nosocomial Acinetobacter species meningitis. Keywords: Intrathecal, Polymyxins, Multidrug resistant, Acinetobacter species, Nosocomial, Meningitis
490 Effectiveness of Platelet Rich Plasma for the Management of Knee Osteoarthritis , Adnan Qamar, Saima Naz Mohsin, Uzma Nasim Siddiqui, Sana Naz, Sana Danish
Aim: To determine impact of platelet rich plasma therapy for the management of knee osteoarthritis. Study design: Prospective double-blinded, add –on randomized, placebo-controlled trial Place and duration of study: Department of Orthopedics, Shaikh Zayed Hospital Lahore from 1st January 2019 to 30th June 2019 Methodology: Fifty volunteer participants fulfilling inclusion criteria were enrolled. One hundred knees of patients were randomly allocated into two groups. Knees were assigned either of the two groups. Platelet rich plasma group which was assigned to receive 5ml of platelet rich plasma and normal saline (NS) group which was assigned to receive 5ml of NS labeled as control group. All patients given 3 successive intra-articular injections of 5 mL of autologous platelet rich plasma or 5ml of normal saline was given at weekly intervals. Patients were blinded and subjected to a standardized injection protocol and the intensity of pain was assessed on visual analog scale (VAS) for pain. Results: The VAS scores decreased from 50.9±14.7 at baseline assessment to 43.6±16.2 at 1-month follow-up after completion of therapy for PRP group (p<0.0203). The improvement was maintained from the end of the therapy to 3 and 6 months’ follow-up, as measure of VAS score as 30.54±11.8 and 20.2±8.6 respectively (p<0.0001). In normal saline group, there was very slight decrease in VAS score from baseline i.e. 49.8±19.5 to 48±22.7, 44±16.6, and 42±21.7 at 1, 3 and 6 months interval. Conclusion: Platelet rich plasma therapy can provide effective pain control up to 6 months post injection in knee osteoarthritis. Key words: Platelet rich plasma (PRP), Knee osteoarthritis (OA), Pain score
491 Outcomes of Redivac Drain in Primary Closure of Pilonidal Sinus , Samina Karim, Ahmad Shah, Ahmad Raza Nsar
Aim: To determine the effectiveness of redivac drain in primary closure of pilonidal sinus. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st January 2020 to 31st December 2020. Methods: Ninety patients of both genders were presented in this study. Patient’s details demographics age, sex and BMI were recorded after taking written consent. Patients were divided into two groups; group I and group II. Group I had 45 patients and underwent for redivac drain and group II was without redivac drain and had 45 patients. Complete follow up was done in duration of 6 months. Outcomes wound healing, infection of wound and recurrence of pilonidal sinus in both groups were observed. Results: Majority of the patients 66 (73.33%) were males and 24 (26.67%) were females. Mean age of the patients in group I was 28.52±6.88 years with mean BMI 24.16±7.33 kg/m2 and in group II mean age was 29.68±7.45 years with mean BMI 25.14±3.16 kg/m2. In group I 36 (80%) cases showed complete healing, partially healing was observed among 7 (15.55%) and 2 (4.44%) showed non-recurrence and in group II complete healing was among 26 (57.8%) patients, partially healing was found in 14 (31.11%) and non recurrence was among 5 (11.11%) patients. Rate of recurrence in group I was 3 (6.67%) less than that of group II (8.9%). Conclusion: The redivac was more effective as compared to primary closure of pilonidal sinus without redivac. Keywords: Redivac drain, Primary closure, Pilonidal sinus, Recurrence
492 Comparison of Outcomes between Elective Tracheostomy versus Emergency Tracheostomy , Tarique Khan, Abid Rashid, Muhammad Awais Samee, Ahmed Ali
Aim: To compare the frequency of early postoperative complications of elective tracheostomy and emergency tracheostomy. Study design: Comparative/observational study Place and duration of study: Department of ENT/Head & Neck Surgery, Mayo Hospital Lahore from 1st July 2012 to 31st December 2012. Methodology: One hundred patients of both genders undergoing tracheostomy were enrolled. All the patients were divided equally in two groups; Group A (elective) comprised 50 patients and group B (emergency) tracheostomies also comprised 50 patients. Early postoperative complications were examined and compare between both groups. Results: There were 28 (56%) and 22 (44%) males and females in group A with mean age 42.45±10.55 years while in group B 30 (60%) and 20 (40%) patients were male and females with mean age 43.06±9.84 years. Patients received emergency tracheostomy had high rate of postoperative complications as compared to elective tracheostomy (36% vs 16%). The difference was statistically significant(P<0.05). Conclusion: Early postoperative complications were high in patients underwent emergency tracheostomy as compared to elective tracheostomy. Keywords: Early complications, Elective tracheostomy, Emergency tracheostomy
493 Reduction in Glomerular Filtration Rate Following Live Kidney Transplant Donor , Afsheen Akbar,, Maryam Raza,,Amtul Huda,Sadia Zia, Shaheena Naz, Aasma Nighat Zaidi, Zulfiqar Ali
Aim: Renal replacement therapy is best possible treatment for end stage renal failure, but current research suggestive of augmented long-term risk in renal function for the donor. Methods:At this time, we evaluate the subjects for the risk of decreased (eGFR) estimated glomerular filtration rate within old 50 giver, who undergo pre-donation assessment and live benefactor nephrectomyamong 2007 and 2015by multiple centers of Pakistan. Results:The mean pursuepoint in time was 8.5 years (0.9–28.2). Inco relational analysis, subject age and status of hypertension (arterial) by thereference line were considerablylinked witha elevatedhazard of unfavorable renal effect, in particular, eGFR <60mL/min/1.73m2 (age/year: hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.04–1.08, (HTN): HR 1.09, 95% CI 1.21–4.0), eGFR <60 mL/min/1.73 m2 and a turn down of _39% from the initial measured line (age: HR 1.07, 95% CI 1.03–1.13,HTN: HR 4.22, 95% CI 1.71–10.35), and, eGFR <45mL/min/1.73m2. Age and HTN HR 2.13, 95% CI1.04–1.21, HR 4.05, 95% CI 1.47–18.15 respectively, Adding together, eGFR levels at occasion of contribution was linked with a lesserhazard of eGFR <60 mL/min and eGFR <40 mL/min. The only significantpredictor for adverse renal outcomes was Age. Conclusion: Arterial hypertension, lower level of eGFR, and age at the time of donation are powerful prognosticating factor for undesirable kidney adverse effects in live renaldonor. Keywords: eGFR (per mL/min/1.73 m2) Estimated glomerular filtration rate, arterial hypertension HTN; ESRD
494 Ameliorarting Action of Methylcaobalamin on Degenerated Cerebellar Molecular Cell Layer , Tazeen Kohari, Zaheer Amjad, Zaffar Malick
Background: Cerebellum the hindbrain is located in the posterior cranial fossa.The cerebellar cortex consists, of a gray matter and a white matter and the gray matter comprises of outer molecular layer, middle purkinje cell layer and inner most is the granule cell layer. The antimaniac drug lithium caused distortion to the outer molecular cell layer which was repaired and the damage was lessened by injecting the albino rats with Methylcobalamin. Aim: To observe and document the data of the restored thickness of molecular cell layer after Methylcobalamin administration. Methods: Eighteen albino rats were selected and were treated with lithium and Methylcobalamin for a period of 4 weeks. Results: The results showed regeneration and improved thickness of molecular cell layer stressing the need for educating our masses in dietary use of vitamin b12 and the consultants to prescribe Methylcobalamin in neuronal injuries. Conclusion: My study proved that the use of vitamin b12 is mandatory in strengthening and restoring the cerebellar molecular gray matter. Keywords: Cerebellar molecular cell layer,Degeneration, Regeneration
495 Anti-diabetic effect of Momordicacharantiaplant extract in streptozotocin induced diabetic mice , Nayyab Sultan, Zahid Hussain, Sabahat Javaid Butt, Aqib Javaid Butt  
This study describes anti-hyperglycemic effect of Momordicacharantia extract commonly known as bitter melon. Random blood glucose levels were observed before and after plant extract administration. Powdered form of plant extract was used as an oral treatment. Diabetes was induced in animal (mice) models by using streptozotcin which is an artificial diabetes inducer. Maximum anti-hyperglycemic effect and blood glucose level reduction was observed in individual treatment of Momordicacharantiaextract (500mg/kg) which was 75% ± 1.3. This treatment was more effective as compared to Amaryl (3mg/kg) which shows effectiveness of 52% ± 2.4 and Glucophage (500mg/kg) which shows effectiveness of 29% ± 2.1. Results indicate that bitter melon contain anti-hyperglycemic proteins which are helpful in diabetes treatment without any toxic side effects. Still more research, experiments and testing needs to be perform. Keywords: Amaryl; Anti-hyperglycemic effect; Blood glucose levels; Body weight; Diabetes mellitus
496 Documented Lipid Per oxidative Intoxication of Cerebellar Molecular Cell Layer , Zaheer Amjad, Tazeen Kohari, Zaffar Malick
Background: Cerebellar cortexconsists of three layers. The outer molecular, middlePurkinje cell layer, inner granule cell layer. Lithium the alkali metal hasdeleterious effects on nervous tissue and this study proved the injurious effects of lithium on molecular cell layer of cerebellum. Aim: To observe and report the damaging histological and morphological change of the decrement in the thickness of cerebellar molecular layer by Lithium. Methods: This study was designed to observe the microscopic changes of thickness of molecular layer in rat cerebellum. For this experimental study 12 animals were used, they were divided into two groups, each comprising of 6 animals. Results: Group-A received normal lab diet and water ad libitum while group B received injectable lithium carbonate 20 mg/kg/ for 4 weeksrespectively. Micrometry was done and changes of the thickness of molecular cell layer were recorded and documented. Conclusion: The pernicious effects of Lithium Carbonate on molecular cerebellar cortex were visualized and evaluated .Highly significantly decreased changes of thickness of molecular cell layer were documented in rat cerebellum. Keywords: Lipidperoxidation,Molecular cell layeratrophy, decomposition
497 Prevalence of dental caries among 3 to 11 years old children in Lahore , Adeel Ijaz Rana, Saleem Rana, Arooj Ul Hassan, Fareed Ahmad , Ali Anwaar, Marryam Riaz, Amina Tariq
Aim: To determine frequency of dental caries in mal-occluded teeth among children 3-11 years of age and compare dental caries in children with mal-occluded teeth Methodology: This cross sectional analytical study using purposive sampling technique was carried out at Dental hospital of Institute of dentistry, CMH Lahore Medical College, Lahore for 09 months After permission from institute of dentistry, CMH Lahore medical college and informed consent form participants or their parents/ guardian, they were included as male and female children aged 3-11 years that attended dental hospital of Institute of dentistry, CMH Lahore Medical College for dental treatment and had mal-occluded teeth. Children with mental, physical disabilities and whose parents/ guardian refused to take part were excluded. Dental caries in mal-occluded teeth of children was examined to report the frequency of dental caries. SPSS version 23 was used for analysis data. Results: Among the total of 330 patients included in the study, dental caries was observed in 260 (78.8%) of patients. Conclusion(s): Significant associations of dental caries were observed in terms of gender and age, monthly income, interventional urgency, and occupation and education status. Higher frequency of dental caries was observed in the upper middle and lower middle class groups. Keywords: Dental caries, Mal-occlusion, Pre-school children, Dental treatment
498 Association of maternal oral health with early childhood caries among rural areas of Punjab , Roheen Shakeel, Aliya Ishaque, Aaqil Malik, Shahzad Waheed Qureshi, Gulrez Amin, Faisal Ali Baloch, Amina Tariq
Aim: To explore the relationship between oral health status of mothers and caries prevalence of caries among their children in rural areas of Pakistan. Methodology: This crossectional study was conducted in 9 rural health centers of Punjab, Pakistan. Purposive convenient sampling was used to collect data. Sample size was 500 mothers with their children. Results: Socioeconomic status of family as well as the purpose for the last visit at dental hospital for the treatment of child were found positively linked with the dmfs of child. Sample of children at very low socioeconomic status (OR: 2.16; 95%CI: 1.36-2.98). Children who visited dental hospital with the reason of having dental problems (OR: 1.89; 95%CI: 1.25-2.59). Greater dmfs score was found among children with poor oral hygiene (OR: 1.98; 95%CI: 1.27-3.25). The education of mother was found to be negatively linked with dmfs score of child. Conclusion: The relationship between maternal and dental caries in children was clearly explained by socioeconomic status or dental behaviors of mother and child in terms of intake of sugar, oral hygiene and reason for last dental visit for child. Keywords: Maternal oral health, dmfs, childhood carries
499 Umbilical Artery and Middle Cerebral Artery and Cerebroplacental Ratio for Doppler Indices’ Reference Ranges , Arjuamnd Sultana, M. Nawaz Anjum, Naveed Asad, Rizwan Ul Haq, Taimoor Shahid Qudsia Sadaf, Amina Tariq  
Aim: To investigate the reference values of Doppler indices for umbilical artery and Middle Cerebral Artery as well as Cerebro-placental Ratio and specifically, to evaluate the quality of methodology used on which these reference values are grounded, with the help of already established quality standards for research design, statistical analysis as well as methods of results reporting. Methodology: The methodological quality of the full-text versions of eligible studies was assessed independently by the same reviewers and a medical statistician (E.S.U.). Disagreements were resolved by consensus or consultation with two other reviewers (A.T.P. and E.F.). Quality criteria for evaluation methodologies of the published articles was developed which was based on the already available research publication25,36,37. The methodology evaluation criteria was segregated into two levels, one is study design and the other one is statistics used as well as its reporting methods. Total no. of criteria of quality were 24 to be evaluated. Results: Generally, methodological quality score was parallel for the research articles designed to evaluate umbilical artery range (median 42%; range 13.8–63.8%). For the studies focusing on middle cerebral artery range showed a median of 48% with a Class interval of 22.1–72.1% whereas the median score of cerebroplacental ratio was 47.1% with a Class interval of 34.6–55.5%. Conclusion: Rigorous methodology of this review study is the major strength, which is consisted of a standard and well developed methodology of scoring the quality of studies according to their methodology selection as well as the statistical analysis and the level of its interpretation. Keywords: Umbilical artery, Middle Cerebral Artery, Cerebro-placental Ratio, Doppler indices
500 Assessment of Parental self-management of epileptic pediatric in terms of adherence of antiepileptic drugs , Danyal Iftikhar, Rabia Farooqi, Shahzad Waheed Qureshi, Amina Tariq, Amna Mehwish Ikram, Adeel Haidar
Aim: To assess the parental self-management of epileptic pediatric in terms of adherence of antiepileptic drugs Methodology: A descriptive cross-sectional study was conducted in Children Complex Hospital of Multan. Convenient sampling technique was used to collect the data from included population, care giver of epilepticus children. Reliability checked by Cronbach alpha which was 0.71. Data was analyzed in SPSS 25, to get percentage and frequency. Results: The majority of the responses were agree 86(81.9%) on the doctors/nurses fully explained seizures/epilepsy (diagnosis). 10(9.5%) were strongly agree that doctors and nurses fully explained seizures to them. What side effects they have to look for while they are in treatment, was reported in positive by 73(69.5%) participants. 63(60%) were agree about whom to contact for questions or problems. The results show that the 71(67.6%) were agree about the confidence with which they can in partnership with the health care team can manage side effects if occur. Conclusion: Parental self-management was found higher in epileptic pediatrics in Multan Keywords: Epileptic drugs, Pediatrics, self-management, nurses
501 Orthodontic Principles and Practice based Knowledge and Attitude among general dental practitioners , Shoaib Masood,Ch. Rehan Qamar, Fareeha Amdad, Muhammad Hassan, Amina Tariq
Background: This study was formulated for the comparative evaluation of the knowledge and attitude of the general dental practitioners and non-orthodontic specialties about the orthodontic treatment. Methodology: Data of this cross sectional study was collected from 100 general dentists between an age ranges of 30 to 50 years using simple random sampling from all over Lahore. Results: The percentage for the positive responses was 85.69% whereas the negative response rate was very low which was reported as 14.3%. This showed that dental practitioners in market are practicing orthodonticskills. The response rate of general practitioners was: 60.42% positive responses and 39.57% negative responses were obtained which showed that more than half of general dental practitioners have a positive attitude towards orthodontic treatment guidance to their patients with general complaints. Conclusion: The overall attitude of general dental practitioners is satisfactory towards orthodontic treatment in general patients. Moreover, dental practitioners in Pakistan are were well aware of the Skills used before, during and after the orthodontic treatment. Keywords: Clinical practice, Knowledge, Orthodontic treatment, Dental Practitioners
502 Protective Effect of Prunus Dulcis Against Acetylsalicylic Acid Injury on Gastric Parietal Cells , M. Saad Abdullah, Kishwar Nahid, Fareeha Mushtaq, Aneeqa Chughtai, Saba Izhar, Faiza Irshad, M A. Khan, T. Laique  
Background: Acetylsalicylic acid is in common clinical use but has the side effect of causing gastric mucosal erosions and selective injury to parietal cells. Aim: To explore if prior treatment with Prunus dulcis (almond) had a protective effect against acetylsalicylic acid induced injury. Study design: Experimental study. Methodology: Albino mice weighing 30 to 40 grams were given two drops of almond oil without peel and 300 mg of finely ground whole almond kernel by oral gavage for sixty days followed by 400 mg/kg body weight of acetylsalicylic acid orally. Gastric mucosal damage was observed and recorded as ulcer index. The number of parietal cells/ sq. micrometer and area of parietal cells were observed and recorded under microscope in formalin fixed H and E stained sections. Data analyzed by SPSS 22.0v. Results: Mucosal damage, distortion of gastric glands and damage to parietal cells was pronounced in the positive control animals. The number of surviving parietal cells after acetylsalicylic acid insult in animals given almond oil was significantly higher when compared with positive control animals (p<0.001) and even better in animals receiving whole ground almond kernel. The area of parietal cells was also similarly larger in the treated animals. Conclusion: This study concluded Prunus dulcis offers protection against acute gastric mucosal injury and damage to the gastric parietal cells caused by acetylsalicylic acid in mice. Keywords: Prunus Dulcis, Parietal Cells, Gastric Erosions and Acetylsalicylic Acid.
503 Interrelationship of Electrolyte and Vitamins Profile in Patients Experiencing Tumor Lysis Syndrome , Khadija Mastoor, Bushra Suhail, Asma Inam, Nada Azam, Maria Amjad, Fareeha Bashir
Background:Tumor lysis syndrome is a metabolic derangement which is seen in patients with malignancy and receiving drugs for cancer treatment. It can arise in children or older cancer patients and is considered life threatening. Anticancer drug therapy is most commonly used method to treat cancer. Aim: To investigate the role of electrolytes and vitamins (A, C and E) in cancer patients suffering from tumor lysis syndrome during anticancer therapy. Study design: Prospective clinical study Methods: The study enrolled fifty diagnosed patients of Tumor lysis syndrome.Informed consent was taken from patients.Twenty patients, clinically healthy, age and sex-matched were selected as a control in the present study. 5cc blood was withdrawn from enrolled cases. The obtained samples were centrifuged at the speed of 4000-5000rpm for 10-15 minutes to obtain serum. The levels of Electrolytes (Na+, K+), and Vitamins A, C, E were estimated. Results: Study showed elevated serum levels of sodium (Na+) (28.26) in comparison withcontrol normal persons (21.26) and this is significant statistically (0.02<0.05). Serum Potassium levels among Tumor lysis syndrome (TLS) cases was (13.26) as observed in normal controlled persons (14.26) and results were significant statistically (0.03<0.05). Vitamin A level in Tumor lysis syndrome(TLS) cases decreased outstandingly (102.20) in contrast to normal control study persons.(188.26) and this is significant statistically (0.026<0.05). The values for Vitamin E in Tumor lysis syndrome cases was (4.26) and in controlled normal individuals (7.26) and proved significant statistically (0.015<0.05). Conclusion: Present study showed inverse relationship between Vitamins and electrolytes in TLS. Increased level of electrolyte imbalances and decreased vitamin levels is the reason responsible for the development of tumor lysis syndrome. Keywords: TLS, Vit A, Vit C, Vit E, Na+,K+
504 Factors for In-hospital Mortality after Percutaneous Coronary Intervention in Patients with ACS , Muhammad Asif Farooqi, Bilal Rafique Malik, Aneeqa Ilyas  
Background: Percutaneous coronary intervention (PCI) is a nonsurgical technique for treating obstructive coronary artery disease. Aim: To assess the causes / factors leading to mortality after percutaneous coronary intervention Study design: Cross sectional study Setting: Department of Cardiology, Punjab institute of cardiology, Lahore. Duration: Six months i.e. from1stJuly 2020 to 31stDecember 2020. Methods: Medical records of 100 cases who dies after PCI for acute coronary syndrome were taken from record center. Medical record of patients aged 40 to 70 years, both genders underwent PCI and did not survived after PCI were included. Location of lesion, and severity of vessel disease, type of procedure and acute renal failure were considered as factors of mortality and were noted on proforma while analyzed in SPSS 20. Results: The mean age of the patients was 54.20 ± 8.84 years. There were 42(42%) males and 58(58%) females. History of smoking was positive in 48 (48%) cases, diabetes in 51(51%) and hypertension in 55(55%) cases. Among the factors, old age (≥50 years) was observed in 64(64%) patients while 36(36%) had age <50 years. There were 39(39%) patients who underwent PCI under emergency situation and 61(61%) patients had PCI under elective circumstances. Acute renal failure was noticed in 37(37%) patients. There were more patients of right coronary artery disease i.e. 54(54%) who underwent PCI. Conclusion: Out of all factors leading to mortality after PCI, older age at the time of PCI is the most common factor, followed by right coronary artery disease and multi-vessel disease. Keywords: Mortality, PCI, angiography, cardiovascular complications
505 Diagnostic Accuracy of Magnetic Resonance Imaging in Predicting Malignancy in Musculoskeletal Tumors , Sadia Ali, Saba Maqsood, Sana Akhtar, Nazish Hameed, Shaima Abdul Ghaffar, Madeha Hussain
Background: Tumors of the musculoskeletal system may arise in bone or soft tissues including muscle and cartilage. Because of experimental chemotherapeutic medications and regimens, as well as improvements in imaging and surgical methods, the prognosis of patients with musculoskeletal tumors has increased dramatically. Aim: To determine the diagnostic accuracy of magnetic resonance imaging in detection of musculoskeletal tumor taking histopathology as gold standard Study Design: It was cross sectional study Setting: Department of Radiology, Mayo Hospital, Lahore Duration: six months i.e. July 2020 to Dec 2020. Methods: After meeting the inclusion criteria 135 cases were enrolled. Informed consent and demographic information was taken from all the patients. All malignancies were confirmed by surgical histology. MRI was performed routinely on 1.5 Tesla and 3 Tesla. Patients were considered as the confirmed cases of tumors on MRI and histopathology as per operational definition. All the collected data was analyzed on SPSS vr 21. Results: In this study the mean age of the patients was 42.59±10.16 years, male to female ratio of the patients was 0.68:1. The mean value of duration of disease of the patients was 2.95±1.42 months. The sensitivity, specificity, and diagnostic accuracy of MRI for detecting musculoskeletal tumors was 89.23%, 88.57%, & 88.89% respectively taking histopathology as gold standard. Conclusion:This finding concluded that the magnetic resonance imaging is very useful and reliable technique in detection of musculoskeletal tumor with high diagnostic accuracy Keywords: Magnetic Resonance Imaging, Musculoskeletal Tumor, Histopathology
506 Compare frequency of wound infection with ceftriaxone versus amoxicillin in females undergoing C section , Aneeqa Ilyas, Bilal Rafique Malik, Rehan Anwar
Background:Post-caesarean wound infection is a frightful complication of cesarean delivery and increase burden on health care system. Prevention of post-cesarean wound infection must be the priority in any healthcare center in developing countries. Amoxicillin is an antibiotic often used for the treatment of a number of bacterial infections. Aim: To compare the frequency of wound infection with ceftriaxone versus amoxicillin in females undergoing cesarean section at term Study design: Randomized Controlled Trial Setting & duration: Department of Medicine and Gynecology, SIMS, Lahore from 01-07-2020 to 31-12- 2020. Methods: After fulfilling the selection criteria, 250 females were enrolled and were divided randomly into two equal groups. Group 1 was given intravenous amoxicillin and group 2 was given intravenous ceftriaxone. Then cesarean was done under spinal anesthesia. Post-op wound infection was noted in all the females. The data was analyzed in SPSS. Results: The mean age of the females of amoxicillin group was 28.09±6.01 years whereas the mean age of the ceftriaxone group females was 29.38 ± 6.41 years. The mean gestational age of the females in amoxicillin group was 38.98 ± 0.85 weeks whereas the mean gestational age in ceftriaxone group was 38.94±0.79 weeks. The mean BMI of the females in amoxicillin group was 26.58 ± 6.27 kg/m2 whereas the mean BMI in ceftriaxone group was 29.32±6.36kg/m2. The post-cesarean wound infection was found in 2(1.6%) females in amoxicillin group while in 8(6.4%) females in ceftriaxone group. This difference was statistically insignificant i.e. p-value=0.0.053. Conclusion: The amoxicillin is more effective from prevention of post-op wound infection than to ceftriaxone in females underwent cesarean section. Keywords: Amoxicillin, Ceftriaxone, cesarean section, post-cesarean wound infection
507 Relationship between alanine and aspartate transaminases (ALT and AST) and fatty liver on ultrasound , Adeena Khan, Sadia Ali, Muhammad Usman Ul Haq, Mamoona Sultan, Saba Maqsood, Sana Akhtar  
Background: Non-alcoholic Fatty liver disease, also known as NAFLD is said to result from a number of disorders such as insulin resistance, Obesity & diabetes mellitus possibly as a result of an unhealthy and sedentary life style. The prevalence of NAFLD is stated to be 25.23%, but it ranges between 115 to 45% in Asian countries globally. Plasma aminotransferases (aspartate1aminotransferase [AST] & alanine aminotransferase [ALT]) are increased in patients with non-alcoholic fatty liver disease (NAFLD). Aim:To find the relationship between alanine and aspartate transaminases (ALT and AST) and fatty liver on ultrasound. Study design & duration: Retrospective Study, September 2017-2018. Settings: Radiology Department of Avicenna Medical College and Hospital, Lahore. Methods: 274 patients present with age of 18 years and above with demographic features as body mass index, grade of fatty liver and also noted ALT, AST and size of fatty liver were included from the study. Grade I was labeled if there was increased hepatic echogenicity but visible periportal & diaphragmatic echogenicity. Grade II was considered if increased hepatic echogenicity causes imperceptible periportal echogenicity, without obscuration of diaphragm. Grade III was considered as marked increase in liver echogenicity with imperceptible periportal echogenicity and diaphragm. The patients were then followed for the Alanine transaminase (ALT) and Aspartate transaminase (AST) Results: In this study The mean age of patients 53.8±11.94. There were 116(42.3%) male and 158(57.6%) females. Majority of patients were of grade II fatty liver 126(45.9%). Grade III fatty liver was found in 110(40.1%) and grade I fatty liver was found in 38(13.8%). hepatomegaly was seen in 153(55.8%) patients. None of the grade I fatty liver patients were found to have raised ALT or AST. Raised ALT was found in 21 patient of grade II and 15 of grade III fatty liver patients. Raised AST was found in 20 of grade II and 7 had grade III fatty liver patients. Conclusion: The conclusion of this study that mean of ALT increased as compare to AST. None of the grade I fatty liver patients were found to have raised ALT or AST. Raised ALT was found in 21 patient of grade II and 15 of grade III fatty liver patients. Keywords: Fatty liver disease, Grade I, II, III, AST, ALT
508 Spirometric Values of petrol pump workers of Lahore - A cross sectional study , Waqas Aslam, M. Zubair Ashraf, M. Saqib Saeed, Fariha Salman
Background: Petrol pump workers are exposed to air pollution and fumes of petrol and diesel that may lead to poor lung function followed by chronic diseases, where the city is highly polluted. Aim: To determine lung functioning capacity by spirometry among petrol pump workers Methods: A cross sectional study was designed and conducted in the pulmonology department of Mayo, hospital Lahore. Two seventy five (275) subjects were enrolled in the study after fulfilling the inclusion/exclusion criteria and giving informed consent by consecutive sampling. Information like name, age, weight, height, duration of working was recorded. Spirometry was performed to calculate FEV1, FVC and FEV1/FVC ratio. Data was entered and analyzed by statistical software SPSS version 23. Mean and standard deviation of age, height, weight, and work duration, Spirometric values for lung functions (FEV1, FVC and FEV1/FVC Ratio) were calculated. Data was divided into groups by age and work duration and spirometric values for lung functions were compared in these groups. T test & Pearson correlation was used for analysis and p value less than 0.05 was considered significant. Results: Participant age was 28.75±6.89.FEV1 was2.35±0.44, FVC 3.18±0.66 and FVC 74.91+9.40. FEV1 & FEV1/FVC ratio were significantly different (p<0.05) in age groups(<30, ≥30) & work duration groups(<8, ≥8yeras). Negative Correlation was found between work duration & lung functions (FEV1, FEV1/FVC ratio). Conclusion: Spirometric values were lower in petrol pump workers. Age and working duration further affects lung function of petrol pump workers. Keywords: FVC, FEV1, Spirometer, Petrol Pump Workers, Pulmonology
509 Investigation of Knowledge and Practices Managing Traumatic dental injuries among dental Professionals , S. Akbar Abbas Zaidi, P. Rani Harjani, M. Mubeen Arshad, S. Z. Abbas Zaidi, Rajesh Kumar, S. Suresh Hotchandani
Background: The rise in prevalence and complications associated with dental traumatic injuries among Pakistani population is considered a topic of discussion at International Association of Dental Traumatology nowadays. Understanding the multifactorial etiology, therapeutic techniques and choosing management approaches are vital to dental traumatic injuries. Aim: To assess the knowledge, qualification and practices followed by dental professionals from a tertiary healthcare centers based in Sindh Pakistan. Methodology: The study population of this cross-sectional descriptive study comprised of dental care providers attending the seminar on World Oral Health Day at Bibi Aseefa Dental College, Larkana, Sindh, Pakistan. A self-administered questionnaire consisting of two parts; demographic and knowledge about management of trauma was administered to participants on 20 March 2021. The detailed demographic details of research participants were collected and further analyzed by using SPSS 20 and MS Office 2010 tools. Results: Out of total 134 participants, 40(29.9%) were males while, 94(70.1%) were females with mean age of 24.31?4.088. Among them 45(33.6%) were undergraduate dental students; in them 4(8.9%) were in 1st year dental students, 17(37.8%) in 2nd year, 10(22.2%) in 3rd year and 14(31.1%) were in final year of their undergraduate studies. 31(23.1%) were house officers, 19(14.2%) were post graduate residents and 39(29.1%) were general dental practitioners (GDP). Conclusion: Lack of qualified dental experts with post-residency trainings dealing dental traumatic complexity in Sindh Pakistan is considered a major underlying associated with heightened case rates of pediatric dental injuries. Keywords: tooth injuries, Dentists, Restorative, Pediatric
510 Investigation of Knowledge and Practices Managing Traumatic dental injuries among dental Professionals , S. Akbar Abbas Zaidi, P. Rani Harjani, M. Mubeen Arshad, S. Z. Abbas Zaidi, Rajesh Kumar, S. Suresh Hotchandani
Background: The rise in prevalence and complications associated with dental traumatic injuries among Pakistani population is considered a topic of discussion at International Association of Dental Traumatology nowadays. Understanding the multifactorial etiology, therapeutic techniques and choosing management approaches are vital to dental traumatic injuries. Aim: To assess the knowledge, qualification and practices followed by dental professionals from a tertiary healthcare centers based in Sindh Pakistan. Methodology: The study population of this cross-sectional descriptive study comprised of dental care providers attending the seminar on World Oral Health Day at Bibi Aseefa Dental College, Larkana, Sindh, Pakistan. A self-administered questionnaire consisting of two parts; demographic and knowledge about management of trauma was administered to participants on 20 March 2021. The detailed demographic details of research participants were collected and further analyzed by using SPSS 20 and MS Office 2010 tools. Results: Out of total 134 participants, 40(29.9%) were males while, 94(70.1%) were females with mean age of 24.31?4.088. Among them 45(33.6%) were undergraduate dental students; in them 4(8.9%) were in 1st year dental students, 17(37.8%) in 2nd year, 10(22.2%) in 3rd year and 14(31.1%) were in final year of their undergraduate studies. 31(23.1%) were house officers, 19(14.2%) were post graduate residents and 39(29.1%) were general dental practitioners (GDP). Conclusion: Lack of qualified dental experts with post-residency trainings dealing dental traumatic complexity in Sindh Pakistan is considered a major underlying associated with heightened case rates of pediatric dental injuries. Keywords: tooth injuries, Dentists, Restorative, Pediatric
511 Investigation of Knowledge and Practices Managing Traumatic dental injuries among dental Professionals , S. Akbar Abbas Zaidi, P. Rani Harjani, M. Mubeen Arshad, S. Z. Abbas Zaidi, Rajesh Kumar, S. Suresh Hotchandani
Background: The rise in prevalence and complications associated with dental traumatic injuries among Pakistani population is considered a topic of discussion at International Association of Dental Traumatology nowadays. Understanding the multifactorial etiology, therapeutic techniques and choosing management approaches are vital to dental traumatic injuries. Aim: To assess the knowledge, qualification and practices followed by dental professionals from a tertiary healthcare centers based in Sindh Pakistan. Methodology: The study population of this cross-sectional descriptive study comprised of dental care providers attending the seminar on World Oral Health Day at Bibi Aseefa Dental College, Larkana, Sindh, Pakistan. A self-administered questionnaire consisting of two parts; demographic and knowledge about management of trauma was administered to participants on 20 March 2021. The detailed demographic details of research participants were collected and further analyzed by using SPSS 20 and MS Office 2010 tools. Results: Out of total 134 participants, 40(29.9%) were males while, 94(70.1%) were females with mean age of 24.31?4.088. Among them 45(33.6%) were undergraduate dental students; in them 4(8.9%) were in 1st year dental students, 17(37.8%) in 2nd year, 10(22.2%) in 3rd year and 14(31.1%) were in final year of their undergraduate studies. 31(23.1%) were house officers, 19(14.2%) were post graduate residents and 39(29.1%) were general dental practitioners (GDP). Conclusion: Lack of qualified dental experts with post-residency trainings dealing dental traumatic complexity in Sindh Pakistan is considered a major underlying associated with heightened case rates of pediatric dental injuries. Keywords: tooth injuries, Dentists, Restorative, Pediatric
512 Clinical Outcome of Class II direct composite restorations using total-Cetch versus selective etch adhesives , Dilawar Sultan, Zuhair Arif, Essa Arshad, Saba Mushtaq, Kinza Khalid, Maheen Ahmad
Background: The composite restoration of anterior is always a challenging job. Aim: To compare the clinical outcome of class 2 direct composite restorations using total-etch and selective etch adhesives, according to USPHS criteria. Methods: One hundred patients were included in this randomized controlled clinical trial study at Operative Dentistry department of LMDC, Lahore. They were divided in two groups. Group 1 for total etch technique, group 2 for selective etch technique enamel was etched with 37% phosphoric acid for 20 second and then washed thoroughly with water for 5-10 seconds and was dried with air for 5 seconds till frosty white and bond with self etch. Results: The majority of patients were in the age range of 25-31 years, 25 (50%) patients used total etch technique and 22 (44%) patients used selected etch technique. When compare the overall rating for restorations, 38 patients (76%) have acceptable restoration in total etch technique and 46 patients (92%) in selected etch technique. Statistically the difference was significant (P<0.05). Conclusion: Selected etch technique presented a successful clinical performance over total etch technique for Class II restorations. Keywords: Class II direct composition restoration, Total etch technique, Selected etch technique.
513 Attitude of Final Year Students Dental Specialty, Subject Preference & Factors Influencing Their Decision , Haider E, Hassan S, Mehmood R, Dayar J, Mahmmod A, Ali F, Khan H
Aim: To find whether final year dental students want to do post- graduation and factors that governs their decision for specialization. Method: A cross-sectional survey was carried out on final year dental student with the help of a questionnaire. Results: The results showed that 40.8% of the students want to specialize in maxilla-facial surgery followed by orthodontics by 12.4%. 37.2% of the students want to specialize for internal satisfaction. 41. 6% student thought doing specialization would be too much time consuming. Conclusion: It was concluded that orthodontics is the second preference for specialization as subject and the most common reason for specialization was talent in the field. The most discouraging factor was specialization is too much time consuming. Keywords: Attitude, dental specialty, specialization
514 Relationship of dental anxiety and pain during inferior alveolar nerve block , Shakeel Ahmad, Usman Sana, Muhammad Haseeb, Iffat Umair Niazi, Zubair Ahmed Khan, Omer Yousaf
Aim: To understand impact of pre-operative anxiety during inferior alveolar nerve block based on pain perception. Methods: Data of 299 dental patients who collected. These patient were treated for restorative need in the Dental Section of Islam Dental College, Sialkot. Modified. Dental. Anxiety. Scale. (MDAS) was used to assess the patient’s anxiety levels.. Visual. analog. scale. was used to document the pain perceived of inferior alveolar nerve block. Results.: Anxiety and pain showed a statistically significant correlation-ship. Our findings were suggestive of increased pain associated with anxiety. Conclusion.: Assessment of anxiety levels prior to performing painful procedures can pro-actively benefit the patient and the operator. Yes, advanced methods of pain control are available but they need to be implicated judiciously. Assessing patient’s anxiety and then providing dental care will help improve dental care. Keywords.: Local anaesthesia (LA), Inferior alveolar nerve block IANB, dental anxiety
515 Assessing the level of Happiness among dental students of Pakistan: Web-based study , Beenish Fatima Alam, Talib Hussain, Saman Tauqir, Saqib Ali, Arqam Najmi, Sikandar Javed Bajwa
Background: Dental students in Pakistan suffer greatly from unusual distress and are unable to maintain happiness from the start of first year to final year. They are deprived from maintaining their mental wellbeing and happiness. There is lack of evidence Oxford happiness inventory (OHI) evaluation among the students. Aim: To detect the level of happiness in dental students from different professional years. Methods: A cross-sectional study in Bahria University Medical and Dental College was carried out. Dental students were enrolled from first year to final year using purposive sampling method. Results: This study included females 209, and 55 males. Majority of students (48.5%) belonged to 18-20 years age group followed by 21-22. About 50% students were from 1st year BDS, followed by 2nd year (28%). Question assessing happiness of students, 30.9% male students and 35.4% female’s students moderately agreed. Conclusion: The study concludes that overall dental students had an average level of happiness. It is necessary that all the dental educationists in any institution should work with close association to psychologists, there shall be different student services provided and student supporting groups shall be encouraged. Keywords: Oxford Happiness Questionnaire, happiness, well-being, students,
516 Dental Anxiety Measurement of Children in Abbottabad Using Audio Visual System , Talib Hussain, Sikandar Javed Bajwa, Salvan Ghani, Beenish Alam, Malik Arshman Khan, Adil Durrani
Aim: To measure the anxiety and fear in children while visiting dentist and to observe effectiveness of audiovisual assistance to overcome anxiety Study design: Qualitative study Place and duration of study the study is done in Rehmat Memorial Hospital Abbottabad department of operative dentistry, affiliated with Women Medical and Dental College Abbottabad, from December 2014 to February 2017. Methods: Total two hundred children were observed aged between 5-8 years at Rehmat Memorial Hospital Abbottabad under controlled conditions showing cartoons on TV screen by using wireless headphones. There were two main groups divided into the controlled group and uncontrolled group containing one hundred participants in each group. Each patient's pulse rate, heart rate was recorded and live pulse rate was in sight by using wristband with pulse rate detector. Venham's picture test was used to check the correct reaction of the patient for the assessment of degree of anxiety more realistically. Results Controlled group n=100 and uncontrolled group n=100 patient aged 5-8 years treated for various procedures in different appointments. With mean age 6-7 years, Male to female ration of participants in controlled group was 34% and 66% and in uncontrolled group male and female ration was 45% and 55%. Significant reduction in anxiety was noted in controlled group distracted by audio visual stories and rhymes. Conclusion: Both groups were statistically evaluated and the result showed that audiovisual distraction can decrease the anxiety level in the controlled group but couldn't eliminate completely. This issue needs more studies and experiments to resolve anxiety in children completely. Keywords: Dental anxiety, Venham’s picture test, child behaviour
517 Class I Composite Restorations Using Total-Etch Versus Selective Etch Adhesives , Zuhair Arif, Dilawar Sultan, Kinza Khalid, Ayesha Maroof, Syed Ali Haider, Essa Arshad  
Background: Total etch versus selected etch adhesives can either be used. Aim: To compare the clinical outcome of class 1 composite restorations using total-etch and selective etch adhesives. Methods: 50 patients of class I restorations were included in this study. They were divided in two groups i.e. Group 1 for total etch technique, while Group 2 for selective etch technique. Results: The mean ages in total etch technique were 27.72±5.26 years and 27.52±5.56 years in selected etch technique. There were 20 males (40%) and 30 females (60%) in total etch technique with male while in selected etch technique, 22 males (44%) and 28 females (56%). Selected etch technique was found to be more successful in clinical performance for Class I filling restorations (P<0.05). Conclusion: Selected etch technique was found to be more successful in clinical performance for Class I filling restorations. Keywords: Class I direct composition restoration, Etching.
518 Increased Serum Inflammatory Markers have worsened Clinical Outcomes and Mortality in Sars-Cov-2 Infection Irrespective of High or Low Serum Viral Load , Zahid Asgher, Saed Aftab Ahmad, Mahnoor Mohydin, Hira Babar, Wali Zaidi, Adil Asghar, Zunairah Mughal, S Asharf
Aim: To determine the viral load in the patients admitted in Covid-19 isolation and its correlation with the inflammatory markers and the following clinical outcome. Methodology: A retrospective study was conducted in the Pathology Department of Doctors Hospital and Medical Centre in Lahore, Pakistan from November 2020 to January 2021. IRB approval was granted. A total of 86 patients met the inclusion criteria for the study. Data was analyzed using research tool SPSS 24. Results: Increased serum viral load in SARS-CoV-2 infection showed positive correlation with inflammatory markers IL-6 (P =0.04) and D-dimer (P =0.029). Inflammatory markers LDH, Ferritin, Procalcitonin, D-Dimers and viral load itself (CT) all correlated with higher mortality while IL-6 did not. Conclusion: Serum viral load in patients infected with SARS-CoV-2 correlates with higher mortality rates itself and also raises certain inflammatory markers (IL-6, D-Dimers), which are independently accountable for causing higher mortality as well. Hence, increased inflammatory markers resulted in poor prognosis regardless of high or low viral load. Their correlation with mortality can still serve as prognostic indicators. Keywords: viral load, inflammatory markers, Covid-19, mortality
519 Restoration of Cerebellar Gray Matter Thickness by Methylcobalamin (6 Weeks Study) , Aftab Ahmed, Tazeen Kohari, Qanbar Abbas Naqvi, Rana Muhammad Zeeshan, Faiza Irshad, Zafar Iqbal Malik
Background: Methylcobalamin is essential vitamin required for DNA synthesis during cell division therefore maintain the architecture of nervous tissue distorted by soft metals such as Lithium Carbonate. Accurate documentation of the thickness cerebellar cortical thickness was required in subjects who were injected with methylcobalamin distorted by Lithium Carbonate. Aim: To provide data of cerebellar gray matter thickness distorted by Lithium Carbonate by the anti-oxidant effect of methylcobalamin. Methods: Fifteen albino rats were maintained on food and diet in Animal House of the Basic Medical Sciences Institute, JPMC Karachi for a period of 6 weeks. Results: The results obtained of the thickness of cerebellar gray matter distorted by Lithium Carbonate was restored by methylcobalamin in our study. Conclusion: To observe the neuroprotective effect of B12 on distorted cerebellar cortex treated by Lithium Carbonate. Keywords: Methylcobalamin, Lithium Carbonate, Gray Matter, Cerebellum
520 The Diagnostic Accuracy of Dynamic MRI in diagnosis of complex adnexal masses , Anum Awais, Saulat Sarfraz, Fatima Saleem, Sidra Sajjad, Tuba Tariq, Aqsa Gul Niazi, Aruj Alam
Background: When ultrasonographic data are restricted, magnetic resonance imaging (MRI) scans can assist identify adnexal mass features. Two European centers have done pioneering work on Dynamic MRI with varied accuracy in diagnosis of complex adnexal lesions. Aim: To evaluate diagnostic accuracy of Dynamic MRI in diagnosing complex adnexal masses, Methods: The Department of Radiology conducted a cross-sectional study. Sheikh Zayed hospital, Lahore for 6 months (September 2017-March 2018). Procedure was done for MRI and histopathology for detecting the adnexal masses. Results of MRI were compared with histopathology results, which are taken as gold standard. Reporting was done by researcher herself under supervision of consultant radiologist. SPSS version 20 was used to enter and evaluate the data. Results: The mean age of patients was 41.57±11.69 years. Dynamic MRI has a 95% sensitivity, specificity, and diagnostic accuracy. 94.37% and 94.7% respectively. Conclusion: Dynamic MRI is reliable and useful tool with high values of responsiveness, for detecting complicated indeterminate adnexal masseson Doppler considering histopathology as gold standard.Specificity and diagnostic accuracy are important. Keywords: Dynamic MRI, Histopathology, Complex Adnexal Mass
521 Frequency of Anemia among Primary School Children Visiting the Paediatrics OPD of a Tertiary Care Hospital , Misbah Nargis, Nosheen Iftikhar, Shabir Ahmed, Waheed Ahmad, Mohammad Akram, Allah Nawaz Sultan
Background: In young children, Anemia is a common public health issue which significantly contribute in childhood morbidity and mortality. Anemia is associated with growth retardation, impaired cognition, decreased physical activity and contributor as a high national infant mortality rate. Aim: To determine the frequency of anemia in school going children presenting to OPD of a tertiary care hospital. Methods: A Cross Sectional Study conducted at Paediatric outpatient department of Sharif Medical City Lahore from 15.02.2018 to 14.08.2018. About 150 primary school children presenting to the Paediatric outpatient department of Sharif medical city Lahore for minor acute ailments and fulfilling the inclusion criteria were approached and an informed consent was taken from their parents before enrolling in the study. Results: From 150 patients , it was observed that the minimum age was 5 years and maximum age was 11 years with mean and standard deviation of the age was 8.10 ± 1.89 years. The minimum hemoglobin level was found as 7.8 gm/dL and maximum hemoglobin level was 14 gm/dL with mean and standard deviation was 12.47±1.62 gm/dL. The minimum body mass index was found as 10 kg/m2 and maximum BMI was 20 kg/m2 with mean and standard deviation was 15.52 ± 2.91 kg/m2. Presence of anemia was found in 14% patients while anemia was not found in 86% children. Conclusion: Presence of anemia was found in 14% primary school children presenting to the outpatient department of a sharif medical city Lahore, tertiary care hospital. Effect modifiers showed significant association. Keywords: Anemia,Hemoglobin Level, Body Mass Index, Socioeconomic Status.
522 Rate of HCV Seroconversion And Its Associated Factors In Hemodialysis Patients , Muhammad Usman Javaid, Azhar Ali Khan, Mateen Akram, Muhammad Asif, Nasir Iqbal, Munaza Javed
Background: CKD is a worldwide public health problem. HCV is the most frequent complication of patients on hemodialysis, it is very important to screen patients for HCV seropositivity, asit may lead to severe liver disease, complications in renal transplant and death. Aim: To find the incidence of HCV seropositivity and identify factors associated with hemodialysis patients at the Dialysis Center. Methodology: A Retrospective Cohort study conducted at Hemodialysis Unit, Sheikh Zayed Hospital, Lahore from January 2015 to December 2015. Secondary data was collected from all the record files of all the patients included in the study available at Sheikh Zayed hospital. Data was also collected by a questionnaire from patient to determine different variables. Data for age, gender, HCV seroconversion, number of transfusions, emergency dialysis at any other hemodialysis center, surgeries, previous history of HCV, dialyzer reuse and dental procedure etc. was collected and patients were divided in two groups according to HCV status at the end of study. Data for seroconversion was studied for relation with given risk factors using Chi-square test and odds ratios with 95% confidence interval. Binary logistic regression was used to see the adjusted odds ratio of various risk factors for seroconversion. P-value ≤0.05 was considered significant. Results: The mean age of the patients was 43.40±16.37 years. The frequency of previous transfusions was 120(48%) The frequency of emergency dialysis outside Shaikh Zayed Hospital was 76(30.4%). The frequency of surgeries was 126(50.4%). The frequency of dental procedures was 102(40.8%). The mean duration of dialysis was 17.6±5.73. The incidence of HCV seroconversion in hemodialysis patients was 124(49.6%). Conclusion: We concluded that the incidence of HCV seroconversion in hemodialysis patients was 8.2% per year and over a period of six years nearly 49.6% who were undergoing dialysis in our dialysis center. Keywords: HCV seroconversion, hemodialysis patients
523 Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures , Muhammad Akram, Ali Muqadas, Arif Mahmood, Faheem Mubashir Farooqi, Shumaila Jabbar
Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss
524 Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery , Hafiz Ali Wasay, Muhammad Aamir Jameel, Muhammad Imran Anwar, HaroonJavaid Majid, Sameen Tahir
Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain
525   Chronic intake of valproic acid decreases total cholesterol level in adult population , Rao S Aziz, Usman Saeed, Liaqat Ali, Muhammad Arshad, Roman Abbas, Sana Mushtaq, Asif Shahzad, A. Shaukat
Background: Valproic acid (VA) serve as the antimigraine, anti-mental disturbances agent and antiepileptic medicine. After using VA, metabolic rearrangements seen in patients that include alteration in lipoproteins levels; however, this topic is still under discussion and disputable. Aim: To discuss the effects of VA after using for long duration on total levels of cholesterol in adult. Methods: About Eighty candidates participated and they were divided into two groups namely, case group (40 candidates) and control groups40 candidates). All the candidates were asked for collection of venous blood sample in order to determine total cholesterol serum level among them via aid of enzymatic cholesterol oxidase phenol 4-aminoantipyrine peroxidase. By the aid of the logistic regression analysis, the relationship of the long-term VA treatment and the level of total cholesterol was obtained. With respect to our analysis, there is a co relation between total levels of cholesterol and long term usage of VA (P=0.003). Results: There were no noteworthy link for age, sex, body BMI, height medication usage, smoking, diabetes mellitus and VA dosage , except combination of anti-epileptic drugs Conclusion: In a net shell, by using VA for long duration, the total level of cholesterol in adults reduces. Keywords: Lipid profile, side effects, total cholesterol, valproic acid
526   Chronic intake of valproic acid decreases total cholesterol level in adult population , Rao S Aziz, Usman Saeed, Liaqat Ali, Muhammad Arshad, Roman Abbas, Sana Mushtaq, Asif Shahzad, A. Shaukat
Background: Valproic acid (VA) serve as the antimigraine, anti-mental disturbances agent and antiepileptic medicine. After using VA, metabolic rearrangements seen in patients that include alteration in lipoproteins levels; however, this topic is still under discussion and disputable. Aim: To discuss the effects of VA after using for long duration on total levels of cholesterol in adult. Methods: About Eighty candidates participated and they were divided into two groups namely, case group (40 candidates) and control groups40 candidates). All the candidates were asked for collection of venous blood sample in order to determine total cholesterol serum level among them via aid of enzymatic cholesterol oxidase phenol 4-aminoantipyrine peroxidase. By the aid of the logistic regression analysis, the relationship of the long-term VA treatment and the level of total cholesterol was obtained. With respect to our analysis, there is a co relation between total levels of cholesterol and long term usage of VA (P=0.003). Results: There were no noteworthy link for age, sex, body BMI, height medication usage, smoking, diabetes mellitus and VA dosage , except combination of anti-epileptic drugs Conclusion: In a net shell, by using VA for long duration, the total level of cholesterol in adults reduces. Keywords: Lipid profile, side effects, total cholesterol, valproic acid
527   Chronic intake of valproic acid decreases total cholesterol level in adult population , Rao S Aziz, Usman Saeed, Liaqat Ali, Muhammad Arshad, Roman Abbas, Sana Mushtaq, Asif Shahzad, A. Shaukat
Background: Valproic acid (VA) serve as the antimigraine, anti-mental disturbances agent and antiepileptic medicine. After using VA, metabolic rearrangements seen in patients that include alteration in lipoproteins levels; however, this topic is still under discussion and disputable. Aim: To discuss the effects of VA after using for long duration on total levels of cholesterol in adult. Methods: About Eighty candidates participated and they were divided into two groups namely, case group (40 candidates) and control groups40 candidates). All the candidates were asked for collection of venous blood sample in order to determine total cholesterol serum level among them via aid of enzymatic cholesterol oxidase phenol 4-aminoantipyrine peroxidase. By the aid of the logistic regression analysis, the relationship of the long-term VA treatment and the level of total cholesterol was obtained. With respect to our analysis, there is a co relation between total levels of cholesterol and long term usage of VA (P=0.003). Results: There were no noteworthy link for age, sex, body BMI, height medication usage, smoking, diabetes mellitus and VA dosage , except combination of anti-epileptic drugs Conclusion: In a net shell, by using VA for long duration, the total level of cholesterol in adults reduces. Keywords: Lipid profile, side effects, total cholesterol, valproic acid
528 Attention Deficit Hyperactivity Disorder among English language learners of Sterilization program COVID-19 , Intakhab Alam Khan
Background: This study explored the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among the students of ‘sterilization program’ while learning English language amidst COVID-19 in Saudi Arabia. Aim: To diagnose ADHD among the learners, and later propose some digital strategies to motivate the learners for resilience. Methods: A qualitative exploratory study was undertaken in April, 2020. A diagnostic tool was administered to 41 students pursuing ‘Sterilization program’ at king Abdulaziz University in Kingdom of Saudi Arabia (KSA). Later, learners with ADHD (N=9) were selected for in-depth study. Data was collected using the ADHD self-report scale V1.1 screener. Results Five professors from the concerned department were purposively selected for the interviews for qualitative analysis using thematic analysis. Confidentiality and anonymity was ensured as per the ethical standard. Many students demonstrate signs of ADHD, therefore there is a need of assessment and intervention. Teachers, counselors and managers need to take care of such learners. Conclusions: Conclusions were drawn that students with ADHD need relevant interventions in general and specific pedagogy. Keywords: ADHD, English language, sterilization, Attention deficit hyperactivity, digital strategies, motivation
529 Intra-abdominal fibroid lesion of colonic involvement , Muhammad Awais, Sundas Javeed, Mahnoor Mohydin, M. Kamil Zulfiquar, Usama Rafi, H. Waheed Malik, S Mohydin
Fibroid is a benign lump of growth, occurring within or outside the uterus. It is a rarity for such growths to occur intra-abdominally. Such cases are of aggressive fibromatosis which are marked by the presence of desmoid tumours. It is most commonly seen in patients with a history of familial adenomatous polyposis (FAP) or past surgical procedures. As FAP has a wide fibroepithelial growth spectrum, the symptomatology and therefore the prognosis varies. Unpredictable clinical behaviour, varied location and non-specific presentation are the factors accounting to diagnostic difficulty. Therefore, misdiagnosing the disease is not uncommon. Here we report a case ofa26-year-old pregnant female presenting with lower abdominal pain and mass. Preoperative diagnosis was of uterine fibroids as per radiological evidence, but on exploration it turned out to be a large right colonic mass. The patient underwent right hemicolectomy. Histopathological reports confirmed morphological and immuno-histochemical features indicating fibromatosis. This fibromatous mass though intra-abdominal was not growing from the mesentery/mesocolon or the pelvis. It appeared to grow from the wall of the colon. This is a confirmatory presentation of true colonic wall fibromatosis which is deep and isolated form of intra-abdominal desmoid tumours. As this lesion was isolated in nature, the treatment of choice was surgical resection. It is essential to have a multi-disciplinary team approach in the management of such a patient. This improves the treatment and the prognostic outcomes. Keywords: Fibroid, Colon, Fibromatosis, Hemicolectomy, Desmoid Tumour
530 Frequency of Peripheral Neuropathy in Newly Diagnosed Type 2 Diabetes Presenting in a Tertiary Care Hospital of Lahore , Muhammad Mubashar Tahir, Aijaz Z Khan Chachar, Miqdad Haider, Afaq Shamim, Mohsin Asif, Sajjad Ali, Sajjad Ali
Background: Among the common complications of diabetes, neuropathy has its place. About 50% of diabetics suffer from this complication. It is one of the most common cause of elevated morbidity mortality in diabetics. Duration of diabetes, its control and association with other micro vascular complications can result in an raised incidence of neuropathy in patients. Aim: To find frequency of peripheral neuropathy in newly diagnosed type 2 diabetes in a tertiary care hospital. Methods: Cross sectional study carried out in newly diagnosed patients with type II Diabetes Mellitus presented at department of Medicine, Fatima Memorial hospital, Lahore. 200 newly diagnosed type II diabetes patients who met the inclusion criteria were selected. Information was recorded on predesigned questionnaire regarding peripheral neuropathy and socio-demographic variables. Results: The mean age among peripheral neuropathy respondents was 47.05±6.37 years while it was 45.19±6.50 years among not having peripheral neuropathy. Peripheral neuropathy was seen in 42 (21%) respondents while in 158 (79%) there was no peripheral neuropathy. Gender among peripheral neuropathy showed that males were 36 and females were 06 in number; and among non-peripheral neuropathy group there were 135 males and 23 females. Most of the low income respondents were suffering from peripheral neuropathy as compared to other income groups. Post stratification regarding age and gender yields significant results within income groups while the later showed only male respondents were significant. Conclusion: This study reports that in type 2 diabetic patients diagnosed less than one year back, there is an increased prevalence of peripheral neuropathy. Male respondents were more in number than females but both had shown almost having same occurrence of peripheral neuropathy. Keywords: Peripheral Neuropathy, Type II Diabetes, Neuropathy
531 Comparison of Clinical Efficacy of 0.1% Intralesional Bleomycin Solution and 0.05% Intralesional bleomycin Solution in Patients with Warts , Karim Bukhsh, Annum Ashraf, H. B. A.Kalhoro, Zonish Khalid, A. Z. K.Chachar, M. Suleman Pirzado, M Asif Ansari
Background: Warts are the hard, hyperkeratotic benign growths over the skin caused by human papilloma virus. It is one of the common skin conditions presented to the outpatient department. Various treatment options are available with variable success but sometimes it is resistant to treatment due to its depth in the dermis and relapsing nature. Aim: To compare clinical efficacy of 0.1% intralesional bleomycin solution and 0.05% intralesionalbleomycin solution in the patients with warts. Study settings & design: Experimental, Dermatology, LUMHS Jamshoro Duration: 1st January 2018 to 30th June 2018 Methods: 90 patients with persistent common warts were enrolled. Patients were examined and number of warts located on right and left hand, feet and leg of each patient were categorized in two groups as right sided group and left sided group respectively. The two concentrations of bleomycin were randomly adminitered to either right sided and left sided warts which are called, the lesion A in which 0.1% IL bleomycin solution was injected and the lesion B in which 0.05% IL bleomycin solution was injected respectively. The Response of the both therapies was assessed by measuring the size of warty lesions on 6thweek. Then patient was advised to report at the end of 14th week to observe any recurrence in the treated lesions and to assess the final clinical efficacy. Results: - Mean age of patients was 25.36 ± 6.09 years. There were 50(55.56%) male and 40(44.44%) females. Clinical efficacy as per operational definition i.e. Complete disappeared or >50% regression in size of warts with no recurrence was significantly high in lesion A than lesion B [93.3% vs. 68.9%; p=0.0005]. Regarding number of warts in patients, 86.1% of the warts were cured in lesion A while 64.9% were cure in lesion B. The difference was statistically significant. Conclusion: - Our results support that 0.1% IL Bleomycin is more effective in the treatment of viral warts as compared to 0.05% bleomycin. Keywords: Common Warts, Intralesional, Bleomycin treatment
532 Comparison of Efficacy of Nd-YAG Laser with Adjuvant Eflornithine Cream versus Nd-YAG Laser alone for the treatment of facial hirsutism in women , Iqbal Hassan Khan, Annum Ashraf, Uzma Sarwar, Amna Munir, Habiba Tariq, Aijaz Z. Khan Chachar, Azam Bukhari
Background: Hirsutism is an important array of clinical syndrome that ranges from various dermatological to gynecological concerns. This is characterized by growth terminal hairs in women in male-pattern. Aim: To compare the efficacy of Nd-YAG laser with adjuvant eflornithine cream versus Nd-YAG laser treatment alone for facial hirsutism in women. Methods: It was a Randomized Controlled Trial conducted in the Department of Dermatology, Shalamar Hospital, Lahore from 25th February, 2020 to 25th October, 2020. Sampling technique used was probability consecutive sampling. In this study female cases with age 18-40 years with Fitzpatrick type III-IV were enrolled having facial hirsutism for > 6 months and were randomly allocated in two groups A and B. In group A, cases were provided with eflornithine cream to apply on face after cleaning and drying in the form of a thin film only on the treatment area every night. Results: A total 162 cases (81 in each group) were enrolled in this study. Mean age of the subjects in group B and A was 30.23±5.43 vs 30.94±4.88 years. Efficacy was observed in 64(79.01%) cases in group B managed with ND-Yag laser alone and 78(96.30%) cases in group A managed with ND-Yag laser along with Eflornithine with p=0.001. For age group 30-40 years efficacy in group B was 41(80.39%) cases and in all the 49(100%) cases in group A with p= 0.001.In cases with BMI up to 25 kg/m2 efficacy in group B and A was observed in 44(88%) vs 49(100%) cases (p=0.03) and those with BMI more than this, this efficacy was found in 20(64.52%) and 29(90.63%) cases respectively with p=0.02. Conclusion: Efficacy in facial hirsutism is significantly better in ND-Yag laser combined with Eflornithine as compared to ND-Yag laser alone and this difference is also significantly better for combination group in terms of age group 30-40 years, BMI up to 25mg/m2 and in those with duration of complaint upto 2 years. Keywords: Hirsutism, Efficacy, Eflornithine, Nd-YAG laser
533 Frequency of Eye Changes in Patients of Chronic Kidney Disease , Waqar Zaheer, Miqdad Haider, A. Z. Khan Chachar, Sajjad Ali, Mohsin Asif, M. M. Tahir, Afaq Shamim, S Ali, I Haider
Background: One important and often ignored aspect in treatment of patients of chronic kidney disease (CKD) is screening for eye disorders. There is a need for continuous monitoring and examination, with cooperation from an ophthalmologist, of all dialysis patients with increased risk of vision loss like patients with coexisting diabetes and hypertension. It is not very common to find vision disorders or other anatomical defects of eye which can be directly attributed to kidney diseases. In general, eye disease is found as incidental finding during screening of patients with kidney diseases. Aim: To evaluate the frequency of eye changes in patients of chronic kidney disease. Methods: It was a Cross-sectional descriptive study performed in Department of Medicine and Nephrology Indoor, Fatima Memorial Hospital Lahore. The total duration was 6 months after approval of the project i.e. from 26-12-2019 to 25-06-2020. All patients admitted in the hospital under department of Medicine or Nephrology from 13 to 70 years of age diagnosed as a case of Chronic Kidney Disease as per the Glomerular Filtration Rate (GFR) were recruited for the study. Results: Total cases were 213, 44(20.65%) were from the age group of 13-40, 169(79.35%) were in 41-70 years age group, mean±Standard deviation(SD)was 47.82±8.55years, 114(53.52%) male, 99(46.48%) females, 129(60.56%) had diabetes mellitus, 141(66.19%) had hypertension, mean duration of disease was calculated as 14.23±4.99 months, 41(19.24%) retinal disorder, 79(37.08%) had cataract while 93(43.66%) had no eye disorder, out of 41 cases of retinal disorders, 17(41.46%) had hypertensive retinopathy while 24(58.53%) had diabetic retinopathy. Conclusion: There is a high prevalence of cataract and retinal disorders in chronic kidney disease patients. However our study was limited to single center, more extensive studies with a bigger sample size are needed to validate our results. Keywords: Chronic kidney disease, Eye disorders, Retinal disorders, Cataract, End stage renal diseases
534 Frequency of Atrial Arrhythmias in the Patients With Chronic Obstructive Pulmonary Disease , M. Mueed Yasin, A Zeeshan Khan Chachar, Sajjad Ali, Sajjad Ali, Asim M. Khan, Sana Arshad, H Javeria Shaheen
Background: Chronic obstructive pulmonary disease (COPD) has been linked with various kind of cardiac arrhythmias. The risk of arrhythmias in patients with COPD has been driven by the stage and disease state, with a higher frequency of supraventricular tachycardia during exacerbations. Aim: To evaluate the frequency of atrial arrhythmias (which include atrial fibrillation, atrial flutter, and multifocal atrial tachycardia) in the patients who were suffering from COPD. Methods: It was a cross sectional analysis or prevalence study. This research was piloted in the Medicine Department, Medical Division IV, Services Hospital, Lahore. This research was ended in 365 days after endorsement of synopsis from 1st June, 2017 to 30th May 2018. Results: In our study, 111(46.25%) were in range 40-55 years of age while 129(53.75%) were in range 56-70 years of age, the calculated mean standard deviation was 56.23±8.19 years, 134(55.83%) were male and 106(44.17%) were females, 142(59.17%) between 1-2 years and 98(40.83%) had >2 years of duration. Frequency of atrial arrhythmias in the patients who were suffering from COPD was recorded as 22(9.17%) having Atrial Fibrillation, 53(22.08%) had Atrial flutter and 31(12.92%) had Multifocal atrial tachycardia. Conclusion: Atrial arrhythmias are common findings in patients with COPD. So, it is very important for treating physicians that every patient having COPD, should undergo Electrocardiogram (ECG) for picking up the atrial arrhythmias. Keywords: Chronic obstructive pulmonary disease, atrial arrhythmias, frequency
535 Prevalence of Wound Infection in Patients Undergoing Elective or Emergency Abdominal Surgery , Arshid Mahmood, Aqeel Ahmad, Muhammad Hammad Muzaffar, Sarfraz Ahmad
Objective: To compare the surgical wound infection in patients undergoing elective or emergency abdominal surgeries. Study Design: Comparative study Place & Duration of Study: Study was conducted at surgery department of Divisional Headquarter Teaching hospital Mirpur Azad Kashmir for eighteen months duration from June 2019 to November 2020. Materials and Methods: 150 patients of both genders with ages 15 to 65 years who received laparotomy treatment due to intra-abdominal infection or complicated appendicitis were included in this study. Patient’s medical history, age, sex and residency were recorded after taking informed consent. All the patients were divided into two groups, Group A contained 75 patients (Elective) and Group B contains 75 patients (emergency) received laparotomy. Deep surgical wound infection was examined at the 7th day after surgery and compared between both groups. Results: Ninety eight (65.3%) patients 49 in each group were males and 52 (34.7%) patients 26 in each group were females. In Group A and B 27 and 29 patients were ages 15 to 30 years, 33 and 31 patients had ages 36 to 45 years, 15 and 15 patients were ages between 46 to 60 years. 10 (13.3%) patients in Group A and 12 (16%) patients in group B had deep surgical infection within 1 week after surgery. Statistically there is no significant difference between the both groups (p>0.356) Conclusion: It is concluded that the frequency of wound infection was high in emergency abdominal surgeries as compared to patients undergoing elective surgery, but the difference was not statistically significant. Keywords: Emergency laparotomy, Deep surgical site infection, PO Drain placement
536 Surgical Management of Complex Bile Duct Injuries in Specialized Hepatopancreatobiliary (HPB) Unit , Muhammad Khawar Shahzad, Tariq Ali Bangash, Amer Latif, Hussam Ahmed, Muhammad Asif Naveed, M. Ashraf
Objective: To describe the surgical management of complex bile duct injuries in a specialized hepatopancreatobiliary unit. Design of the Study: It was a retrospective study. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: This retrospective study includes 80 patients of bile duct injury who underwent surgical correction of bile duct injury at specialized Hepatopancreatobiliary [HPB] and liver transplant department of Shaikh Zayed Hospital Lahore. All the subjects were evaluated by retrospectively. The information regarding primary operative procedure, drain placement, T-tube placement, presentation, hospital stay, Liver Function Tests [LFTs], level of biliary tract injury and type of surgical procedure obtained from patients records. Results of the Study: During the study period 80 patients – 65 females and 15 male were operated for bile duct injury. Mean age was 39.89 years range 21 to 65 years. Hospital stay ranges from 9 to 36 days with mean of 16.18 days. Patients underwent open cholecystectomy, 43.8% laparoscopic cholecystectomy and in 3 patients procedure was converted from laparoscopic to open. 52.5% patients underwent open cholecystectomy, 43.8 laparoscopic cholecystectomy and in 3 patient’s procedure was converted from laparoscopic to open. Conclusion: It is concluded that the correct long lasting and physiological method to treat injuries of bile duct is only surgical repair. Although, surgical repair of bile duct must be operated by skilled hepatopancreaticobiliary surgeons. A practical method which is selected appropriately and implemented successfully has surely improved surgical outcome without any problem faced during the operation. Keywords: Hepatopancreatobiliary, Bile Duct Injury, Surgical Management
537 Comparison between methyldopa and combination of methyldopa and nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension , Bilqees Akhtar Malik, Shahzad Bashir Momina, Tazeen Ashraf
Objective: Comparison between Methyldopa and combination of Methyldopa and Nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension. Material and methods: This randomized controlled trial was conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Bahawalpur from February 2020 to August 2020 over the period of 6 months. Total 80 patients with pregnancy induced hypertension as per operational definition having age 20-40 years and having gestational age ≥ 20 weeks assessed on LMP were selected. Results: Mean age of the patients was 30.81 ± 5.670 years, mean age of patients of group A was 31.50 ± 5.809 years and mean age of group B was 30.13 ± 5.515 years. Mean gestational age was 30.17 ± 5.981 weeks, mean gestational age of patients of group A was 29.70 ± 6.329 weeks and mean gestational age of patients of group B was 30.65 ± 5.65 weeks. In group A, mean diastolic blood pressure was decrease from 101.2250 ± 4.97938 to 84.5000 ± 3.26599 and in group B from 107.7750 ± 7.18434 to 82.5000 ± 2.25320. Comparison of mean decrease in diastolic blood pressure between group A (High dose Methyldopa) and group B (Low dose Low dose Methyldopa with Nifedipine) was done. Mean decrease in diastolic blood pressure in group A was 16.72 ± 3.935 and in group B was 25.28 ± 6.876. Statistically significant difference of mean decrease in diastolic blood pressure between the both groups was noted with p value 0.000. Conclusion: Results of this study showed that Low dose Methyldopa with Nifedipine combination is more effective as compared to High dose Methyldopa to reduce diastolic blood pressure in pregnant women suffering from pregnancy induced hypertension. Keywords: Diastolic blood pressure, Methyldopa, Nifedipine, Pregnancy induced hypertension, Systolic blood pressure
538 Positive rate of COVID 19 in the setting of GGH Ghulam Muhammadabad , Babar Rafiq Khan, Mazhar Iqbal, Muhammad Saleem, Muhammad Hanif
Background: The corona virus disease also known as COVID-19 has opened gates to a lot of research about detection, treatment and prevention in the last past year due to lack of information regarding the SARS-CoV-2 virus. PCR corona via nasopharyngeal swab is the standard method of detection in our set-up. Materials and methods: Nasopharyngeal swabs were taken by ENT department using precautions and following proper SOPs. Swabs were sent for rRT-PCR tests. Data was collected and analyzed. All the subjects meeting the inclusion criteria were included in study. Data was analyzed using SPSS version 20. Frequency and percentage was calculated for gender. Positivity rate was calculated using CDC formula. Study design: - Descriptive studies Place and Duration of Study: - Government General Hospital, Ghulam Muhammadabad, Faisalabad. 889 samples were taken from 7.1.2020 to 6.12.2020. Results: Standard PCR for corona test by nasopharyngeal route was taken of suspected corona patients and of patients with contact with corona positive patients. 894 samples were taken from 7.1.2020 to 6.12.2020. 263 were positive for corona. The calculated positive rate is 29.41%. Conclusions: Calculation of positive rates is a very easy metric to give us a quick overview of the spread of the virus. Keywords: COVID-19, Positive rates, PCR-Corona
539 Anti dyslipidemic effect of Ficus Carica Fruit (Fig) on Lipid Profile of Diet Induced Hyperlipidemic Rats , Fouzia Perveen, Fariha Ahmad Khan, Zoobia Irum, Amir Hassan Siddiqui, Maira Bhatti, Robina Iqbal
Back ground: Hyperlipidaemia, characterized by elevation of one or more lipid types in blood, is a major risk factor for cardiovascular diseases and stroke. Management of hyperlipidaemia is helpful to control the fatal outcome of cardiovascular diseases. This experimental study was done to observe the effects of pulp of Ficus carica fruit on lipid profile in induced hyperlipidemic rats in comparison to atorvastatin. Methodology: The duration of study was 12 weeks. In this study forty male rats were taken and divided into four groups. One group was normal control which was given normal diet throughout study period of 12 weeks. The second group was positive control which was given high fat diet for 12 weeks. The remaining two groups were experimental groups which were given high fat diet for 12 weeks. Hyperlipidaemia was induced after giving high fat diet for first four weeks to the experimental groups. The pulp of Ficus carica fruit and atorvastatin was then added to diet of two experimental groups respectively in addition to high fat diet for the next 8 weeks. Body weight, fasting lipid profile, LDL/HDL ratio and AIP were measured at baseline, 4th, 8th, and 12th week of study. Results: Pulp of Ficus carica fruit significantly improved fasting lipid profile, AIP and LDL/HDL ratio. HDL was also significantly increased. However there was no change in body weight. Conclusion: Ficus carica fruit has marked antihyperlipidemic properties comparable to standard drug atorvastatin. Key words: Hyperlipidaemia, ethanolic extract, pulp, Ficus carica
540 Understanding Patient’s Predisposition for Physician’s apparel: A Cross-sectional Study from Mayo Hospital, Lahore. , Muhammad Fareed Khalid, Mahboob Alam, Fakeha Rehman, Rahat Sarfaraz
Objective: To understand patient’s predisposition for physician’s apparel Methodology: Using a cross-sectional study design, a total of 96 participants were approached at Mayo Hospital, Lahore. An interview based pre-tested semi structured questionnaire consisting of both open and close ended questions was used for data collection. Data was analyzed using SPSS version 26 Results: Out of 96 patients, 48(50%) were male and 48(50%) were female. Out of these 78.1% believed that doctor’s dress is important to them. 63.5% of patients preferred name tag and 84.4% preferred whitecoat. The most desired apparel for male physician was western attire with white coat (53.1%) and national attire with white coat for female doctors (54.2%) Conclusion: This study accentuated the patients’ predisposition for physician’s apparel which can lead to better rapport and ultimately improved healthcare services. Keywords: physician apparel, patient preference, attire
541 Influence of Covid -19 on the management of Appendicitis , Mahreen Zahra, Muhammad Kashif, Shafiq Ahmed, Saif Rasool, Ikramullah Khan  
Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic
542 Prevalence, Awareness Level and Attitude of Self-Medication Among Student Nurses , Nadia Saddique, Nafeesa Safdar, Aiman Zahra, Qamer Ali, Rizwan Khalid, Muhammad Zeeshan Sarwar
Introduction: Asthma is a clinical condition associated with recurring airway obstruction, airway hyperresponsiveness and airway inflammation. Asthma and br