DHQ Hospital Research Articles

Average HbA1c in Diabetic Patients in Southern KPK-Pakistan

Abstract Diabetes mellitus is a complex metabolic syndrome characterized by either insulinopenia or insulin resistance. This study is focused on the ever-growing prevalence of diabetes mellitus and its poor glycemic control in southern KPK This descriptive cross-sectional study was conducted at the outdoor unit, Department of medicine DHQ hospital Bannu, over six months, extending from 30th December 2021 to 30th June 2022. The sample size was 91 and was calculated using the standard WHO formula. The confidence interval used was 95%, with a 5% margin of error. P value <0.05 was taken as statistically significant. Consecutive non-probability sampling technique was applied. Diabetic patients under treatment below 70 years were included in the study. HbA1c was used as an assessment tool for glycemic control and divided into three categories: good glycemic control with HbA1c<7%, poor glycemic control with HbA1c>9%, and very poor glycemic control with HbA1c>10%. Data was entered and analyzed using SPSS version 19.0.About 18.6% diabetic patients had HbA1c>6%, 25.6% patients had HbA1c between6-8%, 26.7 % patients had HbA1c between 8-10% and 29.6 % had HbA1c>10%.This study revealed that the majority (55%) of diabetic patients belonging to southern KPK had poor glycemic control, as revealed by HbA1c, more than 8%.

Frequency of Acute Exacerbation of COPD Among Non-smokers in Tertiary Care Hospital of Bannu KPK-Pakistan

ABSTRACT
 Background: chronic obstructive pulmonary disease is common disease with frequent exacerbations especially in winter season. Frequency of COPD exacerbation is more among smokers as compared to general public. Current study was done to evaluate the frequency of acute exacerbation of COPD among non-smokers.
 Methods: this cross-sectional descriptive study was performed at Department of medicine, DHQ hospital Bannu over a period of one year from 22-2-2021 to 22-2-2022. About 193 COPD patients aged 35 to 80 years were included in this study. Patients with other lung diseases like TB, pneumoconiosis, silicosis, pleural effusion, interstitial lung diseases, bronchiectasis and history of pneumonectomy were excluded from the study. Complete history including history of smoking, socio economic status and co morbidities was taken. Complete general physical and systemic examination including chest and cardiovascular examination was performed. Spirometry was done and findings were recorded.
 Results: Among 193 patients, 55.4% and 44.6% were male and female respectively. Mean age was 58.89 years ± 10.82 SD. Among these 193 patients, 88.1% were uneducated, 6.2%, 29.6%, 32.6% and 31.6% were presented with mild, moderate, severe and very severe COPD respectively. Among them, 22.3% patients were hypertensive, 14% were diabetic and 1.6% were having thyroid disease. Frequency of non-smoker (50.3%) was stratified on the basis of gender (p=0.01), age (p= 0.16), duration of COPD (p=0.001), educational status (p=0.03), spirometry findings (p=0.73), hypertension (p=0.41), diabetes mellitus (p=0.85) and thyroid diseases (p=0.55).
 Conclusion: Approximately half of patients with acute exacerbation of chronic obstructive pulmonary disease were non-smokers. Of these, females were more likely to be non-smokers than males.

Predictors of Ischemic Stroke Among the Patients with end-Stage Renal Disease: A Single Centric Study of Local Population

Objective: The incidence of stroke is greater in patients with end-stage renal disease (ESRD) as compared to the general population. It is thought that there may be a few extra risk factors in ESRD patients suffering from stroke as compared to ESRD patients without stroke. This study aims to better understand the risk factors for stroke that are unique to patients with ESRD. Methods: In order to find out the different causative factors influencing the production of ischemic stroke (IS) in patients with ESRD, we carried out this retrospective study at the DHQ hospital in Faisalabad. In this study total of sixty patients were recruited and further divided into two groups. The first group consisted of 30 patients with ESRD with a history of ischemic stroke, while 30 patients with stroke-free dialysis were selected as the age and gender control group. Patients with and without ischemic stroke were compared in terms of demographic characteristics, stroke risk factors, and lab results. Results: Patients with acute ischemic stroke had an average age of 56.70 ± 8.87 years with 52% male whereas the non-ischemic stroke group had an average age of 58.9 ± 9.20 years. Small vascular obstruction was found to be the most common subtype of IS (42%), followed by atherosclerosis of large vessels (28%). Compared with patients who did not have a stroke, patients who had a stroke had significantly higher rates of hypertension (HTN), higher systolic (SBP) and diastolic blood pressure (DBP) at admission. The group with a stroke had significantly lower total cholesterol and LDL cholesterol. Lower levels of low-density lipoprotein (LDL) and higher systolic blood pressure were found to be the independent risk factor for an ischemic stroke in a multivariate analysis (OR=1.025, 95% CI p=0.045 and OR=1.458, 95% CI, P=0.03 respectively). Conclusion: According to the findings of our study, ESRD patients with hypertension and diabetes have a higher chance of ischemic stroke and the lower LDL levels and higher systolic blood pressure were the independent predictors of ischemic stroke. Keywords: Hemodialysis, Ischemic stroke, risk factors, Hypertension, end stage renal disease,

Frequency of Microalbuminuria in Essential Hypertension and type II Diabetes Mellitus in Tertiary Care Hospital

Introduction: Hypertension is the growing issues of public health problem of adult population in both developed as well as developing world, affecting single person in every four people. Objectives: The main objective of the study is to find the frequency of microalbuminuria in essential hypertension in tertiary care hospitals. Material and Methods: This Randomized Control Trial was conducted in DHQ hospital Sahiwal during 2020 to 2021. Blood sample of all the patients diagnosed with microalbuminuria in hypertension presented to the hospital were taken and sent to laboratory for performing fasting blood glucose and 1st morning Urine sample was taken and analyzed for albumin to creatinine ratio of these patients. Results: The age range of patients in this research was from 18-75 years. The mean age of patients was 40.35 ± 8.65 years. In group A the mean age of patients was 39.60 ± 10.12 years and in group B was 41.0 ± 8.05 years. Conclusion: This study concluded that efficacy of losartan is higher than lisinopril for reduction of microalbuminuria in patients with type-2 diabetes mellitus. Keywords: type II diabetes, microalbuminuria, losartan.

Prevalence of severity and type of hearing loss in Rheumatoid Arthritis patients

Rheumatoid arthritis (RA) is a chronic heterogeneous autoimmune disease characterized by painful joint inflammation which may cause destructive bone erosions. It also affects the auditory system and cause hearing loss. Objective: To find out the prevalence of Severity and type of Hearing Loss in Rheumatoid Arthritis Patients. Methods: Cross sectional descriptive study was conducted to find the prevalence of Severity and type of Hearing Loss in Rheumatoid Arthritis Patients. The study was performed at DHQ Hospital Bhimber, Mayo Hospital Lahore. The duration of data collection was 6 months (April 2022 to September 2022). Non-probability convenient sampling technique was used for data collection. Patients of both gender with ages 30 to 50 years were included. Patients with rheumatoid arthritis with other co-morbid factors were excluded. Results: Out of 117 patients, there were 33 (28.2%) male patients and 84 (71.8%) female patients. Most patients were in age group 41-45 years 38 (32.5 %). There were 19 (16.2%) lower class patients, 93 (79.5%) middle class patients and 5 (4.3%) upper class patients. The prevalence of Hearing Loss in Rheumatoid Arthritis patients was high 70 (59.5%). Sensorineural hearing loss 66 (56.4) was most prevalent. Majority of them had mild to moderate degree hearing loss 50 (42.7%). Conclusion: The study showed the prevalence of Hearing Impairment in Rheumatoid Arthritis was high. The result of this study also concluded that majority of the patients had mild to moderate degree sensorineural hearing loss.

Validation of Pedsql™ Duchenne Muscular Dystrophy Module (Acute Version 3.0), in Young Children (Age 5-7)

Objective: The goal of this project was to accurately translate the “PedsQLTM 3.0 DMD” Module into Urdu and to assess its validity in health-related quality of life in the Duchenne muscular dystrophy (DMD)” children age 5 to 7 years reported by their parents. Method: The study was conducted with the parents/caregivers of DMD children in Rising Sun Institute, PSRD, Hope,Gosha e Shifa, Special gems, Ghazali Foundation Rawalpindi and DHQ hospital Jhang. Study was cross cultural validation including 56 primary care givers. First of all questionnaire of primary care giver was translated in Urdu by using forward translation, the second step was reconciliation of items; in this the best Urdu translation was selected. Backward translation was completed in the third phase, and a review was conducted to evaluate the full forward-backward procedure in order to produce a final forward translation. Validity & Reliabity were measured. To determine in the internal consistency Cronbach’s Alpha was used Test-Retest reliability was checked. Content Validity Index and Content Validity Ratio were measured through 5 experts. To analyze the collected data SPSS 26 was used. Results: The results showed that in both genders from age 5 to 7 years DMD affects the quality of life of child as reported by parents. The value of Cronbach's alpha was 0.913.After factor analysis KMO was 0.793 and because the p value was less than 0.05, the test was significant. Conclusion: Urdu version of “PedsQLTM Duchenne Muscular Dystrophy Acute Version 3.0(age 5-7) Parent report for young children” is a stable and consistent instrument for assessing quality of life measures of the DMD children and can be applied in Urdu speaking population throughout the world. Keywords: Duchenne Muscular Dystrophy, “PedsQL™ 3.0 DMD Module”, Urdu translation, validity, quality of life.

Cardio Vascular Autonnomic Dysfunction in Type 2 Diabetes Patients with Microalbuminuria

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: Department of Cardiology, DHQ Hospital Alpurai, Shangla, from December, 2021 to May, 2022. 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

Care of Labour by Trained Midwife and Effect on Maternal Outcome in a Hospital Based Labour Ward

Midwifery service quality affects delivery outcomes the most. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Methodology: This retrospective study at DHQ Hospital MishtiMela Orakzai studied the district's rural midwife-led maternity healthcare system from July 2019 till June 2020. All midwives' cases were recorded and analyzed to establish the frequency of various maternal outcomes. All rural pregnant patients between 15 and 45 who presented to the government facility midwife at any stage of labor were recorded and maternal outcome and related factors were gathered. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Results: In our study, mean age of the patients was 27 SD 5.9 years (from 15 to 45) with gestational age of the patients from 14 to 42 weeks (mean 37.3 SD 2.5 weeks). Among the total 635 cases, 54% of the cases were of the age group 20 to 29 years. Around 19% of the cases in the labor room landed were preterm (<37 weeks of gestation), and 78% of the patients were multigravida. Incidence of LSCS in mid-wife managed pregnancies was 4.1% (26 of 635 cases), and successful vaginal deliveries were carried out in 92.9% cases (590 of 635). Conclusion: Researchers are hopeful that the findings will serve as a solid basis for further research and help them better understand how midwives and expectant mothers communicate and how to strengthen the relationship. These findings can be implemented as the basis for future courses in midwifery education. Efforts should be made to evaluate these educational programmes and their outcomes in the delivery room. Keywords: Mid-wife, LSCS, SVD, Vaginal delivery, Maternal Outcome

Disc Prolapses In The Spine on Magnetic Resonance Imaging

A disc herniation occurs when the nucleus, cartilage, or fragmented annular tissue are displaced outside the intervertebral disc area. Because of its high sensitivity and specificity for disc herniations, MRI is the method of choice for assessing disc morphology (both protrusions and extrusion).Objective: To use MRI to diagnose disc disorders, to create optimal MRI sequences for diagnosing spine pathologies, to detect which gender was affected, and to correlate the spinal disc with patient age.Methods:It was a descriptive cross-sectional study carried out in a DHQ Hospital, Gujranwala, Pakistan and the sample size for this research was 71 calculated via a convenient sampling approach. The data were collected in four months from December 2021 to March 2022 after informed consent. Patients who presented to the MRI department for spinal disc prolapse were included in this study. Patients were to be registered with age, gender, type of examination, and protocol used. An MRI scanner was made by a Japanese manufacturer (Toshiba). Data were analyzed using SPSS version 20. Results: Disc prolapse is widespread in older patients, with an average age of 41-50 years. Males are more likely than females to have disc prolapses 45(63.4 %). In approximately 50(70.4%) of patients, the sagittal and axial technique is the best for confirming disc prolapse. Lower back discomfort is the most prevalent complaint among patients.Conclusion: Disc prolapse is widespread in older male individuals. The sagittal and axial technique is the best for confirming disc prolapse. Lower back discomfort is the most prevalent complaint among patients.

Frequency of Vitamin Cobalamin Deficiency in Macrocystic Anemia Cases Reporting at Tertiary Care Hospital

Objective: The purpose of this study is to determine the frequency of vitamin cobalamin deficiency in macrocystic anemia cases reporting at tertiary care Hospital. Study Design: Cross-sectional Place and Duration: In Medicine department of DHQ Teaching Hospital, Sargodha and DHQ Hospital, Dera Ismail Khan for the duration of six months from August 2021 to January 2022. Methods: Total 210 cases of macrocytic anemia of both genders with ages 18-62 years were presented. Age, sex, and body mass index were among the specific demographics of the enrolled cases that were documented after receiving informed written consent. Ante-cubital fossa blood was sampled for 5 mL. To estimate the amount of vitamin cobalamin using an ELISA test kit, samples were centrifuged and sera were collected. SPSS 24.0 was used to analyze all data. Results: Among 210 cases, 130 (61.9%) were males and 80 (38.1%) females in this study. 70 (33.3%) cases had ages 18-35 years, 90 (42.9%) had ages 36-50 years and 50 (23.9%) had ages >50 years. Mean BMI of the presented cases was 24.66±14.49 kg/m2. We found that 180 (85.7%) patients had deficiency of cobalamin and 30 (14.3%) cases had normal cobalamin. Among 180 cases of cobalamin deficiency, 70 (38.9%) patients were severe, border line was found in 45 (25%) cases and deficient cases were 65 (36.1%). Conclusion: We concluded in this study that patients with macrocystic anemia had higher number of vitamin cobalamin deficiency found in 85.7% cases. Majority of the patients were deficient and had severe deficiency of cobalmin. Keywords: Vitamin Cobalamin, Macrocystic Anemia, Severe Deficiency

PREVALENCE OF RIFAMPICIN RESISTANCE AND PROBES IDENTIFICATION OF 81BP RRDR RPO-B GENE IN PULMONARY TUBERCULOSIS PATIENTS OF DISTRICT BANNU, PAKISTAN

Background: Tuberculosis is a major public health problem in developing countries due to the emergence of drug resistance against conventional anti-tuberculosis drugs. Rifampicin is considered to be one of the most potent first-line anti-TB drugs but in most cases, it has lost its efficiency due to bacterial resistance. The objective of this study was to detect the prevalence of rifampicin-resistance and probe mutation in 81bp RRDR of the rpo-B gene in Pulmonary TB patients of District Bannu, Pakistan. Materials and methods: This cross-sectional study was conducted in the Department of Pathology, Bannu Medical College, Bannu from March 2021 to June 2021. The samples were collected for the period from January 2014 to December 2018 and the laboratory tests were performed at the District TB facility DHQ hospital Bannu, Pakistan. A total of 1965 sputum samples were processed by Xpert MTB/RIF assay using the standard N-Acetyl-L-cysteine–NaOH technique. Results: Among total 1965 processed cases 1382 were MTB positive and the prevalence of rifampicin-resistant detected (RRD) cases among 1382(70.33%) MTB detected pulmonary isolates was 75(5.6%). The mutation detected in 81bp rpo-β Gene was highest in probe E; 42(56%) followed by B; 16(21%), D 09(12%), A 04(5.3%), C 2(2.66%) and B&D/E&D; 01(1.33%). Conclusion: From the current study, it has been concluded that the prevalence of RRD in Bannu, Pakistan was 5.6% and the most common probe having the highest mutation rate was probe E; 56% followed by B; 21%, D; 12%, A; 5.3%, C; 2.66% and B&D/C&D; 1.33%.

Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation

Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality.
 Material and Methods: The Descriptive cross-sectional study was conducted DHQ Hospital Rawalpindi from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (> 18 years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded. Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia. Data was analyzed by SPSS with significant p< 0.05.
 Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years). Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs. 55.30+7.47 in patients without hypomagnesaemia (p=0.228).
 Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations.

Cholecystectomy Via Laparoscopy for Acute Cholecystitis

Objective: The purpose of this study is to determine the outcomes of laparoscopic cholecystectomy among patients of acute cholecystitis. Study Design: Retrospective study Place and Duration: Jinnah International Hospital, Abbottabad and DHQ Hospital Battagram From Aug, 2021 to Jan, 2022. Methods: There were 170 cases of both genders were presented in this study. Included patients were aged between 12-70 years. Included patients had acute cholecystitis were underwent for cholecystectomy and standard open procedure. After obtaining written consent, participants' personal information was collected, including their age, sex, BMI, and geographic location. Patients were equally divided into two groups. 85 patients received LC in group I and 85 patients received open procedure in group II. Post-operative outcomes among both groups were compared in terms of complications, efficacy, surgery time and pain score. SPSS 23.0 was used to analyze all data. Results: Among 170 included patients, majority of the patients were females 105 (61.8%) and males were 65 (38.2%). Mean age of the patients was 37.07±16.67 years. Majority of the patients 125 (73.5%) had body mass index <25kg/m2 and 45 (26.5%) had BMI >25kg/m2. 70 (41.2%) were from urban areas and 100 (58.8%) patients were from rural areas. Frequency of gallbladder empyema was found in 110 (64.7%) cases followed by GB phlegmon in 48 (28.2%) cases and perforation in 12 (7.1%) cases. Mean operative time in group I was significantly lower 32.12±9.81 minutes and compared to group II 51.11±11.74 minutes with p value <0.02. Successful rate of LC was 85 (100%) and none of patient had bile duct injury. Post treatment, significantly fast recovery was found in LC group as compared to open surgery with p value 0.008. Frequency of complications was higher in group II 26 (30.6%) and as compared to group I 2 (2.4%). Lower pain score was found in LC group. Conclusion: We concluded in this study that the acute cholecystitis was successfully treated by laparoscopic cholecystectomy with faster relief and lower operative time as compared to open surgery. Except this low pain score and complication rate was minimum observed after surgery in patients underwent for LC. Keywords: Acute Cholecystitis, Laparoscopy, Open surgery, Complications, Pain score

Frequency and Type of Ovarian Tumors in Gynecological Women presenting to DHQ Teaching Hospital Gujranwala

Background: Ovarian cancer (OC) average lifetime risk is 1 in 70(1.4%).Ovarian cancer is diagnosed in 7300 women every year in UK and 239,000 women world wide.There are variations in incidence with ethnicity, white women have the highest incidence approximately14/100,000 where as Asian women have a lower incidence at 10/100,000. Aim: To find the frequency and different types of ovarian carcinomas in women presenting with pain lower abdomen. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, DHQ Hospital Gujranwala from1st May 2020 to 31st October 2020.A total of 282 women presenting with pain lower abdomen were included.All women underwent ultrasonography and ovarian tumors were noted as per operational definition. Patients with ovarian tumor underwent laparotomy, the specimen of tumors were collected with excision biopsies and sent for histopathological analysis. Results: The mean age of cases was 33.808±7.70 years, and the mean duration of complaint was 4.322±1.46 weeks and mean weight was 69.560±13.00 kg. Majority of the patients (82.3%) belonged to 20-40 years age groups. Ovarian Tumor was seen in 65(23%) patients. Among 65 patients with ovarian tumor, 72.3% were benign, 3.1% borderline and 24.6% were malignant. Conclusion: It was concluded that ovarian tumors were common between the 20 and 40 years of age. The frequency of Malignant neoplastic lesions was higher than the benign neoplastic lesions. Keywords: Women, Pain lower abdomen, Ovarian tumors

Improving Care in Accident and Emergency Departments in Pakistan

Introduction: Emergency departments (EDs) are perceived as 24/7 portals where a rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients. Objectives: The main objective of the study is to analysed the improving care in accident and emergency departments. Material and methods: This analytical study was conducted in DHQ hospital, Sahiwal during 2020 to 2021. For this 5 hospitals were selected for the determination of improving care in accident and EDs. All hospitals were visited one by one and collect the data for the determination of mode of clinics and improving care. Number of patients and number of doctors were also counted. Results: Analysis of results was performed by comparing the data of hospitals with international standards. Patient case notes were checked for compliance with RCP 12 point generic medical record keeping standards on 5 point scale to stratify the level of compliance. Hospitals where case notes fulfilled all the 12 standards were placed at point 5. EDs safety scores were measured on 4 point scale and different hospitals were categorized according to grades A, B, C, D and F. Conclusion: It is concluded that the emergency service would be provided largely by doctors in middle grade or career grade posts supported by nurse practitioners, general practitioners, and senior house officers working under much closer supervision than at present.

Impact of Critical Success Factors on Project Success Through the Mediation of Knowledge Creation.

Several factors affect health project success. This research aims to examine the impact of critical success factors on health project success and show how the essential factors of success interact with knowledge creation to impact health project success. The self-administered questionnaire was distributed to collect data from 246 managers, supervisors and zonal supervisors of DHQ hospital Attock and PIMS hospital Islamabad. The analysis was done using Smart PLS to understand the effect of exogenous variables over endogenous variables and the impact of mediating variables between two constructs. The results show that all critical success factors (MGTRF, DRF, CRF, PMRF, CLRF) are significantly affecting project success, in addition, tacit knowledge creation mediate the association between critical success factors and project success. In contrast, explicit knowledge creation does not mediate the relationship between critical success factors and project success. This study intends to expand the theoretical understanding of process improvement by providing practical insights into the impact of strategies used by project managers to develop new knowledge by capturing explicit and implicit information. This study also reinforces past findings and increases awareness about using knowledge creation to gain a competitive advantage in the health sector.

Assessment of Mitochondrial Dysfunction in Autistic Individuals by Measuring Plasma Lactate Levels

Introduction: Autistic disorder, Asperger syndrome and pervasive developmental disorder-not otherwise specified comprise a heterogeneous group of neurodevelopmental disorders known as autism spectrum disorders (ASDs). ASDs are behaviorally defined by impairments in communication and social interaction along with restrictive and repetitive behaviors. Objectives of the study: The main objectives of the study will determine the mitochondrial dysfunction in autistic individuals by measuring plasma lactate levels. Material and methods: This cross sectional study was conducted in DHQ Hospital Sahiwal. This study will include 200 children aged 7 to 9 years. Randomly selected sampling technique will be used for the data collection. For the purpose of analysis of mitochondrial dysfunctionality we will collect the blood samples of each individual. Results: The data was collected from 200 children. In this study, blood ammonia, serum lactate, AST, ALT and CK level were higher in 29(90%), 18(80%), 23 (30%), 20(20%) and 14 (40%) subjects of study group. Conclusion: It is concluded that mitochondrial dysfunction occur in children with autism spectrum disorder children

Comparative Effects of Spirulina with Iron Supplemented Sangobion Capsules among Anemic Females in Hafizabad

Anemia is a most common health problem in women that causes a variety of disorders in individuals, especially in females. About 80% of females suffered from anemia during pregnancy. Spirulina is a superfood that contains macronutrients and micronutrients and has 70% iron in its composition. Sangobion is an Iron Supplement active compound is Ferrous Sulphate and treated Iron-Deficiency Anemia. The current study aimed to investigate the effect of Sangobion and spirulina could increase Hemoglobin levels and Ferritin levels compared to usual supplementation in anemic females. The pre-post-test design was conducted for 8 weeks to 10 women in Go (control group) and 10 women in the intervention group G1(spirulina)and 10 women in intervention group G2 (Iron Supplement) at DHQ Hospital in Hafizabad from 1 January to March 2022. Women with age (21-35) years and Hb concentration range of 7 to 9 g/dl were included in this study. 30 Anemic Females were included in this study. The mean of Hb before the intervention was 7g/day and increased significantly to 13.5g/dl after taking spirulina for 8 weeks(p=0.001). In Contrast, women who took iron supplemented sangobion show near to significant improvement in Hb concentration. Keywords: Spirulina, Anemia, Iron supplemented Sangobion,

Electrocardiogram Testing in Symptomatic Patient with Type-II Diabetes and Left Ventricular Diastolic Dysfunction

Objective: The main objective of the study is to find the exercise electrocardiogram testing in asymptomatic patient with Type-II diabetes and left ventricular diastolic dysfunction. Methods: This descriptive study was conducted in DHQ Hospital, Sheikhupura during January 2019 to November 2019. The data was collected from 50 patients of type II DM. These all patients has normal electrocardiogram (ECG) and normal systolic function. Result: The data was collected from 50 patients of both genders. The mean age of the patients was 47.83±5.61 years. After getting data the results were divided into two parts. There were 25 patients in group A and 25 patients group B. The mean duration of diabetes is 2.5±5.61 years. There were 20 males and 30 females in this data. There were no significant difference of fasting blood sugar in both groups. There was no statically significant difference between two groups regarding left atrial dimension, aortic root dimension, LV end-diastolic dimension, ejection and LV mass. Conclusion: It is concluded that It is concluded that coronary supply route sicknesses is a typical issue in DM, with diastolic brokenness and increment uniquely in patients with positive pressure practice electrocardiography. Keywords: Exercise, Ventricular, Function

Management of Iron-Deficiency Anemia on Inpatients and Appropriate Discharge

Introduction: Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions, particularly iron deficiency. Aims and objectives: The main objective of the study is to analyse the management of iron-deficiency anemia on inpatients and appropriate discharge. Material and methods: This cross sectional study was conducted in DHQ hospital Sheikhupura with the permission of ethical committee of hospital. Data were collected from 100 patients. Participants were selected through randomly sampling technique. Iron deficiency criterion for men was defined as hemoglobin under 13 g/dL, and women under 12 g/dL, with ferritin less than 30 ng/dL for any patient. Diagnostic criteria in patients with congestive heart failure were ferritin below 300 ng/dL and transferrin saturation (TSAT) under 20%. Results: The data was collected from 103 patients. The only factors which emerged as statistically significant from the adjusted logistic regression analysis model were insufficient intakes of iron (OR = 7.39; 95% CI: 1.45-37.57) and vitamin C (OR = 6.14; 95% CI: 1.34-28.27), frequent (≥2 times per week) tea consumption (OR = 0.01; 95% CI: 0.01-0.08), infrequent (≤2 times per week) red meat consumption (OR = 3.71; 95% CI: 1.01-13.61), and the possession of a personal history of IDA (OR = 6.00; 95% CI: 1.45-24.76). Conclusion: It is concluded that Iron-deficiency anemia is also tricky in patients with chronic diseases. Iron supplementation has been shown to help reduce mortality in those with blood loss.