Fatima Memorial Hospital Research Articles

Association of polymorphism of NLRP3, ICAM-1, PTPN22, INS genes in childhood onset type 1 diabetes in a Pakistani population.

Type 1 diabetes (T1D) is an organ-specific autoimmune disorder characterized by the destruction of pancreatic β cells, leading to absolute insulin deficiency. The genes NLRP3, ICAM-1, PTPN22, and INS are reportedly associated with T1D in other populations. However, the genetic pattern of T1D in the Pakistani population is not clear. This study aimed to find the association of polymorphisms in the PTPN22, INS, NLRP3, and ICAM-1 genes with T1D susceptibility in the Pakistani population. This case-control study includes 100 T1D patients (3-14 years), recruited randomly from the pediatric endocrinology department of Fatima Memorial Hospital, Lahore, Pakistan and 100 age-matched healthy controls were selected from different localities of the same population. The polymorphisms in PTPN22 (rs601, rs33996649, rs2488457), INS (rs80356664), NLRP3 (rs10754558, rs35829419), and ICAM-1 (rs1799969, rs5498) genes were genotyped by Sanger sequencing. The genotypic and allelic frequencies, haplotypes, and linkage disequilibrium were computed using the genetic toolset PLINK to investigate their relationship to T1D. The results indicate that the occurrence of the GT genotype of the rs33996649 variant is significantly higher in children with T1D compared to a control group of healthy individuals (P = 0.001, OR: 2.0, 95% CI = 0.15-0.45). Furthermore, the CT genotype of rs2488457 was notably associated with T1D patients (P = 0.007, OR: 2.8, 95% CI = 0.56-0.67). The CG genotype of rs80356664 showed a slight association with T1D (P = 0.03, OR: 1.9, 95% CI = 0.35-0.59). The prevalence of the AT genotype of rs10754558 showed a strong association with T1D (P = 0.005, OR: 3.4, 95% CI = 0.45-0.69). The TG genotype of rs5498 was also strongly associated with T1D (P = 0.009, OR: 2.8, 95% CI = 0.75-0.89). The present study provides evidence that SNPs in the PTPN22, INS, NLRP3, and ICAM-1 genes are associated with the development of T1D. Further research is needed to explore their potential use in genetic screening and personalized medication.

Prevalence of Hepatitis C in Liver Cirrhosis Patients

Background: Hepatitis C Virus (HCV) is a major cause of chronic liver disease, including liver cirrhosis, globally. Identifying the prevalence of HCV among cirrhotic patients can improve clinical outcomes and guide management strategies.Objective: To determine the prevalence of HCV in patients with liver cirrhosis and assess the association between liver enzyme levels (ALT and AST) and HCV infection.Methods: This retrospective observational study was conducted at Fatima Memorial Hospital, Lahore, from June 2023 to December 2023. Fifty liver cirrhosis patients with abnormal liver function tests were included. HCV infection was evaluated using ELISA for antibodies and PCR for RNA detection. Data analysis was performed using IBM SPSS version 25.0, with a p-value of <0.05 considered significant.Results: Among 50 cirrhotic patients, 60% tested positive for HCV antibodies via ELISA, and 46% were confirmed positive by PCR. Mean ALT levels were significantly higher in ELISA-positive (867 U/L) and PCR-positive (1096.43 U/L) patients compared to ELISA-negative (42 U/L) and PCR-negative (59.96 U/L) patients (p < 0.001).Conclusion: A significant prevalence of HCV was observed among liver cirrhosis patients, with elevated ALT and AST levels indicating liver damage associated with HCV infection.

Prevalence of Diabetic Nephropathy among Patients of Type 2 Diabetes at Tertiary Care Hospital Lahore

Background: Diabetic nephropathy is a significant complication of Type 2 Diabetes Mellitus, often leading to chronic kidney disease (CKD) and potentially progressing to End-Stage Renal Disease (ESRD). Approximately 90% of individuals with diabetes and hypertension may develop ESRD in the later stages of the disease. Objective: The study aimed to determine the prevalence of diabetic nephropathy among patients with type 2 diabetes at a tertiary care hospital in Lahore. Methods: This retrospective study included 100 reports from the chemical pathology and microbiology laboratory at Fatima Memorial Hospital, Lahore, covering renal function tests (RFT) such as Urea, Blood Urea Nitrogen (BUN), Creatinine, and estimated Glomerular Filtration Rate (eGFR), as well as HbA1c levels and Albuminuria. Data collection involved accessing electronic medical records (EMRs) to obtain comprehensive clinical data, including patients' medical history, duration of diabetes, glycemic control measurements, blood pressure, and prescribed medications. The study included patients with type 2 diabetes and kidney disease, excluding those without renal disease. Ethical approval was obtained from the Institutional Review Board (IRB) of FMH College of Medicine and Dentistry, adhering to the principles of the Declaration of Helsinki. Data were analyzed using IBM SPSS version 25, with categorical variables expressed as frequencies and percentages and continuous variables as mean ± standard deviation (SD). Correlation analysis was conducted, with a p-value of less than 0.05 indicating statistical significance. Results: The study included 100 participants, with 53% being male and 47% female. The mean age was 59.19 years (SD = 18.812), ranging from 18 to 91 years. Albuminuria was present in 88% of participants. Elevated serum creatinine was observed in 93%, HbA1c levels >6.4% in 68%, high urea levels in 87%, and eGFR <60 in 14%. Correlation analysis showed a significant positive correlation between HbA1c and eGFR (Spearman's rho = 0.432, p < 0.001) and between urea and serum creatinine (Spearman's rho = 0.701, p < 0.001). Conclusion: The high prevalence of albuminuria and elevated renal function markers among individuals with type 2 diabetes underscores the importance of early detection and comprehensive management. Regular screening for urinary albumin, stringent glycemic control, and optimal blood pressure management are crucial for preventing the progression of diabetic nephropathy.

The Effect of Hyperlipidemia on Cardiovascular Diseases: A Risk Factor in Cardiovascular Diseases at FMH Hospital Lahore

Background: Cardiovascular diseases (CVDs) represent a major global health concern, causing approximately 17.9 million deaths annually, accounting for 32% of all global deaths. Among these fatalities, 85% are attributed to heart attacks and strokes. Hyperlipidemia, a common metabolic disorder, significantly contributes to the risk of CVDs by causing disturbances in lipid metabolism, including elevated levels of low-density lipoprotein cholesterol (LDL-C), increased triglycerides, elevated total cholesterol (TC), and decreased levels of high-density lipoprotein cholesterol (HDL-C). Objective: To determine the impact of hyperlipidemia on cardiovascular diseases, focusing on its role as a prominent risk factor. Methods: This retrospective study was conducted at the Department of Pathology, Fatima Memorial Hospital, Lahore, from June 2023 to December 2023, following approval from the Institutional Review Board (IRB). Data were collected using a non-probability convenient sampling technique. The sample size was calculated based on a 95% confidence level, an estimated prevalence of hyperlipidemia in CVD patients of 4.5%, and a desired margin of error, resulting in a sample size of 65-70 patients. Inclusion criteria included CVD patients diagnosed with hyperlipidemia, while patients with hyperlipidemia but no CVD were excluded. Data were collected from medical records using a self-designed Performa. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp.). Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation (SD). Bar charts were used for categorical data and histograms for continuous data. A p-value of less than 0.05 was considered statistically significant. Chi-square analysis was used to identify correlations between lipid levels and CVD status. Results: Out of the 65 subjects, 45 (69.2%) had no CVD, while 20 (30.8%) were diagnosed with CVD. Total cholesterol levels were <200 mg/dL in 36 patients (55.4%), 200-240 mg/dL in 15 patients (23.1%), and >240 mg/dL in 14 patients (21.5%). LDL levels were <100 mg/dL in 21 patients (32.3%), 130-189 mg/dL in 38 patients (58.5%), and >190 mg/dL in 6 patients (9.2%). HDL levels were <39 mg/dL in 36 patients (55.4%) and >40 mg/dL in 29 patients (44.6%). Triglyceride levels were <150 mg/dL in 15 patients (23.1%), 150-199 mg/dL in 30 patients (46.2%), and 200-499 mg/dL in 20 patients (30.8%). Chi-square analysis revealed a significant association between triglyceride levels and CVD status (p < 0.001) and significant results for LDL and HDL levels (p < 0.005). Conclusion: This study highlights the profound impact of hyperlipidemia on cardiovascular health, emphasizing its role as a significant risk factor for CVDs. The strong association between elevated lipid levels and increased risk of cardiovascular events underscores the need for effective lipid management strategies to reduce the burden of cardiovascular diseases and improve patient outcomes.

P017 Planned infliximab use during pregnancy for pakistani patients with immune-mediated inflammatory disease - case series of 12 patients

Abstract Background/Aims Immune-mediated inflammatory diseases (IMIDs) affect mostly young females during their reproductive age. Therefore, a better understanding is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used. Studies have shown that anti-TNF are considered safe and do not increase the risk of adverse events during pregnancy. Nevertheless, the data is quite limited, hence fall in FDA pregnancy category B. We wish to report a series of 12 pregnant women with IMIDs who were intentionally being treated with infliximab for the treatment of active intractable IMIDs. Methods The study included pregnant patients with IMIDs who were treated using anti-TNF between January 2021 to July 2023 at Fatima Memorial Hospital and Doctors Hospital & Medical Centre, Lahore. All patients receiving infliximab were reviewed by a dedicated medical team, who maintained a detailed medical record of each visit. The patients were prospectively followed up and the neonatal outcome was also recorded. Results 12 pregnant women with IMIDs received Infliximab during this study. All these patients required >7.5mg of deltacortil to control their arthritis and hence decision was made to add bDMARDs. 10 patients successfully completed their pregnancies uneventfully and two additional patients are in the later stages of pregnancy. Seven patients had complete remission of their underlying IMIDs and the rest had overall good improvement but continued to have low grade active disease. All our patients presented a satisfactory response to treatment and the pregnancy progressed without any complications. Median gestational week of birth was 38 with a median birth weight of 3490 grams. Conclusion This is the first reported series from Pakistan of intentional infliximab use throughout pregnancy. Our data, combined with many other studies, suggests that anti-TNF is safe during pregnancy and its benefits in achieving control of IMIDs may outweigh the risk of foetal exposure to the drug. This is further supported by the available data suggesting the inflammatory activity as the main risk factor for unfavourable outcome. However, the benefits and risks must be discussed with the patient and management decisions should be taken on individual basis. Disclosure Z. Tayyab: None. M. Haroon: None.

Pattern of cytopenias and systemic immune-inflammation index among hospitalised patients of COVID-19.

To compare the extent of cytopenias and systemic immune inflammation index of hospitalised coronavirus disease-2019 patients during the first and second/third waves of the pandemic. The retrospective, cross-sectional study was conducted in October 2021 at Fatima Memorial Hospital, Lahore, Pakistan, and comprised data of hospitalised coronavirus disease-2019 patients regardless of age and gender from May 2020 to June 2021. Data was segregated into first wave that lasted from May to July 2020, second wave that lasted from early November to mid-December 2020, and third wave that ranged from mid-March to June 2021. For comparison purposes, the data of first wave was in group A, while data of second and third waves was pooled into group B. Age, gender, comorbidities, requirement of ventilator support and outcome of the patients was noted. Inflammatory markers were compared on the basis of complete blood count and systemic immune-inflammation index data. Data was analysed using SPSS 25. Of the 202 patients, 90(44.5%) were in group A and 112(55.4%) were in group B. There were 108(53.5%) males and 94(46.5%) females. The median age in males was 58 years (interquartile range: 21 years) and it was 56 years (interquartile range: 21 years) in females. Neutrophilia (p<0.001), leukocytosis (p<0.001) and lymphocytopenia (p<0.001) had direct association with increased systemic immune-inflammation. Raised systemic immune-inflammation also had an association with increased requirement of ventilator support (p=0.2) and increased mortality (p=0.001). There were more females, more critical patients, more patients with anaemia, leukopenia, lymphocytopenia and thrombocytopenia in group B compared to group A (p<0.05). Need for ventilator support and mortality were also higher in group B compared to group A (p<0.05). All the indicators analysed were worse during the second and third waves of coronavirus disease-2019 compared to the first wave of the pandemic.

Mycophenolate mofetil vs. cyclophosphamide-based induction regimens for lupus nephritis: Outcomes at a tertiary care centre in Lahore, Pakistan.

To compare the efficacy of mycophenolate mofetil with intravenous cyclophosphamideas induction therapy in lupus nephritis. The observational, prospecrive, cohort study was conducted at the Rheumatology Department of Fatima Memorial Hospital, Lahore, Pakistan, from July 2016 to June 2019, and comprised lupus nephritis patients. For induction therapy, the patients were assigned at the discretion of the treating rheumatologist to mycophenolate mofetil group MMF, and intravenous cyclophosphamide group CYC. The latter group was further divided into NIH subgroup that received the therapy as per the protocol of the National Institutes of Health, and ELNT subgroup which recived the therapy as per the Euro Lupus Nephritis Trial protocol. Maintenance therapy in all groups was mycophenolate mofetil. Tacrolimus was added in case of non-response. The outcome was the achievement of complete renal response at 6, 12 and 24 months. Data was analysed using SPSS 26. Of the 131 patients, 126(96.2%) were females. The overall mean age was 27±7.7 years. There were 58(44.2%) patients in group MMF and 73(55.7%) in group CYC, which had subgroup NIH 46(63%) and subgrpup ELNT 27(37%). The complete renal response rates at 6, 12, and 24 months were 22 (43.1%), 35 (71.4%), and 40(83.3%) for group MMF; 5(12.5%), 9(22%) and 24 (58.5%) for subgroup NIH, and 6(26.1%), 8(36.4%) and 14(63.6%) for subgroup ELNT. Group MMF outcomes were significantly better than the rest (p<0.05). Mycophenolate mofetil induction therapy was more effective than intraveenous cyclophosphamide in terms of achieving remission at 6, 12 and 24 months.

Association of Diabetes Mellitus II and Hypertension with Types of Cataract

Objective: The purpose of this study was to determine the association of diabetes mellitus and hypertension with types of cataract. Methodology: After ethical approval, this cross-sectional study involved 61 patients, age between 40 to 85 years who were advised cataract surgery with phacoemulsification at Department of Ophthalmology, Fatima Memorial Hospital. Proper informed consent was obtained from participants. Those who did not give consent were excluded. The type of cataract and the presence of two systemic diseases—hypertension and diabetes mellitus II—that have been identified as risk factors for the development of cataract were investigated in the patients. Data was entered and analysed in SPSS. Results: Out of 61 patients, who were involved in this study, there were 26 (42.6%) males and 35 (57.4%) females. In this study the most presented systemic disease was combination of both hypertension and diabetes mellitus II and most occurring type was nuclear cataract. DM II had very low incidences in all groups. There was insignificant difference and association (p=0.784) between cataract (All types) and system diseases (Hypertension and Diabetes Mellitus) in the age group 40-85 years. Conclusion: There was no association of types of cataract with hypertension and diabetes mellitus type II. Key words: Cataract, Diabetes Mellitus, Hypertension

Examination-Related Stress Leads to Temporomandibular Joint Disorders in Medical and Dental Students - An Institutional-Based Study

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Stress-related behaviors such as challenging academic atmosphere and rigorous examinations exert a negative impact on the normal function of temporomandibular joint. This study aimed to determine the prevalence and severity of temporomandibular joint disorders (TMDs) and their association with examination-related stress among medical (Bachelor of Medicine and Bachelor of Surgery) and dental (Bachelor of Dental Surgery) students.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional survey was conducted at Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan, from June 2022 to November 2022 using the Fonseca&amp;rsquo;s Questionnaire. A total of 198 medical and dental students were included as study participants. They were required to select just 1 response for each of the 10 items mentioned in the adopted but customized and validated questionnaire. TMD was categorized as mild, moderate, severe, or no TMD based on the sum of these responses. The data were analysed using statistical software and a p-value less than or equal to 0.05 was set as significant.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 52 (26.2%) males and 146 (73.7%) females with a mean age of 24.2 +1.22 years. Among 198 students, 104 were dental students while 94 were medical students. The prevalence of TMD was found to be 63.6% among all students. There was no TMD in 36.4% of students while 42.9% of students had mild TMD, and moderate and severe TMD was found in 14.1% and 6.6% of students, respectively. Mild (74%) and severe (6.7%) TMD were more prevalent in dental students than in medical students while moderate TMD was found more in medical students (16%). However, these differences were statistically not significant between dental and medical students (p &amp;gt; 0.005).&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; TMD was found in both medical and dental students with no significant difference in severity between them. The study indicates the need to take on certain preventive and therapeutic strategies to address this disorder among anxiety-prone medical and dental students.&lt;/p&gt;

Prevalence of Neck Pain in Dental Surgeons

Background: Cervical pain, or cervicalgia, is increasingly recognized as a significant occupational hazard among dental surgeons. The demands of dental practice, including prolonged static postures and repetitive motions, have been implicated in the development of musculoskeletal disorders, with a notable impact on the cervical spine. Objective: This study aimed to determine the prevalence of cervical pain among dental surgeons and identify associated risk factors, focusing on the impact of work-related postures. Methods: A cross-sectional study was conducted among 90 dental surgeons from June to December 2022, employing non-probability convenience sampling. Participants were recruited from Farooq Hospital (Westwood branch), Akhtar Saeed Medical and Dental College, and Fatima Memorial Hospital, Lahore. Inclusion criteria targeted dental surgeons aged 20 to 35 years, excluding those over 35, dental assistants, other medical doctors, and individuals with cervical spondylosis. Pain intensity was measured using the Numeric Pain Rating Scale (NPRS). Data analysis was performed using SPSS version 25, with quantitative variables presented as means, standard deviations, ranges, and histograms, and categorical variables as frequencies and percentages. Results: The study found that 83% of the participating dental surgeons experienced neck pain, attributable to faulty work postures. The age distribution of participants was primarily within the 20-25 age group (65.6%), and a significant majority were females (62.2%). Regarding pain intensity, 50% reported mild pain, 27.8% moderate pain, and 5.6% severe pain, with 16.7% reporting no pain. Conclusion: The high prevalence of cervical pain among dental surgeons underscores the critical need for ergonomic intervention and awareness in dental practice. Implementing ergonomic principles and promoting a better understanding of occupational health risks can potentially reduce the incidence of cervical pain and improve the overall well-being of dental professionals.

Assessing the predictive validity of Provincial Medical & Dental College Admission Test (MDCAT).

To assess the predictive validity of Punjab Provincial Medical & Dental College Admission Test (MDCAT). A retrospective correlational study was conducted at the Fatima Memorial Hospital College of Medicine & Dentistry in Lahore, Pakistan. Data were analysed from 415 medical students who had completed the MBBS program from 2018-2020. Bivariate and multivariable regression models were used to adjust for confounders such as age, gender, city of origin, and pre-medical performance. A novel performance-trajectory analysis was used to evaluate whether students with different preadmission MDCAT scores had different performance trajectories in medical school. On simple bivariate analysis, there was a weak but significant (correlational coefficient 0.22-0.33, p<0.001) correlation between MDCAT scores and professional exam scores for all years of medical college. However, multivariable analysis of Matric/Fsc track showed no significant correlation (p > 0.05) between MDCAT and professional exam scores after the first two years. For O/A level students, there was no correlation between MDCAT and professional exam scores for any year of medical college (p>0.05). Trajectory analysis showed that students with exceptionally high MDCAT scores had a superior performance trajectory compared to those with the lowest quartile of MDCAT scores while students with average MDCAT scores had overlapping performance trajectories. For students from the Matric/FSc track only, there is a weak but significant correlation between MDCAT scores and professional exam scores for the first two years. No such correlation exists for O/A level students. Exceptionally high MDCAT scores are predictive of higher achievement in professional exam scores.

Effects of 6cm versus 2cm Resection Margin from Pylorus on Excess Weight Loss &amp; Complication Rate for Laparo- Scopic Sleeve Gastrectomy: A Nine-Year Experience

Introduction: LSG is the gold standard sole bariatric procedure for morbid obesity. Small (2cm) and large (6cm) distance of resection margin from pylorus are both being used for neogastric sleeve formation however what is optimal distance remains controversial. Aims &amp; Objectives: To assess excess weight loss results and complication rate with 6cm and 2cm distance of staple line from pylorus during a prolonged surveillance period. Place and Duration of Study: This retrospective cohort study was conducted at Fatima Memorial Hospital from Dec 2013 to Dec 2022 spanning 9 years. Material &amp; Methods: Medical records of 50 morbidly obese patients aged 41- 50 yrs were segregated into two groups of 25 each based on the LSG procedure conducted. Group 1 had LSG with 6cm resection margin from pylorus while group 2 had a staple line distance of 2cm from pylorus for neogastric sleeve formation. The patients were subsequently followed up for excess weight loss (EXL) and BMI at 6 months, 1 year, 2 years, 3 years &amp; 4-year interval. Data was entered and analyzed using SPSS version 21.P value ? 0.05 was considered significant. Results: EWL in Group 1 &amp; 2 was 39.2± 6.77kg &amp; 41.9± 4.35kg at 6 months,73.64± 6.49kg &amp; 71.06± 7.77kg at 1 year, 65.52± 5.53kg &amp; 63.92± 7.07kg at 2 years,58.16± 4.97kg &amp; 57.28± 5.75kg at 3 years and 55.48± 3.39kg &amp; 55.36± 3.72kg for 4 years were, not significant statistically. BMI in group 1 &amp; 2 were 39.47± 5.11 &amp; 35.88± 4.40 at 6 months, 29.22± 2.68 &amp; 29.12± 2.00 at 1 year, 25.44± 1.96 &amp; 24.73± 2.86 at 2 years, 22.84± 1.79 &amp; 22.40±2.20 at 3 years and 21.66± 1.32, 21.67± 1.62 at 4 years were found to be statistically insignificant. Conclusion: With regards to extra weight loss, distance of resection margin from pylorus of 2cm or 6cm have identical effects but the latter has lowest complication incidence after 4 yrs of surveillance. Hence, a distance of 6cm is favoured to ensure safety of LSG for morbidly obese patients. And the findings of this study will help bariatric surgeons to improve technique of LSG in a safe and successful way for effective weight loss in morbidly obese patients.

Evaluation of Restless Leg Syndrome in Patients with Non-Dialysis Dependent Chronic Kidney Disease at Fatima Memorial Hospital Lahore: A Cross-sectional Study

Objective: To determine the occurrence of restless leg syndrome in individuals with non-dialysis-dependent chronic kidney disease.Study Design: A descriptive cross-sectional study.Place and Duration of Study: The study was carried out at the Outpatient Department (OPD) of Fatima Memorial Hospital, Lahore, Pakistan, from March 2020 to August 2020.Methods: A total of 280 CKD patients not dependent on dialysis were included in the study. The data were collected through interviews containing questions from international restless leg syndrome study group (IRLSSG). Patients were stratified into different stages according to the estimated glomerular filtration rate (eGFR). Restless leg syndrome was diagnosed by analyzing the responses of the interview marked by the examiner. Results: Among 280 patients, 15.7% (n=44) of chronic kidney disease patients were noted to have restless leg syndrome. The syndrome was significantly more frequent in females and was associated with higher CKD stages (Stage V &gt; Stage III and IV). There was no association with either age or BMI.Conclusion: Restless leg syndrome is more common in chronic kidney disease stage V as compared to lower chronic kidney disease stages (III &amp; IV). If untreated, it can affect patients' quality of life and increase the risk of cardiovascular activities.&#x0D; How to cite this: Basit MB, Sabir O, Shahid AH, Kanwal A, Qadri GA, Rizvi N. Evaluation of Restless Leg Syndrome in Patients with NonDialysis Dependent Chronic Kidney Disease at Fatima Memorial Hospital Lahore: A Cross-sectional study. Life and Science. 2024; 5(1): 95-100.doi: http://doi.org/10.37185/LnS.1.1.516

Barriers in Implementing Evidence-Based Practice among Nurses at Tertiary Care Hospitals of Lahore

Evidence-based practice is a technique used in solving clinical issues regarding patient care by integrating well-designed evidence. It also takes into account patient preferences to promote quality of care and improve patient outcomes. Objectives: To identify the barriers in implementing evidence-based practice among nurses and to identify personal and organizational obstacles in implementing EBP. Methods: A descriptive cross sectional quantitative study design was used. Total sample size was 116 staff nurses of the tertiary care hospital with experience more than three years. The study was conducted at two tertiary care hospitals of Lahore; Jinnah hospital, Lahore, Fatima Memorial hospital, Lahore. Results: The findings showed that biggest barrier in implementing EBP are lack of health care facilities to empower nurses with EBP environment (72.4%). Conclusions: This study concluded that financial situation of country which leads to inadequate health care resources and equipment’s for EBP implementation. Identifying the barriers that affect the implementation of EBP can become a stepping stone for the commencement of discussion concerning the elimination of these barriers from the healthcare sector and finding ways to resolve existing problems.

Characteristics and Frequency of Hyponatremia in Newborns

Background: Hyponatremia, defined as a serum sodium level below 135 meq/L, is a significant and often overlooked problem in neonatal intensive care unit. Local data on the severity and chronicity of hyponatremia in neonates is lacking. This study aimed to investigate the features, risk factors, and frequency of hyponatremia in infants admitted to our NICU. Objective: To determine the incidence, identifying potential risk factors, assessing its severity, as well as understanding the recovery period and the duration of hospital stay associated with hyponatremia in neonates. Study Design: Cross-sectional study. Settings: Study was conducted in Neonatal ICUs of Fatima Memorial Hospital, Lahore Pakistan. Duration: January to December 2022 (1 Year). Methods: Sample size was 300, calculated with 95% confidence interval, 10% margin of error and 5% level of significance. It was done by using formula; n=Zs (p)(1-p)/d2 by using consecutive, non-probability sampling technique. After IRB approval all neonates meeting the inclusion criteria were included in the study after seeking informed consent from parents and relevant data was collected on the predesigned proforma. Results: Among 300 neonates included in final study 42% had mild hyponatremia and 58% had moderate-severe hyponatremia. Risk of severe hyponatremia were GA 28-32+6 weeks, IUGR and APGAR-5&lt;7. PIH increased the risk of chronic hyponatremia. Conclusion: In our study population 58% neonates had moderate to severe hyponatremia. Among 73.1% neonates born at GA 28-32+6 had moderate to severe hyponatremia. APGAR-5 of &lt;7 and IUGR increases the risk of moderate-severe hyponatremia by 42374 and 200 times respectively. Whereas maternal PIH is associated with increased risk of chronic hyponatremia.

The prevalence of dental agenesis among children with cleft lip and palate patients in Lahore, Pakistan.

This retrospective, cross-sectional analytical study investigated the incidence of tooth agenesis in cleft lip and palate (CLP) patients. Cone Beam Computed Tomography (CBCT) radiographs of the CLP children were examined for congenitally missing teeth. This study was conducted at three radiology centers in Lahore, namely, the Pakistan Jinnah MRI and Body Scan Centre, the University of Lahore Radiology Centres, and Fatima Memorial Hospital, from September 2021 to August 2022. The CLP patients were divided into four groups based on the location of the cleft: Cleft Lip and Palate Right (CLPR), Cleft Lip and Palate Left (CLPL), Bilateral Cleft (CLPB), and Midline Cleft (CLPM), inside and outside the cleft region. Two-way ANOVA was employed to compare the means of agenesis. Tukey's test was utilized to ascertain where the difference lies. The significance level was set at p ≤ 0.05. Moreover, a significant number of missing teeth were found inside the cleft. This study observed the CLPL (42.3%) and CLPR (13.6%) types more in number. Maxillary first premolars were found more missing outside the cleft region in CLPL and CLPB types. Although CLPB and CLPM types revealed a pattern of missing teeth, only a few cases were found in this study. Moreover, mean tooth agenesis was highest (4.5 SD.71) in the CLPM group, followed up by CLPB (2.75 SD 2.49), CLPR (1.23 SD 1.27), and CLPL Group (1.15 SD 1.12). Unilateral cleft lip and palate patients reported significant agenesis patttern compared to bilateral and median cleft cases.

PERSISTENT SYMPTOMS IN PATIENTS AFTER ACUTE COVID-19 INFECTION": A SINGLE CENTER EXPERIENCE: ARE WE DOING ENOUGH FOR THIS?

This study aimed to determine the frequency of persistent COVID-19 symptoms after recovery from the infection. The study design was cross-sectional and conducted at the Department of Medicine, Fatima Memorial Hospital, Lahore. A non-probability consecutive sampling technique was employed, and the study duration was six months (from 28th June 2021 to 27th December 2021) after approval from the ethical committee. The sample size was 400. The study found that symptoms persisted for varying durations of less than one week, one to two weeks, two to four weeks, and more than four weeks. The most common persistent symptoms were lethargy (70.6%), body aches (55%), and cough (50%). The symptoms that persisted for more than four weeks were hair fall (71%), loss of smell and taste (53%), and body aches (43%). The mean duration of illness was two to four weeks from the start of the disease. The study concluded that COVID-19 infection was associated with residual symptoms that could persist for more than four weeks and affect patients' quality of life, interfering with daily life activities.

TO ASSESS THE INCIDENCE AND SEVERITY OF COVID 19 INFECTION IN PATIENTS ALREADY ON HEPATITIS C TREATMENT

The COVID-19 pandemic has caused a significant impact worldwide, affecting almost every continent and every nation and causing economic challenges. Even patients who were undergoing antiviral therapy for chronic hepatitis were not spared from the deadly virus. The objective of this observational cross-sectional study was to evaluate the incidence of COVID-19 in patients already undergoing HCV treatment and to assess the severity and recovery of the disease in these patients. The study was conducted in the Department of Medicine and Gastroenterology at Fatima Memorial Hospital in Lahore and was approved by the ethical committee. The study lasted six months, and the sampling technique used was continuous non-probability sampling. The sample size was 100. The results showed that Sofosbuvir and Velpatasvir were prescribed to 91.4% of subjects, while 8.6% were taking triple therapy, including Ribavirin, Sofosbuvir, and Velpatasvir. The antiviral therapy (AVT) course lasted for three months for 95% of participants, while 5% took AVT for six months. Only 7.4% of the participants underwent COVID-19 testing; of those, 3.7% had positive results. 14.8% of participants had received the COVID-19 vaccine, and 4.9% had been in contact with someone who had tested positive for COVID-19. During the AVT period, 11.1% of participants had a history of fever, 80% had symptoms lasting for less than one week, and 20% had symptoms. These findings suggest that antiviral treatment may have a protective and preventive role in COVID-19 infection. However, further studies with a larger population will be required to strengthen these observations.

Characteristics of Newborn with Persistent Pulmonary Hypertension (PPHN) Admitted In Neonatal Intensive Care Unit in a Tertiary Care Hospital

Objectives: To find the frequency, aetiologies, treatment options and outcomes in neonates with persistent pulmonary hypertension of the new-born and to identify risk factors associated with severe pulmonary hypertension. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore Pakistan, from Apr to Oct2020. Methodology: All neonates admitted to the Neonatal Unit with signs and symptoms suggestive of PPHN and confirmed on echocardiography were included in the study. Multiple maternal and neonatal risk factors leading to PPHN were identified. Results: A total of 70 neonates with persistent pulmonary hypertension were identified. The all-cause mortality rate was 18.6% (13 of 70). Pneumonia was the primary cause of pulmonary hypertension (64.3%). Pneumonia was the primary cause of pulmonary hypertension (64.3%). Out of 72, 46(65.7%) were male and 24(34.3%) were female. The mean gestational age was 35.38±3.39 weeks. On binary logistic regression analysis, severe pulmonary hypertension showed a significant association with maternal septic risk factors (OR 0.26, p=0.03, emergency section (OR 3.69, p=0.05). Conclusions: The persistent pulmonary hypertension of newborns in the current study was higher than in Western countries. Pneumonia and sepsis are the primary aetiologies of developing PPHN. Maternal septic risk factors and emergency section are associated with an increased risk of severe pulmonary hypertension.

HELP SEEKING ATTITUDES FOR MENTAL ILLNESSES AMONG UNDER-GRADUATE MEDICAL STUDENTS IN LAHORE

Objective: The reluctance of medical students to seek help for stress is attributed to a lot of factors involving stigma, their help-seeking attitudes and psychological openness. The objective of this study is to gauge help seeking attitudes for stress and mental health issues among Pakistani medical students. Design: Two questionnaires were used to form a self-administered questionnaire, including Hopkins Symptom Checklist (SCL-5) and Inventory of Attitudes towards Seeking Mental Health Services (IASMHS). Place &amp; duration of study: Students from King Edward Medical University, Lahore and Fatima Memorial Hospital were administered the questionnaire in physical form as well as an online version. Responses were gathered over a time of 3 months. Methods: We conducted a cross-sectional survey in two selected medical colleges in Lahore in 2022. After IRB approval and informed consent, a self-administered questionnaire which included Hopkins Symptom Checklist (SCL-5) and Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) was utilized for data collection. Analysis was conducted with SPSS 26. Results: Six hundred and forty-one undergraduate medical students participated in the study with majority being female (64.2%) and hostellers (59%). SCL- 5 scores of the participants (mean=13.36, S. D=4.95) showed moderate levels of distress among students. Participants’ mean Attitude Score on IASMHS was 53.66 (S. D=10.72). Attitudes towards help seeking were fairly negative especially with regard to feeling indifferent towards stigma (mean=18.95, S.D=5.69). Student’s attitudes reflected some psychological openness (mean=14.48, S.D=5.35), while propensity to seek help was slightly better (mean=20.23, S.D = 4.75). Females and clinical year students showed more positive attitudes towards help seeking as compared to males and students belonging to pre-clinical years (P&lt;0.05). Conclusion: The study showed that stress among under-graduate medical students remains a significant issue. While female students and clinical years’ students portrayed better help seeking attitudes towards mental illnesses and stress, further studies including interventions to address mental illness stigma are required to improve the trend.