Headquarter Hospital Research Articles

Epidemiology of malaria and hematological analysis in district Dir (lower), Pakistan

Background: Malaria is considered as a tropical disease, in developing countries. Among all parasitic infections malaria is most widespread and devastating disease. According to WHO malaria is endemic in 24 countries. Methods: This cross-sectional study was conducted at Department of Medical Laboratory Technology University of Haripur. Total 995 samples were collected at District Head Quarter Hospital (DHQ), Tehsils Hospitals (THQs), and other private laboratories in District Dir (Lower). These samples were processed to observe the shape of RBCs as well as plasmodium species in the smear microscopically, and for hemoglobin estimation. Data was analyzed through SPSS version-21. Results: Highest percentage of malaria was recorded in Munda (35.17%) followed by Timergara (19.59%) whereas the lowest number of cases were found in Khall (5.02%). Prevalence of P. vivax was (98.0 %) and P. falciparum was (2 %) in district Dir Lower. Mean red blood cell count (RBCs) was 4.2±0.64 mm3 while mean Hb was 11.0±1.99g/dl. Based on different age categories, the highest RBCs and Hb levels were found in age group 41-50 years, whereas the lowest RBCs were found in age group 11-20 years while the lowest Hb levels were recorded in group 1-10 years. In associated diseases, the upper respiratory tract infections (URTIs) were the most frequent (20%) followed by diarrhea (18%). Mean Hb of males was 11.8±1.53 g/dl while the mean Hb of female was 11.5±5.384 g/dl. Hb in both males and females were low as compared to the standard. However, as compared to females, Hb of males were significantly lower with p-value <0.001. Conclusion: We concluded that males are more commonly infected from malaria as compared to females. Males and children were found to have low Hb as compared to females and higher age group patients. URTIs and diarrhea were the most common associated illness.

Comparison study of genexpert MTB / RIF assay versus sputum smear microscopy results in presumptive tuberculosis cases in district Ghotki, Sindh.

Objective: To evaluate the performance of GeneXpert MTB/RIF assay by comparing its results with sputum smear microscopy. Study Design: Comparative Cross-Sectional Study. Setting: Department of Outpatient (OPD), Taluka and District Head Quarter Hospitals of District Ghotki Sindh. Period: October 2022 to 2023. Methods: In this study 350 Participants were included and all sputum specimens were tested for both above mentioned diagnostic tools that are sputum smear microscopy and GeneXpert MTB/RIF assay during the period October 2022 to April 2023. All details regarding the study such as Demographic details, sputum smear microscopy results, and GeneXpert MTB/RIF assay test results of patients were collected. A case of pulmonary tuberculosis (PTB) was considered to be a patient having mycobacterium tuberculosis detected in sputum by GeneXpert MTB/RIF assay. Results: In this study, 61 cases (17.4%) out of 350 participants, were detected in GeneXpert MTB/ RIF assay and 35 cases (10%) out of 350 participants were positive in sputum smear microscopy. Male ratio is slightly higher than female among GeneXpert positive cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy sputum smear microscopy were 57%, 100%, 100%, 91.7%, and 92.5%, respectively, when GeneXpert test is taken as reference test. Conclusion: Sputum smear microscopy is as specific as GeneXpert but less sensitive test for the diagnosis of pulmonary tuberculosis than GeneXpert MTB/RIF assay.

ISOLATION, CHARACTERIZATION AND ANTIBIOTIC SUSCEPTIBILITY OF KLEBSIELLA SPECIES IN URINE SAMPLES OF UTI PATIENTS VISITING DHQ HOSPITAL D.I. KHAN

Background A gram-negative rod-shaped pathogenic bacterium-Klebsiella, repeatedly causing Urinary Tract Infection. Objectives: Isolation, Characterization and antibiotic susceptibility of Klebsiella species in urine samples of UTI patients. Methodology: For thispurpose, a total of 105 samples were randomly collected from the patients with urinary tract complications visiting District Head Quarter Hospital D.I. Khan, Pakistan. Results: Urine samples with pus cells were inoculated on Cystine-lactose-electrolyte-deficient(CLED) agar and it was revealed that only 12 out of 105 samples were Klebsiella positive on the basis of cultural characteristics.Further confirmation was done using biochemical characterization through Analytical Profile Index (API 10) and out of 12 all the isolates were Klebsiella pneumoniae. Disc diffusion method was used to test the antibacterial susceptibility on Muller Hinton Agar.Klebsiella isolates showed 100% resistance to Cefepime, Cotrimoxazole and Ceftriaxone, 91% to Ampicillin, Doxycyclineand Cefazoline and 83% to Piperacillin/Tazobactam, Imipenem, Ciprofloxacin and Gentamycin. Only two antibiotics Fosfomycinand Nitrofurantoin were two antibioticsKlebsiella isolates showing sensitivity. Conclusion: It is assumed that excessive use ofantibiotics without proper diagnosis is among one of the main reasons responsible for antibiotic resistance.

Dextromethorphan Role on Cough Suppression and Patient Procedure Tolerance in Flexible Bronchoscopy

Objective: To determine the role of Dextromethorphan on cough suppression and patient procedure tolerance in flexible bronchoscopy. Study Design: Quasi-experimental study. Place and Duration of Study: Pulmonology Department, District Head Quarters Hospital, Faisalabad Pakistan, from Oct 2019 to Mar 2020. Methodology: Patients were divided into Group-1 and Group-2. Group-1 was given syrup Dextromethorphan 20miligram one hour before bronchoscopy and Group- 2 was given a placebo one hour before procedure. During procedure, oxygen saturation and blood pressure were recorded continuously by monitor. 10cm Visual analogue scale was used to chart their cough perception where 0 taken as no cough and 10 as incessant cough. Patients recorded their tolerability of procedure after 2 hours on 10cm visual analogue scale. Results: Mean age of whole study population, Group-A and Group-B was 48.80+11.24, 46.63+11.70 and 47.72+11.43 respectively. Females were 25(41.7%) and males were 35(58.3%). Both groups have same mean SpO2 with supplemental oxygen. Four patients had an oxygen saturation below 90% during flexible bronchoscopy in both groups (p-value 0.647). Similar doses of Midazolam were used in the Dextromethorphan and placebo groups (p-value 0.879). The perception of cough by the patient, assistant staff and bronchoscopist in Dextromethorphan group 1 was significantly low (p-value 0.041, 0.0001, 0.037 respectively). Duration of procedure was also significantly lower in Dextromethorphan group p-value 0.0001. Conclusion: Dextromethorphan use in addition to Midazolam and local anesthetic during flexible bronchoscopy results in

Perinatal Potential Hazards of Hepatitis; a Tertiary Care Study

Objective: To explore the frequency of HEV infection in pregnancy, associated risk factors and its prenatal and maternal consequences. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Gynaecology Obstetrics, Divisional Head Quarter Hospital, Multan, Pakistan from Nov 2021 to Jun 2023. Methodology: The research comprised 100 patients, 50 pregnant patients who met the criteria for eligibility. For seroprevalence, anti-HEV antibodies (IgG) were detected. Hepatic profile, CBC, coagulation markers, and standard workup/protocol were also assessed for prenatal fetomaternal hemorrhage. Results: Data was gathered using pre-designed questionnaires. Of the 50 patients, 31 (62%), were HEV positive with mean age 26.90±4.16 year. Serum bilirubin levels >1.5 mg/dL in 47 patients (94.00%) with SD1.68±0.28, AST (SD85.87±51.878), ALT (SD149.42±71.90) in 38 (76.00%), low platelet count in 24 cases. There were 6 cases (9.35%) IUD, 3 (8.75%) fetal distress and 4 (12.09%) maternal distress, preterm deliveries 4 (12.09%) and 3(2.5%) neonatal deaths. Mortality rate was (38.7%) 12 cases, due to hepatic comma and intravascular coagulation and Fulminant hepatic failure. Conclusion: Hepatitis E (HEV) infection during gestation may result in serious consequences such as elevated hepatic profiles, acute anemia, low platelet count, IUD, premature delivery, and postpartum issues, which are primarily caused by inadequate sanitation and a contaminated water source. Maternal fatalities and fetal consequences are exacerbated by HEV infection.

Knowledge, Aptitude, and Practice Study Regarding Modifiable Factors Among Females Diagnosed With PCOS

Background: Polycystic Ovarian Syndrome (PCOS) is a lifelong endocrine disorder affecting reproductive, metabolic, and psychological health. Despite its prevalence, especially in South Asian populations, awareness of lifestyle modifications for managing PCOS remains inadequate.Objective: To assess the knowledge, attitudes, and practices regarding modifiable factors such as exercise among women diagnosed with PCOS in Pakistan.Methods: A cross-sectional study was conducted over four months at the Divisional Head Quarter Hospital in Gujranwala, Pakistan, involving 255 women aged 18-45 years diagnosed with PCOS. Data were collected using a self-designed Knowledge, Attitude, and Practice (KAP) questionnaire and analyzed with SPSS version 25. Descriptive statistics and Pearson’s correlation were used for analysis.Results: The mean knowledge, attitude, and practice scores were 18.16 (SD = 3.56), 8.45 (SD = 2.66), and 6.57 (SD = 1.74), respectively. 44.31% of participants had poor practice habits, and only 2.7% had been referred to physiotherapists. Emotional distress was common, with 35.3% reporting anxiety.Conclusion: Despite moderate knowledge and favorable attitudes, the adoption of lifestyle modifications for PCOS management is low. A multidisciplinary approach integrating physiotherapy and psychological support is needed to improve health outcomes for women with PCOS.

Sonographic Evaluation of Cholelithiasis in Diabetic Patients at District Swabi

Background: Cholelithiasis, the formation of gallstones in the gallbladder, is prevalent among individuals experiencing abdominal discomfort such as epigastric pain, nausea, and loss of appetite. The relationship between diabetes and the increased risk of developing gallstones has been noted, highlighting the importance of understanding this association for better disease management. Objective: The aim of this study was to evaluate the prevalence and characteristics of gallstones in diabetic patients in the district of Swabi using ultrasonography to enhance early diagnosis and treatment approaches. Methods: This cross-sectional study was conducted at the Department of Radiology, District Head Quarters Hospital, Swabi, Pakistan. Participants included individuals presenting with upper right quadrant pain or with a history of diabetes. Ultrasonographic examinations were performed using a Toshiba Xeiro convex probe with a frequency range of 3-5 MHz. Data was collected through clinical histories and radiographic examinations, and analyzed using SPSS version 25. Ethics approval was obtained in accordance with the Declaration of Helsinki, and all participants provided informed consent. Results: A total of 112 patients were enrolled with ages ranging from 8 to 80 years (mean ± SD = 39.37 ± 16.72 years). Females constituted 56.4% (n=62) and males 43.6% (n=48) of the study population. The majority, 88.2% (n=97), reported right hypochondriac pain. Among the patients, 60% (n=66) had multiple gallstones; of these, 36.4% (n=24) were diabetic. Conversely, 40% (n=44) had a single stone, with 38.6% (n=17) being diabetic. Conclusion: The study indicates a significant association between diabetes and the presence of multiple gallstones, underscoring the need for routine ultrasonographic screening in diabetic patients experiencing right hypochondriac pain. Early detection could lead to better management and potentially reduce complications associated with cholelithiasis.

Enhancing WHO prescription writing guideline adherence through an educational intervention: a quality improvement study of Azad Jammu and Kashmir.

Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices. A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. The authors recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages. An improvement in compliance was observed during the second audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). The authors also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the second audit cycle. This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in a better quality of care for patients.

Molecular Investigation of Cutaneous Leishmaniasis (CL) from Biopsy Samples: A Case Study of District Mohmand, KPK

Background: Leishmaniasis is a complex disease with diverse clinical manifestations and remains a significant public health concern, particularly in tropical and subtropical regions around the world. Cutaneous leishmaniasis (CL), being the most prevalent type, causes significant morbidity and social stigmatization. District Mohmand, an arid mountainous region in the KPK province of Pakistan, has an increased burden of CL with no prior molecular study reported on it in this region of Pakistan. Methods: The current study investigated CL using molecular techniques to detect and evaluate the risk factors associated with this disease in the affected population of District Mohmand. The study was conducted at Tehsil Head Quarter Hospital Mamad Gat, District Mohmand. Results: Out of 150 samples, 106 were found to be positive and 44 turned out to be negative under microscopy, while 122 were positive and 28 were negative using PCR analysis. Statistical analysis revealed that children between the ages of 1 and 10 years are frequently affected. Similarly, male gender is affected to a greater degree as compared to the female gender. Furthermore, the proportion of facial lesions was 62%, followed by upper limbs (17%), lower limbs (17%), and lesions on multiple sites (4%). These numbers are associated with various factors, such as the presence of domestic animals, lack of bed net usage, migration, and the type of wall and roof. Conclusion: The study concluded that children are more prone to infection. The PCR method was found to be more reliable for diagnosing CL as compared to microscopy.

Evaluation of Practices about Pediatrics Cardiac Catheterization among Nurses at District Head Quarter Hospital

Pediatric cardiac catheterization is a critical procedure that plays a vital role in diagnosing and treating congenital heart defects and other cardiac conditions in children. This procedure involves inserting a catheter into the heart chambers or vessels through a vein or artery. Nurses play multifaceted roles throughout the continuum of cardiac catheterization. Objective: To evaluate the practices of nurses about pediatrics cardiac catheterization. Methods: This study employed cross-sectional descriptive design at pediatric department of a District Head Quarter (DHQ) Hospital. Target population was registered nurses of age above 20 years and who had at least 6 months of practical experience with cardiac pediatric patients. Data were collected conveniently through observational checklist and analysis was done through SPSS Version 24.0. Results: Majority nurses were not encouraging bed rest to the pediatric patients nor keep affected extremity bend for 2-4 hours (80%) after catheterization. Moreover, they did not regularly check the vitals of the children and unable to monitor in every 15 minutes /hour or 30 minutes for next hour (81%). Nurses were unable to educate the pediatric parents for the removal of pressure dressing and nor assess the dressing site appropriately (92%). Conclusions: The present study findings suggested that majority nurses have poor practices before and after cardiac catheterization procedure while some have an average level of practices during the procedure. So, training programs should be arranged to enhance the practices of nurses about cardiac catheterization in pediatric population.

Characteristics of Tinnitus and its Association with Clinico-Demograhic Factors & Mental Health

Objectives: To determine the characteristics of tinnitus and its association with clinical and demographic variables including psychological health. Methodology: This cross-sectional study recruited 80 tinnitus cases from ENT outpatients of District Head Quarter Hospital Chakwal from over a period of 6 months from 1st Jan 2019 to 31st June, 2019, using convenience sampling. Sample included both genders, aged 18-75 years with tinnitus for at least three months. Tinnitus Handicap Inventory (THI) & Depression Anxiety and Stress Scale 21 (DASS-21) were used for data collection & analysis done using SPSS-version 20. Anova statistics & Pearsons correlation was determined for THI and DASS-21. Chi-square test was used to see any association with clinic-demographic variables. P<0.05 was considered significant. Results: Study revealed 30(37.5%) cases with mild, 20(25%) each with moderate and severe while least 4(5%) catastrophic tinnitus. Tinnitus severity was significant associated with gender (p=0.005), age (p=0.035), educational level (p=0.049), occupation (p=0.002), duration of tinnitus (p=0.038), site of tinnitus (P<0.001) and type of tinnitus sound (P=0.003). Duration of tinnitus was associated with anxiety (p=0.024), site of tinnitus was associated with THI (p=0.016), anxiety (p=0.021), stress (p<0.001) and depression (p=0.02) and total DASS-21 (p=0.005). A significant positive correlation was present between tinnitus handicap, Anxiety, stress, depression and DASS-21 total score (P<0.001). Conclusion: Mild tinnitus was most prevalent (37.5%) with Tinnitus severity having significant association with gender, age, educational level, occupation, duration of tinnitus, site of tinnitus, and type of tinnitus sound. Duration of tinnitus was also associated with anxiety while site of tinnitus has association with THI, anxiety, stress, depression and total DASS-21. Significant positive correlation is present between THI and Anxiety, stress, depression and DASS-21 total score.

Evaluation of Hemodialysis Complications among Children with Chronic Kidney Disease at District Head Quarter Hospital, Nankana Sahib

A patient with chronic kidney disease depends on hemodialysis to mechanically remove fluid, electrolytes, and waste products from the blood. Chronic kidney disease (CKD) is a universal matter of concern that affects around 15% of the population globally. Objective: To evaluate hemodialysis complications among children with chronic kidney disease. Methods: A cross-sectional descriptive study was carried out at the renal department of DHQ hospital. The duration of study was six months from April to September, 2023. The sample size was 45 children on hemodialysis with kidney disease. A purposive sampling technique was used. Data were gathered through self-administrated questionnaire. Data were analyzed through SPSS-25.0 and results were presented in the form of frequencies tables. Results: Majority of the participants suggested that initiation of hemodialysis lead to cardiovascular problems (72%), anemia (83%), and metallic taste (79%) in children. Moreover, majority of them complained about skin problem and itching as an adverse effect (78%). Other complications as indicated by participants are headache, restlessness, vertigo, nausea and vomiting (86%). Conversely, some subjects did not considered the hypertriglyceridemia (27%), gastric problems (31%), sleep problems (24%) and muscular pain (34%) as the result of initiation of hemodialysis procedure. Conclusions: Findings of present study suggested the most common complications of hemodialysis are hemodynamic instability, anemia and hypertension/hypotension, skin problems and itching. Other complications of hemodialysis as indicated by participants are headache, restlessness, vertigo, nausea, vomiting and decease concentration in children. However, most of the participants have limited understanding about additional complications of hemodialysis.

Role of Forensic Osteolgy in positive identification for Forensic investigations to solve medicolgal cases in Punjab, Pakistan

Background: Positive identification of human skeletal remains is prime importance to solve the medicolegal cases in unidentified dead bodies. In case of mass disasters, genocide, mass graves, manslaughter and other medicolegal cases, the skeletal data provides enough information to solve the question of identification of the deceased human beings to provide justice even many years after their death. Aim: To see evidentiary value of skeletal data to determine the positive identification by using race ,age sex, stature and other parameters of identification in medicolagal cases of human skeletal remains in medicolegal forensic investigations in Punjab from 2015 to 2022. Study design: In this retrospective study 100 medico-legal cases where positive identification was done from skeletal remains in different medico-legal work performing Forensic departments of Punjab, were analyzed. Methods: In this retrospective study 100 medico-legal cases where positive identification was done from skeletal remains. This skeletal data was collected from different medico-legal cases where the identification was done on bones from five district of Punjab. This data was collected from the District Head Quarter hospitals of these cities from their medico-legal offices to conduct this research study. All the information collected were interred in predesigned Performa before analyzing the data. Descriptive statistics was implied on all the medico-legal cases for data collections and analysis of skeletal data from different bones recovered from the crime-scenes in this research study. Furthermore, standard deviation, F-statistics, and Chi test p-value were also applied to see the association of these parameters of identification with different skeletal remains with highest probability of positive identification from different bones.

Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan.

Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.

Impact of Short Birth Spacing on Maternal Anemia at District Head Quarters Hospital Nankana Sahib

Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Maternal anemia is one of the commonest complications of short birth spacing that further can enhance the risk of poor fetal and maternal outcome. Objective: To determine the effect of short birth spacing on maternal anemia at District Headquarters Hospital Nankana Sahib. Methods: This analytical cross-sectional study was done at Gynecology and obstetrics Department of District Headquarters Hospital Nankana sahib. A total of 135 pregnant women of 18 to 40 years’ age, 18 to 59 months of inter-pregnancy intervals were included. All the demographic and clinical data was collected according to predesigned questionnaire. Results: In this study all females were anemic, whereas there were 57(42.22%) females had mild anemia, 61(45.19%) females had moderate and 17(12.59%) females had severe anemia. There was association between severity of Hb levels with higher age group, lower socioeconomic status, previous history of vaginal + C-section and females with third trimester. Moreover, there was significantly negative correlation between Hb levels and higher gravida, p-value ≤ 0.05. Conclusions: Itis concluded from the results of our study that all mothers had different degrees of anemia. There was a statistically significant association between severity of Hb levels with higher age group, lower socioeconomic status, previous history of vaginal + C-section and females with third trimester (p < 0.05). While, no significant association and a negative correlation was found between Hb levels and multigravida (r = - 0.181 & p = 0.035).

Effect of left tilt of operating table during elective caesarean section on maternal haemodynamics and vasopressor requirement.

Objective: To compare the effects of left tilt of operating table on maternal hemodynamics and vasopressor requirement in contrast to supine position during caesarean section. Study Design: Comparative Analytical Study. Setting: District Head Quarter Hospital, Rawalpindi. Period: December 2021 to February 2022. Material & Methods: A total of 38 participants were included by the lottery method of randomization into the two groups according to the inclusion and exclusion criteria: supine group and left tilt group. For Supine Group, spinal anesthesia was administered in the sitting position, and then supine position was maintained. For Left tilt group, spinal anesthesia was administered in the sitting position and was then maintained in the supine position until the full anesthetic effect was achieved, and the table was tilted 15 °to the left. The Systolic and the diastolic blood pressures were noted at regular intervals. Data were entered and analyzed using SPSS version 25. Results: The results showed that systolic blood pressure decreased significantly in the supine group (F= 16.65, p< 0.000) compared to the left-tilted group (F= 2.1, p= 0.12). Intraoperative phenylephrine was required by four out of 20 participants in the supine group after 10 and 15 minutes, of out 2/20 participants after 20 minutes and out of 6/18 participants after 30 minutes. None of the participants in the left-tilt group required intraoperative phenylephrine. Conclusion: The left tilted position of the operating table is better than the supine position in terms of maternal hemodynamics and vasopressor requirement during Caesarean section.

Fistulotomy versus fistulotomy with marsupialization, a randomized controlled trial.

Objective: To compare the efficacy of fistulotomy and fistulotomy with marsupialization in the management of simple anal fistula. Study Design: Randomized Controlled study. Setting: Department of Surgery, District Head Quarter Hospital, Mardan, Pakistan. Period: 1st September 2021 to 31st August 2022. Material & Methods: A total of 60 Patients coming to hospital with simple anal fistula were randomized into two equal groups. In group A, 30 patients were treated with fistulotomy, while in group B, 30 patients were treated with fistulotomy with marsupialization. The primary outcome was set as time required for complete wound healing. Secondary outcomes were operation time, postoperative pain, anal incontinence, incidence of recurrence and patient satisfaction. Results: The mean wound healing time after 6 weeks was shorter in group B in comparison to group A (4.7± 0.74 versus 6.4± 0.85 weeks; p=0.0001). There was no significant difference in mean operation time between Group B and Group A. The difference in mean pain score was also not statistically significant. There was no significant difference in the incidence of anal incontinence, incidence of recurrence and patient’s satisfaction among two groups. Conclusion: Fistulotomy with marsupialization is more effective procedure than fistulectomy alone in shape of early wound healing without increase in operation time and therefore can be taken as surgical procedure of choice for the simple anal fistula.

High consumption of pesticides in agricultural fields leads to prevalence of cancer cases in rural pockets of eastern India: A case study

AbstractThis study was performed to evaluate the carcinogenic health risk of pesticides used in agricultural field in rural pockets of eastern India. The analysis of pesticide residue in rice grain sample was performed by Gas Chromatography Mass Spectrometry (GC‐MS). It was observed that for pesticide DDT, the HR values was ranging between 0.5 to 3.2 and for lindane HR was 0.4 to 1.1, respectively. The DDT and Lindane exhibited HR values >1 in some sampling sites which revealed the carcinogenic effects and HR <1 in some sampling sites which revealed non carcinogenic effects of same pesticide. These results revealed a clear indication of potential carcinogenic health risk to human health through consumption of contaminated rice in some areas of Bargarh district. DDT has a long half‐life, so it persists in the environment for a longer period of time and induces carcinogenic risk to human health predominantly than other pesticide lindane. A case study on cancer prevalence in Bargarh district was also carried out to support the findings of quantitative analysis. The primary data collected from the cancer affected area by personal questionnaires method to the person concern and the secondary data collected from the Bargarh District Head Quarters Hospital's register. The cancer death reported by the from the year 2015 to 2021 was 320, 380, 293, 323, 278, 409, 346 in the year of 2015, 2016, 2017, 2018, 2019, 2020, 2021 respectively, with the total number of 2349 cases. From the questionnaire data, it was observed that the occurrence of male and female cancer cases was 51.75% and 48.25%, respectively. Therefore, it was concluded that there was no significant difference in gender wise cancer prevalence. The most affected age group was 51–60, that is, 26.92% followed by 41–50, that is, 23.42%. Therefore, it was concluded that the middle‐aged adults (40–60) were more vulnerable to the cancer than young adults (3–40) and old adults (60–100). The most prevalent cancer was breast (22.72%) followed by stomach (14.33%).

Assessment of Knowledge on Noncommunicable Diseases among the Adult Patients who are Attending the Noncommunicable Diseases Outpatient Department in Government Head Quarters Hospital at Cuddalore

Assessment of Knowledge on Noncommunicable Diseases among the Adult Patients who are Attending the Noncommunicable Diseases Outpatient Department in Government Head Quarters Hospital at Cuddalore

Investigating the Effects of Retro Walking on Pain, Physical Function, and Flexibility in Chronic Non-specific Low Back Pain

Objectives: Chronic non-specific low back pain (CNSLBP) is described as pain whose pathoanatomical cause cannot be determined. The current study aims to evaluate the impact of retro-walking on pain, flexibility, and physical functions in patients with CNSLBP. Methods: A randomized controlled trial was conducted in the Physical Therapy Department of District Head Quarter Hospital Nankana Sahib, Punjab, Pakistan from September 2021 to March 2022. The trial was conducted on 36 patients, randomly divided into 2 groups of 18 patients. Conventional treatment and retro-walking were given to the experimental group and the conventional treatment alone was provided to the control group for 1 month with 3 sessions per week. The outcome variables were pain, the flexibility of hamstrings and lumbar region, and physical function assessed by numeric pain rating scale, sit and reach test, modified Schober test, and modified Oswestry disability index, respectively. The data were assessed at pre-treatment after the sixth and twelfth sessions. Results: This study showed a significant difference in the numeric pain rating scale, sit-and-reach test, and modified Oswestry disability index with a P<0.05 in both groups after intervention. However, in the group comparison, these variables showed better results in the retro-walking group compared to others with a P<0.001 after both the sixth and twelfth sessions. Discussion: The current study suggested that when added up to conventional treatment, retro-walking was more beneficial in reducing pain and enhancing the flexibility and physical function in patients with CNSLBP when compared to conventional treatment alone; therefore, it should be added to the treatment protocol for chronic non-specific pain in the lower back.