Holy Family Research Articles

Electrolyte Imbalance Among Bangladeshi Patients With COVID-19.

Introduction Infection with SARS-CoV-2 begins in the lower respiratory tract, but COVID-19 often involves the renal system, resulting in serum electrolyte imbalance. Monitoring serum electrolyte levels and parameters of liver and kidney function is essential to understand disease prognosis. Objectives This study aimed to determine the effect of imbalances in serum electrolytes and other parameters on COVID-19 severity. Material and method This retrospective study comprised 241 patients, ages 14 years and older, including 186 patients who were moderately affected and 55 who were categorized as severely affected by COVID-19. Serum electrolytes (sodium (Na+), potassium (K+), and chloride (Cl-)) and biomarkers of kidney and liver function (creatinine and alanine aminotransferase (ALT)) were measured and correlated with disease severity. This research was conducted among admitted patients of Holy Family Red Crescent Medical College Hospital designated into two groups based on retrospective hospital records. Individuals with moderate illness had evidence of lower respiratory tract infection (cough, cold, breathless, etc.) during clinical assessment or imaging (chest X-ray and computed tomography (CT) scan of the lungs) and have an oxygen saturation by pulse oximetry (SpO2) ≥ 94% on room air at sea level. The severely ill group involved individuals with SpO2 ≤94% on room air at sea level and respiratory rate ≥ 30 breaths/minute, and critically ill patients are those who needed mechanical ventilation or required intensive care unit (ICU) care. This categorization was based on the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/). Results Average Na+and creatinine increased by 2.30 parts (95% confidence interval (CI) = 0.20, 4.81, P = 0.041) and 0.35 units (95% CI = 0.03, 0.68, P = 0.043) in severe cases compared with moderate cases. Older participants had relatively Na+lowered to -0.06 parts (95% CI = -0.12, -0.001, P = 0.045), significant Cl- reduction by 0.09 units (95% CI = -0.14, -0.04, P = 0.001), and ALT by 0.47 units (95% CI = -0.88, -0.06, P = 0.024), whereas serum creatinine was increased by 0.01 parts (95% CI = 0.001, 0.02, P = 0.024). The creatinine and ALT of COVID-19 participants were significantly higher in males by 0.34 units and 23.2 units, respectively,compared with females. In severe COVID-19 cases compared with moderate cases, the risks of hypernatremia, elevated chloride levels, and elevated serum creatinine levels were increased by 2.83-fold (95% CI = 1.26, 6.36, P = 0.012), 5.37-fold (95% CI = 1.90, 15.3, P = 0.002), and 2.00-fold (95% CI = 1.08, 4.31, P = 0.039), respectively. Conclusion Serum electrolyte and biomarker levels can serve as good indicators of the condition and disease prognosis of patients with COVID-19. Our purpose in this study was to determine the association between serum electrolyte imbalance and disease severity. We collected data from ex post facto hospital records and did not intend to assess the mortality rate. Consequently, this study expects that the prompt diagnosis of electrolyte disparity or disturbance possibly minimizes COVID-19-related morbidity and mortality.

An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone.

Background and objective Facial aesthetics have a huge impact on how individuals view themselves and areviewed by society. The aesthetics of the face are tremendously influenced by the shape of the chin and neck. In this study, we aimed to observe the outcomes in individuals after the use of ATX-101(deoxycholic acid injection) in an expanded safe zone for submental fullness. To ensure optimal outcomes and reduce the risk of adverse events, appropriate patient selection is the key. ATX-101treatment may be administered in combination with hyaluronic acid fillers, botulinum toxins,cryolipolysis, and radiofrequency treatment. This is the first study of its kind to becarried out at the national level in Pakistan. Materials and methods This was a quasi-experimental study conducted at the Rawalian Burn and Reconstructive Surgery Unit, Holy Family Hospital, Rawalpindi, Pakistan for a period of nine months, from 10-1-2021 to 11-10-2021. A total of 62 patients who fulfilled the inclusion criteria were enrolled. We recordedif any complications had occurred or not. Moreover, the total number of treatment sessions, the volume of injectables used, and the interval between sessions were also documented. ATX-101 package was injected into the treatment area. Due care was taken to avoidthe region of the marginal mandibular nerve. After the procedure, outcomes and complications were observed. Results In this study, patient satisfaction was reported in 59 (95.2%) patients. After the fourth session,final improvement was observed in 59 (95.16%) patients. Tenderness was found in seven (11.3%) patients, bruising was noted in four (6.5%), edema was found in seven (11.3%), numbness was noted in one (1.6%), whereas paresis and alopecia were not found in any of the patients. Conclusion Our study concluded that ATX-101 is a very useful modality with fewer complication rates and is associated with significant improvement in the expanded safe zone for submental fullness.

The Prevalence of Hypomagnesemia in Critically Ill Patients Admitted in Medically Intensive Care Unit

Background Magnesium is the fourth most abundant cation in the human body. Hypomagnesemia can result from decreased intake, redistribution of magnesium from the extracellular to the intracellular space, or increased renal or gastrointestinal loss. Hypomagnesemia can cause severe outcomes in ill patients. So, we conducted this study to determine the frequency of hypomagnesemia in critically ill medical patients. Methods This is a Descriptive cross-sectional study involving 120 patients admitted in the medical intensive care unit (MICU) of the Holy Family Hospital, Rawalpindi, Pakistan. The study was conducted from July 2020 to September 2021. About 1 ml sample of blood was taken from each patient included and sent to the hospital laboratory for evaluation of serum magnesium levels. All the collected data was entered and analyzed on SPSS v. 23. A p-value of ≤ 0.05 was taken significant. Results In our study, the mean age of the patients was 42.76±12.77 years, and the male-to-female ratio of the patients was 1:1. The mean value of the APACHE II score of the patients was 29.68±2.571. Hypomagnesemia was found in 28 (23.33%) patients. Conclusion According to our study, the frequency of hypomagnesemia in critically ill medical patients was 23.33% (28 patients).

Comparison of the Effects of General Anesthesia & Spinal Anesthesia for Elective Cesarean Section in Diabetic Pregnant Women

Introduction: Caesarean section (CS) is now one of the most commonly performed major operations in pregnant women throughout the world. While regional or general anaesthesia (GA) are both acceptable for caesarean delivery, use of GA has decreased dramatically in the past few decades due to a higher risk of anaesthesia-related maternal mortality. As a consequence, spinal anaesthesia (SA) is now the technique of choice for CS. It has become the preferred anesthetic technique when providing anesthesia for patients undergoing elective cesarean section as the risk of maternal and fetal complications associated with spinal anesthesia is less than with general anesthesia. Aim of the study: The aim of this study was to compare the effects of general & spinal anesthesia for elective cesarean section in diabetic pregnant women. Methods: This was a comparative observational study and was conducted in the Department of Anaesthesiology of Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh during the period from January,2022 to December,2020.In our study we included 120 pregnant women with diabetes who were given spinal and general anesthesia during C-section surgery. Our patients were equally divided into two groups – i) Group A (Patients were given general anesthesia) & ii) Group B (Patients were given spinal anesthesia). Result: In total 120 patients from both the groups completed the study. In our study we found the mean age and BMI was 34.48± 11.79 years & 38.48± 14.89 kg/m2 respectively. Among all patients 16%, 58% & 27 % patients had Type 1, Type 2 & gestational diabetes respectively. The mean blood glucose level was significantly lower in SA (80.9 ±17.7) compared to GA (121.1± 17.4) after one hour of surgery. The mean of mother’s perioperative difference was significantly lower in SA (4.0 ± 0.19) compared to GA (9.4 ± 0.21). Conclusion: In our study, we found that general anaesthetic had a substantially higher influence on blood glucose concentrations ..

Impact of General Anesthesia on Preeclamptic Women in a Tertiary Care Hospital

Background: General anesthesia can be necessary during delivery for women with preeclampsia, a serious pregnancy condition characterized by high blood pressure and organ damage. However, the impact of general anesthesia on pregnant women with preeclampsia is not well understood and studies show conflicting results. The decision to use general anesthesia in such cases should be carefully weighed by the healthcare provider, considering the individual circumstances and potential risks and benefits. Aim of the study: The aim of this study was to assess the impact of general anesthesia on preeclamptic women. Methods: This cross-sectional study was conducted in Department of Anaesthesiology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, during the period from January 2022 to January 2023. Total 120 pregnant women with preeclampsia were included in this study. Result: Demographic and clinical data of participants in the general anesthesia group showed a mean maternal age of 24.12 years, 63.3% of whom were primigravida, and a mean weight of 76 kg. Pulse rate decreased from 97.8 before anesthesia to 91.1 after 1 hour, while systolic blood pressure decreased from 152.3 to 135.5 and diastolic blood pressure decreased from 92.5 to 79.4. The mean time from skin incision to delivery was 5.8 minutes and surgery lasted 43.5 minutes. Adverse events included surgical site infections (5.0%), anesthesia complications (7.5%), pulmonary edema (14.2%), and 1 death (0.8%). The mean postoperative pain score was 7.2. In this study, 29.2% patient were admitted to critical care unit. Newborns had a mean systolic arterial pressure of 55 mm Hg, heart rate of 141 beats per minute, and weight of 2.3 kg. Apgar score was below 6 for 20% at 1 minute and 10% at 5 minutes, with 52.5% of newborns admitted to the NICU. Conclusion: The present study provides important insights into the impact of general anesthesia on pregnant women with preeclampsia. While general anesthesia ......

Risk factors of diabetic retinopathy - a cross sectional study from Holy Family Hospital, Rawalpindi.

Objective: To assess the major risk factors of diabetic retinopathy in patients presenting to the eye OPD of the Holy Family Hospital, Rawalpindi. Study Design: Descriptive Cross-sectional study. Setting: Department of Ophthalmology, Holy Family Hospital, Rawalpindi. Period: March 2018 to September 2018. Material & Methods: 330 patients presenting at the diabetic clinic of Holy Family Hospital aged between 30-70 years with both type I and type II diabetes for ≥5 years (diagnosed by checking fasting blood sugar or HbA1C). History including age, gender, weight, height, duration of diabetes mellitus and control of diabetes mellitus was taken on a pre-designed proforma. Slit lamp examination was performed by the consultant ophthalmologist to check for Diabetic Retinopathy (NPDR and PDR). Results: Mean age of the patients was 50.4±9.8. Patients were distributed according to the age groups showing that 56(56%) of the patients were diabetics, 61(49.9%) with NPDR and 48(48%) with PDR in the 30-50 year group. While 51-70 year group included 44(44%) diabetics, 69(53.1%) with NPDR and 52(52%) with PDR. There was no significant association between history of hypertension and diabetic retinopathy (p=0.804) or BMI and diabetic retinopathy (p=0.451). There was significant association between diabetic retinopathy and duration of diabetes (p=0.035) as well as diabetic retinopathy and Hb1Ac levels (p=0.001). Gender variations were statistically significant (p=0.001), with females being more affected than males. Conclusion: Diabetic retinopathy is strongly associated with female gender, longer duration of diabetes and poor glycemic control.

A Study on the Effects of Pregabalin and Amitriptyline in Treatment of Patients with Painful Diabetic Neuropathy

Objective: To compare the effect of Amitriptyline and Pregabalin in treatment of painful diabetic neuropathy. Material and Methods: The design of this study was Randomized Controlled Trial study design. This study was conducted in the Department of Medicine in, Holy Family Hospital, Rawalpindi and the duration of this study was Six months after the approval of synopsis i.e from 1st November 2019 to 1st May 2020. Approval from ethical committee of the hospital was taken. Written informed consent was taken from patients. Consent form is attached with this. Patients were randomly allocated into two groups by lottery method. The dose of Pregabalin was used as 50mg thrice daily for a period of six weeks and label as group-A and group B received amitriptyline as 25mg once daily before bedtime for a period of six weeks as prescribed by a senior consultant who was blind to object of the study. At the start and end of treatment pain was marked by patients on Visual Analogue Scale (VAS) and numerical score. It was noted on the Performa. Results: Total 100 patients were included according to the inclusion criteria of the study. The dose of Pregabalin was given in patients in group-A and group-B received amitriptyline. Mean age (years) in the study was 55.87+6.43 whereas there were 55 (55.0) male and 45 (45.0) female patients who were included in the study according to the inclusion criteria. In our study, frequency and percentage of effect (pain relief) among Pregabalin and Amitriptyline in treatment of painful diabetic neuropathy was 27 (54.0) and 11 (22.0) respectively which was statistically significant (p-value 0.001). Practical Implication: In this study Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of amitriptyline and Pregabalin in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Conclusion: The study concluded that Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of Pregabalin and amitriptyline in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Keywords: Amitriptyline, Pregabalin, Neuropathy, Pain Relief, Diabetic Sensorimotor Polyneuropathy, Prevalence.

A Cros Sectional Study on the Plateletcrit and Platelet Indices in Different Forms of Dengue Fever

Background: Dengue fever is a viral disease caused by four different serotypes of dengue viruses from DENV, transmitted mostly by the Aedes aegypti mosquito. The disease has history of many outbreaks mostly in tropic and sub-tropic countries, costing many lives annually, with millions in mild to complicated forms, bringing stress to health systems and economies of poor countries. Dengue epidemic occurred in Pakistan in 2010 with 257 deaths during the epidemic and prevalence of 16580 cases in Rawalpindi, repeated epidemic in 2015, 2017, 2018 and 2019 with higher prevalence. Objective: To determine the frequency of dengue hemorrhagic fever in patients of dengue fever and to compare mean platecrit and platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever. Materials And Methods: The design of this study was an observational cross sectional study design. This study was conducted in the Department of Infectious Diseases, Holy Family Hospital, Rawalpindi and the duration of this study was 6 months after the approval of synopsis i.e 1st May 2021 to 30th Oct 2021. Patients fulfilling selection criteria were enrolled in the study from emergency of Department of Infectious Diseases, Holy Family Hospital Rawalpindi. Informed consent was taken. Then patients were evaluated and divided for severity score (annexure I). Reports were assessed for Platelet indices including platelet count, mean platelet volume, platelet distribution width (as per operational definition). All this information were recorded on proforma (attached). Results: Total 150 participants were enrolled in the study as per the inclusion criteria. Mean age in the study was 38.42+13.74 whereas there were 94 (62.7%) male and 56 (37.3%) female patients who were included in the study according to the inclusion criteria. Among 150 patients, 28 (18.7%) patients were presented with dengue hemorrhagic fever in patients of dengue fever. Mean Platecrit indices in patients with or without dengue hemorrhagic fever due to dengue fever in the study was 0.26+1.62 vs 0.08+0.02 (p-value 0.552) whereas mean platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever in the study was 64.19+41.11 vs 78.10+32.74 (p-value 0.097). Practical Implication: To determine the frequency of dengue hemorrhagic fever in patients of dengue fever and to compare mean platecrit and platelet indices in patients with or without dengue hemorrhagic fever due to dengue fever Conclusion: The study concluded that different indices of platelets within different forms of dengue fever to assess the severity of the disease process may serve as an early indicator of disease progress and severity which will help to decide early intervention. Keywords: Dengue Fever, Hemorrhagic, Platelet, Indices, Serotypes, Epidemic, Participants

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after shifting to PACU. If at any time, the score was >3 and the patient required a rescue analgesic, effective anaglesia was not achieved. Results: Effective analgesia was achieved in 82.46% of the patients (n=141) in Group-A versus 87.13% patients (n=149) in Group-B (p-value: 0.23). Conclusion: There is no significant difference in the efficacy of analgesia in paracetamol/diclofenac combination group compared with caudal bupivacaine group.

Maternal and perinatal outcome of Ramadan fasting in women with gestational diabetes.

To compare maternal and perinatal outcome of Ramadan fasting during pregnancy in women with/without gestational diabetes. This prospective case-control study was conducted at Department of Obstetrics & Gynecology Unit 1 Ruth PKM Civil Hospital & Dow Medical College and Holy Family Hospital, Karachi during 1st April to 31st July, 2022. In this study normoglycemic pregnant women and those identified as gestational diabetes (n=52) on oral glucose tolerance test, who fasted during Ramadan were included. Women, on diet control or diet plus metformin were included in the study. Study questionnaire included demographic details, days of fasting, self-reported hypoglycemic episodes. Maternal outcomes included preterm birth, pregnancy induced hypertension. Perinatal outcome included hyperbilirubinemia, hypoglycemia, weight of placenta, and apgar score. Eighty two women were included in the study, gestational diabetes (n=57) and normoglycemic (n=25). Average days of fasting were 16 ±9.0 days (range 5-30). Women with GDM were older (28.6 vs. 26.0 years, p-value=0.034), had raised levels of HbA1c (5.5 vs. 5.1, p-value=0.004), mean FBS (102.8 vs. 84.6 mg/dl, p-value <0.001), mean RBS (135.3 vs. 106.4 mg/dl, p-value <0.001) and had higher BMI at delivery (31.0 vs. 26.6 kg/m2, p-value=0.004). HbA1c (p-value=0.016) and head circumference of baby (p-value=0.038) were found lower in the group who fasted for more than 20 days among normoglycemic pregnant women. No other maternal and neonatal outcomes were found to be significantly affected by Ramadan fasting among pregnant women with/without GDM. Gestational diabetes do not affect maternal and perinatal outcome among pregnant women.

Effects of body mass index on propofol-induced cardiovascular depression in the Pakistani population.

To determine the relationship between the patient's Body Mass Index (BMI) and the cardiovascular effects produced by propofol at a dose of 1.5 mg/kg in the Pakistani population. This descriptive cross-sectional study was conducted in the Holy Family Hospital Rawalpindi from August 2021 to January 2022. According to their BMI, one hundred twenty Pakistani individuals 18 to 60 years of age were equally divided into three groups. Group N (n = 40) with a BMI of 18 to 24.9, group OW (n=40) with a BMI of 25 to 29.5, and group O (n=40) with a BMI of 30 to 34.9 were randomized to receive propofol injections at a 1.5 mg/kg dose for induction of anesthesia. We measured mean blood pressure before the propofol and then at one, three, and ten minutes after the injection. Data were analyzed by using SPSS 22. Mean blood pressure decreases significantly in all groups, as shown by p-values of <0.001 for the first two readings. In group N, blood pressure returned to near normal within ten minutes (p-value 0.061), but in groups, OW and O, mean blood pressure was significantly lower even after ten minutes (p-values 0.005 and 0.001, respectively). Individual variations in propofol response were also observed. In the Pakistani population, propofol at an induction dose of 1.5 mg/kg to patients with different body weights produces cardiovascular effects with marked standard deviations in each group, which indicate different individual responses. Clinical Trial Number: NCT05383534 https://register.clinicaltrials.gov/.

The Routledge Handbook of African Theology

The Routledge Handbook of African Theology

Effect of Pretreatment of Lignocaine Versus Midazolam in the Prevention of Etomidate Induced Myoclonus

Background: The myoclonus after induction of anesthesia with etomidate can lead to increased risk of regurgitation and aspiration. We conducted this study to compare the effectiveness of midazolam and lidocaine for the prevention of etomidate induced myoclonus.&#x0D; Methodology: This randomized controlled trial was done in the Department of Anesthesiology and Intensive Care, Holy Family Hospital, Rawalpindi from January-June 2015 after approval of hospital ethical committee. Informed consent (written) was taken from 224 patients. Patients were allocated into 2 equal groups randomly with the help of computer-generated numbers. Two minutes after induction with etomidate, Group A got 1 ml of 2% lidocaine, and one ml (1 mg) of midazolam was given to Group B. Myoclonus was evaluated in the following one minute, after which 0.5 mg/kg of succinylcholine was given to the patient to facilitate endotracheal intubation.&#x0D; Time of onset of induction was marked by loss of eyelash reflex. Myoclonus was recorded at 20, 40, and 60 seconds. Drug was found to be effective if there was no myoclonus within one minute of etomidate induction. Analysis of data was done using SPSS 17.&#x0D; Results: Lignocaine was effective in preventing myoclonus in 55.40% of patients and Midazolam prevented it in 69.60%. The variation between the results of the groups was found significant statistically. (P&lt; 0.05)&#x0D; Conclusion: Both midazolam and lignocaine are effective in preventing the occurrence of myoclonus associated with etomidate. However, midazolam is the more effective of the two drugs.&#x0D; Keywords: Etomidate, Lignocaine, Midazolam, Myoclonus&#x0D;

ЭКФРАЗИС «СВЯТОЕ СЕМЕЙСТВО» В «ЗАПИСКАХ ИЗ ПОДПОЛЬЯ» (1864) Ф. М. ДОСТОЕВСКОГО

The article is devoted to the consideration of the place and role of the ekphrasis “The Holy Family” in F. M. Dostoevsky’s “Notes from Underground” (1864). During the first meeting with Lisa, Podpolniy spontaneously creates a picture of family life, which is based on an idyllic and picturesque tradition. With the ecphrasis “The Holy Family”, the central value orientation enters the history of the heroes. For Podpolniy, ecphrasis at first becomes a means of manipulating the feelings of the prostitute Lisa. However, having come into contact with the world of the sacred, the hero discovers a moral principle in himself, which he is not able to accept. The image of the Holy Family for the heroine is an ideal model that gives her hope to get out of the brothel. This image is included in the context of F. M. Dostoevsky’s reflection on the phenomenon of man in the 19th century.

Sex Differential Regarding the Ethical Dilemma to Start a Career or a Family

Embarking from childhood into adulthood presents all human beings with the dilemma of discerning where their future will take them. In the Catholic faith, human beings are called to either Holy Matrimony and family life or a vocation which leads them to celibacy, such as choosing the priesthood or religious life. This decision is more complicated for women in part because the reality of human reproduction dictates that their prime reproductive years are limited. In this article, the author argues in favor of young women called to Holy Matrimony and family life pursuing that call first and choosing a profession later in life.

Comparison of the outcomes among patients undergoing emergency open appendectomies by senior and junior surgeons: A cross-sectional study.

Objective: To compare the senior and junior surgeons in terms of the outcome of the open appendectomies. Study Design: Comparative Cross Sectional study. Setting: Holy Family Hospital, Rawalpindi. Period: January 2019 to April 2019. Material &amp; Methods: Patients of 16 years and above who underwent emergency open appendectomies for suspected appendicitis were included while elective appendectomies and those done for gynecological indications were excluded from the study. After informed consent, 65 appendectomies were included in the study. SPSS v23.0 was used for data entry and analysis. Frequencies, percentages, means and standard deviations were calculated. Chi-square, t-test and Kruskall-Wallis tests were applied to test the significance of the results. Results were then presented in the form of tables. Outcome variables of the study were duration of the symptoms, Alvorado score, WBCs count, duration of surgery, per-operative findings, post-operative antibiotic, home treatment prescription, post-operative hospital stay and complications. Results: Out of total 65 appendectomies, 35 (53.8%) were done by junior surgeons, out of which 16 (45.71%) were males. Out of 30 appendectomies done at the hands of senior surgeons, 16 (53.3%) were done by males. There was no significant difference between the senior and junior surgeons except for Alvorado score (higher mean score for senior surgeons), per-operative findings (more complicated appendicitis in case of senior surgeons) and post-operative hospital stay (prolonged for senior surgeons’ appendectomies), p values are &lt;0.000, 0.001, and &lt;0.000, respectively. Conclusion: This study concludes that junior surgeons can safely perform open appendectomies with no difference in the incidence of complications as compared to senior surgeons.

Effect of Convex Lens on the Magnitude of Esotropia among Patients Visiting Ophthalmology Department of Holy Family Hospital Rawalpindi Pakistan

Effect of Convex Lens on the Magnitude of Esotropia among Patients Visiting Ophthalmology Department of Holy Family Hospital Rawalpindi Pakistan

Institutional metaphysics for the Trinity

This paper explores and defends an institutional metaphysics for the Trinity as providing us with an inherently interpersonal reality, and provides general and specific methodological arguments in that direction in the first section. The actual argumentation is then first of all directed against Augustine’s rejection of the family as a suitable analogy for the Trinity. It is instead argued that the family does in fact offer an interesting and suitable analogy. Next, several more general and historic precursors to such an institutional analogy are explored and fleshed out, relying on the legal and economic meaning of the term ‘substance’ as an estate, such as the shared inheritance between a father and a son. The main section further develops the outlines and main features of such an institutional metaphysics, relying on both analogies to result in three persons in one numerically identical substance. The final section returns to the methodological issue but now in an explicitly Marian key, culminating in the Holy Family as a key exemplar for the family analogy.

Hortus conclusus. La Sacra Famiglia lauretana di Lorenzo Lotto

"Hortus conclusus. The Holy Family of Loreto by Lorenzo Lotto. The contribution is an excerpt from Dalla parte di Lorenzo Lotto. Il ciclo lauretano (On the Side of Lorenzo Lotto: The Loreto Cycle), an essay to be completed soon on the pictorial cycle which Lorenzo Lotto (Venice, 1480-Loreto, 1556) ordered in 1555 in the chapter chapel of the church of Santa Maria di Loreto. This is the painter’s last work for a public destination; due to the difficulties in providing a unitary and coherent interpretation, the cycle risks being expunged from Lotto’s catalogue despite the indication made both by Giorgio Vasari in the 1568 edition of the Vite (Lives) and by Carlo Ridolfi in 1648 in Le Meraviglie dell’arte: ovvero Le vite degl’illustri pittori veneti (The Wonders of Art: The Lives of the Illustrious Venetian Painters). Of the seven works making up the cycle, the Holy Family is one of the five painted before 1550, some of which had to be adapted to harmonize their format. The painter intervened on the Holy Family in order to adapt the content of the painting, originally intended for domestic devotion, and make it suitable for the new destination. Keywords: Lorenzo Lotto, Santa Maria di Loreto, Giorgio Vasari, the Holy Family "

Psychosocial Impact of Electrical Burn in Children: A Follow-Up Study Conducted at a Tertiary Care Hospital.

Introduction Electrical burn injuries are very common in the pediatric population and are usually accidental and sometimes occupational. The objective of our study was to evaluate the epidemiology of electrical burn injuries and prospectively evaluate the long-term psychosocial impact of electrical burn injuries in children. Materials and methods A qualitative interview study was conducted prospectively among sixty patients presented to Holy Family Hospital, Rawalpindi, Pakistan. Demographic details, mode of presentation, detail of injury, total body surface area, initial condition, and surgical interventions were noted during their stay at the hospital. Their physical and psychological outcomes were evaluated by administering the Strength and Difficulties Questionnaire (SDQ) and Body Dysmorphic Disorder Questionnaire (BDDQ) via telephonic interviews after six weeks of discharge from the hospital. The study was conducted over a span of 1 year from January 2021 to January 2022. Results There were 60 patients who presented to the department of pediatric surgery during the span of the study. The mean age was 9.9 years ± 3.133 years (SD) and 80% of the patients were above 8 years of age with a male-to-female percentage of 86.67% to 13.33%, respectively. Forty-two (70%) patients incurred high-voltage electrical burns while 18 (30%) suffered low-voltage electrical burns. Mortality was 13.33% (n=8). Out of 52 patients who survived, 35 (67.30%) were labeled as having Body Dysmorphic Disorder upon administration of BDDQ through a six-week follow-up. The majority of the patients had abnormal or borderline results in different scales of SDQ. Conclusion The long-term psychological stress and the varied spectrum of psychiatric disorders in electrical burn patients are profound. The prevention of burn injuries can be effectively achieved by educating parents about safety measures and improving health infrastructure. Implementation of a dedicated national program for psychological support of burn patients should be made accessible to all patients.