Hospital Islamabad Research Articles

Molecular Spectrum of K-RAS Mutations in Colorectal Cancer Patients in Peshawar, Pakistan

Background: The global incidence of colorectal cancer (CRC) has surged, presenting a significant health challenge with an annual occurrence of 1.7 million cases. The American Cancer Society reports that KRAS and BRAF mutations contribute to 20-50% of CRC cases. This study addresses the gap in data on KRAS mutations in CRC patients in Peshawar, Pakistan. Objective: To determine the prevalence and types of KRAS mutations in colorectal cancer patients in Peshawar, Pakistan. Methods: This retrospective, cross-sectional study was conducted at the Nuclear Medicine, Oncology, and Radiotherapy Institute (NORI) Hospital in Islamabad from April to November 2022. DNA was extracted from formalin-fixed, paraffin-embedded tissue blocks of 58 CRC patients, regardless of age and gender, following informed verbal consent. KRAS mutation testing was performed using the Cobas Z480 Real-time thermal cycler. Results: Among the 58 CRC patients, 34 (58.6%) were females, and 24 (41.4%) were males. The highest CRC incidence (36.2%) was observed in the 11-25 years age group. KRAS mutations at codons 12 and 13 were found in 18% of cases, with all isolates carrying the G12D mutation. Kaplan-Meier analysis revealed a lower survival probability for patients with codon 12 mutations compared to those with codon 13 mutations. Conclusion: The study highlights the need for broader research on KRAS mutations across diverse ethnicities and geographical regions in Pakistan to better understand CRC prevalence and improve patient outcomes.

Disease Spectrum and Outcome of Patients in PICU of Federal Govt. Polyclinic Hospital (FGPC) Islamabad

Objective: To summarize the spectrum of disease and outcome in children admitted to the Pediatric Intensive Care Unit of FGPCH. Methodology: It is a retrospective descriptive study conducted at Pediatric ward and Intensive care unit of Pediatric department of Federal Govt. Polyclinic Hospital, Islamabad from June’2018 to June’2020. The outcome variables are classified as discharge from PICU, death, shift to the ward after stabilization, and referral to other hospitals due to the unavailability of further specialized services. Results: A total of 424 pediatric patients were included in this study. The overall mean age was 19.6±29.2 months and there were 239 (56.4%) males and 185 (43.6%) females. The most common diagnosis was pneumonia 37.3% (158/424), followed by sepsis and meningitis 14.6% each (62/424 each), and acute gastroenteritis 11.3% (48/424). There were 116 out of 424 (27.4%) who required ventilatory support in the PICU, while the remaining 308 (72.6%) did not require ventilatory support. In terms of outcomes, there were 106 (25.0%) pediatric patients who expired, 277 (65.3%) were shifted to the ward from PICU, 29 (6.8%) were discharged and 12 (2.8%) were referred to a specialized facility. The mean duration of stay was 3.1±2.7 days. Conclusion: The most susceptible age group was under five years with the highest mortality rate and the most common cause of death is pneumonia preceded by other infections which can be controlled with better preventive measures.

Review of High-Resolution Computed Tomography Chest Incidental Findings in COVID and Post-COVID Era in PIMS Hospital Islamabad

Objective: To scrutinize the frequency of alternative pulmonary infectious diseases, and incidental findings ofthe High resolution CT scan chest in COVID-19 screening trials during peak and late COVID era.Study Design: A cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Radiology, Pakistan Institute ofMedical Sciences (PIMS), Islamabad, Pakistan from June 2021 to June 2022.Methods: High-resolution computed tomography (HRCT) scan chest reports of 191 patients were analyzedfrom the Peak COVID period from May 2020 to May 2021 and 191 reports of patients in the late COVID periodfrom June 2021 to June 2022. Reports were evaluated for any alternative disease process or incidental findings,further classified according to their clinical significance.Results: Incidental findings were seen in 60% of scans in the Peak period of SARS-CoV-2 infection and 75% in the late COVID era. The mean age group of patients in the peak period was 50.76 years and in the late COVID period was 56.65 years, with significant male predominance (76%) in the peak period. Around 30.5% and 56.7% of “major" incidental findings in each peak and late COVID period were recorded, respectively, with Pulmonarynodule being the most frequent incidental finding in the peak period and Tuberculosis often repeatedlyencountered incidental finding in the late COVID period.Conclusion: Incidental findings appear in more than half of the High-resolution CT chest scans in suspectedCOVID-19 patients, with a substantial number requiring further workup. How to cite this: Shahid S, Isani A, Abbasi HW, Rizvi A, Mubarik HH. Review of High-Resolution Computed Tomography Chest Incidental Findings in COVID and Past COVID Era. Life and Science. 2024; 5(2): 237-243. doi: http://doi.org/10.37185/LnS.1.1.417

Caregivers' Burden and Mental Health of the Caregivers of β-Major Thalassemia Patients: Mediating Role of Religious Coping

Background: Caregiver burden among those caring for patients with thalassemia major in Pakistan poses significant psychological challenges. The role of religious coping mechanisms in alleviating psychological distress and enhancing well-being among caregivers has been highlighted in prior research, suggesting a complex interplay between caregiver strain, coping strategies, and mental health outcomes. Objective: This study aims to investigate the relationships between caregiver burden, positive religious coping, and mental health outcomes, specifically psychological well-being and distress, among caregivers of thalassemia patients in the Twin cities of Islamabad and Rawalpindi. Methods: Employing a cross-sectional design, the study included 180 caregivers of thalassemia patients, recruited through non-probability purposive sampling from major thalassemia centers and hospitals in Islamabad and Rawalpindi. Data were collected using the Zarit Caregiver’s Burden Scale, the Brief Religious Coping Scale, and the Mental Health Inventory. Structural Equation Modeling (SEM) was utilized to analyze the data, using SPSS and AMOS software, with a focus on the mediating role of positive religious coping between caregiver burden and mental health outcomes. Results: The analysis revealed that caregiver burden significantly predicted the use of positive religious coping (β = .32, p < .001) and was negatively associated with psychological well-being (β = -.33, p < .001) while positively associated with psychological distress (β = .23, p < .01). Positive religious coping positively influenced psychological well-being (β = .28, p < .01) and negatively influenced psychological distress (β = -.21, p < .05). The model explained 38.2% of the variance in psychological well-being and 34.1% in psychological distress. Conclusion: The findings underscore the significant impact of caregiver burden on the mental health of caregivers, with positive religious coping serving as a beneficial mediating factor. Enhancing positive religious coping among caregivers may be a viable intervention strategy to improve their mental health outcomes.

Experiences of cardiac care nurses related to the management and delayed removal of trans-radial band of patients at a private tertiary care hospital, Islamabad.

To explore the experiences of cardiac care nurses in managing transradial band of patients in a tertiary care setting. The exploratory, descriptive, qualitative study was conducted at a private-sector tertiary care hospital in Islamabad, Pakistan, from March to September 2021, and comprised registered cardiac care nurses with >6 months of relevant experience. Data was collected through face-to-face interviews using a semi-structured interview guide. Data was analysed qualitatively using the Creswell and Creswell framework. Of the 10 nurses, 5(50%) were males and 5(50%) were females. In terms of age, 5(50%) were aged <25 years. Cardiac specialisation had been done by 2(20%) nurses, and none of the subjects had formal training related to transradial band. The main theme that emerged from the data was nurses' management of patients with transradial band, and the three categories were nurses' knowledge and practices about transradial band, reasons for delayed transradial band removal, and strategies to minimise complications. To minimise transradial band-related complications, in-service training of nurses and ensuring a safe nursepatient ratio are necessary.

Impact of CYP3A4 rs2242480 polymorphisms on Imatinib HPLC determined trough concentration and response in Chronic Myeloid Leukaemia in Pakistani patients

Objective To ascertain the impact of CYP3A4 polymorphism on the therapeutic outcome of imatinib and its trough concentration Study design Descriptive analytical study Place and duration of the study This study was conducted in the Department of Pharmacology &amp; Therapeutics, Islamic International Medical College, between December 2020 and February 2022, in collaboration with the Institute of Biomedical Genetic Engineering, KRL Hospital Islamabad. Methods Patients with Chronic Myeloid Leukaemia age range–18-70 years were included in this study. One group comprised responders and the other group comprised non-responders. Imatinib trough levels in both groups were determined using High-performance Liquid Chromatography and compared, and the association was determined with therapeutic outcomes. DNA was extracted, and the PCR restriction fragment length polymorphism technique was used to identify the alleles. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Results The imatinib concentration in patients with the homozygous wild allele CC of rs2242480 was higher(1298ng/ml) as compared with the mutant homozygous TT allele (489ng/ml) or heterozygous allele CT(873ng/ml) Conclusion There was a significant association between imatinib trough levels and CYP3A4 polymorphism, and trough concentration was found to be lower in patients with the TT or CT variant of rs2242480 than in patients with the CC genotype.

Evaluating the moderating role of management inspection between safety hazards in hospital working conditions: A study of hospitals in Islamabad

The study identifies the relationship between safety hazards and hospitals working conditions. The management inspection role supported by the management in hospitals is identified to bring safety measures precautions and effectiveness for the healthcare staff and make the hospital working conditions better. The hospital management inspection role helps to accomplish occupational safety and better working conditions. The objective of this study is to identify the relationship of management inspection role in tackling with the safety hazards to find out working conditions in Al-Shifa International hospital and Pakistan Institute of Medical Sciences hospital. The study used various statistical tests like Pearson’s correlation and KMOs Bartlet’s test to evaluate the predictors of safety barriers, working conditions and management inspection role. Data was gathered using research questionnaire and the response rate was 73%. Among the 500 respondents, 75% were males while 25%were females. The age range was 40 or above years with a mean of 2.5. The reliability analysis for the constructs is in the acceptable range. The management lacking in providing the safety information rated as 0.61 correlation matrix. The medical doctors’ responded noise as the most detrimental factor resulted with 0.70 communality and lack of health facility comes as 0.61. The structure matrix shows biological hazards rated as 0.66 and physical explosion hazards rated as 0.70 which is analyzed through KMO Bartlet’s test. The safety hazards existence in the hospitals calls upon the attention on conducting research on inspection, detection and reporting of the hazards.

COMPARISON OF TRANSTHORACIC AND TRANS-ESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF CARDIAC EMBOLI IN AFIB PATIENTS

Atrial fibrillation (AFib) predisposes patients to an increased risk of thromboembolic events, including stroke, due to the formation of cardiac emboli. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) are commonly used to detect cardiac emboli in AFib patients, but their comparative effectiveness remains unclear. Objective: This study aimed to compare the diagnostic accuracy of TTE and TEE in detecting cardiac emboli in AFib patients. Methods: A prospective observational study was conducted at the Shifa International Hospital in Islamabad, Pakistan, from January 2022 to January 2023. The study included 100 adult patients diagnosed with AFib, undergoing evaluation for suspected cardiac emboli. Both TTE and TEE examinations were performed as part of routine clinical care. Diagnostic accuracy parameters were calculated for both modalities using standard formulas, and comparative analyses were conducted using appropriate statistical tests. SPSS version 25 was used, and a P value less than 0.05 is considered statistically significant. Results: The study included 100 patients with atrial fibrillation (AFib), of which 55 were male, and 45 were female. The mean age of the patients was 65 years (standard deviation [SD] ± 7 years). Transoesophageal echocardiography (TEE) demonstrated a higher sensitivity in detecting cardiac emboli than transthoracic echocardiography (TTE). TEE identified a significantly higher number of emboli than TTE (48 vs. 40, p &lt; 0.05). TEE was also associated with a lower risk of complications than TTE (0 vs. 2 cases, p &lt; 0.05). Conclusion: In evaluating cardiac emboli in AFib patients, transoesophageal echocardiography (TEE) showed superior diagnostic accuracy and a lower complication risk than transthoracic echocardiography (TTE). Therefore, TEE may be considered the preferred imaging modality for this patient population.

A Cross-Sectional Study on the Use of Computed Tomography Scan for Diagnosing Renal Masses in Pakistani Adults

Objective: The aim of this study is to assess the validity of Computed Tomography (CT) in evaluating solid renal masses by comparing CT findings with histopathological results.&#x0D; Methodology: This cross-sectional study involved 210 patients at the Department of Radiology PESSI Hospital Islamabad, spanning July 2022 to June 2023. Patients were selected based on predefined inclusion criteria, and their detailed medical histories were examined. Each patient underwent both non-contrast and contrast CT scans, and the radiological diagnoses were confirmed. The CT-based diagnoses were then compared with histopathological results, and measures such as positive predictive value (PPV), accuracy, sensitivity, specificity, and negative predictive value (NPV) of CT in diagnosing renal masses were calculated.&#x0D; Results: The mean age of the study participants was 48.00±810 years. Male to female ratio was 2:1. The majority of the study participants were belonging from the urban area and were under graduate. The results of the study further revealed the frequency of renal masses which was more in male (71.90%, n=151) as compared to female (28.09%, n=59). The study found that the right kidney was affected in 58.09% (n=122) of cases, the left kidney in 36.19% (n=76), and both kidneys in 5.71% (n=12). In our study, we observed variations in density among patients, with 39.06% exhibiting mixed density, followed by 23.80% with hypo-dense, 20.95% with hyper-dense, and 16.19% with iso-dense lesions. When it comes to enhancement, we found that 40.01% had a moderate degree, 24.76% had mild enhancement, 21.90% had intense enhancement, and 13.33% showed no enhancement.&#x0D; Conclusion: In this study, we found a strong correlation between histopathological diagnosis and computed tomography (CT) in identifying solid renal masses, with notably high validity test results. Given these robust validity parameters, we can confidently conclude that CT scans serve as an effective and reliable diagnostic modality for identifying and diagnosing renal masses.

A Study of Frequency of Anemia in Pregnant Females in Tertiary Care Hospital, Islamabad

Background: Anemia is among the most public hematological disorders, especially in pregnancy. It is a nutritional deficiency disorder that affects pregnant women, mainly in underdeveloped countries. Pregnant women who suffer from anemia often have bad pregnancy outcomes and may lead to difficulties that endanger both the mother's and the fetus's health. This study aimed was to determine the frequency of anemia among pregnant women in tertiary care hospitals in Islamabad. Material and Methods: This cross-sectional investigation was carried out in the Dr. Akbar Niazi Teaching Hospital's pathology and gynecology department in Islamabad. All the pregnant women who visited for antenatal check-ups from January 2021 to December 2021 were involved in the study. Data was taken through a specially designed proforma and statistical analysis was accomplished using SPSS version 21. Results: A total number of 93 pregnant females were enrolled in the study. The average age of pregnant women was 30.6 ± 6.0 (20-43). The average hemoglobin in our study population was 11.1± 1.4 (8-13 g/dL). The mean range of WBC counts was 11,304/mm3 ±7722 (4100/mm3 - 81000/mm3), the mean value of RBC count was 4.1 mil/mm3 ± 0.6 (2-5 mil/mm3). The overall prevalence of anemia in pregnant females was 45% (n=42). Out of 42 pregnant anemic women, 25 (59%) had normocytic normochromic type of anemia, 15 (36%) had microcytic type of anemia, and 2 (5%) had macrocytic type of anemia. Mild anemia was recorded in 26 (30%) of the pregnant females, while moderate anemia was recorded in 16 (17%) of the pregnant females, and 51 (55%) of the pregnant females had no anemia. Conclusion: Anemia was found in the majority of pregnant females visiting tertiary care teaching hospitals. The frequency of mild anemia was high and also according to severity. The most common morphological type of anemia was normocytic normochromic. The overall prevalence of anemia in pregnancy was 45% (n=42).55% of pregnant women were non-anemic and new severe anemia was detected.

Antimicrobial Resistance Patterns of Urine Culture in Tertiary Care Teaching Hospital Islamabad, Pakistan

Background: Urine cultures are performed in laboratories to identify any bacteria or other microorganisms present in urine samples. The purpose of this study was to investigate the microorganisms growing resistant to antibiotics in the urine culture and their antibiotics susceptibility testing. Methods: For this investigation, the Microbiology Department's hospital management information systems records provided the culture and sensitivity data of the uropathogens found in urine samples. Urine samples collected midstream were prepared for microscopy and culture, and the organisms were identified using globally accepted methods. The Kirby-Bauer disk diffusion method was used to determine antibiotic susceptibility in accordance with hospital clinical and laboratory standards as well as international protocols. In this investigation, the information and data were assessed using descriptive statistics. Results: A total number of 207 urine culture data were extracted from the hospital management information system records of which, 116 samples showed positive bacterial growth. Candida had positive growth in 16.4%. Out of positive samples gender-wise, females were in the majority 66.4% and males were 33.6%. Escherichia coli bacteria frequently isolated in positive samples 58/116 (50%), whereas, Enterococcus spp were positive in 17 patients out of 116 (14.7 %). Gram-negative rods were positive in 16 patients out of 116 (13.8%), Klebsiella spp were positive in 4 patients out of 116(3.4%) and Pseudomonas aeruginosa were least positive in only 2 patients out of 116 positive samples (1.7 %). Conclusion: In our study according to gender distribution female frequency was higher than males. Escherichia coli bacteria were the most common isolate in positive samples, whereas, Enterococcus spp were observed. Vancomycin was most sensitive in all urine cultures against all organisms and Erythromycin was most resistant in urine culture. Antimicrobial resistance is a serious subject on national and international levels that needs continued surveillance and resolute management.

Antimicrobial Susceptibility Pattern of Bacterial Pathogens in Our Setup: Ear, Nose and Throat Perspective

With a high prevalence of infections involving the ear, nose, and throat, and the occurrence of drug resistance the antimicrobial susceptibility pattern of bacterial pathogens is of immense importance. Objective: To determine the antimicrobial sensitivity profile of pathogenic bacteria isolated from representative infected areas of patients with ear, nose, and throat infections. Methods: This cross-sectional observational study was conducted at Ear, Nose and Throat (ENT) Outpatient Department (OPD), Capital Hospital Islamabad, over two years. The sample included 639 pathogenic bacterial culture specimens, grown from the representative infected ear, nose, or throat of patients who attended ENT outpatients of the hospital. The bacterial cultures were subjected to the standard disc agar diffusion method to know the antimicrobial susceptibility profile. Data collected included the patient’s age, gender, area/ site of infection, bacterial pathogen isolated, and sensitivity to antibiotics. Results: The sample included 49.30% males and 50.70% females and mean age of 30.13±19.24 years. Gram-positive organisms were predominant [n=441, (69.01%)] with Staphylococcus aureus being the commonest isolate (67.92%) followed by Pseudomonas spp. (26.13%). Gram-positive isolates were sensitive to Cefoperazone+Sulbactam, Ceftazidime, Cefoperazone, Amikacin, Pipercillin+Tazobactam, Vancomycin, Gentamycin, Linezolid, Amoxicillin + Clavulanate, and Ceftriaxone with resistance to Cefixime, while the Gram-negative isolates were sensitive to Vancomycin and Meropenum, Ciprofloxacin, Levofloxacin, Ceftriaxone and Ceftazidime and highly resistant to Cefixime, Cefuroxime, Amoxicillin+Clavulanate and Co-trimoxazole. Conclusions: Since ENT infections are predominated by Staphylococcus aureus and Pseudomonas spp. When unavoidable the empirical therapy should cover these pathogens, however culture and sensitivity studies are justified keeping in view the growing resistance to antimicrobials.

Prevalence and Causes of Blood Deferral in Tertiary Care Teaching Hospital Islamabad

Background: A blood transfusion is a vital and potentially life-saving operation in modern therapeutic and surgical procedures; yet, it requires a sufficient supply of safe blood from a healthy donor. In addition to laboratory testing of blood bags for infectious illnesses, appropriate, safe, and healthy donor selection is required. On the other hand, the loss of valuable blood components that are accessible for transfusion results from fit donors deferring. Understanding the reasons for both temporary and permanent deferrals can help us prevent this, put our knowledge into practice. The current study aimed to assess the incidence and reasons behind blood donor deferrals at Islamabad teaching hospital that provides tertiary care. Methods: This cross-sectional study was conducted at Dr. Akbar Niazi Teaching Hospital’s blood bank. All Blood donors reporting to donate blood at a blood bank between the periods of 1st September 2020 to 24th December 2021 were included in the study. The data was obtained by interviewing the donors using specially designed Performa. The collected data of deferred blood donors was analyzed using SPSS version 21. Results: Out of a total of 2054 blood donors, 523 (25.5%) were deferred due to different reasons and ineligible to donate blood. Out of 523 deferred donors, 455(87%) were males and 68(13%) were females. The average age of the blood donors was 26(4.2%) and most blood donors were between 20 to 40 years age. The common causes for deferral were low hemoglobin (41.3%), recent COVID-19 vaccination (12.6%) and increased TLC (7.1%). Hepatitis B virus 39(7.5%), Hepatitis C virus (4.4%), HIV 5(1.0%) and Syphilis 18 (3.4%). Conclusion: The most frequent reasons for delay were elevated TLC count, recent COVID-19 immunization, and low hemoglobin levels. The cornerstone of a safe blood supply is the donor education on self-exclusion and strict selection criteria.

Frequency of Prostatic Adenocarcinoma in Transurethral Resection of Prostatectomy Done for Benign prostatic Enlargement and Correlation with Serum Level of PSA

Background: Around the world, transurethral resection of the prostate, or TURP, is the most often used surgical procedure for treating benign prostatic hyperplasia (BPH). The current study is designed to evaluate the Frequency of prostatic Adenocarcinoma in transurethral resection of prostatectomy and its correlation with serum levels of PSA. Methods: The Retrospective study was conducted in the Histopathology Lab of Dr. Akbar Niazi Teaching Hospital Islamabad which is an PMDC-approved and ISO-9001-certified hospital. The data for this study was obtained by including consecutive cases of transurethral resection prostatectomy received for analysis in the histopathology lab during the study period. The data was retrieved from Histopathology record files. The slides were viewed and the diagnoses were confirmed. The patient’s serum PSA levels were retrieved from pre-operation hospital medical records. The Patients who presented to the histology lab for diagnosis were reassessed using a Questionnaire based on Performa divided into different sections such as socio-demographic data, reasons, History of Diseases, PSA level, Age, and complications. The collected data was analyzed using SPSS Version 21. Results: In 53 patients 11 were of Prostatic Adenocarcinoma, 14 were benign prostatic hyperplasia and 28 were prostatitis. with number and percentage. Prostate Specific Antigen value was different in patients. The highest reported value was 28ng/ml. The mean was 2.68 ng/ml. Most cases were present between the age group of 50-60 years with 32.1% Prostatic adenocarcinoma frequency was higher in the older age group levels above 4ng/ml were seen in prostatitis and BPH. Conversely, there were cases of prostatic adenocarcinoma with less than/ml PSA levels Conclusion: PSA levels were raised, above 4ng/ml in 8 cases while low in 3 cases of Prostatic adenocarcinoma. PSA levels were also raised in a case of prostatitis and two cases of BPH. We conclude that PSA levels although suggestive are not entirely specific for prostatic adenocarcinoma.

Quantitative and Qualitative Assessment of Hospital Waste Management at Capital’s Health Care Facility, Pakistan

The improper disposal of solid waste, particularly in developing countries, poses significant threats to the natural environment and public health, leading to increased pollution and disease prevalence. Hospital-generated solid waste, characterized by its heightened toxicity and contagion potential, further exacerbates these risks when mismanaged. This study undertakes an evaluation of the solid waste management (SWM) practices implemented at Pakistan Institute of Medical Sciences (PIMS) Hospital in Islamabad, with a specific focus on assessing their impact on the staff responsible for SWM. The data collection process encompasses on-site visits to check and compare the hospital wastes data available athospital servers as well as by the structured questionnaires. According to the gathered data, PIMS Hospital generates an annual total of 61,030 kilograms of hazardous waste and 254,866.9 kilograms of non-hazardous waste. Given its status as the capital&amp;#39;s healthcare facility, PIMS Hospital maintains a well-established and satisfactorily functioning standard of SWM system. This system includes the segregation of hazardous and non-hazardous waste at the point of generation, facilitated by a color-coded scheme. Non-hazardous waste is then transported to a secure covered storage site using specialized trolleys, while hazardous waste is safely disposed of through the utilization of on-site, double-chambered incinerators. Data analysis underscores the heightened occupational risks faced by SWM personnel, including an increased likelihood of sharp injuries, and disease exposure, as well as the prevalent experience of stress and anxiety. The study's findings necessitate the imperative adoption of standardized practices for the proper handling, treatment, and disposal of solid waste by the involved staff. Furthermore, a critical recommendation arises from the need for routine health monitoring of SWM workers by qualified medical professionals through established mechanisms to mitigate the potential transmission of diseases to their family members. Such measures are paramount in safeguarding the health and well-being of both the SWM staff and the broader community.

The frightening disease burden of blood culture proven XDR Typhoidal isolates in pediatric population in a tertiary care hospital in Islamabad; Time to implement a holistic approach countrywide

Background: Typhoid fever is a deadly enteric bacterial infection and millions of people all over the globe are endangered of acquiring it. Since the first outbreak of XDR typhoid in Pakistan in 2016, the ever-rising resistance of typhoid has become a major threat faced by the pediatric population of Pakistan. There is a dearth of available data in children harboring this extensively drug resistant pathogen countrywide. The objective of this study is to highlight the alarmingly increasing prevalence of XDR S. typhi in pediatric population in Federal territory in Pakistan. Material and Methods: This Cross-sectional study was conducted at Microbiology Lab, Children Hospital, PIMS from June 2022 to May 2023. Blood culture samples of children (with strong clinical suspicion of typhoid) ranging one till 12 years (both genders). Result: Out of a total of 245 typhoid suspected blood culture samples, 153 (62%) samples yielded growth of typhoidal Salmonella isolates with 109 (71 %) isolates proved as XDR Salmonella Typhi ,35 (23%) as MDR Salmonella Typhi and the rest 09 cases (6 %) were Salmonella paratyphi A. There was a male predominance of 96(63%) and the rest 57(37%) were females. Age range most commonly affected was 5-8 years followed by 9-12 yrs. There was 100% susceptibility to Meropenem in XDR typhoid cases and 99% XDR cases were susceptible to Azithromycin. Conclusion: We concluded that there is widespread existence of MDR/ XDR S.typhi in pediatric population in federal territory as well as all over Pakistan but there is scarcity of documented data nationwide. Hence, our study signifies that a holistic approach should be implemented along with continuous ongoing surveillance to combat this frightening MDR/ XDR disease burden in this particular population. Key Words: Salmonella Typhi, Extensively Drug Resistant (XDR), Typhoidal isolates

Frequency Of Hematological Abnormalities in Children (Age 1 Month To 12 Years) Presenting With Sars-Cov-2 Infection At Shifa International Hospital

Objective: To determine the frequency of haematological abnormalities in pediatric patients presenting with COVID-19 infection. Methods: A Cross-Sectional analytical study was conducted at the paediatric department of Shifa International Hospital Islamabad, over a period of six months from December 2021 to June 2022. A total of 325 pediatric patients of 1 month to 12 years of age who presented with symptoms of COVID-19 having positive reverse transcription polymerase chain reaction results were included in this study. Effect modifiers such as age and gender were controlled through stratification. Post-stratification Chi-square test was applied to determine the association of these effect modifiers with haematological abnormalities. A p-value equal to or less than 0.05 was considered significant. Data analysis was done using SPSS version 24.0. Results: The mean age of patients included in this study was 5.62±2.70 years. The majority were males with a male to female were 187(57.54%) and 138 (42.46%) respectively. Low WBC count was found in 58 (17.8%), leukocytosis in 20 (6.2%), thrombocytopenia in 43(13.2%), thrombocytosis in 06(1.8%), neutropenia in 69 (21.2%), lymphopenia in 17 (5.2%), lymphocytosis in 59 (18.2%), monocytopenia in 10 (3.1%), deranged fibrinogen levels in 07 (2.2%), deranged D-Dimers in 154 (47.4%) and deranged INR in 166 (51.1%) patients. Conclusion: Hematological abnormalities are common in children presenting with COVID-19 infection. Deranged INR, D-Dimers, low WBC count, thrombocytopenia and neutropenia were commonly found in haematological abnormalities in children with COVID-19 infection. Keywords: COVID-19, Hematological abnormalities, Neutropenia, SARS-COV-2 infection.

Efficacy Of Triamcinolone Injection In Management Of Oral Lichen Planus

Objective: To study the efficacy of triamcinolone injection in the treatment of oral lichen planus patients presented to the department of oral and maxillofacial surgery at KRL General Hospital Islamabad. Method: This study was conducted in the Department of Oral &amp; Maxillofacial Surgery, Kahuta Research Laboratories Islamabad. 100 patients who fulfilled the inclusion-exclusion criteria were selected. All the enrolled patients were treated with intralesional TA injection once a week for 4 weeks. A 0.5ml TA (40mg/ml) dose was used. The subepithelial tissue just beneath the lesion and next to the normal mucosa was the exact location of the injection. The treatment was stopped earlier when all three of the symptoms of burning, pain and patch colour were removed. The patients were examined clinically on the 7th, 14th, and 21st day of treatment and based on the examination, the decision of the next dose was decided. The final examination of the patient was on the 28th day of treatment. To assess the oral pain and burning, we used the Visual Analogue Scale (VAS) having 10 grades (0-10). Results: The mean age of the patients in the study was 35.47±13.459 ranging from 18 to 65 years. In frequency of gender of the patients, there were 57(57%) male and 43(43.0%) female patients. In frequency of distribution of patients, 38(38.0%) patients had unilateral while the remaining 62(62.0%) had bilateral disorders. In frequency of efficacy, 87(87.0%) patients found with improved symptoms and 13(13.0%) were not improved/inefficient. Conclusion: This study concluded as much of previous literature concluded that the efficacy and safety of intralesional TA injection were found efficient after observation at 28th weeks of treatment. Keywords: Triamcinolone injection, Oral lichen planus, Efficacy, Reticular, Plaque.

Effectiveness of Hypnobirthing in Reducing Anxiety Level among Pregnant Women During Childbirth: A Quasi-Experimental Study in Tertiary Care Hospital of Islamabad

Background: Anxiety during pregnancy is a prevalent concern with significant implications for both maternal and fetal health. Traditional approaches to managing this anxiety vary in effectiveness, highlighting the need for alternative strategies. Hypnobirthing, a technique focusing on mind-body relaxation, has emerged as a promising intervention to reduce pregnancy-related anxiety. Objective: This study aimed to evaluate the effectiveness of hypnobirthing in reducing anxiety levels among pregnant women. Methods: A quasi-experimental design was employed, involving 30 primigravida women with gestational ages between 32 and 38 weeks, recruited from a tertiary care hospital in Islamabad. Participants were divided equally into experimental and control groups. The experimental group received four weeks of hypnobirthing sessions, while the control group received standard prenatal care. Anxiety levels were assessed using the Hospital Anxiety and Depression Scale (HADS) before and after the intervention. Data were analyzed using SPSS version 25.0, with paired samples t-tests comparing pre- and post-intervention anxiety levels. Results: The average age of participants was 22.17 years. Initially, 87% of participants reported high levels of anxiety. Post-intervention, the experimental group showed a significant reduction in anxiety levels, with 67% of participants reporting normal anxiety levels (p&lt;0.000), while the control group showed no significant change in anxiety levels (p=0.314). The mean difference in anxiety levels between the pre- and post-intervention phases in the experimental group was significant at 6.867 (SD=4.470, p&lt;0.000). Conclusion: Hypnobirthing significantly reduced anxiety levels among pregnant women, suggesting its efficacy as a therapeutic intervention for managing pregnancy-related anxiety. This technique offers a valuable addition to prenatal care, potentially improving maternal and fetal outcomes by alleviating anxiety during pregnancy.

Comparison of Functional Outcomes of Two Different Rubber Dam Systems in Dental Practices

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; The rubber dam is the only method that can ensure complete isolation during dental procedures. During endodontic and restorative procedures, it improves patient protection, treatment efficacy, and infection control. A novel rubber dam system called Optradam has introduced a remarkably comfortable, user-friendly clamp-free technique. Therefore, this study was conducted to compare conventional rubber and OptraDam&amp;reg;Plus (Ivoclar Vivadent) based on patients&amp;rsquo; and dentist preferences.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;After receiving ethics board clearance, this trial was carried out at the Department of Operative Dentistry at a tertiary care hospital in Islamabad from June to December 2022. A total of 30 participants were assigned to each group; conventional rubber dam (Group-1) and OptraDam&amp;reg;Plus (Group-2). Two questionnaires were designed and validated one to be completed by dental practitioners and the other by patients. The gathered information was analyzed using statistical tests of significance.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 60 patients were treated; 31 (52%) males and 29 (28%) females with a mean age of 32.35 years (SD = 4.59). Both the dentists (80% ) and the patients (73.3%) favored the conventional rubber dam system (Group-1). Concerning patient comfort, the conventional rubber dam (96.7%) was considered more comfortable than the OptraDam&amp;reg;Plus (Group-2) (86.7%). More effective moisture management was seen in Group-1 patients (90%). Other factors, such as time, convenience of application, and imaging radiography, had statistically insignificant results among both groups.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The results indicate that both patients as well as operators, preferred the use of conventional rubber dams over OptraDam&amp;reg;Plus during an endodontic and restorative procedure.&lt;/p&gt;