Pakistan Institute Research Articles

Comparison of Phenylephrine infusion vs Nor-epinephrine Infusion on Maternal Hemodynamics and Neonatal Outcomes During Elective Lower Segment Caesarean Section under Sub-Arachnoid Block

Objective: To compare the efficacy of Phenylephrine and Nor-epinephrine IV infusions in maintaining maternal hemodynamics during EL-LSCS. Methodology: This randomized control trial study was conducted department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad from March, 2023 to November, 2023. This study enrolled 62 patients fulfilling the inclusion criteria i.e., patient of age 18-45 years undergoing elective LSCS under SAB were enrolled in the study. While those having hypertension, pre-clampsia, eclampsia, pre-existing bradycardia, fetal distress and hypersensitivity to the medications used in the study were excluded. Enrolled patients were divided into two groups using computer generated random numbers with Group N patients received Nor-epinephrine infusion at rate of 2.5 Mcg/min while Group P patients received phenylephrine infusion at rate of 50 Mcg/min. Intraoperatively maternal hemodynamics were monitored and infusions were titrated to effect. Neonatal outcomes were assessed using APGAR score with umbilical cord ABGS carried out if clinically indicated. Results: Group P patients had statistically significant lower mean heart rate at 5,10,15 and 20 minutes as compared to group N. Similarly, pressures were significantly higher in group P than group N at 5,10,15,20 and 25 minutes. This required frequent changes in the rate of Phenylephrine infusion with the desired effect being achieved after 25 minutes of induction of Sub-Arachnoid block. Conclusion: Low dose Nor-Epinephrine infusion is safe and provides a better hemodynamic profile during Caesarean Section.

Expression of Bcl-2 in Squamous Cell Carcinoma of Oral Cavity

Objectives: To investigate the expression of Bcl-2 in squamous cell carcinoma of the oral cavity. Methodology: This descriptive cross-sectional study was conducted at the Department of Histopathology, Pakistan Institute of Medical Sciences, Islamabad, from December 2021 to June 2022. Sixty patients aged 30 to 85 years, of both genders, diagnosed with squamous cell carcinoma of the oral cavity based on histopathology reports, were included. Immunohistochemistry for Bcl-2 was performed and assessed. All results were subsequently analyzed using SPSS Version 20. Results: Out of the 60 cases studied, 36 were males (60%) and 24 were females (40%). The mean age of the patients was 55 years. The most common histological grade was well-differentiated squamous cell carcinoma, accounting for 26 out of 60 cases (43.3%), followed by moderately differentiated squamous cell carcinoma (21/60, 35%). Poorly differentiated squamous cell carcinoma was the least common grade, found in 13 out of 60 cases (21.7%). Bcl-2 expression was positive in 23 patients (38.3%). Regarding grade-wise expression of Bcl-2, there was an increasing expression with increasing grades of oral squamous cell carcinoma: 19% Bcl-2 expression in well-differentiated squamous cell carcinoma, 38% in moderately differentiated squamous cell carcinoma, and 77% in poorly differentiated carcinomas. This demonstrated a significant correlation between Bcl-2 expression and histopathological grades (p value <0.001). Conclusion: In summary, Bcl-2 expression was detected in 38.3% of oral squamous cell carcinoma cases. Its immuno-expression is significantly associated with the histopathological grades of oral squamous cell carcinoma. Therefore, Bcl-2 can be considered an important prognostic marker as well as a potential target for chemoresistance cases through Bcl-2 inhibition.

Atracurium for Rapid Sequence Induction; A dose determining Randomized Control Trial at a Tertiary Care Hospital.

Introduction: Expert airway management is one of the essential anesthetic skills. Rapid Sequence induction is a technique of providing rapid securement of airway with endotracheal tube in patients who are at risk of aspiration. Objective: To find out the efficacy of 3-4 ED95 dose of Atracurium in providing optimal intubating conditions for Rapid Sequence Induction. Methodology: Single-blind randomized control trial was carried out Department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad. 118 patients were included and divided into two groups by help of computer-generated random numbers. All the patients were pre-medicated with 8 mg of IV Dexamethasone. Group A patients received 1 mg/kg while group B patients received 0.75 mg/kg of Atracurium. Intubating conditions were assessed on the basis of number of coughing episodes along with degree of vocal cord movement or paralysis. Results: Patients who received 0.75 mg/kg of Atracurium had statistically significant better intubating conditions as compared to those receiving 1 mg/kg of Atracurium (p value < 0.05). Coughing episodes were more common among patients receiving higher dose of Atracurium while degree of vocal cord paralysis was similar in both groups. Furthermore 75% of histamine related adverse effects such as erythema and bronchospasm were observed in higher dose group. The difference was statistically significant with a p value of <0.05. Conclusion: Atracurium at a dose of 0.75 mg/kg along with pre-medication with 8 mg of IV Dexamethasone provided better and safer intubating conditions for rapid sequence induction.

Therapeutic Effects of Probiotics In The Reduction of Neonatal Hyperbilirubinemia

Objective: To evaluate probiotics' effects in reducing hyperbilirubinemia in late preterm and term neonates. Study Design: Quasi-experimental study Place and Duration of Study: Department of Neonatology, Pakistan Institute of Medical Sciences (PIMS), Islamabad Pakistan, from Oct 2018 to Mar 2019. Methodology: The quasi-experimental study was conducted on 60 neonates with hyperbilirubinemia. They were randomlydivided into two Groups. Group-A (n=30) received phototherapy. Group-B (n=30) received probiotics containing Lactobacillus reuteri at a dose of 5 drops daily for three days, in addition to phototherapy. Total serum bilirubin was calculated at 0, 24 and 72 hours for both Groups. Results: In Group-A, the mean total bilirubin in mg/dl at 0, 24 and 72 hours were 18.14±2.35, 15.28±2.93 and 12.31±2.29, respectively. Similarly, in Group-B, it was 19.86±5.85, 16.23±4.01 and 10.75±2.23 at 0, 24 and 72 hours, respectively. There was an insignificant statistical difference in mean total bilirubin between Groups A and B at 0 and 24 hours (p<0.001). However, when comparison was made at 72 hours, a significant statistical difference was observed in Group-B (Intervention Group) (p=0.005) Conclusion: Probiotics significantly lowered total serum bilirubin in neonates with hyperbilirubinemia. Further studies are required to evaluate its role in physiological and pathological jaundice.

Leadership on Performance vs. Mediating Effect on Job Satisfaction: Evidence From Higher Educational Institutions in Pakistan

This study aims to determine how transactional leadership influences organizational performance with a mediating effect on employees’ job satisfaction. The theoretical and numerical link between these variables of the research topic is highlighted in this study. Quantitative information is gathered for the study utilizing a random sampling method. The HODs of the academic institutions in the Gujranwala region filled out 290 questionnaires that were used to collect the data. Two hundred seventy-two can be used while the remaining are partly filed. Smart PLS 4 was used to examine the data’s validity and verify the correlations between the research variables. The validity and reliability of the questionnaire, which was used to gather the data, may be assessed by how precisely the findings were analyzed. Based on data generated by the “smart PLS 4 program,” an organization’s success depends on its leadership practices, and the mediating variable positively correlates with transactional leadership. This is a unique study for the educational sector of the Gujranwala region, Pakistan, and it calls for more research on leadership and organizational performance.

Academic community’s use of university digital library and their searching behaviour

Purpose This study aims to explore the evidence-based usage patterns of higher education commission (HEC) subscribed e-journal databases in the university digital library used by the scholarly community and the academics’ online searching behaviour at a higher education institution in Pakistan. Design/methodology/approach The study used an explanatory sequential mixed methods approach. Raw transaction log data were collected for quantitative analysis, and the interview technique was used for qualitative data collection and thematic analysis. Findings Log analysis revealed that HEC subscribed databases were used significantly, and among those, scholarly databases covering various subjects were more frequently used than subject-specific society-based databases. Furthermore, the users frequently accessed the needed e-journal articles through search engines like Google and Google Scholar, considering them sources of free material instead of the HEC subscribed databases. Practical implications It provides practical implications for examining the evidence-based use patterns of e-journal databases. It suggests the need for improving the access management of HEC databases, keeping in view the usage statistics and the demands of the scholars. The study may also help create market venues for the publishers of scholarly databases by offering attractive and economical packages for researchers of various disciplines in developing and underdeveloped countries. The study results also guide the information professionals to arrange orientation and information literacy programs to improve the searching behaviour of their less frequent users and enhance the utilization of these subscribed databases. Originality/value The study is part of a PhD project and, to the best of the authors’ knowledge, is the first such work in the context of a developing country like Pakistan.

C-Reactive Protein as a Prognostic Indicator: Navigating the Challenge of Predicting Severity and Mortality in Acute Pancreatitis

Objective: The main goal was to evaluate the effectiveness of C-reactive protein (CRP) in assessing acute pancreatitis severity 48 hours after onset by contrasting its results with CT scans.
 Methodology: This cross-sectional study, which lasted six months from May to December 2019 at the Department of General Surgery, Pakistan Institute of Medical Sciences, comprised 150 suspected cases. CT scans and serum samples were taken 48 hours after the onset of symptoms. A postgraduate trainee created reports using a standard proforma to record CT scan results and CRP levels.
 Results: The average age of the patients was 45.03±10.86 years, with severe acute pancreatitis confirmed in 28.7% of cases by CT scans. CRP demonstrated notable diagnostic values: sensitivity 81.4%, specificity 92.52%, PPV 81.4%, NPV 92.52%, and an overall accuracy of 89.33%.
 Conclusion: C-reactive protein (CRP), a product of interleukin-1 and interleukin-6 responses by the liver, emerges as a valuable and cost-effective biomarker. Its consistent elevation in correlation with pancreatitis severity, especially within the critical 48-hour window, suggests its potential as a reliable predictor. This study underscores CRP's diagnostic utility and accessibility, emphasizing its role in assessing acute pancreatitis severity.
 
 Key Words: C-reactive protein, CT scan, Acute pancreatitis

Assessment of sleep quality in severe COVID-19 hospitalised patients.

To evaluate the quality of sleep in patients hospitalised with coronavirus disease-2019, and its impact on hospitalisation duration, need for intensive care unit admission and mortality. The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from May 2, 2021 to April 30, 2022, and comprised hospitalised coronavirus disease-2019 patients. Data was gathered using the Pittsburgh Sleep Quality Index questionnaire, including demographics, comorbidities, length of hospital stay, need for intensive care unit admission, C-reactive protein and D-dimer values at admission, and the outcome. The patients were divided into group A having good sleep quality score >5 and group B having poor sleep quality score <5. Data was analysed using SPSS 25. Of the 1,250 patients, 559(44.7%) were males and 691(55.3%) were females. There were 560(44.8%) patients in group A with mean age 53.80±14.85 years, and 690(55.2%) patients in group B with mean age 53.71±14.32 years. There were no significant intergroup differences in terms of age and high-resolution computed tomography scan (p>0.05). The difference was significant with respect to gender, comorbid conditions, education status as well C-reactive protein and D-dimer levels (p<0.001). Group B patients had a longer duration of hospitalisation (p<0.001) and a higher need for intensive care unit admission (p<0.001) compared to group A. The outcome was death in 166(13.28%) patients in group B compared to 40(3.2%) in group A (p<0.001). Poor sleep quality was found to be associated with longer hospital stay, increased need for mechanical ventilation, and higher mortality rate in coronavirus disease-2019 patients.

The antibiogram of pus cultures in federal tertiary care hospital, Islamabad and its utility in antimicrobial stewardship.

Antimicrobial resistance has emerged as a significant global health threat. Infections caused by Multi Drug-Resistant (MDR) bacteria pose formidable challenges in terms of treatment options and patient outcomes. Pus cultures serve as crucial diagnostic tools in identifying the agents responsible for various infections, and their antimicrobial susceptibility patterns which help in establishment of empirical therapy guidelines. This study was conducted to determine the pathogen and its susceptibility pattern from pus cultures and to generate antibiogram in our tertiary care setting. It was a cross-sectional study, conducted for a period of six months, from July 2022 to December 2022, in the Pathology Department of Pakistan Institute of Medical Sciences (PIMS). Out of total 2507 samples received, 1242 (49.5%) showed positive culture. Among the 1242 positive samples, 364 were Gram positive cocci (GPCs) and 878 were Gram negative rods (GNRs). Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolate (23%) followed by Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (16.9%), Enterobacter spp. (15.5%) and Escherichia coli (14.2%). Vancomycin was found to be highly effective (100%) against MRSA. GPCs were highly susceptible to linezolid (98%) while GNRs showed high level of sensitivity to colistin (96%) and tigecycline (92%). The generation of a local antibiogram specific to the hospital setting is essential to effectively manage infections empirically and preserve the efficacy of existing antibiotics. By implementing antimicrobial stewardship practices based on a better understanding of antibiotic susceptibility patterns, we can contribute to the mitigation of antibiotic resistance and improve patient outcomes.

Political Stability and Performance of Financial Institutions in Pakistan

The purpose of the present study is to analyze the impact of political stability on the performance of financial Institutions in Pakistan. This is the first study in the context of Pakistan that analyzes the performance of financial institutions during the period of political stability. The study's sample period was from 2008 to 2017 because, for the first time in Pakistan, two pure political governments completed their electoral term since the country's independence in 1947. The data is collected from the balance sheet analysis provided by the State Bank of Pakistan on its official website. For the data analysis, the study used the CAMEL analysis technique. The CAMEL analysis technique was also used by the IMF in 2020 to analyze the performance of underdeveloped and developing countries of the world. The results show that the performance of locally owned financial institutions (MCB Bank, United Bank Limited, and Allied Bank) in Pakistan increased during this period. Still, foreign-owned bank's performance is not good even if they cannot fulfill the minimum requirement established by the State Bank of Pakistan. The results contribute to the efficiency theory of financial institutions. Further, the study suggests that the researchers can test the significance of the results by changing sectors to confirm, modify, accept, or reject the results.

Enhancing Trust in Healthcare: The Role of AI Explainability and Professional Familiarity

The integration of Artificial Intelligence (AI) in healthcare has been impeded by a significant issue: a lack of trust among healthcare professionals, stemming from the opacity of AI decision-making processes and a general unfamiliarity with AI technologies. This study investigates the impact of AI's explainability and healthcare professionals' familiarity with AI on their trust in AI applications within healthcare settings. Adopting a quantitative research methodology, the study utilized a structured questionnaire to gather data from a diverse group of healthcare professionals, including doctors, nurses, and administrators, across various hospitals and healthcare institutions in Pakistan. The research employed a stratified random sampling approach to ensure a comprehensive and representative data set. The results indicated a positive and significant relationship between AI explainability and trust in AI (Path Coefficient: 0.62, t-Value: 5.20), suggesting that clearer and more transparent AI decision-making processes enhance healthcare professionals' trust., Similarly, familiarity with AI was found to positively influence trust in AI (Path Coefficient: 0.48, t-Value: 4.35), highlighting the importance of exposure and understanding of AI systems among healthcare professionals. These findings have crucial implications for both AI developers and healthcare administrators. For AI developers, the emphasis must be on creating more transparent and interpretable AI systems. For healthcare administrators, the results suggest the need to invest in training and educational programs to increase professionals' familiarity with AI, thereby enhancing trust and acceptance. The study significantly contributes to the existing literature by empirically validating the importance of AI explainability and familiarity in building trust in AI within the healthcare context, especially in a developing country setting. For policymakers, these insights are critical in guiding strategies and policies aimed at effectively integrating AI into healthcare systems. By addressing the identified factors, healthcare sectors can better leverage AI's potential, leading to improved patient care and more efficient healthcare operations.

Knowledge, attitude, and awareness of cardiopulmonary resuscitation among university enrolled medical and non-medical students of Pakistan: An online study.

To evaluate the awareness, attitude and knowledge of cardiopulmonary resuscitation (CPR) among university-enrolled medical and non-medical undergraduate students of Pakistan. Cross-sectional online survey-based study was conducted across institutes in Pakistan from December, 2022 to January, 2023. The study involved university-enrolled undergraduate students across the country. The structured questionnaire was disseminated via Google forms. For statistical analysis, SPSS version 20 was used to analyze the data by applying independent sample t-tests and ANOVA. A total of 249 responses were received. After the exclusion of two responses, the overall awareness score of participants was found to be 2.49 ± 1.33, attitude score of 4.09 ± 1.74, and knowledge score of 3.51 ± 2.13. Female respondents, medical students, unmarried (single), private institutes, and respondents with educated parents achieved relatively higher scores. The overall difference in awareness scores among different regions of Pakistan was also significant (p <0.05). Gender, region, and parental literacy rate also showed effects on participants' basic life support (BLS) and CPR knowledge (p <0.05). Overall knowledge and awareness were unsatisfactory and inadequate in university-enrolled undergraduate students, with no one getting a complete score on very basic knowledge questions. Significant differences in awareness, attitude, and knowledge among different regions, genders, and parental literacy rates were found.

The role of Satisfaction predictors in determining Revisit Intentions of patients in Private Health Institutions of Pakistan

This study is conducted to investigate the relationship of patient satisfaction with service quality and revisit intention of patients in private hospitals of Pakistan. The research was conducted by quantitative and cross-sectional survey-based method, where 334 responses were collected through convenience sampling technique from patients and attendants visiting the private hospitals in Pakistan. The data was analysed using SEM-PLS. Results revealed that patient satisfaction levels mediate the relationship between service quality parameters and revisit intentions of patients in private healthcare sector of Pakistan. This study contributes in helping the healthcare policy makers in adopting patient-centric structures for betterment of their service quality and enhancing patient satisfaction, eventually increasing the revisit intentions.

Social Acceptability and Health Concerns of Smoking and Vaping Among University Students: A Cross-Sectional Study.

This study aimed to assess tobacco and vaping habits among university students, exploring awareness of university policies, attitudes, and behaviors related to smoking and vaping. An online questionnaire was distributed among students from various universities, including institutions in Pakistan, covering demographics, smoking and vaping behaviors, awareness of policies, and beliefs. Data was analyzed using descriptive statistics, Binomial tests, Chi-square tests, and logistic regression. Out of the total 683 respondents, 65.02% were female, and 34.98% were male. Most participants were undergraduate students (71.31%), with Dentistry being the most represented field (50.36%). Most students perceived smoking or vaping as socially acceptable (58.3%) and were aware of university policies (59.3%). However, 46.6% were aware of cessation programs. Most of the students expressed concern about long-term vaping health risks (74.5%). Logistic regression identified gender (Male) and field of study (Dentistry) as significant predictors of policy awareness. University students exhibit varied perceptions and behaviors related to smoking and vaping. The study highlights the importance of implementing effective policies and interventions to address tobacco and vaping use among them.

Work Engagement in Higher Education Institutes of Pakistan: The Role of Skill, Motivation and Opportunity Enhancing HRM Practices

In the current business environment, organizations are giving a lot of attention to employee engagement. Therefore, the present study’s goal was to examine the connection between skill, motivation, and opportunity -enhancing HRM practices and employee engagement with respect to academic staff working in higher education, Sindh, Pakistan. The studyemploys a quantitative research design based on SPSS and Smart PLS. Data were gathered from 307 academician working in the staff working in higher education Sindh, Pakistan. The survey approach was used to gather the data for the cross-sectional research. The findings of the study show a connection between employee engagement and HRM practices. Organizations’ HRM practices gave employees more authority and engagement, which improved their performance in their jobs. The findings of the study suggest that for universities to succeed in the long run, skill, motivation, and opportunity enhancing HRM practices should be prioritized. Therefore, organizations should concentrate on and efficiently apply human resource management practices to increase employee commitment and engagement physically, cognitively, and emotionally with their work. This study extents social exchange theory, it also offers universities insight into the significance of having efficient HRM procedures to raise academicians' levels of commitment to their jobs.

Challenges and Prospects of Private Higher Education in Pakistan

Private Higher Education (PrHE) in Pakistan has experienced significant growth in recent decades, contributing substantially to the nation's educational landscape. This study explores the multifaceted challenges and prospects confronting PrHE in Pakistan. Through a comprehensive review of existing literature, the research aims to provide a nuanced understanding of the current state of PrHE and its potential trajectories. The desk research was used to gather information and data from books, journals, reports, databases, and online resources, including relevant websites related to PrHE in Pakistan. The challenges facing private Higher Education Institutions (PrHEIs) in Pakistan encompass diverse dimensions. Financial sustainability emerges as a prominent concern, with institutions grappling with funding constraints, tuition fees, and students' economic realities. Quality assurance and accreditation processes pose inherent challenges, necessitating a robust framework to uphold educational standards and credibility. Furthermore, issues related to governance, regulatory frameworks, and equity in access underscore the complex landscape within which PrHE operates. Despite these challenges, the prospects for PrHE in Pakistan present opportunities for innovation, collaboration, and positive contributions to national development. The sector has demonstrated adaptability, responding to evolving demands by introducing diverse programmes and modes of delivery. The potential for public-private partnerships, industry linkages, and global collaborations offers avenues for enhancing educational quality and relevance. Moreover, the role of PrHEIs in fostering entrepreneurship and addressing specialised educational needs is critical for addressing the evolving demands of the job market. This research underscores the need for a strategic and collaborative approach to address the challenges while capitalising on the prospects within PrHE in Pakistan. By identifying key areas of improvement and fostering a conducive environment for growth and innovation, policymakers, educators, and stakeholders can contribute to the continued development and sustainability of PrHEIs in the country. Keywords: Growth, Challenges, Prospects, Private Higher Education, Pakistan

Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan

Objective: This study examined the levels of Post-Traumatic Stress Disorder (PTSD) in pediatric cancer caregivers and the impact of spirituality on PTSD in Pakistan. Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Oncology, Shaukat Khanum Memorial Cancer Hospital &amp; Research Centre, Peshawar, Northwest General Hospital &amp; Research Centre, Peshawar in Khyber Pakhtunkhwa (KPK), Pakistan Institute of Medical Sciences, Islamabad and Quaid-e-Azam International Hospital in Islamabad, Pakistan from January 2023 to March 2023.Methods: The study comprised 153 Caregivers of pediatric cancer patients aged One month –12 Years using convenience sampling. The PTSD Checklist-Civilian Version (PCL-C) and Caregiver's Spirituality Scale (CSS-10) were used to collect data. Results: Results of the study found that 81 caregivers (52.94%) had high PTSD, and 96 (62.74%) had high spirituality. Females reported higher PTSD and spirituality than guys. Graduates have more PTSD and spirituality than illiterates and matriculate. PTSD and spirituality had a negative Pearson's Correlation Coefficient. Conclusion: The study emphasizes spirituality as a caregiver's mental health protector. Healthcare practitioners caring for pediatric cancer patients can use the findings to lessen PTSD symptoms by targeting caregivers' spiritual needs. Convenience sampling and self-report measurements decrease generalizability. Future study is needed to investigate the association between PTSD and spirituality in caregivers of pediatric cancer patients.How to cite this: Bashir N, Ain Q, Karim N, Niazi H, Khan MI, Asghar AK. Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan. Life and Science. 2024; 5(1): 33-40. doi: http://doi.org/10.37185/LnS.1.1.440

Perceptions, Challenges, and Opportunities of Chinese Language Learning in Punjab and Sindh, Pakistan: Exploring the Role of CPEC

China-Pakistan Economic Corridor (CPEC) projects and Confucius Institutes in Pakistan encourage Chinese language (CL) learning for education, jobs, and other activities. The study explores CL learners’ attitudes, obstacles, and motivations in Punjab and Sindh, Pakistan, and the CPEC’s role in promoting CL education. The research uses a mixed-methods approach to obtain quantitative and qualitative data. The data collection comprised a 5-point Likert scale study with 19 closed-ended and two open-ended questions. Results suggest that both provinces’ students favor CL learning. However, the Mann–Whitney U test indicates Sindh learners’ perspectives, and motivations differ significantly. They generally support CL learning but express concerns about their local language and culture, leading to resistance against foreign language influence in their province. The study illuminates’ student attitudes, obstacles, and motivations in Punjab and Sindh CL learning. The research also explores the potential impact of CPEC on CL education and identifies postproficiency opportunities for learners. These findings influence educational policymakers, language educators, and stakeholders in Pakistan to encourage CL learning. Ultimately, the research is aimed at enhancing CL education in Pakistan, enabling learners to benefit from language proficiency in the context of growing socioeconomic ties between Pakistan and China.

Esophagogastroduodenoscopy at a Tertiary Care Hospital: Common Indications, Endoscopic Findings and Interventional Approach

Objective: Esophagogastroduodenoscopy (EGD) is frequently performed as a screening, diagnostic and therapeutic procedure in patients presenting to gastroenterology department. No data documentation of EGD with demographics, indications, findings and intervention performed is available for our tertiary care setup in recent years. The aim of this study is to assess the common indications, esophagogastroduodenoscopy (EGD) findings and therapeutic procedures performed in patients undergoing EGD for various gastrointestinal (GI) symptoms.&#x0D; Methodology: A cross sectional study was conducted on 127 patients in department of Gastroenterology, Pakistan Institute of Medical Sciences Hospital. Duration of study was six months. Collected data included name, age, gender, indications for EGD, mode of presentation, EGD findings and therapeutic procedures that were performed. Statistical package for social sciences version 23 was used to analyze the data.&#x0D; Results: Mean age was 47.85 ± 6.74 years with male to female ratio of 1.04. Most common indications for EGD included upper GI bleed 25.19% and dyspepsia 22.83%. The three most common EGD findings were esophageal varices (34.64%), portal gastropathy (24.4%) and mild gastritis (14.96%). Variceal banding was the most common procedure performed.&#x0D; Conclusion: In our tertiary care hospital, upper GI bleed is the most common indication for EGD. Esophageal varices is the most common EGD finding encountered and variceal banding is the commonest procedure performed.&#x0D; Key words: Esophagogastroduodenoscopy; EGD; Upper gastrointestinal endoscopy; Upper gastrointestinal bleed; Varices; Gastritis; Gastropathy; variceal banding

Accuracy of Haematology Analyzer in the Diagnosis of Malaria in Comparison with Gold Standard Microscopy

Objective: To assess the accuracy of Haematology analyzer in the diagnosis of malaria in comparison with gold standard microscopy.&#x0D; Methodology: A cross-sectional study was conducted at the Pakistan Institute of Medical Sciences and the Pakistan Atomic Energy Commission in Islamabad, Pakistan. The study was conducted for around six months, from May 2023 to October 2023. The Mindray BC-6200 haematology analyzer was utilised to evaluate a total of 191 samples, comprising 127 samples from that were infected with malaria and 64 samples from healthy controls. When the presence of malaria parasites, identified as Plasmodium vivax and Plasmodium falciparum, was detected in dyed thick blood film, a microscopy examination was carried out as a reference. Analyse-it v4.92.3 was used to create the receiver operating characteristic (ROC) curve analysis. The agreement between BC-6200 and light microscopy was assessed using the Kappa value.&#x0D; Results: The InR by BC-6200's sensitivity and specificity for P. falciparum and P. vivax infections. The sensitivity of the InR by BC-600 for P. falciparum and P. vivax was 27.9% and 85.5%, respectively. The specificity of the InR by BC-6200 for P. vivax and P. falciparum was 82.7% and 86.5%, respectively. The infection densities in microscopy varied statistically significantly between the various InR groups (χ2 = 14.50, P &lt; 0.005).An analysis was conducted on the correlation between the cell blood count and the count of InR in both the P. vivax and P. falciparum-infected patient groups. The results showed a clear correlation between InR (P. vivax group R2 = 0.87) and ΔWBC (WBCDIFF–WBCBASO). In the Mindray BC-6200 haematology analyzer, WBCBASO represents the number of WBC counting in the BASO channel with severe membrane degradation, while WBCDIFF represents the number of WBC counting in the DIFF channel with mild lyse. The volume distribution widths of RBC, HGB, and red blood cells did not differ substantially. The reticulocyte characteristics of the P. vivax/P. falciparum patient group and control group differed significantly (P&lt;0.02), although RBC, HGB, and red blood cell volume distribution width (RDW) did not differ significantly (P &gt; 0.05). There was a significant difference (P&lt;0.02) in the PLT count between the P. vivax/P. falciparum patient groups and the control group.&#x0D; Conclusion: The results imply that malaria might be screened for in a clinical setting using the BC-6200 haematology analyzer's "InR" flag and "InR#/InR‰" parameters.