Jinnah Hospital Lahore Research Articles

Dengue Hemorrhagic Fever: Risk Factors in Pakistani Cohort

Background: Dengue fever is a mosquito-borne infectious disease with potential complications such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and has fatality risk of greater than 20% if left untreated. There is lot of heterogeneity in factors predicting development of DHF in different populations. Objective: To determine clinical, biochemical and radiological parameters associated with risk of developing DHF in Pakistani population. Methods: This prospective observational study was conducted in Jinnah Hospital Lahore from October 2022 to December 2022. 180 patients with confirmed Dengue fever were included. Detailed history, clinical examination and laboratory/radiological investigations were performed. Patients were followed for development of DHF. Univariate analysis followed by logistic regression analysis was used to determine independent predictors for DHF. Results: Among 180 patients with Dengue fever with mean age of 33.04 (+14.12) and male to female ratio of 1.53/1 (109/71), we identified presence of mucosal bleeding {OR 4.7 (95% CI 2.05-10.78)p value <0.000}, abdominal pain {OR 2.73 (95% CI 1.17-4.38)p value 0.013}, persistent vomiting {OR 3.09 (95% CI 1.51-6.34)p value 0.002}, tender right hypochondrium {OR 3.98 (95% CI 1.94-8.16) p value <0.000} and presence of peri-cholecystic fluid {OR 7.78 (95% CI 3.25-18.63)p value < 0.000} to be significantly associated with risk of developing DHF with 83.6% accuracy on logistic regression analysis. Conclusion: Mucosal bleeding, right hypochondrium pain, persistent vomiting and presence of peri-cholecystic fluid in a patient of dengue fever predict risk of developing dengue hemorrhagic fever.

Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata.

Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.

Frequency of Diastasis Recti in Second and Third Trimesters of Pregnancy in Jinnah Hospital Lahore. A Cross-Sectional Study

Background: Diastasis Recti (DR) is a condition characterized by the separation of the rectus abdominis muscles, commonly occurring among pregnant women. Despite its prevalence, awareness of DR and its implications remains low. This study aims to investigate the frequency of DR in the second and third trimesters of pregnancy and to identify any associated risk factors. Objective: To determine the prevalence of DR among pregnant women in their second and third trimesters and to assess the level of awareness about the condition. Additionally, the study seeks to explore the relationship between DR and potential risk factors such as the number of pregnancies, Body Mass Index (BMI), and engagement in abdominal muscle exercises. Methods: This cross-sectional study was conducted at Jinnah Hospital Lahore, involving 64 pregnant women in their second and third trimesters. Participants were selected through non-probability convenience sampling. DR was assessed using the Finger width method, alongside a questionnaire to gather demographic information and assess awareness levels. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics to summarize demographic data, and chi-square tests to explore associations between DR and identified risk factors. Results: Among the 64 participants, DR was present in 45.3% (29/64) of the sample, with a higher prevalence observed in the third trimester. The majority of participants (90.6%) reported never performing abdominal muscle exercises. A systematic review indicated that antenatal exercises could reduce DR cases by approximately 35%. However, awareness of DR among participants was notably lacking, with none having prior knowledge of the condition. Additionally, there was no significant association between DR and BMI, or the frequency of abdominal exercises. Conclusion: DR is a prevalent condition among pregnant women, particularly in their third trimester, with a significant lack of awareness observed. While the number of pregnancies appears to be a contributing factor, other explored risk factors such as BMI and engagement in abdominal exercises did not show a significant association with DR. These findings highlight the need for increased educational efforts and further research to better understand and manage DR during pregnancy.

Association of Different Risk Factors with Iron Deficiency Anemia in Children

Iron Deficiency Anemia (IDA) arises from an imbalance in the body's iron production and demand, making it a prevalent form of anemia in children. While its causes are varied, many contributing factors to IDA are adjustable. If identified and addressed promptly, these factors can be modified to improve both immediate and extended health effects in children. 13It is an established fact that iron is an important component for growth of body and our nervous system. IDA in children may permanently disturb their sensory and cognitive ability. It is therefore important to determine its risk factors to ensure early screening and prevention among children. Aim and Objective: To determine correlation of different risk factors with Iron deficiency Anemia. Material and Methods: This case-control study, comprising 150 participants in each group, was carried out in the Pediatric department of Jinnah Hospital Lahore over a nine-month period, spanning from May 1, 2022, to January 31, 2023. Inclusion criteria involved children aged between 6 months and 12 years. Non-Probability consecutive sampling was employed to collect data, with informed consent obtained from parents/guardians. A pre-designed proforma was utilized for data collection. Statistical analysis using SPSS v.22 involved calculating mean and standard deviation for quantitative data, and presenting frequency and percentages for categorical data. Risk assessment and association were determined using odds ratio and chi-square tests, with a p-value below 5% considered significant.

Exploring the live experiences of the nursing faculty, working in public sector institutions of Punjab regarding educational transformation from diploma to degree programme.

The objective of the study was to explore the faculty's views regarding nursing education transformation from diploma to degree programme. Phenomenological descriptive qualitative approach was adopted to explore the experiences of 10 nursing faculty members who were teaching for more than two years in two public sector nursing colleges (inclusion criteria) in Punjab-College of Nursing, Jinnah Hospital Lahore, and College of Nursing, Nishtar Hospital, Multan-from 2021 to 2022. Data was collected by in-depth interviews of the 10 participants. It was tape recorded, transcribed, and analysed by using Braun and Clarke`s thematic analysis technique. Seven themes were derived, in which good transition, change in instructional methodology, several strengths of degree programme, higher authorities' ignorance, lack of resources, resources can be managed at government level as well as institutional level, positive impact, improved skills in all dimensions were the main elements. This transition is facing challenges, and authorities need to pay proper attention, while policy formation for smooth implementation is needed.

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

EFFECTS OF MULLIGAN ROTATIONAL MOVEMENT VERSUS MEDIAL GAPPING TECHNIQUE ON PAIN, RANGE OF MOTION AND DISABILITY IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background and Aim: To compare the effects of mulligan rotational movement and medial gapping technique on pain, range of motion and disability in knee osteoarthritis patients. Methodology: This study was a Randomized Clinical Trial. The data was collected using a convenience sampling technique. Data was collected from Jinnah Hospital Lahore, from 15th December – 30th June 2022.36 subjects (males and females) were recruited in two groups. The first group received Mobilization with movement along with a conservative treatment protocol. The second group received the Medial gapping technique along with conservative treatment protocol. Each group was treated for four weeks in which three sessions per week were given. Numeric pain rating scale and the disability index were used as outcome measures. Data was analyzed through statistical package for the social sciences (SPSS) version 25. Results: Within-group comparison by paired t-test showed the p-value was significant <.05, indicating that both treatment was effective in improving symptoms. Between groups, comparison by independent t-test showed that Mulligan Mobilization Technique is more effective than the medial gapping technique in improving pain disability and quality of life. Conclusion: The study concluded that Mulligan Mobilization Technique provides more clinical benefits regarding pain, disability and range of motion in osteoarthritis patients than Medial Gapping Technique. Keywords: Arthritis, knee osteoarthritis, movement, pain, patients, range of motion.

Assessment of Pregnancy Intention and Its Related Factors among Females Attending the Antenatal Clinic

Background and Objective: The intention of pregnancy is considered one of the major factors contributing to the foetal or maternal outcome. An exploration of the magnitude of this problem and its related factors can lead to improved foetal or maternal health. Thus, the objective of this study was to assess pregnancy intention and its related factors among females attending antenatal clinics of tertiary care hospitals. Methods: It is a Cross-sectional (analytical) study conducted at the Antenatal clinic, Jinnah Hospital Lahore, within the duration of January-April 2022. Two hundred and fifty(250) pregnant women aged 20 to 39 years were enrolled using non-probability convenience sampling. All the information was noted in a structured questionnaire based on study variables. The collected data was analysed using SPSS version 27.0 and frequency tables were generated. Appropriate test of significance was applied and p-value < 0.05 was taken as statistically significant. Results: Among 250 pregnant females, about 195(78%) of the females reported the current pregnancy to be intentional while 55(22%) were unintentional. It was also seen that age and parity were significantly related to the intention of pregnancy p-value<0.05. The main reasons behind unintentional pregnancies were; 28(51%) unaware about contraception, and 20(36.4%) contraception methods had failed. Conclusions: Approximately one-fourth of all pregnancies were unintentional which raises a concern regarding contraceptive usage and its effectiveness. The prevalence is high compared to reported by the Pakistan demographic health survey. Health education, advocacy, and health protection measures taken on all levels of health care to increase the use and access to contraceptive services are need of hour to address this unwanted situation of unwanted pregnancies.

Prevalence of musculoskeletal disorders among nurses of Jinnah Hospital Lahore

Introduction: Nursing is a professionally challenging and stressful job and nurses are at high risk of developing musculoskeletal disorders. This study was conducted to determine the prevalence of musculoskeletal disorders among nurses of Jinnah Hospital, Lahore. Methods: A questionnaire-based cross-sectional survey was conducted in Jinnah Hospital, Lahore, which was selected using a convenient sampling technique. A questionnaire comprised of demographic data, risk factors, psychological factors and the Nordic scale, was distributed among 100 nurses. One hundred nurses returned a filled questionnaire response rate of 100 percent. Data was analyzed using SPSS statistics IBM 23. Results: The prevalence of musculoskeletal disorders in nurses of Jinnah Hospital, Lahore was eighty four percent and the most common site being the lower back 69% followed by shoulders 64%, neck 60% and ankle 56%. Married and morning shift nurses were more prone to MSDs and seventy percent of them were between the age limit of 21 to 30 years. Psychological factors affecting nurses are overburdening (91%), having less break periods (87%) and poor working environment (77%). Standing position (93%), Repetition of work (84%) and holding patients while shifting patients (55%) are the most important risk factors. Conclusions: A high proportion of nurses reported MSDs at some body sites in their occupational life with lower back injuries the most. Education programs on prevention of musculoskeletal disorders are recommended for nurses in order to reduce the risk of MSDs and promote patients care.

Pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease.

Objective: To establish the frequency in regards to pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Setting: Pulmonology Division of Jinnah Hospital Lahore. Period: January, 2023 to April, 2023. Material & Methods: A total of 200 patients of both male and female patients with age from 40 to 70 years having chronic obstructive pulmonary disease were included by nonprobability consecutive sampling. Patients with history of other respiratory disease like interstitial lung disease, bronchiectasis, allergic broncho-pulmonary aspergillosis (ABPA), sarcoidosis, occupational lung diseases, asthma, ischemic heart disease, pulmonary hypertension, collagen vascular disease were factored out of the study. Cardiac echocardiography was performed in all the patients and pulmonary hypertension as assessed. Results: In this study, 87 (43.5%) were between 40-55 years of age while 113 (56.5%) were within the ages of 56-70, and thus the mean age was 57.28±8.44 years. 131 (65.5%) patients were male and 69 (34.5%) were females. 49 (24.5%), 103 (51.5%) and 48 (24%) patients had mild, moderate and severe COPD respectively. Pulmonary hypertension was found in 105 (52.5%) patients. Pulmonary hypertension is more prevalent in severe cases of COPD than mild and moderate patients with p-value = 0.0001. Conclusion: Patients with chronic obstructive lung disease have a high prevalence of pulmonary hypertension. This is shown to be more common within patients suffering from severe cases of COPD.

Relationship Between Job Satisfaction and Burnout Among Nurses

Over the last spans burnout and job satisfaction were highly momentous in nursing. Burnout and job satisfaction is a psychosomatic issue that appears in difficult personal relations as sections of their work environment Objective: To explore the relationship between job satisfaction and burnout among nurses. Methods: A descriptive correlational study design was used to determine the relationship between job satisfaction and burnout in nurses. The study sample is 133 staff nurses. A convenient sampling technique is used to collect data from nurses of Jinnah Hospital Lahore. The study took approximately 9 months. Data analysis were done through SPSS version 21.0. Results: The majority of nurses were found to be unsatisfied with their jobs. It was observed that staff nurses' job burnout and its element existed. Most of the nurses were higher levels of depersonalization and emotional weariness compared to low accomplishment when it came to burnout components, particularly concerning emotional exhaustion. The biggest percentage of nurses experienced severe burnout and low levels of job satisfaction. The KMO, Bartlett’s test, Cronbach alpha, correlations, ANOVA, coefficients, and value have been checked the validity and reliability in our context. The value shows negative and significant results. Which also identified a substantial negative association between job satisfaction and burnout. Conclusions: Most nurses are facing significant levels of burnout and low level of job satisfaction. It recommended recently created techniques to overcome burnout and enhance job satisfaction, ultimately improving healthcare.

High and Low Level Mupirocin Resistance among Clinical Isolates of Methicillin Resistant Staphylococcus aureus (MRSA)

Background: Staphylococcus aureus is a significant source of nosocomial infections, causing illnesses ranging from minor to life-threatening septic shock. Routine culturing and specific testing can confirm the presence of the bacteria. Antibiotic resistance is a major concern, and methicillin-resistant Staphylococcus aureus (MRSA) is particularly dangerous as it has mutations in the mecA gene, making it resistant to beta-lactam antibiotics. Mupirocin is an effective antibiotic against MRSA, binding to isoleucyl transfer-RNA synthetase to inhibit protein and RNA synthesis.
 Objective: In this study, two different concentrations of mupirocin were tested against MRSA.
 Material & Method: This study aimed to determine the antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) against two different doses of mupirocin. Clinical samples were collected in the duration of one year from different wards of Jinnah Hospital Lahore and processed in microbiology laboratory of Allama Iqbal medical college and after confirmation of Staphylococcus aureus, the modified Kirby Bauer method was used to test antimicrobial susceptibility. MRSA was confirmed by resistance to cefoxitin. High and low-level doses of mupirocin were applied, and zone sizes were measured.
 Results: Total 172 isolated methicillin resistant Staphylocuccus aureus (MRSA) from all age and genders were tested against two doses of mupirocin. Both (mupriocin 5 µg and 200µg) were highly effective and MRSA were around 97% sensitive to mupirocin.
 Conclusion: After the resistance of all beta lactam drugs, mupirocin can be very helpful in the treatment of MRSA infections.
 Key Words:MRSA, Mupriocin

Severity of Maxillofacial Trauma in Motor Bike Riders among Helmet Wearers vs. Non-Helmet Wearers

Aim: To evaluate the severity of maxillofacial trauma in motorbike riders among helmet wearers and non-helmet wearers. Study Design: A cross-sectional study was conducted. The setting was Jinnah Hospital Lahore from April 1, 2021, to October 1, 2021. Method: The study was conducted at Jinnah Hospital Lahore from April 1, 2021, to October 1, 2021. The sample size of our study was 143 patients. The data were collected from the clinical records of individuals who had suffered maxillofacial trauma. Subjects engaged in motorcycle accidents with thorough case records and radiological studies met the inclusion criteria. The collected data were analyzed using the SPSS 23 version. Results: In our study, the mean age of patients was 31.10±9.15, with 129 (90.2%) patients being male and 14 (9.8%) patients being female. 41 (28.5%) patients were helmet users, and 102 (71.3%) patients were non-helmet users. In our study, we also found the severity of maxillofacial trauma: 39.2% of patients had mandible fractures, 35.7% had zygomatic arch fractures, 65.7% had soft-tissue injuries, and 21.0% had dentoalveolar fractures. Observed the greater severity of maxillofacial trauma in non-helmet users with a significant p value (p<0.05). Non-helmet wearers noted more general comminuted fractures, loss of organs like blindness and loss of vision due to orbital fractures, more deep facial lacerations causing lifetime esthetic concerns, a greater hospital stay, and more expenditure at the hospital. Also, more trauma to teeth and injuries lead to a more expensive burden for tooth prostheses afterwards. In helmet wearers, there were fewer fractures, and patients had to stay less or didn’t need to stay at the hospital; they could continue with their daily routine work and job.

Caffeic Acid, Chlorogenic Acid, Garlic Acid, and Protocatechuic Acid as Hypolipidemic Agents

As the pathophysiology of dyslipidemias is clarified, one system is likely to emerge in which the underlying mechanism explains the phenotypic pattern observed on lipoprotein analysis. Every day, millions of vials of blood are drawn to assess patients’ risk for the disease. These tests measure three biomarkers, or factors in the blood known to be associated with CAD: low-density lipoproteins (LDL cholesterol), high-density lipoproteins (HDL cholesterol), and triglycerides. All three biomarkers are lipids – water-insoluble molecules that are among the structural and functional building blocks of living cells. Highly altered Body Mass Index (BMI) and hypertension are independent and reversible determinants for coronary artery disease. Hypolipidemia can prevent hyperlipidemic patients to be victim of coronary artery disease. This study was conducted to compare hypolipidemic effects of Niacin and Jujube fruit in primary as well as secondary hyperlipidemic patients. Study was conducted in 2023 at Jinnah Hospital Lahore, Pakistan. Sixty participants were enrolled of both gender male and female hyperlipidemic patients age range from 20 to 70 years. Written and explained consent was taken from all patients. They were divided in two groups. Group-I was advised to take two grams Niacin in divided doses for the period of two months. Group-II was advised to take 500 grams of fruit Jujube daily for the period of two months. Their baseline LDL and HDL cholesterol was determined by conventional method of measuring Lipid Profile. After two months therapy, their post treatment lipid profile was measured and mean values with ± SEM were analyzed biostatistically. Group-I which was on Niacin their LDL cholesterol decreased significantly and HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was decreased significantly but HDL increase was not significant with p-value of >0.05. It was concluded from the research work that Niacin is potent in lowering LDL and increasing HDL cholesterol, while Jujube has significant effect as LDL cholesterol lowering agent, but it does not increase HDL cholesterol significantly.

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Objective: To compare talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion. Study Design: Controlled Clinical Trial. Setting: Division of Pulmonology, Jinnah Hospital Lahore. Period: September, 2022 up until May, 2023. Material & Methods: 100 individuals, both male and female, ranging in age from 20 to 80 years, diagnosed with malignant pleural effusion confirmed on biopsy were included by nonprobability consecutive sampling. Patients with active pleural infection, hemodynamic instability, systemic infection, serum hematocrit < 25%, hemothorax, chylothorax, multiple etiologies of pleural effusion, prior chemical pleurodesis, sensitivity to study drugs, life expectancy < 1 month, pregnancy and chest X-ray displaying trapped lung post chest tube drainage on the affected side were excluded. The patients were allocated into two groups at random using a lottery system. In group 1, patients received pleurodesis with talc poudrage and in group 2, patients received pleurodesis alongside tetracycline. Success was assessed after 4 weeks of pleurodesis. Results: In this study, mean age in talc group was 58.94±13.6 years and in tetracycline group it was 59.26±13.7 years.65% patients were male and 35% were females.Success was 94% in talc group and 76% in tetracycline group with p-value = 0.012. In terms of adverse effects, there is no statistically significant difference between the two groups. Conclusion: Talc pleurodesis has a higher success rate than the tetracycline pleurodesis. Talc pleurodesis also has less adverse effects than tetracycline pleurodesis.

Phenotypic identification of Candida species and relative expression of candida drug resistance (CDR1) gene in fluconazole resistant and sensitive Candida albicans

ABSTRACT:
 Background and objective:
 Candida albicans belongs to the genus Candida. It is a commensal yeast in healthy individuals and can cause wide variety of infections in immune-compromised patients. The aim of the present study was to observe the frequency of Candida species, resistant profile of C. albicans against fluconazole and over-expression of CDR1 gene in both fluconazole resistant and sensitive C. albicans.
 Methodology:
 A total number of 206 Candida species were collected on Sabouraud Dextrose agar from Jinnah hospital Lahore. The isolates were re-confirmed by using various microbiological techniques like wet preparation, Gram stain and Germ tube test. Identification upto the species level was done by APIC 20AUX. Antifungal susceptibility profile of C. albicans against fluconazole was determined by broth microdilutiom method. Real Time PCR was performed on both the sensitive and resistant C. albicans to observe the role of CDR1 gene against fluconazole resistance. Results:
 
 tropicals was the most common species with the frequency of 66 (32.0%) followed by C. albicans 41(19.9), C. glabrata 24 (11.7%), C. lusitaniae 14 (6.8%) and other less common species. The majority of infected patients were females (59.2%) than males (41%). Antifungal susceptibility testing showed that 80% C. albicans were sensitive to fluconazole. Results of gene expression showed that CDR1 gene play a major role towards fluconazole resistance in C.albicans.Conclusion: Fluconazole was found to be effective in treating infections caused by C. albicans. 
 
 Keywords: Candida albicans, Candida Drug Resistant Gene 1, Polymerase Chain Reaction, Candida Tropicalis, Candida glabrata, and Candida lusitaniae

COMPARISON OF ARTERIAL PRESSURE AND VASOPRESSOR (PHENYLEPHRINE) AMONG PATIENTS UNDERGOING TURP WITH SPINAL ANESTHESIA VERSUS SADDLE BLOCK

Transurethral Resection of Prostate (TURP) is a common procedure for treating Benign Prostatic Hyperplasia (BPH) in elderly males. Spinal Anesthesia is conventionally used during the procedure; however, some studies have preferred saddle block regarding the average time of induction requirement for vasopressors. This study compared the mean change in mean arterial pressure and the mean vasopressor requirement (phenylephrine) among patients undergoing TURP with spinal anesthesia versus Saddle block. This randomized controlled trial was conducted at the Anesthesia Department, Jinnah Hospital Lahore, for Six months on 120 cases (group 1: 60, group 2: 60) of male patients aged 40-80 years undergoing TURP surgery. Patients in Group A received 2 ml of 0.75% bupivacaine and were placed supine with one pillow, while Group B received 2 ml of hyperbaric 0.75% in the same manner as Group A but remained in the sitting position for 10 minutes and then made supine with one pillow under the head. Demographic and clinical data was entered and analyzed using SPSS. Mean, Standard Deviation, Frequency, and percentages were calculated for quantitative and qualitative data, respectively, and an independent sample t-test was used for mean differences, keeping p-value<0.05 as significant. The mean age in the Spinal anesthesia group was 61.23 ± 12.06 years, while the mean age in the Saddle block group was 59.55 ± 11.57 years. In the Spinal and Saddle block, the mean arterial pressure before the procedure was 102.60 ± 5.33 and 95.52 ± 4.52, respectively. The mean change in MAP in the spinal group was 20.02 ± 5.76, and in the Saddle block group was 10.95 ± 5.93. The mean vasopressor requirement in Spinal anesthesia was 102.18 ± 19.17, and in Saddle block was 30.67 ± 26.46, respectively. All measures showed significantly lower mean change in Saddle block groups, p-value < 0.05 for all. This study's findings concluded that the mean change in mean arterial pressure and Vasopressor (phenylephrine) requirement among patients undergoing TURP Saddle block was favorable. So, TURP can be safely performed under saddle block without hypotension and less vasopressor requirement.

Frequency of Anxiety During Exam / Assessments among Medical Students

Background: The phenomenon of severe anxiety and self-doubt experienced by individuals prior to taking exams or assessments can significantly impair their performance, potentially leading to poor outcomes. Research on the prevalence and contributing factors of assessment-related anxiety among medical students in Pakistan is scarce. Objective: The aim of this study was to ascertain the prevalence of exam-related anxiety among medical students and identify its associated factors. Study Design: Cross sectional study. Settings: Allama Iqbal Medical College/ Jinnah Hospital Lahore Pakistan. Duration: Six months from 09-12-2022 to 09- 06-2023. Methods: After approval of the study proposal and attaining the informed consent of the medical students, they were explained the purpose of study. After inclusion, all the students were asked questions as per PHCC test anxiety questionnaire to determine presence as well as healthy or unhealthy nature of stress. All these students with anxiety were assessed for factors related to this stress including female gender, 1st year of medical college, oral exam, poor time management skills and pre-existing psychological distress. All data was collected in a self- made pro forma. Results: Total of 135 students, mean age was 23.30±2.48 years. Frequency of anxiety was 51.1% (n=69). Frequency of female gender factors in students with anxiety versus without anxiety was 52.3%% (n=56) versus 47.7% (n=51), 1st year in medical college 87.9% (n=58) versus 12.1% (n=8), oral exam 79.7% (n=59) versus 20.3% (n=15), poor time management skills 95.6% (n=43) versus 4.4% (n=2) and pre-existing psychological distress was 92.3% (n=24) versus 7.7% (n=2). Conclusion: The results indicate that a considerable proportion of medical students experience significant exam anxiety, with 51.1% affected. The study further revealed a notable correlation between anxiety and factors such as being in the first year of medical college, facing oral exams, inadequate time management skills, and pre-existing psychological distress. Given its prevalence, the issue of problematic exam anxiety among medical students warrants increased attention.

Knowledge of Pregnant Women Regarding the Mode of Delivery among the Primary Gravida

Caesarean sections (CS) are becoming more commonplace. Pregnant women's awareness of childbirth options, the causes contributing to their lack of information, and their desire for CS delivery were little understood. Objective: To assess the knowledge of pregnant women regarding the mode of delivery among the primary gravida. Methods: A descriptive cross-sectional research study design was conducted at Jinnah Hospital Lahore during January to June 2023. About 171 pregnant patients were enrolled to assess the knowledge of pregnant women of the first gravida. Data analysis was done through (SPSS) version 21.0. The Bartlett and KMO values have been checked to ensure validity and reliability in our context. Results: Out of 171 pregnant females, 90.6% were aged 21-30 years. Approximately 67.3% believed that vaginal birth is a natural and appropriate way of delivery, and 87.7% believed that the infant might be obtained early within minutes by vaginal delivery. About 88.3% females thought that vaginal delivery is better than cesarean section, however 85.5% also thought that it is also risky for baby. Conclusions: Generally, the knowledge of pregnant women about the mode of delivery and benefits of vaginal delivery is good in this study. But due to their thought about risk to the fetus, mostly select cesarean section over vaginal delivery. Therefore, the patient should be educated about the knowledge of pregnant women’s mode of delivery to control the (CS) rate.

Burnout and Health Related Quality of Life among emergency physicians working at emergency at Tertiary Care Hospital in Lahore Pakistan.

To determine frequency of burnout in emergency physicians and to identify its impact on their health-related quality of life (HRQOL). In this cross-sectional study, physicians from departments with emergency cover of Jinnah Hospital Lahore were included. Their burnout and HRQOL scores using Maslach Burnout Inventory (MBI) and Short Form (SF)-36 respectively were determined in March 2022. Burnout scores were graded as low, moderate and high and were correlated with domains of HRQOL using chi X2 and analysis of variance (ANOVA). One hundred fifty physicians were included with mean age 26.2 (±2.59), male to female ratio 0.78:1 (66/84) and House Officer (HO) to Postgraduate Resident (PGR) ratio 1.94:1 (99/51). High burnout was identified in 76 (50.7%) participants while 48 (32%) had moderate and 26 (17.3%) had low burnout. Males scored better than female physicians in vitality (0.008), general mental health (0.004), and mental component summary (0.01) domains of HRQOL. Doctors with high burnout had significantly lower scores in both physical component summary (p-value 0.004) and mental component summary (p-value < 0.0001) domains of HRQOL. Physicians working in emergency settings have high frequency of burnout and it adversely affects their mental and physical health related quality of life.