King Edward Medical University Research Articles

Determining the Frequency of Non-Obstructive Coronary Artery Disease in Elective Angiography Cases

Cardiovascular disease particularly ischemic heart disease has emerged as a leading cause of death. Atherosclerosis in epicardium results in CAD without the restriction of coronary circulation but the other processes that may disrupt the myocardial supply and demand in patients exhibiting angina symptoms or indications may be suspected of having non-obstructive CAD. Objective: To find out the prevalence of non-obstructive CAD in patients enrolled for elective angiography. Methods: A cross-sectional descriptive analysis was done in the Cardiology department in King Edward Medical University and Mayo Hospital, Lahore. The duration of study was for six months from 01-08-2022 to 01-02-2023. After approval from hospital ethical committee, 150 patients were enrolled in the study with informed written consent. Demographics including Name, age, BMI, confounding factors like (diabetes, hypertension, smoking and family history) and address were noted. All selected patients underwent coronary angiography via right femoral artery approach by a consultant cardiologist. Non-obstructive coronary artery disease was assessed as per operational definition. All the information was noted on pre-designed proforma (attached). Results: A total of 150 patients were selected for the study. It showed that out of 150 patients, 2.7% (n=4) fall in age group of 18-40 years and 97.3 % (n=146) were in age group of 41-60 years, average age was 51.94±5.26 years and the BMI was 27.96±6.44 kg/m2. There were 62.7 % (n=94) male and 37.3 % (n=56) females. Frequency of diabetes mellitus was 34.7 % (n=52), hypertension was 24.7 % (n=37), smokers 16.7 % (n=25), family history was 12.7 % (n=19) and frequency of non-obstructive CAD was 27.3 % (n=41). Conclusions: It is to be concluded that a considerable percentage of patients enrolled for elective coronary angiography had non-obstructive CAD.

Pattern and burden of thrombocytopenia in chronic hepatitis C virus patients at a tertiary care hospital

Objective: To determine the frequency of thrombocytopenia in chronic Hepatitis C virus infection. Material and Methods: This Descriptive cross-sectional study was conducted at department of Hematology, King Edward Medical University, Lahore from February 2023 to October 2023. A total of 143 patients of either gender with chronic Hepatitis C virus infection were included in the study. For every patient, a fresh 3 ml blood sample was collected by syringe using aseptic technique in a vacutainer containing EDTA. A complete blood count was carried out using Automated Hematology Analyzer and peripheral blood smear was prepared using Wright Giemsa stain to establish whether thrombocytopenia was present or not. Thrombocytopenia was assessed by Neubauer chamber. Results: Age range in this study was from 18 to 65 years with mean age of 44.132±7.34 years, mean duration of HCV 12.685±4.53 months and mean platelet count was 238076.923 ± 100165.08/µL. Thrombocytopenia was seen in 37.1% patients. Conclusion: Our results show that chronic hepatitis C infection is related to high frequency of thrombocytopenia. The higher the duration of disease process, higher is the risk of thrombocytopenia in these patients. This study highlights that identification by screening, timely diagnosis and treatment of Hepatitis C infection can prevent thrombocytopenia and its complications. Serial hematological follow up can play a pivotal role in such patients. Keywords: Chronic hepatitis, Hepatitis C virus, Thrombocytopenia

Generalized Anxiety Disorder among Paediatricians During the COVID-19 Pandemic

Background: COVID-19 pandemic has put healthcare professionals at risk of developing mental health issues. Primarily, because of their increased chances of being affected and fulfilling their job commitments despite insufficient knowledge about the new disease and its management. Hence, it is essential to assess the burden of such mental health issues amongst healthcare providers. Objective: To determine the frequency and severity of generalized anxiety disorder among paediatricians during the COVID-19 pandemic. Methods: Cross-sectional observational study conducted in Department of Paediatrics (unit 1), King Edward Medical University/ Mayo Hospital Lahore, duration of 03 months. After IRB approval, an online survey form was developed based on GAD-7 Scale as an assessment tool for assessing anxiety among paediatricians. A survey form was dispersed using social media to pediatricians of different ages and working statuses. The responses were recorded and assessed using SPPSS. Quantitative variables (age, GAD-score) were summarised as mean and standard deviation. Qualitative variables (gender, place of work, individual GAD- component score) were summarised as frequency and percentages. Results: A total of 147 responses were received, out of which 13 were excluded. The remaining 134 were analysed through SPSS 26. Out of these, 106 (79.1%) turned out to be suffering from new-onset anxiety. Amongst these 106 paediatricians, 69 (65.1%) were females, and 37(35.9%) were males (p-value 0.013). The severity of anxiety was mild, moderate and severe in 62 (46.3%), 37 (27.6%) and 7 (5.2%) of paediatricians, respectively. Conclusion: More than three-fourths of paediatricians had higher GAD 7 scores during the COVID-19 pandemic suggesting generalized anxiety disorder.

PROF ZAHEER UD DIN (1935-2023)

Prof Zaheer Ud Din Principal of Army Medical College Rawalpindi passed away on 26th October 2023, he was 88 the cause of death was cardiac arrest.He was born in Jullandar Indians migrated to Pakistan on during 1947.He graduated from King Edward Medical College (now university) in 1958, he was commissioned in Army Medical Corps after serving afew year in the medical fields units got training in internal medicine at Armed Forces Medical College Rawalpindi (now Armed Forced Post Graduate Medical Institute (AFPGMI) and become graded specialist in medicine

PROF MUHAMMAD NISAR KHAN (1930-2023)

Prof Muhammad Nisar Khan was born in 1930 at Mardan NWFP (now KPK) his father passed away when he was four year old was nutured by his grandfather.He obtained the MBBS Degree from King Edward Medical College Lahore (now university) joined the Army Medical Corps in 1955. In 1959, he had training in surgery under the Legendary Surgeon Shaukat Hassan Malik at AFM Armed Forces Medical College Rawalpindi (now AFPGMI) Rawalpindi.Becomes graded specialist in surgery.

Correlation of Cerebrospinal Fluid Total Protein and Serum Neutrophil-to-Lymphocyte Ratio with Clinical Outcomes of Guillain-Barre Syndrome Variants.

To evaluate the correlation of cerebrospinal fluid total protein and serum neutrophil-to-lymphocyte ratio with the clinical outcomes and the various clinical and electrophysiological variants of Guillain-Barre syndrome. Cross-sectional study. Place and Duration of the Study: Department of Neurology, Mayo Hospital and King Edward Medical University, Lahore, Pakistan, from November 2022 to April 2023. Fourty-six Guillain-Barre syndrome patients, aged 12-70 years, were included in the study diagnosed by using the Brighton's criteria. Functional disability and respiratory insufficiency were assessed by using the modified Hughes disability score and the Erasmus Guillain-Barre syndrome respiratory insufficiency score, respectively.Serum neutrophil-to-lymphocyte ratio and cerebrospinal fluid total protein were calculated for each patient at the time of admission. Axonal variants had a higher mean neutrophil-to-lymphocyte ratio (5.29 ± 4.38) than demyelinating variants (4.71 ± 3.4) and Miller-Fischer syndrome (3 ± 2.828). This ratio was positively correlated with the modified Hughes's disability score (r = 0.790, p = 0.001) and the Erasmus Guillain-Barre syndrome respiratory insufficiency score (r = 0.936, p = 0.002). Mean cerebrospinal fluid total protein was higher for demyelinating (218 ± 136 mg/dl) than axonal variants (86 ± 56 mg/dl) and Miller-Fischer syndrome (34 ± 21 mg/dl). However, higher modified Hughes disability score (4-6) (r = 0.020, p = 0.117) and a high Erasmus Guillain-Barre syndrome respiratory insufficiency score (5-7) (r = 0.115, p = 0.302) did not significantly affect mean cerebrospinal fluid total proteins. Serum neutrophil-to-lymphocyte ratio can be regarded as a reliable biomarker to assess disease severity and clinical outcome in Guillain-Barre syndrome. Cerebrospinal fluid total protein is a poor predictor of the prognosis and severity of Guillain-Barre syndrome. Guillain-Barre syndrome (GBS), Clinical outcome, Cerebrospinal fluid total protein (CSF-TP), Neutrophil-to-lymphocytic ratio (NLR), Prognostic biomarker.

A Randomized Controlled Trial Comparing Injection Polidocanol, with Injection 50% D/W in Rectal Prolapse

Background: Rectal prolapse manifests as the protrusion of the rectal mucosa through the anal opening. There can be partial or full thickness prolapse. It usually occurs before 4 years of age. Rectal prolapse in childhood tends to affect both males and females equally. Aim: To compare Inj. Polidocanol with Inj 50% D/W in rectal prolapsed in this randomized controlled trial. Methods: The study was conducted in the pediatric surgical ward of Mayo Hospital & King Edward Medical University Lahore, after receiving approval from the Hospital's Ethical Committee. There were 60 patients rectal prolapse with 30 patients in each group. Polidocanol was used in group A while 50%dextrose water was used in group B. The procedure was performed under general anesthesia. In the postoperative period children were observed for early complications like fever, anaphylaxis, diarrhea, hemorrhage, pain while defecating, mucosal edema and constipation. Results were analyzed with SPSS. Results: Out of 60, 36 were male while 24 were female. Group A included 16 male and 14 females whereas group B had 20 males and 10 female children. Mean age was 5.35years with SD of 2.7 and ranging from youngest child of 8 months till eldest of 12 years. In group A mean age was 5.44 while mean age of group B was 5.26 years. All 30 patients in group A were relieved of their symptoms after single session of Polidocanol so giving 100% of success rate while 28 patients (93.33%) in group B were relieved of their symptoms while 2(6.66%) patients developed recurrence with no significant difference. The complications observed in the study were post-operative constipation in 3(10%) patients in group A, however no patient developed postoperative stricture, infection or adverse drug reaction. In group B no patient developed any post-operative complication. Practical Implication: This comparative study helps us to find more effective and better drug available as a sclerosing agent to treat rectal prolapse in pediatric population. It’s also cost effective and with fewer side effects and easily available. Conclusion: In conclusion, injection sclerotherapy using polidocanol emerges as an equally successful procedure for managing RP in children. This medication demonstrates enhanced efficacy, safety, and accessibility. The process is not only less time-consuming but also entails minimal complications. Keywords: Rectal Prolapse Manifests, Protrusion, Mucosa, Chronic Constipation, Hirschsprung’s Disease,

COMPARISON OF LACOSAMIDE VERSUS LEVODOPA IN THE TREATMENT OF RESTLESS LEGS SYNDROME IN HEMODIALYSIS PATIENTS

ABSTRACT
 Objective: To compare Lacosamide and Levodopa for treating restless-legs-syndrome in hemodialysis patients in terms of mean change of International Restless Leg Syndrome (IRLS) score.
 Methods: It was a Randomize control trail done at Department of Medicine & Nephrology Department of Mayo hospital, Lahore from April 2019 to March 2020. After taking approval from institutional-Review-board (IRB) of the King Edward Medical University (KEMU), sixty patients coming to hemodialysis unit of Mayo Hospital, Lahore and fulfilling the inclusion criteria were enrolled for study. We used lottery method and randomly divided them in to two groups that is Group-A: Lacosamide (50 mg) given at bedtime. (30 cases) and Group-B: Levodopa (110 mg) given daily 2 hours before bedtime (30 cases). Treatment was continued for 4 weeks. We calculated IRLS score at start of study and four week after treatment and any Change from baseline was calculated for every patient. That difference of –IRLS score documented on the attached Performa along with demographic details about patient.
 Results: This study showed that after 4 weeks of treatment there was not much difference seen in International Restless Leg Syndrome score in each treatment groups. i.e. [Pre-Treatment (Lacosamide: 20.80±4.78 vs. Levodopa: 22.60±4.66), Post Treatment (Lacosamide: 14.20±2.89 vs. Levodopa: 15.73±3.58), Mean change of score (Lacosamide: 7.10±4.99 vs. Levodopa: 6.86±6.63 . p - Value = 0.878)
 Conclusion: This trial concludes that Levodpoa and Lacosamide were equally good in treating Restless-Legs-Syndrome among patients who are on Hemodialysis.
 Key words: Restless legs syndrome, Hemodialysis, Lacosamide, Levodopa.

Comparison of Treatment Outcome of the Effectiveness of Isometric Exercises as Compared to General Exercises with Cervical Spine Mobilization in The Management of Chronic Non Specific Neck Pain

The purpose of this study was to evaluate the “effectiveness of isometric exercises as compared to general exercises along with cervical spinal mobilization to reduce pain, disability and to increase range of motion in chronic non-specific neck pain”For this randomized controlled experiment total 32 patients (16 in each group) with chronic non-specific neck pain were recruited from physiotherapy Ward Mayo Hospital Lahore, Department of Physiotherapy King Edward Medical University Lahore between October, 2019 and March, 2020. Simple randomization method was used to assign participants into isometric exercise group and general exercise with cervical spine mobilization group. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises with cervical mobilization group performed active range of movement exercises for all neck movements. Patients in both groups received 4 supervised treatment sessions per week for 6 weeks. Visual Analogue Scale (VAS), Neck disability index Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 6 weeks.Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001for isometric exercise group, p = 0.05 for general exercises group and p= <0.001 for range of movement. However, mean improvements in post intervention VAS score and Neck disability index Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non- specific neck pain however; isometric exercises are clinically more effective than general exercises with cervical spine mobilization.

Morphometric Measurement of Distance of Nutrient Foramen from Proximal, Distal Ends and Circumferential Diameter at the level of Nutrient Foramen in dry adult Humerii

Objective: To analyse the morphometric measurements of different parameters of adult dry humerii bones with reference to its clinical importance in different surgical conditions. Bones were available in the department of Anatomy, King Edward Medical University Lahore Pakistan. Methods: Across sectional morphometric study which was done from 1st March 2021 to 30th April 2021 in the department of anatomy by having 60 dry humerii. Bones which were not in good condition or damaged by any means were excluded from study. Different parameters like maximum length of humerus, distance of nutrient foramina from the different ends of humerus and the circumferential diameter of shaft at the level of nutrient foramen were also noted. The number, distance and site of nutrient foramina were noted macroscopically by using a vernier caliper, measuring scale and metallic wire. Ethical clearance was taken from Ethical review board of King Edward medical university. Results: The number of right sided humerii were 31 and the number of left humerii were 29. The number of nutrient foramen varies in right and left side. On the right side the number of nutrient foramina were more as compared to the left side. Out of total right sided; 9 humerii were having double nutrient foramen and out of total left sided humerii ; the double nutrient foramen was found in only 1. When it compared to this study, the results for total length of humerus between right and left side it showed no significant difference as p-value was 0.311. But when it compared to the diameter between the two groups it showed the significant difference as p-value is < 0.05. Conclusion: It is concluded that variations in the morphometry of humerus was present in current study. Such as humerus can have more than one nutrient foramen. Single nutrient foramen is mostly seen in both sides of humerii. Although there was no difference seen in the size and location of foramina and no statistical difference was found between maximum length of right and left humerii. But this study will add further knowledge of humerus into literature regarding variations in its morphology present in local population. This knowledge will also help clinicians during any type of reconstructive bone surgery.

Challenges in Work-Life Balance of Gynecologists Perspectives

Objective: Challenges gynecologists face in work life issues and their opinion how they cope. Material and Method: The Study type was Qualitative of phenomenological type and the study was conducted for 15 days at two places Gynae Unit V, King Edward Medical University, Lahore Lady Aitchison Hospital Lahore and Obstestric & Gynaecology Unit-2 Services Institute of Medical Sciences, Lahore. The qualitative, phenomenological study was conducted, views of consultants in the field of gynecology were explored and a self-designed Performa were given to participants to answer open-ended questions. The answers were transcribed manually and codes were formed that led to themes. Results: out of 10 subjects included, 1 (10%) was department head, 2 (20%) were associate professors, 2 (20%) were assistant professors, and 5 (50%) were senior registrars. Data was segregated into codes of the workplace, home challenges, coping strategies, job satisfaction, and maintaining work-life balance. There are 5 -7 themes that fell under each of these seven codes. Conclusion: Challenges faced by consultants in field of gynecology are explored and we can suggest and recommend policies at work place and how these can help in policy-making rules at local and national levels.

Preparing for the future of healthcare: Digital health literacy among medical students in Lahore, Pakistan.

Digital Health Literacy (DHL) is becoming a cardinal competence for all healthcare professionals (HCPs) including medical students for meaningful digital transformation of healthcare. As medical students need to navigate an increasingly digitalized healthcare environment, thus the study's objective was to assess digital health literacy among medical students. This cross-sectional analytical study was conducted at King Edward Medical University, Lahore from October 2022 to August 2023. Medical students were asked to complete a pen and paper questionnaire of the Digital Health Literacy Instrument (DHLI) after informed consent. DHLI covers seven categories: operational skills, information searching strategy, analyzing the usefulness of online information, navigational abilities, contributing user-generated material to internet-based platforms, and privacy protection. SPSS was used for data analysis. Eight hundred ninety one medical students, from first year to final year, participated in the study. The overall mean score for DHL was 63.5 (SD=8.82). Medical students achieved a score of 83.2% of total score in their operational abilities, and 82.3% proficiency in privacy protection, which were deemed highly desirable. Furthermore, they achieved a satisfactory level in navigation skill (76.0%), information searching (73.1%), adding content (71.0%), determining the significance of data (70.1%), and assessing data reliability (68.7%), based on the overall score. A significant relationship was observed between the performance level of DHL domains and gender with higher scores in males in all domains except protecting privacy, which was higher in females and clinical years students (p-value < 0.05). The assessment of the DHL of medical students was deemed desirable. But certain obstacles were encountered in few domains of DHL i.e., data reliability, relevance determination, and content augmentation. It is imperative to elevate the level of DHL of medical students to harness the potential of digital technologies in enhancing healthcare.

Disease Outcomes of COVID-19 in Diabetic and Hypertensive Patients During the Hospital Stay.

Background A single-stranded RNA genome-encapsulated virus known as severe acute respiratory syndrome coronavirus 2 is known to cause severe acute respiratory syndrome in humans. People with diabetes and hypertension are often more susceptible to developing coronavirus disease 2019 (COVID-19) and experience a disproportionately higher rate of morbidity and death compared to the general population. The COVID-19 pandemic has become an urgent worldwide issue. Therefore, the main goal of this study is to assess how diabetes and hypertension,both separately and together, affect clinical outcomes in terms of morbidity and mortality in patients hospitalized with COVID-19. This study aimed to evaluate the disease outcomes in hypertensive and diabetic patients hospitalized with COVID-19. Methodology This descriptive, cross-sectional study was conducted from June 2022 to November 2022. Using purposive selective sampling, a total of 90 known hypertensive and diabetic patients with COVID-19 aged 18-90 years admitted in COVID-19 isolation wards and intensive care units (ICUs) of Mayo Hospital Lahore were recruited in this study after obtaining informed consent and IRB approval from the Institutional Review Board of King Edward Medical University, Lahore. Patients who did not provide consent, patients whose positive polymerase chain reaction reports for COVID-19 were not available, pregnant females, and patients with other comorbidities were excluded from the study. Data were collected from the COVID-19 isolation medical wards and ICUs from patient charts containing age, the status of hypertension and diabetes, disease status, severity, and levels of inflammatory markers, i.e., D-dimers, serum lactate dehydrogenase (LDH), serum ferritin, C-reactive protein (CRP). Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Quantitative variables such as age were presented as mean ± SD. Qualitative variables such as hypertension, diabetes, and levels of inflammatory markers were presented as frequency and percentages. Results In this study, 90 patients were included, with 51 (57%) females and 39 (43%) males, all of whom were either hypertensive, diabetic, or both. In total, 70 (78%) patients were admitted to ICUs and 20 (22%) to COVID-19 medical isolation wards. Among 70 ICU patients, 39 (43.3%) were on continuous positive airway pressure/bilevel positive airway pressure, seven (7.8%) were on ventilators, and 44 (48.8%) were on normal oxygen masks/non-rebreather masks with high-flow oxygen. Overall, 100% of the patients included in the study had raised levels of inflammatory markers, low lymphocyte count, and increased neutrophil count. In total, 84 (93%) patients had severely high and six (7%) patients had moderately high CRP levels. Moreover, 33 (36.7%) patients had severely high and 57 (63.3%) patients had moderately high D-dimer levels. Further, 25 (28%) patients had severely high, 26 (29%) patients had moderately high, and 39 (43.3%) patients had significantly raised levels of serum ferritin. In total, 21 (23%) patients had severely high, 37 (41%) had moderately high, and 32 (36%) had significantly raised levels of serum LDH. Among the 90 patients, 65 (73%) expired and 25 (27%) survived. Of the expired patients, 62 (95%) were admitted to ICUs, and three (5%) were admitted to wards. Conclusions Diabetes and hypertension are strong predictors of COVID-19 severity in terms of morbidity and mortality due to respiratory deterioration.

Comparison of outcome of conventional suture ligation versus ligasure vessel sealing in patients undergoing total thyroidectomy for multinodular goiter.

Objective: To compare the results of Ligasure versus conventional suture ligation for thyroidectomy for multinodular goiter in terms of mean operative time and post-operative drain output volume. Study Design: Comparative Prospective study. Setting: Department of General Surgery, Mayo Hospital Lahore. Period: 1st April 2020 to 31st March 2021. Material &amp; Methods: After approval from the Institutional review board of King Edward medical university, a sample of 140 patients was obtained. Patients were divided into 2 groups, Group A and Group B. Group A patients underwent total thyroidectomy with Ligasure vessel sealing while Group B patients underwent total thyroidectomy with conventional suture ligation. Operative time and post-operative drain volume were measured and documented. The P-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 36.04 ± 9.78 years with minimum and maximum ages being 18 &amp; 61 years respectively. The mean surgery time was 137.80 ± 26.21 minutes in group A while in group B the mean surgery time of the patients was 164.91 ± 31.94 minutes (P-value= &lt;0.001). The mean post-op drain volume in group A was 91.28 ± 7.82 ml, almost similar to group B patients i: e 70.28 ± 4.33 ml (P-value=0.14). Conclusion: Ligasure vessel sealing is significantly better than conventional suture ligation in terms of mean surgery duration but there is no difference in post-operative drain volume in both groups.

PROBLEMS WITH ORTHOPEDIC SURGERY TRAINING IN PAKISTAN

PROBLEMS WITH ORTHOPEDIC SURGERY TRAINING IN PAKISTAN

HELP SEEKING ATTITUDES FOR MENTAL ILLNESSES AMONG UNDER-GRADUATE MEDICAL STUDENTS IN LAHORE

Objective: The reluctance of medical students to seek help for stress is attributed to a lot of factors involving stigma, their help-seeking attitudes and psychological openness. The objective of this study is to gauge help seeking attitudes for stress and mental health issues among Pakistani medical students. Design: Two questionnaires were used to form a self-administered questionnaire, including Hopkins Symptom Checklist (SCL-5) and Inventory of Attitudes towards Seeking Mental Health Services (IASMHS). Place &amp; duration of study: Students from King Edward Medical University, Lahore and Fatima Memorial Hospital were administered the questionnaire in physical form as well as an online version. Responses were gathered over a time of 3 months. Methods: We conducted a cross-sectional survey in two selected medical colleges in Lahore in 2022. After IRB approval and informed consent, a self-administered questionnaire which included Hopkins Symptom Checklist (SCL-5) and Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) was utilized for data collection. Analysis was conducted with SPSS 26. Results: Six hundred and forty-one undergraduate medical students participated in the study with majority being female (64.2%) and hostellers (59%). SCL- 5 scores of the participants (mean=13.36, S. D=4.95) showed moderate levels of distress among students. Participants’ mean Attitude Score on IASMHS was 53.66 (S. D=10.72). Attitudes towards help seeking were fairly negative especially with regard to feeling indifferent towards stigma (mean=18.95, S.D=5.69). Student’s attitudes reflected some psychological openness (mean=14.48, S.D=5.35), while propensity to seek help was slightly better (mean=20.23, S.D = 4.75). Females and clinical year students showed more positive attitudes towards help seeking as compared to males and students belonging to pre-clinical years (P&lt;0.05). Conclusion: The study showed that stress among under-graduate medical students remains a significant issue. While female students and clinical years’ students portrayed better help seeking attitudes towards mental illnesses and stress, further studies including interventions to address mental illness stigma are required to improve the trend.

Determination of Multidrug Resistance and Extended Drug Resistance Pattern of Pseudomonas aeruginosa in Clinical Isolates of Tertiary Care Hospital Lahore

Background: &#x0D; Pseudomonas aeruginosa (PA) is a major public health community-acquired threat around the globe due to the growing rate of antimicrobial resistance. It is one of the most common trending causes of nosocomial infections. &#x0D; Objective: &#x0D; The current study aimed to check the rate of multidrug-resistant (MDR) and extended drug-resistant (XDR) PA and to analyze the invitro activity of different antimicrobial agents against clinically isolated bacterial samples. Molecular Detection and amplification of L lipoprotein (OprL gene) were also done to determine the frequency and species of different strains of Pseudomonas aeruginosa (PA2192, C3719, PA01, PA14 and PACS2).&#x0D; Method:&#x0D; This cross-sectional study was conducted at at the Department of Pathology, King Edward Medical University/ Mayo Hospital Lahore. Total 140 patients were included in the study. Biochemical characterization, molecular identification, antimicrobial susceptibility profiling and DNA sequencing of the desired gene were done to confirm different strains' identification. &#x0D; Results:&#x0D; MDR and XDR Pseudomonas aeruginosa infection are more common among males 81(57.5%) and high among the 31-45 age group, i.e., 55 (39.3%). After antibiotic susceptibility testing, 60% of strains were found to be MDR PA, while 40% were categorized as XDR PA. Doripenem showed the highest sensitivity, 93 (66.4%) among all carbapenems. Polymyxin B showed the highest activity against Pseudomonas aeruginosa multi and extensively drug-resistant strains, i.e., 108 (77.1%). &#x0D; Conclusion:&#x0D; The present study suggests that doripenem can be the only active agent for combating infections, and the Carbapenem drug appears effective against highly resistant strains of Pseudomonas aeruginosa.&#x0D;

Impact Of COVID-19 Pandemic On Ophthalmology Residency Training- A Cross-Sectional Survey Among Pakistani Residents

Background: The purpose of this study was to get an idea of the impact of COVID-19 on Ophthalmology post-graduate training.&#x0D; Materials &amp; methods: This cross-sectional questionnaire-based study was conducted at the College of Ophthalmology and Allied Vision Sciences/Eye Unit III (King Edward Medical University), Lahore from 01-03-2021 to 31-08-2021. A web-based close-ended questionnaire (Google form) was developed consisting of questions related to residency training in the wake of the COVID-19 pandemic. Eighty-one Ophthalmology residents from across the country participated in this survey. Based on the responses to 21 questions, percentages of various variables in questions were calculated. Data analysis was done on SPSS version 22. Responses to questions are mainly presented as percentages. A chi-square test was applied to see the significant difference in survey questions. For categorical variables, Fisher’s Exact test was applied. P-value ≤0.05 is considered significant.&#x0D; Results: Twenty-seven ophthalmology residents were 1st year residents 23 were 2nd year residents while 3rd and 4th year residents were 14 and 17 respectively. 33% of residents thought their surgical training was affected badly due to covid-19 pandemic while 55% of them were concerned about their basic cataract surgery skills. 67% of residents were in favour of their training extension for 6-12 months. The majority of residents stated that COVID-19 affected their training adversely (p=0.000) and cataract surgery training was the most affected one (p=0.000)&#x0D; Conclusion: The COVID-19 pandemic has severely affected the clinical and surgical training of post-graduate ophthalmology residents. Formulation of institution-based &amp; nationwide short and long-term strategies regarding web-based teaching, surgical simulation courses and necessary adjustments in curriculum are the need of the hour.&#x0D;

The Intake of Junk Food as an Etiological Factor of Megaloblastic Anemia in Patients visiting Mayo Hospital, Lahore

Objective: The study was performed to determine role of junk food intake in the development of megaloblastic anemia.&#x0D; Methodology: It was a clinical based cross-sectional study conducted at Mayo Hospital Lahore in collaboration with Pathology Department of King Edward Medical University from June 2017 to June 2021. All the patients of age 7 to 70 years including males and non-pregnant females attending the Out Patient Department or admitted in the hospital and having hemoglobin values&lt;12 gm/l, MCV more than 95 fl and bone marrow examination suggestive of a megaloblastic change in the marrow (WHO criteria)were included in our study. The patients who had received blood transfusion or hematinic in less than 6 months before diagnosis and pregnant females were excluded from our study. A total 1333 patients were screened, out of which only 160 patients were diagnosed with megaloblastic anemia who had undergone bone marrow trephine biopsy. Their dietary history was taken in detail and history of depression was noted on validated questionnaires. The obtained data was analyzed on the basis of age groups (7-25 years, 26-50 years, 51-75 years) using SPSS descriptive analysis and results were formulated.&#x0D; Results: The study revealed that 160 (12%) of total 1333 patients were diagnosed with megaloblastic anemia on bone marrow trephine biopsy with male to female ratio of 1:1.28. Total 58 (36%) patients belonged to 1-25 years age group 68 (43%) patients to 26-50 years age group and 34 (21%) patients belonged to 51-75 years age group. Junk food consumption was seen (60.3%) in 7-25 years age group as a prevalent etiological factor.&#x0D; Conclusion: Junk food consumption is the major cause of megaloblastic anemia in young population and poor diet in middle age group, whereas comorbidities are the major etiological factor in older people.&#x0D;

Diagnostic Accuracy of Modified Alvarado Score (MAS) and Ohmann Scores (OS) in Diagnosing Acute Appendicitis

In the field of General Surgery AA is the frequent clinical condition for which patients who need emergency surgery present with abdominal pain.1 Diagnosis of this pathology is made with the help of history, patient symptoms, and clinical exam and lab investigations. Ultrasonography (USG) and computed tomography (CT) images for acute appendicitis should be considered.2 Methodology: The purpose of the study is to compare the diagnostic accuracy of Modified Alvarado Score (MAS) and Ohmann Scores (OS) in diagnosing the pathology of Acute Appendicitis, while retaining histopathology as the basis for final diagnosis. A total of 411 patients were admitted via the Accidents &amp; Emergency Department of Mayo Hospital Lahore, meeting the inclusion and exclusion requirements having the clinical diagnosis of acute appendicitis. For each patient, both Modified Alvarado and Ohmann scores were assessed prior to undergoing the procedure, i.e. open appendectomy. Abdominopelvic assessments and laboratory results were assessed and abdominal USG was performed in all patients. Biopsy of the removed appendix was sent for histopathology to Pathology Department of King Edward Medical University. Results: For the modified Alvarado and Ohmann score; sensitivity and specificity of was 89.74%, 90.48%, 85.13% and 80.95% respectively. The positive predictive value (PPV) and negative predictive value (NPV) for “modified Alvarado score” was 99.43% and 32.2% and for “Ohmann score” it was 98.81% and 22.67% respectively. Conclusion: Both scoring system are sensitive and specific enough for diagnosis of acute appendicitis. However, sensitivity and specificity of modified Alvarado score is higher as compared to Ohmann score. Keywords: Acute Appendicitis, Diagnostic Accuracy, Modified Alvarado Score, Ohmann Score, Histopathology.