King Edward Medical University Research Articles

Boruta-driven analysis of telehealth amalgamation across healthcare stratifications with diffuse-dual-channel and tiered-gatekeeper systems.

This study aimed to evaluate the adaptation and effectiveness of telemedicine with the diffuse-dual-channel system (DDS) and tiered-gatekeeper system (TGS) across different tiers of the healthcare system on technical-organizational-environmental (TOE) framework. The telemedicine services were extended as Tiered-gatekeeper system (TGS) by Primary and Secondary Healthcare (PSHC) and Diffuse-dual-channel system (DDS) by King Edward Medical University (KEMU) in 2020 benefiting 2605 and 21,905 patients, respectively. This cross-sectional survey is based on a structured questionnaire conducted on 172 healthcare practitioners (HCP) from KEMU and 76 from PSHC selected by purposive sampling and analysis is conducted through descriptive analysis and the Boruta features selection method. The diffuse-dual-channel system is found to be flexible, easy to implement, and impactful due to innate compatibility with prevailing healthcare practices, however, it is a parallel effort to the existing healthcare system. The tiered-gatekeeping system is found to be complex in adaptation initially, but is more organized, deeply integrated, accountable and channelizes the flow of patients, resultantly aiding the preservation of resources.

Dermoscopic Features and Algorithm- A Guide to Detecting Pre-Malignant Facial Pigmented Skin Lesions in Ethnic Skin

Introduction: Detection of pre malignant facial pigmented lesions on a photo damaged ethnic skin has been crucial for dermatologists in preventing malignant transformation. Facial Pigmented Skin Lesions (FPSLs) that render a diagnostic challenge include, Pigmented Actinic Keratosis (PAK), early Seborrheic Keratosis (SK), Solar Lentigo (SL) and Lentigo Maligna (LM). Dermatoscopy or epiluminescence microscopy, is skin surface microscopy that has demonstrated to be a non-invasive, in vivo, high yield technique to evaluate a pigmented macule for an atypical evolution. Objective: To establish dermatoscopic findings of clinically challenging FPSLs conforming PAK, SK, SL and LM and derive an Algorithm with diagnostic features for detecting Premalignant Facial Pigmented Skin Lesions. Subjects and Methods: We here in conducted a largest case study a cross-sectional analysis of clinically challenging 182 flat FPSLs, evaluated dermoscopic images consistent to pigmented AK, early SK, SL and LM and subsequently biopsied for histopathological evidence. Four major dermoscopic features were appraised: pigment pattern, sharp demarcation, vascular criteria and follicular/epidermal pattern. Study Design: Cross sectional validation-study Setting: Department of Dermatology Unit II, King Edward Medical University, Mayo Hospital Lahore. Study was conducted for a period of six months. Result: We derived an “Algorithm” elucidating diagnostic findings of FPSLs. Pigmented AK on dermoscopy has strawberry pattern in 42% of lesions (pink to red pseudo-network with erythematous background, prominent follicular ostia fenced by a white targetoid halo), while Sharp demarcation (57.15%) and follicular/epidermal pattern (cerebriform pattern 100% of lesions, milia-like cysts, 50%, and comedo-like openings 38.57%) are distinctively observed SK. In SL, homogenous structureless pigmentation is significant entirely (100%). However, in LM predominates pseudonetwork (89.47%), homogenous structureless pigmentation (78%) and vascular patterns while strawberry pattern is observed in (26.31%) of lesions. Conclusion Our “Dermoscopic Algorithm” constitutes diagnostic characteristics of “Facial Pigmented Skin Lesions,” that would not only aid in early corrective detection of clinically similar lesions with different biologic behavior, but serve the the purpose to prevent vigorous malignant transformation in photo damaged ethnic skin, particularly Lentigo Maligna turning into a potential Melanoma, Hence, Sharp demarcation with cribriform pattern is specific of Sebhorric Keratosis (SK), while homogenous structureless pigmentation without prominent vascular pattern is distinctive of Solar Lentigo (SL). Pigmented Actinic Keratosis (AK) is described by prominent strawberry pattern. Nonetheless, homogenous structureless pigmentation and vascular pattern with pseudonetwork are featured in Lentigo Maligna (LM), lacking of prominent strawberry pattern. Conflict of Interest: The Authors have no conflict of interest to disclose.

Role of minimal F-wave latency in the electrodiagnosis of polyneuropathy

Background and objective: Polyneuropathy is a debilitating condition that causes damage to more than two peripheral nerves in the body. The objective of this research was to detect the role of minimal F-wave latency as compared with other nerve conduction parameters for the electro-diagnosis of polyneuropathies. Methods: In this descriptive, prospective cross-sectional study, 80 consecutive patients with clinical diagnosis of polyneuropathy (both acute and chronic) between July and December 2023, presenting to the Neurology Department at King Edward Medical University were enrolled. Patients with clinical diagnosis of cervical/lumbar radiculopathies, plexopathies, compressive myelopathy , neuromuscular junction diseases, motor neuron disorders, or localized neuropathies were excluded from this research. NCS and EMG were carried out using conventional procedure. The results were recorded in the predesigned pro forma along with the history and demographic information. Statistical software SPSS 25.0 was used for the analysis of the recorded data. Results: F-wave abnormality was detected in 57 (71.3%) for median nerve, 57 (71.3%) for ulnar nerve, 79 (98.7%) for tibial nerve and in 79 (98.7%) patients for peroneal nerve. Nerve-specific motor nerve conduction study (MNCS) abnormality was found in 47 (58.8%) for median nerve, 43/80 (53.8%) for ulnar nerve, 59 (73.7%) for tibial nerve and in 57(71.3%) patients for peroneal nerve. Nerve-specific sensory nerve conduction study (SNCS) abnormality was present in 43 (53.3%) for median nerve, 43 (53.3%) for ulnar nerve, 50 (62.5%) for sural nerve, and in 49 (61.3%) patients for superficial peroneal nerve. Overall rate of abnormality was 85% for F-wave minimal latencies in comparison with 64% for MNCS and 56% for SNCS. Conclusion: Minimal F-wave latency can be an effective diagnostic parameter for detection of polyneuropathy. This can facilitate in early detection and management of polyneuropathy.

Audit of Genito-Anal Injuries in male and female sexual abuse cases - A retrospective study.

Background: Sexual assault is a global issue wherein timely examination of sexual assault victims by medico-legal officers and an understanding of the characteristics and factors influencing their injuries have a crucial impact on medico-legal evidence collection and its use in the court. Genital injury findings improve the level of justice for victims, but the lack of injury does not negate the possibility of sexual violence incurred on the victim. The following study describes in great detail the different factors associated with injury characteristics and the medico-legal importance of all these factors. Methodology: It was a retrospective descriptive study conducted at the Forensic Medicine Department of King Edward Medical University, Lahore, Pakistan. All the cases included that fulfill the predefined inclusion criteria were included. A record chart was designed, and six years’ data was recorded in it from the medical records of the medico-legal clinic. It was entered and edited manually. Methods used to prevent data entry errors included double entry and validation following data entry Difference of proportions between variables, where appropriate, has been calculated by Pearson Chi-Square test and Fischer Exact test at 95% confidence interval. Data were analyzed using SPSS v23. All procedures performed in this study involving human participants were following the ethical standards of the institutional and/or national research committee and the Helsinki declaration. Results: Genito anal injury was present in 28.2% cases and was absent in 71.8% cases. Most of the victims were aged 11 to 15 years. The most common injury in the victims was a tear. In females, the most common injury site was the vagina, while the perianal area was the most injured site in males. There was a significant relation (p<0.05) between type and site of injury, gender, site of injury, and prior sexual intercourse experience and prevalence rate of injury. Conclusion: This study concludes that the presence of injuries in the Genito anal area is suggestive of sexual assault and provides useful court evidence.

Association between Storage Time of Corneal Grafts and Primary Graft Failure in Penetrating Keratoplasty

Purpose: To determine association between storage time of corneal grafts and primary graft failure in Penetrating Keratoplasty (PK). Study Design: Quasi experimental study. Place and Duration of Study: Institute of Ophthalmology, Eye Unit-III, King Edward Medical University, Mayo Hospital, Lahore from June, 2019 to December, 2019. Methods: In this study, 120 patients (between 11 and 30 years of age) diagnosed with keratoconus were enrolled and divided into two groups. Group A comprised individuals who underwent PK with donor tissues stored for 8 to 14 days, while Group B consisted of patients whose donor tissues were stored for a duration not exceeding 7 days. Patients were followed up for three weeks post-operatively. The data was analyzed using SPSS version 19 and stratified for age, gender and primary graft failure. Post stratification RR was calculated with p-value ≤ 0.05 as significant. Results: The mean age of patients in Group A was 21.38 ± 6.29 years and in Group B was19.80 ± 5.81 years. In Group A there were 32 male and 28 female while in Group B there were 29 male and 31 female. In Group A 16(26.7%) patients and in group B, 4 (6.7%) patients had primary graft failure. The risk of primary graft failure was higher in Group A, with RR = 4, p-value < 0.05. Conclusion: The risk of primary graft failure in PK is higher when the storage time of corneal grafts is longer. Hence, minimization of storage time may ensure better success rate of corneal grafting.

Diagnostic Accuracy of Cell block Using HistoGel Tube Method in Breast Cancer in Pakistan

Background: Breast malignancy is the major cause of cancer-related deaths among women globally. Therefore, early diagnosis is the primary requisition for an effective treatment plan. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of fine needle aspirate cell blocks made by the HistoGel-tube method in patients with breast cancer. Methods: This cross-sectional study was carried out at the Department of Pathology, King Edward Medical University /Mayo Hospital, Lahore. The study duration was six months. 62 patients with breast lumps, of all ages, both genders, having easily accessible breast lesions and C III, C IV, C V smears on rapid onsite evaluation were included while patients who had received neo-adjuvant chemo- or radiotherapy and those reported as C I ,C II smears on ROSE were excluded. FNA was performed and HistoGel cell blocks were made in addition to the conventional smears. Data was entered in SPSS version 26. Results: The mean age of patients included in the study was 47 ± 13 years. 61(98.4%) patients were female while only 1(1.6%) patient was male. Sensitivity, Specificity, Positive predictive value, Negative predictive value and diagnostic accuracy came out to be 96%, 69%, 92%, 81%, and 90% respectively. Conclusion: HistoGel cell blocks have overall good diagnostic accuracy for the evaluation and diagnosis of breast malignancy.

Anti-Microbial Effects of Vaccinium Macrocarpon (Cranberry) Extract on Serotypes 26 and 45 of Escherichia Coli as a Prophylaxis of Recurrent Urinary Tract Infection (UTI)

Background: Urinary tract infection (UTI) is the second most common type of bacterial infection globally, affecting people of different age groups. Cranberry is renowned for its antibacterial properties and has been used to treat UTIs in recent years. Objective: This study aimed to assess the antimicrobial effects of cranberry extract on the prophylaxis of recurrent UTI caused by different serotypes of Escherichia coli (E. coli). Methods: This quasi-experimental study recruited 60 recurrent UTI patients from the Urology department of King Edward Medical University, Lahore, Pakistan. Patients with a history of recurrent UTIs caused by E. coli were included. Urine microscopy and culture tests were performed, and only E. coli-positive cases were serotyped. Patients received Vaccinium macrocarpon (cranberry) extract at a dose of 500 mg/day for four weeks along with their standard treatment. Follow-up evaluations were conducted after one and three months to assess UTI symptoms and the presence of E. coli in urine samples. Statistical analysis was performed using SPSS version 25, with quantitative variables expressed as mean ± standard deviation and qualitative variables as frequencies and percentages. Results: Of the 60 patients, 15 (25%) were positive for E. coli. Serotyping revealed 8 patients (53%) with serotype 26 and 7 patients (47%) with serotype 45. After three months of treatment, cranberry extract eradicated E. coli in 12 patients (80%); specifically, it eradicated 100% of serotype 45 and 62% of serotype 26 cases. Conclusion: Cranberry extract (500 mg/day) for three months demonstrated significant antimicrobial effects on E. coli serotypes 26 and 45, with greater efficacy observed in serotype 45. These findings suggest cranberry extract as a potential prophylactic treatment for recurrent UTIs. Keywords: Cranberry extract, recurrent UTI, E. coli serotypes, antimicrobial effects, prophylactic treatment, Vaccinium macrocarpon, urinary tract infection, Escherichia coli

Film as an educational tool in medical pedagogy: a study on cinemeducation and its effectiveness

Objective: To find out the possibilities and usefulness of introducing cinemeducation in medical institutions, and to formulate suggestive inserts for faculty and policy-makers. Methods: The quantitative study was conducted in Lahore from January to June 2021 after approval from the ethics review committee of King Edward Medical University, Lahore, and comprised fourth and final year medical students. Relevant short clips from seven movies of different genres were selected and shown to the students who were then divided into eight equal groups. Every session lasted 30 minutes, and was followed by an interactive discussion between the students and faculty members. The critical aspects of the sessions were discussed and analysed. Data was collected using a 7-item questionnaire that was scored on a 5-point Likert scale. Data was analysed using SPSS 21. Results: Of the 240 participants, the questionnaire was returned duly filled by 219(91.25%). Among them, 176(80.4%) said they found the experience worthwhile and that they would like to have such an experience again, while 184(84%) said such sessions should be made a part of regular curriculum. Also, 166(75.8%) participants felt that the session had helped them learn about crucial features of medicine, and 169(77%) thought that the session facilitated the understanding towards patient management. Conclusion: Cinemeducation was found to be an excellent tool of pedagogy that should be incorporated in all the relevant disciplines of medicine and allied sciences. Key Words: Cinemeducation, Methodology, Curriculum.

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,

Frequency of the Most Common Fungal Infection in Biopsies of Patients, Presenting to Pathology Department King Edward Medical University Mayo Hospital, Lahore, Keeping the Pas Stain as Gold Standard

Frequency of the Most Common Fungal Infection in Biopsies of Patients, Presenting to Pathology Department King Edward Medical University Mayo Hospital, Lahore, Keeping the Pas Stain as Gold Standard

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.