King Edward Medical University Research Articles

Vitamin D Deficiency (VDD) and Susceptibility towards Severe Dengue Fever-A Prospective Cross-Sectional Study of Hospitalized Dengue Fever Patients from Lahore, Pakistan.

Dengue is a mosquito-borne flaviviral serious febrile illness, most common in the tropical and subtropical regions including Pakistan. Vitamin D is a strong immunomodulator affecting both the innate and adaptive immune responses and plays a pivotal role in pathogen-defense mechanisms. There has been considerable interest in the possible role of vitamin D in dengue viral (DENV) infection. In the present prospective cross-sectional study, we assessed a possible association between serum vitamin D deficiency (VDD) and susceptibility towards severe dengue fever (DF) illness. Serum vitamin D levels were measured at the time of hospitalization in 97 patients diagnosed with dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) at Mayo Hospital, King Edward Medical University, Lahore, PK, from 16 November 2021 to 15 January 2022. In terms of disease severity, 37 (38.1%) patients were DF, 52 (53.6%) were DHF grade 1 and 2, and 8 (8.2%) were DSS. The results revealed that most patients (75 (77.3%)) were vitamin-D-deficient (i.e., serum level < 20 ng/mL), including 27 (73.0%) in DF, 41 (78.8%) in DHF grade 1 and 2, and 7 (87.5%) in DSS. The degree of VDD was somewhat higher in DSS patients as compared to DF and DHF grade 1 and 2 patients. Overall, serum vitamin D levels ranged from 4.2 to 109.7 ng/mL, and the median (IQR) was in the VDD range, i.e., 12.2 (9.1, 17.8) ng/mL. Our results suggest that there may be a possible association between VDD and susceptibility towards severe dengue illness. Hence, maintaining sufficient vitamin D levels in the body either through diet or supplementation may help provide adequate immune protection against severe dengue fever illness. Further research is warranted.

An Obituary-Brigadier Chiragh Hassan Breathes his Last

An eminent senior Pathologist, Brigadier Chiragh Hassan, died in Lahore on 20th October 2022. He wasborn in the Hoshiarpur District and migrated to Lyallpur in 1947.He graduated from King Edward Medical College,Lahore in 1961; had a span of government service, firstas House Physician in Mayo Hospital and later asRegistrar till September 1965. He volunteered for thearmed services in the 1965 war, where he continued toserve till his retirement as Brigadier from CombinedMilitary Hospital, Lahore Pakistan. He did his FCPS in1978 and proceeded to on-the-job training in Tumor Pathology in a specialist unit in London for about a year.He spent a considerable part of his service at Pakistan Naval Ship, Shifa Hospital and did an excellent job in upgrading its laboratory.Dr Chiragh was a keen tennis player. He was very hospitable and loved by his friends and family alike. After retirement, he was an honorary consultantin a Lahore laboratory run by a Non-GovernmentOrganizations (NGO) in Lahore Cantt, Pakistan. The profession will be the loser with the departureof Brigadier Dr Chiragh.May Allah bless the soul!

Conflict Management Among Nurses in Tertiary Care Hospital Lahore

Conflict amongst healthcare workers has been noted as a problem in healthcare settings all around the world. Objective: To analyze the most frequently occurring conflict management strategy utilized by nurses in the hospital setting. Methods: A descriptive cross sectional study design was used to carry out this study. The study was conducted in Mayo hospital, Lahore attached to King Edward Medical College, Lahore. Sampling size of 122 cases was calculated with 95% confidence interval and 6% margin of error. Random sampling method was used to collect data from nurses. Data were analyzed through SPSS V.21 using descriptive statistics (frequencies, and percentages). Results: A total of 122 female nurses were recruited and analyzed in this study. Majority of nurses were aged between 25-30 years, 45 (36.8%). This study showed that there are conflicts among nurses in a hospital setting. Comparison of the subjects' conflict management strategy mean scores according to length of time in nursing position revealed differences in frequency of occurrence of the five strategies. The strategy of avoiding was the most frequently utilized behavior in all categories except the category of time in position of less than 1 year. The results of this descriptive study revealed that the most frequently occurring conflict management strategy utilized by this sample was avoiding. Conclusion: Findings of this study conclude that nurses who practice in the hospital setting tend to approach conflict with concern for the other party’s wishes

Role of Apparels in Burns due to Domestic Violence – A tool for assessing Degree of Burns

Background: Human life is subject to certain environmental, cultural and ethnic origin factors. Based upon the above facts loose and tight variety of clothing/apparel are commonly used. Fire and flames are an integral part of human life on the other hand and accidents do occur in natural course of history. In such accidents type of apparel one might be wearing play a great role in degree or severity of burns. Association and assessments need to be established in this regard. Methods: The study has been conducted on 250 cases of dry flame burns in AED of Mayo Hospital Lahore/Medicolegal Clinic of King Edward Medical University Lahore for a period of nine months in 2017-18. The population of 250 cases were selected through convenient non-probability purposive sampling technique. The study descriptive cross-sectional study design was applied to the above population selected for the study. Results: Our study revealed1.6% females were involved more than males in the burn incident during the period of study. A wide majority up to 70% used Shalwar and Kameez of loose wearable category as per culture of the country in comparison to the relatively tight clothing of Trousers and Pantaloons variety. A grossly significant role has been established with a p value of 0.024 that loose variety of apparel are responsible for causing greater degree of damage in burns as compared to that of tight variety of apparel worn at the time of incidence. Conclusion: The study concludes that wearing relatively short apparels or of tight i.e. Trousers and Pantaloons variety can be safe, protective and a healthy habit during cooking, working in fire burning vicinity like that of industry, hotels, restaurants and winter outdoor activities. The loose variety hereafter referred as Shalwarand Kameezvariety of cultural apparels can be dangerous and even life threatening when it involves higher percentages of burns. Keywords: Burns, Apparel, Clothing, Degree of Burns

Magnitude of Hydrocephalus in Neonates: Its Surgical Management and Complications

Abstract: Background: To determine magnitude of congenital or acquired hydrocephalus and its possible management and complications. Materials and Methods: This Hospital based Retrospective observational study was conducted in department of pediatric surgery King Edward medical university / Mayo hospital Lahore from January 2021 to March 2022. All patients presented from neonatal life till 3 months of age with hydrocephalus due to congenital or acquired reasons were included in this study. There were 55 male and 28 female patients with male predominance. A detailed Proforma was made giving patients information, associated congenital or acquired anomaly and surgical management of hydrocephalus. All patients were operated on elective operation theatre list. Post-operative complications were noticed on admission files and addressed. Results: During the study period, 83(n=1) patients with hydrocephalus were admitted in department of pediatric surgery Mayo hospital Lahore. Among these patients, 56(67.5%) patients have hydrocephalus associated with myelomeningocele while 10(12%) patients with encephalocele. 11(13.3%) patients showed hydrocephalus due to post tuberculosis meningitis while 3(3.6%) patients with Arnold chiari 2 malformation. 1(1.2%) patients presented with hydrocephalus due to Congenital obstruction of cerebral aqueduct while 2(2.4%) with Intracranial hemorrhage ventriculoperitoneal shunting was performed in 55(66.3%) patients to treat hydrocephalus. Conservative management of hydrocephalus was done in 24(28.9%) patients while in 4(4.8%) patients ventricular taping was done. Wound infection was major post-operative complication and was noted in in 13 (15.7%) patients. Conclusion: Ventriculo peritoneal shunting is main treatment modality for obstructed hydrocephalus. Major complication of ventriculo pertoneal shunting is infection which can be prevented by proper prophylactic antibiotics as well as sterile environment of operation theatre.

An Autopsy based unaided Eye Study of Lambdoid Suture of Skull– the Science of Forensic Estimation of Age

Background: The criminal investigation starts at crime scene and ends in the laboratory. The most vital of which is mortuary where the postmortem examination of the deceased is carried out to answer the questions of interest in that investigatory menu. Aim: Unaided eye estimation of age from the lambdoid suture of skull on autopsy. Methods: The subjects under study were taken from mortuary of the department of Forensic Medicine and Toxicology in the King Edward Medical University Lahore during the year 2016. The targeted population for study was the draining are of the mortuary of King Edward Medical College having designated police station. A pretested questionnaire was used to collect the calculated sample among the research population as a research method. A non-probability convenient consecutive sampling technique was applied to collect the data. The comparative descriptive study design was utilized to analyze the results. Results: The study revealed that among the targeted population a higher percentage more than third of the sample size were adolescents of age between 21 – 30 years being 35% followed by elderlies of age between 41 – 50 years amount to 20%. The research depicted that age can be determined from degree of closure of lambdoid suture in the dead body on the autopsy table with closure taking place earlier in males as compared to that of females. Conclusion: This study concludes that it is possible to estimate age from the degree of lambdoid suture closure of the deceased skull vault during the postmortem examination. Keywords: Age, Lambdoid, Suture, Autopsy, Cranial, Post-mortem Examination, Skull

ASSOCIATION BETWEEN IRON DEFICIENCY ANEMIA AND FIRST EPISODE OF FEBRILE SEIZURES IN CHILDREN AGED 6-59 MONTHS

Background: Febrile seizures are one of the most common types of seizure in children, affecting 2% to 5% of all neurologically healthy infants and children. Since fever can exacerbate the symptoms resulting from anemia, relationship between iron deficiency anemia and febrile seizure can be the main cause.&#x0D; Objective: To determine the relationship between 1st episode of febrile seizures in iron deficient children aged from six months to five years.&#x0D; Methods: This case control study was performed in Pediatrics department of King Edward Medical College in the duration of six months from January 2014 to June 2014. Two hundred and fifty patients of either sex, aged between 6-60 months, with first episode of febrile seizures were enrolled by non-probability convenient sampling. After obtaining demographic and clinical data, 125 children served as cases (Fever with seizures) while 125 children served as control (Fever with seizures). Hb, MCV, and MCHC, serum ferritin level of both cases and control was determined. Data was analyzed using SPSS 20. Odds ratio was found to find out the significant association between iron deficiency anemia and seizures episode in both groups. An odds ratio &gt;1 was considered as significant.&#x0D; Results: Iron deficiency anemia was present in 80(32%). Out of 125(50%), 34(27%) cases and 46(36.8%) controls have normal iron levels. There were 91(72.8%) of cases and 79(63.2%) of control who had low levels of iron in blood. The odds-ratio came out to be 1.55.&#x0D; Conclusion: Considerable association was found of febrile convulsions in iron deficient growing age children. This predicts anemia as an important predictor of fever fit.

Frequency of thrombocytopenia in neonatal sepsis.

Objective: To determine the frequency of thrombocytopenia in neonatal sepsis. Study Design: Descriptive Cross Sectional study. Setting: King Edward Medical University, Mayo Hospital Lahore. Period: November 2020 to April 2021. Material &amp; Methods: The study was conducted over a period of six months. Neonates with clinical diagnosis of sepsis admitted in Neonatal intensive care unit, who fulfilled the inclusion criteria were enrolled in the study. Platelet count was measured on automated hematology analyser (SYSMEX,XN-1000) and verified on peripheral smear examination. The variables under study were subjected to SPSS 26. Chi Square test was used as a test of significance. P value &lt;0.05 was considered significant. Results: Among 90 neonates with sepsis, Thrombocytopenia was present in 75% cases. P value &lt;0.05%. Conclusion: Frequency of thrombocytopenia was statistically high in neonatal sepsis. Platelet count is a sensitive indicator of neonatal sepsis.

Early outcome of mechanical ventilation in pediatric surgery patients.

Objective: To report early outcome of mechanical ventilation in pediatric surgical patients. Study Design: Retrospective Analytical Cross-sectional study. Setting: Pediatric Surgical Intensive Unit, Mayo Hospital/ King Edward Medical University, Lahore. Period: January 2020 to December 2020. Material &amp; Methods: The patients requiring mechanical ventilation were included, while patients requiring non-invasive ventilation (CPAP), or with cardiac anomalies and pneumonia were excluded. Demographic variables, diagnosis, source of ICU admission, mechanical ventilation setting and cause of mechanical initiation was recorded. Outcome noted were mortality and morbidity, sepsis, ventilator associated pneumonia (VAP), and ventilator associated lung injury (VILI). For pneumonia and sepsis, vancomycin and meropenem was started, while for VILI chest intubation was done. Results: Total numbers of children enrolled in study were 60. Mean age of the patient was 14.6±3.8 months. Mean weight was 6.3±0.99 kg. Mean number of days on mechanical ventilation were 1.8±0.3 days. Mean length of hospital stay was 7.9±1.2 days. There were 35 patients (58.3%) on Synchronus mode (SIMV) group, and 25 patients (41.7%) on control mode (A/C, pressure) group. Mortality was noted in 39 (65%) children, while 21 (35%) children survived. Thirteen (21.7%) children developed VAP, while 40(66.7%) developed sepsis. VILI was noted in 12 (20%) children. No association was seen between mortality and sepsis, VAP, VILI. Conclusion: If initiated at the right time, mechanical ventilation is not only useful but also life-saving. However, to prevent complications like VAP, VILI early weaning off is mandatory. Mortality was noted in 65% children, while 21.7% developed VAP, 66.7% developed sepsis, and 20% suffered from VILI.

Frequency and Etiology of Pediatric Trauma, Experience at Tertiary Care Hospital

Abstract: Objectives: To determine etiology and spectrum of trauma in children and to make recommendations for its prevention. Materials and Methods: This Hospital based Retrospective observational study was conducted in Department of Pediatric Surgery King Edward Medical University / Mayo Hospital Lahore from March 2021 to February 2022. All patients presented in Pediatric Surgical emergency King Edward Medical University/ Mayo Hospital Lahore were included in this study. Data regarding age, gender, mechanism and severity of trauma and its management was analyzed and recorded on a prescribed Performa. Results: During the study period a total of 3850 patients having trauma were presented in pediatric surgical emergency. There were 2206 (57.3%) male patients and 1644 (42.7%) females with male to female ratio of 1.3:1. Majority of children affected were 8 to 10 years age. Burn trauma was noted in 2400 (62.3%) while 1450 (37.7%) patients have poly trauma due to different etiological factors. Regarding burn trauma, majority of patients 1620 (67.5%) were having scald burn injury. Pedestrians 260 (17.9%) hitting with motor vehicle was noted to be major mechanism of trauma. Conclusion: Motor vehicle collision is most common mechanism of pediatric trauma after pediatric burn injury. There is a need for parental education and strict implementation of traffic laws to prevent trauma at pediatric age group.

Co-Relation Between Metabolic Status and Stage of Diabetic Retinopathy in Patients Visiting Mayo Hospital, Lahore

Purpose: To find out correlation of metabolic status (HbA1c, liver function tests, renal function tests, and hemoglobin (Hb)) with stage of diabetic retinopathy. Study Design: Observational correlational study. Place and Duration of Study: Mayo hospital Lahore, from April 2016 to October 2016. Methods: After approval from the Institutional Review Board of King Edward Medical University,188 patients with diabetic retinopathy (DR) in any one of their eyes, were enrolled. The mean age of subjects was 54.43 ± 9.17 years. Staging of diabetic retinopathy was done by an ophthalmologist and relevant blood workup was carried out. If a patient had DR in both eyes, the eye in the advanced stage was recorded. Spearman rho (ρ) correlation coefficients were analyzed. The determination coefficient (r2) was also evaluated. Results: The male-to-female ratio was 1:1. There were 161 (85%) patients with NPDR, 16 (8.5%) had PDR, and 11 (5.8%) had Adevanced diabetic eye disease. Spearman rho correlation of stage of retinopathy with HbA1c, BUN, Serum creatinine, Bilirubin, SGPT, SGOT, ALP, and Hb were -0.20, 0.160, 0.052, 0.008, -0.13, 0.119, 0.294 and -0.61 respectively; showing positive correlation to BUN, Serum creatinine, Bilirubin, SGOT, and Alkaline phosphate, and negative to HbA1c, SGPT, and Hb. The correlation was significant with BUN and ALP; p = 0.03 and p &lt; 0.001 respectively. Conclusion: Stages of DR showed a positive correlation with BUN, Serum creatinine, Bilirubin, SGOT, and ALP, and negative to HbA1c, SGPT, and Hb. Metabolic state of the diabetic patients should be determined and kept under control while managing diabetic retinopathy.

ANATOMICAL VARIATIONS IN ARTERIAL SUPPLY OF THUMB AND INDEX FINGER IN CADAVERIC HANDS

Human hand is highly evolved in terms of complexity and variations. In this modern medical era, vascular anatomy of the human hand has clinical importance in medical, surgical and radiological sciences. The intention of the current study is to determine the variations which occur as the radial artery branches thus making a contribution to the arterial supply of the index finger and the thumb. The study design was descriptive case series, carried out in the Department of Anatomy in King Edward Medical University from December 2018 to May 2019 on 30 cadaveric limbs. Vivisection of the cadaveric hands was performed following Cunningham’s Manual of practical anatomy. The origin and the course of RA, UA and MA were dissected and identified with further exploration of the blood supply of the index finger and the thumb. All details were entered in a predesigned proforma, and the dissected limbs were photographed. Data was analyzed to find the frequencies of superficial palmar arch as well as the arterial supply of thumb and index finger were also expressed in frequencies. Great variation was observed in the arterial supply to palmar aspect of index finger and thumb. Main contributing artery being radial artery in majority of cases through its common palmar or proper palmar branches arising from SPA or SPBRA. Ulnar artery and median artery were also observed to be supplying these areas in 6.6% and 3.3% cases respectively. The median artery when present was replacing the radial artery on palmar aspect of hand. The dorsum, however, was supplied by the princeps pollicis and the radialis indicis branches of radial artery in all the cases. We concluded that in about 1/3rd (11/30 are incomplete SPA) of our studied sample, arterial supply of the index finger and the thumb is highly dependent on radial artery and should any damage occur to it, vitality of these useful structures will be compromised.

The inclination of undergraduate students at King Edward Medical University towards research and its perceived barriers and facilitators; a cross-sectional study

IntroductionResearch participation by medical students in the early years of their medical studies can change their attitude towards research conduction in the years to come. To identify the shortcomings in our system, it is essential to determine the perception, tendencies, and knowledge of Pakistani medical students about the field of research. MethodsThis survey-based cross-sectional study was conducted at KING EDWARD MEDICAL UNIVERSITY, Lahore with 305 MBBS students. The relevant data for the study was collected in the shape of a pretested, semi-structured questionnaire assembled in the form of google form. The collected data was analyzed using SPSS (Statistical Package for Social Sciences) version 16. Results36.7% of the final year students have conducted research, however, the percentage comes down to 0% and 10.6% for 1st and 2nd year respectively. 50.6% of the final year students claimed they had a good grip on the steps involved in the conduction of research while the percentage for 1st, 2nd, 3rd, and 4th year was 7.1%, 21.3%, 20.9%, and 51.2% respectively. More than 70% of the participants from each year considered research as an important help for critical thinking and improvement in patients’ care. DiscussionThe reasons for the interest of the students in research as indicated by our study include improvement in the professional standards, help in becoming a better self-directed learner, and opportunities for team-based learning via research conduction. Academic overload, lack of structured research training, and difficulty in publishing are the biggest barriers to the conduction of research as recognized by our study. ConclusionConduction of research seminars, organizing platforms for communication between students and teaching staff, restructuring of the medical curriculum, and providing students with the required technical staff can help us overcome these hurdles.

Frequency of Preeclampsia Induced Acute Kidney Injury

Objective: The purpose of this study is to ascertain the prevalence of preeclampsia-related acute renal injury among patients who report to a tertiary care facility. Methodology: This Cross-sectional study was conducted at King Edward Medical University and allied hospitals in Department of Nephrology/Mayo hospital Lahore and department of Gynecology, Lady Atchison Hospital Lahore, affiliated with King Edward Medical University. After obtaining the patient's informed consent, if the patient is able to give it; otherwise, consent was obtained from the attending guardian; the study included all 180 pregnant females with acute kidney disease who were in the third trimester of pregnancy and were presenting for delivery. Patients' ages ranged from 15 to 50 years. Women who were pregnant and had a blood pressure reading that was greater than 140/90 mmHg after 20 weeks of pregnancy and who had proteinuria on a urine dipstick examination were recorded. This information was taken from a previous record. The laboratory at King Edward Medical University and Mayo hospital in Lahore was where all of the investigations were carried out. Following the establishment of a diagnosis, the patients were then treated in a hospital environment in accordance with the protocols. Results: Patients' mean ages were 30.21+5.35, their mean blood pressure was 154.27+108.15 mm Hg, their mean serum creatinine was 4.39+0.28 mg/dl, the mean frequency of urine protein was 112.22 percent, and the mean frequency of preeclampsia-induced AKI in pregnancy was 26.11 percent. Conclusion: This research led me to the conclusion that preeclampsia-induced acute kidney damage occurs frequently and must be detected and treated effectively to prevent maternal mortality and morbidity and to improve foetal outcome. A nephrological workup should be performed on women with pre-eclampsia if their proteinuria and hypertension persist longer than 6-8 weeks after delivery. Keywords: Pre-eclampsia, acute kidney injury, frequency

Awareness of Oral Cancer Among Professionals Practcing General Medicine and General Dentistry in Lahore

Objective: To inquire the oral cancer awareness among general medical and general dental professionalsand their knowledge of early detection and prevention of oral squamous cell carcinoma. Study design: cross sectional study Place and duration of study: Oral and maxillofacial surgery Department King Edward Medical University from 5th November 2019 to 5th February 2020. Methodology: A questionnaire was given to dental and medical practitioners and their responses were included in the results. This study was done in three months’ period from 5th November 2019 to 5th February 2020 after ethical approval from institutional review board. Results:The questions were given back by 57 general medical practitioners and by 40 general dental practitioners, producing return rates of 38% GMPs and 26.66% GDPs respectively. The questions were answered by 93 GMPs and by 110 GDPs producing rates of 62% GMPs and 73.33% GDPs respectively. Conclusion: Patients suffering from oral pathologies often go to their general medical practitioner and dental practitioners. The number of patientsof squamous cell carcinoma of oral cavity are rising in the Pakistan, hence general medical and general dental practitioners need to play significant role. This study talks mainly about the on the need for improvement in awareness about oral squamous cell carcinoma. Keywords: oral cancer, awareness, risk factors

Perception of Undergraduate Medical Students about Integrated Modular Curriculum and Factors Affecting

Aim: To explore the perceptions of undergraduate medical students about integrated modular curriculum and to identify the factors affecting it. Study design: Mixed method study Place and duration of study: King Edward Medical University (KEMU) from 1st November 2021 to 30th April 2022. Methods: The questionnaires were distributed to 391 MBBS students. In depth interviews were conducted from 16 students and audio-recorded. Results: Three hundred and fifty seven (91.3%) considered integrated curriculum a useful approach, 88% preferred this approach over traditional, more than 70% considered it useful for clinical insight and improvement in academic performance. Many (43%) of the students complained that the institutional environment was not helpful regarding implementation of integrated curriculum which was further explored by in-depth interview. Conclusion: The majority of students have shown a positive response to the modular integrated curriculum .It has helped them in improving academic performance and clinical insight. There is a need to improve university environment to implement integrated assessment more effectively. Keywords: Integrated modular curriculum, undergraduate, medical students, perception

Haematological and Clinical Findings Especially Third Space Fluid Accumulation Observed in Major Dengue Outbreaks of Pakistan

Introduction: Dengue fever is a mosquito-borne disease caused by the bite of female aedes mosquito. It is a flavivirus and belongs to the family of arboviruses. According to WHO estimate about 50 million people are afflicted with dengue each year. The outbreak of dengue fever has serious implications on public health and should be dealt efficiently.&#x0D; Aims &amp; Objectives: The purpose of this study was to observe the haematological parameters, frequency of third space fluid accumulation (TSFA) and its association with these parameters so that this fatal complication can be detected early to improve patient management.&#x0D; Place and duration of study: It was a cross-sectional study conducted in Haematology Department KEMU, in collaboration with Dengue Unit, Mayo Hospital Lahore between December 2021 to February 2022.&#x0D; Material &amp; Methods: This was a cross-sectional study conducted at Hematology Department King Edward Medical University Lahore. The patients of dengue fever diagnosed on serology were included in our study. The complete blood counts, ALT and third space fluid accumulation on radiological examination was noted in all patients. The data was analyzed using SPSS version 20 and association among the variables was seen.&#x0D; Results: Total 200 patients were included with mean age 35.03 ± 15 years and male to female ratio of 2.07:1. TSFA was seen in (60) 30% patients, and showed positive correlation with increased hematocrit, low platelet count, increased lymphocyte, and monocyte count. The results were compared with previous outbreaks in 2008 and 2012.&#x0D; Conclusion: Haematological parameters are helpful in disease monitoring and predicting the development of complications especially third space fluid accumulation which has high mortality rate. Early follow-up of haematological findings with clinical correlation can help to prevent the disease complications and increase overall survival.

COMPARISON OF THE EFFICACY OF DULOXETINE VERSUS DULOXETINE PLUS ORAL VITAMIN D IN TREATING PERIPHERAL DIABETIC NEUROPATHY

Painful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus that affects the quality of life. Duloxetine and vitamin D have been used for its management, but there is limited literature comparing the efficacy of these drugs. In this study, we aimed to compare Duloxetine alone versus Duloxetine in combination with vitamin D for treating PDPN. An open-labeled randomized controlled trial was conducted at King Edward Medical University, Mayo Hospital, Lahore, for a duration of 6 months, starting from July 1, 2021, to December 31, 2021. The study included 78 patients aged 20 to 60 years suffering from PDPN as per inclusion and exclusion criteria. Participants were randomly assigned to two groups, with 39 participants in each group. Group A was given Duloxetine 60mg OD, and Group B was given Duloxetine 60mg OD plus oral Vitamin D3 2000IU daily for 8 weeks. Patients were assessed before the start of treatment and followed up after 8 weeks in the outpatient department to measure the mean reduction in pain score using the Visual Analogue Scale. All the collected data was analyzed using SPSS 26.0. The mean age of the participants was 44.46 ± 6.51 years. Of the 78 participants, 51 were female, and 27 were male. 89.8% of patients tolerated the drugs well with no side effects. Only 6.4% of patients complained of tiredness, and 3.8% experienced constipation. The mean VAS before treatment and at the end of the 8th week was 7.41 ± 0.98 and 3.48 ± 1.01, respectively. There was a marked reduction in pain after using both regimens, which was statistically significant (p-value &lt; 0.001). The mean VAS before and after the treatment in Group A was 7.46 ± 0.99 and 4.17 ± 0.72, respectively. In Group B, the mean VAS before and after the treatment was 7.35 ± 0.978 and 2.79 ± 0.832, respectively. This reduction was statistically significant compared to the two groups (p-value &lt; 0.001). The combination of Duloxetine and vitamin D proved superior to the Duloxetine group and is a recommended regimen according to our results. Further studies with more extensive data from multiple centers are required to establish the guidelines.

ERGONOMICS IN OPHTHALMOLOGY PRACTICE: CROSS-SECTIONAL SURVEY AMONG PAKISTANI OPHTHALMOLOGISTS

OBJECTIVE: To assess the ergonomic practices and prevalence of musculoskeletal symptoms among Pakistani ophthalmologists. METHODS: This cross-sectional questionnaire-based study was conducted at College of Ophthalmology and Allied Vision Sciences/Eye Unit III (King Edward Medical University), Lahore, Pakistan from 01-03-2021 to 31-08-2021. A web-based close ended questionnaire (Google form) was developed consisting of questions related to posture in out-patient and operating room in addition to questions related to musculoskeletal symptoms, their effect on routine practice, management. Questionnaire was circulated via a social media application (WhatsApp) to ophthalmologists across Pakistan. Ophthalmologists at various levels of healthcare were included in study. One hundred and seven ophthalmologists consented to part of study and recorded their responses in questionnaire which were then evaluated. RESULTS: Twenty (18.7%) of the participants were diagnosed as having musculoskeletal disorders. Lower back pain was the main symptom in 39 (36.4%) survey responders while 38 (35.5%) of them reported decreased clinical productivity owing to symptoms. Twenty-five (23.36%) participants had to modify their OPD activity owing to development of musculoskeletal symptoms (p&lt;0.01). Majority of those diagnosed with musculoskeletal symptoms adopted neutral spine postures (ergonomically safe) during work hours as compared to those who were not diagnosed with similar disease (p&gt;0.05). Participants who spent ≥6 hours in operation theatre at a stretch were more prone to develop musculoskeletal symptoms (p=0.013). CONCLUSION: Majority of participants experienced musculoskeletal symptoms related to work necessitating the need for change in work place practices focusing on maintaining a neutral spine posture.

The efficacy of zinc as an adjuvant therapy in the treatment of severe pneumonia in children between 2 months to 2 years of age.

Objective: To compare the efficacy of zinc as an adjuvant therapy in the treatment of severe pneumonia in children between 2 months to 2 years of age. Study Design: Case Control study. Setting: Department of Paediatrics, Mayo Hospital Lahore. Period: 20 February 2019 to 20 August 2019. Material &amp; Methods: After approval of Institutional Review board of King Edward Medical University Lahore Pakistan total 200 cases were selected by Consecutive (non probability) sampling and were divided into 2 groups each containing 100 cases. Group A children were given 20 mg elemental zinc per day plus Ampicillin plus cloxacillin while Group B patients were given only on Ampicillin plus cloxacillin. Mean + Standard deviation were calculated for continuous variables like age, base line zinc level and duration of fever. Post stratification chi square test was applied in which P value ≤0.05 will be considered as significant value. Results: Mean Age was recorded as 09 Months ± 5.54 in Group A while in Group B it was recorded as 12 Months ± 6.47. In Group A, 56 (56%) infants showed improvement who were administered zinc while 44 (44%) did not. Similarly, in Group B, 38 (38%) infant patients showed improvement who were not administered zinc whereas 62 (62%) did not show any improvement. This improvement was statistically significant P Value = 0.010. Conclusion: This study revealed a statistically significant efficacy estimate for zinc in the resolution of severe pneumonia.