King Edward Medical University Research Articles

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 & 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 <0.05 was considered significant. Results: Among 90 neonates with sepsis, Thrombocytopenia was present in 75% cases. P value <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 & 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 < 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.
 Aims & 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.
 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.
 Material & 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.
 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.
 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 < 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 < 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<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>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 & 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.

Relationship of Nottingham Prognostic Index with prognostic parameters of breast carcinoma

Background: Breast cancer (BC) is the commonest malignancy in the female and it is gaining its significance due to worldwide rising incidence. It is also important due to 2.5% higher incidence in Pakistan as compared to neighbouring countries. Nottingham prognostic index (NPI) is an important prognostic factor of BC. It provides information about survival and morbidity. There are significant variations in different studies. Aim: To carry out current study relating NPI with various histopathological parameters of BC. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 137 cases of breast carcinoma were included. Information about age, grade, primary tumor size, axillary lymph node status and stage was entered in the pre designed proforma. NPI was calculated as 0.2xtumor size(cm)+lymph node grade. NPI was scored as excellent, good, moderate and poor and its correlation was calculated against primary tumor size, lymph node grade, tumor grade and stage. Results: We studied 137 cases of breast carcinoma with mean age 49.32±11.64 years. Mean NPI was 5.4±1.4 with range of 2.4 to 9.4. NPI scores in poor 65(47.4%) and moderate 61(44.5%) groups were significantly high as compared to good 10(7.3%) and excellent scores 1(0.7%). Most of the cases of poor NPI were in p T3 and p T4 whereas this was p T2 with moderate score. Poor score of NPI was significant in grade 3 which is in contrast to moderate score where grade 2 dominated the picture. Correlation of NPI with LNG was in favor of LNG 1 with good and moderate scores while LNG3 dominated in the poor group. In stage III, 49 cases (35.8%) were seen with poor score of NPI. Conclusion: NPI is an important prognostic parameter and it can be studied with different histopathological parameters to see correlation between them. In the current study majority of the cases of NPI scored at poor and moderate levels. Correlation coefficient was linear, strong and positive especially with LNG. Mean NPI has ascending correlation with these parameters. Thus NPI can be used as a prognostic indicator when comparing with histopathological parameters of BC. Keywords: Breast cancer, NPI, tumor grade, tumor stage, LNG

‘Sheldon' in the Medical Field: Emotional Intelligence and Its Associated Factors in Medical Students of Pakistan

AimsThe dearth of emotional intelligence leads to medical students’ inability to handle the pressures of medical education, sub-sequently causing burnout and mental illnesses. Poor emotional intelligence in young doctors also begets increased mistrust from the public, lowering the quality of healthcare delivery. Emotional intelligence of Pakistani students, similar to global context, is impacted by a myriad of psycho-socio-economic factors. It is pertinent to find out the detrimental and/or protective factors, and design interventions to enhance emotional intelligence as a soft skill. With this aim in mind, we explored the relationship of emotional intelligence with adverse childhood experiences and prevalent mental illnesses (depression and anxiety) amongst the medical students of one of the most populous cities of Pakistan; Lahore.MethodsA cross-sectional study was conducted including currently enrolled MBBS (Bachelor of Medicine and Surgery) students from first year to final year in 2 medical schools of Lahore. An online google form was constructed by combining Modified Adverse Childhood Experiences Score Scale (ACES), Brief Emotional Intelligence Scale (BEIS-10) and Hospital Depression and Anxiety Scale (HADS). Data were exported to SPSS version 25.0 for descriptive and analytical analysis. Pearson's chi-square analysis and logistic regression analysis were used to study the association between the outcome and dependent variables; Odd's ratio (OR) with 95% Confidence Intervals (CI) were calculated.ResultsParticipants (N = 324) belonging to two different medical colleges in Lahore, namely King Edward Medical College (public) and Shalamar Medical and Dental College (private), took part in the study.Pearson's chi-square showed significant association of emotional intelligence with early private schooling (p = 0.029), nuclear family system (0.044) and the presence of symptoms of depression (0.005). The adjusted logistic regression model showed that people who studied in a private sector school (OR: 2.12, CI: 1.01–4.45) and people who lived in a nuclear family (OR: 2.02, CI: 1.00–4.08) had significantly twice the likelihood of having high emotional intelligence. Also noteworthy is that respondents who were depressed according to HADS showed significantly lower emotional intelligence (OR: 0.37, CI: 0.16–0.86)ConclusionEmotional intelligence is now being recognized as an important life skill for healthcare providers. Emotional intelligence of medical undergraduates is influenced by a number of factors such as early schooling, family's living situation, current mental health and adverse childhood experiences. More prospective researches should be conducted to evaluate these relationships. Carefully crafted interventions for improving emotional intelligence for medical students must be implied at an early level to achieve better outcomes from medical education.

Spectrum of Aplastic Anaemia; presentation, etiology and overall survival: ASpectrum of Aplastic Anaemia: Presentation, Etiology and Overall Survival-A Tertiary Care Hospital Experience Tertiary Care Hospital Experience

Aplastic anemia (AA) is a hematological disorder with immune pathophysiology. There is a decrease in bone marrow precursors and cellularity which lead to a peripheral decline in at least two cell lines. The incidence of AA is higher in the Asian population as compared to that in the west. Objective: To highlight the disease spectrum of aplastic anemia patients from the clinical presentation and etiological factors to the disease outcome and overall survival. Methods: It was a descriptive cross-sectional study, conducted at Hematology Department King Edward Medical University. All the patients of both genders, diagnosed with aplastic anemia on peripheral smear and bone marrow trephine biopsy findings were included. The patients were followed up, the results were recorded and data were analyzed using SPSS V22. Results: The study included total 91 patients of aplastic anemia out of which 46(50.5%) were males, 45(49.5%) were females The patients were divided into three groups according to the severity of which moderate aplastic anemia was present in 19 (20.9%) patients, severe aplastic anemia was seen in 42 (46.2%) patients and very severe aplastic anemia was seen in 30 (33%) patients. The etiological factors seen included idiopathic 61.5%, hakim medication 14.3%, infections 12% drugs 9.8% and radiation exposure 2.1%. It was observed that the patients with severe aplastic anemia presented with high ECOG score. Conclusion: Aplastic anemia has life detrimental outcome with high mortality rate if left untreated can be provided to the patients since it is one of the high incidences hematological disorders in Asian population.

Causes of Postponement of Pediatric Surgical Cases on Elective Operation Theatre List

Aim: To establish factors resulting in postponement of patients on elective operation theatre list. Material and Methods: The design of this study was Prospective observational study. This study was conducted at department of pediatric surgery King Edward medical university / Mayo hospital Lahore from October 2019 to October 2021. Elective operation theatre list is made one day before elective operation theatre list. Patient information regarding diagnosis and possible cause of postponement was noted on prescribed proforma. Results: The total number of scheduled cases was 3900 (Average of 15 cases per list). Out of these 3545(90.9%) patients got operated while the remaining 355(9.1%) patients were postponed due to different reasons. Thus, the overall rate of postponement was 1.36 patients per list. Out of these 355(n=1) postponed cases, 160(45.1%) cases were cancelled due to operation theatre related reasons like shortage of surgical instruments, medicine and linen. 120(33.8%) patients were postponed due to reasons directly related to patients and parents. 65(18.3%) cases postponed due to shortage of man power. 10 (2.8%) patients, were postponed due to unscheduled holiday and power breakdown of operation theatre. Conclusion: Postponement of patients from elective surgery list is avoidable. Timely optimization and team work can reduce these issues. Keywords: postponement, elective operation theatre list, pediatric surgery.

Frequency and Pattern of GIT Anomalies in Neonates: A Retrospective Study at NICU Mayo Hospital Lahore

Aim: To acknowledge magnitude and spectrum of congenital anomalies of gastrointestinal tract in neonates and to establish possible factors resulting in these congenital anomalies. Material And Methods: The design of this study was Retrospective observational study. This study was conducted at NICU department of pediatric surgery King Edward medical university / Mayo hospital Lahore from June 2021 to May 2022. Neonates admitted in NICU department of pediatric surgery with gastrointestinal congenital anomaly were included in this study. Neonates having congenital anomaly other than GIT were excluded. Patient information regarding diagnosis and possible cause of congenital anomaly was noted on prescribed proforma. Results: During the study period total 256 neonates were admitted in neonatal ICU department of pediatric surgery Mayo hospital Lahore. Out of these 156(60.9%) neonates were having congenital anomalies of gastrointestinal tract while reaming 100(39.1%) neonates were having congenital anomalies of other structures. Most common congenital anomaly of GIT was anorectal malformations 35(22.4%) followed by Intestinal atresia’s in 30(19.2%). Conclusion: Congenital anomalies play an important role in neonatal mortality rate of any developing country like Pakistan. Chromosomal disorders, environmental and infectious factors are major contributing factors. Gastrointestinal tract anomalies are the most common anomalies of neonates with predominance of anorectal malformations. Antenatal care and timely interventions can reduce frequency of these anomalies. Keywords: Congenital anomalies, gastrointestinal tract, pattern.

Comparison of Breast Cancer Aggressiveness in Young and Older Patients

Objective: To compare aggressiveness of breast cancer in young and old patients. Study Design: Cross-sectional Place and Duration of Study: Department of Histopathology, King Edward Medical University, Lahore from 1st January 2016 to 31st December 2018. Methodology: One hundred and fifty women were divided into young (<40 years) and adult (>40 years) group depending upon their age. Women with breast cancer within 20-80 years were enrolled. Modified Radical-Mastectomy specimens as well as lumpectomy having axillary-clearance were sent to pathological laboratory. Biopsies were fixed in formalin in addition to hematoxylin, eosin staining. Data was documented and aggressiveness of breast cancer within both groups was evaluated on the basis of factors as tumor size, tumor type, lymph nodes, metastasis, tumor staging and tumor grading. Results: A significant variance in young and adult cases tumor grade, lymph node involvement and tumor size. The young patients had 12.90% cases of metastasis than old only having 4.5% (p<0.05). Similarly high tumor stage and aggressive tumors were also seen in young patients when compared with old. Conclusion: Young patients with breast cancer are more prone towards aggressive carcinoma than older patients. Keywords: Breast cancer. Metastasis, Tumor grade

Impact of COVID-19 pandemic on postgraduate training in Paediatrics.

To assess the impact of the coronavirus disease-2019 pandemic on paediatric postgraduate training as perceived by the trainees. The cross-sectional exploratory study was conducted at the Department of Paediatrics, King Edward Medical University, Lahore, Pakistan, from May to June 2020, and comprised paediatric postgraduate trainees associated with various hospitals across the country who were approached online with a pre-designed 24-item questionnaire during the peak months of the pandemic. Data was analysed using SPSS 25. Of the 226 postgraduates, 134(59.2%) were females. The overall mean age was 28.85±3.06 years. Of the total, 200(88.5%) and 195(86.2%) reported that pandemic had adversely impacted their training and research. The number of trainees managing >30 patients and doing >5 procedures per week before the pandemic decreased from 126(55.8%) and 150(66.4%) to 38(16.8%) and 41(18.1%), respectively, during the pandemic (p=0.01). Regarding e-learning, 168(74.3%) trainees thought it might partly compensate for training, 135(59.7%) showed readiness for it, and 179(79.2%) believed this could not replace actual patient interaction. The coronavirus disease-2019 pandemic was found to have adversely impacted paediatric postgraduate training.