Patients In Pakistan Research Articles

The Epidemiology of Chronic Kidney Disease-Related Pruritus and its Effect with Sleep Quality in Hemodialysis Patients in Pakistan A Cross-Sectional Study

A glomerular filtration rate of less than 60 ml/min/1.73 m2 for more than three months is the medical definition of chronic kidney disease (CKD) caused by damaged kidneys. The incidence of chronic kidney disease, which can be fatal if left untreated, has been rising for the past 30 years. An unpleasant condition, Pruritus due to chronic renal disease causes itching and decreases the quality of sleep. This study aims to examine the factors associated with Pruritus in CKD patients on maintenance hemodialysis and their impact on sleep quality. Duration and Place: Since 01/01 2019 and ending in 30/06/2019 that year, I will be working as a Post graduate trainee Nephrology in the Nephrology Department at the Institute of Kidney Diseases in Peshawar. Methodology: The department of Nephrology Institute of kidney diseases provided 120 patients with the chronic renal illness. Patients with chronic kidney disease who experienced Pruritus and sleep disruption were included in the study, but those with rashes and Pruritus unrelated to CKD were not. All patients were questioned about their age, gender, typical sleeping habits, illness severity, poor sleep quality, and the location of any pruritus they experienced. Results: CKD-associated This is how pruritis was dispersed: Eighty-one Percent of patients were older than 90, while the remaining 24 percent were younger. Only 43% of those diagnosed with Pruritus reported it affecting their ability to sleep, while 57% reported no such disruptions; also, only 31% of those diagnosed were female, and 74% were male. About 56 percent of those suffering from Pruritus have it quite seriously, whereas 44 percent do not. 62% of Pruritus people experience it on their trunks, compared to 38% elsewhere. A high degree of Pruritus was associated with the female gender, affected body parts, and lack of sleep. Conclusion: Pruritus (sometimes called "uremic pruritus") is the most prevalent skin symptom among persons with ESRD. Despite the absence of evidence linking it to uremia, a significant connection exists in men over 45, causes sleep disruption, and predominates in the trunk. Keywords: CKD-Related Pruritus, Effect, Sleep Quality, Hemodialysis

Vitamin D Level and its Association with Mortality in Children Admitted in Pediatric ICU

Objective: To study the relationship between the levels of vitamin D of pediatric ICU patients in Pakistan and its effect on the rate of mortality among them which will pave ways to improve the clinical outcomes among Pediatric ICU patients of Pakistan. Study Design: Prospective observational study. Place and Duration of Study: Pediatric Emergency Ward, Ghulam Muhammad Mahar Medical College, Sukkur Sindh Pakistan from 1st June 2018 to 31st December 2019. Methodology: Seven hundred and eighty two children of both genders and aged range 1 to 15 years were enrolled. There Vitamin D levels were taken at the time of admission. Results: The overall mortality rate was 13%. Mortality rate in sufficient group was ~9%. Mortality rate in insufficient group was up to 15% and in deficient group, it was 20.2%. The mortality rate was significantly higher in deficient and in insufficient group. Conclusions: Vitamin D levels are a significant predictor in the outcome of mortality in pediatric ICU. It is essential to monitor Vitamin D levels regularly, and efforts should be made to increase Vitamin D levels if they are deficient. Keywords: Vitamin D, Mortality, Pediatric ICU

Clinico-Immunological Profile of Systemic Lupus Erythematosus Patients in Pakistan and Their Correlation

Objective: To see the clinical and immunological profile of systemic lupus erythematosus (SLE) patients and their correlation with the central nervous system and renal involvement.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Fauji Foundation Hospital Rawalpindi from Sep 2019 to Sep 2020.
 Methodology: One hundred forty patients were selected according to SLE ACR (American College of Rheumatology) criteria. Detailed history and examination, including dermatological examination, were done, and blood samples were taken for baseline investigations and SLE-related autoimmune profile. Statistical analysis was done using SPSS 23 to determine the correlation between skin, central nervous system and renal involvement.
 Results: In our study, among the lupus-specific lesions, photosensitivity was most frequent 119 (85%) finding followed by oral ulcers 114 (81.4%), alopecia 112 (80%) and malar rash 81 (57.9%). Among the immunological profile, antinuclear antibody (ANA) was the most frequent 116 (82.9%) finding, followed by anti-double stranded antibody 71 (51.7%). Hypocomplementemia and anti-Sm antibody was significantly associated with lupus nephritis (p-value <0.05). There was no correlation between skin and neuropsychiatric involvement and skin and nephritis.
 Conclusion: This study depicts the clinical immune profile of SLE patients in Pakistan. In our patients, autoimmune profile and complement levels could predict renal involvement.

Pathophysiology of Methicillin-Resistant Staphylococcus aureus Superinfection in COVID-19 Patients.

The global spread of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has infected humans in all age groups, deteriorated host immune responses, and caused millions of deaths. The reasons for individuals succumbing to COVID-19 were not only the SARS-CoV-2 infection but also associated bacterial infections. Antibiotics were largely used to prevent bacterial infections during COVID-19 illness, and many bacteria became resistant to conventional antibiotics. Although COVID-19 was considered the main culprit behind the millions of deaths, bacterial coinfections and superinfections were the major factors that increased the mortality rate in hospitalized patients. In the present study, we assessed the pathophysiology of methicillin-resistant Staphylococcus aureus (MRSA) superinfection in COVID-19 patients in Pakistan. A total of 3492 COVID-19 hospitalized patients were screened among which 224 strain were resistant to methicillin; 110 strains were tazobactam-resistant; 53 strains were ciprofloxacin-resistant; 23 strains were gentamicin-resistant; 11 strains were azithromycin-resistant; 3 strains were vancomycin-resistant. A high frequency of MRSA was detected in patients aged ≥50 with a prevalence of 7.33%, followed by patients aged >65 with a prevalence of 5.48% and a 5.10% prevalence in patients aged <50. In addition, pneumonia was detected in the COVID-19-associated MRSA (COVID-MRSA) that showed decreased levels of lymphocytes and albumin and increased the mortality rate from 2.3% to 25.23%. Collectively, an MRSA superinfection was associated with increased mortality in COVID-19 after 12 to 18 days of hospitalization. The study assessed the prevalence of MRSA, mortality rate, pneumonia, and the emergence of antibiotic resistance as the main outcomes. The study summarized that COVID-MRSA aggravated the treatment and recovery of patients and suggested testing MRSA as critical for hospitalized patients.

Estimating the pre- and post-diagnosis costs of tuberculosis for adults in Pakistan: household economic impact and costs mitigating strategies

BackgroundDespite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.MethodsWe conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The costs were estimated during pre-diagnostic and post-diagnostic phase which includes diagnostic, treatment, and hospitalization phases. A descriptive analysis including mean and standard deviation (± SD), median and interquartile range (IQR), and frequencies and proportions (%) was employed.ResultsOut of 516 TB patients, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient during the pre-diagnostic, diagnostic, treatment and hospitalization periods were estimated at USD63.8/ PKR7,377, USD24/ PKR2,755, USD10.5/ PKR1,217, and USD349.0/ PKR40,300, respectively. The total household median cost was estimated at USD129.2/ PKR14,919 per patient. The median indirect cost was estimated at USD52.0/ PKR5,950 per patient. Of total, 54.1% of patients preferred and consulted private providers in the first place at the onset of symptoms, while, 36% attended public healthcare services, 5% and 4.1% went to dispensary and pharmacy, respectively, as a first point of care.ConclusionsTB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB programs. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan towards reducing the burden.

Predictors of Comorbid Depression in Osteoarthritis Patients at Tertiary Care Settings of Islamabad

Objective: To estimate the co-morbid depression in the patients of knee osteoarthritis at the tertiary care hospital settings of Rawalpindi/Islamabad.Study Design: Cross sectional Analytical studyMethods: Data of four hundred and four patients (n=404; 307 females and 97 males) was collected. Patients were selected from the OPD of Rheumatology Units of two Tertiary Care Hospitals of Rawalpindi/Islamabad and were assessed for co-morbid depression using Urdu translated Depression scale (CES-D). Basic demographical data and some variables directly having an impact with depression were assessed.Results: Frequency of co-morbid depression in osteoarthritis patients was 27.7%, of which females were 19.8% and males were 7.9%. Old age, illiteracy, rural residence, employment status, joint family system, obesity, co-morbidity with osteoarthritis, duration of disease and inability in performing routine activities were the variables positively associated with the depression (p&lt; 0.05).Conclusion: Depression is comparatively prevalent in the osteoarthritis patients in Pakistan. Medical practitioners and rheumatologists must be vigilant about this co-morbidity and identify depression timely for the better attributions to life of the patients.

Geriatrics Breast Cancer: Stage at Presentation and Relationship of Various Factors with Advanced Stage

Objective: To determine the frequency of various stages of breast cancer at presentation and the relationship of various factors with advanced stage in geriatric patients in Pakistan.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Oncology, Hameed Latif Hospital, Lahore Pakistan, from Feb to Jul 2018.&#x0D; Methodology: A total of 130 geriatric breast cancer patients between the ages of 60-80 years were included. A biopsy report was noted, which was done in the surgical ward and histopathology was done in the institutional pathology department. The researchers evaluated all the reports. In addition, the stage of the breast cancer documented (stage documented by CT scan chest abdomen and pelvis and bone scan. Chest X-ray and ultrasound abdomen and pelvis report were reviewed in case of CT scan report not available) as per American joint committee on Cancer (AJCC) TNM staging system for breast cancer 8th edition.&#x0D; Results: Mean age was 69.10 ± 5.89 years. 106 (81.54%) patients were between 60 to 70 years of age. The mean duration of disease was 7.48 ± 3.87 months. 52 (40.0%) geriatrics patients presented in stage IV followed by stage III, II, I as 48 (37.00%), 30 (23.0%) and 00(0.0%) respectively. The long duration of illness has a significant relationship with advanced disease (pvalue&lt;0.05).&#x0D; Conclusion: Stage IV is the most common stage of breast cancer at presentation in geriatric patients, followed by stages III, II and I, respectively and the long duration of illness has a significant relationship with advanced disease.

Abstract 6316: Minimizing ineffective treatment using an in vitro patient derived cancer cell screening platform for local oral squamous cell carcinoma patients in Pakistan

Abstract According to GLOBOCAN’s 2020 report, in Pakistan, lip and oral cavity is the second most prevalent cancer with a low survival rate due to late detection and ineffective treatment regimens. To reduce ineffective treatment, this study aims to develop a cost-efficient in vitro drug screening platform using patient-derived primary cell lines to identify effective drugs against Oral Squamous Cell Carcinoma (OSCC) patients. Chemotherapeutic drugs to be screened were identified from NCCN guidelines as well as the local standard of care after oncologists from three tertiary care hospitals. These included 15 chemotherapeutic drugs along with 14 combinations. For this pilot study, tumor biopsies were collected, after relevant IRB approvals from consenting patients as part of the Oral Cancer Genomics Study project. Patient-derived primary cell lines were generated from tumor biopsies of 20 local OSCC patients recruited at Rehman Medical Institute and Hayatabad Medical Complex, Peshawar, Pakistan. Primary cell lines were derived from tumor biopsies within 30 minutes of resection and propagated till confluency using an optimized DMEM protocol. The readouts of our screen include cell viability, cell proliferation and cytotoxicity. This pilot screen presents a first of its kind dataset of the performance of drugs and drug combinations in primary cell lines derived from the tumors of local patients in Pakistan. This is not just an ideal platform to test novel and re-purposed drugs but also to develop into a service for personalized treatments, minimizing ineffective treatment and improving patient outcomes. Citation Format: Sabaoon Zeb, Khudeja Salim, Hina Zamir, Madina Shirdel, Momal Agha, Asma Qudrat, Sajjad Ahmad, Muhammad Faisal, Muhammad Atif Munawar, Muhammad Mushtaq Khattak, Mushtaq Ahmad, Zubbair Durrani, Faisal F. Khan. Minimizing ineffective treatment using an in vitro patient derived cancer cell screening platform for local oral squamous cell carcinoma patients in Pakistan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6316.

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications.

Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.

Artificial Intelligence, a New Germ Theory in Medicine: From Pakistan’s Perspective

Artificial intelligence (AI) has introduced a new dimension in the different fields of science. In the Western world, AI has been adopted enthusiastically in healthcare fields due to its efficiency and precision. In contrast, the healthcare system in Pakistan has not given due attention to this scientific advancement. Lack of awareness, and financial and moral concerns related to AI, undermine its usefulness of AI. There are opportunities and obstacles in every evolutionary step. It is crucial to embrace the brighter side of AI for a better approach to the healthcare of patients in Pakistan. Keywords: Machine intelligence; Machine learning; Robotics

Patient-reported outcomes for immediate breast reconstruction with mastectomy among breast cancer patients in Pakistan

Introduction: The rate of immediate breast reconstruction (IBR) with mastectomy is less than 1% in Pakistan. It is important to assess the change in the quality of life in women undergoing mastectomy with IBR in a developing country where resources are limited, and patients are not accustomed to reconstructive procedures. This study aimed to evaluate the effect of IBR with mastectomy in the Pakistani patient population.

Nonalcoholic Fatty Liver Diseases in Newly Analyzed Diabetes Mellitus Patients with Risk Factors

Aim: NAFLD is becoming more common among Asians, as is type-II DM &amp; obesity both of which are connected to fatty liver disease. The goal of the research was to govern the pervasiveness of NAFLD in T2DM patients, as well as their risk factors, in Pakistani population. Materials and Methods: This cross-sectional study was held in the medicine department of Islam Medical and Dental College Sialkot for one-year duration from January 2021 to December 2021. This research included adult individuals who had been diagnosed with T2DM during the previous six months. Ultrasound of the liver was used to detect NAFLD. Measurements that were clinically and biochemically important were completed. Results: NAFLD was detected in 124 T2DM individuals out of a total of 160. (77.5 percent). According to multivariable analysis, NAFLD is associated with dyslipidemia (95 percent, p = 0.035), higher LDL (OR 1.02, p = 0.003), HbA1c (OR1.27, p = 0.045), and diastolic blood pressure (OR 1.05, Hypertension, dyslipidemia, waist circumference, BMI, triglycerides, lack of physical activity, reduced LDL, HDL, ALT and HbA1c all had a combined risk of 11.2 for NAFLD. Conclusion: Numerous lifestyle-related factors have been investigated in connection to a high incidence of NAFLD. It assesses risk factor values to demonstrate the need for NAFLD screening in newly diagnosed DM patients in Pakistan. Keywords: diabetes, risk factors, non-alcoholic fatty liver disease and obesity

Prevalence and associated factors of restless leg syndrome (RLS) in Pakistani women during pregnancy

There is a dearth of literature studying restless leg syndrome (RLS) among pregnant patients in Pakistan. The objective of this study was to determine the prevalence and associated factors of RLS among pregnant Pakistani patients. It was conducted in 2018 among 478 women attending ante-natal check-up in the outpatient department of five hospitals in Karachi, Pakistan. Individuals were interviewed for socio-demographic information, the key criteria for RLS and its associated factors. RLS was reported in 54 (11%) individuals based on International Restless Legs Syndrome Study Group (IRLSSG) criteria. The mean age was 33.44 ± 4.42 years. Association between pregnant women with RLS and those without reveals statistically significant differences with increasing age (p=.01), gravida (p<.01) and para (p<.001). RLS was significant among working women (p=.001), during third trimester (p=.001), with insomnia (p<.001), use of tobacco (p<.001) and among women with gestational diabetes (p<.001), hypertension (p<.001). The study showed a low prevalence of RLS among women during pregnancy. It further reported gestational diabetes, hypertension, insomnia and tobacco use to be independently linked to RLS. Impact Statement What is already known on this subject? Pregnancy has been demonstrated to be strongly associated with development of secondary restless leg syndrome (RLS). RLS in pregnancy has also been shown to portend poor maternal and neonatal outcomes such as postpartum depression and preterm birth. Various conditions and lifestyle factors in pregnancy have been shown to be associated with the development of RLS, but there are variations in these across different populations. What do the results of this study add? The prevalence of RLS was only reported twice in pregnant patients in Pakistan and our research helps to address this data shortage. In addition, the results of our study document a strong association of RLS with gestational hypertension and gestational diabetes and also show that smoking and exercise were correlated with RLS during pregnancy, both of which were previously unstudied in the pregnant Pakistani population. What are the implications of these findings for clinical practice and/or further research? Demonstrating the prevalence of RLS in pregnant Pakistani patients highlights the need to screen these patients, particularly those with associated conditions identified in our findings, for RLS during antenatal visits and to treat their condition to improve maternal and neonatal outcomes.

PATIENT SATISFACTION WITH TELEPSYCHIATRY CONSULTATIONS IN THE TIME OF COVID19: DATA FROM A TERTIARY CARE HOSPITAL IN PAKISTAN

OBJECTIVES: To assess the patient satisfaction with telepsychiatry consultations, and whether time and money was saved by patients availing the service. METHODS: Anonymous internet survey using Google Form method, was conducted between April 2020 and September 2020 to collect data from patients using teleconsultation in out-patients psychiatry clinic. The google form consisted of patient satisfaction questionnaire, demographic details, and additional questions about the money and time saved by patients using the service. RESULTS: Out of 260 participants, 152, (58.5%) were males, 148 (58.3 %) were married and majority (n=157: 60.4%) of patients were &lt;40 years of age. About 62.7% (n=163) were highly educated. Majority (n=108; 41.5%) of the survey participants were from Khyber Pakhtunkhwa province. The average cost saving was Pakistani Rupees 3000 for the consultation whereas the average time saved was 1.5 days. Patients were happy during communication with doctor including seeing doctor on screen (85.7%), hearing to doctor (90.4%), talking to doctor (84.6%) and discussion of their care plan (81.6%). Majority (79.2%) of the survey participants were happy with the meeting of care needs and 86.5% were happy to avail the service in future. CONCLUSION: The study underscores the importance of telepsychiatry as mode of service delivery during the pandemics. The findings demonstrated a high level of patient satisfaction, considerable amount of time and money saving indicates the effectiveness of telepsychiatry consultation. It needs to expand the telepsychiatry service both in public and private hospitals and also test this model on a representative sample of patients in Pakistan.

Assessment of the Quality of Life of HIV Positive Individuals in Tertiary Care Hospitals using Whoqol-Bref Questionnaire

Background: Harmonious balance in health depends upon the quality of life (QOL). QOL is the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness, education, social and intellectual attainments, freedom of action, justice and freedom of expression. Aim: To assess the QOL of people affected with HIV/AIDS, which is pertinent in countries like Pakistan, as it is on the rise and one of the leading causes of stigmatization in our society as far as disease is concerned. Methods: This exploratory study by non-probability, convenient sampling was conducted on 139 selected HIV/AIDS positive and registered cases at the Voluntary Counseling Testing Centers (VCT centers) at Services and Jinnah hospitals Lahore, within 6 months in 2019. Data was collected using WHOQOL BREF Questionnaire. The SPSS software was used for data compilation and analysis. The investigator herself took the interviews, after an informed consent. Results: A total of 139cases of HIV/AIDS positive registered individuals were taken. The mean age was 32.12 ± 8.54, with 78.4% males and 21.6% females. Quality of life (QOL) tables with domains were calculated; in the WHOQOL-BREF; higher score in the domains refers to good QOL. Results of the study depicted that the highest mean score was in Social relationships domain (64.75± 16.89) and lowest mean score in quality of life &amp; general health (41.37± 30.28). Conclusion: The study results demonstrated the dire need to explore the QOL in HIV/AIDS patients in Pakistan. There is an urge for measures to be taken, in regards to enhance the QOL. These results conclude that it is imperative to conduct health and vocational education, counseling sessions to augment awareness of the masses regarding QOL. Keywords: Quality of life, HIV/AIDS cases, Lahore, Voluntary Counseling Testing Centers, People Living with HIV/AID’s

INVOLVED CULPRIT ARTERIES AND PROPORTION OF SPONTANEOUS ARTERIAL RECANALIZATION IN ACUTE LATERAL WALL MYOCARDIAL INFARCTION ADULT PATIENTS IN PAKISTAN

Objectives: To elucidate the involved culprit arteries and proportion of spontaneous arterial recanalization (SAR) in acute lateral wall myocardial infarction (ALWMI) patients in Pakistan. Methodology: This cross-sectional study was conducted in the outpatient department (OPD) of a tertiary care cardiac center from February 2019 to July 2019. Patients meeting selection criteria of ALWMI were included. Key angiographic outcomes were recorded for each patient. Proportion of SAR in terms of involved culprit arteries was assessed. Results: One hundred fifty two (152) patients were included, out of which 81% (124) were males. Mean age was 54.73 ± 11.03 years. Most (46.4%) of the study patients presented with single vessel disease. Overall, 89 (59%) patients showed SAR with settled ECG changes. Of them 73 (66%), 8 (33%) and 8 (47%) patients had diagonal artery involvement, 1st obtuse marginal artery involvement and ramus intermedius artery involvement respectively. Statistical significance (p=0.006) is observed for relationship of involved culprit arteries and SAR in ALWMI patients. Conclusion: This cross-sectional study reports the proportion of arterial recanalization in terms of involved culprit arteries. Diagonal was the culprit artery (~ 73%) in most patients presented with ALWMI. SAR proportion is also highest in patients with diagonal artery involvement. This tendency of SAR was more in single vessel diseases patients compared to double vessel and triple vessel diseases patients.

Zero-inflated and hurdle models with an application to the number of involved axillary lymph nodes in primary breast cancer

ObjectivesThis study aims to explore factors influencing the number of axillary lymph nodes in women diagnosed with primary breast cancer by choosing an efficient model to assess excess of zeros and overdispersion presented in the study population. MethodsIt is based on a retrospective analysis of hospital records among 5196 female breast cancer patients in Pakistan. Zero-inflated and hurdle modelling techniques are used to assess the association between under-study factors and the number of involved lymph nodes in breast cancer patients. Count data models including Poisson and negative binomial, zero-inflated models (zero-inflated Poisson and zero-inflated negative binomial), and hurdle models (hurdle Poisson and hurdle negative binomial) were applied. Performance evaluation of models was compared based on AIC, BIC, and zero counts capturing. ResultsThe zero-inflated negative binomial model provided an acceptable fit. Findings indicate women who had a larger tumor in size suffered from the greater number of axillary involved lymph nodes from high-risk patients' group, also tumor grades II and III contributed to higher numbers of lymph nodes. Women’s ages do not have any significant influence on nodal status. ConclusionsOur analysis showed that the zero-inflated negative binomial is the best model for predicting and describing the number of involved nodes in primary breast cancer when overdispersion arises due to a large number of patients with no lymph node involvement. This is important for accurate prediction both for therapy and prognosis of breast cancer patients.

Quality of Life of Melasma Patients in Pakistan

Objective: To assess the quality of life in Pakistani melasma patients.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Dermatology, Combined Military Hospital Lahore, from Oct 2020 to May 2021.&#x0D; Methodology: The study was conducted on 126 adult patients of both genders by non-probability, consecutive sampling technique. Melasma severity was assessed by 'melasma area severity index (MASI) and quality of life impairment by 'dermatology life quality index (DLQI).&#x0D; Results: A total of 126 patients participated in the study, out of which 85.7% were females, and 14.3% were males. Mean MASI score was 12.21 ± 6.87, and mean DLQI score was 8.22 ± 7.46. Male patients had higher MASI scores and statistically signifycant DLQI than female patients (p=0.016). Employed people and those from the higher socio-economic group showed a more significant impairment of their quality of life.&#x0D; Conclusion: There was moderate impairment of quality of life in melasma patients. Healthcare givers need to recognize the effect of melasma on mental health while counselling patients and devising management strategies.

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study.

BackgroundTreatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events.Study aimThis study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan.Study designThis retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018).Measures and outcomesThe Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events.ResultsA total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993).ConclusionAdverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.

Using Skindex-29 Scale to Assess The Impact of Androgenetic/Patterned Hair Loss on Quality of Life of Patients in Pakistan

Objective: to assess the impact of androgenetic alopecia (AGA)/female patterned hair loss (FPHL) on the quality of life of Pakistani patients using Skindex-29 scale.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Outpatient Department of Dermatology, Combined Military Hospital, Lahore Pakistan, from Oct 2020 to Mar 2021.&#x0D; Methodology: Three hundred patients (150 males and 150 females) having androgenetic alopecia (AGA)/female patterned hair loss (FPHL) were selected by consecutive sampling. Skindex-19 questionnaire was used to assess the impact of alopecia on their quality of life.&#x0D; Results: Mean age of study participants was 41.6 ± 12.4 years (range: 18-72 years). Maximum patients (40.7%) had grade-1 severity of alopecia. Most of the patients (37.3%) had disease duration of 1-5 years. Mean global score, symptoms scale score, emotion scale score and function scale score were 31.3 ± 14.8, 22 ± 22.56, 41.67 ± 28.1 and 30 ± 26.5 respectively. Gender and disease duration were statistically significant (p=0.001 and p=0.013 respectively).&#x0D; Conclusion: Skindex-29 can be successfully used in our setup for quality of life studies in AGA/FPHL patients. Females were more severely affected than males as per global scores on Skindex-29.