Rawalpindi Medical Research Articles

Suprachoroidal Injection of Triamcinolone Acetonide: Advancing Treatment for Resistant Diabetic Macular Edema

Purpose: To evaluate the effectiveness and safety of suprachoroidal triamcinolone acetonide (SCTA) in managing treatment-resistant diabetic macular edema (DME) over a 6-month period. Study Design: Interventional case series. Place and Duration of Study: Benazir Bhutto Hospital, Rawalpindi Medical University from June 2023 to May 2024. Methods: A total of 64 phakic eyes with refractory DME were included. All eyes received a single SCTA injection (4 mg in 0.1 ml).Re-injection if needed was given after 3 months.Central subfield thickness (CST), best-corrected visual acuity (BCVA), and intraocular pressure were measured at baseline, 1st, 3rd, and 6th month post-injection. Analysis was performed using paired t-test and repeated measures ANOVA in SPSS version 27, with p value< 0.05 considered significant. Results: The mean baseline BCVA was 0.800±0.16LogMAR, improving to 0.709, 0.386, and 0.480 at 1st, 3rd and 6th month respectively after injection (p=0.000). The mean baseline CST was 685.20±133.21, which significantly reduced to 308µm at 1st month, 298.78 µm, and 346.91 µm at 3rd and 6th month respectively (p=0.000). There was no statistically significant difference in IOP and cataract grading 6th month after SCTA. A re-injection was required in 28.1% of patients after 3 months, with no major complications observed. Conclusion: Suprachoroidal triamcinolone acetonide is an effective and safe therapy, resulting in both anatomical and functional improvement in patients with resistant diabetic macular edema for up to 6 months.It is advisable that SCTA be utilized with caution by skilled surgeons when treating resistant DME.

Effect of Information Channels on Covid-19 Vaccine Acceptance among University Students of Rawalpindi/Islamabad: A Cross Sectional Study

Objectives: To find the effect of information channels on Covid-19 acceptance among university students of Rawalpindi/ Islamabad. Study Design: Cross sectional analytic study. Place and Duration of Study: Study was conducted in four imminent Universities in Rawalpindi/Islamabad, Air University,Rawalpindi Medical University, Riphah University and Quaid-e-Azam University, Rawalpindi, from May to Aug 2022. Methodology: Participants from four universities in Rawalpindi/Islamabad Pakistan, were recruited for this current research from May to August 2022. A sample size of 377±14 was computed using the Rao soft sample size calculator, maintaining a 5% margin of error and a 95% confidence interval a population proportion (50%). Non-probability convenient sampling was used.Data was analysed using SPSS version 26. Results: There were 377 students recruited, out of which majority 207(55%) were female. Most of the students were in the Medicine and allied fields 227(60.2%). Almost, half of the respondents (44.56%) received information about the COVID-19 vaccine from mobile networks. The level of trust in vaccine information was also highest for Mobile Networks (31.30%).Participants' perceptions of the covid 19 risk, 156(41%) revealed high concerns for infecting family and friends with the virus.There was a significant association of female gender (p<0.05) and being from the Medicine and allied fields (p=p<0.05) with vaccine acceptance. Conclusion: In our study the mobile and traditional media were reported as the main sources of information about the COVID-19 vaccination however they were not significantly associated with vaccine acceptance. Female gender, education level and being from the Medicine and allied fields was associated with intention to be vaccinated.

Prevalence of Anxiety Related Irritable Bowel Syndrome Symptoms Among Medical Students of Rawalpindi

Objective: The aim of the study was to find prevalence of Irritable Bowel Syndrome (IBS), compare its prevalence among male and female students and find association of IBS with anxiety among medical students of Rawalpindi. Study Design: Descriptive cross-sectional study Place and Duration of Study: It was conducted among the Medical Students of Army Medical College and Rawalpindi Medical University, Rawalpindi Pakistan, from Mar to May 2021. Methodology: A structured, self-administered questionnaire was distributed after obtaining consent. Systematic Random Sampling was done. Sample size was 363. Questionnaire consisted of two parts; IBS Questionnaire for healthcare professionals and Generalized Anxiety Disorder Questionnaire. Data analysis was done using SPSS 26. Results: All the questionnaires were inquired from the age group of 15 to 30 years. A total of 243 responses were collected from females and 120 from males. Analysis of the data revealed that 84 out of 363 respondents (23.1%) had probable IBS. There was a preponderance of females with IBS (26.7%) over males (15.8%). There was significant association of IBS with Gender. Out of 243 females, 37 had severe anxiety, 46 had moderate anxiety, 96 had mild anxiety and 64 had no anxiety. Six males had severe anxiety, 20 had moderate anxiety, 29 had mild anxiety and 65 had no anxiety. Overall prevalence of severe anxiety was 11.845%. 20.2% individuals with probable IBS had severe anxiety. Data analysis revealed (p<0.05) implying that the association of IBS with anxiety is highly significant. Conclusions: The overall prevalence of Probable IBS was found to be 23.1%. A significant association was found between IBS and gender as well as IBS and anxiety levels. The problem can be addressed by managing the stress levels among medical students.

Knowledge, attitude and practices of surgeons regarding venous thromboembolism prophylaxis in tertiary healthcare hospitals of the Rawalpindi Districts.

To assess doctors' knowledge, attitudes and practices regarding venous thromboembolism prophylaxis. The cross-sectional study was conducted from April to September 2021 in three public-sector hospitals affiliated with the Rawalpindi Medical University: Holy Family Hospital, Benazir Bhutto Hospital and Rawalpindi District Headquarters Hospital, Rawalpindi, Pakistan, and comprised physicians of either gender who were actively involved in patient care. Data was collected using a predesigned questionnaire regarding venous thromboembolism. Data was analysed using SPSS 25. All the 220(100%) subjects approached responded positively to the study questionnaire. There were 144(65.45%) general surgeons, 50(22.72%) gynaecologists and 26(11.81%) orthopaedic surgeons. Overall, there were 26(11.81%) senior consultants, 65(29.54%) postgraduate residents and 129(58.63%) house officers. There were 150(68.2%) doctors who reported having witnessed deep-vein thrombosis in their patients, and 113(51.4%) had witnessed deaths related to pulmonary embolism. Among the methods employed for DVT diagnosis, the use of clinical criteria was the most common 136(36.1%), while venography was the least common technique used by 8(2.2%). While 210(95.5%) subjects expressed the desire for adopting an institute-wide regimen for venous thromboembolism prophylaxis, only 66(30%) were currently following such a regimen.

Multiple mediation analysis of a task-shared psychosocial intervention for perinatal anxiety: Exploratory findings from a randomized controlled trial in Pakistan

BackgroundThe “Healthy Mother Healthy Baby” (HMHB) study is a phase three, single-blind randomized clinical trial conducted at Holy Family Hospital (HFH) in association with Rawalpindi Medical University (RMU). We aimed to examine the mediators of a specialized psychosocial approach based on Cognitive Behavioural Therapy principles, targeting pregnant women experiencing anxiety. The HMHB intervention was effective in treating perinatal anxiety symptoms and preventing future depressive episodes. MethodsThe trial randomized participants into two arms: the HMHB intervention or Enhanced Usual Care (EUC), following World Health Organization guidelines. The HMHB intervention comprised strategies to strengthen social support networks, improving mother-baby bonding and strategies to deal with interpersonal conflicts, economic challenges, and societal gender preferences using cognitive and behavioural techniques and culturally resonant illustrations. Participants underwent rigorous data collection at three pivotal timepoints: baseline, third trimester, and 6-weeks postnatal. The primary outcome was anxiety symptom severity scores using the Hospital Anxiety and Depression Scale (HADS) at 6-weeks post-childbirth. Four potential mediators – social support, behavioural activation, perceived stress, and pregnancy experience – were assessed in the third trimester of pregnancy. ResultsA total of 1200 participants were randomized to the HMHB and EUC arms. In the six-week follow-up time point, 379 participants remained in the EUC group, and 387 continued in the HMHB group. Post-intervention, HMHB participants displayed significant improvements in postnatal anxiety and depression scores. Mediation analyses revealed social support and pregnancy hassles as significant mediators of the intervention's effect on postnatal anxiety outcomes, while only social support emerged as a significant mediator for depression outcomes. ConclusionThe HMHB intervention showed promising results in improving anxiety and depression scores among pregnant women. Significant mediation effects suggest the importance of targeting social support and managing pregnancy-related hassles for optimal intervention effectiveness.

Assessing the attitudes and knowledge of medical students towards Patient-Centred Care across different study years: A cross-sectional study.

To determine how medical students viewed the importance of patient-doctor communication, to assess their knowledge about patient-centred care, and to compare the attitudes of medical students in their pre-clinical and clinical years of study towards patient-centred care. The cross-sectional study was conducted from April to September 2023 at Federal Medical and Dental College, Islamabad, and Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students of either gender from 2nd to 5th academic year. Data was collected using the Patient-Practitioner Orientation Scale. Data was analysed using SPSS 27. Of the 322 students, 178(55.3%) were males and 144(44.7%) were females. The mean score was 3.60±0.47, while the sharing and caring sub-scores were 3.23±0.66 and 3.99±0.52, respectively. The attitude of students overall was slightly patient-centred. Different study years showed variance in patient-centred scores which were also affected by cultural, demographic and gender parameters (p<0.05). The attitude of the students leaned slightly towards patient-oriented behaviour.

Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital

Objective: The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications. Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26. Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications. Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.

Comparison of Dexamethasone-Denenhydraminate and Dexamethasone-Ondansetron in Preventing Post-Operative Nausea and Vomiting after Laparoscopic Cholecystectomy

Introduction: Postoperative nausea and vomiting (PONV) is one of the most common problems after implementation of general anesthesia. Laparoscopic cholecystectomy for the treatment of cholelithiasis is popular amongst surgeons as well as patients due to its associated advantages, which includes a short hospital stay. However high incidences of PONV have been reported after laparoscopic cholecystectomy. Objective: To compare the efficacy of combination dexamethasone-dimtenhydrinate with dexa-methasone-ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. Study design: Randomized controlled trial Settings: Department of Anaesthesia, Holy Family Hospital, Rawalpindi Medical University and Allied Hospital. Duration of study: Study was carried out over a period of six months from 01-01-2022 to 30-06-2022. Methodology: A total of 160 patients were enrolled, 80 patients each to either group D for Dexamethasone-Dimenhydrinate group or group-O for Dexamethasone-Ondansetron. Results: Mean age of the patients was 42.3±13.2 and 42.4±14.0 in group-D and Group-O, respectively. There were 40 (50%) males and females in group-D while 29 males (36.3%) and 51 females (63.7%) in group-O. Efficacy of combination dexamethasone+ dimtenhydrinate with dexamethasone+ondansetron in preventing PONV showed at 30 minutes (5.0% vs 12.5%; p=0.093), at 60 minutes (7.5% vs 20.0%; p=0.022), at 120 minutes (6.3% vs 17.5%; p=0.028) and at 24 hours (5.0% vs 18.8%; p=0.007). Conclusion: In conclusion, our study demonstrated that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron combination in prevention of nausea and vomiting after laparoscopic cholecystectomy.

Relationship between academic stress and sleep issues among students at Pakistani Government Medical Colleges

Objectives: To identify the relationship between academic stress and sleep issues among medical students. Study Design: Cross-sectional study. Place and Duration: From August 6, 2022 to September 28, 2022, at 09 Government Medical Institutes of Pakistan hosted by Rawalpindi Medical University. Methodology: A study on 359 students of the MBBS from 09 Government Colleges all over Pakistan using convenient sampling technique. The study was conducted in several government colleges of Pakistan which involved students from all over Pakistan predominantly from Punjab. The questionnaire was composed of 3 sections: 1. Demographics, 2. Kessler Psychological Distress Scale (K10), 3. Pittsburgh Sleep Quality Index (PSQI). The prevalence of stress was measured along with poor sleep quality and their association with each other. Results: Total response rate was 94%. The total prevalence of stress was (69.5) Mean K10 score of the participants came out as 23.54±7.732 (max=50, min=10). Incidence of poor quality of sleep (PSQI ≥ 5) amongst students came out as 84.7% and mean value of PSQI score came out as 8.54 ± 3.03 (max=21). It was observed that there was a statistically significant association between stress and sleep quality (p&lt;0.01). Conclusion: Our study found that Pakistani medical students frequently experience academic stress and have poor sleep pattern. Stress and sleep disturbances were strongly influenced by academic pressures. Keywords: Psychological Stress, Medical Students, Sleep Quality, Kessler Psychological Distress Scale, Pittsburgh Sleep Quality Index Scale, Academic Stressors.

A Comparative Study of the Graston Technique and Alfredson Protocol in the Management of Achilles Tendinopathy.

The Achilles tendon, the largest and strongest tendon in the human body, is frequently injured by overuse; this condition is known as Achilles tendinopathy (AT). It serves as a link between the heel bone and the calf muscles and is necessary for motions, such as walking, sprinting, and jumping. Evidence is presented to support the efficacy of the Graston technique and Alfredson protocol for pain reduction and improvement of function and calf muscle strength. The objective of this study is to compare the efficacy of the Graston technique versus the Alfredson protocol in patients with AT. Methods and data collection: After obtaining approval from the ethical review board of the Rawalpindi Medical University, all patients fulfilling the inclusion criteria are divided into two groups, A and B, by generating random identity numbers using Microsoft Excel for allocation. Group A comprises patients who undergo treatment with the Graston technique as conventional therapy with Alfredson protocol (12-week calf muscle eccentric exercises), while those in group B follow a Graston technique with sole heel lift. Individuals in the eccentric exercises group follow an Alfredson method-based 12-week eccentric exercise plan for their leg muscles. The workouts need to be done twice a day, seven days a week for 12 weeks. The plan includes two exercises: the first done with the knee straightened to work the gastrocnemius and the second done with the knee bent to work the soleus. Three sets of 15 repetitions with no rest interval for each exercise are completed twice a day on the affected limb to yield functional improvement. The results showed that both the Alfredson protocol and the Graston technique were effective in managing AT symptoms. The study involved dividing 32 participants into two groups who received either treatment for four weeks. The main way to measure improvement was a score called the Villalta-Scanlon Achilles Tendonitis Index score. In both groups, these scores showed significant improvement (with a p-value less than 0.001, which means that the results are very statistically significant). For Group A (who received the Alfredson protocol), the average Villalta-Scanlon Achilles Tendonitis Index score before treatment was 29.25. This score increased to 31.25 at mid-treatment and 34.38 after the full four weeks of treatment. Group B (who received the Graston technique) started with an average Villalta-Scanlon Achilles Tendonitis Index score of 22.94. Their scores also increased throughout the treatment, reaching 34.94 at mid-treatment and 42.88 after four weeks. These findings provide evidence that both treatments can improve AT symptoms, with some suggestions that the Graston technique might be even more effective based on the higher average Villalta-Scanlon Achilles Tendonitis Index scores after treatment. The Graston technique shows promising results, particularly in the mid- and post-treatment phases, indicating its potential efficacy in comparison to the Alfredson protocol in the treatment of AT.

Mapping the Oncological Landscape: Insights from the Oncology Care Clinic at Rawalpindi Medical University

Mapping the Oncological Landscape: Insights from the Oncology Care Clinic at Rawalpindi Medical University

Prevalence, predictors, and consequences of workplace violence among female healthcare workers in tertiary care hospitals: A cross-sectional study in Pakistan.

To determine the prevalence, predictors and perpetrators of violence, and its impact on the mental health of female healthcare workers. The cross-sectional study was conducted from June to October 2022 at three tertiary care hospitals after approval from the ethics review board of Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised female healthcare workers, including doctors, nurses and paramedical staff. Data was collected regarding workplace violence using a structured questionnaire adopted from literature. The incidence of verbal, physical and sexual violence in the preceding 12 months was noted, and predictors were analysed. Data was analysed using SPSS 25. Of the 140 subjects with an age range of 16-60 years, verbal violence was experienced by 102(72.9%) and physical violence by 26(18.6%), while verbal and physical forms of sexual violence were reported by 33(23.6%) and 13(9.3%), respectively. Those in the Medicine department had significantly lower odds of experiencing verbal violence compared to those from the Surgery department (adjusted odds ratio=0.223; 95% confidence interval: 0.078-0.036; p=0.005). Those in the Emergency department had significantly greater odds of experiencing physical violence compared to those in Surgery (adjusted odds ratio=8.716; 95% confidence interval: 1.693-44.87; p=0.01). Violence had a significant detrimental impact on the mental health of female healthcare workers (p<0.05). Violence was found to be prevalent in the healthcare sector, specifically in stressful and critical-care departments, like Emergency and Surgery.

Frequency and risk factors of cigarette smoking among male medical students of Bacha Khan Medical College, Mardan

Tobacco consumption is a major global health issue that contributes significantly to morbidity and mortality rates. The World Health Organization (WHO) estimates that over five million deaths occur each year due to tobacco use, projected to rise to 8 million by 2030. Furthermore, current research reveals that 47% of males and 12% of females worldwide smoke. Of particular concern is cigarette and tobacco use among medical students, given their role in crafting public health policy and guiding society's tobacco prevention measures. Studies show that smoking rates among medical students in developing countries are between 16-21%, with multi-country surveys in countries like Malaysia, India, Pakistan, Nepal and Bangladesh indicating rates between 6.7% and 17.8%. For example, a study conducted on medical students in Damascus University Faculty of Medicine revealed a 10.9% prevalence of cigarette smoking, 23.5% for water pipe, and 7.3% for both, with higher rates reported among final-year students. Likewise, a study of Rawalpindi Medical College students found that 24% had smoked at least once, with greater prevalence among hostellites rather than day scholar students.

Descriptive Analysis Of Electrolyte Imbalance In Relation To Severity Of Illness In Covid-19 Pediatric Patients Admitted In A Tertiary Care Hospital In Rawalpindi Pakistan

Objective To determine the frequency of electrolyte imbalance in pediatric COVID-19 patients and their impact on the severity of disease and outcome. Methods: A retrospective observational study was done from January 2021 to July 2021 on 61 children admitted in Benazir Bhutto Hospital Rawalpindi, a tertiary care teaching hospital affiliated with Rawalpindi Medical University (RMU) Pakistan. The age of the patients ranged from infants to 12 years. All the children who were PCR positive or those whose HRCT was suggestive of COVID-19 were included in the study. Results: During the study period of 7 months, 61 confirmed COVID-19 patients were admitted. 37(60.7%) were males and 24 (39.3%) were females. The age of the patients ranged from infants to 12 years with a mean age of 27.25 months. Out of 61 admitted cases, 28 children (45.9%) had moderate &amp; 33(54.1%) patients had severe disease. 46(75%) patients were discharged while 15(25%) patients expired. A number of electrolyte abnormalities were observed. A total of 30 patients (49.2%) were hyponatremic &amp;13 patients (21.3%) were hypernatremic. Hypokalemia was observed in 34(55.7%) &amp; hyperkalemia was found in 2 patients (3.3%), hypochloremia was observed in 13(21.3%) while hyperchloremia was present in 3(4.9%) patients. Hypocalcemia was found in 9(14.7%) patients. 11(18%) patients with Hyponatremia and 6(9.8%) patients with hypernatremia expired. The potassium abnormalities were also associated with significant mortality.14(22.9%) patients with hypokalemia and 2(3.2%) with hyperkalemia expired. Hypocalcemia was found in 9(4.9%) patients who expired. Conclusion: Hypokalemia and hyponatremia were frequent electrolyte disorders in children with COVID-19. These electrolyte abnormalities were associated significantly with severity of disease and a higher risk of death in children with COVID-19 Keywords: COVID-19, Electrolytes, Hypokalemia, Hyperkalemia, Hyponatremia, Hypernatremia, Hypocalcemia

Outcomes, Symptomatology, and Mortality of Children Presenting With Bacterial Meningitis at Allied Hospitals of Rawalpindi Medical University, Pakistan: A Cross-Sectional Study.

Introduction Bacterial meningitis (BM) is a neurologic emergency mainly affecting children under the age of two. Clinical symptoms are rarely evident in children, thus making a diagnosis is a challenge. Antibiotic therapy should be started timely to ensure the avoidance of significant morbidity and mortality. This study aims to assess the outcomes, mortality, and symptomatology of children presenting with BM in allied hospitals of Rawalpindi Medical University, Pakistan. Methods It is a cross-sectional study employing a sample size of 201, conducted at the Allied Hospitals of Rawalpindi Medical University, Pakistan from a period of January 2023 to August 2023. Non-probability convenience sampling was used. Children aged between newborns and 14 years of age with a confirmed diagnosis of bacterial meningitis were included in this study. The study population was divided into five different age groups. Three different outcomes were studied including complete recovery, development of complications, and death. Data was entered into and analyzed by Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY, USA). Descriptive statistics were applied to the demographic data. The chi-square analytical test was applied to study the association between the categorical variables. Results One hundred nineteen (59.2%) of the study's population were males. One hundred twenty-six (62.7%) of the patients were born through a spontaneous vaginal delivery (SVD). The majority (54%) of the study population were infants. Twenty-three percent were newborns, 13% were toddlers, 6% were preschool children, and 4% were school-age children. The majority (85%) of the study participants belonged to lower socioeconomic backgrounds. Ninetypercent of the cases had symptoms of fever, seizures, and poor feeding. Neck stiffness was significantly associated with death as an outcome (p-value=0.01). The overall mortality amongst the study population was 20%. Forty-ninepercent of the study population recovered completely, whereas 31% had complications following the diagnosis.Neonates had a higher mortality rate than infants (45% vs 9% respectively). Conclusion The most common presenting symptoms were fever, vomiting, seizures, and neck stiffness. Poor feeding was also seen in most cases. The rate of complications and death is observed to be relatively higher following the diagnosis of bacterial meningitis as compared to rates in the surrounding and developed countries. Out of all signs and symptoms, the presence of neck stiffness was significantly associated with death as an outcome among children with bacterial meningitis.

Prevalence of Acne and its Association with Stress in Female Medical Students

Background: Acne vulgaris is described as a chronic skin disease involving blockage and inflammation of pilosebaceous units. The objective of this study was to determine the prevalence of acne and its association with stress in female students. Methods: This is a cross-sectional study carried out at Rawalpindi Medical University. The study included female medical students of all five years of MBBS excluding lactating and pregnant females and the ones who were diagnosed with skin disorders other than acne. The sample size was 271. A questionnaire consisting of PSS (Perceived Stress Scale) and GAGS (Global Acne Grading System) was used. Data was analyzed by using SPSS and basic statistics and Spearman correlation were applied. Results: In this study, it was found that out of a total of 271 students, 138(50.9%) students didn’t have acne, and 133(49%) did have Acne. Out of a total of 271 students, 19 (7%) students had low stress, 204 students (75.3%) had moderate stress, and 48 students (17.7%) had high perceived stress. Out of 133 who were found to have acne, 87(32.1%) of the participants had mild acne, 36(13.3%) had moderate acne, 9(3.3%) had severe acne, and 1(0.4%) had very severe acne. An increase in stress severity was moderately correlated (r=0.393) with an increase in acne severity which was not statistically significant (p&gt;0.05). Conclusions: Almost half of the study population was found to have Acne. A positive correlation has been found between stress and acne indicating stress as one of the causative factors of acne.

Complications In The Management Of High-Energy Closed Fractures Of Proximal Tibial Plateau. A Retrospective Study

Objective: To analyze the management of high-energy Schatzker type V and VI tibial plateau fractures which are associated with infectious and noninfectious complications. Methods: This study was carried out in the Department of Orthopedic Surgery, Rawalpindi Medical University from July 1, 2018, to June 30, 2021. This is a retrospective study which is done in three years. Patients had to be between the ages of 18 and 60, have no history of arthritis, have a closed fracture of the proximal tibia (Schatzker type V and VI), or have AO type 41-C1, C2 or C3 involvement of the lower limb. Each patient received treatment using techniques such as internal fixation with locking plates and open reduction which are minimally invasive. Results: This study involved a total of 132 patients.Mean age was 35.15±10.59.115(87%) were men and 17(13%) were women out of 132. A total of 39 out of 132 patients experienced complications (29.54%). Infectious complications (18.93%) were found in (25/132) patients 16 out of 25 patients had superficial infections. Routine dressing changes and antibiotic treatment were carried out in patients who had superficial infections.9 out of 25 patients who had faced a deep-seated infection underwent repeated implant removal, debridements, amputation, and flap covering depending on the reaction of the host. Noninfectious complications had been reported in 14 patients(10.6%). Six patients had hardware-related issues and four of them required a secondary treatment.08 individuals had malalignment, with five of them having it in their immediate postoperative radiographs and three others having it in their late postoperative radiographs. Conclusion: In closed wounds, substantial soft tissue destruction is linked to the fractures of the proximal tibial plateau, particularly Shatzker type V and VI. By selecting the right patients and minimising soft tissue dissection, the problems related to the management of these fractures can be reduced. Keywords: Proximal tibial plateau, Malalignment, Infectious complications, Debridement, Schatzker type V and VI.

Prevalence of non-suicidal self-injury in medical students of Rawalpindi; its socio-demographics, methods, and functions

Objective: To investigate the prevalence of non-suicidal self-injury among Pakistani medical students, its association with demographic variables, and the distribution of its methods and functions. Method: The cross-sectional study was conducted in from April 2021 to March 2022 at Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students regardless of gender and year of study. Data was collected using the inventory of statements about self-harm scale to assess their socio-demographics, non-suicidal self-injury behaviors and functions. Data was analyzed using SPSS 28. Results: Of the 411 subjects approached, 386(94%) correctly filled the forms; 170(44%) males and 216(55.9%) females. The overall mean age was 19.7 ±1.5 (range: 17-27 years). There were 132(34.1%) students from first year, 146(37.8%) second year, 44(11.3%) third year, 54(13.9%) fourth year and 10(2.5%) from the final year. There were 110(28.4%) with non-suicidal self-injury; 60(54.5%) males and 50(45.4%) females (p=0.008). There were 18(4.7%) subjects aged 18 years, and, of them, 14(77.7%) exhibited self-harm behavior. Among specific non-suicidal self-injury behaviors, ‘interfering with scabs and wound healing’ was the most common method 80(72.7%). As for the functions of non-suicidal self-injury behavior, there was a significant difference between intrapersonal and interpersonal functions (p&lt;0.05). Conclusion: Non-suicidal self-injury was highly prevalent among the young subjects, and it needs proper intervention for timely management. Key Words: Behavior, Behavior mechanisms, Pakistan, Personality inventory, Self-injurious behavior, Young adult.

Changes in Ocular Surface and Precorneal Tear Film in Tobacco Smokers

Purpose: To determine the changes in “ocular surface” and “pre-corneal tear film” in tobacco smokers. Study Design: Cross sectional, comparative. Place and Duration of Study: Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan from February 2022 to May 2022. Methods: Eighty four patients (42 smokers and 42 non-smokers) were selected for ocularevaluation. “Ocular surface” and “pre-corneal tear film” were assessed by “tear film break up time (TBUT)”, “Schirmer test”, “corneal punctate staining” and “corneal/conjunctival sensitivity” in both smokers and non-smokers. Chi square test and unpaired t-test were applied and p ≤ 0.05 was taken as significant. Results: Meanage of participants was 36.07 ± 5.75 years. There were 76.2% males and 23.8% females. In terms of age and gender, there was no statistically significant difference between smokers and non-smokers. In terms of TBUT (p = 0.000), corneal punctate staining (p = 0.000) and corneal/conjunctival sensitivity (p = 0.000) values were significantly lower in smokers as compared to non-smokers while in terms of “Schirmer test” there was no statistically significant difference between smokers and non-smokers (p-value of 0.827). Conclusion: Use of cigarettes results in multiple adverse effects in the “ocular surface” and “pre-corneal tear film” including unstable tear film, dry eyes, poor sensitivity of cornea as well as the conjunctiva making their eyes more prone to damage and disease.

Antenatal Care - How to ensure quality!

Antenatal Care - How to ensure quality!