Annals of King Edward Medical University <p style="text-align: justify;">Annals of KEMU is a biomedical research journal that is devoted to publishing the recent advances in all areas of biomedical research for physicians, surgeons, post-graduate trainees, and undergraduate students with special emphasis on clarity of presentation and accuracy of the presented data.</p> <p style="text-align: justify;">Articles published in the Annals of KEMU cover a wide range of fields from basic medical sciences, clinical specialties, and super-specialty areas. Articles describing original clinical or laboratory investigations, case reports, and public health-related studies and surveys are always considered for publication.</p> <p style="text-align: justify;">As a multi-disciplinary journal published by the most renowned and oldest medical institute in Pakistan, Annals of KEMU publishes the most relevant original research articles that form the foundations of tomorrow's medicine in Pakistan and around the globe.</p> <p style="text-align: justify;"><strong>Links:</strong></p> <p style="text-align: justify;">1) <a href="" target="_blank" rel="noopener">Tutorial on how to Upload your Submission</a></p> <p style="text-align: justify;">2) <a href=";id=911140#journal_result" target="_blank" rel="noopener">HEC Ranking</a></p> en-US <p>This is an open-access journal and all the published articles / items are distributed under the terms of the <a href="">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments <a href="" target="_blank" rel="noopener"></a></p> (Publication Office (Annals Editorial Board)) (Annals KEMU Technical Support (IT)) Thu, 15 Jun 2023 00:00:00 +0500 OJS 60 THE ROAD LESS TRAVELED: NURTURING A MEDICAL JOURNAL'S QUEST FOR INTERNATIONAL INDEXATION AND IMPACT FACTOR Journal Impact Factor (JIF), proposed by Eugene Garfield in early 1960s, is considered as the one of the most widely recognized and influential metrics for scholarly journal ranking in the world. It provided a standardized measure based on the citation data for evaluation of journals. In 1975, the Institute for Scientific Information introduced the initial version of the Journal Citation Reports (JCR) as an essential part of the Science Citation Index, spearheaded by Eugene Garfield. First JCR was based on 4,248,065 citations of around 400,OOO source items published during 1974 in 2400 journals.1 Since then, JCR & JIF have undergone significant developments and transformations. They became widely adopted tools for evaluating research impact and journal prestige. Over the years, the IF and JCR expanded their coverage, incorporating more journals and disciplines. Recently released JCR 2023 comprised of 21,522 journals (including 13,668 science journals) from 112 countries across 254 research disciplines.2 Akhtar Sherin Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Writing an Effective Medical Manuscript and Avoiding Errors for Smooth Publication Writing for a biomedical journal is an important part of completing a research project. It is vital to publish original articles or other types of articles in various medical journals. This can be a challenging process, and it requires a sense of responsibility. The process starts with conceiving an idea, forming and conducting the research, and writing about the results, before finally getting it published. Before beginning to write a paper, the language must be properly structured and technical details must be included. Additionally, a cover letter must is sent to the journal's chief editor, mentioning any ethical considerations. Mulazim Hussain Bukhari Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Management of Cirrhotic: Double Edged Sword Cirrhosis of liver has been the centre of attention for all the gastroenterologists for decades in terms of different manifestations and complications and at the same time very challenging to manage.1 There has been some success but not complete eradication of the disease as the risk factors including chronic hepatitis B, C, autoimmune hepatitis , Wilson disease, and most importantly alcohol especially in the western countries remain a daunting task to treat.2 Those who are compliant to treatment are relatively easy to address. Without treatment the complications are devastating leading to the death of the patient. Jibran Umar Ayub Khan, Azhar Zahir Shah, Ayesha Qaisar Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 A unique case of adrenal insufficiency coexisting with two primary malignancies Endocrine system originated lymphoma accounts 3% of all extra-nodal lymphoma cases and primary adrenal lymphoma (PAL) constitutes only 0.2% of them (1). In our literature research, there are nearly 250 cases published about PAL, until today. To the best of our knowledge, in addition to this extremely rare incidence of PAL, another accompanying primary malignancy has not been reported in the literature to date. Here, we present the first case of adrenal insufficiency, coexisting with bilateral PAL and follicular thyroid carcinoma. Hilal Bektas Uysal, Murat Duran, Engin Güney, Irfan Yavasoglu, Hulki Meltem Sonmez Copyright (c) 2023 Fri, 22 Sep 2023 00:00:00 +0500 Mutiple Hybrid Odontomas Involving All Four Quadrants of Jaws: A Rare Case Report Odontomas are odontogenic tumors in which complete functional discrepancy of ameloblasts or odontoblasts occur with the development of enamel and dentine in an irregular arrangement due to lack of association of these cells to reach usual state of morphodifferentiation. Multiple hybrid odontomas present as many complex or compound odontomas involving one to all four quadrants of jaws. this present case is of a female aged 12 years who presented with mild pain and swelling in the right body of mandible for 1 year. After initial clinical and radiographic assessment, a tentative diagnosis of multiple hybrid odontomas involving all four quadrants of jaws was made. Surgical excision of the lesion which was causing facial deformity was performed. Excisional biopsy report verified the clinical diagnosis. This case report describes the first unique case of multiple hybrid odontomas involving all four quadrants of jaws presented in last five years' literature. Sana Arif, Nabeela Riaz, Ehsah-ul- Haq, Hafiz Nasir Copyright (c) 2023 Fri, 22 Sep 2023 00:00:00 +0500 The Invisible Killer: Investigating the Lack of Research on Smog in Pakistan Smog, a combination of smoke and fog, is a major public health hazard in Pakistan, although it has gotten little attention and research. Despite the negative impacts of smog on the population, there is a dearth of studies and data on the subject, making it difficult for politicians and public health professionals to properly comprehend the issue and design effective solutions. Smog hurts public health in Pakistan, with research attributing it to an increase in respiratory infections and mortality. However, a paucity of study makes it difficult to completely comprehend the scope of the problem and its impact on the community. The purpose of this article is to highlight the critical need for additional study and data collection on the issue of smog in Pakistan and its effects on public health. We also emphasize the need for the government to prioritize this issue and take steps to alleviate the consequences of smog on the population. Saira Afzal Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Fear of Missing Out in University Students: A Psychometric Study Background: Fear of missing out is a subcategory of social anxiety and an upsurge issue which may lead university students to experience many detrimental effects on their well-being. Objective: To develop an indigenous scale with sound psychometric properties to measure fear of missing out by highlighting the culture-specific experiences of university students. Method: A mixed cross-sectional research design was used. This study was carried out from October 2020 to May 2021. Data was collected from different government and private universities in Lahore. Initially, 82 items were generated by conducting interviews with university students. After eliminating dubious items, a list of 57 items was generated. These items were given to a committee of experts for empirical validation. After that, a list of 48 items was finalized. Then these items were piloted on 14 university students. Finally, this scale along with the demographic form was administered to a sample of 400 university students (men=194, women=206) in the age range of 18 to 28 years (M=21, SD=2.15) using purposive sampling technique. Results: Exploratory Factor Analysis revealed four-factor structures of fear of missing out scale named, Low Self-Esteem, Lack of Contentment, Apprehensions, and Jealousy. In each subscale, no. of items ranges from 6 to 14 items. Results revealed the newly developed scale has a high internal consistency of a=.73, test-retest reliability r=.89, and good concurrent validity r= .34. Results also revealed that 14.0% of participants have mild, 37.3% have moderate, 32.0% have severe and 16.8% have a very severe level of fear of missing out. Conclusion: As a result of this study a 41-items self-reported measure of fear of missing out for university students, having sound psychometric properties was developed. Amna Saba Sabir, Ayesha Jabeen Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Outcome of Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) with Doppler Guidance for Symptomatic Grade-II, III and IV Internal Haemorrhoids Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy . Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids. Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates. Wasif Majeed Chaudhry, Hania Aamir, Amber Mohsin, Salman Majeed Chaudhry, Samar Ghufran, Maryam Jamil Copyright (c) 2023 Tue, 15 Aug 2023 00:00:00 +0500 Leadership in Undergraduate Medical Education: A Study of Pakistani Medical Students’ Perceptions, Attitudes, and Interest Background: Despite calls for the much-needed involvement of physicians in leadership, very few medical colleges in Pakistan provide explicit training on the knowledge, skills, and attitudes necessary to be an effective physician leader. Objective: To explored Pakistani medical students’ perceptions, attitudes, and interests regarding Leadership training in medical education. Methods: Participants were asked about their perceptions and attitudes towards medical leadership on a 5-point Likert scale. Students also self-rated their leadership competencies noted as per Medical Leadership Competency Framework. Survey also assessed the perceived need and topics for a leadership curriculum for physician leaders, the teaching format, and barriers to leadership training in medical schools. Data were analyzed using SPSS 26. Results: 60.6% of the total 1204 respondents rated their leadership training in medical college as “very poor” or “poor” and 80.3% of them endorsed their interest and need for it. 77.4% of the participants agreed that clinicians should influence leadership decisions in a clinical setting. Only 25% of respondents were aware of the demands of a leadership rank in medicine. Leadership competencies endorsed for training included problem-solving, leading a team, confronting problematic employees, and communication skills with a multimodal teaching approach, including teaching methods like small group discussions. The main barriers to leadership training were identified as time constraints (66.1%), lack of available curriculum (69.0%), and disinterest by faculty (67.0%). Conclusion: Our study suggests that medical students in Pakistan appreciate the importance of leadership training in undergraduate education. There is a need for dedicated leadership teaching and study data to specify the possible content and delivery methods to serve as goals for an undergraduate leadership curriculum in Pakistan. Nazish Imran, Bakhtawar Khalid, Zubia Afzal, Saleha Azeem, Osheen Fatima, Imran Ijaz Haider, Muhammad Waqar Azeem, Afzal Javed Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Determination of Multidrug Resistance and Extended Drug Resistance Pattern of Pseudomonas aeruginosa in Clinical Isolates of Tertiary Care Hospital Lahore Background: Pseudomonas aeruginosa (PA) is a major public health community-acquired threat around the globe due to the growing rate of antimicrobial resistance. It is one of the most common trending causes of nosocomial infections. Objective: The current study aimed to check the rate of multidrug-resistant (MDR) and extended drug-resistant (XDR) PA and to analyze the invitro activity of different antimicrobial agents against clinically isolated bacterial samples. Molecular Detection and amplification of L lipoprotein (OprL gene) were also done to determine the frequency and species of different strains of Pseudomonas aeruginosa (PA2192, C3719, PA01, PA14 and PACS2). Method: This cross-sectional study was conducted at at the Department of Pathology, King Edward Medical University/ Mayo Hospital Lahore. Total 140 patients were included in the study. Biochemical characterization, molecular identification, antimicrobial susceptibility profiling and DNA sequencing of the desired gene were done to confirm different strains' identification. Results: MDR and XDR Pseudomonas aeruginosa infection are more common among males 81(57.5%) and high among the 31-45 age group, i.e., 55 (39.3%). After antibiotic susceptibility testing, 60% of strains were found to be MDR PA, while 40% were categorized as XDR PA. Doripenem showed the highest sensitivity, 93 (66.4%) among all carbapenems. Polymyxin B showed the highest activity against Pseudomonas aeruginosa multi and extensively drug-resistant strains, i.e., 108 (77.1%). Conclusion: The present study suggests that doripenem can be the only active agent for combating infections, and the Carbapenem drug appears effective against highly resistant strains of Pseudomonas aeruginosa. Dilshad Ahmed, Hasnain Javed, Wajiha Kanwal, Warda Fatima, Nida Abdul Qadir Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Sofosbuvir-Velpatasvir for Chronic Hepatitis C Virus-Infected Children and Young Adults: Efficacy and Safety Background: Sofosbuvir-Velpatasvir has a high efficacy in adult patients with chronic hepatitis C infection .In this study, we reported treatment outcome with this drug in children and younger adults in Pakistani population. Objective: To assess the efficacy and safety of Sofosbuvir-velpatasvir in treating HCV-infected children and young adults. Methods: This Interventional(Clinical trial) was done in Hepatitis clinic Jinnah Hospital, Lahore from April 10, 2021 to January 9, 2022.A total of 45 patients aged 6 to 18 years with detectable HCV RNA by PCR were registered. They were evaluated clinically. HCV genotyping was not done as Sofosbuvir – Velpatasvir is pangenotypic. All of the patients were given a single oral dose of Sofosbuvir-velpatasvir per day. Ribavirin was included for patients with compensated cirrhosis and for those who were treatment-experienced .Clinical assessment, CBC, LFT, RFT, and PT were performed monthly to determine side effects and safety. To evaluate treatment efficacy, HCV RNA was measured by PCR at 12 weeks (end of treatment) and 12 weeks post-treatment (sustained virological response). Treatment lasted for 24weeks for those with compensated cirrhosis. (Child Turcotte Pugh score 5 and 6; Child class A) or those who were treatment experienced. SPSS 24 was used for data analysis. Results: Non cirrhotic patients had a mean age of 13.6±1.45 years, while those with compensated cirrhosis had 14.1±2.15 years. There were 63.6% males (28) and 36.4% female (17). 41 patients (91.11%) had undetectable HCV RNA by PCR ,12 weeks after treatment (Sustained virological response), indicating treatment effectiveness. Nine patients had HBV co-infection and took HBV medications as well during HCV treatment. At 12 weeks post-treatment, all HBV-coinfected patients had undetectable HCV RNA by PCR and lower HBV titers. Some of the patients experience minor side effects. However, none of the patients stopped their treatment due to these side effects Thus, this treatment was safe and effective. Conclusion: Sofosbuvir/ velpatasvir has effectiveness and safety in treating HCV in children and young adults. Attique Abou Bakr, Shahid Sarwar, Naeem Aslam, Mamoona Ghias, Imran Mehfooz Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Effects of Core Stabilization Exercises on Low Back Pain, Disability and Back Muscle Endurance in Patients with Lumbar Disc Herniation Background: Lumbar disc herniation is a common musculoskeletal disorder leading to spinal degeneration. Core stability influences lumbar biomechanics, which improves muscle endurance through decreased pain of the lower back leading to minimal chances of disability. Objective: To determine the effects of Core stabilizing exercises on low back pain, disability and endurance of back muscles in Lumbar Disc Herniation patients. Methods: Randomized controlled trial was conducted on 52 patients . it was conducted 3 times a week for 30 minutes for 6 months. Participants allocated into two equal groups by lottery method. Group A was treated with controlled conventional treatment and core stabilizing exercises. Group B received only conventional treatment. This information was collected using NPRS and ODI. Besides this Biering-Sorenson and trunk flexion endurance tests were used. Probability sampling was used .Settings included AMTH, PSRD and NHMC. The study was conducted for 6 months. Ethical permission by ethical review board. data analysis by SPSS. This included male and female patients, age 20 to 60 years with disc herniation. Participants with recent surgery, inflammatory arthritis, cauda equina syndrome and spinal tumor were excluded. Results: After 8-weeks of core stabilization exercises, values of Group A are 1.93 for pain, 16.08 for disability, 1.27 and 40.54 for endurance whereas Group B showed values of 4.74 for pain, 34.08 for disability, 2.15 and 34.81 for endurance. Independent t-test showed significant difference between 2 groups with p value < 0.05. Results of current study showed considerable reduction in low back pain and disability, and a significant increase in back muscles endurance in the treatment group. Conclusion: Core stabilization exercises were effective in improving function, reducing pain, reducing functional disability and enhancing endurance in patients of lumbar disc herniation and lower back pain Mohammad Abbas Jamil, Muhammad Salman Bashir, Rabiya Noor, Rehana Niazi, Nazeer Ahmad, Shahzad Ahmad, Haseeb Ullah Ahmad Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Outcomes of Fisher Technique for Unilateral Incomplete Cleft Lip Repair Background:- Cleft lip repair is imperative for a child’s physical and mental well-being. Fisher’s innovative technique adds versatility to conventional methods with optimal aesthetic results. An inconspicuous scar along the anatomical subunits is a hallmark of this procedure. Objective: This study aimed to evaluate the outcomes of Fisher technique for unilateral incomplete cleft lip. Methods:- This Quasi experimental study was conducted at the Plastic Surgery Department, Mayo Hospital Lahore from 2017 to 2021. 50 consecutive patients with primary unilateral incomplete cleft lip were included in the study. Qualitative analysis was performed using Steffensen Grading Criteria 9. Improvement in pre-operative and post-operative anthropometric ratios was also analyzed. Symmetry of repaired cleft to normal cleft side was also assessed 9,12 . Results:- Mean age of patients was 4.14±0.72 months. Parent’s satisfaction score on the Likert scale was 4.84±0.37 (Mean ±SD). Significant improvement in anthropometric parameters (vertical lip height, vermilion height, nostril width and nostril height) except lip width was recorded. Significant symmetry was achieved for all parameters (p-value less than 0.05) except nasal height ratio (p- value=0.071). Good results were also achieved on all parameters according to Steffensen criteria. Conclusion:- Fisher anatomical subunit repair is a reliable option for unilateral incomplete cleft lip repair producing aesthetically pleasing results. Sana Saeed, Farid Ahmad Khan, Saadia Nosheen Jan, Zara Shakeel, Bismah Bilal, Muhammad Mustehsan Bashir Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Effect of Intravenous Magnesium Sulphate on in-Hospital Mortality in Neonates with Perinatal Asphyxia: A Prospective Cohort Study Background: Early neonatal deaths in Pakistan account for 7% of global neonatal mortality rate, with perinatal asphyxia being responsible for 23% of these cases. Controversy exists in the literature regarding role of magnesium sulphate administration on reducing in-hospital mortality in newborns with perinatal asphyxia. Objectives: To determine the effect of intravenous magnesium sulphate on in-hospital mortality in neonates with perinatal asphyxia. Methods: This prospective cohort study was conducted at the Department of Pediatric Medicine, Nishtar Hospital Multan over a period of six months from January 2022 to June 2022. A total of 183 consecutive full-term neonates, weighing ≥ 2500 grams, with Apgar score < 7 at 5-minutes after birth, presenting within 48-hours of life were included in the study. Neonates presenting within 6-hours after birth received intravenous magnesium sulphate (MgSO4) – exposed group and neonates presenting after 6-hours did not get MgSO4 – unexposed group. Baseline characteristics and survival outcome was recorded. Binary logistic regression analysis was run and Kaplan-Meier survival curve is constructed for the assessment of mortality. Results: There were 90 neonates in exposed group and 93 in unexposed group. Males constituted 53% of the study population. Overall mortality rate was 15.8% (n=29). Severe asphyxia (RR 8.5, 95% CI 4.0 – 18.0; p < 0.001) and spontaneous vaginal delivery (RR 1.8, 95% CI 1.1 – 2.9; p = 0.02) were the independent predictors of mortality. Mortality (7.8% vs. 23.6%, p-value 0.003) was significantly higher in unexposed group compared to exposed group. In exposed group the median survival time was 16 days (95% CI- 8.7 – 23.3) compared to 11 days (95% CI 9.9 – 12.0) in unexposed group (Log-rank test: χ2 = 6.03, df -1, p = 0.01). Conclusion: Magnesium sulphate was effective in lowering neonatal mortality due to moderate-severe perinatal asphyxia. In order to further validate its impact on mortality, multi-center studies are suggested. Javaria Rasheed, Muhammad Khalid, Barera Maryam, Shazia Parveen Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Prevalence of Emotional Intelligence in Students at a Medical College in Pakistan Background: Traditional thinking places high Intelligence Quotient (IQ) as the most important predictor of success but its contribution is only half that of Emotional Intelligence (EI), the ability to manage emotions. EI encompasses several skills, all of which need to be mastered for professional and personal success. Objectives: To determine the emotional intelligence level of medical students at a private medical college in Lahore, Pakistan, and to see its association with gender and years of study. Methods: This cross-sectional study was conducted between January and March 2022. Convenience Sampling was used to select 370 medical students at a private college in Lahore, Pakistan, who filled out a questionnaire to measure their emotional intelligence. SPSS 20 was used for data analysis. Results: The majority scored in the middle range of EI, with a mean score of 58.6±7.8 (out of a possible lowest score of 20 and highest of 80). There was a significant association of EI with gender as well as with years of study. Males had higher total EI scores than females (p.002), as well as higher mean EI score of 59.9±8 compared to 56.9±7.3 for females (p.001). Students from higher classes had higher total scores as well as higher mean scores than those from lower classes (p.001) and (p.001) respectively. Conclusions: Half the respondents got mid-range EI scores. While there were very few low scores, only a third scored in the desirable higher ranges indicating a need for counselling. Muhammad Ashraf Chaudhry, Shireen Rafeeq, Daniyal Asim Khan, Javaria Nosheen, Shahid Munir Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Antibacterial Effects of Chewing Stick Extracts on Streptococcus Mutans Background: Streptococcus mutans is considered as a major microorganism causing tooth decay, affecting individuals globally. Different types of chewing sticks possess anti cariogenic properties, traditionally been consumed in maintaining dental hygiene. Usage of these sticks can be economical in developing and rural regions where dental caries is a major health concern. Objective: The current study aims to evaluate antibacterial action of different type of chewing sticks extract on Streptococcus mutans. Methods: Aqueous extracts of Azadiracta indica (Neem), Melia azedarach (Bakain), Mangifera indica (Mango), Salvadora persica (Peelu), Terminalia chebula (Harhar), Dalbeigia sissoo (Tali) and Juglans regia (Akhrot) plants which have justified folk use were prepared in Punjab University College of Pharmacy, Punjab University. Next, in vitro antimicrobial activity was studied by broth dilution method in Post Graduate Medical Institute, Lahore. Moreover, minimum inhibitory concentration (MIC) as well as the minimum bactericidal concentration (MBC) were quantitatively evaluated on basis of turbidity index. Results: There is a significant effect of aqueous extracts of plants on the bacterial inhibition. MIC and MBC values were in the range of 6.125 to 100 mg/mL against S. mutans. The notable effect occurred with aqueous extracts of Azadiracta indica showing MIC and MBC values as 6.25mg/mL and 12.5 mg/mL, respectively. Alternatively, Salvadora persica demonstrated 8.33mg/mL and 16.66 mg/mL values of these parameters Conclusions: Each plant studied exhibited moderate to high antibacterial activity against tested bacterial strain. However, Azadirachta indica and Salvadora persica aqueous extracts showed promising effect against Streptococcus mutans Naureen Sarwar, Sadia Sharif, Saira Aslam, Bushra Nisar, Shahab Sarwar, Attika Batool Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Association of Severe Disease Activity with Metabolic Syndrome in Patients with Early Rheumatoid Arthritis: A Cohort Study from Tertiary Care Hospital of Pakistan Background: The peripheral joints are particularly vulnerable to the autoimmune disease rheumatoid arthritis. Patients with rheumatoid arthritis often exhibit symptoms of metabolic syndrome. Metabolic syndrome in rheumatoid arthritis is connected with increased morbidity and death. Objective: This study aimed to examine whether or not rheumatoid arthritis patients who had high levels of disease activity also developed metabolic syndrome. Methods: The cohort study was conducted on 64 patients (32 in each group), included via Non-probability convenient sampling. Disease activity score of 28 joints (DAS-28 score) was used to assess the severity of disease activity in patients of rheumatoid arthritis and two groups were developed i.e. group I with score ≥3.2 and group II with score <3.2. Patients were then assessed for metabolic syndrome. All data was analyzed in SPSS version 21.0. The association between severe disease activity and metabolic syndrome was calculated as relative risk. Results: The mean age of patients in group I & II was 31.26 ± 5.07 years & was 33.57 ± 3.73 years respectively. The mean DAS-28 score of patients in group I was 4.93 ± 0.79 while in group II was 2.32 ± 0.40 and the difference between both groups for DAS-28 score was highly significant (p<0.001). Metabolic syndrome was diagnosed in 13 (40.6%) patients in group I while in 3 (9.4%) patients in group II. The difference was significant, association observed between metabolic syndrome and severity of disease i.e. Relative risk = 2.053 (95% confidence interval: 1.347, 3.128, p-value = 0.0094). Conclusion: Rheumatoid arthritis patients who also have metabolic syndrome tend to have more severe illness. Tooba Fatima, Yaser Imran, Mamoona Ghias, Samara Siddique, Bilquis Shabbir, Asif Islam, Tazeen Nazar, Bilal Aziz Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Impact of Bifurcation Angle on Side Branch Occlusion in Provisional Bifurcation Stenting Background: Bifurcation angle (BA) is the critical angle that has impact on side branch (SB) occlusion during coronary intervention due to plaque shift. There have been few research studies especially in Pakistan on the role of BA in plaque shift. Objective: To know the impact of bifurcation angle on the side branch occlusion during provisional stenting. Methodology: A retrospective cohort study was conducted at Punjab Institute of Cardiology, Lahore on consecutively enrolled patients between July 2017 and June 2019. The subjects were split into two groups: high angle and low angle using the median BA. Binary logistic regression analysis was performed to identify BA as an independent predictor of occlusion of SB. Results: Occurrence of side branch occlusion was found in 7.7% of the total of 600 bifurcation lesions. SB occlusion rate was found to be significantly higher in higher angle (HA) group compared to lower angle (LA) group i.e. (37/292, 12.7 %) and (9/308, 2.9 %) respectively, (P < 0.001). Binary logistic regression analysis demonstrated high angle to be an independent predictor for the occlusion of side branches (odds ratio [OR]: 1.026 per degree increment, 95% confidence intervals [CI]: 1.016 – 1.045, P < 0.001). Conclusion: Higher branching angle was noted as the independent predictor of the occlusion of side branches following provisional stenting of main vessel. Muhammad Irfan Tahir Khan, Aamir Hussain, Muhammad Ammar Rashid, Zeeshan Malik, Rana Salman Aslam Copyright (c) 2023 Sat, 02 Sep 2023 00:00:00 +0500 Prevalence of Primary Palmar Hyperhidrosis and its Impact on Hand Grip Strength and Quality of Life Background: Primary palmar hyperhidrosis is a disorder resulting in abnormally excessive sweating of palmar side of hand. Patients present with cold and wet hands. It can also occur in combination with other areas like soles, axillae, and craniofacial region. Objective: To estimate prevalence of primary palmar hyperhidrosis in Faisalabad and its impact on hand grip strength and quality of life. Methods: This analytical cross-sectional study was conducted at Dermatology departments of three tertiary care hospitals of Faisalabad, Pakistan. Sample size was calculated using formula. Both genders with age ranging from 15 to 65 years were selected as participants using convenient sampling. Participants filled self made form which included demographics, screening and valid and reliable quality of life measuring tools (HDSS and Keller scale). Then, after screening, grip strengths of hyperhidrotics (group 1) and non-hyperhidrotics (group 2) were measured using modified sphygmomanometer test (cuff method) and were compared. Data were analyzed using SPSS version 22. Results: Prevalence of primary palmar hyperhidrosis was 15.5% (11/71) consisting of 6 females and 5 males. Age of onset occurred during 5-15 years. 63.64% patients had positive family history. 90.91% patients had normal (18.5-24.9) BMI. Mean right and left grip strength values of hyperhidrotic patients were 168.55±55.446 and 157.55±44.568, respectively. Mean right and left grip strength values in non-hyperhidrotic participants were 157.63±53.126 and 148.67±53.85, respectively. 54.55% patients reported 3 on HDSS. On Keller scale majority reported mild to severe distress especially when shaking hands with others, writing papers, driving cars, grasping heavy objects, and wearing gloves. Conclusion: Current study showed 15.5% prevalence rate of primary palmar hyperhidrosis. Hand grip strength values of hyperhidrotic patients were higher when compared with non-hyperhidrotic participants. Majority of patients reported barely tolerable sweating which resulted in mild to severe distress experienced during activities of daily living. Duaa Ejaz Saigaal, Anam Shahzad, Ramesha Tahir, Iqra Waseem, Qurat-Ul- Ain, Komal Tariq Copyright (c) 2023 Thu, 21 Sep 2023 00:00:00 +0500 Effective Application and Outcome of Negative Pressure Wound Therapy in Management of Complex Wounds with External Fixator Background: Negative pressure wound therapy ( NPWT ) has been commonly used in the management of complex traumatic wounds of extremities. It reduces oedema, increases perfusion and enhances granulation tissue formation. But presence of external fixator makes it difficult to apply and maintenance of seal in presence of external fixator thus affecting wound healing. Objective: To study the effective application and outcome of NPWT in the management of complex wounds. Methods: Retrospective study conducted in Department of Plastic and Reconstructive Mayo Hospital/KEMU over a period of 2 years (June20- June 22). All patients presenting with wounds on either upper or lower limb with external fixator applied during this period were included. After wound debridement NPWT was applied according to our technique. Demographic data of patients, mode of injury, time of presentation after injury and site/size of wound were noted. Outcome of seal (Effective maintenance of suction pressure at the completion of NPWT application and Seal failure as loss of suction within 72 hrs ) , no. of NPWT sessions and outcome of wound (skin grafting/flaps) were documented. Results: In this study, total number of patients was 26. Seventeen were (65.4%) males and 9(34.6%) females. Mode of injury was road traffic accident (69.8%) and machine injury (30.8%). Mean age was 23±14.2 years. Mean wound size 31.3±12.6 in2. Mean time of presentation after injury was 11.8±6.14 days. In 3 patients seal was not maintained. In 23 patients seal was maintained. Skin grafting was done in 21 patients and local/ distant flaps in 5 patients. Conclusion: NPWT has been in use for the management of wounds for many years. But problem arises in its application over wounds with external fixator. There are chances of air leakage and difficulty in maintaining seal. With our technique of application, we have been able to manage this problem. It is a simple, quick and inexpensive technique with overall good results. Use of this technique minimizes the use of major local and free flaps for soft tissue coverage of limbs. Lubna Maqsud Cheema, Zahid Tayyab, Sobia Manzoor, Romaisa Shamim Khan, Muhammad Mustehsan Bashir, Sehrish Ijaz Copyright (c) 2023 Thu, 21 Sep 2023 00:00:00 +0500 Vaccination Readiness of COVID-19 and Generic Conspiracist Beliefs Among Young Adults: The Mediated Role of Health and Wellbeing Background: The significance and seriousness of COVID-19 vaccination are regarded as a public health emergency for national and international forums. Despite this fact, vaccination readiness is a challenge in young adults due to their belief in general conspiracy theories. Objective: The prime objective of the study was to explore the relationship between vaccination readiness and generic conspiracist beliefs in young adults. Method: A correlational research design was used to conduct this research study. A total sample of 185 young adults (male=83, female=102) aged (20-39 years) fulfilling the inclusion criteria were purposively recruited from different areas of Lahore, Pakistan. An online survey was conducted having demographic information form and standardized questions about vaccination readiness, generic conspiracist beliefs, and health and well-being. The link was sent to the participants through email, WhatsApp, Facebook, Twitter, LinkedIn, and other social media channels. During this survey participants recorded their responses in around ten weeks. Results: Data were analyzed by utilizing SPSS-23 and AMOS-21. The results of correlation analysis revealed that vaccination readiness was inversely associated with generic conspiracist beliefs in young adults. Moreover, generic conspiracist beliefs have a significant negative impact on vaccination readiness. Health and well-being partially mediated the association between generic conspiracist beliefs and vaccination readiness. Conclusion: The authorities should initiate awareness programs to enhance the readiness of the COVID-19 vaccination and also metastasize its effectiveness in young adults. Preventive measures should be taken to eradicate the elements that enhance the generic conspiracist beliefs about vaccination. Bushra Naz, Muhammad Kashif Fida, Muhammad Zohaib Khan, Azkaa Safdar, Aqeel Asghar Copyright (c) 2023 Thu, 21 Sep 2023 00:00:00 +0500 Comparison of Slit Lamp Teaching Versus Bedside Teaching in Post Graduate Ophthalmology Residency at a Teaching Hospital Background: Globally, 80 % of the visual loss is preventable. A major proportion of patients presenting in tertiary care hospitals is that of ophthalmology constituting 20% emergency patients and 18 % outpatient consultations. Objective: To compare the effect of slit lamp teaching versus bedside teaching in ophthalmology residency at a tertiary level teaching hospital. Methodology: This questionnaire based cross sectional survey was conducted after ethical approval at College of Ophthalmology and Allied Vision Sciences/Institute of Ophthalmology, Mayo Hospital, Lahore. Ophthalmology residents from first to fourth year of their training program were included in the study while Consultants, medical officers, fellows and house officers were excluded from the study. A web based close ended questionnaire (Google form) was developed consisting of 13 questions covering different aspects of slit lamp and bedside teaching. Paired sample t-test was applied to check significance among two methods. Results: Upon stratification of the data based on year of residency training, among 3rd year residents, the mean score of bedside teaching was significantly reduced as compared to slit lamp teaching [1.29±0.48 vs 1.86±0.37, t(6) = 2.828, p = 0.03] when they were asked whether practical skills trainings facilitated. Moreover, mean score of bedside teaching was significantly reduced as compared to slit lamp teaching among 1st year and 3rd year students when they responded to the question “Is clinical reasoning demonstrated”, 1st year: 1.13± 0.64 vs 1.75±0.46. t(7) = 3.416, p = 0.011 and for 3rd year: 1.14±0.37 vs 2.00±0.00, t(6) = 6.00, p = 0.001. Conclusion: Both slit lamp Teaching and Bedside teaching are vital in ophthalmology residency as they complement each other in making up shortcomings of each other. Zahid Kamal Siddiqui, Asima Rafique, Muhammad Shaheer Copyright (c) 2023 Thu, 21 Sep 2023 00:00:00 +0500