Annals of King Edward Medical University https://annalskemu.org/journal/index.php/annals <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="https://www.youtube.com/watch?v=rXNiQyOWs0E" target="_blank" rel="noopener">Tutorial on how to Upload your Submission</a></p> <p style="text-align: justify;">2) <a href="https://hjrs.hec.gov.pk/index.php?r=site%2Fresult&amp;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="http://creativecommons.org/licenses/by/4.0/">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="mailto:jspark@kemu.edu.pk" target="_blank" rel="noopener">jspark@kemu.edu.pk</a></p> publications@kemu.edu.pk (Publication Office (Annals Editorial Board)) farhan@kemu.edu.pk (Annals KEMU Technical Support (IT)) Fri, 15 Dec 2023 00:00:00 +0500 OJS 3.2.0.2 http://blogs.law.harvard.edu/tech/rss 60 The Need to Integrate Fundamental Radiology in Undergraduate Medicine Curriculum https://annalskemu.org/journal/index.php/annals/article/view/5633 Dear Editor, Since its advent in the early Twentieth Century, Radiology beholds capital significance in diagnostic and therapeutic medicine. Imaging techniques of the likes of X – Ray, CAT scan, MRI and the positron emission tomography (PET) have taken the world by storm over the past 20 years so much so that they have become indispensable in Medical Investigation. There is a growing school of thought with the view that basic radiological knowledge of X – Rays and Ultrasound should be imparted to medical students from the get-go.1 As a matter of fact, until recently an overwhelming majority of Medical Institutions in Pakistan have been adherent to the orthodox Non - Modular system which was essentially based on the then transformative Flexner Report of July 1910 where Abraham Flexner vehemently advocated learning basic biomedical sciences prior to clinical sciences; thereby preferring less practical theoretical knowledge to that of empirical importance to the clinician.2 Unfortunately, that is not how patients are to be treated.3 Recently, all Medical Colleges under University of Health Sciences have adopted the Integrated Modular system4 which endorses the studying of basic and clinical subjects side by side. In addition to this much needed step, the concerned authorities are exhorted to look into the need to include fundamental radiological techniques in the under graduate Medical curriculum in order to properly integrate the modular system. Muhammad Hamza Masood, Dilawar Ali Khan Copyright (c) 2024 http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5633 Sun, 31 Dec 2023 00:00:00 +0500 Vaccine-Induced Thrombotic Thrombocytopenia (VITT) Associated with AstraZeneca Vaccine: A Comprehensive Review https://annalskemu.org/journal/index.php/annals/article/view/4703 <p>Several vaccines have been approved to be used during the COVID-19 pandemic. However, serious concerns have been raised due to vaccine-induced thrombotic thrombocytopenia (VITT) reported with the AstraZeneca vaccine. This study is done to assess the vaccine's safety and summarize the background, evaluation, and management of a patient with VITT. Employing a meticulous literature search on PubMed and Google Scholar using keywords such as "AstraZeneca," "COVID-19 vaccine," "Clot," "Clots," "Thrombosis," and "Thrombus formation" in various combinations, 34 resources were identified, with 11 containing primary data on 28 documented VITT cases. The analysis revealed a gender distribution of 28.6% male and 71.4% female, spanning ages 22 to 74 years (median: 36 years). VITT symptoms manifested within 1 to 17 days post-vaccination. The predominant thrombotic sites were Central Venous Thrombosis, Splenic Vein Thrombosis, and Pulmonary Embolism. Notably, 46.4% of cases showed improvement, while 53.6% resulted in fatalities. This research underscores the rare but serious risk of vaccine-induced thrombotic thrombocytopenia associated with AstraZeneca vaccination, highlighting the importance of continued vigilance and monitoring in the ongoing global vaccination campaigns.</p> Babar Naeem, Junaid Saleem, Mamoon Akbar Qureshi Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/4703 Sun, 31 Dec 2023 00:00:00 +0500 Impact of COVID-19 on Learning Behavior of Undergraduate Medical Students during Ophthalmology Module; Lessons Learnt https://annalskemu.org/journal/index.php/annals/article/view/5136 <p>This qualitative study was carried out at Batterjee Medical College, Jeddah; KSA to explore the impact of COVID-19 and its related lockdown on the learning undergraduate medical students from December 2019 till July 2020. This qualitative exploratory study, utilizing online focus group discussions to explore the psychological impact of COVID-19 on student’s learning at Ophthalmology department of Batterjee medical college, Jeddah; KSA. Ethical approval was taken from the college and purposive convenient sampling technique was used to collect data. Data was transcribed and analyzed by using thematic analysis. The study identified multifold impact of COVID-19 on student’s learning faced by the 4<sup>th</sup> year undergraduate medical students during an Ophthalmology module. Social isolation and shift to online mode of teaching and learning were the main challenges that affected student’s learning in many ways. Four major effects of COVID-19 explored in the study were; psychological effects, impact of social disconnect with the peers and patients, impact on learning behavior changes and moment of myself. Results can be used by the medical educators to understand student’s mind and needs to enhance their academic participation, learning and performance especially in current circumstances of COVID-19 pandemic</p> Sumera Nisar, Asim Alshanberi, Areeb Rehman, Durraiz Rehman Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5136 Sun, 31 Dec 2023 00:00:00 +0500 Autoimmune Hemolytic Anemia in Patients of Non Hodgkin’s Lymphoma https://annalskemu.org/journal/index.php/annals/article/view/5138 <p>The study was conducted to determine the frequency of autoimmune haemolytic anaemia in non-Hodgkin’s lymphomas. A cross sectional study on 100 patients of Non-Hodgkin Lymphoma was conducted in Pathology department, KEMU, Lahore. The mean age among the patients was 50.14 ±17.053 years. The mean haemoglobin was 10.73g/dl ± 2.74 . Out of 100, 88 patients had Coomb’s Test negative and 12 patients had a positive result. Those having a positive coomb’s test showed a higher retic count i.e., 5.05 ± 2.37. The average bilirubin levels in all NHL patients were 0.901 0.995 mg/dL, with a substantially higher mean of 2.15 1.19 mg/dL among patients who tested positive for Coomb's. The LDH levels of those immensely high 764.5 ± 441.Post stratification chi square testing showed no significant relationship was found between autoimmune hemolytic anemia among NHL patients. Age and gender have no significant effect. However, disease stage can be a risk factor. Therefore, it is emphasized that all patients of NHL, regardless of age and gender, must be thoroughly investigated.</p> Fatima Zahra, Arsala Rashid, Maria Zaman, Amber Arshad, Nabila Aslam, Uzair Rashid Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5138 Sun, 31 Dec 2023 00:00:00 +0500 Ten Tips on How to Write and Publish a Case Report https://annalskemu.org/journal/index.php/annals/article/view/5256 <p>Case report is a form of medical writing that describes an unusual presentation of common diseases, a rare disease / phenomenon, or a novel treatment of disease in a scientific manner. Case report is often seen as an easy and quick form of medical writing. However, it can be daunting at times, if the writer does not know where to begin and how to write different sections of a case report. We share ten easy and practical tips that can help novice and expert medical writer alike, to draft a ‘publication’ worthy case report in the minimum amount of time. These tips will help the writer to avoid common mistakes associated with case reports.</p> Farooq Azam Rathore, Muhammad Tawab Khalil, Fareeha Farooq Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5256 Sun, 31 Dec 2023 00:00:00 +0500 Comparative in-Vitro Evaluation of Material Properties of Commonly Used Root-End Filling Materials https://annalskemu.org/journal/index.php/annals/article/view/4509 <p><strong>Background: </strong>Standard guidelines for performing conventional endodontic procedures have undergone a number of modifications recently. An ideal characteristics of a root end filling materials include dimensional stability; radio-opacity; non-resorbability; compressibility, adequate working and quick setting time; biocompatibility especially in peri-radicular area; bioactivity and easy handling properties<strong>. </strong></p> <p><strong>Objectives:</strong> This study evaluated and compared different root-end filling materials by determining their solubility, sorption and fluid uptake after immersion in deionized water over a period of 28 days.</p> <p><strong>Methods:</strong> Materials were mixed a per manufacturer’s instructions and disc-shaped specimens were made (15mm×1mm). After 24h curing, discs were immersed in deionized water and incubated at 37±1◦C. At specified time intervals, measurements for mass and volume of discs were taken to calculate fluid sorption, solubility and uptake.</p> <p><strong>Results:</strong> Fluid uptake of MTA was 0.029±0.0025g at day 1 and 0.066±0.004g at day 28 whereas, for Acroseal it was 0.0006±0.0001g at day 1 and 0.006±0.001g at day 28. Fluid uptake of MTA and Acroseal increased with passage of time but for Biodentine fluid uptake decreased from day 1 (0.017±0.005g) to day 28 (0.008±0.005g). Acroseal exhibited lowest values of fluid sorption (0.006±0.0005%) and solubility (0.0006±0.00005%) whereas bio-dentine exhibited maximum values of fluid sorption (0.06±0.007%) and solubility (0.04±0.03%).</p> <p><strong>Conclusions:</strong> Percent water solubility and sorption of Biodentine is higher than MTA and Acroseal, whereas its fluid uptake decreases over a period of 28 days in comparison to MTA and Acroseal, indicating its stability and thus making Biodentine a better root-end filling material.</p> Maryam Maqsood, Hashmat Gul , Muhammad Kaleem Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/4509 Sun, 31 Dec 2023 00:00:00 +0500 Social Support as a Mediator between Psychological Maladjustment and Quality of Life among Patients with Hemodialysis https://annalskemu.org/journal/index.php/annals/article/view/4529 <p><strong>Background: </strong>Renal issues are highly devastating and can significantly impact health, particularly in developing nations like Pakistan.</p> <p><strong>Objectives: </strong>To assess the relationship between psychological maladjustment, social support, and quality of life among patients on hemodialysis. </p> <p><strong>Methods: </strong>Correlational research design was used to assess the relationship between the variables. The sample comprised <em>N</em>= 60 hemodialysis patients including (male=32, female=28) with an age range from 28 to 71 years. Informed consents were taken and confidentiality of the responses were ensured. The data were elicited through reliable and valid research instruments. Furthermore, data were analyzed using SPSS-23 and AMOS-19.</p> <p> <strong>Results: </strong>The mean age of the participants was 48<u>+</u>3.1 years. Psychological maladjustment negatively correlated (<em>p</em>&lt;.05) with patients’ quality of life and social support. Further, path analysis through structure equational modeling revealed that social support mediated the association between psychological maladjustment and quality of life (χ<sup>2</sup>/<em>df</em>=1.08, <em>p&lt;</em>.05, CFI=.94, GFI=.93). However, the quality of life in the mediational model appeared to be statistically significantly influenced by the covariates.</p> <p> <strong>Conclusion: </strong>Research highlights the adaptive functions of social support as a defensive mechanism to improve the patient’s quality of life and the need to incorporate the belief in developing culturally sensitive intervention programs to enhance the social support and quality of life with hemodialysis patients.</p> Bushra Naz, Muhammad Zohaib Khan, Muhammad Kashif Fida, Azkaa Safdar, Muhammad Aqeel Asghar Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/4529 Sun, 31 Dec 2023 00:00:00 +0500 Impact of Hydroxychloroquine, on QTC Interval, in Patients with Rheumatologic Diseases https://annalskemu.org/journal/index.php/annals/article/view/4725 <p><strong>Background:</strong></p> <p>Hydroxychloroquine (HCQ) has been historically used for treatment of autoimmune diseases and more recently, it is used for treatment of COVID-19 patients. Using HCQ in COVID-19 patients resulted in corrected QT(QTc) prolongation which has potential to deteriorate into Torsades de Pointes and sudden cardiac death. As it is used chronically by rheumatologic patients so this study was designed to establish effect of HCQ on QTc in rheumatic patients.</p> <p><strong>Methods:</strong></p> <p>A cross sectional comparative study conducted in Rheumatology Department Shaikh Zayed hospital, Lahore. Non-probability consecutive sampling technique was used. Duration of study was 169 days. 45 patients used HCQ for three months and 45 patients did not use HCQ. ECG was done at induction in the study and after three months. Serum calcium, potassium and magnesium were also checked at onset. QTc was calculated by Bazett’s formula.</p> <p><strong>Results:</strong></p> <p>QTc did not raise in 21(46%) patients, in both groups. QTc raised between 1- 50msec in 20(44.4%) and 23(51.1%) patients in HCQ exposed and unexposed patients, respectively. QTc rise more than 50msec in 4(8.88%) and 1(2.2%) patient in HCQ exposed and unexposed patients, respectively (p-value=0.344). The QTc change is associated with heart rate showing 75.0% chances of increased QTc among those with increased heart rate.</p> <p><strong>Conclusion:</strong></p> <p>HCQ did not increase QTc interval in 46% study. 8.88% of HCQ exposed population and 2.22% of HCQ unexposed population had significant change in QTc. However, no adverse cardiac events were observed in study duration</p> Faizan Ahmad, Tafazzul e Haque Mahmood, Aflak Rasheed, Usman Hafeez, Amna Asad, Roma Gulzar Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/4725 Sun, 31 Dec 2023 00:00:00 +0500 Speech Audiometry in Pakistan: Development of Urdu Spondee Words List (USWL) https://annalskemu.org/journal/index.php/annals/article/view/4980 <h5>Background: Hearing impairment (HI) is a common barrier to communication which impacts the HI in achieving higher educational goals, impacts them at work and leisure and can result in social exclusion</h5> <h5> Objective: To developed Urdu Spondee Words List for establishing Speech Recognition Threshold in Urdu speaking hearing impaired population.</h5> <p><strong>Methods: </strong>This descriptive study was conducted in twin cities of Rawalpindi &amp; Islamabad from July 2018 to January 2019. Study involved development of a tool called Urdu Spondee Word list (USWL) and familiarity judgement utilizing a sample of N=50 Urdu speaking participants of both genders aged 10-16 years utilizing convenience sampling, and finally voice analysis on PRATT software. SPSS version 21 was used for data analysis. </p> <p><strong>Results: </strong>The results revealed that the final selected list of 18 spondee words has equally stressed syllables, with the accomplishment of the criteria of familiarity judgment for the participants. The recorded list shows minimum and maximum intensity variation of 3db to 8db in the homogenous audibility of the words making it suitable for speech recognition threshold measures.</p> <p><strong>Conclusion: </strong>The developed 18 item Urdu Spondee Word list (USWL) with criteria of familiarity and homogenous audibility of words is suitable for speech recognition threshold measurement for Urdu speaking population.</p> Tehreem Ijaz, Humaira Shamim Kiyani, Ghulam Saqulain Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/4980 Sun, 31 Dec 2023 00:00:00 +0500 Perceptions About COVID-19 Disease and Vaccination Against it Among Adults in Lahore https://annalskemu.org/journal/index.php/annals/article/view/5040 <p><strong>Background</strong>: Vaccination against COVID-19 disease is the best available option for its prevention. However, many people In Pakistan were hesitant to get vaccinated against this disease.</p> <p><strong>Objective</strong>: The main aim of this study was to find out the perceptions of people in Lahore about COVID-19 disease and vaccination against it.</p> <p><strong>Methods</strong>: In a cross-sectional design, a questionnaire comprising of 40 questions was administered to 420 working class adults (18-70 years; both males and females) in Western Lahore with informed consent. Data were analyzed by using various statistical tests including logistic regression. A p &lt; 0.05 was considered significant.</p> <p><strong>Results</strong>: Eighty percent of the respondents got vaccinated against COVID-19 disease. Protection against the disease was the main reason to get vaccination. The odds of vaccination against COVID-19 was 3.14 times more among assistants (a job level between manager and worker) compared to workers adjusted for age, gender, conveyance, place of living, income, education, and smoking (AOR=3.14;95% CI; 1.49-6.64). The odds of vaccination against COVID-19 was 1.88 more among participants owning their home compared to participants living in rental places, adjusted for age, gender, conveyance, income, education, and smoking (AOR=1.88;95% CI; 1.01-3.49). Similarly, odds of having vaccinated were more than 7 times and 6 times among those with high school education and college level education compared to illiterate subjects after adjustment with covariates (AOR=7.55, 95% of CI; 2.26-25.21 and AOR=5.97;95% of CI; 1.87-19.11, respectively).</p> <p><strong>Conclusion</strong>: Acceptance of vaccination against COVID-19 was quite high (80%) among working middle class adults in Lahore.</p> Qasim Jamil, Muhammad Khurram, Saleem Perwaiz Iqbal, Mohammad Perwaiz Iqbal Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5040 Sun, 31 Dec 2023 00:00:00 +0500 Transfusion Transmitted Infections in Blood Donors of Pakistan Red Crescent Lahore: A Mixed Method Study https://annalskemu.org/journal/index.php/annals/article/view/5068 <p><strong>Background:</strong> According to Punjab Blood Transfusion Authority, blood donors are screened for five “Transfusion Transmitted Infections (TTIs). But lack of adequate screening methods threatens the rapid spread of TTIs.</p> <p><strong>Objective:</strong> This study aimed at adding to the surveillance data about TTIs in Pakistan and explored blood banking phenomenon to find workable ways for minimizing their spread.</p> <p><strong>Methods</strong>: It was a mixed method study, with retrospective cross-sectional design to find out the frequency of TTIs amidst the blood donors of “Pakistan Red Crescent Punjab” during 2015 to 2019, and with phenomenological design to explore reasons for any changes in the trends of TTIs. Records were analysed for descriptive statistics of the five TTIs, and reasons for the observed changes in the trends were explored through semi-structured interviews from the blood bank’s managers. The qualitative data was analysed by deductive thematic analysis.</p> <p><strong>Results: </strong>Among 6380 blood donors, 2.19% (n=140) were positive for at least one of five TTIs<strong>. </strong>Out of total donors<strong>,</strong> 1.12 % (n= 72) were HCV positive, 0.83 % (n= 53) HBV positive, 0.2 % (n= 13) Syphilis positive, and 0.03% (n = 2) HIV positive, whereas none was positive for Malaria. 61.34% (n= 3914) of donors were males, and 38.65% (n= 2466) were females. Of the total, 86.52% (n= 5520) were mobile blood camp donors, and 13.47% (n= 860) were walk-in donors. The reasons for the observed increasing number of Syphilis cases and other observed trends were found to be due to differences in sensitivity of screening method used and other blood bank processes like Donor recruitment.</p> <p><strong>Conclusion: </strong>TTI prevalence among donors of said blood bank in private sector is more in male donors in comparison to female ones and is more in “mobile blood camp donors” than in “walk-in donors”.</p> Unum Aslam, Awais Gohar, Farah Ahmad, Muhammad Hasan, Muhammad Nausherwan Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5068 Sun, 31 Dec 2023 00:00:00 +0500 Hospital Associated Variation in Nutritional Status and Dietary Compliance of Elderly Patients https://annalskemu.org/journal/index.php/annals/article/view/5071 <p><strong>Background:</strong></p> <p>Malnutrition is associated with detrimental aftermaths for patients including increased infections, complications, exacerbated muscle loss, prolonged hospital stay, and is often underdiagnosed.</p> <p><strong>Objective:</strong> The study was carried out to determine the hospital associated variability of nutritional status, impact of length of stay on malnutrition in geriatrics.</p> <p><strong>Methods:</strong></p> <p>A sample of 100 participants was selected for a single group pretest posttest quasi experimental study. Interviewer administered questionnaire and Subjective Global Assessment (SGA) tool were used to collect data both at the time of admission and discharge. Within group pre-admission and post-discharge outcomes including nutrition practices, dietary compliance and nutritional status assessed by SGA were compared.</p> <p><strong>Results: </strong></p> <p>The BMI of the participants decreased at the time of discharge (22.89±4.44 kg/m<sup>2</sup> pretest vs. 22.25±4.46 kg/m<sup>2</sup> posttest) and more adults were categorized undernourished (13% in pretest vs.17% in posttest). A significant decrease in well-nourished participants (45.0% pretest vs. 32.0% posttest), and increased malnourished individuals (12.0% pretest vs. 25.0% posttest) was observed.</p> <p><strong>Conclusion: </strong></p> <p>Length of stay along with dietary constraints in geriatrics affects the nutritional status drastically. Targeted dietetic interventions can decrease hospital associated malnourishment. Dietary compliance of hospitalized patients can be ensured by educating the patient/caregiver to reduce the risk of malnutrition and hospital readmission. Patients already malnourished at admission are more prone to have deteriorating health.</p> Fatima Farooq, Syeda Uroosa Jafri, Afifa Tanweer, Rida Khan Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5071 Sun, 31 Dec 2023 00:00:00 +0500 The Association of Renal Cortical Echogenicity and Length with Serum Creatinine in Patients with Chronic Kidney Disease https://annalskemu.org/journal/index.php/annals/article/view/5102 <p><strong>Background: </strong>The prevalence of chronic kidney disease is 21.2% in Pakistan and rising due to increasing prevalence of diabetes. Ultrasonography is effective tool in early detection and diagnosis of impaired renal function along with renal function tests.</p> <p><strong>Objective: </strong>To study the correlation of serum creatinine with renal echogenicity grading and renal length in patients with chronic kidney disease.</p> <p><strong>Methods: </strong>This prospective cross sectional study was conducted at Medicine, Nephrology and Radiology departments of Pakistan Railway General Hospital, Rawalpindi from 30<sup>th</sup> September 2021 to 15<sup>th</sup> July 2022. A total of 200 patients with chronic kidney disease were enrolled randomly by consecutive non probability sampling from medical and nephrology in and out patients after fulfilling inclusion and exclusion criteria per study design. After history, physical examination of serum creatinine was done and the patient was sent for ultrasound in the radiology department. Demographic data and study data was entered on pre designed proforma and analyzed using SPSS21.</p> <p><strong>Results:</strong> Mean age of the patients was 53.45±8.93 years. There were 110 male and 90 female patients in our study. Mean renal length was 9.55 cm. Mean serum creatinine was 1.921 mg/dl with grade 1 cortical echogenicity, 3.561 with grade 2, 4.267 with grade 3 and 6.001 with grade 4 echogenicity respectively on ultrasound. A negative correlation (r= -0.144) was present between renal length and serum creatinine.</p> <p><strong>Conclusion:</strong> Renal cortical echogenicity is a valuable sonographic parameter and is found to be significantly related to serum creatinine level in chronic kidney disease. While renal length showed weaker association with serum creatinine levels.</p> Samia Kausar, Fazila Fareed, Kiran Fatima, Zunera Jahanzeb, Habib ur Rehman Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5102 Sun, 31 Dec 2023 00:00:00 +0500 Comparison of T2-Weighted 3D-Space and T2-Weighted 2D-TSE Sequences in Lumbar Spine Magnetic Resonance Imaging (MRI) https://annalskemu.org/journal/index.php/annals/article/view/5177 <p><strong>Background:</strong> Spine-related issues like low back pain have substantially increased in the past few decades across all age categories having various reasons.</p> <p><strong>Objectives: </strong>To compare the image quality and diagnostic value of 3D space MRI sequence with 2D TSE MRI sequence in lumbar spine imaging.</p> <p><strong>Methods: </strong>Fifty patients, irrespective of gender having age between 30-70 years, who presented with lower back pain were enrolled for the study. Lumbar spine imaging was done using 2D TSE and 3D space sequences and the subsequent images were evaluated by two senior consultant radiologists for qualitative analysis of visibility and pathologic indices of both sequences. Data was analyzed on SPSS 25.0. Statistical analysis was done using Cohen's kappa (k).</p> <p><strong>Results: </strong>Female participants were 56% of total study population. Mean age of study participants found to be 53.62±10.76 years. Statistically significant difference (p-value =0.000) was noted for visibility score <strong>of</strong> all the lumbar spine components, when the 3D SPACE and 2D TSE images were compared with 3D-SPACE images found being superior in visibility. Inter- observer agreement for visibility of various regions of lumber spine was nearly perfect (k&gt; 0.8) and substantial (0.6 to 0.8) for 3D-SPACE, while substantial (0.8&lt;k&gt; 0.6) for 2D-TSE. Pathologic indexes had a significant level of inter-observer agreement (k &gt; 0.6). Inter-observer agreement for 3D sequence (k = 0.72) was greater than that for 2D-TSE sequence (k = 0.64).</p> <p><strong>Conclusion: </strong>Images from 3D-SPACE sequences provide superior visibility over 2D-TSE and could be recommended as alternative imaging method for lumbar spine pathologies. Higher inter observer agreement illustrate that it may be included in routine sequences to make the better diagnosis for lumbar spine pathologies correctly.</p> Quratulain Khan, Syed Farrukh Nadeem, Tariq Mahmood Mirza, Mazhar Shafiq, Zahida Batool, Khadijah-tul-Kubra Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5177 Sun, 31 Dec 2023 00:00:00 +0500 The Immunohistocehmical Expression of Beta Human Chorionic Gonadotrophin (β-HCG) in Different Grades of Human Papillary Urothelial Neoplasm https://annalskemu.org/journal/index.php/annals/article/view/5213 <p><strong>Background:</strong> Urothelial carcinomais the most common urological malignancy and following prostate and lung cancer, it is the third most common carcinoma in male population<strong>.</strong></p> <p><strong>Objective:</strong> The main aim of this study was to determine the expression of beta hCG in different grades of human urothelial carcinoma in our population.</p> <p><strong>Methods:</strong> The study was conducted in Pathology Department of Faisalabad Medical University, Faisalabad, between 2018-2020.Sections were taken on frosted slides for H&amp; E, and on lysine coated slides for IHC.H&amp; E and IHC were performed according to protocols.</p> <p><strong>Results:</strong> Out of the 65 tumor studied, 35(54%) were graded as low and 30(46%) were graded as high. In 35 low grade tumors 4(11%) were muscle invasive and 31(89%) were non-invasive and in 30 high grade tumors, 24(80%) were found to be muscle invasive and only 6(20) were non muscle invasive. Out of 65 specimens, 52 (80%) cases were found to be positive for beta hCG while only 13(20% ) were found to be negative of 35 low grade tumors, 27(77%) tumors were stained positive for beta hCG and 8(23%) were negative. Of 30 high grade tumors 25(83%) tumors were stained positive for beta hCG and 5 (17%) were negative. Chi-square test was applied showed that there was no significant association between tumor grade and beta hCG expression.</p> <p><strong>Conclusion: </strong>The immunohistochemical expression of beta hCG is positive in majority of low and high grade urothelial carcinoma but it may not be utilized as a marker for prognostic determination.</p> <p> </p> Ammara Anwar , Aamir Imtiaz Khan , Asmaa Qureshy , Muhammad Tahir Bashir Malik, Asima Naz , Khawaja Moeen ud Din Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5213 Sun, 31 Dec 2023 00:00:00 +0500 Bacteriological Profile of Patients Suffering from Acute Versus Chronic Port Site Infection at a Tertiary Care Hospital https://annalskemu.org/journal/index.php/annals/article/view/5305 <p><strong>Background: </strong>Surgical (port) site infections can complicate the course of recovery in a surgical patient. It is important to know the spectrum of organisms and their antibiotic sensitivity pattern for targeted treatment of SSI.</p> <p><strong>Objective: </strong>To determine bacteriological profile of patients suffering from acute and chronic surgical (port) site infection (SSI).</p> <p><strong>Methods: </strong>This descriptive cross-sectional study was held at CMH, Rawalpindi from May-Dec 2022 which included the patients who had elective laparoscopic surgery and eventually developed acute or chronic surgical-site infection. Bacteriologic profile of both acute and chronic surgical-site infections was assessed along with their sensitivity to various commonly used antibiotics. Data was analyzed by statistical package for social sciences 21.</p> <p><strong>Results: </strong>A total of 526 patients had elective laparoscopic surgical procedures during study period amongst which 60 patients (11.40%) developed SSI which were included in the study. Amongst these 60 patients, 39 (65.00%) were male and 21 (35.00%) were females with a mean age of 34.31 ± 8.93years. Acute SSI occurred in 38 (63.30%) while 22 (36.70%) were found to have chronic SSI. In cases of acute SSI, Staphylococcus aureus while in chronic SSI cases, Mycobacterium fortuitum was common. Pseudomonas aeruginosa was found in both types of SSI.</p> <p><strong>Conclusion: </strong>Overall frequency of SSI was 11.40%. In acute SSI, Staphylococcus aureus was the main culprit while in chronic SSI, Mycobacterium fortuitum was found to be the major pathogen.</p> Hammad Qayyum, Aymen Ziafat, Waqas Farooq Ali, Muhammad Shehzad, Sultan Ahmed Minhas, Abdul Rehman Rashid Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5305 Sun, 31 Dec 2023 00:00:00 +0500 Determinants of Eating Habits and Body Mass Index in transition; A Comparative Cross-Sectional Study of Public and Private Schools of Lahore https://annalskemu.org/journal/index.php/annals/article/view/5411 <p><strong>Background</strong></p> <p>Pakistan is facing a double burden of disease. Nutrition has an impact on nutritionally related non-communicable diseases. Malnutrition in adolescent age continues in adulthood so interventions in this stage can help us fight this emerging problem.</p> <p><strong>Objective:</strong></p> <p>To determine the nutritional status of school-going adolescents and their eating patterns and then compare them between public and private secondary schools of Lahore.</p> <p><strong>Methods</strong></p> <p>This analytical cross-sectional study was done on 372 school-going adolescents from 01.03.2023 to 20.06.2023 (3.5 months). A self-structured questionnaire was filled with interviews by convenience sampling. Weight and height were measured and BMI was plotted on WHO z charts to determine the nutritional status. Data were entered and analyzed by SPSS Version 21. The chi-square test was used to compare BMI and its determinants. Factors found significant were subjected to Binary logistic regression. P-value ≤ 0.05 was taken as significant. </p> <p><strong>Results</strong></p> <p>Out of the 372 school-going adolescent participants had a mean age of 14.86 years SD ± 1.75 (164 males and 208 females). 76(20.43%) were underweight, 201 (54.03%) had normal weight, 66(17.74%) were overweight and 29(7.8%) were obese. Public Schools had higher odds of undernutrition AOR 1.49 and lower odds of overweight and obesity AOR 0.38. Males had a reduced chance of undernutrition AOR 0.59 while the increased odds of overweight/ Obesity AOR 1.81. Age groups 11 to 15 years had reduced odds of undernutrition as compared to 16 to 19 years AOR 0.53 and increased odds of overweight/ obesity as compared to 16 to 19 years AOR 2 .00.</p> <p><strong>Conclusion</strong></p> <p>There is a significant difference in the nutritional status and eating habits of adolescents between public and private schools. Undernutrition is higher in public schools, among females and age 16 to 19 years. Nutritional interventions should be strengthened in school health services</p> Mehreen Nasir, Khunsa Junaid, Amber Arshad, Saadia Rafique Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5411 Sun, 31 Dec 2023 00:00:00 +0500 Does Vitamin D Deficiency Cause Chronic Low Back Pain: A Case-Control Study https://annalskemu.org/journal/index.php/annals/article/view/5429 <p><strong>Background:</strong> Chronic low back pain (CLBP) is an important cause of morbidity worldwide and is routinely treated by vitamin D supplementation alongwith other measures. Whether vitamin D deficiency is responsible for CLBP, is a matter of debate. The aim of this case-control study is to find out weather vitamin d deficiency is associated with CLBP.</p> <p><strong>Objective:</strong> The objective of the study to find out whether hypovitaminosis D causes CLBP.</p> <p><strong>Methods:</strong> This case-control study was conducted in the Department of Surgery and Medicine of Aero Hospital Wahcantt from 2<sup>nd</sup>May 2022 to 31May 2023 after ethical approval from IMC vide letter No 44(33)/2023-IMC. 195 cases of CLBP and an equal number of controls were selected through non-probability convenience sampling. After matching confounding factors between the two groups, their vitamin D levels were recorded. The null hypothesis that there is no difference between the mean vitamin D level of cases and controls was tested by applying an independent sample t-test. Taking vitamin D levels below 20ng/ml as hypovitaminosis D, the odds ratio was calculated as well. </p> <p><strong>Results:</strong> Both groups, cases, and controls had an equal number of males (n=63, 32.3%) and females (n=132, 67.7%). The mean age of cases was 44.6 years with SD ± 13.54 while the mean age of controls was 45.2 years with SD ± 13.46 years. The mean level of vitamin D of patients was 23.22 ng/ml with SD ± 17.76 while the mean vitamin D level of controls was 26.48ng/ml with SD ± 20.64. Independent sample t-test showed that there is no statistical significant difference between the mean vitamin D levels of the two groups (p-value &gt; 0.05). The odds ratio was 1.31 showing no or very weak correlation between hypovitaminosis D and CLBP.</p> <p><strong>Conclusion:</strong> There is no causal relationship between CLBP and hypovitaminosis D.</p> Muhammad Tahir Ghani, Syed Hassan Murtaza Shah, Akkad Rafiq, Nain Sukh Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5429 Sun, 31 Dec 2023 00:00:00 +0500 Evidence – Informed Policy Formulation and Implementation: A case study of ‘Clean Air Policy’ in Punjab, Pakistan https://annalskemu.org/journal/index.php/annals/article/view/5518 <p><strong>Background</strong>: There has been an accelerating momentum globally, for the use of scientific research evidence to support public health policy formulation and implementation. Policymakers, nonetheless use a variety of information over and above research evidence in the process. A case study of ‘the Clean Air policy’ was undertaken to explore the Policy makers practices related to Evidence Informed Policy in Punjab, Pakistan.</p> <p><strong>Objective: </strong>The objective of this study was to investigate policy makers’ perceptions regarding ‘evidence’ and how it is gathered and used in policy formulation and implementation processes</p> <p><strong>Methods</strong>: The empirical data was collected by qualitative research techniques. Document review and semi-structured in-depth interviews were conducted with 87 purposively selected policymakers between December’22-October’23. Data Analysis was guided by principals of grounded theory. A conceptual model for Evidence Informed Policy Formulation and Implementation (derived from the Frameworks of Bowen and Zwi and Dodson et al.) was experientially applied to organize the data.</p> <p><strong>Results</strong>: The case study of the ‘Clean Air Policy’ of the Govt. of Punjab highlighted that the policy had been formulated in a structured manner with incorporation of relevant evidence (research and other) at all stages of policy formulation. Policy makers considered ‘evidence’ as an expansive concept not limited to research evidence. Overall, the use of evidence for policy-making and implementation is rooted in complexities inherent to the local context, policymakers understanding and organizational culture and processes. </p> <p><strong>Conclusion</strong>: The study contributed to understanding the arena of Evidence Informed policy practices in Pakistan. Addressing the highlighted challenges can inform strategies for enhancing evidence use in policy processes for improving health system performance.</p> Saira Tariq, Rubeena Zakir Copyright (c) 2023 Annals of King Edward Medical University http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5518 Sun, 31 Dec 2023 00:00:00 +0500 Primary Healthcare System Reforms in Pakistan to Achieve Universal Health Coverage https://annalskemu.org/journal/index.php/annals/article/view/5602 Primary health care (PHC) is crucial for a country's health system, serving as the first point of contact for patients and providing clinical management at a local level. Primary health care (PHC) aims to achieve physical, psychological, and social well-being, facilitating fair interaction with the patient.1 It is the cornerstone of global health systems and requires efficient resource allocation, sustainable financing, and a strong primary healthcare system. Primary health care (PHC) principles include universal access, equitable care provision, prevention, health promotion, and community participation. Balancing social and medical aspects is essential in PHC service provision to meet the needs of its users.2 Primary health care doctors in the UK, Ireland, Australia, and New Zealand provide first-contact care, saving time and money by preventing patients from going to the hospital. This model is increasingly being adopted in countries like Qatar, Saudi Arabia, and the United Arab Emirates.3 Qatar has a government-led Primary Care Health Cooperation, Saudi Arabia invests in primary care, and United Arab Emirates recognizes the importance of preventive medicine for a healthy life. Strengthening primary health care and achieving universal health coverage are crucial global health policy initiatives, aiming to provide accessible, affordable, and high-quality health services to all individuals.4 Saira Afzal, Khunsa Junaid Copyright (c) 2024 http://creativecommons.org/licenses/by/4.0 https://annalskemu.org/journal/index.php/annals/article/view/5602 Sun, 31 Dec 2023 00:00:00 +0500