Pakistan Journal of Health Sciences

Advancement of Dengue Virus Vaccine: Progress and Challenges

Riffat Mehboob — 2024-04-30

The dengue virus (DENV), which causes dengue, infects 100 to 300 million people globally each year [1]. Aedes aegypti mosquitoes carry the Dengue virus, which causes dengue fever, which is still a serious global health risk, particularly in tropical and subtropical areas [2]. Since there are now no targeted antiviral therapies and due to difficulties with traditional vector control techniques, the focus has shifted to developing vaccines as the main preventive measure. In order to create a variety of vaccination forms, including live attenuated, recombinant subunit, inactivated virus, viral vectored, DNA, and mRNA vaccines, scientists have targeted E protein and NS1.

An important advancement in the fight against Dengue fever has been the development of vaccinations that are able to neutralize all four serotypes. But there are obstacles such as lack of vaccine effectiveness against specific serotypes, side effects produced by vaccine in progeny and vaccine-induced immunological enhancement (ADE).Immunization can lessen the burden on healthcare systems, lower the number of hospitalizations caused by dengue, and help stop outbreaks.

The development and implementation of dengue vaccine research are significantly accelerated by international cooperation, public-private partnerships, and regulatory cooperation. Effective programs show how crucial it is to work together to combat dengue fever on a worldwide scale. The difficulties involved in developing a dengue vaccine, ongoing funding, campaigning, and research are crucial. There are several viable approaches to increase the efficacy and accessibility of the Dengue vaccine, including cross-disciplinary cooperation, novel vaccination platforms, and emerging technology.

In conclusion, overcoming obstacles unique to each serotype, embracing creative approaches to vaccine design, and negotiating scientific intricacies are all necessary steps on the path to developing successful Dengue virus vaccines. The convergence of state-of-the-art technologies, computational modeling, and cooperative research endeavors can potentially realize the objective of vaccination-based comprehensive dengue prevention.

Evaluating Communication through Work Authorization between Dentists and Dental Technicians for Fixed Prosthesis

Anam Fayyaz Bashir — 2024-04-30

Communication within the dental profession can be challenging and may affect the quality of prostheses delivered to the patient. A methodical investigation into the dynamics between dentists and dental technicians is lacking in Lahore. Objective: To assess adequate practice of communication between dentists and dental technicians through work authorization for fixed prosthesis. Methods: This cross-sectional study was conducted in dental laboratories of Lahore. A questionnaire concerning work authorization forms was distributed to 80 dental technicians through Google Forms and hard copies. The survey concentrated on inquiries related to various aspects of work authorization, including gender, years of experience, impression disinfection, patient demographic data, impression materials used, fixed prosthesis design, and shade selection. An adequate work authorization was assessed in the end. Statistical analysis was conducted SPSS version 25.0 and was analyzed using chi-square, with significance set at p ≤ 0.05. Results: Out of the 80 survey forms disbursed, only 73 completely filled responses were accepted, giving a response rate of 91%. Information regarding patient demographic data (19.2%), patient photographic record (5.5%), pontic design (13.7%), margin design (37%), surfaces covered by metal (9.6%) and occlusal scheme (6.8%), were all on the inferior side of the scale ranging below 40%. Adequate practice of work authorization was discouraging, at only 17.8%. Conclusions: Poorly filled work authorization forms lead to patient and dentist dissatisfaction with fixed dental prostheses. This highlights the importance of clear communication between technicians and dentists. Dental students should learn to complete these forms during their training.

Analyzing the Direct and Indirect Effects of Coping Self-Efficacy on Well-Being via Quality of Life

Shahla Saeed — 2024-04-30

Understanding the intricate interplay between coping self-efficacy, quality of life, and overall well-being is essential in exploring the factors that contribute to individual resilience and psychological thriving. Objective: To test coping self-efficacy's direct and indirect (through quality of life) effect on well-being. Methods: Using purposive sampling, data were collected from literate adults aged 18 and above in Pakistan. Sample (N=150), mean age=22.65 years consisted of 51 males (34%) and 99 females (66%). Informed consent was taken, and participants filled out the questionnaire consisting of the PERMA profiler, generalized self-efficacy scale, world health organization quality of life brief and demographic sheet. Results: Data analysis showed that coping self-efficacy positively affects well-being (B=3.98, p <0.01). The meditational model showed a significantly positive direct effect (B=.2.78, p >0.01) as well as the indirect effect of coping self-efficacy on well-being (B = 1.20, 95% CI = 0.46, to 1.90). These results show that having higher coping self-efficacy will have an accelerating effect on well-being. Similarly, coping self-efficacy also increases the quality of life, further increasing well-being. Conclusions: An individual’s well-being increases in the presence of higher coping self-efficacy, and this relation is accelerated further in the presence of better quality of life. Thus, the quality of life and self-efficacy can be targeted in intervention programs to enhance well-being for living a more fulfilling life and to create more resilient citizens.

Examining the Predictive Relationship between Perceived Social Support and Perceived Stress among Pregnant Women

Ayesha Ahmad — 2024-04-30

The woman's mental and physical health will unavoidably suffer throughout her pregnancy. Extreme mood swings and, in rare occasions, mental instability can occur. These factors make pregnancy a time when a woman has to undertake bio-psycho-social modifications, such as establishing strong social support systems, in order to alleviate the stress that comes with being pregnant. Objective: To investigate the predictive relationship between perceived social support and perceived stress among pregnant women in Pakistan. Methods: The study used a correlational cross-sectional research design. The sample consisted of (N=72) pregnant females in their third trimester with an age range between 18 to 37 years (Mean age= 26.3; SD=4.4) was selected from departments of Obstetrics and Gynecology of various hospitals in Karachi, Pakistan by using purposive sampling technique. The data were collected from December 2022 till January 2023. The demographic information form, Multidimensional Scale of Perceived Social Support and Perceived Stress Scale were used, and analysis of data were done by using Regression analysis and One-way ANOVA through SPSS version 25.0. Results: The findings revealed a significant negative predictive relationship between perceived social support from friends and perceived stress of pregnant women (b= -.482, p<.05). The analysis of variance reveals that significant mean differences in socioeconomic status and number of miscarriages on perceived stress are present among pregnant women. Conclusions: These results emphasize the need to develop comprehensive strategies for assisting pregnant women by taking into account the aspects of social support, and make interventions to tackle stress successfully, and enhance maternal well-being throughout the pregnancy.

Insights into Standard Precaution Knowledge and Adherence among Healthcare Workers: Evidence from Tertiary Care Hospitals in Peshawar, Pakistan

Salman Zahir — 2024-04-30

Healthcare workers (HCWs) are at risk of being exposed to blood-borne infections when performing clinical activities, hence conventional measures must be followed. The study conducted in Peshawar was motivated by the inadequate adherence to standards in Pakistan. Objective: To evaluate tertiary care hospitals' healthcare workers' (HCWs) awareness of and adherence to standard precautions. Methods: Over the course of six months, 421 HCWs employed in a variety of public and commercial tertiary healthcare settings in Peshawar, Pakistan, participated in cross-sectional research. Convenient sampling was employed in the selection of participants. Three portions of a standardized questionnaire addressing adherence, knowledge, and demographics were administered. For data analysis SPSS version 27® was used, evaluating adherence and knowledge using scoring methods. Results: The majority of participants (78.1%) were new in their areas, and 68.2% had completed standard precautions training. Although the majority of healthcare workers (HCWs) showed high understanding (67.46%), there were still significant gaps in their knowledge, especially when it came to false beliefs about HIV and Hepatitis patient care. However, there was excellent adherence, particularly for trash disposal (73.6%) and hand hygiene (91.4%). When it came to knowledge and adherence, doctors outperformed lab technicians and nurses. Conclusions: Despite knowledge limitations, healthcare workers (HCWs) in Peshawar displayed outstanding adherence to basic procedures, going beyond theoretical comprehension. This underscores the importance of practical implementation in healthcare settings.

Assessment of Tongue Scraper and Using Baking Soda Mouth Wash in Reduction of Halitosis

Pirah Talpur — 2024-04-30

Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odor is present. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder. Objective: To compare the effectiveness of tongue scraper and sodium bicarbonate (baking soda) mouthwash in reduction of halitosis. Methods: This comparative cross-sectional study was organized in undergraduate students of Paramedics Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro. Individuals aged 18 to 30 years of age were included by non-probability convenient sampling technique. Data were analysed by SPSS Version-26.0. Results: A total of 302 cases were comparatively studied. Males were in preponderance in both groups. Before treatment, 2.6% had slight odor, 33.8% had moderate odor, 28.5% had heavy odor, 23.85% had strong odor and 11.2% had intense odor in Group A, while 14.6% had slight odor, 19.9% had moderate odor, 25.8% had heavy odor, 21.8% had strong odor and 17.8% had intense odor in Group B (p=0.04). After treatment baking soda mouthwash showed more efficacious in terms of decrease the halitosis and its severity. In 21.2% halitosis was completely reduced and remaining most of the cases had mild and moderate halitosis compared to tongue scraper technique, while strong odor was completely reduced in both groups (p-0.001). Conclusions: Sodium bicarbonate (baking soda) mouthwash was observed to be the more effective in terms of decrease the halitosis and its severity compared to the tongue scraper technique among individuals presented with halitosis.

Perinatal Outcomes of High Risk Pregnancies: Experience of a Tertiary Care Hospital

Saima Ghaffar — 2024-04-30

High Risk Pregnancy (HRP) denotes a condition where the mother, the fetus, or both are predisposed to complications during the gestation period, at birth, or postnatally, which is affected by several factors. Objective: To analyze the perinatal outcomes of high-risk pregnancies, focusing on the experience of a tertiary care hospital. Methods: A longitudinal study over two years, from October 1, 2020, to December 31, 2022, was conducted on 213 high-risk pregnant women, via purposive sampling, who attended the antenatal clinic Liaquat University Hospital, Hyderabad and Jamshoro. After obtaining informed written consent, interviews were conducted with the participants to collect data about their sociodemographic, obstetric, and gynecological histories. Perinatal outcomes were evaluated on the 8th day post-delivery, during which details concerning maternal and fetal complications in terms of morbidity and mortality, were documented. Results: Rh-negative pregnancy was found to be the most high-risk factor with 24.4% (52) of the cases, followed by teenage pregnancy at 12.2% (26), and short stature at 10.9% (23). Additionally, severe anemia was found in 21 women (9.8%), Pregnancy Induced Hypertension (PIH) in 18 women (8.6%), and obesity was also seen in 18 women (8.6%). Other noted risk factors included grand multigravida in 13 women (6.1%), thyroid disorder 4.9% (10), twin pregnancy 3.7% (8) and congenital fetal anomaly, polyhydramnios, oligohydramnios each with 2.4% (5). Conclusions: This study significantly contributes to the body of knowledge on high-risk pregnancies and their outcomes.

Frequency of Depressive Symptoms in Women with Polycystic Ovary Syndrome and Obesity versus Women with Polycystic Ovary Syndrome without Obesity

Sheeba Faryal — 2024-04-30

Polycystic Ovary Syndrome (PCOS) is a complicated hormonal condition that impacts women globally. Its association with obesity and its potential impact on mental health, specifically depressive symptoms, has gained increasing attention. This study aimed to determine the relationship between depressive symptoms and PCOS in women, with a focus on the influence of obesity. Objective: To compare the frequency of depressive symptoms among women who have PCOS, categorized based on whether they are obese or not. Methods: A cross sectional descriptive study was conducted on electronic medical records of 194 women with PCOS from a tertiary care hospital. Data included demographic information, clinical characteristics of PCOS, and depressive symptom scores measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. The study was conducted from Apr 2021 to Oct 2021 for a period of 6 months. Results: Women with PCOS and obesity exhibited significantly higher mean CES-D scores and a higher prevalence of clinically significant depressive symptoms (CES-D ≥ 16) compared to those without obesity. Hyperandrogenism, oligomenorrhea, and hirsutism were more prevalent in women with PCOS and obesity. Conclusions: The study found out that women with PCOS and obesity appear to be at a higher risk of experiencing clinically significant depressive symptoms. Healthcare providers should consider the mental health needs of this population, emphasizing a multidisciplinary approach to care.

Violence-Related Injuries: The Most Common Cases in Hyderabad, Pakistan

Ishrat Bibi — 2024-04-30

The law influences every aspect of human activity, including medical practice. The nature of casualty is affected by geographical regions, cultures, and social values. Determining characteristics of casualty can guide health policy and can assist in managing healthcare resources. Objective: To profile the cases at casualty department of a tertiary teaching hospital. Methods: The study was conducted at the casualty department of Liaquat University Hospital Hyderabad, Pakistan and Department of Forensic Medicine & Toxicology LUMHS, Jamshoro, over a period of one year from January 2021 to December 2021. A total of 3,487 cases were recorded and categorized into violence-related, transportation-related, substance-related, and sexual assault-related injuries. Results: The majority of cases were violence-related incidents (84.65%), followed by transportation-related accidents (14.65%), substance-related injuries (3.61%), and sexual assault-related injuries (0.69%). Violence-related injuries were divided into assault cases, firearm incidents, and police torture. Transportation-related injuries were categorized as road traffic accidents and train accidents. Assault and road traffic accidents were the leading cause of violence-related and transportation-related injuries, respectively. The highest numbers of cases were observed in April, June, and May. Conclusions: A substantial portion of cases at casualty department of Liaquat University Hospital, Hyderabad is contributed by violence-related injuries

Early Complications of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Sanaullah Pathan — 2024-04-30

Obstructive hydrocephalus (HCP) occurs when cerebrospinal fluid is blocked leading to the enlargement of ventricular pathways stream resulting into increase pressure within skull. Endoscopic third ventriculostomy (ETV) is considered an effective management strategy for hydrocephalus especially for third/fourth ventricle level. Objective: To study the per-operative and post-operative early complications of endoscopic third ventriculostomy in obstructive hydrocephalus patients.

Methods: This prospective study was conducted at Department of Neurosurgery, Liaquat University Hospital, Hyderabad, from 1^st January 2020 to 31^st December 2022. One hundred and fifty patients were included. All the cases, were underwent general anesthesia and elective surgery was performed in them. The patients were followed post operatively for 7 days in context to cerebrospinal fluid (CSF) leakage, wound infection, bleeding, seizures as well as meningitis. Results: Seventy six (50.7%) were males and 74 (49.3%) were female. Mean age was 5.5 ± 2.3 years with maximum number of patients (70.7%) were under or equal the age of 5 years. Complications occurred in 18 patients (12%) out of 150 patients. Cerebrospinal fluid leakage was the most common complication occurred in 5 (3.33%) patients, wound infection was seen in 2 (1.3%) patients, meningitis developed in 3 (2%) patients, minor bleeding was seen in 3 (2%) patients, seizures developed in 4 (2.6%) patients, in hospital mortality occurred in 1 (0.66%) patient on 3rd post-operative day. Conclusions: Ventriculostomy appeared to be the better surgical approach for obstructive hydrocephaly management. Minimum numbers of associated complications were observed in present study group.

Pattern of Mechanical Asphyxia Deaths in Forensic Autopsies at Medicolegal Section of Liaquat University Hospital, Hyderabad

Nadia Aslam — 2024-04-30

Asphyxia is characterized by oxygen deprivation in cells resulting from insufficient or altered oxygen supply. Mechanical asphyxia refers to inadequate breathing caused by external forces. This study assessed the pattern of mechanical asphyxia-related autopsies carried out at a medico-legal section of Liaquat University Hospital, Hyderabad. Objective: To assess the pattern of mechanical asphyxia-related autopsies carried out at a medico-legal section of a tertiary care teaching hospital. Methods: This prospective observational study was performed to analyze the forensic autopsy reports from January 2021 to December 2022 at Liaquat University Hospital. Hyderabad and 103 medico-legal cases of mechanical asphyxia were enrolled. All autopsy reports related to mechanical asphyxia were included. The data were collected on a predesigned pro forma. Autopsies of non-medicolegal nature and related to unnatural deaths apart from mechanical asphyxia were excluded. Results: Most of the cases (n=51) were identified as caused by the drowning. The hanging and strangulation occurred in an equal number of mechanical asphyxia-related autopsies (n=26 each). The male gender dominated the frequency of drowning and strangulation while hanging was more prevalent in females. Conclusions: Drowning was observed as the most prevalent mechanism of mechanical asphyxia in medico-legal autopsies conducted over a period of two years

Infant Hearing Loss: Are Mothers Aware?

Amna Asghar — 2024-04-30

If hearing impairment goes unnoticed, negative effects on the infant’s communication, academic, learning, socio-emotional, and language skills occur. Mothers have an essential and significant role in screening and early intervention. Hence, the level of their knowledge and attitude needs to be addressed. Objective: To determine the maternal awareness towards infant hearing loss. Methods: This cross-sectional study was conducted at Isra University, Islamabad from February to July 2020. The study recruited a sample of n=377 pregnant women aged 18-45 years, utilizing convenience sampling. A basic demographic sheet and a Maternal Awareness about Hearing Loss questionnaire were used for data collection. Data were statistically analyzed using SPSS Version 26.0. ANOVA and independent sample t-test statistics were utilized to determine any significant difference in knowledge and attitude scores for demographic variables and p< 0.05 was considered significant. Results: Overall mothers responded positively to knowledge and attitude items with good scores for knowledge (25.71 ± 6.27) and attitude (8.01 ± 1.88). There was a significant (p<0.05) difference in knowledge and attitude scores for educational level, financial status, and employment status and age revealed significant difference for level of knowledge. Conclusions: This study concluded that maternal awareness about hearing loss is variably distributed for different risk factors and has a positive attitude about hearing loss and a highly positive attitude and willingness to accept the management options in case hearing loss is detected.

Comparing the Impact of Workload on the Mental Health of House Officers at Public and Private Hospitals of Peshawar

Aiman Zia — 2024-04-30

Healthcare environments place a high priority on the mental health of medical personnel, especially house officers. Objective: To compare the impact of workload on the mental health of house officers at public and private hospitals of Peshawar. Methods: Descriptive cross-sectional design was used to gather data from 164 house officers at four major hospitals in Peshawar, Pakistan (Khyber Teaching Hospital, Hayatabad Medical Complex, Kuwait Teaching Hospital, and Northwest General Hospital). In order to investigate the relationships between workload and mental health, data gathered from October 2023 to February 2024 via a standardized questionnaire on demographics, mental health, and workload was analyzed using descriptive statistics as well as inferential tests like chi-square and t-tests. Results: Out of 164 hospital patients, 29.7% had ages between 26 and 28. Among them 41.8% were female and 57.6% were male. Surgery (44.8%) and Medicine (54.5%) were the departments' representatives, while General Surgery (34.5%), Medicine (36.4%), Eye (15.2%), and ENT (13.3%) were the wards. The mean scores were (public: 30.69, private: 28.76; p-value.345), patient distribution (public: 11-40, private: 0-40; p-value 0.008), shift distribution (public: 0-15, private: 0-10), and self-reported concentration levels (p-value 0.051) showed significant differences between public and private hospitals. However, there was no discernible fluctuation in the strain levels (p-value = 0.658). Conclusions: House officers in Peshawar need special assistance from all sectors because of their tremendous responsibilities, particularly in public hospitals.

Seasonal Decomposition of Sexual Victimization-Related Cases in Hyderabad, Pakistan

Aisha Rasheed — 2024-04-30

The issue of sexual assault is a serious concern that contributes to abuses of human rights and risks to public health. Evaluating situations like these is absolutely necessary in order to make the judicial process easier for both the victim and the person who committed the crime. When the seasonality of sexual assault-related incidents is determined, it can provide the community and law enforcement authorities with information that can help them implement preventative measures. Objective: To assess the seasonality of sexual assault-related cases at casualty department of a teaching hospital in Hyderabad, Pakistan. Methods: In current descriptive/prospective study, ninety two sexual assault-related medico-legal cases (MLCs) were included. This study based on the seasonality of sexual assault-related MLCs using seasonal decomposition of three-year from January 2020 to December 2022 data from a leading tertiary care teaching hospital in the Hyderabad region. Results: Most of the cases (N=42) were reported in the year 2021. The percentage of sexual assault-related MLCs was found to be concentrated from June to August (10.86% to 14.13%). The highest number of sexual assault-related MLCs occurred in July. The seasonal decomposition also showed pronounced peaks in summer, with intense peaks in July for rape and total sexual assault cases. Conclusions: The number of sexual assault-related cases was aggregated in mid-year, showing a higher trend in summer season. Efficient preventive measures in certain seasons and education of vulnerable groups can minimize sexual violence in the community

Comparison of Air Puff Tonometer with Gold Standard Applanation Tonometer for Measurement of Intraocular Pressure in Adult Population

Yaruq Sami Shaikh — 2024-04-30

Detecting and treating glaucoma early is vital to prevent vision loss. Two main instruments, the Air Puff Tonometer and the Gold Standard Applanation Tonometer, are used to measure Intraocular Pressure (IOP). However, there is ongoing debate among ophthalmologists regarding the accuracy and reliability of these devices. Objective: To evaluate and contrast the measurements of intraocular pressure obtained through Air puff tonometry and Goldmann applanation tonometry. Methods: A cross-sectional comparative study was conducted upon 900 patients of Glaucoma, selected through purposive sampling technique, attending the Eye OPD of Isra University Hospital, Hyderabad. Patients with age more than 18 years, of both genders who provided consent for eye examination and treatment, were included in the study while patients with corneal disease or prior surgery, ocular trauma, or those presenting with active infection or ocular disease were excluded from the study. Results: 396 (44.0%) of patients were males and 504 (56.0%) were females. The results indicate that the mean IOP measurement for air puff tonometry (17.43 mm Hg) is significantly higher (p-value=0.0001) than the mean measurement obtained by Goldman tonometry (13.84 mm Hg). Overall, the distribution of IOP was similar for both types of tonometry, with a slightly higher proportion having high IOP values (19-22 mmHg) with Goldman tonometry compared to air puff tonometry. Conclusions: The findings of this research demonstrated a noteworthy contrast between the two techniques, where the air puff tonometry produced noticeably elevated intraocular pressure measurements in comparison to the widely accepted applanation tonometry

Religious Coping and Emotional Adjustment among Patients Undergoing Dialysis: Treatment Perception as Moderator

Tahir Aziz — 2024-04-30

Kidney problems are increasing in world as well as in Pakistan. Waste produced in the human blood is filtered through kidneys. When human kidney fails to operate their functions properly, dialysis is the way people can live the rest of their life. Objective: To explore the moderating role of treatment perception on religious coping and emotional adjustment among patients undergoing dialysis. Methods: Treatment Perception Questionnaire, Brief R-Cope Scale and Emotional Adjustment Measure were used for data collection. 200 dialysis patients; 100 males, 100 females from 19-80 years were selected by using purposive sampling. Results: The results showed significant positive correlation among treatment perception, positive religious coping and emotional adjustment. Treatment perception is significant positive moderator between positive religious coping and emotional adjustment. Positive religious coping and emotional adjustment were greater in older patients, while negative religious coping is greater in younger patients. Female patients have perceived their treatment positively and have greater use of positive religious coping as a result they were more emotionally adjusted than male patients. Additionally, less treatment duration patients have high level of treatment perception, positive religious coping and emotional adjustment than patients having more treatment duration. Conclusions: The findings of this study will help clinical professionals and social workers to have better understanding of these variables, to introduce, promote and modify the required remedies and therapeutic techniques to help out the patients so that they can improve their level of religious coping and emotional adjustment.

Efficacy of Combination of Topical Ketoconazole 2% Cream and Adapalene 0.1% Gel versus Topical Ketoconazole 2% Cream Alone in Treatment of Pityriasis Versicolor

Faiza Munir — 2024-04-30

Pityriasis Versicolor (PV) is a superficial skin infection caused by Malassezia yeasts, resulting in hypo and hyperpigmented macules. It affects up to 40% of individuals, often leading to itching, decreased quality of life, and social stigma. Objective: To compare the efficacy of combination of topical ketoconazole 2% cream and adapalene 0.1% gel versus topical ketoconazole 2% cream alone in treatment of pityriasis versicolor. Methods: A comparative cross-sectional study was conducted at the Department of Dermatology, Nishtar Hospital, Multan, spanning from November 2020 to April 2021. Total 90 patients were divided equally into two groups: Group A received a combination of Ketoconazole 2% cream and adapalene 1% gel, while Group B received Ketoconazole 2% cream alone. The efficacy of both treatments was evaluated and compared. The study utilized SPSS version 26.0 for data analysis. Results: In terms of gender, 52.22% were male, and 47.78% were female across both groups. The mean duration of the disease was 5.84 ± 3.26 years in Group A and 6.04 ± 3.11 years in Group B, with an overall mean of 5.95 ± 3.17 years. The efficacy of Group A was 91.11%, with 41 participants showing positive results, while Group B had an efficacy of 75.56%, with 34 participants showing positive results. Conclusions: The study findings indicate that using a combination of adapalene 0.1% gel and ketoconazole 2% cream is more efficacious than using ketoconazole 2% cream alone in treating PV

Knowledge, Attitude and Practice among Nurses Regarding Prevention of Central Line Associated Bloodstream Infection in Tertiary Care Hospital of Peshawar

Mudassir Khan — 2024-04-30

Healthcare Associated Infections (HAIs), particularly Central Line-Associated Bloodstream Infections (CLABSIs), remain a significant global public health concern. CLABSIs, associated with catheter use, pose critical challenges in critical care and cancer treatment settings, necessitating evidence-based measures for prevention. Objective: To assess the knowledge, attitude and practice of nurses regarding prevention of central line associated bloodstream infection in tertiary care hospital of Peshawar. Methods: This conducted study possessed a cross sectional study design with a random sample of 173 nurses who were presently working or had worked in ICUs of the hospital. Data were collected through a self-administered questionnaire. Data analysis was performed on SPSS version 22.0. Results: 45% of nurses demonstrated good knowledge with mean score of 12.35 and standard deviation of ± 1.45, positive attitudes were observed in 74% with mean score of 33.7 and standard deviation of ±2.1 and good practices in 80% of participants with mean score of 40.5 and standard deviation of 1.45 observe. Conclusions: This study clearly indicated that majority of the nurses (54.9%) have poor knowledge regarding CLABSI. Despite of the poor knowledge level most nurses (74%) followed standard practice. Interestingly, greater number of nurses (85%) were found to have positive attitude towards CLABSI.

A Cross-Sectional Preview of Correlates of Treatment Delay of Urinary Incontinence

Shazia Saaqib — 2024-04-30

The prevalence of urinary incontinence in geriatric women and its silent endurance poses high emotional burden as stigma attached to this condition often leads to reluctance in seeking timely medical assistance. However, affirmation to common characteristics of delayed help seeking behaviour can identify vulnerable women for further assistance.Objective: To determine the correlates of treatment delay of urinary incontinence by evaluating common characteristics of those who had delayed their treatment. Methods: This cross-sectional study was conducted at Lady Willingdon Hospital's gynecology outdoors over a three-year period from June 1, 2019, to May31, 2022. Out of 364 incontinent women, 198 participants were selected with ages above eighteen and incontinence for at least one year. Demographic information and UI-related factors of the participants were collected and evaluated by dividing data into short (less than or equal to three years) and long (greater than three years) delay groups. Correlates of treatment delay were determined by regression analysis using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: The respondents reported a treatment delay between one and thirty years; nearly half (59.60 percent) indicated a delay of more than three years. Age above fifty (odds ratio [OR] = 11.39; confidence interval [CI]: 4.30-30.18), embarrassment (OR = 3.63; CI: 1.19-11.12), lower subjective severity of symptoms (OR = 6.31; CI: 2.06-19.35), and stress incontinence (OR = 5.80; CI: 1.97-17.12) were significantly associated with treatment delay in regression analysis. Conclusions: In this study population, the correlates of treatment delay were age above fifty, embarrassment, lower subjective symptoms, and stress incontinence.

Depression, Anxiety and Stress among Undergraduate Students of Shah Abdul Latif University, Khairpur

Yasir Abkar Jamali — 2024-04-30

Higher rates of stress, anxiety, and depression are seen among university students. Objective: To find out the prevalence of stress, anxiety, and depression among undergraduate students. Methods: This was a cross-sectional survey study. The study was conducted among undergraduate students of Shah Abdul Latif University, Khairpur. The Depression Anxiety Stress Scale (DASS-21) was distributed to undergraduates in their first through last year of university. 132 students completed the DASS survey. We used Fisher's exact tests to compare the variations between the student groupings. Results: There were 132 students in all, and their mean age was 20.75 ± 2.1 years. The participants were categorized into two age groups: the first age group consisting of those aged 17-19 years, accounting for 63 (47.7%), and the second age group including individuals aged 20-22 years, representing 69 (52.3%). The male students were represented by 75 (56.8%), while the female students were represented by 57 (43.2%). Over 82 (62.1%) of students had a poor socioeconomic status. Conclusions: Female students were found with high frequency of depression, stress and anxiety.

Study of Anatomical Divergences in Facial Artery Endings

Atif Hussain — 2024-04-30

Facial artery supplies musculocutaneous tissue, visceral organs, and salivary glands at the upper cervical and facial level. This artery has wide range of anatomical variations in its course. Objective: To find the anatomical divergences in facial artery endings. Methods: It is a cross sectional study conducted at Jinnah international hospital, Abbottabad from January 2023 to July 2023 for duration of 6 months after taking approval from the ethical review committee. A group of 86 people were selected and anatomical course of facial artery was categorized in to four types. Angiographic images of each participant were evaluated by radiologist to categorize the course of facial artery. Results: The average Body Mass Index (BMI) of the participants was 28.3 ± 5.6. The study of angiographic images has concluded that 38.37% (n=33) has Type I course of facial artery, 47.67% (n=41) participants has Type II, 9.3% (n=8) participants has Type III and 4.65% (n=4) has Type IV category (p=0.01. Of the type I category of facial artery, 5 (15.2%) participants met the criteria of type IA, 7(21.2%) has Type IB and 21(63.6%) participants Type IC course of facial artery (p=0.01). Conclusions: This study has concluded that there exists vast variation in the anatomical course of facial artery in local population that streamlines with other studies conducted internationally. Facial artery with a nasal branch with or without alar endings is the most common anatomical variation.

Microdebrider Assisted Endoscopic versus Conventional Sinus Surgery in Sinonasal Polyposis: A Comparative Study

Waqas Khalily — 2024-04-30

For sinonasal polyposis, functional endoscopic sinus surgery or conventional is the standard surgical approach. Microdebrider assisted endoscopic sinus surgery provides patients with a better therapeutic approach. Objective: To assess and compare intraoperative, loss of smell, synechiae formation and polyp recurrence between microdebrider and conventional method in nasal polyposis patients. Methods: Cohort Study was carried out in Department of Ear Nose Throat, Shaikh Zayed Hospital, Lahore, 2022-2023. A total of sixty individuals with sinonasal polyposis, presenting in both genders, were included. Once written consent was obtained, the patient's comprehensive demographics were documented. Every patient was split evenly into two groups. Thirty patients each from Group A and Group B underwent endoscopic sinus surgery using traditional endoscopic tools and microdebrider respectively. Results were compared between the two groups in terms of synechiae production, length of operation, postoperative crusting, loss of smell, and intraoperative blood loss. Results: Age and gender differences between the two groups were not statistically significant (p-value >0.05). Regarding synechiae and loss of scent, there was no discernible difference between the two groups. Conclusions: The endoscopic sinus surgery with microdebrider was more effective for sinonasal polyposis as compared to conventional procedure

Immunohistochemical (IHC) Expression of p16 in Various Grades of Oral Squamous Cell Carcinoma (OSCC) with Snuff Use in Tertiary Care Hospitals of Peshawar

Karishma Ali — 2024-04-30

Oral squamous cell carcinoma (OSCC) is a significant health concern, with various factors influencing its development and progression. Understanding these factors, including p16 expression and clinicopathologic features, is crucial for improved diagnosis and treatment. Objective: To compare various grades of OSCC based on immunohistochemical expression of p16 and clinicopathologic parameters. Methods: The comparative cross-sectional study was conducted at the Department of Pathology, Peshawar Medical College (PMC), and Peshawar Dental College (PDC) from August 2020 to August 2021. It included 53 cases of OSCC with documented snuff use history. Tumor sections were stained with Hematoxylin and Eosin and underwent immunohistochemical staining for p16 expression. Sample size calculation utilized G Power software. Statistical analysis was performed using SPSS version 20.0, employing the Chi-Square test to assess categorical variables. Results: Among the 53 OSCC cases, the majority were male (66.0%) with ages ranging from 26 to 85 years, the most common age group being 51-70 years. The tongue was the primary site for OSCC development. Well-differentiated cases were predominant (64.2%), followed by moderate (20.8%) and poor grade cases (15.1%). However, no significant association was found between p16 expression and OSCC grades. Notably, p16 expression tended to be higher in snuff users and well-differentiated OSCC cases, although not statistically significant. Conclusions: Well-differentiated OSCC cases exhibited the highest expression of p16, followed by moderate and poorly differentiated cases. However, no significant correlation was observed between p16 expression and OSCC in snuff users.

Characteristics of Bleeding Peptic Ulcers and the Outcome after Endoscopic Therapy at a Tertiary Care Centre of Pakistan

Farwah Javed — 2024-04-30

Peptic ulcers are a global health concern. Bleeding episodes, a common complication require urgent intervention. Endoscopic therapy for managing bleeding peptic ulcers offering both diagnostic and therapeutic benefits. Objective: To analyze the characteristics of bleeding peptic ulcers and assess the outcomes following endoscopic therapy. Methods: A descriptive case series was conducted at Lahore General Hospital (LGH) between June 2021 and January 2022. Patients aged 18-80 with upper GI bleeding due to peptic ulcers or undergoing endoscopy with bleeding peptic ulcers were included. An 80mg bolus of omeprazole was given, followed by infusion at 8mg per hour and an urgent endoscopy was planned. Patients were observed for re-bleeding for 72 hours post-endoscopy. Results: Out of total 100 patients with upper GI bleeding, 70% of patients were male and 30% were female. The most common diagnosis was duodenal ulcers (75%), with the anterior wall being the most common site (86.67%). Dual therapy was administered in all patients, with hemostatic clips being applied in 68% of patients and electrocoagulation heat therapy being used in 32% of patients. Initial hemostasis was successful in 88% of patients treated endoscopically. But, 12% of patients experienced heavy bleeding during endotherapy and out of these, 8 patients required urgent laparotomy. Patients needed a second look endoscopy, 4 patients requiring angiographic embolization and 6 being managed with endotherapy. Conclusion: Dual therapy, hemostatic clips and electrocoagulation heat therapy are effective in achieving initial hemostasis in most cases

An Evaluation of Platelet Indices in Newly Diagnosed Cases of Acute Myocardial Infarction

Muhammad Bilal Ghafoor — 2024-04-30

Acute myocardial infarction (AMI) is characterized by prothrombotic phenotype associated with endothelial dysfunction, an increase in platelet activation and systemic inflammation. Platelet aggregation and activation are crucial in the formation of thrombi and acceleration of atherosclerosis, associated with unstable angina, sudden cardiac death is brought on by an acute myocardial infarction. Objective: To evaluate the platelet-indices in newly diagnosed cases of acute myocardial infarction. Methods: This cross-sectional study was conducted during November 2022 to December 2023 in Pathology Department of Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Samples were collected from the patients of AMI admitted to Emergency Ward and from healthy controls as well. Complete Blood Count (CBC) with platelet indices, platelet count, Mean Platelet Volume (MPV), Platelet Crit (PCT) and Platelet Distribution Width (PDW) were investigated on five-part automated hematology analyzer BT-PRO 2300. Analysis of the data was done by using SPSS version 20.0. Results: Total 140 patients were divided into a healthy control group (70) and newly diagnosed cases of acute myocardial infarction (70). Among diagnosed cases of AMI 46 (65.7%) had ST-elevation myocardial infarction (STEMI) and 24 cases (34.2%) got non-ST-elevation myocardial infarction (NSTEMI). It was found that AMI patients had lower platelet counts and PCT with higher MPV and PDW. Conclusions: It was concluded that the platelet indices (PDW, and PCT, MPV) are significant predictors of myocardial infarction. They might be applied as an easy, reliable, and economical way to anticipate an impending acute coronary event.