[en] Objective: To compare mean blood loss by prophylactic balloon tamponade versus B-lynch suture in patients with placenta previa. Study Design: Randomized controlled trial (Clinicaltrials.gov: NCT05133167). Place and Duration of Study: Obstetrics and Gynecology Department, Combined Military Hospital, Jhelum Pakistan, from Apr to Oct 2021. Methodology: A total of 60 patients with placenta previa, ranging in age from 18 to 40, were included in the study. Computer-generated random sample allocation was used to assign equal number of patients to Groups A and B. In Group-A, balloon tamponade (using Foley catheter 28 Fr) was used intra-operatively to prevent post-partum hemorrhage. Post-operative blood loss within first 24 hours was estimated by measuring the amount of blood collected in Foley balloon tamponade bag, in milliliters. In Group-B, B-lynch suture was used intra-operatively to prevent post-partum hemorrhage. Post-operative blood loss within first 24 hours was estimated by the weight difference of the pads before and after being used by the patient. Results: The mean blood loss in Group-A (prophylactic balloon tamponade) was 118.97±20.26 ml, while it was 154.13±15.21 ml in Group-B (B lynch suture Group) (p-value=0.0001). Conclusion: In cases of placenta previa, prophylactic balloon tamponade resulted in reduced post-intervention mean blood loss compared to B-lynch. (author)

[en] Objective: To determine the frequency of clinopathological characteristics of systemic lupus erythematosus (SLE) patients presenting to Military Hospital (MH) Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was carried out at MH Rawalpindi, from Jan 2011 to Dec 2013. Material and Methods: All patients presenting to Rheumatology department, MH Rawalpindi with a diagnosis of SLE were included in this study. Presenting features, clinical profile and laboratory parameters of patients were recorded. Results: A total of 76 patients were included in this study, 70 (92.1%) were females and 6 (7.9%) male patients with female- male ratio of 11.6:1. Mean age at presentation was 33 ± 8.31 years. Seventy two patients (94.7%) were anti nuclear antibody (ANA) positive, 63 (83%) were positive for anti-double stranded deoxyribonucleic acid (anti-dsDNA) antibody and 6 (7.9%) were anti Smith positive. Seventy (92.1%) patients had musculoskeletal symptoms, 65 patients (85.5%) had fever, 36 (47.4%) patients had cutaneous symptoms, and 20 patients (26.3%) had oral ulcers. About 13 patients (17.1%) had alopecia and 15 patients (19.7%) had serositis. Forty two patients (55.3%) had nephritis, 20 patients (26.3%) had lupus cerebritis, 57 patients (75%) had hematological involvement, 9 patients (11.83%) had pulmonary involvement, 8 patients (10.5%) had rheumatoid arthritis (RA) factor positive and 7 patients (9.2%) had overlap syndrome. Conclusion: Renal and hematological involvement was more common in this study population while mucocutaneous features and neuropsychiatric features were comparable to many local studies with exception to that of Lahore based study that showed much higher percentage of these features. These results reflect the need to have a high index of suspicion for kidney and hematological involvement in SLE patients. (author)

[en] Objective: To compare hemodynamic changes (systolic blood pressure and pulse) after intubation with Macintosh and McCoy laryngoscopes. Study Design: Randomised control trial (Clinicaltrials.gov: NCT05133375) Place and Duration of Study: Combined Military Hospital, Jhelum Pakistan, from Apr to Oct 2021. Methodology: A group of 272 patients reporting to the operation theatre were selected and divided into Group-A and B using the lottery method. All patients had ASA class I and II score and Mallampati score of I and II with no comorbid conditions. Macintosh laryngoscope was used in Group-A, and McCoy laryngoscope was used in Group-B. Before intubation, systolic blood pressure and pulse were measured, as well as 30 seconds, 2 minutes, and 3 minutes following intubation. In addition, a comparison of both groups regarding systolic blood pressure and pulse was made. Results: The patients in the study had a mean age of 34.93±9.66 years. The increase (20%) in heart rate was significantly higher in the Macintosh-Group 23(16.9%), than in the McCoy-Group 8(4.4%), (p=0.001), and the 20% increase in systolic pressure was also found to be significantly higher in the Macintosh-Group as compared to the McCoy-Group, 26(19.1%) versus 8(6.6%), (p=0.002). Conclusion: According to our research, using the McCoy blade is a safer mode of intubation in terms of the hemodynamic response. (author)

[en] Objective: The objective of this study was to find out the frequency of ECG abnormalities in patients of COPD in relation to disease severity. Study Design: Cross Sectional study. Place and Duration of Study: This study was carried out at the Department of Medicine, Military Hospital Rawalpindi, from Oct 2011 to Jun 2012. Material and Methods: All patients presenting to the Department of Medicine both inpatient and outpatient, with diagnosis of COPD were included in the study. Patients with cardiac comorbidities were excluded. Also, patients on diuretics and long term oxygen therapy were excluded. A total of three hundred and forty three patients (343) were included in the study. Spirometry of all these patients was done to determine the FEV1 and FVC in order to classify the grade of severity of COPD. Standard 12 lead ECG of all these patients was done to find out the various ECG abnormalities. Results: About 77 (22.5 percent) patients had mild COPD, while moderate COPD was seen in 121 (35.3 percent). Severe COPD was seen in 100 (29.2 percent) patients and very severe COPD was seen in 45 (13.1 percent) patients. The most common ECG abnormalities noted was right atrial enlargement (RAE) in 6 (7.8 percent) patients of mild COPD, 27 (22.3 percent) patients of moderate, 48 (48 percent) patients of severe and 24 (53.3 percent) patients of very severe COPD. Right ventricular hypertrophy (RVH) in 1 (1.3 percent) patient of mild, 7 (5.8 percent) patients of moderate, 19 (19 percent) patients of severe and 12 (26.7 percent) patients of very severe COPD. Sinus tachycardia was present in 6 (7.8 percent) patients of mild, 17 (14 percent) patients of moderate, 19 (19 percent) patients of severe and 10 (22.2 percent) patients of very severe COPD. Right bundle branch block (RBBB) was seen in 5 (6.5 percent) patients of mild, 9 (7.4 percent) patients of moderate, 13 (13 percent) patients of severe and 9 (20 percent) patients of very severe COPD. SVT was present in 1 (1.3 percent) patient of mild, 6 (5 percent) patients of moderate, 10 (10 percent) patients of severe and 8 (17 percent) patients of very severe COPD. Low voltage ECG was seen in 3 (3.9 percent) patients of mild, 7 (5.8 percent) patients of moderate, 12 (12 percent) patients of severe and 6 13.3 percent) patients of very severe COPD. Atrial premature contractions (APCs) were present in 3 (3.9 percent) patients of mild, 11 (9.1 percent) patients of moderate, 14 (14 percent) patients of severe and 6 (13.3 percent) patients of very severe COPD. Normal ECG was seen in 54 (70.1 percent) patients of mild, 52 (43 percent) patients of moderate, 14 (14 percent) patients of severe and 3 (6.7 percent) patients of very severe COPD. Conclusion: A number of ECG abnormalities were seen in patients with COPD. They were more frequent with increased grade of severity of COPD. Therefore, it is recommended that ECG should be done routinely in patients with COPD. (author)

[en] Summary: Broad production, utilization, and scrapping of pesticides worldwide increase the health concern of humans and animals, due to their bio-persistent and bio-accumulating nature. Among the present treatment methods, metaloxide based photocatalysis is the emerging technology for pesticide removal in aqueous medium, and has gained the interest of many researchers in the past years due to its feasibility, cost efficiency and higher degradation rate. This review briefly discusses the mechanism of metaloxide based photocatalytic degradation, reaction kinetics of pesticides degradation, optimization of operational parameters to enhance the degradation process, and different modifications such as binary, ternary or metal/non-metal dopped metaloxide photocatalysts to improve the effectiveness of degradation has also been analyzed. The effect of operational parameters like effect of catalyst dosage, pH, initial pesticide concentration, UV/sunlight, and irradiation time on the photocatalytic degradation of pesticide has been reviewed. The comparison of various photocatalysts for the degradation of diazinon from aqueous medium is summarized. However additional research is required to achieve fast and maximum degradation to keep the environment safe. (author)

[en] The topic of debriefing has been receiving some attention in the simulation literature. Because of the significance of debriefing on learning, evaluation of the de-briefer is done to ensure optimal performance. Structured debriefing as a learning tool was evaluated at the end of modular teaching of first year MBBS. This study is a descriptive cross sectional study to analyze the usefulness of debriefing as an instructional strategy during observed structured clinical examination conducted at the end of two consecutive modules of first year MBBS students. Methods: Performance of 150 students of first year MBBS was evaluated at the end of modules called Foundation module and skin and musculoskeletal module. Debriefing was structured and conducted after training of six staff members who conducted and supervised Objectively Structured Clinical Examination. Results: Apart from description of results of Objectively Structured Clinical Examination that were generally good, students praised the debriefing session. Ninety percent students thought the timing of debriefing to be perfect. Only 2% percent students complained about negative debriefing. Ten percent students wanted the debriefing session to be conducted in camera so that they could evaluate their own performance. Conclusion: Debriefing session at the end of modular teaching Objectively Structured Clinical Examination is a useful learning tool as not only it provides immediate feedback about the performance but gives students opportunity to discuss own performance with the instructor in order to develop habit of lifelong self-directed adult learner. (author)

[en] Objective: To review all the patients of spinal dysraphism referred to our center over a three year period in order to identify the most typical neuro-radiological appearances on Magnetic Resonance Imaging. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi from Jan 2016 to Dec 2018. Methodology: MR spine reports of 144 patients of spinal dysraphism were retrospectively analyzed. Age, gender, indication for MRI, operative status, and neuro-radiological features (including site and type of lesion) were recorded for these patients. Results: Congenital spinal malformations were more frequent among females 87 (60.4%) and between 0-20 years 135 (93.9%) of age. Tethered cord 97 (67.4%) was the most common congenital spinal abnormality followed by spina bifida, diastematomyelia, vertebral segmentation anomalies, myelomeningocele, menigocele. Lip-myelomeningocele, lipoma of filum terminale, and sacral agenesis. Frequently observed associated abnormalities included scoliosis 61 (42.4 %), syrinx 47 (32.6%) and dural ectasia 40 (27.8 %). Conclusion: Congenital spinal malformations are usually complex with variable radiological appearances. Modern high resolution MRI screening is the examination of choice for identification, preoperative evaluation, and long term follow up of such congenital anomalies. (author)

[en] To investigate the relationship of general literacy with control levels of HbA1c among the patients of diabetes at a tertiary care hospital of Pakistan. Study Design: Cross-sectional analytical study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, form Dec 2017 to Jun 2018. Methodology: The sample population included patients of diabetes mellitus (DM) reporting for the routine checkup at medical Outpatient department (OPD) of Pak Emirates Military Hospital (PEMH) Rawalpindi. Serum HbA1c level was done after >8 hours of fasting and values were interpreted as normal reference percentages of excellent glycemic control 5%-6.5%, good glycemic control 6.6%-8% and poor glycemic control >8%. Relationship of education level was assessed with the glycemic control along with the age, gender and duration of diabetes mellitus. Results: Out of 190 patients included in the final analysis, 18.4% had excellent glycemic control, 36.8% had good glycemic control while 44.7% had poor glycemic control. After applying the chi-square, it was found that increasing age and longer duration of diabetes mellitus has significant relationship with glycemic control while level of education has no association with glycemic control in our study population. Conclusion: There was a high frequency of poor glycemic control among the patients of diabetes mellitus. Special attention should be paid to the older patients or those who have long standing diabetes mellitus. (author)

[en] Objective: To assess the association of various factors with the presence of urinary tract infections among patients suffering from stroke. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun to Sep 2021. Methodology: A total of 130 patients with ischemic or hemorrhagic stroke diagnosed by the consultant medical specialist or neurologist based on clinical and neuro-radiological findings were included in this study. Urinary tract infection was diagnosed based on urine culture and sensitivity test. Age, gender, type of stroke and severity of stroke was associated with the presence of urinary tract infection among the study participants. Results: Out of 130 patients with acute stroke included in the study, 81(62.3%) were males, while 49(37.3%) were females. The mean age of the stroke patients included in the study was 56.823±8.737 years. In addition, 33(25.4%) patients had urinary tract infections confirmed on the culture and sensitivity report, while 97(74.6%) had no evidence of urinary tract infection. Statistical analysis revealed that female gender and stroke severity had a statistically significant relationship (p-value <0.05) with the presence of urinary tract infection among patients suffering from acute stroke. Conclusion: Around one-fourth of our patients presenting with acute stroke had urinary tract infections in our study participants. Female patients and patients with severe stroke symptoms were more at risk of urinary tract infections than male patients and patients with less severe symptoms. (author)

[en] Objective: To assess the risk of COVID-19 to healthcare workers (HCWs) in Tertiary care hospitals and its association with demographic factors. Study Design: Cross-sectional analytical study. Place and Duration of Study: Tertiary Care Hospital, Rawalpindi Pakistan, from May to Dec 2020. Methodology: Healthcare workers working in a designated COVID-19 Tertiary care hospital were included in the study. A modified ^Risk assessment and management of exposure of HCWs in the context of COVID-19 tool was distributed. HCWs were categorized as ^high risk and ^low risk of COVID-19 infection. Frequency and percentages were computed for demographic variables. Results: A total of 182 healthcare workers were included, and 167(91.7%) returned the study questionnaire. Most of them were nurses (n=65, 40.1%) working in the medical unit (n=99, 61.1%). Low risk HCWs were 73.5%( n=119) and only 26.5%( n=43) were high risk. Gender (p-value: .02) and type of HCWs (p-value: .01) were significantly associated with the risk of COVID-19. Conclusion: One-fourth of HCWs were at high risk of COVID-19 virus infection. Female gender and nurses were more likely to acquire COVID-19 infection. (author)