Effects of measles vaccine and its associated risk factors among children presenting in a tertiary care hospital, Rawalpindi/Islamabad

Objectives: To identify risk factors associated with the development of measles among children under 12 years of age in a tertiary care hospital in Rawalpindi/Islamabad and to determine the effectiveness of measles vaccination in the study population. Methods: A retrospective case control study was done from January 2022 to January 2023 at the Department of Pediatrics, Holy Family Hospital (HFH), Rawalpindi & PAEC General Hospital, Islamabad. Total 600 children were included in the study. The hospital data record had children under the age of 12 with measles. Case controls were enrolled without measles at the same hospital, matched for age and sex. Study outcomes were analyzed by multivariant regression test adjusted with age and sex. Results: The average age of the children was 32.24±14.58 months. Mothers with low education were mostly have measles [OR: 4.1, 95% CI: 1.9-6.5, for primary schooling and OR: 1.1, 95% CI: 0.7-2.0, for matriculation]. Children with measles were mostly not breastfed during the first 2 years of life [OR: 0.8, 95% CI: 0.5-1.4]. Cases were also more likely to have never been vaccinated [OR: 8.2, 95% CI: 5.5-15.0] and never vaccinated other children at home [OR: 6.5, 95% CI: 4.5-10.0]. Conclusion: The study concluded that breastfeeding and proper weaning practices are necessary to eradicate measles

Breast Cancer And Self Breast Examination Awareness Amongst Pakistani Female Medical Students and Hospital Employees: Assessing Shortcomings in Health Literacy

Objective: To assess the knowledge, attitudes, and practices related to breast cancer and breast cancer screening among female medical students, healthcare workers, and hospital employees. Methodology: This cross-sectional study was conducted from September 1, 2021, to October 30, 2021. A questionnaire on breast cancer awareness and self-breast examination was distributed to female medical students across all five years at Fatimah Jinnah Medical University, Lahore, and to female hospital employees at Sir Ganga Ram Hospital, Lahore. A total of 404 women participated and were included in the study. Results: Out of the respondents, 71.2% were medical students, and 26.7% were doctors. Approximately 24% reported a family history of breast cancer. Media was identified as the primary source of information on breast cancer by 79.2% of women. Only 64.9% of respondents practiced self-breast examination, with merely 23.8% performing it monthly. Furthermore, only 37.1% correctly identified all the essential steps for conducting a breast self-examination. Conclusion: While the knowledge of breast cancer is satisfactory among healthcare workers and hospital employees, there is room for improvement in attitudes and practices related to early detection and screening. Initiatives should be undertaken by medical undergraduate curriculum coordinators to incorporate breast self-examination, clinical breast examination, and screening guidelines in both pre-clinical and clinical years of medical education. Additionally, information dissemination programs should be implemented in hospitals for all employees

Prognostic and predictive implications of Sokal scoring system in newly diagnosed Chronic Myeloid Leukemia patients

ABSTRACT OBJECTIVE: To assess the predictive utility of the Sokal scoring system for determining disease prognosis in newly diagnosed patients of chronic myeloid leukaemia (CML). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from Sep 2021 to Sep 2022. METHODOLOGY: This study employed all newly diagnosed Philadelphia-positive chronic myeloid leukemia (CML) patients. Patients having CML in the accelerated and blast phases, as well as those with atypical CML, were excluded from the study. The qualitative variable of interest included gender, while the quantitative variables of interest included platelet count, spleen size, age and percentage of myeloblasts in the peripheral blood. These variables were documented on preformed data and the prognostic class of every patient was recorded. Follow-up was assessed after 03 months for those patients who had received the same tyrosine kinase therapy (TKI) to avoid any bias. RESULTS: A total of 62 patients were employed in this study. The mean patient age was 46 5 years. Based on the Sokal scoring system, 20 of 62 patients (32%) were classified as a low-risk category, 34 patients (54.8%) as an intermediate-risk category and 8 (12.9%) as a high-risk category. CONCLUSION: Owing to the cost-effectiveness of the traditional prognostic scoring systems, their routine implication is beneficial in the stratification of CML patients into different risk groups. KEYWORDS: Chronic Myeloid Leukemia (CML), Sokal scoring system, Philadelphia

Comparison of Ultrasound Biometry with Optical Biometry for Measurement of Axial Length and Calculation of Intraocular Lens Power in Patients Undergoing Routine Cataract Surgery

Background The most common cause of visual impairment in adults is Cataract all over the world. Ultrasound biometry and optical biometry are two methods used to calculate the power of intraocular lens by measuring the axial length. To get good refractive results after surgery the exact estimation of intraocular lens power is very important. Objective To compare the axial length and intraocular lens power calculated by using ultrasound biometry and optical biometry in patients with cataract Material & Methods It was prospective, randomized control study comprising of 50 patients undergoing contract surgery in Eye Department of PIMS using non-probability consecutive sampling. Patients having traumatic or juvenile cataract, glaucoma, macular or retinal diseases, high myopes, corneal opacities or diseases, vitreal hemorrhages and uveitis were excluded. After taking informed written consent from patients biometry was performed using optical scan and ultrasound biometry (with appalation probe). Axial length and intraocular power calculated by both methods was recorded. SPSS 22 was used to analyze and enter the data. Results The mean axial length measurement by ultrasound of the patients’ eyes was 22.72±0.85 mm and by optical biometry was 22.67±0.86 mm. Similarly the mean intraocular lens power calculated by ultrasound was 20.60±1.56D and by optical was 20.51±1.51D. Optical and ultrasound method showed strong positive correlation in measurements of intraocular lens power and axial length of eyes, i.e. r=0.965 & 0.939 respectively. Conclusion The findings of this study suggested that optical biometry is good alternate of ultrasound in measurement of axial length and intraocular lens power of patients, as strong correlation exist between both techniques

COMPARISON OF THE EFFICACY OF COMBINED THERAPY WITH ORAL TAMSULOSIN PLUS ORAL DICLOFENAC AND TAMSULOSIN ALONE IN TIME AND RATE OF EXPULSION OF DISTAL URETERIC STONES

Background Active Medical Expulsive Therapy (MET) is an aggressive outpatient approach that reduces pain, increases stone passage, and lowers surgery requirements in nephrolithiasis. MET employs alpha-1 selective blockers like Tamsulosin to relax the ureter and NSAIDs as the first-line pain management therapy. Surgical intervention is reserved for cases where medical treatment is ineffective or unlikely to cure the disease. Objectives To compare the effectiveness of combined therapy with Tamsulosin and Diclofenac sodium and Tamsulosin alone in the rate and time of expulsion of distal ureteric stones of size ranging from 5-<9mm. Methodology All male and female patients presenting to urology OPD of Benazir Bhutto Hospital Rawalpindi and Institute of kidney Diseases-Hayatabad medical complex. Peshawar, diagnosed to be having unilateral distal ureteric stone on X-ray KUB were recruited by systematic random sampling and divided into two groups A (study group) and B (control group). Group A was given, Tab.Tamsulosin 0.4mg OD and Tab.Diclofenac sodium 75mg BD for 21 days. Group B was given Tab Tamsulosin 0.4 mg OD for 21 days and acetaminophen 500mg SOS. Results The clinical trial revealed that in the group of patients receiving Tamsulosin and diclofenac, the rate of expulsion of distal ureteric stones was improved with a statistically significant difference. Time of expulsion of stones in two groups was not statistically different.   Conclusions Tamsulosin and Diclofenac sodium given together have added effect as compared to Tamsulosin alone in the rate and time of expulsion of distal ureteric stone

A Multi-centered study to evaluate causes of amputation amongst patients of depression and anxiety

Background: Trauma is among one of leading causes of amputation followed by vascular disease, while other causes were uncontrolled diabetes, malignancies and infections. RTA was the cause of 58.8% of all traumatic amputations. Traumatic limb amputations could occur because of an occupational, agricultural, environmental, suicidal injuries, assaults, or the domestic accidents. Materials and Methods: Three Main Rehabilitation Centers from Quetta, were involved in 3 month’s cross-sectional research. 54 subjects were included in this research. Inclusion Criteria was “newly amputees to 10years’ time since an amputation, amputees with nonpsychiatric history & background, “Upper & lower limb uni-lateral amputees. Exclusion Criteria was amputation because of congenital malformation, amputees from an Afghanistan, amputees with bi-lateral Amputation. Adopted structured questionnaire “Hospital Anxiety and Depression Scale†(HADS) was used. Chi-square test was done. Results: 47 were men while women were 7. 66.7% amputations were as a consequence of Traumatic injuries whereas 33.3% were as a result of non-traumatic causes. Regarding traumatic causes, major was RTA’s with 46.3% (25), while among non-traumatic diabetes stood first (1st) with 24.1%. Tumor along with fall were least responsible for amputation (4%) contribution each. Chi-square test reveals statistically insignificant relationship between anxiety, depression with different causes of amputation (p value= 0.13, 0.10) respectively. Conclusion: RTA and diabetes were the main reasons of amputation. Causes of amputation have an impact on anxiety & depression despite the insignificant relationship. Outcomes of this study can also be utilized for prevention planning. Keywords: Amputation, Anxiety, Causes, Depression, Traumati

Comparison of the accuracy of phone applications with Snellen chart in determining visual acuity

Objective: To correlate the visual acuity assessment as tested by smartphone application with standard Snellen visual acuity. Methods: A total of 136 individuals were included in this analytical cross-sectional survey conducted at Shifa Foundation Community Health Center, Islamabad between January 2022 and January 2023. Individual’s age ≥ 18 years were included. Snellen’s visual acuity was assessed using a standard Snellen’s visual acuity chart by the optometrist, while the Paxos checkup by DigiSight technologies was used to assess visual acuity on smart phone using one appropriately color calibrated I-phone 7 device. Both assessments were done in physically separate areas to reduce observation bias. Visual acuity from each assessment was noted in the decimal format. Data was analyzed through SPSS v 23. Frequency distribution and Pearson’s correlation was calculated to ascertain the relationship between the two study variables. Results: A total of 88 males and 48 females were included in the study (n=136). The mean age of patients was 29.72±9.0 years. The mean visual acuity of right and left eyes as assessed with Snellen’s chart were 0.88±0.2 and 0.86±0.22, respectively. The mean visual acuity for right and left eyes as assessed by Paxos checkup were 0.84±0.19 and 0.86±0.21, respectively. There was positive correlation was present in both eyes. The Pearson’s correlation for right eyes was r = 0.66 and significant at p = 0.001, while the correlation for left eyes was r = 0.71 and significant at p = 0.001. Conclusions: There is a strong correlation between Snellen’s visual acuity assessment and assessment of visual acuity by the smartphone application. This makes the latter a viable strategy for screening at places where taking a Snellen’s chart might not be feasible

IMAGING APPEARANCE OF ENLARGED CISTERNA CHYLI MIMICKING RETEROPERITONEAL NODAL DISEASE

It is very common to see enlarged retroperitoneal lymph nodes. However there are circumstances where we report an enlarged retroperitoneal lymph node that is actually not pathological rather an enlarged cisterna chyli mimicking retroperitoneal nodal disease. We present a case report of a patient with known hepatocellular carcinoma, CT scan triphasic liver was performed and a finding was made with enlarged retroperitoneal lymph node involved by the disease process, however MRI and FNAC correlation was advised, which turned out to be an enlarged cisterna chyli rather than enlarged retroperitoneal node

Comparison of Parkin Score and New Ballard Score for Gestational Age Assessment in Newborns with Ultrasound Scan as the Standard Reference

Objective: To compare the assessment of gestational age (GA) in newborns using the Parkin Scoring and the New Ballard Scoring methods with the Ultrasound Scan Method as the Standard Reference, conducted at a peripheral military setup. Methodology: A descriptive, cross-sectional study was conducted at the Pediatrics department of Combined Military Hospital (CMH), Abbottabad from July 2019 to June 2020. A total of 102 newborns were recruited from the CMH Nursery. GA was assessed using ultrasound scan, Parkin Score (PS), and the New Ballard Score (NBS). Pearson correlation coefficient statistics were calculated to evaluate the strength of associations among the three methods. The significance level (p value) was set at 0.05. Results: The study included 47 (46.1%) females and 55 (53.9%) males. The highest GA (days) was calculated by ultrasound scan (268.76 ± 0.83), followed by PS GA (266.65 ± 1.00) and NBS (264.38 ± 1.05). There was no significant difference in GA assessment between PS and the ultrasound scan (2.32 ± 1.37 days; p = 0.208). The GA assessment between NBS and the ultrasound scan was found to be significant (4.38 ± 1.37 days; p = 0.004). However, this difference is not clinically significant. The NBS and PS GA assessment had a strong positive correlation (Pearson Coefficient = 0.80). Conclusions: The PS is a reliable method for assessing GA in newborns and is comparable to the NBS. Further research with a larger sample size should be conducted to validate these findings

The Effect of Smokeless Tobacco on the Histopathology of Thyroid Gland in Albino Rats

Objective: To investigate the effect of smokeless tobacco on the histopathology of the thyroid gland in albino rats. Methodology: The experimental study was conducted at the Animal House of Sindh Agriculture University over a three-month duration from June to August 2018. Thirty healthy, non-pregnant female albino rats, aged 8-10 weeks and weighing 200-230 grams, were divided into three groups. The Control group received a standard diet, Experimental Group A was exposed to 5% smokeless tobacco, and Group B to 10%. Rats were housed under hygienic conditions. After the experiment, the rats were weighed, euthanized via cervical dislocation, and their thyroid glands were removed for detailed dissection. Tissues were preserved in 10% formaldehyde, processed for microscopic examination through paraffin embedding and sectioning (2-5 µm thick), and finally stained with Hematoxylin and Eosin (H&E) and trichrome stain. Results: Significantly reduced weight was observed in albino rats from Group 2 and 3 compared to controls (p-value < 0.0001). In the control group (Group I), histological examination revealed a normal structure of thyroid follicles. In Group 2, stroma exhibited mild infiltration of chronic inflammatory cells, whereas Group 3 showed benign lesions with mild fibrosis. Conclusion: In summary, smokeless tobacco has adverse effects on the weight of albino rats and may alter the normal histology of the thyroid gland. Further investigation into the effects on thyroid hormone levels and a study of the dose-dependent effects of various chemicals in smokeless tobacco on the thyroid gland are recommended