Journal of Rawalpindi Medical College https://journalrmc.com/index.php/JRMC <p>Journal of Rawalpindi Medical College (JRMC) is an official publication of Rawalpindi Medical University (RMU- formerly Rawalpindi Medical College, Rawalpindi, Pakistan). It was first published in 1997. It is open access, double-blind peer-reviewed journal. It is published quarterly. It follows the <a href="https://publicationethics.org/files/u2/Best_Practice.pdf">Committee on Publication Ethics (COPE)</a>, and <a href="http://www.icmje.org/icmje-recommendations.pdf">International Committee of Medical Journal Editors (ICMJE)</a> guidelines. ISSN (Print) 1683-3562. ISSN (Online) 1683-3570</p> <p> </p> Rawalpindi Medical University, Rawalpindi, Pakistan (https://rmur.edu.pk/) en-US Journal of Rawalpindi Medical College 1683-3562 Untoward Azoospermia by absurd testosterone therapy https://journalrmc.com/index.php/JRMC/article/view/2110 <p>The established role of the male partner in overall infertility is almost 50%.<sup>1</sup>&nbsp;The most significant cause is degraded number as well as the quality of sperms.<sup>2</sup>&nbsp;Spermatogenesis is governed by gonadotropin-releasing hormone (GnRH) then follicle-stimulating hormone (FSH) and finally by testosterone, which is linked with puberty, and essentially required well controlled hypothalamic-pituitary axis leading the Leydig cells along with Sertoli cells.<sup>3</sup>&nbsp;In Pakistan incidence of azoospermia is 12.32%, and another study reported it to be 16%, this incidence is comparable to infertility in the USA at 10% while 11.35% in Kenya.<sup>4</sup><br>The non-obstructive azoospermia (NOA) is mostly treated with testicular sperm extraction and then intracytoplasmic sperm injection (ICSI), but only a small percentage can afford it, and mostly it requires multiple attempts. So, most couples end up with adaptation or sperm donation.<sup>5,6</sup>&nbsp;One percent of all men and 10% of infertile are azoospermic. In non-obstructive azoospermia primary testicular failure occur, testosterone therapy (TTh) negative feedback mechanism can cause suppression of luteinizing hormone (LH).<sup>7</sup>&nbsp;In 30% of infertile men, the cause cannot be established, but genetics, chronic infection, prostatitis, anti-sperm antibodies, and persistent obesity can lead to it.<sup>8</sup><br>Unfortunately, in Pakistan, most of our physicians are fond of prescribing a high dosage of testosterone for the long term, to infertile male patients. Patients become satisfied due to the positive characteristics of testosterone, but the most painful aspect is that high TTh leads to complete azoospermia. Moreover, in most such cases, it is permanent due to damage to the germinal layer. More than six-month high TTh is contraceptive.<sup>9</sup>&nbsp;In 2018 the Endocrine Society and the American Urological Association recommend testosterone therapy to treat infertility and preserve fertility.<sup>10</sup>&nbsp;The first management of such cases is the cessation of TTh. An integrated analysis of 1549 men on high TTh was reported as the median time to recover was 3.4 months, to a sperm concentration of 20 million/ mL and the median time to recover to baseline sperm concentration was 5.4 months.10 According to this analysis, 90% of men recovered in 12-month time after stopping TTh with 20 million/ml sperms, and 100% recovered after 24 months, all of them were on average 31.8 years of age. They were on TTh for 9.5 months.<sup>11</sup>&nbsp;Hypothalamic-pituitary-gonadal (HPG) axis is almost terminated by testosterone replacement therapy (TRT) and anabolic androgenic steroids (AAS) resulting in very much suppressed or even the complete arrest of the spermatogenesis. Spontaneous cessation of such overwhelming male infertility treatments can recover spermatogenesis depending upon the length and strength of such treatments.<sup>12,13</sup>&nbsp;The Prime concern is the weightage of the decision by a physician to start such therapies, which have an abusive role in treating infertility. Most physicians are unfortunately causing such azoospermia.<br>Many very reputed international guidelines and recommendations are against such TTh, TRT, and even AAS for the treatment of male infertility. Clomiphene citrate (CC) and human chorionic gonadotropin (HCG) along with the revival of the hypothalamic-pituitary-gonadal axis can help to restore spermatogenesis in these men, after 1-2 years of the cessation of the TTh.<sup>14</sup></p> Irfan Afzal Mughal Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 A Comparative Study on the Sensitivity of D-Dimer with Doppler ultrasound in the Diagnosis of Deep Venous Thrombosis https://journalrmc.com/index.php/JRMC/article/view/2111 <p><strong>Introduction:</strong>&nbsp;Deep venous thrombosis (DVT) is a coagulation disorder that is on the rise due to lifestyle changes. Patients with DVT are at risk for developing a life-threatening complication, pulmonary embolism which urges the importance of its early diagnosis. The Gold standard modality for its early diagnosis is invasive which is Venography. Other modalities like compression ultrasound and duplex imaging are noninvasive but operator-dependent and not routinely available during evening and night shift hours. D-Dimer is a simple, noninvasive, cost-effective, and easily available diagnostic test that can be helpful in diagnosis. The objective of this study is to compare the sensitivity of D-Dimers with Doppler ultrasound for the diagnosis of deep venous thrombosis.<br><strong>Materials and Methods:</strong>&nbsp;A cross-sectional comparative (validation) study in which 65 admitted patients with a high risk of DVT on Well’s criteria for clinical diagnosis were enrolled by non-probability convenience sampling from March to August 2018. Both D-Dimer and Doppler ultrasounds were performed on all suspected patients of DVT.<br><strong>Results:</strong>&nbsp;Amongst 65 cases, 60 (92.3%) had positive Dimer results compared to 65 (100.0%) with the Doppler ultrasound. The difference between the two diagnostic modalities was statistically significant (p-value = 0.02). The sensitivity of D-dimers was 92.3% however specificity, PPV, and NPV were 0% as none of the cases was negative on ultrasound Doppler.<br><strong>Conclusion:</strong>&nbsp;The D-dimer test is a conveniently performed, cost-effective test with a sensitivity of more than 90% in the current study and can be useful for Emergency and critical care departments.</p> Aneza Jalil, Muhammad Azeem Khan, Ahmed Farhan, Ana Jalil, Hira Jalil, Farogh Elahi Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of Bacterial Load measured by X-pert / MTB RIF Assay with Smear & Myco-Bacterial Culture, as a marker for monitoring disease outcome in Cavitary Pulmonary Tuberculosis https://journalrmc.com/index.php/JRMC/article/view/2112 <p><strong>In</strong><strong>troduction:</strong>&nbsp;Tuberculosis (TB) is one of the major public health problems in Pakistan. Treatment depends on the diagnosis and bacterial load. The smear and culture of the sputum sample are considered as the gold standard. However, another recently invented diagnostic criteria i.e. X-PERT / MTB RIF Assay can also give high accuracy and can be used as a substitute for sputum culture.</p> <p><strong>Objective:</strong>&nbsp;To determine the validity of Xpert MTB/RIF and sputum smear in monitoring the outcome of cavitary pulmonary tuberculosis by taking culture as the gold standard</p> <p><strong>Study design:</strong>&nbsp;Descriptive Cross-sectional Study.</p> <p><strong>Setting:</strong>&nbsp;Department of Pulmonology, Fauji Foundation Hospital Rawalpindi.</p> <p><strong>Duration:</strong>&nbsp;15th Feb to 15th Dec 2018.</p> <p><strong>Materials and Methods:</strong>&nbsp;250 Patients who meet the criteria were integrated into the study. A sputum sample was taken two times and two samples were sent to the laboratory of the hospital for Xpert MTB/RIF, sputum smear, and culture. Findings were recorded. Then patients were given standard treatment for tuberculosis. Data was entered in SPSS 23. Age, laboratory variables like HB, Platelets count, etc. were presented as mean and standard deviation. Gender, outcome of diagnosis were presented as mean and standard deviation. Sensitivity, specificity measure on –rays, findings, smear test, and Xpert MTB/RIF.</p> <p><strong>Results:</strong>&nbsp;Total 187 patients including 12 (6.4%) male and 175 (93.6%) female. The mean age was 44.14+17.13 years. Positive findings on X-pert and smear were found in 35(53%) patients and MTB/ RIF were found in 41(62.1%). Sensitivity, specificity of X-pert MTB/RIF were found to be 77.6% and 13.6% at baseline while 40% and 40% respectively at end of treatment.</p> <p><strong>Conclusion:</strong>&nbsp;Thus, X-pert MTB/RIF is an important tool than sputum smear and AFB culture in monitoring the outcome of cavitary pulmonary tuberculosis.</p> Aisha Shafique, Sara Daud, Asma Sabir, Kanwal Fatima Khalil, Amber Mazhar, Anum Ilyas Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of outcome of oral and intravenous antibiotics at the time of discharge for management of pneumonia in children https://journalrmc.com/index.php/JRMC/article/view/2113 Tayyab Javed, Tehmina Maqbool, Jawairia Aslam Copyright (c) 1 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparative Metabolic Properties of Aloe Vera Extracts and Sitagliptin in Diabetic Rats https://journalrmc.com/index.php/JRMC/article/view/2114 <p><strong>Introduction</strong>: Diabetes Mellitus, a global epidemic affecting millions of people is pretty challenging to cure as all the available antidiabetics have various health hazards, especially, in long-term administration. So, a safe alternative is always desired.<br /><strong>Objective</strong>: To compare the metabolic (hypoglycemic and hypolipidemic) effects of Aloe Vera extracts with novel anti-diabetic medicine, “Sitagliptin” on diabetic rats.<br /><strong>Materials and Methods</strong>: The study design was a Randomized Control Trial. The study was conducted in the Pharmacology department of Islamic International Medical College, Rawalpindi in collaboration with NIH, Islamabad, Pakistan, from September 2019 to August 2020. Adult, fifty Albino rats were taken and randomly grouped into A and B. After induction of type 2 diabetes with low dose streptozotocin, group B was subdivided; GroupB1 (Diabetic Control), Group B2 (Aloe Vera whole leaf treated), GROUP B3 (Aloe Vera gel treated), and Group B4 (Sitagliptin treated). Fasting blood sugar (FBS), Hemoglobin A1c (HbA1c), and triglycerides were measured. Statistical Analysis was done by SPSS version 25. A one-way ANOVA test was used for assessing any difference in the mean values. Post-hoc Turkey analysis was conducted to compare any inter-group mean differences. A p-value of &lt;0.05 was considered significant.<br /><strong>Results</strong>: On completion of study, Fasting blood sugar in Group A was 82.40mg/dl, Group B1 498.40 mg/dl, Group B2 89.30 mg/dl, Group B3 95.70 mg/dl, Group B4 93.00mg/dl; HbA1c in Group A was 3.71%, Group B1 11.84%, Group B2 4.02%, Group B3 4.17%, Group B4 3.73%; Serum triglycerides in Group A 125.40mg/dl, Group B1 221.00 mg/dl, Group B2 112.50 mg/dl, Group B3 129.70 mg/dl, Group B4 125.00 mg/dl respectively, showing significant improvement in Diabetes Mellitus in study subjects.<br /><strong>Keywords</strong>: Aloe Vera gel, Sitagliptin, diabetes, glycated haemoglobin.</p> <p> </p> Sobia Javaid, Maleeha Zafar Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of efficacy and safety of zinc gluconate versus placebo for treatment of Primary Dysmenorrhea https://journalrmc.com/index.php/JRMC/article/view/2115 <p><strong>Background &amp; Objectives</strong>:</p> <p>Dysmenorrhea is a common gynecological complaint in women of reproductive age. Primary dysmenorrhea is defined as painful menstruation in the absence of any pelvic pathology and occurs in response to increased prostaglandin release from the ischemic endometrium. Conventional treatments include NSAIDs and oral contraceptive pills.&nbsp; Zinc is an essential micronutrient with anti-inflammatory properties. We conducted this study to evaluate the efficacy and safety of zinc supplementation in treatment of primary dysmenorrhea in our target population as it presents as very common gynaecological issue in young adolescents females.</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods</strong>:</p> <p>100 participants with primary dysmenorrhea were enrolled in study from outpatient department via non-probability consecutive sampling. They were randomized into two groups. The intervention group (Group A) received zinc gluconate 50mg once daily and the control group (Group B) received placebo drug once daily, for 5 days before and 2 days after onset of menstruation. After three and six months of treatment severity of primary dysmenorrhea was assessed and compared in both groups using visual analogue scale for pain, along with side effect profile.</p> <p><strong>Results:&nbsp;</strong>The treatment with Zinc gluconate reduced the mean pain score in females with primary dysmenorrhea after 3months with a further reduction after 6 months of treatment (P&lt;0.001) as compared to placebo. Very few (4% after 3 months &amp; 6% after 6 months) participants experienced the side effects of Zinc supplementation.</p> <p><strong>Conclusion:&nbsp;</strong>zinc gluconate 50mg daily for 5 days before and 2 days after onset of menstruation can effectively treat the primary dysmenorrhea. The drug has very few side effects at this dose and duration of use.</p> <p><strong>Key words:&nbsp;</strong>Primary dysmenorrhea, zinc gluconate, pain severity, visual analogue scale.</p> <p><strong>&nbsp;</strong></p> Faiza Safdar, Shabana Kalsoom, Noreen Majeed, Khairun Nisa, Mamoona Riaz, Shamsa Tariq Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Depression, Anxiety and Stress in Female Doctors: A Cross Sectional Study from Rawalpindi https://journalrmc.com/index.php/JRMC/article/view/2116 <p><strong>Introduction:</strong>&nbsp;Studies have shown that toiling in the medical field, especially in comparison to other professions is stressful. There is evidence that depression leads to reduced productivity in the workplace. Poor clinical judgement, increased chances of error in patient care and absenteeism all lead to reduced quality of work. Female doctors, in particular, are vulnerable to mental health issues owing to elements such as bullying, workplace sexual harassment, long working hours, frantic shifts, and domestic commitments.</p> <p><strong>Materials and Methods:</strong>&nbsp;Over a six-month period (June 2020 to November 2020), we conducted a cross-sectional survey in three tertiary care hospitals in Rawalpindi, two of which were public sector and one private sector. We collected 328 samples by means of non-probability consecutive sampling.</p> <p>We used the Depression, Anxiety, and Stress Scale (DASS), a 42-item questionnaire via Lovibond and Lovibond with a Cronbach’s alpha of 0.89.</p> <p>Mean and SD of DASS total and subscale scores were compared for subjects stratified by age, marital status, designation, hospital status, and monthly household income via Student t-test and ANOVA.</p> <p><strong>Results:</strong>&nbsp;The total mean DASS score reported by our participants was 31±26.92. Total mean DASS scores were significantly greater in House Officers and decreased as the designation rank increased (p=0.007). Mean DASS subscale scores showed that the junior female doctors were significantly more anxious (p=0.004) and depressed (p=0.041) compared to the senior doctors. However, there was no significant difference in stress scores, indicating that all the female doctors that participated were experiencing stress regardless of their designation. There was also no significant difference in DASS scores between private and public sector hospitals.</p> <p><strong>Conclusion:</strong>&nbsp;Female doctors working in tertiary care hospitals of Rawalpindi reported depression, anxiety, and stress. Steps need to be taken to reduce risk factors for these mental health issues in order to boost workplace satisfaction and productivity.</p> Fatima Ali Raza Mughal, Hina Sharif, Raima Asif, Mehwish Riaz, Mariam Razzaq, Naila Azam Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Frequency of High Titre Anti-A and Anti-B Antibodies in Blood Group O Blood Donors https://journalrmc.com/index.php/JRMC/article/view/2117 Hajira Khurshid, Sehar Khaliq, Lubna Zafar, Attika Khalid Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Reticulocyte Count and Platelet Count as Predictors of Morphological Remission/Hemopoitic Recovery in Acute Lymphoblastic Leukemia (ALL) after Induction Chemotherapy https://journalrmc.com/index.php/JRMC/article/view/2118 <div class="page" data-page-number="1" data-loaded="true"> <div class="textLayer"> <div><strong> Objectives</strong>: To determine the predictive values of reticulocyte and platelet count for remission in cases of acute lymphoblastic leukemia after induction therapy.</div> <div> </div> <div><strong>Materials and Methods</strong>:This cross-sectional observational study was conducted in the department of hematology, MTI Hayatabad Medical Complex, Peshawar. All cases of ALL referred to the department for remission after taking induction therapy, irrespective of age and gender were included. Relevant information wascollected on a predesigned proforma prepared in accordance with the objectives of the study.</div> <div> </div> <div><strong>Results:</strong> A total of 84 cases referred for remission were included, 56(66.7%) were males and 28 (33.3%) were females. 50(59.5%) cases were in the age range of 5-18 years. The mean with a standard deviation of the age of patients was 15+ 4 years. 75(89.3%) of the cases were classified into ALL-1) by FAB classification. 50(59.5%) of the referred cases had achieved morphological remission by bone marrow aspiration. There was a statistically significant rise in Platelet count of the remission vs non-remission cases (p-0.001). Again there was a statistically significant difference in the retic count of the cases with remission (p-0.05). We observed a statically significant downhill moderate correlation ofretic count with remission (in termsof blast count of BM aspiration) (p-0.04, r:-0.32). Platelet count also had an inverse significant correlation with remission ( p-0.01, r:-0.37). The diagnostic roles of the peripheral platelet count and retic yielded an area under curves of (0.768 and 0.648 respectively) to predict remission.We observed that the retic count and platelet count havebeen shown to have strong predictive valuesfor remission in ALL with interaction values of (R= 0.28**, ΔR²=0.02, p=0.08). Similarly, an increase in platelet also has a strong predictive value for remission in ALL cases with interaction values of (R= 0.41**, ΔR²=0.16, p=0.001)</div> <div> </div> <div><strong>Conclusion:</strong> In ALL cases of post-induction therapy, The peripheral blood reading for an increase in Retic and platelet count predictsremission with 95% confidence. These values if strictly observed can reduce the frequency of invasive procedures like bone marrow aspiration.</div> <div> </div> <div><strong>Keywords:</strong> ALL, Remission, Reticulocyte count, Platelet count.</div> </div> </div> Huma Riaz, Hamzullah Khan, Shahtaj Khan, Sadaf Chiragh Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 A comparative study of Emotional Quotient with relation to Blood Groups among medical students of Punjab https://journalrmc.com/index.php/JRMC/article/view/2119 <p><strong>Introduction</strong>: Emotional quotient (EQ) is the ability to monitor one’s own and other's feelings and emotions for managing relations appropriately. It implies critical thinking and has a key role in augmenting coherence between the team members to work at their full potential for achieving their goals and success in life. There are numerous lines of evidence that shows the influence of blood groups on skills and abilities related to EQ. Individuals with blood group B are active and passionate but those with blood group A are intelligent, loyal to their work, and have maudlin behavior. People with AB blood group are spiritual and O blood groupers have leadership character and least respond to stress. This study aims to compare the EQ-related skills and abilities among medical students with various blood groups.<br><strong>Materials and Methods</strong>: A cross-sectional study was conducted at Aziz Fatimah medical and dental college, Faisalabad. Validate proforma consisting of questions related to demographic, blood groups, and Emotional intelligence scale (EIS) for EQ-related questions was constructed on google form and the link was shared among 600 MBBS students of different medical colleges in Punjab, Pakistan. Only 566 students filled out complete proforma and fulfilled our inclusion criteria for enrollment in the study. Data were retrieved from the individual responses of google form and transformed on SPSS 22 for data analysis. P values less ≤ than 0.05 were considered significant.<br><strong>Results</strong>: The most frequent blood group was B positive (B+ve) in this study. The highest score concerning self-awareness was in blood group A positive (A+ve) followed by O positive (O+ve) with a P-value=0.017. The highest score was observed in B+ve in the case of empathy but the difference in mean score was not statistically significant (p value= 0.326). Similarly, blood group A+ve showed the highest value in self-motivation, emotional stability, and managing relations with P-values of 0.036, 0.005, and 0.046 respectively. Participants with the A+ve blood group were more value-oriented, committed, showed integrity and altruistic behavior with P-value=0.032, 0.000, 0.013, and 0.032 respectively.<br><strong>Conclusion</strong>: People with the blood group A+ve had the highest emotional quotient than other blood groups. Blood group B was the most prevalent blood group in our study population.</p> Rida Naseer Ghouri, Muhammad Ehtisham, Shireen Jawed Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of Surgical Outcome of Open versus Laparoscopic Nephrectomy https://journalrmc.com/index.php/JRMC/article/view/2120 <p><strong> Introduction: </strong>Removal of a kidney is a common surgical procedure for a longtime. The procedure was traditionally done by open surgery. Since the advent of laparoscopic surgery, nephrectomy is being done increasingly laparoscopically. The laparoscopic approach has obvious advantages. Better cosmetics, less operative time, lesser need for blood transfusions, feweranalgesia requirements, early mobility,and oral feed, early return to work,and fewerintraoperative and post-operative major complications all contribute to thesuperiority of laparoscopic nephrectomy.</p> <p><strong>Objective:</strong>To compare surgical outcomesof open versus laparoscopic nephrectomy.</p> <p><strong>Materials and Methods:</strong>This Retrospectives study was conducted in the Department of Urology, Institute of kidney disease, Hayatabad, Peshawar over a period of 2 years from January 2018to January 2020.</p> <p><strong>Results:</strong>Our study included a total of 78 cases, 48.7% males and 51.3% females. The patient means the age of 42.69 years. 39.7% had hypertension and 19.2% had diabetes mellitus. Open nephrectomy was done in 40 patients and laparoscopic nephrectomy in 38 patients. The average operating time for open nephrectomy was 160.5 minutes and 130.9minutes for laparoscopic nephrectomy. The average blood loss during open and laparoscopic nephrectomywas 361.25ml and 59.86ml. Blood transfusion rate in open and laparoscopic nephrectomy was 55% and 10.5% (p=0.001). Overall, the post-operative complication rate was 52.5% and 21.5% for an open and laparoscopic approach. Post-operative pain was noted in 7.9% of patients in laparoscopic and 97.5% for an open approach. Fever was noted postoperatively in 26.3% and 62.5% of patients in laparoscopic and open approaches (p=0.001). The average hospital stay in the laparoscopic approach was 2.8days and 4.5days in the open approach. The mean tumor size was 5.65cm in laparoscopic while 8.1cm in the open approach. Catheter and drain removal was on average 1.18 days and 1.32days post-op day in the laparoscopic group while it was 2.35days and 2.3days post-op day in an open group, respectively. There were no per-op complications in the laparoscopic approach as compared to 2 Cases of minor IVC injury in open.</p> <p><strong>Conclusion</strong>:In our study,we conclude that the laparoscopic approach for nephrectomy is far superior as compared tothe open approach and it is recommended that Laparoscopic simple and radical nephrectomy shouldbe considered a gold standard treatment.</p> <p><strong>Keywords:</strong>Open nephrectomy, laparoscopic nephrectomy, tumor, HTN, DM</p> Akhtar Nawaz, Fazl e Manan, Nasrum Minallah, Romana Bibi, Khalil Ur Rehman Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid https://journalrmc.com/index.php/JRMC/article/view/2121 <p><strong> Introduction</strong>:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks.</p> <p><strong>Objective:</strong>To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid.</p> <p><strong>Study design:</strong>Randomized controlled trial.</p> <p><strong>Setting:</strong>Department of Gynae &amp; Obstetrics, unit 2, Shalamar Hospital, Lahore.</p> <p><strong>Duration:</strong>Six months from 12th September 2018 to 12th March 2019.</p> <p><strong>Materials and Methods:</strong>The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1&amp; 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age &amp; BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013.</p> <p><strong>Conclusion:</strong>Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids.</p> Shabnam Tahir, Faiza Iqbal, Saima Jabeen, Asma Nawaz, Zunaira Arshad, Shazia Rasul Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Bacteriological Spectrum of Pediatric Urinary Tract Infection and Its Drug Sensitivity and Resistance Pattern https://journalrmc.com/index.php/JRMC/article/view/2122 <p><strong>Introduction: -&nbsp;</strong>Urinary tract infection (UTI) is common infection in children. It has high morbidity and long term sequelae.</p> <p><strong>Objective:&nbsp;</strong>To determine the frequency of bacteriological organism of Pediatric UTI and its drug sensitivity and resistance pattern and to improve the treatment of UTI according to culture sensitivity, hence to minimize the resistance pattern and disease burden.</p> <p><strong>Material and methods:&nbsp;</strong>It was a descriptive cross sectional study conducted during 2018 over a period of 6 months. Total 225 children with UTI were enrolled. Urine culture and sensitivity reports were evaluated and an isolated microorganism along with their sensitivities to the mentioned drugs was entered through designed Performa.</p> <p><strong>Results: -&nbsp;</strong>The average age of the children&nbsp;<strong>was 7±.18 years</strong>. Common bacteriological agents leading to UTI was E.Coli (59.1%), followed by&nbsp; Pseudomonas aeruginosa (14.2%),&nbsp; klebsiella (13.8%) , stapylococcus aureus (8.9%) and enterococcus (4%).</p> <p>Most common organism isolated was E.coli ( 133 cultures). It was fully resistant with amoxicillin clavulanate and ofloxacin (100%), while resistant pattern with other antibiotics, ceftriaxone (88.7%), imipenam (88.7%), ciprofloxacin (75.9%). the most effective antibiotic for E.coli was amikacin (81.2%). klebisella was isolated in 31 cultures.</p> <p><strong>Conclusion:&nbsp;</strong>Most common organism that cause UTI was E.coli followed by Pseudomonas Aeroginosa and Klebsiella. These isolates were highly resistant to commonly used antibiotics. Therefore new antibiotics policy should be adopted to treat these infections.</p> Nadia Mumtaz, Qaiser Shehzad Humayoun, Israr Liaquat, Tariq Mahmood, Muhammad Hafeez, Hifza Zeb Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Factors Leading to an Unexpected Early Control of Covid-19 in Pakistan https://journalrmc.com/index.php/JRMC/article/view/2123 <p><strong><u>Introduction</u></strong></p> <p>Different types of planning and strategies have been formulated following the up rise of Covid-19 in an attempt to limit the spread and to minimize both the crisis but the situation is still getting worse even in the developed states. Unexpectedly the rate of rise of Covid-19 declined after June 2020 in Pakistan and the slope decreased to 8,884 active cases out of 313,984 confirmed cases till September 2020. In addition to this unexpected decline, number of covid-19 related deaths. The fall in the covid-19 was unforeseen in this area and it led to the curiosity regarding the factors that were responsible for this scenario</p> <p><strong><u>Methodology</u></strong></p> <p>A country based research project was carried out in the Northwest School of Medicine for a period of 6 months. A sample group of 877 individuals of both the genders, age range from 15 to 80 years, belonging to various occupations, educational and socioeconomic backgrounds were included. Questionnaire on probable responsible factors for early control and shared with the participants.</p> <p><strong><u>Results</u></strong></p> <p>Most of the participants had an adequate level of knowledge and positive attitude towards Covid-19. The most prominent factor identified was the lack of stress and optimistic attitude.</p> <p><strong><u>Conclusion</u></strong></p> <p>&nbsp;The optimistic attitude and low stress levels not only decreased the disease spread but also reduced its morbidity level.</p> <p><strong><u>Key words;</u></strong>&nbsp;<em>Covid-19, unexpected control, morbidity, factors</em></p> Sarwat Jahan, Abdus Salam, Farrukh Ansar, Manzoor Khan, Syed Irfab Ullah, Sonia Javed Sarwat Jahan, Abdus Salam, Farrukh Ansar, Manzoor Khan, Syed Irfab Ullah, Sonia Javed Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Comparison of the Postoperative Pain, Septal Perforation and Synechiae Formation following Septoplasty done with Trans Septal Suturing Verus Nasal Packing https://journalrmc.com/index.php/JRMC/article/view/2124 Aeimen Fatima, Sundas Masood, Asmara Hussain, Tahira Ikram, Fatima Shahid, Memoona Afzal Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Does 10mg versus 12.5mg of 0.5% hyperbaric bupivacaine influence the incidence of epigastric discomfort encountered during caesarean section under spinal anesthesia? https://journalrmc.com/index.php/JRMC/article/view/2125 <p><strong>Objective: </strong>To determine effect of two different volumes of 0.5 % hyperbaric bupivacaine in relation to epigastric discomfort during Cesarean section under spinal anaesthesia.</p> <p><strong>Study design: </strong>Randomized double blind study.</p> <p><strong>Place and Duration of study: </strong>Department of anaesthesiology, Combined Military Hospital Lahore over period of twelve months from June 2020 to May 2021.</p> <p><strong>Methodology: </strong>A total of 168 women presenting for elective Cesarean section were divided in two equal groups. In group A, 2 milliliters of hyperbaric 0.5% bupivacaine was given in intrathecal space while in group B, 2.5 milliliters of hyperbaric 0.5% bupivacaine was given after standard volume loading. Presence or absence of epigastric/visceral pain was observed. Mean arterial pressure was also recorded at 1, 5, 10, 20 and 40 minutes. </p> <p><strong>Results: </strong>Demographic data including age, body mass index and American society of anesthesiology status was comparable in both groups. Hypotension was seen in 44 (52.38%) in group A whereas it was seen in 52 (61.9%) in group B. This difference was insignificant with p-value of 0.212. In group A, 22 (26.19%) patients complained of epigastric discomfort, while in group B, 12 (14.29%) patients complained of epigastric discomfort. Though fewer patients in group B suffered epigastric discomfort but this difference was statistically insignificant with a p-value of 0.055.</p> <p><strong>Conclusion: </strong>There was no statistically significant difference between 2 ml and 2.5 ml 0.5% hyperbaric bupivacaine in terms of frequency of visceral pain.</p> Rehana Feroze, Aftab Hussain, Faisal Wahid, Muhammad Tariq, Muhammad Asif Saleem, Abdul Wasay Toor Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Factors associated with perceived stress in students appearing for medical university entrance test: A cross-sectional study https://journalrmc.com/index.php/JRMC/article/view/2126 <p><strong>Objective:</strong> To evaluate the factors or stressors associated with perceived stress in students appearing for university entrance test-cross sectional study.<br /><strong>Materials and Methods:</strong> It is a descriptive cross-sectional study, duration was two months from August to September 2021. The Ethical &amp; scientific review committee of KMDC of Karachi, have given written permission. The non-probability convenience sampling technique was used. The Rao soft calculator was used for Sample size and 377 (5% margin of error and 95% confidence level) were calculated. Students were enrolled from four Entrance test/ aptitude training centers of Karachi with written informed consent. The students were having past history of antipsychiatric illness or having history of taking drugs like antidepressants or anxiolytics were excluded. The Cohen’s scale was used for evaluation of perceived stress in students with degree of perceived stress. The statistical Analysis was done by using IBM-SPSS version 23.0, Counts with percentages, Pearson Chi Square test and Binary Logistic Regression Analysis for identification of Risk Factors of Stress. P-value less than 0.05 was considered statistically significant.<br /><strong>Results:</strong> The association of perceived stress was significantly associated with Mothers job/ working Mother (p&lt;0.05) in our study participants. Anyone from family or friend was suffering from Stress showed significant (p&lt;0.05) association with perceived stress (moderate / high level) in our study.<br /><strong>Conclusion:</strong> In our study results, factors associated with perceived stress in students, showed working mothers are responsible for development of stress in students.</p> Saleem Ullah Abro, Qurratulain Saleem, Amna Begum, Jamal Ara, Nabeel Khan, Taif Hameed Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Dysphagia among Middle-Aged Females https://journalrmc.com/index.php/JRMC/article/view/2127 <p><strong>Objective:</strong> To assess the association of dysphagia with iron deficiency anemia in female patients.</p> <p><strong>Study Design:</strong> Descriptive</p> <p><strong>Study Setting &amp; Duration:</strong> Department of ENT at Fauji Foundation Hospital Rawalpindi from April 2019 to April 2021.</p> <p><strong>Material and Methods:</strong> Approval of the study was obtained from the Hospital Ethical Committee and then Informed Consent was obtained from all the patients. A total of 42 female patients with dysphagia were selected by Consecutive convenient sampling. After detailed history and physical examination, Complete Blood Count and X-ray Barium Swallow were done in all these patients, followed by Rigid Endoscopy under GA. Tissue biopsy was done in all the patients from suspicious areas. The data was analyzed for frequencies by SPSS 24.</p> <p><strong>Results:</strong> 42 female patients were included in this study. The mean age of these patients was 46.30 years, ranging from 32 to 65 years. 40 (95%) of these patients showed Esophageal webs in the cricopharyngeal region, while 2 (5%) of them had irregular strictures in the post cricoid region of Hypopharynx. Iron deficiency anaemia was found in 32 (76.19%) patients. Histopathology report showed Squamous Cell Carcinoma in 2 patients with post cricoid strictures, while the rest 40 with webs showed chronic inflammation with fibrosis. Rigid esophagoscopy with web dilatation was highly effective procedure for treatment in 40 (95%) patients. Repeated dilatations were needed in 14 (33%) of the patients. The 2 patients with malignancy underwent Chemo-radiotherapy.</p> <p><strong>Conclusion: </strong>Iron deficiency anemia has a strong association with dysphagia in middle age female patients and is a potential risk factor for malignant transformation. Timely diagnosis and prevention of anaemia may result not only in decrease in PVS but also a decreased incidence of hypopharyngeal carcinoma in the vulnerable population.</p> <p><strong>Key words</strong>: Dysphagia, Iron deficiency anemia, Post cricoid Carcinoma.</p> Nudrat Khalil, Mirza Khizar Hameed, Iftikhar Aslam, Irshad Ali, Amir Akbar, Mahum Khizar Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Frequency of High Antimicrobial Susceptibility Carbapenemase Producing Enterobacteriaceae in Clinical Isolates of a Set of Population https://journalrmc.com/index.php/JRMC/article/view/2128 <p>dsdsj</p> Faisal Iqbal Afridi, Saeeda Baig, Aliya Irshad Sani, Qamar Jamal Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Two years audit of Ponseti technique for the management of clubfoot: Challenges encountered in a developing country https://journalrmc.com/index.php/JRMC/article/view/2129 Muhammad Shahid Khan, Bilal Rajpoot, Wael Azzam Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Surgical site infection; effect of contamination and duration of surgical procedure https://journalrmc.com/index.php/JRMC/article/view/2130 <p><strong>Introduction:</strong> Surgical site infections are responsible for increased treatment cost, prolonged hospital stay and increased morbidity on surgical floor. Increased level of per operative contamination and prolonged surgery increases the incidence of surgical site infections.<br><strong>Objective:</strong> To know the effect of contamination and duration of surgery on the incidence of surgical site infections in emergency surgical patients so that specific strategies can be developed to decrease the morbidity and mortality caused by these infections.<br><strong>Materials and Methods:</strong> All the patients who underwent general surgical operations on an emergency basis at the surgical unit-1 of the Benazir Bhutto Hospital Rawalpindi from 01-01-2019 to 31-12-2020 were evaluated for surgical site infections. The level of contamination per operatively and duration of surgery were documented. Surgical site infections suspected clinically were confirmed by culture and sensitivity.<br><strong>Results:</strong> Among 2202 emergency-operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, seventy (29.09%) patients underwent laparotomy for penetrating and blunt abdominal trauma. About fifty-eight percent of SSI patients had contaminated wounds per operatively. Operative time was one to three hours in about sixty-seven percent of SSI-positive patients. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the most commonest Gram-ve micro-organism (70.95%).<br><strong>Conclusion:</strong> Surgical site infection causes a significant rise in morbidity on the surgical floor. Increased levels of contamination per operatively and prolonged operative time increase the incidence of SSI in emergency surgical operations.</p> Muhammad Iqbal, Muhammad Naeem Zia, Sadaf Ijaz, Naveed Akhtar Malik Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Changes of Testicular Histogenesis during Prenatal and Early Postnatal Life in Bisphenol A Exposed Rats by Ascorbic Acid https://journalrmc.com/index.php/JRMC/article/view/2131 <p><strong>Objectives:</strong>&nbsp;In this study we aimed to investigate the conservation of testicular histogenesis in bisphenol A exposed rats by ascorbic acid during prenatal and early postnatal life.</p> <p><strong>Material and Methods:</strong>&nbsp;Eight weeks old 15 pregnant rats were divided into 3 groups, each containing 5 rats. Pups were delivered by spontaneous vaginal delivery. Group A had 15 male rat pups, from 5 pregnant female rats, which were fed on standard diet during pregnancy and lactation till day 21. Group B had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously during pregnancy and lactation till day 21. Group C had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously and 150mg/kg/day ascorbic acid orally during pregnancy and lactation till day 21.</p> <p><strong>Results:</strong>&nbsp;There was significant deterioration of seminiferous tubule and basement membrane regularity with BPA along with detachment of germinal epithelium and cell debris in group B. These parameters were conserved significantly with ascorbic acid in group C.</p> <p><strong>Conclusion:&nbsp;</strong>Biphenol A adversely affects histogenesis of testes by causing oxidative stress when given during pregnancy and lactation and ascorbic acid conserves BPA exposed developing testes and may preserve spermatogenesis and male fertility.</p> <p><strong>Key words:</strong>&nbsp;Bisphenol A, ascorbic acid, histogenesis, rat, developing testes, prenatal, early postnatal.</p> Tooba Khurshid, Faiza Umbreen, Tayyaba Faisal, Ayesha Yasser, Tayyaba Qureshi, Amber Rashid Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Assessment of awareness of orthodontic emergencies and psychosocial wellbeing of patients during novel coronavirus pandemic through teledentistry https://journalrmc.com/index.php/JRMC/article/view/2132 Kanwal Zulfiqar, Ghina Rizwan, Zarnab Rizwan, Syed Hamza Zia, Huma Ghazanfar Kiani, Amina Javed Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Is Anesthesia an attractive career choice for undergraduates and young doctors of Pakistan? https://journalrmc.com/index.php/JRMC/article/view/2133 <p><strong>Objective</strong>:To evaluate the factors that act as a barrier for medical students and young doctors inPakistan to choose anesthesia as a career choice.</p> <p><strong>Study design</strong>:Cross-sectional study.</p> <p><strong>Study settings</strong>:CMH Lahore.Study duration: From January toJune 2021.</p> <p><strong>Materials and Methods:</strong>A total of 163 medical students and house officers who were on rotation in operation theatre in various specialties were recruited for this study. A questionnaire was distributed to all the participants. Participants had to select theirspecialty of choice and the reason for not choosing anesthesia. They also had to choose the most important factor for choosing the specialty and the person who influenced them the most to choose the specialty.</p> <p><strong>Results</strong>:Only 10 (6.1%) participants chose the anesthesia specialty for their post-graduation, out of these ten, 5 (50%) were male and 5 (50%) were female. The most commonly chosen option {62 (54.87%)} for not selecting anesthesia was “no personal interest”. In response to “What is the most important factor while choosing a specialty?” most of the participants (55%) chose the option “Scope of the specialty”. In response to “Who had the most influence in choosing a specialty?” most of the participants {63 (38.7%)} chose the option “Teachers of the clinical rotations”.</p> <p><strong>Conclusion</strong>:It is concluded in our study that only a very small number of students and young doctors willingly opt for anesthesia for their post-graduation which results in a shortage of workforce in this specialty. It is recommended that anesthesia rotation be made compulsory and that the barriers tomentorship in anesthesia be properly addressed.</p> <p><strong>Keywords:</strong>Anesthesia, career choice, Influencing factors, specialty, workforce.</p> Aftab Hussain, Rehana Feroze, Khursheed Hassan Leghari, Faisal Wahid, Aijaz Ali, Abdul Khalique Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Estimation of the burden of high-volume disease among metastatic hormone-sensitive prostate cancer patients presenting to urologists in Pakistan https://journalrmc.com/index.php/JRMC/article/view/2134 <p><strong> Introduction:</strong>There is a scarcity of data in Pakistan, describing the extent of metastases in men with hormone-sensitive prostate cancer (HSPC).We aimed first to determine the proportion of high-volume/extensive disease among metastatic HSPC patients, presenting to urologists. Secondly, to evaluate the profile of these patients and theiradherence to the treatment plan.</p> <p><strong>Materials and Methods:</strong>This prospective observational study recruited consenting men with metastatic HSPC between October 2016 and September 2018. The high-volume disease was defined by the presence of visceral metastases or four or more bone lesions with at least one beyond the vertebral bodies and pelvis. Adherence to the treatment plan was observed during a period of three and six months. Descriptive statistics were used for the analysis of categorical and continuous variables.</p> <p><strong>Results:</strong>The study included 100 patients fromfive cities inPakistan. Their mean and standard deviation (SD) of age was 69.2 ± 9.9 years. Performance status 2 was reported in 45% (n=45/100) patients, and Gleason score 8-10 in 69% (n=69/100). High-volume disease was prevalent in 68% (n=68/100) of patients, with bone metastases positive in 91% (n=91/100). Visceral metastases were identified in 26% (n=26/100) of patients with 10% reported in the lungs. At three and six months, physicians reported that 90% (n=85/94) and 91% (n=81/89) of patients adhered to the planned treatment, with hormonal manipulation in 86% (n=81/94) and 88% (n=78/89) respectively.</p> <p><strong>Conclusion</strong>:Our first nationwide study in Pakistan demonstrated a high metastatic burden among HSPC patients presenting to a urologist. A multidisciplinary team approach, with the early involvement of oncologists, is imperative for the most appropriate management.</p> <p><strong>Keywords:</strong> Prostatic Neoplasms, Carcinoma, Metastasis, Urologists, Pakistan.</p> Aziz Abdullah, Liaqat Ali, Ahmed Fawad, Naveed Iqbal, Navira Chandio, Irfan Hashemy Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Sub-categorization of Pediatric Small Round Blue Cell Tumors using Immunohistochemistry https://journalrmc.com/index.php/JRMC/article/view/2135 <p><strong>Introduction:</strong> The category of Small Round Blue Cell Tumors includes neoplasms that are undifferentiated and contain similar-looking growth of small round blue cells having bigger nuclear size as compared to the cytoplasm (high N/C). It includes Non-Hodgkins Lymphoma, Synovial Sarcoma, Ewings Sarcoma/ Primitive Neuroectodermal Tumor, Rhabdomyosarcoma, Hepatoblastoma, Retinoblastoma, Neuroblastoma, Neuroendocrine carcinoma, Nasopharyngeal Carcinoma, Desmoplastic Small Round Cell Tumor, Dysgerminoma, and Wilm's tumor. Immunohistochemistry can be very helpful in the accurate diagnosis of this diverse group of tumors.</p> <p><br><strong>Objective:</strong> The objective of the study is to sub-categorize pediatric malignant small round blue cell tumors using immunohistochemistry.</p> <p><br><strong>Study design:</strong> Descriptive cross-sectional study<br><strong>Setting:</strong> Meezan private lab, Faisalabad, Pakistan<br><strong>Duration of study:</strong> 4 years, from January 2017 to December 2020.<br><strong>Sample size:</strong> 46 cases.<br><strong>Sampling technique:</strong> Non-probability purposive sampling<br><strong>Materials and Methods:</strong> 46 cases, which fulfilled the inclusion and exclusion criteria were selected for the study. All these cases were subjected to immunohistochemistry. The IHC technique used was based on the Peroxidase anti-peroxidase (PAP) method. Based on site and morphological clues, initially Leukocyte common antigen (LCA), Myogenin, Cytokeratin (CK), Desmin, Chromogranin, Neuron Specific Enolase (NSE), S-100, Smooth Muscle Actin (SMA), and CD99 were used. Further immune stains panels were used afterward, as and when needed like CD20, CD3, CD30, BCL2, CD117, Ki-67, Tdt, Synaptophysin, SMA, CD56, Melan A, HMB45, and WT1.<br><strong>Results</strong>: Among all the malignant Small Round Cell Tumors, Rhabdomyosarcoma was the highest in frequency i.e. 8 (17.4%), followed by Ewing’s sarcoma/PNET 7(15.2%). Both Diffuse Large B cell lymphoma and Neuroblastoma were 5 each in number (10.9%). Non-Hodgkins lymphoma as a whole was 13 (28.2%), including 5 cases (10.9%) of diffuse large B cell lymphoma, 4 cases (8.7%) of T lymphoblastic lymphoma, 3 cases (6.5%) of Burkitt’s lymphoma, and only 1 case (2.2%) of NK/T cell lymphoma.<br><strong>Conclusion:</strong> Immunohistochemistry is an essential tool for accurate sub-categorization of pediatric small round blue cell tumors.</p> Muhammad Mudassar, Shireen Hamid, Muhammad Sarwar Zia, Sadia Hameed, Muhammad Usman, Muhammad Asif Aleem Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Adherence to growth hormone therapy in children with growth hormone deficiency: Experience at a public sector tertiary care hospital https://journalrmc.com/index.php/JRMC/article/view/2136 Hina Sattar, Aqeela Ayub, Rehmana Waris, Jaweria Zain, Hina Hanif, Abdul Malik Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 The frequency of stroke-acquired pneumonia in patients admitted to ICU with Cerebrovascular accident (CVA) https://journalrmc.com/index.php/JRMC/article/view/2137 <p><strong> Introduction:</strong> Stroke is themost prevalent disorder. In our country, it can cause significant mortality and morbidity due to its associated complications such asstroke-associated pneumonia (SAP). Stroke can be fatal directly due to affecting the respiratory system andneurological damage. Stroke-acquired pneumonia is defined as any respiratory tract infection acquired within 7 days of stroke.</p> <p><strong>Objective</strong>:To find out the actual frequency of stroke-acquired pneumonia in ICU patients.</p> <p><strong>Study Design</strong>:Descriptive case series.</p> <p><strong>Setting:</strong>Department of Medicine, DHQ Teaching Hospital, Sargodha.Duration:Six months from 15thOctober 2018 to 15thApril 2019.Materials and</p> <p><strong>Methods</strong>:In this study, the cases of either gender or aged30 to 70 years suffering from stroke within 12 hours were included. SAP was labelled based onfever, cough,and non-homogenous opacities on chest X-ray.</p> <p><strong>Results:</strong>Current study comprises about 160 cases of stroke and out of these 78 were (48.75%) females and 82 (51.25%) were males. The mean duration of stroke was 7.05±2.54 hours and the average age of the subjects was 54.24±7.15 years. They were 30 (18.75%) cases that had a history of smoking, 28 (17.50%) had HTN,and 35 (21.88%) cases that had DM. Stroke-acquired pneumonia (SAP) was seen in 20 (12.50%) of the cases. SAP was seen in 12 (15.38%) female cases as compared to 8 (9.75%) males with p= 0.34. SAP was more seen in cases with DM where this was observed in 7 (20%) of the cases as compared to 13 (10.4%) with no DM with p= 0.15. SAP was seen in 5 (17.85%) cases with HTN and 4 (13.33%) cases with a history of smoking with p valuesof 0.35 and 1.0 respectively. SAP was seen in 15 (14.42%) cases with a duration of stroke of 6-12 hours in contrast to 5 (8.92%) cases with a duration less than this with p= 0.45.</p> <p><strong>Conclusion</strong>:SAP is not infrequent and is found in more than 1 out of every 10 cases and the cases of SAP were found more in females and those who have a history of DM, HTN,and a duration of stroke of 6 to 12 hours; though none of this variable was found statistically significant.</p> <p><strong>Keywords</strong>:SAP, HTN, DM, Smoking.</p> Muhammad Azeem-ur- Rehman, Muhammad Asim Saddique, Muhammad Bilal, Kashif Rauf, Komal Jabeen, Qudsia Anjum Qureshi Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Perception of undergraduate medical students regarding civic responsibility through service learning by visiting persons with different abilities https://journalrmc.com/index.php/JRMC/article/view/2138 Sajida Naseem, Syeda Hanaa Fatima, Saima Rafi, Lubna Meraj Copyright (c) Array Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 White Blood Cell to Platelet Ratio as a Marker of Adverse Outcome in Organophosphate Poisoning: A Retrospective Cross-Sectional Survey https://journalrmc.com/index.php/JRMC/article/view/2139 Aimen Malik, Muhammad Azam Awais, Saba Shafiq, Maria Aziz, Abrar Akbar, Abdur Rehman Copyright (c) 1 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Outcome of Ender’s nailing in pediatric patient with Shaft of Femur Fracture in a Tertiary Care Hospital https://journalrmc.com/index.php/JRMC/article/view/2140 Rahman Rasool Akhtar, Waqas Ali, Riaz Ahmed, Muhammad Umair Qammar, Omair Ashraf, Amna Iftikhar Copyright (c) 1 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Acute Lymphocytic Leukemia in a child presenting as a solitary intracranial epidural mass https://journalrmc.com/index.php/JRMC/article/view/2141 <div class="item abstract"> <p>Acute Lymphocytic leukemia (ALL) is the most common childhood malignancy, CNS involvement occurs in 3-5% of the patients. We present a case of a 14-year-old boy who presented to us with nighttime fever, headache, and right-sided focal fits. Reports showed decreased platelets, increased WBC with predominant eosinophils and imaging showed a subgaleal, epidural and subdural collection. Bone marrow biopsy and CSF analysis were negative for any hematological malignancy. A biopsy and histopathology of the CNS lesion confirmed the diagnosis of Precursor B-cell Lymphocytic Leukemia. Although CSF analysis is useful for evaluating CNS involvement, ALL cannot be ruled out by negative CSF reports</p> </div> Shahid Ahmed Shah, Umar Riaz, Ibad ur Rehman, Ayhan Amir Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-09-30 2022-09-30 26 3 Case Series of Post Covid-19 Vaccine Cervical Lymphadenopathy https://journalrmc.com/index.php/JRMC/article/view/2142 <p><strong>Objective:</strong>&nbsp;The objective of this case series reporting is to add cervical lymphadenopathy as one of the side effects of the COVID-19 vaccine in the adult population presenting with neck swelling.<br><strong>Materials and Methods:</strong>&nbsp;This case series of twenty patients were collected at our facility over a period of six months, from March 2021 to the end of August 2021, with an age interval from 17 years to 52 years. The Post COVID Vaccine window to develop cervical lymphadenopathy was from the 3rd day till the 16th. All patients received their first dose of the COVID vaccine.<br><strong>Results:</strong>&nbsp;Out of all the patients, 16 were females and 4 were males. Six female and one male patient developed suppurative ipsilateral upper cervical lymphadenitis, which necessitated hospitalization and surgical intervention with incision and drainage, as well as IV medications.<br>Five patients were admitted by internal medicine for workup and supportive care as they were having generalized symptoms, such as fever, chills, headache, myalgia, and inadequate oral intake. The OMFS department was called for evaluation and to rule out any oral infection. Four patients were diabetics with a mean HbA1C of 6.7% to 7.5%. All of these patients did not have any active dental or salivary gland infections.<br>Eventually, all subjects fully recovered with no residual lymphadenopathy and were followed for a period of two weeks to two months, using ultrasound.<br><strong>Conclusion:</strong>&nbsp;Cervical Lymphadenopathy and suppurative lymphadenitis have become increasingly common in patients who received the COVID-19 vaccine. Therefore, it must be referenced for the differential diagnosis of neck swelling, especially during this time.</p> Sher Ali Khan, Ahmad Nayef Habahbeh ,Mohammad Alsyed Abdul Hadi Sher Ali Khan, Ahmad Nayef Habahbeh ,Mohammad Alsyed Abdul Hadi Copyright (c) 2022 Journal of Rawalpindi Medical College 2022-10-29 2022-10-29 26 3