Journal of Liaquat University of Medical & Health Sciences 2023-01-17T09:58:41+05:00 Prof. Dr. Ali Muhammad Waryah Open Journal Systems <p>Journal of Liaquat University of Medical and Health Sciences (JLUMHS) Jamshoro, Pakistan, publishes original research articles, reviews articles and case reports on medical and health sciences topics.</p> <p>JLUMHS is a peer reviewed open access journal and has been published quarterly (4 issues per year) since July 2002.</p> <p>It agrees to accept manuscripts prepared in accordance with the “Uniform Requirements for submission of manuscripts for biomedical journals adopted by the International Committee of Medical Journal Editors (ICMJE), updated October 2001 (Refer JLUMHS July – December 2002 issue).</p> Social Anxiety as Predictor of Depression in Adolescents: Mediating Role of Dysfunctional Daydreaming 2022-05-08T21:50:50+05:00 Sameera Shafiq Hajra Zafar <p>OBJECTIVE: To investigate the relationship among Dysfunctional Daydreaming, Social Anxiety and Depression in adolescents and explore the mediating role of daydreaming between two variables.<br />METHODOLOGY: Cross-sectional correlational research design was conducted to collect data from 200 participants (Males=94, Females=106) of age range 12 to 19 years (M=17.08, SD= 1.93) with a convenient sampling technique via google form due to COVID-19 during the lockdown period April to June 2020. Inclusion criteria focused on willing participants who were studying online during the pandemic. Unwilling students, along with the freezing of study, were excluded. Three standardized questionnaires, Patient Health Questionnaire (PHQ-9) for measuring Depression, the Social Anxiety Scale for Adolescents (SAS-A) for measuring Social Anxiety and Dysfunctional Daydreaming Scale (DDS) for measuring malfunctioning fantasies, were used. The demographic sheet and informed consent form were filled out correctly to administer the questionnaires. Data were analyzed in SPSS-24 for<br />frequencies, percentages, and correlations. Mediation analysis was conducted in AMOS-24.<br />RESULTS: Pearson Product Moment Correlation Coefficient revealed a positive correlation of Dysfunctional Daydreaming with Social anxiety (r=.50, p&lt;0.05) and Depression (r=0.58, p&lt;0.05).<br />Dysfunctional daydreaming mediated between social anxiety and Depression in adolescents (?=0.34, p&lt;0.05).<br />CONCLUSION: The research indicated social support as a predictor of Depression in adolescents with a <br />strengthening impact of abnormal Daydreaming on Depression. An implication for mindfulness interventions that focus on the present moment without judgment is necessary to regulate anxiety, Depression, and daydreaming in college students.<br />KEYWORDS: Dysfunctional Daydreaming, Depression, Social Anxiety. </p> 2023-01-03T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Genetic Counselling and Genetic Diseases 2023-01-17T09:58:41+05:00 Ali Muhammad Waryah <p>Pakistan has over 200 million people with rich ethnic diversity, showing significant social and cultural differences from the Kashmir Mountains to the shores of interior Sindh. This variation has divided the population into tribes and isolated clusters of people strongly bonded with their specific customs and trends. The familial obligations in the population have resulted in a well-differentiated cast system, having distinct genetic lineages. The social and economic influences advocate and propagate the custom of inter-family and inter-cast marriages. Consanguineous marriages are more common in Pakistan when compared to other world populations<a href="#_ENREF_1"><sup>1</sup></a>. The global prevalence of consanguineous marriages is around 10%, whereas 73% of marriages in Pakistan are consanguineous and 80% among first cousins.</p> 2023-01-17T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Hallervorden-Spatz Disease: Case Report based on Radiological and Genetic Analytical Findings 2022-05-23T11:23:22+05:00 Ayesha Sardar Muhammad Ashfaq Bader- U-Nisa Aijaz Ahmed Hira Waseem <p>Hallervorden-Spatz disease is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. The disease can be familial or sporadic. PKAN is inherited recessively; it has been linked to chromosome 20. A mutation in the pantothenate kinase (PANK-2) gene has been described in patients with PKAN.<br />This case belongs to a 9-year-old girl who presented with dystonia for two years, speech disturbance and difficulty walking for the past four months. She was diagnosed based on MRI followed by genetic mutation analysis showing nonspecific PANK-2 mutation. The genetic panel of both parents was sent, which was positive for a heterozygous mutation of the PANK-2 gene in both parents. It is concluded that this variant is of uncertain significance. <br />Keywords: Dystonia, Hallervorden-Spatz disease, Tiger-eye appearance, Movement disorder, Pantothenate kinase two deficiency.</p> 2023-01-03T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Moral Distress among Nurses in Developing Countries of Asia: A Systematic Review 2021-11-08T18:55:12+05:00 Sonia Joseph Hanna Khair Tunio Samuel Shahzad Eraj Abbass Ruqaya Nangrejo <p>Compromising moral values and professional reliability can cause moral distress among nurses. Nurses have to play a significant role in the profession of care providers. They have to use their moral beliefs to make important decisions when providing care to patients. Nurses' struggle for professional compatibility and success has been seen for many years. They have an inner strive to be recognized for the hard work in their profession. This systematic review aims to examine existing literature on moral distress among nursing working in developing countries of Asia from September 2010 to September 2021. The total number of articles meeting the critical appraisal criteria was 19. The articles selected were quantitative (n=12), Qualitative (n= 4), Mixed-method (n=2) and literature review (n=1). Several studies were conducted to measure the frequency and intensity of moral distress and its related factors among nurses. Most scientific studies have shown consistency in measurements of moral distress. Studies have shown that nurses facing moral distress express their distress through various physical and psychological responses. Further several studies have shown moral distress is more related to workload and work-related stress among nurses. Ethical values are the segment of organizational culture, and space for ethical values, if not provided to the nurses, may lead to moral distress among nurses. Workload and unnecessary orders from supervisors and physicians further increase nurses' moral distress. Institutes need to understand their responsibility in producing an ethical distress environment.</p> <p>KEYWORDS: Moral distress, Ethical values, Nurses, Workload, Professional environment</p> 2022-12-29T00:00:00+05:00 Copyright (c) 2022 Journal of Liaquat University of Medical & Health Sciences Development of a High-Risk Pregnant Women Class Model with the Application of Inter Professional Education - Collaboration Practice (IPE-CP) 2022-09-09T10:01:16+05:00 Sudarmi Sudarmi Bertalina Bertalina Yuni Kusmiyati Abdul Wahab <p>OBJECTIVE: To obtain a procedural model for pregnant women aimed at pregnant women who are classified as high risk by implementing Inter-Professional Education - Collaboration Practice (IPE-CP).<br />METHODOLOGY: This study was carried out with the ADDIE research method. The study's purpose was to obtain a class model of pregnant women classified as high-risk by applying the IPE-CP concept. Data collection techniques include interviews, questionnaires, documentation, FGDs and expert input. The model trial was conducted in 5 classes with a sample size of 100 pregnant women aged &lt; 32 weeks.<br />Quantitative data analysis uses descriptive-analytic and qualitative data validation, classification and triangulation.<br />RESULTS: A model for developing classes for pregnant women was obtained, with modification of activity procedures: The implementation team consisted of interprofessional collaboration, implementation of education with the application of IPE-CP, screening for high-risk pregnant women was carried out, and assistance was provided for high-risk pregnant women. The results of the trial of the feasibility of the highest model on the criteria of benefit with a score of 86.14 and SD. 12,171.<br />CONCLUSION: The IPE-CP Class Model for Pregnant Women is feasible to be implemented for pregnant women who are classified as high-risk. Suggestions for the need to develop a class model for pregnant women that are carried out by application or online system. <br />KEYWORDS: Model, Class of pregnant women, High Risk, Inter-professional Education Collaboration Practice (IPE-CP)</p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Bacteriologic Profile and Antibiotic Susceptibility in Patients with UTIs in Tertiary Care Hospital 2022-12-05T11:10:19+05:00 Ambreen Fatima Fatima Fasih Saima Naseem Mehwish Sajjad Hareem Gohar Uzma Bukhari <p>OBJECTIVES: To evaluate the bacteriological profile and antibiotic susceptibility in patients with urinary tract infections.<br />METHODOLOGY: This retrospective study with a cross-sectional design was held at Dow University of Health Sciences, Karachi; we evaluated records of patients from January to December 2020 at the Department of Microbiology, Dow Diagnostic Reference and Research Laboratory, Karachi, who requested urine culture due to urinary tract infection. Details such as the most common bacteria, specific antibiotic susceptibility and resistance with all demographic information were recorded.<br />RESULTS: A total of 57785 samples were collected, of which 19620 were positive. The highest bacterial contaminations of the urinary region were detected among Females. E.coli remains a dominant pathogen that affects all age groups and genders, followed by Klebsiella, Acinetobacter, Enterobacter and Proteus. The most resistant drugs observed in our study were cefixime and cefuroxime, followed by ampicillin and Cotrimoxazole. The most sensitive and minor resistant drug against isolates is Colistin, followed by Amikacin and nitrofurantoin.<br />CONCLUSION: It is among the studies with significant findings and delivers essential data regarding bacterial trends. Current research can be compared with other studies for antimicrobial susceptibility approaches of pathogens and helps us decide on empirical treatment of UTIs. Parallel analysis should be designed on a large scale in diverse areas and regions, forming empiric antibiotic therapy guidelines according to the local antimicrobial susceptibility pattern, which helps improve patient outcomes and unjudicial antibiotic use.<br />KEYWORDS: Urinary infections, Uro-pathogens, antibiotic resistance and sensitivity </p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Reconstruction of Soft Tissue Defects of Upper Extremity 2022-09-21T10:34:31+05:00 Moeez Fatima Faisal Akhlaq Ali Khan <p>OBJECTIVE: This study aims to evaluate the etiology of upper extremity soft tissue defects and determine the outcome of the various methods for covering upper limb soft tissue defects.<br />METHODOLOGY: This case series study was done at the Plastic and reconstructive Surgery department Civil Hospital, Karachi, from December 2018 to May 2019. Seventy-six cases were operated on in the department of plastic surgery. All patients with upper extremity defects with or without exposed bone, open fractures, and early presentation were included. Segmental bone defects, dirty wounds and patient’s denial of consent were excluded. The mechanism of injury, association with fractures and the method of fixation was documented. Radiographic images were taken. Further, the functional and aesthetic outcome was assessed. Performa data has been analyzed using SPSS 21.<br />RESULTS: The mean age of the patient was 33±10.87 years. Road traffic accidents 32.89% and machine cut injuries 31.58% were the commonest etiologies of upper limb defects. Postburn contracture was seen in 10.53%, secondary to debridement at 13.16%, secondary to fasciotomy at 3.95%, secondary to flap harvest at 6.58%, and secondary to tumor resection at 1.32%. 33(43.42%) upper limb defects were treated by grafting, and flaps were used in 43(56.58%). <br />CONCLUSION: Road traffic accidents and machine cut injuries are the main etiological factors of upper extremity defects. Grafting and flaps are used in the management of soft tissue defects. They have relatively low complication rates, provided that all measures should be taken to eliminate soft tissue or bone infection.<br />KEYWORDS: Soft tissue defect, Upper extremity defects, soft tissue coverage, Flaps for upper limb, Upper extremity reconstruction, Upper limb trauma.</p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences The Effect of Preoperative Naproxen Sodium on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis 2022-11-02T12:12:26+05:00 Hina Khan Abdur Rehman Syed Abrar Ali Fariha Irfan Hira Akhtar Muhammad Hammad <p>OBJECTIVE: To inspect the effects of naproxen sodium pre-operatively on the potency of Inferior<br />alveolar nerve block in patients suffering from symptomatic irreversible pulpitis. <br />METHODOLOGY: A cross-sectional study was conducted at Operative Department, Hamdard University Dental Hospital Karachi, from July 2018 to February 2019 using a non-probability consecutive sampling technique, including patients between 18-45 years of age. One hundred patients with symptomatic irreversible pulpitis in the posterior teeth of the mandible were randomly given 550 mg naproxen sodium or similar placebo capsules 60 minutes before the delivery of a conventional inferior alveolar nerve block. Patients having allergies, contraindications to naproxen sodium, pregnancy, lactating mothers, not giving consent, patients experiencing only mild pain (verified with Visual Analog scale) or taking pain medication in the last 6 hours were excluded. Fifteen minutes after the inferior alveolar nerve block delivery, sufficient lip numbness was confirmed, and endodontic therapy was commenced. Success<br />determined if the subjects remained pain-free or showed mild pain (?54mm on a 170mm Visual analog scale) on access or instrumentation. SPSS version 22 was utilized for data analysis.<br />RESULTS: The success of the inferior alveolar nerve block demonstrated by the placebo group was 40%, and the experimental group was remarkably 98%. A substantial significant difference was evident between the two research groups.<br />CONCLUSION: Variations in the two groups support that a significant rise in the success rate of the inferior alveolar nerve block was observed in subjects who consumed a pre-operative dose of 550 mg naproxen sodium with symptomatic irreversible pulpitis. <br />KEYWORDS: Local anaesthesia, Inferior alveolar nerve block, Naproxen Sodium, Symptomatic Irreversible Pulpitis, Pre-operative Analgesics, and Endodontic treatment.</p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Acalculous Cholecystitis in Dengue 2022-09-21T12:18:22+05:00 Fatimah Kashif Rasool Ayesha Nageen Ahmed Kashif Rasool Farhat Bashir <p>OBJECTIVE: To assess the incidence of acute acalculous cholecystitis in patients with dengue fever and assess its association with laboratory parameters.<br />METHODOLOGY: This cross-sectional study was conducted in Creek General Hospital, United Medical and Dental College, Karachi, Pakistan, from September 2020 to October 2021. Patients were included in the study through consecutive sampling. After their informed consent, all adult patients diagnosed with dengue fever, based on serological tests, were included in this study. Exclusion criteria were co-existing cholelithiasis, chronic liver disease, hemolytic and rheumatological disorders, metabolic syndrome, dyslipidemia, chronic kidney disease, use of oral contraceptive pills, pregnant females, enteric fever, vasculitis and recent surgery or trauma.<br />The ultrasonographic features of these patients were recorded along with other laboratory investigations. SPSS ver 23.0 was used to analyze the data. Student t-tests and Chi-square tests were used to assess the association between the variables, and a P-value of &lt;0.05 was considered significant.<br />RESULTS: 248 patients with dengue fever were included in this study. More than 49% of these patients were diagnosed to have acalculous cholecystitis. Development of this condition was significantly associated with hemoconcentration, thrombocytopenia, leucopenia and transaminitis. All the patients recovered with conservative management, but the duration of hospital stay for these patients was considerably higher than in those without this condition.<br />CONCLUSION: Almost half of the patients diagnosed with Dengue fever developed acalculous cholecystitis. These patients recovered with conservative management.<br />KEYWORDS: Dengue, acalculous cholecystitis, hemoconcentration, thrombocytopenia, leucopenia.</p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences To Evaluate the Role of Serum Sialic Acid as Non-Invasive Bio-marker of Leukoplakia and Oral Cancer 2020-10-27T02:58:03+05:00 Muhammad Rafique Tagar Saleem Raza Khuhawar Yousif Ali Shah Mushtaque Ahmed Shaikh Ashfaque Ahmed Shaikh Allah Bux Ghanghro Muhammad Abdul Hafeez <p>OBJECTIVE: To evaluate the role of serum sialic acid as a non-invasive biomarker of Leukoplakia and oral cancer.<br />METHODOLOGY: This comparative cross-sectional study was conducted from December 2017 to November 2019 at the Institute of Biochemistry and Tertiary care hospital, Larkana. The 34 diagnosed cases of oral Leukoplakia and Erythroplakia were 20 to 72 years age. The controls with history of using tobacco, areca nut, alcohol, corticosteroid drugs and systemic diseases were excluded from this study. <br />The dysplasia was graded histopathologically as mild, moderate and severe. The Blood samples were collected and centrifuged at 3000 rpm for 15 minutes; then, serum was separated and Sialic Acid was analyzed spectrophotometrically. Finally, Statistical analysis was done by SPSS version 20 and results were expressed with mean and standard deviation.<br />RESULTS: Out of 34 cases and controls15 (44.1%) were male, and 19(55.9%) were female. Their ages were from 20 to 72 years, and the mean age was 47.47±17.97. The typical sites of lesion were buccal mucosa 35.3%, tongue 26.5%, right cheek 14.70%, left cheek 8.8%, Juxta mandibular area 8.8% and lip 2.9%, respectively. Clinically Oral Leukoplakia was 58.8% and Erythroplakia 29.4%. The Sialic Acid levels were 78.7±16.6 mg/dl in Leukoplakia, 105.4±22mg/dl in Erythroplakia and was 60.2±4 mg/dl in controls. The serum sialic acid levels were increased in case group as compared to control group in both genders, with significant p-value 0.001.<br />CONCLUSION: The Sialic Acid levels were significantly increased in cases of Oral Leukoplakia and Erythroplakia as compared to healthy controls.<br />KEY WORDS: Sialic Acid, Oral Leukoplakia, Erythroplakia, Buccal mucosa, Juxta mandibular </p> 2023-01-02T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences MRI Grading of Lumbar Spine Degenerative Disc Disease using a Modified Pfirrmann Grading System 2022-09-27T13:03:19+05:00 Rabia Hafeez Inayatullah Memon <p>OBJECTIVE: To evaluate the extent of involvement and severity of intervertebral degenerative disc disease on MRI lumbar spine by using a modified pfirrmann grading system in patients with low back pain.<br />METHODOLOGY: This cross-sectional study was conducted at the radiology department of GMC hospital Sukkur from August 2021- January 2022. T2 weighted images of the MRI lumbar spines of 460 consecutive patients were retrospectively reviewed, and the severity of degeneration was assessed using a modified pfirrmann grading system. Patients with imaging features of degenerative disc disease on MRI lumbar spine were included in the study. Patients with a history of trauma, surgery and infection of the lumbar spine were excluded from the study. Data was collected and analyzed using SPSS version 21.<br />RESULTS: Disc degeneration was classified by a modified pfirrmann grading system score from 1-8, with no disc score in grades 1, 2 and 3. Other discs score were 13(2.82%), 41(8.9%), 187(40.6%), 125 (27.1%) and 94(20.4%) in grade 4,5,6,7 and 8 respectively.</p> <p>CONCLUSION: This study concludes that a modified pfirrmann grading system is helpful in the assessment of the severity of lumbar spine intervertebral disc degeneration. It is an easy and reliable method and can be easily applicable for better correlation between radiological findings and clinical diagnosis. This grading helps in early detection and decides the mode of treatment; there is a lack of precise knowledge and data available in our country.<br />KEYWORDS: MRI lumbar spine, low back pain, intervertebral disc degeneration, intervertebral disc scoring system, modified pfirrmann grading.</p> 2023-01-03T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Assessing the Effectiveness of Training and Education on the Knowledge about active Management of 3rd Stage Labor by Nurses and Midwives 2022-03-22T11:38:17+05:00 Salma Memon Bushra Imdad Amina Aziz Farhana Aziz Farzana Memon Shehla Naeem Zafar <p>OBJECTIVE: To Assess the Effectiveness of Educational Training on Knowledge and practice about Active Management of 3rd Stage of Labor by Nurses and Midwives.<br />METHODOLOGY: A quasi-experimental study was conducted among nurses and midwives in January- June 2020. The participants for the study were selected based on a non-probability convenient sampling technique. In total, 140 nurses and midwives participated in the study (70) in the interventional group and 70 in the control group. Data collection was done via the adopted questionnaire, and the sample size was calculated through an open epi version 3.0 using the Randomized Clinical Trials formula.<br />RESULTS: In this study, in the intervention group, most women were 18-25 years old, whereas only 2.9% of women were over 40 years old in our study. Age group and previous training on the AMTSL variable are significantly associated with the study group variable. There was a significant mean difference in post-knowledge between the control and intervention groups. Furthermore, there was a significant mean difference in post-practice between both groups. The overall post-test Knowledge of nurses revealed that the intervention group had a better understanding than the control group.<br />CONCLUSION: It is concluded from this study that training and education about the active management of<br />the third stage of labor (AMTSL) is as highly effective as post-test Knowledge, and post-training practice scores were higher than pre-test scores.<br />KEYWORDS: AMTSL, Nurse, Knowledge. Labor, Practice, Postpartum Hemorrhage </p> 2023-01-03T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences Managerial Psychology and its Impact on Job Satisfaction among Public Healthcare Employees in Sindh 2022-09-15T11:01:41+05:00 Saleem Raza Qureshi Abdul Razaque Larik Qamaruddin Mahar <p>OBJECTIVE: To determine the influence of managerial psychology on healthcare workers drawing from the construct of managerial psychology.<br />METHODOLOGY: A quantitative research approach based on survey design was used. The data was gathered from respondents between February - November 2020 who were chosen randomly from five tertiary-level hospitals in Sindh and 37 rural health centres. Data analysis was analyzed using SPSS Version 22 and AMOS version 22. Employing the psychological capital (PsyCap) scale and Deci and Ryan's self-determination questionnaire, this study gathered data from 385 public sector employees working in the healthcare sector, examining the association between the study variables. The inclusion criteria comprised participants who were employees in both clinical and non-clinical capacities, male and female, working in 5 designated public sector hospitals or 37 Rural Health Centres in Sindh province.<br />RESULTS: The findings demonstrate a favourable association between optimism and job autonomy. Hope had a significant impact on healthcare employees" job autonomy.<br />CONCLUSION: The findings highlight a correlation between psychological capital and job autonomy.</p> <p>KEYWORDS: Psychological capital; job autonomy; managerial psychology, self-efficacy, hope,<br />optimism, resilience</p> 2023-01-03T00:00:00+05:00 Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences