Journal of Liaquat University of Medical & Health Sciences

The Integration of Artificial intelligence and Diagnostic Medicine: A New Era of Healthcare

Feriha Fatima Khidri — 2023-04-03

Stem Cells and Nanosilver Saved Diabetic Foot

Ahmad Mansour Hamad — 2023-03-29

We showed a case of 65 years-old Iraqi male who suffered from uncontrolled type 2 diabetes mellitus for 13 years. He developed an ulcer in his left big toe for five days in March 2021. The clinical assessment proved an infected stage 3 diabetic ulcer. We discussed the patient's condition with the patient/family, and they agreed and then consented. The therapy continued for one month and incorporated four sessions of surgical debridement, application of stem cells, and nanosilver. The patient/family noticed marked wound healing documented by the camera. Stem cells and Nanosilver therapy saved diabetic foot, and we advise it.

Human Monkeypox Virus (hMPXV) Remerges - Another Global Health Concern during the COVID-19 Disaster

Prithiviraj Nagarajan — 2023-03-29

The increase in human monkeypox virus (hMPXV) cases amidst the COVID-19 pandemic has raised fear among the general public. The monkeypox virus and the now-extinct smallpox virus belong to the orthopox family of viruses. Although first discovered in 1958, Monkeypox was only well recognized outside the sub-Saharan African countries until the world experienced a monkeypox pandemic in May 2022. The virus is common in some areas of Africa and is often spread through close contact with an infected person or animal. However, recent international trade, travel, and tourism developments have caused viral outbreaks outside Africa. The most recent pandemic in 2022 has been strange because epidemiologists have not found a link between cases and the virus’s ability to spread through sexual contact. The structural and pathogenic activities of the virus that attack host cells need to be better understood. Because of this, it is important to know how viruses and the immune system work together to develop effective ways to treat and prevent diseases. To summarize existing research on Monkeypox, we conducted a narrative review using the MEDLINE, EMBASE, PUBMED, and Scopus databases to look at simultaneous zoonotic pandemics caused by the SARS-CoV-2 or COVID-19 coronavirus and presented the most to date information on the symptoms, epidemiology, diagnosis, prevention, and treatment of Monkeypox. However, more research on epidemiological details, ecology, and virus biology in endemic areas is required to understand the virus better and prevent further human infection.

Relationship between Sleep Quality and Gait Speed in Geriatric Patients

Tezcan Kaya — 2023-03-29

OBJECTIVE: To identify the relationship between sleep quality and gait speed in geriatric patients.

METHODOLOGY: This cross-sectional study involved 140 Geriatric patients (aged ?65 years) who consecutively applied for the internal medicine outpatient clinic of an Education Research Hospital between July and September 2021 using a non-probability consecutive sampling technique. Participants with cancer, rheumatic or muscle disease, insomnia, amputations or motor dysfunction in the extremities, Parkinson's or Alzheimer's disease, who could not walk alone, and those with cognitive impairment who could not answer questions were excluded. The Pittsburgh Sleep Quality Index (PSQI) assessed participants' sleep quality. Gait speed for a 4-meter distance was measured. Parameters were compared concerning sleep quality and gait speed.

RESULTS: The gait speed of poor sleepers was significantly slower than good sleepers (p=0.012). Slow walkers were more prevalent among the poor than good sleepers (p=0.030). The median PSQI score of slow walkers was higher than that of normal walkers (p=0.009). The ratio of patients with poor sleep quality was significantly higher among slow walkers than among normal walkers (p=0.030). A significant positive correlation was found between the total PSQI score and gait speed time (r=0.250, p=0.003). The receiver operating characteristics curve of gait speed time was statistically significant for predicting poor sleep quality (AUC=0.629; p=0.012).

CONCLUSION: Gait speed was slower in geriatric patients with poor sleep quality. Poor sleep quality and gait speed time were positively correlated, and gait speed was a predictor of sleep quality in geriatric patients.

Evaluation of Factors Causing a Delay in Management and Hospital Stay in Diabetic Foot Amputation Patients: A Prospective Cohort Study

Syeda Anjala Tahir — 2023-03-29

OBJECTIVE: To determine the rate of different amputation levels in diabetic foot patients and the
incidence of repetitive foot surgeries and evaluate the factors causing a delay in hospital stay and
amputation of patients.
METHODOLOGY: This prospective cohort study was conducted in Dr. Ruth K.M. Pfau, Civil Hospital
Karachi, Pakistan. The study selected 375 participants from the clinic's daily patient inflow from October 2021 to March 2022 using a non-probability consecutive sampling technique. Those who had a delay in hospital stay and amputation were further followed up from May - October 2022. The chi-square test and Kruskal Wallis test (p-value <0.05) were used to correlate the effect of the level of lower limb amputation and the cause of delay in amputation using SPSS version 24.0.
RESULTS: Total 246(65.60%) were males and 129(34.40%) were females. Toe amputation was the most commonly seen amputation in 173(46.1%) participants. About 168(44.8%) patients had some in-hospital delay stay during their treatment. Preoperative hurdles (Uncontrolled RBS, Osteomyelitis, etc.) were the most common factor causing an in-hospital delay in 92(24.5%) patients. The level of amputation performed was found to be statistically significant with factors causing a delay in hospital stay through chi-square (p=0.003*) and Kruskal Wallis test H (2) statistic= 13.3, df = 3, H (2), P=0.004*).
CONCLUSION: Diabetic foot is a frequent cause of amputation globally, majorly in developing countries like Pakistan. On-time provision of treatment to these patients can decline the global amputation rate due to diabetic foot ulcers.

Genetic Association of DPP4 C/T and GLP1R C/A with Cytokines and Hormones in Undiagnosed Diabetic Subjects

Nazish Waris — 2023-03-29

OBJECTIVE: Genetic relationship with biochemical, hormones and markers of inflammation.
METHODOLOGY: This collaborative study was cross-sectional and carried out by the Department of
Biochemistry, Karachi University, Baqai Diabetology and Endocrinology Institute (BIDE), Karachi Pakistan and Kansai Electric Power Institute of Medical Research (KEPIIMR), Osaka-Japan. The duration of the research was from March 2019 to May 2020. Both genders aged 30-70 (years) visiting the outpatient department of BIDE and fulfilling the inclusion criteria were recruited. An oral glucose tolerance test as diagnostic criteria was used. Subjects were categorized into healthy (glucose levels of fasting glucose (FPG) less than 100 (mg/dL), a two-hour glucose post level (2-hr PGL) below 140mg/dL). Newly diagnosed diabetics (NDD) (FPG ?126mg/dL or 2-hr PGL ?200mg/dL or both without any antidiabetic medicines use). Subjects with any complications were excluded. SPSS (Social Science Package for Statistical) Version 20 was used to analyze data.
RESULTS: Of 34 subjects, 17 were NDD and 17 were healthy. The mean age was 49.65±1.95, and the
mean BMI was 28.12±0.93. DPP-4 C/T exhibited significant findings (p<0.05) compared with GLP-1R C/A among healthy and NDD subjects. Polymorphism of GLP1R C/A is associated significantly with fasting triacylglycerides and GLP1. In Comparison, polymorphism of DPP4 C/T was associated significantly in fasting with GLP1, GIP, HDL and IL-1? when compared to NDD with healthy participants.
CONCLUSION: We found significantly more association of DPP4 C/T polymorphism rs2970932 with
biochemical parameters than GLP1R C/A polymorphisms rs1042044 in NDD individuals.

Relationship of Metabolic Syndrome Indicators in Gestational Diabetes with Adiponectin Levels

Yasmin Akhtar — 2023-03-29

Objective: To assess the relationship between MetS in gestational diabetes with adiponectin.

Methodology: This analytical cross-sectional study was carried out from February 2015 - January 2016 at Gynecology and Obstetrics OPDs in four public and one private tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, Pakistan. Purposive sampling was done. Group one comprised 100 healthy pregnant women, while the second group included 100 pregnant women with known gestational diabetes. Women in the third trimester, with a single fetus, and who did not have pre-existing diabetes mellitus were Included. Women in the first or second trimester, with twin (or more fetuses) pregnancies, and pre-existing diabetes were excluded. BMI and systolic and diastolic blood pressure of participants were recorded. Blood was tested for serum lipids, HbA1c, and serum adiponectin levels.

Results: Thirty percent of participants had a BMI ?30 kg/m². Forty-three percent of participants had HbA1c ?6.5%. HDL levels were below normal in 30% of participants, and triglyceride levels were higher than average in about 80%. Systolic Blood Pressure was elevated in 23% of participants, and adiponectin level was low in >60% of cases. BMI was not statistically different between both groups. HDL levels and adiponectin levels were lower than normal in the diabetic group. Triglyceride levels were high in both groups. Regression analysis showed that adiponectin levels were affected by HbA1c and low HDL levels, and vice versa. Data were analyzed by SPSS version 20.

Conclusion: Low adiponectin levels could predict two MetS indicators in gestational diabetes and vice versa.

Acute Diarrheal Outbreak in 2022 Karachi, Pakistan: To Determine its Clinical Spectrum, Risk Factors and Complications

Amanullah Abbasi — 2023-03-29

Objective: To identify the possible source of the outbreak and risk factors and suggest evidence-based recommendations for prevention and disease control in Pakistan.

Methodology: This cross-sectional study was conducted in Civil Hospital Karachi, Pakistan, from March to May 2022. A total of 90 patients with a history of more than one watery stool in 24 hours were included in the study. The data about demographics, hygienic practices, illness characteristics, treatment, and biochemical parameters, including serum electrolytes and creatinine levels, were recorded. IBM SPSS version 26 was used for data analysis.

Results: The majority (83.3%) of symptoms were for less than one week. The mean family size was 6.7, SD 3.2, and 73.3% of patients had low income. Un-filtered municipal pipelines were the primary source of drinking water for 85.6% of patients, and 82.2% drank from tap water. Diarrhea (100%) and vomiting (81.1%), followed by abdominal discomfort (53.3%), were the most common symptoms, and 19 patients suffered acute kidney injury that resulted in the need for dialysis for a short time. Among 91 cases, only seven stool samples were positive for Vibrio cholera.

Conclusions: The study suggests the contaminated drinking water as a source of the outbreak, with independent risk factors such as large family size and low income. V. Cholera was indicated as the causative pathogen but with a low positivity rate; it may be due to the presence of uncommon serotype or a mutant variant of vibrio cholera for the outbreak.

Diagnostic Utility of Bone Marrow Biopsy/ Bone Marrow Culture in Pyrexia of Unknown Origin: A Ten-Year Retrospective Analysis

Sehar Khaliq — 2023-03-29

Objective: This study was carried out to assess the diagnostic utility of BMB and BMC in patients with PUO.

Methodology: This retrospective cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi. The clinical, laboratory and radiological records from January 2012 - December 2021 were retrieved from our hospital management information system for this study. Data from 63 patients with PUO were analyzed according to Petersdorf criteria.

Results: Out of 63 patients with PUO, BMB was diagnostic in 25 (39.68%) patients. The leading cause of PUO was infectious disorders (mycobacterium tuberculosis, visceral leishmaniasis, malaria), followed by inflammatory disorders and hematological malignancies. In 38 (60.31%) patients, BMB could not detect any underlying pathology. BMC showed growth in only 03(4.76%) patients, and the diagnostic yield of BMC was meagre.

Conclusion: BMB is essential in establishing a diagnosis in patients with PUO. Infectious diseases are the leading cause of PUO, and BMC should not be included as a routine investigation in the initial evaluation of a patient with PUO.

Review of Key Performance Indicator in a Hematology Laboratory: A Preventable Source of Error

Shaheen Kouser — 2023-03-29

Objective: To assess the key performance indicators and the laboratory errors in the hematology laboratory.

Methodology: A cross-sectional study was conducted at the DDRRL Hematology laboratory from October 2021 to September 2022. Data from the blood bank and hematological laboratory were collected. The primary investigator managed every step of the data-gathering operation. All the tools required for the process were gathered and arranged on a tray or trolley to be safe, accessible, and readily visible. Sterile glass or plastic tubes with rubber covers were used for blood collection. The information acquired during the study was inserted into a computer using an Excel sheet. SPSS version 20 was used for the analysis.

All samples from the hematology section of DDRRL were included in this study, while all error-free samples were excluded.

Result: From July to December, 414,400 hematology request forms were collected from OPD, private wards, IPD and Emergency. Overall, 2376 (0.573%) hematology laboratory errors were detected, of which 419 were Pre-analytical errors, 122 were analytical, and 1834 were post-analytical errors.

Conclusion: We can lower the errors' likelihood if we appropriately handle the pre-analytical variables. Additionally, care must be taken when training workers to minimize the possibility of mistakes.

Effectiveness of Mini-CEX as an assessment tool in Pediatric Postgraduate Residents’ Learning.

Shaista Ehsan — 2023-03-29

Objective: To determine the effectiveness of Mini-CEX as a formative assessment instrument in improving the clinical skills of postgraduate residents in Pediatrics.

Methodology: This cross-sectional study was conducted from January to August 2021 at Ziauddin Medical University. A total of 176 Mini-CEX encounters were conducted on twenty-two Pediatric postgraduate residents by eight faculty members. The non-probability convenience technique was used for sampling. Each resident underwent one Mini-CEX encounter per month, and the ratings were recorded. An Objectively Structured Clinical Evaluation (OSCE) was conducted before the first Mini-CEX session, and the last and the mean scores were compared. Data were analyzed using SPSS version 20. ANOVA was used to determine inferential statistics to calculate the p-value and the improvement in score over time to report statistical significance.

Results: Mean scores of all clinical competencies improved with subsequent Mini-CEX sessions. Maximum improvement was noted in clinical management skills and organization/efficiency. Marked improvement was observed in OSCE scores before the first Mini-CEX session and after the eighth session (p-value <0.001). An increase in the satisfaction rate of both faculty and residents with each subsequent Mini-CEX session was also noted.

Conclusion: Mini-CEX effectively improves pediatric postgraduate residents' clinical learning; therefore, it should be incorporated into the national residency program.

Fear of Childbirth: Wellbeing and Partner Support in First-time Pregnant Women

Ambreen Anjum — 2023-03-29

Objective: To assess the fear of childbirth, well-being and partner support in first-time pregnant women.

Methodology: This Cross-sectional study included 100 participants selected by purposive sampling. The sample was collected from two Hospitals in Lahore (Lady Wallington Hospital and Hameed Lateef Hospital) from June to October 2019. Wijma Delivery Expectancy Questionnaire, Wellbeing in Pregnant Women Questionnaire and Partner Support Questionnaire was used to collect data. Analysis was completed using SPSS version 23. Pearson correlation was used to assess the relationship between study variables. An Independent sample t-test was used to compare study variables, and simple linear regression analysis was calculated to predict fear of childbirth on their perception of partner support.

Results: 62% of first-time pregnant women showed fear of childbirth. Women who had more fear of childbirth had a low level of well-being (p<0.001). Partner support was significantly negatively correlated with fear of childbirth while positively correlated with well-being (r = .48, p < .001).

Conclusion: Women with first pregnancy suffer from fear of childbirth. However, partner support is essential to overcome this fear and help increase first-time pregnant women's well-being.

Speaking up Behavior and Safety Climate in Saudi Public Hospitals

Lujain ALSHRAIM — 2023-03-29

OBJECTIVE: To assess the safety climate among and between health practitioners in Saudi Arabia by
identifying speaking up behavior and speaking up about the related climate.
METHODOLOGY: A cross-sectional study was conducted among 135 physicians and 434 nurses in
Saudi public hospitals using the Speaking Up about Patient Safety Questionnaire to assess various
speaking up dimensions. Study questionnaires were completed from May to June 2019. The research purpose and confidentiality and anonymity assurance were provided at the beginning of the questionnaire. The individuals' participation was regarded as informed consent.
RESULTS: A total of 569 physicians and nurses participated. Both professions perceived concerns
regarding patient safety, and nurses kept silent more yet reported a higher likelihood of speaking up than physicians. Psychological protection for speaking up was equal for both professions, but nurses reported the environment as encouraging, and physicians were more resigned.
CONCLUSION: The findings of this study support further investment into research to design
interventions and improve patient safety by enhancing speaking up behavior and speaking up climate through recognizing and eliminating the barriers in healthcare settings. Despite ongoing improvement efforts, the current findings highlighted that safety is yet to be fully established.

Tele-Psychiatry during COVID-19 at HMC Peshawar

Wajid Ali Akhunzada — 2023-03-29

Objective: The main objectives of the current study were to find out the frequencies of Psychiatric disorders in the general population during COVID-19 and to compare the gender-based association between newly diagnosed patients during COVID-19 with already existing psychiatric patients in Peshawar to provide patient care on priority bases.

Methodology: This Cross-sectional design study was carried out in the Department of Psychiatry and Behavioral Sciences, HMC/MTI, from May to August 2020. Those patients who approached psychiatry OPD through video/audio online calls and could understand and respond to suggestions were included. The bio-data was collected, and DSM-5 criteria were used for diagnosis. Descriptive statistics were used for statistical significance, and the statistical package of social sciences (SPSS-21) was used for analysis and results.

Results: The results findings of the current study revealed that 59.3% of the patients approached for telepsychiatry consultation were from the district of Peshawar. Among them, 54% were female, and most patients were young married females (50.7%) with no job outside the home. The finding further revealed that most of the sample affected by psychiatric illness were uneducated (31.3%) and unemployed (28%). Furthermore, in the present findings, 46% of patients were diagnosed with depression, and 12% had Dissociative disorders.

Conclusion: It is concluded from the present study that in the Covid-19 Pandemic, primarily females who were married with no job description are more vulnerable to psychiatric illness. Furthermore, during Covid-19 mostly cases were reported with depression and dissociative disorders.

Effectiveness of educational campaign in promoting knowledge and attitude of pressure ulcer among physical therapists working in tertiary care hospitals

Mahat Zafar — 2023-03-29

OBJECTIVE: This study aimed to evaluate the effectiveness of an educational campaign in promoting knowledge and attitudes concerning pressure ulcers among physical therapists working in tertiary care hospitals.
METHODOLOGY: This study quasi-trial was conducted from January to October 2021 in which 45 PTs who worked in Neuro-spinal units were selected by purposive sampling from five randomly selected tertiary care hospitals in Faisalabad. The participants completed a questionnaire regarding their knowledge and attitude regarding pressure ulcer prevention and treatment, and their pre-test scores were recorded. After the pre-test, the primary researcher reviewed the incorrect responses of participants to develop and offer educational materials about the prevention and care of pressure ulcers. The "Pieper Pressure Ulcer Test" was used to evaluate changes in physical therapists' knowledge and attitudes toward pressure ulcer. SPSS 21 was used for the data analysis.
RESULTS: The educational campaign had a significant effect on the knowledge and attitudes of PTs, with the mean of the pre-test true response of 31.65, the mean of the post-true response of 39.00, and the mean of the pre and post-incorrect response of 8.19, and 4.62 and don't know answers of 5.04, and 1.38, respectively. Based on one sample t-test, pre-true responses showed a 95% CI difference between 28.99 to 35.53 with a significant p-value <.001 and post-true responses showed 36.63 to 41.36 with a significant p-value <.001.
CONCLUSION: This study concluded that the educational campaign improved physical therapists' knowledge and attitudes regarding pressure ulcers.