The International Journal of Frontier Sciences

Background: Accidental parathyroidectomy during thyroid surgery can lead to temporary or permanent hypocalcemia and serious morbidity. Proper identification of parathyroid glands during surgery can be an effective way to prevent this complication. Methods: The keywords “parathyroid gland,” “preserve,” “protect,” “inadvertent or accidental parathyroidectomy,” “surgery,” and “dissection” were used to search Medline and Embase databases. A total of 133 articles were selected after preliminary review, of which 80 indexed papers were reviewed for subject relevance. Results: Imaging techniques, such as the use of carbon nanoparticles or indocyanine green angiography, and operative techniques, such as meticulous capsular dissection of the thyroid gland, were associated with significantly improved rates of avoidance of inadvertent parathyroidectomy. Conclusion: During thyroid surgery, the use of imaging and careful operative techniques can prevent parathyroid injury. This, in turn, can prevent complications resulting from hypoparathyroidism such as tetany, ECG changes, and neurological sequelae. Full article

Background: The use of mosquito coils has increased exponentially, especially in the under developed countries. Many researches have been conducted over the past few years to advocate both the possible risks and potential benefits. These coils and the inhalation of their smoke have been proved to cause upper and lower airway tract infections. But still the possible side effects of inhalation of these coil smoke on other organ systems of the body were unclear. Methods: Adult male Wistar rats were divided into two groups each containing eight rats. Group A was control group while group B was allowed to inhale mosquito coil smoke for four week. The experimental group was exposed to MCS for 8 hours / day. Histopathological analysis of testis was carried out. Results: Histopathological studies of rats exposed to MCS revealed changes in parenchyma of testis. Decrease in the height of germinal epithelium and diameter of seminiferous tubules and increase in and vascular congestion was observed. Conclusion: The results of present study suggest that allethrin based mosquito coil smoke has harmful effects on testis Full article

Background: Prescribing errors are quite common and according to one estimate out of 100 patients admitted into UK hospitals 15 will have some form of prescribing error in their records. It is a general understanding that most of the time these errors are made due to lack of awareness. Severity of these errors can range from minor to major mistakes that can lead to fatal results. Materials and Methods: A simplified anonymous approach of identifying these errors and then using a step wise approach to educate the prescribers’ especially junior doctors can be quite fruitful in reducing these errors. Unfortunately there are not many studies or projects available to back our proposal however these seems a logical way forward and is exactly what we have shown in our study. Results: We performed a prospective snapshot study involving 100 inpatients to get baseline measurements. The errors and mistakes were identified and fed back to the junior doctors in an anonymous manner. Clear & legible writing, frequency of use, responsible consultant name, allergy box filled, VTE assessment, oxygen prescribing and labeling of medication discontinuation were the most common negligence identified. At the same time junior doctors were reminded of local prescription standards and guidelines which usually don’t form part of induction. Conclusion: Multiple deficient areas were identified during this audit like legible writing, dosage frequency, VTE prophylaxis and oxygen prescription. It was highlighted to junior doctors how important are these components as they play a key role in patient getting better after medical review. Above mentioned steps did improve prescription errors to an extent, but aim should be to achieve 100% results. Repeated reminders are important in this case as that helps to improve practice and avoid clinical accidents. Full article

Background: Education is the most hopeful discipline which provide pathway for a purposeful and productive life. The progress in any filed is achieved through education. Education is a complex process. Academic failure is the one of the main challenges which students face during academic years. Current study was conducted to identify the causes of academic failure among the nursing students and determine the correlation between these causes. Materials and Methods: A quantitative descriptive cross-sectional study design used to explore the causes of academic failure among the nursing students and correlation between these variables. A convenient sampling technique use to collect the data. Questionnaire distributed in 134 participants. SPSS version 24 was used for data analysis. Results: The mean score of question related to teacher behavior was 2.62 and the overall mean score was 2.62 ± 0.20. Lack of commitment to study was 2.23 and the overall mean score was 2.23 ± 0.22. Problem with learning environment mean 2.61 and the overall mean score 2.61 ± 0.26. The mean score of courses content and examination problem 2.52 and the overall mean score was 2.52 ± 0.32. The unsatisfying relation with family mean score 3.27 and the overall mean score was 3.27 ± 0.30. The future concerns related chosen field mean score was 2.64 and the overall mean score was 2.64 ± 0.20. Conclusion: Causes of student’s failure are the unsatisfied relation with the family and psychological problems of the students. There was positive correlation between all variables except the unsatisfied relation with family and future related concern to the chosen field of study. Full article

We present a rare case of a child with penetrating cardiac injury (PCI) with a knife and its successful repair. A 10-year-old boy was brought to the emergency department with penetrating injury under the nipple on the left side of the chest, with entrance sized 1x0.5 cm, in a hemodynamically unstable condition. Physical examination showed findings suggestive of cardiac tamponade and shock. Focused Assessment with Sonography in Trauma (FAST) and echocardiography visualized pericardial effusion, and chest X-ray showed left pleural effusion. Needle thoracentesis was performed, followed by urgent sternotomy. Right ventricular tear of size 1x1cm visualized and repaired. The left pleura was drained blood up to 800 milliliters. The pericardium was closed with sutures. We then placed retrosternal and pericardial drains and sealed the chest with wire sutures at the sternum. During the induction of anesthesia, the patient underwent cardiac arrest, immediate cardiopulmonary resuscitation revived the patient and surgery was performed. Here, expertise lies in performing the procedure on a pumping heart without cardiac bypass. In addition, the most common cause of PCI is an intentional gunshot injury in adults. In contrast, our case presents the accidental nature of injury in children by knife, which makes this interesting. Therefore, we documented our experience of this rare finding. In addition, we present a literature review about penetrating injury to the heart, focused on the pediatric population and survival, morbidity, and mortality of the condition with and without access to the hospital. Full article

Background: Abnormal CSF accumulation within ventricles of brain leading to raised intracranial pressure is a potentially life-threatening state that is commonly seen in neurosurgical patients. Aim of this study is to assess the efficacy of endoscopic third ventriculostomy (ETV) in treatment of pediatric hydrocephalus in pediatrics. Materials and Methods: A total of sixty-two patients were included in this prospective study. Patients were generally discharged from the hospital on the 2nd or 3rd postoperative day unless some complication arose. All the information was recorded in a pre-structured proforma, and data were analyzed by SPSS. Statistical significance was defined as p-value less than or equal to 0.05. Results: At follow up, clinical improvement and radiological findings did not necessarily correlate with each other, as ventricular size was reduced in only 42 (67.7%) out of 62 patients. Remaining 20 (32.3%) patients had no change in the size of ventricles. The difference was not statistically significant. However, as observed by cine PC MRI, CSF flow was observed in all the patients. Conclusion: In non-communicating hydrocephalus, ETV is a simple technique and safe and effective treatment if done by an expert surgeon correctly. It is a reasonable alternate of VPS due to its simplicity and effectiveness. Full article

Background: This is a report from Multan Medical and Dental College about obesity among lady doctors and factors associated with it. Methodology: A cross sectional descriptive study was carried out in Multan medical & dental college and hospital from 1st January 2020 to 30th March 2020 after taking approval from institutional review board. Closed ended questionnaire was used to collect data from 159 lady doctors of age from 22 to 60 years including both married and unmarried females using simple random sampling technique. Results: Obesity was seen more in married lady doctors i.e. 64 (83.1%) as compared to 13 (16.88%) unmarried lady doctors and highest frequency of obesity was seen in 50 to 60 years age group i.e. 22 (88%) obese as compared to 3 (12%) non obese. The results were statistically significant. P=0.000. Conclusions: There is alarming rate of obesity among married lady doctors and also in upper age group i.e., 50 to 60 years. Full article

Background: Cerebrovascular ischemic cases are 3rd leading cause of fatality and neurologic dysfunction in adults. Atherosclerotic lesions outside the carotid cranial circulation are main cause of cerebral ischemia in almost 10-20 percent cases and carotid endarterectomy (CEA) has been proved beneficial for patients with severe carotid artery stenosis to prevent acute cerebrovascular events. Current study is conducted to assess the short-term outcomes of carotid endarterectomy among patients in terms of morbidities and mortalities at our institution during the study period. Material and Methods: This cross-sectional analytical study was carried out at Combined Military Hospital, Rawalpindi during August 2019 to July 2021 to analyze the short-term outcomes of carotid endarterectomy (CEA) with primary closure. All the patients who underwent carotid endarterectomy (CEA) with primary closure during study duration were included in the study. Patients who received selective shunting if Electro Encephalogram (EEG) changes noted were excluded from study. Data was collected after taking verbal consent by using preformed questionnaire. Frequency of morbidities like bleeding, infection, stroke, transient ischemic attacks (TIA), myocardial infarction, repeat operation and revision with stent were noted within postoperative period of one month. Frequency of mortalities in one-month postoperative period among patients undergoing carotid endarterectomy was also calculated. Data was entered and analyzed by using SPSS version 22. Results: Total 198 patients who underwent carotid endarterectomy with primary closure during study duration were included in the study. Age range of the study participants was between 35 to 80 years. Male patients were 107 (54.04%). The comorbidities evaluated in the study participants showed that 172 (86.87%) patients were hypertensive and 73 (36.87%) has diabetes mellitus. The most frequent postoperative morbidities among patients were bleeding and repeat operation. Conclusion: It is concluded that carotid endarterectomy with primary closure is a safe and effective surgical means of stroke prevention. Full article

Background: An Uncontrolled Novel COVID-19 started from Wuhan city of China in Late 2019 and spread worldwide has called for unprecedented measures, to prevent it Pakistan government Imposed lockdown on the entire country. Lockdown has a huge impact and affected on mental health of population. The present study aims to assess the effect of COVID-19 on mental health of population and identify the coping strategies to overcome this mental health issues caused by pandemic. Methods: An online survey was administered from 26 May-14 June 2020 to 398 participants. Post Hoc test was performed to examine the associations between general health questionnaire GHQ-12 and socio-economic variables. Results: Losing jobs due to pandemic and lockdown situation and using negative coping strategies were the factors associated with psychological disorders.This study shows high rates of anxiety and stress in younger population specifically in young women with higher odds of endorsing a worst mental health outcome. Outcomes were associated with a number of COVID-19 related risk factors such as challenging family relations, loss of job, no physical activity, financial burden, experiencing stress full events and suicidal ideation. Conclusion: The present situation requires awareness in public media which could be helpful to deal with this and this present article provides details of COVID-19 pandemic situation on mental health of younger population. Full article

Background: People nowadays have developed a new passion of weightlifting. Weightlifting focuses on vigorous muscle development. But injuries are also common in weightlifting. This study aims to compare the injury rates among supervised and non-supervised weightlifters. Methods: A group of 138 weight lifters was divided into two groups i.e. who did training under supervision and the other who did training without any supervision. Injuries related to musculoskeletal system were identified using Nordic musculoskeletal questionnaire. Data was analyzed using SPSS. Chi square test was used to see the association of musculoskeletal pain among weightlifters with or without supervision. Results: Significant association found between musculoskeletal injuries and supervision. Injuries lesser in number among supervised weightlifters as compared to unsupervised weightlifters. Mean age of weight lifters under supervision and without supervision was 21.99 (SD 3.81) and 24.64 (SD 5.01) respectively. Mean workout days /week among weight lifters under supervision was almost same i.e. 5.67 (SD .63) and was 5.62 (SD .81). Out of 51 participants who work-out for 46-60 min, 30 were not under supervision while 31 weightlifters who work-out for 61-90 min were working out under supervision. Injury rate was more in the region of shoulder in both groups supervised and unsupervised groups while hip/thigh region was less involved in both supervised and unsupervised groups. Conclusion: Overall results showed significant association between musculoskeletal injuries and supervision. Injury rate was more among weightlifters who work without supervision as compared to those who work under supervision. Care should be taken and weight lifting and exercises must be performed under expert’s supervision. Full article

Background: Childhood Recurrent Abdominal Pain results in the one of the adulthood complications i.e., irritable bowel syndrome, which is a gastro-intestinal disease. The stomach’s acidic environment is the growth site for Helicobacter Pylori, a pathogenic Gram-negative bacterium with rod shape. It is the main reason for chronic gastritis, gastric adenocarcinoma, peptic ulcers, non-ulcer dyspepsia and mucosa-associated lymphoid tissue (MALT) lymphoma. According to one estimate, 50% of people in world are infected with Helicobacter Pylori. Currently the developing countries are on the hit list of Helicobacter Pylori. The objective of this study was to determine the frequency of Helicobacter pylori infection in the children having recurrent abdominal pain. Materials and Methods: It was a cross-sectional study. This research was carried out during 1.1.2018 to 1.6.2018 in the D.H.Q hospital Mirpur AJK. The sample was consisted of 200 participants among them the proportion of Helicobacter was 8% in patients with Recurrent Abdominal Pain. Results: The mean age of the patients was 12.43 ± 1.23 years. Mostly the age of the sample group was between 8 to16 years. The 4.23 ± 0.47 months was the mean time period of abdominal pain. Helicobacter pylori was found in 47% of patients. Conclusion: In paediatric population, Helicobacter pylori is very common with Recurrent Abdominal Pain. It is a severe problem in children and further study is recommended to explore the risk element associated with this increase trouble of Helicobacter Pylori. Full article

This study aimed to assess the cosmetic outcomes of shave excision for the treatment of acquired melanocytic nevi in a Pakistani tertiary care setting. In total, 120 patients were enrolled in this study. All patients underwent shave excision upon being administered with intra-lesional local anesthesia (2% lignocaine with adrenaline). The lesion was shaved with a 15 number Bald Parker blade. Hemostasis was secured by pressure and 20% aluminum chloride solution. The final cosmetic outcomes (excellent, acceptable, or poor) were assessed three months post-shave excision. Statistical analysis was performed using SPSS, v22. Data were evaluated using chi-square tests, and the phi coefficient. A P value of less than 0.05 was considered statistically significant to determine associations of age and gender to cosmetic outcomes. The mean age of included patients was 29.7±7.4 years. There were 30 (25%) male and 90 (75%) female patients. Out of these, 35 (29.2%) patients had excellent outcomes, 75 (62.5%) patients had acceptable and 10 (8.3%) patients had a poor outcome. The associations of gender and age to dermatological outcomes post-excision were significant (P<0.001). Sufficient evidence was collated to determine a relationship between age (Pearson Chi-Square = 113.94) and gender (Pearson Chi-Square = 97.143) to cosmetic outcomes (P<0.001). The phi (?) coefficient also confirmed the significance of positive associations between the cosmetic outcomes to gender and age (?= 0.974). Shave excision presents as an exceedingly useful and inexpensive method for the removal of acquired melanocytic nevi especially in a low and middle-income country like Pakistan. Full article

Background: The outcome for this neurosurgical problem is still far from set target in many developing countries like Pakistan. Major proportion of cases presenting with EDH in hospital still has poor outcome. This poor outcome of EDH is attributed to many factors including weak health systems of most developing countries. Objective of study was to analyze factors influencing outcome among patients of head injury with an extradural hematoma before surgery admitted in neurosurgery department of Dera Ghazi Khan Medical College, Dera Ghazi Khan. Materials and Methods: This cross-sectional analytical study was conducted in neurosurgery department of Dera Ghazi Khan Medical College from January 2019 to December 2019 after ethical approval. All the patients with extradural hematoma of either gender admitted in the department during the study duration in which surgery was performed to evacuate extradural hematoma were included in the study. Data was collected by using preformed, pretested questionnaire. A vital signs and Glasgow coma scale record was maintained at thirty minutes interval. Computerized tomography was done in every patient. The EDH volume was calculated by using Peterson and Epperson equation a x b x c x 0.5. Data was entered and analyzed by using SPSS version 22. Chi square test was applied to observe any statistically significant difference between various strata if existed and p value <0.05 was taken as significant. Results: Total 237 patients with Extradural Hematoma (EDH) were admitted in neurosurgery department during the study period were included in study. More than half 136 (57.4%) patients were more or equal to the age of 18 years. Majority of the patients 218 (91.9%) in the study were male. Major cause of extradural hematoma among patients in this study was road traffic accident 154 (64.9%). The outcome of EDH was found to be significantly (p <0.001) associated with age of patients. More than ninety percent of the patients who were directly admitted to tertiary care hospital has good outcome as compared to 109 (60.2%) patients which were referred and difference in outcome was statistically significant (p<0.001). The volume of EDH is not significantly associated with the outcome (p=0.090). The GSC score of the patients at the time of admission is significantly associated with the outcome (p<0.001). Study findings showed that GCS score of the patients at the time of surgery was also found to be significantly associated with outcome of EDH (p<0.001). Conclusion: There is a strong association of outcome in extradural hematoma with age, gender and GCS of the patient. In higher GCS the outcome was excellent but in low GCS the outcome was poor. Full article

Background: Hepatitis is a major health issue. The aim of this study was to assess the knowledge, attitude and practices (KAP) of medical students regarding hepatitis B and C. Methods: A descriptive cross-sectional study conducted from March, 2018 to May, 2018. 310 medical students from Allama Iqbal Medical College participated. KAP towards Hepatitis B and C was assessed by using a pre-validated questionnaire. Association of gender and year of study was established with KAP of respondents. Also, associations of knowledge with attitude and practices were also established using Chi-square test taking ≤0.05 as standard p-value. SPSS version 21.0 was used. Results: 269 (86.77%) out of 310 distributed questionnaires were received. 116 (43.1%) respondents fell in age group 16-20, 150 (55.8%) in 21-25 years while 3 respondents (1.1%) were 25 year and above. 146 (54.3%) respondents were females and 123 (45.7) respondents were male. There were 54 (20.1%) respondents from first year, 59 (21.9%) respondents from second year, 53 (19.7%) respondents from third year, 55 (20.4%) respondents from fourth year and 48 (17.8%) respondents from final year. 132 (90.4%) female respondents and 98 (79.7%) male respondents had good knowledge regarding hepatitis B and C. No significant relationship was established between gender of respondents with their attitude and practices. As for relationship of knowledge of respondents with their attitude and practices, no significant association could be established. Full article

Background: Pakistan established the Punjab healthcare commission to improve patient care catering to professional accountability in the public and private sectors. As per the World Health Organization, quality of care comprises of six dimensions where the care must be effective, efficient, accessible, patient-centered, equitable, and safe. Objectives: The objectives are to determine if patients are satisfied with the quality of services in public and private sectors, or if any neglect was present. Methods: The literature on patient care and satisfaction was compiled using a scoping review methodology. PubMed, CINAHL Plus, and Scopus were used to collate information. Duplicates were removed using Endnote X9. Results: Of the 467 abstracts and titles that were screened for relevance, 74 were considered for full-text review and potential inclusion in the scoping review. Out of 16 included studies, 7 (43.8%) of the included studies originated from Pakistan. The characteristics of included studies such as quality of care and patient satisfaction are tabulated. Conclusion: Current literature does not provide quality- and satisfaction- focused studies, and has methodological discrepancies. It is required that the medical profession adopt a sense of self-monitoring. Gaps in service provision must be addressed by healthcare managers, policymakers, and physicians in Pakistan. Full article