Life and Science

Strengthening Health Security through Sustainable Vaccine Economics and Equity

Wasim Alamgir — 2024-07-30

The COVID-19 pandemic has highlighted substantial inequities in access to vaccines. A primary reason behind this inequity was the concentration of manufacturing capacity in developed regions of the world. The lack of a distributed spread of local facilities has meant that many countries are reliant on global suppliers and manufacturers, making the low- and middle-income countries (LMICs) vulnerable to pandemics.¹ Addressing this imbalance in terms of accessibility to life-saving vaccines is crucial for health security and vaccine equity.

Gavi’s new five-year strategy (Gavi 6.0’ for 2026–2030) aims to address these issues with a vision “leaving no one behind with immunisation”. GAVI mission was revised for Gavi 5.0 and puts ‘equity’ at the heart of the Alliance’s strategy to increase equitable and sustainable use of vaccines. GAVI 6.0 incorporates a new principle on the climate change while equity will remain at the core of Gavi’s next strategy, as a key contribution to the Immunisation Agenda 2030 (IA 2030) and the Sustainable Development Goals. At the heart of the Gavi model is also a unique approach to programmatic and financial sustainability.² Grounded in Gavi’s eligibility, transition and co-financing (ELTRACO) policy, the model has been highly successful so far in bolstering country ownership of vaccine programmes and in driving domestic public resource allocation towards immunisation. From 2011 to 2023, countries increased their resources for Gavi-supported vaccines from US$ 36 million to US$ 630 million, representing 41% of the combined investment by Gavi and countries into routine, Gavi-supported vaccines. At the end of 2023, 19 countries had fully transitioned out of Gavi support.

In line with Gavi’s vaccine policy, based on the country’s Gross National Income (GNI); Pakistan will eventually graduate from GAVI support which would result in added economic capitals to sustain the vaccine accessibility which are acquired as country co-financing share. Despite progress, immunisation coverage in Pakistan remains low, and the country has not met its 2015 health, nutrition, and population (HNP) Millennium Development Goals targets.⁴ Establishing a local vaccine manufacturing facility is imperative to reduce reliance on contract manufacturing and streamline the supply chain for the Expanded Programme on Immunisation (EPI) and health security.

The BioNTech mRNA Vaccine Manufacturing Facility in Rwanda serves as a model for sustainable vaccine production in LMICs. With a $150 million investment and local personnel training, the facility aims to produce mRNA-based vaccines by 2025, promoting vaccine production and supply in African Union member states. Similar initiatives can be replicated regionally to enhance vaccine self-sufficiency.⁵ Currently, over 60% of BCG and over 80% of measles vaccines are produced in India and Indonesia, underscoring the need for Pakistan to develop its vaccine production capabilities. The domestic market’s annual vaccine intake is Rs 17.6 billion, indicating substantial demand and potential for local manufacturing.⁶

Developing the capacity for essential immunisation in the country requires more than market-driven solutions. Achieving global vaccine equity demands transparency, active government oversight, favourable intellectual property policies, proactive technology transfers, and building regional technical, manufacturing, and regulatory capacities. Public-private partnerships (PPP) can expedite the establishment of Bioequivalence and Bioavailability centres, ensuring sustainable vaccine technology aligned with international standards (FDA, WHO, EU). By addressing these challenges, we can create a resilient and equitable global health security system, ensuring vaccine equity and sustainability in the fight against infectious diseases.

Editor-in-Chief

How to cite this: Alamgir W, Sajjad W. Strengthening Health Security through Sustainable Vaccine Economics and Equity. Life and Science. 2024; 5(3): . doi: http://doi.org/10.37185/LnS.1.1.768

Comparison of CD-138 Expression in Different Grades of Oral Squamous Cell Carcinoma

Shifa Basharat — 2024-08-15

Objective: To compare the expression of CD-138 (Syndecan-1) in different morphological grades of oral
squamous cell carcinoma.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Histopathology, Rehman Medical
Institute Peshawar, Pakistan from June 2022 to February 2023.
Methods: A total of 110 biopsy specimens from patients of either gender suspected as cases of oral squamous
cell carcinoma (OSCC) underwent histopathological examination in the laboratory of Rehman Medical
Institute. After eosin and hematoxylin staining, the diagnosis of oral squamous cell carcinoma and the grade
were confirmed. Thereafter, immunohistochemical analysis for CD-138 was performed. Age, gender, biopsy
site intensity, and positivity for CD-138 expression in different grades of OSCC were the parameters recorded.
Results: Mean age of the patients included in the study was 58.91 ± 6.42 years while the gender distribution
showed a male predominance with 98 (89.1%) males and 12 (10.9%) females. The most common affected site
in these patients was buccal mucosa of the oral cavity in 50 (45.5%) participants followed by 43 (39.1%)
participants in which the affected site was tongue. The intensity of CD-138 (Syndecan-1) expression decreased
significantly with a change in the histological appearance of the tissue samples from well-differentiated to
poorly differentiated morphology with a P-value of <0.01.
Conclusion: Loss of CD-138 expression in oral squamous cell carcinoma is associated with a higher histological
grade, tumor aggressiveness and poor prognosis.

Association of Return of Spontaneous Circulation with the Duration of Cardiopulmonary Resuscitation in Patients Presenting to the Emergency Department of a Tertiary Care Hospital in Karachi Pakistan – A Quasi-Experimental Study

Arsalan Mufti — 2024-07-31

Objective: To determine the association between the duration of Cardio-pulmonary resuscitation and the return of spontaneous circulation in cardiac arrest patients.
Study Design: A retrospective quasi-experimental study.
Place and Duration of Study: It was carried out over a 6-month period on cardiac arrest patients presenting to the Emergency Department from June till December 2020 at Ziauddin University Hospital, Karachi, Pakistan.
Methods: A sample of 178 patients was selected through consecutive sampling. The patients were divided into two groups each consisting of 89 participants. The conventional group received cardio-pulmonary resuscitation for 20 minutes, while the interventional group had it for more than 20 minutes.
Results: The mean age was 59.49 years (SD ± 17.2), predominantly males. In the conventional group, 64 patients (36%) experienced recovery with a Return of Spontaneous Circulation, while in the interventional group, this was achieved in 37 patients (20.8%). Overall, among the 176 patients who received Cardio-pulmonary resuscitation, 56.7% (n = 101) achieved a Return of Spontaneous Circulation. Among these 101 patients with a Return of Spontaneous Circulation, the documented average duration of their Cardio-pulmonary resuscitation was approximately 12.17 ± 4.77 minutes, compared to 34.47 ± 7.22 minutes for patients who did not achieve a Return of Spontaneous Circulation (P < 0.0001). Similarly, the mean time of Cardio-pulmonary resuscitation initiation was statistically significantly different between the two groups (P < 0.001) using the Pearson chi-Square test.
Conclusion: Increasing the duration of Cardio-pulmonary resuscitation does not benefit patients in terms of resuscitation, recovery, or survival. Cardio-pulmonary resuscitation lasting less than 20 minutes had a higher likelihood of achieving spontaneous circulation recovery compared to that lasting for more than 20 minutes. Initiation of Cardio-pulmonary resuscitation as early as possible had better chances of recovery and survival especially when initiated immediately after cardiac arrest.

Evaluation of Electrolyte Levels in Patients with Acute Coronary Syndrome

Amna Saleem — 2024-08-15

Objective: The study aims to assess electrolyte imbalances in patients diagnosed with acute coronary
syndrome (ACS) and to explore whether these imbalances are associated with poor clinical outcomes in ACS.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: The study was conducted at the Department of Cardiology, Mardan Medical
Complex Mardan, Pakistan from September 2023 to December 2023.
Methods: A cross-sectional study on 360 patients was conducted using the WHO sample size calculator.
Patients from both genders were included in this study. Demographic information of patients was obtained.
Serum electrolyte levels were done from the hospital's laboratory. Information was collected in predesigned
proforma. Sampling was done via non-probability convenient sampling. Informed consent was taken from all
patients, ensuring confidentiality and the fact that there will be no risk to the patients who are taking part in this study.
Results: Unstable angina was found in 60 (16.7%), in Non-ST-elevation myocardial infarction (NSTEMI) 154
(42.8%) and in ST elevation myocardial infarction (STEMI) 146 (40.6%) patients. Hyponatremia was found to be
in 108 (30%) patients, and it was associated in causing heart failure in around 58 (16.11%) patients.
Hypokalemia was present in 65 (18%) patients and showed VT in 28 (7.77%) cases. Hypomagnesemia (31.9%)
caused heart failure in 30 (8.33%) patients followed by VT in 26 (7.22%), cardiogenic shock in 24 (6.66%). All
electrolyte disturbances of the current study carried statistical significance in causing complications i.e. P-value
<0.001.
Conclusion: We concluded that electrolyte disturbances are common in patients with acute coronary
syndrome, and they carry adverse outcomes with respect to ACS related complications and mortality.

Unlocking the Code: Exploring Autism Spectrum Traits among Medical Students through the Lens of Blood Group Phenotypes

Aiman Farogh Anjum — 2024-08-15

Objective: To assess autistic spectrum disorder traits (based on language, social relatedness, sensory-motor
discrepancies, and circumscribed interests) prevalence among undergraduates, explore associations with
sociodemographic factors and blood group phenotypes, and investigate correlations with anthropometric
measures.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at the Physiology Department, CMH Kharian Medical
College Kharian, Pakistan from January 2024 to April 2024.
Methods: A total of 527 undergraduate students were included in the study. Sociodemographic data, blood
group phenotypes (ABO and Rh), and anthropometric measures were collected. Autism spectrum disorder
traits were assessed using the Rapid Autism Diagnostic Screening (RAADS-14) scale.
Results: Females exhibited higher autism spectrum disorder trait prevalence (35.9%) than males (15.4%). A
positive correlation was found between height-to-waist ratio and autistic spectrum disorder traits (r = 0.103).
No significant associations were observed between autism spectrum disorder traits and area of residence,
blood group phenotypes, or body mass index categories.
Conclusion: Gender and height-to-waist ratio showed significant associations with autism spectrum disorder
traits, no significant links were found with blood group phenotypes.

Unraveling the Complexities of Coagulation Dysfunction in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Investigating the Interplay between Infection, Hypercapnia and Hemostatic Abnormalities

Bilal Ahmed — 2024-08-15

Objective: To understand how the acute exacerbations of chronic obstructive pulmonary disease (COPD) can
lead to coagulation dysfunctions causing hemostatic abnormalities (prolonged prothrombin time, slightly
longer activated partial thromboplastin time, higher fibrinogen levels, higher D-dimer levels, and slightly lower
platelet counts).
Study Design: Comparative cross-sectional.
Place and Duration of Study: The study was conducted at the Department of Internal Medicine Pak Emirates
Military Hospital (PEMH) Rawalpindi, Pakistan during the period of July 2023 to December 2023.
Methods: The current study utilized patients with a confirmed diagnosis of Acute Exacerbation of Chronic
Obstructive Pulmonary Disease (AECOPD) who were hospitalized in the respiratory care unit and were above 50
years of age. A total of 200 patients were accessed including their demographic characteristics (age, gender,
residence, and job), clinical parameters (spirometry results (Forced expiratory volume in one second/Functional vital capacity ratio), complete blood counts, fibrinogen, prothrombin, activated partial thromboplastin time, D-dimers and arterial blood gas analysis. The intricate relationship between coagulation dysfunction and acute exacerbations of chronic obstructive pulmonary disease was analyzed using SPSS 26.
Results: The results obtained that; patients with acute exacerbation of chronic obstructive pulmonary disease
had prolonged prothrombin time (13.5 ± 1.2 seconds, P < 0.001) slightly longer aPTT (32.1 ± 2.5 seconds, P =
0.014), along with higher fibrinogen levels (350.2 ± 45.8 mg/dL, P < 0.001) and D-dimer levels (550.4 ± 120.3
ng/mL, P = 0.002), as compared to patients with stable chronic obstructive pulmonary disease. The platelet
counts of Acute exacerbation of chronic obstructive pulmonary disease patients obtained were slightly lower
(260.3 ± 45.4x10^3/μL, P = 0.009) compared to stable chronic obstructive pulmonary disease patients.
Furthermore, results provided that coagulation dysfunction was significantly associated with infection,
hypercapnia, and acute exacerbation of chronic obstructive pulmonary disease. The prevalence of coagulation
dysfunction markers was higher among patients with acute exacerbation of chronic obstructive pulmonary
disease.
Conclusion: Coagulation dysfunction and its associated risk factors are higher in patients with acute
exacerbation of chronic obstructive pulmonary disease and are elevated with increased exposure to air
pollution.

Incidence of Hepatic Encephalopathy in Patients with Spontaneous Bacterial Peritonitis Using Rifaximin and Lactulose: A Study at a Tertiary Care Hospital in Rawalpindi

Muhammad Saad Aziz — 2024-08-15

Objective: To determine the incidence of hepatic encephalopathy (HE) in cirrhosis patients with spontaneous
bacterial peritonitis receiving Lactulose, Rifaximin, or a combination of both, and to compare the efficacy of
these treatments.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Medicine, Pak Emirates Military
Hospital Rawalpindi, Pakistan, from September 2021 to August 2022.
Methods: Using consecutive sampling, diagnosed cases of decompensated Chronic Liver Disease with clinically
apparent ascites, visiting the outpatient department, with or without signs and symptoms of spontaneous
bacterial peritonitis (SBP) were included in the study after laboratory confirmation of spontaneous bacterial
peritonitis. The drug history was taken, and hepatic encephalopathy was diagnosed using Mini-mental Scale
Examination and West-Haven criteria. The incidence of hepatic encephalopathy was compared across the
groups using the Pearson Chi-square test.
Results: A total of 60 diagnosed Chronic liver disease patients with spontaneous bacterial peritonitis were
included in the study. Rifaximin was being used by 41.7% (n=25), 41.7% (n=25) patients were using lactulose
alone and 16.7% (n=10) were using a combination of both drugs. 58.3% (n=35) of patients were found to have
hepatic encephalopathy. Out of these, 42.8% (n=15) were using rifaximin alone, 54.2% (n=19) were using
lactulose alone, while just 2% (n=1) patients were using the combination of both drugs (P < 0.001).
Conclusion: Spontaneous Bacterial Peritonitis is an important trigger of hepatic encephalopathy in the setting
of decompensated chronic liver disease and is associated with high mortality. The use of lactulose and rifaximin
combination is superior to monotherapy with either of them for preventing hepatic encephalopathy in these
patients.

Abdominal Aortic Calcifications in Patients with Chronic Kidney Disease: A Single Center Study in Lahore, Pakistan

Mubashir Dilawar — 2024-08-15

Objective: To determine the prevalence of abdominal aortic calcification in patients diagnosed with chronic
kidney disease stage III to V.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was carried out at the Department of Nephrology, Fatima Memorial
Hospital Lahore, Pakistan from December 2022 to December 2023.
Methods: A total of 295 patients diagnosed with chronic kidney disease stages III to V were included. The lateral view of the lumbar radiograph was carried out in the standing position. All the X-rays were confidentially
submitted to the Central Radiology Department where a consultant Radiologist interpreted the X-ray in the
light of the Abdominal Aortic Calcification Score. Significant Abdominal Aortic Calcification (AAC) was
designated as per the Operation ACC score interpreted and reported by the consultant Radiologist. Chronic
kidney disease (CKD) and Aortic Calcification were designated.
Results: Abdominal aortic calcification was found in 89 (30.17%) patients. Male gender was significantly
associated with the presence of abdominal aortic calcification (χ2 = 50.019, df = 1, P-value 0.001).
Conclusion: We concluded that there is a moderately high frequency (30%) of abdominal aortic calcification in
patients with chronic kidney disease.

Comparative Analysis of Pathological Cardiotocography as Predictor of Adverse Perinatal Outcome among High-Risk Pregnancy Group

Alishba Naeem — 2024-08-15

Objective: Determination of the frequency of pathological cardiotocography in laboring women with high-risk
pregnancies and to compare perinatal outcomes with and without pathological CTG among them.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: The study was conducted at the Gynecology Department, Combined Military
Hospital (CMH) Lahore, Pakistan from March 2023 to September 2023.
Methods: A total 75 women with high-risk pregnancies were included in this cross-sectional comparative study.
Women were selected by consecutive nonprobability sampling techniques. Adverse perinatal outcomes were
assessed in terms of stillbirth, cesarean section, low Apgar score, neonatal mortality, and morbidity. Statistical
Package for Social Sciences (SPSS) version 25 was used for data analysis. Quantitative variables like age, parity,
gestational age, and Apgar score were presented as mean± SD. Frequency and percentage were used for
qualitative variables like high-risk illness, pathological CTG finding, cesarean section, stillbirth, neonatal
mortality, and neonatal intensive care unit admission. Two groups were compared by using Chi-square test.
Data stratification was done for age and gestational age. P-value ≤0.05 was considered as significant.
Results: A mean age of 28.0±4.1 years was found in included women. Pathological CTG was found in 28 cases
(37.3%). The adverse perinatal outcome was found significantly higher in a group with pathological CTG
(P≤0.005).
Conclusion: The relationship and frequency of pathological CTG in high-risk pregnancies should be timely
determined to get good maternal and fetal outcomes. Women with pathological CTG, are at great risk of
caesarean section with rising trends of low Apgar score at birth, increased rate of NICU admission, and
mortality.

Study of Efficacy and Acceptability of Levonorgestrel-Releasing Intrauterine Device in Heavy Menstrual Bleeding Patients

Robina Kousar — 2024-08-15

Objective: To determine the efficacy and acceptability of levonorgestrel-releasing intrauterine device (LNGIUD)
in females with heavy menstrual bleeding (HMB).
Study Design: A Quasi-experimental study design.
Place and Duration of Study: The study was conducted at the Obstetrics and Gynecology Department of Pak
Emirates Military Hospital (PEMH) Rawalpindi, Pakistan for a duration of 6 months from November 2022 to
April 2023.
Methods: A total of 96 patients accomplishing the selection criteria were enrolled after taking written informed
consent after the screening, LNG-IUD was inserted in all participants and patients were followed up till the 6th
menstrual cycle and outcomes (like having less bleeding or amenorrhea, improvement in hemoglobin,
improvement in doing daily tasks, etc.) were assessed.
Results: The mean age of the females was 38.08±5.83 years. Efficacy of treatment was seen in 64 (66.7%)
females, and acceptability was seen in 61 (63.5%) females. In terms of side effects, spotting occurred in 17
(17.7%) patients, amenorrhea in 3 (3.1%) patients, oligomenorrhea in 4 (4.2%) patients, weight gain in 6 (6.3%)
patients, breast heaviness in 3 (3.1%) patients, 3(3.1%) females had mood fluctuations and 2 (2.1%) had
depression.
Conclusion: For treating females with HMB, LNG-IUD was efficacious in 66.7% of females and acceptable in
63.5% of females.

Endoscopic Transcanal Surgery versus Endaural Microscopic Surgery in the Management of Attic Cholesteatomas at a Tertiary Care Center in Multan

Sanaullah Bhatti — 2024-08-15

Objective: To compare postoperative outcomes in terms of hearing recovery, taste abnormalities and pain, and
audiological results of microscopic surgery and endoscopic surgery for the management of attic cholesteatomas.
Study Design: A prospective cohort study design.
Place and Duration of Study: The study was conducted at the ENT Department, Bakhtawar Amin & Nishtar
Medical Hospital Multan, Pakistan from June 2021 to December 2022.
Methods: A total of 90 patients were included by consecutive sampling, who were consecutively divided into 45
patients each in group A, microscopic endaural approach arm, and group B, endoscopic surgical approach arm.
The sample size was calculated by Epi Info keeping 50% population proportion, 5% margin of error, and 95% CI.
Patients diagnosed with cholesteatoma in epitympanum by otomicroscopic findings and CT and booked for
surgical treatment were included in the study. Patients with extended cholesteatoma, labyrinth fistulae, wide
mastoid involvement eustachian tube dysfunction, revision surgery, and pregnant women were excluded.
Informed consent of the participants was taken. Microscopic and endoscopic surgeries were performed by an
experienced operator. Patients were followed up after 1st, 3rd, and 6th months of surgery.
Results: Postoperatively, dizziness occurred in 4 (8.8%) patients in microscopic surgery groups and 3 (6.6%)
patients in endoscopic surgery group. Abnormal taste sensation was reported in 16 (35.5%) patients in Group A
and 12 (26.6%) patients in Group B. In terms of post-operative pain, 9 (20%) patients and 6 (13.3%) had
postoperative pain requiring analgesics (P= 0.3) in respective groups. The graft success rate in group A was
93.3% and in group B was 91.1%. The mean healing time in group A was 32.1 days and in group B was 34.7 days
(P= 0.5). Postoperatively, 55.5% of patients in the MES group and 51.1% in the endoscopic ear surgery (EES)
group had a hearing threshold between 21-30 decibels.
Conclusion: Both endoscopic endaural and microscopic approaches have similar outcomes for surgical
management of attic cholesteatomas in terms of hearing improvement, post-operative pain, and healing times.

Comparison of Frequency of Postpartum Hemorrhage in Spontaneous versus Prostaglandin Induced Labour at Term Gestation

Sumaira Mubasher — 2024-08-15

Objective: To compare the frequency of postpartum haemorrhage in spontaneous versus induced labor at
term.
Study Design: A comparative cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynecology,
Benazir Bhutto Hospital Rawalpindi, Pakistan from April 2021 to March 2022.
Methods: A sample size of 108 women fulfilling inclusion criteria was categorized into two equal groups of 54;
Group-A spontaneous onset of labor (SOL) and Group-B of induced labor with prostaglandin (IOL). Both groups
were analysed for the frequency of postpartum haemorrhage PPH. Also, the association was checked by using
Pearson Chi-square test of significance and t-test for comparing means. A P-value of ≤ 0.05 was considered as
significant.
Results: The mean age of women in Group-A vs Group B was 26.78±4.78 years vs 25.96±4.70 years. Mean
gestational age was 38.33±0.97 weeks vs 38.72±1.02 weeks. Multigravida (67%) were more than primigravida
(33%). Postpartum haemorrhage was seen more in Group-B 24 (44.4%) compared with Group-A 11 (20.4%),
with a significant P-value (P = 0.008). The mean estimated blood loss (EBL) was higher in Group-B
(675.00±420.41 ml) than in Group-A (442.78±279.25 ml) with a significant P-value (P = 0.003). EBL in each group
was cross checked by Haematocrit levels (%Hct) and mean value of %Hct was decreased post- delivery in
women with postpartum hemorrhage. Consequently, blood transfusions were more in Group-B 16 (29.6%)
than Group-A 9 (16.7%). Upon stratification for parity, the rate of PPH was higher in multigravida. The secondary
maternal outcomes like; prolonged second stage of labour, uterine atony and retained placental tissues were
also more in Group-B.
Conclusion: The induction of labor is associated with a significant risk of postpartum hemorrhage and should be offered only when it is deemed necessary.

Association of Serum Albumin Levels with Severity of Illness in Patients with Dengue Fever at Margalla Institute of Health Sciences Islamabad

Muhammad Afzal — 2024-08-16

Objective: To identify the association of serum albumin levels with the severity of illness in patients diagnosed
with dengue fever
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Medicine Department of Margalla Institute of
Health Sciences Islamabad, Pakistan from July 2022 to June, 2023.
Methods: A total of 82 diagnosed cases of dengue fever were included in the study. All the baseline
investigations were done including serum albumin at the time of diagnosis. The severity of the illness was
determined on the basis of platelet counts during the first week of illness. The association of various sociodemographic factors including albumin levels was determined with the severity of illness in the study
participants.
Results: The mean age of study participants was 32.6±8.71years with 56 (68.3%) were males and 26 (31.7%)
were females. Out of 82 dengue fever patients, 61 (74.4%) had mild illness while 21 (25.6%) had severe form of
dengue fever. 53 (64.6%) had normal albumin levels while 29 (35.4%) had deranged albumin levels. Pearson chi square analysis revealed that deranged albumin levels and wide pulse pressure had statistically significant
relationship with presence of severe dengue fever in our study participants (P-value<0.001).
Conclusion: Patients with deranged albumin levels and wide pulse pressure during the course of illness were
more at risk of having severe dengue fever.

Laparoscopic vs Open Appendectomy: Surgical Outcomes with Early Recovery and Length of Hospital Stay - A Comparative Study in Rawalpindi, Pakistan

Naeem Yousaf — 2024-08-15

Objective: To compare the surgical outcomes in terms of recovery and complications of laparoscopic versus
open appendectomy in patients presenting to tertiary care hospitals in Rawalpindi.
Study Design: Prospective comparative study.
Place and Duration of Study: The study was conducted at the Department of Surgery at Combined Military
Hospital (CMH) Rawalpindi, Pakistan from 1^st July 2022 to 31^st December 2022.
Methods: Seventy patients with clinically and radiologically confirmed acute appendicitis were segregated by
lottery method into two equal groups of 35 each. Patients undergoing open appendectomy (OA) were placed in
Group A, those planned for laparoscopic appendectomy (LA) were placed in Group B. Pre and postoperative
outcomes, including Alvarado score, operating time, postoperative pain, and hospital stay documented and
compared between the groups.
Results: A mean age of 28.40 ± 6.73 years in the open appendectomy group and 29.06 ± 9.84 years in the
laparoscopic appendectomy group was noted (P=0.745). The mean Alvarado score was 7.29 ± 0.95 in Group A
and 6.86 ± 1.16 in Group B (P=0.098). A statistically significant difference was noted in the mean operation time
of 67.29 ± 9.67 minutes for open appendectomy versus 38.77 ± 8.67 minutes for laparoscopic appendectomy (P
< 0.05). The mean hospital stay was shorter for laparoscopic appendectomy, with 1.51 ± 0.61 days compared to
2.00 ± 0.54 days for open appendectomy (P<0.001).
Conclusion: Laparoscopic appendectomy offered intra- and post-operative advantages like less operating time,
shorter hospital stays, and quicker resumption of normal activities.

Mediating Role of Self-Objectification between Emotional Maturity and Psychological Distress in Pakistani Women

Kiran Tariq Malik — 2024-08-15

Objective: The present research intended to find the association among emotional maturity, selfobjectification,
and psychological distress in Pakistani women. It also aimed to investigate the mediating role of
self-objectification between emotional maturity and psychological distress.
Study Design: Correlational research.
Place and Duration of Study: The study was conducted at the Department of Clinical Psychology, Riphah
Institute of Clinical and Professional Psychology Lahore, Pakistan from March 2020 to June 2020.
Methods: A sample of 153 women was recruited from all over Pakistan and data was collected through an
online Google Forms link. The emotional maturity scale, objectified body consciousness scale, depression
anxiety stress scale, and demographic sheet were used for assessing the target study variables.
Conclusion: Findings revealed that emotional maturity and self-objectification were significantly positively
correlated with psychological distress. It was observed that emotional maturity predicts psychological distress
(depression, anxiety, stress). Whereas, the self-objectification subscale (body shame) predicts psychological
distress (stress). Moreover, body shame mediates the relationship between emotional maturity and
psychological distress (stress).

Dental Problems Present among Healthcare Professionals in Pakistan due to the Consumption of Carbonated Drinks

Asma Shakoor — 2024-08-15

Objective: To comprehend the association between frequencies of consumption of carbonated drinks and oral
complications as well as to recognize the practices of healthcare workers regarding intake of carbonated drinks.
Study Design: A descriptive cross-sectional study.
Place and Duration of Study: The study was conducted at Department of Community and Preventive Dentistry,
CMH-Lahore Medical College and Institute of Dentistry Lahore, Pakisttan from October 2021 to May 2022.
Methods: The study was conducted on recognized MBBS, BDS, and Allied Health Science healthcare
professionals from urban and rural areas of Pakistan. A pre-tested questionnaire was filled out by 1930
healthcare workers from government and private setups. Frequency and cross-tabulation analysis was done to
obtain chi-squared results and P values.
Results: Almost 90.6% of respondents were consumers and 9.3% weren't or had stopped consumption. From
the daily consumers 85% had cavities, 84% had sensitivity . 97% of them had discoloration and 87% had erosion.
It was found that increased frequency of consumption caused more of the above-mentioned dental effects and
the P-value was found to be significant.
Conclusion: This study suggests that increased frequency of consumption can cause cavities, sensitivity,
discoloration, and erosion of teeth. There is a need to create awareness among the general public by healthcare
givers, about the injurious effects of carbonated drinks.

Potassium Disorders in Diabetic Patients with Chronic Kidney Disease and Poor Glycemic Control Associated with Hyperkalemia: A Single Center Cross-sectional Study

Mehwish Qamar — 2024-08-15

Objective: To determine the incidence of hyperkalemia in diabetic patients with chronic kidney disease (CKD).
Also, to establish the effect of blood sugar control and duration of DM and CKD on the development of
hyperkalemia in this group of patients.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at Nephrology Outpatient Department (OPD), Liaquat
National Hospital Karachi, Pakistan over one year from January 2022 to December 2022.
Methods: Data were collected from endocrine and nephrology outpatient departments. Blood analysis was
performed for serum potassium, HbA1C level, and serum creatinine level. SPSS version 21 was used to analyze
the data.
Results: One hundred and fifty-six (156) patients were included in this study. Ninty (90) patients were males &
66 patients were females. Hyperkalemia was noted in ninety patients (57.6%) with a serum potassium level of
5.8±0.1 mg/dl in these patients and was seen predominantly in male patients. The mean HbA1c level was
9.288+1.185%. However, no significant relationship between the duration of diabetes and hyperkalemia was
found. Most patients had stage IV CKD. Also, hyperkalemia is most commonly seen in stage IV CKD followed by
stage V CKD. No significant relationship between the duration of CKD and hyperkalemia was found. Sixty-five
percent (65%) of patients were taking medications that could lead to hyperkalemia and ACE/ARB were the most
commonly used drugs followed by NSAIDs and diuretics.
Conclusion: Patients with diabetes mellitus with CKD were found at significantly increased risk of hyperkalemia
importantly, patients with stage IV &V CKD and those who had poor glycemic control.

Speaking in the Lingua Franca of Patients: Nurses' Perspective on Language Concordant Care

Salma Naz Khattak — 2024-08-15

Objective: The research endeavors to investigate nurses' perspectives regarding the delivery of languageconcordant care to patients with diverse lingua franca, while also pinpointing the language obstacles that hinder effective communication in the provision of quality healthcare.
Study Design: A qualitative descriptive study.
Place and Duration of the Study: The study was conducted at soldier family ward Military Hospital (MH)
Rawalpindi, Pakistan, from January 2023 to May 2023.
Methods: Thirteen nurses working in family ward of a Military Hospital in Rawalpindi were selected as
participants who have working experience of 8-10 years. Semi-structured interviews were carried out in Urdu,
audiotaped and later translated into English and transcribed verbatim. Manual thematic analysis was carried
out to address the study objectives.
Results: The five main themes are antecedents of language barriers, repercussions of language barriers,
momentousness of patient's lingua franca, provision of language-concordant care, and linguistic
empowerment.
Conclusion: Language barriers can impede nurses' ability to communicate effectively with their patients in any
location, which can result in inadequate, delayed, unsafe, and ineffective care delivery to meet patients' needs.

Role of Nasal Splints in Prevention of Nasal Adhesions following Septal Surgery at CMH Lahore: A Comparative Cross-Sectional Study

Anam Asif — 2024-08-15

Objective: To compare the incidence of nasal adhesion formation following nasal surgery in patients of DNS
(Deviated Nasal Septum) with and without postsurgical application of nasal splints with long-term follow-up.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: This study was carried out at the Department of ENT, Combined Military Hospital
(CMH) Lahore, Pakistan from July 2020 to July 2021.
Methods: Sixty patients between the ages of 18 and 60 with deviated nasal septum who got corrective Septal
Surgery were incorporated in this study. They were divided into two equal groups for analysis: Group I – where
splints were placed in both nostrils of patients, and Group II – In which no splints were placed. The removal of
nasal splints typically occurs on the 10th day after surgery. Both nasal cavities of patients of both groups were
examined two weeks postoperatively and then after 02 months, the absence or presence of adhesions was
noted.
Results: In Group I patients who were given intra-nasal splints, 1 (3.330%) out of 30 developed nasal adhesions
whereas 29 (96.7%) did not develop nasal adhesions. However, in Group II patients who were not given nasal
splints, 6 out of 30 (20.0%) patients developed nasal adhesions while 24 (80%) were observed to have no
formation of nasal synechiae with a P-value of 0.044.
Conclusion: The study concluded that the use of nasal splints in patients undergoing septal surgery significantly reduces the incidence of adhesion formation in post-operative septal surgery patients, compared to those without nasal splints.

Tympanoplasty: A Comparative Cross-sectional Study to Assess the Predictors of Surgical Success at a Tertiary Care Setting in Karachi

Tahira Ikram — 2024-08-15

Objective: To determine the factors that could affect the success of tympanoplasty and the surgical outcomes
at a tertiary care hospital in Karachi.
Study Design: Comparative cross-sectional study design.
Place and Duration of Study: The study was carried out at the Department of ENT, Head and Neck Surgery, Dow University of Health Sciences, Dr. K.M Ruth Pfau Civil Hospital Karachi, Pakistan from January 2021 to January 2022.
Methods: Fifty-two patients with chronic otitis media without cholesteatoma (COMNC) who had
tympanoplasty (underlay, inlay with graft) were included in this study. The examiner assessed the patients by
assessment protocol that included patients who presented signs and symptoms with NCCOM with detailed
history taking, a targeted physical exam (Rhinoscopy and otoscopy), nasofibroscopy, an audiogram, and video
documentation via video-otoscopy to better visualize the tympanic membrane perforation. Descriptive
statistics were applied to all parameters. The parameters under investigation were compared by using the chisquare test, and the Whitney U test or the Wilcoxon Rank Sum Test statistical were used for stratification
considering P-value ≤ 0.05 as significant.
Results: Tympanic membrane perforations were significantly affected by factors such as age, location, and size
of the perforation, number of ear infections per year, family history of hearing loss and otorrhea, history, the
status of tympanic cavity, graft type, Surgery success rate, the graft, technique, or access used. The closure
success rate was 73.1%.
Conclusion: Our study concluded that the factors that interfere with tympanic membrane restoration were
statistically significant. After the initial surgery, the closure success rate was 73.1% with audiometric Gain.

Feeling Safe: A Comprehensive Systematic Literature Review of Psychiatric Disorders through the Lens of Polyvagal Theory

Iram Mansoor — 2024-08-16

Safety on a psychological level is progressively renowned as fundamental to mental health issues and
psychological well-being. The concept of feeling safe based on polyvagal theory, proposed by Stephen Porges
(2011), has emerged as a comprehensive structure for understanding the autonomic nervous system's role in
regulating social behavior, emotional processing, and physiological reactions. This review aims to explore the
application of polyvagal theory in the understanding of psychiatric disorders, with a focus on how autonomic
nervous system dysregulation influences emotional and behavioral manifestations, thereby contributing to the
development of effective therapeutic interventions aimed at enhancing feelings of safety and well-being in the
patients suffering from psychiatric disorders. The systematic literature review technique based on the PRISMA
model was used for this purpose. Sources were obtained through PubMed, APA PsycArticles, PLOS, Research
Gate, Google Scholar, and PubMed Central (PMC) database, using different keywords as the primary descriptor
and limiting the sources to English-language articles published in the last ten years from 2013 to 2023. The
review synthesized findings from various studies investigating the association between the polyvagal theory
and psychiatric disorders, including anxiety disorders, depression, psychotic disorders, post-traumatic stress
disorder (PTSD), borderline personality disorder, and childhood disorders including conduct disorder, attention
deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The results exhibit that individual
suffering from these psychiatric disorders frequently displayed autonomic nervous system dysregulation, as
proposed by the polyvagal theory, which seems to be a shared feature in many psychiatric disorders. The
systematic review highlighted the significance of physiological aspects of mental health and indicates that
interventions focusing on autonomic regulation may hold the potential to assuage the basic symptoms relevant
to psychiatric disorders. Additional research work is defensible to clarify the primary mechanisms and improve
the implication of interventions which are based on polyvagal theory for better clinical outcomes.

AI Integration in MCQ Development: Assessing Quality in Medical Education: A Systematic Review

Fizzah Ali — 2024-08-16

This systematic review focuses on examining how artificial intelligence is included in multiple-choice questions
and how this affects the efficacy and quality of assessments used in education. Several papers investigating the
application of artificial intelligence in multiple-choice question creation have been found through a thorough
literature analysis. The present study employed a systematic literature review to comprehensively analyze the
existing literature and underscore the effects of incorporating artificial intelligence into creating multiplechoice
questions on the standard and efficacy of assessments used in education. Between January 2019 and
January 2024, we examined papers from credible publications, concentrating on sixteen chosen articles for indepth examination. The results show how artificial intelligence can revolutionize traditional evaluation
methods in education by improving the accuracy, efficiency, and diversity of multiple-choice questions. While
artificial intelligence models like ChatGPT, Bard, and Bing have shown encouraging results in creating multiplechoice questions, issues with validity, complexity, and reasoning ability still need to be addressed.
Notwithstanding its drawbacks, artificial intelligence-driven multiple-choice question holds great potential for
enhancing evaluation processes and enhancing educational opportunities in a variety of subject areas. This
Systematic review highlights the necessity of further research and advancement to fully utilize artificial
intelligence in creating multiple-choice questions and its incorporation into frameworks for educational
assessments.