Life and Science

Mpox and Neglected Tropical Diseases in Pakistan: A Growing Planetary Health Concern

Wasim Alamgir, Hina Shan — Thu, 21 Nov 2024 14:23:52 +0500

Aug 14, 2024, was the day the World Health Organization (WHO) announced, mpox (previously known as
monkeypox) as a Public Health Emergency of International Concern (PHEIC-2024).¹ While mpox undoubtedly
remains a global public health problem, neglected tropical diseases (NTDs) such as dengue, chikungunya,
rabies, snake bite, and leishmaniasis, listed among the 20 NTDs by WHO, predominate in Pakistan. The fragile
health system of Pakistan, overwhelmed for the past decades by infectious diseases such as tuberculosis and
malaria, further worsened due to the COVID-19 pandemic. The synchronal rise of mpox, dengue, and
chikungunya infections is posing increasing concerns for the population and healthcare system further straining the economy's capacity to respond effectively.

Mpox is a zoonotic infection caused by the monkeypox virus (MPVX), an orthopoxvirus in the same genus as the
variola virus, which is the causative agent of smallpox and, vaccinia virus (the virus used in the smallpox
vaccine).¹ Mpox has two clades, Clade I (Central Africa) and Clade II (West Africa). Clade I, which was recently
reported from Sweden, is more contagious and has a higher fatality rate (10%), raising global health concerns.
The figures show that the global mpox count in 2024 surpassed last year's with 15,600 cases and 537 deaths.¹
Integrated Disease Surveillance & Response (IDSR), NIH, Islamabad, Pakistan has recorded a total of 14 travel
related cases including one death (co-infection of HIV). All confirmed cases in Pakistan have been identified as
the Clade IIb strain, and no evidence of local transmission has been documented. A worrying aspect of mpox is
that no antiviral treatment is currently available for mpox and the initial clinical trials of the antiviral
'Tecovirimat' are not very promising against Clade Ib.1 Moreover, controlling mpox infections in the younger age groups is particularly challenging as vaccination is not recommended for individuals that are 15 and under. This poses a grace concern as mpox infection is known to cause higher mortality in children younger than 15 as was reported in the Democratic Republic of Congo. Pakistan currently doesn't have the availability of the mpox
vaccine, making it inaccessible for those in need.

Another endemic NTD that accounts for a huge burden of disease in Pakistan is rabies. Human infections are
mostly due to dog bites and cases are diagnosed on clinical grounds only. Pakistan ranks in the top five countries globally in rabies-related mortality, with an estimated 2700-5000 deaths attributed to rabies in Pakistan.

Dengue fever is yet another daunting health threat in Pakistan. About half of the world's population is at risk of
dengue with an estimated 100–400 million infections annually.² In 2024, dengue cases surged globally, with the
WHO reporting over 7.6 million cases by April, including 3.4 million confirmed cases, 16,000 severe cases, and
more than 3,000 deaths. Re-infection with a different dengue serotype increases the risk of severe illness,
adding to the complexity of the outbreak.² Pakistan faces a critical public health emergency, with 2,800 new
dengue cases reported in September 2024, mostly in Baluchistan. Since May 2024, Karachi has experienced a
surge in mosquito-borne infections, including dengue and chikungunya. The situation is being exacerbated by
inadequate sanitation, optimal monsoon weather for mosquito breeding, prolonged heat waves, inadequate
vector control measures, as well as contributing factors such as climate change, increased vector abundance
(primarily Aedes aegypti and Aedes albopictus mosquitoes), and population movements.^2,3 Both diseases are
transmitted by Aedes mosquitoes, also vectors for Zika and yellow fever. Thankfully, despite the presence of the
vector, Pakistan remains free of yellow fever and Zika cases.

Strengthening surveillance systems and training healthcare workers to ensure timely identification and management of mpox and other NTDs are crucial. The interconnected efforts for healthy ecosystems and
communities are essential for resilience in the face of environmental challenges. By actively addressing climate
change, we can enhance planetary health and ensure a sustainable future for all. Collaborative initiatives that
involve governments, communities, and individuals will be crucial in achieving these goals. Strong advocacy
and resource mobilization at national and global levels are essential to secure funding for outbreak
preparedness, support the stockpiling of medical supplies, and reinforce public health measures. A
multisectoral approach is required to tackle the rise in mpox and NTDs which remains a persistent challenge not only for Pakistan but also for planetary health. Despite the grim circumstances, there are positive
breakthroughs, such as the recent success in eliminating trachoma, a long-standing NTD in Pakistan. This is a
promising development for Pakistan, the 19^th country to reach this milestone. The trachoma elimination
reflects the government's commitment, WHO's support, and the contributions of partners and communities.
Eliminating one disease is an achievement that reinforces our optimism in working towards controlling NTDs in
the future for the well-being of our planet and all its inhabitants.

Editor-in-Chief

How to cite this: Alamgir W, Shan H. Mpox and Neglected Tropical Diseases in Pakistan: A Growing Planetary Health Concern. Life and Science. 2024; 5(4): 431-432. doi: http://doi.org/10.37185/LnS.1.1.835

Bacterial Diversity and Their Antimicrobial Susceptibility Patterns in Diabetic Foot Infections, a Tertiary Care Hospital Study

Thu, 21 Nov 2024 14:38:17 +0500

Objective: To determine the frequency of bacterial pathogens and their antimicrobial profile in diabetic foot
infections.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Microbiology, Combined Military
Hospital (CMH) Lahore, Pakistan from January 2022 to December 2022.
Methods: Three hundred and forty-one samples with a history of diabetic foot infections were processed.
Antibiotic susceptibility testing was done using the Kirby-Bauer Disk Diffusion technique for the commonly
used antibiotics. Clinical and Laboratory Standard Institute Guidelines (CLSI) 2022 were used to interpret the
result of susceptibility testing.
Results: Three hundred and forty-one clinical samples with bacterial isolates causing diabetic foot infections
were processed. The most common organism isolated was Pseudomonas aeruginosa (25.5%). Gram-positive
isolates where found most susceptible to vancomycin and linezolid while gram negative was most sensitive to
meropenem.
Conclusion: In the current study gram-negative bacteria were found to be the main pathogens. Effective
antibiotic therapy based on microbiological profiles will definitely improve clinical outcomes.

How to cite this: Hussain C, Farooque MA, Ain Q, Khan SH, Younas A, Huma Z. Bacterial Diversity and Their Antimicrobial Susceptibility Patterns in Diabetic Foot Infections, a Tertiary Care Hospital Study. Life and Science. 2024; 5(4): 433-438. doi: http://doi.org/10.37185/LnS.1.1.633

Suboptimal Health Status and Stress: An Observational Study on Medical Students in Islamabad, Pakistan

Thu, 21 Nov 2024 14:44:56 +0500

Objective: This study was conducted to find the frequency of suboptimal health and its association with
perceived stress levels among medical students at a private university medical college in Islamabad, Pakistan.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Community Medicine,
Foundation University Medical College Islamabad, Pakistan over a period of 6 months from February 2024 to
July 2024.
Methods: A total of 210 medical students were randomly selected. They were asked to fill in questionnaires.
Data on demographic profile, Suboptimal health status using (SHSQ-25) tool, and stress using the perceived
stress scale (PSS-10) were obtained. SPSS version 20 was used to enter and analyze the data.
Results: The frequency of sub-optimal health status was (50%, 105/210). The majority of students (80.0%) had
moderate levels of perceived stress. Mostly females (82.4%) and day scholars (85.2%) reported moderate levels
of stress. A weak positive correlation between SHS and stress was found. (P<0.005). The hostelites were twice
as likely to have suboptimal health status as compared to day scholars (OR 2.040, CI= 1.157- 3.598). However,
males have no more odds of suffering from SHS as compared to females (OR =1.393, CI=0.788-2.463).
Conclusion: Suboptimal health status was frequently found among medical students in the study sample.
Suboptimal health status and perceived stress have a statistically significant relationship.

How to cite this: Iqbal M, Masood S, Arshad M, Eman M, Ali S, Ramzan M, Shafique O, Ahmad AY, Nauman A, Azam N. Suboptimal Health Status and Stress: An Observational Study On Medical Students in Islamabad, Pakistan. Life and Science. 2024; 5(4): 439-445. doi: http://doi.org/10.37185/LnS.1.1.470

Factors Predicting Uterine Rupture Following a Cesarean Section

Shehla Tabassum, Bushra Khan, Hina Zahra Qureshi, Humaira Imran — Thu, 21 Nov 2024 00:00:00 +0500

Objective: This study was conducted to evaluate factors that predict uterine rupture following a previous
cesarean section.
Study Design: A cross-sectional study.
Place and Duration of Study: The Study was conducted at the Department of Gynecology, Bakhtawar Amin
Hospital Multan, Pakistan from June 2022 to June 2023.
Methods: The study included 100 women who had previously given birth. Women who had a successful vaginal
birth after cesarean section (VBAC) were controls and who had rupture/scar dehiscence were considered
cases. Socio-demographic data and information related to delivery, labor, and pregnancy were collected.
Results: A total of 100 women (40 cases and 60 controls) were included in the study. All women had
spontaneous onset of labor. 12.5% (8) cases and 85% (51) controls had a successful vaginal birth after the
cesarean section (VBAC). 34.1% of all rupture cases happened during the second stage of labor and 41.4%
during the latent phase of labor. Upon arrival 30% (12) of cases had shock. Maternal complications in cases
included anemia (21 patients), death (2 patients), uterine artery involvement (3 patients), and bladder rupture
(4 patients). According to multivariate analysis factors including previous vagina delivery, duration of labor, fetal
weight, and number of ANC visits were significantly related to rupture of uterus after previous cesarean (P<.05).
Conclusion: Factors including prolonged labor, lesser antenatal care follows ups, and fetal weight > 3.8 kg
increase the likelihood of uterine rupture following a C-section. It is crucial to develop strict criteria, considering
intrapartum obstetric care, infrastructure, and referral system, for the selection of favorable candidates for trial
of labor.

How to cite this: Tabassum S, Khan B, Qureshi HZ, Imran H. Factors Predicting Uterine Rupture Following a Cesarean Section. Life and Science. 2024; 5(4): 446-451. doi: http://doi.org/10.37185/LnS.1.1.540

Efficacy of 2% Coal Tar in Petroleum Jelly Over Plain Petroleum Jelly (Emollient) in The Treatment of Atopic Dermatitis in Pediatric Population

Muhammad Erfan; Uzma Ali, Wajiha Sajid, Tahir Mukhtar Sayed, Haseeb Noor — Thu, 21 Nov 2024 15:07:10 +0500

Objective: The study was performed to evaluate the efficacy of topical 2% coal tar in petroleum jelly as
compared to plain petroleum jelly (Emollient) in the management of mild to moderate atopic dermatitis in
children 1 to 16 years of age.
Study Design: Quasi-experimental study design.
Place and Duration of Study: The study was carried out at the Department of Dermatology, Capital Hospital
Islamabad, Pakistan over a period of six months, from January 2023 to July 2023.
Methods: A total of 68 patients, 34 in each group who fulfilled the inclusion criteria were enrolled in this study.
Group- A received topical 2% coal tar in petroleum jelly while Group B was only administered plain petroleum
jelly, twice daily for 12 weeks. The response was recorded using the eczema area severity index (EASI) and then
analyzed using Statistical Package for the Social Sciences version 20.
Results: The mean age and the duration of disease in Group-A was 6.8±4.8 years & 27.9±28.0 months
respectively, while it was 4.9±3.7 years & 20.9±18.2 months in Group-B. Males were predominant in Group-B
n= 21 (61.8%), while males and females were equal in Group-A n=17 (50%). Final analysis at 12 weeks
comparing the EASI revealed that treatment of Group-A (52.9%) was more effective than Group-B (17.7%). The
difference being statistically significant (P=0.002).
Conclusion: Topical 2% coal tar in petroleum jelly was more effective than petroleum jelly alone in treating mild
to moderate AD in the pediatric population.

How to cite this: Erfan M, Ali U, Sajid W, Syed TM, Noor H. Efficacy of 2% Coal Tar in Petroleum Jelly Over Plain Petroleum Jelly (Emollient) In The Treatment of Atopic Dermatitis in Pediatric Population. Life and Science. 2024; 5(4): 452-458. doi: http://doi.org/10.37185/LnS.1.1.545

Frequency of Diabetic Nephropathy in Type 2 Diabetic Patients Using Spot Urine ACR and Its Associated Risk Factors

Fri, 22 Nov 2024 00:00:00 +0500

Objective: To determine the frequency of diabetic nephropathy in type 2 diabetic patients using spot urine ACR
ratio and identify its associated risk factors.
Study Design: Descriptive, cross-sectional study.
Place and Duration of Study: This research was carried out at the Department of Medicine, Muhammad
Teaching Hospital (MTH) Peshawar, Pakistan from February 01, 2023, to July 31, 2023.
Methods: A total of 150 patients having type 2 diabetes mellitus were investigated. The sample size was
calculated with a WHO sample size calculator using a reference study with a 10.8% prevalence of diabetic
nephropathy in individuals with type 2 diabetes mellitus; confidence interval = 95% and the margin of error was 5%.
Results: With an SD ± 5.146, the mean age was 49 years old. There were 87 (58%) females and 63 (42%) males
present. Out of 150 individuals, the spot urine ACR was analyzed. Of these, 47 (31%) had microalbuminuria (less
than 300 mg/m) while, 28 patients (19%) had macroalbuminuria (more than 300 mg/m), whereas end-stage
renal disease was found in 6 (4%) with GFR < 30 ml/m -1.73 m2. A study was conducted on 150 individuals to
determine the status of diabetic nephropathy. Of these, 81 (54%) had diabetic nephropathy and 69 (46%) did
not.
Conclusion: Using the spot urine ACR ratio, our study suggests that 46% of type-2 diabetic patients had diabetic
nephropathy. The incidence was 24% in people with diabetes for 5–10 years and 26% in patients with diabetes
for 11–15 years. Patients with diabetes for 16 to 20 years had a 50% incidence. In conclusion, those with
diabetes for a longer period are at a much greater risk of diabetic nephropathy.

How to cite this: Ullah A, Kausar SAZ, Ayaz M, Khan MS, Ullah S, Saeed RF. Frequency of Diabetic Nephropathy in Type 2 Diabetic Patients Using Spot Urine ACR and Its Associated Risk Factors. Life and Science. 2024; 5(4): 459-464. doi: http://doi.org/10.37185/LnS.1.1.805

Antibody Response of COVID-19 Vaccine in Subjects after Renal Transplantation - A Case Control Study

Fri, 22 Nov 2024 00:00:00 +0500

Objective: To evaluate the immune response to COVID-19 vaccination in patients after renal transplantation.
Study Design: A case-control study.
Place and Duration of Study: The study was conducted at the Kidney Transplant Department, Shaikh Zayed
Hospital Lahore, Pakistan from September 2020 to September 2021.
Methods: A total of 180 renal transplant recipients who had received a third dose of the Pfizer vaccine were
selected for the study. The patients were evaluated before and after vaccine administration for seropositivity
and anti-spike antibody levels. The results were compared with a control group of 50 healthy controls. T-cell
response was assessed in only 50 transplant recipients.
Results: 50 (27.7%) KTRs and 48 (96%) controls achieved optimum antibody level (4160 AU/ml) (P<.001). All
(100%) of the controls were seropositive after 3rd dose. Among kidney transplant recipients (KTRs), there was a
significant increase in the median anti-spike antibody level from 13.7 AU/ml before to 515.46 AU/ml after the
3rd dose (P< .001). There also was a significant increase in log-transformed antibody level after 3rd dose in both
the study and control group (P<.001). Of 50 randomly selected subjects, 6 (12%) showed positive T cell
response.
Conclusion: Pfizer vaccine improved antibody response in renal transplantation recipients.

How to cite this: Afzal U, Hussain M, Khan AI, Adnan M, Muzammil M, Ahmad I. Antibody Response of COVID-19 Vaccine in Subjects After Renal Transplantation - A Case Control Study. Life and Science. 2024; 5(4): 465-470. doi: http://doi.org/10.37185/LnS.1.1.508

Synergistic Effects of Coenzyme Q10 & L-Carnitine on Oligodendrocyte Necrosis and Myelination, in a Rat Model of Multiple Sclerosis

Fri, 22 Nov 2024 09:25:30 +0500

Objective: Determining the synergistic effect of Coenzyme Q10 & L-Carnitine on Oligodendrocyte necrosis and
Myelination, in a rat model of Multiple sclerosis.
Study Design: Laboratory based experimental study.
Place and Duration of Study: The study was conducted at the Department of Anatomy, Islamic International
Medical College Rawalpindi, Pakistan from March 2022 to May 2022 in collaboration with NIH Islamabad, for a
duration of 12 weeks.
Methods: A total of fifty male Sprague Dawley rats were divided into five randomized groups, each with a
distinct treatment plan. While Group 1 received a standard diet, the remaining four groups were induced with
Multiple Sclerosis and administered 0.2% Cuprizone (CPZ) over a period of 12 weeks. After four weeks, Group 3
was given 150 mg/kg/day of Coenzyme Q10/Ubiquinone (CoQ10), Group 4 received 100 mg/kg/day of LCarnitine (L-Car), and Group 5 was treated with a combination of both, all while still receiving CPZ. Upon
completion of the 12-week protocol, the rats were sacrificed, and their brains were extracted. H & E staining
was performed on coronal sections to assess any changes in oligodendrocyte necrosis, while Luxol Fast Blue
(LFB) staining was utilized to visualize alterations in myelination.
Results: The combination of CoQ10 and L-Car was significantly better than the single agents in controlling the
oligodendrocyte necrosis and controlling vacuolation of myelin, as evidenced by ANOVA and F-test.
Conclusion: This study has unequivocally demonstrated that taking CoQ10 and L-Car together has a greater
effect on promoting myelination and preventing oligodendrocyte necrosis compared to using them
individually. Therefore, it is highly recommended to prescribe both medications simultaneously for those with
multiple sclerosis, as it can potentially provide greater advantages for patients.

How to cite this: Qureshi T, Ali S, Shahid A, Beenish H, Khurshid T, Fahad T. Synergistic Effects of Coenzyme Q10 & L-Carnitine on Oligodendrocyte Necrosis and Myelination, In A Rat Model of Multiple Sclerosis. Life and Science. 2024; 5(4): 471-476. doi: http://doi.org/10.37185/LnS.1.1.547

Navigating Vascular Access Challenges in End-Stage Renal Disease: A Comprehensive Study of Ultrasonographic Guided Tunneled Hemodialysis Catheters

Fri, 22 Nov 2024 09:32:21 +0500

Objective: This study aims to assess the efficacy of Ultrasonographic Guided Tunneled Hemodialysis Catheters
in patients with ESRD. The primary objectives include assessing catheter placement success, blood flow
adequacy, and the prevention of catheter related blood stream infections.
Study Design: A cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Nephrology, Central Park Medical
College and Hospital Lahore, Pakistan from December 2022 to May 2023.
Methods: In this study, enrolled 40 end stage renal disease patients aged 20 to 60 years. Tunneled Hemodialysis Catheters (THCs) were inserted under ultrasonographic guidance, predominantly in the right internal jugular vein. Demographic and clinical data were recorded, and blood flow was assessed for dialysis adequacy. The study followed STROBE guidelines and obtained ethical clearance.
Results: Of the 40 patients, 50% were male, 85% had hypertension, and 87.5% had diabetes. Ultrasonography
guided Tunneled Hemodialysis Catheters were predominantly placed in the right internal jugular vein (55%)
with overall success rate of 100 percent. Mean blood flow was 317 ml/minute, and patients had a history of
4.29 ± 1.18 previous catheters. No CRBSIs were reported within the study period.
Conclusion: Ultrasonographic guided Tunneled Hemodialysis Catheters demonstrated effective placement,
adequate blood flow, and a notable absence of catheter related blood stream infections. The study contributes
valuable insights into the role of Tunneled Hemodialysis Catheters in ESRD care, emphasizing their significance
as an interim solution while awaiting arteriovenous fistula maturation.

How to cite this: Sikandar MZ, Javed M, Waheed MA, Khan AA, Amjad H, Moeen SMH. Navigating Vascular Access Challenges in End-Stage Renal Disease: A Comprehensive Study of Ultrasonographic Guided Tunneled Hemodialysis Catheters. Life and Science. 2024; 5(4): 477-481. doi: http://doi.org/10.37185/LnS.1.1.541

Ameliorative Effects of Grape Seed Proanthocyanidin Extract on Histomorphological Changes in Rat Mandible Induced by Intramuscular Injection of Botox in Masseter

Fri, 22 Nov 2024 00:00:00 +0500

Objective: This study was aimed to assess the histomorphological changes in rat mandible induced by injection
botox in masseter muscle and to assess the possible remedial effects of grape seed proanthocyanidin extract
(GSPE) on histomorphology of the rat mandibular condylar cartilage.
Study Design: Laboratory based experimental study.
Place and Duration of Study: This study was conducted at the Department of Anatomy and Pathology, Army
Medical College Rawalpindi, Pakistan from 16th June 2020 to 07th August 2020, with the collaboration of the
Military Hospital, Rawalpindi and the National Institute of Health (NIH), Islamabad.
Methods: Forty, healthy, female (non-pregnant) “Sprague Dawley rats”, 10 weeks of age with weight of 200-
250gm were selected and divided into four groups. Group A control, Groups B, C and D were experimental
groups. Group B was sham injected whilst group C and D were injected by botox in left masseter muscle. Group
D was treated with Grape seed proanthocyanidin extract for 1 month whereas rats from group B and C were
given saline solution as a vehicle. H&E and Toluidine Blue after decalcification of the mandible were used for
staining. Data was analyzed using the SPSS 23. The P-value of ≤0.05 was considered significant. One-way
analysis of variance was applied followed by Tukey's post-Hoc test to seek distinction of quantitative variables
between the groups.
Result: Botox injected group C developed changes when compared with the control group A and sham group B,
including the discontinuation of the condylar cartilage surface and chondrocyte hypertrophy, cluster formation
and disorientation of chondron columns. The experiment did not show any improvement in experimental
group D after treatment with grape seed proanthocyanidin extract.
Conclusion: The administration of grape seed proanthocyanidin extract did not yield the expected
improvements in the histomorphology of the mandibular condylar cartilage.

How to cite this: Iram M, Kiani MRB, Qamar A, Atta MF, Shan M, Zia MS. Ameliorative Effects of Grape Seed Proanthocyanidin Extract on Histomorphological Changes in Rat Mandible Induced by Intramuscular Injection of Botox in Masseter. Life and Science. 2024; 5(4): 482-490. doi: http://doi.org/10.37185/LnS.1.1.766

Effect of Crystalloid Administration Timing on Hypotension in Spinal Anesthesia for Cesarean Delivery: Preload Versus Coload: A Study at a Tertiary Care Hospital in Rawalpindi

Fri, 22 Nov 2024 00:00:00 +0500

Objective: To assess and compare the occurrence of hypotension and the demand for vasopressors in
parturients undertaking spinal anesthesia during cesarean delivery, distinguishing between those who
received crystalloid preload and those who received coload.
Study Design: Quasi-experimental study.
Place and Duration of Study: The study was conducted at Department of Anesthesiology, Combined Military
Hospital (CMH) Rawalpindi, Pakistan for two years from July 2021 to July 2023.
Methods: Fifty-four parturients, categorized as ASA II, with full-term singleton gestations planned for elective
cesarean delivery under spinal anesthesia, were randomly divided into two groups. Both groups received
15ml/kg of crystalloid as a preload and a coload. The initial readings of heart rate and arterial pressures were
evaluated before spinal induction and subsequently at one minute intervals until the completion of the
operation. Intravenous ephedrine was administered to manage hypotension, characterized by a more than
20% reduction in systolic blood pressure.
Results: The group receiving preload demonstrated notably lower values in both the minimum recorded
systolic and mean blood pressure, as well as in the reduction of systolic and mean blood pressure from the
baseline, in comparison to the coload group (P < 0.001). The occurrence of hypotension in the preload group
was significantly elevated at 92.6%, indicating a statistically significant difference (P = 0.039) when compared to
the coload group, where the incidence was 67%. Additionally, the mean ephedrine dose requirement was
significantly higher in the preload group at 12.2 ± 5.9 mg (P = 0.029) compared to the coload group, which had a
mean ephedrine dose requirement of 8.3 ± 6.8 mg. There were no significant differences between neonatal
outcomes, such as APGAR score and blood gases, between the two groups.
Conclusion: The adoption of the crystalloid coload method proved more effective than the preload technique
in reducing the incidence of intraoperative maternal hypotension and decreasing the necessity for
vasopressors in parturients undergoing cesarean delivery.

How to cite this: Zahid TR, Hinna R, Farooq U, Waraich AA, Bashir R, Ali I. Effect of Crystalloid Administration Timing On Hypotension in Spinal Anesthesia for Cesarean Delivery: Preload Versus Coload: A Study at a Tertiary Care Hospital in Rawalpindi. Life and Science. 2024; 5(4): 491-496. doi: http://doi.org/10.37185/LnS.1.1.468

Association of ABO and RH Blood Group with Dengue Infection: A Cross-Sectional Study at a Tertiary Care Hospital in Rawalpindi

Fri, 22 Nov 2024 10:13:07 +0500

Objective: To determine an association of ABO and Rh blood group with dengue infection
susceptibility.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at Department of Pathology, Army Medical College in
alliance with Pak-Emirates Military Hospital (PEMH) Rawalpindi, Pakistan from November 2022 to December
2022.
Methods: The study was conducted on two groups, one group had 102 dengue positive patient and the other
group had 928 normal sample population presenting to the hospital. We applied Fisher's Exact/Chi-square test.
Samples were collected by convenience sampling technique. Patients with any other concomitant infection
such as malaria or typhoid the study were excluded from group 1. ABO and Rh blood grouping done by tube
method and verified by forward tile method. Serological testing for dengue for presence of IgM and NS1 done
by Rapid chromatographic immunoassay test (ICT) method.
Results: The distribution of ABO and Rh blood groups in both the normal population and dengue-positive
patient groups was similar. In the normal sample population, the prevalence of O+ blood type was 30.1%,
closely aligning with the 38.2% observed in dengue-positive patients. While the 38.2% figure is higher than that
of the normal population, it reflects a notable increase. Similarly, other blood group distribution is matched
with O- 3.3% in normal sample and 2.0% in dengue positive. Blood group B+ is 28.0% in normal sample and
26.5% in dengue positive patient. Blood group A+ being 22.4% in normal sample population and 24.5% in
dengue positive patients.
Conclusion: According to this study, blood group O has a slightly higher percentage of dengue patients
compared to its prevalence in the general population. The prevalence of other blood groups in dengue patients
closely mirrors their prevalence in the general population. Further research is needed to assess if HLA and ABO
are dependent or independent risk factors and if certain blood groups have a higher chance of DENV infection.

How to cite this: Zarrar J, Tashfeen S, Shahid S, Bashir S, Sharif I, Sajjad Z, Zulfiqar A. Association of ABO and RH Blood Group with Dengue Infection: A Cross-Sectional Study at a Tertiary Care Hospital in Rawalpindi. Life and Science. 2024; 5(4): 497-503. doi: http://doi.org/10.37185/LnS.1.1.447

Internet Gaming among Medical Students: Its Impact on Quality of Life

Asif Azeem Bajwa, Sikandar Ali, Junaid Tahir, Tashfeen Bin Nazir, Abdullah Asif — Fri, 22 Nov 2024 10:19:47 +0500

Objective: To determine the frequency of Internet gaming disorder among medical students and its impact on
Quality of life on these students.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted in a tertiary care Mental Health Facility Armed Forces
Institute of Mental Health (AFIMH) Rawalpindi, Pakistan from 1^st January 2021 to 30^th June 2022.
Methods: Basic demographic data including age, gender, medical college and year of study among
consecutively sampled 950 participants was recorded. Each participant was given internet gaming Disorder
score (IGD) and world health organization quality of life assessment score (WHO-QoL) to ascertain level of
involvement in internet gaming and quality of life respectively. Students were to fill both forms within twenty
four hours.
Results: Out of total 950 participants 30 (3.2%) students scored severe, 92 (9.7%) scored moderate, 320 (33.7%)
students scored for mild levels while 508 (53.5%) attained normal or no internet gaming disorder scores.
Assessment of quality of life revealed that 500 (52.6%) enjoyed good quality of life, 361 (38%) experienced
average quality of life while 89 (9.4%) of students experienced below average quality of life. IGD scores show
higher level of significance with quality of life among medical students (P < 0.05).
Conclusion: Indulgence in internet gaming negatively affects quality of life.

How to cite this: Bajwa AA, Ali S, Tahir J, Nazir T, Asif A. Internet Gaming Among Medical Students: Its Impact On Quality Of Life. Life and Science. 2024; 5(4): 504-510. doi: http://doi.org/10.37185/LnS.1.1.790

Comparison of T2 Dixon and Standard Sagittal MRI Sequences for Evaluating Lumbar Spine Degeneration

Fri, 22 Nov 2024 10:40:51 +0500

Objective: To evaluate the diagnostic performance and inter observer agreement between standard sagittal
protocol and Dixon protocol in assessment of high intensity zones and Modic end plate changes in patients who
undergo magnetic resonance imaging of lumbar spine for lumbar radiculopathy.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Diagnostic Radiology, Wah
Medical College Wah Cantt, Pakistan in period of three months from March 2024 to May 2024.
Methods: Total 163 patients of either gender above age of 30 years were included in the study presented with
complaint of lumbar radiculopathy. All patients underwent magnetic resonance imaging of lumbar spine. Two
experienced radiologists first assessed the high intensity zones and Modic end plate changes for each level of
lumbar spine on the sagittal T2 Dixon sequences and then on standard sagittal sequences independently from
one another. Findings were recorded on performa. Data was analyzed using SPSS version 23. First the
agreement between readers 1 and 2 was examined for the Dixon protocol and then on standard protocol in
assessment of high intensity zone and Modic end plate changes using kappa statistics and the size of the interreader agreement was compared between standard protocol and Dixon protocol. Secondly the K values and their standard errors were used to perform a Z-test to examine if there are significant statistical differences
between the two sequences.
Results: Both the Dixon and standard protocols demonstrate high inter observer agreement with Cohen's Kappa values indicating almost perfect concordance. The Z-test comparisons between the protocols show no
statistically significant differences in agreement for either high intensity zones or Modic end plate changes
assessments at any spinal level, as all P-values were above the 0.05 threshold. Both protocols exhibit
comparable reliability in evaluating lumbar spine conditions.
Conclusion: Single sagittal T2 Dixon sequence could replace the standard sagittal sequences for the assessment of high intensity zones and Modic end plate changes with a 30% acquisition time reduction at 1.5T.

How to cite this: Raza SJ, Madiha, Ikram M, Gul N, Jabeen F, Ajmal A. Comparison of T2 Dixon and Standard Sagittal MRI Sequences for Evaluating Lumbar Spine Degeneration. Life and Science. 2024; 5(4): 511-520. doi: http://doi.org/10.37185/LnS.1.1.759

Antioxidative Effects of Vitamin C on Methotrexate Induced Hepatic Damage in Rat

Fri, 22 Nov 2024 10:49:14 +0500

Objective: This study aimed to explore the protective effects of vitamin C against Methotrexate induced
biochemical and histological changes in rats.
Study Design: Experimental study.
Place and Duration of Study: The study was conducted at the Department of Anatomy, Baqai Medical
University Karachi, Pakistan from June 2017 to July 2018.
Methods: This study included 45 adult male albino Wistar rats aged between 10-12 weeks and weighing around
180-200g. The rats were randomly divided into 3 groups: Group A, received no intervention and was kept on
standard diet for 10 days; Group B, received 20mg/kg intraperitoneal single dose of Methotrexate; Group C
received 200 mg/kg oral tablets of vitamin C for seven days and 20mg/kg intraperitoneal single dose of
Methotrexate. At the end of the study period, animals were anesthetized with ether, cardiac blood samples
were collected for enzyme estimation and organs were removed for histopathological examination.
Results: Liver sections from Group A demonstrated normal parenchyma with cords of hepatocytes radiating
from the central vein with portal triads at the ends of hepatic lobules while Methotrexate treated Group B
showed severely degenerated architecture along with hemorrhagic parenchyma with dilatation of central vein,
and sinusoids. Comparatively, liver sections from Group C displayed less deranged histologic and morphologic
changes. A significant increase in serum levels of AST, ALT and ALP and albumin and reduction in hepatocyte
count, increase in hepatocyte diameter and a decrease in hepatocyte nuclear diameter occurred in group B,
while above parameters improved in vitamin C protected group C.
Conclusion: This study exhibited that the potential biochemical and histological alterations caused by
Methotrexate can be attenuated by antioxidant effects of Vitamin C.

How to cite this: Younus N, Kazmi T, Askari R, Ali AB, Rasheed A, Mukhtar S, Nangrejo R. Antioxidative Effects of Vitamin C on Methotrexate Induced Hepatic Damage in Rat. Life and Science. 2024; 5(4): 521-529. doi: http://doi.org/10.37185/LnS.1.1.626

Effect of Copper Dope Calcium Phosphate on Mechanical Properties of Modified Dental Composites

Fri, 22 Nov 2024 10:57:36 +0500

Objective: To evaluate the mechanical, biological, and antibacterial properties of copper doped calcium
phosphate (Cu-CaP) modified dental composites.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was carried out at the Department of Dental Materials, Khyber Medical
University Peshawar, Pakistan from February 2023 to January 2024.
Methods: The process involved adding ethyl alcohol, distilled water, silane, and octyltriethoxysilane to
powdered silica, refluxing, centrifuging, washing, and preparing copper oxide nanoparticles and copper doped
calcium phosphate. Composite was prepared using TEGDMA i.e. Triethylene glycol dimethacrylate, camphor
quinone, and dimethyl aminoethyl methacrylate.
Results: The microscopic image of Copper oxide nanoparticles were gathered together with agglomerated
structure, irregular shapes having voids, and size range of 80 nm to 5 μm. The shape was irregular with void
spaces and composition was confirmed with Edx analysis. Scanning electron microscope image of copper
doped calcium phosphate, shows a build-up of nanometric needles over entire base, with asymmetrical form
and translucent appearance, ranging from 10 nm to 50 nm. The Energy dispersive X-ray (EDX) analysis
demonstrated the presence of materials. The Fourier transmitted infrared microscopy of silica and salinized
silica showed characteristics peaks of salinized silica at 1016 cm-¹ and 1439 cm-¹ with a main peak at 950 cm-¹,
while the Fourier Transform Infrared Spectroscopy of calcium phosphate, 2%, 4%, and 6% copper doped
calcium phosphate in dental composite showed charcateristics peak at 1020 cm-¹ which was due to increase of
phosphates upon increasing copper doped calcium phosphate concentration. The compressive strength results
of native dental composite and 2%, 4%, and 6% copper doped calcium phosphate in dental composite have
values of 15.6 MPa, 18.72 MPa, 20.2 MPa, 49.15MPa while the flexural strength were of value 19.32MPa
(dental composite) and that of 2%,4% and 6% have a value of 22.2MPa, 26.1MPa and 30.3MPa. The control
group i.e. the dental composite had Vickers hardness of 14.55 MPa, while the experimental groups with 2% ,
4%, and 6% copper doped calcium phosphate had values of 16.97 MPa, 21.49 MPa and 26.5 MPa respectively.
Conclusion: The Vickers's hardness, flexural strength, and compressive strength of experimental dental
composite increased with an increasing percentage of copper doped calcium phosphate added as a filler in a
proportion of 2%, 4% and 6% with salinized silica in the dental composite.

How to cite this: Ahmad W, Ahmad F, Babar BZ, Khan A, Khalid S, Ahmad SA. Effect of Copper Dope Calcium Phosphate on Mechanical Properties of Modified Dental Composites. Life and Science. 2024; 5(4): 530-537. doi: http://doi.org/10.37185/LnS.1.1.679

Association of Claustrophobia in Patients Referred for MRI with Premature Termination of Examination and Limited Study Acquisition: A Cross-Sectional Study in Rawalpindi City

Aneela Akram, Sara Khan, Nazia Dildar, Laiba Zahid, Bushra Nayyar, Zeeshan Ali — Fri, 22 Nov 2024 00:00:00 +0500

Objective: To find the association of claustrophobia with premature termination of examination or limited
study acquisition in Magnetic Resonance Imaging examination.
Study Design: A cross-sectional study.
Place and Duration of Study: The study was conducted in the Department of Magnetic Resonance Imaging (MRI) at Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan from August 2022 to February 2023.
Methods: Patients were asked to fill out a self-made claustrophobic questionnaire. Data regarding premature
termination and limited study acquisition was taken from a magnetic resonance imaging technologist. Data was
analyzed by using 26 version of the Statistical Package of Social Sciences (SPSS). Relative frequencies of
quantitative variables were calculated. P value was calculated by using Chi-square analysis.
Results: The frequency of the claustrophobia was 6% (9 out of 150). Around 2.7% of male patients were
claustrophobic while 3.33% of female patients were noted to be claustrophobic through the claustrophobic
questionnaire. The incidence of premature termination of Magnetic Resonance Imaging examination was
noted in 4.67% while 1.33% was included in limited study acquisition.
Conclusion: Conclusively, the termination rate was high in the claustrophobic cases which can cause the loss of
resources so a prescreening may be advised to the cases for proper utilization of the Magnetic Resonance
Imaging and time of the consultant.

How to cite this: Akram A, Khan S, Dildar N, Zahid L, Nayyar B, Ali Z. Association of Claustrophobia in Patients Referred for MRI with Premature Termination of Examination and Limited Study Acquisition: A Cross-sectional Study in Rawalpindi City. Life and Science. 2024; 5(4): 538-543. doi: http://doi.org/10.37185/LnS.1.1.471

Comparative Potential of Histological Effect in Antioxidants to Prevent Doxorubicin Induced Toxicity in Male Infertility in Rats

Fri, 22 Nov 2024 00:00:00 +0500

Objective: This research intended to compare histological impacts of various antioxidants in preventing
doxorubicin-induced testicular toxicity and subsequent male infertility in rats.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at the Animal House and Histopathology Laboratory of
Peshawar Medical College, Peshawar, Pakistan from May 2023 to April 2024.
Methods: An overall of 120 male rats were included in the research. The rats were divided into six groups: the
control group, the doxorubicin only group, and four treatment groups receiving doxorubicin along with
different antioxidants. The antioxidants administered were Vitamin C, Vitamin E, Coenzyme Q10, and
Selenium. Histological analyses were performed on testicular tissues post-treatment to assess the extent of
damage and protective effects of the antioxidants.
Results: The doxorubicin only group showed statistically significant histological damage, including marked
reductions in spermatogenesis and degeneration of seminiferous tubules. Antioxidant treated groups
demonstrated significant protective effects, with the Selenium group exhibiting the highest level of protection,
closely resembling the control group, followed by Vitamin E and Coenzyme Q10, which also provided
substantial preservation of testicular structure.
Conclusion: The study concluded that antioxidants, particularly Selenium, Vitamin E, and Coenzyme Q10,
provided significant protection against doxorubicin induced testicular toxicity in rats. These findings suggested
possible use of these antioxidants in mitigating male infertility associated with doxorubicin therapy.

How to cite this: Jan RU, Yunas S, Ara N, Amjid M, Fareed S, Rinkeviciute J, Badar A. Comparative Potential Of Histological Effect In Antioxidants To Prevent Doxorubicin Induced Toxicity In Male Infertility In Rats. Life and Science. 2024; 5(4): 544-551. doi: http://doi.org/10.37185/LnS.1.1.736

The Pattern of Maxillary Cleft Alveolus in Patients from Khyber College of Dentistry, Peshawar, Pakistan: A Cross-Sectional Study

Hina Afsar, Maryam Gul, Madeeha Gul, Muhammad Jawad Ullah, Mr, Nauman Khan — Fri, 22 Nov 2024 11:23:14 +0500

Objective: This study aimed to determine the pattern of a maxillary cleft alveolus in patients from Khyber
College of Dentistry Peshawar, Pakistan.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Oral and Maxillofacial Surgery,
Iqra National University Peshawar, Pakistan from 2^nd February 2022 to 2^nd July 2022.
Methods: A total of 98 paediatric patients aged from birth to 16 years were chosen using a consecutive nonprobability selection method. Thorough clinical and radiographic investigations were conducted to verify the diagnosis and determine the specific characteristics of the cleft alveolus. The data were examined using R studio, utilising descriptive statistics, chi-square tests, t-tests, and ANOVA.
Results: The average age of patients was 0.31 ± 0.32 years. The gender distribution was about equal, with a
male-to-female ratio of 1.04:1. The occurrence of unilateral cleft alveolus was considerably higher (83.67%)
than that of bilateral cleft alveolus (16.33%). No significant statistical connections were discovered between
age, gender, and cleft type (P > 0.05). The t-test and ANOVA analyses revealed statistically significant variations
in average ages between unilateral and bilateral cleft types, albeit clinically negligible.
Conclusion: The study highlighted the prevalence of clefts on the left side of the face, emphasising the
importance of this information for planning surgeries and allocating resources. Although there are no
significant demographic connections, the results affirm the need for early intervention and a multidisciplinary
approach to enhance patient outcomes.

How to cite this: Afsar H, Gul M, Gul M, Ullah MJ, Khan N. The Pattern of Maxillary Cleft Alveolus in Patients from Khyber College of Dentistry, Peshawar, Pakistan: A Cross-Sectional Study. Life and Science. 2024; 5(4): 552-558. doi: http://doi.org/10.37185/LnS.1.1.762

Antioxidant Effect of Extra Virgin Olive Oil and Apple Cider Vinegar in Type 2 Diabetic Rat Model

Fri, 22 Nov 2024 11:34:28 +0500

Objective: Comparison between the antioxidant effects of extra virgin olive oil and apple cider vinegar in rats
induced with diabetes mellitus type 2.
Study Design: Randomized controlled trial.
Place and Duration of Study: This Study was conducted in Postgraduate Medical Institute, Animal House,
Lahore, Pakistan from May 2021 to June 2021.
Methods: In this study, 40 male Sprague Dawley rats were divided into 4 groups i.e., Group I was NC (negative
control), Group II PC (positive control), Group III EVOO (Extra virgin olive oil) and Group IV (Apple cider vinegar),
each group having 10 rats. Diabetes was induced in all rats except the rats of NC group at the start of the study by intraperitoneal administration of injection nicotinamide, followed by injection Streptozosin (STZ) after 15
minutes. Group III was given 1ml/100gBW/ day EVOO and Group IV was given 2ml/kg BW/day diluted ACV with
distilled water in 1:5 orally for 4 weeks. Sampling was done after 4 weeks for determination of oxidative stress
markers Malonaldehyde, Superoxide dismutase and Total antioxidant status in serum.
Results: Intake of EVOO and ACV showed reduction in serum Malonaldehyde levels as compared to positive
control group with P-values 0.000 and 0.014 respectively. Serum superoxide dismutase activity and Total
antioxidant status were lowest in the positive control group while both the treatment groups showed
significant enhancement in these parameters as compared to positive control group with P-value = 0.000.
Conclusion: Both extra virgin olive oil and apple cider vinegar have antioxidant effects in type 2 diabetic rats.
However, Extra virgin olive oil is more potent.

How to cite this: Nazir R, Saeed M, Lodhi HN, Mustafa G, Naeem S, Chaudry ZR. Antioxidant Effect of Extra Virgin Olive Oil and Apple Cider Vinegar in Type 2 Diabetic Rat Model. Life and Science. 2024; 5(4): 559-564. doi: http://doi.org/10.37185/LnS.1.1.780

Pattern of Etiologies of Early Neonatal Mortality in Tertiary Care Hospital, Peshawar

Lal Muhammad, Hina Pervaiz, Afzal Khan, Bakhat Beland, Inayat ullah — Fri, 22 Nov 2024 00:00:00 +0500

Objective: To identify the pattern of etiologies responsible for the early neonatal mortality in neonates
admitted in the neonatal intensive care unit.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: This study was conducted in Neonatal Intensive Care, Lady Reading Hospital,
Medical Teaching Institute Peshawar, Pakistan from September 2023 to January 2024.
Methods: Data was collected for both groups according to sample size and parents were interviewed through
Semi semi-structured questionnaire at the time of expiry. Through SPPS 27, data analysis was performed for
quantitative and qualitative variables. Chi-square test was performed and then Binary logistic regression was
performed taking outcome as the dependent variable.
Results: The estimated neonatal mortality for our study was 25.5%. The mean age at the time of admission was
2.69 days±1.75. Overall females were 19.2% and male neonates were 80.8%. Neonatal mortality was significantly associated with the age of the mother, mode of delivery, sepsis, preceding birth interval in months,
antenatal clinic visits in pregnancy, mother's education, father's education, and wealth index. The age of the
mother had a significant relation with neonatal mortality age <16 years caused 9.9 times higher mortality when
compared with the reference category. Considering the antenatal visits during pregnancy, no antenatal visit is
4.5 times more associated with mortality. Similarly, maternal illiteracy had a significant impact on mortality
with an odds ratio of 3.6. The short preceding birth interval was significantly associated with neonatal mortality
with an odds ratio of 2.8 on multivariate analysis.
Conclusion: The findings of this research depict an association between early neonatal mortality and various
factors including the mother's age, preceding birth interval, antenatal clinic visits during pregnancy, mother's
and father's education, and wealth index of the family.

How to cite this: Muhammad L, Parvaiz H, Khan A, Beland B, Ullah I. Pattern of Etiologies of Early Neonatal Mortality in Tertiary Care Hospital, Peshawar. Life and Science. 2024; 5(4): 565-572. doi: http://doi.org/10.37185/LnS.1.1.699

Food Security Challenges Emanating from COVID-19

Shizma Junejo, Quratulain Javaid, Mehreen Lateef — Fri, 22 Nov 2024 00:00:00 +0500

Food security is a multidimensional notion and it can be achieved at individual, domestic, regional,
countrywide and global levels. This is achieved when all individuals, at all times, have physical and economic
access to adequate, safe, and nutritious food to fulfill their intake needs and food choices for an active and
healthy life. As a result of COVID-19, global activity has witnessed an exceptional decline. The physical
distance, school closures, trade restrictions, and country lockdowns for controlling the COVID-19 pandemic
have led to escalated nutritional challenges globally. Food insecurity is defined as the persistent concern about
access to sufficient and affordable food at all times. Food insecurity causes stress in people. This review aimed
to evaluate the extent of disruption and break in the chain of continuity of food security as a result of the COVID-
19 pandemic. The review perused peculiar causes of food insecurity in the context of the COVID-19 pandemic
along with measures to counter them for the attainment of sufficient food security. This review article
methodology was inclusive of the utilization of three search engines. These included PubMed, Google as well as
Google Scholar. The keywords included food security, food chain, challenges as well as COVID-19, and health
outcomes. Articles were included based on being published from the year 2008-2023. Out of 66 articles, 50
were included (75%). The food availability having deteriorated due to the COVID-19 pandemic has affected food
security globally leading to various adverse health outcomes. Also, this has added to the burden of hunger and
malnutrition across the globe. A special focus on agriculture can aid in dealing with the shortage of food. The
COVID-19 pandemic has culminated in tremendous detrimental repercussions on food security. Food chain
improvement and efficiency can be of pivotal importance in connection with the food security challenges
having ensued following the COVID-19 pandemic.

How to cite this: Junejo S, Javaid Q, Lateef M. Food Security Challenges Emanating from COVID-19. Life and Science. 2024; 5(4): 573-. doi: http://doi.org/10.37185/LnS.1.1.574