Journal of Liaquat University of Medical & Health Sciences

Conjunctivitis: Types, clinical manifestation and management

2024-11-13T10:05:43+05:00

This narrative review analyses the different types, clinical manifestations, and management strategies for conjunctivitis to facilitate accurate diagnosis and treatment planning. It gathers information on the types of conjunctivitis and their management based on findings from primary and secondary literature sources. Conjunctivitis is broadly categorized into bacterial, viral, allergic, and some less common forms. Each type has unique causes and symptoms. Bacterial conjunctivitis is often characterized by purulent discharge. At the same time, the viral type is characterized by watery discharge. Allergic conjunctivitis typically presents with itchy eyes. The symptoms vary depending on the underlying cause. Common symptoms include redness, irritation, discharge, and photophobia. Many cases of bacterial conjunctivitis require antibiotic therapy, but viral conjunctivitis is generally managed with supportive care. Allergic conjunctivitis responds well to antihistamines and mast cell stabilizers. Accurate diagnosis protects against the development of antibiotic resistance and ensures proper management is delivered. This review emphasises the importance of accurate diagnosis and the development of personalised treatment plans to enhance patient care.

CHEK2, MCM3 and MSH6 may have a Potential Role as Molecular Markers of Screening in the Detection of Cervical Premalignant and Malignant Lesions: A Scoping Review

2024-11-08T12:07:59+05:00

Lesions of the uterine cervix, including neoplasia, are the foremost cause of female deaths worldwide. Cervical malignancy ranks as the third most common gynecological malignancy globally, with an increasing prevalence reported in Asia each year. Early detection through cytology-based screening makes it one of the most preventable forms of malignancy. This review was planned to investigate the potential role of CHEK2, MCM3, and MSH6 in detecting cervical lesions. Therefore, a scoping review involved searching for published articles on databases such as PubMed, MEDLINE, EMBASE, and the Cochrane Library. According to the searched literature, several genes contribute to cervical cancer occurrence. The CHEK2 gene acts as a tumour suppressor by regulating the cell cycle pathway. At the same time, the loss of function of MSH6 leads to high rates of mutations in microsatellites, thereby deactivating the mismatch repair pathway. Moreover, the MCM3 gene's helicase activity in cell cycle regulation is overexpressed in various malignant tissues and cancer cell types. Tumor microsatellite instability (MSI) indicates the loss of mismatch repair function, which is seen in cervical cancer and reported in many other tumors. Expression of these genes may be associated with the "abnormality of the epithelial cell" term in the Bethesda system for classifying cervical lesions on cytology, ranging from atypical squamous cells to low-grade and high-grade dysplasia, which can potentially lead to invasive squamous cell carcinoma linked to transient HPV infection. Due to the scarcity of local data regarding the role of these genes in cervical malignancy, further research is crucial.

Health Systems Science: A Third Pillar of Medical Education

2025-06-20T12:25:36+05:00

After the Flexner report more than a century ago (published in 1910) and subsequent curricular reforms in medical education, medical education and its curriculum have continuously evolved concerning advancement in medical sciences and technology globally, especially in developed countries¹. With the guidance of Abraham Flexner, William Osler, and other medical educationists, a curriculum was developed in the early twentieth century, focusing on students' learning in the preclinical and clinical years, which is now commonly referred to as a traditional curriculum. This curriculum is based on two pillars, namely fundamental or foundational science and clinical science.

Prevalence and Determinants of Intrauterine Contraceptive Device Uptake among Childbearing Age Women in Nigeria: A Cross-Sectional Study

2024-11-26T10:43:09+05:00

OBJECTIVE: To investigate the prevalence and determinants of intrauterine contraceptive device (IUCD) uptake among childbearing-age women in Northern Nigeria.

METHODOLOGY: A cross-sectional study was employed among 278 childbearing-age women attending a family planning clinic at Wudil General Hospital in Kano State, Nigeria, from June to August 2022. A nonprobability purposive sampling technique was used to recruit participants. The study included women of childbearing age who were within the reproductive years (18 years and above), have conceived at least once, are still reproductive, and wish to delay future pregnancy for at least a year. The study excluded women with primary or secondary infertility who were confirmed pregnant at the study time and had possible cognitive impairment. Data was collected using a self-administered questionnaire. The data were analyzed by using SPSS software version 25.0.

RESULTS: The prevalence of IUCD uptake among participants was 23.0%. There were significant differences in IUCD uptake with the number of children and pregnancies, with women having five or more children being five times more likely to use an IUCD. The univariate logistic regression model test showed a significant association between IUCD uptake and the number of pregnancies but not with other factors, including perceived social support.

CONCLUSION: The uptake of IUCDs was significant among women who had five or more children. Involving substantial others like husbands, family members, and peers in the issue of IUCDs as a contraceptive method will still help promote the uptake even though perceived social support was found not to be significant.

Knowledge of General Dental Practitioners and Specialists in Emergency Management of Traumatic Dental Injuries

2024-12-04T11:10:22+05:00

OBJECTIVE: To assess the knowledge level of general dental practitioners and specialists regarding the emergency management of traumatic dental injuries.

METHODOLOGY: A cross-sectional study was conducted in Erbil City between May 2024 and August 2024, utilizing convenience sampling to collect data from dentists, including general practitioners and specialists, in various settings such as specialized dental centres, clinics, and dental schools. Data collection involved distributing 180 self-administered questionnaires to the participants. The questionnaire consisted of two sections: the first covered demographic details, including age, gender, type of practice (general dental practitioner or specialist), specific dental specialty (if applicable), practice sector, and experience. The second part included 12 questions to assess proficiency in managing dental emergencies involving luxation injuries (intrusion and extrusion), complicated crown fractures, and avulsion injuries.

RESULTS: Specialists demonstrated greater proficiency in managing luxation injuries than general dental practitioners (GDPs), with a significant difference in managing avulsion injuries. Specialty was the only factor significantly affecting mean knowledge scores (P < 0.001). Male gender, experience (<5 years and 5-10 years), and public sector employment had negative but not statistically significant effects on high knowledge (P-values: 0.636, 0.289, 0.526, 0.579), respectively.

CONCLUSION: The study suggests that many general dental practitioners require additional experience treating avulsed teeth. Implementing continuous education programs to ensure dentists can effectively manage avulsion injuries is highly recommended. These programs are designed to enhance practitioners' skills and knowledge in dental trauma management, ultimately leading to improved patient care and outcomes in this critical area of dentistry.

Prenatal Visits as Determinants of Maternal Hemoglobin Level and Neonatal Birth Weight in Tertiary Care Hospital

2024-12-17T11:07:57+05:00

OBJECTIVE: To determine the association between the number of prenatal visits, maternal hemoglobin level, and birth weight of newborns.

METHODOLOGY: This cross-sectional study was conducted in the Department of Obstetrics & Gyneacology, Darul Sehat Hospital, Karachi, from July 2022 to January 2023. Females with any parity and full-term gestational age, regardless of mode of delivery, were included, while patients with preterm deliveries, miscarriages, and referred cases were excluded. The convenience non-probability technique is a method of sampling. A questionnaire containing demographic information, the number of antenatal visits, and the timing of the first visit to the hospital, as well as Hb level at the time of birth and fetal outcome, was introduced. The Chi-square test was used to assess the association between variables. SPSS 21 was used for data calculation.

RESULTS: 155 women were interviewed. The mean age of the respondents was 29±6.2 years, the mean parity was 2.2±1.07, and the mean number of visits was 6.3±3.2. 34% had eight or more visits. The mean gestational age at booking is 16.7±9.4 weeks, and the mean Hb level of the population is 10.1g/dl±1.2. 67% of the population is found to be anemic. A p-value of (0.04) indicates a relationship between the mother's hemoglobin level and prenatal visits. 52.3% of newborns were born with low birth weights.

CONCLUSION: Prenatal attendance is significantly associated with maternal hemoglobin level and neonatal birth weight. The number and quality of prenatal visits must be ensured at the national level to improve maternal and neonatal health.

Development of the "Pegasting" Module and the Effectiveness of Module Utilization for Intensive Assistance for Mothers in Preventing Stunting

2025-01-06T12:30:53+05:00

OBJECTIVE: To develop the "Pegasting" Module and evaluate the effectiveness of module utilization in intensive assistance for Mothers in Preventing Stunting.

METHODOLOGY: The Design involved research and development, utilizing a quasi-experiment (one-group pre-post test design). The location was 10 villages in the North Konawe Health Service Work Area. The total sample consisted of 90 participants. Determining the number of samples using the Slovin formula. The data were analyzed using a questionnaire based on the data collected from the research instrument. The pre-test and post-test results were compared using the Wilcoxon signed-rank test. The analysis was conducted using the SPSS Statistics 22 application. The inclusion criteria were mothers with toddlers who were mentally healthy, had visited a health centre, and were not illiterate.

RESULTS: The module validation stage was conducted by media experts, achieving a score of 68.48% in the feasible category and 97.33% from material experts in the very worthy category. The study indicates that providing training significantly enhances the knowledge and behaviour of pegasting cadres, with p-values of 0.001 and 0.012, respectively. The experimental group showed a significant difference in knowledge before and after the intervention compared to the control group, with p-values of 0.002 and 0.001, respectively.

CONCLUSION: The intervention had a significant impact on the behaviour of mothers in both experimental and control groups.

Risk Factors for Early Childhood Caries among Children in Multi-centered Montessori at Karachi

2024-12-23T12:16:24+05:00

OBJECTIVE: To explore the possible risk factors associated with early childhood caries (ECC) at one point in time in Montessori children.

METHODOLOGY: A multi-centred cross-sectional study was conducted where n= 370 children aged ? 37 to ? 72 months from different Montessori of Karachi were randomly selected. After getting informed consent from the caregivers, a self-administered questionnaire was distributed to collect data. The oral examination of children was conducted to assess their dental caries status using the decayed, missing, and filled teeth (DMFT) index. Data was analyzed using Stata/SE version 17.

RESULTS: The factors significantly associated with ECC in Montessori children were the age of leaving bottle feeding, sleeping with a bottle and delayed initiation of toothbrushing [p ? 0.05]. Guided toothbrushing practice was observed to be higher in children with ECC [AOR=1.77, p=0.048]. The multivariate analysis also suggested that an increased toothbrushing duration significantly reduced the chances of ECC by 70% in Montessori children.

CONCLUSION: This study concludes that bottle feeding alone or in combination with breastfeeding, prolonged bottle feeding, and children sleeping with a bottle are significant predictors of ECC. Increased brushing duration significantly reduces the chances of ECC.

Comparison of Rapidec Carba NP test versus modified Hodge test in Finding Frequency and Resistance Pattern of E. Coli and Klebsiella Species

2024-10-14T11:40:12+05:00

OBJECTIVE: To compare the investigations that would ultimately benefit the healthcare professionals to opt for better management against the disease process on time.

METHODOLOGY: This cross-sectional study was conducted at Lifeline General Hospital, Karachi, from March to November 2023. The CLSI guidelines for isolates showing inhibition zone size of antimicrobial agents were documented as potential carbapenemase producers and short-listed for confirmation of carbapenemases and their respective classes. SPSS 22 was used to analyze data. A chi-square test was used, keeping a p-value of < 0.05 as significant.

RESULTS: The frequency of positive and negative samples was recorded as 287 (75.5%) and 93 (24.4%), respectively. The distribution of microorganisms within samples indicated the presence of E. coli at 47 (12.3%), 18 (4.7%), 21 (5.5%), and 4 (1%) in urine, pus, respiratory tract, and blood samples, respectively. The distribution and identification of microorganisms, as reported using the techniques employed, yielded no statistically significant results, with p-values of 0.81 and 0.26 for E. coli and Klebsiella, respectively.

CONCLUSION: This study concludes that Carba NP is a cost-effective option, providing rapid results within 30 to 120 minutes. The high specificity and sensitivity of the test contribute to improved patient management and the prevention of healthcare-associated infections.

Novel Phytochemical Inhibitors of Leptin: A Molecular Docking Approach for Potential Cardiovascular and Antidiabetic Therapies

2024-09-20T12:19:05+05:00

OBJECTIVE: To identify phytochemicals as potential leptin inhibitors, particularly in the context of immune and cardiovascular health, using molecular docking analysis.

METHODOLOGY: This study was conducted from 2023 to 2024 with the joint efforts of the Department of Bioinformatics and Biotechnology, Government College University Faisalabad, and the Center of Excellence and Molecular Biology, University of Punjab Lahore. The 3D structure of Leptin was retrieved from the Protein Data Bank and refined for docking analyses using PyRx. A ligand library consisting of 5,006 phytochemicals was prepared from various databases. The interactions were visualized using Discovery Studio. Compounds with high docking scores were further analyzed for their ADMET properties, based on Lipinski's Rule of Five, to ensure their drug-like characteristics and predict their safety profiles.

RESULTS: The compounds Peonidin, Diosmin, 7-[3-(3-hydroxy oct-1-enyl)-4,6-dioxabicyclo[3.1.1]heptan-2-yl]hept-5-exonic acid, Carnitine, Dihydrodaidzin, 4-dimethylpodophyllotoxin, 4-demethyldeoxypodophyllotoxin, (+)-sophorol and Tylophorinidine demonstrated successful binding to the Leptin. Thus, it potentially interferes with the leptin-leptin receptor interaction. Diosmin and Dihydrodaidzin showed the most vital binding score of -7.9 Kcal/mol of all the top-ranking compounds.

CONCLUSION: These compounds may act as effective inhibitors of Leptin, which may help develop natural, affordable therapies for cardiovascular disorders and diabetes. However, further research is required to validate their efficacy and safety.

Transferring Information about Human Papillomavirus and Vaccine from Student to Family

2024-12-24T09:46:53+05:00

OBJECTIVE: Determining and increasing the awareness of midwifery students and their families about Human Papilloma Virus (HPV) and vaccines (HPVV).

METHODOLOGY: The study is of descriptive type. The study was conducted at Ege University Faculty of Health Sciences (EUFHS). The population consisted of all students studying in the Department of Midwifery at EUFHS and their families, and the sample consisted of voluntary participants. Data were collected between September and November 2023. Trainings were conducted face-to-face in faculty classrooms, brochures were distributed, and the questionnaire and Human Papillomavirus Knowledge Scale (HPV-KS) were collected online (Google Forms). The questionnaire and scale were administered twice to the students (before and after the training) and once to their families. Students were asked to educate at least one family member with the brochure. 303 pre-training (PR-T), 179 post-training (PS-T) students and 105 family members participated. Data were analyzed using a t-test, Bonferroni test, and Analysis of Variance in the SPSS 25, and significance was evaluated at a 95% confidence interval.

RESULTS: The mean HPV-KS scores of the students were calculated as PR-T 10.95±5.52 (min: 0, max: 21.0), PS-T 15.39±2.70 (min: 9.0, max: 27.0), and the difference between them was found to be statistically significant (t = 11.806; p < 0.05). It was determined that 71.3% of the students who received training provided education to their families about 'HPV and HPVV.

CONCLUSION: As a result of the research, the students' knowledge level increased, and accurate and reliable information was relayed from them to their families.

Patient Satisfaction and Preference for Metered-Dose Inhalers vs. Dry Powder Inhalers in the Treatment of Obstructive Airway Disease

2024-11-27T09:55:56+05:00

OBJECTIVE: To evaluate patient preference for different inhaler devices in the treatment of obstructive airway disease (OAD).

METHODOLOGY: This cross-sectional study was conducted at the Department of Pulmonology, Indus Hospital, Korangi Campus, Karachi, Pakistan, from July 2023 to January 2024. A non-probability, consecutive sampling technique was adopted. The inclusion criteria were patients aged 18-70 years presenting with OADs, regardless of disease duration, and using either a metered dose inhaler (MDI) or a dry powder inhaler (DPI). Patients who were using pressured MDI (pMDI) were given DPI containing the same drugs at the exact dosage for two weeks. Patients who were using DPI were given pMDI containing the same medications at the precise dosage for two weeks. Patients were trained on the techniques for using the inhalers, and the patient preference between two inhaler devices was determined using the PASAPQ questionnaire. Data analysis was performed using SPSS 26.0.

RESULTS: In a total of 100 patients, the mean age was 51.64±13.52 years. There were 59 (59.0%) male patients. Forty-nine percent of patients had COPD, whereas asthma was present in 51 (51.0%). Out of 100 patients, 50 (50%) were using MDI inhalers, and 50 (50%) were using DPI inhalers. The mean PASAPQ scores were significantly higher in terms of satisfaction (p = 0.0002), performance (p = 0.0002), and convenience (p = 0.0374) domains for DPI inhalers.

CONCLUSION: The DPI inhalers were associated with higher levels of satisfaction, performance, and convenience compared to MDI inhalers in the management of oral antidiabetic medications (OAD).

Expression and Characterization of Trastuzumab in Baby Hamster Kidney Cell Line to Check its Anti-Cancer Activity in HCC 1954

2025-01-06T12:46:05+05:00

OBJECTIVE: To investigate Trastuzumab's production and anti-cancer effects on hepatocellular carcinoma (HCC1954) cells.

METHODOLOGY: This study was conducted in IMBB/CRiMM, The University of Lahore, Pakistan. A humanized IgG1 monoclonal antibody (Trastuzumab) with a high affinity for the extracellular domain of HER2 was produced. Antibody includes humanized sequences. Its antiproliferative effect was quantified using the MTT assay on the Hepatocellular carcinoma (HCC1954) and BHK cells. SDS-PAGE confirmed HER2 protein expression. Statistical Analysis was performed using the Social Package for the Statistical Sciences (SPSS) version 17.0 (SPSS, Chicago, IL, USA).

RESULTS: The expressed monoclonal antibody (Trastuzumab) exhibited anti-cancer activity, specifically targeting and inhibiting cell proliferation in the HCC1954 breast cancer cell line. The MTT quantified the antibody's antiproliferative effects, & SDS-PAGE confirmed HER2 protein expression. The quality & expression levels of Trastuzumab were optimized, paving the way for its local manufacturing and use as a therapeutic option in Pakistan.

CONCLUSION: Trastuzumab effectively targets HER2, disrupting cancer-promoting pathways, which may provide therapeutic benefits. The study supports the feasibility of local production in Pakistan, which could improve treatment access and affordability for patients.

Aggravating and Relieving Factors of Migraine and Tension Type Headache in the adult general population of Karachi, Pakistan

2025-01-07T13:54:15+05:00

Objective: To determine the common aggravating and relieving factors among tension-type headache patients.
METHODOLOGY: This study employed a cross-sectional design, with data collected from patients who frequently visited the outpatient neurology clinic at M. Rab Medical Centre and the neurology clinic. The study duration was one year, and the sample size was calculated using the online software Open Epi. At a 95% confidence level, the resulting sample size consisted of 500 participants from both sexes and the data collection instrument was a structured questionnaire.
RESULTS: All study responses included both males (30.6%) and females (69.4%). It revealed that the most common aggravating factors increasing the intensity of headaches were Stress and anxiety (64%) along with sleep deprivation (61.4%) as well as exposure to loud noise. Regarding the reliving factors, it was revealed that 71.2% of individuals showed a significant reduction in headache intensity with Sleep, while Tea was identified as a relieving factor among 258 individuals (51.6%). Other interesting factors were also identified, including Ablution and recitation of the Holy Quran.
CONCLUSION: The study revealed that migraine and tension-type headaches in Karachi's adult population are exacerbated by factors such as anxiety, bright lights, hunger, loud noises, family problems, and insufficient Sleep. These causes differ among genders, age groups, and individuals. Women are more sensitive to anxiety, loud noises, and family problems, while younger individuals are more affected by bright lights and excessive Sleep.

Diagnostic Accuracy of Transvaginal Ultrasound for Tubal Ectopic Pregnancy Using Laparotomy as the Gold Standard

2025-01-21T08:41:53+05:00

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal Ultrasound (TVUS) in detecting tubal ectopic pregnancies compared to laparotomy, which is considered the gold standard for diagnosis

METHODOLOGY: This study employed a cross-sectional design and was conducted within the Obstetrics and Gynaecology Department of Khyber Teaching Hospital, Peshawar, from February to August 2017. A total of 223 women aged 15 to 45 years were included in the study. Consecutive patients suspected of having an ectopic pregnancy were enrolled. All participants underwent transvaginal Ultrasound (TVUS), followed by laparotomy for the definitive diagnosis of ectopic pregnancy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TVUS were calculated based on the comparison with laparotomy findings. Data analysis was performed using SPSS version 22.

RESULTS: The average age of the participants was 29.8 years (SD ± 6.8). Transvaginal Ultrasound detected ectopic pregnancy in 60.1% of patients, while laparotomy identified ectopic pregnancies in 50.2% of patients. The diagnostic accuracy of TVUS was calculated as follows: sensitivity: 90.1%, specificity: 70.3%, positive predictive value (PPV): 75.4%, negative predictive value (NPV): 87.6%

CONCLUSION: Transvaginal Ultrasound, a widely recognized diagnostic tool for ectopic pregnancy, demonstrates high sensitivity and specificity when compared to laparotomy as the gold standard. It serves as an essential radiological tool for the early and accurate diagnosis of tubal ectopic pregnancy, supporting timely clinical decision-making and management.

Knowledge, Attitude, and Practice of Antibiotic Use among Medical Students in the College of Medicine, National University, Oman

2024-12-23T11:33:59+05:00

OBJECTIVE: To assess the knowledge, attitude, and practice toward antibiotic use among medical students at the College of Medicine, Oman.

METHODOLOGY: A cross-sectional study was conducted at the College of Medicine, where both pre-medical and medical students participated in data collection from November 2023 to January 2024. A structured pretested questionnaire was used to collect data from all students. SPSS version 20 was used for data analysis. Independent variables were presented as frequencies and percentages, while the total knowledge score was presented as the mean and standard deviation. The mean total knowledge score was analyzed to independent variables using a t-test.

RESULTS: A total of 472 students participated in this study, with most (74.2%) having no prior training on antibiotic use. Students with prior training on antibiotic use had better knowledge (81.5±18.4) than those without it (62.1±25). Most students (87.7%) recognised that improper antibiotic use could lead to antibiotic resistance in the future, and the mean total knowledge score was 67.14 ± 24.9. A high percentage of students reported stopping the antibiotics once symptoms subsided (56.6%).

CONCLUSION: Medical students' knowledge of proper antibiotic use was generally good. Knowledge of students with previous training courses and those from clinical years was higher. There was a very significant association between poor knowledge and bad antibiotic practices, like using antibiotics for self-medication and stopping antibiotics when symptoms subside.