Resident Journal of Rawalpindi Medical University

Role of Evolving Artificial Intelligence in Modernizing Otorhinolaryngological Procedures

Shahzaib Maqbool — 2024-10-19

In this modern era of healthcare, technological
advancements have revolutionized the way medical
procedures are conducted, leading to improved patient
outcomes and enhanced efficiency. One area where this
transformation is particularly evident is in
otorhinolaryngology, a branch of medicine specializing
in the diagnosis and treatment of disorders related to the
ears, nose, and throat. With the rapid evolution of
artificial intelligence (AI) technologies, there has been a
paradigm shift in the approach to otorhinolaryngological
procedures, ushering in a new era of precision, accuracy,
and innovation. Artificial intelligence, encompassing
machine learning algorithms and deep neural networks,
has demonstrated remarkable capabilities in analyzing
complex medical data, interpreting diagnostic images,
and assisting healthcare professionals in decisionmaking processes¹
.In the field of otorhinolaryngology,
AI applications are increasingly being integrated into
various aspects of patient care, from diagnosis to
treatment planning and surgical interventions.

Variations In Electrocardiographic Changes Across Different Spectrums Of Heart Failure

Muhammad Asad Muhammad Asad — 2024-10-19

Objective: Study aims to compare the electrocardiographic (ECG) abnormalities in patients of heart failure presenting with
different spectrum of syndrome based upon value of ejection fraction.

Methods: This was a retrospective cross-sectional study based on previous record and new cases collected from Department
of cardiology, Benazir Bhutto Hospital. Consecutive sampling was done and data of patients with HF who were admitted or
visited outdoor clinics of hospital was collected. The data was entered and analyzed in SPSS version 25.

Results: The study found that male and female heart failure patients have different EF distributions. EF is more likely to be
reduced in men and mildly in women. Age was also associated with cardiomyopathy (p=0.022). There was a significant
association between smoking and the development of heart failure. Heart failure patients with reduced ejection fraction
(HFrEF) have longer PR and QT intervals, ST segment elevation, and T wave inversion. The study found that arrhythmia
distribution differed by ejection fraction. HFrEF patients had a higher rate of atrial fibrillation (3%) and flutter (8%) than
HFpEF or HFmrEF patients.

Conclusion: We found that patients with HFrEF are more likely to have ECG abnormalities and arrhythmias than patients
with other types of heart failure. Early detection and treatment of arrhythmias can help to prevent serious complications.

Keywords: Heart failure, ECG, Ejection Fraction, Arrhythmia.

Prevalence Of Hypomagnesaemia In Critically Ill Patients Admitted In Medical Intensive Care Unit

Syed Ali Akbar Shah Syed Ali Akbar Shah — 2024-10-19

Objective: We conducted this study to determine the frequency of hypomagnesaemia in critically ill medical patients.

Methods: This is a Descriptive cross-sectional study involving 120 patients admitted in medical intensive care unit (MICU) of
Holy Family Hospital, Rawalpindi, Pakistan. The study was conducted from July 2018 to September 2019. About 1ml sample
of blood was taken from each p atient included and sent to hospital laboratory for evaluation of serum magnesium levels. All
the collected data was entered and analyzed on SPSS v. 23. A p-value of ≤ 0.05 was taken significant.

Results: In our study the mean age of the patients was 42.76 ±12.77 years, the male to female ratio of the patients was 1:1. The
mean value of APACHE II score of the patients was 29.68±2.571. The hypomagnesaemia was found in 28(23.33%) patients.

Conclusion: According to our study the frequency of hypomagnesaemia in c ritical ill medical patients was 28(23.33%)

Keywords:Critical, Medically Ill, Hypomagnesaemia, Patients

Effectiveness Of Normal Saline Versus Tetrachlorodecaoxide Dressing In The Management Of Diabetic Foot Wounds

Nuzhat Faqir Hussain Nuzhat Faqir Hussain — 2024-10-19

Introduction: Pure solutions are used to produce an electrically treated aqueous solution high in reactive oxygen species
(ROS). It is a potent anti-microbial. TCDO has been shown to be bactericidal in vitro. Wound healing is made possible by the
mitogenic activities of TCDO on fibroblasts and new blood vessels. The primary goal of this study to Compare the effectiveness
of Normal Saline Dressings versus Tetrachlorodecaoxide Dressings in the management of Diabetic Foot Wounds. The study
was conducted at Department of Gen eral Surgery, Postgraduate Medical Institute/Shaikh Zayed Hospital, Lahore. Aim is to
compare the effectiveness of normal saline versus tetrachlorodecaoxide dressing in the management of diabetic foot wounds.

Methods: A sample size of 40 (20 in each group) in group A, dressing was done with normal saline and in group B, dressing
was done with tetrachlorodecaoxide solution. Statistical analyses were performed using IBM SPSS version 20. The mean
difference was calculated using an independent t -test, and catego rical variables were stratified using a chi square test or a
Fisher exact test as appropriate.

Results: Normal saline significantly shortened the healing duration and wound area after 8 weeks when added to a routine
therapy for DFU. A comprehensive strategy is nece ssary to treat DFU effectively. To assist limit the number of patients who
may eventually have to have their legs amputated due to DFU -related complications, it may be possible that normal salt water
can be used as an alternate treatment option.

Conclusion: In conclusion, normal saline significantly shortened the healing duration and wound area after 8 weeks when
added to a conventional therapy for DFU. A comprehensive strategy is necessary to treat DFU effectively. To assist limit the
number of patients who may eventually have to have their legs amputated due to DFU -related complications, it may be
possible that normal salt water can be used as an alternate treatment option.

Keywords: Diabetes, Normal saline, Tetrachlorodecaoxide, Diabetic foot, Foot ulcers, Super-oxidized solution

Attitude of Pakistani Women towards Breast Reconstruction after Mastectomy for Breast Cancer

Pashmal Yousaf Pashmal Yousaf — 2024-10-19

Introduction: The trends in breast reconstruction after mastectomy for breast cancer have changed significantly in the western
world but in our part of the world, breast disease and reconstruction are still considered a taboo. This study assesses the attitude
of breast cancer patients planned to undergo mastectomy towards breast reconstruction; whether they are familiar with the
availability of such procedure and if they would opt for it given the option.

Methods: 150 patients (75 in one-month after mastectomy and 75 in one-year after mastectomy group) were included in this
cross-sectional study carried out at tertiary care hospitals’ breast clinics in Lahore, Pakistan.

Results: Majority of patients would opt out of breast reconstruction, in both one month and one-year post-mastectomy group
(93.9% and 90.7%) respectively. More patients (61.3%) in one-year post-mastectomy were found familiar with methods of
reconstruction while only 35% patients knew about it in one-year post-mastectomy patients.

Conclusion: Majority of the women diagnosed with breast cancer do not want to undergo breast reconstruction surgery.
Specific approaches are needed to address at the patient level, the negative opinion regarding breast reconstruction for women’s
own emotional health.

Keywords: breast cancer, breast reconstruction, decision-making, women.

Clinical Correlation between Hyponatremia and Complicated Appendicitis, A Prospective Cohort Study

Fareeba Fareeba — 2024-10-19

Introduction: Acute appendicitis is a frequent surgical emergency; therefore, prompt diagnosis and management are essential.
Certain clinical predictors are used to diagnose it. However, no such predictor is available to assess the complicated appendiciti
s in the absence of radiological investigations like CT scan. Serum sodium levels have gained a lot of attention in recent times
to assess the severity of the disease and is believed to be a clinical parameter in the diagnosis of complicated appendicitis
preoperatively.

Methods: This study involves correlation of hyponatremia with complicated appendicitis. We included 236 patients in this
study, meeting the inclusion and exclusion criteria. For each patient, preoperative serum sodium levels were measured and corelated post operatively.

Results: Our study reported a strong correlation between hyponatremia and its pre-operative accuracy in diagnosis of
complicated appendicitis.

Conclusion: Hyponatremia can be considered as a reliable marker of complicated appendicitis due to its cost effectivity and
easy availability in emergency departments.

Keywords: Complicated appendicitis, Clinical markers, Hyponatremia, Low-income country, Cost effective marker

Improving The Quality Of Psychiatric Inpatient Discharge Certificates Through A Two Cycle Audit In A Tertiary Care Hospital In Pakistan

Bahjat Najeeb Bahjat Najeeb — 2024-10-19

Objective: To assess the quality of inpatient discharge summaries according to defined standards. To design a format for
discharge summary in accordance with these standards and to provide education and training to the residents about these
standards. To reassess the discharge summaries after implementation and evaluate the improvement.

Methods: Cycle 1: In order to improve the quality, and standardize the format of discharge summaries we formulated a set of
criteria after taking input from consultants and residents. Two researchers evaluated a total of 30 discharge summaries which
were randomly chosen from those issued on April May 2022. Following this a new format of discharge summary was designed
and distributed. Residents were educated regarding the procedure of filling new discharge summaries.Cycle 2: Two researchers
evaluated a total of 30 discharge summaries which were randomly chosen from those issues on July -August 2022.

Results: In cycle 01 there was 03 (10%) mention of ICD code, gender was mentioned in 11 (36.6%), Contact Details mentioned
for 02(6.67%), Inpatient Treatment 07 (23.3%) and Consultant incharge 5(16.67%). Cycle Two revealed significant
improvement in most of the areas. Following the implementation there was mention of ICD code in 24 (80%), Contact Details
in 20 (66.7%), Inpatient Treatment for 29 (96.7%) and Consultant-Incharge, 19(63.3%).

Conclusion: Cycle 2 showed improvement in most of the areas. Factors which contributed to this would be resident education
and circulation of standardized discharge forms.

Keywords: Quality Improvement, Psychiatry, Inpatient, Discharge

Efficacy of Upper Limb Orthosis in Pregnant Women Presenting with Carpal Tunnel Syndrome

Aimen Shahbaz Aimen Shahbaz — 2024-10-19

Objective: To find the efficacy of orthosis on the symptoms of CTS in pregnant women and to investigate the impact of use of
CTS splint on symptom relief in pregnant women with CTS.

Methods: A randomized controlled trial (RCT) was conducted involving 28 pregnant women diagnosed with CTS. Fourteen
participants were assigned to the intervention group, receiving upper limb orthosis for four weeks, while the remaining 14
comprised the control group. Outcome measures were assessed using the Modified Boston Questionnaire (MBQ), focusing on
symptoms such as tingling, numbness, discomfort task difficulty and weakness.

Results: Before the intervention, the distribution of patients based on symptom severity according to the Modified Boston
Questionnaire (MBQ) showe d that 85.7% experienced numbness or tingling, 71.4% reported pain or discomfort, 78.6% woke
up at night due to symptoms, and 100% had difficulty grasping small objects, difficulty with activities, and weakness in hands
or fingers. After the intervention, the intervention group demonstrated a significant reduction in MBQ scores (96.5%) and
symptoms (92.9%), compared to the control group (3.5% and 7.1%, respectively). The t-test analysis revealed a significant
difference (p < .001) between the intervention and control groups, indicating the efficacy of upper limb orthosis in pregnant
women presenting with CTS.

Conclusion: The study demonstrates the effectiveness of upper limb orthosis in reducing symptoms of carpal tunnel syndrome
(CTS) among pregnant women . With a significant reduction in MBQ scores and symptoms severity observed in the
intervention group compared to control over a four -week period, early intervention with orthosis proves beneficial. These
findings tell the importance of timely diagnosis an d conservative management in alleviating CTS symptoms during pregnancy,
potentially minimizing the need for more invasive interventions.

Keywords: Carpal Tunnel Syndrome, Pregnancy, PRCTS, Wrist Splint, Upper limb orthosis, Median Nerve.

Effectiveness of Total Contact Cast in Patients with Diabetic Neuropathic foot Ulcers

Muqadas Mazhar Muqadas Mazhar — 2024-10-19

Introduction: To assess the effectiveness of Total Contact Cast (TCC) in treating diabetic neuropathic foot ulcers, including
percentage reduction in ulcer surface area and healing time.

Methods: A quasi-experimental investigation took place in Benazir Bhutto Hospital Rawalpindi, Medical University, for six
months, from August 1st, 2023 to January 31st, 2024. The study included thirty diabetes patients with non-ischemic neuropathic
foot ulcers up to grade 2A, as classified by the University of Texas. The pre-intervention ulcer size was measured with metal
ruler. Debridement was performed in some individuals to remove necrotic tissue, calluses, and foreign objects and Total Contact
Cast (TCC) was applied. TCC was repeated every two weeks until the ulcer was healed. Post-intervention ulcer size
measurements were taken. The key outcome measures were percentage reduction in ulcer surface area and time to heal in the
cast.

Results: Twenty-two patients (73.3%) were males, whereas eight (26.7%) were female. The patients' average age was 59±7
years. Every patient had NIDDM. The majority of forefoot and mid-foot ulcers in the current study healed with a total contact
cast. Average healing time was 39 days (three cast’s duration). Patients identified as grade 1A recovered completely over the
research period, but those classified as grade 2A showed a considerable reduction in ulcer size until the eighth week. Among
Thirty patients with diabetic Non-ischemic neuropathic foot ulcers, the mean ulcer size (cm²) at baseline was 4.6583±2.41090
SD. It changed to 1.3550±1.26228 SD at the end of the trial. The ulcer size at baseline and the ulcer size at the 8-week followup were compared using a paired sample t-test. The percentage reduction in ulcer size surface area from baseline at the eighth
week was 71% with total contact cast. P< 0.05 was considered significant.

Conclusion: The results of the study showed that total contact cast was a successful therapy for neuropathic diabetic foot ulcers
of Texas grade up to 2A that were located in the forefoot and midsole region.

Keywords: Diabetic Neuropathic foot ulcers, Total contact cast, offloading.

From Novice to Self-Healer: Exploring Self-Medication among First-Year Medical Students

Minahil Iman Janjua Minahil Iman Janjua — 2024-10-19

Objective: To study discusses what first-year medical students know about self-medication, their attitudes toward it, and their
actual practices in managing their health.

Methods: The study surveyed 200 first-year medical students from October to December 2023 in Rawalpindi to assess their
understanding, approach, and practice of self-medication using a non-random convenience sampling method. Data was
analyzed with SPSS Version 27, employing descriptive statistics and correlation analysis.

Results: The prevalence of self-medication among the students was found to be 96%. Females (62.5%) showed a significantly
higher association with self-medication compared to males (33.5%). Around 90% of students had basic knowledge of selfmedication safety and precautions, and over half had a positive attitude towards it, with only 43.5% feeling confident in its
success.

Conclusion: The study highlights a significant prevalence of self-medication among first-year medical students in Rawalpindi,
with a majority demonstrating a basic understanding and positive attitudes toward its practice. Despite a lack of confidence in
its efficacy, a high percentage of students still engage in self-medication practices. Further research could explore the factors
influencing students' confidence in self-medication success to better inform future interventions and healthcare policies.

Keywords: Self-Healer, Self-Medication, Medical Students

A Cross-Sectional Study To Analyse The Prevalence Of Dysmenorrhea With Its Associated Complaints And Management Strategies Among Students Of Rawalpindi Medical University

Javeria Sehir Javeria Sehir — 2024-10-19

Objective: To study prevalence of dysmenorrhea, its impact on daily routine, the associated complaints and the symptomatic
management by the medical students at RMU.

Methods: Our research was based on a cross-sectional study from Aug 2023 to Dec 2023. Questionnaires were distributed
among medical students of RMU with total participants of 170. Collected data was analyzed using SPSS version 27.0. The chisquare test was used for evaluation. Simple frequencies, percentages, and mean were obtained.

Results: We collected responses from 170 participants. Mean age of respondents was 20.59 ± 1.5 years. Based on the data we
collected, we found that 70% of the respondents experienced dysmenorrhea with varying frequency. Dysmenorrhea had a
considerable impact on students' daily life activities. 45% of the participants faced productivity issues, 28% experience
emotional stress while 23.5% reported they avoid social events and 19% even miss school. Several complaints were associated
with dysmenorrhea experience; most common were muscle cramps (45%), back pain (40.5%), nausea (27%) and fatigue (27%).
We also investigated that majority of the students use self-management strategies to overcome their symptoms, which mainly
included relying on pain relievers (36%) and use of heat therapy (37%). Use of herbal remedies was also common among 34%
participants. 28% of the respondents had daily exercise routine, 19% avoid junk and 36% avoid cold water during menstruating
days.

Conclusion: The study revealed that primary dysmenorrhea is a prevalent complaint among female at RMU, which severely
affects their daily life. Meanwhile the myalgia, digestive, mental, physical, sleep, and appetite issues were self-managed by
63% while 37% sought medical help. The most prevalent symptomatic management are over the counter medicines, heat
therapy some practice herbal remedies as well.

Keywords: dysmenorrhea, medical student, associated symptoms, pain relievers

Exploration of Newborn Care Practices among Mothers in Tertiary Care Hospitals of Rawalpindi; Insights and Implications

Mehreen Noor Mehreen Noor — 2024-10-19

Objective: To evaluate the newborn care practices of mothers who presented to a tertiary care hospital of Rawalpindi district
and to ascertain the correlation between newborn care practices and different socio-demographic characteristics

Methods: In this Cross-sectional study, 232 mothers of newborns during the first seven days of live birth who reported In Holy
Family Hospital, Rawalpindi were interviewed through a self-structured questionnaire. The questionnaire comprised of 3
sections. The participant's socio-demographic profile was the first, prenatal care was the second, and newborn care practices
comprised the final section containing 15 items. Data generated was analyzed using SPSS version 25.

Results: 69.4% of mothers practiced averagely, 19.8% practiced well, and 10.8% practiced poorly. Mothers who reported
having at least one prenatal visit were 92.7%. Ill practices regarding cord-care were reported as Eighty-six percent said they
used pyodine, oil, or spirit on the cord stump. Providence for appropriate skin and eye care was 93.5% and 71.1%, respectively.
Delayed Bathing (after a 24-hour period) following delivery was reported by 88.4% of respondents. The percentage of exclusive
breastfeeding was 38.4%. Only 15.9% of mothers started nursing in the first hour after giving birth. Pre-lacteal meals were
given by majority of our study participants i.e. 64.2% .65.5% participants reported giving colostrums to the newborn. A strong
correlation was established between good practices and urban living (p=0.006). Better hand hygiene before touching a newborn
(p=0.048) and bathing the infant after each episode of stool (p=0.026) was significantly associated with higher maternal
education level.

Conclusion: The care practices for newborns were mediocre. Health education can help women become more knowledgeable
about best practices for caring for their newborns.

Keywords: Newborn care, Cord Care, Pre-lacteal, Exclusive breast-feeding

Chimeric Antigen Receptor (CAR) T-Cell Therapy And Cytokine Release Syndrome: Do We Need To Be Innovative To Overcome The CAR T-Cell Associated Toxicities

Shahzaib Maqbool Shahzaib Maqbool — 2024-10-19

Chimeric antigen receptor (CAR) T -cell therapy is the target specific therapy that utilizes the function of genetically
engineered T -cells in production of artificial T-cell receptors for being utilized as immunotherapy for treating cancers. It’s
not only an exciting revolution in the field of hematology, but also now being utilized in treatment of solid tumors. Despite of
having such an exciting revolution, the use of CAR T-cell therapy is restricted due to its associated toxicities like
cytokine release syndrome (CRS) and neurotoxicity thus posing the dire need of development of new strategies that could
ameliorate the toxic side effects and can provide better target specific therapies like CAR off switches, suicide gene
strategies, modifying the CAR transduced T cells, and altering the affinity of the CAR -T cell’s antigen binding domain.

Keywords: CAR-T cell therapy, Cytokine release syndrome, Toxicity.

A Rare Case Of Sino-Nasal Sarcoma With Intracranial Extension: A Case Report

Ahmed Hasan Ashfaq Ahmed Hasan Ashfaq — 2024-10-19

Herein, we are reporting a rare case of sinonasal sarcoma with intracranial extension. Patient presented with complaints of nasal
obstruction and epistaxis. The investigations including histopathological analysis were suggesting a highly aggressive sinonasal
sarcoma with intracranial extension also involving the internal carotid artery in circumferential manner. Tumor was
unresectable due to extent of invasion and patient was referred to radiotherapy department for reduction of tumor size with
radiotherapy.

Keywords: Sinonasal sarcoma, intracranial extension, Spindle cells, Fascicular pattern