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Open access Opinions | December 30, 2022
Official WhatsApp groups - a communication burnout

Nadia Naseem

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The drive towards adopting modern ways of communication is nothing but a blessing in terms of quick, easy and valuable correspondence amongst professionals especially if they are working remotely. The provision of a group feature as a simple and instant messaging platform in WhatsApp is a highly popular channel for such communications. Unfortunately, a number of poor practices have also arisen which call for designing and implementing specific extrinsic and intrinsic communication-related policies for monitoring and balancing this social media correspndence hub available officially to most of the employees in an organization. Because of the lack of control and breach in the borderline between personal and professional life, an unclear, disjointed, and disconnected workplace communication is taking place. WhatsApp groups are thus hurting productivity more than these can help.

Open access Review Article | December 30, 2022
Commiphora wightii and molmol have therapeutic effects in oral cancers and COVID-19 disease by modulating anti-apoptotic proteins and inflammatory pathways

Nida Rasheed, Sarah Ghafoor

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Oral Squamous Cell Carcinoma (OSCC) has become prevalent worldwide and is one of the leading cause of death. Derangement of anti-apoptotic proteins is important regarding OSCC development. Over-expression of these proteins lead to prolonged cellular survival, thus increasing the susceptibility of tumor formation. Commiphora wightii and molmol are the natural herbs with ability to down-regulate anti-apoptotic proteins by acting on Nuclear Factor-kappa B (NF-κB) pathway, p53 pathway, signal transducer and activator of transcription pathway, estrogen, cyclooxygenase 2 and mitogen activated protein kinase pathway. NF-κB pathway has been found to involve in the release of cytokine storm associated with COVID-19 disease. Commiphora wightii and molmol suppress the COVID-19 infection by their anti-inflammatory and anti-viral properties. This review sheds light on the effect of Commiphora wightii and molmol on suppression of oral cancer and COVID-19 infection by modulation of anti-apoptotic proteins and inflammatory pathway.

Open access Case Report | December 30, 2022
Lipoma arborescence of knee joint in an adolescent male patient: a case report

Shuja Uddin, Adeel Hamid, Ahmed Umair Asad Khan, Hafiz M. Umar, Iqra Fatima, M. Rizwan Shah, Mian Muhammad Haneef

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A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion’s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.

Open access Original Article | December 30, 2022
Risk of malignancy index: a useful tool in primary evaluation of ovarian masses at tertiary care center in Pakistan

Rabia Nafees, Humaira Zareen, Zoofishan Imran, Dr Maujid Masood Malik, Assistant Professor Shazia Jang Sher

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Background and Objective: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. The risk of malignancy index (RMI) is a combined parameter that is a simple, highly sensitive, and more specific scoring system based on three factors: serum cancer antigen 125 (CA-125) levels, ultrasonographic (USG) score, and menopausal status. The objective of the study is to evaluate the diagnostic efficacy of RMI for the primary evaluation of ovarian masses in females presenting at a local tertiary care hospital in Pakistan.

Methods: This prospective observational study was carried out at the Gynecology outdoor clinic of Fouji Foundation Hospital, Rawalpindi, Pakistan. The study comprised 141 females admitted for surgical exploration of ovarian masses. Pre-operative USG evaluations of ovarian mass, menopausal status, and serum CA-125 levels were determined for all the patients. RMI was calculated and post-operative histopathology of resected ovarian masses was done in all the cases to confirm the diagnosis.

Results: The sensitivity and specificity of CA-125 alone at a cut-off value of 35 U/ml was 67.64% and 83.17% respectively. Using a cutoff value for RMI at 200 U/ml, the specificity and sensitivity of CA-125 were 85.98% and 76.47%, respectively. The receiver operating characteristic curve revealed that RMI was a better discriminate than CA-125, ultrasound, and menopausal status alone.

Conclusion: The RMI is a useful tool in the primary evaluation of ovarian masses. It can be used to differentiate between benign and malignant ovarian masses with high sensitivity and specificity. Suspected malignant patients can be referred to a gynecological oncologist for further management.

Open access Original Article | December 30, 2022
Prevalence of nomophobia and its associated factors among medical students of a private medical college in Lahore

Aniq Saleem, Maham Shahzad, Seema Hasnain, Hafsa Asad

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Background and Objective: Mobile phones have become an indispensable part of our daily life. Nomophobia (NMP) is an abbreviation for “no-mobile-phone phobia,” which defines apprehension faced by mobile phone users in its absence which leads them to become technically unable to communicate. Objective of the study is to determine the prevalence of NMP and its association with the demographic factors among medical students of a private medical college in Lahore.

Methods: A cross-sectional study was conducted among the medical students from first to final year classes from May to November 2021. A validated NMP questionnaire was used along with questions related to the sociodemographic profile and frequency of mobile phone usage by the respondents. The self-reported questionnaire was filled out by all the students who were present on the day of data collection. Data were analyzed by SPSS 20.

Results: Out of 646 medical students, 618 filled the questionnaire. Out of 618 respondents, 51.5% had moderate and 38.2% had severe NMP. Among sociodemographic variables, females (40.8%) had a statistically significant association with NMP (p = 0.027). Usage of mobile phones per day and disturbance in the students’ daily routine had a statistically significant association with the NMP (p = 0.029 and p = <0.001, respectively).

Conclusion: NMP is very common among medical students and females are more likely to experience this phenomenon. Frequent usage of mobile phones is directly related to NMP affecting the daily routine of the medical students.

Open access Original Article | December 30, 2022
Serum calcium levels as biomarkers of birth asphyxia in neonates

Maria Hassan, Iffat Batool, Hasan Mujtaba, Muhammad Mohsin Javaid

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Background and objective: Birth asphyxia is a common pathological condition seen in newborns with increased morbidity and mortality. Grave consequences following birth asphyxia require earlier recognition of the precipitating factors and prompt treatment in intensive care units. Multiple electrolyte imbalance has been related to this condition. This study aimed at determining the mean serum total calcium levels in neonates with birth asphyxia.

Methods: This cross sectional study was performed at the neonatal intensive care unit of the Pediatric Department of Fauji Foundation Hospital, Rawalpindi, Pakistan over a period of 6 months. A total of 100 full-term neonates of either gender with evidence of birth asphyxia of any stage were enrolled on their first hour of birth. Serum calcium levels were estimated in each neonate at 24 hours after birth.

Results: A total of 60 (60%) neonates were males. Mean serum calcium levels were found to be 7.64 mg/dl ± 0.59 with no significant difference among males and females (7.67 ± 0.64 and 7.59 ± 0.50 mg/dl, respectively). Neonatal distribution in Stages I, II, and III was 64 (64.0%), 23 (23.0%), and 13 (13.0%), respectively. Hypoxic-ischemic encephalopathy stage stratification with mean serum calcium levels with higher stages deciphered significant correlation (7.89 ± 0.54, 7.36 ± 0.28, and 6.88 ± 0.28 mg/dl, respectively, in stage I, II, and III).

Conclusion: Markedly decreased levels of mean serum calcium were seen in higher hypoxic stages with ischemic encephalopathy hence delineating a linear correlation with the onset and progression of disease.

Open access Original Article | December 30, 2022
Knowledge and attitude of young female population toward early diagnosis of polycystic ovary syndrome

Saima Naz, Farhana Asghar, Yusra Iqbal, Zulekha Naseem, Mahnoor jathol

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Background and Objective: The heterogeneous illness known as polycystic ovary syndrome (PCOS) causes multisystem morbidities and is one of the major causes of female infertility. This study aimed at assessing the knowledge and attitude of the young female population towards the early diagnosis of PCOS in Pakistan.

Methods: This cross-sectional questionnaire-based survey study was carried out at the Lahore Wapda Hospital Complex, Pakistan over a period of 1 year (January 2021 to 2022). A total of 1,278 females with active PCOS from 18-23 years of age were selected for the study from all provinces of Pakistan. A total of 96 responses were excluded because of inconsistency, incompletion, or duplication while the remaining 1,182 respondents were finally included in the study. Regression analysis, analysis of variance, and t-test were applied for statistical inferences.

Results: Only 45.3% of the patients had significant knowledge (p-value = 0.001) or a positive attitude about the early diagnosis of PCOS. The participants who were diagnosed with abdominal ultrasonography scored significantly higher in attitude towards earlier diagnosis than those who were diagnosed with serum gonadotropins and/or androgens levels (p = 0.001).

Conclusion: Lack of appropriate information and awareness regarding PCOS and its complications while bearing a poor attitude concerning the early diagnosis of this syndrome leads to higher disease burden and morbidity in our younger female population.

Open access Original Article | December 30, 2022
Agreement between arterial and venous blood gas measurements in patients with sepsis and septic shock

Abida Pervaiz, Sadia Bashir, Zareen Gulrohi, Usman Pasha, Xiao Ning, Khalid Mehmud Khan

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Background and Objective: Acid–base status is mandatory for clinical assessment of patients with septic shock and severe sepsis. Generally, venous blood gas sample collection is easier, however, the data regarding this approach are lesser defined in our population as a substitute for arterial blood gas (ABG) sample. The present study aimed to determine and compare the pH, pCO2, and bicarbonate levels in VBG and ABG samples in patients with sepsis and septic shock.

Method: A cross sectional comparative study was conducted on 350 patients with sepsis and/or septic shock admitted to the medical emergency of Jinnah Hospital, Lahore, Pakistan. Both ABG and VBG samples were collected and pH, pCO2, and bicarbonate levels were determined by standard methods. Data were analyzed using Pearson correlation and the Bland–Altman method for bias.

Results: An interclass correlation (r = 0.995, r = 0.929 and r = 0.946) was found for pH, pCO2, and bicarbonate between ABG and VBG samples, respectively. The Bland–Altman method showed a high degree of agreement for two sets of measurements; pH (bias ± SD, 0.089 ± 0.00472) and pCO2 (bias ± SD, -1.1096 ± 1.0089) with a clinically acceptable difference whereas the difference in bicarbonate measurement was found slightly higher (bias ± SD, 1.124 ± 0.674) revealing, however, a good degree of agreement with clinically acceptable bias.

Conclusion: Use of a venous blood sample in patients with sepsis or septic shock is a clinically acceptable substituent for ABG measurement in evaluating acid-base status of these patients for further management.

Open access Original Article | December 30, 2022
Factors influencing career choice in Generation Z: a study from students of private colleges in Lahore

Hina Ahmed, Aziza Ahmed, Hamza Ahmed, Eeman Khan

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Background and Objective: Choosing a career is a difficult decision, especially among young adults, which is influenced by many dynamics. Every adolescent faces the dilemma of choosing a career due to exposure to so many avenues in today’s digitalized world. The objective of this study was to determine the factors influencing the career choices of Generation Z studying in different private colleges in Lahore city of Pakistan.

Methods: It was a cross-sectional survey enrolling n = 196 young students of private colleges of Lahore between the age group of 17 and 20 years selected through the convenient sampling technique. An online, validated questionnaire was distributed via WhatsApp groups and the participants were asked to return the filled but anonymous proformas within 1 week. The data compilation and analysis were done by using Statistical Package for Social Sciences software version 26.0 by keeping the level of significance at 5%.

Results: The mean age of the participants was 18 ± 1.93 years. The mean age for starting to think about their career choices was 15 ± 3.32 years. Influences like social, internal, and external factors were rated as 38.8%, 37.1%, and 49.6%, respectively. The odds of making a career choice were higher for those with parental influence, a prestigious profession, and a job with a higher salary.

Conclusion: The most influencing factors affecting the career choice in Generation Z were parents’ wishes, pressures, or role modelling followed by a prestigious profession and higher salaries.