Journal of Rawalpindi Medical College
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Worsening Of Existing And New Onset Headaches Associated With Face Masks Among Healthcare Professionals
Full text linkObjective: This study aims to investigate the frequency of protective facemask-associated headache disorders among Pakistani doctors in terms of new-onset and exacerbation of existing headache disorders
Methodology: A cross-sectional survey was designed to get data from medical doctors working at tertiary care hospitals of Islamabad/Rawalpindi from November 2023 to June 2024 after the hospital’s ethical committee approval. The online survey was designed as a specifically developed questionnaire, and it was distributed in the form of a Google form link to various medical doctors working in tertiary care hospitals of Islamabad/Rawalpindi until the sample of 300 medical doctors was achieved. Some doctors were approached personally as per convenience and their responses were noted after informed consent.
Results: The mean age of study participants was 29.78±4.31 years, with 128 (42.7%) males and 172 (57.3%) females. 33.0% of medical doctors reported having a history of previous headaches, while 48 (16.0%) developed a new onset of headache. A significantly higher number of participants who had migraine headaches reported experiencing an increase in the frequency of their headache as compared to those with history of tension-type headache or cluster headache (52.3% vs 34.1% vs 13.6% respectively, p=0.017) and increased severity of their headache as compared to those with history of tension-type headache or cluster headache (54.8% vs 35.7% vs 9.5% respectively, p=0.003). About 83 out of 147 (56.5%) reported that they had noticed improvements in headaches after taking off the facemasks.
Conclusion: It can be concluded that there is a significant relationship between facemask use and the worsening of existing headaches and also onset of new headache episodes among medical doctors who use PPE for prolonged periods during clinical practice.
Keywords: Headache, Masks, Migraine Disorders, Personal Protective Equipmen
Comparative Study Of Ketamine Versus Dexmedetomidine As An Adjunct For Transversus Abdominis Plane (TAP) Block For Cesarean Sections
Full text linkObjective: To compare the efficacy of adding dexmedetomine versus ketamine to bupivacaine for TAP block in terms of postoperative pain score, rescue analgesia requirements and postoperative nausea and vomiting.
Methodology: The study was a Quasi-experimental study, conducted in the Anesthesia Department, Tertiary Care Hospital from July to December 2023. We selected 120 patients scheduled for cesarean section and randomly divided them into two groups. At the end of surgery, group BD patients received a total volume of 40 ml, 20 ml on each side. This volume consisted of bupivacaine 0.125% with 0.5mcg/kg dexmedetomine. On the other hand, group BK patients received the same amount of volume on each side but instead of bupivacaine and dexmedetomidine we used bupivacaine 0.125% and ketamine 1 mg/kg. All patients were observed for post-op pain for 16 hours using a visual analogue scale. The need to give rescue analgesia was also recorded. Post-op vomiting was also noted.
Results: Both groups were comparable in terms of visual analogue scale scores at 4, 8, 12 and 16 hours post-operatively with a p-value of 0.462, 0.295, 0.848 and 0.154 respectively. In group BD out of 60 patients, only 12 (20%) patients required rescue analgesia, whereas in group BK 16 (26.67%) patients were given rescue analgesia (p-value 0.388). In group BD, out of 60 only 3 (5%) patients had vomiting, whereas in group BK it was seen in 7 (11.67%) patients (p-value 0.186).
Conclusion: It is concluded in our study that the addition of dexmedetomidine or ketamine to bupivacaine for transvesus abdominis plane block is equally effective and may provide effective analgesia at least for 16 hours.
Keywords: Adjuncts, Bupivacaine, Dexmedetomidine, ERAS, Ketamine, Nerve block, Cesarean section
Knowledge and perspective of artificial intelligence in dentistry among dentists and dental students: A cross sectional study
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Objective:
In some areas of dentistry, artificial intelligence (AI) is the newest buzzword. This study set out to evaluate knowledge and perspective of AI among dental students and professionals of Ziauddin University, Karachi, Pakistan.
Methods:
The study employed a validated self-reported questionnaire in a cross-sectional design to assess 250 dental students and dentists of Ziauddin University.
Results:
A total of 84% of respondents said that they understood what AI is, and 77.2% said they were somewhat familiar with its applications in dentistry. Overall 75.6% of participants agreed or strongly agreed that AI will result in significant advancements in dentistry. On the other hand, 59.2% disagreed or strongly disagreed that dentists would ever be replaced by AI. Dentists scored considerably higher on attitude than dental students, although there were no gender-specific differences.
Conclusion:
The dental faculty and dental students at Ziauddin University are generally positive in their perceptions towards artificial intelligence in dentistry and have a reasonable level of awareness of it. Though, AI is not used much in reality. Given the global shift to digitalization, AI must be included in dentistry curricula
Opioid Free Anesthesia For Laparoscopic Cholecystectomy; A Randomized Control Trial At A Tertiary Care Hospital.
Full text linkObjectives: This study evaluated the role of Erector Spinae Plane Block as non-opioid analgesic regimen for Laparoscopic Cholecystectomy in terms of intraoperative and post operative analgesia.Methods:This double-blind randomized control trial included patients aged 16-80 years, ASA-PS I, II who underwent elective laparoscopic cholecystectomy of less than 1h. The participants were randomly divided Group E vs Group O. The primary outcome measures were adequacy of intra-operative and post operative analgesia in terms of intra-operative hemodynamics and post-operative Visual Analog Scale. The secondary outcome measures were the amount of intra-operative rescue IV fentanyl and total analgesics consumed in 6h post operatively. Results:72 participants were enrolled. Intraoperatively DBP, MAP, HR upon skin incision and pneumoperitoneum along with MAP and HR at end of surgery were significantly lower in group E vs group O. The median intra-operative rescue opioid consumption in group O was 57.5 Mcg while group E was 0.00 (p value= 0.000). Post operatively pain scores were significantly lower in group E vs group O. Post operatively IV Tramadol was given to 4 patients in group O vs 0 in group E. Post operative consumption of IV Paracetamol was 2.0 in group O vs 1.0 in group E (p value of 0.000). Post operative IV Ketorolac consumption in group O was 15.0 mg vs 0.0 in group E (p value =0.000). Conclusions: Pre-incisional ESPB in laparoscopic cholecystectomy is an effective regional anesthetic technique which greatly reduces analgesic consumption and enhances the quality of post operative recovery.Keywords: Laparoscopic Cholecystectomy, Non Opioid Analgesic, Nerve Block, Acute Post-operative Pai
The Effects Of ND: Yag Laser Capsulotomy On Intraocular Pressure In Diabetic Patients
Full text linkObjective: To determine the mean intraocular pressure (mean IOP) changes after Nd: YAG laser capsulotomy for posterior capsule opacification (PCO) and to compare IOP in diabetic and non-diabetic patients after Nd: YAG laser capsulotomy.
Methods: Total 200 patients of all genders between 26 and 60 years of age who have undergone cataract surgery within 6 months to 3 years prior were included and were treated with minimum possible pulses of Nd: YAG with an energy of 1-13 ml/pulse and capsulotomy with an opening of 3.0-4.0mm of diameter in posterior capsule. After the laser, the intraocular pressure was measured at 1 hour, 2 hours, 4 hours and 24 hours. An independent t-test was used to compare the mean intraocular pressure between two groups at first hour, 2 hours, 4 hours, 24 hours and one week time points. A paired t-test was used to compare the mean difference in IOP from baseline at each post-Laser interval in each group, respectively.
Results: Out of 200 patients (200 eyes), 100 patients (50%) were diabetic and 100 patients (50%) were non-diabetic. The mean pre-laser IOP was 14.72 ± 2.67 in the diabetic group and 14.36 ± 1.47 in the non-diabetic group. At one hour after laser treatment, the mean IOP was 19.17 ± 3.16 in the diabetic group and 15.62 ± 2.33 in the non-diabetic group, with p p-value of 0.0001. Mean intraocular pressure difference at 1st hour is 3.55 mmHg in the diabetic group, which is significantly higher than that in the non-diabetic group, which is 1.26 mmHg.
Conclusion: This study concluded that IOP rises at the 1st and 2nd hour after Nd: YAG capsulotomy, and after that it gradually decreases to prelaser values after 24 hours. The mean intraocular pressure difference at 1st hour in the diabetic group is significantly higher than that in the non-diabetic group
Post-Menopausal Symptoms: Do They Affect A Woman’s Quality Of Life?
No full textObjective: Menopause is a physiological event and transition of life in all women at the age of 45. Assessment of Quality of life (QoL) at menopause has been largely inadequate. The study aims to assess the Quality of life in post-menopausal women of Pakistan
Methods: An Analytical cross-sectional study was conducted in the gynaecology/obs unit of Holy Family Hospital, after taking approval from the ethical review board. 580 women were included in the study. Data collection was facilitated through a questionnaire, administered by the gynaecology OPD duty doctor after conducting interviews with the postmenopausal women. The questionnaire was adopted from the Menopause Rating Scale (MRS) and the World Health Organisation Quality of Life (WHOQoL) proforma.
Results: Mean age at menopause was 49.9 years. Postmenopausal symptoms were experienced by 95% of women of varying severity, with the most commonly reported symptoms being hot flushes (79%), followed by palpitation (70%), depressive illness (45%), sexual problems/decreased libido 33% and urinary problems 25%. Around 16 per cent of women reported an effect on Quality of life due to menopausal symptoms. A positive correlation was found between QoL and the education of the patient. There was a negative correlation between QoL and parity and the age of the patient. In multiple regression analysis, vasomotor symptoms score (hot flashes and night sweats), psychological symptoms (depressive mood) and urogenital symptoms (sexual problem and bladder problem) remained as main predictive factors of QOL of postmenopausal women, accounting for 38% of variance (adjusted R2 =0.38).
Conclusion: The experience of menopausal symptoms varies across cultures and regions, impacting women's quality of life. Factors like symptom prevalence, parity, economic status, and cultural beliefs significantly shape the menopausal experience, highlighting the need for tailored support and interventions to improve women's well-being during this phase of life
Towards A Safer Health System: Attitudes Of Health Care Professionals Towards Patient Safety Culture
Full text linkObjectives: To measure the attitudes of health care professionals towards patient safety culture and to identify areas of improvement that will assist in achieving improved service excellence in the organization.
Methods: A mixed-method study was conducted at Shifa International Hospital and Shifa Foundation Community Health Centre. A total of 350 participants were recruited, and the duration of the study was six months after IRB approval. Demographic data was collected, and a safety attitude questionnaire (SAQ) with 1- 36 items was used for quantitative purposes. This questionnaire had some additional open-ended questions, 37-41, which were used as a qualitative analysis to enrich information. For quantitative analysis, the data was analyzed using SPSS version 21.00. The demographic data was analyzed by descriptive statistics. The answers to open-ended questions (37-41) were analyzed through thematic analysis, coding the data to identify themes.
Results: The Overall response rate was 78%. Out of all items, safety climate and job satisfaction scored highest, followed by teamwork climate and working conditions. The lowest scores obtained were of stress recognition and perception of management. Qualitative analysis resulted in the emergence of three main themes, i.e. Awareness of safety attitude culture, Reporting of adverse events and Recommendations for improving.
Conclusion: The institutions must prioritize a safety-oriented culture and continuously evaluate practices to ensure a safe and effective health system
Patterns And Determinants Of Caesarean Section Rates According To Modified Robsons Criteria: A Descriptive Study From A Tertiary Care Hospital
Full text linkObjective: The underlying purpose of this clinical audit is to categorize cesarean sections according to maternal characteristics as described in Modified Robson’s Criteria, which facilitates the identification of the major contributing factors to the rapidly rising rate of cesarean sections (CS).
Materials and Methods: This retrospective study was conducted at Shalamar Hospital, Lahore, Pakistan. It is a descriptive analysis based on the delivery records of 3,925 women who delivered in the obstetric units of Shalamar Teaching Hospital from October 1st, 2022, to September 30th, 2023. Data collection was done using a research questionnaire which recorded data for relevant maternal characteristics. Then, the data was classified per Robson's criteria. The resultant involvement of each group was calculated to monitor each group’s share in the consequent CS rate. Lastly, sorting data observations for noting the frequency of cesarean indications was included in the study to deliver eloquent discernments. Non-reassuring CTG and failed induction of labor were found to be the most prominent indications for cesarean deliveries.
Results: Out of the 3925 deliveries recorded, 2886 (73.5%) were cesarean sections. According to the criterion used, the major contributor to the overall Cesarean Section rate was Group 5, which includes previous cesarean delivery, single, cephalic, ≥37 weeks, accounting for almost 50% of the cesarean deliveries. The second largest group was Group 2 (22.1%), followed by Group 1 (9.3%), which heightens the overall CS rates. An enhanced level of medical intervention during pregnancy and low preferences of vaginal birth shift maternal as well as obstetric preferences towards cesarean sections which needs to be addressed.
Conclusion: Modified Robson’s criteria is an effective tool for auditing cesarean sections to identify exact areas where efforts and strategies are required to reduce the overall CS rate. Women with previous 1 scar should be assessed and offered a trial of labor after cesarean section, where appropriate. Groups 1, 2 and 5 should be subjected to necessary intervention to curb the rising CS rates and support VBAC
Prioritizing Maternal Mental Health: A Study Of Prenatal Depression In Southern Punjab, Pakistan
No full textObjective: To determine the prevalence of prenatal depression and investigate its associated socioeconomic, demographic, physical, and psychological characteristics among pregnant women in Southern Punjab, Pakistan.
Methodology: This cross-sectional study on prenatal depression was conducted from October 2024 to March 2025 in South Punjab tertiary care hospitals. The Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of 11 was used to measure depression. Chi-square test was employed to identify significant associations (p < 0.05) between prenatal depression and various characteristics on SPSS 27.
Results: This study of 350 pregnant women in South Punjab found a high prevalence of prenatal depression (56.3% with a mean EPDS score of 11.61). Significant associations with depression (p < 0.05) included respondents' employment status (housewives higher), lower monthly income, husband's employment type (non-business higher), having children with special needs, experiencing husband's violence, feeling sad about the pregnancy, and experiencing pressure for a baby boy.
Conclusion: In conclusion, this study reveals that prenatal depression is linked to socioeconomic disadvantages (unemployment, lower income, husband's occupation), negative social experiences (husband's violence, pressure for a boy, negative attitudes), and pregnancy-related factors (having a child with special needs, negative feelings about the pregnancy)
Comparison of Efficacy and Safety of Ferrous Bisglycinateand Ferrous Sulphate in Iron Deficiency Anemia (IDA) of Pregnant Patients: Comparative Analytical study
No full textObjective: To compare oral ferrous bis-glycinate and ferrous sulfate as regards the mean change in haemoglobin, serum ferritin and tolerability in treating Iron Deficiency anaemia during pregnancy.
Methods: This Experimental Study was carried out in the outdoor department of the Gynaecology and Obstetrics department of Kahuta Research Laboratories (KRL) hospital in Islamabad from 26th September 2022 to 26th March 2023. A total of 150 pregnant patients with iron deficiency anaemia were included in the study. Group I was for oral ferrous sulfate, Group II was for oral ferrous Bis-Glycinate. Hb level, serum ferritin and tolerability were noted from both groups after 8 weeks.
Results: Mean Hb level was 9.760±0.63 g/dl in group I as compared to 10.853±0.81 g/dl in group II (p=0.000) after 8 weeks, and mean serum ferritin level was 23.640±1.14 ng/ml in group I as compared to 29.960±1.03 g/dl in group II (p=0.000) after 8 weeks.
Conclusion: Our study has concluded that ferrous bis-glycinate has a superior efficacy in increasing HB level and serum ferritin, and also has better tolerability.
Keywords: Pregnancy, Anaemia, Iron-Deficiency, Ferritins, Ferrous sulfat