Effect of Acute Aerobic Exercise on Diastolic blood Pressure in Preclinical Medical Students of Services Institute of Medical Sciences, Lahore

Objectives: To evaluate the response of acute bout of moderate exercise on DBP in preclinical medical students of Services Institute of Medical Sciences (SIMS), Lahore and to compare it with gender, family history, lifestyle and waist-hip-ratio of the study participants. Methods: This cross-sectional study was performed in the Department of Physiology, SIMS from May to December 2019. Ninety-three (93) healthy male and female MBBS students were recruited through nonprobability convenient sampling. Socio-demographic components were gathered using a ques-tionnaire. Anthropometric data (height, weight and waist-hip-ratio) and resting DBP was recorded before the exercise. All participants underwent exercise challenge on a treadmill. Post-exercise DBP was measured by taking serial recordings at zero minutes, 2 minutes and 5 minutes after exercise cessation. Data was analyzed using SPSSv20. Results: Within the 93 participants, 87(93.5%) were physically inactive, with only 6(6.5%) were physically active. In comparison with the baseline DBP, the DBP at zero and 2 minutes post exercise was statistically significant (p<0.001) in study participants. There was no significant correlation between DBP immediately after exercise and gender (p = 0.751); family history of hypertension and diabetes mellitus (p = 0.603); and lifestyle (p = 0.954). A non-significant (p = 0.636) yet positive correlation was observed between post exercise DBPand waist-hip-ratio among males. Conclusion: Our study revealed that an acute bout of exercise significantly raised the DBPimmediately after exercise. This rise in BP was not significantly related to gender, lifestyle and family history of diabetes mellitus and hypertension. Keywords: Diastolic blood pressure, aerobic exercise, waist-hip-ratio, medical students, treadmill How to cite: Shafiq M., Qutab M., Javaid S., Fatima R., Ijaz M., Shafiq A. Effect of acute aerobic exercise on diastolic blood pressure in preclinical medical students of Services Institute of Medical Sciences, Lahore. Esculapio 2021;17(02):170-174.

Comparison Between Paracetamol Vs Voltral Suppositories For Post Operative Pain In Gynaecological Procedure

Objective: To compare intravenous paracetamol vs Voltral (Diclofenac) suppositories for post operative pain in gynaecological procedures. Methods: This was a non randomized controlled trial that was carried out at Department of Anaesthesiology, Sheikh Zayed Hospital, Rahim Yar Khan during 01-07-2019 to 31-12-2019 in which all female cases with age range of 20 to 60 year undergoing any gynaecological surgery requiring general anaesthesia were included. The cases were divided into two equal groups and anesthesia was offered in standard doses. Just before reversal the cases in group Awere given intravenous paracetamol in a dose of 1 gm stat and then at 8-hour interval and those in group B were offered diclofenac suppositories in a dose of 50 mg twice a day, 12 hours apart. The pain was assessed at 4,8,12 and 24 hours and was labelled on visual analogue scale (VAS). Results: In this study there were 62 cases (31 in each group). The mean age in group A and B was 45.41±10.21 vs 48.12±11.13 years with p= 0.47. Mean duration of surgery in both groups was 57.51±15.23 vs53.11±14.79 minutes with p= 0.81. There was no significant difference in mean pain score at 4 and 8 hours with p= 0.91 and 0.81 respectively in group A and B. Mean pain score was 4.43±1.67 vs 3.21±1.09 with p= 0.01 at 12 and 4.57±1.71 vs 3.34±1.27 at 24 hours in group A and B with p values of 0.01 each. Mean time taken for rescue analgesia was 9.13±2.11 in group Aand 13.11±1.23 hours in group B with p= 0.001. Conclusion: Voltral (Diclofenac sodium) suppositories are better than paracetamol infusion in controlling pain after gynecological surgeries and this difference is significantly better at 12 and 24 hours. Key words: Gynaecological surgery, Pain, Paracetamol, Voltral suppository How to cite: Khan Z., Khaleeq S., Rehman Ur A., Maan A., Farooq U. Nadeem A. Comparison Between Paracetamol Vs Voltral Suppositories for Post-Operative Pain in Gynaecological Procedures. Esculapio 2021;17(02):191-194.

Knowledge, Attitude and Practices Regarding COVID-19 among Postgraduate Trainees and House Officers

Objectives: To assess the knowledge, attitude and practice among house officers and post graduate trainees towards COVID-19 in tertiary care hospitals. Methods: An online questionnaire was used as research tool to collect data from 115 house officers and post graduate trainees working in tertiary care hospitals. Questionnaire was divided into three sections. Knowledge was assessed on basis of choosing the best option, attitude was evaluated with agree/disagree and practices were considered on yes/no format. Data was analyzed with SPSS 24®(Armonk NY:IBM corp). Results: 115 doctors responded to online survey. Mean age was 26.92±2.92, 62(53.9%) were female and 53(46.1%) were male. Regarding the status of participants, 46(40%) were house officers and 69(60%) were post graduate residents. Considering the domain of knowledge, maximum score was 12 and minimum was4. Mean score was 8.75. It was observed that 82(71.3%) participants agreed that COVID-19 will be successfully controlled, while 114 (99.1%) of participants counselled patients and their attendants about preventive measures. Regarding practice domain, 110(95.7%) participants replied in affirmative that they wore mask when leaving home while 19(16.5%) had undergone training for nasopharyngeal sample collection. Only 45(39.1%) had undergone training for doffing and donning. Pearson correlation was applied between the three domains and status of doctors. It was observed that postgraduate residents were significantly better in Covid-19 related knowledge (p<.05). Among the three domains, no significant relationship was observed. Conclusion: Doctors have positive attitude though factors have been identified in knowledge and practice that need improvement. Keywords: COVID-19, knowledge, attitude, practice How to cite: Tarique S., Sarwar S., Knowledge, Attitude and Practices regarding COVID-19 among Postgraduate Trainees and House Officers. Esculapio 2021;17(02):179-182.

Induction of Labour with Isosorbide Mononitrate Versus Prostaglandin E2 (PGE2) in Primigravidas (PGs) at Term

Objective: To compare the frequency of caesarean section due to fetal distress with Isosorbide mononitrate versus PGE2 for the induction of labour in primigravida at term. Methods: It was Randomized Control Trial conducted in Unit I, Department of Obstetrics & Gynaecology, Lahore General Hospital, Lahore from 11th April 2015 to 10th October 2015. 230 primigravida were randomized into two groups i.e. Prostaglandin E2 and Isosorbide mononitrate for induction of labour. The difference in the frequency of caesarean section due to fetal distress with Prostaglandin E2 and Isosorbide mononitrate for induction of labour in the primigravidas at term was calculated as outcome. Results: The mean age of 27.62 ± 3.909 ranging from 21 to 34 years. The frequency of cesarean section was 12.2%in Prostaglandin E2 group while 0% in Isosorbide mononitrate. There was no effect of gestational age, age of mother and number of doses on outcome. Conclusion: There is no difference in frequency of cesarean section in primigravida groups induced by either Isosorbide mononitrate versus prostaglandin E2. Wherever applicable and feasible we should opt for Isosorbide mononitrate for induction of labour. Keywords: Cesarean section, Prostaglandin E2, Isosorbide mononitrate, Dinoprostone, Induction of labour, Primigravida How to cite: Waheed R., Ashraf N., Sabeen N., U Allah I.M., Javed Q., Khalid A. Induction of Labour with Isosorbide Mononitrate Versus Prostaglandin E2 (PGE2) in Primigravidas (PGs) at term. Esculapio 2021;17(02):166-169

Correlation of Depression, Anxiety and Stress with Quality of Life in COVID-19 Pandemic

Due to Covid-19 pandemic the psychological health of individuals is disturbed globally. There is a dire need of looking into details about the effects of mental health issues on quality of life (QOL). Objectives: To determine correlation between depression, anxiety, stress, and quality of life among adults in Covid-19 and evaluate the impact of demographics on quality of life. Methods: It was a cross-sectional study carried out at a tertiary care hospital. Patients presenting in the psychiatry outdoor of age 18 to 60 years, of both genders and scoring ≥21 on Depression, Anxiety, and Stress Scale (DASS) were enrolled in the study and depression, anxiety and stress severity was assessed and Quality of Life Scale (QOLS) was applied on all to assess their quality of life. All findings were then subjected to statistical analysis. Results: The mean age of the patients was 21.78±3.204, mean depression score on DASS was 8.58±4.510, mean anxiety score on DASS was 11.68±4.160 and the mean stress score on DASS was 14.84±3.192. There were 63.5% males and 36.5% females. Depression, anxiety and stress had a negative correlation with quality of life. Depression and stress were significantly correlated negatively with quality of life (p=0.000). No demographical factor was significantly associated with poor quality of life. Conclusion: Depression, anxiety and stress were negatively correlated with poorer QOL and depression and stress had significant association with poor QOL. Key words: Anxiety, Depression, Covid-19, Quality of life How to cite: Rashid A., Mudassar U., Tariq I., Zaheer A., Iftikhar M., Mazhar N. Correlation of Depression, Anxiety and Stress with Quality of Life in COVID-19 Pandemic. Esculapio 2021;17(02):195-199.

Comparison of Alvarado Score and Paediatric Appendicitis Score for Diagnosing Appendicitis in Children

Objective: To compare diagnostic accuracy of Alvarado score (AS) and Paediatric Appendicitis Score (PAS) for diagnosis of acute appendicitis in children. Methods: This study was conducted at the department of Pediatric Surgery Children Hospital Lahore, over a period of 1 year. All the patients undergoing appendicectomy were included. Alvarado score and Pediatric Appendicitis score (PAS) was evaluated, compared and appendix specimen sent for histopa-thology. All findings were recorded in proforma. The collected data was analyzed by SPSS version 24. The mean Alvarado score and PAS was calculated, and stratified according to the histopathology reports. The sensitivity and specificity of both Alvarado score and PAS for three strata including score 3-5, 5-7 and 8-10 were also calculated. Results: A total of 177 patients were included in the study. The mean age of the patients was 9.16 ± 2.386 years. Among these 118 patients (67%) were male. The mean duration of pain was 21.42 ± 19.05 hours. Biopsy report showed that 18 patients (10.1%) had normal appendix with no signs of inflammations while 159 patients (89.9%) had inflammation on histopathology. We stratified the histopathology reports according to Alvarado score ≤7 and >7 and P-value was found significant. Similarly PAS ≤7 and >7 was stratified and P-value was not significant. The difference in mean Alvarado score between having acute appendicitis and those with normal histopathology was significant (P= 0.000) while this difference in mean PAS was not found significant (P= 0.325). Conclusions: None of the scoring system has adequate diagnostic accuracy and clinical judgment is preferred. Key Words: Alvarado Score; PAS; Appendicitis; Children How to cite: Liaqat N., Iqbal A., Rehman ur W., Ahmed Z., Bashir F., Dar H.S. Comparison of Alvarado score and Paediatric Appendicitis Score for diagnosing appendicitis in children” Esculapio 2021;17(02):175-178.

Comparison of 21 Days Versus 10 Days Bladder Catheterization after Hypospadias Repair

Objectives: To compare 21 days versus 10 days bladder catheterization after hypospadias repair. Methods: After approval from ethical committee, Randomised controlled trial performed, in which 196 male patients were enrolled in the study that was conducted at department of pediatric surgery, Children hospital, Lahore. All patients underwent Snodgrass procedure. Group-1 patients were considered for 10 days bladder catheterization for hypospadias repair and group-2 patients were catheterized for 21 days. Complications were documented on follow-up visits in group 1 at 1 week (17 days), 3 weeks (34 days), and 6 weeks (51 days) after catheter removal. In group 2 at 1 week (day 28th), 3 weeks (day 42nd), 6 weeks (day 63rd) after catheter removal. Results: The mean age in group-1 and group-2 was 7.25 ± 3.22 years and 6.29±3.02 years. There were significantly less cases of urethrocutaneous fistula in group 2 when compared to group 1. Urethro-cutaneous fistulas (UCF) developed in 13(13.26%) ,11(11.22%) and 10 (10.2%) cases at 1, 3, and 6 weeks post catheter removal follow up in group 1. While in group 2 UCF developed in 4 (4.08%), 3(3.1%) and 2(2.04%) at 1, 3, and 6 weeks follow up. There were 5(5.2%) and 4(4.1%) cases of post-operative wound infection in groups 1 and 2 respectively (p-value = 0.500). Wound dehiscence was seen in 1 (1.02%) case in group 1 and was not seen in group 2(p value =0.500). glans dehiscence was not seen in group 1 while 1 (1.02%) case seen in group 2 (p value 0.500). Conclusion: We conclude that 21 days catheterization after hypospadias repair gives better outcome and fewer complications when compared to 10 days catheterization. Keywords: Bladder catheterization; Hypospadias repair; Fistula formation. How to cite: Abdullah M., Saleem M., Zafar M.G., Sattar M.F., Hasnain I, Wasti R.A. Comparison of 21 Days Versus 10 Days Bladder Catheterization for Hypospadias Repair. Esculapio 2021;17(02):187-190.

Patient Denialism for COVID19 Pose Difficulty for Treating Physicians

Objective: As patients refusal has been a major issue in diagnosing the disease, we carried out this study to determine the magnitude of the refusal or denial of suspected COVID 19 cases. Methods: All patients seen with COVID 19 symptoms in medical out doors and emergency in Bahria International Hospital, Lahore in two weeks period from April 15, 2020 to April 30, 2020 were included in study. COVID 19 symptoms were ascertained on WHO guidelines labelling patients as COVID 19 suspected through laboratory tests. Depending upon results individual consultation with each patient was arranged to convince them to carry out nasopharyngeal swab for SARS Co-V-2 PCR. Some patients refused despite counselling for follow up regarding symptoms and advised tests. The public fear was the main barrier for the suspected cases to get tested. Each patient who refused PCR test was labelled as in denial. Results: Of the 40 cases diagnosed as suspected COVID 19. 21 refused to get tested. Majority (15) were male. Fever with chills was common among all with majority presented with shortness of breath (43%) followed by diarrhea (33%) and chest pain (9%). Conclusion: Patients who remain in denial pose a great threat to society as by spreading the virus or deteriorating themselves. An effective campaign on government level should be run to overcome the fear which has made this infection a social stigma to help contain this pandemic in a resource scarce country like Pakistan. Keywords: Coronavirus denial, COVID-19 denial, COVID in Pakistan, Public reaction to COVID 19 How to cite: Pervaiz R., Rana A.M., Qayyum A.M., Munawar A., Tariq S., Lashari A.A. Patient denialism for COVID19 pose difficulty for treating Physicians. Esculapio 2021;17(02):183-186.

Trends of Self-Medication Amongst the Patients Visiting the Out-Patient Department of Combined Military Hospital, Lahore

Objective: The purpose of our study was to assess the trends of self-medication practices and to determine the prevalence, characteristics, related factors, and effects of self-medication among the patients conducted. Methods: This descriptive cross-sectional study was on patients of Combined Military Hospital Lahore on a sample size of 365. The data was collected and entered in a predesigned questionnaire about self-medication later analyzed using SPSS version 17.0. Results: The prevalence of self-medication was 95.3% and effectiveness was 87.7%. The common reasons for self-medication were prior knowledge of usefulness of remedy (63.3%), non-affordability of consultant charges (18.4%), and lack of time (21.9%). Frequently used medicines included antibiotics (30.1%), analgesics (69.6%), antipyretics (51.0%), and antihistamines (23.6%). Respondents claimed to receive information about these drugs from various sources including doctor (38.6%), previous prescription (31.8%), retailer seller (13.4%), family/friends (43.6%), media (7.9%) and other sources (1.6%). Conclusion: It had been concluded that there is a high prevalence of self-medication. There is a need to raise public awareness about the appropriate use in order to prevent potential hazards of self-medication. Key Words: trends, self-medication, out-patient department How to cite: Khan B.A.A, Muzahir F, Rauf S.A, Fatima S.R, Pervaiz A, Jamil S. Trends of self- medication amongst the patients visiting the out-patient department of Combined Military Hospital, Lahore. Esculapio.2021. 30-33

Serum Potassium Levels and Adverse Outcomes in Patients with Acute Myocardial Infarction

Objective: To determine the effect of serum potassium levels on short term mortality outcomes in patients with acute myocardial infarction. Methods: This Descriptive Case Series was conducted in the CCU of Mayo Hospital Lahore from 15th November, 2017 to 15th May, 2018. A total of 156 patients of either sex between the age group of 30-60 years and diagnosed as cases of myocardial infarction with symptoms of less than 24 hours duration and serum potassium level of <3.5 mEq/L were included in the study. Patients were then followed up for 7 days and adverse outcome was recorded. Data was analyzed using computer software SPSS Version 22.0. Results: Out of the 156 patients, 119 (76.3%) were males and 37 (23.7%) were females. Mean age of the patients was 47.88±6.24 years, mean weight 85.31±13.14 Kg, mean duration of presenting complaints was 10.269±4.51 hours and mean Serum Potassium levels were 3.05±0.25 mEq/L. Adverse outcome in the form of mortality due to arrhythmias was seen in 15 (9.6%) patients. Conclusion: Low serum potassium level (<3.5mEq/L/L) was significantly associated with increased adverse outcome in acute myocardial infarction patients. Keywords: Acute myocardial infarction, Low serum potassium levels, Adverse outcome How to cite: Abbas R., Nazar T, Aziz B., Saeed F., Nawaz K., Nabeel M. serum potassium levels and adverse outcomes in patients with acute myocardial infarction. Esculapio 2021;17(01):5-8