Papers by arshad khushdil
Pakistan Armed Forces Medical Journal, May 4, 2023
Pakistan Journal of Medical and Health Sciences, May 27, 2023
Pakistan Journal of Medical and Health Sciences, Jan 31, 2023
Background: Professionalism is one of the basic attributes of a doctor patient relationship. Duri... more Background: Professionalism is one of the basic attributes of a doctor patient relationship. During development of professional identity, doctors interact with their community which provides opportunity for mutual negotiation of identity and they keep improving their abilities. The development of this professional identity is a difficult skill indoctors working in Military hospitals. Aim: To explore development of Professional Identity in doctors working in pediatrics department of military hospital. Study design: Qualitative study based on phenomenological design. Place and duration: The study was conducted in Combined Military Hospital Quetta from Jan 2022 to June 2022. Methodology: All doctors serving in uniform in paediatrics department were included.In depth interviews were taken, recorded, transcribed and anonymized. Data interpreted manually, common themes originating from interviews were analysed and results formulated. Results: Six themes were found from transcript. Participants discussed about their professional life during service in military and road to gain professional excellence. Conclusion: Military residents working in paediatrics department have dual roles of serving the nation during peace as well as war and natural disasters.
Pakistan Journal of Medical and Health Sciences, May 27, 2023
Background: Immunization has tremendously reduced the incidence of childhood illnesses. Aim: To i... more Background: Immunization has tremendously reduced the incidence of childhood illnesses. Aim: To identify the causes of failure of immunization in our setups and help strengthen the EPI by solving those causes. Study design: Descriptive cross-sectional study. Place and duration of study: Department of Paediatrics, CMH Quetta from July 2022 to December 2022. Methodology: Two hundred and seven children (0-24 months) of both genders with acute diarrhoea passing three or more loose stools per day for no longer than two weeks were chosen. Using EPI cards, all parents of these patients were asked about their children's vaccination status. The demographic information like name, age and gender were noted. Results: There were 104 (51%) females and 103 (49%) females with a mean age of 18±1.5 months. 91.8% received BCG and OPV0, about 82% received Penta +OPV1+Hib at 6 weeks and 157 children were vaccinated at 10 weeks. Complete vaccination was received by 137 children at the age of 14 weeks, 52% of the children received measles vaccine, however, only 32% of the children had received their second dose of the measles vaccine by the time they were 15 months old. Conclusion: The immunization practices in children were decreased with advancing age of the children. The vaccination rate was highest at birth, 6 weeks and 10 weeks but significantly reduced at 9 months and 15 months. A robust awareness campaign is needed in order to sensitize the parents regarding the immunization of their children particularly at 9 months and 15 months of age.
PubMed, Sep 1, 2017
Caudal regression syndrome (CRS) is a very rare and unusual disorder affecting the lower part of ... more Caudal regression syndrome (CRS) is a very rare and unusual disorder affecting the lower part of the body along with multiple systems'involvement. It is mostly found in association with maternal diabetes mellitus during pregnancy; but there is a rare familial form of the disorder, as well. We describe a newborn who presented with the classic clinical and radiologic features of CRS along with bilateral microtia. Our search of the available English language literature did not reveal any such association of CRS with microtia.
Neoreviews, Sep 1, 2016
A female infant weighing 2,730 g is born at 37+4 weeks of gestation by elective cesarean delivery... more A female infant weighing 2,730 g is born at 37+4 weeks of gestation by elective cesarean delivery to a multigravida mother. This is the mother's fifth pregnancy. She has had 3 abortions and an undiagnosed neonatal death at 30 days. The infant who died suffered unexplained neonatal jaundice and received an exchange transfusion at 10 days of age. Because of poor obstetric history and death of the last infant, the parents were very apprehensive. This infant developed jaundice on day 1 of age. Because of her total serum bilirubin (SBR) of 5.4 mg/dL (92.3 μmol/L) at 15 hours and 9.6 mg/dL (164.1 μmol/L) at 24 hours of age, she was referred to the authors’ practice. On arrival, at 2 days of age, she had jaundice, with a heart rate of 120 beats per minute, respiratory rate of 65 breaths per minute, oxygen saturation of 95% in room air, and a capillary refill of less than 3 seconds. Systemic examination findings were unremarkable. A diagnosis of neonatal jaundice was made and phototherapy commenced. Her complete blood cell (CBC) count revealed the following: hemoglobin, 15.5 g/dL (155 g/L); white blood cells (WBC), 12,100/μL (12.1 × 109); platelets, 336 × 103/μL (336 × 109/L); SBR, 13.3 mg/dL (229 μmol/L) at 48 hours of age (just above the phototherapy threshold line); blood group, O positive (mother's blood group, B negative); reticulocyte count, 1.2%; and direct and indirect Coombs test, negative. A prefeeding blood glucose concentration was 98 mg/dL (5.4 mmol/L). Though the mother had had anti-D in the past, a presumed diagnosis of blood group incompatibility was considered because the infant’s jaundice had appeared in the first 24 hours of age. On day …
Journal of Postgraduate Medical Institute, Jul 25, 2014
The aim of this study was to determine the frequency of different histopathological findings of b... more The aim of this study was to determine the frequency of different histopathological findings of biopsy specimens obtained through colonoscopy in children presenting with lower gastrointestinal bleeding.
JCPSP. Journal of the College of Physicians & Surgeons Pakistan, Dec 1, 2021
An observational cohort study was performed at Neonatal Intensive Care Units of two military hosp... more An observational cohort study was performed at Neonatal Intensive Care Units of two military hospitals to see the effects of citicoline in neonates diagnosed to have moderate to severe hypoxic ischemic encephalopathy. Twenty newborns fulfilling the inclusion criteria were selected for the study and were given injection citicoline via the IV route. The outcomes in the immediate newborn period, including neurological features and mortality, were studied. Only one baby, who was given injection citicoline, died during the study period and 19 babies were discharged and sent home after establishment of oral feeds. Citicoline was found promising in treatment of newborns with moderate to severe birth asphyxia.
PubMed, Jul 19, 2017
Prolidase deficiency is a rare autosomal recessive disorder characterized by recurrent and nonhea... more Prolidase deficiency is a rare autosomal recessive disorder characterized by recurrent and nonhealing skin ulcers along with facial dysmorphism and mental retardation. We report a 13-year-old girl who has clinical manifestation of Proliodase deficiency. It is a very rare disorder and no such case has been reported so far from Pakistan.
PubMed, Jul 1, 2016
Objective: To compare the efficacy in terms of reduction in melasma area and severity index (MASI... more Objective: To compare the efficacy in terms of reduction in melasma area and severity index (MASI) score by more than 10 of a combination of 20% trichloro-acetic acid peel plus 5% topical magnesium ascorbyl phosphate versus 20% trichloroacetic acid peel alone in the treatment of epidermal melasma. Study design: Randomized controlled trial. Place and duration of study: Department of Dermatology, Lady Reading Hospital (LRH), Peshawar, from May 2012 to May 2013. Methodology: Patients aged 18 - 65 years, with Fitzpatrick skin type III-V were divided into two equal groups having 74 patients each. Detailed history was taken and Wood's lamp examination done to rule out mixed and dermal melasma. Melasma area and severity index (MASI) score was calculated for every patient. Priming was done for all patients with tretinoin cream applied once daily at night for 2 weeks, and to use a broad spectrum sun block cream before sun exposure. Patients in group Awere subjected to combined treatment, i.e. trichloro-acetic acid peel 20% (weekly) plus magnesium ascorbyl phosphate cream (applied once daily), while patients in group B were subjected to trichloro-acetic acid peel 20% (weekly) alone. Treatment was continued for 6 weeks. After completion of treatment, MASI score was recalculated. Proportion of patients with significant MASI score reduction was compared using chi-square test with significance at p < 0.05. Results: Male and female patients were 11 (14.9%) and 63 (85.1%), respectively in group A, whereas 13 (17.6%) and 61 (82.4%) in group B. The mean age in group Awas 30.28 ±8.08 years, and 29.36 ±6.84 years in group B. Significant MASI score reduction in group Awas seen in 60 (81.1%) patients and in group B 49 (66.2%, p= 0.040). Conclusion: Combination of trichloro-acetic acid peel and topical magnesium ascorbyl phosphate cream was significantly more effective than trichloro-acetic acid peel alone in treatment of melasma.
PubMed, 2016
Objective: To ascertain the efficacy of chloroquine as first line agent in treatment of uncomplic... more Objective: To ascertain the efficacy of chloroquine as first line agent in treatment of uncomplicated malaria -caused by Plasmodium vivax in children---and to determine its current treatment practice in Pakistan. Methods: This pilot study was conducted at the Paediatrics Department of Combined Military Hospital (CMH), Lahore, Pakistan. Forty-eight children between six months and twelve years of age having positive blood film for Plasmodium vivax were included. They were treated with chloroquine as a drug of - choice. Efficacy of chloroquine was assessed by clinical response, absence of parasitaemia on day seven and twenty-eight after initiation of therapy. A survey was also conducted to determine the first line therapeutic choice of Paediatricians in the treatment of uncomplicated Plasmodium vivax malaria in children in Pakistan. Results: The results showed 100% efficacy of chloroquine in treating uncomplicated malaria caused by Plasmodium vivax in children. Artemisin was preferred by 74.28% Paediatricians' in combination therapy as 1st line treatment. Conclusions: Guidelines proposed by Malaria Control Programme Pakistan (MCPP) in collaboration with World Health Organization (WHO) are comprehensive but not being adhered to. The recently reported resistance of Plasmodium vivax to artemisin should urge measures to implement WHO guidelines.
PubMed, Oct 1, 2014
Objective: To determine various perinatal factors leading to birth asphyxia among term newborns i... more Objective: To determine various perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. Methods: In a cross sectional study, a total of 196 asphyxiated cases were selected through consecutive non-probability sampling technique from neonatal intensive care unit (NICU) of a tertiary care Military Hospital in Pakistan from 1st December 2012 to 1st December 2013. Data obtained was analyzed using SPSS version 15.0. Descriptive statistics were used to calculate means, standard deviations and frequencies. Stratification with respect to maternal age, gestational age, newborns weight, parity and gravidity was done and post stratification chi-square test was applied to find statistical significance. Findings: Out of 196 cases, 125 (64%) were males and 71 females (36%). Mean maternal age was 27.04+4.97 years and gestational age of babies was 39.86+1.24 weeks. Majority (57.14 %) of 112 mothers were 1-3 para and ≥4 parity was recorded in 84 (42.86%) cases. Majority (64.80%) of the 127 mothers were 1-3 gravida while 69 (35.20%) had ≥4 gravidity, mean of 3.45+0.87. Mode of delivery as a factor leading to birth asphyxia was found in 32.14% (n=63) cesarean section, 44.39% (n=87) spontaneous vertex delivery, and instrumental delivery in 23.47% (n= 46). Prolonged second stage of labor reported in 72% (n=141), 29.08% (n=57) had prolonged rupture of membranes, 7.65% (n=15) had meconium staining, 5.61% (n=11) had multiple births, 21.94% (n=43) had maternal fever, and 58.84% (n=113) had anemia at delivery. Conclusion: Birth asphyxia is a preventable problem and long term neurological sequelae almost untreatable. Timely identification of the perinatal risk factors and their prompt solution can prevent and reduce the neonatal morbidity and mortality from birth asphyxia. Early identification of high-risk cases with improved antenatal and perinatal care can further decrease such high mortality.
Pakistan Armed Forces Medical Journal, May 31, 2022
Objective: To determine the frequency and risk factors of meconium aspiration syndrome in babies ... more Objective: To determine the frequency and risk factors of meconium aspiration syndrome in babies delivered to mothers with meconium-stained amniotic fluid attending neonatal unit of tertiary care hospital.
Social Science Research Network, 2020
BACKGROUND: COVID-19 virus infection, first identified in Wuhan city of China was declared a pand... more BACKGROUND: COVID-19 virus infection, first identified in Wuhan city of China was declared a pandemic by WHO in March 2020. Since then, the disease has spread to almost all parts of the world. It has affected all segments of society. The effects of infection on neonates born to mothers who are infected with SARS-CoV-2 virus have not been fully studied in detail thus far. We aimed to study the clinical and epidemiological profile of neonates born to COVID-19 positive mothers in Pakistan. METHODS: In a first observational, prospective cohort study from Pakistan, conducted between April 2020 to August 2020, at secondary and tertiary care hospitals, we studied 106 pregnant women who tested positive for SARS-CoV-2, most of whom were asymptomatic and we followed their newborn babies. Stable asymptomatic newborn babies were kept in SARS-CoV-2 specified incubators, at specially designated areas in NICUs, for observation. Nasopharyngeal swabs were taken at 24 hours of life and if negative, babies were handed over to clinically stable mothers who were educated regarding use of face masks and proper hand washing while caring for their babies. Neonates who tested positive for SARS-CoV-2 were evaluated for SARS-CoV-2 again at 48 hours and then every 48-72 hours, until found to be negative. Maternal and neonatal data, like maternal age, gestational age, duration of hospital stay, birth weight etc. were collected and analyzed using SPSS version 16. FINDINGS: Total 106 women were found to be SARS-CoV-2 positive during the study period. All 106 women delivered singleton babies. Of the 106 babies, five were found to be positive for SARS-CoV-2 at 24 hours and only one baby was found to be positive at 48 hours of life and then found negative at 7 days of life. None of the babies were found to be symptomatic and discharged home. INTERPRETATION: Babies born to SARS-CoV-2 mothers were mostly asymptomatic and there was no increased risk of morbidity or mortality to neonates suffering from the infection. FUNDING: None DECLARATION OF INTERESTS: There are no competing interests. ETHICS APPROVAL STATEMENT: Study was approved by institution ethical review board.
PubMed, Nov 1, 2018
Objective: To observe the duration for normalization of the Total Leucocyte Count (TLC) with adju... more Objective: To observe the duration for normalization of the Total Leucocyte Count (TLC) with adjuvant Granulocyte-Colony Stimulating Factor (G-CSF) treatment in leukopenic neonatal sepsis, and to compare the neutrophilic response to G-CSF in neutropenic vs non-neutropenic subgroups. Methods: This prospective cohort study was carried out at the Neonatal Intensive Care Unit at Military Hospital Rawalpindi (NICU) from 1st August 2015 to 25th January 2017. Fifty one newborns with sepsis and leucopenia were sampled judgmentally from a population of 5666 admitted to NICU during the study period. The sample was then divided into neutropenic (exposed) and non-neutropenic (non-exposed) subgroups on basis of the absolute neutrophil count (ANC). Adjuvant G-CSF was given to all subjects and stopped once TLC normalized. SPSS v22 was used to calculate mean G-CSF treatment duration and rise in ANC. A Pearson correlation coefficient and simple linear regression were computed to assess the relationship between pre-GCSF ANC and the duration of treatment with GCSF. Comparison of subgroups with respect to rise in ANC was done using independent samples T-test. Results: The mean duration of G-CSF treatment was 1.82±0.81 days (1.0 - 4.0). Neutropenic neonates constituted 49% (n=25). The Pearson correlation coefficient showed a positive but negligible and non-significant correlation between the two variables, r = 0.070, n = 51, p = 0.625. A non-significant regression equation was found (F(1,49) = 0.242,p=0.625) with an R2 of 0.005. There was a 7.06±4.5 fold rise in ANC in the neutropenic subgroup compared to the 4.5±3.1 fold rise in the non-neutropenic subgroup (p=0.04). Conclusions: The mean duration for recovery from leukopenia with G-CSF treatment in neonatal sepsis was less than 2 days and had no significant relationship with pre-GCSF absolute neutrophil count. The neutrophilic response was significantly higher in neutropenic compared to non-neutropenic neonates. As GCSF made no difference to the outcome in terms of mortality, its routine use is not recommended in leukopenic neonatal sepsis. .
Journal of Pakistan Medical Association, 2019
Background: Open myomectomy remains the main option has been shown to have satisfactory results a... more Background: Open myomectomy remains the main option has been shown to have satisfactory results as regard fertility preservation and symptom resolution, especially when the number and size of leiomyomas do not permit any other routes of intervention. Hemorrhage remains the most important concern with open myomectomy. Blood loss during surgery mainly depends on the number, size of the removed fibroids and the technique adopted during myomectomy. Objective: Evaluation of the effect of intra-operative oxytocin infusion in decreasing blood loss during abdominal myomectomy. Patients and Methods: This controlled clinical trial was on 134 women: 67 interventional group and 67 control group who were candidates for elective abdominal myomectomy at Al-Hussein University Hospital. After induction of general anesthesia and immediately prior to the operation, an infusion of 30 IU oxytocin in 500 ml normal saline at a rate of 120 ml/h was started in the study group patients during myomectomy. In placebo group patients, a pure normal saline infusion was used at the same volume and rate. Results: There was no significant difference between the studied groups regarding preoperative hemoglobin. Postoperative hemoglobin was significantly higher among oxytocin group. Hemoglobin reduction was significantly lower among oxytocin group. Conclusion: The infusion of oxytocin intra-operatively (immediately after induction of general anesthesia) may be a safe and reliable method to help decrease blood loss during abdominal myomectomy.
PAFMJ, Dec 31, 2018
Objective: To study the spectrum and antimicrobial sensitivity of bacterial pathogens causing neo... more Objective: To study the spectrum and antimicrobial sensitivity of bacterial pathogens causing neonatal sepsis, in neonatal intensive care unit
Journal of Postgraduate Medical Institute, Jun 21, 2013
Objective: To identify the patients of Jervell and Lange-Nielsen syndrome (JLNS) amongst congenit... more Objective: To identify the patients of Jervell and Lange-Nielsen syndrome (JLNS) amongst congenitally deaf children. Methodology: This was a cross-sectional study, conducted at Hamza Foundation Academy for the Deaf, and Combined Military Hospital Lahore over a period of 4 months from February to May 2012. A total of 379 children with congenital sensorineural hearing loss were included in this study. Echocardiographs of all children (ages 4-18 years) were obtained. The corrected QT (QTc) intervals of all 379 ECGs were calculated using the Bazett's formula. Using the Schwartz's criteria, patients with long QTc intervals were further evaluated for Jervell and Lange-Nielsen Syndrome. Results: Out of 379 children, 84 (22.1%) were found to have QTc intervals equal to or longer than 0.44 seconds. As per Schwartz's criteria, 31 (36.9%) out of 84 children with Long QTc (8.17% in sample population), scored high points (4.0 to 6.0), proving presence of JLNS. Conclusion: A sizable proportion of congenitally deaf children had Jervell and Lange-Nielsen Syndrome in our study.
PubMed, Jul 18, 2017
Background: Cryptosporidiosis is a common cause of persistent diarrhoea in children in developing... more Background: Cryptosporidiosis is a common cause of persistent diarrhoea in children in developing countries. Previously it was thought to be a major pathogenic organism in immuno-compromised children, but recent studies have shown it to be a common infectious agent in immune-competent children as well. Methods: This descriptive case-series was carried out at Combined Military Hospital Skardu, Pakistan from August 2014 to June 2015. Fifty-three children aged 12 months to 12 years with history of persistent watery diarrhoea for more than 2 weeks, with no blood or mucous in it and no other systemic findings, were included in the study. Results: We examined 53 stool specimens from children with persistent diarrhoea for the presence of cryptosporidium as well other pathogenic organisms. There were 22 (41.5%) females and 31 (58.5%) males. Out of 53 samples, 11 (20.8%) samples were found to be positive for cryptosporidium. Twenty-seven (50.9%) samples were found to be negative for any intestinal pathogen. Conclusions: It is concluded from this study that cryptosporidium is a very common infectious organism of persistent diarrhoea in this part of the country.
JCPSP. Journal of the College of Physicians & Surgeons Pakistan, Dec 1, 2018
Objective: To determine the effect of dexamethasone administration to women between 37 to 39 week... more Objective: To determine the effect of dexamethasone administration to women between 37 to 39 weeks of gestation on neonatal outcome in terms of respiratory morbidity and the need for NICU admission.
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Papers by arshad khushdil