bluuebunny/crossref_metadata_2025 huggingface dataset:
HEPATITIS C VIRUS INFECTION
Authors: Saeed Muhammad , Iram Shagufta , Hussain Shahida , Mobeen Rabeea , Ahmad Maqsood , Ashraf Maleeha
Published: September 2021

Hepatitis C virus (HCV) is the main causative agent of post transfusion hepatitis.The virus is distributed worldwide with varying prevalence in different countries, which couldeasily lead to chronic infections, cirrhosis, and even hepatocellular carcinoma (HCC). The aimof this study was to determine the prevalence of HCV infection among asymptomatic Pakistaniblood donors community. Study Design: Cross sectional study. Setting: Medicine Department,Allama Iqbal Medical College (AIMC) & Jinnah Hospital Lahore (JHL). Period: One year (Jan2014 to 30 Dec 2014). Material & Methods: A total of 18,274 blood samples were collected fromasymptomatic healthy blood donors (age range 19–59 years) at allama iqbal Medical College& Jinnah Hospital Lahore Pakistan. Blood samples were screened for anti-HCV by Immunochromatographictechnique (ICT). Results: Out of 18,274 blood samples, the overall HCVprevalence was 2.62%. Among the HCV positive cases, male were more prevalent, accordingto marital status married individuals were more prevalent and the age group with 31-40 yearswas more frequently infected.in relation with blood group high frequency of HCV positivityseen in Blood Group B. Conclusion: We conclude that HCV is asymptomatic infection andeasily can lead to chronic stat. therefore control of transmission requires continuous monitoringand surveillance. Trend of HCV infection is decreasing in recent years, In comparison withcountries in geographic region, Pakistan has still high rate of HCV infection. The HCV epidemicin Pakistan continues due to lack of education and awareness of the disease. A multidisciplinaryapproach and the best policies for management will be required to adopt suitable technicalmethods increase awareness in both lay and medical communities. And produce more accuratediagnosis and effective treatment of HCV patients
COMPARISON OF HCV TREATMENT
Authors: Asim Maleha , Shabbir Faizania , Jabeen Wajeeha Mah , Munira Kiran-e- , Khan Shakir , Shabbir Faizania , Khan Shakir , Khan Shakir , Rajput Tausif Ahmed
Published: September 2021

Objectives: To analyze End of Treatment Response (ETR) and SustainedVirological Response (SVR) to HCV mono-infection in comparison with HCV/HBV co-infection.Study Design: Retrospective, multicenter study. Place and duration of study: The study wasconducted at Department of Biochemistry and Molecular Biology, Army Medical College incollaboration with Armed Forces Institute of Pathology (AFIP), Rawalpindi and was completed in12 months. Material and Methods: This study included two hundred and twelve HCV infectedpatients, treated with IFN-α-2b 6MU thrice weekly plus ribavirin 1000-1200 mg daily for 24 weeksduration. The subjects were divided into two groups of 152 HCV mono-infected and 60 HCV/HBVco-infected patients. Pretreatment biochemical factors, EVR and SVR were compared betweentwo groups. Results: There is no significant difference between the proportions of HCV monoinfectedversus HCV/HBV co-infected patients with ALT & AST levels before interferon therapy.The analysis by intention to treat exhibit EVR of 75% and 60% among co-infected and monoinfectedpatients respectively (p = 0.038). Similarly, SVR of 50% and 45% was observed in HCV/HBV co-infected and mono-infected patients (p = 0.489). Conclusions: HCV/HBV co-infectedand HCV mono-infected patients had similar biochemical characteristics with significant lowerHCV-RNA titer in mono-infected patients. HCV/HBV co-infected patients showed higher EVRand SVR rates to interferon-alpha/ribavirin combination therapy as compare to mono-infectedpatients. The most possible factors responsible for favorable response rate in co-infectedpatients would be due to positive host immune reaction and reciprocal viral interaction.
ANALYSIS OF SELF MEDICATION PRACTICES
Authors: Humayun Shumaila , Imran Warda , Naheed Iram , Javid Nazish , Hussain Misbah , Azhar Maheen
Published: September 2021

Background: Worldwide practice of self-medication is increasing and due to lackof awareness emphasis is put on counseling of general public. Aim: To assess the practices ofself-medication among general public. Design: Descriptive cross sectional study. Place andduration of study: Fauji Foundation Hospital, Rawalpindi from February 2015 to September2015. Methods: Two hundred and fifty five attendants accompanying patients in general OPDof Fauji Foundation Hospital completed a self-administered questionnaire translated in urdulanguage for this study. Results: Out of 255 study participants, 168 (or 65.9%) practiced selfmedication.The prevalence was found highest among 25 to 38 years old (70.2%) and wasalmost equally distributed in males 65 (65.65%) and females 103 (66.02%). The main reasonsfor self-medication were lack of time (43.45%), and high doctor fee (35.71%).Factors influencingthis practice were age, employment, income and the education level. Conclusions: The studyrevealed that prevalence of self-medication was high among study population. Majority ofrespondents practiced self-medication for minor ailments and to get quick relief, or to avoidhigh doctor fee. Pharmacies are a big source of providing drugs for self-medication. Thereis need for healthcare professionals to educate the general public about the hazards ofinappropriate medicine use, and there should be restrictions on over-the-counter sale of drugswithout doctor’s prescription.
TRANSVERSE TESTICULAR ECTOPIA
Authors: Orfi Fayyaz Ahmad , Shakeel Saira , Shahzad Farrukh
Published: September 2021

Crossed testicular ectopia (CTE) is a rare congenital anomaly14. It is also knownas transverse testicular ectopia (TTE). In this condition both testis descend/migrate towardsthe same hemi-scrotum. About 100 cases have been reported so far. It may be associatedwith other congenital anomalies which include persistent Mullerian Duct Syndrome, truehermaphroditism, pseudo-hermaphroditism, inguinal hernia, hypospadias and scrotalanomalies. We are reporting one such case in 6 years old boy who presented to CMH Malir inMarch 2014 with left inguinal hernia and per-operatively found to have right testis in left inguinalcanal. Left testis had descended into left upper scrotum. Vasa were tethered together in upperportion by fibrous tissue. Right testis and vas was separated, mobilized extra-peritonially anddone in right scrotum (ipsilateral). Left orchiopexy was done in left scrotum. Hernia repair wasthen preformed. Post-op u/s scan was done to detect any other associated pathology whichwas negative. In most of the published reports diagnosis was made per-operatively as was thecase in this patient.
IMMUNE THROMBOCYTOPENIA
Authors: Aktas Gulali , Altinordu Rabia , Mercan Zuhal , Savli Haluk
Published: September 2021

Immune thrombocytopenia (ITP) is an idiopathic disorder which could betriggered by various factors including; drugs, rheumatic diseases and malignancies. We aimedto present a 66 year old woman diagnosed with ITP whose history was relevant for influenzavaccine and non-steroidal anti-inflammatory drug (diclofenac) use. She responded well tostandard ITP therapy. In conclusion, medications should be elaborately questioned in patientswith thrombocytopenia, especially, when a diagnosis of ITP was considered.
TETANUS SITUATION IN PAKISTAN
Authors: Talpur Altaf Ahmed , Surahio Abdul Rasheed , Memon Abdul Salam , Junejo Afzal , Jamal Akmal
Published: September 2021

Objectives: To determine demographic and clinical profile of Tetanus patientsand to highlight various management strategies as well as the outcome of the tetanus patients.Background: Tetanus, a preventable disease still found in high frequency in developing world.Globally one million cases are recorded annually. This disease found more frequently in patientswho are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made onclinical grounds with no definitive investigation available to confirm the diagnosis. Mortality ofTetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptiveobservational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period:1st Nov 2008 to 31st Oct 2015. Materials & methods: It includes patients of either sex abovethe age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected forvariables related to demography, incubation period, site of injury, history of tetanus vaccination,co morbidity, stage of presentation, management & outcome of treatment, complications &mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%)male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers byoccupation. History of injury was present in 109(83.20%) patients & incubation period was < 10days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%)patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinicalfindings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients,restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%)patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was notedin 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is foundin significant frequency in our setup which carries substantial morbidity and mortality.
ADOLESCENT PREGNANCY
Authors: Tanveer Quddsia , Fatima Anees
Published: September 2021

Objectives: To compare the obstetric outcomes in adolescent and adultprimigravida. Study Design: A comparative, cross sectional study. Setting: Gynae unit 3,Jinnah hospital, Lahore. Period: One year from Jan-Dec 2014. Methodology: Study populationwas adolescent primigravida (<19 years) and adult primigravida between the ages 20-29 years,250 in each group who were > 24 weeks of gestation. Obstetric complications were recordedas percentages of anaemia, pre-eclampsia, antepartum hemorrhage, postpartum hemorrhage,gestational diabetes mellitus, preterm delivery, instrumental delivery, cesarean section rate, lowbirth weight, Apgar score <7 at 5 minutes and NNU admission. Data was entered into SPSS 16.Chi square test applied and a p-value of<0.05 was considered significant. Results: The meanage of adolescent group was 18.4+ 0.56 years while it was 24+2.47 years in adult primigravida.The data revealed that the adolescent mothers are at higher risk of certain obstetric risks whencompared to adult primigravida .These include anaemia ( 41.2% VS 17.6%), pregnancy inducedhypertension (14.4% VS 1.6%), preterm delivery (21.6% VS 13.6% ), instrumental delivery (6.4%VS 1.6%), cesarean section rate (24% VS 12%), low birth weight (20.4% VS 8%), Apgar score<7 at 5 minutes (4% VS 2%) and NNU admission (19.2% VS 8%). The risk of antepartumhemorrhage (1.6% VS 1.2%), postpartum hemorrhage (0.8% VS 1.6%), gestational diabetesmellitus (1.2% VS 2%) and malpresentation (1.6% VS 2%) were not different in two groups.Conclusion: Adolescent pregnancy is associated with a higher rates of certain obstetric riskslike anemia, preterm delivery, pregnancy induced hypertension, instrumental delivery, cesareansection and poor neonatal outcome However the risk of antepartum hemorrhage, postpartumhemorrhage and malpresentation is no greater than adult pregnant mothers.
WHERE PATIENTS MATTER
Authors: Khan Bakht Baidar
Published: September 2021

Heart problem cases, fractures, semi–and fullyunconscious patients are attended on prioritywith no distinction of any type relative to colour,creed, or caste. Getting medical aid at a publichospital is considered ones birth right.
PEPTIDES, GLUTEN, CASEIN AND AUTISTIC BEHAVIOR – A REVIEW
Authors: Saeed Umair , Ishaq Muhammad , Zil-E-Ali Ahsan , Zafar Hannan , Zafar Shiza
Published: September 2021

Autism is a complex disease with spectrum of communication deficits andsocial limitations. There are multiple approaches in explaining this disease. Literature showsan association between peptides and its derivatives to have an effect in altering the mentalfunctions presented as autism. Gluten and casein, forms of proteins have been suggestedto aggravate the symptoms and is advised to give a gluten and casein free diet to thesepatients. Such special diet plans and psychiatric intervention may reduce the symptoms inthese patients. More investigations are required to establish the facts regarding effect of diet onautistic behavior.
HOSPITALIZED PATIENTS
Authors: Saeed Muhammad , Rasheed Farhan , Hussain Shahida , Ahmad Maqsood , Arif Mizna , Hashmi Ihsan ullah
Published: September 2021

Objectives: An alarming rise in Methicillin resistant Staphylococcus aureus(MRSA) associated hospital based infections has been reported in recent decades.Prolongedhospital stay, unhygienic health services are confined to this challenging serious problem.Anterior nares of humans are a natural reservoir for Staphylococcus aureus with asymptomaticcolonization. This study was designed to determine the prevalence of nasal carriage rate ofMRSA among hospitalized patients. Study Design: Cross sectional study. Setting: PunjabInstitute of Cardiology, Lahore, Pakistan. Period: January 2013- 2014. Materials & Methods:Nasal swabs were collected from hospitalized patients. Total 2,440 patients were screened forthe nasal carriage of MRSA. Microbiologically, identification of S. aureus was done on the basisof colony morphology, Gram staining and biochemical tests. Identified isolates of S. aureus werefurther tested for cefoxitin susceptibility testing, following the technique of modified Kirby Bauer discdiffusion using Mueller-Hinton agar as per Clinical Laboratory Standards Institute (CLSI) guidelines2013. Results: Out of total 2,440 nasal swabs, 60.45% (1475/2440) were Staphylococcusspecies. Among Staphylococcus group, 86.10% (1270/1475) were Staphylococcus aureus.The frequency of MRSA and MSSA (Methicillin sensitive Staphylococcus aureus) was 5.20%(66/1270) and 94.8% (1204/1270) respectively. Overall nasal carriage of MRSA is 2.70%(66/2440). The coagulase negative Staphylococcus were found in 205 (13.90%) cases whileMRSE (Methicillin resistance Staphylococcus epidermdis) were found in only 7 (3.41%) cases.Conclusion: Overall nasal carriage rate of MRSA was 2.70%.
RIFAXAMIN VS LACTULOSE
Authors: Younis Irfan , Butt Zamir , Yasir Malik Irfanullah , Ali Shah Syed Muhammad
Published: September 2021

Objectives: To compare Rifaxamin and Lactulose in improving the gradesof hepatic encephalopathy in patients with decompensated liver disease. Study design:Randomized controlled trial comparing the use of rifaxamin and Lactulose. Place and durationof study: 1st July 2014 to 30th June 2015 in Department of Medicine, Aziz Bhatti ShaheedTeaching Hospital Gujarat. Results: 1st July 2014 to 30th June 2015 in medical departmentof Aziz Bhatti Shaheed Teaching Hospital Gujarat. Results: 400 cases were divided in twoequal groups: Group A took Rifaximin & Group B Lactulose. Improvement in grades of hepaticencephalopathy were calculated on weekly bases. Monitoring was done by checking bloodammonia levels, number connection tests, flapping tremors and mental status. 40 patients(10%) did not stay in ward for one week. In ninety percent etiology of decompensated liverdisease was hepatitis C virus. Improvement was noted in 76.96% (n=137) in Group-A and72.52% (n=132) in Group-B, p value was found insignificant (>0.05). Conclusions: Rifaximinand lactulose had similar efficacy in the treatment of mild to moderate hepatic encephalopathy.
COMPARING DEPRESSION LEVELS AMONG DIABETICS
Authors: Rajput Aatir H. , Muneeb Muhammad , Shah M. Iqbal , Syed Nehan , Ali Abid
Published: September 2021

Introduction: This descriptive (cross-sectional) study compares depressionlevels among diabetic patients using different treatments (insulin users v/s non-insulin) atHyderabad. Objectives: This study evaluates the depressive symptoms and their associationwith education, medication adherence, demographic variables and health complaints amongdiabetics based on type of therapy used. Setting: Liaquat University Hospital, Hyderabad.Material and methods: 264 patients visiting Liaquat University Hospital, Hyderabad and differentdiabetic clinics at Hyderabad in the months of February and March, 2014 were included in thestudy via simple random sampling. 106 patients (40.16%) of the total sample are females and158 (59.84%) are males. Patients were interviewed to attain information about age, sex, onsetand type of diabetes, type of medication used (insulin or oral hypoglycemic), glycemic control,medication adherence and diabetes associated health complaints. Results: 36.36% of thepeople in the sample were insulin users while 63.64% were not. Out of 96 insulin users, 30.2%of the sample has DM-type 1 and 69.8% have DM-type 2. Mean depression level of male insulinusers is 21.93 while that of females is 22.81. Conclusion: Demographic factors, low education,additional health complaints and low medication adherence also significantly contributed todepression levels. Mental health assessment of diabetics should be made a part of routineclinical assessment at primary healthcare clinics to decrease adversarial consequences amongdiabetic patients.
RUBINSTEIN TAYBI SYNDROME
Authors: Khan Firdous , Cheema Tahseen Ahmed , Tahir Muhammad
Published: September 2021

Rubinstein Taybi Syndrome (RTS) was first described in 1963 by Rubinsteinand Taybi. The characteristic features of this syndrome include broad thumbs and toes,facial abnormalities like hypertelorism, beaked nose, micrognathia, microcephaly and mentalretardation. Cardiac, renal, ophthalmological and various orthopedic problems can also occur.Prevalence in the general population is approximately 1 case per 300,000 persons and is as highas 1 case per 10,000 live births. There is no definite inheritance pattern so far and recurrenceis very unlikely. In some patients, multiple chromosomal anomalies have been described. Wereport here a case of Rubinstein Taybi syndrome in an 18 months old girl presented with typicalfeatures which is the first case reported in our population.
COPD
Authors: Baloch Saba Ajaz , Zafar Farya , Ali Huma , Naqvi Ghazala Raza , Naqvi Ghazala Raza , Khan Sohail , Qureshi Muhammad Saquib , Siddiqui Shehla
Published: September 2021

Due to high occurrence of COPD the health care providers faced multiplechallenges in reducing COPD burden worldwide. In this review we compiled informationsrelated with features, risks, occurrence, health and economic burden of COPD and strategiesadopting for reducing the COPD burden on patients.
PREMATURE CORONARY ARTERY DISEASE
Authors: Ansari Wafa Munir , Naveed Abdul Khaliq , Khan Muhammad Nadir , Khan Omer Jamshed , Khan Dilshad Ahmed
Published: September 2021

Objectives: Interleukin-6 receptor (IL-6R) gene (A>C, rs8192284) polymorphismhas been associated with inflammatory biomarkers. We sought to investigate the association ofIL-6R gene (A>C, rs8192284) polymorphism with IL-6, IL-18 and hS-CRP levels in PCAD. StudyDesign: Case control study. Setting: Army Medical College, National University of Sciencesand Technology, Islamabad, Pakistan Methods: Total 520 subjects were recruited. 281 PCADpatients aged ≤45 years with >70% stenosis in at least one major coronary vessel along with239 age and sex matched controls were recruited. IL-6R polymorphism was determined byTaqMan genotyping while IL-6 and IL-18 levels were measured using ELISA technique and hSCRPon Immulite 2000. Results: The genotype distribution of IL-6R(rs8192284) in the cases andcontrols was: AA-56%(n=143);AC-36% (n=102); and CC-13% (n=36) and AA-59%(n=139);AC-33% (n=80); CC-8% (n=20) respectively. The risk allele frequency was significantly differentbetween the cases and controls (p=0.038) .IL-6 levels were significantly high (p<0.01) whilehS-CRP levels were significantly low (p<0.05) in subjects with IL-6R (rs8192284) CC genotypeas compared to the AC and AA genotypes. Multivariate logistic regression analysis revealedthat IL-18, IL-6 and hS-CRP still remained significant in the prediction of PCAD with a high oddsratio OR (p<0.05). Conclusions: Our study is the first to show that the presence of the IL-6Rrs8192284 is associated with significantly high IL-6 level and significantly low hS-CRP levels inPakistani Premature Coronary Artery Disease Patients.
BMI TO BLOOD PRESSURE
Authors: Samad Faiza , Fahim Muhammad Faisal , Farooqui Waqas Ahmed
Published: September 2021

Objectives: To establish association of BMI, hypertension and ethnicity. StudyDesign: Observational cross sectional survey. Setting: Patients attending medical OPD of JinnahMedical College Hospital Korangi, Karachi. Period: April 2014 to December 2014. Methods:Blood pressure was measured and BMI calculated. The WHO recommended BMI cut off pointsfor South Asians were applied, overweight or obese were with a BMI of >23 kg/m2 or >27.5 kg/m2 respectively. Cardiometabolic risk factors Diabetes and hypertension were recorded. SPSSVersion 20 was used to analyze data. Results: Of n= 420 (100%) patients n= 130 (31%) weremales and n=290 (69%) females. Mean age was 36.37 SD±12.98 years (CI 35.13-37.61)Overweight (BMI 23-<27 kg/m2) were n=124(29.5%), and obese (BMI>27.5 kg/m2)) weren=83 (19.8%). There were 6 major ethnic groups. Mean BMI>24kg kg/m2 was present infemales of all ethnic groups. Normal diastolic blood pressure in females was higher thanmales in all ethnic groups except Urdu speaking p-value 0.000 Hypertension prevalencen= 98(23.3%) showed significant differences (p-value 0.039) in ethnic groups, with highestprevalence in SindhI n=10(30%) Urdu speaking n=27(27.8%), Punjabi n=14(26.9%), ofthese n=66(69.3%) were overweight and n=37 (41.1%) obese p-value 0.000. There was asignificant relationship between BMI and hypertension in overweight and obese males andfemales’ p-value 0.000 and 0.028 respectively. Conclusion: Significant relationship of BMI tohypertension and ethnic differences in prevalence of hypertension exists. Mean BMI in femalesis in the overweight category. Females have significant higher diastolic blood pressure thanmales in all groups except Urdu speaking; Intervention for prevention of obesity and reducingchronic disease burden needs to be urgently addressed.
DIAGNOSTIC LAPAROSCOPY FOR INFERTILITY
Authors: Ara Bilqees , Zaibunnisa Miss , Ara Firdous , Baloch Aslam
Published: September 2021

Objective: To assess the causes of infertility by laparoscopy. Study design:Observational study. (Prospective). Place & Duration of study: Imdad hospital & MahnazLaparoscopy Center, Quetta from 1st Jan 2013 to 31st Dec 2013. Methodology: All the infertilepatients either with primary or secondary infertility was included after thorough evaluation.Diagnostic laparoscopy was done on these patients. Different causes were seen like tubalblockage, T.B, Endometriosis, adhesion of previous abdominal surgery, polycystic ovaries.Results: The study group consisted of 35 cases of infertile patients’ aged between 16 to 46years. 19 (54.3%) patients comprised primary infertility and 16 (45.7%) patients had secondaryinfertility because of tuberculosis (TB), pelvic inflammatory disease, endometriosis, polycysticovaries and previous surgery. 37.1% were asymptomatic, while irregular cycles, dischargeand dysmenorrhea were common symptoms Normal findings were in 3(8.6%) women.8.5% had unilateral blockage and 14.3% had bilateral blockage. 22.9% (8) cases had pelvictuberculosis and endometriosis was found in 3(8.6%) patients.11.4% (4) had pelvic adhesions.No major complication occurred except nausea, vomiting, pain and mild fever. Conclusion:Pelvic tuberculosis was most common pathology detected followed by Endometriosis, Pelvicinflammatory disease and adhesions.
HEPATITIS “C”
Authors: Iqbal Muhammad , Ahmed Adnan , Hingoro Muhammad Rafique
Published: September 2021

Objectives: To determine incidence of steatosis in non-responder casesof chronic HCV. Study Design: Cross-sectional study. Setting: Tertiary Care Sanatorium inMedicine Department of LIAQUAT University Hospital Hyderabad/Jamshoro. Period: 26-9-2011to 25 August 2012. Material & Methods: Total 144 non-responders cases of Hepatitis C wereintegrated. Both gender, age 18 to 50 yrs, chronic HCV non-responder cases as well as cases fitfor hepatic biopsy were integrated in study. Grading of Inflammation was carried out as indicatedby histopathological measures. Results: Mean age was 48.5 + 5.2years. Uppermost prevalenceof chronic HCV disease was 65(45.13%) at 41 to 50 years age interval whereas 42(29.1%) caseswere noticed in 31 to 40 yrs age group and 25(17.3%) cases were observed in 20 to 30 yearsof young age group. In this study hepatic steatosis occurrence was observed in 103 (71.5%)cases and these were categories as: grade 1, grade 2, grade 3, as (<33%) 45/103(43.68%), (33to 66%) 35/103(33.98%), (>66%) 23/103(22.33%) respectively. Conclusion: Hepatic steatosisis a important risk factor the cases of HCV to decreased response to antiviral therapy and forprogression toward fibrosis as observed in cases related to metabolic steatosis.
CIRRHOTIC PATIENTS
Authors: Sahto Abdul Aziz , Shahzad Amir , Sahito Mahnaz Faiz
Published: September 2021

Objectives: The aim behind this study was to determine the prevalence of portalhypertensive gastropathy in cirrhotic patients undergoing upper gastrointestinal endoscopy at atertiary care hospital in Shaheed Benazeerabad. Study Design: Hospital based cross sectionalstudy. Setting: Medicine Department of People’s Medical University, Shaheed Benazeerabad.Period: Six months from 20th August 2014 to 21st February 2015. Material and Methods: Atotal of 115 patients presenting with variceal bleeding (having history of liver cirrhosis since>2 years) and who further was undergoing diagnostic Endoscopic gastrodudenoscopy wereenrolled in the study. All endoscopies were performed by the endoscopists using a GIFQ 160Gastroscope (Olympus, Tokyo, Japan) in the left lateral position. The presence or absenceof PH gastropathy (outcome variable) was noted at each endoscopy. SPSS version 17.0 wasused to analyze the collected data. Results: The average age of the patients was 39.98±11.02years and mean duration of liver cirrhosis was 4.62±1.5 years. There were 70 (60.87%) maleand 45 (39.13%) were female. Regarding socioeconomic status, most of the cases were inlower and middle class. Frequency of portal hypertensive gastropathy (PHG) in patients of livercirrhosis undergoing upper gastrointestinal endoscopy was observed in 60% (69/115) cases.Conclusion: The frequency of PHG was 60% in the studied group of cirrhotic patients. Thisconcludes that if in the liver cirrhosis patients early identification and appropriate therapeuticmeasures of PHG is taken the morbidity in these patients can be decreased.
ACUTE ANTERIOR WALL MI
Authors: Asghar Naeem , Ahmad Shakeel , Ahmad Muhammad Nouman
Published: September 2021

Objectives: To compare the frequency of in-hospital mortality of anterior wallmyocardial infarction with and without right bundle branch block. Study Design: Cohort Study.Setting: Cardiology Department of Faisalabad Institute of Cardiology, Faisalabad. Duration:1st September, 2013 to 28th February, 2014. Methodology: 80 patients including both gendersfulfilling the inclusion criteria were collected. Informed consent was obtained from the patients.Effect modifiers such as hypertension, diabetes mellitus, hyper-lipidemia and smoking werenoted. Patients were monitored according to the hospital protocol and mortality was noted.Results: Out of 80 patients, 62(77.5%) were males and 18(22.5%) were females. Smokingwas present in 45% patients, diabetes mellitus in 35% patients, hypertension in 27.5% patientsand hyper-lipidemia in 23.8% patients. In hospital mortality in group A was 23(57.5%) and ingroup B was 7(17.5%) with P value of 0.0001. Conclusion: Acute anterior wall myocardialinfarction combined with right bundle branch block suggests the severity of disease and is anindependent predictor of increased mortality. RBBB after myocardial infarction suggests poorprognosis.
OPTICAL COHERENCE TOMOGRAPHY
Authors: Ahmad Faheem , Hussian Muhmmad
Published: September 2021

“Glaucoma an optic neuropathy is a caused by progressive retinal ganglion cell(RGC) loss associated with characteristic structural changes in the optic nerve and retinal nervefiber layer (RNFL).Glaucoma induced damage causes the retinal ganglion cells loss that canresult in functional loss and decrease in vision of patient . Measurement of intraocular pressureby Tonometery, characteristics of the optic nerve head changes and associated visual fieldloss are used for diagnosis of Glaucoma. Objectives: To determine the diagnostic accuracy ofOptical Coherence Tomography in detection of glaucoma taking perimetry as gold standard.Study Design: Cross sectional (validation). Period: Six months from 17-02-2014 to 16-08-2014.Material and Method: Regarding the Inclusion Criteria patients of glaucoma suspects that meetthe criteria mentioned in operational definition of either gender with age range between 35- 60years were included while patients having refractive errors, hazy media, pupil size less than4mm after dilation were not included in this study. Also patients with history diabetes mellitus,refractive or retinal surgery were also excluded. All the data was entered and analyzed by usingSPSS V-16. Results: A total of 100 patients were included in this study during the study period.Majority of the patients were between 35-45 years of age and minimum patients were 56-60 years old. Mean age of the patients was 47.10±8.02 years. Males and females were 50(50%). At OCT glaucoma was present in 71 patients while at perimetry glaucoma was presentin 69 patients .Sensitivity, specificity and diagnostic accuracy of OCT was 92.7%, 77.4%, 88.0%,respectively .Positive predictive value and negative predictive value of OCT was 90.1% and82.7%, respectively. Discussion: Regarding the pathogenesis of Glaucoma induced damageis due to result of retinal ganglion cell (RGC) death with progressive loss of axons located inthe retinal nerve fiber layer (RNFL). Many clinical studies showed that optic nerve head (ONH)damage and thinning of the RNFL occur earlier than the appearance of Glaucoma inducedvisual field defects; Conclusion: In conclusion, glaucoma suspects undergoing the OCT canbe assessed for the presence of glaucoma based purely on the results of the OCT.
KELOID
Authors: Babar Abdul Mannan , Nagi Abdul Hannan
Published: September 2021

Keloids and hypertrophic scars are basically an overabundance of fibrosis in cutaneous healing process. Unfortunately, keloids are only found in human beings. So far no successful animal model of keloid has been reported. Objectives: To produce an animal model of keloid. Main Outcome Measure: Animal model of keloid. Design: Prospective quasiexperimental trial. Setting: Department of Pathology and Experimental Research Laboratory, University of Health Sciences, Lahore, Pakistan. Duration: One year. Sample Size: Twelve albino animals i.e. three mice, three rats, three Guinea pigs, and three rabbits. Sampling Technique: Simple Convenience. Material and Methods: Three different techniques of keloid productionwere used. First animal of each species was given skin punch excision only; second was given Transforming Growth Factor Beta 1 injection only; and third was given Transforming Growth Factor Beta 1 injection followed by skin punch excision. Results were noted at four weeks. Results: Out of twelve animals, keloid was produced only in one rabbit (ear) which was given Transforming Growth Factor Beta 1 injection followed by skin punch excision. Conclusion: Keloid animal model can be produced in rabbit ear by giving Transforming Growth Factor Beta 1 injection followed by skin punch excision of ventral surface skin.
SUPERDISINTEGRANT ON DISINTEGRANT AND DISSOLUTION
Authors: Qureshi Muhammad Saquib , Zafar Farya , Ali Huma , Hameed Kamran , Mallick Neelam , Khan Sohail , Baloch Saba Ajaz
Published: September 2021

In tablet formulation superdisintegrants are added to accelerate the rate of tabletdeaggregation and thus enhancing the rate of tablet dissolution. In this review article we gatherthe information related to the superdisintegrants, their mechanism of actions and their impacton disintegration and dissolution processes. The easiest way to achieve quick release is to usea superdisintegrants with appropriate concentrations of excipients. Different superdisintegrantsare usually added to facilitate the tablet disintegration, thus increasing the rate of tabletdissolution.
MID FACE FRACTURE
Authors: Punjabi Suneel Kumar , Channar Kashif Ali , Talpur Altaf Ahmed , Banglani Munir Ahmed
Published: September 2021

Background: Mid Face fractures remain one of the common injuries managedby Oral & Maxillofacial Surgeons as routine practice. The goal of treatment in these fracturesis the three-dimensional fixation and restoration of the severely disturbed anatomical structureof mid face so as to achieve pre-injury form and function. Study Design: Descriptive caseseries study. Setting: “Oral & Maxillofacial Surgery Department, Institute of Dentistry, LiaquatUniversity of Medical & Health Sciences, Jamshoro”. Period: January 2011 to November 2015.Materials and Methods: Sample size of 64 patients. Results: Among 64 study subjects,46(71.90%) patients were male and 18(28%) patients were female, with male to female ratio2.5:1. The age distribution showed that 11(55%) patients were <25 years, 23(45%) patientswere <30years, 12 patients were <35 years and 8 patients were <40 years of age. The etiologyof fracture showed that 42 fractures were due to RTA, 10 due to assault, 8 due to fall and 4sports injuries. In thirty six Zygomatico-maxillary buttress procedure, in twenty four the frontozygomatic,and infraorbital rim fixation were done; but a mixture of web sites was needed inseveral cases. Conclusion: This study utilizing miniaturized scale plates has given us accurateand promising outcomes subsequently might be used and considered as a legitimate devicefor the management of middle third facial fractures.
TIBIAL-TALO-CALCANEUM ARTHRODESIS
Authors: Ahmad Saeed , Ikram Mohammad , Ahmed Ashfaq , Aziz Amer , Javed Shahzad , Ahmed Naeem , Ahmed Ijaz , Akram Rizwan , Zaman Atiq uz
Published: September 2021

Objectives: To determine the clinical and radiological outcome of Tibio-talocalcanealarthrodesis with Retrograde intramedullary SIGN Nail in patients with tibiotalar andsubtalar joint pathologies. Study Design: Descriptive case. Period: September 2012 to May2015. Setting: OPD or Emergency at Orthopaedics Unit of Ghurki Trust Teaching HospitalLahore. Materials and methods: 40 patients study. Detailed history, clinical examination andinvestigations were done after proper consent. Pre operative diagnosis was made on anteroposterior and lateral views of plan x rays. Retrograde Intramedullary fixation was done underimage control. All post operative patients were followed regularly on opd basis and outcomeof intramedullary fixation was determined on 6th post-operative month. Results: There were40 patients who underwent arthrodesis and fixation. There were 82.5% male and 22.5%female with mean age of 41.5 years. 95% of the patients having pain improvement whileonly 2.5% of the patients didn’t get benefit from it. Infection and non union were seen inonly 1 patient. Conclusion: retrograde sign nail is a good option for ankle and subtalar jointarthrodesis. Early weight bearing and healing in shorter period of time are its main advantages.
ACUTE HEART FAILURE PATIENTS
Authors: Asghar Naeem , Ahmad Shakeel , Nazim Muhammad , Faiq Ilyas Hafiz Muhammad , Ahmad Muhammad Nouman
Published: September 2021

Objectives: The objective of the study is to identify the precipitating factorsamong the patients presenting with AHF (Acute Heart Failure). Study Design: Cross sectionalstudy. Setting: Punjab Institute of Cardiology, Lahore. Duration of Study: 6 months. From01-01-2007 to 30-06-2007. Methodology: The calculated sample size was 170 cases with 5%margin of error, 95% confidence level taking expected percentage of uncontrolled hypertensioni.e. 12% (least percentage among all precipitating factors). Results: In the study group, mostlypatients of AHF were young with mean age of 55 + 6.99 years, male (61.8%), Diabetic (53.5%)and have history of chronic Heart Failure (63.5%). In male the most common precipitating factorof AHF was ACS (39.04%) while in female uncontrolled hypertension (38.46%). Conclusion:In diabetic patients the most common precipitating factor of AHF was ACS (30.7%). In patientswith acute decompensation of chronic heart failure the most common precipitating factor wasnon-compliance of medication (30.55%) while in patients with de novo Acute Heart Failure itwas ACS (41.93%). ACS was the common precipitating factor of Acute Heart Failure (28.2%)among the study group irrespective of gender, diabetes and history of Heart Failure.
DENTAL FLOSS
Authors: Rajpar Shazia Parveen , Banglani Munir Ahmed , Punjabi Suneel Kumar , Priya Miss
Published: September 2021

Objectives: To assist the concept and use of dental floss amongundergraduate dental students of Liaquat University of Medical & Health sciences,Jamshoro. Study Design: Cross-sectional, descriptive case series study. Setting:Institute of Dentistry, Liaquat University of Medical Health, Jamshoro, Pakistan.Period: June 2015 to December 2015. Methodology: In this study 192 studentsof BDS Department, Institute of Dentistry, Liaquat University of Medical & HealthScience, Jamshoro were selected. Questions related to assess the knowledge 87.14%students knew what dental floss was. Results: 74.29% students knew that dentalfloss remove plaque from interdental areas, whereas 25.71% replied don’t know.48.57% of the students thought that dental floss should be customarily used alongwith tooth brushing every day, 24.29% of the students thought that dental floss harmsthe interdental gingiva, whereas majority 40% said that it would not harm the gingiva,35.71% replied don’t know. only 18.57% respondent thought that toothbrushes withadvanced bristles designs would remove interdental plaque similar to dental floss,whereas majority (60%) of the respondent had no any idea about the effectiveness oftwo cleaning methods, practice of using dental floss 18.57% of students use interdentalaids commonly floss and while 81.43% did not use dental floss. 27.14% of the studysubjects use some other interdental aids like tooth picks to clean interdental areas,whereas 72.86% did not follow any other interdental cleaning practice. Conclusion:This study has focused light on the knowledge and practice of interdental aid, sofurther studies are needed. Finally, it could be concluded that awareness regardingdental floss needs to be bolstered in the population as preventive oral health carebehavior.
ASYMPTOMATIC DIABETICS
Authors: Ali Liaqat , Asghar Naeem , Khan Imran
Published: September 2021

Background: Diabetes mellitus (DM) is not only a significant independent riskfactor for developing of atherosclerotic ischemic heart disease or ventricular hypertrophy but itis also able to trigger a diabetic cardiomyopathy due to dysmetabolic processes resulting heartfailure. Cardiovascular complications are known to be the main cause of death and morbidity indiabetic patients. Objectives: How frequent is the diastolic dysfunction in asymptomatic diabetic?Study Design: Descriptive cross sectional. Setting: Echocardiography department FaisalabadInstitute of Cardiology Faisalabad. Patients were recruited from outpatient department ofFaisalabad institute of cardiology Faisalabad. Duration of Study: Six months from: 28-06-2015to 28-12-2015. Methodology: 200 patients were included in the study. Patient’s bio data wasrecorded and informed consent was taken. All echocardiographic studies were performed withVIVID-07 echo machine by the same operator. Detailed assessment of left ventricular systolicand diastolic function by using standard 2-dimensional, color flow Doppler and tissue Dopplerimaging (TDI) was done. Images were obtained in all patients. Each patient underwent leftventricular (LV) diastolic function assessment by conventional Doppler, tissue Doppler imaging(TDI). LV ejection fraction was calculated using conventional method. Blood flow velocities atmitral valve leaflets and pulmonary veins were recorded with averaged from 3 end-expiratorycycles at a sweep of 100 mm/s. This information was collected through a specially designedproforma by the author. Results: In our study, out of 200 cases, 52%(n=104) were between 50-55 years of age while 48%(n=96) were between 56-60 years of age, mean+sd was calculatedas 55.54+2.59 years, 49%(n=98) were male while 51%(n=102) were females, frequency ofdiastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus wasrecorded as 45.5%(n=91) while 54.5%(n=109) had no findings of the morbidity. Conclusion:We conclude that the frequency of diastolic dysfunction is quite high (45.5%) in asymptomaticdiabetics.
D ANTIGEN
Authors: Saqlain Nazish , Ahmed Aatika , Fateen Tooba , Ahmed Nisar
Published: September 2021

Background: In 1939 Rh antigen was discovered by Levine and Stetson. Rhsystem antigens are very immunogenic, they can produce significant Hemolytic Disease of thefetus and Newborn as well as hemolytic transfusion reactions. There are numerous variants ofD, the most common subtypes are Weak D and Partial D, now called as abnormal D antigens.The incidence of Rh negativity worldwide varies between 3%-25% and that of weak D antigenranges from 0.2%-1%. Objectives: To find out the frequency of Rh negativity and weak Dantigen among the donors coming to the blood bank of The Children’s Hospital & Institute ofChild Health, Lahore and to review the clinical significance of weak D antigen in transfusionperspective especially its role in alloimmunization caused by Weak D antigen when transfusedto Rh negative individuals. Study Design: Cross- sectional study. Setting: The Children’sHospital and Institute of Child Health, Lahore. Period: 1st Jan 2015 to 31st May, 2015. Materialsand Methods: 6320 healthy donors were randomly selected. All samples were grouped forABO and Rh-D factor by immediate spin tube technique. All samples found Rh negative, werefurther processed for weak D antigen with monoclonal anti D sera by using indirect Coomb’stechnique. The presence of macroscopic or microscopic agglutination was recorded as Rhpositive. In case there was no agglutination the mixture was washed 4 times with normalsaline. After the last wash, saline was decanted and 2 drops of monoclonal, polyvalent antihuman globulin was added. Macroscopic and microscopic agglutination was looked for andany agglutination at this stage was recorded as weak D antigen. Positive control (check cellsi.e. washed O positive cells with diluted anti D) and negative control (washed O positive cells)were always put. Results: Among the 6320 healthy donors, 1224(19.4%) were Rh-D negativeand 5096(80.6%) were Rh-D positive. Of the 1224 Rh D negative samples, 3 (0.2%) samplesfound positive for weak D antigen. Conclusion: The frequency of Rh negative blood groupwas 0.2% among the healthy donors at The Children’s Hospital and ICH, Lahore. Although thefrequency is low but it’s proven by literature that weak D antigen can produce alloimmunizationif transfused to Rh-D negative subjects. At the same time the cases of hemolytic reactionsreported previously with Weak D antigen have been scarce.
GESTATIONAL DIABETES
Authors: Anwer Ashba , Asif Uzma , Bhalli Muhammad Asif , Asif Midhat
Published: September 2021

Objectives: To find the frequency of gestational diabetes in pregnant womenusing 50 grams glucose challenge test. Study design: a descriptive study. Place and duration:Department of Obstetrics and Gynecology, Lady Atchison Hospital, Lahore from August 2012to August 2013. Methodology: Through non-probability convenient sampling, 200 pregnantwomen between 24-28 weeks of gestation were studied. All known diabetic patients wereexcluded from the study. Pulse, BP, weight and height were recorded and Body Mass Index wascalculated. Physical and antenatal examination were done. Patients were given 50 gm glucosedissolved in 200 ml of water without any dietary preparation. Glucose levels were measuredin venous plasma after one hour according to American Diabetic Association protocol. Bloodglucose level more than 140mg/dl was diagnosed as screened positive and less than 140mg/dl screened negative. The data analysis was analysed by SPSS 20. Results: Out of total 200women studied, 28 (14%) had abnormal screening test while 172 (86%) had normal test. Historyof obstetric complications was noted in 10 (5%) women. PIH was noted in 19 (19.5%) andpast history of GDM was present in 14 (8.13%). Mean age of patients screened positive was25.03 ± 2.9 years. Gestational age of positive group ranged between 19 to 32 weeks. Meangestational age was 26.17+3.37 weeks. Among screened positive women, 7 (25%) womenwere primigravida while 21 (75%) women were multigravida. Conclusion: Significant riskfactor associated with GDM include family history of DM, maternal obesity, previous history ofobstetric complications. Failure to recognize and treat the GDM results in maternal and fetalmorbidity and mortality.
STAPLED HEMORRHOIDECTOMY
Authors: Arif Saleem , Waseem Talat , Ashraf Javaid-ur-Rehman , Ahmad Farooq
Published: September 2021

Stapled hemorrhoidectomy has been recently advocated as a procedure of choicefor prolapsed hemorrhoids. Studies consistently show that this newer technique is associatedwith less postoperative pain and may be cost effective; however others have questioned its moregeneralized application. Study Design: Randomized controlled trial. Setting: Tertiary hospitalsettings at Services Institute of Medical Sciences, and Ittefaq Hopsital Trust, Lahore. Period:2002 to 2007. Patients & Methods: Short and long-term outcomes of stapled and conventionalhemorrhoidectomy were compared. 538 patients with Grade II, III & IV hemorrhoids wererandomized to undergo either stapled (n=251) or conventional hemorrhoidectomy (n=287).Perioperative and postoperative complications, length of hospital stay, patient satisfactionand long-term recurrence rates for at least 5 postoperative years were analyzed. Results:In the short term, patients undergoing stapled hemorrhoidectomy (n=251) were associatedwith less operative time, less postoperative pain, shorter hospital stay and acceptable overallfirst post-op year patient satisfaction score as compared to patients undergoing conventionalhemorrhoidectomy (n=287). In the long-term however; there were significantly higher ratesof recurrence and tenesmus in stapled group. Over the postoperative years, these rates ofcomplications increased significantly among patients undergoing stapled hemorrhoidectomy.The subgroup analysis showed that Grade IV patients undergoing stapled hemorrhoidectomyhad higher long term postoperative complication rate and poor patient satisfaction scores asopposed to Grade III hemorrhoid patients and had to undergo secondary surgical interventions.Conclusions: The stapled hemorrhoidectomy is an acceptable treatment for selected patientswith Grade II & III hemorrhoids in terms of less postoperative pain and shorter hospital stayat expense of mildly higher long- term recurrence rate; however for grade IV hemorrhoidsstapled hemorrhoidectomy is clearly is an ‘under treatment’ in the long-term as opposed toconventional hemorrhoidectomy.