bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL BREAST EXAMINATION;
Authors: Zafar Afsheen
Published: September 2021

Objective: To determine sensitivity and specificity of standardized clinical breast examination (CBE) for benign and malignant breast lumps. Design: A prospective validation study. Place & duration of study: The study was conducted at Railway hospital, Rawalpindi from September 2008 to February 2010. Patients & Methods: A total of 110 female patients presenting with breast lumps were recruited in the study. All of them underwent a standardized clinical breast examination along with complete triple assessment. The sensitivity and specificity of CBE was calculated and compared with that of triple assessment in the same patient. Likelihood ratios for individual characteristics of breast lumps were also calculated. Results: Sensitivity of a structured CBE to pick up carcinoma breast in a patient with lump breast was 100% (95% CI, 0.8-1) while specificity was 94.6% (95% CI, 0.86-0.97). The likelihood ratio for carcinoma breast was 17.8 (95% CI, 7.6 - 41.7). Conclusions: The standardized CBE can differentiate between palpable benign and malignant lumps reliably. This is especially important in benign lumps where a policy of follow up clinical examination can be utilized, particularly when the investigative facilities may not be readily available.
CHOLECYSTO HEPATIC DUCT;
Authors: Rathore Altaf Hussain , Riaz Usman
Published: September 2021

A rare congenital anomaly of extra hepatic biliary tract is presented. Its embryology and treatment is discussed. It is concluded that every abdominal surgeon should be aware of such extra hepatic anomaly in detail to avoid prolonged drainage of bile from the drainage tube, even death after cholecystectomy1.
BIOAVAILABILITY AND DISPOSITION KINETICS OF AMOXICILLIN
Authors: Hassan Zulfiqar-Ul- , Riffat Sualeha , Nazir Aamir , Naseer Rahat , Asghar Anila , Imran Muhammad
Published: September 2021

OBJECTIVE: The study was planned to observe the bioavailability anddisposition kinetics of amoxicillin in adult rabbits (irrespective of sex) under healthy anddehydrated conditions. Design: Comparative. Place and duration of study: The study wasconducted at the department of pharmacology, University of Veterinary and Animal Sciences,Lahore from April 2013 to October 2013. Methodology: Initially all rabbits were weighed andtheir packed cell volume (PCV) and other biochemical parameters were observed under normalconditions. Bioavailability and disposition kinetics of amoxicillin (10mg/kg body weight) werestudied in normal rabbits following oral and intravenous route of drug administration. After 10days washout period, these rabbits were made dehydrated by keeping the animals off waterbut not food. The animals with 10% decrease in body weight were declared dehydrated. Theirparameters were again measured. Treated rabbits were administered amoxicillin orally andintravenously (10mg/kg body weight). Samples were drawn at prescribed time. Amoxicillinwas assessed in plasma by using microbiological assay method. Plasma concentration wasanalyzed using non compartmental method. Results: The water deprived or dehydrated rabbitsshowed a significant increase in the packed cell volume, blood glucose and plasma globulins ascompared to the normal rabbits. However, there was a significant (p<0.05 & p<0.01) decreasein body weight, total proteins, albumins and albumin globulin ratio of the dehydrated rabbits.The peak plasma concentration, volume of distribution and rate constant of elimination waslower in the dehydrated rabbits as compared to the normal rabbits. The plasma concentrationof amoxicillin after intravenous administration in dehydrated rabbits had a significant (p<0.05& p<0.01) larger area under curve, area under 1st moment curve, a longer half life and a largermean residence time. Conclusions: The study in the dehydrated rabbits indicated the need ofmodification of dosage regimen.
HUMAN SPERM COUNT
Authors: Sultan Jahangir , Kokab Kokab , Ahmed Muneer
Published: September 2021

Objectives: Reports from many parts of the world suggest that chemical andphysical agents in the environment, introduced and spread by human activity may affect fertilityin men. The objective of this article is to highlight the environmental factors and their associationto male sperm quality and count as well. Materials and Methods: This study focusing onexposure to environmental factors affecting the semen quality of the workers working in differentfactories for a period of 5 to 7 years in Lahore. Results: The results from this study suggest thatthere are many environmental factors which may affect semen quality and sperm count. It isnecessary to prevent parental exposure to the agents associated with those hazards.
ORAL SQUAMOUS CELL CARCINOMA
Authors: Syed Sofia Ali , Bukhari Mulazim Hussain , Warraich Riaz Ahmed , Quadir Fauzia , Iqbal Asifa , Syed Faryal Ali
Published: September 2021

Background: The aim of this study was to evaluate clinico-pathologicalparameters and the status of argyrophilic nucleolar organizer regions stain in various histologicalgrades of oral squamous cell carcinoma. Materials and Methods: A cross sectional studywas conducted on fifty cases of oral squamous cell carcinoma. The specimen were collectedfrom the department of Oral & Maxillofacial Surgery and processed for hematoxylin and eosinstain and AgNOR stain Pathology Laboratory, King Edward Medical University Lahore. Results:Bidi smoking is associated with oral squamous cell carcinoma. The AgNOR (mAgNOR andpAgNOR) status was significantly low in well differentiated and moderately differentiatedcompared to poorly differentiated oral squamous cell carcinoma (p =0.001). AgNOR size inpoorly differentiated was significantly higher than the AgNOR size in well differentiated oralsquamous cell carcinoma. Similarly the distribution of AgNOR in moderately and poorlydifferentiated oral squamous cell carcinoma was significantly high. The AgNORs index wassignificantly high in poorly differentiated squamous cell carcinoma as compared to welldifferentiated and moderately differentiated squamous cell carcinoma. Conclusions: The useof AgNORs stain is easy, valid and reliable method to assess the histological grading of oralsquamous cell carcinoma and should be used to predict the prognosis of patients.
HEMORRHOIDAL ENDOSCOPIC BAND LIGATION
Authors: Bajwa Muhammad Akram , Farid Javeria , Khushk Maimoona , Saeed Muhammad
Published: September 2021

Objective: To determine the management outcome of the endoscopic bandligation in the patients with internal haemorrhoids at isra university Hospital Hyderabad Sindh.Pakistan. Materials and methods: All the patients were under went sigmoidoscopy andcolonoscopy for the complete diagnosis and the patients were excluded, if polyps or evidenceof malignancy was found at colonoscopy. Haemorrhoids were sucked with the tip of endoscopefrom the anal canal and elastic bands were applied. After first treatment session, patients wereasked to complete a questionnaire to evaluate the subjective satisfaction, which was classifiedas poor, good and best. Patients who had with multiple haemorrhoids were recalled for theligation on remaining haemorrhoids after 2 weeks, if indicated. Results: Total 100 patients wereincluded in the study, In complications, intensive pain was found in the 55% of the cases whileother complications were seen in very few patients and many patients were seen without anycomplication. Hospital stay was only one day was noted in the very few patients and mostlypatients were discharged after few hours of the procedure. Outcome of the endoscopic bandligation was found excellent in 40% of the cases, good results found in the 45% of the cases andpoor results were seen only in the 15% of the cases. Re-endoscopic band ligation was donein the 20% of the cases and recurrence of hemorrhoids was noted in the 30% of the cases.Conclusions: We concluded that the endoscopic band ligation is very good management forhaemorrhoids without typical complications, with very short hospital stay and recurrences rate.
RENAL COLIC PATIENT
Authors: Hasnain Muhammad Ali Zul , Khalid Malik Muhammad , Perveen Saima , Perveen Saima
Published: September 2021

Objectives: To compare Un-enhanced Helical Computed Tomography (UHCT),Ultrasonography (US) + Plain X-Ray and Intravenous Urography (IVU) in the evaluation ofpatients with suspected renal colic. Subjects: In 70 patients with renal colic US, plain X-ray,IVU and UHCT were performed to demonstrate urinary stones and other relevant pathologies.Patients were then followed-up to stone passage or removal, and the course of clinicalsymptoms were noted. Results: 57 patients had ureteral stones based on stone passageor removal. 13 patients did not have ureteral stones based on failure to recover a stone,disappearance of symptoms, and diagnosis unrelated to stone disease. Un-enhanced helicalcomputed tomography was found to be the most useful method in the demonstration of ureteralstones with a sensitivity of 97%. Reformatted images clearly depicted the intraureteral locationof stones in most cases. Spiral UHCT showed renal calculi in 15 patients, USG + KUB in 12 andIVU in 9 patients. Conclusions: Non-contrast axial and reformatted spiral CT (UHCT) imageswere found superior to USG + KUB and IVU in the depiction of ureteral and renal calculi.Reformatted images offer a good alternative to IVU in problematic cases.
OLDER PERSONS
Authors: Chaudhry Abid Ghafoor , Ahmed Aftab , Bhatti Altaf Ghani
Published: September 2021

Background: The Older Persons (OPs) are the knowledge and experiencebanks who hand over their life experiences to run society to the youth to further take up thesociety for the continuity of life and its progressive upward mobility. Objective: The aim of studywas to explore the interrelationship of older persons’ health care and social protection in thelight of United Nations Principles for Older Persons in Rawalpindi city. Study Design: CrossSectional Study. Materials and Methods: Structured questionnaire was developed to collectinformation on Older Persons’ health, economic and psychological status. In this regard, anextensive questionnaire was designed and pre-tested vigorously. Place & Duration of Study:The data collection was done in various union councils of Rawalpindi city. The study durationwas three months and lasted from September 2013 to December 2013. Results: Family isconcerned about the welfare of OPs but the financial liabilities. In 82.8% cases children werefound to be caring whereas in 17.2% cases kids were totally forgetful. 46% OPs were primarilynursed by their spouses and 34% by sons or daughters. 44.3% OPs still managed their financialaffairs. In 66% case no secondary financial facility was provided by the government. 28.9%cases were those where OPs requested help from other sources. Conclusions: The IslamicJurisprudence, Constitution of Islamic Republic of Pakistan and UN Principles demand thegovernments and states to intervene in the situation and make sure that the OPs are enjoyingequal access to independence, (social) participation, care, self-fulfillment and dignity.
REPRODUCTIVE HEALTH
Authors: Tarar Muhammad Ali , Akhtar Saira , Zafar Muhammad Iqbal , Muhammad Sher
Published: September 2021

Reproductive health is concerned with the people’s ability to have a satisfyingand safe sex life ensuring their capability to reproduce with a liberty of making a decision thatif, when and how often they have to do so. Objective: (1) To examine the females perceptions,attitude and practices about reproductive health services. (2) To determine the level of theirempowerment to take decisions and make choices regarding their own reproductive health. (3)To determine the level of the quality, availability and accessibility of reproductive health servicesand to suggest some measures for policy makers to improve the reproductive health state ofyoung mothers in district Faisalabad. Study Design: A sample of 600 young married females ofage 15-32 years were selected through multistage sampling technique. Period: 2009. SettingArea: Rural and urban area of District Faisalabad. Material and Method: Uni-variate (frequencydistribution and percentage) and Bi-variate analysis (Chi square and Gamma Statistics) wascarried out. Results: Most (44.0%) of the respondents belonged to age category of 26-30years; 35.5% were married up to 18 years; 39.3% had passed up to 5 years marriage duration;71.8% had primary and above level of education. Majority (65.9%) had up to Rs.10,000 permonth income, 49.2% possessed 6-10 family members, 73.5% beard at least 2 and abovelive children, 74.0 % perceived family planning good,79.7% had knowledge of FP and 26.0%practiced FPM (Family Planning Method). The most common FPMs were condom (33.3%) andtubectomy (21.8%) while 41.0% faced side effect because of FPM during their reproductive life.A huge majority (79.8%) of the respondents received ANC, 87.8% made regular visits for medicalcheckup and 48.8% got ANC from Pvt. Hospital during last pregnancy. Bi-variate analysisshowed highly significant relation among age at marriage, awareness level, monthly income,education, number of pregnancies, number of children, number of visits to medical centre,availability of RH services, cultural hindrance and age of respondents vs. their reproductivehealth. Conclusions: Although most of the females were young & educated mothers with goodreproductive health experience and perceived FM good but still lacking in practicing FMPswhich indicates that we need to pay more attention towards female empowerment and decisionmaking authority status at domestic level.
GJB2 GENE
Authors: Ullah Sana , Rahman Khaista , Tariq Muhammad , Ahmad Tauseef
Published: September 2021

This article reviews the most prevalent sensory illness of mammals especiallyhumans – Genetic Deafness or hearing loss (HL). For genetic hearing loss more than 100candidate genes have been discovered. The most common candidate gene of these all that isfound all around the world is GJB2 gene. Different types of mutations are found in GJB2 gene.Some of these mutations are non-sense while some are sense mutations. This study is focus onmutation in GJB2 gene and its prevalence in different region of the world.
AGRICULTURE RELATED INJURIES
Authors: Mehmood Riffat , Aziz Sajid , Jehan Shazia , Ateeq Muhammad
Published: September 2021

Traumatic injuries related to agricultural related profession can lead to seriousdisability and even mortality. Objectives: To study the spectrum of agricultural productionrelated injuries and their management outcome in General Surgical unit. Study Design:RetrospectiveDescriptive, Interventional. Study Period: January 2012 to December 2013.Setting: Surgical Department Aziz Bhatti Shaheed Teaching Hospital Gujrat & Surgicaldepartment Islam Medical & Dental College Sialkot. Material & Methods: Data of 33 patientsinvolved in an accident and sustained injury while operating agriculture machine/ equipmentis being presented with reference to age, gender, nature of injury, type of equipment /machineinvolved and management outcome. Results: Record of total 33 patients with agriculturerelated injuries was analysed retrospectively. Male population is more involved in agriculturerelated accidents seen in 20 out of 33 patients (60.6%), female involvement in such accidentsis not uncommon seen in 13 patients (39.9%). Fodder Cutter (TOKA) was the commonestagricultural equipment found involved in 17 (51.5%) cases. Traumatic amputation both minor ormajor type of upper limb was most frequent injury seen in 19 (57.7%) cases and infection wasthe commonest complication occurred in 13 cases. Fournier’s gangrene and tetanus was themost dreadful complication with 100% mortality. Overall mortality was 03.03%. Conclusions:Agriculture machinery related accidents cause serious injuries that lead to disability, morbidityand often mortality. Victims are usually young. Awareness campaigns regarding hazards andsafety measures in using agriculture machinery should be launched with the help of media.Re-implantation / re-vascularization surgery must be considered in case of limb amputations inselected cases.
GLYCATED HEMOGLOBIN (HbA1c)
Authors: Bhatti Saeed Akram , Khan Abdul Haseeb , Yaqoob Naeem
Published: September 2021

HbA1c gives an integrated index of glycemia over the entire 120 days lifespan of red blood cells. Therefore, measuring HbA1c would be appropriate in diagnosing adisease characterized by chronic hyperglycemia and a gradual progression to complications.Objectives: our primary objective was to evaluate the use of HbA1c as screening test forundiagnosed diabetes (WHO criteria of Fasting plasma glucose (FPG) of ≥ 7mmol/l (126mg/dl))in healthy asymptomatic individuals in Pakistani population. Study Design and Methodology:A cross sectional population survey was carried on asymptomatic, healthy individuals withoutpast history of diabetes. Venous blood was obtained to measure fasting plasma glucose(fasting > 8 hours) and Hb A1c. Place and Duration of Study: Khan lab Sargodha from July2013 to March 2014. The test: It was performed by using NycoCard HbA1c in vitro diagnosticmedical device for quantitative determination of glycated hemoglobin in whole blood. Results:In our sample size of 775, the lowest HbA1c was found to be 5% and Highest 13.2%. Arithmeticmeans was 6.7565%, while the median value was 6.2% and standard deviation 1.3323. Whenusing FPG only, the detection rate of diabetes was 32.65% (female, 14.71%; male, 17.94%).When HbA1c was included as a diagnostic test, the detection rate increased to 40% (female,18.84%; male, 21.16 %). An additional 7.6% of participants were diagnosed with diabetes whenusing HbA1c criteria. ROC (A receiver operating characteristic) curve was used for analysis.At HbA1c cutoff of ≥6.5% it demonstrated sensitivity of 98.02% (95% CI) and specificity of88.12% (95% CI) for detection of undiagnosed diabetes mellitus in healthy asymptomaticindividuals in Pakistani population. Area under the ROC curve was 0.981354 with significancelevel P (Area=0.5) 0.0001. Conclusions: Our study reveals that HbA1c is a highly specific andconvenient alternative to fasting plasma glucose for screening of diabetes mellitus in Pakistanipopulation. A large scale survey should be carried out to set our own national standardizations.
ANTI RETROVIRAL LIFE-SAVING THERAPY
Authors: Imran Muhammad , Nasir Jamal Abdul , Zaidi Syed Arif Ahmed
Published: September 2021

Objectives: Effective implementation of mathematical and statistical modelsmaximizes the likelihood of understanding the trajectory, level and pattern of incurable diseasesand their therapies, so that precise demand strategies for costly lifesaving therapies for future,resource allocation and timely intervention could be ensured, a significant concern for lessdeveloped countries like Pakistan. Methods: The record of monthly number of patients onlifesaving anti-Retroviral Therapy for more than 18 HIV treatment centers in Pakistan wasacquired for the period January 2011 to July 2013.A set of eleven curve fitting models namelylinear, quadratic, cubic, logarithmic, inverse ,exponential growth model, logistics-curve andcompound models was carried out for prediction. Results: After the execution of various curvefitting models by taking the ANOVA approach along with coefficient of determination and theforecast accuracy measures namely, mean percentage error (MAPE), mean absolute error(MAE) and mean square error (MSE) in the selection of final efficient model. Cubic model wasselected for forecasting the monthly anti-retroviral therapy cases for all categories i.e. overall,male female and children. On the basis of final selected model 3% increment is expectednumber of paticuts on anti-retroviral therapy annually in HIV treatment center in all Pakistan.Male patients are expected to increase 14% who will get lifesaving anti-retroviral therapies.While the annually expected reduction of 17% and 42% in female and children cases takinganti-retroviral therapy is expcted in future respectively. Conclusions: The overall number ofpeople on anti-retroviral therapy are expected to increase in Pakistan. Males are expected tohave greater risk as compared to female and children in Pakistan.
SURGICAL SITE INFECTION
Authors: Faraz Ahmad , Hameed Abdul , Bari Fazal , Ali Irum Sabir , Khan Hamzullah , Rahim Fazl-e- , Naeem Amjad , Khan Mumtaz , Hussain Abid
Published: September 2021

Ceftriaxone is used in wide range of day to day microbial infections in clinicalpractice3. Despite the incumbent drug regulating authority in Pakistan, there is scanty literaturecomparing the anti-microbial efficacy of different available brands of ceftriaxone. Objectives:To know the in-vitro activity of various brands of ceftriaxone against bacteria most commonlyisolated from surgical site infection (SSI). A comparison of five days cost of these brands willalso be done. Design: Experimental study. Period: Feb 2013 to Aug 2013 Setting: Surgical“C” unit Lady Reading Hospital (LRH) in collaboration with departments of pharmacologyKhyber Girls Medical College (KGMC) and microbiology department of Lady Reading HospitalPeshawar. Material & Methods: Isolates of five bacteria i.e. Staphylococcus aureus, Proteusmirabilis, Escherischia coli, enterobacter Spp, and Klebsiella pneumoniae, found sensitive toceftriaxone were grown on 50 slops each and the zone of inhibition was checked for each ofthe ten brands of ceftriaxone. Results: The zones of inhibitions of different brands of ceftriaxoneagainst the above mentioned bacteria were not significantly different. The cost of therapy wassignificantly different for ten brands. Conclusions: Various brands of ceftriaxone of variablecost had no influence on their activity against bacteria involved in SSI.
INDUCTION OF LABOUR
Authors: Afzal Munawar , Asif Uzma , Miraj Bushra
Published: September 2021

It is now widely accepted that trial for vaginal delivery should be attempted unlessa genuine indication exists for C- section. Objective: To determine the efficacy of membranesweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients withprevious one cesarean section (C-Section). Study Design: Randomized control trial. Setting:Department of Obstetrics & Gynaecology, Benazir Bhutto hospital, Rawalpindi. Period: Jan2008 to Dec 2008. Methods: Pregnant women with previous one C- section were randomlyallocated to Group-A (sweeping of membrane) and Group-B (no intervention) each having 55patients. There was no absolute indication of cesarean section in present pregnancy. Aftercomplete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening forhepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective Csectionwas done depending upon the bishop score. In group B, patients awaited spontaneousonset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesareansection was done. Results: In Group A, 43 (78.18%) patients had onset of labour aftersweeping of membranes while 12 (21.82%) patients had no onset of labour. In Group-B, 28patients (50.90%) had spontaneous onset of labor while 27 (49.10%) had no onset of labours.In Group-A, 34 (61.82%) patients and in Group-B only 14 (25.45%) were delivered vaginally (pValue 0.001). In Group-A, lower segment cesarean section was done in 6 (10.91%) patientswhile in Group-B, 23 (41.82%) had cesarean section (p Value 0.001). Assisted vaginal deliverywas done in 15 (27.27%) in Group-A while 18 (32.73%) patients in Group-B had assistedvaginal delivery (p Value 0.533). Conclusions: In patients with previous one cesarean section,the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery issignificantly higher as compared to patients who had no sweeping of membranes.
TYPHOID FEVER WITH JAUNDICE
Authors: Anjum Muhammad Usman , Khan Hafizullah , Shah Syed Humayun
Published: September 2021

Typhoid fever is a systemic infection which is caused by Samonella entericaserotype typhi. It is a multi-system disorder involving many organs including liver. Liverinvolvement could be in the form of jaundice, rise in liver enzymes or hepatomegaly. It canpresent as acute hepatitis in rare cases, called typhoid hepatitis. Objectives: This study wascarried out to study the association of typhoid fever in patients with jaundice. To determinethe frequency of typhoid fever among patients presenting with jaundice. Design: Descriptivecross sectional study Setting: at Gastroenterology Unit, Ayub Teaching Hospital, Abbottabad,Period: March 2011 to December 2011. Methods: Total 115 patients were included in thestudy based on inclusion and exclusion criteria. Typhidot IgM test was performed to confirmthe diagnosis of typhoid fever. Results: The mean age of patients was 28.5 ± 10.14 years,with 54.8% male gender predominating the overall sample. The male to female ratio was 1.2:1.Typhoid fever was found in 22 (19.1%) out of 115 patients with jaundice and there were 68.2%were males and 31.8% were females. Conclusions: Typhoid fever is not rare to present asjaundice in our part of the world where typhoid fever is endemic. Therefore, all those patientswho have fever, jaundice, abnormal liver function tests or hepatomegaly must be screened fortyphoid fever especially in areas where typhoid fever is endemic.
PSYCHIATRIC MORBIDITY AMONG JAIL INMATES
Authors: Arshad Muhammad , Lodhi Muhammad Aslam
Published: September 2021

Objective: (1) To find out the prevalence of psychiatric disorders among prisonpopulation. (2) To find out whether any association exist between psychiatric disorders anddifferent demographic variables. (3) To assess the severity of the problem and need for theprevision of psychiatric services to jail inmates. Study Design: Crossectional study. Period: Sixmonths starting from June 5th 2007 to November 30th 2007. Setting: Kot Lakpat Jail, Lahore.Method: All the prisoners who had been sentenced by session court for the crime of murderwere the target of the study Sample Size: Five hundred cases were interviewed to completethe study. The study had a 2 stages design. During the first stage all the randomly selectedprisoners (18 or more than 18 years of age and sentenced for the charge or murder) werecalled in the library of the jail and given screening instrument. The GHQ-12 was completed bythe prisoner on voluntary basis with minimal explanation. If the prisoner was unable to reador understand assistant researcher, jail Medical officer had to read it in front of the prisonerand record his responses. In this way expected cases were selected and screened out. In thesecond stage diagnostic interviews were administered by the author on the same day to all theprisoners who scored two and above on the GHQ-12 and 1/10th of those who were low scores(1 or 0). These responses were recorded on rating forms. The author was blind to the scoresof GHQ-12. Results Five hundred jail inmates were interviewed in the study. Out of those total500 prisoners 176 (35.2%) prisoners were GHQ-12 positive cases while 324 (64.80%) prisonerswere GHQ-12 negative (Table I). The difference was statistically highly significant (P<0.00001).Conclusions: In this study the prevalence of minor psychiatric morbidity was assessed. Fivehundred randomly selected prisoners were interviewed. Out of them 397 prisoners wereselected from open prison and 103 prisoners from closed prison. In the first stage GHQ-12 wasadministered to detect the cases. In the second stage PAS was administered to all high score(2 or above) and 10% of low scores. PAS detected minor psychiatric morbidity like depression,anxiety, panic disorder and phobic disorders. Diagnosis was based on DSM-111-R criteria.Their demographic characteristics were also obtained and comparison was made among openand closed prisoners.
HUMAN BRAIN
Authors: Raza Ali , Raza Syed Ali , Qamar Muhammad Fiaz , Liaqat Ahtesham
Published: September 2021

Aging is an irreversible and universal phenomenon of every living organism’slife. Many recent studies provide evidences that is strictly related to decline in cognitive functionimpairment but along with various causes behind these abnormal changes, change in brain!unction and structure is one of the most important factors are being widely used to studythe hypothesis that ‘the deficits in and temporal order memory are closely related. Increasein age causes reduction in memory processing tasks, which involve information storage andprocessing. In other explanation it is mentioned that frontal activity, differences underlyingaging is associated with recruitment of brain areas and neural circuit efficiency reduction. Incase of young subjects increase in activity mean shorter reaction time but in older subjectsresults are opposite.
REFLECTION ON QUALITY OF HEALTH SERVICES
Authors: Yasin Raheel , Anjum Ghulam Abbas
Published: September 2021

Health care is the crucial and fundamental right of every human being. Qualityhealth care is the strong desire of every human being. Quality is considered as one of theprime pillar of differentiation in services. Service quality is lifeline of organizational success.This paper throws a public eye on patient’s expectations and the satisfaction level pertaining toquality of service provided by public hospitals. Objectives: (1) To dig out the quality of servicein public teaching hospitals of Lahore, Pakistan by using SERVQUAL model. Study Design:Quantitative Study. Period: Sep 2014 to Oct 2014. Setting: Five Teaching Hospital, JinnahHospital, Mayo Hospital, Services Hospital, General Hospital, Sir Ganga Ram Hospital, Lahorewhich are the Medical Giants of Pakistan. Material & Methods: The research is carried out onprimary data, recording 250 responses from target audience by using structure questionnaire.Regression and correlation analysis were performed to confirm a relationship between ServiceQuality dimensions and patient satisfaction. Results: Study shows that empathy is the mostimportant factor that brings happiness and satisfaction to the patients. Conclusions: Researchfindings are fruitful for health department and hospital administration to plan strategies in orderto improve service quality and become benchmark for others in industry.
PERCEIVED AGEING AND ELDERS HEALTH
Authors: Ahmed Aftab , Chaudhry Abid Ghafoor , Farooq Haris
Published: September 2021

Culture and society always an important factor that contributed to build thestereo types rather positive and negative that affect our everyday life. As with other social issuesageing is also effected the cultural and societal stereo types. Concept of old age was not theonly creation of old age rather it was started when they were young and strong concepts weredeveloped and concreted with the passage of time as he get older and older. Objective: (1) Toexplore what Older Persons (OPs) perceived about old age. (2) To find the cross relationshipbetween their concept of old age and their disease status. Methodology: Statistically calculatedsample of 384 OPs were randomly interviewed by taking their verbal consent after introducingthem about objective of study. Structured questionnaire was developed for data collectionpurposes. Data was entered and analyzed in SPSS. Results: among 384 respondents 31.3%perceived old age as illness and disease, 15.9% consider it stress and depression, 25.5% wereof the view that old age is phase of social isolation and ignorance, increased dependencywas also recorded 9.1% and less social participation as 11.7%. Hypertension was reportedby 8.1% of the study respondents, Heart problem in 12.8% cases and Diabetes in 15.1%cases. Conclusion: Awareness of religious education along with role of social institution playsthe leading role to reduce the intensity of negative stereo types and helps elders to developpositive concepts about their last age will be supplementary measure for active, and healthyand prosperous old age.
IMPACT OF THALASSEMIA MAJOR ON PATIENTS
Authors: Ishfaq Kamran , Shabbir Muhammad , Naeem Salman Bin , Hussain Safdar
Published: September 2021

Objectives: The objectives of this study were to examine the level of awarenessof the parents regarding Thalassemia Major; the cost of treatment of Thalassemia Major Patientsand the sufferings it brings to the families; the social problems faced by patients’ families; toidentify the barriers patients’ families face in the treatment of Thalassemia child. Study Design:Descriptive study. Setting: Four Thalassemic Centers (i) Thalassemia / Hemophilia Centre, TheChildren’s Hospital & the Institute of Child Health Multan (ii) Fatimid Foundation Multan (iii) AmnaBlood Foundation (iv) Minhajul Quran Multan. Period: January-2013 to June-2013. Methods:A sample of 500 respondents was drawn from the total population and structured interviewschedule was administrated. Data were analyzed and interpreted by using SPSS (StatisticalPackage for Social Sciences) 19.0 version software. The structured interview was discussedwith two experts of the Sociology Department and two Senior Doctors (>8 years’ experiences)working in the Thalassemia centers and Government Health Institutions. It was revised toincorporate recommended improvements. Descriptive and inferential statistics were applied toanalyze the data that includes: frequency, percent, mean, standard deviations. Results: Dataindicated that 100(20.0%) respondents were patients’ father while 329(65.8%) were mothersand 71(14.2%) were close relatives. Of the 500 respondents, 306(61.2%) were married to theirfirst cousins, 91(18.2%) of the respondents were married to their second cousins, 34(6.8%) ofthe respondents married in distance relatives and 69(13.8%) of the respondents married out offamily. Conclusion: The study summarized that the health care providers should be encouragedto talk about Thalassemia as a public health problem in Pakistan and should enhance the publicawareness to eliminate the Thalassemia in Pakistan.
MULTIPLE PESTICIDE RESIDUES
Authors: Amir Muhammad , Anjum Faqir Muhammad , Randhawa Muhammad Atif , Sarwar Muhammad
Published: September 2021

Background: Food safety is a major public concern worldwide. This is seriousproblem in the whole world especially in economically poor countries like Pakistan. Theproduction of safe food is an important aspect of food quality assurance as well as humanhealth. The people are demanding fresh, hygienic and quality food. Objective: To study thelevel of pesticide residues in spinach grown in peri-urban area of district Faisalabad andcompare the level of contaminants respective their maximum residues limits (MRLS). Materialsand Methods: Ten farmers were selected randomly for spinach in the peri-urban area ofdistrict Faisalabad and vegetable samples were collected at optimum maturity in triplicate andtransported to the laboratory of National Institute of Food Science and Technology, Universityof Agriculture, Faisalabad for further processing. The residues of pesticide were determinedby GC-ECD. Results: The results regarding pesticide residues in different spinach samplesshowed variations and residues varied as deltamethrin 0.024 to 0.143 mg kg-1, permethrin 0.159to 0.573 mg kg-1, cypermethrin 0.098 to 0.503 mg kg-1, profenofos 0.016 to 0.425 mg kg-1,chlorpyrifos 0.009 to 0.212 mg kg-1, bifenthrin 0.012 to 0.623 mg kg-1, endosulfan 0.043 to 0.103mg kg-1, dimethoate 0.077 to 0.515 mg kg-1, respectively. The chlorpyriphos has no residues inany sample of spinach. Conclusion: The spinach samples are found to be contaminated witha number of different pesticides and these pesticides are not applied judiciously according togood agricultural practices and recommended doses. The farmers are unaware of pesticide useand other agricultural practices due to lack of extension as result causes of serious problemsto all community.
PAKISTAN AND URBAN AGEING SCENARIO
Authors: Chaudhry Abid Ghafoor , Ahmed Aftab
Published: September 2021

Ageing is exactly the organic process of growing older and showing the effectsof increasing age. The state of Pakistan is caught in the complicated web of various socioeconomicand political problems. In such scenario, efforts to voice the rights of elderly seema bit surprising and out-of-priority box. Objective: The paper attempts to serve as an eyeopenerfor the policy makers both in public and private sectors to interrelate the factors deemedimperative for taking concrete steps to redress the menace arising out of ignoring ageingand dropping it from the national development agenda. Materials and Methods: Structuredinterview schedule was developed to collect information on Older Persons’ health, economicand psychological status. In this regard, an extensive questionnaire was designed and pretestedvigorously. Study Design: This paper is extracted out of the base-line exploratory study.Setting: Rawalpindi city. Period: Oct 2013 to Dec 2013. Results: 69.3% OPs reported variousdiseases, 19.7% respondents never visited the doctor. 25.1% respondents’ last visit to thedoctor was between six months to more than a year. 15.3% visited the doctor for a medicaltreatment. Older persons with no permanent income made them more vulnerable to suffervarious illnesses. Conclusions: Pakistan is not an aged-friendly country that even lacks a policyat national level for the welfare rights of older persons.
HEAD AND NECK INFECTIONS
Authors: Akhtar Naeem , Saleem Muhammad , Mian Farooq Ahmed , Shareef Muhammad Javaid , Hussain Fiaz
Published: September 2021

Objectives: To analyse the risk factors responsible for different head and neckinfections secondary to dental causes. DESIGN: Retrospective study. Settings: Department ofENT and Head & Neck Surgery, Allied Hospital, Punjab Medical College, Faisalabad. Period:October 2011 to September 2014. Patients and Methods: The study consisted of 50 patientswho presented with history of head and neck infections secondary to dental causes in thedepartment of ENT and Head & Neck Surgery at Allied Hospital Faisalabad. Inclusions criteria:Patients of head and neck infections of either sex ranging from 12 to 57 years of age and havinghistory of dental infections / extractions were included in the study. Exclusion Criteria: Patientshaving head and neck infections secondary to some other cause other than dental etiologywere excluded from the study. Data Analysis: SPSS software, version 10 was used to analysethe data. Chi square test was applied to analyse the data. Results: In our study 62 % patientswith head and neck infections were males while 38 % patients were females. Age ranged from12 years to 57 years with mean age 33.68 years. 96% of our patients presented with deep neckabscesses while only 02% of the patients had osteomyelitis of maxilla and further 02% of thepatients presented with necrotizing fasciitis of the submandibular region. 58% of the patientshad dental infections whereas 42% patients were having dental extraction as the root causeresponsible for these head and neck infections. Moreover, all the patients had poor oro-dentalhygiene. It was also observed that 76% of the patients, having history of dental extraction, weretreated by unqualified dental practitioners without adequate aseptic conditions. Twelve patientsout of fifty (24%) were found to have diabetes mellitus and one patient each was suffering frommalignancy and chronic renal failure. 10 (20%) of our patients were smokers. Some of thepatients (16%) were having anemia. Two patients out of fifty (04%) were suffering from pulmonarytuberculosis. Treatment: All these patients were managed with adequate parentral antibioticsand surgical interventions. We had to perform an emergency tracheostomy in one patient. Allthe patients had good response to the management without any complication. Conclusions:Dental infections and dental extractions are still an important cause for potentially life threateninghead and neck infections in developing countries like Pakistan. Unhygienic dental practicesand lack of proper dental care facilities along with immunocompromizing conditions such asdiabetes mellitus are most common risk factors for these avoidable head and neck infections.Therefore it is necessary that unhygienic dental practices as well as practices by unqualifieddental practitioners should be strictly banned.
BACTERIAL VAGINOSIS
Authors: Waheed Afifa , Yasmeen Humera , Shami Nabeela
Published: September 2021

Bacterial vaginosis is the most common vulvovaginal infection and representsthe 35% of all the infections occurring in women in the reproductive age. Serious forms ofcan induce several complications such as spontaneous preterm labour and preterm birth, latemiscarriage and postpartum endometritis, PID, infertility, vaginal cuff infection and postabortalsepsis. Objective: To compare the efficacy of vaginal metronidazole and vaginal clindamycinin the treatment of bacterial vaginosis. Study Design: Interventional: Quasi experimental study.Setting: Obstetrics outpatient department, Ghurki Trust Teaching Hospital, Lahore. Durationof study: Six months i.e. from 01-01-2009 to 30-06-2009. Results: Mean age of patients wasfound to be 24.33 years. In the 100 patients enrolled, no statistically significant difference wasfound between Clindamycin 2% vaginal cream compared with metronidazole 0.75% vaginalgel using Amsell’s criteria. Metronidazole has a failure rate of 13% while failure rate was 6% inthe clindamycin group. Conclusion: A 3 day regimen of clindamycin 2% vaginal cream wasas effective as 5 day regimen of metronidazole 0.75% vaginal gel in the treatment of bacterialvaginosis.
VAGINAL BREECH DELIVERY
Authors: Naz Samina
Published: September 2021

Objective: To determine the obstetric and perinatal outcome of pregnancieswith singleton breech presentation, and to scrutinize the causes of increasing incidence ofcesarean section in breech presentation. Design: Analytical Observational study. Place andduration: Department of obstetrics and gynecology Fatima hospital Baqai university campusfrom Jan 2010 to Oct 2011. Patients & Methods: This study includes 135 patients with singletonbreech presentation ≥ 34 weeks of gestation, were analyzed in detail with help of designedperforma. Patients were categorized in three groups. Groups a, who had elective C-section,group b. who underwent emergency caesarean section or had C-section after failed trial ofvaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section wasdone in those cases that had some other indications for carrying out this procedure apart frombreech presentation. Trial of vaginal breech delivery was planned for all multiparous womenexcept those falling in group A. All antepartum fetal demise, twin pregnancies and placentaprevia of major degree were excluded. Results: Of 135 women, 7(5%) underwent prelabourcesarean, and 128(95%), had trial of vaginal delivery, of whom 117(91.5%) delivered vaginally.Significantly more infants weighing> 3.5kg were selected for prelabour and intrapartumcesarean than vaginal delivery. Two neonates had Apgar score< 7 at 5 minutes but both werenormal neurologically. There were no nonanomalous perinatal death and no case of significanttrauma or neurological dysfunction. Two infants died due to lethal anomalies. Conclusion:Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate optionwithout compromising prenatal and maternal outcome. It also decreases the rate of cesareansection.
DIABETES MELLITUS
Authors: Ahmed Munir , Munir Shamin
Published: September 2021

Objective: This study was done to find HbA1c levels in diabetes mellitus (DM)patients presenting at Bolan Medical Complex Hospital Quetta and observe the effects ofantihyperglycemic treatment and physical exercise on HbA1c level. Study design: A crosssectional comparative study. Patients and methods: One hundred (100) patients were selectedfrom Bolan Medical complex Hospital Quetta. Patients were divided in three groups. Group Aincluded the patients who were on antihyperglycemic drugs, following dietary restrictions anddoing physical exercises. Group B included patients who were on antihyperglycemic drugsfollowing dietary restrictions but not doing physical exercises. Group C included the patientswho were not using any antihyperglycemic drug, not following dietary restriction and not doingany physical exercise. HbA1c of all patients was determined, data was analyzed using SPSS.Anova was applied. Results: HbA1c of group A was higher than group B and group C. HbA1cof group B was higher than group C. Conclusions: HbA1c is a valuable test for monitoringglucose control over extended period of time and plays role in taking measures to avoiddiabetes mellitus complications, therefore it should be tested regularly.
MEASLES
Authors: Haq Muhammad Zahoorul , Masood Najaf , Sharif Muddassar , Asghar Rai Muhammad
Published: September 2021

Background:Despite efforts to promote widespread vaccination,measles stillremains an important cause of morbidity and mortality in children especially in developingcountries. The aim of this study was to review the pattern and outcome of measles patientsadmitted at Benazir Bhutto Hospital (BBH) Rawalpindi during measles epidemic 2013.StudyDesign: Cross sectional descriptive study. Period:Three months during measles epidemic 2013(March - May). Setting:Pediatric department BBH Rawalpindi. Materials and Methods:Dataregarding demographic profile, clinical presentation, complications and outcome of measlespatients was collected and analyzed using SPSS 15.Results:A total of 192 patients of bothsexes were included with mean age of 35.48+32.71 months. Majority of patients(71.4%) wereunvaccinated and 88% had history of contact with measles patients. The common complicationsobserved were pneumonia and pneumonia with gastroenteritis and both were found statisticallysignificant in patients with malnutrition and low socioeconomic status.Conclusion:The currentstudy concluded that improving measles immunization and nutritional status in children isessential for reducing morbidity and mortality of measles.
TREATMENT OF BRONCHIOLITIS
Authors: Masood Jawaria , Anjum Zahid Mahmood , Taseer Ali Asgher , Ayesha Hina
Published: September 2021

Objective: To compare the efficacy of normal saline and inhaled β-agonist inthe treatment of bronchiolitis. Study design: Randomized clinical trial. Settings: The studywas conducted in Paediatric Medicine Department, DHQ hospital/Punjab Medical CollegeFaisalabad. Period: 06 months from 1st October 2013 to 31st march 2014. Results: In thisstudy, 58.33%(n=21) in Group-A and 66.67%(n=24) in Group-B were between 0-9 monthsof age, mean and sd was calculated as 11.43+3.87 months in Group-A and 10.52+3.32months in Group-B, 52.78%(n=19) in Group-A and 61.11%(n=22) in Group-B were male while47.22%(n=17) in Group-A and 38.89%(n=14) were females, mean clinical score in both groupswas recorded as 4.11+1.32 in Group-A and 5.65+1.89 in Group-B, comparison of efficacy inboth groups was recorded which shows 58.33%(n=21) in Group-A and 25%(n=9) in Group-Bwere treated effectively while rest of 41.67%(n=15) in Group-A and 75%(n=27) in Group-Bwere not treated effectively, p value was calculated as 0.008, which is statistically significant.Conclusions: The results of this study reveal that inhaled β-agonists are more effective thannormal saline.