bluuebunny/crossref_metadata_2025 huggingface dataset:
UTERINE ATONY;
Authors: Khan Shazia Majid , Saeed Mohammad , Mustafa Ghulam , Durrani Haq Dad
Published: September 2021

Background: Uterine atony is one of the causes of postpartum hemorrhage, resulting in increased maternal morbidity and mortality. Objective: To determine the association of low serum vitamin D level with uterine atony, among women delivering in a tertiary care hospital. Subjects and Methods: Study design: Case control Study. Setting: Gynae and Obstetrics department of Sheikh Zayed Medical College, Rahim Yar Khan. Duration: 1st January to 31st December, 2013. A total of 130 patients were recruited and grouped as A (Cases) including patients with uterine atony (100 patients) and group B (Controls) patients having no uterine atony (30 patients) after cesearean section or vaginal delivery and fulfilling the inclusion or exclusion criteria. The test for 25 OH vitamin D was performed on Elecsys 2010 Roche by using electrochemiluminescence technique. Oral informed consent was taken from all subjects and approval from institutional ethical committee was obtained. Chi square test was applied to compare atony and non atony groups in terms of presence or absence of vitamin D deficiency. The data was entered and analysed on SPSS version 17. Results: It was noted that those who have uterine atony 87% were having vitamin D deficiency or insufficiency as compared to 68% in group with no uterine atony. This difference was statistically significant. (p=0.02) so uterine atony was significantly associated with vitamin D deficiency or insufficiency. In atony group mean age was 25±4 years, gravida 2.64±1.2, gestational age, 37±1.2, blood loss 1032±400, and serum vitamin D level 15.9±6, ng/ml. In non atony group, group mean age was 26±3 years, gravida 2.7±1, gestational age, 38±.8, blood loss 309±92, and serum vitamin D level 23±9 ng/ml. The mean level of serum vitamin D level was significantly low (15.9±6 ng/ml) in atony group as compared to non atony group(23±9 ng/ml). Mean blood loss was significantly high (1032ml) in atony group as compared to non atony group (309ml). Conclusion: Our results revealed that low vitamin D level is strongly associated with uterine atony and hence is a risk factor for uterine atony.
EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY
Authors: Akbar Abdul Ahad , Mahmood Shaukat , Majid Abdul
Published: September 2021

Objective: To evaluate the effect of urinary calculi attenuation values fromnon enhanced computed tomography (stone radiodensity) and stone size in determiningthe outcome of treatment by ESWL. Study design: Descriptive case series study. Setting:Department of Diagnostic Radiology, Lahore General Hospital Lahore, in collaboration with theDepartment of Urology, Lahore General Hospital Lahore. Duration of study with dates: Studywas carried out over a period of six months from January 2012 to July 2012. Subjects andMethods: Seventy patients with solitary renal calculus of 05 mm – 20 mm size were evaluatedfor calculus attenuation values in Hounsfield Units on non enhanced computed tomography.Patients were being grouped according to calculus attenuation values as: 1) less than 500 HU(soft) 2) 500-1000 HU (medium) 3) more than 1000 HU (Hard). Patients were also distributed inthree groups according to stone size as: 1) 5-10 mm 2) 11-15 mm 3) 16-20 mm. Patients werebeing subsequently treated with ESWL. During each ESWL session 3000 shockwaves weregiven. Stone clearance was documented by USG within three month after start of treatment.Results: Out of 70 patients stones were cleared in 84.3% (n=59) patients. According to thestone density, the rate of stone clearance was 100% (n=19) in group 1, 88.9% (n=27) in group2 and 66.7% (n=24) in group 3. Regarding the stone size, stones were cleared in 88.9% (n=9)in group 1, 77.4% (n=31) and 90% (n=30) in group 3. The best outcome was in patients withstone diameter of 16-20 mm and a density of < 500 HU. The worst outcome was in patients withstone diameter of 11-15 mm and a density of >1000 HU. Conclusions: The attenuation valueof stone has a greater impact on ESWL outcome than the stone size. Further these attenuationvalues of urinary tract stones before ESWL helps in determining the treatment outcome and inplanning alternative treatment in patients with likelihood of poor outcome from ESWL.
TYPE 2 DIABETES MELLITUS
Authors: Khawaja Rehan , Munir Tahir , Hassan Uzma , Shah Syed Shoaib
Published: September 2021

Objectives: To access the Antioxidant Status in Patient with Variation in Durationof Type 2 Diabetes Mellitus. Data source: 90 selected patients suffering from Type 2 DiabetesMellitus (DM) and 30 subjects as control group. Design of study: Case Control Study. Setting:Rawal Institute of Health Sciences, Islamabad. Period: July 2013 – March 2014. Materials& methods: Out of 120 selected subjects, 90 were of DM type 2and 30 were assigned ascontrol group (group 1). Based on duration, patients of DM type 2 were divided into; group2, 3 and 4; group 2 – patients with DM (type 2) duration less than 5 years, group 3 - with DMduration between 5-10 years and group 4 - with duration of DM more than 10 years. Smokers,renal failure, coronary artery disease, thyroid disease and previous antioxidant treatmentpatients were excluded from the study. Diabetes mellitus type 2 was diagnosed according tothe standards set by American Diabetes Association. The fasting plasma glucose levels weremeasured by glucose oxidase method; HbA1c by automated kit on Cobas Integra of Roche.The TAC was measured by calorimetric TAC Assay Kit (BioVision) while Vitamin C and E weremeasured by using ELISA Kit (HUMAN). Cut off values for HbA1c was taken as ≤6%; FBS≤110 mg/dl; TAC ≥1.16 mmol/L; Vitamin C ≥2 mg/dl; Vitamin E ≥ 9.5nmol/ml. Results: Asthe duration of type 2 diabetes increases, it was seen that vitamin C levels and TAC levels inall groups except between groups 1 & 2 decreased significantly; however, anti-oxidant vitaminE, was found to be significantly decreased in all the groups as the duration increases. Asignificantly increased level of HbA1c were noticed in groups 2, 3 and 4 as compared to group1 as the duration of diabetes increases; however, the levels were found to be non-significantwhen group 4 was compared with that of group 2 and group 3. When fasting blood sugarwas compared between the diabetic groups a significant increased levels were noticed in allthe groups with the exception between group 3 and 4. A significant differences between eachgroup and within the groups was observed when Hb1Ac, vitamin E, vitamin C, &TAC werecompared using ANOVA. A statistical significant correlation was observed when HbA1c wascorrelated with FBS; however, it shows an inverse relationship with TAC, vitamin C and vitaminE. A significant inverse correlation of FBS was noticed with TAC, vitamin C, and vitamin E. Asignificant positive correlation was seen when TAC was correlated with vitamin C and vitamin E.A similar trend of significant positive correlation was seen when vitamin C was correlated withvitamin E. Conclusions: The levels of total anti-oxidant capacity, vitamin C, and vitamin Egradually decrease with duration of diabetes and are associated with oxidative stress. Theseantioxidant vitamins (vitamin C and vitamin E) should be supplemented in diabetics to increasetheir quality of life. TAC status may be taken as early marker to detect complications in diabetictype 2 patients especially of longer duration.
EMERGENCY SERVICES (1122)
Authors: Mansoor Shehzad Adil , Imam Humayun Suqrat Hasan , Shahzad Muhammad Asif
Published: September 2021

Emergency services were working all over the world to deal with different types ofemergencies and the frequency of emergencies were increased with the passage of time. Manydeveloping countries even don’t have such services and it was difficult to estimate the scaleof emergencies in those countries. Objectives: To know about the types of emergencies andto help to plan for their prevention in future. Place and duration of study: Data was collectedfrom emergency services department 1122 in four big cities of Punjab from Nov.2004-Feb.2014.Methods: Descriptive observational study. Results: The road traffic emergencies received were243481 in Lahore, 92367 in Faisal Abad, 52507 in Multan and33847 in Rawalpindi. Medicalemergencies were 247692 in Lahore, 82910 in Faisal Abad, 112531 in Multan and 31069 inRawalpindi. Fire incidences were 14594 in Lahore, 6369 in Faisal Abad, 3707 in Multan and3929 in Rawalpindi. Crime incidence related emergencies were 13301 in Lahore, 15051 in FaisalAbad, 5326 in Multan and 1705 in Rawalpindi. Conclusions: Road traffic related emergencieswere increased even some times more than medical emergencies. Fake calls were also inhigher proportion.
NEGATIVE APPENDECTOMY
Authors: Ibrar Mohammad , Alam Bakhtiar , Malik Zafar
Published: September 2021

Acute appendicitis is the most common surgical emergency. Despite advancesin diagnostic techniques, an accurate pre-operative diagnosis may still pose a challenge tothe clinicians. Therefore, even today we are facing a high rate of negative appendectomy.The current study explores this aspect of a common and important disease. Objectives: Toknow the percentage of negative operative findings in acute appendicitis in our hospital thatdrains wide area of population from lower socioeconomic strata. Patients and methods: Thisprospective cross-sectional study was conducted at Department of Surgery, Lady ReadingHospital, Peshawar within two years from 1-1-2009 to 31-12-2010. This study included 673cases undergoing appendectomy. All the patients operated for clinical diagnosis of acuteappendicitis over the study period were included. Their history, clinical features, and resultsof investigations were noted. Gross examination of intact appendix specimen, and on-tablecross sectional inspection of appendix was made; and were correlated with histopathologicalfindings (as gold standard). Results: The study included 673 patients. There were 478 males(70%), and highest number of patients was in second decade of life. On gross examination,545 (81%) appendices were swollen, 531 (79%) were reddened due to inflammation; 63 (9.4%)were gangrenous; and 50 (7.5%) had perforated; while in 128 patients (19%) the appendix wasnormal looking with shiny surface. Fibrino-purulent exudate in the peri-appendeceal regionwas noticed in 253 (37.6%) patients. The cut section of appendix showed wall abscess in 474(70.4%) cases, and mucosal ulceration in 325 (48.2%). Necrotic foci in mucosa were seen in188 (27.6%) cases, and in 61 cases (9%) the necrosis was extending through the wall up toserosa. Histopathology revealed marked acute inflammation in 416 (61.8%) cases, moderateinflammation in 92 (13.7%), and mild inflammation in 47 (6.9%); while in 118 cases the appendixhad no evidence of inflammation (giving negative appendectomy rate of 17.5%). Negativeappendectomy rate in females was 29.2% compared to 12.7% in males. Probable alternatediagnoses are also addressed. Conclusions: The negative appendectomy can be avoidedin many cases if ultrasound facilities were available during odd hours of patient presentation.Similarly, the rate of negative appendectomy can be further reduced in adults, especially femalesaround puberty and reproductive age, by the provision of laparoscopy during emergency hoursof the day.
ARTHROSCOPIES
Authors: Orfi Fayyaz Ahmad , Majeed Shahid
Published: September 2021

Knee pain due to injury is a common presentation in orthopedic outpatientdepartment. X-rays, MRI and arthroscopy are the basic investigation tools when meniscoligametousinjury is suspected. If MRI is normal usually arthroscopy is withheld. In this studywe analyzed the arthroscopic findings of such cases in which X rays and MRI were normalor near normal. Objectives: 1- To find out knee injuries in patients with painful knees. 2- Tofind out any other pathology of knee joint. Design: It’s a retrospective study in which 42 suchcases were analyzed who underwent arthroscopy with a normal or near normal MRI. Setting:This study includes cases done at CMH Rawalpindi, Muzaffarabad, Kharian and Malir. Periodincludes May 2005 to August 2014. A total number of 209 arthroscopies were done by thesame orthopedic surgeon. Results: Out of 42 cases 31 were males while 11 were females.Mean age was 31.4 years (range 18-54 years).In all cases arthroscopy was done by the sameorthopedic surgeon within 6 weeks of MRI. MRI films were reported by a qualified radiologist. Inall cases there was a strong clinical suspicion of menisco-ligamentous injury while X-rays andMRI were near normal or normal. Out of 42 cases in 36 (85.7%) cases, one or more findingswere detected on arthroscopy which were not picked by MRI. Conclusions: It is concludedthat if a menisco-ligamentous injury is strongly suspected in a knee on clinical examination,arthroscopic evaluation should not be denied to a patient even if X-rays and MRI are normal.
THYROID DYSFUNCTION
Authors: Mehmood M. Arif , Qureshi Muhammad Arshad , Taseer Ijaz Ul Haque
Published: September 2021

Hepatitis C is a burning issue. Prevalence of hepatitis C virus reported in Pakistanis 5% with areas of high infection in different cities and subsets of population. Objectives: Tofind out the frequency of thyroid related dysfunctions in chronic hepatitis C patients on Peg-Interferon Alpha-2a and Ribavirin therapy. Study Design: A prospective cohort study. Placeand Duration of Study: Hepatitis Center DHQ teaching hospital Sahiwal from July 2013 to June2014. Material and Methods: We studied 100 patients of chronic HCV infection with baselinelevel of TSH,T3 and T4. Baseline serum ALT and serum AST were also measured. Patients wereput on Peg-Interferon Alpha-2a (180 ug) weekly and Ribavirin (800 to 1000 mg/d) for 24weeks.All patients were followed up for thyroid dysfunction at weeks 0, 12, 18 and 24. Result: Outof 100 treated patients 65 were female and 35 were male. Fifteen (15%) patients developedthyroid dysfunction and out of these 15 patients (11 female [73.3%] and 4 male [26.7%]).Ten (66.6%) out of 15 patients developed hypothyroidism and 5(33.3%) out of 15 patientsdeveloped hyperthyroidism. Seven (70%) out of 10 patients who developed hypothyroidismneeded levothyroxine therapy. Two (40%) out of 5 patients who developed hyperthyroidismneeded carbimazol therapy for their symptoms and disease control. All patients completedhepatitis C treatment with combined Peg-Interferon Alpha-2a and Ribavirin therapy.
ISCHEMIC STROKE
Authors: Shahwani Irfan Murtaza , Shahab Faisal , Ansari Shuaib , Shah Syed Zulfiquar Ali
Published: September 2021

Stroke is characterized by the sudden loss of blood circulation to an areaof the brain, resulting in a corresponding loss of neurologic function. It is also called ascereberovascular accident (CVA) or stroke syndrome. Objectives: To determine frequencyof hypertension, diabetes mellitus and smoking in patients with ischemic stroke. Patientsand methods: This cross sectional study of six months was carried out in the department ofmedicine, Liaquat University of Medical and Health Sciences. Patients aged 20-70 years of agewith ischemic stroke on CT were enrolled in the study after taking consent from caretaker ofpatients. Detailed history focusing on hypertension, diabetes and smoking and their durationwas taken. Blood pressure was recorded and fundoscopy was done to find out diabetic orhypertensive retinopathy. Thorough neurological examination was done and blood sugar(fasting and random) was evaluated. Data was entered and analyzed using SPSS version 16.Results: A total of 100 patients were included in the study during study period. 64% of patientswere in ≥ 50 years of age group with mean age of 52±11 years. A total of 66 (66%) were male;with male to female ratio was 2:1. Hypertension was present in 61% of cases, Diabetes wasfound in 32% cases and 40 patients were cigarette smokers. Conclusions: It was concludedthat high blood pressure, diabetes mellitus and smoking are associated with ischemic stroke.
MALIGNANT TERATOID MEDULLOEPITHELIOMA OF RIGHT EYE IN A CHILD
Authors: Mwakyoma Henry , Longquan Xiang , Shan Cong
Published: September 2021

Objective: Medulloepithelioma is a rare intraocular tumor, and it is also one ofthe most common congenital tumors originated in the epithelium of ciliary body. Since its onsethidden, it is often discovered after the invalid treatment of glaucoma, cataracts or strabismus.This paper will show you one case of malignant teratoid medulloepithelioma and combine withrelevant literature review.
ACUTE DIARRHEA
Authors: Shaikh Farzana , Bhand Sikandar Ali , Kumar Parkash , Nizamani Mohammad Akbar
Published: September 2021

Acute diarrhea is the fourth-ranking cause of death in children under the ageof 5 years. after neonatal causes, malaria, and acute respiratory infections. Objectives: Todetermine the role of Saccharomyces boulardii in the treatment of acute diarrhea. Design:Comparative study. Period: Six months, Mar to Aug 2013. Setting: Pediatric Unit II- LiaquatUniversity Hospital Jamshoro/ Hyderabad. Patients and methods: It consisted of 100 patients,of acute diarrhea with age between 3 months to 5 years reported to pediatric unit and fulfilledthe inclusion criteria. Cases were given low osmolar ORS, Zinc & Saccharomyces boulardii250mg twice daily for three days and controls were given low osmolar ORS and Zinc. P-value≤0.05 was considered as significant. Results: The results showed that 51 patients were maleand 49 patients were female. 27 male patients were in control and 24 were in case group. 23female patients were in control and 26 were in case group. The overall mean age of studysubjects was 26.73±12.65 months. Among reported patients most of the patients 84% werereported on 1st day. All reported patients had a complaint of loose motion with 73% also hadvomiting. All patients had watery loose motion. The mean duration was 4.20±1.70 days withthe mean frequency of 9.82±6.16 times. Among the patients 96 patients were hospitalized and97 patients were given I/V fluid. Among reported patients 10 were without dehyderation, 8 hadsome dehyderation, and 82 had severe dehyderation. 52 had acceptability of probiotics. Theresults were evaluated according to 1st, 2nd, and 3rd day post intervention. Among 50 patientsof case group, 18 patients were compliance. 49 patients had decrease in duration. The sameresults were observed in the decrease in frequency. Consistency was improved in 39 patients.The duration of hospitalization was reduced in 36 patients. It was observed that improvement inthe duration, frequency, and consistency was mostly observed on 2nd day of post intervention.Conclusions: The role of S. boulardii as a good biotherapeutic agent allowing to prevent and/ortreat several grastrointestinal diseases. In comparison to probiotic bacteria, the use of probioticyeast is beneficial when the treatment is combined to antibiotherapy.
TEMPORARY HEMODIALYSIS
Authors: Sabir Omer , Tarif Nauman , Rizwan Sheikh , Rafique Kashif , Rizvi Nabiha , Khan Amanullah
Published: September 2021

Catheter related blood stream infections (CRBSI) in patients undergoinghemodialysis frequently results in significant morbidity and mortality. Attempts at prevention ofCRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidinehave emerged over years. Objectives: To determine the role of taurolidine lock in presentationof Catheter related infection in hemodialysis. Design: Multicentre un-builded, randomizedcontrolled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology,Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, randomizedcontrolled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were randomizedinto two groups. In group A catheters were locked with Taurolidine 2% and Heparin (5000IU/ml) equal to the catheter volume according to the protocol. In group B (control) catheters werelocked with Heparin alone. 36 patients completed the study protocol. For primary end pointanalysis (30 days) the mean duration of catheter days was 27.25 + 5.5 days (median 30 days).During this period of follow up only one patient from Group B had CRBSI resulting in a pointincidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combinationwith heparin compared to heparin alone had no additional benefit in prevention of CRBSI. Thishowever needs to be evaluated in a larger study using non cuffed temporary vascular access(TVA).
NATURE OF ORAL BIOPSIES
Authors: Hassan Syed Ghazanfar , Shahzad Muhammad , Shams Salman , Bashir Uzma
Published: September 2021

Biopsy is the removal of a tissue sample from a living body with the objectiveof providing the pathologist with a representative, viable specimen for histopathologicinterpretation and diagnosis. Objectives: To find out frequency and nature of oral biopsiesreported at liaquat university hospital Hyderabad. Design: Descriptive/Cross sectional. Period:1st February 2012 to 31st January 2014 Setting: Oral & Maxillofacial Surgery Department, LiaquatUniversity Hospital Hyderabad. Material & Methods: A total of 180 patients were reported atOPD and Oral & Maxillofacial Surgery ward of Liaquat University Hospital for oral incisional,excisional and punch biopsy purpose. Study design was descriptive/cross sectional study. Allpatients were treated both under general anesthesia as well as local anesthesia and sedation.All the biopsies were sent to histopathology department for confirmation of diagnosis. Results:119 patients (66.1%) were males and 61 patients (33.8%) were females with age range from10-80 years. Malignancy was diagnosed in 80 patients (44.4%) while odontogenic cysts werediagnosed as second common category with 38 patients (21.1%). Conclusions: Squamouscell carcinoma was diagnosed as the most common malignant lesion which is rising danger tothe society specially as the age advances.
HEMATOLOGICAL MALIGNANCIES
Authors: Hanif Umair , Ahmed Mughees , Hanif Imran
Published: September 2021

Infection rate of CMV in adults is approximately 60% in the developed countriesand almost 100% in the developing countries. Objectives: To evaluate the frequency ofcytomegalovirus (CMV) infection in patients with different hematological malignancies. Design:Observational study. Setting: Gulab Devi Chest Hospital & INMOL Hospital Lahore. Period: Sixmonths. Materials and methods: The blood samples were drawn from the selected patientsafter taking their written informed consent. The DNA was extracted from the whole blood andthe polymerase chain reaction was performed for CMV DNA using CMV PCR kit (CinnagenInc. Catalog # PR7836C). The 222bp fragment corresponding to the size marker and positivecontrol was considered as positive. The data was analyzed by SPSS version 16. Results: Themean age of patients was 36 years. Out of 16, 3 were presented with interstitial pneumonitis, 14with retinitis, 3 with esophagitis and 5 were presented with colitis respectively. In this study onesample was tested positive for CMV DNA. Conclusions: CMV infection may be a serious threatfor the patients with compromised immune system such as those receiving chemotherapy. Thescreening for CMV should be done before the blood transfusion to such patients.
DISORDERS OF SEXUAL DEVELOPMENT
Authors: Rasool Naima
Published: September 2021

Objectives: To evaluate the etiology, clinical presentations, investigationsand surgical management of patients presenting with atypical genitalia in Pediatric surgerydepartment. Disorders of Sexual development are one of the most complex congenitaldisorders encountered by the treating physicians. In recent years, the diagnostic ability andsurgical techniques of gender reconstructions have improved remarkably. The spectrumincludes chromosomal, genotype and phenotype abnormalities. The birth of a baby withatypical genitalia poses diagnostic and treatment challenges. This article focuses on etiology,clinical presentations, investigations and surgical management of patients presentingwith ambiguous genitalia. Study Design: A descriptive, prospective case series. Setting:Department of Pediatric Surgery, Military Hospital, Rawalpindi, Pakistan. Period: October 2010to June 2014. Methods: All patients with atypical genitalia, who underwent any kind of genitalreconstruction surgery were included in the study. Results: A total of 28 patients were operatedupon during the study period. Age ranged from 11months to 12 years. Patients were dividedinto two groups on the basis of their karyotyping. Seventeen patients had 46 XY and 11 had 46XX. No mosaic pattern was seen. Male genital reconstructive surgery was done in 16 patientswhile 12 underwent female genital reconstructive surgery. Conclusions: Disorders of sexualdevelopment present as a complex spectrum of psychosocial, sexual, endocrine and surgicalimplications, thus management demands a multidisciplinary team approach. Appropriatelytimed surgical intervention after thorough work up and detailed counseling, produce excellentcosmetic and functional results.
HEPATITIS C
Authors: Iqbal Sajjad , Rahman Khalil-Ur- , Yousuf Muhammad Haroon , Jahan Nazish
Published: September 2021

Hepatitis C virus (HCV) has infected about 200 million individuals across theworld and is known as the major cause of liver disease . Objectives: Viral load measurementat early stages of the therapy in Hepatitis C patients is believed to be a more effective toolto predict the sustained virological response (SVR). The primary aim of the present studywas to evaluate whether the decline in viral load of HCV at early stages of the therapy maypredict the treatment response. Another objective was to see the benefits of therapy extensionin non-responders. Study Design: Descriptive, analytical study. Setting: Shalamar HospitalLahore. Period: November 2010 to October 2013. Methods: Four hundred and thirty patients,chronically infected with different genotypes of Hepatitis C virus were treated with Interferonalpha 2b plus Ribavirin (IFNα-2b + RBV). Viral load was assessed at day zero, week four, inthe mid time of therapy and at the end of therapy. The treatment duration was extended 12-24weeks (according to HCV genotypes) in non-responders. Results: The patients with <2 MIU/mL viral load at day zero, able to drop ≥2 log viral load at week-4 or showed no virus at thetime of half therapy completion, exhibited better response. The extension of therapy was morebeneficial for those non-responder who had <0.05 MIU/mL viral load at the end point of therapythan those who had ≥0.05 MIU/mL at that stage. Conclusions: The viral load detection at earlystages of the therapy will be useful in clinical practice. Moreover, the patients with <0.05 MIU/mL viral load at the end of therapy are suitable candidates for the therapy extension.
INFANT POLIO IMMUNIZATION
Authors: Imran Muhammad , Nasir Jamal Abdul , Zaidi Syed Arif Ahmed
Published: September 2021

Poliomyelitis is a highly infectious disease but preventable by effective vaccines.Children under five year of age affected by this disease as a result a permanent paralysis.Objectives: To uncover the trend of infant polio immunization coverage through modeling isa significant concern to formulate an adequate vaccination strategies and program after theoutbreak of new cases of polio in a recent year in Pakistan. Design: The reported data ofmonthly infant polio immunization coverage to National Institute of Health, Islamabad, Pakistanfrom January 2008 to July 2013 for the present study has been taken from Pakistan bureau ofstatistics with total time series entities 67. National Institute of Health, Islamabad took the recordof per month number of doses administered ( 0-11 months )children by the registered healthcentre in pakistan. Period: January 2008 - July 2013. Setting: Pakistan bureau of statistics(Statistics House) Methods: A set of various short term time series forecasting models namelyBox-Jenkins, single moving average, double moving average, single parameter exponentialsmoothing, brown, Holts and winter models were carried out to expose the infant polioimmunization coverage trend. Results: Among the several forecasting models ARIMA modelsare chosen due to lower measure of forecast errors namely root mean square error (RMSE),mean absolute error (MAE) and mean absolute percentage error (MAPE). ARIMA (2,1,1), ARIMA(1,0,2), ARIMA (0,1,2) and ARIMA (2,1,1) models are established as an adequate models for theprediction of OPV-0, OPV-1, OPV-2 and OPV-3 respectively. Conclusions: With the exceptionof OPV-1 the infant polio immunization coverage is expected to rise in Pakistan.
CORONARY ARTERY DISEASE
Authors: Iqbal Usman Javed , Kaleem Majid , Hanif Muhammad Imran
Published: September 2021

Background: Development of heart failure is always secondary to presenceof risk factors like diabetes mellitus, hypertension, age, smoking and underlying coronaryartery disease. Objective: The objective of this study was to find the frequency of risk factorsand coronary artery involvement in patients of heart failure after myocardial infarction. StudyDesign: A non-randomized cross sectional study. Setting: Gulab Devi Chest Hospital. Period:Six months. Methods: 100 patients was done. Using non probability (purposive) samplingtechnique; all patients with ages between 20 to 80 years, irrespective of gender, diagnosedwith heart failure (with ejection fraction ≤ 40%) secondary to STEMI were included in thestudy. Patients that were not having heart failure secondary to STEMI and those that hadn’ttheir coronary angiography done were excluded from the study. The data were analyzed usingSPSS Version 20. Descriptive statistics was used to see analyze the data. Results: Mean ageof patients was 52.61±10.2years. There was an overall male predominance (81%). Commonrisk factors that we observed were smoking (65%), hypertension (62%), diabetes (58%) andpositive family history (38%). In this study 51% patients had triple vessels disease, 15% patientshad double vessels disease and 34% patients had single vessel disease. Most common lesionwas of LAD following LCX, RCA and LMS. Conclusion: Our study conclude that coronaryartery disease is the main causative factor for the development of heart failure in patients ofmyocardial infarction and even a single vessel disease can lead to heart failure with severesystolic dysfunction. Most common associated risk factor was smoking, hypertension being thesecond most common following diabetes and positive family history.
HEAT RELATED ILLNESSES
Authors: Mustafvi Sajid Ali , Yousaf Nadeem , Amjad Zainab , Munir Tahir Ahamd , Shah Syed Shoiab , Majeed Rehan
Published: September 2021

Objective: To study the adaptive strategies from harmful effect of heat waveon an urban, educated, well to do subjects for a period of May to July 2014.Data Source:250 selected young students of RIHS. Design of Study: Descriptive Study. Setting: RawalInstitute of Health Sciences, Islamabad. Period: March – July 2014. Method: A questionnairewas circulated among the students of Rawal Institute of Health Sciences Islamabad regardingeffects of heat and measures taken to combat its effects. Results: A total of 250 urban studentswith mean age of 19.77±1.10 years were inducted in the study, having resources to face theextreme heat. A significant number of female non boarder students (p=0.000), wearing cottonclothes (p=0.000) having fair skin (p=0.000) and using air condition at homes (p=0.000) werenot acclimatized to heat waves still have headache and anxiety. A great percent of students didnot complaint of headache, heat exhaustion, heat cramp or syncope, except mild sweating,effect on studies. A great percentage (>65%) of students complained of malaise, nauseavomiting. Male students showed increase thirst than female, while anxiety state was noticedmore in female than male students. Conclusion: The use of cotton clothing, daily bathing,increased water intake and use of air conditioner minimized the severe adverse effects likeheat exhaustion, heat syncope, and heat stroke, although the minor effects like skin tanning,disturbed sleep, anxiety and adverse effects on studies cannot be avoided in heat wave season.
HCV
Authors: Amin Muhammad , Tabassum Hina , Amanullah Muhammad , Tabassum Sana
Published: September 2021

Objective: To find out the risk factors associated with HCV disease and evaluatethe association of risk factors of HCV disease patient’s in the population of Multan District. StudyDesign: Experimental study. Setting: Nishter Hospital of Multan District. Period: 1st January2011 to 1st April 2012. Methods: 540 patients with ages 11 to 90 years old of both sexes wereincluded in this study. All those who were surviving with HCV disease were studied with theirassociated risk factors such as age, family history; barber/parlor services, blood group types,drug use and weight loss were collected. For the data analysis, descriptive and Chi-squareanalysis are used to determine the association between risk factors and HCV. Results: Resultsshows that out of 540 patients surviving with HCV, out of which 48% are female and 52% aremales. The mean age for male and female was 37 ± 12.62 and 34 ± 11.22 respectively. Resultsshowing that blood groups types and age of the patients were significantly related to the HCVsurvival status at 5% level of significance. The study shows that HCV patients with blood group“O’ patients are maximum as compared to other groups. Conclusion: HCV is more commonin males as compare to female. Persons who are above 30 years old were more affected withHCV disease. Age and blood group types are the most significant factors in the patients whoare surviving with HCV disease.
AXILLARY LYMPH NODE STATUS IN PRIMARY BREAST CARCINOMA
Authors: Shamsi Farwa Batool , Naseem Nadia , Nagi A.H.
Published: September 2021

Objectives: The most important prognostic factor in patients of breast carcinomais axillary lymph node metastasis. Current study was conducted to find the frequency of lymphnode metastasis in hundred cases of primary breast carcinoma and association of lymphnode status with immunohistochemical expression of ER/PR,HER2/neu and MMP-1(matrixmetalloproteinase-1).Design: Descriptive study. Period: Aug 2012 to Jun 2013. Setting: U.H.Slaboratory of Morbid Anatomy and Histopathology Lahore. Materials and methods:Onehundred mastectomy specimens with axillary lymph node dissection were included. Aftergross examination, tissue processing and microtomy the tissue slices of 4 micrometer weretaken on frosted and lysine coated slides. H/E and IHC for ER/PR,HER2/neu and MMP-1 weredone according to protocol. Results: Among 100 breast cancer subjects, 72 were positivefor lymph node metastasis while 28 subjects were negative. A significant association betweenlymph node status and ER IHC expression was noticed. When Chi square test was appliedwith p-value of 0.001 was observed.Also a significant association between lymph node statusand PR IHC expression was noticed. Chi square test was applied and the p-value of 0.004 wasobtained.Association between lymph node status and HER2/neu IHC expression was analysed.Chi square test was applied with a p-value of 0.467 was obtained (not significant).A significantassociation between lymph node status and MMP-1 IHC expression was observed. Chi squaretest was applied anda p-value of 0.004 was obtained. Conclusions: Most of the primary breastcarcinomas were presented with axillary lymph node metastasis (72%).Significant associationswere observed between lymph node status and ER/PR immuonohistochemical expressionshowever the association between HER2/neu IHC and lymph node status was not statisticallysignificant. The immunohistochemical expression of MMP-1 is significantly associated withlymph node status. It shows that it is an important marker for metastatic potential in breastcarcinoma.
PROFESSIONALISM
Authors: Mahboob Usman , Evans Phillip
Published: September 2021

Objectives: This paper describes a practical and valid technique for curriculumaudit of professionalism theme of an MBChB programme in a UK medical school. The objectivewas to match the learning outcomes of professionalism covered in an MBChB course, with theguidelines laid by the GMC in Tomorrows Doctors 2003. The benefit being to determine theissues that needs to be addressed in response to the GMC Tomorrows Doctors 2009. StudyDesign: A qualitative study design. Period: 2011. Setting: University of Glasgow. Methods: Toanalyse the learning outcomes set out in the curriculum documents. All the statements fromthe explicit curriculum, and the GMC recommendations in Tomorrow’s Doctors (2nd and 3rdEditions) were noted and the individual statements were entered into the NVivo software. Apurposive sampling procedure was undertaken to identify “professionalism” in the Year 1 and 2MBChB curricula and the Tomorrows Doctors, and a comparative content analysis completed.Results: The coverage of learning outcomes related to professionalism was between 10-20%,scattered throughout the course in different domains of the MBChB, giving a balanced weightto each outcome. Conclusion: The professionalism theme of the MBChB course has coveredall the learning outcomes of the Tomorrows Doctors in almost exactly the same frequency assuggested by the GMC according to the course requirements of Year 1 & 2. However, theMBChB course needs to be slightly modified to align it with the new guidelines by the GMC.
GOOD TEACHER
Authors: Malik Arshad Nawaz , Bashir Sana
Published: September 2021

Background: The enriched learning and effective teaching is one of necessaryaspect to develop competent health professionals. In literature number of studies presentsthe best qualities of an effective teacher. There are different descriptive surveys depictingthe rating of student and expert professional opinion. Objectives: The purpose of this studywas to determine the top qualities of a good teacher in health sciences. Materials and StudyDesign: A descriptive cross sectional study. Methods: Setting: Riphah College of rehabilitationsciences. Period: January – February 2014. Methods: 179 students were recruited in sample.A structured questionnaire was prepared and twenty qualities were selected after the detailreview of literature. A scale ranging from 1 to 5 were described against each qualities fromstrongly disagree to strongly agree. Results: The result showed that the top qualities rankedby the students were effective communication skills score 112, encourage students 103, soundknowledge 100 and good presentation skills 99. The lowest score qualities were constructivecriticism 28 and sense of humor 53. The 49% students want to be teacher while 51% don’twant to be teacher in future. Conclusion: A good teacher has vital role in producing a goodstudent. According to the perception of students a good teacher must have strong and effectivecommunication skill, ability to motivate students and must have sound knowledge of subjects.This study suggests the basic training program for teacher to enhance the student teacherrelationship. Further study should be done to explore the teacher’s perception of a good teacher.
GYNECOLOGICAL SURGERIES
Authors: Iqbal Mubashir , Yasir Saadia , Ghafoor Fauzia
Published: September 2021

Objectives: To evaluate the use of ultra-sound guided transversus abdominisplane block for effective postoperative analgesia in patients undergoing gynaecological surgeryvia transverse lower abdominal skin incision. Study Design: Randomized Control Trial. Period:Six months from April 2013 to October 2013. Setting: Department of Anesthesiology, HolyFamily hospital, Rawalpindi .Sampling technique: Consecutive non-probability sampling.Material and Methods: 200 female patients undergoing gynecological surgery via transverselower abdominal skin incision were enrolled in the study. They were divided into two groups;both received ultra-sound guided transversus abdominus plane block with either bupivacaine(Group A) or saline (Group B). SPSS version17.0 was used to analyze the data. Results:Two hundred female patients undergoing gynecological surgeries were included. Mean ageof patients was 41 yrs (17-71yrs). There were 100 patients in each group. Both groups werecomparable with respect to baseline features. The US-TAP block significantly reduced painintensity as compared to standard care in the PACU at 4hrs(5.2±3.1vs.8.4±1.3,p=0.003).Therewas insignificant difference between the visual assessment score of pain at 8hrs between thetwo study groups(3.6±2.3vs.2.3±2.4,p=0.4). Conclusions: Ultrasound guided transversusabdominis plane block (TAP) is an effective modality for reducing postoperative pain aftergynaecological surgery via transverse lower abdominal skin incision.
COMMON BILE DUCT INJURY
Authors: Mannan Ambreen , Soomro Suhail Ahmed , Bhanbhro Rizwanullah Junaid , Ghauri Amir , Laghari Muhammad Hussain , Shakir Shakir
Published: September 2021

Objectives: To evaluate management and outcome of Iatrogenic Common BileDuct injury after cholecystectomy. Material and methods: Study Design: Descriptive study.Place and Duration of Study: Isra University Hospital Hyderabad during the period of April2013 to April 2014. Methodology: All patients presented with CBD injury after cholecystectomyincluded while CBD tumor and CBD stone and trauma were excluded from study. Total ofsixteen patients with CBD injury were admitted from outside the hospital in surgical ward in IsraUniversity hospital either through OPD or Emergency Room or Endoscopy Suite depending onthe mode of presentation and failure of ERCP if performed according to the need and clinicalpresentation. All patients were resuscitated and investigated thoroughly and the procedurewhether ERCP, or reconstructive surgery or conservative treatment performed based on patient’sclinical presentation and mode of injury and is recorded in the preset approved Performa fromrelative hospital’s ethical review committee and the data compiled in SPSS version 10. Results:All 16 patients; 4(25%) male and 12(75%) females admitted from outside the hospital in twoyear period. Presented in variable time interval12 (75%) patients admitted in 1 month, 3(18.8%)in 6 months& 1(6.3%) in 12 months. Jaundice was the main presenting symptom. Patientswere resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery.Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and1with some biliary drainage responded to simple conservative treatment. Operative successrate was 75% with 25% mortality which was related to the presence of peritonitis, developmentof multiorgan failure and late repair of bile duct injury. Conclusion: Although CBD injury is oneof the most devastating complication but its early diagnosis and prompt treatment can preventpatient’s life with subsequent few or no complication even after its reconstructive surgery.Training must be emphasized to find the all possible ways of recognizing biliary tract anatomyduring surgery and possess skills to overwhelm the primary and leading cause of bile ductinjury i.e. the visual misperception.
FORENSIC MEDICINE
Authors: Sheikh Attia , Ahmad Farhatulain
Published: September 2021

The subject of Forensic Medicine is a clinical subject requiring a variety of teachingand learning modalities. The Department of Medical Education (DME) at Multan Medical andDental College (MMDC) coordinated and cooperated with the faculty of Department of ForensicMedicine in order to introduce a few small group discussion strategies as new teaching toolsfor students of 3rd year MBBS in 2013. These strategies have since been routinely adopted aspart of the curriculum for the subject of Forensic Medicine at MMDC. This paper describes theintroduction, importance and implementation success and challenges of these modalities indetail.
OBESITY
Authors: Aslam Muhammad , Asif Muhammad , Altaf Saima
Published: September 2021

Obesity is currently considered as a global issue to public health. Overweight andobesity among professional workers, particularly among professional drivers and conductorsis becoming an equally challenging, yet under recognized, problem in developing countriesincluding Pakistan. The study aimed to assess the prevalence of obesity and central obesityamong professional drivers and conductors in Multan city, Pakistan. Study Design: A crosssectionalstudy. Methodology: A total of 345 professional drivers and conductors were studiesfor public transport and loader vehicles. The anthropometric characteristics of the participantswere focused including the body mass index (BMI), waist circumference (WC) and waist-to-hipratio (WHR). Along with descriptive statistics and percentages, two-sample t-test was used.Results: The mean BMI of all the participants was 24.35. More than 50% of the drivers andconductors had excess body weight (i.e. BMI > 25 kg/m2). For central obesity, 86 (43.7%)drivers and 28(18.9%) of conductors had increased waist (i.e. WC > 94 cm). Similarly, 34.5%of the said professionals had WHR above the adequate level (i.e. WHR > 0.95). The averagesof BMI, WC and WHR of the public transport vehicle drivers were significantly higher than thoseof the loader vehicle drivers. Conclusion: The present study concludes that the professionaldrivers and conductors are much likely to have excess weight.
ADHERENT PLACENTA PREVIA
Authors: Jahan Tanvir , Siddiq Arif , Chaudhry Mehwish , Ishaque Muhammad
Published: September 2021

Background: Abnormally adherent placenta is a condition in which all or part ofthe placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi.In majority of cases chorionic villi are in contact with the myometrium i.e. placenta accretes.Objective: To detect the prevalence of morbidity adherent placenta and its outcome in termsof maternal morbidity and mortality. Period: Over one year from October 2006 to October2007. Setting: Gynaecology Unit-II, Nishtar Hospital, Multan. Material and methods: Allwomen who had pregnancy complicated by morbidity adherent placenta were identified andtheir case notes retrieved. Information was collected on a prescribed Performa designed for thispurpose. Results: There was 2114 deliveries during the study period in labour ward of NishtarHospital, Multan. Eight women fulfilled the study criteria. The prevalence was found to be 0.4%.Complications were PPH, acute renal failure, depression, cellulities of wound site and UTI.Conclusion: Due to rising rate of LSCS in present era, the prevalence adherent is also on raise.
SLEEP PATTERNS OF MEDICAL STUDENTS
Authors: Saeed Zeba , Hasan Zainab , Atif Maria
Published: September 2021

Objectives: To identify sleep patterns of medical students and determinethe relationship between sleep habits and academic performance. Background: Humanbeings adopt three different sleeping patterns; monophasic, biphasic and polyphasic. Sleepallows synaptic molding to return by developing faster memory union. When such memoryprocessing is not present, memory keeping is reduced which can have an adverse effecton the academic performance of students. Professional education in the field of medicinerequires learning a greater amount and variety of syllabi to practice as a satisfactory medicalgraduate. Among medical students, the burden of the extensive curriculum often results inthe development of non-recuperative sleeping patterns, which can, in turn, affect their overallacademic performance. This study strives to deduce the sleeping patterns of students and theconnection between those sleeping patterns and academic performance. Study Design: Across-sectional questionnaire based survey. Setting: Jinnah Medical & Dental College, Karachi.Period: 2013. Methods: Sleep patterns of 347 medical students from year 1 -4. The resultsof the midterm examinations were cross-tabulated with the sleep patterns to determine therelationship between them. Results: Our study showed that out of 347 medical students, 38.9%(n=135) had monophasic, 46.7% (n=162) had biphasic and 14.4% (n=50) had a polyphasicsleep pattern. 67.4% of monophasics, 87.0% of biphasics and 66.0% of polyphasics passedtheir midterm examination. Conclusion: Biphasic students performed the best in their midtermexaminations. This is in agreement with scientific proof that sleeping in two phases matchesthe body’s instinctive circadian rhythm, hormonal regulation and memory creation. These twophases are sleeping once at night and having one shorter period during the day. Professionalcolleges should advise and educate students in order to encourage them to acquire adequatesleep through appropriate sleeping patterns by which they may support their academic learning.