bluuebunny/crossref_metadata_2025 huggingface dataset:
PEDIATRIC SURGICAL PATIENTS
Authors: Sadaf Sairah , Durrani Haq Dad
Published: September 2021

Almost all the Pediatric surgeons and most of pediatric anesthetists are adheredto traditional paed’s solution against recommendations due to fear of hypoglycaemia and notbeing aware of hyponatremia. Objective: To compare the effects of balanced salt solutionwith1% dextrose and Pead’s solution on blood glucose and sodium levels in pediatric surgicalpatients intra operatively. Study Design: Interventional quasi experimental study. Setting:Department of Anesthesia, Intensive care and pain medicine in Sheikh Zayed Medical College/Hospital Rahim Yar Khan (Pakistan). Period: December 2014 to February 2015. Methodology:60 patients were enrolled and divided into equal groups named after their respective iv fluidsi.e.‘Pead’s Solution’ & ‘RLD1’. Patients aged between 1 month and 08 years, without genderdiscrimination, with ASA 1,2 , fasted according to ASA guidelines undergoing elective surgicalprocedure general anesthesia were included in this study. Blood sampling for levels of serumsodium and glucose was done pre-operatively and 01 hour post-operatively. Results: Inimmediate post-operative period incidence of hyperglycemia was statistically higher in ‘Pead’sSolution’ group (93.3%;28/30) vs ‘RLD1’ group(10%;3/30) p=0.000. Relative risk was 9.3 in‘Pead’s Solution’ compared with ‘RLD1’ solution. Hyponatremia was statistically higher in‘Pead’s Solution’ group (56.6%; 17/30) than in‘RLD1’ group (16.6%;5/30) p=0.001. Relative riskwas 3.4 in ‘Pead’s Solution’ compared with ‘RLD1’ solution. Hypoglycemia and hypernatremiawere not found in any patient in either group. Conclusion: Our results reflected that ‘RLD1’isa better option than ‘Pead’s Solution’ as it is less likely to cause hyponatremia and doesnotcause hypoglycemia. However a large number of clinical trials in almost every teaching hospitalare required to convince pediatric surgeons and anesthetists to use evidence based solutions.
FRACTURES
Authors: Zulfiqar Nasir , Mahmood Hamid , Irfan Ghazia , Waqar Ammara , Iqbal Nadeem
Published: September 2021

To find out the effect in increase in serum 25(OH) vitamin D levels aftersupplementation with 1000 IU/day of vitamin D in patients with low vitamin D levels and otherfactors which may affect the increase in vitamin D levels. Study Design: Retrospective study.Period: January 2013 and June 2014. Setting: Ch. Rehmat Ali Trust Teaching Hospital in theLahore. Methods: The study included patients > 50 years with a low-energy fracture and avitamin D level < 25 nmol/l. Results: 85 patients were included, mean basal 25(OH) vitamin Dlevel was 22 nmol/l. After a mean of 10 weeks, the mean increase in vitamin D was 49.5 nmol/l.Only 45.1% reached the target level of > 50 nmol/l. The increase was correlated with the basallevel of vitamin D (p < 0.05), and the time interval between the two vitamin D measurements(p < 0.05) and was inversely related to body weight (p < 0.05), but was not related to age,gender or renal function. Conclusions: We found that the generally recommended dosage of1000 IU of vitamin D per day resulted in suboptimal serum levels after ten weeks of treatment inmore than half of the patients. The increase in vitamin D levels was higher in patients with lowbody weight and in patients with very low basal vitamin D levels. These data suggest that thesepatients should initially be treated with higher dosages of vitamin D. If not possible, vitamin Dmeasurements should be performed after at least six months of supplementation with dosageadjustment.
INFANT HEALTH CARE
Authors: Asim Muhammad , Mahmood Babak , Sohail Malik Muhammad
Published: September 2021

In Pakistan 1 in every 14 infants die before reaching one year of age. Infant mortalityhighly depends upon the health care practices by the caretakers. Objective: To investigate theinfant risky health care practices and their impact on infants’ health in Pakistan. Study Design:Descriptive systematic literature review. Setting and Period: All the research articles that waspublished in between 2000 to 2015. Methods: Focusing on newborn health care practices withspecial reference to mothers utilization of antennal and postnatal care, pre-lacteal feedings,colostrum, breastfeeding, cord care practices and complementary feeding. A systematic searchof national and international literature especially from developing countries was undertakenfrom peer-reviewed indexed journals and news articles from 2000-2015 to access the infanthealth care practices. Results: sixty five articles were included in this review article. All thestudies focused on the determinants of infant health care practices. It was found that mother’sprenatal and postnatal care utilization service was poor. It was further investigated that colstrumis not preferred first feed of the mothers and family members to their infants. Mostly mothersgave the pre-lacteal feeding to their children irrespective to their education and social statusand it cause the delayed in initiating the breastfeeding to the neonates. Only a small proportionof the mothers initiate the breastfeeding with in the first hour of birth and mothers are unawareabout the importance of breastfeeding. Furthermore, the mothers are also unaware about cordcare and use conventional methods for cord care. Conclusion: It was investigated that infanthealth care practices is highly influenced by the culture and religious belifs of the caretakers.Due to the lack of proper health care of infants, Pakistan is facing high infant mortality rateand substandard infant health indicators. It is suggested that government and policy makersshould arrange the trainings/ workshops for the mothers and adolescents for the purpose todiscourage the risky health care practices.
ACUTE MYOCARDIAL INFARCTION
Authors: Ahmed Jamil , Rathi Nandlal , Alam Muhammad Tanveer , Baloch Zaman , Munaf Alvina , Maheshwari Bhunesh , Lohana Komal , Memon Feroz
Published: September 2021

Objective: To compare the angiographic findings in patients with acutemyocardial infarction (AMI) and compare it with diabetic and non-diabetic patients admittedin the cardiology department of LUHMS. Study Design: Descriptive analytical study. Setting:Department of cardiology at Liaquat University of Medical and Health Sciences (LUMHS)Hospital, Hyderabad. Period: Periods of 1st June 2012 to 31st July 2013. Patients & methods:All patients with AMI and had diabetes mellitus and age eighteen or more than eighteen yearsboth male and female were included after taking informed consent. Results: Out of 297 patientsdiagnosed as AMI, 195 (65.65%) patients had acute ST elevation Myocardial Infarction and 102(34.35%) patients had acute non ST elevation myocardial infarction. Among 297 patients, 190(64%) patients were non-diabetic and 107 (36%) patients were diabetic. Diabetic patients wereolder, more often males, but prevalence of smoking was less marked. Coronary angiographicfindings among patients with AMI and diabetics revealed three vessels disease. Conclusion:Older patients with male predominance presented with AMI and had diabetes mellitus werefound to have three vessels disease in coronary angiography.
LAPAROSOPIC ASSISTED RIGHT HEMICOLECTOMY
Authors: Khan Jahangir Sarwar , Shafique Muhammad Salman
Published: September 2021

Objective: Experience with Laparosopic assisted Right Hemicolectomy ispresented. Study Design: Prospective study. Setting: Surgical Unit-I, Holy Family Hospital,Rawalpindi, Pakistan. Period: 2010 to 2014. Materials and Methods: 20 patients underwentlaparosopic assisted right hemicolectomy. Duration of operation, postoperative pain, durationof post operative analgesia, frequency of surgical site infection and length of hospital stay werenoted. Results: There were 13 male and 7 female patients with the age range of 25-70 years(45±11years). Eleven (11) patients were suffering from carcinoma colon wheras nine (09)were suffering from Tuberculosis. Mean operative time was about 92 minutes. Only four opiodinjections were required as post-operative analgesia. Oral intake was started after 24 hours. Themean length of hospital stay was 5.5 days with no case of surgical site infection. Conclusion:Laparoscopic assisted right hemicolectomy is a safe and viable option in our setup.
TB KNOWLEDGE AND PERCEPTION
Authors: Imran Muhammad , Nasir Jamal Abdul , Chohan Abid Ali , Zaidi Syed Arif Ahmed
Published: September 2021

Objectives: To uncover the trend regarding TB knowledge and perception ofits transmission as well as underlining the socio demographics aspects associated with TBcure among the reproductive venerable women. Methods: Quantitative frame work along withinferential analysis have been carried out by using the Pakistan Demographic and Health Survey2006-07 and 2012-13 of ever married women. Results: Trend regarding TB awareness and itscure and treatment have been changed over time by 4.31% and 4.49% respectively in PDHS2012 compared to PDHS 2006. Whereas an adequate knowledge of TB transmission thoughtair when coughing and sneezing remain constant after equating the two surveys. To understandthe functional relationship of variables multinomial logistic regression analysis was carried outseparately for PDHS 2006 and PDHS 2012. Two models revealed that early reproductive agegroup 15-19 of ever married women believed that TB cannot be curable compared to theircounterparts upper age groups 45-49. Illiterate ever married women are more pronounced[OR=5.38 and OR=10.30] that TB is an incurable infectious disease compared to womenhaving higher educational degree in PDHS 2006 and PDHS 2012 respectively. Location andgeographical area of residence, wealth index, and media exposure have positive associationabout TB knowledge of cure and treatment. Conclusion: Although the awareness level improvedbut it still needs to launch some massive and wide-ranging awareness programme regardingan adequate knowledge of various diffusion modes of tuberculosis by utilizing all media modespredominantly television. Potential struggles are obligatory where the subordinate literacy rateand limited health care settings meticulousness in remote areas, so that the illness and deathdue toTB can be minimized.
ACADEMIC ACCOMPLISHMENT
Authors: Jabeen Surriya , Matloob Aneesa , Mirza Nighat
Published: September 2021

Objective: To evaluate sleep hygiene and its relationship with academicperformance in adults. Study Design: Cross sectional. Place and duration of the study. Thestudy was conducted at Dow Medical College, Dow university of Health sciences Karachi fromDecember 2012 to November 2013. Material and methods: Subjects were students fromfirst year to final year. Instrument was an integrated questionnaire (Horne JA and Ostberg OMorningness- Eveningness questionnaire MEQ original 1976) designed to assess chronotypeof young adult population. Subjects (N = 690) completed a questionnaire packet and providedtheir GPA. Results: it was observed that students organizing their activities closer to themorning reported higher GPA whereas students with lower grades reported evening typepersonality. Conclusions: This study may help universities to decrease the prevalence of poorsleep hygiene by developing interventions programs that target adolescents with low academicachievement.
WOMEN’S PARTICIPATION
Authors: Amanat Tanzeela , Nawaz Naima , Maann Ashfaq Ahamd , Ch Khalid Mahmood , Ashraf Ijaz , Akhtar Saira , Hasan Gulfam
Published: September 2021

Livestock production is of paramount importance in minimizing the vulnerabilityof poor and marginalized people in remote rural areas. Women play an active role in managingand care taking of the herd by participating in different activities of livestock management. Thegrowing population is exerting pressure on all the resources and in future, it is expected that thelivestock demand will also increase for fulfilling the demands of masses. Due to women’s crucialrole in livestock management activities, they are more susceptible to zoonotic diseases. Thezoonotic diseases are becoming a threat by becoming responsible for the death of 2.2 millionpeople every year and majority of the victims belong to developing countries. Objectives: Tofind out health related issues while participating in livestock management activities. StudyDesign: Survey. Period: 2011-2012. Methods: The present study was conducted in rural areasof district Toba Tek Singh. One Union Council (UC) and three villages from the selected UC wereselected by using simple random sampling technique. The sample size of the study was 120respondents of rural females having forty respondents from each village. Results: The studyrevealed that majority of the respondents was involved in grazing and fodder cutting activitiesand they are satisfied with their role. It was also noted that the highly educated respondents weremore secure from diseases than that of less educated and illiterate respondents. Conclusion:It is the sole responsibility of the government and public sector department to run campaignregarding livestock diseases to whom human are susceptible so that the risks regarding thissituation may be minimized.
CATARACT SURGERY
Authors: Aslam Rao Muhammad Tariq , Qamar Rao Muhammad Rashad , Siyal Nisar Ahmed
Published: September 2021

Objectives: To compare the effectiveness of topical and retobulbar anesthesiain term of pain relief in patients subjected to cataract surgery. Material and methods: Thiscomparative study was conducted at Department of Ophthalmology, Bahawal Victoria HospitalBahawalpur from 18th July, 2012 to 18th January, 2013. Total 100 patients with cataract wereincluded in this study. Results: Mean age of the patient was 64.14 ± 8.7 years. No. of patientsin RA group who reported the pain scores (0- 4) during cataract surgery, was 46 (effectivenesswas positive in 92% patients), while it was 33 (effectiveness was positive in 66% patients) in TAgroup. A significant difference between effectiveness of both anesthetic group was observed. (P= 0.001). Conclusion: It is observed that topical anesthesia in cataract surgery is a simple, safeand noninvasive technique but it cannot be proposed as a very good alternative to retrobulbaranesthesia in cataract surgery of all patients regarding its effectiveness interms of pain relief.
POST HEMORRHOIDECTOMY PAIN RELIEF
Authors: Hashmi Syed Muhammad Maroof , Nasir Shua , Shehbaz Lal , Anwar Muhammad Absar , Ali Ahmed
Published: September 2021

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.
CAUDAL EPIDURAL STEROIDS
Authors: Awan Malik Yasin , Amjad Mohammad
Published: September 2021

Introduction: About 85% of the population experience low back pain duringadulthood and annual incidence is 5 to 15% with no gender discrimination. Design: Quasiintervention experimental study. Setting: DHQ teaching Hospital & at Fazil Memorial HospitalGujranwala. Period: November 2010 to November 2012 (two years). Material & Methods:Hundred patient fulfilling the inclusion criteria with SYMPTOMATIC LUMBER DISC herniationwere selected. Efficacy was determined by improvement in Denis Pain scale and Mcnab’sfunctional criteria. Safety was determined by absence / rareness of complications i.e spinalanesthesia, transient hypotension, and paresthesia, difficulty in voiding, infection andmeningitis. Follow up was weekly for 6 weeks Results: Out of hundred cases 53 were gentsand 47 were ladies. Mean age was 37.56 (22-50 yrs). Maximum cases 72% were in third decadeof life. Maximum pain relief was noted after three weeks of first injection, 72% of the cases wereeither having no or mild pain. Functional recovery was excellent in 44% and good in 40% of thepatients. Complications were fewer and mild, Spinal anesthesia in 2%, transient hypotensionin 3%. Paresthesia in 8% and 10% of the patient developed supra pubic fullness but only oneneeded catheterization. Infection and meningitis was not observed in any case. Conclusions:Caudal epidural steroids injection is safe & effective mode of treating lumbar disc herniation.
LEFT VENTRICULAR HYPERTROPHY
Authors: Das Bhagwan , Ansari Rafique , Kumar Santosh , Memon Shafique-ur-Rehman
Published: September 2021

Cardiovascular system diseases are playing the outstanding role in the cause ofmorbidity and mortality in dialysis patients. Left ventricular hypertrophy is one of the universalstructural abnormalities in patients on regular dialysis. Objective: The target of the study wasto search out the frequency of left ventricular hypertrophy in end stage renal disease patientson maintenance hemodialysis. Study design: Single center case-series study. Setting:Department of Nephro-Urology, Liaquat University of Medical & Health Sciences Jamshoro.Period: Begin from 1st March, 2013 to 30th August 2013. Results: Total numbers of patientswere seventy three. Thirty three patients were male and 40 were female. Mean age of thepatients was 44.19 years. High blood pressure was the most typical cause of nephropathy thatis as certain in twenty 9(39.7%) cases pursue by Diabetes and Chronic Glomerulonephritis intwenty (27.4%) in each, renal stone in four (5.5%), unresolved acute renal failure four(5.5%)and Chronic Tubulointerstitial nephritis in two(2.7%) patients. Left ventricular hypertrophy wasascertained in nineteen (26%) patients. Conclusion: Our study concedes the high frequency ofleft ventricular hypertrophy in dialysis patients.
TRADITIONAL BONE SETTERS
Authors: Khan Imran , Saeed Mohammad , Inam Muhammad , Arif Mohammad
Published: September 2021

Objectives: To evaluate the factors for preferring the traditional bone settersby people. Study Design: Observational study. Setting: Department of Orthopedics andSpine Surgery Hayatabad Medical Complex Peshawar. Period: October, 2013 to March, 2014.Materials and Methods: Sixty consecutive patients who presented at orthopedics out-patientclinic after attending Traditional Bone Setting Centers were recruited for the study. Informationabout the patients’ bio data, mechanism of injury, who advised them to contact TBS and whatare the factors that compelled them to attend TBS were obtained and filled into preparedproforma. The data obtained was recorded and analyzed on SPSS version 17.Results: Themean age was 25.57 years with minimum age 5 years and maximum 65 years. Sixteen patientswere females and 44 were male. Two (3.3%) patients first attended Modern orthopedic services(MOS) and 58(96.7%) patients attended TBS.47(78.3%) patients were taken by their ownimmediate family members to TBS, 20% were referred by friends and 1.7% were self-referral.Thirty seven (61.7%) opted for TBS because of their belief, 11(18.3%) considered this servicecheap, 7(11.7%) attended it because it is quick service and 5 (8.3%) reverted to TBS becauseof attitude of hospital personals. Conclusion: A considerable of people still have great trust onTBS regarding management of musculoskeletal problems. Belief is the most leading cause ofconsulting traditional bonesetters, other causes include low cast, quick service and attitude ofhospital personnel.
QUADRICEPS TENDON AND PATELLAR LIGAMENT
Authors: Hijazi M. Mazhar , Khan M. Afzal , Altaf Faris Mohammed Nour , Ahmed M. Rashid , Alkushi Abdullah Galil , Sakran Ashraf Mohamed Elsayed Ali
Published: September 2021

Background: Anterior cruciate ligament (ACL) is commonly injured especiallyin sportsmen. Autografts using tissue from various sources including the quadriceps tendonand patellar ligament are popular but still controversial due to varying degree of success. Themorphological characteristics of the quadriceps tendon and the patellar ligament are of primeimportance for this purpose. Objectives: This cadaveric study was undertaken to evaluate themorphometric characteristics of the quadriceps tendon and patellar ligament as an autograft forACL reconstructive surgery. Study design: Qualitative cadaveric study. Material and methods:The morphometric observations of the quadriceps tendon and patellar ligament on 36 (18 maleand 18 female) adult formalin fixed cadavers were recorded by dissection. The observationsincluded the length, breadth and thickness of the quadriceps tendon and the patellar ligamentand were recorded on both sides separately in the male and female subjects. The data weretabulated, compared and statistically analyzed. Results: There was no significant differencein measurements on the right and left sides both in the male and in the female specimens.However the length and width of the quadriceps tendon was more in the males as comparedto the females. The patellar ligament was significantly longer in the male specimens as wasits width. Thickness of the patellar ligament, however, was not significantly different in the twogenders. Conclusion: Both the quadriceps tendon and the patellar ligament are safe andconvenient sources of autograft tissue for reconstruction of the ACL.
CONGENITAL BLIND AND SIGHTED
Authors: Arshad Muhammad , Lodhi Muhammad Aslam
Published: September 2021

Background: Visual impaired people have difficulty perceiving the nonverbalcues and human conversation. While understanding of a conversation greatly relies and dependon nonverbal cues .this deficiency generate many problems. It affect on their perception ofexternal environment thinking and on their interpersonal skill. Objective: of the present studyis to investigate the effects of congenital blind on interpersonal intelligence and adoptability.Research Design: The research design for the present research was Independent Subjectdesign, Sample and Method: The samples consist of 60 schools going adolescent that is 30students from special education institute (visual impaired) and 30 students from main streamranging from age 11-18 year with the middle socioeconomic class. Period: November 2013 tojune2014. Data source setting different schools of Karachi city. It is hypothesized that there isa significance difference in interpersonal intelligence and adoptability between visual impairedand sighted adolescents. Bar-on emotional quotient inventory youth version (EQ: Yv.200) wasused to assess emotional intelligence and for statistical interpretation of data t-test was used.Conclusion: The finding of the research indicates that there is no significance difference ininterpersonal intelligence as well as in adoptability.
UROTHELIAL CARCINOMA OF URINARY BLADDER
Authors: Zafar Muhammad Salman , Asadullah Muhammad , Ahmad Usman
Published: September 2021

In spite of the fact that inflammation has been regarded as a localized orgeneralized defensive component of the body to different types harmful stimuli, there hasbeen becoming confirmation of its strong part in initiation or progression of different ailmentsparticularly related with cancer. Objectives: Aim of this study was to recognize the pattern ofexpression and level of intensity of COX-2 in different grades of papillary urothelial carcinomaof urinary bladder along with significance of COX 2 in tumerogenesis of urothelial carcinoma ofurinary bladder. Setting: Department of Pathology, BMSI, JPMC. Period: 1.1.2009 to 31.12.2012.Methods: The marker of COX-2 was investigated by using Immuno- histochemistry. Results:COX 2 was not detected in normal urothelium, but its intensity was expressed as 68% in lowgrade, 72 % in high grade and 80 % in invasive urothelial carcinoma. Conclusion: Results ofthe present study indicate that COX-2 as a component of inflammation play an important rolein progression of urinary bladder tumor and encourage use of COX 2 inhibitors as potentialantitumor agent.
PES PLANUS & GENU VALGUM
Authors: Khalid Zara , Rai Mishal Ali , Mobeen Bushra , Amjad Imran
Published: September 2021

Pes planus (flat foot) is a musculoskeletal abnormality of lower limb, oftenassociated with some degree of malalignment at the knee i.e. genu valgum (knock knees). Inmajority of cases, these deformities resolve by themselves during infancy and childhood, butif they persist in adolescent age, then there is no chance of resolution and might pose seriousproblems for the individual in the future. Objectives: The objective of this study was to determinethe factors associated with pes planus and genu valgum in adolescents. The two main factorsunder investigation were physical activity and dietary habits of adolescents and their effect onthese lower limb musculoskeletal conditions. Material and methods: A case-control study wasconducted on 400 (161 cases and 239 controls) school- going adolescents (11-16 years). Aftercompleting the demographic data and recording the height and weight of each participant, thediagnosis of pes planus was made on the basis of physical examination and special tests. Thedata for genu valgum was collected by the measurement of clinical tibiofemoral angle. A selfreportquestionnaire was used to collect other relevant data such as the symptoms experiencedby the individuals. Data was analyzed on SPSS 21. Results: Out of 400 adolescents, therewere 171 males and 229 females. The physical activity level of cases was 2.17 ± 0.70, slightlyless than that of control group 2.32 ± 0.76. The diet score of cases (11.087 ± 3.75) did notdiffer much from that of controls (11.214 ± 3.75). Tibiofemoral angle of cases was 15.7 ± 3.42degrees valgus for controls it was 14.1 ± 3.49 degrees valgus. There was also a greater trendof cases towards overweight (12.8% cases and 7.43% controls) and obesity (5.84% cases and2.62% controls), whereas the frequency of controls was higher in underweight (19.8% casesand 27.5% controls) and healthy/ normal weight category (55.5% cases and 66.8% controls).Other associated symptoms such as foot pain, knee pain, trauma to foot and knee, difficultyin running and jumping activities etc were also found to be in higher frequency in cases ascompared to in controls along with significant gender differences. Conclusion: Our study resultsshowed that reduced physical activity can be a factor for causation of flat foot and knock-kneesbut the difference in diet habits was not very significant between cases and controls. Thereforeunhealthy diet is not a very considerable factor in the contribution to musculoskeletal conditionsin lower limb. There was a direct link between obesity and pes planus, along with a greater TFA.There was also a higher incidence of knee pain in the flat foot cases who complained of footpain along with various other associated symptoms.
INFORMED CONSENT
Authors: Memon Khalida Naz , Sushel Champa , Shaikh Shazia , Memon Fahad Ahmed
Published: September 2021

Introduction: Informed consent is the back bone of patients’ autonomy. Theadvancement in medical technology has further increased its importance. In the developingcountries including Pakistan, general physicians play a vital role in providing health careto the patients but unfortunately majority of them are unaware about the ethical aspects oftheir medical practice. Methodology: Objectives: 1. To determine the level of awarenessabout informed consent among general practitioners. 2. To assess the association betweenvarious socio-demographic factors to the awareness about informed consent. Study Design:Community based cross sectional study. Settings: General medical practitioners of districtHyderabad were the study population. Period Of Study: Two months. Material & Methods:One hundred & forty subjects were selected for the study through purposive non-probabilitysampling. A pretested self-administered questionnaire was the tool for the data collection. Thedata was analyzed by using SPSS version 16.The variables of interest were gender of generalpractitioners, their age, level of qualifications, residence & occasions when informed consentwas taken. The association between various socio-demographic variables was determined byapplying Chi-square test at ≤0.05 level of significance. Results: One hundred & forty generalmedical practitioners of varying ages from 32-60 years participated in the study. The meanage of the general physician was 39 ± 1.8 years. The awareness about informed consent wasfound among 128(91.4%) subjects but unfortunately only 45.7%of them actually practiced it.The results regarding awareness as well as practice of informed consent among males andfemales were however not significant (p=0.520). The young general practitioners i.e age 31-40years were less practicing informed consent as compared to older general practitioners i.e.age 51-60 years and onwards (p= 0.04).The physicians practicing in urban areas were morecognizant about informed consent (p=0.05).Informed consent from patients was obtainedbefore giving local anesthesia (80%), blood transfusion (24.3%)&before examination of femalepatients (46.4%). Conclusions: Informed consent taking is not a routine process adopted bygeneral medical practitioners so there is a strong need for general practitioners to change theirattitude and acknowledge the patient’s autonomy by taking informed consent, which is thebasis of modern medical ethics.
GESTATIONAL DIABETES
Authors: Majeed Tayyaba , Adnan Rabia , Mubshar Irum , Mahmood Hamis , Saba Kanwal , Imam Sardar Fakhar , Zafar Muhammad Al-Fareed , Bukhari Mulazim Hussain
Published: September 2021

Objectives: To compare the efficacy of Metformin with insulin in gestationaldiabetes mellitus in terms of fetomaternal outcome. Study Deign: Randomized clinicaltrial study. Setting: Lady Aitchison Hospital Lahore. Period: January 2014 to March 2015.Methodology: Total 500 pregnant females with GDM were included in the study through nonprobability,consecutive sampling. Patients were divided into 2 equal groups (A: B). Patientsin group A were given tablet metformin 500 mg by oral route and group B was administratedregular injection Insulin by subcutaneous route. Results: The mean age of females was32.14±6.13 years. The mean gestational age was 31.07±3.8 weeks. There were 78 (15.6%)females who had 0 parity, 107 (21.4%) females had parity 1, 175 (35%) females had parity2, 95 (19%) females had parity 3, 33 (6.6%) females had parity 4 and 12 (2.4%) femaleshad parity 5.There were 54 (10.8%) cases had PTB, out of which 12 (4.8%) had PTB withmetformin while 42 (16.8%) had PTB with insulin. There were 115 (23%) neonates requiredNICU admission, out of which 37 (14.8%) neonates with metforminand78 (31.2%) neonateswith insulin. There were 87 (17%) neonates who had neonatal hypoglycemia, out of which23 (9.2%) neonates with metformin and64 (25.6%) neonates with insulin. The difference wassignificant between both groups for all fetal outcomes (P<0.05). Conclusion: The metforminis more effective in preventing adverse fetal and maternal outcome as compared to insulin.
VITAMIN D ASSOCIATION
Authors: Hashmi Sayed Fasih Ahmed , Haidar Ambreen
Published: September 2021

OBJECTIVE: The target of this study to focus, vitamin D level is the significant riskfactors for the patients with cardio vascular disease at Liaquat University Hospial Hyderabad /Jamshoro. Materialand Methods: This observational study was done at cardiology departmentof Liaquat University Hospital Hyderabad. All the cases with history of congenital heart disease,pregnancy, malignancy, renal failure and chronic liver disease, were excluded from the study.Complete medical history was taken, and major risk factors of the cardiovascular diseaseincluding, diabetes, smoking, family history, hypertension, hypercholestremia, dyslipidemiaand history of alcohol consumption and others were documented. Serum VD level was testedby blood samples from research laboratory of Liaquat Medical hospital Hyderabad, and all theresults were noted on the Performa according to the risk factors. Consequences of VD levelwere arranged by criteria, that’s taken from the study of Satish Karur etal.10 Results: Total 100patients were incorporated in the study with the mean age of 48.2+ 12.4. Male were found inthe majority. According to distribution of heart disease of his study ischemic heart disease hadnoted commonest58%. In the hypertensive patients VD deficiency had noted in 39. 63%. Insmoker patients VD deficiency was noted in 52.77%. In patients with hypercholestremia 50.0%,Alcoholic patients were found with deficiency of VD were 50.0%. In patients with obesity 57.14%.In the diabetic patients deficiency 15.0%, insufficiency 50.0% and sufficiency was seen 35.0%.In the Patients of dyslipidemia deficiency5.0%, insufficiency 50.0% and sufficiency was seen45.0%. Patients with family history of cardiovascular disease having deficiency 25.0% of thecases, insufficiency 12.50% while sufficiency in 62.50% in the cases. Conclusion: In this studywe concluded that VD deficiency in one of the major risk factor for cardiovascular disease;its possible association was found in this study with many risk factors of heart diseases. Likeour study there is very need of experimental and prospective more studies, to find out themechanism undergoing increasing cardiovascular risk, and prevent the cardiovascular disease.
DEPRESSIVE SYMPTOMS
Authors: Irfan Saba , Qazi M. H
Published: September 2021

Introduction: Depression is a leading source of disability world-wide withprevalence ranging from 8.8% to 18.3% in people aged 60 years or older. Depression is a not asimple term but has been used to describe a variety of infirmities, ranging from minor to debilitating.It is a multi-symptom disease and can even lead to suicidal attempt. Major depressive disorder(MDD), although one of the most common psychiatric illnesses, has an unknown etiology.Decreased serum levels of vitamin D have been implicated in the pathogenesis of MDD. Casecontrol studies have supported a relationship between low vitamin D as possible predictorsof depression. We designed a study to determine relationship, if any, between low vitaminD deficiency with depression and with severity of disease in our local population. Objective:The aim of this study to see any association of vitamin D deficiency in depressed Pakistanipatients. Study Design: Cross-sectional study. Setting: Fatima Memorial Hospital, Shadman,Lahore. Period: 2013-2015. Methods: Total of 150 diagnosed patients of 18-75 years of agewas enrolled for this study, after a written consent. Depressed patients were further categorizedinto three groups depending on severity of disease i.e.; mild, moderate and severely depressedpatients. Blood measures included serum vitamin D levels and data was recorded on structureddata collection form. Results: In this study, we investigated the association between vitamin Dstatus and depression in our local Pakistani population. Out of 150 depressed patients, 84.7%were vitamin D deficient. In our study, Out of 44 male depressed patients 9 (20.5%) had milddepression, 8 (18.2%) had moderate depression and 27 (61.4%) had severe depression. Outof 106 depressed female patients 42 (39.6%) had mild depression, 26 (24.5%) had moderatedepression and 38 (35.8%) had severe depression symptoms. A negative correlation of vitaminD with severity of disease was also found in female depressed patients in our study.A significantnegative correlation of vitamin D in all 44 male subjects with severity of disease was observedin our study. Higher prevalence of vitamin D deficiency was found in both males and females inour study. Conclusions: Vitamin D deficiency is associated with an increased risk of developingdepression, but more prospective observational studies may be needed. Efficacy of vitamin Dsupplementation for preventing onset of depressive disorder is unknown. Efficacy of vitamin Dsupplementation for reducing depressive symptoms is largely unstudied. The study suggestsdietary intervention with vitamin D would boost brain serotonin concentrations and help preventand possibly relieve some of the symptoms associated with depression without side effects.
JOB SATISFACTION OF PHYSICIANS AND TEACHERS
Authors: Dogar Imtiaz Ahmad , Afzal Samreen , Ali Muhammad Arif , Haider Nighat , Asmat Aliya
Published: September 2021

Objectives: To determine the level of job satisfaction of physicians and teachershaving regular jobs and those having contract based jobs and to compare level of job satisfactionbetween these types of jobs and between the two professions. Study design: Cross sectionalstudy. Duration and place of study: This study was conducted with teachers and physiciansrecruited at different schools, colleges and hospitals of Faisalabad in six months from October,2008 to March 2009. Subjects and methods: A sample of 200 participants, 100 physicians(50 regular and 50 on contract basis) from public hospitals and 100 teachers (50 regular and50 on contract) from public schools and colleges was drawn through purposive convenientsampling technique. Result: In overall profession wise analysis teachers scored higher onjob satisfaction scale (m=131.98) than physicians (m=126.98). Personals having regular jobshad lower job satisfaction (m=128.52) than professionals have contract jobs (m=130.45).Conclusion: Contract based jobs carry higher levels of job satisfaction for employees than theregular based jobs.
DIABETES MELLITUS PATIENTS
Authors: Hussain Mehmood , Ali Syed Ahsan , Hassan Syed Imran , Yazdanie Nazia , Khan Mohammad Yawar , Khan Moin
Published: September 2021

Objectives: To observe Quality of Life (QoL) in diabetes mellitus patientsafter fabrication of immediate dentures. Setting: Department of Prosthodontics in HamdardUniversity Dental Hospital, Karachi. Period: Two years from October 2011 to September 2013.Methodology: Thirty patients with established diagnoses of diabetes mellitus reported. In thisstudy by purposive non-probability sampling technique. In this study patients were selected,male and female patients were 24 and 6 respectively with the age range of 22- 74 years. Aftergetting consent Questions mention in OHIP-14 were asked from the patients on 1st visit and2 months later after fabrication of immediate denture to assess the QoL of in these patients.Data was obtained after using SPSS-version 19. For analysis Wilcoxon Signed Ranks Testwas applied to get results. Probability level of P< 0.05 was considered statistically significant.Results: There was marked improvement in different domains of QoL in diabetes mellituspatients after fabrication of immediate dentures, most of the patients were pleased with theirprosthesis. Three patients had complained of pain on buccal side which was corrected bytrimming the overextended flange of their denture. All patients had improvement in phonetics(P value 0.01), better choice of food (P value 0.00), eating ability (P value 0.01), decreaseembarrassment (P value 0.08) and self-assurance (P value 0.025). However, effect of immediatedenture on variable like tension was not advantageous having P-value of 0.157. Conclusion: Byfabrication of immediate dentures to diabetes mellitus patients, QoL can be markedly improvedin such patients.
HYPERTENSION
Authors: Rahim Sheikh Kashif , Ali Shaukat , Latif Zafar
Published: September 2021

Objectives: To assess awareness about Hypertension among patients. Studydesign: Cross-sectional Survey. Setting: Medical OPD at Rawal General Hospital, Islamabad.Period: Three months from 1st April to 30th June. Materials and Methods: A total of 150 male,female patients attending Medical Out Patient Department at Rawal General Hospital Islamabadwere assessed regarding awareness about Hypertension using a self-constructed mixedquestionnaire (In English and Urdu). Results: Following findings were observed among patientsattending RGH, Islamabad: 82% of patients found to have family history of HTN, while 13%responded negative. 5% of the patients were unaware. 33% of patients found to have diabetesmellitus, while 29% responded negative and 38% of the patients were unaware of having or not.Hypertensive population found to be 51%. 45% found to adhering to anti-hypertensive treatment,while 55% responded negative. 80.6%, 90%, 73%, 82% and 85% considered the obesity, lackof exercise, cigarette smoking, anxiety and high cholesterol respectively as causative factor ofHTN. Excessive intake of salt was considered by 84% as causative factor of HTN. About 82%considered DM as causative factor of HTN. 79%, 73%, 93%, 55% of the patients considered thecardiac disease, renal failure, brain hemorrhage and loss vision respectively as complicationof HTN. 80%, 90%, 73%, 27% consider the regular exercise, reduced salt intake, no smoking,keeping weight under control respectively as preventive measures of HTN. About half and morethan half of the respondents considered frequent use of vegetables, excessive intake of sweets,as preventive measures of hypertension. Conclusions: The assessment of awareness aboutHypertension among population of various areas can be beneficial in effective planning fordisease prevention and control.
FAMILY PLANNING
Authors: Waqar Ammara , Khan Athar , Ismail Khalid , Hanif Ummara , Saleem Iqra
Published: September 2021

In Pakistan the total fertility rate is 4.5 which is too high and the main reason forthis is the low contraceptive prevalence rate of only 28%. A woman’s ability to space and limither pregnancies has a direct impact on her health and as well as on the outcome of eachpregnancy”. The population of Pakistan represents 2.56% of the world’s total population whichmean that every 39th person of the world is resident of Pakistan. Objectives: To highlight thefactors affecting male’s decision making regarding family planning in district Buner KPK. StudyDesign: A cross sectional study. Setting: District Buner, KPK. Period: March, 2015 and July,2015. Methods: Stratified simple random sampling was performed for collecting data. Samplesize of 210 was collected from two Union Councils of Buner. Outcome variable was husband’sdecision making regarding family planning. Researcher administered questionnaire was usedfor data collection. Results: Husband’s decision making regarding family planning was mainlyeffected desire for more children, 68.5% of the respondents were male decision maker whohad desire for more children. Family structure also influence the decision maker’s decision asin nuclear families 90.7% were decision maker were from nuclear family. Religious perceptionand side effects was contributing to family planning decision making. Conclusion: The studyshowed that 71.9% of male and 6.9% female take the decision of family planning. The studyresults showed that desire for more children, lack of information, family structure, and fear ofside effects and perception of people that family planning is against Islam played an importantrole in decision making regarding family planning.
DEPRESSION
Authors: Ali Habiba Sharaf , Shams Hina , Kessani Leela Vikram , Ali Roomana
Published: September 2021

Infertility is very stressful event and is proven to associate with depression,anxiety, sexual dysfunction loneliness, sadness and impaired couple’s relationship. Objectives:To determine the frequency of depression in infertile females and to determine the various riskfactors associated with infertility and depression. Study Design: Prospective cross sectionalstudy. Setting: Department of Obstetrics and Gynecology of Ziauddin University Karachi. Period:January to June 2014. Methodology: Infertile women were interviewed and the diagnosis andseverity of depression was assessed together with the effects of different predicators such asage, duration of infertility, employment educational and socioeconomical status using PHQ-9 scale scoring. Results: This study showed that 199 (58%) of the infertile women sufferedfrom depression. There was a statistically significant association with socio economical statuswhile no significant association was detected with age of women, duration of infertility andeducational status. Conclusion: We found a high prevalence of depression among infertilewomen. Depression was more among women belonging to higher socioeconomic class.
ORAL SQUAMOUS PAPILLOMA AND SQUAMOUS CELL CARCINOMA
Authors: Liaqat Rajia , Barkat Najiya , Hanif Asif
Published: September 2021

Objectives: The objective of this study was to determine the diagnostic utility ofp53 in differentiating oral squamous papilloma and squamous cell carcinoma. Study Design:A cross-sectional study. Setting: Pathology Department of Shaukat Khanum Memorial CancerHospital and Research Center Lahore. Period: Six months (6-10-10 to 6-04-11). Patients andMethods: A total of 100 oral biopsies fulfilling the inclusion criteria were collected. The expressionof P53 was observed in biopsies of squamous papilloma and squamous cell carcinoma. Datawas entered and analyzed on SPSS version 20 and was analyzed in same package. Sensitivity,specificity, positive predictive and negative predictive values were calculated along theirconfidence intervals at 95% level. Results: One hundred oral lesions were studied, of which 90cases were of squamous cell carcinoma and 10 cases were of squamous papilloma. Majorityof the patients were male (60%). Mean age was 46 years. P53 IHC stain had sensitivity of 92%and specificity of 80% and diagnostic utility of 91% in lesions of squamous cell carcinoma.Conclusion: P53 is positively expressed in oral squamous cell carcinoma and is negativein squamous papilloma. Hence evaluation of p53 expression can be a useful adjunct in thediagnosis of squamous cell carcinoma, especially in cases where it is difficult to distinguishbetween these two entities on morphological grounds.