bluuebunny/crossref_metadata_2025 huggingface dataset:
SUPERFICIAL BLADDER TUMOR;
Authors: SIDDIQUI AMJAD ALI , RAHIM JAMSHED , MAHMOOD ATHAR , Rahim Jamil
Published: September 2021

Introduction: Bladder cancer is the second most common urologic cancer. Approximately 90% are transitional cellcarcinoma among which superficial bladder cancer constitutes about 50-70%. It is usually treated by transurethral resection withadjuvant intravesical instillations of chemotherapy or immunotherapy. Primary problems in superficial bladder cancers are its tendency torecur, about 50-80%, following surgical ablation alone, with progression to muscle invasive disease in 20-25% cases. Intravesicalchemotherapy appears to have major impact on decreasing chances of recurrence of superficial bladder cancer. Objective: To determinethe efficacy of single dose perioperative intravesical mitomycin C in reducing recurrence of superficial bladder tumor. Study Design:Comparative study. Settings: Department of Urology Shaikh Zayed Hospital Lahore. Duration of Study: One year.13-04-2009 to 13-04-2010. Methodology: Patients were divided into two groups randomly by using random numbers i.e. 40 patients in group A and 40 patientsin group B. Group A (40 patients) of bladder tumor received post TURBT single dose Mitomycin-C 40 mg/40ml N/Saline intravesically andGroup B (40 patients) was control group i.e. TURBT alone without Mitomycin-C. Results: The recurrence at first year follow up in bothgroups were showed a significant difference (p<0.05) as shown in Table No V: There were only 10% recurrence in Group A i.e. patientswho had intravesical Mitomycin –C as compared to 55% recurrence in Group B, who did not received postoperative intravesicalMitomycin–C. Conclusions: It is concluded that one perioperative (within 6 hours of TURBT) intravesical instillation of chemotherapysignificantly decreases the risk of recurrence after TURBT in patients with stage Ta T1, single and multiple papillary bladder cancer in lowrisk as well as high risk tumors. One immediate instillation after TUR reduces the recurrence.
MID-SHAFT CLAVICLE FRACTURES;
Authors: QURESHI KASHIF KHURSHID , AHMED ZULFIQAR , BAJWA IMRAN ASIF , Ahmed Saeed , Moin Hassan
Published: September 2021

Objectives: To study the time to union and complications after open reduction and internal fixation of mid-shaft claviclefractures. Design: Retrospective. Settings: Midlands Orthopedic/ Sports Injury Clinic, Bahawalpur. Study Period: 2003 to December2012. Material and Methods: The medical record of the patients operated for mid-shaft clavicle fractures was searched to find out thetime to union and occurrence of complications during this period. Results: The time to union was 4.6 months and there were twocomplications. A prominent implant had to be removed and one non-union required additional bone grafting procedure. Conclusions:This small series shows that the rate of complications is low and a larger study is needed to expand the indications for operative fixation ofclavicle fracture safely.
BREAST CANCER PATIENTS;
Authors: QAMAR MUHAMMAD FIAZ , REHMAN FARAH , ILYAS SABEEN , Abbas Seher
Published: September 2021

Objective: Genetic factors contribute to the high rates with breast cancer patients. Our objective was to screen themutations in the BRCA 1 gene in exon 20. Design: A diagnostic study. Place and Duration of Study: The study was carried out inmolecular biology lab, Department of Zoology, GC University Lahore and Institute of Molecular Biology and Biotechnology (IMBB),University of Lahore over a period of one year from July 2011 to Aug 2012. Patients and Methods: To screen for mutation in the BRCA1gene, blood samples were collected from 22 different patients suffering from breast cancer from the Anmol Hospital and Sir Ganga RamHospital Lahore. The collected samples were processed to screen any mutation in exon 20 which is indicative of the fact that exon 20 isnot a hotspot for mutations. Results: In our study of 22 females, we have found no mutation in the gene. It is becoming increasingly clearthat breast cancer is a multifaceted and heterogeneous disease and histopathological characteristics of breast cancer are controlled bysubsets of genetic alterations, providing convincing hints of genotypic–phenotypic correlations between morphological patterns andmolecular changes. BRCA has emerged as the master regulator of the genome through its ability to regulate and coordinate various stepsof DNA damage response. Women who carry a mutation of the gene have greatly increased chance of developing breast cancer. Thepopulation of Pakistan has been substantially screened for somatic and germline mutations in BRCA. Conclusions: Breast cancer is themost common cancer of women in Pakistan. One every 8th women is found to carry the disease. A female may develop the diseasethrough inherited mutations in the BRCA1 gene. The absence of mutation maybe attributed to small sample size of the study or may be dueto the fact that the size of the gene is so large that a single axon may not be enough to screen for mutations.
EMERGING HUMAN HEALTH RISKS PERTINENT TO MODERN AGRICULTURE;
Authors: Chaudhary Khalid Mehmood , Ashraf Saleem , Ashraf Ijaz , Iftikhar Muhammad , Khan Ghazanfar Ali , Sagheer Aqeela
Published: September 2021

In developing countries week and dispersed link has been shown between agriculture and human diseases. In this regardpresent review was conducted and revealed several examples that there exist strong link between agriculture and diseases. Reviewcategorized the major disease into zoonotic, vector borne and food associated. Zoonotic diseases were found to be transmitted by thelivestock. Some of these diseases are also associates with vectors that were found to be transmitted by the agriculture. Mosquito is themajor vector transferring malaria, cholera and skin diseases. Agricultural intensification is the major source of their climate changethrough increased emission of green house gases. Agricultural intensification, ecological disturbance and inadequate agriculturalmanagements are the dominant reason revealed. Rate of future agricultural diseases such as zoonotic diseases emergence orreemergence will be closely linked to the evolution of the agriculture–environment nexus. Meanwhile, the available research is not enoughto address these issues. Agriculture sector is for peace and sustainability and to strengthen this sustainability there is dire need ofConvergence is needed between integrated pest management strategies and integrated vector management strategies to help farmersimprove their agricultural practices while minimizing environmental risks to health. In addition, further research by the medical scientistsand agricultural scientists is needed to explore the epidemiology of various diseases caused by the agricultural activities throughpromotion of vector.
CHOLECYSTECTOMY;
Authors: Hassan Iram , Khan Muhammad Sohaib , Malik Naveed Akhtar , Khan Jahangir Sarwar , Zaman Saadia , Khan Muhammad Mussadiq
Published: September 2021

Objective: To compare the operative time, blood loss, postoperative pain andlength of hospitalization between open (OC) and laparoscopic cholecystectomy (LC) in Livercirrhotic patients with Child –Pugh class A & B. Study Design: Randomised Control Trial (RCT).Setting and Duration: This study was conducted at Surgical department, Holy Family Hospital,Rawalpindi from Jan 2010 to Dec 2011. Subjects and Methods: A total of 142 patients havingLiver cirrhosis secondary to Hepatitis A & Hepatitis B, who presented in OPD and ER with signsand symptoms of gall stones were randomly allocated into two groups for open (OC) andlaproscopic cholecystectomy (LC). All of them were either in Child–Pugh class A or B. Data on theabove two groups( LC &OC) was collected and analyzed for operative time, blood loss andlength of hospitalization after operation. Results: The mean blood loss in LC group was61.33+39.64 ml vs 90.84+29.88 ml in OC group, Mean operation time was 50.49+18.26 min inLC group vs 59.22+15.66 in OC group which is statistically significant (p<.05). In LC group, themean hospital stay was 1.8+.97 days, while in OC group is 2.4+.91 days which is alsostatistically significant. Conclusions: LC (laparoscopic cholecystectomy) is a safe and effectiveapproach for the treatment of symptomatic cholelithiasis in patients with mild cirrhosis with lessblood loss, less postoperative pain, shorter operative time and decreased hospital stay.
PSEUDO AINHUM - A PROSPECTIVE STUDY
Authors: E Kibria Rehan
Published: September 2021

Background: Amniotic band syndrome also known as ADAM complex, amnioticband sequence, congenital constrictions, bands and Pseudo Ainhum is a congenital disordercaused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while inutero. Syndrome which is featured by one or more characteristic fibrous bands that encircle,deepen, strangulate and amputate parts of the human body. It start in a fetus & continuesthroughout life if not checked and treated . It is not an uncommon condition in our country butunfortunately data remains scarce. Design: A prospective study. Setting: Pediatric & GeneralSurgical Department of CMH Multan. Period: June 2010 to June 2012. Materials and methods:Characteristic progressive constriction band was undertaken. The patients were examinedclinically and findings recorded. An X-ray to rule out underlying bone anomaly was done.Treatment required multiple staged procedures. Correction of the constriction ring was done byexcision and Z-plasty to prevent or alleviate lymphoedema, separation of distally fused digits andskin grafting of defect. Results: Fifteen patients comprising of ten male & five females wereseen. Age of presentation ranged from second week of life to 12 years with mean age of 14months. A total of twenty one limbs and one penile shaft were effected. These included two rightupper limbs, three left upper limbs, ten right lower limbs and six left lower limbs. Penile shaft ofone of the patients just short of glans was involved. Four main types of lesions were found whichcomprised of constriction rings, intra uterine amputations, acrosyndactyl and simple syndactyl.Conclusions: Pseudo Ainhum is a disease of unknown etiolgy & could cause morbidity in newborn. The syndrome & its complications are amenable to corrective surgery with good results.Early surgery is required for successful outcome.
HYPOGLYCEMIA;
Authors: Bajwa Muhammad Ahsan , Malik Fiaz Ahmed
Published: September 2021

Introduction: Hypoglycemia is a common condition found in neonates. Much ofmorbidity and mortality is related to it, although it can be prevented and managed promptly. It isimportant to estimate the frequency of hypoglycemia in neonates particularly who are sick andare admitted in hospital. Objective: To estimate the frequency of hypoglycemia in hospitalizedneonates. Study Design: Cross-sectional descriptive study. Sample technique: Conveniencesampling. Place & duration of study: The study was conducted in nursery section of Pediatricsunit I at B.V.Hospital, Bahawalpur. from 01-10-2011 to 31-03-2012. Subjects & Methods: 60neonates were taken who were admitted for various ailments in Nursery Section. They werechecked for blood sugar level at the time of admission/presentation by glucometer. If foundhypoglycemic, blood sample taken for laboratory conformation. Blood sugar levels were takenand analyzed to compare qualitative variables by chi-square test at 5% level of significance.Results: 30% among hospitalized neonates were found hypoglycemic including bothsymptomatic and asymptomatic. Conclusions: Neonatal hypoglycemia is observed commonlyin hospitalized neonates so blood sugar level of every neonate brought to hospital should bechecked.
HYPERCHOLESTEROLEMIA;
Authors: Khan Zahidullah , Khan Inamullah , Subhan Fazle
Published: September 2021

Objective: To compare the efficacy of Simvastatin with Atorvastatin in loweringLow Density Lipoprotein Cholesterol (LDL-C) in patients with Hypercholesterolemia in a tertiarycare hospital. Design: Prospective, observational, single center study. Setting: Department ofMedicine, Khyber Teaching Hospital, Peshawar. Period: December 2011 to December 2012.Subjects and Methods: A total of 200 cases having base line fasting LDL-C level of ≥ 130 mg/dland meeting the inclusion criteria were included in the study through both outpatient department(OPD) and admitted patient. After detailed history and clinical examination, all patients weredivided randomly into two groups, A and B. Patients in Group A were given Simvastatin20mg/day and Group B received Atorvastatin 20mg/day. Fasting blood samples were taken fromthe selected patients in the start of study and after 12 weeks. Results: A total of 200 subjects witha serum LDL-C level ≥ 130 mg/dL were included in the study. They were divided into 2 groupsrandomly, 100 in each group. Each group comprised of 75 male and 25 female. The mean age ingroup A was 52 years and in group B it was 54 years. The age ranges between 40 years and 73years. Mean base LDL-C level was 165 mg/dl in group A and 170mg/dl in group B. Simvastatin 20mg/dl reduced LDL-C level by 26% and Atorvastatin 20mg/dl reduced LDL-C level by 33% after 12weeks of treatment. Conclusions: Atorvastatin is a more effective drug to reduce serum LDLcholesterolthan Simvastatin in the same doses.
POSTERIOR CAPSULOTOMY
Authors: Khattak Lal Muhammad , Qadir Afzal , Khan Umer , Kamran Muhammad Kashif
Published: September 2021

Objective: To study the complications of ND: YAG laser capsulotomy. Design:Clinical trial. Setting: Department of Ophthalmology KHYBER Medical University Institute ofMedical Sciences Teaching Hospital Kohat Development Authority (KDA) Kohat. Period: Jan2007 to June 2008. Material and methods: A total number of 250 patients with posterior capsularopacification were studied and look for complications after ND: YAG Laser application. Onehundred and thirty five (54% )were male and one hundred fifteen( 46%) patients were female.63% of patients had right eye involvement while 37% had left eye were involved. Patients werethoroughly examined before and after the procedure. All patients were followed for minimum sixmonths after the procedure. Data was analyzed by SPSS version 16. Chi square test wascalculated for the significance of analysis. Results: After Nd YAG laser capsulotomy there wassignificant improvement in visual acuity of my patients. There was transient rise of IOP in 25 (10%)of patients. Mild anterior uveitis in 20 (8.0%) of patients. Intra-ocular Lens pitting or cracks in 30(12%) of cases. Macular edema in 20 (8.0%) of cases. Retinal detachment in 5 (2.0%) of cases.Conclusions: Nd YAG laser is safe, effective and non-invasive procedure outdoor procedure bywhich we can get better visual outcome. Which had also some serious complication for that wehave to avoid and educate the patient about the complications of procedure.
SCREENING MAMMOGRAPHY
Authors: Naeem Shafia , Mahmood Faisal , Qamar Ali , Liaqat Umer , Anwar Ayesha , Aftab Muhammad Imran , Abbassi Farkhanda
Published: September 2021

Background: Worry about risk for breast cancer and pain are associated withmammography use. Both have been found to be a barrier to mammography use by women.Objective: To examine the anxiety and pain associated with mammography use in a sample ofwomen stratified according to breast cancer risk. Design: This prospective observational study.Setting: Department of Obstetric and Gynecology, Benazir Bhutto Hospital. Period: August2011 to June 2012. Patients & Methods: Women awaiting screening mammography in thereception area were asked to complete a questionnaire containing demographics for calculationof breast cancer risk and the Likert scale for anxiety before the procedure and VAS forassessment of pain after the procedure. Results: Our study included 100 women undergoingscreening mammography with an average age of 53.9±8.8 years. 15% were classified “higherrisk” by the Gail model. The average anxiety level was 4.03±1.3 on Likert scale and average painduring the procedure was 3.3±2.18 on VAS. Significant differences (p<0.05) were foundbetween average and higher risk groups. Conclusions: The population of women in this sampleappears to have a level of breast cancer worry and procedure related pain that is proportionalwith their risk for developing breast cancer.
REPRODUCTIVE HEALTH
Authors: Asghar Kanwal , Nawaz Yasir , Maann Ashfaq Ahmad , Ashraf Ijaz , Ashraf Ijaz , Mahmood Khalid , Batool Zahra , Sultana Razia , Saghir Aqeela
Published: September 2021

Practicing reproductive health rights is not an individual attribute but an outcomenegotiated between partners. Large differentials can place the less powerful partner at risk byreducing his or her ability to negotiate safer sexual relations. Negotiation between partners isaffected by material assistance which is given by men. Hence, the present study was designed togauge the extent of practicing the reproductive health rights among married men and womenand to see the relationship between respondents' characteristics and practicing of reproductivehealth rights by them. A cross-sectional survey was carried out from Punjab province. Welldesigned interviewing schedules were constructed in the light of research objectives and theconceptual framework of the study to collect data and draw inferences. A representative sampleof 700 married women and 600 men were interviewed. The SPSS/PC+ 15.0 Statistical Packagefor Social Sciences were used for analyzing the data. A strong and positive association betweenthe demographic characteristics of married men and women and their attitude towards thereproductive health behavior and those women who were currently engaged in paid jobs hadhighly favorable and consistent attitude towards RHR-Practices. It was strongly suggested thatencourage women's employment by increasing their education level and creating jobs in everydepartment and encourage women's participation in decision making process.
MIDSTREAM URINE ISOLATES
Authors: Khan Haroon-ur-Rashid , Maheen Safirah , Mahmood Zahid , Bhatti Ahmad Nawaz
Published: September 2021

Objectives: The objectives of the study was to determine differentmicroorganisms responsible for causing urinary tract infections UTI in children and to evaluatesensitivity and resistance pattern of different antibiotics used in UTIs. Setting: Study wasconducted in Children Hospital Complex (CHCM), Multan, Pakistan. Methods: Total 125 childrenhaving UTI were taken to determine the antibiotic sensitivity and resistance pattern againstmicroorganisms causing urinary tract infections in children. The urine samples were collected inurine bottles and smears were made within 2 hours of sample collection. Urine sample wasinoculated on agar media and then incubated for 24 hours. A smear was prepared on a slide formculture of microorganisms and gram testing was conducted. The microorganisms were thencharacterized by use of API (Analytical Profile Index) MICROBACT TM 24E of Oxoid England. Theantimicrobial susceptibility testing of various antibiotics was performed by disc diffusion method.Results and Conclusions: The percentage of Gram +ve bacteria causing urinary tract infectionsin children was 28%, Gram –ve 62.4% and Yeast 9.6%. The most prevailing species are S. aureus,S. epidermidis and E.coli. Results showed that female children are more prone to UTI than malechildren. Norfloxacin is effective in S. Aureus UTI while cefaclor is effective in S.epidermidis UTI.Amikacin, Norfloxacin and Cefuroxime are effective in UTI caused by E.coli.
CLOSED TIBIAL PLATEAU FRACTURES;
Authors: Memon Shakeel Ahmed , Laghari Muhammad Ayub , Mahar Imran Khan , Baloch Nizam Ahmed , Pirwani Mehtab Ahmed , Mahar Imran Khan
Published: September 2021

Objective: The aims & objectives of the study are to compare the results of tibialplateau fracture treated by plaster of paris cast and percutaneous screw fixation. Study design:Comparative study. Place and duration of study: Study was carried out at the OrthopaedicsUnit-II, Liaquat University Hospital Hyderabad / Jamshoro , from January February 2010 tooctober 2011. Methodology: Between February 2010 to october 2011, 31 men and 9 womenaged 20 to 40 years with means 28.25 years underwent plaster of paris and percutaneous screwfixation for schatzkar type I closed tibial plataue fracture in Orthopaedics Unit-II, LiaquatUniversity Hospital Hyderabad / Jamshoro. Data was analyzed through SPSS software version16.0. Results: In both groups 31(77.5%) men and 9(22.5%) women with male: female ratio of3.4:1 and aged 20 to 40 years with means 28.25 years. Union time range 10 to 24 weeks in bothgroups(p value 0.001). The mean healing time in PSF group was 11.6 weeks while in POP groupit was 13.9 weeks. The complications seen in this study were pain during walking (5 (25%)patients in POP VS 3 (15%) patients in PSF group), knee stiffness (4(20%) patients in POP VS 2(20%) patients in PSF group ), ankle stiffness (3(15%) patients in POP VS 1(5%) patients in PSFgroup), delay union (2(10%) patients in POP VS 1(5%) patients in PSF group ), non union (2(10%)patients in POP VS 0(0%) patients in PSF group ) P value 0.040. The longer duration of hospitalstay about -10-20 days in 13(65%) of POP patients as compared to PSF cases where majority16(80%) were discharged within 1 to 10 days( p value 0.148). The patients with complications hadstill longer stay in both group. The mean hospital stay in POP group was 14.6 days and PSF groupwas 8.4 days. The clinical results seen in this study were excellent (5(25%) patients in POP VS13(65%) patients in PSF group), good (8(40%) patients in POP VS 5(25%) patients in PSF group),fair (5 (25%) patients in POP VS 2 (10%) patients in PSF group ) and poor (2(10%) patients in POPVS 0 (00%) patients in PSF group. Conclusions: We conclude that percutaneous screw fixationgives better results in type I schatzkartibial plateau fracture compared to plaster of paris cast. Thecomplications were seen higher in POP cast.
CHRONIC HEPATITIS;
Authors: Akhund Anwar Ali , Akhtar Rehana , Naqvi Syed Qaiser Husain , Kamal Mustafa
Published: September 2021

Objective: To determine the correlation between HCV genotypes and serum ALTlevels in various patients of chronic hepatitis induced by hepatitis C virus, in our setup. Design: Aprospective study carried out from August 2006 to December 2009. Setting: Research MedicalCenter LUMHS Jamshoro, Pathology Department Peoples University of Medical & HealthSciences Nawabshah and Biotechnology Department University of Karachi. Patients: A total of344 HCV-PCR positive patients with different genotypes were evaluated 239 men and 105 womenwith ages between 18–55 years of age years were included in the study. Methodology: All thepatients went for ELISA test for the presence of HCV antibodies by ELISA kit of Biokit Spain, then a10.0 ml sample of blood was collected in a tube with separating gel, to obtain serum, which wasO stored at -80 C, for the determination of HCV RNA by RT- PCR (Real time cephid smart cycler) andfor determination of HCV-RNA genotypes by comparison in sizes of the products amplified by RTPCRusing HCV genotype- specific primers, then subjecting the product to electrophoresis byAnagen kit. 5.0 ml of blood was also collected in a tube with separating gel, to obtain serum,which was stored at room temperature for the determination alanine aminotransferase by usingUV enzymatic kinetic method. Results: when HCV genotypes were correlated with serum ALTlevels, 09 cases were found < 50 mg % and among these 06 cases were of genotype 1a, 02 caseswere of genotype 2a and one case of untyped. 55 cases shows serum ALT level between 50-100mg % and among this majority of cases belongs to untyped category. 209 cases shows serumALT level between 100-200 mg % and among this majority of cases belongs to genotype 3a. 71cases shows serum ALT level >200 mg % and among this majority of cases belongs to genotype3a. Conclusions: The data in the current study indicates the strong correlation between HCVgenotypes and serum ALT levels. The genotypes 3a, 3b and 2 were found associated with highserum ALT levels and the genotype 1 was found associated with low levels of serum ALT.
COMPLICATIONS OF COLOSTOMY;
Authors: Ashraf Muhammad Naeem , Kayani M. Shahbaz Bakht , Mahmood Shahid , Sultan Saad
Published: September 2021

Objective: To study the frequency and types of complications in colostomypatients. Stuyd Design: Prospective cross sectional study. Setting: Department at Surgery, FaujiFoundation Hospital Rawalpindi. Period: 1st December 2009 to 30th November 2011. Material &methods: A total of 104 consecutive patients who end up with colostomy due to any reason wereincluded in the study. Results: It was noted that 52 patients had stoma due to malignancy andcomplications was noted in 40 patients. Same number of Patients operated for non-malignantdisease i.e. 52. Complications noted in only 24 patients while 28 were without complications.Conclusions: The chances of complications in different type of stomas are much higher in caseof malignancy. It is recommended that such operations are performed by senior surgeons inorder to avoid post-operative morbidity and mortality.
OSTEOPENIA AND OSTEOPOROSIS;
Authors: Masood Zahid , Shahzad Sumera , Saqib Ali , Ashraf Khizer
Published: September 2021

Objective: Osteopenia and osteoporosis are one of the main health concerns ofPakistani females now days. Our objective was to study the frequency of osteopenia andosteoporosis among females in the Faisalabad and its suburbs. Material and Methods: Studywas initiated after approval of Ethical Review Committee. It was an observational cross sectionalstudy conducted by the Department of Community Medicine, University Medical & DentalCollege Faisalabad in a private sector university of Faisalabad city and a private clinic in People’scolony, Faisalabad. Study included a total of 600 women. Convenient sampling was done. Studywas conducted from 1st January 2013 to 30th September 2013 in six different sessions. Age,marital status, education, socio-economic status (SES), occupation, parity and residence werevariables of interest. Bone Mineral Density (BMD) was tested using calcaneal quantitativeultrasound machine and right heel of participant. Machine converted the BMD values into TScore.According to the recommendations of World Health Organization (WHO) participant wasconsidered normal, osteopenic and osteoporotic. SPSS version 16 for windows was used toanalyze data. Results were considered significant if p - value was < 0.05. Results: Our resultsreflected that 72.9% of study participants were osteopenic while 2.4 % were osteoporotic and24.7% were normal. By place of residence no significant difference was observed, 48% of ruralpopulation and 47% of urban population was osteopenic and insignificant correlation was found(p=0.438). However, 46.77% and 10% of urban participants were normal and osteoporoticrespectively. Education in relation to osteopenia and osteoporosis revealed that 42% of educatedfemales were osteopenic while 31.33% of illiterate females were osteopenic (p > 0.05). 69.88%married females were osteopenic and 43.22% unmarried females were osteopenic (p < 0.001).Conclusions: In our study frequency of osteopenia and osteoporosis was significantly high in allage groups. There is need for large-scale population-based studies using calcaneal quantitativeultrasound or DEXA scan to assess the prevalence of osteopenia and osteoporosis in thecommunity. Further health education with special reference to balanced diet should be impartedto target population.
PEDIATRIC ABDOMINAL PAIN;
Authors: Siddiqui Ejaz Hussain , Siddiqui Saad , Ayub Romana , Shah Noreen
Published: September 2021

Objectives: To assess common presenting features of children with abdominalpain and to determine role of High frequency & Doppler Ultrasound in evaluation of thesepatients. Material and Methods: This is a cross sectional study conducted from August 2012 toDecember 2012. Data from patients presenting for evaluation of abdominal pain was analyzed forpresenting complaints and ultrasound findings according to objectives of the study. Results: Intotal 262 cases were included in the study. The mean age of patients was 6.3 years with a male tofemale ratio of 1.47:1. Dysuria followed by Diarrhoea and vomiting were most commonassociated complaints, Urological pathologies were most common ultrasound findings uponevaluation of patients. Conclusions: Abdominal pain is a frequent presenting feature inpeadiatric population, Urological pathologies were most common examination findings.Ultrasound is a useful and safe modality in evaluation of abdominal pain in children.
VOLKMANN’S ISCHEMIC CONTRACTURE;
Authors: Khan Firdous , Cheema Tahseen Ahmed , Bhatti Zahid Iqbal
Published: September 2021

Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) of the forearm seen in our setup. Design: A descriptive case series study.Setting: National Orthopedic Hospital, Bahawalpur, Pakistan. Period: January 2005 toDecember 2013. Methodology: A total of 42 patients were registered during the study period.Patients with VIC of the forearm resulting from direct circumferential compression were includedin the study. Patients who developed VIC of forearm indirectly secondary to arm pathology orother causes were excluded from the study. Assessment was made by detailed history, clinicalexamination and radiographs of the involved extremity. The age, sex, duration, side and type ofcontracture, length and width of forearm and resulting deformities were all documented on adetailed proforma. Patients were categorized into three types accordingly. Results: Forty twopatients comprising 29 males and 13 females were seen. Their ages ranged from 1 to 53 yearswith mean age of 14.47 years. Duration of established VIC of the forearm after insult ranged from 3months to 6 years with mean duration of 2 ½ years. Most frequent type of contracture wasmoderate variety seen in 19 patients (45.23%) with 14 cases on the right and 5 cases on left sidefollowed by severe varieties which were present in 13 patients (31%) with 10 cases on the rightand 3 cases on left side. Mild contractures were found in 10 patients (23.9%) with 6 cases on theright and 4 cases on left side. In 26 of 42 patients, a difference in forearm length that ranged from79% to 94% (mean, 80%) was observed. Majority of cases (37 cases) of VIC occurred after TBS forradius and ulna fractures while in the remaining 5 cases, contractures of forearm occurred due totight plaster of paris (POP) splint. Conclusions: Post-circumferential forearm contractures afterTraditional Bone Setters (TBS) are common in our society. Community awareness through healtheducation and conducting medical camps and seminars might play a role in decreasing theinfluence of TBS.
UPPER GI ENDOSCOPY
Authors: Zakria Muhammad , Shuja Awais
Published: September 2021

Objective: To document various endoscopic findings in patients undergoingupper GI endoscopy in our endoscopy unit. Design: Observational. Patients and methods: Thedata of 100 patients who underwent upper GI endoscopy in Endoscopy Unit of IndependentMedical College/ Independent University Hospital from April 2010 to December 2012 wasanalyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted.Results: Among 100 patients, 35% were referred due to persistent vomiting, 28% due toepigastric pain / discomfort, 18 % due to dyspepsia and 7% due to retrosternal burning and uppergastrointestinal bleeding. Common endoscopic diagnoses were gastritis (28%), duodenitis(14%), gastroesophageal reflux disease / esophagitis (6%), esophageal varices (5%) andesophageal growth (4%). Conclusions: The most common presenting complaint was persistentvomiting followed by epigastric pain / discomfort and the most common endoscopic finding wasgastritis.
DISEASE PATTERNS;
Authors: Ashraf Muhammad , Zakria Muhammad
Published: September 2021

Communicable and gastrointestinal diseases followed by respiratory diseasesare the main reasons of admission in medical ward of developing countries. This is different fromthe developed countries where non communicable diseases are the main reasons of hospitaladmission. In developing countries the data of hospital admission are still lacking. Therefore thisstudy will help us to assess the common patterns of diseases admitted in a medical ward, theaverage length of hospital stay etc. Objective: The objectives of this study are to assess thepatterns and prevalence of diseases, the most common diagnosis and average duration ofpatient’s hospital stay. Design: Observational retrospective cross-sectional study. Patients andmethods: The record of 327 hospitalized patients in medical ward was analyzed for the period ofthirteen months from Mar 2013 to Mar 2014. Patient’s medical records were retrieved and dataanalysis was done to obtain age, sex, common diagnosis, the affected system and the duration ofthe hospital stay. The data was analyzed by using SPSSV 16. Results: After reviewing the data,the most common age of patients being admitted were between 46-65 yrs (37.6%), followed bybetween 26-45yrs (33%), < 25yrs (15.9 %) , between 66-85 yrs (12.5 % )and > 85 yrs were only1% . Among the admitted patients females were more than the males except in case of liverdiseases. The most affected system was gastrointestinal ( 22.63 % ) and the most commondiagnosis was Diabetes Mellitus (12.84 %). The next common system involved wascardiovascular (15.29 %), respiratory (14.37 %), endocrine / DM (10.70 %), neurology (9.48 %),heamatology (3.36 %), renal (2.45 %) , rheumatology (1.84 %) and others ( including pyschiarty ,poisoning, infectious , electric shock etc ) (5.81 %). The cause for hospital admission by infectionin different system was (20.48%) The average duration of hospital stay of the patients was 4 days.Conclusions: The gastrointestinal diseases and the infectious diseases are the most commondiseases. The communicable diseases still hold a greater position in developing countries, whilenon communicable diseases are main reasons for admission to the medical wards in developedcountries.
ORBITAL FLOOR RECONSTRUCTION WITH TITANIUM MESH;
Authors: Khalid Muhammad Usman , Malik Arshad Mahmood , Janjua Omer Sefvan
Published: September 2021

Objective: To determine the outcome of orbital floor reconstruction with titaniummesh in terms of diplopia, enophthalmos, dystopia and infection etc. Study design: Descriptivecase series. Place & duration of study: Department of Oral & Maxillofacial Surgery, PunjabMedical College / Allied Hospital Faisalabad. One and Half year from 01-10-12 to 31-03-14.Material and Method: Twenty two patients clinically and radiographically having defect in theorbital floor due to trauma were included in the study. Titanium mesh was used to reconstruct theorbital floor through infraorbital rim incision and secured in place with 5mm micro screws. Thevariables to be analyzed were diplopia, enophthalmos, orbital dystopia and infection. Results: Inour study male gender predominates over female 20/22. Mean age of patients is 29.36 years ±5.21. Diplopia persisted in 2/10 (20%) patients. Enophthalmos persisted in 7/18 (38.8%) patients.dystopia persisted in ¼ (25%) patients. Infection didn’t develop in any of our patient (0%). Visualacuity was not affected in any of the patient (0%). Conclusions: Titanium mesh is a suitablematerial for reconstruction of orbital floor fractures with little complication rate and no donor sitemorbidity.
ALCIAN BLUE pH;
Authors: Mwakyoma Henry A , Tonya2 Ponsianus T.
Published: September 2021

Background: Alcian blue (AB) is a cationic dye that stains mucins especially acidic mucins into varying shades of blue colour depending on the pH of the dye. GIT comprises of three main portions, fore-, mid- and hind-gut, which develops from different embryological areas. Their epithelial lining presents with varying degree of diversity including their secretions. Studies have shown that there is a tendency of cellular modification (physical and chemical) including secretions during tumour morphogenesis. With recent increase in GIT tumours especially epithelial tumours, Alcian Blue staining of mucins produced by these tumours at different pH more than conventional pH might give valuable information on the property of these tumours. Setting: The study was conducted in the Histopathology and Morbid Anatomy unit, department of Laboratory services, Muhimbili National Hospital, Tanzania. Study design: This was a hospital based retrospective study, in which archival data and blocks were retrieved. Objective: To determine the effect of pH and pattern of Alcian blue staining on primary GIT epithelial tumours tumours. Materials and Methods: Information on patients were obtained from cancer registry and patient files. Paraffin blocks were retrieved from archive, sections were cut using rotary microtome at 3μm (SAKURA). Haematoxylin and Eosin (H&E) and AB staining at pH 1, 1.5, 2 and 2.5 was done for each case and control. H&E slides were reviewed for confirmation of the diagnosis primary epithelial tumours and AB stained slides were evaluated for staining reaction and graded. Results: Out of 87 GIT primary epithelial tumours which were evaluated, AB staining was positive in 21 (24.1%) cases, the majority of these (11 (52.4%)) were from hindgut. Positive AB staining of GIT epithelial tumours increased as the tumour became more differentiated irrespective of location. Majority of tumours with positive AB staining was observed at pH 2 in GIT epithelial tumours as opposed to the conventional pH of 1 and 2.5 respectively. Conclusions and recommendation: The majority of primary GIT epithelial tumours stained positively at pH 2 irrespective of the location. However tumour differentiation influenced AB staining whereby well-differentiated tumours were mostly positively stained. It is recommended that AB at pH 2 should be applied when staining GIT epithelial tumours rather than conventional pH of 1 and 2.5. However the degree of differentiation should be considered since poorly differentiated tumours are likely to give negative results with AB staining.
CORONARY HEART DISEASE;
Authors: Ahmed Munir
Published: September 2021

Objective: This study was done to find any correlation among total cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol estimated in serum of offsprings of coronary heart disease patients. Study Design: A cross sectional comparative study. Patients and Methods: Two hundred and fifty (250) subjects having parents with coronary heart disease were selected from Punjab Institute of Cardiology Lahore. The serum total cholesterol, triglycerides, low density lipoprotein cholesterol, and high density lipoprotein cholesterol were estimated. Coefficient of variation was calculated to find whether observations in one series vary correspondingly with observations in another series. Results: Highly significant positive correlation was found between total cholesterol and triglycerides, and, total cholesterol and low density lipoprotein cholesterol. Highly significant negative correlation was found between low density lipoprotein cholesterol and high density lipoprotein cholesterol. Correlation between TG and LDL-c was also significant. Conclusions: Serum total cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol have strong association with one and other. For prediction, prevention and management of coronary heart disease it is important to estimate and observe the correlation among these parameters.
DIABETES MELLITUS MODIFYING FACTORS;
Authors: Maheen Safirah , Rashid Haroon-ur- , Baber Khan Mohammad , Khan Hafeez ullah , Uttra Ambreen Malik , Khan Fatima , Hasan Umme Habiba
Published: September 2021

Objective: Diabetes mellitus is wide spread non transmissible disease but its prevalence is increasing everyday so this study was conducted with an aim to investigate the factors that are modifying diabetes mellitus among patients at DHQ (District Head Quarter) Hospital Sargodha. Methodology: A prospective study was carried out by well-trained pharmacists in DHQ Sargodha, Pakistan to assess the factors modifying diabetes mellitus. Data was collected from 110 patients randomly by using convenience sampling method. A well structured questionnaire was designed to collect information from patients and entire procedure was conducted with the permission of concerned authorities of Hospital management. The factors that are considered in present study are medication, treatment, patient physician interaction and society attitude towards diabetic patients which are helpful in halting the progression of diabetes and prevention of co morbidities. Results: The results of study disclose that 74.5% diabetic patients felt better after treatment whereas 56% diabetic patients were satisfied with the information provided by physician to them but still 70% patients were suffering from co morbidities. The survey indicated that 62.7% patients said that exercise proved to be healthy activity in improving diabetes. However 59% diabetic patients were following a proper diet plan which was helpful in modifying their diabetes. Conclusions: The diabetic patients must be informed about importance of regular follow-up in averting long-standing complications. Patients should be guided about importance of dietary recommendations, exercise and strict metabolic control, that can holdup or avert the series of complications allied with diabetes.
BILATERAL IRREVERSIBLE BLINDNESS
Authors: Iqbal Asif , Idrees Muhammad , Bashir Bilal , Rehman Mubashir , Orakzai Omer Khan
Published: September 2021

Objective: To find out the causes of bilateral irreversible blindness in patients of different age groups in District Swabi. Design: It is a prospective observational study of one hundred and eighty nine consecutive blind cases. Place and Duration of Study: The study was conducted from July 2010 to June, 2012 at the Ophthalmology Department of District Headquarter Hospital, Swabi. Subjects and Methods: Informed consent was taken from the patient or guardian of the patient. Patients fulfilling inclusion and exclusion criteria were included in the study. A standard proforma was designed and entries were made regarding present, past and family history, thorough ocular examination of every patient was performed on slit-lamp with relevant biomicroscopic aids and posterior segment examination was conducted with direct as well as indirect ophthalmoscope. Biomicroscopy was performed as and when required. lntraocular pressure using schiotz tonometer, corneal diameters, retinoscopy and ocular mobility were noted and relevant investigations were performed when needed. Children and mentally retarded patients were examined using short general anaesthesia. Results: Of 189 patients 61.4% were males and 38.6% were females. Congenital Causes were present in 49.7% and acquired causes in 50.3%. Diseases accounted for 88.9%, trauma in 10.1% and unknown causes in 1.1% cases. Congenital diseases included congenital glaucoma in 35.1%, retinitis pigmentosa in 29.7% and albinism in 19.1% cases. Acquired diseases included primary glaucoma in 33.8%, diabetic retinopathy 23 %, secondary glaucoma in 17.5% and childhood infection in 10.8% cases. Corneal findings included corneal opacity in 31.2%, corneal edema in 4.8% and absent cornea in 7.4%. Optic nerve findings included optic atrophy in 16.4%, glaucomatous optic atrophy in 16.9%, new vessels in 9.5%. Retina findings included retinal dystrophy in 14.3%, maculopathy in 5.3%, chorioretinopathy in 0.5%, vascular retinopathy and hypopigmentation in 9.5% each respectively. Conclusions: Irreversible blindness is more common in children and young adults and mostly males are affected. Glaucoma is the commonest cause followed by retinitis pigmentosa and albinism in this study.
ACUTE MYOCARDIAL INFARCTION;
Authors: Khan Shahzad Alam , Safdar Sohail , Ijaz Asna , Taseer Ijaz-Ul-Haque
Published: September 2021

Objective: To determine the frequency of family history of IHD and related risk factors in the first degree relatives of patients suffered from acute myocardial infarction (AMI). Study Design: Descriptive study. Setting: PMRC Research Centre, Nishtar Medical College, Multan, Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology, Multan. Duration: One year from July 2011 to June 2012. Material and methods: In this descriptive study 331 patients of AMI of either sex and age ≥ 20 years admitted in Cardiology unit of Nishtar Hospital Multan and Chaudhary Pervez Elahi Institute of Cardiology Multan were registered. For data collection non-probability convenient sampling technique was used. Informed consent was taken from each patient. The information were recorded in a pre-designed questionnaire. The data were analyzed through SPSS-11. Results: Mean age of the study cases was 54.99±11.25 years (Minimum age was 20 years and maximum was 90 years). Two hundred sixty four (79.8%) were male and 67 (20.2%) were female patients and male to female ratio was 3.9:1. Out of these 331 patients 111 (33.6 %) were having positive family history of IHD. In these 111 (33.6 %) cases history of diabetes was seen in 45 (40.5 %), 43(38.8 %) had history of hypertension and history of hyper-cholesterolemia was present in 23 (20.7 %) of cases. Conclusions: The family history of IHD in addition to traditional risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking is itself an important risk factor for IHD. Relatives of the young patients with IHD should be considered as high risk group and it calls for close surveillance of their first degree relatives and early intervention. All their family members should be advised life style modification, appropriate management of risk factors and regular follow up of even apparently healthy descendents.
DEFENSIVE MEDICINE;
Authors: Khan Fahad , Ahmed Sara , Khan Hira Husain , Khan Ateeba Ayesha , Sajjad Romesa , Fraz Tayyab Raza
Published: September 2021

Objective: To determine the prevalence of defensive medicine among doctors of Civil Hospital and Jinnah Hospital Karachi and to introduce it towards the community of doctors. Material And Methods: 200 doctors from different wards of Civil Hospital Karachi and Jinnah Hospital Karachi played crucial role in filling of Performa which was especially designed for this research. Study Design: Cross sectional study. Site of Study: Civil and Jinnah Hospital Karachi. Duration: January 01, 2013 to December 31, 2013. Results: 47.9% doctors already knew about defensive medicine while 52.1% didn’t. 40.7% doctors avoid invasive procedures while 50.3% don’t. 92.4% of doctors care for high risk patients while 7.6% avoid caring for them. 109 out of 190 doctors agree and 30 doctors strongly agree about the practice of defensive medicine, 34 doctors are neutral and the rest of them disagree with its practice. Mostly ordered tests are CBC 78.9%, urine D/R 3.2%, 1.1% stool D/R, 1.6% MRI, 2.2% CT scan, 1.1% UCE, 2.7% blood cultures, 0.5% LFTs 9.1% other tests and the doctors with experience of 10 or 15 years are found ordering only CBC mostly. Conclusions: The conclusion obtained from the results shows that most of the participants were experienced doctors but many of them were unaware of the defensive medicine and in spite of that too great number of doctors strongly believe in its practice. Majority of the doctors were found caring for high risk patients. However the prevalence and practice of defensive medicine reduced among doctors having experience of more than 5 years.