bluuebunny/crossref_metadata_2025 huggingface dataset:
INTRAOCULAR PRESSURE
Authors: Faruqi Muhammad Shahid Faruqi , Khokhar Abdul Rehman , Ghaffar Khan Abdul , Shirwany Tanvir Ali
Published: September 2021

Objectives: To evaluate the intraocular pressure in diabeto-hypertensivesubjects and age and sex matched normal healthy adults. Study Design: Cross-sectionalanalytic study. Methodology: 50 subjects visiting the out-patient department (OPD) ofOphthalmology in Lahore General Hospital, Lahore, were examined. 25 were newly diagnoseddiabeto-hypertensive, and 25 normal healthy were selected from the relatives of these patients.IOP was checked by Goldman Applanation Tonometer. Blood pressure was checked bymercury sphygmomanometer. Blood glucose level checked by glucometer. Results: The IOPwas raised in both eyes of diabeto-hypertensive patients and there was a significant differencein intraocular pressure of normal healthy control and diabeto-hypertensive subjects. Thedifferences between two groups was analyzed by paired Student’s t-test. The P-value was<0.001. Conclusion: Intra-ocular pressure can be raised in all diabeto-hypertensive subjects,which shows that co-existence of diabetes and hypertension were important risk factor forraised intraocular pressure.
MEDICAL SERVICES
Authors: Khanum Zohra , Khanum Amna , Khanum Fatima
Published: September 2021

A better health care delivery system is dependent on many factors. For effectivehealth delivery, its important to identify those factors. Objectives: This study was conducted tostudy the factors responsible for health care delivery system in a tertiary care hospital. Studydesign: An exploratory study. Period: June 2015 to August 2015. Methods: The study wasconducted at Sir Ganga Ram hospital. Fifty doctors were interviewed on a designed Performato know the medical services quality & its attributes. Results: Quality of health services isinfluenced by the factors related to patients, health care system and factors related to healthcare providers. The factors related to patients were very important as seriousness for seekinghealth services was dependent on these factors. Conclusion: Health services are dependenton multiple factors. Factor related to patient’s attitude towards health services needs to beaddressed.
COLORECTAL CANCER (CRC)
Authors: Ather Hafiz Mughees , Sarfraz Muhammad , Anwaar Touseef
Published: September 2021

Colorectal cancer (CRC) is a common cancer. It has got significant morbidity andmortality. It is a common malignancy. Obesity is defined as BMI equal or above 25.1 kg/m2.Obesity is associated with an increased risk of developing CRC and poor prognosis in patientswith colorectal cancer. We conducted a study on 414 patients to look for correlation of obesitywith T, N, M and DUKES stage and frequency of obesity in CRC patients. Period: It involvedall CRC cases presented between 2004 to 2009. Methods: It was a single center retrospectivechart review. Total patient were 414. Data was collected on Performa and analyzed on SPSSversion 19. Results: Out of 414 patients males were 243 (58.7%) and females were 171 (41.3%).Mean age was 56 years. It was 57.7 years for males and 54.6 years for females. 221 patientswere obese. 123 patients presented in advanced DUKES stage. Mean BMI was 26 and meanCEA level was 76.60. 134 patients presented in advanced T stage (T3 and T4). 20% patientswith positive polyp history were obese while 80% patients with positive polyp history were nonobese. Majority of patients with family history of CRC, previous history of IBD, smoking andprevious colonoscopy were non obese. Abdominal pain, abdominal distension, constipation,bleeding per rectum and fever were more common in obese patients but this difference was notstatistically significant. About 56% of patients with abdominal pain and abdominal distensionwere obese and about 59% of patients with constipation and bleeding per-rectum were obese.About 65% of diabetic and hypertensive patients were obese (P value 0.01, 0.01) while 70%patients with coronary artery disease were obese. Conclusion: CRC affects more males andadvanced age group. Obese CRC patients are more than non-obese patients but obesity is notassociated with advanced stage of disease. Co-morbidities like diabetes mellitus, hypertensionare more common in obese CRC patients.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Dalwani Abdul Ghafoor , Laghari Ahsan Ali , Ali Syed Asad
Published: September 2021

With surgeon’s growing experience and advancement of technology laparoscopiccholecystectomy has gone thru many modifications including reduction in number and size ofports. Midline three port laparoscopic cholecystectomy is not performed extensively and istechnically possible. Aim of our study is to see outcome of midline three port laparoscopiccholecystectomy. Study Design: Descriptive study. Period: January 2013 to December 2013.Setting: Surgical unit I, Liaquat University Hospital Jamshoro. Materials and Methods: Midlinethree port laparoscopic cholecystectomy was performed in 75 patients. Outcome of procedureincluded patient’s safety, procedure’s duration, quantitative analgesic requirement, postoperativepain assessed on 10cm visual analog scale after 24 hours, post-operative hospitalstay and post-operative complications. Results: Total of 75 patients underwent midline threeport LC with majority of females 84%. Mean age being43.62±6.85 years. Mean operative timewas 41.30±6.38 minutes. Mean post-operative pain assessed on visual analog scale after24 hours was 2.5±0.45. Maximum site of tenderness was at 10mm subxiphisternal port. 47patients (62.66%) tolerated post-operative pain on NSAID (injection diclofenac), while remaining28 patients (37.33%) required additional opiate (injection Nalbuphine). Mean post-operativehospital stay was 1.186 ±0.60 days. 1patient (1.33%) had port site infection. Conclusion:Midline three port laparoscopic cholecystectomy prevents one extra scar of traditional 4portlaparoscopic cholecystectomy. This technique is safe, efficient and feasible. This techniquecan be used as an alternative approach to traditional 4 port laparoscopic cholecystectomy inuncomplicated cases.
EARLY OUTCOMES
Authors: Pasha Tayyab , Ahmed Rafaqat , Amir Muhammad , Iqbal Amir , Siddiqa Ayesha
Published: September 2021

Objectives: Off pump TACR/MACR performed in experienced hands hascomparable results to on pump TACR/MACR. Period: January-2012 to December-2015.Material and method: 405 patients with two and three vessel coronary artery disease (two &three VCAD) underwent OPCAB at the department of cardiac surgery, Jinnah hospital, Lahore.73 of them got total or multiple arterial coronary revascularizations. 34 patients (41%) hadtwo VCAD and 47 (59%) had three VCAD. Total arterial revascularization was performed in 70(95.8%) patients using right internal mammary artery and left internal mammary artery and/orradial artery. 3 (4.10%) patients got multiple arterial grafts using BITA, RA and SVG. Results:There was no death reported in first 30 days post operatively. Deep sternal wound infectionoccurred in only one patient. The rate of perioperative stroke and renal failure was zero. Two(2.46%) patients had acute MI and 1 patient was reopened due to bleeding. Conclusion: Weconclude that early outcome of OPCAB total or multiple arterial coronary revascularizations, inexperienced hands, are as safe and effective as ONCAB.
DIABETIC FOOT ULCER
Authors: Jan Abdul Waheed , Khan Hanifullah , Ahmad Ishtiaq Ahmad , Khan Matiullah
Published: September 2021

Objectives: To determine the risk factors contributing to the development ofdiabetic foot ulcers. Study Design: A descriptive observational study. Setting: Unit of surgery,City Hospital Lakki Marwat, Khyber Pakhtunkhwa. Period: 1st July 2013 to 30th June 2015.Patients and Material: One hundred and fifty diabetic patients with foot ulcer were studied.After taking informed consent, detailed history, clinical examination and relevant investigationswere performed according to a devised proforma. All the proformas were analyzed in the endof study. Results: One hundred and fifty patients comprising 95 male and 55 female werestudied. The average diabetic duration was 11 years. HbA1c was more than 8% in 98 (65.3%)patients. Peripheral neuropathy was present in 60 patients (40%), peripheral vascular diseasein 80 patients (53.3%), neuro-ischemic ulcers in 45 patients (30%), hypertension in 70 patients(46.6%), Ischemic heart disease in 20%, Dyslipidemia in 50%, foot deformity in 42% andaccidental/ foot wear trauma in 44%. Conclusion: Foot ulcer in diabetes results from multiplepathophysiologic mechanisms. Implementation of strategies for prevention, early detection,and appropriate treatment at the primary health care level are urgently needed.
GYNAECOLOGICAL HYSTERECTOMIES
Authors: Yousaf Farah , Tabassam Sofia , Rasul Noreen
Published: September 2021

Objective: To evaluate the indications, complications and justifications ofhysterectomy. Period: One year, from 1st January to31st December 2015. Setting: Gynaeand Obstetrics Department Unit 2 of SIMS Lahore. Methodology: This study included allgynecological hysterectomies. Most hysterectomies were done through abdominal route(84%), followed by vaginal (16%). Most common indication for hysterectomy was fibroid uterus(50.45%), followed by adenomyosis, 9.17% and uterovaginal prolapse (15.59%). Complicationrate was 7%, it included hemorrhage, infection and injury to surrounding organs. Hysterectomywas justified in 92% cases. Conclusion: Hysterectomy is used to treat HMB, and it improvesquality of life. However it is associated with certain degree of morbidity and mortality. Soalternative conservative method should be discussed /tried before hysterectomy.
AFGHAN MUTATION OF CA-II GENE
Authors: Faisal Anila , Kiani Amarah , Farooq Ahsen
Published: September 2021

Carbonic anhydrase-II deficiency is an autosomal recessive disorder groundedon a triad of cerebral calcification, osteopetrosis and renal tubular acidosis away in whichproximal tubules, distal collecting ducts or combined.1 Other features include growth andmental retardation along with the complications of osteopetrosis.2 The only treatment to curethe calcification is allogeneic bone marrow stem cell replacement; however it does not have anyconsiderable effect on the renal lesions3 We report a case of a 3 week old male child of Afghanorigin with all these features who was clinically diagnosed as having carbonic anhydrase type IIdeficiency however unfortunately the baby passed during cranioplasty and genetic testing forenzyme deficiency could not be done. Our aim to present this case of a male child of Afghanorigin is to enhance the awareness about this rare syndrome in our medical community andinviting further research for a possible Afghan mutation of CA-II gene.
ADULT HEALTHY SMOKERS
Authors: Raqeeb Abdul , Memon Azhar , Humaira Mona , Khoharo Haji Khan
Published: September 2021

Objectives: To determine superoxide dismutase (SOD), glutathione peroxidase(GPX), and malondialdehyde (MDA), uric acid and serum bilirubin in healthy adult smokers.Study Design: Case control study. Place and Duration: Liaquat University of Medical andHealth Sciences Hospital. Hyderabad, Sindh from December 2013 - July 2014. Subjects andMethods: 77 smokers and 50 healthy controls were selected through non-probability purposivesampling. Blood glucose, lipids, MDA, antioxidant enzymes (SOD & GPX), serum bilirubin anduric acid (UA) were measured. Data was analyzed on Statistic software 8.1 by student’s t testand Chi square test. The significant p-value was taken at ≤ 0.05. Results: Anti-oxidant enzymes(SOD & GPX), blood lipids, lipid per oxidant marker; the MDA, bilirubin and UA showedstatistically significant differences between smokers and controls (p<0.001). Total blood lipidsand lipid sub fractions were elevated in smokers. MDA in smokers was 3.17±0.91 μmol/mlcompared to 1.15±0.61 μmol/ml (p=0.001) in controls. Smokers showed reduced SOD, GPX,serum bilirubin and UA, was significant (p=0.0001) in comparison to controls. Conclusion:Cigarette smoke is a significant source of oxidative stress. Smoking increases malondialdehydeand reduces superoxide dismutase, glutathione peroxidase, uric acid and bilirubin.
HOSPITAL WASTE MANAGEMENT
Authors: Qadir Murad , Murad Rafat , Faraz Naveed
Published: September 2021

Objectives: To evaluate the knowledge and practices of hospital administrationregarding hospital waste management at Tertiary Care Hospitals of Karachi. Study Design:Cross sectional study. Period: June 2014 to December 2014. Methods: Study was conductedin fifteen tertiary care hospitals. Five government, eight private and two trust hospitals wereselected by quota sampling technique. Information was collected from selected hospitalwaste management staff, using a pretested questionnaire regarding knowledge and practicesof hospital waste disposal. Results: Data shows that only 33.3% had knowledge regardinginfectious and noninfectious waste disposal and 27% of the understudy hospitals wereseparate infectious and noninfectious waste. Only 20% of the total hospitals were using propermethod for the separation of the sharps.93.3% hospital waste management staff was notvaccinated against hepatitis ‘B’ and tetanus. Only 53.3% hospitals have their own incineratorfacilities. Conclusions: This study showed that the practices employed by the hospital wastemanagement staff were not safe. There is a need to implement the recommended SOP’s ofhospital waste management program.
HYPOGLYCAEMIA
Authors: Khan Muhammad Umar , Kumar Darshan , Faraz Adil , Adnan Muhammad , Soomro Hala
Published: September 2021

Objectives: Find out the hypoglycaemia in patients with diabetic nephropathicpatients. Study Design: Cross sectional study. Setting: National Institute of Diabetes &Endocrinology at Dow University Hospital, Ojha Campus, Karachi. Duration of Study: For theperiod of one year, from October 2014 to November 2015. Methodology: Known “diabeticpatients” with nephropathy which were present at National Institute of Diabetes & Endocrinology,Dow University Hospital, Ojha Campus, Karachi Patients presenting with signs and symptomsof hypoglycemia are diagnosed cases of “diabetes mellitus with nephropathy”, age 30 andabove, Type-I and type-Il diabetes mellitus, on oral hypoglycemic agents I insulin were includedin this study. Questions regarding the time period for which patient has been using these drugsand if the patient is suffering from illness which may be acute or chronic, should be askedregarding the relevant disease & its association with hypoglycaemia be mentioned, & patientsurine D/R & Serum Creatinine & Urea are measured by sending to the appropriate laboratory.Patients with severe malnutrition and starvation, chronic liver disease, alcoholics, chronicdisease as tuberculosis, patients with renal diseases without diabetes, any other malignancypatients were excluded from this study. Results: Depending upon the selection of 200 patients,the result concluded in our study consisted of 54% male patients and 46% were females, out ofwhich 11% had type I and diabetes and type II diabetics constituted 89%. Most of the patientsage between 60 to 75 years of age. The average duration of diabetes was 12.20 + 6.14 years.Out of 24 hypoglycaemic patients, 6 (25%) had type-I diabetes in which 4 were male and 2 wasfemale while 18 (75%) had type-II diabetes in which 10 were male and 8 were female patients.Conclusion: Observed that hypoglycaemia was common in diabetic patients, who developedrenal failure due to diabetic nephropathy.
HEALTH BENEFITS OF SALAT (PRAYER)
Authors: Ghous Misbah , Malik Arshad Nawaz
Published: September 2021

Science and religion have always been consideredas separate entities. Man’s thinking has alwaysbeen very shallow, he never overthinks. The thingssaid 1400 years ago were never believed outsidethe Muslim world but now science is proving themright via logic. Religion is the key to soul and aperson can only be healthy when one is havinghealthy soul and eternal peace. Islam as a majorreligion followed by well over a billion people hasmade its impact very obvious in this aspect byalleviating physical and mental afflictions amongits followers. Advances in science and technologyhave fueled both our quest for knowledge and themechanisms available to obtain and retrieve it.One manifestation derived from these discoverieshas been our ability to engage new ways ofexploring Salat activity and its influence on ournervous system. Salat (prayer) performed byMuslim worshippers five times a day is secondpillar of Islam and is regarded as an essentialritual. Salat is spiritual and physical act in where,nearly all muscles of human body become moreactive than any kind of physical exercise withoutmuscle fatigue and induces serenity on body andsoul. Scientific evidence also supports the notionthat even moderate intensity activities, whenperformed daily, can have some long-term healthbenefits.
ACADEMIC INTEGRITY
Authors: Ahmed Farhat ul ain , Sheikh Attia
Published: September 2021

Academic misconduct is a serious and a common problem. The aim of this articleis to review the literature for different methods used to counteract this problem. My synthesisis that the use of these mechanical methods of detecting and deterring dishonesty leads toa climate of us versus them between students and faculty and to an environment of policesrather than a culture of integrity. Moral development can be integrated into curriculum throughprofessional ethics courses with the purpose to develop academic integrity.
IDIOPATHIC RECURRENT MISCARRIAGES
Authors: Ahmed Farhat ul Ain , Faryad Numeera
Published: September 2021

Objectives: The rationale of our study is to investigate whether aspirin alone,or aspirin combined with low molecular weight heparin as compared to placebo (intensivepregnancy surveillance), would improve the live birth rate (primary outcome) among withidiopathic recurrent miscarriages. Secondary outcomes included rate of serious adverse eventsduring pregnancy among pharmacological intervention group and intensive surveillance group:rates of miscarriage, intrauterine fetal death (fetal death after 24 weeks of gestation), small forgestational age, premature delivery, APH and PPH. Study Design: A prospective, randomized,single-blinded, placebo- controlled trial was conducted at Tertiary Referral Obstetric Hospital.Setting: Fatima Memorial Hospital, Lahore Period: 2007 to 2013. Method: The participantswere 172 women with a diagnosis of idiopathic recurrent miscarriage.12 patients dropped outof the study. Women with 2 or more recurrent fetal losses and after exclusion of all knowncauses of recurrent miscarriage were randomly allocated to receive aspirin alone (n=54),combination treatment aspirin and heparin (n=56) or placebo (n=50 intensive pregnancysurveillance). The results were analyzed by SPSS (version 17) and they were tested by chisquaretest. Results: Out of 160 women who underwent randomization, live birth rate did notdiffer significantly among the three groups. The live birth rate was 70.3% among aspirin onlygroup, 73.2% among aspirin and heparin group and 70% among intensive surveillance group(placebo) with a p value equal to 0.11. No significant differences in secondary outcome wereobserved among three groups. Conclusion: In conclusion, our findings do not support thehypotheses that use of aspirin alone or in combination with enoxapirin improves the live birthrate in women with idiopathic recurrent miscarriages.
COMMUNITY ACQUIRED PNEUMONIA
Authors: Raza Samar , Shaikh Tariq Zaffar , Baloch Ghulam Hussain , Ahmed Zaheer , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency of raised serum CRP level in patientswith community acquired pneumonia. Study Design: Cross sectional descriptive study.Period: Six months. Setting: Liaquat University Hospital Hyderabad. Patients and Methods:All the patients with 20 -75 years of age, either gender diagnosed as community acquiredpneumonia were further evaluated for C-reactive protein while the data was analyzed in SPSSversion 16. Results: During six month study period, total 135 patients with community acquiredpneumonia were evaluated for C-reactive protein. The mean ±SD for age of patients with CAPwas 48.93±8.41 whereas it was 53.53±6.73 and 50.54±5.81 in male and female subjectsrespectively. The mean age ±SD of patient with raised CRP was 46.94±8.43. The mean ±SDof CRP in overall population was 08.8±1.52 while it was 07.94±1.32 and 10.83±1.64 in maleand female individuals respectively. Of 135 subjects 84(62.2%) were males and 51(37.8%) werefemales while the CRP was elevated in 91(67.4%) patients. The age in relation to gender andCRP was statistically significant (p= 0.02 and 0.05) while the gender in relation to CRP was alsostatistically significant (p=0.03). Conclusion: The present study found that the CRP was raisedin 91(67.4%) predominantly male individuals with community acquired pneumonia
IN VITRO FERTILIZATION
Authors: Khan Haroon Latif , Khan Yousaf Latif , Makhdoom Rameen , Khawaja Abdul Rahman
Published: September 2021

Various ovarian reserve tests were developed to estimate the ovarian reserve andpredict about the outcome in subfertile females undergoing evaluation for assisted reproduction.FSH and AMH levels are considered to be good ovarian reserve indicators along with antralfollicle count. Objectives: To explore relationship of AMH and FSH in patients undergoing IVFwith respect to ovarian reserve and outcome of the treatment. Study Design: Prospective cohort.Study Period: 1st January 2015 to 31st December 2015. Place of study: Lahore Institute ofFertility and Endocrinology, Hameed Latif Hospital, Lahore Material and Methods: In 346 IVF/ICSI patients after anthropometric measurements and transvaginal ultrasound antral folliclecount were assessed in each ovary. For the hormone measurements blood samples were takenduring the early follicular phase of menstrual cycle. Clinical pregnancy was also visualizedthrough transvaginal ultrasound. Results: From the 346 IVF/ICSI patients 89 (25.79%) clinicalpregnancies resulted. The mean age in pregnant group was 32.89 ± 2.99 years and in nonpregnantgroup was 33.62 ±4.36. Mean FSH and AMH in pregnant group was 6.38 ±2.38,3.27 ±1.86 and in non- pregnant group was 7.54±3.76, 2.72 ± 1.82 respectively. Age andFSH are significantly associated with each other (p-vale = 0.000) and mostly patients had FSHbelow 9(mIU/mL). Age and AMH are significantly associated with each other (p-vale = 0.000)and mostly patients had AMH above 1.5 (ng/mL). Conclusions: Better pregnancy rate wasassociated with FSH below than 9 (mIU/mL) and AMH above 1.5 (ng/mL).
TECHNOLOGY DRIVEN TEACHING HOSPITAL
Authors: Khan Rahmatullah , Akram Ashfaq , Rizwan Farzana , Daud Zahedi , Md Johar Md Gapar
Published: September 2021

Bedside teaching is the heart of clinical teaching in a medical programme.Most of times, it is conducted inside the ward which hinders the privacy of patientsand enhances the disturbance of other inpatients. In resource constrained countries,a teaching hospital serves for multiple medical schools. It is major challenge toprovide satisfactory clinical teaching to students of multiple medical schools becauseof shortage of teaching hospitals in those countries. The present article presents aproposal to enhance clinical teaching for multiple medical schools being attached toa single teaching hospital. Its template and potential benefits are discussed.
PRIMARY POSTPARTUM HEMORRHAGE
Authors: Yasir Rozina , Lakhwani Mumtu Bai , Naz Shaista , Ali Zain
Published: September 2021

Objectives: The aim of our study is to determine the effectiveness of uterinemassage with active management and compare it with active management alone, in primarypostpartum hemorrhage prevention. Study Design: Randomized control trial. Period: 8months from September 2014 to April 2015. Setting: Tertiary Care Hospital in Karachi, Pakistan.Method: The study population consists of n=118 patients, both emergency and elected cases,who came to the gynecology and obstetrics ward at our hospital. The patient population wasdivided into two groups, group I received active management of labor ( third stage ) while groupII received active management of labor (third stage) in addition to the uterine massage (for a 2hrduration), the outcome was measured by measuring the amount of blood loss and the need foruterotonic agents. A p value of less than 0.05 was considered significant. Results: The studypopulation consisted of n=118 patients, undergoing spontaneous labor, and divided into twogroups, the mean blood loss in group I (control group) was 211.4mls and in group II (massagegroup) was 167.8mls (p value= 0.015). In group I n=15 patients required additional uterotonicsupport, while in group II only n=3 patients required it (p value= 0.00058). Conclusion:According to the results of our study, uterine massage in addition to the active managementof labor reduces post-partum hemorrhage, and it also reduces the requirement for additionaluterotonic agents for the control of hemorrhage.
SUPRACONDYLAR FRACTURE FEMUR
Authors: Memon Faheem Ahmed , Pirwani Mehtab , Memon Abbas
Published: September 2021

Objectives: Our experience by dynamic condylar screw in the treatment ofsupracondylar femur fracture, which is quite a long time, has stayed challengeable issue inorthopedic surgery, at LUH. Study Design: An observational cross sectional study. Setting:Orthopedic Surgery Department, Liaquat University. Methodology: Cases along both sexeswith additional articular fractures, conceded inside of 2-3 days were incorporate and caseshaving open epiphysis, open fracture, pathological and intra articular fractures were not a pieceof this study. Hospital stay average was 18 days. Follow up was done of every one of thePatients after each third week for two only visits, then every 6th week for about 6 months. Allthe data were recorded on particularly outlined proforma. Results: In this study 19(63.3%) maleand 11 female (36.6%) patients. Mean age was found 35yrs. Commonest cause of injury wasRTA in 80% patients. 65% patients got injury to left lower limb while 35% to right lower limb. Therewere only two infections i.e. the infection rate was 6.66%. Union rate was 93.3% and nonunionrate was 3.3% and there was only one mal union i.e. mal union rate was 3.3% .Bone grafting wasdone in 21 patients. The overall good to excellent results were in 84% cases and fair to poor in16% cases. Conclusions: DCS gives solid fractures fixation after decrease and makes postoperativerecovery simple, so in light of patient’s financial state in Pakistan. DCS is perfect insertfor distal femoral exceptionally for these fractures.
INGUINAL HERNIA
Authors: Ahmed Khan Agha Nadeem , Ullah Shafiq , Aftab Muhammad Farrukh , Qureshi Khalid Hussain
Published: September 2021

Objectives: To highlight an economical laparoscopic technique for rapidrecovery & early return to work especially for the 3rd world inguinal hernia patients. StudyDesign: Descriptive study. Setting: Surgical unit of Nishtar Hospital Multan. Period: 02 yearsi.e. from January 2014 to January 2016. Methods: There were 90 patients in the study. A prolenemesh of 15 x 15 cm used for the repair of inguinal hernia laparoscopiclly without the use ofspacer balloon & tacker (To make it cost effective). Results: Out of 90 patients only 3 patientsdevelop scrotal seroma. All the patients discharged on the 1st postoperative day & allowed toreturn to their normal routine work from the 3rd postoperative day onward. Conclusion: (e-TEP)without spacer balloon & tacker is an economical approach toward the inguinal hernia repair.
SMOKING
Authors: Hassan Uzma , Ul Haq Mirza Inam , Qadeer Asma Abdul , Rahim Kashif , Naiyar Iffat
Published: September 2021

To observe the frequency of smoking in female medical students and to determinethe associated factors. Study Design: Cross-sectional survey. Setting: Data was collectedthrough a self-administered questionnaire from female students at Rawal Institute of HealthSciences. Period: February 2015 to August 2015. Methods: Information about demographiccharacteristics, smoking status in family members, number of cigarettes smoked per day,influence for starting smoking and use of sheesha and hash was obtained. Results: A total of100 female students were asked to fill the questionnaires. Response rate was 60%, out of which,52.6 % (31/60) were smokers and 48.4% were non-smokers.6 out of 31 were hash smokersand 20 out of 60 were cigarette smokers, remaining were sheesha smokers. Majority of thesefemales started smoking after 18 years of age, with greatest influence being life style and peerpressure. Our results show substantial trend of smoking in female medical students. Majorityhave smokers in their families but their families were not aware of their smoking habit. Eventhough almost everyone was aware of the associated risks, 24% never tried to quit. Most of thestudents spent Rs 1500 to 3000 per month on smoking.
ISCHEMIC HEART DISEASE
Authors: Hussain Ch Shahadat , Ul Hassan Anwaar , Nazir Shafqat
Published: September 2021

Objectives: To find out distribution of cardiovascular risk factors for women inestablished coronary artery disease. Study Design: Retrospective cross sectional descriptivestudy. Place and Duration of Study: Private clinic of consultant cardiologist at Bahawalpur fromJune 2013 to December 2015. Methodology: Total 6345 patients were registered and only 820female patients were diagnosed cases of ischemic heart disease selected for analysis of theircardiovascular risk factors. Results: The overall mean age of women was 57.75±11.28 years,weight was 66.3±15.14 kilogram, height was 153.77±7.87 cm, body mass index (BMI) was27.89±6 kg/m2 and body surface area (BSA) was 1.76±0.28 m2. Significantly high frequencyof obesity was found in premenopausal women as compared to other group i.e. 56.5% with pvalue <0.0001. BMI was also high in premenopausal women 32.13±7.91 then perimenopausalwomen, postmenopausal women and women with hysterectomy 28.06±6.93, 27.84±5.51 and27.33±6.03 respectively. The overall weight is also more in premenopausal group as comparedto postmenopausal, perimenopasaul and hysterectomy group i.e. 77.54±21.18, 66.46±13.66,66.07±16.33 and 64.41±15.31 respectively and P Value was <0.0001. There was no differencefound when DM, HTN and smoking compared within these four group. Smoking, CVA and PCI orCABG were 13(1.5%), 30(3.7%) and 13(1.5%) women respectively. Conclusion: Hypertensionand DM are most common risk factor in women with IHD. Weight, BMI and different class ofobesity are more common in younger age group as compare to older age. Smoking, PCI andCABG are very less frequent in women in this area.
HYPERTENSION
Authors: Alam Shazia , Ali Huma , Zafar Farya , Bushra Rabia , Ahmed Maqsood
Published: September 2021

Objectives: The study aim was to analyze the awareness of hypertension, lifestyle changes, treatment compliance and drug utilization of antihypertensive drugs amongHTN patients. Study Design: The prospective study. Setting: Cardiology Section of a TertiaryCare Private Hospital, Karachi, Pakistan. Period: Six months. Methods: Approximately 243HTN patients were enrolled. Patient’s history, demographic descriptions and antihypertensivetreatment were recorded through medical profiles. The descriptive statistical data was analyzedwith Statistical Package for Social Sciences (SPSS-20). Results: Out of 243 patients, majoritywere male (56.8%) with mean age of 59 years. Smoking and physical inactivity (39.5% and28.8%) were found the two leading environmental risk factors associated to hypertension.Majority of patients were still untreated (53.9%) and only (19.8%) patients treated appropriately.The reasons obtained behind included poor compliance (48.1%) against antihypertensivemedicines, less awareness of HTN (23.9%) than unawareness (76.1%) and lack of clinical visitsin relation to financial problems (25.1%, 26.7%). Antihypertensive drugs utilized were β-blockers(28%), ACE inhibitors (25.1%), CCBs (20.6%) followed by ARBs (19.8%) and diuretics (6.6%).Conclusion: Hypertension can be overcome by advancement of knowledge, health educationalprograms, promoting awareness of early recognition and treatment protocol.
DIABETES
Authors: Sultan Jahangir , Khan Shafqat Husnain , Subhani Riaz-Ul-Haq , Javaeed Arslaan , Ghauri Sanniya Khan
Published: September 2021

Objectives: The objective of this study was to evaluate the variations in HbA1con repetition over a span of about two weeks. Period: June 2015 to May 2016. Setting:Department of pathology, Continental Medical College Lahore, attached with Ch. Rehmat AliMemorial Trust Teaching Hospital. Method: A total of 60 newly diagnosed or with no apparentdiabetic complications were included in this study. Venous blood repeated samples wereobtained for evaluation of HbA1c. Results: The result of our study show that in 65% of patientsthe repeated values were lower than the initial values, 25% were higher and 10% were below thediagnostic threshold. So it is indicated that HbA1c values vary over a span of time and repeatedtests values should be considered for borderline patients. Conclusion: It is concluded from thisstudy that values of HbA1c do differ on retest. Therefore, physicians should understand and notbe confused with a little bit variations in values. It is recommended to repeat the test for newlydiagnosed and borderline value patients to reach a final conclusion about diagnosis. It is alsorecommended that a separate study should be conducted to evaluate the cause/mechanismbehind variations in HbA1c over a short period of time in our settings.
POSTMENOPAUSAL UTERINE BLEEDING
Authors: Memon Fareen , Munwar Rahila , Bilquees Miss , Rajpar Sajida , Shoukat Razia , Sikandar Raheel
Published: September 2021

Objectives: To find out the significance of the transvaginal sonography (TVS)in postmenopausal women (PMW) with postmenopausal bleeding (PMB) and compare it withthe histopathological diagnosis at curettage, so that unnecessary operations could be avoided.Study Design: Descriptive study. Setting: Radiological Department for TVS and H/P at theDepartment of Gynecology & Obstetrics (Gynae: Unit IV) at Liaquat University Medical, HealthSciences Hospital Jamshoro and Hyderabad. Period: September 2010 to September 2011.Material and Methods: The present study was conducted on patients with postmenopausalbleeding. Results: The mean age + SD of the women was 51 + 3.1 years, ranging from aminimum of 49 to 55 years. The mean endometrial thickness was from 1.8-15mm. TransvaginalSonography and Histopathological Findings: Histopathological findings revealed endometrialatrophy in 64 (57.14%) patients, Endometrial hyperplasia in 24(21.4%), endometrial polyp in7(6.25%), Endometrial carcinoma in 8 (7.14%), Pyometra in 5(4.46%) and Fibroid uterus in4(3.57%). With a cut off value of 4mm endometrial thickness, TVS showed a sensitivity of 100%,specificity of 73.33%, a positive predictive value of 76.47%, a negative predictive value 100%and an accuracy of 85.71%. At a cut off limit of 5mm endometrial thickness (endometrium>5mm indicating pathology), the sensitivity of the present study was 92.3% and the specificitywas 86.6 %. The positive predictive value was 85.71%, the negative predictive value was 92.86% and the accuracy was 89 %. Conclusion: TVS is a useful tool to triage post menopausalwomen with bleeding and avoid un convenient invasive procedure.
ILEOCAECAL TUBERCULOSIS
Authors: Hussain Ahmed , Bhatti Naeem ul Karim , Shah Syed Kashif Ali , Ahmed Zaheer , Ali Memon Hamid Nawaz , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To evaluate the management strategies of patients with ileocaecaltuberculosis. Study Design: Cross sectional multi-institutional study. Period: One year. Setting:Liaquat University Hospital Hyderabad / Jamshoro and Peoples University Hospital Nawabshah.Patients and Methods: All the patients of ≥11 years of age, either gender diagnosed asileocaecal tuberculosis were recruited, enrolled and evaluate for management strategies. Thedata was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:During one year study period total 85 patients were identified and diagnosed as ileocaecaltuberculosis. The mean age ±SD for whole population was 39.72±7.73 while it was 37.87±8.83and 40.88±8.52 in male and female population whereas the mean ± SD for duration ofsymptoms of whole study population was 5.52±1.61 months respectively. Sixty nine (81%)patients managed surgical while 16 (19%) managed conservatively. The non specific symptomsi.e. fever, pain and tender abdomen, loss of weight and appetite was observed while 70%subjects had Hb% was <10 gms and 80% of individuals had ESR > 40 mm/1st hour whereascommon radiological impression observed were narrowing of terminal ileum, pulled up caecumand obtuse ileocaecal angle. Conclusion: Ileocaecal tuberculosis management includesconservatives and surgical, the surgical options are ileocaecal resection, right hemicolectomiesand stricturoplasty
ENDODONTICS PROCEDURAL ERRORS
Authors: Khawaja Naveen , Lal Ramesh , Rehman Mujeeb , Punjabi Suneel Kumar
Published: September 2021

The rationale of this study was to assess the results of training endodontic topostgraduates. This study was assumed to evaluate the procedural quality of root canalobturation and occurrence of ritual errors in the root canal treatment cases performed bypostgraduates in the department of Operative Dentistry. Study Design: Cross sectional caseseries study. Setting: Department Operative Dentistry, Liaquat University of Medical HealthScience, Jamshoro. Period: May 2014 to Apr 2016. Methodology: Total two hundreds eightyeight cases were evaluated, out of which 144 were prepared using Pro-taper universal (Dentsply)rotary system and 144 were prepared using conventional hand file system. Each group of teethwas evaluated by radiograph for the occurrence or lacking of procedural errors i-e overfill, underfill, instrument separation. Results: Among 288 cases, out of 144 conventionally treated teeth58 (49%) had procedural errors. Whereas out of 144 teeth treated with Pro-taper next rotarysystem, 61 (51%) had technical errors. Most of errors seen in both groups but farthest wereoverfill. Chi square test showed P value > 0.05 (0.416) which illustrate an irrelevant relationshipamong the systems applied & the incidence of errors. Conclusion: There was variation amongoverfill & under fill prevalence of practical errors in both systems; nonetheless, there was adisparity in the nature of error produced. It is accomplished that even though rotary systems arenot as simple to use as formerly alleged.
SODIUM TUNGSTATE
Authors: Samad Afra , Shah Munawar Hussain , Mahmood Rana Khalid
Published: September 2021

Objectives: To determine the possible morphological effects of sodium tungstate(ST) on liver of streptozotocin (STZ) induced diabetic rabbits. Study design: This prospectivestudy was conducted on 30 rabbits of 30 weeks age. Diabetes was induced in 20 animalsby a single intraperitoneal injection of streptozotocin (50 mg/kg). 10 animals were used ascontrol. 10 diabetic rabbits were treated with sodium tungstate (ST) orally and 10 animals wereleft untreated. Histological examination of liver was performed. Setting: Place: Post graduatemedical institute lahore. Duration of study: July 2010 to August 2011. Methods: Blood glucoselevels of the rabbits were checked before and after treatment. Histological examination of liversections of 30 rabbits was performed. Sections were stained with Hematoxylin & Eosin (H & E),Trichrome and Reticulin stains separately. Results were analyzed statistically. Results: Bloodglucose levels of diabetic rabbits without Sodium Tungstate therapy were high as compared tonormal rabbits and diabetic rabbits treated with sodium tungstate. Histological examination ofliver of diabetic rabbits with Sodium Tungstate therapy did not reveal any irregular chromatinpattern or fibrosis. Conclusion: On the basis of histological examination and blood glucoselevel it is concluded that sodium tungstate is a powerful anti-diabetic agent when administeredorally with no morphological changes in liver.
COMMON HUMAN PATHOGENS
Authors: Faraz Naveed , Khurram Shaista , Sehrish Miss
Published: September 2021

Background: Due to easy availability or excess to antibiotics people usuallystart antibiotic without consulting doctors when they are suffering from illness and as they werefeeling well they discontinue the treatment and as a result these bacteria become resistantto those antibiotics which are inadequately used. Also most of the antibiotic have side effectthat also produce undesirable effect so after considering all of these issues we want toexplore natural compounds for their antimicrobial activity as these compounds have no sideeffect and cost effective as well. Objectives: We analyzed the antimicrobial activity of ginger(ZINGIBER OFFICINALE) against common human pathogens. Study design: Experimentalstudy. Place and duration of study: All clinical isolates were identified at BUMDC (BahriaUniversity Medical and Dental College) Microbiology Lab (Karachi) by standard biochemicalmethods. Study conducted between april2015-nov 2015. Material & Methods: Staphylococcusaureus, Pseudomonas, Vibrio cholera and E.Coli culture sample were taken and againcharacterized using conventional biochemical, cultural and molecular methods. Then I checkedthe antimicrobial activity of ginger alone and with soyaoil against these isolates using discdiffusion method. Result: It shows that ginger alone having good antimicrobial activity againstpseudomonas but when using after mixing with soya oil its antimicrobial activity decreasedas it was note when individually used. Conclusion: Ginger when using alone having goodantimicrobial activity then when using in combination with soya.
DANDY-WALKER SYNDROME;
Authors: Zeeshan Qazi Muhammad , Hashim Muhammad , Hashmi Syed Mohammad Maroof , Anwar Mohammad Absar
Published: September 2021

Introduction: Dandy-Walker Malformation is an inborn condition that includesthe triumvirate of cystic enlargement of the fourth ventricle, posterior fossa distension with riseof the tentorium and agenesis of cerebellar vermis. The purpose of this study is to determinethe Clinical presentation and associated complications, mortality and morbidity of patientundergoing placement of shunt with Y- connector in Dandy Walker Malformation. StudyDesign: Case Series comprised of 85 cases. Setting: Neurosurgery Ward of Tertiary CareHospital in Karachi. Period: February 2011 to December 2015. Methodology: All patients whowere presented in OPD with complaints reminiscent of DWM with accompanied Hydrocephalusand then underwent CT scan Brain without contrast to confirm the diagnosis were admitted.The patients who have previous history of operation and other co-morbid anomalies wereomitted. These patients undergo drainage of Ventricular system and Posterior Fossa cyst wasdone mutually via Dual Shunt including Ventricular-peritoneal and Cysto-peritoneal shunt withY connector. There were few complications and mortality after this surgical intervention whichwas noted for a month. All records were recorded and evaluated by SPSS v.20. Result: Avast majority of patients included were Female. The average age of patients was 2.5 years+/- 1 Standard Deviation. The chief complaint was Hydrocephalus, existing in all patients,after that cerebellar signs in 55 (64.7%) and other signs in 10 (11.8%) patients. Others signsincludes; milestones were delayed, atypical gait and few patients were suffered from psychiatricproblems. Complications which were observed were shunt; Fracture/Dislocation in 10 (11.8%),shunt blockage in 8 (9.4%), malpositioning is also 8 (9.4%), Intracranial Hemorrhage in 7(8.24%) patients and Infection in 10 (11.8%). These complications were observed within amonth of surgery. Unfortunately, two (2.35%) patient were also expired after surgical approach.Conclusion: It is concluded that Dandy Walker Malformation is categorized by a triumvirate.Hydrocephalus is a most common symptom and principal cause of referral to hospitals. Thecommonest difficulty acknowledged after shunting is Malfunction and shunt infections. Thelowest mortality is related to Dual Shunt with Y connector when compared to other approachesfor management of shunt with Y-connector. Thus, it is found to be a worthy decision in givenDWM patients.
CSF SHUNT INFECTION;
Authors: Anwer Muhammad Sohaib , Waqas Muhammad Ali , Khan Atta-ur-Rehman
Published: September 2021

Hydrocephalus is the abnormal accumulation of CSF with in the ventricles andsubarachnoid spaces. It is often associated with dilatation of ventricular system and increasedICP. Hydrocephalus is almost always a result of an interruption of CSF flow and rarely becauseof increased CSF production. The definitive treatment of hydrocephalus is surgical treatmentwhich includes shunting and non-shunting procedures. The most common and overwhelmingcomplications that can occur due to the CSF shunts is infection. The risk factors associated withpediatric CSF shunt infection has been analyzed in this study. Study Design: Descriptive study.Setting: Department of Neurosurgery, Nishtar Hospital Multan & Sheikh Zayed Hospital RahimYar Khan. Period: Three years 01-07-2013 to 01-07-2016. Method: Total 209 eligible patientswho were operated for CSF shunt were keenly monitored. Several variables were observedand the responses against these variables were noted down. Post operative follow up of allthese cases done for 6 months in order to notice any development of infection (clinical signsof infection & CSF examination) in CSF shunt system. Chi-square method was used appliedin order to analyze the association among the variables and shunt infection development.Inour population of 209 patients only twenty six patients (12.44%) suffered from shunt infection.In this study four variables were qualified as having significant association with greater risk ofshunt infection. 1) Patient age. 2) Inadvertently exposure of surgical instruments to the shuntsystem. 3) the existence of large number of previous shunt systems. 4) manual handling ofshunt system Conclusions: Four variables have been reported by this study which can be agreat source of shunt infection.it is recommended that changes in clinical practice should beconsidered in order to avoid these. Few recommendations are as follows. 1) While handling theshunt system great care should be taken. 2) It should be taken care that the manual contactof the Surgeons with the shunt system should be minimum. 3) it is recommended that thealternatives other then the shunt insertion should be considered especially for the children. 4)Great number of previous shunt system is also a great risk factor and these patients must behandled as individuals at high risk.