bluuebunny/crossref_metadata_2025 huggingface dataset:
TYPE 2 DIABETES;
Authors: SHAIKH ZULFIQAR ALI , AKHUND SAIMA , ALI MUKKARAM , Khan Masood Hameed
Published: September 2021

Objective: To determine the effects of various socio-demographic factors upon the prevalence of diabetes mellitus.Background: Type 2 Diabetes is growing at an epidemic scale. Besides genetic predisposition, numerous environmental factors elicit thedevelopment of diabetes. An estimated 246 million people are suffering from diabetes worldwide. Majority of diabetics (80%) live in verypoor countries of the world, where even the least expensive lifesaving diabetes drugs are not available. Pakistan ranks number seven interms of global diabetes burden and is projected to reach number five in 2025. Approximately half of the diabetics are aware of theirdisease status, and most of them are diagnosed with complications and poor metabolic control. This study determines the effects ofvarious socio-demographic factors upon the prevalence of diabetes mellitus. Material and Methods: Study Design: Cross-sectional.Place: National Institute of Diabetes and Endocrinology, DUHS, Karachi, Pakistan. Duration of study: March 2008 to December 2009.Sample size: 1029. Results: The mean age of the study sample was 50.5 ±12.1 years. Fifty two percent study participants were malesand 48% females. They were from various occupations, educational levels and socio-economic strata. Among these diabetics, 73% hadfamily history of diabetes; 20% were doing exercise, 20% knew self monitoring blood glucose and 6% had knowledge to inject insulin.Only 29% followed diabetes diet. Conclusions: A vast majority of diabetic patients was not doing exercise; had least knowledge of selfmonitoring blood glucose and did not follow diabetes diet. Various environmental factors, lack of related information and peoples’reluctant attitude played important role in the high prevalence of diabetes.
DIABETES MELLITUS;
Authors: SINDHU, GHAZANFAR ALI , NAZ, SADAF , QURESHI, FRAZ SAEED , Ahmed, Zaheer , Islam, Tamur
Published: September 2021

Introduction: Hepatitis C virus (HCV) is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma(HCC). HCV infection and type 2 diabetes are two common disorders with a high impact on health worldwide. There is growing evidenceto support the concept that HCV infection is a risk factor for developing type 2 Diabetes Mellitus. Both insulin resistance and diabetes canadversely affect the course of chronic hepatitis C, and lead to poor response to antiviral therapy and increased incidence of Hepatocellularcarcinoma. Objective: The objective of the study was to assess the frequency of type 2 Diabetes mellitus in newly diagnosed chronichepatitis C patients presenting in Allied hospital Medical unit II during six month period. Design: Cross sectional study. Setting: Medicalunit-II, Allied Hospital, Faisalabad. Period: 01-08-2009 to 28-02-2010. Material and methods: All newly diagnosed patients of chronichepatitis C on the basis of PCR for HCV-RNA were included in the study. Fasting and two hours postprandial blood sample were tested.Diabetes Mellitus was labeled as per slandered. Results: Out of 180 patients with CHC 19 (10.6%) were found to have Diabetes mellituswhile 161(89.4%) were non-diabetics. Conclusions: There is close association in the development of type 2 diabetes mellitus in patientswith chronic hepatitis C.
REFRACTIVE ACCOMMODATIVE ESOTROPIA;
Authors: IQBAL MUHAMMAD SAFDAR , HUSSAIN SYED AHMER , QAZI ZAFAR ULLAH
Published: September 2021

Purpose: To determine the efficacy of all time wear of full cycloplegic correction in the management of refractiveaccommodative esotropia. Design: Descriptive study using non-probability purposive sampling technique. Setting: Ophthalmology OPDand Department of Nishtar Hospital, Multan. Period: Oct 2009 to Sep 2010. Material and Methods: All children with accommodativeesotropia associated with hyperopia were included in the study. The features studied were ocular alignment, association of anisometropiawith strabismus and amblyopia, improvement in deviation of squint after amblyopia therapy and full cycloplegic hyperopic correctionand regain of binocular single vision and requirement for surgery in patients with accommodative esotropia with hyperopia. Results:Forty four children with refractive accommodative esotropia were identified. Cycloplegic refraction was done for all patients and fullcycloplegic correction was given. At presentation 36.4% of children were amblyopic in either eye and most of them had anisometropichypermetropia. The esotropia was present in more hypermetropic eye. 63.6% of the patients became straight with glasses only andanother 25% became straight after amblyopia therapy. Fusion with gross stereopsis was demonstrated in 75% of patients. Cycloplegicrefraction remained stable throughout the follow up period. None of these patients was able to discontinue glasses and maintainalignment. Surgery was required in only 11.4% of total patients. Conclusions: Most children with refractive accommodative esotropiahave an excellent outcome in term of visual acuity, ocular alignment and binocular single vision with the glasses. Full cycloplegiccorrection and amblyopia therapy resulted in marked reduction in the deviation of squint and improvement in visual acuity of theamblyopic eye as compared with the prevalence at presentation. The degree of hyperopia remains unchanged with poor prospect fordiscontinuing glasses wear.
MALARIA;
Authors: MALIK NAZIR AHMED , AHMAD TARIQ MAHMOOD , KHAN AMANAT , Jaffery Shama
Published: September 2021

Objectives: To see the effects of malaria infection on platelet count and haemoglobin in children suffering from malaria.Design: Descriptive study. Setting: CMH Okara and CMH Pano Aqil Cantt. Period: July 2008 to June 2012. Methodology: Childrenadmitted with fever of less than seven days duration who had positive smear for malaria parasite were included in the study. After detailedhistory and thorough examination, patients were investigated to find out the cause of fever. All the patients with localizing cause for feverand history of drug intake were excluded. All patients were investigated with complete blood counts and serial peripheral smears formalaria parasite. Peripheral blood smear examination for malarial parasite was taken as gold standard for the diagnosis of malaria. Cut off9 value for low hemoglobin (anemia) was taken as 10gm/dl and platelet count of less than 150x10 /L, was used to definethrombocytopenia. Patients with thrombocytopenia were divided in to three categories. Mild thrombocytopenia was defined as patients9 9 9 with platelet count of <50x10 /L to >150x10 /L, moderate thrombocytopenia included patients with platelet counts of <20x10 /L to9 9 >50x10 /L and severe thrombocytopenia consisted of patients with platelet counts of <20x10 /L. Results: A total of one hundred andfourteen smear positive patients were analyzed, out of which 93% had low and 7% had normal platelet count. 95% had Vivax and only 5%9 9 9 had Falciparum malaria. Mean platelet count was 87x10 /L. Mean platelet count in Falciparum was 42x10 /L whereas it was 88 x10 /L inVivax malaria. Sixty two (54%) patients had anaemia. Mean haemoglobin was 9.54gm/dl. Mean Hb in Falciparum malaria was 7.5gm/dland in Vivax it was 9.6gm/dl. Conclusions: Higher frequency of mild to moderate thrombocytopenia and anaemia was observed inhospitalized children suffering from malaria. Plasmodium Vivax was found to be the most common species.
GESTATIONAL DIABETES;
Authors: SHAHEEN SHAZIA , ALI ROBINA , AFZAL UZMA ,
Published: September 2021

Objective: To determine the Accuracy of GCT for screening of gestational diabetes in high risk population comparing oralGlucose Tolerance Test (GTT) as gold standard. Main outcome measures: Accuracy of GCT. Study design: Cross-sectional study.Setting: The study was conducted in outpatient department of Punjab Medical College and affiliated hospitals, Faisalabad. Subjects: 207patients. Methods: High risk women from outpatient department were recruited on the basis of inclusion and exclusion criteria afterexplaining pros and cons of procedure. These women were subjected to GCT & GTT. GTT was taken as gold standard test and results ofGCT were compared with it. Main outcome measures recorded and results obtained. Results: Out of 207 women, GCT truly diagnosed 24women as having diabetes (true positive) & 175 women were found to have normal glucose metabolism (true negative). GCT failed todiagnose 5 diabetic women (false negative) & wrongly diagnosed 3 normal women as diabetics (false positive) against gold standardGTT. So GCT has diagnosed Gestational diabetes mellitus with the sensitivity of 82.7%, specificity of 98.3%, positive predictive value of88.8%, and negative predictive value of 97.2% and accuracy of 96.1%. Conclusions: GCT is a simple, easy, convenient and sensitive testthat has no limitation for time or prior fasting for gestational diabetes screening.
RADIOLOGY REQUEST FORM;
Authors: SALAM, ABDUS , SAIF, SAIF-UD-DIN
Published: September 2021

Background: An incompletely filled Radiology Request Form (RRF) is a common problem faced by both radiologists andradiographers. Objective: The study was carried out to objectively evaluate the adequacy of completion of radiology request forms in atertiary care centre. Indoor and outdoor patient departments of POF Hospital Wah Cantonment. Design: Descriptive, retrospective study.Setting: Radiology Department POF Hospital, Wah Cantonment. Period: 01 Jul 2009 to 01 September 2009. Methods: A total of 1500request forms received by the radiology department from 01Jul 2009 to 01Sep 2009 were reviewed. These included requests for a varietyof examinations from different departments within POF Hospital, Wah Cantonment. A database of the collected forms was created, notingwhich of the various fields were adequately completed. Results: Only 270 out of the 1500 forms were completed in full and 1230 were notcompletely filled. The only parameter fulfilled in all the forms was the presence of referring doctor’s signature. The commonest blankfields were as follows: patient location: 62%, clinical notes: 67.26%, doctor's name: 47.33% and date of referral: 14.2%. Conclusions:The inadequate transmission of clinical information observed in this study is typical example of the various problems that radiologistshave to face.
IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP);
Authors: AFRIDI ITAAT ULLAH KHAN , SAQIB MUNAZZA
Published: September 2021

Objective: To find the frequency of common clinical features of Idiopathic Thrombocytopenic Purpura (ITP) in childrenand to see whether bone marrow aspiration needed in every child with typical presentation of ITP. Design: Cross-sectional study. Setting:Hematology/Oncology Department, the Children Hospital & the Institute of Child Health Lahore Pakistan. Duration: April 2008 to March2009 (One year). Material and Methods: A total of 30 children presenting with bleeding through any orifice with diagnostic evidence ofITP were evaluated by a cross sectional study. Common clinical features were recorded along with the related hematological parameters.After taking detailed history and thorough examination, relevant investigations like peripheral smear, bleeding time and coagulation screenwere carried out in all cases. Bone marrow examination was done only in selected cases. The cases were then managed according tostandardized management criteria. Results: Male: Female ratio was 3:2, age ranging from 18 months to 14 years (mean±SD of 5.2±years) with median age of 5.2 years. 26.6% (n=08) patients were having preceded history of upper respiratory tract infection. Thepositive clinical findings were bruises in 30% (n=09) cases; petechiae in 23.3% (n=07) cases; epistaxis in 23.3% (n=07) cases; gumbleeding in 13.3%(n=04) cases and hematuria only in 10% (n=03) cases. Anemia (<9gm%) was noted in 40% (n=12) patients. Onperipheral smear examination this was microctic hypochromic in nature. Bleeding time was prolonged in all patients in line withdocumented thrombocytopenia i.e platelet count < 150,000. PT/APTT was normal in all 30 patients. Conclusions: Bruises, Petechiaeand epistaxis are the commonest clinical findings of ITP. Bone marrow aspiration revealed inconclusive results in such cases.
PERIODONTAL DISEASE;
Authors: HABIB ZAHRA M. , MOSHY J.
Published: September 2021

Background: Periodontal disease and systemic diseases are inter-related, each influencing one another. Adequateknowledge on periodontal disease among medical doctors will enable them to refer their patients to dentists for timely management. Thisstudy aimed to assess knowledge, awareness and attitudes of medical doctors towards periodontal disease in Dar-es-Salaam, Tanzania.Settings and design: Cross sectional study on medical doctors working at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.Materials and methods: The study involved 151 medical doctors drawn randomly and who are practicing at Muhimbili National Hospitalin Dar-es-Salaam, Tanzania. Data were obtained via a structured questionnaire and included demographic information’s, knowledgeregarding periodontal disease, their awareness and their attitude towards periodontal disease. They were entered into the SPSS statisticalsoftware for analysis. Frequencies and percentages were calculated and association between variables was done using the chi-squaretest. Results: Of the 151 questionnaires administered, 124 were returned (response rate of 82.12%). One hundred and eleven (89.5%)medical doctors believed poor oral hygiene was the main cause of periodontal disease, only 49(39.5%) told their patients to brushproperly, 47(37.9%) believed that there was a bidirectional relationship between periodontal disease and systemic disease and only35(28.2%) referred all patients with systemic diseases to dentists. 34(27.4%) believed that medical doctors have adequate knowledgeregarding periodontal disease and 18(14.5%) believed that the medical curriculum provides enough knowledge regarding periodontaldisease. Conclusions: Medical doctors had inadequate information about periodontal disease and this should be addressed in themedical curriculum so as to enable proper patient management.
INCIDENCE OF OPEN NEURAL TUBE DEFECT (ONTD)
Authors: ALI ALGAHTANY MUBARAK
Published: September 2021

Objective: To determine the incidence of open neural tube defect (ONTD) in Asir Province, Southern region of KSA andcompare with eastern region and central region of the country and determine if the incidence is stable or changing over the years. Design:Prospective study. Period: January 2009 to December 2011 and retrospective study of the period March 2003 to January 2007. Materialand methods: We compared the number of newborns with ONTD for different periods. Results: Out of 18 patients in the prospectivegroup 12 were female and 6 male. The incidence is 1.34 per 1000 live births. Hospital Data from year 2003 to 2007 shows 32 totaladmissions for ONTD in 4 years. Conclusions: Comparison with eastern region and central regions gives a slightly high incidencecomparing 1.34/1000 live births to 1.09/1000 in central region and 0.97/1000 live births in eastern region. There is a decline in thenumber of ONTD cases in Asir Province, Southern region of Saudi Arabia.
ANATOMY RESOURCE CENTRE
Authors: ULLAH SHAFIQ , NIZAMI SHAHID MANSOOR , REHMAN MUHAMMAD ZIA UR
Published: September 2021

It has been seen that just delivering the lectures of anatomy followed by dissection may fail to produce a long lastingunderstanding of the subject. The students are also unable to appreciate the importance of clinical anatomy integrated within variousmedical disciplines. A medical college or university may look at restructuring the medical curriculum with an anatomy resource centrewhich can have a pivotal influence on self-directed learning. Objectives: (1) To prepare an innovative resource centre for teachers. (2). Totrain student to achieve sufficient knowledge, skill and attitude when given a problem-solving exercise. Methodology: The resourcecentre is equipped with routine cadaveric dissection. Such gross structural relationships are made more meaningful by the use of livinganatomy such as conventional radiographs, CT, MRI, ultrasound, laparoscopic, videos and surface anatomy. Simultaneous presence ofmicroscopic anatomy (histology) can help to understand cell biology and molecular medicine in great detail. It is also necessary to useplastic models to overcome the complexity of the structures such as perineum and joints. Web-based computer sites can supplement theeffort and to achieve what is called ‘self-directed assessment skill’. Once the students are aware of the normal structures, they can bechallenged with abnormal structures or tissues. An anatomy resource centre thus, can be integrated with various disciplines. However, itis felt that an efficient clinical anatomy curriculum can only lead to the success in developing an innovative anatomy resource centre forteachers and students.
TYPE 2 DIABETES MELLITUS;
Authors: BALOCH GHULAM HUSSAIN , DALL ABDUL QADIR , HAYAT ATIF SITWAT , Shah Syed Zulfiquar Ali , Devrajani Bikha Ram
Published: September 2021

Objective: To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Design: Crosssectional descriptive study. Patients and methods: Patients with history of type 2 diabetes mellitus for ≥ 02 years duration with ≥ 35 years ofage and of either gender with dental pain visit at medical and dental outpatient department (OPD) of Liaquat University Hospital Hyderabad.The detail history was taken and the blood samples were taken for haemoglobin A1c (HbA1c) to assess the glycemic status. The existenceof dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience ≥05 years. The datawas collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. Results: A total of 137 type 2 diabetic patients wereselected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 (71.5%) patients. Out of these ninetyeight, 53 (54.08%) were males and 45 (45.92%) were female. Upper molar teeth involvement was present in 46 patients and lower molarteeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients,lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 (43.9%) patients in patients whose duration ofdiabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, whileregarding duration of <5 years only 24 (24.5%) patients had dental carries. Conclusions: The diabetic patients are more prone to acquiredental caries.
DEPRESSION IN DISSOCIATIVE (CONVERSION) DISORDER PATIENTS;
Authors: AKHTAR SAEED , MANZOOR, ASIA , YASMEEN AZRA
Published: September 2021

Objective: Prevalence of depression in Dissociative (Conversion) disorder Patients. Place and Duration of Study: Thestudy was conducted in the Department of Psychiatry & Behavioural Science / Bahawal Victoria Hospital & Quaid-e-Azam MedicalCollege, Bahawalpur, from February 2012 to May 2012. Subjects and Methods: The sample consisted of 100 consecutive in patients(Female 84, Male 16) of Dissociative (Conversion) disorder. They were interviewed and results were analyzed from the entries in aPerforma and Hamilton Rating Scale for Depression. Results: Majority of the patients were female (84%), uneducated (54%) andunmarried (60%). Mean age of our patients was 21.84±7.29 years. Depression was found in 76% of patients. Out of 76 depressedpatients had moderate depression, 24 had severe depression. Conclusions: Our study collaborates that depression was present in highproportion in patients with dissociative (conversion) disorder, which shows that co-morbid depression should not be over looked in thesepatients. It is recommended that every patient presenting with dissociative (Conversion) disorder should be assessed for co-morbiddepression and should be managed accordingly.
DERANGEMENTS OF PULMONARY FUNCTION TESTS;
Authors: MEHBOOB QAMAR , ARIF MUHAMMAD
Published: September 2021

Introduction: Asthma is one of the commonest diseases not only in Pakistan but also worldwide. Study Design: This iscross-sectional analytical study. Settings: The study was carried out at Chest Department Civil Hospital Faisalabad. Duration: (Sixmonths) Sep 2011 to Feb 2012. Material and methods: The effects of exercise in asthmatic patients as revealed by their pulmonaryfunction tests(PFT’s) and arterial blood gas(ABG) analysis.: Total sixty male subjects having age from thirty to forty years were included.They were divided into experimental and control groups, each consisting of thirty cases. In experimental group all asthmatic patients wereincluded who have been diagnosed six months earlier. Results: The results of PFT’s and ABG were recorded and compared, during preand post exercise periods. At rest there was non-significant difference of PFT’s and ABG in two groups. After six minutes exercise onbicycle-ergometer ,there was a significant decrease in Forced Expiratory Volume during first second (FEV , P=0.026), Forced vital 1capacity( FVC, P=0.036) , Partial Pressure of Oxygen (PaO ,P=0.036) and Partial Pressure of Carbondiaoxide (PaCO ,P=0.020) in 2 2asthmatics. Conclusions: We concluded that in response to exercise challenge in asthmatics, PFT’s have more precision for assessmentthan ABG.
AN AUDIT OF LAPAROTOMIES;
Authors: KHAN TAHIR AHMAD , AWAN SAFDAR HUSSAIN , KHAN SAFDAR ALI , Amin Shahbaz
Published: September 2021

Objective: To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period.Study design: Cross sectional, retrospective study. Place and duration of study: Study was carried out at surgical department ofcombined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients and methods: Patients withsignificant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patientswere either electively admitted via outpatient department or through Accident and Emergency (A&E) department. Patient charts andrecords were used to collect data. Results: All 174 patients underwent laparotomy. In (27.6%) cases, intestinal perforation was theunderlying cause; gynaecological pathology was found in (21.2%) patients. In 19.5% cases blunt and penetrating abdominal trauma wasthe cause of acute abdomen. Acute intestinal obstruction was found in (21.3%), tumors were found in (7.9%) and miscellaneous causeswere identified in (2.3%) cases. Conclusions: Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidencebased medicine criteria.
ORGAN TRAFFICKING;
Authors: NASIR MUHAMMAD , NASIR TEHMINA , KHAN HIRA ASHRAF , Khizar Saba
Published: September 2021

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LAPAROSCOPIC CHOLECYSTECTOMY;
Authors: ADNAN NAZEER MOHAMMAD , IMTIAZ HASAAN , DAR HARUN MAJID , Ali Zulfiqar , Samreen Asma
Published: September 2021

Introduction: The role of laparoscopic cholecystectomy in treatment of acute cholecystitis is still controversial. Objective:The objective of this prospective randomized controlled trial was to evaluate the outcomes of early laparoscopic cholecystectomy foracute cholecystitis and to compare the results with delayed cholecystectomy. Setting: Sheikh Zayed Hospital, Lahore. Period: 1st Feb,2012 to 31st July 2012. Materials & Methods: 60 diagnosed patients of acute cholecystitis were randomly allocated to two groups,Group 1 underwent early laparoscopic cholecystectomy (Group 1, n = 30) and Group 2 to initial conservative treatment followed bydelayed laparoscopic cholecystectomy, 6 to 12 weeks later (Group 2 , n = 30). Results: The overall complication rate was 3.3% (01) inearly group and 16.7% (05) in the delayed group. There was no common bile duct injury in both groups. The complications includedwound infection and intraperitoneal collection. Conclusions: According to the results our study we concluded that early laparoscopiccholecystectomy can safely be carried out for acute cholecystitis as the complications for early laparoscopic cholecystectomy are lessas compared to delayed laparoscopic cholecystectomy. Early laparoscopic cholecystectomy has also an edge over delayed because ofsingle hospital stay.
STRAY BULLET A DILEMA:
Authors: YASIN GHULAM , ARAIN GHULAM MUSTAFA
Published: September 2021

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PREVENTION OF SHIVERING DURING LOWER SEGMENT CESAREAN SECTION;
Authors: AHMED ASHFAQ , ASLAM MOHAMMAD
Published: September 2021

Objectives: To compare the efficacy of low-dose prophylactic use of ketamine with ketamine plus midazolam for theprevention of shivering caused by spinal anesthesia, during lower segment cesarean section. Main Outcome Measures: Heamodynamicmonitoring, avoidance of lactic acidosis/ increased carbon dioxide production and patient satisfaction. Design: Prospective RandomizedControlled trial. Place: Department of Anesthesia and ICU PNS Shifa Karachi. Duration of study: March 2010 to June 2010. Patients andMethods: 100 ASA-I & II consecutive patients who reported for LSCS in PNS Shifa Hospital were studied. In this double-blind study,patients were randomly allocated to receive ketamine alone (Group I, n= 50), and ketamine plus midazolam (Group II, n = 50). Afterstandardized Spinal anesthesia, a shivering was recorded at 5 min intervals for 15 minutes. Results: Shivering was observed in 9/50(18%) patients of group I (Ketamine only) as compared to only 2/50 (4%) patients in Group II (ketamine + midazolam) (p=0.025) whichis statically significant. The two groups were comparable regarding distribution of age (p=0.37), BMI (p=0.27) and duration of surgery.Results were analyzed by using chi square test. Conclusions: The efficacy of i.v. ketamine plus midazolam is better as compared to lowdosei.v. ketamine alone in preventing shivering in lower segment Cesarean Section patients, during spinal anesthesia.
ORAL HEALTH OF PREGNANT WOMEN;
Authors: A K BYANAKU , D S RWAKATEMA
Published: September 2021

Objective: To assess level of knowledge, attitude and practice on oral health mong pregnant women attending antenatalcare clinic in Morogoro Municipal, Tanzania. Design: A cross sectional study. Setting: Morogoro Municipality, Morogoro Region,Tanzania. Subjects and Methods: Pre tested questionnaires were administered randomly to 216 participants attending antenatal careclinic seeking to find out quantitative data on their specific socio-demographic characteristics, oral health knowledge, attitude andpractice in 2012. A sample of 26 par ticipants was involved in focus group discussions (FGD's). Questionnaire data were analyzed byStata Version 12.1 programme. Chi-square test and Logistic regression models were used. A p-value <0.05 was considered significant.FGD's qualitative data analysis was done manually using thematic framework analysis. Results: Majority (73%) of the participants hadadequate oral health knowledge. About 76% of the respondents agreed to the positive statements towards oral health. Focus GroupDiscussions revealed negative attitude towards dental treatment during pregnancy. Adequate oral health practice was found in majority ofthe participants (72%). Levels of education and marital status of the participants were found to be strongly associated with oral healthpractice (p-value < 0.05). Conclusions: Majority of the participants had overall adequate knowledge, practice and positive attitudetowards oral health. However, unsatisfactory knowledge on possible connections between bleeding gums and pregnancy and negativeattitude towards dental visits were noted. Level of education was significantly associated with oral health practice and attitude. Dentalvisits from the first stages of pregnancy should be part of antenatal care clinic in this community.
SUPRA CONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN;
Authors: AMEEN MOGHEES IKRAM , SAFDAR AQEEL , MOGHEES FAUZIA
Published: September 2021

Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients presentvery late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years withsupra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried outand necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation bytraditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% wereType I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositisossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displacedsupracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by OpenReduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocolhad to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full rangeof movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction andlifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus inchildren different management protocols have to be made, tailored to individual needs of the patient.
INCIDENCE OF PLACENTAL ABRUPTION;
Authors: MEMON NAILLA YOUSUF , MUMTAZ FIRDOUS , FAROOQ SHAISTA
Published: September 2021

Objective: To determine the Incidence of Placental Abruption and the morbidity / mortality associated with it. Design:Prospective and Observational case Study. Setting & Duration: Department of Obstetrics & Gynecology, Liaquat University of Medicaland Health Sciences Hyderabad, for a period of 15 months from January 2007 to March 2008. Patients & Methods: Among all theantenatal patients delivered during the period under review, those suffering from Placental abruption were entered into this study bycompleting a proforma for each patient. After history, examination and initial management, investigations were carried out. These patientswere managed on case to case basis depending on the progression of abruption and delivery. After delivery whether spontaneous or bycesarean section the condition of mother and subsequent complications were recorded and results analyzed on SPSS version 10.Results: During the period 15 months, 2760 patients were admitted to labour room /labour ward and delivered. Among these, 100patients had abruption making an incidence of 2.89% per year. According to the degree of abruption 33 had mild, 50 had moderate and 17had severe abruption. 42% had spontaneous vaginal delivery, and 52% underwent cesarean section. 36% of Abruptio patients, developedcomplications like shock, PPH and DIC. One (1%) patient died in severe abruption. Conclusions: The incidence of Abruptio Placentae inthis study is comparable to local studies and studies from developing countries, but is high in comparison to studies from developedcountries. The maternal morbidity and mortality rate is not as high as in other studies.
ACUTE MYOCARDIAL INFARCTION;
Authors: HAYAT ATIF SITWAT , BAWANY MUHAMMAD ADNAN , QADRI JAWAD AHMED , Khalil Kiran
Published: September 2021

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.
ALVARADO SCORE;
Authors: RASHID ASIF ZAMAN , TARIQ MUHAMMAD , ASIF MARRIAH
Published: September 2021

Objective: To evaluate the usefulness and accuracy of Alvarado scoring system in the precise diagnosis of acuteappendicitis to decrease the rate of negative appendectomies. Design: Descriptive study. Place and duration of study: The study wasconducted in Military Hospital Rawapindi from Aug 2010 to Dec 2011. Patients and methods: In this study, initially 351 cases byconvenience sampling, were included but later 31 patients were excluded specially females because they turned out to be cases of PID ,renal / ureteric colic or UTI . Patients with score of 4 or above underwent appendectomy. 320 patients were operated. All exceptgangrenous and perforated appendices were subjected to histopathology. Six operated cases were found to be having normalappendices. Twenty patients were treated conservatively because their scores were less than 4 according to Alvarado scoring system.Those patients were observed till their symptoms settled. Results: Male to female ratio was 1.46:1. 71.2 %( n=196) patients werebetween 13-24years. On the basis of Alvarado score 62.50 %( n=200) patients secured 7 and above while 31.25 %( n=100) werehaving 4 and above score. Remaining 6.25 %( n=20) had less than 4 score. Out of total (n=300) 98 %( n=294) were histopathologicallyproven to be acute appendicitis while 2 %( n=6) were of normal histopathology. Conclusions: We concluded that Alvarado Score is auseful parameter / yardstick in diagnosis of acute appendicitis
DIAGNOSIS OF TUBERCULOUS ASCITIES;
Authors: PHULPOTO JAVED AHMED
Published: September 2021

Diagnosing Tuberculous ascites is a challenge. Polymerase chain reaction (PCR) and adenosine deaminase activity(ADA) have come up as promising modalities to aid diagnosis of tuberculosis in body fluids. Objective: To find and compare theusefulness of ADA and PCR in ascitic fluid in diagnosis of peritoneal tuberculosis. Study Design: A cross-sectional study. Place of Study:Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Duration of Study: From January 2010 to July 2011.Methods: Fifty five patients of exudative ascites, were diagnosed as peritoneal tuberculosis by following criteria- clinical suspicion, PPD(Skin Tuberculin test) positive, suggestive bacteriological and/or imaging findings and ascitic fluid showing lymphocytosis withdecreased glucose and SAAG (Serum- Ascites albumin gradient) of <1.1 gm/ dL. PCR and ADA were performed in the ascitic fluid andpositivity rates determined and compared. Results: Out of 55 study subjects, 50 patients (90.9%) were PCR positive and 48 (87.3%)were ADA positive; both were equiefficacious (p=0.54). High agreement between PCR and ADA tests was noted. Conclusions: ADA andPCR are comparable as diagnostic modality for tuberculous peritonitis, however ADA scores over PCR because of easy availability, lowcost, less infrastructure requirement and less-time consuming.
CHRONIC VIRAL HEPATITIS C INFECTION;
Authors: ANJUM MUHAMMAD SOHAIL , MAQBOOL SHAHID , SAEED MUHAMMAD HAMID , Hussain Tanveer , Kalsoom Naila
Published: September 2021

Objective: The objective of the study was to measure the frequency of impaired glucose tolerance (IGT) in patients havingchronic hepatitis C at medical outpatient department (OPD) of Allied hospital Faisalabad. Sample technique: Non probability consecutivesampling. Duration of study: Duration of study was 6 months with first patient enrolled on 3.02.2010 and last patient enrolled on 07-08-2010. Setting: Medical (OPD) Outpatient Department of Allied Hospital, Faisalabad. Subjects: 375 patients with chronic hepatitis C,coming in Medical OPD of Allied hospital Faisalabad were enrolled. Methods: 375 patients diagnosed as having chronic hepatitis Ccoming in Medical OPD of Allied hospital Faisalabad, were included in the study. Fasting and two hours after glucose load blood samplewere collected in sterilized syringes and was tested for fasting blood glucose (FBS) and random blood glucose level (RBS). Results: Inthis study 375 patients having HCV positive on Elisa were enrolled. Out of 375 patients with chronic hepatitis C, 143 (38.1%) were foundto have IGT while 232 (61.9%) were having no IGT. There was significant association between chronic hepatitis C and development of IGT.Conclusions: It is concluded that there is close association in the development of IGT in patients with chronic hepatitis C.
GROWTH HORMONE ESTIMATION;
Authors: HAMEED MUHAMMAD NADEEM , SADIQ FAUZIA , MUMTAZ ASIM , Mohiuddin Hina , Khan Sana , Quereshi Tariq Jaffar
Published: September 2021

Introduction: Despite the use of growth hormone replacement therapy for decades, our ability to make a definitive diagnosisof growth hormone deficiency in children is limited. Growth hormone stimulation tests have been used to discriminate between Growthhormone deficiency and idiopathic short stature. However all these tests lack reproducibility, accuracy, cost affectivity and safety. Insulinlikegrowth factor-1 is an effector hormone and its serum level may be used as simple, easy to perform diagnostic test for growthhormone deficiency. Objective: To determine the efficacy of IGF-1 as a diagnostic tool in children with growth hormone deficiency. StudyDesign: Prospective cross sectional survey. Place of Study: Departments of Pediatrics and Pathology, Shalamar Medical & DentalCollege, Lahore. Duration of study: 1st July to 31st December, 2011. Material & Methods: We included 40 children of 3.5 – 17 year ageand detailed clinical data was collected. All these children were subjected to stimulation by standardized exercise on treadmill, after takingbasal blood samples for GH and IGF-1. Post stimulation growth hormone was recorded to identify growth hormone deficient children.Results: 17 (42.5%) children had post stimulation growth hormone level <10ng/ml while 23 (57.5%) had values >10ng/ml. Postexercise stimulation GH level showed weak correlation with IGF-1 in either of the two study groups. P value was found >0.05 in deficientas well as sufficient groups, depicting non significance of IGF-1 in relation to post stimulation GH level. Conclusions: IGF-1 is not asuitable surrogate diagnostic marker for growth hormone deficiency. Diagnosis should always be based on combination of auxologicalbiochemical, radiological and genetic considerations, Abbreviations: GHD – Growth Hormone Deficiency, GH – Growth Hormone,GHSTs – Growth Hormone Stimulation Tests, IGF-1 – Insulin-like Growth Factor-1, MPH – Mid Parental Height, BA – Bone Age.
ESSENTIAL HYPERTENSIVE PATIENTS;
Authors: JAMALI SHAH NAWAZ , AHSAN SHAHID , LAGHARI MUHAMMAD JAMIL , Ahmad Usman
Published: September 2021

Objective: To compare blood pressure lowering effects of angiotensin II type I receptor blocker candesartan cilexetil incomparison with calcium channel blocker amlodipine in essential hypertensive patients. Study design: Randomized, open-labeled,prospective comparative study. Place and duration: The study was carried out in the department of pharmacology and therapeutics,Basic Medical Sciences Institute (BMSI), Jinnah Post Graduate Medical Centre (JPMC), Karachi from July 2007 to January 2008.Subjects and methods: In this study (80) newly diagnosed essential hypertensive patients were enrolled and divided into two groups(DR1) and (DR2) respectively. DR1 patients received candesartan 16mg once a day and DR2 patients received Amlodipine 10mg once aday for 3 months duration. Results: The mean systolic blood pressure of DRI was 162.23 on day 0 which decreased to 141.05 on day 90,versus DR2 which decreased from 160.12 on day 0 to 140 on day 90. The mean diastolic blood pressure decreased significantly for DR 1group from 99.87 mmHg to 87 to 89. mmHg, versus DR2 which decreased from 98.5 to 86.25. All values of blood pressure have beentaken in mmHg. The results of this study were observed statistically significant. Conclusions: Candesartan cilexetil is a newer and saferalternative for the treatment of essential hypertensive patients in comparison to conventional antihypertensive treatment.
CAESALPINIA DECAPETALA
Authors: BAIG MUHAMMAD KASHIF , IRSHAD IRAM , NASEER FAIZA
Published: September 2021

Members of genus Caesalpinia are found world widely in tropical and temperate areas. Caesalpinia species have variouspharmacological actions that include antidiabetic, antiulcer, anticancer, anti-inflammatory, antimicrobial and antirheumatic. Objectives:To assess the Hepatoprotective activity of ethanol extract of Caesalpinia decapetala. Duration of study: September 2012 to November2012. Setting: Pharmacology and Pathology departments of Independent medical college and animal House of university of agriculture,Faisalabad. Study design: Experimental study. Materials and Methods: Hepatoprotective activity was determined by measuring the livermarker enzymes like Bilirubin, AST, ALT and ALK levels and then hepatic biopsy to see any structural changes. Phytochemical analysis ofplant extract indicates that it contains polyphenols and flavonoids that possess antioxidant potential and hence possess Hepatoprotectiveactivity. Results: Liver enzyme levels were significantly raised in rabbits receiving paracetamol and the enzyme levels were significantlyreduced in rabbits who were receiving Caesalpinia Decapetala and paracetamol comparable to silymarin and Paracetamol. Resultsobservation was done in concentration and dose dependent manner. Histopathological studies indicated centrizonal and focal necrosisand ballooning in liver of rabbits treated with paracetamol. It showed only mild steatosis with sinusoidal dilatation and binucleate cells ingroups receiving Caesalpinia decapetala. Conclusions: It is concluded that Caesalpinia decapetala possesses significantHepatoprotective activity.
ACNE VULGARIS;
Authors: LEGHARI NAEEM-ULLAH , AKRAM BUSHRA , LUQMAN NAIMA
Published: September 2021

Objective: To find out the frequency and pattern of psychosocial stressors and adverse life events in patients presentingwith Acne vulgaris. Study design: A descriptive study. Place & duration of study: The study was conducted in the Department ofPsychiatry & Behavioural Sciences, in collaboration with Dermatological Department, Nishtar Hospital, Multan from September, 2012 toNovember, 2012. Subjects & Methods: The sample consisted of 50 consecutive out-patients (Female-42, Male-8) with acne. They wereinterviewed and The Presumptive Stressful life Events Scale (PSLES) was administered to elicit major life events and psychosocialstressors they had to face. Results were analysed from the entries in a semi structured Performa. Results: Out of 50 patients, 94%subjects reported more than one stress & 6% reported no stress. 15(30%) were suffering from the disease 6 months to one year. Wefound more than one stressor. Results showed 46% of the participants reported Social Withdrawal, 40% had Academic Problems, 38%showed Frustration and Anger, 32% had to face Critical Remarks / Stigmatization, 30% had Low self esteem & Negative thoughts aboutself, 12% presented with Suicidal Ideas / Attempts, about 22% reported disturbed Relationship with Spouse while 14% reported theRelationship problems with other family members. Conclusions: We concluded that psychosocial stressors and life events were presentin significant majority of patients with acne and these emotional, social, behavioural and psychological reactions have strong associationin patients suffering from acne vulgaris.
HEPATITIS C IN CHILDREN;
Authors: REHMAN ABDUL
Published: September 2021

ABSTRACT…..The knowledge of the hepatitis C management in children is scanty but rapidly growing. This review will discuss theupdate in the management of the disease in children. Abbreviations: Hepatitis C virus (HCV); International unit (IU); Polymerase chainreaction (PCR); Sustained virological response (SVR); Rapid virological response (RVR); Early virological response (EVR); End-oftreatmentresponse (ETR)
BREAST DISEASES;
Authors: ZAFAR AFSHEEN , REHMAN AHMED
Published: September 2021

Objective: To determine pattern of breast diseases presenting in the surgical OPD of a General hospital. Design: Aprospective observational study. Place & duration of study: The study was conducted at Railway hospital, Rawalpindi from September2008 to Feburary 2010. Patients & Methods: Female patients presenting with complaints regarding breast were recruited in the study. Allof them underwent clinical breast examination followed by necessary radiological and / or histopathological investigations to diagnosethe disease. Data regarding personal information, clinical examination findings and results of investigations done was collected on aproforma. Results mainly as frequencies were analyzed using software SPSS 16.0. Results: A total of 207 female patients presented inthe OPD with breast complaints. 15 patients were lost to follow up before a definitive diagnosis could be made; therefore they wereexcluded from the study. Out of 192 patients 21.9% had mastalgia followed by fibroadenoma (19.3%), breast abscess (15.6%),carcinoma breast (13.5%), fibrocystic disease (6.25%), duct ectasia (5.7%), acute mastitis (4.7%), no disease (4.2%), nipple eczyma(2.1%). Benign phylloides tumour, chronic mastitis, prominent axillary tail, cracked nipple were each 1% and 3 patients presented withmammary fistula (0.5%), accessory nipple (0.5%), and lipoma(0.5%). Conclusion: Breast diseases make a sizeable portion of thegeneral surgical practice. In our set up benign diseases are far more common than the malignant ones. Mastalgia is the commonestbreast problem. Malignancy of breast presents usually in late stages.