bluuebunny/crossref_metadata_2025 huggingface dataset:
ST ELEVATION MYOCARDIAL INFARCTION
Authors: Hashmi Syed Fasih Ahmed , Dasti Mashooq Ali , Shah Nisar Ahmed , Hussain Syed Saad , Gohar Munaza , Farah Zul , Shah Syed Zulfiquar Ali
Published: September 2021

OBJECTIVE: To evaluate the frequency of hyponatremia and its prognosticimportance in ST elevation myocardial infarction. Period: Six months. Design: Case series.Setting: Tertiary care hospital Hyderabad. Methods: All the cases with ST elevation myocardialinfarction admitted in the CCU were recruited and evaluate for serum sodium level at admissionand then at 24, 48 and 72 hours. The data was analyzed in SPSS 16 and the frequency andpercentage was calculated. Results: One hundred patients with acute myocardial infarctionwere recruited and assessed for sodium level. The mean age ±SD of whole population was57.52±9.51 whereas in male and female population it was 58.72±7.53 and 53.84±7.93respectively. The sodium level was 130.21±3.42 and 127.41±4.21 in male and femalepopulation. The p-value was statistically significant (<0.01) in context to age and sex whereasthe age in context to hyponatremia is non significant (p=0.77). The hyponatremia and itsseverity was statistically significant in context to sex (p=0.04) and duration of the myocardialinfarction (p=0.03). The serum sodium level in context to duration of MI was also significant(p=0.03) whereas the mortality at the end of 30 days was 11% of which 02 patients had normalsodium level while the 09 had low sodium level (hyponatremia). Conclusion: Hyponatremia inpatients with acute STEMI is a important predictor of thirty days mortality.
HIV/AIDS AWARENESS IN PAKISTAN
Authors: Nasir Jamal Abdul , Imran Muhammad , Zaidi Syed Arif Ahmed
Published: September 2021

Globally 35 million people were living with HIV in 2013 whereas around 78 millionpeople have been infected since the start of the epidemic and 39 million people have died ofAIDS- related illness. Objectives: To examine the factors associated with HIV/AIDS awareness ofever married men and women age 15-49. Design: The secondary data sets are used of Pakistandemographic and health survey (PDHS) of ever married men and women with sample size 3134and 13558. Period: PDHS 2012-13. Setting: The national institute of population studies done thissurvey with the technical support from ICF International and Pakistan bureau of statistics and theUSAID supported the financially. Methods: Bivariate and binary logistic regression analysis hasbeen carried out to evaluate the significant socio demographic factors. Results: Every 7 out of10 ever married men have heard about AIDS, while the situation is much critical for ever marriedwomen, 6 out of 10 have not heard about HIV/AIDS. Generally finding revealed that almost bothof the respondents have misconception regarding HIV/AIDS transmission. Two binary logisticregression models are executed one for ever married man and other for ever married women.Two models revealed that early age groups have less knowledge about HIV/AIDS; urban hasmore knowledge compared to rural. Education level, media assess and wealth index have positiveassociation regarding to HIV/AIDS awareness. Conclusions: Socio-demographic aspects suchas age, education, place of residence and access to media TV, radio and newspaper, wealth indexand occupation are found to be significant varied systematically with the awareness of HIV/AIDS.These statistical outcomes will enhance the capability in disease management and control.
A STUDY ON ESTIMATION OF STATURE FROM FOOT LENGTH
Authors: Malik Arif Rasheed , Akhter Nasreen , Ali Riasat , Farrukh Ra’ana , Aziz Khalid
Published: September 2021

Stature is considered as one of the important and significant parameters forestablishment of personal identity in forensic medical examination or anthropological studies.With the alarming increase in frequency of road and train accidents, floods, fire, deliberatemutilation, disfigurement and natural disasters, there is a need of studies that provide help toidentify the deceased from fragmentary and dismembered human remains. In such situations,measurements of feet provide a reasonably good estimation about the stature of a person.The paucity of data that allowing reconstruction of stature from the dimensions of feet whichhighlights the need of such study. Objectives: 1). To determine the relationship between footlength and stature by calculating correlation coefficient. 2- To establish a regression model forestimation of stature from foot length in both male and female. Study design: Cross sectionalsurvey study was carried out on the MBBS students of above 20 years of age of King EdwardMedical University, Lahore. Sampling technique: Systematic sampling technique applied.Amongst the total students (873) of 3rd year, 4th year and final year, every third student wasincluded. Place of study: Department of Forensic Medicine & Toxicology KEMU, Lahore.Duration of study: It was carried out in one year. Material and methods: The subject selectionwas based on following criteria: Inclusion criteria: The MBBS students of King Edward MedicalUniversity, Lahore irrespective of sex with age above 20 years were included in this study.Exclusion criteria: The subjects having diagnosed lower limb or foot deformities on clinicalassessment were excluded. Results: A significant and positive correlation was found betweenfoot length and stature in male and female subjects and regression equation was framed forboth sexes. The correlation coefficient was highest between stature and foot length in malesand females. Conclusion: Dimensions of feet can provide good reliability in estimation ofstature. The correlation coefficient was highest between stature and foot length of both in malesand females.
DEATH ANXIETY SCALE
Authors: Saleem Tamkeen , Gul Seema , Saleem Shemaila
Published: September 2021

Patients with cardiovascular disease (CVD) have the symptoms of anxiety incommon that may result in adverse outcomes. Objectives: Due to the significant associationof anxiety and CVD, scheduled screening of all cardiac patients has been recommended bythe medical authorities like the American Heart Association. But in Pakistan it is not a commonpractice to use such tools, reason being unavailability of such screening tools in nationallanguage therefore specifically death anxiety is unrecognized and no measures are takenfor it and patients remain undertreated with death anxiety that may eventually influence onthe treatment and prognosis of the patients. Data source& Settings: Colleges and hospitalsof the Rawalpindi and Islamabad. Period: 6 months. Methods: The study was designed totranslate and validate the Death Anxiety Scale in Urdu language to be used with Pakistanipopulation. The sample consisted of 210 participants (70 Youngsters (normal group) 70 Elderlyand 70 patients with cardiovascular diseases (clinical group) from colleges and hospitals of theRawalpindi and Islamabad. To determine the psychometric properties, reliability and validity;cronbach alpha, split-half reliability, correlation, factor analysis were computed. Results: DeathAnxiety Scale-Urdu (DAS-U)( ) has adequate reliability and validity. Factor analysisshowed multifaceted structure for the DAS-U, bearing in mind the apposite psychometriccharacteristics; it can be used in researches about death anxiety. Conclusions: The use ofthe scale is reasonable for the measurement of death anxiety in CVD patients and it can beemployed in order to have successful treatment and improve the prognosis of the patients.
POSTPARTUM HAEMORRHAGE
Authors: Baig Faiqa Saleem , Shahzad Nadeem , Khurshid Hafiza Naveeda , Malik Aisha
Published: September 2021

The most common complication 0f the third stage of labour is postpartumhaemorrhage, which remains a leading cause of maternal mortality (25.0%), especially indeveloping countries. In developed countries, 3-5% of deliveries are complicated by postpartumhaemorrhage: in developing countries, it is 50 times more common .Third stage of labourwhich exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage andpuerperal infection. The best preventive strategy for these complications is active managementof third stage of labour. Active management includes administration of oxytocin within oneminute of birth of baby. Objectives: To compare the mean blood loss after administration ofintra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active managementof third stage of labour. Study Design: Randomized controlled trial. Period: Six months from1-1-2013 to 30-06-2013. Setting: Department of Obstetrics and Gynaecology, Unit-III JinnahHospital Lahore. Methodology: 100 patients fulfilling selection criteria were included in thestudy from labour room. These patients were randomly divided into two groups by usinglottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml ofnormal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocinintravenous stat at anterior shoulder. Total blood loss was noted after complete delivery ofplacenta. Results: Mean age was 25.0±3.9 and 24.4±3.5 in group-A and B, respectively. Meangestational age was 38.20±0.96 weeks in group-A and 38.40±0.94 weeks in group-B. Meanblood loss in intraumbilical oxytocin group was 311.20±27.23 ml and in intravenous oxytocingroup mean blood loss was 373.60±66.47 ml. There was statistically significant differencebetween two groups (p<0.001). In group-A 15 patients (30.0%) and in group-B 20 patients(40.0%) were primigravida while remaining patients were multigravida. Conclusion: The usageof intraumbilical oxytocin in active management of third stage of labour is beneficial in reducingthe blood loss in third stage and thus helps in preventing postpartum haemorrhage.
HYPERTENSION
Authors: Mushtaq Mamoona , Najam Najma
Published: September 2021

The literature review portrays a reasonable picture of the role of certain copingstrategies in developing hypertension. Objectives: Present research based on self-regulationtheory explored correlation of coping strategies of stress with hypertension. Design: Crosssectional research design. Setting: Shaikh Zayed Hospital, Services Hospital, Ganga RamHospital, Lahore. Period: June 2010 to June 2011. Method & material: Sample (N = 400)outdoor hypertensive males (N = 100) and hypertensive females (N = 100) between ages30-60, and their age matched healthy controls (N= 200, 100 males, 100 females) were takenfrom 3 hospitals. Measures: Brief COPE scale was used to measure coping strategies.Analysis: Chi-square and logistic regression analysis were carried out. Results: Significantpositive correlation of hypertension with active coping, substance use, instrumental support,positive reframing, acceptance, and self-blame was found and active coping, acceptance,instrumental social support and self-blame coping strategies appeared as significant predictorsof hypertension.
MENOPAUSE AND HRT
Authors: Shaheen Shugufta , Mahmood Anila , Kadri Farzana , Rajput Ana Mehreen
Published: September 2021

Objective: To find out awareness about menopause and HRT in thepostmenopausal women. Study Design: Cross sectional and observational study. Setting:Gynaecological Department of Al Tibiri Medical College Isra University, Karachi Campus andLady Dufferin Hospital Karachi. Period: May 2013 to December 2013. Method: Total 150women were selected in the study. All the cases were undergone interviewed after takingconsent form. All the data regarding residential status and awareness about menopause andHRT, along socioeconomic characteristics were entered on Performa. Results: The meanage of respondents was 52.6 ± 8.5 years.Mostly women were belongs with rural areas 68%,with poor socioeconomic condition 63%and uneducated 51%.In the majority 65% caseswere documented without awareness regardingmenopause and HRT. Conclusions: In theconclusion of this study mostly women lacked awareness regarding menopause and hormonereplacement therapy. Mostly ideasof the women concerning menopause are such as; it isnatural thing and without medical association.
CHRONIC IDIOPATHIC URTICARIA
Authors: Aamir Iram Saddiqa , Shakoor Shazia , Siddiqui Khalid , Choudary Usama Khalid , Atif Alina
Published: September 2021

Objectives: Urticaria is a condition in which itchy red bumps or wheals appearon the skin unexpectedly. There are two main types ,acute condition which last for up to sixweeks while chronic idiopathic urticaria (CIU) last for more than six weeks. There are multiplefactors in causation of chronic idiopathic urticaria (CIU) and therefore association with elevatedthyroid stimulating hormone (TSH) was evaluated in this study. Study Design: Prospectivecase control. Setting: Department of Physiology Dow University of Health Sciences Karachi.Period: December 2004 to January 2006. Subjects / Patients and Methods: A total number ofninety subjects/patients were enrolled. They were divided in three groups having 30 subjects/patients in each group. Group A consist of diagnosed cases of chronic urticaria. Group Bconsist of diagnosed cases of hypothyroidism and group C consist of age and sex matchedhealthy subjects. In all selected patients/subjects, serum antithyroid autoantibodies and thyroidprofile (serum TSH, T3 and T4), complete blood count, IgE levels, ESR were done. All patientswere selected from dermatology and medical units of civil hospital, Agha Khan Hospital, JPMCand community health clinics in Karachi. Results: Out of 90 patients, 47(78%) were found tohave chronic urticaria compared to control. Out of 47 patients , serum TSH (thyroid stimulatinghormone) was found to be elevated in 20(42.6%) patients with or without hypothyroidismcompared to control group.(P <0.001) Conclusion: Statistically significant association wasfound between elevated serum TSH and chronic urticaria symptoms.
PERIANAL FISTULA
Authors: Amjad Muhammad Fahim , Muhammad Abdul Nasir
Published: September 2021

MRI is increasingly used nowadays in the evaluation and management of PerianalFistula. Objectives: To assess the role of MRI in the detection and classification of PerianalFistula and correlation of preoperative MRI findings with the findings on surgery. Study Design:Prospective study. Setting: Department of Radiology King Khalid Civilian Hospital TabukKingdom of Saudi Arabia. Study Period: Two years between February 2013 and February 2015.Material and Methods: 60 patients were referred from surgical department for evaluation ofPerianal fistula by MRI during the above mentioned period. MRI was performed in 48 Patients.(42 males and 6 Females) using variety of MRI sequences. Fistulas were classified according toSJUH (St James’s University Hospital classification MR imaging based grading system) and MRIfindings of individual MRI sequence used were correlated with operative findings. Results: Mostcommon fistula was Grade 1 (37.5%).In majority of the cases internal opening was found at 6 Oclock position. Post intravenous contrast enhanced Axial and coronal oblique (CE FST1WFSE)Fat suppressed T1 weighted Fast spin echo and Axial and coronal Fat suppressed T2W FSEsequence (FST2WFSE) showed the highest Accuracies 98.13% and 97.06% respectively indiagnosis of anorectal fistulae. Conclusion: MRI should be used as a first line imaging modalityin the preoperative assessment of Perianal fistula. Findings on Axial and coronal oblique CEFST1WFSE, axial and coronal oblique FST2WFSE showed the excellent agreement with thesurgical findings. By using MRI as the first line imaging modality in the evaluation of PerianalFistula one can percept best possible surgical management resulting in prevention of residual/recurrence disease and complications such as fecal incontinence.
CRANIAL MEASUREMENTS
Authors: Khan Mohammad Afzal , Chaudhry Muhammad Naeem , Altaf Faris Mohammed Nour
Published: September 2021

Human body exhibits regular age, sex and race dependent proportions amongstits various segments relative to its height. Knowledge of the cranial morphometry is importantfrom clinical and forensic view point. The stature of a person being genetically predeterminedis an inherent characteristic, the estimation of which is considered to be important assessmentin identification of human remains. Norms of regression formulae for calculation of height arerequired for different populations. Objectives: To document norms for cranial dimensions andpresent linear regression formulae for stature prediction in adult male and female populationof Southern Punjab. Place and duration of study: The study was conducted at the MultanMedical and Dental College, Multan and took about fourteen months to complete. Materialand methods: The study was conducted on 672 adult individuals (430 males and 242 females)from in and around the city of Multan in Punjab. Measurements of the head including maximumcranial length (glabella-inion length), maximum cranial breadth (maximum bi-parietal diameter)and maximum auricular head height were taken. Results were expressed as mean ± SD.Height was measured in standing anatomical position. Correlation coefficient of Pearsonwas used to find the relationship between various cranial dimensions using which the linearregression formulae to predict the stature were derived. Results: The mean height of the studypopulation was found to be significantly different between genders. The males appeared tobe considerably taller than females. The mean cranial length, cranial breadth and auricularhead height the measurements were larger significantly in the males as compared to females.Pearson’s correlation coefficient between stature and cranial measurements was found to behighly positive for both sexes. Linear regression formulae to predict the stature from the cranialdimensions were derived. Conclusion: The study is conducted to document norms for cranialdimensions and it presented gender specific linear regression models for stature prediction inadult South Punjab population.
PHOTOTHERAPY
Authors: Ahmed Farhan , Hasan Ali , Mehmood Noormah
Published: September 2021

Objective: To compare mean duration of stay (in hours) of patients with newimprovised versus conventional methods of phototherapy among neonates with jaundice.Study Design: Randomized control trial. Period: Six months. Setting: Neonatal ward,Department of Paediatric Medicine, Lahore General Hospital, Lahore. Subjects and Methods:160 patients, with the help of random number table, all the patients were randomly dividedinto 2 groups A and B, after getting the informed consent from their parents. Group A patientsreceived conventional phototherapy. Group B patients received phototherapy with reflectingmirrors placed beneath and at the side of the patient in baby’s cot (new improvised methodof phototherapy). Results: In this study the mean age of patients in group-A and group-Bwas 2.70±1.13 days and 2.12±1.98 days respectively. In group-A there were 47 (58.75%)male and 33 (41.25%) female patients while in group-B there were 51 (63.75%) male and 29(36.25%) female patients. According to hospital stay, the mean hospital stay in group A was39.76±11.80 hours and in group-B it was 44.90±14.21 hours, the mean hospital stay wasstatistically significant (p<0.001) Conclusion: Shorter mean duration of stay (in hours) wasrecorded in patients treated with new improvised as compared to conventional methods ofphototherapy among neonates with jaundice, the data is primary in our country, this techniquemay be used further but after some more trials to confirm its efficacy regarding shorter durationof hospital stay
PONV
Authors: Azeem M. , Ullha Zia , Nasim Ahsan , Cheema M.A.
Published: September 2021

Background: Postoperative nausea and vomiting is reduced if inj Dexamethasoneis given preoperatively in patient undergoing Laparoscopic Cholecystectomy. The aim of thisprospective randomized, controlled trial was to look into effectiveness of dexamethasone beforesurgery may improve nausea, vomiting after surgery in patients undergoing laparoscopiccholecystectomy. Study Design: Prospective randomized study. Setting: Department of Surgery,King Edward Medical University, Lahore - Pakistan. Period: Nov 2010 to April 2012. Methods: 138Patients with Laparoscopic Cholecystectomy were randomized to receive 08 mg Dexamethasone(n=66) or placebo (n=72) intravenously before surgery. Seven patients were excluded on accountof already on steroid treatment due to various reason. Vomiting and nausea were seen in next 24hours after operation. Dexamethasone has minimal side effect after single dose administration. Sixpatients (12%) has nausea and vomiting in treatment group while 26 (47%) in the control group(p<0.001). Patient having dexamethasone, five (10%) need antiemitics as compare to 24 (44%)of those receiving placebo (p<0.001). Conclusion: Single dose of Inj Dexamethasone givenpreoperatively reduce nausea and vomiting markedly in Laparoscopic Cholecystectomy and maybe routinely used in Laparoscopic procedure.
ENDOMETRIAL CARCINOMA
Authors: Khan Shazia Majid , Yasmeen Farhat , Riaz Abida
Published: September 2021

Background: Bleeding from the reproductive tract in women is a naturallyoccurring event, generally the result of menstruation and childbirth, and is not associated with ableeding disorder in most cases. Dysfunctional uterine bleeding is the most common reason forwomen to undergo an interventional gynecologic procedure. The major task of the clinician is toexclude endometrial carcinoma in women and to identify organic pathology in order to manageit effectively. Objective. To determine the incidence of endometrial carcinoma in women withabnormal uterine bleeding. Study Design: Cross sectional study. Setting. Department ofObstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of study: Sixmonths (16th February 2013 to 15th August 2013). Material and method: One hundred andsixteen women with complaint of abnormal uterine bleeding, meeting the inclusion criteria wereselected. All the patients were undergone endometrial sampling and assessment of endometrialthickness was done which was confirmed by endometrial biopsy to evaluate endometrialpathologies. The collected data was noted on pre-designed proforma. Results: The mean agewas 42.07 years. According to parity, 56 women (48.2%) have 1-4 parity, 48 women (41.4%)have 5-8 parity and 12 women (10.4%) have 9-14 parity. The mean duration of dysfunctionaluterine bleeding was 14.64±7.87 months. Six women (5.2%) have endometrial carcinoma while110 women (94.8%) have no endometrial carcinoma. Conclusion: This study thus proved thatin our setup the incidence of endometrial carcinoma is very high. So every patient with abnormaluterine bleeding should undergo endometrial biopsy to rule out endometrial carcinoma.
PREVALENCE OF HEPATITIS C INFECTION
Authors: Akhtar Abdul Majeed , Majeed Sadia , Jamil Muhammad , Rehman Abdul
Published: September 2021

Objectives: The aim of the current study was to estimate the seroprevalence andrisk factors investigation associated with hepatitis C virus (HCV) infection in general patientsattending various public and private hospitals of Lahore metropolitan. Study Design: Crosssectional study. Setting: Out Patient Departments (OPDs) of public hospitals, comprising ofMayo Hospital, Sir Ganga Ram Hospital, Services Hospital, Jinnah Hospital and Lahore GeneralHospital of Lahore. Period: 2012. Material and Methods: A total of 904 patients from outpatientdepartments of five public and two private hospitals were enrolled during 2012. Bloodsamples were collected to evaluate their anti-HCV status using 3rd generation ELISA. To findout the risk factors associated with HCV infection, the data was collected on a pretested andvalidated questionnaire. Results: The seroprevalence was estimated to be 14.6%. Mean ageof reactive and non-reactive general patients was significantly associated (P=0.012) with anti-HCV status. Marital status (OR=2.042), socioeconomic status, blood donation (OR=2.15),prescription by doctor or non-doctor (OR=2.664), route of drug administration, relatives havinghepatitis and towel sharing (OR=1.987) were significantly associated (P<0.05) risk factors forHCV infection. Conclusion: The study reveals a higher prevalence of HCV infection in generalpatients of Lahore due to poor socioeconomic status, treatment by quacks, excessive use ofinjectable drugs, house hold contacts with hepatitis patients and lack of awareness about theHCV transmission.
DIATHERMY INCISIONS V/S SURGICAL SCALPEL INCISIONS
Authors: Jamali Khawar Saeed , Khan Naveed Ali , Jawed Muhammad , Shaikh Ubedullah
Published: September 2021

Objectives: The objective of this study was to compare the outcome of diathermyincisions v/s surgical scalpel incisions in general surgery. Study Design: Cross sectional study.Place and Duration of Study: This study was conducted at surgical unit 7, Sindh Govt. LyariGeneral Hospital and Dow University of Health Sciences between January to December 2009.Methodology: 100 consecutive patients for elective general surgery were randomly assignedto either group A incision with cutting diathermy (n=50) or group B cold steel scalpel (n=50).Data including demographic details, hospital stay, infection rate and non-infective complicationslike swelling, bleeding, dehiscence and seroma formation were recorded in both groups tocompare the final surgical outcome compared. Results: A total of 80 patients were included inthe study, placed alternatively into two groups of 40 patients each with majority being male (n =61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group Awas 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basisof Gender for the two groups, the positive predictive value for male patients of Group A and Bwas 90.09% and 89.28% respectively, but for females the positive predictive value of Group Aand B was 100% and 50% respectively. In Diathermy (Group A) total 20% patients developedcomplications and these were seroma formation (n=4, 8%), wound dehiscence (n=3, 6%) andwound infection (n=3, 6%). In Scalpel (Group B) total 26% patients developed complications(P-value=0.370) in which seromas was noted (n=5, 10%) then wound infection (n=4, 8%), thenwound bleeding (n=3, 6%) and lastly seroma formation (n=1, 2%). Hospital stays were alsoalmost similar with mean value 8.24 days in diathermy group and 10.54 days in scalpel group.No remarkable difference in demographics, characteristics and in other variables of patientswas noted. Conclusion: We conclude that no significant difference in surgical outcome ofboth groups (cutting diathermy Vs. steel scalpel). Therefore, use of either technique to createsurgical wound merely depends upon preference of surgeon.
PHOTOTHERAPY
Authors: Bahawal Sadida , Naqvi Umm-Ul- Baneen , Siddiqui Mehboob Alam , Ahmad Dr.Shakil , Sarwar Imran
Published: September 2021

Hyperbilirubinemia is the most common abnormal physical finding in first fewweeks of lif and its most common management is phototherapy. Amongst other commoncomplications a less known complication of phototherapy is hypocalcemia. Objectives: To studythe incidence of phototherapy induced hypocalcemia in neonates and to have a comparisonbetween preterm and term neonates. Study design: Descriptive cross-sectional study.Setting: Paediatric Unit II DHQ Hospital Faisalabad, which is a tertiary care centre for all kind ofpatients. Duration of study with dates: Six months from 1-11-2012 to 30-04-2013. Methods:196 neonates with hyperbilirubinemia full term / preterm neonates admitted in pediatric DHQhospital faislabad were selected. Inclusion criteria. 1) Hyperbilirubinemia. 2) No hypocalcemiaon admission. 3) Received phototherapy for hyperbilirubinemia. Serum Calcium levels weremeasured in all neonates before and 48 hours after receiving phototherapy. Incidence ofhypocalcemia among all neonates was calculated as an absolute percentage and the samplepopulation was also divided into preterm / full term neonates to evaluate the incidence ofhypocalcemia in these two groups individually. RESULTS: Mean serum calcium in neonateswas 7.5+- 1.5 mg / dl .16.84 % of neonates were found to have calcium level below the cut offvalue. 33 out of 196 developed hypocalcemia after phototherapy and out of these 54 % werepreterm and 45 % were term neonates < P-value (0.01)>. Conclusion: Phototherapy induceshypocalcemia in neonates more so in preterm neonates. Impact: Consideration for additionalcalcium supplementation should be undertaken in all neonates undergoing phototherapy andfurther randomized trials need to be done with these concerns.
ACUTE POISONING
Authors: Owais Komal , Khan Ishratullah
Published: September 2021

Acute poisoning with various substances is common worldwide. Exposure toagrochemicals, medicines and environmental agents are the major causes of poisoning.1 It isone of the commonest causes of morbidity and mortality to the patients which has drawn theworld attention. Objectives: To determine the socio-demographic characteristics and causesand agents of poisoning among patients visiting emergency department with acute poisoning.Methods: All the poisoning cases that fulfilled the inclusion criteria and attended the emergencydepartment from February 2014 till March 2015 with acute poisoning were evaluated. A hospitalmedical record form were used for data collection in which the details of patient’s demography,agents of poisoning and intension of poisoning, were entered from hospital records andanalyzed. Results: A total of 364 patients attended the emergency department of Zia Uddinuniversity hospital over period of 12 months. In this population 36% were male and 64%were females. Commonest age group for poisoning was 15-30 yrs. and commonest agentwas organophosphate. Intentional poisoning comprised of 88% while accidental poisoningcomprised of 12%. Conclusion: On the basis of our study we can conclude that femaleadolescents and adults are more prone to intentional acute poisoning and pesticides are thecommonest agents involved in acute poisoning.
ELECTRONIC APEX LOCATOR VERSUS CONVENTIONAL R ADIOGRAPH
Authors: Khawaja Naveen , Punjabi Suneel Kumar , Dal Abdul Qadir , Banglani Munir Ahmed , Lal Ramesh
Published: September 2021

For successful endodontic outcome, accurate working length has to be determined.Even with improved systems of working length (WL) measurement, different readings may berecorded in different electrolytes present in the canal. Methodology: Total 90 patients wereselected for this prospective in vivo study resented at Department of Operative Dentistry, LiaquatUniversity of Medical & Health Sciences, Jamshoro, during 6 months i.e. from 1st Sep 2014 to28th Feb 2015, with single rooted permanent mandibular first premolars with matured apices.After extirpated pulp tissue a file was inserted in the canal and WL was obtained by radiographas well as by electronic apex locator (EAL). The measurements determined by both methodswere compared by applying paired sample t-test. SPSS 18 was used for data analysis. Results:Among 90 subjects 37 were males. Mean±SD WL obtained radiographically was 19.8±1.03-mwhereas mean±SD WL obtained electronically was 18.9±1.05 mm. Mean difference betweenmeasurements of both methods was 0.87-mm, which was statistically significant (P <0.05).Conclusion: The electronic apex locator was better than the radiograph in determining workinglength of root canal at statistically significant level.
UNILATERAL MENIERE’S DISEASE
Authors: Bangash Wajahat , Hussain Altaf , Javed Aslam Dr. Muhammad , Sharif Atif , Najeeb Tallat
Published: September 2021

Meniere’s disease is chronic progressive disease with unclear idiopathic etiologyand symptomatic improvements with treatment. Objectives: To analyze the efficacy of lowdose intratympanic injection of gentamicin for vertigo control in unilateral Meniere’s disease.Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM &IMDC Islamabad. Materials & Methods: Gentamicin was used intra tympanically in thismulticentre study of 75 patients over a period of 8.5 years between 1st January 2005 to 30th June2013 in definite Meniere’s disease according to the 1995 Document of American academy ofotolaryngology- Head and Neck Surgery (AAO-HNS).All these centers followed same criteriaand procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middleear through the grommet under microscope and followed up for 3 months and two years. Thestaging of disease (hearing thresholds) the degree of disability (frequency of attacks per month)and the functional level were assessed before and after treatment. Results: Among 75 patients,41 were female & 34 were males between age ranges of 25 to 70 years. Most of the patients inthe study had stage 2 (23/75) and stage 3 (41/75) Meniere’s disease. About 68(91%) patientswere having good control of vertigo at the end of two year of intratympanic gentamicin withoutany loss of hearing. Conclusion: A single Low dose intratympanic gentamicin is effective incontrolling vertigo in patients with Meniere’s disease with no further deterioration in hearing forat least two years follow up.
VACCINATED HEMODIALYSIS PATIENTS
Authors: Mobin Ahsan , Qureshi Fawed , Umar Khan Muhammad , Jabeen Rakhshinda
Published: September 2021

Objectives: Determine the status of immunity against the hepatitis B virus amongvaccinated hemodialysis patients at a tertiary care hospital. Study Design: Cross sectionalstudy. Place and Duration of Study: All medical wards of Civil Hospital and Ojha campus, DowUniversity of Health Sciences, Karachi, Pakistan from May 2013 to January 2015. Methodology:Patients with chronic kidney disease on hemodialysis attending out-patient department wereenrolled. Patients with either gender and aged 18-70 years, who give consent for participation,who are on HD for more than 9 months with a proven diagnosis of ESRD who have receiveda complete course of 4 doses of hepatitis B vaccination atleast 2 months back were includedin this study. Non-consenting patients, present/past history of viral hepatitis, patients whowere hepatitis B surface antigen (HBsAg) positive, patients on immunosuppressive agents,pregnant patients were excluded from this study. Results: Out of the 103 patients, 69 (67%)males and 34 (33%) females with mean age of study population was 51.1 ± 14.3 years (17 to70 years), mean duration post vaccination was 7.6 ± 0.9 months (6 to 9 months), mean antiHBs antibody level was 184.6 ± 293.4 (level rang 0 to 1000) and mean hemodialysis durationwas 26.4 ± 12 months (10 to 50 month). Out of 37 non-responders 28 (75.7%) had twice weeklyschedule of hemodialysis and 09 (24.3%) had thrice weekly schedule of hemodialysis, out of 19weak responders 13 (68.4%) had twice weekly schedule of hemodialysis and 06 (31.6%) hadthrice weekly schedule of hemodialysis and out of 47 high responders 29 (61.7%) had twiceweekly schedule of hemodialysis and 18 (38.3%) had thrice weekly schedule of hemodialysis(p=0.395). Conclusion: Excellent response of HbsAg B vaccination for those patients, undergodialysis procedure that is not associated with age, systemic inflammation or nutritional. Effectivedialysis procedure associated with excellent response to the vaccine hepatitis B.
PAINLESS DELIVERY
Authors: Dehghanpisheh Laleh , Sabetian Golnar , Fatahi Zeinabosadat
Published: September 2021

One of the most severe pain that a woman experiences in her lifetime is laborpain which leads to increase their desire to perform caesarean section. In the present study weassessed the attitudes and awareness of obstetricians and midwives by raising their knowledgeand skills, to increase the rate of vaginal delivery and reduce the cesarean. Methods: StudyDesign: Qualitative study. Setting: Obstetricians and Midwives from throughout the ShirazCity, South of Iran, were participated by completing the questionnaire. Period: 6 months in2015. Statistical analysis was performed using the SPSS software, version 20.0. The resultswere presented as frequency (percentage). Results: 118 individuals including 25 (21%)Obstetricians and 93 (79%) Midwives were participated in the current study. Both obstetriciansand midwives preferred normal vaginal delivery (NVD) (83.9%). 91% of subjects believed thatthe reason of preference of NVD is the safety of mother and child. 34.7% of individuals wasfully aware of painless labor. 21.2% had average information. Most of the subjects was agreedwith the painless labor method (92.4%) and 4.2% was disagreed. Lack of pain and calmnessduring labor (62.2%) and reduction of fear of natural childbirth (50.5%) were the main reasonsof agreements. 85.2% of obstetrics and midwives believed that the number of painless labor inIran in comparison to international standards is less than desired. Conclusions: Although themajority of obstetricians and midwives were agreed with the painless labor in hospitals, almosthalf of them were aware of the painless delivery. Raising the knowledge of health care providersabout painless delivery can influence on awareness and attitude of them and parturient towardnormal vaginal delivery.
TONSILLECTOMY IN PAEDIATRIC POPULATION
Authors: Ahmad Raheel , Salam Farhan , Khan Abdul Saeed , Bashir Faisal , Rafique Atif
Published: September 2021

Objectives: To compare mean operative time and Intra operative blood lossbetween bipolar electro dissection and cold dissection tonsillectomy in paediatric population.Study Design: Randomized controlled trial. Place and Duration: Department of ENT and Headand Neck Surgery, Continental Medical College, Hospital Lahore, from 1 January 2015 to 30September 2015. Materials and Methods: This study included 164 patients of age group 4 to12 years of either gender undergoing tonsillectomy. The patients were divided into two equalgroups designated as A and B each having 82 patients using simple random sampling. Patientsin group A were operated for tonsillectomy by bipolar electrocautry while group B underwenttonsillectomy by cold steel dissection method. All patients in both groups were assessed foroperating time and intra-operative blood loss. Results: Out of 82 cases of Bipolar DissectionGroup 49(60%) patients were male and 33(40%) patients were female. Whereas in 82 casesof Cold Dissection Group 51(62%) patients were male and 31(38%) patients were female.Mean age of patients was 7.2(SD ± 1.97) years. Mean operation time was 15 minutes withstandard deviation ± 1.21 in group A as compared to group B where mean operation time was20 minutes with standard deviation ± 1.87. Mean blood loss was 7 ml with standard deviation± 2.53 in patients of group A as compared to Patients in group B who mean blood loss of 30ml with standard deviation ± 3.46. Group A had statistically significant lower operative time andblood loss than group B. Conclusion: Tonsillectomy with bipolar electro dissection method ismuch better than cold steel dissection method. It has an advantage of less blood loss duringsurgery. It significantly reduces intra operative time.
SPECTRUM OF PANCYTOPENIA
Authors: Rehmani Tariq Hameed Rehmani , Arif Mizna , Heraid Sajjad , Arif Sarah , Ahmad Rabia , Saeed Muhammad
Published: September 2021

Pancytopenia refers to a reduction in all the three cellular elements of blood.Pancytopenia is a common but important hematological problem encountered in routineclinical Practice. It may be a presenting feature of many underlying serious and life threateningillnesses. Objective: Present study was planned to appraise various clinico- etiologicalfactors underlining Pancytopenia. Study Design: Cross-sectional study. Setting: HematologyDepartment of Allama Iqbal Medical College/ Jinnah Hospital Lahore (AIMC&JHL). Period:July 2011 to Jun 2015. Materials and Methods: Two hundred and forty four patients withPancytopenia were included in the study. Complete blood count, bone marrow aspirations andtrephine biopsies were performed after clinical history and physical exam. Data were analyzedby using SPSS 20.0 version. Results: Out of total 244 Pancytopenia cases, hypoplastic bonemarrow 66 (27.04%) and Megaloblastic anemia 49 (20.08%) were the most common etiologicalfactors with male predominance. Fever and pallor were striking presenting clinical features.Conclusion: We conclude that Pancytopenia is a common problem with an exhaustive listof differential diagnosis, some of which are easily treatable and reversible. Therefore earlydetection with optimal diagnostic approach to Pancytopenia is required for better managementof patients.
TYPE 2 DIABETICS
Authors: Memon Azhar , Raqeeb Abdul , Humaira Mona , Khoharo Haji Khan
Published: September 2021

Objectives: To evaluate serum cobalamin with special reference to dyslipidemiain type 2 Diabetic subjects. Study Design: Observational study Place and Duration:Department of Medicine, Isra University Hyderabad, Sindh from January 2014 to July 2014.Methodology: A sample of 107 type 2 diabetic subjects was selected according to inclusionand exclusion criteria. Cobalamin was measured on Roche Cobas e411 chemistry analyzerand blood lipoproteins by standard laboratory methods. Data was analyzed by SPSS 21.0(IBM, Incorporation, USA) using student t and Chi square tests for continuous and categoricalvariables respectively. P-value of ≤ 0.05 was taken significant. Results: Cobalamin deficiencywas noted in 51 (47.6%) of diabetics and cobalamin deficiency was associated withdyslipidemia. Mean ± SD of cobalamin in normal and reduced cobalamin groups were notedas 355±29.5 and 183±17.5 pg/ml respectively (p=0.0001). Triglycerides, total cholesterol,HDLc, LDLc and VLDLc differed significantly in the normal and reduced cobalamin subjects(p<0.001). Lipoprotein sub fractions showed a negative correlation with serum cobalamin(p≤0.02). Conclusion: Cobalamin deficiency is common in type 2 diabetics and is associatedwith dyslipidemia.
NONULCER DYSPEPSIA
Authors: Zahra Farrukh , Younis Muhammad , Nisar Uzma
Published: September 2021

Objectives: To determine the frequency of nonulcer dyspepsia in patientspresenting with the peptic ulcer like symptoms and to determine the effect of H. pylori eradicationon dyspeptic symptoms and the effect of six weeks trial of proton pump inhibitor as treatmentmeasure. Study design: Cross-sectional study. Setting: Combined Military hospital Quetta,Department of medicine. Period: Six months from Oct, till March 2009. Subjects and Methods:Patients coming to medicine department with complaints of dyspepsia. Results: Total no ofpatients were 145 out of which male were 90 while 55 were females. The mean age was 29.68+ 4.53. These subjects were given H pylori eradication therapy and response was graded aspatients responded or no response. 89 subjects (61.4%) responded to H pylori eradicationtreatment while 56 subjects (38.6%) showed no symptomatic benefit. Non responder toeradication i.e., 37 males and 36 females were given further six week treatment with omeprazole,and subjective response to treatment was graded as complete resolution found in 31 patients (21.4% ), while partial resolution was present in 15 patients (10.3%). 07 patients (4.8%) showedno improvement while 03 patients (2.1%) showed worsening of symptoms. Conclusions: Theprevalence of non-ulcer dyspepsia is high among symptomatic individuals. The response toH pylori eradication was significant. Non responders also showed considerable symptomaticbenefit with PPI. Therefore, individuals with recurrent dyspeptic symptoms should be given trialof H. pylori eradication.
RIGHT ILIAC FOSSA MASS
Authors: Hussain Ahmed , Ali Shah Syed Kashif , Bhatti Naeem ul Karim , Ahmed Zaheer , Ali Memon Dr. Hamid Nawaz , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency and clinical pattern of mass in rightiliac fossa. Study Design: Cross sectional multicenter study. Period: One year (from 03 March2014 to 02 March 2015). Setting: Patients with right iliac fossa mass of >11 years of and ofeither gender admitted in department of surgery at Liaquat university hospital Hyderabad /Jamshoro and Peoples University Hospital Nawabshah. Patients and methods: The data wasanalyzed in SPSS 16 and the frequency and percentage was calculated. Results: During oneyear study period, out of 227 patients, 112 subjects were observed to have right iliac fossa massdue to different etiologies, of which 82(73.2%) were males and 30 (26.8%) were females. Themean age ±SD for overall population was 39.32±8.66 while it was 37.88±6.75 and 38.93±7.72in male and female population respectively. The male population was predominant while thepatterns observed were appendicular mass in 19(17%), appendicular abscess in 26(23.21%),ileocaecal tuberculosis in 38(34%), carcinoma caecum in 14(12.5%), psoas abscess in 5(4.46%)and others in 10(9%) respectively. Conclusion: The highest incidence of mass in the right iliacfossa was seen in second, third and four decades with male population predominance. Thecommon disorders identified were ileocaecal tuberculosis, appendicular mass and abscessand carcinoma caecum respectively
FRACTURE SHAFT OF FEMUR IN CHILDREN
Authors: Orfi Fayyaz Ahmad , Shakeel Saira , Bhutta Irtiza
Published: September 2021

This study was carried out to check the efficacy of external fixators as comparedto conservative management in treating fracture shaft of femur in children from 2 to 8 years.Fracture shaft of femur in this age group are usually managed with traction for 2-3 weeksfollowed by hip spicca of 3-4 weeks. It is difficult to achieve good reduction by traction. Thisis not well tolerated by children. Hospital stay is prolonged. Perenial hygiene is difficult andpressure sores are common. LLD (limb length discrepancy), knee stiffness and gait changesare the long term complications associated with conservative management.6 We managed 31cases of fracture shaft of femur in 30 children from the age of 2-8 years with external fixators(ex-fix) and compared the results with 24 cases of fracture femur managed with traction andhip spicca. Study design: Prospective study. Tertiary care hospitals of military at Muzaffarabad,Kharian and Malir. Period: Sep 2008 to Mar 2015. Material & Methods: Informed consent wasobtained. Children from 2 to 8 years were included in this study. AO External fixator with 3.5mm shanze screws was used with 2 screws on each side of fracture. External fixators wereremoved after 8 weeks in most (>90%) of the cases. Patients were discharged on 1st postopday. Results: Observations were made during hospital period and then fortnightly and aminimum follow up of 6 months was done. Union was assessed clinically and on X-rays (3surfaces union). Observations made regarding reduction achieved, complications of procedureand compliance of children. Any LLD, knee stiffness and gait abnormality were noted during the6 months of follow up and compared with 24 cases managed conservatively (control group).