bluuebunny/crossref_metadata_2025 huggingface dataset:
FAMILY PLANNING METHODS;
Authors: Rashid Shaista , Sohail Sumbul , Munim Tazeen Fatima
Published: August 2021

Objectives: To evaluate the knowledge, perception and ever use of moderncontraception methods among women of reproductive age. Study Design: Cross sectionalstudy. Place and Duration: Gynecology and Obstetrics unit II in Abbasi Shaheed Hospitalduring 1st Mar 2015 to 30th Jul 2015. Method: This is a prospective study which was carried outat Abbasi Shaheed Hospital. All Female of reproductive age attending Gynecology ward weretaken except those not willing to participate .Data was collected by researcher through face toface interview after taking verbal consent in local language. Participants were asked about sociodemographic characters including age, parity, education, knowledge, income, perception,its barrier and use of contraception and source of information regarding contraception. Apredesigned questionnaire was used to enter data. Data analysis was performed using SPSSVersion 20. Results presented in tables. Dependent variables were included knowledge ofmodern family planning methods, perception, and ever use of modern contraception methods.Regression analysis will be used to identify respondent characteristics that predict ever useof modern contraception methods. Result: The mean age of respondents was 27.9 years.Literacy rate: 70.2% had no education.17.7% had primary education, and higher education wasfound only in 2.3%. 22.55% had heard about modern contraceptive methods while 77.44%had never heard about it. Amongst users of different modrencontracetion.80% had never usedany kind of contraceptives, while the most common form of contraception was condoms usedby 7.9%. Conclusion: Frequency of contraception is low among the target population, bothbecause of low level of awareness, along with a desire for large family not only amongst womenbut also pressure from husband, mother in law, religious concern.
PRETERM LABOUR:
Authors: Azher Tasneem , Aslam Iram , Bano Saadia , Shahzad Uzma
Published: August 2021

Objectives: (1) to find out of aetiological factors of preterm labour. (2) To makea proposed remedy for prevention of preterm lobour. Material and Methods: This study wascarried out at Independent University Hospital. This is located at richly populated area ofFaisalabad, providing health care facilities to poor socioeconomic group. The patient who fitinto inclusion criteria was included in study and a well designed Proforma was used to collectthe sample. Duration of study: One year study from 1 May, 2014 to 30 April, 2015. Studydesign: It is a descriptive study. Sampling technique: A purposive random sample techniquewas used to collect the sample. Sample size: A total of 80 cases ware collected who wereadmitted through antenatal outdoor and emergency of IUH. Inclusion Criteria: All patients withdiagnosed preterm labour who had attended outdoor or emergency of Independent UniversityHospital were included in study. Exclusion Criteria: (1) Patients with Iatrogenic preterminduction of labour due to maternal factors like patients on chemo therapy or any debilitatingillness causing threat to maternal life. (2) Patients with congenitally abnormal foetus & intrauterine death of fetus. Results: A total of 80 cases with preterm labour were included in studyat Independent University Hospital. In current study 30 (37.5%) patients had age between 18 –25 years, 30 (37.5%) patients had age between 26-35 years and rest of the 20 (25%) patientshad age > 35 years. Among 80 patients 25 (31.3%) patients had parity b/w 1-3 while 28 (35%)patients had parity b/w 4-5 and rest of the 27 (33.8%) had parity > 5. More patients i.e 50(62.5%) patients were admitted through emergency while 30 (37.5%) patients were admittedthrough Out Patient Department (OPD). 37 (46.3%) patients had Spontaneous vaginal deliveryand 43 (53.8%) patients underwent lower segment cesarean section. In our study, the mostcommon risk factor associated with preterm labour was bacterial vaginosis 20 (25%) patientshad bacterial vaginosis. 10 (12.5%) patients had chorioamniotis. Previous history of pretermbirth was present in 10 (12.5%) patients. History of Preterm Premature ruptures of membranesin 8 (10%) patients. 11(13.5%) patients has history of previous C-section and impending scardehiscence. History of anti partum hemorrhage and pregnancy induce in hypertension waspresent in 5 (6.5%) patients. FGR with oligohydramnios was present in 6 (7.5%) patients. 3((3.75%) patients presented with preterm breech
MEDICATION DISPOSAL;
Authors: Husain Tazeen , Farooqi Sadaf , Khan Madeeha , Humayoon Rabia , Jabeen Sabahat
Published: August 2021

Introduction: Due to irresponsible and unsafe methods of drug disposal employedby consumers pharmaceutical waste enters the ecosystem, ultimately having a detrimentaleffect on both human health and environment. Objectives: The purpose of the study is tomeasure attitude and practice of local community in Karachi, Pakistan regarding safe disposalof unwanted medicines and assess willingness of participants to take part in a medicationtake-back program. Study Design: A two-phase observational study was conducted usingconvenience sampling. Period: January to February, 2016. Methodology: In Phase I (n = 200)students enrolled in various health sciences institutions in the study were asked to take part inthe survey. In Phase II(n = 300) household consumers were contacted by telephone and socialmedia. Results: Participants (response rate 84.4%) were given a questionnaire to explore theirattitudes towards medicine disposal. More than half of the consumers surveyed reported storingunused/expired medications in their homes, and majority threw away unwanted medicine in thegarbage. The most common reason was unawareness of expiry date (32.7%). Only 12.32%reported returning medication to a pharmacy for disposal. Majority of the consumers had neverreceived advice about medication disposal by a health care provider but were aware of thepossible negative consequences and were willing to participate in national pharmacy take-backprograms if implemented by the government. Conclusions: Our findings suggest that effectivecommunication and established protocols will promote appropriate disposal practices. Publicservices in Pakistan, and especially pharmacies, must play a more proactive role in this regard.
OPTIMAL BREASTFEEDING PRACTICES;
Authors: Kaleem Rameeza , Sherwani Rehan Ahmad Khan , Adnan Muhammad , Rahat Tayyaba
Published: August 2021

Background: Breastfeeding is a common practice in Pakistan but the reportedrates of optimal breastfeeding are quite low. A baseline data about maternal knowledgeand practices was required for the effective implementation of Infant and Young ChildrenFeeding (IYCF) strategy in the settings. Therefore, the study was aimed to assess the existingknowledge and practices of the mothers about optimal breastfeeding practices. Study Design:Cross sectional study. Setting: Pediatrics OPD of Sir Ganga Ram Hospital, Lahore. Period:November and December 2015. Methods: Mothers (n=100) having children less than 2 yearsof age. Optimal breastfeeding practices recommended by the WHO were used as a goldstandard to compare with the mothers’ knowledge and practices. Data was collected by usinginterviewer administered questionnaire; and analyzed by using Statistical Package for SocialSciences (SPSS) version 21. Results: Mean age of the mothers was 27.06±4.67 years. Othercharacteristics included urban background 94%; literate 81%; and housewives 96%. Meanmonthly income of the family was 20840±13850 PKR. Only 34% mothers were counseledabout optimal breastfeeding practices during antenatal care visits. Assessment of mothers’knowledge revealed that 57% were known to initiate breastfeeding within 1hr of birth; 93%replied that colostrum must be given to the child; and 75% said that exclusive breastfeedingperiod is upto 6 months of age. Mothers’ practices in comparison to their knowledge weredisappointing because only 29% mothers started breastfeeding within 1hr of birth; 71% mothersfed colostrum to their child; and 34% exclusively breastfed their child upto the age of 6 months.Inferential statistics showed statistically significant difference between mothers’ knowledge andtheir practices (p <0.05). Conclusion: Two-third of mothers had not received any counselingabout breastfeeding practices during antenatal care visits. Though, mothers’ had betterknowledge about breastfeeding but the practices were suboptimal. Policy Message: Mothersneed continuous counseling and support to make their knowledge translated into practices.
UPPER GI HEMORRHAGE;
Authors: Panhwar Sanam , Rind Muhammad Aslam , Khyber Maria Nazir
Published: August 2021

Objectives: To predict the frequency of rebleeding by pre-endoscopic clinicalRockall scoring system in patients presenting with upper gastrointestinal hemorrhage. StudyDesign: Descriptive Case series study. Period: six months. Settings: Departments of Medicine,Liaquat University of Medical and Health sciences Jamshoro/Hyderabad. Material & Methods:The source of data was 187 patients who reported with the presenting complaint of hematemesisin ER and were then transferred to Medical Unit for further management. At the time of inclusionthe concerned Physician collected the demographic data, vital and relevant information for thepresence of co morbidities. After admission patients were shifted to endoscopy suite (situatedin Medical Unit) for the endoscopic diagnosis of the underlying condition. Any new episode ofhematemesis was considered as a re-bleed (within 120 hours of time zero). Rockall scoringwas calculated as per operational definition in the specifically designed proforma for the study.Mortality was noticed in the time the patient stayed in the hospital. Rebleeding was the endpoint of this study. Results: A total of 187 patients were selected for this study. Out of these 119were males (63.64%) and 68 (36.36%) were females. The mean age of patients was 59.25 years± 10.3 SD. Mean systolic BP was 107.08 ± 13.3, heart rate was 90.3 ± 11.9 and clinical Rockallscore of 3.5 ± 0.8 SD. A total of 111 (59.4%) patients presented with bleeding esophagealvarices, 36 (19.3%) presented with bleeding gastric varices, together chronic liver diseasewas responsible for 78.4% (147) of patients. Gastric erosions were seen to be the cause ofupper gastrointestinal hemorrhage in 18 (9.6%) of patients, whereas peptic ulcer disease wasthe cause responsible in 20 (10.7%). Lastly gastric carcinoma was seen in only 2 (1.1%) ofpatients. A total of 35 (18.7%) of patients experienced rebleeding episodes during the hospitalstay. Mortality was seen in 31 patients (16.6%). Conclusion: Clinical Rockall score is a goodpredictor of rebleeding and mortality. However, application of this score for the purpose oftriage of patients reporting with bleeding esophageal varices is problematic because this grouphas the presentation of liver failure along with hematemesis so getting low Rockall scores (andpredicting survival without endoscopic intervention) is not possible in this group of patients.
STRESS RESPONSE;
Authors: Jawwad Ghazala , Khan Humaira Fayyaz , Ali Amanat
Published: August 2021

Introduction: Psychological stress activate two axes: Hypothalamic- Pituitary-Adrenal axis and Sympathoadrenal axis leading to production of cortisol and catecholamines.Autonomic disturbances in the body can be evaluated by estimating heart rate variability.Study Design: Cross sectional study. Setting: Islamic International Medical College. Period:June 2014 to December 2014. Materials and Methods: Subjects were labeled as stress andcontrol on basis of DASS questionnaire proforma. Morning Cortisol level of all the subjectswas measured by quantitative ELISA method. Heart rate variability recording of all the subjectswas done. Results: Low frequency in absolute and normalized unit and low to high frequencyratio was significantly higher in stressed group, compared to control (p≤ .05, p ≤ .001, pp ≤.001 respectively). High frequency in normalized was significantly lower in stressed subjects,compared to control (p ≤ .001). Cortisol level was significantly higher in the stressed group incomparison with control (p ≤ .05). Conclusion: Stress can lead to increase morning cortisollevel and can cause autonomic disturbances which can be evaluated by measuring heart ratevariability.
METHYLPHENIDATE FOR BIPOLAR DEPRESSION
Authors: Mehmood Muhammad Sajid
Published: August 2021

There is close association between Bipolar Disease (BPD) and Attention DeficitHyperactivity Syndrome (ADHD). It has been reported that patients who suffer ADHD inchildhood are more prone to BPD in adult life. So, there seems to be a same pathophysiologyof both the diseases. Bipolar depression is one of most difficult challenge for psychiatristto deal with; because of inconsistent results of available drugs authorized for use in BPD.Methylphenidate (MPH) is drug of choice in ADHD but not used in bipolar depression. MPHis considered contraindicated in BPD because it can switch on mania in BPD patients. Thiscase report is written, based on the effects of MPH seen in this specific case along with otherantidepressant in BPD. MPH may serve as a miracle for BPD patient and may reduce theirsuffering to a great extent.
ACUTE INFERIOR MYOCARDIAL INFARCTION;
Authors: Abbas Shahid , Maan Aurangzeb , Aslam Shehzad , Qasim Muhammad
Published: August 2021

Objectives: To compare the frequency of mortality in hospitalized patientswith acute inferior wall myocardial infarction with or without right ventricular infarction. StudyDesign: Cohort study. Setting: Faisalabad Institute of Cardiology, Cardiology Department.Period: 2013-2014. Materials and Methods: 180 patients of acute inferior wall myocardialinfarction were included after obtaining informed consent. Group A (exposed) had acuteinferior wall myocardial infarction with right ventricular infarction and group B (un exposed) hadpatients with inferior wall MI without right ventricular infarction. Results: Out of 180 patients,150(83.3%) were male and 30(16.7%) were female. In group A, patients having Hypertension25(27.8%), Diabetes Mellitus 35(38.9%), Smoking 40(44.4%) and Dyslipidemia 13(14.4%). Ingroup B, Diabetes Mellitus present in 26(28.9%), Hypertension 22 (24.4%), Smoking 23(25.6%)and Dyslipidemia 19(21.1%). In hospital mortality in group A(exposed) was 9(10%) and in groupB(un Exposed) was 4(4.4%). Conclusion: The mortality with inferior wall MI with right ventricleinfarction was higher than patients without right ventricle infarction, although no statisticaldifference was found.
TETRAPLEGIC SPINAL CORD INJURED PATIENT;
Authors: Marryam Misbah , Umar Muhammad
Published: August 2021

Spinal cord injury is a very disabling condition that significantly impairs the abilityof a person to perform his activities of daily living on his own. This not only increases burden onfamily but on the community as well. Among spinal cord injured patients, tetraplegics are mostobvious ones to suffer due to marked disability. Subject of current case report is C6 incompletetetraplegic who showed marked impairments in activities of daily living thus compromisingfunctional independence. Task specific training for 50 minutes per day for 3 days per weekwas provided for 3 month. After which patient was given home exercise plan and was again reevaluated after 6 months. Marked improvements were noted in her all activities of daily livingincluding self care, mobility and respiratory and sphincter management.
POST PARTUM HEMORRHAGE;
Authors: Zafar Sardar Alfareed , Shaukat Asim , Khalid Ayesha , Niaz Ammara , Noor Shagufta
Published: August 2021

Primary postpartum hemorrhagic, rightly called as obstetrician’s nightmare,refers to excessive blood loss of more than 500ml during the third stage of labour or in the first24 hours after delivery. It continues to be one of the leading causes of maternal mortality andmorbidity all over the world including Pakistan where it is responsible for 21-31% of maternalmortality and morbidity. Objectives: Objective of study was to determine the efficacy of balloontamponade in the management of primary PPH, so that a low cast, easy to use technology isavailable for conserving future fertility by treating postpartum hemorrhage. Settings: Departmentof Gynae & Obs, Allied Hospital, Faisalabad. Study Design: Descriptive cross sectional study.Study Period: 6 months from 1st Oct, 2015 to 31st March, 2016. Material & Methods: All patientsdelivered vaginally at term (after 37 completed weeks of gestation) who developed PPH due touterine atony after failure of conventional medical therapy were included in this study. Patientselection was based on inclusion and exclusion criteria. Their demographic profile and efficacyof balloon tamponade was checked in terms of time required to control hemorrahage andneed of laparotomy. Results: During study period total no. Of vaginal deliveries were 3000.Out of these 298 developed PPH, 220 had PPH due to uterine atony and did not respond toconventional medical therapy. The age of patients ranged between 22 and 40 years with meanage of 30 year (±4.88SD). The parity of the patients ranged between 1 and 14 with the meanparity of 4 (±2.26SD). The condom catheter was introduced in all the selected 80 patients andwas successful in 73 patients. Conclusions: In developing countries such as Pakistan wherethe maternal death rate from PPH is very high, this safe, in expensive and easy procedure (itdoes not require any expertise) can be applied in any situation to save a life and to save theuterus in young patients to conserve reproductive capacity and prevent them from surgery andits morbidity. This will protect the patients from irreversible shock and even death with a successrate of 85-95%.
BUCCAL MUCOSAL TUMORS;
Authors: Ahmed Adnan , Khahro Muslim , Memon Mushtaque Ali , Channa Surwaich Ali , Shah Arhama
Published: August 2021

Objectives: To know the accuracy of puffed cheek technique in detecting buccalmucosal tumor keeping histopathology as gold standard. Study Design: Cross sectional study.Setting: Radiology and Imaging Department of Liaquat University of restorative and HealthSciences, cases were referred from dental department. Period: 2014 to 2015. Subjects andMethods: All these patients were underwent subsequently CT scan and histopathology. TheCT results were then compared with the histopathological results. Results: Total number ofpatients comprising my study was 44. Out of these 28 were males and 16 patients were females.Range of the age was from 25 to 55 years with mean of 36.2+4.3 years. The results provedthat sensitivity 88.2%, specificity was 100%, positive predictive values PPV was 100% and thenegative predictive values NPV 71.4% of CT scan with puffed cheek technique in detectingmucosal tumors while overall accuracy of CT in diagnosing buccal mucosal tumors patientswas 90.9%. Conclusion: CT puffed cheek is accurate technique to detect small buccal mucosaltumors.
ACUTE KIDNEY INJURY;
Authors: Khan Shahzad Alam , Hassan Shahnawaz , Khan Humayun Riaz , Safdar Sohail
Published: August 2021

Objectives: To determine the frequency of acute kidney injury in hospitalizedpatients at Nishtar hospital, Multan. Study Design: Cross sectional study. Setting: MedicalUnit-IV, Nishtar Hospital, Multan. Duration: Duration of study was 6 months from 17/07/2015to 16/01/2016. Material and Methods: This study involved 383 patients of either sex agedbetween 37-60 years admitted to medical ward for various medical conditions. Results: Themean age of the patients was 48.96±7.24 years. There were 198 (51.7%) male and 185 (48.3%)female patients in the study group. The most frequent underlying cause requiring hospitaladmission was a respiratory tract disease observed in 153 (39.9%) patients. AKI was observedin 104 (27.2%) patients. When stratified the frequency of AKI increased significantly withincreasing age of the patient; 37-42 years vs. 43-48 years vs. 49-54 years vs. 55-60 years (17.3%vs. 22.7% vs. 26.2% vs. 42.0%; p=.001). It was also significantly (p=.000) higher in patientswith diabetes (47.4%) and hepatobiliary disease (34.7%) at admission followed by infections(26.4%) and respiratory tract diseases (17.6%). However, there was no significant difference inthe frequency of AKI across genders; male vs. female (25.8% vs. 28.6%; p=.525). Conclusion:Very high frequency of acute kidney injury was observed in our study. Acute kidney injury wassignificantly associated with increasing age particularly more than 50 years and underlyingmedical conditions with particular reference to the diabetes mellitus and hepatobiliary diseases.Serial renal parameters monitoring should be adopted for early diagnosis followed by timelymanagement of acute kidney disease. It will decrease associated disease morbidities andmortalities and will also improve quality of life of these patients.
SENSORINEURAL HEARING LOSS IN ADULTS;
Authors: Yazdani Khan Mehboob , Ashfaq Ahmed Hasan , Ahmed Saeed , Bashir Faisal
Published: August 2021

Objectives: The objective of the study was to determine the etiology of SNHLin young adults between 18-45 years of age. Study design: Prospective study. Place andduration: The study was conducted at Benazir Bhutto Hospital, Rawalpindi from Jan 2012-13. Patients and methods: Patients presenting with hearing loss/ear blockage and additionalsymptoms were selected. Psychiatric problems were excluded from study. Patient’s problemwas analyzed through a protocol consisting of history, clinical examination, lab investigations,radiology and audiology. Results: The results of 25 patients were as follows: The age rangedfrom 18-45 years with marked preponderance of patients in 31-45 years age group amounting to60% of the total cases.18-20 years groups were least affected. The incidence of SNHL graduallyincreased in older age groups. There were more female patients 56% of the total as comparedto males, which were 44%. Bilateral SNHL was more 72% with compared to unilateral losswhich was 28%. The mode of onset was insidious in 72% cases while sudden loss was 28%.The duration of symptoms ranged between 3 days to 15 years. While fluctuation of hearing losswas observed in one case (4%). The nature of problem ranged from mild to severe. Associatedsymptoms were present in different percentages. The hearing loss ranged from 10-80 decibel.Trauma was the major cause 28% followed by infections in 16% with various causes in variouspercentages. Conclusion: The trauma in the form of surgery, blast injury and occupationalnoise is the major cause of SNHL in adults ranging between 18-45 years of age. Males are moreaffected because of trauma than the females and younger groups more than older groups.
DENGUE FEVER;
Authors: Khan Wasil , Amin Khan Bacha , Khan Zar , Rehman Abid ur , Akbar Mohammad , Khan Ishtiaq Ali
Published: August 2021

Introduction: Dengue fever is arboviral infection transmitted from infected personto non-infected one by mosquitoes Aedes Aegypti or Aedes albopectis. All four serotypes (DEN-1, DEN-2, DEN-3 & DEN-4) can cause the clinical manifestations of disease. Dengue infectioncan cause acute febrile illness, dengue hemorrhagic fever (DHF) and dengue shock syndrome(DSS). About 50-100 million cases of dengue fever reported annually worldwide in which 0.5million may need admission. Overall mortality of dengue fever is 3%. The diagnosis of dengueis established by classical clinical features along with specific investigations like PCR, detectionof dengue NS1 antigen or IgM or IgG antibodies in the blood of infected person. Dengue isendemic in most part of our country and can become epidemics on and off. Objectives: Tostudy the pattern and mortality of Dengue fever during epidemic and post epidemic years inSwat. Setting: This study was conducted in Medical Department of Saidu Group of TeachingHospital, Swat. Period: Aug 2013 to November, 2016. Patients and method: Patients sufferingfrom acute febrile illness with features suggestive of Dengue fever were included in the study.Clinical criteria for initial diagnosis directed the subsequent diagnostic work up. Dengue wasconfirmed in these patients by either Dengue NS1 or Ig M antibodies in their blood. Writtenconsent for participation in study was taken from all the included patients. Formal permissionwas taken from Institutional Review Board of the institution to perform this study. The clinical andlaboratory data were recorded on a proforma and analyzed using SPSS 20. Results: Among5569 patients, 3834 (68.85 %) were male and 1735 (31.15%) were female. The mean age ofthe patients was 30 years SD 15.20. The most common age group that suffered with Denguefever was the adult age group (13-30 years). Dengue Hemorrhegic Fever was diagnosed in2543 (45.6%) patients and 50 (0.89 %) had features of DSS. A total 5018 (90.1 %) patients werecompletely cured while 37 (0.66 %) patients died. The overall mortality was 0.66%. Patientswith Dengue fever presented to the hospital though out the year but more than 50% of caseswere reported in the month of September. Conclusion: Adult age group and male gender ismost commonly affected by Dengue fever. Dengue fever was endemic in Swat valley and it canbecome cyclic epidemic in post epidemic years. Dengue fever can claim so many preciouslives if proper preventive measures were not taken in future.
CEREBRAL INFARCTION;
Authors: Sarwar Muhammad Adnan , Muzaffar Huma , Ahmad Shakeel
Published: August 2021

Objectives: To determine the frequency of different risk factors among patientsof stroke due to cerebral infarction. Study Design: Descriptive cross sectional survey. Setting:Punjab Medical College and affiliated hospitals (Allied Hospital and DHQ), Faisalabad. Durationwith Dates: Six months from June 2006 to November 2006. Methods: This was a crosssectional survey that included 195 patients with stroke due to cerebral infarction. The mainoutcome variable was frequency of different risk factors which were described as frequencydistribution table. Results: Hypertension was seen among 142 (73%) patients, followed bydiabetes mellitus in 83 42.5% patients, ischemic heart disease in 74 (38%) patients, smokingin 59 (30.3%) patients, obesity in 53(27%) patients, atrial fibrillation in 43 (22%) patients anddyslipidemia in 23 (11.8%). Conclusion: Hypertension is the most common risk factor followedby diabetes mellitus associated with stroke due to cerebral infarction.
LEUKEMIA;
Authors: Farooq Muhammad Shahzad , Malik Arif , Shaheen Bushra , Ain Qurat-ul- , Waquar Sulayman
Published: August 2021

Background: Leukemia is a hematological malignancy i.e. that arises in theblood progenitor cells. It is a tumor of white blood cells which is characterized by uncontrolledproliferation of immature hematopoietic WBCs in bone marrow. Leukemia is of two types myeloidand lymphoid and two subtypes acute and chronic. Acute lymphoid leukemia is most commonin children. There are certain risk factors associated with leukemia like ionizing radiations,genetic polymorphisms. Drug resistance in leukemia is linked with polymorphisms for genecoding enzymatic antioxidants. Multiple circulating biochemical markers depict pathogenesisof leukemia. Elevated reactive oxygen species and decreased antioxidant elements revealoccurrence of various malignancies. Study Design: Case Control Study. Setting: Study wasconducted at Institute of Molecular Biology and Biotechnology (IMBB), University of Lahore.Period of Study: One year. Materials and Methods: Blood samples of 270 leukemic patientsbetween the age of 30-55 were collected from PINUM and Allied Hospital, Faisalabad. Whilethe samples of 100 individuals were served as a control. Levels of both enzymatic and nonenzymaticantioxidant such as CAT, GSH, SOD, GPx and GRx, vitamin A, C and E and levels ofMDA were determined spectrophotometrically. While the concentration of IL6, AOPPS, AGEs,TNF-α, MMP9 and Isoprostanes were measured by using commercially available Elisa kits.Results: This research work was conducted on a total of 100 control subjects and 270 leukemicpatients and the results were described on mean values. Many circulating biochemical stressmarkers, antioxidants and vitamins were investigated. All enzymatic and non-enzymaticantioxidants, vitamins were decreased in leukemic individuals while markers which showedhigh oxidative stress like MDA, IL6, AOPPS, TNF-α and MMP9 were elevated in leukemicpatients. Conclusion: It is concluded from this study that low levels of antioxidants and highlevels of oxidative stress depict the pathological state of leukemia and defected cell proliferationand growth. Continuous evaluation of antioxidant levels during leukemia can serve as a way ofbetter prognosis and treatment of leukemia.
VISUAL FIELD DEFECTS;
Authors: Khalid Muhammad , Aslam Mehwish , Raina Umer Farooq , Zaman Khaleeq UZ
Published: August 2021

Objectives: To obtain and compare the exact visual status before and afterexcision of sella supra sellar tumors using the computerized perimetry as a standard measuringtools and then compare with the international studies. Background: Sella suprasellar tumorsare though not so common but affect visual acuity of patients and their quality of life drops.These tumors include pituitary adenoma commonest in the adult population, meningioma,Craniopharyngioma, astrocytic glioma, Optic nerve Glioma, Germinoma, Dermoid, Pituitarymetastases. We planned a descriptive case series study to compare the pre and post excisionvisual field defects using computerized perimetry. Study Design: Case series study. Setting:Department of Neurosurgery, Pakistan Institute of Medical Sciences, SZABMU, and Islamabad.Period: 2 years from January 2015 to December 2016. Methods: A total of 73 patients withsella suprasellar tumors were identified and enrolled. Patients between the age of 10 and55 years were selected on the basis of having sella supra sellar tumor on CT/MRI brain withcontrast. Patients whose age was less than 10 years and more than 55 years were excluded.Moreover, patients with post radiation necrosis diagnosed on MRI and MR spectroscopy brain,those operated for other eye pathology and patients with sella supra sellar SOL having comorbiditieslike diabetes mellitus, hypertension etc. were also excluded from the study. Thestudy outcome was measured in terms of comparison of visual field defects after excision ofsella suprasellar tumors using computerized perimetry. Results: The average age of patientswas 42.1 + 6.8 years ranging from 10 to 55 years. Female gender was predominant; therewere 40 (54.8%) female patients. The mean computerized perimetry was 0.65 + 0.34 LogMARbefore surgery which improved to 0.19 + 0.12 LogMAR after surgery. Overall, of the 73 cases,63 (86.4%) had improvement whereas 10 (13.6%) study cases had no improvement in thevisual field on follow-up. Conclusion: It can be concluded that after craniotomy and excisionof sella suprasellar tumors, perimetry showed improvement in the majority of the study cases.
SUBARACHNOID BLOCK;
Authors: Nabeel Syed Hassan , Furqan Aamir , Fayyaz Aatir , Akhtar Rahat
Published: August 2021

Introduction: Subarachnoid block has been in practice for below umbilicalsurgery more than 110 years.1 in recent era all over the world most of cesarean sections arebeing done under subarachnoid block because of high mortality rate associated with generalanesthesia due to failed intubation and aspiration pneumonia. Objectives: To compare theefficacy of phenylephrine versus ephedrine in the treatment of hypotension during cesareansection under subarachnoid block. Study Design: Randomized control trial. Setting:Department of Anesthesiology Nishter Hospital Multan. Period: March 2014 to August 2014.Materials and Methods: A total 80 patients included in the study and patients were divided intotwo equal groups. Phenylephrine group (P group) and Ephedrine group (E group), 40 patientsin each. Results: A total of 80 (100%) patients included in the study. As concern to the age ofpatients, mean age in group E was 30.50 and standard deviation was 5.383, similarly in groupP mean age was 30.75 and SD was 5.921. As concern to the efficacy in group E, 7 were havinggood efficacy and 33 were have poor efficacy. In group P 30 had good efficacy and 10 hadpoor efficacy. P=0.000 a significant value. Conclusion: Phenylephrine is more effective thanephedrine for the treatment of hypotension due to subarachnoid block during cesarean section.
POLYPOID NASAL MASSES;
Authors: Khan Amjad Ali , Asghar Abdul Shaheed , Ishaq Muhammad , Akhund Israr Ahmed
Published: August 2021

Objectives: The purpose of this study is firstly to signify the occurrence ofunusual nasal polypoid masses by analyzing their histopathological spectrum and to be on thelookout for them. Secondly to highlight the fact that nasal polypoid masses should not be takenlightly as they may be representing an underlying grave pathological process meriting urgentmedical advice. Study Design: Retrospective/observational study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: March 2010 to March 2015.Methods: In this study, all the surgical pathology cases with clinical diagnosis of nasal polypswith no suspicion for malignancy were retrieved from archives of Charsada Teaching Hospitalaffiliated with Jinnah Medical College Peshawar. The slides and diagnoses of all the retrievedcases were reviewed. The number of cases for each diagnostic category were recorded andanalyzed according to the non-neoplastic, neoplastic and their subcategories. Results: Thereview of cases from March 2010- March 2015 showed that most of the polypoid masses werenon-neoplastic, while only few were neoplastic. Of all the non-neoplastic masses, inflammatory/allergic polyps were much more common followed bypolyps with fungal infections andeosinophilic angiocentric fibrosis. Amongst the neoplastic masses, benign tumors were morecommon than the malignant. The benign masses comprised of hemangioma, angiofibroma,inverted papilloma and schwannoma. The malignant nasal masses constituted one case eachof polypoid extraskeletal Ewings sacoma, plasmacytoma, non-Hodgkin lymphoma and renalcell carcinoma. Conclusions: Awareness about the occurrence of the usual and unusualentities in the nasal cavities needs to be increased. Important diagnostic categories requiringurgent management include polyps with invasive fungal infection, inverted papilloma and allmalignant cases. Therefore, all unilateral nasal cavity masses with frequent epistaxis, pain orbone erosions should be submitted for histopathological examination.
ACADEMIC PERFORMANCE;
Authors: Batool Hijab , Mumtaz Asim , Chughtai A.S , Sadaqat Ameelia , Ali Shah Syed Imran
Published: August 2021

Objectives: To explore the factors affecting academic performance ofundergraduate MBBS students in Central Park Medical College Lahore. Background: Inmedical education, academic achievement tends to be an important aspect of professionaldevelopment later in the life of medical graduates. In Pakistan, pre-admission grades are oneof the most important criteria for admission in medical colleges. Several other factors are alsobelieved to play an important role to predict performance of undergraduate students in medicalcolleges. A detailed study of these factors can help to improve the performance of studentsin medical colleges. Study Design: Cross-sectional analytical study. Setting: Central ParkMedical College, Lahore. Materials and methods:Two MBBS batches (n=200) of Central ParkMedical College. Student data regarding gender, parent occupation, being a boarder or dayscholar, marks scored in F.sc and MCAT along with the score obtained in all professionalexaminations was collected. The data was analyzed using SPSS 23.0. Results: Thisstudy revealed that there was a positive correlation between preadmission grades of studentsand their academic performance throughout the five year period of medical college. Therewas no significant difference (p-value >0.05) between the academic performances ofstudents from parents of medical background as compared to those from parents withoutany medical background. The performances of students living in hostels were almost same astheir counterparts who were day scholars (p-value>0.05). The overall performance of studentswas better in the final years of medical colleges as compared to the initial years with femalesperforming better than males. Conclusion: The findings of this study support the fact that preadmission grades may prove to be a predictor of performance later in professional college life.Factors like parent occupation and place of accommodation have little role in predicting theacademic achievement of medical students. Learning though interactive manner tend to helpin achieving better grades as compared to students who learn through less interactive/didacticlecture technique.
ANKLE AND MIDFOOT FRACTURES;
Authors: Shabir Mohammad , Iqbal Shahid , Inam Muhammad , Shehzad Arif , - Ihsanullah
Published: August 2021

Objectives: To determine the diagnostic accuracy of Ottawa rule in ankle andmidfoot fracture keeping x-ray as gold standard. Study Design: Descriptive study. Setting:Department of Orthopedics, Lady Reading Hospital Peshawar. Period: June 2014 to May 2016.Materials and Methods: Through a Cross Sectional Study Design, a total of 175 patientspresenting with suspicion of ankle/mid foot fracture were selected in a consecutive mannerfrom the OPD and subjected to detection of fracture through Ottawa Ankle Rule followed byX-ray to confirm the diagnosis of fracture. Results: The mean age group of patients in ourstudy was 36.1+10.4 years. There were 85.7% males and 14.3% were females. The sensitivityanalysis shows OAR has a sensitivity of 81.2% and specificity 61.9%., positive predictive valueof the OAR is 79.1% and negative predictive value is 65.0% keeping X-ray as a gold standard.Conclusion: The overall sensitivity and specificity of the OAR lies within an acceptable rangein our local population however, we still recommend further research work over it beforerecommendations as a routine screening test for the fracture of ankle or mid foot.
ISCHEMIC STROKE;
Authors: Rehman Naveed ur , Alam Muhammad Absar , Rehman Kashif
Published: August 2021

Background: Patients with acute ischemic stroke frequently test positive forhyperglycemia, which is associated with a poor clinical outcome. This association between poorglycemic control and an unfavorable prognosis is particularly evident in patients with persistenthyperglycemia, patients without a known history of diabetes mellitus (DM), and patients withcortical infarction. Objective: To determine the frequency of raised hemoglobin A1c in patientspresenting with ischemic stroke. Material & Methods: Study design: Retrospective study.Setting: Department of Medicine, Independent University Hospital, Faisalabad. Duration:6 months. Data collection procedure: Reports of 150 patients fulfilling selection criteriawere selected from medical record section of Independent University Hospital, Faisalabad.Demographic details were obtained. Then medical record of patients was assessed for presenceof HbA1c. If HbA1c of patients was reported ≥ 6.5%, then raised HbA1c was labeled. Results:In this study raised HbA1C level in patients presenting with ischemic stroke was 25%. Amongthese patients the most affected age group of patients was 41-60 years. Female patients weremore effected than male patients. Among these patients only 27% were diabetic while 73%were non-diabetic, 54% were smokers, 32% patients were hypertensive and in 14% patientshyperlipidemia was seen. All these factors were not significantly associated with raised HbA1clevel in patients presenting with ischemic stroke. Conclusion: Results of this study demonstratea high frequency of raised HbA1c level in patients presenting with ischemic stroke. i.e. 25%. Sokeeping in mind these findings it is recommended that stroke patients should also be screenedfor hyperglycemia or increased HbA1c so that patients can be prevented from development ofpermanent hyperglycemia or other complications associated with it.
SPONTANEOUS BACTERIAL PERITONITIS (SBP);
Authors: Ghafoor Ayesha , Ahmed Ifrah , Javid Riaz Ahmed
Published: August 2021

Objectives: To assess the SBP in patients with Hepatic Encephalopathy andits association with grades of hepatic encephalopathy. Study Design: Cross sectional study.Setting: Department of Medicine, Medina Teaching Hospital. Period: January 2017 to June2017. Material and Methods: Total 143 patients of HE having age range from 18-65 years eithermale or female selected. SBP was assessed in these selected patients. SBP defined as positivewhen ascetic fluid neutrophil count > 250/ml. West heaven criteria was used for grading of HE.Results: In present study, mean age of patients was 37.45 ± 10.63 years. Out of 143 patients,SBP was found in 77 (54%) patients. HBsAg was found positive in 58 (40.56%) patients followedby Anti-HCV was found positive in 77 (53.85%) patients and Both Anti-HCV & HBsAg was foundpositive in 8 (5.59%) patients. Total 51 (35.66%) patients were found with grade I HE followed by60 (41.96%) patients grade II, 23 (16.08%) patients grade III and 9 (6.29%) patients found withgrade IV HE. SBP was found in 36 (70.59%) patients, 32 (53.33%) patients, 5 (21.74%) patientsand 4 (44.44%) patients respectively. Statistically significant association between grade of HEand SBP was noted with p value 0.001. Conclusion: Results of present revels that frequencyof SBP is very high in cases of HE. Hepatitis C was found positive in most of the patients.Statistically insignificant association of SBP with gender was observed. But highly significantassociation of SBP with grade of HE was seen.
NEURAL TUBE DEFECTS (NTDS);
Authors: Shahzad Nadeem , Riaz Afshan , Ameer Uzma , Nadeem Daniyal
Published: August 2021

Background: The most common congenital malformations are Neural tubedefects (NTDs) occurring in 0.6 per 1,000 live births in the United States, and almost 4000pregnancies are recorded of babies with neural tube defects, among them anencephalyand Spina bifida are the most common and their annual incidence is 2,500 to 3,000 births inthe United States. The etiology of NTDs is still an enigma, however, in the past few decadesvaluable advances has been made in understanding the causation and measures to preventNTDs and many risk factors are indentified which are associated with it. Objectives: This studywas designed to determine the risk factors and their association with neural tube defects. StudyDesign: Case control study. Place and Duration of Study: This study was conducted at unit111 Lady Willingdon Hospital Lahore and duration was one year from 1.1.2016 to 31.12.2016.Methodology: A total of 120 mothers were included in the study, of which 30 were having ofbabies delivered with NTDs, matched with 90 mothers delivered babies without NTDs (Threecontrols for each NTD case). Informations were collected on special Performa, data was analyzedon SPSS version 20. Results: Majority of the patients in both groups were found between 31-40 years of age, 43.33 %( n13) in patients with NTD group and 56.67 %( n51) in controls whileonly 16.67% (n5) in NTD and 17.78 % (n16) were found between 21-30 years. The mean agewas recorded as 33.06+1.21 and 32.12+ 0.89 respectively. Regarding parity, 23.33% (n7) werefound between P1-2, 26.67% (n11) were P2-3 while 40% (n12) with Parity >4 in the NTD group,while 21.11% (n19) were p1-2, 37.77% (n 34) with P 3-4 and 41.12% (n37) were P >4 in controlgroup. 86.67% (n 26) were found with poor economic status and 13.33% (n4) were found withrich status in NTDs, while 18.89% (n17) were found with poor and 81.11% (n73) with rich statusin control group. Distribution of fetuses according to their gender revealed that 20% (n6) weremales, and 80% (n24) were females in NTDs while 47.77 %( n43) were found males and 52.23%(n47) were females in controls. Regarding family history 80% (n24) with positive history of NTDsin patients of NTD group and 20% (n6) with no history while 4.44% (n4) had positive history and95.56% (n86) had no familial history of NTD in control cases. About previous history of NTDs,93.33% (n28) were found with positive previous history of NTDs and only 6.67% (n2)with noprevious history of NTDs in NTD group, while only 5.56% (n5) were found with positive previoushistory of NTDs and 94.44%(n85) with no previous history in controls. Conclusions: Poor socioeconomic status, family history and previous history of a baby with Neural tube defects are themajor risk factors.
ACUTE CORONARY SYNDROME;
Authors: Muzaffar Huma , Ahmad Shakeel , Asghar Naeem
Published: August 2021

Objectives: To determine the frequency of raised low density lipoprotein (LDL)cholesterol in patients with acute coronary syndrome. Study Design: Cross sectional study.Setting: Coronary care unit (CCU) and medical wards at Allied Hospital Faisalabad. Durationand Dates: Six months from 01-01-2010 to 30-06-2010. Methods: This was a cross sectionalstudy that included 215 patients fulfilling the criteria of acute coronary syndrome admittingin CCU and medical wards. The demographic details, history and clinical examination of thepatients were recorded and blood samples were collected for the estimation of LDL cholesterol.Statistical Test: Descriptive statistics like mean and standard deviation (S.D) was appliedon age and LDL cholesterol. Gender and type of coronary artery event will be presented aspercentages. Frequency of raised LDL cholesterol was calculated in patients with ACS. Results:In this study population, out 215 patients, 183 (85.1) were found to have raised LDL cholesterollevels. There were 117 (54.4) males and 98 (45.6) females. Mean age was 56.29+- 13.01. Thefrequency of raised level of LDL cholesterol was slightly high in among males. STEMI was mostcommon type of ACS followed by unstable angina and NSTEMI. Conclusions: Frequency ofraised LDL cholesterol was high among the patients with acute coronary syndrome. It supportsthe potential for preventive efforts in persons with high risk of coronary artery disease.
CITRULLUS COLOCYNTHIS
Authors: Faisal Muhammad Saleh , Ali Niaz , Ali Kashif
Published: August 2021

Objectives: To evaluate the methanolic extract of Citrullus colocynthis andits different fractions for possible spasmogenic effects on rat’s ileum model. Study Design:An experimental study. Setting: Department of Pharmacology, Institute of Basic MedicalSciences, Khyber Medical University, Hayatabad, Peshawar. Period: August 2016 to March2017. Methodology: Different fractions i.e n-hexane, chloroform, Ethyl acetate, n-butanol andaqueous fractions of methanolic extract were tried in concentrations of 0.01, 0.03, 0.1, 0.3, 1.0,3.0, 5.0, 10 and 15 mg/ml to identify the portion with maximum spasmogens. Results: Aqueousand n-Butanol fractions showed spasmogenic effects on the spontaneous contractions of rat’sileal preparations at the concentrations of 0.1, 0.3, 1.0, 3.0 and 5.0 mg/ml while at 10 and15 mg/ml, they showed spasmolytic effects. Ethyl acetate and chloroform fractions did notshow significant spasmogenic effects, rather showed spasmolytic effects in rabbit’s jejunalpreparations with respective EC50 values of 0.1283 ± 0.007 mg/ml and 2.703 ± 0.235 mg/ml. Respective EC50 values for spasmolytic effects of Ethyl acetate and chloroform fractionsupon KCl induced contractions were 5.37 ± 0.515 mg/ml and 12.36 ± 1.484 mg/ml. RespectiveEC50 (log [Ca++] M) of ethyl acetate fraction at 1mg/ml vs control were -2.563 ± 0.04 and-2.846 ± 0.035. Similarly, respective EC50 (Log[Ca++]M) in the absence and presence of0.1 μM verapamil were -2.45 ± 0.06 and -1.7 ± 0.07. EC50 (log [Ca++] M) for control vschloroform fraction at 3 mg/ml and 5 mg/ml were -2.95 ± 0.035 vs -3.02 ± 0.03 and -3.06 ±0.0264, respectively. Similarly, respective EC50 (Log[Ca++]M) in the absence and presenceof 0.1 μM verapamil were -2.45 ± 0.06 and -1.7 ± 0.07. Conclusion: Thus, it is concluded thatspasmogens concentrated in the residual aqueous fraction followed by n-butanol fraction whilespasmolytic constituents are concentrated in the ethyl acetate fraction followed by chloroformfraction.