bluuebunny/crossref_metadata_2025 huggingface dataset:
EDUCATIONAL ENVIRONMENT;
Authors: Kamran Rizwana , Al-Eraky Mohamed , Izhaar Faisal , Anjum Khalid Mahmood
Published: August 2021

Objectives: To measure the perceptions of medical students on the learningenvironment in surgical theater of FMH College of Medicine and Dentistry, Lahore, Pakistan.Study Design: Teaching hospital-based cross-sectional study. Setting: Fatima MemorialHospital College of Medicine and Dentistry, Lahore, Pakistan. Period: January 2017 to June2017. Methods: The Mini-Surgical Theater Educational Environment Measure (mini-STEEM)(thirteen items from the STEEM inventory) was used to measure perceptions of medicalstudents on the learning environment in surgical theater. Mini-STEEM was administered tomedical students of fourth and final year during their rotation in surgical theater at FMH Collegeof Medicine and Dentistry. Social Sciences (SPSS) Version 20 was used for non-parametricstatistical analysis. Results: Questionnaire was filled by all 134 students, with a response rate of100%. The mini-STEEM was shown to be a reliable tool to measure overall learning environmentin the surgical theater of FMH College of Medicine and Dentistry. The overall mini-STEEM meanscore was 37.66 which was below the midpoint score (39). Students’ ratings were low for twosubscales, namely: ‘Atmosphere’ and ‘Operating experience. Discrimination subscale showedhigh ratings as no significant differences of perceptions were found between male and femaleparticipants. Conclusion: The medical undergraduates perceived the educational environmentwithin the surgical theater of FMH College of Medicine and Dentistry below satisfactory. Resultsof the study implied that the environment required multiple measures for improvement in thesurgical theater to promote surgical education in undergraduate medical students.
ANKLE FRACTURES;
Authors: Khan Umar Zia , Muhammad Wali , Qureshi Abdur Rehman
Published: August 2021

Objectives: To evaluate the pattern of ankle fractures presented to our regionaltrauma and tertiary care center. Study Design: Prospective Study. Place & Duration of Study:Lady Reading Hospital, Peshawar from November 2016 to October 2017-Twelve months.Methods: The study group included 107 patients with ankle fractures where age, gender,mechanism of injury, presence of closed or open fracture was recorded. The fractures wereclassified according to Lauge-Hansen and Danis-Weber classifications. Medial malleoluscomminution and presence of talar shift was recorded. The pattern of fractures was analyzedand compared with literature. Results: 52.3% sustained these fractures while running/walkingfollowed by road traffic accident in 25.2%. Supination external rotation injures and Weber B werethe commonest followed by supination adduction injuries and Weber A fractures. 25 % of anklefractures were open. 27.1 % showed medial malleolus comminution and talar shift was noticedin 77% cases. Conclusion: We observed high proportion of open and unstable fractures alongwith higher rate of medial malleolus comminution in our patients. High proportion of supinationadduction injuries were recorded which is associated with impaction injury of medial tibialplafond.
PREGNANCY INDUCED HYPERTENSION;
Authors: Jamil Uzma , Mukhtar Anam , Hussain Shaista , Munawar Farida
Published: August 2021

Objectives: To investigate serum uric as an indicator of fetomaternal complicationsin women with late pregnancy. Study Design: Cross sectional study. Setting: Shalamar Medicaland Dental College Lahore ethical committee. Period: One year from October 2016 to October2017. Methodology: Continuous variables were presented as mean and standard deviationlike age and Serum malonaladehyde concentration; categorical variables were presented asnumbers and percentages like intra uterine growth restriction, Mild to moderate and sever preeclampsia and fetal distress. One way ANOVA, independent sample t test and chi square testwere applied to check significance of results, p value less than or equal to 0.05 was consideredas significant. Results: Overall, 100% (n=400) patients were included in this study. The meanage of the patients was 25.81±4.33 years. The age difference was not statistically significant,in groups (p=0.383). The mean serum uric acid levels of the patients for maturity (weeks)36, 37, 38, 39 and 40 was 247.96±2.52 (nmol/l), 253.95±2.04 (nmol/l), 261.19±3.15 (nmol/l),263.95±2.75 (nmol/l) and 296.19±2.55 (nmol/l) respectively. The differences were statisticallysignificant (p=0.000). Fetal distress, number with rising levels were (n=23) 71.8%, number withno change in levels were (n=3) 9.4% and number with falling levels were (n=6) 18.8%. Thedifferences were statistically significant. (p=0.000). Conclusion: The observations of our studyconcluded that serial increase of serum uric acid from 36th week to 40th week was observedin pregnancy induced hypertion patients, and raised serum level of uric acid had significantrelation with fetomaternal complications. like Fetal distress, preeclampsia, and intrauterinegrowth retardation. So serum uric acid can be used an indicator for fetometernal complicationsin late pregnancy.
CONGENITAL GLAUCOMA;
Authors: Hayat Khan Sikander
Published: August 2021

Objectives: To compare the incidence of congenital glaucoma of childrenin Pakistan with the world incidence. Study Type, Setting and Period: Comparative study,conducted at Al Shifa eye hospital Rawalpindi from August 2010 to September 2014. Materialand Method: The record was analyzed of congenital eye anomalies of the children comingto hospital, focusing on congenital glaucoma. Results: There were total five hundreds andfourteen congenital anomalies of eyes (225 females, 289 males). The main bulk of patients werebetween births to two years. The frequency of congenital glaucoma was17 (3.3%) with variablevisual standards. Conclusion: Although the frequency of congenital glaucoma is not alarmingin this study but early management will prevent from permanent blindness.
C-SECTION DELIVERY;
Authors: Jahan Tanvir , Siddiq Arif
Published: August 2021

Objective: To evaluate the common reasons for C/section done at tertiary carehospital and to look into their major determinants, in order to reduce the rate of C/sectiondelivery and its associated mortality and morbidity. Study design: Retrospective, descriptivestudy. Place and duration of study: At Ibn-E-Siena Hospital, the duration of study was 1 yearfrom November 2016 to October 2017. Material methods: The study included 250 patientswho were delivered by Caesarean delivery. All the patients who were delivered abdominallyafter 28 weeks of gestation were included in this study. The women delivered abdominallybefore 28 weeks gestation were excluded from study. Results: The common indications forC/section in this study were previous C/section delivery in 37.6%, oligohydramnios 36%, fetaldistress 12%, hypertensive disorders of pregnancy 7.2%, multiple pregnancy 5.6%, pretermlabour 5.6%, failed progress of labour and bad obstetrical history 4.8% each, placenta previa3.2% and cardiac disease 0.8%. Conclusion: Repeat C-section has become the commonestindications for C-section effort should be put in to reduce the rate of C/section in primigravidas,proper trial of labour should be given, and fetal distress should be properly diagnosed beforegoing for C/section.
CHRONIC BRONCHITIS;
Authors: Saleem Sufyan , Sardar Kashif , Javed Nasir
Published: August 2021

Chronic bronchitis is chronic inflammation of the airways resulting from exposureto noxious particles and gases which is slowly progressive and accentuated by episodes of acuteexacerbation. These exacerbations tend to become more frequent and more severe as the underlyingdisease advances resulting in increased morbidity. More than half of these exacerbations are dueto bacterial infections and use of antibiotics in such cases result in early recovery. Moxifloxacinis a newer fluoroquinolone that is very effective against respiratory pathogens including atypicalorganisms and even in resistant pathogens as compared to beta lactams and macrolides.Objectives: To compare the effectiveness of Oral Moxifloxacin compared with Oral clarithromycinin the treatment of acute exacerbation of chronic bronchitis. Study Design: Randomized controltrial. Setting: Department of Pulmonology Multan Medical and Dental College Tertiary carehospital, Multan. Period: Six months, from October 2017 to March 2018. Materials and Methods:64 patients with acute exacerbation of chronic bronchitis were included in the study. Patientswere diagnosed on history of smoking and chronic productive cough with recent onset increasein shortness of breath, sputum amount and purulence. Patients were divided into 2 equal groupsA and B containing 32 patients each. Group A was given oral clarithromycin 500mg daily for 7days and Group B was given oral moxifloxacin 400mg daily for 5 days. Response to this treatmentwas assessed before treatment and at 14 days by an improvement in both the breathlessnesson Borg dyspnea scale and by decrease in sputum purulence on sputum microscopy. Results:There were 64 patients in our study. Females were 12 (18.75%) while 52 (81.25%) were males.Mean age of the patients was 52. 19 + 6.37 years. Mean number of Pack years was 24.8 + 9.32.Mean age for group A patients was 51.09 + 7.56 years. There were 7 (21.87%) females and 25(78.13%) males. Mean number of pack years was 24.47 + 9.88. Oral moxifloxacin was found to beeffective in 30 (93.75%) patients in comparison with oral clarithromycin which was effective in 27(84.37%) patients (p-value = 0.23). Conclusion: Oral Moxifloxacin is not more effective than oralclarithromycin in the treatment of AECB in our local population of COPD patients.
UPPER LIMB FRACTURE
Authors: Rasool Sajjad , Manzoor Basharat , Amjad Ali
Published: August 2021

Introduction: Upper limb fractures are one of the common fractures presentingin Accident and Emergency departments. Some of the upper limb fractures need openreduction and internal fixation. Use of suction drains after upper limb surgery is still debatableissue. Some surgeons routinely use, others never use and few occasionally use. Objectives:Aim of this study was to compare the results of upper limb fracture surgery by using or not usingthe suction drains. Design: Quasi Experimental Design. Settings: Orthopedic department AzizBhatti Shaheed Teaching Hospital Gujrart. Period: From December 2015 to November 2016.Method & Material: Total 120 patients were selected as per selection criteria. In 60 patients weused suction drain post-operatively & remaining 60 patients without Suction drain. Results:In our study we selected 120 patients .Patients divided in two groups. In group A 60 patientsincluded in the study. We did not use suction drain in these patients. In group B we also selected60 patients of upper limb fractures. We used suction drain in these patients. We compared theresults of both groups on the basis of superficial wound infection and pain. In group A, sixpatients developed superficial wound infection while four patients developed superficial woundinfection in group. There was no difference in severity of pain in both groups. Conclusion:We concluded from our study that there is no added advantage of suction drain in upper limbfracture surgery.
PROCEDURAL SKILLS;
Authors: Ul Haq Inam , Jamil Brekhna , Durrani Misbah
Published: August 2021

Objective: To compare the effectiveness of Directly Observed ProceduralSkills (DOPS) and Traditional Method of Learning of Procedural Skills in Ophthalmology atundergraduate Level. Setting: Armed Forces Institute of Ophthalmology Rawalpindi. Period:Nov 2015 to June 2016. Study Design: It is an interventional study and is based on randomizedpre and post-test comparison of DOPS with Traditional method of teaching & learning proceduralskills. Methods: After obtaining informed consent; a batch of 40 students were equally assignedto interventional and non interventional study groups through stratified randomization. TheObjective Structured Clinical Examination (OSCEs) was used as data collection instrument aftervalidation. Pre and post test were taken from both groups before and after intervention. Thedata were analyzed using SPSS version 20. Results: By comparison of means of post test oftwo groups it was found that Post test torch examination traditional group had a mean of 5.35and post test mean of DOPS group was 6.80 with a p value <0.05 which was significant. Posttest Fundoscopy had a mean of 4.70 in traditional group and post test mean DOPS group was6.50 with p value < 0.05. Conclusion: There is significant difference between the two groupsand the students in DOPS group performed better than their counterparts in traditional group.
NUTRIENT FORAMEN;
Authors: Hussain Anwaar , Khalid Jawaria , Rauf Abdul
Published: August 2021

Objectives: To study the nutrient foramina of the dried human clavicle with respectto their position, number and direction for clinical interest. Study Design: Cross sectional study.Setting: Anatomy Department Faisalabad Medical University Faisalabad. Period: Six monthsfrom July to December 2017. Material and Methods: 60 dried human clavicles taken frombone bank of Anatomy Department Faisalabad Medical University Faisalabad. The foraminawere studied according to their location, and number and direction. The foramina index wascalculated using Hughes Formula by measuring the average total length and average lengthof foramina from sternal end of the clavicle. Results: The nutrient foramen was observed in all60(100%) of the clavicle. Single foramen was present in 22 (36.6%) clavicle and double foramenin 30(50%) clavicle. Triple and quadruple foramen in 6(10%) and 2(3.3%) clavicles respectively.The 34 left clavicles posses single foramen 12 (41.1%), double foramen 14(35.2%) while tripleand quadruple are 6(17.6%) and 2(5.8%) respectively. Total 26 right clavicles had 10 (38.4%)single foramen and 16(61.5%) double foramen. Total number of foramen in all 60 clavicleswere 108 of which 61.1% are located on posterior surface of the clavicle, 27% were found oninferior surface and rest 11.1% were on anterior surface. The clavicle having more than oneforamina are 28 out of which 64.2% was having both inferior and posterior foramina, 21.4 % wasanterior and posterior while 14.28% was located on triple sites anterior, inferior and posterior.We also found 90% of foramina were present on middle 1/3 and 10% on lateral 1/3. 98.3% ofthe foramina were directed to acromial end while rest 1.7 % to sternal end. The mean length offoramina from sternal end is 7.46 cm and mean maximum length of the clavicle was 14.51cm.The mean foramina index was 51.41. Conclusion: It is concluded from the study that most ofthe foramina are located on middle 3rd of the clavicle the commonest site of the fractures of thebone. Most of the foramina are located on the posterior surface denoting its blood supply fromthe neighboring blood supply. The knowledge of the foramina and its blood supply is importantfor fracture healing and bone grafting.
PROFESSIONALISM;
Authors: Latif Muhammad Zahid , Hussain Intzar , Nizami Rahila , Khan Muhammad Athar
Published: August 2021

Medical professionalism is an ethical phenomena which is based on therequirements about competence, truthfulness and high moral values during the practice ofmedicine. It develops the foundation of the trust between doctor, patient and the society. It isrobustly associated with concepts of social responsibility and accountability. There is a needto study the concepts of professionalism in the context of cultural diversity related with crosscultural believes, values and attitudes. The conflicting values of different cultures may affectthe perception about professionalism in the local and global context. Medical educationalistsare facing the challenges of teaching professionalism due to the explosion of informationtechnology and globalization. Similarly the rapid privatization of medical education in Pakistanhas raised versatile issues related with medical professionalism. This article reviews the relevantliterature regarding professionalism and medical education in the context of Pakistan.
DEPRESSION;
Authors: Gul Ejaz , Khan Muhammad Muslim , Azeemi Mukhtiar , Muneeb Pirzada Muhammad
Published: August 2021

Depression is a common problem among women. Different variables contributein influencing depression among women. Menopause is one variable that may trigger symptomsof depression. Different variables jointly contribute in influencing the presentation of menopausalsymptoms including sociocultural, psychological and environmental factors. No studies havebeen conducted to assess mean age and symptoms of depression among menopausalwomen of Mardan. Objectives: To assess accompanying symptoms of depression and theirseverity among menopausal women. Study Design: Cross-sectional study. Setting: GynaeOut-patient Department at Mardan Medical Complex. Period: February 2017 to October 2017.Methods: The sample consisted of 200 women ranging in age from 45-71 years. Each patientwas assessed using sociodemographic sheet, menopausal symptoms were assessed usingMenopausal rating scale and severity of depression was measured using Hamilton depressionscale. Data was entered and analyzed using SPSS Version 21.0. Results: According to thefindings of this study, mean age at menopause was noted to be 49.1 ranging from 44-59. Amongthe many predominant menopausal symptoms, the most common among these symptomsreported were joint and muscle discomfort in 62% of women, followed by sleep problem (17%),and physical and mental exhaustion (11%). The least reported menopausal symptoms weredrying of vagina, sexual problems and anxiety. Depression was found among 26 % of thefemale participants according to Hamilton scoring criteria. Mild depressive symptoms werenoted among 24%, moderate depressive symptoms 14%, severe 5% and very severe 7%.Conclusion: According to the results of the current study, 50 % of the participants lies in therange of depression according to Hamilton depression scores. Among these 50%, more thanhalf 26 % lies in the range of severe to very severe depression while the rest 24% lies in therange of mild to moderate depression.
DIABETIC KETOACIDOSIS;
Authors: Hassan Khan Muhammad Imran , Mushtaq Junaid , Amjad Ibtesaam , Haque Toor Israr ul , Nabi Tayyab Ghias un
Published: August 2021

Objectives: To observe the frequency, precipitating factors and outcome ofdiabetic ketoacidosis (DKA) in adults with established and newly diagnosed type 1 diabetesat a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore GeneralHospital, Lahore. Period: From January 2013 through December 2015. Methods: Patients whowere admitted with a diagnosis of DKA. The clinical presentations, laboratory investigations,management, time of recovery and outcome were compared. Data were collected viaretrospective chart review. Results: A total of 202 patients were included who fulfilled the criteriaof DKA, of which 160 (79.2%) were less than 26 years of age with a male predominance of 156(97.5%). Out of all cases 72 (35.6%) had established Type 1 diabetes and 130 (64.4%) werenewly diagnosed. The most common presenting complaints in both groups were sepsis 105(52%). The comparison of clinical improvement and laboratory investigations between the twogroups showed that newly diagnosed Type 1 diabetes patients had lower pH, low bicarbonateand high BSR at presentation as compared to those with established type 1 diabetes. Thepatients with established diabetes improved earlier, required lesser duration of intravenousfluids and IV insulin was changed to subcutaneous in less time. Hospital stay of more than 7days was observed in patients with new diagnosis. Conclusion: It can be concluded from theabove data that earlier diagnosis of type 1 diabetes mellitus, appropriate treatment, regularscreening for complications and infections will result in less hospital admissions and betteroutcome.
CAESAREAN SECTION
Authors: Naeem Ayesha , Anwer Ashba , Sajjad Saadia
Published: August 2021

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.
MOLAR EXTRACTION
Authors: Qureshi Shahzad Waheed , Siddiqui Maha , Amin Gulrez , Liaquat Aliha , Chaudhary Sundas
Published: August 2021

Introduction: Dry socket (DS) or Alveolar osteitis (AO) is a common postextraction complication in third molar removal. Various techniques have been used to reducethe risk of DS. Objectives: To evaluate the effect of Chlorhexidine (CHX) gel in preventing thedevelopment of DS. Study Design: Randomized double blind case-control study. Setting: Oraland Maxillofacial Surgery Department of University College of Dentistry(UCD), The Universityof Lahore, Pakistan. Period: July 2017 to December 2017. Methodology: Patients havingimpacted mandibular 3rd molars selected for surgical extraction. Randomly selected one groupconsisted of 30 patients received CHX gel and the other group again of 30 patients consideredas the control. The outcome variable was formation of DS and the predictor variable was CHXgel application. Data were processed using chi-square test with the confidence interval of95%. Results: 60 cases (39 females and 21 males) with average age of 22 years ± 5 yearsunderwent 3rd molar extractions. Total 09 sockets (15%) developed DS. The frequency of DS inCHX gel (2 cases, 6.7%) was significantly lower than control (7 cases, 23.3%) (P-value < 0.05).Conclusion: CHX gel can reduce the risk of development of DS after mandibular 3rd molarsurgical extraction.
VENTILATOR-ASSOCIATED PNEUMONIA
Authors: Zubair Saba , Ali Huma , Zafar Farya , Raza Syed Faheem , Ashraf Irfan , Warind Javaid , Beg Anwer Ejaz , Rizvi Mehwish , Nisa Zaib-un- , Naqvi Ghazala R. , Tariq Anum
Published: August 2021

Background: Patients associated with VAP having mortality rates range from 20to 50% and this may extend up to 70% when multi-resistant and invasive pathogens accountablefor infection, however, VAP is also interrelated with noteworthy rate of morbidity, extendedperiod of stay in ICU, protracted MV, and augmented hospitalization cost. Objectives: To reviewthe risk factors, incidence and transience rate of mortality for ventilator-associated pneumonia.Design: Prospective and cross sectional way. Period: From April 2016 to December 2016.Setting: Different Tertiary Care Institutes of Karachi, Pakistan. Method: A structured datacollection form was prepared to record the information and validated using spearman correlationcoefficient and Cronbach’s α value. Value of α = 0.902 and p = 0.913 have revealed the suitabledegree of reliability and uniformity. Data was collected with respect to gender, age, antibioticutilization record, and main diagnosis outcomes. Microbiological basis of ventilator-associatedpneumonia was assessed using patient lab record for rate and seclusion of organism. Results:In this study a detail of significant virulence factor articulated by these microorganisms hasbeen depicted. Statistically insignificant differences were observed among the groups withrespect to clinical and demographic characteristics like mean age, gender, infection severityscores (SOFA, MODS, CPIS and APACHE II), immune status of patients and type of the casesincluding surgical or clinical scenario. 39.3% patients developed early onset while 60.6% ofcohort was observed with late onset of VAP. Conclusion: The precise microbial source of VAPare numerous and diverse. The realistic challenge at the present time is to portray the authenticapproximate of the clinical consequences associated with VAP. Henceforth such investigationsmay be supportive in origination of the most favorable institutional antimicrobial strategy toreduce the associated complications of this threat.
FRESH FROZEN PLASMA
Authors: Khan Muhammad Asim , Khan Maryam Alam , Dar Aneela , Maroof Syed Asad , Zarin Mohammad , Muqim Rooh ul , Ullah Najeeb
Published: August 2021

Introduction: As the use of Fresh Frozen Plasma (FFP) is having establishedcomplications including Allergic reactions, infectious complications, hemolysis, fluid overload, transfusion related acute lung injury (TRALI) and immune suppression, therefore it mustbe used cautiously. Objectives: To evaluate the inappropriate use of FFPs, to carry out anaudit of appropriateness of FFP transfusion with reference to international guidelines and setfoundations for blood bank and transfusion protocols. Study Design: Cross sectional study.Setting: Khyber Teaching Hospital Peshawar. Period: 6 months, 1st January 2016 to 30th June2016. Methods: During which FFP transfusion requests made to the blood bank by various unitsof the hospital were studied including general surgery, surgical ICU, general medicine, medicalICU, gynecology and obstetrics. Seventy Six requests were received that were judged using6 variables: indication for FFP use, sampling errors, laboratory analysis errors, interpretationerrors, dosage of FFP (number of units being transfused) and timing of FFP transfusion. Scoreof “1” was given for each correct variable. After matching data to the international protocols, ascore of 4-5 was taken as appropriate and <3 was classified as inappropriate. Results: TwentySeven (35.5%) FFP transfusions were done with a score of 4-5 and were considered appropriatewhile 49(64.5%) FFP transfusions were given a score of 3 or less and were consideredinappropriate. Conclusions: Almost two third of FFP were used inappropriately in our hospital,the commonest indication being acute Disseminated Intravascular Coagulation (DIC) andmostly requested from surgical units. Maximum cases of inappropriate transfusions were dueto wrong sampling techniques and wrong dosage calculations. Most inappropriate transfusionswere done in MICU. It is recommended that annual clinical audit of all blood products usageshould be conducted. Local guidelines for physicians and training programs for nurses andparamedics regarding proper use of blood products should be established.
CHRONIC KIDNEY DISEASE
Authors: Mal Pooran , Ahsan Muhammad Nadeem , Bukhari Mehwish , Junejo Abdul Manan
Published: August 2021

INTRODUCTION:Chronic kidney disease (CKD) is a progressive health care issue that is increasing cost burden on patients and health care system. In different researches it was concluded that relatives of patients suffering from CKD are at more risk of development of kidney problems and diagnosed with CKD. OBJECTIVE: To evaluate the early diagnosis of CKD in at risk population by screening the close family relatives of CKD patients. PATIENTS AND METHODS: A cross-sectional screening study of family members of CKD patients performed in Nephrology department of Jinnah Postgraduate Medical Centre (JPMC), Karachi from September 2015 to January 2017. Total 200 relatives (58% male and 42% female) of CKD patients close relatives  were enrolled and screened for medical history, physical examination (weight, height and BMI) and clinical investigations such as urine analysis,  serum Creatinine  and Glomerular filtration rate (GFR)  calculated by Cock GraftGault equation for assessment of renal functions.RESULTS: we observed53 abnormalities in relatives of CKD patients. Family history for Diabetes was present in 58(29%) relatives, Hypertension in 42(21%) relatives,  26 (13%) relatives with Glomerulonephritis (GN), and 74 patients (37%) with Tuberculosis (TB), Kidney damage and Stone diseases. Albuminuria was high in 33% relatives of CKD patients, mostly affecting first degree relatives 20.5% as compared to second degree relatives 2.5%. Relatives of CKD patients were diagnosed with high albuminuria in DM (36.2%) as compare to HTN (35.8%) and GN (27.0%).  For final diagnosis, albuminuria and CrCl were monitored, that were found abnormalin 26.5% relatives of CKD patients.CONCLUSION:The screened relatives of CKD patients are at higher risk of kidney problems in the future, especially patients suffering from DM, HTN and GN.
RHEUMATOID ARTHRITIS
Authors: Malik Arif , Ansari Umar Saeed , Aslam Bushra , Aslam Nighat , Shafique Hassan , Waquar Sulayman
Published: August 2021

Objectives: Assessment of upstream levels of lipid peroxidation and DNAdamage regulating the development of rheumatoid arthritis. Data Source: All the sampleswere collected from Jinnah Hospital Lahore. Study Design: Comparative cross sectional study.Period: Two years from 18-09-2014 to 24-10-2016. Setting: The Institute of Molecular Biologyand Biotechnology (IMBB) in The University of Lahore-Pakistan. Material and Methods:Blood, saliva and synovial fluid of fifty (n=50) individuals diagnosed with Rheumatoid Arthritisand fifty (n=50) age-sex matched controls were added in current study. Levels of MDA weredetermined spectrophotometrically while the concentrations of isoprostanes, 8-OHdG and4-HNE were measured by the help of commercially available Elisa Kit. Results: Levels oflipid peroxidation products including MDA (μmol/ml), isoprostanes (pg/ml), 4-HNE (μmol/ml)and DNA damage in the form of 8-OHdG (pg/ml) were significantly high (p<0.015, p<0.022,p<0.004 and p<0.036) in patients as relative to normal individuals. Levels of MDA in serum(1.95±0.094 vs. 0.95±0.019), saliva (0.012±0.0034 vs. 0.056±0.0056) and synovial fluid(3.26±0.65 vs. 0.019±0.0016) were differed significantly in each groups. Level of isoprostanesin serum (12.26±5.26 vs. 1.26±0.015), saliva (2.16±0.019 vs. 0.816±0.017) and synovial fluid(34.26±4.26 vs. 0.136±0.019) were recorded higher in RA patients as compared to control.Concentrations of 8-OHdG in serum (0.945±0.014 vs. 0.019±0.0035) saliva (0.0024±0.0003/0.0029±0.00017) and synovial fluid (1.33±0.451 vs. 0.055±0.0016) were recorded high in RApatients. Significantly higher concentration of 4-HNE in serum (4.265±1.25 vs. 1.99±0.016),saliva (1.26±0.15 vs. 0.191±0.0091) and synovial fluid (6.35±1.16 vs. 0.094±0.00165) wererecorded in patients with RA. Conclusion: Present study concluded the role of oxidativebiomarkers and their differential expression in the onset of autoimmunity in patients with RA.Increased stress is involved in the DNA damage and increased lipid peroxidation in the synovialfluid. Therefore, antioxidant therapy may have some prognostic role in the patients with RA bydecreasing the intensity of oxidative stress and DNA damage.
ACUTE HEART FAILURE
Authors: Din Jasia Reham , Maqbool Shahid , Rehman Shakeel ur , Hameed Naeem
Published: August 2021

Objectives: To determine the frequency of the major precipitating factorsamong the patients presenting with acute heart failure. Study Design: Cross sectional study.Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: July 2014 to January 2015.Materials and Methods: 190 patients of acute heart failure were included after obtaininginformed consent from emergency department. Patients from age of 25 years to 80 years andof either sex either diabetic or non-diabetic were enrolled in study. ECG and CXR were takenin emergency with baseline investigations. Precipitating cause was identified from collectedhistory, clinical examination and ECG, CXR and lab results. Results: Mean age of these patientswere 54.4 + 8.92, 100 (52.6%) were male, 90 (47.4%) were females, 88 patients (46.3%) werediabetic, 102 patients (53.68%) were non-diabetic and 124 (65.3%) had previous history of heartfailure and 66 (34.7%) had no past history of heart failure. ACS was the common precipitatingfactor of Acute Heart Failure ( 31.57% ) among all the patients of the study with non-complianceof drugs 27.9% , arrhythmias 17.9% uncontrolled hypertension 17.36% and infections 5.3%.Conclusion: Young, male, diabetics and patients with history of chronic HF suffered more fromAHF. ACS was the most common precipitating factor while in patients with de novo Acute HeartFailure; it was ACS and non-compliance with drugs.
BETA THALASSEMIA
Authors: Ahmed Iqbal , Sadiq Muhammad Ammar , Arshad Umair , Haq Hafiz Muhammad Anwar ul , Tabassum Sobia , Sabir Arshia , Haq Muhammad Ejaz ul
Published: August 2021

Background: Inadequate Blood Transfusion is responsible for various problemsin children with Thalasseima. On the other hand, repeated transfusions are related with hazards.About 25-50% of the children with thalassemia major have impaired glucose tolerance (IGT)or diabetes. Objectives: To find out the frequency of IGT in children with blood transfusiondependent β thalassemia. Study Design: Descriptive analytical study. Setting: Department ofPediatrics, Shahida Islam Teaching Hospital, Lodhran. Period: 1st July 2017 to 31st December2017. Material and Methods: Known 120 cases of beta Thalassemia major children between3-17 years of age that were regularly transfused. Demographics, disease history and personalinformation regarding all the patients were collected. Glucose tolerance test was performedand Serum ferritin levels were measured. Results were analyzed by SPSS software version20.0. Results: There were 78 (65.0%) children between 3-10 years and 42 (35.0%) between11-17 years. There were 70(58.3) male and 50 (41.7%) female. Frequency of impaired glucosetolerance was noted in 15 (12.5%). Conclusion: Frequency of IGT is high amongst children withthalassemia major having regular blood transfusions.
DIABETES MELLITUS
Authors: Hafeez Arsalan , Rehman Kashif , Rehman Aqib , Ch Abdul Hafeez
Published: August 2021

Background: Diabetes mellitus is associated with significant morbidity andmortality worldwide and Pakistan is no exception. Objectives: To determine the morbidity andmortality in patients admitted with Diabetes Mellitus in a teaching hospital of Pakistan, throughretrospective analysis of admission and patient file records. Study Design: Retrospectivelyanalyzed. Setting: Independent University Hospital, a Teaching Hospital, Faisalabad. Period:1st January 2016 to 31st December 2017. Patients and Methods: Data included age, gender,total numbers of admissions and those due to Diabetes Mellitus, the indications for admissions,presenting symptoms and method of diagnoses in diabetic patients, mortality rates and causesof death. Data obtained were analyzed using chi square. Results: Out of 10490 medicaladmissions, 5706 (54.4%) were males and 4784 (45.6%) females. Diabetes was detected in 1450(13.8%) patients [810 (55.9%) males, 640 (44.13%) females]. The mean age of diabetic patientswas 53.6+16.1 years (range 18 – 94 years). Poor glycemic control (29%) and diabetic footsyndrome (23.4%) were the most common reasons for admission in diabetic cases. The overallmortality rate among medical admissions was 21.8%, with diabetes accounting for 6.7% deaths.Within the cohort of diabetic cases, mortality was 15.9%, with significantly higher mortalityin those aged > 65 years (p < 0.05). The most common causes of death in diabetic caseswere cerebrovascular disease and complications associated with the diabetic foot syndrome,accounting for 26.1% and 21.7% of deaths respectively; the least common causes of death indiabetic patients were pulmonary tuberculosis, meningitis, malaria and hepatic encephalopathyaccounting for 4.4% of deaths. Conclusions: Cerebrovascular disease was the most frequentcause of mortality among admitted diabetic patients with diabetic foot syndrome (a preventablecomplication) as the second most frequent cause of mortality. Increased screening for diabetesmellitus morbidities in the clinic and community settings and adequate health education isrequired to reduce morbidity and mortality associated with diabetes mellitus.
MEATAL STENOSIS
Authors: Khan Firdous , Khan Ihsanullah , Shah Syed Asif , Tahir Muhammad , Hayat Waqas
Published: August 2021

Background: Hypospadias is one of the most common congenital anomaliesoccurring in males. It is a condition in which the urethral opening, called urinary meatus, doesnot form completely to the tip of the penis. Instead, this opening may be located anywhere alongthe penis. Incidence rates of hypospadias differ greatly by urologic centres. Studies reported0.4% (1/250) to 0.8% (1/125) incidence rates in all newborn male infants. This study will help usfinding the complications, mainly meatal stenosis, after repairing distal hypospadias as well asthe surgical procedures preferred by our Pakistani surgeons for it. Objectives: To determinethe frequency of meatal stenosis after two stage Bracka’s technique procedure repair for distalpenile hypospadias. Study Design: Descriptive study. Setting: Department of Plastic Surgery,Hayatabad Medical Complex, Peshawar. Period: 1st June 2014 to 31st May 2015. Methodology:All male patients ranging from 1-20 years old, patients with distal penile hypospadias withoutchordae since birth were included. Along with meatal stenosis after Bracka repair procedurefor distal penile hypospadias was recorded on a predesigned proforma. Results: In this study53.4% patients were in age range 1-5 years, 34.7% patients were in age range 6-10 years,10.2% patients were in age range 10-15 years. Mean age was 6.17 years with SD ±3.34. Inwhich 11.4% patients had meatal stenosis while 88.6% patients didn’t had meatal stenosis.Conclusion: Our study concludes that the frequency of meatal stenosis in our setup was 11.4%after two staged Bracka repair for distal penile hypospadias.
NASAL POLYPS
Authors: Ahmad Waseem , Iqbal Muhammad , Amin Gohar
Published: August 2021

Background: Nasal polyposis is a provocative situation of indefinite etiology thatinvolve nasal as well as sinus mucous membrane. Quality of life of a person can damage by nasalimpediment due to these nasal polyps. Further, it can cause of persistent postnasal drainage,hyposmia, sinusitis, taste sense change even bony demolition. It shows that inflammationreason a reactive hyperplasia of intra-nasal mucosal membrane resulted in the polyp formation.Objectives: To discover the kind of fungus concerned in nasal polyps fungal. Study Design:Descriptive study. Setting: ENT department of Sir Ganga Ram Hospital Lahore. Period: 1stJanuary 2017 to 30th June 2017. Materials and Methods: In microbiology department, thesecollected samples were processed to check the involvement of fungal. Out of all, 118 caseswere included in this study which culture was positive. Increase for microscopic assessment,mycological culture to determine the involvement of fungal and fungus kind, these sampleswere processed for diagnosis by potassium hydroxide (KOH). By using seaboard dextroseagar at 25ºC and 37ºC the fungal culture was done. Periodically it was identified through culturecharacteristics & microscopy if growth was present. Results: In this study, 118 culture positivesamples were included. In 82 cases Aspergillus Spp. was observed among positive specimens;In 32 samples Aspergillus flavus was observed while in 10 samples Aspergillus fumigates wasfound and species was not cleared in 40 samples. The fungal element was isolated in 36samples but genus was not determined. Conclusion: In fungal nasal polyposis, AspergillusSpp. is very general pathogen and we observed in our study that Aspergillus flavus is verycommon agent.
ARTERIOVENOUS FISTULA CARE
Authors: Iqbal Qura Tul Ain , Shareef Amna , Afzal Aurangzeb , Ashraf Sania
Published: August 2021

Objectives: To determine knowledge, attitude and practice regarding AV fistulacare in patients of end stage renal disease on hemodialysis. Study Design: Cross sectionalstudy. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by usingself-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: Thestudy included about 141(consecutive sampling) patients of chronic kidney disease using AVfistula for hemodialysis. Data was collected using self designed questionnaire. Data analysiswas done using SPSS version 22. Result: The most well- known precautionary measures to betaken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on thearm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge wasseen to be particularly deficient about the measures to be taken in case of swelling. The attitudetowards AV fistula care was observed to be positive, majority of our study population claimed tofollow maximum precautionary measures most of the time, but percentage of practicing doesnot coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevationof limb in case of swelling, observed by only 36.9% of our study population. Conclusion:Knowledge regarding fistula care was adequate about most of the precautionary measures,most of the participants showed positive attitude towards practicing precautionary measures forfistula care, but number of patients actually practicing these precautions is less than the numberof patients that have knowledge about them.
SYNOVIAL OSTEOCHONDROMATOSIS
Authors: Zakir M. , Tauqir Javed , Munawar Faiza , Munawar Saman , Rasool Nadir , Gilani Syed Amir , Ahmad Tauqir
Published: August 2021

The shoulder joint trauma after one to two years usually induces growth ofits traumatic separated articular cartilage pieces, which sometime further deteriorates intoan uncommon condition termed as SOC (Secondary synovial osteo-chondromatosis).Objectives: Is to determine the secondary osteochondromatosis of shoulder joint by itsspecific differentiating features in history, skiagram, sonogram, MRI and microscopic findingsof tissue of the affected joint. Methods: A male of 34 years with complaint of pain, stiffness anddecreased range of movement in left shoulder joint came to an adult orthopedic outdoor unit,Shalimar Hospital, Lahore, Pakistan and admitted in the orthopedic unit 3 for treatment. Afterphysical /clinical examination, Skiagram, sonogram and MRI of the patient’s affected shoulderjoint were performed by the Radiology department and diagnosed as secondary variety ofosteochondromatosis of the shoulder joint. Its nodules excised through arthroscopy wereexamined histopathologically and found to contain fragments of articular cartilage with ringof calcification. Conclusion: MRI imaging as compared to other medical imaging modalitiesis more precise in estimating diagnosis of secondary osteochondromatosis. However thediagnosis of this disorder is counter confirmed by presence of loose bodies of hyaline cartilageencircled by calcification lamellae on histopathological examination.
POLYORCHIDISM
Authors: Arshad Muhammad , Manzoor Muhammad Arshad , Arshad Zimar , Arshad Talia
Published: August 2021

Polyorchidism is a very rare anomaly that is defined by the presence ofmore than two testes. Knowledge about the condition and accurate imaging diagnosis andcharacterization is important to decide the optimal line of management and avoid unnecessarysurgery. A 14-year-old male reported for Scrotal Color Doppler Ultrasound with complaint ofa painless mass in the left scrotum with no history of trauma. On physical examination, therewere two palpable, ovoid, mobile, non-tender masses in the left hemiscrotum. Scrotal ColorDoppler Ultrasonography (USG) revealed a well circumscribed supernumerary testicle in theleft scrotum adjacent to superior pole of left testis with parenchymal echogenicity and dopplervascularity like that of normal testis parenchyma. In conclusion, diagnosis was polyorchidismwith duplication of the left testicle. The patient was advised follow-up after one-year. USG is themodality of choice to assist in the diagnosis.
ISLAND FLAP
Authors: Ali Hayder , Wahab Noor ul , Ahmed Sufyan , Ul Khair Huzaifa Saeed , Pervaiz Mujtuba , Ali Syed Muhammad , Rao Masood Hussain , Ganatra Muhammad Ashraf
Published: August 2021

Objectives: To determine the role of Supraclavicular Artery Island Flap as analternate to local and other regional flaps for complex soft tissue reconstruction of head and neckdefects created by tumor resection, fire arm injuries, and burns. Study Design: A descriptiveclinical experimental study. Place and Duration of Study: From December 2014 to November2017, at Department of Plastic & Reconstructive Surgery, Dow University of Health Sciencesand Dr. Ruth KM Pfau, Civil Hospital Karachi, Pakistan. Methodology: Pedicle supraclavicularartery island flap was used to reconstruct facial soft tissue defects. Recipient and donor siteoutcomes, functional consequences and complications were assessed. Patients with soft tissuedefects either due to tumor extirpation and supraomohyoid neck dissection, trauma due tofirearm arm and burn were included. Patients with level IV neck dissection or having scarred orinjured supraclavicular areas were excluded. Results: Eighty-Four Supraclavicular Artery Islandflap reconstructions were performed for the reconstruction of lower face defects. Mean age ofpatients was 40.7 years. Through-and-through defect involving the oral lining and skin of thelower face after tumor excision in 78 cases, fire arm injury and burn was the cause in3patientseach. Complete flap failure was 3 (3.5%) and partial flap failure was in 6 (7.1%) patients. Meanperiod of follow-up was 11.86 months (range 7-19 months). Conclusion: Supraclavicular ArteryIsland Flap is an excellent alternate to other local and regional flaps with impressive recovery,acceptable skin color match and restoration of anatomic function at recipient site without anyserious complications. Majority of donor sites were closed primarily, and healed without anymajor complications.
PILONODAL SINUS
Authors: Jamali Abdul Hakeem , Ghumro Ali Akbar , Ghumro Altaf Hussain
Published: August 2021

Objectives: Pilonidal sinus is chronic inflammatory condition that usually affectyoung adult population, despite the current medical advances in the field of medical sciences.The acceptable management of pilonidal sinus is still lacking. This study evaluates the outcomeof pilonidal sinus after excision of the whole tract then its closure with a Z plasty technique whichis a simple cleft lip repair like method which provides a quick and comfortable remedy. Design:A seven years retrospective study. Setting: Surgical Department of Peoples Medical CollegeHospital (later University) and at Private Medical Center at Nawabshah. Period: January 2010to March 2017. Methodology: A total of 55 patients suffering from pilonidal sinus were admittedat both sites from the outdoor department. All the data were collected from the admitted recordand proforma. All required investigations were done. Excision of sinus followed by Z plastyclosure were done in a single stage with drain put by separate stab on one side of the wound.Results: Out of total 55 patients 41 (74.5%) patients recovered smoothly while 6 (10%) patientsdeveloped major wound disruption, 3 (5.45%) patients developed minor wound disruption and5 (9.09%) developed wound dehiscence. Conclusion: Primary closure of pilonidal sinus with Zplasty technique is technically a simple closure method which provides a comfortable closurewith minimum results of wound disruption and dehiscence. Healing is rapid due to comfortableapproximation of the wound flaps and thus avoids the problem created in simple closuretechnique. It can be applicable with every type of patients from heavy build to thin build type.