bluuebunny/crossref_metadata_2025 huggingface dataset:
IRON DEFICIENCY ANEMIA:
Authors: SIDDIQUI SAEED , HAYAT ATIF SITWAT , SIDDIQUI M. KHALID , Atif Naila , Shah Hamayun
Published: September 2021

Objectives: To estimate the frequency of iron deficiency anemia in a sample of population of pregnant women residingpermanently at high altitude of ≥5000 feet in different areas of district Abbottabad. Study Design: Cross sectional Study. Place & duration ofStudy: Northern Institute of Medical Sciences Abbottabad: From 17 August 2009 to 15 June 2010. Subjects and Methods: This study wascarried out on hundred pregnant women residing permanently at an altitude of ≥5000 feet above sea level in district Abbottabad. The agerange was fixed to 15-45 (child bearing age ) years. Suspected study participants having anemia were tested for iron status by serum ferritintest. Pregnant women having both anemia and iron deficiency were labeled as patients of Iron deficiency anemia. Results: The age range was15-41 years with a mean of + / - SD of 28.13 + / - 6.61. All women were of low and middle socioeconomic class with 74 % illiteracy. 60 % of womenhad birth spacing of two or less than two years. 64 % of pregnant women had three children. Anemia was detected in 74 % (X2 =9.42 p > 0.05),iron deficiency in 66 % (X2 = 14.76 p <0.01) and iron deficiency anemia in 60 % (X2 = 13.56 p < 0.01). Conclusions: High altitude residentpregnant women remain at high risk of developing iron deficiency anemia because of illiteracy, poverty and ignorance. With adequate nutritionand health education the problem can be addressed effectively.
PREVENTIVE MEDICINE DEPARTMENT;
Authors: BHATTI MUHAMMAD AYAZ , RAHMAN MAHMOOD UR
Published: September 2021

Objectives: To measure the current status of preventive activities in civil and military hospitals. To compare the quantum ofpreventive and curative activities in the hospitals. To make recommendations for promotion of preventive activities to reduce the curative burdenfrom the hospitals. Study Design: This was a cross-sectional study. Sampling Technique: Universal sampling. All the major military and publicsector hospitals having bed strength more than 400 in Rawalpindi were included in the study. All the preventive and curative work was taken intoaccount. Methodology: A structured questionnaire was developed and data regarding the quantum of work was collected from all the fourmajor Military and civil hospitals having bed strength more than 400 beds through registers and annual reports of the hospital and was analyzedin the form of frequencies, tabulation, cross tabulation, percentages and was displayed in tables and graphs using SPSS (10.5), Microsoft Exceland calculus. Results: Only seven percent work is preventive and ninety three percent is curative. In the preventive activity MH is marginallyhigher than the rest of the hospitals. In all the hospitals among the preventive activities 31% are antenatal visits, 20 % tetanus toxoid injection,19% BCG, Growth monitoring 13%, Measles injection 11% and family planning 6% in all the hospitals. Ante natal activities in the army sectorhospitals are more prominent 39-44% and also in the public sector 17-26%. Next to the antenatal are tetanus toxoids to pregnant ladies whichrange from 16-35% in military and 16-20 % in the public sector hospitals. Growth monitoring is more efficiently carried out in the RawalpindiGeneral Hospital i.e. 17% while in others 7-12%. Family Planning services are delivered very poorly only 9% in RGH and 6% in DHQ, zero % inCMH and 5% in MH. Measles vaccination is carried out efficiently in DHQ 27%, 11% in RGH and 8% in MH and again poorly 3% in CMH. BCG is27% in DHQ, 20% in MH, 17% in RGH and 10% in CMH. Conclusions: The study show that hospitals are showing very poor performance inpreventive aspect and this is the reason that countries like Pakistan are facing economic burden on the national exchequer and this burden willkeep on increasing if no appropriate action is taken.
SMOKING;
Authors: ANJUM MUGHEES , SHAHID KHALIL AHMED
Published: September 2021

Introduction: World Health Organization estimates that approximately 5 million people die each year world wide from Tobaccorelated diseases. Cigarette smoking is the commonest form of tobacco and is incidence increasing specially in teenagers and womenparticularly despite of increasing awareness of harmful effects of smoking. This study aims the knowledge of determinants of smoking.Objectives: The objective of the study is to determine the knowledge about factors responsible for smoking. Study Design: Cross sectionalsurvey. Setting: Study was carried out in Quaid-e-Azam Medical College, Bahawalpur. Duration: 1st Jan, 2010 to 31st May, 2010.Subject/Methods: A sample of 100 medical students of QAMC was selected according to stratified random sampling. Data was collectedthrough pre-designed questionnaire. Results: Out of total 100 students 94% of the students know the determinants of smoking. According to(31.30%)) of the students, tension/stress was the most important factor responsible for smoking with enjoyment (21.73%)) and style/statussymbol (20.86%). Conclusions: High proportion of students were aware of the determinants of smoking.
ULTRASOUND;
Authors: SIDDIQUI EJAZ HUSSAIN , SIDDIQUI SAAD , SHAH NOREEN
Published: September 2021

Objectives: To assess common presenting features and the role of Ultrasound in evaluation of Hepatobiliary diseases in ourpopulation. Design: Cross sectional study. Setting: Khyber X rays, Khyber Medical Centre, Peshawar. Period: August 2010 to December2010. Material and Methods: Data from patients presenting for evaluation of Hepatobiliary diseases was analyzed for presenting complaintsand ultrasound findings according to objectives of the study. Results: In total 197 cases were included in the study. The age wise categorizationincluded pediatric population (6.1%) adult population (87.3%) and geriatric population (6.6%). Upper abdominal pain was the most commonpresenting feature in all age groups as well as in both genders. Cholelithiasis with or without cholecystitis was the most common ultrasoundfinding in all age groups. No statistically significant difference was found between presenting features or ultrasound findings in different agegroups as well as across gender. Conclusions: Hepatobiliary diseases are among major illnesses in our region. Ultrasound is a sensitive anduseful tool for screening and evaluation of Hepatobiliary disorders.
TRICYCLIC ANTIDEPRESSANTS;
Authors: KHALID Shah , HUSSAIN RANA MOWADAT , AKHTAR NAJAM
Published: September 2021

Introduction: Despite advancements in the treatment of depression and availability of newer compounds, TCAs likeamitriptyline remain to be the cornerstone of antidepressive therapy for more than three decades, however significantly more patients receivinga tricyclic withdraw from treatment mainly because of side effects. Higher response, lower incidence of side effects and improved compliancecan be enhanced by the optimal use of Therapeutic Drug Monitoring (TDM). No research data is currently available on the therapeutic drugmonitoring of TCAs in Pakistan. Objectives: To compare the relative efficacy of Tricyclic antidepressant in the treatment of depression, with andwithout Therapeutic Drug Monitoring Main Outcome Measures: Changes in HAMD scores in patients on TCAs. Study Design: A Quasiexperimental study design was used. Setting: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi. Subjects:34 patients completed the study in the monitored group (with TDM) and 33 in control group (without TDM). Methods: Serum TCA levels andHAMD scores at baseline and subsequently at sixth, eighth and tenth week of treatment were collected. In all the subjects, all the blood sampleswere drawn as a fasting sample in early morning. Results: The mean age of the monitored group was 31.97 years (SD=10.432) while that of thecontrol group was 33.52 years (SD=9.385). in the monitored group 20 (58.82 %) of the patients were males while 14 (41.17%) were females, inthe control group 22 (66.66%) were males and 11(33.33%) were female patients. A significant reduction in HAMD scores was noted at 8 weeksof treatment. The groups did not differ in terms of efficacy of TCAs, however the monitored group had fewer dropouts than the control group.Conclusions: Lower incidence of side effects and improved compliance can be enhanced by the optimal use of Therapeutic Drug Monitoring(TDM) of TCAs.
HELICOBACTER PYLORI INFECTION;
Authors: FAISAL NABIHA , UL HAQ MUHAMMAD MANSOOR , SHAIKH HAFEEZULLAH , Ashraf Pervez , Esmail Jamila. H.
Published: September 2021

Objective: To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care centerin Karachi. Data source: Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Design of study: Cross sectional descriptivestudy. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi. Period: May 2008–October 2008. Material andmethods: All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinalbleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two eachfrom antrum and body and one from fundus were taken for histology. Results: A total of 123 dyspeptic patients were included in the study. 76(61.8%) patients were males and 47 (38.2%) were females. H pylori was detected in mucosa of 49 (39.8%) patients. The mean age of thepatients was 41.41 ± 13.15 Years (95%CI; 39.06 to 43.75). Rate of H.pylori infection was not found statistical significant with age, gender,duration of symptoms and BMI. Conclusions: The prevalence of H pylori infection in dyspeptic patients was lower than reported in previousstudies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pyloriin our setup.
GAUCHER DISEASE;
Authors: GHORBANI MOHAMMAD HOSSEIN , ABDOLLAHZADEH MEHRSIMA , BLOURCHIAN MAHDI JAHANGIR- , Joshari Sima Parandakh , Ramasanian Maryam
Published: September 2021

Objective: Gaucher disease is a lipid storage disease characterized by the deposition of glucocerbroside in cells of the ReticuloEndothelial cells (RET) system ,which encoded by a gene located on chromosome 1q21-q31.Gaucher disease occurs 1/50000 to1/100000people in the general population. There are three clinical subtypes delineated by the absence or presence and progression of neurologicmanifestation. All 3 types of Gaucher disease are inherited as autosomal recessive traits. Case report: A 13-month -old- female infant was bornfrom relative parents referred to the 17-shahrivar hospital with tachypnea, Respiratory distress, and abdominal distension. In the physicalexamination, the patient was pale, ronchi on both lungs were heard. Respiratory distress and substernal retraction, abdominal distension due tohepatosplenomegaly, fine parallel lines in different sizes on the abdomen due to phlebotomy observed. Laboratory findings, pancytopeniareported and Bone Marrow Aspiration (BMA) Gaucher cells have been observed and abdominal sonography has been reported hugehepatosplenomegaly. For definitive diagnosis, β glucosidase activity was measured and Hydrolase acid β glucosidase activity deficiency wasimproved. The patient was treated by intravenous acid β glucosidase every other week. Conclusions: Genetic counseling is recommended forprospective parents with a family history of Gaucher disease.
EMERGENCY CONTRACEPTION;
Authors: YASMEEN FOUZIA , SHAMI NABEELA
Published: September 2021

Objectives: To assess the knowledge of family medicine health care providers and their attitude towards emergencycontraception (EC) in Lahore Medical and Dental College and out-patient centers of Ghurki Teaching Hospital Lahore. Data Source: MedlineData Base. Design of Study: Cross sectional descriptive study. Duration: 3 months period, from March to June 2011. Materials & Methods:Faculty physicians from different specialties, residents, and medical officers were included in the study. Data was collected on a structured precoded21 –item questionnaire containing demographic profile of the respondents and questions concerning their knowledge, attitudes andbeliefs towards emergency contraception. Results: In total 85 interviews were conducted with the response rate of 100%. There were 43facultymembers (50%), 14 residents (16%) and 28 medical officers (32%), 51 male (60%), 34 female (40%) physicians, the majority58 (68%) weremarried. Although 79 of the respondents (92.9%) reported considerable familiarity with EC, objective assessment revealed deficiency in theirknowledge. Only 41(48%) correctly chose menstrual irregularity not being most common side effect of Per oral emergency contraception(POEC) while only 28(32.9%) of respondents answered that EC is not an abortifacient. Only 30 respondents (35%) had an opportunity to learnabout EC through workshops. Among the barriers identified 27 respondents believe that as use of POEC would promote sexual promiscuity(31%)and 59 were concerned about birth defects/ side effects (69%).Religious and ethical barriers were also a concern in 57(67%) and62(69%) of the respondents respectively. Overall attitudes regarding emergency contraception were positive, however 45(52.9%) wereunsatisfied with their current knowledge and 77 (90%) were interested in learning more about EC. Conclusions: Physicians need moredetailed information about EC, which would increase the application rate of the users and decrease their own prejudices
TYPE 2 DIABETES MELLITUS;
Authors: IFTIKHAR RAHEEL , MANZAR MUHAMMAD ADNAN , SAEED Fatima
Published: September 2021

Objectives: Determine frequency of hypertension in type 2 diabetics. Determine pattern of hypertension in type 2 diabetics.Study design: Cross sectional survey. Setting: The study was conducted in the out patient department of Combined Military Hospital, Lahore.Duration of study: Study was carried out over a period of 01 year from July 2010 to July 2011. Material and methods: Total 700 cases wererecruited in this study. Blood pressure of all the patients was recorded in a sitting position with a mercurial sphygmomanometer 4–6 hours apart.It was interpreted as prehypertension, stage 1 and stage 2 according to operational definitions. Results: Out of total 700 patients, 490 (70.0%)were hypertensive .Pattern of hypertension showed 100 (20.4%) pre-hypertension, 160 (32.6%) stage-I and 230 (47.0%) stage-II .Majority ofthe patients i.e. 245 (50.0%) were between 41-50 years and minimum 9 patients (1.8%) were 20-30 years old with mean age of 55.9±3.7 .Out of700 patients, 350 (50.0%) were male while remaining 350 (50.0%) were females. Married patients were 400 (57.1%) and unmarried 300(42.9%). Conclusions: Patients with diabetes mellitus have increased risk of developing hypertension than normal population.
PSYCHOPHARMACOLOGICAL ACTIVITY;
Authors: AHMED SAIMA , ASADULLAH Muhammad
Published: September 2021

Objective: The purpose of this study was to screen some herbal medicine as psychotropic drugs those has strong modulatingeffect on brain and behavior. Material & methods: Herbal drug Reserpine, Nux- Vomica, Anacardium and Chlorpromazine with a wide range ofpharmacological actions. In our present study, we evaluate the effectiveness of these drugs as Psychotropic agents and accessed bybiochemical-parameters. Rats (weighing 180-250g) and Mice (22-32g) either sex were used in this study. One group was kept as control fordrugs. Mice were kept under room temperature. Tap-water was allowed ad-Libitum. Animals were observed during and after 21 days. A tabletcrushed in 10ml of water, 1cc was given. Screening method used was swimming induced-despair. Results: Among these, Strychnos Nux-Vomica has strong action on cholinergic system, CNS activity and observed as an antispasmodic. Rauwolfia serpentine is an active alkaloidparticularly present in reserpine are used to treat essential hypertension and in certain neuropsychiatry disorders. It has sedative andtranquilizing effects, as it depletes catecholamine from the central nervous system. Keeping in view, the medicinal importance of these herbs,our present study was designed to screen these herbs as for CNS activity on Albino mice and rats.
ANTIMICROBIAL RESISTANCE;
Authors: AZIZ QAMAR , ALI ZULFIQAR , IZHAR MATEEN , Hassan Shah Vaqar
Published: September 2021

Introduction: Since the development of antibiotics there is a growing concern about the increasing incidence of antibioticresistance. As a result the therapeutic value of originally effective antibiotics become significantly reduced overtimes. Extensive data isavailable on antibiotic susceptibilities of hospital isolates but very little information is available about the susceptibilities of community strains.Design: Descriptive. Period: July 2004 to June 2005. Setting: Department of Microbiology, Shaikh Zayed Hospital Lahore. Hence the presentstudy was design to assess the environmental load of the antibiotic resistance using fecal flora as an indicator of overall problem. It will alsoprovide guidance in antibiotic protocol for antibiotic policy. Objective: Objective of the present study was to determine the developingresistance to β – Lactam Antibiotics which is the commensal microbe of enteric tract. Materials & Methods: One hundred samples werecollected from ten different areas of Lahore city (10 samples from each area) and were inoculated on Mac Conkey’s agar. Five morphologicallydistinct lactose fermenting colonies were selected & identified using standard laboratory methods. Five hundred different colonies of E.coli wereidentified and analyzed for their susceptibility to b-lactam antibiotic. Results: Out of 500 isolates, the resistant isolates with ampicillin (48%), coamoxiclav(40%) and cephradine (37%) were detected, with cheaper oral agents high prevalence of resistance was detected. Conclusions:Ampicillin, co-amoxiclav and cephradine are not much useful for the treatment of urinary tract infection and septicemia caused by E-coli & otherMembers of fecal flora.
PREVENTION OF POST SPINAL HYPOTENSION;
Authors: BOOTA MUHAMMAD , Baig BILAL , IQBAL SALEEM , Munir Sajid , Mohsin Syed Tariq
Published: September 2021

Objective: Objective of the study is to evaluate the efficacy of intramuscular ephedrine along with preloading in prevention ofpost spinal hypotension in elderly patients undergoing inguinal hernia surgery. Study design: This is a quasi experimental study. Place andduration of study: The study was conducted at the department of Anaesthesia and Intensive Care Combined Military Hospital, Peshawar overa period of one year. Patients and Methods: In a double-blind, randomized study, 80 elderly patients undergoing inguinal hernia surgery underspinal anaesthesia divided into two equal groups of A and B. Forty patients received i/m inj of ephedrine 45mg deep in the paravertebralmuscles immediately after injection of bupivacaine, and 40 received an equal volume of saline. Patients in both groups were given the samevolumes of fluid before anaesthesia. The incidence of hypotension (Systolic arterial pressure <90mmHg or <80 % of baseline) were recorded.and incidence of fall in the heart rate was recorded. Results: Systolic arterial pressure during the first 60 min after anaesthesia remainedsignificantly more stable in the ephedrine-treated group, and there was also a significantly smaller number of patients in this group who haddecreases in pressure of more than 30% of pre-block levels and fewer required rescue i.v. Ephedrine. An increase in heart rate or systolicpressure of > 20% from baseline was found in two patients in the ephedrine group and in one patient in the placebo group. Conclusions: Weconclude that ephedrine 45mg administered in the paravertebral muscles immediately after plain bupivacaine spinal anaesthesia is a simpleand effective means of reducing the incidence of hypotensive episodes in the elderly patient.
DIFFICULT LARYNGOSCOPY;
Authors: FARZI FARNOUSH , MIRMANSOURI ALI , FORGHANPARAST KAMBIZ , Abdolahzade Mehrsima , Nahvi Hassan
Published: September 2021

Background: Preoperative evaluation of anatomical landmarks and clinical factors helps to identify potentially difficultlaryngoscopies; however, its predictive reliability is unclear. As the ratio of height to thyromental distance (RHTMD) is a newer upper airwaypredictive test for difficult laryngoscopy, the predictive value and odds ratios of RHTMD versus mouth opening, thyromental distance(TMD),neck movement, and oropharyngeal view (modified Mallampati) were evaluated. Methods: Data of 407 consecutive patients scheduled forelective surgery with general anesthesia requiring endotracheal intubation were collected and all five factors were assessed before surgery.Four senior anesthesiology residents, not aware of the recorded preoperative airway assessment, performed the laryngoscopy and grading (asin Cormack and Lehane’s classification). Results: Difficult laryngoscopy (Grade 3 or 4) occurred in 94 patients (23.1%). In the multivariateanalysis, three criteria were found independent for difficult laryngoscopy (neck movement ≤80 degrees; Mallampati Class 3 or 4, and RHTMD≥ 24). Neck movement (NM) ≤ 80 degrees had a higher sensitivity, specificity and PPV than the other factors. After neck movement,Mallampati class 3 and 4, IIG ≤ 3.5 cm and then RHTMD ≥ 24 were valuable with lowest NPV. The multivariate analysis Odds ratio (95%confidence interval) of the NM, Mallampati class, IIG and RHTMD were 18.16 (9.634 – 34.265), 12.498 (6.744 – 23.16), 11.183 (6.571 – 19.03)and 3.123 (1.933 – 5.047) respectively.TMD ≤ 6.5 cm was not recognized as independent variable for difficult laryngoscopy. Conclusions:RHTMD is a useful and valuable screening test for preoperative prediction of difficult laryngoscopy along with common predictive examinations.
TRAMAL AS A MONOTHERAPHY;
Authors: AHMAD MALIK JAMIL , LATIF RANA KHAWAR , NASIR MUHAMMAD
Published: September 2021

Purpose of study: To achieve reduction in postoperative pain and improved quality of analgesia accompanied by reduction inside effects. Material and methods: This study was carried out by the anaesthesia department and intensive care unit, Nishtar Hospital, Multanfrom June 2009 to May 2010. A total of 200 patients were observed, which were undergoing for thyroidectomy and were divided into two groups.Results: The duration of analgesia in the two groups was almost similar. Rescue analgesia was given to 10 patients out of 100 patients inBuprenorphine and 24 patients out of 100 patients in tramadol. Pain scores were more in group-I than group-II, although nausea/vomiting weremore in group-I than in group-II. Conclusions: This analgesia regimen of intramuscular buprenorphine was found to be an improved, balancedand safe analgesic technique for postoperative pain relief.
BENIGN PAROXYSMAL POSITIONAL VERTIGO;
Authors: BABAR NIAZI SOHAIL , TAHIR Muhammad , BHATTI Muhammad Ali
Published: September 2021

Objective: To compare the efficacy of Vestibular sedative versus Epley manoeuvre in the management of benign paroxysmalpositional vertigo. Study design: Interventional Quasi experimental study. Place and duration of study: This study was conducted in ENTOPD Combined Military Hospital Rawalpindi from 1st January 2008 till 30th June 2008. Results: In this study out of 30 cases managed byvestibular sedative, 10 cases showed complete relief of symptoms after 01 month. Out of 30 cases managed by Epley manoeuvre, 28 casesshowed complete recovery after 01 month. The results were compared by Chi square test, as the data was mainly qualitative in nature. Theresults of both the groups were compared on day 3, day 7 and day 30, which revealed that Epley manoeuvre, is more effective than vestibularsedative in treatment of BPPV. Conclusions: Epley manoeuvre is more effective than vestibular sedative for treating the patients of benignparoxysmal positional vertigo.
RAISED SERUM CHOLESTEROL;
Authors: AHMAD SADIA , DEEBA FARAH , MUSHTAQ MAZHAR , Irshad Ghazala , Hafiz Samra
Published: September 2021

Introduction: Hypercholestrolemia has a strong association with Atherosclerosis and coronary artery disease (CAD). It is amajor worldwide health problem and the incidence is rising in Pakistan. Hypocholesterolemic effect of green tea (GT) has been proven invarious research studies in the world. Objective: Present study aims to evaluate this effect in Pakistani population in the context of specificdietary and social habits prevailing here. Setting: The university of Lahore. Methodology: Sixty subjects were included in the study comprisingof thirty healthy subjects and thirty hypercholesterolemic individuals who were not taking any medication to control their serum cholesterol. Theywere all given GT in a dose of 3 gm twice daily for sixty days. Serum cholesterol levels were estimated at day 1 and then every 2nd week till the60th day. Results: Significant lowering of serum cholesterol was observed (p<0.001) in hypercholesterolemic individuals after 60 days. Therewere no side effects reported of GT intake. CONCLUSIONS: Our results suggest that GT can safely reduce the raised serum cholesterol level inPakistani population.
CHRONIC LIVER DISEASE (CLD);
Authors: ALAM KHAN SHAHZAD , TAREEN TARIQ MUHAMMAD KHAN , HAQUE TASEER IJAZ-UL- , Safdar SOHAIL
Published: September 2021

Objective: To determine the frequency of chronic liver disease in patients presenting with upper gastrointestinal bleeding(UGIB) at Nishtar Hospital, Multan. Study Design: Descriptive case series. Duration of study: Six months from August 2009 to January 2010.Setting: Department of Internal Medicine, Nishtar Hospital Multan. Methodology: A total of 88 patients with upper GI bleed were registered.Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GIEndoscopy was done to find out the source of bleeding. For identification of each patient, personal data was collected. All the data collectedwere entered and analyzed using SPSS-10. Results: Mean age was 41.64±13.56 years with 49 (55.70%) male patients and 39 (44.30%)female patients. Majority of the patients 38(43.18%) were between 36-50 years of age. In our series frequency of chronic liver disease was56.82%. Conclusions: Chronic liver disease is the most common cause of upper GI bleeding in our setting.
PRAMIPEXOLE INDUCED RECURRENT PLEURAL EFFUSION
Authors: GHAZI MUHAMMAD A. , MALIK KHALID SAEED
Published: September 2021

Context: Recurrent pleural effusions are relatively uncommon and as clinicians we keep drug induced pleural effusion lower inour list of differentials. Pramipexole induced recurrent pleural effusion can be life threatening if not recognized early and has been reported inliterature only a few times. Case Report: A 44 years old man with history of traumatic brain injury presented with pneumonitis and p leuraleffusion which was tapped. Patient returned with pleural effusion within 2 weeks and a careful analysis of all the risk factor and drugs revealedthat the most likely etiology was chronic use of Pramipexole leading to recurrent pleural effusion and early pulmonary fibrosis. Conclusions:Pramipexole induced recurrent pleural effusion can cause significant morbidity and should be recognized early. Physician prescribing thismedication should be aware of this rare side effect of the medication.
LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS
Authors: SAJID MUHAMMAD , MISBAH Junaid
Published: September 2021

Objective: It was conducted to evaluate laparoscopic cholecystectomy in cirrhotics in terms of procedural safety and betteroutcome with decreased morbidity. Study Design: A retrospective, multicenteric study. Setting: Surgical Unit-III and IV DHQ Faisalabad.Period: Jan 2000 to Dec 2009. Methods: 2610 patients undergoing laparoscopic cholecystectomy from January 2000 to December 2009 forcholecystitis and symptomatic gallstone disease. 61 of the patients being cirrhotics falling in child’s class A&B. Evaluation of results was done byanalyzining the data in SPSS V-17. Results: of the 2610 patients who underwent laparoscopic cholecystectomy, 61(2.3%) were cirrhotic. Ofthese 61, 47(77%) belonged to Childs group A and 14(23%) were group B. Hepatitis C was the major cause of cirrhosis (72%). Morbidity incirrhotics was 11.4% in the form of ascities leakage (57%) and port site infection (43%). Mean hospital stay was 2±1 days and the meanoperative time as 60±20 minutes in cirrhotics. Conclusions: Laparoscopic cholecystectomy offers a better post op recovery and decreasedmorbidity in Childs group A & B cirrhotics as it does in non cirrhotic patients.
PLACENTAL ABRUPTION;
Authors: YOUSUF MEMON NAILA , MUMTAZ FIRDOUS , FAROOQ SHAISTA
Published: September 2021

Objective: To determine the frequency of risk factors associated with Placental Abruption. Design: Prospective andObservational Case Study. Setting & duration: Department of Obstetrics & Gynecology, Liaquat University of Medical and Health SciencesHyderabad, for a period of 15 months from January 2006 to March 2007. Patients & methods: All the antenatal patients/ pregnant ladiesadmitted to labour room /ward and delivered during the above mentioned period were scrutinized and those suffering from Abruptio Placentaewere entered into this study by completing a proforma for each patient. The risk factors studied were; Age of Patient, Parity, past history ofabruption, rural belonging, history of trauma, association with diabetes, hypertension, smoking and anemia. Results were analyzed on SPSSversion 10. Results: A total of 100 patients suffering from placental abruption were studied during 15 months period. The commonest age groupwas 30 years (47%). Majority (54%) was multiparous, 66% belonged to rural population and among these, 2/3 were unbooked. Only one patientgave history of trauma. 5 patients had history of previous abruption. History of diabetes was present in only one patient, whereas 38% werehypertensive. Only 4 patients gave positive history of smoking. Anemia was the single most common factor present in 83% ladies.Conclusions: Age around 30 years, multiparity, hypertension, presence of anemia, rural belonging and previous abruption are the risk factorsfor placental abruption as per this study. No association of abruption has been found with trauma, diabetes or smoking in this study.
HEPATITIS C;
Authors: KITCHLEW RIZWANA , AHMAD SIDDIQI FUAD , HASHMI ASIF
Published: September 2021

Background: Liver biopsy the gold standard for the histological assessment in chronic hepatitis C is an invasive procedure withcertain limitations. Objective: It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screenedpositive for HCV. Study Design: This cross sectional comparative study Setting: It was conducted at department of medicine CombinedMilitary Hospital Lahore, from January to August 2004 Method: 76 apparently healthy blood donor soldiers age 20 – 49 years positive for HCVantibodies by third generation ELISA test, evaluated by medical history, physical examination, serum ALT levels , PCR test for HCV RNA andultrasound abdomen were enrolled. Liver biopsy was done through percutaneous route and histology was graded according to Knodell scoringsystem. Results: Serum ALT levels showed a skewed distribution with mean of 130.9+96.9 IU/L and median of 8.5IU/L. Eleven patients hadnormal ALT (<40 IU/L).On histological analysis of liver biopsy specimen 17 had Knodell score ≤3 (mild inflammation),38 had score between 4and 7 (moderate inflammation)and 21 had > 8. Patients with score > 8 were older than the former groups.The difference was significant(p=0.047). Relation of ALT levels with stage of fibrosis and grade of inflammation was estimated using ANOVA it showed no statisticalsignificance. Patients with stage 1 fibrosis had highest mean serum ALT levels (p=0.108). Conclusions: No association found between theALT level & liver biopsy histological score. However patients with normal ALT levels usually had mild necroinflammatory changes.
POST TRAUMATIC STRESS DISORDER;
Authors: SHEIKH NOSHEEN
Published: September 2021

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OXYTOCIN IV BOLUS VS INFUSION;
Authors: ABDULLAH MUHAMMAD , - RAHEEL , ABASSI TARIQ , Khurshid Tassaduq , Ghauri Asim
Published: September 2021

Introduction: Obstetric texts advocate the use of oxytocin, either intramuscularly or as a dilute infusion, but warn against the useof intravenous bolus oxytocin, fearing significant maternal hemodynamic consequences. Objective: To compare the hemodynamic effects ofoxytocin given intravenous bolus versus infusion form. Study design: Randomized clinical trial. Setting: Study was conducted in mainoperation theatre and OPD of Combined Military Hospital, Rawalpindi. Duration of study: Study was carried out over a period of six monthsfrom 24-03-2009 to 23-09-2009. Subjects and methods: Total 138 patients were included in this study. Patients were divided into two groups(Group-A received oxytocin as bolus of 5 iu given as quickly as possible (approximately over 1 s) and in group-B 5 iu diluted to 20ml normalsaline given over 5 minute using an infusion pump). Each group comprised of 69 patients. Results: Mean age of the patients in group-A was27.3±1.8 and in group-B, 26.9±1.7. Heart rate (beast/min) effect of oxytocin given intravenous bolus vs infusion showed statistically significantdifference from 1 minute to 15 minute (P<0.001). Similarly mean arterial pressure (MAP) rate (beast/min) effect of oxytocin given intravenousbolus vs infusion also showed statistically significant difference from 1 minute to 15 minute (P<0.001). Conclusions: In conclusion, we foundthat at elective Caesarean section, 5 iu of i.v. oxytocin results in less haemodynamic change than 5 iu diluted to 20ml normal saline given over 5min using as an infusion pump.
CONTRACEPTION;
Authors: SHUKR FURQAN , JAWEED RUKHSANA , NOOR LUBNA , LAGOS DANYA R.
Published: September 2021

Background: The uptake of oral contraceptive pill as a method of contraception is very low in Pakistan with a highdiscontinuation rate. This study aimed to assess the knowledge of contraception seeking, married women in Pakistan about the oralcontraceptive pill. Setting: Gynaecology clinic and family planning department Military hospital Rawalpindi. Period: 1st Oct 2011 to 31st Dec2011. Methods: 102 eligible women completed a cross-sectional survey that consisted of a detailed questionnaire which was completed bythe interviewer to assess the womens’ level and source of knowledge concerning the risks and benefits of the oral contraceptive pill. Results:102 eligible women participated in the survey. Mean age was 33 and mean parity was 4.01.Majority belonged to low income group42(41%) and33% had a fair socioeconomic status. Majority 35(34%) had low education level and 11(10.8%) were graduate or more. Majority 49(48%) scoredintermediate on knowledge score with 33(32.5%) scoring poorly. Overall only 15% were aware of cancer preventing powers and 70% of noncontraceptive virtues of the pill. Misconception rates were particularly high in this study sample with 46(45%) having high misconceptionscores.96.6%% of the respondents were convinced that pill leads to obesity.58(57%) of the overall subjects felt that pill use could be consideredbut lack of self efficacy could lead to problems with compliance. Conclusions: Knowledge about pill efficacy and advantages was low andmisbelieve regarding safety and side effects was high. More education regarding safety and health benefits is needed to improve acceptanceand compliance.
SHORT HEAD-UP TILT TEST
Authors: FAYYAZ KHAN HUMAIRA , HAMEED MUHAMMAD AMJAD , SALEEM KAMAL , Ahmed Ayyaz , Naeem Nida
Published: September 2021

Objective: The aim of the present study was to evaluate the time to syncope in Nitroglycerine potentiated short Head-up tilt test.Study Design, Settings & Duration: This was a descriptive cross sectional study conducted in Armed Forces Institute of cardiology from May2006 to May, 2007. Patients and methods: A total number of 90 patients with orthostatic intolerance both male and female were studied.Head-up tilt test protocol consisted of a Stabilization phase which lasted for five minutes Passive tilt phase: Patients were tilted at 70̊ fororthostatic stress for 15 minutes. In case of no symptoms the test continued with the drug provocation phase which lasted for 15 minutes. Thepatients were administered 400μg of nitroglycerine sublingually in aerosol preparation. Development of symptoms were noted at 5, 10 and 15minutes. Results: A total number of 90 patients were examined during the study period. The tilt table test was classified as positive in 58.9 % ofpatients and was negative in 41.1%. The test was positive in five patients without the drug provocation (9.4%). The responses were classifiedas positive vasodepressor in 35.8%, 15.09% as mixed and cardioinhibitory 15.09% in patients of neurally mediated syncope. The total time todisplay of symptoms to positivity in HUTT was 17.89± 6.99. The mean time to syncope after the administration of nitroglycerine was 5.61± 4.17minutes. Conclusions: Our study concludes that the drug administered phase can be reduced to 12±3 minutes.
HEAVY SMOKING
Authors: ALI SHAIKH MUMTAZ , YAKTA DUR-E- , SHAIKH DARGAHI
Published: September 2021

Objective: This study is conducted to observe the serum lipoprotein alterations in chronic heavy smokers in LUMHS Sindh. Study Design: Analytical study Material and Methods: It was conducted on 60 non obese adult smokers, both sexes, who smoked more than twenty cigarettes or beeries a day regularly for more than five years. All the participants were current smokers. Sampling technique was simple random technique. Setting: The study was conducted in outdoor department of LUMHS Jamshoro/Hyderabad. Period: Jan 2010 to Jan 2011. Eighteen hours fasting blood sample was sent for lipid studies. Lipids studied were serum cholesterol, serum triglycerides, high density lipoproteins and low density lipoproteins. For control values ATP 3 guidelines were used. Statistics: Mean of statistical values was calculated with standard deviation and variance in standard deviation. Results obtained were analyzed by SPSS 11. Results: Age of the patients was 25-70 years. Mean age was 47.81±12.96 years. Median age was 50 years. Male/ female ratio was 45/15. Patients were from both rural and urban areas. Mean duration of smoking was 25.5±9.15 years. The study carried out on 60 chronic heavy smokers, showed deranged lipid levels as: Total cholesterol mean 237.57 mg/dl ±37.89; TG mean 203.76 mg/dl ±47.08; LDL-C mean 158.62 mg/dl ±17.25; HDL-C mean 29.67 mg/dl ±3.12. Results are shown in Table No I. Conclusions: Our study concluded at LUMHS showed that by continuous heavy smoking the serum lipid levels get deranged.
MYOCARDIAL INFARCTION
Authors: KHAN BABAR HAROON AZIZ , RAFIQUE BUTT ZAHID , AHMAD JAMIL
Published: September 2021

Objective: To assess the frequency of hyperhomocysteinemia in patients of first attack of ST-segment elevated myocardialinfarction under age of 40 years. Design: Cross sectional study. Period: December 2009 to June 2010. Setting: Ch. Pervaiz Elahi Institute ofCardiology, Multan. Material and methods: A total of 65 patients of acute myocardial infarction were included in the study on the basis of chestpain, ECG changes and increased cardiac enzyme. Results: A total of 65 patients fulfilled the inclusion criteria were included the study. Meanage was 35.68 years. Out of the 65 patients, 87.7% were male and 12.3% were female, 41.5% patients has increased homocysteine level while68.5% had normal homocysteine level. Conclusions: Plasma Hcy is an important risk factor for the development of the acute myocardialinfarction.
WERDNIG HOFFMAN IN HETEROZYGOTE TWINS
Authors: GHORBANI MOHAMMAD HOSSEIN , ABDOLLAHZADEH MEHRSIMA , BLOURCHIAN MAHDI JAHANGIR- , Fasihi Masomeh , Alizadeh Maryam
Published: September 2021

Introduction: Spinal Muscular Atrophy (SMA) consists of three types of disease including Werdnig Hoffman (SMA type1) whichis an autosomal recessive degenerative motor neuron disease. These patients have abnormality in motor function of the muscles and will die inthe first few years of life. The genetic locuses of all three types of SMA are on the chromosome numbers and a deletion in locus 5q11-q13 willresult in a variety of this disease. Case Report: heterozygous twin infants (boy and girl) were born from relative parents admitted to the hospital,one in three days after another, with upper respiratory tract infection, respiratory distress and coughing. They were hypotonic and had tonguefasciculation. They were intubated and ventilated in the PICU. SMA was suspected because of the general muscular weakness; therefore,biopsy and neurophysiologic studies were performed. Quadriceps muscle biopsy showed fascicular atrophy of muscle fibers and in geneticanalysis of SMN1 gene in twin homozygous deletion of the SMN1 gene at exon 7was found. They became ventilator dependent and sufferedrespiratory failure and two weeks after their admissions in hospital, and with three day interval, died. Conclusions: it seems prudent to performgenetic assessments before having children in the parents who are close relatives especially after having one affected child.
TUBERCULOUS MENINGITIS
Authors: AMIN SAID , USMAN Muhammad , WAZIR MUHAMMAD NOOR
Published: September 2021

Objective: To evaluate the role of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for Mycobacterium Tuberculosis inrapid diagnosis of tuberculous meningitis (TBM). Study Design: Prospective observational study. Place and Duration of Study: Medical A unitHayat Abad Medical complex Peshawar from 1st September 2010 to 30th August 2011. Methodology: A total of 20 Patients having fever,constitutional symptoms (malaise, vague ill health, headache, vomiting), nuchal rigidity with altered mental and behavior changes weresuspected as TBM and hence included in the study. Patients were divided into two groups based on direct and indirect evidence of tuberculosisin central nervous system (CNS) of patients. Group1: Patients having direct evidence of mycobacterial infection in CNS as Acid Fast Bacillismear positive in CSF. Group 2: Patients with indirect evidence of TB in CNS in form of typical CSF findings of TBM, positive sputum smear forAcid fast bacilli (AFB) or computed tomographic (CT) Scan brain findings suggestive of TBM or evidence of TB in x-ray chest or family History oftuberculosis and/or history of contact with TB patients or positive Mantoux Test or evidence of TB elsewhere in the body. Results: Out of total 20patients, 3 (15%) belonged to Group 1 having direct evidence of TBM the remaining 17 (85%) patients belonged to Group 2. Female patientswere 60% while 40% patients were male. Mean age was 35.8 years. All patients had fever and headache. Productive cough was present in 40%patients. Thirty five percent had lost weight. Contact with TB patients was revealed in 35% patients. Signs of meningeal irritation were elicited in90% patients. Cranial nerve palsies were seen in 25% patients, 10% had hemiparesis while 35% had impairment of consciousness. X-ray chestwas normal in 65%.Computed tomographic scan was showing meningeal enhancement in 30% patients, hydrocephalus in 15% patients,meningeal enhancement plus hydrocephalus in 55% patients and infarct in 15% patients. Three patients were enrolled in group 1 and all hadPCR positive for mycobacterium tuberculosis. Of 17 patient in group 2, 64% patients had positive CSF PCR. Conclusions: Tuberculousmeningitis is an important serious extrapulmonary complication of TB, related with high mortality and morbidity. The prompt and accuratediagnosis of TBM is a daunting challenge. CSF PCR for Mycobacterium tuberculosis is an excellent test for rapid diagnosis of TBM.
GESTATIONAL DIABETES MELLITUS
Authors: IKRAM M. , HASAN ALAM SYED HAIDER , MUKHTAR SHAFQAT , Saeed M.
Published: September 2021

Introduction: Gestational diabetes mellitus is common disorder in pregnancy. It is associated with adverse pregnancy outcome. There is no consensus regarding the optimal approach to screening of gestational diabetes mellitus. The present study has tried toobserve the value of fasting blood glucose in screening of gestational diabetes. Objective: To determine the frequency of patients in whomfasting blood glucose and 100gm glucose tolerance show agreement for screening of gestational diabetes mellitus at 24 -28 wks. Studydesign: Comparative cross sectional study. Settings: The study was conducted at Gynecology and Obstetrics department Shaikh ZayedFederal Post Graduate Institute Lahore. Duration of study with dates: 6 months from 12Nov 2010 to 11 May 2011. Material and method: Thestudy included 135 booked patients with positive family history of diabetes mellitus. All patients underwent fasting blood glucose at 24-28 weeksof gestation, regardless of results of fasting blood glucose on next visit they underwent 100g oral glucose tolerance test (OGTT). The agreementbetween fasting blood glucose and 100g oral glucose tolerance test was calculated in frequency and percentages. Results: The mean age ofwomen in studied population was 27.15±3.70.Out of 135 patients 86.7 %( 117) showed agreement between results of fasting blood glucose and100g OGTT while 13.31 %( 18) showed no agreement between both of the tests. Conclusions: Fasting blood glucose is a good screeningoption for gestational diabetes mellitus along with positive history. It provides a simple, cheap and more practical test for screening of gestationaldiabetes mellitus. However diagnostic confirmation with 100g OGTT should be done.
SPONTANEOUS BACTERIAL PERITONITIS
Authors: KHAN INAMULLAH , KHAN ZAHIDULLAH , SUBHAN FAZLE
Published: September 2021

Objective: To compare the efficacy of ciprofloxacin with ceftriaxone in the treatment of spontaneous bacterial peritonitis inpatients with cirrhosis liver and ascites. Design: This hospital based quasi-experimental study. Setting: Department of Medicine, KhyberTeaching Hospital Peshawar. Period: October, 2009 to April, 2010. Material and Methods: A total of 200 patients were selected by nonprobabilitypurposive sampling method after obtaining an informed consent. Sample size was calculated through WHO statistical calculator. Allthe selected patients had clinical and biochemical evidence of cirrhosis liver and spontaneous bacterial peritonitis. Both sexes were included inthe study. They were randomly divided into two groups; group I was treated with ciprofloxacin and group II was treated with ceftriaxone.Results: 200 patients including 124 males and 76 females with spontaneous bacterial peritonitis were included in the study. 100 patients eachwere treated with ciprofloxacin and ceftriaxone in the two groups. 82% responded favourably to 5 days course of I/V 200mg ciprofloxacin and91% were cured with 5 days therapy of I/V 2gm ceftriaxone. Conclusions: Both ceftriaxone and ciprofloxacin are equally effective in thetreatment of spontaneous bacterial peritonitis.