bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE APPENDICITIS
Authors: Farid Javeria , Bhambhro Rizwanullah Junaid , Soomro Sohail
Published: September 2021

Objectives: To determine the clinical presenting pattern and postoperativecomplications of acute appendicitis. Study design: Observational and cross-sectional study.Setting: Isra university hospital Hyderabad. Period: 7 months. Methodology: All the patientsabove 12 years of age and both genders male/female after diagnosis of acute appendicitishad integrated in the study. Complete clinical pattern and postoperative complications hadrecorded. Results: Symptoms/sign nausea, vomiting, anorexia, rebound tenderness, fever,constipation, diarrhea and leukocytosis were noted with the percentage 98.0%, 65.0%, 95.0%,90.0%, 85.0%, 58.0%, 30.0% and 89.0% respectively. Paraumblical pain was noted in 50.0%of the cases, right iliac fossa pain was in the 99.0%, epigastric pain was seen in 61.0% and theother abdominal pain was noted in the 39.0%. Postoperative complications found in 33.0% ofthe cases and majority was seen wound infection. Conclusion: In the conclusion of this studyclinical features nausea, vomiting, anorexia, rebound tenderness, fever, and leukocytosis wereseen as most common and the most important postoperative complication is infection whichprobably created with the uncompleted sterilization.
INFERTILE MEN
Authors: Sultan Jahangir , Husnain Khan Shafqat , Rashid Fatima
Published: September 2021

Objectives: The objective of this study was to compare the level of traceelements Zinc, Cadmium and lead in seminal plasma and serum of infertile men to the fertileones. Period: June 2014 to August 2015. Setting: Pathology Department of Continental MedicalLahore, attached with Ch. Rehmat Ali Memorial Trust teaching Hospital Methods: A total of 400samples of workers working in different factories for a period of 5 or more years were collected.Out of theses 80 were azoospermic. The relationship of trace elements in serum and seminalplasma of infertile men was compared with the normospermic individual controls. Results: Theconcentration of trace elements Pb and Cd was higher in seminal plasma and serum of infertileindividuals while Zn level was lower. So it is suggested that high levels of Pb and Cd may affectthe fertility and Zn is a crucial element for sperms and fertility in men.
AO EXTERNAL FIXATOR
Authors: Hussain Mirjat Ashfaque , Bhutto Irshad Ahmed , Memon Shakeel Ahmed
Published: September 2021

Objectives: To appraise effectiveness of AO external fixator, a treatment methodfor open diaphseal tibial fractures (type II, IIIA). Methods: Study Design: Cross sectional study.Setting: Department of Orthopedic Surgery and Traumatology (DOST) Liaquat University ofMedical & Health Sciences Jamshoro. Period: Two year from 2009 to 2011. Total 40 cases ofopen tibia fracture had selected all the cases with fresh open diaphyseal fractures of tibia andpatient arriving within one week injury. And Grade II, IIIA had included. All the cases associatedwith head injury or abdominal injury, diabetic mellitus and liver or kidney disease had excluded.Results: Total 40 cases of open diaphyseal fracture of tibia were selected in this study basedon inclusion criteria. The mean age was 33.1 + 10.27 years. Out of 40 cases, 36(90.0%) weremale. Majority of patients of RTA were injured due to motorcycle accidents 24(60.0%). Mean ofunion time was 18.1 + 3.72 weeks. Wound became infected in 5(12.5%) cases, 5.0%, n = 40)were seen with late union, screw sites infection found in 5.0% cases, Knee stiffness was foundin 10.0% cases, six 15.0% patients developed pain during walking. Conclusion: AO fixationis very safe, insignificant intrusive, get short surgical time, following by hospital duration, lowinfection rate and can be utilized as unequivocal and effective administration of open tibialfractures.
PREGNANCY
Authors: Ahsan Muhammad Aslam , Rafique Cheema Muhammad
Published: September 2021

Thromboembolic complications are considered as the major cause of deathin pregnant ladies. Objectives: To evaluate the presence of this complication. Design:Retrospective and comparative study. Setting: Services Hospital Lahore. Period: From 2010 to2012. Materials and Methods: Forty pregnant ladies admitted in Services Hospital Lahore weresubjected to estimation of fibrinogen level, FDP level and plasma D-dimer level within 24 hoursof delivery. Results: Twenty controls and 40 patients (pregnant ladies) were studied. Fibrinogenlevel, FDP level and plasma D-dimer levels were increased in all patients as compared to thecontrols and this increase in all three investigations was statistically significant (P˂ O.O5).Conclusion: Significant changes in Fibrinogen level, FDP level and plasma D-dimer level werefound in pregnant ladies immediately after delivery (within 24 hours).
LIVER CIRRHOSIS
Authors: Sahto Abdul Aziz , Bawany Muhammad Adnan , Shumail Muhammad
Published: September 2021

Objectives: The aim behind this study was to scientifically assess the poorprognostic factors and in-hospital mortality rate in patients infected with HCV and HBV infectionwith liver cirrhosis. Study Design: Comparative hospital based study. Setting: Gastroenterologyand hepatology dedicated center, Asian Institute of Medical Sciences (AIMS), Hyderabad.Period: Thirty one months from 1st October 2012 to 31st May 2015. Patients and Methods: 419participants between the ages of 20 to 80 years including both male and female and diagnosedeither with HCV or HBV infection along with cirrhosis were included. Data were entered andanalyzed by using Statistical Package for the Social Sciences version 20.0. Results: Out of total419 patients, the mean age and S.D. of HBV patients were 41.21 ± 11.77 and HCV patientswere 50.44 ± 10.07 years. The overall mortality rate was 11.69% (N = 49) among them patientswith of HBV infection had a comparatively higher mortality rate than patients with HCV infection,13.07% and 11.07%, respectively. The most common risk factors observed in our study wereHepatorenal syndrome (41.17%) in HCV cirrhotics and hematemesis (34.37%) in HCV cirrhoticpatients. Conclusion: Our study shows that overall mortality is greater in HBV cirrhotic patientsthan with HCV cirrhotics. Poor in-hospital mortality factors vary in both HBV and HCV relatedcirrhotic patients and this discrepancy in the observation is universally observed
ANXIETY AND DEPRESSION
Authors: Aslam Muhammad Naveed , Qureshi Umar Farooq , Nadeem Muhammad
Published: September 2021

Introduction: Chronic Hepatitis C (CHC) is a leading health issue for Pakistan.Other than the late complications of chronic liver disease, such as cirrhosis and hepatocellularcarcinoma, a high frequency of anxiety and mood-disorder related symptoms has beendescribed. Objective: To evaluate the morbidity Chronic Hepatitis C causes in the form of anxietyand depression in the affected individuals. Study Design: Observational, cross-sectional study.Setting: Medical Outdoor in Ibn-e-Sina Hospital, Multan. Period: 1st October 2014 to 1st March2015. Methodology: In patients presenting with Chronic Hepatitis C and evaluated them forthe presence of anxiety and depression using Hospital Anxiety and Depression Score. We foundhigh prevalence of anxiety (36.6%) and Depression (29.2%) in the study population. The studypopulation consisted of 281 patients with CHC (175 males---62.3% and 106 females-----37.7 %,mean age 39.3 ± 11.3). Results: Out of 281 patients, 94 (33.4%) were in the age group from16-30 years, 104 (37%) in the age group 31-45 years whereas 68 (24.2%) were from the agegroup 40-60 years. Patients with were 103 (36.6%), while 178 patients were normal. Patientswith depression were 82 (29.2%). Conclusion: Chronic Hepatitis C is associated with highpercentage of anxiety and depression in the affected individuals and adds to the morbidity ofthe disease.
BCG SCAR
Authors: Tahseen Shahzadi Asma
Published: September 2021

BCG vaccination may cause scar formation but it does not occur in 100% children.Objectives: To know the frequency of BCG scar in the infants 9-11months of age and its relationwith sex, gestational age, weight at birth, the timing of vaccination and the pattern of feeding inthe first month of life. Setting: Immunization Center of Department of Pediatrics, Civil HospitalBahawalpur. Period: 1st June 2015 to 15th August 2015. Subjects and Material: The infants 9 to11 months of age coming for measles vaccination and having record of BCG immunization bythe single vaccinator done at the same centre were included for the study. The scar on the rightarm was observed at the time of measles vaccination. Result: There were 500 infants includedin the study. The BCG scar was absent in 55 cases giving absent scar rate of 11%. There was nostatistically significant difference among different sexes, birth weights, gestational ages, timingsof BCG vaccination and patterns of feeding in the first month of life. Conclusion: Absent BCGscar is not an uncommon feature and is independent of sexe, birth weight, gestational age, andtiming of BCG vaccination and pattern of feeding in the first month of life.
ACUTE ISCHEMIC STROKE
Authors: Ali Dasti Mashooq , Ahmed Hashmi Syed Fasih Ahmed Hashmi , Hussain Jaffery Mukhtiar , Ahmed Hashmi Syed Fasih , Ali Memon Hamid Nawaz , Hussain Memon Athar , Maqbool Jalbani Arshad , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the electrocardiographic and echocardiographicfindings in patients with acute ischemic stroke (potential source of cardiac emboli). StudyDesign: Cross section descriptive study. Period: Six months. Setting: Liaquat University HospitalHyderabad. Patients and Methods: The subjects with history and clinical features suggestiveof cerebrovascular accident (CVA). After establishing the diagnosis of acute ischemic strokethe electrocardiography (ECG) was advised and those subjects had abnormal findings onECG were went for echocardiography to evaluate the specific cause related to acute ischemicstroke. The two-dimensional and M-mode echocardiography was performed by consultantcardiologist had ≥ five years experienced in echocardiography because echocardiographicstudy in patients with cerebrovascular accident (confirmed on CT scan) is evidence of potentialcardiac abnormalities as a predisposing cause for the vascular event. The data was collectedon pre-designed proforma and was analyzed in SPSS 16 and the frequency and percentagewas calculated. Results: Total one hundred patients with acute ischemic stroke were studiedfor electrocardiographic and echocardiographic findings during six months study period. Themean ±SD for age of patients with acute ischemic stroke was 43.67±10.62. Majority of thepatients were males and 69% while the age and gender cross tabulation was also statisticallysignificant (p=0.03). The electrocardiographic abnormalities were indentified in 80% patients(AF in 16.2%, LVH in 22.5%, LBBB in 10%, wide QRS complex in 10% and ischemic changesin 8.7%) while the echocardiographic abnormalities were detected in 70% patients of whichglobal hypokinesia (28.5%), LVH (25.7%) and diastolic dysfunction (17.14)% were predominant.Conclusion: The cardiac embolic source is the major cause for acute ischemic stroke anddetected by echocardiography as it is the main tool in diagnosing the source of embolus.
COLORECTAL CANCER
Authors: Shah Muhammad Fahd , Ali Irum Sabir , Faraz Ahmed
Published: September 2021

Introduction: Colorectal cancer is a potentially fatal gastrointestinal disease andhas been studied extensively. In an effort to decrease the morbidity and mortality associatedwith this disease, studies have been performed to gain insight into the anatomic distribution,average age at presentation, mean age at presentation for different segments of colon involvedand intersex differences. Objective: The objective of this study is to determine the frequencyof sites of colorectal cancer involvement. Material and methods: Study design: Study wasdescriptive case series. Setting: General surgical department post graduate Lady ReadingHospital Peshawar. Period: From 01/01/2011 to 30/06/2012. Sample size: Sample size was416 using 3.57% proportion of descending colon5, 95% confidence level and 1.785% margin oferror under WHO software for sample size determination. Sampling technique: Consecutivenon probability sampling. Results: This study was carried out in 416 consecutive patients.These patients included 233 men (56 %) and 183 women (44%). Age varied from twelve yearsto seventy years. The commonest age group in the study at the time of presentation was63-72 years. Commonest site involved was rectum (26%) followed by sigmoid colon (16%).Bleeding per rectum was the commonest symptom (62.05%) followed by altered bowel habits(35.71%). Twelve patients (21.43%) presented with intestinal obstruction. Histopathologically,twenty patients had well differentiated adeno-carcinoma (35.72%) whereas eighteen patientshad anaplastic tumour (32.14%) and mucinous adeno-carcinoma was found in five patients(8.92%).Conclusion: Rectum is the most common site of tumour followed by left, right andtransverse colon respectively. The site of involvement affects the surgical procedure required.In conclusion the symptoms of colorectal cancer may not be representative of any anatomicalsite, by the time symptoms appear the lesion may have become invasive.
INTRAUTERINE FETAL DEATHS
Authors: Bano Nosheen , Asif Uzma , Qamar Saima , Asif Midhat
Published: September 2021

Objectives: The objective of the study was to identify the frequency of causesof intrauterine fetal deaths in patients presenting to a tertiary care setting. Study Design: CrossSectional Survey. Settings: Study was conducted at department of obstetrics and gynaecology,unit- ii Lahore General Hospital, postgraduate medical institute, Lahore. Duration: From April2010 to October 2010. Results: Majority of the patients of the subjects under the study wererecorded between 21-30 years of age with mean age 26.24+3.58 years. Distribution of ofcauses of intrauterine fetal death shows 42% (n=63) with no cause, 23.33% (n=35) with morethan two causes, 20.67% (n=31) with two causes and 14%(n=21) with one cause. Hypertensivedisorders 41.43%(n=62), unexplained 42%(n=63), 35.33%(n=53) were found with physicalinjuries, 17%(n=24) with congenital anomaly, antiphospholipid syndrome in 14%(n=21) whilediabetes mellitus was found in 12.67%(n=19) cases. Most of the women were found primiparityi.e. 49.33% (n=74), Multi para 2-4 in 31.33% (n=47) and only 19.34% (n=29) were found with >4 grand multi para. Conclusion: The frequency of causes of intrauterine fetal death in patientspresenting to a tertiary care setting shows most of the patients with hypertensive disorders,unexplained and physical injuries while antiphospholipid syndrome and diabetes mellitus werefound the less common causes.
HIRSUTISM
Authors: Anjum Muhammad Usman , Yasmin Surriya , Riaz Hashim , Shah Syed Humayun
Published: September 2021

elf-esteem, psychological distress and cosmetic embarrassment. Objective: Tostudy the clinical, biochemical and etiological profile of patients with hirsutism in Abbottabad,Pakistan. Duration and place: This descriptive study was performed in Frontier Medical & DentalCollege, Abbottabad from January, 2015 to December, 2015. Methods: Fifty patients wereincluded in the study. Complete clinical assessment and abdominal and pelvic ultrasonographywas carried out. Ferriman and Gallwey score was used to assess the extent and pattern ofhirsutism. Endocrinological investigations performed in these patients included prolactin,testosterone, luteinizing and follicular stimulating hormone (LH, FSH), thyroid function testsand cortisol. Results: Fifty patients were included in the study. Their mean age was 28.30±5.83years. About 88% of the women were married and 70% were obese. The polycystic ovariansyndrome (58%) was diagnosed as the main cause of hirsutism followed by idiopathic hirsutism(38%) and drug-induced hirsutism (4%). Majority of patients, 50%, had hirsutism for 1-5 yearswhile 22% and 20% had hirsutism for 6-10 years and > 10 years respectively. The rate of infertilityamong hirsute women was 70% (35 cases), out of which, 24 (48%) cases had primary infertilitywhile 11 (22%) had secondary infertility. Most of the hirsuite patients, 26 (52%), presented withthe complaints of infertility and menstrual disturbances followed by infertility alone in 9 (18%)cases, hirsutism in 6 (12%) cases and menstrual irregularities in 5 (10%). The 60% of patientsbelonged to moderate category according to FG score, (FG score 17-24). The 26% belonged tomild category (FG score 8-16) and 14% belonged to severe category (FG score 25-30). About72% of our patients used treatment of any kind for their disease. The common hair removingpractices used by these patients included bleaching (22%), waxing (20%), epilation (20%),electrolysis (6%) and shaving (4%). Serum free testosterone levels were elevated in 44% of ourpatients, LH/FSH ratio was more than 2 in 42.1% patients and prolactin levels were raised in10% of the patients. Conclusion: Hirsutism is not uncommon in Pakistan. The most commoncause of hirsutism was polycystic ovarian syndrome and idiopathic hirsutism. There is a need toconduct large scale studies to determine the true prevalence and etiological profile of patientswith hirsutism.
SPINA BIFIDA;
Authors: Iqbal Muhammad Arslan , Chaudhary Muhammad Zohaib , Abbas Muhammad Waseem , Maqsood Faiza , Fatima Fiza , Nouman Iqbal Muhammad
Published: September 2021

Spina Bifida (SB) is a neural tube defect (NTD) due defect in neural tube,characterized by incomplete closure of spinal column. Occurrence of SB varies in differentcountries. In developed countries, it is about 0.4 per 1000 births, in US 0.7 per 1000 births and inAsia 1.9 per 1000 births. SB mostly occurs during first trimester of pregnancy. Variants of SB areSpina bifida Occulata, Spina bifida Cystica [meningocele and myelomeningocele], Spina bifidaManifesta and Spina bifida Aperta. Among these myelomeningocele is the most common type.Causing agents of SB may be genetic, non-genetic or environmental factors. Non-genetic factorsinvolve anti-convulsant drugs, anti-epileptic drugs, maternal obesity, maternal diabetes andpoor nutritional status (folate and vitamin B12 deficiency). Environmental factors are pesticides,nitrated compounds and air pollution. Common manifestations are brain malformations (ArnoldChiari II malformation and hydrocephalus), spinal cord abnormalities, latex allergy, breathingproblems, urological abnormalities and cardio-metabolic dysfunction. Diagnostic techniquesfor Spina bifida are ultrasound screening, Magnetic Resonance Imagining (MRI), amniocentesisand maternal serum alpha-fetoprotein. To prevent the risk of Spina bifida, it is recommended forthe mother to use 0.4mg of folic acid per day or in mothers affected with multiple pregnanciesrecommended dose of folic acid is 4mg per day.
DIATHERMY HAEMORRHOIDECTOMY
Authors: Shaikh A. Razaque , Dalwani Abdul Ghafoor , Sushel Champa , Halepoto Ahmed
Published: September 2021

Objectives: Hemorrhoids is a common ano-rectal disorder, and heamorridectomyis universally accepted procedure. Haemorrhoidectomy can be carried out under severalmodes of anesthesia. Local anesthetic produce a loss of sensation and muscle paralysis ina circumscribed area of body by localized effect on peripheral nerve endings. The aim ofthis study is determine long term and short term outcome of diathermy haemorrhoidectomyunder local anesthesia, in term of early recovery, hospital stay, postoperative pain, bleedingand recurrence. Study Design: Cross sectional, descriptive case series study. Period: 24-02-2014 to 24-02-2015. Setting: Department of General Surgery, Liaquat University of Medicaland Health Sciences Jamshoro / Hyderabad. Method: 50 patients of haemorrhoidectomy. Allpatients of III and IV degree hemorrhoids, which are fit for surgery were included whereasthose patients who had previous anal surgery, co-existing disease i.e. Crohn’s disease, chronicdiarrhea illness, malignancy of anal region, hyper sensitivity to local anesthetics were excludedfrom the study. Data was collected and analyzed in SPSS version 20.0. Results: A total of 50patients of haemorrhoidectomy were included. The mean operative time was 15.04 minutes (n= 50). 9(18.0%, n = 50) patients had the complaint of pain, 15(30.0%, n = 50) patients haditching around anus. Postoperatively 9(18.0%, n = 50) patients got pain relief within one week,no post operative bleeding was observed within the one week. Two patients (4.0%, n = 50) hadtemporary incontinences infection. Only 1(2.0%, n = 50) patient developed anal stenosis withinthe long term period of one month to 1 year. Conclusion: Diathermy hemorrhoidectomy underlocal anesthesia feasible, safe and well tolerated by our environment and population.
EXUDATIVE PLEURAL EFFUSION
Authors: Saifullah Nosheen , Baig Saifullah , Soomro Niaz Hussain , Rizvi Nadeem
Published: September 2021

Objectives: To compare the pleuroscopic and closed pleural biopsy by Abramsneedle in terms of diagnostic yield and obtaining specific diagnosis in cases of exudative pleuraleffusion. Study Design: Cross sectional study. Period: August 2014 to February 2015. Setting:Department of Thoracic Medicine Jinnah Post Graduate Medical Center Karachi. Methodology:All patients with pleural effusion who were admitted and fulfilling the inclusion criteria wereincluded in the study .Closed pleural biopsy using Abrams needle followed by pleuroscopy witha flexible pleuroscope was performed from the same incision, in the same sitting. The sampleswere sent for histopathology. To control bias samples were coded as A and B and the codewas not known to the histopathologist. Results: Among 60 patients, Mean age was 42.85 yearswith ±18.2 standard deviation and male to female ratio was 1.6 :1. Specific diagnosis throughpleuroscopic biopsy had shown 27 (45%) cases of tuberculosis, 25 (41.7%) of adenocarcinoma,5 (8.3%) of chronic non specific inflammation, one (1.7%) case of lymphoma and 2 (3.3%)cases could not be reached for any diagnosis. Conclusion: Pleuroscopy has better yield thanthe Abrams needle biopsy in terms of both diagnostic yield and specific diagnosis
WATER DISPERSIBLE TABLETS
Authors: Khan Sohail , Zafar Farya , Ali Huma , Hameed Kamran , Mallick Neelam , Qureshi Muhammad Saquib , Baloch Saba Ajaz
Published: September 2021

Water dispersible tablets are considered to be an attractive alternate tothe conventional tablets. In this review we reported the information related to the desiredcharacteristic and formulation challenges of these formulations.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Authors: Hayat Atif Sitwat , Khan Abdul Haque , Pathan Ghulam Nabi , Mushtaque Mohammad Zubair
Published: September 2021

Objectives: Chronic obstructive pulmonary disease (COPD) leads to partialreversible obstruction of airways. The objective of our study is to determine frequency ofelevated C-reactive protein (CRP) level in patients of COPD at Liaquat University HospitalJamshoro/Hyderabad. Study Design: Cross-sectional study. Setting: Medical Unit-I of LiaquatUniversity Hospital Jamshoro/Hyderabad. Period: 1st March 2013 to 31st August 2013. Patientsand Methods: Patients of either sex and ages from 40-80 years old and having COPD for atleast two years duration were included. Patients below 40 years of age, having malignanciesor autoimmune disorders were excluded from this study. Results: We enrolled 186 patientswith COPD and their mean age was ± SD 57.63±8.45 years. Majority 182 (97.8%) had habitof smoking while 4(2.2%) were non-smokers. Mean CRP level in COPD patients was ± SD1.26±0.79 (range 0.1- 3.0 mg/d1). Out of 186 COPD patients, 94(50.6%) have raised CRP level(higher than 1.0 mg/dl). Median value of CRP level during this study was 1.10 mg/dl. About92(49.4%) patients have normal level of CRP (less than 1.0 mg/dl). Conclusion: On conclusion,frequency of raised C-reactive protein in our study was much higher (50.6%).
TYPE 2 DIABETES MELLITUS
Authors: Khawaja Rehan , Sarwar Muhammad , Bloach Muhammad Hussain , Ahmad Iftikkhar , Munir Tahir Ahmad
Published: September 2021

Objectives: To access the Homocystein and Antioxidant Status in Patient withVariation in Duration of Type 2 Diabetes Mellitus. Data source: 90 selected patients sufferingfrom Diabetes Mellitus Type 2 (DMT2) and 30 subjects as control group. Design of study: CaseControl Study. Setting: Rawal Institute of Health Sciences, Islamabad. Period: July 2013 –March 2014. Materials & methods: Out of 120 selected subjects, 30 were assigned as control,(group 1) and 90 of DMT2. Based on duration, patients of DMT2 were divided into; group 2(DMT2 <5 years), 3 (DMT2 = 5-10 years) and group 4 (DMT2 >10 years). Smokers, renalfailure, coronary artery disease, thyroid disease and patients on antioxidant treatment wereexcluded from the study. DMT2 was diagnosed according to American Diabetes Associationstandards. The fasting plasma glucose levels were measured by glucose oxidase method;HbA1c by automated kit, TAC by calorimetric TAC Assay Kit (BioVision), Vitamin C and E byELISA Kit (HUMAN) while homocysteine measured by AXSYM HCY assay kit (ABBOTT). Cut offvalues for HbA1c was taken as ≤6%; FBS ≤110 mg/dl; TAC ≥1.16 mmol/L; Vitamin C ≥2 mg/dl;Vitamin E ≥ 9.5nmol/ml and homocysteine was < 6.3 μmol/L. Results: As the duration of DMT2increases, levels of vitamin C and TAC fall significantly (p <0.05) in all groups except betweengroups 1 & 2; however, vitamin E, decreased significantly in all the groups with increased DMT2duration. A significantly increased level of HbA1c was noticed in groups 2, 3 and 4 comparedto group 1 with increased DMT2 duration. The fasting blood sugar increased significantly in allthe groups except between group 3 and 4. ANOVA showed significant differences (p <0.05)between each group and within the groups when Hb1Ac, vitamin E, vitamin C, & TAC werecompared. A positive significant correlation was observed when HbA1c was correlated withFBS; TAC correlated with vitamin C and E and between vitamin C and vitamin E. Conclusions:The levels of TAC, vitamin C and E gradually decrease with increased DMT2 duration; so shouldbe supplemented in diabetics. TAC status can be taken as early marker to detect complicationswhile homocysteine levels to prevent diabetic complications.
PREGNANCY INDUCED HYPERTENSION
Authors: Sharif Nadia , Usman Irum , Azhar Tasneem
Published: September 2021

Introduction: The hypertensive Disorders of pregnancy are major contributors tomaternal and perinatal morbidity and mortality. The aim of hypertensive therapy is to preventcomplications associated with hypertensive disorders of pregnancy. Objective: To compareefficacy of methyldopa and labetalol in management of pregnancy induced hypertension.Study Design: Randomized control trial. Setting: Punjab medical college and affiliatedhospitals Faisalabad. Methods: Patient were be randomly assigned to either group A or Groupby lottery method. Each group included 157 patients. In group A: labetalol was started at 100mg three or four times a day and increased up to 1200 mg a day in divided doses. In group B:methyldopa was started at 250mg per day 3 to 4 divided doses and increased up to 500 mg in 3to 4 divided doses. Blood pressure was recorded by sphygmomanometer. Blood pressure wasrecorded after 48 hours and then weekly till term on outpatient basis. Results: The treatmentof methyldopa in group I was proved to successful in lowering the mean blood pressure andmaintaining mean blood pressure within normal limits in 142 of 155 patients. It can be said itwas successful in 91.61% cases. 8.39% cases progressed to severe hypertension or eclampsiabecause methyldopa was unsuccessful to prevent progress of disease. Conclusion: It isconcluded that antihypertensive therapy such as methyldopa and labetalol are successful inlowering blood pressure in patient with pregnancy induced hypertension.
RENAL AND URETERIC CALCULI
Authors: Akbar Syed Ali , Ali Johar , Shahzad Talat
Published: September 2021

Objectives: To assess the role of double J stent in management of renal andureteric calculi measuring 1.5 to 2.5 cm size prior to ESWL. Period: 1st January 2015 to 30thDecember 2015. Study Design: Retrospective study. Methods: We included 120 patientswhich were divided in two groups. In group A we took 40 patients in whom double J stentswere inserted before ESWL while in group B, 80 patients underwent ESWL without stenting. Weincluded patients of both sex having radio-opaque stones in kidney or proximal ureter measuring1.5cm to 2.5cm in size in adults (age > 18) years where stone fragmentation resulted afterESWL. The average stone size in both groups was comparable (p > 0.05). Patients with urinarytract infections, pregnancy, radiolucent stones, bleeding disorders, larger or small stones,anatomical abnormality, nonfunctioning kidney and where ESWL was not successful after thirdsession were excluded from study. The patients were randomized on basis of their choice foreither procedure and majority 80 patients (66 %) refused stenting before ESWL due to fearof invasive procedure and socioeconomic reasons. Patient’s pre-operative investigations likecomplete blood count, urea/creatinine, X-ray & ultrasound KUB and IVU were done. ESWL wasdone without anesthesia and after complete clearance of fragments stents were removed withinthree months. Results: Out of 120 patients 70 were male (58.33 %) and 50 were female (41.66%). In group A (with ureteric stenting) there was no ureteric obstruction noticed after ESWLand fragments clearance resulted with mild pain or discomfort in 12(10%) patients. There wasdelayed clearance of the fragments in patients but that had no impact on patient daily activities.While in group B (without ureteric stenting) 30 (37.5%) patients developed complications likesevere colicky pain for which they were hospitalized whereas remaining 50(62.5%) patientshad mild to moderate pain with stein-stresse appearance which was managed using oral andsystemic analgesics, increase oral fluids and reassurance to the patients. The time of stonefragments clearance was delayed in group A as compared to group B (p < 0.05). Conclusion:We conclude that double J stent should be passed prior to ESWL in cases of large renal andureteric calculi to avoid severe colicky pain.
LUMBAR POSTURAL SYNDROME
Authors: Irshad Sameha , Malik Arshad Nawaz , Anwar Sahreen
Published: September 2021

Background: The most prevalent disabling condition in clinical practice islow back pain. The poor posture has highest risk for the development of low back pain inyoung population. There is different conservative treatment approaches used to treat lumbarpostural syndrome. Purpose of The Study: The objective was to determine the effectivenessof Piriformis stretching with hip external rotation in the treatment of lumbar postural syndrome.Study Design: Randomized control. Setting: District Headquarter hospital Faisalabad. Period:06 month from 01st January- 30th June 2014. Materials and Methods: The purposive samplingtechnique was used to collect sample of 30 patients and then assigned to 2 groups randomly(Hip external rotation HER and Hip Internal rotation HIR group). Standardized treatment protocolinclude heating modality, hamstring stretching, back strengthening & stretching exercises andpostural education was implemented to all patients. Participants in the hip external rotation(HER) group received Piriformis stretch with hip external rotation and participants in HipInternal rotation (HIR) group received piriformis stretch with hip internal rotation as an additionaltreatment in order to compare both stretch positions. The changes in the symptoms weremeasured in the form of pain and Modified Oswestry Disability Index (MODI). Results: Thestatistical analysis showed the P value for total score of Modified Oswestry Disability Index(MODI) was (0.00<0.05). So there is a significant difference in both group showing that thepiriformis stretching with hip external rotation is effective than hip internal rotation combinedwith conventional physical therapy in subjects with lumbar postural syndrome. Conclusions:It is concluded that piriformis stretching with hip external rotation together with conventionaltreatment is an effective treatment approach in treating lumbar postural syndrome.
HELICOBACTER PYLORI INFECTION
Authors: Qadir Adnan , Younis Irfan , Khalid Shahid Raza , Butt Zamir , Sarwar Shahid
Published: September 2021

Objectives: To determine diagnostic accuracy of H.pylori Stool Antigen test fordiagnosing Helicobactor pylori infection, keeping histopathology as gold standard. Studydesign: Cross sectional Validation Study. Place and duration: Study was conducted indepartment of Gastroenterology Military Hospital, Rawalpindi for six months from 1st November2014 to 30th April, 2015. Patients and methods: Serial patients presenting with dyspepsiafulfilling the inclusion criteria were entered in study program. Endoscopy was performed to takeantral biopsies for histopathology and stool was taken to test H.pylori antigen. SPSS version16.0 was used to analyze the data. Results: Eighty (72.2%) out of 110 patients were male, themean age and standard deviation was 33 ±16yrs. Three patients left study just before startingendoscopy. Eighty (74.76%) cases out of 107 patients were both positive for histology andHpSA test. Stool for H.pylori test was positive in 82 (76.63%) while histopathological diagnosiswas made in 83(77.57%) patients. The sensitivity and specificity were 96.3% and 91.66% whilepositive and negative predictive values of the stool H.pylori test were 97.56%, and 88.0%respectively. Overall the diagnostic accuracy of stool H.pylori test was 94.4% for diagnosisof H. pylori infection. Conclusion: Stool for H.pylori Antigen can be used as alternative tohistopathology due to its non-invasive nature, patient’s preference and ease of repetition.
VIRAL HEPATITIS C PATIENTS
Authors: Rajput Aisha , Das Bagwan , Kumar Santosh , Ansari Rafique , Kumar Beshan , Qadeer Abdul
Published: September 2021

Objectives: To determine the frequency of hypothyroidism in patients with viralhepatitis receiving interferon treatment. Study Design: Descriptive cross sectional. Setting:Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi. Duration of Study: Sixmonths. Subjects and Methods: All patients with age 30 to 60 years of either gender havingpersistent or intermittent elevation of alanine arninotransferase (ALT, the upper limit of normalALT is 40 IU/L) over a six-month period and Anti-HCV positivity and detection of HCV-RNA inthe sera On IFN-α mono therapy for more than 3 months were enrolled. History of duration ofdisease and treatment was obtained from patients. A 3 cc blood sample of Patients were drawnand send for TSH level. Presence of TSH level >4.0 miU/L was labelled as Hypothyroidism.Results: Mean age of the patients was 51.79±7.96 years. There were 51 (43.60%) males and 66(56.40%) females. Mean TSH level was 3.98±0.23 mIU/L. Mean duration of HCV was 6.42±1.67months. Mean duration of treatment was 5.42±1.67 months. Frequency of hypothyroidism wasfound in 62 (53%) patients. Conclusion: The frequency of hypothyroidism in patients with viralhepatitis receiving interferon treatment was found to be 62 (53%).
TETROLOGY OF FALLOT
Authors: Waqar Tariq , Usman Riaz Muhammad
Published: September 2021

Tetralogy of Fallot is the most common cyanotic congenital cardiac diseases. Itis also associated with other cardiac abnormalities; however, its association with dextrocardiaand situs inversus is rarely reported. We report a case of these findings in a 9-year-old boy,describe the patient’s postoperative course, and review the medical literature relevant to thesecombined conditions.
SURGICAL SITE INFECTIONS (SSI)
Authors: Akhter Farkhunda , Khawar Maliha , Hamid Tooba , Ali Moazzam
Published: September 2021

Objectives: The objective of this study is to determine the frequency ofpost-caesarean SSI and determine the frequency of factors leading to post-caesarean SSI.Study design: Descriptive case series. Setting and duration: Department of Obstetrics &Gynaecology, District Headquarters Teaching hospital, Rawalpindi from June 2015 to Nov2015. Materials and methods: Through non-probability consecutive sampling, 180 patientswho have undergone caesarean section who fulfilled the inclusion criteria were enrolled in thestudy. The data was collected manually on a formatted proforma. All patients suspected ofhaving SSI within 30 days of CS were identified for any pre-operative factors leading to theirSSI. Suspected SSI was confirmed by Culture testing of wound swabs, prior to commencementof an antibiotic treatment or as soon as the diagnosis was suspected. Data was analyzed usingSPSS version 20. Results: Of the 180 patients, 8 suffered from SSI (4.4%). The average agefor the patients was 25.42±3.68 years. The operations were elective in 38.9% of the cases and61.1% were urgent. On data analysis, Diabetes, Anaemia and emergency CS were significantlyassociated with SSI with a p-value less than 0.05. Conclusion: SSI continues to be a significantpost-operative complication. A thorough assessment of risk factors that predispose to SSI andtheir prevention may help in reduction of SSI rates. We recommend that above mentionedfactors to be taken into consideration before planning obstetrical surgeries. Prevention of theseinfections should be a clinical and public health priority.
INTESTINAL TUBERCULOSIS
Authors: Ahmad Raheel , Shafique Muhammad Salman , Zafar Shahbaz , Mehmood Saqib , Mehmood Sajid , Qureshi Usman , Khan Jahangir Sarwar
Published: September 2021

Tuberculosis is one of the leading causes of morbidity and mortality, responsiblefor annual 7–10 million new cases and 6 per cent of deaths in developing countries. It caninvolve any part of abdomen but most common is intestinal tract in which it can present withwide variety of symptoms. Early diagnosis and appropriate management is challenging forclinicians. Objectives: To determine the modes of presentation of abdominal tuberculosisand effectiveness of surgical procedures in our setup. Study Design: A retrospective study.Setting: Surgical unit-I of Holy Family Hospital, Rawalpindi. Period: January 2014 to December2014. Materials and Methods: 50 patients with abdominal tuberculosis were included inthe study. Histopathology confirmed the diagnosis of abdominal tuberculosis. Age, gender,mode of presentation, evidence of co-existing tuberculosis, family history, drug history of antituberculoustreatment, laboratory and radiological investigations, treatment modalities andduration of hospital stay were recorded. Results: There were 28 female (56%) and 22 male(44%) patients with a mean age of 29± 10.23 years. 56% patients presented with subacuteintestinal obstruction, 16% with acute intestinal obstruction and 14% with peritonitis. All 50patients underwent laparotomy. Ileocecal mass with perforation (40%) was seen as the mostcommon per-operative finding. Limited right hemicolectomy with ileocolostomy (44%) wasperformed in most of the cases. Mean length of hospital stay was 10 ± 4.67 days. Conclusion:Abdominal tuberculosis is a common cause of acute abdomen especially intestinal obstructionin our setup, with a variable mode of presentation. Early diagnosis with appropriate surgicalmanagement and chemotherapy can prevent significant morbidity and mortality.
LOWER URINARY TRACT SYMPTOMS
Authors: Rasool Mumtaz , Saleem Muhammad Shahzad , Waqas Muhammad , Pansota Mudassar Saeed , Tabassum Shafqat Ali
Published: September 2021

Introduction: Lower urinary tract symptoms are one of the commonestpresentation in urology clinics. Lower Urinary tract symptoms include storage symptoms(frequency, urgency, urge incontinency and nocturia), voiding symptoms (hesitancy, dysuria,intermittency, poor stream of urine, terminal dribbling and residual urine sensation). Correctdetermination of prevalence of LUTS might help the health service provider to plan appropriatemanagement strategies. So this study was designed to determine frequency of LUTS in menaged 40 or above. Study Design: Descriptive, cross sectional study. Period: January 2015to December 2015. Setting: Urology Department of Bahawal Victoria Hospital, Bahawalpur.Materials & Methods: Total 228 patients of 40-80 years of age with lower urinary tract symptomswere included. Patients with foleys in situ, previously operated for urinary tract disease, urinarytract stones and urinary bladder mass were excluded. These patients were assessed todetermine frequency of lower urinary tract symptoms. Results: Mean age was 65.69 ± 7.91years. Mean duration of disease was 5.36 ± 2.19 months. Frequency of LUTS was seen in 138(60.53%) men with urgency in 22.81%, nocturia in 57.89%, frequency in 19.30%, poor streamin 15.79%, incomplete emptying of bladder in 33.33%, urge incontinence in 22.81%, terminaldribbling in 55.26% and hesitancy in 15.16% men. Conclusion: This study concluded thatthe frequency of lower urinary tract symptoms were urgency in 22.81%, nocturia in 57.89%,frequency in 19.30%, poor stream in 15.79%, incomplete emptying of bladder in 33.33%, urgeincontinence in 22.81%, terminal dribbling in 55.26% and hesitancy in 15.16% patients of age≥40 years with nocturia being the most common symptom and frequency of all symptomsincreases with age.
LABOR AT TERM
Authors: Tanveer Quddsia , Fatima Anees , Sana Ummara Maqsood
Published: September 2021

Objectives: To compare the obstetric outcome between primigravida andmultigravida presenting in labor at term. Study Design: Cross sectional study. Period: Sixmonths from Jan 2013 to Jun 2013. Setting: Obs/Gynae unit III, Jinnah hospital, Lahore.Patients and methods: 800 patients were included in the study which comprised 400of primigravida and 400 of multigravida. Patients having single, alive fetus with cephalicpresentation at 37-41 weeks were included in the study. Those having recurrent miscarriages,parity >5, antepartum hemorrhage, previous uterine scars and significant medical illness wereexcluded from the study. The data was collected on specially designed proforma. Observationsmode of delivery including the indication of cesarean section or instrumental vaginal deliveryif applicable. Maternal complications such as postpartum hemorrhage along with its cause,retained placenta and uterine inversion were also recorded. Fetal and neonatal observationsincluded CTG abnormalities, oligohydramnios, low birth weight, macrosomia, Apgar score < 7at 5minutes, NICU admission, fresh still birth and early neonatal death. Results: Mean age was25.57+ 3.46 years in primigravida women while it was 25.75 + 3.44 years in multigravida group.CTG abnormalities (15.5% VS 4.25%), instrumental deliveries (9.75% VS 1%), cesarean section(15.25% VS 1%) and postpartum hemorrhage (5.7% VS 1.75%) were commoner in primigravidawomen. In addition, NICU admissions, low birth weight babies and a low Apgar score at5-minute were also commoner in primigravida women. Conclusion: Nulliparous women areat greater risk of labor abnormalities, fetal distress, instrumental deliveries, cesarean section,postpartum hemorrhage and neonatal morbidity. These adverse factors should therefore belooked for and treated well in time.
AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
Authors: Hayat Atif Sitwat , Humaira Mona , Pathan Ghulam Nabi , Bawany Mohammad Adnan
Published: September 2021

Objectives: Autoimmune hemolytic anemia (AIHA)- an immunological diseaseresulting from red cell hemolysis caused by circulating autoantibodies against antigens on redcell membrane. Positive direct antiglobulin test (DAT) always exist in association with AIHAand form basis for its serologic diagnosis. The objective of our study was to determine clinicalpresentation and etiological pattern in autoimmune hemolytic anemia at a tertiary care hospital.Study Design: Descriptive, cross-sectional study. Setting: Medical unit I of Liaquat UniversityHospital Jamshoro / Hyderabad. Period: 1st January 2010 to 30th June 2010. Patients andMethods: We enrolled 125 patients of either sex and ages from 13 to 81 years for evaluationof possible AIHA. We screened patients by performing direct and indirect antiglobulin tests(DAT and IAT) and cold agglutinin titre (CAT) levels. Pregnant women or those with historyof blood transfusion in previous three months, DAT positive patients due to Rh and ABOincompatibilities in neonates and IAT positives cases in Rh-negative pregnant women wereexcluded. Results: We evaluated 125 patients who were DAT positive autoimmune hemolyticanemia. About 93(74.4%) were females and 32(25.6%) males with female to male ratio of2.9:1. The mean age of our patients was SD ± 36.73 ± 9.32 years. Our patients commonlypresented, generalized weakness in 33(26.4%), pallor of face and extremities in 22(17.6%)and breathlessness in 20(16%) respectively. On clinical examination, moderate to severeanemia was noted in 100(80%), splenomegaly in 40(32%), hepatosplenomegaly in 28 (22.4%)and no visceromegaly in 30(24%) of our cases. We found 35(28%) with primary and 90(72%)patients due to secondary causes of AIHA. The connective tissue disorders, renal failure andhematological disorders were common causes of secondary AIHA in this study. Conclusion:Our study showed females in their thirties presented with generalized weakness, pallor of faceand extremities and breathlessness. Majority had secondary AIHA due to consecutive tissuedisorders, renal failure and hematological disorders as underlying causes. Doctors must becautious regarding whole blood transfusion as means for treating mild to moderate anemia.
TYPE-2 DIABETES MELLITUS
Authors: Tanweer Salma , Tahir Muhammad , Usman Muhammad , Kamal Rashid , Ibrahim Muhammad
Published: September 2021

Objectives: To determine the frequency of microalbuminuria in patients withtype 2 diabetes mellitus with retinopathy. Study Design: Descriptive study. Setting: Out PatientDepartment Nishtar Hospital Multan. Period: June 2015 to December 2015. Methodology:Sample size of 296 was calculated according to formula. Results: Of these 300 study cases,179 (59.7%) were male while 121 (40.3%) were female patients. Mean age of our study caseswas 52.10 ± 5.65 years (with minimum age was 42 years while maximum age was 60 years).Majority of our study cases had low educational level such as illiterate i.e. 60 (20%), primaryeducation in 71 (23.7%) secondary education 53.3% while only 3 % had bachelor’s degree orabove. Mean duration of diabetes was 14.18 ± 2.73 years (with minimum duration of disease10 years and 19 years was maximum duration of the disease). Among these patients Grade IIIdiabetic retinopathy was more prevalent i.e. 149 (49.7%) followed by grade IV retinopathy i.e.100 (33.3%) and grade11 retinopathy (17%). Diabetes was controlled (HbA1c<7%) in only 81(27%) of our study cases and obesity (BMI>30kg/m2) was present in 101 (33.7%) of our studycases. Microalbuminuria was present in 121(40.3% of our study cases. Conclusion: Very highfrequency of microalbuminuria was noted in patients with diabetic retinopathy in our study.