bluuebunny/crossref_metadata_2025 huggingface dataset:
CEFIXIME
Authors: Ashraf Muhammad Mudassar , Javed Ijaz , Aslam Bilal , Khaliq Tanweer
Published: September 2021

Cefixime is a third generation and orally acting cephalosporin. It is a cell wallsynthesis inhibitor and is well stable to presence of beta lactamase enzymes. Environmentaland genetic differences play a greater role in disposition kinetics of a drug. Objectives: Todetermine disposition kinetics of cefixime in local population and to evaluate the bioequivalenceof multinational and national brands of cefixime. Period: 2013-2014. Setting: Institute ofPharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad. Methods: Inpresent study disposition kinetics and bioequivalence of two brands of cefixime, cefspan andceforal-3, were investigated in 10 adult healthy male subjects after a single oral dose of 400 mgcapsule of each with a 7 days washout period. After blood sampling, plasma concentration ofcefixime was determined by HPLC method. For computing disposition kinetic parameters, onecompartment open model was applied. Results: Mean values of disposition kinetic parameters;t1/2β 5.01 and 4.72 hours, Vd 1.10 and 1.29 L/kg and ClB 0.16 and 0.21 L/hr/kg of cefspan andceforal-3, respectively, were found non significantly (P 0.05) different. Similarly mean values ofbioavailability parameters; AUC 36.58 and 32.99 μg.hr/mL, AUMC 282.95 and 264.13 μg.hr2/mLand MRT 7.79 and 7.83 hours of cefspan and ceforal-3, respectively, remained non significantly(P > 0.05) different. All the parameters were compared by paired t-test. Relative bioavailabilitywas found to be within the range 80-125% which is acceptable for bioequivalence. Conclusions:The test formulation, ceforal-3, was found bioequivalent to the reference formulation, cefspan.
EFFECTS OF L- CARNITINE
Authors: Siddiqui Muhammad Khalid , Mughal Sikander Adil , Siddiqui Muhammad Saeed , Hayat Atif Sitwat
Published: September 2021

L-carnitine (L-car) is a trimethylated amino acid required for the transformation oflong chain free fatty acids into acylcarnitine and their subsequent transport into the mitochondrialmatrix. It enhances the fatty acid oxidation for energy thus delaying the skeletal muscle fatigue.Objectives: Objectives of this study were to determine effect of L-carnitine supplementation onskeletal muscle lactate after fatigue, to observe effect of L-carnitine supplementation on forceof contraction in skeletal muscle and to estimate the time to onset of fatigue after L-carnitinesupplementation. Animals & treatment: In control group, the rabbit sedated and soleusmuscle was excised, Homogenized and centrifuged. Supernatant collected, was mixed withreagents of lactate test kit. Absorbance of light was read with the help of spectrophotometerand readings were noted. In experimental group, L-carnitine was given in a dose of 80mg / kg.The period of administration was two weeks. Soleus muscle was excised after giving the lastdose of L-carnitine.Lactate level was measured by using lactate test kit (Randox®). Readings forlactate measurement were noted after fatigue in both groups. Results: Statistically significantresults (p <0.05) were found in all three variables. Data was analyzed by applying “t” test in IBMSPSS Statistics - 20 soft ware. Conclusion: L -carnitine delays the onset of fatigue of skeletalmuscle. This was the stated alternative hypothesis.
AMYAND’S HERNIA
Authors: Iqbal Muhammad Rafaih , Younis Muhammad Umar , Saeed Huma
Published: September 2021

Introduction: An appendix in an inguinal hernial sac is called as Amyand’sHernia. The appendix may or may not be inflamed. It is a rare occurrence in surgical practice.Case Presentation: A 23 years old male presented with the clinical diagnosis of strangulatedright inguinal hernia. On surgical exploration acutely inflamed appendix was found in the hernialsac. Appendicectomy and hernia repair was carried out. Conclusion: Inguinal hernia is oneof the most common general surgical procedure. Unexpected hernial sac contents like aninflamed appendix may be encountered and dealt accordingly.
AUTOIMMUNE LIMBIC ENCEPHALITIS
Authors: Almerie Samer , Ashraf T , Barbosa F
Published: September 2021

A young female patient presented to the Emergency Department with complainsof headache, photophobia and seizure suggestive of viral or bacterial encephalitis/meningitis.After examination and multiple investigations, the patient was found to have autoimmune limbicencephalitisrelated to Thyroid Peroxidase antibodies.
ACUTE APPENDICITIS
Authors: Memon Abdul Salam , Khatoon Shahida , Memon Riaz Ahmed , Junejo Afzal
Published: September 2021

Objectives: To study mean platelet volume (MPV) in acute appendicitis andits correlation with leukocyte count. Study Design: Case control study Place and Duration:Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabadfrom January 2013 to February 2014. Subjects and Methods: Subjects with clinical suspicionof acute appendicitis were selected according inclusion and exclusion criteria. A sample of 49acute appendicitis patients and 37 controls were studied. The Blood samples were collected insodium citrate vacutainers and processed on Sysmex KX 21 analyzers. The main analysis wasthe comparison of the difference of MPV between acute appendicitis and controls. Data wasanalyzed on SPSS version 21.0 by student’s t-test, Chi-square test and Pearson’s correlation (r)was used to evaluate association of MPV with platelet counts and leukocytes. A p-value of ≤0.05was taken significant. Results: The mean platelet volume and leukocytes were significantlyelevated in patients with acute appendicitis. MPV and leukocytosis in controls and cases werenoted as 7.93±2.1 vs. 9.10±2.9fl (p=0.0001) and 6980±120 vs. 13980±340 μL-1 respectively.MPV was positively correlated with leukocytosis (r=0.419) (p=0.0001), while Platelets showeda negative correlation. Conclusion: Elevated MPV and leukocytosis are observed in acuteappendicitis. MPV may be exploited for clinical diagnosis of acute appendicitis but in a properclinical context along with leukocytosis.
E-COLI AND KLEBSIELLA PNEUMONIAE
Authors: Bari Fazli , Akram Muhammad , Shah Hamidullah , Shafiq Muhammad Imtiaz
Published: September 2021

Objectives: To evaluate extended spectrum betalactamase (ESBL) in E.coli andKlebsiella pneumoniae in bacterial cultures and its frequency at LRH. Study Design: Crosssectional analytical study. Setting: Lady Reading Hospital, Peshawar. Period: June 2013 toDecember 2013. Methodology: Total of 1037 bacterial isolates including 614 E.coli and 423 ofKlebsiellapneumoniae were evaluated. All cases were subjected to double disc diffusion methodfor ESBL detection using amoxacilln-clavulanic acid and a third generation cephalosporin asall ESBLs are hydrolysed by clavulanic acid. The data were analysed using SPSS-16. Results:Out of 1037 cases five ninety two (55%) were males and four fourty five (45%) were females. Ofthese, E. Coli were 614 (59.2%) and K. Pneumoniae were four twenty three (40.8%). Of these1037 isolates, four hundred & ninety five(47.7%) tested positive for ESBL enzyme. Frequencyof ESBL positivity in E.coli isolates was 264 (43%) and in Klebsiellapneumoniae isolates was231 (54.6%).Frequency of ESBL in pus was 34.3%(152/395),in urine, it was 31.8%(141/368),in blood it was 28.6%(127/233) and in sputum it was 5.1% (23/41). Unit wise frequency ofESBL was surgical & allied 24.6% (109/283), medical and allied 21.4%( 95/241), paediatrics18.5% (82/203), obstetrics & gynaecology 23.2%( 103/178) and outpatients 12.1 %(54/132).No significant correlation between ESBL positivity, gender, unit or specimen was found.Conclusion: ESBL positive isolates of E.coli and K.pneumoniaeshould be properly detected inroutine laboratory workflow to avoid unnecessary use of otherwise effective antibiotics.Theseresults indicate that such organisms are highly prevalent in our Hospital and need immediateinfection control measures to reduce their further spread.
ETHNOBOTANICAL SURVEY
Authors: Rehman Fariha , Hussain Tanveer , Abdullah Muhammad , Ashraf Ijaz , Ch Khalid Mahmood , Rafay Muhammad , Bibi Ismat
Published: September 2021

Medicinal plants are used for the production of different medicines and alsofor the treatment of different diseases. Stuyd Design: Study is based on a survey. Setting:Traditional medicinal uses of common medicinal plants of Cholistan desert. Objectives: Thepresent investigation is aimed to conserve and create awareness about the ethno medicinalvalue of the plants and their uses to draw the attention of pharmacologists, phytochemistsand pharmaceuticals. Methods: In the study area a total of 33 plant genuses belonging to21 families are reported. In current study the medicinal plants and their indigenous medicinaluses are only presented by interviewing the local informants and Hakims. The informationgained by these sources is presented here. For every plant basic information like family ofplant genus, botanical name, local name, plant origin, abundance, status, plant form, part usedand medicinal importance are given. Results: Field observations showed that deforestation,over grazing, agricultural expansion and unscientific collection, processing and preservation ofnatural vegetation are the major threats in the investigated area. Conclusion: There is dire needto conserve plant resources of Cholistan desert.
HEPATITIS C INFECTION
Authors: Naveed Shabnam , Ahmed Syed Masroor , Ali Zeeshan , Awan Romana , Zakir Humaira , Ghazi Lubna
Published: September 2021

Objectives: To determine the prevalence of Hepatitis C virus infection in Type IIDiabetes Mellitus patients and its associated risk factors in our population. Duration and Placeof Study: Study was conducted in Jinnah Post graduate Medical Centre, Karachi betweenDecember 2013 to December 2014.Study Design: It is a Cross-sectional study. Data collectionand Results: Data was collected from registered diabetic patients, 355 diagnosed Type IIdiabetes mellitus patients including 128(36.1%) males and 227(63.9%) females were selectedand their Hepatitis C screening was done by ICT method. The bio-data of the patients, history andduration of diabetes mellitus, history of blood transfusion, previous surgery, accidents, shavingfrom barber, tattooing, nose piercing, acupuncture,insulin use were recorded on a proforma.Out of the 355 diabetes mellituspatients tested, 33 were positive for anti-HCV antibodies givinga prevalence of 9.3%. Conclusion:There is increased prevalence of HCV infectionin diabeticpatients when compared with general prevalence of HCV in Pakistan.
DECOMPENSATED CIRRHOSIS
Authors: Iqbal Sarwat , Yousaf Muhammad Haroon , Yousuf Muhammad Ifitikhar , Uddin Wasim
Published: September 2021

Cirrhosis with subsequent portal hypertension is a major health problemworldwide. Among various etiologies, HCV is the leading cause of chronic hepatocellularinjury. Cirrhosis being the commonest cause of portal hypertension results in a spectrum ofcomplications. Approximately 5-15% of cirrhotic develop varices. Gastric varices althoughpresent less frequently as compared to esophageal varices but are associated with greatermortality and morbidity. Objectives: To determine prevalence of Gastric varices in patients withdecompensated cirrhosis. Study Design: Cross sectional study. Place & Duration: Carriedout at two centers, Pakistan Ordinance Factories Hospital Wah Cantt and Shalimar HospitalLahore from Jan 2014 to Jan 2015. Subjects: A total of 421subjects of decompensate cirrhosiswere included in the study. Methods: Patients with decompensate cirrhosis of any etiology whowere visiting the two hospitals as inpatient or outpatient were included in the study. Upper GIendoscopy was done in all these subjects for determination of gastric varices. Results: Among421 patients of decompensate cirrhosis, frequency of gastric varices was 10.9%, GOV1 as themost common variant. Gastric varices contributed to 5.4% of all variceal bleeds. Conclusion:Gastric varices are found in significant number of patients of decompensate cirrhosis. Sincegastric varices are associated with increased mortality and poor outcomes, these shouldbe carefully looked during upper GI endoscopy. Successful management of gastric varicealhemorrhage necessitates availability of expertise and newer diagnostic modalities.
DIABETIC FOOT INFECTION
Authors: Rahimoon Abdul Ghani , Alam Muhammad Tanveer , Talpur Muhammad Saeed
Published: September 2021

Objectives: To determine the frequency of common bacterial isolates culturedfrom diabetic foot infection in patients with type 2 diabetes mellitus (DM) falling in Wagner’sgrade-2 and grade-3 classification of diabetic foot (DF) infection. Study Design: Descriptivestudy. Period: A six months. Setting: Dow University of health sciences and civil hospital Karachi.Methods: Completed to examine the bacterial identification in cases admitted with the infectiondiabetic foot along with gave Wagner’s evaluation 2 and 3 at tertiary care hospital Karachi.Bacteriological finding and anti-biotic affectability profiles were completed and analyzed withutilizing standard strategies. Results: Out of 115 cases, 82 (71%) were male and 23 (29%) werefemale. The mean age of patients was 51.7 ±9.45 years, mean duration of diabetes was 10.6± 4.73 years, similarly mean length of time of diabetes foot wound was 46.15±23.75 days. 45(39%) patients had Wegner’s evaluation 2 and 70 (61%) patients had Wagner’s evaluation 3. 99cases indicated with culture growth, out of which 65 (65.65%) with gram negative microbes and25 (25.25%) gram-positive microbes. The most successive bacteria’s were Proteus (35.35%),Staph. Aureus (25.25%), Klebsiella (16.16%) and Pseudomonas (15.15%). Both gram positiveand gram negative showed frequent resistance to Cloxacillin, Amoxacillin, Levofloxacin, andLinezolid, gram negative life forms likewise indicated high resistance rate to Clindamycin,Vancomycin, and Cefotaxime. Tienam (Imipenem), Sulzone (salbactam in addition tocefoperazone) and Amikacin were the best effective against gram -ve and gram +vemicrobes.Staph. Aureus and Staph. Epidermidis were profoundly susceptible to Ciprofloxacin, Ceftriaxone,Clindamycin, and Vancomycin. Conclusion: Gram negative microbes were more common thangram positive living beings. Proteus, Staph Aureus, Klebsiella and Pseudomonas aeruginosawere the most widely recognized microorganisms of DF infection. Tienam (Imipenem), Sulzone(salbactam in addition to cefoperazone), and Amikacin were best effective agents.
PREMATURE CORONARY ARTERY DISEASE
Authors: Ansari Wafa Munir , Naveed Abdul Khaliq , Khan Dilshad Ahmed
Published: September 2021

Introduction: Genetic information which is specific to an individual has thepotential to improve Coronary Artery Disease (CAD) risk prediction. 13 CAD risk SNPs wereselected by removing SNPs in loci which had not been identified in CARDIoGRAMplusC4DGWAS. Linkage disequilibrium patterns differ between ethnic groups pointing towards theneed to investigate how the gene score would perform in different populations which is stilllargely unknown. Objective of the study was to investigate whether the 13 SNP CAD risk genescore has a role in the risk prediction of Pakistani Premature Coronary Artery Disease (CAD)cases and controls and to compare the CAD risk allele frequency between Pakistanis andCaucasians (samples obtained from the Northwick Park Heart Study II). Study Design: Casecontrolstudy. Setting: Army Medical College, National University of Sciences and Technology(NUST) in collaboration with the Cardiovascular Genetics Institute, University College London,UK. Materials and Methods: Total of 650 subjects with a history of chest pain were selected bynon-probability convenience sampling. Out of these subjects with > 70% stenosis in at least 1coronary vessel on angiography were labelled as Premature coronary Artery disease (PCAD)cases (n=340). The 13 SNPs were genotyped in a Pakistani case-control study (n=340 CADcases, 310 controls) using KASPar and Taqman assays. The use of 13 SNP gene score wastested in the prospective Northwick Park Heart Study (NPHSII) of 2775 healthy UK men (284cases) and the Pakistani case-control study subjects (n=650). Results: Mean ± SD age ofCAD patients was 42.7±3.80yrs while in controls it was 39.0±7.8yrs. Complete genotypingwas obtained for 635 samples (333 cases, 302 controls). The mean 13 SNP gene score wassignificantly higher in cases compared to controls (p=0.044). Odds ratio for CAD for eachquintile of 13 SNPs gene score showed a trend for higher quintiles of gene score to haveincreased odds ratio for CAD (p-value for trend=0.01) especially after adjusting for age, sexand ethnicity. There was a significant difference in risk allele frequency between Pakistanis andCaucasians (NPHSII) for all CAD risk SNPs except rs599839 (SORT1) (p=0.08). Conclusion:A 13 SNP gene score has significant potential role at differentiating between Pakistani PCADcases and controls. Risk allele frequencies for CAD differ significantly between Pakistanis andCaucasians stressing the need to develop population specific gene score keeping in view theethnic stratification.
BRONCHIAL ASTHMA
Authors: Hassan Syed Hafeezul , Rehman Javeria , Ashfaq Ahsan
Published: September 2021

Asthma is a chronic inflammatory disorder of the airways, which is associatedwith excessive airway narrowing in response to stimuli that have little or no effect on healthysubjects. Airway hyper-responsiveness with a short duration of asthma is coupled with airwayinflammation which may or may not be associated with lung impairment. Objectives: To studycorrelation of asthma duration with total anti oxidant capacity and lung function parameters.Design: Cross sectional study. Period: June 2013 to Dec 2013. Setting: Baqai MedicalUniversity and Hospital. Methodology: A total of 92 known and diagnosed cases of asthmameeting the inclusion criteria were recruited in the study. The subjects included both male andfemale with age ranging from 16-70 years. Portable handheld electronic Spirometer was usedfor performing spirometry. FRAP assay was done to measure TAC according to the method ofBenzie and Strai. Results: The mean age of patients (n-92) was 34.88±12.14 SD. The meanduration of asthma was 11.57 ± 11.30 SD years. Mean value of TAC was found to be 11.46± 4.34SD. Mean FEVI was 1.90±0.82SD, mean FVC was 2.17±0.88 SD, mean PEFR was247.8±122.7 SD and mean FEV1/FVC was 86.21±16.58 SD. Paired sample t – test was appliedto compare the spirometric values which were found highly significant. Pearson correlationwas applied and showed negative but insignificant correlation of asthma duration with patients’FEV1, FEV1/FVC and PEFR as well as insignificant correlation with other spirometric parametersand TAC. Conclusion: Our study showed that duration of asthma has no significant correlationwith lung function parameters and antioxidant capacity.
CERVICAL SPINE INJURY
Authors: Anwer Muhammad Sohaib , Younis Amir Dawood , Ali Muhammad
Published: September 2021

Objectives: To measure outcome of patients with cervical spine injury treatedwith and without surgical intervention. Study Design: Cross sectional study. Place andDuration of Study: 3years, Department of neurosurgery, Nishtar hospital Multan. Patients andMethods: Total 43 patients with cervical spine injury fulfilling the inclusion and exclusion criteriawere admitted from OPD and emergency department of Nishtar Hospital Multan. Patients wereexamined for motor loss at the time of admission and on follow after the assigned treatment.MRI neck was performed in all patients. Results: There were 43 patients in total. Males were31 (72%) while females were 13 (28%) with 2.5:1 ratio. Mean age was 33.92 ± 11.4. MeanPower grade was 2.2± 1.4 at the time of admission while on follow mean Grade of power was3.34±1.51 with P value of 0.00. Conclusion: Cervical spine injury patients are associated withImprovement in power with or without surgical intervention.
ANEMIC PATIENTS
Authors: Majeed Tayyaba , Adnan Rabia , Mahmood Zahid , Majeed Ishrat , Saba Kanwal , Mahmood Hamis , Imam Sardar Fakhar , Zafar Muhamamd Al-Fareed , Bukhari Mulazim Hussain
Published: September 2021

Pregnant women are particularly considered to be the most vulnerable groupbecause of the additional demands that are made on maternal stores during pregnancy. Theiron deficiency anemia is the most common nutritional deficiency problems in females and isresponsible of high maternal death rate in our society. Objectives: To determine the relationshipof frequency and severity of iron deficiency anemia to preterm labor and eventual perinatalout come in anemic patients. Study Design: It was a case control study. Study Setting: InObstetrics and Gynecology Unit-III, Sir Ganga Ram hospital, Lahore from July 2012 to June2013. Methodology: The study was conducted on 200 patients (100 cases and 100 controls)were studied. Cases were patients admitted in labor room with preterm labor and Controlswere females in labor at term at. Convenience sampling was done. On admission relevanthistory taking examination and investigation were done. The data was collected on a Performa.Results: There were 50 patients with anemia amongst the patients with preterm labor. In thecontrol group, 40 patients were suffering from anemia. In the patients with preterm labor themean hemoglobin was 9.83 grams/deciliter. In the control group the mean hemoglobin was10.3gm/dl. (Pregnant women having hemoglobin <10gm/dl are considered to be anemic). Theodds ratio was calculated to be 3.4 and P value was <0.05. Conclusions: Iron deficiencyanemia was associated with increased risk for low birth weight, preterm delivery, and perinatalmortality. The frequency of iron-deficiency anemia was seen in both groups of pregnant women.
TIMI RISK SCORES
Authors: Bhatti Muhammad Ijaz , Iqbal Usman Javed , Iqbal Nasir
Published: September 2021

Background: Thrombolysis In Myocardial Infarction (TIMI) risk score predictsadverse clinical outcomes in patients with non–ST-elevation acute coronary syndromes(NSTEACS). Whether this score correlates with the coronary anatomy is unknown. Objective:To determine the frequency of low, moderate and high TIMI risk score in patients of NSTEACSand to compare the frequency of two vessel coronary artery disease on angiography withlow, moderate and high TIMI risk scores in patients of NSTE-ACS. Study design: This was across sectional study. Setting: Department of Cardiology, Gulab Devi Chest Hospital, Lahore.Duration: Six months. Patients and Methods: Total 170 patients were included in the study.Patients’ selection was done with the help of a pre-defined inclusion and exclusion criteria. TIMIrisk score was calculated for each patient and patients were categorized into low, moderate andhigh risk groups (as per operational definition). Patients were further evaluated with coronaryangiograms to assess the double vessel CAD. All angiographies were performed by a singlephysician. Data analysis was done on SPSS version 17. Results: Mean age of our patients was54.81±10.55 years. Gender distribution shows that there were 106(62%) male and 64(38%)female patients. TIMI score risk classification showed that among 50(29.4%) patients TIMI riskscore was low, among 107(62.9%) patients it was moderate and in 13(7.6%) patients it washigh. There were 105(62%) patients who had two vessel coronary artery disease. Among 105patients who had two vessel coronary artery disease, 25(23.8%) had low TIMI score, 69(65.7%)had moderate and 11(10.5%) of the patients had high TIMI score. Conclusion: In patientswith non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMIrisk score is significantly associated with two vessel coronary artery disease. So it should berecommended that a routine invasive strategy be carried in patients with moderate or higherTIMI risk score.
PATTERN OF MAXILLOFACIAL TRAUMA
Authors: Khan Tahir Ullah , Khan Zafar Ali , Khalid Muhammad Usman , Afsar Rozi , Qayum Zahid
Published: September 2021

Objectives: To determine the pattern of maxillofacial injuries in the localpopulation. Study Design: Retrospective clinical and epidemiologic study. Period: January2009 to December 2013. Setting: Tertiary care hospital. Methods: 3360 patients reported formaxillofacial injuries. A number of parameters, including age, gender, facial bone fractures,laceration on face, injury of trigeminal and facial nerve branches, sensory and motor deficit inrelation to soft tissue trauma and bone fracture, were evaluated. Results: Males were dominantand male to female ratio was 6.3:1. Patients of 3rd decade were more and constitute 63.2%.Road traffic accident was the common etiological factor (78%). Mandible fracture was dominantand it was present in 1591 patients (47.7%). Soft tissue laceration frequency was high in cheekregion and was 13.7%. Sensory deficit (Trigeminal nerve injury) was present in 1167 patients(34.7%). Motor deficit (Facial nerve injury) was present in 249 patients (6.83%). Nerve injuriesin relation to mandible fracture were common. Conclusion: Road traffic accident was the mostcommon etiological factor and mandible fracture was common. Trigeminal nerve injuries werecommon and frequency of nerve injuries was high in relation to mandible fracture.
POP BOOT TRACTION
Authors: Orfi Fayyaz Ahmad , Waqas Maira , Majeed Shahid
Published: September 2021

Introduction: Fractures of upper end of femur are generally applied sometraction pre- peratively. Traditionally either skin or skeletal traction is applied. In this study weapplied traction via POP Boot with a T behind ankle in 354 cases of fracture upper end of femurduring pre-operative management and the results were compared with those of skin and skeletaltraction. Objectives: To see whether effective pre-op traction can be applied via POP Boot inupper femur fractures and what are the complications and cost effectiveness as comparedto skin and skeletal traction. Study: In 354 patients POP Boot was applied and 3 kg trationapplied to the injured limb with fracture femur while in 50 cases skin traction and in another 50cases skeletal traction was applied. Design: It’s a randomized prospective double blind study.Settings: Study was carried out in tertiary care hospitals including combined military hospitalsof Rawalpindi, Muzaffarabad and Kharian. Period: Study was conducted between the periods of10 Sep 2003 to 20 Sep 2012 (9 years and 10 days). Methods: All patients have either simple orcommunited fracture of upper end of femur. All patients were adults and received same amountof analgaesia. 3 kg traction was applied as standard in all cases. All patients were operated fortheir fracture femur within 2 to 10 days of applying traction. Results: Results were compared interms of pain control, reduction achieved, rotational control, and discomfort during applicationof tration, complications, and cost effectiveness and compared with standard skin and skeletaltractions. Conclusion: POP Boot traction is an easily applied, effective and cost effective way oftraction which has very low rate of complications and should be used for pre-op traction in alladult cases with upper femur fracture.
EFFECT OF TAMSULOSIN ON STENTRELATED SYMPTOMS
Authors: Rehman Rana Ata ur , Tahir Muhammad Muzammil , Seerwan Muhammad
Published: September 2021

Introduction: Cystoscopic intraluminal placement of ureteral stents has become a routine practice in urology. Ureteral stents preserve urine flow from the kidney to the bladder in cases of ureteral obstruction (intrinsic or extrincis). In patients with obvious ureteral obstruction, the placement of a ureteral stent will restart urine transport and protect the kidney from possible risks. Ureteral stents are troublesome in some patients and causes LUTS. Study Design: Prospective randomized controlled trial. Setting: Urology Department, Sheikh Zayed Hospital Lahore. Period: Six month started from August 2015 to December 2015. Material and Methods: 100 patients who were randomly divided into two equal groups. The patients were between 18 to 50 years of age of both gender undergo retrograde double-J ureteral stent placement. Before the double-J stent will be applied, all patients completed an International Prostate Symptom Score (IPSS) questionnaire for evaluation of lower urinary tract symptoms.Patients were divided in two groups on the basis of lottery method tamsolusin group (1) and placebo group (2). Tamsulosin group patients was given tamsulosin post operatively and placebo group was given a placebo postoperatively. Results: There were total 100 patients who were enrolled in this study with a mean age of 42.63±6.24. There were 75(75%) were male while 25(25%) were female. The mean IPSS sore at presentation was 2.47±1.43 and post treatment was 5.20±1.65. There was significant difference in IPSS score in control group with mean 5.28±1.69 versus study as mean 2.22±1.05 group, p-value= 0.010. Conclusion: There is difference in lowering of IPSS score in the patients who are given tamsolusin versus those who were retained on placebo.
DIABETIC FOOT ULCER
Authors: Rashid Asif Zaman , Iqbal Mohammad Zafar , Mehmood Khalid , Bashir Riaz Anwar
Published: September 2021

Objective: The number of diabetic patients is increasing at a rapid rate1.Management of diabetic foot has been a challenge for medical professionals. This study wascarried out to find the sequelae of diabetic foot ulcer management. Study design: Observationalanalytical study. Setting: Military Hospital, Combined Military Hospitals Rawalpindi and MIMCteaching Hospital, Mirpur (AJK). Period: Sep 2009 to August 2013. Materials and methods:Total 310 patients were included in this study as outdoor and indoor cases. Out of these 184were males and 126 were females. Age affected ranged from 20 years to 90 years. Average agewas 50 years. Wagner’s grading for diabetic foot ulcer was used as guideline for management.Results: Hyperglycemia was controlled in consultation with physicians in all these patients.Out of these 310patients 199 (64%) patients got their feet wounds healed on conservativemanagement without amputation while 111(35.8%) patients had to undergo some amputationat some level. Conclusion: Diabetes mellitus, fore runner of so many diseases requires multidisciplinaryapproach. Well controlled diabetes mellitus, good feet hygiene, rational antibioticsin light of culture/sensitivity report and timely conservative or active surgical interventionproduce good results in diabetic foot management.
DEEP VENOUS THROMBOSIS
Authors: Memon Abdul Salam , Rehman Mujeeb , Shaikh Aijaz Ahmed , Jamal Akmal
Published: September 2021

Objectives: To study mean platelet volume (MPV) in deep venous thrombosis(DVT) as evaluated by D-Dimmer and Doppler sonography. Study Design: Case control study.Place and Duration: Department of Surgery, Liaquat University of Medical and Health SciencesJamshoro/Hyderabad from May 2013 to April 2014. Subjects and Methods: A sampleof 106 subjects; 50 controls and 53 diagnosed patients of DVT were studied. DVT patientswere included according to inclusion and exclusion criteria and after results of Sonographyand D-Dimer were available. The Blood samples were collected in bottles containing sodiumcitrate as anticoagulant. MPV was generated by Sysmex KX 21 hematology analyzer. Informedconsent was sought from the volunteer subjects. The Data was analyzed using SPSS version21.0. Statistically significance was defined at p-value of ≤0.05. Results: Mean plateletvolume was elevated in deep venous thrombosis patients which were confirmed by clinicalexamination, sonography and D-Dimer. MPV was elevated in cases; 10.0±0.7fl compared tocontrols; 9.55±0.63fl (p=0.001). D-Dimmer was elevated in deep venous thrombosis patients(p=0.0001). Age, gender and platelet counts did not revealed any significant differencesbetween cases and controls (p>0.0.05). Conclusion: The present study reports elevatedMPV in patients suffering from deep venous thrombosis and it is concluded that MPV may beconsidered as a risk factor for DVT
ACUTE LOWER RESPIRATORY TRACT INFECTION
Authors: Bahawal Sadida , Manzoor Farida , Siddiqui Mehboob Alam , Ahmad Shakil , Sarwar Imran
Published: September 2021

Zinc is an essential rnicronutrient with catalytic role in over a hundred specificmetabolic enzymes in human metabolism regulates the expression of the metallothioneingene, apoptosis and synaptic signaling and needed for many aspects of immune system. Thusthe zinc ‘supplementation in patients with acute lower respiratory tract infections might havepotential benefits. Objectives: To evaluate the efficacy of zinc supplementation in patientswith acute lower respiratory tract infections. Study design: Quasi experimental study. Setting:Study was conducted in the pediatrics department Independent hospital Faisalabad; the indoorpatients meeting the inclusion criteria from 26th January to 25th July 2013 were included instudy. Material and methods: 100 children meeting the inclusion criteria were included in thestudy which were divided into two groups with random allocation i.e. Group A (Odd number)& Group B (Even number). Group A was given zinc supplementation 20mg of elemental zincfor 14 days. Along with antimicrobials, oxygen and antipyretics for fever while 50 childrenin Group B were given with antimicrobials. Oxygen and antipyretics for fever without zinc.Results: Baseline clinical parameters were comparable in both groups at admission. Outcomemeasures considered were duration of fever, tachypneoa, chest indrawings and total durationof hospital admission. Effect of zinc supplementation is significant with p-value of less than 0.05for duration of tachypnoea and chest indrawings and total duration of hospital admission whileresult showed p-value equal to 0.05 that is just significant for duration of fever.
CHILDHOOD IMMUNIZATION
Authors: Muhammad Jafri Syed Aoun , Saddiqa Aamir Dr. Iram , Abid Marium , Hanif Maliha
Published: September 2021

Introduction: Childhood immunization remains one of the most important waysof preventing outbreaks of deadly diseases. Even with full-fledged active Expanded programmeof immunization (EPI) initiated in Pakistan, the percentage of children getting vaccinated remainfar below our required levels. Infant mortality in Pakistan is highest among SAARC countries,which at present stands at 70 deaths per 1,000 live births, according to a report compiledby the Society for the Protection of the Rights of the Child (SPARC). Objective: This studywas carried out to assess mother’s education, knowledge and level of awareness of childhoodimmunization among the pregnant women. Study design: Cross sectional descriptive study.Setting: Jinnah Medical and Dental College Karachi in department of community Healthsciences (CHS). Study period: April 2012 to June 2012. Methods: A total number of Fourhundred pregnant (400) women were interviewed in both OPDs and wards of Lady DufferinHospital and JMCH Karachi. The questionnaire contained a total of nineteen questions. All ofthem were self-asked in local language. Results: A significant number of child bearing women(81.5%) had good knowledge and aptitude about childhood immunization and are likely to gettheir children vaccinated. Conclusion: The higher the people are aware regarding childhoodimmunization, the more they are likely to get their children vaccinated. The level of awarenessinvariably correlated with the level of education of pregnant women. This tells us the literacyrate along with efficient immunization campaigns can help us fight against the war of high infantmortality rate against curable diseases.
TEMPOROMANDIBULAR JOINT PAIN SYNDROME
Authors: Awan Uzma , Tariq Nadeem
Published: September 2021

Introduction: The temporomandibular joint disorders TMD and theirmanagement is a problem in dentistry and complaints associated to this problem are painin the area of joint and associated muscles along with limitations and clicking sounds duringmandibular opening and closing. One of the popular method of treatment is splint therapy.Study design: It was longitudinal intervention study. Objectives: The purpose of this study is toassess about oral splint as an effective treatment for TMD patients. Period: Total study time forthis study was about two years. Setting: Study was carried out in prosthodontics department ofSharif medical and dental college Lahore. Methodology: In the present study 40 patients wereincluded the study. All patients were suffering from some psycho-social issue. Their maximummouth opening MMO was measured and all of them were treated with occlusal splints. Results:There was significant improvement in MMO and reduction in pain.75% patients responded totreatment very well, however, 22.5% responded moderately and 2.5% patients did not respondto treatment. Conclusion: Splint therapy is an effective way to treat TMD. Splint therapy alongwith some psychological rehabilitation of patients which may produce better results.
PHARMACOVIGILANCE AND ADVERSE DRUG REPORTING SYSTEM
Authors: Ali Huma , Zafar Farya , Naveed Safila , Shah Shabana N. , Baloch Saba A. , Naqvi Ghazala Raza , Siddiqui Shehla
Published: September 2021

This study was conducted to assess the pharmacy students and graduateknowledge and awareness about pharmacovigilance & adverse drug reporting (ADR) systemin Karachi, Pakistan. Objectives: This study was designed to identify the trends, perception andapproaches of pharmacy students and graduate towards current scenarios of pharmacovigilanceand ADR contextual to our setting. Study Design: It was cross sectional, qualitative study.Setting: Pharmacy final year students and fresh graduates of two public and two private sectoruniversities were included in the study. Period: Data was collected between January to August,2015. Method: Relevant information was collected using questionnaire with 18 open ended and7 close ended questions. 400 final year participants and 150 fresh graduates were incorporatedin this survey. SPSS 20.0 was used to analyze the results and Percent, frequencies and meanscores were calculated for various outcomes. Results: Response rate of final year studentsand fresh graduates was found (97%, n = 388) and (88%, n= 132) respectively. Students levelof awareness about pharmacovigilance was found (54%, n =216) in final year students whilelittle higher rates were observed (78%, n=110) in graduates. Concept of pharmacovigilancegained through pharmacy curriculum was calculated 45% rated by final year students. Thepharmacovigilance knowledge mean score was found to be 2.368.5 and 2.886.3 for final yearstudents and fresh graduates respectively. 58% total respondents were aware with relationshipbetween the drug and the ADR. Conclusion: The results of this study demonstrate that pharmacystudents of final year in public and private sector universities of Pakistan are aware with somebasic knowledge of ADRs and pharmacovigilance, but it is a need of time to incorporate morecontents of such aspects in curriculum with some practical exposure that how to report ADRs.
SHEAR WAVE ELASTOGRAPHY
Authors: Saldera Kausar , Fatima Naqvi Nargis , Mahmood Tariq , Sarwar Shaikh Shazia
Published: September 2021

Objectives: Assessment of liver fibrosis by shear wave elastography in a patientof chronic liver disease associated infected by hepatitis B and C. Study Design: ObservationalStudy. Place and Duration of Study: This study was conducted in the Department ofRadiology JPMC Karachi from January to September 2015. Methodology: All the diagnosedcases of Chronic liver disease aged between 30 to 60 years and both gender associated withhepatitis B and C were selected. Patients using lipid-lowering drugs were excluded from thisstudy. Assessment of liver fibrosis dividing into two groups, 1st group patients suffering liverdisease since 2 years and 2nd group more than 2 years on SWE Qualitative and Quantitativeanalysis was done and staging of fibrosis according to METAVIR SCORE was done. Shearwave elastography and scoring are F0-F1 (5.3-7.1), F>2 (7.5-8.5) Grade 1-Mild, F>3 (9.5-13)Grade 2- Moderate and F>4 (13.1-18.8) Grade 3-Severe. Results: Out of the 80 patients, themajority was found to be male. 44(55%) males and 36(45%) females. Ratio between the maleand female is 1.2:1. Mean age was found to be 44.57+7.54 years. Mostly Grade 2- Moderatechanges observed in liver were 15(18.75%) of Hepatitis B Surface Antigen positive patients while14(17.5%) Hepatitis C Virus Antibodies positive patients. Followed by Grade 1-Mild changeswere 12(15%) of Hepatitis B+ve patients and 7(8.75%) Hepatitis C+ve positive patients.Grade 3-Severe were 9(11.25%) of Hepatitis B+ve patients and 4(5%) Hepatitis C+ve positive(Table No 2). 4(5%) cases observed mild changes in both positive. Conclusion: Elastographytechniques is noninvasive method can provide clinicians with innovative options as potentialalternatives to liver biopsy for improving the quality of care for those patients with liver diseases.
RUPTURE OF UTERUS (FUNDUS)
Authors: Pansota Mubasher Saeed , Ajmal Aisha , Zaman Bushra Sher
Published: September 2021

Rupture of a gravid uterus is a surgical emergency. Predisposing factorsinclude a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is arare occurrence. We hereby present the case of a spontaneous complete uterine rupture at agestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at theCivil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polypone year back. She presented with mild abdominal pains of sudden onset. After conservativemanagement for 10 hours in hospital she suddenly developed severe abdominal pains with P/Vbleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomywas done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavitywith rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs whenthere is an upper segment uterine scar. This case report shows that past history of curettage isa risk factor for the presence of uterine scar.
CHRONIC LIVER DISEASE
Authors: Mobin Ahsan , Qureshi Fawed , Kumar Darshan , Haroon Hussain , Jabeen Rakhshinda
Published: September 2021

Objectives: To determine the frequency of non variceal upper gastrointestinalbleeding in the patients of chronic liver disease. Study Design: Cross sectional study. Placeand Duration of Study: All medical wards of Civil Hospital and Ojha campus, Dow Universityof Health Sciences, Karachi, Pakistan from May 2013 to January 2015. Methodology: A total of267 patients of chronic liver disease (CLD) who presented with upper GI bleed (hematemesis ormelena) were included in this study. Before the endoscopic procedures, patients were clinicallyevaluated by gastroenterology fellows at the time of patient’s presentation. Upper GI endoscopywas performed within 48 hours in all hemodynamically stable patients. Results: The averageage of the patients was 44.27±12.13 years. Frequency of non variceal upper gastrointestinalbleeding (NVUGIB) in the patients of chronic liver disease was 56.93% (152/167). Conclusion:It is concluded that current magnitude of NVUGIB is very high in cirrhotic patients thereforeadequate planning and knowledge of the specific mechanisms explaining the prognosticfactors of NVUGIB to prevent it and thereby reducing the morbidity and mortality in ChronicLiver Disease.
HEPATOCELLULAR CARCINOMA
Authors: Rehman Khalil ur , Samiullah Dr. Muhammad , Sharif Sidra , Farhat Saira
Published: September 2021

Background: Hepatocellular carcinoma (HCC) also known as malignanthepatoma, accounts for most of the liver cancers. Alpha fetoprotein (AFP) has been undoubtedlywidely used as a marker for the detection and monitoring of HCC. This study aimed to find thecorrelation of serum alpha fetoprotein and tumor size in HCC in the tertiary care hospital. StudyDesign: This cross sectional descriptive study. Setting: Pathology Department of Allama IqbalMedical College, Lahore (AIMC). Materials and Methods: The study was carried out on 45HCC patients (13 females and 32 males) came to Jinnah Hospital Lahore. Five ml of venousblood was drawn aseptically from anterior cubital vein of patients and added into plain vial toclot. The samples were centrifuged, to get the plasma separated from blood cells. Serum AFPwas measured by using Enzyme linked Immunosorbent Assay technique (ELISA). Results:There were 10 (22.2%), 19 (42.2%), 16 (35.6) cases in AFP group 1,2,3 respectively. While10 (22.2%), 13 (28.8%), 22 (48.8%) cases in tumor size groups A,B,C. Group C with largetumor size got 48.8% raised AFP levels as compared to group B (28.8%) and group A (10%).Conclusion: This study shows there is significant correlation between serum AFP and tumorsize in HCC (r=0.668). Serum AFP progressively increases with tumor size especially in largersize. Although AFP have suboptimal sensitivity but it is still proves a beneficial in early diagnosisand screening of HCC, when used in combination of USG/Imaging technique.
MANAGEMENT OF ACNE
Authors: Asghar Aneela , Minhas Qurrat-ul-ain , Asghar Butt Muhammad
Published: September 2021

ABSTRACT…Objective: To highlight the errors in the management of acne by GPs, qualifieddermatologists having minor degrees or fellowship and those who do not have any qualificationand practicing as dermatologists. Study design: Observational case series study. Setting:Dermatology department, Allied and D.H.Q hospitals, Faisalabad and at private setup.Period: From September 2012 to September 2013. Material & Methods: 100 patients withacne were divided in four groups. Those treated by general practitioners, those treated bydermatologists with minor degrees and diplomas, those with fellowship and those who practiceas dermatologists but they don’t have any qualifications. Results: None of the patients wasassessed properly for severity of acne and none of them was being treated according to thecurrent recommendations. Conclusion: General practitioners and dermatologists still needextensive education regarding the treatment of this common skin disease.
DIABETIC PATIENTS
Authors: Arshad Muhammad , Lodhi Muhammad Aslam , Ahmad Shahbaz , Siddique Humera
Published: September 2021

Objectives: The aim of study was to measure the prevalence depressionlevel in diabetic patients. Sample and studied sources: Total sixty patients were randomlywho a in medical OPD with diabetes both male and female patients were included in studyformal approval was taken from hospital administration. Hypothesis: Depression level maybe height in diabetic patients after taking informed consent patients were interviewed. Period:Data collection was completed during May to June, 2014. Material and method: Depressioncan be measured by use Beck depression inventory, a structured psychiatric diagnostic toolafter which the diagnosis can be made according to criteria of the Diagnostic and StatisticalManual of Psychiatric Disorders (DSM IV). However, these interviews are time consuming; formy population it’s difficult to understand the English there for patient convert question wereasked in Urdu these questionnaires are often used as a screening instrument. DemographicInterview form: Demographic personal information was obtained through items which focuson subject name, father name, age, gender marital status education, occupation, sibling, familystructure, family history of disease, random blood sugar, fasting blood sugar, duration of illnessand other complication. Beck’s Depression Inventory Results: The statistics analysis revealedthat depression level is high in diabetic patients. Correlation is significance at 0.05.