bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTIDOTES;
Authors: Butt Zunaira , Shahid Saima , Gull Zujajah , Riaz Munaza
Published: August 2021

Introduction: To assess the current status of antidotes in hospital formulary& their comparison with list of antidotes mentioned in National Essential Drug List (NEDL).Evaluation of treatments for poisoned patients and establishment of Poison Control Center (PCC).Study Design: Cross-sectional study. Setting: Different Government and Private Hospitalsof Lahore. Period: 02 months (August 2015 - September 2016). Material and Methods: Adetailed questionnaire was prepared for the collection of data. Data was illustrated as graphsand tables. Results: All antidotes mentioned in NEDL are present not in a single hospital ofLahore. Atropine (87%), Flumazenil (80%), Magnesium Sulphate (80%) were present in majorityof the hospitals. On the contrary, Penicillamine, Obidoxime and Sodium Thiosulphate wereobsolete in all hospitals. Although antidotes were not fully available in both government andprivate hospitals of Lahore but the situation is worse in case of private hospitals. Conclusion:High cost and late procurement are the reasons for Delay in treatment of poisoned patients.Not a single Poison Control Center is present in Lahore. Affirmative actions should be taken toimprove the accessibility of antidotes in hospitals. There is emergent need to establish PoisonControl Center.
FRACTURE OF SPINE:
Authors: Jabbar Faisal Abdul , Hashim Muhammad , Ali Khan Abdul , Ahmed Shahid , Ali Shah Rehana
Published: August 2021

Objectives: In this study we analyze and study the effectiveness of pediclescrew and rod fixation for the management of unstable fractures of the thoracolumbar spine.The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 toSeptember 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods:N= 35 patients were operated at our institute and included in the study. The inclusion criteriawas all those patients who presented to us with unstable fractures of the thoracolumbar spinevia the accident and emergency department of the hospital, and were operated upon and gavefull informed consent to partake in the research were included in this study. All the patientswere operated under general anesthesia. The short segment fixation with pedicle screw rodfixation using the posterior approach was the technique utilized for treatment. Rehabilitationwas started immediately after the surgical procedure. Data was analyzed using SPSS version23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) weremales and n= 10 (28.57%) were females, the mean age of the study population was 33.5years. A history of fall from height was the most common cause of injury in n= 26 (74.28%)of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture wasthe most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O postoperatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittalindex values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (finalfollow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%)showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n=1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show anyimprovement. The mean duration between injury and surgical intervention was 5.5 days witha range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. Themost common complication observed was pressure sores in n= 4 (11.42%) and urinary tractinfections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%)patients. Conclusion: According to the results of our study unstable burst fractures was themost prevalent type of fracture observed, there was a marked improvement in the radiologicalparameters post operatively, while the neurological improvement was decent. The technique ofpedicle screw rod and fixation using the posterior approach provides good surgical outcomeand better stabilization, with a fair amount of neurological improvement for these patients.
SUPRACONDYLAR FRACTURE;
Authors: Talib Awais , Niaz Ch. Muhammad Atif , Sultan Yasir , Furqan Aamir
Published: August 2021

Objectives: is to compare the outcomes of open versus closed PercutaneousK wire fixation in displaced supracondy fracture of humerus in children. Period: May 2016 toMay 2017. Setting: Orthopedic unit of Nishtar Hospital Multan. Methodology: Total numberof 170 (100%) patients of displaced supracondylar fracture of humerus was enrolled. Patientswere divided into two equal groups by lottry method (85 patients in each group). SPSS version23 was used to analyze the data, mean and standard deviation was calculated for numericalvariables like age and flayn et al score, and frequencies with percentages were calculated forcategorical variables like gender and outcome variable satisfactory/unsatisfactory. Chi squaretest was applied to see the effect of effect modifiers on outcome variable. P value of ≤0.05was considered as significant. Results: Total of 170 (100%) divided in two equal groups Aand B, 85 patients in each group. Out of 170 patients 97 (57.1%) were male and 73 (42.9%)were female. Out of these in group A 75 (88.1%) patients have satisfactory outcome and 10(11.7%) patients have unsatisfactory outcome. Similarly in group B, 71 (83.5%) were havingsatisfactory and 14 (16.47%) have unsatisfactory outcome and P= 0.37. Conclusion: Results ofour study concluded that open reduction with K wire fixation technique have better satisfactoryoutcome (union rate) as compared to closed reduction and K wire fixation in the managementof supracondaylar fracture of humerus in young age group.
ENDOSCOPIC SINUS SURGERY;
Authors: Asghar Adnan , Awais Muhammad
Published: August 2021

Background: Endoscopic sinus surgery has become a preferred modalityfor management of various nasal and sinus disorders. Orbital complications, though rare,are reported amongst patients undergoing ESS. Study Design: Case series. Methods: Aretrospective review was undertaken of four cases of orbital complications during endoscopicsinus surgery. Results: Two patients suffered from periorbital haematoma and subconjunctivalhaemorrhage. One patient developed subcutaneous emphysema and numbness of lower eyelidand cheek. One patient got oedema of lower eyelid. Conclusion: Ophthalmic complicationsoccurring during ESS should be timely and properly addressed. By having sound knowledge ofanatomy of nose, paranasal sinuses and orbit and detailed preoperative assessment, chancesof orbital complications can be lessened.
SOCIO-DEMOGRAPHIC DETERMINANTS;
Authors: Salam Malik Abdul , Shahid Khalil Ahmad
Published: August 2021

Background: Thalassemic children require regular multiple blood transfusions.It leads to multiple complications such as blood born infections, iron over load (Haemosidrosis)and spleen enlargement. Thalassemia transmission to future generations can be preventedand life of thalassemic children can also be prolonged by proper devoted pre-marital and intrauterine life management and mitigation of fatal complications. Objectives: The objective ofthis study was to assess the socio-demographic determinants of thalassemic children. StudyDesign: Descriptive study. Setting: Thalassemia Centre Bahawal Victoria Hospital Bahawalpur.Period: One year from January 1, 2016 to December 31, 2016. Material and Method: Parents/guardians of 200 diagnosed children as thalassemic, who were receiving blood transfusionswere selected for interview. The data was collected by Pre- designed Performa to assess sociodemographicdeterminants. The data was analyzed to formulate hypothesis. Results: It wasfound that maximum number of patients coming for blood transfusion were from 7-9 years and10 years and above contributing 30% each while 4-6 years were 24% showing that majority ofpeople seeking for frequent blood transfusion service were over 4 years of age in this area. Atleast one thalassemic child death was disclosed by 32 (16%) families. The birth order of thepresent thalassemic child as 2nd one was told by 60 (30%) parents. There were 72 (36%) comingfrom distance <20 km which shows maximum utility of this center by local area population. Itwas found that 104 (52%) belong to poor socio-economic class. There were 188 (94%) childrenreceiving blood transfusion from teaching hospital blood transfusion center where as 100(50%) blood donors were unknown people. There were 104 (52%) children who were neverchecked for Hepatitis C virus markers while 116 (58%) mothers were illiterate. Regular use ofiron chelating therapy was found to be 8% only. There were 128 (64%) marriages proposed byparents and 72 (36%) enforced by grand elders resulting 144 (72%) marriages with first cousins.There were 160 (80%) consanguineous marriages and 188 (94%) without premarital thalassemiatest. There were 142 (71%) new born deliveries without prenatal thalassemia test. Conclusion:The enforced consanguineous marriages, lack of pre- marital and pre-natal diagnosis, poverty,illiteracy and lack of iron chelating agent support are the thalassemia problem exaggeratingfactors. Reducing magnitude of these problems can mitigate over load and socio-demographicconstraints of thalassemic patients in our country.
ALKALINE PHOSPHATASE;
Authors: Kamal Mustafa , Ahmed Fariha , Iqbal Sara , Safdar Sohail
Published: August 2021

Background: This study was carried out to determine the role of total serumalkaline Phosphatase in bone metastasis among patients of breast cancer. Setting; Departmentof Surgery, Nishtar Medical University, Multan in collaboration with breast clinic MINAR. StudyDuration; January 2016 to June 2017 Subjects and methods; It was a retrospective studycarried out at breast clinic MINAR, Multan. The medical record of the female patients havingbreast cancer aged 25 to 70 years (who presented from January 2016 to June 2017) wasscrutinized. All the registered patients during above mentioned period having breast carcinomawith metastatic bone disease, as depicted on bone scan, were taken as index cases. All thecases underwent total serum alkaline Phosphatase estimation. We collected 86 cases for thisresearch study. Primary bone tumours, lymphomas, sarcomas and bone metastasis due toother primary visceral malignancies were excluded. All the required data were entered andanalyzed using computer program SPSS version 20.0. Results; The mean age of the breastcancer patients was 46.51 ± 11.11 years (ranging from 25 – 70 years). Eighty four (97.7%) weremarried. All the patients presented with lump breast. Only 3 (3.5%) of the cases gave familyhistory of breast cancer and history of contraceptive pills was positive in 4 (3.7%) of the cases.History of breast feeding was positive in 63 (73.3%) of the cases. Mean age at menarche was13.21± 0.896 years in our study cases. Mean age at menopause in our study was 46.86 ±5.66 years. Total serum alkaline Phosphatase was raised in 27 (31.4%) cases. Only 6 (6.9%) ofthe cases showed its level more than 500 IU/L. Conclusion; Our study results don’t favor totalserum alkaline Phosphatase estimation as biological marker of bone metastasis among breastcancer patients. Bone scan is more reliable and hence be employed for detection of bonemetastasis. Further studies on bone ALP and total ALP estimation are required to generatefurther evidence on this subject.
OVARIAN VEIN THROMBOSIS;
Authors: Younis Muhammad Umar
Published: August 2021

Introduction: Ovarian Vein Thrombosis is a rare presentation in the surgicalemergency. It usually is reported in the postpartum period but may present as an acuteabdomen in the ER. Case Presentation: A 38 years old female presented with a history ofDilation and Curettage 3 days back Presented with severe lower abdominal pain, fever andvomiting. An exploratory laparotomy revealed left ovarian thrombosis with 1L hemorrhagicfluid in the peritoneal cavity. Left oophorectomy was done and anticoagulation started post op.Conclusion: OVT poses a diagnostic dilemma for the patient presenting to the emergency withan acute abdomen because prompt diagnosis and treatment are necessary to prevent furthercomplications.
OESOPHAGEAL & GASTRIC CARCINOMA;
Authors: Mannan Ambreen , Soomro Suhail Ahmed , Maheshwari Tek Chand , Laghari Muhammad Hussain
Published: August 2021

Objectives: To know the frequency of gastroesophageal carcinoma andits management at Isra University Hospital Hyderabad Sindh. Study Design: Descriptive,Prospective. Place and Duration of Study: Isra University Hospital Hyderabad during the periodof January 2014 to January2016. Patient and Methods: Fifty two patients with gastroesophagealmalignancy were scrutinized for elective and emergency surgery according to the stage andtumor resectability & observed for postoperative complication rate. Data is prepared in SPSSversion 17. Inclusion Criteria: Carcinoma of esophagus and stomach. Exclusion Criteria:Benign lesions of esophagus and stomach (Tuberculosis, Bourevet’s syndrome, Band ofLadd’s, Diaphragmatic Hernia, Phyto/Tricobezoar). Gastric outlet obstruction (GOO) causedby bilio pancreatic, retroperitoneal or abdominal wall mass. Results: Among fifty two patients11(22%) were with carcinoma of esophagus and 41(78%) with carcinoma stomach causingGOO; accounting 38(73%) male & 14(27%) females with age range of 29-69 years. Majorpresenting complaints of carcinoma of esophagus were progressive dysphagia from solid toliquid with significant weight loss while history of heamatemesis was found in only two patients.Carcinoma stomach mainly presented with symptoms of gastric outlet obstruction (GOO);partial or complete I.e. vomiting, fullness and epigastric mass with weight loss. Out of total 52patients; 35 were biopsied and staged preoperatively while 17 patients could not be biopsiedbefore surgery either because of inadequate tissue specimen or scope negotiation problem.However after surgery their biopsy was found out malignant. All such patients were optimizedbefore surgery for correction of hemoglobin, electrolyte imbalance and nutritional supportFeeding jejunostom & gastrojejunostomy were mainly performed for carcinoma esophagus andstomach while for resectable tumors Ivor Lewis, McKeon or Billroth I or II were also performedaccording to the general patient condition and the local resectability of the tumor mass. Ourpost-operative complication rate was 26% and comprised nausea, vomiting, wound infection,and delayed gastric emptying which were treated conservatively. Our operative mortality wasnone. Conclusion: Most of our cases were in advanced stage of malignancy which was mainlydealt with Feeding jejunostomy & Gastrojejunostomy. However Esophagogastric intubation inadvanced malignancy is the safe & effective alternative if available.
SIMPLE NEPHRECTOMY;
Authors: Masood Nauman , Hameed Asif , Javed Muhammad Iqbal , Zaidi Ali Imran , Bilal Ayyaz , Naeem Khalid
Published: August 2021

Objectives: The aim of this study was to identify the main etiological factorsresponsible for non-functional kidneys and the most common presenting complaints in patientsundergoing simple nephrectomy in a tertiary care hospital. Setting: Urology departmentof Nishter Medical College and Hospital Multan. Period: January 2014 to June 2015 wereselected for this study. Methods: A total of Eighty (80) patients with non-functional kidney, whounderwent simple nephrectomy. Patients of any age and gender were included. Patients havingnon-functional kidney due to any malignancy were excluded from this analysis. Detailed clinicalhistory regarding pain, micturition, radiographic findings and co-morbid conditions was takenfrom every patients. Results: The mean patient’s age was 29.21+11.80 years and the medianage was 25 years. Most common presenting complaints was flank pain. Mean Duration of flankpain was 21.86+35.06 months. 45 (56.2%) were presented with Rt. Flank pain, 29 (36.2%) werepresented with Lt. Flank pain and 6 (7.5%) were of not having pain. Most common presentingcomplaint along with flank pain was fever presented in 19 (23.8%) patients. The 2nd mostcommon was dysuria, 15 (8.8%) patients were presented with flank pain+dysuria. 11 (13.8%)were with flank pain + pyrexia. Stone disease was the most common pathology responsible fornon-functional kidney diagnosed in 40 (50%) patients, out of which 35 (43.8%) were with renalstones and 5 (6.2%) with ureteric stones. The 2nd most common pathology was Uretero-pelvicjunction obstruction (UPJO) presented in 25 (31.2%) patients. Conclusion: Renal stones aremost common benign cause responsible for most of the nephrectomies and UPJO is the 2ndmost common pathology. While most common presenting complains of patients suffering fromnon-functional kidney are flank pain, and flank pain along with fever or Pyuria.
OBESE PRIMIGRAVID WOMEN;
Authors: Junejo Raheela Rani , Junejo Rabail Rani , Sikandar Raheel , Baloch Shahla , Khaskheli Mehrunnisa
Published: August 2021

Objectives: To determine the frequency of macrosomia in obese primigravidwomen. Study Design: Case series study. Period: Six months. Setting: Department ofGynecology and Obstetrics Department Jamshoro. Patients and Methods: The inclusioncriteria of the study were primigravida women between age 18 to 35 years with singletonpregnancy and gestational duration of 37 to 42 weeks, and during labour with BMI 30 or >30kg/m2 and All booked women who were primigravid during antenatal visit try to come and BMIcalculated by weight in kg and height in meter square. The variables include post-delivery ifthe weight of baby is 4.5 kg is macrosomic and mode of the delivery. The data was analyzed inSPSS version 17, the frequency and percentage was calculated while the chi-square test wasapplied on categorical variables and the p-value ≤0.05 was considered as significant. Results:During six months study period total 203 pregnant obese ladies were observed for macrosomicbabies. Age group was analyzed which shows that in age group between 18-25 years were105(52.00%) women, in age group of 26-30 years were 62 (30.69%) women and age group of30 years and above were 35 (17.31%) women with mean age ± SD of ladies was 24.6 ±6.2years. Regarding modes of delivery shown 132 (65.02%) ladies had C-section and 71 (34.97%)ladies had vaginally delivery. Weight of the babies was assessed which shows 27 (13%) wereborn with less than 2.5 Kg, babies having weight between 2.6-3 Kg were 71 (35.3%) , babieswere having weight 3 kg to 4.5kg 38 (18.7%) and babies having more than 4.5kg which shows67 (33%). Neonatal complications observed were macrosomic babies 67 (33.1%). Frequencyof macrosomic babies was higher in women with BMI more than 3.5kg/m2 44(21.67%) andin women with BMI between 30 to 35kg/m2 25(12.31%). Conclusion: Obesity responsible forcomplications during pregnancy and delivery for both mother and babies. Fetal complicationsare macrosomia and these obese ladies should motivate for maintenance of weight.
HEPATOTOXICITY;
Authors: Khokhar Aamna , Qayyum Aisha , Khokhar Momina
Published: August 2021

Objectives: To evaluate the protective role of silymarin against methotrexate(MTX) induced hepatotoxicity in mice. Study design: Randomized controlled trial on animalmodel. Period: 06 months from March 2016 to August 2016. Settings: Department ofPharmacology and Therapeutics, Army Medical College, Rawalpindi. Material and Methods:Thirty male BALB/c mice were randomly divided into five groups (n=6). Group A received 0.2 mlnormal saline intraperitoneally served as control for MTX. Group B received 0.2 ml distilled waterorally for 7 days served as control for oral silymarin. Group C received single intraperitonealinjection of MTX 20 mg/kg. Group D received silymarin 25 mg/kg orally for seven days. GroupE received silymarin 25 mg/kg orally for 7 days with MTX 20 mg/kg intraperitoneally at day 4.Blood samples for measuring serum ALT (Alanine Transaminase), AST (Aspartate transaminase)and ALP (Alkaline Phosphatase) along with liver samples for hepatic histological examinationwere taken after 24 hours of last dose. Results: Silymarin show hepatoprotective effect againstMTX induced hepatotoxicity. Conclusion: Silymarin has hepatoprotective potential whenadministered along with MTX.
RARE OVARIAN TUMOUR IN A YOUNG FEMALE;
Authors: Samad Afra , Shafique Khurram , Samad Arbaz
Published: August 2021

Granulosa cell tumour (GCT) along with concurrent dermoid cyst involving thesame ovary is very rare. Nine such cases have been reported in the literature. Most of thereported cases are seen in older patients. Here we present a case of a young female withgranulosa cell tumour and dermoid cyst in the same ovary.
DENGUE RAPID DIAGNOSTIC TESTS;
Authors: Kidwai Aneela Altaf , Ara Jamal , Ghaznawi Samina , Rasheed Shumaila Abdul , Paracha Saleemullah , Hussain Tahir
Published: August 2021

Objectives: To determine the point of care role of dengue IgA and Dengue IgM/ IgG rapid diagnostic tests (RDTs) in a tertiary care setting in terms of day of onset of illness atpresentation and frequency of positive RDTs in dengue hemorrhagic fever (DHF) and dengueshock syndrome (DSS). Study Design: Cross-sectional study. Setting: Abbasi ShaheedHospital, Karachi. Period: August-2014 to January-2016. Method: Patients aged 13years andabove with acute febrile illness, fulfilling the WHO case definition criteria of probable DF andDHF were included. Two immunochromatograpic (ICT) based RDTs, Assure dengue IgA andPanbio Dengue Duo Cassette (IgM / IgG) were used. Dengue IgA was employed in all patientsfrom day 2 of illness whereas IgM / IgG was employed after day 4 of onset of fever. Result:Among 174 probable cases, 108 (62%) presented between 2 – 5 days of onset of fever, amongwhom 87 (80.5%) were found to be dengue IgA positive. Sixty-nine (39.65%) patients had DHF,among whom 97.1% were seropositive for IgA. Of 118 patients presented after 4 days of onsetof illness, 59.3% were positive by IgM / IgG rapid assay. Conclusion: Considering the higherfrequency of secondary dengue and DHF in dengue endemic-hyperendemic regions, IgAbased ICT might be a helpful diagnostic assay for early diagnosis of dengue infection.
HAEMOGLOBIN A1C;
Authors: Siddiqui Muhammad Saeed , Ahmad Ali Makki , Zakaria Muhammad , Aziz Muhammad
Published: August 2021

Objectives: Our aim was to determine the prevalence of controlled diabeteson the basis of HbA1c test (Hb ≤ 7 ) in registered diabetic population in three Primary HealthCenters of Ministry of Health Makkah al Mukarrahma. Study Design: Retrospective review ofmedical records of registered adult Saudi patients with type 2 diabetes. Setting: Three PrimaryHealth Centers of Ministry of Health Makkah al Mukarrahma. Period: 20 June 2015 to 31December 2015. Methods: The sample size calculated was 354 patients with confidence levelof 95% and confidence interval of 5. The cut of values adjusted for all diabetes mellitus patientswas, haemogloblin A1c (HBA1c) ≤ 7. Three last readings were recorded and to be declared ascontrolled diabetic case (valid control), last two readings were required to be within this normallimit. Data was processed on Microsoft Excel and SPSS-23 software. Results: Overall the agerange was 21–79 (58) years and a mean of +/- SD of 56.67 +/- 11.97. Male were 206 and female148 in number. Hb A1c test entries recorded in 292. On the basis of set HbA1c criteria no validcontrol entry was found in one PHC while in other two, there were 15 (4.23% prevalence) validcontrol entries. Valid control results were found significant (P < 0.05). Conclusion: Very lowPrevalence of controlled diabetes on bases of HbA1c test in Primary Health Centers indicatenoncompliance of this test in our study group. Guidelines of the Ministry of Health regardingcare of diabetic patients in Primary Health Care should be followed to achieve the recommendedoutcome.
METABOLIC SYNDROME;
Authors: Sohail Sumbul , Nadeem Shabnum , Ali Fouzia
Published: August 2021

Metabolic syndrome is a congregation of central obesity, dyslipidemia, raised bloodsugar levels, increasing the individual’s susceptibility to Type II Diabetes and cardiovasculardiseases. Objectives: (1) To determine the prevalence of metabolic syndrome in young, urban,female population. (2) To determine the risk factors in poor, urban, female population. StudyDesign: This was a descriptive cross sectional study. Setting: The department of Gynae/Obst Unit II KMDC/Abbasi Shaheed hospital. Period: One year starting from January 2016 toDecember 2016. Material and Method: Approval was taken from ESRC of KMDC. All healthyasymptomatic married/single women between 18-49 years of age were included while women<18 or >50 years of age, diabetic, hypertensive or having bleeding disorders were excludedfrom study. Laboratory data included blood sugar, triglycerides, HDL-cholesterol, collected byphlebotomist from the participants in fasting state through venipuncture. A Chi-square test wasapplied to evaluate the association of demographic group variables and metabolic syndrome.P-value <0.05 was considered as statistically significant. There was no conflict of interest. Result:A total of 343 participants were recruited. The socio and demographic data is summarized inTable-I. The prevalence of Metabolic syndrome was found to be high. 227(66.2%) of participantswere having Metabolic syndrome according to NCEP ATP III criteria. 63(18.4 %) had history ofPIH while 52(15.2%) had family history of hypertension and 126(36.7 %) had family historyof both Hypertension and Diabetes. 232 (67.6 %) of women had sedentary life style and only3(0.9%) practiced aerobic exercises. 287(83.7%) had their waist circumference of >80cm, themean systolic blood pressure was 127.5 +-23.76 while the mean diastolic blood pressure was86.99+-57.36. The mean of BMI was at higher level 30.97+-6.41. Obesity is the most commonrisk factor for Metabolic syndrome. The mean of fasting blood sugar was 105.08+-42.16which was on higher side. The mean of Triglycerides 142.43+-61.12 and HDL 39.04+-12.45were within normal limits. Increased prevalence was observed in women who had PIH duringpregnancy and childbirth 25.1% v 5.2%(p value=0.001). Conclusion: Prevention and treatmentof metabolic syndrome is a big challenge. Lifestyle interventions should begin from the earlychildhood to reduce weight and to prevent development of obesity and metabolic syndrome.
MYOCARDIAL INFARCTION;
Authors: Anjum Muhammad , Rashid Muhammad Ammar , Hussain Aamir , Imam Sadia
Published: August 2021

Objectives: To determine the frequency of new onset heart failure after acutemyocardial infarction and factors contributing it. Methods: A total of 228 patients were studiedfor occurrence of new onset clinical heart failure within24 hours after admission with anacute Myocardial Infarction. Clinical parameters were used to diagnose heart failure. Variousrisk factors were analyzed which contributed to occurrence of heart failure after MI. Patientsundergoing primary angioplasty were not included into this study as medical thrombolysis wasthe most common mode of therapy (in >90% of patients). Results: Among the 228 patientsstudied 77.2 %( 176) were males and 22.8 %(52) were females. Mean age of the populationwas 56.3(±12.1) years. Women were relatively older on presentation as compared to men(mean age 58.9±10.9yr vs 55.5±12.3yr). Similarly mean age for NSTEMI was higher ascompared to STEMI (58.59±11.1 vs 54.2±12.6yr.). A total of36.8 %( 84) patients exhibitedclinical signs of heart failure within24 hours of their admission. These patients tend to be olderthan patients without HF (mean age 60±11years vs 54±12 years). Females after MI showed agreater frequency for going into HF as compared to males (42.3% vs 35.2% respectively). Nowregarding the association of HF with various factors it was seen that, having a previous historyof MI was found to be the strongest factor associated with occurrence of HF, with HF beingnearly three times more common in these patients (i.e. 73% vs 26.1%, p value < 0.05). Thecurrent type of MI on presentation also showed a direct relationship with HF, being highest inpatients with NSTEMI (i.e. up to 50 %) followed by AWMI (35.5%) and lowest in inferior wall MI (pvalue < 0.05). Diabetes, hypertension and smoking also showed a higher but statistically nonsignificantrelationship with HF development (41.2% vs 34.3%, 41% vs 32.2% and 44% vs 32%respectively p value > 0.05). The blood pressure on presentation however was significantlyassociated with HF in these patients. Patients having high BP (> 140/80) on presentationdepicted an overall higher incidence of HF as compared to patients having BP equal to or lessthan 140/80 (45.2% vs 31.3% p value < 0.05). Conclusion: Heart failure is a fairly commonentity after acute MI, being the commonest in patients suffering an NSTEMI. Previous history ofan MI showed to be the strongest coexisting factor associated with HF.
BMI;
Authors: Khatoon Shafat , Ahmed Aijaz , Zubair Muhammad
Published: August 2021

Malnutrition results in the death of about 54 percent of all child death each year.From the time of birth of a children to the growing age nutrition and balanced diet is one of themajor concerns of parents and the nutritionists. Many different ways are devised to assess thenutritional status of the child. One of the widely accepted tools is to measure the Body MassIndex (BMI) of child. BMI provides a non-interventional and easy method for early diagnosis ofmalnutrition. Objectives: To determine current dietary practices among school going childrenand highlight the health risks associated with abnormal BMI. Place and Duration: Governmentsetup, Primary and Middle Schools of Islamabad were visited, from 1st August 2015 to 31stNovember 2015. Study Design: A questionnaire based cross-sectional study. Patients andMethods: A sample size of 184 was taken. Parents of class 6, 7 and 8 included. Parents wereasked to fill with diaries of students and was taken back after 3 days. Height and weight wastaken. Results: Out of 184, male students were 109 and female students were 71. 125 childrentook breakfast. 61 eat vegetables 3 times a week and 3 twice a week. 16 children never eatvegetables. 103 children had good appetite. Conclusion: Dietary habits in children in urbanarea is satisfactory, but slightly increase tendency towards unhealthy food is observed.
MULTIPLE CHOICE QUESTIONS;
Authors: Iqbal Muhammad Zafar , Irum Shumaila , Yousaf Muhammad Sohaib
Published: August 2021

Objectives: The main objective of this study was to judge the quality of MCQs interms of their cognition level and item writing flaws, developed by the faculty of a public sectormedical college. Setting: This study was conducted in Sheikh Zayed Medical College, RahimYar Khan. Duration with Dates: Data was collected between June 2014 to March 2015 andthis study was completed in July 2016. Sample Size: A sample of 500 MCQs collected from25 faculty members were included in the study. Study Design: Quantitative method. StudyType: Cross sectional descriptive analysis. Material and Methods: This quantitative study wasconducted in Sheikh Zayed Medical College Rahim Yar Khan over six months period after theapproval of the study proposal. Every faculty member is supposed to write 25 MCQs in order tobecome supervisor. I collected 500 multiple choice questions from 25 faculty members readyfor submission to CPSP. The quality of all MCQs was checked in terms of item writing flawsand cognition level by panel of experts. Results: Absolute terms were observed in 10(2%),vague terms in 15(3%), implausible distracters in 75(15%), extra detail in correct option 15(3%),unfocused stem 63(12.6%), grammatical clues 39(7.8%), logical clues 18(3.6%), word repeats19(3.8%), >then one correct answer 21(4.2%), unnecessary information in stem 37(7.4%),lost sequence in data 15(3%), all of above16(3.2%), none of above 12(2.4%) and negativestem 23(4.6%). Cognition level l (recall) was observed in 363(72.6%), level ll (interpretation) in115(23%) and level lll (problem solving) in 22(4.4%) items. Total 378(75.6%) flaws were identifiedand four commonest flaws were implausible distracter 75(15%), unfocused stem 63(12.6%),grammatical clues 39(7.8%) and unnecessary information in stem 37(7.4%). Conclusion: It isconcluded that assessment of medical students is very demanding and need of the time. A wellconstructed,peer-reviewed single best type MCQ is best one to complete this task becauseof cost effectiveness, better reliability and computerized marking. It is very important to startfaculty development program in order to decrease the number of item writing flaws and improvecognition level towards problem solving and application of knowledge.
PRIMARY CONGENITAL GLAUCOMA;
Authors: Ahmad Iftikhar , Nadeem Nida , Ashraf Nahdia , Ahsen Muhammad , Ahmad Zubair
Published: August 2021

Objectives: To determine the outcome of trabeculotomy in patients presentingwith primary congenital glaucoma at a tertiary care hospital in Pakistan. Design: It wasa descriptive case series. Place and Duration of Study: This study was conducted at theDepartment of Ophthalmology, Allied Hospital Faisalabad over 3 years from January 2014to December 2016. Material and Methods: 45 consecutive children presenting with primarycongenital glaucoma were included after written informed consent. These children underwenttrabeculotomy. Outcome variable was frequency of successful treatment which was definedas persistent intraocular pressure below 20 mmHg without medication for at least six monthsand reduction or stabilization of cupping of the optic disc. A predesigned proforma was usedto record patient’s demographic details along with outcome variables. Results: The mean ageof the patients was 17.47±5.77 months. There were 28 (62.2%) male and 17 (37.8%) femalechildren with a male to female ratio of 1.6:1. It was bilateral in 37 (82.2%) patients. There wassignificant improvement in the mean intraocular pressure (12.69±2.12 vs. 25.09±4.52 mmHg;p<0.00001), horizontal corneal diameter (11.96±1.49 vs. 14.87±2.03mm; p<0.00001),axial length (20.16±2.51 vs. 20.69±2.37mm; p=0.0002) and cup-disc ratio (0.30±0.15 vs.0.51±0.19; p<0.00001) from baseline at 6 months follow-up after trabeculotomy. Treatmentwas successful in 39 (86.7%) patients. There was no significant difference in the frequencyof successful treatment across age and gender groups. Conclusion: Trabeculotomy is aneasy to perform procedure with high success rate of 86.7% in children with primary congenitalglaucoma. The complications observed in the present series were related to surgical skill andtechnique and were successfully managed.
HEAVY METALS TOXICITY:
Authors: Khalil Kashif Ur Rehman , Mehsood Naheed , Faisal Muhammad Saleh , Awan Baber
Published: August 2021

Objectives: To estimate the concentration of heavy metals (Lead, cadmium,Chromium and copper) in branded and non-branded (local) snacks in the markets of Peshawar,Khyber Pakhtunkhwa, Pakistan. Study Design: Cross-sectional analytical study. Setting:District Peshawar, Khyber Pakhtunkhwa, Pakistan. Period: 6 months; from December 2016 toApril 2017. Materials and Methods: A total of 96 different samples of potato and corn snackswere selected from four towns of district Peshawar by convenient sampling technique. Allsamples were subjected to wet digestion using acid digestion technique and Lead, Cadmium,Chromium and copper were quantitatively detected, using Atomic Absorption spectrometer inthe Public Health laboratory Khyber Medical College Peshawar. Results: Mean concentrationof Lead, cadmium, chromium and copper in potato based branded snacks were in the rangeof 0.085-0.423mg/kg, 0.003-0.046 mg/kg, 2.186-2.328 mg/kg and 0.008-0.108 mg/kg andconcentration of heavy metals in corn based branded snacks were in range of 0.240-0.351mg/kg, 0.007-0.012mg/kg, 2.254-2.179 mg/kg, 0.030-0.082 mg/kg respectively. While meanconcentration of Lead, cadmium, chromium and copper in non-branded (local) snacks were0.057-0.324 mg/kg, 0.005-0.012 mg/kg, 2.137-2.247 mg/kg and 0.018-0.06 mg/kg respectively.Conclusion: Lead and chromium were exceeding in majority samples of branded and localsnacks. Particular concern was of chromium, which was exceeding far beyond the allowedlimits in all samples.
TIBIAL DIAPHYSEAL FRACTURES;
Authors: Iqbal Sajjad , Saeed Hafiz Salman , Aslam Bushra , Fayyaz Iqra
Published: August 2021

Objectives: To evaluate the management of tibial diaphyseal fractures treated byPOP cast versus intramedullary nailing in terms of time of union. Design of study: Randomizedcontrolled trials. Setting: Department of Orthopaedic, Allied / DHQ Hospital, Faisalabad.Duration of Study: Six months (01-08-2013 to 31-01-2014). Materials and Methods: 80patients fulfilling the inclusion and exclusion criteria were included in the study. After laboratoryand radiological assessment, the patients in Group 1 were treated by long leg cast. The patientsin Group 2 were treated with intramedullary interlocking nail. The patients were followed on OPDbasis. Results: 80 patients divided into 2 groups. Each group had 40 patients. Mean age ofpatients was 30.99 ±8.092 years. There were total of 65% males and 35% females in this study.According to geometry of fractures simple transverse fractures were 47.5%, spiral fractureswere 17.5%, oblique fractures were 25% and segmental fractures were 10%. There were 71.25%closed fracture and 28.75% type l open fractures. Mean time of union was 23.86 ± 5.48 weeks ingroup 1 while in group 2, mean time of union was 18.35 ± 4.12 weeks. P-value was 0.001 whichis statistically significant. Conclusion: It is concluded that reamed intramedullary interlockingnailing is a good mode of internal fixation comparing with conservative management of closereduction and POP cast in both close and type I open fractures in terms of union.
ACUTE ORGANOPHOSPHATE POISONING;
Authors: Sajid Nida , Saba Noor-us- , Ghuman Faiza , Iqbal Sadia , Nisa Qamar un , Asim Sadaf Ahmed , Sarwat Ayesha , Qasim Afzal , Azmat Rabia , Saba Noor-us-
Published: August 2021

Introduction: Organophosphate poisoning (OP) is a serious public healthproblem. Cardiac manifestations are seen in majority of patients with OP and may range fromsinus tachycardia to more serious ventricular tachyarrhythmias. Objectives: To determinethe electrocardiographical manifestations of acute organophosphate poisoning at a tertiarycare hospital. Study Design: Observational study. Setting: Department of Medicine, AbbasiShaheed Hospital, Karachi. Period: February 2011 to August 2011 over a period of six months.Patients and methods: All patients of either sex presenting with the history or evidence ofexposure to organophosphorus compounds within 24 hours with characteristics manifestationsof organophosphate poisoning were included in the study. Electrocardiographic manifestationswere observed before the institution of medical therapy. Results: A total of 123 patients, 81(65.9%) male and 42 (34.1%) female were included in the study. The Mean (+SD) age ofthe study participants was 29.07 (+ 9.61) years. Majority (74%) patients had age <35 yearsand 78 (63.4%) patients in this study had time duration of <6 hours between ingestion oforganophosphorus and institution of therapy. The overall electrocardiographic changes wereobserved in 86.2% of patients. Out of these, ST elevation was seen in 19.8%, T-wave inversion in17.9%, prolonged PR interval in 9.4%, atrial fibrillation in 6.6% and prolonged QTc interval seenin 46.2%. Conclusion: Electrocardiographical changes are common manifestation of acuteorganophosphate poisoning. Prolonged QTc interval and ST segment elevation are the mostcommon finding in our patients. As these changes in ECG can lead to serious consequences,therefore it should be carefully evaluated in every patient with OP so that early intervention canbe done.
NEONATAL SEPSIS;
Authors: Abbasi Nazia Bashir , Jabeen Nighat , Khatoon Shafat
Published: August 2021

Introduction: Neonatal sepsis is a systemic condition characterized bybacteremia that occurs in the first month of life. It is a fatal condition and need to be treatedpromptly. Bacterial isolates include both gram positive and negative bacteria and the cureof condition is highly dependent on antimicrobial drug sensitivity and resistant patterns. It isthere for utmost important to known commonly occurring bacteria in neonatal septic statesand their drug sensitivity patterns. Objectives: To determine the frequency of the bacterialisolates in blood and their sensitivity patterns to commonly used antibiotics in neonatal sepsis.Setting: Neonatal intensive care unit(NICU), Department of Shifa International Hospital. (SIH),Islamabad. Study Design: Cross sectional. Duration: This study was conducted between 6 1stJune 2013 to 30th November 2013. Subject and Methods: A total of 180 neonates, admittedin NICU with evidence of clinical sepsis i.e. with signs and symptoms suggestive of septicemia(fever, lethargy, reluctance to feed, seizures, and irritability) were included in this study. Thesamples for blood cultures were taken. Identification of bacterial isolates was carried out by thestandard bacteriological techniques, which include gram staining and bacterial cultures andantimicrobial sensitivity patterns which was performed by modified Kirby and Bauer disc diffusemethod as per CLSI (Clinical and Laboratory StandardsInstitute)guidelines.A predesignedPerforma was filled. Results: Culture revealed bacterial growth in 7.2% samples. Gram negativeorganisms were observed in 6.67% and only 1 were gram positive. In this study, 50% and 100%of E-coli were sensitive to ampicillin, meropenem and amikacin, gentamycin respectively. Sixtyto 100% of pseudomonas was sensitive to ceftazidime, tazobactum, meropenem and 100%of enterococcus was sensitive to ampicillin and vancomycin. Conclusion: Antimicrobial drugresistance and constantly changing resistance patterns is emerging issues in various groupsof infections and septic states, especially for routinely used antibiotics as found in our study.Thus by prescribing rational use of antimicrobial as per bactriogram, It‘ll be easier totreat sepsiseffectively and economically and reduce the mortality and morbidity related to neonatal sepsis.
CORONARY ARTERY DISEASES;
Authors: Habib Afzal Qari Hafiz Muhammad , Ruaf Kamran , Khan Areej Umber , Ashfaq Asma , Basit Muhammad Bilal , Anjum Khalid Mahmood
Published: August 2021

Introduction: Ischemic heart disease (IHD) is one of the leading causes ofdeath. Short sleep duration may increase the risk of coronary artery disease (CAD). The studywas designed to evaluate the association between CAD and sleep duration. Objectives: Todetermine the frequency of patients who have short sleep duration may suffer from CAD. Studydesign: Case series. Setting: Punjab Institute of Cardiology (PIC), Lahore. Period: It was carriedout in six months. Methods: 400 patients admitted who presented with IHD. Sleep durationwas categorized into three categories like <6 hours, 6-8 hours and >8 hours. Angiographywas performed for patients who have CAD. Results: Sleep duration was <6 hours, 6–8 hours,and >8 hours in 172 (43%), 124 (31%) and 104 (26%) patients respectively. Significant CADwas presented among 84 (21%) patients of sleep duration <6 hours, 16 (4%) patients of sleepduration 6–8 hours and 32 (8%) patients of >8 hours sleep duration. Conclusions: Significantnumber of patients has short sleep time and suffering from CAD.
SUBTOTAL THYROIDECTOMY;
Authors: Ahmed Shabbir , Ahmad Ishtiaq , Riaz Asad , Furqan Aamir
Published: August 2021

Objectives: To compare the mean operative time in subtotal thyroidectomy withharmonic scalpel and conventional vessel ligation method. Study Design: Randomized controltrial. Setting: Surgical unit of Bakhtawar Amin Medical and Dental College Multan. Period: April2015 to April 2016 for one year. Methodology: A total number of 92 cases were selected forthis study and these were randomly divided into two equal groups by lottery method (GroupA= operated with harmonic scalpel, Group B= operated with conventional vessel ligationmethod) each containing 46 patients. The sample size was calculated with the help of the WHOSample Size Calculator. (WHO sample size determination software version of KC Lun and PeterChiam). Sample Size, n= 92 (46 in each group). Expected mean operative time with harmonicscalpel method (44.9 ± 8.3 minutes) compared with the Conventional ligation method (69.5 ±10.7 minutes; P < .001). Data was analyzed with the use of SPSS version 23. The frequencyand percentage were calculated for qualitative variables like gender. Quantitative variables likeage and operative time were presented as mean and standard deviation. T test was appliedto compare the mean operative time between two groups. Results: A total number of 100%(n=92) patients were included in this study. Gender distribution showed that there were moremales i.e 52.2% (n=48) and 47.8% (n=44) were females. The mean age of patients was 42.75+ 14.33 years. Recorded mean duration of operation time was 47.69 + 6.51 minutes for groupA compared to the mean duration of operation of 71.61 + 7.32 minutes. This time differencewas statistically significant with a p-value of < 0.001. Conclusion: Subtotal thyroidectomy withharmonic scalpel leads to a significantly reduced mean operative time compared to conventionalvessel ligation technique and should be opted routinely for this surgical procedure.
POLYPROPYLENE MESH REPAIR IN ABDOMINAL WALL HERNIAS;
Authors: Hussain Malik Azhar , Malik Naveed Ashraf
Published: August 2021

Objectives: To determine the beneficial out comes, recurrence rate andcomplications of the repair of abdominal wall hernia reinforced with polyprolene mesh. StudyDesign: This was a retrospective interventional quasi experimental study. Setting: Surgicaldepartments of Central Hospital and Prince Abdul Aziz Bin Musaad Hospital, Arar, SaudiArabia. Duration of Study: November 2012 to October 2016. Material and Methods: Adultpatients of both genders, who underwent repair for various abdominal wall hernias duringabove mentioned period, were included in the study. Their demographic data, relevant historyand physical examination, post-operative notes, prognosis and any complications, includingrecurrence, infection, adhesions, pain and mesh degradation were recorded in a pre-structuredquestionnaire. The data was then analyzed with standard statistical methods. Results: From atotal of 156 patients, 94 (60.3%) were males and 62 (39.7%) female between the age of 20 to75 years. There were relatively fewer complications, including seroma (12.8%), post-operativepain (9.6%), infection (3.8%), adhesions (0.6%) and no recurrence rate. The uneventful recoverywas observed in 73% of cases. Conclusions: Pure polypropylene mesh is economical than thenewer composite meshes for the open repair of abdominal wall hernia, is easily available andcaused relatively fewer complications with no recurrence rate.
ASCORBIC ACID;
Authors: Shaikh Aftab Ahmed , Soomro Umair Ali , Siddiqui Shomail Saeed , Shaikh Kashif Rasheed , Qureshi Mumtaz Ali
Published: August 2021

Objectives: Investigating the Renoprotective effects of Ascorbic acid ingentamicin induced renal injury (GIRI) in male Wistar rats. Study design: Experimental study.Place and Duration: Animal house of Al-Tibri from September 2016 to December 2016.Methodology: 60 male Wistar rats were selected by non-probability purposive sampling,and were divided into three groups; Group A- control, Group B- Gentamicin induced renalinjury (GIRI) (70 mg/kg/bwt i.m) daily , and Group C- GIRI + AA (Ascorbic acid - 0.2 mg/kg/bwt) daily. Cardiac puncture was performed by a Disposable Syringe for blood sampling.Sera were used for biochemical testing. Renal tissue was stained with H & E for histologicalexamination. Statistix 8.1 software (USA) was used for data analysis at P≤ 0.05. Results:Blood urea and serum creatinine were elevated in the group B (GIRI) compared to GIRI+AAand the controls (P=0.0001). Serum superoxide dismutase, glutathione peroxidase, andcatalase were low in GIRI compared to GIRI+AA and control groups. Renal tissue in ascorbicacid treated rats showed improved tissue architecture. Conclusion: It is concluded that theAscorbic acid exerts Renoprotective effects in gentamicin induced renal injury in rat model.