bluuebunny/crossref_metadata_2025 huggingface dataset:
STATE OF HEALTH
Authors: Rathore Altaf Hussain , Rathore Kashif
Published: August 2021

The plight of surgical diseases in Pakistani workers in the gulf countries ishighlighted. Objective: To highlight the health problems of Pakistani workers in GS. It is doneby taking the information from the expatriates returning from the gulf states who present to usin the foundation hospital, Rajana, district Toba Tek Singh (TTS), for the treatment of varioussurgical illnesses. It is concluded that Pakistanis working in the gulf countries are not satisfiedby the treatment received in those states. Only one out of 50 patients was satisfied with thetreatment he got for his disease.
TRIAL OF LABOR
Authors: Ishtiaq Shahina , Ali Habiba Sharaf
Published: August 2021

Objective: To determine the frequency and types of vaginal delivery in womenwith previous one caesarean section and to observe the effect of women age on success ofvaginal birth. Method: A descriptive study was carried out in the department of obstetrics& gynecology, Ziauddin University Hospital Kemari campus Karachi from January 2011 toJanuary 2013. 200 patients with previous one caesarean section for a non recurrent cause wereincluded in the study after fulfilling the inclusion and exclusion criteria. The women selectedwere evaluated and counseled for trial of labor. The frequency and mode of vaginal delivery wasrecorded in cases of successful trial of labor and caesarean section was performed in case offailed trial of labor. Results: Successful vaginal delivery was achieved in 67% of the patients andrepeat emergency caesarean section was carried out in 33% of the patients. Leading indicationfor repeat caesarean section was failure to progress, fetal distress and scar tenderness. Nomaternal and fetal complication occurred. We also observed that patients of less than 30 yearswere more likely to have a successful vaginal delivery (82%) as compared to patients older than30 years (18%). Conclusions: The trial of labor should be encouraged with vigilant monitoringin patients with previous one Caesarean section and is a safe and successful option if carefullyselected and monitored.
THE FUNCTIONAL E1–E2 HETERODIMER HCV GLYCOPROTEINS
Authors: Mahmood Hamid , Zulfiqar Nasir , Irfan Ghazia , Riaz Hashim , Waqar Ammara , Shahzad Naeem , Farooqi Irfan
Published: August 2021

Introduction: The two HCV envelope glycoproteins E1 and E2 are released fromHCV polyprotein by signal peptidase cleavages. These glycoproteins are type I transmembraneproteins with a highly glycosylated N-terminal ectodomain and a C-terminal hydrophobicanchor. Methods and pathways: After their synthesis, HCV glycoproteins E1 and E2 associateas a non covalent heterodimer. The transmembrane domains of HCV envelope glycoproteinsplay a major role in E1–E2 heterodimer assembly and subcellular localization. The envelopeglycoprotein complex E1–E2 has been proposed to be essential for HCV entry. Results andconclusions: However, for a long time, HCV entry studies have been limited by the lack of arobust cell culture system for HCV replication and viral particle production. Recently, a modelmimicking the entry process of HCV lifecycle has been developed by pseudo typing retroviralparticles with native HCV envelope glycoproteins, allowing the characterization of functionalE1–E2 envelope glycoproteins., we review our understanding to date on the assembly of thefunctional HCV glycoprotein heterodimer.
FLOW-MEDIATED VASODILATATION
Authors: Memon Muhammad Qasim , Macdonald Ian A
Published: August 2021

Objective: To assess whether flow-mediated dilatation (FMD) affectedcardiovascular (CV) parameters after consuming fructose or sucralose. Data source: Finometer.Design of study: Randomized, cross-over, single-blind design. Setting: School of biomedicalsciences, University of Nottingham, UK. Period: July, 2009. Materials and methods: Tenhealthy, white European males were studied twice. A Finometer continuously recorded CVparameters. Following 30 min baseline, a BP cuff, around mid-point of right arm was inflated 50mmHg above Systolic BP for 5 min. Upon deflation, FMD measurements were made. Volunteersthen consumed 500 ml of fructose or sucralose containing drink. Forty min later, 2nd FMD wasdone. Results: Pre-fructose FMD: SBP increased in late-occlusion and post-occlusion period(POP). HR and CO decreased and SV and TPR increased during POP (P < 0.01 & 0.001).Post-fructose: DBP rose (2 mmHg; P = 0.04) during occlusion; HR (P = 0.02) and CO (P <0.05) increased whereas TPR decreased (0.023; P < 0.04) in recovery period. Pre-sucralose:SBP, DBP and MAP increased in POP and thereafter. Decreased HR and CO and increasedTPR and SV were noted (P < 0.01 & 0.001). Post-sucralose: SBP rose in POP and thereafter (5mmHg; P < 0.01); MAP (3 mmHg; P = 0.04) and SV (P = 0.05) increased in POP. Conclusions:Attenuated BP and TPR, after fructose, indicate fructose’s possible vascular effects.
DIABETIC CONTROL SITUATION;
Authors: Siddiqui Muhammad Saeed , Aziz Muhammad , Ali Makki Ahmad
Published: August 2021

Objectives: To determine the prevalence of controlled diabetes in registereddiabetic patients with Hemoglobin A1c (HbA1c) ≤ 7 or Fasting blood Sugar ≤ 130 mg/dl inthree primary Health Care Centers of Al- Ameer Ahmad Sector of Makkah. Methods: This studywas a descriptive study (cross sectional) started from 20 June 2012 to 30 September 2012. ThePrimary Health Care Centers randomly selected were AL-Zahir, Al-Hindavia and Kudai Al- Hijra.The sample size calculated was 320 patients with confidence level of 95% and confidenceinterval of 5. The cut of values adjusted for all diabetes mellitus patients was, haemogloblin A1c( HBA1c) ≤ 7 or fasting blood sugar (FBS) ≤ 130 mg/dl .Hypertension values were set as 140/90 mm of Hg. Results: Overall the age range was 25 – 87 (62) years and a mean of +/- SDof 58.66 +/- 11.97. Out of 320 diabetic patients selected (152 only diabetes + 168 patients ofdiabetes with hypertension) 21.25 % have disease under control. Most effected age range ofuncontrolled diabetes was 45-74 years. HbA1c test for study year was not done in 83.43 %cases. The age and Gender difference in two groups were not significant, however the resultsof controlled and non-controlled diabetic patients in three Primary Health Care Centers wassignificant (P <0.05 ). Conclusions: Diabetes Control programme at the level of Primary HealthCenters showed a very low level of success in study groups. There is a need to reconsider thecontrol strategy.
ANTERIOR SAGGITAL ANORECTOPLASTY
Authors: Rasool Naima , Khan Mohammad Asghar , Aslam Mushahid , Safdar Aqeel
Published: August 2021

… Anorectal malformation is the common congenital malformation. Ectopic anusand vestibular fistula are Intermediate types of anorectal malformations (ARM), which are themost common in female babies. Many surgical procedures have been described for the treatmentof ARM. Anterior Saggital Anorectoplasty (ASARP) is not only convenient for the anesthetist formaintenance of anesthesia but also gives better exposure of surgical structures during surgery.Objectives: To determine the technical suitability and outcome of ASARP in intermediate typesof ARM in female children. Design: This Descriptive study with prospective collection of dataaccording to a set protocol. Setting: The study was carried out at the department of PediatricSurgery, Military Hospital, Rawalpindi, Pakistan. Period: November 2010 to March 2014, overthe period of 3 years and 5 months. Patients and Methods: The data of all female patientspresenting with intermediate types of ARM and undergoing ASARP, during the study periodwere analyzed, with respect to age, type, associated anomalies, complications and cosmeticoutcome. Results: A total of 36 patients of intermediate variety underwent ASARP. Age rangedfrom 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery,posterior vaginal wall tear occurred in 2 patients (5.5%). Postoperatively, 2 patients (5.5%) hadretention of urine, 2 patients (5.5%) developed wound infection with superficial disruption, analstenosis occurred in 2 patients (5.5%) and 1 patient (2.7%) had rectal mucosa prolapse. Noneof them required re_ do surgery. Cosmetic outcome was excellent in 31 patients (86.1%), while itwas satisfactory in 5 (13.8%) patients. Conclusions: Anorectoplasty through anterior approachis not only technically easy but has good cosmetic results in intermediate type of imperforateanus in female children.
DIABETIC EYE SCREENING IN SIR GANGA RAM HOSPITAL, LAHORE.
Authors: Adnan Muhammad , Zafar Humera , Ali Zahra , Shabbir Iffat , Rahat Tayyaba
Published: August 2021

Background: Diabetic retinopathy is the optical complication that may leadto impaired vision. It is one of the most prevalent but preventable blinding disease. Its earlydiagnosis is prerequisite for the prevention of the visual loss and blindness associated withdiabetic complication. Objective: To estimate frequency of eye examination and various typesof retinopathy; and to find the association between diabetic retinopathy and its risk factors.Methods: The cross sectional study was conducted from Apr-Sep 2012 by PMRC ResearchCentre, FJMC, Lahore. Using non probability convenient sampling, eighty known type IIdiabetics were recruited. Venous blood was drawn for plasma glucose level (GOD-PAP) andglycosylated hemoglobin (Ion-Exchange Resin). Arterial blood pressure was measured usingdigital apparatus (Oscillometric method). Visual acuity was tested by Snellen’s chart and dilatedfundus examination was done to screen diabetic retinopathy. Data was analyzed using StatisticalPackage for Social Sciences (SPSS-20). Results: The study included 41% males and 59%females. Mean age was 51±9 (33-67) years. Diabetics who never screened for retinopathy were54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequencyof bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR wasslightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity wasequal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eyeof 20% participants. DR was significantly associated with longer duration of diabetes (p-0.010),poorly controlled diabetes (p-0.044) and hypertension (p-0.006). Odd ratios (95% CI) showedthat duration of diabetes ≥20 years, glycosylated hemoglobin ≥7.5 %, Systolic blood pressure ≥140 mm/Hg and diastolic blood pressure ≥90 mm/Hg had 3-5 times higher risk of retinopathy. Conclusion:Majority of patients were neither knew nor referred for eye examination. Strict control of diabetesand hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eyeexamination must be prescribed by the physician/ diabetologist. An education and awarenessprogram for diabetics and community based survey is highly recommended.
INTERVAL TONSILLECTOMIES
Authors: Javed Muhammad , Wahid Fazal-I- , Khan Nadar , Khan Qaisar , Haq Naseemul , Shahabi Isteraj Khan
Published: August 2021

Introduction: Peritonsillar abscess is a common clinical problem faced byotorhinolaryngologist all over the world. There are different schools of thoughts regardingtonsillectomy after peritonsillar abscess due to its expected complications. This comparativestudy was conducted to know about frequency of complications in each of the techniques.Objective: To compare per and post operative complications in patients undergoing early anddelayed interval tonsillectomy after peritonsillar abscess. Design: This was randomized controltrial. Setting: Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. Period:From Jan 2012 to Dec 2013. Material and Methods: After taking detailed history, thoroughexamination, relevant investigations and informed written consent peritonsillar abscess wasdrained and then interval tonsillectomy was performed. The complications were noted onpredesigned proforma. Chi square test was used to compare the complications in both thegroups while keeping P < 0.05 as significant. Results: Out of 60 patients males were 38 andfemales were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SDwith a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SDwith a range of 13-46 years. Findings of per-operative and post operative hemorrhage showedthat there was insignificant difference in both the groups (P=0.601). However pain and hospitalstay in both the groups was significantly different with P value of 0.004 and 0.000 respectively.Conclusions: Early interval tonsillectomy is an easy and safe procedure for peritonsillarabscess.
MEAN ANTI-MULLERIAN HORMONE LEVELS
Authors: Parveen Naila , Afaq Erum , Zulfiqar Farah , Rehman Javeria
Published: August 2021

Objective: To compare the means of Anti-Mullerian hormone levels in bothfertile and infertile women. Study Design: Case-Control study. Place and Duration of Study:This study was conducted at infertility clinic of Gynecology& Obstetrics Unit-II, Civil Hospital,Karachi. The total duration of the study was approximately 1 year from October 2011 to October2012. Methods: A total of 52 infertile women attending the Gynae-Unit-II out-patient clinic at CivilHospital, Karachi and 48 fertile non-pregnant females of reproductive age group i.e. 20-35 yearswho met the inclusion criteria were included in the study. The serum Anti-Mullerian hormonelevels were measured in both the infertile and fertile groups. Blood samples to determine AntiMullerianhormone levels were obtained irrespective of their menstrual cycle days. Results:Independent sample t-test showed decreased mean serum Anti-Mullerian hormone levels ininfertile group (cases) than the fertile controls. Conclusions: Mean concentration of serum AntiMullerianhormone in infertile women was sig nificantly lower than that in fertile control women.
OUTCOME OF THE CLOSED DIAPHYSEAL HUMERAL FRACTURE TREATED WITH DYNAMIC COMPRESSION PLATE
Authors: Maher Imran Khan , Laghari Muhammad Ayub , Memon Shakeel Ahmed , Arain Muhammad Saeed
Published: August 2021

Objective: To determine the treatment outcome of the closed diaphyseal humeralfracture treated with dynamic compression plate at Liaquat university hospital Hyderabad.Materials and methods: Total 30 patients having displaced diaphyseal humeral fracture wereincluded in the study. All the patients having fracture of less than 10 days and between the ages15 – 45 years were selected. All the patients selected after counseling and diagnosed as a caseof closed diaphyseal humeral shaft fracture on the basis of clinical examination and X-rays.In this study dynamic compression plates (DCP) were used for stabilization of humeral shaftfracture as assessed by pre operative workup, operative findings and outcomes were recordedwith postoperative complications. To avoid the radial nerve palsy it is isolated during operativeprocedure. Results: Present study was comprises of 30 patients with humeral fracture with themean age of 30.29±8.92 years and male/ female ratio of 7:3. On the radiological findings mostcommon type of fracture was oblique in 54%. From the complications, postoperative pain wasfound in 6.6% of the cases along with postoperative Infections in 10%. 90% fractures unitedwhile 10% fractures found with non union. Excellent result were seen in 60% of the cases, while30% cases were noted with satisfied results and very poor results were found in 10% of thecases. Conclusions: It is concluded that DCP is the good option for the fixation of diaphysealhumerus fracture. Radial nerve palsy is less likely if isolated during operation.
DIABETIC PATIENTS;
Authors: Kitchlew Rizwana , Mazhar Syed Abdullah , Mirza Ilyas Baig , Jaffri Ahmed Raza
Published: August 2021

Objective: To study the clinical profile of diabetic patients on haemodialysiswith a view to identify common clinical features and the trend of compliance with treatment andfollow up. Place and Duration of study: Haemodialysis unit Fatima Memorial Hospital, Lahore,from January to August 2011. Method: Data collected from all patients above 14 years of agethrough medical history, record, examination and fundoscopy. Results: Out of total 76 patientson haemodialysis 50(65.7%) had DM and of these 42(84%) also had hypertension. Amongdiabetics 28 (56%) were male & 22 (44%) female. Mean age was 56.68 ± 9.09. Among these15(30%) were illiterate and 27 (54%) belonged to lower social class. Ever smokers were 18(36%).Mean duration of diabetes since diagnosis was 10.9 ± 5.99. Mean duration of hypertension8.28 ± 8.07, Duration of onset of dialysis 6 months to 8 years with mean 2.16±1.47. Retinopathywas found in 29(58%), 18(36%) had diabetic &11(22%) had hypertensive changes. Both fastingand random blood sugar levels were monitored by 28 (56%). None had regular follow up withHbA1c levels or urine for protienuria prior to onset of haemodialysis. Compliance with dietaryadvice & treatment claimed by 24(48%) and 36(72%) respectively. History of intake of Hakeemand homeopathic medications was found in 16(32%) and 10(20%) respectively. Conclusions:65.7% of ESRD were diabetics. Majority were in 6th decade of life. Retinopathy was present in58%. Low trend was observed towards compliance with treatment &follow up.
MITRAL VALVE REPLACEMENT ON BEATING HEART;
Authors: Ahmad Naseem , Hussain Ghulam , Shahzad Muhammad Naveed
Published: August 2021

Introduction: Cardiac reperfusion injury is a well-described complication occurringafter ischemia or following cardioplegic arrest. The primary aim of this study was to evaluateand compare safety of Mitral valve replacement on beating heart without using cross clampwith the conventional Mitral valve replacement. Material and methods: It was a retrospectiveobservational study for study duration from 2012-2014. A total of 50 patients were randomlyselected and were divided in 2 groups, 25 patients in each group. This study was conductedat the Department of Cardiovascular Surgery of Choudhry Pervaiz Elahi Institute of Cardiology,Multan. We divided the patients in two groups. All operations were carried out by team led bya consultant surgeon in our institution. Results: Our patients had the age range from 12 to 65years (Mean ages=32.5 years ± 13.9000) the mostly this study included males 60 %. The studyincluded Group A and Group B (beating heart versus conventional heart surgery) both groupscontained randomized controlled patients with purposeful sampling. Minimum operative time100 minutes or maximum operative time 160 minutes (Mean 195± 95.75) The P value remainednon significant that P <0.001. The CPB time was 22 to 388 minutes (104.8 ± 97.4. Cross Clamptime, ICU stay intubation time, drainage, inotrope remained almost same in both groups. With P<0.001 Outcome variables of the patients. Discussion: The hazards of cardiopulmonary bypassand Cardioplegia are well known. Various studies have demonstrated decreased accumulationof extra cellular fluid, diminished lactate production and greater preservation of high energystores when a strategy of myocardial protection simultaneous antegrade/ retrograde continousnormothermic, normokalemic blood perfusion was used. These findings were the basis forusing beating heart technique for mitral valve replacement, Aortic cross-clamping, Cardioplegia,and reperfusion injury leads to myocardial ischemia and is a critical issue in mitral valve surgerydespite novel approaches to myocardial protection. Myocardial edema induced by the lack ofmyocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remainingin diastole is another cause of myocardial dysfunction. Conclusions: Outcomes obtained usingthis strategy of myocardial protection seem to compare favorably to those of historical series inwhich conventional myocardial protection with cardioplegic arrest were used.
PSEUDOANEURYSM OF THE SUPERFICIAL FEMORAL ARTERY;
Authors: Ali Bashir Muhammad , Obaid–ur Rehman , Jehanzaib Shah , Furqan GillaniSyed , Imtiaz Shakir , Rana Adnan Muhammad
Published: August 2021

… The case report is of a 30-year male patient who had a fracture shaft of femurand after open reduction and internal fixation developed swelling which was painful and waspresent on the medial aspect of the thigh. It was decided to do an angiogram as the swellingwas expansile and confirmed superficial femoral artery pseudo aneurysm and the reason wasthought to be over penetration of the bit of the drill while doing the surgery for shaft of femurfracture. Treatment decided by the multidisciplinary team was to remove the condylar buttressplate, resection of the aneurysm and repair of the aneurysm with inter-positional graft
BURN WOUND INFECTION;
Authors: Naqvi Syed Zulfiqar Ali , Naqvi S. M. Abbas , Usman Muhammad , Naqvi Syed Baqar Shyum
Published: August 2021

Background: Burn injuries are common and major health problem throughoutthe world. The burn wound represents as a favorable area for opportunistic colonization ofmicroorganisms with exogenous and endogenous origin. In burns patients infections arisefrom multiple sources. Burn wounds become initially colonized and infected with Gram positivebacteria, mainly Staphylococci, that are superseded during the second week by Gram Negativebacteria. Objectives: it is a microbial surveillance retrospective study; that aimed to evaluatethe significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection andcarried out in between June 2007 to September 2011 in the Department of Pharmaceutics,University of Karachi. Study Design: Descriptive retrospective study. Materials: A total of 118patient irrespective of age, sex, date and time of burn, date and time of hospital admission,interval between time of burn and hospital admission, degree and percentage (%) of burn andduration of hospital stay (when specimen collected) were registered for this study. All patientswere divided into two groups (A and B). Results: Out of 58 patients of group A isolation rate perpatient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in groupB rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus(23%)P.aeruginosa(21%). Conclusions: Burn patients are incubator for variety of aerobic bacteriaand rate of isolation of these organisms increase with rise in TBSA. The wounds of these patientmust required continuous microbial surveillance that may reduce the rate of mortality
NOSE
Authors: Abou-Elhamd Kamal-Eldin Ahmed
Published: August 2021

Objectives: The nose is used more than any other organs of the body in differentcultures as a symbol. This symbol may indicate honor, shame or sex. Some of them are factsand others are myths. This paper reviews most of these symbols. Conclusions: The nose isused in many cultures in different ways. It is used daily in greetings within Arabic Gulf area. Itis the most used body organ in proverbs. Myths about its relation to sexual activity are funnyones. Scientifically, priapism in the nose occurs in sickle cell disease. Vicarious menstruationmay occur in the nose resulting into epistaxis.
FACTORS AFFECTING ON OBESITY AND UNDERWEIGHT WITH OUTCOME AMONG PEOPLE LIVING IN THE VICINITY OF MARZIPURA, FAISALABAD
Authors: Zakria Muhammad , Ashraf Muhammad
Published: August 2021

… Due to transformation in nutritional status, along with epidemiological and sociodemographic changes in developing countries like Pakistan, obesity and underweight coexistin our community. Date about coexistence of obesity (body mass index, BMI ≥ 30kg/m2) andunderweight (BMI ≥ 18.5 kg/m2) and related factors are lacking in this region of our province.This study will help us to relate different sociodemographic factors with obesity and underweight.Objective: To know the prevalence of obesity and underweight by body mass index (BMI) andto investigate the association of obesity and underweight with selected health conditions andsocioeconomic differences in this group. Study Design: Observational retrospective crosssectionalstudy. Material & Methods: The record of 1656 individual presented in medical OPDor Independent University Hospital Marzi Pura Faisalabad, during the period of 4 months Mar2013 to June 2013 was analysed. Age, Sex, Body Weight and height were enter in a structureformat sheet. Date was analysed by SPSS Version17. Results: Mean BMI was 24.0 kg/m2 (SD= 6.2), and was higher for women and decreased with age. Prevalence of obesity was 19.6%and was positively associated with female gender, family income, hypertension, and diabetesand inversely related to physical activity. Underweight affected 15.6% of participants mainly ofage group < 25 years and in elderly people, and was higher among women and low-incomefamilies. It was negatively associated with hypertension and diabetes and directly associatedwith Mycobacterium tuberculosis infection and ≥ 2 hospitalizations in the previous 12 months.Conclusions: Both obesity and underweight were associated with increased morbidity. Theassociation of underweight with Mycobacterium tuberculosis infection, increased hospitalization,and low family income may reflect illness-related weight loss in all age groups especially <25years due to poor care in younger by family and social deprivation of elderly in this community.Aging in poverty may lead to an increase in nutritional deficiencies and health-related problemsamong the elderly.
ATRIO-VENTRICULAR BLOCK
Authors: Majeed Babar Muhammad Zafar , Majid Abdul , Chaudhary Abdul Waheed , Raza Baig Mirza Ahmad
Published: August 2021

Objectives: The incidence of high degree atrioventricular block (HAVB) variesfrom 2.7 to 14% after acute STEMI. The aim of this study was to evaluate the incidence of highdegree atrioventricular block (HAVB) in patients of acute myocardial infarction. Study Design:Observational study. Setting: Sheikh Zayed Medical College/Hospital Rahim Yaar Khan. Period:March 2016 to May 2016. Material and Methods: Two hundred patients of acute myocardialInfarction were included in this study. Patients suffering from 2nd degree Mobitz type II or 3rddegree heart block were labelled as High Degree Atrioventricular Block (HAVB). Data Analysiswas made using Statistical Package for Social Sciences Software V17. Chi-square test wasused to compare in-hospital mortality between the groups taking p-value <0.05 as significantdifference. Results: The mean age of patients who presented with myocardial Infarction inour hospital was 50.13+6.97 years. Out of 200 patients, 35 (17.5%) were smokers, 83 (41.5%)hypertensives, 69 (34.5%) diabetics and 48 (24.0%) were with positive family history of IschemicHeart Disease. Most common type of MI was anterior wall present in 50.5% patients and 2ndmost common was inferior wall MI presented in 26.5% patients. High degree atrio-ventricularblock was present in 9 (4.5%) patients. In-hospital mortality was significantly high in patientswith HAVB, in these patients in-hospital mortality was 2 (22.2%) as compared to only 8 (4.2%)in patients of without HAVB (p-value 0.01). Conclusion: Myocardial infarction complicated withhigh degree atrio-ventricular block (HAVB) is associated with higher rate of in-hospital mortality
LIVER INJURY
Authors: Hakim Zunera , Waheed Akbar , Hakim Bareera , Hassan Najam ul
Published: August 2021

Methimazole (MMI) is a widely used antithyroid drug for hyperthyroidism.However its clinical use is associated with many deleterious effects including hepatotoxicity.MMI induced liver injury is dependent upon bio-activation to toxic intermediates revealing theimportant role of drug metabolizing enzymes in generation of this adverse reaction. Studydesign: Randomized controlled laboratory trial. Period: 04 months from March 2015 to June2015. Settings: Department of Pharmacology and Therapeutics, Army Medical College,Rawalpindi. Aim of the study: The effect of isoniazid (INH) on MMI induced hepatotoxicity wasevaluated in mice. Materials and Method: Thirty male BALB/c mice were randomly dividedinto five groups. Group I served as control group (C-I). Group II (C-II) served as control forINH treated group and received plain drinking water for ten consecutive days. Hepatotoxicitywas induced by single intraperitoneal injection of MMI at a dose of 1000mg/kg in Group III(MMI).Group IV (INH) received isoniazid (0.1%w/v) in drinking water for ten consecutive days.A separate group V (INH +MMI) of isoniazid pretreated mice was given MMI at eleventh day fordetermination of combined effect of both drugs. The extent of hepatic damage was determinedby estimation of serum ALT and ALP along with histopathological analysis of liver samples.Results: MMI resulted in markedly elevated ALT and ALP with hepatic inflammation. INHadministration produced no significant change in both serum biomarkers and histopathologyappearance. Pretreatment of INH with MMI produced insignificant escalation of liver enzymesand microscopic parameters. However, biochemical and histological comparison of this groupwith MMI group revealed statistically consequential differences. Conclusion: INH has beneficialrole in preventing MMI induced hepatic injury.
ARTHROSCOPY OF THE KNEE
Authors: Ameen Moghees Ikram
Published: August 2021

Introduction: Arthroscopy has a significant efficacy amongst patients, butis dependent on the anasthesia used. This is particularly important, as research on kneearthroscopy has established importance on anasthesia, particularly the type and number used.Study Research Objective: This study conducted over a period of 2 years, included all patientsundergoing knee arthroscopy, irrespective of age, gender and underlying conditions (whethertraumatic, degenerative, infective or inflammatory). In this study the Impact of postoperativepain management on patient recovery was evaluated. There is evidence that the knee joint hasmorphine receptors, thus nalbuphin was used. Study Design: Randomized Case Control Study.Setting: Department of KRL Hospital. Period: Jan 2014 to Dec 2015. Methodology: Randomizationwas done through the random number generator function provided by Open EPI Ver. 3.01.The random numbers generated were compared with serial numbers assigned to patientsthrough consent forms and then assigned to the three groups accordingly (Control, Lignocaine,Lignocaine + Nalbucin). Out of 117 patients 6 patients were given general anesthesia and 111were given spinal anesthesia. Arthroscopy was done under tourniquet control. To measure painthresholds, a visual analogue scale from 1 to 9 was used and then made into three groups:mild (1-3), moderate (4-6) and severe (7-9). Patient Mobilization was measured 4, 6, 8, 10, 12,14, and 16 hours post operation. Analysis was done using OpenEPI Ver. 3.01 and MicrosoftExcel 2013 separately for both Lignocaine and Lignocaine + Nalbuphin. A systematic literaturereview was done to compare the results found in this study with those found in this study. Forthis purpose, the following string was used in Google Scholar and Pubmed: “Arthroscopy”AND “TB” AND “Synovial Biopsy” and “Postoperative Pain Management” AND “Arthroscopy”AND “Knee Joint”. Results: Interventions of Lignocaine and Lignocaine + Nalbucin were moreeffective than control. Lignocaine + Nalbucin combined showed higher chances of mobilitywhen compared to Lignocaine and control. Systematic Literature Review also provided similarresults. Conclusion: If this procedure is performed with the correct expertise and the patientgiven intra articular lignocaine and Nalbuphin, the patients show early and good recovery andtherefore they can be discharged the same day thus reducing the cost on the patient as wellas the hospital.
CCl4 INDUCED LIVER INJURY;
Authors: Naz Sana , Irshad Faisal , Mawani Hina
Published: August 2021

Objectives: Evaluate the mitigating effect of aqueous extract of Ginkgobiloba (GkbE) on liver enzymes and histology in carbon tetrachloride (CCl4) induced liverinjury in albino rat. Study design: Experimental study. Setting and Duration: Animal house,Bhitai Dental and Medical College Mirpurkhas and Agriculture University Tando Jam fromAnimal house from May 2015 - August 2016. Subjects and Methods: Sixty rats were equallydivided into 3 groups Group 1- Controls (0.9% isotonic saline), Group 2- (CCl4 CCl4 1.0mg/kg intraperitoneal) and Group 3- (CCl4+ GkbE). Blood samples were collected at end ofexperiment from tail veins. Liver was obtained after rat sacrifice by cervical dislocation. Tissuewas fixed in formaldehyde and embedded in paraffin. Microscopy of 3μ tissue sections wasperformed after H & E staining. Statistix 10.0 (USA) software was used for data analysisat 95% confidence interval. Results: Four weeks GkbE administration in CCl4 rat showedsignificant amelioration of liver enzymes and improved liver histology (p=0.0001). In GkbEtreated rats, the histological changes of degeneration, fatty change, inflammatory cellinfiltration, sinusoid congestion and necrosis was minimal (p=0.0001). GkbE was provedof mitigating the hepatocellular injury inflicted by carbon tetrachloride. Conclusion: GkbEmitigates the carbon tetrachloride induced liver injury in rat model. GkbE may be used in drugand chemical induced liver injury.
PLATELET AGGREGATION
Authors: Mushtaq Sidra , Fatima Mufakhara , Mushtaq Zobia , Khan Roohi Manzoor , Iqbal Muhammad Naeem , Aamir Sadida
Published: August 2021

The herbal use for medical purposes is increasing world over. Aloe vera is onesuch herb with established anti-inflammatory action. It has great prospect in terms of replacingtraditional NSAIDS due to better side effect profile on gastrointestinal tract but its effect onplatelet aggregation is what needs to be determined. Objectives: This study was designed tosee the concentration dependent action of Aloe vera gel on platelet aggregation. Study Design:Comparative study. Setting: Post Graduate Medical Institute Lahore, Children Hospital Lahore.Duration of Study: One Year. Methodology: This study was conducted on healthy volunteersselected from staff and students of Ameer-ud-din Medical College. After determining baselineHb and platelet counts, PRP was prepared and then incubated with 2 different concentrationsof Aloe vera low (AVL) and Aloe vera high (AVH) for 30 minutes. Aggregation was stimulatedby adding the agonist arachidonic acid. Light transmission aggregometer was used to recordplatelet aggregation activity graphically for 3 minutes. Results: The data was analyzed usingSPSS version 20. Kruskal Wallis H test was performed to compare the platelet aggregation,which revealed that platelet aggregation with AVL and AVH were statistically significantly lower,amounting to 25.89% and 16.72% respectively as compared to 88.28% observed with control.Conclusion: This study has established in vitro anti-platelet effect of Aloe vera which is dosedependent.
PHACOEMULSIFICATION
Authors: Ahmad Faheem , Iqbal Syeda Iqra
Published: August 2021

Introduction: Objectives: To find out improvement in visual acuity andcomplications in low socioeconomic status patients that underwent phacoemulsification withlow price IOL in a teaching hospital. Study Design: Descriptive study. Setting: Departmentof Ophthalmology Independent University Hospital, Faisalabad. Period: One year from 01-04-2016 to 31-03-2017. Material and Methods: Composed of 100 patients. In this study Inclusioncriteria was poor old aged patients of both gender having grade one to grade three nuclearsclerosis with or without posterior sub capsular cataract. However patients having history ofuncontrolled hypertension or diabetes mellitus, inadequate dilated pupil, subluxated lens orhaving previous history ocular surgery were excluded. Results: In this study 100 eyes withcataract operated by phacoemulsification with low cost rigid IOL under peribulbar anesthesia.The mean age of patients was 67.50 years (range 50-85 years). Male patients in this studywere fifty Two (52%) While 48% were female Patients. Regarding the visual acuity in operatedeyes with or without glasses, 80 eyes (80 %) had visual acuity of 6/6-6/12, visual acuity of 6/18to 6/36 in 12 eyes and 6 eyes (6 %) had a best corrected visual acuity of 6/60 to CF. Whilevisual acuity less than counting finger (CF) was percent in only 2 percent patients. Discussion:Un-operated cataract can induced severe visual impairment or blindness in cataract patients.In a study conducted in Pakistan reported that in about 76% cases of poor socioeconomicstatus most important barrier to cataract surgery was cost of surgery. According to this studydifferent methods that can be adopted to reduce the cost of surgery by improving efficiencyby conducting high volume cataract surgery and bulk purchasing of consumables surgicalitems especially cheaper intraocular lenses thus allowing even the poorest patients to haveophthalmic care. So it was observed that in patients of poor socioeconomic status numbersof barriers are being faced by such community in which cost is frequently mentioned andproviding low cost phaco surgery with good postoperative vision allow to underwent cataractsurgery who would not otherwise have it. Conclusion: In this study it was concluded that indeveloping countries like Pakistan in which majority of population belong to low socioeconomicstatus phacoemulsification with low cost rigid IOL not only yield good post-operative visualacuity but also reduced cataract induced blindness.
HEPATITIS C
Authors: Khan Momin , Jabbar Abdul , Khan Bacha Amin , Ahad Abdul , Akbar Fazal
Published: August 2021

Introduction: WHO estimates that there are more than 185 million people overthe globe infected with hepatitis C. Among these 350,000 die each year with hepatitis. Heprevalence of hepatitis in Asia is estimated to be 3.4%. Pakistan has been rated as the secondmost common country in the world with active hepatitis C infection. This study aims at identifyingthe frequency of risk factors for hepatitis C irus transmission. Understanding the frequency ofcommon factors of HCV would help to implement strategies in long-term prevention of hepatitistransmission among community. Objectives: To determine the frequency of common factorsfor transmission of hepatitis C in adult patients. Study Design: Descriptive cross-sectionalstudy. Setting: Department of Medicine, Saidu Teaching Center, Swat. Period: 01-01-2016 to01-12-2016. Methodology: 140 patients were observed and evaluated. Detailed medical historywas taken.5 ml of venous blood sample was collected under aseptic conditions. Blood wascentrifuged at 5000 rpm for 5 minutes and serum was transferred to separate test tubes for furthertesting. The initial screening was carried out by immunochromatography for the qualitative detectionHCV antibodies in serum or plasma. Output variable was stratified among age andgender. Chi square test was applied to see effect of modification. All the positive samples onICT were tested on ELISA (third generation) with signal-to-cut-off ratio > 1.0 for confirmation.Results: Our study shows that mean age was 45 years with SD ± 12.24. Fifty eight percentpatients were male and 42% patients were female. Forty two percent patients had hepatitis Cdue to Injection, infection and-* /transfusions, surgical scars were present in 23% patients withhepatitis C, (2%) patients with hepatitis C had tattoos, 8% patients had hepatitis C due to nose/ear piercing and 25% patients had hepatitis C due to dental procedures. Conclusion: Our studyconcludes that the most common risk factors responsible for transmitting hepatitis C in adultswere infections/transfusions (42%) followed by dental procedures (25%) and surgical scars(23%).
ANTI-DIABETIC ACTIVITY
Authors: Faisal Muhammad Saleh , Nawaz Usman , Khan Abdul Matin
Published: August 2021

Objectives: The study was designed to evaluate the hypoglycaemic effects ofCassia sophera’s powdered seeds and its different fractions. Study Design: An experimentalstudy. Setting: Faculty of Veterinary, University of Agriculture, Faisalabad, Pakistan. Period:November 2014 to February 2017. Methodology: Initial experiments were designed to find outthe hypoglycaemic effects of Cassia sophera powdered seeds in increasing doses i.e. 2, 3, 4g/kg body weight at 0, 2, 4, 8, 12 and 24 hours intervals. The effects of methanolic and aqueousextracts equivalent to 4g/kg body weight of Cassia sophera seeds were also studied in bothnormal and diabetic rabbits. Results: At 4 hours interval, 2grams/kg body weight of grindedseeds results no significant decrease in mean blood level of glucose. At 8 and 12 hours intervals,a significant decrease while at 4, 8 and 12 hours a highly significant reduction were observedwith both 3g/kg and 4g/kg body weight. With methanolic and aqueous extracts equivalent to4g/kg body weight, normal rabbits showed significant decrease i.e. with P value less than 0.05at 8 and 12 hours. In addition, the methanolic extract of Cassia sophera seeds produced betterhypoglycaemia as compared to aqueous extract. The effects of these extracts were comparableto Acetohexamide. The same study was also done in alloxan-induced diabetic rabbits and it wasnoticed that Cassia sophera powdered seeds caused significant decrease in blood glucoselevel at increasing doses 2, 3 and 4gram/kg of body weight and highly significant reduction(with P value less than 0.001) in blood level of glucose was noticed with methanolic extracts at4 hours interval which continued upto 8 hours while treatment with aqueous extract with Cassiasophera seeds showed highly significant decrease at 12 hours. Conclusion: It is concludedthat powdered seeds of Cassia sophera constitutes more than one type of hypoglycaemicelements, which have exerted a significant and consistent hypoglycaemic effects in normal andalloxan treated diabetic rabbits.
CLUB FOOT AFTER TREATMENT
Authors: Rasheed Nusrat , Khani Ghulam Mustafa Kaim , Zaidi Itaat Hussain
Published: August 2021

Background: Ponseti technique for club foot treatment has become morepopular during the last decade. But the most common problem following correction byPonseti technique is the relapse of deformity. Setting: Dow University Hospital as well asother hospitals were included in the study. Period: April 2013 to April 2016. Methods: 335children with idiopathic club foot presented in OPD with relapse, treated with Ponseti technique.Pirani scoring was used to assess the severity of relapse. Children with both unilateral andbilateral involvement, aged up to 5 years were included. 335 children with idiopathic club feetwho underwent treatment with Ponseti technique, presented with relapse of deformity wereenrolled in the study. Results: There were 207(59.7%) boys and 128(37%) girls. Mean age atpresentation for casting (previous treatment age) was 5.98 months (SD ±6.07), and 153(44.2%)had Right sided involvement, 112 (32.4%) had left sided involvement and 69(19.9%) hadbilateral involvement. Mean age at which relapse occurred was 24.7 months (SD ±7.35). Themean Pirani score was 4.78 (SD ±4.30). Percutaneous heel cord tenotomy was done in 286(82.7%) children. Number of cast to maintain initial correction was 7.58 (SD ±1.19).Out of 335patients 246(71.1) used brace and out of them 123 (50%) used brace up to one year, 70 (25.5%)used for1-2 years, 30 (15.5%) used for 2-3 years and 23 (9%) used for 3-4 years. Conclusion:Ponseti method is safe and effective method of treatment for club foot. Despite the proper use ofPonseti method, relapses and recurrences still occurs due to certain factors. The best treatmentfor recurrent club foot is prevention in the form of consistent primary treatment, constant use ofbraces and regular follow up
GUILLAIN-BARRÉ SYNDROME
Authors: Zia Muhammad Ahmed , Masood Yasser , Salman Muhammad Kashif
Published: August 2021

Objectives: To determine the outcome of autonomic disturbances in childrenwith Guillain Barre Syndrome. Study Design: Case series study. Setting: Pediatric ICU andNeurology ward of Nishtar Medical University/hospital Multan. Period: 9th June 2014 to 8th June2015. Methods: 48 children having age less than 18 years. Clinical examination of centralnervous system was conducted by single examiner to see presence of acute flaccid paralysisand to detect autonomic dysfunction. Cerebrospinal fluid analysis for albumino-cytologicdissociation, electromyography and nerve conduction studies was done in every patient ofGuillain Barre Syndrome. Outcome was noted as expired, discharged or LAMA. Results: Meanage was 5.4 years and male female ratio was 1.2:1. Total 34 children were found to have clinicalevidence of autonomic instability. Among 48 children, 17 children (35.4%) received no therapy,28 children (58.3%) received Intravenous immunoglobulin (IVIG) therapy, and 3 children (6.3%)received plasmapheresis. In children with autonomic disturbance, 24 children (70.6%) weredischarged, 8 children (23.5%) expired and 2 children (5.9%) LAMA. Of the total 14 childrenwithout autonomic disturbance, 11 children (78.6%) were discharged, 3 children (21.4%)expired and no child LAMA (p-value >0.05). Mean duration of stay for patients with autonomicinstability was 130 days versus 63 days in patients without autonomic instability (p-value<0.005). Demyelination variety was seen in 35 children (72.9%) and axonal degenerationin 13 children (27.1%). Mortality was high in children who had axonal degeneration but withinsignificant p-value of >0.05. Conclusions: Autonomic instability is common in patients ofGBS and is associated with increased risk of morbidity. Prompt recognition and treatment ofautonomic instability can improve the outcomes of children with GBS.
BETA THALASSEMIA TRAIT
Authors: Khan Muhammad Ihtesham , Khan Hamid Nawaz , Usman Muhammad
Published: August 2021

Objectives: To assess the sensitivity of the various discrimination indicesas screening test in beta-thalassemia trait patients in our population. Study design: Crosssectional descriptive study. Period: 1-Sep 2012 to 31-Jan 2013 (5 months). Settings: PathologyDepartment, District Head Quarters (DHQ) Hospital, Rawalpindi. Materials and Methods: Atotal of 150 diagnosed cases of beta thalassemia trait were included in the study. Study wasdone from 1-Sep 2012 to 31-Jan 2013 in DHQ hospital, Rawalpindi. Four discrimination indicesi.e. Mentzer, Shine & Lal, Srivastava, and Red cell Distribution Width Index were calculated forall the patients. The number of correctly identified cases were determined and sensitivity ofeach discrimination index was calculated accordingly. Results: The sensitivity in diagnosingbeta thalassemia trait patients was highest for Shine and Lal index (95%), followed by Mentzerindex (52% sensitivity), and then Srivasava index (46% sensitivity). Red cell distribution widthindex had poor sensitivity of 2% in our study. None of the discrimination indices showed 100%sensitivity. Conclusion: We concluded that Shine & Lal and Mentzer index are the most sensitiveindices. They can be used for cheap and quick screening of beta-thalassemia trait patients inlaboratories where advanced investigation tools are not available. Patients who give positiveresult for beta thalassemia trait with these indices may then be referred for further workup toconfirm the diagnosis.
GENITAL TRACT TRAUMA
Authors: Zulfiqar Anam , Saeed Afshan , Rahat Shahana
Published: August 2021

Aims and objectives: To record frequency of factors responsible for genitaltract trauma in pregnant females undergoing vaginal delivery. Study Design: Descriptivecross sectional trial. Period: 18-11-2015 to 17-02-2016 (3 months). Settings: Holy FamilyHospital, Rawalpindi. Material & methods: 100 cases with genital tract trauma during delivery(at hospital or referral) in the form of tears or laceration, which may be cervical, vaginal orperineal were included in the study. After third stage of labour, we examined vulva, vagina andcervix for presence of any tears/lacerations. The causative factors of lacerations/tears includingmode of delivery (assisted/spontaneous) birth weight of the neonate (<4kg/>4kg), multiparous/ primiparous and place of labour (referral/institutional) were recorded. Results: Mean age28.88+3.41 years, cervical injury in 26% (n=26) cases, vaginal injury was present in 36%(n=36) and 38% (n=38) and findings of perineal injury. Risk factors causing genital tract traumawere recorded as 10%(n=10) had institutional place of labour while 90%(n=90) were deliveredoutside hospital through untrained health care providers, 24%(n=24) were primiparous while76%(n=76) were multiparous, 69%(n=69) were delivered spontaneously, 31%(n=31) hadassisted delivery, 67%(n=67) had >4kg fetal weight at birth while 33%(n=33) had <4kg weightof fetus at birth. Conclusion: Un-booked and birth outside hospital by unskilled health careworkers was the significant risk factor responsible for genital tract trauma.