bluuebunny/crossref_metadata_2025 huggingface dataset:
SPONTANEOUS BACTERIAL PERITONITIS
Authors: Khan Umme Aeman , Iqbal Hamna , Aslam Muhammad Omer , Saqib Muhammad Ehtisham , Yassen Hafiz M. , Hussain Hafiz Amjad
Published: August 2021

Objectives: To find out the diagnostic accuracy of ascitic fluid LactateDehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absoluteneutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design:Cross sectional (validation) study. Setting: This study was conducted in department ofMedicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting afterapproval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluidwas withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cellcount, total protein, albumin and LDH wascalculated along with serum albumin and serumLDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer,serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin fromserum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratiowas calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derivedfrom total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years,53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standardwas recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenasein diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil countequal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%,88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictivevalue and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negativelikelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluidLactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using asciticfluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard.
POST TRAUMATIC EPILEPSY (PTE)
Authors: Mushtaq Mohammad , Durrani Adil Umar , Arif Syed Irfan Raza
Published: August 2021

Objectives: To estimate the predictors and frequency of post traumatic epilepsy inpatients with moderate to severe traumatic brain injury. Study Design: Observational prospectivestudy. Duration and Place of Study: Frontier Medical and Dental College, Abbottabad, fromJanuary 2015 to December 2015. Materials and Methods: Patients between 4-50 years of age,having GCS . 5, with a history of moderate to severe TBI and non-epileptics were enrolled inthe study. Patients with history of epilepsy or who were taking anti-epileptic drugs, or thosewith firearm or penetrating head injuries or with GCS scores < 5 or who were brain dead uponarrival were excluded. Details were recorded regarding age, gender, presence of early andlate seizures, diagnosis (hematoma, fracture, intracerebral bleeding, etc.) and cause of injury,GCS scores and plain radiographs and non-contrast enhanced CT scan of head and EEG.Patients were followed up at regular intervals (1, 3, 6, 9 and 12 months) but they were askedto report immediately in case of seizures. SPSS version 21 was used to process and analyzedata. Results: The study included 120 patients and their mean age was 26.69}12.59 years. Asper the gender, there were 90 males and 30 females. Maximum numbers of patients, 41.67%and 30%, were between 11-20 and 21-30 years of ages respectively. Regarding the severityof head injury, 54 (45%) persons had sustained moderate head injury while 66 (55%) patientshad suffered severe head injury. Most of the patients, 50%, developed subdural hematomafollowed by skull fracture and intracerebral bleed in 25% and 20% patients respectively. Out of120 patients, 20 patients had developed seizures. Therefore, 16.67% of our patients developedPTE after TBI. Male patients who were between the ages of 11-30 years with severe head injuryand with subdural hematoma and skull fracture preferentially developed seizures. Conclusion:Post traumatic epilepsy is a major complication of brain injury. There are numerous risk factorsassociated with the risk of developing PTE after TBI. Male gender, age between 11-20 years,depressed skull fracture, extra parenchymal hemorrhages and severe brain injury are importantrisk factors that we have found out in our study which when present considerably increases therisk of seizures after head injury.
FRACTURE OF SHAFT OF FEMUR
Authors: Rasool Sajjad , Manzoor Basharat , Aslam Muhammad Omer
Published: August 2021

Introduction: Fracture of the shaft of the femur is among the most commonfractures encountered in orthopedics practice.1 Objectives: The aim of the study was alsocompare the outcome of solid versus canmulated inter locking nails as a method of internalfixation in closed fractures of the shaft of femur in adults. Design: Quasi Experiment design.Setting: Orthopedic Department Allied Hospital P.M.C Faisalabad. Results: We had total of60 cases, 30 in groups of solid I/M nailing and 30 in group B of Cannulated in I/M nailing wehave reported the follow up study up to 9 months. (1) There were 27 (90%) males and 3 (10%)females in group A. (2) If in group B 26 (86.666%) were males 4 (13.333%). (3) The mean agewas 37.4 + 1.61 years. Union: Group A, In 26 (86.666%) patients the fracture uniting within 3months. 3 (10%) patients went into phase of delayed union which ultimately united. 1 (3333%)patient into non-union for which bone grafts has to be done after nine months. Group B: In 26(86.666%) patients the fracture united within 3 months. Patient in group B went into nonuniondue to deep infection, second due to nail breakage an in third no apparent causes was found.Total no of cases of non-union in group B were 3. Infection: In group A one patient in groupB 2 patient had superficial infection which were treated with appropriate antibiotics. In groupB one patient had deep infection and went into non-union due to infection. Implant Failure:In group B one case with nail breakage.. 2 Cases with distal Inter Locking screws breakage& 1 case with proximal interlocking screw breakage were noted. Conclusion: (1) There isno statistical difference in union and infection in both groups (P-Value > 0.05). (2) There issignificant difference in implant failure in both groups no patients in group A went with implantfailure but four patients in group B developed implant failure (P-value < 0..05) so Solid interlocking nail is stronger than cannulated interlocking nail.
PAEDIATRIC FEMUR FRACTURE
Authors: Khan Umar Zia , Ali Mian Amjad , Shah Faaiz Ali
Published: August 2021

Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.
SPINE SURGERY
Authors: Khalid Muhammad , Qurashi Muhammad Asad , Afzal Wasim
Published: August 2021

Introduction: low back pain is basic medical issue in our general population,it influence our day by day life exercises and bargains our personal satisfaction. Intervertebraldisc herniation is one of the commonest reasons for backache and sciatica. Discectomy isthe essential treatment of decision for disc herniation. Objective: To determine the incidenceand indication of revision spine surgery after lumber discectomy. Study Design: Retrospectivestudy. Setting: Spine Surgery Unit of Central Military Hospital Rawalpindi. Period: Ten yearsfrom July 2007 to August 2017. Methods: Patients who presented with disc herniation for whichdiscectomy was done were included into this retrospective study. Patient’s statistic profile,indications, signs and imaging finding were recorded. Discectomy was performed throughone-sided Fenestration at symptomatic side. Post-operative patient’s changes was notedand recorded. Three hundred and fifty two patients were contemplated amid most recent tenyears. Results: out of 352 patients, 214 were male 138 were female patients; age ranged from20 to 70 years. 74(21.02 %) patients out of 352 again presented with severe backache andsciatica, recurrent disc herniation was confirmed on MRI lumbosacral. 46 (62.16%) out of 74patients were complaining of backache than sciatica, backache more severe on activity andrelieved on rest. 28(37.83%) out of 74 patients had sciatica than backache. TLIF was done in46 patients and remaining 28 patients treated with laminectomy and discectomy. Back painand sciatica was relieved in all patients (100%) after TLIF and discectomy and quality of lifeimproved. Conclusion: Our study concluded that incidence of spine surgery revision is 21%and indication of surgery is either stability or recurrence of disc herniation. TLIF is having goodresult in patient with stability issue and discectomy in patients’ with sciatica than backache.
SEVERE ANAEMIA
Authors: Chattha Mazhar Nazir , Mazhar Muhammad Idris , Hasan Taqi , Rai Manzoor Elahi , Waqas Kashif
Published: August 2021

Anaemia is common reason of morbidity and mortality in children especially inthird world countries. 300 million children had anaemia globally in 2011. Nutritional IDA (irondeficiency anemia) is a most common anaemia especially in children as well as women.1Severe anaemia was present in 5.4% of anaemic children (62.1%) in national nutritional survey2011.1 Iron deficiency anaemia (IDA) is also a most common cause of childhood anaemia inPakistan. Factors causing anaemia are multiple including poverty, illiteracy and poor dietaryhabits. Objective: To know about the awareness of severe anaemia in children by their parentsand effect of various risk factors causing severe anaemia. Study Design: Prospective crosssectional study. Setting: Paediatric OPD Islam Teaching Hospital, Sialkot. Period: Jan 2016 toJune 2017. Methods: Children who came to paediatric OPD of Islam Teaching Hospital, havingpallor were investigated for level of haemoglobin (Hb). Those included in this study were havingHb% < 7 gm/dl and parents were interviewed according to a questionnaire. Results: Only23% of parents were aware of anaemia in their children. Inadequate or no weaning was seen in95% of patients. 26% of children were underweight, had weight for age (WAZ) score less than-2 according to WHO standards. 83% of mothers were educated up to matric. All the childrenhad markedly low mean corpuscular volume (MCV). 72% of children were 24 months old orbelow. 80% of children were taking cows/buffalos milk. Conclusion: Age less than 24 months,poor socioeconomic status, lower education qualification of mother, poor weaning habits wereassociated with increased chances of severe anaemia and parents had poor awareness ofpallor/anaemia in children.
COLORECTAL CANCER
Authors: Shaikh Muhammad Saleem , Ali Muharram , Naper Muhammad Ali
Published: August 2021

Objectives: To determine the changing clinicopathological pattern anddistribution of colorectal cancer in our setup, highlighting future planning and designing forits prevention. Study Design: A retrospective study. Place and Duration: Department ofSurgery, Chandka Medical College and LINAR, Larkana from January 2012 to December 2016.Methodology: All the diagnosed cases of colorectal cancer were included in our study. Therecords analyzed for age, gender, clinical presentation, socioeconomic status, risk factors,histopathological variable types, site of distribution, tumor grading & staging based on TNM.The method of treatment & surgical procedures performed, were also recorded. Statistics datawas entered and analyzed by SPSS version 17. Results: 363 diagnosed cases of colorectalcancer were registered from January, 2012 to December, 2016. 211 (58. %) were male and 147(40.9%) female, with ratio of 1.3:1. Age ranged between 17 to 88 years with mean age of 56 +12. 217 patients were > 50 years, while 146 < 50 years. The predominant subsite distributionwas found in rectum & recto sigmoid junction in 205 cases (56.49%). Majority of cases belong tolow socioeconomic class with Duke’s B and C stages (45.73%. and 39.11%). The mortality ratewas observed in 12.9%, however 30% of patients were not returned for follow-up. Conclusion:Colorectal cancer is shown rising higher up and vated cancer was found increasing in incidenceamong young population < 50 years. There is a need of early detection, to reduce the numberof CRC in future.
CORONARY CATHETERIZATION
Authors: Siddique Aamir , Riaz Rehan , Javaid Imran
Published: August 2021

Introduction: In recent years the trans-radial approach has been increasinglyemployed as an alternative approach to percutaneous coronary intervention. Loss of radial pulsemay lead to ischemic symptoms like pain in hand, claudication etc. There is a lack of local dataregarding complication associated with trans-radial coronary catheterization. Therefore, thereis need for local study to find out the frequency of complications associated with trans-radialapproach. Objectives: To determine the frequency of loss of radial pulse in patients undergoingtrans-radial coronary catheterization. Design: Cross sectional study. Setting: Department ofCardiology, Jinnah Hospital, Lahore. Period: From 3rd June 2014 to 2nd December 2014.Methodology: All 325 cases fulfilling the inclusion/exclusion criteria undergoing coronarycatheterization were included in the study. Results: A total of 325 patients, both male and femalewith positive Allens test, undergoing Trans-radial angiography for intervention were included.Loss of radial pulse was evaluated clinically at four weeks follow up.In our sampled population,mean age was 57.01 ± 6.8 years and 240 patients (73.8%) were male while 85 patients (26.2%)were female. Only 14 patients (4.3%) out of 325 had loss of radial artery pulse while remaining311 patients (95.7%) didn’t have loss of radial artery pulse. There was found no effect of genderon outcome i.e. loss of radial pulse but older age made a person prone to loss of radial pulse.Conclusion: It is concluded that the frequency (percentage) of loss of radial pulse is quite low(4.3%) in our patients undergoing trans-radial coronary catheterization.
TB DIAGNOSTIC CENTERS
Authors: Ayub Taimia , Ayub Saima , Maqsood Saim , Ayub Maryam , Ali Ayub
Published: August 2021

Introduction: Tuberculosis is the leading infectious cause of death and wasdeclared as global emergency in 1993. Sputum smear microscopy is the gold standard fordiagnosis of the pulmonary tuberculosis. Blinded rechecking of the slides and panel testingare WHO recommended methods for assuring the quality of the TB diagnostic centers. Period:Oct, 2014 to Dec, 2014. Objectives: To assess the quality of sputum microscopy at diagnosticcenters through proficiency testing.To compare the performance of trained and untrainedlaboratory staff in terms of sputum microscopy. Study Design: Cross-sectional descriptive.Setting: Lahore District. Methodology: Blinded rechecking and panel testing was performedand data was collected with the help of checklists in all the 30 (75%) functional diagnosticcenters of Lahore district. Results: Errors in reporting were found in 13 (43%) out of 30diagnostic centers during the blinded rechecking. There was no error in the blinded recheckingin microscopy of 17 (68%) AFB microscopy trained lab workers, while all the 5 (100%) untrainedlab workers committed error. Only 17 (56%) lab workers reported 80-100% slides correctlyduring the panel testing; a minimum acceptable level of skill, while 13 (44%) reported 40-60%slides correctly. One of the most striking findings of the study was the relation of training withthe performance of lab workers. Conclusion: Untrained lab staff should immediately undergostandardized training for sputum smear microscopy and refresher training should be given tothe trained lab workers to enhance their knowledge and skills.
PNEUMONIA
Authors: Abbasi Anwar Hussain , Abid Shahab , Abid Shahab
Published: August 2021

Introduction: Stroke is a major cause of death and disability globally, with anexpected rise in number of patients with ageing and economic transition of developing countries.Pneumonia is one of the major complications after stroke. Stroke associated pneumoniaincreases risk of death by three fold and is the major cause of morbidity and mortality afterthe stroke. Objective: To determine the frequency and factors leading to stroke associatedpneumonia in all acute stroke patients admitted at a tertiary care hospital. Study Design: Caseseries. Setting: Medical Department, Aga Khan University Hospital (AKUH), Karachi. Period:six months and extended from 1st July 2015 to 31st December 2015. Material and methods:All adult patients (age 14 years and above) admitted through emergency room in the medicalward of Aga khan university hospital Karachi with the diagnosis of acute stroke on the basis ofMRI findings were enrolled after taking informed consent through Non purposive consecutivesampling technique. Demographic data like age and sex were recorded. Diagnosis of strokeassociated pneumonia was made on basis of CDC criteria for pneumonia. All analyses wasconducted by using the Statistical package for social science SPSS (Release 19.0, standardversion, copyright © SPSS; 1989-02). Results: A total of 157 patients admitted with a mean ageof the inducted patients were 61.75 ± 13.91 years. According to this stratification, 23 patients(14.65%) were aged less than 45 years and remaining 134 subjects (85.35%) were above theage of 45 years among them 110 were males (70.1 %) and 47 were females (29.9 %). Strokeassociated pneumonia was found in 33 (21%) out of 157 patients. Out of 33 patients havingstroke associated pneumonia; 14 (42.4%) patients had Diabetes mellitus. Out of 33 patientshaving stroke associated pneumonia; 28 (84.8%) patients had hypertension. Out of 33 patientshaving stroke associated pneumonia; 2 (6%) had COPD. Out of 33 patients having strokeassociated pneumonia; 2(6%) had Chronic Atrial Fibrillation. Out of 33 patients having strokeassociated pneumonia; 21 (63.6%) patients had impaired swallowing. Conclusion: Strokeassociated pneumonia is the common and serious complication after stroke. All the effortsshould be taken to control various factors leading to stroke associated pneumonia like DM,hypertension, and impaired swallowing to improve stroke outcome.
VITAMIN B12 DEFICIENCY
Authors: Lakho Arshad Sattar , Channa Aqeel Ahmed , Dars Abdul Ghaffar , Shah Syed Zulfiquar Ali , Iqbal Muhammad
Published: August 2021

Objectives: To determine the frequency of vitamin B12 deficiency in patientswith hypothyroidism. Study Design: Cross sectional descriptive study. Period: 12-05-2016to 11-11-2016. Setting: Liaquat University Hospital Jamshoro / Hyderabad. Patients andMethods: All the patients of known hypothyroid patients for ≥01month duration, 20-50 yearsof age, either gender were explored for serum vitamin B12 level. The SPSS was used tomanipulate the data in relation to mean ±SD, frequencies and percentages and through chisquaretest to get the p-values and its level of significance (≤0.05). Results: Total 145 patientswith hypothyroidism were evaluated for B12 deficiency, of which 97 (66.8%) were males and48 (33.1%) were females respectively. Ninety patients (62%) were from urban areas while 55(37.9%) was rural population. The mean ±SD for age of overall population was 41.83±8.93years while the mean age ±SD for vitamin B12 deficient and non deficient was 39.96±7.82and 40.74±8.54 years respectively. The vitamin B12 deficiency was observed in one hundredand five patients (72%), of which 69 (65.7%) males and 36 (34.3%) females. The mean ± SDfor duration of infection in overall population was 5.32±1.53 months while it was 5.81±1.43 invitamin B12 deficient individuals. Conclusion: The vitamin B12 deficiency is more pronouncedin hypothyroid patients. In present series vitamin B12 deficiency was observed in 105 (72%)individuals with male predominance 69 (65.7%).
PREMATURE CORONARY ARTERY DISEASE
Authors: Omer Wafa , Siddiq Amer , Khan Omer Jamshed , Khan Dilshad Ahmed , Khattak Ejaz Hassan Khan , Naveed Abdul Khaliq
Published: August 2021

Introduction: Integrative genomics may help in the identification of novelbiological pathways in the pathogenesis of CAD. Objectives: To find out the association of 5Cytokine SNPs and 13 CAD SNPs gene risk scores with serum cytokine levels in PrematureCoronary Artery Disease (PCAD). To identify the direct and indirect protein interactions of the 13CAD risk genes and the 5 cytokine genes in PCAD. Study Design: Case-control study. Setting:Army Medical College, in association with University College London (UCL), London, UnitedKingdom (UK). Materials and Methods: 340 PCAD patients and 310 age and sex matchedcontrols were recruited. Serum IL18, TNFA, IL6 and IL10 levels were measured using ELISA(Invitrogen). The SNPs were genotyped using TAQMAN and KASPar assays. Data analysis wasdone using standard SPSS software version-21 (SPSS Inc, Chicago, Illinois, USA). The proteinproteininteraction (PPI) network was generated using STRING version 9.0, Genemania andI-Tessar web. Results: The patients of PCAD had mean ± SD age of 42 ± 3.80 years consistingof 329 males and 11 females. The 5 SNP cytokine gene risk score correlated significantly withthe serum IL-18, IL-6, TNF-alpha, IL-18: IL-10 and TNF-alpha: IL-10 ratios (p<0.01). The 13 CADSNP gene risk score also correlated significantly with the serum IL-18, TNF-alpha, IL-18: IL-10and TNF-alpha: IL-10 ratios but not with serum IL-6 levels. IL-6 works in close interaction withIL-6R, STAT3 and NFKB1. While MRAS, MIA3 and SORT1 interact with each other CXCL-12mediates its actions by interacting with IL-18, JAK-2 and CCR4. LPA interacts closely with APOBand LPL acts via interaction with APOA4 and APOA5. Conclusion: The correlation betweengene risk scores and serum cytokine levels can aid in the analysis of complex networks tounderstand the pathogenesis of PCAD.
TIBIAL PLATEAU FRACTURES
Authors: Ahmad Saeed , Mahmood Tariq , Haider Muhammad Imran
Published: August 2021

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.
MANDIBULAR SYMPHYSIS FRACTURES
Authors: Ali Zahid , Shakeel Junaid , Furqan Muhammad
Published: August 2021

Introduction: Mandible is one of the most commonly fractured bones inmaxillofacial trauma. Mandibular symphysis is a common site of mandibular fractures. Compareto conventional miniplates, three dimentional plates were found more effective in terms of postoperative occlusion, post operative mobility of reduced fractured segments and the degree ofanatomic reduction. Objectives: Compare the conventional 2.0mm mini plates versus 3D miniplates in the fixation of isolated mandibular symphysis fractures. Study Design: Interventionalstudy. Setting: Oral & Maxillofacial Surgery Department, Abbasi Shaheed Hospital Karachi.Period: Two years from 1st January 2013 to 2nd January 2015. Material & Methods: Onehundred and fifty four patients were randomly selected and allocated into two groups. Group‘I’in which patients were treated with conventional mini plates and group‘II’ where patients weretreated with 3D mini plates. Results: Mean (+SD) age of patients was 29.53 (±7.88) years.Among 154 patients in this study, majority (75.3%) of cases had age 20 - 35 years. Majority,124 (81.2)were males and 29 (18.8%) were females. In Group I, anatomic reduction at 3 monthpost-operative was observed in 30 (39%). In Group II (3D Plates) at 3 months post-operatively,ideal molar relationship was higher (89.6% Vs. 98.7%; p-value = 0.016), fracture mobility waslower (14.3% Vs. 2.6%; p-value = 0.009) and higher anatomic reduction. Conclusion: Threedimensional miniplates are more effective compared to conventional miniplates.
β-THALASSEMIA MAJOR
Authors: Shamaoon Muhammad , Nawaz Junaid , Ahsan Muhammad
Published: August 2021

Background: Â-thalassemia is a common single genetic disorder in Pakistanwith about 8% gene frequency and roughly 10 million carriers. Growth impairment leadingto short stature in thalassemic patients is an important cause of morbidity. Objectives: Todetermine the frequency of short stature in children with muti-transfused â-Thalassemia major.Study Design: Descriptive cross sectional study. Place and Duration of Study: PediatricDepartment, Allied Hospital, Faisalabad from December 2015 to May 2016. Patient & Methods:Ninety multi-transfused â-thalassemia major patients diagnosed by hemoglobin electrophoresisbetween 06 to 10 years of age of either gender were included. Patients with â-thalassemiamajor with a concomitant chronic illness like congenital heart disease, tuberculosis, celiacdisease and immunodeficiency and those with familial short stature as determined by historyand mid-parental height were excluded. Results: Out of 90 cases, 56.67% (n=51) werebetween 6-8 years of age while 43.33% (n=39) between 9-10 years of age, mean + SD was7.85+1.50 years, 51.11%(n=46) male and 48.89%(n=44) were females. Frequency of shortstature in children with â-thalassemia major receiving multiple transfusion was 41.11% (n=37)while 58.89% (n=53) had normal stature. Conclusion: The frequency of short stature is highamong â-thalassemic multi-transfused children. It is recommended that every patient withâ-Thalassemia major, should be sort out for short stature. However, surveillance of growth anddevelopment in these patients is important.
ESSENTIAL HYPERTENSION
Authors: Khan Imran , Dars Abdul Ghaffar , Shah Nisar Ahmed , Shah Syed Zulfiquar Ali
Published: August 2021

Objectives: To determine the frequency of microalbuminuria in patients withessential hypertension for postpartum hemorrhage. Study Design: Cross sectional study.Setting: Department of Medicine at Liaquat University Hospital Hyderabad. Period: Six months(from January 2015 to June 2015). Patients and Methods: All the patients ≥35 years of age bothgender had essential hypertension were enrolled and explored for microalbuminuria by urineexamination while the data was analyzed in SPSS 16. Results: Total one hundred subjects withessential hypertension were studied and explored for microalbuminuria. The mean age ±SDof for overall population was 52.82±7.85 and it was 51.23±8.21 and 53.32±6.52 in male andfemale gender respectively. The overall mean ± SD for systolic blood pressure was 170±12.62whereas it was 160.82±10.82 and 165±11.92 in male and female gender respectively. Themean ±SD for blood pressure (diastolic) was 105±71 while it was 95.01±7.21 and 100.82±6.42in male and female sex respectively. The duration of hypertension as mean ±SD was 3.72±2.52in overall population. The microalbuminuria was identified in 59 (59%) patients with statisticalsignificance in relation to age (p=0.00), gender (p=0.00), duration of hypertension (p=0.01),treatment status (p= 0.04), hypertension (p=0.002), BMI (p=0.05) and residence (p=0.00).Conclusion: In present series the prevalence for microalbuminuria in essential hypertensionwas detected as 59% and correlate with age, gender and duration and treatment status of thepatients along with raised systolic and diastolic blood pressure
CHRONIC HEPATITIS C
Authors: Malghani Waseem Sarwar , Chaudhary Farooq Mohyud Din , Wadhak Muhammad Ali , Tameez Ud Din Asma , Khakwani Anum , Tameez Ud Din Asim
Published: August 2021

Background: Pegylated interferon (PEG-IFN) plus ribavirin combination was themain treatment for chronic hepatitis C (CHC) patients in Pakistan till 2016. An important sideeffect of this combination was thyroid dysfunction (TD). Objectives: To evaluate thyroid functionabnormalities in Chronic Hepatitis C patients treated with PEG-IFN and ribavirin. Study Design:Descriptive study. Setting: Outpatient Department of Gastroenterology and Hepatology,Nishtar Hospital Multan. Period: January to September 2016. Methods: Using non-probabilityconsecutive sampling. There were 337 CHC patients enrolled in the study who fulfilled theinclusion criteria. Patients were given PEG-IFN plus ribavirin combination therapy and at 12weeks their serum Thyroid Stimulating Hormone (TSH) levels were measured to identify any TD.Data was entered and analyzed by computer program SPSS-17. Results: Of these 337 cases,211 (62.6%) were male patients while 126 (37.4%) were female patients. Mean age of our caseswas noted to be 30.92 ± 5.84 years. Mean disease duration was 16.19 ± 6.42 months. In ourstudy 98 patients (29.1%) had genotype 2 while 239 (70.9%) had genotype 3. TD was seenin 28 (8.3%) patients, 70% of whom were females. Equal number of cases of Hypothyroidismand hyperthyroidism were seen (14 each). Hypothyroidism was significantly associated withrelatively older age group patients and genotype 3 (p value <0.05). A statistically significantassociation (p<0.05) was found between hyperthyroidism and genotype 3, female gender andyounger patients. Conclusion: PEG-IFN plus ribavirin combination therapy induces TD amongpatients with CHC with equal incidence of hypothyroidism and hyperthyroidism.
HEART FAILURE
Authors: Bhatti Muhammad Ijaz , Kaleem Majid , Hanif Asif
Published: August 2021

Objectives: To identify factors which cause deterioration with worsening ofsymptoms in previously stable heart failure patients. Study design: Descriptive case seriesSetting: Gulab Devi Chest Hospital, Lahore. Duration: 01-04-2017 to 30-09-2017. Patientsand Methods: The study was done on 100 patients diagnosed with LV systolic dysfunctionor cardiomyopathy with LVEF<40%. Patients were examined regarding clinical signs ofdecompensation and detailed history was taken to probe the cause of decompensation. Allinformation was noted down on a pre-defined questionnaire. Mean ± S.D was applied forquantitative data like age and LVEF. Frequency (%) was used for qualitative data like gender.Results: Non compliance to drugs was the most common cause of decompensation (56%),amongst them 73.21% cases were noncompliant due to poor awareness about the importanceof continuing use of medicines. Infection was the second common precipitating factor(51%), where chest infection was the most common cause in 74.51% cases. Other causes ofdecompensation were ischaemia (28%), renal impairment (36%), and arrhythmias (23%) whilemore than one precipitating factors were found in 41% of cases. Conclusion: Multiple factorscan trigger deterioration in patients with previously stable heart failure. Recognition of thesefactors is important for good long term outcome in these patients.
DENGUE FEVER
Authors: Khan Hamzullah , Bari Fazli
Published: August 2021

Objectives: To determine the frequency and characteristics of dengue patients.Study Design: Cross sectional observational study. Setting: Qazi Hussain Ahmed MedicalComplex Nowshera. Period: 5th July to 25th Sept 2017. Material and Methods: A total of72 cases were received for dengue serology. Relevant information’s were collected on a predesignedquestionnaire prepared in accordance with the objectives of the study. Results: Atotal of 117 patients were referred from fever clinic and emergency OPD for dengue serology.72(61.5%) were males and 45(38.5%) were females. 24(20.5%) cases were dengue positive.14(12%) were NSL1 positive, 8(8.8%) were IgM positive and 2 (1.7%) were IgM&IgG positive.We received patient in the range of 4 years to 60 years, Mean with SD was 27 +3 years. Out of14 NSL1 positive cases 8 were males and 6 females. 2 females were IgG positive. The spectrumof dengue in correlation with gender was significantly positive with p value .026. In two casesplatelet at first visit were 58000/cmm3 that were both IgM&IgG positive. Out of 24 positivedengue cases two cases were also positive for plasmodium vivax (ring tropozoites). 6 caseswere managed in hospital and discharged home with an average stay of 3 days and 4 casesreferred to Lady Reading Hospital Peshawar for repeated platelet transfusion. Mortality waszero in our cases. Conclusion: The suspicion rate of the clinician for dengue from fever clinicwas 1:7. The cause of poor rate can be contributed to the patient insist for doing the denguetest before they are screened for MP and FBC etc. NSL1 was positive in 6 cases that showsthat people reach the health care facility for screening well in time and patient are educatedabout the dengue. Females 50% positive cases were IGM and IGG positive that shows femalereceive the health care later than males as NSL1 positivity in female gender is less than males.The spectrum of dengue in correlation with gender was significantly positive with p value .025that shows mosquito has some affinity for specific gender, or dengue virus has it for differencein gender or the inside immunity of the both gender is involved that causes different mode ofpresentation and activation of antibodies.
EVIDENCE BASED MEDICINE
Authors: Samad Faiza , Saeed Zeba , Hasan Zainab , Fahim Muhammad Faisal
Published: August 2021

Objectives: Evaluate perception and barriers of practice of Evidence basedMedicine of first and third year medical students of Jinnah Medical and Dental College Karachi.Study Design: Descriptive, cross sectional. Setting: Department of Medicine, Jinnah Medical andDental College Karachi. Period: Dec 2013 to Oct 2014. Subjects & Methods: Of 100 students,response rate was 71% in each year, first year males were n=20 (28.2%) females n=51 (71.8%)in third year males were n=17 (23. 9%) and females n=54 (76.1%). A student based medicineEBM curriculum was imparted to the first and third year medical students in each of 2 semestersof 18 and 16 weeks duration. A Questionnaire based on Likert scale comprising of 10 questionswas filled out at the end of the course of the first and third years during October 2014. Result:Response rate was 71%, on Likert scale 4 and 5 First year students interest in EBM Classeswas n=61(89.5%) as compared to n=36(50.8%) in third year students. Importance of stepsof EBM for practicing clinical medicine was appreciated by n=60(84.5%) of first year studentsversus 47(66.2 %) in third year students. EBM course helped in understanding importance ofarticles in practice of medicine articles in n=44(61.9%) of first year students as compared to39(54.9%) of third years. Barriers perceived were practice of EBM in the institution was lackingas reported by n=35(49.3%) of first year students and n=47(66.2%) in third year students, alonger duration of course was desired by n=41(57.8%) of first year students the respondentsagreed versus=35(49.3%) of third years, and the course was considered more theoretical thanpractical n=35(48.3. %)by first years and n=48(67.6%) by third year students, p values were notsignificant. Conclusion: More Pre-clinical as compared to clinical medical students recognizedEBM as an important component of undergraduate education. This positive attitude needs tobe nurtured for self-directed learning as is evident in their realization of articles being importantfor clinical practice. The declining interest is due to EBM not being an examination subject,lack of practice of EBM in the institution, and poor electronic resources and lack of vision of theinstitution to embed EBM in the curriculum in to sustain interest as students moved to higherlevels and will remain a barrier till senior faculty give way to innovations in the field of medicaleducation.
DRUG INDUCED BRADYCARDIA
Authors: Ahmad Munir , Yasir Muhammad , Fatima Sehar
Published: August 2021

Background: Bradycardia in patients on rate slowing drugs i.e. beta blockers,digoxin and non dihydropyridine calcium channel blockers is common after discontinuation ofrate slowing drugs. Bradycardia persists in majority of patients, so bradycardia is not truly druginduced but due to underlying conduction system disease. Objectives: To determine the outcomein patients with bradycardia after discontinuation of rate slowing drugs in terms of frequencyof persistent bradycardia. Study Design: Descriptive cross-sectional. Place and Duration ofStudy: Cardiology Department, Faisalabad Institute of Cardiology, Faisalabad, from September2015 to March, 2016. Methodology: After written informed consent 95 patients who fulfilled theinclusion and exclusion criteria were selected for this study. Patients with bradycardia (heartrate less than 60 beats per minute) identified by pulse and electrocardiography (ECG) wereadmitted and culprit drug was discontinued. All admitted patients were followed everyday bydoing ECG and counting pulse twice. Patients, in whom bradycardia resolved, were discharged.Patients were monitored for persistent bradycardia after discontinuation of culprit drug for 5days. Results: Out of 95 patients 46 (48%) were male and 49 (52%) female, age range was25-85 years with mean age 61±11 years. Heart rate ranged 25-45 beats per minute with meanvalue of 31.28± 6.08, 72 (75.8%) patients were on beta blockers, 19 (20%) on calcium channelblockers and 4 (4.2%) patients were on digoxin. 73 (76.80%) patients had 30 AV block, 19(20%) 20 AV block while 3 (3.20%) had sinus bradycardia. Bradycardia persisted in 69 (72.60%)patients out of which 32 (69.6%) were male and 37(75.5%) female. Bradycardia resolved in 26(27.40%) patients in which 14 (30.4%) were male and 12(24.5%) were female. Conclusion:Persistent bradycardia is common in patients with drug induced bradycardia. Such bradycardiais not truly drug induced but is related to unmasking of subclinical conduction system diseaseby rate lowering drugs like beta blockers, calcium channel blockers and digoxin.
TUBERCULOSIS DIAGNOSIS
Authors: Nawaz Iram , Usmani Rabia Arshed , Zahra Taskeen , Asif Asima , Baig Shahbaz
Published: August 2021

Background: Delay in diagnosis of Tuberculosis (TB) and initiation of antituberculartreatment (ATT) contributes to more severe disease manifestations in the individualand higher disease transmission in the community. Objective: To find out the delays indiagnosis and treatment of TB patients and to describe determinants related to these delays.Study Design: Cross-sectional descriptive study. Setting: TB Directly Observed TreatmentShort course (DOTS) Center of Jinnah Hospital, Lahore. Period: July to September 2013.Methods: 373 tuberculosis patients attending TB Directly Observed Treatment Short course(DOTS) Center of Jinnah Hospital, Lahore were included using simple random sampling. Delaywas then categorized into low delay and high delay depending upon the median of total delaywhich was of 97 days. Results: It was concluded that the total median diagnostic and treatmentdelay related to both patients as well as health system was 97 days. Results revealed that about55.7% patients had high total delay (delay>median) and 44.3% patients had low total delay.Among those patients with high delay, 58.7% were aged above 35 years, 81.4% were females,96.4% were illiterate, 54.8%were living in rural areas, 76.7% travelled greater than 5 km to reachthe nearest health facility and 56.9% patients had more than one health seeking encounterswith health care professionals before initial diagnosis. Conclusion: Current study, therefore,highlights the delays in diagnosis, treatment and the determinants of delay showing healthsystem related diagnostic and treatment delay being the main contributor to the total delay.More than half of the patients with TB showed a delay in initiation of treatment. Efforts should bemade to minimize health system related delays. Local private practitioners should also be takenon board in combating tuberculosis.
HYGIENE
Authors: Yousaf Haroon , Zafar Muhammad Iqbal , Anjum Farkhanda , Adil Sultan Ali
Published: August 2021

Background: Hygiene is very important aspect of health, it helps preventmany diseases. According to WHO, 25% admission to hospitals are due food and water bornediseases which can be prevented through good hygiene practices. Objectives: To check thehygiene status and practices of rural farmer and non-farmer households and to examine thedeterminants of hygiene status. Association between hygiene and diarrhea was also examinedin this study. Study design: Cross sectional study. Research Area: Farmer and non-farmerrural households of Punjab. Period: April 2016 to January 2017. Material and Methods:probability sampling technique was used and a total of 576 households (50% farmer and 50%non-farmer) were surveyed from six districts of Punjab. Responses were obtained using astructured interview scheduled. SPSS version 24 was used for analysis. Results: Mean age forfarmer and non-farmer households was about 50 and 47 years respectively. Mean number ofschooling years for farmer and non-farmer households were 6.2 and 5.1 respectively. Averagemonthly income of farmer and non-farmer households was 24728 and 16432 PKR respectively.About 18% farmer and 27% non-farmer households had low hygiene status. About 11% farmerand 25% non-farmer households did not have any toilet. About 19% farmer and 24% non-farmerhouseholds reported that they had diarrhea at least once in last 6 months. Association betweendiarrhea and hygiene was found significant at p<0.01. Income and education were importantdeterminants of hygiene status for both farmer and non-farmer households. Conclusion:Authors conclude that hygiene status varies for farmer and non-farmer households that can beexplained by the difference in income, education and awareness. It was empirically establishedthat better hygiene helps prevent diarrhea.
USE OF TOBACCO
Authors: Saleem Raheela , Siyal Fahad Jibran , Dayo Abdullah , Memon Naheed , Ghoto Muhammad Ali , Arain Mudassar Iqbal
Published: August 2021

Objective: To evaluate the frequency and trend of tobacco use among thedoctors of Medical University. Study Design: Cross-sectional survey. Period: 06 Months fromAug 2016 to Jan 2017. Setting: Medical College and Tertiary Care Hospital affiliated with MedicalUniversity of Larkana, Sindh, Pakistan. Methods: Collection of data through the modifiedquestionnaire of IUATLD, on a total of 140 doctors of Medical University, Larkana. Results:A total of 140 respondents, 116 were male and 24 were females. Out of 116 males, 65 (56%)were smokers and out of 24 females, 04(16.66%) were smokers. Sixty four (45.7%) were currentsmokers, 5(3.6%) were ex-smokers and 71(50.7%) were non-smokers. Majority 37(26.4%) ofsmokers start smoking between the age of 21-30 years. Most frequent form of tobacco usedis cigarettes. Non-smokers were affected by passive smoking in their environment. Majorityof smokers use caffeinated drink with smoking cigarettes. 23(16.4%) smokers need properguideline of smoking cessation plan. Conclusion: Mostly male doctors involved in smokingas compared to female doctors. Most of them lie in the moderate addiction index. There isa extreme need for special trainings in the educational institutes for both the students andteachers so that to make it smoke free zone.
PRIMARY POSTPARTUM HEMORRHAGE
Authors: Sultana Mussarat , Irum Nabeela , Karamat Huma
Published: August 2021

Objectives: To see the changing trends in causative factors and various treatmentoptions in pirmary PPH. Study Design: Retrospective study of all the cases who experiencedprimary postpartum hemorrhage. Period: 4 years i.e: June 2013 to June 2017. Setting:NESCOM Hospital Islamabad. Material and Methods: The sociodemographic characteristics,mode of delivery, antenatal risk factors, causative factors and the treatment received by thepatients were extracted from patient’s case notes, entered into computer programme SPSSand analysed. Results: Total number of cases who went into PPH were 77. Majority of patientswere belonging to age group 26-34 years. 50% of patients were multiparous whereas 41% wereprimiparous and 7.7% were grand multiparous. 66% of patients had caesarean section while34% were delivered vaginally. Commonly identified risk factor was anaemia as in 19% of cases.Others were high parity 12%, prolong labour 7%, augmented labour 5%, and fetal macrosomiain 7% of cases. No risk factors were identified in 43% of cases. Uterine atony was found to bea major causative factor in 70% of cases and genital tract trauma in 23% of cases. 51.9% ofpatients were successfully managed with medical treatment. Special feature of the medicaltreatment was the use of tranexamic acid which added to success rate.48% of patients requiredsurgical intervention. Conclusion: It is worthy to note that postpartum hemorrhage can occurin the absence of any identifiable risk factors. Therefore, the anticipation of its occurrence andprompt, adequate, and timely intervention will go a long way in reducing the adverse outcome.