bluuebunny/crossref_metadata_2025 huggingface dataset:
METABOLIC SYNDROME
Authors: Shaikh Tariq Zaffar , Memon Hamid Nawaz Ali , Shah Nisar Ahmed , Shah Syed Zulfiquar Ali , Shahwani Irfan Murtaza
Published: September 2021

Objective: To determine the role of gamma glutamyltransferase as a biochemicalmarker for the diagnosis of metabolic syndrome. Study Design: Cross sectional descriptivestudy. Period: One year. Setting: Department of Medicine, Liaquat University HospitalHyderabad / Jamshoro. Methods: All the patients with metabolic syndrome visited at OPD /admitted in the ward were further evaluated for serum gamma-glutamyltransferase level. Thedata was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:During one year study period, total one hundred patients (23 males and 77 were females) withmetabolic syndrome were recruited and study for gamma glutamyl transferase level. The meanage ±SD for overall population was 56.84±6.52 whereas it was 48.92±5.82 and 58.61±7.73in male and female population respectively. The mean ± SD of systolic and diastolic bloodpressure (mmHg), triglycerides (mg/dl), high density lipoprotein pressure (mg/dl) and fastingblood sugar (mg/dl) in overall population was 161.20 ± 16.74 and 95.60 ± 8.34, 176.38 ±11.93, 29.44 ± 2.90 and 108.42± 6.25. The mean gamma glutamyl transferase level in overallpopulation was 86.75±7.74 while it was 84.83±5.32 and 89.52±6.84 in male and femalepopulation respectively. The gamma-glutamyltransferase was raised in 75 patients of which13 were males and 62 were females (p=0.02) and majority of patients were 50-59 year agegroup (p <0.01). Conclusions: It is concluded that GGT is a good diagnostic tool in metabolicsyndrome with statistical significant results.
VALVULAR PATIENTS
Authors: Ahmad Shahbaz , Ali Faisal , Sajid Muhammad , Nazeer Mohsin , Riaz Rehan , Akhtar Raja Pervaiz
Published: September 2021

Cost effectiveness in any surgical procedure is a major contributory factor in thecontinuation of medical services in developing countries. Limited data is available in assessingthe factors related with the duration of ICU stay and treatment after valvular replacementsurgeries. Objectives: Our aim was to see the correlation of pre operative Left Atrial size of thepatient and duration of post operative stay in ICU. Study Design: Observational Study. Period:March 2010 to April 2014. Setting: Faisalabad Institute of Cardialogoy, Faisalabad. Method:A total of 550 consecutive patients with valvular lesions were included in the study. Their LeftAtrial size was measured echocardiographically pre-operatively and their stay /course in theICU was monitored. Result: Three categories were identified in regard with the Left Atrial sizeand the ICU stay. If LA size is below 60 cm2, the post operative course & stay in ICU is normaland lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course maybe complicated & prolonged by the atrial fibrillation / flutter for which pharmacological cardioversion may be needed and the stay in ICU is prolonged and may last for about 2-3 days. Andif pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. Hisatrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion andhis stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. Conclusions:LA size can predict the post operative behavior of the patient in ICU and duration of stay andexpected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thuslesser is the post operative cost & vice versa.
COPING STRATEGIES DURING CHRONIC ILLNESS
Authors: Yasmeen Bushra , Khan Muhammad Zohaib , Jamshaid Nermeen , Salman Munnaza
Published: September 2021

Introduction: Pakistan is a developing country where the majority of the populationbelongs to the lower socioeconomic class. Chronic diseases such as cardiovascular and kidneydiseases are increasing day by day in Pakistan. Individuals suffering from chronic illnesses are ata greater risk of problems as compared to the un-sick. Their vulnerable situation and the stressof the event creates a lot of changes, changing the meaning of individual lives altogether. Tounderstand the dynamics of chronic illnesses, it is important to find out what coping strategieswere used by the cardiac and renal failure patients? Objectives: The researchers tried to findout whether cardiac and renal failure patients differ in their coping strategies. Study Design:Quantitative cross sectional study. Period: August 2014. Setting: The data was collected fromthe Dialysis Units of Mayo Hospital, Jinnah Hospital, Lahore General Hospital and all admittedpatients of Punjab Institute of Cardiology, Lahore. These four hospitals have good turn-over ofthe patients. Materials and Methods: Purposive sampling method was used in this study. Forthe collection of quantitative data, a hospital-based survey was conducted by using a structuredinterview schedule. 275 patients (131-cardiac and 144-renal failure) including 184 males and91 females between age of 20 to 110 years were interviewed. Mean age was 44 years (S.D= 15.338). T-Test for independent groups and Pearson’s correlation tests were carried out tocompare cardiac and renal failure patients coping strategies along with descriptive statistics.Results: Results indicate that renal failure patients used more physical coping (M = 11.23), t (df= 273) = -1.235, p<.01 that cardiac patients (M = 10.83), t(df = 273) = -1.242, p<.01. Cardiacpatients used more psychological (M = 28.69), t(df = 273) = 1.511,p<.01and behavioral coping(M = 17.37), t(df = 273) = 3.977,p<.01 than renal failure patients psychological(M = 27.97),t(df = 273) = -1.517,p<.01 and behavioral coping(M = 15.43), t(df = 273) = 3.980,p<.01. F =11.800.1.882, and 0.623 which are greater (i.e., p<.05). Pearson’s Product-moment correlationcoefficient show strong correlation exists between behavioral and psychological coping (r =.428). Conclusions: Study found significant differences between the cardiac and renal failurepatients coping strategies. Renal failure patients used physical coping strategies more whereascardiac patients used more psychological and behavioral coping strategies.
CHILDREN ATTENTION DEFICT HYPERACTIVITY DISORDER
Authors: Awan Inayatullah , Junejo Jmail , Jabeen Sabahat , Perveen Asma
Published: September 2021

Objective: To determine the frequency of functional impairment in the domainof “school and learning” among school going age children with ADHD. Study Design: Crosssectionalstudy. Setting: Neuropsychiatry OPD at National Institute of Child Health (NICH),Karachi. Period: April 2012 to October 2012. Methodology: A total 122 child and adolescentpatients of school going age i.e. 05-15 years diagnosed as having ADHD were included in thestudy. A Proforma was used to denote demographic details of the patients. Impairment in thedomain of “school and learning” was measured by using the Weiss Functional ImpairmentRating Scale – Parent Report (WFIRS-P). Results: of the total 122 patients 74% were malesand 26% were females. 61% were studying in primary school whereas 28% either never wentto school or had quit school. overall the domain of school and learning was impaired in about48% of children with females’ representation being slightly more (50%) compared to males(46%). within the domain of school and learning maximum number of children were impairedin keeping up with schoolwork and needing tutoring (61%); whereas the least frequency ofimpairment was observed in being suspended or expelled from school (30%). Conclusions:ADHD causes functional impairment among children of school going age in the domain ofschool and learning.
EFFICACY OF EYE MOVEMENT
Authors: Bilal Muhammad Sami , Rana Mowadat Hussain , Khan Col Safi Ullah , Qayyum Rashid
Published: September 2021

Objectives: To demonstrate the efficacy of EMDR in complex multiplepsychological trauma after failed drug treatment from selective serotonin reuptake inhibitor(SSRI) in a diagnosed case of post-traumatic stress disorder (PTSD). Method: Singleparticipant of this case study, a sitting session judge of judicial governmental scaffold reportedto this mental health tertiary care facility at his own accord with features of intense anxiety,depression, maladjustment issues and post- traumatic stress for a duration of several months.As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address hissymptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low selfesteem,inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal andinability to perform as a judicial head in active war stricken area of northern Pakistan. Completepsychiatric evaluation was carried out and after the discontinuation of SSRIs he was scoredon Impact of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by theEnglish version of the PTSD module of the Structured Clinical Interview for DSM-IV administeredonce before commencement of EMDR. Safe place of the client was established and 8 stagedprotocol of EMDR was started with him. Multiple EMDR sessions were conducted. Result:The case presented in this paper had multiple psychological trauma forms and failed drugtreatment and yet it was observed that EMDR provided marked improvement in all the domainsof his deficits and this was at a prompt speed as compared to cognitive behavioural therapy(CBT) which usually takes longer duration of therapy to achieve similar results. Conclusions:EMDR provides marked improvement in all domains of complex mental trauma and traumaticmemories. Improvement attained was prompt and enduring as compared to other formsof established therapies and drug treatment indicating permanent changes happening atneurobiological levels of brain.
EFFECTIVENESS OF DENGUE FEVER PREVENTION CAMPAIGNS
Authors: Yasmeen Bushra , Jamshaid Nermeen , Khan Muhammad Zohaib , Salman Munnaza , Ullah Raza
Published: September 2021

Objectives: Dengue fever badly hits Pakistan in 2011. A large number of peopledied due to dengue fever. To control the alarming situation, other than treatment, work had beenstarted at all levels. Department of Social Welfare and Bait-ul-Maal, Punjab was involved by theCity District Government to work for the awareness among public for the preventive measuresand practices to reduce the spread of the epidemic. Anti-dengue awareness campaigns wereorganized at the community level with the help of non-government organizations. A survey wasconducted with the following objectives to evaluate the effectiveness of anti-dengue awarenessactivities: (1) Public knowledge of Dengue fever. (2) Anti-mosquito Preventive Practices.Study Design: A cross sectional household survey. Setting: Out of ten towns of Lahore city,Samanabad Town was selected. Period: Januarys to March 2014. Methods and Material:Instrument: A structured interview schedule of three sections was designed. Interviews wereconducted from urban/semi-urban communities. Sampling: By using multistage randomsampling, Out of ten towns of Lahore city, Samanabad Town was selected. Samanabad Town isconsisted of 24 union councils with a population of 17 million. Three union councils: 86, 104 and112 were randomly selected. 400 household were randomly selected from these union councilsfor interview to ensure representativeness of the sample. Respondents: Males/Females aged15–65 & above lived in the households of Samanabad Town were the respondents. Onerespondent was selected from each household. Method: In this cross-sectional study, by usingTaro Yamni Formula, 400 interviews were successfully conducted with a response rate of 100%.Other than demographics, 17-items questionnaire measured knowledge and practices aboutawareness and dengue prevention. Descriptive statistics and Pearson Correlation coefficientwas used for the analysis of the data. Data was analyzed by using SPSS 20. Results: Maturity ofthe community members’ 76 - 92% was aware and had knowledge of preventive measures. 66- 83% practicing regularly in the households. Data analysis indicated a positive and significantassociation between knowledge about dengue prevention and practices about dengueeradication (r = 0.000, p < .005). Conclusion: Consistent awareness campaigns for denguefever prevention and control enhances public knowledge and motivates individuals to adoptpreventive practices in day to day routine life. To foster and maintain public interest, attractivebeneficial public friendly practical economical practices need to be publicized to motivateyoung ones in communities. Orientation training programs of community paid health workerswill be helpful to improve skills to assert effective dengue fever preventive measures and controlactivities to reduce the breeding sites of mosquitoes.
OBSTRUCTED LABOR
Authors: Shaikh Shazia Rahman , Memon Khalida Naz , Usman Gulzar
Published: September 2021

The women of developing countries are at risk of pregnancy-relatedcomplications including pre-eclampsia/ eclampsia, obstructed labor, sepsis etc. Obstructedlabor results due to three delays while woman is full term & is in labor. If detected and managedearly and correctly, the pregnancies can be made safe and may result in birth of healthybabies. Objectives: (1) To assess frequency of obstructed labor among pregnant women. (2)To determine socio-demographic risk factors associated with obstructed labor among studypopulation. (3)To determine outcomes of obstructed labor among pregnant women. StudyDesign: It was a hospital based descriptive cross sectional study. Period: Two months. Setting:Department of Gynaecology and Obstetrics units I, II and III of Liaquat University Hospital(LUH) Hyderabad. Methods: To estimate the frequency, risk factors & outcomes of obstructedlabor as of third trimester adverse pregnancy outcomes & to seek association of this adversepregnancy outcome with the socio-demographic characteristics of the pregnant women i.e.their age, residence, parity, level of education & socio economic class. Results: Out of total sixhundred & nine women enrolled in the study, only 22 (3.61%) were in obstructed labor. 63.64%of them were of age > 30 years. More than 60% women in obstructed labor had reported fromrural areas; and more than eighty percent of them were illiterate & belonged to lower socioeconomicclass. Only 4.55% of the women in obstructed labor were the booked cases. All thecases of obstructed labor were at full term. Cesarean section was done on 90.90% women. Nota single maternal mortality was reported among women enrolled in the study as obstructedlabor. Conclusion: Neglected obstructed labor is a major public health issue. It can be avoidedby addressing various socio-demographic determinants of pregnant women.
HEALTH ISSUES AND WELLBEING
Authors: Anjum Farkhanda , Zafar Muhammad Iqbal , Maann Ashfaq Ahmad , Ahmad Munir
Published: September 2021

Children are perceived as the future of any country. With this in mind, child labordoes nothing but destroy the future of the children. Carpet weaving is destructivefor childrenbecause children often sit in odd positions for extensive hours, inhaling dust and working ininadequate lighting situations, all these aspects are hazardous to the wellbeing of children.Child carpet weavers have to face occupational damages and diseases. Objective: To identifythe factors contributing to child labor and effects of work-related health issues on the wellbeingof carpet weavers. Study Design: Cross sectional survey. Setting: Punjab province. Meterial &Method: A sample of 320 carpet child workers of age group 8-17 years was interviewed. A wellstructuredquestionnaire was constructed to collect the data. The SPSS/PC + 20.0 StatisticalPackage for Social Sciences were used for analyzing the data. Results: The study found thatmajority of the respondents was facing the problem of body aches, backbone problem, eyestrain and general exhaustion and cuts and wounds. The significant relationship was observedbetween work-related illness (type of illness) and the personal wellbeing of carpet workingchildren. It was strongly suggested that comprehensive strategy consisting of macro as well asmicro policies is to be commenced to control, reduce and eradicate. The ill effects related tocarpet weaving. The participation of children in carpet weaving industry should be stopped orat least immunizad present. Conclusion: The carpet workers immediately need concentratedefforts not only to solve their work-related issues, but also to make them productive adult in theirown wellbeing as well as in the welfares of society.
ROAD TRAFFIC ACCIDENTS
Authors: Imran Muhammad , Nasir Jamal Abdul
Published: September 2021

Objective: To determine the trend of road traffic accidents (RTAs) and forecastingtheir incidence is an emerging to take safety measures so that general public health relatedmorbidity and mortality can be minimized. Setting: The data for present study has been takenfrom Pakistan bureau of statistics (statistics House). Period: January 2002-2003 to December2011-2012. Methods: A set of eleven curve fitting models namely linear, quadratic, cubic,logarithmic, inverse, exponential growth model, logistics-curve ,and compound models werecarried out for prediction. Results: Under the descriptive analysis, the annual average numberof fatal and non-fatal accidents is 43.3% and 56.7% respectively. In provinces Punjab contributesto a high rate of total number of accidents, while Khyber Pakhtunkhwa, Sindh and Baluchistanplaced second, third and fourth respectively. Under the curve fitting estimation, the cubicmodel was selected for predicting the annual traffic road accident for all categories i.e.(i) Total Number of Accident (ii) Fatal Accident (iii) Non-Fatal Accident (iv) Killed People(v) Injured People and (vi) The Number of Vehicle Involved. Rising trend in all categoriesare expected in Pakistan. Conclusions: The traffic road accident is expected to rise in Pakistan.
INGUINAL HERNIOPLASTY
Authors: Abbasi Mujeeb Rehman , Shaikh Razzak , Sangrasi Ahmed Khan , Shaikh Noshad A , Shaikh Ubedullah
Published: September 2021

Objective: To compare laparoscopic TEP Inguinal hernioplasty with & withoutdissection balloon. Study Design: Observational study. Setting: Minimal Invasive SurgicalCentre Jamshoro and General Surgical Department at Dow University Hospital, Ojha CampusKarachi. Period: May 2011 and Dec 2012. Subjects and methods: Twenty (20) male patientswith uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in twogroups; group A Commercially available dissection balloon & group B. Telescopic dissectionfor creating TEP working space. Results: We had 20 male patients for this study. The averageage was 43.6 & ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia,4 patients 40% had direct inguinal hernia in group A & 5 patients 50% had direct hernia in groupB. Peritoneum was breached in 5 (50%) patients with telescopic dissection. One patient (10%)with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP whileother group normal. The incidence of scrotal edema/seroma was greater in group B then groupA. 40% patient in group B developed seroma while 0nly 1 (10%) patient with bilateral groinhernia in group A developed seroma. Pain was scored on VAS at 1 & 4 hours after surgerywas higher in group B. The mean operation time was 55 min (45-100) in the group with theballoon and 73 min (50-120) in the group without the balloon (p = 0.004). Conclusion: TEPlaparoscopic inguinal hernia repair is probably the best option amongst the two techniquesused in laparoscopic inguinal hernia repair & dissection with balloon is though costly but morehelpful in dissection & safer.
EXISTING SURGICAL GOWNS
Authors: Kishwar Farzana , Kalsoom Samia
Published: September 2021

Textiles perform as an interface between the body and environment. In the newgeneration of textiles, this potential of textiles is being utilized to provide the resistance not onlyagainst weather but also against micro-organisms and collision forces etc. the type of weavehas a strong impact on its physical properties. Type of weave also affects the suitability of thematerial end use. According to a study by Behera plain weave is more suitable for surgicalapparels in comparison with twill weave because of large pores between two adjoining yarns onintersection. Fabric construction parameters determine the strength of the fabric. Parametersare: mass per unit area, number of threads per unit length, maximum force using the stripmethod, & yarn count (yarn number). A fabric with high thread count does not allow themicroorganisms to pass through a fabric than a fabric having low/less count. Different Surfacefinishes help to decrease the bacterial growth on the surface of fabric. Plasma coated Nonwovensamples are better repellent of pathogens than re-usable woven fabrics. All surgicalattire has to meet some given standards for tensile strength which dictates the rate of wear andtear that will affect the required properties. The thought behind this study was to evaluate andcompare the tensile strength of existing surgical gowns among the groups. Objectives: 1) Tofind out the Tensile Strength of existing surgical gown fabric before and after laundering (amongthree groups of hospitals). 2) To compare the results of Tensile Strength of existing surgicalgowns (among three groups of hospitals) being used in hospitals of Lahore. Study Design: Thestudy has experimental design. Period: March 2011- March. 2012. Materials and methods:Samples of fabric used for making surgical gowns were collected from different hospitals ofLahore and evaluated for Tensile Strength before and after laundering at Textile Lab. Resultand Conclusions: On the whole a decreasing trend was observed for tensile strength in all3 groups of hospitals from 0 to 20th laundering. Group B of hospitals showed lowest tensilestrength observation whereas the highest value was observed in group A of hospitals. Thelowest observation for tensile strength was found in Group B of hospitals whereas in group Cthe highest value was observed it’s clear that fabrics of group B showed lowest tensile strengthrating in test results for both warp and weft directions. Whereas group A of hospitals showedhighest tensile strength test results among the groups in warp and in weft group C showed highresults.
MALIGNANT PLEURAL EFFUSION
Authors: Daula Muhammad Imran Hameed
Published: September 2021

Objectives: To assess the role of video assisted thoracoscopic talc pleurodesisin the surgical management of malignant pleural effusions by comparing this procedure withpleurodesis via talc slurry through an intercostals chest tube. Design: Prospective analysisof fifty patients with malignant pleural effusion which were divided into two groups. Groupone included twenty patients while group two included thirty patients. Setting: Department ofThoracic Surgery and the Department of Oncology, Combined Military Hospital, Rawalpindi.Period: October 2008 till November 2010. Subjects: Fifty patients of malignant pleural effusionwere included in the study. They were divided into two groups. Group one included twentypatients whereas group two included thirty patients. Interventions: Patients in group onewere subjected to videoassisted thoracoscopic talc pleurodesis. Patients in group two weresubjected to pleurodesis via talc slurry through an intercostal drainage tube. RESULTS: Fiftypatients were included in the study. The mean follow up time was 5.7 months for group oneand 5.5 months for group two. Out of the twenty patients in group one 95% had successfulpleurodesis (defined as satisfactory pleurodesis three months post procedure). Adverse effectsincluded fever in three patients (15%), empyema in one patient (5%) and malignant invasionof the scar in one patient (5%). Out of the thirty patients in group two 70% had successfulpleurodesis. Adverse effects included fever in five patients (17%), empyema in one patient (3%),and pulmonary infection in one patient (3%). No mortalities occurred during the procedures ineither of the group. Conclusions: Videoassisted thoracoscopic talc pleurodesis is a safe andeffective method of producing reliable pleurodesis in patients with malignant pleural effusion. It issuperior to pleurodesis via talc slurry through an intercostal drainage tube in terms of producinga reliable and complete pleurodesis. It should be performed early in patients presenting withmalignant pleural effusions to avoid the risk of respiratory failure, this being directly linked to thegeneral and respiratory status of the patients at the time of the procedure.
HYPERGLYCEMIA
Authors: Abbasi Palwasha , Memon Abdul Rahim , Abbasi Sadia Tabassum , Kazi Sadia , Siddiqui Shomail
Published: September 2021

Objectives: To investigate blood glucose regulaitng effects of CatharanthusRoseus (C.roseus) and Nigella sativa (N.sativa) in alloxan induced diabetic rats. Study Design:Experimental study. Place and Duration: Animal house Isra University Hyderabad. From Aprilto Novermber 2013. Methodology: 50 male rats were housed at normal température, 12 hourdark - light cycle with free access to chow and water. A single intraperitoneal bolus of alloxan(120 mg/kg) was given to induce diabetes mellitus. Glimepiride, C. roseus and N. Sativa wereadministered at doses of 0.1 mg/kg, 125 mg/kg and 50 g/kg respectively. Data was analyzed onSPSS version 21.0. Significant P - value was defined at ≤ 0.05. Results: C.roseus ad N.sativashowed blood glucose lowering potential but the effect was less when compared to glimepiride(P = 0.001). However, C. roseus was more effective compared to N.sativa (P = 0.001) inreducing blood glucose. Findings suggest that both C. roseus and N. sativa possess glucoseregulating potential. Conclusion: It is concluded that the C. roseus and N. sativa exert bloodglucose regulating effects in alloxan induced diabetic rat model.
LOWER GASRTOINTESTINAL BLEEDING
Authors: Nazish Zahra , Inayatullah Muhammad , Khan Muhammad Younus
Published: September 2021

Objectives: To determine the etiology of lower GI bleeding based oncolonoscopic findings Study design: Retrospective study. Place and Duration of study: Thisstudy was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 toAugust 2014. Patients and methods: Two hundred and fifty four patients, ≥ 14 years old whopresented with history of lower GI bleeding to the gastroenterology unit of Nishtar HospitalMultan Results: Out of 254 patients, 59.05% were males and 40.95% were females. Mean ageof patients was 37.22±10.68 years. Most common findings were haemorrhoids (40.9% cases),ulcerative colitis(35.4%), no abnormality (8.2%), solitary rectal ulcer (7.5%), growth (7.1%),proctitis (3.5%), polyps(2%), rectal varix (1.2%), infective colitis (0.8%), uremic colopathy(0.8%), rectal prolapse (0.8%), multiple polyposis coli (0.8%), petechiae (0.8%), stricture (0.8%),diverticula(0.4%)and fissure (0.4%). Conclusion: Colonoscopy is the investigation of choice forpatients of lower gastrointestinal bleeding. More common colonoscopic findings in our studywere haemorrhoids, ulcerative colitis, solitary rectal ulcer, malignancy and proctitis. Polyps anddiverticula which are common in the west were uncommon in our patients. Rectal prolapse,petechiae, stricture, uremic colopathy and multiple polyposis coli were rare causes.
REPRODUCTIVE HEALTH ISSUES OF MOTHERS
Authors: Asim Muhammad , Sohail Malik Muhammad , Manj Yasir Nawaz
Published: September 2021

In Pakistan maternal mortality rate is very high as compared to other low incomecountries. Maternal mortality rate in Pakistan 260/100,000 is the highest in South Asia. Indeveloping countries one woman dies in sixteen from pregnancy related diseases. Objective:This study was aimed to explore reproductive health issues of mothers in Faisalabad. StudyDesign: A sample of 200 respondents was obtained from Faisalabad city through multistagesampling technique. Period: 2013-2014 Setting Area: Urban Area of district Faisalabad Materialand Method: Uni-variate (frequency distribution and percentage) and Bi-variate analysis (Chisquare and Gamma Statistics) was carried out. Results: It was found that antenatal andpostnatal care utilization services were poor. Majority of the respondents 79% got at least oneantenatal care service but only more than one third 34% got the four recommended checkupduring pregnancy. It was also investigated that only 60% women got postnatal visits andonly 18% deliveries took place at homes. Two third of the respondents 66% had the positiveattitude towards the contraceptive methods for birth spacing. The bi-variate analysis shows thatage (p=.003), education (p=.013), income (p=.001), type of family (p=.002) were significantlyassociated with the positive attitude towards the contraceptive for birth spacing.Conclusion:It is suggested that mothers should be aware of the importance of antenatal and postnatalrecommended visits to overcome the reproductive health issues through LHW’s visits massmedia compaigns and easy assess towards the health care centers.
LEARNING PREFERENCES
Authors: Ch Abdul Rashid , Sandhu Irshad Nabi , Ali Muhammad Arif , Sandhu Asad Ali
Published: September 2021

Introduction: This study has focused to know the learning preferences amongfaculty considering different methodologies and considering about CME to improve healthcare.Objectives: To identify the gaps in knowledge regarding CME in medical faculty of Lahore andto see the awareness of the CME among them. Study Design: This is a cross-sectional study ofmedical faculty in Lahore. Settings: Three hospitals in Lahore are included from both private/public sectors. Period: It was conducted over a period of 2 months from JULY, 2014 to August,2014 Methods: A questionnaire comprising of 21 questions was distributed at random for datacollection among doctors having done post graduation. Results: Most of the faculty memberswho attended CME found it as useful tool for improving the knowledge and techniques forbetter patient care. Conclusions: Majority teachers are not interested in CME and do notparticipate and ask for some incentives.
PLASTIBELL CIRCUMCISION
Authors: Akbar Syed Ali , Mehmood Syed Qasim , Khan Muhammad Safdar
Published: September 2021

Design: Prospective Study. Setting: Different hospitals as a day care surgery.Period: March 2005 up to March 2012. Patients and Methods: Plastibell circumcision in infantsand children’s up to the age of 7 years was conducted using Plastibell device in different hospitalsas a day care surgery. Results: In Plastibell method, local edema was minor complication thendelayed separation of the ring, infection, mild bleeding after plastibell separation, respectivelyand no major complication was noted. Conclusion: Plastibell device circumcision preventsthe most serious complications like bleeding, infection etc. It is fast and ensures excellentcosmoses and it takes short operating time.
DISTAL RADIUS FRACTURE
Authors: Saeed Mohammad , Inam Muhammad , Khan Imran , Durrani Alamzeb , Satar Abdul
Published: September 2021

Objectives: The objective of the study is to find out functional outcome inpatients with distal radius fractures irrespective of radiographic deformities after close reductionand cast splint age. Design: Case series study. Setting: Department of Orthopedics and SpineSurgery, Hayatabad Medical Complex Peshawar. Period: May 2010 to April 2015. Materialsand Methods: 28 consecutive patients of either sex with age above 40 years, having distalradius fracture. Functional outcome was assessed with disability of arm, shoulder and hand(DASH) and Patient Rated Wrist/Hand Evolution (PRWHE) questionnaire. Results: Out of 28patients male were 12(42.9%) and female were 16(57.1%). minimum age was 40 maximum81 and average was 50. Right side was involved in 17 (60.7%) while left side was involved in11(39.3%). The DASH Score Record shows that no Disability was seen in 13(46.4%), MinimalDisability in 7(25%), Mild Disability in 5(17.9%), Moderate Disability in 1(3.6%) and SevereDisability in 2(7.1%) patients. While the PRWHE Score Record shows that no Disability wasseen in 14(50%), Minimal Disability in 6(21.4%), Mild Disability in 5(17.9%), Moderate Disabilityin 1(3.6%) and Severe Disability in 2(7.1%) patients. Conclusion: A majority of the distal radiusfractures can achieve good results after treatment by closed reduction and cast immobilization,for which conservative treatment should be the first choice. Deformity of the distal radius cannotaffect the functional outcome of the wrist and hand.
ACUTE HEPATITIS E DURING PREGNANCY
Authors: Alvi Aftab Haider , Sabir Omer , Haq Raja Ikram Ul , Nawaz Arif Amir , Riaz Iram
Published: September 2021

Liver disorders during pregnancy may have a strong bearing on both mother andthe foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regionalstudies have shown it to be the most common cause of Acute Hepatitis in pregnant females. Wecarried out our study to elaborate the demographic profile of pregnant females presenting withAcute Hepatitis E along with the fetomaternal outcomes. Study Design: It was a prospective,observational study. Intervention: None. Settings and Participants: Over a period of two years,73 pregnant patients were evaluated by our team in the Department of Gastroenterology forsuspicion of liver disease. Outcomes and Measurement: Data was evaluated for quantitativeand qualitative variables. Outcome of mother, pregnancy and neonates was also recordedwhere available. Results: During the study period 73 pregnant patients presented with liverdisease giving an incidence of 3.6%. Serological evidence of Acute Hepatitis E was found in 50(68.5%) of the patients. Fulminant hepatic Failure developed in 5 (10%) patients. All five patientswith FHF could not survive. There were 4 (8%) intra-uterine deaths, 1 (2%) abortion and 5 (10%)neonatal deaths. Shortcomings: Relatively small sample size. Conclusions: Acute hepatitis Eduring pregnancy predicts poor outcomes for the mothers, foetus and neonates
ECLAMPTIC PATIENTS
Authors: Zahoor Sadia , Malik Tahira , Zulfiqar Sonia
Published: September 2021

Background: Hypertensive disorders are the second most common cause ofmaternal death worldwide. Eclampsia is the extension of pregnancy induced hypertension tothe point of conclusions, coma or both. Objectives: To find out the incidence of eclampsiaamong pregnant women and to identify the maternal and perinatal outcomes of eclampticpatients treated in a tertiary care referral hospital. Study Design: Discretional cross sectionalstudy. Setting: Department of Obstetrics & Gynecology, Sheikh Zayed Hospital, Rahim YarKhan. Period: January 2014 to December 2014. Methods: A total number of 96 patients out of10513 who were diagnosed as being eclamptic during the study period were included in thisstudy. While normal pregnant women and Patient’s with uncertain diagnosis was excluded. Allpatient variables were entered and analyzed using SPSS v20. Frequency and percentages wereused to express qualitative variables. Results: There were total ninety six patients (0.913%) outof 10,513 who presented with eclampsia. Most of eclamptic patients were of having age >21years. Among patients who developed eclampsia 52 (54.16%) were in Ante partum period and40 (41.66%) were in postpartum period. Out of 96, five patients died before delivery and thirteenafter delivery, seventy eight patients developed one or more complications during delivery.Out of total 91 deliveries, 54 (59.30%) were delivered by cesarean section (C/S). Main reasonfor C/S was unfavorable cervix. Out of total ninety one deliveries two were twins and eightynine singletons. Fifty eight (62.36%) babies were born at a gestational age <37 weeks. Birthasphyxia occurred in sixty one (65.60%) newborns. There were twenty two (23.65%) perinataldeaths, fourteen (63.64%) were stillbirths and eight (36.36%) were early neonatal deaths.Conclusion: Eclampsia is found to be associated with very high rates of maternal mortality andmorbidity as well as perinatal mortality. Early diagnosis of eclampsia and its timely managementcan reduce the risk of this mortality. This can be made possible by provision of basic facilitiesand improvements in the quality of basic care provided by our antenatal clinics.
HEALTH CARE FACILITIES AT SCHOOL
Authors: Omar Naureen , Khan Rameeshey , Farooq Faizan , Karim Humera , Ayoub Muhammad , Habib Ushna
Published: September 2021

Schools should pertain to a comprehensive system to deal with day to dayemergencies, as children spend more than six hours at school and are liable to suffer frominjuries and illnesses. Objectives: This study was conducted with the objective of assessingthe experiences of students regarding healthcare management especially first aid patterns atschool. Study Design: Cross sectional study. Setting: Study was conducted on 50 studentsenrolled from ten identified public and private schools of Lahore Period: Six months. Methods:In depth interviews were conducted on students from classes 6-10 who had suffered from aninjury or illness during school hours within the last six months. Results: In these 50 studentsthe most common injury were fractures and dislocations (15), most common illness was fever(19). Majority (41) were managed at schools with a first aid facility and provision of sick rooms(28). Teachers were the main healthcare providers in private schools (17), as compared topublic schools (9). Lack of properly trained health professionals was observed; only 7 out of 50schools had employed nurses. Health education regarding hand washing, personal hygiene,dengue prevention was being provided in (45) schools. Conclusion: This study highlights theimportance of provision of first aid services at school and the need to train teachers regardingbasic life support. Implementation of the existing school health program needs to be emphasizedin all schools of Lahore.
OPERATING ROOM (OR) UTILIZATION AND EFFICIENCY
Authors: Khan Muhammad Ahmad , Sheraz Dr. Motsim , Ahmad Dr. Shakeel
Published: September 2021

Introduction: Operating room (OR) is a key department in any institution and itruns with heavy resources. Improper running carries not only loss of revenue but it also effectspatient care. Delays in operating room are deleterious and methods to decrease these delaysare important not only for patient care, but to maximize operating room resource utilization.Objective: To determine the causes effecting the OR utilization and efficiency and to find outways to overcome it. Study Design: Observational Study. Period: 15-01-2011 to 08-06-2011.Setting: King Khalid Hospital, KSA. Patients and Methods: Operating room baseline data wascollected for one month and it was compared with historical data of the last six month. Operatingroom utilization was found to be 41% overall and 34% for elective cases (benchmark 85%). Inpatient pathway, on average 17 min were required from call to ward to enter in operating room.First incision time was 11%=8-8:30, 31% = 8:30-9 and 58%= 9+. Cancelation was 9%. Variousimprovement projects were started including surgical list management, OR rescheduling, starton time dashboard, pre-anesthesia clinic and reinforcement of day surgery program. Results:The results showed 47% improvement in elective OR utilization and OR utilization reaching69%. There was 76% improvement in emergency case booking and 18% improvement in pre/post-op process time. There was 64% improvement in 1st cases before 9 am Conclusion:Integrated management working can improve the working and outcome of the operating roomresulting in high efficiency and best patient satisfaction.
ECZEMA
Authors: Agha Humaira Maryum , Asim Sadaf Ahmed , Alam Dr. M. Zafar , Wahid Zarnaz
Published: September 2021

Objectives: To determine the frequency of different types of eczema inpatients presenting in a tertiary care hospital. Study Design: Cross sectional descriptive typeof study. Setting: Hamdard University Hospital Karachi. Period: January 2013 till December2013. Patients and Methods: All new cases of any type of eczema were registered by nonprobabilityconvenient sampling. Total 192 patients of both genders and all ages were enrolledafter taking informed consent. Diagnosis was made on detailed history and clinical examinationby consultant dermatologist. All specific and relevant investigations were done accordingto requirement. Patients were divided in two groups, exogenous eczema and endogenouseczema, for convenience. Data was analyzed by the latest version of SPSS. Results: Therewere 192 patients, out of which 52.08% were males and 47.91% females. Out of the totalpresented patients 50% had endogenous eczema, 43.37% had exogenous eczema and25.62% had unspecified eczema. In endogenous group 11.45% had hand dermatitis followedby seborrhoeic dermatitis, atopic dermatitis and asteatotic eczema in descending frequencyof presentation. Pityriasis alba, discoid eczema and pompholyx were seen less frequent. Inexogenous eczema allergic contact dermatitis was seen in 14.06% patients, while irritant contactdermatitis in 11.45% patients. Infective eczema and photo-allergic eczema were seen in smallnumber of patients. Conclusion: It was found in this study that allergic contact dermatitis wasmost common type of eczema followed by other types. Whatever the type is, eczema can betreated, symptoms can be relieved and recurrences can be prevented by appropriate therapy.All types of eczema affect patient’s quality of life adversely. However, they can be prevented byeducating patients and their relatives to take adequate safety measures like using good qualityemollients prophylactically.
LAPAROSCOPIC HYSTERECTOMY
Authors: Kahnum Zohra , Kahnum Amna , Rehman Aman ur , Ali Liaqat
Published: September 2021

Introduction: In current era, the trend for minimal invasive surgery is increaseddue to its established advantages. With the same, there increasing trend for laparoscopichysterectomy. But it carries certain risks in certain situations. Objectives: The study wasconducted to see the outcome of laparoscopic hysterectomies. Study Design: Retrospective,analytic study. Study Period: June 2012 to May, 2015. Method: A study was conducted to reviewthe outcome of Laparoscopic hysterectomy over a period of three years from June 2012 to May2015. Total one hundred cases were included in the study. These patients had hysterectomyeither total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy. Afterpreoperative evaluation, hysterectomy was done either total laparoscopic or laparoscopicassisted vaginal hysterectomy. Data was collected regarding patients profile variables,indications for hysterectomy, intraoperative findings, intraoperative time, postoperative recoveryfindings, analgesia requirements and discharge time from the hospital. Results: Results of thestudy showed that there was no significant increase in complication of urinary tract or bowelinjury. Operative time was decreased with time. Most common indication for hysterectomywas fibroid uterus or dysfunctional uterine bleeding. Patient recovery was smooth and postoperativeanalgesia was much less as compared to the routine. Patient hospital stay was lessas compared to the routine procedures for hysterectomy. Conclusion: It is concluded fromthe study that laparoscopic hysterectomy is safe procedure with the clear advantages for thepatient. In the study complication rate, operating time was comparable to the already publishedstudies. With proper training it is acceptable alternate to abdominal hysterectomy with clearadvantages for the patient.
COBALAMIN DEFICIENCY
Authors: Shaikh Shumaila , Memon Azhar , Ata Muhammad Atif , Khoharo Haji Khan
Published: September 2021

Objectives: The present study aims to evaluate the serum cobalamin inHelicobacter pylori (H. pylori) infected patients. Study Design: Case control study. Place andDuration: Department of Medicine, Isra University Hospital Hyderabad from March 2013- April2014. Methodology: A sample of 109 subjects including Helicobacter pylori positive subjectsand controls were selected according to study criteria. Centrifugation of blood was performedat 4000 rpm for 10 minutes and sera were stored at -20oC. Blood sera were used for H. pyloriserological testing. Blood counting was performed on hematoanalyzer. Cobas e411 analyzerwas used for detection of cobalamin. 64 kD H. pylori antigens was detected by ELISA. Thedata was entered into SPSS version 21.0. (IBM, Incorporation, USA) A 2-tailed p-value of ≤0.05was considered significant for statistical analysis. Results: Of total 109, 54.1% (n=59) wereH. pylori seropositive cases and others were controls i.e. 45.9% (n=50). Cases and controlsshowed cobalamin levels of 290±49.3 vs. 351±32.9 pg/ml respectively (p=0.0001). Red bloodcell indices were found to show statistically significant difference between cases and controls(p=0.001). Conclusion: Serum cobalamin deficiency was noted in both Helicobacter pyloripositive and controls, however deficiency was more pronounced in Helicobacter pylori positivesubjects.
TYPE 2 DIABETES
Authors: Naveed Shabnam , Ahmed Syed Masroor , Nageen Ayesha , Ali Zeeshan , Kumar Santosh , Zakir Humaira , Ghazi Lubna
Published: September 2021

Objectives: To determine the prevalence and the associated risk factors ofNAFLD in Type 2 diabetic patients. Study Design: Cross sectional study. Setting: Diabeticclinic of Medical Unit 3, JPMC. Methods: It is a cross sectional study. 262 patients wereenrolled between the ages of 18-70 years attending Diabetes Clinic of Medical Unit III, JPMC.Each consenting patient underwent a detailed medical history-taking, physical examination,laboratory assessment and abdominal ultrasonography (US). Fatty liver was diagnosed onabdominal US on the basis of two out of the three criteria: increased hepatic echogenicity,blurring of liver vasculature and deep attenuation of the ultrasonographic signal. In accordancewith the guidelines, subjects diagnosed with NAFLD had to fulfill the following criteria: nohistory of current or past alcohol consumption, other systemic illness known to cause fatty liverdisease; absence of history and clinical, biochemical and US findings consistent with cirrhosis.Body mass index (BMI) was calculated. Blood pressures of greater than 130/90 were takenas hypertensive. LFTs, FBS, HbA1c, Lipid profiles were taken. Results: Out of 262 diabeticpatients 107 (40.8%) of them were found to be having NFALD. Prevalence was found out to behigher in age group of 41-50 years, females, obese & in Pashtoon subjects.It was also moreprevalent in sedentary lifestyle patients and those on oral anti diabetics in contrast to insulintherapy. It was correlating well with US findings when the ALT cut-off value was taken as 30 IUfor males and 19 IU for females compared to standard values of ALT. There was associationwith hypertension, metabolic syndrome and dyslipidemia. Conclusion: Prevalence of NAFLDwas higher in our diabetic patients. Middle age, female gender and obesity were found to bestatistically strong risk factors in our study.
SUBFERTILE PATIENTS
Authors: Abbass Shazia , Ahmed Ejaz , Shabbir Iram
Published: September 2021

Objective: To determine the efficacy of Letrozole as a first line drug in subfertile patients in term of pregnancy rate. Study Design: Case series study. Setting: OutpatientDepartment of Gynecology, Nishtar Hospital Multan. Period: May 2012 to December 2012.Material and methods: A total of 246 females with primary subfertility were enrolled in studyfrom gynecological outpatient department. Results: Mean age of the patients was 25.92 ±3.93years. 132 patients (54.0 %) had BMI of 2-25 kg/m2 and 101 patients (41%) had increasedof BMI 26-30 kg/m2 and 13patients (5%) were obese and had BMI of >30 kg/m2. 42 patients(17%) were illiterate. 54 patients (22%) were primary to middle and 62(25%) were matricand 88(36%) were FSC and > than FSC. 39(16%) patients had monthly income 10,000 and120(49%) patients had monthly income 10,000 -30,000 and 87(35%) patients had monthlyincome >30,000. Pregnancy was seen in 34% (83 patients). Conclusion: Aromatase inhibitors,Letrozole significantly increases pregnancy rate as a primary treatment in subfertility patients.