bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of serum Vitamin D and omentin-1 in patients with coronary artery disease.
Authors: Nazar Shazia , Qamar Ambreen , Mughal Akbar , Butt Fareeha
Published: July 2020

Objectives: The aim of the present study was to investigate the association between serum vitamin D (calcediol, D2) with omentin-1 in patients with coronary artery disease (CAD). Study Design: Case Control Study/ Cross Sectional Study. Setting: Civil Hospital Karachi (CHK). Period: January 2016 to June 2016. Material & Methods: In this cross-sectional study, total of 250 cases of coronary artery disease were recruited randomly from the civil hospital, Karachi. Diagnosis based upon coronary angiography. Serum Vitamin D and omentin levels determined by using enzyme linked immunosorbent essay (ELISA) in Dr. Abdul Qadeer khan Institute of Biotechnology and Genetic Engineering (KIBGE). 120 apparently healthy controls were recruited. Results: we observed significant low levels of serum vitamin D and omentin-1in patients of coronary artery disease. Vitamin D (calcidiole, D2) deficiency (<30ng/L) was found in 82 % (n= 205) of CAD patients, moreover; 50.8% (n=127) patients were found with severe vitamin D deficiency (8.77± 3.87) placed in group III, 31.2% (n=78) patients were found with moderate deficiency (17.09 ±4 ng/mL) in group II, whereas only 18% (n=45) had optimal serum vitamin D levels (33.02 ±16.00 ng/ mL) placed in group I. Mean serum omentin-1 level was (578± 21.87, 409±32.09, 321± 23.01) in these subgroups respectively. Serum vitamin D (calcidiole, D2) level was associated positively with omentin-1 in CAD patients (P = 0.002) after adjustment for potential confounding variables; basal metabolic rate, waist circumference, blood pressure and lipid profile. Conclusion: Within the limits of the study, we concluded that low levels of vitamin D and omentin-1 are associated with prevalent coronary artery disease (CAD) and are independent of other cardiovascular risk factors. Further investigations are required in different ethnic groups and populations to confirm the findings.
Human amniotic membrane:	A biological cost effective dressing in chronic wounds.
Authors: Yamin Ibrahim , - Ayesha , - Ramla , Ajmal Muhammad
Published: July 2020

Objectives: The use of human amniotic membrane is essential new concept in wound healing which functions as a biodegradable scaffold on wound surface, as it is a rich hub of stem cells which play an important role in wound healing. Study Design: Randomized Control Trial. Setting: Department of Surgery THQ Hospital Gojra. Period: 1st January 2019 to 30 September 2019. Material & Methods: Experimental study using clinical trial. A case series of 50 patient cases were picked from surgical OPD. Who fall in criteria of chronic non-healing wound with at least three months duration comprising of diabetic, venous ulcers and traumatic non healing wound and neuropathic ulcers. All located on lower limbs. Results: All 50 patient were treated with standard protocol by applying freshly prepared amniotic membrane out of which 4 chronic wounds more than 4 year duration were not healed and 2 cases escaped from the study. HAM dressing was changed after every 7 days and its effect were studied by seeing measuring the reduction in wound size and improvement in pain, swelling and mental stress. Success rate was found about 90% with complete healing. Conclusion: There is a dire need in developing countries to promote the use of HAM, in chronic non healing wounds which is a biological membrane, readily available (free if fresh) with simple sterilization techniques, easy storage and easy application with ultimate goal in achieving speedy cost effective wound healing.
Frequency of anemia in patients with increased level of parathyroid hormone among patients on maintenance hemodialysis.
Authors: Azeem Saad Muzaffar , Haroon Anita , Alam Ishtiaque , Azeem Sadia , Sultana Mahrukh , Mansoor Kulsoom
Published: July 2020

Objectives: One of the most frequently occurring complication of end stage renal disease is anemia. It can be defined as decrease in red blood cells with hemoglobin concentration less than 12 g/dl in women and less than 13 g/dl in men. Parathyroid hormone levels are also raised among patients with end stage renal disease to maintain serum calcium levels. The objective of this study is to evaluate the degree of anemia in patients with end stage renal disease currently on maintenance hemodialysis and have raised PTH levels. Study Design: Cross-sectional study. Setting: Kidney Center, Karachi. Period: November 2015 to July 2016. Material & Method: Patients undergoing maintenance hemodialysis during the study duration with PTH levels greater than 300 ng/L were included in the study. Patients with other co-morbid conditions like chronic liver disease and hypersplenism were excluded from the study. Results: The total number of patients on maintenance hemodialysis in the kidney center that matched our inclusion criteria was 110. Amongst them there were 47.3% (n=52) males and 52.7% (n=58) females. The mean age of patients in our study is 50.15 ± 12.92 years. The mean PTH level of patients was found to be 642 ± 405.9U. Since all the participants of the study are on maintenance dialysis, the mean duration of hemodialysis was found to be 4.2 ± 3.19 months. The mean hemoglobin level of patients was found to be 9.75 ± 1.47 g/dl. Conclusion: Patients with hyperparathyroidism and undergoing maintenance hemodialysis frequently develops anemia. Many factors account for this including raised PTH levels causing bone marrow fibrosis, decreased production of erythropoietin and resistance of produced erythropoietin are some factors responsible for the anemia.
Frequency of spinal hypotension in patients undergoing elective lower segment caesarean section using preoperative preload and intramuscular ephedrine.
Authors: Maqbool Shumyala , Askri Mohsin Riaz , Shafique Sahir , Shah Kausar Abbas
Published: July 2020

Objectives: To observe the frequency of spinal hypotension in patients undergoing Elective Lower Segment Caesarean Section receiving pre-operative preload compared with intramuscular ephedrine. Study Design: Cross Sectional study. Setting: Department of Anesthesia, Independent Medical College, Faisalabad. Period: July 1st 2018 to December 31st 2018. Material & Methods: This study included fifty-two female patients, aged 20-35 years, undergoing elective C/section under spinal anesthesia with ASA physical status I & II, pre-operatively preloaded and given prophylactic intramuscular ephedrine. Hemodynamic changes were recorded in both groups after receiving spinal anesthesia. Results: Compared with the prophylactic ephedrine group, frequency of Post spinal hypotension was higher significantly in pre-load group (p=0.019). Conclusion: It has been concluded that there is the use of prophylactic intra muscular ephedrine is associated with low incidence of post spinal hypotension.
Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.
Authors: Ahmad Munir , Yasir Muhammad , Saeed Muhammad Hamid , Khan Muhammad Saeed Ali , Rauf Qasim , Hameed Naeem
Published: July 2020

Objectives: To determine the frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery. Study Design: Cross-sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: Six months, from 02 February, 2017 to 01 August, 2017. Material & Methods: After taking approval from hospital ethical committee, patients coming through outpatient department who fulfilled the inclusion criteria were enrolled and informed consent was taken from them. History of smoking, diabetes mellitus, renal dysfunction, dyslipidemia, hypertension and family history of coronary artery disease was assessed. Coronary angiography was performed by senior consultant interventional cardiologist for assessing obstructive coronary artery disease as per operational definition. All the information was collected on prespecified Performa. Results: In this study, out of 140 cases of valvular heart disease (VHD), 47.14%(n=66) were between 30-50 years of age whereas 52.86%(n=74) were between 51-70 years of age, mean ±sd was calculated as 51.71+9.09 years, 57.14%(n=80) were male while 42.86%(n=60) were female, frequency of obstructive coronary artery disease in patients undergoing valvular heart surgery was recorded as 29.3% (n=41) whereas 70.7% (n=99) had no such finding. Conclusion: The frequency of obstructive coronary artery disease was (29.3%) in patients undergoing valvular heart disease surgery. However, coronary artery disease was less frequent in rheumatic as compared to degenerative heart valve disease.
Detection of mecA gene by latex agglutination and its molecular analysis by PCR in methicillin resistant staphylococcus aureus.
Authors: Khawaja Aneela , Javed Iffat , Mushtaq Sohaila , Anwar Saeed , Arshad Faiqa , Raja Naseer Ahmad
Published: July 2020

Antimicrobial resistance (AMR) is a devastating question that is threatening the health globally. The extensive and indiscriminative use of antibiotics has evolved a notorious resistance in Staphylococcus aureus.  This resistance developed through possession of mecA gene, which codes for modified penicillin binding protein (PBP2a) and the emergent strain being labeled “methicillin resistant Staphylococcus aureus”. Conventional phenotypic techniques for detection of MRSA rely on standardization of cultural characteristics. The drawbacks of diagnostic error to report MRSA include: poor prognosis, expensive treatment, dissemination of multi-drug resistant strains and even treatment failure. Latex agglutination method can be adopted as a more accurate and quick strategy for rapid detection of methicillin resistance. Objectives: To compare detection of mecA gene in methicillin resistant isolates of Staphylococcus aureus by latex agglutination and PCR; by assessing the sensitivity and specificity of both methods. Study Design: Descriptive Cross-Sectional study. Setting: Pathology Department, Post Graduate Medical Institute, Lahore. Period: From January 2015 to December 2015; according to standard operating procedures at Microbiology laboratory. Material & Methods: A total 713 consecutive, non-duplicate isolates of Staphylococcus aureus were processed. Methicillin resistance was determined using cefoxitin (30mg) by Kirby-Bauer method using CLSI guideline (2016), latex agglutination method; and PCR for mecA gene. Results: The results showed that out of 713 Staphylococcus aureus isolates, 92 (12.90%) isolates were resistant to cefoxitin and were labelled as MRSA. majority MRSA isolates recovered from pus (44.57%) and wound swab (20.65%), followed by blood (13.04%), fluid (8.70%), CSF (4.35%), CVP (3.26%), HVS (3.26%) and tracheal secretion (2.17%). By latex agglutination method, 87 (94.50%) were positive for PBP2a; while on PCR mecA gene was detected only in 82 (89.10%) MRSA isolates. When assessed with PCR (gold standard) the sensitivity and diagnostic accuracy of latex agglutination was 100% and 94.57%, respectively. Conclusion: Latex agglutination test can be employed as rapid and reliable diagnostic technique in MRSA isolates for mecA gene detection, where resources for molecular methods are inadequate. This can effectually lessen the misdiagnosis of resistant strains, and over/ ill-use of antibiotics.
Comparison of analgesic effect of peritonsillar infiltration with bupivacaine versus bupivacaine-dexamethasone in children undergoing tonsillectomy.
Authors: Ahmad Humaira , Sagheer Asif , Saleem Muhammad , Tariq Khansa , Aslam Samina , Iqbal Muhammad Masood
Published: July 2020

Objective: To compare analgesic effect of peritonsillar infiltration with bupivacaine versus bupivacaine-dexamethasone in children undergoing tonsillectomy. Study Design: Randomized Control study. Setting: Aziz Fatimah Hospital, Faisalabad. Period: 01-03-2018 to 31-12-2018. Material & Methods: 80 patients were enrolled in the clinical study using non-probability consecutive sampling technique. They were divided into two groups, before start of surgery group BD received peritonsillar infiltration of bupivacaine and dexamethasone combination, whereas group B received local infiltration of bupivacaine only. Primary outcome measures were pain score recorded immediately after recovery of patient (0 hour) and at 2, 6, 12 and 24 hours after surgery and requirement for analgesia postoperatively. Other parameters recorded were time to first oral intake and sleep pattern over 24 hours. Results: Mean pain scores in group BD were 0.075, 0.225, 1.675, 0.75, 0.275 and in1 group B were 0.65, 0.975, 2.95, 1.5, 0.95 at 0, 2, 6, 12, 24 hours postoperatively respectively. 92.5% patients in group BD and & 57.5% in group B had good sleep whereas 7.5% in group BD and 42.5% in group B had disturbed sleep. 6 patients in BD group and 26 in B group required analgesia. Conclusion: Our study concluded that infiltration of tonsillar fossa with bupivacaine – dexamethasone prior to the start of surgery provides better postoperative analgesia, early start of oral intake, less rescue analgesic requirements and better sleep pattern.
Adenoid cystic carcinoma of breast: A case report in breast clinic at a Tertiary Care Hospital.
Authors: Ghazanfor Ramlah , Tariq Maham , Changez Mehwish , Malik Sara , Khadija Ghulam , Hanif Hina , Malik Javaria
Published: July 2020

Incidence of adenoid cystic carcinoma of breast ranges from 0.1% to 1%. Its rare occurrence makes its surgical management options debatable. However rarity of metastasis contributes to an encouraging prognosis inspite of its triple negative receptor status. Herein, we report the case of a 60 year old woman who presented with a breast lump that turned out to be adenoid cystic carcinoma.
Comparison of Bracka I versus Blair-Byar’s technique in chordee correction.
Authors: Mahmood Masood , Qadir Imran , Ali Sadaqat , Khan Muhammad Sarfraz
Published: July 2020

To compare the outcome of the Bracka I Graft Technique versus Blair-Byar’s Flap technique in orthoplasty for urethral plate in terms of procedure time, hospital stay and urine stream after removal of Foley catheter. Objectives: There are multiple types of procedures to correct the chordee in hypospadias with chordee cases. We planned to perform study to discuss the differences between Bracka I where Graft is used for the plate of urethra and Blair-Byar’s flap technique in term of procedure time hospital stay and urine stream after removal of Foley catheter. Study Design: Randomized Control Trial study. Setting: Pediatric Urology Department, Children Hospital Faisalabad (CHF). Period: 1 year and 9 months, from April 2016 to December 2018. Material & Methods: Total 80 patients were taken with Non probability consecutive sampling technique was adopted with inclusion criteria with more than 2 years of age and hypospadias with chordee while, exclusion criteria of patients were previous surgery of chordee correction and any other associated anomalies. Results: In the patients with Bracka I procedure, n=37 patients (92.5%)  have uneventful uptake of graft, where two (5%) patients have failure of uptake of graft while one (2.5%) of them had wound infection and adequate urinary stream after removal of Foley was found in all 40 patients. In Blair-Byar’s technique procedure had uneventful uptake of graft in n= 36 patients (90%) where two (5%) patients have failure of uptake of graft while two (5%) of them have wound infection. Cosmetically acceptance was in 39 patients (97.5%) by the parents and feasibility to do the second stage.  While among Blair-Byar’s technique cosmetically acceptance was in 35 patients (87.5%) by the parents and feasibility to do the second stage. Conclusion: Bracka I (graft) Orthoplasty and Blair-Byar’s (flap) Orthoplasty has equivocal results in terms of tissue uptake and uneventful recovery, urinary stream post operatively, post-operative meatal diameter while cosmetically Bracka 1 is superior to Blair-Byar’s  technique while feasibility of the availability of local tissue to make tube for urethroplasty in stage II.
Role of table salt in management of umbilical granuloma: An interventional study.
Authors: Khan Jehangir , Kashif Muhammad , Khan Muhammad Javed , Fawad Muhammad , - Niazuddin , Kamran Haider , Khan Ishtiaq Ali , - Ziaullah
Published: July 2020

Umbilical granuloma is a benign growth composed of granulation tissue at the base of umbilicus presents as red, soft, moist and friable lump at umbilicus. Objectives: Objective of our study is to evaluate the therapeutic role of table salt in umbilical granuloma in infants. Study Design: A Prospective Interventional Study. Setting: Outpatient Department of Pediatric Surgery, Bacha Khan Medical Complex (BKMC) Swabi. Period: Seventeen months (from 1st October 2017 to 31st March 2019). Material & Methods: First 66 consecutive fit infant were included in the study. Parents of infants were taught to apply a pinch of table salt on umbilical granuloma after cleaning with warm water. A dressing was applied over umbilicus for 30 minutes for the table salt to remain on granuloma and granuloma washed again with warm water. Parents’ learning was assured and they were advised to repeat the procedure twice a day for consecutive five days. Parents were counseled to bring their infants for follow up at end of week and then after completion of three weeks. Result: Out of 66 infants, 30 were male and 36 were female. We observed complete resolution of granuloma in all infants except one that turned out umbilical polyp and was excised under general anesthesia. Conclusion: Treatment of umbilical granuloma with table salt is safe, simple and very economical.
Diagnostic accuracy of urine dipstick in detection of patients of UTI keeping urine culture as a gold standard.
Authors: Ali Malik Abid , Ahsan Muhammad , Ahmad Arslan , Shamaoon Muhammad , Maqbool Tehmina , Javaid Saad , Azhar Salman
Published: July 2020

For children below age of five urinary tract infection (UTI) is the foremost common sources of infection. To lessen the danger of renal scarring it is critical to have immediate diagnosis and treatment. Quick, cost-effective, methods for the analysis of UTI are needed as substitute to culture. Objectives: To determine the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard. Study Design: Cross sectional validation study. Setting: Outpatient Department, Madinah Teaching Hospital, Faisalabad. Period: 01-2018 to 07-2018. Material & Methods: After taking permission from the hospital ethical committee all female patients with urinary tract infection were included. A rapid dipstick analysis for leukocyte esterase and nitrite was done by a staff nurse using Meditest Combi 10 SGL. The reaction of dipstick strip was read visually by a trained nurse who has five year experience working in the Outpatient Department, Madinah Teaching Hospital, Faisalabad. All dipstick positive and dipstick negative samples underwent cultures by sending samples in a clean container to the pathology lab via a sanitary attendant within one hour of the urine collection. Results: In our study, 69.21%(n=281) were between 2 months to 3 years of age while 30.79%(n=125) were between 4-5 years of age, mean+sd was calculated as 2.63+1.36 years, frequency of UTI in children on urine culture as a gold standard was recorded in 20.69%(n=84), the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard was recorded as 80.95%, 62.42%, 35.98%, 92.63% and 66.26% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: We conclude that the diagnostic accuracy of urine dipstick in detection of UTI in children keeping urine culture as a gold standard is higher and this cost effective and easy technique may be used in our routine practice for prediction of UTI in children.
The outcome of two stage repair in anorectal malformations with rectovestibular fistula.
Authors: Rehman Shafiq ur , Makki Yasir , Ishtiaq Fareena , Fazal Saad , Aziz Nauman , Shamikha Waleeja
Published: July 2020

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.
Outcome of double nerve transfer close to target muscle both for shoulder abduction and elbow flexion in early C5 –C6 Brachial Plexus injury.
Authors: Khan Husnain , Shafique Muhammad , Bhatti Zahid Iqbal , Cheema Tehseen Ahmad
Published: July 2020

Adult brachial plexus injury is a now a common problem due to high incidence of motorbike accidents. Among all types, C 5 and C6 (upper brachial plexus injury) is the most common. If the patient present within 6 months then nerve transfer is the preferred treatment. However, there are different options for nerve transfer and different approaches for surgery. Objectives: The objective of the study was to share our experience of nerve transfer close to target muscles in upper brachial plexus injury. Study Design: Quaisi experimental study. Setting: National Orthopaedic Hospital, Bahawalpur. Period: January 2015 to June 2018. Material & Methods: Total 32 patients were operated with isolated C5 and C6 injury. In all patients four nerve transfers were done. For shoulder abduction posterior approach was used and accessory to suprascapular nerve and one of motor branch of radial to axillary nerve were transferred. Modified Oberlin transfer was done for elbow flexion. Both shoulder abduction and elbow flexion was graded according to medical research council grading system. Results: After one year follow up more than 75% of the patients showed good to normal shoulder abduction and 87.50% showed good to normal elbow flexion. Residual Median nerve damage was noted only in two patients (6.25%). Conclusion: If there is no evidence of recovery up to three months early nerve transfer should be considered, ideal time is 3-6 months. Nerve transfer close to target muscle yields superior results. The shoulder stabilizers and abductors should ideally be innervated by double nerve transfer through posterior approach. Similarly double fascicular transfer (modified Oberlin) should be done for elbow flexion.
Barriers and missed opportunities towards immediate and early post-partum family planning methods in Pakistan.
Authors: Abbasi Yasmeen , Shaikh Shazia Rahman , Memon Khalida Naz
Published: July 2020

The postpartum family planning (PPFP) services are offered immediately after delivery (immediate PPFP), within 40 days after delivery (early PPFP) and within 12 month after delivery (extended PPFP). To promote PPFP the counselling during antenatal visit, before discharge from maternity ward, during postnatal visit and visit during immunization of their babies are the opportunities where health providers help them to decide about the post-partum contraception. Objectives: To compare the coverage of immediate and early postpartum family planning to extended postpartum family planning. To analyze the socio demographic barriers for adopting immediate and early postpartum family planning methods. To identify the missed opportunities for immediate and early postpartum family planning. Study Design: Community Based Comparative Cross Sectional study. Setting: Tando Jam and Hali Road Hyderabad, Sindh. Period: Three months from 01-07-2017 to 30-09-2017. Material & Methods: Three Hundred females of reproductive age (15 to 49 years) during immediate, early and extended postpartum period residing in study area were selected through Purposive Sampling Technique. A pre-designed questionnaire was used as a data collection tool. The data was analyzed using SPSS version 16. The participants were inquired about the usage and concerns towards immediate and early post-partum family planning methods. Barriers and opportunities were identified. The association between various socio-demographic variables and family planning method was determined by applying Chi-square test at ≤0.05 level of significance. Results: Highest number of the study participants were practicing extended method of post-partum family planning i.e. 223(74.33%), only 65(21.67%) had adopted early PPFP and 12 (4%) were practicing immediate post-partum family planning.  Low socio-economic status, low literacy rate of both partner, young age of women, and permission from husband, fear of health problem due to contraception and previous bad experience with contraceptive methods were identified barriers towards family planning adoption. Deliveries in homes or in maternity home, facilitated by Dais, not going through ante-natal checkups and not bringing the last born for vaccination were reported with non-adoption of immediate post-partum family planning. Conclusion: The coverage of immediate and early postpartum family planning is very low in the community so the barriers and opportunities identified should be addressed to overcome the hindrances.
Evaluation of efficacy and adverse effects of paroxetine in the treatment of major depressive disorder patients.
Authors: Tunio Ali Gul , Aamir Kausar , Shaikh Ghulam Serwar , Rajput Muhammad Tariq , Wagan Rehmat Ali , Tanwani Bhojomal
Published: July 2020

Major depressive disorder is a serious and disabling disease in world; it is a most common chronic and recurrent disorder with fourth cause of loss in disability in the worldwide. Objectives: To evaluate the efficacy and adverse effects of Paroxetine in major depressive disorder patients. Study Design: Open Labeled study. Setting: Department of Psychiatry, Chandka Medical College Hospital Larkano. Period: Three months (August to October 2019). Material & Methods: Total 40 patients of either sex were enrolled from OPD of Psychiatric department with age of 18 to 65 years. Follow-up visits were carried out fortnightly after making evaluation on symptoms at base line visit (day 0) continued till 90 days, and then results were compiled. The SPSS-16 version was used for the analysis of data. Results: Paroxetine is highly significant (p=0.001) to decrease the symptoms of depression during treatment of 90 days. Conclusion: In this study, Paroxetine is more effective drug to decrease the symptoms like, weight loss, sexual disturbance, insomnia and with less adverse effects in patients of major depressive disorder.
Comparison of outcomes of Desarda versus Lichtenstein repair for inguinal hernia in terms of operative time, postoperative pain and return to normal activity.
Authors: Zahra Syeda Hussane , Murtaza Mudassar , Aslam Muhammad Ansar
Published: July 2020

Objectives: The most appropriate treatment of inguinal hernia is to repair surgically. Worldwide more than 50 different techniques have been employed due to some but different problems with all techniques. Commonly used techniques are basically of two types. One is based on tissue repair and other uses the mesh. These include Shouldice, Lichtenstein, Darning repair, Totally Extra-Peritoneal (TEP) and Trans Abdominal Pre-Peritoneal (TAPP) repair. All the techniques have certain benefits and trade-offs as well. Our aim was to compare the outcome of Desarda repair versus Lichtenstein repair. Study Design: Randomized Controlled trial. Settings: DHQ Hospital Gujranwala. Period: From 27 October 2017 to 27 March 2018. Material & Methods: We included 60 patients in the study. In 30 patients Lichtenstein Hernia Repair was done and in 30 patients Desarda repair was done. The demographic information, outcome in the form of duration of operation, postoperative pain, and return to normal activity was recorded. All this information was collected through a predesigned performa. Patients were followed up on OPD basis. Data analysis was done by using SPSS 20. Results: Mean operative time in group A and group B was 61.20±12.558 and 71.89±13.118 respectively. Statistically significant difference was present in treatment group in term of operative time i.e. (P-value = ˂ .05). In both treatment group, mean time to require to start normal activity in A and B  was 10.06±1.771 and 11.14±2.485 and it is statistically significant (P-value=.001). Postoperative pain was less but statistically insignificant in study group. Conclusion: Desarda repair is better than Lichtenstein repair in terms of operative time and return to normal activity.
Role of oral gabapentin in attenuating cardiovascular response to laryngoscopy and tracheal intubation.
Authors: Askri Mohsin Riaz , Maqbool Shumyala , Shah Kausar Abbas , Ahmad Shahbaz
Published: July 2020

Objectives: To determine the role of 800 mg oral gabapentin in attenuating cardiovascular response to laryngoscopy and tracheal intubation. Study Design: Double Blind Randomized Control Trial. Setting: Independent University Hospital/Independent Medical College, Faisalabad, Pakistan. Period: Six months from January1st 2019 to June 30th 2019. Material & Methods: This study included 60 patients which were divided into two equal groups. 800 mg oral gabapentin was given to group I while capsule placebo was administrated to group II patients in pre-operative area one hour prior to surgery. Heart rate, systolic, diastolic and mean arterial blood pressure were taken after induction of anesthesia at base line and then 1,2,3,4,5,10 and 15 minutes after endotracheal intubation. SPSS version 11 was used to analyze the data. Heart rate systolic, diastolic and mean arterial blood pressure were dependent variables while placebo and gabapentin were independent variables. Results: Out of total 60 patients there were 36 (60 %) males and 24 (40 %) females. In group I mean age was 37.1 while in group II it was 36.3. As compare to group II there was decreased cardiovascular response in group I. There was a significant decrease in systolic blood pressure at 1,2 and 10 minutes; diastolic blood pressure at 3 minutes; heart rate at 10 and 15 minutes and mean arterial blood pressure at 3 minutes after induction in group I. Conclusion: Cardiovascular response to laryngoscopy and intubation is significantly reduced with oral gabapentin.
Injury patterns in patients with QINGQI motorcycle rickshaw related road traffic accidents presenting at accident and emergency department of Mayo Hospital, Lahore.
Authors: Awan Waseem Sadiq , Ahmed Arslan , Bilqees Umme , Malik Unaiza , Naseer M. Kashaf , Qamar M. Sohail Iqbal
Published: July 2020

Objectives: The objective of this study was to determine the patterns of the injuries in patients of Qingqi rickshaw related accidents. Study Design: Descriptive Cross-Sectional study. Setting: Accident and Emergency Department of Mayo Hospital, Lahore. Period: Six months from 1st of March, 2019 to 31st of August, 2019. Material & Methods: Non-probability consecutive sampling technique was used and all tri-wheeler Qingqi related trauma patients fulfilling the inclusion and exclusion criteria were included. Frequency and percentages were calculated for patterns of injuries and presented as tables. Results: A total of 356 Qingqi rickshaw related injured patients presented in six months study period. There were 243 (68.3%) males and 113 (31.7%) females and a mean age of 32.5 +2.5 years. Soft tissues injuries like subcutaneous edema, abrasions and lacerations were noticed in 206 patients (57.9%). Most common region involved was lower limb in 98 (27.5%) cases followed by upper limb trauma in 65 (18.2%) cases. Ploy trauma was present in 58 (16.3%) and head and spinal injuries were noticed in 27 (7.6%) and13 (3.7%) cases, respectively. The turning over of the rickshaw due to different reasons (47.2%) and head on collision (38.4%) were the leading cause of serious injuries. None of the Qingqi rickshaw drivers (0%) were wearing helmet. A total of 46 (12.9%) cases were pedestrians. Three patients had to undergo amputation for mangled limb injuries. Conclusion: The common pattern of injuries related to Qingqi accidents include lower limb injuries followed by upper limb and poly trauma comprising of head injuries. Males in their younger age group are most commonly injured. These accidents can result in serious morbidity and even mortality. It is now time to consider measures for safety of three-wheelers to reduce such incidents.
Comparison of posterior open screw fixation with percutaneous fixation among traumatic thoracolumbar fracture patients.
Authors: Adnan Muhammad , Khan Muhammad Jahangir , Rehman Attique ur , Zahid Hassaan , Jabbar Rakhshanda , Shams Shahzad
Published: July 2020

Objectives: To compare outcome and adverse events of open posterior pedicle screw fixation with percutaneous posterior pedicle screw fixation among patients suffering traumatic thoracolumbar fractures in our population. Study Design: Retrospectively Analyzed. Setting: Department of Neurosurgery, DHQ Teaching hospital, Gujranwala. Period: June 2015 to May 2019. Material & Methods: The patients who underwent open pedicle screw fixation (group 1) and percutaneous fixation (group 2) for traumatic thoracolumbar fractures information’s collected included patient’s age, gender, operation time, intra-operative blood loss, duration of radiation exposure during surgery, hospital stay duration, non-union at 6months and post-operative screw malpositioning and infection. Statistical analysis was done using SPSS version 25. Independent sample T test and Chi-square test for independence were used for quantitative and qualitative variables respectively to determine their significant association with type of surgery. The p values were statistically significant if < 0.05. Results: Out of 82 patients, 60.9 (n=50) underwent open pedicle screw surgery and 39.1% (n=32) underwent percutaneous fixation. Both cohorts had similar preoperative data including age (p=0.54) and gender (p=0.505). In comparison to open surgery group, the patients who underwent percutaneous fixation had significantly lesser operation time (46.63 + 6.25 minutes vs 89.88 + 9.05 minutes, p<0.01), lesser intraoperative blood loss (78.75 + 23.93 ml vs 330.40 + 101.87ml, p<0.01), greater intraoperative fluoroscopic exposure time (400.19 + 31.22 seconds vs 190.06 + 30.28 seconds, p<0.01), and lesser hospital stay time (3.13 + 0.871 days vs 5.08 + 1.209days, p<0.01). The incidence of post-surgery complications like screw malpositioning (p=0.621) and infection (p=0.733) was similar in both cohorts. The fracture union rates were also comparable in both cohorts (p=0.664). Conclusion: Minimally inavsive percutaneous posterior pedicle screw fixation had lesser operation time, blood loss, and hospital stay duration and greater fluoroscopic exposure than conventional open posterior pedicle screw fixation among patients with traumatic thoracolumbar fractures in our studied population. It also had a similar radilogic outcome and post-operative adverse events like screw malpositioning and local infection, showing the non-inferiority as compared to conventional open instrumentation. Prospective trials with large sample size are required to find superiority if any of one modality over other exists in our people.
Management of open diaphyseal fracture of tibia in adults: A comparative study between plaster of paris cast versus external fixator.
Authors: Ahmed Parvez , Umrani Khawand Bukhsh , Shahani Mahtab Ali , Tunio Zamir Hussain , Qureshi Abdul Hafeez , Mengal Mohammad Aslam
Published: July 2020

Objectives: To determine the management of open diaphyseal fracture of tibia with plaster of Paris (pop) cast vs external fixator in orthopedic ward PUMHSW Hospital Nawabshah. Study Design: Cross-Sectional Comparative study. Setting: Orthopedic Department, Peoples University of Medical And Health Science Shaheed Benazirabad. Period: 18 months from January 2017 to June 2018. Material & Methods: The data was analyzed in SPSS Version 22.0. Results: Out of 50 patients with tibial diaphyseal fractures, there were 34 males compared to females 16 (2.1:1) (68% vs 32%) with an average age of 41 years. Patients with external fixator applied yielded decreased rates of infection; shorter duration of hospital stay and early union compared to patients with plaster of Paris (pop) cast application. However, the difference reached statistical significant value. Conclusion: Open Tibial diaphyseal fractures should be managed with external fixation that yields better results. A plaster cast is the initial treatment of modality in patients with open tibial diaphyseal fractures.
To compare rosuvastatin with atorvastatin in terms of mean change in LDL-C in patient of diabetes mellitus.
Authors: Javed Masood , Mohammad Dilshad , Iftikhar Muzzammal , Jameel Mohsin , Masood Zain , Ahmed Nazir
Published: July 2020

Diabetes Mellitus is a very common metabolic disorder characterized by hyperglycemia and altered metabolism of lipids, proteins and carbohydrates due to absolute or relative insulin deficiency or insulin resistance. There is a close association between complications of Diabetes and Diabetic Dyslipidemias. The lowering of LDL levels with statins varies from 20 to 60% and greatest effects are seen with the most potent statins such as Atorvastatin, and Rosuvastatin in higher doses. Objectives: The objective of the study was; to compare Rosuvastatin with Atorvastatin in terms of mean change in LDL-C in patients of Diabetes Mellitus. Study Design: Randomized Control Trail. Setting: Department of Medicine DHQ Hospital, Faisalabad. Period: Six months from 01/10/2018 to 31/03/2019. Material & Methods: Results: A total of 160 cases (80 in each group) fulfilling the inclusive/exclusive criteria were enrolled to compare Rosuvastatin with Atorvastatin in terms of mean change in LDL-C in patients of Diabetes Mellitus. Mean LDL-C levels at baseline was recorded as159.61+1.22 in Group-A and 159.51+1.21 in Group-B, p value was calculated as 0.603 showing insignificant difference. Mean LDL-C after 6 weeks of treatment was recorded as129.11p+1.50 in Group-A and 129.89+2.23 in Group-B, p value was calculated as 0.01 showing significant difference. Mean change in LDL-C level after 6 weeks of treatment was recorded as 30.5+1.88 in Group-A and 29.63+2.57 in Group-B, p value was calculated as 0.01 showing a significant difference. The data was stratified for Age, Gender, Duration of Diabetes Mellitus and control of Diabetes Mellitus. Conclusion:  This study proves superiority of Rosuvastain over Atorvastatin in reducing LDL-C level in type 2 DM Patients.
Outcome of open heart surgery in patients with age above 75 years.
Authors: Siddiqui Muhammad Mujtaba Ali , Ansari Muhammad Zubair Ahmad , Ghaffer Abdul
Published: July 2020

Objectives: Open heart surgery is considered as high risk procedure in elderly patients. We study the operative outcomes of open heart surgery in patients of age above 75 years in geography of world where life expectancy is around 67 years. Study Design: Retrospective Study. Setting: Research of Rawalpindi Institute of Cardiology (RIC). Periods: From January 2014 to December 2018. Material & Methods: Demographic and baseline characteristics of patients were retrieved from cardiac surgery database (cascade, Lahore) of RIC. For all patients who underwent open heart surgery and had age above 75 years. Operative mortality, neurological outcome, low cardiac output state(LCOS), peri-operative myocardial infarction, postop.erative atrial fibrillation (POAF), acute kidney injury (AKI), chest reopening, ICU stay, hospital stay and 1-year survival etc. Are analyzed from retrieved data. Results: Operative mortality is 5.71%, type II neurological deficit is 16.42% and POAF is 25%. Incidence of peri-operative mi, lcos, aki and chest reopening etc is low along with acceptable ICU stay and hospital stay durations. 1-years survival is 95.46%. Conclusion: open heart surgery can be offered to patients with age above 75 years with low operative mortality and morbidity except with relatively higher incidence of type ii neurological deficit and POAF. 1- years survival is impressive with figures of 95.46%.
Screening for hepatitis b and c viral infections among pregnant women attending the Bolan Medical Complex Hospital and Sandeman Provincial Civil Hospital Quetta, Pakistan.
Authors: Tanveer Zunera , Ahmad Irshad , Javed Muhammad Shahid , Malik Shoaib Ahmad , Kakar Nargis Haider , Ahmad Mushtaq , Patching Simon G. , Naeem Muhammad , Mustafa Mohammad Zahid
Published: July 2020

Infectious diseases caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) are a worldwide burden to health, especially in developing countries. Pakistan has one of the highest levels of HBV and HCV infection, causing a severe health problem with significant challenges and priorities. To prevent vertical transmission of infection, regular screening of pregnant women for HBV and HCV is vital. Objectives: The objective of this study was to evaluate the prevalence of HBV and HCV virus in pregnant women having prenatal care. Study Design: Cross-Sectional study. Setting: Bolan Medical Complex Hospital and Sandeman Provincial Civil Hospital Quetta. Period: August 2017 to July 2018. Material & Methods: Blood serum samples were screened for HBV surface antigen (HBsAg) and for anti-HCV using immunochromatography methods. Results: A total of 12,209 pregnant women were tested over a period of one year (August 2017 to July 2018). The overall HBV infections frequency was 1.3% (95% CI 1.1-1.4%) and for HCV infections it was 0.6% (95% CI 0.6-0.7%). Whilst there was only small month-wise variation in the occurrence of HBV and HCV infections, HBV prevalence was highest in May (1.7%) and HCV prevalence was highest in August and December (0.8%). Conclusions: Screening of all pregnant women for HBV and HCV is essential for reducing and eliminating vertical transmission of infection. Risk factors for infection need to be avoided and managed properly.
A comparative study of oral health in preclinical and clinical years of undergraduate dental students of Peshawar by using (DMFT) index.
Authors: Khalil Zia Ur Rehman , Hameed Aamir , Raza Muhammad , Khan Aliya , Nazir Kanwal , Khattak Amjid
Published: July 2020

Objectives: The present study aim was to compare oral health status among the undergraduate dental students of the preclinical and clinical years. Study Design: Cross-sectional comparative survey. Setting: Preclinical and clinical Dental students of all dental colleges of district Peshawar. Period: 15 December 2016 to 14 May 2017. Material & Methods: Clinical examination was conducted among the undergraduate students in all the dental colleges of district Peshawar. The sample was drawn from both the preclinical first year and the clinical final years. Examination was done to evaluate decayed tooth component of DMFT. The questionnaire included demographic details and questions on the students’ oral health practices. A clinical oral examination was done to evaluate decayed tooth component of DMFT. Data Analysis and Results: Chi-square analysis was performed for group comparisons of data. Statistically there is a trend of significance (0.074). In the pre-clinical group almost 66.3% of students had bad oral health status while in the clinical group comparatively a low percent of students (33.7%) had poor oral health status. Conclusion: Oral health status and oral hygiene practices of dental students had improved as they advances towards clinical years.
Efficacy of dacaltasvir and sofosbuvir combination therapy in chronic HCV population in private clinic set up.
Authors: Ather Hafiz Mughees , Shani Idrees , Aamer Muhammad , Mahmood Arfan , Ahmad Nazir
Published: July 2020

All- oral antiviral therapy for chronic hepatitis C is standard of care in 2018. Daclatasvir and Sofosbuvir combination therapy was approved in 2015 by EASL. Generics are also available since 2016. Objectives: We evaluated efficacy of Daclatasvir and Sofosbuvir based therapy in cirrhotic and non-cirrhotic patients. Study Design: Retrospective Observational Study. Setting: Athar Medical Center Muslim Town, Sargodha Road, Faisalabad. Period: One Year Dec 2017 to Dec 2018. Material & Methods: 151 patients were treated with Daclatasvir 60 mg daily and Sofosbuvir 400 mg daily combination therapy. Decompensated Cirrhotic patients were treated for 6 months along with ribavirin according to weight of patient. Treatment experienced patients were treated along with ribavirin. Naïve non-cirrhotic patients were treated for three months or 12 weeks.  Primary end point was negative SVR 24 weeks after completing therapy. Results: Over all 151 patients were treated. 85 (56.29%) patients were male. 30(19.86%) patients were cirrhotics and remaining were non-cirrhotics. SVR was obtained in 149 patients. Treatment failure was seen in one cirrhotic and one non-cirrhotic patient. Conclusion: Daclatasvir and Sofosbuvir combination is highly effective in chronic hepatitis C patients in our population of Faisalabad division.
The Time Machine: challenging perceptions of time and place to enhance climate change engagement through museums
Authors: McGhie Henry , Mander Sarah , Minns Asher
Published: July 2020

This article explores how museums can help empower people to engage constructively with climate change, through applying a range of time-related concepts to their exhibitions and events. Museums are mostly collections of the past. Climate change now and future presents particular challenges as it is perceived to be psychologically distant. The link between this distance and effective climate action is complex and presents an opportunity for museums, as sites where psychological distance can be explored in safe, consequence-free ways. This paper explores how we can use museums to help develop understanding within the rhetoric of climate change to assist visitors with their personal or collective response to the climate challenge. Time-related concepts including Foucault’s heterotopia, long-term thinking as advocated in the History Manifesto and the ‘Big Here and Long Now’, are explored in relation to museums as potential tools for constructive climate change engagement.