bluuebunny/crossref_metadata_2025 huggingface dataset:
CHRONIC KIDNEY DISEASE
Authors: Shah Muhammad Iqbal , Suthar Ramesh Kumar , Soomro Mukhtiar Ahmed
Published: September 2021

Chronic kidney disease is usually related with anemia and the level of anemiacorrelates with the severity of renal failure. A chronic kidney disease is complicated byanemia and anemia may contribute to adverse clinical outcomes. No large-scale populationdata are available for patients with chronic kidney disease regarding prevalence of anemia,subpopulations at risk, and relationships between anemia and renal dysfunctionObjectives:Theobjective of this study is to determine the frequency of different patterns of anemia in relationto glomerular filtration rate in patients suffering from chronic kidney disease stage II and abovepatients.Material &Methods:Study Design: Cross sectional study. Setting:Medical andNephrology wards of Liaquat University Hospital Hyderabad / Jamshoro. Period:20th January2013 to 19thDecember 2013.Results:During the study period, total 339 patients of chronickidney disease with stage II and above patients were enrolled. The mean age + StandardDeviation and range) of patients was 50.65 + 11.86 (16 to 80 years, n = 339). 211(62.2%) weremale and 128(37.8%) were female. (Male to Female Ratio 1:6). Mean Hemoglobin + SD was7.16 + 3.89 (3.0 to 17.0 g/dL). The frequency of anemia was present in 285(84.1%) patientswith mean Hb+ SD 6.02 + 2.1 (g/dL). The mean weight + SD was 56.50 + 9.84 (40 to 81 kg).The mean serum creatinine + SD was 5.63 + 2.48 (0.9 to 12.0 mg/dL) and we observed thatmost frequent pattern of anemia was normocytic-normochromic anemia in 216(77.0%) patients,hypochromic-microcytic in 61(18.0%) and macroyctic in 17(5.0%) patients. We also found thatas anemia increased progressively with declining GFR with mean hemoglobin concentrationof 11.78 +2.8 g/dL in CKD stage 2, 10.14 + 3.6 g/dL in CKD stage 3, 6.8 + 3.6 g/dL in CKDstage 4, 7.44 + 4.0 g/dL in CKD stage 5.Conclusion: Frequency of anemia increases withthe progression of stage of chronic kidney disease (decreased GFR) and anemia was mostcommon in stage 5 patients of chronic kidney disease.Most frequent pattern of anemia isnormocytic normochromic anemia.
HBV AND HCV PATIENTS
Authors: Rehman Atiq ur , Kazmi Syeda Farhana
Published: September 2021

Objectives: The main purpose of this research was to compare the level ofpsychological distress between HBV and HCV patients and to determine the effect of genderand age on psychological distress. Determine the relationship between coping strategies andpsychological distress. Method: For the present study 100 HBV patients (50 male and 50 female)and 100 HCV patients (50 male and 50 female) were selected. The sample was selected fromLiver Centre, district headquarter hospital Faisalabad. This was a cross sectional study. MHI-38was used to measure the psychological distress and CRI was used to measure the copyingstyles among HBV and HCV patients. Result: HCV patients have higher levels of psychologicaldistress t (198) = 6.54, p< .05 compared to HBV patients. Female hepatitis patients weresuffering from high levels of psychological distress t (198) = 3.90, p < .05 as compared to malehepatitis patients, with male, age is positively correlated with psychological distress, r = .32,p < .01 but with female age is negatively correlated with psychological distress r = -.49, p <.01. Approach coping is negatively correlated with psychological distress in male and femalehepatitis patients, respectively, r = -.45, p < .01 and, r = -.29, p <.01. Conclusion: HCV andfemale patients have higher levels of psychological distress comparatively of HBV and malepatients. Age is correlated with psychological distress. The approach coping styles play animportant role in controlling the psychiatric comorbidity in HBV and HCV patients.
TYPE II DIABETIC PATIENTS
Authors: Saeed Zeba , Hasan Zainab , Sohail Fadieleh Adnan
Published: September 2021

Objectives: To determine the frequency of camel milk users as a dietary adjuncttherapy in Diabetes Type 2. Study Design. A cross sectional questionnaire based survey. Period:May to August 2013. Setting: Liaquat National Hospital & Jinnah Medical College Hospital)and one public sector hospital (Jinnah Postgraduate Medical Centre) in Karachi. Methods:Minimum sample size using 11.1% prevalence of type II diabetes mellitus, confidence interval of95% and 5% margin of error and finite population correction for large population was calculatedto be 152. Using purposive sampling, type II diabetes patients (taking oral hypoglycemicmedication or insulin to control serum blood glucose) visiting outpatient departments fordiabetes management at two private and one public sector hospital in Karachi, were requestedto participate. After obtaining informed consent, a structured pre-coded questionnaire was filledby trained interviewer. Two laboratory assessed fasting blood (FBG) readings from previousthree months were also recorded from their files. Those who affirmed the use of camel milk wereasked further questions on reasons and consumption pattern. All responses were entered intoSPSS version 17.0 and descriptive frequencies and statistics were obtained for camel milk usersand non-users. Results: 300 patients consented to participate and filled the questionnaire. 36forms did not have two FBG lab reports from previous three months and were excluded. Inthe remaining sample size of n = 264, camel milk use frequency was 35.98% (n=95). In thepreceding three months, the median FBG of users was 121.0 mg/dl as compared to medianFBS of non-users (64.01%;n = 169) of 202.06 mg/dl. 90.5% (n=86) of all users considered oralmedications as main modality for control and only 15.8% of these patients attributed bloodglucose control solely to use of camel milk. Camel milk users were found to use more of homeremedies (13.7%, n = 13), homeopathic medicine (15.8%, n = 15) and exercise (45.3%, n=43)as adjunct modalities to control their blood glucose as compared to 6.5%, 8.9% and 31.4%of non-users. 71.6% (n= 121) of non- users used dietary modification to manage diabetesas compared to 47.4% (n = 45) users. 71% (n = 121) non-users were regularly measuringtheir blood glucose levels as compared to 56.8% (n=54) users of camel milk. Conclusions:Diabetics drinking camel milk showed a marked decrease in mean Fasting Blood Sugar valuesas compared to non-users. More experimental studies should be conducted on a larger scaleand on different regions so as to ascertain the biological plausibility.
MANAGEMENT CHALLENGE IN CHEST WALL NEOPLASMS
Authors: Soomro Niaz Hussain , Zafar Aneeqa Ahsan , Baig Saifullah , Maxood Guzel , Rao Nisar
Published: September 2021

Introduction: Chest wall neoplasms are rare and represent only about 5% ofall thoracic neoplasm. We present our 2 years analysis of the clinical features, presentation,diagnosis and treatment of chest wall neoplasms. Study design: Case series study. Place andduration of study: Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi,Pakistan from Nov 2012- Oct 2014. Methodology: Between 2012 and 2014, 39 patients with solidchest wall masses were enrolled in the study. Tumors were categorized as benign and malignant,including primary and secondary, after histopathological diagnosis with tissue biopsy. Data onpatients’ characteristics, symptoms, tumor type and management was recorded and analysed.Results: The study included 39 patients (20 males and 19 females) with age range 18-71years(mean 36.3). 21(53.8%) patients had benign chest wall tumors while 18(46.1%) patients hadmalignant tumors. Among malignant tumors, 14(77%) patients had primary malignancy whereas 4(22%) patients had chest wall tumor secondary to primary tumor elsewhere. Among these4, the primary tumor remained unknown in 1 patient. The most common benign solid lesionwas chest wal lesion lipoma in 8/21 patients (38%). Among malignant tumors, chondrosarcoma(4/14, 29%) was the most common. Conclusion: Preoperative needs careful assessment of thepatient, radiological imaging and histopathological examination for diagnosis of the tumor inthe chest wall. Using a multidisciplinary team approach, excellent results can be available withcomplete surgical resection, reconstruction of the chest wall and appropriate or neo adjuvanttreatment where necessary.
COMMON BIRTH MARKS
Authors: Asim Sadaf Ahmed , Maryum Humaira , Din ShaziaShukar-ud- , Jamalvi Waseem , Aurangzeb Muhammad
Published: September 2021

Objectives: To identify the frequency of common birthmarks presenting inoutpatients department of dermatology until and to increase awareness among doctor aboutthe common phenomena. Patients and Study Design: A cross sectional study. Setting: OPDof Dermatology department of Dow University Hospital. Period: January 2014 till October 2014.Methods:During a year, by using non-probability convenient sampling only 100 patients of bothgenders were enrolled in the study after ensuring inclusion, exclusion criteria. Complete historywas recorded and a thorough general physical and cutaneous examination was performed.Information was collected on predesigned questionnaire after taking informed consent. DataAnalysis was carried out on SPSS statistics software. Results: Out of 100 patients, 43% weremales and 57% were females. In 69.6% patients, the birthmarks were noticed around time ofdelivery, 28.3% patients were noticed within 1st year of life and 2.2% later in 5 year. Pigmentedbirthmarks were identified in 65.2% patients while 34.8 % have vascular birthmarks.71.1% hadno changes in color during life span. While 37.8% had 1-3 cms birthmark and 45.7% havereported an increase in birthmark. Conclusions: We found birthmarks benign; they may growwith age but they do not need treatment unless there is concern either cosmetically or they havepain and discharge.
JOB SATISFACTION
Authors: Deeba Farah , Usmani Rabia Arshed , Akhtar Mahwish , Zahra Taskeen , Rasool Hafsa
Published: September 2021

Background: Doctor’s profession has been among one of the most attractiveprofession in Pakistan Society, but doctors are getting increasingly dissatisfied with their jobs inour region as unfortunately job satisfaction has still not received the proper consideration frompolicy makers. Objectives: To determine the level of satisfaction with variousjob characteristicsand compare the characteristics of doctorswith level of job satisfaction among doctors workingin public and private sector teaching hospitals. Study Design: Cross sectional study. Period:July 2014 to August 2014. Setting: Public sector (Jinnah Hospital Lahore) and a private sector(Fatima Memorial Hospital) Lahore. Methods: A total of 308 medical officers, 154 from eachhospital were included through simple random sampling. They were interviewed regarding theirsocio demographic and work related characteristics and satisfaction level regarding variousjob characteristics, using a structured, pretested questionnaire. The job satisfaction was ratedon the basis of a three point liker scale with scores ranging from 1 – 33 and scores > 25were considered as satisfied. All the data was entered and analyzed using SPSS version 17.0.Results: Among the total study respondents, majority 212 (68.8%) doctor were dissatisfied withtheir jobs while high level of satisfaction was seen only regarding timeliness of pay 92.9% andjob safety 98%.On comparing characteristics of doctors with job satisfaction, it was seen thatage, gender, marital status, number of family members, total family income, work experienceand nature of job was not significantly related with satisfaction while doctors working in privatehospital were more satisfied with their job as compared to doctors working in governmenthospital and this result was statistically significant (P = 0.000) Conclusion: Satisfaction levelof doctors especially working in public hospitals was low as compared to doctors working inprivate sector. There is need to address the reasons of dis-satisfaction and formulate strategiesto eliminate these issues.
HEPATITIS-C VIRUS INFECTION
Authors: Akhtar Abdul Majeed , Majeed Sadia , Majeed Sufia , Kanwal Shamsa , Javed Hasnain
Published: September 2021

Objectives: Nursing staff is at potential danger of getting HCV infection. Objectiveof present study is to determine the prevalence and associated risk factors of hepatitis C amongnurses in Lahore, Pakistan. It also aimed to estimate the HCV genotypes and find out anyrelationship between their working area and the incidence of HCV infection. Setting: Variouspublic and private hospitals of Lahore. Period: January 2013 to December 2013. Subjectsand Method: This study comprised 186 Nurses. All the samples were processed for Anti-HCVantibody detection through ELISA by using third generation ELISA Kit. Genotyping was alsoperformed on all positive samples. In this study the data were analyzed using SPSS version 16.A P-value < 0.05 was considered to be significant. Results: A total of 186 nurses were enrolledand screened for Anti HCV in the study. The mean age of reactive and non reactive nurses was22.33±1.15 and 23.66±1.97 years, respectively. Working experience in surgical wards, habitsfor going to beauty salon as well as the purpose for which nurses visited beauty salon wassignificantly associated with HCV status. i.e. p-value<0.05. Out of 9 reactive nurses, 8 patientnurses had 3a viral genotype while 01 patient had un-typeable viral genotype. Conclusion: Inour study nine nurses have HCV infection and are at danger of the disease.Theworking areaespecially surgical wards is a source of infection of HCV.
BALANCED DIET
Authors: Haque Sirajul , Basit Shehla , Tanwani Ramesh Kumar , Zehra Tabassum , Solangi Nazir Ahmad
Published: September 2021

Objective: Non-pharmacological intervention to manage the health by healthybalanced diet and life style modifications. Study Design: Randomized Cross sectional Study.Place & Duration: Pakistan Council of Scientific and Industrial Research (PCSIR) laboratoryKarachi from March 2012 to June 2013. Material & Methods: In this study, 210 volunteers wereincluded (137 male and 73 female) aged between 25-60 years. The study was conducted withthe questionnaire being filled at PCSIR labs, Karachi. The study period included from March toMay 2012. One year later the same group of volunteers were re-examined from March to June2013, who managed to alter the diet and life style for one year. The questionnaire was filled by anexpert well versed in collecting the data from the patients who attended the OPD at PCSIR labs.Results: The results indicate that a lot of people in our population lead a sedentary life styleand do not take part in physical activity which leads to health problems due to comparativelyless energy / calories expenditure. Conclusion: Efforts should be made globally to createa public awareness and provide healthy environment to the people about pursuing healthylifestyles. Several life style behaviors may influence to maintain energy balance over long term.The primary approach for achieving weight loss is lifestyle changes which includes reducedintake of calories and increase in physical activity. Regular, moderate intensity physical activityenhances long term weight maintenance and balance between energy input and output.
HEPATITIS B AND C
Authors: Shahbaz Tazeem , Farid Ghulam , Asghar Raja Sajjad , Rashid Abdul
Published: September 2021

Background and Aims: The working conditions of Health care workers (HCW’S)expose them for a constant threat of contracting and spreading hepatitis B (HBV) and C virus(HCV) not only to their patients but family members as well. The aim of this study was to assessthe knowledge and attitude toward hepatitis B and C infection among the health-care workersand correlate the level of awareness to their behavior towards prevention of the disease. StudySettings: The study was conducted in Rashid Latif medical college and its two affiliated hospitals(Arif memorial teaching hospital and Hameed Latif Hospital). Study Design: Descriptive crosssectional study. Methodology: A closed ended questionnaire was designed which consistsof questions for evaluating the knowledge and attitude of the participants regarding hepatitisB and C infection. Sampling was done by convenient method. 350 participants took part inthe study, which includes physicians, nurses and lab Technicians. Using the SPSS 16, we didstatistical analysis. Results: Total 350 health care workers filled the forms. 52.6 %( 184) of themwere nurses with 25.7% (90) physicians, and Lab workers were 21.7 %( 74). The mean age ofthe participants was 25.9 years with a range from 17-59 years. The service length of 73.2% ofhealth care workers was noted to be 1-5 year. (97.7%) participants know about hepatitis B andC. 88.6% identified blood and blood products, needles and sharps and 68.6% marked sexualintercourse routes of transmission. 56% gave opinion that Hepatitis B and C is a noso-comialinfection. 70.3% reported that both infections are widely transmitted like HIV/AIDS. Almost all ofthe participants (83.7%) mentioned that they are in a position to acquire these infections becauseof their duty with patients 88% of the respondents reported vaccination against Hepatitis B asa tool of prevention. Proper disposal of sharps, a needle and blood product as a preventingmeasure was also written by 88%of participants. A lot of them believe that transmission of theseinfections can be prevented by avoiding needle/sharps injury (73.7%) and casual sex (61.1%).82.9 mentioned wearing of gloves while in contact with patients and 80.6% said that adequatedisposal of sharps are the best ways of prevention. Complete vaccination for the hepatitis Bwas reported by 47.9 %( 174) with 36 %( 126) was partially vaccinated and 14.8 %( 52) were notvaccinated at all. No specific reason was identified for lack of vaccination. It is noted that morefemales (87.7%) and physician (88.9%) and Nurses (88.2%) have completed the vaccinationschedule than the Lab. Technicians (75%). Conclusion: There is a need of extensive healtheducation campaign for training of HCWs to control and prevent the spread of these infections.
PREVALENCE OF CARDIAC DISEASES
Authors: Latif Lubna , Iqbal Usman Javed
Published: September 2021

Objectives: The objective of this study was to find the prevalence of cardiacdisease among pregnant females and its impact on feto-maternal outcome. Study Design:Descriptive case series. Setting: Cardiology department Gulab Devi Chest Hospital LahoreDuration: April 2013 to April 2014. Patients & Methods: All pregnant females with cardiacdisease at any gestation with booked or un-booked statutes were included in this study. Patientswere admitted for thorough evaluation and investigations. Labor was monitored intensively. Dataregarding maternal outcomes were noted down on pre-formed questionnaire. Intra partum andpostpartum details were also noted down along with fetal outcome. The results were analyzedusing SPSS version 16.0.. Results: The total number of females presented with cardiac diseasewas 2650, out of which only 35 women were reported as pregnant. The duration of pregnancyat the time of presentation was as follows: 05 (14.2%) females presented in first trimester, 20(57.1%) in second trimester, 08 (22.8%) in third trimester and 02 (5.7%) patients presented inpostpartum period. There were 08 (22.8%) patients who had preterm labor. In terms of fetaloutcome 04 babies had birth weight of less than 1.5 kg, 12 had 1.5-2.0 kg, 15 were in rangeof 2-2.5 kg and 04 were more than 2.5 kg. 27 (77.1%) were term and 08 (22.8%) were pretermbabies. Cleft lip and atrial septal defect were the only two identified congenital anomalies.Conclusion: The overall prevalence of cardiac diseases during pregnancy was found to be1.3% in this study. Most common affected age group was of 20-25 years. Most common cardiacdisease found in our patient was mitral stenosis. 02 pregnancies ended in intrauterine fetaldeath. 08 babies were born preterm. Cleft lip and atrial septal defect were the only two identifiedcongenital anomalies in newborn delivered by our pregnant patients. Every effort should madeto create awareness regarding pre-pregnancy counseling, so that associated fetal and maternalmorbidity can be reduced.
CVC RELATED BACTEREMIA
Authors: Ali Syed Asad
Published: September 2021

Objectives: To characterize clinically, epidemically and microbiologically the episodes ofconfirmed bacteremia associated with intravascular catheters of patients in the pediatric intensive careunit. Study Design: An analytical, prospective study. Setting: Intensive care unit of Pediatric HospitalJosé Luis Miranda”. Period: January 2003 to December 2007. Methods: 453 patients. Rates, densityof incidence, risk factors, static’s and mortality were determined and analyzed. Results: 96 patientsdeveloped bacteremia episodes and 90 (74%) had microbiological criteria. The risk factors associate were:to have multiple catheters, permanency with the catheter more than 7 days, parenteral feeding, prolongedmechanical ventilation, previous transfusions and surgical interventions. The isolations of coagulasenegative staphylococci prevailed in 33 patients (36, 7%). The previous demurrage to the insert of thecatheter was of 4,0 ± 9,4 days for the healthy ones and 11, 6 ± 24,6 days in the sick persons (p = 0,000);the definitive demurrage was of 56,1 ± 62,4 days in the sick persons versus 24,6 ± 31,7 days in the healthyones (p = 0,000). The mortality of the second group was superior (26%). Conclusions: Multiple dependentand independent factors exist on which actions should be focused to prevent and to diminish the mortalityby bacteremias associated with catheters in children admitted in intensive care units.
HYPOVITAMINOSIS D
Authors: Ahmad Ghazala , Hashmat Nadeem , Satti Naureen Kanwal
Published: September 2021

Objectives: To determine the frequency of vitamin D deficiency in children under12 years of age in the absence of significant clinical signs and symptoms in an ambulatory caresettings. Study Design: Descriptive study. Settings and duration: This study was conductedin Pediatric Out Patient Department of KAUH from June 2013 to June 2014. Materials andmethods: Patients attending the pediatric clinic in KAUH Riyadh, KSA, from June2013 to June2014, in which 287 healthy children under 12 years were enrolled. Serum calcium, phosphorus,alkaline phosphatase and 25-hydroxyvitamin D [25(OH) D] were measured .X ray wrists weretaken for radiological evidence of rickets. 25(OH) D levels <50 ng/mL and <25 ng/mL weredefined as insufficiency and severe vitamin D deficiency, respectively. Results: A high prevalenceof vitamin D deficiency is observed in healthy children even in absence of clinical signs andsymptoms. The problem should be highlighted and there is a need to create awareness amongpeople about the etiology of vitamin D deficiency and its prevention.There is a strong need forlong term planning including populationscreening, dietary supplementation with vitamin D andfood fortification.
ESSENTIAL HYPERTENSION
Authors: Dasti Mashooq Ali , Hashmi Syed Fasih Ahmed , Shah Nisar Ahmed , Hussain Syed Saad , Gohar Munaza , Farah Zul , Shah Syed Zulfiquar Ali
Published: September 2021

Objectives: To determine the frequency of hyperuricemia in patients withessential hypertension. Study Design: Cross sectional descriptive. Period: Six months study.Setting: Liaquat University Hospital Hyderabad. Patients and Methods: All the patients withessential hypertension visited at cardiac OPD / admitted in the ward were further evaluated forserum uric acid level. The data was analyzed in SPSS 16 and the frequency and percentage wascalculated. Results: During six months study period, total one hundred and eighty (180) patientswith essential hypertension were recruited and study for uric acid level. The mean age ±SDfor overall population was 52.84±8.72 whereas it was 55.83±7.93 and 50.75±8.95 in male andfemale population respectively. The mean ± SD of systolic and diastolic blood pressure (mmHg)in overall population was 160.50 ± 12.74 and 100.70±5.95 respectively. The mean ±SD serumuric acid level in overall population was 13.74±4.83 while it was 11.74±6.44 and 14.43±4.31 inmale and female population respectively). The male population was predominant in relation toage (p=0.02), the hyperuricemia was identified in 117/180 (65%) patients and it is statisticallysignificant in context to age (p<0.01) and gender (p<0.05) whereas mean ±SD of systolic anddiastolic blood pressure was also significant in relation to hyperuricemia. Conclusion: There isa relationship between hyperuricemia and hypertension and shown that the serum uric acid levelwas significantly increased in patients with essential hypertension.
AORTIC VALVE REPLACEMENT
Authors: Hussain Ghulam , Ahmad Naseem , Ahmad Sohail , Baig Mirza Ahmad Raza , Zaheer Sara
Published: September 2021

Precise determination of the size of aortic annulus is very important for thepreoperative evaluation before aortic valve replacement. Objectives: To determine thepreoperative prosthesis size using echocardiography in patients undergoing aortic valvereplacement. Study Design: Prospective observational study. Setting: Ch. Pervaiz ElahiInstitute of Cardiology (CPEIC) Multan. Period: January 2013 to October 2014. Methods: (100patients) Aortic annulus sizes were measured with TTE one week before surgery and with thehelp of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variableswere analyzed using mean and standard deviation and percentages were used for qualitativevariables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulussize. Results: Out of hundred patients, 84(84%) were male. Mean age of the patients was 33.77+13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations weredone only in 4% patients. In 96% patient’s mechanical prosthesis was used and in 4% patient’sboiprosthesis was used for valve replacement. We found no significant difference in Aorticannulus measured pre-operatively with the TTE (23.54+ 3.54) and measured per-operativewith the sizer (23.96+3.36) with highly insignificant p-value 0.58.Aortic annulus size was almostsame measured by these two techniques. Conclusion: Aortic annulus size measured with TTEhelps to arrange the optimum size prosthesis before aortic valve replacement surgery.
ACUTE APPENDICITIS
Authors: Jamali Khawar Saeed , Ahmed Humaid , Jawed Muhammad , Shaikh Ubedullah
Published: September 2021

Objectives: The objective of this study was to compare the efficacy of ClinicalEvaluation and modified Alvarado scoring system in diagnosing acute appendicitis. StudyDesign: Cross sectional study. Place and Duration of Study: This study was conducted atSurgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: Thisstudy consisted of eighty patients. Patients were divided in two groups. Group A for completeclinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring systemcomprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea,vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively andundergoing emergency appendectomy during this period, age >12 years and both gender.Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant femalepatients and those who did not give written consent. Results: A total of 80 patients were includedin the study, placed alternatively into two groups of 40 patients each with majority being male(n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients ofGroup A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared onthe basis of Gender for the two groups, the positive predictive value for male patients of GroupA and B was 90.09% and 89.28% respectively, but for females the positive predictive valueof Group A and B was 100% and 50% respectively. Conclusion: We conclude that modifiedAlvarado score can be used safely and effectively in diagnosing acute appendicitis in adultmales especially as the score increases from seven to nine.
GARTLAND TYPE III SUPRACONDYLAR FRACTURE HUMERUS
Authors: Lal Krishan , Chachar Muhammad Bux , Chohan Mohammad Haroon , Baig M. Akhter , Khoso Jamil Ahmed
Published: September 2021

Objectives: The purpose of present study is: 1. To know the results of surgicalintervention of Garland type III fracture Humerus in children.2. To know the early and latecomplication of surgical intervention. Study Design: Prospective interventional study. Setting:Department of Orthopedic Unit-II, Civil Hospital Karachi. Period: February 2010 to January2012. Methods: 200 male and female patients with Gartland type III supracondylar fracture ofhumerus presenting within 24 hour of injury, with age limit varying between 1- 12 years wereincluded in our study. The anteroposterior and lateral view X-rays were taken and evaluatedfor displacement and angulation, medial/ lateral displacement and angulation and rotation ofdistal fragment. After all aseptic measures, patient under general anesthesia, through posteriorapproach skin was incised, subcutaneous tissue dissected along the line of incision. Tricepsapponeurosis was splitted and interposed soft tissue was released and fracture reduced andfixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateralview and an angle of 30o – 40o in A/P view. Wound closed in layers, aseptic dressing appliedand well-padded back slab with elbow in appropriate angle of flexion was applied and pulseswere checked. Postoperatively the hand was held elevated. Plaster of parries black slab wasremoved after four weeks; the wires were removed after six weeks. The follow-up ranged from 3to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteriafor assessing the results were based on healing period, anatomical appearance, function andradiographic appearance. Results: Excellent results according to Mitchell–Adam’s criteria wereobserved in 60 %. (120/200) cases, good results were observed in 27 % (54/200) cases. Overallexcellent to good results were observed in 87% of cases. Conclusion: It is concluded thatoutcome of surgical treatment of supracondylar fractures of humerus (Gartland type III) fixedwith medial and lateral placement of k- wires were excellent to good and it achieves stablefixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injurieswere decreased as compared to closed reduction and percutaneous k-wiring. As this method istechinically easy, less demanding and effective for stabilization and can be applied for patientswith these fractures.
URINARY TRACT INFECTIONS
Authors: Anjum Muhammad Usman , Khan Muhammad Safdar , Shahid Abdul Razzaq , Shah Syed Humayun
Published: September 2021

Background: Urinary tract infections (UTIs) constitute important bacterialdisease which contributes to significant morbidity world-wide. Empirical treatment in patientssuffering from UTI depends upon the local knowledge of common microorganisms responsiblefor UTI in that geographical area as well as their antimicrobial susceptibility patterns.Objectives: To determine the frequency and antimicrobial susceptibility of uropathogenswhich are responsible for urinary tract infections. Study Design: Experimental study. Setting:Department of Pathology, Frontier Medical & Dental College and Mohi Ud Din Islamic MedicalCollege. Period: January 2015 to June 2015. Material & methods: Total of 113 patients wereincluded in the study. Urine samples were cultured on MacConkey’s agar and Cysteine LactoseElectrolyte Deficient (CLED) agar. Micro-organisms were identified using standard tests andantimicrobial susceptibility was checked using modified Kirby Bauer method following Clinicaland Laboratory Standards Institute (CLSI) guidelines. Results: The average age of patientswas 32.19±16.47 years. Gram negative organisms accounted for majority of cases, about 89(78.76%) cases. Escherichia coli was the most common micro-organism which was found in50 (44.24%) cases followed by Staphylococcus aureus in 24 (21.24%), Enterobacter spp. in19 (16.81%), Klebsiella spp. in 11 (9.73%) and Proteus spp. in 9 (7.96%) cases. E. coli wassensitive to imipenem and ciprofloxacin and was resistant to amoxicillin/clavulanic acid andgentamicin. Conclusion: Gram negative organisms are largely responsible for UTIs and E. colibeing the most common etiological agent. E. coli is sensitive to commonly prescribed drugs forUTI like ciprofloxacin.
GESTATIONAL DIABETES MELLITUS
Authors: Qazi Afsheen , Fahim Amin , Qureshi3 Aneela , Haque Mazhar ul
Published: September 2021

Objectives: The present study was designed to find the importance of properscreening and early diagnosis of gestational diabetes mellitus. Study Design: A prospective/descriptive study Place of Study: tertiary care hospital Hyderabad. Duration of Study: fromSeptember 2014 to November 2014. Materials and Methods: A total of 168 pregnant femalesbetween the ages of 20-40 years & in their 24th to 28th week of gestation were enrolled for thestudy. Oral Glucose Tolerance Test of all the participants was done after an overnight fasting of10-12 hours. All the participants were given 75gm of glucose per 100 ml of distilled water. Theblood samples were collected after two hours time for serum glucose levels. Results: Mostof the participants were below 26 years of age 47(27.9%) with the mean age of 30.2±5.83years. However the highest prevalence of GDM was observed in age group 31-35 years (36%).Among the 25 cases of gestational diabetes mellitus the highest number of patients with GDMwere multipara (40%) followed by parity of 3-4 gravida (32%). Twenty seven women (16%)women had family history of diabetes mellitus. Among these 12/27 (44.4%) women were foundwith GDM, compared to 15/141 (10.6%) who have no family history of diabetes mellitus. Total14 (8.33%) women were found obese, out of these 8 (57%) women had GDM while only 6(42.8%) women had no GDM. Conclusion: The prevalence of GDM in the present study isfound to be 14.8%. A prevalence of GDM was higher in the elderly multiparous females whowere overweight and had family history of diabetes mellitus.
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Authors: Alavi Nusrat , Amin Saima , Mumtaz Madiha
Published: September 2021

Objectives: To assess the incidence of NAFLD and biochemical profile in nondiabeticand diabetic patients. Study Design: It was a cross sectional descriptive study. Setting:Shalamar Institute of Health Sciences (SIHS), Lahore. Period: Six months, Jan 2015 to Jun2015. Methods: The patients coming to the Radiology Department for abdominal ultrasoundwere age and sex matched into fatty liver and non-fatty liver groups and diabetic and nondiabeticgroups and were further evaluated on the basis of glucose, alanine aminotransferase(ALT) and triglycerides (TG) levels from the laboratory data. Results: The findings of allbiochemical parameters were raised in diabetic patients with fatty liver as well as in non-fattyliver diabetic group and the differences were found to be statistically (P value less than 0.05)significant. In non-diabetic group, out of 200 subjects 56.5% had NAFLD whereas 43.5% hadno NAFLD. In diabetic patients, out of 200 patients 69% had NAFLD and 31% had no NAFLDand the difference was significant statistically (P= <0.05). The prevalence of NAFLD 12.5%was higher in type-2 diabetic patients as compared to non-diabetic group. In non-diabeticgroup, 113 subjects had TG value of 181±82.49, while 87 subjects had TG of 141±44.5. Indiabetic patients, 138 patients had TG value of 467±277.64 whereas 62 patients had TG valueof 178±46.52, which was statistically significant (P= <0.05). Conclusion: Fatty liver is animportant marker for metabolic syndrome which is a pre-diabetic condition. The occurrenceof NAFLD was elevated in type II patients of diabetes. The traditional risk factors for NAFLDare considered to be female sex, type II diabetes mellitus, obesity and hypertriglyceridemia.Hyperglycemia, hypertriglyceridemia and elevated ALT were observed more repeatedly in fattyliver than in non-fatty liver (type II) diabetic patients
TUBERCULOUS PATIENTS
Authors: Naeem Abid
Published: September 2021

The objective of present study was to screen out the diabetes mellitus by fastingblood glucose (FBG) in patients with pulmonary tuberculosis. Background: Diabetes mellitusand Tuberculosis has strong co-relation and complicates each other. Diabetes increases therisk of infections including tuberculosis particularly pulmonary TB, Therefore making antituberculousdrugs ineffective. Similarly M. tuberculous infection predisposes to diabetesmellitus and complicates it further. Patients simultaneously having, both diabetes mellitus andtuberculosis, the chances of multiple systems involvement becomes high. The delayed orineffective response to anti tuberculous chemotherapy raises suspicion of underlying diabetesmellitus .There for such patients should be screen out by fasting blood glucose (FBG) levels soas to treat the treat the diabetes as well. Objectives: The objective of this study was to screenout diabetes in pulmonary TB patients by fasting blood glucose level (FBG) especially wherethe treatment response of anti-tuberculous drug is delayed or poor. Study Design: This wasprospective observational study. Place and Duration of Study: This study was conductedat DHQ-teaching hospital Mirpur Azad Kashmir from February 2013 to December 2014 .Thisincluded both in and outdoor patients. Inclusion criteria: 1. Age range of tuberculous patientsbetween 20-40 years. 2. Pulmonary tuberculous patients. Exclusion criteria: 1. PulmonaryTB patients with co-existent diabetes mellitus. 2. TB patients with renal failure, autoimmunediseases like rheumatoid arthritis, SLE, immunosuppressant drugs and steroid were excluded.Material and Methods: Ninety-five diagnosed patients of pulmonary TB were selected. Thequestionnaire form was designed according to objective of study. This Included with patientshaving pulmonary TB with but still not screened out for diabetes .The questionnaire containedhistory, general physical and systemic examination, especially respiratory system. Risk factorslike family history of diabetes and TB were evaluated. The socio–economic status of patients wascarefully assessed. Routine investigations like complete blood count, ESR, fasting and randomblood glucose were done. Three morning sputum specimens and fasting blood glucose (FBG)were main tools of diagnosis of TB. The data thus obtained, was subjected to SPSS verssion-20for statistical analysis. Results: A total of 95 patients with pulmonary tuberculosis were selectedincluding in and outdoor patients. Out of them, 65 patients were males, and 30 were females.Age group mainly ranging between 20-40 of years. Screening of diabetes in 95 tuberculouspatients was done by fasting blood glucose. Seventeen patients (17), twelve (12) male and five(05) female were screened out to be diabetic. Conclusion: Screening by fasting blood glucoseis an effective tool in diagnosis of diabetes mellitus in tuberculous patients.
IN-SILICO ANALYSIS
Authors: Chaudhary Hammad Tufail , Hasnain Shahida
Published: September 2021

ntroduction: Different pathogen reducing technologies are being implementedwhich includes S-303. CD-61 is important receptor for clotting. Pathogen reducing agents arebeing studied extensively to probe its effects. Objective: We conducted this study to reviewthe docking of S-303 at CD-61, to look into the effect of S-303 on function of platelets. StudyDesign: This was an observational study. Setting: In-silico study. Period: March 2015 toAugust 2015. Method: The study was carried out in-silico. PDB (Protein data bank) code ofTirofiban bound to CD-61 was 2vdm. CD-61 was docked with Tirofiban using online dockingtools i.e. Patchdock and Firedock. Then, S-303 and CD-61 were also docked. Best dockingposes to active sites of 2vdm were found. Interactions of ligands and CD-61 were obtained.Then comparison of Hydrogen Bonds, Hydrogen Bond Lengths, Hydrophobic bonds of 2vdmmolecule and best poses of docking results were done. Patchdock and Firdock results of bestposes were also analyzed using SPSS-16. Results: The Hydrogen bonds and Hydrogen bondlength and hydrophobic bonds of docking results were compared to 2vdm. 2 best poses wereobtained for docking of tirofiban to CD-61. No docking to active site was observed in Patchdockand firedock for S-303to CD-61. Conclusion: S-303 did not bind to the active site of CD-61. Wecan assume that S-303 doe
FRACTURED MAXILLARY CENTRAL INCISORS
Authors: Khawaja Naveen , Punjabi Suneel Kumar , Kalhoro Feroze Ali
Published: September 2021

Fractured incisors are restored with composite resin is a routine procedure. Theretention of composite restoration is related to the bond strength of adhesive and the surfacearea existing for bonding. In absence of adequate bonding areas in fractured tooth of youngerindividuals with resilient dentin, additional retention through placement of self threaded pinswill give the required support and maintain esthetics. additional retentive means, in the form ofpins are often required for restoration of damaged and broken tooth, particularly in adolescentpatient’s teeth where pulp chamber is comparatively large, dentinal tubules are relativelyimmature and still gingival lines are high. The threading acts scatter and devour some of theplacing energy by cutting part of pin channel in the dentinal walls. This case report fuses theretentive feature of self threaded pin with the esthetic advantage of composite restoration infractured anterior teeth.
NEONATAL OUTCOME
Authors: Chetandas Pushpa , Sham Neeta , -Nissa Qamar-un , Afsheen Shehla
Published: September 2021

Objective: The objective of this study was to determine the neonatal outcomein women undergoing cesarean section due to non-reassuring cardiotocography (CTG). Crosssectional study. Setting: Department of Gynecology & Obstetrics at Liaquat University ofMedical & Health Sciences Hyderabad. Period: October 2012 to August 2013. Methodology:Detailed Clinical examination of the patient was done. Systemic review was also done to seeany co-morbidity. All patients underwent for base line like CBC and specific investigationsespecially ultrasound pelvis. Inclusion criteria were all patients with gestational age > 37 weeksand maternal age 20 -30 years with non-reassuring CTG. Exclusion criteria were history ofprevious caesarean section operation, less than 37 weeks pregnancy, any other obstetricalindication for caesarean section (except non reactive CTG) like cephalo pelvic disproportion,previous caesarean section and severe intrapartum hemorrhage. Results were prepared withhelp of tables and graphs. Data was analyzed through SPSS software. Results: This studywas conducted on 112 patients. Wide variation of maternal age ranging from a minimum of 20years to 30 years with mean age was 26+2.1 years. Gestational age was > 37weeks, rangingfrom a minimum of 37 weeks to 42weeks. The mean age was 37+2.4 weeks. Mostly patientswere observed 37-38wks in 52.67%, 39-40wks in 32.14% and 41-42wks in 15.17%. Apgarscore was more than 7 in 61.60% cases and less than 7 apgar score in 38.39% cases whichis statistically not significant. Conclusion: It is concluded that apgar score was >7 in 61.60%cases and <7 apgar score in 38.39% cases which is statistically not significant. CTG is a usefuland indispensable adjunct to monitor the condition of endangered fetus. Reduce the incidenceof false positive findings that may result in increased incidence of unnecessary interventionparticularly caesarean section CTG should not be used as sole test CTG finding should becorrelated with colour of liquor ,if facility is present scalp PH should be done.
ERECTILE DYSFUNCTION
Authors: Rafique Ansari Muhammad , Mal Pooran , Bhagwan Das Jairamani , Memon Shafique-Ur-Rehman , Tahir Syed M , Tahir Benish
Published: September 2021

Objectives: Erectile dysfunction (ED) is a very common and distressing healthproblem in chronic maintenance hemodialysis patients. There is no such data available fromSind province of Pakistan on this issue; we want to highlight the factors and prevalence oferectile dysfunction among hemodialysis patients in this part of our country. Study Design:This hospital based observational, cross-sectional study Setting: It was conducted at 04hemodialysis centers of Hyderabad city Perod: In 2014 Methods: The Study was conductedby using International Index of Erectile Dysfunction (IIEF-5) for determination of prevalence& severity of ED among these patients. Comparative analysis for frequency of ED was alsodone between urban & rural patients. Adapted Urdu version of IIEF-5 was used for those whocannot understand English pro forma. Results: There were total 62 male patients; all of themwere on maintenance hemodialysis for more than 6 months. Their ages were between 20 to59 years with mean 36±11. In this series of patients 80% (n=50) were < 50 years of age whilethe diabetic patients were 58% (n=36). The overall prevalence of ED observed in patients was88.7% (n=55) in our study. Severe ED was seen in 30 (48.4%) patients. The prevalence &severity of ED was significantly higher in diabetes mellitus and over 50 years of age. There washigher incidence of ED 94% observed in patients who are living in rural areas as compared tourban areas patients 82%. Conclusions: It has been concluded in this study that majority ofmale hemodialysis patients were suffering from ED problem. Diabetes mellitus and & > 50 yearsof age has the highest prevalence of ED. Erectile dysfunction is very common and distressinghealth related issue among hemodialysis patients and this should be addressed with routine
ACUTE LYMPHOBLASTIC LEUKEMIA
Authors: Nizzamani Ghulam Shah , Nizamani Zaheer Ahmed , Fahim Amin , Ujjan Ikram Uddin
Published: September 2021

Objectives: The aim of the present study is to evaluate the frequencyof chromosomal abnormalities in childhood acute lymphoblastic leukemia at a tertiarycare hospital of Sindh. Study design: Observation study. Place of study: Isra UniversityHospital, Hyderabad and Oncology Unit Liaquat University of Medical and Health Sciences,Jamshoro. Duration of study: From January 2014 to March 2015. Materials and Methods:Cytogenetic analysis was conducted on peripheral blood and bone marrow samples of 100diagnosed cases of acute lymphoblastic leukemia (ALL). Peripheral blood and bone marrowsamples were collected and putted into sodium heparinized bottles. Cytogenetic analysiswas performed by karyotyping according to the ISCN guidelines for human cytogeneticnomenclature using cytovision-+ system for image analysis. Data was analyzed on statistic8.1 USA and expressed as means, percentage and chi-square with P-value of ≤ 0.05 beingdefined significant. Results: Chromosomal abnormalities were found in 53% of the ALLcases. Numerical abnormalities were found in 71% whereas 35% cases showed structuralabnormalities. 29% cases of ALL showed diploidy and aneuploidy was found in 69% of casesand 2% cases were unknown. Highest number of patients 51% showed hyperploidy followedby 12% cases of hypoploidy and 6% showed pseudoploidy. Chromosomal translocationst(9; 22) (q34; q11) and t(8; 22) (q24; q11) were noted in 6% each and t(8; 14) (q22; q32)were seen in 5% of the cases of childhood ALL. Conclusion: The present study reportschromosomal abnormalities in 53% of cases. Numerical abnormalities were found in 71%whereas 35% cases showed structural abnormalities.