bluuebunny/crossref_metadata_2025 huggingface dataset:
SEMEN PARAMETERS
Authors: Khan Haroon Latif , Khan Yousaf Latif , Mehfooz Irfan , Burhan Muhammad , Sardar Saba , Khawaja Abdul Rahman
Published: September 2021

Semen is a pale whitish fluid secreted by male during ejaculation and containsspermatozoa which are male gametes essential of fertilizing the oocytes which are femalegametes. In a quest to evaluate male’s fertility potential semen is analyzed to look into some ofits characteristics and of the sperms contained within the semen analyzed. Method of collectioninfluences the results of Semen analysis as does the technique of analysis. Spermatozoa areexamined for number (count), shape (morphology) and movement (motility) in order to assesstheir quality. Non sperm cells, volume, Fructose level, pH, liquefaction are also checked asa part of routine analysis. Objectives: To describe the pattern of semen parameters in subfertilemales. To look into frequency and distribution of abnormal semen parameters in a groupof Pakistani males in Lahore. Methods: In this Retrospective, cross sectional, observationalstudy all males undergoing for evaluation and treatment for sub-fertility at a private AssistedReproductive Technology clinic in Lahore, Pakistan were included. Approval of the IRB wassought and data collection instrument was a specially designed Performa which was validatedby the biostatistician of LIFE research cell. Data was extracted from the files of LIFE (LahoreInstitute of Fertility and Endocrinology) and entered in SPSS version 15. Sampling techniquewas non-probability, consecutive. Semen analysis was done by methods defined by the WHO(World Health Organization). Results: Of total patient (n=679) 92.2% (626) males passed sampleat LIFE (Lahore institute of fertility and endocrinology) and (7.8%) 53 brought sample fromhome. Of the males who passed sample at LIFE (78.8%) 535 collected semen by masturbation,(11.9%) 81 by coitus; the source of sample of (9.3%) 63 males was not known. As 2-6 ml semenwas consider to be normal by WHO criteria, (80.6%) 547 males were in normal range (14.1%)96 found to be less than 2-6 ml and (5.3%) 36 found to be more than normal range. Accordingto WHO criteria 15 million/ml count is said to be normal, in our research (82.0%) 557 were foundto be normal, in (2.9%) 20 count was found to be less than 15 million/ml and in (5.9%) 40 countwas less than 1 million/ml. In (9.1%) 62 counts was found to be abnormally low. In this research(66.1%) 449 had normal sperm motility, (21.8%) 148 had less than 40% and abnormally lowsperm motility was found in (12.1%) 82 males. Conclusion: The results of the single semenanalysis are of limited utility and no decision should be taken on the bases of these results interm of diagnosis and treatment strategies.
PREVALENCE OF HUMAN MALARIA
Authors: Majeed Muhammad Zafar , Hussain Muhammad Shahbaz , Sarwar Faiza
Published: September 2021

Malaria is one of the devastating diseases worldwide. More than 3 billion peoplelive under the threat of malaria in endemic countries and kills more than one million each year.Malaria leads to multiple hematological (thrombocytopenia) and other abnormalities like renalsystem, nervous system with increased morbidity and mortality. Aim: The present study wasconducted to determine the prevalence of human malaria, its correlation with thrombocytopeniaand treatment in patients of District Rahim Yar Khan. Materials and Methods: A total of 200patients including 140 males and 60 females were the part of our study. Blood samples collectionwas done during September to November following monsoon season. Patients were diagnosedthrough peripheral blood smear. Both P. falciparum and P. vivax parasites against 300 white bloodcells (WBCs) were examined on the thick smear. Platelet count was done by using an automatedcell count analyzer. A platelet count of less than 150 x109/L defined thrombocytopaenia. Firstline of treatment was Chloroquine in cases of Plasmodium vivax whereas Neo fansidar incases of Plasmodium falciparum. Results: Gender wise distribution of patients was 140 (70%)males and 60(30%) females. We had 74 (37%) patients from urban and 126 (63%) from ruralpopulation. Malaria was most frequent 64% by P.vivax and 36% by P.falciparum. Fever was highduring admission to hospital and after usage of antimalarials recovery and improvement innumber of platelets was noted. Conclusion: The high prevalence rate of P. vivax pose a majorhealth hazard but of P. falciparum also may lead to serious complications. The high frequencyof human malaria infection should be a major concern for authorities in the fight against malariacontrol programs in Pakistan.
OBESITY
Authors: Rani Keenjhar , Memon Ali Raza , Akram Muhammad , Memon Paras Javed
Published: September 2021

Objectives: The main aim of the study was to evaluate the association betweenserum Vitamin D levels with Obesity. Study Design: Case-Control study. Place of Study:Department of Medical OPD Liaquat Medical University Hospital, Jamshoro/Hyderabad,Sindh, Pakistan. Duration of Study: June 2015 to December 2015. Material &Method: Total200 subjects including 100 Non obese as control group & 100 obese subjects participatedvoluntarily in this study. This study was conducted in Medicine Department of Liaqat UniversityHospital Jamshoro/Hyderabad. Serum Vitamin D Levels were measured by commerciallyavailable kit. Results: This research found that the serum vitamin D levels are less in obesepersons as compared to non-obese people. Conclusion: Vitamin D levels are less in obesewhen compared to non-obese.
HYPONATREMIA
Authors: Khan Abdul Haque , Hayat Atif Sitwat , Humaira Dr. Mona , Pathan Ghulam Nabi , Akbar Ali
Published: September 2021

Background objective: Hyponatremia is not uncommon complication of livercirrhosis and may affect hospital mortality. This study was aimed to determine frequency andoutcome of hyponatremia in liver cirrhosis patients. Patients and Methods: The cirrhotic subjectswere assessed for hyponatremia while outcome measured in relation to hyponatremia and itsseverity. Data was analyzed in SPSS 16.0 and frequencies as well as percentages calculatedfor hyponatremia. Results: Out of one hundred liver cirrhosis patients, 65% were males and35% females. Mean age ±SD of overall cirrhotic subjects was 40.79±7.83. Hyponatremia wasidentified in 72% (51% males and 21% females) patients. The mean ± SD for sodium levelin overall population was 129.73±8.35 while 119.92±3.61 in hyponatremic cirrhotic patients.Conclusion: Dilutional hyponatremia is a frequent finding in liver cirrhosis patients.
IRON DEFICIENCY ANEMIA
Authors: Mansoor Malahat , Raza Hammad
Published: September 2021

Around 65% of pregnant women in South Asia suffer from IDA & in Indiansub-continent alone, the rate of developing IDA during pregnancy is 88%. Moreover anemicpregnant patients are more likely to give birth to low birth weight babies which itself is anotherfactor adding to socio-economic burden on the whole family. The food has not been fortified forIron, Zinc & Vitamin D & hence the prevention of anemia has not yet been achieved Objectives:To study Awareness of women about food fortification & prevention of IDA Vs cost for treatinganemia. Period: August 2015-Dec 2015. Study Design: Observational Study. Settings: At BhattiInternational Hospital, Kasur Results: Among the selected anemic women, almost half (55%)had mild anemia, while rest had moderate to severe anemia indicting that the prevalence is verycommon. The treatment offered was oral &/or IV Iron with blood transfusions. The cost of iv Irontherapy & blood transfusions estimates in thousands with added risks of Transfusion Reactions,allergic reactions& transmission of blood-borne diseases like HCV,HBV,HIV(AIDS)&others. Theawareness level was found to be poor among these women .Only 8/60 i.e 13% had someidea about iron deficiency anemia & almost none knew about food fortifications. The insightabout their own disease of IDA was also 35% (21/60) indicating that most of the women incommunity live with IDA without any understanding of a preventable condition. Conclusion:The cost & time spend to treat IDA can be minimizes creating awareness about food fortification& supplementation.
EFFECTS OF ALCOHOL
Authors: Aziz Hira , Naz Fauzia
Published: September 2021

Objectives: The present study examined the effects of alcohol consumptionon cognitive failures, depressive symptoms, pessimism and psychological maladjustmentamong alcoholics. The research further explored predictive relationship between cognitivedisturbances, depressive symptoms, pessimism and psychological maladjustment inalcoholics. Study Design: Between-groups correlational research design. Settings: Lahorecity. Method: A sample of 33 men and 4 women (age: 20-60 years) who were addicted toalcohol were recruited. Equal number of comparison group who do not use alcohol, matchedon age, gender and socioeconomic status were recruited. Cognitive Failure Questionnaire1,Personality Assessment Questionnaire2, Life Orientation Test3 and Centre for EpidemiologicalScale for Depression Scale4 were used as assessment measures. Results: Results of thestudy showed that alcoholics had higher scores on cognitive failures, depressive symptoms,pessimism and psychological maladjustments as compare to the non-alcoholics. There was asignificant predictive relationship between cognitive failures, pessimism, depressive symptomsand psychological maladjustment. Results of AMOS show model fit with cognitive failure,depressive symptoms and pessimism as significant predictors of different dimensions ofpsychological maladjustment among alcoholics.
MANDIBULAR CONDYLE FRACTURES
Authors: Hassan Syed Ghazanfar , Shams Dr. Salman , Rehman Mujeeb , Kumar Suneel
Published: September 2021

Objectives: To analyze frequency, gender, age, cause of injury and type/locationof Condylar fracture among patients reported at Liaquat university hospital Hyderabad. Settingof Study: This study was conducted at Oral & Maxillofacial Surgery Department, Faculty ofDentistry, Liaquat University Hospital, and Hyderabad. Period: 1st February 2013 to 31st January2015. Methodology: The statistics of 108 patients both males and females who had beenaffected with mandibular Condyle fracture were prospectively reviewed. Patient’s data includinggender, age, cause of injury, type of Condylar fracture were recorded on Proformas and thenprospectively analyzed. Results: Out of 108 patients 81(75%) male and 27 (25%) female wereaffected with mandibular Condylar fracture. The common age group was 2nd decade of life(11-20 years). Most common cause of injury was fall in 51 cases (47.2%) followed by RTA in43 cases (39.8%). Sub condylar fracture was most common type of fracture occurred i.e in56 cases (51.8%). Conclusion: Children’s are commonly affected with mandibular Condylefracture & fall was the most common etiology in our study sample that explains the associationbetween fall and Condylar trauma. The second common etiological factor was Road trafficaccident for Sub condylar fractures in our study sample.
ILIZAROV TECHNIQUES
Authors: Chohan Mohammad Haroon , Lal Krishan , Chachar Muhammad Bux , Baig M Akhter , Kumar Sunil , Khoso Jamil Ahmed
Published: September 2021

Objectives: 1. To assess the results of infected nonunion of tibia by Ilizarovtechniques. 2. To ascertain the incidence of complications and advise methods to prevent them.3. To determine various risk factors which contribute to these complications. Study Design: Thisdescriptive case series. Setting: Department of Orthopaedic Surgery, Dow University of HealthSciences/ Civil Hospital Karachi. Period: 1st March 2010 to 28th Feb. 2013. Methods: A total of 30patients with infected nonunion of tibia with or without shortening and bone loss was includedin the study. Patients lying in supine position, after spinal anesthesia, radical debridement weredone and all previous infected implants and necrotic bone removed, pre-assembled ilizarovframe was applied with the help of four or five rings, each ring was fixed with k-wires andschanz pins. Olive wires were used where interfragmentary compression, correction of axialdeviation of fragment, in osteoporotic bones, transport of fibular fragment or more stability wasrequired. Results: Results were divided into bony and functional parts by ASAMI. We achieveexcellent to good bony result in 86.66% (26/30) of cases and excellent to good functional resultin 76.66% (23/30) of cases. Conclusion: It is concluded that bony and functional outcome ofinfected nonunion of tibia treated with ilizarov ring fixator is satisfactory. Although its applicationis lengthy but once applied patients get benefits, they can start walking with full weight bearing,limb length equality and soft tissue coverage achieved, so we recommend its applications insuch type of cases.
MATERNITY CARE SERVICES
Authors: Faiz Sadaf , Batool Zahira , Ejaz Sana , Rashid Abid
Published: September 2021

Introduction: Maternal health care refers to high quality health care providedto a pregnant woman during pregnancy, delivery and postnatal period. The maternal mortalityratio is quite high in the rural areas of Pakistan. Rural society is highly associated with itstraditions and cultural values. There are some cultural and social barriers for women. Theyare being considered negligible part of the population and are facing a number of hardshipsin availing health facilities. Objective: The aim of the study was to find out the socioeconomic,cultural and demographic factors affecting the access of rural women to maternity care services.Study Design: A cross-sectional study was conducted in the rural areas of District Faisalabad.Quantitative research method was used to get meaningful, detailed information. Material andMethods: A sample of 205 pregnant women aged 18-38 was taken, purposively to explore theresearch objectives through pre-designed interviewing schedule with open and closed endedquestions. Results: Univariate and bivariate analysis reveal the factors associated with theutilization of maternity care services such as education of the respondents and their husbands,family type, household income, age at marriage, attitudes towards health care facilities werefound to be associated with the utilization of maternity care service. Conclusion: The studyreveals that a number of reproductive problems occurred among pregnant women in the ruralareas of Pakistan due to the limited health facilities, socio-demographic and cultural barricadeswhich restricted them to utilize maternity care services
SCHIZOPHRENIA
Authors: Majid Zain , Haider Anum , Kapadia Habib Feroz
Published: September 2021

Schizophrenia is a psychiatric disorder and self harm is considered to be a rarepresentation of it. Lack of early intervention is mostly suggestive of leading to it. We herebypresent a case of a elderly male with chronic schizophrenia who came to our ER with thecomplains of self assault one day prior to admission, odd behavior, somatic delusions since 8days, self laughter and self talking since the last 25 years. Being a previously diagnosed caseof schizophrenia, he was non complaint with his previous medications, which worsened hiscondition and led to the patient stabbing himself multiple times after being convinced that therewere snakes in his abdomen. The patient was treated with antipsychotics and benzodiazepines,his family was given psycho education and after being stable for a few weeks, he was laterdischarged and asked to follow up regularly in our OPD.
POLYCYSTIC OVARIAN DISEASE
Authors: Qureshi Razia Tarique , Rahim Fouzia , Haidar Gulfreen
Published: September 2021

Objectives: To determine the role of metformin in correcting the irregularity ofmenstrual periods and infertility due to PCO. Study Design: Descriptive observational study.Setting: Gynecology Department of PUMHS Nawabshah. Period: 4th February 2010 up toNovember 2011. Patients and methods: Total 329 patients had selected in this series, based onpresence of PCO on ultrasound with 2 or extra following criteria like oligomenorrhea, hirsutism,hyperandrogenism and reversed FSH: LH ratio. Other endocrinal reasons of female infertilityas Cushing syndrome, congenital adrenal hyperplasia, hyperprolectinemia and cases thyroiddisorder had excluded. After detailed history, Metformin was started with dose of 250mgonce a day initially then gradually adjusted to 500mg TD. Weight decreased was encouragedwith diet and the exercise. Cases assessed after six months for checking regularity of theirmenstrual cycle, fertility and the BMI change. Cases those not be success to conceive following6 months, than the ongoing criteria of clomiphene. Women those failed to conceive afteruses of clomiphene citrate, than metformin alone was sustained and fertility had re evaluatedon end of 1 year. Results: 329 cases had selected. Commonest menstrual irregularity wasoligomenorrhea with hypo menorrhea which is seen in 46% of patients. After six months ofmetformin treatment 82% cases assessed improvement of menstrual cycle, while 13% still haveoligomenorrhea. Results found significant (P<0.001) .BMI of all study patients was comparedprior and then treatment and significant results were found (P <0.001). After six months forfertility analysis, complete data was available from 117 patients only. Overall fertility rate was91.1%. Conclusion: Metformin is successful treatment of cases having PCOS.
CELIAC DISEASE
Authors: Shahzadi Nagina , Hashmi Muhammad Almas , Bahawal Sadida
Published: September 2021

Objectives: Probiotics are alive organisms which confer health benefit whentaken at an appropriate dosage. This study was done to determine the efficacy of probiotics indecreasing the frequency of diarrhea in children with celiac disease. Study Design: Randomizedcontrolled trial. Setting: Department of Pediatrics/DHQ Allied Hospital, Faisalabad. Period:November 2011 to October 2012. Methods: Newly diagnosed patients with CD having diarrheawere included by consecutive non-probability sampling. Patients were randomized in twogroups using computer generated numbers. One group was given probiotic along with glutenfree diet while other was only prescribed gluten free diet. Reduction in frequency of diarrhea intwo groups was compared after a period of 28 days. Results: A total of 116 cases (58 in eachgroup) were enrolled. Mean age was 9.11 years. The groups were similar in age and gender ofpatients. Comparison of efficacy of probiotics in children with CD was done with control groupwhich revealed reduction in stools frequency to less than half in 86.21% (n=50) in probioticgroup but only 62.07% (n=36) in control group. P-value was 0.00015 which shows a highlysignificant difference in both groups. Conclusion: Probiotics in addition to gluten free diet arehighly effective in reducing the frequency of diarrhea in newly diagnosed patients with CD, incomparison with gluten free diet alone.
EMERGING RESISTANCE
Authors: Shoaib Maria Ali , Choudry Usama Khalid , Aamir Iram Saddiqa , Aqeel Qurrat-ul-Ain , Ahmed Syed Ahsan Uddin , Fatima Ghulam
Published: September 2021

Objectives: To study the bacteriological profile of enteric fever and their antibioticsensitivity pattern to commonly used antibiotics in view of emerging resistance at Civil HospitalKarachi (C.H.K.) and provide a guideline for making a protocol for empirical antibiotic therapywhere culture facilities are not available. Methodology: Design: Descriptive laboratory Basedstudy. Place and Duration of study: The study was conducted from 1st January, 2010 till 30thJune, 2012 at the Central Lab, Civil Hospital Karachi. Patients and Methods: A cross sectionalanalysis was done on a total of 37,805 blood specimens sent for C/S from the entire inpatient andoutpatient departments to the central lab, CHK. All blood cultures were inoculated in thioglycolatebroth and incubated at 37° for 7 days. Positive blood cultures were processed, colonies wereidentified using standard biochemical tests and antibiotic susceptibility was checked by Kirby-Bauer disc diffusion method as per CLSI criteria. Results: Out of these specimens, 430 sampleswere found positive for the salmonella strains, among them 395 (91.86%) were Salmonella typhiand 35 (8.14%) were Salmonella paratyphi A. Salmonella infection was more common in male(55.85%) and more prevalent in children under 10 years of age (34.88%). The resistance patternfor Amoxicillin, Chloramphenicol, Co-trimoxazole, was (29%), (41%) and (5%) respectively;while the resistance was found to be higher in the commonly prescribed drugs belonging to firstand second generation of cephalosporins and flouroquinolones. Conclusion: Amoxicillin andChloramphenicol, the first line of drugs for the treatment of enteric fever are losing their efficacyand most of the organisms have developed resistance. Also, resistance against the second lineof therapy, involving the use of cephalosporins and quinolones is rapidly emerging.
KNOWLEDGE OF WOMEN
Authors: Fatima Anum , Saif Nadia , Ghani Mansoor , Ali Sardar
Published: September 2021

Objectives: Around 50 to 70% of the neural tube defects can be prevented if awoman consumes sufficient folic acid daily before conception and throughout first trimester ofher pregnancy. Therefore, the women should be well aware about the apt supplementation offolic acid to mitigate those miseries that can be resulted from its deficiency. Study Design: Adescriptive survey design. Setting: Obstetrical OPDs of Lahore General Hospital, Lady AitchisonHospital, Jinnah Hospital Lahore, DHQ Hospital Multan, DHQ Hospital Faisalabad, and DHQHospital Rawalpindi. Methodology: A total of 300 pregnant women were studied to assess thelevel of knowledge and practices among women regarding use of folic acid before and duringpregnancy. Non probability convenient sampling technique was used for the purpose. Data wascollected by a self administered questionnaire and was analysed by SPSS version 20. A p-valueof ≤ 0.05 was considered statistically significant. Results: The results signified that a majorfraction of pregnant women 227 (76%) were having poor level of knowledge as they scoredless than 50% on knowledge based questions in the questionnaire. Only 4% were distinguishedwith excellent knowledge according to arbitrary scale, which were made-up to be a very lowpercentage. Conclusion: Findings of the study suggested that the knowledge of the womenregarding folic acid supplementation is insufficient that may in response lead to increase risk forthe incidences of neural tube defect.
COMPARISON OF INFECTION
Authors: Ahmed Khan Agha Nadeem , Parhar Allah Bakhsh , Malik Zafar Iqbal , Qureshi Khalid Hussain
Published: September 2021

Objectives: To describe the incidence of wound infection when gall bladderremoved through umbilical port using the bag formed by surgical glove with a group where bagis not used. Study Design: Descriptive study. Setting: Surgical units of Nishtar Hospital Multan.Period: Two years from November 2013 to November 2015. Material and Method: There were100 patients in study. All patients were divided in two groups, in one group a bag formedby surgical glove is used in other group gall bladder removed without bag. Results: In firstgroup where bag is used minor wound infection occurred in only one patient at the umbilicalport site. In second group where bag is not used for the extraction of gall bladder, the minorwound infection occurred in three patients. Conclusion: The use of endoglove is beneficial inminimizing the port site infection & it is also economical.
MESH REPAIR
Authors: Tagar Muhammad Paryal , Jamali Khawar Saeed , Jawed Muhammad , Tagar Sarang
Published: September 2021

Objectives: Compare the complications of inlay versus sublay mesh repairin epigastric hernia. Study Design: Observational study. Setting: Surgical department ofmultiple hospitals and compares the results, JPMC, Civil Hospital Karachi and NaushahroFeroze. Period: March 2015 to February 2016. Methodology: 94 patients presenting withupper abdomen midline swellings aged between 25 to 60 years attended as outdoor patientat a tertiary care hospital. Patients associated with chronic obstructive pulmonary disease likeasthma, abdominal malignancies and cirrhosis with end stage liver disease, multiple hernia,patients with prior hernia repair with mesh and defects < 4cm were excluded. Results: Outof the 94 patients, the majority was found to be male. 61 (64.89%) males and 33 (35.10%)females. Mean age was found to be 41.57+4.54 years. Inlay mesh repair group observed highcomplications as compared to sublay mesh repair group. Wound Infection observed 4(8.5%) cases inlay mesh repair group and 2(4.25%) cases in sublay mesh repair group. SeromaInfection observed 3(6.38 %) cases inlay mesh repair group and 1(2.12 %) cases in sublay meshrepair group. Recurrence occurred inlay mesh repair group was observed in 2(4.25%) cases.Short Hospital stay was observed in sublay mesh repair group. Conclusion: We concludethat sublay mesh repair is a better alternative to only mesh repair for all forms of ventral herniacases.
SCREENING TOOLS FOR OBESITY
Authors: Ghafoor Muhammad Umar , Rahman Mahmood-ur- , Irshad Faiza
Published: September 2021

Background: Various anthropometric tools employed to assess obesity includebody mass index (BMI) and waist to hip ratio (WHR) and waist circumference (WC) amongothers. An increased prevalence of central obesity in Asians calls for evaluation of WHR, WC andBMI as screening tools for obesity among them so as to give a clue about performance of thesescreening measures in detection of obesity. Study Design: Cross sectional analytical study.Setting: Allied Teaching Hospital Faisalabad. Study Period: December, 2014 to November,2015. Methods: 377 patients of essential hypertension screened for obesity, using BMI, WHRand WC as screening tools and analyzed and compared their performance in detecting obesityamong study subjects. Taking BMI as gold standard, the sensitivity and specificity of WHR andWC was measured along with their positive and negative predictive values. Study subjects werealso categorized according to “BMI trigger points for public health consideration” risk categoriessuggested by WHO for Asian populations. Results: Among 377 study subjects, 239 (63.39%)were categorized as obese by WHR measurements and 254 (67.33%) individuals were labelledas obese by WC measurements compared to 209 by BMI (p-value 0.00 in both cases). Thisshowed a trend towards abdominal pattern of obesity among study subjects. The differencewas significant among male as well as female portions of study population, where out of 249study subjects of male gender, 145 (58.23%) were categorized as obese according to WHR and156 (62.65%) were labelled as obese according to WC, compared to 125 overweight or obeseby BMI (p-value 0.00). Females showed a similar trend with 98 (76.56%) out of 128 labelledas obese by WC and 94 (73.43%) by WHR compared to 84 (65.62%) by BMI. The differencebetween WHR and BMI in detecting obesity among females was a less significant comparedto males. Out of 377 total subjects, 335 fell into increased, high or very high risk categoriesaccording to “BMI trigger points for public health consideration”. WC showed a sensitivity of97.13% and specificity of 69.64% whereas WHR showed a sensitivity of 96.65% and specificityof 77.98% when compared as screening tools with BMI as gold standard. Conclusions: WCperformed better as a screening tool for obesity when compared with WHR among hypertensivepatients. Higher number of obese patients detected by both WC and WHR than BMI showedtendency towards central obesity among study subjects. This difference underscores therelevance of using WC or WHR as measures of obesity especially among Pakistani population.
DIABETES MELLITUS
Authors: Yousfani Akbar Hussain , Memon Iqbal Ahmed , Shaikh Tariq Zaffar , Ahmed Zaheer , Ali Memon Hamid Nawaz , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency of hypophosphatemia in patientswith diabetes mellitus. Study Design: Cross sectional study. Period: Six months. Setting:Liaquat University Hospital Hyderabad. Patients and methods: All the patients of ≥35 yearsof age, either gender with known cases of diabetes mellitus type 2 for one year duration wererecruited, enrolled and evaluate for serum phosphate level. The data was analyzed in SPSS 16and the frequency and percentage was calculated. Results: During six months study period,total one hundred patients with type 2 diabetes mellitus were studied for serum phosphatelevel. The mean age ±SD for overall population was 53.85±7.63 whereas it was 54.53±6.87and 55.93±6.94 in male and female populations respectively while the mean ±SD for serumphosphate in male and female population was 1.52±0.74 and 1.90±0.93 respectively. Thehypophosphatemia was observed in 67% patients of which 37(55%) were males and 30(45%)were females (p=0.03) statistically significant. The HBA1c was raise in 72% patients of which52 cases had hypophosphatemia (p=0.05) statistically significant. Conclusion: One hundreddiabetic patients were studied and 67% shown significantly decreases serum phosphate level incontext to age and gender while raised HBA1c, shown inversely proportional relationship withHBA1c respectively.
ISCHEMIC STROKE
Authors: Kumar Ramesh , Shah Muhammad Iqbal , Lakhair Manzoor Ali , Memon Zaheer
Published: September 2021

Objectives: To determine the frequency of Dyslipidemia and other risk factorsin patients with ischemic stroke. Study design: Descriptive and case series. Setting: Thisresearch study was carried out in the Medicine department of Liaquat University HospitalJamshoro/Hyderabad. Duration of study: Six months. Sample size: Total 100 patients of bothmale and female sex were enrolled in this research study. Results: Total 100 cases of ischemicstroke were included. The mean age + SD (range) was 59.72 + 6.40 (45 – 70 years), 76(76.0%)were males and 24(24.0%) were females. Speech deficits was present in 28(28.0%, n = 100)patients. Eighty seven (87.0%, n = 100) patients had difficulty in walking, 17(17.0%, n = 100)patients had seizures, confusion was observed in 35(35.0%, n = 100) patients, 35(35.0%, n =100) had headache, Vertigo was seen in 11(11.0%n = 100) patients, Visual disturbances wasseen in 14(14.0%, n = 100) cases and 20(20.0%n = 100) patients had vomiting. High bloodpressure was in 51(51.0%, n = 100), diabetes mellitus and dyslipidemia in 30(30.0%, n = 100)respectively. Eighteen (18.0%, n = 100) patients were known cases of cardiovascular diseases,36(36.0%, n = 100) were smokers, 22(22.0%, n = 100) patients had family history of strokeand only 2(2.0%, n = 100) patients had the history of alcoholism. High cholesterol (mg/dL) wasseen in 21(21.0% n = 30) patients, High LDL (mg/dL) in 37(37.0%, n = 30), Low HDL (mg/dL) in90(90.0%, n = 30) and High Triglycerides (mg/dL) were seen in 40(40.0%, n = 30). Conclusion:High Blood pressure, Diabetes mellitus, Dyslipidemia and Smoking are chief risk elements ofischemic stroke. Prevalence of stroke is high in poor socioeconomic demographics with singleor multiple risk elements and this may be because of unawareness about these risk elements,unaffordability of treatment or proper follow up.
SCREENING MARKERS
Authors: Khan Sikandar Hayat , Raza Bokhari Syed Aown , Hanif Muhammad Shahzad
Published: September 2021

The screening measures to identify various cardiovascular risks relatedto hyperglycemia, hypertension and hypercholesterolemia are involves both anatomicassessments like anthropometric measures or body’s physiological evaluation by performingbiochemical parameters. In this regard “lipid accumulation product” (LAP) has surfaced as amarker to incorporate both these anatomic and physiological considerations. Objectives: 1. Tomeasure the LAP differences between subjects having normal and higher levels of glucose, totalcholesterol, age, carotid intima media thickness and subjects with and without hypertension. 2.To compare BMI and LAP in terms of effectiveness as a screening marker for diagnosis of diabetesmellitus and hypertension through ROC curve calculation. Design: Cross-sectional analysis.Place and duration of study: This study was carried out at the departments of pathology, PNSRAHAT hospital from Jan-2011 to Oct-2011. Subjects and methods: After several exclusionsincluding know diabetics a total of 202 subjects were enrolled to undergo sampling for Fastingblood glucose, and lipids in exact medical fasting status. These subjects were later evaluatedfor their various anthropometric measurements including BMI and WHpR (Wait to hip ratio) asper the WHO protocol. Then the individuals went to radiology department where carotid intimamedia thickness measurements were made by experienced radiologist. LAP (Lipid accumulationproducts) score was calculated as: LAP score (Male) = [WC (cm) - 65] x triglycerides (mmol/L)LAP score (Female) = [WC (cm) – 58] x triglycerides (mmol/L). LAP scores, BMI. WHpR andmean CIMT readings were grouped as per their high or low results. Results: Out of BMI, WHpRand LAP score, only groups based upon LAP score were observed to be significantly differentfor fasting blood glucose, total cholesterol and mean CIMT levels. Hypertensive subjects hadhigher LAP scores and WHpR than non-hypertensive subjects; however, BMI differences werenot considered significant. One way ANOVA shows the LAP scores progressively rising formnormoglycemic subjects {58.38 (95% CI: 51.08-65.67)} to subjects having IFG {70.94(95%CI:60.88-81.00)} to newly diagnosed diabetes mellitus {101.59(95%CI: 78.35-124.83)}.[P=0.001]The AUCs for diagnosing hypertension was higher for LAP scores than for BMI and WHpR[{(LAP score: 0.648 (95% CI: 0.536-0.760), p= 0.027} vs {(WHpR: 0.588 (95% CI: 0.466-0.709),p= 0.191} vs {(BMI: 0.541 (95% CI: 0.412-0.670), p=0.545}]. Similarly, the AUCs for BMI andWHpR were lower than that of LAP score for predicting a diagnosis of diabetes mellitus [{(LAPscore: 0.584 (95% CI: 0.502-0.665), p= 0.047} vs {(BMI: 0.531 (95% CI: 0.448-0.613), p=0.468}vs {WHpR: 0.518 (95% CI: 0.435-0.601), p=0.668}]. Conclusion: LAP scores were higherin subjects with established cardiovascular risks like hyperglycemia, hypercholesterolemia,accelerated atherosclerosis and hypertension that simple anthropometric indices like BMI andWHpR.
SPILLED BILE AND GALLSTONES
Authors: Khan Rao Abdul Mannan , Ghafoor Dalwani Dr. Abdul , Sushel Champa , Shaikh Ubedullah
Published: September 2021

Objectives: Intra-peritoneal bile leak and gallstones spillage is a commonevent, during laparoscopic cholecystectomy. Some time it is not possible to retrieve all spiltgallstones, these unretrieved intra-peritoneal gallstones, initially considered harmless, with timea number of complications have been reported. Our aim was to study, factors predisposing togallbladder perforation during laparoscopic cholecystectomy, and the incidence and adverseconsequences of intra-peritoneal spilt gallstone. Period: November 2008 to December 2011.Setting: Liaquat University Hospital were studied. Method: Patients who underwent successfullaparoscopic cholecystectomy for biliary colic and cholelitiasis. Patients who had intraperitonealbile and gallstones spillage during laparoscopic cholecystectomy were follow upfor long period, and all patients studied for risk of perforation and complications. Results:1038 patient underwent successful laparoscopic cholecystectomy, among them in 812(78.23%)patient intact gallbladder were removed, and in 226 (21.77%) patient gallbladder perforationoccurred. Patients had gallbladder perforations in 129(12.43) patients only bile leak was noted,and in 97(9.34%) patients bile and gallstones spillage occurred. Conclusion: We concludedthe outcome and incidence of serious complications after intra-operative spillage of gallstonesand bile, during laparoscopic cholecystectomy, is low and avoidable.
THORACIC EPIDURAL ANALGESIA
Authors: Soomro Niaz Hussain Soomro , Mehmood Hamid , Din M. Aleemud , Zafar Aneeqa Ahsan , Siddiqui Sadaf
Published: September 2021

Objectives: The aim of this study is to determine whether thoracic epiduralanalgesia with bupivacaine is better than intravenous narcotic analgesia for pain relief inthoracotomy patients. Study design: Prospective randomized study. Setting: Department ofThoracic Surgery, Ojha Institute of Chest Diseases and Dow University of Health Sciences.Period: May 2014- Nov 2015. Methods: 144 patients were allocated randomly into 2 Groups.Group A received thoracic epidural analgesia with bupivacaine and Group B received intravenousnarcotic analgesia with tramadol. Pain was monitored in both groups using the VAS pain scaleevery hour for the first 6 hours and then at 20, 24, 30, and 48 hours postoperatively. Results: Itwas observed that Group A patients experienced less pain at rest, coughing and on movementsas compared to patients in Group B throughout the monitoring from first hour to 48 hourspostoperatively. There was no significant difference between the groups in respiratory rate, O2saturation, adverse effects and performance status on day one and day two postoperatively.The mean hospital stay after operation was 7 days in both groups. Conclusions: Optimal painrelief after thoracotomy improves patient recovery and satisfaction. We determined that thoracicepidural analgesia with bupivacaine is better than intravenous narcotic analgesia for pain reliefin thoracotomy patients.
BRACHIAL PLEXUS BLOCK
Authors: Ali Muhbat , Ahmed Bashir , Raza Hamid , Suchdev Kamlaish , Khan Saqib
Published: September 2021

Objectives: The aim of our study is to find out the efficacy of dexamethasone(8mg) on prolonging the duration of motor and sensory blockade as used in brachial plexusblock required for forearm and hand surgeries. Study Design: Prospective randomized doubleblind trial. Period: April 2013 to May 2014, for a period of 14 months. Setting: Tertiary carehospital in Karachi Pakistan. Method: The study population consisted of 42 patients belongingto ASA classification, grades I and II, who underwent elective surgical procedures involving theforearm and hand. The patients were divided in to three groups, group A consisted of patientswho were given 2% of prilocaine at 5mg per kg of body weight, group B consisted of patientswho were given 2% of prilocaine with dexamethasone (8mg as 2ml) at group C consisted ofpatients who were given 0.5% of levobupivacaine at 1.5mg per kg of body weight. The timeduration and onset of sensory and motor blockade was duly noted for all the three groups.Data was analyzed using SPSS version 20. Results: The time of onset of motor and sensoryblock in group A and B, were very similar, there was a difference of longer duration was dulynoted in group C, which was statistically significant (p<0.001). In terms of the duration of block,a statistically significant difference was found when compared in the three groups (p<0.001).The duration of sensory and motor blockade was longer in Group C when compared to theother two groups, and they were found to be longer in group B when compared with group A(p<0.001). Side effects were not found in the study population due to small number of patientsevaluated. Conclusion: According to our study the addition of dexamethasone to the prilocaineused in hand and forearm surgeries resulted in increased duration of the sensory and motorblockade achieved. While levobupivacaine was found to be a very potent anesthetic when usedlocally for post op analgesia requirements and during long procedures.
DIFFERENT BLOOD GROUPS
Authors: Parveen Naila , Rehman Javeria , Hassan Syed Hafeezul , Hassan Zoya , Rehman Madiha
Published: September 2021

Objectives: To find out the association of body mass index with different bloodgroups in medical students. Background: Increased body mass index leads to obesity and is aprominent risk factor for hypertension and diabetes. Blood groups are known to be associatedwith various diseases and recent studies have shown that a particular blood group with thehighest body mass index appeared to be more susceptible to predisposition to hypertension.Study Design: Cross-sectional study. Setting: Liaquat National Medical College, Karachi.Period: June 2015 to September 2015. Methodology: 181 medical students with 85 malesand 96 females and age ranging from 18-22 years. Weight and height of each student wasmeasured using the standard stadiometer and blood groups were determined using the antisera.Results: Mean age of the participants was 19.92 ± 1.10 years. Blood group “O” wasfound to be most prevalent (39.2%) while blood group “AB” was found to be the least (8.3%).Mean BMI of subjects with blood group A, B, AB and O were found to be 24.3 ± 5.04, 22.6 ±3.59, 23.0 ± 2.91 and 23.7 ± 4.20 kg/m2 respectively. The highest BMI was found in subjectswith blood group “A” 24.3 ± 5.04 kg/m2 and lowest in blood group “AB” 23.0 ± 2.91kg/m2. TheRhesus-D positive and male students had greater body mass index 23.6 ± 3.56 than females23.2 ± 3.44. Comparison of overall mean BMI values among different blood groups showedsignificant difference with p-value < 0.001. Conclusion: Blood group “A” and Rhesus-D positivesubjects especially males were found to be the high risk blood type with predisposition tomorbidity associated with increased body mass index.
PRESCRIPTION ADHERENCE
Authors: Mahmood Zahid , Baber Khan Muhammad , Rashid Haroon-ur- , Maheen Safirah , Uttra Ambreen Malik
Published: September 2021

Objective: The aim of current research was to highlight the abilities of patients tounderstand and follow prescription. Study design: Cross sectional study. Setting: District HeadQuarter (DHQ) hospital Sargodha, Punjab, Pakistan. Duration: Data was collected betweenApril to June, 2015. Methods: Study was conducted by well-trained pharmacists regardingprescription understanding and following. A well structured questionnaire was designed to gatherinformation from 150 patients that comprised of questions based on all factors to be evaluated forprescription understanding and following. Results: The findings of this critique reveal that, 30%of patients understood instructions given on prescription where as, 12% of patients were able tocomprehend physicians writing and 23% were those who even didn’t understand prescriptionabbreviations. Similarly, correct method of drug administration, compliance with frequencyof dose and dosage form and accurate dose intake were acknowledged by 66%, 65%, 73%and 80% patients, respectively while, 28% patients were able to make clear understandingwith precautions written on prescription. However, 20% of patients reported that medicineshave disturbed their routine life, 29% recognized their dependency on prescribed medications,22% consulted with a third person for prescription interpretation, 36% reduced their dose tohalf due to side effects, 35% stated that prescribed brands were available to them and 65%missed their doses due to high cost of brands. Moreover, 76% patients showed consciousnessregarding value of therapy and only 31% patients acknowledged that prescribed brandswere economical. Conclusion: There is a lot of room for improvement in factors related toprescription understanding and following. Enhanced literacy rate, generic prescribing practicesand cost-effectiveness should be considered for prescription consideration. Most importantfrom Pakistan’s point of view, role of pharmacist should be implemented in every health sectorof country to mimic most of prescription related problems.
CESAREAN DELIVERY
Authors: Beesham Meshwari , Sham Neeta , Chetandas Pushpa
Published: September 2021

In obstetrics, the rate of caesarean section has consistently expanded globally.Generally, after caesarean section the solid food has been stopped to women for 1st 24 hoursso that it could avoid gastro intestinal complications. Mostly in all the cesarean section caseswas operated by regional anesthesia where in little intestinal manipulation and short operativetime. The aim of this study is to know that the gastrointestinal effect on early feeding versusdelayed feeding after uncomplicated cesarean section and the better practice as well asadvocated in future. Objective: Evaluation of the gastro intestinal effects with early feedingis better than delayed feeding after cesarean delivery. Study Design: Randomized controlledclinical trial. Setting: Obstetrics & Gynaecological Department, Liaquat University Hospital,and Hyderabad. Period: January 2012 to January 2013. Methodology: A total number of352 women uncomplicated emergency or elective cesarean section under spinal anesthesiawas included in this study. Consenting women were randomly assigned into two groups suchas early feeding group and delayed feeding group. Any complaint about anorexia, nausea,vomiting, abdominal discomfort and abdominal distention on physical examination was noted.Results: Rate of ileus, anorexia was significantly low in early feeding groups as compare todelayed feeding group while rate of vomiting and abdominal distension were not significantbetween groups. Average time of first bowel sound and time of passage of flatus and passageof stool were significant between groups. Conclusion: In conclusion, early feeding fastens therecovery and lowers complication rate.
CARCINOMA OF LARYNX
Authors: Ahmed Adnan , Memon Mushtaque Ali , Iqbal Muhammad
Published: September 2021

Objectives: The objective of this study was to determine the diagnosticaccuracy of CT scan in detecting thyroid cartilage invasion by carcinoma of larynx keepinghistopathological findings as a gold standard. Study Design: Cross sectional and descriptivestudy. Setting: Department of Radiology of LUMHS, And Karachi Institute of Radiotherapy &Nuclear Medicine. Period: February 2013 to August 2015. Subjects and Methods: Overall 86patients were incorporated in this study. All these patients subsequently had their histopathology.The CT outcomes were then contrasted with histopathological results & measures of variablescalculated, were based on the results. Results: Fifty patients were men & 36 patients werewomen. The ages varied from 31 to 65yrs with mean age of 50yrs. The specificity & sensitivityof CT in diagnosing thyroid cartilage invasion was 84.5% and 93.3% respectively. Accuratenessof CT in diagnosing thyroid cartilage invasion was 86.05%. Conclusion: The study establishedthe specificity, sensitivity, negative as well as positive predictive value and accuracy of CTscan for the detection of thyroid cartilage invasion as 84.5%, 93.3%, 98.4%, 56% and 86.05%respectively. Very low negative predictive value was found in patients of age more than 50 years.
BRUCELLOSIS
Authors: Malik Rafaqat , Begum Shazma , Khan Zar
Published: September 2021

Objectives: Brucellosis is one of the most common zoonotic diseases and is stilla great health problem in Middle East, the Mediterranean and South Asia. The aim of this studywas to evaluate epidemiological and clinical features of brucellosis. Study Design: Crosssectionalstudy. Period: 1st Jan 2015 to 31st Dec 2015. Setting: Registered medical specialistclinic in a rural area of District Mansehra of Khyber Pakhtunkhwa province of Pakistan. Materialsand Methods: In this study, two hundred adult patients with brucellosis were included from aregistered medical specialist clinic in Mansehra District of Khyber Pakhtunkhwa province ofPakistan, Diagnosis of brucellosis was made using Standard Tube Agglutination test (STA).Epidemiological and clinical characteristics were evaluated. Results: Out of two hundredpatients with brucellosis, 64% were female and 36% male. Fever was the most commonsymptom (84%), followed by low backache (76%), arthralgias (66%), and headache (59%).Hepatomegaly was seen in 18% while splenomegaly was present in 28%. Use of unpasteurizedmilk and dairy products was present in 66% of patients while 36% of patients were involved inanimal care. Conclusion: Brucellosis should always be considered in patients presenting withfever, low backache, joint pains and headache in endemic areas.