bluuebunny/crossref_metadata_2025 huggingface dataset:
3rd TRIMESTER OF PREGNANCY;
Authors: Naseem Nasira , Taseer Ijaz-Ul-Haque , Safdar Sohail
Published: September 2021

Objective: To see the frequency of anemia in pregnant ladies and its possible outcomes. Study design: Descriptive cross sectional study. Setting: Fatima Jinnah Women Hospital, Multan. Duration of study: Six months. Material and method: This prospective cross sectional study was conducted at Gynae and Obst. OPD at Fatima Jinnah Women Hospital, Multan. Non probability convenient sampling technique was used. All the pregnant women between 20-35 years irrespective of gestational age or any concurrent illness having parity upto 5 were registered for the study after getting written consent for participation. The pregnant ladies were evaluated by asking history of blood loss, parity, multiple pregnancy, worm infestation, use of NSAIDS and blood transfusion. They were especially asked about dietary habits which were rated as good, average and poor. Their socio economic status was assessed and was placed into high, middle and low income groups. Blood samples were drawn for blood counts and hemoglobin estimation in all the women presenting at hospital. Reflotron photometer, Roche Diagnostic was used for the blood testing. A cut off value of< 11 g/dl irrespective of duration of pregnancy was used for anemia. Peripheral blood film was examined for RBC morphology. Mean corpuscular volume (MCV) was used to categorize into micorcytic (< 76fl), macrocytic (>98fl) and normocytic (78-98fl). Fetal well being was evaluated by serial abdominal ultrasounds. Results: Three hundred pregnant women attending Gyne and Obst. OPD, Fatima Jinnah Women Hospital, Multan, were registered according to the study protocol. The duration of the study was 6 months. Maternal age was between 25-35 years. 86 % women were multiparous, 79% women presented during 3rd trimester, 15% during the 2nd trimester and 6% during 1st trimester. Thirty eight percent women had hemoglobin 8-9.9 g/dl, 48% had from 7-7.9 g/dl and 10%were falling between 5-7 g/dl. Eighty eight percent had microcytic hypochromic anemia, 12% with dimorphic picture and 4% were having low MCV and MCH but normal MCHC and these were referred for hemoglobin electrophoresis. Fifty eight percent had monthly income 2-4 thousands rupees and only 10% were earning 4-10 thousands per month. Seventy eight percent had poor diet and 22% had an average and no women were fit into the criteria for good diet. History of breast feeding was positive in 92% of the women. History of use of iron supplement was also asked, 28% had used various preparations of iron and folate for a variable period from 1-4 months, 72% never used hematinic supplements. History of previous blood transfusion during pregnancy and labour was present in 16% of the women. Three percent had fetal growth retardation. Conclusions: Prevalence of anemia during 3rd trimester of pregnancy in is high our society. It can have significant effects on maternal and fetal out come. It is a preventable cause which can be treated easily. Poverty and lack of education are the most important causes of anemia during pregnancy.
KNOWLEDGE AND CONCEPTION OF TUBERCULOSIS;
Authors: Abbas Safdar , Malik Jacob , Issac Noman , Safdar Rabia , Yasmeen Bushra
Published: September 2021

With the very high incident of tuberculosis, Pakistan ranks fifth globally among the 22 high tuberculosis risk countries. Amongst other factors, socio-demographic factors play a significant role in determining “knowledge of tuberculosis” Objectives: This study used secondary data from the Pakistan Demographic and Health Survey to estimate the impact of socio-demographic factors determining the knowledge of tuberculosis and conception on how it is spread. Data Source: The relevant variables and the other parameters were extracted from the both pdf and SPSS files of PDHS. Study Design: Bi-variant cross tabulation was used to determine the level of association between the hypothesized variables using the Pearson chi-square statistic. Results: Age and wealth index showed a highly significant relationship (p<0.0001) in determining the knowledge of tuberculosis. Moreover, the increasing level of education showed a decreasing trend of misconception about the spread of TB. Conclusions: Though the results of the study indicated a highly significant relationship between the socio-demographic factors and knowledge of tuberculosis, there is a dire need to launch awareness campaigns by the public and private sector organizations to enhance the level of correct knowledge and conception of large masses.
FRACTURE SHAFT OF FEMUR;
Authors: Memon Habibullah , Khani Ghulam Mustafa Kaim , Solangi Naveed Ahmed , Chachar Muhammad Bakhsh
Published: September 2021

Introduction: In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. Patients and Methods: This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Results: male were 58% while female were 42%, the average age of the patients were 11.78±1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. Conclusions: We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries.
LATERAL EPICONDYLITIS
Authors: Afsar Sardar Sohail , Gulzar Mohammad , Idrees Mohammad , Babar Iqtidar Ullah
Published: September 2021

Objective: With aging, chemical hormonal and vascular factors have their partto play in lateral epicondylitis. The objective is to compare results of autologous blood injectionand corticosteroid injection in treatment of lateral epicondylitis. Place and Location: Out PatientDepartment of Peshawar Institute of Medical Sciences, Peshawar from March 2013 to February2014. Material and Methods: A prospective randomized control trail conducted on 58 patientsfulfilling inclusion criteria. DASH score and VAS score used as outcome measures and bothwere recorded before injections and at each follow up made at 2 weeks, 6 weeks, 12 weeksand 24 weeks interval. P-value was calculated where applicable. Results: Out of 79 patients 65met the inclusion criteria. Mean age was 41.43 years ±13.43. 36 were females and 29 males.Dominant elbow involved in 39 patients. Mean duration of symptoms was 7.1±2.9 months. 7patients lost in follow up. DASH score improved in both groups (P value <0.0001) but whencompared there was no significance difference between the two groups ( P value 0.33 at 12weeks and 0.09 at 24 week follow up). Similarly Mean VAS improved at 12 and 24 week followup (P value <0.0001) in both groups but when compared the difference was non-significant(P value .071 at 12 weeks and 0.12 at 24 weeks follow up. Conclusions: Both steroid andautologous blood injection has shown improvement in pain and physical activity and provideacceptable results although none superior to other significantly.
TUBERCULOSIS DIAGNOSIS AND TREATMENT
Authors: Khan Nida , Chaudhry Abid Ghafoor , Khan Shaheer Ellahi , Khan Muhammad Amir , Khan Muhammad Ahmar
Published: September 2021

Pakistan is eighth among countries with high burden of tuberculosis (TB). InPakistan free-of-charge TB diagnosis and treatment services are available. The objectiveof qualitative exploratory study was to understand how TB patients and their families copewith the lost earnings and increased expenditures (other than diagnosis and treatmentcost) related with disease and its treatment. The research methods included literaturereview, focus group discussion using vignettes and in-depth interviews with TB patients.The study was done in the rural areas of Lahore District with the support of district andlocal health facility staff. The study revealed that, Results like in many other developingcountries, TB patients rely mainly on financial and physical support of family membersand friends. Conclusion The study also highlighted the need for developing institutionalmechanisms to help patients cope with economic consequences of tuberculosis.
CELIAC DISEASE
Authors: Zulfiqar Sana , Fahim Amin , Qureshi Aneela , Adnan Sadia , Siddiqui Shomail Saeed , Kashif Sumreen , Haque Mazhar ul
Published: September 2021

Objective: To find out the Modified Marsh type of celiac disease (CD)patients on histopathological examination of duodenal (D2) biopsies and to correlate it withtissue transglutaminase IgA levels. Study Design: Cross sectional study. Place of Study:Histopathology laboratory (Department of Pathology), Isra University Hospital and AsianInstitute of Medical Sciences (AIMS), Hyderabad. Duration of Study: July 2013 to December2013. Materials and Methods: 96 patients with a history of malabsorption or atypical symptomswith clinical suspicion of CD were subjected to endoscopy. Endoscopic duodenal (D2) biopsieswere taken regardless of age and gender. D2 biopsies were processed for histopathologicalexamination under light microscopy. Results: Out of 96 patients, 45 (46.9%) patients hadmoderate type of lamina propria inflammation along with highly significant p-value (0.0001).CDtype 3a was observed in 34 patients (35.4%). In this study the comparison of serological level oftissue Transglutaminase IgA (tTGA) and histological severity revealed significant correlation. AllModified Marsh types of CD with tTGA level seen in our study were highly significant (p-value0.001). Conclusion: In this study strong correlation was observed between the serologicaltTGA level and histological findings by Modified Marsh classification along with lamina propriainflammation of duodenal mucosa in CD patients.
EMERGENCY OBSTETRIC HYSTERECTOMY
Authors: Ara Sarwat , Umbreen Umbreen , Fouzia Fouzia
Published: September 2021

Background: Emergency hysterectomy in obstetric practice is generallyperformed in the setting of life-threatening hemorrhage which fails to be controlled byconservative management. Objective: To review 8 years’ experience of emergency obstetrichysterectomy in a teaching hospital. Study Design: A retrospective descriptive study based onhospital data of 156 patients undergoing emergency Obstetric hysterectomy. Settings: Obs. &Gynae. Department Unit-I, PMC Allied Hospital Faisalabad. Methods: This was a retrospectivereview carried out from March 2004 to Feb 2012 Main outcome measures were frequency,indications, associated risk factors and maternal morbidity and mortality associated withemergency peripartum/obstetric hysterectomy. Results: During 8 years there were total 156(0.38%, 3.8 per 1000) emergency obstetric hysterectomies out of which there were 46 caesarianhysterectomies, 65 post partum, 45 for ruptured uterus with total number of delivery 40062.Number of hysterectomies was 48 in the first 4 years of the study (March 2004- Feb 2008) andduring the last 4 years (March 2008- Feb 2012) it was 108. Maximum obstetric hysterectomieswere in para 3-5 (53.20%) and in 26-30 years age group (35.89%). The most common indicationfor hysterectomy was uterine atony (44.23%) followed by uterine rupture (28.85%), Placentaaccreta (14.745%) and placenta previa (11.53%). The maternal mortality was 6.41% (10patients). In this series 80% patients were referred from other areas. Conclusions: Frequencyof emergency Obstetric hysterectomy is high in our tertiary center and it is continuouslyincreasing due to increased referral of patients. The mortality and morbidity of performingobstetric hysterectomy is higher in patients referred from outside hospital.
VISUAL SCREENING
Authors: Arif Muhammad , Mehboob Qamar
Published: September 2021

Background: Various eye diseases affect school going children. They do notcomplain of defective vision usually. Uncorrected visual problems are the basic reason for earlyvisual impairment and blindness. An early diagnosis and treatment can reduce it to a greatextent. Purpose: To reduce the prevalence of avoidable blindness among urban children inPakistan. Study design: It was an observational and interventional study conducted in variousGovernment, Private and Community Schools. The children requiring detailed ophthalmicexamination and surgeries were referred to Diagnostic and Research Centre, Department ofOphthalmology, Allied Hospital, Punjab Medical College, Faisalabad. Period: January, 2013 -December, 2013. Age: 5 -16 years. Subjects and settings: Total 60,402 children were screenedfrom 87 government, private and community schools. All the students were screened for eyedisorders by testing visual acuity with Snellen’s chart, anterior segment by torch light examinationand fundus examination with ophthalmoscope. The study team included the school teachers,a clinical ophthalmologist, a refractionist, a community ophthalmologist, an optometrist, anophthalmic technician, physiologist, PG trainees and a community social worker. The childrenidentified with more complex visual problems were referred for detailed examination to AlliedHospital. Every government, private and community school of the target area was visited. All thedata was collected, arranged and analyzed. Results: During study period, total 60,402 childrenwere screened from 87 government, private and community schools. The students having visualacuity ≥ 6/12, with or without glasses, were considered as normal. Out of 60,402 screenedchildren, 54966 (91.01%) were normal and 5436 (8.99%) were identified by the teachers with theeye problems. 2,028 (3.35%) students were provided spectacles. Among these, 364 were boysand 1664 were girls. This shows 18 % refractive error in boys and 82% in girls. 120 children weretreated by surgery; 63 for cataract (0.1%), 42 for squint (0.06%) and 15 (0.02%) for ptosis. Otheridentified ocular problems were chalazion 671(1.11%), blepheritis 696 (1.15%), corneal ulcer/opacity 7 (0.01%), conjunctivitis 1133 (1.87%), non-cooperative 781 (1.29%). Conclusions: Inurban areas of Faisalabad district, 8.99% of school going children needed treatment for theirocular problems. School screening programs could play an essential role in the betterment ofeye health and the avoidance of blindness among urban children in Pakistan.
RESEARCH AMONGST JUNIOR AND SENIOR MEDICAL STUDENTS
Authors: Zehra Nayyab , Hassaan Ahmed , Mushtaq Shafaq
Published: September 2021

Background: Evidence based scientific knowledge and research is an integralpart of medicine. This led us to this study to find out the knowledge, attitude and practiceregarding research in medical students of final year and first year at Army Medical College-NUST, Rawalpindi, Pakistan. Objectives: The objectives of the study were to compare thelevel of knowledge, attitude and practice regarding research amongst medical students of finalyear MBBS and 1st year MBBS. Study Design: Cross sectional descriptive study. Place ofStudy: Army Medical College-NUST Rawalpindi, Pakistan. Duration of Study: Three months(October 2013 to December 2013). Materials and Methods: A questionnaire consisting of 23closed questions, was filled by students of first and final year MBBS, through non-probabilityconvenience sampling. The data was analyzed by SPSS 21. p value of < 0.05 was consideredto be significant. Results: Over 50% of first year students and 21.53% of the final year studentshad poor knowledge of research methodology. 89.30% students from final year along with51.30% students from first year were motivated and had interest in research activities. Not asingle student from first year and only 12.37% of students from final year were actively involvedin research process at the time of undertaking the research. 50.40% first year students and58.46% from final year strongly disagreed that there are ample opportunities for research inthe college. Conclusions: A working scientific forum should be established in the collegewith introduction of student mentor link. Students should be guided on how to carry out aresearch and how to make a good research question, how to develop skills for paper writingand evaluating the data collected.
ATTITUDE, BEHAVIOURAL IMPROVEMENT AND PREFERENCES
Authors: Memon Muhammad Qasim , Shaikh Naseer Ahmed , Memon Muhammad Saad
Published: September 2021

Objective: Present study endeavoured to assess medical student’s ethicalbehaviour, preferences and improvements one year later. Design of study: Cross-sectional,questionnaire-based. Setting: Liaquat University of Medical & Health Sciences Jamshoro.Sindh. Pakistan. Period: October 2013 - Jan 2014. Materials and methods: First year (FY) andsecond year (SY) MBBS students (n = 122 each year) of both genders, were randomly selectedand a questionnaire administered. Results: Fifty six percent male and 40% female studentsof FY marked proxy attendance; 72% males and 65% female would mark proxy attendance ifgiven a chance. Percentages increased in SY. Significant co-relation existed between genderand proxy attendance (p = 0.01); self-financed or hostlers showed no association withmarking proxy attendance. Sense of responsibility in females and courteous behavior in bothgenders improved in SY. Teacher’s behaviour affected student’s conduct; and improvementin understanding English was noted in both genders in both years, however, the small % ofstudents finding English as a barrier were prone to mark proxy attendance (p = 0.05). Malespreferred physiology whereas female preferred anatomy in both years. In FY, subject of choicewas anatomy, substituted for Physiology in SY. Majority students preferred chalk and black boardvs. multimedia based teaching. Conclusions: Cheating behaviour and sense of responsibility,but civilised behaviour, did not improve after one year education.
PERINATAL OUTCOME IN LOW AMMNIOTIC FLUID INDEX
Authors: Aslam Iram , Mussarat Nazia , Bano Sadia
Published: September 2021

Introduction: In high risk pregnancies, there is a dire need to assess amniotic fluidvolume. If values of amniotic fluid volume fall within normal limits, it reassures us regarding wellbeing of fetus. The chronically stressed fetus is likely to have low amniotic fluid. Amniotic fluidindex is a reliable fetal surveillance test and in some obstetrical units highly reliable parameter.Decreased amniotic fluid index has been considered as an indicator of poor neonataloutcome. AFI may be used to predict the occurrence of thick meconium stained liquor andneed for intervention for fetal distress in post date pregnancies. Study Design: DescriptiveStudy. Settings: Obstetrics and Gynaecology department of Fatima Memorial Hospital,Lahore affiliated with Fatima College of Medicine & dentistry Lahore. Duration: 6 month from7/2/2007 to 7/8/2007. Subjects and Methods: All pregnant women, meeting the inclusioncriteria admitted in labour room either through emergency or OPD were selected. The AFIwas calculated ultrasonically and these patients were followed till the time of delivery and theAPGAR scores of newborn were compared with AFI. Results: During the study period AFIwas measured in 60 patients. Among these patients, 32 patients had AFI between 3-4 cm andbabies were meconium stained, 23 patients had AFI of 5-6 cm and babies had normal APGARat the time of delivery. AFI was < 2 cm in 5 patients and babies required resuscitation andadmitted in nursery. Conclusion: The AFI is a reliable predictor of neonatal outcome.
SEND-UP EXAM PERFORMANCE
Authors: Yaqoob Naeem , Bhatti Saeed Akram , Javed Muhammad Shahid
Published: September 2021

One of the criteria for admission in Annual Professional Exam for medical studentsin Pakistan is to have 75% attendance during the session and the other is to pass Send upexam with 50% marks. Objectives: To assess the usefulness of send-up exams in predictingthe annual marks by comparing their results with annual University examination results forpreclinical medical students. Study Design: A cross sectional analytical study. Methodology: Atotal of 173 preclinical students of 1st and 2nd year MBBS passing the First Professional Examin first attempt were included in the study. Send up result of each student during the year wasentered as percentage and compared with percentage total marks of same students in their 1stprofessional exam conducted by the University. Data maintained by Physiology Departmentwas entered and analysed by SPSS 21. Descriptive statistics in the form of numbers andpercentages were used and further analyzed using Pearson Correlation and Paired T Test ofSignificance. The p value of < 0.05 was considered significant. Results: A total of 173 students(81 from 1st Year and 92 from 2nd Year) who had passed the annual exam in first attempt wereincluded in the study. Out of these, 132(76.3%) were females and 41(23.7%) males. All studentswere within the age group of 18-24 years, mean age being 21.06 years. Mean send-up scorein the subject of Physiology was 57.37 (Range=33-78). Percentage total marks in all subjects(Anatomy, Physiology, Biochemistry) in annual exam had a mean of 69.46 (Range=55-84).Send-up result in percentage was directly assessed against the percentage marks obtainedin annual exam for each student. The send-up marks were significantly related to the marks inthe final exam (p=0.01). The strength of association was same as that for average test markswith annual marks. Girls performed better than boys during the send up (Mean 58.35 Vs 54.21)as well as in the annual exam (Mean 70.12 Vs 67.33). There was also a difference amongstdifferent classes with 2nd year performing better than first year in both send-up (Mean 58.60vs 55.98) and annual exams (Median 70.83 vs 67.91). Conclusions: Send-up results may begood predictors of the academic performance in professional examination in preclinical years ina medical college. Female students perform better than their counterparts during both send-upand annual exams.
SURGICAL SITE INFECTION
Authors: Bashir Jamshed , Sahito Rafique Ahmed , Abbasi Mushtaque Ahmed , Jabeen Asma
Published: September 2021

Wound infection can be defined as invasion of organisms through tissuesfollowing a breakdown of local and systemic host defenses. The basic principles of wound careand antisepsis introduced during the past century improved surgery dramatically. Objective:Evaluation of causative organisms which evolved in the surgical site infection (elective abdominalsurgery) at surgical unit of Liaquat university hospital Jamshoro. Subjects & Methods: Thisprospective observational study was contains 103 patients undergoing elective, abdominalsurgery were included in this study. Surgical wound categories i.e. clean, clean contaminated,were included. Prophylactic antibiotics were given in all cases. Primary closure of wounds wasemployed in all cases. Follow up period was 30 days postoperatively. All cases were evaluatedfor postoperative fever, redness and swelling of wound margins, collection and discharge of pus.Cultures were taken from all the cases with any of the above findings. Results: The mean ageof the patient was 37 years with male to female ratio of 1:5:1. The overall rate of wound infectionwas 13.04%. Most frequently involved pathogen was E.col 33.33% followed by Staph Aureus20%, Klebsiella 20%, proteus 13.33%, Pseudomonas 6.66% and no organism was isolated in6.66% cases. Most effective antibiotics were cephalosporins, quinolones and aminoglycosides’whereas septran, erythromycin and tetracycline’s were ineffective. Conclusions: Surgicalwound infections are quite common. Time of postoperative hospital stay was twice longer ininfected case. Male sex, old age, anemia, longer duration of operation and wound class weresignificant risk factors. Most common organims are found in this study E-Coli, Kllebcella andStaph Aureus, these are mostly sensitive to cephalosporins, quinolones and aminoglycosides.
HYPERTENSION
Authors: Mushtaq Mamoona , Najam Najma
Published: September 2021

Hypertension is a condition of the person in which blood pressure is chronicallyhigh. Hypertension is a leading factor to damage health and turn out many chronic conditionsin human body1. Objectives: To study the relationship of hypertension with psychologicalstates of anger, stress and anxiety and do they predict hypertension? Study Design: A corelational study. Methodology: Outdoor hypertensive patients (N = 200, men = 110, women= 90) between ages 30-65, and control group (N = 170, men = 90, women = 80), matchedwith age, gender and monthly income were taken from the public hospitals. STAXI (Spielberger,1988) and DASS (Lovibond & Lovibond, 1995) were used for data collection. Data analysis:Descriptive statistics, chi-square, logistic regression analyses were used. Results: Significantpositive correlation of hypertension with anger, stress and anxiety was found. Anger-control,anger-in, stress and anxiety emerged as strongest predictors of hypertension.
HEART AND KIDNEY PATIENTS
Authors: Yasmeen Bushra , Khan Muhammad Zohaib , Jamshaid Nermeen , Salman Munnaza , Abbas Safdar
Published: September 2021

The prevalence of chronic diseases is exceptionally high (37.9%) among theadult population of Pakistan. Social support could play a significant role in shaping the copingstrategies and determining the subjective wellbeing of chronically ill patients. Objectives:This research documents the correlation patterns of social support with coping strategiesand subjective well-being among Heart and Kidney Patients. Methods: The primary data wascollected from four major hospitals in Lahore by using purposive sampling method. For thecollection of quantitative data, a hospital-based, cross-sectional survey was conducted with275 admitted patients (131-heart and 144-kidney) 184 male and 91 female (20 to 110 yearsof age) by using a structured interview schedule. Pearson Product-moment Correlation andMultiple Regression Analysis were performed on the data set. Results: Strongest correlationwas found between emotional and informational social support (r=.853). Instrumental socialsupport also indicates strong relationship with the emotional social support (r=.838). Therewas a moderate positive correlation (r=.339) between behavioral coping, emotional socialsupport and informational social support (r=.424). Data show a negative relationship betweenphysical coping and subjective well-being (r=.381). Results of the study suggest that emotional(β=.230) and informational (β=.217) social support affect the patients’ ability to actively engagein behavioral and physical coping for the subjective well-being; however, physical copingindicated negative effects (β=-.225) on the subjective feelings of well-being. Conclusions: Astrong correlations among four types of social support exists and behavioral coping has thestrongest impact on the subjective well-being (β=.629).
SNAKE BITE
Authors: Ansari Mohammad Asif , Hussain Ahmed , Shah Nisar Ahmed , Shah Syed Zulfiquar Ali , Baloch Zulfiqar Ali Qutrio
Published: September 2021

Snake bites are increasing amongst those who unlawfully keep snakes as petsworldwide. The rural population active in agricultural works, laborers, herders, professionalsnake handlers, trekkers, snake charmers and fishermen are at risk for snake bites. Objectives:To determine the frequency and pattern of vasculotoxic effects in patients with snake bite.Design: Case Study. Period: Six Months Setting: Liaquat University Hospital Hyderabad.Patients and methods: All the patients who initially present in casualty department of hospitalwith the history of snake bite were enrolled in the study. The vasculotoxic effects were evaluatedby whole blood clotting time (WBCT) test, bleeding time, PT/APTT, hypofibrinogemia, DIC andthrombocytopenia. Relevant information would be entered in specifically designed proformafor this study. The data was entered, saved and analyzed in SPSS. So no test of significancewould be applied. Results: Out of 140 patients 112(80%) had vasculotoxic effects, of which80(72%) were males and 32(28%) were females. The mean age ±SD of the overall patients was37.53±8.72 whereas the mean age ±SD of male and female population was 38.98±7.44 and34.88±4.32 respectively. The systemic bleeding was observed in 99% patients, the fang marksin 94 patients, the prolonged bleeding time, WBCT and PT/APTT in 103, 96 and 101 patients,thrombocytopenia in 93 patients, hypofibrinogemia in 81 patients and DIC in 76 patients.The hamaturia (22%), hamoptysis(16%) and hametemesis (11%) was predominant features.The gangrene was observed in 02 patients, vomiting was observed in 60% of patients hadhaematemesis in 11%, bleeding gums in 03 cases and haemoptysis in 16%. Renal failure wasobserved in 12 cases. Conclusions: The coagulation tests disturbed as venom increases theclotting time. Proteins digesting enzymes or thrombin like activity of venom may be one of thecauses for prolongation coagulation tests (vasculotoxic effects)
PARASITIC INFESTATIONS
Authors: Abro Shahnawaz , Bhurgiri Ashfaque Ahmed , Hussain Ahmed , Shah Syed Zulfiquar Ali , Khero Musaib Ali
Published: September 2021

Parasitic infections lead to burden of morbidity and mortality in developingcountries. Surgeons practicing in the tropics are familiar with the parasitic disorders. Objectives:To determine the role of surgery in parasitic infestations of Echinococcus granulosus and Ascarislumbricoides. Design: Cross sectional case series study. Period: Two years. Setting: LiaquatUniversity Hospital Hyderabad. Patients and methods: All the patients with Echinococcusgranulosus and Ascaris lumbricoides were admitted in the ward and were observed for differentmanifestations and surgical procedures aimed to cure the echinococcosis and ascariasisinfestation. The data was analyzed in SPSS 16 and the frequency and percentage wascalculated. Results: During two years study period, total sixty cases of parasitic infestations(50 cases of Echinococcus granulosis and 10 cases of Ascaris Lumbricoides) were detectedat Liaquat University Hospital Hyderabad / Jamshoro. The hydatid cysts was more common inthe age group of 30-39 years while the mean age ± SD in overall patients with Echinococcusgranulosis infestation was 38.74±7.84 whereas it was 35.87±8.64 and 40.43±6.73 in male andfemale population respectively. The Ascaris Lumbricoides was more common in the age groupof 15-20 years while the mean age ± SD in overall patients with Ascaris lumbricoides infestationwas 16.62±5.21 whereas it was 15.42±7.31 and 16.43±5.41 in male and female populationrespectively. Among 47 surgically treated cases of echinococcus, the approach used werecyst evacuation and tube drainage in 40 patients, total cystopericystectomy in 04 patients andlaparoscopically in 03 subjects accordingly. Seven (70%) cases of intestinal obstruction dueto ascariasis underwent surgical intervention like external milking of the obstructing bolus ofworms from the ileum into colon in 03 patients, intestinal resection and end to end anastomosisin 01 case and enterotomy and manual extraction of worms in 03 subjects accordingly.Conclusions: Hydatid disease and Ascaris lumbricoides may cause fatal complications andsurgical intervention has been the valuable option.
ILEOSCOPY
Authors: Haq Muhammad Mansoor ul , Khalil Ayesha , Shaikh Hafeezullah , Mahmood Shahid , Makhijani Kailash
Published: September 2021

Colonoscopy is one of the most important modalities to investigate complaintsrelated to lower gastrointestinal tract. Terminal ileum is an essential part of the completecolonoscopic examination. Objectives: To observe the diagnostic yield of ileoscopy in patientsundergoing colonoscopy. Design: Retrospective and observational study. Period: January 2010to May 2014. Setting: Liaquat National Hospital and Medical College. Patients and methods:Patients undergoing colonoscopy fulfilling inclusion and exclusion criteria were enrolled.Terminal ileum was examined and biopsies taken if abnormality present. Statistical analysiswas done by SPSS- 18. Result: A total of 1296 patients were included, 884 (68.2%) were maleand 412 (31.8%) were female. Age ranged from 15-90 years. The commonest indication wasbleeding per rectum (35.6%).1133(87.4%) patients had normal mucosa and 163 (12.6%) hadabnormal mucosa on ileoscopy. Of these 163 patients, 68 had ulcers, 56 had inflammation, 29had nodular mucosa and 10 had polyp. Histopathological examination showed non-specificinflammation in 139 patients; granulomatous inflammation in 7; reactive lymphoid hyperplasiain 8; 3 had normal result; biopsies were not taken in remaining 6 patients. By using chi-squaretest we found a significant statistical relationship between macroscopic abnormality of terminalileum mucosa and age of patients, weight loss, chronic diarrhoea, and abdominal pain. Onlogistic regression, age group, chronic diarrhoea and weight loss retained strong relationshipwith macroscopic abnormality of terminal ileum mucosa. Conclusions: Though a large numberof patients (12.6%) had abnormal terminal ileum mucosa, histopathological analysis did notshow any significant yield of ileoscopy. Terminal ileal abnormality was more common in youngand middle aged patients and in patients presenting primarily with chronic diarrhoea andweight loss.
INTERNALLY DISPLACED PERSONS (IDPS)
Authors: Akhunzada Wajid Ali , Qadir Altaf , Maqsood Niaz , Rasool Ghulam , Rahman Raza Ur
Published: September 2021

Most internally displaced persons (IDPs) live in low-income countriesexperiencing a war; their psychosocial health has not been well addressed. Objectives: To findout the prevalence of anxiety and depression in internally displaced persons (IDPs). Design:A randomized cluster sampling, case-controlled study. Period: 10th April 2009 to 10th July2009. Setting: This study was conducted at Kacha Ghari camp and Sheikh Yaseen camp forIDPs. Patients and Method: A total of 220 cases (those whom were exposed to traumaticexperiences) were selected through cluster random sampling. 220-matched controls (thosewhom were not exposed to traumatic experiences) were selected same day using the samesampling method. Both sexes were included. Socio-demographic information was obtainedfrom IDP- information form. Anxiety and depression was assessed using Hopkins symptomschecklist – 25 (HSCL-25). SPSS version -17 was used for statistical analysis. Chi square testwas applied for group comparison to calculate statistical significance. Results: More thanhalf of the participants (60 %) in this study were in age group between 18 to 38 years. 55 %of the population were females. Majority of participant were married (86% - 90%) and wereuneducated (74% - 90%) belongs to lower socio-economical class. The total Scores and theDepression Scores on Hopkins symptoms checklist – 25 (HSCL-25), were significant high incase group than in control group with the P values of 0.04 and 0.05 respectively. Discussion:Trauma and torture leaves a permanent scar on the survivors. It has physical, psychological andsocial squeals. Hopkins Symptoms Checklist-25 is intended to provide primary care physicians,mental health practitioners and other health care providers with an instrument for detectinganxiety and depression in torture and trauma victims. Conclusions: Besides being displacedfrom their residence exposure to trauma come out to be the important causative factor increating psychological disturbance among internally displaced persons.
SCLEROSING EPITHELIOID FIBROSARCOMA
Authors: Longquan Xiang , Mwakyoma Henry
Published: September 2021

Sclerosing epithelioid fibrosarcoma (SEF) is a rare subtype of Fibrosarcomaand was first reported in 1995. This tumour is rarely encountered and can easily be mistaken byclinicians for other diagnoses. This paper reports one case of SEF and review related literature.Objectives: To determine the clinical pathologic characteristics and discuss differentialdiagnosis of sclerosing epithelioid fibrosarcoma (SEF). Methods: One case of SEF was studiedby clinical analysis, light microscopy and the review of the literature. Results: The patient wasan adult and had a tumor located in the subcutaneous tissue of the left leg, which waspainless and grew slowly. Macroscopically, it was described as nodular and non-encapsulated.The cut section was gray-white, firm to elastic in consistency. The microscopic examinationshowed that the round to ovoid epithelioid cells with clear or eosinophilic cytoplasm arrangedin cords, nests, sheets or alveolar pattern. The stroma showed a dense hyalinized collagenousbackground. Conclusions: Sclerosing epithelioid fibrosarcoma is a low-grade variant offibrosarcoma, histologically, it should be differentiated from a variety of tumors which have theepithelioid appearance and sclerosing stroma.
REFRACTORY MYASTHENIA GRAVIS
Authors: Anees Muhammad , Idrees Jawaria , Arifullah Mashaal , Salman Saad , Abbas Sudhair
Published: September 2021

Myasthenia gravis (MG) is prototypical neurological autoimmune disorder,characterized by limb and occulo-bulbular fragility. Our case study will facilitate the practitionersas well as the scientific community to consider other therapy plans with patients presented withacute respiratory failure due to the use of rituximab.A 25-year-old man presented with acuterespiratory failure This case reporte sheds light on the importance of differential diagnoses ofrefractory myasthenia gravis for inexplicable acute respiratory failure upon rituximab treatment.The case study demonstrates the problems associated with use of rituximab in refractorymyasthenia gravis. It can cause acute respiratory failure among the patients with relapsespecially. Our case study will facilitate the practitioners as well as the scientific community toconsider other therapy plans with patients presented with acute respiratory failure due to theuse of rituximab.
HYPOGLYCEMIA
Authors: Singh Dolat , Memon Hamid Nawaz Ali , Shaikh Tariq Zaffar , Shah Syed Zulfiquar Ali
Published: September 2021

Objective: To determine the frequency and severity of hypoglycemia in patientswith liver cirrhosis. Study Design: Cross sectional case series study. Period: Six months.Setting: Liaquat University Hospital Hyderabad. Methods: All the patients of liver cirrhosis,of >12 years of age and of either gender were evaluated for hypoglycemia by assessing theglycemic status through random or fasting blood glucose level. The severity of liver cirrhosiswas identified according to the Child-Pugh classification whereas the severity of hypoglycemiawas grouped in mild, moderate and severe categories. The data was entered and saved inSPSS and frequency and percentage was calculated for hypoglycemia in patients with livercirrhosis. The stratification was done for age, gender, hypoglycemia and severity of the diseaseand hypoglycemia. The chi-square test was applied between categorical variables at 95%confidence interval and p -value ≤0.05 was considered as statistically significant. Results:During six months study period, total 100 cirrhotic subjects were studied for hypoglycemia,of which 59% were males and 41% were females. The mean ± SD for age in all (100)cirrhotic patients was 42.33 ± 8.87 while the mean ± SD for age in male cirrhotic patientswas 44.06±11.45 where as in female cirrhotic subjects it was 39.92±12.55 respectively. Thehypoglycemia was observed in 67%, of which 45(67.2%) were males and 22(32.8%) werefemales. The mean random blood glucose level in male and female hypoglycemic cirrhoticpatients was 67.88±8.43 and 65.62±6.75 while the mean fasting blood glucose level in maleand female hypoglycemic cirrhotic patients was 52.93±5.31 and 53.64±8.73 respectively. Outof sixty seven hypoglycemic cirrhotic subjects 45(67%) were males and 22(33%) were females.Of sixty seven, 32(47.8%) had moderate hypoglycemia while 30/67(44.8%) were in Child-Pughclass B (p<0.05). Conclusions: The hypoglycemia was detected in patients with liver cirrhosis,hence frequent blood glucose monitoring is one of the most important way to detect mildhypoglycemia and prevent serious and severe episodes.
SENILE CATARACT
Authors: Javed Ammara , Gul Roquyya , Malik Tayyaba Gul , Alam Rabail , Khalil Muhammad
Published: September 2021

Objective: To estimate the serum lipid profile of patients having different typesof senile cataract and compare them with that of the controls. Study Design: Observationalcase control study. Place of study: Tertiary care centre in the city of Lahore, Pakistan. Period:Six months. Methods: We selected fifty patients with senile cataract and fifty control individualsfrom tertiary care hospital of Lahore. History, ophthalmic and systemic examinations weredone. Fasting serum samples were taken for estimation of lipid profile from all the subjects.Results: In the patient group, female to male ratio was 1.63:1. 78% patients had Nuclearcataract, 16% had cortical and 6% had posterior sub capsular type of senile cataract. SerumTriglycerides, Cholesterol, LDL, HDL and VLDL of patients were compared with controls. Thep-value of cholesterol, LDL and HDL was non-significant. The p-value of triglycerides and VLDLwas significant. Conclusions: Serum Triglycerides and VLDL are modifiable risk factors in thedevelopment of senile cataract in Pakistani patients. Serum Triglycerides is the only lipid, whichhas shown consistent results related to cataract development in different parts of the world.Other lipids show variable results in different countries.
VIVAX MALARIA
Authors: Mangrio Ghulam Mustafa , Memon Mushtaq Ali , Shaikh Mumtaz Ali , Memon Hamid Nawaz Ali , Arwani Suneel , Shah Syed Zulfiquar Ali
Published: September 2021

Objective: To determine the frequency and severity of thrombocytopenia and toevaluate the variation of red cell distribution width (RDW) in patients with acute vivax malaria.Study Deign: Cross sectional descriptive case series study. Period: Six months. Setting:Liaquat University Hospital. Methods: All the patients with acute vivax malaria were evaluatedfor thrombocytopenia its severity and RDW. The data was analyzed in SPSS 10 and thefrequency and percentage was calculated. Results: Total 126 patients with acute vivax malariawere recruited, of which 88 were males and 38 were females. The mean age ±SD for male andfemale subjects was 44.76±6.83 and 40.83±7.42. The common features observed were fever31%, rigor 15% and combined features 14% (p=0.05). The thrombocytopenia was identified in86 patients of which 65 were males and 21 were females (p=0.04). The increased RDW wasobserved in 75 patients of which 57 were males and 18 were females (p=0.05). The bleedingwas detected in 56 and dyspnea and heart failure was found in 30 thrombocytopenic subjects(p=0.02). Regarding outcome 82 subjects were recovered while the 04 patients were expired(p=0.05). Regarding severity of thrombocytopenia majority 48.8% were in moderate categorywith male predominance (p=0.02). Conclusion: The thrombocytopenia and increased RDWwas observed in patients with acute vivax malaria.
IMPROVED STREPTOKINASE PRODUCTION
Authors: Faran Gull-e- , Zia Muhammad Anjum , Shahid Muhammad , Abdullah Sajid
Published: September 2021

Several strains of beta-hemolytic Streptococci produce streptokinase enzymethat can bind and activate human plasminogen to plasmin. Streptokinase degrades the fibrinlump by its explicit lysine joining site and so it is applied as a remedy in thrombolytic therapy.The purpose of the study was to subject wild strain of Streptococcus equisimilis to straindevelopment technique, using random mutagenesis by UV irradiation for enhanced productionof streptokinase. Objective: To evaluate the hyper production of streptokinase after mutagenesisof wild Streptococcus equisimilis by means of UV irradiation. Study Design: Randomized study.Period: 2012-2014. Setting: Enzyme Biotechnology Laboratory, Department of Biochemistry,University of Agriculture, Faisalabad-Pakistan. Materials and Methods: UV lamp (TUP 40wlamp which has about 90% of its radiation at 2540-2550 A0) was used for the mutation ofStreptococcus equisimilis cells (1x 107 cells mL-1) for enhanced production of streptokinase. 10mL fresh inoculum was transferred to sterile petri plates, which were exposed to UV light for 30,60, 90, 120, 150, 180, 210, 240 and 270 minutes. The exposure was carried out at distance of20cm from the centre of lamp. A dose producing 87% killing was selected as optimum dose,after preparing kill curve. The kill/ survival curve was prepared and time of exposure giving(210 minutes) 3 log kill was selected for mutation of the Streptococcus equisimilis for hyperproduction of streptokinase enzyme. Results: Enzyme assay was performed for both wildand mutant strains. Dose of 210 minutes was selected as best dose which was followed bythe selection using triton X-100. Finally the selected strain S. equisimilis EBL-UV-210 showed480 U mL-1 of streptokinase activity in quantitative blood clot liquefaction test, which is quitehigher than wild strain (370 U mL-1). This maximum yield of streptokinase was obtained after24h, at CSL 4%, pH 7.5, 37oC, KH2PO4 0.04%, K2HPO4 0.05%, MgSO4. 7H2O 0.04%, NaHCO30.15%, CaCO3 0.004%, CH3COONa. 3H2O 0.10%, FeSO4. 7H2O 0.04%, MnCl2. 4H2O 0.02%,glucose 2%, yeast extract 3% and 5% inoculum size in liquid state fermentation. Conclusions:Results showed that mutated strain gave enhanced streptokinase activity in comparison tothe wild strain. Our current study focused on streptokinase production from this UV mutatedstreptococcus equisimilis species and purification of this enzyme by ammonium sulfateprecipitation, Ion exchange and gel filtration chromatography. The activity of streptokinase wasdetermined by using quantitative blood clot liquefaction method.
RURAL URBAN MIGRATION
Authors: Malik Asma Seemi
Published: September 2021

Movement towards the urban centers of a country has been found to be acommon element in regards to the population dynamics. These dynamics however have asignificant economic, cultural, political and social impact on the lives of not only the migrantsbut also the place of destination. Through this research, it has been studied as to how therural urban movement in Pakistan impacts the social and cultural dimensions of the place ofdestination as well as those of the migrant. Furthermore, this research focused on findings themeasures taken by the government to curb the issues, however has found that the governmentof Pakistan is not taking any notice at all of the issues that exist. There is no long term vision orpolicy, a plan or implementation that would help in keeping the society and cultural of urbanand rural centers segregated.