bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracorporeal Shockwave Lithotripsy: Initial Experience at Bahawalpur
Authors: Rasool Mumtaz , Tabassum Shafqat Ali , Sheikh Abid Hameed , Mumtaz Fariha
Published: June 2016

Place of Study: American Kidney Stone Centre (AKSC), Bahawalpur, a private setup.Duration of Study: January 2005 to June 2007.Design of Study: Prospective, Observational.Material & Methods: A total of 250 patients were evaluated for ESWL results. The one session comprised of 1500-2500shocks with intermittent fluoroscopy with X-Ray focusing. A period of 7 – 10 days was given between two sessions. Theprocedure was repeated till the clearance of stone no matter what was the number of sessions. The complications like pain,colic, hematuria were addressed adequately and immediately. The development of steinstrasse was initially observed and fewrequired manipulation. The stone size is the only matter of concern in few patients especially lower pole stones.Results: The stone clearance was achieved in 89% of patients. Auxillary procedures were required in 10.8% before ESWLand 9.6% of patients after ESWL. Which include Endoscopic stenting and manipulation with uretero-renoscopy andintracorporeal lithotripsy. Prophylactic insertion of DJ stenting reduced complication rate and incidence of steinstrasse.Conclusion: ESWL can be safely recommended for patients of urolithiasis irrespective of age and stone size with promisingresults of stone clearance and patient acceptance.Key Words: ESWL-Extracorporeal shock wave lithotripsy, URS-Ureterorenoscopy. ICL-Intracorporeal lithotripsy.
The Versatility of Temporalis Muscle Flap in Reconstruction of Maxillofacial Region Defects
Authors: Ahmad Shakeel , Warriach Riaz Ahmad , Abid Hina , Ali Sadiq
Published: June 2016

Introduction: The temporalis muscle flap is an axial pattern flap based on the anterior and posterior deep temporal arteries.It is most commonly utilized after maxillectomy. The temporalis flap splits into anterior and posterior halves, or the entiremuscle used as a flap.Objectives: The purpose of this study was to: 1. Evaluate the esthetic and functional outcome by using temporalis muscleflap for reconstruction of intraoral defect. 2. Assess the effectiveness of temporalis muscle flap in intraoral defects.Study Design: It was a Descriptive studySetting: The study carried out at department of Oral and Maxillofacial Surgery King Edward Medical University / MayoHospital Lahore.Subjects and MethodsDuration: The study was completed in six months from 1st June 2005 to 30th Nov 2005.Sample size: 30 patients who presented with intraoral defect were included in this study.Sample Technique: Nonprobability Sampling (Purposive).Results: Success rate was ninety percent in this study. Failure of flaps encountered in 10% cases especially in older andimmunocompromised patients.Conclusions: Temporalis muscle flap is a good choice for most of the intraoral defects especially those in palatal and buccalregion.Key Words: Temporalis muscle flap, Palatal reconstruction, oral cavity, Mucosalisations.
Evaluation of the Treatment of Frozen Shoulder by Hydraulic Distention Under
Authors: Ghauri Shakeel Khan , Anwar Muhammad Aftab , Hanif Asif , Akram Muhammad
Published: June 2016

Objective:  To evaluate the result of treatment of frozen shoulder by Hydraulic Distention under local anesthesia with steroid and intra-articular steroid alone. Study Design:  It was a prospective and comparative study. Samples size:  60 patients were taken in this study and were divided into two groups. Duration and Setting:  The study was conducted in 2000 - 2001  treated in the department of Orthopaedic, Mayo Hospital Lahore. Methodology:  The patients were divided into two groups. Group-I were treated by hydraulic distension of glenohumeral joint with 50 ml normal saline under local anesthesia with steroid followed by medicines (oral analgesics and muscle relaxants) and exercises. Patients in group-II were treated by intra-articular steroid followed by medicines (oral analgesics and muscle relaxants) and exercises. Results:  The average age of patients in group I was 52 ± 2.16 years and 50 ± 2.03 in group II. There were 37 (63%) females and 22 (37%) males in our study. Female to male ratio was 1.7:1. All patients in group-I noted immediate pain relief with excellent return of range of motion (ROM) and resumption of normal sleep. At the end of 45 days of follow up all patients had returned to their normal daily activities. Most of them got excellent ROM and pain relief. All patients in group-II noted immediate pain relief and resumption of almost normal sleep. At the end of 45 days of follow up most of the patient presented with good relief of pain but could not return to most of their normal activities because of less improvement in ROM. Conclusions:  Hydraulic distension technique is a quick, safe and gives early results, so it should be considered first for the treatment of frozen shoulder. Key Words:  Frozen Shoulder, Hydrologic Distention, Intra articular steroid.
Knowledge, Attitude and Practices of the Mothers and Doctors Regarding Feeding,
Authors: Seyal Tallat , Hanif Asif
Published: June 2016

Introduction:  Since it’s a common observation that most cases of acute diarrhea are not managed according to WHO guidelines. Irrational use of drugs is a major problem of present day medical practice, as well as use of ORS is underesti-mated. The mothers /grand mothers reduce or stop feeding(except for breast feeding) do not know the importance of fluid therapy or ORS and cannot prepare ORS properly. This study was designed to know the exact situation. Objective:  To assess the knowledge, attitude and practices of the mothers and doctors in acute diarrhea in children ≤ 5 years of age about feeding, preparation and use of oral rehydration solution (ORS) and drugs. Design:  Cross Sectional. Place and duration:  ORT corner of Pediatric OPD at Sir Ganga Ram Hospital, Lahore from May, 2007 to September, 2007. Patients and Methods:  Nine hundred and fifty children under 5 years of age having acute diarrhea were included in the study. Data was collected on a specified questionnaire by a doctor who entered the  required information after interviewing the mothers/grandmothers accompanying the children. The information was collected regarding use of ORS and who prescribed, or they already had knowledge that it should be given, how to prepare ORS, whether or not continued feeding and used drugs during current acute diarrhea episode. The data was entered and interpreted as frequency distribution. Results:  ORS was used (given) by only 464 (49.67%) of the mothers, out of which 125(27%) used it by their own know-ledge (through newspaper, television, told by neighbours or previous consultation by the doctor). 400 (42.82%) mothers knew about preparation of ORS. Feeding was continued by 697 (74.62%) of the mothers and 400 (42.82%) used drugs, prescribed by general practitioners, medical officers of government hospitals, few by paediatrician and self during acute diarrhea. Conclusion:  It is concluded that ORS was given by 49.67% of the mothers, 42.8% could prepare it properly, feeding was stopped/reduced/diluted by 25% of the mothers. Drugs were used in 42.82% of the cases. Diarrhea control programme needs to be reinforced to improve existing practices regarding management of acute diarrhea in children ≤ 5 years of age. Inappro-priate use of drugs during diarrhea should be discouraged. Key Words:  ORS(oral rehydration solution), acute diarrhea, ORT( oral rehydration therapy).
20 YEARS OF ANNALS OF KEMU (1995 � 2015)
Authors: Awais Prof Dr. Syed Muhammad
Published: June 2016

The Annals of KEMU was first published in 1995, and Prof. Abdul Majeed Ch. was the first editor. I was appointed as editor on 15th May 2007, the responsibility which I will be completing on my retirement on 9th December, 2015. A brief report of Annals of KEMU from 15-05-2007 to 09-12-2015 is stated below for kind information of the authors, reviewers and readers of the Annals. The title of Annals of KEMC was changed to Annals of KEMU, new editorial board was constituted and editorial policy was made and approved on 14th June 2007. According to editorial policy 2007, the editorial process was divided into six (6) steps; 1-Manuscript Submission, 2-Plagiarism Check with Turnitun, 3-review of manuscript by two reviewers, 4-acceptance/rewriting/rejection, 5-publication and 6-circulation. As a result of high quality, the Annals was recognized by PMDC in 2009. The HEC recognized Annals first in category Z and later on raised the category to Y and in July 2015 to highest category X. Annals of KEMU has been indexed with; 1-Pak MediNet (1996), 2-EMRO Indexus of WHO (1997), 3-Directory of Open Access Journals-DOAJ (2007), 4-ICJME Database(2010), 5-PKP Harvester Database, 6-Open J Gate Database (2010), 7-Google Scholar. From June 2007 to November 2015, thirty five (35) issues of Annals of KEMU were published. Five hundred and sixty (560) manuscript were received, four hundred and thirty eight (38) manuscripts were accepted and published, forty three (43) were rejected, and four (04) manuscripts were withdrawn by authors. Until December 2015, seventy five (75) manuscripts are in editorial review process. Total income of the Annals from June 2007 to December 2015 was Rs. 12,52,280/- (Grant from HEC Rs. 6,12,280, collection from authors at rate of Rs. 1,000 for processing each manuscript Rs. 5,60,000 and from advertisements Rs. 80,000. During this period the expenditures of Annals have been Rs. 12,80,215 (publication cost Rs. 11,36,215 and correspondence and circulation Rs 1,44,000). In this way the cost to KEMU treasury has been Rs. 27,935/-. The credit for the achievements of; maintaining good quality (plagiarism below 19% and approval by two reviewers of same specialty), achieving PMDC recognition and highest HEC rank, having Annals indexed with 7 databases and just cost of Rs. 27, 935 to KEMU treasury for publishing of 35 Issues goes to our able editorial board, authors, reviewers and the staff. I take this opportunity to thank all of them, espe-cially the editorial secretaries, Mr. Asim Saeed and Mr. Muhammad Afzal (Assistant Annals of KEMU), who have worked very hard.
MARITAL SATISFACTION AND EXTRAMARITAL BEHAVIORAL INTENTIONS IN MEDICAL PROFESSIONALS
Authors: Mansoor Ayesha , Khalid Shazia
Published: June 2016

Objectives:The present research was conducted to investigate the relationship between marital satisfaction and extramarital behavioral intentions in medical professionals.Study Design:Cross sectional research design was used to conduct the present study.Material And Methods:Relationship Assessment Scale constructed by Hendrick in 1988 was used to assess marital satisfaction of the study sample.1 Extramarital behavioral intentions were assessed by using extramarital behavioral intentions scale by Buunk in 1981.2 Cross sectional research design was used in the research. Correlation, hierarchal regression, one way ANOVA and independent sample t-test was applied for analysis using SPSS version 16.0.Results:Overall, the results proved that there is a negative relation among marital satisfaction and extramarital behavioral intentions. Male participants are likely to indulge in extramarital behavioral intentions than female participants. Whereas participants who had love marriage and had lesser number of children were more martially satisfied than those who had arra-nged marriage. Demographic variables collectively accounted for 11% of the variance and extramarital behavioral intentions overall accounted for 5% of variance predicting marital satisfaction.Conclusion:Marital satisfaction and extramarital behavioral intentions in medical professionals are negatively correlated.Keywords:Marital Satisfaction, Extramarital behavioral intentions, Medical Professionals.
MALIGNANCY IN SOLITARY COLD NODULE THYROID
Authors: Virk Usman Habib , Muhammad Yar , Gondal Khalid Masood , Siddique Humayun
Published: June 2016

AbstractIntroduction:The thyroid gland is one of the largest endocrine gland constitute of two lobes connected by an isthmus. Thyroid nodules are a frequent clinical problem and its incidence is rising. The solitary nodules are the palpable nodule in otherwise normal gland whereas dominant nodules are the palpable nodule in an enlarged gland. There is a variable frequency of malignancy in solitary cold nodule. Our study is aimed to find its frequency in local population.Objective:To determine the frequency of Maligna-ncy in solitary cold nodule thyroid.Material and Methods:This is the descriptive case series study conducted at East Surgical Ward, Mayo Hospital Lahore in 1 year duration from 01-01-2014 to 31-12-2014. 140 patients age more than 12 years of either sex with confirmed solitary cold nodule thyroid of any size on physical examination, ultrasound and thyroid scan through non-probability purposive sampling technique were included in the study. A biopsy of the cold nodule was sent to hospital laboratory to determine the frequency of malignancy. All demographic and clinical findings were recorded on a predesigned proforma. All collected data was entered and analyzed by using SPSS 20. Quantitative variables like age and size of nodule was presented in the form of mean SD and qualitative variables like gender and malignancy was presented in the form of frequency and percentages. Post-stratification chi-square test was applied, P-value ? 0.05 as significant.Results:The mean age of the patients was noted as 40.10 11.62 years. There were 47.14% male patients while 52.86% female. Malignancy was found in 23 (16.43%) patients whereas absent in 117 (83.57%) patients.Conclusion:It is concluded that the malignancy is more frequent in solitary cold nodule thyroid in our local population and in timely intervention and proper screening is recommended.Keywords:Malignancy, Cold Nodule Thyroid, Thy-roid Scan, Biopsy.
FREQUENCY OF UNRUPTURED ECTOPIC PREGNANCY IN A TERTIARY CARE HOSPITAL OF HAIL CITY, SAUDI ARABIA
Authors: Rasheed Saadia , Shahbaz Sehar , Hammad Shazia
Published: June 2016

AbstractAims and Objectives:Determine the frequency of unruptured ectopic pregnancy in a tertiary care hospital of Hail City, Saudi Arabia.Study Design:It was an observational case series.Material and Method:A total of 150 cases between 15 44 years with history of amenorrhea (6 8 weeks) and vaginal bleeding with or without lower abdominal pain, positive urine pregnancy test were enrolled in the study while heterotopic pregnancy, ruptured ectopic pregnancy and patients in first trimester with obstetric problem other than ectopic pregnancy were excluded from the study. All these cases were collected from Maternity and Childrens hospital Hail, Kingdom of Saudia Arabia during 2011 to 2014.Results:In our study, 64.67% (n = 97) of the cases were between 15 30 years of age while 35.33% (n = 53) were between 31 44 years, mean sd was calculated as 26.34 2.67 years, frequency of unruptured ectopic pregnancy was recorded in 14% of the cases.Conclusion:The frequency of un-ruptured ectopic pregnancy is higher and TVS may be used for early detection of this morbidity.Key Words:Ectopic pregnancy, un-ruptured, Transvaginal sonography.
ADMINISTRATION OF SALINE INJECTION IN EPIDURAL SPACE AVOIDS INTRAVASCULAR CATHETER INSERTION IN PATIENTS UNDERGOING CAESARIAN SECTION: A RANDOMIZE CONTROLLED TRIAL
Authors: Azam Muhammad , Akthar Naila , Butt Tanvir Akhtar
Published: June 2016

AbstractObjective:The objective of this study was to determine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women undergoing cesarean section can decrease the frequency of inadvertent intravascular catheter placement.Study Design:Randomize Controlled Trail.Place and Duration of Study:Department of Anaesthesia at Gynaecology and Obstetrics operation theater, Jinnah Hospital, Lahore affiliated with College of Physician and Surgeon Pakistan from April 2008 to March 2009.Methodology:Sixty pregnant patients (ASA I and II) randomly allocated in Group A and B equally for elec-tive cesarean section were selected. In each patient epidural space was identified with LOR technique using air in sitting position. In Group A (dry group), no saline was injected while in Group B (saline gro-up), 10 ml saline was injected before epidural catheter placement. Using 16 G Toughy needle, catheter was inserted up to 4 cm in the epidural space. To find out inadvertent intravascular catheter placement, epidural catheter was aspirated to exclude blood. After negative aspiration, test dose of 3ml injection xylocain 2% (with adrenaline 1:200,000) was administrated and patient were monitored one minute for increase in heart rate (> 20% of baseline), tinnitus and perioral numbness.Results:In both group data collected was analyzed in SPSS version 11 and Chi-square test was applied. P value of 0.05 or less was taken significant. Percentage of positive inadvertent intravascular catheterization in term of bloody aspirate (20 and 13.3%) was not signi-ficantly different between two groups (P value = 0.488). Increase in heart rate, tinnitus and perioral numbness was not observed in any patient.Conclusion:There was no significant difference in accidental intravascular catheterization if 10 ml saline is injected through needle before catheter insertion.Key word:Epidural catheter, accidental intravascular catheterization, anaesthesia.
DIAGNOSING PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH KNOWN CORONARY ARTERY DISEASE IN A TERTIARY CARE CENTER IN LAHORE AND ASSESSING DIAGNOSTIC ACCURACY OF ANKLE � BRACHIAL INDEX TAKING DUPLEX ULTRASOUND AS GOLD STANDARD
Authors: Naseer Nauman , Hassan Ahmed , Ghous Zeeshan
Published: June 2016

IntroductionIt is common for patients with PAD to have concomitant CAD because both are caused by atherosclerosis, a systemic process. This has been well established in international studies. The incidence of PAD in patients with known CAD in our population is unknown. The ankle brachial index (ABI) can be calculated by taking the ratio of ankle systolic pressure and brachial systolic pressure. It is a simple, easy and cost effective bedside tool to diagnose peripheral arterial disease (PAD).Objective:The objective of the study was to:Determine the incidence of PAD in patients with known coronary artery disease (CAD) in our population.Determine the diagnostic accuracy of ABI in diagnosing PAD in patients with CAD taking dup-lex ultrasound as gold standard in local population.Study Design: Cross sectional study.Setting:Department of Cardiology (CCU), Jinnah Hospital, Lahore.Study Duration:Six months from 01 June 2014 to 31 December 2014.Subjects and Methods:310 patients who met the inclusion / exclusion criteria were entered in the study. Mercury sphygmomanometer was used to take the systolic blood pressure of all the four limbs, and the ratio of ankle systolic pressure (higher of systolic pressure taken in both left and right limb was taken) to brachial systolic pressure (higher of systolic pressure taken in both left and right limb was taken) was used to calculate the ABI. An abnormal ABI was conside-red if the ratio was < 0.9. All subjects underwent duplex ultrasound as a gold standard to detect the presence or absence of PAD.Results:Out of 310 cases, common age was calcula-ted as 59.21 8.93 years, 53.23% (n = 165) were male while 46.77% (n = 145) were female, frequency of peripheral artery disease (PAD) on gold standard was recorded as 28.71% (n = 89), diagnostic accuracy of Ankle-Brachial Index (ABI) in diagnosing peripheral artery disease (PAD) in patients with coronary artery disease (CAD) was calculated as 93.25%, 94.21%, 86.46%, 97.20% and 93.87% as specificity, sensitivity, negative predictive value, positive predictive value and accuracy rate respectively.Conclusion:There is a 28.7% incidence of PAD in patients with known CAD in our study population. The ABI is a simple, easy low cost and yet underutilized tool that can detect PAD with high diagnostic accuracy in this population.Keywords:Coronary artery disease (CAD), peripheral artery disease (PAD), diagnosis, ankle bra-chial index (ABI), accuracy
COMPARISON OF FETAL OUTCOME IN PLANNED ELECTIVE DELIVERIES AT 38 AND 39 GESTATIONAL WEEKS AT LADY WILLINGDON HOSPITAL, LAHORE
Authors: Qaisrani Gul Hani , Rizvi Sarwat , Jafri Anum , Haider Rubar
Published: June 2016

AbstractIntroduction:Planned elective cesarean delivery is carried out when a patient has no emergency maternal or fetal indication for cesarean section. Such a planned cesarean section can be delayed.Objective:To compare fetal outcome of planned elective cesarean deliveries at 38 and 39 weeks of gestation in a tertiary care hospital.Study Design: Cohort Study.Place and Duration of Study:Lady Willingdon Hos-pital, Lahore. The study was carried out over a period of six months from 1st October, 2012 to 3 st March, 2013.Sample Size:A total number of 470 live born neonates were included in the study. 235 neonates were born at 38 weeks while other 235 neonates were born at 39 weeks of gestation.Results:Majority of patients, 121 (51.48%) who underwent cesarean section at 38 weeks of gestation were at 26 30 years of age with mean age of 27.69 3.5 years. Mean parity at 38 weeks cesarean delivery group was 2.4 1.35. 19 (8.1%) neonates were admitted to intensive care unit in this 38 weeks gestational age cesarean delivery group. Majority of patients 122 (51.91%) who underwent cesarean section at 39 weeks of gestation were between 26 30 years of age with a mean age of 27.36 3.54 years. Mean parity of patients in this group was 2.30 1.280. 6 (2.6%) neonates delivered at 39 weeks of gestation were admitted to neonatal intensive care unit.Conclusion:Neonatal outcome was better at 39 weeks of gestation as compared to 38 weeks of gesta-tion.Key Words:Planned cesarean delivery, neonatal intensive care unit admission (NICU), transient tachypnea of newborn.
EXPERIENCE OF HALOPELVIC TRACTION IN THE TREATMENT OF SEVERE SPINE DEFORMITY: A CASE SERIES
Authors: Ali Syed Asif , Ch Asad Ali , Humayun Ahmad Sarfraz , Dar Usman Zafar , Awais Syed Muhammad
Published: June 2016

AbstractBackground:Severe and rigid scoliosis and kyphosis are difficult to treat but with the advent of new spinal operative techniques and implants, it has become man-ageable in expert hands. However these implants are too expensive for developing countries like us. The Halo-pelvic traction is a relatively cheaper device sys-tem used to treat such deformities. Moreover, rapid curve correction and one stage surgery may lead to permanent neurological deficit.Objective:To evaluate treatment outcome of Halo-pelvic Traction in the treatment of severe scoliosis and kyphosis.Methodology:This descriptive study was conducted in the department of Orthopedics surgery and traumatology unit I, King Edward Medical University, Mayo Hospital Lahore from September 2010 to August 2012. The patients with severe spinal deformity which could not be corrected at a single stage were included. A Performa was made for each patient and results were statistically analyzed by using SPSS version 20.Results:Total no. of 07 patients were treated, out of them 04 scoliosis patients having mean Cobbs angle of 77.25 5.31 before treatment, improved significantly to 45 5.35 after surgery (p?0.0001), 03 kyphosis patients with mean Kyphus angle of 96.67 24.66 improved to 58.33 17.56 (p?0.0001). Two major complications i.e. one paraplegia which recovered incompletely and one had CSF discharge from cranial pin that was also revived thoroughly after changing the position of the pin.Conclusion:Halopelvic traction device can help in treating the patients of severe scoliosis and kyphosis.Keywords:Kyphosis, Halo-Pelvic, Kyphus angle, Cobbs angle.
DEVELOPMENT OF MDR TB IN SHORT DURATION IN A PATIENT RECEIVING TREATMENT FOR SIMPLE TB: A CASE REPORT
Authors: Munir Muhammad Kashif , Rehman Sana , Iqbal Rizwan , Saeed Muhammad Saqib
Published: June 2016

AbstractMultidrug resistant (MDR) tuberculosis (TB) is becoming more cumbersome especially in developing countries. Already supportive infrastructures are weak as compared to disease burden. Numerous diagnostic techniques for early diagnosis of TB and MDR TB have brought incremental improvements however; the technical intricacies of these assays and their reliance on enthusiastic laboratory infrastructure have restricted their implementation, particularly in low resource and high burden settings. Recently introduced GeneXpert MTB / RIF assay simultaneously detects the presence of MTB, and its susceptibility to the important first line drug rifampicin. Aim of this report is to understand the role of physician in prompt diagnosis and its control in spread of MDR TB and conversion of normal TB to MDR TB using available resources. Watchfulness of physician is an important factor in treating TB patients and early diagnosis of MDR TB using available resources. A good skilled team work is necessary to locate such cases in early stages and pro-mpt treatment can save many lives and ultimately serve as a big barrier in spreading primary MDR TB.Keywords:MDR TB, Tuberculosis, Prompt Diagnosis, GeneXpert.
Effects of Aloe Vera in Local Massage Oils in Alternative Medicine for the Treatment of Joint Pains: A Double Blind Study
Authors: Arain Innayat Ullah , Husnain Amina , Talat Aisha
Published: June 2016

AbstractIntroduction:Aloe vera has been reported to have effects upon skin, joint pains and diabetes but without scientific evidence. It has never been studied in isolation as a single drug. Our study was a small study to study the symptom lowering effects of Aloe Vera gel when used in combination with a topical massage oil.Patients and Methods:A prospective double blind interventional study was conducted with patients of osteoarthritis knee randomized in two groups of patients (20 in each). Both groups were given topical oil for massage over the affected joints. They were provided oral analgesic tablets in fixed numbers and during follow up Visual analogue score and number of tablets used was taken as measure of alleviation of symptoms.Results:Both groups comprised of 20 subjects each and had similar characteristics for age/sex/laterality of joint involved. The epidemiological characteristics of the groups were similar. Group A used Topical Mas-sage Oil without addition of Aloe Vera Gel while Group B used the same oil with addition of the gel. It was observed that patients who had been given massage oil with addition of Aloe Vera gel showed less use of oral analgesics during study period and their VAS scores were less as compared to the Group A who were using the same massage oil but without Aloe Vera Gel.Conclusion:Aloe Vera as local application seems to improve pain relief and decrease oral analgesic use in patients of osteoarthritis knees who are being treated with local massage oils of alternative medical origin. Further studies need to be done to reach a conclusion.Key Words: Massage Oil, Aloe Vera, Analgesia.
Frequency of Successful Vaginal Birth after Previous One Cesarean Section in Low Risk Pregnant Women
Authors: Rasheed Saadia , Shahbaz Sehar , Hammad Shazia
Published: June 2016

AbstractAims and Objectives:determine the frequency of successful vaginal birth after cesarean section VBAC in low risk pregnant women.Study Design: It was a descriptive study.Duration:From 2010 to 2014.Material and Method:A total of 130 cases who were at term (37)+ weeks of gestation, between 20 40 years of age with a single prior cesarean section, presenting in their next pregnancy (G2) with a single, live fetus in cephalic presentation and those who given the consent of trial of VBAC were included in the study while high risk cases e.g. hypertensive disorders, gestational diabetes mellitus, placental abruption etc were excluded from this review. All these cases were collected from Maternity and Children's hospital Hail, Kingdom of Saudia Arabia.Results:In our study, 63.85% of the cases were between 20 30 years of age while 36.15% (n = 47) were between 31 40 years, mean sd was calculated as 27.24 3.52 years, mean gestational age was 38.43 2.43 weeks while successful vaginal birth after cesarean section was recorded in 78.46% (n = 102) while 21.54% (n = 28) had failed trial of VBAC.Conclusion:Higher success rate of vaginal birth after one cesarean section in low risk pregnant women is recorded while no significant adverse outcome in these cases is found. However, in our setup it is safe and cost-effective as well.Key Words:Cesarean delivery, low risk, VBAC, success rate, safe, cost effective.
Comparison of Maitland Thoracic Spine Manipulation Versus Maitland Cervical Spine Mobilization in Chronic Unilateral C6 – C7 Cervical Radiculopathy
Authors: Waqas Shoaib , Ahmad Ashfaq , Ahmad Shahzad , Shafi Tariq , Shahid Hassan Anjum
Published: June 2016

Background:  Radicular pains are very common in cervical region due to C6 – C7 nerve root involvement which results discomfort and restriction of mobility of upper and lower segments of cervical and thoracic spine. A lot of evidences about non-operative treatments have been derived for managing cervical radiculopathies with a little documentation of manual therapy. So, in this study, Maitland concept of manipulation and mobilization at two different regions of spine (thoracic and cervical) respectively, was used to see the change in pain reduction and restoration of normal functional abilities.Methodology:  A study design of Comparative single blinded, randomized control clinical trials was used. 100 patients having chronic unilateral C6 – C7 cervical radiculopathy’s symptoms due to disc prolapsed, divided into two groups with simple random sampling as guided per-consolidated standards of reporting trials (CONSORT) guidelines were used. First group was managed with Maitland thoracic spine manipulation (MTSM), mechanical intermittent cervical traction (MICT) for 10 minutes and regime of strengthening exercises (SE) and second group was managed with Maitland cervical spine mobilization (MCSM), MICT and SE. The duration of treatment was four weeks at the rate of three times in one week. Two outcome measures numeric pain rating scale (NPRS) and Neck disability index (NDI) questionnaire were used for evaluation and investigation. Data was collected at start, after two and after four Weeks’s treatment. Independent T test with extension of Levene’s test was used with 0.05% level of confidence.Results:  The calculated p value for NPRS and NDI for group A (MTSM) was P = 0.000which was less than 0.05 having validation of significant changes. So, we reject our Null hypothesis that MTSM is more effective than MCSM.Conclusion:  The result shows that MTSM and MC-SM were effective techniques for pain reduction and functional abilities restoration. However, the subjects of first group with MTSM, MICT and SE presented better progress in reduction of neck ache and refining functional status during comparison.
Medical Management of Cervical Ectopic Pregnancy
Authors: Arif Wasima , Mukhtar Farrah , Naheed Iffat , Naz Farhat
Published: June 2016

Cervical ectopic pregnancy is a rare condition with implantation in the endocervical canal below the closed internal os. It accounts for less than 1% of all ectopic pregnancies. It is associated with high morbidity and mortality. A case of cervical ectopic pregnancy is reported. She was a young nulliparous female, timely referred from peripheral hospital. She was treated successfully with medical management and thus fertility was preserved
Types of Conflicts in Doctors in Private and Public Sector Hospitals
Authors: Khalid Shazia , Fatima Iram , Khan Waheeda
Published: June 2016

Objective:  The present research was conducted to assess whether doctors of private and public sector hospitals would differ in organizational conflict types after controlling gender.Material and Method:  The sample comprised of 178 doctors employed in private and public sector hospitals among which 84 were from private hospitals and 94 were from public sector hospitals. Rahim Organizational Conflict Inventory – III was used to assess the types of conflicts.Results:  Results revealed that the doctors from private sector hospital experienced all types of conflicts more than doctors from public sector hospitals, after controlling for the gender. Further substantive conflict was experienced more than other types of conflicts in both settings.Conclusion:  Although, type of sector plays a major role in determining level of conflicts in doctors, yet task related conflicts named as substantive conflicts are dominant in both types of settings whether private or public.
Personal Belief in a Just World and Self – Compassion as Predictors of Body Appreciation in Individuals with Amputation Using and not Using Prosthesis
Authors: , Farhat-ul-Ain , Fatima Iram
Published: June 2016

Objectives:  To investigate the relationship of personal belief in just world self – compassion with body appreciation in individuals with amputation who use prosthesis and in those who do not use prosthesis.Methods:  A sample of 78 individuals using prosthesis and not using prosthesis (n = 39 each) was selected. Cross – sectional research design was used. Urdu translated version of Personal Belief in Just World Scale (PBJW), Self – Compassion Scale and Body Appreciation Scale were used. Moderated regression analysis was used to assess if personal belief in just world and self – compassion predict body appreciation similarly or differently in the two groups using SPSS 20.Results:  Among individuals with amputation using prosthesis were 30 (76.9%) men and 9(23.1%) women while among 39 individuals not using prosthesis were 30 (76.9%) men and 9 (23.1%) women. Age of individuals with amputation using and not using prosthesis was, M = 37.10, SD = 14.30 and M = 39.13, SD = 14.14 respectively. Duration of amputation of those using and not using prosthesis in years was M = 6.10, SD = 7.74 and M = 8.35, SD = 11.82 respectively. Duration of use of prosthesis in years was M = 3.29, SD = 3.86. Personal belief in just world positively predicted body appreciation in both groups. Self – compassion predicted body appreciation only in individuals with amputation using prosthesis. Individuals using prosthesis had better body appreciation than those not using prosthesis.Conclusion:  Use of prosthesis helps in body appreciation of individuals with amputation. Over and above the use of prosthesis, personal belief in a just world is a personal resource that plays its role in maintaining body appreciation. However, Self – compassion aids in body appreciation among individuals with amputation using prosthesis.
Metabolic Syndrome in Rural Community
Authors: Pasha Mehmood Alam
Published: June 2016

According to our observation, prevalence of metabolic syndrome is rising in urban populations as well as rural communities. However, this rising problem is largely being ignored and according to preliminary results quality adjusted life years can be increased by preventing Metabolic Syndrome. The first attempt to give a proper definition of Metabolic Syndrome was done by World Health Organization (WHO) in 1998.1 According to WHO criteria metabolic syndrome consists of diabetes mellitus along with any two of the following: BP greater than 140/90 mm Hg, hypertriglyceridemia, decreased HDL, central obesity and microalbumenemia.2 Metabolic syndrome is a major use of morbidity in diabetic patients and medical establishments.
Ileostomy in Typhoid Perforation
Authors: Bashir Mustehsan , Nadeem Tahir , Iqbal Javed , Rashid Abdur
Published: June 2016

This is a prospective observational study carried out during last five years (Jan, 1998 to Nov, 2002) The purpose was to study guidelines of case selection for different available procedures to treat typhoid perforations. Ninety cases of typhoid perforation were treated by different procedures. The complete records were maintained and a designed protocol of management was observed. Male to Female ratio was 4 to 1. Average age 26 years (7 cases below 10 years and 6 cases above 40 years) Only 17 cases (18.88%) presented within 24 hours, the largest group of 31 cases (34.44%) presented after 72 hours. Although complication rate was very high in the late reporting, no significant mortality difference was noted. Primary ileostomy (group 1) 18 cases had no mortality, 53 cases of simple perforation closure had 5 mortalities (9.43%), resection anastmosis group that is 19 cases had 2 mortalities (10.5%), closure of the ileostomies (19 cases) had no mortality and a very low complication rate. In our study ileostomy is a good life saving procedure to be used judiciously, accepting its inconvenience to the patient.
Off-Pump Coronary Revascularization preserves Renal Function in patients with Preoperative Non-Dialysis dependent renal dysfunction - A Prospective, Randomized Study
Authors: Raja Shahzad Gull , Haider Zulfiqar , Zaman Haider
Published: June 2016

The off-pump coronary artery bypass operation (OPCAB) is a relatively new surgical procedure, which avoids the use of cardiopulmonary bypass and is intuitively considered renoprotective in patients with preoperative normal renal function. However, no prospective, randomized study has been done so far to show whether these benefits may also apply to patients with preoperative non-dialysis dependent renal dysfunction. This first ever prospective, randomized, controlled trial was performed in 50 patients (45 men, mean age 51.2±4.8 yrs) with preoperative nondialysis dependent renal insufficiency, undergoing first-time elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on-pump) or beating heart revascularization (off-pump). Glomerular and tubular functions were assessed upto 48 hrs postoperatively. There were no deaths, strokes or myocardial infarctions in either group. Glomerular function as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on-pump group (p=0.0003 and p=0.008, respectively). Renal tubular function was also significantly impaired in the on-pump group as assessed by the increased N- acetyl glucosaminidase activity (p=0.021). Six patients in the on-pump group developed acute renal failure requiring renal support compared with one in the off-pump group although statistically the comparison was not significant (p=0.098). This study suggests that off-pump coronary artery bypass surgery reduces the likelihood of acute renal failure in patients with preoperative non-dialysis dependent renal dysfunction and thus shortens postoperative intensive care and length of hospital stay.
The Adjunctive Use of the Erbium, Chromium: Yttrium Scandium Gallium Garnet Laser in Closed Flap Periodontal Therapy. A Retrospective Cohort Study
Authors: Al-Falaki Rana , Cronshaw Mark , Parker Steven
Published: June 2016

Objectives:

The current periodontal literature has been inconsistent in finding an added advantage to using lasers in periodontal therapy. The aim of this study was to compare treatment outcomes following root surface instrumentation alone (NL group), or with adjunctive use of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser (L group).

Material and Methods:

Patients diagnosed with generalized chronic periodontitis, having a minimum of 1 year follow up were selected by a blinded party for inclusion in a retrospective analysis from patients treated prior to and after integration of laser in a single clinic setting. Probing depths (PD) of all sites ≥5 mm and full mouth bleeding scores were analyzed. Further analysis was carried out on the treatment outcomes of only the molar teeth and of pockets >6mm.

Results:

53 patients were included (25 NL,28 L). There was no significant difference between baseline PDs (NL=6.19mm, L=6.27mm, range 5-11mm). The mean PD after one year was 2.83mm (NL) 2.45mm (L), with the mean PD reductions being 3.35mm (NL) and 3.82mm (L) (p<0.002). The mean PD reduction for the molars were 3.32mm (NL) and 3.86mm (L) (p< 0.007), and for ≥7mm group were 4.75mm (NL) compared to 5.14mm (L) (p< 0.009). There was significantly less bleeding on probing in the laser group after one year (p<0.001)

Conclusion:

Both treatment modalities were effective in treating chronic periodontitis, but the added use of laser may have advantages, particularly in molar tooth sites and deeper pockets. Further research with RCTs is needed to test this hypothesis further.
Reconsidering adjuvant versus salvage radiation therapy for prostate cancer in the genomics era
Authors: Lobo Jennifer M , Stukenborg George J , Trifiletti Daniel M , Patel Nirav , Showalter Timothy N
Published: June 2016

Aim:
We developed a decision analysis framework to simulate the clinical choice of early adjuvant versus delayed salvage radiation therapy after radical prostatectomy.
Materials & methods:
We designed a Markov decision analysis model to represent two alternative treatment approaches for prostate cancer after prostatectomy over a 10-year time horizon. The model contained individualized inputs including genomic classifier score. Sensitivity analyses were performed to evaluate model results.
Results:
Observation with delayed salvage radiation is preferred according to the base case, with greater average length and quality of life. However, adjuvant therapy is preferred over observation with salvage when genomics-based estimates of recurrence are high.
Conclusion:
Model results were sensitive to genomics-based estimates of cancer recurrence and to nonprostate cancer mortality.
Are drug-coated balloons cost effective for femoropopliteal occlusive disease? A comparison of bare metal stents and uncoated balloons
Authors: Poder Thomas G , Fisette Jean-François
Published: June 2016

Aim:To perform a cost–effectiveness analysis to help hospital decision-makers with regard to the use of drug-coated balloons compared with bare metal stents and uncoated balloons for femoropopliteal occlusive disease.Methods:Clinical outcomes were extracted from the results of meta-analyses already published, and cost units are those used in the Quebec healthcare network. The literature review was limited to the last four years to obtain the most recent data. The cost–effectiveness analysis was based on a 2-year perspective, and risk factors of reintervention were considered.Results:The cost–effectiveness analysis indicated that drug-coated balloons were generally more efficient than bare metal stents, particularly for patients with higher risk of reintervention (up to CAD$1686 per patient TASC II C or D). Compared with uncoated balloons, results indicated that drug-coated balloons were more efficient if the reintervention rate associated with uncoated balloons is very high and for patients with higher risk of reintervention (up to CAD$3301 per patient).Conclusion:The higher a patient's risk of reintervention, the higher the savings associated with the use of a drug-coated balloon will be. For patients at lower risk, the uncoated balloon strategy is still recommended as a first choice for endovascular intervention.
The Shape of the Glucose Response Curve During an Oral Glucose Tolerance Test Heralds Biomarkers of Type 2 Diabetes Risk in Obese Youth
Authors: Kim Joon Young , Michaliszyn Sara F. , Nasr Alexis , Lee SoJung , Tfayli Hala , Hannon Tamara , Hughan Kara S. , Bacha Fida , Arslanian Silva
Published: June 2016

OBJECTIVE

The shape of the glucose response curve during an oral glucose tolerance test (OGTT), monophasic versus biphasic, identifies physiologically distinct groups of individuals with differences in insulin secretion and sensitivity. We aimed to verify the value of the OGTT-glucose response curve against more sensitive clamp-measured biomarkers of type 2 diabetes risk, and to examine incretin/pancreatic hormones and free fatty acid associations in these curve phenotypes in obese adolescents without diabetes.

RESEARCH DESIGN AND METHODS

A total of 277 obese adolescents without diabetes completed a 2-h OGTT and were categorized to either a monophasic or a biphasic group. Body composition, abdominal adipose tissue, OGTT-based metabolic parameters, and incretin/pancreatic hormone levels were examined. A subset of 106 participants had both hyperinsulinemic-euglycemic and hyperglycemic clamps to measure in vivo insulin sensitivity, insulin secretion, and β-cell function relative to insulin sensitivity.

RESULTS

Despite similar fasting and 2-h glucose and insulin concentrations, the monophasic group had significantly higher glucose, insulin, C-peptide, and free fatty acid OGTT areas under the curve compared with the biphasic group, with no differences in levels of glucagon, total glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, and pancreatic polypeptide. Furthermore, the monophasic group had significantly lower in vivo hepatic and peripheral insulin sensitivity, lack of compensatory first and second phase insulin secretion, and impaired β-cell function relative to insulin sensitivity.

CONCLUSIONS

In obese youth without diabetes, the risk imparted by the monophasic glucose curve compared with biphasic glucose curve, independent of fasting and 2-h glucose and insulin concentrations, is reflected in lower insulin sensitivity and poorer β-cell function, which are two major pathophysiological biomarkers of type 2 diabetes in youth.
How Does Student Educational Background Affect Transition into the First Year of Veterinary School? Academic Performance and Support Needs in University Education
Authors: Rutland Catrin S. , Dobbs Heidi , Tötemeyer Sabine
Published: June 2016

The first year of university is critical in shaping persistence decisions (whether students continue with and complete their degrees) and plays a formative role in influencing student attitudes and approaches to learning. Previous educational experiences, especially previous university education, shape the students' ability to adapt to the university environment and the study approaches they require to perform well in highly demanding professional programs such as medicine and veterinary medicine. The aim of this research was to explore the support mechanisms, academic achievements, and perception of students with different educational backgrounds in their first year of veterinary school. Using questionnaire data and examination grades, the effects upon perceptions, needs, and educational attainment in first-year students with and without prior university experience were analyzed to enable an in-depth understanding of their needs. Our findings show that school leavers (successfully completed secondary education, but no prior university experience) were outperformed in early exams by those who had previously graduated from university (even from unrelated degrees). Large variations in student perceptions and support needs were discovered between the two groups: graduate students perceived the difficulty and workload as less challenging and valued financial and IT support. Each student is an individual, but ensuring that universities understand their students and provide both academic and non-academic support is essential. This research explores the needs of veterinary students and offers insights into continued provision of support and improvements that can be made to help students achieve their potential and allow informed “Best Practice.”
Diagnosis of Rheumatic Fever and Rheumatic Heart Disease in Evolution
Authors: Islam AKM Monwarul , Khan HI Lutfur Rahman
Published: June 2016

Abstract not availableBangladesh Heart Journal 2015; 30(1) : 1-4