bluuebunny/crossref_metadata_2025 huggingface dataset:
HEPATITIS C VIRUS (HCV) INFECTION
Authors: Sajjad Aiza , Gardezi Shahnawaz , Mukhtar Fatima , Anjum Amna , Saeed Qiarush , Dawood Noor
Published: September 2021

Background: With a high magnitude of hepatitis C in the country and theburden still rising it was imperative to assess the knowledge of HCV infected individuals, whichwould determine the further spread of the disease or otherwise based on the adoption of goodpractices by these patients. Objectives: To evaluate the knowledge and practice regardingHCV in Hepatitis C patients presenting at Ghurki Trust Teaching Hospital, Lahore and toformulate recommendations based on study results to improve knowledge about hepatitisC. Study Design: Descriptive cross-sectional study. Setting: Ghurki Trust Teaching Hospital(GTTH), Lahore. Period: January to May 2015. Methods: The patients of hepatitis C registeredat GTTH for treatment were included in the study after obtaining voluntary informed consentfrom the respondents and approval of the study from the institutional ethical review board. Theconvenience non-probability sampling technique was used to recruit 169 study participants.A pre-tested structured questionnaire was used to collect information, which was recordedand analyzed using the statistical package for social sciences version 21.0. Data is describedin the form of frequencies and percentages for categorical variables and mean and standarddeviation for continuous variable. Results: Of the 169 HCV patients, 110(65%) had heard ofhepatitis C before acquiring it, the popular source of information regarding HCV was identifiedas relatives by 67(39.8%) of the patients. 70(41.4%) of the respondents were aware of a virusbeing the cause of hepatitis C, 140(82.8%) knew that HCV can be spread through sharinginjecting equipment, nearly half the respondents 87(51.5%) had asked their family membersto get tested for HCV and 68(40.2%) patients practiced safe sex. Conclusion: Majority of therespondents had heard of HCV before acquiring the disease. A large proportion of patients wereaware of the disease being spread through sharing injecting equipment. Half of the patients hadtheir family members tested for HCV. But less than half practiced safe sex.
COPING STRATEGIES OF MOTHERS WITH ASD CHILDREN
Authors: Mahmood Hamid , Saleemi Munir , Riaz Hashim , Hassan Yasir , Khan Farzana
Published: September 2021

Introduction: Autism spectrum disorder (ASD) is a group of developmentaldisabilities that can cause significant social, communication and behavioral challenges”.American Psychiatric Association’s defined ASD as “a single disorder that includes disorders thatwere previously considered separate — autism, Asperger’s syndrome, childhood disintegrativedisorder and pervasive developmental disorder not otherwise specified”. Objectives: Toexploration of the coping strategies of mother who are the primary care giver of the familyand children with ASD. This study correspondingly emphasized on the policy makers to bringthis subject to the agenda for the training (Coping) and support (Insurance) of mothers andASD children for special education needs (SEN) by the government. Study Design: Qualitativestudy. Methods: This research explored mothers coping practices with ASD children inRawalpindi by means of qualitative study design phenomenology. Theoretical frameworkused were, life course perspective and social constructivism which will facilitate the completeprocess. Interview guide is made on the format suggested by Steinar Kvale. Data analysiswill be done by two analytical techniques, grounded theory analysis. Results: The results ofthis study were categories which were generated were divided into two main parts positive/healthy and negative/impaired coping strategies they are as follow:- Positive coping strategies.a) Integration b) Networking c) Religion. And the Negative coping strategies a) Avoidance b)Ignorance c) Isolation. Conclusion: Overall, findings indicated that mothers sorrow and griefassociated with ASD is common in every mother. Mothers coped by educating themselves.Findings indicated feelings of shock, grief and acceptance were the part of mother’s responses,on the discovery of their child’s autism diagnosis. Findings indicated daily routines were notaffected but the ASD child.
BATTERY OPERATED AND MANUAL TOOTH BRUSH
Authors: Banglani Munir Ahmed , Jahangir Mohammad Feroz , Punjabi Suneel Kumar , Khawaja Naveen , Talpur Nida
Published: September 2021

Background: Dental plaque may cause oral problems that may include dentalcaries, periodontal problems, and halitosis. Motivation, awareness and manual dexterity havemuch effect on tooth brushing. The advantages related with manual and battery operated toothbrushing have been reported different in the literature. Objective: To compare the manual andbattery operated tooth brush for plaque removal efficiency. Study Design: Randomized controltrial. Setting: The Dental OPD of Department of Community Dentistry, Liaquat University ofMedical and Health Sciences, Jamshoro. Period: November 2011 to June 2013. Methods: Total100 patients of both genders, aged ≥18 years were included. Patients were equally divided intomanual and battery operated brush groups. The presence of plaque was checked and plaqueindex was recorded. Wilcoxon sign pair test was applied to compare pre and post plaquescore for manual and battery operated tooth brush. Independent sample t test was applied tocompare percent reduction of plaque score between groups. The significance level of P-valuewas up to 0.05. Results: In manual brush group, 27 were male and 23 were female. Meanage was 25.65±5.87 years. In battery operated brush group, 32 were male, 18 were female.Mean age was 29.92±10.37 years. Before manual brushing mean plaque score was 1.88±0.65while after brushing it was reduced to 1.11±0.43. Percent reduction was 40.96%, p=0.0005.Mean plaque score was 1.35±0.37 and 0.69±0.29 before and after brushing respectively inbattery operated brushing. Percent reduction was 48.9%, p=0.0005. Battery operated brushingwas significantly more effective than manual (p=0.023). Conclusion: Battery operated toothbrush was significantly more effective than manual toothbrush. It removes significantly moresupragingival plaque than manual tooth brush.
ENDOTRACHEAL INTUBATION PROCEDURES
Authors: Nasir Shua , Shehbaz Lal , Raza Hamid , Basar Saqib
Published: September 2021

Objective: The objective of the study is to study the procedure of endotrachealintubation; its methods between Rapid sequence intubation and crash intubation its successrates and the associated short term complications at the accident and emergency departmentof a government run hospital in Karachi, Pakistan. Study Design: Case series. Setting: Accidentand Emergency Department of Civil Hospital Karachi. Period: 2010 to 2012. Methods: Thesample size taken is of 260 patients, all of whom must be above the age of 14 years, andundergo the procedure of emergency endotracheal intubation. Rapid sequence intubation isanalyzed against crash intubation using descriptive type of statistical analysis. The significancelevel was p<0.05. Results: From the 260 Endotracheal intubations performed, 45 (17.30%)had to be discarded on account of incomplete data. The remaining study population was 215patients (123 males, 92 females) Rapid sequence intubation was the commonest type (n=138,64.18%). Head and neck injury, pulmonary edema was the common complication. Crashintubation was the second type (n= 77, 35.8%) Primary attempt success was found to be 97%(n=134) in rapid sequence intubation and 80% (n = 62) in crash Endotracheal intubations. Atotal of 13 complications (6.04 %) were observed. Conclusion: In light of the results obtainedour study shows a satisfactory success rate on using either mentioned types of intubationprocedures that is either RSI or Crash Intubation.
CHRONIC EXPERIMENTAL DIABETES MELLITUS
Authors: Khan Mohammad Afzal , Altaf Faris Mohammed Nour , Chaudhry Muhammad Naeem
Published: September 2021

Background: Multiple factors operate in the development of diabetic neuropathy.Sensory neurons are not protected by blood-brain or blood-nerve barrier; also the dorsal rootganglion cells (DRG) have a higher metabolic requirement than the nerve trunks. Oxygen levelat the dorsal root ganglions also appears to be lower. All these physiological characteristicssuggest that DRG may be particularly susceptible to damage in prolonged diabetic conditions.Objectives: To observe the quantitative cellular changes in dorsal root ganglion cells in rats withprolonged experimental diabetes. Study Design: An experimental study. Setting: Departmentof Human Anatomy, Faculty of Medicine, Umm al Qura University, Makkah, Saudi Arabia.Period: Fifteen months to complete. Material and methods: Observations were made on sixcontrol and six streptozotocin-treated male Sprague-Dawley rats after 12 months of diabetes.Cell count was done on silver-stained paraffin sections. DRG cells were arbitrarily groupedas large A-type and small B-type. Statistical examination of the cell count was done using atwo-tailed t-test. Values were considered significant at P ≤ 0.05. Results: In the control groupof animals the mean total number was 15856.33 ± 552.538 while in the diabetic animals itwas 11836.666 ±583.177; the reduction in the number of cells was significant. The number ofA-type and B-type cells and their percentages in the control group and the diabetic group ofanimals were 2753.833±257.683 (17.36%), 13102.5±443.092 (82.63%) and 1202.833±87.082(10.16%), 10633.833±517.900 (89.83%) respectively. The differences in the number of A-typeand B-type of cells when compared between control and diabetic groups of animals werestatistically highly significant. Conclusion: Selective cells damage to DRG cells may be theharbinger of diabetic neuropathy in experimentally induced diabetic rats.
WILSON’S DISEASE
Authors: Kumar Sunil , Bashir Awais , Ahmed Raheel
Published: September 2021

Objectives: To determine the frequency of various neurological manifestationsof Wilson’s disease in patients presenting to tertiary care facility. Study design: Cross sectionalstudy. Setting: Neurology ward, JPMC, Karachi. Period: 14-03-2012 to 13-09-2012. Patientsand Methods: A total of 150 diagnosed patients of Wilson’s disease between the age 15 and55 years were recruited. Structured questionnaire was used to collect the data regardingneurological manifestations of Wilson’s disease along with slit lamp examination for kayser-Fleischer rings. Data were entered and analyzed in SPSS version 17. Chi-Square test was usedas test of significance. Results: Mean age + S.D of patients was 38.7 + 8.23 years. Most of thepatients (42%) belongs to age between 41 to 50 years. Male to female ratio was 2:1. Tremorwas the most common neurological manifestation (88.7%) followed by dysarthria in 77.3%,dystonia was present in 59.3%, chorea in 36%, and Parkinsonism in 28.7%. All patients hadthe Kayser-Fleischer ring positive. Upon stratification of gender, tremor & dysarthria were morecommon in males as compared to females. Only dysarthria was significantly noted to increasewith increasing age up to 5th decade of life and decreased after age of 51 years. (P value< 0.001). Conclusion: Neurologic manifestations are very common in patients of Wilson’sdisease, tremor being the most common with male predominance.
PATHOGENS CAUSING BLOOD STREAM INFECTIONS
Authors: Saeed Muhammad , Rasheed Farhan , Ashraf Fouzia , Iram Shagufta , Hussain Shahida , Khawaja Abdul Rehman
Published: September 2021

Blood stream infections (BSI) remain a major cause of debility and death aroundthe world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials arebased on the susceptibility pattern of the pathogens isolated in a specific institute from timeto time. We have conducted this study only on cardiac Patients over two & half years of studyduration. Study design: Cross sectional study. Settings: Microbiology Department, Allama IqbalMedical College/Jinnah Hospital, Lahore. Study Period: January 2013 to July 2015. Materials& Methods: A total of 5411 blood culture specimens were collected from cardiac patientsincluding patients admitted to cardiology ward, coronary care unit (CCU), pre-operative andpost-operative cardiac surgery patients. The bottles containing BHI broth were incubated andwere subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkeyagars. Isolates were further identified with the help of Gram staining, biochemical reactionsand rapid tests like catalase, oxidase, coagulase, Analytical Profile Index (API) 20E and API20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar byModified Kirby Bauer disc diffusion technique according to the isolate as per recommendationsof Clinical and Laboratory Standards Institute (CLSI) guidelines 2013. Results: Out of total 5411patients, 3958(73.14%) were male, 1453(26.85%) were females. Out of total 5411 Specimens,only 486 (8.98%) were positive for bacterial growth. Out of total 486 positive blood cultures,261 (53.71%) were Gram positive isolates and 225 (46.29%) were Gram negative isolates.Out 486 positive blood cultures, 96 (19.75%) were from cardiology ward, 67 (13.78%) werefrom CCU, 113 (23.25%) were from pre operative cardiac surgery ward, 210 (43.20%) werefrom post operative cardiac surgery ward. Among Gram positives, Staphylococcus Specieswere most common organism isolated from 246 (50.61%) blood culture specimens. AmongGram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolatedfrom 81(16.66%) and 72(14.81%) blood culture specimens respectively. Conclusion: GramPositive isolates were more common as compared to Gram negative isolates. Vancomycin andLinezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactamwas most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecyclinewas most effective drug.
HEPATITIS B AND C
Authors: Aslam Muhammad Naveed , Nadeem Muhammad , Qureshi Umar Farooq
Published: September 2021

Background: Pakistan is a developing country of 180 million people with lowhealth and educational standards. According to the Human Development Index of the UnitedNations, it is ranked 146th out of 187 countries. Objective: To know the actual disease burdenof Chronic Hepatitis Viruses B and C in Southern Punjab. Study Design: Cross-sectional,Observational study. Setting: Ibn-e-Sina Hospital and Research Centre. Period: March 2010 toFebruary 2014. Methodology: A total of 26800 people from general population were includedin the present study. Free vaccination camps were established in rural and urban union councilswith the help of local politicians, in Schools, Madrassahs and Industrial units and a permanentcamp was established in Ibn-e-Sina Hospital. People of all age groups and either sex werevaccinated. Results: A total of 26800 individuals were screened, (mean: 36.47 ± 13.81). 2090(7.8%) tested positive for Anti-HCV. Among these 68.6 % (n=1433) were males while 31.4%(n=657) were females. 616 (2.3%) tested positive for HBsAg of which 401 (65.2%) were maleand 215 (34.8%) were female. 75 subjects (0.28%) were positive for both HBsAg and Anti-HCV.Conclusion:- We as a community need to be more vigilant as the disease burden of HBsAg isnot decreasing in the general population and the Burden of Anti-HCV is one of the highest inthe world.
DECOMPENSATED CIRRHOSIS
Authors: Mobin Ahsan , Haroon Hussain , Shaikh Hafeezullah , Qureshi Fawed , Ali Murtaza
Published: September 2021

Objective: The objective of the study is to find out, the levels of thyroid hormonesin serum of the patients having decompensate cirrhosis and to determine the frequency of signsand symptoms of thyroid dysfunctions in such patients. Study design: Prospective descriptivestudy. Setting: All medical wards of Civil Hospital and Ojha campus, Dow University of HealthSciences, Karachi, Pakistan. Period: May 2013 to January 2015. Methodology: 76 patientshaving decompensated liver cirrhosis with various presentations, which were fulfilling theinclusion and exclusion criteria and were admitted in medical wards during the study period,were included in this study. Detailed history and examination of each case was performed.Thyroid hormone levels were performed along with other relative laboratory investigations andthe results were obtained. Results: Out of 76 patients 58 patients had low serum T3 levels,whereas 18 had normal T3 levels. 65 patients had normal T4 levels and 11 had low serum T4levels. The TSH levels were found normal in 74 patients and two patients had raised TSH levels.Conclusion: It is concluded that T3 levels is low in cirrhotic patients but at the same time T4 andTSH levels remains normal in majority of cases and the patients remain euthyroid. As far as theclinical scenario is concern, no significance was found in the frequency of sign and symptomsof thyroid dysfunction. Most of the patients did not show signs and symptoms of hyper andhypothyroids.
CAROTID ATHEROSCLEROSIS
Authors: Bukhari Hassan , Shaukat Asim , Ahmed Nosheen Ahmed
Published: September 2021

Objectives: To determine the frequency of carotid atherosclerosis in obesepatients having hepatic steatosis and its effect on the development of MI. Design: Crosssectionalstudy. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: FromJanuary 2012 to June 2013, Patients and method: A total of 96 patients were included in thisstudy. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of commoncarotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Ultrasoundwas done in supine position & elevation of chest by pillow. Patient head will be turned to theopposite side. Intima media thickness was accessed in the distal wall of common carotidartery of both sides 1.0 cm proximal to carotid bulb. Results: Mean age of the patients was46.69±11.86 years. Out of 96 patients, 51 (53.1%) were males while remaining 45 patients(46.9%) were females. Presence of carotid atherosclerosis was noted in 96 patients (100.0%).Out of these patients, myocardial infarction was present in 81 patients (84.4%). Mean BMI was30.67±0.47, mean weight was 91.86±7.57 Kg and intima media thickness was 0.84±0.12 mm.Conclusion Prevalence of atherosclerotic changes in carotid arteries detected by Dopplerultrasound among obese patients having hepatic steatosis and its effect on the developmentof MI is remarkable
CHRONIC HEPATITIS C
Authors: Salim Rind Muhammad , Iqbal shah Muhammad , Suthar Ramesh Kumar , Jahangir Syed
Published: September 2021

The major causative factor of hepatic cirrhosis and its complications in chronichepatitis C is due to presence of liver fibrosis. To assess prognosis and management relateddecisions, the exact staging of liver fibrosis is of greatest importance. Now, liver biopsyis the inexact gold standard for this purpose. APRI or AST to platelet ratio Index is the bestnoninvasive marker which can predict presence of fibrosis in majority of chronic hepatitis Cpatients without the need of biopsy. It is also cost effective and only depends on routine testing(Platelet count and serum AST). Objectives: To determine the positive predictive value ofAPRI Score for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients. Studydesign: Cross sectional study. Setting: Medical wards and Out Patient Medicine Departmentof Liaquat University Hospital Hyderabad / Jamshoro. Period: 6 months. Methodology: A totalof 51 patients of either gender, age >14 years presenting to Medical wards and OPD for theevaluation of chronic hepatitis were enrolled in this research study after giving preference andavoiding criteria. Clinical data was collected at the time of liver biopsy and blood samples forliver function tests, blood glucose and complete blood picture with platelet count were collectedbefore the biopsy (only AST and platelet count are needed for APRI score) a core biopsy needleof 14 gauge was used and the procedure was conducted under ultrasound guidance. Fibrosisstage was determined according to the METAVIR group scoring system. The patients wereexamined in a very comfortable manner and all the information collected from the patients waskept confidential and entered in the predesigned proforma. Results: A total of 51 patients wereselected for this study. Out of these 31 (60.78%) were male and 20(39.22%) were female. Themean age was 42.53 years (±11.2 SD). The positive predictive value for APRI score between0.5 to 1.0 was 58.82% whereas the positive predictive values for APRI score 1.1-1.5 was 70.58%.Conclusion: The positive predictive values of APRI score in the ranges of 0.5 to 1.5 were notindicative of the presence of significant liver fibrosis in this research study. However, additionaldata are required to authenticate or disprove the usefulness of APRI score for the prediction ofsignificant hepatic fibrosis in chronic hepatitis C patients.
SPINAL ANESTHESIA
Authors: Raza Hamid , Ahmed Bashir , Kamlaish Kamlaish , Basr Saqib , Ali Ahmed
Published: September 2021

Objective: The purpose of the study is to compare and assess the sensoryand motor block along with the associated hemodynamic changes that occur in the patientpopulation operated for a lower segment cesarean section (LSCS), when they are given 0.5%hyperbaric bupivacaine versus 0.5% isobaric bupivacaine as used for spinal anesthesia.Study Design: Prospective double blind randomized trial. Period: 6 months duration fromApril 2014 to September 2014. Setting: A tertiary care hospital in the city of Karachi, Pakistan.Method: The study population consisted of 60 patients belonging to the ASA 1 and ASA 2category, who underwent a lower segment cesarean section, and comparative analysis ofthe efficacy and associated hemodynamic changes of hyperbaric with isobaric bupivacaine.The patient population was segmented into two groups both groups containing 30 patients,group A receiving hyperbaric bupivacaine 0.5% as 2.5ml ( 12.5mg dose ) and the secondgroup designated as, group B receiving isobaric bupivacaine 0.5% as 2.5ml ( 12.5mg dose)intrathecally. The resultant sensory and motor blockade was determined using pin prick andbromage scale respectively. Results: There was a significant difference found among the twogroups under study, when compared at 3min interval regarding the sensory blockade. The levelof T6 block was reached in 33.33% (n=10) patients belonging to group A and 56.66% (n= 17)patients in group B. It was observed that there was no significant change among the two groupsat 5min interval regarding sensory and motor blockade respectively. The immediate sensoryblockade with isobaric bupivacaine in group B produced greater decrease in the systolic andmean arterial blood pressure when contrasted with hyperbaric bupivacaine in group A at 5mininterval, but after time interval of 45min there was no statistically significant change observed.Conclusions: According to our study the effects of isobaric bupivacaine were more significantlypredictable; hence have a higher efficacy, when contrasted against hyperbaric bupivacainein lower section cesarean section spinal anesthesia. Quick sensory blockade with isobaricbupivacaine was associated with more decrease in blood pressures when contrasted with thehyperbaric bupivacaine, but this result is not statistically significant.
PATIENTS WITH SYSTOLIC HEART FAILURE
Authors: Kazi Shazia , Bawany Muhammad Adnan , Memon Feroz , Hashmi Fasih Ahmed , Kazi Sajjad , Bohio Rabail
Published: September 2021

Objective: The objective of this study is to determine the prevalence of IRfunction in the patients with systolic heart failure. Study Design: Cross-sectional study. Setting:Patients admitted in the Cardiac Ward of Civil Hospital. Methodology: IRF was evaluated onthe basis of creatinine and GFR. Cases having creatinine of more than 1.2mg/dl and GFR lessthan 90ml/min were considered to have IRF. Serial measurement of creatinine was made initiallyon admission then on fifth day. Elevated creatinine of 0.3mg/dl from baseline creatinine duringadmission had justified as WRF. All patients were followed daily for 10 days and final outcomewas measured at the end of 10 days. Results: 377 cases were enrolled in this study during studyperiod. (70.03%) were male. Mean weight was 79.36±12.2 kg and 70.8% patients of weight 70kg. Of 377 selected cases 57% patients developed IRF. Conclusion: It was concluded fromthis study that renal impairment is highly linked with Heart Failure. 57% patients were found tohave developed IRF in this study.
ASSESSMENT
Authors: Awan Uzma , Ahsan Uzma
Published: September 2021

Introduction: Assessment results have been proved as major hallmark for theprogress or regression of teaching and learning. University of Health Sciences is the examiningbody to assess the students of B.D.S. by four methods; MCQs, SEQs, VIVA and OSCE/OSPE.The oral examination is an important part of the practical examination that helps assess threeareas which are clinical knowledge, cognitive and professional skills. Objectives: purpose ofthis study was to explore student’s perspective on viva as an assessment method for subject ofscience of dental materials. Study design: cross-sectional study. Period: Started in November2014 completed in December 2015. Setting: Questionnaire was filled by B.D.S. 2nd professionalstudents of three dental colleges of Lahore of private sector. Sharif medical and dental collegeLahore. CMH dental college Lahore. University College of medicine and dentistry. University ofLahore. Methodology: 120 students from three different institutions were included in this study.30.9% of the students were boys whereas 69.1 % were girls. All students were interviewed abouttheir choice of assessment among the routine methods of assessment; MCQ, SEQ, Viva andOSPE. Results: 15% of the students replied MCQ to be their first choice of assessment. SEQwas selected as first choice of assessment by 26.6% of the students. 56.6% were in the favourof OSPE whereas only 1.7 % students were in the favour of viva examination. Conclusion: Theoral examination has intrinsic weakness of low reliability and objectivity. Structuring the vivaexamination can be implemented and improve viva method of assessment.
PATTERNS OF MEDIASTINAL TUMORS
Authors: Soomro Niaz Hussain , Shariff Dr. Ali Shan , Zafar Aneeqa Ahsan , Ehtisham Omar , Maxood Guzel , Panjwani Kinza
Published: September 2021

Objective: To review all the mediastinal tumors and cysts operated uponat Department of Thoracic Surgery, OICD, DUHS over a 2.5 year period. Study design:Retrospective descriptive study. Place and duration of study: Ojha Institute of Chest Diseases,Dow University of Health Sciences, Karachi, Pakistan from November 2012- April 2015. Materialand methods: 50 patients with mediastinal masses of either sex were included in the study.Tumors were categorized as arising from the anterior, middle and posterior mediastinum onthe basis of CT scan chest. Tumors were classified into various type based on the results ofhistopathology. Data was obtained from hospital medical records and proformas were filledfor each patient. Results: A total of 50 patients with mediastinal masses were seen at theDepartment of Thoracic Surgery, Ojha Institute of Chest Diseases between Nov 2012- April2015. There were 30 males and 20 females (ratio 1.5:1). Most of the patients were between 11-70 years of age, with mean age of 32 years. The most common location for mediastinal tumorswas found to be the anterior mediastinum which comprised of 40% of all tumors, followed byposterior (32%) and middle mediastinum respectively (28.0%). Shwanomma (18%) was themost common type of tumor observed, followed by lymphoma (12%) and germ cell tumors(10%). Conclusion: Mediastinal tumors are relatively uncommon in clinical setting. Thesetumors represent a group of heterogeneous masses present between two pleural cavities. Adefinitive early diagnosis is the key in management and prognosis of the patient.We present our5 year experience of patterns of mediastinal tumors.
COLONIC CANCER
Authors: Abbas Shah Tajammal
Published: September 2021

A prospective study was conducted to see presentation and management of coloniccancer presenting to a surgical unit in a teaching hospital at Faisalabad. Objectives: To knowdifferent presenting symptomatology like abdominal mass, pain, intestinal obstruction, alteredbowel habits, rectal bleeding, age co-relation, sex distribution, anatomic location among coloniccancer patients and management done for these patients. Study Design: A prospective study.Period: February 2009 to March 2010 for one year. Material and Methods: Total 8 patients werediagnosed and treated for colonic cancer presenting in a single surgical ward. Patients with ageabove 14 years were included in study while patients presenting with trauma and metastaticdisease for other carcinoma were excluded. Results: Among 8 patients diagnosed for coloniccancer, age’s range from 26 to 50 years at maximum, 2 patients (25 %) were males and 6 patients(75 %) were females. Only one patient (12.5%) presented with single complaint of left iliac fossamass, 2 patients (25 %) with only single complaint of rectal bleeding as a presenting symptomwhile all other 5 patients (62.5%) presented with more than one or two symptoms at the sametime. Among 5 patients presented with more than one symptom all had presented with abdominalmass associated with additional symptoms like, one patient (12.5%) developed intestinalobstruction with left sided abdominal mass, another one patient (12.5%) left sided abdominalmass with alternate diarrhea and constipation, another one patient (12.5%) right sided masswith pallor, one patient (12.5%) had constipation with left sided mass while another one patient(12.5%) developed abdominal pain, weight loss and palpable left sided abdominal mass. Patientswere staged according to TNM staging system. All patients were above stage II and Dukes B. Allpatients were operated in Surgical Unit II at Allied Hospital Faisalabad. Left hemi-colectomy wasdone for 2 patients; right hemi-colectomy was done for single patient presented with mass andanemia on right side, sigmoid resection with colostomy for one patient, Hartmann’s procedurefor another one patient and single stage resection with primary anastomosis for one patient. 2patients underwent abdomino-perineal resection with end colostomy. Conclusion: This studytells that majority of the patients with colon cancer presented with left sided abdominal mass andother associated symptom, the age’s range from 26 to 50 years. Disease affected 6 females out oftotal 8 patients. Two patients underwent APR with end colostomy while other patients were treatedwith alternate procedures like primary anterior resection with anastomosis or end colostomy
CHOLEDOCHOLITHIASIS
Authors: Hussain Shabab , Aslam Viqar , Muhammad Khan Sajjad , Alam Jan Waqar
Published: September 2021

Objectives: To determine the frequency of choleducholethiasis in patientswith symptomatic gall stone disease and evaluation of primary closure of common bile ductwithout T-Tube placement after open exploration as a treatment modality in its management.Study Design: Prospective (descriptive) study. Setting: Surgical Unit of Postgraduate MedicalInstitute, Lady Reading Hospital, Peshawar. Period: One year from 15-03-2013 to 15-03-2014. Subjects and methods: Total 0f 206 patients of symptomatic gallstones disease wereincluded in the study to find out frequency of choledcholithias and patients with common bileduct (CBD) stones were subjected to open choledochotomy and primary choledochorrhaphy,and follow up of patients was done to find out any post operative complication. Results: Atotal of 206 patients underwent open cholecystectomy during the study period. The age ofthe patients ranged from 17 to 70 years with mean of 44.24±1.23 years. Most of the patientswith symptomatic gall stones disease were female in the age range of 41-50 years. Frequencyof choledocholethiasis was 24 out of 206 constituting 11.65%. Among the patients with CBDstones 4 were male constituting 16.6% and 20 were female that is 83.33% with male to femaleratio of 1:4 respectively. Mean hospital stay of the patients in which open CBD explorationand primary repair was performed was 7.25±1.45 days. Complications developed in only 4patients constituting 16.66%. Complications were wound infection in 2 (8.33%) patients, intraabdominalpus collection in 1 (4.16%) patient and bile leak in 1 (4.16%). One patient lost fromfollow up. In none of the patients retained CBD stones and stricture observed. Conclusions:There should be low
H.PYLORI INFECTION
Authors: Naveed Shabnam , Ahmed Syed Masroor , Ali Zeeshan , Awan Romana , Zakir Humaira , Ghazi Lubna , Nageen Ayesha
Published: September 2021

Objectives: To study the frequency of H. pylori infection and its association as acause of upper G.I bleeding in cirrhosis. Study Design: Cross Sectional Study. Setting: MedicalUnit III, JPMC Karachi. Period: January 2014 to December 2014. Methods: 100 patients ofestablished cirrhosis with upper G.I bleeding were included in this study. These patients wereevaluated for viral etiology of cirrhosis. An upper G.I Endoscopy was performed in all patientsand antral biopsies were taken. Rapid urease test was performed on biopsy specimen fordetection of H.pylori infection. Results: Out of 100 patients 71 were males and 29 were femaleswith age ranging between 14 to 70 years. Among them 53% patients turned out to be positivefor H.Pylori infection with rapid urease test. H.pylori infection was detected in 68.7% of HBsAgpositive patients and in 50% of Anti HCV positive patients. On upper G.I endoscopy 96 patientshad PHG and among them 50 (52%) were positive for H.pylori. 4 patients did not have PHGand among them 3 (75%) were positive for H.pylori. Gastric ulcer was present in 17 patientsand amongst them H.pylori was detected in 10 (58.8%) cases. Duodenal ulcer was present in 5patients and among them 2 (40%) were positive for H.pylori. Gastritis was present in 17 casesamong them 11 (64%) were positive for H.pylori. Duodenitis was present in 13 cases amongthem 11 (84.6%) patients were positive for H.pylori infection. Conclusion: The frequency ofH.pylori infection was low in cirrhotic patients. No association was seen in H.pylori infectionand causes of upper G.I bleeding in cirrhosis including PHG, gastric ulcer and duodenal ulcer
RHEUMATIC HEART DISEASE (RHD)
Authors: Beg Ahsan Beg , Younas Muhammad , Asma Touseef
Published: September 2021

Objectives: To investigate the role of socio-economic factors for Acute RheumaticFever (ARF) and Rheumatic Heart Disease (RHD) in Pakistan. Methodology: Study Design:Descriptive cross-sectional. Setting: OPD of Pediatric Cardiology Department, CPE Institute ofCardiology, Multan. Period: July 2014 to December 2014. Convenience Sampling was done.Sample size of 130 cases with ages between 5 to 12 years were selected for the study. Results:Overcrowding was noticed in 61% and 85% in urban and rural areas, respectively. In rural areas,most parents were illiterate; similar status was seen in urban areas (64.4%; 67.1% respectively).60% and 55 % patients have habit of hand washing in rural and urban patients respectively.Toilet facility is available to 60% and 55.6% in rural and urban patients respectively. Economicstatus of the family is even worse. Average income per family was only Rs.3800 per month.Conclusion: There is a high prevalence of Rheumatic heart disease (RHD) and acute rheumaticfever (ARF) in Pakistan. Overcrowding, poor hygienic conditions, low socio-economic status,illiteracy are major risk factors for ARF and RHD in Pakistan. In order to address this alarmingsituation, platforms like Pakistan Pediatric Cardiac Society and Pakistan Pediatric Associationneed to be mobilized.
PREVALENCE OF ROAD TRAFFIC ACCIDENTS
Authors: Abbas Shah Tajammal
Published: September 2021

To see the percentage, the different groups affected and pattern of injury by roadtraffic accidents among patients attending a unit of surgery in a teaching hospital. Objectives: Tosee the percentage of trauma among patients admitted in one surgical unit of a tertiary hospitalin one year and to compare this with the patients admitted in all surgical units of same tertiaryunit. To evaluate the pattern of trauma, male to female ratio, affected age groups, mechanismof injury, the organs affected, and the mortality rate in one surgical unit of a tertiary hospital of3rd most populated city of Pakistan during one year. Study Design: Prospective study. Setting:Surgical Unit II at Allied Hospital Faisalabad. Period: January 2009 to February 2010. Materialsand Methods: Patients admitted during this period for road traffic accidents in surgical unit IIof Allied Hospital Faisalabad were 94 (4.8 %) out of total 1956 patients presented and admittedin surgical unit II during this year. Total number of patients admitted in all surgical units of thishospital were 7388 while 21,400, patients received and admitted by all other specialties throughemergency units of Allied Hospital Faisalabad. Patients with road traffic accidents admitted insurgical unit II through emergency unit of this hospital were part of this study. Among these94 patients 78 patients (82.97%) were adults and 18 children (19.14%). Patients with all otheremergencies modalities and minor injuries treated and discharged from emergency wereexcluded from this study. Results: Out of 1956 patients admitted in Surgical Unit II from total 7388of all surgical admissions and 21400 all emergencies ward patients, 94 patients (4.8%, 1.27%,and 0.439% respectively) were injured by road traffic accidents. Out of these 94 patients, 78patients (82.97%) were adults and 18 children (19.14%) patients. 58 patients (61.70%) were malesand 36 patients (38.29%) were females. 43 patients (45.74%) were pedestrians, 10 patients were(10.63%) on bicycles, 26 patients were (27.65%) on motorcycle while 15 patients (15.95%) werein other vehicles. 52 patients (55.31%) developed head injuries, 10 patients (10.93%) blunt traumaabdomen, 5 patients (5.31%) blunt trauma chest and 26 patients (27.65%) skeletal injuries ( 10patients forearm bones fracture, 6 patients with fracture mid-shaft of tibia, another 5 patients withfracture lower 1/3rd of femur and 5 patients with hand bones fracture ). All patients were treated bycombined specialty trauma surgeons. 3 patients (3.19%) died out of which 2 patients (2.12%) withsevere head trauma and one pedestrian (1.06%) with blunt trauma abdomen and lower chest. Allother patients survived and recovered with some morbidity. Conclusion: Road traffic trauma isone of major dilemma of our society. 94 road traffic accidents causalities were admitted duringone year in one surgical unit of a tertiary care center and 3 patients died. It is an alarming signto properly protect people, educate general population, employ dedicated road safety staff andfollow rules and regulation of traffic authorities.
FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)
Authors: Tagar Muhammad Paryal , Jamali Khawar Saeed , Pathan Mohammad Rafique , Tagar Sarang
Published: September 2021

Objectives: The objective of this study was role of fine needle aspirationcytology (FNAC) and neck swellings. Study Design: Observational study. Place and Durationof Study: This study was conducted at surgical department of multiple hospitals and comparesthe results, JPMC, Civil Hospital Karachi, Naushahro Feroze and Jamshoro, from January 2015to October 2015. Methodology: This study consisted of 145 patients. All patients presentingwith multiple neck swellings attended as outdoor patient at a tertiary care hospital. BeforeFNAC, patients were screened, which included the recording of clinical history and clinicalfindings are important. The proper investigations were carried out according to the needs. Aftera brief description of the procedure, the patient’s informed consent was obtained. Results:83(57.24%) males and 62(42.75%) females. Ratio between the male and female is 1.33:1.Mean age was found to be 41.57+4.54 years (25 to 60 years). Patients presented in OPDfor multiple neck swelling likely lymph nodes were involved in 70(48.27%) cases, followed bySalivary Gland in 26(17.93%) cases and thyroid in 35(24.16%) cases. Soft tissue and other wereinvolved in 8(5.51%) cases and 6(4.13%) cases respectively. Fine needle aspiration cytologyresults showed Lymph node mostly involved in tuberculous 42(28.96%) cases while metastaticinvolved in 4(2.75%) cases. Thyroid FNAC showed mostlygoitre 21(14.48%) cases and rarelyinvolved malignant disease like papillary carcinoma 1(0.68%) case and medullary carcinomain 2(1.37%) cases. Salivary Gland results showed pleomorphic adenoma in 14(9.65%) casesand sialadenitis in 8(5.51%) cases were involved. Lipoma in 5(3.44%) cases. Conclusion:We conclude that fine needle aspiration cytology is a rapid, simple and accurate diagnosis oftissues that can be made from outside the patient. FNAC provides a simple method of diagnosisof neoplastic and non-neoplastic lesions of head and neck.
ISCHEMIC HEART DISEASES
Authors: Hashmi Syed Fasih Ahmed , Dasti Mashooq Ali , Jaffri Muhammad Sajid Abbas , Ali Memon Hamid Nawaz , Memon Athar Hussain , Qutrio Baloch Zulfiqar Ali , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency of hyperhomocysteinemia level inpatients with ischemic heart diseases. Study Design: Case series study. Setting: LiaquatUniversity Hospital Hyderabad. Period: Six months. Patients and Methods: All the patientswith known ischemic heart disease of either sex gave the history of myocardial infarction andechocardiography showed motion wall abnormalities were recruited and entered in the study.After confirmation of IHD, the 2cc venous blood sample was taken in sterilize disposablesyringe and sent to laboratory for evaluation of serum homocysteine levels while the data wascollected on pre-designed proforma and the data was analyzed in SPSS 16 and the frequencyand percentage was calculated. Results: Total one hundred patients with known ischemiccardiac disease were recruited and evaluated for homocysteine level. The mean ±SD forage of patients with ischemic heart diseases was 55.82±10.94. Majority of the patients weremales 57% and the male to female cross tabulation was statistically significant (p=0.02). Thehyperhomocysteinemia was not statistically significant in relation to age while it is significantin relation to gender (p=0.01). The overall frequency of hyperhomocysteinemia in IHD was62% with male predominance 66%, of sixty percent hyperhomocysteinemic individuals 41.9%had severe, 37.1% had intermediate and 21% had mild elevated homocysteine level (p=0.02).Conclusion: It was concluded that hyperhomocysteinemia was associated
BURDEN OF MALARIAL PARASITEMIA
Authors: Iram Shagufta , Saeed Muhammad , Hussain Shahida , Mobeen Ayesha , Jabbar Rabia , Aslam Maleeha
Published: September 2021

Background : Hematology: 21st century is evolutionary in the arena of medicallaboratory sciences but immunological adverse reactions of blood transfusion and possibletransmission of transfusion transmissible infections are still in their peak. Transmission ofplasmodium via blood is significantly important because only a small fraction of infected redcells of donor blood can lead to cause malarial parasitemia in the recipient. Present studywas planned to determine the frequency of Transfusion based transmissible malaria amongapparently healthy blood donors. Method: This study was conducted in the department oftransfusion medicine, Jinnah Hospital, Lahore. A total of 18,274 clinically healthy (volunteerand replacement) blood donors were included from 1stJanuary to 30th December 2014.Blood sample was collected through standard venipuncture method. The presence of malariaantigens was detected by the use of respective good quality immuno-chromatographic (ICT)devices. Results: Among the total 18,274 blood donors, 17,276 (94.53%) were found healthyand safe for transfusion. The remaining 998 (5.46%) donors were infected with any onetransfusion transmissible infection and therefore not suitable for blood donations. Among theinfected donors 20 (0.11%) blood donors were positive for malaria.We also evaluated monthwise prevalence of malaria, with highest positive rate detected in November. According toblood groups, highest prevalence was found in blood group B and the lowest was recorded inblood group AB. Conclusion: This study provided recent scenario of asymptomatic transfusiontransmissible Malaria among healthy blood donors population, therefore, it could play animportant role in limiting by drawing the attention of policy makers and health departmentofficials towards this serious health issue.
EPINEPHRINE
Authors: Mirmansouri Ali , Farzi Farnoush , Raoufi Azadeh , Sorouri Ziba Zahiri , Najafabadi Fereidon Mortazavi
Published: September 2021

The most common complication of spinal anesthesia for cesarean section ishypotension. Ephedrine is the most commonly used vasopressor that increases blood pressurewith minimal impact on uteroplacental blood flow. An alpha-1 adrenergic receptor agonist mayneed to be administrated when ephedrine is ineffective. Unavailability of alpha-1 receptoragonists in a period of time in our center leads to administration of epinephrine as the seconddrug. In the present study, the data of 14 patients with ephedrine resistant hypotension duringspinal anesthesia for cesarean section were reviewed. Increase in maternal blood pressurewas recorded one minute after epinephrine administration in all patients. Surprisingly, thismedication also causes uterine relaxation after one to five minutes. Ease of fetal extractionwas noticed in 13 patients. All patients achieved adequate uterine contraction after delivery.Epinephrine helped regulate blood pressure and surprisingly facilitate uterine relaxation inpatients with emergency cesarean section with spinal anesthesia.
CLEFT LIP AND PALATE
Authors: Abbas Shah Tajammal
Published: September 2021

A prospective study was conducted to look for prevalence of cleft lip and palate ina population presenting to a surgical unit in a teaching hospital. Objectives: To see prevalenceof cleft lip and palate alone, lip and palate combined, right or left sided, male to femaledistribution, and possible factors responsible for clefting. Study Design: A prospective study.Setting: Surgical Unit II at Allied Hospital Faisalabad. Period: March 2009 to March 2010 forone year. Materials and Methods: Total 55 patients were treated in year 2009 out of total17900 (0.3 %) patients admitted in all surgical wards and 6508 patients admitted in surgicalunit II (0.8%). Patients were divided into three groups, cleft lip alone (group A), cleft palatealone (group B) and combined cleft lip and palate (group C). Children up to the age of 5 yearswith congenital abnormality were included in study. Results: Out of 6508 patients admitted insurgical unit II 55 patients (0.8%) had cleft lip and palate defect. 55 patients were divided inthree groups. In group A, 32 patients presented with cleft lip alone ( 58.1 % ), 16 ( 29 % ) weremales and 16 ( 29 % ) were females, 21 patients have left sided ( 38 % ), 4 right sided (7.27% )and 7 patients have bilateral ( 12.72 % ) defects. 2 patients (3.63 %) had family history of cleft lipand both were males. In group B, 12 patients ( 21.8 %) had cleft palate alone, 7 patients ( 12.72% ) were males and 5 patients ( 9 % ) were females, 10 patients ( 1.18 % ) had soft palate onlywhile 2 patients ( 3.63 % ) had compete ( hard and soft ) palatal defect. In group C, 11 patients,had cleft lip and palate combined ( 20 % ), 6 patients were males ( 10.9 % ) and 5 patients ( 9% ) were females, 8 patients ( 14.54 % ) had only soft palate defect while 3 patients ( 5.45 % )had complete palatal defect associated with 8 patients ( 14.54 % ) left sided unilateral lip defectand 3 patients ( 5.45% ) had bilateral cleft lip. All patients were operated without any mortality.Ages of mothers at earliest were 16 and 18 years, 3 cousin marriages, ( 5.45 % ) all fathers weresmokers, belonged to poor socio economic families and no history of mother’s exposure toradiation, drug abuse during gestational life. Conclusion: As it is obvious from this study thatall patients belongs to poor socio economics group, and all fathers were smokers, 3 patientsborn in parents who had cousin marriages ( 5.45 % ) 2 patients ( 3.63 % ) with family history,cleft lip and palate are multifactorial congenital abnormalities, runs in families and is influencedby various environmental factors.