bluuebunny/crossref_metadata_2025 huggingface dataset:
CANCER PROSTATE
Authors: Aslam Nighat , Nadeem Khalid , Noreen Razia , Jamil Amer
Published: September 2021

Prostate specific antigen was identified and characterized first time in 1977. Thereis no doubt that the PSA has significant role in prostate cancer diagnosis with help of DigitalRectal Examination and biopsy. Study design: This study was designed to assess the level ofPSA in prostate cancer patients before and after the treatment given to patients. To determinethe specific and precise finding regarding the tumors stages, the cancer biomarkers are handyand helpful. For this purpose researchers monitor changes in the cell on chromosomal level bycomparing primary tumor with secondary tumor. The prostate-specific gene kallikrein 3 (KLK3),encodes PSA located on chromosome 19q13.4. KLK2 and KLK4 genes are also present herewhich are present in a family of fifteen closely related serine proteases. Setting: Allied Hospital,Faisalabad. Period: Jan 2014 to Dec 2014. Material and methods: We use the PSA (Human)CLIA Kit which is a solid phase two site immunoassay. One antibody was coated on the surfaceof the microtiter wells and another antibody (used as a tracer) was labeled with horseradishperoxidase. The PSA molecules present in the standard solution or serum were “sandwiched”between the two antibodies. Results: All prostate cancer patients had highly variable serumPSA values ranging from 12.90 ng/mL to 193.5 ng/mL. The post treatment PSA analysisrevealed that the increase level of PSA (15%) which showed that the PSA level increased afterthe treatment. Whereas in all other 17 patients the PSA level was found to decreased. Our studyalso shows that sometime PSA level is increased by non-cancer associated benign prostatichyperplasia (BPH), prostatitis, medications and environment and diet alterations. Conclusions:This study indicated that PSA serum level has a useful role in diagnosis of prostate cancer.
SPINAL ANAESTHESIA
Authors: Yousuf Muhammad , Haider Syed Aftab , Aziz M. Mudassir , Waris Salman
Published: September 2021

Perioperative shivering is a common problem during spinal anaesthesia. Itcauses tremendous deleterious effects on metabolism of body. Despite of re-warming andraising the ambient temperature, several drugs are under research to evaluate their preventiverole in shivering during anaesthesia like tramadol, butorphanol, midazolam, ketamine andondansetron. The present study was conducted to evaluate the effect of prophylactic low doseketamine and ondansetron for prevention of shivering during spinal anaesthesia. Objective:To compare prophylactic low dose ketamine with ondansetron for prevention of shiveringduring spinal anaesthesia in patients undergoing lower abdominal surgeries. Study Design:Randomized controlled trial. Setting: Department of Anaesthesia, Nishtar Hospital Multan.Period: November 2012 to May 2013. Material and methods: A total of 256 patients wereincluded in the study divided into two equal groups. Results: In this study basic demographicslike age, gender, mean weight and height and type of surgery patients underwent weresimilar, having no significant difference in both groups, while on comparison in both groups,the frequency of shivering revealed 4.69%(n=6) in K Group and 11.72%(n=15) in O Groupwhile remaining 95.31%(n=122) in K and 88.28%(n=113) in O Group had no findings of themorbidity, p value was calculated as 0.03, which showed significant difference. Conclusion:The result of the study concluded that prophylactic intravenous administration of low doseketamine (0.25mg/kg) is significantly more effective than ondansteron (4 mg) for prevention ofshivering during spinal anesthesia in patients undergoing lower abdominal surgeries.
ACUTE SEVERE ASTHMA IN CHILDREN
Authors: Irfan Sumaira , Anjum Zahid Mahmood , Taseer Ali Asgher , Ayesha Hina
Published: September 2021

Objective: To compare the efficacy of intravenous magnesium sulfate andconventional treatment with conventional treatment alone in acute severe asthma in children ofage group 5 to 15 years known cases of bronchial asthma. Study design: Randomized controltrial. Setting: Indoor and outdoor patients of pediatrics department of DHQ hospital, Faisalabad.Duration: Six months. Results: In this study, 43.58%(n=17) in Exposed and 53.85%(n=21) inUn-exposed group were male and remaining 56.42%(n=22) and 46.15%(n=18) were females,mean pulse rate in both groups was recorded which shows 97.32+6.58 in Exposed Groupand 103.67+8.32 in Un-exposed Group, p value was calculated as 0.02, mean FEV1 rate inboth groups was recorded which shows 60.32+7.56 in Exposed Group and 54.07+6.43 in UnexposedGroup, p value was calculated as 0.03. Conclusion: We concluded that intravenousmagnesium sulfate along with conventional treatment is significantly better than conventionaltreatment alone for the management of acute severe asthma attack.
UTERINE RUPTURE
Authors: Saeed Shazia , Ahmad Ashfaq , Akhtar Nasreen
Published: September 2021

Objective: To determine frequency and to identify social, demographic andobstetrical causes of rupture uterus in Bagh Azad Jamu Kashmir and to define appropriaterecommendations for its prevention and effective management. Study Design: A descriptivecase series study. Setting: DHQ Hospital Bagh at AJK. Period: 1st September 2008 to 30thSeptember 2012 was done. Methodology: Data was entered on pre-design proforma includedage, parity, booked or un-booked cases, time delay to reach hospital and etiological factors.Results: Incidence of rupture uterus is 1:185 deliveries. Mostly occurred in grand multipara andinjudious use of syntocinon and neglected labor are most common cause. Conclusions: Skilledbirth attendant, free transportation and avoidance of undue use of syntocinon in peripheralhealth center are key element for better maternal outcome.
SEVERE PSYCHIATRIC ILLNESSES
Authors: Awan Inayatullah , Junejo Badaruddin , Junejo Jamil , Perveen Asma
Published: September 2021

Objectives:To find out the effectiveness of “Illness management and Recovery(IMR)” program as a group intervention for improving daily functioning of clients suffering fromsevere psychiatric illnesses.Setting:The Recovery House, a Psychiatric Rehabilitation Centerin Karachi, Pakistan. Period:Dec 2012 to Sep 2013.Methodology:Fifteen(15) patients wereenrolled in the study. They were randomly divided into two groups, one group with 7 patientsand the second with 8 patients. Informed consent was obtained from the patients and theirfamily. A semi-structured Proforma was used to record the demographic details of patients.Before Starting the IMR program, 15 points rating scale was administered on patients (pre-IMRassessment) and after 9-month program implementation, the scale was again administered(post-IMR assessment) to evaluate the effectiveness of Illness management Program as a groupintervention. After each IMR session patients received sheets to work as homework assignmentsfrom the handouts. Patients received IMR program with, supportive, educational, motivationaland cognitive behavior interventions in group and individual sessions with practitioner. Datacollected was entered into and analyzed by using statistical package for the social science –seventeenth version (SPSS 17).Results:Out of the total 15 patients, 12 (80%) were male and 3(20%) were female. Age range 15 to 67 years with mean age was 37+8.5 years. Education statusof the patients revealed that all patients were educated; 04 (26.7%) had achieved education tothe graduation level; 04 (26.7%) were matriculate; 04 (26.7%) were primary passed; and 03(20%) were educated up to intermediate level. Patients with severe psychiatric illnesses werebipolar disorder 2(13.3%) cases, personality disorder 3(20%) cases, delusional disorder 1(6.7)case, schizophrenia 8(53.3%) cases and schizoaffective 1(6.7%) cases. Total number of WMR(Wellness management and recovery) session attended by each patient ranged from 30 to 62sessions. Results in 15 areas of assessment on the rating scale before the application of illnessmanagement and recovery sessions (Pre-IMR sessions) and after the application of sessions(Post-IMR sessions).Conclusion:Illness management and recovery program is an effective toolto bring about a significant improvement in several domains of life among patients sufferingfrom severe psychiatric illnesses.
LOW VISION DEVICES
Authors: Ullah Muhammad Saad , Safdar Sohail , Ahmad Muhammad Nabeel
Published: September 2021

Objective: The main objective of the present study was to find out visual outcomeof Low Vision Devices among patients suffering from different diseases causing reduced visualacuity in the area of Dera Ghazi Khan, Southern Punjab, Pakistan. Setting: OphthalmologyDepartment, Dera Ghazi Khan which is a tertiary care hospital. Period: 10th February, 2014 to31st December, 2014. Material and Methods: Patients (n=55) presented for their low visionassessment included two groups age wise as patients equal or more than 18 years age (n=22)and patients less than 18 years (n=33). LOG MAR VA charts, contrast sensitivity test, visualfields through arc perimeters, color vision with color pencils hue 16 test along with objective andsubjective refractions were applied. All the data were entered and analyzed using SPSS version16.00. Results: Patients (n=55) aged 7-90 years presented for their low vision assessment hadmean age 23.73+ 2.9 years. The patients were divided into two age groups. First group was22 (40%) patients equal or more than 18 years age and second consisted of 33(60%) patientsless than 18 years age group. Among the patients examined, 40 (72.7%) were males and 15(27.3%) were females. Our study results revealed that the low vision devices provision wasassociated with a statistically significant improvement in both near and distance visual acuitiesand with patients’ fulfillment. Conclusion: There was a significant improvement in far and nearvisual acuity of the patients suffering from a multiplicity of blindness caused diseases by whichpatients are able to improve their quality of life and able to do their tasks without getting helpfrom others.
HEPATOTOXICITY
Authors: Khan Ammara , Waheed Akbar , Chaudry Zahid Azam
Published: September 2021

Background of Study: Sepsis is characterized by overwhelming surge ofcytokines and oxidative stress to one of many factors, gram negative bacteria being one ofit. Mortality remains very high in septic patients despite the advanced treatments rendered inintensive care units due to multiple organ damage including hepatotoxicity. Study Design:Randomized controlled laboratory trial. Period: 04 months from March 2014-June 2014. Setting:Department of Pharmacology and Therapeutics, Army Medical College, NUST, Rawalpindi.Aim of the Study: The present study was undertaken to learn dexamethasone’s competencein prevention and treatment of LPS/ endotoxin induced hepatotoxicity in mice. Material andMethods: Endotoxin induced hepatotoxicity was reproduced via LPS of serotype E.ColiO111:B4 administrationintraperitoneally at a dose of 10mg/kg and all mice were sacrificed 17hours latters. Dexamethasone (3mg/kg of b.w. i.p) was given 30 minutes before LPS in separateset of animals to determine its preventive role. Whereas therapeutic efficacy was adjudgedby giving dexamethasone 2 hour after LPS administration. Hepatotoxicity was determined byestimation of serum ALT and AST and histopathological analysis of liver sections. Results:LPS administration was associated by statistically elevated serum ALT and AST and markedhepatic inflammation. Dexamethasone was efficacious in a version of LPS induced hepaticdystrophy both when given as pre and post-treatment. Serum ALT and AST were statisticallylower when compared to LPS group. Also hepatic inflammation was statistically lessened bydexamethasone. Conclusion: Low dose dexamethasone has beneficial role in reduction ofLPS/endotoxin induced hepatic injury in experimental model of sepsis.
PATIENTS WITH SUICIDE ATTEMPT
Authors: Junejo Jamil , Junejo Badaruddin , Awan Inayatullah , Perveen Asma
Published: September 2021

Objective: To determine the demographic details (gender, age, marital status,level of education, and occupation) of suicide attempters attending the tertiary care hospitalservices at Hyderabad, Pakistan. Study Design: Cross sectional study. Setting: Liaquat universityhospital Hyderabad and Sir Cowasjee Jahangir Institute of psychiatry (CIJP) Hyderabad.Period: Twelve months from the 1st January 2011 to 31st December 2011. Methodology:The aim of the study was. Patients with a history of attempted suicide. Two hundred (200)consecutive cases were recruited and selected according to the inclusion criteria. An informedconsent was obtained from patients for being included in the study. A specially designed semistructuredProforma was used to record demographic details of the patients. Data were enteredinto and analyzed through statistical software SPSS version 20. Results: Total 200 hundredcases were included in the study. Males 78.5 % (N=157) outnumbered female patients 21.5% (N= 43). The age range of study subjects was between 15 -59 years. Mean age of the totalcases was 22.6 years. Majority of the patients presenting with suicide were single comprising61 % (N= 122) of study cases with a P value < 0.001. Total cases of married subjects were 27.5% (N= 55) with a P value < 0.001. While 5.5% subjects were separated and 6 % were divorced.Unskilled labors made the largest group comprising of 24.5 % (N=49) of all the cases. Otheroccupations included farmers (15.5 %), skilled labor (15%), jobless (11.5%), house wives (8.5%), students (7 %), and shopkeepers (6%). Out of the total 200 patients with attempted suicide32% were illiterate, 33.5 % were educated up to primary level, 19.5% were matriculate, 09 %were intermediate passed, and only 6 % were graduate. (Table-II). Conclusion: In Pakistan stillSuicide attacks are reported. Our results suggest that suicidal thoughts can be entirely predictby common reported in male and younger age due to very sensitive to family issues, lowereducation level and major depression due to unemployment or low level earning of unskilledlabor occupation in the Pakistan population.
POST-OPERATIVE ATRIAL FIBRILLATION
Authors: Hussain Ghulam , Ahmad Naseem , Zaheer Sara , Baig Mirza Ahmad Raza
Published: September 2021

Atrial fibrillation is the most common arrhythmia observed following CoronaryArtery Bypass Graft surgery. Objectives: To determine the incidence of post-operative atrialfibrillation in patients undergoing coronary artery bypass grafting. Materials and Methods:Study Design: Non-randomized prospective. Setting: Cardiac Surgery Department ofMultan Institute of Cardiology, Multan. Period: 20-1-2014 to 01-05-2015. A total number offour hundred and ninety (490) patients having age more than 40 years undergoing isolatedcoronary artery bypass graft surgery were included in the study. Data was analyzed in SPSSV20 software. Frequency and percentages were used for Atrial Fibrillation. To see the impact ofAF on morbidity, patients developing AF was compared with those who do not develop AtrialFibrillation post-operatively using independent sample t-test for quantitative variables. Chisquaretest and Fischer’s Exact test (whenever appropriate) was used to compare qualitativevariables. Results: A total number of four hundred and ninety (490) patients were included inthis study. There were more 431 males (88.0%) in this study. of the patients 71.6% were in LVGrade I before surgery. Incidence of post-operative atrial fibrillation was 13.5%. In 4.5% patientsIABP was inserted due to hemodynamic instability. Ventilation time and hospital stay time wassignificantly higher in patients with AF postoperatively (p value 0.03 and 0.02 respectively).But duration of inotropic support, post-op CKMB levels and IABP use were not significantlydifferent in both groups. Conclusion: The incidence of post-operative Atrial Fibrillation is 13.5%according to this study. And these patients were associated with increased risk of morbidity.
BREAST CANCER
Authors: Sadiq Sarah , Naveed Abdul Khaliq , Jamal Shahid , Sadia Aiza
Published: September 2021

CK2 enzyme is up regulated in several cancers. It has many substratesincluding survivin which is up regulated in cancers. Objectives: To find out the correlationbetween expression of CK2α and survivin and evaluate it as a prospective prognostic marker inpathogenesis of the breast cancer and to find if positive correlation between CK2 and survivinwas associated with advancing disease. Study Design: Cross Sectional Analytical type of study.Setting: Department of Biochemistry & Molecular Biology, Army Medical College, Rawalpindiand Armed Forces Institute of Pathology, Rawalpindi. Duration of study: January 2013-December 2014. Methods: The research protocol was approved by Armed Forces Institute ofPathology Ethical Committee. Paraffin embedded tissue sections of diagnosed breast cancer,obtained from AFIP, were used. Immunohistochemistry was performed to determine nuclearand cytoplasm expression of survivin, and CK2 .Scoring done by three histopathologists,independently. Results: Total CK2 expression was high in invasive as compared to noninvasivecases (p =0.209). Cytoplasm and nuclear localization of CK2 in invasive group was alittle higher too (p = 0.092) and (p=0.286) respectively. Total survivin expression was high ininvasive as compared to non-invasive cases (p= 0.449). Cytoplasm and nuclear localizationof survivin in invasive group was higher as compared to noninvasive group with no significantdifferent (p=0.472) and (p=0.367) respectively. A positive and strong correlation was found inCK2 and survivin expression and localization in both non-invasive as well as invasive groups.Conclusion: CK2 and survivin correlation in cancers can be used in predicting the cancerphenotype and aggression at early stages.
POST-HERETIC NEURALGIA
Authors: Asim Sadaf Ahmed , Agha Humaira Maryum , -Nisa Qamar-un , Masroor Muhammad
Published: September 2021

Objectives: To assess the efficacy of intra-lesional triamcinolone in for thetreatment of Post Herpetic Neuralgia. Study Design: Prospective interventional study. Setting:Dermatology Department of Dow University Hospital. Period: July 2014 to June 2015. Patientsand Methods: Twenty nine patients with diagnosis of Post Herpetic Neuralgia were includedafter taking written and informed consent. An insulin syringe was used for the injections andthe medicines were injected intralesionally. The mixture contained 30/70% of triamcinolone toxylocaine ratio for local infiltration in post herpetic scars. Pain relief assessment was done withthe help of visual analogue scale (VAS) after two months. Mean pain score before therapy andafter therapy was compared with one sample student t test. Results: Out of total 29 patients 14were male and 15 were females. The mean age ±SD was found to be 45.9± 15.4 years. Themost common region involved was Chest. The mean ±SD duration of Symptoms was 5.58 ±1.80 weeks. The mean pain score before therapy was 6.86 ± 1.66 which after one month oftherapy reduced to 3.72 ± 1.86. The reduction in pain was statistically significant (p<0.001).Conclusion: Post Herpetic Neuralgia can be effectively treated by the local infiltration of amixture of triamcinolone and lignocaine. It is recommended that long-term follow-up studiesshould be done with corticosteroids only or in combination with local anesthetics to additionallyevaluate the effectiveness of such treatment in postherpetic neuralgia.
DYNAMIC HIP SCREW (DHS)
Authors: Pirwani Mehtab , Memon Abbas , Memon Shakeel Ahmed
Published: September 2021

Objectives: To analyze the comparative results of dynamic DHS fixation in stableand the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting:Orthopedic unit I of LUH Jamshoro. Period: 26th May 2010 – 25th August 2011. Methodology:All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groupsevery having 20 patients, group A stable fracture and group B unstable fractures. After completephysical examination, examinations and fracture arrangement evaluation, patients were readiedfor operation. Fracture table was used in each operation. Fracture reduction was initiallyattempted by close manipulation and was successful in 30 (75%) cases. Lateral approach forproximal femur was used in every case. All fractures, whether stable or unstable, were reducedanatomically without any type of osteotomy and then fixed with 135o dynamic hip screw.Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to modeof injury were found RTA in 21 (70%) patients. Postoperative complications were recorded as;superficial infection noted in 2 (5%) patients and there was no case of deep infection. Averagestay of hospital found 16.5 days in 17 (42.5%) patients belongs to stable group and 06 (15%)patients belong to unstable group. All (n=40) patients were pain free on their discharge fromhospital. In all (n=40) patients we achieved union and there was no case of delayed unionor non-union. We assessed functional outcome of our patients on the base of Stinchfield HipAssessment system. According to SHAS 28 (70%) patients were excellent, 05 (12.5%) patientswere good, 04 (10%) were fair and 03 (7.5) were poor. We had not found mortality in our patients.Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracturefixation. No matter; whether fracture is stable, unstable and fresh or old.
PRIMIGRAVIDA
Authors: Malik Shahida , Asif Uzma , Asif Midhat
Published: September 2021

Objectives: Determine the mode of delivery in primigravida with engagedversus unengaged fetal head with spontaneous onset of labour at term. Study design: Casecontrol study. Setting: Department of Obstetrics and Gynaecology, Lady Aitchison Hospital,Lahore. Duration of Study: Jan 2012 to Dec 2012. Patients and Methods: Two hundredcases were included in this study and divided into two groups (A & B) 100 in each group.Primigravidas presenting with engaged fetal head were included in Group A and thosepresenting with unengaged fetal head were included in Group B. The course of labor in allpatients was recorded on partogram. Partogram was maintained according to departmentalprotocol. Cesarean section was decided if labour failed to progress or fetal head failed todescend after observing as per departmental protocol (12 hours). All patients were studiedin detail with reference to mode of delivery regarding vaginal (spontaneous and instrumental)or cesarean section delivery. Results: Mean age was 23.65+3.72 years in Group-A and24.96+4.12 years in Group-B, 31%(n=31) in Group-A and 38%(n=38) in Group-B between37-39 weeks, 60%(n=60) in group-A and 51%(n=51) in Group-B between 40-41 weeks and9%(n=9) in Group-A and 11%(n=11) in Group-B were with 42 weeks of gestation, mode ofdelivery in primigravida with engaged versus unengaged fetal head with spontaneous onsetof labour at term was compared which showed that 19%(n=19) in Group-A and 39%(n=39)in Group-B were delivered with cesarean section, 65%(n=65) in Group-A and 42%(n=42) inGroup-B were spontaneously delivered vaginally while 16%(n=16) in Group-A and 19%(n=19)in Group-B had assisted vaginal delivery. Conclusion: Cesarean section was more prevalent inunengaged fetal head in primigravida women at term.
LEFT PARA-DUODENAL HERNIA
Authors: Ahmad Asrar , Saleem Irum , Ahmed Nisar , Ayub Farrukh
Published: September 2021

Internal hernia is defined as herniation of viscera through a defect in themesentery or peritoneum. Internal hernias can cause intestinal obstruction. Paraduodenalhernias though a rare cause of intestinal obstruction, are more common on the left side. Thesehernias may cause strangulation and gangrene of the intestines so a high index of suspicion isrequired for diagnosis. Treatment is always surgical. We hereby report a case of acute intestinalobstruction due to left paraduodenal hernia.
DIABETIC NEPHROPATHY
Authors: Liaquat Jahangir , Bawany Muhammad Adnan , Shaikh Noman , Khahro Adnan Ali , Naz Falak
Published: September 2021

Objectives: To find out the frequency of hypoglycemia in patients with diabeticnephropathy. Study Design: Cross sectional study. Setting: Emergency department anddepartment of medicine Liaquat university Hospital Hyd/ Jamshoro. Study Period: One yearfrom 01-03-2009 to 28-02-2010. Methodology: Two hundred cases of diabetic nephropathy onthe basis of symptoms and signs of hypoglycemia were selected in this study. Results: Out of200 patients, 102(51%) were males and 98(49%) were females, 10.5% had type-1 diabetes and89.5% had type-2 diabetes. Most of the patients belonged to 60 to 75 years of age. The averageduration of diabetes was 12.20 ± 6.14 years. Out of 23 hypoglycemic patients, 5 (21.7%)had type-1 diabetes in which 4 were male and one was female while 18 (78.3%) had type-2diabetes in which 10 were male and 8 were female patients. Conclusion: It was observed thathypoglycemia
SURGICAL MUSCLE RELAXATION
Authors: Ahmad Khan Muhammad , Raza Kazmi Syed Sajjad , Ahmad Shakeel
Published: September 2021

In Anesthesia practice neuromuscular blocking agents (muscle relaxants) areused for intubation and surgical muscle relaxation. The use of modern inhalational anestheticslike sevoflurane is commonly practiced in paediatric anesthesia for induction and endotrachealintubation. LMA (Laryngeal Mask Airway) is alternative to endotracheal intubation. It iscommonly used supraglotic device for the elective surgical procedures in adults and paediatricpopulation. We conducted this study to see whether sevoflurane produces enough surgicalmuscle relaxation so that the use of neuromuscular blocking agents can be avoided. StudyDesign: Observational study. Setting: King Khalid Hospital (KSA). Period: April 2013 toFebruary 2014. Material and Methods: 84 paediatric patients posted for elective surgicalprocedure were included. Regarding the adequacy of surgical muscle relaxation. Induction ofanesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/kg. Airway was maintained withLMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heartrate was kept with 20 % of baseline reading. Adequacy of surgical muscle relaxation was askedby the surgeon during surgery and was graded as good, fair or poor. Results: Mean age of thepatients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operatedfor inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical musclerelaxation was good in all of the patients and none of them required use of muscle relaxants.Recovery of all patients was smooth. Discussion: Adequate surgical muscle relaxation isimportant to facilitate surgery. In paediatric population sevoflurane produces enough musclerelaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can beclinical as well as through muscle twitches. Conclusion: Our study showed that in paediatricpopulation
ISOLATED ZYGOMATIC BONE FRACTURE
Authors: Kumar Punjabi Suneel , Channar Kashif Ali , Banglani Munir Ahmed , Kumar Naresh , Munir Ambreen
Published: September 2021

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.
NEOSTIGMINE
Authors: Furqan Aamir , Aslam Adnan , Zahoor Afifa
Published: September 2021

Objectives: To compare the effect of Neostigmine as an Adjunct to 0.5%Lignocaine for increasing the duration of anesthesia and analgesia. Study Design: Randomizedcontrolled trial. Setting: Department of Anesthesiology, Nishtar Hospital, Multan. Period: January20014 to January 2015. Material and Methods: One hundred (100) patients were selected forthis study. Microsoft Excel 2013 was used for data analysis. Frequacy and percentage wereused to present categorical varibales and mean+standard deviation for numerical variables.Results: There was a rapid onset of Sensory and motor blocks in neostigmine group, 3.9+2.5minutes for sensory block and 5.8+2.3 minutes for motor block versus 9.3+2.2 minutes and13.3+2.0 minutes respectively in control group. The time of recovery of sensory and motorblocks was delayed in neostigmine group as compared to the control group patients. Thesurgeons agreed that the anesthesia was perfect in 46 (92.0%) cases in neostigmine groupand in control group IVRA declared to be perfect in only 34 (68.0%) cases. Dryness of operativefield was same between the two groups. Conclusion: The addition of neostigmine in lignocainesolution for intravenous regional anesthesia improves the quality of anesthesia and analgesia.
GENERAL SURGEONS
Authors: Qayyum Abdul , Khan Hamzullah
Published: September 2021

Objectives: The objectives of this study were to find out the frequency ofsurgical cases and types of surgical interventions in a tertiary care hospital of Peshawar. StudyDesign: Descriptive observational study Period: Jan to June 2015. Setting: Surgical “D” Unitof Medical Teaching institution, Lady Reading Hospital Peshawar. Material and methods:Relevant information’s were recorded on a pre-designed proforma prepared in accordancewith the objectives of the study. Results: A total of 842 patients who were admitted in the MTILRHSurgical D Unit were enrolled in the study irrespective of age, gender and geographicalrepresentation. Out of total 58% were males and 42% females. The age range of patient wasfrom 2 years to 92 years the maximum. The mean of age with SD was 30 years +3.5 SD. Modeof age was 27 years. The frequency of surgical cases presentation (via emergency or outdoordepartment) were; Acute appendicitis 26%, cholilithiasis 17%, acute abdomen 9.2%, fire arminjuries/medico-legal cases 3.3%, peri-anal problems (pilonodal sinuses, hemorrhoids, fistula,anal fissure) 8.8%, Hernia (RIH& LIH 13%), carcinoma cases (stomach, rectum, pancreas) 1.5%,diabetic foot 3%, intestinal perforation & ileostomy 2.8%, etc. The frequency of types of surgicalprocedures were; The frequency of types of surgical procedures were; Open appendicectomy25%, Exploration laprotomy 8.4%, debridement 2%, Peri anal surgeries (EUA, Haemorridictomy,anal dilatation, fistulectomy 9.4%), hernirraphy and hernitomy 16%, open cholecystectomy 13%,laproscopic cholecystectomy 4.4%, orchiodectomy & orchidopexy 5%, and colostomy reversal2.2% etc. 2% patients managed conservatively. Eight patients expired during the treatment(1%). 97% discharged satisfactorily. There were 2 medico-legal cases that after dischargedwent in law in forces custody. Conclusion: The commonest cause of seeking surgical carewas acute abdomen, FAI/MLC, cholilithiases, perianal disorders, hernia and testicular/scrotalproblem are major surgical emergencies that we receive in our unit. In response the major typesof surgical interventions are appendicectomy, Exploration laprotomy, open cholecystectomy,laproscopic cholecystectomy, hernirraphy and hernitomy, orchiodectomy &orchidopexy andcolostomies. There is 1% moratlity rate as observed.
ISCHEMIC HEART DISEASE
Authors: Khalid Zaigham Rasool , Ahmed Naseem , Rizvi Farhan Ali , Raza Baig Mirza Ahmad
Published: September 2021

Objectives: To find the correlation between the non-alcoholic fatty liver disease(NFALD) and ischemic heart disease. Study Design: Retrospective cross-sectional study.Period: May 2014 to Nov 2014. Setting: CPE Institute of Cardiology. Material and methods:One hundred and thirty five participants were incorporated in the study. In Group I; patientswere with NAFLD and in group II; patients were without NAFLD. Data was Analyzed using SPSSV20 software. Results: Mean age in NAFLD group was 52.0+02.6 years and in without NAFLD53.0+1.89 years. There were 73.2 % males in NAFLD group. Incidence of Family history anddiabetes was higher in NAFLD group. The incidence of carotid artery stenosis was 4 (9.7%) inNAFLD group versus 6 (6.3%) in without NAFLD group. we also found a significantly higherincidence of triple vessel and left main stem disease in NAFLD group, it was 34 (80.87%) and3 (7.31%) in NAFLD group versus 9 (9.7%) and 2 (2.12%) in without NALD group respectively.Conclusion: Non-alcoholic Fatty liver Disease has a strong correlation with ischemic heartdisease.
TESTICULAR HISTOMORPHOLOGY
Authors: Farsi Kazi Salman Ahmed , Shah Mohammad Ghiasuddin , Gandahi Jameel Ahmed , Rathi Shankar Lal
Published: September 2021

Objectives: The present study was conducted to investigate the effects ofrecombinant human interferon-α-2b (rh-INF-α-2b) on testicular histomorphology in adult ratmodel. Study Design: Experimental study. Place & Duration: Animal house, Sindh AgricultureUniversity Tando Jam and Isra University Hyderabad from January to December 2014.Methodology: 80 adult albino rats were selected according to inclusion and exclusion criteriaand divided into 4 groups. Group I: Control rats 0.9% saline, Group II: rhIFN α-2b (3MIU),Group III: rhIFN α-2b (5MIU) and Group IV received rhIFN α-2b (10MIU). The rhIFN α-2b wasinjected intra-peritoneal (i.p) three times a week for 3 weeks in doses of 3MIU, 5MIU and10MIU. Animals were euthanized. Orchidectomy was performed and testicles were stored in10% formaldehyde. 5μ thick tissue sections were stained by Hematoxylin & Eosin (H & E).Results: Atrophic seminiferous tubules with clumping of lining epithelia were noted. Germ cellmaturation arrested was prominent; hypervascularity with reduced germ cells and sperm cellswere noted in high dose rhIFN α-2b treated groups. Tubular desquamation and thick basementmembrane were visible. The sertoli cells and interstitial cells of Leydig counts were increased.Conclusion: It is concluded that the recombinant human interferon-α-2b exerts serious adverseeffects on testicular histomorphology.
PANCREATIC ABSCESSES
Authors: Rani Reeta , Uz Zaman Muhammad Arif , Mirani Abdul Jabbar , Sheikh Ahmed Ali
Published: September 2021

Objectives: The objective of our study is to determine the surgical outcome,effectiveness and the complications of computer tomography guided drainage of pancreaticabscesses. Study Design: Descriptive case series. Setting: Tertiary care hospital in KarachiPakistan. Period: Three years from November 2012 to October 2015. Methods: The patientpopulation consisted of all those patients who were diagnosed as a case of pancreatic abscessboth clinically and on radiographic analysis, and who had to have the computer tomographyguided percutaneous drainage of the abscess. The drained fluid was sent for histopathologicand cytological analysis, and a drain was placed in the pancreatic tissue for further collectionof the discharge material. Patients were followed for up to 40 days post operatively, and variouscomplications were noted. Results: The patient population consisted of n=550 patients ofacute pancreatitis, out of which n=30 (5.45%) were diagnosed cases of pancreatic abscess, outof these patients n=5 (16.67%) were males and n=25 (83.33%) were females, and the meanage of patients was 44 +/- 11 years. In n=24 (80%) of patients the abscess resolved completelyin 20 to 40 days. N=5 (20%) of patients had complications and had to undergo laparotomy.Conclusion: According to the results of our study, the computer tomographic guided drainageof the pancreatic abscess is a very safe and effective procedure for the treatment of pancreaticabscess. The rate of complications is low, and patients show swift recovery post operatively.
CARDIOVASCULAR DISEASES
Authors: Basit Ashraf Muhammad Abdul , Rizwan Razia , Arooj Mahwish , Malik Arif , Bashir Sarmad
Published: September 2021

Background: Atherosclerosis, with chief contribution of vascular injury,inflammation and oxidative stress is the major cause of majority of cardiovascular diseases.Understanding of its pathophysiology provides initial prognosis, designing of new therapeuticsfor its prevention and different treatment protocols. Objectives: The present study wasdesigned to evaluate the role of oxidative and inflammatory markers of medical importancein the development of cardiovascular diseases. Study Design: Prospective case controlstudy. Setting: Sample collection from Punjab Institute of Cardiology (PIC), Lahore and allthe experimental work was done at Institute of Molecular Biology and Biotechnology (IMBB),The University of Lahore. Period: February 2015 to April 2016. Methodology: Biophysical,hematological, antioxidative capacity, inflammatory markers and lipid profile were estimatedin atherosclerotic patients. Results: The BMI (31.26±1.66) were significantly increased inatherosclerotic patients when were compared with controls. MDA was recorded as 3.99±0.16in atherosclerotic patients followed by 1.66±0.11 nmol/ml in healthy control respectively. Nitricoxide (NO) in the patients (35.26±4.26 ng/ml) was also significantly raised in the patientsthan normal subjects (21.26±2.35 ng/ml). Whereas mean serum levels of MPO and AGEsin patients were 0.237±.0013 pmol/ml and 2.46±0.09 U/ml respectively. Increased levels ofTCh (217.56±10.99, TG (199.67±11.02), and LDL (131.87±9.56) along with decrease in HDL33.76±3.85 mg/dl were recorded respectively. The hs-CRP showed significant increased levelsin atherosclerotic group (3.93±0.14mg/dl) as compared to normal control (1.68±0.06mg/L).The mean serum level of TNF-α and IL-6 in diseased group was recorded as 41.25±3.65pg/mland 6.35±0.64 pg/ml respectively. The significant decreasing trend of total anti-oxidant capacity,SOD, CAT, GSH, GPx, GRx, vitamin A and C but increasing drift of vitamin E was observed inatherosclerotic patients. Conclusion: Following study reported that elevated oxidative stressand inflammation along with lipid peroxidation are the major contributors in the progression ofatherosclerosis.
SELF-MEDICATION;
Authors: Nagi Muhammad Luqman Farrukh , Kazmi Syed Tehseen Haider , Mehboob Sufyan , Basit Salman Abdul , Ali Sultan , Haider Rana Haroon
Published: September 2021

Background: The utilization of medication by individuals in an attempt totreat self-recognized symptoms themselves is termed self-medication. Medical students faceobscurity when they seek health care for themselves. This study was conducted to assessthe prevalence of self-medication among the private undergraduate medical students of aprivate medical college of Lahore to assess the students’ attitudes regarding the practice ofself-medication. Study Design: Cross sectional study. Setting: The participants were studentsof Shalamar Medical and Dental College, Lahore a Private Institute, in Lahore. Period: Mayto September 2015 (5 months). Methods: The sampling frame constituted of 600 eligiblestudents. The sample size of 192 was calculated assuming 76% prevalence of self-medicationpractice with 5% relative precision and 95% confidence interval. Systematic random samplingwas utilized to administer a modified, self-administered, structured questionnaire. Institutionalreview board (IRB) of Shalamar Institute of Health Sciences granted permission to carry outthe research. The questionnaires were distributed to a sample of 200 subjects after a signedinformed consent was obtained. The data entry and analyses were done in SPSS for Windowsversion 20.0. Results: The response rate was 100%. The average age of the participants(n= 200) was 21.7 ±1.5 years. Almost 83% (n= 159) of students admitted to practice selfmedicationwith a different range of antibiotics. Convenience 62% (n= 124) was chosen to bethe main reason of self-medication followed by cost saving 14% (n= 28) and lack of trust inprescribing physician 12% (n= 24). Fever 18% (n= 77), sore throat 19% (n= 81) and cough18% (n= 79) were the main reasons for self-medication. Opinion of family members 30% (n=60), personal previous experiences 25% (n= 49) and doctor’s previous prescription 18% (n=35) were major criterion for selection of antibiotic. Local community pharmacies were used asa source of obtaining antibiotics for self-administration by 72% (n =144). The relation betweenself-medication and type of antibiotic taken in consideration before use was highly significant,Χ2 (1, n= 200) = 12.37, p<.001. The relation between local community pharmacies as a sourceof getting antibiotics for self-administration and self-medication was also highly significant, Χ2(1, n= 200) = 17.87, p<.001. Conclusion: Self Medication with antibiotics and analgesics iscommon among undergraduate medical students. Local community pharmacies play a criticalrole as a source of disbursement of antibiotics.
AFI IN PREGNANT PATIENTS;
Authors: Akhtar Farkhunda , Aziz Arooj , Hamid Arfa , Hamid Tooba
Published: September 2021

Background: Amniotic fluid plays major role in fetal growth & development.Abnormalities of fluid volume can affect fetal development causing many structural anomalies.Maternal dehydration leads to changes in amniotic fluid index by changing net movement of fluidinto or from the fetus. Study Design: Cross sectional study was carried out to asses increaseincidence of reduced amniotic fluid index in Quetta due to dehydration. Period: Year of 2015.Method: The study was a cross sectional study for this purpose 50 pregnant patients referringto obstetric Out Patient Department of Combined Military Hospital Quetta were investigatedfor changes (improvement, or no change) in amniotic fluid index after hydration therapy. Theunder studied population was pregnant women between 20th_ 38th week of gestation referringto obstetric Out Patient Department of Combined Military Hospital Quetta with amniotic indexless than 10.The study was conducted after approval of ethical committee. Result: Patientsshowed significant improvement in AFI after hydration therapy. Conclusion: QUETTA region,a combination of dry and cold weather leads to decrease fluid intake and greater insensiblelosses that results in reduced AFI. Increased incidence of reduced AFI is highly due to maternaldehydration that can be improved with maternal hydration.
CORONARY ARTERY DISEASE (CAD);
Authors: Asghar Naeem , Ali Liaqat , - Asadullah
Published: September 2021

Background: Coronary artery lesion severity is physiological assessed byfractional myocardial flow reserve (FFR). Angiographic assessment of intermediate severitylesions is problematic as inter-observer variability is significant. Hence one is not sure aboutthe hemodynamic or functional significance of these lesions. FFR is helpful in this situationby assessing functional or hemodynamic significance of these intermediate coronary lesions.An FFR value <0.80 identifies ischemia-causing coronary stenosis with an accuracy of >90%suggesting that intermediate coronary lesion is in fact functionally important. Objective: Todetermine the correlation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) of proximal and mid segment of major coronary arteries and mean fractional flowreserve (FFR). Study duration: From 1-07-2015 to 31-12-2015. Study design: Cross sectionalstudy. Methodology: After approval from hospital Ethical committee and Informed consent, 60patients with intermediate diffuse lesions on coronary angiography from Faisalabad Institute ofCardiology were enrolled. FFR assessment of diffuse intermediate lesion was done by author.FFR assessment was done using FFR wire during maximal blood flow (hyperemia) whichwas induced by injecting bolus dose of intracoronary adenosine. The cost of procedure wasmanaged by hospital. Results: In this study, 28.33% (n=17) were between 20-50 years of age,mean+SD was calculated as 55.17+8.04 years, 51.67% (n=31) were male and 48.33% (n=29)were females. Correlation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) of proximal and mid segment of major coronary arteries and mean fractionalflow reserve (FFR) was recorded it shows that mean lesion length was 24.53+4.78 mm whileFFR was recorded as 0.72+0.12, the value of R is -0.1928, technically a negative correlation,the relationship between variables is only weak (the nearer the value is to zero, the weakerthe relationship). The value of R2, the coefficient of determination, is 0.0372. Conclusion: Thecorrelation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) ofproximal and mid segment of major coronary arteries and mean fractional flow reserve (FFR)was weak and did not suggest any hemodynamic significance of diffuse intermediate coronaryartery lesions.
MALOCCLUSION AMONG TANZANIAN ADULTS;
Authors: Rwakatema Deogratias Stanslaus , Ananduni Kanankira Nnko , Katiti Victor William , Msuya Marycelina , Chugulu Juliet , Kapanda Gibson
Published: September 2021

Introduction: An increase for oral health care uptakes in Tanzanian through currentsurge of health insurance establishments has placed adult individuals to seek for orthodonticcare which was nonexistent at their adolescent age. However, prevalence of malocclusion andmagnitude of orthodontic treatment needs not known in Tanzanian adults. This study aimed tosurvey on the prevalence of malocclusion and objective orthodontic treatment needs among theadult population in Tanzania. Study Design: Survey study. Setting: Conducted at KilimanjaroChristian Medical Centre Teaching Hospital, Moshi, Tanzania. Period: January to April in2014. Subjects and methods: A population of 217 nursing student at Kilimanjaro ChristianMedical Centre Teaching Hospital in Moshi, Tanzania were involved for clinical examinationof malocclusion traits. The traits were registered according to the criteria developed by Bjork,Krebs and Solow in 1964. Dental Aesthetic Index (DAI) was used to determine orthodontictreatment needs in this group of Tanzanian adults. Data for malocclusion traits were analyzedusing Statistical Package for Social Sciences. The Intraclass Correlation Coefficient (ICC) wasused to determine intra-examiner reliability of the discrete variables of Bjork criteria and DAIcomponents. ICC value classification was based on those developed by Landis and Koch in1977. The intra-examiner reliability by ICC in our study was almost perfect (ICC=0.895-1.000).Results: The overall prevalence of malocclusion was 94.4%. Angle’s Class II and Class IIImalocclusion occurred in 12.9% and 6.7% respectively of the studied population. Aplasia orimpacted teeth excluding the last molar occurred in 8.4% of the students. Deep bites occurredin 7% and frontal open bites in 9.3% of the students studied respectively. Crowding in both jawswere found in almost half of the students with more crowding in mandibular incisors. Midlinedisplacement was registered in 38.8% of the students. The populations mean DAI score was27.7 (8.64 ±SD). About 51% of the students had either no need or slight orthodontic treatments.About 49% were found with orthodontic treatment needs ranging from elective, highly desirableto mandatory. Conclusion: The current findings showed presence of malocclusion traits in thispopulation with tendency for some of the traits to increase in severity compared to the findingsin the adolescents studied previously in Tanzania. Higher overall prevalence of malocclusionaccording to Bjork criteria in this population corresponded with considerable orthodontictreatment needs assessed by DAI scores.