bluuebunny/crossref_metadata_2025 huggingface dataset:
LOSARTAN POTASSIUM 50MG (F-6);
Authors: , Asnad , Fida Ruqia , Muhammad Said
Published: September 2021

Introduction: Hypertension is one of the strongest modifiable risk factors forcardiovascular and kidney disease and has been identified as the leading risk factor for mortality.The reduction of blood pressure lower than 130/85 mmHg provides additional benefits regardingboth protection of organs and cardiovascular mortality. It suppresses the effects of angitensinII at its receptors, thereby blocking the rennin-angiotensin system. The rennin-angiotensinsystem plays a crucial role in the control of blood pressure, and in particular it is felt to playcrucial role in hypertension. Objective: The objective of this double-blind, comparative studyevaluating efficacy and biochemical effects of optimized Losartan Potassium 50mg (F-6) asmonotherapy in adult patient with essential hypertension. Study design: Double-blind,comparative study. Place and Duration of Study: This study was conducted at the Departmentof Biochemistry, University of Karachi from January 2010 to August 2010. Methods: This wasmulticenter randomized, double-blind, comparative study. Patients were randomized to receiveonce Losartan Potassium 50mg (F-6) daily for 8 weeks and at the end of study efficacy andbiochemical evaluation was done. Result: The patients treated with optimized Losartanpotassium (F-6) alone, blood pressure reduction was lower, although significant; reaching valuesof 140.9 ± 11.3 / m88.9 ± 5.5 mmHg (p < 0.05 versus Placebo) by the end of eight weeks oftreatment. . No significant variation of blood glucose was observed and different parameters oflipid profile were also observed during the eight weeks of treatment with antihypertensiveregimen used. Thus, the drug regimens used may be considered neutral as regards glucose andplasma lipid metabolism profile because drug used at low doses. Conclusions: We can suggestthat the high antihypertensive efficacy, good tolerability and no biochemical effects of theoptimized Losartan potassium (F-6) it is an excellent option for the treatment of hypertension in awide range of hypertensive patients, with a high potential to reduce cardiovascular risks.
FAST ULTRASOUND
Authors: Jawed Muhammad , Shaikh Ubedullah , Zaman Khan Muhammad Laiq uz , Shaikh Shazia Ubed
Published: September 2021

Objective: Fast ultrasound is a basic tool to evaluate the blunt abdominal traumapatient and help to decision making for emergency surgery. Study design: Observational study.Place and duration of study: The King Fahad Hospital Madina Munawara, over a periodbetween 2010 and 2011. Methodology: This study consisted of 765 patients came in Emergencydepartment The King Fahad Hospital Madina Munawara Level II, or Regional Resource TraumaCenter Saudi Arabia. Detailed History was taken from all the patients with special regard to blandabdominal trauma. All patients were brought to a trauma resuscitation area where a trauma teamconducted a primary survey, after an airway and adequate oxygenation/ventilation wereestablished. The FAST examinations were performed using 4 windows: subxiphoid, right upperquadrant, left upper quadrant, and suprapubic. The critical areas for intra-abdominal bleedingwere the hepatorenal space (Morrison’s pouch), the spleno-renal space, and the pelvic pouch ofDouglas. The FAST examinations were interpreted on the spot and results Recorded. Resultswere prepared with help of tables and graphs. Data was analyzed through SPSS software.Results: 73 out of 765 patients who underwent FAST ultrasound in the Emergency Room. 40(54.79%) cases were road traffic accident (RTA) injuries followed by injury due to fall were in33(45.20%) cases. Findings are fast ultrasound observed 49 out of 73 patients (67.12%) wereconsidered positive FAST who had fluid (blood) in the peritoneal cavity and these patients shift toOperative Room for surgery. While 24(32.87%) patients with no evidence of intraperitoneal fluidwere considered negative for FAST and these patient underwent CT scans for evidence of solidorgan injury(Chart No.2). 5 out of 24 cases of solid visceral trauma found on CT scan abdomen,but had not been detected by FAST then shift to operative room after resuscitation. Conclusions:We conclude that FAST ultrasound is very helpful to assessment of blunt abdominal trauma andto detect intraabdominal fluid. Fast ultrasound can help in the quick decision for surgicalintervention within minutes of a patient's arrival at emergency department.
MILD TO MODERATE ACUTE BILIARY PANCREATITIS;
Authors: Khan Muhammad Sohaib , Khan Jahangir Sarwar , Khan Muhammad Mussadiq
Published: September 2021

Introduction: Acute biliary pancreatitis is a serious complication of biliarycalculous disease and is associated with significant morbidity and mortality. Incidence is moreoften in females and cause is the gall stones in majority of the cases. Definitive treatment ischolecystectomy and with the advancement of minimal invasive surgery, laparoscopiccholecystectomy has been considered as a gold standard for the management of acute BiliaryPancreatitis. The optimal timing when to perform laparoscopic cholecystectomy is still underdebate. Many surgeons recommend early surgery whereas others are in favor of delayedsurgery. This study is carried out to compare the timing of laparoscopic cholecystectomy in casesof acute biliary pancreatitis. Objective: To compare the frequency of conversion fromlaparoscopic to open cholecystectomy in early versus delayed laparoscopic cholecystectomy inmild to moderate acute biliary pancreatitis. Study design: Randomised Control trial (RCT).Setting: Department of surgery, Holy Family Hospital, Rawalpindi. Duration: Six months, fromJanuary 2010 to June 2012. Material and methods: 306 patients, diagnosed as mild tomoderate acute Biliary Pancreatitis were randomly allocated into two groups for laparoscopiccholecystectomy. Those who were operated within two weeks of index hospital admission werelabeled as Early laparoscopic cholecystectomy (EC) group whereas those undergoing surgeryafter 02 weeks of index hospital admission were considered as Delayed laparoscopiccholecystectomy group(DC). Conversion rate from laparoscopic to open cholecystectomy wascompared in two groups. Results: Out of 153 patients enrolled as EC group, 138 were female and15 were male patients. Mean age was 39.19 ± 11.25years where as in DC group , there were 134female and 19 male patients in a total of 153 patients, and the mean age was 39.54 ±10.37 years.Conversion from laparoscopic surgery to open cholecystectomy was 8.5%(13 patients) and13.1%(20 patients) in EC and DC groups respectively. The overall conversion rate was 10.8%.There was no statistical significance between conversion rate of the two groups. (p = 0.197)Conclusions: Acute Biliary Pancreatitis should be managed by laparoscopic cholecystectomyregardless of the time elapsed since the start of symptoms. There is no statistical significance ofconversion rate from laparoscopic to open cholecystectomy associated with the timing ofsurgical intervention in the case of acute Biliary Pancreatitis.
VITAMIN D STATUS AND DIABETES MELLITUS
Authors: Magsi Mohammad Anwar , Ijaz Aamir , Maryam Aaizah , Yousaf Shagufta , Sana Fawaad , - Najamuddin
Published: September 2021

Introduction: Diabetes mellitus is a worldwide epidemic, similarly low Vitamin Dlevels constitutes a largely unrecognized epidemic in many populations. There is no study in ourcountry to document the association between these two common metabolic disorders.Objective: To assess the degree of correlation between vitamin D status and various categoriesof hyperglycaemia in a Pakistani population. Study Design: Descriptive cross sectional study.Place & Period of Study: Department of Pathology, PNS SHIFA Hospital, Karachi; Jan 2013 toAug 2013. Glucose levels were measured in eight six patients divided on the basis of their 25-hydroxyvitamin D3 (25OHD) levels in three groups, normal (>31 ng/ml), insufficient (20-31ng/ml)and deficient (<20ng/ml). 25OHD was measured by electrochemiluminescence using RocheElecsys® Systems while glucose was estimated by routine methods on Roche Hitachi®Autoanalyser. Results: Vitamin D levels were inversely correlated with plasma glucose levels(r=0.38; p<0.01) with an Odd Ratio of 3.59 (95%confidence interval 1.29 to 8.70). Fasting plasmaglucose was significantly higher in vitamin D deficient patients as compared to patients withnormal vitamin D status (p<0.05). Conclusions: Vitamin D deficiency is negatively associatedwith plasma glucose levels.
FETAL MACROSOMIA;
Authors: Ali Habiba Sharaf , Ishtiaque Shahina
Published: September 2021

Objective: To review the deliveries of macrocosmic babies and their obstetricaland neonatal outcomes. Methods: A prospective case control study involving a total of 3700deliveries at term of macrocosmic babies between Jan 2011 to Dec 2012 in Ziauddin HospitalKemari Campus. The study concerned risk factors, mode of delivery and the incidence ofmaternal and perinatal complications. Results: Macrosomia occurred in 5.2% of all deliveries.The main risk factors of macrosomia identified in our study were multiparty and diabetes mellitus.The significant maternal complications were caesarean section, postpartum hemorrhage andperineal tear. Significantly male gender, shoulder dystocia and admission to NICU were noted inmacrosomic group compared to controls. Conclusions: Macrosomia is potentially dangerousfor the mother and the neonate. It is important to identify the suspected fetal macrosomia toprevent its risk factors and complications. There is a need to provide all delivery facilities and careservices to prevent and reduce the maternal and neonatal complications.
ECLAMPTIC PATIENTS;
Authors: Kadri Farzana , Khan Nusrat H. , Shaheen Shugufta , Saeed Muhammad
Published: September 2021

Objective: To compare the frequency of fits in the eclamptic patients before andafter use of magnesium sulphate as anticonvulsant and enlist the complications of MgSo4.Subjects & methods: All the patients with more than 20 weeks, of gestational age, with any paritywere includes in the study. Patients developed fits before giving magnesium sulphate and afterwere evaluated, all the patients were monitored for occurrence of complications due to drug.Magnesium sulphate administered for 24 hours after last fit of delivery and patient’s bloodpressure, pulse, respiratory rate tendon reflexes and urine output was monitored half hourly.Results: Mostly fits were noted in the patients before the treatment of magnesium sulphate and 1to 3 fits were noted in the 57.1% of the cases, 28.5% patients were seen with 4 to 6 numbers of thefits while more than 6 fits were noted in the 14.2% of the cases, and after the treatment (use ofmagnesium sulphate) 1 to 3 fits were seen in the 5.7% of the cases, 4 to 6 fits were only in the 2.8%of the cases while no any patient was noted with above 6 fits. Proteinuria was present in the 80% ofthe cases and edema was found in the 42% of the patients Conclusions: In the conclusion of ourstudy MgSO4 found to be very effective and cheap for control of fits and has lower risk of recurrentconvulsion.
POSTOPERATIVE PAIN;
Authors: Jatoi Altaf Hussain , Younus Syed Muneeb , Ghayassuddin Muhammad , Mirani Abdul Jabbar , Ghayas Nighat , Qazi Aamna , Suchdev Sunil , Bakshi Saqib
Published: September 2021

Introduction: Postoperative inguinal pain is one of the most significantcomplications following inguinal hernia repair. Routine ilioinguinal nerve excision has beenproposed as a means to avoid this complication. Objectives: To compare the postoperative painafter preservation and elective division of ilioinguinal nerve during inguinal hernioplasty.Methods: This was a Randomized Controlled Trial conducted at the department of generalsurgery at KVSS Site Hospital for a period of 6 months from Jun 2011 to Nov 2011. 84 patientswho underwent mesh hernioplasty for unilateral inguinal hernia, were randomly assigned into twogroups (A and B), 42 in each group. Ilioinguinal nerve was preserved in group A patients, whereaselective division was carried out in patients of group B. Mean postoperative pain scores wererecorded using numerical analogue scale on first and third postoperative day, and one monthafter surgery. The SPSS version 16 was applied to the data. Results: Mean±SD age was38.46±14.36 years. Seventy four (88.1%) patients were male whereas ten (11.9%) were female,with male to female ratio being 7:1. Using the numerical analogue scale to detect pain severity onpostsurgical day 1 and 3, mean scores±SD in the nerve-preservation and nerve-excision groupswere 2.88±0.43 versus 2.04±0.39, and 1.95±0.39 versus 1.43±0.44, respectively (p<0.05). At 1month after surgery, these scores were 1.73±0.62 versus 0.98±0.25, respectively (p<0.05).Conclusions: Postoperative pain after inguinal hernioplasty significantly decreases in electivedivision of ilioinguinal nerve as compared to nerve preservation.
NUCLEAR FUNCTION AND RELEASE OF IL-33
Authors: Koma Mousa Komai-
Published: September 2021

Interleukin-33 (IL-33) is the most attractive novel cytokine identified as an IL-1family member. IL-33 was first named NF-HEV (nuclear factor from high endothelial venules), as itwas known to interact with nuclear chromatin although its exact intracellular functions are still tobe clarified. IL-33 is now recognized as the specific ligand for the orphan IL-1 receptor familymember ST2 and to be involved in polarization of T cells towards T helper 2-cell phenotype and inactivation of mast cells, basophils, eosinophils and natural killer cells. It is essential for IL-33 to beextracellularly released in order to bind to the ST2 receptor and consequently play a crucial role ininflammatory, infectious and autoimmune diseases. However, like the IL-1 family members, IL-1beta and IL-18, IL-33 mRNA is translated without a signal sequence for secretion. Additionally, IL-33 cannot be released by the processing and secretion mechanism shared by IL-1beta and IL-18as IL-33 is not a substrate of caspase-1 and does not require proteolysis for activation. In contrast,IL-33 can be inactivated by apoptotic caspases. Accordingly, IL-33 is proposed to be released asan alarmin from necrotic cells but deleted during apoptosis. Besides the known autocrine,paracrine mechanisms of cellular interaction with cytokines, release by necrotic cells is anotherpathway for a cytokine to display its function, which we suggest might be called 'necrocrine'.
BREAST CANCER;
Authors: Nisar Abeer , Siddiqi M Naim , Rehman Naveed ur , Rahman Raza ur
Published: September 2021

Objective: To assess the risk factors for breast cancer in patients attending oncology OPD of civil hospital Karachi, Pakistan. Introduction: Breast cancer is the single largest cause of death among women1,2. The probability of American woman developing breast cancer in their life is 7 in 11. Studies from subcontinent show that the incidence of breast cancer is increasing, with an estimated 80,000 new cases diagnosed annually. Breast cancer is the second most common type of cancer after lung cancer in Pakistan and ranked first in women. Only 10% women are diagnosed, out of them, 75% women do not get treatment and die within 5 years6. Data from Pakistan about the risk factors or association is not only scanty but also does not comment on the use of fatty diet in breast cancer patients. Method: A cross-sectional descriptive study conducted at Oncology OPD of civil hospital Karachi (CHK) from October 2009 -April 2011. One Hundred and Fifty consecutive patients having histopathalogical diagnosis of breast cancer were assessed for different risk factors that included marital status, parity, age, menopausal status, family history of breast cancer, prolong use of oral contraceptives, breast feeding, , early menarche, trauma to the breast and fatty diet. Result: Mean age of patients was 48 years. Three fourth (73%) of these female were above the age of 40 years. Consumption of fatty diet was found in 62.67% while positive family history of breast cancer was present in 34% of the cases. Early menarche and being nulliparous were not as strong risk factors as in previous studies. Conclusions: Our study has highlighted the need of further exploration in this area that would not only help this population but also enhance our understanding of different risk factors. This will have important implications for the overall management of breast cancer.
OPTICAL COHERENCE TOMOGRAPHY (OCT);
Authors: Qamar Mehboob Qamar , Qazi M.H , Arif Muhammad
Published: September 2021

Objectives: To see the consequences of diabetic macular edema as assessed by optical coherence tomography (OCT) and visual acuity (V/A). Design: A prospective observational study. Patients were selected by simple random technique. Duration: Jan 2012 - Dec 2013. Material and Methods: A total of one hundred patients (200 eyes) of ages forty two to sixty three years with an average age of 51.04 ± 6.26 years of either sex were included. All these patients were examined in the outpatient department and were diagnosed as diabetic with macular edema and no opacity in refractive media. Their V/A was checked. OCT was performed in the Diagnostic & Research Centre, Department of Ophthalmology, Allied Hospital, Faisalabad. Results: Out of 200 eyes on OCT our findings were Diffuse Retinal Thickening in 199 eyes (99.5%), Cystoid Macular Edema in 119 eyes (59.5%), Subretinal Fluid in 48 eyes (24%), Epiretinal Membrane in 15 eyes(7.5%), Vitreomacular Traction in 11 eyes (5.5%) and Taut Posterior Hyaloid Membrane in 4 eyes(2%). The visual acuity on the right side was 0.29±0.19 and on left side it was 0.38±0.11. The macular thickness was 437.10±82.57 microns on the right side and 414.01±69.35 microns on the left side. The best-corrected visual acuity was significantly correlated with central foveal thickness. Our results showed, on the right side, a significant negative correlation (correlation coefficient: -0.355, p<0.01) between them. On the left side, a significant negative correlation (correlation coefficient: -0.362, p<0.01) was recorded.
HEROIN DEPENDENCE;
Authors: Maqsood Niaz , Akram Bushra , Luqman Naima , Amin Rizwana
Published: September 2021

Objective: To determine the frequency and level of family support in Heroin Dependent patients presenting with 1st treatment and also the patients presenting with relapses. Study design: A descriptive study. Place & duration of study: The study was conducted in the Department of Psychiatry & Behavioral Sciences, Nishtar Hospital, Multan from September, 2013 to December, 2013. Subjects & methods: The sample consisted of 50 consecutive inpatients presenting with Heroin Dependence. They were interviewed and Family support Scale (FSS) was administered to know the level of support in heroin dependent patients. Results: Results showed that 20% patients relapsed 3 times while 38% had more than three times relapses among whome 30% patients have family support, but 70% have very low level and family support decreased with increasing number of replace. Conclusions: We concluded that higher level of family support was during in the 1st treatment of Heroin Dependence and family support decreased as the number of relapses increased.
INDUCED ABORTION;
Authors: Asif Uzma , Mudassir Asma , Zaman Salma
Published: September 2021

Objective: To determine the frequency and types of various complications and in-- hospital maternal outcome in induced abortion. Study design: An observational descriptive study. Place and Duration: Islam Medical College Sialkot, from January 2011 to January 2013. Methods and Materials: A descriptive study, 130 patients of induced abortion were selected by purposive convenient method. All patients with history of induced abortion were included. All patients with history of spontaneous or medically induced abortions were excluded. Patients were asked who performed the abortion, reason for seeking abortion, techniques and material used. Patients underwent a thorough clinical examination. Routine investigations, abdominal ultrasonography were performed. Evacuation of retained products of conception and Laparotomy was done if required. Pre--designed research proforma was used. SPSS--17 was used to analyze data. Frequency and percentages were calculated for categorical variables. Means and standard deviations were calculated for quantitative data like age, blood pressures, gestational age, and lab parameters. Results: Majority of the patients 63/130 were in the age group 31years and above,123 patients were married while 07 patients were unmarried., 76.92% (100/130) patients were illiterate, , 52.30% (68/130)of patients were from the urban and 47.69% (62/130)were from the rural areas. In 126 (96.92%) cases, abortion was done to get unwanted pregnancies terminated. Majority of cases were induced by unskilled persons. Majority, 51.53%(67/130) were para 5 and above. Commonest method employed was instrumentation which was used in 93.07% cases. Hemorrhage was seen in 69.23%, fever in 50% abdominal pain in 16.19%. Evacuation and curettage was done in 91 (70%) cases, laparotomy in 25 (19.23%) and only 14 (10.76%) were managed conservatively. Twenty five patients who underwent laparotomy had gut and uterine injuries. Seven women (5.38%) died during the study due to septicaemia and DIC. Postoperative complications occurred in 8 (6.15%) patients. Conclusions: Maternal mortality and morbidity due to induced abortion is still very high. Being a preventable cause of death, it can be controlled by proper implementations of family planning programs, training of midwives and easy access to contraceptive methods.
EFFECT OF DIFFERENT FACTORS;
Authors: Iqbal Sajjad , Tarar Maryam Riaz , Zia Rashid , Naeem Tahir
Published: September 2021

Objectives: To determine the effect of different factors on the efficacy of treatment in Hepatitis C patients. Study Design: Descriptive, analytical study. Setting: Shalamar hospital Lahore. Period: October 2010 to May 2013. Materials and Methods: A total of 254 Hepatitis C patients infected with different genotypes of Hepatitis C virus (HCV) were treated with Interferon alpha 2b plus Ribavirin (IFNα-2b+RBV) for 6-12 months according to viral genotype. Before starting the treatment, the presence of HCV and its quantity in the patient was done by real-time PCR. HCV Genotyping was done by multiplex PCR. Results: The patients with <40 years of age or had less than 2 million international units per milliliter basic viral load (<2 MIU/ml) showed better end of therapy (EOT) and sustained virological response (SVR) than ≥40 years of age or ≥2 MIU/mL basic viral load. The response of males to Interferon therapy was better than females. The patients infected with HCV genotype 1 or 4 exhibited lower response than those infected with other than 1 or 4 genotype. The affect of other variables like alcohol, diabetes, hypertension, smoking, injection brand change or missing the injection during therapy were also remarkable in the present study. Conclusions: With proper management of the factors mentioned in the present study efficacy of the treatment can be improved.
PRIMARY DIAPHYSEAL TUBERCULOUS OSTEOMYELITIS OF TIBIA
Authors: Khan Ghulam Mustafa Kaim , Humail Syed Mujahid , Hafeez Kamran
Published: September 2021

Diaphyseal tubercular osteomyelitis of long bone is extremely rare and few cases have been reported in literature. We are presenting a case of 17 years old girl presented with pain and swelling over lower half of leg for 7 months. There was often low grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays and MRI of involved leg were suggestive of osteomyelitis. Curettage and biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries, for an osteolytic lesion in bone, tuberculous osteomyelitis should be considered in differential diagnosis.
ASSOCIATION OF HIV WITH DRUG DEPENDENCE;
Authors: Dogar Imtiaz Ahmad , Baig Mirza Yasir Umer , Ali M. Arif , Nisar Usman , Haider Nighat , Ali Istikhar
Published: September 2021

Objective: This study was undertaken with an objective of collecting basic data to assess the extent and variety of drug abuse in patients presenting to the model drug abuse and treatment center, DHQ hospital, Fsd as per social and demographic circumstances. Study design: cross sectional study. Place and duration of study: The study was conducted in the indoor Department of Model Drug Abuse Treatment Center of Department of Psychiatry and Behavioral Sciences, DHQ Hospital, Faisalabad from Jan-2014 to March-2014. Method: 80 patients dependent on different drugs participated in this study through purposive convenient sampling technique. Personal, Social, and Demographic variables were recorded on a demographic sheet. The results were obtained by using SPSS 17. Results: Descriptive statistics showed that 31 patients (38.8%) were HIV positive. Most of the patients were males (97.5 %), between 30 to 35 years of age (28.8%), married (61.3%), lived in urban areas (55%), illiterate (32.5%), had primary level education (21.3%), or middle level education (22.5%). 51.3 % patients were laborers. Conclusions: As illiteracy, low education, unemployment, labor as profession, and peer pressure are the key features of drug abusers. So, parents, health professionals, and state personals should take these as risk factors and focus upon these population segments to spread awareness and take measures of control to minimize the incidence of substance abuse.
ATONIC UTERUS;
Authors: Ara Bilqees , Nisa Zaib-un- , Ara Firdos , Kakar Palwasha , Salam Abdul , Aslam Mahrang
Published: September 2021

Objective: This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage (PPH) and to point out risk factors for it and observe different ways of management for control of atonic primary (PPH). Design: Prospective cross sectional study. Place and Duration of Study: This prospective cross sectional study was conducted in Obstetrics & Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 (one year). The study was conducted on 80 patients. Subjects and Methods: The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done.All the data was analyzed by SPSS version 10. Results: Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony (37.5%) was found in women aged 26-30 years, followed by (27.5%) women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 (56.3%), 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins (PGF2-alpha & PGE2) were administered in 32 cases & successful in 22 (68.7%) cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled (62.5%). Ligation of uterine arteries was performed in 5 cases, it proved successful in 4(80%) & hysterectomy was done in 7.5% cases. Conclusions: Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg & prolonged labour.
GLUTATHIONE;
Authors: Ullah Hashmat , Khan Muhammad Farid
Published: September 2021

Background: Compounds of lithium are used as drug of choice in many psychiatric disorders including bipolar disorder, depression, schizophrenia etc. Objective: The aim of this study was to analyze the effect of lithium on lymphocyte’s GSH levels for which terasaki technique was used to separate T-cells and B-cells of human volunteer’s venous blood. Study Design: Experimental Study. Setting: Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Gomal University, Dera Ismail Khan.Period:1st December 2012 to 26 February 2013.Statistical Analysis: One-way ANOVA followed by Dunnet’s HSD test. Results: Thiol quantification was done by using Ellman’s method and was found statistically significant (p < 0.001) decrease in T-cells/B-cells GSH level which was dose and time dependent. T-cells/B-cells dose dependent drop in GSH level was 2.752μM (9.41%) and 2.554 μM (16.12%) by lowest used concentration (0.003μM) of lithium citrate. Conclusion: We have noted that there is significant drop in T-cells and B-cells GSH due to which immunological alterations happen which are linked with GSH contents of lymphocytes and hence inhibition in lymphocytes activity is co-related with depletion in GSH level of these cells which ultimately with the increase in Li+1 concentration cause further decrease in GSH level leading to cells death.
EFFECT OF AEROBIC AND RESISTANCE TRAINING;
Authors: Hayat Irum , Lys Isabelle , Krebes Jeremy , Page Rachel
Published: September 2021

Objective: The aim of this investigation was to examine the effect of aerobic and resistance training on the skeletal muscle mitochondrial function. Setting: Wellington Hospital New Zealand, Massey University, Wellington Campus New Zealand. Period: Sep 2008- Sep 2011 Results: There was a very large effect (6.7 ± 1.2) in the AER group for BHAD activity whereas in the PRT group a large effect (2.7 ± 1.2) for BHAD activity was observed. There was an increase in CS activity in both groups (PRT; p = 0.007, AER; p=0.03) however, the activity increase was more in the PRT group (effect size = 1.8 ± 1.3). COX activity was raised in both groups as well though the effect size in the PRT group was 2.3 ± 1.2 meaning a very large change with PRT exercise compared to a moderate effect (1.0 ± 1.2) with AER exercise. Conclusion: Overall these findings suggest that both PRT and AER exercise can be effective therapeutic modalities for the induction of changes at the cellular level in muscle of people with T2DM.
GYNAECOLOGICAL HYSTERECTOMY;
Authors: Qureshi Saima , Mussarat Nazia , Sharif Nadia , Azhar Tasneem
Published: September 2021

Objectives:The aims of study are (1)To make an audit of hysterectomies by either route in a teaching hospital.(2)To determine the morbidity and mortality associated with this procedure. Study design: Descriptive study Setting: Gynae & Obstetrics units, Independent University Hospital Faisalabad Period: From 1-1-2006 to 31-12-2008 Material & Methods: retrospective collection of data by convenience sample technique. Results: 27% cases were due to fibroids, 22% were due to uterovaginal prolapse, 19% (DUB), 13% (chronic PID). The complications were 28% (UTI) by abdominal route and 13.3% were by vaginal route, 26.6% wound infection and 2.6% in vaginal hysterectomy, rest of complications were comparable by both routes. Conclusion: vaginal hysterectomy has more promising results but is reserved for specific indications.
SLEEVE GASTRECTOMY
Authors: Jawed Muhammad , Khan Muhammad Iqbal , Shaikh Ubedullah , Iqbal Pervez , Shaikh Shazia Ubed
Published: September 2021

Objective:-The aim of our work is to present Experience of Sleeve Gastrectomyat Centre of Bariatric Surgery of Dow University of Health Sciences. Methods: All patients wereassessed multidisciplinary team before operation. Indications for LSG were BMI 35kg/m2 withcomorbidites and BMI >40kg/m2 without comorbidities. Standard surgical technique adapted.Gastric division by a cutting stapler. The whole staple line was observed for bleeding and testedfor leak. Results: Total 10 patients were studied of which were four males and six females,Median age of was 40 years. Pre-operative median BMI was 52.2kg/m2 (range from 46 to 61kg/m2). Median post-operative BMI of 9 months was 34.33kg/m2 (range from 28 to 40). Out of10 patients, observed complications of bleeding was seen in one case and wound infectionoccurred in 2 cases. Conclusions: Considerable weight loss observed in LSG.
ORAL HYGIENE AMONG PREGNANT WOMEN
Authors: Shabbir Saima , Zahid Masooma , Qazi Aamna , Younus Syed Muneeb
Published: September 2021

Objective: To define the self-reported oral health knowledge, attitudes and oralhygiene habits, among pregnant women getting antenatal care at Kulsoom Bai Valika HospitalKarachi. Method and Material: A cross-sectional questionnaire-based survey was conductedat the KVSS Site Hospital antenatal clinic during the period January - June 2013. The data wasanalyzed using the SPSS for Windows (version 16.0; SPSS Inc. Chicago. IL) statistical softwarepackage and was validated visually. Result: Most of the respondents revealed a reasonablelevel of oral health knowledge and positive attitudes towards oral health. However, there weregaps in the oral health knowledge of the women surveyed. The relationship between the levelof oral health knowledge and ethnicity (p=0.856), level of education (p=0.079), age category(p= 0.166), and trimester of pregnancy (p=0.219) were not statistically significant. In addition,the women’s knowledge and attitude towards oral health was not reflected in their oral hygienepractices. Conclusions: There is a need to provide oral health education for pregnant womenduring antenatal care in order to highlight the significance of good oral health in achieving goodhealth for both the mother and her baby.
MEDICAL GRADUATES?
Authors: Mukhtar Fatima , Aziz Abuzar , Khawaja Shayan Rashid , Amjad Akasha , Haider Alina
Published: September 2021

A universal challenge faced by developing countries these days is the inequitabledistribution of health professionals, which compromises the capacity of the health system todeliver efficient and effective health care. Availability of reliable data on medical graduatesis important for health planning and development of policies and plans dealing with healthworkforce labour market. Objectives: To determine the proportion of medical graduates whoremained affiliated with the profession three to six years after graduation from a private medicalschool, To find out the specialty selection and practice location of these graduates, and todetermine the association between their gender and affiliation with the profession. Methods:A cross-sectional study was undertaken at the Lahore Medical & Dental College from March toMay 2014 selecting graduates through convenience sampling. The graduates were contactedthrough e-mail, Facebook and telephone. After obtaining voluntary informed consent fromthe respondents, a pre-tested structured questionnaire was used to collect information.Thedata was recorded and analysed using the statistical package for social sciences version 16.0.Chi-square test is used to test statistical significance between respondent’s gender and theiraffiliation with the medical profession at p < 0.05. Results: A large proportion 98(88%) ofmedical graduates remained affiliated with the profession. Those who didn’t pursue it were allfemales (p < 0.05). Majority 86(88%) were located in Pakistan. A greater proportion worked inthe tertiary health care facilities 65(94%). The popular specialty being pursued was medicine24(24%). Conclusion: Female medical graduates should be provided opportunities for parttime work.Medical schools should provide early and prolonged exposure of students to primaryhealth care facilities, in order to increase their uptake of rural postings.
SHISHA-SMOKING
Authors: Syed Nehan , Rani Kenjhar , Memon Muhammad Qasim
Published: September 2021

Worldwide, annual rate of 4.9 million deaths have been reported due to thetobacco abuse and this rate might rise to 10 million in the next 20-30 years. Seventy percentof these deaths take place in developing countries. Objectives: To determine the prevalenceand knowledge of shisha-smoking among the university students of Jamshoro and HyderabadSindh, Pakistan. Methodology: A Questionnaire-based cross-sectional study was conductedfrom December 2013 to August 2014. A convenient sampling of 400 participants was donefrom three universities at Jamshoro and one at Hyderabad i.e., Liaquat University of Medicaland Health Science (LUMHS), University of Sindh and Mehran University of Engineering andTechnology (MUET) Jamshoro and Isra University, Hyderabad. Undergraduate male students,age ranging between 18-23 years, were included whereas females, postgraduate studentsand house officers were excluded. Data were analyzed using SPSS (Statistical Package forthe Social Sciences) version 16. Results: Ninety-two percent students were aware of shishasmokingwhereas 8% had no knowledge. Thirty-six percent have ever smoked shisha while64% of students never smoked it. Of the smoking students, 45% mentioned smoking shishararely, 25% of students smoked sometimes, 13% smoked always, 6% smoked it often and10% smoked just once. Most of the students (92%) knew the hazards associated with shishasmoking. According to 48% participants, shisha-smoking is far more dangerous than cigarette-smoking. Conclusions: Prevalence of shisha-smoking in the educated youth is high; however,only half were aware of its harmful effects.
ACUTE FEBRILE ILLNESS
Authors: Ahmad Shahbaz , Nazir Mohsin , Ali Faisal , Sajid Muhammad , Riaz Rehan , Akhtar Raja Pervaiz
Published: September 2021

Oral anticoagulation is needed in many patients like after prosthetic valvesinsertion, in atrial fibrillation, clots in LA, clots in LV and DVT etc. It is mainly achieved by warfarinsodium which has many interactions with multiple other drugs and its action varies in differentother chronic diseased states. Objectives: to see the response of acute febrile illness on thechronic stable state of INR on a fixed dose of oral warfarin sodium. Methods: All the patientswith acutely deranged INR who had a stable and controlled INR previously and a fixed doseof warfarin sodium were admitted in the cardiac surgical ward at FIC and their history wasexplored and recorded. A total of 966 patients were admitted in (CSW) during the period ofApril, 2012 to April, 2014 with deranged INR. INR was checked twice or sometimes thrice torule out the laboratory error. 504 patients were female & 462 patients were male, 56 patientshad repeated admission for their INR control, most of them were callous regarding taking doseof warfarin so they were excluded from the study. Result: A total of 631 patients had low INRdue to missed dose of warfarin sodium. Out of them 13 patients got stuck valve for whichemergency redo prosthetic valve replacement was done. 06 patients died in emergency dueto late presentation after the prosthetic valve got stuck. Only 279 patients had high INR onthe previous dose of warfarin sodium, out of them 216 patients had out of range INR. Theywere treated by FFP transfusion and holding the Warfarin sodium dose for certain period oftime.76% of the patients give H/o acute febrile states 101-103 with rigor & chills (Malaria, entericfever, pharangitis, cellulitis, boils and UTI etc. etc.) since last 3-4 days for which they had gottreatment from some local Gen. practitioners and gave the H/o bleeding gums, general bodymalaise, bruising, joint aches & pains. 24% of patients denied any acute febrile illness beforetheir INR got out of range 2 patients died in emergency due to intra cerebral bleed after INRgot uncontrolled. Conclusions: Any acute febrile illness even of short duration may causesudden derangement of previously controlled INR on certain fixed dose of warfarin sodiumwhich can create a life threatening situation like intra-cerebral bleed, haem-arthrosis, excessivemenstrual blood loss leading to severe anemia. Other less dangerous situation are gum bleed,bruising, joint aches & pains and general malaise. So, it is always advisable and logical to getINR check when ever any acute febrile illness even of short duration is encountered to avoidgrave situations.
ARRHYTHMOGENESIS IN MITRAL VALVE PROLAPSE
Authors: Khan Muhammad Alamgir , Majeed Syed Muhammad Imran , Shabbir Faizania , Rajput Tausif Ahmed
Published: September 2021

Mitral valve prolapse is generally considered a benign condition, however, asubset of patients remains at high risk of arrhythmogenesis which may lead to sudden cardiacdeath. Objective: To stratify risk of arrhythmogenesis in patients with mitral valve prolapseon the basis of high resolution ECG, Holter monitoring, resting heart rate and mitral leafletgeometry. Study Design: Cross sectional comparative study. Place of study: Armed ForcesInstitute of Cardiology (AFIC)/National Institute of Heart Diseases, Rawalpindi and Army MedicalCollege, Rawalpindi, Pakistan Methodology: Mitral leaflet displacement and thickness weremeasured on echocardiography in 37 patients with mitral valve prolapse. Resting heart rateand time domain indices of heart rate variability of each patient were recorded from 24 hoursHolter monitoring. High resolution ECG of all the patients was carried out to record ventricularlate potentials. Statistical analysis was performed using SPSS and the alpha value was set at<0.05 for significance. Results: The mean values for resting heart rate, leaflet displacement andleaflet thickness were 77.19±6.29 per minute, 3.64±0.92 mm and 4.96±0.79 mm respectively.Ventricular late potentials were present in 8 (21.62%) whereas heart rate variability was reducedin 5 (13.51%) patients. Leaflet thickness was significantly greater in patients with ventricularlate potentials as compared to those without (p-value 0.004). Patients with reduced heart ratevariability had significantly higher resting heart rate as compared to those with normal variability(p-value 0.02). One patient (2.7%) had ventricular late potentials, reduced heart rate variability,resting heat rate of 88 beats per minute and leaflet thickness over 5 mm. Conclusions:Combined effects of high resolution ECG, holter monitoring and leaflet geometry identified thehigh risk subset, comprising of 2.7% of the study population.
CORONARY ARTERY DISEASE
Authors: Bhalli Muhammad Asif , Badshah Lal , Babar Momin Ali
Published: September 2021

Objectives: To determine the frequency of risk factors of coronary artery disease(CAD) in healthy male paramedical staff of our hospital. Study Design: Descriptive study. Placeand Duration of Study: Armed Forces Institute of Cardiology and National Institute of HeartDiseases, Rawalpindi, from January 2009 to June 2009. Methodology: Three Sixty Three (363)healthy male paramedical staff members were studied. Patients with heart disease, chronic liverand kidney diseases were excluded. Presence of hypertension, diabetes, smoking, dyslipidemia,physical activity, a family history of (CAD) and medication was documented. Fasting bloodglucose, lipid profile, uric acid levels were done. Body mass index and waist circumferencewere measured and Waist to Hip ratio calculated. Data was analysed using SPSS-20. Ten yearrisk was calculated using Heart Score software. Results: Mean age of subjects was 31.85 ±8.10 years. Maximum number of patients (152, 41.9%) aged between 31 to 40 years. Smokingwas documented in 76 (20.9%), hypertension in 26 (7.2%), diabetes in 27 (7.4%) and a familyhistory of premature CAD was recorded in 26 (7.2%) persons. Eighty (22.01%) patients wereoverweight (BMI = 25-29.9) while 26 (7.2%) were obese (BMI >30). Waist circumference > 94cm was found in 79 (21.8%). High cholesterol (>200 mg/dl) was documented in 33 (9.1% ) ,high LDL( >100 mg/dl ) in 68 (18.7% ), low HDL in 92 (25.4%) and high triglycerides (>150mg /dl) in 116(32%) persons. Conclusions: Dyslipidemia, obesity, smoking, hypertension anddiabetes were most frequent risk factors. Public awareness to control risk factors can reducethe prevalence of CAD.
C – REACTIVE PROTEIN
Authors: Hussain Ahmed , Abro Shahnawaz , Bhurgiri Ashfaque Ahmed , Memon Raheel Imtiaz , Shah Syed Zulfiquar Ali
Published: September 2021

Acute appendicitis is the most common abdominal surgical emergency despiteadvances in radiographic imaging and diagnostic laboratory investigations; the diagnosis ofacute appendicitis remains challenge. Objectives: To evaluate the C-reactive protein in patientswith acute appendicitis. Patients and methods: This cross sectional descriptive study of sixmonths study was conducted at Liaquat University Hospital Hyderabad. All the patients withacute appendicitis were admitted in the ward and were further evaluated for C-reactive protein.The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:One hundred subjects with acute appendicitis were recruited and studies. The mean age ±SD ofthe patients was 27.83±07.52 in overall population while it was 29.73±06.64 and 25.84±04.92in male and female subjects with acute appendicitis. The CRP was raised in 60% patients. Thedistribution of age in relation to gender and CRP was statisitically significant (p= 0.01 and<0.01) whereas the CRP was also observed as statistically significant in context to genderand histopathology (p= 0.02 and 0.03) respectively. The mean ±SD of CRP was 7.53±1.52in overall population while it was 6.84±1.64 and 8.65±1.53 in male and female patients withraised CRP. Conclusions: The CRP was elevated in patients with acute appendicitis.
ACUTE ISCHEMIC STROKE
Authors: Muhammad Dilshad , Javed Masood , Sheikh Ghulam Abbas
Published: September 2021

Among all deaths, 40-50% are due to vascular events and out of these 10% aredue to stroke. More than 66% of the global stroke occurrence is in developing countries, wherethe average age of patients with stroke is 15 years less than in developed countries. Objectives:To determine the correlation between higher total cholesterol level and high Barthel Indexscore(estimate of functional daily independent activity level) in patients with acute ischemicstroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units ofDHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collectedand patients were included through Consecutive (non-probability) sampling technique. Allpatients underwent CT scan Brain from the radiology department of the hospital to determinethe respective changes (hypo dense area) of the ischemic stroke. Fasting serum cholesterolwas measured in all patients after an overnight fast of 12 hours. Then patients were assessed byusing Barthel Index score (BI). The data was analyzed by using SPSS version 16.0. SpearmanRank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results:The mean age of the patients was noted as 61.76±11.55 years. In this study 55.50% weremales and 44.50% patients were females. The mean total cholesterol value of patients wasnoted as 251.58±71.15 mg/dl. Out of 200 patients, 111(55.5%) patients had high cholesterol(>200mg/dl) whereas 89(44.5%) patient had low cholesterol of(<200mg/dl).In statical analysisthe results showed that the mean value of total Barthel index score was 57.50±19.52. The studyresults described that 51.50% patients had high Barthel index score (>53) whereas 48.50%patients had low Barthel index score (<53). Spearman correlation coefficient was calculatedbetween high TC and high BI score as r= 0.641. This value was statistically significant i.e.p-value=0.000*. Conclusions: With the help of this study, we found a significant positiverelationship between high TC and high BI score in patients presented with ischemic stroke.Now we can better prognosticate the functional outcome of ischemic stroke in our patients.