bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores
Authors: Sajjad Yawar , Rahat Beenish , Hameed Salman 
Published: August 2017

<p>Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.</p><p><strong>Objective:</strong><strong> </strong>To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.</p><p><strong>Methods:</strong><strong> </strong>A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.</p><p><strong>Results: </strong>In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent <em>reoperation</em> and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.</p><p><strong>Conclusion:</strong> Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.</p>
Antibiotic Stewardship: Battle to Defeat Superbugs
Authors: Afzal Muhammad Faheem 
Published: August 2017

The practice of medicine has been transformed by antimicrobials. However, overuse and misuse of anti-microbials is one of the major global health problems. Longer and expensive hospital stays are expected for those patients who are suffering from multi-drug resistant organisms.1
Antibiotic stewardship is an emerging concept and may be defined as coordinated interventions to imp-rove and measure the appropriate use of antimicrobials with selection of the optimal antimicrobial drug regimen, duration, dose, and route of administration.” Antibiotic stewardship program (ASP) is aimed to tar-get the antibiotic related optimal clinical outcomes, minimal toxicity and adverse events, cost reduction for infections, and curtail the selection for antimicrobial resistant strains.Centre for disease control and prevention (CDC) has described core elements of hospital ASP, the essentials of these are leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.2 This program has larger impact on infection rates, resistance patterns, costs and clinical outcomes in many studies.3, 4
Pakistan, being the developing country, is facing the problem of antimicrobial resistance at large due to irrational use of antimicrobials. Review of data on drug use in Pakistan shows the excessive and irrational drug use in Pakistan with higher use of antimicrobials and injections and choice of more expensive drugs with inadequate dispensing, compared to the lower middle income countries. The injudicious use of anti-microbials attribute towards antimicrobial resistance and emergence of new mutant strain.5-8
In Pakistan, there is need to conduct drug utilization to identify appropriate usage of drugs in terms of medical, social and economic aspects. To overcome the problem, strategies to decrease unnecessary anti-biotic prescription like “Antibiotic Stewardship Programs” must be implemented.9 In Pakistan, Medical microbiology and Infectious diseases society of Pakis-tan (MMIDSP) has taken initiative to develop indigenous ASP and training program. The ASP should be the part of undergraduate curriculum to sensitize our future doctors. The regulatory authorities should also be active in monitoring the judicious use of antimicrobials. The masses should have easy access to the quality health care services, so as to minimize the irrational antimicrobial use.
Frequency of Caesarean Section in Pregnancies with Borderline Amniotic Fluid Index at Term
Authors: Bushra Natasha , Zeeshan Khaula , Ejaz Sara , Mushtaq Javeria , Waheed Khadija , Khanum Amna 
Published: August 2017

AbstractThe increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives: To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results: Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion: It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.
Imposter Syndrome among Pakistani Medical Students
Authors: Qureshi Muhammad Atif , Taj Jamshad , Latif Muhammad Zahid , Rafique Shumaila , Ahmed Rafique , Chaudhry Mohammad Akbar 
Published: August 2017

<p><strong>Abstract</strong></p><p><strong>Background: </strong>Imposter syndrome (IS) first described in 1978 is recently gaining more importance due to its long lasting, strong and detrimental implications on the Medical students as well as the institutions and society. The sufferers are competent objectively but they have a secret fear in them, that they are inadequate in the skills and knowledge and this secret will be open to others anytime. It is strongly associated with burnout phenomenon, anxiety, depression, many other psychological effects and many significant implications on medical education and training. Suffering students develop different styles of learning and find it difficult to learn through conventional or usual teaching strategies.</p><p><strong>Objectives: </strong>This study objective was to find out the frequency of IS among Pakistani medical students.</p><p><strong>Methodology: </strong>This was a cross sectional, descriptive study, conducted in a private medical college of Lahore, Pakistan in November 2016. Sampling technique was convenient non-probability type and study instrument was 08 items questionnaire. The students who answered “Yes” for five or more out of eight questions were considered positive for Imposter Syndrome.</p><p><strong>Results: </strong>Out of 143 final year MBBS students 58.7% were females &amp; 41.3% males. Sixty eight (68) students (47.5%) were found having Imposter Syndrome according to the Young Imposter scale (YIS) used as questionnaire. Out of these 45 (53.5%) were females and 23 (38.9%) males.</p><p><strong>Conclusion: </strong>Imposter syndrome or phenomenon may be present in significant frequencies and number among medical students. This may have detrimental effects on body, mind, personalities and academic as well as professional developments. Efforts should be made to find out IS/IP among students and to train both students and teachers.</p>
Urinary Incontinence in Pregnant Multigravida from Second Trimester up to the Delivery
Authors: Sharif Sadia , Ijaz Gondal Muhammad Junaid , Kamboh Salman Malik , Adeel Muhammad , Qamar Mustafa , Chaudhry Asad , Nadeem Ramsha 
Published: August 2017

AbstractStructural and physical changes take place in pregnancy such as altered function of urinary tract. The mechanism lying behind low urinary tract function can be described in terms of effects of hormones, compressive dysfunction of uterus and structural changes in pelvic support function. The prevalence of urinary incontinence in developed countries is 27.6% and in developing countries 28.7%. Urinary incontinence is a functional pelvic floor disorder which affects the well-being of all age’s women. Urinary incontinence frequency is increased by pregnancy but the cause of this incontinence is still unknown. The prevalence of in-continence differs greatly.Objective: To know the frequency of urinary incontinence among pregnant multigravida from second trimester up to delivery.Methods: The study design used was a cross-sectional survey. The place of study was Lady Aitchson Hospital Lahore Pakistan and Lady Willington Hospital Lahore Pakistan. It was completed within six months after the approval of synopsis from September 2015 to February 2016. The sample of this study was 706. Mean age of the multigravida belonging to the lower socioeconomic status was 25-28 years of age. Women’s continence and pelvic health center urinary incontinence questionnaire was used in this study.Results: Multigravida included in this study showed 51.1% of urinary incontinence and 48.8% with no urinary incontinence. The level of the beginning of urinary incontinence was more in second trimester.Conclusion: Urinary incontinence is more prevalent in multiparous especially in second trimester of pregnancy.
Prevalence and Determinants of Iron Deficiency Anemia in Adolescents Girls of Low Income Communities in Lahore
Authors: Hassan Fatima , Salim Shafya , Humayun Ayesha 
Published: August 2017

AbstractBackground: Iron deficiency anemia (IDA) in adolescent girls has strong health implications during re-productive years. Current research aimed to assess prevalence and determinants of iron deficiency anemia in adolescent girls of low income families residing in semi urban communities of Lahore, Pakistan.Method: This cross sectional analytical study selected 116 unmarried adolescent girls between the ages of 13 – 19 years from low income families through convenience sampling from semi-urban communities. Dietary data was collected using 3 – day recall, whereas a self-constructed, structured questionnaire was used to collect data on socio-demographic factors. Hemoglobin and serum Ferritin levels were assessed along with an assessment of clinical signs and symptoms of folate and iron deficiency. Data was enteredand analyzed using SPSS version 21.Results: IDA was present in 68.8% of adolescent girls, of which 40.2% were moderately (8 – 10 gm/dl) and 28.8% were mildly (10.9 – 11.9 gm/dl) anemic. Working status (p < 0.041), source of dietary iron (p < 0.001), frequency of heme iron consumption (p < 0.001), protein consumption/day (p < 0.001) and HEI score (p < 0.001) showed statistically significant association with IDA. Binary regression analysis showed frequency of heme iron consumption [AOR = 29.13, 95% CI (9.627 to 88.203)] and HEI score [AOR = 6.877, 95% CI (.065 to 44.405]) to be the most significantly associated determinant of IDA. Mean Hb level was also significantly different between working and nonworking adolescents (p = 0.001, 95% CI = -1.124 to -0.322). Significant mean difference in serum Ferritin levels between working and nonworking adolescents (p = 0.04 [95% CI = -21.89 to -0.50]) was also observed. 94% and 91% girls showed signs and symptoms of iron and folate deficiency respectively. How-ever BMI, age, educational status of the girls and their parents were not found to be associated with IDA.Conclusion: Prevalence of IDA was alarmingly high in adolescent girls of low socioeconomic class. Working status, source of dietary iron, frequency of heme iron consumption, protein consumption/day and HEI score were found to be determining anemia. Nutrition education targeting IDA is the need of the day to control and prevent this public health epidemic.
Clinical Outcomes of Open Ventral Hernia Repair in a Public Sector Hospital
Authors: Ali Shah Syed Kashif , Memon Gulshan Ali , Jamali Khawar Saeed , Sahito Rafiq Ahmed , Rehman Habib Ur , Leghari Shahnawaz , Baloch Shahida 
Published: August 2017

AbstractObjective: This prospective study was designed to see the outcomes in two different types of surgical repairs (suture or mesh) of primary ventral hernia.Methods: A total of 70 adult patients under went for elective primary ventral hernia suture or mesh repair at surgical unit-I of Peoples Medical College Hospital Nawabshah and Surgical Unit-I from March-2010 to Feb-2016 were included in this study on the basis of inclusion – exclusion criteria. Patient’s demographic characteristics, operative details, post-operative out-comes (complications and recurrence) were studied.Results: A total number of 70 consecutive patients having primary ventral hernia under went for an elective open repair either with suture (32/45.7%) or synthetic mesh (38/54.3%) were evaluated in this study. Among these patients 52 (74.2%) and 18 (25.8%) were female and male respectively, with mean age of 51.5 ± 12. A total of 3(7.89%) patients had recurrence with Mesh Repair and 06(18.75%) with suture repair at 3 years follow-up, p-value = 0.176.Conclusion: The mesh repair in ventral hernia has low wound complications and less recurrence of the hernia when compared with suture technique.
Frequency of Hypercholesterolemia in Recent Onset Type – 2 Diabetics with Microalbuminuria
Authors: Hasham Muhammad Adnan , Abbas Sakhawat , Baig Mirza Ilyas , Randhawa Fawad Ahmad 
Published: August 2017

AbstractAmongst diabetes, type 2 diabetes encompasses more than 80% and even higher percentage is present in un-industrialized countries. Kidney disease in diabetic patients is clinically characterized by increasing rates of urinary albumin excretion, starting from no albuminuria, which progresses to microalbuminuria, macro-albuminuria and eventually to End Stage Renal Disease. Dyslipidemia is observed in patients with DM and microalbuminuria. Total cholesterol increases significantly with albuminuria.Objectives: Frequency of hypercholesterolemia in recent onset type-2 diabetics with microalbuminuria.Methodology: The study was conducted in Department of Endocrinology & Metabolism, Services Hospital Lahore. Study was conducted and completed over a period of six months from 15th September 2014 to 15th March 2015. It was a cross sectional survey with non-probability, purposive sampling technique. 200 patients fulfilling the criteria were enrolled. Informed consent was obtained. Demographic information of each patient was noted. Urine was obtained and samples were sent to the laboratory of the hospital and reports were assessed. If the value of albumin is raised in urine analysis (as per operational definition) then albuminuria was labeled. In patients who were diagnosed as with albuminuria, total cholesterol was noted. If cholesterol was > 240 mg/dl, then hypercholesterolemia was labeled by researcher himself.Conclusion: The results of the study conclude that frequency of microalbuminuria among patients of newly diagnosed type-2 diabetic mellitus is in agreement with other studies while the frequency of hyper-cholesterolemia in patients with microalbuminuria was also recorded higher which needs special physicians attention for its timely management so that patients can be prevented from severe cardio vascular morbidi-ties and mortality.
Frequency of Ovarian Tumors According to WHO Histological Classification and Their Association to Age at Diagnosis
Authors: Khan Muhammad Arif , Afzal Saira , Saeed Hassan , Usman Hnia , Ali Rooqash , Khan Manaquibb Zain Ali Shaheer , Mumtaz Aqsa , Ramazan Nimra , Fatima Alina , Haider Jawad , Latif Ahmad , Nawaz Anum 
Published: August 2017

Ovarian tumors, or ovarian neoplasms, are benign or malignant tumors arising from the ovaries. They may arise from any of the three components of ovary i.e. surface epithelium, germ cells and the stroma of the ovary including sex cords. Tumors in the ovary can also be secondary or metastatic tumors.Objective: To determine the frequency of Ovarian Tumors according to WHO Histological classification and their relation to age at diagnosis in almost one year.Methods: A cross-sectional study was carried out, that included all the consecutive cases of ovarian neoplasms diagnosed at the Pathology department of a public sector university in Lahore from 1 January 2015 to 13 February 2016.Results: In 95 female patients diagnosed with ovarian tumors, the mean age was found to be 29.58 ±11.493 with a range of 3-65 years. Tumors were most common between the ages of 15 to 30 years. The highest rates of malignancy were in the 0-15 and 45-60 age groups (Figure 1). About 78.9% of the tumors (75/95) were benign, 1.1% (1/95) were borderline and 20% (19/95) were malignant (Figure 3), 72.6% (69/95) were epithelial tumors, 23.2% (22/95) were germ cell and 4.2% (4/95) were sex cord stromal tumors (Figure 4). Among the 95 cases, serous tumors were the most common (49.5%), followed by mucinous (16.8%) and teratomas (15.8%).Conclusion: According to our study, ovarian tumors were common between the age of 15 to 29 years. Benign neoplastic lesions were more common than malignant neoplastic lesions. The frequency of malignant and benign ovarian neoplasms found in our research differed from other studies conducted in Pakistan. There is a significant association of ovarian tumors in age less than 30 year as compared to older age groups (P < 0.001).
Safe Completion of Laparoscopic Cholecystectomy and Its Conversion Rate in a Tertiary Care Hospital
Authors: Farooq Muhammad Shahid , Altaf Rabia , Qureshi Ahmad Uzair , Naumeri Fatima , Ali Abrar Ashraf 
Published: August 2017

AbstractObjectives: Laparoscopic cholecystectomy is a very good and safe procedure for the removal of gall bladder. The objective of our study was to see the conversion rate of laparoscopic cholecystectomy in our unit.Methods: This is a retrospective descriptive study. We conducted this study on 167 patients who under-went gall bladder removal in our unit at a Public sector hospital of Lahore.Results: Our study showed that 163 (97.6%) out of 167 patients had safe complete laparoscopic cholecystectomy while 4 (2.4%) had to be converted to open cholecystectomy. About 40% of the procedures completed by laparoscope were difficult. Approximately 98% were completed by consultants and 42% weresafely performed by the senior registrars.Conclusion: Gall bladder surgery can be safely completed with laparoscope with good team effort and self-awareness of team.
Therapeutic Potential of Cinnamomum Zeylanicum Extract to Mitigate Hyperglycemia
Authors: Jahangir Muhammad Ahmar , Shehzad Aamir , Butt Masood Sadiq , Shahid Muhammad 
Published: August 2017

Background: Nutrition and health have become one of the most intriguing focuses in the world today. Technological advancement, nutritional imbalances and sedentary lifestyle have ascended numerous health issues worldwide. Scientific evidences have provided the chemo-preventive and chemotherapeutic role of dietary phytochemicals to cure these ailments. Cinnamon (Cinnamomumzeylanicum) has been utilized as a potential therapeutic agent in various cultures for centuries.Objective: Trans-cinnamaldehyde (3-phenyl-2-propanal) contributes as a major constituent of cinnamon bark oil approximately about 49.9-62.8% of the total amount and has hypoglycemic, hypocholesterolemic and anticancer potential.Methods: The ethanolic and supercritical fluid extracts of cinnamon bark were subjected to in vivo modelling to evaluate the hypoglycemic potential of cinnamaldehyde. Purposely, efficacy trial was performed on normal and hyperglycemic Sprague dawleyrats for 8 weeks. Three types of diets i.e. normal (D0), nutraceutical containing 0.5% conventional extract (D1) and nutraceutical containing 0.1% supercritical fluid extract (D2) were used throughout the study.Results: Feed & drink intake and body weight were increased during the trial. Serum analyses exhibited the maximum reduction 11.65% in glucose level in hyperglycemic rats as an effect of diet D2 followed by D1 which depicts 9.94% reduction. Nutraceutical diet D2 also increased the insulin level up to 7.23% in hyperglycemic rats whereas this increment was 2.37% in normal rats.Conclusion: The current research helps us to conclude that cinnamon extract is effective against hyperglycemia.
Maternal Health Care Expenditure among Women in Rural Areas of Pakistan
Authors: Rehman Abdul -ur- , Adnan Muhammad , Mahmood Hina , Hassan Mahmoodul , Humayun Ayesha 
Published: August 2017

Background: With Pakistan failing to achieve Millennium Development Goals we have now entered into a new era of Sustainable Development Goals. Decreasing child mortality, improving maternal health and increasing the proportion of births by trained birth attendants, are the areas with unmet goals. As 29.5% of population of Pakistan is below the poverty line, expenditure on maternal health care services is of great importance as it determines the utilization of health care services to a large extent.Objective: To assess maternal health care expenditure and its sociodemographic predictors in rural Khanewal, Punjab, Pakistan.Methodology: In this cross sectional study average cost on delivery (both SVD and Cesarean section) was assessed in both public and private sector of ruralKhanewal. Total 257 women who had delivered in the last one year were included.Results: Results revealed that 69.3% of mothers were illiterate.56.8% sought antenatal care in public health unit and 43.2% in a private health care facility. 49.8% delivered in a public health unit and 50.2% in private health care facility. Total expense on antenatal care and delivery was found to be <4,000PKR (<$38.16) in 55.6% (reportedly in a public health care unit) and was >16,000PKR (>$152.65) in 23.3% (reportedly in a private health care facility). A significant difference was found between expense, in public vs private sector and SVD vs. C-section.Conclusion: This study revealed that there is high financial cost on maternal health services in both public and private sector of rural Khanewal. Although in private sector the cost is more as compared to public sector but still it is high keeping the notion of free health care services in Pakistan by the government. There-fore it is suggested to improve the quality of health care in public sector and if possible to provide free of cost services to mothers during delivery.