bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beta Cell Function: A Useful Measure of Insulin Resistance in Adolescent with Polycystic Ovarian Disease
Authors: Irum Reema , Qureshi Ghazala , Dilawar Alia , Khurshid Rukhshan , Khawar Shirin 
Published: January 2017

<p>Polycystic ovarian syndrome (PCOS) is the universal endocrine disarray in premenopausal women, These women are prone to insulin resistance as well as altered beta cell function. Study was designed to find out the relationship of insulin resistance and betacell function in adolescent with PCOS.</p><p><strong>Material and Methods:</strong><strong>Â Â </strong>Study included 50 female patients, aged range 16-20 years from Obstetrics and Gynaecology department in Lahore. All subjects were already diagnosed and documented as patients of polycystic ovarian syndrome on the basis of pelvic ultrasonic findings. Level of serum insulin was estimated by ELISA technique using standard kit. Level of fasting glucose was estimated by glucose oxidase method. The value of insulin resistance, glucose: insulin ratio and Beta cell function were calculated.</p><p><strong>Results:</strong>Â Â Mean age of subjects with PCOS and control was 18.9 and 18.6 year respectively. Fasting glucose of PCOS subject was non-significantly decreased when compared to their controls. Serum level of insulin was significantly (P &lt; 0.001) increased in patients compared to their controls. Glucose insulin (GIR) ratio was significantly decreased (P &lt; 0.001) when compared to their controls. Insulin resistance was non-significantly increased in subjects as compared to their controls. Increased function of beta cell was found in PCOS subjects as compared to their controls. The Pearsonâ€™s correlation showed a positive significant correlation between HOMA-IR and fasting insulin. A significant correlation was observed between level of insulin and insulin resistance. Weak correlation was observed between level of insulin and beta cell function.</p><p><strong>Conclusion:</strong>Â Â It is the concluded that function of beta cell failure to compensate insulin resistance increases the risk of diabetes in adolescent with PCOS. More research is needed to define the degree of beta cell effect.</p>
Usage of Unreamed Interlocking Nails for the Management of Gustilo Anderson Grade 2 and 3 Open Fractures of Shaft of Tibia â€“ A Prospective Study
Authors: Zaman Tariq , Farooq Omer Khalid , Hussain Faisal Nazeer 
Published: January 2017

<p>Long bones fractures are the main emergency procedures in most trauma centers. Tibial fractures are commonly open as described by the Gustilo classification. Grade III fractures of the tibia (diaphysis) are very challenging injuries. Intramedullary nailing is one of the best known treatments for tibial fractures. Itâ€™s still being debated which is the most appropriate surgical approach to treat such fractures especially the choice between reamed vs. unreamed nails. This study was designed to determine the outcome of unreamed interlocking nail in open type II and IIIA tibial shaft fractures in terms of infection, bone union, delayed union and nonunion.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>It was a prospective, quasi â€“ experimental study, conducted at Department of Orthopedics, Lahore General Hospital/PGMI Lahore upon sixty patients. All subjects with Grade II and III open fractures of shaft of tibia were operated using the unreamed nails. They were followed regularly on 3<sup>rd</sup> then 10<sup>th</sup>, 20<sup>th</sup>, 30<sup>th</sup> post-op days. Later a monthly OPD follow up for 9 months was maintained. Records were maintained and analyzed using SPSS 20. Modified Anderson criteria was used to segregate results from poor to excellent.<strong></strong></p><p><strong>Results:</strong><strong>Â Â </strong>Mean age of all patients was 32.82 Â± 8.87 years. Fracture geometry shows that 9 patients had transverse, 27 had oblique, 18 had spiral and 6 patients had comminuted fracture. According to the Gustilo â€“ Anderson Classification 43 fractures were Type II and 17 fractures were Type IIIA. Only 9 patients developed infection. Union was seen in 51 (85%) patients and delayed union was observed in 7 (11.66%) subjects. Two patients (3.34%) had nonunion. According to the Modified Anderson grading 47 (78.34%) patients had excellent, 7 (11.66%) patients had good and 6 (10%) patients had poor results.<strong></strong></p><p><strong>Conclusion:</strong><strong>Â Â </strong>On the basis of the results obtained, it was shown that unreamed interlocking nail for treating type II and III A fractures of tibial shaft shows promising and effective results in terms of low rate of infection and bone union. Overall excellent results were seen in 47 (78.34%) patients according to the modified Anderson criteria.</p>
Phototherapy in Hyperbilirubinemic Neonates; Does it Affect Platelet Count?
Authors: Sajid Aisha , Mahmood Tahir , Riaz Sohaib , Nabi Saba Ghulam 
Published: January 2017

<p><strong>Objective:</strong><strong>Â Â </strong>To determine the effect of phototherapy on platelet count in neonates having unconjugated hyperbilirubinemia.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>This cross sectional study was conducted in the Neonatology unit of a Hospital, Faisalabad during a period of nine months i.e., January to September 2015. All the neonates having unconjugated hyperbilirubinemia and requiring phototherapy with normal initial platelet count were included in the study. Platelet count was evaluated before the start of phototherapy and then during phototherapy at 24 hrs, 48 hrs and 72 hrs interval. Platelet counts were compared after 24, 48 and 72 hours of phototherapy. P value &lt; 0.05 was considered significant.</p><p><strong>Results:</strong><strong>Â Â </strong>Total 150 newborns having unconjugated hyperbilirubinemia were included with mean age of 3.95 Â± 1.71days. After 24 hours of phototherapy, about 8.1% of the patients were having severe thrombocytopenia (platelet count &lt; 50 Ã—10<sup>9</sup>/L); this percentage rose to 18.4% after 48 hours and 33.3% after 72 hours of phototherapy. None of the patients developed clinical manifestation of bleeding. The number of patients with normal platelet count (1,50 Ã— 10<sup>9</sup>/L â€“ 400 Ã— 10<sup>9</sup>/L) after 24 hours of continuous phototherapy was 50%, gradually reducing Â to 38% after 48 hours and only 33% after 72 hours of completion of phototherapy(p value &lt; 0.05).</p><p><strong>Conclusion:</strong><strong>Â Â </strong>Hyperbilirubinemic neonates undergoing phototherapy had a fall in platelet count without any clinical manifestation of bleeding.</p><p>Â </p>
Effect of Hydrotubation in Unexplained Infertility â€“ A Randomized Controlled Trial
Authors: Saaqib Shazia , Chohan Muhammad Arshad , Ashraf Misbah , Mumtaz Ammara 
Published: January 2017

<p>Unexplained infertility is a major gynecological problem with complex etiolgy. Partial tubal blockage with inflammatory reaction and thick mucus plugs in fallopian tubes and cervix is one of the likely causes in such cases. This study is based on the hypothesis that women having unexplained infertility could be helped by transcervical flushing of fluid through the fallopian tubes which would remove reversible blocking factors and help in achieving pregnancy.</p><p><strong>Objective:</strong><strong>Â Â </strong>To compare the outcome of hydrotubation<br /> in unexplained infertility in clomiphene citrate stimulated cycles with control group (no Hydrotubation).</p><p><strong>Setting:</strong><strong>Â Â </strong>Infertility Centre of a Public Sector Hospital.</p><p><strong>Study Design:</strong><strong>Â Â </strong>A two years Prospective randomized controlled trial from Jan 2014 to Dec 2015.</p><p><strong>Method:</strong><strong>Â Â </strong>128 women participated in the study. Participants were divided into study and control group with 64 members in each group. Ovulation induction was done with clomiphene citrate in all the participants and confirmed by ovulation detection strips and follicular tracking on Ultrasonography. 50 cc cocktail of inject-ion (inj.) kanamycin 1 gm, inj. hydrocortisone and normal saline was injected transcervically in study group for three consecutive days from the next day after end of menstruation. No hydrotubation was done in control group. Main outcome measures were number of conceptions within next 3 cycles and complications of hydrotubation.</p><p><strong>Results:</strong><strong>Â Â </strong>In hydrotubation group, 20 women conceived. Out of these, 14 women conceived in the same cycle in which hydrotubation was done while 6 pregnancies occurred in subsequent cycle. 4 pregnancies occurred in the control group. Complications of hydrotubation were mild abdominal pain (59 women), vomiting (49 women) and Per vaginum bleeding (18 women). There were significantly more pregnancies in women who experienced right shoulder tip pain after the procedure.</p><p><strong>Conclusion:</strong><strong>Â Â </strong>In women with unexplained infertility, tubal hydration can increase conception rate and decrease the time to achieve pregnancy.</p><p>Â </p>
Comparative Evaluation of Grahamâ€™s Omentopexy Versus Modified Grahamâ€™s Omentopexy in Perforated Duodenal Ulcers
Authors: Jat Muhammad Ayub 
Published: January 2017

<p>Perforated peptic ulcer is a serious and the most frequent complication of peptic ulcer disease which demands urgent diagnostic procedure, reanimation and surgical intervention.</p><p><strong>Objective:</strong><strong>Â Â </strong>To compare Graham's omentopexy versus modified Grahamâ€™s omentopexy in perforation of duodenum due to peptic ulcer disease in terms of post- operative complications and better outcome.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>This randomized control trial study had included 84 cases of perforation of duodenum due to peptic ulcer disease which were randomized by using random number table into two groups Grahamâ€™s Omentopexy 42 casesÂ group A and modified Grahamâ€™s Omentopexy 42 cases group B. The Patients with gastric perforation or other parts of the bowel were excluded. The present study was conducted in the Department of Surgery, at Ghulam Muham-mad Mahar Medical College Sukkur from May 2009 to April 2012. All patients were post operatively followed-up for the period of 12 months at outpatients department.</p><p><strong>Results:</strong><strong>Â Â </strong>Out of 84 patients, 76 {90.5%} were males and 8 {9.5%} were females with M: F ratio 9.5:1. The peak age of patients at presentation was between 30 â€“ 49 years (61.8%). In group A Graham's omentopexyÂ there was Â wound infection in 13 cases {30%} biliary leakage in 2 cases (4.6%} ,intra-abdominal abscess in 2 cases (4.6%} and 4 patients died (9.5%} but in group BÂ modified Graham'â€™ omentopexy, wound infection was noted in 9 cases (21.3 %) but there was no biliary leakage and intra-abdominal abscess .There was three mortalities (7.1%} in group B. The average in- patients hospital stay in group A Grahamâ€™s omentopexy Â was 11.5 days and in group B modified Grahamâ€™s omentopexy 10.0 days.</p><p><strong>Conclusion:</strong><strong>Â Â </strong>Patients undergoing<strong> </strong>modified Graham's omentopexy in perforated duodenal ulcer had lesser post-operative complications and a shorter hospital stay with better outcome than Graham's omentopexy.</p><p>Â </p>
Role of Computed Tomography in Pediatric Traumatic Brain Injury and its Correlation with Glasgow Coma Scale at Presentation
Authors: Imran Ahmad , Qureshi Abid Ali , Tariq Amna 
Published: January 2017

<p>The study was aimed at documenting the relationship between Glasgow coma score with imaging findings on computed tomography in children with traumatic brain injury. Un-necessary radiation exposure can be detrimental in pediatric age group and can lead to an increased risk of radiation induced malignancies.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>This retrospective study was conducted in Department of Radiology Lahore from 15.8.11 to 15.11.11. It included 48 children who presented in emergency department with history of fall or trauma to head. These patients underwent computed tomography using standard imaging protocols. All the data was analyzed by using SPSS version 17.</p><p><strong>Results:</strong><strong>Â Â </strong>A total of 48 patients from 6 months to 15 years of age with history of fall or trauma to head who underwent CT scan were included in study. 20 (42%) patients revealed normal study. Extra/intra axial bleed is noted in 11 (23%), evidence of cerebral edema was</p><p>noted in 4 (8%) patients. 9 (19%) patients had fracture of skull bones and cephalhematoma was noted among 4 (8%) patients. Imaging findings were seen in majority of the patients with GCS less than 13/15.</p><p><strong>Conclusion:</strong><strong>Â Â </strong>Neuroimaging can serve as a useful guide regarding management of traumatic brain injury however un-necessary radiation exposure is detrimental in pediatric age group. A correlation between GCS and decision regarding imaging can serve as an effective approach to decrease rates of neuro imaging after pediatric head trauma.</p>
Awareness Regarding Emergency Contraception
Authors: Anjum Farhan , Jabeen Asma , Sanjrani Hamlata 
Published: January 2017

<p><strong>Objective:</strong><strong>Â Â </strong>To know the awareness of emergency contraception (EC) among our population.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>Women were asked about their age, education, socioeconomic condition and parity.</p><p><strong>Results:</strong><strong>Â Â </strong>Total 400 women were interviewed in the cross â€“ sectional survey. Out of these, only 193 had heard about EC and they were further asked about knowledge relating to EC utilization. 132 (68.39%) answered incorrectly about emergency contraception. While only 31 (16%) women had knowledge of its correct utilization. Only 19 (9.84%) women knew that OCPS can be used as EC while 151 (78.23%) answered incorrectly that it can be used on regular basis. Out of 193 women, 53 (27.46%) women practiced EC while 140 (72.53%) had never used EC.</p><p><strong>Conclusion:</strong><strong>Â Â </strong>Our study showed limited knowledge of women concerning EC. Media should be used to disseminate the awareness of women about safety, use</p><p>and effectiveness of EC. Also it is responsibility of health care providers that they should give information of EC to every sexually active woman visiting their clinics.</p>
In the Land of Pain
Authors: Latif Asnia , Malik M Faisal Amir , Hashmi Ali Madeeh 
Published: January 2017

<p>(<em>Authors' Note</em>: Alphonse Daudet (1840-1897) was a nineteenth century French novelist. A contemporary of Gustave Flaubert, Edmond de Goncourt and Emile Zola, among others, he achieved much fame and renown in his life time. He contracted syphilis sometimes in his twenties. In the last ten years of his life, he suffered from the effects of neurosyphilis. â€œIn the Land of Painâ€ is a personal account of his struggle with the illness which eventually took his life).</p><p>Â Â Â Â Â In the early nineteenth century, the tertiary form of syphilis began to be recognized. After lurking in the victimâ€™s blood for several years, syphilis attacked the central nervous system. The resulting condition, called neurosyphilis, was invariably fatal. It usually manifested in two major forms: Locomotor ataxia (also called tabesdorsalis) or general paresis (also called general paresis of the insane).</p>
Frequency of Cervical Pre-Malignancy in Pregnant Women
Authors: Rasheed Imrana , Waheed Khadija , Ejaz Sara , Mushtaq Javeria 
Published: January 2017

<p><strong>Abstract</strong></p><p>The abnormal growth of precancerous cells on the surface of the cervix is cervical intraepithelial neo-plasia (CIN). Cervical intraepithelial neoplasia is classified according to extent of the abnormal cell growth and is classified as low grade and high grade. Human papilloma virus, a sexually transmitted virus is commonly associated with CIN. A regular Pap smear test can detect CIN at early stages and this helps in treating disease at early stage and protection against human papilloma virus can be provided with vaccine.</p><p><strong>Objective:</strong><strong> </strong>To find the frequency of cervical pre-malignancy in pregnant women.</p><p><strong>Patients and Methods:</strong><strong> </strong>This cross – sectional study was conducted at Department of Obstetrics and Gyna-ecology, Lahore. A total of 260 patients were included in this study. Pap smear samples were collected and fixed in 95% alcohol solution. Smears were sent with a histopathology form for reporting.</p><p><strong>Results:</strong><strong> </strong>Mean age of the patients was 27.32 ± 5.12 years. Mean gestational age was 29.60 ± 6.36 weeks. Cervical pre-malignancy on pap smear was observed in 8 patients (3.01%). All of them were CIN – I. Stratification with regard to history of smoking, history of oral contraception, low socioeconomic status, multiple marriages and early marriage was done.</p><p><strong>Conclusion:</strong><strong> </strong>Women having history of low socio-economic status and oral contraceptive were more prevalent in developing CIN. It is recommended that cervical cancer screening by pap smear is for all women who are sexually active.</p><p> </p><p> </p>
Is the Birth PCR Still Necessary for HIV Exposed Newborns?
Authors: Bula Fernando , Rathore Mobeen H. 
Published: January 2017

<p>In 2009 the Unites States Public Health Service (US-PHS) changed its recommendations for diagnostic testing of HIV exposed infants. However, barriers for compliance to testing remain. We evaluated the compliance with the 2009 USPHS recommendation at our center. A total of 244 HIV exposed infants were identified from 2009 to 2012. HIV DNA PCR was done in less than 48 hours of life in 216 (90.7%) infants, bet-ween 14-21 days in 143 (60.1%). We believe it remains important to perform HIV testing at birth especially when testing at 14 to 21 days of life cannot be assured. regimen during pregnancy, cesarean deliveries when appropriate, avoidance of breast feeding, use of antiretroviral medication during labor and delivery and in the neonate in the first six weeks of life.<sup>1</sup> Despite these recommendations, barriers to prevention of MTCT still exist.<sup>2</sup> It is important to follow the protocol for determination of HIV status in HIV exposed infants in order to determine as soon as possible if the infant is infected or uninfected.</p><p> This study aims to evaluate the compliance to most recent 2009 United Public Health Service (US-PHS) recommendations for diagnostic testing infants born to HIV infected mothers.</p>
Manto’s ‘Toba Tek Singh’
Authors: KEMU Annals 
Published: January 2017

<div class="WordSection1"><p align="left">‘<em>No live organism can continue for long to exist sanely under conditions of absolute reality’</em></p><p align="left"><em> Shirley Jackson "The Haunting of Hill House"</em></p><p align="left"><em> </em></p><p align="left"><em>‘Toba Tek Singh’</em></p><p> <em>‘Toba Tek Singh’</em><sup>1</sup> is a tale about the partition of the Indo-Pak subcontinent. It is, by some accounts, the best short story ever written on this subject<sup>2</sup>. Ironically, the story shows us that when faced with the chaos and bloodshed of partition, the response of a person committed to a mental institution appears more 'sane' and appropriate than those around him.</p></div><p> Published in 1955, the story takes place inside the Lahore insane asylum (today called the Punjab Institute of Mental Health), two or three years after partition. At a high-level conference, a decision has been made for the exchange of lunatics in insane asylums. When news of this decision spreads, it causes consternation among the inmates of the asylum. Their fear is made worse by their ignorance of 'Hindustan' and ‘Pakistan’. According to one of the inmates, Pakistan is ‘the place in Hindustan where razors are made.’<sup>1</sup> Another volunteers that the people in Hindustan ‘go strutting around like devils.’<sup>1</sup> One of the in mates</p><p>climbs a tree, seats himself on a branch and gives an unbroken two hour speech about the subtle problem of Pakistan and Hindustan. When the guards ask him to come down, he climbs even higher. When he is warned and threatened, he says, “I dont want to live in either Hindustan or Pakistan. I'll live right here in this tree.” A quiet radioengineer, for some obscure reason decides that the situation warrants freedom from clothes and starts to wander around the garden completely naked.</p><p> Manto gives us brief, pithy descriptions of some of the lunatics e.g. A Muslim lunatic from Chiniot, a past member of the All-India Muslim League, announces that he is Quaid-e-Azam and then promptly declares war on a Sikh, who, in his madness considered himself Master Tara Singh.</p><p> Midway through the story, Manto introduces the titular character, known to everyone as <em>‘</em>Toba Tek Singh’. His real name is Bishan Singh and he has been confined to the asylum for fifteen years, during which time, he has not, even once, sat or lain down. The only words he has spoken during the fifteen years are the nonsensical, ‘Upar di gur gur di annex di be dhyana di mung di dal of the lantern.’<sup>1</sup> Once a month when his relatives came to meet him, he agrees to take a bath and cleanup. He has a daughter who has grown older visiting him, and still cries every time she sees her father</p>
Clinical Profile of Type 1 Diabetes Mellitus in Saudi Children: a Hospital Based Study
Authors: Rafique Muhammad , Ishaq Fouzia , Masood Muhammad Khalid , Al-Qahtani Youssef Ali Mohamad , Ahmed Assiri Walaa Ibrahim , Assiri Manal Ahmed Ali , Qureshi Muhammad Atif , Zia Shumaila 
Published: January 2017

<p><strong>Abstract</strong></p><p><strong>Objective:</strong> To determine the clinical characteristics of newly diagnosed type 1 diabetes mellitus (T1DM) in children under15 years of age. Cross sectional study conducted at Aseer Central Hospital Abha, South-western Saudi Arabia from June 2011 – May 2015.</p><p><strong>Patients and Methods:</strong><strong> </strong>Study included 141 Saudi children, &lt; 15 years old with newly diagnosed T1DM. The demographic and laboratory data were collected from file records. The patients were divided into younger (&lt; 5 yr), middle (5 – 10 yr) and older (&gt;10 – 15 yr) age groups. Data were analyzed by using SPSS version 16.</p><p><strong>Results:</strong><strong> </strong>Age of 141 children at onset of T1DM (mean ± SD) was 6.5 ± 3.2 years and majority 62 (44%) belonged to middle age group. Older 43 (30.5%) age group had female predominance (2:1) (p &lt; 0.0001). Diabetic ketoacidosis (DKA) (39%), obesity (11%) and male predominance (2.6:1) were found in younger 36 (25.5%) age group (p &lt; 0.0001). Family history (F/Hx) of T1DM 29 (20.6%) and HbA1c (10.36 ± 1.8%) successively increased with advancing age of patients. Main presenting symptoms like polyuria (96%), polydipsia (85%), weight loss (62%), nocturia (47%), polyphagia (28%) and DKA (22%),were significantly more frequent in children with F/Hx of T1DM (p &lt; 0.0001). Duration of symptoms at first presentation was 17.3 ± 10.7 days and daily insulin requirement was found 0.82 ± 0.2 units/ Kg.</p><p><strong>Conclusion:</strong><strong> </strong>Polyuria, polydipsia, weight loss, noctu-ria and polyphagia were the main presenting symptoms and more frequent in middle age group children especially having F/Hx of T1DM. Under five years, obese and male children were found at higher risk for DKA development. Girls usually present late in adolescent age.</p>