bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency of Pelvic Pain and Bleeding per Vaginum in First Trimester of Pregnancy in a Tertiary Care Hospital of Karachi
Authors: Mehreen Iqbal  , Syeda Rabia  , Samreen Fakeer Muhammad  
Published: February 2023

Objective: The objective of this study was to determine the frequency of pelvic pain and per vaginal bleeding, in the first trimester of pregnancy.
Methods: A total of 150 pregnant women 18 to 35 years in first trimester were recruited in this cross- sectional study, conducted from July 2015 to July 2016. Non-probability sampling technique was used to collect the data. The collected information from patients were entered in pre-designed proforma after taking informed consent. Data was analysed by using SPSS version 20.
Results: The average age of the patients was 26.33 ± 4.23 (range 18-35) years. Frequency of pelvic pain and per vaginal bleeding in first trimester of pregnancy was observed in 29.33% (44/150) and 12% (18/150) respectively. Stratification analysis was performed and it was observed that rate of pelvic pain and per vaginal bleeding was not statistically significant among different age groups. Rate of pelvic pain was significantly high in women with primigravida as compare to multigravida (p=0.003).
Conclusion: We found in our sample a significant number of women experiencing pelvic pain and vaginal bleeding in first trimester of their pregnancy. The practitioner must employ sound clinical and diagnostic skills in the management of the patient as early pregnancy complications can cause sig- nificant distress for some women and their partners.
Neonatal Nephrocalcinosis and Diagnostic Implications
Authors: Syed Kashif Abbas  , Neelum Tahirkheli  , Fatima Asif  
Published: February 2023

Nephrocalcinosis and its outcome has been widely studied in the preterm population. There is a paucity of data regarding nephrocalcinosis in term babies. Prospective case series, in which ten neonates were included in the study from November 2013 and April 2014. All neonates with nephrocalci nosis diagnosed by ultrasound of kidney, ureters, bladder (KUB) done antenatally or during evaluation for urinary tract infection in neonates with hyperbilirubinemia/sepsis were included. All preterm neonates and neonates with congenital urinary tract anamolies were excluded from this case series. Cases were followed to know the outcome of the condition by follow-up ultrasonography. Follow-up ultrasound kidneys after 2-4 weeks revealed no evidence of nephrocalcinosis in majority of the cases. In one case, hypocitrateuria was documented. Hence, nephrocalcinosis is a transient phe- nomenon but needs close monitoring with follow-up scans.
In this case series we investigated nephrocalcinosis with early follow-up and ultrasound of kidneys to compare the baseline findings.This helped us in defining absolute outcome to the parents in case of neonatal nephrocalcinosis. Moreover, it helped our fellows in making timely diagnosis and proper counselling.
Knowledge and Attitude towards Emergency Contraceptives among Nursing and Midwifery Students in Tertiary Care Hospitals, Karachi
Authors: Fouzia Perveen  , Mahjabeen Khan  
Published: February 2023

Objective: To assess the knowledge and attitude about the emergency contraceptives among nursing and midwifery students in tertiary care hospitals in Karachi.
Methods: This cross-sectional study was carried out in the nursing school of Dow University Hospital and & Civil Hospital Karachi. Duration of the study was January 2017 to June 2017. All nursing and midwifery students, after verbal consent, were interviewed face-to-face using a pretested structured questionnaire. The questionnaire was developed to assess knowledge and attitudes; the way in which the respondents think and behave towards emergency contraceptives (EC). Some questions were objective in nature with 'Yes' or 'No' options, whereas few questions were of multiple choice. The variables were age, educational level, religion, marital status, source of information, EC types and method of use, side effects and source of availability and the attitudes of participants towards the use of EC (11 items). The data was recorded in MS Excel (2010 version). Data analysis was done by SPSS 16. Mean and SD of age was calculated while the categorical variables were analysed by using frequency and percentages. Chi-square test was applied and significance of test was decided at p-
value £0.05.
Results: There were 149 respondents out of the 165 targeted population. The response rate was 90.30% among nurses and midwives working in public sector of health care system in Karachi, Pakistan. The mean age of the respondents was 20.63 ± 1.69 years. Most respondents were between the ages of 20-35 years; 98 (65.8%), with majority having educational level of matriculation; 66 (44.3%). There were nurses and midwives with optimum knowledge for EC based on the scale of having three or more correct responses out of four items. The best positive attitude was scaled by correct response of seven or more items out of eleven. The association of demographic factors with attitude towards EC was only significant at p-value£ 0.05 among married students.
Conclusion: Awareness regarding EC with optimgum knowledge and positive attitude was found in about two-thirds of nurses and midwives. Information must be spread through media and training to remove barriers and misconceptions among nurses and midwives.
Evaluation and Comparison of Anti-Epileptic Activity of Methanolic Extracts of Seeds of Cuminum Cyminum L. and Centratherum Anthelminticum L. in Seizure Model
Authors: Raana Mahmood  , Rahila Najam  , Mohammad Irfan Khan  , Talat Tariq  
Published: February 2023

Objective: Evaluation and comparison of anti-epileptic activity of methanolic extracts of seeds of Cuminum cyminum L. and Centratherum anthelminticum L. in strychnine-induced seizure model.
Methods: The study was conducted in the Department of Pharmacology, University of Karachi. After 15 days of dosing, experiment was performed. A total of 40 healthy mice were selected from animal house of the Pharmacology department, University of Karachi, and were equally divided into four groups. Group 01 was on DMSO (dimethyl sulphoxide) organic solvent as control; Group 02 was on methanolic extract of Cuminum cyminum L. (500 mg/kg); Group 03 was on methanolic extract of Centratherum anthelminticum L. (200 mg/kg) and Group 04 was on reference drug diazepam (3 mg/kg). On the day of experiment, after giving doses of DMSO, methanolic extract of Cuminum cyminum L., methanolic extract of Centratherum anthelminticum L. and diazepam, respectively to all groups, strychnine was administered and animals were observed for latency period and duration of Mortality rate was also evaluated.
Results: Group 02 and 03, receiving methanolic extracts of Cuminum cyminum L. and Centratherum anthelminticum L. showed significant seizure protection as observed by delayed seizure onset (p <0.001) and decreased total duration of convulsions in groups 02 and 03 (p£ 0.01, p£ 0.05) respectively. The mortality rate also decreased significantly (p £ 0.05) in comparison with group 01.
Conclusion: Anticonvulsant activity of methanolic extracts of Cuminum cyminum L. and Centratherum anthelminticum L. could be due to their antioxidant activity and further enhanced by potentiation of GABAergic and glycinergic activity. Further studies are required to confirm exact mechanism of action.
Correlation of Craniofacial Measurements between Cephalometric Radiographs and Facial Photographs
Authors: Warda Arif Khan  , Syed Shah Faisal  , Syed Sheeraz Hussain  
Published: February 2023

Objective: The aim of this study was to correlate the linear and angular measurements between lateral cephalogram and lateral photographs.
Method: An observational cross-sectional study was carried out at the department of orthodontics, Karachi Medi- cal and Dental College, Karachi, Pakistan. The study was conducted for six months from 30th October 2016 to 30th April 2017. Inclusion criteria included no previous orthodontic or surgical treatment, having all six maxillary anterior teeth present, no craniofacial trauma and no neurologic disturbances. Exclusion criteria includes those patients in whom radiation exposure cannot be given. A sample of 179 patients was selected which included 49 males and 139 females and they were examined by the researcher. A lateral cephalogram and a digital single lens reflex (DSLR) camera was used to obtain the linear and angular craniofacial measurements. A standard lateral cephalogram and standardized lateral photograph of each patient was taken respectively and then their measurements were taken with respect to different variables. Cephalogram measurements taken were as follows: (1) SNA (sella-nasion to A point); (2) SNB (sella-nasion to B point); (3) SNMP (sella-nasion to mandibular plane); (4) total facial height; (5) lower facial height; and (6) mandibular length. Whereas photo- graphic measurements taken were as follows: (1) TN'A' (angle between tragion-soft tissue nasion line and soft tissue nasion-soft tissue A-point line); (2) TN'B' (angle between tragion-soft tissue nasion line and soft tissue nasion-soft tissue B-point line); (3) FH'MP' (angle between soft tissue Frankfort plane and soft tissue mandibular plane); (4) CP'MP' (angle between cranial plane and soft tissue mandibular plane); (5) lower facial height; (6) total facial height; (7) mandibular length; and (8) chin projection. The lateral cephalogram and lateral photo- graphs measurements of patients were compared respectively and the Pearson correlation between them was calculated using SPSS 20.
Results: The results obtained showed that there was a moderate correlation between SNA and TN'A', SNB and SN'B', SNMP and FH'MP' whereas the correlation between facial heights and lower facial heights was very weak and CP and CP'MP' holds no correlation between them. All the correlations found between were statistically sig- nificant and had linear, positive co-relation between them.
Conclusion: Photographs can be used in place of lateral cephalogram X-rays for diagnostics and treatment planning.
Procalcitonin as a Diagnostic Marker of Sepsis in Neonates
Authors: Muhammad Jameel Ashraf  , Syed Kashif Abbas  , Atika Sher  
Published: February 2023

Objective: To determine the diagnostic accuracy of serum procalcitonin levels (PCT) by taking blood culture as gold standard.
Methods: This was a cross-sectional study conducted in neonatal intensive care unit (NICU) of Liaquat National Hospital, Karachi over a period of six months from June 2017 to December 2017. A total of 141 babies were enrolled in the study that had evidence of neonatal sepsis. Non-probability consecutive sampling was the technique used in our study for sample collection. Later on, after completion of data of required sample, a data base was developed on SPSS for windows version 22.0 for data analysis. Mean, median and standard deviation were calculated for continuous while fre- quency along with percentages was drawn for qualitative variables. Pearson Chi-square test (c2) was applied on all qualitative variables by taking p-value <0.05 as significant. Finally, the diagnostic accuracy of serum procalcitonin levels in neonatal sepsis was calculated in terms of sensitivity, specificity, positive predictive values and negative predictive values using blood culture as gold standard.
Results: Of 141 neonates, 68 were males and 73 were females which constitutes 48.2% and 51.8%, respectively. The mean weight of neonates was 2.49 ± 0.55 kg, while mean height and FOC (frontal- occipital circumference) were found to be 46.22 ± 3.17 cm and 33.29 ± 1.41 cm, respectively. The sensitivity of PCT in this study was found to be 70.90% while the specificity was 77.90%. Further- more, positive predictive value (PPV) and negative predictive value (NPV) accounted for 67.24% and 80.72%, respectively.
Conclusion: Although blood culture is the gold standard method to diagnose neonatal sepsis in neo- nates, however PCT has also shown good accuracy with quick results in diagnosing neonatal sepsis in this study. The early use of PCT in neonatal infection may definitely help us limiting number of neonates putting on antibiotics due to suspected risk of infection.
Evaluation of Chronic Back Pain Improvement after Single Dose of Epidural Steroid Plus Lignocaine Injection in both Genders at a Tertiary Care Hospital, Karachi
Authors: Abdul Latif Sonija  , Saeed Mazhar  , Abdul Ali Khan  , Nasim Ahmed  , Jalaluddin Muhammad Shaikh  , Shabbeer Hussain  , Syed Wasim Akhter  
Published: February 2023

Objective: To evaluate chronic back pain improvement after single dose of epidural steroid plus li- gnocaine injection in both sexes.
Methods: A consecutive cases series of 65 patients having age of ³18 to 80 years and of both sexes from one institution were retrospectively studied. The study was conducted from January 2011 to July It was designed to evaluate the pain improvement after single dose of epidural steroid plus li- gnocaine injection with lumbar interlaminar technique in chronic back pain patients. Patients were di- vided into two groups, to assess the effectiveness of pain relief following the injection in between different age groups with Magnetic Resonance Imaging (MRI), evidence of lumber disc prolapse and non-responder to oral medication were included. Those having red-flags (neurosurgical deficit) for surgical intervention were excluded from the study. Chronic back pain patients were treated with single dose of lumbar interlaminar epidural steroid plus lignocaine injection. Follow-up visits were carried out to assess pain reduction by patient perception as well as decrease requirement of oral medication.
Result: Out of all 65 patients, 28 were male. Mean age of 50.04 ± 14.26 range 18-80 years. After the epidural steroid plus lignocaine injection, all patients of both the groups showed decrease in pain severity, evidenced by both patient perception and decrease requirement for oral medication. There was no gender difference. Two patients needed second injection after interval of 6 months. One fe- male developed spinal anaesthesia after the injection, who recovered within 1 week.
Conclusion: This study concludes that epidural injection of steroid plus lignocaine is effective and safe in relieving chronic back pain in both sexes.
Traumatic Diaphragmatic Hernia in a 40-Year-Old Lady after 34 Years of Trauma
Authors: Hajrah Hilal Ahmed  , Saliha Afzal  , Muhammad Jamaluddin  
Published: February 2023

The diaphragm is a sheath made of muscle and tendon that separates the thoracic cavity from the ab- dominal cavity. A diaphragmatic hernia is the protrusion of intra-abdominal contents through an abnormal opening in the diaphragm. Acquired diaphragmatic tears are rare and occur mainly due to direct penetrating injury to the diaphragm or, less commonly, secondary to blunt abdominal trauma, causing her- niation of the abdominal contents into the thorax resulting in a condition known as post-traumatic diaphragmatic hernia. Signs and symptoms include orthopnea, dyspnea, diminished breath sounds on the side of the rupture and audible gut sounds in the chest. We report a case of a 40-year-old woman with a 34-year-old history of an unmanaged road traffic accident who presented with a complain of gradual in onset shortness of breath, which when approached surgically, revealed to be due to an absent left sided diaphragm. Upon diagnosis, successful primary hernia mesh repair was performed.
Variation in Calibre of Arteries of Circle of Willis with Age: An MRA Based Study
Authors: Aisha Hassan Brohi  , Kevin Joseph Jerome Borges  , Nuzhat Hassan  , Muhammad Ali  , Syed Nudrat Nawaid Shah  , Gulraiz Hikmat Yar  
Published: February 2023

Objective: To establish reference range for the diameters of arteries forming the Circle of Willis (CoW) and to correlate it with age.
Methods: This cross-sectional study was conducted at the Radiology Department from January to July 2018. It comprises of patients referred for MR imaging of brain without any manifestation of cere- brovascular diseases. Patients who were claustrophobic or had a history of atherosclerosis, vasculi- tis, thrombus, aneurysm, arteriovenous malformation (AVM), intracranial tumour, diabetes and hypertension were excluded. 300 individuals comprising both males and females with mean age of 45 ± 11.6 (years) were recruited via non-probability sampling technique. Three-dimensional Time of Flight (TOF) Magnetic Resonance Angiography (MRA) was performed. Diameters of all component vessels forming the Circle of Willis were measured.
Results: The diameter of the anterior cerebral, anterior communicating, internal carotid, posterior communicating, posterior cerebral and basilar arteries were found to be 1.51 ± 0.28 mm, 1.05 ± 0.37 mm, 3.69 ± 0.23 mm, 1.10 ± 0.11 mm, 1.85 ± 0.23 mm, 3.00 ± 0.11 mm respectively. Spearman correlation demonstrated that the diameters of the arteries were significantly correlated with age in different ways. Significant moderate positive correlations of internal carotid and basilar artery diameters were seen with age. Significant weak negative correlations were seen in anterior and posterior cerebral arteries. Significant very weak negative correlations were seen in anterior and posterior commu- nicating artery diameters and age.
Conclusion: The normal reference values for vessels diameter of CoW were determined in general population living in Karachi. Diameter of the arteries showed statistically significant correlation with age in different ways. Knowledge of calibre of the arteries is helpful in cerebrovascular surgeries and radiological neuro interventions.
Secondary Postpartum Haemorrhage: Causes and Management In A Tertiary Care Hospital
Authors: Shazia Jabbar  , Shakira Perveen  , Raveesha Kumari  
Published: February 2023

Objective: To find out the frequency of secondary postpartum haemorrhage (pph) as well as its causes and management in women presenting in a tertiary care hospital
Methods: It was a descriptive case series study conducted from 1st January 2016 to 31st December 2016 at the Department of Gynaecology and Obstetrics, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. All the patients presenting with secondary postpartum haemorrhage in the specified time period were included in the study. The patient's age, parity, booking status, mode of delivery, place of delivery, cause of secondary postpartum haemorrhage and management done was noted on a predesigned proforma.
Results: The average age of the women was 30.62 ± 4.37 years. Postpartum haemorrhage was ob- served in 130 patients, out of these 27 patients had secondary postpartum haemorrhage with a fre- quency of 20.67%. Majority of the women with secondary pph were multiparous 17 (62.96%) with 21 (77.77%) being delivered vaginally compared to 6 (22.22%) who had caesarean section. Most of the women 16 (59.25%) presented with secondary pph around 10-14 days post-delivery. Retained placen- tal pieces was identified as the commonest cause in 19 (70.37%) women, antibiotics was given to all the patients, evacuation done in 19 (70.37%) cases, 2 (7.40%) women had obstetrical hysterectomy and 1 (3.70%) woman had repair of uterus while 5 (18.51%) cases were managed conservatively. No maternal death was recorded.
Conclusion: Secondary postpartum haemorrhage though less common but is found to be associated with significant maternal morbidity which require timely diagnosis and management so as to prevent life threatening complications.
Coeliac Disease Complicating to B Cell Lymphoma and Enterocolic Fistula
Authors: Wajeeha  Khalid  , Jamaluddin  
Published: February 2023

We describe the case of 66 year old male, known case of COPD and type II diabetes mellitus, with a diagnosis of coeliac disease confirmed by the elevated titers of antigliadin and antiendomysium IgG antibodies together with partial villous atrophy in jejunal histology, complicating to diffuse large B cell lymphoma presented as enterocolic fistula. Laparotomy was performed which included gastrojejun- ostomy to bypass the fistula, ileo-ileal anastomosis to prevent obstruction, and end-transverse colos- tomy. Histology was taken from fistulous tract following laparotomy suspected high-grade non-Hodgkin's lymphoma. Further supplementary reports showed immunoperoxidase studies that the tumor cells are strongly positive for LCA and negative for CD30 and S100. These findings are sug- gestive of high grade non Hodgkins lymphoma which is confirmed by immunohistochemistry results. The biopsy showed high proliferation and soft tissue infiltration by diffuse large B-cell lymphoma which shows extensive apoptosis secondary to a complication of coeliac disease presenting as enterocoloc fistula.
Spiritual Health and Coping Strategies Among Medical Students in Crisis Situation: A Cross-Sectional Survey
Authors: Naveed Mansoori  
Published: February 2023

Objective: To assess the spiritual health of medical students and to identify the coping strategies used in crisis situation.
Methods: A cross sectional study was done during 2017 at Hamdard College of Medicine & Den- tistry, Karachi. Simple random sampling technique was used for data collection. Spiritual Health As- sessment Scale was used to measure the level of spiritual health and Brief COPE scale was used to assess the varying coping strategies practiced in response to stress. Descriptive analysis was done, overall spiritual health score was obtained, while frequencies of various coping attributes were determined by using SPSS version 22. Independent t-test was used for association of different domains of spiritual health between male and female students. P-value <0.05 was considered as statistically significant.
Results: Out of total 511 students, 298 (58.3%) were male and 213 (41.7%) female. Mean age was 21 ± 1.8 years. Students 261 (51.1%) were found to have good spiritual health. Statistically signifi- cant (P<0.05) differences was observed between male and female students doing gratitude, act ac- cording to moral values, introspection, knowing purpose of own life, own strengths, solutions to deal with weaknesses, performing yoga to achieve and maintenance of spirituality. Students using active coping were 146 (28.6%), substance use 289 (56.6%), turning to religion 188 (36.8%) and
humour 178 (34.4%).
Conclusion: The study reveals that most of the medical students have good spiritual health. Coping strategies used by medical students during their academics are mainly substance use, active cop- ing and turning to religion for management of stress.