Volume 4 Issue-3 July-Sep, 15

  • Editorial
  • Original Article
  • Case Report
  • Review Article


The articles for the PJMD Issue July-Sep 2015 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.


Plagiarism Free Academic Environment

Plagiarism is found to be the most common form of misconduct among researchers across the globe. It is particularly affecting the biomedical sciences communities engaged in writing and reporting research. Unfortunately many young writers are not aware of the various types of plagiarism they might unintentionally indulge in 1 . Even in some cases, the writers do not consider plagiarism as a serious issue. Plagiarism can range from simple dishonesty in reporting parts of other’s work without proper attribution to a more serious issue such as duplicate publication. With the emergence of new technologies and search engines it has become easier to copy and paste from innumerable sources and yet not citing the exact source. As one can accumulate information in a fraction of time, but quite often the creative skills and ability to write one‘s own original thoughts do not match the required level of output. Irrespective of position and ranks, this situation is in existence at all levels of education and research, In the current situation of knowledge explosion, we are also witnessing an increasing trend in the duplication, falsification and unverifiable data presentation in student reports, theses and even journal articles written by researchers. It is very important for the younger generation of medical students to follow ethical guidelines while writing any scientific publications2 . Senior researchers and experienced writer are duty bound to explain basic reasons why plagiarism warrants a punitive action.

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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Anwar Ali Siddiqui
    • Director Research Office, Aga Khan University, Karachi
  • Shamim Mushtaq
    • Assistant Professor, Ziauddin Medical University, Karachi


The Efficacy of Doxylamine Succinate and Pyridoxine Combination in Nausea and Vomiting Of Pregnancy

Background: Nausea vomiting of pregnancy (NVP) is a common problem .A severe form called hyperemesis gravidarum occurs in 0.3–2.3% of pregnancies, which can adversely affect the lifestyle. This study is conducted to improve the confidence of obstetricians for treatment of nausea and vomiting of pregnancy.

Objective: To determine the efficacy of doxylamine succinate with pyridoxine combination in nausea & vomiting of early pregnancy.

Methods: Study conducted at Dr. Ziauddin University and Hospitals Karachi, from 25-02-2011 to 25-07-2011. Study design was case series, during the period of study total number of OPD patients in gynaecology and obstetrics department Ziauddin hospital were 821, out of them 190 patients of 20 years to 39 years of age with 9+ 2 weeks gestation were enrolled and sample was taken by Consecutive sampling.

Results: 182 (95.8%) patients reported improvement in symptoms i.e. positive efficacy, 7 patients ( 3.7%) reported no difference in nausea vomiting & only 1 patient i.e. 0.5% reported aggravation of her symptoms. Total PAQUE score before treatment was as high as 12.3526 with standard deviation of 2.12739, which reduced to 5.7211 with standard deviation 2.0908 after treatment of nausea vomiting with doxylamin succinate + pyridoxine combination. P value calculated for total PAQUE score before and after treatment is 0.000

Conclusion: This study concluded that for nausea and vomiting of pregnancy, doxylamine succinate is effective when given for moderate to severe symptoms. So it should be considered as 1st line of treatment for nausea and vomiting of pregnancy.

KEY WORDS: Doxylamine succinate and pyridoxine combination, nausea vomiting of pregnancy, efficacy.

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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Hina Shams Solangi
  • Rubina Hussain
  • Shahina Ishtiaque
    • Gynaecology & Obstetrics Department, Ziauddin University & Hospitals Karachi

Assessment of Risk Factors for Gestational Diabetes Mellitus

Background: Gestational diabetes is a condition due to glucose intolerance that occurs in the few of the mothers during gestation. The pathophysiology originates as a result of increased placental hormones which have strong diabetogenic effect. It is strongly associated with multiple problems in mother and the baby and can even leads to unexplained fetal deaths in the end trimesters. So it is important to diagnose and treat females who are at greater risk than the others for developing gestational diabetes mellitus.

Objective: To access the high risk factors associated with the development of gestational diabetes mellitus in 75 GDM diagnosed females

Methods: After screening and diagnoses 75 GDM patients (Diabetic, Group B) and 25 normal healthy patients (Control, Group A) in Lyari General and Mamji Hospital were enrolled in the study. Their detailed history was taken regarding occupation, parity, history of abortions, still births, preterm births and family history of diabetes. Parameters including age, weight, fasting and random blood sugar level and glycated hemoglobin were recorded in a predesigned data form. The results were evaluated using SPSS 16.

Results: Statistically significant difference was found between the mothers of diabetic and normal control group as regards the weight, age (p-value=0.01 and p=0.03) and family history of diabetes (p-value=0.00). Non-significant differences were found in the maternal occupation, parity, abortions, still births and pre-term births between the two groups

Conclusion: Advance maternal age, weight and familial association of diabetes are the risk factors associated with the development of gestational diabetes.

KEY WORDS: Diabetes, Gestational, Risk Factors, Glucose intolerance, Pregnancy trimester


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Rabia Arshad
    • Pharmacology Department, Sir Syed College of Medical Sciences
  • Nasim Karim
    • Pharmacology Department, Bahria University Medical and Dental College
  • Muhammad Omar Shamim
    • Islam Medical and Dental College

Laproscopic Evaluation of Primary Infertility Causes and Post Procedure Complications among Infertile Females from a Tertiary Care Hospital of Karachi

Background: Infertility is a common problem globally affecting a large proportion of world population. Laparoscopy provides meaningful information regarding different factors that may cause infertility.

Objective: To determine the frequency of causes of primary infertility in women by diagnostic laparoscopy.

Study Design: Cross sectional study design

Setting: Study was performed at the Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi

Duration: September 2011 to February 2012

Subjects and Methods: 86 patients with primary infertility were included in the study and underwent laparoscopy for deter – mining causes of infertility. Data was analyzed on SPSS, frequencies and percentages were determined for qualitative variables while mean and standard deviation was determined for quantitative variable.

Results: Eighty six females were included in the study with mean age of 28.6 + 5.2 years and mean duration of infertility was 4.9 + 1.9 years. Findings on laparoscopy were analyzed and 51.2% of females were found with tubal blockage, while other findings were; hydrosalpinx in 25.6%, PCOs in 22.1%, Ovarian abnormalities in 38.4%, Pelvic adhesions in 38.4% and uterine congenital anomalies in 3.5%.

Conclusion: Tubal diseases found to be one of the major factor causing primary infertility and diagnostic laparoscopy will play a valuable role in early and prompt diagnosis and management of causes leading primary infertility.

Key Words: Primary Infertility, Diagnostic Laparoscopy, Tubal Blockage, PCOs, Pelvic Adhesions, Hydrosalpinx.


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Samra Rizwan
  • Nagina Fatima Liaquat
  • Sidra Liaquat
    • Department of Gynecology & Obstetrics Jinnah Post Graduate Medical Center, Karachi
  • Nosheen Zehra
    • Department of Community Health sciences Ziauddin University

Chemical Characterization of Silorane by FTIR and Raman spectroscopy

Background: Silorane, introduced to the dentistry recently. It is named after the functional groups present in the material i.e. Siloxane and Oxirane. It is introduced in the market to overcome the main problems of composite resins i.e. Polymerization shrinkage. Claims are being made that the polymerization shrinkage have been overcome in the material and the material results in less than 1% polymerization shrinkage. The material claims to have properties which may fulfil the criteria of being the ideal restorative materials of all times.

Objective: To confirm the presence of Siloxane and Oxirane in the chemical structure of the Silorane by Fourier Transform Infra-red (FTIR) and Raman Spectroscopy.

Methods: Solvation of Silorane was done in Tetrahydrofuran (THF) using the magnetic stirrer. After the evaporation of THF, the resultant powder was then evaluated under the FTIR and Raman Spectroscopy.

Results: The FTIR spectrum of Silorane shows some primary reference bands in the spectrum of Silorane and shows the absorption of primary oxirane bands. The peaks indicated the presence of Siloxane bands and CH groups. Raman spectrum of Silorane confirming the presence of ν phase of Siloxane. The peaks show the presence of O-Si-O and C = C group.

Conclusion: The FTIR and Raman spectrums confirms the presence of Siloxane and Oxirane bands which results in low polymerisation shrinkage due to the cationic ring opening mechanism when compared with methacrylates which polymerises via a free radical mechanism.

KEY WORDS: Silorane, Fourier Transform Infra-red, FTIR, Raman Spectroscopy


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Shoaib Khan
    • Department of Science of Dental Materials, Ziauddin College of Dentistry, Ziauddin University. Karachi, Pakistan
  • Madiha Pirvani
    • Department of Science of Dental Materials, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of
      Health Sciences, Karachi, Pakistan
  • M. Asif Nathani
    • Department of Science of Dental Materials, Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan.

Effects on blood glucose, glutathione and lipid profile by Murraya in experimental animals (Rabbits)

Background: Obesity is responsible for beta dysfunction and insulin resistance. This is main cause of type 2 diabetes and excess in glycosylated hemoglobin. The concentration of glycosylation is directly proportional to the amount of blood glucose. It is investigated that oxidative stress can play a major role in the destruction of tissue that directly link with diabetic complication. This condition also associated with elevated level of lipid peroxidation. Murraya leaves may cause hypoglycemic and hypolipidemic effects and thus reduce lipid peroxidation in experimental animals.

Methodology: The animals (rabbits) were randomly divided into three groups of equal size; a control group that did not receive any sort of modification in diet throughout the study while the group 2 and 3 were orally administered 10gm of fructose and 6gm of butter in addition to normal animal chow. While a dietary modification by addition curry leaves , was made in group 3 and it received 10g curry leaves per day for the next 45 days. The blood levels of glucose, glutathione and lipid profile were measured.

Results: After consumption of Murraya leaves concentration of blood glucose and LDL-C, TC, TG was significantly decreased and increased HDL-C. Glutathione evaluation was used as a parameter for the oxidative stress showed a mark decline. Conclusion: Murraya leaves acted as anti-diabetic because it is also responsible to decrease the absorption of the glucose from gastrointestinal tract and anti-hyperlipidemic effects.

KEY WORDS: Murraya Koeniigi, diabetes mellitus, hypoglycemic, anti-hyperlipidemic


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Humaira Ansari
    • Department of BHS; Ziauddin University
  • Samia Perwaiz Khan
    • Pharmacology, Ziauddin University
  • Ghazala Yasmeen
    • Department of Physiology, Karachi University

Impact of Academic interventions on Students Performance in Electives

Background: Elective clinical rotations have become a significant part of most of the medical educational curricula. Evaluation of electives is imperative to assess their usefulness in achieving the objective of improving the competencies of graduating students. Results of these evaluations can be used to guide future academic developments.

Objective: The purpose of this study was to assess the change in the performance of medical students after academic intervention based on the results of evaluation of previous year electives.

Methods: Students’ performances in elective rotations were evaluated in the year 2012 and again in 2013 after bringing modifications in teaching / learning program. The data collected was from 60 students. Students consisted of two sets, those who completed their electives in the country while the other completed their electives abroad. Scores were calculated in three distinct domains of education i.e knowledge, attitude and ethical behavior. Independent Sample T test was applied to compare the scores.

Results: Findings suggest that as a result of the academic interventions carried out in 2013 in the educational program by the combined efforts of the faculty and students, the scores for all the three educational domains in both the local and abroad groups improved considerably. Conclusion: Study findings conclude that active curricular interventions play important role in improving the outcomes of teaching programs.

KEY WORDS: Knowledge, attitude, participatory action research, ethical behavior


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Arshia Samin Naqvi
    • Quality Enhancement Cell, Ziauddin University
  • Abbas Zafar
    • Department of Otolaryngology, Ziauddin Medical College

Medical Management with Vaginal Misoprostol Versus Surgical Management for First Trimester Pregnancy Failure

Background: The incidence of clinically recognized miscarriages remains around 10-20%.The most common type of early pregnancy failure include spontaneous abortion, anembryonic gestation and embryonic or fetal death (missed miscarriage).In this study we compared the effectiveness of vaginal misoprostol for the management of first trimester pregnancy loss in obtaining adequate evacuation of uterus as an alternative to surgical evacuation in a tertiary care hospital.

Methods: This was a Quasi experimental trial conducted at Ziauddin University Hospital and the study participants were 180 women who presented with first trimester miscarriage upto 12 weeks of gestation. The women were divided into two groups according to their choice (90 women in each). Group one named Misoprostol group who received tablet Misoprostol 800mcg vaginally, two dose 6 hours apart. Group two named surgical evacuation group, who underwent surgical evacuation under general anesthesia.

Results: The success rate in achieving complete evacuation of uterus was 82.8% in misoprostol group in the current study while in surgical evacuation group it was 100%.No serious side effects were encountered in misoprostol group.

KEY WORDS: Misoprostol, Medical management, Miscarriage


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Rehana Yasmeen
    • Ziauddin University and Hospital Karachi
  • Rubina Hussain
    • Department of Obstetrics & Gynaecology, Ziauddin University & Hospitals, Karachi


Birth of Quintuplets a Great Challenge

Different names have been used for multiple births depending on the number of offspring of which common multiples are 2 and 3, in our case we have 5. They are associated with high rates of complications like: preterm labor, pre eclampsia, low birth weight and significant perinatal mortality and morbidity. Quintuplets occur rarely making the survival of infants even rarer. We here report a case of non-booked woman who presented in her third trimester of gestation. Who on ultrasound was found to be having 4 babies but surprisingly at the time of delivery,5 babies were delivered by caesarean section, of which one was IUD (intrauterine death) and another baby expired on the second day of operation due to interventricular hemorrhage as the infant was of low birth weight and premature. The remaining infants were kept in NICU. This is a very precious pregnancy and since we found out that the frequency of multiple pregnancies with more than two fetuses has increased considerably since the introduction of methods of ovulation induction the case was looked on carefully according to the requirements.

KEY WORDS: Quintuplets, antenatal care, caesarean section, perinatal mortality, perinatal morbidity, IUD(intrauterine death)


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Samina Kemal
  • Huma Muzaffar
  • Shama Chaudhry
  • Rubina Hussain
    • Department of Obstetrics & Gynaecology, Ziauddin University Hospital

Undiagnosed Cervical Ectopic Pregnancy is a Threat to Life

Cervical ectopic pregnancy implants in the lining of endocervical canal. Cervical ectopic is rare form of ectopic pregnancy and incidence of cervical ectopic pregnancy is 1:9000 pregnancies .We are reporting a case report of a 35 years old female P1+0 was presented in OPD with continuous per vaginal bleeding since 3 months. MRI pelvis showed 4.8×4.5×4.2 cm lesion involving the entire cervix including stroma with partial obstruction of endocervical canal. Growth was removed digitally with difficulty and was sent for frozen section & biopsy. Hemostasis was secured with great difficulty by taking sutures & cervix was packed. Report of frozen section showed products of conception. Injection Methotrexate was given intramuscularly. Cervical ectopic pregnancy was associated with significant hemorrhage which led to hysterectomy in the past. Mortality is limited and fertility is preserved by improved ultrasound resolution, MRI and earlier detection of these pregnancies which has led to the development of more conservative treatments.

KEY WORDS: Cervical ectopic pregnancy, Methotrexate, endocervical canal, frozen section

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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Shama Chaudhry
  • Misbah Hareem
  • Rubina Hussain
    • Department of Obstetrics & Gynaecology, Ziauddin University hospital


Epicardial Adipose Tissue and its Emerging Importance

It is an emerging concept now a day that epicardial adipose tissue (EAT) thickness has an essential character in the progression for cardiac risk profile. It is now consider as a new and consistent cardiovascular risk factor. EAT thickness is the indicator for cardiac adiposity. It modifies the cardiac morphology and function. It has close anatomical relation to myocardium. It causes local paracrine interactions between myocardial tissues. It causes enlargement of left ventricle with its diastolic dysfunction. Measurement and assessment of epicardial adipose tissue thickness is now done by new method echocardiography. It appraises visceral adiposity and inflammation. Association of EAT location and its physiological or pathological impor – tance requires advance research. EAT in future may replace waist circumference, as a marker of abdominal obesity. This article briefly discussion the structure of epicardial adipose tissue and its function. It also describes the method for its assessment.

KEY WORDS: Epicardial adipose tissue thickness, Cardiac adipose tissue, Brown adipose tissue, Visceral adipose tissue


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Sadaf Shaheen
  • Nuzhat Hassan
    • Department of Anatomy, Ziauddin University and Hospitals, Karachi
  • Mohammed Asad Bilal Awan
    • Department of Cardiology, Ziauddin University and Hospitals, Karachi
  • Nosheen Zehra
    • Department of Community Health Sciences, Ziauddin University and Hospitals, Karachi

OCT- A Window to Retina

Optical coherence tomography (OCT) is a non-contact, non invasive imaging modality that helps diagnosing a variety of diseases involving the eye. It provides quantitative measurements of retinal nerve fiber layer (RNFL), optic nerve head and macular thickness parameters 1, 2 and can be used as a valuable tool in many intraocular surgeries. This article discusses the applications of different OCT systems available commercially for diagnosing and managing various ophthalmic conditions. Furthermore, future directions of OCT technology, clinical uses and benefits are also discussed. Different articles published till year 2014 majorly in between 2005 to 2014, obtained from online search engines Pubmed and Google Scholar were used in preparation of this review. Those articles were included that contained information regarding OCT and its uses in various ophthalmologic conditions and its future advancements. We excluded those articles that did not contain relevant information regarding OCT and its uses. Due to advancements in OCT technology, it is now possible to reveal the structural changes associated with retinal diseas – es that help in improving early analysis and monitoring of disease progression and response to treatment. Three generations of OCT have been introduced till date. Early versions of this technology i.e. OCT 1 and OCT 2 are relatively slow, limiting both the amount of data to be captured and the quality of image. The older versions required dilation of the pupil but the latest version, the Stratus OCT can be used without dilating the pupil. 3 Commercially, OCT is employed in diverse applications including diagnostic medicine, interventional cardiology and art conservation. Ophthalmology is still the most important field of OCT application because of transparent ocular structures.

KEY WORDS: Optical Coherence Tomography (OCT), Retinal Nerve Fiber Layer (RNFL) thickness, Glaucoma, Diabetic Retinopathy


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Volume 4 Issue-3 July-Sep,15
ISSN : 2308-2593
  • Sahrish Mukhtar
    • Department of Anatomy, Ziauddin University, Karachi, Pakistan.
  • Nuzhat Hassan
    • Department of Anatomy, Ziauddin University, Karachi, Pakistan.
  • Zafar Dawood
    • Department of Ophthalmology, Ziauddin University, Karachi, Pakistan