Volume 5 Issue-4 Oct-Dec, 16

Welcome to the internationally indexed edition (IMEMR) of the PJMD. Since the initiation of the journal in 2012 we have striven to maintain high quality research publications, and involve the local scientific community in sharing and collaborating with the clinicians and healthcare sector.

Read More

Background:

Menopause lead to changes in women’s physiological functioning. It has significant physical, mental, social and psychological impact on women’s life. The purpose of this study was to investigate the knowledge and attitude of middle age women toward the menopause.

Methods:

A cross sectional study based on sample of convenience was conducted at the outpatient department of Ziauddin Hospital, Karachi from 1st July 2014 to 31st January 2015. The study participants were 250 menopausal women between the ages of 45-60 years. Data was collected by means of a questionnaire, which consists of three parts containing questions about demographic information, knowledge and attitude.

Results:

The mean age of women in the current study was 51.9 +/- 4.2years (range 45 – 60 years). The mean age at menopause was 45.9 +/- 3.8years. As far as the knowledge about menopause is concerned 4.8% (12women) had weak, 71.2% (178women) had moderate and 24% (60women) had good knowledge about menopause phenomenon. Majority of respondents had positive (72.4%) attitude towards menopause and 27.6% had negative attitude towards menopause.

Conclusion:

Majority of women in the current study had moderate knowledge about menopause. Women’s attitude towards menopause in majority of women was positive and they perceived menopause as a natural event and not a disease. The study reflects that the respondents widely varied in their ideas about the mean age of menopause as well as about the impact of menopause on their routine life.

Key Words:

Menopause, knowledge, attitude, Pakistan.

Read More

Background:

The prevalence of thyroid nodular disease is commonly found in iodine deficient areas. Majority of these nodules are benign and less than 5% of thyroid nodules being malignant. High resolution Ultrasonography is primary modality of choice in diagnosis of thyroid nodules. To determine the accuracy of Color Doppler ultrasonography in diagnosis of malignant thyroid nodule conformed on Fine needle aspiration cytology.

Methods:

This cross-sectional study was carried out in Department of Radiology PNS Shifa Hospital Karachi from 27th July 2012 to 26th February 2013. A total of 76 patients, having fixed palpable thyroid mass on examination, referred by clinicians for diagnostic workup were included in this study. Ultrasonography was performed using 7 MHZ linear array transducer. Thyroid nodule was assessed by grey scale sonographic features including number, size, echogenicity, margins and micro calcification. FNAC sampling was directed to the solid portion of the lesion. Cytological specimens were smeared according to the Papanicolaou technique, and were evaluated. All information was documented in the predesigned proformas.

Results:

Accuracy of Color Doppler Ultrasound in detection of malignant thyroid nodule was 92.1%, with sensitivity 75%, specificity 93%, positive predictive value 37.5%, and negative predictive value 98.5%.

Conclusion:

We found a comparable sensitivity and specificity to other international studies. An institutional protocol is devised to diagnose the malignant thyroid nodule as early as possible non-invasively employing Colour Doppler ultrasonography. This is helpful in early appropriate management of patients suffering from thyroid nodules.

Key Words:

Color Doppler ultrasonography, malignant thyroid nodule, Fine needle aspiration cytology

Read More

Background:

Laparoscopic cholecystectomy is excellence of care for the dealing of indicative disease of the gallbladder and commonly repeated operation being carried out by the surgeons. Occasionally done straightforwardly and rapidly and sometimes hard and prolonged. Guess of the situation involving exposure to danger of complication to turning or pitfall of surgery is a key angle for surgeons to setting up of surgery accordingly. But there is no handy scoring tool. The point at a target of our pilot survey is to analyze the feasibility of conducting a large study to validate a scoring tool developed at our institution.

Methods:

Eleven patients included, study conducted in general surgery department, Ziauddin University and hospitals. Patient’s assessment and surgery done by four experienced Surgeons. The variables such as up in years especially in male sex, past events of cholecystitis, pancreatitis, Overweight, past surgery on abdomen, noticeable gallbladder, gallbladder status and wall thickness, CBD diameter hematological/biochemical appraise in scoring method.

Results:

We found that history of cholecystitis/pancreatitis, Significant variables were status and density of the gallbladder for the guess of tough laparoscopic cholecystectomy. P Values of scoring tool were p 0.001 for easy and p 0.001 for difficult case. The turning figure was 1(14.3%) and p 0.388 from conventional to open cholecystectomy.

Conclusion:

This preoperative prediction scoring system is accurate, feasible, and inexpensive tool for use in selected clinical trials of gallstone disease. Further studies with large sample size and validation of this new method for assessment of treatment response are warranted.

Key Words:

Laparoscopic cholecystectomy, validation study, Pilot study, scoring system

Read More

Background:

Herpes Simplex Virus type 1 (HSV1) is the primary cause of cold sores. This study aimed to determine seroprevalence among HIV positive patients attending the Highly Active Antiretroviral Therapy (HAART) clinic of the University of Ilorin Teaching Hospital, Ilorin.

Methods:

A total of 200 blood samples were collected from consenting adult and were analyzed for HSV 1 antibodies using ELISA. Socio demographic data, socio economic factors, behavioral characteristics and the health status of the subjects were obtained via the administered questionnaire.

Results:

A seroprevalence of 56.0% (112/200) was obtained from the subjects out of which 87 (43.5%) were from urban and 25 (12.5%) rural (P= 0.354). High seropositivity was noticed amongst subjects of monogamous marriage (34.5%) (P= 0.314). Seropositivity of 24.5% (Christians) and 31.5% (Muslims) was recorded at P= 0.471. Trend of increasing seropositivity was recorded in order of single, married, divorced and widowed (P=0.429). The group with primary level of education had the highest HSV1 prevalence (P= 0.969) while analysis of subject by occupation reveals that the retiree and self-employed had the highest seroprevalence (66.7% and 58.0%) at P= 0.795. Respondent that reported no use of condom and those without an answer had the highest prevalence (P= 0.098) and similarly, subject that gave no answer for frequency of condom usage had the highest prevalence (P= 0.463).

Conclusion:

Since most of the infected human are asymptomatic to HSV1, adherence to clean hygiene and safe sex should be maintained.

Key Words:

HSV1, HIV, Seroprevalence, Co-infection

Read More

Background:

Laparoscopic surgery is a minimal invasive procedure frequently used in recent years for diagnostic and therapeutic purpose. The aim of study is to highlight the role of Laparoscopy in acute or chronic gynecological conditions, findings and complication observed in the last three years in tertiary care hospital.

Methods:

All the cases of laparoscopy performed during Jan 2013-2016 at Department of Obs. & Gynae Ziauddin Hospitals were retrospectively analyzed.

Results:

Data of 167 patients were collected from medical record. In 27% cases diagnostic laparoscopy was done where as the remaining 73% cases had both the diagnostic as well as therapeutic procedures. The indications of laparoscopy were subfertility in 40 (23.9%) ,chronic pelvic pain in 73 (43.7%) and acute pelvic pain in 54(32.33%) cases. No major complication observed in this study. Laparoscopy was converted in to laparotomy in two patients due to massive adhesions and significant hemorrhage.

Conclusion:

Laparoscopy is a less invasive, safe and effective diagnostic as well as therapeutic procedure in different gynecological conditions.

Key Words:

MAS (Minimal Access Surgery), Minimal Invasive Surgery, Laparoscopy.

Read More

Background:

Dengue is a mosquito borne disease with worldwide distribution which has become endemic in certain regions of Pakistan and has given rise to a few epidemics. Infection with the Dengue virus can manifest itself as a severe, non-fatal viral syndrome or a rapidly progressive and a commonly fatal hemorrhagic fever. This study was conducted to investigate the prevalence of Dengue fever in the urban region of Karachi, Pakistan.

Methods:

This retrospective, cross-sectional study was conducted at the Ziauddin Hospital System comprising of three hospitals catering to various socio- economic strata of the society. 823 samples were collected from the hematology and microbiology department of the hospital and the Dengue NS 1 antigen ELISA test was performed. Patients of all age and both genders were included.

Results:

823 patients were included in this study, out of which 32.1% (264) were found to have sera positive for Dengue IgM. Division according to sex demonstrated a predominance of males at 70.8% (n=177) while affected females accounted for 29.2% (n= 77). The most susceptible age group was found to be 30-39 years of age.

Conclusion:

The inhabitants of Karachi face a high probability of contracting this disease due to the unsanitary living conditions and lack of basic amenities .This study has shown the prevalence of Dengue to be higher in Karachi than in other cities of Pakistan, therefore effectual methods of prevention and control are the need of the hour.

Key Words:

Dengue fever, prevalence, NS1 antigen, Pakistan

Read More

Background:

PIH is the commonest medical disorder comprises of 10-15% of all pregnancies. Hypertensive disorders of pregnancy are responsible for significant maternal and perinatal morbidity and are one of the leading causes of maternal mortality. Early detection and appropriate management of the pregnancy may improve the outcome for both the mother and fetus. The aim of the study was to identify pregnancy induced hypertension as a risk factor for low birth weight of baby at term in tertiary care hospital.

Methods:

A sample of 100 patients was selected from Dr. Ziauddin Hospital Karachi through non-probability purposive sampling technique. Patients were divided into two groups on the basis of presence and absence of pregnancy induced hypertension. Total of hundred patients were taken. Fifty patients of PIH and fifty were normotensive patients. The patients in both groups were followed till term. After the delivery of the patients, weight of the babies was compared in both groups. Low birth weight is classified as the weight of the infant below 2.5 kg at term.

Results:

Babies born to the patients with PIH were found to be low birth weights as compared to the birth weight of the babies born to normotensive patients. 76% of the babies born to hypertensive patients were low birth weight whereas 18% of the babies born to normotensive patients were found to be of low birth weight.

Conclusion:

There is significant association between PIH and low birth weights of babies at term. It was significant enough to make the p-value 0.01 which is less than the level of significance (0.05).

Key Words:

Pregnancy induced hypertension, low birth weight, term pregnancy.

Read More

Background:

Early enteral feeding in bowel anastamosis is being encouraged and this can lead to decrease hospital stay and less financial burden. This study compares the mean hospital stay in early and delayed enteral feeding after bowel anastamosis.

Methods:

A total of 80 patients underwent bowel anastomoses and were included in this study to record the hospital length of stay. Patients were randomly allocated into two groups. Forty patients in group A received early feeding and 40 in group B on delayed feeding. Patient was assessed on daily basis after surgery, time of passage of flatus or stool noted so that the patient can be discharged, Data was analyzed using Chi-square test.

Results:

The average hospital stay was significantly low in group A than group B. Rate of anastamotic leakage was low in group A than group B (7.5% vs. 25%; p=0.0034). Similarly paralytic stay, pneumonic patch, unsettling fever, deep venous thrombosis and wound dehiscence are also the reason of delay hospital stay.

Conclusion:

It is concluded that early oral feeding after intestinal anastomosis leads to decrease hospital stay as bowel movement comes back early. However, a large sample size is recommended to further confirm our findings.

Key Words:

Bowel anastamosis, early feeding, deep venous thrombosis, pneumonic patch, unsettling fever.

Read More

Corneal epithelial wound healing is a continuous and multistep process involves cell migration proliferation and differentiation after an injury. Any defect in these processes will result in loss of corneal transparency and function. Around 135 million people are visually impaired, which illustrate the need for better understanding of corneal healing mechanisms and development of efficient ways to accelerate and improve wound healing. Delayed corneal wound healing contains the risk of bacterial infection causes corneal opacity and neovascularization that could lead to corneal blindness. It is therefore important that epithelium should rapidly regenerate after an injury. Reepithelialization involves cell migration proliferation and differentiation to restore the cornea to its highly organized architecture. The molecular mechanisms underlying these processes are yet to be established. Hence the identification of various proteins that could associate with healing process is of great significance.

Key Words:

Corneal Epithelium, Proliferation, Wound Healing, Migration

Read More

Background:

Diabetes and hypertension frequently coexist, leading to additive increases in the risk of life-threatening cardiovascular events. Large scale proteomic studies implicate the role of aberrant protein expression in these groups’ specifically post translational modifications. Protein S-nitrosylation conveys a large part of the ubiquitous effect on cellular signal transduction, accumulating evidence indicates important roles in normal physiology. Dysregulated S-nitrosylation has been implicated as a cause or consequence of a broad range of diseases, including asthma, cystic fibrosis, Parkinson disease, heart failure, and stroke. The purpose of study is to identify molecular changes and potential alterations in expression of specific aberrant s-nitrosylation in hypertensive and diabetic hypertensive patients. We aimed to identify such blood biomarkers and potential drug targets which can provide insight into the underlying molecular mechanisms, associated with its pathology.

Methods:

Proteome mapping of hypertensive, diabetic hypertensive serum samples was conducted to get the expression of aberrant nitrosylated proteins. Serum samples (n=15 from each group) by using sodium dodecyl sulphate polyacrylamide gel electrophoresis coupled with immunoblot by using anti S-nitrosylated antibody followed by imaging and statistical analysis by Quantity-One software (BioRad).

Results:

We have identified in total fifteen nitrosylated protein components with altered expression among the studied groups. The 177.8KDa, 119KDa, 74.02KDa, 61.5KDa, 52.3KDa protein, and 24.93KDa proteins are showing hyper-nitrosylation in diabetic hypertensive serum samples. However, he 119KDa, 74.02KDa and 61.5KDa protein components showed hyper-nitrosylation in hypertensive serum samples as compared to normal controls while rest of the proteins component were found hypo-nitrosylated.

Conclusion:

The characterization of aberrantly expressed nitrosylated proteins globally and their association with disease associated pathways probably are playing modulatory roles in the pathophysiology of the disease, following post-translational modifications.

Key Words:

S-nitrosylation; proteomics; Diabetic hypertensive ; Hypertension; Post-translational modification.

Read More