Volume 2 Issue-3 July-Sep,13

  • Editorial
  • Original Article
  • Case Report
  • Review Article
  • Students Corner

 

The articles for the PJMD Issue July-Sep,13 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.

EDITORIAL

Genetic Impact of Second Hand Cigarette Smoke

Second hand smoke is a complex mixture of more than 4000 chemical compounds that are generated during the burning of tobacco products and affects all those who are exposed to smokers in a closed environment either at home or work place. This mixture contains numerous irritants and toxicants which leave severe as well as carcinogenic health effects in humans1.

Short as well as long-term effects of tobacco exposure can lead to multiple health implications. It has been estimated that secondhand smoke is responsible each year for 22,000 hospitalizations, between 150,000 and 300,000 cases of bronchitis and pneumonia, and between 8000 and 26,000 cases of asthma. The SHS exhibits hazardous particles and gases. The par¬ticulate phase contains more than 4000 sub¬stances, most of them toxic or otherwise noxious while the gaseous phase contains about 500 substances. Non¬smokers exposed to second hand smoke absorb significant amounts of these harmful substances. The blood levels of carbon monoxide, nicotine and other toxic substances rise in passive smokers. In the long run, non-smok¬ers exposed to ETS could find their respiratory function decreased to the same level as that of a moderate smoker.2

Second hand smoke plays a pivotal role in etiology of lung cancer. A large number of models of carcinogenesis provide an outline for considering the associations of lung cancer incidence with smoking intensity, duration, and smoking cessation. These models suggest that carcinogens derived from chemical components in tobacco smoke react with the DNA of respiratory epithelial cells. Some of the carcinogens instigate mutagenic changes while others support the growth of these mutated cells or disable genes that restrain tumor growth. Mutagenesis, growth promotion, and inhibition of tumor suppression may all be compulsory for clinically evident cases of lung cancer. Procarcinogens in tobacco smoke must be metabolically altered in order to exhibit their carcinogenic outcome. Various enzymes are involved in detoxification of these chemicals into inactive compounds. Genetic polymorphisms generate slightly different forms of the enzyme, resulting in variations in enzyme kinetics. These inherited differences in the transformation rate are source of variability in risk of cancers. In this regard, the enzyme CYP2D6 can transform polycyclic aromatic hydrocarbons and acrylamines into reactive chemical species that can bind covalently to DNA and induce mutations. The people who have CYP2D6 enzymes are extensive or intermediate metabolizers, as measured by the speed with which they metabolize the compounds present in second hand tobacco smoke. Extensive and intermediate metabolizers would be expected to have higher concentrations of these carcinogens in the lung than would slow metabolizers. The extensive metabolizing phenotype is associated with more than double the risk of lung cancer.3

Second hand smoke has an obvious role in the development of oxidative stress. Free radicals production due to oxidative stress modifies cardiac autonomic control resulting in heart rate variability (HRV). A positive association is found between polymorphisms in oxidant-scavenging glutathione S-transferase (GST) genes and their interactions with second hand smoke. The modifying effect of GSTM1 for the association of second hand smoke with heart rate variability suggests that these exposures cause systemic oxidative stress. This oxidative stress is scavenged by GSTM1 in the liver. The GSTM1 is responsible for the association between second hand smoke, GST polymorphisms, and lung cancer in passive smokers.4

Compared to adults, children may be more susceptible to secondhand smoke. This susceptibility may be exacerbated by alterations in inherited genetic variants of innate immunity genes. A genetic polymorphism in the mannose binding lectin-2 (MBL2) gene is found in the children with lung cancer exposed to second hand smoke. Functional MBL2 haplotype associated with high circulating levels of MBL and increased MBL2 activity was associated with increased lung cancer risk among those exposed to childhood.5 It has long been suspected that cytogenetic deletions and/or loss of heterozygosity on the short arm of chromosome 3 may be involved. The chromosomally fragile site, FRA3B, has been linked to lung cancers and more recently has been explored in cervical carcinomas. A large number of smokers and passive smokers showed fragility at FRA3B. FRA3B maps within the fragile histadine triad gene (FHIT), which is a tumor suppressor gene involved in tumorogenesis, including cervical neoplasia.6

Health professionals are also target of passive exposure to cigarette smoke which makes them also a focal group essential for creating awareness regarding hazards of passive smoking.7 In our environment, bidi and huqqa smokers is another addiction that needs to be studied from genetic aspect to find out the multi-factorial polymorphism. With new technology enabling scientists to analyze the interactions between genomic structure and environmental stimuli, researchers should be able to make efforts in clarifying the role that SHS exposure plays in different types of cancers. There should be valid methods for describing the interactions between environmental exposures, pathogens, and genetic composition in the trail to understand the mechanism of all cancers.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 1-2
Published : 2013
Publisher Name : Ziauddin University
  • Dr. Zil-e-Rubab
    Associate Professor, Department of Biochemistry, Ziauddin University

ORIGINAL ARTICLE

Zinc and Copper Levels Fluctuate with Altered Glucose Homeostasis

Background:

Type 2 diabetes mellitus is becoming one of the major health problems worldwide. Especially in South East Asia, type 2 diabetes has gained critical significance. As pre-diabetes prevalence is increasing worldwide, it has become an important concern to prevent diabetes at an early stage. Trace elements have been gaining attention in improving the glucometabolic conditions like pre-diabetes and diabetes. Zinc and copper are the major trace elements present in the human body and they play a significant role in the pathogenesis of diabetes mellitus and pre-diabetes.

Objectives:

The purpose of this study was to compare serum zinc and copper levels in type 2 diabetes and pre-diabetes.

Methods:

This study was conducted in department of Biochemistry BMSI, JPMC Karachi. Total 90 subjects were taken out of which 30 were type 2 diabetics, 30 were pre-diabetics and 30 were normal healthy individuals. Serum fasting glucose was measured by glucose oxidase method. Serum zinc and copper were measured by colorimetric method. Statistical analysis was done using SPSS version 16.

Results:

Serum zinc levels were significantly lower in type 2 diabetics as compared to pre-diabetics and normal individuals (mean differences were 45.17±15.63µg/dl, 59.97±13µg/dl and 86.57±14.34 µg/dl respectively). Serum copper was significantly increased in type 2 diabetics compared to pre-diabetes and control samples (mean differences were 325.55±88.34 µg/dl, 175.53±47.45µg/dl and 126.87±21.57µg/dl respectively).

Conclusion:

It was concluded that serum zinc was significantly lower in type 2 diabetics and prediabetics and is inversely related to serum fasting glucose while serum copper is significantly higher and positively related with fasting blood glucose.

KEY WORDS:

Type 2 Diabetes, Pre-Diabetes, Zinc, Copper.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 3-7
Published : 2013
Publisher Name : Ziauddin University
  • Nudrat Anwar Zuberi
    • Associate Professor, Department of Biochemistry, BMSI, JPMC, Karachi
  • Sabeela Noor
    • Researcher Department of Biochemistry, BMSI, JPMC, Karachi
  • Fasiha Fatima
    • Researcher, Department of Biochemistry, BMSI, JPMC, Karachi
  • Khalilullah
    • Researcher, Department of Biochemistry, BMSI, JPMC, Karachi
  • Muhammad Iltaf
    • Researcher, Department of Biochemistry, BMSI, JPMC, Karachi

In-vitro Susceptibility of Levofloxacin against Different Clinical Isolates

Background:

Levofloxacin is a broad spectrum quinolone, widely used to treat infections caused by gram negative and gram positive bacteria. Development of resistance by pathogens against different broadspectrum antibiotics is increasing and now becoming a global issue.

Objectives:

The aim of the study is to evaluate the current sensitivity pattern of levofloxacin against various common clinical isolates like Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa,and Klebsiellapneumoniae.

Methods:

A total of one hundred and ten samples were collected from different pathological laboratories of Karachi, Pakistan. The above mentioned pathogens were isolated from blood, stool/urine, sputum, skin samples.

Results:

Results show least resistance of levofloxacin against E.coli (27.5%), and P.aeruginosa (27%), while S.aureus possessed highest resistance (45%).

Conclusion:

Study concluded levofloxacin still possesses excellent anti-microbial activity against common pathogens. Routine monitoring and surveillance is further required to ensure effective treatment regimens to community. KEY WORDS: Levofloxacin, Resistance, Susceptibility, Clinical Isolates, Pathogens.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 8-12
Published : 2013
Publisher Name : Ziauddin University
  • Rabia Bushra
    • Associate Professor, Faculty of Pharmacy, Ziauddin University & Hospitals Karachi
  • Mehwish Rizvi
    • Assistant Professor, Faculty of Pharmacy, Ziauddin University & Hospitals Karachi
  • Maqsood Ahmed
    • Assistant Professor, Faculty of Pharmacy, Ziauddin University & Hospitals Karachi
  • Shazia Alam
    • Assistant Professor, Faculty of Pharmacy, Ziauddin University & Hospitals Karachi
  • Nusrat Bano
    • Associate Professor, Faculty of Pharmacy, Ziauddin University & Hospitals Karachi
  • Corresponding Author
  • Rabia Bushra

Risk Factors for Nutritional Rickets in Children under 36 months: A Civil Hospital Case Study

Background:

Nutritional rickets is a common problem in Pakistan especially in Karachi with majority of the population living in enclosed housing and slums having limited or no sun exposure. There is a dearth of significant data regarding rickets in Pakistan especially in Sindh which emphasizes the need for further research. This study can be a foundation for other studies regarding strategies for prevention and early diagnosis of rickets.

Objectives:

To determine the clinical presentation and identify risk factors for nutritional rickets in children less than three years of age.

Methods:

A cross sectional study conducted in the department of pediatrics DUHS/CHK from June 11, 2007 to December 10, 2007. Fifty patients aged two months to thirty six months presenting with the clinical manifestation of rickets were included in the study. Information recorded included symptoms, socioeconomic status, feeding patterns, sun exposure, clothing, housing and malnutrition. Diagnosis was based on clinical signs, serum levels of alkaline phosphatase, calcium, phosphorus and radiological changes in X-ray wrist joint.

Results:

Approximately 60% reported a weight for height less than ISD criteria set by WHO. Of the total assessed 58% percent were exclusively breast fed, 30% partial breast fed and 12% on formula milk. Weaning age was not reached in 20% of the children. Complementary feeding initiated late for 40% of the children with 78% percent exposed to sunlight less than 30 minutes per day and. Gross motor delay existed in 30% of children and hypocalcaemia convulsions in 14%. Past H/O repeated was in 32% had 22% had persistent/recurrent diarrhea.

Conclusion:

Exclusivity breast feeding to complementary feed, inadequate exposure to sunlight and delayed introduction of complementary foods are the main risk factors for the development of nutritional rickets which can manifest itself in the form of ARI and diarrhea.

KEY WORDS: Rickets, Vit-D Deficiency, Biochemical Abnormalities.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 13-17
Published : 2013
Publisher Name : Ziauddin University
  • Sangeeta Santosh
    • Senior Registrar, Ziauddin University & Hospitals Karachi
  • Fehmina Arif
    • Professor, DUHS, Civil Hospital Karachi
  • Hina Raess
    • Senior Registrar, Liaqat University of Medical and health Sciences, Jamshoro
  • Corresponding Author
  • Sangeeta Santosh

Comparing Attitudes of Medical and Engineering Students in Karachi Towards Smoking

In Pakistan, tobacco consumption is at an all-time high with the tobacco industry witnessing a boom. According to the Pakistan Tobacco Company, production and sale has taken a sharp leap from Rs.1,000 million rupees to Rs.1,750 million in 2008. The youth remain particularly vulnerable as massive antismoking ad campaigns have failed to drill in the health hazards. The aim of this study is to assess the attitude, perception and practices of youth regarding cigarette smoking. Comparative cross-sectional study was conducted in Ziauddin University and Bahria University. Sample was taken from all years of teaching. Data was collected through self-administered structured questionnaire that was developed in English. It comprised of questions pertaining to their year of study, smoking history, and perception and practices regarding smoking. A total of 450 students were surveyed, medicine (n=260) and engineering (n=190). One-fourth of the survey sample admitted to have tried to smoke at least once in their lifetime (p=0.001), and at least 20% medical students (n=53) and 35% of engineering students (n=66) surveyed had smoked a cigarette (p=0.001). While students studying medicine were better aware of the risks associated with smoking and tobacco consumption, however compared to engineering students their overall knowledge of the health risks was unsatisfactory. A significant number of medical students were unable to list and hence effectively counsel about long and short term health benefits. Peer pressure and media played a large role in students picking up the habit.

KEY WORDS: Pakistan/Epidemiology, Smoking, Karachi, Mechanism Medical Students.

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Volume 2 Issue-1 Jan-Mar,13
ISSN : 2308-2593
Page No. : 24-32
Published : 2013-01-01
Publisher Name : Ziauddin University
  • Nadia Jajja
    • Lecturer, Department of Forensic Medicine and Technology, LSATs, Ziauddin University & Hospitals Karachi.
  • Farah Ahmad
    • Assistant Professor, Department of Community Health Sciences, Ziauddin Sciences University & Hospitals Karachi.
  • Syed Hasan Danish
    • Senior Lecture, Department of Community Health Sciences, Ziauddin University & Hospitals Karachi.

CASE REPORT

Incidentally Diagnosed Lobular Carcinoma-inSitu in a Case of Multiple Fibroadenomas

A case of lobular carcinoma in situ (LCIS) arising within a fibroadenoma. Diagnosis of LCIS was made based on histopathological examination of the excised lumps. The case report highlights the role of histopathology in the diagnosis of this entity coexisting in a fibroadenoma, as ultrasound missed the presence of pre-malignant cells. Fibroadenomas have genetic correlation, as was defined in our case. This case stresses the need for histological evaluation of all breast masses in women.

KEY WORDS: LCIS, fibroadenoma, Histopathology, Non Invasive Breast Cancer.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 25-27
Published : 2013
Publisher Name : Ziauddin University
  • Asma Niaz Khan
    • Assistant Professor, Department of Anatomy, United Medical and Dental

Massive Endometroid Ovarian Carcinoma and Synchronous Uterine Malignancy

The diagnosis of ovarian carcinoma is a challenging task especially when women usually present vague symptoms like abdominal distension and pain. The aim of this paper is to report a case of synchronous ovarian malignancy in a young patient. A 36 year old unmarried female presented with a huge right ovarian cystic mass occupying the whole abdomen, breathlessness, jaundice and urinary retention. She underwent laparotomy for surgical removal of the mass and during the surgical procedure a frozen section was performed that showed malignancy. Total abdominal hysterectomy and bilateral salpingo ophorectomy was thereafter performed on her. Final histopathological report of the mass revealed well differentiated endometroid ovarian cancer and endometroid endometrial cancer. Synchronous endometroid tumors are generally present in young patients; these tumors tend to be of low grade malignancy. Prognosis of endometroid carcinoma is relatively better than other histological types.

KEY WORDS: Endometroid Tumour, Total Abdominal Hysterectomy, Bilateral Salphingo-Oophorectomy, Laparotomy.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 28-32
Published : 2013
Publisher Name : Ziauddin University
  •  Shazia Sultana
    • Senior Registrar, Department of Obstetrics and Gynecology, Ziauddin University Karachi
  • Rubina Hussain
    • Chairperson and HOD, Department of Obstetrics and Gynecology, Ziauddin University Karachi
  • Wasiya Irfan
    • Student, Ziauddin University & Hospitals Karachi
  • Corresponding Author
  • Shazia Sultana

Morgagni Hernia – Presenting as Vague Abdominal Pain Since 8 Years

Morgagni hernia is the rarest type of Congenital Diaphragmatic Hernia(CHD). It accounts for 2% of all CHD cases and is detected incidentally through a chest xray The hernia occurs mostly on right side of diaphragm with incidence of 90%, 8% occur bilaterally and 2% limited to left side. It is predominant in females presenting symptom of abdominal pain. The presence of colonic sounds on chest examination is a significant finding in diagnosis. CT scans usually reveal a retrosternal or parasternal mass or fat density which represents omentum and air containing viscus. A case of a middle aged lady presenting with vague abdominal pain for the last eight years is reported. Suspicion was raised over a chest xray which highlighted the right dome of diaphragm being pushed up and the presence of gaseous shadow under the right dome .Subsequent computed tomography showed morgagani hernia . The patient underwent open transabdominal of the stomach and omentum , where the hernia sac not resected and a primary closure of the defect was performed. The post operative course was uneventful. Morgagni though rare, often remains undiagnosed and can lead to life threatening complications. Surgical intervention regardless of patient ‘s asymptomatic state should be offered to avoid complications.
KEY WORDS: Congenital Diaphragmatic Hernia, Morgagni, Surgery.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 33-37
Published : 2013
Publisher Name : Ziauddin University
  • Tahir Muhammad Yaseen
    • Resident, Department of Surgery, Ziauddin University & Hospitals Karachi
  • Syed Asif Ali Zaidi
    • Resident, Department of Surgery, Ziauddin University & Hospitals Karachi
  • Shafiq-ur-Rehman
    • Professor, Department of Surgery, Ziauddin University & Hospitals Karachi
  • Corresponding Author
  • Syed Asif Ali Zaidi

REVIEW ARTICLE

Molecular Epidemiology of Hepatitis B Virus in Pakistan: Link with Southern Asia

Viruses and their genotypes reflect the relationship of their hosts. How these strains evolve, is one question and how they cross the borders is another. Since the HBV genotypes have been described by Okamoto and colleagues in 1988, Hepatitis B virus is expressed by a classification of different HBV strains into genetic genotypes and sub genotypes. A degree of 8% divergence between the groups has since then become the definition for HBV genotype. Now HBV is known by its geographic genotype and sub-genotype distribution. They also exhibit combination of both separately or in the form of a hybrid and hybrid of HBV genotypes is a common event in countries where movement of people is frequent across the borders, thus, providing a mixture of variation within individuals and in the population in general. It is seen that if travelling is by road then the different genotypes are prevalent around the borders, but if travelling is by air then they exist in general population as a less prevalent genotype. This review highlights the genotypic link between Pakistan and its South Asian neighbors.

KEY WORDS: Hepatitis B Virus, Genetics, Genotypes.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 38-43
Published : 2013
Publisher Name : Ziauddin University
  • Saeeda Baig
    • Professor and HOD, Biochemistry Department Ziauddin University & Hospitals Karachi

STUDENTS' CORNER

Majority of the Population Disregards Obesity as a Health Risk: Obesity among different Socioeconomic Strata in Karachi – A Hospital Case study

Background:

Obesity is a chronic disease which requires aggressive management. Obesity, although not a direct cause of most diseases, unfavorably alters the risk factor profile. It may lead to high blood pressures and high cholesterol levels, which can result in cardiovascular diseases or strokes. In addition to these diseases, the quality of life is also severely impaired. Successful treatment of obesity not only alleviates the associated medical problems, but also improves the quality of life dramatically.

Objectives:

To observe and compare obesity, its perception and complications among different socioeconomic classes in Karachi.

Methods:

A predesigned questionnaire was filled out at two hospitals of Karachi for a sample representing patients from lower and higher socioeconomic strata. BMI of these patients was calculated and assessed with respect to their income, education level and occupation, eating patterns, frequency of exercise. The presence of associated non-communicable diseases like hypertension and diabetes mellitus was also recorded. Data was analyzed using SPSS software.

Results:

The patients· population comprised 31 males and 19 females. The mean age was 45.56 (SD + 12.08). Minimum age was 15 years, while maximum was 75 years. Pathological analysis revealed that majority of SCC cases were moderately differentiated, SCC with clinical stage T2 or T3, N0,M0/N1,M0. Most common oral sites came out to be buccal mucosa of cheeks followed by lateral borders of tongue and lips. All patients underwent primary resection ± neck dissection and reconstruction when necessary.

Conclusion:

Obesity was observed in all classes irrespective of the education, income and occupation of the respondents with sedentary lifestyle being the main causal factor. There exists lack of awareness of the harmful consequences of obesity

KEY WORDS: BMI, Obesity, Morbid Obesity.

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Volume 2 Issue-3 July-Sep,13
ISSN : 2308-2593
Page No. : 44-49
Published : 2013
Publisher Name : Ziauddin University
  • Talat Nur
    • Student, College of Business Administration Karachi
  • Usra Shah
    • Senior Lecturer, Department of Community Health Sciences, Ziauddin University & Hospitals Karachi
  • Nosheen Zehra
    • Assistant Professor, Department of Community Health Sciences, Ziauddin University & Hospitals Karachi