Volume 3 Issue-4 Oct-Dec,14

 

The articles for the PJMD Issue Oct-Dec 2014 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.

EDITORIAL

The Hemorrhagic Fever: Ebola and Other Viruses

Presently, Ebola epidemic in West Africa emphasizes an immediate need to update management guidelines of viral hemorrhagic fever and develop new vaccines and treatments. Already, there are reports of an experimental monoclonal antibody being prepared and administered in two American healthcare workers who recently acquired Ebola virus infection in Liberia.1 The World Health Organization (WHO) is closely monitoring the evolving Ebola outbreak in Guinea, Liberia, and Sierra Leone and has now declared public health emergency…

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 1-2
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Faraz Ahmed Baig
    Department of Pathology, Ziauddin University & Hospitals, Karachi.
  • Amna Hamid
    Department of Medicine, Ziauddin University & Hospitals, Karachi.

ORIGNAL ARTICLE

Medico-legal Assessment of Non-fatal Cases of Fall from Height in Karachi

Background:

Fall from height is a tragedy, largely avertable, often leading to death or morbidity. Apart from the physical dimension, it also has important medico-legal implications. There is a dearth of serious study to document the overall fall from height cases in the metropolis of Karachi or to formulate suggestions to improve the situation. The current study has been undertaken in this direction.

Objective:

To assess and document the incidence of medico-legally relevant cases of fall from height in the metropolis of Karachi and to suggest ways to minimize this mishap.

Methods:

Descriptive, retrospective, cross-sectional study of medico-legally relevant cases of falls from height in Karachi registered from 1st January, 2007 to 31st December, 2011; the data having been retrieved from the three medico-legal sections of Karachi located at Abbasi Shaheed Hospital, Jinnah Post-graduate Medical Centre & Civil Hospital and from the Police Surgeon’s Office, Karachi. Findings were expressed in numbers & percentages.

Results:

The total number of registered medico-legal cases of fall from height in Karachi during the study period was 1029. Of these 49.17% (n=506) were reported at ASH, followed by 28.67% (n=295) at CHK and 22.16% (n=228) at JPMC. Of the total number of fall cases, 86.01% (n=885) were non-fatal and 13.99 (n=144) proved fatal. Further, 51.41% (n=455) of the non-fatal cases were referred to ASH while 28.59% (n=253) went to CHK and 20% (n=177) to JPMC. Most of the referrals to ASH were due to location of the hospital.

Conclusion:

Fall from height is one of the leading causes of medico-legal cases in Karachi with a high morbidity rate as well as mortality with about 15% of them being fatal in the five year period 2007-2011. Despite the incidence, most of these mishaps are preventable. As majority of these cases involve the construction industry, a multi-pronged team effort is required to improve the situation.

Key Words:

Falls from Height, Karachi, Medico-legal, Morbidity, Abbasi Shaheed Hospital.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 3-8
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Syed Perwez Alam
    Assistant Professor, Department of Forensic Medicine & Toxicology, Karachi Medical and Dental College, Karachi.
  • Roohi Ehsan
    Assistant Professor, Department of Forensic Medicine & Toxicology, Karachi Medical and Dental College, Karachi.
  • Wasiq Ahmed
    Demonstrator, Department of Forensic Medicine & Toxicology, Karachi Medical and Dental College, Karachi.
  • Farhat Hussain Mirza
    HOD, Department of Forensic Medicine & Toxicology, DOW Medical College, DOW University of Health Sciences,Karachi.
  • Corresponding Author
    Syed Perwez Alam

The Killing of Women Without Weapon: 5 year medico-legal study of rape cases in Karachi

Background:

Rape is amongst the most prevalent sexual assault against women in Pakistan.These bullets when fired damage the physical, psychological, social, and economical well being of the victim, culminating often into problems culminating in a myriad of social, psychological and medical problems.

Objective:

To analyze the various medico legal parameters & dimensions of alleged rape cases in metropolis of Karachi and present this analysis in relation to the demographic parameters of the alleged cases.

Methods:

A descriptive and cross sectional study on a total of 1210 cases of alleged sexual assault, that were reported from January 1, 2007 till December 31, 2011, at the three authorized medico legal centers of Karachi: Jinnah Post Graduate Medical Center, Abbasi Shaheed Hospital and Civil Hospital Karachi.

Results:

Amongst the total of 1210 cases, majority involved unmarried females (n=898; 74.21%), whereas married cases were 312(25.79%). On an average 20% of the cases were reported per year (n=292), with peak incidence in 2011 when the percentage rose to 21.65 %( n=262) and the minimum being at 17.27 %( n=209) in year 2007. Most cases were reported 0-6 th day post incident with the percentage being 35.70 %.( n=432). The cases in which examination was carried out between 1 week to 1 month after incident were 64.29 %( n=778). The negative cases came out to be 62.56 %( n=757) and positive cases came out to be 37.43 %( n=453), on the bases of clinical findings (i.e. tears local injuries) and laboratory investigations. Sexual assault is more common, in the age group of 15-20 years (n=586; 48.42%).

Conclusion:

Rape as sexual assault is still a major concern in our region. Most of the cases reported were however not proved to be positive; Reasons being many, especially when the victim report their cases late or the nature of cases being such (as in rape after abduction) that relevant physical findings were rendered useless to provide evidence. There is a need to provide safeguards to such victims so that they may seek legal and medical attention sooner, and measures to provide social security to such sufferers so that their physical and mental health can be restored in due time.

Key Words:

Rape, Indecent Assault, Incest.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 9-17
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Farhat H Mirza
    HOD, Department of Forensic Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi.
  • Hamid Ali Parhyar
    Assistant Professor, Department of Forensic Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi.
  • Qudsia Hasan
    HOD, Department of Forensic Medicine & Toxicology, Ziauddin University & Hospitals, Karachi.
  • Ishtiaq Ahmed Langah
    Lecturer, Department of Forensic Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi.
  • Corresponding Author
    Qudsia Hasan

Lower Risk of Thrombosis in Blood Group O Patients: Are low clotting factor levels the reason?

Background:

The ABO Blood group system has been evaluated many a times for increased risk of vascular accidents and heart diseases. This study aims to prove that the reason behind the decreased risk of thrombosis in O blood group population could be the decreased levels of clotting factors in its plasma compared to other blood groups.

Objective:

To assess the levels of clotting factors VII, VIII, IX and X in all blood groups to determine whether blood group O has the lowest levels of all clotting factors in its plasma.

Methods:

This is a Descriptive Cross sectional study, conducted at Dr. Ziauddin Hospital Karachi and Dow University of Health Sciences over a period of six months. The study involves 16 plasma units divided into four of each blood group. On the day of testing plasma was thawed and assays of factor VII, VIII, IX and X were performed on all blood groups and results noted.

Results:

Levels of Factor VIII, IX and X were found to be highest in blood group AB and lowest in blood group O. Factor VII levels varied from others.

Conclusion:

Our results showed that factor VII levels vary in different blood groups, may be due to its short half-life. Thus we could not establish a link between ABO blood groups and clotting factor levels.

Key Words:

Fresh Frozen Plasma, Thawed Plasma, Clotting Factors, ABO Blood Groups.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 18-22
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Rahila Razzak
    Lecturer, Department of Physiology, Ziauddin University and Hospitals, Karachi.
  • Sana Ansari
    Department of Pathology, Ziauddin University and Hospitals, Karachi.
  • Syed Tousif Ahmed
    Professor and HOD, Department of Physiology, Ziauddin University and Hospitals, Karachi.
  • Nosheen Zehra
    Assistant Professor, Department of Community Health & Sciences, Ziauddin University and Hospitals, Karachi.
  • Corresponding Author
    Rahila Razzak

Factors Leading to Late Sleeping Habits and its Effects on Academic Performance

Background:

For an adolescent the requirement of sleep does not decline though the opportunity to sleep is limited on account of lifestyle predilections, academic schedules, and compelling changes in the biological processes. Sleep affects physical growth, performance and emotional thinking in addition to influencing the cognitive functioning and attention span.

Objective:

The primary purpose of this study was to know the effects of late sleeping habits on academic performance in school girls aged 10-13 years and to identify the factors leading to late sleeping habits in school girls aged 10-13 years.

Methods:

A cross sectional survey was conducted on 355 girls studying in girls only schools. Multistage sampling technique was used. Sleep and academic performance questionnaire was administered after taking written informed consents from principals, students and their parents/guardians. Chi square test was applied for finding association between sleep habits and academic performance. P value less than 0.05 was taken as significant.

Results:

No significant association was found between late sleeping habit and academic performance since majority of the students i.e. 267 (75%) students slept before 11pm, the time which demarcates the late sleeping time with normal time. Significant association was found between habit of book reading before bed time and above average academic performance. Around 43% students drink milk before sleeping and majority watch television before sleeping. Likewise students who wake up fresh in the morning and do breakfast have above average academic performances.

Conclusion:

Study findings conclude that majority of the girl students in the age group of 10-13 years sleep at an appropriate time and satisfy the day’s requirement of 9 hours sleep. Therefore it does not affect their academic performance as majority of the students in the survey secured good grades.

Key Words:

Late Sleeping Habit, Academic Performance, Sleep Behavior, Bedroom Environment

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 23-30
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Farah Ahmad
    Assistant Professor, Department of Community Health Sciences, Ziauddin University, Karachi.
  • Syed Danish Hasan
    Assistant Professor, Department of Community Health Sciences, Ziauddin University, Karachi.
  • Huma Tahir
    Assistant Professor, Department of Community Dentistry, Margalla Institute of Health Sciences, Islamabad
  • Mohsin Wahid
    Assistant Professor, Dow University of Health Sciences, Karachi.
  • Corresponding Author
    Farah Ahmad

Importance of Cadaveric Dissection in Learning Gross Anatomy

Background:

The trend of dissection training is at the verge of extinction all around the world. With literal mushrooming of private medical colleges, supporting varied degree of medical facilities. There is increasing debate regarding the significance of cadavers in the teaching of gross anatomy. A study was conducted among graduate & postgraduate doctors in order to understand the importance of cadaveric dissection.

Objective:

To understand the importance of cadaveric dissection and determine the level of supportive rendered by cadaveric dissection at an undergraduate level for choosing the surgical field careers. To assess whether the stress and depression caused by cadaveric dissection at first exposure fades out with further exposures or lingers on.

Methods:

A cross-sectional multicentre study conducted in Karachi at various hospitals and medical colleges from November 2013 till February 2014. Graduate and postgraduate doctors from basic sciences and clinical sciences involved in teaching as professors and assistant professors were included in the study. A structured questionnaire was administered after taking verbal consent from the participants. The data was tabulated and analyzed using the computer program SPSS Version 15.0 for the production of descriptive statistics.

Results:

Out of 124 graduate and postgraduate doctors, 51.6% (64) were male, 48.4% (60) were female. The first visit experiences to dissection hall was documented through questionnaire, which was exiting for 71.8% (89), and 38.7% (48) got depressed. Cadaver dissection (CD) was avoided by 25% (31), out of which 18.5% (23) had allergy to formaldehyde, and 12.1% (15) had scared of the dead bodies. In 49.2% (61) helped in developing their professional endeavors, 54% (68) got inclined towards anatomy by CD, 71.8% (89) had clear concepts of gross anatomy. Understanding of in depth knowledge of structural details was found in 58.1% (72), regional anatomical concepts were cleared in 71.8% (89) of doctors.

Conclusion:

Cadaveric dissection is a good tool in learning the concepts of gross anatomy. It helped doctors to evaluate their interest and trends towards surgical fields, and also build up concepts which were utilized in their professional life

Key Words:

Cadaver, Dissection, Teaching & Learning Tools, Anatomy

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 31-35
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Asma N Khan
    Assistant Professor, Department of Anatomy, United Medical and Dental, Karachi.
  • Salman Baig
    ENT Consultant, Ziauddin University & Hospitals, Karachi.
  • Syeda Zain
    Assistant Professor, Department of Pharmacology, United Medical and Dent

Normative Data of Hepato-Splenic Sizes in Pakistani Pediatric Population Using Ultrasonography

Background:

Hepatosplenic sizes of children vary with age .There are many diseases which affect the sizes of the liver and spleen ranging from acute liver disease to other hepatosplenic disorders . Ultrasound is a quick and reliable method .Unfortunately there is lack of sufficient data in our population therefore my study would be beneficial in determining various disease processes.

Objective:

To establish normative data of Hepato-Splenic sizes in Pakistani pediatric population using ultrasonography.

Methods:

The study was conducted at the Ziauddin University Hospital, a tertiary care teaching facility in Karachi. The cross sectional prospective hospital based study was conducted with 150 patients aged 1 month to 14 years. Ultrasonographic evaluation for the assessment of liver, spleen and portal vein size was performed. These were correlated with the age, sex, height/length and weight of the children.

Results:

Normal liver and spleen length and its ranges with portal vein diameter were obtained. The liver, spleen length and portal vein significantly correlated highly with the height/length (r=0.7,0.7,0.6 )respectively and weight of the subjects (r=0.7,0.7,0.4 respectively).

Conclusion:

The study provides the normal values of liver and spleen size by ultrasonography in healthy Pakistani pediatric population.

Key Words:

Hepatosplenic Size, Ultrasound, Liver Transplant, Chronic Liver Disease.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 36-42
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Farheen Raza
    Resident, Department of Radiology, Ziauddin University, Karachi.
  • Sajjad Hussain
    Resident, Department of Radiology, Ziauddin University, Karachi
  • Sanobar Bhugio
    Resident, Department of Radiology, Ziauddin University, Karachi.
  • Nosheen Zehra
    Assistant Professor, Department of Community Health Sciences, Ziauddin University, Karachi.
  • Naila Younus
    Resident, Department of Radiology, Ziauddin University, Karachi.
  • Pashmina Gul
    Assistant professor , Department of Radiology, Ziauddin University, Karachi.
  • Waseem Mehmood Nizamani
    Senior Registrar, Department of Radiology, Ziauddin University, Karachi.
  • Corresponding Author
    Farheen Raza

Uncomplicated Urinary Tract Infection: Isolated bacteria, outcome and their susceptibility to antibiotics

Background:

Urinary tract infection (UTI) remains a common clinical problem in both the community and health care associated settings. In Pakistan, this is also a common issue and each patient should be carefully assessed to ensure that a correct diagnosis is made and that antimicrobial therapy is appropriately prescribed. UTI is a common problem and it effect’s both gender and all ages.

Objective:

o determine typical symptoms of urinary tract infection locally employing urine test for diagnosis and outcome after use of antibiotics against isolated bacteria.

Methods:

The cross-sectional descriptive, observational study was conducted at the department of emergency medicine, Ziauddin University Hospital, Karachi from June 2013 to November 2013. Adult patients of either gender with painful and/or frequent maturation were queried for symptoms (history) of urinary tract infection and underwent urine test. Clean catch mid stream urine was collected and the specimens were cultured for isolation of microbial agents of urinary tract infection. The isolated bacteria were identified using biochemical test. The diffusion susceptibility test was used to determine susceptibility of bacterial agents to antibiotics. Data was analyzed by descriptive statistics using SPSS software version 19.

Results:

In this study, 251 (83.7%) out of 300 patients presented numerous (positive) leucocytes in urine detail report. For these 251 (83.7%) patients, the urine culture and sensitivity was performed. Out of these, E-coli was the most common bacteria found in about 150 (59.8%). The other bacteria are Pseudomonas 18 (7.2%), Proteus 37 (14.7%), Kabsella16 (6.4%), enterococcus 20 (8.0%), and staphylococcus aureus 10 (4.0%). Most of the patients were sensitive to cephalosporin’s, amikacnine, and third generation cifixime and ceftrixon. The outcome of patient with appropriate antibiotics was higher at 97.3% for 5 days compared to 83.3% for 3 days.

Conclusion:

Gram negative bacilli is responsible for urinary tract infection and most frequent isolated bacteria was E-coli. The most effective antibiotics are cepholine, amikacin, and third generation cefixem and ceftrexone in patients. Urinary tract infection occurs within 5 days in our local settings comparing to 3 days in developed communities which can enable emperical use antibiotics with typical symptoms of uncomplicated urinary tract infection for about 5 days in our community.

Key Words:

Urinary Tract Infection, Isolated Bacteria, Empirical Antibiotics.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 43-47
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Shazia Yasir
    PG Resident, Department of Emergency Medicine, Ziauddin University & Hospitals, Karachi.
  • Corresponding Author
    Shazia Yasir

Frequency and Clinical Presentation of Oral Submucous Fibrosis

Background:

Oral submucous fibrosis (OSMF) is a chronic, precancerous condition of oral mucosa characterized by juxta-epithelial inflammatory reaction along with hyalinization of lamina propria. These alterations causes fibrosis and stiffness of oral mucosa leading to limited mouth opening and related problems.

Objective:

To evaluate the frequency and clinical forms of Oral Submucous fibrosis.

Methods:

A retrospective study conducted on patients from Oral & Maxillofacial Surgery department of Dr. Ziauddin hospital Clifton, Kemari & North Nazimabad campus from 2009 till 201 3. Patients with OSMF irrespective of age and gender were the inclusion criteria. The demographic information along with clinical presentation of patients was tabulated and analyzed by descriptive statistics.

Results:

A total number of 70 patients with OSMF were evaluated. The most commonage group was 11- 20 years in the study. There were 42 male and 28 female patients with male female ratio. The most common complaint of OSMF patients was burning sensation in oral cavity followed by limited mouth opening and dryness of mouth. The majority of patients presented with an advanced stage of disease with grade 3 interincisal distance.

Conclusion:

OSMF is becoming a disease of younger adults with a slight male predilection. The majority of patients presents with a progressive and advanced form of disease.

Key Words:

OSMF, Precancerous Condition, Fibrosis, Interincisal Distance.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 48-53
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Noor-ul-Wahab
    Associate Professor & HOD, Department of Oral & Maxillofacial Surgery, Ziauddin University & Hospitals, Karachi.
  • Salima Asifali
    Assistant Professor & HOD, Department of Oral & Maxillofacial Surgery, Ziauddin University & Hospitals, Karachi.
  • Muslim Khan
    Associate Professor, Department of Oral & Maxillofacial Surgery, Khyber College of Dentistry.
  • Shoaib Khan
    Assistant Professor & HOD, Department of Dental Materials, Ziauddin University & Hospitals, Karachi.
  • Hassan Mehdi
    Associate Professor, Department of Oral & Maxillofacial Surgery, Fatima Jinnah Dental College, Karachi
  • Asifali Sawani
    PG Resident, Faculty of Dentistry, University of Toronto, Canada.
  • Corresponding Author
    Noor-ul-Wahab

Pelvic Arterial Embolization for the Control of Intractable Pelvic Hemorrhage: Retrospective Analysis of 13 Cases

Background:

Obstetric hemorrhage is one of the most important causes of maternal mortality. Severe postpartum hemorrhage is known to raise the mortality rate. There is a higher incidence of death from obstetric hemorrhage in developing countries as opposed to developed countries

Objective:

To emphasize the role of interventional radiology in the management of obstetric and gynaecological haemorrhage in under developed countries like Pakistan.

Methods:

The retrospective data of all patients requiring pelvic artery embolization for the control of pelvic hemorrhage was studied at Ziauddin University Hospital during the period from April 2011 to June 2014. Main outcome measure was the effectiveness to control hemorrhage. Technical success was defined as the cessation of bleeding on the post embolization angiogram and cessation of vaginal bleeding at speculum inspection performed immediately after PAE. Clinical success was said when the bleeding stopped completely after the first course of PAE and no additional PAE or surgery was required.

Results:

A total of 13 patients underwent pelvic artery embolization (PAE) during this period. Five patients had primary postpartum haemorrhage (PPH), in which 3 patients had PPH after caesarean sections, one due to uterine atony secondary to triplets delivery, second had placenta praevia and third had placenta accreta. Two patients had uterine rupture, one following the normal vaginal delivery & other had previous 2 caesarean sections, uterine scar ruptured at 28 weeks of gestation. Two patients had secondary PPH, one due to uterine artery pseudo aneurysms after caesarean section and other had normal vaginal delivery. Six patients underwent pelvic artery embolization due to gynaecological cause i.e. heavy menstrual bleeding & pain secondary to fibroids. One patient had total abdominal hysterectomy and bilateral salpingoopherectomy due to fibroids but she continued to have bleeding from vaginal vault .Laparotomy was done twice but she continued to bleed so finally underwent pelvic arterial embolization after which bleeding stopped. All patients underwent selecti ve embolization of the uterine artery or anterior divisional branch of the internal iliac artery with successful haemorrhage control and no immediate complications. PAE when done, in Gynae patients with fibroid resulted in severe abdominal pain immediately after the procedure for which analgesic medicines were given and the pain settled. These patients were followed in clinics and found to have significant decrease in their symptoms like 88% reduction in menorrhagia &100% improvement in pain in six months period after procedure. Imaging scans were also done to follow the size of fibroid that were found reduced 17 -63%.

Conclusion:

Selective pelvic embolization is a safe and effective treatment for acute obstetric or gynaecological haemorrhage and should be part of the management algorithm for PPH and for the treatment of symptomatic fibroids in females who especially want to conserve their uterus .

Key Words:

Uterine Artery Embolization, Postpartum Haemorrhage, Fibroid.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 54-63
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Nigar Sadaf
    Assistant Professor, Department of Obstetrics & Gynecology, Ziauddin University & Hospitals, Karachi.
  • Rubina Hussain
    Chairperson & HOD, Department of Obstetrics & Gynecology, Ziauddin University & Hospitals, Karachi.
  • Anjum Afshan
    Associate Professor, Department of Obstetrics & Gynecology, Ziauddin University & Hospitals, Karachi.
  • Samina Kamal
    Department of Obstetrics & Gynecology, Ziauddin University & Hospitals, Karachi.
  • Aliya Waheed
    Department of Obstetrics & Gynecology, Ziauddin University & Hospitals, Karachi.

Frequency of Stressful Activities Amongst Doctors, Engineers and Teachers

Background:

Different professions are under a great deal of stress related to a variety of oc cupational stress factors. These factors contribute to decreased job satisfaction, decreased work output, mental and physical exhaustion and absenteeism due to sickness. It often occurs when individuals’ cannot cope with their job demands, physically or emotionally.

Objective:

To determine the frequency of stress among three highly challenged occupations which are doctors, engineers and teachers.

Methods:

The cross sectional study was conducted in the District South of Karachi using separate questionnaires for doctors, engineers and teachers. In this research the total of 600 individuals were included, 200 from each profession. Only those individuals were surveyed who are currently working in government institutions of this district. The data obtained was analyzed using SPSS v.20.

Results:

The results showed that engineers are under a higher level of stress as compared to doctors and teachers. Workload, lack of power and influence, office politics, inadequate or poor quality of training/management development and lack of encouragement are the major factors that are contributing to build stress in engineers.

Conclusion:

As the frequency of stressful activities found higher in engineer, their workload should be minimized and divided among the relevant posts rather than putting the entire burden on an individual. Office politics must be discouraged as this has proved to have detrimental effects on individual’s life. Lack of knowledge, power, influence, training and encouragement has led to increased stress. Stress management programs will improve management, and good intrapersonal relationships .

Key Words:

Stress, frequency, Profession.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 64-69
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Ghazala Usman
    Assistant Professor, Department of Community Medicine, Sindh Medical College, Jinnah Sindh Medical University,Karachi.
  • Urooj Zafar
    Student, Sindh Medical College, Jinnah Sindh Medical University, Karachi.
  • Mohammad Dilawwar Jan
    Student, Sindh Medical College, Jinnah Sindh Medical University, Karachi.
  • Asim Saeed Khan
    Student, Sindh Medical College, Jinnah Sindh Medical University, Karachi.
  • Corresponding Author
    Ghazala Usman

CASE REPORT

Postpartum Infection can be a Disaster

Abstract:

Endometritis is the most common infection that occurs postpartum. Postpartum endometritis is tenfold to 20-fold more common among women who delivered by cesarean section than women who delivered vaginally. It can present with puerperal pyrexia, abscess formation & rarely rupture of uterus. Reported risk factors for dehiscence of the lower segment uterine scar following CS are multiparty, infection, and an incision placed too low in the lower uterine segment. The case presents a report of a 34 year old female Para 3+0 who was presented in emergency with high grade fever and abdominal pain. She undergone a caesarean delivery 9 days prior to presentation in a private clinic. Due to infection her uterus was found to be ruptured on exploratory laparotomy which is reported very rarely. Uterus was irreparable so obstetrical hysterectomy was done &patient was kept in ICU.

Key Words:

Endometritis, Obstetrical Hysterectomy, Chorioamnionitis.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 70-73
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Shama Chaudhry
    Assistant Professor, Department of Obstetrics & Gynecology, Ziauddin University and Hospitals, Karachi.
  • Rubina Hussain
    SHOD, Department of Obstetrics & Gynecology, Ziauddin University and Hospitals, Karachi.
  • Corresponding Author
    Shama Chaudhry

Ectopic Supernumerary Kidney: A Rare Anatomic Variant

Abstract:

Urogenital anomalies are common, correspond to 33% of all congenital anomalies and supernumerary kidney is one of the rarest entity; less than hundred cases have been reported in the past. The Supernumerary kidney is considered a third kidney in addition to the two already present independent kidneys and considered an infrequent developmental anomaly of the urinary tract. The accessory kidney most commonly located on left side caudal to the normal kidney. Because of uncommon occurrence and prevalence, it frequently causes diagnostic challenges in clinical practice. The supernumerary kidney must be differentiated from the more common congenital anomaly, duplex kidney, having two pelvicalcyceal systems that are connected with single or double ureters. The supernumerary kidney, in distinction, is thought to be an accessory organ with a separate arte rio-venous supply, collecting system and a different capsule. The case of a 33 years old male patient is depicted who presented a history of hypertension and was diagnosed as having left sided unilateral supernumerary kidney located cranial to normal renal parenchyma.

Key Words:

Urogenital Anomalies, Supernumerary Kidney, Accessory Kidney

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 74-77
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Bhesham Kumar Shahani
    Senior Registrar, Department of Radiology, Ziauddin University and Hospitals, Karachi.
  • Aneel Kumar Vaswani
    Assistant Professor, Department of Radiology, Ziauddin University and Hospitals, Karachi.
  • Waseem Mehmood Nizamani
    Senior Registrar, Department of Radiology, Ziauddin University and Hospitals, Karachi.
  • Rekha Haresh
    General Practitioner, Ahalia Medical Hospital, Abu Dhabi.
  • Corresponding Author
    Aneel Kumar Vaswani

REVIEW ARTICLE

IL6 Gene Polymorphism and Oral Cancer: A Review

Abstract:

Oral cancer is labeled as one of the most common human malignancy worldwide. Regardless of the advancements made in its treatment it has a very low 5 years survival rate. This is due to late diagnoses and poor responses to treatment because of advanced/late stage at the time of presentation. Specific early biomarkers are required that can predict severity and stage of the disease. Inflammatory cytokines especially, IL-6 plays a central role in cancer. IL-6, a pro-inflammatory cytokine, secreted by various cells of the body, has been thoroughly investigated in oral cancer development and progression by various studies. An electronic article search was done through PubMed, Google Scholar and Medscape, using the following keywords: oral cancer, Interleukin-6 and IL6 gene polymorphism. All types of articles were included to discuss the role of IL 6 gene polymorphism in the development of oral cance r.

Key Words:

IL 6 Gene Polymorphism, Oral cancer.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 78-82
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Mehwish Zafar
    Lecturer, Department of Pathology, Ziauddin University and Hospitals, Karachi.
  • Naila Hadi
    Assistant Professor, Department of Pathology, Ziauddin University and Hospitals, Karachi.
  • Saeeda Baig
    Professor and HOD, Department of Biochemistry, Ziauddin University and Hospitals, Karachi
  • Corresponding Author
    Mehwish Zafar

Nephrin: An emerging biomarker for detecting damage of glomerular filtration barrier

Abstract:

Nephropathy due to damage of filtration barrier is a primary origin of end stage ren al disease in Diabetics. It is associated with considerable morbidity and mortality. Mostly clinicians rely on urine analysis of Albumin. In the recent years extensive research has been conducted to find out a novel biomarker which can help in the early diagnosis of nephropathy. A search was conducted regarding publications of new diagnostic biomarkers for nephropathy. Among many renal biomarker researched lately, Nephrin was identified as the one that can become an early predictor of nephropathy and the levels of which can also ascertain the severity of the disease.

Key Words:

Nephrin, Microalbuminuria, Diabetic Nephropathy.

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Volume 3 Issue-4 Oct-Dec,14
ISSN : 2308-2593
Page No. : 83-88
Published : 2014-10-01
Publisher Name : Ziauddin University
  • Moazzam Ali Shahid
    Lecturer, Department of Biochemistry, Ziauddin University and Hospitals , Karachi.
  • Saeeda Baig
    Professor and HOD, Department of Biochemistry, Ziauddin University and Hospitals , Karachi.
  • Syed Nudrat Nawaid Shah
    Lecturer, Department of Anatomy, Ziauddin University and Hospitals, Karachi.
  • Corresponding Author
    Moazzam Ali Shahid