Non Communicable Disease
Non Communicable Diseases (NCD’s), the emerging of major cause of morbidity and mortality worldwide including developing countries, are estimated to accounts for 50% of total deaths in Pakistan according to WHO country profile of 2014. Hypertension was recognized but considered as essential response to aging and not a treatable condition. American president Franklin D. Roosevelt had a blood pressure of 200/120 but his physician gave him a clean bill of health. He subsequently had a fatal hemorrhage. Hypertension was not given the name but was recognized as hard pulse since ancient times. The debate continued even in 1960s to treat and not treat hypertension. It was labeled as essential hypertension as a part of aging process and not considered a disease. The Medical research council in UK conducted first Randomized Controlled Trial (RTC) in 1948; thus leading a way to develop further studies in treatment of diseases. The first such a trial was conducted for thiazides and thiazides like compounds for treatment of blood pressure. Since then there has been a number of trials beginning with (VA1-2 VA cooperative study 1967 and 1970) trial in 1967 to SPRINT (Systolic Hypertension intervention trial) in 20151,4.
Joint National Committee (JNC) in USA was first established in 1976 to provide recommendation for management of hypertension. JNC was established by The National Heart, Lung and Blood Institute (NHLBI) to promote prevention, detection of blood pressure and treatment2.
- Ejaz A Vohra
- Chief Editor, Ziauddin University. Karachi.
IMPACT OF ANTIOXIDANTS AND PRO-OXIDANTS ON FEMALE FERTILITY
Oxidative stress, an imbalance of pro-oxidants and antioxidants, is reported to be associated with female infertility. This study was aimed to compare cortisol (oxidative stress marker) and vitamin E (antioxidant) levels in the fertile and infertile female population of Karachi, Pakistan.
Materials and Methods:
A total of 88 females, recruited from Australian Concept Infertility Medical Centre, were divided equally into infertile cases and fertile controls. Serum cortisol and vitamin E (VE) levels were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Statistical comparison was done by Chi-square and Mann-Whitney U-test. Correlation between two continuous variables was determined by Spearman’s Correlation. The P value < 0.05 was considered significant in all cases.
The median age for the fertile group was 31.0 (IQR= 27.0-37.0) and for the infertile group, 32.0 (IQR= 28.0-38.0). Of the infertile females, 70.5% (n= 31) had primary infertility while 29.5% (n= 13) had secondary infertility. A significant difference in the cortisol levels was seen between the fertile and the infertile groups. (p value= 0.001). VE levels were significantly decreased in the infertile females (p value= 0.026). The levels of cortisol and VE were found to be in a weak negative correlation in the infertile women (-0.163).
A balance between oxidants and antioxidants is required to maintain the reproductive potential in females. Decrease in the antioxidant vitamin E, and an increase in pro-oxidant cortisol, may be associated with a risk of infertility in females.
KEYWORDS: vitamin E, fertility, pro-oxidants, antioxidants
|Publisher Name :||Ziauddin University|
- Sofia Amjad
- Associate Professor of Physiology, Ziauddin University
- Amara Zafar
- Student, Final year, Dow Medical College
- Maria Habib
- Ex-postgraduate Student, Military Hospital, Rawalpindi
- Mussarat Ashraf
- Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University Hospital
AURAL FOREIGN BODIES: A RETROSPECTIVE STUDY OF 162 PATIENTS
Foreign bodies in the ear are relatively common in the practice of otology. Children below 10 years of age are usually more involved than adults. The physical characteristics of these foreign bodies will determine the mode and the instrument required for their removal.
Objectives: To determine the types of foreign bodies, age commonly involve, method of removal of aural foreign bodies (with or without anesthesia) and complications associated.
This is a 5-year retrospective study conducted at the Otolaryngology Unit of the Department of Surgery Federal Medical Centre Lokoja. After obtaining a written permission from the Hospital Medical Records Department, patient’s data such as age, sex, presentation and duration of symptoms, treatment modality and outcome were extracted, studied and analyzed.
Eventually 162 patients with the age range from 1 to 60 years, a mean age of 8.14 years, and a modal age of 1-10 years underwent analysis. Of all patients, Seeds/grains 41(25.3%) were the commonest foreign bodies found in this study, followed by beads 36(22.2%). Furthermore, it was found that 95.1% of foreign bodies were removed in clinic without anesthesia and six patients (3.7%) had complications such as tympanic membrane perforation 2(1.3%), external auditory canal bruises 2(1.3%), hearing loss 1(0.6%) and acute mastoiditis 1(0.6%).
In conclusion, we found thatgrains, seeds and beads form the bulk of aural foreign bodies encountered mostly in children while cotton, matchsticks and insects are common in the adults. With the right kind of instrument, an ENT Specialist can successfully remove 95% of these foreign bodies without anesthesia and less complications.
KEYWORDS: Aural, foreign bodies, removal, anesthesia
- Stephen AgbomhekheOgah
- Consultant Oto-rhino-laryngologist, Head and Neck Surgeon, Otolaryngology Division, Department of Surgery, Federal Medical Centre, Nigeria.
ASSESSMENT OF ROOT CANAL WORKING LENGTH EMPLOYING MANUAL AND ROTARY INSTRUMENTATION TECHNIQUE. AN IN VITRO STUDY
The objective of root canal treatment is to eliminate infection and irritants from the root canal system.Working length determination and maintenance are essential for the success of treatment. To determine changes in root canal working length after preparation with manual or rotary instrumentation technique.
This In vitro Quasi Experimental study was carried out over a period of six months. Mandibular molars, extracted due to caries or periodontal reasons and mesiobuccal canals, with curvature between 20- 400 were included.In Group A preparation was carried out with ProTaper instruments and in group B with manual Nickel Titanium files. An ISO #15 NiTi file was placed in the canal and radiograph taken to determine working length.Upon completion of preparation, radiograph with #30 NiTi file was taken and working length assessed. Changes in working length were assessed by comparing preoperative and postoperative values. Data analysis was done withPaired and Independent sample ttests using Statistical Package for the Social Sciences (SPSS) version 20.0 available at university campus. P-value < 0.005 was taken as statistically significant.
Working length was better maintained in ProTaper group as compared to group prepared with Manual Ni-Ti instruments.
ProTaper instrumentation technique maintained working length better than manual instrumentation technique.
KEYWORDS: Pulpectomy, Root Canal Therapy, Tooth apex
- Hina Ahmed
- Ziauddin College of Dentistry/Ziauddin University
ETIOLOGY, PATTERNS AND TREATMENT MODALITIES FOR MAXILLOFACIAL FRACTURES
Over the years, the epidemiology of maxillofacial fractures keeps changing and new trends in etiology, pattern of presentation and management are constantly evolving. This, therefore, necessitates a constant appraisal of these fractures injuries in order to keep abreast with recent developments and changing pattern of their management. The aim of this study was to determine the frequency, etiology, patterns and different treatment modalities for maxillofacial fractures in patients treated at Lahore Medical and Dental College/Ghurki Trust Teaching Hospital (LMDC/GTTH).
This cross sectional descriptive study was carried out at Lahore Medical and Dental College/Ghurki Trust Teaching Hospital (LMDC/GTTH) from February 2014 to October 2017.A total of 161 patients having maxillofacial fractures were included in the current study. Data on patients, including age, gender, cause of injury, fracture site, pattern and treatment modalities were collected and analyzed using SPSS version 20.
The age range was 3 to 62 (mean/SD, 26.42±11.24) with peak frequency occurring in age group 21-30 years. The male to female ratio was 5.2:1. The most common cause of maxillofacial fractures was road traffic accident (RTA) in 134 (83.23%) of patients, followed by in fall 12 (07.46%) and assault in 09 (05.59%) patients. The most frequent bone fractured was the mandible, which accounted for 117 (72.67%) cases and parasymphysis (43.22%) was the most frequent site affected, followed by 67 (41.61%) cases of zygomatic complex fracture and 56 (34.78%) cases of maxillary fractures. Open reduction and internal fixation (ORIF/ORIF with IMF) was performed in 127(78.88%) of patients while closed reduction and indirect fixation (IMF with eyelet wiring/arch bar elastics & splint fixation) was done in 34 (21.12%) of patients.
As evidenced by the present study, majority of fractures were caused by RTA in 21-30 age group with male predominance. Mandible was the predominant fractured bone followed by the zygomatic complex area. ORIF was treatment of choice in the current study. According to present study, it seems reasonable to recommend that road traffic legislation enforcement and continuous public education towards the use of restraining devices and helmets should be encouraged by relevant authorities.
KEYWORDS: Maxillofacial fractures, Road traffic accidents, Open reduction& internal fixation, Intermaxillary fixation
- Muhammad Asif Shahzad
- Department of Oral &Maxillofacial Surger ,Lahore Medical & Dental College, Lahore
- Momin Ayub Marath
- Department of Oral Pathology,Lahore Medical & Dental College, Lahore
FREQUENCY OF ABNORMAL URIC ACID LEVEL IN HAEMODIALYSIS PATIENTS
Hyperuricemia and hypouricemia have been implicated as a cause of high mortality in haemodialysis patients. Our study is designed to determine the frequency of abnormal Uric Acid levels in haemodialysis patients and to identify those at risk of increasing mortality.
140 End Stage Renal Disease (ESRD) patients undergoing haemodialysiswere enrolled in a retrospective cross sectional study. Uric Acid levels done as routine sampling was noted and data analyzed using SPSS for windows, version 23. All data are presented as mean ±SD. A relationship was considered statistically significant at p-values less than 0.05. Patient’s age and comorbidities like Diabetes and Hypertension were noted. Patients with mean UA levels between 2.4-6 mg/dl were specified as normouricemic, above this range as hyperuricemic and below this range as hypouricemic.
Out of 140 patients, 71(50.7%) were males and 69(49.3%)were females. Mean age of our patient population was 56.64 ± 12.207. 56 (40%) patients were hyperuricemic and 8 (5.7%) hypouricemic. 87 (62.1%) were diabetic,122 (87.1%) were hypertensive whereas 83 (59.3%) were both hypertensive and diabetic but no notable (p> 0.05) link was found to exist between hyperuricemia and these co-morbidities.
We report a very high frequency of abnormal Uric Acid levels in haemodialysis patients. Nearly half of our haemodialysis population is at high risk of all-cause mortality based on Uric Acid levels alone.
KEYWORDS: Hyperuricemia, Uric Acid, Hemodialysis, End Stage Renal Disease (ESRD)
- Kunwer Naveed Mukhtar
- Department of Nephrology, Liaquat National Hospital and Medical College
- Farheen Malik
- Ayema Haque
- Sobia Mansoor
- Dow University of Health Sciences
OUTCOME OF TRAUMATIC HEAD INJURY IN CHILDREN AND ITS COMPARISON WITH SEVERITY
Head injury (HI) is a leading cause of morbidity and mortality in children in Pakistan. The King’s Outcome Scale for Childhood Head Injury (KOSCHI) has been developed to measure outcomes following HI in children.
Material and Methods:
This case series study was conducted at the Department of Pediatrics in Ziauddin University Hospital, Karachi from March 2017 to September 2017. A total of 181 patients with head trauma were included. Severity of head injury was assessed using the Glasgow coma score. Outcomes of head injury were assessed at 2 months using KOSCHI. Descriptive statistics were calculated. Comparison was done using chi square test with p-value ≤ 0.05 was taken as significant.
There were 69.6% male and 30.4% female patients. Mean duration of head injury was 2.08 ±1.02 hours. The mean comma score was 12.41 ±3.61. 65.2% injuries were mild, 15.5% were moderate, and 19.3% were severe. By KOSCHI, 9.9% of the cases were expired and 1.1% were vegetative. Severe disability was observed in 4.4% of the cases, moderate disability in 8.3%, and 76.2% of the cases were observed as good recovery.
Children with mild HI had moderate disability and those with severe injury had high mortality rate and severe disability at follow up
KEYWORDS: Outcome, Traumatic Head Injury, Traumatic Head Injury Severity
- Mamoona Saher
- Muhammad Iqbal
- Department of Pediatric Medicine, Dr. Ziauddin University Hospital, North Nazimabad Campus
ABO AND RHESUS BLOOD GROUP DISTRIBUTION IN RESIDENTS OF KARACHI.
Blood transfusion till recently was a life threatening procedure until the discovery of ABO blood groups. Today committee of League of Nations has recommended A, B, AB & O classification for general use. This study was aimed to determine the frequency of ABO and Rh blood groups in residents of Karachi, so that necessary measures should be taken to maintain the blood product inventory.
A study was conducted at Dr. Ziauddin Hospital Clifton laboratory Karachi, Pakistan over a period of 07 months from 1st June- 31st Dec 2016. Healthy blood donors and patients requiring blood products of different age groups were included. After an informed consent, blood grouping was performed by taking blood samples under aseptic measures in EDTA and Gel separating serum tubes for ABO & Rh blood grouping by tube method.
A total of 1583 individuals presented during the study period with 868 (54.8%) males and 715(45.2%) females. Blood group O+ve was found to be more common (31.9%) followed by B+ve (31.2%). In Rh system, Rh+ve (97.2%) were more common than Rh negative (2.8%) blood groups.
This study was carried out to maintain the blood product inventory concerning the management of blood bank and transfusion services for the patient.
Blood groups, ABO, Rhesus (Rh)
- Dr. Sumera Shaikh
- Department of Haematology, Ziauddin Hospital, Karachi
- Dr. Ali Shariq
- Department of Microbiology, Ziauddin Hospital Karachi
- Dr. Adnan Mustafa Zuberi
- Department of Pathology, Ziauddin Hospital Karachi
- Dr. Syed Sohail Abbas
- Department of Pathology, Ziauddin University Karachi
ERRORS IN THE CONSTRUCTION OF MULTI-CHOICE QUESTIONS: AN ANALYSIS
This study investigated the frequency of errors in the construction of multiple- choice questions used for the assessment of para-clinical sciences in medical course at the University of Western Australia.
In all there were two hundred and ninety (290) questions reviewed to examine if they adhere to the uniformly accepted guidelines for writing multiple – choice questions. Of these, one hundred and fifty-one questions were already administered in examination so performance of distracters in those questions was also reviewed in addition to the guidelines for the construction of the questions.
38% of the reviewed questions did not adhere to general guidelines for their construction and 12% had more than one error. A placement bias was also observed in placing correct choices.
A number of flaws were identified in the review process which raises doubt about the use of objective test items as a true indicator of student learning. This review has led to changes in the assessment policy at Faculty level and Pre-examination reviews have been introduced to identify any flawed items before their administration in the examination. Regular series of workshops on item writing and item analysis have been arranged and a Faculty Teaching and Learning Grant were provided to create online resources on assessment.
KEYWORDS: Educational Assessment, Reliability of Results, Student Performance, Multiple Choice Questions.
- Zarrin Seema Siddiqui
- MD Education Unit, The University of Western Australia,Perth, Australia
CANDIDIASIS IN PERSPECTIVE OF PAKISTAN
Candidiasis is one of the common fungal infections. It is known as the disease of people with compromised immunity, that usually infects premature infants, elderly and hospitalized patients with co-morbids. Although a concise national data is unavailable on prevalence of candidiasis in Pakistan but few studies conducted in tertiary set ups have shown prevalence of albicans around 56-59%. WHO has labelled Pakistan having the highest global burden of candidemia (invasive candidiasis) which is exceedingly fatal. Few hospital-based studies displayed vaginitis as frequently occurring candidiasis, ranging from 18 to 38%.While the resistance against commonly used antifungal drugs varies from 34 to 61%. It is noticed that due to environmental variations fungal infections are increasing day by day but at national level no surveillance program has been developed so far. The current review was undertaken to highlight the issues related to incidence, causes, culture and sensitivity pattern of candidiasis in Pakistan and to identify the gaps in this domain. There is intense urge to formulate new drugs or alternative agents with better efficacy, safety and affordability to combat this slowly growing enemy (candida). Therefore, preventive steps should be taken to decrease its spread, especially in hospital settings which are the main harbor of these infections.
KEYWORDS: Fungi, Candidiasis, C. albicans, fluconazole
- Rabeea Rizwan
- Zahida Memon
- Shehla Shaheen
- Department of Pharmacology, Ziauddin University, Karachi.
AN OVERVIEW OF SALIVARY INTERLEUKIN-1 AS A BIOMARKER FOR PERIODONTITIS
Periodontitis is a chronic inflammatory condition characterized by destruction of the periodontal tissues resulting in loss of connective tissue attachment and alveolar bone, with formation of pathological pockets around the affected teeth. In recent times, salivary diagnostic tests are becoming popular as saliva is an easily accessible source for detecting several chemokines and cytokines related to various oral pathologies. Moreover, this may also help in detecting periodontitis before the appearance of clinical effects, after which treatment becomes difficult. Many cytokines and chemokines related to periodontal tissue destructionare found in saliva. Though majorly produced in gingival crevicular fluid(GCF), these chemicals eventually leech out to become part of the saliva. Interluekin-1 beta (IL-1β), generated through immune response is considered to be one of the most important cytokine that has detrimental effects on the periodontal tissues. This paper aims to convey an extensive overview regarding the role of salivary IL-1β in periodontitis.
- Dr. Zaeem Arif Abbasi
- Oral Pathology Department, Ziauddin College Of Dentistry, Ziauddin University
- Dr. Naila Hadi
- Pathology Department, Ziauddin College Of Medicine, Ziauddin University.
- Dr. Ayesha Tariq Niaz
- msc Trainee Oral Biology, Dow University Of Health Sciences.
CAESAREAN SCAR ECTOPIC PREGNANCY: A CASE SERIES
Rates of cesarean section (CS) are increasing globally; hence pregnancies with previous CS are also increasing at an alarming rate. This leads to increased complications in pregnancy such as morbidly adherent placentae, ruptured uterus and the rare complication of ectopic scar pregnancy. The aim of this case series is to highlight this serious complication and provide awareness to obstetricians. Early diagnosis and early treatment of cesarean scar ectopic pregnancies is essential to prevent maternal morbidity and mortality. Sonographic expertise is required to get the best results. Hemodynamically stable patients have many treatment options.
KEYWORDS: cesarean scar pregnancy, Ectopic pregnancy, uterine rupture
- Dania Junaid
- Shama Chaudhry
- Marium Usman
- Rubina Hussain
- Department of Obstetrics and Gynecology, Ziauddin University Hospital Karachi.
CRANIOSYNOSTOSIS: A CASE REPORT
Craniosynostosis has a prevalence of 1 in 2000 to 2500 live births. We report on a case of craniosynostosis managed surgically.
Method: A 2-year old male, case of craniosynostosis which presented to Ziauddin Hospital North Nazimabad OPD. This child had a history of multiple falls since the past 4 months for which sutures were required twice. His head circumference was above 95 percentile for his age. He was diagnosed as a case of trigonocephaly based on the findings of the 3D CT scan. He underwent surgical remodelling
Result: Patient was discharged after an unremarkable post-operative period.
Key words: Craniosynostosis, case report, remodeling
- Abdul Naveed Khan
- Consultant Neurosurgeon, Ziauddin Hospital North Nazimabad
- Zawwar Reza
- Mujeeb u Rehman
- Tehniat Abdul Khaliq
- Syed Hussain Ali Imam
- Maha Hasan Siddiqui
- Department of Surgery, Ziauddin Hospital North Nazimabad
A SURVEY OF PARTIAL EDENTULISM BASED ON KENNEDY’S CLASSIFICATION IN MAXILLARY ARCHES
The objective of this study was to determine the various patterns of partial edentulism of maxillary arch in patients seen at department of Prosthodontics, Dr Ishrat- Ul -Ebad Khan Institute of Oral Health Sciences Karachi.
The duration of the study was six months. Utilizing consecutive sampling technique, 527 patients were included. Partial edentulism pattern was recorded by visual examination using Kennedy’s classification after applying Applegate’s rules.
Class III dental arch was the most dominant pattern with class IV being the least in number. Kennedy’s Class III modification 1 was the most common modification encountered and location of modification was mostly involved posterior areas. With increasing age, there was a decrease in percentage of Kennedy’s class III and an increase in percentage of class I, class II and class IV patients. In present study gender had no significant effect on distribution of various Kennedy’s classification, whereas there was statistically significant association between age and pattern of partial edentulism.
The Kennedy’s class III was the most common pattern of partial edentulism irrespective of age and gender Key words: Partial edentulism, Kennedy’s classification, Modification, Maxillary arch
- Bharat Kumar
- Department of Prosthodontics,Dow International Dental College, Karachi.
- Asma Naz
- Department of Prosthodontics,Jinnah Medical & Dental College, Karachi.
- Haroon Rashid
- Department of Prosthodontics,Ziauddin University, Karachi.
PERCEIVED WEIGHT STATUS AND WEIGHT MANAGEMENT INTENTIONS OF ADULTS: A CROSS-SECTIONAL STUDY IN PAKISTAN.
To study the phenomena of weight misperception and to assess the intentions of weight management in the adult population of Karachi, Pakistan. Factors which lead to weight loss efforts will also be identified.
A cross-sectional study was conducted with a total of 450 male and female adults aged 20 to 60 years. Data was collected through purposive sampling technique. All participants had their weight and height measured and filled a questionnaire asking about perceived weight status. Data was analyzed using SPSS version 20. Chi square was used to form associations, with P value of less than 0.05 being taken as significant.
Based on body mass index (BMI), 13.3% of the participants were underweight, 54.9% were of normal weight, 25.3% were overweight and 6.4% were obese. Misperception was prevalent in 37.8% (40.3% in females versus 33.1% in males) of the subjects. 28% overestimated their weight and 9.3% underestimated their weight. About 46.7% of underweight, 17.6% of overweight and 31.7% of obese participants were not making any efforts about the discrepancy in their weight. 28% were trying to lose and 28.7% were trying to control their weight. The highest rated reason for this weight consciousness was ‘feeling better about myself’.
There was more weight misperception in females than males with a tendency of overestimation in females and underestimation in males. More females were trying to lose weight and more males were trying to gain it. A significant number of participants were making efforts that were not in correspondence with their weight status. Satisfaction about self was rated to be more important than health concerns.
- Sharmeen Sorathia
- Fatima Salman Anwar
- Tabish Rehman
- 5th year MBBS Student, Ziauddin University
- Syed Hasan Danish
- Farah Ahmad
- Department of CHS, Ziauddin University