- Original Article
- Review Articles
- Kap Study
- Case Reports
- Short Communication
- Student Corner
- Medical Education
The articles for the PJMD Volume 9 Issue 2 2020 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.
From Viral Vaccines to Messenger RNA Vaccines
Today, the swiftness of epidemics of infectious disease is alarming. To date vaccines have been an enormous success for not only preventing but completely eradicating a number of malicious infectious disease like small pox, rubella, mumps, measles and polio as well as decreasing the burden of diseases like tetanus, measles and diphtheria etc. Vaccination has been the hallmark of disease control for hundreds of years since it was first tested by English physician Edward Jenner in 1796 and further validated by Louis Pasteur through their work on smallpox vaccine.
- Saeeda Baig
- Department of Biochemistry, Ziauddin University,
- Zoha Asghar
- Student, Ziauddin University, Karachi, Pakistan.
Histopathological Spectrum of Premalignant and Malignant Lesions of Esophagus in the Population of Karachi
Squamous cell carcinoma (SCC) and adenocarcinoma are the most common esophageal cancers. Barrett’s esophagus is the change of esophageal stratified squamous epithelium to columnar cells which if remain undiagnosed follows the dysplasia – carcinoma sequence. The last two decades show a change in the histologic pattern of esophageal carcinoma. Adenocarcinoma is at majority rate than SCC in the West, however, in Asia, SCC is still the commonest cancer of esophagus. In this study, we aim to define a spectrum of premalignant and malignant neoplasms of esophagus in our region.
This study was done at Dow Diagnostic Research and Reference Laboratory (DDRRL). All the cases of preneoplastic and neoplastic lesions of esophagus received during the period of 7 years (2009-2015) were reviewed. The data obtained were subjected to descriptive statistical analysis using SPSS version 21.
Out of 94 premalignant cases, 70 (74.5%) were diagnosed as Barrett’s esophagus, 23 (24.5%) as dysplasia and 1 (1.1%) as adenoma. From the total of 450 malignant cases, 395 (87.7%) were SCC, 54 (12%) were adenocarcinoma and a single case of leiomyoma was diagnosed. Grade II SCC was found to be most the common lesion.
Barrett’s esophagus was more than dysplasia and showed male preponderance. SCC was the predominant esophageal cancer, which is similar to the other studies in our country. SCC was found more common in females than males and vice versa for adenocarcinoma. Majority of all the cases belonged to 41-60 years of age group.
Keywords: Squamous Cell Carcinoma; Adenocarcinoma; Precancerous; Leiomyoma.
- Asma Shabbir
- Department of Pathology, Sindh Medical College, Jinnah Sindh Medical University,
- Muhammad Asif Qureshi
- Nehad Khan
- Dow International Medical College, Dow University of Health Sciences,
- Talat Mirza
- Department of Research, Dr. Ziauddin Hospital and University, Karachi, Pakistan.
Protective Effect of Thyroxine on Minocycline Induced Thyroid Gland Damage
Thyroxine has shown beneficial effects on intelligence, learning, and memory process in patients of congenital hypothyroidism. Minocycline has been used in clinical practice for various indications and reported to have anti-thyroid effects. This study was specifically designed to observe the role of thyroxine on minocycline induced damage to thyroid gland.
This experimental study was undertaken at Anatomy department of BMSI, JPMC, Karachi, for eight weeks, from October to November 2019. Thirty adult (10-12 months) male guinea pigs, weighing from 450-650 gm were obtained and divided into 3 groups. Group A served as control, group B was given Minocycline 0.02mg/gram/day once daily and group C was administered Minocycline in similar amount as group B along with thyroxine 0.5µg/gram/day for the same duration. Dosing was continued for 8 weeks, at the completion of which all the animals were sacrificed. Thyroid gland was processed and tissue sections were stained with Haematoxylin and Eosin for morphology.
The absolute weight of thyroid gland was significantly increased (p<0.001) in minocycline treated group B animals compared to the control animals, whereas substantial decrease (p<0.01) in absolute weight of thyroid gland was witnessed in group C in comparison to group B animals. The follicular cells showed hypertrophy and shrinkage of colloid in the thyroid follicles. These changes were prevented when animals were co-administered with thyroxine and minocycline in Group C.
Concomitant administration of thyroxine with the antimicrobial drug minocycline showed protective effects of thyroxine on Minocycline induced damage to thyroid gland of animals.
Thyroxine; Minocycline; Thyroid Gland; Guinea Pig; Protective Effect.
- Naheed Gohar
- Department of Anatomy, Sir Syed College of Medical Sciences for Girls,
- Aisha Qamar
- Department of Anatomy, Bahria University Medical and Dental College
- Asma Siddiqui
- Tahira Assad
- Department of Pharmacology, Karachi Institute of Medical Sciences, Malir Cantt, Karachi
- Sahal Salman
Outcome of Single Dose Prophylactic Antibiotic in Carpal Tunnel Release Surgery
It has been well documented that administering a prophylactic antibiotic brings down the rate of postoperative wound infection very strikingly in carpal tunnel release (CTR) surgery. Carpal tunnel syndrome (CTS) is definitely a compressive neuropathy of the upper limbs, which is both benign and frequent. The study objective was to determine the postoperative wound infection rate in carpal tunnel release surgery after having administered a single dose of a prophylactic antibiotic.
This cross-sectional study was carried out at the department of Neurosurgery, Dammam Medical Complex-Saudi Arabia. The study was based on 122 patients who were operated for carpal tunnel release procedures at the centre. Pre-operatively all patients were subjected to nerve conduction studies (NCS) to document CTS as the definitive diagnosis. As a routine, every patient was administered intravenous loading dose of cefuroxime (1.5g) at least 1 hour prior to surgery. All patients were treated as day care cases and were discharged after a few hours of surgery. On discharge, no further antibiotics were administered. Their wounds were examined at three, ten and fourteen days. Suture removal was performed on the fourteenth postoperative day.
Superficial redness over the site of incision was noted in three of the patients and wound infection in two others. These two patients improved with oral antibiotics. Not a single patient needed re-exploration.
The current study showed that this is an efficacious and a very safe protocol to follow. Assuming the fact that the incidence of surgical site infection (SSI) in CTR surgery is low, the results were not different when compared to the results from other centres.
Prophylactic/Prophylaxis; Antibiotics; Carpal Tunnel Release Surgery; Infection; Carpal Tunnel Syndrome.
- Inayat Ali Khan
- Department of Neurosurgery, Dammam Medical Complex, Dammam, Saudi Arabia.
Diagnosis of Stage II Rheumatoid Arthritis through Functional Evaluation of Wrist and Hand among Adult Females
Rheumatoid arthritis (RA) is a commonly prevailing disease among women. Disease progression deformities such as ulnar and radial shift of the wrist, Boutonnière, swan neck deformity and mallet finger become evident, which results in marked limitation of hand function. Patients usually lose the ability to hold, grasp and pinch thus activities of daily living are compromised. This study aimed to diagnose stage II Rheumatoid Arthritis through assessing the limitations of hand functions in adult females.
A sample of 37 adult females with Stage II RA presenting to the rheumatology department of National hospital, Lahore and Combined Military Hospital, Lahore were recruited in the study. Patients with clinically diagnosed Stage II RA presenting with pain and dysfunction of the hands and wrist joints were included. Patients with any traumatic condition or any other bone disease that limits hand function were excluded from the study. The scale used for the assessment was Patient Rated Wrist/Hand Evaluation (PRWHE) with the reliability of >0.75 and validity of 0.7.
In a sample of adult women with a mean age of 42, 39% reported moderate pain and 61% had severe pain whereas the functional limitations was reported to be moderate in 47.3% while 52.7% had severe limitation of hand function. These results prove that there is a negative impact of hand malformations on hand function.
The adult females with stage II Rheumatoid Arthritis had severely limited hand function. The functional limitations of hand were increased with disease progression especially in adult females.
Functional Limitations; Patient Rated Wrist/Hand Evaluation; Rheumatoid Arthritis.
- Sana Saleem
- Maleeha Fuad
- Samreen Sadiq
- Hafiz Muhammad Asim
- Lahore College of Physical therapy, Lahore Medical and Dental College, Lahore, Pakistan.
Agreement between Two Commonly Used Pulp Tests in Determining Pulp Vitality
The pulp tissue is confined within hard tissue boundaries and cannot be examined directly for health evaluation. Hence, its assessment is usually based on sensibility tests. Accurate diagnosis of the pulpal status requires evaluation with combination of sensibility tests. The objective of this study was to assess the mutual agreement between the electric pulp test and cold test in determining pulp vitality.
Total 106 patients, aged 18 to 30 years, attending the dental OPD of Operative Dentistry/Endodontics department; Dr. Ishrat-ul-Ibad Institute of Oral Health Sciences, Karachi were selected for the study. The cold and electric pulp tests were used to determine the presence or absence of tingling sensation. Teeth were marked as vital in presence and non-vital in absence of any tingling or painful response. Agreement between these two tests was calculated using SPSS-18. To calculate the mean and standard deviation, descriptive statistics were applied for quantitative variables. For qualitative variables, frequencies and percentages were calculated. Kappa statistics was applied for agreement between electric pulp and cold test.
The cold test showed that 70.8% of the teeth were vital and 29.2% were necrotic. The electrical pulp test showed that 74.5% were vital and 25.5% were necrotic. The outcome showed 83.0% agreement between the tests; with kappa value of 0.574 which provided sufficient agreement with p-value=0.000.
There was a high agreement found between the cold test and electric pulp test. Assessment of pulp vitality would be more accurate when EPT and Endo frost are used in combination.
Pulp Vitality; Electric Pulp Testing; Thermal Testing; Cold Testing.
- Tazeen Zehra
- Juzer Saifee
- Department of Operative Dentistry, Liaquat College of Medicine and Dentistry,
- Fazal-Ur-Rehman Qazi
- Shehbaz Ahmed Jat
- Department of Operative Dentistry, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences/ DUHS,
- Yawar Ali Abidi
- Department of Operative Dentistry, Sindh Institute of Oral Health Sciences, JSMU,
- Saima Khalili
- Department of Operative Dentistry, Hamdard College of Medicine and Dentistry, Karachi
Factors Inﬂuencing Cervical Spondylosis
Cervical spondylosis is a degenerative disorder of cervical spine prevalent in our population. The disease advances insidiously that worsens with time. This study aims to highlight the factors influencing cervical spondylosis.
The present case control study was conducted at orthopedic OPD (Out Patient Department) and Radiology department of the Patel hospital from September 2018 to February 2019 after acquiring ethical approval from Ethical Review Committee (ERC) of Bahria University Medical and Dental College and Patel Hospital. The study enrolled 88 cases suffering from cervical spondylosis based on history and clinical examination and 88 controls i.e., healthy attendants. The radiography of cervical spine was used to assess degenerative changes of cervical spine. They were asked basic history entailing age, gender, working hours, nature of job, use of computers, mobiles. The independent t-test was used for comparison between these variables, and Fischer exact test and Chi square test was employed to find association between them.
The study revealed a significant preponderance of females (56.8%) with shorter stature (159.14±8.88) in patients. There was a predilection for cases in outdoor workers (44.3%) and homemakers (43.2%) as well as increased working hours (73.9%). The mobile use had a significant impact (59.1%) on disease.
Considering factors like Middle Ages, females, short stature, obesity, outdoor workers and house workers with increased working hours and use of mobiles for more than 4 hours can influence development of cervical spondylosis. One can intervene in the progression of disease by adopting healthy lifestyle to prevent it.
Cervical Spondylosis; Cervical Radiculopathy; Myelopathy; Neck Pain; Body Height; Spine.
- Syeda Bushra Ahmed
- Aisha Qamar
- Ayesha Saba Naz
- Department of Anatomy, Bahria University Medical and Dental College
- Iffat Raza
- Department of Anatomy, Karachi Institute of Medical Sciences
- Muhammad Fawad Saeeduddin3,
- Department of Research, Jinnah Sindh Medical University,
- Sarwath Fatimee
- Department of Anatomy, Fatima Jinnah Dental College, Jinnah Sindh Medical University, Karachi, Pakistan
Effectiveness of Nebulized Magnesium Sulphate as an Adjuvant Therapy (With Salbutamol) in the Management of Acute Asthma
Although the treatment of acute asthma in the emergency department varies, the administration of magnesium sulfate (MgSO4) is usually recommended adjacent to corticosteroids and bronchodilators. This study aims to ascertain the influence of inhaled MgSO4 as complement treatment with salbutamol regarding treatment of urgent asthma exacerbations.
A single-blind randomized control study was carried out, from 1st January 2017 to 30th June 2017, involving asthmatic patients presenting to Ziauddin Hospital and Jinnah Hospital in Karachi, with severe acute asthma exacerbations. The Sealed Envelope calculator was used to calculate a sample size of 84 patients, and data was collected through non-probability consecutive sampling. Both batches were administered salbutamol and ipratropium, with Batch A patients also receiving nebulization with MgSO4. Dyspnea, respiratory rate, pulse, peak expiratory flow rate, and oxygen saturation were recorded for each participant. An independent sample t-test was used to assess the effectiveness of MgSO4, as a significant means of improving asthma treatment, with a p<0.05 interpreted as significant.
A sum of 115 patients was included in the research, out of which 63.5% had a family history of asthma. Treatment with MgSO4 was seen as significant (p<0.01). MgSO4 administration showed significant improvement in mean pulse rate (p = 0.001), peak expiratory flow rate (p = 0.004) and mean respiratory rate (p = 0.003), as compared to treatment with salbutamol only. Conclusion: Treatment outcomes between the two groups differed significantly. Intervention with MgSO4 showed significant improvement in pulse rate, respiratory rate, dyspnea, and peak flow, without any observed side effects.
Asthma; Magnesium Sulfate; Dyspnea; Expiratory Peak Flow Rate.
- Gul Ahuja
- Department of Emergency Medicine, Dr. Ziauddin University Hospital
- Ashok Kumar
- Maryam Ali Gohar
- Department of Pulmonology and MICU, Dr. Ziauddin University Hospital
- Uzma Ghori
- Department of Internal Medicine, Dr. Ziauddin University Hospital
- Maheen Nisar
- Vanita Motiani
- Student, Ziauddin University, Karachi, Pakistan
Frequency of HIV in Patients with Central Nervous System Tuberculosis
Tuberculosis (TB) is the most widely recognized reason for death in patients of acquired immune deficiency syndrome (AIDS). Human Immunodeficiency virus (HIV) and AIDS continue to be on an increase in Pakistan. This study aimed to assess the magnitude of HIV among patients with Central nervous system (CNS) tuberculosis as its progression to AIDS significantly influences mortality in these patients. The main objective of the study was to determine the frequency of HIV among patients with CNS tuberculosis.
This Cross-Sectional study was conducted at Medicine Wards of Civil Hospital, Karachi from 7th October 2016 to 7th April 2017. A total of 140 newly diagnosed Central Nervous System tuberculosis patients were included. Blood sample collected for HIV test (ELISA) was interpreted as either: Reactive for HIV or Non-reactive for HIV. HIV infection was considered as HIV positive by using 3 Rapid Diagnostic testing kits according to guidelines of World Health Organization (WHO). All the patient data were collected through a pre-designed proforma. Data were analyzed using SPSS v.23.0. Chi-square test was applied post stratification with p- value≤0.05 taken as statistically significant.
Sixteen patients (11.43%) of CNS tuberculosis were found to have HIV positive results. Out of total 140 patients, 50(35.71%) were female and 90(64.29%) were male. The average age of the patients was 39.37±12.8 years.
CNS tuberculosis can be the primary clinical manifestation of HIV positive patients. Early recognizable proof of HIV in patients with CNS tuberculosis may warrant early inception of anti-HIV treatment.
Human Immunodeficiency Virus; Tuberculosis; Meningitis; Mycobacterium Tb.
- Lubna Shafi
- Wishhal Sundar
- Ammna Qazi
- Rashid Qadeer
- Dr. Ruth K.M. Pfau Civil Hospital Karachi,
- Department of Nephrology, Jinnah Post Graduate Medical Center Karachi,
- Ahsan Ashfaq
- Department of Physiology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Patterns of Suicidal Poisoning Cases in Three Tertiary Care Government Hospitals in Karachi, Pakistan
Suicidal attempts are a global problem and their rate of incidence is increasing day by day. This study aimed to elucidate the patterns of suicidal poisoning cases presenting in three tertiary care government hospitals of Karachi, Pakistan.
In this retrospective observational study, past data records of 627 suicidal (poisoning) cases of the three tertiary care hospitals of Karachi from a period of January 2016 to December 2016 were evaluated to see patterns of suicidal cases. Data was analyzed using SPSS version 25.0 via Chi-squared test.
Majority of the cases (36.4%) belonged to the 9-25 years’ age group. Mean age of the cases was 25.31 ± 9.92. Females (57.3%) considerably outnumbered males (42.7%). The greatest number of cases reported was from Southern district of Karachi (23%) followed by West (21.5%), central (20.9%) and East (11%) reported mainly at Jinnah Postgraduate Medical Centre. The most common poisoning agent used for suicidal attempts was insecticide (40.2%), followed by rodenticide (19.9%). Majority of patients were examined on the same day of attempting suicide (95.5%), majority were in conscious state (76.2%). Admission record for most cases was unmentioned. (66.3%)
Majority of the cases presented at three tertiary care government hospitals who attempted suicide were young female adults mainly from South district of Karachi followed by West, Central and East Karachi. Pesticides, specifically, insecticides and rodenticides, were the most commonly used poisoning agents used for suicide. Majority of cases were brought at Jinnah Post Graduate Medical Centre in the conscious state.
Suicide; Insecticides; Pesticides; Tertiary Care Hospital.
- Lubna Riaz
- Department of Forensic Medicine, Dow Medical College,
- Riaz Ahmed Shahid
- Department of Physiology, Dow Medical College,
- Ashhad Mazhar Siddiqi
- Department of Anatomy, Dow Medical College,
- Muhammad Rameel Riaz
- Mahreen Umer Zubair
- Abdul Rafay Shaikh
- Ansarullah Khan
- Raazia Maryam
- Student, Dow Medical College,
- Ramsha Riaz
- Internal Medicine, Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan.
Change in Post Partum Family Planning Behaviour Observed in Pakistani Men and Women in a Squatter Settlement in Karachi: A Pre-Post Observational Study
Unfortunately, in Pakistan, there are many myths associated with family planning practices hence general reluctant perception of couples is observed especially just after childbirth. In fact, post partum is the most vulnerable period to discuss contraception. In our study, we aimed to see the change in post partum contraceptive behaviours after thorough counselling to individuals in a squatter settlement in Karachi, Pakistan.
This is a pre-post observational study done from September 1st 2018 until November 15th 2018 in a squatter settlement in Sikanderabad Karachi. A total of 1023 subjects, both males and females of reproductive age group were recruited in the study. The base line knowledge was assessed by using pre-prepared extensive questionnaire adapted from Best Paper Practice (BPP) PPFP (Post Partum Family Planning) Royal College of Obstetrics and Gynaecology (RCOG) about contraceptive behaviours, after taking informed consent and providing privacy. After filling the pre-test forms, an awareness talk describing the advantages and disadvantages of all methods of contraception currently available in Pakistan, was discussed in detail. Data was analyzed using SPSS 20 filled a post-test questionnaire consisting of the same questions. Mc-Nemar’s test was used to see the difference in the pre and post questionnaire. p-value <0.05 was considered significant.
Knowledge of use, side effects and efficacy of all the contraceptive methods was enhanced considerably post session showing statistically significant results (p-value <0.00).
It is clearly seen that giving contraceptive education helped couples to choose the appropriate contraceptive method to give birth spacing.
Obstetrics; Gynaecology; Contraception; Progesterone
- Fatima Jehangir
- Madiha Ahmed Usmani
- Saima Ghouri
- Department of Family Medicine, Ziauddin Medical College,
- Rubina Hussain
- Shazia Sultana
- Department of Obstetrics and Gynaecology, Dr Ziauddin Hospital, Karachi, Pakistan.
Tele-rehabilitation versus Face To Face Rehabilitation after Knee Joint Replacement
Joint substitution of lower limbs like hip and knee replacements are viewed as a high volume surgery with great achievement rates and physical restoration assumes a significant role in recovery of these patients. However, access to recovery and follow up is restricted. Post joint substitution patients living in remote territories and those with the danger of joint dislocation find difficulty to recovery benefits once they are released from emergency clinic. Access issues produce extra burden. The purpose of current study was to evaluate whether telerehabilitation performed from a health center to patient’s place after discharge from hospital among knee replacement was practically effective as alternative treatment.
A quasi-experimental study was conducted on 50 post total knee replacement patients for a period of 6 months at Ghurki hospital. Patients were divided into two groups. Group A received telerehabilitation. Group B received face to face rehabilitation for 2 months. Ranges, muscle strength and functional status were measured through goniometer, manual muscle testing and timed get up and go test. Assessment was done using Fischer exact test at baseline, after 2 weeks and followed up after 2 months.
p-value for knee flexion came out to be 0.03 where as for quadriceps it was 0.02 after 2 weeks, which was found to be statistically significant. After 2 months, p-value for knee flexion was 0.016 and 0.000 for functional status.
Use of telerehabilitation is found to be equally effective as compared to face to face rehabilitation among knee replacement patients.
Knee Arthroplasty; Standard Rehabilitation; Telerehabilitation; Knee Replacement.
- Samreen Sadiq
- Hafiz Muhammad Asim
- Lahore College of Physical therapy, Lahore Medical and Dental College
- Ashfaq Ahmad
- Arooj Fatima
- Institute of Physical Therapy, the University of Lahore,
- Iqra Khan
- Bakhtawar Amin Medical and Dental College,
- Amer Aziz
- Department of Orthopedic, Ghurki Trust and Teaching Hospital, Lahore, Pakistan.
Emotional Intelligence may have Association with Blood Groups
Emotional intelligence (EI) can be described by means of capabilities possessed by a person to recognize feeling, and to manage emotions. For instance, active types of blood are O and B i.e. they are (belligerent and developing) On the other hand blood types A and AB are submissive i.e. (unchanging and unprogressive). The study aimed to find out the association between emotional intelligence and blood groups.
A cross sectional study was carried out on 184 male and female students of a private university, Karachi. Blood group of these subjects was determined by using hematological and aseptic techniques and samples were collected through finger prick method acknowledged by the students. Results were recorded by applying the Fisher’s exact test and one way ANOVA to see the significance.
Self-awareness having highest mean score in O- group 17.00±1.00 with p-value of 0.011. In empathy blood group A+20.20±3.22 and O- 20.00±1.73 achieved highest mean values with p-value of 0.000, self-motivation level also got highest mean score in O- group 23.67±3.51with p-value of 0.035, managing relations level was highest observed in O- group 17.00±1.73 with p-value of 0.001. In addition, altruistic behavior found positive in O- blood group 8.67±0.58 with significant p-value of 0.000 among all students.
Blood groups were identified significantly with different emotional intelligence level. The students having blood group O found to be more emotionally intelligent. However, large-scale studies are required in different parts of the world to explore the new aspects.
Emotions; Empathy; Intelligence
- Saif Ullah Shaikh
- Samina Mohyuddin
- Department of Physiology
- Muhammad Faisal Fahim
- Department of Physical Therapy Bahria University Medical and Dental College, Karachi, Pakistan.
Kras Diagnosing the Little-Known Cancers Oncogene through Liquid Biopsy: Review
Tissue biopsy, till date, is a gold standard for tumor diagnosis, grading, treatment, and detecting genetic evidences for identifying appropriate personalized treatments. However, it is painful, invasive, expensive, and risky making sequential biopsies basically impractical. Detection of Kras genes through liquid biopsy is the growing theragnostic technique, which is more sensitive, specific, much cost-effective and quick method for detecting the mutational status of cancers. Liquid biopsy detects biomarkers present in various body fluids, such as plasma, urine, saliva and cerebrospinal fluid, harboring cancer degraded fragments and cells shed by carcinoma such as circulating tumor cells, microRNA and circulating tumor DNA. It can be utilized as a pre-screening test for initial stage cancers also where multiple sampling is required for monitoring cancer therapies. Kras is the most extensively mutated cancer oncogene involve in altering the downstream signaling pathways, increasing oncogenic signaling, which is typically associated with poor prognosis and resistance to therapy. This review was conducted to clarify its prognostic significance as well as its mutational role in different carcinomas. To identify studies related to Kras mutation Medline, PubMed, Google Scholar and Web of Science search engines were explored and forty two relevant researches were finalized from year 2005 to 2019.
Kras Gene; CfDNA; Liquid Biopsy; CtDNA.
- Hafiz Syed Mohammad Osama Jafri
- Saeeda Baig
- Shamim Mushtaq
- Department of Biochemistry, Ziauddin University
- Jawed Malik
- Department of Oncology, Ziauddin University
- Sabra Siraj
- Department of Oral Biology, Dow University of Health Sciences, Karachi, Pakistan
A Review on Outcomes of Distal Radius Fracture Treated With Different Modes of Treatment and Rehabilitation
Fractures around wrist joint are common complication happening after fall on an outstretched hand. It is more common in female, and mostly in age above 55 years. Different methods of treatment has been established such as surgical and conservative management, each mode of treatment has its own complication such as, pain, stiffness, swelling, deformity, infection. Non operative treatment include splinting or casting with or without reduction, operative treatment includes percutaneous k-wiring, external fixator for complex fracture or fracture with open wound, open fixation with volar or dorsal plate. Still there is controversy that what method is better in getting the good functional outcome, minimizing the duration of cast immobilization, early fixation, and early start of rehabilitation. All of them play part in better functional outcome. In the past manipulation and fixation without opening the fracture site has been the choice of treatment, comparatively in recent advances fixation with plate through anterior approach is a preferred option because it has less complication rate, plays better role in early range of movement. The information was retrieved from reliable search engines e.g. PubMed, Medline, Google scholar and others, through original research papers and reviews from2003 to 2019. Purpose of this study is to know which method of management has better outcome and its role in early rehabilitation.
Fracture; Radius; Rehabilitation; Casting; External Fixator.
- Asad Aziz
- Aqeel Ahmed Memon
- Idress Shah
- Imtiaz Hashmi
- Sohial Rafi
- Department of Orthopedics and Spine Surgery, Dr. Ziauddin University Hospital, Clifton, Karachi, Pakistan.
Role of PD-L1 in Oral Cancer: From the Perspective of Immuno-oncology
Oral cancers are prevalent in our region and their management requires an upgrade in terms of advanced techniques. Immunotherapy is a novel therapeutic approach across the world that has shown significance in the sphere of oncology. Tumor cells escape detection from the immune surveillance mechanism resulting in proliferation. Through cancer immunotherapy, body’s own immune defense mechanism is stimulated with the aid of immunomodulating drugs. Scientists are underway studying the tumor microenvironment where immune editing takes place resulting in tumor escape and evasion. Many immune checkpoint proteins are being studied for clinical implications, however, the immune checkpoint blockade of Programmed death ligand-1(PD-L1) has proven to be successful and FDA approved in certain tumors. Role of increased expression of PD-L1 in oral cancer has been explored with variable results. Most researches have related it with tumor progression and prognosis. This review focuses on the importance of PD-L1 as an emerging immune checkpoint inhibitor, emphasizing its expression in cancers, particularly in oral cancer. The information was retrieved from reliable search engines e.g. PubMed, Medline, Google scholar and others, through original research papers and reviews published hitherto, from 2010-2019. It is essential to explore advanced treatment modalities for oral cancer especially via immunotherapy. Furthermore, additional studies on PD-L1 expression in OSCC are required including standardized protocols to reach definitive conclusions for clinical implications.
Oral Squamous Cell Carcinoma; Programmed Death Ligand- 1(PD-L1), Immunotherapy, B7 Protein.
- Moomal Aslam Khan
- Saima Akram Butt
- Department of Pathology, Ziauddin University, Karachi, Pakistan.
Frequency of Regular Voluntary Blood Donors and Factors Associated with Blood Donation in Karachi, Pakistan
Regular voluntary unpaid blood donation assures safe blood supply in association with minimum infection transmission. The purpose of this study was to identify the frequency of regular voluntary blood donation and to evaluate the causes of donating blood as well as factors impeding blood donations among the medical and nonmedical students of Karachi.
A comparative cross sectional study was conducted among medical and nonmedical students of JSMU and NED University respectively from May to October 2018. Sample size was 272 including 137 medical and 135 non-medical students. Data was analyzed using SPSS version 22.0. Chi-square test of independence/ Fischer’s exact test were applied to assess statistical significance.
In medical group 5/21(23.8%) voluntary regular donors were recorded. In non-medical group, voluntary regular donors were found to be 8/30 (26.6%) (p>0.00). Medical students most commonly 15/21 (71.4%) donated blood voluntarily in a camp while non-medical participants frequently donated blood as replacement donors 13/30 (43.3%) (p>0.00). Major hindering factor for blood donation in both study groups was non-participation in blood donation derives i.e. 66/116 (56.8%) in medical and 53/105 (50.4%) in non-medical groups respectively. Anemia, 20/116 (17.2%) in medical and 15/105 (14.2%) in nonmedical students was the second major cause of not donating blood.
The frequency of regular voluntary blood donations is very low among undergraduates. However, comparatively, the trend is slightly higher among non-medical group. The major hindrance in not donating blood was non-participation in blood donating derives.
Blood Donation; Blood Donors; Medical Students; Anemia; World Health Organization (WHO).
- Rabisa Batool
- Nazish Jaffar
- Syeda Ramsha Batool
- Insia Hasan
- Suresh Klanghani
- Suresh Kumar
- Department of Pathology, Sindh Medical College (SMC), Jinnah Sindh Medical University,
- Rubina Ghani
- Department of Biochemistry, Jinnah Medical and Dental College, Karachi, Pakistan.
The Nature and Frequency of Medical Emergencies in Dental Ofﬁces of Karachi, Pakistan
Medical emergencies are an unfortunate part of the dental practice, to which the dentist must have the required knowledge and means to counter them. In this study, we aimed to determine the nature and frequency of medical emergencies occurring in the dental offices of Karachi, Pakistan. We also aimed to ascertain the awareness and preparedness of dentists and their attitude towards training in management of these medical emergencies.
In this study, 300 questionnaire forms were distributed to dentist at various colleges in Karachi city in the year 2015, out of which 244 complete and valid forms were received and used, giving a response rate of 81%. SPSS version 16.0 was used to compute and analyze the collected data.
Out of 244 respondents, 23% were males and 77% were females. Since, 83% of the dentist had faced a medical emergency at least once in their practice. Highest recorded medical emergency was found to be syncope (faints) being reported by 71% of the dentist. Most of the medical emergencies (89%) took place during an extraction procedure. 55% dentist claimed that they were prepared enough to manage an emergency. Irrespective of their perceived abilities, 100% showed keen interest in the field of improvement through continuing education in management of medical emergency.
Medical emergencies are common in dental practice and a substantial proportion of dentists feel incompetent in handling such situations. This requires better medical emergency management courses and training in undergraduate dental programs as well as continued dental education and training.
Awareness; Dentist; Dental Office; Emergency Treatment; Medical Emergencies.
- Ayesha Tariq Niaz
- Jaffar Zaidi
- Department of Oral Biology, Dow University of Health Sciences,
- Zaeem Arif Abbasi
- Department of Oral Pathology, Ziauddin University, Karachi, Pakistan
Papillon-Lefèvre Syndrome: Detrimental Periodontal Condition in the Affected Individuals
This paper aims to highlight the detrimental periodontal condition in patients with Papillon-Lefèvre syndrome (PLS) and the pivotal role of a Periodontist in the diagnosis of the condition. PLS is also known as palmo-plantar keratosis (PPK) with an unusual periodontal status. Uncontrolled early-onset periodontitis, which affects both primary and permanent dentitions alike, is a hallmark of the syndrome. PLS patients exhibit defected neutrophil chemotactic function due to substandard activity of Cathepsin C (CTSC) gene. The result is the failure of elimination of periodontal pathogens that leads to severe periodontal destruction. We report a case of an 11 years old Pakistani girl affected with PLS whose parents are consanguineously married. Since PLS is a rare autosomal recessive disorder and multiple consanguinity in a family, increases the risk of the occurrence of the syndrome in the off springs, the case report also highlights the importance of pre-marital genetic mapping and conception counseling for the families.
Papillon-Lefevre Disease; Cathepsin C; Periodontitis; Palmoplantar keratosis.
- Ayesha Hanif
- Zaheer Hussain Chachar
- Department of Periodontology, Ziauddin College of Dentistry
- Haroon Rashid Baloch
- Department of Prosthodontics, Ziauddin College of Dentistry, Karachi, Pakistan.
Identiﬁcation of Precompetitive Anxiety among Professional Footballers: A Cross-Sectional Study in Pakistan’s Context
Precompetitive anxiety refers to an indistinct but unrelenting feeling of uneasiness and dread in hours prior to the competition. Precompetitive anxiety has been shown to affect an athlete at various levels including match performance, sporting injuries, rehabilitation of sports injuries, return to activity and risk or re-injury. It has become a common practice to differentiate between the two common forms of anxiety. Therefore, the purpose of current study was to assess precompetitive anxiety in footballers of Pakistan.
A descriptive cross section survey was conducted on 58 male footballers aged between 18-26 years. The data was collected from Pakistan football federation club and Fame football club. Total 34 footballers were assessed at the Pakistan football federation club and 24 at the Fame football club. The sampling strategy utilized was non-probability convenience sampling. The study was conducted over a period of 6 months from July 2018 to January 2019. Competitive state anxiety inventory was used to assess precompetitive anxiety 1 hour preceding the competition. Data analysis was carried out using Statistical Package for Social Sciences version 21and results were presented in the form of frequency and percentages.
Out of 58 participating footballers, 44.8% (n=26) reported moderate levels of somatic state anxiety, 72.4% (n=42) reported moderate levels of cognitive state anxiety and 48.3% (n=28) reported moderate levels of self-confidence.
The study concluded that moderate to low levels of somatic state anxiety, moderate levels of cognitive state anxiety and moderate to high levels of self-confidence were present in majority of participating footballers.
Anxiety; Footballers; Precompetitive state.
- Rija Kamran
- Muhammad Nouman Tabassum
- Hafiz Muhammad Asim
- Samreen Sadiq
- Lahore College of Physical therapy, Lahore Medical and Dental College
- Waqar Ahmad
- COMSATS University Lahore, Pakistan.
Assessing Knowledge of Zika Virus and a need for Continuous Medical Education (CME) in Post-Graduate Doctors of a Tertiary Care Hospital: A Single Center Experience
The 2015-2016 Zika Virus Outbreak caused global concern. A study was done to assess knowledge about viral hemorrhagic fevers amongst healthcare professionals, which found only 57% doctors knew clinical features of hemorrhagic viral fever. The aim of this research was to assess the knowledge of physicians as well as the need for continuous medical education.
A cross-sectional study was conducted on doctors working or undergoing postgraduate training in a private tertiary care hospital. A sample size of n=91 was reached after including most of the doctors working in these hospitals in the department of medicine, pediatrics, gynecology and obstetrics. Data was collected through self-administered questionnaire. Convenience sampling technique was employed. Informed oral consent was taken before administration of questionnaire. Analysis was done on SPSS version 20.
The doctors included in the study were from the departments of internal medicine, which were 46.2% (42), pediatrics, which were 19.8% (18), and gynecology and obstetrics. Only 17.6% (n=16) participants knew that the Zika virus can affect pregnant women in any trimester. If pregnant woman is infected only 65.9% (n=60) of all doctors were aware of the fact that it can cause microcephaly in the infants. Thus, 44% (n=40) of the participants demonstrated correct knowledge that Zika virus is associated with the Guillain-Barré syndrome (GBS).
Our study determined that although many doctors demonstrated good knowledge regarding the clinical features of Zika virus, they had poor knowledge regarding the prevention of spread of disease.
Zika Virus; Epidemic; Knowledge; Doctors.
- Zawwar Reza
- Abdul Ahad Sohail
- Mujeeb U Rehman
- Syed Fahad Ali Kazmi
- Mahad Amjad
- Cardiothoracic Surgery Department, Aga Khan University Hospital, Karachi, Pakistan.
Inﬂuence of Next-Generation Sequencing on Advancements in the Diagnosis of Major Psychiatric Diseases – A Review
Rapid progress is being made in the development of next-generation sequencing (NGS) technologies, allowing repeated findings of new genes and a more in-depth analysis of genetic polymorphisms behind the pathogenesis of a disease. In a field such as psychiatry, characteristic of vague and highly variable somatic manifestations, these technologies have brought great advances towards diagnosing various psychiatric and mental disorders, identifying high-risk individuals and towards more effective corresponding treatment. Psychiatry has the difficult task of diagnosing and treating mental disorders without being able to invariably and definitively establish the properties of its illness. This calls for diagnostic technologies that go beyond the traditional ways of gene manipulation to more advanced methods mainly focusing on new gene polymorphism discoveries, one of them being NGS. This enables the identification of hundreds of common and rare genetic variations contributing to behavioral and psychological conditions. Clinical NGS has been useful to detect copy number and single nucleotide variants and to identify structural rearrangements that have been challenging for standard bioinformatics algorithms. The main objective of this article is to review the recent applications of NGS in the diagnosis of major psychiatric disorders, and hence gauge the extent of its impact in the field. A comprehensive PubMed search was conducted and papers published from 2013-2018 were included, using the keywords, “schizophrenia” or “bipolar disorder” or “depressive disorder” or “attention deficit disorder” or “autism spectrum disorder” and “next-generation sequencing”
Gene Polymorphism; Next-Generation Sequencing; Genome Wide Association Study; Psychiatric Diagnosis.
- Maheen Nisar
- Areeba Shaikh
- Erum Mir Ghazi
- Ailiya Haider
- Duaa Nini
- Student, Ziauddin University, Karachi, Pakistan.
Perspective of Medical and Dental Undergraduates towards Complementary and Alternative Medicine
The prevalent use of complementary and alternative medicine (CAM) requires health professionals including doctors and dentists having the essential knowledge to have better recommend their patients. This has lead to an increased need for integration of CAM teaching at the undergraduate level. Thus, the purpose of the study was to assess the perspective of complementary and alternative medicine among Pakistani medical and dental undergraduates.
A questionnaire based cross sectional survey was conducted among first to fifth year undergraduate medical and dental students at Sindh Medical College and Ziauddin University in Karachi, during April until May 2019, using a structured 13-item questionnaire. Descriptive statistics were calculated for baseline characteristics. Frequency and proportions were calculated for categorical variables using SPSS version 20.
The response rate was 100% (40.7% for males and 59.3% for females). The mean age of medical and dental students was 20.5±1.39 years. Almost three-fourth of students (75.1%) had the knowledgeof CAM. The most experienced CAM modality amongst all was Yoga (23.4%) and Homeopathy (20%). Nearly 69.4 % of students believed that CAM is beneficial for medical and dental healthcare and 44.1% students will recommend CAM to their patients in future. Almost 39% of students think that CAM should be included into undergraduate medical and dental curriculum.
This study showed an encouraging interpretation of both medical and dental students regarding CAM knowledge and benefits. Majority of the students have optimistic attitude towards CAM practice in future and for the integration of CAM studies at undergraduate level.
Complementary; Alternative Medicine; Medical; Dental; Undergraduates; Perspective; Knowledge.
- Fizza Saher
- Department of Oral Biology, Ziauddin Dental College, Ziauddin University
- Jabbar Ahmed Qureshi
- Department of Pharmacology, Ziauddin Medical College, Ziauddin University
- Zohaib Jawed Abubakr
- Muhammad Muaz Abbasi
- Ahmed Jamshed
- Muhammad Taha Sohail
- Student Ziauddin Medical College, Ziauddin University, Karachi, Pakistan