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Background: Psoas abscess is a rare condition but one with potential for severe morbidity. Many factors may be implicated in the treatment outcome of the condition and efforts must be directed to identify, understand and control the factors for a better prognosis. Objective: To identify the factors associated with surgical treatment outcome of psoas muscle abscess. Methodology: This descriptive cross-sectional study was conducted upon a sample of 58 patients (chosen via non-probability, consecutive sampling) scheduled for surgical treatment for psoas muscle abscess (aged 18 to 60 years) at department of General Surgery at Liaquat University Hospital, Hyderabad & Jamshoro. All the patients underwent surgical treatment. The data was recorded via pre-structured questionnaire comprising of inquiries pertaining to socio-demographic details, presenting complaints, and factors association with surgical treatment outcome (in terms of resolution of abscess cavity). Data was analyzed via SPSS version 20. Results: Mean age of study subjects was 37.6 ± 12.5 years. Out of all 72.4% were males and 27.5% were females. Most common presentation of patients was pain in flanks, followed by fever. The commonest etiological factor was tuberculosis (TB) and consequently spinal (TB) was the most common. Resolution of abscess cavity was noted among 77.5% of the cases with a greater proportion of recovery falling in line non- tuberculous etiology. Conclusions: After careful consideration, it can be concluded that secondary psoas muscle and that with tuberculous etiology have a poorer surgical outcome, thus greater care and more effective surgical techniques may be employed to achieve complete resolution of abscess.

Chronic hyperglycemia in Type 2 Diabetes Mellitus (T2 DM) is associated with ongoing damage, dysfunction, and failure of many organs, particularly the eyes, kidneys, nerves, heart, lungs, blood vessels and the diabetic patients may have considerable reductions in lung functioning. Diabetes Mellitus, Peak Expiratory Flow, and Fasting Blood Sugar are some of the terms used in this study. One hundred T2 DM patients, ranging in age from 30-70 years old and of either gender, were submitted to spirometry, vital parameters were recorded, glycated hemoglobin (HbA1c) and fasting blood sugar (FBS) were evaluated, and healthy controls were a matched. Diabetics forced vital capacity (FVC) ranged from 1.51 to 4 (Liters) with a mean of 2.4 ±0.6SD, whereas controls' FVC ranged from 2.2 to 4.74 with a mean of 3.14 ±0.7SD and a significant P value. (P

Gentamicin is an important member of the aminoglycoside class of antibiotics having broader spectrum with extend to ototoxicity and nephrotoxcity. A reliable and accurate high performance liquid chromatography (HPLC) procedure was established using Agilent Zorbax Eclipse plus phenyl hexyl C18 (4.6 × 250 mm, 5 μm) column and UV detection at 330 nm. Recovery of gentamicin from biological and pharmaceutical samples was more than 95-98% after spiking the drug. The sensitivity of method is predicted by calculating a lower level of the limit of detection and lower limit of quantification (0.286 and 0.867 μg/mL, respectively. The procedure was used to quantify gentamicin in biological fluids and pharmaceuticals dosage form.

Background: Cognitive impairment is common and disabling in Parkinson’s disease (PD). Cognitive testing can be time consuming in the clinical setting. One rapid test to detect cognitive impairment in non-PD populations is the Clock Drawing Test (CDT), which calls upon the brain’s executive and visuospatial abilities to draw a clock designating a certain time. Objective: Test the hypothesis that PD participants would perform worse on CDT compared to controls and that CDT would correlate with other measures of cognition. Methods: This study evaluated two independent CDT scoring systems and differences in CDT performance between PD (N = 97) and control (N = 54) participants using a two-sample t-test. Pearson’s correlations were conducted between the CDT and tests of sleepiness (Epworth Sleepiness Scale) and vigilance (Psychomotor Vigilance Test); executive function (Trails B-A); and global cognition (Montreal Cognitive Assessment). Receiver operating characteristic curves were used to determine cut points on the CDT that identify individuals who need additional cognitive testing. Results: PD participants had worse performance on CDT compared to controls. The CDT was correlated with executive function (Trails B-A) and global cognition (Montreal Cognitive Assessment). The CDT correlated with vigilance (Psychomotor Vigilance Task) only in healthy controls. However, the CDT was not correlated with measures of sleepiness (Epworth Sleepiness Scale) in either group. A cut point of 9 on the Rouleau scale and 18 on the Mendez scale identified PD participants with cognitive impairment. Conclusion: The CDT is a rapid clinical cognitive assessment that is feasible in PD and correlates with other measures of cognition.

OBJECTIVE The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care. MATERIAL AND METHODS We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3. RESULTS The search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD=-3.71 [-4.46, -2.96]; p

Bile acid metabolism is altered in neonates on parenteral nutrition (PN), predisposing them to parenteral nutrition-associated liver disease. Cholesterol 7α-hydroxylase (CYP7A1), the rate-limiting enzyme in the bile acid synthesis pathway, is repressed by fibroblast growth factor 19 (FGF19) and phytosterols (PS). We describe a case of a preterm infant who developed necrotizing enterocolitis (NEC) and received exclusive PN for over 2 months. Our objective was to serially assess CYP7A1 activity and plasma FGF19 and PS concentrations in this infant case compared to five healthy preterm infants. We found that CYP7A1 activity increased during the first 2 weeks of life in control infants but was undetectable in the infant case. FGF19 concentrations were high at birth in all infants and subsequently declined and did not differ between the case and control infants. As expected, PS concentrations were elevated in the infant case and continued to increase despite lipid minimization. In conclusion, CYP7A1 activity was gradually upregulated in healthy preterm infants but remained suppressed in the infant requiring prolonged PN. Preterm infants also had elevated FGF19 concentrations at birth, which decreased with advancing postnatal age.

Mitochondrial DNA copy number (mtDNA-CN) is a surrogate biomarker of mitochondrial dysfunction and is associated with type 2 diabetes (T2D) and cardiovascular disease (CVD). However, despite being associated with both CVD and T2D, it is not known what role mtDNA-CN has in the association between T2D and CVD. Our aims were to investigate whether, (1) baseline mtDNA-CN is associated with CVD incidence and (2) mtDNA-CN has a role as a mediator between T2D and CVD.We quantified absolute mtDNA-CN by droplet digital PCR method in a population-based follow-up study of middle aged (52-65 years) women (n = 3062). The median follow-up period was 17 years.Our results show that low baseline levels of mtDNA-CN (111 copies/μL) were associated with an increased risk of CVD (HR = 1.32, 95% CI = 1.08; 1.63) as well as with specific CVDs: coronary heart disease (HR = 1.28, 95% CI = 0.99; 1.66), stroke (HR = 1.26, 95% CI = 0.87; 1.84) and abdominal aortic aneurysm (HR = 2.61, 95% CI = 1.03; 6.62). The associations decreased but persisted even after adjustment for potential confounders. Furthermore, our results show that the total effect of T2D on future risk of CVD was reduced after controlling for mtDNA-CN and the proportion mediated by mtDNA-CN was estimated to be 4.9%.Lower baseline mtDNA-CN is associated with incident CVD and may have a mediating effect on the association between T2D and CVD; however, this novel observation needs to be confirmed in future studies.

Genetic alterations in cancer cells trigger oncogenic transformation, a process largely mediated by the dysregulation of kinase and transcription factor (TF) activities. While the mutational profiles of thousands of tumours have been extensively characterised, the measurements of protein activities have been technically limited until recently. We compiled public data of matched genomics and (phospho)proteomics measurements for 1,110 tumours and 77 cell lines that we used to estimate activity changes in 218 kinases and 292 TFs. Co-regulation of kinase and TF activities reflects previously known regulatory relationships and allows us to dissect genetic drivers of signalling changes in cancer. We find that loss-of-function mutations are not often associated with the dysregulation of downstream targets, suggesting frequent compensatory mechanisms. Finally, we identified the activities most differentially regulated in cancer subtypes and showed how these can be linked to differences in patient survival. Our results provide broad insights into the dysregulation of protein activities in cancer and their contribution to disease severity., Molecular Systems Biology, 19 (3), ISSN:1744-4292

Objective: To determine the incidence and management of post cholecystectomy biliary fistula at tertiary care Hospital. Methodology: This was a prospective study which was conducted at general surgery department of Liaquat University of Medical and health Sciences, during one year from March 2017 to February 2018. All the patients those underwent laparoscopic cholecystectomy or open cholecystectomy, age more than15 years and either of gender were included. All the patients were evaluated for developed biliary fistula after cholecystectomies. All the patients of biliary fistula were managed conservatively and surgically and their management outcome was recorded. After operation most of patients were followed up to 6 months. The data was collected via study designed proforma. Data was analyzed by using SPSS version 20. Results: Out of 318 patients, 280 patients underwent laparoscopic cholecystectomies, 38 patients underwent open cholecystectomies. Mean age of the patients was 41.34+8.23 years. Females were in majority 233(73.3%) and males were 95(29.7%). Out of all post-cholecystectomy biliary fistula was seen in 10(3.14%) patients. Incidence of post-cholecystectomy biliary fistula was insignificantly associated with types of cholecystectomies (p=0.425), while it was highly prevalent in females (p=0.001). Conclusion: In the conclusion of this study the post cholecystectomy biliary fistula was observed to be 3.14% and mostly patients were manged via conservative treatment.

Objectives: A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh. Material and Methods: All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated. Results: Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%. Conclusion: X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former.

Objective: To determine the frequency and presentation of colorectal carcinoma (CRC) among the patients presenting with lower gastrointestinal (GI) symptoms. Study Design: Observational study Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from January 2013 to February 2014. Methodology: A sample of 105 patients complaining of lower GI symptoms was selected. Data regarding the age, sex, presenting symptoms and signs, local examination and location of lesions were noted in a pre-structured proforma. Patients were examined by digital rectal examination (DRE), proctoscopy, colonoscopy; computerized tomography and biopsy. Data analyzed on SPSS 21.0 at 95% CI (P≤ 0.05). Results: Age of the patients was 53.17±14.90 years (95%CI: 51.28 to 55.05). Of 105 subjects; 65 (61.9%) were males and 40 (38.09%) were females. The CRC was observed in 11 (10.47%) patients of ≤ 40 years, 77 (73.3%) patients of 40 – 59.9 years and 17 (16.19%) cases were ≥60 years of age. Anemia 81 (77.14%), weight loss 74 (70.47%), abdominal pain 60 (57.14%), bleeding per rectum 79 (75.23%), tenesmus 55 (52.38%) and constipation 48 (45.71%) were common presenting symptoms of the CRC patients. Adenocarcinoma was found in 87 (82.85%), carcinoid tumor in 11 (10.47%), lymphoma in 5 (4.76%) and squamous cell carcinoma in 2 (1.9%). Conclusion: Colorectal adenocarcinoma was most common tumor found in males in their sixth decade of life. Anemia, weight loss, abdominal pain and bleeding per rectum were common clinical symptoms and rectum was common tumor site.

Objective: To evaluate success rate of the endoscopic third Ventriculostomy (ETV) in non-communicating type of hydrocephalus in pediatric age group. Material and Methods: This study was carried in the department of neurosurgery at Liaquat university hospital, Jamshoro in which an endoscopic third Ventriculostomy procedure was performed in patients (n = 55) with non-communicating hydrocephalus from October 2016 to April 2017. Post-operative follow-up was done on the 15th day post-operative to assess clinical and radiological improvement. Results: 55 patients were included in this study, 26 (47.27%) males and 29 (52.73%) females. The mean age was 3.96 years. The most common etiology was aqueductal stenosis 28 (50.90%) patients followed by posterior fossa tumors in 18 (32.72%) patients. The operative technique was successful in 41 (74.55%) patients. Out of 41 successful patients, 34 (82.92%) patients had clinical as well as radiological improvement whereas 7 (17.07%) patients had clinical improvement only. Conclusion: The success rate of ETV was 74.55% in the non-communicating hydrocephalus in the pediatric age group in our study. Endoscopic third Ventriculostomy is an effective treatment for non-Communicating hydrocephalus in pediatric age groups by diversion of CSF intracranially. This procedure provides shunt freedom and can be used alternative to shunts in pediatric age groups with non-communicating hydrocephalus.

Objective: Cardiovascular diseases are 1.7 times more prevalent in patients with diabetes mellitus. The aim behind this study was to examine the correlation of glycosylated hemoglobin and complexity of coronary artery disease among middle aged population with diabetes mellitus Patients and Methods: This was a clinical prospective hospital-based comparative study carried out in the department of the cardiology department of Isra University Hospital Hyderabad for 10 months. 153 participants with diabetes mellitus having age ≥45 years both male and female and undergoing their first coronary angiography were included. Data were entered and analyzed by using Statistical Package for the Social Sciences version 21.0. Results: A total of 153 patients were finally analysed. Patients were divided into two groups; group I (HbA1c 6.5%, impaired). The mean age was slightly higher in group II 54.60 as compared to group I 53.65 years, respectively. The Syntax score was correlated with HbA1c levels in patients older than 45 years of age (r = 0.001; p >0.05). Moreover, the higher HbA1c levels were observed in every three categories of Syntax score but they were insignificantly associated with each other in patients with diabetes mellitus and having age more than 45 years. Conclusion: The HbA1c is insignificantly correlated with the complexity of coronary artery disease in diabetic patients having age more than 45 years. While only two factors, hypertension and increased triglycerides are significantly different among the HbA1c groups.

Objective: To determine the severity of anemia among pregnant women and its impact on feto-maternal outcome at tertiary care Hospital. Materials and Methods: This was a cross-sectional study; conducted at gynae department of LUMHS; during 6 months from November 2019 to April 2020. Women with age >15 years, visited antenatal clinic and admitted for delivery and those who were admitted through emergency with labour pain and either of parity were included. A 3 ml fresh blood sample was taken from each woman and was sent immediately to the Hospital diagnostic laboratory for the assessment of haemoglobin level. Mothers having haemoglobin levels

Objective: This study aims to determine the in-hospital outcome of patients with acute ST-segment elevation myocardial infarction who did not receive reperfusion therapy at our institute. Methodology: Cohort of patients recruited from Emergency Department of Liaquat University Hospital, Hyderabad affiliated with Liaquat University of Medical & Health sciences, Jamshoro, Sindh, Pakistan from August 2nd, 2019 to 1st July 2020. All the patients who were diagnosed as a case of acute STEMI belongs to any age group of either gender and who did not receive reperfusion therapy either percutaneous or pharmacological therapy due to any cause were included in our study to assess their in-hospital outcome. Results: Total of 106 patients were enrolled having mean age and SD of 51.09 ± 13.50 years in which 67.92% were males. Significantly higher proportion of patients who did not receive reperfusion therapy died during hospitalization (27.35%, N = 29). The most common risk factors associated with higher mortality rates were increasing age, increased mean duration of hospitalization from the onset of chest pain, raised RBS, diabetes mellitus, and smoking, p

Background: Alopecia induced by androgens in genetically predisposed individuals is termed as Androgenetic alopecia (AGA). There is proof appearance the relationship between Androgenetic alopecia and metabolic condition. Objective: To determine frequency of metabolic syndrome in Androgenetic alopecia as a biomarker of disease in adult male patients. Materials and methods: It was a Cross Sectional Study conducted at the Department of Dermatology, Liaquat University of Medical and Health Sciences Hospital, Jamshoro/Hyderabad. Total 178 diagnosed male patients of Androgenetic alopecia were included. The grading of male pattern Androgenetic alopecia was done according to modified Norwood-Hamilton classification. Norwood-Hamilton Stage I-III were regarded to be mild to moderate and Stage IV and higher were regarded as severe. Vein was engorged by a tourniquet applied above the cubital fossa. Blood glucose levels were estimated. The level of triglycerides was determined. HDL-Cholesterol was estimated by a pre­cipitant method. Descriptive statistics were calculated using SPSS. Chi square tests were applied to determine the relationship of independent variables with metabolic syndrome. Results: The overall mean age of the patients was 39.08±10.14 years. The mean waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and fasting blood glucose were 94.71±12.30 cm, 133.83±13.27 mg/dl, 48.10±7.89 mg/dl,102.94±17.67 mmHg, 76.88±8.56 mmHg, and 93.06±9.78 mg/dl respectively. A total of 10.1% of the patients were found to have metabolic syndrome. There was a significant association between metabolic syndrome and age and family income. Conclusion: Metabolic syndrome was observed in 10.1% of the patients and this was more commonly found in: the age group >40 years, married individuals, low socioeconomic status individuals, and illiterate individuals.

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Background: The anal fissure is a small spilt in the distal anoderm, and it most commonly occurs in the posterior midline of anal canal. Anal fissure causes severe sharp pain on defecation, occasionally accompanied by streak of blood on outside of stool or blood on toilet tissue. Fissures are classified as acute or chronic, acute fissure usually heal spontaneously within six weeks. Fissurectomy had been used as separate technique in the treatment of chronic anal fissure with favorable result. Parallel inside sphincterotomy produces an enduring fall of anal resting pressure, that reestablish mucosal perfusion bringing about recuperating, yet genuine drive component is obscure, and the instrument that travel from intense to constant gap stay dark. This study is design to assess the outcome between two groups, than better modality of the two could be chosen. Objective: To compare fissurectomy and lateral internal sphincterotomy in the management of chronic anal fissure. Patient and Methods: The Randomized controlled trial was conducted during 18-02-2015 to 17-08-2015 at Department of surgery,Liaquat University of Medical & Health Sciences, Hyderabad. A total of 218 patients with chronic anal fissure were included in this study. Patients were randomly divided into two groups. Patients in Group A were underwent fissurectomy and patients group B was underwent lateral internal sphincterotomy. Surgery was performed and patients were followed for 8 weeks on regular basis and satisfactory out comes was noted. Information along with demographics was entered in the proforma. Results: Rate of satisfactory outcome was significantly high in group B as compare to group A [92.66% vs. 76.15%; p=0.001]. Conclusion: Subcutaneous sidelong internal sphincterotomy is a significant surgery for patients with persistent anal fissure. It is compelling and safe, offers fast help of torment, and advances early gap mending without being gone to by any significant complexities.

Objective: To determine the outcome of endoscopic pilonidal sinus treatment (EPSIT): Is a new minimally invasive treatment in pilonidal sinus. Study Design: This is a observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2020 to Feb 2021. Materials and Methods: Patients aged between 20-40 years, both gender having sinus in the cleft of the buttocks on clinical examination with associated symptoms like pain when sitting or standing, reddened, sore skin around the area, pus or blood draining from sinus, hair protruding from the lesion and formation of more than one sinus tract, or holes in the skin were included in this study. Patients with abscess and recurrent pilonidal sinus were excluded. Outcome measurements were postoperative pain, return to normal daily activities and complication rates including infection, recurrence. Results: 44 patients with Pilonidal Sinus were included in this study. 15 to 40 years with mean age ± SD (range) was 26.56±4.1 years. 40(90.90%) were male where as 4(9.09%) were females. Mostly patients have single external openings in 37(84.09%) patients with midline opening location in 26(59.09%) patients. The mean operative time±SD (range) was 21.09±3.62 minutes (15 to 45 min). According to the visual analog scale (VAS) score for postoperative pain assessment after 48 hours of surgery, 36 patients (81.81%) reported a VAS between 1 to 3, and 8(18.18%) reported a score between 4 to 6. Postoperative wound infection was seen in one case 2.27% while recurrence was observed in two cases 4.54%. The overall healing rate was 93.18%. The mean time to return to normal daily activities was 6.1±11 (range, 2–15) days. Conclusion: To conclude that the EPSiT is safe, effective, simple, repeatable and very welcomed by the patients if explained correctly. We can say that EPSiT can be labeled as a day surgery, with fast post-operative recovery and early return to work.

Introduction: Asymptomatic bacteriuria in pregnancy (ABU) is poorly understood and neglected in developing countries. It causes certain lethal maternal and fetal consequences if left untreated including low weighted births, premature delivery, full-blown urinary tract infection and pyelonephritis. Objective: Our aim was to explore such factors having bad impact on pregnancy associated with asymptomatic bacteriuria and aware our community about these unspoken perils so that ABU likelihood may be reduced. Prevalence varies country to country. Developing and low economic countries are suffered more than developed so thereby upgrading and providing basic amenities of life the risk factors may be reduced. Materials and Methods: This was a cross sectional study carried out in department of pathology PUMHSW. Sample size was 377, all selected were 18 years and above. All urinary samples were collected in sterile container and labeled and immediately transported to microbiology laboratory. Dipstick test, wet mount microscopy and Gram's staining were done. Blood, MacConkey's agar was inoculated and streaked with inoculi. Data were analyzed using SPSS version 23. Results: Samples found unlabeled (02) and contaminated (03) were dropped from study. A total of 372 were study samples. The most of patients were Gram negative 65(90.20%) predominantly Enterobacteriocae. When cultured, 72 were found growth positive (mixed plus pure) while 300 were negative. Risk factors were assayed in culture positive patients (ABU). A large number of patients (74%) belonged to lower economic class. Most common age group varied from 26-30 years (43%). Third trimester was the most common found in 37 patients ((49.3%). Gravid (G3 or more) were strong risk factors and were 55(73.3%). Most of patients were illiterate 65 (90.27%). The past history of UTI was a significant risk 46(63.88%) while anemia was found statistically insignificant 17(23.61). Conclusion: Asymptomatic bacteriuria is frequent in pregnant females and significantly increased when compounded by past history of UTI and low socioeconomic status. Therefore, it is necessary for mothers to be screened for ABU. There is a need of rapid and reliable screening methods so that upcoming disease burden can be reduced.

Introduction: Overactive bladder (OAB), defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. Methods: A retrospective review of patients getting intradetrusor onabotulinumA injections for OAB and NDO over a 6-year time frame was conducted. The principal outcome measures involved patient’s subjective improvements in OAB and NDO symptoms and the duration of symptomatic relief following every treatment. The secondary results measured relation of patient’s age and duration of each effective treatment cycle. Results: One hundred and thirty-Eight (138) consecutive patients who met the inclusion criteria were included in the study. The average age of women was 59.43 years. Eighty four (61%) of participants were still receiving botox injections while 54 women stopped treatment. The average time period between botulinum A injection and its efficacy in controlling OAB symptoms varied from 3 -8.5 months. There was no decrease in efficacy of the treatment with more cycles of treatment. The average age of women who received one, two, three and four or more cycles were 61.7, 53.87, 63.03, and 56.75 years respectively, which showed with advanced age efficacy of botulinum toxin does not decrease. Conclusions: Our results suggest that in patients who respond to intradetrusor botulinumA treatment, the duration of response does not decline with more treatment cycles, suggesting it as a safe long term treatment option for controlling OAB symptoms. Also there is no relation between advanced age and subsequent efficacy of botulinum A intradetrusor injections.

Objectives: To determine the frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients. Setting: Department of Medicine at LUMHS hospital Hyderabad/Jamshoro. Study Design: Descriptive Cross sectional study. Duration of Study: 6 months from 01-03-2019 to 31-08-2019. Methods: A total of 232 patients with severe acute exacerbation of COPD were included in this study. A 12 lead ECG was performed. QT intervals were measured on a resting ECG tracing in lead II. The QT interval was measured manually from the starting point of the QRS complex to the terminal point of the down slope of the T wave. Results: A total of 232 patients with COPD were included in this study. Most of the cases were above 50 years of age. The average age of the patients was 53.74±4.35 years. There were 92.67% (215/232) male and 7.33% (17/232) female. Out of 232 patients, 21.14% were current smoker and 75.86% were ex-smoker. A QTc interval >0.44 seconds was considered abnormally prolonged. Frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients was 31.47% (73/232). Rate of altered cardiac repolarization was not significant among different age groups (p=0.641). Rate of altered cardiac repolarization was significantly high in male as compare to female (33.5% vs. 5.9%; p=0.018). This was not significant between obese and non-obese groups (p=0.100). Rate of altered cardiac repolarization was significantly high in former smoker (p=0.0005) and those patients whose duration of COPD was above 15 years (p=0.0005). Conclusion: Patients with hypoxic chronic obstructive pulmonary disease (COPD) have evidence of a subclinical parasympathetic autonomic neuropathy, with apparent preservation of sympathetic function. Measuring heart rate corrected QT interval (QTc) test is repeatable, easy to perform and a sensitive indicator for autonomic dysfunction in breathlessness individuals with COPD.

Aim: The aim of this study was to evaluate the clinical presentation of mandibular impacted teeth and associated pathologies in Unaizah, Al Qaseem; Saudi Arabia. Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery (OMFS), King Saud Hospital Unaizah Saudi Arabia from March 2019 and December 2020. Methodology: The record of patients attending dental section was reviewed from hospital record. Demographic data of patients were recorded through medical record Number by Medicapluse software. Orthopantamograms (OPGs) xrays were reviewed by maxillofacial surgeons on Dell LCD using software IMPEX 6.3.1.2794 enterprise unlimited Agfa. The variables like presence of impacted tooth, type of angulations, reason for extraction, caries on distal surface of 2nd molar tooth, and occlusal or mesial surface of 3rd molar were examined on OPGs. Data was analyzed using SPSS version-21. Results: Males and females were 49% and 51% respectively. The most common type of impaction was vertical 45%, followed by horizontal 27% and mesio angular 22%. The impacted tooth on right side was observed as 51% and on left side as 49%. The relationship of gender with type of impaction was statistically insignificant (p value-0.157). The relationship was reasons and type of impaction was statistically insignificant (p value-0.317) Conclusion: the both genders were almost equally affected. Vertical Impactions were more frequent and the pericoronitis was common reason for extraction of mandibular third molar. The relationship of gender and type of impaction was not significantly associated with type of impaction.

Background: Gallstone disease (cholelithiasis) remains the commonest medical issue leading to surgical intervention. Causes of the Gall stone has been not properly understood, but it is thought to have several factors. Untreated gall stones can cause the various complications like inflammation of gall bladder, tissue damage, gallbladder tears and infection. Objective: To determine the clinical pattern and frequency of comorbidities among patients presented with cholelithiasis at Isra University Hospital Hyderabad, Pakistan. Materials and methods: This cross-sectional study was conducted at general Surgery department, Isra University Hospital, Hyderabad. All the patients having diagnosis of gall stone disease, age>18 years and either of gender were included in the study. Patients were selected on outpatient department (OPD) basis. Complete clinical examination was done including abdominal ultrasound and required laboratory investigations. Data regarding demographic information including clinical presentational and comorbidities like diabetes, hypertension and obesity was recorded and also smoking status was assessed. All the data was recorded via study proforma and was analyzed by SPSS version 20. Results: A total of 149 patients were studied, their mean age was 49.23+7.33 years. Females were commonest as 57(38.3%) and males were 92(61.7%). As per clinical presentation pain was found to be most common, particularly as epigastrium pain was found in (93.95%) cases, right Hypochondrium pain (73.82%), pain radiation was more towards scapula (50.33%), dyspepsia was noted in (49.66%), nausea was observed in 44 patients, flatulence in 45 patients and vomiting was least common (21.47%). Diabetes mellitus was 76(51.0%), hypertension was 67(45.0%), overweight were 63(42.3%), obese were 25(16.8%), HCV positive cases were 34(22.8%) and HBV positive cases were 09(59.7%). However smokers were 48(32.2%) and 06(4.0%) were alcohol consumers. Diabetes mellitus, hypertension and obesity were significantly more prevalent in females as compared to males (p=27kg/m2), diabetes mellitus and belonged to fourth decade (40 to 50 years) of their life. Commonest clinical presentations were epigastrium pain, right Hypochondrium pain, pain radiation towards scapula and dyspepsia.

Background Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhibiting ineffective hematopoiesis and tendency for transformation into acute myeloid leukemia (AML). The available karyotyping and fluorescent in situ hybridization provide limited information on molecular abnormalities for diagnosis/prognosis of MDS. Next generation DNA sequencing (NGS), providing deep insights into molecular mechanisms being involved in pathophysiology, was employed to study MDS in Pakistani cohort. Patients and methods It was a descriptive cross-sectional study carried out at National institute of blood diseases and bone marrow transplant from 2016 to 2019. Total of 22 cases of MDS were included. Complete blood counts, bone marrow assessment and cytogenetic analysis was done. Patients were classified according to revised WHO classification 2016 and IPSS score was applied for risk stratification. Baseline blood samples were subjected to analysis by NGS using a panel of 54 genes associated with myeloid malignancies. Results The median age of patients was 48.5 ± 9.19 years. The most common presenting complaint was weakness 10(45.45%). Cytogenetics analysis revealed abnormal karyotype in 10 (45.45%) patients. On NGS, 54 non-silent rare frequency somatic mutational events in 29 genes were observed (average of 3.82 (SD ± 2.08) mutations per patient), including mutations previously not observed in MDS or AML. Notably, two genes of cohesin complex, RAD21 and STAG2, and two tumor suppressor genes, CDKN2A and TP53, contained highest number of recurrent non-silent somatic mutations in the MDS. Strikingly, a missense somatic mutation p.M272Rof Rad21 was observed in 13 cases. Overall, non-silent somatic mutations in these four genes were observed in 21 of the 22 cases. The filtration with PharmGKB database highlighted a non-synonymous genetic variant rs1042522 [G > C] located in the TP53. Genotype GG and GC of this variant are associated with decreased response to cisplatin and paclitaxel chemotherapy. These two genotypes were found in 13 cases. Conclusion Sequencing studies suggest that numerous genetic variants are involved in the initiation of MDS and in the development of AML. In countries like Pakistan where financial reservation of patients makes the use of such analysis even more difficult when the availability of advanced techniques is already a prevailing issue, our study could be an initiating effort in adding important information to the local data. Further studies and large sample size are needed in future to enlighten molecular profiling and ultimately would be helpful to compare and contrast the molecular characteristics of Asian versus global population.

Objective The literature regarding gonadoblastoma risk in exonic Wilms’ tumor suppressor gene (WT1) pathogenic variants is sparse. The aim of this study is to describe the phenotypic and genotypic characteristics of Asian–Indian patients with WT1 pathogenic variants and systematically review the literature on association of exonic WT1 pathogenic variants and gonadoblastoma. Design Combined retrospective–prospective analysis. Methods In this study, 46,XY DSD patients with WT1 pathogenic variants detected by clinical exome sequencing from a cohort of 150 index patients and their affected relatives were included. The PubMed database was searched for the literature on gonadoblastoma with exonic WT1 pathogenic variants. Results The prevalence of WT1 pathogenic variants among 46,XY DSD index patients was 2.7% (4/150). All the four patients had atypical genitalia and cryptorchidism. None of them had Wilms’ tumor till the last follow-up, whereas one patient had late-onset nephropathy. 11p13 deletion was present in one patient with aniridia. The family with p.Arg458Gln pathogenic variant had varied phenotypic spectrum of Frasier syndrome; two siblings had gonadoblastoma, one of them had growing teratoma syndrome (first to report with WT1). On literature review, of >100 exonic point pathogenic variants, only eight variants (p.Arg462Trp, p.Tyr177*, p.Arg434His, p.Met410Arg, p.Gln142*, p.Glu437Lys, p.Arg458*, and p.Arg458Gln) in WT1 were associated with gonadoblastoma in a total of 15 cases (including our two cases). Conclusions WT1 alterations account for 3% of 46,XY DSD patients in our cohort. 46,XY DSD patients harboring exonic WT1 pathogenic variants carry a small but definitive risk of gonadoblastoma; hence, these patients require a gonadoblastoma surveillance with a more stringent surveillance in those harboring a gonadoblastoma-associated variant.

Risk of metastatic disease in the cluster 2-related pheochromocytoma/paraganglioma (PPGL) is low. In MEN2 patients, identification of origin of metastases from pheochromocytoma (PCC) or medullary thyroid carcinoma (MTC) is challenging as both are of neuroendocrine origin. We aim to describe our experience and perform a systematic review to assess prevalence, demographics, biochemistry, diagnostic evaluation, management, and predictors of cluster 2-related metastatic PPGL. Retrospective analysis of 3 cases from our cohort and 43 cases from world literature was done. For calculation of prevalence, all reported patients (n = 3063) of cluster 2 were included. We found that the risk of metastasis in cluster 2-related PPGL was 2.6% (2% in RET, 5% in NF1, 4.8% in TMEM127 and 16.7% in MAX variation). In metastatic PCC in MEN2, median age was 39 years, bilateral tumors were present in 71% and median tumor size was 9.7 cm (range 4–19) with 43.5% mortality. All patients had a primary tumor size ≥4 cm. Origin of primary tumor was diagnosed by histopathology of metastatic lesion in 11 (57.9%), 131I-MIBG scan in 6 (31.6%), and selective venous sampling and CT in 1 (5.3%) patient each. In subgroup of neurofibromatosis 1 (NF1), median age was 46 years (range 14–59) with median tumor size 6 cm and 57% mortality. To conclude, the risk of metastatic disease in cluster 2-related PPGL is low, being especially high in tumors with size ≥4 cm and associated with high mortality. One-third patients of NF1 with metastatic PPGL had presented in second decade of life. Long-term studies are needed to formulate management recommendations.

Objective: To assess the incidence and outcome of gestational diabetes mellitus (GDM) during pregnancy among sampleof Pakistani population. Study Designand Setting:This was an analytic case-control prospective study carried out at two centers (CMH Kharianand PNS Shifa Hospital Karachi) from 1st Jan till 30th July 2021. MethodologyPreviously healthy mothers were divided into three groups according to their risk of elevated glucose levelsgestational diabetes mellitus (GDM) during pregnancy. Associations between GDM eminence (exposure variable) andpregnancy-related, fetal, and neonatal outcomes were reviewed (i.e., mode of delivery, preterm baby, pregnancy-inducedhypertension, and fetal macrosomia, stillbirth, premature delivery etc. One way ANOVA was employed to compare thesignificant differences in different dependent variables amongst three groups. P Values of

Breast cancer is a strong risk factor of cancer amongst women. One in eight women suffers from breast cancer. It is a life-threatening illness and is utterly dreadful. The root cause which is the breast cancer agent is still under research. There are, however, certain potentially dangerous factors like age, genetics, obesity, birth control, cigarettes, and tablets. Breast cancer is often a malignant tumor that begins in the breast cells and eventually spreads to the surrounding tissue. If detected early, the illness may be reversible. The probability of preservation diminishes as the number of measurements increases. Numerous imaging techniques are used to identify breast cancer. This research examines different breast cancer detection strategies via the use of imaging techniques, data mining techniques, and various characteristics, as well as a brief comparative analysis of the existing breast cancer detection system. Breast cancer mortality will be significantly reduced if it is identified and treated early. There are technological difficulties linked to scans and people’s inconsistency with breast cancer. In this study, we introduced a form of breast cancer diagnosis. There are different methods involved to collect and analyze details. In the preprocessing stage, the input data picture is filtered by using a window or by cropping. Segmentation can be performed using k -means algorithm. This study is aimed at identifying the calcifications found in bosom cancer in the last phase. The suggested approach is already implemented in MATLAB, and it produces reliable performance.

Objective: To determine the association of estrogen and progesterone receptor expression with the clinical and histological findings of endometrial cancer. Study Design: Prospective observational study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi between Sep 2017 to Oct 2019. Methodology: A total of 130 patients were diagnosed with endometrial carcinoma. Data from patient files were collected regarding tumour histology, grade, stage, tumour receptor expression, and the clinical characteristics: parity, menopausal status. The receptor expression profile was documented for each patient. Data were analyzed using SPSS version 25. The association between ER/PR expression categories and clinical/histological features were explored using the chi-square test. Results: The estrogen and progesterone receptor expressions were significantly associated with low-grade (Grade I and II) tumours and with Stage I and Stage II endometrial carcinoma with p

Aim: To report the experience of vesicovaginal fistula repair among patients attending Khairpur Medical College. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Khairpur Mir’s and Department of Obstetrics & Gynaecology, GMMC, Sukkur from 1st February 2018 to 20th November 2020. Methodology: Thirty five known case of vesicovaginal fistula presenting with continuous leakage of urine were consecutively included. Patients with failed previous repair were also included. After pre-operative work-up, fistula repair was done either through abdominal or vaginal route in two layers tension free and watertight with absorbable suture. All patients were called for follow-up visits at two weeks initially and then depending on the presence of symptoms later on. Results: Transabdominal repair was observed in 18 (51.4%) patients whereas transvaginal vesicovaginal repair in 17 (48.6%) patients. The mean operative time was significantly higher among patients with transabdominal repair than transvaginal repair (p

Objective To evaluate the protective role of L-Arginine in cisplatin induced acute renal injury through assessment of renal, oxidative stress and inflammatory markers in albino wistar rats. Methods: Quasi-experimental study was conducted at the department of physiology and postgraduate research laboratory at Isra University, Hyderabad, Sindh from April 2019 to September 2019. Thirty male Albino wistar rats were selected through non-random purposive sampling and divided equally into three different groups: Group-A (Control group), Group-B (experimental group) received Cisplatin alone and Group-C (experimental group) received Cisplatin along with arginine. After sacrificing the animals, blood samples were collected through cardiac puncture while renal histopathological analysis was under the light microscope. The changes in severity were observed using a graded scale. Data was analysed using SPSS v23.0. Results: There was a statistically significant (p-value

Objective: To compare the frequency of patients with successful Trial of voiding without catheter (TWOC) after acute urinary retention secondary to benign prostatic hyperplasia in patients taking ketoconazole and tamsulosin vs tamsulosin alone. Study Design: A randomized controlled trial. Place and Duration: The current study was conducted at Urology Ward, Liaquat National Hospital, Pakistan for a period of six months. Methodology: A total of 162 patients presenting with acute urinary retention were divided into two groups. Group A received tamsulosin 0.4mg OD and ketoconazole 200mg while Group B received tamsulosin and placebo. Trial of voiding without a catheter was induced after one week of medication. SPSS version 20 was used for data compilation and analysis. Results: In Group-A, 85.2% of patients were able to void as compared to group B, where only 74.1% of patients were able to void (p

Background The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non–community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

Objectives: This study aims to scientifically fill the gap and provide the scientific data regarding frequency of hyperuricemia in the patients with acute myocardial Infarction admitted at Liaquat University of Medical & Health Sciences, Hyderabad. Study Design: Prospective descriptive case series. Setting: Department of Cardiology, Liaquat University of Medical & Health Sciences, Hyderabad. Period: From 7th Feb 2016 to 6th August 2018. Material and Methods: Was conducted on either gender having age ≥35 to ≤70 years presented with ST elevation myocardial infarction was included in the study. ECG and laboratory investigations were carried out. Relevant investigation like serum uric acid was sent to laboratory. Final outcome was assessed at the end of 5th day, hyperuricemia was labeled if serum uric acid levels above 6.5 mg/dl. All the information was noted in proforma and analyzed using SPSS version 21.0. Results: There were 95 male and 50 female patients. The mean age was 49.57 ± 8.53 years, with range 35 (35 - 70) years. The age of 49 (33.8%) patients was ≤45 years and age of 96 (66.2%) patients was >45 years. 17.9% patients were obese and 50.3% patients were hypertensive. The hyperuricemia was present in 27 (18.6%) patients. Among patients who were found with hyperuricemia, the mean age was 49.41 ± 8.34 years. The results showed that significant association of hyperuricemia was observed with obesity. No significant association of hyperuricemia was observed with gender, age, and hypertension. Conclusion: Based on the findings of our study, raised serum uric acid levels are associated with adverse cardiovascular outcome. The prevalence of hyperuricemia is high in a population of patients with acute myocardial infarction.

Continuous health monitoring for an infant is crucial for detecting and preventing several diseases. Recent advancement in wearable technology has given rise to the development of wearable infant health monitoring systems (WIHMSs). These systems provide an edge over conventional infant health monitoring systems which are not only bulky and uncomfortable for the infants but are also limited to the clinical settings. This study reviews some state-of-the-art WIHMS, mentions the advantages, limitations and the challenges faced by such systems. This study, for the first time, contributes an appraisal of research prototypes and commercially available systems for WIHMS, which is the need of the day.

Objective: This study aimed to evaluate the age, gender, causes, place of trauma, and type of crown fracture in permanent dentition among patients attending Liaquat University of Medical and Health Sciences Hospital (LUMHS), Jamshoro, Pakistan. Methodology: This cross-sectional study was conducted at the Operative Dentistry Department of LUMHS hospital over a period of six months. All patients (6 - 40 years of age) who had a history of dental trauma and attending dental OPD were included in this study. The data for all patients were recorded in a predesigned proforma. Data were collected on age, gender, place of trauma (playground, road, home), cause of trauma (fall, playing, road accident, bicycle accident, collisions, fighting) and associated symptoms. The data were analyzed using SPSS 22.0. Mean and the standard deviation was computed for a quantitative variable like age. Frequency and percentage were calculated for qualitative variables like gender, risk factors, and pattern of trauma. Results: A total of 82 patients were enrolled. The most frequent age group involved was 13 - 20 years (46%) with males (58.5%) predominance. The majority of trauma cases were due to fall (36.6%) while playing and 19.5% were bicycle accidents. The most commonly affected tooth was right maxillary central incisor (46.6%) followed by left maxillary central incisor (28.4%). Of the 116 teeth examined, 56.0% had a complicated crown fracture and 44.0% had an uncomplicated crown fracture. Conclusion: Safety measures should be implemented where dental traumatic accidents occur most frequently like at home and on the roads.

Objective: To determine the effect of CoQ10 supplementation in reduction of oxidative stress by index marker, Malondialdehyde (MDA), super oxidase dismutase(SOD), catalase(CAT) and glutathione peroxidase (GPx) in patients with pre-eclampsia. Methodology: A cross-sectional study was conducted at the Department of Biochemistry LUMHS, Jamshoro. During the period of January 2018 to June 2018. Total 200 pregnant women were recruited and divided into two groups. 50 females were normotensive pregnant women as a control group, 150 were pre-eclamptic patients as case group. Obstetric history, clinical data was gathered and then 5ml of blood sample was collected from each patient. The blood samples were taken before and after a 3 months’ supplementation to analyse Malondialdehyde (MDA). The CoQ10 was evaluated by High performance liquid chromatography (HPLC-DAD) and MDA, SOD, CAT and GPx were performed on UV- spectrophotometer. Data was analysed by using SPSS version 22. Student t­test was used for analysed of continuous variables. Results: The pre-eclamptic women treated with CoQ10 supplementation the plasma CoQ10 levels and MDA, SOD and CAT levels increased marked after 3 months(p

Objective/Background To evaluate the efficacy and outcome of adding low-dose fractionated radiotherapy (LDFRT) to induction chemotherapy plus concurrent chemoradiation in locally advanced nasopharyngeal carcinoma (LANPC). Methods A single-institute, phase II–III, prospectively controlled randomized clinical trial was performed at King Faisal Specialist Hospital and Research Centre. Patients aged 18–70 years with WHO type II and III, stage III–IVB nasopharyngeal carcinoma, Eastern Cooperative Oncology Group performance score of 0–2, with adequate hematological, renal, and hepatic function were eligible. In total, 108 patients were enrolled in this trial. All patients received two cycles of induction docetaxel and cisplatin (75 mg/m2 each) chemotherapy on Days 1 and 22, followed by concurrent chemoradiation therapy. Radiation therapy consisted of 70 Gy in 33 fractions, with concurrent cisplatin 25 mg/m2 for 4 days on Days 43 and 64. Patients were randomly assigned to either adding LDFRT (0.5 Gy twice daily 6 hours apart for 2 days) to induction chemotherapy in the experimental arm (54 patients) or induction chemotherapy alone in the control arm (54 patients). Results There was no significant difference in the post-induction response rates (RRs) or in toxicity between the two treatment arms. The 3-year overall survival (OS), locoregional control (LRC), and distant metastases-free survival (DMFS) rates for experimental arm and control arm were 94% versus 93% (p = .8), 84.8% versus 87.5% (p = .58), and 84.1% versus 91.6% (p = .25), respectively. Conclusion The results showed no benefit from adding LDFRT to induction chemotherapy in terms of RR, OS, LRC, and DMFS.

Objective: Is it necessary to perform pre operative upper gastrointestinal endoscopy in elective symptomatic cholelithasis? Study Design: Prospective observational study. Place and Duration of Study: This study was conducted at surgical departments of Services Hospital, Ruth PFAHU, Civil Hospital Karachi, Shaheed Benazir Bhutto Medical College, Lyari Karachi and Liaquat University Of Medical and Health Sciences, Jamshoro from July 2018 to December 2019. Methodology: Study consisted of 382 patients. All patients were subjected to Upper Gastrointestinal Endoscopy 24 to 48 hours before cholecystectomy followed by biopsy were obtained for histopathology if required. Those patients not willing for surgery, General anesthesia problem, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructive jaundice were excluded. Results: Out of the 382 patients, 66(17.27%) males and 316(82.72%) females with mean age of study population was 46.10 ± 6.31 years (22 to 65 years). Patients were present typical pain in 146(38.21%) cases and atypical pain in 236(61.78%) cases. Pre operative upper gastrointestinal endoscopy findings revealed Esophagitis in 22(5.75%) cases, GERD in 26(6.80%) cases, gastritis in 88(23.03%), gastric ulcer 49(12.82%), duodenal ulcer in 39(10.20%), polps 21(5.49%) and carcinoma of stomach 9(2.35%). Out of 236(61.78%) cases with atypical pain had persistence of symptoms in 141 (59.74%) cases upto four months. Conclusion: We conclude that upper gastrointestinal endoscopy preoperatively for gallstone disease should be performed. So that preoperatively atypical symptoms are evaluate and taken care of, and patients is fully informed and also treated for associated conditions.

Objectives: Clinical assessment of OSMF patients visiting Isra dental college Hyderabad Sindh and correlation of trace elements in OSMF pathogenesis. Study Design: Observational Study. Setting: Outpatient Department, Oral Surgery Isra Dental College Hyderabad Sindh. Period: February 2016 January 2017. Material & Methods: Sixty research participants were categorized into control (group-II) and experimental group (group-I). Both clinical and physiological demographics of the research participants were recorded on a pre-designed questionnaire. In next phase, estimation of serum copper and serum zinc levels were determined for both control and OSMF patients by using spectrometric analysis. Patient data analysis was done by using Chi-square test and student’s t test. Where Microsoft office 2010 tools were also used for data presentation. Results: Based on clinical presentation 80 % patient were presenting with burning sensation in oral cavity in thirty OSMF patients. Where in control group only 3.3% patients were facing burning sensation in oral cavity. By assessing the functional staging of oral submucosa fibrosis about 50 % patients were presenting stage-II OSMF cytology. Where all the thirty participants in experimental group were presenting mucosal blanching. About 36 % patients suffering from OSMF were using Gutka and 33 % patients were using areca nut. Serum Zn mean value estimation in controls (Group II) and cases (Group I OSMF) was noted as 68.06 ± 17.10 and 94.20 ± 15.11 µg/dl respectively (t = 6.27, p=0.001). Conclusion: The present study concludes that increased serum trace element levels has significant correlation in the development and progression of OSMF.

Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings.We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP]120 mm Hg and diastolic blood pressure [dBP]80 mm Hg), elevated blood pressure (sBP 120-129 mm Hg and dBP80 mm Hg), stage 1 hypertension (sBP 130-139 mm Hg or dBP 80-89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140-159 mm Hg or dBP 90-109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties.Between Nov 1, 2014, and Feb 28, 2017, 21 069 women (6067 in India, 4163 in Mozambique, and 10 839 in Pakistan) contributed 103 679 blood pressure measurements across the three CLIP trials. Only women with non-severe or severe stage 2 hypertension, as discrete diagnostic categories, experienced more adverse outcomes than women with normal blood pressure (risk ratios 1·29-5·88). Using blood pressure categories as diagnostic thresholds (women with blood pressure within the category or any higher category vs those with blood pressure in any lower category), dose-response relationships were observed between increasing thresholds and adverse outcomes, but likelihood ratios were informative only for severe stage 2 hypertension and maternal CNS events (likelihood ratio 6·36 [95% CI 3·65-11·07]) and perinatal death (5·07 [3·64-7·07]), particularly stillbirth (8·53 [5·63-12·92]).In low-resource settings, neither elevated blood pressure nor stage 1 hypertension were associated with maternal, fetal, or neonatal mortality or morbidity adverse composite outcomes. Only the threshold for severe stage 2 hypertension met diagnostic test performance standards. Current diagnostic thresholds for hypertension in pregnancy should be retained.University of British Columbia, the BillMelinda Gates Foundation.

Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries’ regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study’s findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.

Muhammad Asif Syed,1 Aneela Atta Ur Rahman,2 Muhammad Nadeem Shah Syed,3 Naveed Masood Memon4 1Field Epidemiology & Laboratory Training Program (FELTP), Karachi, Pakistan; 2Department of Community Medicine & Public Health Sciences, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan; 3Federal NSTOP Officer, National Emergency Operation Center, Islamabad, Pakistan; 4Provincial Disease Surveillance and Response Unit, Hyderabad-Sindh, Field Epidemiology & Laboratory Training Program (FELTP), Karachi, PakistanCorrespondence: Muhammad Asif SyedField Epidemiology Laboratory Training Program (FELTP) Pakistan, Karachi, Sindh, PakistanTel +0092-286-34-77Email asif.mph@gmail.ccomIntroduction: Drug-induced aplastic anemia has long been a menacing outcome of modern pharmacotherapy. The incidence of idiosyncratic, drug-induced aplastic anemia varies depending on the genetic susceptibility and the associated drug. Only scarce studies have explained the epidemiology and actual incidence of this reaction.Purpose: The aim of the study was to establish the association between drugs and aplastic anemia.Methods: A case-control study was conducted with 191 cases and 696 controls at a tertiary hospital for blood diseases in Karachi-Pakistan. Cases were patients of aplastic anemia diagnosed through bone marrow biopsy. The controls did not have either AA or chronic diseases. Each case was paired with four sex and age group match controls. Cases and controls were compared with respect to the drugs used. Univariate and multivariate analysis were performed in order to delineate the association.Results: Median age of the study-participants was 27 years (04– 69 years). The majority 84 (44%) were from age group 16 to 30 years. The male-to-female ratio was 2:1. Among study participants, various drugs were significantly associated with aplastic anemia. Treatment of epilepsy with carbamazepine showed a positive association (OR=2.7, 95% C.I, 1.0– 6.8). An increased risk of aplastic anemia was noted with exposure to thiazide (OR=3.1, 95% C.I, 1.3– 7.4) and mebendazole (OR=3.7, 95% C.I, 1.5– 9.2). However, risks were not increased with chloramphenicol, trimethoprim/sulfamethoxazole, benzodiazepines, antihistamines, oral contraceptives, and herbal medicine.Conclusion: This large-scale case–control study provide association of aplastic anemia with exposure to carbamazepine, thiazides and mebendazole in population of Pakistan. Patients should be monitored with complete blood indices for early detection of drug toxicity.Keywords: drug induced aplastic anemia, case–control study, Karachi, Pakistan

Background: During gestational period, the most common disorder is hypertension that directly affects the gestation. The frequency of gestational hypertension is increasing day by day and ultimately the pressure is developed on the endothelial wall. Gestational hypertension mostly reduces the platelet counts. Aim of Study: The major theme of this research is evaluating the count of platelet during pregnancy and other gestational conditions. Methodology: A Retrospective research was carried out for the period of 06 months at Gynae and Obstetrics ward at tertiary care hospital of Sindh, Pakistan. Total 104 females were selected with different gestational age and trimester. A questionnaire was filled by all participants that were comprised of demographic data and gestational conditions such as preeclampsia, eclampsia, parity and seizure episodes. Females with highest risk factors diseases such as Diabetes, Hepatic disorder, Anemia, renal disorder and cardio vascular disease were not included in our research. Blood samples were collected from all selected participants for proper platelet count and data was compared with normal ranges of platelet count among the pregnant females. Data was analyzed by using statistical software 24.00 versions. Results: It was observed that 49 patients were having normal pregnancy, 32 had preeclampsia and 23 had eclampsia. 38 participants were first timer & 52 were having second time parity. 58 participants had 2nd trimester of pregnancy. According to condition of anemia, 27 had severe anemic condition whereas 43 had moderate anemic condition. 49 participants had reduced level of platelet count and 17 had very low platelet count. Severity of gestation can be managed through proper management and physician instructions. Hypertension was measured through severity scale, 29 patients had moderate level of hypertension and 22 had severe level of hypertension. 19 participants had very abnormal level of blood count. Conclusion: It was concluded that proper diagnostic test should be conducted on time for proper management of reduced platelet count and there should be proper mass counseling should be conducted in order to overcome the deficiency of platelet count. There should be proper diet and exercise during pregnancy that can manage the condition of hypertension. Severity of gestation can be managed through proper management and physician instructions.

Objective: To assess the prevalence rate of Hepatitis B and C among those patients who had tuberculosis in local community of Sindh, Pakistan. Study Design:Survey-based study Place and Duration of Study: Department of Pathology, Liaquat University of Medical & health Sciences Jamshoro from 1stJanuary 2020 to 31stDecember 2020. Methodology: Five hundred and eighty nine confirmed cases of tuberculosis patients were enrolled. The patients were further analyzed to assess either HBV, HCV or both are present or absent. Results: Three hundred and forty one (57.8%) were males and 248 (42.1%) were females. The majority of participants were in the age group of 45-54 years 147 (24.9%).The residence detail showed that 167 (28.3%) belonged to urban areas. Further 143 (24.2%) had sickness history of 2-6 months, 239 (40.5%) had history of 6-12 months, The prevalence of hepatitis B and C among tuberculosis patients showed, 17.8% (n=105) with Hepatitis B, 26.3% (n=155) were diagnosed with hepatitis C, 15.7% (n=93) had Both Hepatitis B and C, however 236 (40.0%) had no history with hepatitis. Hepatitis C was most frequently found age of above 54 years, 55 (9.3%). Conclusion:The control of tuberculosis has remained one of the greatest goals globally till date, the higher risk of liver complications, along with the Hepatitis B and Hepatitis C. Although the complications of Tuberculosis patients remain unsolved yet the possible efforts can be made to identify the earlier problems for the clinical prospective and a complete follow up of the records can optimize the management of Tuberculosis in co-existing conditions of hepatitis B and C. Key Words: Hepatitis B, Hepatitis C, Tuberculosis, Liver diseases

With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH. A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool. According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P

Background: Female pattern hair loss is also observed in women without increased androgen levels. Vitamin D is a factor that has recently been considered in dealing with these patients. Deficiency of Vitamin D might be correlated with diffuse hair loss. Objective: To determine the frequency of serum levels of Vitamin D3 in patients with female pattern of hair loss (FPHL) at tertiary care hospital Karachi. Methodology: This cross-sectional research was conducted upon a sample of 163 female patients (chosen via non-probability – consecutive sampling) presenting to the Dept. of Dermatology, Abbasi Shaheed Hospital, Karachi from 29th July 2018 to 28 th January 2019, with a clinical diagnosis of FPHL. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and inferences obtained from blood tests (CBC, serum ferritin, TSH level and vitamin D level). Serum 25 OH Vitamin D level < 20 was taken as deficient, 21-29 was insufficient and over 30 was sufficient. Data was analyzed using SPSS. v. 21.0. Results: The mean age was 30.39±6.36 years. Mean FPHL duration was 5.85±2.89 months. Total 63.2% patients were classified as mild, 26.45% patients were classified as moderate and 10.4% patients were classified as severe. Total 73% patients were found as vitamin D deficient, 22.1% as vitamin D insufficient and 4.9% as vitamin D sufficient. Significant association of vitamin D deficiency was observed with education status, vitamin D intake since past 6 months, and socio economic status. Conclusion: Results showed high vitamin D3 deficiency (73.0%) among patients with female pattern of hair loss (FPHL).