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Objective: To determine an association of single nucleotide polymorphism of the NRF2 gene (RS6721961) with semen parameters of primary male infertility patients in the Pakistani population. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Biochemistry, Islamic International Medical College, Rawalpindi, in collaboration with two private infertility clinics (American Infertility Center, Rawalpindi and Mother and Child International Hospital and Research Institute, Mirpur, AJK) from Oct 2020 to Sep 2021. Methodology: A total of 288 participants were included in this study. There were 144 diagnosed cases of primary male infertility and 144 healthy fertile males, age and ethnicity matched controls. Blood samples were collected from participants after obtaining written informed consent. DNA was extracted by the Chelex TM Methodoogy. Multiplex PCR was done to determine the respective allelic frequencies of NRF2 (RS6721961) genotypes using specific primers. Results: There was no significant association between NRF2 genotypes and semen volume and semn colour in infertile males (p-value 0.32 and 0.84, respectively). Out of 144 cases, 111 (77%) had normal sperm count, 29 (20.1%) had oligospermia, while 4 (2.7%) patients had azoospermia. A significant association was observed between NRF2 genotypes and sperm concentration of infertile males (p-value <0.001). Out of 144 cases, 80 (55.5%) had normal motility, 57 (39.5%) had asthenospermia while 7 (8.4%) patients had necrospermia. A strong association was observed between NRF2 genotypes and sperm motility in infertile males (p-value <0.001). Conclusion: Single nucleotide polymorphism (RS6721961) of the NRF2 gene is significantly associated with sperm concentration and sperm motility in infertile males in the studied Pakistani population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of combination therapy of platelet rich plasma (PRP) with arthrocentesis and to compare it with arthrocentesis alone in the temporomandibular dysfuction (TMD) patients. Study Design: Quasi experimental study. Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Combined Military Hospital Rawalpindi, from Jan 2017 to Jun 2019. Methodology: Forty-two patients diagnosed with refractory unilateral temporomandibular dysfuction, were included in the study. Patients were divided in two groups with 21 temporomandibular joints in each. Arthrocentesis alone was the control group (group I) and arthrocentesis with intra-articular injection of platelet rich plasma (group II) was the study group. Treatment outcomes were assessed and compared for all patients based on clinical parameters of pre and post treatment; for pain, maximal mouth opening and temporomandibular joint clicking sounds. Results: Out of 42 patients, 33 (79%) were females and 9 (21%) were males with mean age of 34.3 ± 8.4 years. There was statistically significant difference in both groups for all variables. The p-value of maximum mouth opening of both groups before and after treatment was 0.746 and 0.01, joint clicking sounds were present in 69% of our patients before the treament and it reduced to 14% after the treatment. There was marked gradual decrease in pain of both groups, group I (6.48 ± 1.470 to 1.81 ± 0.602) and group II (7.29 ± 1.007 to 1.19 ± 0.402). Conclusion: Combination therapy of platelet rich plasma with arthrocentesis is more effective treatment method than arthrocentesis alone for chronic temporomandibular dysfuctions. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2-cyanoacrylate treatment. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019. Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted. Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005). Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks. [ABSTRACT FROM AUTHOR]

Objective: To determine prevalence of depression among university students in Pakistan according to patient health questionnaire. Study Design: Cross-sectional survey. Place and Duration of Study: University of Karachi, from May 2017 till Aug 2017. Methodology: Depression was assessed by using Patient Health Questionnaire. Questionnaire was distributed to 130 students of different departments. Results: Response rate of our study was 72.30%. Males were slightly more (51.10%) than females in our survey. Majority of our survey participants belonged to on-campus (59.60%) courses. Students belonging to Punjabi community were having the highest participation (35.10%) in the survey. Urdu speaking and Pathan students were next in line with higher participation (33% and 21.30% respectively). The number of the students from Anatomy department was in higher proportion (59.60%). A big majority of students belonged to moderate to severe depression categories (54.30%, 13.80% and 10.60% with moderate, moderately severe and severe depression respectively). Females were suffering more from moderate to severe depression (78.20%) than the males. Students younger than 22 years of age were suffering more from depression according to our study (92.50%). Sindhi students were all suffering from severe depression while those of Urdu speaking were in moderate to moderately severe category. Conclusion: Hence it is concluded from our survey that four out of five students are suffering from depression and it was also affected by different demographic variables as well. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the treatment outcomes of isolated mandibular angle fractures managed by open reduction and internal fixation using intra oral and extra oral approaches. Study Design: Randomized control trial. Place and duration of Study: Department of oral and maxillofacial surgery, Liaquat University Hospital Hyderabad, from May 2011 to Nov 2011. Patients and Methods: The patients who presented with isolated mandibular fracture were selected according to inclusion criteria. The diagnosis was made by standard history, clinical examination and radiographic investigations. The patients were randomly divided into two groups, A and B. Group A patients were managed by extra oral approach and group B patients were managed using intra oral approach. The patients were prescribed antibiotics for one week and follow up was carried for four weeks. Nerve damage, limited mouth opening, infection, mal-occlusion, hypertrophic scar and aesthetic dissatisfaction were immediate and late post operative complications observed and documented. Results: Road traffic accident (RTA) was the main etiologic factor (66.66%). Marginal mandibular nerve damage was noted in 20% cases treated with extra oral approach (group A). Post operative esthetic dissatisfaction was present in 60% patients (group A) as compared to 6.66% of the patients (group B). The rate of mouth opening compromise and mal-occlusion were also higher in the patients treated with extra oral approach compared with intra oral approach, although statistically not significant. Conclusion: The intra oral approach for mandibular angle fracture management is an effective and comparatively better technique as compare to the extra oral approach. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safely of oral surgical procedures without stopping low dose aspirin. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Rawalpindi, from Mar 2008 to Mar 2009. Material and Methods: Seventy patients taking aspirin 75 to 150 mg daily and requiring minor oral surgery were included. Patients were randomly divided into two groups, group A (control group) who stopped taking aspirin and group B (intervention group) in which aspirin was not stopped. Their bleeding time (BT) and platelet count were assessed before surgery. Suturing and pressure pack were used to control bleeding. Data were entered in SPSS version 10. Results: Out of 70 patients, 48 (68.57%) were male and 22 (31.43%) female. The mean age was 58.83 ± 10.94 years. The mean bleeding time was 2.23 ± 0.013 minutes for group A, and 2.71 ± 0.12 minutes for group B. The difference was statistically significant (p=0.01). Severe bleeding was noted in 2 patients from group A and 3 patients from group B, but local haemostatic measures were sufficient to control bleeding. Conclusion: The patients on low dose aspirin can safely undergo routine minor oral surgical procedures, without alteration in their regular therapeutic aspirin regimen. [ABSTRACT FROM AUTHOR]

Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015. Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure. Results: All patients who underwent ligation and excision procedures did well initially. One (3.2%) patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five (16.1%) patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero. Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization. [ABSTRACT FROM AUTHOR]

Objective: To study the morbidity and mortality of early laparoscopic cholecystectomy in acute cholecystitis by comparing its results with laparoscopic cholecystectomy in chronic cholecystitis and simple cholelithiasis. Study Design: Quasi-experimental study. Place and Duration of Study: Pakistan Naval Ship (PNS) Shifa Hospital Karachi and Combined Military Hospital (CMH) Lahore Pakistan, from Nov 2009 to Jan 2013. Material and Methods: Total 398 patients with symptomatic gall stone disease were included in the study after exclusion of patients with upper abdominal surgery, perforated gallbladder with abscess formation, cardiopulmonary disease, equipment failure and those with choledocholithiasis. Cholecystectomy was performed using a three port technique in most of the cases. On the basis of per-operative findings regarding degree of inflammation of gallbladder, all patients were divided into three groups irrespective of duration of symptoms i.e. acute cholecystitis group, chronic cholecystitis group and no inflammation group. The collected data included age, sex, diagnosis, history of previous surgery, co-morbidities, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications. Statistical comparison was performed using the chi square test. Statistical significance with value of p was less than 0.05 was considered significant. Result: Out of 398 patients, 31.2% had acute cholecystitis, 10.1% had chronic cholecystitis and 58.8% had no inflammation of gall bladder. Complication rates and conversion rates were higher in chronic cholecystitis group as compared to acute cholecystitis group and no inflammation group. Similarly, mean hospital stay was also highest in chronic cholecystitis group. Conclusion: Early laparoscopic cholecystectomy was found safe in acute cholecystitis in expert hands and should be performed in all cases of acute cholecystitis rather than delayed interval cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy (OC) in 450 patients who underwent laparoscopic cholecystectomy (LC) by the same surgeon in tertiary care teaching hospitals. Study Design: Descriptive study. Place and Duration of Study: The study was conducted initially at Pakistan Navalship (PNS) Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013. Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was filled which included the demographic data of the patients, indications for cholecystectomy, histories of previous abdominal surgery, their comorbidities (if any), operating time, intraoperative findings, complications, post-operative hospital stay and rate and reasons for conversion to open cholecystectomy (if required). Results: Out of 450 consecutive patients for whom LC was attempted by a single surgeon, 7 patients (1.6%) were converted to OC. There were 380 female and 70 male patients (F: M ratio 5.4:1). Their mean age was 44.6 ± 13.5 years, ranging from 9-82 years. All patients who required conversion to OC were females. The mean operating time was 38.9 ± 16.2 minutes (range 15-120 minutes). The reasons for conversion included cystic artery bleeding², liver bed bleeding¹, common hepatic duct injury¹, cholecystoduodenal fistula¹, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle¹ and cystic duct avulsion¹. Conclusion: The overall rate of conversion to OC was 1.6%. Laparoscopic cholecystectomy is a safe procedure with very little chances of conversion to open even in acute cases, when performed by an experienced surgeon. [ABSTRACT FROM AUTHOR]

Objective: To determine glucose levels in late preterm and term newborns at one hour of life in our population, along with the frequency of symptomatic hypoglycemia and it's known risk factors. Study Design: Descriptive study Place and Duration of Study: Quaid-e-Azam International Hospital (QIH) Islamabad from July 2012 to September 2013. Material and Methods: Two hundred and seventy newborns were selected by consecutive purposive non probability sampling who were born at QIH either by spontaneous vaginal delivery or cesarean section. Only healthy neonates were included. Gestational age, weight, fetal and maternal risk factors were assessed. Glucose level was measured by glucometer at 1 hour of life after first feed. Neonates that became symptomatic with low glucose levels were thoroughly studied, readings reconfirmed from laboratory and were promptly managed. Results: Thirty (11%) babies showed sugar level < 30 mg/dl at 1 hour of life. Out of them 18(60%) were late preterm and 12(40%) were term babies. Out of them 12(40%) babies weighed <2kg, 8(26%) were between 2-2.5 kg and 6(20%) were 2.5-4.0 kg while 4(14%) babies were between 4.0 to 4.6 kg. Only 6(2.2%) newborns became symptomatic with low sugar level. Among symptomatic newnates, 4 mothers had gestational diabetes and other two were with pregnancy induced hypertension (PIH). Important risk factors were gestational diabetes, PIH, fetal distress and SGA babies. Safest lower glucose level was found to be 30 mg/dl at 1 hour after birth. Conclusion: Plasma glucose levels measured at 1 hour of life in late preterm and term newborns in our population are consistent with international studies. Frequency of symptomatic hypoglycemia is quite low and normal newborns without risk factors do not need screening. However one needs to be vigilant in babies with risk factors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of peripheral streptomycin injection in relieving the pain of idiopathic trigeminal neuralgia Study Design: Quasi experimental study. Place and duration of Study: Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry Rawalpindi, from 1st June 2006 to 31st December 2007. Patients and Methods: Thirty patients of idiopathic trigeminal neuralgia were selected. They received five consecutive injections of streptomycin 1g in 3 ml of 2% Lignocaine (Septodont) with 1: 100,000 adrenaline at one week interval. Follow up was carried out at one, two and six months after the last injection. Results: Age ranged from 15-78 years (mean 44.67). Male to female ratio was 1:1.14. Right side of the face was involved in 70% and left side in 30% cases. Mandibular division of trigeminal nerve was involved in 43.3% and maxillary division in 40% of the cases. In the rest both maxillary and mandibular divisions were involved. Pain was significantly decreased from baseline to 1 month (p < 0.001). The level of pain was increased a bit but the increase was significant at two months (p = 0.006) and at 6 months (p = 0.020). Conclusion: Best treatment modality for this devastating disease is yet to evolve. Within the confines of the study it can be stated that efficacy combined with low post treatment morbidity makes streptomycin a useful treatment option. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the complications of first 400 laparoscopic cholecystectomies (LC) for patients with symptomatic gall stone disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: PNS Shifa Karachi and CMH Lahore, Pakistan from Nov 2009 to Jan 2013. Patients and Methods: A prospective analysis of complications occurring in first 400 consecutive laparoscopic cholecystectomies by a single consultant/unit at a tertiary care hospital was made. Out of total 421 patients presenting with symptomatic gall stone disease in a single unit, 21 cases that underwent open cholecystectomy were excluded from the study. Laparoscopic Cholecystectomies were performed using three port and four port technique and data including age, sex, diagnosis, number of trocar placements, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications was collected on personal computer and analyzed using Statistical package for social sciences (SPSS) version 13. Results: Total 400 patients were included in study with median age of 44years. Female to male ratio was 5.3: 1. Depending upon the preoperative diagnosis and laparoscopic findings, patients had diagnosis of Chronic cholecystitis / biliary colic 68.25%, acute cholecystitis 23.75%, empyema gall bladder 7.25%, gallstone pancreatitis 0.5% and mucocele gallbladder 0.25%. Median operating time was 30 min. Median hospital stay was 1days (range 1 - 20 days). Conversion rate was 1.25%. Postoperative complications included bleeding 0.5%, biliary peritonitis due to cystic duct leak 0.25%, biloma 0.25%, sub hepatic abscess 0.25%, subcutaneous fat necrosis right flank at drain site 0.25%, umbilical trocar site infection 2%, keloid at umbilical port site 0.25% and incisional hernia at umbilicus 0.25%. There was one hospital death due to myocardial infarction on 2nd post-operative day. Conclusion: Laparoscopic Cholecystectomy is associated with some serious complications which can be avoided with adequate training of surgeons as well as knowledge of mechanism of typical complications. [ABSTRACT FROM AUTHOR]

Objective: To find out the effectiveness and safety of laparoscopic cholecystectomy for treatment of empyema gallbladder. Study Design: Quasi-experimental study. Place and duration of study: PNS Shifa Karachi and CMH Lahore, Pakistan from January 2010 to August 2013. Material and Methods: Out of 493 patients who underwent laparoscopic cholecystectomy (LC) by a single consultant surgeon during the study period, 40 patients who had empyema gall bladder on laparoscopic findings were included in the study. All patients with diagnosis of acute cholecystitis (n=117) who had no pus present in gall bladder and patients with diagnosis of biliary colic or chronic cholelithiasis (n=336) were excluded from the study. Results: Forty patients were diagnosed to have empyema gall bladder. LC was successfully completed in 39 patients (97.5%). In one patient (2.5%) the procedure was converted to open cholecystectomy (OC) due to finding of cholecystoduodenal fistula on laparoscopy. Mean operating time was up to 58.62 ± 26.33 minutes. Postoperative complications occurred in 3 (7.5%) of the operated patients. Mean duration of hospital stay was 1.7 ± 2.09 days. One patient with co-morbidity of diabetes mellitus died of septicemia resulting in a mortality rate of 2.5%. Conclusion: In laparoscopy for empyema gallbladder the complications are related to the advanced disease process and not to the approach. In skilled hands, laparoscopic cholecystectomy can be performed successfully in patients with diagnosis of empyema gallbladder. [ABSTRACT FROM AUTHOR]