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Objectives: To predict the role of different clinical and biochemical parameters in identifying nonalcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) in Abha city, southwestern Saudi Arabia. Methods: A stratified random sample was selected. A detailed clinical and biochemical examinations were performed. Using portable abdominal ultrasound examination, NAFLD was identified. The study used receiver operating characteristic (ROC) analysis. Results: The study covered 237 T2DM patients. NAFLD was detected among 174 patients. Area under the curve (AUC) calculations showed that the ability of age, duration of DM in years, and body mass index to predict NAFLD was poor (AUC < 0.6). Similarly, biochemical factors like HbA1c%, AST, cholesterol, triglycerides, HDL, LDL, and VLDL were poor in discriminating between those with and without NAFLD among T2DM. On the other hand, the ability of ALT to predict NAFLD among T2DM was good (AUC = 0.701, 95% CI: 0.637–0.761). The analysis identified the optimal cutoff point of ALT to be ≤22.1 nmol/L. The corresponding sensitivity was 60.7% (95% CI: 53.0–68.0) and specificity was 62.5% (95% CI: 49.5–74.3). Conclusions: Early identification of NAFLD among T2DM is important. A threshold cutoff value of 22.1 nmol/L of ALT has been identified to predict NAFLD. They should be referred for ultrasound examination for NAFLD.

Background & Objective: Despite the fact that knowledge enhancement workshops are held in medical sciences universities of the country, studies have shown that the status of programs and activities related to these workshops have not been evaluated. In this regard, the present study aimed to describe the experiences of faculty members from knowledge enhancement workshops held at Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran. Materials & Methods: This inductive qualitative study was performed based on conventional content analysis from October 2021 to May 2022. The required data were collected through 18 in-depth semi-structured and in-person interviews with 16 faculty members of Ahvaz Jondishapur University of Medical Sciences. Participants were selected by purposive sampling method and the sampling continued until data saturation. The data were analyzed in MAXQDA software (version 10) using the Braun and Clarke method. Results: The interviews were divided into more than 401 open codes, 31 subcategories, 14 categories, and 2 main categories (themes). The themes that emerged included "challenges and weaknesses" and "solutions to improve the workshops". The theme of challenges and weaknesses was divided into eight categories, including the topic needs assessment, appropriateness of the content, methods of holding and teaching, registration in workshops, the time of workshops, the place of workshops, evaluation methods, and instructors of workshops. Moreover, the theme of solutions was divided into six categories, namely improvement of the selection process of instructors, usage of the capable and expert selection process of instructors, improvement of the topic needs assessment methods, modification of content matters, facilitation of information channels, and improvement of the categorization evaluation system. Conclusion: The main goal of knowledge enhancement workshops is to improve the abilities of professors. Therefore, paying attention to the challenges, weaknesses and providing solutions can improve the quality of these workshops and also encourage the faculty members to participate in them.

Objective: To assess the existing healthcare and delivery services and to evaluate the factors that affect the effectiveness of the care of patients. Study Design: Cross-sectional study. Place and Duration of Study: Seven Districts Headquarter Hospitals of Azad Jammu and Kashmir Pakistan from Dec 2020 to May 2021. Methodology: The data were collected using a questionnaire based on the Material Safety Data Sheet (MSDS) set standards by Punjab Healthcare Commission (PHC) for monitoring and evaluating the services delivery at the hospitals. Data were collected by observing every department of the hospital, interviewing the concerned person of every department, and checking the medical record of the hospital. Results: All the seven DHQ hospitals including DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber, and DHQ Mirpur were working throughout the week and service delivery was ensured for 24 hours in all health facilities. It was observed in this study that the management of medication was the area with the highest degree of compliance (76.2%). On the other hand, the area involving patient rights and education showed the lowest level of compliance with an average score of 6 and a percentage compliance of 25%. Conclusion: The compliance of health delivery services with respect to MSDS was very low in district headquarter hospitals of AJK. Targeted strategies are needed to improve the overall quality of the service delivery.

Abstract Objective: To determine the association between osteoporosis and dyslipidemiain pre-menopausal women. Study Design: Comparative cross sectional study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, from Jul to Dec 2014. Methodology: In study group A, fifty (n=50) osteoporotic females were taken, while same number offemales were included in group B. Detailed medical history of every patient was documented. Fasting blood samples were obtained and analyzed for plasma glucose, bone profile and serum lipid profile. Dyslipidemia was assessed using guidelines from the National Cholesterol Education Project Adult Treatment Panel III (ATP III) and was defined as “total cholesterol >6.2 mmol/l, HDL-C 3.4 mmol/l or triglycerides >2.3 mmol/l”. Results: Among 100 study participants, the difference in mean ages of group A and group B was insignificant (44.32 ± 5.17 yearsand 43.46 ± 5.53 years, p>0.05). Frequency of dyslipidemia was significantly higher in group Athan their group B (p

Objective: To examine the effects of delayed admission to rehabilitation on functional outcomes in post stroke patients. Study Design: Observational study. Place and Duration of Study: Department of Physical Medicine and Rehabilitation of Combined Military Hospital Kohat, from Sep 2016 to Sep 2017. Material and Methods: A total of 55 patients with age ranging from 20-80 years who were diagnosed with first ever stroke and reported within 150 days of the onset of stroke to rehabilitation setup were selected through non-probability purposive sampling. The patients were divided into 2 groups as early (group-A ≤30 days) and delayed admission group (group-B=30-150 days) based on the length of time from stroke onset to admission to inpatient rehabilitation facility. Reasons for delay admission were identified and noted. Functional independence measure (FIM) score was used to assess functional status of the patient at admission. Patients in both groups underwent identical eight weeks of regular rehabilitation program with therapy sessions 3 hours a day, 5 days a week. Functional independence measure score was noted again at eight week of indoor rehabilitation. Results: Total 52 patients completed the study with 27 (51.9%) male and 25 (48.1%) female. Lack of awareness of Rehabilitation was the most common patient related factor found in 11 (34.4%) while Lack of care giver support was most common external factor reported in 6 (18.7%). The patients with early admission to inpatient rehabilitation facility had a better functional independent measurement scores gain than the patients with delayed admission to inpatient rehabilitation facility (40.4 ± 11.4 vs. 11.9 ± 8.4, p=0.01). However, FIM scores at admission in both groups were not statistically significant. Conclusion: Delayed admission to inpatient rehabilitation facility after stroke event caused poorer functional outcomes in stroke patients.

Objective: To compare the intra-articular corticosteroid versus physiotherapy in the management of adhesive capsulitis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient department, at Armed Forces Institute of Rehabilitation Medicine, from Jul 2013 to Jul 2015. Material and Methods: A total of 90 patients with adhesive capsulitis were enrolled as per inclusion criteria by non probability consecutive sampling. Forty five patients were assigned to group “A” and were given intra-articular injection of triamcinolone 40mg (2ml) and bupivacain 2ml into the shoulder joint. Group “B”, having forty five patients received eight session of physiotherapy on alternate day. Outcome measure included mean pain score using visual analogue scale at six week follow-up. Results: Statistically significant improvement in pain score on visual analogue scale was found in patients with group “A”, with improvement in score from 7.2 ± 0.91 at the start of the study to 5.6 ± 0.18 at six week follow-up (p

Fibroblast growth factor-21 (FGF21) levels are elevated in patients with primary mitochondrial disorders but have not been studied in patients with inborn errors of metabolism (IEM) known to have secondary mitochondrial dysfunction. We measured plasma FGF21 by ELISA in patients with and without IEM. FGF21 levels were higher in patients with IEM compared to without IEM (370 pg/dL vs. 0–65 pg/dL). Further study of FGF21 as a biomarker in IEM is warranted.

Trifunctional protein deficiency/Long-chain hydroxyacyl-CoA dehydrogenase deficiency (LCHAD/TFP) deficiency is a disorder of fatty acid oxidation and ketogenesis. Severe neonatal lactic acidosis, cardiomyopathy, and hepatic dysfunction are caused by the accumulation of toxic long-chain acylcarnitines. The feasibility of umbilical cord blood use in screening for acylcarnitine analysis and free carnitine has been hypothesized but not reported in LCHAD/TFP neonates. We present a 4 week old female who was at risk of inheriting LCHAD/TFP deficiency and was diagnosed at the time of delivery using umbilical cord blood. Umbilical cord blood was collected at delivery and sent for acylcarnitine analysis. Treatment was started immediately. Acylcarnitine analysis demonstrated findings that are consistent with a biochemical diagnosis of LCHAD/TFP deficiency. Patients with LCHAD/TFP deficiency should have treatment initiated as early as possible to avoid acute decompensation and minimize the long-term complications of the disorder including cardiomyopathy. In pregnancies at risk of having a child with LCHAD/TFP deficiency, umbilical cord blood sample is an efficient method to diagnose an inborn error of metabolism such as LCHAD/TFP deficiency.

Purpose: The prevalence of cerebral palsy is high in Pakistan, however, it needs to be further explored. This study aimed at assessing clinical presentations and etiological factors among children with cerebral palsy in a Pakistani hospital. Materials and Methods:It was a descriptive case series recruiting 102 children who presented to cerebral palsy rehabilitation clinic of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi fulfilling the criteria adopted by Surveillance of Cerebral Palsy in Europe. Results:Of 102 children, 46 (45.1%) were male and 56 (54.9%) were female with a mean age of 5.6 +/- 2.25 years. Spastic cerebral palsy was the commonest presentation (90.2%) mainly presenting as diplegia (33.3%) and quadriplegia (32.4%) followed by atonic, ataxic/mixed and athetoid CP accounting for 3.9%, 3.9%, and 2.0% respectively. Birth asphyxia was the most encountered etiologic factor (32.4%) followed by prematurity (26.5%), kernicterus (12.7%) and meningoencephalitis (10.8%). Spastic quadriplegic and diplegic CP were primarily related to birth asphyxia, hemiplegic, ataxic and mixed CP to prematurity and atonic and athetoid CP to kernicterus. Conclusion:Spastic quadriplegia or spastic diplegia are the commonest presentations in Pakistani children diagnosed with CP. The frequent etiological factors in CP development are birth asphyxia, prematurity, meningoencephalitis and kernicterus. [Cukurova Med J 2014; 39(4.000): 705-711]

Omuz ağrısı ve kas zayıflığının pek sık rastlanmayan olmayan bir nedeni de Supraskapular sinir hasarıdır. Supraskapular sinirdeki lezyonlar, Supraspinatusda ya da Spinoglenoid Notchda ortaya çıkabilir. Burada yıkama işiyle uğraşan 26 yaşındaki hastanın sol omuzunda ağrı saptanmıştır. Klinik değerlendirme ve elektrodiagnostik çalışmalar; Spinoglenoid Notchda sol suprascapular sinirde hasar meydana geldiğini göstermiştir. Hastaya altı hafta boyunca dinlenme, denetimli fizyoterapi ve non-steroid anti-inflamatuar ilaçlar verilmiştir. Bunu izleyen süreçte hastanın fonksiyonel aktivitesinde gelişme ve ağrıda azalma gözlenmiştir.

Introduction: There is a powerful relationship between high-risk human papillomaviruses and lung cancer. In fact, inactivation of p53 is the most common genetic abnormality in lung cancer. Indeed, the frequency of HPV types and TP53 mutations in squamous cell carcinoma of lung, among patients from the northwest of Iran has been evaluated in this article. Methodes: Fifty Paraffin embedded blocks of lung SCC were selected for detection of HPV DNA by Nested PCR, and then DNA was sequenced for HPV typing. Equal numbers of positive and negative samples for the HPV DNA were examined for the presence of mutations in exons 5-7 of the TP53 gene by PCR and direct sequencing. Results: Overtly 9 (18%) of 50 samples presented the HPV DNA: eight were HPV-18 and one was HPV-6. TP53 mutations were found in 5 samples (27.7%). Of these, 4 cases showed mutations in exon 5 and one case contained a mutation in exon 7.The most frequent mutation in exon 5 was the C to G transversion (c.409C>G), and also the T to A tansversion (c.770T>A) in exon 7. Conclusion: This study showed that HPV-18 is more likely to conscequence in the development of lung cancer among some communities. Genetic alterations, alongside with environmental factors, all play a significant role in the pathogenesis of lung cancer.

Suprascapular Nerve injury is an uncommon cause of shoulder pain and weakness. Lesions of the Suprascapular Nerve can occur at the Supraspinatus or the Spinoglenoid Notch. We present here, report of a 26-year-old washer man who presented with pain in left shoulder and difficulty washing clothes. Clinical evaluation and electrodiagnostic studies confirmed injury to the left Suprascapular Nerve at the Spinoglenoid Notch. The patient was managed conservatively for six weeks with relative rest, supervised physiotherapy and non-steroidal anti-inflammatory drugs, following which he showed substantial reduction in pain and improvement in functional activities.

Amaç: Pakistan"da serebralpalsi frekansı yüksektir ancak bu durumun daha fazla araştırılması gerekmektedir. Bu çalışmanın amacı Pakistan"da hastanede serebralpalsili çocuklar arasında klinik sunumların ve etyolojik faktörlerin değerlendirilmesidir. Materyal ve Metod: Bu çalışmaya dahil edilen 102 çocuk, Avrupa"daki Surveillance of CerebralPalsyde gözetim altında bulunan çocuklarla aynı kriterlere sahiptir ve Rawalpindi"de Silahlı kuvvetler rehabilitasyon merkezi enstitüsünde bulunmaktadır. Bulgular: 102 çocuktan 46"sı (%45.1) erkek, 56"sı (%54.9) kızdır, çocukların ortalama yaşları 5.6 ± 2.25" tir. En sık spastik serebralpalsi (%90.2) görülmektedir, bu da dipleji (%33.3), kuadriplejiyi (%32.4) takip eden 3.9% atonik, % 3.9 ataksik/karışık ve %2 atedoit CP olarak görülmektedir. Doğum asfiksisi en sık karşılaşılan etyolojik faktördür (%32.4) bunu prematürite (%26.5), kernikterus (%12.7) ve meningoensefalit (%10.8) takip etmektedir. Spastik kuadriplejik ve diplejik CP, ana olarak doğum asfiksisi, hemiplejik, ataksik ve karışık CP prematurite, atonik ve atedoit CP ise kernikterus ile ilişkilidir. Sonuç: Spastik kuadripleji veya spastik dipleji ,CP teşhisi konulan Pakistanlı çocuklarda en sık karşılaşılan durumlardır. CP gelişiminde en sık karşılaşılan etyolojik faktörler doğum asfeksisi, prematürite, meningoensefalit ve kernikterustur.