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Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B & C patients were found to have more significant malnourished states.

Backgrounds:. Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. Methods:. PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) 30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF 10.0% is not appropriate for all eligible districts.

Objective: To gauge the effect of increasing access to care and streamlining testing and diagnosis on hepatitis C burden (incidence of disease, rate (%) of complications, adverse events and mortality) in a rural population. Methodology: This quasi-experimental research was conducted at Taluka Gambat (Khairpur, Sindh, Pakistan) from August 2019 to January 2021. This public health intervention, comprised of establishing collection points, near healthcare centers in Gambat Taluka, that facilitated the sample collection, transport and testing of patient samples (for Hep C). The test results along with basic biodata, sociodemographic details, disease particulars, presenting signs and symptoms (and their duration), of consenting patients, were recorded onto a structured questionnaire and the data analyzed using SPSS. v. 21.0. Results: A total of 492 individuals were studied. The mean age of the sample was 32.5± 6.9 years with an age range of 18 to 65 years. Pre-Intervention (establishment of collection units) records showcased a lower frequency of cases being reported, which jumped to more than three-fold following provision of greater access to testing and diagnosis. The number of cases presenting with Hep C complications though, steadily declined (from 66.7% to 12.1% - p: < 0.05), and the mortality rate took a significant dive (33.3% to 0% - p: < 0.05). The incidence of diagnosed cases presenting with adverse outcomes (liver cirrhosis, liver failure and hepatic carcinoma) fell sharply, from 33% to 6.1% - p: < 0.05. Conclusion: Enhanced access to care and streamlining testing and diagnosis, overtime reduced the disease burden associated with Hepatitis C, by identifying patients with the disease early before the disease progresses and leads to adverse events.

Malaria microscopy, microscopic examination of stained blood slides to detect parasite Plasmodium, is considered to be a gold-standard for detecting life-threatening disease malaria. Detecting the plasmodium parasite requires a skilled examiner and may take up to 10 to 15 minutes to completely go through the whole slide. Due to a lack of skilled medical professionals in the underdeveloped or resource deficient regions, many cases go misdiagnosed; resulting in unavoidable complications and/or undue medication. We propose to complement the medical professionals by creating a deep learning-based method to automatically detect (localize) the plasmodium parasites in the photograph of stained film. To handle the unbalanced nature of the dataset, we adopt a two-stage approach. Where the first stage is trained to detect blood cells and classify them into just healthy or infected. The second stage is trained to classify each detected cell further into the life-cycle stage. To facilitate the research in machine learning-based malaria microscopy, we introduce a new large scale microscopic image malaria dataset. Thirty-eight thousand cells are tagged from the 345 microscopic images of different Giemsa-stained slides of blood samples. Extensive experimentation is performed using different CNN backbones including VGG, DenseNet, and ResNet on this dataset. Our experiments and analysis reveal that the two-stage approach works better than the one-stage approach for malaria detection. To ensure the usability of our approach, we have also developed a mobile app that will be used by local hospitals for investigation and educational purposes. The dataset, its annotations, and implementation codes will be released upon publication of the paper.

Background: Obesity and metabolic syndrome (MS) are prevalent and associated with negative health outcomes in the elderly. There is a need to identify risk factors for these diseases in this population. Methodology: The 2013-14 National Health and Nutrition Examination Survey was used in this study. Adults aged 60 or under were categorized into normosmia, hyposmia, anosmia, and combined anosmia + hyposmia using the Pocket Sniff Test. Taste was evaluated using quinine and NaCl solutions. Multivariate logistic regression models were used to characterize associations between smell and taste status and obesity and MS. Results: In univariate obesity analysis, normosmia, combined anosmia + hyposmia, and 0.32M NaCl taste dysfunction were significant. 0.32M NaCl taste dysfunction remained significant in multivariate analysis. MS was significantly associated with only tongue tip quinine dysfunction in univariate and multivariate analyses. Conclusions: Salty taste dysfunction was found to be negatively associated with obesity while bitter taste dysfunction was found to be positively associated with MS.

Background and objectives: ABO blood group distribution defers with racial and geographic variations. They are related with diseases like cardiovascular diseases, cerebral thromboembolism. Prothrombin time may varies among ABO blood group system which may increase the future risk of thrombosis. The present study is to assess prothrombin time among ABO blood groups in healthy adults. Materials and methods:A prospective type of analytical cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020. After obtaining ethical clearance, a total 190 healthy adults were selected from different areas of Dhaka city based on inclusion and exclusion criteria, with age ranging from 18-45 years. The subjects were interviewed and detailed history regarding personal, family, medical and drug were taken. Prior to sample collection, informed written consent was taken from the participants. Individuals of blood group A was selected as group A, blood group B as group B, blood group AB as group AB and blood group O as group O. Prothrombin time was measured in the Department of Hematology and BMT Unit, Dhaka Medical College Hospital, Dhaka. Blood grouping was done in the Department of Physiology, Dhaka Medical College, Dhaka.For statistical analysis, One way ANOVA followed by Bonferroni test were considered using SPSS 25.0 version. Results:In this study, blood group B was most common (33.2%). Prothrombin time was lower in blood group A (12.93±0.30 sec), B (12.92±0.61 sec), AB (12.98±0.54 sec) than blood group O (13.08±0.39 sec) which was not statistically significant. Conclusion:It can be concluded that blood group A, B, AB individuals may have more chance of thrombosis due to lower prothrombin time than blood group O individuals.

Background:Intracranial hemorrhage after endovascular thrombectomy is associated with poorer prognosis compared with those who do not develop the complication. Our study aims to determine predictors of post-EVT hemorrhage – more specifically, inflammatory biomarkers present in baseline serology.Methods:We performed a retrospective review of consecutive patients treated with EVT for acute large vessel ischemic stroke. The primary outcome of the study is the presence of ICH on the post-EVT scan. We used four definitions: the SITS-MOST criteria, the NINDS criteria, asymptomatic hemorrhage, and overall hemorrhage. We identified nonredundant predictors of outcome using backward elimination based on Akaike Information Criteria. We then assessed prediction accuracy using area under the receiver operating curve. Then we implemented variable importance ranking from logistic regression models using the drop in Naegelkerke R2 with the exclusion of each predictor.Results:Our study demonstrates a 6.3% SITS (16/252) and 10.0% NINDS (25/252) sICH rate, as well as a 19.4% asymptomatic (49/252) and 29.4% (74/252) overall hemorrhage rate. Serologic markers that demonstrated association with post-EVT hemorrhage were: low lymphocyte count (SITS), high neutrophil count (NINDS, overall hemorrhage), low platelet to lymphocyte ratio (NINDS), and low total WBC (NINDS, asymptomatic hemorrhage).Conclusion:Higher neutrophil counts, low WBC counts, low lymphocyte counts, and low platelet to lymphoycyte ratio were baseline serology biomarkers that were associated with post-EVT hemorrhage. Our findings, particularly the association of diabetes mellitus and high neutrophil, support experimental data on the role of thromboinflammation in hemorrhagic transformation of large vessel occlusions.

Non-small cell lung cancer (NSCLC) is the chief origin of death due to cancer. The development of a less invasive diagnostic technique for NSCLC, especially at the beginning, can improve outcomes. By means of microarray platforms, we formerly diagnosed 12 microRNAs (miRNAs) abnormally expressed in primary cancer cells associated with early NSCLC. Objective: In this study, we will extend previous studies to determine if miRNAs may be beneficial as a NSCLC potential plasma biomarker. Methods: We primarily confirmed miRNA expression from PCR of 32 stage one NSCLC patients with lung tumor and plasma specimens were assessed, then assessed the investigative value of plasma miRNAs in 61 patients of NSCLC and 30 normal subjects. It was confirmed that the alteration of MiRNA expression influences the regeneration of neoplastic tumors. MiRNAs were steady and reliable in plasma measurements. The cohort consisted of 21 men and 11 women. Their age ranges from 47 to 80 years. AC tumors were classified in 17 and SCC in 15 patients. Smoking packets use in these patients were 39 ± 28. In addition, IV blood were taken from healthy subjects with matched data distribution to studied group as age, race, sex and smoking, and aided as a control to evaluate fluctuations in plasma in cancer patients. Results: Five out of 12 miRNAs showed a significant change of level in plasma and the corresponding tumor tissue (all r40850, all P< 0.05). Four genes (miRNA-126, 21, 486-5 and 210p) set the best logistic regression pattern, with 87% sensitivity and 97% of specificity of at the time of NSCLC in differentiating from healthy patients. Moreover, the miRNA genes generated a sensitivity of 79.41% and 92.59% of specificity in patients diagnosed with SCC and AC. Moreover, genes have specificity of 96.67% in the analysis of lung adenocarcinoma and squamous cell carcinoma. (P less than 0.05). A change in square miRNA expression may offer potential NSCLC blood-derived biomarker. Conclusion: Finally, we show that miRNA expression identified from surgical tumor tissue can be easily and correctly determined in plasma. Though, prominently, a plasma miRNA recognition panel would be cast-off as a less invasive analytic method for NSCLC, including long-term adenocarcinoma. However, the presence of an independent potential biomarker requires further verification. Keywords: Lung cancer; Diagnosis; Plasma; Microrna; Qrt-PCR

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).

Background Ovarian cancer is one of the rarest lethal oncologic diseases that have hardly any specific biomarkers. The availability of high-throughput genomic data and advancement in bioinformatics tools allow us to predict gene biomarkers and apply systems biology approaches to get better diagnosis, and prognosis of the disease with a tentative drug that may be repurposed. Objective To perform genome-wide association studies using microarray gene expression of ovarian cancer and identify gene biomarkers, construction and analyze networks, perform survival analysis, and drug interaction studies for better diagnosis, prognosis, and treatment of ovarian cancer. Method The gene expression profiles of both healthy and serous ovarian cancer epithelial samples were considered. We applied a series of bioinformatics methods and tools, including fold-change statistics for differential expression analysis, DisGeNET and NCBI-Gene databases for gene-disease association mapping, DAVID 6.8 for GO enrichment analysis, GeneMANIA for network construction, Cytoscape 3.8 with its plugins for network visualization, analysis, and module detection, the UALCAN for patient survival analysis, and PubChem, DrugBank and DGIdb for gene-drug interaction. Results We identified 8 seed genes that were subjected for drug-gene interaction studies. Because of over-expression in all the four stages of ovarian cancer, we discern that genes HMGA1 and PSAT1 are potential therapeutic biomarkers for its diagnosis at an early stage (stage I). Our analysis suggests that there are 11 drugs common in the seed genes. However, hypermethylated seed genes HMGA1 and PSAT1 showcased a good interaction affinity with drugs cisplatin, cyclosporin, bisphenol A, progesterone, and sunitinib, and are crucial in the proliferation of ovarian cancer. Conclusion Our study reveals that HMGA1 and PSAT1 can be deployed for initial screening of ovarian cancer and drugs cisplatin, bisphenol A, cyclosporin, progesterone, and sunitinib are effective in curbing the epigenetic alteration.

BACKGROUND Obesity may affect efficacy and safety of biologic treatments for ulcerative colitis (UC). Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of UC. AIMS To assess efficacy and safety of tofacitinib in patients with UC, by baseline body mass index (BMI). METHODS This post hoc analysis evaluated patients with UC receiving placebo or tofacitinib from the 8-week OCTAVE Induction 1 and 2 (NCT01465763, NCT01458951) and 52-week OCTAVE Sustain (NCT01458574) studies. Patients were stratified by BMI at OCTAVE Induction 1 and 2 baseline (

Aims/Introduction This study aimed to investigate whether insulin resistance (IR) in individuals with type 2 diabetes undergoing intensive glycemic control determines the extent of improvement in neuropathy. Materials and Methods This was an exploratory substudy of an open‐label, randomized controlled trial of individuals with poorly controlled type 2 diabetes treated with exenatide and pioglitazone or insulin to achieve a glycated hemoglobin, This study shows that patients with type 2 diabetes and insulin resistance undergoing intensive glycemic control with pioglitazone plus exenatide or basal–bolus insulin show blunted small nerve fiber regeneration. Therefore, interventions, such as physical activity and weight reduction, to improve insulin resistance might benefit diabetic neuropathy, and insulin resistance should be considered when assessing the benefits of disease‐modifying therapies for diabetic neuropathy.

Background: Chronic obstructive pulmonary disease (COPD) is one of the common respiratory conditions which involves the airways and is characterized by persistent airflow obstruction. About five percent of the adult population of the world is being affected by this disease. COPD is associated with several different comorbidities. These comorbidities increase the risk of hospital admission and affect health outcomes in COPD. Aims & Objectives: To study the frequency of comorbidities in patients with COPD. Place and duration of study: The study was conducted at Department of Pulmonology of FPGMI, Shaikh Zayed Hospital. The duration of study was 6 months from 01-01-2019 to 30-06-2019. Patients & Methods: It was a cross sectional study, 115 were enrolled from OPD. The data were recorded in SPSS 20.0. Data were described by using frequencies and percentages and presented in tables, pi-charts, and bar charts. Results: Total 115 male COPD patients who consented to participate in the study were registered in the study from OPD. The mean age of the patients was 61.09±10.8 years. The co-morbidities were present in 84.3% patients, and the most common disease was hypertension (65.2%) followed by ischemic heart disease (56.5%) osteoporosis (54.8%), cardiac failure (46.9%), diabetes (40.0%), anemia (36.5%), depression (27.8%), acid peptic disease (26.0%) and malignancy (11.3%). (Figure 2) Thirty one (26.9%) patients had single comorbidity, while 39.1% of patients had two co-morbid conditions, and 18.3% had more than two co-morbidities. Conclusion: The co-morbidities in COPD patients are common & most frequent comorbidities include hypertension, ischemic heart disease, diabetes, osteoporosis and depression.

Aim To assess whether maintenance variables have a differential effect on tooth loss due to periodontitis (TLP) based on staging and grading. Materials and methods Patients treated for periodontitis for a minimum of ≥10 years follow-up were included and categorized according to their stage and grade at baseline. Impact of number, regularity, and pattern of supportive periodontal therapy visits (SPT) on TLP was explored by dividing teeth into test (5 year time periods prior to TLP events) and control groups (random 5 year periods without tooth loss). Results The regularity of maintenance visits, but not the overall quantity, had a significant impact on risk of TLP and showed higher importance as staging and grading increased (larger impact for stages III/IV and grade C). The minimum threshold of visits below which the risk of TLP was equivalent to that of the control group was one visit every 7.4 months for stages I-II, 6.7 months for stage III-IV, 7.2 months for grade B and 6.7 months for grade C. This frequency should be increased for former and current smokers, diabetics and elderly patients. Stage III and IV patients who skip more than 1 year of maintenance in a 5 year period have an increased risk of TLP (OR = 2.55) compared to those only miss 1 year. A similar trend was noted for grade C patients, but not for stages I/II or grades A/B. Conclusions Lack of SPT regularity and missing multiple years of maintenance had a larger influence on risk of TLP for higher-level staging and grading.

Background Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance. Methods Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP. Results A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA. Conclusion All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.

Aims/Introduction Painful diabetic peripheral neuropathy (pDPN) is associated with small nerve fiber degeneration and regeneration. This study investigated whether the presence of pDPN might influence nerve regeneration in patients with type 2 diabetes undergoing intensive glycemic control. Materials and Methods This exploratory substudy of an open‐label randomized controlled trial undertook the Douleur Neuropathique en 4 questionnaire and assessment of electrochemical skin conductance, vibration perception threshold and corneal nerve morphology using corneal confocal microscopy in participants with and without pDPN treated with exenatide and pioglitazone or basal–bolus insulin at baseline and 1‐year follow up, and 18 controls at baseline only. Results Participants with type 2 diabetes, with (n = 13) and without (n = 28) pDPN had comparable corneal nerve fiber measures, electrochemical skin conductance and vibration perception threshold at baseline, and pDPN was not associated with the severity of DPN. There was a significant glycated hemoglobin reduction (P, There has been a resurgence of interest in identifying new drug targets or, predictive biomarkers of disease‐modifying therapies in diabetic neuropathy. We show that the presence of painful diabetic neuropathy was associated with greater corneal nerve regeneration and an improvement in painful neuropathic symptoms in patients with type 2 diabetes undergoing intensive glycemic control.

The aim of this study was to determine if a previous history of periodontitis according to the preset definitions of the 2017 World Workshop is correlated with increased implant failure, and occurrence and severity of peri-implantitis (PI).A retrospective analysis of patients with a history of periodontitis who received nonsurgical and, if indicated, surgical corrective therapy prior to implant placement was performed. Periodontitis stage and grade were determined for each included patient based on data from the time of initiation of active periodontal therapy. Cox Proportional Hazard Frailty models were built to analyze the correlation between stage and grade of periodontitis at baseline with implant failure, as well as occurrence and severity of PI.Ninety-nine patients with a history of periodontitis receiving 221 implants were followed for a mean duration of 10.6 ± 4.5 years after implant placement. Six implants (2.7%) failed and a higher rate of implant failure due to PI was found for Grade C patients (P0.05), whereas only an increased trend was seen for Stages III and IV compared with I and II. Grading significantly influenced the risk of marginal bone loss (MBL)25% of the implant length (P = 0.022) in PI-affected implants. However, a direct correlation between higher-level stage and grade and PI prevalence was not recorded.No statistically significant association between periodontitis stage or grade and the prevalence of PI was found. However, when PI was diagnosed, there was a relationship between periodontitis grade and severity of PI or the occurrence of implant failure.

Objective: To determine the fetal outcome of Caesarean Sections (CS) performed for abnormal Cardiotocography (CTG) Material and Methods: This retrospective data review was conducted in Gynaecology and Obstetrics unit B of Lady Reading Hospital Peshawar from June 2015 till June 2016 after approval from the hospital ethical committee, using a non-probability convenient sampling technique. The hospital record of 234 patients who had CS for fetal distress was reviewed. Patients with singleton and term gestation, who had CS for fetal distress diagnosed based on abnormal Cardiotocography were included in the study. The fetal outcome was noted in terms of Apgar score at 5 minutes, admission to neonatal intensive care unit (NICU), and perinatal mortality. Fetal blood sampling (FBS) and postnatal analysis of fetal arterial blood gases and PH were not carried out in any patient because of non-availability. The results are expressed in frequencies and percentages, shown in tables and figures. Results: In one year, a total of 1255 C-sections were performed. Amongst these, 234 (18.64%) patients fulfilling inclusion criteria were enrolled. Babies delivered with 5 minutes Apgar score of 7 or above were 166 (70.94%). Twenty-one (8.97%) babies were admitted to NICU and perinatal mortality was 6 (2.54%). Conclusion Out of 234 patients who underwent CS due to abnormal CTG, more than 2/3rd of patients had normal babies with an Apgar score of 7 or more, which indicates that abnormal CTG alone should not be used as an indication for CS Keywords: Fetal Distress, CTG, Caesarean section

In the present study an attempt has been made to figure out the remarkable factors that were responsible for higher body mass index (BMI) and obesity as well as to observe the existing trends of BMI in Azad Jammu and Kashmir. The factors were age, sex, diabetes, blood pressure, total cholesterol, triglycerides, blood glucose and random glucose. The statistical analysis with both classical and Bayesian methodologies was carried out for the investigation of significant risk factors. The results showed that with the increase in age the BMI also increases i.e., respondents of age group > 60 have the highest percentage of 82.76% for BMI. Moreover, it was found that except sex and blood pressure all other factors had significant association with BMI. Additionally, four factors namely, age, diabetes, total cholesterol and triglycerides were selected for the development of the parsimonious model of BMI based on generalized linear model, step wise regression and Bayesian model averaging.

Introduction: Primary health care is essential healthcare made universally accessible to individuals and acceptable to them through their full participation and at an affordable cost. It can be effectively delivered at the Basic health unit (BHU). Assessment of its performance at regular basis is also crucial for the health care system. Objectives: To assess the services (EPI, antenatal care and basic healthcare) provided at selected BHUs of Peshawar with a view to determine service provision gaps in these BHUs. Materials & Methods: It was a questionnaire based descriptive survey conducted from September to November 2019, in which simple random sampling technique was used to select 15 BHUs of district Peshawar for assessment and evaluation purposes. Data were collected using a checklist and an indigenous structured questionnaire where responses were recorded in yes/no format. Data analyzed using SPSS V.22 for descriptive statistics. Results: All vaccines of the EPI program were being provided in BHUs except for Hepatitis B. Regarding BHU staff, in 80% BHUs male medical officers were absent, and in 40% BHUs female medical officers were absent. For the Maternal and Child Health Care (MCHC) services, Tetanus Toxoid vaccine and Folic Acid supplements were present in all BHUs but status of malnutrition was unsatisfactory. About 80% of BHUs had a satisfactory infrastructure; the safety and sanitation precautions in BHUs were not up to the mark regarding disposal of hazardous waste and needles. Conclusion: Majority of the healthcare facilities were present in sampled BHUs including immunization services, MCHC services, infrastructure, safety, and sanitation. While the female staff was adequate in number, the attendance of male staff was poor. Primary health care; basic health unit; Immunization; Prenatal care

Introduction: Hirsutism is in fact unwanted growth of hairs on the various parts of body of females. Hairs arises particularly on those parts of the body on which hairs are not grown normally in females such as chin, upper lips, abdomen, legs, shoulder and back of the body. Various reasons are reported till so far for the hirsutism development. The prevalence of hirsutism was very low. Methodology: Across-sectional study was conducted at tertiary care hospital of Sindh, Pakisan for the period of 06 months. A well structured questionnaire was developed comprises on three parts. Which was given to the female students and all the participants were guided regarding filling of that proforma and Ferriman-Gallway scale was used to measure the frequency parameters of Hirsutism. Results: The condition of hirsutism was found among 183 participants, the distribution of hairs was quite different in all selected study subjects. 26 females had hairs on chin, 154 females had hair grown on upper lips, 24 females had hairs on lower abdomen, 13 had hairs on upper abdomen, 11 participants had hairs on arms and legs whereas only 04 girls had hair grown on their shoulders and back of the body. As far as their family background is concern 41 females were belongs to upper class, 117 females belongs to middle class while 25 females were belonging to lower class families. Conclusion: The prevalence of hirsutism was very much common among the females with the associated condition of Idiopathic hirsutism (53%), pulmonary chronic obstructive diseases (31.5%) and Acanthosis nigricans was the most widely recognized cutaneous finding related with hirsutism.

Objective: The aim behind this study was to scientifically assess the pattern of coronary artery disease in young males with acute coronary syndrome. Study Design: Prospective Observational study. Setting: Department of Cardiology, Isra University Hospital, Hyderabad. Period: March 2014 to February, 2019, Material & Methods: Data of 260 patients were enrolled who were males and having age less than 50 years and more than 25 years and presented with acute coronary syndrome. All the patients underwent coronary angiography for the assessment of pattern of coronary artery disease. Data were entered and analyzed by using Statistical Package for the Social Sciences version 21.0. Results: Out of total 260 patients, the mean age and SD of admitted patients was 42.21 ± 4.69 years and the age ranging between 33 to 50 years. The most common risk factors among young males who were admitted with ACS were cigarette smoking (39.61%, N = 103) and Hypertension (19.61%, N = 51) while least common was alcohol consumption (6.53%, N = 17). The most common pattern of CAD we have observed in our study was presence of three vessels coronary artery disease (25%, N = 65) and Branched Vessel Disease (23.07%, N = 60) while two Vessels CAD was least common (17.30%, N = 45). Conclusion: Our study shows that overall burden of coronary artery disease in males belongs to above 40 years of age residing at urban areas and belongs to middle socioeconomic background. The most common risk factor was cigarette smoking and the most common pattern of coronary artery disease was 3 vessel coronary artery disease and Branched Vessel Disease, respectively.

Background and aim Excess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. Subjects and methods This was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. Results Out of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ± 13.79 and 50.38 ± 11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. Conclusion The findings from second NDSP (2016–2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

Introduction: Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements. Aims were to determine the effects of iron and amloki on serum zinc level in IDA with pregnancy. Materials and Methods: This Prospective, longitudinal and interventional study was done by non blinded, non randomized sampling followed by inclusion and exclusion criteria. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017. They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Dhaka. For statistical analysis, Paired Student’s ‘t’ test and Unpaired Student’s ‘t’ test were considered using SPSS 22.0 version. Results: Significant decrease (p

This study investigated the impact of neurofeedback training on the deeper cortical structures that comprise the “pain matrix” and are involved in processing neuropsychological functions. Five paraplegic patients with central neuropathic pain received up to 40 sessions of neurofeedback training. They were asked to simultaneously modulate the relative power of the theta, alpha and beta bands, provided as a feedback from the sensorimotor cortex. The source localization technique was applied on EEG data recorded with 16 electrodes placed over the whole head. Neurofeedback training from the sensorimotor cortex induced effects on the pain matrix and in the areas involved in processing neuropsychological functions such as memory, executive functions and emotional regulations. Alpha and beta band activity was most increased in insular, cingulate and frontal cortex regions, and other areas corresponding to executive and emotional function processing. Theta band decreases were noted in the frontal, cingulate and motor cortices. In group analysis, theta and beta band activity was significantly reduced. The single channel electroencephalogram-based neurofeedback training produced effects on similar areas that are targeted in 19 channels standardized low-resolution brain electromagnetic tomography and expensive time-delayed functional magnetic resonance imaging feedback studies.

Breast cancer is one of the most prevalent and reoccurring cancers and the second most common reason of death in women. Despite advancements in therapeutic strategies for breast cancer, early tumor recurrence and metastasis in patients indicate resistance to chemotherapeutic medicines, such as paclitaxel due to the abnormal expression of ER and EGF2 in breast cancer cells. Therefore, the development of alternatives to paclitaxel is urgently needed to overcome challenges involving drug resistance. An increasing number of studies has revealed miRNAs as novel natural alternative substances that play a crucial role in regulating several physiological processes and have a close, adverse association with several diseases, including breast cancer. Due to the therapeutic potential of miRNA and paclitaxel in cancer research, the current review focuses on the differential roles of various miRNAs in breast cancer development and treatment. miRNA delivery to a specific target site, the development of paclitaxel and miRNA formulations, and nanotechnological strategies for the delivery of nanopaclitaxel in the management of breast cancer are discussed. These strategies involve improving the cellular uptake and bioavailability and reducing the toxicity of free paclitaxel to achieve accumulation tumor site. Furthermore, a molecular docking study was performed to ascertain the enhanced anticancer activity of the nanoformulation of ANG1005 and Abraxane. An in silico analysis revealed that ANG1005 and Abraxane nanoformulations have superior and significantly enhanced interactions with the proteins α-tubulin and Bcl-2. Therefore, ANG1005 and Abraxane may be more suitable in the therapeutic management of breast cancer than the existing free paclitaxel. miRNAs can revert abnormal gene expression to normalcy; since miRNAs serve as tumor suppressors. Therefore, restoration of particular miRNAs levels as a replacement therapy may be an effective endocrine potential strategy for treating ER positive/ negative breast cancers.

Objective: To assess the effects of oral fluids and intravenous fluids in terms of frequency of improving Amniotic Fluid Index during third trimester of pregnancy having oligohydramnios.Study Design: Comparative prospective survey. Place and Duration of Study: Obstetrics and Gynaecological Department of Fauji Foundation HospitalRawalpindi, from Apr 2018 to Oct 2018. Methodology: A total of 100 patients with singleton pregnancy (50 in each group) at gestational age of 28-37weeks and AFI of 5cm or less than 5cm were included. Non probability consecutive sampling technique wasused. Ethics approval from hospital ethical committee and research board was taken. Patients were randomizedinto 2 groups (50 patients each) by lottery method. Group A was instructed to drink 2 liters of water per day fora time period of seven days and patients in group B was given 2 liters of 5% D/W which was in addition to theirnormal fluids intake. Amniotic fluid index was measured pre hydration and post hydration in both groups. Datawas analyzed using SPSS-21. Results: Mean age of the patients was 33.62 ± 5.45 years and 34.70 ± 4.76 years for groups A and B respectively.In group A and group B mean gestational age was 34.28 ± 1.85 weeks vs 34.32 ± 1.82 weeks. In group A, 44 (88%)..............

Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements.To determine the effects of iron and amloki on serum zinc level in IDA with pregnancy. The study was a non blind, non random sampling interventional type of clinical trial. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017. They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Bangladesh. For statistical analysis, Paired Student’s‘t’ test and Unpaired Student’s‘t’ test were considered using SPSS 22.0 version. Significant decrease (p

Background: Hair loss is a worldwide problem with significant prevalence in the developed countries. Although many pathophysiological factors have been involved in the development of hair loss, its etiology is still unclear. Trace elements. Objective: To assess duration of hair loss with serum iron level in alopecia. Methods: This cross sectional study was carried out in the Department of Physiology, Dhaka Medical College, Dhaka during January 2017 to December 2017. Serum iron level was estimated by flame atomic absorption spectrophotometry of thirty five newly diagnosed hair loss patients aged 18 to 45 years were study group and thirty five ages, sex and BMI matched healthy subjects were control group. Both male and female was assessed by analyzing time. In this study, the duration of hair loss was 1 to 18 months. Duration of hair loss in study group was divided in two groups such as ≤2 months and >2 months. Patients were selected from Department of Dermatology and Venerology, Dhaka Medical College Hospital, Dhaka. For statistical analysis Unpaired Student’s‘t’ test, Chi square tests and Pearson’s correlation coefficient (r) tests were performed. Results: In this study, serum iron level showed negative correlation with the duration of disease in study group. Conclusions: From this study, it is concluded that serum iron deficiency is associated with duration of hair loss patients. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 29-32

Background: ABO blood group distribution defers with racial and geographic variations. They are related to diseases like cardiovascular diseases, cerebral thromboembolism. ABO blood group system may influence coagulation factor VIII which may increase the future risk of thrombosis. Aim: To assess the relation of ABO blood group with coagulation factor VIII in healthy adults. Material and Methods: A prospective type of analytical cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020. After obtaining ethical clearance, a total of 190 healthy adults were selected from different areas of Dhaka city based on inclusion and exclusion criteria, with ages ranging from 18 - 45 years. The subjects were interviewed and detailed history regarding personal, family, medical and drug were taken. Prior to sample collection, informed written consent was taken from the participants. Individuals of blood group A were selected as group A, blood group B as group B, blood group AB as group AB and blood group O as group O. Coagulation factor VIII was measured in the Department of Hematology and BMT Unit, Dhaka Medical College Hospital, Dhaka. Blood grouping was done in the Department of Physiology, Dhaka Medical College, Dhaka. Statistical Analysis: For statistical analysis, ONE way ANOVA followed by Bonferroni test were considered using SPSS 25.0 version. Results: In this study, blood group B was most common (33.2%). Coagulation factor VIII was significantly higher (p < 0.001) in blood group A (105.76% ± 11.82%), B (112.00% ± 15.02%), AB (109.80% ± 11.93%) than blood group O (82.00% ± 12.86%). No significant difference was observed among A, B and AB blood groups regarding coagulation factor VIII. Conclusions: It can be concluded that blood group A, B, AB individuals may have more chance of thrombosis due to significantly higher coagulation factor VIII than blood group O individuals.

Cervical cancer is a potentially life-threatening disease marked by health practitioners. The late diagnosis and treatment, being quite challenging, stake the precious lives of patients. In both developed and undeveloped states, the formal screening for disease identification suffers due to its medical cost, unavailable health facilities, society norms, and late appearance of symptoms. Machine intelligence is cost-effective, computationally inexpensive, and early diagnosis of several types of diseases, including cervical cancer. The patients are not required to pass through contemporary and tedious medical procedures, and early diagnosis of cervical cancer is quite handy with machine-intelligent solutions. The problem with the current machine classification methods for disease identification is the reliance on a single classifier’s prediction accuracy. The adoption of single classification methods doesn’t ensure the optimum prediction due to bias, over-fitting, mishandling of noisy data, and outliers. This research study proposes an Ensemble classification method based on majority voting for an accurate diagnosis addressing the patient’s medical conditions or symptoms. The study experiments a wide range of available classifiers, namely Decision Tree (DT), Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbor (KNN), Naive Bayes (NB), Multiple Perceptron (MP), J48 Trees, and Logistic Regression (LR) classifiers. The study records a significant enhancement in prediction accuracy of 94% that outperforms the prediction accuracies of single classification methods tested on the same benchmarked datasets. Thus, the proposed model bestows a second opinion to health practitioners for disease identification and timely treatment.

Background: The prevalence of anxiety disorders is increasing in the world. Studies revealed that generalized anxiety disorder may lead to change in platelet size, volume and functions. Thus, the changes in platelet indices may increase the future risk of thrombotic diseases in patients with Generalized Anxiety Disorder (GAD). Aim: To evaluate platelet indices (total count of platelet, mean platelet volume, platelet distribution width, plateletcrit) levels in patients with generalized anxiety disorder. Material and Methods: A cross-sectional study was performed in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020. After obtaining ethical clearance, a total of 144 individuals were selected based on inclusion and exclusion criteria with ages ranging from 18 - 50 years. Group A was the study group selected from Out Patient Department of Psychiatry of Dhaka Medical College Hospital, Dhaka, diagnosed by an experienced psychiatrist. Group B was the control group who were apparently healthy adults selected from different areas of Dhaka city. The subjects were interviewed and detailed history regarding personal, family, medical and drug history were taken. Prior to sample collection, informed written consent was taken from the participants. Platelet indices (total count of platelet, mean platelet volume, platelet distribution width, plateletcrit) were measured in the Department of Laboratory Medicine, Dhaka Medical College Hospital, Dhaka. Statistical Analysis: For statistical analysis, the Unpaired Student’s “t” test was considered using SPSS 25.0 version. Results: Mean platelet volume of generalized anxiety disorder patients was significantly higher (p < 0.001) than the control group. Platelet distribution width and plateletcrit were higher in the study group than the control group. Conclusion: It can be concluded that generalized anxiety disorder patients may have more chance of thrombotic diseases due to significantly higher mean platelet volume and higher platelet distribution width, plateletcrit than healthy adults.

Background: Urinary bladder diseases are one of the clinical problems encountered in our daily practice.The incidence of these diseases rises with advanced age. These diseases are diagnosed clinically andconfirmed by various non invasive as well as invasive procedures and wall abnormalities are themost important indicator to diagnose such diseases. All these conditions require medical and surgicalintervention. Thereby knowledge regarding normal capacity of urinary bladder is essential to determinethe physiologic variation of this organ. Therefore, full knowledge about gross and histological features ofthe urinary bladder has hard & fast implication for the investigation, diagnosis and further management.With this background the present study has been designed to evaluate the capacity of urine in postmortemhuman urinary bladder. Objectives: To identify the socio-demographic determinants and to determine thecapacity of urine in post mortem human urinary bladder. Materials and Methods: This was a descriptivetype of longitudinal study. Sample size was estimated by reviewing literatures and by expert opinion and70 human postmortem urinary bladders fulfilling the inclusion and exclusion criteria were selected in thisstudy. This study was conducted in the Department of Anatomy, Sylhet MAG Osmani Medical College,Sylhet in collaboration with the Department of Forensic Medicine, Sylhet MAG Osmani Medical College,Sylhet from 1st January 2015 to 31st December 2015. Results: The age of the cadaver ranged from 10 to65 years with the mean age of 32.20 (SD ± 14.38) years; 15 (21.40%) cadavers were in the age group of10-20 years, 36 (51.4%) cadavers were in the age group of 21-40 years and 19 (27.1%) cadavers werein the age group 41-65 years. There were 52 (74.3%) male and 18 (25.7%) female with a ratio of maleto female was 2.89:1. The mean capacity was 35.23 (SD ± 7.48) ml. The mean capacity of the urinarybladder was 31.20 ml (SD ± 7.28); 37.92 ml (SD ± 7.31) and 33.32 ml (SD ± 6.13) in the age group of A,B and C respectively. The difference between group A and B was highly significant (p=0.004); betweengroup B and C was significant (p=0.023); but not significant between group A and C (p=0.364). The meancapacity of urinary bladder of male and female did not differ significantly in age group A (p=0.117),group B (p=0.145) and group C (p=0.241). Conclusion: The gross capacity of urinary bladder was foundincreased with age up to certain limit then slightly decreased in the late age. But the capacity did not differsignificantly between male and female. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.170-176

Purpose Volume-assured pressure support in noninvasive ventilation (VAPS-NIV) is a newer mode providing automatic pressure support adjustment to ensure a constant alveolar ventilation. Previous studies have shown that NIV effectiveness depends on patient adherence and tolerance. The aim of this study was to determine the adherence and efficacy of VAPS-NIV compared to spontaneous-time (S/T) mode in pediatric patients with neuromuscular disease (NMD). Methods This was a prospective observational study. Children with NMD who utilized NIV at home for ≥ 3 months were recruited from the Long-term ventilation clinic at The Hospital for Sick Children, Toronto, Canada, from July 1, 2015, to July 1, 2019. Baseline characteristics, date of initiation of NIV, and pulmonary function tests were recorded. Polysomnogram (PSG) data and adherence were recorded and analyzed comparing VAPS and S/T modes. Results Twenty children with NMD (17 male, 85%) were enrolled. The mean (SD) age at initiation of NIV was 11.6 ± 4.6 years. The median (IQR) duration of ventilation was 1.36 (0.80–2.98) years. The mean average daily usage and the median daily usage for VAPS mode and S/T mode were 8.4 ± 1.6 versus 7.2 ± 2.5 h (p = 0.012) and 8.6 ± 1.4 versus 7.8 ± 2.1 h (p = 0.022), respectively. There was no difference in sleep architecture, gas exchange, or parent proxy report of NIV tolerance between S/T and VAPS modes. Conclusion VAPS was associated with an improvement in adherence to therapy in children with NMD compared to S/T mode. Longitudinal studies are required to evaluate long-term clinical outcomes using VAPS mode in children with NMD. Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02288-1.

Objectives The current study aimed to assess the impact of factors such as age, gender, and the tooth type on postoperative endodontic pain in necrotic teeth with symptomatic periapical periodontitis and radiolucency dressed randomly with either calcium hydroxide or propolis paste. Materials and Methods The standard chemomechanical root canal preparation of 80 teeth was performed by the primary investigator. The intracanal medicaments were inserted by the secondary operator. Patients self-recorded their postoperative endodontic pain intensity with the help of visual analog scale at 4, 12, 24 (day 2), 48 (day 3), and 72 (day 4) hours. During analysis, patients (68/80) were grouped according to gender, age, and the tooth type. Statistical Analysis Mann–Whitney’s U test was applied for mean pain score comparison between genders and between tooth type. Kruskal–Wallis’ test was applied for mean pain score comparison between the age groups. Results No significant difference (p > 0.05) in pain scores was found between the age groups and between the tooth types. Males had significantly higher pain scores as compared with females at days 2 (p = 0.035), 3 (p = 0.023), and 4 (p = 0.020). Conclusion The results suggested that there was no impact of age and tooth types on postoperative endodontic pain.

BACKGROUND: Family planning helps couples to attain their desired number of children and proper timings of their births (1). It is best achieved with different contraceptive methods. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is an excellent contraception providing safe, effective and long term reversible contraception in women after both normal delivery and c/section(2). It reduces postpartum undesired pregnancies and thus induced abortions (3). It is coitus independent, easy to insert and does not affect breastfeeding. Both care provider and client are available in the same setting, securing time and cost of interval IUD insertion. PPIUCD is associated with primary complications like pregnancy and secondary ones as irregular vaginal bleeding, abdominal pain, infection, expulsion and uterine perforation. PPIUCD counselling services regarding its common side effects and complications are important. There is minimal research comparing follow up outcomes between vaginal and caesarean insertions. The objective of study is to compare outcomes of IPPIUCD as a factor of route of insertion. METHODS: In this prospective comparative study 200 patients in whom postpartum IUCD was inserted within 10 minutes of delivery of placenta after normal vaginal delivery or c/section were included. About first 100 cases of vaginal and first 100 cases of intra-cesarean PPIUCD insertions formed study groups. Record of clients was maintained and analysis at 6 weeks to 12 weeks post insertion follow up visit was done at gynae and obstetric unit of Lady Reading Hospital Peshawar. RESULTS: Of total 1005 IPPIUCD inserted during the study period, about 156( 15.5%) were inserted intra-cesarean and 849 (84.4%) after vaginal delivery. Follow up of 200 (19.9%) clients i.e. about 100 intra-cesarean and 100 vaginal insertions was recorded. Complications rate was low. No life threatening complication such as perforation was recorded. Most common complications observed between vaginal vs intra-cesarean insertions were irregular vaginal bleeding in (11% vs 5%), abdominal pain(6% vs 9%), vaginal discharge(8% vs 5%),spontaneous expulsions (8% vs 2%) and lost strings (14% vs 1%). Statistically significant difference was found between two groups with respect to lost strings (P=0.0006). CONCLUSION: IPPIUCD is an acceptable, safe (in terms of complications) and effective contraceptive option after both vaginal and intra-cesarean insertions. Early follow up examinations are helpful in identifying spontaneous expulsions and dealing common problem.

Background: According to International Diabetic Federation, around 20-25% of world adult population have the clinical features of metabolic syndrome (MetS). Different organizations recommend to modify lifestyle and dietary habit as primary intervention. Green tea has several pharmacological effects on metabolic diseases including MetS. Objective: To evaluate the effects of green tea consumption on two glycemic variables in women with MetS. Method: This interventional study was conducted in the Department of Physiology, Dhaka Medical College from January 2016 to December 2016. After fulfilling the ethical aspect, a total number of 42 female patients with MetS aged 40 to 50 years were selected from the outpatient department of Endocrinology, Dhaka Medical College Hospital. Participants were randomly assigned in study group (n=22) and control group (n=20). Study group consumed green tea for 12 weeks and the control group did not consume green tea. In both groups fasting serum glucose (FSG) and glycosylated hemoglobin (HbA1c) were measured by glucose oxidase (GOD/ PAP) method and modified high performance liquid chromatography (HPLC) method respectively 2 times (before and after 12 weeks). Data were analyzed by paired Student’s ‘t’ test and unpaired Student’s ‘t’ test. Results: After 12 weeks of intervention, FSG & HbA1c significantly (p

The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging.Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging. A transperineal biopsy was advised if multiparametric magnetic resonance imaging PI-RADS® (v.2.0) score was 4 or 5, and score 3 required a prostate specific antigen density 0.12 ng/ml or greater. Primary threshold for clinically significant prostate cancer was defined as any Gleason 3+4 or greater. Multivariable logistic regression analysis identified pre-biopsy predictors of clinically significant prostate cancer in nontargeted systematic prostate biopsies, regardless of targeted pathology (p0.05, R, version 3.5.1).A total of 1,719 men underwent a pre-biopsy multiparametric magnetic resonance imaging, with 679 (39.5%) proceeding to combined targeted systematic prostate biopsies and nontargeted systematic prostate biopsies. In these men clinically significant prostate cancer was detected in 333 (49%) and 139 (20.5%) with targeted systematic prostate biopsies and nontargeted systematic prostate biopsies, respectively. In those men with clinically significant prostate cancer in targeted systematic prostate biopsies, clinically significant prostate cancer was also present in nontargeted systematic prostate biopsies in 117 (17.2%); Gleason 3+3 was present in 50 (7.4%). In 287 men without any cancer in the targeted systematic prostate biopsies, 13 (1.9%) had clinically significant prostate cancer in nontargeted systematic prostate biopsies. In addition 18/679 (2.7%) had Gleason 3+3 disease and no Gleason greater than 4+3 was detected. Predictors associated with clinically significant prostate cancer in nontargeted systematic prostate biopsies were prostate specific antigen 5 ng/ml or greater (OR 2.05, 95% CI 1.13-3.73, p=0.02), PI-RADS score 5 (OR 2.26, 95% CI 1.51-3.38, p0.001) and prostate volume less than 50 cc (OR 2.47, 95% CI 1.57-3.87, p0.001).Detection of clinically significant prostate cancer in exclusively nontargeted transperineal systematic biopsies in a pre-biopsy multiparametric magnetic resonance imaging pathway was low (1.9%).

Objectives: To share our experience with laparoscopic surgery using TAPP technique, for groin hernias using light weight parietene mesh, to find out early post operative pain and foreign body sensation as complications. Study Design: Cross sectional study. Setting: Department of Surgery Khyber Teaching Hospital Peshawar. Period: January 2018 till August 2018. Material & Methods: A sample of 100 patients was recruited into study. All patients underwent standard transabdominal preperitonial repair with light weight Mesh. Data was collected by predesigned Performa and analyzed with SPSS 21. Results: Out of 100 patients 98% were male, 2% female, mean age was 43.2± 5.3years (minimum 17years and maximum 64years). Regarding frequency of type of hernia data showed 68% patients had indirect inguinal hernia while 32% patients had direct inguinal hernia. 65% patients had right sided inguinal hernia, 26% left sided while 9% had bilateral inguinal hernia. Post operative hospital stay showed hematoma in 5% patients, seroma in 12% patients, wound infection in 8% of patients while foreign body sensation in 4% patients. Conclusion: Most of the patients presented were of middle age. Indirect inguinal hernia was more frequent than direct inguinal hernia. Common complications apart from pain were seroma formation, hematoma, wound infection and foreign body sensation.

De Garengeot hernia is a rare femoral hernia that contains the vermiform appendix. It has always been a subject of interest, mainly because of its uncommon entity, but also because of the diagnostic challenge it presents and the lack of consensus in its surgical management. It mainly presents as an emergency, with strangulation of the femoral hernia and acute inflammation of the appendix. The purpose of this study is to present two cases of De Garengeot hernias, the different surgical approach in each one and to perform a systematic literature review on all published accounts of De Garengeot hernias focusing on the surgical management of the hernias that contained an inflamed appendix. A literature search was performed using the keywords 'De Garengeot hernia' and 'appendicitis in femoral hernia'. All the published papers in the English language from 1898 to the end of 2019, as well as two patients from Lewisham and Greenwich NHS Trust, were included. There were 110 female vs 17 males. The majority of the described approaches were via either a Lockwood, or a transinguinal (Lothestein/McVay) incision. Most of the operations were done with an open incision. In the presence of an inflamed appendix, most hernias were repaired with sutures. Forty-one patients had their hernia repaired with non-absorbable sutures and four with absorbable. Most of the patients recovered without complications and were discharged after an average of 4.82 days.

BackgroundThe Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan.MethodsDuring September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases.ResultsOverall, 22% (2230/10 094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin.ConclusionEnteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever.

Background Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan. Methods Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available. Results Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0–15 (117/242; 48%) and 16–30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived. Conclusions Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi.

Background Up to 30% of patients with sickle cell disease (SCD) develop chronic liver disease via etiologies including sickle cell hepatopathy, acquired viral hepatitis, or secondary hemochromatosis. It is unclear how many patients with SCD ultimately undergo liver transplantation (LT) and what factors are associated with survival after LT. In this study, we examined LT outcomes in these patients by reviewing the Scientific Registry of Transplant Recipients (SRTR) and our institutional experience. Methods Analysis of the SRTR identified 23 LT recipients and five simultaneous liver and kidney transplantation (SLKT) recipients with SCD. Patient demographics and graft and patient survival were analyzed. Two patients with SCD at our institution underwent SLKT. Results Review of the SRTR revealed that recipients with SCD had significantly higher model for end-stage liver disease scores (33 versus 21, P = 0.004), preoperative intensive care unit admission (43.5% versus 19.1%, P = 0.007), preoperative dialysis (17.4% versus 4.9%, P = 0.009), and were more likely to be status 1 (26.1% versus 12.1%, P = 0.041) when compared with the reference population of African American LT recipients. Despite being higher risk at the time of LT, patients with SCD had equivalent posttransplant graft and patient survival when compared with the reference population (P = 0.5 and P = 0.2, respectively) and a 2:1 propensity score–matched group (P = 0.5 and P = 0.2, respectively). Two recent SLKT recipients with SCD from our institution have performed well with stable allograft function. Conclusions Data from the SRTR demonstrate that patients with SCD can expect equivalent graft and patient survival after LT despite exhibiting more comorbidities at the time of LT. The low number of patients with SCD who underwent LT in the SRTR in comparison with the rate of chronic liver disease in this population raises the question as to whether a disparity in access to LT exists for this complex population.

Objectives: The aim of our study is to compare the Canadian Head CT rule to New Orleans Criteria, to find a more efficient guideline in predicting the important CT findings in mild Traumatic Brain Injury (TBI) cases. Study Design: Observational study. Setting: Tertiary Health Care Facility in Karachi, Pakistan. Period: 6 months from June 2017 to December 2017. Material & Methods: We divided a sample of 150 mild TBI patients into two groups of Glasgow coma scale (GCS) scores of 13-14 and GCS score of 15. Then using a separate scoring system for both the CCHR and NOC, we evaluated their accuracy and efficiency in predicting mild TBI through a total of 7 major clinical items. Specificity and sensitivity were calculated to compare both the scoring systems and results were compared through univariate and multivariate analysis. A p value of less than 0.05 was considered to be statistically significant. Results: We analyzed the relation between clinical items and important CT findings and found that the CCHR, through multivariate analysis, was more closely associated with important CT findings. We also found that the factors of age, and the Glasgow comma scale score were also strong indicators of important CT findings regardless of which guideline was used. Conclusion: In our study, we found CCHR to be a stronger predictor of important CT findings than the NOC. We found that CCHR performed significantly higher than the NOC.

Social media is quickly becoming the most available and easiest source for seeking health information due to the emerging popularity of social media among people where everyone is expected to be online and connected to social media. This research was carried out to examine women's online breast cancer-related information-seeking behavior. The comprehensive model of information seeking (CMIS) was tested in Pakistan in order to examine the information-seeking behavior of women. Another significant factor of social stigma was added as an independent variable into the existing model. Researchers hypothesized that the utility of information channels plays a role of mediator in the association amongst the factors, i.e. demographics, social stigma, direct experience, salience, beliefs, and characteristics in the information-seeking behavior about breast cancer. The survey questionnaire was distributed among Six hundred women from Islamabad by using the convenient sampling technique. Researchers collected the data by already developed scales. Statistical test of Multiple Linear Regression was employed by the researchers. Therefore, the study carried out significant findings.

Aim To develop and internally validate a nomogram built on a multivariate prediction model including parameters from the new classification of periodontal diseases, able to predict, at baseline, the occurrence of tooth loss due to periodontal reason (TLP). Materials and methods A total of 315 individuals diagnosed with periodontal disease and receiving a minimum of one annual supportive periodontal therapy visit were included in the study. Patients were staged and graded based upon baseline data. The population was divided into a development (254 patients) and a validation (61 patients) cohort to allow subsequent temporal validation of the model. According to the TLP at the 10-year follow-up, patients were categorized as "low tooth loss" (≤ 1 TLP) or "high tooth loss" (≥ 2 TLP). Bootstrap internal validation was performed on the whole data set to calculate an optimism-corrected estimate of performance. Results The generated nomogram showed a strong predictive capability (AUC = 0.81) and good calibration with an intercept = 0 and slope = 1. These findings were confirmed by internal validation using bootstrapping (average bootstrap AUC = 0.83). Conclusions The clinical implementation of the present nomogram guides the prediction of patients with high risk of disease progression and subsequent tooth loss for personalized care.

Background: Road traffic injuries are considered as main public health problem; strenuous efforts are required for its prevention. Facility based emergency care for road traffic injuries is considered as an important but challenging component of post-crash care response. It demands healthcare providers to make quick life-and-death decisions based on minimal information. The objective of our study was to explore the challenges for emergency services for road traffic injuries within Tertiary care hospital. Methodology: Qualitative methods were used including 15 interviews and 02 focus group discussions. Topic guide was developed for all the participant’s interviews, in order to explore the challenges for effective emergency care services at tertiary care level in Larkana city, Sindh. Topic guide was developed for all the participant’s interviews. Results: After making the transcripts of qualitative data, thematic analysis framework was used to analyze the transcripts, by which two main themes; recognition of causes and adverse consequences of road traffic accidents and health system challenges for delivering emergency care were extracted. Results suggest that improvement in documentation and record keeping system, security for health care providers, provision of timely interventions and proper training for health professionals at hospital level can be helpful for the provision of effective emergency care services. Conclusion: An integrated trauma care system along with the improvement in documentation, efficient record keeping system, security for health care providers, provision of timely interventions and training for health professionals is needed for effective post-crash care management at the hospital level.