Muhammad Mehr - Academia.edu (original) (raw)

Papers by Muhammad Mehr

Journal of Postgraduate Medical Institute, Jul 18, 2016

Objective: To estimate the mean platelet volume (MPV) in the patients with diabetes who present t... more Objective: To estimate the mean platelet volume (MPV) in the patients with diabetes who present to hospital with various cerebrovascular diseases. Methodology: It was a cross sectional descriptive study conducted in the Department of Medicine, Hayatabad Medical Complex (HMC), Peshawar from 1 st June, 2014 till 30 th Mar, 2015. A total of 137 adult patients between 25 to 75 years of age of either gender with Type 2 DM and stroke attending hospital were included. All patients with prior chronic kidney disease, chronic liver disease or with previous cerebrovascular events were excluded from the study. Under strict aseptic conditions, 10cc blood was obtained and sent immediately to hospital laboratory for measurement of MPV. Results: Among the 137 patients, 85 (62.04%) were females and 52(37.96%) were males. The average age of the patients was 53.01±11.97 years with range of 30-73 years. Average duration of DM in the patients was 5.15±2.87 years with range of 1-12 years. There were 65(47.45%) patients of the less than or equal to 4 years DM duration. Forty two (30.66%) patients were in the range of 5-7 years, 24 (17.52%) were in the 8-10 years range while 6(4.38%) presented with cerebrovascular accidents at more than 10 years of type 2 DM. There were 84 (61.3%) and 53(38.7%) patients having MPV greater than and less than 9.01 fl respectively (average MPV was 9.42±0.92). Conclusion: Increased MPV was found in a significant number of patients and was more in the males and patients with age greater than 50 years.

DOAJ (DOAJ: Directory of Open Access Journals), Jul 1, 2012

Background: Pakistan remains in intermediate prevalence area for hepatitis B with an estimated ca... more Background: Pakistan remains in intermediate prevalence area for hepatitis B with an estimated carrier rate of 2.5%. Over last 10 years, treatment for HBV has improved, improving the prognosis and long term outcome. We conducted this trial to study the efficacy of Telbivudine (LdT) monotherapy in the treatment of HBeAg negative chronic hepatitis B infection with normal ALT levels. Methods: Ninety-six adults of both sexes suffering from HBeAg negative chronic hepatitis B who previously never had any antiviral treatment were recruited in this study between June 2008 and June 2011. LdT 600 mg daily was given to all the patients for two years. Results: Among 85 patients who successfully completed two years of LdT treatment, 54 were males and 31 females between 18 and 62 years of age. All had HBV DNA levels between 2.8 to 13.1 log 10 copies/ml. At the end of one year treatment, the proportion of the patients with serum HBV DNA levels undetectable by PCR was 85% which increased to 94% by the end of second year of treatment. HBsAg seroconversion rate was 2% at end of 1st year and 4.9% at the end of 2nd year. No patient was found to be exhibiting viral breakthrough during the treatment. Conclusion: Telbuvidine therapy is an effective option for the treatment of adult HBeAg negative CHB patients in our population.

Journal of Medical Sciences, Oct 7, 2019

Objective: To determine the frequency of hemolytic anemia in patients presenting with malaria at ... more Objective: To determine the frequency of hemolytic anemia in patients presenting with malaria at a tertiary Care hospital. Material and Methods: This study was carried out at Department of Internal Medicine, Lady Reading hospital, Peshawar-Pakistan. The Study design used was descriptive cross-sectional study. Study duration was one year from July 2017 to July 2018 in which the total number of observed patients were 151. More over all of the patients having malaria at presentation, of either gender and with age ranging from 16 to 70 years were included. Patients in pediatric age group i.e. age up to 10 years, patients with hemolytic anemia due to causes other than malaria as evident by the history, family history and previous medical record were exempted. With thorough history and physical examination, all of the patients were cautiously checked out and screened. Laboratory tests were done in LRH laboratory. The whole data was analyzed using the SPSS version 20. Results: The mean age shown by our study was 38 years ± 11.77. Male patients were 58 % and female patients were 42%. The Mean duration of disease was 1 week ± 1.56. More over 3% patients had hemolytic anemia while 97% patients didn't have hemolytic anemia. Conclusion: The majority of our patients were young, hemolytic anemia in malaria was more common, which can be reduced with early diagnosis and effective management of malaria.

Journal of Postgraduate Medical Institute, Feb 13, 2017

Objective: To determine the frequency of HBeAg positivity in chronic hepatitis B infected patient... more Objective: To determine the frequency of HBeAg positivity in chronic hepatitis B infected patients. Methodology: This descriptive cross-sectional study was carried out for one year between June 01, 2014 till May 30, 2015 in a private consulting clinic at Ibrahimi Hospital, Dabgari Gardens, Peshawar-Pakistan. A total of 149 patients were included in the study. All patients of either gender between 15 to 70 years of age, newly diagnosed with HBV infection in the form of positive HBsAg on third generation ELISA were included in the study. In all the patients, HBeAg was checked. Data were analyzed using SPSS version 20.0. Results: Out of the total 149 patients between 20 to 60 years (mean 41 ±8.7) included in the study, the males 112 (75.2%) outnumbered the females 37 (24.8%). The prevalence of HbeAg in chronic HBV was 28.2 % (males 16.10 %, females 12.08%) with more patients (22.14%) between 21 and 40 years of age. Conclusion: The frequency of HbeAg was found in a significant number of chronic HBV patients. Its frequency was more in males and in the age group of 21 to 40 years.

Journal of Medical Sciences, Jun 18, 2015

Objective: To find out the current practices of sterilization and decontamination of endoscopy eq... more Objective: To find out the current practices of sterilization and decontamination of endoscopy equipment, and to compare them with the current practical guidelines in rest of the world. Material and Methods: This was a retrospective study carried out from January 2014 to December 2014 in the Departments of Medicine HMC, KTH, Peshawar. All the patients scheduled for endoscopy are screened for any evidence of Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) by third generation ELISA test. The approximate cost of these screening tests from the hospital main laboratory is Rs 650 and it is between Rs 900 to 3000 from the outside private laboratory facilities. The endoscope is soaked in a decontaminant solution for 30 mins in the morning before the start of the procedures. The endoscope is the washed with water and air dried. In between the procedures, the endoscope is wiped cleaned with a gauze piece soaked in saline and then introduced in another patient. Results: As all the patients are screened for any evidence of HBV, HCV and HIV, it is presumed that the iatrogenic infection due to endoscope would be negligible. Universal screening for the evidence of these infections comes at average Rs 1000 per patient as compared to Rs 35 for the endoscope cleaning with the cleansing and rinsing of all the channels of the endoscope with 2% glutaraldehyde solution (Cidex, Johnson and Johnson Medical Inc., Arlington, TX) for 15 minutes through automated Endodisinfector followed by rinsing the channels with water and later purging with air. Conclusion: Timely intervention in terms of Endodisinfection and appropriate training of the staff in sterilization and disinfection of the endoscopes as per international guidelines is suggested before it becomes a human rights issue.

Cureus, Apr 8, 2021

Castleman disease (CD) is a disorder characterized by lymphoid proliferation. It is not usually t... more Castleman disease (CD) is a disorder characterized by lymphoid proliferation. It is not usually the first differential for pyrexia of unknown origin (PUO) because of the extremely rare incidence worldwide. We report the case of a 24-year-old man with PUO for six months. He had been previously investigated for infective, rheumatological, and immunological causes. Extrapulmonary tuberculosis was considered as the most likely diagnosis because of his clinical presentation and locality. Based on this, he was given a trial of anti-tuberculous therapy. However, he did not show any signs of improvement despite being compliant with the medications. His condition was further complicated by the development of ascites. Upon treatment failure, the patient presented to our tertiary care hospital and was investigated for a possible revision of diagnosis. Based on clinical assessment and histopathology of the lymph nodes, he was diagnosed with idiopathic multicentric CD overlapping with systemic lupus erythematosus. He was started on azathioprine and prednisone and showed a positive response, indicated by a decreasing erythrocyte sedimentation rate and C-reactive protein. The patient continues to be healthy and in remission to date.

Gomal Journal of Medical Sciences, Jan 21, 2015

Background: Trends in poisoning are changing in our country. Street and Travel related poisoning ... more Background: Trends in poisoning are changing in our country. Street and Travel related poisoning is emerging as a new public health issue. This is the first study in this region to know the types of drugs used for street & travel related poisoning and to know the mode of poisoning. Material & Methods: This descriptive cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from July 2010 to July 2011. A total of 100 cases were enrolled after exclusion criteria. After clinical examination and all relevant investigations their urine, blood and stomach samples were sent for chemical and toxicological analysis. Results: A total of 100 patients between 15-65 years were included in this study, 84(84%) were males and 16(16%) females. Among the drugs benzodiazepines were 60%, opium derivatives 32%, phenobarbitone 4%, while 2% each were rat killer poison, mixed benzodiazepines and opium derivatives. The mode of delivery of drugs were soft drinks 54%, fruits 38% and food in 8% cases. Among the victims there were passengers 60%, pedestrians 20%, Taxi drivers 8%, marriage function attendants 6% (females) and others 6%. Conclusion: Street and travel related poisoning is emerging as a new social and public health issue in our country. The mode of poisoning is usually drinks, fruits and food mixed with benzodiazepines and opium derivatives. This often happens due to low level of education, lack of awareness, poor law and order situation, easy availability of drugs, poor drugs rules implementation due to corruption, unemployment and attitude of the people.

Journal of Medical Sciences, Dec 11, 2015

Objective: To determine the frequency of factors leading to osteomyelitis in diabetic foot ulcers... more Objective: To determine the frequency of factors leading to osteomyelitis in diabetic foot ulcers patients. Material & Methods: It was a cross sectional, descriptive study conducted in the department of medicine, Bacha Khan Medical Complex, Mardan and Hayatabad Medical Complex, Peshawar from June, 2014 to May, 2015. A total of 217 patients were included. This was a multicentre study project with data collection from various medical, surgical and orthopedic units of Bacha Khan Medical Complex, Mardan and Hayatabad Medical Complex, Peshawar. All patients between ages of 18 to 65 years of either sex whether admitted through outpatients or emergency with either type I and type II diabetes having osteomyelitis in diabetic foot ulcers were included in the study. Patients who had foot ulcer of less than one month duration, complicated fractures associated with ulcers or osteomyelitis caused by diseases other than diabetes mellitus were excluded from the study. Data was analyzed in SPSS version 16. Mean + SD was calculated for quantitative variables like age. Frequencies and percentages were calculated for categorical variables like risk factors and gender. Results: The study results show that 4%, 38% and 48% patients were in age range of 31-40 years, 41-50 years and 51-60 years respectively. Mean age was 51 years with SD ± 1.26. Fifty-five percent patients were male and 45% patients were female. Forty-seven percent patients had Peripheral neuropathy, 46% patients had peripheral artery disease while 7% patients had foot deformities. Conclusion: Peripheral neuropathy; peripheral arterial diseases are recognized risk factors for foot ulceration. These risk factors should be taken into consideration while educating diabetic patients.

Rawal Medical Journal, 2016

Objective: To assess the Out of pocket spending (OOPS) by the sick patients admitted in publicall... more Objective: To assess the Out of pocket spending (OOPS) by the sick patients admitted in publically funded tertiary care hospital in Peshawar, Pakistan. Methodology: This descriptive study using consecutive non probability sampling technique was conducted in Khyber Teaching Hospital, Peshawar, Pakistan from January 2015 and June 2015. All admitted patients between 18 to 70 years of age, through outpatients, casualty or private consulting clinics expected to stay in hospital for more than three days were included. The cost incurred on inpatient care was divided in to “Direct Cost” which was the amount spent by the patient, the “Indirect Cost” that was spent by the attendants and the “Hospital Cost” that was the cost of treatment provided by hospital. Results: A total of 120 patients were included of which, 80 were males and 40 were females. During the five days of stay in the hospital, the Direct Cost was 78%, Indirect Cost was 5% and the Hospital Cost was 17%. The total OOPS was average 83% by all the admitted patients. Conclusion: The present tertiary health care system needs to revamped and modified with an aim that the poor and most vulnerable segments of the society are protected in the form of reduced OOPS.

Pakistan Journal of Medical and Health Sciences, Aug 31, 2022

Background: Angiotensin I is converted to angiotensin II by an angiotensin-converting enzyme, whi... more Background: Angiotensin I is converted to angiotensin II by an angiotensin-converting enzyme, which is an important component of renin-angiotensin framework. Multifactorial chronic kidney disease includes risk factors such as hypertension, obesity, inherited factors, and diabetes. A genetic factor associated with premature signs of renal failure is predominantly increased arterial hypertension and albumin excretion, which add to the pathophysiological movement of disintegration in renal capacity. This enzymatic assay aimed to detect ACE levels in various renal patients compared with controls to confirm the relationship between ACE quality polymorphism and enzymatic ACE levels. Materials and Methods: The study population of our study included 56 patients with chronic kidney disease. Who was confirmed to have chronic kidney disease after being diagnosed in the dialysis ward of the tertiary care hospital. Results: A total of 56 chronic kidney disease were enrolled. Mean age of patients were 55.1±13.6. Among total recruited patients, 60% male patients and 40% were female patients. The HDL, and LDL were lower in chronic kidney disease patients than control group. While BMI, total cholestrol, triglyceride, systolic blood pressure, diastolic blood pressure, and ACE level were found higher in CKD patients than control group. The frequency of genotypes ACE II, ID, and DD in patients groups was 12 (12.43%), 28 (48.21%), and 17 (30.35%). Conclusion: Our study result indicates that the D allele is involved in the progression of chronic diseases. When we look at the frequency of I and D alleles it clearly shows that the frequency of the D allele is significantly higher in patients with CKD than the frequency of the I allele.

Journal of Medical Sciences, Oct 1, 2011

Objectives: To determine the frequency and types of Spontaneous bacterial peritonitis (SBP) in pa... more Objectives: To determine the frequency and types of Spontaneous bacterial peritonitis (SBP) in patients having ascites secondary to liver cirrhosis. Material and Methods: This study was conducted in Medical E Unit of Khyber Teaching Hospital, Peshawar and Rehman Medical Institute, Peshawar from 19th March, 2009 to 18th September, 2009. Patients with liver cirrhosis and ascites, aged 13 years and above and of both sexes presenting with fever, chills, abdominal pain, recent increase in abdominal distension, confusion or coma, rebound tenderness or signs of hepatic encephalopathy were included. Results: SBP was detected in 128 (52.24%) patients out of 245 patients aged between 18 and 72 years included in study. Among the group of patients with SBP, 77(60.15%) were male and 51 (39.84%) were female. Classical SBP was present in 50 (39.06%), Bacterascites in 6 (4.68%) and Culture Negative Neutrocytic Ascites (CNNA) in 72 (56.25%) patients. The ascitic fluid mean total leukocyte count in patients without SBP was110.23 /mm and in patients with SBP was 2314.76 /mm. The mean ascitic fluid Polymorphonuclear (PMN) cell count in non-SBP group was 30.21/mm and in SBP group was 1760.56/mm. Conclusion: Spontaneous bacterial peritonitis is quite a common and potentially life threatening complication of liver cirrhosis with ascites.

DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2014

Background: The prevalence of hepatitis C infection is high in Pakistan. Up till now six genotype... more Background: The prevalence of hepatitis C infection is high in Pakistan. Up till now six genotypes have been identified. Genotype 3 is the most prevalent form in Pakistan. However, studies have shown regional variations in the prevalence of different genotypes. The aim of this study was to find out the prevalence of major genotypes of hepatitis C in the North of Pakistan.

Journal of Postgraduate Medical Institute, Jul 18, 2016

It is not uncommon to find low levels of Vitamin D across the world, especially prevalent in deve... more It is not uncommon to find low levels of Vitamin D across the world, especially prevalent in developing countries 9. The major factors thought to be responsible are the food fortification policies, geographic locations, varied demographic features and season. 8 The popu-This article may be cited as: Mehr MT, Khan H, Iman NU. How frequently are people with newly diagnosed pulmonary tuberculosis deficient in vitamin D levels in Khyber Pakhtunkhwa: A pilot study project.

Pakistan Journal of Medical and Health Sciences

Journal of Postgraduate Medical Institute, Dec 14, 2012

Objective: To study the effect of Telbuvidine (LDT) monotherapy in the treatment of HBeAg positiv... more Objective: To study the effect of Telbuvidine (LDT) monotherapy in the treatment of HBeAg positive Chronic Hepatitis B infection (CHB) with normal ALT levels. Methodology: Ninety HBe antigen (HBeAg) positive CHB infection patients were enrolled & followed between June 2008 and June 2011. All of them had ALT levels less than twice the upper normal limit 4 (Mean 36.9 SD 19.9). All patients were HBeAg positive, had serum DNA level ˃10 copies/ml and never had previously received anti HBV treatment. All patients were given LDT 600mg daily as initial antiviral treatment for two years. Results: Out of 83 patients who continued the treatment as per protocol, 59 were males and 24 were 7 females between ages of 21 and 50 years. Baseline HBV DNA levels were 7.82x10 copies/ml (Range 4 9 4.8x10-8.3x10 copies/ml). By the end of first year (52 weeks) the mean decrease in serum HBV DNA levels 10 was 7.88 log copies/ml and the proportion of patients having undetectable HBV DNA levels was 73%. At the end of second year of therapy (96 weeks) the percentage of undetectable HBV DNA levels increased to st nd 86%.At the end of 1 (52weeks) and 2 (96weeks) HBeAg seroconversion rates were 62 % and 86% while HBsAg seroconversion was 8% and 13% respectively. Conclusion: LDT is a reasonable cost effective therapy for HBeAg reactive CHB patients with normal baseline ALT levels resulting in a significant serological and virological response and was well tolerated in our population of Khyber Pukhtunkhwa.

Cureus

Journal of Medical Sciences, 2014

Objective: To know the presentation and prevention of Dengue Fever. Material and Methods: Patient... more Objective: To know the presentation and prevention of Dengue Fever. Material and Methods: Patients suspected to be suffering from Dengue Virus infection were admitted at Mardan Medical Complex (MMC), Mardan. Patients were admitted in concordance with the hospital’s admission policy and treated in an isolation room specified for Dengue cases. All the patients were treated with rigorous preventive measures including antipyretics and fluid requirements, education, properly covering water containers, use of disinfectants and mosquito repellants and maintenance of toilet hygiene. Detailed clinical history was taken from all the patients including the areas visited and the signs and symptoms. Ten cc of the blood was taken and analyzed for peripheral blood smear, Liver function tests, coagulation and renal profile. Another 5 cc of blood was sent to analyze for the Dengue serology using antibody detection against anti-NS1 antibodies. Results: In total, 326 patients were reported during Sept...

Journal of Medical Sciences, 2015

Background: Diabetic retinopathy is one of the many ocular complications of diabetes mellitus and... more Background: Diabetic retinopathy is one of the many ocular complications of diabetes mellitus and is the leading cause of blindness. We conducted this study to find out the incidence of diabetic retinopathy in patients admitted in tertiary care hospital in Peshawar. Results: The age range was 22-76 years with male to female ratio of 315 (68.18%) and 147(31.81%). In patients with DM duration less than 10 years, no case of Proliferative DR was found while in those with DM duration more than 30 years, the incidence rose to 27.45%. Preproliferative DR changes increased from 12.67% in 30 years duration. In individuals with HbA 1 C levels less than 7% over 5-10 years, 44.94% had no DR changes while 62.92% had Background DR, 3.3% had Preproliferative DR while none had Proliferative DR. Individuals with HbA 1 C levels between 7-10% had 33.33%, 50.40% and 12.19% while those with HBA 1C >10% had an alarming prevalence of 39.37%, 35.43% and 25.19% in Background, Preproliferative and Prolife...

Objective: To determine the different Hepatitis B Virus (HBV) genotypes in HBsAg positive patient... more Objective: To determine the different Hepatitis B Virus (HBV) genotypes in HBsAg positive patients . Material and Methods: One hundred and forty three HBsAg positive patients were included in the study. All patients were anti-HCV and anti-HIV negative. All the samples were confirmed for HBV DNA with Rotor GeneTM Real Time Quantitative PCR while HBV DNA positive samples were subjected to type specific PCR for HBV genotyping (A-F). Results: Of 143 samples, 107 (74.82%) were male and 36(25.17%) female, age ranged between 20-40 years. The study demonstrated genotype D in 72 (50.34%) patients as the predominant genotype in KPK population. Genotype B was observed in 37 (25.87%), genotype A in 24 (16.78%) and both genotypes B and D in 10 (6.99%) patients. Genotype C, E and F were not found in any patient. Conclusion: Our study has demonstrated a heterogeneous distribution of HBV genotypes. More extensive studies are required to investigate genetic and geographical divergence and characteri...

Journal of Postgraduate Medical Institute, Jul 18, 2016

DOAJ (DOAJ: Directory of Open Access Journals), Jul 1, 2012

Journal of Medical Sciences, Oct 7, 2019

Journal of Postgraduate Medical Institute, Feb 13, 2017

Journal of Medical Sciences, Jun 18, 2015

Cureus, Apr 8, 2021

Gomal Journal of Medical Sciences, Jan 21, 2015

Journal of Medical Sciences, Dec 11, 2015

Rawal Medical Journal, 2016

Pakistan Journal of Medical and Health Sciences, Aug 31, 2022

Journal of Medical Sciences, Oct 1, 2011

DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2014

Journal of Postgraduate Medical Institute, Jul 18, 2016

Pakistan Journal of Medical and Health Sciences

Journal of Postgraduate Medical Institute, Dec 14, 2012

Cureus

Journal of Medical Sciences, 2014

Journal of Medical Sciences, 2015