National Journal of Health Sciences (original) (raw)

Vol. 1, No. 1, 2016 by National Journal of Health Sciences

Editorial, 2020

Some cancers and some cancer treatments can lead to temporary or permanent infertility. Infertili... more Some cancers and some cancer treatments can lead to temporary or permanent infertility. Infertility is a special issue which need to be considered and addressed in cancer patients who may face this issue due to their malignancy itself or due to the treatment offered to them. Our team had reviewed contemporary literature and came to the opinion that it is vitally important to establish a specialized board of experts who can have regular board meetings in which all selected cases of cancer patients are discussed who can potentially suffer from some form of temporary or permanent infertility.
The relationship between infertility and cancer is being documented in various studies and systemic reviews published lately [1, 2]. Counselling of patients and their next of kin is also an important aspect of this proposed multi-disciplinary team (MDT) Board .Before making any consideration regarding the relevance of the issue of infertility in selected cases of cancer the multidisciplinary team has to develop robust processes in order to make sure that we will not be missing this important problem which our cancer patients may face at the time of diagnosis, treatment or later on as a late sequela of oncological treatment. Practice committee on onco-fertility consortium made clear recommendations highlighting the importance of expert team involvement. The proposals are being published in January 2021 issue of Journal of assisted reproduction [3]. This document provides a valuable insight regarding the establishment healthcare quality processes and their practical implications.

Case Report, 2016

Bortezomib is an important proteasome inhibitor widely used in plasma cell neoplasms. An acute ca... more Bortezomib is an important proteasome inhibitor widely used in plasma cell neoplasms. An acute cardiac dysfunction is not a frequent side effect of bortezomib, but it is mentioned in literature search via multiple case reports. We have discussed here, another case of a young male diagnosed with plasma cell leukemia on treatment, presenting with sudden onset dyspnea due to an acute myocardial toxicity which subsequently upon thorough evaluation turned out to be an association with cyclical bortezomib administration.

Case Report, 2016

Acute Promyelocytic leukemia with central nervous system involvement is one of the rarest occurre... more Acute Promyelocytic leukemia with central nervous system involvement is one of the rarest occurrences. A 25 year old lady, admitted at Shifa International Hospital Islamabad, with complaints of menorrhagia, bruises, petechiae, headache and vomiting. Her laboratory investigation showed patient being in disseminated intravascular coagulation. Complete blood counts and Bone marrow examination showed significant promyelocytes and blasts with flow cytometric analysis consistent with acute promyelocytic leukemia (APL). PCR for PML-RARα detected, CSF examination and its cytology revealed promyelocytes. CT scan of brain showed slight leptomeningeal enhancement. CNS involvement was diagnosed based on the appearance of APL blasts in cerebrospinal fluid (CSF). After treated with all-trans retinoic acid (ATRA), idarubicin, cytarabine and intrathecal methotrexate, she achieved morphological, molecular, and CNS remission. Patient was readmitted, 02 years later with complaints of headache, vomiting, right sided weakness and difficulty in speaking with suspicion of relapse. Lumber puncture was performed which showed many promyelocytes with Auer rods and diagnosis of CNS relapse of APL was made.

Case Report, 2016

Retained surgical swab (RSS) is an infrequent and avoidable complication after any type of abdomi... more Retained surgical swab (RSS) is an infrequent and avoidable complication after any type of abdomino-pelvic surgeries which leads to increased morbidity of patient as well as the cost of treatment. We report one such case of a 32 years old female patient who presented with signs and symptoms of acute intestinal obstruction, 1 year after a cesarean section. On exploration a mass was found in the region of terminal ileum which was resected followed by end to end anastomosis. Upon dissection of the mass, a large surgical swab was found inside the lumen of the gut. The mass which is formed around a retained surgical swab is known as Gossypiboma. Complete intra-luminal migration is very rare and a delayed complication of RSS and is difficult to diagnose due to vague presentation and inconclusive imaging. Surgical intervention is mainstay of treatment although it may be removed endoscopically in accessible parts of the gut and may even pass with defecation without any intervention.

Review Article, 2016

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetra... more Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. In literature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trauma index) as a more accurate method of quantifying the extent of damage in patients with the penetrating abdominal trauma and association of high PATI score (>25) with mortality. Objective: To determine the association of mortality in patient with penetrating abdominal trauma with high PATI score (more than 25). Methods and Design: Medical records of all adult patients (age more than 16 years of age) admitted at Aga Khan University and Hospital with penetrating abdominal injuries from 2006-2012 were reviewed retrospectively; adult patients with complete medical records were included and patients with missing data were excluded from the study. SPSS version 19 was used for data entering and statistical analysis. Results: We included 74 patients, mostly men (95.9%), with a mean age of 34.4 +/-11.9 years. Gunshot injuries accounted in 63 patients. Majority of the patients (31.1%) presented with grade 2 shock. Emergency laparotomies were done in 62 patients, 4 patients underwent damage control laparotomies. Seven patients were treated conservatively. Most commonly injured intra-abdominal organ was small bowel (31%). Mean injury severity score was 12.97, mean revised trauma score was 7.63, and mean TRISS was 96.19. Mean PATI Score was 10.85 +/-8.9. Mortality occurred in 9 patients, among them four patient had PATI score more than 25 (p=0.021). There is a seven time increase in risk of mortality in patients with high PATI score. Conclusion: Gunshots are mainly responsible for penetrating abdominal injuries in our study. Management was by mandatory laparotomy after clinical assessment, in majority of patients. PATI score is a valuable scoring for estimation of severity of penetrating abdominal injury in context with the outcome.

Research Article, 2016

To determine the optimal therapy for lowering the heart rate (HR) of cardio-compromised patients... more To determine the optimal therapy for lowering the heart rate (HR) of cardio-compromised patients by observing the effect of negative chronotropic agents.
Methods: The retrospective study was conducted at the 24 Holter monitoring data centre of Agha Khan University Hospital from August 2010 to July 2011. Data was extracted by using a predesigned Performa on individuals with compromised
cardiovascular disease. The sample population was categorized into four groups. Furthermore, two time intervals were set which included an early morning and a later period.
Result: Of the 600 patients, 369 were males (61.5%) and 231 were females (38.5%) with a mean age of 54.9±19.2 years old. Average HR’s for patients on BB, CCB, combination therapy and drug naïve were 71.14±11.4 bpm, 72.38±11.95 bpm, 66.88±10.37 bpm and 76.47±13.63 bpm respectively (p value<0.01). In period I, 42.5% of patients on BB had the lowest HR with a mean of 50.47±10.27 bpm, 36% on nCCB had a mean of 51.7±13.6 bpm, 50% on combination had a mean of 47.38± 8.3
bpm and 39.86% of drug naïve patients had a mean of 50.87±10.47 bpm (p-value <0.8). In period II, 57.5% on BB had the lowest HR with a mean of 49.87±9.15 bpm, 64% on nCCB had a mean of 50.75±10.23 bpm, 50% on combination had a mean
of 50.5±5.01 bpm and 61.14% of drug naïve patients had a mean of 52.04±11.56 bpm (p value<0.61).
Conclusion: Negative chronotropic agents are highly effective in reducing a patient’s HR as compared to those who were drug naive.

Research Article, 2016

Probiotics are gram positive organisms considered beneficial for combating with various pathogens... more Probiotics are gram positive organisms considered beneficial for combating with various pathogens. Most of them are antibiotic resistant, giving an idea that they may be carrier of r-plasmids. Our aim of the study was to determine the proportion of LABs that associate with r-gene transference as well as in boosting up antibiotic susceptibility range. For that we isolated probiotic cultures of Streptococcus, Lactobacillus, and Leuconostoc from milk sample, and checked the susceptibility pattern of isolated probiotics and pathogens (test organisms) against carbepenem. Results showed all LABs are resistant, while most of the pure test organisms were sensitive, after that these pathogens were treated with Labs coated disc that was prepared by the Kirby Bauer method. These LAB treated organisms were again checked with carbepenem to check the susceptibility pattern, this whole protocol was carried out on Muller Hinton Agar (MHA) plate. According to our results test organisms treated with Streptococcus and Lactobacillus species occurred with a 20% and 1% of resistivity, while organisms treated with Leuconostoc species enhanced the sensitivity 66% and streptococcus 1%, whereas Lactobacillus did not show any change in antibiotic spectrum.

Research Article, 2016

The invitro antibacterial activity of ethanolic extracts of three dietary spices Coriandum sativu... more The invitro antibacterial activity of ethanolic extracts of three dietary spices Coriandum sativum (Coriander), Curcuma longa (Turmeric) and Capsicum annuum (Red chili) were investigated by well diffusion method against clinical isolates which include Gram positive (Enterrococcus spp., Staphlococcus aureus) and Gram negative (Pseudomonas aeruginosa, Salmonella typhi, Escherichis coli, Proteus spp., Klebsiella pneumonia and Acinetobacter baumannii) as well as by minimal inhibitory concentration and by microdilution method. Moreover, killing time of each extract was also calculated against Escherichia coli.

Research Article, 2016

Objectives: The aim of this study was to determine the prevalence of pulmonary hypertension [PH] ... more Objectives: The aim of this study was to determine the prevalence of pulmonary hypertension [PH] and correlate it with the laboratory markers of hemolysis and serum NT-pro brain natriuretic peptide [BNP] concentrations in Sickle cell disease [SCD] patients from Oman. Methods: A cohort of 115 SCD patients was investigated with complete blood counts, blood chemistry, Serum NT-proBNP levels, imaging studies and cardiac evaluation with a 12-lead electrocardiogram and Doppler echocardiogram. They were prospectively screened for pulmonary hypertension [PH] with echocardiography, defined as a tricuspid regurgitation flow velocity of > or =2.5 m/sec. Results: Amongst the 73 evaluable patients, those with PH [n=7] had a median age of 32 years with an interquartile range (IQR) of 25.5-34 years, and a prevalence of 9.6%. No statistically significant differences were detected in the haematological parameters, serum blood chemistry and ECG parameters in patients with and without PH. However, in the PH patients, there was an increased plasma NT pro-BNP levels [p<0.006], and serum CRP levels [p<0.003][Mann Whitney U test]. Furthermore, the differences in the indirect bilirubin levels were statistically significant for one tailed comparison [p<0.04, Mann Whitney U test]. The serum NT-pro BNP levels were also significantly correlated with PH[r=0.368, p<0.025]. Conclusions: The median age of PH patients was decade higher with median serum NT-pro BNP levels being twofold higher and significantly correlated with PH. The significant correlation between serum indirect bilirubin and PH may implicate haemolytic parameters in the pathogenesis of PH.

Perspective, 2016

In Pakistan there is no proper National Cancer Registry. The age-standardized rates (ASR) for can... more In Pakistan there is no proper National Cancer Registry. The age-standardized rates (ASR) for cancer (all sites), 1995 to 1997 in Karachi South (KS) were 139.11/100000 in males and 169.5/100000 in females. Corresponding rates for 1998 to 2002 were 179.0/100000 in males and 204.1/100000 in females. In the 1995-1997 data, the most common malignancies (ASR per 100,000) in males were lung (21.3), oral cavity (14.2), urinary bladder (9.0), and larynx (8.8). The commonest cancers in females were breast (53.1), oral cavity (14.5), and ovary (10.9). Data from 1998 to 2002 showed a rising incidence for lung (25.5), larynx (11.8), and urinary bladder (9.9) cancers in males and breast (69.1), esophagus (8.6), and cervical (8.6) cancers in females. The mean age of cancer for all sites was 51.2 years (95% CI 49.4; 53.1) for males and 50.0 years (95% CI 48.2; 52.4) for females in 1995-1997. Corresponding rates for 1998-2002 were 49.5 years (95%CI 47.5; 51.4) in males and 53.7 years (95% CI51.5; 55.6) in females.

Editorial, 2016

In the field of health sciences, research based work is progressing day by day and need to accred... more In the field of health sciences, research based work is progressing day by day and need to accredit and publish original work of authors is addressed in many ways. We have tried to lay a foundation stone and a platform to serve and help medical and health sciences research accomplishments in Pakistan and abroad, following current international guidelines in the publishing field. In order to facilitate the original research work, National Journal of Health Science (NJHS) is established under the umbrella of NIBD publications that will address: significant and latest development in Health Sciences and Life Sciences, academic research and inspiration to improve practice, provision of online journals and print publications to individuals and institutions and creating public access through our journal by conducting research methodology workshops for researchers to help them prepare research papers and get them published. Quarterly hosting different scholarly manuscripts and latest findings related to broad spectrum of research disciplines for e.g. pathology, dentistry, biotechnology also includes other disciplines. NJHS is offering, a well-organized and user friendly online handling system. Moreover, we will ensure publication of high quality manuscripts via efficient peer review process that involves two independent reviewers and the process will be double blind for the reviewer and the author as well. NJHS aims to provide constructive, substantial and reliable involvement of the scientific community. Our vision is to propel a transformational initiative, by providing dedicated services to medical profession to publish research based knowledge applicable to the best medical practices. NJHS would like to acknowledge persons involved in the establishment of NJHS, it's planning, organization, formulation of mission and vision statement, the editorial board and professional staff members. NJHS would like to thank and express gratitude to the people who got involved in this journal from the authors, reviewers and editorial staff whose sincere hard work has made it reality. We look forward for its positive growth by the help and encouragement of its well wishers and contributors that trusted us from the beginning. NJHS team is certain that with this unconditional support from such a prominent and large team of bio-researchers, doctors, students and healthcare professionals who wish to be kept informed and up-to-date with the latest and most important developments in the field of Health Sciences, will definitely become one of the most prestigious journal.

Vol. 2, No. 1, 2017 by National Journal of Health Sciences

NIBD, 2017

This article convince the Muslim communities worldwide - the second largest religious entity of t... more This article convince the Muslim communities worldwide - the second largest religious entity of the world - to adopt modern medical steps, which provide safety and care. Methods and Discussion: Irrespective of their education, Muslims are highly influenced by Islam. They never consider science equal to their religion; therefore, in Muslim countries it is very difficult for any government, authority or institution to enforce norms in the respective medical sector through acts or ordinances. Instead, the canon source of Shariah can communicate this message easily. The masses practice their daily affairs as per Shariah as they believe that Shariah is the fountain of divine wisdom. Providing Muslim religious sources in this research paper is purely to communicate a scientific study under the guidance of Shariah to the community worldwide. Conclusion: It is hoped that numerous Muslims would take advantage from it. The Ulama [Muslim clergy] and Madrasahs [Seminaries] have a pivotal role in influencing health education and its promotion amongst members of the Muslim community. They can provide potential access to people for raising, understanding and encouraging the use of health services as well as ethnic blood donor drives.

Case Report, 2017

Background: The current study has focused on the complications arising in a patient due to diabet... more Background: The current study has focused on the complications arising in a patient due to diabetes mellitus and how the patient's quality of life has been affected. The most feared complication of the disease is loss of lower limb due to infection and major cardio-vascular complications. Objectives: Management of a patient with diabetes and cardiovascular complication with history of tuberculosis is studied along with antim-icrobial interventions for curing the ulcer and reducing risk of amputation. Cardiovascular complication, one of the co-morbidity of diabetes, was also managed. Methods: After selection of the patient, consent from patient and approval from relevant authority were obtained, patient was kept under observation for a week. Case Presentation: Patient was admitted with complaints of: shortness of breath, palpitation, exertional dyspnea and a spreading right shin discharging foot ulcer. Conclusion: Patient was treated with antibiotics and ionotropic agent and indicated better rate of prognosis.

Case Report, 2017

Spigelian hernia is rare and generally difficult to diagnose because of its location and vague no... more Spigelian hernia is rare and generally difficult to diagnose because of its location and vague non-specific symptoms. A Spigelian hernia occurs through the Spigelian fascia, which is composed of the aponeurotic layer between rectus muscle medially and semilunar line laterally. Nearly all Spigelian hernias occur at or below the arcuate line. The absence of posterior rectus fascia may contribute to an inherent weakness in this area. These are often interparietal, with the hernia sac dissecting posterior to the external oblique aponeurosis. Patient often present with localized pain in the area without a bulge because the hernia lies beneath the intact external oblique aponeurosis and they are easily overlooked by obesity. Ultrasound or CT scan of the abdomen can be useful to establish the diagnosis. Spigelian hernias should always be surgically repaired in view of the high frequency of incarceration. We report a 40 year old lady who presented to us with complaint of pain in her right Epigastric & lumbar region along with vague swelling on standing. Diagnosis of Spigelian hernia was made on the basis of ultrasound & CT scan findings & it was confirmed on exploration. The hernia was reduced & licheneistein mesh repair was performed, her recovery was uneventful.

Review Article, 2017

Introduction: Bilateral long bone fractures are rare and usually are associated with increased ri... more Introduction: Bilateral long bone fractures are rare and usually are associated with increased risk of complications. These fractures are usually associated with poly traumatic injuries or high impact trauma resulting in shock. Commonest etiology is road traffic accident. Closed diaphyseal fractures are best managed by intramedullary nailing; management becomes difficult if there are open fractures and late arrival. In this study we intend to present our experience of managing these patients. Materials and Methods: Medical records of all adult patients (age more than 16 years of age) admitted at Aga Khan University and Hospital with bilateral femur fractures +/-other systemic injuries 2006-2014 were reviewed retrospectively. Adult patients with complete medical records were included and patients with missing data were excluded from the study. SPSS version 19 was used for data entering and Statistical analysis. Results: We retrieved 11 cases of bilateral femur fractures. Mean age of patients was 34.5 +/-20.9, with male predominance constituting 72.7%. Common mode of injury was fall from height and road traffic accident (RTA) 45.5% each, with the exception of one gunshot. Mean Injury Severity Score was 26.9+/-7.79. Mean Revised Trauma Score was 7.39 +/-0.62; mean Trauma Injury and Severity Score was 92.4 +/-6.6%. 2 patients had surgical site infections and 1 had non-union. We encountered no mortality. Increase ISS is associated with increased risk of morbidity and length of hospital stay (p= 0.02).

Review Article, 2017

ZIKV is the most promising mosquito borne Arbovirus infection. Aedes mosquitoes are responsible f... more ZIKV is the most promising mosquito borne Arbovirus infection. Aedes mosquitoes are responsible for causing this disease. About 80% of infections are asymptomatic. Our aim is to get an overview about the epidemics of ZIKV infections throughout the years from the first case in Uganda whyich occurred in 1947 till now. Studies reveal that the disease occurs from being mild to severer with complications like microcephaly, fetal malformations and Guillain-Barre syndrome (GBS). It arises from the regions of Africa, Nigeria, Sierra, Leone, and Gabon. Diagnosis occurs through PCR; Zika viruses can cross-react with other flaviviruses. There are various factors that are vague regarding the Pathogenicity of ZIKV. No medication and vaccine are available for treating Zika virus infection. Vaccine of Zika is expected to arrive soon. If the modern procedures are followed and chased appropriately it could lead to the control of this infection.

Review Article, 2017

Objective: This literature review aims to explore the risk factors, preventive measures and treat... more Objective: This literature review aims to explore the risk factors, preventive measures and treatment options for women with postpartum depression especially in Pakistan. Introduction: Postpartum depression affects 12.5% women on average and is one of the most common complications of pregnancy. Among Asian countries, Pakistan has the highest prevalence rate that is 28%-63%. The consequences of PPD go beyond the mother and affect the partner and the child as well and can even lead to infanticide and maternal death, often by suicide. Besides, not all women are assessed for PPD or receive its treatment despite of several treatment options available.

Research Article, 2017

Background: Over 90% of total blood transfused in Pakistan is donated by the friends and relative... more Background: Over 90% of total blood transfused in Pakistan is donated by the friends and relatives of patients. The population of Karachi particularly healthy and active individuals can be a good source of quality blood if they are motivated and are willing to be voluntary blood donors. Therefore the objective of this study is to determine the knowledge, attitudes and practices about blood donations among people of Karachi. Methods: A cross sectional study was conducted among people of Karachi from April 2015 to September 2015. A total of 300 people were interviewed with the help of structured questionnaire. Data analysis was performed in SPSS version 20. Results: The study showed that the frequency of blood donation was significantly higher in males than females. In total, 273 of the participants have knowledge about blood donation whereas the remaining 27 participants were unaware. In total, 230 participants never donated blood. Regarding attitudes of participants, study showed that 31% participants think that they are weak, 23.7% told that it's harmful, 23% told that they are diseased, and 23.3% told that they have a fear of getting sick/infected. Conclusion: Attitudes and performance regarding blood donation was less than satisfactory among the participants as compared to knowledge and awareness, this may be due to misconceptions, misbelieves and restrictions. An intensive campaign should be implemented to encourage public about blood donation to alleviate their fears and to change their perceptions.

Editorial, 2020

Case Report, 2016

Review Article, 2016

Research Article, 2016

Perspective, 2016

Editorial, 2016

NIBD, 2017

Case Report, 2017

Review Article, 2017

Research Article, 2017

Bacterial gastroenteritis mainly caused by Campylobacter sp. is a major health concern in Pakista... more Bacterial gastroenteritis mainly caused by Campylobacter sp. is a major health concern in Pakistan. In order to investigate the primary sources of Campylobacter infection, total 81 cloacal swab samples were collected from different avian species in Karachi. Campylobac-ter strains were isolated, identified and antibiotic susceptibility pattern was studied. All isolates of Campylobacter were sensitive to Gentami-cin and Ofloxacin. It was observed that 23% of the C. jejuni positive isolates were resilient to tetracycline, 45% to ampicillin, and 12% to erythromycin. The Campylobacter isolates showed susceptibility to the extracts of two plants namely Daphne Mucronata and Symplocos racemosa. The sensitivity of the isolates towards these extracts can be an alternative to the traditional antibiotics for the treatment of Campyl-obacter infections.

Research Article, 2017

Background: Oncologic problems are increasing day by day very rapidly. It includes leukaemia, sol... more Background: Oncologic problems are increasing day by day very rapidly. It includes leukaemia, solid tumors, germ cell tumors and many others. Leukaemia is a growing reason of paediatric mortality. Children with leukaemia, usually have low blood count which requires blood transfusions. These transfusions can lead to transfusion associated viral infections particularly Hepatitis B and Hepatitis C. Objective: To identify the prevalence rate of HBV and HCV infections in paediatric oncology patients and to identify the probable relation of transfusion with that of the spread of the infection and its detection method. Methods: This cross-sectional study was carried out at molecular department of Child Aid Association Karachi from January 2013 to De-cember 2015. A sample size of 200 paediatric oncology patients was taken. The samples were processed by Real Time Polymerase Chain Reaction (PCR) technique. Result: The results showed that out of 200 patients, 17 were HBV positive having a prevalence rate of 8.5% and 69 were HCV positive with prevalence rate of 34.5%. Among 17 HBV positive patients, no patient was infected before the start of treatment while 03 out of 69 HCV positive patients were previously infected. Conclusion: The incidence of HCV and HBV is raising in the paediatric oncology patients on treatment. This demonstrates that the management may be responsible for this predicament. These patients are exposed to cytotoxic and chemotherapeutic drug infusions and multiple blood transfusions. Therefore blood transfusion practices should meet the standard operating procedures which ensure the use of sterilized equipments and the donors should be screened for viral hepatitis through PCR.

Perspective, 2017

Objective: The purpose of writing this article is to convince the Muslim communities worldwide-th... more Objective: The purpose of writing this article is to convince the Muslim communities worldwide-the second largest religious entity of the world-to adopt modern medical steps, which provide safety and care. Methods and Discussion: Irrespective of their education, Muslims are highly influenced by Islam. They never consider science equal to their religion; therefore, in Muslim countries it is very difficult for any government, authority or institution to enforce norms in the respective medical sector through acts or ordinances. Instead, the canon source of Shariah can communicate this message easily. The masses practice their daily affairs as per Shariah as they believe that Shariah is the fountain of divine wisdom. Providing Muslim religious sources in this research paper is purely to communicate a scientific study under the guidance of Shariah to the community worldwide. Conclusion: It is hoped that numerous Muslims would take advantage from it. The Ulama [Muslim clergy] and Madrasahs [Seminaries] have a pivotal role in influencing health education and its promotion amongst members of the Muslim community. They can provide potential access to people for raising, understanding and encouraging the use of health services as well as ethnic blood donor drives.

Editorial, 2017

Making a difference is the main purpose of health sciences journals nowadays, especially for an o... more Making a difference is the main purpose of health sciences journals nowadays, especially for an open access journal. Open access provides means of publishing rapidly and cost effectively. It has revolutionized substantially in searching latest data in limited time span while providing tools for extracting scientific data and literature to make it more graspable. As the society is expanding and developing, hence the information regarding different issues are now easier to obtain from the latest resources online. Mostly, scientific authors or medical researchers are remarkably skilled in their specified fields, but when it comes to write an article or manuscript, they find it difficult and have limited guidelines of writing scientifically for a journal.

Research Article, 2017

The emergence of resistant pathogens is a leading cause of morbidity worldwide. For the treatment... more The emergence of resistant pathogens is a leading cause of morbidity worldwide. For the treatment of diseases

Case Report, 2017

Pure White Cell Aplasia (PWCA) is an extremely rare haematological entity. Various causes have be... more Pure White Cell Aplasia (PWCA) is an extremely rare haematological entity. Various causes have been implicated in its pathogen-esis. We are reporting here a case of a sixty seven years old female, referred to us with the concern of febrile neutropenia and extensive oral candidiasis. Workup for secondary causes of agranulocytosis was negative. Bone marrow findings were consistent with PWCA, and in the presence of convincing previous history of amodiaquine intake, she was diagnosed as drug (amodiaquine) induced PWCA.

Case Report, 2017

Synchronous occurrence of multiple malignancies i.e.: epitheliod and lymphoproliferative are rare... more Synchronous occurrence of multiple malignancies i.e.: epitheliod and lymphoproliferative are rare but well reported. Here we have presenting a case of 82 year old male, known smoker, admitted at Shifa International Hospital Islamabad, with complaints of shortness of breath, productive cough, weight loss, generalized weakness and cervical lymphadenopathy. The laboratory investigations; complete blood counts and peripheral blood showed patient is having absolute lymphocytosis with flow cytometric analysis performed on peripheral blood revealing B-cell Non Hodgkin lymphoma. However p 53 deletion was not detected on using fluorescence in-situ hybridization. Although bone marrow biopsy examination was surprisingly seen with multiple cohesive metastatic clumps and dispersed atypical cells with positivity of CKAE1/AE3, CD56, TTF1 giving diagnosis of metastatic lung carcinoma. Hence occurrence of both epitheliod and lymphoproliferative malignancy was made and reported in Pakistan most likely for the first time.

Case Report, 2017

Any adverse event that occurs during or after transfusion for which no other cause can be establi... more Any adverse event that occurs during or after transfusion for which no other cause can be established is labeled as a transfusion reaction. Since the advancements in screening tests for infectious diseases, non-infectious transfusion reactions are on the rise. The aim of this study was to assess the frequency of transfusion reactions and to do an audit of reaction reporting. It was a retrospective study done from 1st December 2014 to 31st December 2015 at The Children's Hospital and Institute of Child Health, Lahore Punjab. The data was retrieved from blood bank records. 22 transfusion reactions were reported, out of which the most common reaction was febrile non haemolytic transfusion reaction. Only one haemolytic transfusion reaction was seen. Among the blood components, most reactions were seen with packed red blood cells. In 90% of cases completely filled reporting forms were received, in 86% of cases post reaction EDTA samples were received, and in only 50% cases urine samples were received in blood bank. Pyrexia was the most frequent symptom in recipients. Re-audit will be done next year. Guidelines need to be followed and updated.

Mini Review Article, 2017

Over the past 25 years, principles of damage control Laparotomy have saved many lives. Quick reco... more Over the past 25 years, principles of damage control Laparotomy have saved many lives. Quick recognition of injuries and immediate transfer to operating room are essential. Patients with polytrauma have substantial haemorrhage and go into a vicious cycle of death (hypothermia, coaugulopathy and acidosis). Prior to surgery, adequate resuscitation helps to improve both intra and post-operative mortality. And the focus is on control of bowel contamination and haemorrhage. Once achieved, patient is resuscitated in ICU setup to optimize physiology. Adequate hydration, blood transfusion, re-warming of the patient and other supportive measures are taken to arrest the ongoing cycle of coagulation, hypothermia and metabolic acidosis. Later, patient is moved to theatre for definitive management of injuries. Improvement in patient outcome has been reported by an increased understanding of damage control and the anatomical and physiological steps taken to improve the outcomes.

Research Article, 2017

Introduction: A descriptive, non-interventional study was conducted from April 2011 to September ... more Introduction: A descriptive, non-interventional study was conducted from April 2011 to September 2013, at KIRAN hospital, Karachi among n = 811 female breast cancer patients to assess the effects of chemotherapeutic agents that were employed for the treatment of breast cancer. The assessment was done so as to see the variation in response of the patients towards the drugs used specifically the adverse effects that have to be combated during therapy. Methodology: During 3-6 months, a follow up was done to collect data for ADEs (Adverse Drug Events) that occurred among patients after therapy. The SPSS version 16.0 was used for statistical analysis of the data. The adverse events that occurred due to adjuvant chemotherapy including severity, preventability and causality were evaluated using three International scales i.e. Modified Schumock and Thornton scale, modified Hartwig's and Siegal's scale and Naranjo's algorithm. Results and Discussion: Majority of the patients received 6 cycles of FAC therapy (5-fluorouracil, Adriamycin/doxorubicin, cyclophospha-mide) and showed good response. The assessment of ADRs using different scales revealed hair loss, nausea, vomiting, anemia and neutro-penia as the non-preventable definite effects that were experienced by the patients. Mild to moderate diarrhea/constipation was probably preventable and hence doubtful. Moderately probable effects included mucositis and mouth ulcers whereas possible effects included fever and chills. Conclusion: Through the right use of medicines, the mild effect of headache and pain could be certainly preventable. Hence chemotherapeu-tic agents must be chosen for each patient on individual basis to prevent or lessen the toxic effects rendered to them and be useful in the disease course.

Research Article, 2017

Introduction: Hepatitis C virus (HCV) infection is an emerging public health issue affecting youn... more Introduction: Hepatitis C virus (HCV) infection is an emerging public health issue affecting young people in developing countries. It is the common cause of chronic liver disease which if untreated, leads to cirrhosis, hepatocellular carcinoma and ultimately liver transplantation. HCV infection is conventionally treated with Interferon-α (IFN-α) and anti-viral Ribavirin (RBV). Thyroid dysfunction is frequently encountered in patients having HCV and being treated with IFN-α and antiviral (RBV). Objective: To find out the incidence of thyroid dysfunction i.e., hypothyroidism in patients of HCV infection being treated with IFN-α and anti-viral (RBV). Material and Methods: 250 patients having HCV infection were enrolled for the study. All patients were treated with 3 million units sub-continually 3 times per week and antiviral (RBV). Thyroid function tests were performed at the start of the treatment to have a baseline thyroid status and at the end of the treatment. Patients were considered to have hypothyroidism when thyroid stimulating hormone (TSH) was more than 4.0 mIU/L. Results: 47 (18.8%) patients had thyroid dysfunction after 3 months of the therapy. Out of these 47 patients, 36 (76.59%) had hypothyroidism and 11 (23.4%) had hyperthyroidism. It is evident that patients on IFN-α and antiviral therapy for HCV infection developed thyroid dysfunc-tion particularly hypothyroidism that is more in females.

Research Article, 2017

Background: Cubital tunnel syndrome (CuTS) is the second most common entrapment neuropathy in the... more Background: Cubital tunnel syndrome (CuTS) is the second most common entrapment neuropathy in the upper limb, after the entrapment of the median nerve in the carpal tunnel. Different techniques of nerve decompression have been described, however, the idyllic surgical treatment and technique for CuTS remain controversial. Objective: Our aim is to compare the outcome of simple decompression with anterior subcutaneous transposition of ulnar nerve in the treatment of CuTS. Methods: The study included 20 patients that were surgically treated in the Neurosurgery department at Gamal Abdel Nasser Hospital-General Authority for Health Insurance between August 2014 and February 2015. These patients were randomly distributed into two equal groups, each consisting of 10 cases. In the first group, only simple decompression was performed while in the second group, anterior subcuta-neous transposition was supplemented. All cases were followed for at least 6 months. Results: Seventy percent of the patients were females and the mean age was 45.35 ± 14.62. The duration of symptoms before surgery varied from 4 months to 2 years. Occupational repetitive elbow flexion and extension was the most common contributing factor. Seven out of ten patients, in the simple decompression group, showed clinical and electrophysiological improvement at 6 months interval. While in the second group, only six patients showed improvement 6 months after surgery. The difference was found to be statistically insignificant. There was no significant effect of the duration of symptoms or co-morbidities on the outcome. Conclusion: Long term follow up revealed no significant difference between simple decompression and anterior subcutaneous transposition. Simple decompression of the ulnar nerve, in our experience, is an effective and less invasive technique for patients with cubital tunnel syndrome .

Perspective, 2017

In modern healthcare centers physicians play an important and pivotal role in the establishment ... more In modern healthcare centers physicians play an important
and pivotal role in the establishment of quality health care
systems and processes. One of the most important factor in
professional development and growth of specialist is implementation
of processes. I am postulating a plan for the consideration
of specialist faculty colleagues.
A proposed Professional Development Plan (PDP) is being
postulated in the following text. This proposed plan is being
named as “The CART - 25% plan”, denoting the suggested
proportion of skill development required for a specialist who
is working towards a clear strategic vision This proposed
plan is not expected to be a perfect plan which will be applicable
on all individuals under all eventual circumstances,
therefore appropriate modifications can be considered by an
individual or a competent board of professionals who are
designated to perform this task.

Editorial, 2017

The year 2015 marked the completion of twenty years of Bone Marrow Transplant (BMT) programme in ... more The year 2015 marked the completion of twenty years of Bone Marrow Transplant (BMT) programme in Pakistan. In
September 1995, first procedure was done on a 19 year old boy suffering from acute myeloid leukaemia. He succumbed to
intestinal TB few months later. During the first decade, transplant activity was very slow, only 350 BMT were carried out by
only 03 centres. 02 BMT centres were working in Karachi while only 01 in Rawalpindi. The main indications of transplant
were aplastic anaemia, β-thalassaemia major and haematological malignancies. Only HLA (Human Leucocyte Antigen)
matched procedures were performed. The reported outcome was promising, treatment related mortality remained 10-20%,
while 05-year survival was reported to be 78, 72 and 49% in aplastic anaemia, β-thalassaemia major and acute leukaemia/
chronic myeloid leukaemia respectively

Case Report, 2017

Acute lymphoblastic leukemia (ALL), is a lymphoid neoplasm arising from lymphoid progenitors, bro... more Acute lymphoblastic leukemia (ALL), is a lymphoid neoplasm arising from lymphoid progenitors, broadly classified according to lineage into B-cell and T-cell ALL in which T-cell ALL constitutes a small proportion. We are reporting here a case of young female who was diagnosed as T-cell ALL using flow cytometry with acquired trisomy 21, identified on conventional cytogenetics, as a unique finding in this case.

Case Report, 2017

Intrauterine contraceptive devices are among the most effective forms of contraceptives worldwide... more Intrauterine contraceptive devices are among the most effective forms of contraceptives worldwide. However few complications have been associated with it including uterine perforation which may lead to bowel injury. This is a case of 34-year-lady who had Intra Uter-ine Copper Device (IUCD) placed 6 years ago. She presented with feeling of strings of IUCD through anus, low backache, and non-cyclical bleeding per rectum for last four months. On sigmoidoscopy, a Copper-T Device was found lodged in anterior rectal wall, which was successfully removed with mild traction transanally. A simple clinical examination i.e digital rectal examination followed by proctosigmoidoscopy, diagnosed and led to complete treatment of the patient, with no post-operative complications.

Case Report, 2017

Background: Aberrant expression of antigens/or loss of some antigens on leukemic cells is sometim... more Background: Aberrant expression of antigens/or loss of some antigens on leukemic cells is sometimes seen. Such expressions may or not affect prognosis of leukaemia. Aberrant co-expression of CD5 and CD64 on precursor B-cell ALL leukemic cells is found first time. Objective: To report a novel case of precursor B-cell ALL which co-expressed a T-cell lineage (CD5) and a monocytic lineage (CD64) anti-gens.

Review Article, 2017

Significant alterations are seen in hemostatic system during normal pregnancy and puerperium. Ove... more Significant alterations are seen in hemostatic system during normal pregnancy and puerperium. Overall, it is a state of hypercoagu-lability and hypofibrinolysis mitigating the risk of severe bleeding during placental separation at delivery. On the flip side, it threatens a pregnant woman for thrombosis with the risk being four to six folds more in comparison to a non-pregnant woman. It is important to understand the hemostatic changes in normal pregnancy by all health care providers who manage pregnant women in obstetric wards, trauma, anesthesia and other circumstances. This review describes the changes in qualitative and quantitative changes in platelet, clotting factors, anticoagulants and fibrinolysis during normal pregnancy and puerperium.

Review Article, 2017

Stem cells are the cells that have the ability to regenerate themselves and are able to different... more Stem cells are the cells that have the ability to regenerate themselves and are able to differentiate into one or more specialized cell types. This unique property makes them a valuable source for in vitro disease modeling, drug designing, regenerative medicine and tissue engineering. As no specie can fully mimic the human microenvironment, human cell models derived from patients cells provide a fascinating avenue for enhancing our current understanding of the early molecular stages of various diseases followed by validating therapeutics. In this paper, we reviewed the role of stem cells in regenerative medicine that includes use of cord blood derived stem cells in medicine and patient specific induced pluripotent stem cells for future transplant purposes and the hurdles and obstacles that we need to address before we can safely use these cells for patient cure.

Research Article, 2017

Introduction: Pelvic Organ Prolapse (POP) is an important gynecological morbidity. An increasingl... more Introduction: Pelvic Organ Prolapse (POP) is an important gynecological morbidity. An increasingly popular classification system for this disease is the Pelvic Organ Prolapse Quantification System (POP-Q). This study was intended to initiate an information campaign , preventive care management and early treatment to reduce this public and social health problem. Subject and Methods: A Cross sectional study was carried out on 197 women with complaints of something coming out of vagina or heavi-ness in pelvis. General physical and standard pelvic examination in dorsal lithotomy position was performed for the diagnosis of pelvic organ prolapse. Results: Frequency of various stages of pelvic organ prolapse using Pelvic Organ Prolapse Quantification System (POP-Q) in women was observed as stage 0 (10.2%); stage I (9.69%); stage II (52.55%) and stage III (27.55%). Rate of stage of pelvic organ prolapse was also not significant with parity, menopausal status and hormone replacement therapy while effect of increase abdominal pressure on the POP-Q stage was also statistically significant (p=0.0005). Conclusion: In conclusion, increased abdominal pressure and overweight clearly confers a risk for pelvic organ prolapse. Risk factors (age, parity, menopausal status and hormone replacement therapy) may influence the stages of POP, however the relationship between these factors and different stages has not been clearly understood.

Research Article, 2017

Tobacco smoking and chewing is a significant contributing factor of periodontal health. Tobacco c... more Tobacco smoking and chewing is a significant contributing factor of periodontal health. Tobacco consumption increases the probability of periodontal disease by affecting the periodontal attachment, pocket formation as well as bone loss. The purpose of this study was to examine the effects of tobacco consumption and its relationship with periodontal health. This is a cross-sectional study of 169 participants chosen from an urban population with an age distribution from 15 to 65 years. Among the study population, 130 were males and 39 were females with the data collected and analyzed by SPSS version 16. The study revealed a significant relationship between the use of tobacco and gingival index, the plaque index, and the community periodontal index of treatment needs. According to the results, there was a high correlation between intake of tobacco and the gingival score.

Research Article, 2017

Background: Oil contamination is increasing at an alarming rate and to overcome to this problem t... more Background: Oil contamination is increasing at an alarming rate and to overcome to this problem the most efficient method used is biodegradation. Biodegradation is a natural mechanism that can be used effectively for degradation of recalcitrant hydrocarbon pollutants prevailed in the environment by employing environmentally friendly microbes. Methods: Strain CMG 457 was isolated from petrol pump site from Firdous Colony, Karachi and was identified as Enterobacter sp. after morphological and biochemical characterization. Strain resistance towards different organic hydrocarbons (paraffin, aromatics and pesticides) and utilization of various organic compounds as sole carbon source were analyzed on Nutrient agar. MIC of antibiotics and heavy metals was checked on Bushnell Haas (BH) agar at 37°C for 24 hrs. Results: Research investigated the role of Enterobacter sp. in biodegradation of petroleum hydrocarbons. The results showed that the bacterium is a gram-negative aerobic bacillus. Enterobacter sp. designated as CMG 457 was screened for oil degradation using BH agar. Resistance of strain against different organic hydrocarbons was tested and CMG 457 showed high resistance of upto 50% against paraffin. The Minimum Inhibitory Concentration (MIC) of heavy metals and antibiotic sensitivity were investigated for bacterial strains. Screening for antibiotic resistance revealed that CMG 457 was resistant to ampicillin and erythromycin and was able to tolerate heavy metals like CuSO 4 , CdCl 2 and CrCl 2 upto 3mM. Conclusions: From the study, it is concluded that oil contaminated areas are the best source for isolation of hydrocarbon degrading bacteria. Enterobacter sp. has a potential for oil degradation as it showed better hydrocarbon degrading ability.

Perspective, 2017

Genetic haemoglobin disorders are broadly divided into thalassaemia syndromes and abnormal haemo... more Genetic haemoglobin disorders are broadly divided into
thalassaemia syndromes and abnormal haemoglobins.
Thalassaemias are a heterogeneous group of inherited disorders
of haemoglobin synthesis in which one or more globin
chains are either not produced at all (βo) or are produced at a reduced rate (β+). These are classified according to the type of globin chain(s) affected. The abnormal haemoglobins are produced in normal amount but are structurally abnormal
and therefore lack the usual qualities of haemoglobin. Some abnormal haemoglobins like Hb-E, in addition to being structurally abnormal are produced in reduced amount

Editorial, 2017

β-thalassaemia major is an important autosomal recessive disorder in many ethnic groups across th... more β-thalassaemia major is an important autosomal recessive disorder in many ethnic groups across the world. Blood transfusion and iron chelation is the mainstay of treatment in a vast majority of patients [1]. Most of the symptomatology of β-thalassaemia major is considered to be due to low haemoglobin level and effects of massive deposition of iron in the body. Iron chelation is the standard of care and recommended as soon as 10-20 blood transfusions have been given to the patient [1]. Recently, haemoglobin-F augmentation using Hydroxyurea (HU) is explored as a potential treatment option in transfusion dependent and non-transfusion dependent β-thalassaemia patients to ameliorate the need of blood transfusion [2]. Many groups from France, Iran, India and Pakistan have reported encouraging results in a subgroup of study patients [3-6]. Other groups reported additional benefit of iron chelation, along with HbF induction; when used in combination with other chelators, showed the maximum chelation effect [7, 8]. Mechanism of many of the clinical benefits of HU reported in β-thalassaemia is poorly understood. Despite of maintaining a haemoglobin level between 6-7 g/dl, they have a significantly improved quality of life and marked improvement in physical activity. Effects of HU at sub-cellular level i.e. on intracellular anti-oxidant levels, handling of trace elements required for enzymes in different metabolic pathways, oxygen binding and dissociation from haemoglobin-F are not known. Our group started to explore proteomics, metabolomics, genomics and metallomics in β-thalassaemia patients with and without the use of HU to understand the disease biology better [9-12]. Recently, metallomic profile of β-thalassaemia patients before and after treatment with HU was reported. Of 19 elements analysed in serum of these patients, 8 showed correction of impaired levels to the same levels as found in healthy control subjects. Exposure to HU not only improves Hb levels in β-thalassaemia patients but also reduces biometal dysregulations and normalization of many metabolic pathways [9]. This possibly translates into improved quality of life and exercise tolerance. These eight elements including Vanadium (V), Chromium (Cr), Iron (Fe), Cobalt (Co), Nickel (Ni), Copper (Cu), Rubidium (Rb), and Lead (Pb) have differential distribution when compared with HU untreated samples. There have been contradictory reports about copper in β-thalassaemia patients; some studies claimed that thalassaemia patients had elevated levels of serum copper, whereas others reported copper deficiency in some of the patients. A significantly higher copper level was also reported in transfusion dependent thalassaemia patients (before the start of HU in them) as compared to healthy controls. After starting HU, these patients showed a significant reduction in serum copper level similar to those found in normal healthy individuals. These results indirectly support the lower oxidative stress in HU-treated patients as the copper levels return to normal. Elements such as vanadium, chromium, cobalt, lead, nickel and rubidium are found in ultra-trace levels in the human body. Except Rb, they all are toxic. The concentrations of V, Cr, Co, and Pb were found to be significantly elevated in thalassaemia patients before HU treatment as compared to those of healthy controls [13]. However, their levels decreased after HU treatment. Excess vanadium has been reported to cause biochemical imbalances in the body, resulting in body aches, arthritis, a weakened immune system, gastrointestinal disorders and various other symptoms. High lead level causes anaemia, brain damage, kidney disease, impaired growth, impaired reproductive function, and impaired mental functions in children. Our group found lower serum concentration of Ni and Rb in untreated β-thalassaemia patients as compared to healthy controls [13]. Treatment with HU normalized these levels to those of healthy and untreated subjects. Zinc is an essential trace element. Its deficiency results in growth retardation, hypogonadism in males, skin changes, and delayed wound healing. These clinical signs are seen in severe thalassaemia. Zinc deficiency was consistently found in HU treated and untreated β-thalassaemia patients; lower in those of HU-treated patients as compared to healthy controls. Selenium is a component of Glutathione Peroxidase (GPx) and Thioredoxine

Case Report, 2017

Objective: A 30 years old male presented with swelling in right abdomen. Initially it was small b... more Objective: A 30 years old male presented with swelling in right abdomen. Initially it was small but with the passage of time it gradually increased in size. The surgical exploration revealed mass present in anterior abdominal wall without involvement of intra-abdominal structure. CT scan of abdomen was suggestive of intra-abdominal, but surprisingly hydatid cyst was found in anterior abdominal wall without intra abdominal involvement.

Research Article, 2017

Introduction: NPM1 mutation is considered to be an important event in the process of leukemogenes... more Introduction: NPM1 mutation is considered to be an important event in the process of leukemogenesisas it affects the p53 tumor suppressor pathway in the form of frame shift mutation. It is thought to provide a favorable outcome to the disease especially in the absence of FLT3 mutation.This study was conducted to find out the frequency of NPM1 mutations in patients with AML in Pakistani population. Materials & Methods: This was a descriptive cross sectional study conducted for a time period at the National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi. Study subjects' demographics including age, gender, presence and duration of the symptoms. Diagnosis was made on the morphology of blood and/or bone marrow samples in accordance to the revised WHO classification of myeloid neoplasms, 2016. All the patients were treatment naive at the time ofenrollment into the study. Sanger sequencing was performed to detect NPM1 mutation. Results: Out of 100 patients who were enrolled in the study, 60% were males. The mean age of patients was 38.9 years (range: 8yrs-60yrs). NPM1mutation was detected in 14(14%) patients of the total AML cases with equal presence in both genders. According to the WHO classification 2016, NPM1 was found in 3(3%) in AML without maturation, 4(4%) in AML with maturation, 3(3%) in acute promyelocytic leukemia and 3(3%) in acute myelomonocytic leukemia. Conclusion: NPM1 was detected in 14% cases of AML in our study. The presence of the NPM1 mutationhas a considerable impact on the prognosis of the disease as it may help in the tailoring of the future treatment of the AML patients particularly those with normal cytogenetics.

Research Article, 2017

Abstract: To determine the risk factors and complications in patients expired due to measles. Ba... more Abstract: To determine the risk factors and complications in patients expired due to measles.
Background: Measles is one of the vaccine-preventable diseases. Mortality and morbidity due to it has been decreased in many countries with
preventive measures. However, epidemics occur off and on in some communities. Pakistan has faced an epidemic in 2012-13. Started from one
province and affected others. Due to some risk factors, Pakistani children suffered from many complications.
Place & Duration: Measles ward, the Children`s Hospital, Lahore form February to June 2013.
Methodology: All patients who were admitted and expired in measles ward were included in the study. A Performa was filled for each patient
to document the risk factors and complications in affected patients.
Results: 1075 patients were admitted. 44 expired. 27 were males. Minimum age of patients who expired was 3 months and maximum was 7
years. Maximum deaths were in group 4: 27% (12/44), followed by group 2: 23% (10/44). 30 (68%) were malnourished having weight less
than 5th centile. 70% of the patients died within 24 hours (31/44) because of severity of illness. 82% (36/44) patients had contacts in families
or society. 86% (38/44) patients were unvaccinated and only one patient received two doses (2%). 17 patients had co-morbid conditions. These
were; cystic fibrosis, dilated cardiomyopathy, complex cyanotic heart disease, Gaucher`s disease, hypothyroidism, chronic renal failure,
hepatitis (3), seizures disorders, pulmonary tuberculosis, hydrocephalus, Aplastic anemia and severe nutritional anemia (3). Complications
documented were; pneumonia (measles pneumonia with superadded bacterial infection) 100% (n=44), Encephalitis 47% (n=21), Enteritis 9%
(n=4) and respiratory failure 4.5 % (n=2).
Conclusion: Lack of vaccination is the most important risk factor for mortality, followed by malnutrition and co-morbid illness.

Research Article, 2017

Acquired aplastic anaemia is characterized by destruction of haematopoietic stem cells by cytotox... more Acquired aplastic anaemia is characterized by destruction of haematopoietic stem cells by cytotoxic T lymphocytes.
Regulatory T-cells have been reported to be suppressed in aplastic anaemia like many other autoimmune disorders. Haematopoietic response
and haematological recovery after successful immunosuppressive treatment provide the most powerful evidence for the immune mediated basis
of this complex disorder

Research Article, 2017

Background: ß thalassemia is one of commonest inherited disorder in Pakistan having a carrier rat... more Background: ß thalassemia is one of commonest inherited disorder in Pakistan having a carrier rate of 5%. Pregnant women having ß thalassemia trait can have offspring having ß thalassemia major which is lifelong blood transfusion dependent state. Different screening programmes are being carried out in various parts of the world so that the birth of children having ß thalassemia major can be effectively reduced. Objective: To determine the diagnostic accuracy of hematological parameters in identifying β thalassemia trait in pregnant women keeping measurement of HgbA2 as gold standard. Methods: 108 pregnant women were enrolled during one year of the study period. Blood sample was taken and blood complete picture was obtained. By using variables of CP card Green & King index, Shine & Lal index and RDWI were calculated keeping hemoglobin electrophoresis as gold standard. Results: The age of patients ranged from 17 to 37 years with mean age of 24.65. Out of 108 pregnant women enrolled in study 40 were found to have ß thalassemia trait based on results of hemoglobin electrophoresis. Shine & Lal index showed 100% sensitivity, 0% specificity, 35% PPV and 0% NPV. Green & Kings index had sensitivity of 32%, specificity 100%, PPV of 100% and NPV of 71% while RDWI showed 50% sensitivity, 100% specificity, PPV of 100% and NPV of 77% in diagnosing ß thalassemia trait in pregnant women. Conclusion: Automated cell counters based formula including Green & King index, Shine &Lal index and RDWI provide rapid, reliable and cost effective method for screening of ß thalassemia trait especially in third world countries like Pakistan. However none of them have 100% sensitivity and specificity. So they should be collectively looked at in screening programmes.

Research Article, 2017

Objective: The aim of this study is to document different pharmaceutical interventions that took ... more Objective: The aim of this study is to document different pharmaceutical interventions that took place during dispensing through Computerized Physician Order Entry (CPOE) to prevent medication errors at a multidisciplinary tertiary care hospital in Karachi, Pakistan. Method: Study Design: Systematic retrospective review of e-prescriptions received in inpatient pharmacy for dispensing in a multidisciplinary tertiary care hospital. Dispensing Setting: In order to decrease medication administration error, the hospital works on Unit Dose Dispensing System, all the orders are segregated by Health Management Information Software and appeared on inpatient pharmacist window for dispensing, the inpatient pharmacist then check all the medication order, if the pharmacist find any medication error or better alternative, the pharmacist contact the concerned physician and discuss about the error and suggest alternatives, if the physician find the suggestion beneficial for the patient then the order is intervened. Date Collection: These interventions were recorded by in-patient pharmacists from June 2014 till May 2015, which were then filled in a performa and categorized for potential of harm if not intervened. Result: A total of 1336 interventions are accepted during the study period. About 83.2% of the interventions were found to be minor or moderately harmful. Most significant intervention was related to dose correction (26.9%), followed by drug alternatives (therapeutic or brand alternative) (26.6%), wrong frequency of drug (20.7%), excessive duration (9.2%), drug duplication (6.2%), culture and sensitivity based drugs (2.3%), wrong choice of drug (1.9%), wrong route (0.7%), wrong dosage form (0.7%), Addition of drug (0.2%) and drug-drug interactions (0.1%). Conclusion: This study shows that concurrent evaluation of prescription by pharmacist decreases preventable medication errors which probably decrease health care cost and decrease patient hospital stay.

Research Article, 2017

The increasing consumption of probiotics is due to progress made in understanding the use of prob... more The increasing consumption of probiotics is due to progress made in understanding the use of probiotics. In the past, probiotics were used to treat UTIs mostly because of an alarming concern regarding rise in antibiotic resistance. Lactobacillus and Bifidobacterium are mostly use on a large scale nowadays. They are gut beneficial bacteria. These organisms have enzymes, H 2 O 2 , lactic acid, and other acids which are utilized as antimicrobial agents to treat digestive pain, eczema, tumors, and ulceration. Dairy-based products like milk, yogurt, cheese, ice cream, milk powder, dark chocolate, fermented milk etc., mostly contain probiotics. Samples were collected from different markets. All these samples were enriched for 24 hours following morphology observation by catalase test, gram staining and biochemical test. Antimicrobial activity was checked by measuring zone of inhibition formed by isolated species against uropathogens, namely E-coli and Klebsiella. A current study showed results that were probable to promote rate of UTI treatment in women who are above 50 years. It was found that natural products contain probiotics which allow the consumer to get their beneficial health effect. These probiotics colonize in the intestine and act as a barrier to prevent urinary tract infections.

Perspective, 2017

Sudden Cardiac Arrest is considered as a major unresolved health issue and prevalence of cardiac... more Sudden Cardiac Arrest is considered as a major unresolved
health issue and prevalence of cardiac emergencies are
common in Pakistan. Many people are suffering from
different cardiac diseases which include heart attack, cardiac
arrest and congestive heart failure. Multiple deaths are
reported especially in rural areas due to sudden cardiac events.
Cardiac arrest, also known as cardio-pulmonary arrest or
circulatory arrest, occurs suddenly causing complete cessation
of cardiac activity and is confirmed by loss of effective
circulation [1], as a result the blood flow towards the brain
progressively worsen which further causes difficulty in
breathing. This combined effect of depression in breathing
and loss of effective circulation leads to ischemia and causes
sudden death [2]

Perspective, 2017

In the previous several decades it has been noted that prevalence rate of Type 2 diabetes dramat... more In the previous several decades it has been noted that prevalence rate of Type 2 diabetes dramatically rising worldwide. The
substantial increase in morbidity and mortality associated to type 2 diabetes along with the overhead cost for management of the disease render
it onerous global health problem. This scenario required to do serious intervention to overcome its complications. The author focused on
management of diabetes mellitus through intake of barley in the diet to highlight it’s importance whether it has any long term effect on the
management and control of diabetes mellitus.

Editorial, 2017

Most of the symptoms of β-thalassaemia major are considered to be due to anaemia and massive iron... more Most of the symptoms of β-thalassaemia major are considered to be due to anaemia and massive iron overload in the body [1]. Despite of regular blood transfusion and iron chelation, delayed growth, risk of infection & thrombosis, asthenia, and exercise intolerance remain a major reason of debility for patients, and a major concern for treating physicians [1]. Treatment with Hydroxyurea (HU) in β-thalassaemia major and intermedia has ameliorated the need of blood transfusion [2-6]. One consistent finding in these patients is subjective improvement (as reported by almost mothers of these kids) in quality of life, vitality, better exercise tolerance, improved food intake and energy level within a couple of weeks of exposure to the drug despite of minimal or no change in haemoglobin level [2-6]. This improvement persisted during the course of treatment even in partial responders (who were maintaining an Hb of 6-7 g/dl). Recently, additional benefit of HU on iron chelation/reduction in serum ferritin has been reported [7, 8]. How exactly does HU work in β-thalassaemia is poorly understood. Effects of HU at sub-cellular level i.e. on intracellular anti-oxidant levels, metabolic pathways, handling of trace elements required for enzymes in different metabolic pathways, oxygen binding and dissociation from haemoglobin-F are not entirely known. Our group has previously reported interesting results of proteomics, metallomics, metabolomics and genomics in β-thalassemia patients with and without the institution of HU [9-13]. Primary and secondary genetic modifiers, like beta globin gene mutations and presence or absence of XMN-1, HSB1L-MYB, and BCL-11A polymorphisms, have been found to significantly influence the response of HU in improving haemoglobin levels in beta thalassemia patients [14]. Excessive α-globin chains in red cells cause irreversible oxidative damage to inner part of red cell membrane lipids and proteins by hemichromes formation and increasing intracellular calcium concentration, resulting in severe haemolytic anaemia [6]. Prolonged severe anaemia stimulates erythropoietic activity culminating in hepatosplenomegaly due to extramedullary erythropoiesis. It further causes iron overload induced dysfunctions of various organs, thrombosis, diabetes mellitus, severe infections, and growth retardation [7]. It has recently been reported that the Metallomic profile of β-thalassaemia patients is markedly deranged. After commencement of HU, Eight out of nineteen analyzed elements, in the serum of β-thalassemia patients, were shown to be corrected. HU not only improved Hb levels in these patients but also reduced metal dysregulations resulting in normalization of many metallomic pathways [9]. As these metals function as important cofactors and also as part of many enzymes at sub-cellular level, their dysregulation explains some of the symptomatology of this disease. This HU induced normalization effect at metallomics level possibly translates into improved quality of life and exercise tolerance in β-thalassaemia patients [13]. Studying metabolome of β-thalassemia patients, to understand unclear pathophysiological mechanisms of thalassemia and for prognostic evaluation, started to unveil many interesting and important differences in serum metabolites of β-thalassemia patients and normal subjects. Many studies have shown that dysregulation of metabolomic profile is common in β-thalassemia patients. Studies of the biomarkers for lipid peroxidation-induced DNA damage, plasma substance P and soluble P-selectin as indicator of hypercoagulability in these patients, adipo-cytokines related to haemolytic and inflammatory biomarkers, biomarkers of iron and oxidant-antioxidant homeostasis have provided important information to comprehend the symptomatology of β-thalassaemia major and intermedia. Recently, metabolic pathway analysis has reported alterations in fatty acid, glycolytic, galactose, pyruvate, propanoate, glycerophospholipid, and sucrose metabolism along with fatty acid elongation in the mitochondria, glycerolipid, glyoxylate and dicarboxylate metabolism pointing towards a major metabolic shift in β-thalassemia patients compared to healthy individuals [13]. Follow up studies in these patients after exposure to HU revealed reversal of many of these metabolic pathways towards normal. This sheds some light on how asthenia, growth retardation, and many other body functions are compromised in thalassaemia syndrome. Our group also performed proteomics studies in pre-and post-HU-treated β-thalassemia patients, and compared the results in responders and non-responders to HU treatment. One important initial finding was that serum paraoxonase activity and malondialdehyde serum concentrations remain unaffected in response to hydroxyurea therapy in β-thalassemia patients [11]. This implies that HU does not adversely affect metabolic pathways in these patients. Extension of this work revealed that twenty-one proteins were found to be significantly different in pre-vs post-HU treated groups (unpublished data). Interesting finding is reversal of dysregulated proteins towards normal in HU treated patients. Studies on sub-cellular pathways have started to provide important information on the pathophysiology of thalassaemia syndrome. Haemoglobin-F augmentation utilizing HU is now better understood than ever before. There still are many important

Research Article, 2018

Introduction: Brucellosis is a highly contagious zoonotic disease caused by ingestion of unpasteu... more Introduction: Brucellosis is a highly contagious zoonotic disease caused by ingestion of unpasteurized milk or undercooked meat from infected animals or close contact with their secretions. Subject and Methods: Sero-prevalence of brucellosis in pregnant women was conducted for the first time in Kathmandu, Nepal. A total of 80 sera samples were collected from the pregnant women visiting Kathmandu Model Hospital. The patients were categorized on the basis of age, trimester and ethnic groups. The sera samples were tested by ELISA method. Results: The sero-prevalence of brucellosis among pregnant women was found to be 11.25%. Madhesi ethnic group showed the highest (16.66%) seropositivity rates followed by Janajati (11.53%) and the lowest was in Brahmin (8.33%) ethnic group. Similarly, the age group 31-35 years showed highest prevalence (29.41%) followed by the age group 26-30 years (13.33%). There is absence of seropositivity among the age group 16-20 years and 21-25 years. The highest sero-prevalence rate (12.76%) was found in the third trimester followed by first trimester (10%) and the lowest was in second trimester (8.69%). About 3% of them consume raw milk directly from milking animals which is one of the risk factor of brucellosis in pregnant women. Conclusion: The prevalence was found to be high in pregnant women and ELISA was a sensitive and specific test for the detection of IgG antibodies against Brucella.

Research Article, 2018

Abstract: Objective: Diabetes mellitus is well-known endocrine complication of beta thalassaemia ... more Abstract: Objective: Diabetes mellitus is well-known endocrine complication of beta thalassaemia major patients. This study aims to
determine the frequency of diabetes mellitus in BTM patients and to examine its association with age, height, weight, number of transfusions,
serum Ferritin and total duration of blood transfusion.
Methods: Fasting blood samples of BTM patients were analyzed for plasma glucose level by glucose oxidase method. Plasma fasting glucose
level ≥ 126mg/dl on two occasions was considered as diabetes mellitus. Patients with fasting plasma glucose levels ranged from 100 to
125mg/dl were assessed further by oral glucose tolerance test (OGTT).
Results: Of 188 patients, 151 (80.3%) were non-diabetic patients; frequency of diabetes mellitus and impaired glucose tolerance (IGT) was
found in 11 (5.8%) and 26 (13.8%) patients respectively. Higher age group (median age 12.5 years) (p-value < 0.001), frequency of transfusion
(p-value < 0.001), total duration of blood transfusion (p-value 0.007) were found important risk factors.
Conclusion: Our findings confirmed the importance of screening and monitoring of blood sugar levels in thalassaemic patients. However, it
also provides an insight regarding its associations with higher age raised serum Ferritin and total duration of blood transfusions.

Research Article, 2018

Introduction: In our tertiary care hospital, we do not have a specialized ENT in-patient ward. Al... more Introduction: In our tertiary care hospital, we do not have a specialized ENT in-patient ward. All ENT patients are accommodated in any of the surgical wards or medical wards. In the event of any complications, we were not sure as to how adept are the nurses in all the wards to handle different situations in ENT patients. Objective: To assess whether there is difference amongst nurses in terms of knowledge of potential ENT related complications and patient care between different wards and formal ENT training. Methodology: Nursing staff involved in routine care of adult patients in general ward and special care units were included in the study. A ten-point questionnaire was used to assess knowledge of nurses in ENT patient care. Participants were approached during the working day and were asked to fill out the questionnaire 'on the spot'. Each questionnaire was checked and evaluated by two ENT residents and rated out of 10. Result: The average scores of nurses across the wards were not same and there was significant differences (p < 0.01); it was found that in ward b1 nurses scored higher marks compared to those from other wards. Trained nurses were evenly distributed in all wards and there were no association between the distributions of trained nurses across the wards. Positive correlation was observed between the scores and experience of ENT trained nurses. Conclusion: It is advisable to have dedicated ENT and subspecialty wards and provide formal nursing training with respect to managing ENT complications to ensure ultimate patient care.

Research Article, 2018

Background: Clinicians have voiced concerns over the possibly high frequency of Akathesia that oc... more Background: Clinicians have voiced concerns over the possibly high frequency of Akathesia that occur with Aripiprazole use, however, the existing literature is not consistent with these observations. Aim: To compare the frequency of Akathesia occuring with Aripiprazole and Risperidone. Method: A total of 60 patients were included in the study. Patients fulfilling the inclusion criteria were then randomly assigned into 2 groups of 30 patients each. One group is given Aripiprazole (10 mg) and the other is prescribed Risperidone (2mg). Patients of both groups were re-evaluated on the 7th day after the start of the medication and were screened and calibrated for Akathisia using the Barnes Akathisia Rating Scale (BARS) with a cut off value of 2 or more on global assessment confirming the presence of Akathisia. A subgroup , not having akathesia on 7th day was screened again on 21st post treatment day. Result: The Akathesia assessment done on the 7th day revealed the presence of Akathesia in two (6.67%) patients getting Aripiprazole 10 mg and one patient (3.34%) in the group receiving Risperidone 2 mg. Furthermore, no patients in either of the subgroups had Akathesia when assessed on 21st post treatment day. Conclusion: The frequency of Akathesia occuring with Aripiprazole is comparable to that with Risperidone and is considered low.

Research Article, 2018

Objectives: To determine effectiveness of 8 weeks home based PFMEs in the prevention of stress ur... more Objectives: To determine effectiveness of 8 weeks home based PFMEs in the prevention of stress urinary incontinence (SUI) during pregnancy and to see how many women were consistent with them. Materials And Methods: This randomized controlled trial was conducted in the outpatient department (OPD) of Obstetrics/Gynaecology, Kahuta Research Laboratories (KRL) hospital, Islamabad during Nov, 2017 to Jan,2018. After fulfilling the inclusion/exclusion criteria, women were randomly divided into two groups. One group learned to perform PFMEs. A telephonic survey was conducted after 8 weeks and all the women in the study were asked about presence/absence of perceived urinary incontinence. Data were analysed using descriptive statistics. Results: A total of 120 women were randomized into the study. Amongst those who were followed, 63.4% from intervention group didn't adhere to PFMEs and dropped out from study. A total of 42 women were analysed from both groups. Mean age was 25+-3 years and mean gestational age was 23+-4 weeks. Thirty nine percent were nullipara. Amongst women in the intervention group, majority were still continent after 8 weeks of PFMEs (86.6%) and only few experienced SUI (13.4%). However, when these women were matched with controls, fewer women as compared to intervention group were continent after 8 weeks (55.6%). Conclusion: Home based pelvic floor muscle exercises are very effective in prevention of stress urinary incontinence in only highly motivated patients.

Case Report, 2018

Fisher and Bickerstaff, in the 1950s, reported some cases with distinctive features of ophthalmop... more Fisher and Bickerstaff, in the 1950s, reported some cases with distinctive features of ophthalmoplegia and ataxia. Bickerstaff's Brainstem Encephalitis (BBE) is an uncommon nervous system disorder characterized by clinical signs and symptoms including acute ophthalmoplegia, ataxia, and impaired consciousness. In Bickerstaff brainstem encephalitis, hyperreflexia was noted which support of a central pathology.

Case Report, 2018

An overview of a rare clinical case of a tonsillar lymphoangiomatous polyp in a patient with a hi... more An overview of a rare clinical case of a tonsillar lymphoangiomatous polyp in a patient with a history of retinoblastoma. A sample of tonsillar tissue was taken for histological review and appropriate stainings applied to establish the aetiology of the condition and exclude certain malignancies.

Perspective, 2018

Cancer burden is increasing day by day in our Low and Middle Income Countries (LMIC) A practicin... more Cancer burden is increasing day by day in our Low and
Middle Income Countries (LMIC) A practicing clinician faces
the issue of cost of treatment in almost all patients who
approach him or her for clinical consultation . More than
often, the clinician has no formal training in cancer service
development. Establishment of modern oncological services
is dependent on financial resources available to the
professionals who sit across an extra-large sized rectangular
table and try to get the best out of the money pot. Some
skeptics call it beauty out of the junkyard. The allocation of
funds is dependent on the feasibility studies done by the
healthcare economists .These wise guys seem to know a lot
about the health of a nation, but many health care
professionals have some reservations about their
understanding of the practical knowledge of day to day
managerial and clinical problems, faced by the person sitting
at the receiving end.

Editorial, 2018

Thalassaemia syndrome is a group of inherited disorders resulting in low oxygen carrying capacity... more Thalassaemia syndrome is a group of inherited disorders resulting in low oxygen carrying capacity; severe anaemia due to
haemolysis, ineffective erythropoiesis and bone marrow expansion in the bones, liver and spleen being the causes. Globally, there
are approx. 394 ß Thalassaemia mutations (excluding α and other variants genetic mutations) responsible for this disorder [1].
Each ethnic group has 5-6 common mutations causing β-thalassaemia; these mutations may not be shared in other ethnic groups
[2]. Some mutations result in β+ phenotype (producing some functional Hb-A while others have more severe β0
phenotype (no
functional Hb-A is formed). Rare cases are caused by deletion in ß globin gene (deletion of 619 base pairs in exon-1 of β-globin
gene); found in Gujrati, Sindhi, and Memon ethnicities.
Clinically, 40-50% β-thalassaemia major patients (reported by different laboratories on the basis of Hb-F) are in fact have lesser
clinical severity and present late. Despite of Hb-F level above 90%, have total haemoglobin level of more than 6.0 g/dl at the time
of haemoglobin electrophoresis and they present to the medical practitioners after two year of age [2-4]. This has serious
implications on their life long management. Correct diagnosis at this point will help in avoiding regular blood transfusion and
selection of patients who may benefit from haemoglobin augmenting agents and good supportive care. There are multiple genetic
factors responsible for lesser degree of severity in Pakistani β-thalassaemia population. We will discuss some of these factors in
this series of editorials on the “Insight into the Symptomatology of β-Thalassaemia Major”.

Editorial, 2018

Pre-marital or carrier screening before marriage conventionally refers to detect defective or di... more Pre-marital or carrier screening before marriage
conventionally refers to detect defective or diseased genes
causing autosomal or X-linked recessive genetic diseases in
the offspring, having significant morbidity and reduced life
expectancy in the progeny. Despite miraculous advancements
in medical sciences, most of the genetic disorders still remain
a challenge for the medical scientist in term of cure. Lifelong
supportive treatment is the only hope for the patients in such
diseases. This form of treatment puts a huge financial and
social burden on the individuals as well as on health care
system. Thalassaemia makes the most highlighted component
of the list of these lethal genetic disorders and its prevention
through pre-marital screening is now the matter of concern for
most of the country it prevails in. Thalassaemia is caused by
defective synthesis of globin chains (either alpha or beta)
resulting in reduced haemoglobin production with
interestingly variable phenotype from lifelong transfusion
dependency to asymptomatic individuals [1].

Perspective, 2018

TS is a varied group of genetic disorder results from reduced rate of synthesis of alpha or beta ... more TS is a varied group of genetic disorder results from reduced
rate of synthesis of alpha or beta globin chains. Its inheritance
is autosomal recessive [1]. Thalassaemias are considered most
prevalent genetic disorders worldwide; mostly they occur in
tropics and sub-tropics but now sporadic cases are prevalent
in other regions of the globe also, mainly due to resettlements
across the continents [2, 3]. Almost all ethnic groups of
Pakistan represent beta thalassaemia in their community and
its carrier rate is estimated to be 5-8 % [4]. The alpha
thalassaemia which is comparatively infrequent in the country
but northern areas have relatively higher carrier rate for alpha
thalassaemia which is roughly 2.4 % [5]. Unfortunately there
is no official registry of thalassaemia, so there is much
paradox regarding the prevalence and incidence of
thalassaemia patients in Pakistan. It is estimated from various
sources based on number of patients registered at different
thalassaemia centres, total number of patients is more than
one hundred thousand and 5000-6000 thousands new borns
fall prey to this deadly disorder each year. Although a higher
number is claimed because a significant number of patients
die undiagnosed and are unaccounted for.

Research Article, 2018

Abstract: Introduction: The aim of the study was to check the predictability of ‘suction drain ti... more Abstract: Introduction: The aim of the study was to check the predictability of ‘suction drain tip’ and ‘drain fluid’ cultures for detecting their
association with possible surgical site infection.
Material and Methods: This was an observational study conducted in Surgical Unit 1, Civil Hospital Karachi from February 2017 to
November 2017. All post-operative patients having closed drains were included in the study excluding the patients who did not require drains
in post-operative period. Cultures from drain fluid and drain tip were sent. The sensitivity, specificity, positive and negative predictive values
were calculated.
Result: The predictability for surgical infections in positive drain tip cultures showed Sensitivity =100% and Specificity = 61%. With Positive
Predictive Value = 30.3 % and Negative Predictive Value = 100%.
In drain fluid cultures the sensitivity was slightly low (85% ) with Specificity = 76.3%. Positive Predictive Value = 37.8% and Negative
Predictive Value = 96.8%.
Conclusion: We conclude that positive tip cultures and drain fluid can be important predictors of infection with high sensitivity but low
specificity

Research Article, 2018

Abstract: Introduction: Poor sanitation and crowding effect are easy way for transmission of ente... more Abstract: Introduction: Poor sanitation and crowding effect are easy way for transmission of enterobiasis between infected and
uninfected person and it is usually common among playgroup and school kids.
Subject and Methods: Among the various health problem of school children, enterobiasis is one of them still present among the school
children in context of Nepal. Unawareness along with unhygienic lifestyle as well as crowdy environment may be the major reasons behind
this. This study was aimed to find enterobiasis of school children in Chhampi, Lalitpur. The students were categorized on basis of age, sex,
ethnic group, itching habit, nail biting habit and playing with domestic pets habit. A total of 107 cellophane samples of 2-13 years aged children
were included for the microscopic examination.
Result: Overall 11(10.28%) enterobiasis prevalence were reported in children including 10.91% male and 9.26% female. Age group 5-7 years
was found to be highly infected (4.67%). There was absence of enterobiasis among the age group 11-13 years. There was insignificant statistics
association ethnically with the enterobiasis however the prevalence rate was higher in Janajati (54.54%). There were no significant association
between pinworm infection with scratching habit around anus (P > 0.05) and nail biting habit (P > 0.05) of children.
Conclusion: The prevalence was found to be high among primary level children and Scotch tape was a specific test for the detection of eggs
of pinworm against enterobiasis.

Research Article, 2018

Abstract: Background: The unprecedented and unaccounted use of benzodiazepines is running havoc i... more Abstract: Background: The unprecedented and unaccounted use of benzodiazepines is running havoc in many countries in terms of substance
abuse problems and is exponentially increasing. The prescription of benzodiazepines should be minimized and the search for and use of better
alternatives be incorporated into clinical practice of Psychiatry.
Aim: The aim of this study is to compare the efficacy of low dose risperidone and relatively higher dosage of clonazepam in moderate to severe
anxiety states when used in combination with an SSRI.
Method: A group of 60 patients having moderate to severe anxiety level, as measured by Hamilton Anxiety Rating Scale (HARS) were
randomly divided into two groups. First group was given 1 mg risperidone with 50 mg Sertraline and the second group was given 3 mg of
clonazepam with 50 mg Sertraline. The anxiety levels of patients in both groups were again calculated on the 10th post treatment day and
compared to each other. Moreover, the Side Effect profiling of Risperidone was also done in all the Patients by using the Glasgow
Anti-psychotic Side-effect Scale (GASS)’.
Result: The first group had a decrease in the HARS scores having a value of 19.56 between day 0 and day 10. The second group also showed
a decrease in the anxiety levels with a mean HARS score of 31.12 on day 0 to 12.36 on day 10. The mean value of decrease in HARS score was
comparable.

Research Article, 2018

Abstract: Introduction: Maternal and neonatal complications have been linked to pre-pregnancy Bod... more Abstract: Introduction: Maternal and neonatal complications have been linked to pre-pregnancy Body Mass Index (BMI) and gestational
weight gain. Controlling of BMI and weight gain during pregnancy is desirable in order to optimize the maternal and perinatal outcomes. The
aim of this study is to determine gestational weight gain in different BMI groups and its relation with pregnancy outcomes.
Methods: This observational study was performed on 370 reproductive age women with singleton pregnancy from January 2015 to December
2016 at Hamdard University Hospital, Karachi. BMI and total GWG were calculated and patients were followed to see pregnancy outcomes.
Data was analysed by using SPSS 21.
Results: Out of 370 participants, 8(2.2%) were underweight, 119(32.2%) were healthy, 126(34.1%) were overweight and 86(23.2%) were
obese and 31(8.4%) were very obese.
Overweight and obese multiparous women gained weight more than IOM recommendations. Adverse pregnancy outcomes like GDM
124(33.5%), PIH 69(18.6%), Pre-eclampsia 9(2.4%), placental abruption 14(3.8%), cesarean section 214(57.8%), postoperative wound
infection 54(14.6%), macrosomia 27(7.3%), low Apgar score 112(30.3%) and NICU admissions 174(47%) were noted in overweight and
obese women with excessive GWG. We interestingly, noted adverse pregnancy outcomes in women with upper limit of normal BMI and GWG
ranges.
Conclusion: Implementing optimal BMI and GWG helps to avoid adverse pregnancy outcomes. Asians especially Pakistani women need local
BMI and GWG recommendations to have better pregnancy outcomes

Case Report, 2018

Abstract: Intussusception is commonly seen in pediatric age group. It is rarely present as a caus... more Abstract: Intussusception is commonly seen in pediatric age group. It is rarely present as a cause of post-operative obstruction. Ileus and
adhesion band are the common causes of postoperative obstruction. The classical presentation of intussusception is frequently absent in
post-operative intussusception, so high degree of suspicious is required for early diagnosis. Timely intervention can give excellent results, so
we have to consider it as a differential diagnosis in post-operative obstruction in pediatric age group. We are presenting here a case of
post-operative intussusception in one and half year old male child after excision of pseudo cyst of pancreas.

Case Report, 2018

Abstract: Pleomorphic adenomas (PA) are the commonest salivary gland tumors of parotid gland. Cen... more Abstract: Pleomorphic adenomas (PA) are the commonest salivary gland tumors of parotid gland. Central pleomorphic adenomas are
extremely rare and so far only 7 cases have been reported in the literature; 2 in maxilla and 5 in mandible. The mean age of occurrence of central
PA is 58.8, none of the case of central PA in children has been reported in the literature; hence this is the first report of central PA in a child.
An 11 year old Indian boy presented with the jaw swelling from 1 year. Radiographic examination revealed a multilocular osteolytic lesion of
mandible. A complete surgical removal of the lesion was performed and the defect was restored with reconsctruction plates. Histopathological
features were consistent with central PA. Till now this is the first description of central PA in a child.

Case Report, 2018

Abstract: Extradigital presentation of glomus tumors is not common. We are presenting the case re... more Abstract: Extradigital presentation of glomus tumors is not common. We are presenting the case report of glomus tumor around elbow and
review of literature with regard to its clinical presentation, work-up and management. We also want to highlight glomus tumor as the
essential part of differential diagnosis into patients having atypical pain around elbow joint.

Editorial, Sep 19, 2018

Severe Combined Immunodeficiency Disorders (SCID) are rare life-threatening inherited conditions.... more Severe Combined Immunodeficiency Disorders (SCID) are
rare life-threatening inherited conditions. They are
characterised by the absence or non-functional immune
system [1, 2]. As a result, affected children are unable to fight
infections. Living in normal environment usually proves fatal
for affected children. They get very sick with recurrent attacks
of bacterial, viral and fungal infections and do not survive
beyond first year of life. There are many genetic mutations
responsible for different types of SCID. T-lymphocytes,
B-lymphocytes and natural killer cells (NK-cells) can all be
affected; two common types are the X-linked and the
Adenosine Deaminase Deficiency (ADA deficiency).
Affected kids develop symptoms usually within the first few
months of life. Commonly affected body systems are; lungs,
meninges, blood stream, skin, gut and liver. In the absence of
efficient immune system, causative organisms do not easily
respond to anti-microbial agents. Recurrent episodes of
serious and life-threatening infections like pneumonia,
meningitis, septicaemia, chronic skin infections, diarrhoea,
and hepatitis result in death within first year of life [1].

Perspective, Sep 2018

Thrombocytopenia in pregnancy is mostly taken as platelets less than normal lower limit. The nor... more Thrombocytopenia in pregnancy is mostly taken as platelets less than normal lower limit. The normal limit of platelets in pregnancy is 106-120x109/l [1]. Thromocytopenia is the second important cause of haematologic disorders in pregnancy, first being anemia
[1-3].Gestational thrombocytopenia is responsible for approximately 75% of all cases of thrombocytopenia seen mostly in pregnancy. Another important aspect is hypertension in pregnancy. It can result in thrombocytopenia as well. These disorders constitute about 20% and immune thrombocytopenia accounts for about 4% [4, 5]. Other causes of thrombocytopenia are quite uncommon in pregnancy.
The aim of this review is to highlight different aspects of thrombocytopenia seen commonly in pregnancy, their impact on decisions made by physicians and obstetricians as well as causes of thrombocytopenia encountered in pregnant females in Pakistan and challenges faced by obstetricians and haematologists.

Research Article, Sep 2018

Delegation is among the oldest concepts associated to professional and clinical nursing. With the... more Delegation is among the oldest concepts associated to professional and clinical nursing. With the rapid changes in the profession, delegation is becoming more important for nurse leaders and managers. It is highly expected from the manager nurses to effectively organize tasks of other health care workers and supervise them successfully. The ability of a nurse manager is very Crucial to the success of delegation among nurses.

Research Article, Sep 2018

Type 2 Diabetes Mellitus (T2DM) is one of the most important chronic conditions in the world tha... more Type 2 Diabetes Mellitus (T2DM) is one of the most important chronic conditions in the world that cause great economic
burden on healthcare providers. Authors study novel inflammatory markers that derived from routine blood count tests in inflammatory
conditions, such as T2DM. One of these parameters is platelet distribution width (PDW), which refers the size variability of circulating
platelets. In present retrospective study, we aimed to compare PDW levels of T2DM patients to those with healthy subjects. We also aimed to
compare PDW levels of diabetic subjects with and without chronic diabetic complications.

Research Article, Sep 2018

Work place violence is an alarming and devastating issue worldwide particularly in the emergency ... more Work place violence is an alarming and devastating issue worldwide particularly in the emergency departments. Incident of work place violence is common towards nurses in health care settings. Nurses are more prone to workplace violence due to lack of respect towards nursing profession in Pakistani society and the nature of work performed by the nurses.

Research Article, Sep 2018

Type 2 Diabetes Mellitus (DM) is considered as one of the major public health problem resulting i... more Type 2 Diabetes Mellitus (DM) is considered as one of the major public health problem resulting in premature mortality and morbidity [1]. Similarly, low Vitamin D levels constitute a largely unrecognized problem in many populations and its global prevalence has been estimated from 30 to 87 % [2]. DM is a metabolic disease which can affect multiorgans in the body and recently vitamin D has aroused widespread interest in the pathogenesis of DM. Over the last five years, a number of large observational studies have suggested an association between DM type-2 and vitamin D deficiency [3, 4] . Vitamin D levels have been documented to have significant inverse relationship with hyperglycemia [5]. Data from various studies on different populations regarding frequency of vitamin D deficiency in newly diagnosed cases of DM type-2 is showing a significant variation of 30% to 70% [6, 7]. Vitamin D has a well-known role in calcium homeostasis and bone metabolism. The suboptimal levels of vitamin D may contribute to many conditions including rickets, osteomalacia, osteoporosis, falls and fractures. In addition, epidemiologic observations have associated low vitamin D status with an increased risk of non-musculoskeletal diseases, such as cancer, multiple sclerosis and cardiovascular diseases apart from being a risk for developing DM and diabetic complications [8, 9]

Research Article, Sep 2018

Nurses and other healthcare workers are at risk of occupational hazards in the healthcare setting... more Nurses and other healthcare workers are at risk of occupational hazards in the healthcare setting. Nurses are prone to expose with blood born infection like HIV, HCV and Hb B. Proper implication of standard precaution effectively control the hospital acquired infection.

Case Report, Sep 2018

Chylous lymphatic cysts are the rarest variety of the mesenteric cyst. These are the lymph contai... more Chylous lymphatic cysts are the rarest variety of the mesenteric cyst. These are the lymph containing cysts. The underlying pathology is benign proliferations of the lymph vessels due to obstruction in the lymphatic system. These have a variable clinical presentation.
We are presenting here a case of a chylous mesenteric cyst in a 5 years old male child with acute intestinal obstruction.

Case Report, Sep 2018

The larynx is known to be a very rare site for metastases of tumours of various regions due to it... more The larynx is known to be a very rare site for metastases of tumours of various regions due to its terminal position in the lymphatic circulation system. The last case of a massive transglottic deposit of the larynx with associated classical symptoms was described in 1997. Our case describes a unique clinical history of a laryngeal metastasis of colon adenocarcinoma without typical physical presentation but mimicking Paget’s disease.

Editorial, Dec 2018

A nutritional deficiency in younger age group includes both micro and macronutrient deficiencies ... more A nutritional deficiency in younger age group includes both
micro and macronutrient deficiencies leading to protein
calorie malnutrition, failure to thrive, compromised immune
function and nutritional anemia. Deficiencies of iron, vitamin
B12, folic acid, and pyridoxine, compromise red cell production.
Iron deficiency is the most common cause of nutritional
anemia’s worldwide [1]. Iron deficiency anemia (IDA) due to
poor nutrition is commonly found during periods of active
growth spurts i.e. infancy and adolescent age group. Chronic
blood loss due to worm infestation and giardiasis contributes
to iron deficiency. Inflammatory bowel disease and coeliac
disease are also associated with iron deficiency anemia [2].
According to a World Health Organization survey, 40-50% of
preschool children & 69% of children < 2 years were iron
deficient in Pakistani population [3]. Women of child bearing
age who are iron deficient further replenish their iron stores
after getting pregnant and this is a major preventable cause of
perinatal morbidities worldwide [4].

Perspective, Dec 2018

It’s not been long that the case of Baby Zainab from Qasur, a city in Punjab made the headlines i... more It’s not been long that the case of Baby Zainab from Qasur, a
city in Punjab made the headlines in the media. Prior to this
incidence cases of sexual abuse of over 200 children from the
same city created an uproar in the media and in the country. In
the past few years there has been an upsurge in the cases of
child abuse reported in the media. The concerns over rising
incidence of child abuse and neglect has received global attention.
A number of national and international organization
have shown serious concerns and are demanding strict
measures to tackle the issues of child protection.

Research Article, Dec 2018

Thalassemia is a common inherited disorder in Pakistan with around 5000 new cases diagnosed every... more Thalassemia is a common inherited disorder in Pakistan with around 5000 new cases diagnosed every year. Despite various preventive measures taken at the national level, the disease burden is still not declining. In this study the incidence of ß Thalassemia trait among pregnant females presenting to a tertiary care hospital is measured.
Methods: This study was conducted at Pakistan Institute of Medical sciences. 102 Pregnant females who were referred to us for hemoglobin
electrophoresis from July 2017-June 2018 were included. Complete blood count, peripheral film, reticulocyte count and hemoglobin
electrophoresis was performed for each patient.
Results: The mean age was 25 years and the mean period of gestation was 30.30 weeks. Out of 102 patients, 5 (4.9%) were diagnosed as ß
Thalassemia trait. Of these, 2 (40%) did not have a positive family history of Thalassemia. We compared the results of our study with those
done at different regions of Pakistan and found variable incidence of carrier state in different regions of the country.
Conclusion: Antenatal screening is a forward step towards minimizing incidence of Thalassemia in Pakistan however clinicians should be
directed to refer these patients in early pregnancy

Research Article, Dec 2018

Occupational exposure occurs frequently among Health Care Workers (HCWs). The most serious occupa... more Occupational exposure occurs frequently among Health Care Workers (HCWs). The most serious occupational health hazard faced by HCWs worldwide is exposure to Hepatitis B Virus (HBV). Having enough knowledge and proper attitudes toward this
infection is crucial in prevention of occupational hepatitis infection.

Research Article, Dec 2018

Diabetes mellitus is a multi-factorial disease having widespread effect on various functions of b... more Diabetes mellitus is a multi-factorial disease having widespread effect on various functions of body. Electrolyte
imbalance is a major problem presenting in diabetic patients due to direct effect of hyperglycemia on these electrolytes.
Objective: The aim of this study is to evaluate the electrolyte imbalance in patients with diabetes mellitus type 2.
Methods: It is a prospective study, conducted at Department of Pathology, Indus Medical College. Tando Muhammad Khan between the
periods of January 2018 to March 2018. A total of 290 patients were included in this study. Group A contains 140 known diabetic patients and
Group B contains 150 normal healthy individuals. Blood samples of all patients were evaluated for HbA1c, serum sodium (Na), potassium (K)
and chloride (Cl).
Results: A total of 290 patients were included in the study. Male to female ratio was higher in both diabetic and control groups. Hemoglobin
A1C (HbA1c) was found to be higher in diabetic patients as compared to normal healthy individuals with statistically significant difference (p
< 0.001). Sodium (Na) was found to be low in diabetic group as compared to normal healthy individuals with statistically significant difference
(p = 0.02). Potassium (K) and chloride (Cl) did not show any difference in diabetic group and normal healthy individuals.
Conclusion: Diabetes mellitus has wide diversity of effects on major functions and cellular events. Electrolyte imbalance is a major problem
in diabetic patients as disturbs the distribution of cells across the cellular compartments

Research Article, Dec 2018

Abstract: Objective: To investigate association of education, wealth index and access to electron... more Abstract: Objective: To investigate association of education, wealth index and access to electronic media with awareness about TB and its
spread among women.
Material and Methods: Countrywide Pakistan Demographic and Health Survey (PDHS) 2012-13 data was selected for secondary analysis.
From 12,943 occupied households, 13,558 ever-married women and 3,134 ever married men age 15-49 were interviewed. For this study,
women interviews record was selected and analysed for TB awareness and its relationship with education attainment, wealth index and
electronic media exposure.
SPSS logistic regression analyses were performed for statistical significance and to discover association between TB awareness and education
attainment, wealth index and electronic media. A p-value of < 0.05 was considered to be statistically significant.
Results: The poorest uneducated women had the lowest awareness about TB and its spread by air. Awareness about TB and its spread by
coughing and sneezing increased with increase in education level and households’ wealth and living standard.
Women from households having radio, in rural areas, had overall more awareness about TB and its spread by coughing and sneezing than
women from households having no radio. Women of households having TV, in all regions of the country, had distinctly higher awareness about
TB spread by air than women of households who had no TV.
Interestingly, there was more awareness among women of households having no radio and TV about TB spread by sharing utensils, touching
person and sexual contact than women of households having radio and TV.
Education attainment and TV in households were more statistical significant than radio in households and wealth index. Education, wealth
index and TV in households have relationship with TB spread by coughing and sneezing.

Research Article, Dec 2018

Abstract: Background: The diabetic foot complication is further complicated by some UN desired an... more Abstract: Background: The diabetic foot complication is further complicated by some UN desired and wrong practices of such as
Socio-cultural myths of walking barefoot and religious belief of walking on fire etc. Sometimes inappropriate use of footwear and lack of
awareness regarding proper foot care during diabetes mellitus also make the foot complication severe [1].
Objective: The specific objectives of this research work are: To assess knowledge of Diabetic foot self -care among patients attending Diabetic
clinic at LGH Hospital Lahore.
Methodology: A structured questionnaire with demographic variables and causes variables was applied. The data was analyzed on SPSS
version 21.
Result: A high percentages of participants stated that mentioned factors causing medication errors among nurses.
Conclusion: It is concluded that some people do not know good practice for the disease, so it is important for an organization to provide enough
knowledge about the disease for better health and good practice

Case Report, Dec 2018

Ectopic adrenocorticotropic hormone (ACTH) syndrome is responsible about 15% of Cushing syndrome... more Ectopic adrenocorticotropic hormone (ACTH) syndrome is responsible about 15% of Cushing syndrome cases. Malignant tumors,
such as, small cell lung cancer, gastric or bronchial carcinoids, pheochromacytoma, medullary thyroid cancer, are principle causes of ectopic
ACTH secretion. Syndrome manifest with impaired glucose tolerance or overt diabetes, hypertension, hypokalemia and lipid disorders. Here
we report a subject presented with severe hypokalemia due to ectopic ACTH syndrome, who was diagnosed with small cell lung cancer
consequently.
A sixty five year old man presented with severe hypokalemia. He was diagnosed with small cell lung cancer. Serum ACTH and cortisol levels
of the subject were extremely high. Although chemotherapy initiated, he died due to respiratory failure. Radiologic studies should be ordered
to rule out underlying tumoral developments in patients presenting with delirium and hypokalemia. Moreover, hyperglycemia in elderly
without prior history of diabetes mellitus should be evaluated for malignant lesions and ectopic release of ACTH.

Case Report, Dec 2018

Recurrent cytogenetic abnormalities are manifested in approximately fifty percent cases of Myelo... more Recurrent cytogenetic abnormalities are manifested in approximately fifty percent cases of Myelodysplastic Syndromes (MDS)
found as result of genomic instability verifying the presence of oncogenic genetic mutations. Over the years the molecular diagnosis of MDS, has emphasized the relevance of the molecular pathogenesis of this entity by utilizing the refined technology of next generation sequencing.
We herein report a case of Myelodysplastic Syndrome with Excessive Blast 2(MDS EB 2) with isolated deletion 5q and the presence of
oncogenic somatic driver mutation ASXL-1 elucidated through next generation sequencing. The reports pertaining the association of MDS
with deletion 5q and ASXL 1 are relatively exiguous. This case report points towards the diagnostic and prognostic significance of somatic
driver mutations, even in patients exhibiting good risk cytogenetics. This will assist in offering better risk adapted therapies in Myelodysplastic
syndrome patients

Editorial, Mar 2019

According to one definition “intention or gross negligence leading to fabrication of the scientif... more According to one definition “intention or gross negligence leading to fabrication of the scientific message or a false credit or emphasis given to scientist’’ is known as forgery or misconduct in science [1]. There are three types of misconduct in science,
fabrication, falsification and plagiarism. Fabrication is making up and recording of results. Minor form of fabrication is citation in references where references is
either not included or not reinforcing the argument or sometime totally against the argument. Falsification is changing or misinterpreting material, equipment or protocol. Plagiarism is utilization of some ones ideas, process, result or words
without giving him proper credit [2]. There are two main reasons of doing forgery one is career pressure another is ease of fabrication. When everything financial gain, fame and grants all are depending on publication then scientist become more prone to misconduct and forgery [3]. On the other hand, when just sometime paper and pencil gives your required result in a moment then why waste time efforts and money for real results. After all both of them gives publication.

Perspective, Mar 2019

Abstract: WHO proclaims polio a social and community health crisis. Global Polio Eradication Init... more Abstract: WHO proclaims polio a social and community health crisis. Global Polio Eradication Initiative (GPEI) was resolved to make world
polio-free and had contributed significantly to eradicate polio from 1000 cases per day in 1988 to 8 per year in 2017 [1, 2]. However, this
disease is still widespread in Afghanistan and Pakistan, due to number of problems, an important topics for debate, which poses great threat to
the re-emergence of the deadly disease worldwide. Yet, these two countries potential risk should not be taken lightly, as in the seam of 2002 to
2005, reinvigoration and re- entry of polio occurred in 21 countries, with the increase in global migration of people [3]. Till August 13th 2018,
17 WPV1 cases have been reported (thirteen in Afghanistan and four in Pakistan), compared with 22 cases in endemic countries reported in
2017, and its transmission is still continue in Pakistan, as being isolating from the wastewater samples [4]. Therefore, Utmost suggestions are
made to improve the status of polio from the remaining two countries as well, by approaching to it through new different strategies and ideas
focusing current experiences and issues to eradicate polio as soon as possible.

Research Article, Mar 2019

Abstract: Background: Hepatitis B and C infections are endemic in Pakistan. The general populatio... more Abstract: Background: Hepatitis B and C infections are endemic in Pakistan. The general population has poor knowledge about the HBV
vaccine’s availability and the modes of transmission for HBV/HCV. Therefore we decided to assess the knowledge of HBV & HCV infection,
their spread and modes of prevention amongst the general population and its association with the ethnic, socioeconomic and educational status.
Material and Methods: This cross-sectional analytical study was conducted in Gastroenterology clinic, Sindh Institute of Urology and
Transplantation, Karachi, from August 2016 to December 2016. All patients and their attendants of age >18 years visiting GI-OPD were
enrolled. A predesigned questionnaire was filled and data was entered in SPSS version 20.0.
Results: Out of 641 respondents, 382 (59.6%) were males; the mean age of the participants was 38.46 ± 14.15 years. Only 44% respondents
were aware about the availability of HBV vaccination. Most of respondents believed that re-usage of syringes, sharing of razors, use of
unsterilized dental and surgical instruments can spread these infections. Majority had the misconceptions that these viruses can transmit
through handshakes and hugs, smoking, alcohol use, sharing utensils and mosquito bite. Only 23 (3.6%) respondents had good knowledge.
Statistical significance of adequacy of knowledge was noted with profession, monthly family income, education status and ethnicity.
Conclusion: Our study indicates the overall knowledge regarding the modes of transmission and prevention of HBV/HCV is very poor among
the visitors of GI-clinic from different part of the country. We believe that our study highlights the need to increase the public awareness among
general population of HBV/HCV infection in Pakistan. Public awareness seminars should be implemented with special emphasis on mode of
transmission of HBV/HCV infection and measures to control risk factors.
Keywords: Hepatitis B, Hepatitis C, Disease Prevention, Transmission, Awareness.

Research Article, Mar 2019

Abstract: Aims and Objectives: To analyze the data regarding etiological and predisposing factors... more Abstract: Aims and Objectives: To analyze the data regarding etiological and predisposing factors in pediatric burns and make conclusion
for prevention of pediatric burns.
Study design: Retrospective hospital based observational study.
Setting: Department of Pediatric Surgery, King Edward Medical University, Mayo Hospital Lahore.
Duration of Study: From June 2017 to June 2018.
Methodology: Children with electric current injuries were admitted in Pediatric Surgery Department, King Edward Medical University, Mayo
Hospital, Lahore. As it was a retrospective study so the main source of information was the hospital admission files. A detailed research
proforma was made having all variables and data was collected. Data regarding total number of patients, age, gender, mechanism of burn
injury, operating findings, treatment and outcome were noted and statistical analysis was done by using SPSS version 20.
Results: One hundred and thirty (n = 130) patients with burn injuries caused by electric current in age ranging from 2 to 12 years were treated during one year period. There were 72(55%) males and 58(45%) females. Areas involved were mainly the limbs and face. High voltage electric current was responsible for 90(69%) burn cases and low voltage in 40(31%) cases. Electric current injury caused by direct contact occurred in 100(77%) cases whereas electric flash burn was responsible in 30(23%) cases. Fasciotomy was performed in 78(60%) cases amputations at different levels in 24(18%) and disarticulations of shoulder joint were performed in 6(4.5%) cases. Split thickness skin grafting was done in 80(61.5%) cases whereas 12(9%) cases having minor injury were treated conservatively. 92(71%) cases were discharged home, 23(17.5%) cases expired and in 15(11.5%) cases parents refused for treatment.
Conclusion: Burns are caused by human errors and are therefore preventable. Disability due to severe burn adversely affects the life of a
growing child and is a huge social issue. Public awareness through print and electronic media as well as education at school level is to be
stressed in order to prevent electric current burn injury resulting in high morbidity and mortality. There is a need to establish more state of the art pediatric burn units according to population consensus in our country.
Keywords: Electric current, Burn injuries, Predisposing factors, Etiology, Management, Epidemiology, Outcome.

Research Article, Mar 2019

Abstract: Introduction: The aim of this study was to see the incidence of bedsores in our hospita... more Abstract: Introduction: The aim of this study was to see the incidence of bedsores in our hospital and determine relating factors.
Material and Methods: This cross sectional study was performed on 71 consecutive ICU admissions at Ziauddin hospital ICU from March to
May 2015. Data was analyzed on SPSS version 16 by independent sample t-test and chi square test. In 71 patients, 12 developed bedsores, of
which seven were males and five were females. Available data in Performa included: demographics, functional class, comorbidities,
category(surgical, medical or trauma patient), primary cause of ICU admission, total day of ICU stay, total period of mechanical ventilation,
requirement of dialysis, albumen level and if bedsore developed than its details and grade.
Result: In this study, 71 patients were admitted in ICU; 40 patients, which is 56.33%, were male and 31 patients, which is 43.66%, were
female. Twelve patients that are 16.90% were affected with bedsores of which seven were males and five were females and this was found to
be statistically significant.
The mean age of patients with bedsores was 66.75 years ± 18.29 as compared to 52.42 years ± 18.20 in group with no bedsore development.
Total mechanical ventilation required in the group that developed bedsore was 4 days ± 1.67 to group with no bedsore development, which was
2.36 days ± 1.21.
The patients who developed bedsore had serum albumen levels 2.54 ± 0.26 and group that did not develop bedsore had albumen levels 3.14 ±
0.77 and the result was found to be statistically significant.
Duration of Study: From June 2017 to June 2018.
Conclusion: Development of bedsore was found to be statistically significant to the poor functional class, high mean age, total hospital stay,
mean mechanical ventilation and low level of albumin.

Research Article, Mar 2019

Abstract: Introduction: Thalassemia is a common inherited hemoglobinopathy in Pakistan. Despite v... more Abstract: Introduction: Thalassemia is a common inherited hemoglobinopathy in Pakistan. Despite various preventive measures taken, each
year around 5000 new cases are diagnosed. The problem occurs due to undiagnosed beta Thalassemia carriers. This is because of lack of
massive screening programs and unavailability of hemoglobin electrophoresis in different cities of Pakistan. The aim of this study is to assess
the sensitivity of different discriminating indices in screening of beta Thalassemia trait.
Material and Methods: The study was conducted at Pakistan Institute of Medical Sciences from January 2018-July 2018. All patients who
were diagnosed as beta thalassemia trait through hemoglobin electrophoresis were included in the study. Seven discriminating indices were
applied and sensitivity of each index was calculated.
Results: The male to female ratio was 1:1. 88% of the cases had a positive family history of Thalassemia. Among the various indices used,
Shine and Lal showed a sensitivity of 100%, followed by Ricerca (96.6%) and Ehsani (92.58%). The sensitivities of Mentzer, Srivasta, RDWI
and MCHD were 92.56%, 91.70%, 79% and 70.9% respectively. The results of our study showed that Shine and Lal is the most sensitive index
for screening beta Thalassemia trait.
Conclusion: Shine and Lal index is useful to the clinicians as an initial screening tool of beta thalassemia trait. Such cases can then be referred
to laboratories where hemoglobin electrophoresis facility is available.
Keywords: Beta Thalassemia, Thalassemia trait, Discriminating indices, Iron deficiency anemia, Microcytic hypochromic anemia,
Hemoglobin electrophoresis,

Review Article, Mar 2019

Abstract: Fanconi anemia(FA) is the most common inherited bone marrow failure disorder characteri... more Abstract: Fanconi anemia(FA) is the most common inherited bone marrow failure disorder characterized by cytopenias, somatic defects and
increased propensity to develop malignancies. Chromosomal breakage analysis is the gold standard diagnostic test for this disease but it may
produce false negative results. Therefore, genetic analysis is necessary for confirmation and complement group identification that will help in
prenatal diagnosis. Phenotypic presentation of FA is quite variable. 20-30% patients are physically normal. Affected patients may exhibit
anamolies of multiple organs or just a few café au lait spots. Therefore diagnosis of this disease remains challenging. Similar to its phenotype
the pathophysiology of this disease is also complicated and still not completely understood. The basic defect is in the DNA repair mechanism.
The 21 complementation genes responsible for DNA repair are hampered at any one or multiple levels. The chromosomes from the cells of
these patients therefore show spontaneous breakages. The incidence of this disease throughout the world is very rare about 1-2/350000 persons.
It is more common in Jews. In Pakistan incidence of FA is still not known and many of the physicians and surgeons don’t have in depth
knowledge as they consider it as a rare disease. However, because of the custom of inter marriages its incidence may be surprisingly high.
Therefore in depth knowledge of this disease is necessary.
The aim of this review article is to provide information to the physicians dealing such patients so that they should be timely diagnosed and
managed accordingly.
Keywords: Fanconi anemia, Aplastic anemia, Mitomycin C, Chromosomal breakages, Skeletal defects, Café au lait spots

Case Report, Mar 2019

Abstract: CHILD syndrome is a rare X-linked genetic disorder caused by mutation of NSDHL (NADPH s... more Abstract: CHILD syndrome is a rare X-linked genetic disorder caused by mutation of NSDHL (NADPH steroid dehydrogenase-like protein)
at Xq28 gene. The mutation causes the defective synthesis of cholesterol, which is an important constituent of viscera, hormones etc. The
predominantly it affects the musculoskeletal with a tendency to involve the heart, brain etc. Strikingly the signs and symptoms of this syndrome
involve only one half of the body. CHILD syndrome is commonly identified in the females. We report a case of 5-month-old female who
presented to us at Pediatric outpatient department. To our knowledge this is the first reported case of CHILD syndrome in Pakistan. The
exceptionally rare presentation prompted us to report this case.
Keywords: CHILD syndrome, NSDHL mutation, Ichthyosis, Genetic disorder, Alopecia, Abortion, Sporadic

Case Report, 2019

Introduction: This article emphasizes on the importance of time frame for diagnosis and managemen... more Introduction: This article emphasizes on the importance of time frame for diagnosis and management of immunodeficiency syndromes and
also highlights the diagnostic dilemma that most often such cases are misdiagnosed or undiagnosed which contributes to significant morbidity
and mortality.
Case Presentation: This article with the help of five exemplary cases illustrates the different types of primary immunodeficiencies including
severe combined immunodeficiency (SCID), and their varied clinical presentations and management and also describes the difficulty in
reaching final diagnosis and a brief review of literature on primary immunodeficiency and its therapeutic approach.
Management and Outcome: All the patients described in this case based study underwent Hematopoietic stem cell transplant; the definitive
therapeutic approach for all kinds of immunodeficiency syndromes. Four out of five patients were successfully treated, unfortunately one could
not survive.
Discussion: The purpose of this article is to raise public health awareness regarding prevalence of primary immunodeficiency disorders and
their possible cure via hematopoietic stem cell transplant, if diagnosed and managed promptly.
Keywords: Primary immunodeficiency disorder, Severe combined immunodeficiency, Hematopoietic stem cell transplantation, Graft versus
host disease, Myeloablative conditioning therapy, Hypogammaglobinemia.

Case Report, Mar 2019

Abstract: T-Cell Prolymphocytic leukemia is a rare and an agressive lymphoproliferative disease w... more Abstract: T-Cell Prolymphocytic leukemia is a rare and an agressive lymphoproliferative disease which is unresponsive to conventional
chemotherapy. We present a case of 72 years old female hospitalized in July 2018 in National Institute of Blood diseases and BMT, Karachi,
Pakistan, having lymphadenopathy, splenomegaly, and leukocytosis with lymphocytosis, thrombocytopenia and peripheral smear showed
predominant population of mature looking lymphocytes. Immunophenotyping shows CD45 (+), CD3(+), CD4(+), CD5(+), ZAP70(+),
CD38(+)*, CD25(+)* and negative CD19, CD20, CD10, CD11c, CD8, FMC, Kappa & Lambda and cytogenetics by FISH showed del17 p53
in 35% of interphase nuclei. In patients of T-PLL, del 17 p53 has never been reported previously.
Keywords: del17p, T-cell, Prolymphocytic, Leukemia, Lymphoproliferative, CLL.

Editorial, Jun 2019

Site specific Multi-disciplinary Tumor Boards play a pivotal role in the provision of high qualit... more Site specific Multi-disciplinary Tumor Boards play a pivotal
role in the provision of high quality comprehensive cancer
care. This dictum was thoroughly validated via a number of
studies conducted across the world. In our region, our team of
cancer carers came forward and we have tried to establish site
specific Multi-disciplinary Teams in various institutes of the
country and region. As expected, many hurdles of varied
nature were encountered by our team and we are still traveller
of this journey which we have started on voluntary basis. Site
specific teams conduct this activity and maintain quality of
these boards [1].

Perspective, 2019

The therapeutic uses of blood and its components are very well established as a lifesaving tool b... more The therapeutic uses of blood and its components are very
well established as a lifesaving tool but at the same time one
should not forget about the adverse effects related to it. The
desired safe blood transfusions can be done only if there are
enough healthy donors in the society making it a precious
therapy. In order to cover these aspects, the term
Hemovigilance was added to define blood safety. It is a
surveillance mechanism covering the entire blood transfusion,
donor vein to recipient vein chain, starting from the collection
of blood and its components to the follow up of the recipients.
WHO defines it as a process of monitoring, reporting,
investigation and analysis of adverse or undesirable events
related to the transfusion of blood and its components and
taking actions to prevent their occurrence or recurrence [1].
The final results play an essential role in ensuring patient
safety by learning from failures and then placing corrective
changes in the system to prevent such events in future. The
awareness can be generated only after knowing the trends of
transfusion hazards at a particular set up [1, 2].

Research Article, 2019

Amongst all chronic lymphoproliferative disorders B-CLL is the most common. Clinical behavior of ... more Amongst all chronic lymphoproliferative disorders B-CLL is the most common. Clinical behavior of CLL is very variable and in order to identify the clinical spectrum there is a need for risk adaptive prognostic markers which will further facilitate in management strategy. Currently available molecular biomarkers ZAP-70 & CD-38 have gain much interest in providing useful prognostic information in patients diagnosed as B-CLL.

Research Article, 2019

The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Wa... more The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Water pipe (WP) with Neutrophils to Lymphocytes ratio and Platelets to Lymphocytes ratio.

Research Article, 2019

Acute leukemia is characterized by the presence of 20% or more blasts in peripheral blood and/or ... more Acute leukemia is characterized by the presence of 20% or more blasts in peripheral blood and/or bone marrow biopsy. It includes both AML & Acute ALL. However the diagnosis of AML can also be made when the blast percentage in peripheral blood or bone marrow is < 20 % if there is an associated t (8;21), inv (16), or t (16;16) chromosomal abnormality or PML-RAR fusion gene [1-3]. Tumor lysis syndrome is the most common disease related emergency in patients with leukemia & requires immediate management.

Research Article, 2019

The nursing school undergraduates’ performance influences the quality production of graduates. Th... more The nursing school undergraduates’ performance influences the quality production of graduates. These in turn will be the future leaders and workforce for the country in improving the health care system. Thus it is imperative that the students do achieve good
performance standards. Academic achievement or performance is the degree in which a learner, instructor or organization have accomplished their short term or long term learning objectives.

Review Article, 2019

Soft drinks are those drinks which do not contain alcohol. These soft drinks are either carbonate... more Soft drinks are those drinks which do not contain alcohol. These soft drinks are either carbonated or non-carbonated soft drinks. Carbonated soft drinks are consumed widely across the globe. Today, when people are becoming more health conscious, concerns are being raised regarding the impact of carbonated soft drinks on health. When discussing the effects of carbonated soft drinks on health carbon dioxide, phosphoric acid and sugar are of main concern. Most carbonated beverages have acidic pH which results in gastroesophageal reflux disease (GERD) like symptoms. The phosphoric solution in these beverages is powerful enough to cause human teeth to become soft. The caffeine present in colas is known to be a hazardous factor for osteoporosis. When taken after a period of dehydration, the sugar in these beverages is known to cause more renal injury then plain water. The sugar content in these beverages may lead to lipids production in the body and result in obesity, hypertension, non-alcoholic fatty liver disease (NAFLD), and pancreatic cancer. Hence, it is necessary to monitor diet and focus on natural and healthy beverages.

Case Report & Literature Review, 2019

Therapy related Acute Lymphoblastic Leukemia (t-ALL) is a rare secondary malignancy. It occurs in... more Therapy related Acute Lymphoblastic Leukemia (t-ALL) is a rare secondary malignancy. It occurs in patients who are exposed to chemotherapy and/or radiotherapy for primary malignancy. We are reporting here a case of a thirty five years old female patient who was referred to us for fever, malaise and bleeding from gums. She had a history of ovarian carcinoma for which she took carboplatin and other chemotherapeutic agents. Extensive workup was done which was consistent with the diagnosis of Precursor-B cell Acute Lymphoblastic Leukemia. In the context of previous history of exposure to carboplatin, she was diagnosed as a case of therapy related Acute Lymphoblastic Leukemia secondary to carboplatin.

Case Report, 2019

: In childhood and adult acute myeloid leukemia and myelodysplastic syndrome chromosome 7 aberrat... more : In childhood and adult acute myeloid leukemia and myelodysplastic syndrome chromosome 7 aberrations are not an uncommon finding. But in childhood acute lymphoblastic leukemia it is rarely seen. In this case we identified a rare cytogenetic aberration in a girl with Precursor B cell acute lymphoblastic leukemia

Letter to The Editor, 2019

I read the case report titled De Novo Deletion 17p (del17p) in an Adult T-Cell Prolymphocytic Leu... more I read the case report titled De Novo Deletion 17p (del17p) in an Adult T-Cell Prolymphocytic Leukemia as a Rare Presentation, by Zara-tul-Ain Bashir et al. which published in the latest issue Volume 4, Issue 1, 2019 of your journal. As stated by the authors, T cell prolymphocytic leukemia is an exceptional condition that characterized with accumulation of lymphocytes not only in blood stream and bone marrow but also in lymph nodes and spleen. In fact, since malignant lymphoyctes originated from post-thymic T cell, nomenclature as “prolymphocyte” is a misused term.

Editorial, Sep 2019

Human immunodeficiency virus infection leads to acquired immune deficiency syndrome. After horizo... more Human immunodeficiency virus infection leads to acquired
immune deficiency syndrome. After horizontal transmission
(through unprotected sex, contaminated blood transfusion or
sharing contaminated syringes among main line drug addicts)
or vertical transmission (from mother to foetus during
pregnancy or during deliver / breast feeding), the person
remains asymptomatic for years or may develop flu like
symptoms. HIV remains quiescent in the monocytes and
helper T cells interfering with and knocking out host’s
immune system immensely increasing the risk of opportunist
and non-opportunist infections as well as various malignancies. There is no cure for HIV or a vaccine available as of
today; current antiretroviral treatment slows the course of the
disease and may lead to a near-normal life in affected individuals. Treatment is recommended without delay; without
treatment, the affected individuals don't survive beyond first
decade.

Research Article, Sep 2019

Abstract: Objective: To determine the frequency of Urinary tract infections in children presentin... more Abstract: Objective: To determine the frequency of Urinary tract infections in children presenting with fever without a focus – a tertiary care
hospital experience.
Material and Methods: It is a descriptive cross sectional study to find out the frequency of UTI conducted from 26th April to 25th October
2013. Patients of either gender, 1 month to 36 months of age, presenting with the complaints of fever without focus were included. History and
physical examination were done; urine sample was collected for analysis and culture. Data was recorded on a pre designed Proforma. Mean
and standard deviation for quantitative, frequencies and percentages for qualitative variables were computed. Stratification was done to observe
the effects of modifiers on outcome. Post stratification chi square test was applied and p value ≤ 0.05 was considered as significant.
Results: Among total 126 study subjects 62 patients were male. The mean age was 13.96 ± 8.56 months. Mean age of patients was 13.88 ±
6.50 months and 13.97 ± 8.86 months for patients with and without UTI respectively. Among patients with urinary tract infection, 9(52.9%)
were male and 8(47.1%) were female patients. Age of 9(52.9%) patients was ≤13 months and age of 8(47.1%) patients was >13 months. There
was no significant association of UTI observed with gender (p = 0.741) and age (p = 0.794). Conclusion: UTI is a common infection that can be easily missed in young children. Screening patients at risk can lead to proper diagnosis and a reduction in morbidity.

Research Article, Sep 2019

Abstract: Introduction: Intestinal parasitosis is one of the chief causes of public health proble... more Abstract: Introduction: Intestinal parasitosis is one of the chief causes of public health problems particularly in developing countries.
Subject and Methods: Among the various health problems amoebiasis and helminthic infection are still significant among the school pupil in
context of Nepal. In this article, we reported the status of intestinal parasitosis among the school pupil in this area. Present study was aimed in finding out the prevalence of intestinal parasitosis in public and private school pupil below 10 years at Tarakeswor-10 (Kathmandu Valley). A total of 160 (80 from public and 80 from private school) stool samples collected in clean, dry and screw capped plastic container were studied for the presence of parasites using direct smear method as well as by concentration method.
Results: Overall parasite positive rate was 40% (64/160). Positive rate was considerably higher in public school children (47.5%; 38/80)
compared with private school (32.5%; 26/80) (P < 0.05). No significant difference in positive rate among boys (53.13% ; 34/64) and girls
(46.87%; 30/64) was observed (P > 0.05). However, boys in private school had higher positive rate (boys: 57.69%; girls 42.30%; P < 0.05).
Total six genuses of parasites were identified. Of them, Ascaris lumbricoides was most common followed by Trichuris trichiura, Hookworms, Taenia sp., Entamoeba coli and Enterobius vermicularis.
Conclusion: Parasites positive rate were higher in children who were drinking untreated water. Children had higher positive rate that were from families without toilet.

Research Article, Sep 2019

Abstract: Introduction: Lactose Intolerance is an important indicator of under nutrition, as stud... more Abstract: Introduction: Lactose Intolerance is an important indicator of under nutrition, as studied in many setting. More than 60% especially
in older school going children had a hypolactasia and half of them had Lactose intolerance. Another dimension of the problem could be lactose
intolerance leading to underweight.
Objectives: 1. To determine the prevalence of Lactose intolerance in 5-15 years of age group.
2. To determine the peak age group that is most susceptible to lactose intolerance in children of 05 years to 15 years of age.
3. To find out association of lactose intolerance with malnutrition.
Methodology: This is a cross sectional study design where a randomly selected 220 children of school going age were provided with lactose
drink and their intolerance was assessed by H2 breath test. The child ingests a load of carbohydrate 2 gram/kg maximum 50 gram and the breath is collected in sealed plastic containing and limited interval up 2 hour after ingestion. The hydrogen content of the gas can be easily measured and is reported in particle per min.(ppm) and that’s how malabsorption of any lactose can be evaluated.
Results: Results of this study shows 31% percent prevalence in children, who had Lactose intolerance in-group of 220 asymptomatic children.
In this study the highest number of Lactose Intolerance was found in oldest age group that is more than eleven years and 33% in lowest age
group (less than 8 years of age).
The numbers of tolerant and intolerant children in normal height group were 73% and 27% respectively. Stunted group had 42% intolerant and
58% tolerant Children. But when tolerant group (Negative HBT) was observed the difference in stunted and normal height group children was
statistically significant (p = 0.034).
Difference in the number of intolerant children (Positive HBT) in stunted group and normal height group was not statistically significant.
25.9% were underweight, amongst them 37% were intolerant and 63% were tolerant, but on the other hand 74.1% normal weight children,
whose weight was above the 80% of median, 28.8% were intolerant and 71.2% were tolerant. This also indicates that underweight children had
more intolerance in comparison to normal weight children but this was not statistically significant (p = 0.26).
Conclusion: It is possible that nutritional status may affect lactose absorption, so that lactose mal-absorbers may be less well nourished than lactose absorbers. We could not fully link up the lactose intolerance and under-nutrition, but we can recommend on the bases of finding in this research that whenever new policies of combating malnutrition were framed, use of milk in supplementation program should be used with
caution

Research Article, Sep 2019

Abstract: Introduction: Retinoblastoma is most common pediatric ocular malignancy. Majority of pa... more Abstract: Introduction: Retinoblastoma is most common pediatric ocular malignancy. Majority of patients presented with unilateral disease.
Infiltration to other organs is common with bone marrow being one of the most common organ involved.
Methodology: This study was conducted at Pakistan Institute of Medical Sciences Islamabad for a period of one year. A total of 47 known
patients of retinoblastoma were included in study. All patients underwent bone marrow biopsy for evaluation of infiltration.
Results: Out of 47 patients, 32 (68.1%) were male and 15 (31.9%) were female (ratio 2.13:1). 37 (78.7%) patients were unilateral and 10 (21.3%) were bilateral. Bone marrow infiltration was present in 14 (29.78%) cases.
Conclusion: Bone marrow is among most common sites of involvement in patients with bone marrow biopsy. Distant metastatic involvement has great impact on treatment and overall survival of patients.

Review Article, Sep 2019

Abstract: Introduction: Obesity is a form in which there is fat collection of body overweight or ... more Abstract: Introduction: Obesity is a form in which there is fat collection of body overweight or adipose tissue. This accumulation happens in
lean body mass of muscles and unlike connective tissue. Obesity is consummate constantly defined by the body mass index (BMI), a
mathematically formula of weight-for-height index. BMI has a high interaction with adiposity and it interacts well with fat weight at the
population rank. Obesity is defined as abnormal all excessive accumulation that may be harmful to health. Although, its etiology has been associated with and energy imbalance between calories consumed and calories expended, which is mainly as a result of a poor diet and
insufficient physical exercise. Obesity is a worldwide epidemiologic syndrome depict by fat mass accumulation, mainly visceral fat. Obesity
cause several diseases like genetic and metabolic issues, urea cycle problems, turner syndrome, Down syndrome, cystic fibrosis and Wilson’s
disease etc. Several factors are the cause of obesity like high sugar consumption but by taking some precautionary measures we can be secure from obesity.

Case Report, Sep 2019

Abstract: HLH is a rare life threatening systemic disease resulting from unregulated immune activ... more Abstract: HLH is a rare life threatening systemic disease resulting from unregulated immune activation presenting with diverse clinical
manifestations and etiologies. While Primary or familial HLH is a relatively common occurrence in infants and young children, secondary
HLH due to infections, malignancy, rheumatologic and autoimmune disorders is infrequent and carries a grave prognosis owing to delayed or
misdiagnosis. Albeitits rarity in children, EBV infection remains the leading cause of both Hodgkin's lymphoma and HLH worldwide.
Additionally, data for simultaneous presence of these three entities at the time of diagnosis is limited. Our report focuses on one such case
where a patient's clinical signs and symptoms were non-specific and masked by previous history of idiopathic HLH. After being in remission
for 2-3 months patient again relapsed but this time around the etiology was Hodgkin's lymphoma with an underlying EBV infection.

Case Report, Sep 2019

Abstract: Thalassemia is the most prevalent disease in our part of the world. Due to its mode of ... more Abstract: Thalassemia is the most prevalent disease in our part of the world. Due to its mode of inheritance, timely diagnosis and identification
can help in eradicating the fatal and life threatening consequences of this disease. With the advent of new molecular and genetic testing, many novel and rare mutations have been diagnosed that have their own clinical implications. We hereby report a case of a 40 year old male with
multiple comorbidities and significant family history of sibling death at early age. He was worked up and identified as a case Hb Sallanches
which is a rare mutational variant of Alpha thalassemia with codon 105 involvement. This case report highlights the significance of timely
diagnosis and identification of this disease in order to limit its fatal consequences on morbidity and mortality. This will assist in improving
quality of life of such patients and will also help them to plan and save their future generations from this disease.

Case Report, Sep 2019

Abstract: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm in which the major prol... more Abstract: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm in which the major proliferative component is comprised of granulocytes and is characterized by translocation of BCR-ABL and formation of Philadelphia (Ph) chromosome. Extreme thrombocytosis in chronic myeloid leukemia is rare and mimic essential thrombocythemia. Thus, chronic myeloid leukemia should be ruled out in patients who
present with extreme thromobocytosis. A 28 years old female presented to us with abdominal discomfort, bleeding gums and hematuria. Her past medical history was unremarkable and there wasn’t any family history of bleeding disorder. On examination she had pallor and splenomegaly. Laboratory studies showed thrombocytosis with platelet count of 6420 x 10^9/L , moderate leucocytosis of 22.8 x 10^9/L along
with low hemoglobin of 7.9 g/dL. Workup for acquired von willebrand disease was done which showed vWF: Ag 94%, vWF: Ricof 30%, FVIII 75%. Her cyto reduction with hydroxycarbamide 3g/day was started and patient was proceeded for platelet pheresis. On follow up after two sessions of platelet pheresis her platelet count was still high 3104 x 10^9/L. JAK2V617F, MPL, CALR and BCR-ABL mutations were checked and she turned out to be BCR-ABL positive, rest of the mutations were not detected. Bone marrow biopsy findings were consistent with chronic myeloid leukemia in accelerated phase along with marked proliferation of megakaryocytes present in sheets. Anagrelide was administered to control thrombocytosis and nilotinib 800mg/day was started. Although chronic myeloid leukemia can present with thrombocytosis but platelet count exceeding 1000 x 10^9/L is rare. Our patient demonstrated very high count of platelets (6420 x 10^9/L) and relatively unremarkable
white cell count. Most of the symptoms she had were due to thrombocytosis rather than leucocytosis as typically seen in chronic myeloid leukemia.

Editorial, Dec 2019

Immune thrombocytopenia (ITP) is characterized by immune mediated platelet destruction in the bod... more Immune thrombocytopenia (ITP) is characterized by immune mediated platelet destruction in the body. Autoantibodies are formed directed against platelet surface membrane glycoproteins; antibody coated platelets are removed from circulation by the macrophages of reticuloendothelial system in spleen, liver and other parts of the body [1]. When the rate of destruction of platelets exceeds the rate of platelet production in the bone marrow, platelet count starts to decline resulting in thrombocytopenia. The degree of thrombocytopenia may vary; this condition runs a relapsing and remitting course.

Research Article, Dec 2019

Probiotics are live bacteria. They are administered in food, with beneficial effects to the host... more Probiotics are live bacteria. They are administered in food, with beneficial effects to the host, help to prevent or treat diseases, the majority of which are gastrointestinal. The isolation and utilization of Lactobacillus spp. as probiotics from dairy or some other items has been exhibited to be health promoting. Modification in Gut flora contribute in different sorts of disease conditions, and distinctive Microorganisms developing in a biofilm are related with constant and chronic human diseases which are resistant to antimicrobial agents. The biofilm producing organisms are E.coli, Pseudomonas, Klebsiella, Staphylococcus and many more.
Objective: The aim of study is to screen the efficiency of probiotics in the inhibition of bacterial biofilm.
Methodology: Two methods used for screening of biofilm production are, Tube method and Congo red method. Three species of Lactobacillus were isolated and screened for biofilm inhibition. Four commercial isolates of E. coli were obtained and among those, three were efficiently able to produce biofilm. All species of Lactobacillus were able to counteract the biofilm production.
Results: Lactobacillus species were identified to be L. plantarum, L. casei and L. bulgaricus on the basis of sugar test and microscopy, which inhibited the biofilm formation of intestinal bacteria.
Conclusion: After this study there is no doubt in believing that the Probiotics are definitely new hope towards treatment of infections that are prevailed among people. Conventional dairy items are great source of bacterial strains and bioactive compound discharged by these three identified strains could be utilized in pharmaceuticals for recovery from bacterial diseases.

Research Article, Dec 2019

Medical errors (MEs) are flaws in implementation of act and failure of planning associated with p... more Medical errors (MEs) are flaws in implementation of act and failure of planning associated with patients. To avoid errors healthcare units are trying to make safer strategies that decrease morbidity and mortality due to MEs. The aim of this study was to evaluate errors and make strategies to avoid such errors in future.
Methods: A cross sectional study conducted at NIBD-PECHS campus Karachi, Pakistan. Approval was taken from institutional review board.
Data was collected from February 2018 to January 2019. Reporting form included variables like reporting month, location, department, classification, root cause, risk, action taken, financial burden and status. Analysis was done by using SPSS 23.0.
Results: A total of 42 MEs were reported at our hospital which were divided into four categories: patient care events 19 (45.2%), management events17 (40.5%), criminal events 3 (7.1%) and equipment error errors 3 (7.1%). Most of errors occurred in inpatient department 27 (64.2%) and nurses were responsible for 17 (40.5%) errors. In most of cases 23 (54.8%) root cause was staff negligence and to resolve this 22 (52.4%) verbal warnings were given. About 367.62USD (52,000PKR) were consumed to resolve the errors.
Conclusion: We concluded that reporting MEs is practical approach to give quality services to patients and facilitates in making new policies to reduce errors in future.

Research Article, Dec 2019

The contemporary study conceded out on distribution of Mycobacterium tuberculosis in civil hospit... more The contemporary study conceded out on distribution of Mycobacterium tuberculosis in civil hospital new Darband and its rural areas such as Serri, Shanayia, Sookal, Baghwai and Nika paani. During directing research work the information and data was placid from several villages including new Darband. This demonstrates higher indication of tuberculosis in female as compared to males hence high-risk of disease in females is due to their neighboring contact, poor sanitation, and lack of health education, poor-hygiene and lack of awareness.

Research Article, Dec 2019

Sepsis occurs in hematological disorders due to neutropenia, clinical signs and symptoms are not ... more Sepsis occurs in hematological disorders due to neutropenia, clinical signs and symptoms are not specific for its diagnosis. Early biomarkers are potentially helpful for the diagnosis in these patients. This study was done to assess the utility of Procalcitonin (ProCT) as a marker of sepsis in patients with hematological disorders.

Review Article, Dec 2019

Hepatitis is the inflammation of liver which cause liver cirrhosis. It is the health problem. Thi... more Hepatitis is the inflammation of liver which cause liver cirrhosis. It is the health problem. This may be acute or chronic. The chronic stage of hepatitis leads to liver cancer which is the last stage and ultimately causes death. It is the main cause of liver disease. It is much problematic and about 2 billion people infected from this deadline disease. There are three modes of hepatitis B transmission. One from the mother to infant, another one is the sexual transmission, and the last one is through blood transfusion and most in those people who are drug abusers. In 1995, the vaccination system was introduced to cure this disease. To eradicate HBV virus WHO introduced the vaccination system. Then the vaccination dose was given to infants at their birth to eliminate their HBV. This is a three-dose vaccination system and much other vaccination for adults and to eliminate this problem during pregnancy. For combat with this disease, many therapeutically vaccines have been introduced. WHO (World Health Organization) play a major role to eliminate this problem from the society

Review Article, Dec 2019

Nipah virus is one of the deadliest viruses of Paramyxoviridae family, of the order Mononegavira... more Nipah virus is one of the deadliest viruses of Paramyxoviridae family, of the order Mononegavirales. The virus is harbored by Pteropus fruit bats and transmitted to pigs via partially eaten fruits or direct exposure to infectious bat secretions. Viral determinants that contribute to Nipah virus infection include V and W proteins where W protein plays a more prominent role. It is Known for causing severe and rapidly progressive encephalitis and thus classified among BSL-4 organisms due to its high mortality rate and lack of vaccines and drugs. Due to wide spread primary host the potential for outbreaks to occur in new regions remains significant and suggests a serious potential for larger epidemics in the future. Therefore proper management and preventive measures are needed to be implemented by health care workers, as well as at the government level

Case Report, Dec 2019

Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated wit... more Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated with worst prognosis. It hasbeen classified as a specific entity by WHO. Moreover, the incidence and prevalence of Myelodyplastic Syndromes in children and adolescents is very low. Herein, we report a case of a 17 years old boy diagnosed as myelodysplastic syndrome with fibrosis along with ofmonosomy 7. Data pertaining relationship between myelodysplastic syndrome with fibrosis and karyotype abnormalities is relatively sparse. This case report will assist in considering better risk adapted therapies.

Case Report, Dec 2019

Hypopituitarism is defined as pituitary hormone (or hormones) deficiency caused by dysfunction of... more Hypopituitarism is defined as pituitary hormone (or hormones) deficiency caused by dysfunction of pituitary gland and/or hypothalamus. Clinical findings and diagnostic procedure depend to the deficient pituitary hormone. The prognosis of patients with hypopituitarism is associated with presentation, age, the degree and severity of the hormonal disorder, and the response to medical and surgical treatment. In present case, we report a 78 years old woman that presented with hyponatremia, nausea and vomiting, whom consequently diagnosed with hypopituitarism and we discussed diagnostic procedure to establish the diagnosis. In sake of prevention of mortality, physicians
should be aware of hypopituitarism in subjects with nausea, vomiting and electrolyte disturbances. Once the diagnosis established, replacement therapy should be initiated immediately

Case Report, Dec 2019

Cytomegalovirus (CMV) infection poses a serious threat to immunocompromised patients in early lif... more Cytomegalovirus (CMV) infection poses a serious threat to immunocompromised patients in early life. Transmission of CMV to newborn via breastfeeding is a recognized mode. In our case, the affected child presented with the aftermaths of CMV infection affecting gastrointestinal tract (GIT) and central nervous system (CNS) with over-whelming viral replication and via ingestion of infected breast milk many times a day. Worsening clinical manifestations prompted the investigations for a possible primary immune deficiency (PID) disorder, and rising CMV copies in blood despite institution of anti-CMV therapy led to check other body fluids of the infant. There were no viral copies detected in mother’s blood sample; so breast milk was tested to identify the source of CMV being transmitted to him. Here we describe an unusual case of RAG2 gene mutation induced PID presenting clinically as severe combined immunodeficiency (SCID) phenotype rather than Ommen’s syndrome, and acquired CMV infection via breast milk.

Case Report, Dec 2019

Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 glo... more Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 globin gene. It is often heterozygous in form and clinically silent even in the presence of beta thalassemia trait in compound heterozygous form. We identified two Sindhi Hindu families with hemoglobin Q India, one is compound heterozygous for Hb Q India and thalassemia trait, while other has heterozygous Hb Q India variant. These samples were booked for routine hemoglobinopathy screening and the variant was suspected after finding an unknown peak at a retention time of 4.68 seconds, performed on high performance liquid chromatography(HPLC). For confirmation, these samples were sent for DNA analysis for the presence of suspected Hb Q India mutation, using amplification refractory mutation system (ARMS)

Editorial, May 18, 2020

The human coronaviruses (CoV) are the causative agent of respiratory illness in human especially ... more The human coronaviruses (CoV) are the causative agent of respiratory illness in human especially during winter and fall. They were first identified in 1960’s. The four corona strains i.e. NL63, 229E, HKU1 and OC63 accounts for about 30% of the annual common cold incidences ranging from mild to moderate illness in human worldwide. These are the largest RNA viruses from the sub-family Orthocoronavirinae of family Coronaviridae. Interestingly, the crown like spikes on their surface make them unique. So far four different groups of coronaviruses have been identified namely: alpha-, beta-, delta-, gamma- coronaviruses [1]. Beside the reported human-only beta coronaviruses HKU1 and OC63; lethal outbreaks of three other beta corona viruses i.e. Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and SARS-CoV2 - viruses were documented. The later three viral strains were confirmed as evolved viruses from animal origin. The genetic diversity of these viruses is sought to be facilitated by recombination and mutational events within the intermediate host predominantly a mammal

Research Articles, May 18, 2020

Intestinal parasitic infections remain a major public health problem in many parts of the world, ... more Intestinal parasitic infections remain a major public health problem in many parts of the world, particularly in low and middle-income countries like Nepal. Materials and Methods: The different ethnic groups are geographically, socio-economically, culturally, and genetically diverse and their heterogeneity needs explanation to understand the variation in the prevalence of IPIs among them. The aim of this study was to compare the prevalence of intestinal helminths in Satar and Chaudhary communities of Birtamode Municipality and to identify the risk factors associated with either of them. A total of 220 stool samples, 110 from each community were collected and examined by unstained and stained smear preparation, floatation, and sedimentation technique. A set of questions regarding the risk factors of parasitosis was filled by interviewing each respondent. R-version 1.1.463 was used to perform the chi-square test for statistical analysis of data, and 95% confidence interval and P

Research Article, May 18, 2020

To assess the positive academic usage of smart phone to determine the correlation of its potentia... more To assess the positive academic usage of smart phone to determine the correlation of its potential addiction with sleeping disturbances among medical students in Karachi, Pakistan. Methods: A standard scale based questionnaire was constructed and reviewed by a panel of expert for content reliability and validity. The questionnaire consisted of 3 parts: Part “A” for demographic parameters, Part “B” was designed to evaluate Smart phone addiction and Part “C” for assessment of sleep disturbance. The study was conducted in July 2017 which comprised of medical students of the Liaquat National Hospital & Medical College, Karachi, Pakistan. Results: A total of 212 students participated in which Males were 31.1% (n=66), Females were 68.9% (n=146). Out of 212, within which 93.3% (n=198) had Smart Phones, 4.71% (n=10) had Mobile phones other than smart phones and 1.88 %( n=4) did not had mobile phone. Majority of students were found to be using Smart phone for academically beneficial use 86.4 %( n=171). Among 198 smart phone users 51.5% (n=102) were found to be addicted with respect to our scale. A positive significant correlation was found between the scores obtained from the Modified Smart phone addiction scale and Sleep disturbance Scale (rs=0.536; p<0.001).

Research Article, May 18, 2020

To analyze data regarding relationship of myelomeningocele at different anatomical locations alon... more To analyze data regarding relationship of myelomeningocele at different anatomical locations along vertebral canal and size of base defect. Study Design: Descriptive analytic study. Setting: Department of pediatric surgery, King Edward Medical University / Mayo Hospital Lahore. Duration of the study: 2 years from October 2017 to September 2018. Methodology: During study period a total of 60 patients (n=60) with myelomeningocele at different anatomical locations along the vertebral column were admitted. Inclusion criteria was: • All patients under 3 months of age with myelomeningocele. • Patients with intact myelomeningocele membrane. • None infected cases. A detailed research performa was made having all variables and data was collected regarding total number of patients, gender, location of myelomeningocele along vertebral canal, presence or absence of neural tissue in sac, size of base of defect, associated neurological deficits, treatment and outcome were noted and statistical analysis was done by using SPSS version 24.

Research Article, May 18, 2020

Neonatal mortality is the death of newborn baby in first 28 days of life. Approximately 1 million... more Neonatal mortality is the death of newborn baby in first 28 days of life. Approximately 1 million newborn die in early 24 hours and 2 million more will be die in next 7 days of birth. Birth asphyxia is a medical condition which results due to lack of oxygen to newborn and last for long time, causing different morbidities and physical harm. It is the third major cause of newborn death, according to world health organization. Aim: Aim of the study was to observe the practices of nurses for adherence on standard protocols towards birth asphyxia management. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital. The population was n=153 nurses, working in labour room and nursery. Study duration was 4months. Data was collected by observational checklist consisted of 19 items to observe the practices of nurses. Data was analyzed by the categories of the < 60 show poor practices, 61-74 gives average while > 75 show good practices. Ethical approval was taken from participants as in written consent. Results: Majority of Nurses 83% Nurses having experience above 10 years and show good practices towards management of birth asphyxia and 38% have good practices having age 25 years to 34 years. While the nurses having experience of less than five years 44% and age under 24 years (11%) show poor practices. Conclusion: Early detection of Birth asphyxia and management is critical to reduce neonatal mortality. Experienced nurses show good practices but there was some problems due to which standard protocols could not followed, as lack of staff nurses, bad attitude, lack of equipments and overburdened.

Review Article, May 18, 2020

Health seeking practices and well-being management has been considered and the determinants are d... more Health seeking practices and well-being management has been considered and the determinants are divided into physical, financial, social and political environments. Health knowledge as well as the activities is the key elements that ensure high quality of health. The audit found clear practices that pursue differences in sexual orientation, social conditions, infection occurrences and family economic conditions. In this way, an evidence-based approach must be planned by establishing an understanding of the way happiness practices and social insurance are used, and giving enough credibility to all determinants. By focusing on the benefits (network) factors caused by environment, financial variables, training levels, social beliefs and the human service framework itself, it is feasible to improve the requirements for the use of solid behavior and physical medical services. Men are considered to be the main head of a family. Men’s instruction level is considered higher than women because men are dominant in our society.

Review Article, May 18, 2020

Health care delivery system is fair distribution, organization, and arrangement of health resourc... more Health care delivery system is fair distribution, organization, and arrangement of health resources that serves best for any country’s population efficiently and effectively for the achievement of organizational goals. Health care services are the multiple services providing to an individual, families, and communities by health care providers who are skilled to prevent disease, promote health, cure illness for the purpose of maintaining and restoring good health. Human development and economic solidarity can be increased ultimately due to better health that labor of a country. Productive human capital resources and healthy labor force can be achieved by planned healthcare services by the government for its people. Worldwide, health regions contrasts from country to country, it depends on how much costs on health is been efficiently utilized. The primary contributors in health care services are private health sectors, donors, out of pocket expenditures in the most of developing countries which may increase human capital and economic growth of the country as, public health sectors remains deprived due to structural fragmentation, lack of resources, and functional inabilities. In this article we discuss about the healthcare delivery system of Pakistan versus Bangladesh such as organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its application

Review Article, May 18, 2020

Coronavirus 2019 (COVID-19), previously called as 2019-nCoV, was emerged from Wuhan, China in De... more Coronavirus 2019 (COVID-19), previously called as 2019-nCoV, was emerged from Wuhan, China in December 2019. It is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). By 22 March 2020, 323,265 people were infected from this virus, including 13,745 deaths globally. It is declared as pandemic by World Health Organization as it involved 185 countries of the world. World Health Organization also declared it as 6th public health emergency of international concern. COVID-19 presents as various outcomes; asymptomatic (carrier), pneumonia and acute respiratory disease. People of all ages can be affected from this virus but adult population is observed to be involved in high ratio. Additionally, there is possibility that infection can be spread as nosocomial infection to patients and healthcare workers. On chest imaging, ground – glass opacity with bilateral involvement is seen as most common abnormality in patients with pneumonia. Older patients are prone to develop more severe disease as compared to young population. Patients with underlying chronic co-morbidities are also more prone to develop poor outcome. Till now, specific treatment of COVID-19 is not available; however clinical trials are under investigation to see the clinical efficacy of various therapeutic agents in China e.g. remdesivir and chloroquine etc. At this time, standard infection control measures are only possible means for prevention of SARS-CoV-2.

Letter to the Editor, May 18, 2020

Dear Editor, With clearly outlined prospects for research, I congratulate Dr. Neel Kanth and col... more Dear Editor,
With clearly outlined prospects for research, I congratulate Dr. Neel Kanth and colleagues for their interesting study on the “Prevalence of lactose intolerance and its association with malnutrition in children”, published in a recent issue of the National Journal of Health Sciences (NJHS, Volume 4, Issue 3, 2019) [1]. The high prevalence of lactose intolerance documented by the authors is confirmed by a recent meta-analysis, which found a lactose malabsorption among adults and children aged 10 years or older of 58% in Pakistan [2]. The 2018 Pakistan National Nutrition Survey also showed that 40.2% children were stunned, 28.9% were underweight, and 17.7% were wasted [3]. The authors rightly pointed out that further research is urgently needed to better understand the association of lactose intolerance and malnutrition in children [1]. However, in my opinion, here are two aspects worth mentioning.

Editorial, Oct 21, 2020

Coronaviruses (CoVs) are the largest group of viruses; order is Nidovirales while family is Coron... more Coronaviruses (CoVs) are the largest group of viruses; order is Nidovirales while family is Coronaviridae. They are further subdivided into four groups, the alpha, beta, gamma and delta coronaviruses [1]. These viruses usually cause mild infections but two zoonotic epidemics of the betacoronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) [2] and Middle East respiratory syndrome coronavirus (MERS-CoV) [3] have occurred in this century, mortality rates of 10% for SARS-CoV [4] while a very high i.e. 37% for MERS-CoV [5].

Perspective, Oct 21, 2020

Before embarking upon the first modality of cancer management, it is advisable to thoughrouly dis... more Before embarking upon the first modality of cancer management, it is advisable to thoughrouly discuss the patients case in a site specific multidisciplinary tumor board meeting. These meetings are a necessary requirement for a high quality comprehensive cancer service. Published evidence reveals a positive relationship in the form of treatment outcomes. The outcomes are being measured in terms ofs of survival and local control of malignancies for patients who were discussed and deliberated nary tumour boards [1, 2]. These boards are vitally essential for the services offered in Low and Middle Income countries as we regard them as the lifeline for our cancer patients [3].

Research Article, Oct 21, 2020

Abstract: Objective: Functionality and quality of life in patients with osteoarthritis undergoing... more Abstract: Objective: Functionality and quality of life in patients with osteoarthritis undergoing total arthroplasty of the knee.
Materials and Methods: This study was conducted in Ziauddin hospital, Karachi from April 2018 until August 2018, making up 40 individuals who have osteoarthrosis of the knee with an indication for total arthroplasty and not being carriers of any other disease affecting the limbs lower. Two scales of evaluation were applied at two different times: pre and postoperative. Health status questionnaire (SF-36) and Knee injury and osteoarthritis outcome score (KOOS) was applied and answered in the preoperative period (on the day of surgery) and the sixth postoperative week.

Research Article, Oct 21, 2020

Abstract: Objective: To determine the frequency of prevailing microorganism, treatment approach, ... more Abstract: Objective: To determine the frequency of prevailing microorganism, treatment approach, different treatment complexities and rationalize the approach for treating Infective Endocarditis (IE) patient. Material and Methods: The retrospective study was conducted from 01st January 2015 to 31st October 2019. Data was collected and after applying exclusion criterion 40 patients were selected and their available record was evaluated. To obtain the conclusive results, frequency and percentages were calculated.

Research Article, Oct 21, 2020

Background: Hospital Acquired Infection (HAI) is a major global safety concern for the health sys... more Background: Hospital Acquired Infection (HAI) is a major global safety concern for the health system as it increases mortality, morbidity, and length of hospital stay and contributes to the economic burden. These infections are prevalent in hospitals of developing countries such as Pakistan, due to limited resources, unsafe infection control practices and under reporting. However, post-operative patients are more prone to these infections due to immunocompromised state, antibiotic resistance, and most importantly lack of awareness regarding HAIs and their respective preventive measures. Therefore, the objective of this study was to highlight some of the serious but avoidable aspects of this largely ignored but important issue of HAIs in public and private tertiary care hospitals by assessing and comparing the need of knowledge and awareness in post-operative patients to minimize risks which in turn will decrease incidence, morbidity and mortality. Materials and Methods: A descriptive cross sectional study was conducted among post-operative patients of Liaquat National Hospital and Civil Hospital (private and public tertiary care hospital, respectively), over a period of 1 year (July 2017-2018) in Karachi. Individual interviews following verbal consent were taken using a pre-coded questionnaire, which was divided into 3 sections to analyze the social and demographic, knowledge and practices of the patients. We excluded patients with impaired comprehension, less than 15 years of age and those who were reluctant to participate. Data was analyzed using SPSS v.22.0. Pearson's chi-square was used as the primary statistical test. Results: Three-fifty post-operative patients from each, public and private hospital were enrolled. The mean age was found to be 38.41 ± 16.57 years and 40.3% of patients were uneducated. Knowledge regarding the modes of spread, types and risk factors for hospital acquired infections was significantly associated with patients admitted in private hospital, female gender and a higher education level (P <0.05). Among the modes of spread of HAIs, dirty beds (n=666, 95.1%) and dirty toilets (n=662, 94.6%) were widely identified and respiratory tract infection (522 (74.9%) was the most commonly identified type of HAIs. It was also noted that there were misconceptions and fears seen among 37.7% of patients regarding the prevention of HAIs. Perceptions towards HAIs were generally sound with 96.3% respondents agreeing to report previous infections. While about 208 (30%) respondents disagreed with limiting visiting hours in hospital can minimize the risk of HAIs overall. Moreover, with regard to knowledge score, all perception responses reached a statistical significance. A total of 616 (88.0%) patients stated that during their hospitalization they had received no information concerning nosocomial infections. It is indeed noteworthy that 432 (61.7%) patients had received information regarding HAIs outside healthcare units, television (25.7%) being the most popular choice. Conclusion: The study revealed that there was an overall lack of awareness and knowledge regarding HAIs, especially in participants from public hospital. Thus, there is a need to initiate educational campaigns that create community awareness and help improve perceptions of people regarding this issue. Strict monitoring of infection control practices and counseling of the patients upon admission or during the stay can also help reduce the burden.

Case Report, Oct 21, 2020

Abstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AU... more Abstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AUL) as a rare subtype of acute leukemia of ambiguous lineage (ALAL). The prognosis of AUL is considered poor and it expresses no known lineage-specific markers. In majority of the cases, AUL has been associated with karyotypic abnormalities, most commonly deletion 5q and complex karyotype. Deletion 17p correlation with acute myeloid leukemia and myelodysplastic syndome has been previously established and is associated with poorer outcomes. Herein we are reporting a case of forty years old male who was referred to National institute of blood diseases and bone marrow transplantation with complains of fever, multiple neck swellings, and early satiety and was diagnosed as Acute Undifferentiated Leukemia along with deletion 17p. This is a rare entity and can aid in further diagnostic and therapeutic approaches.

Case Report, Oct 21, 2020

Abstract: Acute Promyelocytic Leukemia (APL) is a very uncommon type of acute myeloid leukemiacom... more Abstract: Acute Promyelocytic Leukemia (APL) is a very uncommon type of acute myeloid leukemiacomprising less than 10% of pediatric population. Acute Promyelocytic leukemia is a neoplastic proliferation of abnormal promyelocytes in bone marrow, caused by cytogenetic abnormality t(15;17). Majority of patients (80%) have long term survival, and death occurs in approximately 10% of patients in early course of the disease; mainly because of hemorrhage. Hemorrhagic complications can be reduced by appropriate therapy if started timely, which ultimately reduces the risk of death.We report a case of 7 years old boy with complaints of fever off and on for past 06 months, bruises and swelling on left leg for 1 week, blood containing vomiting for 1day. He was diagnosed as APL on bone marrow biopsy.

Case Report, Oct 21, 2020

Abstract: Chronic myeloid leukemia is a myeloproliferative neoplasm. It is a common disease of el... more Abstract: Chronic myeloid leukemia is a myeloproliferative neoplasm. It is a common disease of elderly, rarely affecting pediatric, adolescent or young adults. The median age of presentation is 65 years. The incidence is 1_2 cases per 100,000 adults. Tyrosine kinase inhibitors (TKIs) are highly successful and have good remission rates in the CML treatment; though multiple factors are associated with failure of treatment. We present a patient of 14 years old male who was diagnosed as CML. He was seven months into TKI therapy, transformed into B-Lineage acute lymphoblastic leukemia.

Short Communication, Oct 21, 2020

Abstract: The availability of accurate data is of vital importance in the COVID-19 pandemic which... more Abstract: The availability of accurate data is of vital importance in the COVID-19 pandemic which has presented itself as a formidable challenge. The objective of our paper was to identify the flaws in simple estimates of case-fatality rate (CFR), the epidemiological indicator currently in use, and compare it to another more effective indicator, the adjusted case-fatality rate (aCFR). aCFR is defined as the number of COVID-19-associated fatalities*100/ total cases that reached outcome, i.e. death or recovery, according to the methodology of Ghani and colleagues. The results showed varying CFRs and aCFRs for several countries, signifying the problem with using CFR. Belgium is a prime example of such a case as it had a CFR of 15.82% while an aCFR of 36.38% and the number of cases in Belgium is high enough to make the discrepancy in these results significant. The deaths caused by COVID-19 are being underrepresented by CFR. It can lead to misleading results, especially when comparing countries and regions on their mortalities.

Short Communication, Oct 21, 2020

Establishment of site specific Multi-Disciplinary Team (MDT) Tumor Boards is an endeavor which is... more Establishment of site specific Multi-Disciplinary Team (MDT) Tumor Boards is an endeavor which is being
performed in the developing countries by individual specialists on voluntary basis. In Low and Middle Income Countries (LMIC) it is still not a mandatory system regulated phenomenon. Unlike centrally regulated healthcare systems, in developing countries we are taking this imperative task as a professional challenge which we are enduring on voluntary basis. This medical journal’s editorial board came up with this innovative idea of devoting a full page for academic work which is being performed for the education and implementation of multi-disciplinary culture in cancer care, notable the site specific tumor boards’ establishment and functioning and peer reviewed clinical practices.

Editorial, Mar 30, 2021

Cancer prevalence is increasing over the past few decades. Spinal osseous metastasis is one of th... more Cancer prevalence is increasing over the past few decades. Spinal osseous metastasis is one of the most common sites of secondary neoplastic disease among cancer patients [1]. Spinal malignancies can broadly be classified into primary spinal cancers and secondary spinal metastasis. Metastatic spinal cancers are more common than primary malignancy of the spine. Metastatic spinal cancers are further subdivided into two parts based on the involvement of the dura mater; metastasis external to dura mater can be termed as metastatic epidural spinal cancers (MESC); metastasis inside the dura mater is called metastatic intradural spinal cancers (MISC) [2]. Bony involvements of vertebrae are common at the presentation of MESC while the involvement of the spinal cord and meninges is a prominent feature of MISC. However, the clinical presentation is quite overlapping and timely-decision making is quite challenging in several cases. Several grading systems have been developed to assess the severity of spinal cancers [3-6]. Such ambiguities require a need for teamwork between different specialties to decide the management plan for better patient care. Multidisciplinary Tumor Boards (MDT) are the practical venue where different specialists are present for the discussion [7]. Spinal cancers require teamwork especially between orthope-dics, neurosurgery, palliative care, radiation oncology, and medical oncology specialists. But spinal cancers with signs of cord compression are considered an acute emergency where intervention is required within 24-72 hours [8]. Undue delays may lead to irreversible paralysis, sphincter dysfunctions, fecal incontinence, and bladder dysfunctions. Time limitation is the major barrier in reaching a multidisciplinary decision in such cases. Hence, single-handed treatment without a multidisciplinary opinion is a common practice in this particular clinical scenario, which can lead to compromised outcomes. We hereby, advise a practical solution to this concerning issue. Hospitals are advised to form an on-call team of one or two consultants or senior registrars, from orthopedics, neuro-surgery, palliative care, radiation oncology, and medical oncology departments who are assigned the task to evaluate patients status of cord compression. coming with spinal neoplasia and reach a conclusive treatment recommendation after multidisciplinary discussion among themselves. The team can be named as Spinal MDT Tumor Board. The team should be accessible when called by the on-duty clinician attending the patient. After reaching a multidisciplinary recommendation, further workups should be carried out and referral of the patient to the appropriate department should be made. The surgical procedure by neurosurgeons or orthopedic surgeons should be carried out while radiotherapeutic options should be carefully decided by radiation oncologists. It should be made clear that the on-call multidisciplinary team shall only be liable for emergency decision making only and further follow-up and planning of the patient should be carried out in formal regular site-specific MDT Team meetings. If a pre-designated multidisciplinary team exists in a hospital one can save valuable time and these team members can talk and discuss the case after evaluating the patients' clinical status. If this team is not formed there is a real danger that undue delays that occur while making contacts with specialist teams, may lead to further deterioration of the already manifested neurological deficit. A quick and early consensus treatment will lead to the reversal of signs and symptoms of paraplegia or quadriplegia. Spinal MDT would prove to be a blessing for neurologically deteriorating patients who genuinely need a swift treatment decision by specialists belonging to various disciplines. CONFLICT OF INTEREST Declared none. ACKNOWLEDGEMENTS

Research Article, 2021

Abstract: Aim: To screen cases who are at high risk and low risk for obstructive sleep apnea in g... more Abstract: Aim: To screen cases who are at high risk and low risk for obstructive sleep apnea in general surgery patients.
Materials & Methods: It is a cross-sectional study. It was done in Liaquat National Hospital from January 2019 to June 2019. After
institutional approval, 335 patients were included in this study, who presented to general surgery OPD. STOP-BANG questionnaire was used
to screen cases who are at high risk and low risk for obstructive sleep apnea in general surgery patients.
Results: 335 patients were screened and 38.5% of individuals in population had age of more than 50 years. In this population 149(44.5%) of
patients were male. Out of 335 patients, 135(40.3%) of them were found to have high risk of obstructive sleep apnea while the remaining
199(59.7%) were classified in low risk group. All of the parameters of STOP-bang questionnaire including age (p<0.001), gender (p=0.026),
BMI (p<0.001), snoring (p<0.001), tiredness (p<0.001), sleep apnea (p=0.001), diastolic blood pressure (p<0.001) and neck circumference
(p<0.001) were significantly different between high risk and low risk patients.
Conclusion: This study can provide a catalyst for more meticulous screening for OSA preoperatively to diagnose high risk group.
Keywords: Sleep Apnea, Obstructive, Care, Preoperative, Surgery, General, Operative Procedures.

Research Article, Mar 30, 2021

Abstract: Background: The incidence of neutropenia in hematological malignancies comprises of hug... more Abstract: Background: The incidence of neutropenia in hematological malignancies comprises of huge burden of febrile neutropenia.
Multinational Association of Supportive Care in Cancer (MASCC) risk index score is the most widely used model for forecast of
complications.
Objective: The aim of this study was to determine diagnostic accuracy of MASCC scoring system in febrile neutropenia patients suffering
from hematological disorders.
Materials & Methods: Patients suffering from hematological disorders and presenting with febrile neutropenia were stratified into low and
high risk groups according to MASSC score. The standard score range from 0 to 26 points; score of more than or equals to 21 were considered
to be low risk and score of less than 21 was high-risk category. As an in-patient at National Institute of Blood Disease & Bone Marrow
Transplantation, they were followed over the course of illness for development of any serious medical condition until resolution of febrile
neutropenia.
Results: Of 217 patients, serious medical conditions were documented in (63%) of individuals among the high-risk group cohort and (13%)
developed serious medical conditions in low-risk cohort. Major disease encountered was acute leukemia (69%). Hypotension 14 (22.2%) and
hepatic failure 14 (22.2%) were among the two most common variables of established serious medical condition. The overall sensitivity and
specificity of MASCC score was 69.8% and 81.8%, with the positive and negative predictive value of 61.1% and 86.8% respectively.
Conclusion: The score has been re-validated in this study and determined its significance in ascertainment of high-risk cohort among febrile neutropenic patients in the current era, thereby helping the physicians to tailor the management approach accordingly.
Keywords: MASCC, Febrile neutropenia, Leukemia, Hematological disorders, Cytotoxic chemotherapy.

Review Article, Mar 30, 2021

Abstract: Internal resorption is an asymptomatic condition in teeth seen with past history of inj... more Abstract: Internal resorption is an asymptomatic condition in teeth seen with past history of injury. In the crown it has a clinical observation of pink mark. It is diagnosed by chance on an x-ray examination. Primal detection and resorption treatment improves prognosis of the condition. Resorption can be broadly classified into normal physiological or pathological process associated with extensive damage to hard structures of tooth such as dentin, cementum and bone. Proper diagnosis of resorption and differentiation of resorption from internal and external resorption by radiographic presentation and the correct diagnosis and treatment planning improves the prognosis of the condition. Untreated cases will cause loss or early exfoliation of the afflicted tooth [1].

Research Article, Mar 30, 2021

Abstract: Objective: This study aims to determine the trend of seropositivity of anti-SARS-CoV-2 ... more Abstract: Objective: This study aims to determine the trend of seropositivity of anti-SARS-CoV-2 antibodies (total including IgM, Ig G) in patients presenting at a private hospital in Karachi.
Materials & Methods: A total of 2500 patientswere included in the study. Informed consent was obtained and a questionnaire including patient’s age, gender, symptoms, history of traveling, contact with people who had travelled recently, contact with confirmed/suspected COVID-19 patient at home or work was filled. Samples were analyzed for anti-SARS-CoV-2 antibodies on Roche Cobase601.
Results: The mean age of the patients was 41.045±20.48 years. 674(26.96%) were reactive, while 1826(73.04%) were non-reactive. Mostly patients were males 1388 (55.52%).The seroprevalence was higher in males 29.75% while females showed 23.47% seroprevalence. Commonest symptoms were found to be fever(88.73%) and dry cough(57.20%).The frequency of seropositive patients revealed an increasing trend with 20.5%and 27.8 % in first andlast 15 days of June respectively, 30.7% and 31.4% in first andlast 15 days of July 2020 respectively.Only221(32.79%) reactive patients reported recent symptoms while 453(67.21%)patients were completely asymptomatic. Odds Ratio(OR) for participants with recent history of travelling, contact with people who had travelled recently,exposure with COVID-19 patients at home or work was 11.50, 3.28, 8.45 and 0.72 respectively.
Conclusion: The seropositivity has shown a definite gradual upward trend over the study period and approximately two thirds of the patients being completely asymptomatic pointing towards the fact that many people are silently exposed to the disease and develop antibodies through their natural immune mechanism.
Keywords: COVID 19, Anti-SARS-CoV-2 antibodies, Trend, Seropositivity, Dry cough, Diarrhea.

Research Article, Mar 30, 2021

Abstract: Objective: The underlying conditions/diseases of scattered white spots in the duodenum ... more Abstract: Objective: The underlying conditions/diseases of scattered white spots in the duodenum are rather not very clear in the literature.
We aimed to find out whether Helicobacter pylori, diabetes mellitus or inflammation has an impact on the presence of duodenal white spots.
Materials & Methods: We included all patients who underwent endoscopy between the time-period 2007-2017 in the Endoscopy Unit of
Cumhuriyet University and had scattered white spots in the duodenum. Our control group was formed by randomly selected patients who
underwent endoscopy at the same time period in whom duodenal biopsy was taken. The demographic data of both the patient and the control
group, the presence of diabetes, endoscopic and histological diagnoses, neutrophil lymphocyte ratio, thrombocyte lymphocyte ratio, mean
platelet volume and erythrocyte distribution width were obtained from the computer system of the hospital in detail.
Results: Peptic ulcer disease was found to be significantly more prevalent in patients with white spots than the control group. We could not
find any difference between the patient and control groups by means of either neutrophil lymphocyte ratio, platelet lymphocyte ratio, mean
platelet volume and erythrocyte distribution width, Helicobacter pylori, positivity or presence of diabetes.
Conclusion: Both diabetes mellitus and H. pylori are causes of systemic inflammation. In our study, we evaluated whether patients with white
spots were associated with systemic inflammation by looking at popular inflammation markers. We could not find any difference between the
two groups in terms of these markers.
Keywords: White spots, Duodenum, Diabetes mellitus, Systemic inflammation, Lymphangiectasia, Giardiasis, Chronic nonspecific
duonetitis

Review Article, Mar 30, 2021

The aldosterone hormone is a type of the mineralocorticoid group of corticosteroids and it is sec... more The aldosterone hormone is a type of the mineralocorticoid group of corticosteroids and it is secreted from the outermost zone of adrenal gland called as Zona Glomerulosa [1, 2]. The aldosterone secretion is regulated by adrenocorticotropic hormone (ACTH) to a very lower extent; rather its principal physiological regulators are atrial natriuretic peptide (ANP), plasma potassium level (K +), and renin-angiotensin system [1, 2]. There are two distinct physiological states for aldosterone secretion. a) Hyperkalemia b) Hypovolemia. In the former one, increased level of potassium ion depolarizes the voltage gated calcium (Ca 2+) channels of the cells, thus stimulating the aldosterone secretion [3, 4]. In the hypovolemic condition, type 1 receptor signaling of angiotensin II (AngII) induced by the rennin-angiotensin system in glomerular cells, activates the aldosterone secretion via Ca 2+ biosynthesis pathway [3, 4]. Regardless of activating pathway in the distal tubule, aldoste-rone hormone increases the transcriptional activity of miner-alocorticoid receptor (MR) and also modulates the level of electrolyte mediators in order to maximize the resorption of either Na + or K + in the distal nephron [5]. Obliging the current belief, the secretion of aldosterone shows bi-phasic response at cellular level. In the first phase, membrane transport proteins are stimulated due to deceleration of normal vital cellular process, as a result Na + ion reuptake occurs at aldosterone sensitive distal tubule of nephron. In second phase which lasts about for few hours, Na + ion re-absorption occurs via three primary Na+ transporters: Epithelial sodium channel (ENaC) α subunit transporter of collecting tubule, sodium-chloride (Na +-Cl-) symporter of distal tubule, and sodium-potassium adenosine triphosphatase (Na +-K + ATPase) α subunit proximal tubule [5]. There are three types of cells in kidney tubules: principal cells, intercalated cells and distal convoluted tubule cells. The overall response of upraised level of aldosterone accompanied with the re-absorption of ions is to be regulated by the coordinated action of these tubular cells [1, 5]. The re-absorption of Na + ion accomplished by four different mechanisms as described below, are the cause for transportation of Na + through the cell membrane into the blood stream and hence indirectly enhancing the retention of water molecules in the Abstract: Objective: The focus of this review is to summarize the recent advancement to understand the molecular pathogenesis of diabetic nephropathy (DN). Also, to highlight the role of abnormal aldosterone secretion on the development and progression of diabetic nephropathy. Background: Diabetic Nephropathy (DN) is a progressive disease of nephron due to slow progressive failure of kidney tubule to perform its filtration process. It is often associated with proteinuria and glomerular stiffening which eventually leads to low glomerular filtration rate, finally succumbs the patient toward the end stage of kidney disease. The abnormal level of aldosterone in diabetes mellitus is a fatal combination to combat because of progressive development of diabetic nephropathy.

Review Article, Mar 30, 2021

Abstract: Background: Coronavirus disease 2019 (COVID-19) has influenced all continents, promptin... more Abstract: Background: Coronavirus disease 2019 (COVID-19) has influenced all continents, prompting extraordinary efforts on worldwide
research and publications to alleviate the crisis.
Methods: We conducted a bibliometric review using Scopus to assess its impact on global scientific production. We searched for the following
terms in titles, abstracts, and keywords to identify relevant literature published until 9th January 2021: 2019 novel coronavirus, 2019-nCoV,
SARS-CoV-2, COVID-19, coronavirus disease-19, coronavirus disease 2019.
Results: Our results retrieved 86,624 documents from 159 countries with the USA, China, and UK being the top three contributors. Overall
citation count was 769,811 with documents from China being cited most. In terms of h-index, China, USA, and UK ranked highest respectively.
Conclusion: Most publications were associated with developed countries that were hit the earliest and/or hardest. This impact on scientific publications was less pronounced in developing countries like Pakistan, highlighting the immediate need to support and facilitate research on COVID-19 in these countries.
Keywords: COVID-19, Research, Bibliometric analysis, Publications, SARS-CoV-2, Developing countries, Research and development.

Case Report, Mar 30, 2021

Abstract Spindle Cell Carcinoma (SpCC) is a biphasic tumor. They are proven to be monoclonal dedi... more Abstract Spindle Cell Carcinoma (SpCC) is a biphasic tumor. They are proven to be monoclonal dedifferentiated forms of conventional
squamous carcinomas. It is a rare tumor which is infrequently observed in head, neck and in the aerodigestive tract. The tumor is aggressive and shows high frequency of recurrence and metastasis. It is an aggressive variant of squamous cell carcinoma which resembles a true sarcoma.
It is a proliferation of spindle cells and squamous cells. For confirmation of diagnosis, immunohistochemistry is used. A Rare case of spindle
cell squamous cell carcinoma in a 61 years old male in the tongue.The patient reported of rapidly growing lesion from six months with pain
severe pain, dysphagia and difficulty in swallowing patient had history of chewing tobacco from past 35 years.
Keywords: Spindle Cell Variant, Biphasic tumor, Head and Neck, Pseudocarcinoma, Sqamous cell, Dysplastic.

Case Report, Mar 30, 2021

Abstract: Regorafenib is treatment option of cancers. It is associated with several adverse effec... more Abstract: Regorafenib is treatment option of cancers. It is associated with several adverse effects, including proteinuria. We report a massive
proteinuria associated with regorafenib which resolved quickly after discontinuation of the drug. A 63 year old male presented with diarrhea
and bilateral swallowing of legs. In urinanalysis, 18.5 g/day of proteinuria was detected. All symptoms, including proteinuria, resolved after
discontinuation of regorafenib. Despite cessation of regorafenib treatment is advised in case of proteinuria, we suggest that regorafenib
associated proteinuria could be rapidly resolved after discontinuation of the drug.
Keywords: Regorafenib, Massive proteinuria, Treatment, Cancer, Adverse effect, Diarrhea.

Case Report, Mar 30, 2021

Abstract: Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thur... more Abstract: Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thurner variant, an anatomic variant
where in the right common iliac artery overlies the left common iliac vein and compresses it against the lumbar spine. The compression of the
common venous outflow tract of the left lower extremity may cause discomfort, swelling, or deep vein thrombosis in the iliofemoral veins. The role of the pelvic surgery particularly the lumbar hardware in the development of symptomatic Venous compression syndrome in patients with May-Thurner syndrome is not well understood. The incidence is presumably very low. Herein, we present six patients who developed IVCS after Lumbar hardware.
Method: The cases were diagnosed between Nov. 2016 to Oct. 2019 in the Outpatient Cath Lab of McKinney, TX. The patient’s medical
records were retrospectively analyzed looking for risk factors, clinical features, venogram findings, and post venogram. The evaluation of each
case was described, and common trends were later presented in a cross-case analysis.
Conclusion: The cases presented in this report suggest that the hardware used in lumbar/spinal surgery could lead to an IVCS. Patient’s
symptoms are unspecific. Venogram/venoplasty is the gold standard for diagnosis and treatment. It is imperative having a high level of
suspicion and familiarizing with the natural history of IVCS due to the invasive nature of venogram and the relevance of an early diagnosis to
reduce the occurrences of complications.
Keywords: Venous disease, Iliac vein compression, May-Thurner syndrome, Lumbar surgery complications, Unexplained edema of left leg,
May-Thurner Syndrome, Lumbar hardware, Venous compression, IVUS, Venogram, Angioplasty.