Issue Vol:64, No:4 April, 2014


Pakistan can progress with sensible family planning
Sadiah Ahsan Pal,

Pakistan is currently the 6th most populated country in the world and rapidly moving to become the 4th most populated by 2050. This is very alarming, as we are already outstripping our resources, with water, gas and power shortages.
Nearly 1 in every 4 births is unplanned in Pakistan. Fift....

Original Articles

Cerebral venous sinus thrombosis presentation in emergency department in Van, Turkey
Sevdegul Karadas, Aysel Milanlioglu, Hayriye Gonullu, Refah Sayin, Mehmet Nuri Aydin,

Objective: To exmaine the distribution of age, gender, time between onset and presentation, clinical findings, predisposing factors, platelet distribution width, mean platelet volume values and neuroimaging findings, together with the treatment regime and the outcome for patients of cerebr....

Blunt thoracic trauma - an analysis of 264 patients in Rawalpindi, Pakistan
Shahzadi Samar Subhani, Mohammad Sultan Muzaffar, Farah Rashid Siddiqui,

Objective: To analyse the outcome in terms of morbidity and mortality in blunt thoracic trauma patients in tertiary care hospitals, Rawalpindi.
Methods: The prospective study was conducted from March 2008 to February 2012 in surgical wards of public and private sector hospita....

Association between oxidative stress index and serum lipid levels in healthy young adults
Kenan Ahmet Turkdogan, Orhan Akpinar, Mustafa Karabacak, Hatice Akpinar, Figen Tunali Turkdogan, Oguz Karahan,

Objectives: To investigate the relationship between lipid levels and oxidative stress index in healthy young adults.
Methods: The study was camed out at the Department of Emergency Service, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, between January 2011 and Ju....

Characterisation of up-regulated immunoglobulins in patients with chronic rhinosinusitis
Seyyed Abdollah Madani, Seyyed Abbas Hashemi,

Objective: To evaluate the role of immunoglobulins in patients of chronic rhinosinusitis.
Methods: Patients were recruited from the Ear, Nose, Throat, Head And Neck Surgery section of Mazandaran University of Medical Sciences, Sari, Iran, from December 2011 to August 2012. Im....

Malignant mediastinal mass in children: A single institutional experience from a developing country
Naureen Mushtaq, Muhammad Matloob Alam, Scherherzade Aslam, Zehra Fadoo, Anwar-ul-Haq,

Objective: To determine the clinical spectrum and management outcomes of paediatric patients with modiastinal mass in a Karachi hospital.
Methods: Medical records of all cases of mediastinal masses in children diagnosed and treated between January 2005 and December 2011 were ....

Evaluation of residents' thoughts about giving the news of death
Gulhan Kurtoglu Celik, Nurettin Ozgur Dogan, Gul Pamukcu Gunaydin, Zeynep Saral Ozturk, Tugba Atmaca Temrel, Alp Sener, Havva Sahin Kavakli,

Objective: To assess behaviours and attitudes of residents toward giving news of death in emergency department and other departments.
Methods: The study was conducted between 1st and 7th December, 2012, in an urban hospital in Ankara, Turkey. It used a questionnarie that was ....

Comparison of CAD risk factors in abdominal obesity versus General obesity with normal WC in adult males
Sultan Mehmood Kamran, Raheel Iftikhar, Amjad Khan, Muhammad Altaf,

Objective: To compare the presence of coronary artery disease risk factors in patients with abdominal obesity versus generalised obesity and to determine the probability of developing the disease in both groups.
Methods: The cross-sectional study was carried out at the Depart....

Frequency of Streptococcus pneumonia and Haemophilus influenza in acute exacerbation of chronic obstructive airway disease and their sensitivity to levofloxacin
Saira Furqan, Saleem Amin Ullah Paracha,

Objective: To determine the frequency of Streptococcus pneumoniae and Haemophilus influenzae in acute exacerbation of chronic obstructive pulmonary disease and their sensitivity to levofloxacin.
Methods: The cross-sectional study was conducted at the Department of Medicine, A....

The evidence of mother to child transmission of hepatitis B virus infection in Pakistan and the need for hepatitis B immunization policy change
Huma Qureshi, Najma Javaid, Syed Ejaz Alam, Khalif Mahmud Bile,

Objective: To establish the hepatitis B surface antigen and hepatitis B 'e' antigen seroprevalence of mothers and their children aged 6-36 months and to assess the risk of hepatitis B transmission occurring in infants born to hepatitis B surface antigen positive mothers in Pakistan.

Experience of managing complicated diverticulitis of colon: a retrospective case series from south asian country
Tanzeela Gala, Abdul Rehman Alvi, Ghulam Murtaza Sheikh, Hassaan Yasin Habib, Zehra Ghafoor, Tahreem Aman Mir, Maira Mirza,

Objective: To assess the morbidity and mortality associated with complicated diverticulitis in Pakistan.
Methods: The retrospective case series was conducted at an urban tertiary care university hospital of Karachi, Pakistan, comprising data from December 1989 to November 201....

Comparison between Tubularised Incised Plate Urethroplasty and Onlay Island Flap Repair in Mid and Proximal Penile Hypospadias
Latif Javid, Mudassar Saeed Pansota, Iftikhar Ahmad, Muhammad Tariq, Shafqat Ali Tabassum,

Objectives: To evaluate the surgical outcome of tubularised incised plate urethroplasty and onlay island flap repair for mid and proximal penile hypospadias.
Methods: The prospective study was conducted at the Bahawal Victoria Hospital, Bahawalpur from June 2011 to May 2013. ....

CT scan in children with acute bacterial meningitis: Experience from Emergency Department of a tertiary-care hospital in Karachi, Pakistan
Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhba Zia, Asher Feroze, Uzma Rahim Khan,

Objective: To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis.
Methods: The retrospective analysis was done on children who were admitted through the Emergency Depart....

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status
Behcet Al, Pinar Yarbil, Suat Zengin, Suleyman Ercan, Vedat Davutoglu, Cuma Yildirim,

Objecive: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes.
Methods: The study was conducted at the Faculty of Medicine, Gaziantep University, Turk....

Oral misoprostol versus oxytocin in the management of third stage of labour
Saima Aziz, Sarah Kazi, Gulfishan Haq, Nargis Soomro,

Objectives: To compare oral misoprostol versus intramuscular oxytocin in the management of third stage of labour.
Methods: The quasi-experimental study was conducted at the Obstetrics and Gynaecology Unit II, Civil Hospital, Karachi, from June 20 to December 19, 2006. A total....

Comparison of clinical effects of prilocaine, dexamethasone added to prilocaine and levobupivacaine on brachial plexus block
Aykut Saritas, Cemil Sabuncu,

Objective: To determine whether the addition of 8mg dexamethasone to axillary brachial plexus block would prolong the duration of sensory and motor block in patients undergoing hand and forearm surgery.
Methods: The prospective, randomised, double-blinded study was conducted ....

Coeliac disease - clinical presentation and diagnosis by anti tissue transglutaminase antibodies titre in children
Shabbir Hussain, Moin-ud-din Sabir, Mohammad Afzal, Imran Asghar,

Objective: To study the spectrum of clinical presentation of coeliac disease and the role of IgA anti-tissue transglutaminase antibodies titer in the diagnosis and effect of gluten-free diet on such titers in children.
Methods: The prospective study was conducted in the paedi....

Professional satisfaction of family physicians in Pakistan - Results of a cross-sectional postal survey
Hiba Ashraf, Nasir Shah, Fahad Anwer, Hina Akhtar, Mairaj Anwar Abro, Asma Khan,

Objective: To assess the level of professional satisfaction amongst family physicians of Pakistan and to identify the factors associated with professional dissatisfaction.
Methods: The study was part of a larger national survey for "Status of Postgraduate Training and Co....

Review Articles

Lipoprotein (A) in clinical practice
Rohan Jayasinghe, Ian Hamilton Craig, Raj Kamal Alfred Mohan,

Lipoprotein (a) is a strong and independent risk factor for atherosclerosis severity and a predictor of the risk of ischaemic heart disease and stroke. Many questions are still unanswered in relation to the clinical relevance of the scientific observations on Lp(a) and its application in the real....

Short Reports

Latex allergy on anaesthesiologist and anaesthesia managements: Are the health workers high risk patients?
Zekiye Bigat, Nurten Kayacan, Fatma Ertugrul, Bilge Karsli,

Anaphylaxis is defined as a severe, life threating, generalized or systemic hypersensitivity reaction. The most common agent involved in intraoperative anaphylactic reactions is muscle relaxant (61-70%); natural rubber latex (NRL) is the second most implicated agent and the incidence of latex-rel....

Short Communication

Beyond the classroom, 'pro-active teaching methods - a must for today's CPD movement'
Farhan Vakani, Mughis Sheerani,

Non-traditional teaching approaches are not recent innovations in the field of continuing medical and professional development; however, there is a lack of employing such methods in our context. The reasons could include lack of awareness, recognition and overlapping and adoption of these approac....

Case Reports

The Roberts Syndrome: A case report of an infant with valvular aortic stenosis and mutation in ESCO2
Mustafa Dogan, Fatih Firinci, Yasemin Isik Balci, Selcan Zeybek, Funda Ozgurler, Ilkay Erdogan, Birgul Varan, Cavidan Nur Semerci,

Roberts syndrome, which is inherited as an autosomal recessive group of disorders, is a rare syndrome characterized with symmetrical extremity defects, craniofacial abnormalities, and prenatal and postnatal growth retardation. Here, we present a case of Roberts Syndrome brought to the clinic with....

Gastrointestinal autonomic nerve tumour of jejunum presenting as a perfore mass
Serdar Altinay, Ramazan Kusaslan,

Gastrointestinal autonomic nerve tumour (GANT) is a rare mesenchymal neoplasm of the gastrointestinal tract arising from the neural plexus of the intestinal wall. Herein, we present a 70-year-old male patient presenting with a clinical picture of acute abdomen. Examination of the specimen obtaine....

A case of Budd-Chiari syndrome associated with alveolar echinococcosis
Sevdegul Karadas, Dulger Ahmet Cumhur, Gultepe Bilge, Beyazal Mehmet, Kosem Mustafa,

Alveolar echinococcosis of the liver is caused by the tapeworm Echinococcus multilocularis. Budd-Chiari Syndrome (BCS) is a hepatic venous outflow tract obstruction and involves abdominal pain, hepatomegaly and high-gradient ascites. A low-gradient ascites in connection with the Syndrome rarely o....

Bilateral synchronous squamous cell tonsil carcinoma treated with chemoradiotherapy
Bekir Hakan Bakkal, Mehmet Birol Ugur, Burak Bahadir,

The incidence of numerous head and neck tumours is a known issue though bilateral synchronous tonsillar carcinoma reports are so uncommon that only 20 cases were found in a literature review. Most of these patients were treated with bilateral tonsillectomy followed by adjuvant radiotherapy. We re....

Drug resistant neuroleptic malignant syndrome and the role of electroconvulsive therapy
Husnain Hashim, Zeb-un-Nisa, Suhail Abdulla Mohammad Alrukn, Abubaker Abdul Rahman Shaffi Al Madani,

Neuroleptic malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic medications e.g.,antipsychotics, sedatives and anti emetics . It is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome of....

Student's Corner

Pseudohypoaldosteronism Type-I; a rare cause of hyperkalemia in neonates
Areeb Sohail Bangash, Nisreen Feroz Ali, Sadaf Sami, Mohammad Iqbal,

Pseudohypoaldosteronism type I (PHA-I) is a rare disorder with only a few cases reported worldwide. It appears early in life with salt-wasting, failure to thrive, dehydration, hypotension, hyperkalaemia and metabolic acidosis. There is a resistance to aldosterone by the mineralocorticoid receptor....

Fears associated with human enhancement technologies: void or justified?
Haris Sheikh, Syed Mohammad Mazhar Uddin,

Madam, the emergence of human enhancement technologies has taken the world with stride. Human enhancement technologies are techniques that can be used not only for treating illness but also for enhancing human characteristics and capacities.1 Previously, therapy was the key....

Intestinal microbiota produced Trimethylamine-N-oxide can increase the risk of cardiovascular disease
Muhammad Shahzeb Khan, Faizan Imran Bawany, Asadullah Khan,

Madam, the involvement of intestinal microbiota has been suggested previously in few metabolic diseases such as obesity.1 However only recently it was suggested that intestinal microbiota can initiate atherosclerosis.2 Intestinal microbial metabolism ....

Letter to the Editor

Multiple flesh coloured nodules with unilateral segmental distribution
Enver Turan, Yavuz Yesilova, Hacer Altin Surucu, Naime Eroglu, Osman Tanrikulu, Sezen Koçarslan,

Madam, Piloleiomyomas are benign smooth muscle tumours arising from the arrectores pilorum muscles in the skin, and they are rare dermal tumours.1 They usually present as small, reddish-brown or skin-coloured, firm, often painful papules or as nodules on the trunk and the e....

Road rage and road side accidents involvement in commercial vehicle drivers of Karachi
Masood Ali Shaikh, Omar Nisar Qureshi,

Madam, rage expressed on the road by occupants of one vehicle directed at the occupants of another in terms of verbal abuse, threats, and acts of physical harm constitute road rage.1 It jeopardizes road safety and increases the burden of morbidity and mortality.1....

A patient with extended pneumonectomy for colorectal lung metastasis
Irfan Eser, Samil Gunay, Ibrahim Can Kurkcuoglu,

Colorectal cancers take the second rank in deaths due to cancer.1 Approximately 35% of patients have already had metastasis during diagnosis and 30% have one organ metastasis especially in liver or lungs. In this letter we aimed to report a 29 year old female patient with c....



Prof. Dr. Javed Iqbal Kazi, a brilliant doctor was targeted and killed on 17th February, 2014 in front of the Karachi Medical And Dental College. He was affiliated with JPMA since 1995 as an author and reviewer and was selected as a Board member in 2005.
Prof. Dr. Javed Kazi was a graduate....

Evidence Based Medicine

State of endovascular therapy for acute ischaemic stroke
Ramsha Malik, Ayeesha Kamran Kamal,

Acute strokes result from an occlusion of intracranial vessels by either a thrombus or embolus. The aim of acute treatment of ischaemic strokes is removal of this occlusion and recanalization of the vessel.The modes of therapy available include the administration of intravenous tissue plasminogen....

Recent Advances In Endocrinology

Alpha glucosidase inhibitors
Sanjay Kalra,

Alpha glucosidase inhibitors (AGIs) are a unique class of anti-diabetic drugs. Derived from bacteria, these oral drugs are enzyme inhibitors which do not have a pancreato -centred mechanism of action. Working to delay carbohydrate absorption in the gastrointestinal tract, they control postprandia....

News & Events

Shahid beheshti University of Medical sciences, Tehran-Iran Otology/Neurotology Fellowship Program

The Division of Otology/Neurotology is currently seeking candidates for the one-year clinical fellowship position in Otology/Neurotology/Skull Base Surgery.

Requirements for Appointment:

  • Board eligible/Board certified Otolaryngologist, International applicants will be considered
  • Ability to begin October 1, 2013
  • Position of Clinical Fellow
  • 4 weeks of vacation
  • Availability and support to present research at national meetings
  • A letter of interest, curriculum vitae, and two letters of recommendation should be sent to:
Ali Eftekharian, MD
Director, Neurotology Fellowship Program
Shahid beheshti University of Medical sciences, Department of Otolaryngology / Head and Neck Surgery Tehran, Iran
Phone: 0098-21-55405315 Fax: 0098-21-55416170




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