Welcome to Journal Of Pakistan Medical Association
   Issue Vol:68, No:2 February, 2018
Editorial >>

Humanitarian crisis in the National Health Service of United Kingdom

Shabih Zaidi.

Red Cross is a globally respected non-governmental organisation (NGO). It has stood the test of time in peace as in wars. It may be called the Red crescent i

Original Articles >>

Assessment of severity of acute gastroenteritis in the paediatric Pakistani population by Modified Vesikari Score

Muhammad Ashraf Sultan, Zeeshan Hassan.

Objective: To assess the severity of acute gastroenteritis in paediatric population.
Methods: This observational cross-sectional study was conducted at 93 randomly selected o

Risk factors and molecular epidemiology of HBV and HCV in internally displaced persons (IDPs) of North Waziristan Agency, Pakistan

Adeel Khan, Javaria Qazi.

Objective: To investigate the prevalence and transmission risks of hepatitis B virus and hepatitis C virus infections among internally displaced persons.
Methods: This study was conducted in district Bannu, Khyber Pakhtunkhwa, Pakistan, from August 2014 to April 2015, and com

Short term outcomes following surgery in brain tumours sans neuronavigation

Mamoon Ur Rashid, Muhammad Junaid, Syed Sarmad Bukhari, Afeera Afsheen.

Objective: To determine the presentation and frequency of various intracranial neoplasms and assess outcomes for patients who underwent surgery without neuronavigation.
Methods: This retrospective study was conducted at Combined Military Hospital, Peshawar, Pakistan, and comp

Characterisation of breeding sites of anopheline mosquitoes in District Bannu, KPK, Pakistan

Sadiq Ullah Khan, Rahmat Ali Khan.

Objective: To highlight the role of habitat evaluation in reducing the potential transmission risk of malaria.
Methods: This study was conducted from January to June, 2015, in District Bannu in Khyber Pakhtunkhwa, Pakistan, where 64 larval habitats were characterised in 10 vi

Research Article >>

MRA-based evaluation of anatomical variation of circle of Willis in adult Pakistanis

Rehana Shaikh, Saba Sohail.

Objective: To determine the frequency and patterns of normal anatomical variation of Circle of Willis on magnetic resonance angiogram in adults without cerebrovascular disease.
Methods: This descriptive cross-sectional study was conducted at the Radiology Department of Dow Un

Outbreak investigation report of dengue fever during June-November 2014: A case study of district Swat, Pakistan

Hussain Ahmad, Inam Ullah, Tauseef Ahmad, Muhammad Tufail, Muhammad Khan, Ijaz Ali.

Objective: To determine the frequency distribution of dengue fever during the 2014 outbreak in a district in northern Pakistan.
Methods: This cross-sectional study was conducted between June and November, 2014, at Saidu Sharif Teaching Hospital, Swat, Pakistan, where patients

Self-reported academic performance in relation to health behaviours among Bahria University students

Rehana Rehman, Amara Zafar, Aleena Mohib, Mehwish Hussain, Rabiya Ali.

Objective: To find an association between self-reported academic performance with different socio-demographic factors, health behaviours and mental health amongst university students.
Methods: This cross-sectional study was conducted at Bahria University, Karachi, from Januar

Development, validity and reliability of an URDU version of the International Prostate Symptom Score

Zeeshan Arshad, Syed Zafar Zaidi, Anila Jamshaid.

Objective: To develop and validate the Urdu version of the International Prostate Symptoms Score.
Methods: The prospective study was conducted at Indus Hospital, Karachi, from January to April 2014, and comprised interviews of subjects at baseline and at 2 weeks for assessing

Association between environmental tobacco smoke and dental caries amongst 5-14 years old children in Karachi, Pakistan

Anna Ali Nayani, Romaina Iqbal, Syed Iqbal Azam, Farhan Raza Khan, Aysha Habib Khan, Naveed Janjua, Azmina Hussain.

Objective: To determine the association between environmental tobacco smoke and dental caries.
Methods: This cross-sectional study was conducted in peri-urban and urban areas of Karachi, from February to August 2014, and comprised children aged 5-14 years. A pre-coded questio

Determination of the life quality and self-care ability of the mothers in post-partum period

Funda Özdemir, Aslihan Öztürk, Özlem Karabulutlu, Ayfer Tezel.

Objective: To determine the life quality and self-care ability of mothers in the post-partum period.
Methods: This descriptive study was conducted at a family health centre based in Kars Province of Turkey from May to September 2015, and comprised mothers who were in the pos

Perceptions of nursing students of educational environment at a private undergraduate School of Nursing in Karachi

Salima Farooq, Rehana Rehman, Mehwish Hussain, Jacqueline Maria Dias.

Objective: To assess educational environment at a nursing school.
Methods: The cross-sectional survey was carried out from May to October 2016 at Aga Khan University School of Nursing and Midwifery, Karachi, using the Dundee Ready Educational Environment Measure tool. The sco

Association of TP53 codon 72 polymorphism in women suffering from endometriosis from Lahore, Pakistan

Rizwana Hussain, Saba Khaliq, Syed Mohsin Raza, Shagufta Khaliq, Khalid Pervaiz Lone.

Objective: To investigate TP53 gene codon 72 polymorphism in women with endometriosis and compare it with healthy samples. 
Methods: This case-control study was carried out at Jinnah Hospital, Services Hospital and Sheikh Zayed Hospital, Lahore, Pakistan, from 2014 to 20

Frequency of obsessive compulsive symptoms in depression: A hospital-based cross-sectional study

Rana Mozammil Shamsher Khan, Ather Muneer, Kalsoom Nawaz, Iffat Shehzadi, Mariam Zahid, Aaruj Iqbal, Sadia Jabeen.

Objective: To determine the frequency of obsessive compulsive symptoms in patients suffering from depression.
Methods: This cross-sectional study was conducted at the Allama Iqbal Memorial Teaching, Sialkot, Pakistan, from February 2014 to March 2017, and comprised patients s

Pilot Study >>

A new management strategy for the treatment of streptococcal gingivitis: A pilot study

Cankat Kara, Ceren Gökmenoglu, Onur Sahin, Sezgi Cinel, Nihal Belduz Kara, Elif Sadik.

Objective: To demonstrate a supportive treatment option based on microorganism\'s growth characteristics.
Methods: This study was conducted at Ordu University, Faculty of Dentistry, Turkey, between January and April, 2017, comprising patients whose periodontal parameters an

Evaluation of effectiveness of a paediatric simulation course in procedural skills for paediatric residents — A pilot study

Abdullah AlShammari, Aman Inayah, Nasir Ali Afsar, Akram Nurhussen, Amna Siddiqui, Muhammad Lucman Anwer, Sadek Obeidat, Mohammed Khaled Bakro, Tawfik Samer Abu Assale, Eyad Almidani, Abdullah Alsonbul, Sami Alhaider, Ibrahim Bin Hussain, Emad Khadawardi, Muhammad Zafar.

Objective: To explore the effects of simulation training on paediatric residents\' confidence and skills in managing advanced skills in critical care.
Methods: The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junio

KAP Study >>

The awareness of childhood autism among residents of neuropsychiatric and other disciplines of a research and training hospital in Istanbul, Turkey

Seyhan Hidiroglu, Nimet Emel Lüleci, Melda Karavus, Ozlem Tanriover, Elif Samiye Bayar, Ahmet Karavus.

Objective: To assess the awareness of childhood autism among physicians undergoing residency training in various disciplines.
Methods: This cross-sectional study was conducted at a research and training hospital in Istanbul, Turkey, in February 2013 and comprised physicians

Review Articles >>

Chikungunya virus; an emerging arbovirus in Pakistan

Ihsan Ali, Javid Iqbal Dasti.

Chikungunya virus (CHIKV), an arbovirus belongs to the family Togaviridae and was discovered in Tanzania in year 953-54. In November 2016, an outbreak occurred in Karachi and approximately 30,000 individuals were infected with CHIKV. More than 4,000 cases were confirmed by qualitative reverse tra

Robotics in neurosurgery: A literature review

Syed Ijlal Ahmed, Gohar Javed, Bakhtawar Mubeen, Syeda Beenish Bareeqa, Hiba Rasheed, Alizay Rehman, Masroor Mubeen Phulpoto, Syeda Sana Samar, Kashif Aziz.

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful res

Special Communication >>

Radiation absorbed dose for cobalt-60 gamma source in phantoms for different materials

Muhammad Akram, Hafiz Muhibb Ullah Zulkafal, Saima Altaf, Khalid Iqbal, Muhammad Afzal Khan, Saeed Ahmed Buzdar.

Current practices in radiation therapy required high doses of radiation to be delivered with increased accuracy. Treatment planning task is exercised till an optimum dose distribution is achieved. The present reported work was performed to compare the various aspects of the cobalt-60 radiation be

Short Reports >>

Prognostic significance of optic nerve sheath diameter on computed tomography scan with severity of blunt traumatic brain injury in the emergency department

Shahan Waheed, Muhammad Akbar Baig, Emaduddin Siddiqui, Danyal Jamil, Masharib Bashar, Asher Feroze.

Optic nerve sheath diameter measurement (ONSD) has been associated with identifying the prognosis of traumatic brain injury (TBI) patients. The study was planned to evaluate the prognostic value of ONSD measured on the initial brain computed tomography (CT) scan performed on patients with blunt T

Influences on medical career choice and future medical practice plans among women: Perspective from final year students and house officers

Masood Ali Shaikh, Samar Ikram, Ramsha Zaheer.

There is a growing perception in Pakistan that comparatively more women are gaining admissions and graduating from medical colleges; however these graduates are not practicing medicine. This pilot study provides perspectives on the influences on medical career choice and plans regarding future me

Self-esteem among eunuchs of Hazara Division, Pakistan

Sajid Mehmood Alvi, Maleeka Rubab Turabi, Syeda Ayat-e-Zainab Ali, Muhammad Shoaib Irfan, Maryam Afridi, Asghar Ali Shah.

Self-esteem among eunuchs is highly influenced by a variety of factors. The aim of the current study was to investigate the differences in self-esteem of eunuchs on the basis of education, income, age and marital status. The study was conducted at the University of Haripur, Pakistan, from Decembe

Case Reports >>

Effect of low level laser therapy on partial tear of supraspinatus tendon

Ashfaq Ahmad, Mohammad Bandpei, Syed Amir Gilani, Arooj Munawar, Amjad Iqbal Burq.

Low level laser therapy (LLLT) is one of the emerging treatment options for supraspinatus tendinopathy. Focus is on the effectiveness of LLLT in patients with partial tear of supraspinatus tendon. Two patients had three assessments; at baseline, six weeks and three months after the treatment. Ten

Appendiceal and rectal carcinomas with Krukenberg tumour mimicking primary ovarian cancer

Ayesha Saba, Rozilla Sadia Khan, Humera Ismail.

Krukenberg tumour is an uncommon metastatic tumour of ovary. It accounts for 1-2% of ovarian malignancies. Pylorus of stomach is the most common site of primary tumour. We are presenting two case reports of patients who had Krukenberg ovarian masses. Case I; an appendiceal adenocarcinoma (AACa) w

Nodular hidradenoma of axilla mimicking papillary breast neoplasm — A case report

Kulsoom Fatima.

Nodular hidradenoma is a benign rare skin tumour arising from the eccrine type of sweat glands. It is usually found on the trunk, extremities and head, however can occur anywhere in the body. It is a slow growing tumour, usually painless. The patient presents with a palpable lump of variable size

Parathyroid adenoma in a patient with congenital hypothyroidism

Eren Gürkan, Zeynep Cantürk, Özlem Ipci, Zeliha Sahin, Gokce Cumali.

Thyroid dysgenesis, the most common cause of congenital hypothyroidism, includes hypoplasia, ectopia, and agenesis. Agenesis may present as hemiagenesis, bilobar agenesis, or isthmic agenesis. A small ectopic thyroid tissue may sometimes be detected on the embryonal migration pathway of suspected

Multiple system atrophy — the cerebellar type with “hot cross bun sign” on MRI

Rehana Shaikh, Saba Sohail, Nasreen Naz.

Multiple system atrophy (MSA) is an adult onset, progressive, idiopathic neurodegenerative disease that clinically manifest as MSA-C with cerebellar signs predominant, MSA-P with Parkinsonian features predominant and MSA-A with autonomic signs and symptoms. MRI has an important role in its diagno

Suppression of refractory electrical storm by microtubule destabilization and dechanneling therapy in a patient with heart failure with reduced left ventricular ejection fraction and implantable cardioverter-defibrillator: A novel therapeutic approach

Nazmi Gultekin, Emine Kucukates.

We investigated the impact of microtubule destabilization and dechanneling therapy on a suppression of refractory electrical storm (ES) in a 63-year-old male patient with ischaemic heart failure with reduced left ventricular ejection fraction (HFrEF), who had a history of previous coronary artery

Safe manual therapy with instant pain relief in the acute central low back pain

Keramat Ullah Keramat, Sajjad Ali, Jawad Ali.

Fifty five year old, previously healthy gentleman presented to the physical therapy, outpatient department (OPD) with complaint of severe low back pain. He sustained injury to his back after pulling a table and was seen 3 hours after the onset. He had a forward stooped posture and could hardly wa

Case Report: Unusual cause of chest pain in an elderly male

Shahrukh Hashmani, Fateh Ali Tipoo Sultan.

A 72-year-old man presented to the outpatient clinic with symptoms of chest pain and dyspnoea on exertion (NYHA III) for past two months. Physical examination was unremarkable with normal first and second heart sounds. Unfortunately, the valsalva maneuver was not performed as no murmur was apprec

Interrupted aortic arch, mixed aortic valve disease and intra ventricular haemorrhage in an adult

Amna Alvi, Muhammad Azeemuddin, Asma Alvi.

Interrupted aortic arch (IAA) is a scarce and generally lethal congenital malformation. Patients with complete IAA rarely reach adulthood without surgical intervention. In this report, we describe the case of a 50-year-old man who was found to have IAA and mixed aortic valve disease after examina

Case Series >>

Non-traumatic avascular necrosis of femoral head in malignant disease: Is it disease induced or treatment related?

Itrat Mehdi, Bassim Jaffar Al Bahrani, Atheel Kamona, Fatima Ramadhan Al Lawati, Ajit Joseph Vennyor.

Avascular necrosis (AVN) of the femoral head is a poorly understood pathologic process often seen with neoplastic process either due to it or its treatment. The pathology is ischaemic bone necrosis and joint collapse or it may be asymptomatic and missed easily. We have described three young patie

Recent Evidences in Endocrinology >>

Classification of type 1 diabetes (T1DM)

Sanjay Kalra, Yashdeep Gupta, Deepak Khandelwal.

Type 1 diabetes (T1DM) has emerged as a common and heterogeneous condition across the globe. Improved understanding of the pathophysiology and clinical features of T1DM has led to in-depth study of the condition. This review describes the classification of T1DM, as proposed by leading internation

Primary Care Diabetes >>

The Hypoglycaemia Awareness Questionnare (HAQ)

Sanjay Kalra, Deepak Khandelwal.

This communication shares a simple structured 12 item Hypoglycaemia Awareness Questionnare (HAQ) which helps in screening and identification of hypoglycaemia. This tool helps complement the role of self-management of blood glucose in diabetes care. The choice of questions is such that they cover

Evidence Based Neuro-Oncology >>

Role of gemcitabine as a radiosensitizer in Glioblastoma Multiforme treatment

Ayesha Quddusi, Muhammad Shahzad Shamim.

Treatment for glioblastoma multiforme comprises of surgical resection of the tumour followed by radiotherapy and chemotherapy. Temozolomide is the routinely used radiosensitizer during radiotherapy and chemotherapy cycles and has shown good results. An alternative to temozolomide is gemcitabine,

Letter to the Editor >>

Publish or Perish: What can reinforce faculty to participate in scholarly activity?

Safa Pervaiz Vasir, Syed Amir Gilani, Muhammad Sikander Ghayas Khan, Rabia Azmat.

Madam, the university faculty members are the main elements of education and research. The faculty member is not just an information provider or a teacher but they have many other roles including facilitation, assessment, curriculum and course planning and resource development. In addition to the

Stethoscope as vector of hospital infections

Rehana Rehman, Khalid Ahmed, Salwa Mansur Ali, Ahmad Raza, Zohaib Rana.

Madam, stethoscope remains an important vector for the spread of health-care associated infections (HAI). It has also been observed that an effective infection control protocols in the clinical settings depend on the comprehensive education from medical student up to the senior clinicians. The st

Use of lytic bacteriophages in controlling multi drug resistant staphylococcus aureus

Madiha Gohar, Hafiz Arslan Ali, Muhammad Qamar Saeed.

Madam, due to increasing multidrug resistant (MDR) bacterial pathogens, clinicians are facing limitations in choice of antibiotics to treat infections. Global reports project mortality rates due to MDR infections to exceed those from cancer until 2050.1,2 Use of lytic bacte

Comment on Imran Khan et al. (J Pak Med Assoc. 67:1693, 2017) - Frequency of acute kidney injury and its short-term effects after acute myocardial infarction

Muhammad Salman, Muhammad Hussnain Raza, Amer Hayat Khan.

Madam, we read with interest the findings of Khan et al. that were recently published in your prestigious journal.1 The authors reported that approximately 21% of hospitalized patients develop acute kidney injury (AKI) after acute myocardial infarction (AMI) which is associ

Response to the Comment on Imran Khan et al. (J Pak Med Assoc. 67:1693, 2017)

Imran Khan.

Thanks for raising the questions regarding the study.The severity/stages of AKI as per AKIN classification were not mentioned. We were interested in the frequency of AKI as mentioned in the title. The severity of AKI needs another whole study to stratify the injury according to the severity and t

Student's Corner >>

Metaphors as artefacts for adults with type 2 diabetes mellitus according to their professional cultures

Melek Ardahan, Leyla Muslu, Ilhan Günbayi.

Objective: To investigate why and what mental images patients who suffer from type 2 diabetes mellitus use to describe their experiences of the disease based on their professional culture.
Methods: This qualitative study was conducted at the Akdeniz University, Antalya, Turkey,

Lutembacher syndrome with mitral valve calcification in a 31-year old male

Arsalan Majeed Adam, Ansab Godil, Muhammad Saad Ali Mallick, Fahad Khan, Ather Hasan Rizvi, Inam-ul-Haq Muhammad Makhdoom.

Lutembacher syndrome is characterized by a congenital ostium secundum atrial septal defect and an acquired mitral valve stenosis. We present a similar case in a 31-year old male who came in with orthopnoea, central cyanosis and pedal oedema. Examination revealed cardiac murmurs in tricuspid and apic

Perioperative measurement of high-sensitivity cardiac troponin T (hs-cTnT): An essential move?

Sarosh Fatima, Hanieya Saiyed, Fahad Khan.

Madam, cardiac troponin is the diagnostic mainstay for cardiomyocyte damage.1 The newly emerging high-sensitivity cardiac troponin T (hs-cTnT) assay has improved sensitivity and precision in detecting myocardial injury and infarct than the standard troponin T assays.

Galvanizing government institutions into vaccinating undergraduate medical students: An indispensable practice

Rabiya Javed, Sarmad Pirzada, Ali Ahmad Jilani.

Madam, healthcare workers (HCW) are at an increased risk of needle-stick injuries due to occupational exposure. A significant fraction of infection with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) amongst HCWs is due to percutaneous injuries, which is around 37%,



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