Welcome to Journal Of Pakistan Medical Association
   Issue Vol:67, No:11 November, 2017
Editorial >>

Women and Diabetes: They have a right to a healthy future!

Sarita Bajaj.

Women of today are at greater risk for non communicable diseases and other health issues at a young age. Epidemiological studies have given a grave picture of epidemic proportions of Type 2 diabetes worldwide and the prevalence is expected to increase exponentially in the coming years.

The challenge of dealing with animal derived ingredients in medical/surgical products

Ali Yawar Alam.

Many pharmaceutical products (capsules, tablets, injections, vaccine, cream) and surgical products (surgical mesh) have ingredients derived from animal sources (pig, cow; not slaughtered as per Islamic law) that are directly in conflict with the Islamic faith and Islamic law.

Original Articles >>

Negative correlation among vitamin B12 levels, obesity severity and metabolic syndrome in obese children: A case control study

Samet Ozer, Ergun Sonmezgoz, Osman Demir.

Objective: To determine the relationship among vitamin B12 status, obesity severity, and metabolic syndrome and its components in obese children.
Methods: This case-control study was conducted at the School of Medicine, Gaziosmanpasa University, Tokat, Turkey, from January 20

Evaluation of several classification methods in carpal tunnel syndrome

Refah Sayin, Siddik Keskin, Mehmet Hamamci.

Objective: To investigate the performance and effectiveness of 4 classification methods including support vector machine, naive Bayes, classification tree, and artificial neural network in the detection of carpal tunnel syndrome.
Methods: This retrospective study was conducte

Association of Vitamin D binding protein polymorphism with risk of type 2 diabetes mellitus in a Pakistani urban population: A case control study

Khalida Iqbal, Najmul Islam, Iqbal Azam, Ali Asghar, Naseema Mehboobali, Mohammad Perwaiz Iqbal.

Objective: To assess if genotypes/diplotypes of vitamin D binding protein have any association with type 2 diabetes mellitus.
Methods: This case-control study was conducted from January 2013 to July 2015 at the endocrinology clinics of the Aga Khan University Hospital, Karach

Assessment of the risk factors of hypertension among adult & elderly group in twin cities of Pakistan

Saba Ishtiaq, Umair Ilyas, Shagufta Naz, Reem Altaf, Hasan Afzaal, Syed Aun Muhammad, Shahiq uz Zaman, Muhammad Imran, Fawad Ali, Farhan Sohail, Sohail Muhammad.

Objective: To estimate the prevalence of hypertension and to explore the risk factors associated with it.
Methods: In a cross-sectional study, a population based survey was conducted on inhabitants of Rawalpindi-Islamabad region, 219 individuals; aged 18 years or above were i

Research Article >>

Effects of supervised structured aerobic exercise training programme on level of Exertion, dyspnoea, VO2 max and Body Mass Index in patients with type 2 diabetes mellitus

Syed Shakil Ur Rehman, Hossein Karimi, Syed Amir Gillani, Shakeel Ahmad.

Objective: To determine the effects of supervised structured aerobic exercise training programme on level of exertion, dyspnoea, maximum oxygen consumption, and body mass index in type 2 diabetics.
Methods: The randomised, controlled trial was carried out at Riphah Rehabilita

Enhanced recovery after surgery (ERAS) protocol in stoma reversals

Muhammad Taqi Pirzada, Faisal Naseer, Raza Haider, Jahanzaib Haider, Monis Jaleel Ahmed, Shams Nadeem Alam, Sheeraz Shakoor Siddique.

Objective: To compare the length of hospital stay and return of bowel movement using the conventional management versus \'enhanced recovery after surgery\' protocol.
Methods: This study was conducted at the Civil Hospital, Karachi, from June 2014 to May 2015, and comprise

Prognostic importance of paraoxonase, arylesterase and mean platelet volume efficiency in acute ischaemic stroke

Mehmet Tahir Gokdemir, Ali Ziya Karakilcik, Gul Sahika Gokdemir.

Objective: To study the prognostic importance activity of paraoxonase and arylesterase, and the value of mean platelet volume in patients with acute ischaemic stroke.
Methods: This case-control study was conducted at Harran University Hospital, Sanliurfa, Turkey, from Januar

Mutation analysis for detection of drug resistance in mycobacterium tuberculosis isolates from Khyber Pakhtunkhwa, Pakistan

Bashir Ahmad, Muhammad Idrees, Kafeel Ahmad, Shumaila Bashir, Sajjad Ahmad, Huang Lin-fang.

Objective: To examine the frequency and distribution of mutations in the \'hot spot regions\' of drug-resistant genes.
Methods: The study was conducted at Provincial Tuberculosis Reference Laboratory, Peshawar, Pakistan, from April 2015 to March 2016, and comprised sputum

Frequency and pattern of common primary headache among depressed patients at tertiary care centre, Karachi

Muhammad Ilyas Jat, Muhammad Iqbal Afridi, Anil Kumar, Chooni Lal, Fatima Toufique, Daulat Ram.

Objective: To determine the frequency of co-morbid common primary headaches among depressed patients.
This study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from July to December 2014, and comprised depressed patients. Diagnosis of depressive di

Frequency of acute kidney injury and its short-term effects after acute myocardial infarction

Imran Khan, Muhammad Habeel Dar, Adnan Khan, Kashif Iltaf, Sarbiland Khan, Shiekh Fahad.

Objective: To find out the frequency of acute kidney injury and its short-term effects after acute myocardial infarction.
Methods: This descriptive, cross-sectional study was conducted at the cardiology department of Lady Reading Hospital\'s Postgraduate Medical Institute,

The impact of health behaviours development training on healthy lifestyle behaviours amongst adolescents with obesity risk: A school example in a city in western Turkey

Duygu Yesilfidan, Filiz Adana.

Objective: To determine the impact of health behaviours development training on healthy lifestyle.
Methods: This pre-experiment research was conducted at a junior high school governed by Aydin Provincial Directorate of National Education in Aydin, Turkey, from November 2014 t

Mental health of cardiac patients in Gilgit, Pakistan: A cross-sectional study

Sadiq Hussain, Mehwish Batool Mir, Sabih Ahmad.

Objective: To assess and compare mental health of cardiac patients with disease-free individuals.
Methods: This cross-sectional study was carried out at the Combined Military Hospital, Gilgit-Baltistan, Pakistan, from August to December 2016, and comprised cardiac patients in

KAP Study >>

Effectiveness of autism training programme: An example from Van, Turkey

Safak Eray, Duygu Murat.

Objective: To determine the knowledge and attitudes of family practitioners before and after their participation in a training programme.
Methods: The study was conducted at Van Training and Research Hospital, Van, Turkey, from December 1to 15, 2016, and comprised family prac

Knowledge and practices of critical care health professionals related to ventilator associated pneumonia in tertiary care hospitals of Islamabad and Rawalpindi

Hassan Bin Usman Shah, Iffat Atif, Farah Rashid, Hafsa Zulfiqar, Kashmala Mian, Maria Sarfraz, Mariam Batool, Umbreen Gul Khan.

Objective: To assess knowledge and practices of critical care health professionals related to ventilator associated pneumonia.
Methods: This cross-sectional survey was conducted at eight tertiary care public and private hospitals of Islamabad/Rawalpindi, Pakistan, from Septem

Pilot Study >>

An effective and doable interventional strategy to enhance vaccination coverage - are we ready to change?

Muhammad Afzal, Asma Yaqub, Sobia Khalid, Fatima Safdar, Madeeha Ikram, Hina Batool Siddiqui.

Objective: To evaluate the effect of patient reminder calls on improvement of routine vaccination coverage.
Methods: This prospective, interventional study was conducted at Rawal Institute of Health Sciences, Islamabad, Pakistan, from December 2014 to August 2016, and compris

Review Articles >>

Risk factors of cardiovascular disease and its recommendations in Pakistani context

Rubina Barolia, Amber Hussain Sayani.

Cardiovascular diseases possess a major cause for fatality and disability the world over. Since last several decades, the rates of cardiovascular diseases-related deaths have decreased in a number of high-income countries but increased in low- and middle-income countries with around 80% of the bu

HIV-1 in Pakistan: Where we stand? Where we will go?

Sheraz Khan, Wasim Abbas.

Adherence to Islamic beliefs and being home to more than 190 million Muslims made many to believe that Pakistan was protected from human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS). More than 30 years of HIV-1 epidemic, the reality is totally different now. HIV/AIDS is

Systemic Review >>

Retinitis pigmentosa genes implicated in South Asian populations: a systematic review

Sidra Zafar, Khabir Ahmad, Azam Ali, Rashid Baig.

Retinitis pigmentosais one of the most prevalent causes of inherited retinal dystrophies worldwide. The widespread custom of consanguineous marriages in South Asian countries puts the population at risk for autosomal recessive disorders including retinitis pigmentosa.
This systematic revie

Short Reports >>

Bacterial contamination of medical uniforms: a cross-sectional study from Suzhou city, China

Zi Yan Du, Ming Xia Zhang, Min Hua Shi, Hui Qin Zhou, Yong Yu.

Few studies have been conducted which evaluate the prevalence of contamination of medical uniforms in China. The present study was designed to explore the characteristics of uniform contamination and associated factors. A total of 120 participants were enrolled in the study and 122 uniforms were

Susceptibility pattern of methicillin resistant Staphylococcus aureus to vancomycin and other alternate agents: report from a private sector hospital laboratory

Faryal Saleem, Naima Fasih, Afia Zafar.

With increasing prevalence of methicillin resistant Staphylococcus aureus in clinical settings and injudicious use of antibiotics, resistance among MRSA against commonly used antibiotics is increasing. To assess the susceptibility pattern of MRSA against vancomycin, linezolid, tigecycline, rifamp

Learning about facts of life: perspective from medical students on sources and preferences about puberty and sex education in Karachi

Masood Ali Shaikh, Syed Muhammand Mubeen, Muhammad Furqan.

Puberty heralds the onset of adulthood, and is fraught with complex physiological and psychological changes and emotions. In this study, we looked at the sources of information about puberty and sex education among males and females, age at which they learned about them, and the opinions on the r

Methanol poisoning: 27 years experience at a tertiary care hospital

Fareed Ahmed, Nadeem Ullah Khan, Noman Ali, Asher Feroze.

Methanol toxicity can result in serious morbidity and mortality without timely diagnosis and treatment. Many cases of methanol poisoning outbreaks have been noted in our population but no study has been performed to estimate methanol exposure and its outcomes and complications. A retrospective st

Case Reports >>

A case of hypotriploid chromosome in a patient with acute lymphoblastic leukaemia

Bilal Ahmed Khan, Mirza Faris Ali Baig, Nadir Siddiqui.

A 58-61, XXXX, hypotriploid chromosome was detected in the cytogenetics report of a 28 years old female patient, known case of B-cell Acute Lymphoblastic Leukaemia. On admission, the patient had normal physical examination findings and mental status, except history of fever spikes and generalized

An elusive case of dermatomyositis

Tasnim Ahsan, Uzma Erum.

Dermatomyositis is an inflammatory myopathy of unknown aetiology. Muscle involvement may eventuate later in the disease course in some patients, who may present with typical skin disease without clinical signs of myopathy and are referred to as dermatomyositis sine myositis. A 48 year old female

A case of Vogt Koyanagi Harada disease in a 16 year old girl

Fahimullah Khan, Salman Zahid, Syed Shahmeer Raza, Mustafa Iqbal.

Vogt Koyanagi Harada (VKH) is an autoimmune disease with widespread systemic manifestations. It typically presents with bilateral sudden painless loss of vision. It is mainly characterized by serous retinal detachment, iridocyclitis and choroidal swelling. The disease is more common in females an

Case Series >>

Neurobrucellosis: A report of two cases

Nosheen Farhan, Ejaz Ahmed Khan, Arsalan Ahmad, Khawaja Sayeed Ahmed.

Neurobrucellosis is a rare complication of brucellosis, a common zoonosis with multisystem involvement. Its clinical presentation is quite heterogeneous and diagnosis requires a high index of suspicion in patients from endemic areas. We present two cases of neurobrucellosis with widely varying cl

Common clinical features of pediatric multiple sclerosis in Pakistan - A report of 15 cases

Muhammad Arshad Javid, Khalida Mubeen, Mustansar Warraich MD, Niama Amin, Zahid Mehmood.

The aim of this note is to assess the common clinical features of paediatric multiple sclerosis (PMS) in Pakistan. For this purpose, 150 MS patients with the age range of (1-72) years and mean age (34.211.09) years were studied during the period 2010 to 2015 from MRI centers of Paki

Effectiveness of locking compression plate in wedge fracture of diaphysis of radius and ulna in adults: A descriptive case series

Muhammad Kashif Naseer, Ranjit Kumar Sah, Rana Dilawaiz Nadeem, Syed Muhammad Awais, Muhammad Akhtar.

The aim of the study was to see the effectiveness of locking compression plate (LCP) in wedge fracture of diaphysis of radius and ulna in adults. This prospective descriptive case series study inducted total 45 patients presenting with wedge fracture (AO Type, 22-B) of radius and/or ulna. The tre

Recent Advances In Endocrinology >>

Risk stratification of persons on premixed insulin in Ramadan

Sanjay Kalra, Fatema Jawad, Zafar Ahmed Latif, Md Faruque Pathan.

The International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance, has recently published practical guidelines on the management of diabetes and Ramadan .The risk stratification categorizes all persons wishing to fast into three groups, based

Primary Care Diabetes >>

The sixth vital sign in diabetes

Sanjay Kalra, Komal Verma, Yatan Pal Singh Balhara.

The vital signs are an integral part of clinical methods. In diabetes, determination of plasma glucose can be taken as the fifth vital sign. The sixth vital sign is well being, which can easily be measured by two item questionnaires designed to assess distress, depression and coping skills. This

Evidence Based Neuro-Oncology >>

Comparison between endoscopic and microscopic approaches for surgery of pituitary tumours

Inamullah Khan, Muhammad Shahzad Shamim.

Surgical techniques for resection of pituitary tumours have come a long way since it was first introduced in late 18th century. Nowadays, most pituitary surgeries are performed through trans-nasal trans-sphenoidal approach either using a microscope, or an endoscope. Herein the authors review the

Letter to the Editor >>

A case for setting-up dedicated peritoneal surface malignancy centers in Pakistan

Raza Sayyed, Samiullah Khan Niazi, Tariq Siddiqui.

Madam, peritoneal surface malignancies (PSM) constitute a diverse group of pathologies arising from the gastrointestinal tract, the female genital tract as well as the peritoneal lining itself.1 The last few decades have seen significant progress in the management of patien

Content validation of the Urdu version of international prostate symptom score

Muhammad Salman, Amer Hayat Khan, Syed Azhar Syed Sulaiman.

Madam, International Prostate Symptoms Score (IPSS)1 is frequently used to assess the severity of lower urinary tract symptoms (LUTS) both in the clinical and community based research. The tool was principally designed for men suffering from benign prostatic hyperplasia. Ho

Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis

Muhammad Khalid, Ali Faisal Saleem.

Madam, Acute Bacterial Meningitis (ABM) is potentially life threatening central nervous system infection, which is estimated to affect ~~ 5, 00,000 children worldwide with 10% mortality.1 Latex Particle Agglutination (LPA) is a rapid diagnostic test for identification of ba

Comment on Mohammad Hamid et al (J Pak Med Assoc. 67: 1019; 2017)

Mehwish Hussain.

The article aimed to report the incidence and pattern of thrombocytopenia in cardiac surgery patients using a cohort study. Going through the literature there were few points which author missed to follow or define.
The cohort study design is surely a prospective study design. However, in

Response to comment on Mohammad Hamid et al (J Pak Med Assoc. 67: 1019; 2017) - Incidence and pattern of Thrombocytopenia in cardiac surgery patients

Khalid Ahsan.

A cohort study can be done with single (exposure) group only. Although in this situation, the relative parameters as "relative risk" or "risk difference" cannot be calculated. In a single group cohort the absolute risk of the exposed patients can be measured.
We followe

Comment on Sanjay Kalra et al (J Pak Med Assoc. 2017; 5: 810-813) - Diabetes mellitus, malaria and HbA1c levels

Jan Broz, Lucie Hoskovcova, Ludmila Brunerova.

We have read with great interest the review by Kalra S. et al. published in the May 2017 issue of JPMA which focuses on various aspects of the relationship between malaria and diabetes mellitus. We wonder whether the authors, while carrying out their search, have come across a communication deali

Response to comment on Sanjay Kalra et al (J Pak Med Assoc. 2017; 5: 810-813) - Malaria, red blood cells turnover and glycated hemoglobin: Pitfalls and challenges

Sanjay Kalra, Deepak Khandelwal, Rajiv Singla, Sameer Aggarwal, Deep Dutta.

The authors acknowledge the observations of the reviewer. The pitfalls and challenges with HBA1c assessment and interpretation in patients with malaria, especially severe malaria, where the red blood corpuscle (RBC) turnover is increased, is the reason why we have not highlighted the use of HbA1c

Student's Corner >>

Knowledge about asthma: A cross-sectional survey in 4 major hospitals of Karachi, Pakistan

Omar Irfan, Babar Irfan, Zain Ahmad Khan, Maha Tahir, Ali Bin Sarwar Zubairi, Javaid Ahmad Khan.

Objective: To determine knowledge and misconceptions about asthma among the local population.
Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha I

Frequency of different lifestyle modification measures among patients with GERD based on monthly income

Philumena Chen, Mahnoor Saeed Khan, Sajida Naseem.

A cross-sectional study was carried out at Shifa International Hospital Islamabad over a period of 6 months, to determine the frequency and compare the different lifestyle modifications among patients with Gastroesophageal Reflux Disease (GERD) of different monthly income groups. Two hundred pati



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