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Ayesha Rashid, Ume Ruqia Tulain, Furqan Muhammad Iqbal, Nadia Shamshad Malikd, Alia Erum
Gomal Journal of Medical Sciences, Volume 18, pp 99-106; https://doi.org/10.46903/gjms/18.03.875

Abstract:
Background: Anti hypertensive drugs like “Nicorandil” require frequent dosing due to their shorter half-life. Such drugs are also pH sensitive, due to which greater portions of these drugs are degraded in acidic pH of stomach resulting in lesser bioavailability. The objective of this study was to formulate graft polymeric carrier system for sustained delivery of nicorandil to minimize dosing frequency and enhance patient compliance. Materials Methods: This animal model study was conducted in Department of Pharmacy, Islamia University of Bahawalpur, Pakistan. Hydroxypropyl methyl cellulose-graft-acrylic acid hydrogels were synthesized by free radical solution polymerization with diverse weight ratios of polymer, monomer and cross linker. Total duration of study was 1.5 years from March 2013 to August 2015. The N, N-methylene bis acrylamide and potassium persulfate were used as crosslinker and initiator respectively. Hydrogels were characterized for swelling ratio, equilibrium swelling, gel content, porosity and in vitro drug release. The surface morphology of synthesized hydrogels was evaluated by using Scanning Electron Microscopy. Thermal properties of hydrogels were evaluated by Thermogravimetric Analysis and Differential Scanning Calorimetry whereas FTIR was done to examine chemical compatibility. Finally, in vivo evaluation of prepared hydrogels was carried out in rabbits using simple parallel study design to estimate various pharmacokinetic parameters.Results: HPMC-co-AA hydrogels had good pH sensitivity whereas; they demonstrated maximum and minimum swelling at pH 7.4 and 1.2 respectively. Swelling ratio, gel fraction and cumulative percent drug release were decreased with increasing crosslinker concentration while these parameters were increased with increasing AA and HPMC concentrations. A porous network was observed in the SEM images. All formulation ingredients of prepared hydrogels showed good compatibility as determined by FTIR. Results of in vivo study proved the pH sensitivity and sustained drug release of prepared hydrogels.Conclusion: The HPMC-graft-AA hydrogels showed good pH-sensitivity and sustained-release profile for model drug nicorandil.
Zeeshan Saleem, Imran Ullah, Muhammad Sarim Bin Farooq Awan, Jamal Tauqir, Faisal Younis, Nisar Khan, Muhammad Hamza Riaz, Huzaifa Tahir Saeed Siddiqui, Asim Alam, Noman Ullah, et al.
Gomal Journal of Medical Sciences, Volume 18, pp 116-131; https://doi.org/10.46903/gjms/18.03.897

Abstract:
Background: Drug-resistant tuberculosis (DR-TB) is the major cause of mortality worldwide. Our objectives were to determine the distribution of DR-TB by sex, age groups, occupation, province, division, district, type of disease, type of drug resistance, treatment regimen and outcome of treatment in DR-TB population in D.I.Khan Division, Pakistan.Materials Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan. A sample of 286 DR-TB patients was selected consecutively from population at risk. Sex, age groups, occupation, province, division and district were demographic while type of disease, type of drug resistance, treatment regimen and outcome of treatment were research variables. All variables being nominal were described by count, percentage cumulative percentage with 95% confidence interval for proportion. Distribution of DR-TB patients by all the ten variables were substantiated by chi-square goodness-of-fit test.Results: Out of 286 DR-TB patients, 123 (43%) were men and 163 (57%) women. DR-TB cases were most prevalent in age group 15-44 years 172 (60.14%), housewife 140 (48.95%), Khyber Pakhtunkhwa 175 (61.19%), D.I.Khan Division 178 (62.24%) and district 121 (42.31%). Most common type of disease, drug resistance and treatment regimen was pulmonary TB 282 (98.60%), MDR 273 (95.45%) and longer treatment (n=273 MDR-TB) 246 (90.11%) respectively. Treatment success rate was 161 (56.29%). The observed prevalence by occupation, province, division, district and type of disease in our sample was similar to expected prevalence in population (p.05 for all), while it was different from population by sex, age groups, type of drug resistance, regimen and treatment outcome (p.05 for all).Conclusion: The prevalence of DR-TB was higher in women, age group 15-44 years, housewife, Khyber Pakhtunkhwa and D.I.Khan Division and District. Most common type of disease, drug resistance and treatment regimen was pulmonary TB, MDR and longer treatment respectively. Treatment success rate was 56.29%. The observed prevalence by occupation, province, division, district and type of disease in sample was similar to population, while it was different by sex, age groups, type of drug resistance, regimen and treatment outcome.
Fauzia Malik, Anila Kamal
Gomal Journal of Medical Sciences, Volume 18, pp 83-92; https://doi.org/10.46903/gjms/18.03.833

Abstract:
Background: Hoarding is a complex phenomenon that has received extensive attention in recent years. Most studies have been conducted in Western culture with few from other regions of world, which advocates need to explore the phenomenon in different cultural contexts. Objective of this study was to ascertain the perception of hoarding behavior among general population of Rawalpindi and Islamabad cities of Pakistan.Materials Methods: This exploratory qualitative study with grounded theory design was conducted in National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan from September 2015-May 2016. Sample of 46 subjects from different socio-cultural backgrounds was selected from otherwise healthy adult (20-60 years) population of Rawalpindi Islamabad cities of Pakistan by purposive sampling. A qualitative research methodology was employed to develop theoretical understanding of phenomenon. Focus group discussions with six groups were conducted to assess existence and phenomenology of hoarding behavior in present cultural framework. Data was analyzed using grounded theory method.Results: Findings of this study support current literature concerning the role of emotional attachments, associated positive and negative affect, certain personality characteristics and early experiences in development and maintenance of hoarding behavior. This study also confirms that material possessions are source of security by providing sense of identity to owner, and are considered symbols of status in society. Finally, it involves the account of socio-cultural aspects like status transformation, with resulting sense of competition, gender role, impact of material deprivation, and religious construction of phenomenon that emerged as more of culture specific elements in indigenous settings of Pakistan.Conclusion: This study addresses factors that underpin major themes in relation to form and prevalence of hoarding behavior in cultural context of Pakistan and discusses the findings in reference to the similarities and differences with extant literature.
Aftab Hussain, Sheikh Muhammad Ibqar Azeem, Imran Ullah, Shahidullah Ahmad, Muhammad Faisal Khan, Muddasar Shahzad
Gomal Journal of Medical Sciences, Volume 18, pp 107-115; https://doi.org/10.46903/gjms/18.03.832

Abstract:
Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020. The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chi-square test of association.Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347).Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively.
Iftikhar Ahmad
Gomal Journal of Medical Sciences, Volume 18, pp 81-82; https://doi.org/10.46903/gjms/18.03.877

Abstract:
The industrial revolution in 1830 led to the urbanization resulting in creation of urban slums. More complex health problems ultimately steered the concept of public health. The social revolution during the Second World War emphasized that health could only be achieved through socioeconomic improvement. Progress in the field of social sciences rediscovered that man is a social being, not only a biological animal. Social services for the improvement of life conditions have been the major factors in reducing mortality, morbidity and improving the standard of life of an individual, family and society.
Khalid Mahmood
Gomal Journal of Medical Sciences, Volume 18, pp 93-98; https://doi.org/10.46903/gjms/18.03.852

Abstract:
Background: The women from non-Muslim community of Karachi have to face several issues regarding their health. The objective of this study was to find out the issues regarding the women health in non-Muslim community of Karachi and to provide suggestions in this context.Materials Methods: This qualitative survey was conducted at Pakistan Study Center, University of Karachi, Pakistan from July 2011 to December 2011. Eleven Non-Muslim populated areas of Karachi were selected. The primary data was collected through structured interview schedule, including 15 open ended questions. One doctor from each cluster of the eleven minority populations was interviewed. The responses were noted on a notebook. The theme was to understand the health issues faced by women around fourteen concepts; provision of food to boys and girls, health of girls before marriage, health of girls after marriage, side effects of early age marriages, women’s health during pregnancy, role of midwife, presence of non-qualified practitioners, problems during maternity, concept of family planning, health facility during emergency, weight of children at the time of birth, mother feed for the children, role of dirty and polluted atmosphere, and diseases due to reserved professions. Results: There was a lack of awareness in the non-Muslim families of Karachi regarding provision of equal food to their children on the basis of sex. The physical health of girls before marriage was not good in these families. After marriage they are also at risk of mental illness due to poverty, illiteracy, uncomfortable residential units and having limited access to the lady doctors. The overcrowded houses and polluted atmosphere also affects badly their physical health.Conclusion: The non-Muslim women are deprived from health facilities due to socio-economic problems. It is the dire need to provide health education to the non-Muslim women in their settlements. Moreover, Health care facilities may be provided by establishing Basic Health Units, Rural Health Centers, Maternal Child Health centers in these areas as per population density.
Farhan Khashim Alswailmi, , Haleema Nawaz
Gomal Journal of Medical Sciences, Volume 18, pp 132-138; https://doi.org/10.46903/gjms/18.03.841

Abstract:
Vitamin D exerts its well-known effects on bone health and calcium-phosphate homeostasis primarily through the vitamin D receptor signaling pathway. Vitamin D also has several extra-skeletal actions and its deficiency is not only implicated in musculoskeletal disorders, but also cardiovascular disorders, diabetes, neurodegenerative conditions and cancers. There is a growing body of research highlighting the link of vitamin D deficiency and alterations in vitamin D signaling with certain infections and autoimmune disorders although the evidence is inconsistent and inconclusive. Vitamin D has been suggested to play a fundamental role in curbing infections and mitigating autoimmune disease processes. The present review was undertaken to explore the promise of vitamin D as a protective agent and a clinically useful therapeutic adjunct against infections and autoimmune diseases and identify knowledge gaps and limitations of the available data for informing future work. An exhaustive search was conducted in established databases including Google Scholar, PubMed, Science Direct and Springer for articles published on vitamin D, immunity, infection and autoimmune disorders. All relevant articles published in the English language between the year 200 and 2020 were retrieved for writing the review. Although a considerable body of evidence highlighting the potential clinical benefits of vitamin D against the development of various autoimmune conditions and for the prevention of infections has emerged over the last decade, the findings are limited by the lack of appropriately designed randomized controlled trials which are needed to formulate precise clinical recommendations.
Published: 16 July 2020
Abstract:
Gomal Journal of Medical Sciences (GJMS) is the official Journal of Gomal Medical College, D.I.Khan, Pakistan
Adnan Khan, Abdul Rauf, Saqib Malik, Imran Ullah, Abdul Majid Khan, Haidar Zaman, Saleem Awan
Gomal Journal of Medical Sciences, Volume 18, pp 68-74; https://doi.org/10.46903/gjms/18.02.850

Abstract:
Background: Deliberate self-poisoning is important cause of deaths in younger population. The objectives of this study were to determine the distribution of deliberate self-poisoning by 12 socio-demographic factors, precipitating events, type of substance and mortality in population of Hazara Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in the Department of Medicine, Ayub Medical College, Abbottabad, Pakistan from October 9, 2017 to December 28, 2018. 102 deliberate self-poisoning patients were selected consecutively from population at risk. Variables were 12 socio-demographic factors, precipitating events, type of substance and mortality. All variables being categorical were described by count and percentage for sample and by confidence intervals for proportion for population at 95% confidence level. RESULTS: Deliberate self-poisoning cases (n=102) were higher in women 80.39%, in age group 18-25 years 54.90%, similar in urban 49.02% and rural 50.98%, higher in non-Pathan 74.51%, in married 57.84%, in joint family 79.41%, in up to matric education 85.29% and in housewives 52.94%, 4.90% with previous history of self-harm, 1.96% with family history of self-harm and higher in lower socioeconomic group 81.37%. The most common precipitating event was interpersonal difficulties with spouse, family members or friends 56.86%, while the most common type of substance was organophosphate 62.75%. Mortality was 3.92%. Conclusion: Deliberate self-poisoning was more prevalent in women, younger age group, married, joint family, educated up to matric, housewives and lower socioeconomic status. Family conflict was most common precipitating factor. Organophosphate was most common type of substance and mortality was high 3.92%.
Muhammad Bilal, Imran Ullah, Syed Abdurehman Shah, Zahidullah Khan, Taj Muhammad Khan, Ghazala Shaheen
Gomal Journal of Medical Sciences, Volume 18, pp 59-67; https://doi.org/10.46903/gjms/18.02.851

Abstract:
Background: Stroke is a devastating public health problem worldwide, considered as the third leading cause of death in developed countries, and the leading cause of disability among adults. Deep vein thrombosis (DVT), including pulmonary embolism (PE) as a sequel, is a serious complication of various medical conditions including stroke. The purpose of this study was to determine frequency of deep vein thrombosis among patients presented with stroke. Materials and methods: This study was descriptive (cross-sectional) study, conducted in the Department of Neurology, Lady Reading Hospital, Peshawar over 6 months. In the study a total of 196 patients were observed. Base line investigations were done and ultrasound was carried out to diagnose deep vein thrombosis. All the laboratory investigations and ultrasound were done by single experience pathologist and sonologist having minimum of five years of experience respectively. Observation and examination was done by neurologist who was not aware about the study and data was recorded in a predesigned proforma. To control confounders and bias in the study results, strict exclusion criteria had been followed. Results: In this study mean age was 63 years with standard deviation ± 28.34. Forty two percent patients were male and 58% patients were female. More over 8% patients had deep vein thrombosis. Conclusion:Our study concludes that the frequency of deep vein thrombosis was 8% among patients presented with stroke.
Iftikhar Ahmad
Gomal Journal of Medical Sciences, Volume 18, pp 43-44; https://doi.org/10.46903/gjms/18.02.831

Abstract:
Obesity is rapidly becoming a major public health problem in many parts of the world, including Pakistan. Developed world is viewing a huge switchover from acute and communicable diseases to the chronic and non-communicable diseases. However many developing countries including Pakistan, experience the double burden of communicable and non-communicable diseases.
Ubed Ullah, Kiran Javed, Muhammad Asim Khan, Imran Ullah, Noor Ul Iman
Gomal Journal of Medical Sciences, Volume 18, pp 45-53; https://doi.org/10.46903/gjms/18.02.869

Abstract:
Background: Escherichia coliresistance to ceftriaxone in UTIs is an emerging health problem.Our objectives were to determine prevalence, distribution and determinants of E. coliresistance to ceftriaxone in adult indoor UTI population of District Peshawar, Pakistan. Materials & Methods:This cross-sectional study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2017 to 30th June 2017. 380 UTIs cases were selected from population at riskconsecutively.Sex and age groups were demographic, while presence of E. coli resistance to ceftriaxone was research variable. All variables were nominal.Prevalenceand distribution were analyzed by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 380 patients with UTI, 136 (35.80%) were men,244(64.20%) women, 262 (68.95%) in age group 18-45 years and 118 (31.05%) in age group 46-65 years. Frequency/ prevalence of E. coli resistance was 287/380 (75.53%, 95%CI 71.20-79.85). Out of 287 patients with E. coli resistance to ceftriaxone, 101 (26.58%) were men and 186 (48.95%) women, 198 (52.11%) in age group 18-45 years and 89 (23.42%) in age group 46-65 years. Our prevalence of E. coli resistance to ceftriaxone was higher than expected (p<.00001), our distribution by sex(p<.00125) and age groups (p<.00001) were different than expected. Presence of E. coli resistance to ceftriaxone was not associated to sex (p=.669333) and age groups (p=.975097). Conclusion:Prevalence of E. coli resistance to ceftriaxone in adult UTI population of District Peshawar, Pakistan was alarmingly high 75.53%. Prevalence was more in women than men and more in younger age group (18-45 years) than older age group (46-60 years) population.Overall prevalence of E. coli resistance to ceftriaxone was higher than expected. Distribution by sex showed higher prevalence than expected in men and lower than expected in women, and higher than expected in younger age group and lower than expected in older age group. Presence of E. coli resistance to ceftriaxone was not associated to sex and age groups respectively in adult UTI population of District Peshawar, Pakistan.
Muhammad Shafiq Khan`, Nusrat Rasheed, Khadim Hussain, Muhammad Zubair Farooq
Gomal Journal of Medical Sciences, Volume 18, pp 75-80; https://doi.org/10.46903/gjms/18.02.847

Abstract:
Background: Scaphoid fractures are common and account for 60-70 % of all carpal fractures. The objectives of this study were to determine the demographic and clinical profiles of adult patients with scaphoid fractures in population of District D.I.Khan, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Orthopedics, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2019. Sample size was 40. Demographic variables were sex, age groups and time to presentation in weeks. Research variables were; cause, laterality, site, management options, time to union in months and presence of infection. All variables were categorical and analyzed by count and percentages for sample and as CI at 80% CL for proportion for population using Wilson score for binomial distribution. Results: Forty patients included 34 (85%) men & 16 (15%) women, 24 (60%) in 17-30 and 16 (40%) in age group 31-50 years. Time to presentation was ≤1 week of injury in 19 (47.5%) patients and 21 (52.5%) presented later. Cause was fall on out-stretched hand in 27 (67.5%) and RTA in 13 (32.5%) patients. Right hand was involved in 29 (72.5%), left in 9 (22.5%) while bilateral in 2 (5%) patients. Site of fracture was waist in 24 (60%), proximal pole 11 (27.5%) and distal pole 5 (12.5%) cases. Conservative treatment was done in 7 (17.50%) patients, percutaneous screw fixation 7 (17.50%), open reduction and internal fixation through palmar in 11 (27.50%) and though dorsal 15 (37.50%) cases. Time to union was ≤3 in 7 (17.50%), >3-6 months 29 (72.5%), while >6 months in 4 (10%) patients. Presence of infection was 1/40 (2.38%). Conclusion: Scaphoid fractures are more common in men and younger adults and most are presented within a week of injury. These are caused mostly by fall on outstretched hand, involving right hand and involving waist. Substantial number of cases requires open reduction with internal fixation. Mostly unite in 3-6 months.
Gul Muhammad Shaikh, Rabia Khan, Rehan Khan, Rahila Yasmeen
Gomal Journal of Medical Sciences, Volume 18, pp 54-58; https://doi.org/10.46903/gjms/18.02.826

Abstract:
Background: Academic failure adds extra pressure to emotional intelligence of students and this may lead to psychological disturbance. The objective of this study was to explore perception of students and teachers regarding academic failure of undergraduate medical students in Lahore, Pakistan. Materials & Methods: This qualitative exploratory study was conducted at Department of Medical Education, University College of Medicine and Dentistry, University of Lahore, Pakistan from January 2018 to October 2018. Sample included nine MBBS students who took their last examination in year 2017 and five teachers, all from University College of Medicine and Dentistry, University of Lahore. Sampling was purposive. These nine students included five who graduated without failure and four who experienced two/more failures. Medical students were interviewed via two focus groups, whereas face to face semi-structured, audio-recorded interviews were done for teachers. Interview questionnaires were designed on basis of attribution theory. The fundamental question of study was “What are the reasons behind undergraduate medical students’ failure in annual examination?” with five more questions. The interviews were transcribed in English and sent back to participants for member checking. The interviews were organized in ATLAS.ti software for thematic analysis based on Weiner’s Attribution Theory. Open coding was done after familiarization of data, leading to formation of categories, sub-themes and themes related to our conceptual framework. Results: 160 open codes were condensed to 35 axial codes leading to two themes. Main reasons for students’ failure in examinations perceived by both students and teachers were lack of ability, lack of effort and lack of motivation. Additionally, the students attributed bad luck to academic failure. Other factors included were teachers’ related factors, curriculum related factors and negative students’ attitude. Conclusion: Medical institutions must take into account reasons for academic failure among medical students and address those issues to improve their performance.
Ayesha Mukhtar Awan, Iram Naz, Muhammad Khurram Mahmood, Hafeez Uddin
Gomal Journal of Medical Sciences, Volume 17, pp 70-74; https://doi.org/10.46903/gjms/17.03.1967

Abstract:
Background: Pseudo-epitheliomatous Hyperplasia (PEH) is a benign proliferation of epithelium occurring in response to various neoplastic lesions, infections and inflammatory processes. It can be mistaken especially in small biopsies for an invasive oral squamous cell carcinoma (OSCC). The objective of this study was to determine the expression and comparison of immunohistochemical marker E-cadherin in OSCC and PEH lesions. Materials & Methods: This cross-sectional study was conducted in Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from January 2013 to March 2016. 60 paraffin embedded cases, 30 each of PEH and OSCC were retrieved and stained with haematoxylin and eosin. They were then immune-stained with E-cadherin and expression evaluated and compared in two lesions by histopathologist. Age, sex, site of lesion and E-cadherin expression were variables. Age was described by mean and SD and other variables as frequency and percentages. Results: Mean age of OSCC group was 60.1±17.3 years and PEH group 52.7±16.6 years. OSCC group included 16 (53.33%) men and 14 (46.67%) women. PEH group included 18 (60%) men and 12 (40%) women. In OSCC group, site of lesion was buccal mucosa 12 (40%) cases, gingiva 10 (33.3%), tongue 7 (23.3%) and floor of mouth 1 (3.4%) case. In PEH group, site of lesion was buccal mucosa 12 (40%) cases, tongue 11 (36.67%), gingiva 6 (20%) and palate 1 (3.3%) case. The expression of E-cadherin was negative in all 30 cases of OSCC and positive in 29/30 (96.67%) cases in PEH. Conclusion: E-cadherin can be used as an ancillary marker in the differentiation of oral squamous cell carcinoma and pseudo-epitheliomatous hyperplasia.
Iftikhar Ahmad
Gomal Journal of Medical Sciences, Volume 17, pp 63-64; https://doi.org/10.46903/gjms/17.03.2079

Abstract:
Lifestyle is the interest, behavior, opinion, style of living or world outlook of an individual, group, or culture; a combination of tangible factors like demographics and intangible factors like personal values and preferences.1 Recently researchers have more interest in the relationship between life style and health. Millions of people, following unhealthy lifestyle (or risk-factors), are plagued with morbidity, disability and mortality due to non-communicable, communicable diseases & nutritional disorders. Persons having unhealthy behaviors may be called as ‘at risk groups’.2 Although a healthy lifestyle has consistently been shown to decrease mortality, the population prevalence of healthy living remains low.3 The mental health of an individual can be assessed by his behavior and attitude. Common lifestyle variables influencing health include diet, exercise, sleep, smoking, alcohol consumption, substance abuse, stress management, sexual behavior, internet, recreation, etc.4 Besides, weight management, exposure to the sun, social contact, work life balance, leisure activities, screening for cancer etc. make a healthy life style. Healthy ways of living are developed through processes of socialization with parents, friends, relatives and community. However, not all life style factors are harmful. There are many life styles that promote health. For example, adequate nutrition, exercise, meditation, enough sleep etc.5 Modern or slow epidemics of non-communicable diseases (NCDs) e.g. hypertension (HTN), coronary heart disease (CHD), diabetes mellitus (DM), obesity, cancer etc. have been increasing in incidence compared to the previous century. With the increase in life expectancy, the prevalence of NCDs is on the rise. About 2 billion people are overweight in developed as well as low to middle income countries.6 Comorbidities of obesity include HTN, CHD, DM, stroke, cancers, gallbladder disease, dyslipidaemia, osteoarthritis, gout and sleep apnoea.7 Obesity is not only preventable but treatable with lifestyle modifications to forestall DM.8 Furthermore, several pathways linking obesity and CHD have been described; in particular coronary atherosclerosis, heart failure, and atrial fibrillation.9 In a study by CDC conducted in late 1970s in US, approximately 48% of all premature deaths prior to age 75 years could be traced to one’s lifestyle or health behavior choices, hence focusing on a personal responsibility model whereas another study accounts for about 63% of all deaths.10 Human behavior is a major obstacle to disease control. Changes in human behavior may prevent most of the world's major health problems & premature deaths at low cost. Public health is defined as ‘the health status of a defined group of people and the governmental actions and conditions at the local, state, and national levels to promote healthy behaviors, prevent spread of disease and injuries, protect against environmental hazards & disasters and assure the curative and rehabilitative health services. Many public health recommendations and clinical guidelines emphasize that healthy lifestyles have substantial health benefits.11 Changes in the life-style of the population by health education encompass three approaches of primary prevention as recommended by the WHO for prevention of chronic diseases. In first approach or primordial prevention, children are discouraged from adopting harmful lifestyles through individual/ mass education in countries in which many adult health problems (e.g., obesity, hypertension) have not yet appeared. Lifestyles are formed during childhood and aim is to prevent the emergence of risk factors. Second approach or population (mass) strategy is directed at the whole population, irrespective of individual risk level. A small reduction in the average blood pressure/ serum cholesterol in the community, helps in reducing the CHD prevalence. Third approach or high-risk strategy, on the other hand, aims to detect individuals at high risk by the optimum use of clinical methods and provide preventive care to them. To have an impact on the population, all the above three approaches should be implemented as they are usually complementary but the results are perceived after several decades and not immediately. Besides health education the population must have access to preventive measures.5 Lifestyle medicine program serves as a systematized approach to manage NCDS by addressing multiple risk factors through self-management skills.12 Physical activity leading to cardiorespiratory fitness is needed in all age groups, both sexes, race & ethnicities to prevent NCDs including CVDs.13 Better control of behavioral risk factors alone could prevent one-third of all acute and two-thirds of chronic disabilities. Physical activity, consumption of fresh rather than processed foods, limited use of cooking/ table salt to
Muhammad Marwat
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/gjms/17.03.2077

Abstract:
A 40 years old man presented with bilateral mild dimness of vision and mild glare. Diffuse and focal illumination on slit lamp biomicroscopy did not reveal any pathology. Retro-illumination on slit lamp showed faint bilateral spokes like cortical lens opacities. Retro-illumination mode on Auto-Ref/Keratometer (HRK 7000A, Huvitz, Anyang-si, Gyeonggi-do, Republic of Korea) prominently revealed these insignificant bilateral spokes like cortical opacities (cataracts). Visual acuity was 6/9 in both eyes. No intervention was advisable and the patient was reassured.
Nazafatul Ain, Saira Khan, Muhammad Marwat, Nisar Khan, Iftikhar Ahmad, Farhana Ramzan, Wajeeha Akhtar, Hadia Fakhar, Yabqa Jehan, Azalfa Zeb, et al.
Gomal Journal of Medical Sciences, Volume 17, pp 81-89; https://doi.org/10.46903/gjms/17.03.2076

Abstract:
Background: Global Health Estimates 2015 has shown the stroke as second leading global cause of death and 3rd leading global cause for DALYs for year 2015. The objectives of this study were to determine the frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from February 1, 2017 to April 30, 2017. A sample 217 was selected with margin of error 5.59%, 90%CL and 50% prevalence of hypertension in 200,000 adults at risk of stroke population through consecutive sampling. All indoor adult patients of stroke were eligible. Sex, age groups, and residence and presence of hypertension were variables. Frequency and distribution of hypertension were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 217 patients with stroke, 123 (56.7%) were men and 94 (43.3%) were women, 86 (39.6%) were≤60 years and 131 (60.4%) were>60 years, and 105 (48.4%) were urban and 112 (51.6%) were rural. Frequency of hypertension was 132/217 (60.83%). Out of 132 patients with hypertension, men were 74 (34.10%), women 58 (26.73%), age group≤60 years 46 (21.20%), >60 years 86 (39.63%), urban 72 (33.18%) and rural 60 (27.65%). Presence of hypertension was associated to residence (p=.023) but not to sex (p=.817) and age groups (p=.072). Conclusion: Frequency of hypertension in adult stroke population of D.I.Khan Division, Pakistan was found to be similar as expected. Frequency was more in men, in older age group (of>60years) and in urban population. The presence of hypertension in adult stroke population of D.I.Khan Division was associated to residence but not to sex and age groups.
Arslan Akhtar, Syed Maisam Ali, Syed Ali Naqi, Tabassum Aziz, Wajih-Ud-Din Shinwari, Syed Faizan Hassan Shah
Gomal Journal of Medical Sciences, Volume 17, pp 90-94; https://doi.org/10.46903/gjms/17.03.2007

Abstract:
Background: Chronic suppurative otitis media (CSMO) is an important cause of preventable hearing loss, particularly in developing world. The objective of this trial was to compare efficacy of 2% acetic acid versus 0.3% ciprofloxacin ear drops in achieving dry ears in CSMO in adult population of Islamabad, Pakistan. Materials & Methods: This trial was conducted at Department of ENT, HBS Medical College, Islamabad, Pakistan from March 2018 to February 2019. With alpha 5%, beta 20% and power of study 80%, sample size was calculated 47 for each group. All adult patients of CSOM, having ear discharge for more than three months were eligible. Patients with aural poly, external auditory canal pathology, ear malignancy, having mastoid surgery in preceding 12 months or having used antibiotics in last one week were excluded. Experimental group received 2% acetic acid, twice daily while control group received 0.3% ciprofloxacin eardrops twice daily. At two weeks, achievement of dry ears was noted. Sex and age in years were matching variables. Primary end point was achieving dry ears, which was compared between the two groups using McNemar chi-square test. Results: Experimental group included 30 (63.8%) men and 17 (36.2%) women and control group included 32 (68%) men and 15 (32%) women. Mean age of experimental group 36±2.14 years was matching to the control group 36±2.59 years. Dry ears were achieved in 35 (74.47%) patients in experimental group and in 11 (23.40%) patients in control group. The efficacy of 2% acetic acid was significantly higher than 0.3% ciprofloxacin eardrops in achieving dry ears (p
Farah Abid, Muhammad Saleem, Saleha Yasir, Shumila Arshad, Sundus Qureshi, Mayyda Asif Bajwa, Sana Ashiq, Samreen Tanveer, Mehiwh Qayyum, Kanwal Ashiq
Gomal Journal of Medical Sciences, Volume 17, pp 96-104; https://doi.org/10.46903/gjms/17.03.2070

Abstract:
Cancer has been a fatal disease since many decades. Over the time, it is presented in multiple ways and is a matter of consideration as accounts for the high rate of mortality. The aim of the current review was to focus on the genetics, epigenetics factors and role of medicinal plants for the cure of this inimical disease. Related articles available in English language (2002-2018) were reviewed with help of different database, including PubMed, Springer Link, Medline, Google Scholar and ScienceDirect. In order to ensure credibility and accuracy of data only those articles were considered which are published in indexed journals i.e. Web of Science and Scopus. This project was conducted at the Department of Pharmacy, Government College University, Faisalabad, Pakistan from 02-01-2019 to 28-02-2019. The genetic machinery is vibrantly involved in the interpretation of the signals and is observed to be affected by various dietary factors. A sequence of modified activities is observed with use of these dietary elements. However, the modification is reviewed through the histone acetyltransferase (HAT), histone deacetylase (HDAC) and DNA methyl transferase (DNMTs), effecting the expression of gene. These modified genes, in turn then express the signals in multiple reformed ways. Different dietary elements that are used such as polyphenol, alkaloid and flavonoids are effective against cancer. The progression of disease involves genetics and epigenetics due to amplification, translocation and mutation during gene expression. Though, many studies have been conducted elaborating the role of plants and their ingredients which play a part in inhibition of cancerous cells by blockade of cell cycle and apoptosis; more in-depth investigations are still required to identify the new drug target and novel therapeutic modalities.
Zafar Hayat, Inam Ullah, Khizar Hayat, Hashimuddin Azam Khan, Fazle Raziq, Habibullah Khan
Gomal Journal of Medical Sciences, Volume 17, pp 75-80; https://doi.org/10.46903/gjms/17.03.2027

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Background: Falciparum malaria is a common disease in our area. Apart from its classical presentation, at times it may present with refractory anemia or pancytopenia. The aim of this study was to determine the refractory anemia and pancytopenia as complications of falciparum malaria and apart from peripheral blood smears the significance of rapid antigen tests and bone marrow examination in the diagnosis of falciparum malaria. Material & Methods: The descriptive study included 200 consecutive cases of fever and refractory anemia or pancytopenia from 2011 to 2014. Stratification of patients according to the clinical scenario included Group-A having fever with refractory anemia and Group-B with fever and pancytopenia. A detailed history, thorough clinical examination, and pertinent laboratory tests were performed. All patients were treated with antimalarial drugs and followed-up for eight weeks. The pre and post treatment hematologic parameters were compared. Results: Among the 200 patients, 85 were males and 115 females. The age ranged from 15 to 55 years. Stratification of patients on clinical scenario revealed 175(87.5%) patients with fever and refractory anemia (Group-A). Among these, 125(62.5%) patients were reported smear positive for P. falciparum. In the remaining 50 smear negative patients rapid antigen tests were performed and all were reported positive. In 25 patients of Group B with fever and pancytopenia, the peripheral smear for malaria was positive only in 5 patients. In the remaining 20 cases both the peripheral blood smears and rapid antigen tests were reported negative. Bone marrow examination was planned to confirm the bone marrow suppression as the cause of peripheral pancytopenia, to exclude leukemia and to identify P. falciparum. The bone marrow examination revealed P. falciparum in all these cases. All the patients had a dramatic response to treatment with antimalarials in terms of disappearance of fever and correction of anemia and bone marrow rescue with reversal of pancytopenia to normal counts. Conclusion: Plasmodium falciparum should be considered in all cases of prolonged fever with refractory anemia or pancytopenia in malaria endemic areas, even with negative smear and rapid antigen tests. Bone examination is mandatory for the diagnosis in such cases. There is dramatic response of such patients to treatment with antimalarial drugs and hematinics.
Nazma Kiran, Nadia Aslam, Tahira Tabassum, Saadia Kanwal, Tanveer Zia
Gomal Journal of Medical Sciences, Volume 17, pp 65-69; https://doi.org/10.46903/gjms/17.03.2021

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Background: Intrauterine growth restriction (IUGR) is a principal cause of fetal and neonatal morbidity and mortality. The placenta, as a vector for maternal-fetal nutrient and oxygen exchange has major influence on birthweight. The objectives of this study were to compare the placental weight (grams), number of syncytial knots and number of blood vessels in villi of IUGR placentas versus normal placentas. Materials & Methods: This cross-sectional study was carried out at Rai Medical College, Sargodha, Pakistan in collaboration with Zainab Memorial Hospital, Rawalpindi, Pakistan from December 2016 to November 2018. Study group included 45 IUGR placentas and control group included 25 normal placentas. Placental weight in grams, number of syncytial knots and number of blood vessels in villi of placentas were three research variables. These were described by mean, minimum, maximum, range and standard deviation for each group separately and were compared between the two groups through independent-samples t-test. Results: Descriptively the mean placental weight in grams in IUGR group (423.35±64.13g) was lower than control group placentas (535.92±44.57g). The number of syncytial knots in IUGR group placentas (22.04±5.21) was more than control group placentas (13.84±4.41). The number of blood vessels in IUGR placentas was lower than control group placentas. All three null hypothesis for research variables between the two groups were rejected (p=
Hend Alkwai, Shimaa Mohammad Aboelnaga, Rania Abdeen Hussain, Fahmida Khatoon
Gomal Journal of Medical Sciences, Volume 18, pp 39-42; https://doi.org/10.46903/gjms/18.01.2080

Abstract:
Surfactant protein D (SP-D) is an important component of pulmonary innate immunity. It is mainly produced by type 2 alveolar and bronchial epithelial cells, but is also found in extra pulmonary tissues and blood. It acts as a primary host defense against inhaled microorganisms. It also enhances adaptive immunity by activating T cells. SP-D deficiency can lead to upper and lower respiratory tract infections. Obesity has reached global epidemic proportions in both adults and children and is associated with numerous co-morbidities and insulin resistance. Type 2 diabetes & obesity are highly associated with recurrent pulmonary & extra pulmonary infections. The primary objective of this study was to determine the association of serum surfactant protein D levels with obesity and type 2 diabetes mellitus.
Muhammad Sharjeel, Farooq Ul Abidin
Gomal Journal of Medical Sciences, Volume 18, pp 37-38; https://doi.org/10.46903/gjms/18.01.2108

Abstract:
Ocular surface squamous neoplasia (OSSN) is a term that describes the spectrum of abnormal growth of atypical squamous epithelial cells of the conjunctiva, cornea, and sclera. It is more common in people working for long in sun-exposed areas. It resembles other common ocular surface conditions such as pterygium, pinguecula, atopic conjunctivitis, diffuse episcleritis, chronic blepharoconjunctivitis which may result in the wrong diagnosis of the entity. Here we report a case of OSSN in a 25 years old man which was referred to us as a case of pterygium. An excisional biopsy revealed clusters of dysplastic squamous epithelial cells.
Ayesha Mukhtar Awan, Iram Naz, Muhammad Khurram Mahmood, Hafeez Uddin
Gomal Journal of Medical Sciences, Volume 18, pp 24-29; https://doi.org/10.46903/gjms/18.01.2120

Abstract:
Background: Oral pseudoepitheliomatous hyperplasia (PEH) appears histologically similar to oral squamous cell carcinoma (OSCC) in small oral biopsies, thus posing diagnostic dilemma. The objective of this study was to compare the expression of matrix metalloproteinase-9 (MMP-9) in differential diagnosis of OSSC and oral PEH. Materials & Methods: This comparative cross-sectional study was conducted in the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan from January 2013 to March 2016. It included sixty archival cases, 30 each of OSCC and PEH. Paraffin embedded blocks were prepared, hematoxylin and eosin stained sections taken and immunostained with MMP-9. The expression of MMP-9 was evaluated in OSCC and PEH. Results: The OSCC group included 16 (53.33%) men and 14 (46.67%) women, whereas PEH group included 18 (60%) men and 12 (40%) women. The mean age of OSCC group was 60.1±17.3 and that of PEH group was 52.7±16.6. In OSCC group, site of lesion was buccal mucosa in 12 (40%), gingiva 10 (33.33%), tongue 7 (23.33%) and floor of mouth 1 (3.34%) case. In PEH group, site of lesion was buccal mucosa in 12 (40%), tongue 11 (36.66%), gingiva 6 (20%) and palate 1 (3.34%) case. The expression of MMP-9 was positive in all the 30 cases of OSCC and negative in all 30 cases of PEH. Conclusion: Compared to pseudoepitheliomatous hyperplasia (PEH), MMP-9 revealed a higher expression in oral squamous cell carcinoma (OSCC). This finding has become mainstream strategy in distinguishing OSCC from PEH in oral mucosal biopsies in cases difficult to diagnose.
Iftikhar Ahmad
Gomal Journal of Medical Sciences, Volume 18, pp 1-2; https://doi.org/10.46903/gjms/18.01.2131

Abstract:
Non-communicable diseases (NCDS) have risen to become a major menace to health worldwide. NCDs include cardiovascular, nervous, renal, mental, chronic lung diseases, permanent results of accidents, arthritis, cancer, diabetes, obesity, senility and blindness etc.
Nazia Liaqat, Qudsia Qazi, Saadia Yasmeen
Gomal Journal of Medical Sciences, Volume 18, pp 12-18; https://doi.org/10.46903/gjms/18.01.1995

Abstract:
Background: Primary postpartum haemorrhage (PPPH) is the leading cause of maternal morbidity and mortality in low resource countries like Pakistan. The objectives of this study were to determine the frequency, distribution by place of delivery and parity, causes, management options and outcome of PPPH in postpartum women of District Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Gynaecology & Obstetrics, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 30th June 2019. Sample size of 4,034 was with 0.39342 % margin of error, 95% confidence level, prevalence of PPPH 2% and a population of 23,607 postpartum women. All postpartum women were eligible. Those with secondary PPH, surgical management for PPPH done at some other hospital, with known bleeding disorders and on anticoagulants were excluded. All these patients were managed according to standard protocols. Data was collected for following variables; presence of PPPH (yes/ no), place of delivery (in-hospital deliveries/ referred cases), parity (primipara/multipara/grandmultipara), causes of PPPH (uterus atony/retained placenta-RPOC/ruptured uterus/genital tract tears), management options of PPPH (conservative management/laparotomy with repair of ruptured uterus/laparotomy with uterine artery ligation and B-Lynch/repair of genital tract tears other than ruptured uterus/removal of retained placenta & RPOC/hysterectomy) and outcome of PPPH (uneventful recovery/maternal near miss/maternal mortality). Frequencies and percentages with confidence intervals were calculated for these variables. Results: Out of 4034 postpartum women, frequency of PPPH was 400 (9.92%). Out of 4034 women, distribution of 400 cases of PPPH by place of delivery was 222 (5.50%) in-hospital deliveries and 178 (4.42%) referred cases and by parity it was primipara 79 (1.96%), multipara 243 (6.03%) and grandmultipara 78 (1.93%) cases. Out of 400 cases of PPPH, frequency of uterine atony was 254 (63.50%) and conservative management 245 (61.25%). Out of 400 cases, frequency of uneventful recovery was 352 (88%), maternal near miss 40 (10%) and maternal mortality eight (2%) cases. Conclusion: Primary postpartum haemorrhage (PPPH) continues to be a common and serious complication of delivery with uterine atony being its most predominant cause.
Mir Attaullah Khan, Hamidullah Shah, Khalid Javed
Gomal Journal of Medical Sciences, Volume 18, pp 19-23; https://doi.org/10.46903/gjms/18.01.2067

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Background: FNAC is usually considered as a reliable, easily performed and inexpensive test for diagnosing palpable lesions of breasts with a high degree of accuracy. The objective of this study was to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC) versus open biopsy in carcinoma breast in adult palpable female breast lesions in population of Khyber Pakhtunkhwa, Pakistan. Material and Methods: This cross-sectional study was conducted at Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 31st December 2019. Sixty (60) FNAC reports of palpable breast lesions in definitive categories {(C2 (benign) and C5 (malignant)} with respective open biopsy reports were included in the study. Nine (9) FNAC reports of inconclusive categories (C1, C3 & C4) were excluded. Age in years was a single demographic variable. The data for “presence of carcinoma breast” for both the open biopsy and FNAC were placed in two-by-two table. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC were determined as percentages with confidence intervals at 95% confidence level. Results: The mean age of the sample was 37 ± 17 (17-70, range 53) years. Out of 60 cases on open biopsy, 14 (23.33%) were confirmed as having and 46 (76.67%) as not having carcinoma breast and on FNAC, 12 (20%) were positive and 48 (80%) were negative for carcinoma breast. Two-by-two table showed 12 true positive (TP), 46 true negative (TN), two false negative (FN) and zero false positive (FP) cases. The sensitivity of FNAC was 85.71%, specificity 100%, PPV 100%, NPV 95.83% and accuracy was 96.67%. Conclusion: FNAC is a reliable method in diagnosing carcinoma breast in adult palpable female breast lesions in population of Khyber Pakhtunkhwa, Pakistan.
Sadiq Amin, Jawad Ahmad, Muhammad Suhail Khan, Amanullah Khan, Rashid Hassan Khan, Muhammad Umar, Muhammad Rehan, Sifat Ullah, Barkat Ullah, Muhammad Sani, et al.
Gomal Journal of Medical Sciences, Volume 18, pp 30-36; https://doi.org/10.46903/gjms/18.01.2135

Abstract:
Background: Blood group of an individual is commonly determined by ABO & Rh status. The objectives of the study were to determine the frequency of ABO, Rh and ABO-Rh blood groups in students of Gomal Medical College, D.I.Khan, Pakistan. Materials & Methods: This cross-sectional study was conducted in the Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from April 1 to May 23, 2019. The population being accessible was taken as sample. Sample size was 452. Our research variables (attributes) were ABO (A, B, AB, O), Rh (positive and negative) and ABO-Rh (A+, B+, AB+ O+, A-, B-, AB-, O-) respectively. All variables being nominal were described by count and percentage. The estimated parameters were given as confidence interval for proportion at 95% confidence level. The observed frequency of ABO, Rh and ABO-Rh blood groups was tested against their expected frequency using chi-square goodness of fit test. Results: Out of 452 students, the frequency of ABO blood group was; A 127 (28.12%), B 165 (36.53%), AB 57 (12.62%) & O 103 (22.73%); Rh blood group was; Rh+ 408 (90.33%) & Rh- 44 (9.67%) and ABO-Rh was; A+ 116 (25.60%), B+ 148 (32.05%), AB+ 50 (11.30%), O+ 91 (20.10%), A- 11 (2.40%), B- 17 (03.70%), AB- 7 (1.50%) & O- 12 (2.60%). The observed frequency of ABO & ABO-Rh blood groups was significantly different whereas of Rh blood group was similar to expected prevalence. Conclusion: In our population, most common blood group was B+ and the least common was AB-. The observed frequency of ABO & ABO-Rh blood groups was different while of Rh was same as expected. Awareness of blood groups in populations will help in the effective management of blood banks record in routine as well as during blood related life emergency situations.
Ali Khan, Mohammad Ismail Khan, Muhammad Afaq Ali, Altaf Hussain, Muhammad Ibrahim, Taj Muhammad
Gomal Journal of Medical Sciences, Volume 18, pp 3-11; https://doi.org/10.46903/gjms/18.01.1949

Abstract:
Background: Foreign body aspiration commonly occurs in young children and is associated with high degree of mortality and morbidity. The objectives of this study were to determine epidemiologic, clinical and endoscopic perspectives of foreign body aspiration in children of District D.I.Khan, Pakistan. Materials & Methods: This descriptive study was conducted in Department of ENT, Gomal Medical College/ DHQ Teaching Hospital, D.I.Khan, Pakistan from November 2017-April 2019. 105 children with suspected foreign body (FB) aspiration were included. All patients underwent rigid bronchoscopy under GA. After check X-ray and one day observation, they were discharged. Variables were sex, age in years and age groups, successful removal, mortality, history of FB aspiration, cough, wheezing, choking, stridor, reduced air entry and location of FB. Age in years was numeric, age groups ordinal and all other variables were on nominal scale. Age in years was described by mean & SD and others by count and percentage. Results: The sample with suspected foreign body aspiration (n=105) included 61 (58.1%) boys and 44 (41.9%) girls, with 20 (19.05%) in age group 0-2.0 years, 58 (55.24%) 2.0-5.0 years and 27 (25.71%) 5.0-14 years. Chest X-Ray was done in 98/105 (93.33%) cases. Frequency of successful FB removal by rigid bronchoscopy was 86/105 (81.90%). Mortality was none. Out of 86 confirmed cases, 51 (59.30%) were boys and 35 (40.70%) girls, with 19 (22.10%) in age group 0-2.0 years, 55 (63.95%) 2.0-5.0 years and 12 (13.95%) 5.0-14 years. Mean age was 3.57±1.78. History of FB aspiration was in 75/86 (87.21%), cough 65 (75.58%), stridor 14 (16.28%), wheezing 54 (62.79%) and choking 28 (32.56%) cases. Reduced air entry was 44 (51.16%) on right side, 17 (19.77%) on left side and 25 (29.05%) bilateral. Location of FB was larynx 6 (9.98%), trachea 20 (23.26%), right bronchus 44 (51.16%) and left bronchus 16 (18.60%). Conclusions: Foreign body aspiration in children in not an uncommon event. The parents should try to prevent such event, and if there, should present the child to emergency department of a hospital. ENT surgeons are supposed to evaluate and plan an earlier intervention as rigid bronchoscopy for these children.
Umbreen Naz, Farhan Sarwar, Muhammad Adnan Sarwar, Muhammad Mudassar Ashraf, Shoaib Zafar, Muhammad Waqas Khadam
Gomal Journal of Medical Sciences, Volume 17, pp 150-154; https://doi.org/10.46903/gjms/17.04.1998

Abstract:
Cervical cancer is a malignant neoplasm of the cervical area or cervix which may present with the vaginal bleeding but symptoms may be absent until the cancer gets in advanced stage. Dysplasia seen on cervical biopsy uses the term cervical intraepithelial neoplasia (CIN) and is grouped into mild (CIN-1), moderate (CIN-2) and severe (CIN-3). The severity of CIN depends upon cellular disorganization, cellular immaturity, increased mitotic activity and nuclear abnormalities. The nuclear atypia, extent of mitotic activity and immature cellular proliferations identifies the degree of dysplasia. Thus, epithelial thickness which shows differentiation is the useful feature in decision about severity of CIN. Treatment of this cancer may be ablative and/ or excision. Cryotherapy is a reasonable treatment of CIN-1 and CIN-2 but not of CIN-3 which is severe cervical carcinoma. Burning the TZ-transformation zone (Electro diathermy) destroys the tissue more effectively than that of cryotherapy but it usually requires general anesthesia, however laser cold coagulations technique requires local anesthesia usually. Laser TZ Excision compromises the fertility. Knife cone biopsy is used as a preferred treatment for removal of abnormal cervical cells. Now the cone biopsy is generally performed using the laser surgery. Early diagnosis of cervical cancer is very necessary for better control and treatment of it. For early phases of cervical carcinoma, the cryotherapy is very reasonable, however in case of late stage of the disease laser methods are used alone or on combination. Therapy will be termed successful if cytology remains negative after at least six months of its treatment.
Muhammad Marwat, Iftikhar Ahmad, Fariha Ashiq, Sania Ali, Sher Zamir, Mehboob Ur Rehman, Maryam Farid, Bakhtawar Rehman, Habiba Zahoor, Zeenat Aman, et al.
Gomal Journal of Medical Sciences, Volume 17, pp 131-143; https://doi.org/10.46903/gjms/17.04.2106

Abstract:
Background: Global Health Estimates 2015 has shown IHD as second leading global cause of death and 3rd leading global cause for DALYs for 2015. The objectives of this study were to determine frequency, distribution and determinants of DM in adult acute coronary syndrome (ACS) population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Departments of Ophthalmology & Community Medicine, Gomal Medical College, D.I.Khan, from February 1, 2017 to April 30, 2017. 331 cases were selected with margin of error 4.511%, 90%CL and 25% prevalence of DM in 73,438 adults assumed to have IHD. All indoor adult patients of ACS were eligible. Sex, age groups, and residence and presence of DM were variables. Frequency and distribution were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 331 patients with ACS, 225 (68.0%) were men and 106 (32.0%) women, 221 (66.8%) ≤60 years and 110 (33.2%) >60 years, and 210 (63.4%) urban and 121 (35.6%) rural. Frequency of DM was 79/331 (23.87%). Out of 79 patients with DM, men were 44 (13.29%), women 35 (10.57%), age group ≤60 years 57 (17.22%), >60 years 22 (6.65%), urban 53 (16.01%) and rural 60 (7.85%). Our prevalence of DM was lower than expected (p=.00214), our distribution by sex was similar to expected (p=.4993) while our distribution for age groups (p=.01209) and residence (p=.00005) were not similar to expected. Presence of DM was associated to sex (p=.011) but not to age groups (p=.0304) and residence (p=.5241). Conclusion: Prevalence of DM in adult ACS population of D.I.Khan Division, Pakistan was found lower than expected. The prevalence was more in men than women, more in younger age group (≤60 years) than older age group (>60 years) and more in urban than rural population. Our prevalence of DM was lower than expected, our distribution by sex was similar to expected while our distribution for age groups and residence were not similar to expected. The presence of DM was associated to sex but not to age groups and residence.
Zubair Ahmad Khan, Omer Nasim, Zeinab Hussain, Jamil Ahmad
Gomal Journal of Medical Sciences, Volume 17, pp 145-149; https://doi.org/10.46903/gjms/17.04.2097

Abstract:
Thirty five years old women presented to the Accident and Emergency Department with acute onset right upper quadrant abdominal pain with normal vitals. CT images revealed a malrotation causing midgut volvulus and intestinal obstruction. On emergency exploratory laparotomy, the gut loops showed partial ischemia due to a double twist at the root of mesentery and malrotation of the gut along with the caecum which was mobile coming from left iliac fossa and lying in the right iliac fossa. Duodeno-jejunal junction was identified. The coils of the intestine were untwisted and rotation was corrected. The gut color changed back to normal. She was discharged painless after routine post-operative care.
Habibullah Khan
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/gjms/17.04.2099

Abstract:
A young lady presented with history of giddiness, blackouts, and darkness of her skin colour especially the face. On examination the colour of her skin was quite dark but not much darker than her spouse. She had buccal pigmentations and her palmar creases were obviously pigmented. Facility for short Synacthen test was not available. Her serum cortisol was on the lower normal side and ACTH was sky high; 1024 pg/ml (ref. range adults: 6-76 pg/ml). She was screened for ectopic ACTH production which could not reveal any pathology. Also plain abdominal x-ray didn’t show any adrenal calcification. She was labeled as Addison’s disease and improved drastically after replacement therapy (Cortisone + Fludrocortisone). Giddiness aloof, she was delighted with the fairness of her colour.
Harish Kumar, Adnan Bashir, Khadijah Abid, Nabeel Naeem Baig
Gomal Journal of Medical Sciences, Volume 17, pp 107-111; https://doi.org/10.46903/gjms/17.04.1861

Abstract:
Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan. Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05. Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=
Muhammad Kamran Khalid, Iftikhar Ahamad, Muhammad Ayub Khan, Muhammad Sharjeel, Muhammad Irfan, Muhammad Marwat
Gomal Journal of Medical Sciences, Volume 17, pp 123-130; https://doi.org/10.46903/gjms/17.04.2025

Abstract:
Background: Pediatric cataracts cause significant visual disability worldwide. The objectives of this study were to determine the distribution of pediatric cataracts by sex, age groups, laterality, type and presentation in population of D.I.Khan District, Pakistan. Materials & Methods: This descriptive study was carried out at Department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2015. Sample was collected from Eye unit, DHQ Teaching Hospital, D.I.Khan. Pediatric cataract patients under 14 years of age were included in the study. Demographic variables were sex and age groups. Research variables were laterality, type and presentation. All variables being nominal were analyzed through frequency and percentages. The observed and expected distribution of pediatric cataract by sex, age groups, laterality, type and presentation were respectively tested by chi-square goodness of fit test. Results: Out of a sample of 47 patients, 29 (61.7%) were boys and 18 (38.3%) girls, 22 (46.81%) were
Muhammad Hanif Mengal, Hina Abbas, Kiran Aamir, Aamir Ramzan
Gomal Journal of Medical Sciences, Volume 17, pp 117-122; https://doi.org/10.46903/gjms/17.04.1968

Abstract:
Background: Thrombophilia is a common risk factor for venous thromboembolism. The objective of this study was to determine prevalence of inherited protein C and protein S deficiency in renal transplant candidates of Sindh Province, Pakistan. Material & Methods: This cross-sectional study was conducted in Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from 16-10-2010 to 15-4-2011. 300 renal transplant candidates were selected. Candidates with acquired thrombotic disorders, women taking oral contraceptives and patients taking anti-coagulants during previous one week were excluded. Venous blood samples were collected before starting dialysis procedure or at least two days after last dialysis session. Platelet-poor plasma (PPP) was parted using plastic pipettes and protein C and protein S were processed on coagulation analyzer. Sex, age groups (
Sher Zamir, Azhar Ijaz, Muhammad Umair, Rahat Jan Wazir, Mohammad Salman, Aamir Nazir
Gomal Journal of Medical Sciences, Volume 17, pp 112-116; https://doi.org/10.46903/gjms/17.04.2083

Abstract:
Background: Literature has reported thyroid functional abnormalities in diabetes mellitus. The objectives of this study were to determine and compare the serum concentrations of T3, T4 and TSH in alloxan-induced type 1 diabetic and control Wistar albino rats. Materials & Methods: It was an experimental animal study on 20 Wistar albino rats, extending over a period of eight weeks. Alloxan, a diabetogenic agent, was used to produce animal models of type 1 diabetes. Animals were divided equally into two groups: control and diabetic. The animals in the diabetic group were injected intraperitoneally with 150 mg/kg body weight of 10% alloxan to induce diabetes. After 72 hours, diabetes was confirmed with glucometer (glucose >350mg/dl). During the course of experiment, one rat in control group and 2 rats in diabetic group died. Blood was collected for estimation of serum concentrations of thyroid hormones, thyroid stimulating hormone at the end of experimental period. Serum T3, T4, and TSH were measured using ELISA kits. Results: At the end of eight weeks, the mean concentration of serum T3 was 0.69 ±0.29 ng/ml and 0.44±0.02 ng/ml in control and diabetic groups, respectively. The mean concentration of T4 was 3.78±1.16 μg/dl and 2.24±0.86 μg/dl in control and diabetic groups respectively. The mean concentration of TSH was 0.77±0.20 μU/ml and 1.41±0.23 μU/ml in control and diabetic groups respectively. The mean serum concentrations of T3 (p=.0025) and T4 (p=<.00001) were significantly lower in diabetic and that of TSH (p=<.00001) were significantly higher in diabetic than control group. Conclusion: This study concludes that the serum concentrations of both T3 and T4 are significantly lower and that of TSH is significantly higher in alloxan-induced type 1 diabetic as compared to control group in Wistar albino rats.
Iftikhar Ahmad
Gomal Journal of Medical Sciences, Volume 17, pp 105-106; https://doi.org/10.46903/gjms/17.04.2094

Abstract:
Being signatory to Alma Ata declaration, the Government of Pakistan started the ‘National Program for Family Planning and Primary Health Care’ (NPFP & PHC), also called ‘Lady Health Workers (LHWs) program’ in 1994. Being one of the largest and successful, community-based program in the world, it is providing door-step PHC services to about one billion people, especially home-bound, rural, poor women, children and elderly. The program has been improving many health indicators including infant and maternal mortality rates in the last two & a half decades.
Muhammad Sharjeel
Gomal Journal of Medical Sciences, Volume 16; https://doi.org/10.46903/gjms/16.04.1989

Abstract:
An eighty years old man presented with a slowly progressing, ulcerative mass near the left eye diagnosed as the advanced stage of facial basal cell carcinoma (rodent ulcer) which has involved his left eye and orbit, left nostril and left cheek area. According to the patient, it was a very slow growing tumor and has reached this stage over a span of more than ten years. He has been advised removal of his left eye and adjacent structure along with plastic reconstruction of the damaged half of the nose and face. It will be important to excise the tumor along with healthy margins to prevent recurrences. Take home message is that basal cell carcinoma should be excised early to prevent damage to the eye and nearby structures.
Sarah Yunus, Sadaf Rasheed, Amir Amanullah, Shehla Aman, Usman Ullah, Fida Ullah Wazir
Gomal Journal of Medical Sciences, Volume 16, pp 101-104; https://doi.org/10.46903/gjms/16.04.1892

Abstract:
Background: Infertility is a social problem and a big stigma. The objectives of the study were to determine the age wise distribution of ovarian volume and the difference in ovarian volume between married fertile and infertile women with transvaginal sonography. Materials & Methods: This comparative, cross-sectional study was conducted in the Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from March 2013 to December 2013. Sample Size was 100 women selected by consecutive non probability sampling technique. Sample size was calculated using online calculator Raosoft. Inclusion criteria were women aged 18-50 years, married, fertile and infertile. Color Doppler sonoscape with multi frequency transvaginal probes were used in measurements on any day in the start of menstrual cycle by the same observer. The volume was calculated by applying formula for ellipsoid called Prolate ellipsoid formula. The total volume was represented by sum of volume of two ovaries. Data collection site was out patient department of Radiology DHQ Teaching Hospital, D.I.Khan. Demographic variable were age groups and presence of fertility. Research variable was ovarian volume. Mean and standard deviation were calculated for ovarian volume whereas frequency and percentages were calculated for age groups and presence of fertility. Descriptive statistics along with estimation of parameter was done at 95% confidence interval for proportion and mean. Student- t test was used for significance of difference in ovarian volume between fertile and infertile women with p value
Shahid Nawaz, Fakhar Hayat, Sarfaraz Khan, Sarah Rehman, Noor Sardar, Shehla Aman
Gomal Journal of Medical Sciences, Volume 16, pp 97-100; https://doi.org/10.46903/gjms/16.04.1694

Abstract:
ABSTARCT Background: Ventriculoperitoneal (VP) shunt is a common procedure for treatment of hydrocephalus. The objectives of the study were to determine the causes of hydrocephalus and complications of VP shunt in our pediatric population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Neurosurgery, Gomal Medical College, D.I.Khan, Pakistan from January 2018 to January 2019. The sample size was 97 selected through consecutive, non-probability sampling technique using online sample size calculator, the Raosoft. The inclusion criteria were all pediatric patients with hydrocephalus. All those post-operative patient operated for other pathologies of brain and spine without VP shunt were excluded from the study. CT or MRI of brain with and without contrast were done. Post operatively all the patients were followed up till 6 months and any complication which occurred were documented. Demographic variable were sex and age in years. Research variables were causes of hydrocephalus and post-operative complications of VP shunt. All variables except age in years being categorical were analyzed through frequency and percentages. Age was calculated by mean and SD using SPSS version 20. Results: Out of 97 patients, boys were 59(60.82%) and girls were 38(39.17%). The mean age of the sample was 4.5 ±5 ranging from 5 months to 13 years. The most common cause was aqueductal stenosis having 58(59.7 %), myelo-meningocele were 17(17.7%), post meningitis were 12(12.3%) and remaining 10(10.3%) were associated with brain tumors. Out of 21 patients 12(57.2%) developed shunt obstruction, 5(23.8%) shunt infection, 2(9.5%) developed post-operative seizures, 2(9.5%) had exteriorization of lower end of shunt through abdominal incision. Conclusion: The most common cause of hydrocephalus is acqueductal stenosis. The most common complication of VP shunt is shunt obstruction in pediatric population, having pre-school boys as modal group.
Fauzia Anbreen, Samina Qadir, Hira Naeem, Najma Farhat, Maria Ghafoor, Sualeh Hassan
Gomal Journal of Medical Sciences, Volume 16, pp 92-96; https://doi.org/10.46903/gjms/16.04.1958

Abstract:
Background: The frequency of hysterectomy varies in same geographical area. The objectives of this study were to determine the type, time trend and indications of hysterectomy in our population. Materials & Methods: This cross-sectional, study was conducted in the Department of Gynecology and Obstetrics, Gomal Medical College, D.I.Khan, Pakistan, from 1st January 2013 to 31st December 2016. A sample size of 571 was selected through consecutive technique. Inclusion criteria were all hysterectomies done for gynecological indications. Demographic variable was age groups. Research variables were type, time trend and indications for hysterectomy. All variables being categorical were expressed as frequency and percentages. 95% confidence interval for proportion were calculated. SPSS version 19 was used for statistical analysis. Results: Out of 571 hysterectomies, 333(58.31 %) were abdominal and 238(41.68 %) were vaginal. Age-wise distribution of hysterectomies shows >61 is the modal age group. The hysterectomy frequency increased from 7% of total gynecological admission during 2013 to 17% of total gynecological admission in 2016. The indication for hysterectomy by type from 2013-2016 was menstrual disorders and uterine prolapse. Conclusion: Trans abdominal hysterectomies were more common than vaginal hysterectomies. Most common age group for hysterectomy was older than 60 years. The indication for abdominal hysterectomy was menstrual disorders whereas the only indication for vaginal hysterectomy was uterine prolapse. Line diagram was showing an increase in hysterectomy frequency over time from 2013-16.
Rashid Azeem, Nadia Altaf, Syed Humayun Shah, Naeem Khattack, Muhammad Tariq Masood Khan, Muhammad Tahir
Gomal Journal of Medical Sciences, Volume 16, pp 105-108; https://doi.org/10.46903/gjms/16.04.1915

Abstract:
Background: Blood products transfusion has been a major treatment modality especially in critical care settings. The objectives of this study were to determine frequency and distribution of blood products transfusion in public and private health care facilities during 2012-2013 in Peshawar, Pakistan. Materials & Methods: This cross-sectional, study was conducted in the Department of Pathology, Northwest School of Medicine, Peshawar, Pakistan from 1st January 2012 to 31st December 2013. Sample size was 2,04,942 blood products transfusion, selected through consecutive non probability technique. All allogeneic cases of transfusions in inpatient and emergency were included. A total of six public, one private and two stand-alone blood banks were enrolled into the study. Demographic variable were name of the health care facility, sex and age groups of donors. Research variables were type of blood products transfusion (whole blood, packed red blood cell, fresh frozen plasma, platelets). All variables being categorical were described as count and percentages. Data was analyzed using software SPSS version 23. Results: Out of 2,04,942 units, 1,33,212 (65%) were men and 71,730 (35%) women. Packed red blood cells were the most commonly used component with 80227 units (39.1%), whole blood 77655 units (37.8%), Fresh frozen plasma 35932 units (17.5%) and platelets 11128 units (5.6%). Blood products transfusion was 46927 units (22.89%) in 65 years. Conclusion: Modal group was men. Packed red blood cells were the most frequently transfused blood component in hospitals of Peshawar especially Lady reading hospital. Most common age group was 18-40 years. Whole blood still comprises a significant fraction of transfusions which is alarming.
Fahmida Khatoon
Gomal Journal of Medical Sciences, Volume 17, pp 58-62; https://doi.org/10.46903/gjms/17.02.2022

Abstract:
The biological samples used in forensics can contain DNA which is highly fragmented as a consequence of exposure to any of the numerous degrading factors. Analysis of the sequence or size of the products of Polymerase chain reaction is at present responsible for the analysis of remains of humans in forensics. Despite the effectiveness of protocols based on PCR, there are certain limitations that are presented by the low numbers of copies of the template and the variations that are imposed by the decaying process to the template. The primary aim of this research is to explore the significance of autosomal SNPs in forensic science through the identification of humans at a crime scene. This study provides an exploration of the applicability of autosomal SNPs for the identification of humans at crime scene. This would fill the gap present in the current literature regarding the significance of autosomal SNPs in the identification of humans during crime scene investigation. It will also enable the identification of the criminals involved in several types of the crimes ranging from general theft to rape and sexual assault, murder, and robberies. It will also allow the identification of dead bodies in cases where it is difficult to identify the dead person due to unrecognizable condition of the body. This study will facilitate the improvement of the investigation of crime scene investigators. It will provide a significant way for the incorporation of recent techniques of the molecular genetics into forensics. Reduction in the workload of the crime scene investigators would also occur through the implementation of outcomes of this study into the field of forensic science. There are several studies which have demonstrated the applicability of SNPs in forensic investigations for identifying the humans at crime scene. Several effective and efficient technological systems have been developed by the researchers which are capable of performing analysis of biological samples containing degraded DNA because SNPs can be obtained from these samples. Physical characteristics of the individuals can be predicted through the analysis of SNPs. This can provide significant information about the color of eye, hair and skin of the individuals involved in crime.
Fazle Bari, Sajjad Ahmad, Hamzullah Khan
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/17.02.1870

Abstract:
Background: Nosocomial infections are major health issues in developing as well as developed countries. The objective of this study was to determine the frequency of MBL production in Pseudomnas aeruginosa that causes resistance to Imipenem and other ß-lactam antibiotics. Materials & Methods: A sample of 52 Imipenem resistant Pseudomnas aeruginosa colonizing or infecting the hospitalized patients were collected in Department of Pathology, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from June 2014 till May 2016. The organisms were identified by routine laboratory tests including biochemical methods and API NE System (Biomeriux) and the sensitivity pattern of commonly used antibiotics was established for each of these isolates using the disc diffusion method. Imipenem resistant strains were tested for MBL production by Imipenem-EDTA disc diffusion method. Results: The frequency of MBL activity was positive in 39 (75%) cases of Pseudomnas aeruginosa which encodes resistance to Imipenem and other ß-lactam antibiotics except monobactam. The sensitivity pattern of these antibiotics was as follows: piperacillin/ tazobactam 30.8%, amikacin and polymyxin B each 17.9%, tobramycin 12.8%, cefoperazone/ sulbactam and ceftazidime each 5.1%, ciprofloxacin, moxifloxacin, colistin sulphate, tetracycline, azithromycin and aztreonam each 2.6% and co-trimoxzole, gentamicin & rifampin each 0%. Conclusion: MBL production in P. aeruginosa confers a challenge for clinicians to treat such resistant infections with conventional antibiotics. Therefore testing each Imipenem resistant Pseudomnas aeruginosa for MBL production must be taken in routine consideration.
Mohammad Riazuddin Ghori, Hamzullah Khan, Muhammad Marwat
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/17.02.1926

Abstract:
Background: The distribution of non-malignant hematological disorder varies across globe by sex, age groups and type of disease. The objectives of this study were to determine distribution of non-malignant hematological disorders by sex, age groups and type of disease based on bone marrow aspiration in population of Khyber Pakhtunkhwa, Pakistan. Materials and Methods: This cross-sectional study was conducted in Department of Pathology, Khyber Teaching Hospital, Peshawar, Pakistan from Jan.-Dec. 2014. 116 cases with non-malignant hematogical disorders were selected. Sex, age groups and type of disease were analyzed by count and percentage with confidence intervals for proportions. Chi-square goodness-of-fit test was used to testify two hypotheses. Results: Out of 116 cases, 63(54.31%, 80%CI 48.38-60.24) were men and 53(45.69%, 80% CI 39.76-51.62) women. Age groups wise; 31(26.72%, 80%CI 21.46-31.99) were child (≤17 years), 57(49.14%, 80%CI 43.19-55.09) young adult (18-35 years), 19(16.38%, 80%CI 11.98-20.78) middle-aged adults (36-55 years) and nine (7.76%, 80%CI 4.57-10.94) older adults (≥56 years). Frequency of type of disease was; hemolytic anemia 17(14.66%, 80%CI 10.45-18.86), megaloblastic anemia 16(13.79%, 80%CI 9.69-17.9), bone marrow hypoplasia 14(12.07%, 80%CI 8.19-15.95), iron deficiency anemia 13(11.21%, 80%CI 7.45-14.96), mixed deficiency anemia 9(7.76%, 80%CI 4.57-10.94), ITP 9(7.76%, 80%CI 4.57-10.94), aplastic anemia 8(6.89%, 80%CI 3.88-9.91), bi-liniage cytopenia 7(6.03%, 80%CI 3.2-8.87), erythroid hyperplasia 3(2.59%, 80%CI .7-4.47) and malaria 2(1.72%, 80%CI 0.18-3.27). In 18(15.52%, 80%CI 11.21-19.83) cases the bone marrow was diluted. Null hypothesis for distribution of sex (p=.3532) was accepted while that for age groups was rejected (p=
Fahmida Khatoon
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/17.02.2022

Abstract:
The biological samples used in forensics can contain DNA which is highly fragmented as a consequence of exposure to any of the numerous degrading factors. Analysis of the sequence or size of the products of Polymerase chain reaction is at present responsible for the analysis of remains of humans in forensics. Despite the effectiveness of protocols based on PCR, there are certain limitations that are presented by the low numbers of copies of the template and the variations that are imposed by the decaying process to the template. The primary aim of this research is to explore the significance of autosomal SNPs in forensic science through the identification of humans at a crime scene. This study provides an exploration of the applicability of autosomal SNPs for the identification of humans at crime scene. This would fill the gap present in the current literature regarding the significance of autosomal SNPs in the identification of humans during crime scene investigation. It will also enable the identification of the criminals involved in several types of the crimes ranging from general theft to rape and sexual assault, murder, and robberies. It will also allow the identification of dead bodies in cases where it is difficult to identify the dead person due to unrecognizable condition of the body. This study will facilitate the improvement of the investigation of crime scene investigators. It will provide a significant way for the incorporation of recent techniques of the molecular genetics into forensics. Reduction in the workload of the crime scene investigators would also occur through the implementation of outcomes of this study into the field of forensic science. There are several studies which have demonstrated the applicability of SNPs in forensic investigations for identifying the humans at crime scene. Several effective and efficient technological systems have been developed by the researchers which are capable of performing analysis of biological samples containing degraded DNA because SNPs can be obtained from these samples. Physical characteristics of the individuals can be predicted through the analysis of SNPs. This can provide significant information about the color of eye, hair and skin of the individuals involved in crime.
Jamshed Khan, Muhammad Junaid, Shahab Uddin, Khalida Moeed, Usman Ullah, Shehla Aman
Gomal Journal of Medical Sciences, Volume 17; https://doi.org/10.46903/17.02.1908

Abstract:
Background: Intellectual disability (ID) is a neuro-developmental defect that is manifested by development delay and learning disability. Such defects may be caused due to chromosomal disorders (trisomy 18 or Down syndrome) or single gene mutation. Its worldwide prevalence is estimated to be 1-3%. The genetic etiology of non-syndromic ID is poorly understood. To date, more than 100 loci have been reported to be associated with non-syndromic ID. The objective of this study was to identify the causative genes for three Materials & Methods: This cross-sectional study was conducted in the Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan from March 2014 to August 2015. The inclusion criteria set for the families was consanguineous relation and more than two patients per family (including cousins). All the patients were tested individually in friendly atmosphere using IQ test to scale the ID on the basis of performance. Thereafter, blood samples were taken by aseptic method and DNA was extracted for the purpose of doing genetic analysis. In genetic analysis, exome sequencing was performed to find the pathogenic variants. Subsequently. Sanger sequencing was also done to see the segregation of pathogenic variants. Results: Genetic analysis found mutation in AP4B1 in Family 1, in WDR62 in Family 2, while Family 3 was unremarkable. Conclusion: The study involved genetic analysis of three consanguineous families and found mutation in AP4B1 in Family 1, in WDR62 in Family 2, while Family 3 was unremarkable. The present research will help in devising molecular diagnostic technics for pre-marital and pre-conception testing.
Sheikh Qais Falah
Gomal Journal of Medical Sciences, Volume 17, pp 56-57; https://doi.org/10.46903/gjms/17.02.2035

Abstract:
A 16 years old boy presented with three months history of left inguinal hernia. On examination, he had two normal testicles in scrotum, one on either side. During left inguinal exploration for hernia repair, a third undescended testicle was found incidentally, which was excised.
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