Journal of Muhammad Medical College ( J Muhammad Med Coll)
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Correlation of serum sodium with severity of hepatic encephalopathy in liver cirrhosis patients presenting at Dr. Ruth K.M. Pfau Civil Hospital Karachi.
Full text linkIntroduction: Cirrhotic patients suddenly or insidiously develop hepatic en-cephalopathy. Approximately three-fourth of the patients usually die within 3 years of onset of their first episode of hepatic encephalopathy. Hypo-natremia, a multifactorial phenomenon in cirrhotic patients may lead to cer-ebral edema and astrocytes swelling.Objective: To determine the correlation of serum sodium with severity of hepatic encephalopathy in liver cirrhosis patients presenting at tertiary care hospital, Karachi.Methodology: This prospective cross-sectional study conducted at Depart-ment of Medicine, Civil Hospital, Karachi between October 31, 2019 till April 4,2020. Data collected from 138 patients after taking written consent; pre-sented as was as mean, standard deviation, frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable taking p-value of ≤0.05 as significant.Results: Among 138 patients 92 (66.7%) were male and 46 (33.3%) were female. Mean age, duration of symptoms, height, weight and serum sodium in our study was 51.14±4.49 years, 12±7.21 hours, 161±6.78 cm, 85.2±8.54 kg and 132.7±6.32 mEq/L. Out of 136 patients, 28 (20.3%), 35 (25.4%), 54 (39.1%) and 21 (15.2%) patients belonged to sodium quartile 1, 2, 3 and 4; while 21 (15.2%), 41 (29.7%), 28 (20.3%) and 48 (34.8%) belonged to hepatic encephalopathy severity grade 1, 2, 3 and 4. Hepatic encephalopathy severi-ty showed correlation with rising sodium levels.Conclusion: Hyponatremia was found with increased frequency in patients with cirrhosis of liver having a correlation with frequency and severity of hepatic encephalopathy.Key words: Encephalopathy, Liver Cirrhosis, Hyponatremia
Histomorphometric effects of Raphanus Sativus leaf ex-tract on Carbon Tetrachloride induced hepatotoxicity.
Full text linkIntroduction: Carbon tetrachloride (CCl4) adversely affect the structural/ and or functional properties of the hepatic tissue, leading to grave implica-tions. Currently plant-based compounds have gained sufficient space in the treatment of liver diseases. Among such plants is Raphanus sativus, a cru-ciferous plant also commonly called Radish, which has since long been used in traditional medicine.Objective: To evaluate the protective role of Raphanus sativus in CCl4-induced hepatotoxicity through assessment of liver function and oxidative stress markers in albino Wistar rats.Methodology: This Quasi-experimental study was conducted between Sep-tember 2019 to March 2020 at the Postgraduate Research Laboratory Isra University, Hyderabad. Albino Wistar selected by non-random purposive sampling were divided equally into three different groups: Group A (control group), Group B (CCl4 experimental group), and Group C (CCl4 plus Raphanus sativus group). Blood samples were collected through cardiac puncture followed by hepatic histopathological analysis using light micro-scope. Data was analyzed using SPSS version 24, with ANOVA and Post hoc Tukey’s analysis used for comparison of different study variables.Results: Statistically significant rise relative liver weight of group B rats compared with the group A and C rats (P <0.05). Moreover, statistically sig-nificant (P <0.05) rise in serum markers of hepatic functions was observed after CCl4 administration in Group B. Treatment with Raphanus Sativus ad-ministration significantly reduced serum levels of LFTs (p<0.05). There was a significant decline in the plasma levels of oxidative markers in group B while marked histopathological changes like necrosis, sinusoidal dilatation and congestion observed among animals of group B.Conclusion: Raphanus Sativus exerts an anti-oxidative, and hepato-protective effect against CCl4-induced hepatic tissue damage.Keywords: CCl4, Hepato-protective, Raphanus Sativus
Clinical Presentation of Alzheimer Disease (ad): a hospital based observational study.
Full text linkIntroduction: Alzheimer's disease (AD) is a neurodegenerative illness that mani-fests itself clinically and pathologically.Objective: To identify the various patterns of Alzheimer’s disease (AD) in adults.Methodology: A hospital based observational study was conducted in the Depart-ment of Neurology Jinnah Postgraduate Medical Centre (JPMC) Karachi, Pakistan from May 2018 to November 2019.Cases with complaint of memory impairment and/or cognitive impairment, with or without behavioral changes were included in the study. Acute delirious state uremia / hepatic encephalopathy hypo / hypergly-cemia and hypo / hypernatremia were excluded diagnosis. The main outcome measures were clinical patterns of AD with age and sex distribution, affective disor-der with cognitive impairment (Pseudo dementia) and affective disorder without cognitive impairment.Results: A sample of 51 cases (36 males and 15 females) with memory impairment was included. Age’s between 25-85years (mean 57years). Out of 51 cases 44 had probable /possible Alzheimer’s disease (AD) 03 had affective disorder with cogni-tive impairment (pseudo dementia), 04 patients had affective disorder without cognitive impairment. Among probable / possible cases of AD 23 (52.27%) had multi infarct dementia (having history of past cerebrovascular disease), same sta-tistics among Parkinson’s patient’s i.e. diagnosis was Parkinson’s disease with memory impairment were 18 (40.90%) followed by alcoholic dementia in 03 (6.8%). There was no definite Alzheimer’s disease case in this study.Conclusion: Vascular dementia not the definite Alzheimer’s disease is the com-monest memory impairment type presentation in our study. Among Parkinson’s disease patient’s dementia was found quite high in our study.Keywords: Alzheimer’s disease (AD), Vascular dementia (MID), Parkinson’s disease (PD), Cognition, Memory
Co-occurrence of sleeping difficulties with urbanization and food choice in female university students.
Full text linkIntroduction: Sleep is a basic and essential need of human beings, large number of sleep related problems are demonstrated in all age groups with different pro-moting factor( s), these may be biological, social, economical or environmental. Literature is scanty to identify co factors of sleep disturbances in apparently healthy females.Objective: To analyze association of sleep disorders in females with rural/ urban settings of living and certain dietary habits.Methodology: A cross sectional /survey-based study was performed in University of Sindh Jamshoro. The sample size (n) was 520.The data comprised of females aged between 18 -26 years. Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality among the participants along with self-structured question-naire which was used for other variables such as consumption of junk food and its frequency of intake and breakfast intake.Results: Out of 520 participants, 310 (60%) were living in urban areas shows com-paratively higher frequency of poor sleep (n=262,50.5%; p=0.01-odd ratio=2.18) than those who were living in rural setups. Poor sleep was also observed in junk food eaters (n=304, 58%) however no association was observed in pattern of breakfast with sleep.Conclusion: The study concluded the prevalence of poor sleep was found more in urban female dwellers.Keywords: sleep, rural, urban, junk food, breakfast, Pittsburgh Sleep Quality Index (PSQI)
Fracture of hyoid bone in association with gender, fusion, symmetry and various modes of strangulation.
Full text linkIntroduction: U-shaped hyoid bone present in the ventral aspect of pharynx is un-likely to be fractured; therefore fracture of hyoid bone when found is a very im-portant finding in unnatural deaths.Objective: To determine association of the fracture of hyoid bone with different modes of strangulation.Methodology: This descriptive study was conducted in the Department of Anatomy and Department of Forensic Medicine; Liaquat University of Medical and Health Sciences Jamshoro Sindh Pakistan from March 2016 to March 2019. During study period total of 63 hyoid bones were grouped according to age, gender, modalities of strangulation. The bones were examined for symmetry, fusion and fracture.Results: Out of 63 bones, 55.6 % found fused and 44.5% were unfused. Among fused hyoid (n=35), 20 found in male and 15 were from female. On the other hand unfused hyoid bone is uncommon in male as compared to female (9 vs 19). The chi-square statistic is 3.9135. The p-value is .047899. Significant at p < .05. Fracture of hyoid bone identified in 30; among these 23 were fused and 7 were unfused.Conclusion: When cause of death is strangulation, fused hyoid fractured more com-monly as compared to unfused hyoid bone.
Keywords: Forensic Age, Fracture Hyoid, Strangulation. Fusion, of Hyoid
Heterotopic pregnancy: A case Report.
Full text linkHeterotopic pregnancy (HP) is a rare phenomenon. It is defined as simultaneous presence of intrauterine and extrauterine pregnancy. A case of HP is discussed. A young patient presented initially with two months amenorrhea and lower abdominal pain. Initial ultrasound showed only 6 weeks intrauterine pregnancy. But, due to increasing severity of pain ultrasound was repeated showing heterotopic pregnancy, which was later confirmed by histopathology.
Keywords: Tubal pregnancy, Ectopic pregnancy, Heterotopic pregnancy .
 
An observational study on congenital talipes equinovarus.
Full text linkIntroduction: Clubfoot or Congenital Talipes Equinovarus (CTEV) is a congenital ab-normality characterized by the permanent foot morphological alteration, conse-quently individual is unable to lean the foot properly on the floor in an appropriate physiological manner.Objective: To execute an observational study on Congenital Talipes Equinovarus (CTEV) in the Orthopedic Department of Indus Medical College Hospital, Tando Mu-hammad Khan.Methodology: Study conducted from Jan 2018 to Jan 2019 at Orthopedic Depart-ment of Indus Medical College Hospital, Tando Muhamad Khan. Medial Crease (MC), Curved Lateral Border (CLB), and Lateral Head of Talus (LHT) assessed based on the Mid Foot Contracture Score (MFCS). Also, an assessment of the Posterior Crease (PC), Empty Heel (EH) and Right Equinus (RE) made as part of the Hind-foot Contracture Score (HFCS). Data collected from 100 participants through conven-ience sampling technique and quantitative analysis performed.Results: Of all participants, Pirani score was calculated from 0 to 1. Scoring is based on the average values. It has been found that the incidence of curved lateral border was 30%, medial crease as 55% and lateral head of talus as 15%. Additionally, it has been found that the empty heel incidence is 35%, posterior crease is 60% and rigid Equinus as 15%. These results reveal that there is a high incidence of CTAV in the given sample.Conclusion: The study revealed that the exact cause (s) of CTEV are still unknown.
Keywords: Congenital Talipes Equinovarus (CTEV), Pirani score, Pediatric Orthope-di
Uterine Perforation Due To Unsafe Abortion: A Case Report.
Full text linkIntroduction: An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both. Majority of these unsafe abortions are carried out in under developing countries, usually by unskilled persons who do not have proper knowledge of the anatomy of reproductive organs and in unhygienic environments thus leading to various complications.
Case: We discuss the case of a 40 year old female who presented in septic shock after she underwent an unsafe abortion of 14th weeks pregnancy with uterine wall perforation and bowel injury that required resection.
Conclusion: Unsafe abortion is an important public health problem which accounts for a significant cause of maternal mortality and morbidity in resource poor countries.
Keywords: Unsafe abortion, Uterine perforation, Intestinal obstruction.
 
Prevalence of Neural tube defects at PUMHS Hospital.
Full text linkIntroduction: Spina bifida, anencephaly, and encephalocele are neural tube defects (NTD) and result from failure of closure of the neural tube between 21and 28 days following conception. Encephaloceles are possibly post-closure defects. NTDs are an important cause of mortality and morbidity globally. NTD encompasses about one-tenth of the burden of all congenital conditions and make up the third largest congenital burden after congenital heart disease and Down’s syndrome. In low income countries, NTDs may account for 29% of neonatal deaths in observable birth defects
Objective: To know the prevalence of neural tube defects at PUMHS Benazirabad..
Methodology: All pregnant ladies when diagnosed to have fetus with neural tube defect through ultrasound examination were counselled for termination of pregnancy. Data collected through proforma with details of demography, gynecological history, and type of neural tube defect evaluated by senior gynecologist and neonatologist. NTDs were defined as cases of anencephaly, spina bifida, encephalocele and meningocele among infants of any gestational age.
Results: A total of 7152 deliveries took place in the obstetrics department of PUMHS Hospital from January 2018 to September 2019. 38 (thirty-eight) pregnancies were terminated at different gestational ages, diagnosed as cases of neural tube defects, making a prevalence of 5.313 per 1000 births. Among the NT defects, 22/38 (57.89%) were anencephaly and 12/38 (31.57%) were spina bifida with hydrocephalus.
Conclusion: The most common neural tube defect is anencephaly followed by spina bifida with hydrocephalus. Overall prevalence of NTD is comparable published literature from South East Asia.
Keywords: Neural tube defects, Anencephaly, Spina bifida, Hydrocephalus.
 
Seroprevalence of Hepatitis-B virus and Hepatitis-C virus in pregnant women in Hyderabad.
Full text linkIntroduction: Infections of the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are major global public health problem. Approximately 350 million and 190 million people worldwide are infected with HBV and HCV respectively.
Objective: To evaluate seroprevalence of hepatitis B and C among pregnant women of Hyderabad.
Methodology: This prospective cross sectional study conducted at Pathology department of a tertiary care hospital of Hyderabad during Jan 2019 to July 2019. During period of study data of 500 pregnant women recorded on pre structured proforma after taking informed consent. Causes of hepatitis other than B or C virus were excluded. Status of HCV and HBV was confirmed using Elisa method.
Results: showed 7% seropositivity for HCV and 4.2% for HBV among pregnant women.
Conclusion: Among pregnant females, in Hyderabad there is a higher seropositivity of anti HCV antibodies as compared to HBsAg. Both seropositivity to HBV and HCV was found to be more prevalent in the 30-39 year age group.
Keywords: Pregnant women, Hyderabad, Seroprevalence HCV, Seroprevalence HBV.