INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH

7-11

Authors: Rabab Batool1, Muhammad Imran2*, Abdul Hafeez Kandhro3, Zainab Barry4,Naseem Salahuddin4 & Muhammad K H Uddin5

Background: The high burden of multi-drug resistance tuberculosis (MDR TB) is a matter of great concern. The increasing resistance to anti tuberculosis drugs has been the area of growing concern and are posing threats to TB control. The aim of this study was to evaluate the drug resistance patterns for the first line and second line anti-Tuberculosis drugs in multiple drug resistant tuberculosis (MDR-TB) patients. Method: The study was retrospective, observational, employing purposive, non-random sampling technique for data collection conducted at the TB Clinic- of the different healthcare centers in the provinces of Pakistan Sindh and Baluchistan from December 2010 to May 2016. All bacteriologically confirmed TB patients who were found to be Rifampin Resistant (RR) on Genotypic drug susceptibility testing (GXP), or detected to be drug resistant on phenotypic Universal drug susceptibility testing were enrolled into the study. Results: Out of total 3776 patients, 96.3% were resistant to Rifampicin and 94.7% were resistant to Isoniazid. 25.5% isolates were resistant to all five first line drugs. Resistances against Pyrazinamide and Ethambutol was 54.2% and 51.6% respectively. 36.3% patients were resistant to Fluoroquinolones (FQ), 9.7% were resistant to Ethionamide (Eto) and 4.1% were resistant to both FQ and Eto. 33.5% patients were MDR plus resistant to FQ. However, the resistance to both FQ plus Aminogycosides was quite low, 2.7%. Conclusion: The drug resistance rates are quiet high in MDR-TB for both first line and second line drugs. The standardized MDR TB regimen needs to be updated, based on the prevalence of drug resistance patterns in the community for the effective management of drug resistant TB.

17-22

Authors: Umaima Waris1*, Tehreem Shafqat1 & Sehrish Hameed1

Background: Depression is an important health problem due to its prevalence and associated consequences. The life time prevalence of depression ranges between 10 to 21 % in population. According to the precipitation of the WHO, depression is estimated to become the second leading cause of dysfunction by the year 2020. Among medical students, academic stressors include the volume of material to be learned, academic performance and evaluation (examinations and continuous assessments). Method: A cross-sectional study was conducted and the total of 300 Medical students from 18 to 25 years to age participated in this study. Students in this study were undergraduate students. Duke health profile were given to the students. Data analysis was done by using Chi square test. Results: 300 students from fourth year and final year were recruited for the study. Mean anxiety score was 35.4 SD + 19.9 with minimum score of 0 and maximum score of 99.6. Mean depression score was 35.9 SD + 21.8 with minimum score of 0 and maximum score of 100. Mean anxiety depression score was 28.8 SD + 33.8 with minimum score of 0 and maximum score of 100. Mental score was compared among medical students, 47.4% of fourth years and 34.2% of had severe mental stress (Score 75 – 100), Anxiety score was compared among medical students, 2.6% of fourth years and 3.4% of had severe anxiety (Score 75 – 100), Depression score was compared among medical students, 3.9% of fourth years and 5.5% of had severe depression (Score 75 – 100), 14.9% of fourth years and 18.5% of had moderate depression (Score 50 – 75). Conclusion: Anxiety score showed a little female predominance. Depression among medical students of fourth year was little more as compared to the final year students. Depression was more among male students than female students.

28-32

Authors: Rahmat Ali Khan1*, Anwar Ali2 & Ali Yasir Khan3

Background: Chronic Hepatitis C (CHC) infection is the most common chronic liver disease in patients with end-stage renal disease (ESRD) and highly prevalent on hemodialysis patients. The DOPPS data reported an overall prevalence of 13.5 percent among adult hemodialysis patients. The reported data in Pakistan reflected 26.02% hemodialysis patients with HCV infection. Over the last few years, the direct-acting antivirals have been revolutionary in the treatment of hepatitis C, and sofosbuvir (SOF) is the backbone of most modern treatment strategies with better prognosis of the infection and tolerability. The aim of the study was to assess the effectiveness and safety of Sofosbuvir regime on HCV infected patients on hemodialysis (HD) in the local population as per routine practice. Method: This was an observational, prospective; single-center study enrolled 30 HCV HD subjects on sofosbuvir ribavirin regime for 12 weeks. Results: As per results of 30 subjects’ (n= female 13, 44% and n = male 17, 56 %) with mean age ± standard deviation 60.5 ± 7.5 years. On SOF/ribavirin (RBV) treatment for 12 weeks, the sustained virological response rate was 100% (27 of 27) at 12 weeks. 95% confidence interval, (95 to 100). No patients had virologic failure during treatment. No patient had treatment discontinuation due to side effects. Adverse events were reported in at least 10% of the patients were mainly pruritus, fatigue, and nausea. No serious adverse event reported. Conclusions: The Sofosbuvir based antiviral therapy is safe and effective in the treatment of HCV with ESRD, including HD patients with a high rate of SVR in patients.

4-16

Authors: Iftikhar Alam,1,2 Attaullah Jan2, Shamoon Noushad3 & Zahoor-ul-Haq4

The main objective of this study was to evaluate the curriculum for BS degree program in Human Nutrition & Dietetics in Pakistan. For this purpose, a working group comprising of experts in the field from NEAT (a Pakistan based registered organization: www.neat.org.pk ) was assigned the responsibility to evaluate the curriculum. As suggested by the working group, a modified Delphi technique was used and a group of expert panelists (n=46) was identified. Three main ‘areas of enquiry’ ‘(AE)’ were proposed, where the responses from the panels were requested: AE(1) evaluated the curriculum against a set of 15 characteristics reported in the literature; AE(2) evaluated the curriculum against 32-item ‘knowledge areas’ based on findings of a recent investigation. AE(3): scored the course contents of individual courses against a ‘perceived standards’ in light of a 14-item Battery. For AE(1) and (2) and (3), the panelists responded, respectively, on scoring scale (0 – 4) and ticked any one from 1 -3. The data were analyzed for mean and median scores for each individual item. Findings of AE(1) suggest that majority of the panelists agreed that the curriculum ‘adequately’/’excellently’ highlighted the fifteen criteria set-forth. Findings of AE(2) suggest 8 out of 32 ‘knowledge areas’ being ‘poorly’ reflected in the curriculum. Findings of AE(3) suggest majority (28/43: 65%) of courses fulfill the perceived standards except 2 courses (“Nutrition through Life Cycle”; and “Research Methods in Nutrition”) fulfilling <50% of the required standards. In all, the findings are of suggestive that the curriculum is ‘good’ except certain shortfalls. It was recommended that the deficiencies may be addressed in the coming revision.

23-33

Authors: The study aimed at examining if social integration was associated with suicidal attitude among non-residential university students and also if there exists any group difference on the basis of private and public nature of the residence. Using purposive sampling technique 408 participants (202 girls and 206 boys) with mean age of 22 years were selected from hostels of government and private universities of Lahore. Social Network Index and Attitude towards Suicide were used to measure social integration and suicidal attitude, respectively. The findings revealed a significant negative correlation between social integration and suicidal attitude and group difference on the basis of nature of residence was also found. Non-residential students of government provided residence scored higher on both variables. The study suggests numerous avenues for further research.

The study aimed at examining if social integration was associated with suicidal attitude among non-residential university students and also if there exists any group difference on the basis of private and public nature of the residence. Using purposive sampling technique 408 participants (202 girls and 206 boys) with mean age of 22 years were selected from hostels of government and private universities of Lahore. Social Network Index and Attitude towards Suicide were used to measure social integration and suicidal attitude, respectively. The findings revealed a significant negative correlation between social integration and suicidal attitude and group difference on the basis of nature of residence was also found. Non-residential students of government provided residence scored higher on both variables. The study suggests numerous avenues for further research.

38-43

Authors: Sobia Idrees1, Shahida Abbasi2, Wais Mohammad Qarani3

One of the important responsibilities of the health care system is to meet the health needs of the population mainly through health promotion and disease prevention initiatives. This objective can be achieved through an equitable resource distribution/allocation. This paper comprises of comparative analysis of health care system of two countries i.e., Pakistan and Japan in relation to the WHO recommended guidelines on Health care system. The analysis consists of organizational environment, health care delivery model, health information management system, health indicators, financing, and workforce of both the countries. This analysis suggests some strategies to overcome the shortcomings for both the countries.

8-20

Authors: Christina Gyawali 1, 2, Chao Wang 1,3, Jie Zhou 1, Sagar Thapa 4, Jinlin Song 1, 2

Background Lingual orthodontics (LiO) has developed rapidly in recent years and research on treatment of overbite by using Rocking Chair Arch (RCA) wire of different curve depths is still limited, especially with 3-dimensional Finite Element (FE) models. The main objectives are to study the biomechanical differences in maxillary anterior teeth between lingual and labial orthodontics and observe the lingual mechanics on different inclinations of teeth. Methods The force produced by Nickel-Titanium, Stainless Steel (SS) RCA for both sides was measured using Electromechanical Universal Testing Machine. 6 FE models were constructed and divided into 2 groups according to SS wire of 0.016×0.022-inch standard and mushroom arch shaped RCA of curve depth 2, 4, 6 mm. Additional 9 FE models were constructed and divided into 3 groups based on Retroclination (-5°, -10°) and Proclination (+10°). Results Use of same diameter of SS RCA with same curve depth but on different sides shows more stress and strain, displacement of teeth in lingual mechanics. Also, stress-strain, displacement increased with increasing RCA curve depth. In LiO, intrusion of normally inclined or proclined teeth are accompanied by little or no labial tipping whereas that of retroclined teeth is accompanied by further lingual tipping. Conclusion In the intrusion using Lingual RCA, to avoid the traumatic force to teeth, the curve depth should be lesser than Labial RCA or apply more elastic arch material; Aligning different inclined teeth into normal inclination firstly and proceed with the application of intrusive force can be the best approach.

28-29

Authors: Peer Asad Aziz, Riaz.A.Raja, Syed Khizr Naim, Noor-ul-ain Qureshi, Sanaullah Pathan & Ali Abbas

This case was reported at Department of Neurosurgery, LUMHS Jamshoro, A 12 year old male patient who admitted to neurosurgery department through OPD with complains of pain in mid back for 2 years ,loss of urinary and fecal control for last 7 months ,weakness of lower limbs for last 6months and unablity to walk since last 2 months . Patient had pain in dorsolumbar region for last 2yrs which was on and off , severe in intensity , nocturnal relieved by injectable medications ,with passage of time initially he suffered from overflow incontinence followed by frank incontined=ce and developed weakness of both lower limbs which progressed from distal to proximal ,it was painless and caused patient to fell down after few steps ,then after short duration of time pt became bedridden ,on examining he had decreased power in upper limbs and had power against resitance i.e. 4/5 , griping was also weak otherwise reflexes ,tone and other findings in upper limb were normal , in both lower limb he had muscular atrophy with flaccidity , reflexes were absent ,fasciculation was negative ,power was 0/5 in both lower limbs , plantars were non responsive ,he had decreased anal tone with loss of bladder control he had anesthesia below D6 level and had kyphotic deformity and tenderness over mid back rest of CNS examination was normal . Patient was investigated and Mri of spine showed A Space occupying lesion extending from cervical to lumbar region with intra medullary presence in axial scans and.so patient underwent D9 to L1 lamenectomy with myleotomy an tumor was gross totally excised . Intraoperatively the tumor was reddish colored,with jelly like thread seen below tumor leve it was adhering spinal cord seprated and removed in piece meal .histopathology revieled oligoastrocytoma spine. Spinal oligoastrocytoma are mixed glial cells having both astrocytic and oligodendroglial components and is one of most rare of spinal cord patholiges .to date only 7 cases were reported in English literature. Such tumors occur in early adolescent and young adults till middle ages 40’s, but they can however occur in children and are very difficult to identify from astrocytomas on radiological imaging .ZHUO described one in may ‘2016 as primary spinal oligoasrocytoma in craniofacial journal. Shinztu described another in 2004 according to him these are one extremely rare conditions to occur and only few cases are reported he reported it 43 yr old and showed that disease had genetic involvement with chromosome 1p & 19q ,those with such associations have better survival ,and in that report patient further went for radiotherapy . Guo JH described primary spinal cord anaplastic oligoastrocytoma in spinal journal in feb’2016 in paraplegic patient .according to him it is rare lesion he reported it in 10 yr old girl and her mri showed intramedullary mass from c5 to d5 with syringobulbia and syringomyleia, genetic analysis showed 1p and 19q association and not 10 q association . Conclusion: To our best of knowledge it is one of extremely rare condition and only 7 cases are reported in past . This case report is to add on knowledge about spinal oligoastrocytoma to occur among children with their unique presentation and large spinal involvement from cervical to lumbar region.

37-42

Authors: Muhammad Imran1, Sumreen Begum2, Dr. Abdul Hafeez Kandhro3, Nazia Ahmed4, Rashida Qasim5

Glycemic control is a very useful parameter for the prevention of the chronic metabolic diseases complications such as diabetes, metabolic syndrome, cardiovascular and kidney disease. Glycemic control management among chronic metabolic diseases has been an area of active research from the past decades. The glycemic index specifies that how fasting blood glucose level is elevated after consuming a high carbohydrate-containing diet. The metabolic studies among the human populations showed that glycemic index is directly related with different chronic metabolic diseases. The sturdiest associations are suggested that the low caloric diet consumption can prevents metabolic complications. Primary and tight glycemic control is compulsory to prevent and reduce the development of vascular complications in individuals with chronic disorders. The aim of this review was to provide a practical guideline on the bases of the survey of the related key studies which had reflected the clinical guidelines and current perspectives related to glycemic management. The objective of this review is also to investigate the interventions, related to glycemic control in patients with diabetes, metabolic syndrome and cardiovascular diseases. In conclusion, we can say that multidisciplinary management of glycemic control are powerful measure for the prevention of metabolic diseases complications, providing necessary support for reducing in economic burden of chronic metabolic diseases.

45-51

Authors: Sonya Arshad1, Muhammad Nisar,2 Syeda Hiba Hashmi2

Objective: The study was aimed to estimate premenstrual syndrome and its consequent symptoms in married and unmarried females during menstrual phase, pre-ovulatory phase and post-ovulatory phase. Methodology: A cross sectional survey based study has been conducted in young females of 25-35 age groups. Participants were divided into two groups. Group A were with PMS and group B were healthy subjects. The evaluation of manifestations in all three phases was gathered by using PRISMcalendar. The data was collected and stored and analyzed by applying Chi-square test by using SPSS v.22.0. Result: The result revealed that the severity were different among unmarried (55%) and married (50%) in all three phases of Menstrual cycle. Unmarried female shows their symptoms 54.5% in menstrual phase , 27.3%in post ovulatory phase and 18.2% in pre ovulatory phase , while married females express 50% , 30%, 20.0% respectively in all the three phases. The significant (p<0.05)result were recorded in menstrual phase by showing back pain, anxiety, breast pain, headache, depression, nausea, abdominal cramps, irritability and swelling in both married and unmarried women. While Diarrhea and vomiting foundnon-significant (p>0.05).Constipation was additional significant factor present in married females. Discussion: The present study among unmarried females and married females revealed that premenstrual syndrome (PMS) differs in each of three groups. Women of reproductive age either married or unmarried showing significant symptoms of PMS, however different phases have different percentage among these two groups. Conclusion: According to our results, we concluded that in unmarried and married females, PMS were found frequently during menstrual phase and remaining two phases has no prevailing clinical manifestation.

5-9

Authors: Mansab Ali1, Syed Mehsam1, Adeel Hussain1, Shahid Rasul1, Sughra Parveen1,

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis. Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome. Results Mean age of the patients was 38.14 ±7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 (65.5%) patients. Stratification of age group shows, that 40 (66.7%) patients in age group ≤ 40 years had raised urinary trypsinogen-2. Stratification of gender showed significant association with raised urinary trypsinogen-2 level (p-value 0.010). Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high.

16-23

Authors: Ahson Memon1 , Junaid Ansari1 , Ghufranullah Khan1 , Khalid Rasheed1 , Ali Shan1 , Imran Ali1 , Peer Asad Aziz3 and Hamid Ali

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. (American Heart Association) AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation (IMR). Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography (TEE). Result Total number of patients included in study was222, out of those 153 (69.9%) patients underwent conventional approach and 69 (31.1) patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach. Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

30-36

Authors: Alvira Ali1, Faizan Mirza2 and Sadaf Ahmed1, 2

Objective Aroma or scent therapy is one of the traditional treatments, which is presumed to be helpful in supporting and balancing the mind, body and soul. It is a complementary therapy that has been clinically proven to be beneficial in improving various attributes of life. The aim of the study was to evaluate the effectiveness of aromatherapy on the physiological vitals of the healthy females. Methodology an observational study has been conducted to determine the effectiveness of Aromatherapy on Vitals and Physical Factors. This study targeted to recruit a small set of healthy females for the study. All the readings were collected at room temperature, between the months of November 2015 to January 2016. The recordings were compared by the two-tailed test, with probability taken as 1, to detect the influence of aromatherapy on physiological workings of the healthy human body that has been exposed to the physical strain due to the moderate level of exercise. The test involved the comparative analysis of the physiological vitals of those females who exercised regularly; their vitals were evaluated after a course of physical activity in two sets i.e. with and without aromatherapy. Result The result showed a significant difference in the pre and post status mainly in the readings for the cardiac output, pulse rate and body temperature, increases after physical activity of average intensity and is further supported by the aromatherapy. Conclusion The study came to the conclusion that aromatherapy has beneficial influences on the rate of body metabolism.

48-62

Authors: Meen Bahadur Budhthoki1 , Puja sharma2 , Saima khan3 , Saroj Singh1 , Fu Chao1 , Li Yong1

CRISPR Cas9 is highly advanced genome editing technology extensively used for the modifications of genetic components in various sectors of living organisms. This technology has been adapted from the prokaryotic immune system, where it plays a vital role in protecting bacteria and archaea from virus attacks. This robust technology has currently been proven efficient in selective and precise editing, the genome of different living organisms for different purposes ranging from therapeutic, diagnostic to programmable gene regulation. This technology has been continuously upgraded, enhancing its performance thus reducing unfavorable outcomes. Customizing this technology is not a piece of cake. Hundreds of thousands of experiments have been conducted all around the world to optimize this highly intellectual technology to make it an error prone programmable technology to serve each and every living kind. In this review, we have summarized the modifications that have been made in different components of CRISPR cas9 system, engineering of CRISPR Cas9 for specific purposes, different external factors that has to be considered to obtain the best possible outcome minimizing the hazards.