INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES

3233-3235

Authors: Muzaffar Munir, Tanveer Ahmed, Farzana Muneer

Background: Anemia is the state or condition in which the volume of blood to take oxygen is less than the capacity required. This retrospective study was conducted to analyzed the immensity of Deficiency of Iron Anemia in THQ Hospital Chowk Azam Layyah, during from Feb 2017 to January 2018 to evaluate the prevalence different stages of anemic patients in this area. Aim: Objective of this study was to evaluate the prevalence of different anemic grades in patients to give better treatment and to improve quality of life of patients. Methods: Two hundred patients were included in this study who met all the criteria needed to this study. In this study we examined blood tests, CBC reports of all patients in the laboratory. Moreover, including detailed patient’s history, previous diseases, current diseases, anemia history in family, gynecological history of women were examined. Results: In all two hundred anemic patients, we found one hundred and seventy (85%) patients had deficiency of iron and 30 (15%) patients had inadequacy of non-iron (lack of other minerals) anemia. Most of the patients (58.8%) who had less volume of iron were aged of 21 to 32 Years. On basis of serum fertin level (SFL), We observed the intensity of deficiency of iron and classify into modest, mildest and acute groups. We found 120 (70.6%) patients had modest IDA (iron deficiency anemia), 20 (11.8%) patients had acute and rest (17.6%) had mildest deficiency of iron anemia. In 160 IDA patient’s women were 95 (55.9%), 40 (23.5%) were men > 19 years and 35 (20.6%) were growing children had an aged < 14 years. Conclusion: In this study, we observed deficiency of iron is the most frequent cause in patients of anemia, especially in females.

3239-3243

Authors: Muhammad Rumais Mahde, Dr. Kinza Imran, Dr. Danish Ahmed

We aimed to evaluate the impact of topical hemostatic sealants and bipolar coagulation during laparoscopic ovarian endometriotic cyst resection on ovarian reserve by comparing the rates of decrease in anti‐ Müllerian hormone. Laparoscopy has become the most common procedure in recent set-ups. It is now a major diagnostic as well as therapeutic modality for infertility, endometriosis, extrauterine pregnancy and benign ovarian tumors. The aim of the study was to share the experience of gynecological laparoscopic surgeries. Frequently repeated adnexal mass in reproductive system is endometrioma. Therapies are partially silent in the treatment of larger than 4 cm endometriomas and its removal is recommended for the pain reduction and rapid improvisation in the management of ovarian endometriomas. Generally agreed decision is conception rate. This process can be potentially difficult because of the dense adherence of the capsule. Surgical laparoscopy is among one of the choices in treatment as a conservative treatment approach combined modified cystectomy is preferred technique. It can be damaging for ovary and with additional risk factor it may also pose incomplete ablation. Keywords: Cystectomy, Combined technique, Laparoscopy and Endometrioma.

3248-3253

Authors: Bakht Ullah, Attia Khan, Rohullah

BACKGROUND: Dual antiplatelet therapy (APD) is the cornerstone of management of coronary artery disease in coronary interventions. The resistance pattern against clopidogrel in our influenza is unknown. The aim of this study was to evaluate the frequency of resistance / hypoactivation to Clopidogrel after percutaneous coronary intervention (PCI) in the Pakistani population. METHODS: The study was conducted in the Mayo hospital, Lahore for 1 year period From June 2016 to June 2017. After informed consent, patients who underwent PCI were received 4 weeks ago. All patients received 600 mg Clopidogrel 4 to 6 hours before PCI and received 75 mg Aspirin and Clopidogrel 75 mg twice daily in addition to their routine medications. Venous blood samples were collected from all selected patients and a blocking analysis test was performed on P2Y12. The test has a "Closing Time" measured within the seconds. Patients were labeled as resistant (closing time <106 seconds), hypo-receiver (closing time between 106 and 224 seconds) and receiver (closing time> 225 seconds) based on this time. Demographic data and coronary risk factors were observed for all patients. Findings: Fifty patients (38 males and 12 females) were studied. Fifteen (30%) patients responded completely to Clopidogrel-resistant, 5 (10%) hypertensive and 30 (60%) closing time criteria. None of them had a clinically significant coronary event 4 weeks after PCI. CONCLUSION: More than 1/3 of the post-PCI patients are more likely to be resistant or hypoactive to clopidogrel. Keywords: Clopidogrel, P2Y12 platelet antiaggregation.

3259-3262

Authors: Muneeba Akbar, Moqadsa Jabeen, Faiqua Nayyer, Maryam, Usama Sardar

Objective: To evaluate the effectiveness of using lactulose and rifaximin combination therapy for curing hepatic encephalopathy in adult patients and its comparison with lactulose only treatment. Method: This research was conducted at Jinnah hospital Lahore, department of internal medicine during period of seven months, from December 2014 to June 2015 after taking consent from hospital ethical committee. The study design is randomised controlled trial. Sample size of one hundred and thirty patients was calculated by using WHO calculator. All these cases were stratified into two groups consisting of sixty five patients each. 30ml lactulose 8 hourly was given to one group and the other group was given lactulose and rifaximin 550mg 12 hourly for 10 days. Informed written consent was taken from patients’ guardians. West-Haven Classification was used to determine grade two to four hepatic encephalopathy. Patients were followed up for 10 days after admission. Results: The mean age of patients was 56.06±11.2 years amongst which females were 46.9% while males were 53.1%. 58.46% patients showed reversal by taking lactulose only therapy while 67.67% patients who were given lactulose and rifaximin treatment, after ten days of follow up. P value was 0.276, which was not statistically significant. The abovementioned results show that there was no difference in effectiveness of using lactulose and rifaximin combination treatment as compared to lactulose only treatment in patients with grade two to four hepatic encephalopathy. Key words: Rifaximin, Lactulose, Hepatic encephalopathy, Chronic liver disease.

3268-3279

Authors: Dr. Sh. Muhammad Usman, Dr. Shaheryar Malik, Dr. Ammara Zafar

Prevalence of peptic ulcers disease is higher in third world countries like Pakistan where it is estimated at about 70 per cent of the population, whereas developed countries show a maximum of 40 per cent ratio. The disease is transmitted by food, contaminated groundwater, and through human saliva. Due to its lethality and high prevalence it is necessary to understand the prevention, treatment and change in life style that may help its risks. Background: The incidence and prevalence of peptic ulcer disease has decreased in recent years, most of the risk factors (NSAIDS, H. Pylori, smoking, stress and dietary habits) are modifiable. The Recent trends from the previous researches shows that excessive use of aspirin pain killers and infection from H. Pylori accounts for more than 50% of the peptic ulcer cases presented. Objective: The aim of the research was investigation of the various risk factors (modifiable and non-modifiable) prevalent in patients of peptic ulcer disease presented at Jinnah Hospital Lahore Ma teria l a nd Metho d s: Stud y Desig n: Cross Sectional Stud y Setting a nd d ura tio n: Setting: Jinnah Hospital Lahore. Duration of Study: 3 months. Inclusio n criteria : Patients diagnosed as suffering from PUD following Endoscopy or suffering from 3 of the 4 major symptoms/features (epigastric pain, family history, nausea and vomiting, heart burn). Da ta Co llectio n a nd a na lysis: A sample of 100-150 patients is recruited from Jinnah hospital, Lahore. The procedure and purpose were explained and consent was taken from study participants. Confidentiality was ensured. Participants were free to leave the study any time. It took approximately 20 minutes to complete the questionnaire. The data thus collected was analyzed with the help of SPSS (version 17). Results: The Major Risk factors (Family History, NSAIDs, H. Pylori infection, High stress levels, low socio-economic status, smoking) contribute to around 60-80% of all cases of PUD. Out of total 110 patients interviewed, 60% of cases had h/o NSAIDs use. 90% were either hypertensive or had high stress levels. 80% of the cases lived in overcrowded residencies. Endoscopy reveals H. pylori in majority of the patients. Most of the male patients were smokers. The Minor Risk factors (caffeine, nicotine, alcoholism, history of radiotherapy/chemotherapy, co morbid conditions, O Blood group, sedentary life style, unhealthy dietary habits and use of tranquilizers) contribute to around 20-40% of all cases of PUD. Co nclusio ns: The Study establishes that peptic ulcer is directly related to NSAIDs use, stressful life style, and poor socio economic status while healthy eating habits and physical exercise can help prevent PUD and its complications. Key words: Peptic ulcer, H.Pylori, NSAID’s.

3284-3287

Authors: Dr. Binyamin Butt, Dr. Rabbia Rizvi, Dr Hafiz Yasir Saaed

Objective: This study aims to determine the hand washing practice among doctors and staff nurses working in neonatology unit of a teaching hospital. Methodology: The study design is cross sectional, to assess the knowledge and practice about hand washing among pediatricians and nurses attending neonates in a tertiary care hospital in Pakistan. Questionnaire was designed and 146 patients were interviewed by the authors, their attitude towards hand washing technique was assessed by face to face interviews and response was recorded on proforma after taking informed written consent and without showing participants identity. No ethical issue certificate was obtained from Hospital ethical committee. Doctors and nurses working in different government teaching hospitals were enrolled in study. Result: Knowledge about hand washing was 94% among doctors and nurses. Practice of hand washing technique was 59.6% among Postgraduate resident doctors and in nurses it was 36%. In consultants it was 40.4%. Thus low frequency of hand washing practice can lead to healthcare provider induced infections. Conclusion: Despite of knowledge about hand washing benefits and technique among doctors and nurses practice rate was very low. Thus it’s a leading cause of hospital acquired infections in neonates. KEY WORDS: Hand washing, infections, doctors, nurses, neonates, knowledge attitude and practice (KAP).

3300-3308

Authors: Mudiganti Ram Krishna Rao*and Balasubramaniam M

The two medicinal plants namely, Moringa oleifera and Tribulus terrestris are well known for their medicinal roles ethnobotanically. The present work is to understand the presence of phytochemicals in each of them by TLC method and by GC MS analysis. The antibacterial study was also conducted for both the plants. The TLC profiles show the presence of terpenoids, steroids, flavonoids and alkaloids in both the plants. It was observed that antibacterial role of Tribulus terrestris was evident but Moringa flower extract did not show any antibacterial activity. The GC MS results show the presence of compounds such as Z-10-Tetradecen-1-ol acetate, Lyxitol, 1-O-hexyl-, 2-Butenoic acid, 2-methyl-, 2- (acetyloxy)- 1,1a,2,3,4,6,7,10,11,11adecahydro- 7,10-dihydroxy- 1,1,3,6,9-pentamethyl-4a,7aepoxy5Hcyclopenta[a]cyclopropa[f]cycloundecen-11-yl ester, [1aR- [1aR*,2R*,3S*,4aR*,6S*,7S*,7aS*,8E,10R*,11R*(E),11aS*]]- in Moringa flowers whereas molecules such as 2,2,4-Trimethyl-3-pentanol, n-Hexadecanoic acid and Z-1,6-Tridecadiene were present in Tribulus terrestris. Further work to understand the molecular mechanism of the compound found in the GC MS analysis is needed. Key words: Moringa oleifera, Tribulus terrestris, GC MS, TLC, Antibacterial.

3316-3322

Authors: Dr. Saddam Ashraf, Dr. M. Ijaz Ud Din, Dr. Mohammad Ali

OBJECTIVE: Analysis of pelvic mass patients in terms of parity, age, clinical presentation, operative procedure and pathology was as per the mass type in the tertiary hospitals of Punjab was the aim of this research. DESIGN: Research design was descriptive case series. PLACE AND DURATION: Research was carried out at DHQ Teaching Hospital Dera Ghazi Khan (Gynecology and Obstetrics Department) in the time period of January – December, 2017. PATIENTS AND METHODS: We included all the case of pelvic mass without any discrimination of parity and age, the disease was diagnosed through clinical assessment, history diagnosis and also through USG. Confirmation of pelvic mass type was made through histopathology and surgery. RESULTS: We included in our research 110 cases diagnosed with pelvic mass; among these cases 61 were (55.45%) in the age group of 30 – 50 years and one case were observed as under twenty and two were above seventy years of age. Maximum of the women were in the category of parous. Through clinical presentations we observed that 42 cases faced lower pain of the abdomen (38.18%) and 38 menstrual disturbances cases were also reported (34.54%). First clinical assessment was observed in 84 cases (76.36%) further confirmation was made through USG. In all the patients we included 104 cases (94.54%) with the help of USG. Gentile tract tumor was observed in 68 cases (61.82%); whereas, four cases were diagnosed with non-gynecological mass. Size of mass was observed (above 20 cm) in 10 cases (9.1%); however, less common observations were made about the malignant lesions below ten centimeters in size. CONCLUSION: Every case of pelvic mass without any discrimination of parity and age was treated and investigated in detail. Diagnosis of the non-gynecological masses was also made; therefore, competent surgeons were assigned the task to treat the cases of pelvic masses.

3331-3334

Authors: Hafiz Ahmad Jalal, Hafiz Ahmad Bilal, Hafiz Ahmad Kamal, Ayesha Khalid

OBJECTIVE: Research objective was the determination of the Zinc Sulphate role as an agent of hepatoprotective in the acetaminophen-induced changes of histopathological nature in the model of animals. DESIGN: Research was Observational Experimental in nature. SETTING: Research was carried out in the Pathology and Pharmacology Department Mayo Hospital Lahore from Dec, 2016 to Mar, 2017. METHODOLOGY: Our research sample was 90 albino rats with the range of weight from 18 – 32 grams and we made three groups each group consisting of thirty albino rats. Control group was A group and normal saline level was maintained in this group as 0.9%; acetaminophen was given (250 mg / kg) in B group through a single dose; Zinc Sulphate (1 – 5 mg / kg) was given to C group for a duration of 1 – 7 days before the acetaminophen (250 mg / kg) Sigle dose. After the six hours’ duration was conducted biochemical studies after giving acetaminophen to albino rats. At last step of the treatment weight of all animals was checked at than sacrificed. Histopathological and gross examination was carried out for liver and statistical evaluation of the data was carried out through Chi-Square test. RESULTS: Demonstration of the zinc’s protective effect was made through serum concentration reduction level of the enzymes of liver such as aspartate aminotransferase, lactate dehydrogenase, alanine aminotransferase and serum sorbitol dehydrogenase, including the histopathological centrilobular congestion changes, necrosis and hepatocellular degeneration. We observed through the histopathological evaluation that typical changes in pathological environment of centri-zonal necrosis, leukocyte infiltration, steatosis, edema in animals and portal tiraditos those were treated only with acetaminophen. Animal pretreatment through zinc sulphate lead the whole procedure to dependent on the dose for the avoidance of various changes. CONCLUSION: It is concluded that Zinc is responsible for the production of hepato-protective effect with the prevention of ultrastructural hepatic tissue injuries and also causes free amino acid metabolism disturbance which is a result of the acetaminophen toxic dose. Keywords: Acetaminophen, zinc, liver toxicity and hepato-protective effect.

3340-3344

Authors: Amna Arshad, Salman Agha, Tahreem Akram

Objective: compare the frequency of post-operative surgical site infection of solid interlock intramedullary nail with cannulated open interlock intramedullary nail for management of isolated femoral fracture. Methodology: A total of 100 cases (50 in each group) with Isolated femoral shaft fracture, closed femoral shaft fractures or Gustilo and Anderson classification type I open femoral shaft fractures, Solid and cannulated open interlock fixation for femur shaft fractures between 20-60 years of age of either gender were enrolled in the study. Patients with bilateral femur fractures, Ipsilateral fracture of any other bone of involved side, unfit for surgery or anesthesia with comorbid condition, conversion to intramedullary nailing from external fixator of femur and presented after 30 days of fracture were excluded from the study. Results: In our study, out of 100 cases, (50 in each group), 18%(n=9) in Group-A and 16%(n=8) in Group-B were between 20-40 years of age while 82%(n=41) in Group-A and 84%(n=42) in Group-B were between 41-60 years of age, mean+sd was calculated as 46.78+7.53 years in Group-A and 47.76+6.49 years in Group-B, 62%(n=31) in Group-A and 60%(n=30) in Group-B were male while remaining 38%(n=19) in Group-A and 40%(n=20) in Group-B were females, surgical site infection was compared in both groups and it was recorded in 26%(n=13) in Group-A and 56%(n=28) in Group-B while remaining 74%(n=37) in Group-A and 44%(n=22) in Group-B had no findings of the morbidity, p value was calculated as 0.00 showing a significant difference between the two groups. Conclusion: We concluded that the frequency of post-operative surgical site infection of solid interlock intramedullary nail is significantly lower when compared with cannulated open interlock intramedullary nail for management of isolated femoral fracture. However, our results may create awareness regarding use of solid interlock intramedullary nail for the management of femoral shaft fracture. Keywords: Femoral fracture, solid interlock intramedullary, with cannulated open interlock intramedullary nail, surgical site infection

3353-3359

Authors: Dr. Sundus Amena, Dr. Madeha Arshad, Dr. Rai Muhammad Fazal-ur-Rehman Khan

Objective: We aimed at the perinatal outcomes evaluation in the mothers having diabetes mellitus at the tertiary healthcare centers. DESIGN: Research was descriptive in nature. Place and Duration: Research was carried out in the OPD, Labor ward, Gynecology and Obstetrics, Lady Atichison Hospital, Lahore. Research was carried out from July, 2016 to June, 2017 and it took one year in its completion. Patients and Methods: We included in the research a total of 110 pregnant cases in the age limit of 20 – 40 years without considering their obstetrics history and parity. Sample was selected through convenience non-probability technique of sampling. All the women having eclampsia, pregnancy induced hypertension, antepartum hemorrhage and medical disorders were not selected in our research. A Performa was used for the documentation of patient’s information and data analysis was made with the help of SPSS – 21. Results: We observed in the cases and peri-natal complications the incidence of macrosomia as 41.8% fetuses, infant’s biochemical abnormalities were observed in the 85.3% of the cases, moderate nature to severe state birth asphyxia was observed in 33.6% and congenital malformations were noticed in the six infants associated to the mothers having diabetes. Conclusion: In the diabetic pregnancy related peri-natal difficulties of mothers having diabetes are repeated in the women with a higher incidence of parity. Macrosomia, asphyxia and biochemical abnormalities are repeated perinatal complications as observed in the setting of this research. Key Words: Diabetes Mellitus (DM), Biochemical Abnormalities, Asphyxia and Macrosomia.

3367-3372

Authors: Dr. Humna Saleem, Dr. Noreen Khalid, Dr. Arfa Nageen

Aims: The aim of our research was the experience sharing about the surgeries of gynecological laparoscopic nature in the Mayo Hospital, Lahore. Methods: We held a descriptive research from Jan, 2015 to May, 2016 for the analysis of the patients who experienced gynecological laparoscopic surgeries for their indications, procedure types and complications. Results: Our research sample was 217 patients; among them a number of the cases were in the age group of 26 – 30 years as 53 (24.4%). Ovarian Cyst cases were 111 (51.1%), ectopic pregnancy cases were 27 (12.44%). There were 8 cases treated through cholecystectomy surgeons and hysterectomy or ovarian cystectomy. Diagnostic laparoscopy cases were 32 (15%). Laparoscopic hysterectomy was carried out in 33 cases (16%). Laparotomy conversion was carried out in 8 cases (3%) and vascular injury was observed in only one case. Repeated and common postoperative complaint was pain in variable degrees, which was treated through oral and parenteral analgesics. The diet through oral way was started in 4th or 6th hour and after 24 hours movement was started. Hospital stay of two days was observed in 164 cases (75%) and above two days stay was observed in 53 cases (25%). Conclusions: Post-operative pain can be reduced through laparoscopic surgery in the setting of our research. It also decreased the rate of morbidity after the operation and lessen the stay at the hospital with immediate and prompt recovery. However, adequate expert and skilled based training is mandatory for the successful and skilled laparoscopic surgeries. Keywords: Cystectomy, Hysterectomy and Gynecological Laparoscopic Surgeries (GLS).

3381-3385

Authors: Dr. Anood Ijaz, Dr. Muhammad Abdul Rehman, Dr. Marjan Haider

Hypertension is a common preoperative anomaly in patients undergoing general surgery and may be associated with cardiovascular adverse events in the perioperative period. Objective: To know the prevalence and severity of hypertension in patients requiring general surgery in the preoperative period. Place and Duration: The study was performed in the surgery department of Nishter Hospital, Multan for the period of one year from March 2015 to March 2016. Patients and Methods: All patients undergoing general surgery in the Nishter hospital in Multan were included in the study. The pre-existing hypertension story of all patients was researched. All male patients and adult women aged 20 to 100 years were included in the study. All patients in resting state were measured first blood pressure and second blood pressure measurements in the operating room. Patients were categorized according to AHA criteria for blood pressure. Results: 590 patients (245 males and 245 females) were included in the study. Ninety-four patients (25 males, 69 females) were hypertensive (15%). 36 had stage-1, 44 had stage-2, 14 had severe hypertension. While 75 hypertensive patients were previously known, 19 patients were hypertensive during the study period. Conclusion: The overall incidence of hypertension among adult patients operated on at Sir Ganga Ram Hospital is 15 percent. In this group of patients, stage 2 hypertension was more frequent. Keywords: Prevalence, Hypertension, Surgical Patients

3391-3395

Authors: Muhammad Shahrukh Qaisrani and Tahira Komal

Hyperglycemia causes a multi-factor disorder known as diabetes. Poor control of the diabetes and hypomagnesaemia are critically associated as confusions are caused about Diabetes Mellitus (DM). Insulin receptor is affected by the key component of Magnesium. In the patients of diabetes, the factor of hypomagnesaemia is involved in resistance of the insulin through the interference of the insulin receptors integration. An inactive insulin receptor phosphorylation is responsible for this act; therefore, the whole process can be viewed as a central system through which hypomagnesaemia is added to the resistance of insulin in the cells. Objectives: This research was aimed at the probe that if low levels of the magnesium in the patients of diabetes in comparison of those patients never diagnosed with diabetes. Settings: Research was held at Quaid-e-Azam Medical College, Bahawalpur (Department of Biochemistry) Material & Method: Source of the collected data was BVH, Bahawalpur. Design of the research was observational and descriptive. Research was completed in the period of six months. Conclusion: It is concluded that there is an association of hypomagnesaemia with Type I & II DM as diabetes cases reflect clear decreased magnesium levels. Its consequences in severity of disorders can be reduced in a drastic way through the diets of magnesium fortified administrated to diabetes cases. Keywords: Frequency, Diabetics, Type-I Diabetes Mellitus (T1DM), Type-II Diabetes Mellitus (T2DM), Hypomagnesemia and Bahawalpur.

3406-3411

Authors: Dr. Awais ur Rehman, Dr. Umair Khizar, Dr. Muhammad Naeem Awan

Objective: To determine the factors associated with quitting suckling Breast feeding in children. Methodology: A cross-sectional study. Children up to the age of two were included. Information entered into a predesigned proforma. Place and Duration: The study was carried out in the Gynecology and Pediatric Department Of services Hospital, Lahore for the period of one year from July 2016 to July 2017. Findings: A total of 543 children were included. Maternal factors were 43% insufficient milk secretion and 43% insufficient rest for the first six weeks after birth. In children, diet and nutrition with a 41% formula is 36%. There is not enough milk in the first days after birth and 62% are starved after breastfeeding and 62% are widespread legends. Conclusions: Maternal and child factors and myths responsible for cessation of male nutrition, inadequate secretion of cigarettes, problems with mothers, maternal stress, infant feeding with bottle feeding and first mothers. These misconceptions should be addressed during prenatal visits. Key words: Maternal factor, Breastfeeding, myths, infant factor.

3417-3424

Authors: Kaur Manpreet*and Kumar Sandeep

Niosomes are novel drug delivery system that are having bilayer in structure and these vesicles are obtained during hydration of synthetic non-ionic surfactants, with the incorporation of cholesterol or their lipids. These vesicles present convenient, prolonged, targeted and effective drug delivery system with the ability of loading both hydrophilic and lipophilic drugs. The hydrophilic drugs are entrapped into aqueous core while the lipophilic drugs into the lipid membrane. Their potential can be enhanced by the use of novel preparations, loading and modification methods. This article reviews the current deepening and widening of interest of niosomes. Keywords: Introduction, Method of preparation, Marketed formulation, Patent citations, Opportunities and Challenges.

3430-3435

Authors: Anum Saleem,Dr Bushra Rafique, Dr. Ali Saeed

Objective: Nocardia species is comprised of strict aerobic bacilli which forms the branched hyphae in culture and tissues. Nocardia infection is not well-known but its importance cannot be underestimated due to the mortality and morbidity in organ transplant cases and immunocompromised cases. As Nocardia species is varying in the various regions, this research is targeted on the study an isolate Nocardia bacteria from immune-compromised cases which were referred to the specialists. Setting and Duration: The research was carried out in Nishtar Hospital Multan with 142 participants observed with advanced symptomatic pulmonary disease. Research was completed in the time span of 7 months. Method: In the total research sample 102 cases were assessed for sputum and Broncho alveolar lavage. In the remaining cases the collection of samples was not possible because of the accessibility issue. We prepared three thin smears to observe the samples through microscopic. Culturing of the samples was made in paraffin agar and sabouraud dextrose agar. To analyze the data, we also documented history of the patients through questionnaire. Asteroids of the Nocardia were isolated from one case who was suffering from the syndrome of Cushing having bronchogenic carcinoma. Further in-vitro studies for isolate differentiation were carried out in order to confirm the growth of organism on primary media which was Nocardia steroids complex. Conclusion: It is revealed through NaOH normal concentration 4%, which has been used for the Mycobacteria species identification, can stop the Nocardia growth. Therefore, collected samples were processed through decontamination procedure to isolate Nocardia with the help of NaOH (1%). Key Words: Pulmonary Nocardiosis, Cushing’s syndrome, Nocardia asteroids complex and immunocompromised host.

3440-3445

Authors: Dr Samra Maryam, Dr Alvina Faiz, Dr Sana Liaqat

Background: To kill someone by another person is known as homicide. Our research was aimed at the identification of cause and pattern of death on the issue of homicide specifically on autopsy in Pakistan. Material & Methods: Research is a descriptive cross-sections research that was carried out in the time of Jan, 2015 to Mar, 2017. 2025 cases of homicide (dead bodies) were studied in our research. We used a proforma for data collection in the Mayo Hospital, Lahore (Department of Forensic Medicine). Ethical permission was taken before the start of the research. The cause of death was studies with the help of internal and external examination, viscera analysis and histopathological assessment. Partially or advanced decomposed including skeletonized dead bodies observed with no external and internal injuries adequate to cause death & toxicological and histological reports that failed to reveal any ambiguous outcome were made a part of the research. Results: We performed autopsies of (2025 dead bodies), all the dead bodies were homicidal cases. The male to female ratio was such as 1375 male (67.24%) and 670 females (32.76%) were made a part of the research. The commonly observed cause the injury caused by the fire-arm causing 1230 deaths (60.14%), second common most injury was the injury of blunt weapon 367 cases (17.94%). Conclusion: Out set-up observed most of the cases of fire-arm causing homicide. Illegal possession of fire-arms is to monitored strictly and policies should be implemented to disco

3454-3458

Authors: Dr Taiba Zulfiqar, Dr Amsal Saeed, Dr Rafia Javed

Background: Young adults face the issue of urinary tract infections as a common disease. Because of the increased use of the fluoroquinolones, empirical therapy in the case of an uncomplicated infection of the urinary in the target age group has also become controversial. Our research was also aimed at the nitrofurantoin efficacy, cotrimoxazole and ciprofloxacin (trimethoprim-sulphamethaxazol); these are orally used drugs available in common. Material & Methods: Our descriptive research was held in Services Hospital, Lahore (Microbiology Department) in the time span of January – June, 2016. We included a total of 270 isolates of urinary tract infection selected from outdoor and indoor respectively 132 and 138; culturing of the specimens was also carried out in the time span of the research. We identified the isolates through conventional techniques with the help of API – 10 S. We also assessed all the isolated for ciprofloxacin, nitrofurantoin and cotrimoxazole (trimethoprim-sulphamethaxazol) along with related common antibiotics which are also used for the urinary pathogens. Results: In the total sample of the research dominant isolated was E. Coli which was cultured in the 158 cases (58.51%), after that the Klebsiella pneumonia in 48 cases (17.77%) & enterococcus spp respectively in 16 cases (5.92%). The sensitive percentage in the outdoor cases (132) was observed as nitrofurantoin (92.4%), ciprofloxacin (47.1%) and cotrimoxazole (62.1%); whereas in the indoor isolates (138) the respective sensitivity was observed as 84.0%, 34.7% and 28.9% respectively. Conclusion: The effectiveness of the Nitrofurantoin is outdoor and indoor isolates is useful in the empirical urinary tract infection which is not complicated. Keywords: Nitrofurantoin, Cotrimoxazole, Ciprofloxacin, Trimethoprim-sulphamethaxazol, Urinary Tract Infections and Urine.

3464-3470

Authors: r. Ali Saeed, Dr. Sibtain Ali Hashmi, Dr. Hasnain Abbas Naqvi

Background: Stress is physiological and mental reaction towards any events. Studies have shown that nurses are under considerable job stress, which can lead to health disorders and failure in duties. Stressors of nursing have been studied in some of quantitative studies; however, a few investigators have studied the nurses’ life experiences in this regard. Objective of the study: The objective of the study is to identify the level of occupational stress and the effect on the performance among the hospitals nurses. Methodology: Descriptive cross-sectional study was conducted at Sir Ganga Ram Hospital in Lahore. The study was carried out on 103 nurses registered by Pakistan Nursing Council. Semi-structured occupational stress questionnaire was used to obtain the data. Data processed and analyzed in SPSS. Results: The result of the study showed that the severe level of stress were 65% mild were 8% and moderate level were 27%. The investigation results built up indisputably that a staggering part of nurses' populace setting had revealed direct and stress level that may discourage their expert and social accountabilities. It is proposed that stress should be lessened by executing appropriate administration and radical changes in benefit condition climate. These outcomes may profit nurses to enhance emotional wellness and to adapt to stress level that enable nurses to guarantee quality patient care. Keywords: Nurses, stress, occupational stress, Pakistan.

3475-3480

Authors: Dr. Saira Munir, Dr. Rabbia Rizvi, Dr. Sadaf Ilyas

Objective: The research was aimed at the measurement of the health warning impact reflected on the packs of cigarette on smokers in their act of smoking. Methods: Our research was cross-sectional and it was carried out in Lahore from February to June, 2016, we focused on the male smokers and distributed a self-administrated questionnaire to all the smokers selected through continence non-probability method of sampling without accounting the educational aspect and data was analyzed through SPSS-22. Results: We selected a total of 1500 smoker, warning was observed by 1330 smokers (88.7%); 730 smokers (54.8%) found the picture significant; 630 smokers (47.3%) made an effort to reduce smoking and 430 smokers (32.4%) made a real effort to quit smoking because of the picture and warning impact. In the group of smokers who tried to quit (430), 300 smokers (69.7%) were influenced by the picture. Conclusion: There is no significant and determinant impact of the warning and picture printed on the cigarette packs being sold in Pakistan in quitting and reducing of smoking. Keywords: Cross-Sectional Research, Pictorial, Textual Health Warnings, Smokers, Lahore, Privileged and Under Privileged Societies.

3492-3498

Authors: Dr Sundus Amena, Dr Madeha Arshad,Dr Rai Muhammad Fazal-ur-Rehman Khan

Objective: We aimed at the perinatal outcomes evaluation in the mothers having diabetes mellitus at the tertiary healthcare centers. Design: Research was descriptive in nature. Place and Duration: Research was carried out in the OPD, Labor ward, Gynecology and Obstetrics Mayo Hospital Lahore. Research was carried out from July, 2016 to June, 2017 and it took one year in its completion. Patients and Methods: We included in the research a total of 110 pregnant cases in the age limit of 20 – 40 years without considering their obstetrics history and parity. Sample was selected through convenience non-probability technique of sampling. All the women having eclampsia, pregnancy induced hypertension, antepartum hemorrhage and medical disorders were not selected in our research. A Performa was used for the documentation of patient’s information and data analysis was made with the help of SPSS – 21. Results: We observed in the cases and peri-natal complications the incidence of macrosomia as 41.8% fetuses, infant’s biochemical abnormalities were observed in the 85.3% of the cases, moderate nature to severe state birth asphyxia was observed in 33.6% and congenital malformations were noticed in the six infants associated to the mothers having diabetes. Conclusion: In the diabetic pregnancy related peri-natal difficulties of mothers having diabetes are repeated in the women with a higher incidence of parity. Macrosomia, asphyxia and biochemical abnormalities are repeated perinatal complications as observed in the setting of this research. Key Words: Diabetes Mellitus (DM), Biochemical Abnormalities, Asphyxia and Macrosomia.

3520-3524

Authors: Abdolreza Gilavand and Fatemeh Espidkar

Introduction: The increasing interest of students to dentistry field of study and the increasing admission of patients for jobs related to this field of study can clearly reflect the importance of the need for specialists in this regard. Thus, this research was conducted to evaluate the educational status and job prospect of graduates of dentistry in Iran. Materials and Methods: This study was conducted analytically using content analysis technique. Results: In Iran, dentistry field of study is divided into two levels of general dentistry and specialized dentistry. The total academic year for the general dentistry is 6 years. They can also study in 10 specialized fields of endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics, prosthodontics, restorative and cosmetic dentists, oral and maxillofacial diseases, oral and maxillofacial diseases diagnosis. Problems in field of dentistry in Iran include increasing number of dentists and the reduction of job opportunities for a large number of them, especially in large cities, being exposed to infectious diseases, AIDS and hepatitis, and suffering from physical diseases such as neck arthritis and spinal problems and eye problems due to high physical activity, lack of insurance coverage for dental services for patients, leading to reduction in their admission except in emergencies. Discussion and Conclusion: In recent years, the number of students entering to dentistry schools has been increased significantly, while many facilities of these schools have remained unchanged. This problem in the future can lead to reduced quality of education and, consequently, a negative impact on oral health in the community. Keywords: Dentistry, Academic status, Job prospect, Iran.

3533- 3553

Authors: Sadia Kanwal, Sobia Kanwal, Abnas Kousar, Abdul Basit

Introduction: Autonomy means freedom to act or function independently. It is the capacity to make an informed unclear decision without the involvement of another system or operator. Objective: Determine the frequency of women’s autonomy at household level. Assess the utilization of antenatal services in married women of reproductive age (15 – 49 years) of Bahawalpur City. Materials and Methods: Study Design: Cross-sectional descriptive study. Study Setting: On judgmental basis Satellite town (Upper socio-economic group) and Shahdara (lower socioeconomic group) of Bahawalpur city. Duration: Study was conducted from May 10, 2015 to July 15, 2015. Methodology: Study Design: Cross-sectional descriptive study. Study Setting: On judgmental basis Satellite town (Upper socio-economic group) and Shahdara (lower socioeconomic group) of Bahawalpur city. Duration: Study was conducted from May 10, 2015 to July 15, 2015. Data Analysis: Data will be entered and analyzed by using statistical package for social sciences (SPSS) version 21.0. Mean and standard deviation will be calculated for numerical data like age. Frequencies and percentages will be calculated for qualitative variables that is women’s autonomy (high, medium, low) and utilization of antenatal services (poor, fair, good).

3568-3573

Authors: Bakht Ullah, Attia Khan, Rohullah

Objective: Assessment of the diagnostic evaluation and presentation of numerous vascular repair methods with associated outcomes. Methods: Research was descriptive prospective in nature and it was carried out in CMH, Rawalpindi. Research was completed in the time span of two years starting from Oct, 2008 to Dec, 2010. Vascular injured patients (54 cases) were made a part of the research in the condition of extremity after experiencing vascular surgical interventions. Patients with an irreversible ischemia or with primary amputation including escaped vascular injuries were not included in the research. Injury mechanism was evaluated in the research including type of injury, site of injury, injury mechanism, related injuries, outcomes and repair type. Data was also evaluated for the values of frequency, percentage, mean and SD. Results: In the total research sample mean age was observed as (26.8 ± 9.2 years), the age was calculated in the age group of 9 – 67 years. The ratio of male to female was as seventeen to one. Most repeated cause was penetrating trauma as 34 cases (62.9%) were noticed. Mostly affected area was the lower extremes 33 (61.1%) and most repeated vessel involvement was observed in 14 (25.9%) cases. Besides, 16 patients (29.6%) were having related fractures, while 12 cases were of concomitant venous injuries (22.2%). Common most type of repair was interposition autogenous saphenous vein graft was 42 (77.7%). Three cases were treated with Prosthetic graft (5.5%) patients. Common complication observed was the infection of wound observed in 6 cases (11.1%). Secondary amputation was observed in 3 cases (5.5%) and associated injuries deaths were observed in 2 cases (3.7%). Successful vascular reconstruction was carried out in 49 cases (90.7%). Conclusion: An in-time re-vascularization and recognition by an expert vascular surgeon is key to treat ninety percent of the limbs facing vascular injuries. Keywords: Extremity Vascular Injury, Amputation and Re-vascularization.

3590-3604

Authors: M. Prasanthi Evangelin*, Gudimetla Priyanka, Manohar Babu S

A simple, Accurate, precise method was developed for the simultaneous estimation of the Amiloride and Hydrochlorthiazide in Tablet dosage form. Chromatogram was run through BDS (250mm 4.6mm, 5µ). Mobile phase containing Buffer and Acetonitrie in the ratio of 45:55A was pumped through column at a flow rate of 1ml/min. Temperature was maintained at 30°C. Optimized wavelength for Amiloride and Hydrochlorthiazide was 296nm. Retention time of Amiloride and Hydrochlorthiazide were found to be 4.081 min and 2.554 min. %RSD of the Amiloride and Hydrochlorthiazide were and found to be 0.57 and 0.71 respectively. %Recover was Obtained as 100.40% and 99.9% for Amiloride and Hydrochlorthiazide. LOD, LOQ values were obtained from regression equations of Amiloride and Hydrochlorthiazide were 0.06ppm, 0.14ppm and 0.18ppm, 0.41ppm respectively. Regression equation of Amiloride is y = 8186x + 1334, and of Hydrochlorthiazide is y = 3525x + 408.9. Key Words: Amiloride, Hydrochlorthiazide, RP-HPLC

3617-3630

Authors: M. Prasanthi Evangelin*, Amgotu Vamsi, Manohar Babu S

Estimation of Naproxen and Esomeprazole simultaneously in tablet dosage forms by RP-HPLC method. The analytical method was developed by studying different parameters. First of all, maximum absorbance was found to be at 332nm Naproxen for and 285nm for Esomeprazole. Common wavelength will be 272nm and the peaks purity was excellent. Injection volume was selected to be 20µl which gave a good peak area. The column used for study was Inertsil C18, ODS chosen good peak shape. Ambient temperature was found to be suitable for the nature of drug solution. The flow rate was fixed at 1.0ml/min because of good peak area, satisfactory retention time and good resolution. Different ratios of mobile phase were studied, mobile phase with ratio of 45:55 Methanol: Buffer was fixed due to good symmetrical peaks and for good resolution. So this mobile phase was used for the proposed study. The present recovery was found to be 98.0-101.50 was linear and precise over the same range. Both system and method precision was found to be accurate and well within range. Detection limit was found to be 0.25 Naproxen and 0.52 for Esomeprazole. Linearity study was, correlation coefficient and curve fitting was found to be. The analytical method was found linearity over the range of 20-80ppm of the target concentration for both the drugs. The analytical passed both robustness and ruggedness tests. On both cases, relative standard deviation was well satisfactory. Keywords: Naproxen, Esomeprazole, RP-HPLC method

3638-3642

Authors: Sriram A*, Dhanapal C.K and Junior Sundresh. N

Hypertension is one of the major global risk factor among the cardiovascular diseases leads to increase in morbidity, mortality rate as well as health burdens1 . In 2020 it has been estimated that 1.32 billion world populations will suffer from hypertension. As per current prevalence rate on hypertension in India is 18.52 and ranks at 67 among worldwide. WHO statistics reported that death rate among hypertensive patients in India was 1.79%. To determine the prescribing trends of antihypertensives involved in patients with hypertension. Out of 73 encounters, 43 (59%) males and 32(41%) females were observed and documented. Most patients with hypertension between the age group of 41 to 60 were 49(67.1%). The drug prescribing pattern involved with hypertension in this study was mostly single therapy (56.1%) when compared with combination therapy (43.9%). The most commonly used drug were amlodipine (4.1%) followed by clopidrogrel (8.2%), telmisartan (6.9%). The combination therapy was used frequently with Atorvastatin and fenofibrate (15%), Atenolol and amlodipine (11%), Telmisartan and hydrochlorothiazide (6.9%). The present study shows that ACE inhibitors and ARB blockers were frequently used in most of the prescriptions. Atorvastatin consumed more in all prescriptions followed by amlodipine and diuretics (furosemide). Key words: Hypertension, ACE inhibitors, ARB blockers

3647-3652

Authors: Dr. Muhammad Hassan Sheikh, Dr. Aijaz Ali, Dr. Anila Umer

Background: Stroke is second most common cause of death worldwide. Stroke-related seizures are a neglected topic and generally considered as a benign and a harmless complication. Post stroke seizures can worsen the condition of patients so this study finds the extent of post stroke seizures in local population. Objective: To assess the frequency of generalized seizures in patients presenting with acute ischemic stroke. Material and Methods: Department of Neurology, Agha Khan University Hospital, Karachi. Design: Descriptive case series. Subject & Methods: There were 150 patients presenting with acute ischemic stroke were included in this study. They were followed-up for 15 days after stroke to assess post-stroke seizures. Results: The mean age of patients was 57.37±11.18 years. Frequency of generalized seizures in patients presenting with acute ischemic stroke was found in 6.67%. Conclusion: Generalized seizures in patients presenting with acute ischemic stroke was low. Key Words: Acute ischemic stroke, generalized seizures, cardiovascular disease.

3656-3660

Authors: Dr. Shub Noor Saeed, Dr. Hira Naveed, Dr. Taiba Zulfiqar

Objective: The study is focused on the analysis of visual consequences in patients who suffer from diabetic retinopathy. The patients involved were treated using pan retinal photocoagulation with or without sub-Tenon triamcinolone acetonide. Patients and Methods: The subjects were divided into two groups based on the treatment i.e. sub-tenon triamcinolone with pan retinal photocoagulation (Group 1) and pan retinal photocoagulation alone (Group 2). The cases were randomly distributed among both the groups. Change in visual acuity was considered to be the only major variable factor in this study. Visual acuity was checked after two months from the treatment and difference was measured from the standard readings. Results: The patients treated with a combination of sub-tenon triamcinolone and pan retinal photocoagulation showed improvement in visual acuity much greater than the patients who were treated with pan retinal photocoagulation only. The difference was statistically significant (p < 0.005). 73% of patients in Group 1 were having improved visual acuity as compared to only 6.6% of patients in Group 2. Conclusion: Sub-Tenon triamcinolone acetonide injection has proved to be an outstanding treatment in the deterrence of pan retinal photocoagulation. The visual acuity has improved much with the dose of the said injection and the visual loss caused by macular edema is minimized. Keywords: Diabetic retinopathy, sub-Tenon triamcinolone acetonide injection, Visual acuity.

3665-3668

Authors: Humera Rafique, Anam Ashraf, Binish Anwar, Syed Mohsin Mehmood, Mujeeb Ullah Makki

Introduction: The street food industry has an important role in the cities and towns of many developing countries in meeting the food demands of the urban dwellers. Street food sector operates in an unstable and precarious state because the sector lacks legal recognition. There have been noticeable increases of food vendors in Lahore. There are not regulated, they operate haphazardly without any monitoring of what they prepare and how they do it. Objectives: Objective of study was to assess personal hygiene of food selling vendors, their practices during food preparation & handling, to assess environmental hygiene around food selling area. Study Design: Descriptive study. Place and Duration of Study: Study was conducted at Lahore. Material and Methods: A study to determine hygienic and sanitary practices of vendors of street foods in Lahore was carried out using a descriptive survey design. Data was collected using in-depth interview schedules and observation checklists. Results: About 50.0% obtained food preparation skills through self-taught while 33.33% were taught by their parents. Sixty seven percent patients did not use aprons, 76.7% wore no hair covering and 93.3% handled food with bare hands. About 66.7% of the vendors had garbage and waste bins beside the food stalls. Mean nasal obstruction in the case of ventilated nasal and with Vaseline nasal pack was observed respectively as (45.62±6.17) & (77.67±4.85) and significant value of p = 0.001in each group. Conclusion: Street food vendors practiced minimal hygienic and sanitary practices. Keywords: Street foods, hygiene and sanitation.

3674-3678

Authors: Dr. Saba Javaid, Dr. Feeha Akhtar, Dr Aisha Bashir

Objective: Evaluation of an enzyme- related immunosorbent assay using filariform larvae of Strongyloidesstercoralis is to identify particular antibodies in patients with strongyloidiasis. Design: Source of Serum samples collection was people infected, with strongyloidiasis, with parasitic diseases and common people. By using crude antigen of filariform larvae, its analysis was conducted with the help of IgG-ELISA. Materials and Methods: The study was conducted at the Nishtar Hospital Multan. Subjects: 46 individuals infected with strongyloidiasis is were selected for serum sample collection. 379 cases infected with different parasitic infections and 37 ordinary people were also part of sample collection. Main outcome measures: Positive and negative predictive values, specificity and the sensitivity of the test. Result: The cut-off point value was noted as 0.537. The specificity of the test was recorded as 96.15% while test sensitivity was calculated as 93.47%. The positive predictive value was 72.88% however; negative predictive value was 99.25%. Twelve individuals with toxocariasis, three individuals with hydatidos is and one individual with ascariasis, had antibodies which were reactive in nature against larval antigen. Conclusion: A specific and sensitive diagnostic assay when ELISA method is used with filariform larval antigen. Key Words: Strongyloidesstercoralis, Strongyloidiasis, IgG-ELISA.

3683-3687

Authors: Ayesha Zaheer, Sana Hadia Qaiser, Aqsa Yaqoob

Purpose: To investigate the outcome of hemorrhoidectomy with staples in third degree hemorrhoids. Materials and methods: This study included 50 patients who underwent stapled hemorrhoidectomy. Place and Duration: The study was performed between February 2015 to February 2016in Surgical Unit of DHQ Gujranwala for the period of one year. Study Design: Prospective interventional study. Findings: In third degree hemorrhoids stapled hemorrhoidectomy (SH) was performed in 50 patients. There were minimal pain in three patients and only one patient had persistent pain and there was a small postoperative bleeding that was treated conservatively in one patient. Conclusion: In the treatment of third degree hemorrhoids SH is an effective surgical procedure. There is strong proof that SH produces less pain postoperatively and has earlier activity than other procedures. In our experience for third degree hemorrhoids SH is the preferred treatment in hospitalized patients. Key words: Third degree hemorrhoids, stapled hemorrhoidectomy (SH).

3694-3698

Authors: Dr. Ayesha Munir, Muhammad Awais Farooq, Dr. Abubakkar

Objective: To determine perinatal mortality pattern and related risk factors of obstetrics. Study Design: A retrospective study Place and Duration: From February 2016 to February 2018 the study was held in th Gynae Unit II of Nishter Hospital, Multan for the period of two years. Methodology: All patients delivered at the Gynae Unit II during the study period were included. These women were recommended to follow OPD a week after birth. Perinatal deaths, including stillbirths and early neonatal deaths (NND), have taken place within the next 7 days of birth. Those with a gestational age shorter than 28 weeks were excluded. The data were collected from the Excel perinatal mortality study page and also collected information such as age, parity, gestational age, complications during pregnancy, and the way of delivery and delivery. Perinatal data included weight, gestational age, sex of the baby, Apgar score at birth and possible causes of death. Findings: 20,231 deliveries were made in the two year period. There were 1373 perinatal deaths. 867 was still born, and 506 died within the next seven days from birth. The overall perinatal mortality rate was 67.8 / 1000 and the still birth rate was 42.9 / 1000. Mechanisms were present in 21% of the cases, prematurity in 20.3% and hypertensive disorders in 18.8% of the cases. Antepartum haemorrhage was 11.8%, maternal infections / medical problems were 6.5%, congenital anomalies were 4.4% and in newborns was 15.3%. Conclusion: Perinatal mortality association was observed due to prenatal care, early gestational age and low birth weight. Thus, providing good delivery services such as antenatal care, emergency birth and neonatal care services at birth will help reduce perinatal mortality in developing countries. Key words: Perinatal mortality, Early neonatal mortality rate, fetal mortality rate.

3705-3709

Authors: Iqra Shoukat, Dr Ammara Farooq,Dr. Iqra Akhter

Objectives: The research aim was the examination of the core stabilization exercises effects on the conventionalphysiotherapy to manage non-specified low back ache and pain also known as LBP. Methodology: The research design was comparative and experimental conducted at Mayo Hospital, Lahore (Physiotherapy Department). Our research included a total of forty cases that were diagnosed with the non-specified LBP in the age group of 18 to 65 years. All the included patients were divided into two groups randomly: Group – A (Experimental Group): The patients of this group were managed with the help of conventionalphysiotherapy and core stabilization exercises. Group – B (Control Group): The treatment of these cases was carried out with conventional physiotherapy as the sole treatment therapy. Measured outcomes were functional outcomes of physical and pain which were measured through VAS (Visual AnalogueScale). Physical outcomes in terms of function were measured through Modified Oswestery Disability Questionnaire (MODQ). Results: We applied T – Test on A group and obtained MODQ and VAS p-values which were significantly observed as (0.000 for both); whereas, in group B the p-values were also same as mentioned earlier. With the AVOVA application insignificant p-values were observed for VAS and MODQ as 0.09& MODQ as 0.018. Conclusion: Improvement was observed in both A and B groups for functional activity and pain; whereas, A group was treated with the core stabilization exercises assisted with the conventional treatment which reflected a bit of improvement in the function and pain in B group. For the attainment of better outcomes any of the mentioned intervention can be used in order to produce effective management. Keywords: Conventionalphysiotherapy, Core stabilization exercises, Lower back pain (LBP), (VAS) Visual analoguescale.

3714-3719

Authors: Bir Pawan Kumar* and Sandeep Kumar

Fast dissolving films is a novel approach that are rapidly gaining interest for the patients having difficulties in swallowing or chewing of solid dosage forms such as tablets or capsules. Fast-dissolving drug-delivery systems were first developed in the late 1970s for pediatric and geriatric patients who experience difficulties in swallowing traditional oral solid dosage forms. These films may deliver the drug in a systemically manner through sublingual or buccal route and also used for local action. The present review reflects the information regarding the ideal characteristics, method of preparation and evaluation tests employed for fast dissolving oral films. However, for future growth point of view these films sector is well-positioned. It shows that the value of overall oral thin films market will be grow significantly. Keywords: Introduction, ideal characteristics, method of preparation, evaluation parameters and marketed products of fast dissolving films.

3726-3737

Authors: Anwar Ali Jamali, Ghulam Mustafa Jamali, Ameer Ali jamali, Muhammad Ali Suhail, Bhojo Mal Tanwani, Naveed Sattar Shaikh, Naeem Mustafa Jamali, Yash Tanwani

Introduction: Iron deficiency anemia is the most frequent public health dilemma in our community. It had an extensive variety of unfavorable consequences like reduced performance, decreased intelligence, retarded growth in newborns, playgroup and school going youngsters, adult females of different age groups. Anemia also causes the impairment of physical capability, routine working ability of youngsters and grown-ups, decline in immune competency and amplified morbidity due to other diseases in every age of life are also related to Anaemia. Objective: The present clinical study was done to assess the prevalence of Iron Deficiency anemia (IDA) in adult female subjects visiting OPD at PMC Hospital Nawabshah. Study Design and Setting: Current study was cross sectional carried out in adult female patients visiting PMC Hospital Nawabshah District Shaheed Benazirabad (Nawabshah). Duration: One year from January 2017 to December 2017. Material and Methods: After taking informed written consent, brief history and clinical examination; samples were collected by simple sampling method, vacutainers (EDTA) were used for sample collection and analysed by using MEDONIC auto analyzer MERCK COMPANY. All the Red blood cell (RBC) parameters including the RBC count, Hct (Hematocrit), Hb (Hemoglobin), MCV (Mean Corpuscular volume), and MCHC (Mean Corpuscular hemoglobin concentration) were tested. All obtained data was analysed through SPSS software version 20.0. Results: Our study was based on 385 female subjects that were selected randomly from different areas attending the OPDs. The total frequency of anemic females was 203(52.7%) and non-anemic 182 (47.3%) were observed. The average Haemoglobin value of 10.5+3.88 was observed in anaemic subjects. The highest frequency of anemia was observed in young age group (20-40 years). Conclusion: The frequency of iron deficiency anemia in adult females is common in district Shaheed Benazirabad especially pregnant and lactating females are at increased risk to develop IDA in comparison to other categories. This warrants extra studies on a larger sample of healthy females to validate the findings and to care the wellbeing of these forthcoming mothers. Key words: Iron Deficiency Anaemia, Haemglobin, Red Blood Cell, Hematocrit.

3742-3746

Authors: Faiza Mujahid, Dr. Ammara Farooq, Dr. Ayesha Munir

Objectives: To compare the local infiltration of bupivacaine with placebo in a caesarean section under spinal anesthesia in terms of the purpose of the study, mean pain scores and analgesic requirement. Study schedule: Randomized controlled Place and time of study: Gynecology and Obstetrics Department, Nishter Hospital, Multan. All patients from OPD, Emergency and high risk Ward were accepted from March 2016 to March 2017. Findings: In our study, 86% (n = 43) patients in Group A and 82% (n = 41) 18 (n = 9) were between the ages of 31 and 45 years, with mean ± SD being 26.52 ± 4.54 in Group A and 26.88 + 4.16 in Group. B. The pain score comparison in both groups was calculated as 1.98 + 0.91 in Group-A, 2.8 + 1.23 in Group-B, 0.00026 in p-value and showed a significant difference between these groups. The two groups were also calculated to have a p value of 0.00057 when the analgesic requirement was compared in both groups, 32.00 mg + 51.27 and in Group-B 82.00 mg + 84.97 tramadol, respectively. there is a significant difference between the two groups. Conclusion: Local infiltration of bupivacaine with the wound was significantly more effective than placebo in relieving postoperative pain and resulted in decreased post-cesarean analgesia requirement. Key words: cesarean section, spinal anesthesia, wound infiltration, analgesia requirement.

3751-3760

Authors: Dobhal Nidhi*and Mukhopadhyay Sayantan

Transdermal drug delivery system comprises one of the most important routes for new drug delivery system. Providing a means to sustain drug release it offers a large number of advantages over conventional drug delivery system. These are self-contained, discrete dosage forms which are known to deliver drug through intact skin at a controlled rate into systemic circulation. This delivery system has undergone a large number of modifications since its introduction in 1800’s, starting from the first generation which included delivery of small, lipophilic, low dose drugs to later ones which target their effects to skin barrier layers of stratum corneum using micro needles, thermal ablation, electroporation, etc.This review also focus on the potential of ionic liquids for transdermal application. This review details about various approaches to transdermal delivery system and describes numerous pharmaceutical developments which have been employed to overcome limitation related to skin delivery system. Key words: Transdermal Drug Delivery System, Skin, Microneedle, Iontophoresis, Ionic Liquid.

3765-3771

Authors: K. Lalitha and *P.Sailaja Rao

In developing countries the gradual revival of use of medicinal plants is attributed to the safety of herbal medicines with minimal adverse effects as comparable to the synthetic drugs. The present study was aimed to evaluate the antimicrobial effect of formulated gel containing chloroform extract of M.hortensis and ethanolic extract of C. longa. An optimized topical gel (carbopol- 934, as gelling agent) formulation in combination with the two herbal drugs was prepared in the 2:3 ratio and was evaluated. The extracts were prepared using standard procedures and physicochemical parameters of the formulated gel were determined. The anti-bacterial and anti-fungal activity was done using agar well diffusion method for determination of zone of inhibition. The studies indicated that with the increase in the concentration of the extract there is increase in the zone of inhibition with both the test extracts. The present study investigated the anti-bacterial activity of chloroform extract of M.hortensis and ethanolic extract of C. longa against various bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli, P.aeroginosa and Candida albicans at different concentrations. In the anti-bacterial activity, the zone of inhibition (ZOI) was highest for S.aureus and P.aeroginosa at 150 mg/ml with the chloroform extract of M.hortensis and similarly ethanolic extract of C. longa produced highest zone of inhibition for E. Coli and B.subtilis. In the anti-fungal activity, the two test extracts chloroform extract of M.hortensis and ethanolic extract of C. longa showed 19 mm and 20 mm at 150 mg/ml as comparable to the standard. From the results it can be concluded that the formulated gel exhibited a potent antimicrobial activity. Key Words: Anti-microbial, anti-fungal, zone of inhibition, herbal extracts, formulated gel.

3776-3779

Authors: Dr. Sana Altaf,Dr. Ishaq Shabbir,Umaima Faizi

Objective: To determine the awareness among mothers visiting pediatrics OPD and ward in THQ Hospita l Ahmed Pur East, Bahawalpur. To create awareness and health consciousness about hazards of not starting weaning at proper time. Study Design: Observational Cross-sectional Descriptive Study. Study Setting: Study was conducted at Pediatrics Ward THQ Hospital Ahmed Pur East, Bahawalpur. Study Duration: From August, 2017 to April 2018. Study Population: A total of 100 mothers of reproductive age (15-45 years) were selected. Questionnaire was designed based on questions relevant to the objective of the study. Data was collected with informed consent and was analyzes by SPSS version. Results: 100 mothers of reproductive age (15-45 years) were questioned. Among them 74% knew about weaning, 18% to some extent and 8% did not know at all.60% of mothers were literate and other 40% illiterate.34% of them were the resident of rural area,16% of them were the resident of semi-urban area and the rest 50% were the resident of urban area.54% knew problems associated with not starting weaning,24% to some extent 22% did not know it all. Among them 37% had income up to 10,000 PKR per month, 14% up to 20,000 PKR per month,27% up to 25,000 PKR per month,15% up to 50,000 PKR per month and 7% above 50,000 PKR per month. 78% fed mother’s milk,1% cow’s milk and other 6% formula milk.59% of them started weaning between the infant age of 4-6months,11% between 7-9 months of age, 12% between 10-12 months and rest 18% between 1-1.5 years of age. 67% continued weaning during illness, 28% stopped weaning during illness and other 5% did not know what to do. 86% continued weaning during routine vaccination, 5% discontinued weaning and rest 9% did not know what to do. Foods which were included in weaning consisted of khichri 61%,Bread 36%,Banana 23%, Halva 20%, Cereals 18%, Cereals 18%.Bisciuts 10%, Dalia 9%, Yogurts 5%,Meshed potato 3%,Meshed meat 3%,Choori 1% and Noodles 1%. Conclusion: Evaluation of awareness among mothers were evaluated and analyzed to be poor with respect to their poor economic and poor educational status. Key Words: Weaning ,Pediatrics ward , THQ Hospital Ahmed Pur East, Bahawalpur

3785-3789

Authors: Hafiza Sameeya Shehzadi, Iqra Asif, Junaid Khan Kundi

Objective: Evaluation of the effects of Buprenorphine, Pentazocine and Tramadol on Respiration. Study design: This study is prospective. Place and duration of study: The study at hand was carried out in the month of July to December 2017. Intensive Care Unit (ICU) of Mayo Hospital, Lahore was the place of this study. Patients and methods: Total 60 patients related to ASA-I&II grades undergoing elective cesarean section were selected. Their age groups range from 18-35 years. Patients allergic to Opioids and those who were having severe systematic diseases not falling in ASA 1 or 2, were not considered in the study. Non-probability convenience sampling technique was used. Selected patients were divided into 03 groups. Twenty patients were allocated to every group. Endotracheal general anesthesia was administered to all the patients. Following operation, injection Buprenorphine 0.5mg IM was received by Group "A", Pentazocine 30mg IM was received by Group "B" and Tramadol 100mg IM was received by Group "C". After giving analgesia, its effects on arterial blood gases, tidal volume, minute volume and respiratory rate, were observed after half an hour, an hour, two hours and four hours. Repetition of the doses was performed eight-hourly. Results: After thirty minutes, respiratory rate and minute volume were seen to be decreasing in case of Buprenorphine. Effect of Pentazocine was dissimilar as it decreased minute volume in five minutes and decrease of respiratory rate was in thirty minutes. However, Tramadol has neither affected respiratory rate nor minute volume. Buprenorphine and Pentazocine decreased PaO2 within thirty minutes. The rise of PaCO2 was seen after one hour with Buprenorphine, whereas Pentazocine raised the same within five minutes. No changes were seen in arterial blood gas values with Tramadol. Conclusion: Opioids possess a respiratory depressant effect which is observable from thirty to sixty minutes of IM administration. In contrary, in equal-potent doses, respiratory depression is not caused by Tramadol being a non-opioid. Keywords: Parenteral, Buprenorphine, Pentazocine, Tramadol, Blood Gas Analysis, Respiration, Analgesia, Buprenorphine, Blood Gas Analysis, Buprenorphine and Recovery room.

3796-3803

Authors: Asadullah, Sana Idrees, Hazrat Ali, Noman ul haq, *Muhammad Samsoor Zarak, Aqeel Nasim

Adherence to a drug regimen is usually defined as the extent to which patients take medication as directed by a physician. Adherence to prescription drug regimens is difficult for all patients and is especially challenging for the elderly. Adherence to medication requires a working relationship between a patient or caregiver and a physician who prescribes should be open and honest with regard to medications., i.e. the administration schedule, intended benefits, adverse effects, and costs. Therefore, this study aimed to assess the level of adherence of hypertensive patients in Quetta, by using MMAS-8 and Hill-Bone Compliance ScaleA Cross-sectional descriptive study was conducted in Sandeman Provincial Hospital and Bolan Medical Complex to assess the adherence among hypertensive patients of Quetta, Pakistan. The study has been conducted from start to end was from March 2016 to October 2016. convenience sampling technique was used to collect data. Those patients who were willing to participate and were suffering from hypertension and receiving medical treatment were included in the study. Hill bone compliance scale was used to assess the level of medication adherence. SPSS V 20 used for descriptive and inferential statistics.Respondents mean age was 45.1 years while the minimum age was 21 and maximum were 95. The MMAS-8 mean score of adherence in hypertensive patients was 3.55. and the median score was 3.0. Among 401 majorities of patients, 306 (76.6%) poorly adhered. Ninety-four (23.4%) were had moderate adherence. While only one (0.2%) were having good adherence. The mean score of hill bone compliance Scale in hypertensive patients was 24.16. and the median score was 25.0. 336 (83.4%) had imperfect adherence and 65 (16.2%) have perfect adherence.It is concluded that chronic conditions, particularly hypertension the non-adherence to treatment are one of the major contributing factors to poor management and control of hypertension. So, for better management of Hypertension patients need to be advised or consultation should be given with a special focus on medication adherence so better therapeutic outcomes will be obtained. Keywords: Medication adherence, Hypertensive patients, Hill- bone compliance scale,

3818-3829

Authors: Mudiganti Ram Krishna Rao*and Lakshmanan V

Preservation of fruits and vegetables is a challenge for farmers, sellers and processors. Many chemical preservatives are used to increase the shelf life, to reduce the spoilage, to protect from microorganisms. The present study is to address this problem with an age old traditional preservative, turmeric, as bio preservative. Aqueous solution of turmeric at 5, 10 and 25 % (w/v) concentrations were used to preserve the tomatoes and the study was undertaken for 30 days. The change in physio-chemical characteristics such as weight, pH, lycopene content, dry matter content, total phenolic content were studied. The antimicrobial role of turmeric was also studied on E. coli, Lactobacillus and Aspergillus Niger. It was observed that there was a perceptible improvement in each of the parameters studied. Thus turmeric is suggested as a cheap and affordable preservative for harvested tomatoes. Further qualitative aspects must be studied to prove the bio preservative role of turmeric on tomatoes. Keywords: Shelf life, Bio preservative, Turmeric, Tomato, Spoilage, Antimicrobial

3834-3838

Authors: Dr. Amina Inayat Ullah, Dr. Azmeena Azam, Dr. Alvina Faiz

Objective: To find correlation between serum CA-125 levels and extent of ascites in chronic liver disease patients. Methodology: It is analytical study, conducted at Shifa international hospital, Islamabad, Pakistan over a period of one year from January 2012 to December 2012. Total 130 patients with chronic liver disease were enrolled, after confirmation of presence of hepatic cirrhosis on abdominal ultrasonography. Serum cancer antigen 125 level was measured in all patients. Presence of ascites was not made necessary for patients to be enrolled in study. The amount of ascites was confirmed by clinical examination and ultrasonography. The relation of CA-125 level with extent of ascites was drawn. Results: 57% patients had chronic liver disease due to hepatitis C virus infection, Child Pugh score C was in 60% patients. Moderate correlation was present between CA – 125 level and abdominal ascites (r 0.642, p value was less than 0.001). Thus it was observed that CA – 125 levels were significantly raised in patients suffering from ascites. P – value less than 0.001, which was statistically significant. Conclusion: There is moderate correlation between extent of ascites and serum cancer antigen 125 levels in patients with chronic liver disease. Thus CA – 125 can be used as a marker for ascites in CLD patients. Key Words: Chronic liver disease, cirrhosis, liver, ascites, cancer antigen 125.

3843-3853

Authors: Syeda Fatima Zahra, Aleena Ali, Syed Basat Raza Naqvi, Syeda Nighat Fatima, Maria Safdar

Introduction: In the today’s competitive world there is a great need of quality assurance among each and every field especially education. Despite their extraordinary infrastructure many institutes fail to provide quality education to the students. In such circumstances purpose of our study was mainly focused toward having an insight of the quality of education in the field of dentistry. And also with the advent of modern educational methodologies, the learner has the major role in deciding his learning styles, so this study also focuses on what and how students want in their curriculum. Methods: This research was cross sectional and it used a questionnaire based survey to evaluate the degree of student satisfaction regarding teaching methodologies followed at their dental colleges. The data was analyzed using SPSS v 17.0. Results: The results obtained by our research showed a high degree of satisfaction among the dental students regarding their teaching methodology. The result obtained was that none of the student showed signs of high dissatisfaction but there were 16/127 i.e. 12.6% of the students who were Dissatisfied and remaining 87.4% i.e. 111/127 of the students were satisfied in which 23/127 18.1% were greatly satisfied with their teachers’ way of educating them. Conclusion: This research provided a proposal to all the dental colleges of Pakistan that they should keep a record of what the students want. This provides the student an encouragement to express their views and also enable the students to take a central role in the system of education.

3859-3863

Authors: Dr. Humaira Atta Ullah, Dr. Muhammad Adnan Shahid, Dr. Muhammad Awais Tahir

Objective: The comparison of the Hepatitis B prevalence, human immunodeficiency virus (HIV) and hepatitis C in a voluntary replacement and non-remunerated donors in Allied Hospital Faisalabad Blood Transfusion Services. The research was completed in the period of 14 months from January 2016 to February 2017. Setting: The setting of the research was the tertiary healthcare Blood transfusion service in the adjoining area of Punjab. Method: We enrolled 3430 blood donors; among these donors 3187 pints were replacement donors (92.9%) and 243 pints (7.1%) were voluntary non-remunerated. Both the groups were screened for the hepatitis B surface antigen (HBsAg), HIV1/2 antibody and hepatitis C virus (HCV) antibody with the help of an automated random access AXSYM that utilized the technology (MEIA). Results: HBsAg prevalence, HIV 1/2 antibody and HCV antibody in replacement donors (3187) was respectively observed as 2.51%, 0.25% and 5.14%. In the 243 voluntary non-remunerated donors of blood the same prevalence was observed as 0.82%, zero % and 2.46% respectively. Conclusion: HBsAg, HIV antibody and HCV antibody prevalence were less in the voluntary non-remunerated blood donors when compared with the donors of replacement. The major source of blood in Pakistan is replacement donors, we need to shift to the voluntary non-remunerated blood donors. The safe blood in Pakistan can be achieved through this way in the prevalent circumstances of Pakistan. Key Words: Hepatitis B, Blood donors, Hepatitis C and HIV.

3869-3873

Authors: Dr .Yasrab

Objective: To assess whether by MRI adenomas can be visualized when CT findings are ambiguous and to assess adrenal adenoma in patients with both MRI chemical shift and unenhanced CT. Study Design: A Retrospective study Place and Duration: The study was performed in the Radiology Department of KRL Hospital Islamabad for the period of 2 Years from March 2015 to March 2017. Materials and Method: 40 patients (42 suprarenal masses) underwent MRI with chemical shift and unenhanced CT were studied retrospectively. For each adrenal mass, adrenal-spleen chemical shift rate, Houns site units and indexed signal intensity were recorded. Qualitative assessment for signal loss in every adrenal mass in the reciprocal phase by the two-passer images was also performed and differentiated with quantitative analyzes. a measure of adenoid-rich lipid, adrenal spleen has a rate of chemical shift lower than 0.71 d, has a rate of signal intensity higher than 16.5%, and if the mass exceeds 10 h, or if the mass satisfies two of the above criteria and there are subsequent images without alteration. Results: Sensitivity and adrenal-to-spleen contrast indicate the Cicadas to identify a lipid-rich adenoma using 92% (33/36) and 17% chemical shift qualitative index signal strength decline and analysis without CT (1/6), 100% (36/36) and (6/6), 100 (36/36) and 67% (4/6) and 78% (28/36) and 83%, 100% respectively (5/6). In lipids Twentyeight (67%) are measured in rich adenomas, or below 10H, a ratio of the chemical lobe of lower than 0.72 adrenal spleen, and strength of signal index of more than 17.0%. 8 masses (19%) were not more than 10H but the adrenal spleen was less than 0.71% of the chemical and a ratio of 16.5% to an index at higher density and the tracking signal was unaltered. Conclusion: Eight of 13 suprarenal adenomas (62%), which were measured more than 10 hours in CT scan unenhanced, were definitively characterized by MRI and chemical shift. Key Words: Adenoma, MRI, CT Scan, Chemical shift, Suprarenal masses.

3880-3883

Authors: Dr. Awais ur Rehman, Dr. Imran Majeed, Dr. Hira Tariq Chaudhary

Background: Allopurinol is commonly used as antihypertensive medicine. Fenofibrate, a fibric acid derivative, is widely used in hyperlipidemia treatment. Fenofibrate reduce serum uric acid levels effectively. Objective: This study was performed to evaluate the safety and efficacy of fenofibrate in patients with hyperuricemia. Study Design: Interventional Study Place and Duration: The study was performed in the Out Patient Department of Nephrology Unit of Nishter Hospital, Multan for the period of six months from January 2017 to July 2017. Materials and methods: Sixty hyperuricemic patients with serum uric acid levels of desil- lary or higher of 7.0 mg were enrolled and assigned to receive 300 mg allofurinol or 200 mg fenofibrate for 12 weeks. The efficacy of the drug was measured in percentage of patients successfully controlling serum uric acid levels of less than 6 mg P. Dl at 90 days. The efficacy of the drug was also checked by measuring the percentage of serum uric acid levels changes at day 1 to 90 days. Safety was checked by observing side effects (AE) and laboratory investigations. Findings: The percentage comparison of cases in which uric acid level in serum was lower than 6.5 mg at 90th day in both groups was statically significant (P = 0.14). However, the percentage difference in uric acid level between 0 and 90 days was significantly highly among the two groups (p = 0.001). Although the proportion of individuals experiencing any side effects was greater in the fenofibrate group, the side effects that caused the allopurinol group to discontinue treatment were found to be higher. Conclusion: Fenofibrate 200 mg is an effective antihypertensive agent once a day. Key words: Uric acid, Fenofibrate, hyperuricemia.

3894-3898

Authors: Dr. Attiya Razzaq, Dr. Ishaq Shabbir,Hafiz Muhammad Rashid Javaid

Abstract: Objective: Nowadays, Upper gastro-intestinal motility disorders are very common. The exact numbers of victims in Pakistan are unknown so far; however, numerous cases are surfaced who are found normal on liver function test and endoscopy test. Research aim was the management of dyspepsia in the patients suffering from nausea, anorexia, vomiting, heartburn, upper abdominal pain and fullness etc. Design and Setting:Our research was descriptive in nature and it was carried out in Mayo Hospital Lahore in the timeframe of August, 2016 to August, 2017. Material and Methods:When emptying of the stomach is sluggish one, such disorders are said to be functional. The related symptoms can be as mentioned above. It seems as if this condition is not problematic but it can be of grave concern in some cases. From mild to severe, symptoms may differ. Questions of dyspepsia management and its assessment are not answered yet. Preliminary Diagnostic ability could be challenging one due to overlapping causes of symptoms. A distinct reason is rarely established in a number of cases. The preliminary investigation of dyspepsia related patients encompasses physical examination and a systematic history while giving particular attention to those elements implying the presence of illness. Patients having alarm symptoms i.e. weight loss, melena and anorexia etc. should be immediately given Endoscopy test. If the test is positive, a cost-effective preliminary approach to check the Helicobacter pylori, Management should be applicable individually. Empiric therapy with prokinetic agent or a gastric acid suppressant is suggested if the said test is negative. Results:Dyspepsia patients’ upper gastrointestinal radiographs were collected historically. Endoscopic tests, nowadays, have lost their reliability for upper endoscopic examination in authenticating or excluding ulcers, malignancies and reflux disease. Though, diagnostic gold standard for pylori infection is endoscopy with biopsy, yet, the whole procedure may be impractical and expensive. Detection of pylori can also be made in the breath with the urea breath test (UBT), in the stool with a polymerase chain reaction (PCR) test or an antigen enzyme immunoassay (EIA), in the serum with antibody titers etc. If H. pylori is detected with the UBT, breaking down of ingested carbon labelled urea into ammonia and labelled CO2, is carried out by urease produced by the organism. It can be identified in breath of patient. The UBT is costlier, more specific and more sensitive. Cost and practicality of serology is acceptable. Its specificity and sensitivity to identify H. pylori infection render it an appropriate position in the market in comparison to UBT. Positive serology test suggests inactive infection and previous H. pylori exposure. Hence, the authenticity of elimination of organism questions the test utility. The UBT is, thus, highly recommended test in this regard. urease is not further originated once H. pylori is eliminated. In younger patients, non-invasive detection of H. pylori in the feces is of poignant significance. Sensitivities reported of PCR and EIA for H. pylori are 93.70% and 88.90%. The relevant specificities are hundred percent and 94.6 %. Conclusion:It is concluded that in such cases endoscopy should be carried out in case recurrence or persistence of symptoms. The base of this appraisal is on extensive search and clinical experience and study through “MEDLINE” on research papers, conference reports on Functional Gastro-intestinal disorders and review articles. Key Words: Diagnosis, Dyspepsia, Endoscopy and Medical Management.

3912-3919

Authors: Dr. Maria Ishtiaq, Dr. Minahil shoukat, Dr. Anam ijaz

The National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) fuses avoidance and control of cardiovascular illnesses (CVD) as a major aspect of a thorough and coordinated non-transferable Disease (NCD) counteractive action exertion. In this program, observation of cardiovascular hazard factors is a piece of an incorporated populace based NCD reconnaissance framework. Psychological warfare has dependably been a mutilating highlight in smooth existence of the states yet to spare numerous from torment some need to give up. . This horrendous issue obliged me to consider its to a great degree reasons that why such savagery is submitted? Why there is no inverse side to counsel for ceasing such heartless acts? What the desires of the aggressors were? Why psychological oppressors assault schools? What sort and energy of reactions is found in the particular circumstance and what remarkable measures state government got a handle on to manage the condition with same debase more reactionary drive and what are the steps taken by the government to overcome this terrorism especially on schools and education system. This study will also expose that how the nuclear weapons effects the health. The need of reconsidering approach structure and territories to be considered is additionally examined. This research writing will inform reader about effects of the Peshawar carnage and efforts of the public along with governing authorities to rectify wreckage to possible extent and safety initiatives and awareness programs for future.

3924-3928

Authors: Dr. Shabana Amir,Dr. Tehmina Hayat,Dr. Arshia Maqbool

Objective: The primary objective of the research was the establishment of the appropriateness of blood gas analysis in the neonates diagnosed with the problem of respiratory distress. Subjects & Methods: Our research was held at the NICU (Neonatal Intensive Care Unit) which is a department of Mayo Hospital Lahore. Every new-born which was hospitalized on the diagnosis of the symptoms leading to respiratory distress were made a part of the research study. We managed these neonates with as a support of respiration with oxygen. No new-born was managed with pressurized ventilation and intubation during the stay at hospital. In the available data and records of the 16 new born children hospitalized for the analysis of the blood gas were also taken in to review. Results: With an exception of two cases there was no case diagnosed with hypoxemia (PaO2 below 80 mm Hg). In the same way there were two cases who were diagnosed with the incidence of acidosis (pH below 7.30); whereas, only single case was observed with the incidence of hypercarbia (PaCO2 above 40 mm Hg). The bicarbonate measurements and the base excess among majority of the patients was observed as in the normal range. Conclusions: It was observed that the analysis of the blood gas was essentially normal in majority of the collected samples which also suggested the unnecessary and inappropriateness utilization of this costly and painful process; on the other hand, in the in the stable newborn children with the respiratory distress. On the basis of these results we also found another alternative method which a combination of the pulse oximeter was reading, clinical parameters and chest x-ray outcomes; which suggested its possible usefulness for the neonate management diagnoses with respiratory distress. The objective was to minimize and reduce the over utilization of the painful invasive procedure. Keywords: Blood gas, tachypnea, neonates, chest x-ray, pulse oximetry and non-invasive.

3934-3939

Authors: Dr. Asad Munir,Dr. Muhammad Junaid Munir,Dr. Muhammad Adnan Akbar

Objective: The assessment of the spectrum and burden of neurological illness in the setting of an intensive pediatric unit and associated motility review was the primary objective of our research. Methods: We consulted the retrospective medical records review about the children between the age of one month to sixteen years who were hospitalized in the Services Hospital, Lahore (Acute Neurological Department) in the period of April, 2015 to March, 2016. The basic diagnosis, demographic and neuro diagnostic procedures were also carried out, outcomes and therapies were also carried out on a data sheet which was well structured. Results: We studied a total of 231 cases which were admitted because of an acute neurological illness in the PICU, the mean age of the children was observed as (67 ± 50) months, 125 children were under the age of five years (54%) and 138 children were male (59.7%). Among these children a total of 144 children had neurological illness (62.3%) and 87 children were diagnosed with neurosurgical illnesses (37.7%). In acute patients of neurological illness, 119 cases were of non-traumatic-coma (51.5%) and 25 cases were of neuromuscular illness (10.8%). Above 500 neuro diagnostic procedures/ tests were carried out in our research on the children having neurological disorders. Our rate of mortality was eighteen percent which was also compared with the total mortality rate observed as twelve percent. Conclusion: In PICU the repeated and common disorders were the of acute neurological nature; which were related to the increased rate of the mortality. CNS infections, severe traumatic brain injuries and status epilepticus were mostly repeated causes of the illness of acute neurological nature in this particular cohort. Key Words: Burden, PICU, Acute Neurological illnesses and Mortality.

3945-3953

Authors: Bommana Anusha*, Girija Karike, Koppula Maheshwari, Ramya Sri Sura

The present investigation was done on lorazepam orodispersible tablets using super disintegrants. The prepared powder blend for all formulations was found to be within limits. Tablets were compressed using rotary tablet compression machine. Post compression studies like weight variation, hardness, thickness, friability, drug content, in vitro disintegration time were carried out which were found to be within limits. In vitro drug release studies revealed that Among all formulations F4 formulation were shown maximum drug release(99.99%) at 45 min. Among these three formulations F4 was considered as optimised formulation due to 2 mg of croscarmellose sodium. Key words: Lorazepam, Super disintegrants, Orodispersble tablets.

3960-3967

Authors: Socorrina Colaco, Ramesh. N, Ramakrishna Shabaraya

The objective of the study was to develop naproxen sodium SR tablets were prepared by direct compression method using hydroxy propyl methyl cellulose (HPMC K 100). To know the effect of polymer concentration invitro study performed it has been observed that as the polymer concentration increases, the drug release rate decreases, and bioavailability study carried out in healthy human subject by administering the developed sustained release and marketed immediate release tablet. The developed naproxen sodium showed confirmed longer time to reach peak concentration than marketed immediate release table, controlled and constant drug delivery system, maintains better plasma concentration than conventional tablet by which it overcome the shortcoming of conservative treatment. The rate and extent of absorption of naproxen sodium SR tablets were higher than the marketed immediate release tablet shows more competent and controlled drug release which would sustain plasma concentration level throughout and produce desired effect. Further evidenced with lower elimination rate and higher half life. Keywords: Naproxen sodium SR tablets, Marketed immediate release tablet, HPMC, LCMS-MS, Bioavailability study

3972-3975

Authors: S.Selvakumar*, S. Vimalanban and D.Sajusha

Herbal medicines and Phytochemicals can be potent agents for lung cancer chemoprevention and treatment by regulating multi-molecular targets involved in angiogenesis, metastasis, and severe side effects; only provided quality control and reproducibility issues are solved. Compared with the conventional drugs used in cancer treatment, the toxicity of medicinal plants may seem trivial; however, it is a serious public health problem. Several medicinal plants are considered toxic and can cause serious damage to the health of patients. Hence it is of interest to investigate the in vitro antioxidant analysis 0f chloroform extract of Anisomeles malabarica was analysed. Our results indicate that the antioxidant potential of Anisomeles malabarica. Key words: Anisomeles malabarica, Medicinal plants, Phytochemicals, Lung cancer, Chemoprevention

3980-3983

Authors: S. Selvakumar* and U.Madhan Kumar.

In recent times, focus on medicinal plants research has increased all over the world and a large body of evidence has collected to show immense potential of medicinal plants used in various traditional systems. For many years herbal medicines have been used and are still used in developing countries as the primary source of medical treatment. Plants have been used in medicine for their natural antiseptic properties. Therefore, research has developed into investigating the potential properties and uses of terrestrial plant extracts for the preparation of potential drugs for treating human cancers. Many plant species are alreadybeing used to treat or prevent development of cancer. Multiple researchers have identified species of plants that have demonstrated anticancer properties with a lot of focus on those that have been used in herbal medicine in developing countries. Hence, the present study envisage that the antioxidant activity of the chloroform extract of Muntingia calabura. The results of the present study indicate that the herbal plant M.calabura contains significant antioxidant activity. Key words: Muntingia calabura, Plant based medicines, Potential drugs, Chemotherapy, Side effects.

3988-3996

Authors: Rahim Ullah*, Muhamad Din, Dildar Ahmad, Shazia Raim, Mansoor Ahmed

The objective of this research was to evaluate the danger of co-virus with human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), and patient’s syphilis. Inability to address this weakness can cause fatalities and death because of undetected and untreated contaminations. The procedure utilized by the specialists is a 42 nm (5 × 10 6 cm) DNA particle with a deficiently twofold stranded DNA genome containing an inward center protein (Hepatitis B focal antigen [HBcAg]) and an external coat (Hepatitis B surface antigen [HBsAg] It is a hepadnavirus and is a HCV disengaged chain RNA virus (hepacivirus). HCV vaccination protein immunoassay, recombinant immunoblot test, and quantitative HCV RNA polymerase chain reaction (PCR) are show tests used to recognize HCV disease. Antibodies against HIV were screened utilizing Determine and ImmunoComb tests. Basically useless conduct is most likely by all account not the only hazard factor and the danger of blood borne viral contamination is presumably identified with poor financial conditions, medication and liquor mishandle ethnic beginning, sex. For example, ancestorism, meningitis, uveitis, optic neuritis, general loss of motion, dorsal skin and skin and skeletal bears It is demonstrated that The aftereffects of various analysts are a piece of the sequelae related with tertiary syphilis. For fundamental and subjective wounds, limit visual field microscopy and direct fluorescence vaccination gear (DFA) are tests used to break down syphilis. Non-treponemal serological tests by Fast Plasma Recover (RPR) or (VRDL) are most generally utilized for screening. In fundamental syphilis, RPR and VDRL impact are 78% and 86%, separately. Both supplementary syphilis was 100%; in tertiary syphilis it was over 95%. HBV and HCV sickness (aOR 2.81, 95% CI 1.02 to 10.12; p = 0.036), HIV and HBV disease (adjusted proportion (aOR) 3.46, 95% CI 1.29 to 9.39, p = 0.014). (AOR 3.86, 95% CI 1.07-12.55; p = 0.039) and syphilis (aOR 2.81, 95% CI 1.05 (aOR 1.81, 95% CI 1.14-2.88; p = 0.013), especially polluted by HIV - 7. 46; p = 0.039). Run for ANC cases was that ladies who were pregnant from blue to go to ANC offices inside the time allotment of the examination the standard of Ob-Gyn OPD patients was another STD tolerant who went to Ob-Gyn OPD amid the investigation time frame and was a patient who went to the intercession focus with or without sign. Keywords: HBV, HCV, syphilis disease and blood borne infection

4003-4010

Authors: Dr. Abdullah Bashir Janjua, Dr. Shaharyar Ahmed, Dr. Umar Farooq

Antihelmintics are the drugs used to eradicate or reside the number of helmintic parasites from intestinal tract or tissue of humans and other animals. The antihelmintic activity of Rauwolfia serpentina root extracts were evaluated separately on adult Indian earthworm (Pheretima posthuma). It was found that methanolic extract and aqueous extract of Rauwolfia serpentina showed antihelmintic activity at various concentration (50,100 and 200 mg/ml). The standard drug used was Albendazole (50, 100 and 200 mg/ml). The methanolic extract of Rauwolfia serpentina showed better result when compared to aqueous extract. Keywords: Antihelmintics, Rauwolfia serpentina, Albendazole and Pheretima posthuma.

4017-4023

Authors: Dr. Waseem Haider, Dr Mahnoor Ahsan, Dr Usama Razzaq

Background and Objective: Coronary heart diseases are being treated by surgical and non-surgical procedures like Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI). The impact of these techniques on the patients with Chronic Kidney Disease (CKD) is a debatable issue. The risk factors (mortality and morbidity) associated with the application of these methods in CKD patients are brought to light in this study. Methods: The study was carried out at Services Hospital, Lahore from Jan 2016 to Aug 2017. A total of 159 CKD patients were selected from the revascularization center of the hospital. They had to undergo either from CABG or PCI. The main results after the treatment were loss of life, Myocardial Infarction (MI) heart attack, or stroke. We analyzed the mode of coronary revascularization having least risk factors of medical results. Results: Among 159 patients with CKD, 85 patients (53.5%) received PCI and 74 patients (46.5%) received CABG. The study revealed that patient with higher intensity of kidney disease were given PCI treatment and surgical procedure (CABG) was adopted in case of patients with mild CKD. However, the medical findings were not much different in both cases. The PCI method was preferred on the basis of factors like patients’ age, heart attack by complete blockage of artery (STEMI), heart attack by partial blockage (NSTEMI) and number of coronary arteries in patients with intense renal problems. Conclusion: The medical results seen in both cases were comparable for CKD patients. No significant difference was noticed in the patients for both methods. Therefore, Percutaneous Coronary Intervention can be agreeable and least intrusive treatment with respect to CABG, especially among patients with higher risks of kidney disease. Key Words: Chronic kidney disease, Creatinine clearance, Coronary revascularization, percutaneous coronary intervention, Coronary artery bypass graft.

4028-4031

Authors: Dr. Faiqa Shafiq, Dr. Muniba Irfan, Dr. Hussnain Abid

Objective: To determine the frequency of Hypersplenism in cases of liver cirrhosis. Methodology: This cross sectional study was conducted at Sheikh Zayed Hospital, Lahore during January to August 2017. The cases with liver cirrhosis were labelled according to clinical symptoms, deranged liver function tests and on Ultrasonography abdomen. The cases were included of both genders with age 20 years or more with child pugh class B and C. The cases with any hematological malignancy or end stage renal of cardiac failure were excluded. Hypersplenism was labelled on bone marrow examination with normal to hyper cellular marrow. Results: In the present study there were total 130 cases of liver cirrhosis. Out of these 84 (64.61%) were males and 46 (35.39%) females. The mean age was 53.45±8.23 years. Hypersplenism was observed in 65 (50%) of the cases. Hypersplenism was significantly high in male group seen in 51 (60.71%) cases with p= 0.01. There was near significant difference in terms of age groups where it was seen in 48 (56.47%) cases with age more than 50 years with p= 0.06. Hypersplenism was significantly high in cases with child pugh class C affecting 55 (56.70%) cases with p value of 0.02. Conclusion: Hypersplenism is not uncommon in liver cirrhosis and is seen significantly high in cases with child pugh class C and male gender. Key Words: Liver cirrhosis, Hypersplenism.

4035-4039

Authors: Dr. Sehrish Abbas, Dr. Usman Saleem, Dr. Fawad Ahmed Khushhal

Background: In the established hydrocephalous a common modality of the treatment is ventriculoperitoneal shunt. Our research was aimed at the determination of the age and sex distribution, cause and site and post-operative year of shunt obstruction of the ventriculoperitoneal obstruction blocked VP shunts patients. Material & Methods: Research design was descriptive and it was carried out at Mayo Hospital, Lahore in the period of Jan, 2016 to Jan, 2017. We included every blocked VP shunt patient in our research study. Age and sex were the demographic; whereas, time from the VP shunt insertion was counted in years, post-operative shunt obstruction year and cause and site of the shunt obstruction were taken as the variables of the research study. To calculate the continuous data, we calculated the values of Mean & SD; whereas, percentage and frequency were also calculated for categorical data. Results: Research sample consisted of 104 patients, 56 males (53.85%) and 48 females (46.15%). The patient’s median age factor was observed as four years (0.58 – 11.75 (IQR)). Below one-year age was involved repeatedly and it was observed in 39 patients (37.5%). Shunt obstruction occurrence was observed in 1st year of the post shunt insertion in 38 patients (36.54%). The occurrence of the Shunt obstruction was observed at the end of ventricular in 57 patients (54.80%); whereas, 47 patients (45.20%) had the blockage of distal catheter. The repeated cause of the blockage of the shunt was observed as lying in brain parenchyma and shunt tip crossing ventricle observed in 20 patients (19.23%). Conclusion: In the early years of the life the occurrence of the shunt obstruction in VP shunts is common and repeated. Its predominance is observed at the end of proximal. In the first insertion years its occurrence is observed. Key Words: Hydrocephalous; Cerebrospinal Fluid; Ventriculoperitoneal Shunt; Pleural Cavity; Peritoneal Cavity; Choroid Plexus and Slit Ventricle Syndrome.

4046-4050

Authors: Dr. Laiq, Dr. Rameez Ahmad, Dr. Sebghat Ullah

Objective: The aim of the research was the comparison of the auto transplantation of parathyroid gland with the preservation of the parathyroid gland in situ keeping in view the parathyroid gland function preservation in total thyroidectomy patients. Methods: Research design was quasi-experimental which was carried out in the time span of July, 2015 to June, 2017 at Mayo Hospital, Lahore with a sample of 388 patients experienced total thyroidectomy for numerous disorders of thyroid gland. The sample of the research was divided in to two groups A and B respectively having 97 cases of parathyroid glands who were preserved in situ and 291 patients underwent at least one auto transplant of parathyroid gland in ipsilateral sternocleidomastoid muscle. Six months follow-up was carried out for the parathyroid function assessment. We used Fisher's exact test for the comparison of both the groups. Results: Mean age of group A and B was respectively (42.46 ± 15.30) years and (39.16 ± 18.91) years. An overall proportion of male to female was (1:3.5). In the population of Group “A”, permanent hypocalcemia was developed in 3 cases (3.09%); whereas, “B” group had only 1 permanent hypocalcemia case (0.34%). Conclusion: At least one parathyroid gland auto transplantation after total thyroidectomy is a process that has always predictable outcomes linked with the lowest risk of the permanent hypoparathyroidism. Keywords: Total thyroidectomy and Parathyroid auto transplantation.

4057-4062

Authors: Dr. Usama Razzaq, Dr. Mahnoor Ahsan, Dr. Waseem Haider

Background: Poisoning trends are changing in Pakistan, travel and street associated poisoning is novel and emerging in the healthcare as a big issue. This research is first in its kind that deals with the regional issue of the travelling and street used drugs and their poisoning mode. Material & Methods: Research is cross-sectional descriptive in design and it was carried out at Services Hospital, Lahore in the period starting from July 2016 to June 2017 having a sample of one hundred cases, which were enrolled in the research after the fulfilling of prescribed criteria. At the end of the clinical assessment necessary urine test, stomach and blood samples were collected and tested in the laboratory to analyses then chemically and toxicologically. Results: The sample was of one hundred cases selected from the age limit of 15 – 65 years including 84 males (84%) and 16 females (16%). Among the used drugs sixty percent was benzodiazepines, 4% phenobarbitone, 32% opium derivatives; whereas, rat killers were used by a meager 2%, mixed opium derivatives and benzodiazepines. Delivery mode in the poison intake was through soft drinks (54%), food (8%) and fruits (38%) cases. The victimized persons included 60% passengers, 8% Taxi drivers, 20% pedestrians, females 6% attending marriages and six percent others were also affected. Conclusion: Travel and Street associated poisoning cases are emerging issue of the healthcare in Pakistan. Delivery mode is often drinks, food and fruit with a mixture of opium derivatives and benzodiazepines. This occurs because of the awareness level and educational lack, law and order in the poor state, corruption, people attitude and un-employment. Key Words: Crime; Travel; Poisons; Street drugs; Opium; Benzodiazepines and Public Health.

4072-4087

Authors: T. Mangilal, K.Chitra*, J. Naveen, M.Ravi Kumar

The aim of the present study is to formulate and evaluate Voriconazole Buccal Patches. Voriconazole is a triazole antifungal drug that is generally used to treat serious, invasive fungal infections. These are generally seen in patients who are immune compromised, and include invasive candidiasis, invasive aspergillosis, and certain emerging fungal infections. In the present study buccal drug delivery of Voriconazole was developed Matrix type of buccal patches was developed by using polymers such as Chitosan and Eudragit S 100. Buccal patches were prepared by employing solvent casting method. Propylene glycol and Tween80 were selected as both permeation enhancer and plasticizer. Drug excipient compatibility studies were carried out by using FTIR, and it was observed that there were no interactions between drug and polymers. Formulations were prepared by the varying concentrations polymers ranging from F1-F6, and all the formulations were evaluated for various physical parameters such as Physical appearance, Flatness, Weight variation, Thickness, Folding endurance, Drug content, Moisture uptake, Moisture content. All the results were found to be were found to be within the pharmacoepial limits, invitro drug release studies done by using dialysis membrane. Among all the 06 formulations F4 formulation which contain Eudragit S 100 100mg has shown 95.76% cumulative drug release within 12 hours. For F4 formulation release kinetics were plotted and the Regression coefficient value was found to be high for Korsemeyer Peppas model plot i.e., 0.999. Key words: Voriconazole, Buccal Patches, Chitosan and Eudragit S 100

4097-4106

Authors: V.A. Ghodake, B.A.Agarwal, A.R. Tekade*

A stability indicating high performance thin layer chromatography (HPTLC) method was developed and validated for determination of Donepezil hydrochloride and curcumin in in situ nasal gel. Study was performed on pre-coated silica gel HPTLC plates using toluene: methanol: glacial acetic acid (8: 2: 0.1 v/v/v) as the mobile phase. A TLC scanner set at 254 nm was used for direct evaluation of the chromatograms in the reflectance/absorbance mode. Method was validated according to ICH guidelines. The correlation coefficients of calibration curves were found to be 0.994 and 0.988 in the concentration range of 300–1800 and 120–720 ng band−1 for donepezil hydrochloride and curcumin, respectively. The method had an accuracy of 100.6 % for donepezil hydrochloride and 99.08% for curcumin. The method had the potential to determine these drugs simultaneously from dosage forms without any interference of the excipients. Donepezil hydrochloride and curcumin were also subjected to acid, base, oxidation, heat and photo-degradation studies. The degradation products obtained were well resolved from the pure drugs with significantly different Rf values. As the method could effectively separate the drugs from its degradation products, it can be used for stability-indicating analysis. Keywords: High-performance thin-layer chromatography, Donepezil hydrochloride and Curcumin, Stabilityindicating method

4114-4120

Authors: M. Ramayyappa*, G. Raveendra Babu, B. Krishna, A. Ravi Kumar

A novel stability-indicating, RP-HPLC method was developed for the simultaneous determination of the Aspirin, Atorvastatin and Clopidogrel in capsules. Chromatogram was run through BDS (150 mm X 4.6mm, 5μ). Mobile phase containing phosphate buffer pH 4.5 and acetonitrile in the ratio of (50:50, v/v) was pumped through column at a flow rate of 1ml/min. Optimized wavelength for Aspirin and Atorvastatin and Clopidogrel was 249 nm. Retention time of Aspirin, Atorvastatin and Clopidogrel were found to be 2.367 min, 5.463 min and 4.658 min, respectively. % RSD of the Aspirin, Atorvastatin and Clopidogrel were and found to be 1.01, 0.89 and 0.77 respectively. % recover was obtained as 99.79 %, 99.73 % and 100.57 % for Aspirin, Atorvastatin and Clopidogril, respectively. Limit of detection and quantification values are obtained from regression equations of Aspirin (0.8 ppm, 0.25 ppm), Atorvastatin (0.14 ppm, 0.41 ppm) and Clopidogrel (0.25 ppm, 0.76 ppm). Regression equation of Aspirin is y = 2433.x + 706.4, and of Atorvastatin is y = 17432x + 872.7and Clopidogrel is y = 2403.x + 412.3. The present method was performed the degradation studies like acid, base, oxidation, UV, thermal and neutral, results founds to be negligible. Key words: Aspirin, Atorvastatin, Clopidogrel, RP-HPLC and Estimation

4129-4142

Authors: Vazir Ashfaq Ahmed *and Divakar Goli

Objective: The goal of this study was to evaluated anti-glaucoma activity of ion-activated in-situ gel of Brimonidine Tartarate (BT) and to predict the shelf of the developed formulation. Method: sol-gel formulation was prepared by using gellan gum as an ion-activated gel-forming polymer, sterculia foetida gum and kappa carragennan as mucoadhesive agent and hydroxy propyl methyl cellulose (HPMC E50LV) as release retardant polymer. Phenyl ethyl alcohol as preservatives in borate buffer. Glaucoma was induced by marginal ear vein using 5% dextrose solution. Schiotz tonometer was use to measure the induced glaucoma. Long terms and accelerated stability studies were carried out. The formulation was characteristics for pH, clarity, sterility, in-vitro gelation studies and drug content by RP-HPLC method. Result: The mean normotensive IOP was in the range of 17.5±0.08 to 19.1±0.40 mm Hg in both the eyes. Glaucoma was induced in the both eye with 5% dextrose solution and the mean IOP in both eyes was in the range of 26.2±0.21 to 29.9±0.25 mm Hg. Student paired Ttest ( F2) vs. Distilled water) was analysed and it was found that there is a highly significant difference between the means. This indicates the test drug is effective in the form of in-situ gels. The repeated measures one –way ANOVA with Tukey's multiple comparison test indicate the data is not significant, i.e p value is greater than p<0.05. In-situ gel are able to control the induced IOP and the IOP values of treated in-situ gel are near to normal IOP reading. Student unpaired and paired T test along with one way ANOVA data shows that there is a marginal significant difference between the means of F1 and F2. With p value of <0.0060 for student unpaired, <0.0050 for student paired T test. There is no significant difference between F2 and normal IOP but there is a marginal significant difference between F1 and normal IOP. Which highlight F2 is better in controlling induced/elevated IOP compared to F1. in-situ gels were translucent, Immediate gelation was formed with in sec, as it was dropped and remained stable. The formulations were free from microorganisms at 30 °C ± 2 °C/65% RH ± 5% RH and at 40°C ± 2°C/75% RH ± 5% RH. The chromatograms were obtained with acceptable tailing factors (<2), not much variation was observed in the retention time. % drug content was found to be in the range of 9 9.46 % to 96% at 40°C ± 2°C/75% RH ± 5% RH by RP-HPLC. The shelf life (t90%) of F2 was found to be 2.5 years at 30 °C ± 2 °C/65% RH ± 5% RH .and at 40°C ± 2°C/75% RH ± 5% RH shelf life (t90%) was found to be 2 years. Conclusion: 5 % dextrose infusion through marginal ear vein is better in inducing IOP. Schiotz tonometer remains the preferred screening instrument. Brimonidine tartarate has a dual mechanism of action by reducing aqueous humor production and increasing uveoscleral outflow. So a synergistic effect can be obtained with help of in-situ gels in order to control elevated intra-ocular pressure in glaucoma. The above study highlights that formulation with sterculia foetida is better compared to kappa carragennan in controlling induced IOP. Key words: Sterculia Foetida gum, marginal ear vein, Schiotz tonometer, Brimonidine Tartarate.

4153-4157

Authors: Muhammad Kamran, Dr. Awais Butt, Shahzaib Nawaz

Objective: To have in depth knowledge about the effects of nonselective and selective inhibitory and activated agents on adenylyl cyclase in rat kidney. Design: A variety of concentrations of pharmacological agents were prepared. They include nebularine, Ap3A, forskolin, Ap4A and caffeine. Furthermore, effects of these agents were noted in relation to rat kidney adenylyl activity. Methods: Tissue of rat kidney was used in the process of preparation of crude extract. Activity of adenylyl cyclase in connection with crude extract was observed. [2-H3] ATP was used as substrate which ultimately lead to the formation of cAMP. Pharmacological agents with their prepared concentrations were tested. Prominent activator of adenylyl cyclase, forskolin, was selected as a compound. Ap4A, caffeine, nebularine, and Ap3A were utilized for comparison purpose. Results: Adenylyl cyclase activity was at peak at 100 M forskolin as per concluded results. Nebularine inhibited activity of enzyme when agent concentration enhanced up to 50 M where the inhibition started to stable. No considerable effect on the enzyme activity in kidney tissue was observed when caffeine with 10 – 300 M on the of adenylyl cyclase activity was used. No effect on adenylyl cyclase activity was noted when Ap3A over the concentration range of 10 – 300 M was used. However, an inhibition effect on the enzyme activity was noted when Ap4A with the concentration 100 M was used. Conclusion: Role of cyclic nucleotides in metabolism control and cell-signaling is undeniably significant. It stimulates inhibitors and activities of cyclase to make some likely physiological impacts. Foreskin being initiator of adenylyl cyclase, Ap4A and nebularine are established to be latent inhibitors of cyclase, which signifies their importance in curing schizophrenia, mania, seizure etc. Key Words: Ap3A, Nucleotides, Caffeine, Forskolin, Ap4A, Nebularine. Adenylyl cyclase

4165-4177

Authors: Dr. Muhammad Bilal, Dr. Shakeel Mazhar, Dr. Muhammad Rashid Ali

Background: expanded program on immunization is carried out to protect all children against nine vaccine preventable diseases; still many children don’t receive vaccination at proper age. The purpose of EPI is to initiate a collective effort to reduce the mortality results from EPI target disease by immunizing children of age less than two years. Hence, monitoring immunization coverage performance is essential for improving the quality of services and current immunization status. Study design: cross-sectional study Study setting: PAEDS Outpatient department of services Hospital Lahore. Study duration: 1st May to 30th may 2015: 1 month Materials and methods: Non probability convenient sampling technique was used. Every Mother of the child less than two years was personally interviewed and a preformed questionnaire was filled in. Data was analyzed using SPSS. Results: 88.7% children received complete immunization till required for their age at proper time according to expanded program on immunization schedule while 7.2% %children were partially immunized and 4.1 % children were non-immunized. Reasons behind incomplete immunization were 27.3% parents of children were not willing for immunization while reasons given by parents for child being not immunized were lack of information in 9.1%, false beliefs in 18.2%, vaccination center not approachable in 45.5%, child sickness in 18.2% and unavailability of vaccinator in 9.1%. Conclusion: The immunization coverage among children was found to be comparatively high and the major reasons for failure of immunization among children were inaccessibility of vaccination center, misconceptions among parents, child sickness and lack of information. Keywords: Expanded program on immunization, Coverage, Failure reasons.

4186-4190

Authors: Iqra Sagheer, Farwa Iqbal, Aqsa Zulfiqar

Objective: The research design was cross sectional survey which was carried out to find out the Restless legs syndrome (RLS) prevalence in the patients of end stage renal disease (ESRD) on hemodialysis (HD). Methods: We obtained this data from a total of 250 patients through chronic maintenance HD. For the assessment of the RLS prevalence, RLS criteria for the clinical diagnostic was made through the research group of international RLS. Results: Research sample size was 250 cases with the male and female proportion of 153 males (61.2%) and 97 females (38.8%) respectively. The factor of mean age was observed as (45.27) years. HD mean duration was (26.10) months. We found a total of 162 RLS cases (64.8%). In the total of 153 males, 87 cases (56%) were diagnosed with RLS and among in the 97 females, 75 cases (77.3%) were diagnosed with RLS. We observed in this research that significant involvement of the gender was present in the research outcomes which was linked with RLS as p-value was observed as (0.001). Concerning to group of age 159 cases (63.6%) were under 51 years of age; in this number 102 cases (64.1%) were diagnosed with RLS; whereas, 91cases (36.4%) were above or equal to 51 years and in the patients of this group 60 cases suffered from RLS (65.9%). It was noticed that no significant link was present in age group and RLS with a significant p-value as (0.776). Conclusions: The patients undergoing routine HD are observed with a common incidence of RLS. Females are commonly observed in this incidence and dominate males. Key Words: Restless legs syndrome (RLS), End stage renal disease (ESRD) and Hemodialysis (HD).

4197-4203

Authors: Dr. Umer Farooq, Dr. Mubashar Alam, Inam ur Rehman

Background: Individuals who keep on changing their jobs are impelled due to dispositional wanderlust commonly known as Hobo syndrome. Key objective of the study at hand was to identify the concept of Hobo syndrome and then its comparative analysis in three realms i.e. health, banking and development. Material & Methods:The size of sample was 228 in this comparative study. Measures employed in the study were various key aspects i.e. openness to experience scale, perceived alternative employment opportunities, job hopping measure, demographic data sheet, number of past quits and intention to search for alternative job. Post Hoc and one-way ANOVA were correlation used to examine the hypotheses. Results:Study was conducted on total 228 individuals. Every sector was allocated 76 individuals. After results, it was confirmed that there is a presence of positive relationship between perceived alternative employment opportunities and Hobo syndrome. It also validated the relationship between Hobo syndrome and openness to experience. On Hobo syndrome, banking sector employees showed greater mean score when they were compared with health and development sector. When mean differences on Hobo syndrome was compared in connection with workers of various levels of management, results were remarkable. As per these results, high mean score was displayed on Hobo syndrome by non-management employees when they were compared to senior and middle management employees. Conclusion:In Pakistan, Hobo syndrome is rampant amongst various employees related to non-management sector especially. The same is true in case of senior and middle management but it is of lesser nature as compared to nonmanagement workers. Banking sector employees have more inclination to Hobo syndrome in comparison to the employees of health and development sectors. Key Words: Job hopping, Openness to Experience, Hobo Syndrome, Perceived Alternative Employment Opportunities.

4218-4221

Authors: *Dr. Preetha S.P, Ph.D., Dr. Karthikeyan Ramaiyan, M.V.Sc., Dr. Vasudevan Ramakrishnan, M.D (Siddha), Dr. SathyaRajeswaran M.D (Siddha)

Colon cancer is the major cause of death worldwide. Pooranachandirodayam is a herbo-mineral siddha preparation used to treat chronic ailments. This study was conducted to elucidate the efficacy and probable underlying mechanism of Pooranachandirodayam in colon cancer using in vitro studies. But Pooranachandirodayam had solubility issues with the methods earlier described for in vitro studies and with different concentrations of other varying solvents. From the results of the in vitro studies, PC shows no effect on the colon cancer cells, which may be due to the inappropriate vehicle used. Keywords: Colorectal cancer - Pooranachandirodayam – solubilisation – in vitro studies

4228- 4251

Authors: Sharmila Dusia a,*, Ramanamma.L, Prasad.DSVS

A RP-HPLC for Donepezil hydrochloride in tablets was developed and validated. Donepezil hydrochloride is a reversible inhibitor of acetylcholinesterase, indicated for the treatment of mild to moderate dementia of the Alzheimer's type. The HPLC method was performed with a unisol reversed phase C18 column (150×4.6 mm, 3 µm) detection at 268 nm and a mixture of Acetonitrile: Water (50:50) as mobile phase. Typical retention time for Donepezil was 4.407 mins. The method was statistically validated for linearity, accuracy, precision and selectivity following ICH recommendations. Due to its simplicity and accuracy, the method can be used for routine quality control analysis. Keywords: Donepezil hydrochloride; Assay; HPLC; Validation.

4258-4261

Authors: Dr Bakht Zia, Dr Aqsa Maryam Marith, Dr Subhan Shahid,

Objective: To determine causes and risk factors leading to depression and mood swings among pregnant females visiting antenatal clinics of teaching hospitals in Lahore, Pakistan. Methodology: 907 pregnant females were included in study, from antenatal clinics of teaching hospitals in Lahore, Pakistan during January to December 2016. Study follows descriptive, cross-sectional design. Demographic profile was recorded on a questionnaire. The measurement tool for depression was Beck Depression Inventory (BDI). Data analysis was done using descriptive statistics, linear regression and Chi- square test. Results: The women with mean age 26.44.4 were included in study. 80.5% females had depression during antenatal period. Depression score was calculated in each trimester and it was 67.9%, 83.5% and 85.8% respectively. There was significant increase in depression as pregnancy progresses (P value 0.001).The regression analysis showed the risk factors, patient’s education (OR 4.67, 95% confidence interval, 1.97 to 11.07), husband’s education ( OR 4.67, 95% CI, 1.9 to 11.07), husband’s employment( OR 4.67, 95% CI, 1.9 to 11.07), , family size( OR 4.67, 95% CI, 1.9 to 11.07), , History of miscarriages( OR 4.67, 95% CI, 1.9 to 11.07), , number of pregnancies ( OR 4.67, 95% CI, 1.9 to 11.07). Conclusion: Depression is quite common among females during antenatal period, which increases as pregnancy progresses. The risk factors responsible for it are husband and wife’s education, family size, number of pregnancies, history of abortions, monthly income and family financial status. Screening and diagnosis of depression and provision of special care to patient improves the healthy progression of pregnancy. Key Words: depression, pregnancy, females, causes.

4266-4269

Authors: Dr. Amna Tahir, Dr. Iqra Liaqat,Dr. Rabia Javed

Objective: To determine the association between serum interleukin 6 levels and angina pectoris. Methodology: The cross sectional study was conducted at Sheikh Zayd Hospital, Lahore during February to September 2016. 40 to 60 years old diagnosed cases of angina pectoris, either males or females were added in the study population. The criteria was normal ECG waves at rest and normal cardiac enzymes level. IL-6 levels were measured in patients by collecting 3ml blood sample. More than 5ng/ml was normal level. Results: 100 angina patients were enrolled. Male to female ratio was 58 and 42 each, respectively. Mean age group was 54.29.3 years. 68 individuals had raised IL6 levels. No association between gender and IL- 6 level was noticed. However the level was higher in individuals with diabetes mellitus and hypertension, affecting 20 and 22 cases in each group. P value was 0.01 and 0.05 respectively, which was statistically significant. Conclusion: IL-6 level was raised in patients with angina pectoris, its level was significantly raised in patients with DM and hypertension. Key Words: Interleukin 6, Angina pectoris, diabetes mellitus, hypertension.

4274-4276

Authors: G. Sowjanya, E. Raja Sree, S. Disharani, M. Neeraja, Y.Lavanya, M. Niranjan babu

Objectives: Carbamazepine is most commonly used for the treatment of seizure disorders, neuropathic pain and bipolar disorders. It is associated with adverse effects such as nausea, vomiting, drowsiness, dizziness, head ache, impairement in motor coordination, aplastic anaemia, agranucytosis. Rarely life threatening cutaneous reaction such as stevensjohnson syndrome (SJS) or toxic epidermal necrolysis (TEN) due to carbamazepine therapy are more common in people with human leukocyte antigen allele HLA-B*1502. Methodology: We report a case of SJS due to carbamazepine therapy in a patient with epilepsy. Results: A 36 years old female patient from rural area was admitted in the dermatology ward in a tertiary care hospital with a chief complaints of fever, blisters, skin peeling, red eyes, painful skin, burning sensation, erythema of lips, throat pain and difficulty of swallowing for 4 days. She had a past medication history of early two month clinical course of carbamazepine for seizures. Conclusion: We high lightening the importance of early diagnosis of this cutaneous adverse reaction may help in adjusting the further therapy so as to avoid the complications. Key words: Carbamazepine, epilepsy, steven jonhson syndrome, cutaneous adverse drug reaction

4286-4289

Authors: Dr. Mohammad Ahmad Shahbaz , Dr. Ramsha Jalal, Dr. Aleena Akram

Introduction: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the head and neck (excluding non-melanoma skin cancer), with more than 300,000 new cases reported annually worldwide. Objectives of the study: The basic aim of the study is to find the some important biomarkers which are useful in the diagnosis and treatment of oral tongue squamous cell carcinoma (SCC). Material and methods: The study was conducted according to the rules and regulations of ethical committee of hospital. The patients who was suffering from oral cancer was selected for this study during the time period of 2016 to 2017. 5.0 ml blood sample was taken from vein. Blood was further processed for the estimation of serum biomarkers i.e Sialic acid, NO, Vita-A, Vit-E and GSH. Results: The data represents that there is a statistical difference among control group and patients. The data shows all the expected prognostic markers which used for the assessment of OSC in humans. The value of GSH and SOD shows that these are the most important biomarkers for the analysis of OSC in humans. Conclusion: According to analysis of data it is concluded that GSH, MDA and SOD are the important diagnostic biomarkers in the assessment of OSSC. Key words: OSSC, GSH, Antioxidants, Cancer

4306-4311

Authors: Dr. Amina Manzoor, Dr. Khadija Aziz, Dr. Sualeha Zulfiqar, Dr. M. Sohaib Yousaf

Objective: The comparison of rate of hospitalization and the requirement assessment for physicians in Emergency Department to have awareness and knowledge about the poisoning cases definitive treatment was the objective of this research. Methods: In our retrospective research we assessed a total of 589 cases which were adult patients hospitalized in the Emergency Department of Mayo Hospital, Lahore in the timeframe of January, 2016 to December 2016 with the incidence of poisoning. We compared the hospitalization rates and epidemiological data among the patients having generally better medical condition, which were requiring simple intervention methods and shortly discharged from the emergency of the hospital after supervision; whereas, poor condition patients were hospitalized for a longer time duration. Data analysis was made through SPSS. Results: In the total 589 cases, 256 cases were of good medical state (43.4%); whereas, 333 cases (56.5%) were in a bad medical state. Good medical condition cases were 244 in number (95.3%) and they were managed in the Emergency Department, after necessary treatment they were discharged from the hospital; whereas, 295 patients (88.6%) of poor medical state were also discharged. A total of fifty patients (8.4%) were hospitalized and complete medical intervention and treatment was extended to them till the time of complete recovery. Conclusion: All the cases of the poisoning who were admitted in the hospital the treatment of the good and nearly poor was made in the emergency department; whereas, fifty cases were hospitalized and discharged after complete recovery. The good general medical condition was regularized with the help of definite interventions by the physicians. Keywords: Poisoning, Emergency department and Hospitalization.

4317-4323

Authors: Dr. Shahpara Alamgir, Dr. Ayesha Rehman, Dr. Muzzamil Riaz

Objective: The comparison of the adverse Feto-maternal outcomes in both the groups of Normal and overweight pregnant woman was the objective of this particular research. Methods: Design of the research was comparative cohort, which was completed in the time span of November, 2016 to October, 2018 (Mayo Hospital, Lahore) on a sample of 200 gravid ladies. Sample was divided into two main groups named as overweight and normal pregnant women of hundred cases each. Sample was comprised of pregnant women having gestational age in the range of 08 weeks – 40 weeks. Overweight and normal cases were categorized respectively as (BMI 25 – 29.9 Kg/m2) and (BMI of 18.5 – 24.9), normal cases were taken as controls. Feto-maternal outcomes were compared through Chi-square test and the pvalue was taken as (< 0.05). Results: Women selected for the research were in the age bracket of 30 – 45 years with a mean age of (30 ± 4.1 years). High frequency of pre-eclampsia was observed in overweight women in comparison to the normal group (27% vs 9%), gestational diabetes mellitus (DM) (22% vs 5%), PIH (24% vs 8%), Caesarean section (44% vs 16%), prolonged labor (4% vs 6%), Postpartum Hemorrhage (5% vs 2%) and Wound infection (3% vs 2%). The significant P-value was taken as (< 0.001). In terms of fetal complications in both the groups when compared were as Early neonatal death (11% vs 1%), Still birth (13% vs 2%), NICU admission (47% vs 10%) and shoulder dystocia (5% vs 1%). Except the incidence of shoulder dystocia outcomes were statistically significant. Conclusion: It is concluded that deleterious effects are related to the incidence of obesity on the Feto-maternal outcomes. Key Words: Outcomes, Controls, Pregnant Overweight Women and Adverse Feto-maternal.

4329-4333

Authors: Hafiza Nimra Shabbir, Aqsa Javed, Sidra Shabbir

Objectives: To know the knowledge of the diet plan in pregnant women according to food and nutrient levels and to know the level of education, the economy, and popular women's choice of food. Place and Duration: The study was performed in the Obstetrics and gynecology department of Services Hospital, Lahore for the period of one year from January 2015 to December 2015. Study Design: An Observational Study Results: 380 pregnant women were interviewed 3 times using a 24-hour diet reminder with recipes. Negotiations were made on health, nutrition and socioeconomic status and on women's weight and height measurements. The result shows nutritional status should be monitored in pregnant women and should be acknowledged to the pregnant women. Conclusions: According to the Pakistan diet, women's (unreinforced) diets were not sufficient for all nutrients except energy and fat. A low level of micronutrient intake of food outside the rice was detected. Food habits and the economy have shown that women have a negative impact on food choice, family type, education level, number of pregnancies and popular dietetics. negative. Recommended foods in proper amount, green vegetables especially, should be given to women. Nutritional recommendations provided by healthcare providers at all levels should be the same and should be local cheap foods that are widely consumed. Keywords: Pregnancy, diet intake, nutritional status.

4338-4346

Authors: Dr. Muhammad Shahid Hussain, Dr. Usman Hussain, Dr. Sameer Ahmed

Hepatitis C Virus (HCV) is affecting 170 million people annually (WHO, 2012) and Pakistan ranks high in chronic hepatitis. HCV is a leading cause of chronic liver disease and hepatocellular carcinoma rapidly transmitting as silent killer. Our objectives were to assess the knowledge of students of Punjab University (Gujranwala Campus) about contributing risk factors for HCV infection. And to impart knowledge to students regarding preventive measures in relation to associated risk factors for HCV transmission. Subjects were 100 students our study was Descriptive / cross sectional study. The following data collection tools were developed and used. A consent form was used to get the consent of the respondents wherever possible. A semi structured Questionnaire was used to get information from study population. The tools were pretested and modified according to requirements. In our study the overall questionnaire response was 100 %. Objectives: To assess the knowledge of students of Punjab University (Gujranwala Campus) about contributing risk factors for HCV infection. To impart knowledge to students regarding preventive measures in relation to associated risk factors for HCV transmission. Result and Conclusion: 35% responded that sexual contact was possible mode of transmission of HCV infection followed by 20% and 19% who believed that organ transplant and blood transfusion were the main modes of transmission of virus. 13 % answered that sharing of tooth brushes and razors were main causes of its transmission. Another 13% responded that use of injections was the source of transmission of HCV. 80% believed that infection was transmittable from mother to child. 47% think recipient of blood and blood products are at the risk of developing HCV infection. 23 % thought that people with multiple sex partners were at the risk of developing HCV infection. 70% were of opinion that Vaccination was available against HCV infection and only 28% knew that it was not available. 77% believed that spread of HCV infection could prevented by avoiding blood contacts. 10% said that prevention was possible by avoiding eating together, 5% said by avoiding hand shake and 8% said that it prevention is not possible. 92 % believed that the treatment of HCV infection was available. 8% said there is no treatment of this infection. 77 % said that recurrence of HCV infection was possible and 7 % responded with no. 17 % said that they did not know about this. Summarizing the results of this study, these findings indicate an ambivalent knowledge about HCV infection amongst Punjab University Gujranwala students, many gaps were observed, suggesting the importance of continuous education about HCV in this population to prevent HCV infection as well as discrimination and prejudice towards patients with hepatitis C.