Welcome to Journal Of Pakistan Medical Association
   Issue Vol:67, No:12 December, 2017
Editorial >>

Involving culinary science as part of the diabetes care team

Sanjay Kalra, Nishant Choubey.

Diabetes is a multi-faceted syndrome, and diabetes care is a team effort.1 One of the most important persons in the diabetes management team is the dietician.2 While the term \'nutritionist\' implies a person with a theoretical knowledge of nutrit

Original Articles >>

Seasonal and spatial quantitative changes in Aedes aegypti under distinctly different ecological areas of Lahore, Pakistan

Ejaz Mahmood Ahmad Qureshi, Amtul Bari Tabinda, Seemal Vehra.

Objective: To find out the variations in larval and adult density of Aedes aegypti in different seasons under different ecological conditions.
Methods: This study was undertaken in all the nine towns and the cantonment board of Lahore, Pakistan, during four seasons in 2

Association of stress with anxiety and depression during pregnancy

Fouzia Gul, Akhtar Sherin, Mussarrat Jabeen, Shajaat Ali Khan.

Objective: To find out the association of stress with anxiety and depression during pregnancy and to identify common stressors in women.
Methods: This cross-sectional study was conducted at Divisional Headquarters Teaching Hospital, Kohat, Pakistan, from February 2011 to Octo

Knowledge of female doctors about smoking risks and their attitude toward cessation in antenatal clinics perspective from tertiary care hospitals in Karachi

Shaista Ghazal, Saima Akhter, Usman Ali, Nadeem Rizvi.

Objective: To assess the knowledge and attitude of doctors with regard to smoking risks and cessation, and to identify factors associated with self- reported assessment of smoking.
Methods: This cross-sectional survey was performed in 5 hospitals of Karachi from February to A

Remaining dentine thickness of root canals prepared with K-3 and ProTaper rotary systems

Sana Ehsen Nagi, Farhan Raza Khan, Munawar Rahman.

Objective: To compare the remaining dentine thickness of root canals prepared with K-3 and ProTaper files.
Methods: This in-vitro experimental study was conducted from 1st April-30th September 2015 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised

Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings

Amanullah Khan, Nabeea Junaid.

Objective: To determine the prevalence of diabetic foot syndrome in type 2 diabetes mellitus patients.
Methods: This cross-sectional study was conducted at 25 centres across eight cities in Pakistan from August 2010 to March 2011, and comprised adult type 2 diabetics. The sub

Screening of cardiometabolic risks clustering in young Pakistani adults classified by anthropometric traits

Muhammad Saqlain, Sadia Saeed, Muhammad Fiaz, Abid Mahmood, Rizwana Abdul Ghani, Shagufta Jabeen, Feroza Hamid Wattoo, Nasir Mahmood Minhas, Syed Muhammad Saqlan Naqvi, Ghazala Kaukab Raja.

Objective: To estimate frequencies of metabolic risk phenotypes and their associations in body mass index and waist circumference-based obesity categories.
Methods: The cross-sectional study was conducted at Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan

Research Article >>

Foeto-maternal outcome in instrumental vaginal delivery attending a secondary hospital in Hyderabad (Aga Khan Maternal and Child Care Centre)

Nigar Jabeen, Raheela Baloch, Pushpa Malhi, Sana Zahiruddin, Kiran Mawani.

Objective: To evaluate the foeto-maternal outcome in instrumental delivery.
Methods: This retrospective record review was conducted at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan, and comprised medical records from January 2014 to January 2016. Data related t

Clinical presentation of acute myeloid leukaemia A decade-long institutional follow-up

Bibi Kulsoom, Tahir Sultan Shamsi, Nikhat Ahmed, Syed Nazrul Hasnain.

Objective: To analyse a decade-long pattern of clinical presentation of acute myeloid leukaemia patients and compare it with contemporary data.
Methods: The retrospective cohort study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantat

Association of dyslipidaemia in patients with varying degrees of Vitamin D deficiency in the Asian population

Mohammad Ali Arif, Rauf Niazi, Saba Ali Arif.

Objective: To investigate the associations of dyslipidaemia with varying levels of 25 hydroxy vitamin D3 deficiency.
Methods: This cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from July 2016 to January 2017, and compr

Comparison of metformin and pioglitazone in achieving sustained virological response in chronic hepatitis C patients with insulin resistance: A quasi-experimental study

Imran Mahfooz Khan, Bilal Rafique Malik, Fawad Ahmad Randhawa, Nasir Farooq Butt, Uzma Malik, Shahid Hamid.

Objective: To compare metformin and pioglitazone with standard interferon and ribavirin in achieving sustained virological response in chronic hepatitis C patients.
Methods: This quasi-experimental, comparative, interventional study was conducted at Mayo Hospital, Lahore, Pak

Visual outcome and its prognostic factors in patients presenting with ocular war injuries at an army hospital in Pakistan

Syed Abid Hassan Naqvi, Sidra Malik, Zulfiqar ud Din Syed, Syeda Birjees Anwar, Shahzad Nayyar.

Objective: To determine the visual outcome and its prognostic factors in patients presenting with ocular war injuries.
Methods: This descriptive, observational study was conducted at the Combined Military Hospital, Peshawar, Pakistan, from June 2012 to March 2016, and compris

Endothelial dysfunction and developmental outcomes of very low birth weight newborns with hypoxic encephalopathy

Saadat Arif Huseynova, Nushaba Farkhad Panakhova, Adila Sabir Hajiyeva, Pusta Ali Orujova, Sevinj Nabi Mukhtarova, Gulnaz Telman Agayeva.

Objective: To investigate the levels of endothelial constricting and dilating mediators in preterm infants with hypoxic-ischaemic encephalopathy and prospectively evaluate the association between levels measured during the perinatal period and the diagnosis of neurodevelopmental disorders

Perception of educational environment in the operating theatre by surgical residents, a single-centre prospective study

Shahzaib Habib Soomro, Syed Sheeraz Ur Rehman, Farhad Hussain.

Objective: To evaluate the perception of operation theatre educational environment using surgical theatre educational environmental measure.
Methods: This cross-sectional study was conducted at Liaquat National Hospital, Karachi, from August 2015 to February 2016, and compris

Evaluation of students' experience with Problem-based Learning (PBL) applied at the College of Medicine, Al-Jouf University, Saudi Arabia

Abdulrahman Abdulwahab Alduraywish, Mazin Omer Mohager, Mohammed Jayed Alenezi, Abdelsalam Mohammed Nail, Alfatih Saifudinn Aljafari.

Objective: To evaluate the students\' experience with problem-based learning.
Methods: This cross-sectional, qualitative study was conducted at the College of Medicine, Al Jouf University, Sakakah, Saudi Arabia, in October 2015, and comprised medical students of the 1st to

KAP Study >>

Needle stick injuries among nurses of two tertiary care hospitals of Lahore: A KAP study

Shamaila Hassnain, Zarbakht Hassan, Sehar Amjad, Muhammad Zulqarnain, Khurram Arshad, Zunaira Zain.

Objective: To estimate the prevalence of needle-stick injuries in female nurses of a public and private hospital and compare the findings.
Methods: This cross-sectional study was conducted at one public and one private tertiary care hospital in Lahore, Pakistan, from March t

Study on awareness of osteoporosis and its associated risk factors among housewives and working women in Karachi

Lubna Raza, Anzar Ahmed, Vinod Kumar, Abid Hasnain.

Objective: To compare awareness of osteoporosis and its associated risks among working women and housewives.
Methods: This cross-sectional study was conducted at Karachi University and Dow University of Health Sciences, Karachi, from January to April 2015, and comprised worki

Pilot Study >>

Pioglitazone attenuates cardiometabolic risk factors in non-diabetic patients with dyslipidemia

Mazhar Hussain, Muhammad Nauman Shad, Lubna Akhtar.

Objective: To determine the effect of pioglitazone on cardiometabolic risk factors in non-diabetic patients with dyslipidaemia.
Methods: This prospective, randomised clinical trial was conducted at Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan, from Augu

Review Articles >>

A historical glance: Challenges for male nurses

Shireen Arif, Sami Khokhar.

Nurses are primary care providers and are responsible for caring of patients. Since centuries, the nursing profession has been known as a profession only for females. Therefore, the history of nurses in early ages only states the role of the female, although males at that time also took part in p

Graft and mesh use in vaginal surgery

Raheela Mohsin Rizvi, Novera Ghayoor Chughtai.

Pelvic organ prolapse and urinary incontinence are among the most common chronic disorders in women. These are common problems whose pathogenesis remains unclear. As life expectancy increases, significantly greater number of women now present with pelvic organ prolapse and urinary incontinence re

Short Review >>

Health literacy in Pakistan: Exploring new ways of addressing an old challenge

Saniya Raghib Sabzwari.

Pakistan continues to struggle with low health literacy that often results in late presentation of disease, poor adherence to treatment and meagre understanding of wellness and disease prevention. In a country burdened by diseases of the developing and the developed world, with poor healthcare in

Special Communication >>

Multiple mini interviews as a measure of non-cognitive skills for admissions into undergraduate medical education programme in Pakistan: A validity study

Rukhsana Ayub, Naveed Yousuf, Munazza Asad, Umer Ali Khan.

Student selection for Undergraduate Medical Education Programmes (UGME) is a highly selective process globally. Health care practice requires many attributes like communication skills, professionalism, critical thinking and problem solving in addition to cognitive abilities. This study reports th

Respiratory and physical ailments correlated with occupational exposure among welders in Pakistan

Nadia Ghani, Foqia Tariq, Sahar Hassan.

Disruption of normal respiratory function is associated with occupational disorders. Exposure to welding fumes on long term basis affects the lung function of the workers and prompts allergic responses. Therefore, the aim of the study was to manifest the association of exposure to welding fumes a

Short Reports >>

Self-esteem in severely burned adults

Syed Muhammad Imran Haider Zaidi, Nazia Yaqoob, Sidra Noreen.

A cross-sectional study was conducted to investigate the level of and gender difference in self-esteem among adult victims of severe burn injuries. Severely burned adults aged 20 to 40 years participated in this investigation from March 2015 to April 2016 in five hospitals of Faisalabad and Lahor

Incidence of acute endophthalmitis after office based intravitreal bevacizumab injection

Muhammad Ali Haider, Usman Imtiaz, Farwah Javed, Zahra Haider.

The burden of intravitreal injections has increased tremendously over the past few years. Since traditionally the operation theatre setup is currently used for this procedure, it is increasingly becoming difficult to manage such a patient load in the theatres. To overcome this challenge, office-b

Correlates of myopia in students of Bahauddin Zakariya University, Multan

Mushtaq Hussain Lashari, Ruby Ayub, Muhammad Saleem Akhtar, Mazhar Ayaz, Zahida Tasawar.

The present study was conducted to determine the prevalence of myopia in young students of Bahaudin Zakariya University, Multan. A total sample of 620 students of both gender (male=295; female=325) was collected during 2014. The data was divided in two breeding pattern groups, five groups on acco

Case Reports >>

Follicular dendritic cell sarcoma presenting as colonic intussusception

Masroor Hassan, Asim Qureshi, Nadira Mamoon, Zafar Ali.

Follicular dendritic cell sarcoma (FDCS) is a rare intermediate grade sarcoma involving a variety of nodal and extra nodal sites. It has two histological subtypes, conventional and inflammatory pseudotumour like variant. We report this interesting case of FDCS presenting colonic intussusception a

Caught in the act Migration of a large right atrial thrombus to pulmonary artery during transthoracic echocardiography A case report

Bilal Hussain, Fateh Ali Tipoo Sultan, Talha Shahzad, Sumaira Punjani.

In cases of pulmonary embolism, the visualization of a free-floating right heart thrombus on conventional transthoracic echocardiography is extremely rare. Even rarer is an echocardiographic recording of migration of a free-floating clot from the right heart into the pulmonary vasculature leading

Hypermucoviscous Klebsiella syndrome its in the community!

Muneeba Ahsan Sayeed, Nida Latif, Syed Faisal Mahmood.

Hypermucoviscous Klebsiella syndrome is a unique syndrome caused by a new variant of Klebsiella pneumoniae (KP), characterized by abscess formation at distant body sites. This emerging KP strain is different from the usual classic strains in having the rmp gene which increases capsule formation m

Anaesthetic management for pheochromocytoma resection in a 5-year-old boy with cerebral haemorrhage and intestinal obstruction

Peipei Sun, Xinjiang Guan, Wei Li, Siyuan Li, Peng Li, Pengbo Zhang.

Pheochromocytoma is rarely seen under the age of 8 years and the anaesthesia for pheochromocytoma surgery is challenging. We present the perioperative management of a 5-year-old boy with intestinal obstruction and two episodes of cerebral haemorrhage who presented for pheochromocytoma resection a

Case Series >>

Phosphine induced acute cardiotoxicity in children: A need for health awareness

Mehnaz Atiq, Abdul Sattar Shaikh.

Aluminum Phosphate (AP) is a cheap and highly effective pesticide. Phosphine is the active pesticidal component which is highly toxic. Mortality is high and ranges between 40-70%. There is a desperate need for creating awareness. We report a case series with a mortality of 40% and emphasize the n

Transcranial approach to craniopharyngiomas; review of management and outcomes

Muhammad Junaid, Syed Sarmad Bukhari, Muhammad Azmat Khan, Mamoon-Ur-Rashid.

Craniopharyngiomas are rare tumours of the central nervous system. Their successful treatment is marred by a high rate of recurrence and postoperative complications. Their occurrence is sufficiently rare to merit treatment at specialized high volume centers. We have described our experience with

Central venoplasty in AV (Arteriovenous) fistula dysfunction a palliative endovascular approach

Tariq Ashraf, Naeem Mengal, Naveed Ullah Khan, Parveen Akhtar.

The ultimate treatment of chronic kidney disease is renal transplant. Patients with CKD who need temporary haemodialysis have to have indwelling catheters. The catheters used are either temporary or permacath (A permacath is a piece of plastic tubing very similar to jugular catheter used for haem

Recent Evidences in Endocrinology >>

Communication in diabetes care

Sanjay Kalra, Bharti Kalra.


The psychosocial domain of diabetes is an important as the biomedical aspects of the syndrome. This perspective traces the evolution of diabetes care model, describes the psychological morbidity of diabetes, enumerates management strategies, and supports readers

Primary Care Diabetes >>

The Berlin Declaration: Inspiration for primary care

Sanjay Kalra, Ashok Kumar Das, Cecilia JImeno, Wannee Nitiyanant, Goh Su-Yen, Truong Le.

This paper describes the seminal Berlin Declaration, released in December 2016, and draws inspiration from it to ensure early prevention, early detection, and early control of diabetes, and provide early access to the right interventions for diabetes care. Discussion focuses on actions which prim

Evidence Based Neuro-Oncology >>

Survival benefit of surgery in recurrent glioblastoma multiforme

Usama Khalid Choudry, Saad Akhtar Khan, Muhammad Shahzad Shamim.

There is an ongoing debate regarding role of surgery for recurrent glioblastoma multiforme (GBM). Older literature hinted at only modest survival benefits with surgery and a high rate of morbidity. However, more recent literature suggests better survival that may be attributed to better surgical

Letter to the Editor >>

Role of Ajwa in the treatment and prevention of ischaemic heart disease

Muniba Khan, Nadir Siddiqui.

Madam, dates have been used as a source of nutrient all over the world for centuries. They are available in many different varieties and types. Though each type has its unique properties, 1 it has been estimated that dates contain 44-88% of carbohydrates, 2.3 -5.6% protein

Use of Nile Tilapia (Oreochromisniloticus) skin in the management of skin burns

Muhammad Osama.

An increase in burn cases has been reported with an ever increasing pace of life, leading to a negative socio-economic impact. 1Literature shows that 0.5 million people with acute burn injuries are managed in the emergency department and 0.08 million patients are hosp

Student's Corner >>

Pathological bone fractures in a patient with parathyroid carcinoma A Case Report

Azib Shahid, Fatima Iftikhar.

Parathyroid carcinoma is a rare malignant neoplasm of the parathyroid glands which results in enlargement and excessive production of parathyroid hormone (PTH) responsible for pathologically raising calcium levels in the blood resulting in bone pain/fractures, renal stones and other signs of hype

Chikungunya virus: Underestimating its burden

Aiman Rehan, Manahil Akmal, Mashal Binte Ali.

Madam, chikungunya, a crippling disease caused by a virus belonging to the alpha virus genus of the Togoviridae family has reared its head in Pakistan. Just as the year 2016 was nearing its end, the country observed a major outbreak of Chikungunya afflicting reportedly about 30,000 people. The he

Chickungunya: Is it more common than we thought?

Muhammad Omer Arif.

Madam, Chickungunya fever is an arthropod-borne virus (arbovirus). It was first described in 1952, following an outbreak on the Makonde Plateau, along the border of Tangankiya and Mozambique. The word "chickungunya" was derived from the Kimakonde language, meaning \'to become contorte

Prophylactic platelet transfusion in dengue: A dilemma

Marium Rehman, Muhammad Armughan Ali, Muhammad Adil Siddiqui.

Madam, dengue fever is a vector borne viral haemorrhagic fever associated with substantial cost to the health care sector in endemic countries. Thrombocytopenia, a major feature of dengue fever results from decreased platelet production from bone marrow suppression or increased platelet destructi



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