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1 CORONA VIRUS –A REAL DANGER ALARM IN PAKISTAN   , Anwar Ali Jamali
Corona virus –A Real Danger Alarm in Pakistan. Anwar Ali Jamali Viral infections are common all over the world. Sometimes they results in out breaks leading to high morbidities and mortalities. Currently in world the infection of corona virus had created a panic situation all over the world targeting the different countries of the world.  China is the main victim of corona virus. Now the countries of world are left china cases behind. At present most of the world countries are affected by corona virus outbreaks, only the valid management options are prevention and precautionary measurements up to now. No current effective treatment is being approved by FDA, only supportive therapy is there and hypothesis based therapies are there. Nowadays it is major killer of human beings as claimed all over the world and Pakistan. Number of patients is increasing day by day here. Social distance is fail here. If we had not adopted the prevention and precaution protocol definitely there will be an unmanageable dangerous situation. At last water will be beyond the human heads. In parallel to rest of world this panic situation had been alarmed in Pakistan because many peoples of Pakistan are working, studding in different areas of china. This virus can be easily transmitted so the persons who travel from the phobia of corona virus may carry or transmit viruses to different countries. 
2 INCIDENCE OF NEUTROPENIA IN LOCALLY ADVANCED ESOPHAGEAL CARCINOMA TREATED WITH CONCURRENT  CHEMORADIATION   , Muhammad Sibtain Shah,1 Nasrullah Aamer,2 Abdul Aziz Sahito,3 Rafique Ahmed Memon,4 Noor Nabi Siyal,5 Abdul Manan Soomro,6 Ashok Kumar Lohana7
ABSTRACT Objective: To analyse incidence of neutropenia in locally advanced esophageal carcinoma treated with cisplatin & 5 flurouracil based chemo radiation.  Methods: This descriptive case series study was conducted in the Department of Clinical Oncology LINAR Cancer Hospital Larkana from January  2016  to August  2017 ,on histological proven squamous cell carcinoma of esophagus with  Inclusion  criteria  locally advanced stage, good performance status (ECOG-0,01,02),normal blood counts, normal hepatic & renal profiles. Exclusion criteria with carcinoma of cervical esophagus, infiltration of tumor in tracheobronchial tree, distant metastasis. We planned our patients with EBRT have total dose of radiation 50.4Gy in 28 fractions. Inj Cisplatin 75mg/m2 IV D1 & Inj 5- Flurouracil 1000mg/m2 IV D1 to D4 were infused during 1st & 5th week of external beam radiotherapy & 8th & 11th weeks. Neutropenia   was assessed on weekly basis through complete blood counts(CBC ) during course of con current chemoradiation & later on during  two cycles of adjuvant chemotherapy infused after chemoradiation. Neutropenia grading were performed on basis of common Terminology  Criteria for Adverse Events  (CTC AE).The data was statistically analyzed.  Results:  Majority of patients have age above 40 years. The average age of patients & duration of disease were 46.45+/- 10.59 years(95%CI :46.45+/- 10.59) and 3.5 +/-1.17 months(95%CI:3.20 to 3.80) respectively.out of 62 cases 27(43.5%) were male & 35(56.5%) were female. Chemoradiation induced neutropenia was assessed on complete blood counts on weekly basis. Neutropenia grading were performed. Neutropenia grading from grade 1 to 4 were 2%,34%,48%,16% cases respectively. Conclusion: Chemotherapy induced neutropenia is most common oncological emergency. It increases morbidity and mortality if not assessed timely during cancer treatment.Key words: Esophageal carcinoma, Neutropenia, Chemoradiation, Filgristim,Cisplatin,5 flurouracil 
3 Mean Reduction In Foveal Thickness After Four Weeks Of Injection Bevacizumab (Avastin) Intravitreally For The Management Of Diabetic Macular Edema     , Fatima Mehmood1, Waqas Asghar2, Uzma Hamza3, Maqbool Ahmed Jamali4, Qasim Lateef Chaudhry5, Imran Manzoor6.
Abstract: Aim: To determine the mean reduction in foveal thickness after 4 weeks of Intravitreal Bevacizumab (Avastin) for the management of diabetic macular edema Patients and methods: This Quasi experimental study included 95 eyes of 95 patients, which were diagnosed with diabetic macular edema, and treated between November 2016 and May 2017 at Ophthalmology department of  Jinnah Hospital, Lahore. The aim and procedure of study was explained and informed consent was taken from all patients. A detailed history and ocular examination in these cases was done. Basic ophthalmological examination was done. The macular thickness was assessed one week before procedure by OCT (Zeiss 4000). Injection Bevacizumab (avastin) 1.25mg/0.05 ml was given intravitreally under topical anesthesia 3.5-4mmaway from limbus by researcher herself. After 4 weeks of injection, OCT was done on all patients and the outcome was decided on the modulation in thickness of of central maculi, which was recorded by the researcher herself. Results: The mean pre-procedure central macular thickness was 387.11+18.07 µm which reduced to 318.75+18.87 µm at 4 weeks after treatment, the mean decrease was recorded as 68.36+7.60 µm; p value was 0.0001, showing a significant difference. Conclusion: The mean reduction in foveal thickness after 4 weeks of Intravitreal Bevacizumab (Avastin) for the management of diabetic macular edema is significantly different as compared with pre-treatment macular thickness. Keywords: Diabetic macular edema, Central macular thickness, Intravitreal Bevacizumab (Avastin), Mean decrease.  
4 POLYCYSTIC OVARY SYNDROME: RISK FACTORS AND ASSOCIATED FEATURES AMONG UNIVERSITY STUDENTS IN PAKISTAN     , Tariq Feroz Memon1, Mehwish Channar2, Syed Abdul Wadood Shah3, Aiman Shaikh4, MehwishBatool5 , NomaShri6.
ABSTRACT Objective: To evaluate the risk factors and common clinical features existent among the female students with polycystic ovary syndrome at ISRA University, Hyderabad, Pakistan. Methods: Cross-sectional study was carried out at the ISRA University Hyderabad, Sindh, Pakistan between February 2019 and July 2019. The female students from the medical section were selected using a simple random sampling technique. All-female students between 19 to 24 years studying in (1st to 5th-year MBBS) were included. While those students studying in other departments (other than MBBS) were excluded. Ethical approval was sought from the ethical review committee of the university. Rotterdam’s criterion was used for the confirmation of the diagnosis of the syndrome. SPSS version 22 was used for the statistical analysis of the data. The level of p-values <0.05 was considered to be statistically significant. Results: Around 40% of participants reported to have menstrual disturbances. The majority (31.7%) of them had been dealing with the syndrome for more than three years. PCOS was prevalent among 37.3% of study participants. PCOS was more prevalent (59.4%) among participants in their late adolescence (22-24 years). A statistically significant difference (p-value <0.05) in mean age of menarche, BMI, Hirsutism score and WHR between participants diagnosed having PCOS in comparison with those without PCOS. Conclusion: The prevalence of PCOS is high among adolescent female. Genetic predisposition is the main risk factor (positive family history of PCOS while menstrual disturbances are the most frequent clinical feature. Keywords: Adolescents, Menstrual disturbances, PCOS, Risk factors
5 OUTCOME OF INCISION DRAINAGE IN BREAST ABSCESS AMONG LACTATING MOTHERS.   , Zahoor Hussain Bhellar1, Abdul Malik Sangri2,Dr:Fozia unar3, Zulfiqar Ali sher4  
Abstract Introduction: - In emergency surgery, abscess of Breast is the commonest mamary ailment influencing in lactating moms. Staphylococcus Aureus is found to be the common micro organism as a causative agent. Nursing mothers are prone to develop it. There is strong evidence that the women have first pregnancy commonly develop this condition in their 1st month of their lactational period. Trauma to mother’s breast caused by baby at weaning at the age of 6 months is also the predisposing factor causing the abscess. Goal, ultrasound guided seepage and entry point wastes are the methods to be finished. Design: Study configuration is Cross sectional research. Place with duration of study:- Surgical division of Khairpur Medical College Hospital from September 2018 to August 2019 Patients and methodology:- All the patients with history of lactation were conceded through Surgical OPD and crisis Department of KMC Hospital Khairpur Sindh. History, neighborhood Examination separated from general physical, fundamental assessment was finished. Required biochemical just as imaging examinations were done trailed by various surgeries. Results: - Total 60 patients were included in this study. Incision drainage was done in most of patients. Culture and sensitivity of pus showed that the most common organism causing this condition was Staphylococcus. Conclusion: - Incision drainage produced the excellent results with no recurrence rate. Keywords:-  Breast Abscess, lactation,  Incision Drainage, Staphylococcus Aureus  
6 Changing trends in facility based deliveries at basic health units after People Primary Healthcare Initiative in Taluka Sinjhoro, District Sanghar: A descriptive study.   , Aftab Ahmed1 , Hanna khan tunio2, Mohammad Bilal3, Salma4, Faiqa Memon5, Saba Leeza Mangi6  
ABSTRACT: The maternal morbidity and mortality and neonatal morbidity and mortality are important health indicators for assessing the health status of a country. Pakistan is having a high maternal mortality and child mortality rate and our country is unlikely to achieve Millennium Development Goals (MDGs) 4 and 5, which are linked with child health and maternal health respectively. Rationale: This study will generate evidence regarding benefits of involving the private sector in provision of health services at very first Primary Health Care level and how facility based deliveries will be an effective way of decreasing the maternal and neonatal morbidity and mortality. Aim: is to improve overall health status of child bearing women of Taluka Sinjhoro. Objectives i) To determine the trends of facility based deliveries before and after PPHI ii) To do the secondary data analysis of the BHUs in terms of facility based deliveries. Study variables: i) Type of delivery ii) age of delivering women frequency of deliveries, iii) Status of human resource available in BHU’s regarding facility based deliveries, iv) referral system. Results: There is an increase in the number of facility based deliveries at BHUs after charge over by PPHI.  20% females were under 18, 52% were between 19-24, 23% were between 25-30 and 5% were above 30 years. Rukan Buriro. 61% of women were presenting for first time at BHU Rukan Buriro while 39% women were presenting for second time. Conclusion: The study yielded a lot of valuable information and gave a picture of the existing situation. It was found that the Peoples Primary Health Initiative had a very positive impact on the facility based deliveries at these basic health units and the involvement of PPHI has created a positive trend not only at the basic health units but also in the minds of the local community and it has changed their past concepts regarding the facility based deliveries. Key words: basic health units, Sanghar, Primary Healthcare, maternal morbidity, neonatal morbidity, health indicators.  
7 PAPAYA SEEDS: THEIR EFFECTS ON QUANTITATIVE PLATETLETS COUNT IN FEMALE RABBITS , Masood Ahmed1, Farzana Memon2, Noreen Irum3, Ghulam Mustafa Dahri4, Azhar Mughal5,Gotam Kumar6  
ABSTRACT: Objective: To evaluate pharmacological effects of Papaya seeds on quantitative platelets count in female rabbits. Place and Duration of Study: Animal House, Department of Pharmacology and Therapeutics, at PUMHSW-SBA  from Feb 2018 to March 2018. Methodology: For this study thirty adult and healthy female rabbits were selected and subdivided into two groups, Group A (Control) n=15, given only fresh hay & water and Group B (study) n=15, given papaya seeds powder as dose of 500mg once a day along with fresh hay & water provided ad libitum, then blood tests for platelets count were performed on Day 0, 15, 30,45& 60 to observe the effects of papaya seeds on quantitative platelets count. Results: Non-significant increase seen in platelets count in Group-B (study) up to 15th day of study. Conclusion: Papaya seeds having the properties of increasing the count of platelets but can be used for limited time. Further sophisticated scientific research is required to evaluate the platelets increasing properties of Papaya seeds. Key words: Papaya seeds, Platelets, Female Rabbits  
8 Management of Infected Non-union Fractures of Tibia by Ilizarov External Fixator; Outcome & Complications   , Muhammad Faraz Jokhio1, Zameer Hussain Tunio 2, Kishore Kumar3, Muhammad Azeem Akhund4, Zameer Abbasi5 Nazar Hussain Shah6  
Abstract: INTRODUCTION: Infected nonunion of tibial fractures is common and its management is challenging for orthopedic surgeons. Ilizarov external fixator is widely used for its management as it provides a stable mechanical environment encouraging union by infection removal and bone transport. The point of this examination was to decide the result and related complexities of patients treated with Ilizarov outer fixator for non-joined cracks of tibia muddled by contamination. Methodology: A retrospective assessment of medical records of the subjects they undergo treatment of non-united fractures of tibia by Ilizarov methods between January 2015 till December 2019 was undertaken. Patients of either age and gender having non-union tibia fracture for a 06 months period of or more & having contamination at the location of non-union were included. The Association for Study and Application of Methods of Ilizarov (ASAMI) criteria was used for assessing the utilitarian result just as bone outcomes. RESULTS: Total 48 subjects were incorporated in this resarch. Mean age of the patients was 33.50 ± 9.33 years. Total 43 (89.6%) were males and 5 (10.4%) were females. Mean bone transport time, mean external fixation time, mean external fixation index and mean bone defect w+ere 80.18 ± 32.48 days, 11.6 ± 3.91 months, 77.41 ± 26.72 days/cm and 5.06 ± 1.53 cm respectively. According to ASAMI criteria, bone results were found to be excellent in 27 (56.3%), good in 11 (22.9%), fair in 6 (12.5%) and poor in 4 (8.3%). Functional outcomes were found to be excellent in 30 (62.5%), good in 11 (22.9%), fair in 4 (8.3%) and poor in 3 (6.3%).CONCLUSION: Ilizarov external fixator method is effective in management of infected nonunion by providing a stable mechanical environment encouraging bone transport. KEY WORDS: Ilizarov apparatus, infected nonunion of tibia, tibia nonunited fracture  
9 PREVALENCE OF MECHANICAL VS. NON-MECHANICAL COMPLICATIONS IN PATIENTS WITH ACUTE STEMI   , Owais Shams1, Nandlal Rathi2, Jagdesh Kumar3, Abdul Aziz Sahito4, Kartik Kumar Rathi5  
ABSTRACT; OBJECTIVE: The aim behind this study was to scientifically determine the prevalence of mechanical vs. non-mechanical complications in patients with acute STEMI. PATIENTS AND METHODS: A prospective observational study has been conducted in the department of cardiology Isra University Hospital Hyderabad through a convenience sampling technique on all patients presented and admitted with acute STEMI after taking written and informed consent. Patients were evaluated for non-mechanical and mechanical complication during 48 hours after admission. Data were entered and analyzed by using Statistical Package for the Social Sciences version 19.0. RESULTS: The mean age of patients was 52.56 years (14.39 ± SD) and the study subjects consisted of 43 males (70%) and 18 (30%) females. Out of 61 patients majority of the patients were presented between the ages of 51 – 65 years (N = 22.25%). The overall prevalence of non-mechanical and mechanical complications was 10 (16.39%) and 24 (39.34%), respectively. The most common non-mechanical complication was development of arrhythmias 8 (80%) and the most common mechanical complication was development of left ventricular failure 12 (33.33%), respectively. CONCLUSION: The present findings indicate that most of the STEMI patients were belongs to middle aged population and among them mechanical complications were more prevalent than non-mechanical complications. KEY WORDS: ST-Elevation Myocardial Infarction, Mechanical and non-mechanical complications  
10 CASE REPORT DISLOCATION THUMB CARPOMETACARPAL JOINT WITH FRACTURE 1ST METACARPAL SHAFT, A RARE ENTITY.   , Khalid Abdullah1, Niaz Hussain Keerio2  
ABSTRACT: Thumb carpo-metacarpal joint dislocation along with fracture first metacarpal bone is very rare entity. Very few cases can be seen in literature. We are reporting a dorsal dislocation of CMC joint thumb along with fracture shaft of 1st metacarpal shaft in 43 years old male patient. He presented and admitted in our hospital one week after injury. Immediately after trauma our patient was treated in some peripheral hospital but his pain was not settled so he presented to our hospital Emergency Department. We did close reduction fracture 1st metacarpal and dislocation thumb CMC joint was reduced and both were fixed with 1.4 mm multiple k wires. Postoperative course was uneventful and patient has full recovery after treatment. In English literature we could found only few reported cases like our case. Keywords: Carpo-metacarpal Joint Dislocation, Thumb, 1st Metacarpal Fracture, Dislocation, Fracture.