Fatima Jinnah Research Articles

Comparison between qualitative and quantitative measurement of strength deficit in shoulder flexors of young females: A cross- sectional study.

To determine the accuracy of manual muscle testing as a diagnostic tool to detect strength deficit across grades 5 and 4 in shoulder flexors at different percentage deficits of dynamometric strength. The cross-sectional study was conducted at the University of South Asia, Lahore, in collaboration with the Association of Fatima Jinnah Old Graduates, Lahore, Pakistan, from May to June 2019. It included young healthy females aged 18-39 years without any ailment of upper extremity or generalised health problem. The strength of shoulder flexors was measured through manual muscle testing and hand-held dynamometer. Data was analysed using SPSS 25. There were 300 women with a mean age of 23.11±4.71 years. The majority 124(41.3%) were aged 20-24 years. The strength of the dominant shoulder flexors of 194(64.7%) participants and the strength of non-dominant shoulder flexors of 206(68.7%) was in grade 4. The overall diagnostic accuracy of manual muscle testing at 10% dynamometric measures was 68.67% (95% confidence interval: 63.21-73.65%) in non-dominant shoulder flexors, and 61.67% (95% confidence interval: 56.05-66.99%) in dominant shoulder flexors. The positive predictive value and specificity of manual muscle testing was better at 10% strength deficit in comparison with dynamometric measures, whereas negative predictive value and sensitivity was better at 20% strength deficit. The subjective area of grades 4 and 5 showed better, though not ideal, diagnostic worth at 10% deficit of dynamometric measures in shoulder flexors.

To assess students' perception about Kahoot! as an innovative learning tool in oral pathology- a qualitative study.

This qualitative study was conducted to investigate the perception of third-year dental students' about Kahoot! as an innovative learning, teaching, and assessment tool for the subject of Oral Pathology at the Fatima Jinnah Dental College, Karachi. This online App was implemented as a teaching and assessment tool in both the first and second semesters during the academic year 2019. Out of 75 students, 50 were females and 25 were males. Students' opinion about Kahoot! was assessed using a questionnaire with a 5-point Likert scale. Kahoot! has been implemented for the first time in the dental curriculum of our institution. Around 90% of the students accepted that they can easily comprehend the knowledge, challenge their mental ability, and become an attentive learner. The quizzes assisted students to identify different oral structures, histological features, and oral mucosal alteration in an interesting way. According to students' opinion, Kahoot! assist them to develop a notion of self-directed learning (69; 92%), and prepared to attempt exams confidently (68; 90%).

The impact of CME on the Knowledge of General Physicians

Breast cancer is one of the leading cancers among fertile females. Once such problem is encountered by a female it is not the quality of life that it affected rather financial burden, social and family stress adds to the misery. In developed nations the average survival rate with breast cancer is 72% whereas in developing nations it is around 50%. The reason for the difference in the survival rate is better healthcare system in the developed nations where the disease is diagnosed an earlier stage as compared to late diagnoses in underdeveloped nations. If awareness is provided to family physicians through CMEs at grass root level, earlier diagnosis can help all such females who are at risk of developing breast cancer. The study was conducted in three cities of Punjab i.e. Lahore, Sheikhupura and Kasur. The medical colleges who participated in the study were Fatima Jinnah Medical College (29.9%), Amna Inayat Medical College (19.9%) and Central Park Medical College (14%). A pre validated questionnaire was filled by the participants, analysis of the study was univariate and was based on McNemars test. In the post test proformas participants showed good response as compared to pretest evaluation, which showed the effectiveness of CMEs. Aim: The aim of the study is to explore the impact of continuous medical education (CME) of general physicians during their clinical practice. Methodology: A prevalidated questionnaire was required to be filled by the physicians who participated in the study which comprised of two parts, a pretest was taken before CME and other posttest was taken after CME to evaluate the effectiveness of CME. Results: Positive results were observed in the pre-test and post-test proforma of nearly all the participants. Conclusion: To conclude the effectiveness of the study, it was a very fruitful study which showed some very good results. If proper awareness and training is imparted to family physicians at grass root level regarding breast cancer, early diagnosis, management and awareness can be provided to these physicians, which result in early referral of the patients who can easily be managed at this level saving not only life of many patients but also reducing time revenue and cost of treatment of all such cases. Key Words: General physician, CME, breast cancer.

Fatima Jinnah & Benazir Bhutto: Initial Saga of Painful Birth of Pakistan’s Feminine Politics

Women’s political participation is a fundamental prerequisite for the assurance of Gender Equality and Genuine goodwill of Democracy. No nation can rise to the height of glory without the participation of their women into legal, political, socio-economic and decision making process of household to public life. Gender-sensitive Governance has been achieved all over the Globe to some extent but struggle is still on its way and it needs much encroachment. Previously, women who partook in electoral campaigns or political uplifting of other women were docketed as deteriorated women by misogynist portions. This article is based on the struggle of two most Empowered Ladies of Pakistan, Miss Fatima Jinnah and Benazir Bhutto for the refurbishment of democracy, women emancipation and equitable and inclusive governance of women. Though, they both faced a lot of backlash, but still they marked a difference among those people for the sake of their women.

Determine the Attitude of Dental Students for Learning Communication Skills at Undergraduate Level

Objective: To assess the attitude of dental students for learning communication skills at undergraduate level.Methods: A research based on cross-sectional comparative study design was conducted on final year BDS students at two reknowned dental colleges of Karachi naming Fatima Jinnah Dental College and Liaquat College of Medicine and Dentistry. Approval was taken from the principals of both dental colleges as well as from Ethical Review Board (ERB). The duration of the study took place from March-May 20. Inclusion were the final year dental students from both colleges.A validated questionnaire 'Communication Skills Attitudes Scale (CSAS)' was used for data collection. SPSS version 23 was used to analyse data. Mean and SD was computed for numeric variables and frequency and percentage was computed for categorical variables. Independent t-test was used to assess the significant difference with respect to gender.Results: 144 students participated in the study. Out of which 42 (28.97%) were males and 103 females (71.03%). The mean age of the students was 21.91 ± 1.03 years. The mean and standard deviation of the positive attitude score was 3.84 and 0.59 whereas of negative attitude score was 2.55 and 0.43. Both male and females had a high score of positive attitudes as compared to negative attitude similarly females had a high score of positive attitudes as compared to negative attitudes. There were no statistically significant differences observed in positive and negative attitudes of males and females (p>0.05).Conclusion: Both male and female students showed a positive attitude towards learning effective communication skills. Therefore, it has become a dire need for the students to acquire communication skills for improving doctor-patient relations and improving dental healthcare. Policy makers should consider including communication skills in the curriculum as part of formal education.

Assessment of nutritional status of lactating mothers in Multan, Pakistan: A case study.

Objective: The main purpose of the study was to assess the nutritional status of lactating mothers. Study Design: Cross Sectional study. Setting: Fatima Jinnah Hospital, Chowk Ghantaghar, Multan. Period: March 2019 to November 2019. Material & Methods: The study comprised of 250 lactating mothers aged 18-40 years. The data for this study was collected by trained nutritionist when lactating mothers came for checkup and SPSS software was used for data analysis. Results: This study showed that mother status mostly effected due to iron deficiency. Only 20% women were having normal Hemoglobin level. 80% women were anemic and 61.6% women were underweight and 4.8% women were overweight during lactation period. Their serum ferritin level was significantly low due to iron deficient diet/ low iron supplementation. In this conducted study 34.4% women were uneducated and 70.8% women were from rural areas of Multan. 42.4% women were poor socioeconomic status. Conclusion: Nutritional status of lactating mother is mostly affected by iron deficiency. Iron deficient diet or lack of iron supplementation due to poor socioeconomic status/ lack of education about nutrients affect the lactating status of mother.

Comparison of Polymerase Chain Reaction With Fluorescent Microscopy for Detecting Pulmonary Tuberculosis in Smear-Negative Sputum Samples in Quetta, Pakistan

Background: One of the common clinical manifestations of extra-pulmonary tuberculosis is tuberculous meningitis (TBM). New methods, which are simple and effective, are necessary for early diagnosis of TBM. Objective: This study aimed to assess the use of fluorescence microscopy and polymerase chain reaction (PCR) techniques targeting pncA and IS6110. PCR is a fast and reliable technique for diagnosing tuberculosis (TB), particularly in paucibacillary specimens such as smear-negative sputum for diagnosing patients with Mycobacterium tuberculosis. Materials and Methods: The pncA and IS6110 multiplex-PCR methods were applied to analyze sputum using a specific pair of primers designed to amplify the insertion sequence, pncA, and IS6110 in the M. tuberculosis genome. A total of 200 sputum samples were collected from patients with TB. Out of 200 patients, 54.0% (n=108) and 46.0% (n=92) were males and females at Fatima Jinnah General and Chest Hospital, Quetta, respectively. Results: M. tuberculosis was detected as 15 (16.3%) and 18 (16.7%) for pncA and IS6110 using PCR and fluorescence microscopy, respectively. M. tuberculosis DNA detected by PCR and smear-negative fluorescence microscopy was 16.50% (n=33) and 14.70% (n=18), respectively. In other words, PCR assay detected the increased prevalence of M. tuberculosis. Risk factors revealed high exposure to receiving TB infection which was associated with urban areas (OR=1.07, 95% CI: 0.34–3.35), TB in family (OR=1.22, 95% CI: 0.38-3.88), over crowdedness (OR=2.93, 95% CI: 0.37-23.7), malnutrition (OR: 1.39; 95% CI: 0.52-3.74), and rural areas (OR: 1.54, 95% CI: 0.72-3.31). Conclusion: A wide range of molecular assays are now being developed and reviewed for detecting TB. We conclude that the use of pncA and IS6110 PCR assays is beneficial in the quick diagnosis of TB meningitis.

EFFECTS OF THREE ORAL ANALGESICS ON POSTOPERATIVE PAIN FOLLOWING ROOT CANAL PREPARATION: A CONTROLLED CLINICAL TRIAL

Objective: To compare the effect of single dose of three analgesics on postoperative endodontic pain following pulpectomy in teeth with irreversible pulpitis.
 Study Design: A quasi-experimental study.
 Place and Duration of Study: Endodontics Department, Fatima Jinnah Dental College Hospital Karachi, from Jan to Oct 2018.
 Methodology: In this Double Blind placebo controlled study, 120 subjects coming with the complaint of irreversible pulpitis in any one tooth were randomly allocated into 4 groups. Each group took either naproxen sodium (550mg), ibuprofen (400mg), tramadol (100mg) or placebo medication (multivitamin tablet) immediately after the pulpectomy appointment. A questionnaire was designed to assess the experienced pain based on VAS scale at 6, 12 and 24 hours postoperatively. KruskalWallis test was applied followed by post-hoc analysis to compare the VAS scores by taking p-value ≤0.05 as significant.
 Results: Pain levels were significantly lower in experimental groups as compared to placebo (p<0.001) but there was no statistically significant difference between the effectiveness of naproxen, ibuprofen and tramadol at 6, 12 and 24 hours postoperatively.
 Conclusion: Naproxen, Ibuprofen and Tramadol were found to beequally effective in reducing pain after instrumentation in teeth with irreversible pulpitis.

Effect of Malus Domestica (Apple Peel) Extract on Peripheral Blood and Bone Marrow Cells of Prednisolone Treated Mice

Introduction: Apple peel is rich in many bioactive compounds and has been studied for its beneficial effects and protective role in multiple disorders, but its effect on blood cells and bone marrow needs to be investigated.
 Aims & Objectives: To determine the effects of apple peel extract on peripheral blood and bone marrow cells of prednisolone treated mice.
 Place and duration of study: Pharmacology Department of Post Graduate Medical Institute and Pathology Department of Fatima Jinnah Medical University, Lahore from June to September, 2016.
 Material & Methods: Forty Swiss albino mice were randomized into five equal groups. Normal control group was given distilled water. Model group was given prednisolone 4 mg/kg orally. Experimental low, medium, and high dose groups were given 25 mg/kg, 50mg/kg and 100 mg/kg apple peel extract respectively along with prednisolone for 14 consecutive days by oral route. On 14th day, blood was analyzed for red blood cell, platelet, total leukocyte, and differential leukocyte count whereas, bone marrow was analyzed for erythropoiesis, megakaryocytes, myelopoiesis, lymphocyte and plasma cell count.
 Results: Prednisolone treatment group exhibited significantly raised neutrophil and decreased lymphocyte percentage, whereas anon-significant rise in RBC, WBC, and platelet count was noted as compared to the normal group. Bone marrow smear megakaryocytes, myelopoiesis, lymphocytes, and cellularity: fat ratio also increased non-significantly by prednisolone treatment. Low dose of apple peel extract enhanced these effects, making significant difference, while medium and high doses negated these effects in accordance with their dose.
 Conclusion: Apple peel extract in low dose complemented the effect of prednisolone on hematological parameters of mice peripheral blood and bone marrow, while high dose nullified these effects in a dose dependent manner.

Performance Evaluation of Xpert MTB/RIF Assay and Prevalence of rpoB Gene Mutation in <em> Mycobacterium Tuberculosis</em> in Clinical Isolates Quetta, Pakistan: A Cross Sectional Retrospective Cohort Study

With the use of Xpert assay, the detection mechanism of tuberculosis has completely transformed. Concurrently detecting mycobacterium and its resistance to rifampin (rif) which is also one of the primary marker for MDR-TB in addition to its surrogate activity against MTB in first line drugs. At large, resistance of mycobacterium strains against rifampicin is caused by rpoB gene mutations about 96.1 % globally while these mutations are generally situated at a site of 507-533rd residuals of amino acid in the rpoB gene of Mycobacterium, this region is also termed as Rifampicin resistance determining region (RRDR). In this study, we determined the mutations of various rpoB genes in different probes of 81 bp of RRD Region. A total of 6353 different specimens obtained at provincial reference laboratory of Fatima Jinnah general and chest hospital, Quetta (FJHQ), between Jan 2016 and Apr 2018 were examined by Xpert MTB/RIF assay. Altogether positive and negative samples for MTB were further examined with the light emitting diode (LED) fluorescence microscope. Pearson Chi square test was used to find out the associations between probe type and gender, treatment history and age group of the patients. Out of 6353 specimens 1297 MTB positive cases were detected by Xpert assay including 184 samples having both mycobacterium and RIF-resistance advised by mutations in 81 bp-RRD Region of rpoB gene which is further divided into five different probes. Further LED fluorescence microscope detected and confirmed 327 positive MTB samples out of 1297 specimens of Xpert assay. The associated probes mutation for rifampicin resistance were as follow: E (98/184), D (23/184), B (15/184), C (5/184), A (3/184), two probe mutation (5/184) in D&E (3/184) and C&D (2/184) and all probe mutation (35/184). The percentage of rpoB gene mutation in the studied population was 14.187 %. The commonest mutation associated with rpoB gene was in Probe E (53.2608%) also termed as 531 and 533 codons, additionally two probe mutation (2.7173%) in D&E (1.6304%) and C&D (1.0869%) and all probe mutation (19.0217%) were also detected that has never been detected before globally.

EFFECT OF PRE-COOLING THE INJECTION SITE ON PAIN PERCEPTION IN PAEDIATRIC DENTISTRY

Objective: To compare the mean Sound, Eye and Motor (SEM) score of pre cooling and topical application atinjection site in pediatric patients.
 Study Design: A quasi experimental study.
 Place and Duration of Study: Fatima Jinnah Dental College and Hospital, Karachi, from Sep to Dec 2017.
 Methodology: Sixty four paediatric patients aged between 8-12 who needed dental anaesthesia were randomlydivided into two groups A and B. Subjects in group A were applied topical anaesthesia at the injection site for one minute before needle penetration and in group B ice pack was applied for the same duration at the injection site. A designed questionnaire based on SEM scale was used to measure the patients‟ reaction. Independent-samples t-test was applied to compare the mean SEM score of both groups by taking p-value ≤0.05 as significant.
 Results: The mean sound, eye and motor (SEM) score was 5.22 ± 1.718 for group A and 3.28 ± 1.373 for group B;with statistically significant differences between both the groups (p≤0.05).
 Conclusion: Injection of local anaesthesia at a precooled site results in lesser pain and thus decreased childanxiety levels, more effective analgesia and increased patient comfort.

Exploration of Knowledge of Tuberculosis Patients Regarding their Disease in Quetta, Pakistan

Background: Knowledge of tuberculosis is very important for the patients.
 Objective: This study was aimed to assess and explore the knowledge of TB patients regarding their diseases in Quetta, Pakistan.
 Methodology: This questionnaire based, cross sectional analysis was conducted in Fatima Jinnah Chest Hospital, Quetta with in all TB patients. Knowledge was assessed by using a pre-validated self-administered questionnaire containing 22 disease related questions. Convenience sampling technique was used for data collection. Descriptive analysis was used to demonstrate the characteristics of the study population.
 Result: Mean age of respondents was 40.99±18.10. Study was dominated by 168 (60.00%) of females. Two hundred (71.40%) were married. One hundred sixteen (41.40%) had no any education. One hundred sixty-eight (60.00%) were Pashtun. One hundred thirty-two (47.10%) having income less than 10000 PKR and ranges between 10000 to 18000 PKR respectively. One hundred fifty-six (55.70%) were having rural residency. One hundred fifty-six (58.10%) having no any co-morbidity. Mean score of knowledge was 11.23±3.616.
 Conclusion: Knowledge is a key factor in understanding any particular disease. If the level of knowledge is low in some or all parts of the disease, it will actually affect the patient. It can be concluded that there is a need to raise awareness of TB symptoms, mode of transmission, prevention, diagnosis and treatment of the disease through health education.
 Bangladesh Journal of Infectious Diseases 2020;7(2):78-83

Relationship of natural occlusal plane with different anatomical landmarks.

To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects. The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper's plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23. Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad. Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide.

A Morphological Study on Gross Anatomical Variations of Embalmed Cadaveric Livers

Objective: To find out gross anatomical variations of embalmed cadaveric livers. Methods: Present study was conducted in dissection halls of Anatomy departments of Allama Iqbal Medical College, Lahore, Sahiwal Medical College, Sahiwal and Fatima Jinnah Medical University, Lahore during 2016-2019. In this study, 74 livers were dissected out from embalmed cadavers and preserved in 10% formalin. Different morphological variations were observed in livers which included presence of accessory lobes, accessory sulci, notches, changes in size and shape of lobes. Liver specimens were photographed and classified according to Netter's classification of morphological variations of liver. Results: The hepatic morphological variations observed included accessory fissures in the right, left, caudate and quadrate lobes of the liver, accessory lobes, elongated left lobe, hypoplastic left lobe, multiple deep diaphragmatic sulci, pons hepatis, Reidel's lobe, notched borders and bilobed caudate lobe. Conclusion: The knowledge of various variations in morphology of cadaveric livers may help the radiologists to make accurate interpretation of the radiological images, thus minimizing the chances of incorrect reporting. It may also be helpful to the hepatobiliary surgeons to be aware of the morphological variations on the liver surface to avoid surgical complications. Key Words: Embalmed cadaveric livers, accessory lobes, accessory fissures

Reviewer List

Prof. Seongah Chin, College of IT Engineering, Sungkyul Univ., Korea.Prof. Pavel Loskot, Swansea University, UKProf. Yilun Shang, Northumbria University, UKProf. Pawel Kossakowski, Kielce University of Technology, PolandProf. Subhendu Kumar Pani, Orissa Engineering College, IndiaProf. Sérgio I. Lopes, Polytechnic Institute of Vianado Castelo, PortugalProf. Daschievici Luiza, University “Dunarea de Jos” Galati, RomaniaProf. Defu Liu, Ocean university of ChinaProf. Seifedine Kadry, Beirut Arab University, LebanonProf. Mihaela Popescu, University of Craiova, RomaniaDr. Weimo Liu, Google, CA, USAProf. Roohollah Bagherzadeh, Amirkabir University, IranProf. Anand Nayyar, Duy Tan University, VietnamProf. Ilya Simanovskii, Technion-Israel Institute of Technology, IsraelProf. Karim eL Moutaouakil, Polydisciplinary Fuculty of Taza, MorrocoDr. Guillermo Escrivá-Escrivá, Universitat Politècnica de València, SpainProf. Zattera Mekkioui, University of Tlemcen. AlgeriaDr. Lecturer, Lutz Schubert, University of Ulm, GermanyProf. M. Prabukumar, School of IT, Vellore Institute of technology, IndiaDr. Senior researcher, Ladislav Zjavka, Technical University of Ostrava, Czech RepProf. Mădălina Dumitriu, University Politehnica of Bucharest, RomaniaDr. Ateeq ur Rehman, University of Agriculture, PakistanProf. Manu Pratap Singh, Ambedkar University, Khandari Campus, AgraDr. Lecturer, Mihaela Andrei, Dunarea de Jos” University of Galati, IndiaProf. Loc Nguyen, Loc Nguyen’s Academic Network, VietnamProf. J.-R. Poirier, Laplace, University of Toulouse, FranceDr. Loganathan. S, Arba Minch University, EthiopiaProf. Taissir Elganimi, University of Tripoli, LibyaProf. Issam Dawoud, Al-Aqsa University, PalestineProf. Zoltán Ernő Csajbók, University of Debrecen, HungaryProf. Nahid Fatima, Amity University, IndiaProf. Vineet Jain, Mewat Engineering College, IndiaSenior Lecturer, Ioan-Lucian Popa, University Alba Iulia, RomaniaDr. Sarah Samad, Lebanese University, LebanonDr. Merouane SALHI, Blida University, AlgeriaProf. Dejan Dragan, University of Maribor, SloveniaProf. Rémi Léandre, University of Bourgogne, FranceDr. R. DELSHIHOWSALYA DEVI, Bharat Institute of Engineering & Technology, IndiaDr. M.M.KAMRUZZAMAN, Al Jouf University, Saudi ArabiaProf. Takfarinas Saber, School of Computer Science, University College Dublin, IrelandProf. Dariusz Jacek Jakóbczak, University of Gdansk, PolandProf. Khadir Mohamed Tarek, University of Badji Mokhtar, AlgeriaDr. Ray-Hwa Wong, Industrial Technology Research Institute, Taiwan, R.O.C.Dr. M. MADHIARASAN, Bharat Institute of Engineering and Technology, IndiaProf. Ayeley P. TCHANGANI, Université Toulouse, FranceProf. Gorakh Nath Chaurasia, Motilal Nehru National Institute of Technology Allahabad, IndiaProf. S.Balakrishnan, Sri Krishna College of Engineering and Technology, IndiaDr. Kotapally Harish Kumar, IIT Roorkee, IndiaDr. Shikha Kumari, Jawaharlal Nehru University, IndiaProf. Hasan AYDOGAN, Selcuk University, TurkeyProf. Hua Yi Lin, China University of Technology, TaiwanDr. Paria Assari, Islamic Azad University, Hamadan Branch IranProf. Elżbieta Macioszek, Silesian University of Technology, PolandProf. Manoj Kumar Patra, National Institute of Technology Rourkela, IndiaDr. A.Venkata Subramanian, Anna University, IndiaDr. Sajib Chakraborty, Vrije Universiteit Brussel, BelgiumProf. Najmeh Neysani Samany, University of Tehran, IranDr. Chaoxian Wu, University of Liverpool, UKDr. Omid Aminoroayai Yamani, K. N. Toosi University of Technology, IranDr. Grzegorz Woroniak, Bialystok University of Technology, PolandProf. Grande Nagajyothi, Dept.of Micro & Nanoelectronics SENSE School, IndiaDr. Mohamad Nejat, Fasa University,IranDr. Arun Kishor Johar, Malaviya National Institute of Technology Jaipur, IndiaDr. Konstantinos M. Giannoutakis, Centre for Research and Technology Hellas, GreeceDr. Ertugrul Dogruluk, Centro Algoritmi / University of Minho-PortugalProf. Galkowski Krzysztof, University of Zielona Gora, PolandProf. Stefan SEGLA, Faculty of Mechanical Engineering, SLOVAKIADr. Shamsa Kanwal, Fatima Jinnah Women University, PakistanDr. Nelson Méndez Lianes, University of Havana, Cuba.Dr. Salem Sati, Misurata University, LibyaDr. Mohamed El-Amine SLIMANI, University of Science and Technology “USTHB”, AlgeriaDr. Ali Al-Balhawi, Mustansiriyah University, IraqDr. Amira Zaylaa, Lebanese University, LebanonProf. Pedram MASOUDI, Geovariances, FranceDr. Seyedahmad Shahahmadi, Universiti Tenaga Nasional, MalaysiaProf. Pavlo Maruschak, Ternopil Ivan Pul’uj National Technical University, UkraineDr. Vaishali Gupta, IPS Academy, Institute of Engineering & Science, IndiaDr. Peter ChunYu YAU, School of Continuing and Professional Education, City University of Hong KongDr. Shonak Bansal, Punjab Engineering College (Deemed to be University), IndiaDr. Ridhwaan Suliman, Council for Scientific and Industrial Research (CSIR), South AfricaDr. Thein, Yu University of Computer Studies, MyanmarProf. Curtis Miller, College of Pharmacy, University of New Mexico, U.S.A.Dr. Mouhat Ouadia, University Mohammed V, MoroccoDr. Amir Shirkhani, Civil Structural Engineering University of Tabriz, IranProf. Volodymyr Khilenko, National University of Life and Environmental Sciences, UkraineProf. Badrul Hisham Ahmad, Universiti Teknikal Malaysia Melaka, MalaysiaDr. Stamatis Karlos, Unversity of Patras, GreeceProf. Said El Kafhali, Hassan 1st University, MoroccoProf. Amirreza Ghadimi-Avval, University of Arkansas, USADr. Vrjayan Gurumurthy Iyer, Open Learning Program in Entrepreneurship of The EDI, India

Posterior and lateral ponticles of atlas: An osteological study at Fatima Jinnah Medical University, Lahore

Background: Among the cervical vertebrae, atlas is known to have many variations, posterior ponticle being the commonest. It may completely or incompletely covers the groove of vertebral artery leading to ischemia of posterior circulation. Therefore, vertebral artery is at greater risk of injury during neurological and spinal surgeries. Prevalence of posterior ponticles varies widely among different populations, for instance in Turkish population it was 10.8%, in American 22.1%, Kenyan 14.7%, Brazilian and Indian 16.7%. The prevalence of lateral ponticle in Kenyan population was reported to be 3.9% and in Indians it was 2%. However, the data regarding the prevalence of these ponticles is largely lacking in Pakistan. Therefore, this research was designed to determine the prevalence of posterior and lateral ponticle in atlas vertebrae of Pakistani population.
 Materials and methods: A total of 47 human atlas vertebrae of unknown age and gender from bone bank of Department of Anatomy Fatima Jinnah Medical University, Lahore were studied for the presence of complete and incomplete posterior and lateral ponticles. The bones studied were completely intact and did not have any pathology.
 Results: Total incidence of ponticles was 38 % in this study, of which 36% were posterior ponticles and 2% were lateral ponticles. Bilateral incomplete posterior ponticles/were found in 8 (17%) atlas vertebrae whereas bilateral complete posterior ponticles/foramen arcuale were found in only 1 (2%) atlas vertebrae. Unilateral incomplete posterior ponticle was identified on right side in 5 (11%) and left side in 2 (4%) atlas vertebrae. Unilateral complete posterior ponticle was found in only 1 (2%) atlas on the left side whereas no such finding was identified on right side in any vertebra. Unilateral complete lateral ponticle was found in only 1 (2%) atlas on the right side but not on left side. No bilateral complete lateral ponticle and incomplete unilateral or bilateral lateral ponticles were identified in this study.
 Conclusion: Presence of posterior and lateral ponticles pose a risk of vertebrobasilar vascular insufficiency and may cause variety of symptoms. Vertebral artery may be at risk during neurosurgical procedures when having a foramen arculae and may give a false impression of much wider posterior arch of atlas. Knowing the prevalence of this can help neurosurgeons, general surgeons, radiologists, and chiropractors in management of the patients.

Causes of autoimmune hemolytic anemia and its clinical presentation.

Objectives: To evaluate various causes of autoimmune hemolytic anemia and its presenting signs and symptoms. Study Design: Cross sectional study. Setting: Fatima Jinnah Medical College Lahore. Period: November 2018 to April 2019. Material & Methods: In this study 90 cases were included having age range of 14-75 years with mean age of 46.5 year with the possibility of autoimmune hemolytic anemia (AIHA). Screening test used for evaluating AIHAin this study include Direct and Indirect Antiglobulin Tests and Cold Agglutinin Titer (CAT). All relevant data was documented properly. Results: Total 90 cases were included in the study comprising on 71% female and 29% male cases. 22.2% cases were having primary and 77.8% were having secondary autoimmune hemolytic anemia. Most common presenting complaint was generalized body weakness in 25(27.7%) cases and on examination most common finding was splenomegaly in 30(33.3%) cases. Hemoglobin was less than 8g/dl in 28(31%) cases. Direct Antiglobulin test was positive in 64(71%) cases, DAT and IATboth were found to be positive in 22(24.4%) cases and DAT and CAT both found positive in 4(4.4%) cases. Blood transfusion was done in 28% cases having severe anemia. Most common cause of autoimmune hemolytic anemia found among study group patients was connective tissue disorder in 25(27.8%) cases. P-value less than 0.05 were considered significant and more than 0.05 was non-significant. Conclusion: In our study autoimmune hemolytic anemia was mostly found in female population with most common presentation of generalized body weakness, pallor of hands, hepatosplenomegaly and severe anemia. Most common cause found of AIHA was connective tissue disorders.

Overview of Breast Conservative Treatment for Early Breast Carcinoma: Experience at Sir Ganga Ram Hospital Lahore

<p><strong>Background and Objectives:</strong> Treatment of early breast cancer involves surgery, chemotherapy and radiation therapy. Present study was designed to describe the cosmetic outcome, prognosis, recurrence rate and complications after breast conservative surgery in patients with early breast carcinoma.<br /><strong>Methods:</strong> A descriptive study was carried out at Surgical Unit III of Fatima Jinnah Medical University (FJMU), Lahore, Pakistan. A total of 54 female patients diagnosed with early breast carcinoma were included from July 2015 to January 2019. All of these patients underwent breast conservative surgery with axillary level II dissection or sentinel lymph node biopsy. Frozen section technique was used to evaluate clear surgical margins per operatively. These patients were followed up for a period of 12 months.<br /><strong>Results:</strong> Mean age of the patients was 49.6 ± 11.3 years. Stage I disease was found in n = 17 (31.5%) females while stage II in n = 37 (68.5%) patients. Most of the patients had invasive ductal carcinoma. Tumor free surgical resection margin status was 1mm-20mm and it was >10mm in 32 (59.3%) patients. Post-operative good cosmetic outcome regarding symmetry of the breast (90.7%), shape of the breast (85.2%), shape of nipple (88.9%) and appearance of scar (81.4%) was observed. A total of 40 (74.1%) patients were satisfied with symmetry of breast, 41 (75.9%) patients were satisfied with shape of breast and 45 (83.3%) patients were satisfied with appearance of scar after breast conservative surgery through a validated questionnaire. Complications noted after the surgery were seroma in 1 (1.8%) and wound infection in 2 (3.7%) patients. Post Radiation oedema was seen in 44 (81.5%) and ulcers were seen in 6 (11.1%) patients. Local recurrence was developed in 2 patients (3.7%). Disease free survival was observed<br />in 52 patients (96.3%).<br /><strong>Conclusion: </strong>Breast conservative surgery for early breast carcinoma is cosmetically good regarding the scar<br />and shape of the breast after surgery and satisfactory for the patients to accept. There were minimal<br />postoperative complications and low recurrence rate therefore breast conserving surgery in early breast<br />carcinoma can safely be recommended for early breast carcinoma.</p>

Validation of Urdu Translation of DREEM Inventory in a Medical College of Lahore

<p><strong>Background and Objective:</strong> Measurement of learning environment is a big challenge in medical education due to complex nature of educational environment such as interaction between students and teachers, learning venue, use of multimedia and other modalities. Introduced in 1997, Dundee Ready Educational Environment Measure (DREEM) is claimed to be a cultural free tool to measure educational environment at undergraduate level. DREEM has been translated and validated in different languages but no study has reported DREEM translation and validation in Urdu Language. This study was carried out to determine validity of Urdu translation of DREEM inventory at an undergraduate medical college in Lahore.<br /><strong>Methods:</strong> This cross-sectional study was carried out at University of Health Sciences Lahore and Fatima Jinnah Medical College Lahore over 2 years (2015-2016) after approval by Institutional Review Board of University of Health Sciences Lahore. Data was collected from 325 undergraduate students using survey method. Urdu translation of DREEM was done by two experts using computer program in page Urdu 2013. Firstly, DREEM questionnaire in English was filled by the participant students. After two weeks, DREEM questionnaire in Urdu was filled by the same students. The DREEM scores in English and Urdu were comparedby applying paired t-test.<br /><strong>Results:</strong> There is no significant difference (P > 0.05) between the DREEM scores in English and Urdu. Thereliability index between 0.7-0.9 was recorded.<br /><strong>Conclusion</strong>: DREEM Inventory has the same validity in Urdu at undergraduate level as in English.</p>

Frequency and morphology of benign histopathological lesions in total abdominal hysterectomy specimens.

Hysterectomy is one of the most frequently performed gynecological procedure all over the globe undertaken for varying indications, to effectively cure many gynaecological conditions. Histopathological analysis of the hysterectomy specimens should be undertaken for justification of procedure and diagnostic purposes. Objectives: To determine the frequency and morphology of different benign histopathological lesions in total abdominal hysterectomy specimens. Study Design: Descriptive cross-sectional study. Setting: Department of Pathology Fatima Jinnah Medical College. Period: From Jan 2015 to June 2015. Material & Methods: The gross and histopathological findings of uterus and cervix in one hundred Total Abdominal hysterectomy specimens were studied. Non-probability, purposive sampling was done. Total abdominal hysterectomy specimens with or without salpingoophorectomy of patients aged between 20 to 70 years were included. While Total abdominal hysterectomy done in mentally retarded patients and for malignancies were excluded. Patient’s data, presenting complaints and preoperative diagnosis was recorded on predesigned proforma. SPSS version 17 was used as an analytical tool. Results: Age of the patients ranged from 30-55 years with 72% between 41-50 years. The microscopic examination of the cervix revealed features of chronic cervicitis in 75% cases. The commonest neoplastic lesion was leiomyoma present in 66% of cases. Myometrium revealed foci of adenomyosis in 21% cases. Endometrial histology showed hyperplasia in 25% of cases(simple hyperplasia 20%, cystic hyperplasia 4% and complex hyperplasia 1%), hormonal imbalance in 21%, pressure atrophy in 11%, atrophic endometrium in 6% , cystic atrophy in 2% while acute and chronic endometritis in 1% and 2% of cases respectively. Conclusion: The commonest cervical lesion was chronic cervicitis (75%). The commonest benign neoplastic lesion was leiomyoma, present in 66% of cases. Other common pathologies on histology were hyperplasia in 25% of cases, adenomyosis and hormonal imbalance in 21 % of cases each, pressure atrophy in 11%, atrophic endometrium in 6% while endometritis (acute & chronic ) in 3% of cases mainly. Histopathological examination of hysterectomy specimens helps to detect the exact cause and underlined pathology.