The International Journal of Frontier Sciences

Objective: to investigate the role of CT and MRI in diagnosis of Arnold chiari malformation of hydrocephalus and its treatment with VP shunt along with complications. Study Design: Prospective study Place and duration: Department of Neurosurgery, DG Khan Medical College from May 4, 2018 to May 4, 2019. Methodology: Fifty patients of congenital hydrocephalus who were not treated previously were selected. Detailed history about disease and clinical examination of patients was performed. Follow ups were done at neurosurgery OPD. SPSS software for data analysis was used and mean ± SD, frequency and percentages were calculated for variables. P value ?0.05 was considered as significant. Results: Treatment in case of congenital hydrocephalus as VP shunt, intra-aneurysmal coiling, excision of meningomyelocele with VP shunt and suboccipital craniectomy + upper cervical laminectomy (scucl) were observed as 10%, 6%, 8% and 8% respectively. Twelve percent of patients were not treated. Conclusion: CT and MRI are the main diagnostic tools for diagnosis of Arnold chiari malformation and VP shunt is the treatment of choice. Among complications of VP shunt infection of shunt and shunt block are the main complications. Full article

Background: The etiology of sleep disruption in intensive care unit is poorly known and often ignored complication. It is caused by the environmental factors especially pain, noise, diagnostic testing and human interventions that cause sleep disruption. Light, medications and activities related to patient care interfere with patient’s ability to have good sleep. There are multi-factorial environmental etiologies for disruption of sleep in ICU. Objective: The objective of this study was to evaluate the factors disturbing the sleep quality in intensive care unit (ICU) admitted patients. Methodology: A cross sectional study was designed involving 150 patients admitted in intensive care unit and high dependency unit of Gulab Devi Chest Hospital. The duration of study was from September 2015 to March 2016. The questionnaire was made and filled with the help of patients. The data was analyzed using SPSS version 16.00. Results: Mean age of patients was 50.46+10.96 with maximum age of 65 and minimum age of 30 years. There was 53.33% male patients and 46.67% females participating in this study. The sleep quality was significantly poor in ICU than at home. After analysis, 54.67% patients were with poor quality of sleep due to pain and 48.67% were due to noise of environmental stimuli. The other factors were alarms, light and loud talking. Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable. Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable. Full article

Background: Oral and Maxillofacial Surgery department is a diverse field in dentistry. Record maintenance has been established as one of the key factors in the success and integrity of health care institutes.Objective: The objective of the study was to evaluate the records of oral and maxillofacial surgery cases reported to oral and maxillofacial surgery department, Abbasi Shaheed Hospital and oral surgery OPD of Karachi Medical and Dental College.Methods: Cross sectional study was conducted in at ASH and KMDC from July 2019 to September 2019. The data from January 2017 to July 2019 was retrospectively noted through electronic surgical record of ASH and records of the Oral Surgery OPD of KMDC. Inclusion criteria was patients records of both genders of 5–70 years age, having complaint of any oral or dental pathology or pathologies, trauma and impactions. Data was calculated manually by calculating frequencies and percentages for the trauma, impaction and pathology cases of patients.Results: In 2017, 239 cases were treated under general anesthesia from which trauma 11. 45% (n=11), followed by 48. 11% (n=115) cases of oral pathologies, total 11.7% (n=28) cases of complicated exodontias. In 2018, among 211, 51.1% (n=108) cases were trauma followed by 39.3% (n=83) cases of oral pathologies, whereas, total 9.4% (n=20) complicated exodontias cases were observed. During 2019 (January to July), 168 cases 36.2% (n=62) cases were diagnosed as trauma, in oral pathology, overall 36.2% (n=62) cases were surgically excised. Total 23.2% (n=39) complicated exodontias. In 2017, 25122 cases were reported in Surgery OPD of Karachi Medical and Dental College. Total 36.2% (n=9097) teeth were extracted from which 1.93% (n=486) cases were surgical impaction. On the other hand, 1.65% (n=416) patients were treated through minor oral surgeries. In 2018, 29008 cases were reported in Surgery OPD. Total 42.7% (n=12377) teeth were extracted from which 0.92% (n=268) cases were surgical impaction. On the other hand, 0.71% (n=208) patients were treated through minor surgeries. In 2019, January till July 13028 cases were reported in Surgery OPD. Total 42.6% (n=5559) teeth were extracted from which 0.66% (n=87) cases were surgical impaction. On the other hand, 0.68% (n=89) patients were treated through minor surgeries.Conclusion: It has been concluded that evaluation of the records of oral and maxillofacial surgery cases reported to oral and maxillofacial surgery department, Abbasi Shaheed Hospital and oral surgery OPD of Karachi Medical and Dental College were high and appropriate measures should be taken in order to manage these problems timely and effectively. Full article

Background: Malnutrition is a health problem affecting growth and development of young children. Children under 15 years of age are the main victims of malnutrition. Malnutrition is attributed to a series of diverse etiological factors. Objective: To determine the nutritional status of the children of various age groups of school going children of Army Public School and to find out the association of socio-demographic variables and dietary habits with nutritional status. Methodology: It was a descriptive cross-sectional study conducted at Army Public School, Okara. Sample was selected through non-probability consecutive sampling. Duration of study was 6 months (Dec 2017 to May 2018). The study was conducted after getting formal approval from Institutional Ethical Review Board AFPGMI. The children were randomly selected for study from the enrollment register available in the principal’s office. Participation in the study was voluntary with guaranteed confidentiality. The participants were given full right to quit study without mentioning reason at any time during data collection. After ruling out the exclusion criteria, 500 children fulfilling inclusion criteria were selected for study. An informed written consent was obtained from all selected children and their parents to take part in the study. Data for the assessment of nutritional status was obtained using anthropometry, biochemical laboratory test and eating habits / food preferences of the children. Results: In our study, mean age of children included in the study was 9.58±1.72 years. Out of 500 children, 252 (50.2%) were male while 248 (49.8%) female. The mean height of children was 134.88±11.69 cm. The mean weight of children was 30.25±8.47 kg. The mean OFC of children was 51.43±1.75 cm. Out of total 500 children, 85 (17%) were having BMI less than 18.5, 338 (67.6%) were having BMI within 18.5–24.9 while 77 (15.4%) children having BMI within 25-29.9. None of child was observed with BMI of ?30. Among 85 children with below normal BMI, 63 had mild malnutrition (BMI between 17-18.4), 19 had moderate malnutrition (BMI 16-16.9) while 3 had severe malnutrition (BMI < 16) Conclusion: Malnutrition is a significant public health problem among preschool and school going children. And improving socio-economic condition along with literacy of mothers and preventing infections through personal hygiene might help in improving the nutritional status of children. Full article

Objective: The objective of study was to find out serum uric acid level in normal andpreeclamptic pregnant women of third trimester visiting outpatient department of obstetrics and gynecology of Bahawal Victoria Hospital, Bahawalpur. Methodology: It was a cross sectional descriptive study conducted form July 2018 to June 2019. All primigravida women of age 18-35 years in third trimester of singleton pregnancy attending in Obstetrics and Gynecology Outpatient Department of Bahawal Victoria Hospital in study duration were included in the study. Statistical analysis was performed by using SPSS version 14. Chi-square test was performed to find the statistical difference regarding uric acid distribution between groups and ‘p’ value <0.05 was considered as a lowest level of significance. Results: Out of total 1212 women 84.6% were normal and 15.4% had preeclampsia. In our study out of 187 preeclamptic women, 63.6% had raised serum uric acid level and out of 268 normal pregnant women uric acid level was raised in only 39.5%. Results were found statistically significant. Conclusion: Results of our study suggest that serum uric acid level in pregnant women can be used as a useful and inexpensive marker in prediction of preeclampsia and preventive measures can be taken accordingly. Full article

Background: The impact of dialysis modality on the rates and types of infectious complications has not been well studied. The aim of the present investigation was to evaluate the rates of hepatitis C virus and hepatitis B virus infections in hemodialysis patients in three general hospitals of Azad Kashmir. In dialysis patient, if left unaddressed these may lead to very fatal consequences at the individual and national level. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent significant public health issues globally. These infections are important causes of morbidity and mortality in hemodialysis patients. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and have an increased risk of hepatocellular cancer (HCC). Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HCV infection and among people at high-risk for parenteral infection. Objective: The present work was aimed to determine the frequency of hepatitis B and C among dialysis patients in Azad Kashmir dialysis centers. Design: Cross-sectional descriptive study. Settings: Pathology laboratory of Abbas Institute of Medical Sciences, Muzaffarabad, Azad Jammu & Kashmir. Participants: A representative sample of 110 patients of dialysis from all Azad Kashmir dialysis centers including both males and females was studied between August and December 2016. BMI was calculated after measuring weight and height followed by measurement of hepatitis B and C in dialysis patients. Results: In this study, out of 110 patients: 52.72% dialysis patients were hepatitis C positive and 13.63% dialysis patients were hepatitis B positive. Conclusion: Our findings revealed ongoing HCV incidence and high HCV/HBV prevalence among HD patients in Azad Kashmir. But incidence and prevalence appear to be declining year by year. About one-fifth of HD patients are chronic carriers of HCV infection, in need of HCV treatment, and potentially can transmit the infection to other HD patients. In context of rapidly growing HD patient population, these findings highlight the need to improve standards of infection control during dialysis in Azad Kashmir. Full article

The International Journal of Frontier Sciences just completed its three years of publication. Start of a journal is always challenging for editors especially if journal is not an official publication of some institute or professional society. However, completing three years also has been a very learning experience for editorial team. From the start, TIJFS team is focused to catch indexation in EMBASE, MEDLINE, PubMed, Scopus and Web of Science. However, starting years of the journal are always challenging. Journal editors are continuously improving practices to achieve these milestones at earliest. In scope, journal is transdisciplinary mainly covering life and environmental sciences. Starting from Pakistan, it was very difficult to run an internationally covered journal, however, our international editorial team putting its continuous efforts to do this. In last year, journal started its indexing process and just became a part of WHO’s Index Medicus. Also, editors started to generate digital object identifiers (DOIs) of all manuscripts published. Currently, journal is in process of indexation in prestigious international bodies including Web of Science etc. Journal editors hope to be a part of many international indices during the current volume year. Also, its worth to mention that journal is following ethical guidelines by Consolidated Standards of Reporting Trials, Committee of Publication Ethics, International Committee of Medical Journal Editors and World Association of Medical Editors. Current volume contains original articles, clinical audit and a report covering broad spectrum domains of life sciences especially medical science including topics of clinical chemistry, dentistry, gynaecology, neurosurgery, nutrition, pain medicine, public health, rehabilitation, sleep medicine, surgery and virology. Full article

Objective: The objective was to study the muscle imbalance, restrictive motility in unlike gazes and the outcomes of the scleral buckling surgery for rhegmatogenous retinal detachment. Study design: Prospective follow-up study Settings and duration: The study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from Aug 2015 to Jan 2016. Methodology: The patients were checked prior to surgery and two follow up visits were done afterwards. Thorough history was taken along with full orthoptic assessment and ocular motility in all four main gazes including elevation, depression, adduction and abduction. Vision, type and position of explants, site of detachment, and risk factors of detachment were also observed. Results: A total of 48 eyes of 46 patients were taken. Mean age of the study participants was 37.16±20.37 years. Horizontal, vertical and combined deviations were observed in study population. Exo deviation was most common deviation among patients. Most reported risk factors of retinal detachment included trauma, pseudophakia, aphakia and myopia. Motility limitations of all four gazes was observed and it was found out that after buckling the squint and restriction is been increased up till two months. Conclusion: Ocular restriction among the patients was observed over a period of 2 months and it depicted that encircling with sclera buckling elicited an increase in restrictive ocular motility from pre-operative to 1 week and 2 months after surgery. Full article

Objective: To compare the efficacies of neurological physical examination, neurothesiometer and PainDETECT questionnaire in diagnosing diabetic neuropathy. Study Design: Prospective cross-sectional Place and Duration of Study: Department of General Medicine, Nishtar Hospital Multan, Pakistan from 1st December 2018 to 10th March 2019. Materials and Methods: One hundred and four patients of both type 1 and type 2 diabetes visiting the outdoor department were included in this study. They were assessed by lab results of glycosylated hemoglobin, fasting and random blood sugar levels and neurological physical examination. Results: The physical examination with Michigan Neuropathy Screening instrument showed that around 29 of the patients were having established neuropathy. The PainDETECT questionnaire on the other hand showed about 42 patients having a definitive neuropathy while the neurothesiometer showed that 79 of the total patients had varying degrees of neuropathy. Conclusion: The neurothesiometer is a better diagnostic tool for diagnosing diabetic neuropathy in patients. Full article

Background: Cervical dysplasia is the most common gynecological disorder of modern era. It initiates around the squamocolumnar junction of the cervix commonly due to the infection of human papilloma virus. Large loop excision of transitional zone is globally a standard procedure of choice both for diagnosing and treating cervical dysplasia. Pap smear is a fast and easy assessment tool for detecting cervical lesions, but it is relatively unreliable. Methodology: Fifty patients of age group 35 to 65 years patients having normal looking cervix with abnormal pap smear or suspicious looking cervix with or without abnormal pap smear, were selected for the study after informed consent. The procedure for LLTEZ was performed under strict aseptic measures in the procedural room and the biopsy specimen was sent for histopathological examination. The pathological findings were presented as percentages. Results: 66% cervical biopsy specimens were suggestive of chronic cervicitis and 24% samples were suggestive of chronic cervicitis with squamous metaplasia. Mild dysplasia in 4% samples, moderate and severe dysplasia were seen in 2% samples. Conclusion: LLETZ is an efficient procedure to deal with cervical dysplasia. It must be recommended for the work-up of uncertain gynecological presentations. The expertise of professionals must be improved through training to obtain maximum benefits. Full article

Background: Viral infection of the respiratory tract is a common illness syndrome in humans. Human respiratory tract is infected by large number of viruses. Self-constraining infections are caused by most of them e.g. normal chilly and intense bronchitis. Seriousness of illness relies upon specific infection and furthermore on host factors. Flu influences all age gatherings; an extensive number of bleakness and mortality happens in high hazard gathering e.g. elderly patients with chronic disease. Methodology: The research was completed in Shujabad, Multan. A prospective study was conducted for a period of three months in order to define burden of flu among cases of influenza-like illness as they visited emergency department of the THQ Hospital Shujabad, Multan. Data was analyzed by using SPSS software with 95% confidence interval. Chi-square test was used to measure the association of risk factors. CI (cumulative incidence) of disease (influenza) was calculated by standard formula. Results: There were 16332 patients visited emergency department of the hospital for the treatment different health issues. Total numbers of influenza like illness patients enrolled in current study were 244 and cumulative incidence was calculated to be 1.49%. Among these 244 ILI patients, 12 patients were hospitalized in the emergency department for advance respiratory care which was 4.9% of the ILI patients and 3 patients died among the 12 hospitalized patients due to the severe respiratory attack which was (1.2%) of ILI while rest of the patients were discharged as they were stable. All of the 244 ILI patient samples were sent to the laboratory for PCR and results was showing that 35 were influenza positive which was 14.3% of the ILI cases presented in emergency department of the hospital. Conclusion: It was concluded that Influenza virus strains are circulating in general public of the Tehsil Shujabad, District Multan. This study therefore indorses the need for continuous surveillance of influenza as an important public-health issue. It also raises the question of rational vaccination policy for influenza. Finally, there is the question of clinical diagnosis where specific treatment/antiviral treatment is available. Full article

Background: Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. Although it is believed that longer pulmonary rehabilitation programs can provide better results, most of the evidence comes from short-term programs. Objective: The objective of this analysis was to determine the effectiveness of respiratory services provided in the hospital or community by respiratory therapists (RTs) in reducing health care utilization and improving patient outcomes. The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease. Methodology: All 65 Pakistani patients who met the inclusion criteria with ages between 40 to 65 years, including both male and female, with mild to severe COPD were enrolled in the study on the basis of convenient sampling. Informed consent was taken from each patient starting about the study and their rights to withdraw from study. A demographics detail (name, age, sex) was noted along with the necessary medical history. A questionnaire was made to see the effects of pulmonary rehabilitation in patients with COPD. All necessary tests were performed to evaluate the patient betterment completely. Results: The mean FEV1 in the subjects was 1.29 ± 0.47 L/min, 64.8 ± 23.0% of predicted. Clinically there is a little effect on CXR pattern, FEV1 and FEV1/FVC after pulmonary rehabilitation. But overall quality of life improved after pulmonary rehabilitation. Mainly improvement occurs in peak expiratory flow rate, BORG dyspnea scale, 6 mint walk test distance (meters) and Oxygen saturation after rehabilitation. Conclusion: These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity. Full article