The International Journal of Frontier Sciences

Background: Pakistan is one of the largest host of refugees. People in Pakistan have bad access to healthcare not only due to bad facilities but also due to discrimination based on their personal characteristics and possessions. The behavior not only damages the dignity of the people being targeted but also creates hindrances in further seeking professional medical help and follow-ups thus deteriorating the health status of the community as a whole. Health providers possess a moral commitment to encourage dignity and treat their patients without any kind of discrimination in their behavior. Patient experiences of discrimination result in delay in seeking healthcare, they do not stick to advice of professionals and ultimately poor health. The objective of this study is to identify sources of discrimination and its effects on patients' health status and their level of satisfaction. Methods: This descriptive study took place in Outdoor Patient Department, Mayo Hospital, Lahore. 170 patients were selected from all the patients coming to OPD with equal male to female ratio. Each patient was given a questionnaire containing relevant questions to know whether they faced any sort of discriminatory behavior or not. Results: 66% females and 49% males of the study sample experienced discrimination at some stage of their hospital visit. Conclusion: Our study concluded that females experienced more discrimination than males. Therefore, gender is the most important factor when it comes to discriminatory experiences. Moreover, people with the higher income had fewer incidents of discrimination than their counterparts. Full article

Background: Gestational diabetes mellitus (GDM) is associated with marked increase in insulin resistance. The objective of study is to determine the relation of gestational diabetes with serum leptin and serum insulin levels during pregnancy and postpartum period. Methods: This case control study conducted on total ninety samples that include cases and controls taken after 24 weeks of gestation. The case sample included 40 pregnant women with GDM and 10 women with GDM at postpartum stage. The control sample included 30 normal pregnant women with no GDM and 10 normal women at postpartum. Fasting serum leptin and fasting serum insulin were measured by ELISA. HOMA index was calculated by fasting serum insulin and fasting blood glucose. Results: Serum leptin (30.89 ± 1.35), serum insulin (27.67 ± 1.32) and HOMA index (8.33 ± 0.53) significantly high in gestational diabetic women than normal pregnant (p<0.05) during pregnancy. However, after delivery of fetus, serum leptin, serum insulin and HOMA index in gestational diabetics significantly decreased compared to during gestation period. Hence a positive correlation of GDM was determined against serum leptin and HOMA index. Conclusion: Serum leptin level is raised in GDM which has a positive correlation with insulin resistance. This study finds that the serum leptin levels may use as a marker to early screen and diagnose Gestational diabetes. Full article

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age. Full article

Background: Energy drinks (EDs) are commonly used to prevent fatigue, enhance physical, and cognitive performance. Its administration induces toxic effects in body. Omega-3 is an antioxidant and anti-inflammatory agent that helps in proper functioning of immune system. Objectives of this study were to evaluate the morphological effects of fish oil omega 3 fatty acids (Eicosapentaenoic acid / Docosahexaenoic acid) on energy drink induced ovarian cytotoxicity in adult female albino rats. Methods: The study was conducted at animal house, Anatomy department, Postgraduate Medical Institute, Lahore from January to march 2019. ARRIVE guidelines were followed for conduct of animal study. Ethical approval was obtained from PGMI, Lahore and Advanced Studies and Research Board of University of Health Sciences, Lahore. The study comprised 36 adult female albino rats divided into 3 groups i.e., control, energy drink and omega 3 treated. Rats were sacrificed, ovaries extracted, and sections were stained with H&E and PAS. SPSS version 21.0 were used. Results: Statistically significant difference was present in gross parameters between the control and experimental groups. Energy drink administration caused a decrease in diameter of mature graafian follicle and diameter of the oocyte. Disruption in basement membrane was more pronounced in Energy drink treated group. Conclusion: Energy drinks were found to cause cytotoxic effects on ovarian and oocyte morphology, ultimately leading to infertility. Omega 3 reduces the extent of damage caused by the intake of energy drinks. Full article

Background: Human face is highly vascular region and vascularity to the skin and other organs is an important indicator of health and disease. Change in blood flow is affected by aging, diabetes, high blood triglycerides, cigarette smoking etc. With so many factors that can alter blood flow in the skin, normal blood flow is important to know for comparison to diseased state. Blood flow in superficial arteries of face has not yet been described, therefore this study was designed to establish baseline blood flow values in arteries of face. Materials and Methods: Blood flow of right and left side was assessed at level of facial and infraorbital artery. Categorical variables were presented in form of frequency and percentages was done by using Mann-Whitney U. Wilcoxon Signed Ranks test was used to compare left and right facial and infra orbital arteries. Results: Peak systolic velocity of right and left facial artery had a significant difference having right side mean of 67.02±12.48 and left side mean as 72.67±11.69. Facial artery diameter of right and left side also had significant difference with mean of 0.14±0.02 and 0.15±0.02 respectively. Conclusion: No difference was found between vascularity in male & female and left or right side. The study might be useful to establish normal baseline values of various parameters on both sides of face in male and female adults. This study may become important reference for future studies measuring blood flow and even progression of vascular diseases may be assessed by indexes developed on the basis of these studies. Full article

Primary percutaneous coronary intervention (PPCI) is a non-surgical procedure that requires catheterization to improve blood flow to the heart and is the recommended therapy for Acute Myocardial Infarction (AMI). The Coronavirus 2019 (COVID-19) pandemic has altered the course of reperfusion therapy for patients with ST-elevation myocardial infarction (STEMI). It is imperative to emphasize the awareness of timely PCI and the effects it has on improving patient outcomes. Based on the consensus statement by the American College of Cardiology (ACC), American College for Emergency Physicians (ACEP), and the Society for Cardiovascular Angiography and Interventions (SCAI), it is critical to inform the public to call the emergency medical system for AMI symptoms and obtain the appropriate level of care. Ultimately, COVID-19 has posed unprecedented challenges to public health. The immediate threat is linked to morbidity and mortality related to the infection, and the masked threat is the waning attention and resources utilized for the care of other diseases. First medical contact is the main time target, and reducing treatment delays to improve patient outcomes in AMI patients with STEMI should be the next immediate objective in healthcare systems worldwide. Full article

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard. Full article

The pandemic of coronavirus disease 2019 (COVID-19) is challenge of the century for humanity. Pre-pandemic normalcy is assumed to never return until a safe and effective vaccine becomes available and a global vaccination campaign is successfully introduced. To tackle the pandemic of Covid-19 safe and effective vaccines has been developed and pharmaceutical companies Pfizer/BioNTech, Moderna and AstraZeneca started to manufacture the vaccine and make it available in the market. Globally all the countries are in race to secure vaccine access for their populations but it is challenge for developing countries to make vaccine available for the population especially the poor and vulnerable groups. Pakistan is developing country which is facing the double burden of the communicable diseases like malaria, HIV/AIDS, tuberculosis and non-communicable diseases along with financial issues faced by the health system. Full article

Background: Our study aims to determine the effectiveness of tranexamic acid in decreasing the intraoperative blood loss during tonsillectomy. Materials and Methods: Study design was randomized double-blind control trial. This study was conducted from 1 November 2017 till 30 June 2019 in the department of ENT unit-II, the civil sandeman provincial teaching hospital Quetta. Ethical approval was taken from Ethical Review Board of the civil Sandeman provincial teaching hospital Quetta. A sample of 100 patients were surveyed, 55 men and 45 woman, 10-30 year age range, 1.2:1 men to female with a mean 20 year age. Patients who met the criteria for inclusion experiencing an elective tonsillectomy were randomly assigned to two groups. Every community has equivalent patients. An injection of 10 mg/kg body weight was given intravenously into group-A 5-10 minutes prior to surgery, and normal saline of the same amount was administered intravenously into group-B. Intraoperative bleeding was measured at Operation Theatre in both groups during surgery. In intraoperative blood loss, the effectiveness of tranexamic acid / placebo was determined by measuring loss of blood computed by Gravimetric method and blood obtained in suction jar by measuring. Results: In Group-A and Group-B patients, there was a significant difference in intra-operative loss of blood during tonsillectomy. In group A, intra-operatively, there was overall blood loss of 1404 ml and the average blood loss was 33ml. During surgery in group-B the blood loss was 3132 ml, and the average loss of blood was 62-64ml. As a result, group B was more intraoperative bleeding and consumed more time compared to group A. Conclusion: Study group patients receiving preoperative intravenous tranexamic acid have less intraoperative loss of blood and less time consuming than placebo patients who have not obtained tranexamic acid intravenous. Full article

Background: Hepatitis C virus is one of the significant causes of morbidity and mortality in the World. Surprisingly, despite national screening campaigns, new cases of HCV are still on the rise. Methods and Results: A total of 5914 healthy blood donors was included in this study after informed consent. Anti-HCV ELISA was used to check presence of antigen in participant’s plasma.using Monlisa HCV Antigen-Antibody Ultra kit. Final confirmation was done by using real time PCR considered as a gold standard. Results: 0.5% of anti-HCV ELISA negative samples showed presence of antigen in plasma, when checked through core Ag detection method. Conclusion: Our result suggested that HCV core antigen detection and/or combo testing are far safer screening methods for the detection of HCV and the use of these methods can avoid/reduce further spread of this deadly disease. Full article