Notes

The end results involving one along with a blend of determining factors associated with anaemia from the early: is caused by the TULIPS consortium.
Myasthenia gravis (MG) is an autoimmune disease. In some patients, Primary Ovarian Insufficiency (POI) is considered to be an autoimmune condition. Their coexistence is rare and suggests autoimmune perturbation. We describe a patient who was determined to have POI at 17 years of age and who developed MG 20 years later. Copyright © Pakistan Journal of Medical Sciences.Objectives To estimate frequency of stunting and associated factors in children aged less than five years in a tertiary care hospital of Lahore. Methods An Analytical cross-sectional study was conducted in Pediatrics Outpatient Department at Akhtar Saeed Trust Teaching Hospital, Lahore from December 2017 to July 2018. Two hundred children of ages under five years coming to outdoor for treatment of minor ailments were included after informed consent from their parents. Non-probability, convenient sampling technique was used to collect sample. Data collected and analyzed on SPSS version 19. To find out association of stunting with multiple qualitative variables, chi-square test was applied and p-value was fixed at ≤ 0.05 to be significant. Results Out of 200 children screened in OPD, 42 (21.0%) were found to be stunted. The total percentage of stunting in male children was 28 (66.6%) and in female children were 14 (33.3%). Stunting was significantly associate with male gender (p=0.047), joint family system (p=0.049), low literacy level in mothers (p=0.031), unvaccinated status (p=0.003) and history of bottle feeding (p=0.037). Conclusion The frequency of stunting in children less than five years of age is 42 (21.0%). The significant risk factors associated with stunting were found as male gender (p= 0.047), joint family system (p=0.049), low maternal education (p=0.031), unvaccinated status(p=0.03). Copyright © Pakistan Journal of Medical Sciences.Diabetes registries can be used to monitor the prevalence and incidence of diabetes. Diabetes registries are used in many countries for population management of diabetes, outcomes management, and development of Clinician finding Support Structure, for example, National Diabetes Registry (NDR) in Sweden and Singapore diabetes registry. According to 2nd National Diabetes Survey of Pakistan (NDSP) 2016-2017, overall 26.3% adult (≥20) suffer from diabetes (27.4 million people). Health Research Advisory Board (HRAB) of Pakistan has initiated the mission of developing disease registries countrywide. Diabetes Registry of Pakistan (DROP) under the supervision of Prof. Abdul Basit and Dr. Asher Fawwad to enumerate the degree of the national disease burden. For type 1 diabetes, Diabetes Registry of Pakistan for type 1 (DROP-1) has already started. DROP-1 can be a good pilot arm for developing the robust methodology for DROP. The upcoming and the ongoing research is periodically being linked with the registry to ensure its modernization. This registry is a useful tool for tracking the status of patient, in order to limit the burden of data collection. A web-based data entry system and automated random sampling has enabled useful data collection and tracking with relatively minimal effort. Copyright © Pakistan Journal of Medical Sciences.Objective To evaluate the correlation between refractive errors and change in intraocular pressure in patients undergoing cataract surgery. Methods This interventional retrospective case study was carried out from September 2018 to April 2019 at Bodla Eye Care and Multan Medical and Dental College, Multan. A total of 127 eyes were recruited in the study among which six were excluded. Out of remaining 121, 53 eyes were emmetropes, 41 were mild myopes and 27 were high myopes. Single surgeon performed the procedure. Pre-operative investigations of IOP and refractive error were done by goldmann tonometry and auto refractometry. IOP was reviewed at day 1, 7, 14 and 28 post cataract surgeries. Results Out of 121 eyes, 53 eyes were emmetropes, 41 were mild myopes and 27 were high myopes, who underwent phacoemulsification. There was an elevation of 2-3mm Hg at Day-1, in emmetropes and mild myopes, and further on, a constant drop was noticed on follow ups. In high myopes a significant fluctuation of IOP was noted in first fourteen days followed by an unremarkable gradual decline afterwards. Conclusion Cataract surgery helps lowering the IOP in patients with refractive errors. Mild myopic and emmetropic patients showed a linear swift pattern while high myopes presented instable and gradual reduction in IOP. A total decrease of 1-2mm Hg was seen at the end of the study depicting that relation between IOP and cataract surgery is insignificant. Copyright © Pakistan Journal of Medical Sciences.Objective This study aims to discuss the value of ultrasonic analysis and anti-cyclic citrullinated peptide (CCP) antibody analysis in evaluating the state of rheumatoid arthritis (RA). Methods This study was conducted during March 2016 to December 2016. Total 82 patients with RA who sought treatment in the Affiliated Hospital of Hebei University were included in this study. Data on ultrasonic and anti-CCP antibody, ESR, and RF were collected and compared. The RA patients were divided into two groups of mild disease activity (DAS28 ≤ 3.2) and moderate-severe disease activity (DAS28 > 3.2) to compare the changes in synovial thickness of joints. The changes of joint ultrasonography were also compared between positive and negative anti-CCP antibodies group. Results It is found that the number of patients suffering from joint involvement in the negative anti-CCP antibody group was larger than that of the anti-CCP positive antibody group (P less then 0.05); the thickness of the synovium of joints of patients in the group with moderate-severe disease activity evaluated via ultrasonography was significantly larger than that of the group with mild disease activity (P less then 0.05). Conclusion It is possible to observe the degree of disease activity dynamically by combining ultrasonography with anti-CCP antibody and make a better assessment of patients to facilitate treatment. Copyright © Pakistan Journal of Medical Sciences.Objective To assess the attitudes of psychiatric patients towards electroconvulsive therapy (ECT) as a treatment modality. Methods This descriptive cross-sectional study was conducted from 1st January, 2017 to 15th April, 2018 in Department of Psychiatry, MTI, Lady Reading Hospital, Peshawar. It comprised of total 154 patients, having previous experience with electroconvulsive therapy (ECT) who were selected through a non-probability consecutive sampling. Their attitude was assessed by their responses to 15 questions on a Likert Scale, each question scoring 01-05 with a summed up cut-off score of 45 points. Score over 45 points is considered positive and below 45 as negative while those scoring exactly 45 points were considered as having Ambivalent attitude towards ECT. Results Of all, 73% patients revealed positive and 27% negative attitude towards ECT. Mean age of the sample was 35 years. Out of all patients, 67.5% were males & 32.5% females, 73% were married & 27% unmarried, 47% were illiterate & 53% variably educated, 43% were employed while 57% were unemployed. Conclusion A significant majority of the patients accepted ECT as an effective treatment modality. However, to make the procedure more acceptable, it may be made more effective and safe to the expectations of the patients and medical professionals for better outcomes. Copyright © Pakistan Journal of Medical Sciences.Objective To discuss the function of mixed reality (MR) technology in guiding location of intervertebral foramen microscopic puncture and analyze its feasibility and clinical application value. Methods Sixty patients with lumbar intervertebral disc who were treated between January 2017 to October 2017 were chosen, and classified into navigation group (30 cases) and traditional control (30 cases) according to random number table. Intervertebral foramen microscopic operation was conducted for both groups. MR technology was applied for the navigation group to guide puncture and establish intervertebral foramen microscopic cannula. Traditional C-arm X-ray apparatus was used for traditional group to establish intervertebral foramen microscopic cannula. Intra-operative puncture times, fluoroscopy times, puncture time and VAS score 1d, 3m and 6m after the operation were recorded and compared. Results Postoperative waist and leg pain symptoms of both groups were relieved obviously, and straight leg raising test for the diseased limb turned to be negative. Intra-operative puncture times, fluoroscopy times, puncture time and operation time had statistical significance decrease. Conclusion Mixed reality (MR) can accurately guide the establishment of intervertebral foramen microscopic cannula, solve the bottleneck problem of intervertebral foramen microscopic technology, promote puncture success rate, reduce repeated puncture times, avoid by-injury, shorten puncture time and reduce X-ray radiation quantity of operators and patients, so it deserves to be promoted and applied. Copyright © Pakistan Journal of Medical Sciences.Objective To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS. Methods Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AUZ454 clinical trial AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined. Results Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%. Conclusion Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients. Copyright © Pakistan Journal of Medical Sciences.Objective To analyze the clinical effect of delivery ball and free position delivery nursing in primipara delivery. Methods Total 110 primipara who were admitted to the department of gynecology and obstetrics of our hospital from August 2017 to August 2018 were included in the study. They were randomly divided into an observation group and a control group, 55 each group. The control group adopted conventional nursing measures, while the observation group adopted delivery ball combined with free position midwifery nursing on the basis of conventional nursing. The pain degree, comfort degree, pregnancy outcome and sense of delivery control were compared between the two groups. Results The number of puerperae with grade 0 and 3 labor pain in the two groups had no statistically significant difference (P>0.05). The number of puerperae with grade 1 and 2 had significant difference (P0.05). The amount of hemorrhage of the observation group 2 hours after labor was 172.50±40.60 mL and that of the control group was 224.
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