ANNALS OF ABBASI SHAHEED HOSPITAL AND KARACHI MEDICAL & DENTAL COLLEGE <p style="font-weight: 400;">The scientific journal, Annals of Abbasi Shaheed Hospital and Karachi Medical and Dental College is a quarterly peer-reviewed journal being published for over 20 years, recognized by PMDC, HEC (Y-Category) and cited on Emerging Sources Citation Index (Thomson Reuters), IMEMR, Pakmedinet. The Editor-in-Chief is a member of World Association of Medical Editors (WAME), Eastern Mediterranean Association of Medical Editors (EMAME), and Pakistan Association of Medical Editors (PAME).</p> <p style="font-weight: 400;"><strong>ARTICLE PROCESSING:</strong></p> <p style="font-weight: 400;">The articles can be submitted online via eJManager throughout the year and on an average, it takes maximum one year to print an article. For any queries please email at</p> <p style="font-weight: 400;">1.Processing Fee: Rs. 1500/-<br>2.Publication Fee: Rs. 1000/- (per side of PDF)<br>3.Publication Fee of Pictorial Quiz: Rs. 1000/-<br>...(Include processing and Publication Both):</p> <p style="font-weight: 400;">Subscription per issue:<br>In Pakistan: Rs.1000/-<br>In Karachi: Rs.800/-<br>Bangladesh &amp; India: Rs.1200/-<br>UK: £ 40<br>USA &amp; other Countires: $ 60</p> en-US ANNALS OF ABBASI SHAHEED HOSPITAL AND KARACHI MEDICAL & DENTAL COLLEGE 1563-3241 Transformation of PMDC to PMC <p>In Pakistan, medical professions are controlled and regulated by a body for proper function. Initially, it was Pakistan Medical and Dental Council (PMDC) but now it has become Pakistan Medical Commission (PMC). The Pakistan Medical Council Ordinance 1962 established the present-day Pakistan Medical and Dental Council as a statutory body in 1962 and all provincial councils were dissolved then. Three amendments were passed after the establishment of PMDC known as (Amendment)<br>Act in 1973, 1999, and 20121. Now the PMC was established on 24th September 2020 for the regulation and control of the medical profession to increase the basic and higher medical education and practice in both medical and dental sections2.</p> Shazia Sarwat Iqbal Muhammad Jamaluddin Maria Saleem Mudassir Copyright (c) 2020-12-17 2020-12-17 25 3 122 123 Visual Outcome of Ocular Trauma and its Medicolegal Interpretation in a Tertiary Care Hospital, Karachi <p>Objective: To evaluate the visual outcome of ocular trauma and its medicolegal interpretation in a tertiary care hospital, Karachi.<br>Methods: This was a prospective, cross-sectional observational study conducted at Abbasi Shaheed Hospital, Karachi. Data was collected through nonprobability consecutive sampling technique. The study duration was 12 months, from 14 September 2014 to 15 September 2015. Inclusion criteria were patients of both genders aged between 18 - 60 years, presenting with ocular trauma in the outpatient department or admitted through an emergency in the department of Ophthalmology. The exclusion criterion was patients suffering from all extraocular injuries. Patients were followed up for a period of 6 months. Statistical analysis was done through SPSS version 20.0<br>Results: There were 99 patients, with a mean age of 31.6 ± 18.5 SD years. Males were 74.7% and 82 (82.2 %) were unskilled. Closed globe injury was seen in 54 (54.5%) and the open globe in 45 (45.5%). Nine percent of the patients were assault cases and 90.9% cases were accidental. The corneal injury was seen in 43 (71.6%) and scleral injury in 5 (8.3%) of the patients. At the time of trauma 39.4% of patients presented with 6/60 visual acuity, in the early post-op period 50.5% were 6/6, whereas at six-month follow-up 90.9% patients were with 6/6 visual acuity. Wilcoxon Signed Ranks Test showed P-value less than 0.01.<br>Conclusion: It was concluded that the major outcome of ocular trauma was impaired visual acuity, which improved significantly on regular follow-ups. Medicolegal interpretation of ocular trauma is imperative and should be accounted for properly. It should be exercised by the medicolegal officer, to not give the final report before at least 6 months of follow-up in case of poor visual outcome. Moreover, educate the person to demand compensation during this period.</p> Raffat Rasool Erum Shahid Roohi Ehsan Hira Ahmed Shazia Fehmi Arshad Sheikh Copyright (c) 2020-12-17 2020-12-17 25 3 124 129 An Analytical Approach to Estimate Prevalence of Depression from a Non-Probability Sample of College Students in Karachi Using Beck Depression Inventory <p>Objective: To estimate and compare the prevalence of depression among college students in Karachi. The analytical&nbsp;approach was aimed to minimize biases produced by profession, gender, and age of samples on the prevalence rate.<br>Methods: A cross-sectional study design was employed. Two hundred and sixty students were chosen from January 2018 to March 2019 through a purposive non-probability sampling technique from different professional colleges in Karachi. Beck Depression Inventory, a self-report questionnaire comprising 21 items was used as a study tool. After taking informed consent, each sample was inquired about the profession, age, gender, and personal and family history of psychiatric illness. Diagnosed cases of any psychiatric illness were excluded. Samples were stratified on the basis of profession, gender, and age. A minimum sample size of 70 students was extracted from the total sample through quasi randomization. Statistical software SPSS version 16 was used for data entry, sample randomization and analyses.<br>Results: Overall prevalence rate was 26.15%. Profession based stratification of samples showed prevalence rates of 21.81% and 29.33% in business and medical college students, respectively. Substrata of medical colleges i.e. public and private medical college students showed prevalence rates of 38.66% and 20%, respectively. Gender-based stratification showed a prevalence rate of 33.33% in female and 17.24% in male students. Age-based stratification showed a prevalence rate of 15.49% in teens (17-19 years) and 21.69% in the post-teen group (20-25 years). Independent sample t-tests showed a statistically significant difference between the strata of the profession, gender, and age and substrata of public and private medical colleges. A prevalence rate of 25.71% was estimated in quasi-randomized samples.<br>Conclusion: Randomization, stratification and large sample sizes are employed to minimize biases in prevalence studies. The present study showed the importance of sample stratification based on age, gender, and profession in estimating the prevalence of depression. Results also showed the validity of the minimum sample size is calculated appropriately.</p> Nuzhat Aisha Akram Nazia Jameel Samira Faiz Mudassir Hussain Abdul Qadir Amina Raza Copyright (c) 2020-12-17 2020-12-17 25 3 130 136 The investigative methodology to confirm Alcohol consumption in all suspects at a tertiary care Hospital at Karachi <p><strong>Background: </strong>Various health problems occur due to alcohol consumption and particularly heavy drinking which contributes to a major burden of diseases globally.</p> <p>&nbsp;</p> <p><strong>Objective: </strong>To identify the investigative methodology carried out by medicolegal officer for the subjects’ evaluation who are brought by the Police in order to confirm the suspected consumption of alcohol.</p> <p><strong>Methods: </strong>In this observational cross sectional study, data related to the subjects who were evaluated for suspected intake of alcohol was analyzed. Statement of Police related to the reason for suspecting the alcohol consumption, subject’s statement who were accused, findings from the examination conducted by the medicolegal officer (MLO), particulars regarding the body fluids chemical evaluation, and conclusive final report of MLO was retrieved.</p> <p><strong>Study design: </strong>Observational Cross sectional study</p> <p><strong>Results: - </strong>In our study total 53 patients were included. All were male, with the mean age of 33.94<u>+</u>10.018 years. The most common age group involved was of 22 to 40 years. Most of the patients belonged to Karachi and Hyderabad and were 54.7% and 22.6% respectively. On chemical analysis, all of the patients were found to have alcohol in blood, while 10 (19%) were found to have alcohol in urine.</p> <p><strong>Conclusion: </strong>Significant correlation was found between the doubt of police regarding alcohol consumption of subjects and opinion of MLO which was based on clinical and laboratory findings. In usual cases, medicolegal officers do not operate under the standard operating procedures.</p> Dr. Iqbal Ahmed Khan Dr. Mir Ghulam Ali Talpur Dr. Naved Ali Qadri Dr. Syed Perwez Alam Dr. Hari Ram Hajrah Hilal Ahmed M. Jamaluddin Copyright (c) 2020-12-17 2020-12-17 25 3 137 143 Opinion of Parents Regarding Conjugate Typhoid Vaccine <p>Abstract</p> <p>Objective : To study the opinion of parents regarding conjugate typhoid vaccine .</p> <p>Method : 400 parents bringing their kids for vaccination were enrolled for the study at the vaccination clinic of The Karachi Adventist Hospital .A cross sectional survey was done from 18<sup>th</sup> November&nbsp; to 30<sup>th</sup> November 2019. All parents attending the vaccination clinic of the hospital with their children during the study period; and who met inclusion criteria were consecutively enrolled. A structured self -administered questionnaire was used to collect information from the parents.Parents whose infants are aged between 9 months to 15 years and mothers whose informed consent were obtained are included in the study.&nbsp; Data was analyzed using SPSS version 21.The Level of significance was set at P = 0.05 and 95% confidence interval reported where indicated.</p> <p>Result :Opinion of parents regarding new conjugate typhoid vaccine correlated positively with parental age and educational level. Our data showed that majority of the respondents knew the typhoid illness though 75.8% had heard of new conjugate typhoid vaccine . A small percentage believed certain myths and feared its side effects to their child/children . After effective cousnselling and health education , 95.3% agreed for the given vaccination .</p> <p>Conclusion : Our study showed encouraging opinion of majority of parents regarding new conjugate typhoid vaccine .Few parents &nbsp;have certain misconcepts and vague beliefs which were efficiently resolved by effective counselling regarding health education .</p> <p>&nbsp;</p> <p>Key Words: Parents,vaccination ,children,new conjugate vaccine</p> <p>&nbsp;</p> M.Hanif Memon Farhan Saeed Muhammad Iqbal Muhammad Athar Khan Erum Saboohi saboohi fatima Siraj fatima Siraj Copyright (c) 2020-12-17 2020-12-17 25 3 144 150 Effect of Exogenous and Endogenous Glucocorticoids on the Spermatogenesis of Albino Rats; A Comparative Study <p>Objective: The objective of the present study was to compare the earlier possible effects of exogenous and endogenous glucocorticoids on the spermatogenesis of albino rats.<br>Methods: This comparative study was conducted at Baqai Medical University in the Department of Anatomy from June till July 2016. Total of 96 adult Sprague rats were used in this study obtained from Agha Khan University; their ages were between 10-12 weeks and their weight ranged between 180-200 gms. Exogenous glucocorticoids were given through intraperitoneal route (i.p. route) at the dose of 1.2 mg/kg/body weight and for endogenous production of cortisol, they were kept in a plastic box daily which was thermostatically maintained at 44º C for 1 hour. They were divided into three main groups and the main group was further categorized into subgroups according to their number of days. The three main groups were; A (control), B (exogenous glucocorticoid), and C (endogenous glucocorticoid). They were sacrificed at the end of the experiment, testes were removed and the effects of exogenous and endogenous glucocorticoids on the spermatogenesis were observed under the light microscope in H&amp;E and PAS stained sections.<br>Results: Spermatogenesis was assessed by Johnsons scoring which ranges from 10 to 1. In the control group, complete spermatogenesis was observed with a Johnson's score of 10 while in group B and C scores were between 10-2 and 10-3, respectively.</p> <p>Conclusion: From the present study, we conclude that exogenous glucocorticoids cause earlier damage and effects all stages of spermatogenesis with decreased production of quality sperms. This animal study will help to decrease the infertility rate due to excessive and unnecessary use of glucocorticoids especially in the early years of life and by taking preventive measures when exposed to high temperatures.</p> Uzma Hameed Sadia Iqbal Fatima Rehman Aisha Hassan Ayesha Majeed Memon Sumera Mustafa Copyright (c) 2020-12-17 2020-12-17 25 3 151 157 Awareness regarding weaning and its associated factors among mothers in rural Sindh <p><strong>Objective: </strong>To determine the awareness regarding weaning and its associated factors among mothers in Kashmore, rural Sindh.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among infant’s mothers regarding awareness for weaning at Kashmore, a rural community in interior Sindh, from March 2108 to November 2018. The inclusion criteria were age of mothers 30 years or above and child’s age more than two years whereas mothers refusing to give verbal informed consent were excluded from the study. A total of 200 mothers were included in the study and were interviewed by using a questionnaire designed specifically for the study. Data were analyzed using statistical package for social sciences version 20 while Mann Whitney U test and Kruskal Wallis H test were used for inferential analysis. The study duration spanned over 9 months.</p> <p><strong>Results: </strong>The mean age of the mothers was 27.1 ± 6.3 years and the average number of children for every household was 2.4 ± 1.3. When participants were asked about what weaning foods should be given to assess their awareness, 176 (88.0%) mothers said bread or roti, 153 (76.5%) said yogurt, 144 (72%) said boiled rice, 133 (66.5%) said vegetables, 130 (55.0%) said suji or kheer, 95 (47.5%) said egg yolk while only 71 (35.5%) said fruits. The study results further showed that among the socio-demographic characteristics compared the mean awareness scores of the mothers were significantly different across categories of mothers’ education (p&lt;0.001), fathers’ education (p&lt;0.001), monthly household income (p&lt;0.001) and type of family (p=0.025).</p> <p><strong>Conclusion: </strong>Based on study results it can be concluded that certain socio-demographic factors influence the awareness of the mothers regarding the weaning of their children. Therefore any effort aimed at improving their awareness should take into account the factors identified in this study.</p> Ahsan Ali Dahani Syed Imtiaz Ahmed Jafry Syed Muhammad Zulfiqar Hyder Naqvi Munir Ahmed Shaikh Muhammad Zafar Iqbal Hydrie Muhammad Zahid Shah Copyright (c) 2020-12-17 2020-12-17 25 3 158 164 Assessment of Tuberculosis Related Knowledge, Attitude and Practices Among Final Year Medical Students in Karachi <p>Objective: To assess tuberculosis related knowledge, attitude and practice among final year medical students of Karachi.<br>Methods: A cross-sectional study was conducted in two medical colleges located in different districts of Karachi from January 2017 to June 2017. Being a final year medical student of the college was the inclusion criterion whereas refusal to give written informed consent was the exclusion criterion of the study. Data were collected on a structured questionnaire administered by the principal investigator to all the participants. Data collected were analyzed using SPSS statistical package version 20.<br>Results: Around two-thirds students knew that tuberculosis cannot be treated only on radiographic findings while a majority of them knew about the treatment regimens but knowledge about the different TB medicines and their side effects was variable. About 90% of the students believed that directly observed treatment short course therapy is effective while a similar number believed Bacille Calmette Guerin vaccination prevents tuberculosis. A fair number of students (63.1%) practice wearing of face mask while a majority (89.3%) of them reported that contagious patients should be isolated. Over 95% of the students stated that they give tuberculosis patients counseling and health education.<br>Conclusion: Majority of students had correct knowledge, attitude and practices regarding tuberculosis. Increased exposure and education to medical students in both academic and clinical settings is recommended.</p> Muhammad Zafar Iqbal Hydrie Syed Imtiaz Ahmed Jafry Haider Ali Shazia Sarwat Iqbal Copyright (c) 2020-12-17 2020-12-17 25 3 165 171 The Orthodontic retention protocol - A review <p>Orthodontics is the branch of dentistry which deals with malalignment of teeth and facial skeleton. The mechanics of fixed appliance therapy completely relies on retention of orthodontic appliance. Retention is the phase of&nbsp; Orthodontic treatment that attempts to keep teeth in corrected position after treatment with orthodontic braces. Without the phase of retention, there is a tendency for teeth to return to their initial position. Hence it is very necessary to prevent relapse. It depends on many factors. Every orthodontic patient should wear retention appliances to prevent relapse. This review article in detail discusses the protocol of retention and various factors affecting it.</p> <p>&nbsp;</p> abdullah Alnazeh Copyright (c) 2020-12-17 2020-12-17 25 3 172 181 Management of Placenta Previa with Accreta: A Case Series in Public Tertiary Care Hospital <p>Placenta previa with accreta is a rare cause of major obstetric hemorrhage resulting in maternal morbidity and mortality. A case series of 08 patients of placenta previa with accreta presented at Abbasi Shaheed hospital Gynecology unit 1 from January 2018 to December 2018. Seven (07) patients were delivered by Caesarean Section and one vaginally. In 05 patients placenta was left in situ and injection methotrexate was given. Removal of placenta during Lower Segment Caesarean Section (LSCS) and bilateral internal iliac artery ligation was done in 02 cases. Febrile illness occurred in 02 patients. One patient required laparotomy on fifteenth postoperative day due to uterine scar dehiscence. Two cases required obstetrical hysterectomy due to torrential hemorrhage. Conservative management in women with placenta previa with accreta has proven to be successful in carefully selected cases at tertiary care hospital with multi-disciplinary team.</p> Shaista Rashid Tazeen Fatima Munim Copyright (c) 2020-12-17 2020-12-17 25 3 182 185 Treatment with Twin-block appliance followed by fixed appliance therapy in a growing Class II Class II Div 1 patient – A case report <p>Intraoral examination revealed poor oral hygiene He was in late mixed dentition. He had Class II Div I malocclusion with excessive overjet</p> <p>Overjet 9mm ,Overbite: 8mm which is represent 100% of lower incisors overlapped by upper incisors ,<br>Mandibular to maxillary midline is deviated to the left by 2 mm. left Molars: full unit Class II , Canines: N.A Right Molars: 3/4 unit Class II , Mild crowdng upper : - 5 mm and lower : - 6 mm ,overlapped upper central incisors ,Proclined upper incisors .There was no transverse discrepancy . However, during TMJ evaluation, he did not report any muscle pain, joint pain, or other symptoms typically associated with temporomandibular disease.</p> Yahya Alsharani Copyright (c) 2020-12-17 2020-12-17 25 3 186 191 Polycystic Ovarian Syndrome: An Uncommonly Known Plight <p>Through this respected journal, I would like to bring the attention of the readers towards the level of awareness of Polycystic Ovarian Syndrome (PCOS) among the general public in Karachi. PCOS is a common endocrine disorder among women of reproductive age, diagnosed by the presence of menstrual irregularity, hyperandrogenemia, and multiple cysts in the ovary that is visualized on transvaginal ultrasound1</p> Tayyaba Ahmed Copyright (c) 2020-12-17 2020-12-17 25 3 192 193 PICTORIAL QUIZ Dr Sana Iqbal Dr Mehwash Kashif Copyright (c) 2020-12-17 2020-12-17 25 3 194 194