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An Early Experience of Stapled Hemorrhoidectomy in a Medical College Setting  [PDF]
Mushtaq Chalkoo, Shahnawaz Ahangar, Naseer Awan, Varun Dogra, Umer Mushtaq, Hilal Makhdoomi
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.65033

Background: Stapled hemorrhoidectomy, popularly known as Longo technique is in use for the treatment of hemorrhoids since its first description to surgical fraternity in the world congress of endoscopic surgeons in 1998. Objectives: To evaluate the feasibility, patient acceptance, recurrence and results of stapled haemorrhoidectomy in our early experience. Methods: Between Jan 2012 and Dec 2013, 42 patients with symptomatic GRADE III and IV hemorrhoids were operated by stapled hemorrhoidectomy by a single surgeon at our surgery department. The evaluation of this technique was done by assessing the feasibility of the surgery; and recording operative time, postoperative pain, complications, hospital stay, return to work and recurrence. Results: All the procedures were completed successfully. The mean (range) operative time was 30 (20 - 45) min. The blood loss was minimal. Mean (range) length of hospitalization for the entire group was 1 (1 - 3) days. Only 3 patients required more than 1 injection of diclofenac (75 mg) while as rest of the patients were quite happy switching over to oral diclofenac (50 mg) just after a single parenteral dose. All the patients returned to their routine work in less than a week’s time. The mean (range) follow-up was 6 (4 - 12) months. There were no major intraoperative or postoperative complications except for retention of urine in 8 patients. The patients are still on regular follow-up and have not had recurrence as yet. Conclusion: Stapled hemorrhoidectomy technique is a safe alternative to the traditional Milligan-Morgan technique. It can be performed as an office procedure, is well tolerated by patients and is cost effective than conventional surgical therapy.

Estimation of HCV viral load and liver enzymes among different patients groups of District Gujrat, Pakistan  [PDF]
Asim Mushtaq, Mujahid Azeem Tariq, Umer Rashid, Amber Afroz, Nadia Zeeshan, Abdul R. Asif, Muzna Zahur
Advances in Bioscience and Biotechnology (ABB) , 2013, DOI: 10.4236/abb.2013.49115

Hepatitis C has a 3% of the global disease burden that remains endemic in many regions of the world. According to a general statistical survey it has approximately 5.3% seroprevalence in Pakistan. HCV is a persistent and silent disease thus making the primary diagnosis complicated. Occasionally HCV positive population could not be diagnosed by routine HCV antibody testing therefore requires molecular diagnosis. This study is aimed to determine the prevalence of HCV and to estimate the HCV viral load by quantitative analysis among different patient groups of District Gujrat, Pakistan. A total of 597 samples were collected from clinically diagnosed liver patients that were categorized into three age groups: 1) up to 25 years; 2) 26-50 years 3) above 50 years. All samples were subjected to real time PCR for determination and quantification of HCV RNA. Activity of liver aminotransferases was measured. The overall prevalence of HCV-RNA was 73.87%. Females had slightly higher HCV prevalence which is 74.06% while 73.45% in males. Highest prevalence of active HCV infection was found in age group 26-50. In addition, liver function tests showed that 28.12% HCV-positive patients do not have elevated ALT level whereas 32.65% did not show elevated AST levels. It may be assumed that there is not a significant relationship between increased viral load and liver amino transferases. The study concluded a significantly higher rate of HCV infection in young population. Moreover screening with antibody and liver function tests alone does not exclude the possibility of HCV infection.

A Prospective Study of Cholilithiasis in Children  [PDF]
Raiees Ahmad, Alfer Nafae, Shahnawaz Bashir, Pervaze Salam, Qayoom Khan, Malik Suhail, Umer Mushtaq, Javid Ahmad
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.63024

Background: Gallstones are generally uncommon in infants and children. Formation of gallstone is a very poorly understood phenomenon. In general, the risk factors for cholithiasis in infants include patients who are ill, are receiving hyperalimentation, are premature, have congenital anomalies and have necrotizing enterocolitis. Children aged 1 - 5 years most frequently have hemolysis as the underlying condition [1]. Materials and Methods: From Jan 2012 to Feb 2014, a study entitled “A Prospective Study of Cholelithiasis in Children” was conducted in Postgraduate Department of General Surgery Govt. Medical College Srinagar. The patients selected for the study were in the age group of 1 to 14 years of either sex. There were a total of 141 cases, out of which only 38 had ultrasound documented gallstones. All the patients included in the study were evaluated for prevalence, clinical presentation, and pathological features of gallstones, and were analysed for metabolic causes of gallstones. Results: The prevalence of chliothiasis in symptomatic patients was found to be 26.95% higher than the prevalence of gallstones in children in other parts of world, also the mean age of presentation was 9.3 years ranging from 6 - 14 years. Male to female ratio was 3:2 and male predominance was found in all age groups contrary to female predominance in adults. Most common presenting symptom was right upper quadrant pain followed by vomiting and nausea similar to presentation of symptomatic gallstones in adults. 4 patients had a positive family history of cholithiasis in the first degree relatives; 25 (65.7%) patients had no underlying risk factor for gallstones contrary to presumption that gallstones in children are mostly secondary to some hematological disorder or other predisposing factors. Chronic cholecystities was found in 81% of patients with gallstones and composition of gallstones retrieved was different from those of adult gallstones with calcium carbonate gallstones relatively common in children but composition of black and brown stones was almost similar to adult stones. Conclusion: Gallstone disease was increasingly gaining recognition in peadiatic practice due to significant documented increase in non-heamolytic cases

Open Underlay Mesh Reinforced Large Incisional Hernia Repair—Prospective Observational Hospital Based Study  [PDF]
Umer Mushtaq, Ishfaq Ahmad Gilkar, Javid Ahmad Peer, Shaukat Jeelani, Asgar Aziz, Farzanah Nowreen, Yaser Hussain Wani, Yaqoob Hassan, Drjavidahmad Peer
Surgical Science (SS) , 2019, DOI: 10.4236/ss.2019.103013
Introduction: Incisional hernias frequently complicate abdominal surgeries with a varied incidence as reported to be 2% - 20%. The risk factors of development of incisional hernias include immunocompromised state, diabetes mellitus, smoking, obesity, wound infection at the index surgery, emergency surgery. Materials and Methods: The study design was prospective and included 62 patients with incisional hernias. The patients were evaluated preoperatively on OPD basis with history, clinical examination, baseline investigation, ultrasound abdomen and computed tomogram. Results: The mean age was 48.9 years with male:female ratio of 1:1.4. Mean BMI was 30.1 kg/m2. Out of 62 patients in the study 61.2% had concomitant hypertension and were on treatment for the same. 30.6% were clinically hypothyroid, 38.7% were diabetic and 54.8% were smokers. There were multiple factors present in patients in the current study which were observed to be possible to have risked the patients to incisional hernias after an abdominal surgery. 21 patients had defect size ranging from 5 to 10 cm and 41 patients were bearing a hernia of the defect size of 10 cm or more. The mean operative time was 221.7 minutes. Conclusion: Incisional hernias are a part of surgical practice that would probably glue to it to the end of time. A progression from primitive suture repair with recurrence rates of over 65% to modern day mesh reinforced repairs with recurrences aimed at 0% is always welcome. But still then the placement of mesh in different positions or layers of abdominal wall yields different results.
Effect of Administration of Withania somnifera on Some Hematological and Immunological Profile of Broiler Chicks
Muhammad Mushtaq*, F. R. Durrani, N. Imtiaz, Umer Sadique1, A. Hafeez, S. Akhtar2 and S. Ahmad3
Pakistan Veterinary Journal , 2012,
Abstract: This study was conducted to assess the performance of broiler chickens based on some hematological and immunological profile, upon inclusion of aqueous extract of Withania somnifera (W. somnifera) in their drinking water. For this purpose, 240 a-day-old broiler chicks were purchased from a local hatchery and divided into four groups i.e. WST-0, WST-I, WST-II and WST-III. Group WST-0 was kept as control, while chicks in group WST-I, WST-II and WST-III were offered in their drinking water with an extract of W. somnifera at 10, 20 and 30g/L for 35 days, starting from day 1 of age. Feed intake and body weight were recorded on regular basis and hematological and immunological profile of the birds was analyzed at the end of experiment. Administration of W. somnifera extract resulted in significantly higher feed intake and body weight of birds in all treated groups. An increase in the values of Hb, PCV and TLC was noted in the treatment groups. A non significant difference was noted in the counts of neutrophils, lymphocytes, eosinophils and monocytes in all treatment groups as compared to control. Antibodies titers against IB and IBD were significantly higher in all treatment groups as compare to the values shown by the chicks in control group. Findings of this study indicated that administration of W. somnifera extract to broiler chicks improve their feed intake, body weight gain, hematological profile and immunological status.
Pathogenesis and Immunohistochemical Studies of Caprine Pleuropneumonia in Experimentally Infected Goats
Umer Sadique*, Zafar Iqbal Chaudhry1, Muhammad Younus Rana2, Aftab Ahmad Anjum3, Zahoor-Ul-Hassan, Abdul Sajid and Muhammad Mushtaq
Pakistan Veterinary Journal , 2012,
Abstract: This study was designed to evaluate the pathogenesis of caprine pleuropneumonia (CPP) in the experimentally inoculated goats with Mycoplasma mycoides subspecies Capri (Mmc). For this purpose, 12 goats (Group B) were inoculated with bacterial isolates of Mmc while four goats were kept as untreated control (Group A). Clinical signs of the disease were recorded twice daily. Two goats from group B were sacrificed on weekly basis to demonstrate gross pathological lesions in different organs. Tissue samples from lungs, trachea, liver, heart, kidney, spleen, and small intestines were preserved for histopathological studies. The lungs and lymph nodes were preserved to demonstrate the antigen in tissue by using immuno- histochemical technique. The disease was successfully reproduced in all infected goats with severe manifestation. The clinical signs and gross lesions of the disease were mild at the beginning and became severe at the third and fourth weeks and then progressed to moderate and chronic forms. The histopathological lesions characteristic of CPP were found in all the organs. Antigen of Mmc was detected in tissue sections of lungs and lymph nodes. In conclusion, the disease was efficiently reproduced in experimental animals that showed acute septicemic form with lethal outcome.
Clinical Presentation and Outcome of Bacterial Meningitis in University Hospital  [PDF]
Maimoona Mushtaq Ahmed
Advances in Infectious Diseases (AID) , 2014, DOI: 10.4236/aid.2014.43019

Purpose: To determine the clinical characteristics and outcome of bacterial meningitis in adult patients using CT, MRI and CSF culture. Methods: Patients admitted to the university hospital with clinical diagnosis of meningitis were included in the present study. All patients were subjected to clinical examination as well as CT, MRI scanning and CSF-bacteriological culture. Results: The age distribution of the patients shows that there is high frequency of symptoms found in the age group between ages 40 - 45. CSF in the present study included WBS, RBC, glucose and protein, which is associated with the adverse outcome. Meningitis can be confirmed by many methods, in the present study three different methods were used, which included CT scan, MRI and CSF analysis and bacterial culture. In CT scan, among the predictors of meningitis, persons with TB (P = 0.037), patients with HIV (P = 0.036) and stroke (P = 0.036) showed significant association. Whereas MRI findings were significantly associated with TB meningitis (P = 0.015). Meningitis was prevalent in the age group of <45. Conclusion: This study highlights the importance of several modalities for diagnosing and predicting the outcome of meningitis in adults.

Expanding public health professionals’ roles in promoting and supporting breastfeeding as optimal infant feeding: A pilot study with online tutorial implications  [PDF]
Amna Umer, Roger A. Edwards
Open Journal of Preventive Medicine (OJPM) , 2013, DOI: 10.4236/ojpm.2013.32025

Background: Their knowledge of preventive health, coupled with their dynamic roles in the community, puts public health professionals in a key position to expand their roles in the health promotion and support of breastfeeding as optimal infant feeding. This online tutorial was created to increase public health professionals’ knowledge about breastfeeding and to assess their attitudes in supporting healthy behaviors related to infant feeding as a health promotion strategy. Method: The study utilized an online breastfeeding tutorial based on the US Breast-feeding Committee recommendations for minimum breastfeeding knowledge for health professionals. Pre- and post-tutorial questionnaires assessed breastfeeding knowledge, and an attitudinal survey evaluated attitudes of public health professionals after the tutorial. Exposing public health students to this information can facilitate the early shaping of their attitudes and understanding about the importance of breastfeeding. Results: Fifty-two Northeastern University MPH students and alumni (62% response rate) completed the study. There was an overall gain in participants’ fundamental knowledge regarding breastfeeding as assessed by pre- (77%) to post-tutorial (97%) correct responses (p = 0.00001). The post-tutorial attitudinal survey showed that 92% of participants were comfortable in answering questions about breastfeeding as part of their professional responsibilities. Conclusion: This pilot study highlights the important role that a short online tutorial can play in expanding public health professionals’ knowledge about breastfeeding. Greater use of online methods can enhance awareness of critical health behaviors, such as breastfeeding, that have not received adequate attention in public health curricula. This pilot study provides the foundation for a larger study. Integration of breastfeeding into public health professionals’ core training could support broader social change.

Walnut Trim down Lipid Profile and BMI in Obese Male in Different Ethnic Groups of Quetta Population, Pakistan  [PDF]
Rehana Mushtaq, Rubina Mushtaq, Sobia Khwaja, Zahida Tasawar Khan
Food and Nutrition Sciences (FNS) , 2013, DOI: 10.4236/fns.2013.410139

A total of 64 male obese subjects were randomized to observe the effect of 40 g of walnut in daily breakfast on lipid profile and Body Mass Index (BMI), total Cholesterol (CHO), Triglyceride (TG) High Density Lipoprotein (HDL) cholesterol and Low Density Lipoprotein (LDL) cholesterol in obese male subjects of various ethnics i.e. Baloch (B), Pathan (P), Hazara (H) and Punjabi (PU) residing in Quetta region of Balochistan for this purpose four weeks controlled study was designed. A batch of 32 obese male subjects 8 from each ethnic group as a control and another batch of 32 obese males 8 from each ethnic group as treated were selected. Twelve hour fasting blood samples a day after stoppage of walnut were taken from obese control and obese treated subjects. Daily walnut consumption in obese male subjects evidently demonstrated reduced BMI in all ethnic groups. Walnut supplementation in obese exhibited significant reduction in cholesterol level in Baloch (P < 0.001) and Punjabi (P < 0.01) males. There was profound and statistically significant [B (P < 0.05), P (P < 0.05), H (P < 0.01) and PU (P < 0.05)] elevation in HDL-C in all male ethnic groups. In male sub-population LDL-C was significantly [P (P < 0.01), H (P < 0.001) and PU (P < 0.05)] reduced in these groups. In these subjects walnut supplementation showed pronounced reduction [B (P < 0.001), P (P < 0.05), H (P < 0.001) and PU (P < 0.001)] in triglyceride levels. The constructive influence of walnut on lipid profile suggests that walnut rich diet may have advantageous effects beyond changes in plasma lipid level.

Study of Serum Cholesterol Level in Adult Obese Population of Karachi, Pakistan  [PDF]
Rubina Mushtaq, Rehana Mushtaq, Ambreen Akram, Sobia Khwaja, Shabbir Ahmed
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2014, DOI: 10.4236/ojemd.2014.411024

Background: The present study was planned to investigate the level of cholesterol in obese/non-obese (normal) individuals according to their body mass index (BMI) and age in different population residing in Karachi. Aim: Comparison of serum cholesterol values of obese with normal subjects and comparison of BMI of obese and normal individuals. Methods: Selection of obese subjects was according to the WHO (1998) criteria. A total of 40 subjects 18 - 55 years of age participated in the study, among which 30 subjects (Mean Age = 29.47 ± 1.99) were obese (Mean BMI = 35.41 ± 0.878) and 10 were controls with Mean age = 21.00 ± 0.547 and BMI = 19.96 ± 0.432. An overnight fasting blood sample was obtained and serum total Cholesterol (T-CH) level was estimated. Results: Obese persons having Mean T-CH = 202.6 ± 14.3 and controls having Mean T-CH = 173.3 ± 14.0. The data were further divided into males and females. Obese females were 11 with their BMI 31.836 ± 0.21, mean age ranged at 28.73 ± 4.04 and T-CH 191.8 ± 21.8, while that of control females were 6 in number with their BMI ranged at 19.183 ± 0.507, age 21.000 ± 0.894 and Cholester 148.7 ± 16.0 in controls. Total numbers of obese males were 19 with their BMI ranged at 37.49 ± 1.14, age ranged at 29.89 ± 2.19 and cholesterol level ranged at 208.89 ± 19.1. Control males were 4 in number with their BMI ranged at 21.125 ± 0.075, age 21.250 ± 0.479 and their T-CH 128.7 ± 8.72. Conclusion: The results of current study have reflected that BMI and total cholesterol concentration are higher in obese subjects.

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