Year 2020, Volume 36 - Issue 1

Open access Letter to the Editor | March 31, 2020
A Nuclear Magnetic Insight Towards the Cytostatic Potential of Medicinal Plant Extracts Replay to Al Wihibi et al Biomedica 2019;35(4):203-209

Alexander A Bukhvostov, Kirill V Ermakov, Dmitry A Kuznetsov

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Cytostatic activities of water and organic extracts prepared from medicinal higher plants including Ducrosia anethifolia should be analyzed by taking into account the “hidden” magnetic isotope effects of stable metal isotopes (25Mg, 43Ca, 67Zn …) pre-(bio) fractionated in the plant tissues. A multi-collector inductively coupled plasma mass spectrometry (MC – ICPMS) might be successfully employed to reveal and detail this specific peculiarity for further pharmacological applications.

Open access Case Report | March 31, 2020
Viable Caesarean Scar Pregnancy: A Case Report

Saima Najam, Sumaiyya Ejaz Malik, Shehla Aqeel, Nida Rizwan, Ali Raza Haider

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Ectopic pregnancy is a pregnancy in which blastocyst is implanted at a site other than the endometrium. When it is partially or completely implanted with in the scar it is known as caesarean scar ectopic pregnancy (CSP). It is a very rare form of the ectopic pregnancy and most of the literature available is in the form of case reports and case series. In the succeeding report of a case, a 31 years old gravida-4 para-2 with one miscarriage and one caesarean section presented in emergency department with the amenorrhea of 9 weeks and 5 days. She had moderate abdominal pain and vaginal bleeding. After in-patient evaluation she 
was diagnosed of having viable CSP, necessitating termination of pregnancy. The challenge after the diagnosis was to remove the CSP and retain future fertility without increasing the morbidity. Uterine artery embolization (UAE) followed by the laparotomy and excision of the ectopic pregnancy was carried out to reduce the risk of the hemorrhage. Early and accurate diagnosis is the key and should be followed by individualized prompt treatment in expert hands. A multidisciplinary approach is essential to reduce the overall morbidity and help retaining the future fertility of the patient.

Open access Review Article | March 31, 2020
Herbal Medicines: An Adjunct to Current Treatment Modalities for Periodontal Diseases

Ghazala Hassan, Sarah Ghafoor

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Periodontal disease is one of the most common diseases affecting oral health causing alveolar bone loss, tooth loss and bad breath with much prevalence in the age group of 35 – 44 years. Remedies such as toothpastes and mouthwashes are available in the market for its cure however; these are associated with side effects such as tooth staining by chlorhexidine-based mouthwash and altered taste sensation. Excessive use of mouthwashes also alters the normal biological flora of the oral cavity. Therefore, herbal alternatives for the cure of periodontal disease may be of an effective therapeutic significance with less side effects on oral and systemic health. This review summarizes the effective role of herbal medicaments such as Acacia nilotica (gum Arabic), Aloe barbadensis (Aloe Vera), Salvadora persica (Miswak), Eugenia caryophyllata (Clove), Nigella sativa (Kalonji), Azadirachta indica (Neem) and Propolis resin (Bee Glue) in the treatment of periodontal disease, thus emphasizing the current need of herbal medicines as better alternatives.

Open access Original Article | March 31, 2020
Effect of Carbonated Drinks on Uterine Development-An Experimental Study

Dr Gong Zhuandi, Professor Wei Suocheng, Wei Limin, Liang Haoqin, Lai Luju

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Background and Objective: Consumption of Coca-cola and Pepsi-cola has harmful impact on human health. Currently, scant data is available regarding effects of carbonated beverages on female reproductive system. This study was aimed to investigate the effects of carbonated beverages on uterine development and expression of follicle stimulating hormone receptor in mice model. 
Methods: A total of 150 female Kunming mice weighing 20.36 ± 2.28 gm. were divided into five groups with  30 mice in each group. Groups COC-1 and COC-2 mice were given 50% and 100% Coca-cola per oral respectively for 25 days. Groups PEP-1 and PEP-2 mice were given 50% and 100% Pepsi-cola per oral respectively. Control group (CG) mice were given tap-water per oral. Western blotting was done to  ascertain the levels of Follicle Stimulating Hormone Receptor (FSHR) protein in ovaries. Follicle  Stimulating Hormone (FSH) levels were measured by ELISA kit.
Results: The weight of uterus in the groups COC-2 and PEP-2 was lower than that of CG. Uterine wall and  uterine cavities were slightly decreased in Coca-cola and Pepsi-cola groups compared to CG. Uterine mucus was ruffled. Uterus wall thicknesses (UWT) were reduced. In comparison with CG, FSHR protein levels in  COC-2 and PEP-2 groups were reduced by 21.14% and 22.80%. Serum FSH levels of COC-1, COC-2 and  PEP-1 were less than that of CG. Body weights of the one-week-old mice from COC-2, PEP-1 and PEP-2  groups were increased in COC-2 and PEP-2 groups in comparison with CG (P < 0.05).
Conclusion: Oral ingestion of Coca-cola and Pepsi-cola for a longer duration reduces uterine weight, affects the uterine histology and inhibits the uterine development. reduced expression of FSHR protein may be  linked with reduced growth and development of new born mice.

Open access Original Article | March 31, 2020
Effect of Garcinia Cambogia Containing Co;mmercially Avaible Weight Reducing Agent on Morphology of Hepatocytes An Experimental Study

Ponum Mirani, Gulafshan, Agha Nadeem Ahmad, Jazib Andleeb, Faiza Mehboob, Naveed Akhter

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Background and Objective: Obesity is the adverse outcome of modern living which has affected both the physical and mental health. Slim Smart and Ultra Slim Plus are the most frequently purchased over the counter products by desperate obese persons in Pakistan having Garcinia cambogia (GC) as the main active ingredient. This study is conducted to determine the effect of GC containing Slim Smart and Ultra Slim Plus drugs on the morphology of hepatocytes in male albino mice.

Methods: Ninety albino mice were divided into control group A, experimental groups B and C receiving Slim Smart and Ultra Slim Smart respectively. Each group was further divided into subgroup I and II and the drug was administered to experimental groups for 4 and 8 weeks respectively via oral gavage. After the completion of experiment, histological examination of liver was conducted.

Results: Marked enlargement of hepatocytes was observed in experimental groups B and C (both I & II) along with ballooning degeneration and fatty change in the cytoplasm.

Conclusion: Both Slim Smart and Ultra Slim Plus has hepatotoxic effects resulting in increase in hepatocyte size, ballooning degeneration and fatty change in liver cells. 

Open access Original Article | March 31, 2020
Spectrum of Breast Lesions on Fine Needle Aspiration Cytology in Punjab

Khalida Ahtesham, Bushra Nisar, Tahira Tabassum, Ambereen Anwar Imran

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Background and Objectives: Breast lumps can be diagnosed in a short time by fine needle aspiration cytology (FNAC). Moreover, being cost effective, it is rendered the first choice by surgeons and patients.This study was carried out to outline the spectrum of breast lesions on FNAC in patients presenting with breast lumps in two tertiary care teaching hospitals of Punjab.
Methods: A cross sectional descriptive study was conducted from January, 2018 to October, 2019.
Hundred cases of lumps in breast were taken from Sahara Medical College and Sughra Shafi Medical Complex, Narowal and Lahore General Hospital, Lahore. Cytological diagnosis was made and correlated clinically and histologically. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 24.0 and expressed as frequency and percentages.
Results: Majority (58%) of cases were Class-2 smears on cytology while 11% were malignant and
belonged to Class-5. Among the benign lumps, fibroadenoma was the most common (55.1%) followed by fibrocystic disease (17.2%) and acute mastitis (12%). Thirty-one cases were in grey zone i.e. Class-3 smears showing atypia and Class-4 smears that were suspicious of malignancy.
Conclusion: By screening patients with lumps in breast, early and effective management can be made possible. Class 3 and 4 smears should be confirmed with excision and biopsy of the lump for conclusive diagnosis.

Open access Original Article | March 31, 2020
Tuberculous Mastitis in Females of South Punjab: A Clinicopathological Analysis of Ten Years from Pakistan

Afra Samad, Aqsa Ashraf Bukhar, Safia Sartaj, Nudrat Fayyaz, Naseem Akhter, Namra Naeem, Muhammad Ejaz Alam, Muhammad Imran Arshad

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Background and Objective: Extrapulmonary tuberculosis occurring in breast is a rare disorder in West but is still present in developing nations where tuberculosis is endemic. Tuberculous Mastitis (TM) is difficult to diagnose as it has vague clinical symptoms and insufficient radiological findings. The objective of this study was to determine the frequency of tuberculous mastitis by accessible modalities for early diagnosis.
Methods: After the Institutional Ethical Board approvals, Pathology laboratory archives and medical records of 5000 patients from Ibn-e-Sina Hospital Research Institute, Multan and Multi Test Laboratory, were retrieved from the year 2008 to 2018. A retrospective analysis of fine needle aspiration cytology (FNAC) results of patients who presented with breast lumps was carried out. The interpretation of cytological findings and Ziehl Neelsen stained smears was carried out by cytopathologists and microbiologists respectively. Mycobacterium DNA was detected using polymerase chain reaction (PCR) in selected cases.
Results: Out of 5000 patients, tuberculosis was diagnosed in 264 (5.28%) cases on FNAC. Acid fast bacilli (AFB) positive smears were found in 79.5%patients while 20.45% cases were AFB negative. Among AFB negative smears, 38 cases were further analyzed by PCR, among which 32 (84.2%) cases showed PCR positive results for TM. An increased frequency of TM among all inflammatory breast lesions from 18% in 2008 to 47.19% in 2018 was observed.
Conclusion: Tuberculous Mastitis is an uncommon form of extra-pulmonary tuberculosis. It has non- specific clinical, radiological and varied histological findings that often mimic breast abscess or carcinoma. FNAC is essential to guide the patient to further tests including histochemistry and PCR that can be used as more sensitive and time effective detection modalities.

Open access Original Article | March 31, 2020
Comparison of Haemonetics MCS Plus and Baxter CS 3000 Plus for Platelet Apheresis: Experienceat a Tertiary Care Hospital

Asma Saadia, Tahir Naeem, Saad Jamal-ud-Din Alvi, Majid Ali, Toqeer Ali Butt

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Background and Objective: Platelet transfusion is one of the most crucial therapeutic approaches in medicine. Single Donor Platelets (SDP) are being preferred because of higher platelet count per unit,leukocyte reduction during collection and fewer donor exposures thus reducing the risk of infection and alloimmunization. This study was conducted to compare Haemonetics MCS plus with Baxter CS3000 plus cell separator in terms of processing time, quality of platelet concentrates, donor experience and individual choice.
Methods: Two hundred platelet pheresis procedures performed on Haemonetics MCS plus during a period from January 2018 to August 2019 were compared with the same number of procedures performed using Baxter CS3000 plus cell separator from July 2015 to April 2019.
Results: The mean platelet count of the product was higher with Baxter, 1741.6 ± 347 x 103/μL as
compared to1676 ± 301 x 103/μL with Haemonetics. No significant difference between the two instruments was observed regarding processing time, product volume and yield.
Conclusion: The two instruments are comparable in terms of time, volume and yield of the product but Haemonetics is better because of donors’ comfort and for being operator friendly.

Open access Original Article | March 31, 2020
Utility of Cell Block in Diagnosis of Serous Effusions in Comparison with Conventional Cytological Smears

Nosheen Khurram, Imran Yousaf, Noshin Wasim Yusuf

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Background and Objectives: Diagnostic issues arise in everyday practice to reach a conclusive diagnosisafter cytological evaluation of smears. This study was designed to determine the diagnostic accuracy of cell block technique by comparing with conventional cytological smears in cytopathological diagnosis of serous effusions.
Methods: This study of diagnostic accuracy comprising of one hundred clinically and radiologically proven cases of pleural and peritoneal effusions was conducted in the Department of Pathology, Rashid Latif Medical College Lahore over a period of one year (January 2018 to January 2019). Non-probability, purposive sampling technique was used. Diagnostic accuracy of conventional cytological smear and cell block was compared using histopathology as gold standard.
Results: The sensitivity, specificity, positive predictive value and negative predictive value of conventional cytological smear and cell block method was 78.40%, 69.20, 87.90%, 52.90%, and 94.6%, 88.5%, 95.90%, 85.20% respectively. Diagnostic accuracy of cytological smears was 76% as compared to 93% of cell block method.
Conclusion: To reach a conclusive diagnosis for cytological evaluation of effusion, cell block analysis is mandatory step in addition to conventional cytological methods especially in smears that remain suspicious or inconclusive on routine cytology.

Open access Original Article | March 31, 2020
Determination of Knowledge of Caregivers about Dietary Practices of Autistic Children

Maryam Yaseen, Bahisht Rizwan, Iqra Gulzar, Ramsha Khalid, Sheza Tanveer, Zoya Abid, Sana Farooq

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Background and Objective: Autism belongs to a complex neurodevelopmental disorder. The lack of knowledge about dietary practices of autistic caregivers is perceived as the triggering factor of ‘Autistic Spectrum Disorder (ASD). In this particular ‘Knowledge, Attitude and Practice (KAP) Survey’ the knowledge (K) of nutrition, attitude (A) of children towards such nutrition and dietary practices (P) among the caregivers of autistic children. The pre-testing and post-testing for knowledge has been observed. Theknowledge questionnaire was designed to facilitate the caregivers to determine their knowledge regarding the dietary patterns of autistic children.
Methods: This quasi-experimental study comprised of 50 caregivers (particularly mothers, and fathers in a few instances) of autistic children enrolled at Amin Maktab Center for Special Education Lahore. The nutrition education program was developed and participants were enrolled. Analysis of the change in knowledge, attitude and practice of autistic caregivers through pre-testing and post-testing at a gap of four months was carried out using statistical tests.
Results: The pre-testing and post-testing phase of the study revealed significant improvement in (a) basic knowledge about nutritional needs of autistic children (22% vs. 100%), (b) practicing patient-tailored special diet (34% vs. 92%) and (c) resolution of food allergies (62% vs. 16%) in autistic children. The most important benchmark in this regard was Body Mass Index (BMI) of children where deranged BMI improved significantly (p = 0.000) to normal BMI in pre- and post-testing phases.
Conclusions: Lack of knowledge is higher among aforementioned caregivers of concerned autistic children. Adoption of nutrition education programs by anutistic caregivers helps in creating optimal knowledge, attitude and practices regarding nutritional needs of autistic children for effective targeted behavior and management.

Open access Original Article | March 31, 2020
Validation of Urdu Translation of DREEM Inventory in a Medical College of Lahore

Meher-un-Nisa, Junaid Sarfraz Khan

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Background and Objective: Measurement of learning environment is a big challenge in medical education due to complex nature of educational environment such as interaction between students and teachers, learning venue, use of multimedia and other modalities. Introduced in 1997, Dundee Ready Educational Environment Measure (DREEM) is claimed to be a cultural free tool to measure educational environment at undergraduate level. DREEM has been translated and validated in different languages but no study has reported DREEM translation and validation in Urdu Language. This study was carried out to determine validity of Urdu translation of DREEM inventory at an undergraduate medical college in Lahore.
Methods: This cross-sectional study was carried out at University of Health Sciences Lahore and Fatima Jinnah Medical College Lahore over 2 years (2015-2016) after approval by Institutional Review Board of University of Health Sciences Lahore. Data was collected from 325 undergraduate students using survey method. Urdu translation of DREEM was done by two experts using computer program in page Urdu 2013. Firstly, DREEM questionnaire in English was filled by the participant students. After two weeks, DREEM questionnaire in Urdu was filled by the same students. The DREEM scores in English and Urdu were comparedby applying paired t-test.
Results: There is no significant difference (P > 0.05) between the DREEM scores in English and Urdu. Thereliability index between 0.7-0.9 was recorded.
Conclusion: DREEM Inventory has the same validity in Urdu at undergraduate level as in English.

Open access Original Article | March 31, 2020
Overview of Breast Conservative Treatment for Early Breast Carcinoma: Experience at Sir Ganga Ram Hospital Lahore

Andleeb Khanam, Afzal H, Farooq N, Aslam H, Abbas M

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Background and Objectives: Treatment of early breast cancer involves surgery, chemotherapy and radiation therapy. Present study was designed to describe the cosmetic outcome, prognosis, recurrence rate and complications after breast conservative surgery in patients with early breast carcinoma.
Methods: A descriptive study was carried out at Surgical Unit III of Fatima Jinnah Medical University (FJMU), Lahore, Pakistan. A total of 54 female patients diagnosed with early breast carcinoma were included from July 2015 to January 2019. All of these patients underwent breast conservative surgery with axillary level II dissection or sentinel lymph node biopsy. Frozen section technique was used to evaluate clear surgical margins per operatively. These patients were followed up for a period of 12 months.
Results: Mean age of the patients was 49.6 ± 11.3 years. Stage I disease was found in n = 17 (31.5%) females while stage II in n = 37 (68.5%) patients. Most of the patients had invasive ductal carcinoma. Tumor free surgical resection margin status was 1mm-20mm and it was >10mm in 32 (59.3%) patients. Post-operative good cosmetic outcome regarding symmetry of the breast (90.7%), shape of the breast (85.2%), shape of nipple (88.9%) and appearance of scar (81.4%) was observed. A total of 40 (74.1%) patients were satisfied with symmetry of breast, 41 (75.9%) patients were satisfied with shape of breast and 45 (83.3%) patients were satisfied with appearance of scar after breast conservative surgery through a validated questionnaire. Complications noted after the surgery were seroma in 1 (1.8%) and wound infection in 2 (3.7%) patients. Post Radiation oedema was seen in 44 (81.5%) and ulcers were seen in 6 (11.1%) patients. Local recurrence was developed in 2 patients (3.7%). Disease free survival was observed
in 52 patients (96.3%).
Conclusion: Breast conservative surgery for early breast carcinoma is cosmetically good regarding the scar
and shape of the breast after surgery and satisfactory for the patients to accept. There were minimal
postoperative complications and low recurrence rate therefore breast conserving surgery in early breast
carcinoma can safely be recommended for early breast carcinoma.