Year 2020, Volume 36 - Issue 3

Open access Editorial | September 30, 2020

Additional Charge to University Faculty - Is There a Way to Stop the Rot or is Continued Decline Inevitable?

Nadia Naseem

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Quality assurance in education is a critical process that includes promoting innovation in teaching, research and scholarship including, but not limited to, novel uses of technology to enhance in-person teaching and learning, with subsequent continuous quality improvement. The development, collection and analysis of appropriate performance metrics, and building a culture of excellence in teaching and research that rewards the best and supports the rest, stipulates as obligatory for every higher education institution working in public or private sector.

Open access Review Article | September 30, 2020
Application of Ribonucleic Acid (RNA) in Forensic Sciences

Muhammad Jawad, Saadia Noreen, Muhammad Faheem Ashraf, Maryam Asif, Hafiza Misbah Asif, Saqib Ali, Allah Rakha

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Forensic science has been helping law enforcement agencies in better understanding and presenting the evidence in the court of law. In certain situations, when conventional forensic methods of investigations cannot make better conclusions with more specific accuracy, then molecular techniques do help in reaching the acquired accuracy in the results regarding the identification of evidence. Advanced molecular techniques, which are using Deoxyribose Nucleic acid (DNA), Ribose Nucleic Acid (RNA), and protein molecules to produce forensically important information from the samples recovered at the crime scene. DNA can only distinguish among individuals but is unable to discriminate the type of samples originated from the same sample. For this RNA has become a molecule of interest for its different levels of expressionin different cells/tissues of an individual. RNA molecules of different types are being used to build up models for several purposes (injury-age, new-born age, molecular cause of death, etc.). Modern techniques like Real-time Polymerase Chain Reaction (PCR) and Microarray are being used for the detection of RNA molecules of interest both in the form of its abundance and as a unique molecular detection. This script will help in understanding the importance of RNA application in forensic sciences by providing an overview of the research done to date and the techniques being used for this purpose.

Open access Case Report | September 30, 2020
Ovarian Mature Cystic Teratoma Combined with Mucinous Boderline Tumor-A Case Report with Literature Review

Lixin Wang, Gang Chen, Jingui Jiang

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Mature ovarian cystic teratoma with co-existing mucinous borderline tumor is an extremely rare finding in literature. Here, we report a case of bilateral mature cystic teratoma of the ovary with mucinous borderline tumors and intraepithelial carcinoma in a very young, 26-year-old female. The case was diagnosed histologically through immunohistochemical support. The biological behavior of mature ovarian cystic teratoma with mucinous borderline tumor is between those of benign and malignant tumors, having low malignant potential. Since the patient had given birth to a child, a radical operation was performed and no 
tumor recurrence was observed after one year follow-up.

Open access Original Article | September 30, 2020
Hepatitis B Virus (HBV) Immunity Status of Laboratory Staff Working at a Tertiary Care Hospital in Lahore: An Interventional Study

Tahir Naeem, Maryam Riaz Tarar, Asma Saadia, Mariam Danish Iqbal, Muhammad Ebrahim Naeem, Sana Tariq

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Background and Objective: Hepatitis B virus (HBV) infection is one of the common chronic viral infections worldwide. The World Health Organization (WHO) had estimated that only a minority are aware of their status and still a fraction of the diagnosed cases were receiving treatment for their ailment.Theaverageburden of disease in Pakistan is about 3.3%. The incidence may appear lower among the healthcare workers (HCWs) as compared to blood donors, but HCWs are at increased risk to acquire the HBV infection and the risk is even greater for laboratory personnel. This risk can be minimized by offering
them the vaccination.
Methods: Blood samples from all categories of staff in the laboratory were tested for hepatitis B Surface Antibodies (HBsAb). Those foundnon-immune were offered recombinant hepatitis B vaccine by intramuscular (I/M) injections. The results were tabulated by entering age/sex of the laboratory staff with HBsAb level. Blood was drawn 4 weeks after completion of 3 doses vaccination course in 6 months. Repeat HBsAb levels were determined in this initially non-immune group. All results were analyzed using SPSS version 21.
Results: Out of 96 staff members, 30were found to be immune on first testing. Remaining 66 non-immune staff were offered complete course (3 doses) of HBV Vaccine. Five staff members were lost to follow up during the course of vaccination, two of them refused vaccination and two were non-responders. The rest 57 became immune after three doses of vaccination.
Conclusion: It is recommended that a national policy be adopted for HBsAb screening and offer of
vaccination, to non-immune HCWs

Open access Original Article | September 30, 2020
Serum Hepcidin Levels in Diabetic and Non-diabetic Chronic Hepatitis C Patients and Its Relation with Serum Iron Levels

Maria Gill, Javaria Sharafat, Muhammad Usman Bashir, Rozina Noreen Hashmi, Khalid Pervez Lone, Faiza

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Background and Objective: Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. Research shows that HCV infection leads to a marked reduction of serum  hepcidin levels which might be a factor in causing systemic iron overload. The present study was aimed to  determine the cause of iron overloadwhich might be due to reduced levels of serum hepcidin in chronic  hepatitis C patients.
Methods: This cross-sectional study was conducted in Department of Physiology at University of Health Sciences, Lahorefrom January 2012 to January 2014. A total of 54 male patients of chronic hepatitis C were recruited for this study and divided into two groups, group A (CHC with diabetes) and group B (CHC without diabetes). Both groupswere tested for serum hepcidin, serum iron and serum ferritin levels. ELISA technique was used to measure serum hepcidin. Serum ferritin levels were measured via CODA analyzer. Serum iron levels were measured by colorimetric method. Frequencies and percentages were calculated for serum hepcidin, serum iron and serum ferritin levels in group. The data was analyzed using SPSS (Statistical Package for Social Sciences) version 20.0. Data was considered significant where P-value was ≤ 0.05.
Results: Patients in both groups showed less serum hepcidin levelsalong with less serum iron levels in 93% cases of both groups. The patients in group A showed raisedferritin levels in 26% cases and normal ferritin levels in 63% cases. Whereas in group B 04% cases showed raisedferritin levels and 92% patients hadnormal ferritin levels; which could be a marker of ongoing chronic inflammation in CHC patients. Non-significant negative correlation was observed between serum iron and serum hepcidin inCHC population.
Conclusion: Hepatitis C virus and decreased serum iron levels in study population may be the reason of less serum hepcidin levels. Raised/normal ferritin reflects chronic inflammation in patients. Non-significant negative correlation between serum iron and serum hepcidin leads the focus towards increasing the sample size in further studies to see any significant negative correlation between studied parameters.

Open access Original Article | September 30, 2020
Frequency of Thalassemia and Its Association with Hepatitis C Infection in Local Population of Pakistan

Ghulam Jilany Khan, Nadeem Reyaz, Muhammad Bahadur Baloch, Analisa Cassandra, Susanne Schlicht

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Background and Objective: Thalassemia major or βeta-thalassemia is a hereditary blood disorder, necessitating continuous blood transfusions. Frequent blood transfusions often result in the development of hepatitis, hepatocellular carcinoma, acquired immunodeficiency syndrome (AIDS) and many other infectious diseases. Incidence of infection of viral hepatitis in thalassemia patients is majorly associated with infections in the donor population. The objective of this study was to ascertain the frequency of HCV infection in patients with thalassemia in Pakistan.
Methods: This study was conducted from January 2015 to September 2018 in various sections of Punjab and Sindh, Pakistan. A total number of 439 patients were enrolled in this study, samples of blood from the patients were collected and their Anti-HCV antibodies were evaluated by enzyme-linked immunosorbent assay (ELISA); HCV-RNA genome presentation was assessed by HCV-nested-real time-polymerase chain reaction (RT-PCR) for the confirmation.
Results: It was found that major population of the thalassemia patients were male (63%). While the female thalassemia population was almost twice in Sindh province as compared to Punjab. In present study, n = 187 were detected positive among those n = 168 were confirmed by PCR. Only 47% thalassemia patients were found vaccinated against hepatitis B whereas all HCV positive patients were not vaccinated, and (84.96%) thalassemia patients were from the family of first cousin marriage. The patients which are not vaccinated also had significant chance to acquire the viral infection (P < 0.001). Moreover there could be some gender and environmental or geographical factors associated with thalassemia that are yet to be 
explored in detail.
Conclusion: Thalassemia patients carry major risk for acquiring transfusion associated infection

Open access Original Article | September 30, 2020
Nuchal Cord and Perinatal Outsome - A Case Control Study

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

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Background and Objective: The nuchal cord means the umbilical cord when it becomes wrapped around the fetal neck by 360 degree. It has been observed that the ultrasound finding of the nuchal cord not only makes the patient more apprehensive but leads to low threshold of the Caesarean section by the managing obstetrician as well. The purpose of this study was to determine the perinatal outcome associated with the cord around the neck in females presenting a hospital setting.
Methods: This case control study was conducted at Dr. Sulaiman al Habib Hospital Riyadh, Saudi Arabia.The data was collected retrospectively with the help of the predesigned proforma for six months and once the selected number of patients with the nuchal cord was enrolled, the total number of the patients was calculated. To create a control group every 12th patient without the nuchal cord was enrolled. Once the control group was formed then the primary and secondary outcomes were compared in both the groups.
Results: It was found that there is significant increase in fetal heart rate abnormalities in the nuchal cord group without increasing the rate of Caesarean section. However, the mean Appearance, Pulse, Grimace, Activity, and Respiration (apgar) score of the neonate in both the groups is not affected. The rate of admission to neonatal intensive care unit (NICU) also did not increase in our study group.
Conclusion: The nuchal cord though found to be associated with fetal heart rate abnormalities but does not increase the rate of Caesarean section. Hence all patients who have nuchal cord should be given trial of labor with continuous cardiotochographic (CTG) monitoring. It is also observed that the apgar score and NICU admission is not affected by the nuchal cord.

Open access Original Article | September 30, 2020
Evaluation of the Clinical Efficacy of Vitrification, Warming and Blastocyst Transplantation in Assisted Reproductive Treatment

Shanshan Gao, Jingjing Jiang, Mei Sun, Yan Sheng, Rong Tang, Lizhen Xu

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Background and Objective: Advances in cell media have led to embryo transfer from cleavage to blastocyst. The extension of embryo culture to blastocyst stage provides some theoretical advantages and disadvantages that have been controversial. The objective of this study was to evaluate the clinical efficacy of vitrified warm cutting and blastocyst transplantation in Assisted Reproductive Technique (ART) therapy. 
Methods: The study was performed on 2740 women undergoing frozen embryo thawing transfer. Patients' basic clinical information, status of frozen embryo transfer cycle, clinical pregnancy rate, early abortion rate, sex ratio of birth and birth weight were retrospectively analyzed. The main clinical outcomes of the recovery of frozen embryos at cleavage and blastocyst stages were compared. In addition, the clinical outcomes of blastocyst cryopreservation on the 5th, 6th or 7th day after oocyte retrieval according to the date of blastocyst expansion were recorded.
Results: The implantation ratio of cleavage stage embryos was 21.62% compared with 43.52% on D5 (P <0.05). The D5, D6, and D7 implanting rates were statistically different. The pregnancy rates were 57.56%, 51.76% and 35.95% versus 37.79%, and the early abortion was 23.08%, 15.42% and 22.35% versus 34.55% respectively for embryos cryopreserved on D5, D6, D7 and D3. There were significant differences between D5 and D3 rates of ectopic pregnancy and early abortion. The sex ratio, the birth weight and birth defect were not statistically different among four groups.
Conclusion: Blastocyst transfer achieved a higher implantation rate than vitrified cleavage stage embryo and decreased ectopic pregnancy rate. With increased incubation days before expansion blastocyst formed, the implantation rate is reduced and the early abortion rate increases.

Open access Original Article | September 30, 2020
Effect of Nigella Sattiva (Kalonji) Oil Based Mouth Wash on Salivary Matrix Metalloproteinase-8 Level in Patients with Chronic Periodonititis- A Randomized controlled Trial

Ghazala Hassan, Sarah Ghafoor, Saima Chaudhry, Zubair Ahmed Khan

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Background and Objective: Salivary level of Matrix metalloproteinase-8 (MMP-8), a collagen degradation enzyme, is known to increase during chronic periodontitis. Nigella sativa is one of the potent anti[1]inflammatory compounds that has a promising role in oral inflammatory conditions. Present study aims to explore the salivary MMP-8 levels after Nigella sativa oil-based mouth wash as compared to placebo(normal saline) after non-surgical periodontal therapy in patients with chronic periodontitis.

Methods: This parallel arm randomized controlled trial was conducted at FMH College of Medicine & Dentistry, Lahore Pakistan from January 2018 to June 2019. Fifty patients suffering from chronic periodontitis were recruited and randomized into the treatment group that received Nigella sativa oil and the control group that received simple normal saline. Salivary samples for MMP-8 levels were collected , once before non-surgical periodontal therapy and secondly after two weeks of rinsing with Nigella sativa oil-based mouthwash in one group and normal saline in the second. Salivary MMP-8 levels were determined through ELISA. The comparison within groups was done through paired t test and between groups through independent sample t-test.

Results: Mean pre-treatment concentration of salivary MMP-8 of the Nigella Sativa group and normal saline group were 199.37 ± 300.75 ng/l and 195.29 ± 175.89 ng/l that decreased post-treatment to 147.35 ± 144.9ng/l and 114.17 ± 129.21ng/l respectively. Statistical analysis revealed no difference in the salivary MMP-8 levels between the chronic periodontitis patients using Nigella sativa or normal saline mouth wash twice daily for two weeks.

Conclusion: The salivary levels of MMP-8 reduced in patients with chronic periodontitis after scaling and root planning with the use of Nigella sativa oil-based mouthwash as well as placebo (normal saline). However, this reduction was statistically non-significant both within and between the study groups.

Open access Original Article | September 30, 2020
Frequency of Molar Incisor Hypomineraliazation and Associated Risk Factors - A Study from Southern Punjab, Pakistan

Rabia Zafar, Amna Urooj, Sehrish Masood

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Background and Objective: The prevalence of molar incisor hypomineralization varies in different regions of the world. This disorder leads to susceptibility to development of complications and hence timely management is mandatory. This study was designed to determine the frequency of molar incisor hypomineralization in children presenting to dental out-patient department of a tertiary care hospital in Pakistan.
Methods: It was a cross sectional descriptive study carried out at Ibn- Sina Hospital Multan, Pakistan. A total of 300 subjects including children and adolescents presenting to the outdoors were included. The detailed dental examination was carried out by two expert dentists for diagnosis of molar incisor hypomineralization. Data regarding risk factors was collected by administering a standardized and validated questionnaire to the parents about prenatal and post-natal risk factors.
Results: A total of 3.33% children were diagnosed with molar incisor hypomineralization. Male to female ratio was 1:1.3. There was no significant difference with respect to gender. The mean teeth affected per child were 2.1 ± 07. Risk factors found in the study population were asthma, history of typhoid and measles, and frequent antibiotic use.
Conclusion: Molar incisor hypomineralization is quite less frequent in general population with no gender predominance. Pre and post-natal factors effect its development that requires timely management strategies by dental specialists.

Open access Original Article | September 30, 2020
Accuracy of Transvaginal Ultrasonography for Diagnosis of Endometriosis Taking Laparoscopy as Gold Standard

Sumera Nighat, Zubda Anwar, Azka Anwar, Taqwa Firdaus, Rohma Saqi

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Background and Objective: Endometriosis is a common gynaecological disease with a diverse clinical presentation. Laparoscopy has long been considered the gold standard diagnostic modality for endometriosis but with the evolution of non-invasive, high resolution transvaginal ultrasonography, it is frequently used as the first line diagnostic technique in making a preoperative diagnosis for endometriosis. This study was designed to determine the diagnostic accuracy of transvaginal ultrasonography (TVS) in diagnosis of endometriosis taking laparoscopy as gold standard.
Methods: A total of 118 women of child bearing age who presented with symptoms of pelvic endometriosis in the department of gynecology, Bakhtawar Amin Hospital Multan were included. The study duration was from June 01, 2018 to May 31, 2020. Patients were first investigated on TVS examination to diagnose endometriosis. Afterwards, diagnostic laparoscopy was performed in all patients to confirm the diagnosis of endometriosis. Accuracy of TVS was determined in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Results: Mean age of the patients was 31.7 ± 7.4 years. Most common presenting complaint was dysmenorrhea in 89 (75.4%) patients followed by dyspareunia in 36 (30.5%), chronic pelvic pain in 30 (25.4%) patients and subfertility in 18 (15.3%) patients. On TVS, endometriosis was diagnosed in 69 (58.5%) patients. While on diagnostic laparoscopy, endometriosis was diagnosed in 75 (63.6%) patients.The sensitivity of TVS in diagnosis of endometriosis was calculated as 82.7%, specificity as 83.7%, PPV as 89.9% and NPV as 73.5%.
Conclusion: TVS appears to be the alternative and safe modality for diagnosis of endometriosis. It can be used as an alternative to diagnostic laparoscopy for the early diagnosis of endometriosis. It has a good sensitivity and specificity for diagnosis of endometriosis.

Open access Original Article | September 30, 2020
Myths and Controversies in Assisted Reproductive Techniques: Gynecologist's Perspective

Rabia Nafees, Haroon Latif Khan, Humaira Zareen, Zoofishan Imran, Shazia Jang Sher

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Background and Objective: Globally infertility affects between 60 million and 168 million all over the world. Regardless of the fact that Pakistan being currently among the most overpopulated nations of the globe and a populace development pace of around 2%, confronts with the higher pace infertility (21.9%); 3.5%primary and 18.4% secondary. The aim of the study was to assess the understanding of gynecologist of Pakistan regarding Assisted Reproductive Techniques (ART).
Methods: It was a descriptive study, conducted only for gynecologists who attended the “Asia Pacific Initiative on Reproduction” (ASPIRE) conference held in Lahore, Pakistan, from 29th Nov to 1st December2019. Data was collected from the n = 252 gynecologist who were attending the conference.
Results: Out of n = 252 doctors, 82.9% participants considered test tube baby a social norm and acceptable option while 55.6% participants were in the opinion of basically a stigma attached to society. According to 77.8% participants, socially and legally involvement of 3rd party like donor eggs, sperms and gametes cannot justify.
Conclusion: Pakistan, gynecologists are the mainstream dealing with infertility. Apart from general population, there are certain myths and controversies among the gynecologist as well. So that gynecologists’ knowledge and perception is the most important point regarding infertility and ART.