Aim and Scope

Objective: The study is conducted to access the effectiveness of Isometric Handgrip (IHG) Exercise in pre-eclamptic females. Material and Methods: Fifty-six diagnosed females with history of pre-eclampsia were randomly allocated into two groups: A with 28 subjects and B with 28 subjects. Participants with group A received isometric handgrip exercise along with medicines while Group B was treated only with medicines. Each patient was treated three times a week for a period of 4 weeks. Pre-treatment, 2nd week and 4th week measurements of blood pressure was taken by a sphygmomanometer, reading was taken according to American Heart Association. Results: While comparing the values of both experimental and control group, both groups show statistically significant changes in the results after treatment, but experimental group shows more improvement than control group. Conclusion: In the study, it has been demonstrated that reduction in SBP and DBP was seen after 4 weeks of isometric handgrip exercise. It is also concluded that IHG training may be an easy, simple, cost-effective, efficacious, and non-pharmacological therapy in clinical management for reduction of blood pressure in pregnancy. Keywords: Hypertension, Diastolic blood pressure, Isometric handgrip exercise, IHG Training, Pre-eclampsia, Systolic blood pressure

DOI:https://doi.org/10.52587/njmhs.v4i2.35 Abstract Objective: Breech presentation is a common complication during pregnancy that increases the risk of fetal morbidity and mortality during vaginal delivery compared to caesarean section. To reduce the number of caesarean sections and associated complications, external cephalic version (ECV) is recommended. The objective of this cross-sectional study was to determine the success rate of ECV in uncomplicated singleton breech presentation at term. Material and Methods: The study was conducted on 85 patients at Gynae-unit I, SPH/ Bolan Medical Complex Hospital, Quetta, Pakistan. The success rate of ECV was found to be 42.4%, while the failure rate was 57.6%. Multigravida had a higher success rate (80.6%). Complications such as fetal distress, ruptured membranes, placental abruption, and emergency cesarean section occurred in a small percentage of cases. Results: According to study, the success rate was 42.4% and failure rate was 57.6%. Multigravida shows higher success rate (80.6%). In one patient (1.2%) emergency cesarean section was done due to abruption placenta, that occur in (1.2%) after the successive version, and in 4.7% cases fetal bradycardia was seen, which was transient, that resolved spontaneously. No complication seen after failed ECV. Conclusion: The study concludes that ECV is an effective and safe procedure in reducing the incidence of breech presentation at term with a low risk of complications. Maternal age and multiparity are associated with a higher success rate, and the procedure is simple to learn and perform. Properly counseled women are satisfied with the procedure, and well-equipped obstetrics units should routinely offer the procedure in selected cases during term pregnancies. Keywords: Abruption placenta, Breech presentation, External cephalic version, Term pregnancy

DOI:https://doi.org/10.52587/njmhs.v4i2.40 Objective: The study was planned to measure markers of myocardial injury in experimental model of acute myocardial infarction. Material and Methods: This was a randomized experimental study. In the study, 40 male rabbits were included and distributed equally into five groups. During first 14 days, G-1 and G-2 (control group and Iso-control group) animals got 1ml normal saline, while G-3, G-4 and G-5 animals got citric acid at the dose of 250 mg/kg, 500 mg/kg and 750 mg/kg body weight respectively. Isoproterenol (85mg/kg body weight) was injected subcutaneously for induction of acute myocardial infarction in experimental model except for G-1. Markers of myocardial injury like serum- CK-MB, LDH., SGOT and SGPT were analyzed in the study. Results: The data in the study shows that there was significant rise in myocardial injury markers such as CK-MB, LDH, SGOT and SGPT as compared to control-group indicating severe infarction and myocardial cell death. On the other hand, citric acid treated groups showed significant restoration of CK-MB, LDH, SGOT and SGPT as compared to Iso-control group. Conclusion: It is clear from this study that citric acid possesses cardio protective potential. It reduces the impact of ischemic injury to myocardium during acute attack of myocardial infarction, evident by reduced cardiac enzymes levels. Keywords: Acute myocardial infarction, Cardio protection, Isoproterenol, Cardiac Enzymes, CK-MB, LDH, Citric acid.

DOI:https://doi.org/10.52587/njmhs.v4i2.43 Objective: This study is carried out to assess the adapted insulin mechanism through comparative insensitivity in early pregnancy in the population of Lahore region. Material and Methods: Sixty-five subjects in early pregnancy stage and twenty-five non-pregnant subjects volunteered for the present study. General data and blood samples of all the participants were obtained. Glucose and insulin level in the blood were assayed and analyzed statistically. Results: It was found that insulinemia was 67 more in pregnant females when compared to non-pregnant controls, with significant difference in the comparing groups (p<0.0001). Comparative study found hyperinsulinemia in the phases of the pregnancy. Glycemia was found to be 5.4% lesser in pregnant females as compared to the non-pregnant controls. Thus there was a non significant difference in values in both the comparing groups. The relationship based on HOMA-IR concept was also analyzed and the value observed was 6.700.37 in the control non-pregnant subjects of the study. In early pregnancy subjects the values were 10.880.39. The relationship shows about 62% greater insulin index in the pregnant subjects as compared to the non-pregnant controls. The difference is highly significantly different statistically (p=0.0007). Conclusion: The responses of the insulin to the glycemia acquired in the early pregnancy certainly showed comparative insulin insensitivity in early pregnant subjects as compared to the non-pregnant controls. The pattern of insulin insensitivity in the early pregnancy in a subject may also provide clue of the development of gestational diabetes at the later stage of the gestation. Keywords: Glycemia, Insulinemia, Pregnancy, HOMA-IR, Gestational diabetes.

DOI: https://doi.org/10.52587/njmhs.v4i2.33 Objective: The objective of this study was to determine the association between sacroiliac joint dysfunction and body mass index (BMI) in postpartum females who had normal deliveries and lower segment cesarean sections. Materials and Methods: Data was collected from postpartum women who provided written consent and were informed about the procedure. Participants underwent five provocation tests, and a diagnosis of sacroiliac joint dysfunction was made if three of the five tests were positive. Results: The study shows that out of the participants (340 postpartum females), 271 (79.7%) were found to have sacroiliac joint dysfunction, while 69 (20.3%) did not. The results showed that approximately 74% of middle-aged participants were overweight, and approximately 51% were obese. The study found a high prevalence of sacroiliac joint dysfunction in this age group. Conclusion: This study concluded that there is a strong association between sacroiliac joint dysfunction and BMI in postpartum females. Obese females with higher BMIs had a higher prevalence of sacroiliac joint pain. Keywords: Body mass index, Postpartum, Sacroiliac joint, Sacroiliac joint dysfunction.

DOI:https://doi.org/10.52587/njmhs.v4i2.41 Objective: The aim of this study was to assess the effectiveness of proprioceptive and therapeutic exercises on pain among patients with knee osteoarthritis. Material and Methods: In this study, fifty-four patients having knee osteoarthritis were arbitrarily assigned into two groups: Group-A with 27 patients and Group-B with 27 patients. Both groups were given local heat for 20 minutes. Group A received proprioceptive exercises while Group B was treated with therapeutic exercises. Each patient was treated four times a week for a period of 4 weeks. Pre-treatment, 2nd week and 4th week intensity of pain, stiffness and physical difficulties were evaluated by using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Results: After the fourth week of exercises, both Groups A and B's mean values on WOMAC scores significantly decreased (P<0.001). However, it was found that the Group A having proprioceptive exercises performed better than Group B with therapeutic exercises. Conclusion: The special effects of proprioceptive exercises on the pain are more effective than therapeutic exercises among the patients of knee osteoarthritis. Further studies are needed to explore the better strategies to manage knee osteoarthritis with the help of proprioceptive exercises. Keywords: Knee Osteoarthritis, Proprioceptive Exercises, Therapeutic Exercises, Pain intensity.

DOI: https://doi.org/10.52587/njmhs.v4i2.28 Objective: This study aims to compare the performance of fentanyl and bupivacane 0.5% with hyperbaric bupivacane 0.5% as spinal anesthetics during transurethral resection of the prostate (TURP). Material and Methods: In the study, 50 male patients aged 55 to 75 years who were admitted for TURP at the Khyber Teaching Hospital over a one-year period from June 2019 to June 2020 were recruited. The patients were randomly allocated in a double-blind fashion in to 2-groups. Group-A got a combination of 0.5% bupivacaine and fentanyl, while Group-B received 0.5% bupivacaine alone. The effectiveness of each anesthetic is determined by examining the relative initiation and interval of both sensory and motor block. A faster onset and longer duration of sensory block is considered a better outcome, while a faster onset and shorter duration of motor block is considered the preferred outcome. Results: The average age of patients in Group-A was 66.6 ± 6.4 years and in Group-B was 76.3 ± 6.1 years, with no significant difference between the groups (P > 0.05). Similarly, there were no significant differences in weight, height, and body mass index (BMI) between the two groups (P > 0.05). The onset of sensory block was significantly quicker in Group-A (4.9 ± 1.1 minutes) compared to Group-B (7 ± 1.4 minutes, P < 0.05), and the regression of two sensory dermatomes was also significantly prolonged in Group-A (125.4 ± 11.8 minutes) compared to Group-B (85.2 ± 10.4 minutes, P < 0.05). The total duration of sensory block was also significantly prolonged in Group-A compared to Group-B (P = 0.00). For motor block, the onset was quicker in Group-A (8.8 ± 2.4 minutes) compared to Group-B (11 ± 2.7 minutes, P < 0.05), but the duration was extended in Group-B (189.4 ± 6.9 minutes) compared to Group-A (146.8 ± 15.4 minutes, P < 0.05) in significant manner. The prevalence of adverse effects was higher in Group-B (13 patients) compared to Group-A (8 patients, P = 0.04), and the mean dose of postoperative analgesics was lower in Group-A (P = 0.035). No significant variance was found in the heart rate and systolic blood pressure during the procedure between the groups examined (P > 0.05). Conclusion: Given the longer duration of sensory block, shorter duration of motor block and reduced postoperative analgesic requirements, of 0.5% buipvacaine and fentanyl compared to hyperbaric bupivacaine, it seems that this drug can be used as an appropriate spinal anaesthetic for patients receiving TURP. Keywords: Bupivacaine and fentanyl, prolonged sensory block, reduced motor block, spinal anaesthesia, TURP.

DOI: https://doi.org/10.52587/njhms.v3i2.26 Objective: Current research work was planned to investigate the medication-related side effects and cytotoxic and bone marrow suppressive effects of DAAs to provide evidence-based findings to convince the local population of HCV infection treatment. Material and Methods: Present research investigated the appearance of medication-related side effects both in males (n=200) and females (n=200) by conducting in-depth interviews with hepatitis C patients and collecting blood samples for measuring selected haemato-biochemical parameters at DHQ Hospital, Faisalabad and Samnabad General Hospital, Faisalabad-Pakistan. Further, grouping was done based on age (below 40 years and above 40 years of old) and regime combination as double regime (SOF + Daclatasvir) and triple regime (SOF + Ribavirin + Daclatasvir). Results: It was reported that headache, fever, body aches, joint pain, heartburn, tension, aggressive behaviour, weakness and abdominal pain are among the general side effects that appeared in HCV patients on oral medications. However, the results explored that patients taking oral medication did not have vomiting, insomnia, nausea, the feeling of chill, blurred vision and tiredness-like side effects, which might imbalance the socioeconomic life of an individual. Further, cytotoxic and bone marrow suppressive effects are non-significant (p>0.05) evaluated by selected blood tests, including ALT, Haemoglobin, Neutrophils percentage, Total leucocytes count, and platelets count in comparison with a control group. Conclusion: It could be concluded that all oral direct acting antiviral therapy is safe and effective compared to previously used therapies. Moreover, physical factors reported in patients could be minimized by improving the socioeconomic status of the local population in Pakistan. Keywords: Hepatitis C treatment, direct-acting antivirals agents, interferon-free, safety profile