Role of Beta Blockers and Band Ligation in upper gastrointestinal tract bleeding.

Objective: To sort out the combine role of beta blockers and band ligation in upper gastrointestinal bleeding Methodology: In this prospective observational study 563 patients were included, (mean age 47 ±6 years, males 69%) with liver cirrhosis and deterioration from Medical ward Mayo hospital Lahore. All the patients had cirrhosis and esophageal varices confirmed by endoscopy. In hospital cirrhotic patients with hypertension and liver cell deteriorations. All the record of betablocker use and band ligation was carefully recorded. Data regarding patient presentation and characteristics were keenly monitored and observe with treatment and improvement as major variables. Mortality was taken as major influential factor. Linear regression model was used. Results: Overall, there were 426 patients getting pharmacological treatment and have band ligation treatment simultaneously. One Hundred and thirty-seven had gastrointestinal bleeding during study time. Standard deviation of patients who had no recurrence of bleeding from last two years was 67±4. Low level of serum albumin, presence of ascites, and treatment with betablockers were the only independent variables that directly influenced the bleeding. The percentage of patients who had only once bleeding during study period was 23±2 percent. The major effects by be ta blockers were preserving after band ligation of source of bleeding. Conclusion: This study demonstrates that best treatment of bleeding in upper gastrointestinal tract is beta blockers, with the use of b and ligation where it is needed. Strict monitoring and guidelines should be under consideration before stop the beta blockers upper gastrointestinal bleeding patients.  Keywords: Beta blockers, Band Ligation, Upper Gastrointestinal Trac

Integration of Requirement Engineering Challenges with Its Practices in Enterprise Resource Planning Systems

This study focuses on the problems and solutions that are useful and insightful evaluated. Requirement Engineering of the standard model of the process of life, in spite of the high degree of implementation, I know very little about the problems that arise and I make the process work better. And besides, many of these specific issues and discuss ways to improve them. I have tried to categorize the types of challenges because of their similarities are connected. And again, I talked about many of these general issues and their application to do so. Keywords: Requirement engineering challenges for Enterprise Resource Planning systems; Practices for Requirement engineering of Enterprise Resource Planning; Better Requirement Engineering model for Enterprise Resource Planning; Enterprise Resource Planning Requirement engineering integration; Categorized solutions to the challenges of Requirement engineering in Enterprise Resource Planning systems

Frequency of types of parturition and their relationship with maternal characteristics: a cross-sectional analysis

Background: The pathways that are involved for the duration of pregnancy and type of parturition are extremely complex, involving maternal as well as fetal systems. The objective of this study was to determine the frequency of types of parturition and their relationship with maternal characteristics among pregnant female patients.Methods: A cross-sectional survey using a non-probability convenient sampling technique was conducted among 195 healthy pregnant females at Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, from 1st March 2019 to 31st August 2019. After taking written informed consent from the participants, the relevant data were gathered with the help of a structured questionnaire designed specifically for the study. Statistical package for social sciences was used for data entry while the chi-square test was applied for inferential analysis. The duration of the study was six months. Data were entered and analyzed using Statistical Package for Social Sciences version 20.0. Descriptive analysis was performed by generating means and standard deviations for continuous variables while frequencies and percentages for categorical variables. A Chi-square test was applied to perform the inferential analysis while the significance level was set at 0.05.Results: A total of 195 pregnant females were included in the study, whose mean age was 29.29±5.22 years. The study results showed that BMI before pregnancy (p=0.021), rest is taken during pregnancy (p=0.034) and gravida status (p=0.047) were all significantly associated with the type of parturition among the study participants, but spacing in pregnancies and parity were not.Conclusions: Maternal characteristics were found to be significantly associated with the type of parturition among pregnant females. For gynecologists the maternal characteristics identified in this study may serve as a useful indicator of the type of parturition expected in their patients

Effects of Subcapsularis Neuro Muscular Reduction (NMR) in Adhesive Capsulitis

Background: To determine the effects of Subscapularis Neuromuscular Reduction (NMR) in Adhesive Capsulitis patients on pain, Range of Motion (ROM) and Quality of life. Methods: In this randomized controlled trail patients with freezing and frozen stage of Adhesive capsulitis and limited range of movement were included. Patients were randomly divided into control (Group A) and experimental group (Group B). The patients of Group A were treated with conventional physical therapy treatment protocol and patients of group B were treated with subscapularis neuromuscular reduction along with conventional physical therapy. The patient outcome measures were assessed using numeric pain rating scale (NPRS), SPADI (shoulder pain and disability index) and ranges via goniometry. Data was analyzed by SPSS 21. Results: Both group showed significant improvement, but the end value comparison showed significant difference. NMR (Neuromuscular Reduction) on Subscapularis muscles improved the pain, ROM and Patient functional status more as compared to the conventional physical therapy group. The NPRS mean value for control group was 2.90±1.09 and mean value for experimental group was 2.05±1.10with p value of 0.021 while the mean value of SPADI for control group was33.52±9.96 and for experimental group was 26.72±8.00 with p value of 0.026. Conclusion: Treatment groups showed improvement by reducing pain, improving range of motion and functional status but neuromuscular reduction of subscapularis muscles was found to be more effective

Effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients:a cross sectional survey

Background: Hypertension is defined as a systolic blood pressure of 140 mmHg or more, or a diastolic blood pressure of 90 mmHg or more or taking anti-hypertensive medication. The clinical presentation of high blood pressure may depend upon several factors such as age, gender, severity and duration of hypertension. There is a paucity of data exploring the role hypertension duration may play in shaping the relationship between blood pressure and signs and symptoms of hypertension. To evaluate the effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients.Methods: A cross-sectional study was carried out among 250 patients, aged 18 or above, with self-reported history of hypertension and on anti-hypertensive medication. Data were collected by means of a structured questionnaire whereas the blood pressure level was measured with the help of sphygmomanometer using stethoscope. Inferential analysis was performed by applying chi-square test whereas the significance level was set at 0.05.Results: The study results revealed that among patients with ≥5 years duration of hypertension headache history (P=0.021), edema (P=0.034), increased urinary frequency (P=0.031), sleep apnoea (P=0.016), palpitation (P=0.005) and confusion (p=0.021) were significantly associated with systolic whereas only increased urinary frequency (P=0.009) was significantly associated with diastolic blood pressure. Moreover, among patients with <5 years duration of hypertension vision problems (P=0.03), sleep apnoea (P=0.015) and palpitation (P=0.035) were significantly associated with systolic whereas sleep apnoea (P=0.048) and palpitation (P=0.028) were significantly associated with diastolic blood pressure.Conclusions: The study results showed that patients with higher blood pressure were more likely to have the signs and symptoms of hypertension. Also, patients with longer duration of hypertension had greater number of signs and symptoms associated with systolic hypertension

Assessment of apparent diffusion coefficient values as predictor of aggressiveness in peripheral zone prostate cancer: comparison with Gleason score

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants were positive for malignancy. 89 lesions with proven malignancy showed diffusion restriction. The mean ADC value for disease with a Gleason score of 6 was 935mm(2)/s (SD = 248.4mm(2)/s); Gleason score of 7 was 837mm(2)/s (SD = 208.5mm(2)/s); Gleason score of 8 was 614mm(2)/s (SD = 108mm(2)/s); and Gleason score of 9 was 571mm(2)/s (SD = 82mm(2)/s). Inverse relationship was observed between Gleason score and mean ADC values. Conclusion. DWI and specifically quantitative ADC values may help differentiate between low-risk (Gleason score, 6), intermediate-risk (Gleason score, 7), and high-risk (Gleason score 8 and 9) prostate cancers, indirectly determining the aggressiveness of the disease

Calcium levels and metabolic disturbance in renal disease patients receiving hemodialysis: a cross sectional study highlighting its association in dialysis patients

Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study

Almond supplementation reduces serum uric acid in coronary artery disease patients: a randomized controlled trial.

Objective Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients. Study design A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the PA and AA were given Pakistani and American almond varieties (10 g/day), respectively; with instruction to soak overnight and eat before breakfast. Results Almonds supplementation significantly reduced (p \u3c 0.05) serum UA among groups, and over time. At week-6, UA concentrations were -13 to -16 % less in PA and AA; at week-12 the concentrations were -14 to -18 % less, compared to NI. Systolic and diastolic blood pressure and body weights of the participants remained fairly constant among all the groups. Conclusion Almonds (10 g/day), eaten before breakfast, reduces serum UA in CAD patients. Prevention of hyperuricemia can confer protection from kidney and vascular damage and if extrapolated for general population, dietary almonds can offer grander health benefit. Trial is registered at Australian New Zealand Clinical trial registry as ACTRN12614000036617

Renal bone disease in patients on hemodialysis: an observational study focusing on the variation of calcium metabolism

Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level &lt;250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level &gt;650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively  (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P &lt;0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin

Smoking and blood pressure levels in hypertensive patients: evaluating the role of gender, age and hypertension duration

Background: Hypertension is estimated to affect about 40% of adults above 25 years of age globally. While many of the risk factors of hypertension are well known, such is not the case with smoking. Pertinent published literature is heterogeneous, with a dearth of relevant local data. Objectives was to study the relationship between smoking and blood pressure levels in hypertensive patients and to assess the effects of gender, age and hypertension duration on such a relationship.Methods: A cross-sectional study was carried out on a total of 298 conveniently sampled patients, aged 18 or above, from the medical outpatient department of a secondary care hospital of Karachi. The relevant data were collected by means of a structured questionnaire whereas the blood pressure level was checked using sphygmomanometer with stethoscope. Mann Whitney U test was used for inferential analysis whereas the significance level was set at 0.05.Results: Overall, both the systolic and diastolic blood pressure levels were significantly associated with smoking history (p<0.05 for both) where they were found to be higher in smokers than in non-smokers. Furthermore, after gender, age and hypertension duration based stratifications; both the systolic and diastolic blood pressure levels were still significantly associated with smoking history in patients who were male, were ≥35 years old and had <5 years hypertension duration (p<0.05 for both) where they were again found to be higher in smokers than in non-smokers.Conclusions: The study results showed a significant association of positive smoking history with higher mean systolic and diastolic blood pressure levels, though after stratifying for gender, age and hypertension duration, this relationship persisted only in patients who were male, were ≥35 years old and had <5 years hypertension duration