The Prevalence & Severity of Depression in patients with chronic obstructive airway disease

Objective:  To determine the Prevalence & Severity of depression in Chronic Obstructive Airway Diseases (COPD) patients. Background: Chronic Obstructive Airway Disease is a chronic heterogeneous disease that is also progressive. Depression is a common entity in chronic diseases. COPD causes long-term respiratory symptoms and depression is commonly found in these patients. The symptoms of these two diseases are overlapping and depression in COPD patients’ needs to be diagnosed and adequately treated. Untreated patients lead to poor control of respiratory symptoms and further deterioration of the illness. Our study aimed to determine prevalence and severity of depression in COPD patients using HAM-D score. Material and Methods: This study was conducted in Medicine & Pulmonology OPD, Fuji Foundation Hospital, Rawalpindi from August 2019 to February 2021. Using a cross sectional study design, a total of 169 cases of COPD were recruited and tested for the presence of absence of depression using the HAM-D rating scale and observations were recorded. Results: Total 169 patients recruited in this study with female & male percentage of 59% and 47% respectively.  The Mean duration of illness was 11.5 years ± 6.48. The incidence of Anxiety & Depression was high (45% and 36%) in moderate to severe disease with total prevalence of 54 % among participants in the study. Conclusion: Anxiety & depression is commonly prevalent in COPD patients. Female patients are found to have more psychological disturbance irrespective to their COPD severity. Psychological impairment must be carefully evaluated in patients having COPD.

ROLE OF MRI IN EVALUATION OF ANTERIOR CRUCIATE LIGAMENT TEAR

Magnetic resonance imaging being a most advanced and non-invasive imaging modality is a gold standard imaging modality in the diagnosis of soft tissue injuries including the injuries of ligament and tendons because of its three dimensional approach.  Almost there are 360 joints in human body with the help of which we can move from one place to other, among them knee joint is the largest joint. It is a synovial joint of hinge variety which mainly allows flexion and extension. Knee joint is supported by a huge network of ligaments and tendons which provide a great strength and flexibility to the knee joint. Anterior and posterior cruciate ligament are the important stabilizing ligaments of the knee joint these two ligaments connects the tibia with femur. Injury or torn to them can cause a critical clinical conditions to the patients suffering from that injury. Injury to anterior cruciate ligament is more frequent as compare to other ligamentous injuries of the knee. Injury to ACL occurs mostly by sudden change in direction so because of which it affects the people who take part in different types of sports like basketball, soccer, baseball skiing. Female athletes are at higher risk of having ACL tear as compare to males. ACL tear should be treated properly because injury to it can cause a serious clinical conditions like it can cause the immobilization of the subject until it is treated properly. For the accurate treatment there should be most advanced and highly sensitive diagnostic approach which aids in the addition of accurate information regarding the location, grading and the condition of ACL tear either there is  complete or partial tear. Magnetic resonance imaging modality can diagnosis ACL tears with a high accuracy with the help of specific protocols which are more sensitive to soft tissue injuries. Keywords: ANTERIOR CRUCIATE, LIGAMENT TEAR DOI: 10.7176/JHMN/93-10 Publication date:September 30th 202

Fetal Transverse Cerebellar Diameter (TCD) Measurement for Gestational Age Prediction in the Second and Third Trimesters of Pregnancy

Background: The purpose of this study was to see how accurate transverse cerebellar diameter (TCD) measurement is at predicting gestational age in normal fetuses. In the 2nd & 3rd trimesters of pregnancy a range of sonographics fetal biometric characteristics can be utilized to determine gestational age. Other parameters, such as bi-parietal diameter and fetal length, are used to determine transcerebellar diameter. Objective(s): To determine the predictability of GA estimated from fetal TCD assessed on ultrasonography in the 2nd and 3rd trimesters of pregnancy. Methodology: This was a cross-sectional study conducted at the Ch. Mohammad Akram teaching and research hospital on 84 pregnant healthy ladies with fetuses ranging in age from 18 to 45 years old. During the 2nd and 3rd trimesters of pregnancy a routine ultrasound scan was done. In additions to the standard biometric parameter the transcerebellar diameter was estimated. Results: The TCD of 84 patients as a measure of gestational age in weeks. These were generated from data collected during the study and include mean and standard deviation TCD measurements of 84 participants ranging in gestational age from 14 to 40 weeks. The current research found a significant link between the GA of TCD and the GA of BPD and fetal length.  The TCD(mm) mean and standard deviations were 33.74 ± 11.762 respectively. The TCD gestational age mean and standard deviations were 28.160 ± 6.7942 respectively. Bi-parietal diameter (mm) has a mean and standard deviation of 68.24 ± 18.503. Bi-parietal diameter had a mean and standard deviation of 27.996 ± 6.9099 gestational age. The standard deviation and mean  50.32 ± 16.265 mm Fetal length The mean and standard deviation of fetal length gestational age are 27.423 ± 6.7625. Different criteria such as transcerebellar diameter, biparietal diameter, and femur length, are used to establish the gestational age of the fetus in this cross-sectional analysis. Conclusion(s): The TCD is a set of accurate variables for assessing GA in pregnant women in the 2nd and 3rd trimesters. Key words: Transcerebellar diameter; Gestational age;  Fetal length ; Bi-parietal diameter. DOI: 10.7176/JHMN/93-08 Publication date:September 30th 202

Frequency of Disc Degeneration at Different Levels of Lumbar Vertebrae in Adult Patients with Backache on Magnetic Resonance Imaging

Objective:To Determine the Frequency of Disc Degeneration at Different Levels of lumbar Vertebrae in Adult Patients with lower back Pain on Magnetic Resonance Imaging. Study Design: An analytical cross-sectional descriptive study was performed. Settings: The study was performed in Bashir Neurospine Institute and Al-Razi Healthcare center, Lahore. Period: An Analytical cross sectional study was conducted from 15 October,2020 to 15 January 2021. Material and Methods: In our study, all those adult patients with lower back pain, obese, dull ache, numbness, tingling, pins and needle sensations, muscles spasms were included. And those patients who were not giving consent, spondylosis, lumbar spine stenosis, cervical and thoracic abnormalities, paedes, and those who were uncooperative were excluded. Data was tabulated and analyze with the help of statistical package for the social science (SPSS version 24). The data was reported using cross sectional descriptive statistics. Results: In our research out of 160 patients 89 females and 51 males were those who  diagnosed with disc degeneration and 10 females and 10 male in which disc degeneration was absent. 10 patients out of 160 patients were those who diagnosed with disc degeneration at the level of L1 - L2 between the age of 24 to 87, 8 patients were those in which disc degeneration present at the level of L2- L3 between the age of 43 to 87, 31 patients were those in which disc degeneration present at the level of L3-L4 and  96 patients diagnosed with  disc degeneration present at the level of L4- L5 which is the lowest lumbar vertebra between the age of 55 to 80 years. Overall out of 160 patients only 3 patients were those who represent with mild pain (25yrs) and 102 were those who came with moderate pain (27-90yrs) and 55 patients who represent with severe backache (30 to 89yrs). In this research out of 160(100%) patients only 102  patients (63%) are those who present with moderate pain and 55 patients (34%)with severe pain .At L1-L2   disc degeneration only 5 patients (50%) were those who came with moderate and 5( 50% )with severe pain. At L2-L3 disc degeneration two patients (25%) with moderate and six patients (75%)with severe pain .At L3-L4 disc degeneration 11 patients (35.4%) with moderate and 20(64.5%) with severe pain. At L4-L5 disc degeneration 51 patients (53%) with moderate pain and 45 patients (46.8%) with severe pain. Our study also revealed that elevated BMI patients had high frequency of disc degeneration. Conclusion: This study conclude that lumbar disc degeneration was approximately in women than men who were represented with lower back pain. Minority of patients had normal lumbar MRI findings. Most of the degeneration occurs at the lowest lumbar vertebrae i.e. L4- L5 and patients who were presented with elevated BMI have increased risk of disc degeneration. Keywords: Lumbar vertebrae, Magnetic resonance imaging, lower back pain. Degenerative disc disease. DOI: 10.7176/JHMN/90-17 Publication date:June 30th 2021

Diagnostic Interstitial Lung Diseases in Patients Having Normal Chest Radiograph through High Resolution Computed Tomography

Background: In Pakistan, the main cause of death is interstitial lung disease (ILD) i.e., 4.75%. In interstitial lung disease majority of the patients is about the age of 57.5 years. The age group maybe varying between the ages of 46 and 65 year. Female gender is more predominantly i.e., 65.6% in all types of ILD except the interstitial pulmonary fibrosis (P< 0.001). Objective: The aim of our study is to diagnose interstitial lung diseases in patients having normal chest radiograph through high resolution computed tomography. Study design: Our study design was cross-sectional descriptive study. Material and method: The descriptive cross-sectional study was conducted in which data of 100 patients were taken. The data was collected from the Radiology department of Sheikh Zayed Hospital Rahim Yar Khan. After informed consent, data was collected through CT Toshiba 164 slices. Result: 100 patients were included in our study out of which 61 were females and 39 were male’s with the mean age of 49.32 years. The chest radiograph of the patients having ILD shows the patchy ground glass opacities (39.0%), consolidation of the lungs (21.0%), reticular shadowing (16.0%) and the pleural effusion (24.0%) while on the high-resolution computed tomography the patients were represented with ground glass haze (42.0%), calcific foci (21.0%), nodular lesion (16.0%), consolidation of the lungs (30.0%) and pleural effusion (22.0%). Conclusion: Chest radiograph nearly misses common radiographical features which are suggestive of interstitial lung disease but can be seen on High Resolution Computed Tomography (HRCT) due to its high resolution. So, it can be concluded that the HRCT is more efficient and authentic diagnostic equipment in assessing the Interstitial Lung Disease as compared to the chest radiograph. Keywords: Interstitial lung disease, Chest radiograph, Computed tomography, High resolution computed tomography. DOI: 10.7176/JHMN/91-04 Publication date:July 31st 202

SONOGRAPHIC EVALUATION OF ESTIMATED FETAL WEIGHT BY DIFFERENT METHOD AT TERM AND POST TERM

Objective: To determine fetal weight estimation by different method on ultrasound at term & to determine actual baby weight after birth Methodology: The research is conducted in Meer Children and Family Clinic Tajpura Lahore. 121 women participate in this study over a 4 month period from January 2021 to April 2021. Systematic random sampling was used to make the selection. The scanner has Hadlock, Shepard, shibozuka and warsof formula.  Results: Out of 70 pregnant women in which 36 (51.5%) nulliparous women and 34(48.5%) multiparous women. A total of 45(64.3%) by vaginal delivery while 25(35.7%) deliver by C – Section. The minimum maternal age for nulliparous women is 21 years and maximum maternal age for multiparous is 39 years. The minimum Actual birth weight i.e. 2.40 correlate with estimated fetal weight. The maximum Actual birth weight i.e. 4.00 correlate with estimated fetal weight. The mean Actual birth weight   is significantly increase with increase in both parity and maternal age at delivery Conclusion: For most pregnant women, estimated fetal weight based on multiple fetal parameters provides reliable and clinically useful information. Despite the fact that there is still an acceptable difference between the actual birth weight and the sonographically EFW. Keywords: Fetal Macrosomia, Term Pregnancy, Hadlocks Formula , Actual birth weight DOI: 10.7176/JHMN/91-11 Publication date:July 31st 202

FETAL HEART RATE WITH HYPERTENSIVE AND NON-HYPERTENSIVE MOTHERS ON ULTRASONOGRAPHY IN THIRD TRIMESTER- A SYSTEMATIC REVIEW

Background: Preeclampsia throughout pregnancy increase a women’s chance of developing cardiovascular disease. Women that develop preeclampsia are at higher risk for development of hypertension and cardiac disease. Objective: To evaluate the relationship between maternal health (blood pressure} and fetal heart rate (FHR) during third trimester, and differentiate FHR in male and female fetuses. Material & Methods: An electronic study including the articles of nearly a decade and half. The studies were added by means of Google Scholar, Research gate, NCBI and PubMed to name a few. All the articles were included in the official language English. Articles were included having sonographic relation between the hypertensive and non-hypertensive mothers with fetal heart rate. Results: Analyzing the topic, 14 articles were added to determine the exact correlation between fetal cardiac output and hypertensive mothers. 25 articles were added in introduction and technique while 4 articles were included to link pre-eclamptic mothers with adolescent offspring regarding their growth and cardiac output. Conclusion: Gestational hypertension has adverse effect on fetal heart rate and studies have proved the difference by comparing them with normotensive pregnancies. Keywords: Fetal, Heart, Maternal, Blood pressure. DOI: 10.7176/JHMN/90-16 Publication date:June 30th 202

Diagnostic Efficacy of MRCP and Ultrasound on Obstructive Jaundice-A Prospective Study

Background: Obstructive jaundice is a common pathological problem that occurs when there is an obstruction to the passage of conjugated bilirubin from liver cells to intestine. Bile, a digestive fluid secreted and produce by the liver. Most common cause of obstructive jaundice is due to gallstones. Objective: The aim of our study was to evaluate the diagnostic Efficacy of MRCP and Ultrasound on obstructive jaundice. Study design: A cross-sectional prospective study was performed. Material & Method: A cross-sectional prospective study was performed in 50 patients who came with the provisional diagnosis of obstructive jaundice were referred to ultrasound for primitive diagnosis and were then shifted to MRCP for a detailed diagnosis. The data was collected from the outpatient department facility of Pakistan Kidney and Liver Institute   Hospital, Lahore. After informed consent, data was collected from MRI GE 1.5 Tesla, Ultrasound Canon Xanio. Results: The results revealed that there are 50 patients of obstructive jaundice. 20 were females’ patients and 30 were males’ patients, with age raging from 20-40 years. There were 17 patients out of  50 in our study which ultrasound showed negative results that were positive on MRCP there were 28 patients that were positive on both ultrasound and MRCP. There were 3 patients that were positive on ultrasound but negative on MRCP and 2 patients that were negative on both modalities Conclusion: Our study concluded that higher ratio of males then females in our sample size, RHC was positive in all the patients with dominant cause of jaundice was stone with in biliary channel. We found that MRCP has better efficiency comparative to ultrasound to detect jaundice and its etiology i.e., 90% true positive. Keywords: Magnetic resonance cholangiopancreatography, Ultrasonography, Obstructive jaundice DOI: 10.7176/JHMN/91-03 Publication date:July 31st 202

Exploring the effect of zinc and boron application on oil contents, protein contents, growth and yield of sunflower

Sunflower is sensitive to boron (B) and zinc (Zn) deficiency when grown on deficient soil, A field experiment was conducted to determine the main and interactive effects of soil applied Zn and B on total production of sunflower at Agronomic Research Area, University of Agriculture, Faisalabad. Experiment was laid out in randomized complete block design (RCBI) with factorial arrangement using three replications with net plot size of 6 m x 4.5 m. The soil application of variable levels of Zn (0, 10, 20 and 30 kg ha-1) and B (0, 1, 2 and 3 kg ha-1) in the form of zinc sulphate and boric acid, respectively were applied at time of sowing. All other agronomic and plant protection practices were kept uniform. The data regarding growth, yield and quality parameters were noted by using standard procedures. Results showed that Zn @ 20 kg ha-1 and B @ 3 kg ha-1 significantly increased the number of plants per plot at harvest, stem diameter, head diameter, number of achenes per head, 1000-achene weight, biological yield and days to maturity, achene yield kg per, harvest index, leaf concentrations or Zn at heading stage, leaf concentrations of B at heading stage (ppm), achene oil content (%), achene protein contents as compared to control. This study concluded that higher growth and yield of sunflower can be achieved by application of Zn at 20 kg ha-1 and B at 3 kg ha-1 under Faisalabad conditions

Maize Adaptability to Heat Stress under Changing Climate

The rapidly increasing human population is an alarming issue and would need more food production under changing climate. Abiotic stresses like heat stress and temperature fluctuation are becoming key issues to be addressed for boosting crop production. Maize growth and productivity are sensitive to temperature fluctuations. Grain yield losses in maize from heat stress are expected to increase owing to higher temperatures during the growing season. This situation demands the development of maize hybrids tolerant to heat and drought stresses without compromising grain yield under stress conditions. The chapter aimed to assess the updates on the influence of high-temperature stress (HTS) on the physio-biochemical processes in plants and to draw an association between yield components and heat stress on maize. Moreover, exogenous applications of protectants, antioxidants, and signaling molecules induce HTS tolerance in maize plants and could help the plants cope with HTS by scavenging reactive oxygen species, upregulation of antioxidant enzymes, and protection of cellular membranes by the accrual of compatible osmolytes. It is expected that a better thought of the physiological basis of HTS tolerance in maize plants will help to develop HTS maize cultivars. Developing HTS-tolerant maize varieties may ensure crops production sustainability along with promoting food and feed security under changing climate