bluuebunny/crossref_metadata_2025 huggingface dataset:
PSYCHIATRIC DISORDERS;
Authors: AMIN RAHEELAH , GUL RUBINA , KHAN M. AKBAR , Tariq M. , - Shaffiullah , Mehrab Amina
Published: September 2021

Objectives: The study was conducted to examine the pattern/trend of psychiatric disorders in a hospital based setting.Settings & Period: Conducted at Govt. Sarhad Hospital for Psychiatric Diseases, Peshawar in March-April, 2010. Study Design: SimpleObservational. Methods: A Retrospective record review was done to determine the disease pattern for patients examined in the OPD(outpatient deptt.). All the patients who attended OPD in year 2010 and 2004 were included.The diseases were coded and classifiedaccording to ICD- 9 & 10. Comparison & Statistical analysis of both years was done. Results: The findings of the study suggested thatdisease pattern seen at hospital, represents mental diseases prevalent in Distt. Peshawar. It showed the predominance of schizophrenicgroup & neurotic (31-35%), stress related disorders (30-31%) group over other diseases. Next were the mode effective disorders (12-16%) and episodal & paroxysmal disorders group (16-17%). Drug dependence and mental retardation showed low percentage of 2%.Rest of diseases also showed low percentage. Although similar patterns were observed for both years but there were statisticallysignificant difference between the two years. Conclusions: Hospital utilization pattern is a useful guide to the prevalence of mentaldiseases in general community.The chronic illnesses consisted of major burden of disease. Major groups were Schizophrenic & Neurotic,and Stress related disorders group. Pattern of psychiatric illness have not changed much from 2004 to 2010. Although the hospital iscatering a large number of patients, yet there is a dire need of organizing mental health services at community level to reach undiagnosedpatients.
BRAIN ABSCESS;
Authors: ALORAIJ MUBARAK
Published: September 2021

Objective: To evaluate the clinical presentation, diagnosis, sources of infection, surgical management outcome andmicroorganisms involved in the brain abscess in our locality. Period & Setting: This study was carried out in the department ofNeurosurgery, Aseer Central Hospital Abha, Southern Province, KSA from 1426 H – 1433 H (2005-2012 AD). Material and Methods: Atotal of 30 children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was5.6±4.4 years. Results: Typically patients presented with fever, vomiting, headache and seizures. The predisposing conditions foundwere cyanotic congenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%) and no underlying causewas found in 5 (17%) children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcusmilleri group (52%). All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation.Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5. Conclusions: It is concludedfrom the study that delayed surgical drainage has high morbidity and mortality. Diagnosis with CT scan, appropriate antibiotic therapy andcomplete aspiration of abscess reduced the mortality and neurological deficits from brain abscess.
COPPER AND CADMIUM LEVELS IN HAIRS & NAILS;
Authors: AYYUB ASMA , AHMAD MUHAMMAD. SHAKEEL , IKRAM NAHEED , Shan Um-e-Ammara
Published: September 2021

Heavy metals ingested or inhaled can affect liver, Brain, Bone and lungs. Raised copper and cadmium levels have beenseen in ischemic heart disease. A level of trace elements varies in blood among population. In this study Copper & Cadmium levels weredetermined in hairs and nails; easy to sample and store. Purpose of this study is to find out relationships with heavy metals pollution andtry to develop as a screening test. Such work is not yet done in our population. 86 male subjects and 20 controls (male) were selected fordetermination of Cu & Cad concentrations in hairs and nails. Medical history was noted. 3-4 fingernails and 1 tbsp of hair cut from thenape of neck close to root were obtained. Samples were analyzed by atomic absorption spectrophotometer. Highly significant (p< 0.001)raised copper levels were seen in hairs and nails of subjects (110.79+26.01 & 99.34 + 7.81μg/gm respectively) compared with control(80.76+ 7.81& 77.65+ 2.48). Similarly significantly (p< 0.001) raised Cadmium levels were found in subjects (hairs 143.57+62.03&nails 104.71+74.52) compared with control (89.20+ 12.98 & 77.54+ 12.32). Highly significant (p< 0.001) raised values of Cd & Cuindicate that hairs and nails concentration may indicate heavy metals pollution & it can be easy sampling test for screening of pollutionabout heavy metal exposure.
LOW BIRTH WEIGHT BABIES;
Authors: ZAIDI KASHIF ABBAS , AIJAZ NIGHAT , HUDA NASR-UL-
Published: September 2021

Objective: To determine the spectrum of problems in LBW neonates at Secondary care level and their immediate outcome.Design: Descriptive Study. Place & Duration of Study: Agha Khan Hospital for Women and Children, Kareemabad and Agha KhanHospital for Women and Children , Kharadar, from January 2009 till December 2009. Results & Conclusions: Of the 4500 babies born inAgha Khan secondary hospitals, 429 were Low Birth Weight and 191 were admitted to the nursery. The ratio of males to females was0.86:1.0 (199 males and 230 females). Approximately 41% of the babies were less than 2 kgs and Preterm babies made up 20.9 % oftotal low birth weight. Of the 191 babies, 99 (51.8%) had hyperbilirubinemia ; 16(8.3%) had respiratory distress syndrome of thenewborn; 16(8.3%) had vomiting and they were observed for necrotizing enterocolitis; 21(10.9%) had presumed sepsis; 12 (6.2%) hadhypocalcemia; 11(5.7%) had hypoglycemia 08 (4.1%) had Meconium Aspiration Syndrome;; 05 (2.4%) had thrombocytopenia; and 02(1.04%) had hyperviscosity with hematocrit of more than 65%. Common causes of morbidity in LBW babies are jaundice, sepsis,Respiratory distress, hypoglycemia and hypothermia. Introduction of standard management guidelines aid in reduction of morbidity. Withcareful selection of cases and predetermined criteria for transfer to the tertiary level nursery, it is possible to care for a vast majority of thenewborns in nurseries at secondary level .
SPINE SURGERY;
Authors: SATAR ABDUL , INAM MUHAMMAD , ARIF MOHAMMAD , Saeed, Mohammad , Wazir, Imran Khan
Published: September 2021

Objectives: The objective of this study is to find out the complication directly related to iliac bone graft harvest in spinesurgery. Design: Observational prospective study. Setting: Department of Orthopedic and Spine surgery, Hayatabad Medical ComplexPeshawar. Period: January 2007 to April 2012 on 139 patients. Material and method: Only those cases were included in whom bonegrafting was done for fusion as part of their spine surgery and were successfully followed for at least 6 months. Results: Out of 139patients 59(42.4%) were female patients while 80(57.6%) were male. Minimum age of the patients was 4 years while maximum was 70years. In 119(85.6%) patients cortico-cancellous bone graft was taken. While in 20(14.4%) patients, tri-cortical graft was taken. Inmajority 106(76.3%) cases graft was obtained from the posterior iliac crest while in 33(23.7%) it was obtained from the anterior iliaccrest. 45(32.4%) had some pain at the bone graft site. 8(5.8%) had early deep infection while 6(4.3%) had early superficial infection. Nine(6.4%) of our patients had nerve injury evident by parasthesia in the zone of distribution. Conclusions: Iliac crest is an excellent sourceand best available material for autogenous bone grafting. However it is not free of complications. The most common complications arepersistent chronic donor site pain, infection and heamatoma.
PRIMARY OSTEOSARCOMA DISTAL FEMUR;
Authors: SHAH FAAIZ ALI , ZIA ABDUL AZIZ , KHAN ZAHIR , - Kifayatullah
Published: September 2021

Objectives: This study was designed to estimate the incidence rate of pulmonary metastasis at the time of diagnosis ofprimary osteosarcoma distal femur in a tertiary care hospital. Study Design: Descriptive case series. Setting and Duration: OrthopaedicSurgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from March 2011 toSeptember 2012. Methodology: Nine patients of primary osteosarcoma distal femur were assessed with CT chest for pulmonarymetastasis. The frequency and patterns of pulmonary metastasis on CT chest were documented. After the biopsy reports all patientswere referred for neo adjuvant chemotherapy before any definite surgical procedure. The histological types of osteosarcoma were noted.RESULTS: Nine patients including 7 male (77.7%) and 2 females (22.2%) with mean age 12.4 years were included in our study. 66.6 %(n=6, 5 males, 1 female) had pulmonary metastasis on CT chest at initial presentation while 33 %( n=3,2 males,1 female) had nopulmonary metastases on CT chest. Three (50%) patients had pulmonary metastasis in the right lung, 1(16.6%) had on left side while2(33.3%) had bilateral pulmonary involvement. Of the cases with metastases at diagnosis, 55.5% had osteoblastic histology ofosteosarcoma compared with 33.3% of those with non metastatic disease. Conclusions: Majority of osteosarcoma distal femurpresented with pulmonary metastasis at initial presentation. A high index of suspicion accompanied by careful examination of the limband appropriate radiographs at initial assessment may reduce the incidence of such delays in diagnosis and the associated risks.
MECONIUM STAINED LIQUOR;
Authors: ASLAM, IRAM
Published: September 2021

The Presence of meconium in amniotic fluid is a risk factor for intrapartum hypoxia. It had been considered as an indicatorof poor neonatal outcome. Objective: To determine neonatal outcome in meconium stained liquor. Design: Descriptive Study. Setting:Department of Gynae and Obstetrics, Fatima Memorial Hospital, Lahore. Period: 06 months from 21-01-2009 to 20-07-2009. Subjectsand Methods: The patients with meconium stained liquor were assessed by per speculum examination and were followed till the time ofdelivery. Neonatal outcome was assessed by APGAR scores at 1 minute, vocal cord staining, admission to ICU Nursery, perinatal death,need of resuscitation and total stay in ICU Nursery. Results and Conclusion: During the study period, 140 patients were included in study.Among these, 97 babies had APGAR score < 5 at 1 minute, 102 babies had staining of vocal cord while 119 babies were admitted to ICUNursery. Incidence of perinatal death was 8.6%. Conclusions: Meconium stained liquor is associated with poor neonatal outcome.
POSSIBLE TOXIC EFFECTS OF BENZODIAZEPINES;
Authors: IQBAL SYED TALAT , BATOOL ZAINAB , MEHMOOD SAJID
Published: September 2021

Introduction: Benzodiazepines and its derivatives are used widely as anxiolytics, hypnotics, seizure control and as musclerelaxants. Design: The prescriptions of 270 patients were evaluated for moderate to severe drug interactions using drug interactiondetection software. Setting: Teaching hospital in Gujrat, Pakistan. Objective: This study is used to evaluate the possible toxic effects ofbenzodiazepine related drug-drug interactions in prescriptions of indoor patients. Material & Methods: The prescriptions wereprocessed through a software program named, The Medical Letter Adverse Drug Interaction program. The randomly collected patientchart profiles included both male and female patients ranging from age of few months old children to old aged patients. Result: Out of 270patients medication charts 210 medication charts were having at least one or more drug interactions ranging from moderate to severe.Out of 80 interacting drug combinations found, 15 were benzodiazepine related drug interactions. So, percentage of benzodiazepinesrelated drug interactions was 18.75%.Moreover, the data also showed that the percentage of DDIs increases as the prescription sizeincreases. Our results indicate that hospitalized patients in Pakistan are at risk of ADRs caused by potential DDIs. Moreover, there arechances that the safe therapeutic doses of benzodiazepines may become toxic or ineffective due to drug-drug interactions andpolypharmacy. Conclusions: So, the use of DDIs detection software programs in hospitals and pharmacies should be promoted in orderto minimize drugs especially benzodiazepines related injuries and to ensure patient safety.
POSTPARTUM STRESS;
Authors: ASIF, HAFIZ MUHAMMAD , HAYYAT KHIZAR , IQBAL ANAM
Published: September 2021

There is no consensus on the amount of exercise necessary to improve pelvic floor muscle (PFM) function. We reviewedthe pathophysiology of PFM dysfunction and the evolution of PFM training regimens since Kegel introduced the concept of pelvic floorawareness and the benefits of strength. This paper describes the effect of pelvic floor muscle training (Kegel Exercises) in stress urinaryincontinence. The design of PFM training logically requires multiple factors to be considered in each patient. Objectives: The objective ofthe study was to determine the effects of pelvic floor muscle training with postpartum urinary incontinence (1) Improvement in urinarycontrol. (2) Improvement in relieving urinary urgency. (3) Time duration in which patient returns to functional activities. (4) Anycomplications after exercises. Study Design: Quasi Study. Place and Duration of Study: the study was carried out in department ofphysiotherapy Ghurki Trust Teaching Hospital Lahore the duration of study was 12 months from May 2011 to April 2012. Patients andMethods: The study was based on 28 patients who were having the complaint of postpartum urinary incontinence. Abdominal and pelviccontrol was assessed and recorded before commencing the exercises and was also assessed regularly on every follow up. Results:Kegel exercises helps to control and eradicate the problem of postpartum stress urinary incontinence. Conclusions: Kegel exercises givea good result in postpartum stress urinary incontinence.
EPIDEMIOLOGY OF AMPUTATION;
Authors: SOOMRO NABILA , BIBI RUKHSANA , AHMED SYED IMRAN , Kamran Brigitte , Minhas Muhammad Ali , Siddiqui Kamran Yousuf
Published: September 2021

Amputation is stated to be a foremost but preventable community health problem causing intense financial, social andemotional effects on the patient and family particularly in developing countries where the prosthetic services are limited. The purpose ofthis study was to identify the causes and levels of amputation in low resource community, Sindh Pakistan. Methods: This was aretrospective chart review study that was carried out at first civilian Institute of physical medicine & rehabilitation-Dow University of healthsciences from October 2007 to June 2012. After verbal informed consent all patients, who underwent major or minor amputation wereenrolled for the study. Data was collected using a pre-tested, coded questionnaire and analysed using SPSS version 16. Results: A total of1115 patients were enrolled into the study. Their ages were ranged between 2–95 years (mean 38.40±17.38). Among total population ofamputees 83.58% were males. The most common cause for major limb amputation was road Traffic accident 38.38%, followed byDiabetes 15.42%, infection 14.26% and trauma 12.37%. Lower limbs (trans-tibial) amputations were in 47.35% of cases and transfemoralin 27.98% of cases. While for the upper limb trans-radial amputation (7.4%) were found to be more common than trans-humeral(5.56%). Other amputations were for shoulder, hip and knee disarticulations. Conclusions: Road traffic accidents, complications ofdiabetic foot ulcers, infections and trauma were the most common causes for major limb amputations found in low resource community,Sindh Pakistan. The majority of these amputations are preventable by endowment of traffic rules, health education, early preventions andappropriate management of the common infections.
BACTERIAL VAGINOSIS;
Authors: SHAIKH SHAHIDA , SHAIKHM SALEEM AKHTER , ZIA BASMA
Published: September 2021

Objective: To establish the frequency of bacterial vaginosis in asymptomatic pregnant women. Study design: Crossst Sectional Descriptive study. Setting: Private tertiary care hospital of Larkana. Period: 1 June 2011 to 31st December 2011. Materialand methods: 120 asymptomatic pregnant women at 14-28 weeks of gestation were included in this study after fulfilling selectioncriteria. A high vaginal swab stick was dipped into secretion through speculum and slides were made and sent to attached laboratory forclue cells. Vaginal PH was tested with PH paper (change in color noted). Whiff test was performed by adding two drops of KOH onposterior blade of speculum for fishy odour. The diagnosis of bacterial vaginosis was made with the help of Amsel’s criteria. Presence of>3 signs was labeled as bacterial vaginosis positive. Data analysis was done on statistical package of social science (SPSS version 13).Results: Although total 120 patients who were recruited in our study, all did not present with any symptom of vaginal discharge, but thefrequency of pregnant women having Bacterial Vaginosis was quite high. A total of 77 (64.1%) patients discovered positive for bacterialvaginosis, while only 43 (35.8%) patient’s samples were negative for bacterial vaginosis. The mean age of our patients was 28.56 ±3.71years, while mean gestational age was 24.65 ±2.34 weeks. Homogenous milky discharge was observed in total 65 (54.16 %) patients,while in rest of patients, we did not detect any discharge. Bacterial Vaginosis was more prevalent in women belonging to lowsocioeconomic group and who had low literacy rate. Conclusions: The frequency of bacterial vaginosis was found to be very high amongasymptomatic pregnant women. Timely diagnosis can be helpful in treating complications related with it.
TOTAL THYROIDECTOMY
Authors: SAJID MUHAMMAD , BIBI SARWAT , MISBAH JUNAID
Published: September 2021

Objective: To find out frequency of hypocalcemia after total thyroidectomy. Study design: Descriptive study. Methods:60 patients undergoing total thyroidectomy for multinodular goiter from January 2010 to December 2010. Evaluation of results was doneby analyzining the data in SPSS V-17. Results: In 60 patients undergoing total throidectomy, only one patient (1.67%) developedpermanent hypocalcemia and 11 patients (18.3%) developed transient hypocalcemia. Conclusions: Total thyroidectomy can safely beperformed in patients with multinodular goiter with very low risk of permanent hypocalcemia.
RISKY GRAND MULTIPARAS
Authors: - IRUM , KAUSAR SAMINA , ALI ROBINA , Shaheen Shazia
Published: September 2021

Grandmultiparity has long been classified as constituting a high risk factor in pregnancy. The complications associatedwith grandmultiparity have been divided into ante-partum, intra-partum and the postpartum. Intrapartum complications most commonlythought to be associated with grandmultiparity are malpresentations, placental disorders, postpartum hemorrhage and uterine rupture.Concerted effort should be instituted for effective family planning initiatives and specialized antepartum and intrapartum management.Objective: To determine the frequency of intrapartum complications and mode of delivery in grandmultipara. Material and Methods: Itis descriptive case series study conducted in department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals,Faisalabad from March 11, 2010 to September 10, 2010. Results: Grandmultipara women who fulfilled the inclusion criteria werestudied for intrapartum complications and mode of deliveries. One hundred and thirty nine patients were included in my study. Mean ageof the patients was 32.38 years. Mean gestational age for delivery was 37.06 weeks. Grandmultiparas had more intrapartumcomplications including malpresentation (19.4%), placental abruption (5.8%), placenta previa (8.6%), postpartum hemorrhage (6.5%)and ruptured uterus (1.4%). Mode of delivery was also assessed and 59%, 7.9 %, 31.7% of patients had normal vaginal delivery,instrumental vaginal delivery and cesarean section respectively. Conclusions: It is concluded that in the developing countries theincidence of grandmultiparity is still high with a significantly increased risk of complications. Grandmultiparity should be considered highrisk and needs active intervention by improving literacy, health care facilities, provision of safe and effective contraception andreproductive health status.
HYPERTENSIVE PATIENTS;
Authors: ARSHI SHAHANA , NAHEED FAKHRA , BADSHAH MAZHAR , Naz Farah , Sardar Kamran
Published: September 2021

Objective: To see the frequency of diabetes mellitus and impaired fasting glucose levels in hypertensive patients. Design:Descriptive study. Place of Study: OPD / Filter clinic. Pakistan Institute of Medical Sciences. Islamabad. Patients and Methods: Thisstudy was carried out on 116 hypertensive patients during the period from August to September '2008. Out of 116 patients, 64 werefemales and 52 were males with age group between 20 to 70 years. Secondary causes are ruled out on the basis of history and physicalexamination. Blood samples were sent to PIMS laboratory for fasting glucose. Data and results were analyzed in SPSS. Results:According to this study, out of 116 patients, there were18 patients who had diabetes mellitus while 33 had hypertension with impairedfasting glucose tolerance which is statistically significant. The females as compared to males were increased in number who had bothdiabetes mellitus and impaired fasting glucose. According to age diabetes mellitus increased in age groups between 41-50 and 61-70years while impaired fasting glucose were increased in age group between 31-60 yrs. The results indicate that impaired fasting glucose ispresent in significant number of hypertensive patients. Conclusions: Hypertension is associated with diabetes mellitus and impairedfasting glucose.
OBSTETRICAL ACUTE RENAL FAILURE;
Authors: GHORI AMBREEN , MADHUDAS CHANDRA , KHURSHID FERKHUNDA , Siakndari Jamila , Devrajani Tarachand , Shah Syed Zulfiquar Ali
Published: September 2021

Background & Objective: Acute renal failure is one of serious complication in pregnancy, in first trimester is usuallyrelated to unregulated and septic miscarriage while in third trimester it is due to obstetric complications. This prospective case seriousdescriptive study was conducted to determine the frequency, etiology and outcome of patients suffering from acute renal failure.Settings: Department of Gynecology & Obstetric at Liaquat University Hospital Hyderabad. Duration: One year (from 1st June 2011 to31st May 2012) Patients and Methods: Patients admitted in labor room during antepartum, intrapartum or post partum period werescrutinized by history, clinical examination, and investigations. Those with urine output less than 50cc in 24hours were defined as case ofARF. Predesigned proforma filled to analyze etiology and outcome of patients with acute renal failure. Results: Out of 3220 patientsadmitted, 35 patients presented with acute renal failure giving incidence of 1.080%. APH(28.57%), PPH(25.7%), P.sepsis (14.28%) andHypertensive disorder(5.14%) were leading cause of ARF. 60% patients recovered from injury and mortality in these patients were 11.4%.Conclusions: Poor health care facilities and lack of quality antenatal healthcare clinics were the major identified causes.
GUILLAIN BARRE SYNDROME;
Authors: ASHRAF SOHAIL , RAHMAN ARSHALOOZ J.
Published: September 2021

Background: Guillian Barre Syndrome is a polyradiculopathy characterized by symmetric ascending paralysis andareflexia. It affects all age groups and both sexes with an unpredictable outcome. Objectives: The aims of this study were to identify thevarious diseases presenting as Acute Flaccid Paralysis and notice clinical features and outcome of cases of Guillian Barre Syndrome.Materials and Methods: Retrospective analysis of 53 patients presenting as Acute Flaccid Paralysis was done. Clinical features andlaboratory investigations of 39 patients of Guillian Barre syndrome were reviewed. Results: Among all cases of Acute Flaccid Paralysis,Guillian Barre syndrome formed the bulk of the cases (73.6%).It was more common in females and in age group of 10 years or below. Inmajority of the cases, rapid onset of weakness was the initial symptom. Mortality was 100% in patients who had respiratory muscleinvolvement and who required mechanical ventilation. Conclusions: In our study the main factor causing death in a case of Guillian Barresyndrome was bulbar involvement requiring mechanical ventilation. Early recognition of the prognostic factors may lead to decreasedmortality in case of Guillian Barre syndrome.
RECURRENT PALATAL FISTULA AND NASAL REGURGITATION;
Authors: ISHAQ IRFAN , FAYYAZ GHULAM QADIR
Published: September 2021

Background: Post Palatoplasty fistulas are the common complications seen after cleft palate repair. This produce varioussymptoms including regurgitation of fluids into nasal cavity, interference with normal speech and middle ear problems . Although smallfistulas can be successfully treated with local flaps such as palatal or buccal mucosal flaps, large fistulas are difficult to treat. Because ofrich blood supply, tongue is a suitable and convenient source of large flap. The anteriorly based dorsal tongue flap is a safe and effectivemethod for closure of relatively large recurrent palatal fistula without any functional impairment of donor site. Objective: To determine thesuccess rate of Tongue flap in correction of the nasal regurgitation in recurrent palatal fistulas Duration of study: 12 months from 16thJuly 2010 to 15th July 2011. Study design: It was descriptive case series. Settings: This study was carried out in the department ofplastic surgery Services institute of medical sciences, Services Hospital Lahore. Methods: Forty patients who were having recurrentpalatal fistula included in this study. All underwent palatal fistula repair by dorsal tongue flap. Each patient was followed after one month ofoperation for fistula closure and correction of nasal regurgitation. Results: In this study 65 percent of the patients were male, while 35percent of them were female. 21 (52.5%) of the patients belonged to age group 10-15 years, while 14 (35.0%) of the respondents had 16-20 years of age and remaining 5 (12.5%) of them had 21-30 years of age. The 90 percent (out of 40) of the patients had complete fistulaclosure, while only 10.0 percent of them had not complete fistula closure. Nasal regurgitation was corrected in 38 (95 %) of the patientsand remaining 2 ( 5%) patients had un-corrected nasal regurgitation. Conclusions: Tongue flap is a effective and reliable method oftreatment, not only for palatal fistula closure but also treating nasal regurgitation which is a social stigma for patients in recalcitrant palatalfistula.
VERNAL KERATOCONJUNCTIVITIS;
Authors: KHATTAK LAL MUHAMMAD , QADAR AFZAL , IQBAL ARSHAD , Khan Umer , Zaman Mir
Published: September 2021

Purpose: To find out safety and effectiveness of supratarsal injection of Triamcinolone in cobble stone papilla e in VernalKeratoconjunctivitis (VKC). Design: Prospective, uncontrolled trial. Period: June 2009 to January 2010. Setting: Department ofOphthalmology KMU Institute Of Medical Sciences Hospital KDA Kohat. Material and Methods: One hundred and fifty diagnosed patientsof VKC, of both sexes and age group between 5 – 40 years were included in the study. Patients with glaucoma, or steroid responder, postherpeticcorneal scar, active infection of cornea or conjunctiva, tightly closed eyelids, patients who lost follow-up, and patients unwillingto be enrolled in this study were excluded from the study. The patients were enrolled and informed consent was taken. Supratarsalinjection of Triamcinolone was given. Their record was maintained and all the patients were followed up for six months for evaluating theireffectiveness and side effects. Results: We treated two hundred and seventy five eyes of one hundred fifty patients. Among them 80%were males. Mean age was 14 years (range: 5—40 years). All of the patients had itching of eyes, redness, watering, photophobia,cobble-stone papillae and Tranta's dots. Mean duration of disease was 27 weeks (Range: 4 weeks to 10 months). Patients were followedup and multiple injections were given for controlling disease. Transient redness was the most common side effect of injection therapy.Study shows 100% effectiveness of supratarsal injection of triamcinolone acetonide in VKC although
DIABETES MELLITUS TYPE 2;
Authors: ALAM MUHAMMAD TANVEER , KHIEMANI HARILAL , MALIK AMIR SHAHZAD , Aurengzeb Muhammad , Pathan Mukhtiar , Imran Khalid
Published: September 2021

Objective: The objective of this study is to determine the pattern dyslipidimia in patients of Type 2 diabetes mellitus. StudyDesign: Cross-sectional study. Place and Duration: This study was carried out in General Medicine department of Peoples MedicalUniversity & Hospital Nawabshah and Civil Hospital Karachi, from June 2011 to July 2012. Methodology: This study consisted of seventypatients. Detailed history was taken from all the patients with special regard to increased thirst and frequent urination, increased hunger,weight loss, fatigue, blurred vision, slow-healing sores or frequent infections and an areas of darkened skin. Inclusion criteria were that allpatients after counseling for study and taking written consent were included in this study >35 years of age with either sex admitted ingeneral medicine ward through outpatient department and diagnosed as case of DM type 2 on the basis of history , clinical examinationand investigations. Exclusion criteria included patients on dialysis, patients on lipid lowering agents, patients with acute complication ofdiabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, nephritic syndrome, type 1 DM and HTN, lacticacidosisand hypoglycemia. Results were prepared with the help of tables and graphs. Data was analyzed through SPSS software.Results: Out of 70 patients included in this study 46 were men (65.8%) and 24 patients were female (34.2%); with male to female ratio of1.9:1. There was wide variation of age ranging from a minimum of 35 year to 75 year. The mean age was 48.65+7.8 years. Mean totalserum cholesterol was 196.04 ± 44.02mg/dl, mean serum triglycerides was 193.04 ± 108.64 mg/dl , mean high density lipoprotein29.28 ± 8.48mg/dl, mean low density lipoprotein 125.24 ± 39.68mg/dl and mean very low density lipoprotein was 31.28 ± 8.48 mg/dl.Total cholesterol was abnormal (>200mg/dl) in 56(80%) patients out of 70[ 21(87.5%) were females and 35 (76.1%) were males],Triglycerides was abnormal (>150mg/dl) in 62(88.5%) patients [ 22 (91.66 %) were females and 40 (86.95%) were males], high densitylipoprotein was abnormal (< 35 mg/dl) in 51(72.8%) patients[ 18(75%) were females and 33(71.73%) were males], LDL was abnormal(>130 mg/dl) in 40(57.1%) patients [ 17 (70.83%) were females and 23(50%) were males] and VLDL was abnormal (> 30 mg/dl) in47(67.14%) patients [19(79.16%) were females and 28(60.86%) were males]. Conclusions: We conclude that dyslipidemia is commonamong type 2 diabetic patients. Males are more prone to suffer from this complication. Patterns of dyslipidemia found more commonlywere decreased HDL levels, increased LDL and Triglycerides levels. There is a need for early detection and treatment of this problem toprevent type 2 diabetic complications .
EPIPLOIC APPENDAGITIS;
Authors: IQBAL MUHAMMAD ZAFAR , AWAN ZEESHAN MAJEED , KHAN NOOR AHMAD
Published: September 2021

Acute epiploic appendagitis is an uncommon cause of abdominal pain that has only recently been recognized. Thediagnosis of this condition primarily relies on cross-sectional imaging and is made most often on CT, although occasionally sonography1 2- has been used . Epiploic appendages are fat- and blood vessel-containing outpouchings protruding from the serosal surface of the colon4. They appear in the fifth month of fetal life and in an adult human, the average number of epiploic appendages is approximately 50-2,3,5 100.They measure from 2-5 cm in length . Epiploic appendagitis is the inflammatory process of the epiploic appendage and hasprimary and secondary types. Primary epiploic appendagitis (PEA) is the infarction and inflammation of an appendage because of torsionor spontaneous venous thrombosis. PEA mimics acute abdominal diseases; thus, it must be distinguished from the secondary epiploic2,3 appendagitis, which is caused by neighborhood inflammatory processes such as diverticulitis, appendicitis or cholecystitis . The mostcommon computed tomographic (CT) appearance of acute epiploic appendagitis is the presence of 1.5- to 3.5-cm-diameter fat-density1 lesion with surrounding inflammatory changes abutting the anterior wall of the sigmoid colon .
COLORECTAL CARCINOMA;
Authors: NAZEER MOHAMMAD ADNAN , SHAHZAD QAMAR , DAR HARUN MAJID , Samreen Asma , Aalam Humaira
Published: September 2021

Introduction: Large bowel obstruction due to colorectal carcinoma occurs in up to 20% of the patients and usually2-4 accompanied by morbidity and mortality . Almost 25 % deaths occur post-operatively following surgery for colorectal cancers occur in1 those who initially present with obstruction . Usually elderly patients with associated co-morbidities presents with bowel obstruction.Objective: Find out the frequency of colorectal cancers in patients presenting with large bowel obstruction. Design: Prospective crosssectional study. Setting: Shaikh Zayed Hospital Lahore. Period: from 31st December 2010 to 31st December 2012. Materials &Methods: A total 20 patients were presented with large bowel obstruction with the age ranges between 40 to 70 years. All the 20 patientsunderwent routine haematological and biochemical tests. In these patients an abdominal x-ray in a supine or standing position was takenand dilated loops of bowel, air-fluid interfaces, or both was observed then Contrast radiography(Barium/gastrograffin) was done todefine the site and extent of the obstruction. An abdominal computed tomography scan was done to evaluate the extent of the disease.Colonoscopy was also carried out in the patients with colorectal cancers to find out the size and location of the tumor and biopsy taken bycolonoscope. Results: 12 patients out of 20 presented with large bowel obstruction were diagnosed to have a colorectal cancers and theage ranges from 60 to 70 years. The 8 patients were diagnosed to have a sigmoid colonic tumour and 4 patients were suffering from atumour of recto sigmoid junction. Whereas in rest of the 8 patients the large bowel obstruction was due to other benign causes likevolvulus and intussusception and age range was 50 – 60 years. 6 patients were suffering from sigmoid volvulus and remaining 2 hadcolo-colic intussusception. Conclusions: It is concluded that the major cause of the large bowel obstruction is the left sided colorectalcancers the tumours of recto sigmoid junction.
PROM;
Authors: NAZEER BUSHRA , KAUSAR SAMINA , ALI ROBINA , Shaheen Shazia
Published: September 2021

INTRODUCTION: PROM is not uncommon in pregnancy. It occurs in 10% of term pregnancies. At term about 75% ofwomen will go into labour within 24 hours of rupture of membranes. At term there are two options, either wait for spontaneous onset oflabour or immediate induction to establish labour. For induction of labour different kinds of drugs are used according to Bishop score. IfBishop score is favorable (
ACUTE MYOCARDIAL INFARCTION;
Authors: ALI DASTI MASHOOQ , HASHMI SYED FASIH AHMED , BALOCH GHULAM HUSSAIN , Shah Syed Zulfiquar Ali
Published: September 2021

OBJECTIVE: To determine the serum zinc level in patients with acute myocardial infarction at Liaquat University HospitalHyderabad. PATIENTS AND METHODS: This six months study was conducted on the patients with acute myocardial infarction presentedat coronary care unit (CCU) of Liaquat University Hospital Hyderabad. All the patients with myocardial infarction, of
DIABETIC NEUROPATHY;
Authors: PHULPOTO JAVED AHMED
Published: September 2021

Objective: To estimate the prevalence of diabetic neuropathy (severity wise) and associated risk factors in patients havingtype 2 diabetes mellitus. Study Design: A cross-sectional study. Place of Study: Diabetes Clinic, Ghulam Mohammad Mahar MedicalCollege Hospital, Sukkur. Duration of Study: From January 2009 to December 2011. Materials and Methods: A patients based sample of1401 persons with diabetes (identified as per the WHO criteria) underwent comprehensive eye examination including direct & indirectFundoscopy for diabetic retinopathy grading. Vibration perception threshold (VPT) measurements were done to assess neuropathy (cutoff
CHRONIC HEPATITIS “C”;
Authors: HAYAT ATIF SITWAT , BAWANY MUHAMMAD ADNAN , SHAIKH TARIQ ZAFAR , Khahro Adnan Ali , Khanzada Shireen Rahat
Published: September 2021

OBJECTIVE: To find spectrum of various dermatological manifestations during hepatitis “C” virus infection in localpopulation of hyderabad. METHODS: This descriptive study was conducted in medicine department of Isra University HospitalHyderabad from January 2011 to June 2012. A total of 325 anti-HCV positive patients were enrolled. All patients were subjected todetailed history, careful clinical examination of skin by a dermatologist to diagnose skin disease. All data was analyzed using statisticalpackage SPSS 14.0. RESULTS: A total of 325 HCV positive patients (61% males and 39% females) were enrolled in this study. Mean agewas 43 (SD+10 years), ranging from 15 to 78 years. About 41% had one or more dermatologic manifestations. Pruritis was the leadingmanifestation found in 11% , lichen planus (oral and cutaneous) was next to be found in 6.7% patients and hyperpigmentation in 5.2%patients. Urticaria (acute & chronic) was next counting in 5.23%. Jaundice, alopecia and vitiligo were seen in 4.9% each. Dry skin andinterferon injection site erythema were observed in 4.6% patients each. Cutaneous vasculitis was noticed in 3.6% each, whilephotosensitivity, psoriasis and Raynaud's phenomenon were seen in 1.8%, 2.5%, 1.5% patients respectively. CONCLUSION:Dermatological manifestations are very common in patients with chronic HCV infection and when confronted with a suspected skinlesion, patient should be screened for it. Epidemiological studies are essential to determine the real prevalence of other dermatoses duringcourse of HCV infection.
URINARY INCONTINENCE THREE MONTHS AFTER DELIVERY;
Authors: ALI HABIBA SHARAF , LAKHANI NIDA ANWAR , SARWAR NAILA GHULAM
Published: September 2021

Objective: The objective of this study was to investigate prevalence of urinary incontinence at 3 months postpartum andto study how continence status during pregnancy and different factors influence urinary incontinence at 3 months postpartum inprimiparous women. Setting: Pregnant women attending routine antenatal clinic at Ziauddin hospital and Kharader general hospitalKarachi were recruited to this study. Methods: Urinary incontinence before and during pregnancy was assessed at study enrolment earlyin the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role ofmaternal and obstetric factors in causing postpartum urinary incontinence. Results: Urinary incontinence was reported in 15 women(10.6% ) out of 141 women, mode of delivery, onset of labor weight of the baby, episiotomy, and the length of the second stage of labor,were not predictive of urinary incontinence after delivery. Adjusted RR for incontinence after spontaneous vaginal delivery compared withelective caesarean section was 2.200(95% CI .6-7.28) among women who were continent during pregnancy. Conclusions: Urinaryincontinence was prevalent 3 months postpartum. The association between incontinence postpartum mode of delivery, onset of labor,perineal trauma and weight of baby was not statistically significant.
THYROID MALIGNANCY IN MULTI NODULAR GOITER;
Authors: NADEEM KASHIF , AKHTAR NAVEED , TARAR JAVED MIRDAD
Published: September 2021

Objectives: To assess the incidence of malignancy in patients with Multinodular goiter in southern Punjab. Study design:A retrospective study. Place & Duration of study: Department of General Surgery, Sheikh Zayed Medical College & Hospital Rahim YarKhan, from April 2010 to May 2012. Patients and Methods: All patients were presented in OPD with history of Multinodular goiter onclinical examination or USG neck. FNAC of any dominant nodule or suspicious nodule on USG neck was performed. All patients wereoperated & total thyroidectomies were done in all patients irrespective of the age. We sent all specimens for histopathological examinationand reports were collected from department. The whole information collected was entered in a pre designed proforma. Results: During 2years period, total 141 patients of thyroid disease were seen in OPD out of which 98 patients have Multinodular goiter. Histopathology ofthese patients showed 10 malignancies & 88 benign. Most of the patients that turned out to be malignant belong to 41-50 years agegroup. 7 patients were female and 3 were male. Among the malignancies 50% were papillary, 30% were follicular, and 10% wereanaplastic carcinoma & lymphomas each. Conclusions: Multinodular goiter (MNG) is the commonest indication of thyroidectomy iniodine deficient areas of Pakistan. This study concludes that don’t consider MNG as a benign disease anymore until proved otherwise.
HAZARDS OF MULTIPLE MAGNET INGESTION IN CHILDREN;
Authors: SHEIKH MUHAMMAD ALI , LATIF TARIQ , SHAH MASOOM ALI , AKHTAR Jamil , Qayuum Abdul
Published: September 2021

Foreign body ingestion is relatively common in the paediatric population and most object pass through the gastrointestinaltract spontaneously. With the popularity of small magnetic toys, there have been numerous reports of magnet ingestion with morbidityand even mortality. We report a case of 3-years old boy who presented with clinical features of subacute intestinal obstruction with nohistory of foreign body ingestion. On exploratory laparotomy, he was found to have multiple small bowel perforations due to two smallmagnets. Magnets were removed and perforations repaired. The aim of this report is to awarepaediatricians of the importance of earlysurgical referral in case of magnet ingestion, to prevent severe complications.
MALE CONTRACEPTION;
Authors: AZIZ ASIA , MALIK ASLAM MAHMOOD , BUKHARI IJAZ AHMAD SHAH , Tahir Abdur Rehman
Published: September 2021

Objective: To determine the knowledge and practice regarding male contraceptive methods among married malepopulation of Hansra basti Bahawalpur, Pakistan. Material and methods: This observational (Descriptive) cross sectional study wascarried out at Hansra Basti Bahawalpur from May 2011, to June 2011. A total of 100 married males were selected by simple randomsampling. Data was collected by pre-designed, pre-tested, questionnaire to collect the information from study population. An interviewwas conducted at respondents' house in local language. Privacy was ensured. Results: About 82% have knowledge about any of the malecontraceptive methods and out of those 18% were practicing any one of the family planning methods. Condom (Barrier) was most usedmethod (77.7%) followed by the traditional methods i.e abstinence (27.7%) and coitus interrupts (11.11%) where as result regardingvasectomy was nil. Source of knowledge mainly was media (44%) followed by through health professional (30%), wife (25%) and friends(21%). Conclusion: In present setting men have good knowledge of male contraceptive methods. However very small number ispracticing the contraceptive measures.
EXTERNAL FIXATOR;
Authors: JAN ROOHULLAH , ASKAR ZAHID , IQBAL JAVED
Published: September 2021

Introduction: Open Tibial shaft fractures are one of the most common fractures of long bones. External fixation is methodof choice for the treatment of open tibial shaft fractures. The subcutaneous location of tibia makes it suitable for the application of externalfixator. Patients and Methods: This study was done on 50 patients at Orthopaedics and Trauma unit “B” at Khyber Teaching Hospital,Peshawar, from Jan 2008 to Feb. 2009 to determine functional outcome of A.O. external fixator in open tibial fractures in terms of knee andankle mobility, pain and gait on full body weight bearing. The data of all patients was entered in standardized proforma and analyzed onSPSS 10. Results: There were 43 (86%) males and 7 (14%) females. There were 17 (34%) type-II and 20 (40%) type IIIA and 13 (26%)type III B fractures. Knee mobility was full (100%) in 49 (98%) cases, 75% in 1(2%). 43 (86%) cases retained 100% ankle joint mobilitywhile it was 75% in 4 (8%), 50 % in 2 (4%) cases and 25 % in 1(2%) cases. On full body weight bearing, 42(84%) patients were pain free,and moderate pain was in 4(8%) cases. In 42(84%) cases the gait was completely normal on full body weight bearing while 3(6%) casesshowed significant limping. Conclusion: The excellent functional results in our series show that external fixation of tibia is safe andeffective in terms of restoring functions of tibia.
STILLBIRTH;
Authors: RABIA SYEDA , PERVEEN FAUZIA , UDDIN SHAZIA SHUKUR , Tabussum Rumina , Ali Arif
Published: September 2021

Pakistan stands second in the world s rating of highest stillbirth rate. This gives an emergency call to authorities involved inmaternity health care of Pakistan to take serious and quick steps to address the problem. Method: Retrospective observational study attertiary health care centre to see frequency and risk factors for stillbirth in cases of severe acute maternal morbidity (SAMM) and maternaldeath over period from January 2008 till Jan 2010. Result: High stillbirth rate 438 | 1000 was found in the study group as compared tostill birth rate of 74 |1000 in rest of the deliveries during the same period. Data analysis by using multivariate regression for variables afteradjusting for co variable showed significant association (p value < .05) with still births of following factors grand multipara ( adjusted OR1.887 CI 1.156-3.081) primigravida (adjusted OR 1.623 CI -1.023-2.573) low education (adjusted OR 19.378 CI- 2.586-145.208) lackof standard antenatal{care Non booked (adjusted OR 10.101 CI 3.847-26. 518) referred cases (OR 5.879 CI 2.166-15.954)}pretermdeliveries (adjusted OR 2.994 CI 1.512-5.931) and vaginal deliveries 1.986 ( CI 1.351-2.920) whereas uterine rupture (adjusted OR4.003 CI 1.647-9.729) prepartum haemorrhage (adjusted OR 3.617 CI 1.756-7.451) and hypertension (adjusted OR 3.298 CI 2.040-5.330)were significant obstetric risk factors. Conclusion: Audit of SAMM and maternal death with emphasis on risk factors of still birthwould help to find strategies to reduce preventable causes of stillbirth .This would be important relatively quick contribution to efforts ofachieving MDG 4.
INGUINAL HERNIA;
Authors: ASLAM RASHID , SHAMSI HABIB KHAN , GUL AYAZ , Aman Zahid
Published: September 2021

Objective: To find out the frequency of recurrence in inguinal hernia mesh repair in Surgical Unit, Khalifa GulnawazTeaching Hospital Bannu / DHQ, Bannu. Material & Methods: 60 consecutive cases of inguinal hernia (direct/ indirect) of either side, inthis study were repaired by Lichtenstein's repair. The study was conducted from January, 2010 to October, 2010 with an initial follow up ofone year. Cases above 76 yrs were excluded from the study. Conclusions: The procedure of choice for inguinal hernia repair is tensionfree mesh repair.