bluuebunny/crossref_metadata_2025 huggingface dataset:
SOLITARY PLASMACYTOMA
Authors: Humail Syed Mujahid , Ahmed Masroor , Mustafa K.K Ghulam , Bux Muhammad , Afridi Hassan Dost
Published: August 2021

Solitary plasmacytoma of bone is one of the subtypes of plasma cell neoplasms.Solitary plasmacytoma is a kind of malignant tumor characterized by localized collection ofmonoclonal plasma cells. It is most frequently seen in vertebrae and long bones. Plasmacytomaof clavicle is very rare. We report a case of solitary plasmacytoma of lateral end of clavicle in a 30year old male presented with complaint of pain and swelling around the right shoulder region,though SPB can involve any bone of body but SPB involving the lateral end of clavicle is very rarepresentation.
GROWTH STANDARDS AND CHARTS
Authors: Rehman Abdul
Published: August 2021

There are a number of growth references available for children internationally butin 2006 the World health organization published growth standards for children 0 60 months.These growth standards have been adopted even by the developed countries though with somemodifications. This article discusses the various aspects of growth standards including plotting ofcharts and their interpretation.
CONGENITAL AGANGLIONOSIS;
Authors: Ahmad Umar Farooq , Ishfaq Muhammad , Akhtar Naz
Published: August 2021

… Objective : To report early and late outcome after a one stage operation andcomparison with others similar work and to see feasibility of this procedures in our limitedresources. Patients and method: We have performed transanal pull through in department ofPaediatric Surgery, Nishtar Hospital Multan during May 2010 to May 2013. Fifty patients out of 117were selected, older than one year, non marasmic and diagnosed as short segmentaganglionosis by barium enema were selected. Transanal Swenson’s pull through wasperformed, aganglionic segment was decided on gross appearance (narrow) due to lack offrozen section facility, anastomosis made with 4/0 vicryl. Results: Procedure completed on anaverage within one hour, without any transfusion. Feeding was started from day one, manageablecomplications were observed in 25% patients, no mortality seen. Hospital stay was on anaverage 6 days. Conclusions: Transanal one stage pull through is very practical, can be donewithout facility of frozen section.
GALL STONES;
Authors: Saqib Alina , Shaikh Saeed Sattar , Sodhar Jawad Mumtaz
Published: August 2021

Objectives: Recognition of various gall stones in the patients attending surgicalOPD by biochemical analysis of gall stones. Study design: Cross sectional study. Place &duration of study: ISRA Hospital, Hyderabad and Institute of Biochemistry Sindh UniversityJamshoro. Duration of study was 18 months. Methods: Cases were patients with gall stones whowere diagnosed on ultrasonography. Gall stone analysis was done from Institute of BiochemistrySindh University Jamshoro. A total of sixty nine subjects were included in the study. Results: Inthe present study the mean Age was 35.81+ 8.12 years. Frequencies in different age groups are15-24 (11.60%), 25-34 (24.64%), 35-44 (53.63%), 45-54 (8.69%), 55-64 (01.45%). Age distributionis shown in Graph III-1. In the present study 49(71.0%) were females and 20(29%) were maleswith the female to male ration of 2.45:1. gender distribution is shown in Graph III-2. In the presentfrequencies of different types of gall stones was, cholesterol stones 38(55.07%), pigmentedstones 20(28.99%) and mixed type of stones 11(15.94%). Frequencies of different types of gallstones is shown in Graph III-3. Conclusions: In our study the frequency of cholesterol gall stoneis more as compared to pigmented and mixed gall stones. A total of 55.07% of cholesterolgallstones were found in our study with the female predominance.
POLYCYSCTIC OVARIAN SYNDROME (PCOS);
Authors: Perveen Rashida , Hamid Sobia , Khakwani Mehnaz
Published: August 2021

Objective: To compare effectiveness of clomiphene alone and in combinationwith metformin in terms of conception rate in patients presenting with polycystic ovary syndrome.Study Design: Randomized clinical trail. Place and duration of study: Department Obstetricsand Gynecology Unit I, Nishtar Hospital Multan, 6 months from 12th September 2009 to 11thMarch 2010. Methodology: Primary subfertile women visiting outpatient department of NishtarHospital Multan with significant irregular menstrual cycle, oligo menorrhea and ultrasonographicfeatures of polycystic ovaries were enrolled in the study. Semen samples from male partners wereanalyzed according to the WHO criteria. Women whose partner’s semen analysis was abnormalwere excluded from study. Group ‘A’ was given clomiphene citrate alone and second group (i.e.group B) was given colmiphene citrate and metformin. All patients were followed till six cycles forregularity of menstrual cycle (determined by history) ovulation by follicular tracking onultrasonography, if patient (conceived), conception was confirmed by urine pregnancy test andgestational sac on ultrasonography pelvis. Final outcome was measured at six month.Information was entered in specifically designed proforma. Results: Frequency of PCOS was14.05%. Mean age of the patients was 31.03 ± 0.58 vs. 29.89 ± 0.53 years in group A and Brespectively. Oligomenorrhea was present in 18(50%) vs. 18 (50%) women, amenorrhea in7(19.4%) vs. 8(22.2%) patients and weight gain in 14(38.9%) vs. 15(41.7%) cases in group A andB respectively. Conception was achieved in 26(72.2%) vs. (18(50.0%) patients in group A and Brespectively. Conclusions: Metformin does not seem to help in achieving higher rates ofpregnancy when combined with CC as compared to CC alone.
CHRONIC RENAL FAILURE IN CHILDREN;
Authors: Sajid Nisar Khan , Ahmad Shakil , Sarwar Imran
Published: August 2021

Introduction: Chronic renal failure is defined as progressive and irreversible lossof renal functions that gradually progress to end-stage renal disease. The etiology of chronicrenal failure in childhood correlates closely with the age of patient at the time when the renalfailure is first detected. Objectives: The aim was to assess the underlying causes and risk factorsof chronic renal failure and to identify the clinical presentation of chronic renal failure in childrenreporting at Allied Hospital Faisalabad. Study design: It was a cross sectional study. Duration ofth study: The study was done in a period of one year starting from March 20th, 2007 to March 20 ,2008. Setting: The study was done in the Department of Pediatrics medicine Allied HospitalFaisalabad. Subjects and methods: CRF was defined as glomerular filtration rate less than 25%of the normal for that age and sex. Patients of either sex ranging from 6 months to 15 yearsfulfilling the inclusion criteria were included in this study. Sampling technique was non-probabilityconvenience sampling. In addition to clinical evaluation, they were investigated to find out theunderline causes. Results: Out of 40 patients of CRF males were (n-28), females were (n-12), withmale to female ratio of 2.3:1. Mean age of males was 7.36+ 3.98 and females was 8.96+ 2.65.Etiological factors found in 34(85%) patients included congenital malformations (9-22.5%)urolithiasis (8-20%) reflux nephropathy (6-15%) glomerulopathies (3-7.5%) neurogenic bladder(2-5%) strictures (1-2.5%) and miscellaneous (5-20.5%) Etiology was unknown in 6 patients(15%). Failure to thrive 77%, Respiratory distress 75%, Pallor 75%, Fever 75%, Headache 67%,Vomiting 63%, Edema 50%, & Anorexia 42% were the most common clinical features atpresentation.
KNOWLEDGE AND UNDERSTANDING OF MEDICAL STUDENTS ABOUT RADIOTHERAPY AND PALLIATIVE CARE
Authors: Arain Abeer Nisar Arain , Ghaffar Zunaira Abdul , Rehman Naveed-ur- , Siddiqi M. N. , Rehman Raza
Published: August 2021

Objective: To assess the knowledge of undergraduate medical students aboutradiotherapy, cancer and palliative care in cancer. Method: A descriptive study to assess theknowledge of radiotherapy, cancer and palliative care is conducted among undergraduatemedical students of Dow Medical College. 300 students from each batch of fourth and final yearwere assessed for knowledge of radiotherapy, palliative care, cancer knowledge, cancerprevention, students’ visits to radiotherapy units, source of cancer information, teachingprograms of radiotherapy in medical college, choice of career and participation in palliative carecourse during their undergraduate years. Results: 246 questionnaires were returned. 41% ofstudents correctly answered to different questions related to the knowledge about radiotherapy.Data regarding cancer treatment knowledge among students showed an average of 32%. Thegeneral knowledge regarding cancer among the students was present in approximately twothirds(60%) of participants. The knowledge regarding cancer prevention prevailed around36.04%. Conclusions: There is a need to change the perception of palliative care and radiationtherapy among medical students. Teaching of radiotherapy should begin early in theundergraduate curriculum of MBBS, and it should be mandatory for all the students. Oncologyrotations should be constructed where the principles of radiotherapy and palliative care can beconveyed.
ASSESSMENT OF GESTATIONAL AGE
Authors: Naseem Faiza , Ali Sabir , Basit Umbreen , Fatima Naheed
Published: August 2021

Objective: To compare correct assessment of gestational age betweenTranscerebeller diameter versus femur length in third trimester (28-40) using first day of lastmenstrual period for actual period of gestation. Study Design: Cross-sectional descriptive study.Place and Duration of Study: Department of Obstetrics and Gynecology, Bahawal VictoriaHospital, Bahawalpur from Jun 2012 to Dec 2012. Methodology: This study was performed on327 patients in third trimester of pregnancy from 28-40 weeks fulfilling the inclusion criteria.Ultrasound measurements of transcerebellar diameter (TCD) and femur (FL) were made withcommercially available real time ultrasound equipment Toshiba Nemio-10 model 2009,Transducer frequency 50/60 Hz. Collected data was analyzed by SPSS version 10. Results: Outof 327 patients, TCD was found to give correct assessment corresponding to the gestational ageby LMP in 262 (80.1%) patients, while in 232 (70.9%) patients FL was found to give correctassessment corresponding to the gestational age by LMP. Conclusions: Transcerebellardiameter is more reliable method of gestational age determination in third trimester of pregnancythan femur length. TCD can be used as a tool to assist in the assessment of gestational age inthird trimester.
BLOOD BANK AND DISASTER RESPONSE SERVICES;
Authors: Ilyas Nasim , Akram Ijaz , Nawaz Usman
Published: August 2021

Objective: Assessment and Comparison of blood group typing among male,female urban and rural population of Tehsil Hassan Abdal, District Attock, Punjab, Pakistan.Materials and Methods: A total of 400 healthy male, female volunteers belonging to both ruraland urban areas were tested for blood group typing. Results: In the selected population in caseof ABO blood groups A, B and O were pre dominant. In the same population in case of Rh bloodgroups Rh + was pre dominant. Conclusions: The assessment and comparison of blood groupsin various subclasses of selected population can be beneficial in effective management of bloodbank, swift management of disasters requiring massive blood transfusions and development ofblood donor society.
GESTATIONAL DIABETES;
Authors: Snover Ayesha , Alam Kinza , Munir Tahir Ahmad , Sajjad Rabia , Naz Farhat
Published: August 2021

Objective: To find sensitivity specificity and diagnostic accuracy of GlucoseChallenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomicaland educational status, dietary habits and ignorance regarding pregnancy relatedproblems probably increase the prevalence and burden of gestational diabetes mellitus (GDM)and its complications in pregnancy. Best and simple strategy to identify women with gestationaldiabetes is still lacking and unclear. Study Design: Cross sectional study. Setting and Duration:This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. Methodology:A glucose challenge test (GCT) was performed on 500 selected pregnant women by giving 50-gglucose in water orally. A serum glucose level ≥140 mg/dl after an hour was taken as positive test.To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs byGlucometer, >200 mg/dl confirmed GDM. Results: An increasing trend in age, gestational ageand BMI and a significant difference regarding positive family history of diabetes and graviditywas seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM2 was noted in multigravida, between 25-29 years, BMI >28kg/m , and a gestational age of 28weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%.Conclusions: Screening is necessary to identify women with GDM. A 50-g glucose challengetest might be acceptable as a screening test for GDM as it has high sensitivity, specificity anddiagnostic accuracy.
ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV);
Authors: Rehman Riaz ur , Khattak Azmatullah , Huq Mian Iftikhar Ul , Shah Mewat , , Mushtaq
Published: August 2021

Objective: To know the surgical outcome of endoscopic third ventriculostomy(ETV) in non communicating hydrocephalous. Materials and methods: This study wasconducted in Abaseen Hospital, Peshawar, from 13th December 2010 to 12th October 2011.Patients with non-communicating hydrocephalous, irrespective of gender discrimination wereincluded in this study. Patients with communicated hydrocephalous, patients below two years ofage and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous wasdiagnosed on CT scan brain. The procedure was done under general anesthesia. ClinicalOutcome of ETV was evaluated by the time of discharge and on subsequent follow up visits i.e.monthly for the first three months and then at six months. Any patient who subsequently neededVP shunting after the ETV procedure was described as having treatment failure. Results: Weoperated 27 patients during our study period. Age ranged from 2 years to 57 years with mean age20.8 years. There were 16(59.26%) males and 11(40.74 %) females. Etiologically,4th ventriculartumors was present in 9 patients(33.33%), tuberculous meningitis in 8(29.62%), aquiductalstenosis in 7(25.92%), brain stem glioma in 1(3.70%). cerebellar haemengioblastoma in 1(3.70%)and pineal tumor (3.70%) with infra tentorial extension in 1 (3.70%) patient. The procedure wassuccessful in 24(88.89%) patients and converted to ventriculoperitoneal shunts in 3(11.11%)cases. Post operatively CSF leakage was present in 2 (7.40%) patients, transient memory loss in1(3.70%), pneumocephalus in 1(3.70%) and pseudomeningocele in 1(3.70%) patients.Conclusions: Endoscopic third ventriculostomy is a good alternative to the VP shunt in cases ofnon-communicating hydrocephalous. Although ETV does have some complications but theseare transient and can be minimized with proper patient selection and meticulous surgicaltechnique
TB CATEGORY
Authors: Amin Muhammad , Ullah Muhammad Aman , Ajmal Muhammad , Tabasum Sana
Published: August 2021

Objective: To determine the risk factors for type of TB category in Multan.Methods: A cross-sectional study was conducted in Nishtar Medical College and Hospital,Multan at Chest and Pulmonology Ward to explore the major factors for the type of TB in Multan,Pakistan. We surveyed 164 patients diagnosed for TB from March 2012 to August 2012. The chisquaretest was used to find the responsible factors for type of TB category. The data wereanalyzed by using SPSS 20 software. Results: The mean age of these patients was 40.5,100male and 64 female patients. 68.9% of cat-1 and 31.1% patients of Cat-2, 65.3% patients havingno education, 35.4% patients were of labor profession working in different scenarios, 76.8%patients have their family income less than ten thousands, 67.7% patients belong to the urbanresidence, 65.2% patients have poor sanitary condition of their houses, 63.41% patients weresmoker and 70.1% patients have TB in their families. On the basis of p-value for each factors, wehave found that blood pressure (p=0.0100), already treated (p=0.0000), doctor visited(p=0.0000), smoking habit (p=0.0263) and area (p=0.0020) of patients are statisticallysignificant factors while gender (p=0.7040), Education (p=0.0800), family history (p=0.3090),current ATT period (p=0.7280), weight (p=0.1300), environment (p=0.2590), income level(p=0.3690), profession (p=0.0540) and age (p=0.4130) are the insignificant factors.Conclusions: We have found that blood pressure, already treated, doctor visited, smoking habitand area of patients are the significant factors for type of TB category.
LAPAROSCOPIC COLORECTAL SURGERY;
Authors: Hanif Zulfiqar , Attique Muhammad , Qandeel Haitham , Khan Abdul Latif
Published: August 2021

Objective: The aim of this study was to assess the outcome of laparoscopiccolorectal procedures performed in a district general hospital within 5 years period and tocompare it with patients who had an open procedure during the same period. Patients andMethods: Data were collected retrospectively from patient’s case notes retrieved from hospitalmedical records. One hundred consecutive cases of laparoscopic colonic resection includingboth benign and malignant diseases between 2005 and 2010 were analysed for perioperativeand long term outcome and were compared with consecutive one hundred cases of opencolectomies. Results: Overall conversion rate was 6% for laparoscopic group. The mean majorcomplication rates in laparoscopic group were 5% (3% in open group) and minor complicationsoccurred in 18% (28% in open group). There was no mortality in either group. The overallmorbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72patients had resections for cancer in open group. The mean lymph node harvest in laparoscopicgroup was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence wasdocumented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes ascompared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13days to 7 days. (Open Vs. Lap). There was no statistically significant difference in majorcomplication rates and mortality. Conclusions: Laparoscopic colorectal surgery is safe andfeasible in elective colorectal cases and reduces the hospital stay without any added morbidity.
HIGH HEEL SHOES
Authors: Younus Syed Muneeb , Ali Tariq , Memon Waqas Ahmed , Qazi Aamna , Ismail Farhan
Published: August 2021

Object: Outcome of wearing high heel shoes in young generation: A CrossSectional Study. Introduction/ Background: High heels increase the heel height, thusincreasing the pressure under the metatarsal head in forefoot, they push the center of mass of thebody forward taking the hips and spine out of alignment moreover the altered posture of walking1-5 in high heels places excessive forces on the inside of the knee joint . All these factors contributein causing deleterious pathologic deformities. The studies carried out previously were morefocused on the adult population furthermore there isn’t much work done to investigate the effectof heels in Pakistan therefore, this was a non-invasive study the purpose of which was to evaluatethese complications particularly targeting the medical students of medical colleges, Karachi.Methods: A total of 220 respondents aged between 15 to 25 years were selected as potentialrespondents meeting the criteria for selection. A convenience based randomized samplingmethod was adopted, where the participants were required to fill questionnaires and give theirdemographic details. They were inquired about the presence of any co morbidities which was anessential part of the exclusion criteria. They were also inquired about their usage of high heelshoes, their size, duration and frequency of usage, and if they had been causing anycomplications such as bunions, heel spur, callosities or pain in soles, calf or back. The dataobtained was analyzed through SPSS and the graphs of frequency for all the complications werecomputed. Results: After analyzing the 220 participants it was found that 7.7% were males while92.3% were females, and 61.8% were found to be within 21 to 23 years of age. After the analysesof data for the complications it was found that out of the total participants 18.8% experience footswelling, 19.4% blisters, 16.4% foot numbness, 12.3% foot callosities, 2.8% heel spur, and 3.7%experience bunions. Conclusions: From this study conducted on the students of medicalcollege it was found that wearing high heel shoes is not associated with any significantcomplications among most of the students
HELICOBACTER PYLORI
Authors: Ansari Shuaib , Shahwani Irfan Murtaza , Channa Aqeel Ahmed , Ali Shah Syed Zulfiquar , Devrajani Tarachand
Published: August 2021

Objective: To determine the frequency of H. pylori in patients with functionaldyspepsia. Patients and methods: This six months multidisciplinary study was conducted attertiary care teaching hospital as well as at private hospital Hyderabad from February 2012 to July2012. All patients presented with history of dyspepsia were admitted and evaluated for functionaldyspepsia by performing endoscopy. After confirmation of functional dyspepsia the subjectswere further evaluated for H. pylori infection by taking the biopsy specimen, label it and sent tolaboratory for histopathological examination. The data was entered, saved and analyzed in SPSSversion 11.00. Results: During six month study period, total 100 patients with functionaldyspepsia were recruited. Majority of patients were from low socioeconomic class (78%), havehistory of spicy food intake (68%) and epigastric pain (94%). The associated symptoms observedwere nausea and vomiting (87%), anorexia (88%), early satiety (84%) and regurgitation (84%).The mean ±SD for age of patients with functional dyspepsia was 37.95±10.85. The mean age±SD of H. pylori identified patients was 35.81±7.72. Majority of the subjects was 30-40 years ofage and the male population predominant 64% (p-value 0.02, statistically significant). The H.pylori was identified in 62% of patients, of which 35 (56.5%) were males and 27(43.5%) werefemales (p-value 0.04, statistically significant) respectively.
TUMOR MARKERS
Authors: Shaikh Naseer Ahmed , Memon Farzana , Samro Rukhsana Parveen
Published: August 2021

Object: Analysis of serum tumor markers CA-125, CEA, AFP, & ß-HCG in patientswith ovarian malignant tumors and correlation of their serum levels with histological types. StudyDesign: Institution based descriptive and prospective study. Place & Duration: Department ofPathology, Liaquat University of Medical & Health Sciences, Jamshoro from January 2009 toJune 2011. Material & Methods: One hundred cases, diagnosed as ovarian malignant tumor onH&E staining were selected for study & measurement of serum CA-125, CEA, AFP, & ß-HCGpreoperatively and postoperatively in each case. Results: Out of 100 ovarian cancers diagnosedon H&E stain 33 were serous cystadenocarcinoma, 29 mucinous adenocarcinoma, 19 germ celltumors and 15 sex-cord stromal tumors, 1 endometroid carcinoma, 1 brenner tumor, 1 clear cellcarcinoma and 1 case of NHL. Increased level of CA-125 was seen preoperatively in 33/33 casesof serous cystadenocarcinoma and 24/29 cases of mucinous adenocarcinoma. Surprisinglyincreased levels were also seen in 10/19 germ cell tumor and 8/15 in sex-cord stromal tumors.CEA is raised in mucinous tumors. AFP & ß-HCG were raised in germ cell tumors & sex cordstromaltumors. Serum tumor marker levels were declined following appropriate therapy of thetumors. Conclusions: Serum tumor markers are useful and important for the detection of ovariantumors. They may also help in assessment of response to specific treatment, prognosis & followup of patient.
ECLAMPSIA
Authors: Qureshi Sumaira Rauf , Zaheer Sana , Channa Shehla Raza
Published: August 2021

Objective: To determine the maternal morbidity and mode of delivery in eclampticpatients. Study design: Descriptive studies (cases series). Duration of study: One year from1.3.2012 to 28.2.2013. Setting: Dept of Obstetrics and Gynecology Unit-III Liaquat UniversityHospital Hyderabad. Patients and methods: This study included 97 eclamptic patients. The mainvariables of interest were maternal age, parity, booking status, gestational age, mode of deliveryand maternal complications like HELLP syndrome, pulmonary edema, post partum hemorrhage,renal failure, neurological deficit and ICU admission. Result: During the study period 2839obstetrical patients were admitted with 97 cases being eclamptic give an incidence of 3.4%.Majority were unbooked 94.8%, Primigravida 58.8% and ≤ 25 years of age 68%. Complicationswere seen in n 50.51% and 12.4% patients have more than one complications. Vaginal route wasmode of delivery in 53.60% and cesarean section was in 44.32% patients. Conclusions:Eclampsia still responsible for significant maternal morbidity and mortality. Eclampsia can onlybe successfully managed by early detection and prompt treatment of pre-eclampsia
NON APPENDICULAR PERFORATION PERITONITIS
Authors: Aziz Sajid , Jehan Shazia , Ateeq Muhammad
Published: August 2021

Objectives: To evaluate the spectrum of non-appendicular perforation peritonitisand their management outcome in a peripheral teaching hospitals. Study design: Retrospectivedescriptive, Interventional. Setting: Surgical Department Aziz Bhatti Shaheed (Teaching)Hospital Nawaz Sharif Medical College University of Gujrat& Surgical Department Islam MedicalCollege Sialkot. Study period: February 2011 to June 2013. Results: All the patients with clinicaldiagnosis of Acute Peritonitis were included, however patients with peritonitis secondary toperforated appendix and traumatic GIT perforations were excluded from study when foundpreoperatively. Total 100 patients with acute peritonitis were operated. 79 patients were male and21 were female. Mean age was 39.9 years, youngest patient was a 12 year old boy whereas oldestwas 73 year old. Perforated duodenal ulcer was the commonest cause of peritonitis seen in 42cases followed by intestinal tuberculosis 18%. Enteric gut perforation was seen in 17% cases.Mortality was 9% and sepsis and multi organ failure was the main cause of death. Conclusions:Management of perforation peritonitis is a complex and demanding. We can avoid thiscomplication by primary prevention, adequate& timely treatment of diseases like Peptic ulcer,tuberculosis and Typhoid fever which are the commonest cause of GUT perforations in Easternregion/ Tropical countries. Early diagnosis of acute peritonitis, adequate efficient resuscitationand early exploration preferable within six hours is the key to reduce both morbidity and mortalitythese patients
OPEN TIBIAL SHAFT FRACTURES
Authors: Khan Muhammad Imran , Saqib Muhammad , Alam Waqar
Published: August 2021

Objective: The purpose of the study was to evaluate the clinical results afteroperative treatment of open tibia fractures (grade IIIA/B) with external fixator. Material andmethods: 25 patients with open fractures of the tibial diaphysis, classified as type III A and B,according to the Gustilo classification, were operatively treated in Agency Headquarter HospitalLandikotal. All the patients were treated with an external fixator. The time of the union of thefracture, problems with the union (malunion and nonunion), infection were examined astreatment outcome. Late complications and their treatment was not the object of the study. Thefollow-up period was at least 8 months. Result: The end results of the external fixation of 25 tibialshaft fractures, 18 (72%) men and 7 (28%) women, average age 37.7 (16-65). The union rate was83%. Nonunion rate was 12%. And malunion rate was 5% (fig-I). Fifteen patients had Gustilo typeIIIA injury while 10 patients had type IIIB injury (fig-II). Pins tract infection rate was 10%. Theaverage time of fractures healing was 28.5 weeks (15-22). There were 3 cases with woundinfection and no sequestrum formation. Conclusions: External fixation is a simple and effectivemeans of treating all types of open tibial shaft fractures
AWARENESS OF PATIENTS REGARDING ANESTHESIA;
Authors: Kadri Irfan Ali , Haider Gulfareen , Memon Imran , Memon Waseem
Published: August 2021

… Awareness of patients regarding anesthesia & their attitude towards basic types ofanesthesia techniques. Objective: The purpose of this study was to assess the knowledge ofpatients regarding anesthesia, their attitudes towards basic types of anesthesia techniques andeffect of previous experience of anesthesia on the awareness. Study design: Descriptiveobservational study. Place and duration of study: This descriptive, prospective study wasconducted in the isra university hospital Hyderabad, Sindh, Pakistan from 2nd August 2013 upto8th March 2014. Patients and Methods: Two hundred thirty one patients were included in thestudy after taking verbal informed consent. All patients who were scheduled for elective surgerywere interviewed while patients who had refused from participation, have language barrier,psychiatric disease, had lack of sufficient mental capacity due to poor health status and patientsundergoing emergency surgeries were excluded from the study. Patients were interviewed intheir local language upon arrival in the preoperative area of operation theatre. Self madequestionnaire was filled. All the data was entered on SPSS version 16. Frequency andpercentages were calculated to show the results. Mean with SD of patients age was computed.Chi-square test was applied to assess the affect of previous experience of surgery on patient’sknowledge regarding anesthesia. P value less than 0.05 was taken as significant. Results: Total231 patients were included in the study. Mean age of the patients was 36 ± SD 1.01. Fifty one(22.1%) patients were illiterate; while 54 (23.4%) patients were graduate. 103(44.6%) patients hadprevious experience of surgery/ anesthesia while 128(55.4%) patients had no experience. Out of231 patients, 111 (48.1%) patients were aware of different type of anesthesia techniques while120(51.9%) patients were not aware. Out of 103 patients, who had previous exposure ofanesthesia, 64 patients answered correctly about different types of anesthesia techniques while81 patients who had no previous exposure of anesthesia, answered incorrectly (P value = 0.000).Fifty three patients who had previous exposure of anesthesia answered correctly that anesthetistis a qualified doctor, while 62 patients answered incorrectly who had no previous exposure (Pvalue=0.546). Out of 231 patients, 91 (39.39%) patients were in favor of having generalanesthesia while 52(22.51%) patients were in favor of regional anesthesia, while 88(38.0%) hadleft the choice on surgeon. Conclusions: Results of the study show poor knowledge of patientsregarding anesthesia and anesthesiologists. Majority of the patients were in favor of havinggeneral anesthesia rather regional anesthesia. There is need to correct the misconceptions ofpatients and to educate the public.
COLORECTAL CANCER IN SAUDI POPULATION;
Authors: Ather Hafiz Mughees , Bajwa Faisal , Quadri Mujataba , Abrar Mohammad
Published: August 2021

Background: The aim of study was to investigate differences inclinicopathological (CPC) features of colorectal cancer (CRC) patients between both genders.Setting and Design: We did a retrospective chart review of CRC patients confirmed byhistopathology. Materials and Methods: 414 patients were included in study from King AbdulAzizmedical city Jeddah. Charts of patients were reviewed; data was analyzed on SPSS version20. Results: Majority of patients were males (58.7%) who were slightly older than females (meanage 57.7 versus 54.6 years) (p value 0.033). The most common age group was fifty to eighty yearsin both genders (64% patients). Abdominal pain was reported more in females (57% vs. 41.5% pvalue 0.002) while there was no difference in reporting bleeding per rectum between bothgenders (50.2% vs. 49.3% p value 0.953). History of diabetes mellitus (DM), smoking and colonicpolyps) was more common in males (67 versus 34 patients), (21 versus 3 patients) and (10 versus1 patient respectively. Patients presenting with acute surgical abdominal complications were lessthan 20%. Only 33 (19.2%) of females received preoperative chemotherapy vs. 80 (33%) of males(p value 0.001). There was no significant gender differences regarding site, histopathology gradeand surgical treatment received. Conclusions: There are important gender differences in CPCfeatures of CRC patients in our population. Female patients tend to be slightly younger thanmales and there is less association with smoking, DM and previous colonic polyps. Abdominalpain was the most common presenting symptom among females. Both genders presented atsimilar stage of disease. These observations should be taken in consideration in makingcolorectal screening guidelines and public awareness programs.
CHOANAL ATRESIA
Authors: Ayub Adil , Ayub Ayesha , Rehman Ayub-ur-
Published: August 2021

Choanal atresia (CA) is a rare, congenital malformation resulting as a failure incommunication between the posterior nasal cavity and the nasopharynx. The clinical course isoften asymptomatic in unilateral CA leading to higher rates of misdiagnosis, in comparison tobilateral CA, which manifests itself as a surgical emergency at birth. Most cases present asisolated malformations, but it may also be associated with other congenital anomalies in 20-50%of cases. Currently, the most important diagnostic tool for CA is computerized tomography (CT)and confirmatory diagnosis is usually achieved with the help of nasoendoscopic examination.Although, different surgical approaches have been used in the past, transnasal endoscopicrepair is currently preferred over others. Herein, we describe our experience of three cases andshare our simple stentless endoscopic technique, to facilitate physicians working in low facilityunits for a timely diagnosis and prompt treatment.
FREQUENCY OF ACID FAST BACILLI (AFB);
Authors: Ahmed Syed Owais , Shahzad Muhammad Asadullah , Ahmed Bashir
Published: August 2021

Objective: To determine the frequency of Acid Fast Bacilli (AFB) in samplessubmitted for Ziehl Neelson (Z.N) Technique. Design: An Observational study. Place andduration of study: This study was carried out from july 2010 to Dec 2012 at Dept. of Clinicalpathology Main Laboratory Jinnah Post Graduate Medical Centre (JPMC) Karachi. Material &Method: A total of 5064 samples were received in the department of clinical pathology mainlaboratory, JPMC, Karachi during the study period. We determined the presence of AFB insamples by Z.N Technique. Result: Out of total 5064 samples, 518(10.2%) specimens revealedthe presence of AFB. The samples received were: sputum 4787 (503 positive; 10.5%), pus 56 (01positive; 1.7%), fluid 118 (no positive), gastric 93 (14 positive; 15%); urine 10 (not positive).Conclusions:- Lower rate of positivity for Acid Fast Bacilli by Z.N Technique can be increased byFluorescence microscopy and culture technique.
SUPRACONDYLAR FRACTURE
Authors: Chachar Muhammad Bakhsh , Mustafa KK Ghulam , Solang Naveed Ahmed , Ishtiyaque Mohammad , Ahmed Malik Wasim
Published: August 2021

Objective: Management of supracondylar femur fracture is complex. Theobjective of this study was to assess the functional outcome of our patients managed withdynamic condylar screw fixation. Methods: This descriptive case series was carried out in thedepartment of Orthopedic Surgery, Dow University of Health Sciences / Civil Hospital Karachifrom 6th October, 2012 to 5th April, 2013.All the patients with Type A supracondylar fractures offemur diagnosed clinically and radiologically presenting within two weeks of injury wereincluded. Patients with systemic injuries were excluded. Final functional outcome were assessedby Schatzker and Lambert Criteria. Results: A total of 97 patients were included in this study. Theaverage age of the patients was 38.36±9.45 years (years + SD) and average duration of fracturewas 6.10 days. Male to female ratio was 2.03: 1. Two third of patients (67.01%) were injured byroad traffic accident, 28.87% suffered fall from height and 4.12% had slips. Acceptable outcome(Excellent and Good) at three months was observed in 86.6% (84/97) patients while unfavorableoutcome (Moderate and poor) were observed in 13.4% (13/97) cases. Outcome was better inpatients below 50 years of age (p=0.0005). Conclusions: Dynamic condylar screw appeared tobe an easy, less technically demanding and effective method for stabilization of supracondylarfemur fractures. Younger age group (age <50yrs) had better functional outcome.
FIBROID;
Authors: Khalil Mehreen , Ali Lubna , Hakeem Nazia
Published: August 2021

.. Introduction: Fibroids are the commonest benign tumors and it is estimated thatthey occur in 20-40% of women during their reproductive years. Reported risk factors consistentwith the hormonal hypothesis include premenopausal status, younger at menarche, and obesity.Reported protective factors include parity and oral contraceptive use. This study was designed togive us the burden of fibroid and factors leading to fibroid. Objectives: To determine thefrequency and factors leading to fibroid in women presenting with menorrhagia in outpatientdepartment of gynae unit-I Civil Hospital Karachi. Study design: Cross sectional study. Setting:Department of Obstetrics and Gynaecology- I, Civil Hospital, Karachi. Duration of study: Sixmonths from 12thMarch, 2011 to 11th September, 2011. Subjects and methods: A total of 121patients meeting the inclusion criteria were enrolled in study. History was taken regardingduration and severity of menorrhagia and the factors leading to fibroid including age, parity,obesity and family history, women with a weight of 50kg or more were taken as obese. If findingsconsistent with fibroid as per operational definition were found on ultrasound then it was termedas -----fibroid +ve. Results: Mean (±SD) age was 27.9 (±5.3) years. Frequency of fibroid wasfound in 68 (56.2%) patients with menorrhagia. Family history fibroid was found in 51 (42.1%)women out of which fibroid was found positive in 30 (58.8%) women, that was the most commonfactor leading to fibroid in this study, followed by obesity 28 (35.4%) and nulliparous 10 (25.6%).Conclusions: Frequency of fibroid was found in 56.2% patients with menorrhagia. Family historyof fibroid was most common risk factor leading to fibroid found in 58.8% women.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Brohi Saifullah , Zaman Khan Muhammad Laiq-uz- , Shaikh Ubedullah , Shaikh Shazia Ubed
Published: August 2021

Objective: To assess various intra operative predictive factors which arereponsible for difficulty in performing laparoscopic cholecystectomy. Study Design: Prospectiveobservational study. Place and Duration of Study: This study was out in Surgical department,Liaquat University Hospital Jamshoro, Dow International Hospital Karachi and JinnahPostgraduate Medical Center Karachi, from October 2012 to October 2013. Methodology: Thisstudy consisted of hundred patients. Detailed History was taken from all the patients with specialregard to the abdominal pain or pain in right hypochondrium, lump in right hypochondrium ,vomiting , dyspepsia and fever. Detailed Clinical examination of the patient was done . Site of righthypochondrium was especially examined for assessment of murphy’s sign , palpable mass ,visceromegaly and recorded in proforma. Systemic review was also done to see any comorbidity.Ultrasound of abdomen as diagnostic modality and for assessment of gallstonedisease. Inclusion criteria were all diagnosed patients of complicated and uncomplicated gallstone disease of any age and either any sex admitted on the basis of history , clinical examinationand investigations specially ultrasound of abdomen. Exclusion criteria included unfit patients forgeneral anesthesia , Pregnant ladies due to risk of foetal loss, patient with carcinoma of gallbladder , patient with acute pancreatitis and Patient with obstructive jaundice. Follow up of allthese patients was done. Results were prepared with help of tables and graphs. Data wasanalyzed through SPSS software. Results: Out of 100 patients included in this study 79 werefemale (79%) and 21 male (21%); with female to male ratio of 3.76:1. There was wide variation ofage ranging from a minimum of 20 years to 65 years . The mean age was 46.28+7.20 years.Symptoms of patients presented with pain in RHC 87% , pain in RHC along with pain inepigastrium 78%, Nausea & Vomiting 15%, dyspepsia 50% and fever in 10% of cases.Ultrasound examination revealed single stone in 20(20%) patients where as multiple stones in80(80%) patients. Operative findings revealed severe adhesions in calot’s triangle in 15(15%)patients where as Severe & tight adhesions around gallbladder in 16(16%) patients, Obscuredanatomy in calot’s triangle in 11(11%) patients and Intrahepatic gallbladder in 9(9%) patients.Complications were Pain in 33(33%) patients, Bleeding in 1(1%) patients, Intraperitonealcollection in 2(2%) patients, Wound Sepsis in 5(5%) patients and Biliary leakage in one case.Conclusions: In conclusion our study revealed that are numerous conditions which make thedifficult laparoscopic cholecystectomy like severe adhesions in calot’s triangle 15%, Severe &tight adhesions around gallbladder 16%, Obscured anatomy in calot’s triangle 11%, Intrahepaticgallbladder 9% and adhesions around gallbladder 26%.
MODERATE PERSISTENT ASTHMA IN CHILDREN;
Authors: Saqib Aqdas , Ismail Saqib , Yasir Saadia
Published: August 2021

Objective: The objective of this study is to compare the effects of inhaledbeclomethasone with oral montelukast in long term management of moderate persistent asthmain children. Design: Quasi experimental study. Period: 6 months, from July 20,2007 to January20, 2008. Settings: Out patient paediatric department at Fauji Foundation hospital, Rawalpindi.Material and Methods: 8o children between 5-12yrs of age presenting with moderate persistentasthma, divided in two groups of 40 each. Group A treated with beclomethasone inhaler whileGroup B was started on oral montelukast. Drugs effect was recorded on a 2 wkly proforma for 8weeks. Results: There were 54(67.5%) male and 26(33%) female. Most common triggeringfactor seen in 54(67.5%) patients was recent history of respiratory tract infection, exposure tocarpet dust in 43(53.75%), cigarette smoke in 42(52.5%),recent psychological stress in 28(35%) ,pollen allergy in 26 (32.5%) , pets exposure in 8 (10%) and to mite was noticed in 5(6.25%)children. Marked improvement was observed in day time cough in group A with 10(25%) patientsbeing free of cough with inhaler, while 20(50%) showed mild intermittent symptoms. 1(2.5%)showed mild persistent symptoms. In Group B 3(7.5%) patients were symptom free,23(57.5%)with mild intermittent and 4(10%) with mild persistant symptoms while 6(15%)continued to have moderate persistent symptoms. P value was 0.01. Regarding day timebreathlessness, P value was significant of 0.258. Similarly marked improvement was observed innight symptoms of breathlessness, cough and sleeplessness in both groups. P value was lessthan 0.05 in majority of the variables showing statistically significant improvement with inhaledbeclomethasone than with oral montelukast. Conclusions: Inhaled beclom
EFFECTS OF CINNAMON EXTRACT IN DIABETIC RAT MODELS IN COMPARISON WITH ORAL HYPOGLYCEMIC DRUGS
Authors: Khan Muhammad Sajid , Qureshi Aneela , Kazi Shuja Anwar , Fahim Amin , Bano Husan , Kazi Navaid , Khan Asghar , Haque Mazhar ul
Published: August 2021

Objective: To evaluate the anti diabetic effect of cinnamon extract in alloxaninduced diabetic animal model (albino rats) in comparison with oral hypoglycemic drugs. StudyDesign: An Experimental study. Place of Study: Al Tibri Medical College, Isra University, KarachiCampus. Duration of Study: December 2012 to December 2013. Materials and Methods: Total60 Albino rats of both genders were divided into 6 groups consisting of 10 rats in each group.Each group of animals was further divided into two sub groups containing 5 rats in each groupResults: The results obtained from the data indicated that there is significant reduction in bloodglucose level rats treated with low dose of cinnamon extract. The animals of low dose cinnamonextract (200mg/kg. bw) when compared with other groups; there is a reduction in the bloodglucose level in alloxan induced diabetic rats. Also tolbutamide and acarbose treated groupsshowed better antidiabetic effects as compared with cinnamon extract treated groups (pvalue<0.007 and p value<0.012 respectively), but cinnamon extract treated group showedsynergetic effects when it was given in combination with tolbutamide or acarbose havingsignificant p value<0.001 and p value<0.011 respectively. Conclusions: Tolbutamide andAcarbose showed better anti diabetic effect in comparison with cinnamon extract treated groupswhen used individually. This effect was enhanced when cinnamon was used in combination witheither tolbutamide or acarbose.
VITAMIN D STATUS;
Authors: Bhatti Saeed Akram , Khan Abdul Haseeb , Ahmad Shoaib
Published: August 2021

… Objective: Our primary objective was to estimate the vitamin D status amongboth the rural and urban dwellers of Sargodha. Study Design: A cross sectional population survey.Place and Duration of Study: Individuals were selected from six different medical centersin the Sargodha city, Vitamin D measurement was done in Khan Lab Sargodha from January2013 to June 2013. Methodology: After an awareness campaign, healthy individuals and medicalpatients from six different clinics in Sargodha city were selected after excluding the diseasesthat interfered with the metabolism of calcium and vitamin D. The initial assessment involvedan interview based questionnaire, at the clinic by the treating doctor. It recorded the informationregarding age, sex, weight, residence, and co-morbid conditions like, DM, hypertension,ischemic heart disease and kidney disease and medications especially oral vitamin D supplementation.The physical assessments included height, weight record and blood pressuremeasurements. The test: It was performed in Khan Lab Sargodha. Quantitative determinationof 25-OH vitamin D was done from the serum by using competitive immunoluminometric assayon Maglumi 1000 fully automated chemistry analyzer. Results: Out of total 100 specimens 46were found to be having low levels of vitamin D levels. Insufficient levels (21-29 ng/ml) were presentin 10 individuals. It was less than 10 ng/ml in 11, less than 5 ng/ml in 4, while 21 individualswere having levels between 10-20 ng/ml. Five individuals had levels more than 100 ng/ml.None of the individuals had level in toxic range. Out of 56 females 27(48.22%) had low vitaminD levels, while out of 44 males 19 (43.2%) were found to be having levels less than 30ng/ml.The median age of individuals having levels less than 30ng/ml was 37 years (14-57 years). Therelationship of high BMI and vitamin deficiency was statistically non-significant (p-value = .282).Conclusions: Although the sample size is small, however our study reveals that a large proportion(46%) of studied individuals representing the asymptomatic general population is havinglow level of vitamin D. in order to address this public issue concrete measures need to be takenin order to prevent adverse consequences of low vitamin D levels.
FETAL TRANSVERSE CEREBELLAR DIAMETER MEASUREMENT;
Authors: Afshan Anjum , Nadeem Shabnam , Asim Shabnam Shamim
Published: August 2021

Objective: To determine the accuracy of fetal transverse cerebellar diametermeasurement in the prediction of gestational age in growth restricted fetuses. Material andmethods: This controlled was conducted at Sobhraj Maternity Hospital, Karachi from July 2012to June 2013. A total of 100 pregnant women in the third trimester of pregnancy satisfying theeligibility criteria were included. Among these 50 were fetuses with normal fetal growth and50 growth restricted fetuses. Results: The mean transverse cerebellar diameter in the fetusesshowing normal growth was not statistically different from the mean transverse cerebellardiameter in the growth restricted fetuses (p-value = 0.219). Conclusions: Transverse cerebellardiameter measurement can be used reliably for accurate estimation of gestational age in growthrestricted fetuses.