bluuebunny/crossref_metadata_2025 huggingface dataset:
BREAST CANCER
Authors: BEGUM MUMTAZ , RUBY GHAZALA , KHURSHID RUKHASHAN , Akhtar Saleem
Published: September 2021

CA 15.3 is a useful parameter in the management of patients in different stages ofthe breast cancer. Objectives: (1) To evaluate the level of CA 15-3 in stage III carcinoma of breast. (2) To study therole of immunoglobulin G and cathepsin D. Patients & Methods: Serum CA 15-3 was assayed in a group of 25 femalebreast cancer patients with stage III. Method used for determination of CA 15-3 is IMMULITE Automated ImmunoassaySystem. Result: 25 patients were taken in the study. It was observed that the level of CA 15-3 and cathepsin D issignificantly increased in patients as compared to control subjects. Although the level of IgG was also increased butit shows no significant difference. Conclusion: It is concluded that CA 15-3 can be used as tumor marker especiallyin the 3 stage rd of breast cancer and also for monitoring the treatment. IgG shows the role of body defense mechanismsystem in breast cancer. Whereas protease like cathepsin D shows the extent of metastasis.
(TIVA) INTRAVENOUS ANAESTHESIA
Authors: AHMED FAROOQ
Published: September 2021

To compare the combination of propofol ketamine , propofolfentanyl and propofol vs midazolam for TIVA in terms of haemodynamic changes, analgesia and recoverycharacteristics. Design A randomized clinical control trial. Setting CMH Rawalpindi. Period. September 2002 toAugust 2003.Material and Methods. The present study consisted of 75 patients of both sexes between the age groupof 18-55 years belonging to ASA grade I and II, who were scheduled for various short surgical procedures. Results.Combination of propofol and ketamine provides better haemodynamic stability throughout the procedure, whencompared to propofol fentanyl. Induction time was significantly shorter in the propofol group. Mean recovery time wassignificantly faster with propofol (12.3 min) compared to midazolam (20.4 min).. Conclusion. Combination of propofoland ketamine gives better haemodynamic stability during induction and maintenance of total intravenous anaesthesia.Both propofol and midazolam are safe and effective for TIVA in children. Recovery was faster and more comfortablefollowing propofol
EPIDURAL ANALGESIA IN LABOUR
Authors: PARVEEN SHAHIDA , KHAKWANI MEHNAAZ , ZAIDI HASSAN
Published: September 2021

Introduction: In modern obstetrics, alleviation of labour pains bysimple, safe and effective means presents a unique problem. Epidural analgesia has emerged as a popular andrelatively safe option in this context. It requires injection of local anaesthetic agent into epidural space, which iscommonly approached through lumber intervertebral space. Objective: Aim of study was to determine effect of epiduralanalgesia on progress of labour and mode of delivery, to find out its complications in labour and puerperium and toevaluate neonatal out come in terms of apgar score. Setting: Obstetrics and Gynaecology, Nishtar Hospital, Multan.Period: one year. Material and methods: Sample size: 50 patients. Results: Out of 50 patients, 4 (8%) were below20 years of age, 8 (16%) over 30 years of age and 17(34%) patients were 25-29 years of age. Highest percentage was21-24 years of age i.e. 21(42%) patients. 43 (86%) patients were primi-gravida, 2 (4%) patients had one spontaneousabortion and 5 (10%) patient were second gravida. Three (25%) patients (1-49 with 95% Cl) were induced for PIH withno evidence of coagulopathy and fetal compromise. Fifteen (30%) of patients (14-34 with 95% CI) required noaugmentation with oxytocin. In 29 (58%) of patients although duration less than 8 hours but labour was augmented withsyntocinon. In 2 (11% patients instrumental delivery was performed due to meconium stained liquor and persistentbradycardia. Highest percentage of patients 89% had instrumental delivery because of prolonged second stage.Conclusion: Epidural analgesia provides excellent pain relief in great majority of patients. Maternal fatigue and distresswith all of its ill effects on labour and puerperium is abolished.
CARDIAC ARREST
Authors: ALI LIAQUAT , AHMED ZAHEER
Published: September 2021

We present hereby a case report of 65 years old female scheduled for laparotomy for excision ofhydatid cyst liver diagnosed on ultrasonography and CT scan, but on laparotomy unexpectedly it turned out to bepheochromocytoma right adrenal and was further complicated by rupture of tumour, avulsion of inferior vena cava,massive haemorrhage, leading to cardiac arrest. Detailed in this report is the management of unexpectedpheochromocytoma, treatment of acute severe haemorrhage with massive transfusion and resuscitation and revivalof patient from cardiac arrest with CPR.
POLIOMYELITIS
Authors: REHMAN ABDUL , RANA IMTIAZ AHMAD
Published: September 2021

Introduction: To study the risk factors of polio in Southern Punjab.Material and methods: The data of Acute Fluid Paralysis (AFP) cases of year 2003 from the districts of South Punjabnotified to the National Surveillance Cell, Islamabad was collected and analyzed. Results: Group A consisted ofBahawalnagar, Khanewal, Lodhran, Multan, Muzaffargarh, Pakpattan, Sahiwal and Vehari districts with polio caseswhile group B consisted of Bahawalpur, Dera Ghazi Khan, Layyah, Rahimyar khan and Rajanpur districts which werepolio free. Total 397 AFP cases with age range of 1-180 months were recorded. Total 17 polio cases (12 confirmedand 5 compatible) were reported with age range of 4-42 months. Total 36 (9.07%) deaths were recorded. Casesrecorded with two stool specimens not collected within 14 days of onset of paralysis (24 hours apart) were 19(4.79%).Children who received routine polio doses < 3 or unknown were 193(48.61%) while 150(37.78%) children received <7 or unknown additional polio doses. Two stool specimens were collected in 380(95.72%) cases. The non-polioenterovirus was isolated from the stool specimens of 92(23.17%) cases while polio vaccine virus was isolated in15(3.78%) cases. There were significantly greater chances of late notification responsible in the non-collection of twostool specimens within 14 days of onset of paralysis (p <0.006) and under vaccination during routine immunization (p<0.0053) in polio cases. Significantly greater number of polio cases received additional polio doses <7 or unknown (p< 0.0001). The difference in deaths rate in polio and non-polio AFP cases was insignificant (p=0.6597). Conclusion:Children remain at risk for polio unless routine immunization is strengthened or additional supplementary immunizationis provided as well as timely collection of stool specimens.
DIAGNOSTIC LAPAROSCOPY
Authors: SHABBIR AZHAR , MIAN AMER , ASHRAF KHADIJA , ASHRAF KHADIJA , Mallhi Ashraf Ali
Published: September 2021

Objective: There are various disease conditions that require a definitivediagnosis before embarking on treatment. Common problems like pain abdomen and abdominal trauma are amongstthe problems that require an early diagnosis and prompt treatment. Non-invasive investigations like CT scan and MRImay be inconclusive. Study Design: This was a descriptive study. Setting: Surgical department of Combined MilitaryHospital Rawalpindi. Period: Jan 2002 to Jan 2003 Material and Methods: Various indications of diagnosticlaparoscopy were assessed with special reference to various modes of presentation. It included fifty patients. Clinicalsigns, symptoms and investigations were reviewed for these patients and records maintained. Patients were dividedin groups according to various modes of presentations. Results: Major indications for which it was done included thesemain groups: pain abdomen, staging and diagnosis of intra abdominal tumors, assessing abdominal trauma andassessment of female infertility. After the procedure the correlation between pre operative diagnoses and post operativefindings was studied. Conclusions: The diagnostic laparoscopy is a useful investigation that may help in avoidingunnecessary laparotomies but further studies are required to establish its precise role in the management of abovementioned indications.
FREQUENCY OF VACCINATION IN MEASLES
Authors: BASHEER FAISAL , AATIF MOHAMMAD , SHAKEEL AHMED SHAKEEL x , Ali Salman
Published: September 2021

Objective: To calculate the frequency of vaccinated children in measles casesand to determine association of age and sex with vaccination status of measles. Design: Descriptive Study. Place andduration of study: Department Of Paediatric Medicine, Military Hospital (MH), Rawalpindi from October 2001 toSeptember 2002. Patients and Methods: 250 cases of clinical measles, selected by convenient sampling, reportingin out patient department or admitted were registered. Age, sex and vaccination status were noted. Statistical analyseswere carried out employing “t Test” and “Chi-Square test”, utilizing SPSS version 10.0 for Windows (SPSS Inc.,Chicago). Test of significance was applied at a confidence limit of 95%. Results: 71.6% were vaccinated and 28.4%were unvaccinated. Ages ranged from 1 to 12 years with a mean age of 5.4±2.4 years. Vaccinated cases had asignificantly (p<0.05) higher mean age (5.9±2.1) as compared to unvaccinated ones (4.0±2.5). Majority (46%) were4-6 years old. Among vaccinated 50.3% were 4-6 years old but among the unvaccinated 52.1% were 1-3 years of age.Male to female ratio was 1.4:1. Proportion of males was significantly more (p value < 0.05) than females in both groups.Conclusion: Vaccination failure observed in this study, that is 71.6% patients contracting measles despite beingvaccinated, is clearly higher than that accepted for measles vaccine (2-10%). Though high immunization coverage(>90%) in the first dose is still crucial for eradication there is need to revise the in-vogue vaccination schedule to reducethe incidence and so is the measles related morbidity and mortality.
USE OF FASCIA LATA & DACRON
Authors: AZIZ MOHAMMUD , KHATTAK MOHAMMUD IQBAL
Published: September 2021

Setting: In Civil Hospital and Bolan Medical College Complex HospitalQuetta. Period: From 1990 to 2003. Materials & Method: Eighty cases of old neglected elbow dislocation weretreated. by arthroplasty using fascia lata (Group A) and dacron meshwork ( group B). Forty cases were included ineach group. Results: Surgery was followed by physiotherapy. Patients were examined periodically upto six months.To evaluate the results three variables i.e range of motion, instability and pain were recorded for each patient for sixmonths. These were recorded before operation, at the time of review and points were awarded. Young patients anddislocated elbows of less duration gave better results. Prognosis in males (As compared to females) and right elbows(As compared to left) was better. Group A achieved better results than group B. Conclusions: Results of both theinterposing materials are encouraging. Fascia lata gave better results than dacron meshwork
HIV / AIDS
Authors: KHAN HAMZULLAH , KHATTAK MIRAJ
Published: September 2021

Objectives: To determine the experience of physicians posted in twotertiary care hospitals of Peshawar regarding HIV/AIDS. Design: Descriptive observational study. Settings: KhyberTeaching Hospital (KHT) and Postgraduate Medical Institute Hayatabad Medical Complex Peshawar (PGMI, HMC).Duration: From 12 September to 21st th December 2005. Material and Methods: A total of 50 clinical experts wereselected, 35 from KHT and 15 from HMC. Medical specialists, Pathologists, gynecologists and dermatologists wereincluded. A questionnaire was designed in accordance with the objectives of the study. Questionnaire containedinformation’s about, 1) The experience of physicians posted in these centers regarding HIV/AIDS management andon. 2) Clinico-pathological aspects, risk behaviors, preventive and precautionary measures, diagnosis and treatmentof the HIV/AIDS. Results: A total of 50 health staff including physicians, pathologists, gynecologists and dermatologistswere selected. Only 2% of physicians were claiming themselves volunteers for management of HIV cases. Main referralcenter for treatment and diagnosis was National Institute of Health (NIH) for 72% of physicians. Of total, 74% ofphysicians had recorded only 0-5 cases during their carrier. No outreach counseling or advertising VCT recorded.Opportunistic infections recorded by physicians were: Tuberculosis (18%), Oral/esophageal candidiasis(14%), STIs(6%),Herpes simplex, CMV Infection & Pneumocystic cranii( 4% each) and septicemia (2%). Malignancies recorded were:Kaposi,s sarcoma (6%) and Non-Hodgkin’s lymphoma (2%). Conclusion: The knowledge and attitude of the medicalstaff was satisfactory but majority of the physician had recorded negligible HIV/AIDS cases. There is need for moreawareness through advertisement, workshops and seminars on HIV/AIDS.
HEPATITIS B, C & HIV
Authors: FAYYAZ MOHAMMAD , Khan Muhammad Ayub , QAZI MASROOR ALI , `Chaudhary Ghulam Mohyud Din , AHMED GULZAR
Published: September 2021

Objective: To determine the prevalence of HBV, HCV and HIV in healthyblood donors in Blood Transfusion Services, Bahawal Victoria Hospital, Bahawalpur. Design: Prospective observationalstudy. Setting: Blood Transfusion Services, Bahawal Victoria Hospital (BVH), affiliated with Quaid-e-Azam medicalCollege Bahawalpur. Period: From 1 January t st o 31st December 2005. Methods and Materials: All the personscoming for blood donations , at the BVH facility, were included. Clinically anaemic, ill, past history of jaundice and ageof less than 18 or more than 50 years were excluded. All the donors (27938) from various areas of Bahawalpur,Bahawalnagar, Lodhran, Vehari and Rahim Yar Khan districts, were screened for hepatitis B surface antigen (HBs)Antigen, hepatitis C antibody (Anti HCV) & Human Immuno-deficiency Virus Antibody (Anti-HIV)on sera by one StepTest Device. All the positives cases were confirmed by Enzyme Linked Immunosorbant Assay. Results: Out of total27938, 25420(91%) were male. Mean age was 28 years with age range 18-50. No HIV positive case was detected.HBV was 2.69%, slightly more than HCV, 2.52%. Males were significantly (p<0.02) more infected than females.Conclusion: Risk of transmission of viral hepatitis is a major problem of blood transfusion. Frequency of viral hepatitisin blood donors is higher in our area as compared to rest of the world. HIV infection is very low. Preventive strategiesinclude good blood transfusion services along with safe sex and other measures.
PULMONARY TB
Authors: AKHTAR FAISAL NAVEED , RANA WARIS ALI , ANSARI SAJJAD AHMAD , Toor Imad Ahmed
Published: September 2021

Objective: To determine the diagnostic yield of microscopy of endobronchialsecretions collected by bronchoscopy in patients who were suspected to have pulmonary TB but their sputum smearwas negative for AFB with ZN staining. Study Design: Descriptive study. Place and Duration of Study: At MilitaryHospital Rawalpindi from June 2004 to May 2005. Subjects and Methods: Fifty patients were included in the study.Convenience sampling technique of non-probability sampling procedure was used for the selection of patients. Onlythose patients suspected to have pulmonary TB on clinical grounds, raised ESR and X-rays chest showing pulmonaryinfiltrates but sputum smear negative for AFB on a minimum of three examinations were included in the study.Bronchoscopy of these patients was done, endobronchial secretions taken and sent for microscopy for AFB. Results:Out of 50 patients, 16(32%) patients were positive for AFB while 34(68%) were negative on endobronchial secretion’smicroscopy. Conclusion: Microscopy of endobronchial secretions collected by bronchoscopy is a useful technique inthe diagnosis of pulmonary TB in patients who are suspected to have pulmonary TB but their sputum smear is negativefor AFB with ZN staining.
TRABECULECTOMY
Authors: SULTAN MUHAMMAD , JAVED BADAR
Published: September 2021

Objective: To compare the final outcome of management of early bleb leak after trabeculectomy bypressure patching versus bleb stitch repair. Setting: Department of Ophthalmology Allied hospital/ Punjab MedicalCollege Faisalabad. Study Design: Interventional Therapeutic Trial and prospective. Period: May 1999 to July 2003.Materials and Methods: 110 glaucoma patients who developed complications after trabeculectomy were included inthe study. The occurrence of relative frequency of various complications was noted. Out of these 110 patients, 44patients having early wound leak were further selected for the study. They were divided into two groups A and B. Awas treated with pressure patching for 48 hrs while B was treated with stitch repair with 10 0/0 Nylon. The final outcomeof the results of management was noted and compared. Results: the frequency of various complications aftertrabeculectomy in 110 patients were found to be early wound leak 43.64 %, failed trabeculectomy 38.18%, hyphema6.36%, cataract 3.64%, blebitis 3.64%, tenon’s cyst 1.82%, malignant glaucoma 1.82%, scleral flap disinsertion 0.9%.The success rate in Group A was 59.1% while in Group B it was 86.4% while the failure rate remained in Group A40.9% while in Group B 13.6%. Conclusion: The success rate for managing wound leak after trabeculectomy wasbetter in repairing the bleb as compared to pressure patching (significant at p< 0.05).
ETIOLOGICAL GENDER DIFFERENCES IN PSYCHIATRIC DISORDERS
Authors: DOGAR IMTIAZ AHMAD , KIRAN MEMOONA , HINA IRAM , Arshed Qurat-ul-ain , Nazir Raisa
Published: September 2021

Background: Recent studies have shown particular differences foundin both gender neurotic disorders but not in psychotic disorders with regard to environmental factors. But research inthis area in Pakistan is direly needed. Aims & Objectives: To find out what gender; either male or female more affectfrom environmental factors whether they are susceptible of that disorder or not and to find out the “etiology of genderdifferences in psychological disorder”. Design: Non-interventional comparative study. Setting: Department ofPsychiatry, District Headquarters Hospital, Faisalabad. Period: From May 2005 to Oct 2005. Material and Methods:A total of 80 patients of all ages are taken from in which we divide the sample i.e. each disorder comprises of 20patients 10 male and 10 females. The Hospital that used is DHQ Hospital Faisalabad. We have used the randomselection. The study is comprises of patient having Mood disorder, Anxiety, schizophrenia and personality disorder.For the simple analysis of data, percentages were applied for the statistical analysis. Results: The result showed thathypothesis is supported because there are significant differences (i.e. 42.5% > 30%) found as environmental factorsaffect more universally on females. Conclusion: Environmental factors affect more in women psychological health.Etiological gender differences in psychological disorders with special reference of mood disorder, anxiety disorder,schizophrenia and personality disorders are real and these gender differences may be due to their both nature ornurture gender. There are significant etiological gender differences in neurotic disorders i.e. Depression and anxietydisorder and minor difference in psychotic disorders i.e. Schizophrenia and mania.
SMALL FOR GESTATIONAL AGE FETUS
Authors: RIZVI SYED MEHDI RAZA , IQBAL NASIR , YASMEEN NAILA
Published: September 2021

Objective: To evaluate the role of Colour Doppler Ultrasound in the management of small forgestational age fetus. SGA or IUGR. Design: Descriptive study. Place & duration of study: Study performed in theDeptt. of Radiology & Deptt. of Gynae. & Obstetrics in Allied Hospital, Faisalabad from August 2005 to July 2006.Material & Methods: This study was carried out on 45 patients admitted through antenatal clinic having suspicion ofcarrying small for gestational age fetus. A brief clinical record including age, parity, nutritional status, intercurrent illness,per-vaginum bleeding, history of drug intake, smoking, past obstetrical history was recorded. Methods involved inscreening SGA fetuses were measurement of Symphyseal Fundal Height chart & Ultrasound biometry, Biophysicalprofile (BPP), Cardiotocography (CTG), Middle cerebral and Umbilical Arteries Doppler studies were performed afteradmission in the management of SGA fetuses. All these information were recorded in a specially designed Performa.Results: Out of 45 SGA fetuses 15(33.3%) were constitutionally small, 20(44.4%) had history of pre-eclampsia,2(4.4%) had cardiac disease, 3(6.6%) had placental abnormalities, 5(11.1%) had multiple gestations. Gestation ofpatients ranged between 30-36 weeks. Umbilical Artery Doppler was used as the primary surveillance tool. Smallfetuses with normal Doppler and anomaly scan were managed on out-patient basis with fortnightly Doppler ultrasound.15 patients (33.3%) with normal end-diastolic flow were delivered at 37 weeks. 20 patients (44.47%) with absent orreversed end-diastolic flow were delivered at 34-35 weeks. 10 patients (22.2%) at 30 weeks gestation with abnormalDoppler study were managed on CTG (Cardiotocography) & biophysical profile over a period ranging between 1-14days. Perinatal mortality was 8.8% (4 cases) mostly due to extreme prematurity. Conclusion: Doppler ultrasound isa very helpful tool in the management of small for gestational age fetuses & it reduces perinatal morbidity & Mortality.
URINARY CALCULI
Authors: FAROOQ MUNAWAR , CH MUHAMMAD ANWAR , BUKHARI MUHAMMAD All , Hameede Awais , Mansoor-ul-Haq Hafiz
Published: September 2021

Objective: To describe frequency of urinary stones according to chemical composition in patients presenting. Study Design: Prospective & descriptive study Setting: Sh. Zayed Hospital, Rahim Yar Khan. Period: Dec 1998 to Dec 2000. Material & Method: Of 125 patients presenting with urinary Lithiasis. who were operated in surgical unit-l. Patients of any age and sex have been included in the study while any patient who did not undergo surgical intervention due to any reason was excluded from the study. Results: Chemical analysis showed that maximum number of specimen (38.4%) had mixed stones having calcium oxalate and urate as main constituents. The next in order of frequency were pure calcium oxalate stones 28%. In 16% of cases calcium oxalate was mixed with phosphate. Only 8 cases (6.4%) had pure uric acid stones. Conclusion: Calcium oxalate was most frequent salt found in urinary stones.
PER-CUTANEOUS FNA BIOPSY WITH OPEN LYMPH NODE BIOPSY
Authors: MAHMOOD QAISER , SIDDIQUE NASREEN , MASOOD AHMED UAZ
Published: September 2021

Objective: To compare the efficacy of per cutaneous FNA biopsy with open lymph node biopsy. Setting: Nishtar Hospital, Multan. Sample size: 50 patients. Duration: One year. Results: Maximum numberof cases 35 (70%) were between the ages of 11-40 years. During this procedure adequate specimens were obtained from all cases for cytological interpretation and no complication was observed. Benign result in 30 cases while malignant disease was observed in 19 cases and an unsatisfactory result was observed in one case. Results of this study showed that tuberculosis is still a common disease in our population. Overall accuracy of FNAB cytology was 98% on comparison with histological diagnosis indicating the usefulnessof this technique. Conclusion: FNAB-C may be performed by clinician, pathologist or radiologist as an outpatient procedure. So along with other advantages it brings a new dimension of cooperation between the medical specialist, cytopathologist and radiologist in this era of emphasis on ambulatory care.
GYNAECOLOGICAL EMERGENCIES
Authors: Ali SARDAR , SHAH SYED TAHIR AHMAD
Published: September 2021

in all the patients. More specific investigations were performed where required. All the patients were resusscitated and operative treatment; where required; was performed under general anesthesia at the earliest possible time. The surgical procedure was tailored according to the circumstances. Further management, conservative or post operative care was done in surgical ward. Results: Pelvic Inflammatory Disease (PID) which is the inflamation of upper genital tract with its complications like pelvic cellulitis and pelvic peritonitis was the most common (40.9%) emergency. The age group between 16 to 30 years was the commonest having gynaecological problems. There was a clear predilection of married than unmarried females facing these problems. Because of lack of experience and limited diagnotistic facilities erroneous diagnosis was made to some extent in almost all the cases. 55.55% of patients suffering from PID were treated successfully by conservative means. Surgical procedurewas performed in all the patients (100%) suffering from ruptured ectopic pregnancy, perforated uterus and torsion of ovarian cyst and pedunculated subserosal fibroid. Wound infection and delayed wound healing were among the most common postoperative complications. Mortality occurred in ectopic pregnancy (16.66%) and PID (5.55%). Conclusion: The different gynaecological problems are commonly encounteredin general surgical practice. The surgeons often fall in this un-wary trap because of (1) close resemblance of clinical features (2) less exposure to gynaecological problems (3) non availability of more sophisticated diagnostic tools in emergency. The overall sufferings of patients can be reduced to some extent by overcoming these shortcomings.
DJ-STENTING
Authors: GHAFFAR ABDUL
Published: September 2021

Background: Obstructive Uropathy is a serious urological emergency. Upper tract Obstruction when it is bilateral or in solitary functioning kidney can lead to renal Impairment resulting in oliguria and anuria. Dialysis or Urinary Diversion by PCN and Retrograde Stenting is required. Purpose of this study was to prove the efficacy of DJ Stenting in cases of obstructive uropathy. D J Stenting overcomes the Emergency and elective definite treatment can be planned when patient is fairly fit and renal functions have come to normal. Study design: It was retrospective, convenient and descriptive type of study. Material and Method : It comprised of 33 cases of obstructive uropathy presented in urology department of PIMS Islamabad from 2001 to 2002 .Patients with Bladder and Prostate Malignancy and other causes of infra vesical obstruction were excluded from study. Results: Male to female ratio was 1.4:1 .Age ranged from 25 to 70 years Pain alone or Pain with Oliguria and Anuria was the major presentation. Stone disease was the cause in 31(93.93%) patients. Serum creatinine was >10 mg/dl in 15 case (45.45 %) preoperatively. Stenting was done in 10 cases bilaterally and in 23 cases unilaterally. Postoperatively creatinine became normal in 10 cases (30.30%) and reduced to range of 1.2 to 2 mg/dl in 8 cases(24.24%). So 54.54% improved dramatically. Hospital stay was one week in in 22 cases (66.66%)and >one week in11 cases. Ten cases required dialyses preoperatively. Conclusion: Retrograde stenting is an easy procedure for the management of obstructive uropathy required no general or regional anesthesia and external ports.
ROLE OF LIPOPROTEINS IN MYOCARDIAL INFARCTION
Authors: IQBAL ZAFAR , ZAFAR TASNEEM
Published: September 2021

Coronary Heart Disease (CHD) is the foremost cause of death in women as well as in men, although the onset of the CHD is earlier on the average in men. Objective: The aim of this study was the evaluation of serum lipids and lipoproteins levels in male and female survivor of first attack of myocardial infarction of various age groups. Place and duration of study: cardiology ward at B.V.H. Bahawalpur 1989 to 1990. Materials and Methods: A total number of 128 patients of myocardial infarction (108 males, 20 females) were selected for study from those who were admitted in coronary care unit. Serum lipids, lipoproteins, relative body weight and blood pressure were assessed in 108 male and 20 female survivorsof first attack of myocardial infarction of various age groups. Results: The majority of patients fall in middle aged category. The mean age and weights were almost similar for patient groups and controls. Generally, there was a significant rise in the mean values of blood pressure, serum cholesterol, triglyceride, VLDL and LDL. The patients of various age groups were also found to have significantly higher levels of VLDLcholesterol,LDL cholesterol and significantly lower levels of HDL-cholesterol than those of control groups Conclusion: HDL-C can be inferred as a marker or predictor of risk of CHD in woman .It has an inverse association with the incidence of CHD in both men and women. It was also conclusion in patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. Suggestion: It is suggested that work may be extended by the comparative study of Troponin with Myoglobin. Which may be used as marker for acute myocardial.
BREAST CANCER
Authors: AHMAD MUKHTAR , MAJEED MUHAMMAD TAHIR , SABZWARI MOHAMMAD JAWAID , Riaz Muhammad , Umair Muhammad
Published: September 2021

Cancer is a group of diseases with uncontrolled cellular proliferation. Breast cancer accounts for 25% of all cancer deaths in females worldwide. Monoclonal antibodies are used for the detection of tumor markers in order for rapid diagnosis and understanding of the nature of cancer at molecular level. On co-fetal antigens like carcinoembryonic antigen 15-3 (CA 15-3) are a new generation of clinically useful tumor markers. Elevated levels of CA 15-3 are related to stages in primary breast cancer, tumor size and nodal status. Significantly elevated sialic acid concentrations havebeen found in breast cancer patients and show correlation with tumor stage. Although total sialic acid has been used as general cancer marker but its role as diagnostic and prognostic marker has not been reported. Objective: This project was designed to study the sensitivity and specificity of sialic acid in breast cancer patients and was compared to CA 15-3, which is one of the most specific markers of breast cancer. Study design: Comparative study. Setting: Shaikh Zayed Medical Complex. Material and Methods: 66 breast cancer patients and 30 normal individuals (controls) were included in the study to compare serum sialic acid with CA 15-3 as tumor marker. Sialic acid was estimated by colorimetric method while CA 15-3 by Enzyme-Linked Immunosorbent Assay. Results: The sensitivity and specificity of CA 15-3 in breast cancer patients was 62.5% and 80% while that of sialic acid was 62% and 76% respectively. The sensitivity of CA 15-3 and sialic acid in patients with ductal breast carcinoma was 62.5% and 54.16% whereas the specificity of CA 15-3 and sialic acid was 80% and 76% respectively. The sensitivity of CA 15-3 and sialic acid in patients with lobular breast carcinoma was 83.33% and 75% whereas the specificity of CA 15-3 and sialic acid was 80% and 76% respectively. Conclusion: It was concluded that sialic acid can be used as a tumor marker in breast cancer patients and has sensitivity and specificity similar to CA15-3. However, CA 15-3appears to have better predictive value.
INTUBATION
Authors: HUSSIAN IFTIKHAR , ZAEEM KHALID
Published: September 2021

Back ground: Endo-tracheal intubation causes hypertensive stress response and increase in bloodpressure and heart rate. This increase in systolic blood pressure causes myocardial ischemia and dysrythmias invulnerable patient . Different drugs 1 are used intravenously to attenuate this hypertensive response during intubation.I compared glyceryltrinitrate with plain Lignocaine intravenous to obtund this hypertensive stress response. Materialand method. In a randomized, double blind study, 60 patients were selected for this study and divided into two equalgroups of I and II based on receiving intravenous glyceryltrinitate and plain lignocaine respectively. A bolus dose ofGlyceryltrinitrate (Nitronal) 200 μg, 20 seconds before intubation. And then titration at a rate of 2 μgm/kg/minute wasstarted. Group II was given plain lignocaine 1.5 mg/kg body weight. The comparative study was carried out to knowthe effectiveness of each drug to blunt the hypertensive stress response and Heart Rate Variability (HRV) duringintubation. Blood pressure and heart rate variability (HRV) immediately after intubation was assessed. Results: Bloodpressure fall was more marked in patient receiving Glyceryltrinitrate (Nitronal) then those of receiving plain Lignocaine,but heart rate variability (HRV) was greater in patient receiving Glyceryltrinitrate (Nitronal). Conclusion:Glyceryltrinitrate (Nitronal) is more effective than plain lignocaine in blunting the hypertensive stress response ofintubation .
BASAL CELL CARCINOMA
Authors: AFTAB MUHAMMAD FARRUKH , AHMAD IRFAN , MANAN ABDUL
Published: September 2021

Introduction:- Basal cell carcinoma is the most common skinmalignancy, accounting for about 80% of all skin cancers and may be lethal. Its recognition and management shouldbe familiar to all the general surgeons. Objective:- To describe the prevalence, mode of presentation and varioussurgical options of reconstruction in the management of basal cell carcinoma (BCC) with a local perspective. Setting:-Nishtar Hospital, Multan. Duration:- One year (October 2002 to September 2003). Sample size:- 60 patients. Studydesign:- Descriptive study. Results:- Out of sixty cases, 50 (83%) were male and 10 (17%) were female. Majority ofthe patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male tofemale ratio was 5:1. Out of 60 cases 26 (20 male, 6 female) 43.3% were farmer, 16 (all male) 26.6% was constructionworkers, 10 (8 male, 2 female) 16.6% were unemployed and 8 (all female) 13.3% were household. No patient presentedbefore 5 years after the development of the lesion. 34 (30 male, 4 female) 56.6% for the last 6-10 years, 20 (16 male,4 female) 33.3% for the last 11-15 years, 2 (all male) 3.3% for 16-20 years and 4 (2 male, 2 female) 6.6% had lesionsfor > 20 years. All the lesions encountered in present study occurred on exposed head and neck region as is evidentfrom the table-III. Most of the patients had the nodular pigmented type of BCC and majority of them were male. Noneof them have Gorlin’s syndrome (Table-IV). Common variant on histopathology was found to be solid type withadenocystic type being the commonest lesion. After the excision of the lesion the skin defect most of the time wasclosed by the mean of split skin graft. Direct closure was done in quarter of the patients. A number of postoperativecomplications were observed after various reconstructive procedures. Wound was found to be commonest complication;with majority of cases getting only minor wound infection. Conclusion:- Delay in presentation has an overall negativeeffect on the outcome. A simple excision, excision biopsy with adequate margin clearance gives surgeon more freedomfor reconstruction.
HEPATITIS B VIRUS
Authors: XIAO JIANBO , Zhang Lei , CHEN XIAOQING , Xu * Ming , JIANG XINYU
Published: September 2021

Dried leaves of Marchantia convoluta are largely used to protect livers,and to treat tumefaction of skins in China. Flavonoids from Marchantia Convoluta (MCF) was one of the mostpotentially effective anti-inflammatory. MCF was studied here for its ability to inhibit the proliferation of 2,2,15 cells(clone cells derived from HepG2 cells that were transected with a plasmid containing HBV, DNA). All concentrations(5,10,20 and 40 :g/ml) of MCF inhibit hepatitis B surface antigen (HbsAg) and hepatitis B E antigen (HbeAg) in thecultured medium released from 2.2.15 cells. Analysis of morphological changes of MCF-treated phase- contrastmicroscope revealed a possible model of action for MCF to inhibit Proliferation of 2.2.15 cells by inducing apoptosis.
DIABETIC PATIENT
Authors: UR-REHMAN KHALIL , UR-REHMAN ATIF
Published: September 2021

Introduction: Limb loss is most feared complication of diabetes. The statistics associated withamputation create a very real concern. Fifty percent of all non-traumatic amputations occur in the diabetic patient. Therisk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year, six of every thousand diabeticindividuals undergo surgery for an amputation. Objectives: To evaluate the frequency of lower limb amputations indiabetic patients, hence emphasizing the importance of timely surgical intervention in salvage of lower limb and toreduce the morbidity and mortality. Study design Descriptive study. Setting: Surgical OPD, Causality Ward andMedical Unit, Nishtar Hospital Multan. Duration: One year. Material and methods: 100 patients. Results: Theincidence of amputations rose steeply with age; most amputation occurred in patients over 60 year. The incidence wasa higher in men than in women. The incidences of major amputations were 32% than that of minor amputations. Nearly40% of all subjects under going afoot level amputation had a previous history of foot amputation. However nearly 40%of all subjects under going a foot level amputation had not been diagnosed either before or during admission withperipheral arterial occlusive disease, suggesting a casual pathway dependent primarily on neuropathy. The main outcome variables were the number of repeat operations and hospitalization for salvage of limb with recurrent or persistentinfection, and time to complete forefoot healing or foot amputation Conclusions: Amputations performed at healthyzones reduce the hospital stay of the patient but mortality was more consistently for proximal amputations. Betterscreening of diabetic patients with appropriate risk directed treatment at primary care level might significantly impactthe large number of preventable diabetes related lower extremity amputations.
SPONTANEOUS PNEUMOTHORAX SECONDARY TO COPD
Authors: BISWAS MANABENDRA , Razzak Akm , Ahsan Shafiqul , MS MD. ZILLUR RAHMAN , Khan M. Nabi Alam , Choudhury GM Akbar
Published: September 2021

Introduction: The high recurrence rate of spontaneous pneumothorax secondary to COPD highlightsthe need for the prevention of recurrence with cheap and cost effective method. Chemical pleurodesis with tetracyclinehydrochlorides may be a good option for the prevention of recurrence of pneumothorax and thereby enablessatisfactory patient outcome. Objectives: (i) To compare the recurrence rate of spontaneous pneumothorax treatedwith chemical pleurodesis with tetracycline hydrochloride and tube thoracostomy alone. (ii) To make a standard protocolfor management. Study design: A prospective randomized case control study. Setting: The dept. of thoracic surgeryof the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh. Period: From January2003 to December 2003. Material & Methods: Sixty patients with spontaneous pneumothorax, secondary to COPD.After randomization, 30 patients were treated with tube thoracostomy followed by pleurodesis with tetracyclinehydrochloride and another 30 patients of control group were treated with tube thoracostomy alone. Results: Patientswere followed up upto 6 months and were looked for recurrence. Patients with spontaneous pneumothorax were of4 to 6 decades of life and most of them were th th male. Most patients presented with moderate size of pneumothoraxand required 91-110 hours for lung expansion after tube thoracostomy. Recurrence rate of spontaneous pneumothoraxsecondary to COPD in the tetracycline group was 3.3%, whereas in control group it was 30%. Intrapleural instillationof tetracycline hydrochloride significantly reduces the recurrence of spontaneous pneumothorax secondary to COPD.(P=0.015). Morbidity related to tetracycline was negligible. Moreover, tetracycline is cheap, easily available, non-toxic,well tolerated. Conclusion: It is concluded that recurrence rate of spontaneous pneumothorax secondary to COPDcan be reduced effectively by chemical pleurodesis with tetracycline hydrochloride without any significant morbidityrelated to tetracycline hydrochloride and it is also very cost effective.
CHRONIC ANAL FISSURES
Authors: KHANZADA TARIQ WAHAB , SAMAD ABDUL
Published: September 2021

Objective: The objective of this study was to compare the topical GTN andlateral internal sphincterotomy for the treatment of chronic anal fissure. Setting: This was a prospective randomizedcohort study conducted at Isra University Hospital, Hyderabad between September 2004 and August 2005. Materialand Methods: Fifty patients fulfilling the selection criteria were randomly divided into two equal groups. One group wastreated with topical glyceryl trinitrate (GTN) ointment and other group was treated with lateral internal sphincterotomy.Patients were followed up in outpatients department after regular intervals for about one year. The data was collectedand two groups were compared with special reference to pain relief, fissure healing and recurrence rate. Results: Painrelief was observed in 96% of the patients in GTN group as compared to 92% of the patients in sphincterotomy groupafter 6 weeks. Complete healing of fissure was observed in 92% of the patients in GTN group as compared to 88% ofthe patients in sphincterotomy group after 6 weeks. Recurrence was observed in 16% of the patients in GTN group ascompared to 4% of the patients in sphincterotomy group after one year. Conclusion: GTN and lateral internalsphincterotomy are comparable in terms of pain relief and fissure healing after 6 weeks. Topical GTN is suggested tobe the initial treatment whereas lateral internal sphincterotomy is suggested to be reserved for the patients notresponding to topical GTN or having recurrence after completion of treatment with GTN.
PRE-EMPTIVE PAIN CONTROL
Authors: NASIR MUHAMMAD , LATIF KHAWAR , AHMAD MALIK JAMIL
Published: September 2021

Introduction: Opioid related side effects have encouraged the use of analgesic drugs that are devoidof these problems. Objective:- This study was done to compare the analgesic efficacy of Ketorolac and diclofenacin 60 adult patients of age group ranging between 30 to 45 years of age body wt 50-60kg belonging to ASA I and IIgrade. Material and Methods: Patients were scheduled for elective gynecological procedure (laparoscopic tuballigation) under general anaesthesia. They were divided into two equal groups using non-probability conveniencesampling technique. Each group comprised of 30 patients. Group A received Ketorolac 10 mg I/V with local infiltrationof 0.5% Bupivacaine and group B received IM Diclofenac sodium 75 mg after local infiltration 0.5% bupivacaine asin Group A ½ hourly before surgery. Post operatively patients were observed after 30 minutes in the recovery roomfor pain relief for two hours. Mean pain scores were noted in the recovery area using visual analog scale with need forsupplementary analgesic after awakening from general anaesthesia. Vital signs were monitored. Result: Results wereanalyzed by using SPSS-8 package by applying Student Test and chi Square Test. There was statistically significantdifference between two groups regarding their mean pain score. Conclusion: The patients who received KetorolacI/V (Group A) had longer pain free time interval and request for first analgesic supplement was made after 90 minutescompared to a shorter interval of 60 minutes in Group-B, who received intramuscular diclofenac sodium.
AIRWAY FOREIGN BODIES
Authors: KHADEMI BIJAN , GANDOMI BEHROOZ , HASHEMI SEIED BASIR , Chohedri Abdul Hamid
Published: September 2021

Objective: To study the pattern oflaryngotracheal foreign bodies in South of Iran and to compare it with other studies.. Design: A retrospective chartreview of patients who had airway foreign body. Period : From 1991 to 2000. Setting: Department of OtolaryngologyKhalili Hospital,Shiraz,Iran. Material & Methods: Patient characteristics including age,sex, laryngobronchoscopicfindings,clinical presentations and history of foreign body aspiration were recorded .Type and site of foreign bodyaspirated was also recorded to determine the common type and site of foreign body enlodgement in this country.Results: From 1012 patients with airway foreign bodies,683 patients were male and 329 patients werefemale.Aspiration most commonly occurred in the 1-6 year age group.The most common presenting symptom wascough,dyspnea and chocking.The most common site of foreign body enlodgement was right bronchus and the mostcommon foreign bodies in our area were various types of seeds. Conclusion: Education of physicians and publicawareness are important steps needed to reduce the morbidity and mortality of foreign body aspiration.Parents shouldbe instructed to abstain from feeding nuts and seeds to young children and to keep small,potentially ingestible objectsout of their reach.
TYPHOID FEVER
Authors: AHMAD MAQSOOD , Bashir Badar , AKHTAR MUHAMMAD SAEED , Irfan Muhammad , ADIL MUHAMMAD AMER , Hashmi Zahid Yasin
Published: September 2021

Objectives: To find out the efficacy and safety of Levofloxacinin patients suffering from typhoid fever. Design: Non-comparative and prospective study. Setting: Medical Units ofAllied & DHQ Hospital (PMC) Faisalabad. Period: From May 2002 to July 2004. Material & Methods: All suspectedfebrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose ofstudy till they were satisfactorily discharged. Results: This clinical study was conducted on 70 patients of Enteric Fever.Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58± 8.13while the mean age of females was 21.92± 4.73 years. Fever as a symptom was present in all 70(100%) of thepatients. Anorexia was there in 61(85.5%)patients and abdominal pain in 49(70%) patients. Twenty-seven (38.5%)patients had constipation along with other features. Diarrhea was present in 6 (8.5%) patients. Relative bradycardiawas present in 20(28.5%) patients. Hepatomegaly was there in 31(44.3%) and Splenomegaly in 24(34.3%). Elevatedliver enzymes were found in 29 (41.4%) of the patients and blood cultures positive for Salmonella typhi was seen in19(27.1%) patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18%of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of feverand other symptoms and signs. The side effects were seen in 17(24.2%) patients. Conclusions: In conclusionlevofloxacin is effective in treatment of typhoid fever and its use in this indication is safe.
HYPOSPADIAS REPAIR
Authors: RASOOL MUMTAZ , SHEIKH ABID HAMEED , TABASSUM SHAFQAT ALI , Amin Mohammad Mughis
Published: September 2021

Place of Study: The Departments of Urology, Paediatric Surgery and Plastic Surgery, Quaid-e-AzamMedical College, Bahawal Victoria Hospital, Bahawalpur. Duration of Study: Jan 1999 to Dec 2004. Design of Study:Prospective. Materials&Methods: Patients admitted with hypospadias in these departments were included in this studyexcept patients with multiple failed repairs previously. Standard procedures were practiced for every type of defect i.e.MAGPI and Mathieu’s repair for coronal hypospadias, Snodgrass urethroplasty for proximal and distal penilehypospadias. Results: The age range observed during this study was 1.5 to 25 years while 64% of patients were lessthan 10 years of age. The type of defect was coronal in 25%, penile in 60%, penoscrotal and perineal in 15% of thepatients. Initial success rate was 78% and overall success rate was 92%. Complications observed were fistulaformation 7% , stenosis of anastomotic site 7% and dehiscence of repair 3%. Conclusion: Thorough evaluation ofurethral and penile malformation brings best outcome of surgery for hypospadias. Hypospadias repair should be offeredto the child before school going age so as to prevent psychological impacts of genital malformations.
GALL STONE ILEUS
Authors: ZUBAIR MUHAMMAD , AMIR MUHAMMAD
Published: September 2021

Gallstone ileus (GSI) is an uncommon cause of intestinal obstruction. Theformation of a fistula between the gall bladder and the bowel wall may allow a gallstone to enter the intestinal tract.Plain abdominal films, abdominal ultrasound and abdominal computed tomography aid in the diagnosis. Surgery is thetreatment of choice in cases of gallstone ileus rate. We describe the case of a 68-year-old man who presented withsymptoms and signs of intestinal obstruction. Diagnostic evaluation revealed a large gallstone impacted in the ileum.The patient was scheduled for exploratory laparotomy. At the time of surgery stone was found in the sigmoid colon.It was milked down and brought out through the rectum.