bluuebunny/crossref_metadata_2025 huggingface dataset:
MANDIBULAR CANINE INDEX (MCI)
Authors: MUGHAL IRFAN AHMED , SAQIB ANWAR SAOOD , MANZUR FARIDA
Published: September 2021

Introduction: Dental evidence is valuable in identification of individuals, especially following mass disasters; estimation of age at death of skeletonised remains and establishing guilt in cases of criminal injury by biting. Mandibular canines are found to exhibit the greatest sexual dimorphism amongst all teeth. Objective: To investigate the accuracy with which gender can be differentiated by using the mandibular canine index in the Punjabi – Pakistani population. Setting: Independent Medical College and Punjab Medical College,  aisalabad. Period: Dec. 2008 to Dec. 2009. Material and Methods: The present study was performed on 200 students, between the age group of 18-25 years, randomly sampled with informed consent (Through 3rd party). Mandibular canine width and intercanine distance were measured with the help of Vernier caliper after observing aseptic conditions. Mandibular canine index was calculated and the observed MCI was compared with the standard MCI value. The data was then analyzed using student’s “t” test. Results: No significant statistical difference was noted between the right and left mandibular canines amongst males and females (same sex) but when comparing between males and females, there was highly statistical significant difference (P < 0.001). The calculated standard MCI for canines of males and females found to be 0.2504. With these calculations we could predict sex correctly at 75.97% in this study (Male: 71.67% and Female: 78.72%). Conclusion: MCI is a quick and reliable method for sexual identification when a standard for the population is available. With these calculations, we could predict the sex correctly at 75.97 % in this study. This method can be used as adjunct to other available tools for sex determination. DNA studies can reveal sex accurately.Availability of comprehensive database with “NADRA” can also be used as adjunct to “MCI” to enhance the accuracy in determination of sex and identity of the person in Pakistan.
EMPYEMA THORACIS
Authors: SALEEM MUHAMMAD , QURESHI MUHAMMAD ASIF , QURESH MUHAMMAD ASIF I
Published: September 2021

Empyema as a complication of community acquired pneumonia (CAP) is relatively common occurrence in developing countries. Study Design: Prospective study. Period: 4 year Jan 2001- Dec 2004. Setting: Department of Pediatric surgery the Children’s hospital Lahore. Patients & Method: A total of 114 cases of empyema thoracic secondary to CAP were dealt with during this period, while in the same duration a total of 1768 cases of pneumonia were treated at the Children’s hospital Lahore. Results: Majority of the patients with CAP (59.61%) were below one year of age whereas the patients who developed empyema, were mainly (45.67%) between 2 to 5 years of age. Patients above 5 years of age having CAP (31.70%) and having repeated attacks of respiratory tract infection were most susceptible to develop empyema. Staphylococcus aureus was the most common organism found (40.35%) in this series. Vaccination, poverty and gender did not significantaffected the development of empyema among the patients of CAP. Antibiotic resistance had no role in the development of empyema. Ibuprofen may be a risk factor. All the patients were initially managed with tube thoracostomy and antibiotics. Forty-eight patients (42.10%) needed subsequently operative management. Three patients (2.63%) had fatal course in this series same as seen in patients of CAP (2%). Conclusions: Immunization against causative organism and modification of out patient treatment may affect the incidence of empyema in children and should be studied prospectively.
THERAPEUTIC ROLE OF ZINC
Authors: SAJID AISHA , SAJID SURRIYA , AHMAD MAQBOOL
Published: September 2021

OBJECTIVES: To evaluate the efficacy of zinc supplementation in patients with diarrheal illnesses. Study Design: Quasi Experimental study. Setting: The study was conducted at the pediatrics department of Madina Teaching Hospital, Sargodha road, Faisalabad, Period: 6 months period from November 2008 to April 2009. Material and Methods: Two hundred children suffering from diarrhea with mild to moderate dehydration were included in the study and divided into two groups, A and B. Group A was given zinc supplementation along with ORS and adequate nutrition according to age. In group B 100 children were taken as control to whom only ORS and adequate nutrition for age was given. Results: Baseline clinical parameters were comparable in both groups at admission. The effect observed on stool consistency was more marked in 72 hours i.e. 71% patients were improved in group A versus 40% in group B, as compared to stool frequency in 72 hours i.e. 56% in group A versus 39% in group B. Although in 7 days, 99% patients showed improvement in stool consistency in group A,70% in group B(p value 0.037) and stool frequency showed improvement of 96% in group A as compared to 77% in group B(p value 0.037). Duration of hospital stay on the average was about 2 days less in case of zinc supplemented group as compared to control group. Conclusion: Zinc supplementation reduced the duration and severity of mild to moderate diarrheal illness and treatment was well tolerated with no significant side effects.
LEGIONELLA INFECTION
Authors: AZHAR ESAM I. , ASHSHI AHMAD M. , ASGHAR ATIF H. , Bukhari Syed Zahid , Zafar Tariq A. , Jukdar Hani A.
Published: September 2021

Respiratory system is most commonly affected during Hajj season. Objectives: (1) to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; (2) to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and (3) to determine whether there is any relationship diseaseincidence and water supply system. Material & methods: The clinical samples were received from in-patients of the following five Ministry of Health (MOH) Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negativeon routine cultures and found negative for acid fast bacilli (AFB) from sputum/bronchial aspirate (BAL). Serological tests was done by Enzyme linked Immunosorbent assay (ELISA) for Legionella antibodies Total IgG and IgM. Results: Out of total 133 patients suspected for Legionella, 83 (62.4%) were male and 50 (37.6%) female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years(63.2%). There were 4 (3.0%) cases of Legionella species isolated from Microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Conclusion: Pneumonia was one of the most common illnesses among pilgrims. The water supplied toall areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians’ awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season.
VISITING HOLY SHRINES
Authors: SHAIKH ZULFIQAR ALI , KHATOON FAHMIDA , HUSAIN SYED SHAJEE , Ibrahim Abdullah Mohammad , Abdullah Mansour
Published: September 2021

Background: There are frequent visits of the devotees to the holy shrines mainly for the purpose of mental healing. The people with various beliefs and religions attribute divine powers to the graves of their saints. This study surveyed the purpose of the visits to shrines, their beneficial effects, and also the sanctity violated by drug addicts and others. Objectives: 1) To assess the common reasons of visiting holy shrines. 2) To determine the use / misuse of these visits. Methodology: Study Design: Cross-sectional. Setting: One most commonly visited shrine in Karachi. Duration of Study: 01-06-2008 to 30-07-2008. Sample size: 120 visitors. Inclusion Criteria: Visitors of 20 years age or older, who consented to participate. Exclusion Criteria: Visitors of less than 20 years age and who did not agree to participate. Results: Total number of study subjects was 120, with male to female ratio of 58:42. Their age varied from 20 to 80 years. They belonged to various socioeconomic and ethnic groups with varying educational level. Majority of the visitors come frequently. The purpose of visits included reward (swab), poverty, domestic problems, infertility, ill health, in addition to see lovers to have an access to commercial sex workers and narcotics Some devotees had a mishap during the visit. Conclusion: Most of the visitors come for mental healing and relaxation with the hope of gettingsolutions for their problems, and a few use these sacred places for their wrong doings.
COMPLICATIONS OF RAISED BMI IN PREGNANCY
Authors: ISLAM ALIYA , KHAN NUSRAT AJAB , EHSAN AMBREEN
Published: September 2021

Objective: To study the effects of raised BMI on maternal and fetal well being. Study Design: Randomized Control Trial prospective study. Setting: Gynae/Obs department Military Hospital Rawalpindi. Duration: January 2006 to June 2007. Subjects & Methods: 200 primiparas with raised BMI (25 or more) were booked in first trimester. Patients were followed up with regular antenatal check-up and routine investigations of pregnancy. Patients found to be anaemic were further investigated and anaemia corrected. Another group of 200 primiparas was also booked with normal BMI (18.5 TO 24.9) in first trimester. Complications encountered during pregnancy were recorded in both groups. Mode of delivery and fetal outcome were also recorded. The relative frequency of pregnancy induced hypertension, gestational diabetes, sleep apnoea, urinary infection, preterm labour and intrauterine deaths were compared in both groups. Obstetric complications were also recorded. Results: The frequency of asymptomatic bacteriuria, sleep apnoea, pregnancy induced hypertension, induction of labour, instrumental delivery, caesarean section and post partum hemorrhage was found to be significantly increased in group-I (raised BMI). Conclusion: Pregnancies in obese women are considerably at higher risk for pregnancy and labour complications. It is advisable to achieve normal BMI before conception.
FAMILIAL DUANE’S SYNDROME
Authors: JAVED EJAZ AHMAD
Published: September 2021

Objectives: To describe a family suffering from Duane’s Syndrome. Study Design: Case series studies. Setting: Diagnosis and Research department of Ophthalmology, Allied Hospital ,PMC, Faisalabad Period; Oct 2009 (One month).Presentation: A Gentle man , 65 years old , shopkeeper , resident of Jaranwala, Faisalabad, presented with his four children two male and two female with complaint of asymmetry of their unilateral eyes, since birth. There was no history of maternal intake of drugs, or smoking during pregnancy. There was no history of trauma or surgery. On examination the unaided vision of all the study cases was 6/6, 6/6.The cornea, conjunctiva , lens, iris, pupil, vitreous and retina of all the subjects was normal. The IOP of the all was also with in normal range. The ocular motility and lid fissure narrowing was noted in different ocular gazes. The lymph nodes and Thyroid gland examination was done. The Hiss screen test was done to quantifyindividual muscle action. The Levator function test, cover tests, papillary reactions, Slit Lamp Examination, Fundus examination were performed. The lids fatigue ability tests and strength of hands grip was estimated at the last.All cranial nerves were examined. Urine ,Blood and Thyroid tests were requested and documented. Results; The all the cases had lid fissure narrowing in one of their horizontal gazes. The all of them had under action of one of their horizontal muscles. So all the children had been proved to be suffering from unilateral Familial Duane’s Syndrome. In our clinical practice the Familial DS is rarely found None of the study patients showed amblyopia, diplopia, upshots or down shoots phenomenon. Similarly no associated systemic anomalies were seen.
ENTEROCUTANEOUS HIGH OUTPUT FISTULAE
Authors: ARAIN GHULAM MUSTAFA , GULZAR MUHAMMAD REHMAN , SUHO KUSH MUHAMMAD , Awan Waseem Sadiq
Published: September 2021

Enterocutaneous fistula is an abnormal communication between epithelial lined lumen of GI tract & epithelium of an adjacent viscous or skin. Objectives: To find out role of octreotide in the management of high enterocutaneous fistula. Design: Case study. Setting: Department of Surgery Unit-II Punjab Medical College & A & E Department of Jinnah Hospital /AIMC Lahore. Period: From Jan 2007 to Dec 2008. Patients & Methods: 479 laparotomies were carried out due to trauma. Out of these 21 i.e. 4.38% developed high out put enterocutaneous fistula. All patients were put on similar conservative management including, TPN, antibiotics, fluid electrolyte replacement and stoma care. Results: Patients were split into two groups alternatively. There were no statistical difference between the study groups with regard to the age (p-value=0.515). Group I contains 11 patients (octreotide) received additionally 100mg octreotide S/C 8 hourly, showed decrease of volume from 680 to 150ml within 10 days. Spontaneous closure was observed in 8(72.72%) patient & surgery was required in 2(18.18%) patients. Death was 1(9.09%). In Group II remaining 10 patients(without octreotide), fistula discharge volume decreased form 650mg to 150ml in 20 days. Spontaneous closure was noted in 5(50%) cases. Surgery was required in 3(30%), while death rate was 2(20%).Conclusions: It is concluded that Octreotide, an analogue of somatostatin with longer half life is effective in treatment of high output fistula.
MODIFIED ALVARADO SCORE
Authors: ALI SHAH SYED WARIS , KHAN CHAUDHRY AHMED , MALIK SIKANDER ALI , WAQAS AHMED , TARRAR AJMEL MUNIR , BHUTTA IRTIZA AHMED
Published: September 2021

objective: To compare the frequency of inflamed appendix in suspected patients of acute appendicitis having Modified Alvarado Score (MAS) of 7 or more with patients having MAS of 6 or below. Design: Comparative cross sectional study. Place and duration of study: The study was carried out at Surgical Departments of Combined Military Hospital (CMH) and Military Hospital (MH) Rawalpindi from April 2006 to April 2007. Material and Methods: This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated and the patients were divided in two groups. Group-I had MAS of 7 or more while Group-II had MAS of 6 or below. Postoperatively appendices of all the patients were sent for histopathological examination and its result regarding presence or absence of acute appendicitis was then compared with MAS of respective group. Results: (a) Group-I:- A total of 72 patients with 64(88.9%) positive inflamed appendices on histology. Negative appendicectomy rate 8(11.1%), (b) Group-II:- A total of 28 patients with 8(28.6) positive inflamed appendices. Negative appendicectomy rate 20(71.4%). There is statistical significant difference of positive appendicectomy rate between two groups with (p-value<0.001). Conclusion: Frequency of inflamed appendix is more in patients having MAS of seven orabove. The number of negative appendicectomies can be reduced by using MAS in clinical practice.
CHRONIC HEPATITIS C VIRUS INFECTION
Authors: MUHAMMAD DILSHAD , AMIN KHALID , ANJUM AMIN , Javed Masood
Published: September 2021

Objectives: (1) To seek the association between chronic HCV infection and type 2 diabetes, mellitus. (2) To verify the effect of age, sex, socioeconomic status, obesity and presence of cirrhosis on the association of chronic HCV infection. Design. Case control study. Setting: DHQ Hospital, Faisalabad. Subjects: The subjects were divided into two groups. One was with positive anti-HCV antibody on ELISA method and other was without liver disease and negative for anti-HCV. Both the groups contained 500 subjects each and were selected according to the inclusion and exclusion criteria. Intervention: After a brief interview regarding age, residence, family history of diabetes, socioeconomic status, both the groups underwent weight and height measurements. The body mass was calculated according to the formulae. Ultrasonography of abdomen was done of all the patients of study groups to assess the liver status. Main outcome measures: Chi – squaretest was applied to see the association and then odds ratio was calculated to check the strength of association. Results: Diabetes mellitus was detected in 174 patients (34.8%) out of 500 patients in the group A as compared to 30 patients (6%) out of 500 patients in the group B. having chisquare value of 127.69 and significance of 0.000 with HCV +/ HCV- Odds ratio 0.120 and 95% CI0.079-0.181. Conclusions: There is strongassociation between HCV infection and type 2 diabetes mellitus. Severity of Liver Disease was strong associated factor.
BRONCHIOLITIS WITH MONTELUKAST
Authors: HASHMAT NADEEM , KANWAL NAUREEN , BUTT MOHAMMAD ASGHAR , Malik Bushra Abdul , Sheikh Saif-Ullah
Published: September 2021

Objectives: To assess the efficacy of montelukast in children with bronchiolitis. Study Design: Experimental-Preventive. Place and Duration of Study: Pediatrics department Allied/DHQ hospital affiliated with Punjab Medical College, Faisalabad, from 1st Nov 2007 to 30th April 2008. Patients and Methods: One hundred children of bronchiolitis were studied in two equal groups, group A and group B. To group A montelukast along with symptomatic treatment was given. Group B was given only symptomatic treatment. The criteria of treatment efficacy was taken as number of symptoms free days and nights, bronchiodilator rescue therapy, duration of hospital stay and complications like worsening of symptoms, ventilatory support and side effects of drug therapy. Results: Symptoms free days were increased in group A as compare to group B (P value = 0.000) whereas duration of symptoms free nights were significant numerically but not statistically. There was a significant reduction in exacerbations (P = 0.046) and use of rescue therapy (beta 2-agonist) in group A. Conclusions: Leukotriene receptor antagonist (LRTA) reduced the duration and severity of lung symptoms in children with Bronchiolitis.
TRANS VESICAL PROSTATECTOMY
Authors: AHMED NISAR , MALIK MASUD , RASHEED ABDUL , Hussain Malik , Iqbal Muhammad , Chugta Mohammad Nawaz i
Published: September 2021

To determine the effectiveness of prostectomy in reducing symptom severity and quality of life. Design: A prospective study. Setting: Urology department civil hospital Dadu. Period: 2005 to 2007. Patients & methods: 100 men under going prostectomy were assessed using the American urological Association (AUA) symptom index score and quality of life. The adverse events like urinary incontinence, erectile dysfunction and retrograde ejaculation also detected. The outcome was assessed after 3 month of prostectomy. Results:Prostectomy was effective in reducing symptoms. Initial mean IPSS was 25 and reduced to 7 with p value < 0.001. Quality of life also assessed which showed majority of cases were mostly satisfied. Adverse events like transient incontinence 10%, retrograde ejaculation in 65% and erectile dysfunction in 25% respectively. Conclusion: Prostectomy is effective in reducing symptom severity and improve quality of life whichwas detected by IPSS and quality of life questionnaire.
SOLITARY THYROID NODULE
Authors: TARRAR AIMEL MUNIR , WAHLA MADIHA SAEED , ILYAS SOHAIL , Khan Obaid Ullah , Waqas Ahmed , Raza Ahmed
Published: September 2021

Objectives: To determine frequency of malignancy in solitary thyroid nodule. Design: Case-series study. Place and Duration of Study: The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi, from April 2002 till April 2003. Patients and Methods: Sixty patients with clinical solitary thyroid nodule fulfilled the selection criteria and were included in the study. Thyroid function tests, ultrasonography and thyroid scanning was done. Finally FNAC and histopathology were done in all the operated cases and record was evaluated. Results: Out of 60 cases studied, 8 (13.33%) were found to have malignant lesions. The remaining 52 (86.67%) cases had benign pathology. Male patients with solitary thyroid nodule showed a higher incidence of malignancy 17.65% as compared to females 11.63%. Maximum malignant cases (50%) were found between the ages of 31 to 40 years. Papillary carcinoma was the most common malignancy (50%)found in our study. Conclusions: The incidence of malignancy in solitary thyroid nodule is quite high (13.33%). So people should be educated to attend thyroid clinics for early diagnosis and adequate treatment.
UNILATERAL ETHMOIDAL POLYPS
Authors: SAEED MUHAMMAD
Published: September 2021

Objectives: To know the etiology and incidence of unilateral ethmoidal polyps. Design: Descriptive. Setting: ENT department Allied Hospital Faisalabad. Period: From Jan 2007 to June 2009. Material and Methods: The patients were admitted through ENT out patient department. The data was collected on the basis of history, physical examination, investigations, management and follow up. Results: Out of 200 patients between 05 years to 60 years of age suffering from ethmoidal polyps the incidence of unilateral ethmoidal polyps was 35% and that of bilateral ethmoidal polyps was 65%. The 57% of patients having unilateral ethmoidal polyps were male and 43% female. The highest incidence of unilateral ethmoidal polyps was seen during second decade of life 43%.The incidence of unilateral ethmoidal polyps and bilateral ethmoidal polyps was 1.6 and 03 cases per month respectively. The most common presenting symptom was unilateral nasal obstruction(100%) in cases of unilateral ethmoidal polyps .The most common associated disease in patients with unilateral ethmoidal polyps was deflected nasal septum (71%). Transantral ethmoidectomy was carried out in majority of patients (43%). The most common etiology held to be responsible for unilateral ethmoidal polyps was Vasomotor rhinitis (57%). Conclusions: The unilateral ethmoidal polyps are not uncommon inyoung adults and the etiological factors are same as that for bilateral ethmoidal polyps.
TISSUE EXPANSION
Authors: AHMAD MUHAMMAD
Published: September 2021

Objective: To share the experience of tissue expansion. Study Design: Descriptive. Duration: June 2005 to May 2009. Setting: Aesthetic Plastic Surgery, Rawalpindi. Inclusion Criteria: Patients of all ages and sex undergoing tissue expansion. Exclusion Criteria: Patients having acute injuries, burns and defects which were closed primarily. Patients undergoing primarily flap surgery. Materials and Methods: The shape and size of the tissue expander was chosen according to the deformity and expected wound geometry. All the surgerieswere performed under general anaesthesia. Drains were removed after 48 – 72 hours. Slightly filled (20 – 50ml) tissue expanders were used. Tissue expansion was started after 7 – 12 days and were filled twice weekly. Results: Total 19 patients (12 males & 7 females) were included in the study. The mean age in males was 32.9 years (range 13 – 44 years) and 21.1 years (range 19 – 36 years) in females. The differentdeformities included contractures 31.6%, Postburn scar 21.1%, hypertrophic scar 15.8% followed by congenital naevus 10.5%. The fill volume ranged from a 140 ml to 480 ml over a period of 8–13 weeks. No major complication was noted. Slight loss of distal flap occurred in 2 patients. No infection/rupture of tissue expander was seen. Conclusion: Tissue expansion is a safe technique for reconstruction of defects, with an obvious advantage of the availability of the adjacent skin.
DEPRESSED SKULL FRACTURE
Authors: MEHDI SYED ANJUM , AHMED BASHIR , DOGAR IQBAL HUSSAIN , Shaukat Asim
Published: September 2021

Purpose of the study: The purpose of study was to interrelate CT findings of depressed skull fracture with clinical findings. Study design: This was exploratory study. Place of study: The study was conducted at Mayo Hospital Lahore and Lahore General Hospital. Duration of study: From March 9, 2004 to October 2004. Sample size: Fifty patients irrespective of their age and sex were included. Patients selection: Only the newly admitted patients in the above mentioned hospitals were included in the study. Previously diagnosed depressed skull fracture or the patients having associated facial abdominal and thoracic injuries were excluded. Methodology: Patients having depressed skull fracture were clinically evaluated and thereafter subjected to 4th generation spiral CT scan at the radiology Department of the above mentionedhospitals. Both bone and brain window were taken for various intracranial structures. Results: Analysis of the data for association between the variables of clinical and CT findings revealed that patients with conscious level, with DSF and having mild head injury were less associated with scalp injury (p=0.1156) which is statistically insignificant. DSF with moderate and severe head injury had more probability of scalp injuries. Scalp laceration seen with DSF had association with scalp injury (p<0.001). Conclusion: It is a key for clinician and neurosurgeon to use GCS score in congestion with the CT findings for early management of DSF.
PITUITARY MACROADENOMAS
Authors: FAROOQ KHALID , MALIK TAYYABA GUL , RASHID ANJUM
Published: September 2021

Objectives: To describe the demographic profile, patterns of visual disturbance and imaging studies of patients with Macroadenoma. Design: Retrospectively. Reviewed the clinical charts and neuroradiologic imaging of 125 patients who were diagnosed as cases of Macroadenoma. Duration: 2000 to 2009. Subjects and Methods: 100 patients were selected who had visual disturbances along with Macroadenomas. Age, sex, visual symptoms and other associated systemic problems of these patients were reviewed. The Neuroimaging data (Magnetic Resonance Imaging) was correlated with the clinical picture. The data was analysed using Statistical package for social sciences (SPSS). The Descriptive Statistics were calculated for age and MR findings. Results: The age ranged from 9 to 85 years (mean 42.92). Male to female ratio was 1.4: 1. 90% patients had visual disturbances including visual field defects and 10% had ocular motor nerve palsies. Tumour extension on MR studies showed optic chiasma compression in 69% patients, cavernous sinus invasion in 57% and Sphenoidal sinus invasion in 14%. Haemorrhagic foci were seen in 8% and intra tumour necrosis was found in 9% patients. Conclusions: The most common path for the extension of pituitary macroadenomas is towards the optic chiasma. Hence majority of these patients present with visual disturbances. MRI is an excellent aid to see the extent and invasion of Macroadenomas to the surrounding structures.
PRETREATMENT WITH LIGNOCAINE
Authors: IKRAM MOBEEN , ISHAQUE MUHAMMAD , MASOOD NAVEED
Published: September 2021

Objective: To assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Study Design: Double blind study. Duration of Study: This study was of six months duration and was carried out from March 2004 to September 2004. Setting: Combined Military Hospital Kharian. Patients and Methods: One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawalmovements of the arm were studied. Results: Out of total of 120 patients, only 17 patients (14%) developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 patients out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Conclusions: Pretreatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium.
AIRWAY DEVICE
Authors: ALI ANSAR , ALI LIAQAT , SHEIKH NASEEM ALI , Siddique Shamila Athar
Published: September 2021

Introduction: Intersurgical-gel (I-gel) is a new supraglottic airway device that is widely being used to secure airway during general anaesthesia. Objectives: The objective of the study is to compare the ease of insertion of Intersurgical-gel and Laryngeal mask airway (LMA). Material & Method: This study was conducted in Department of anaesthesia Hameed Latif Hospital, Lahore. 100 American Society of Anesthesiologists (ASA) I-II, patients were enrolled in this study for elective surgery divided in 2 groups of 50 each. LMA and I-gel were used in groups A and B respectively for intra operative maintenance of airway. Randomization through random number table in Statistical Package for Social Sciences (SPSS) version 17 was used. Results: There were 50 patients in both groups. There were no statistical significant difference between the patients age of two groups. There was absolutely no difference between 2 groups regarding ease of insertion because both groups had 84% easy and 16% satisfactory insertions. Insertion time of LMA and I-gel in First and Second attempt were also comparable and statistically nonsignificant. Airway manipulations was required in both groups for insertion of device, in LMA group 30% required and 70% did not require and in i-gel group 48% required and 52% did not require. There is no statistical significant difference between both groups. Bleeding was noticed on 2% of i-gel and with LMA no bleeding occurred and 2% laryngospasm incidence noticed in both groups. Conclusion: we found that regarding ease of insertion there is statistically no significant difference between I-gel and LMA.
SPINAL ANAESTHESIA FOR CESAREAN DELIVERY
Authors: FARIDI MANZOOR AHMED , RIAZ IRBAZ BIN
Published: September 2021

Objective: To determine the effective dose of intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Design: A randomized, double-blinded dose finding study. Place and Duration: The study was carried out in Combined Military Hospital Gujranwala from March 2009 to March 2010. Methodology: Total patients were 80 full term women who were randomly allocated into four groups and were given Ringer lactate 10 ml per kg body weight intravenously. One minute after the spinal injection, patients were given saline control or ephedrine 0.1mg per kg body weight, 0.25mg per kg body weight, or 0.4mg per kg body weight for 30 seconds. The study period started at the time of spinal injection and continued for 15 minutes. Systolic arterial pressure and heart rate were recorded at 1-minintervals. Side effects like hypotension, hypertension, tachycardia, bradycardia, nausea and vomiting were also recorded. Total rescue ephedrine and total dose of used ephedrine in all groups were measured. Neonates were assessed by APGAR score. Results: There was less incidence of hypotension in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group as compared with ephedrine 0.1mgper kg body weight and the control group, 5(25%),13(65%) vs. 16(80%), 18 (90%) respectively. Systolic arterial pressure (SAP) in the first 15 min after the spinal injection was statistically significant greater in the 0.4mg per kg body weight group compared with other groups (P <0.001). Reactive hypertension occurred in 9(45%) in the 0.4mg per kg group, compared with control group, 0(0%), ephedrine 0.1 mg, 1(5%) andephedrine 0.25 mg 3(15%) patients. The Heart rate in the first 15 minutes in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group was statistically significant higher than those of ephedrine 0.1mg per kg body weight and control group (P<0.001). The incidence of tachycardia was more in ephedrine 0.4 mg per kg body weight and 0.25 mg per kg body weight groups as compared to ephedrine 0.1mg perkg body weight and the control group, 9 (45%), 6 (30%) vs. 3 (15%), 2 (10%) respectively. There were significant decrease in total doses of rescue ephedrine required in the ephedrine0.4mg per kg body weight group as compared to other three groups. Total doses of used ephedrine in all groups were similar. Conclusion: We conclude that although ephedrine 0.25 mg per kg body weight reduces the hypotension but the smallest effective dose of ephedrine to reduce the incidence of hypotension significantly was 0.4mg per kg body weight.
INFERTILITY: STILL AN ENIGMA
Authors: QURESHI SAIMA , KHALIQ SHAHIDA , ROOHI MAHNAAZ , MUSSARAT NAZIA
Published: September 2021

Objectives: (1) To find out the major causative factors in primary versus secondary infertility in study group. (2) To suggest an easy plan of investigation for an infertile couple. Study Design: Descriptive study. Setting: Gynecology & Obstetric Unit in Independent University Hospital, Faisalabad. Period: Two years from Jan 2008 to Dec 2009. Material & Methods: Convenience sample technique was used to collect the patients. Results: Anovulation had contributed 20% in primary infertility and 16% in secondary infertility. Tubal factor wasmore common in secondary infertility. Male factor was 40% in primary infertility and 16% secondary infertility. Conclusions: Counseling, reassurance and efficient, timely and appropriate management plan is essential to minimize the distress of infertile couples.
FETAL BIOPHYSICAL PROFILE
Authors: BANO BUSHRA , HUSSAIN UZMA , ZAHID BUSHRA
Published: September 2021

To evaluate fetal Biophysical Profile as an effective technique for the assessment of fetal condition and to improve fetal outcome by early detection of fetal hypoxia. Design: Co relational study: Place and Duration of Study: The study was carried out for a period of one year from Oct 2004-Oct 2005 at Obstetrics and Gynecology Department of Fatima memorial hospital Lahore. Patients and Methods: All patientswith history of sluggish fetal movements and clinical suspicion of IUGR, were underwent BPP from 32-42weeks. 100 patients were selected and their BPP score was recorded and were followed till delivery. Those who went into spontaneous labor and who were induced monitored during labor and at any sign of fetal distress immediate caesarean section performed. APGAR score of newborn was noted at one and five minutes and those having poor APGAR score were resuscitated and were followed till one week after delivery. APGAR score was compared with BPP score. Results: During this study 100 BPP were performed. 34patients were primigravidas and 66 were multigravidas. Among 100 patients 73had a BPP score of 9-10/10, 21 patients had a score of 7-8/10 and 6 patients had 4-6/10.In 2 patients with 4/10score emergency caesarean section led to the delivery of neonates with APGAR score of 8 at 5 minutes. Majority of patients with normal BPS of 8-9/10 had good APGAR score of 7- 8/10.Only 8 patients having BPP of 9-10/10 had poor APGAR score 6/10 or <6/10. Conclusion: The fetal BPP appears to be an effective technique for assessment of fetal condition.
HISTAMINE RECEPTORS
Authors: TURABI AFTAB , QURESHI GHULAM ALI ASGHAR , ZIAULLAH Muhammad , Hasan S. Saud
Published: September 2021

Objective: This research work deals with the mechanism of action involved in determining the therapeutic potential of histamine and its blockers in gastrointestinal motility. Study Design: Rabbits of equal weights were used in this study. They were brought from the animal house of BMSI, sacrificed in the Pharmacology Research laboratory. Ileum strip were isolated and with special recommended methodology, longitudinal and circular muscles were separated. Individual muscle strip were then exposed separately to the desired drugs in the organ bath and reading were recorded on the polygraph machine. Setting: Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Period: 1996 to 1998. Results: Histamine increases the contractile effects of longitudinal and circular muscle. H and H blockers 1 2 potentiate its effects on longitudinal muscle while in circular muscle no change was observed with H blocker whereas H blocker antagonized 1 2 the histaminic effects. However when H blocker applied directly it increases the amplitude of contraction in longitudinal and circular muscle 1 whereas H blocker decreases the height of contractions. Histamine in the presence of H and H blocker augmented their effects in longitudinal 2 1 2muscle and antagonizes in circular layer. Conclusion: Gastrointestinal motility can be controlled through histamine and its antagonist. New drugs can be formulated on the basis of this study for the regulation of intestinal motility.
CALCIUM
Authors: ISHAQ MUHAMMAD , AKHUND ISRAR AHMED , LAGHARI MOULA BUX , Sabir Muhammad
Published: September 2021

Aims & Objectives: To evaluate the effects of Serum Calcium and Urinary Calcium excretion on upper urinary tract stone diseases in the Peshawar (a high stone incidence belt). Subjects & Methods: One hundred patients (age 20-60years) who were suffering severely from upper urinary tract stone disease were selected from LRH and Hayatabad Medical Complex Hospitals of Peshawar, same numbers of healthy controls from the same region were also selected for the study. Results: When results were summed up and testParameters were compared, it was seen that mean Serum Calcium in stone formers was greater than that of non-stone formers (P<0.001). Same pattern was also observed (P< 0.001) in both groups regarding mean urinary calcium excretion. Conclusions: We concluded that calcium is a definitive risk factor in upper urinary tract stone disease. However we suggest further work and research on wide scale population inorder to evaluate this relation.
SUPRAPATELLA IN RATS
Authors: IQBAL KHADIJA
Published: September 2021

Objectives: Researches have focused their attention on articular cartilage of various bones but neglected suprapatella so this study was designed to study the histological changes in fibrocartilage of suprapatella in rats while studying immobilization. Data Source: 20 male Sprague Dawley rats were procured from animal house NIH Islamabad. Design of Study: Experimental. Setting: The study was carried out at the animal house College of Physician and Surgeons Islamabad. Duration: The duration of study was 6 weeks from 01-06-2009 to 05-07- 2009. Materials & Methods: A total of 20 male Sprague Dawley rats 3 months old were used. They were divided into two groups. Each group contained 10 animals. Group 1consisted of control animals that were not immobilized. Group 2 were immobilized for four weeks. The right hind limbs of rats were immobilized with plaster of Paris cast. Care was taken to cover the knee joint completely. At the end of experimental period the rats were anaesthetized with chloroform. The skin over knee joint was dissected and the joint along with supra patella was exposed. The knee joint was cut in sagittal plane. It was stored in 10% formalin for 48 hours. Specimen was decalcified using Ethylene diamine tetra acid (EDTA). After processing for making paraffin blocks 10μm and 7 μm sections were cut from the same block and stained as given below. Mallory Trichrome stain was used for 10μm thick sections to demonstrate collagen content. H & E stain was used for 7 μm thick sections to study routine histology of supra patellar articular cartilage. Results: On four weeks immobilization small necrotic areas were observed in the suprapatella and splits were also observed. Conclusions: It is therefore concluded that suprapatella can be as prominent as the patella itself. It shows necrotic changes on immobilization and is present in a number of animals that are highly significant in orthopedic research.
PHARMACOKINETICS FOR DOSE PROPORTION
Authors: IQBAL MUNAWAR , BHATTI IJAZ AHMAD , SHAHBAZ ISRAR AHMAD , Muneer Majid
Published: September 2021

Objective: To estimate dose proportion for male volunteers by calculating pharmacokinetics following oral administration of Cefaclor (CCL) 250mg Tablet and to check the relative susceptibility of four bacterial strains Design: Randomized Clinical Trial, case series. Setting: Department of Chemistry and Biochemistry, University of Agriculture, Faisalabad. Period: From Mar 2006 to Feb 2007. Materials and methods: Blood samples were collected for the period of 12 hours in heparinized tubes. Collected samples were centrifuged at 3000xg andplasma thus separated was stored at -10̊C until further analysis. The CCL plasma concentration was determined via bioassay using disc diffusion method. Pharmacokinetics parameters were calculated using American Pharmacology Organization (APO) computer software. Results and conclusion: Renal Clearance (CL), Volume of distribution (VD), Time of Peak (T ), Maximum plasma concentration (C ), max maxMean Residence Time (MRT), Absorption half life, Elimination half life & the Area Under plasma Concentration (AUC ) showed that the four t0 to t12h bacterial strains have different susceptibility against cefaclor and administration of cefaclor at rate of 250 mg as tablet orally thrice daily maintained considerable concentration (>MIC) that prove it to be very effective for the treatment of specific infections in male volunteers.
PSYLLIUM HUSK TO INCREASE HDL-CHOLESTEROL
Authors: KARIM SAMINA , MURAD SHAH , UNAR MANZOOR AHMED , Mahmood Ghazi , Khan Moosa , Ghurbakhshani Amar Lal
Published: September 2021

Objectives: To examine the effects of Psyllium husk on HDL-Cholesterol. Design: Single blind placebo controlled study. Place and Duration of Study: Study was conducted at department of Pharmacology and therapeutics at Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January 2006 to July 2006. Patient and Methods: Forty hyperlipidemic patients were included, among which 20 patients were on placebo as control group, and 20 were on Psyllium husk, 3 gram daily, in divided doses for the period of three months. Patients with peptic ulcer, renal disease, hepatic disease, hypothyroidism, diabetes mellitus, and alcoholism were excluded from the study. HDL- Cholesterol was determined by using kit Cat. # 303210040 by Eli Tech Diagnostic, France. Data were expressedas the mean ± SD and “t” test was applied to determine statistical significance as the difference. A probability value of <0.05 was the limit of significance. Results: Two patients were dropped from the study due to low compliance of metallic taste of psyllium husk. Psyllium husk has increased HDL-Cholesterol, in 90 days of treatment, from 34.61±1.85 to 36.77±1.96 (mg/dl), which was highly significant statistically whenpaired “t” test was applied for results. Percentage change was +6.24. Conclusions: It is concluded from this study that Psyllium husk decreases the risk of CHD by increasing HDL-Cholesterol.
PATIENTS WITH CONVERSION DISORDER
Authors: MAQSOOD NIAZ , AKRAM BUSHRA , ALI WAJID
Published: September 2021

Objectives: To assess the frequency of the various psychosocial stressors and stressful life events in patients presenting with conversion disorder. Study Design: Case series study. Place & Duration of Study: The study was conducted in the Department of Psychiatry & Behavioural Sciences, Bahawal Victoria Hospital & Quaid-e-Azam Medical College, Bahawalpur from January, 2009 to March, 2009. Subjects & Methods: The sample consisted of 100 in-patients (89 Female, 11 Male) with Conversion Disorder. They were interviewed andresults were analysed from the entries in a Performa. Results: Stressors were clearly identified in 100 patients. In all patients, we found more than one stressor. Among patients, there were (24%) In-laws problems, (23%) Love problems, (21%) Relationship problems with family, (20%) exam/study stress, (15%) marriage against will, (13%) demanding and pampered child, (11%) Issue less, (10%) sexual abuse, (8%) demand of marriage, (6%) overage in wait of marriage, (4%) death of partner, (3%) husband abroad and (3%) patient’s engagement break. Conclusions: We concluded that stressors and life events were present in all conversion disorder’s patients and these stressful life events are important causal factors for Conversion Disorder. Conversion Disorder has strong relationship with psychosocial stressors.
LEVEL OF EMPOWERMENT OF WOMEN
Authors: SULEHRI MUHAMMAD ANWAR , SHEIKH NIAZ MUHAMMAD
Published: September 2021

Objective: To Investigate the Level of Empowerment of Women in accordance with human rights. Design: A cross-sectional study. Setting: Residence Colony of Punjab Medical College, Faisalabad. Period: August - September 2007. Material & Methods: There were 600 houses and 6 Blocks A, B, C, D, E & F in the Colony. By Simple random sampling 10 houses were taken from each Block by drawing lots. Sixty married women’s between the age of 25 – 45 years (One from each house) were interviewed using a pre-tested structured questionnaire. Results: The mean age of the respondents was 37.2 years. Among the total 60 (100%) Women, 16 (26.6%) were illiterate, while 44 (73.3%) had primary education and above. Only 10(22.2%) out of 44 educated women had graduate and above degree. Thirty-Eight (63.3%) women had the opportunity to use the reproductive health services and family planning, while 22 (36.6%) could not utilize the family planning methods. A total of 40 (66.6%) women had good nutritional status, while 20 (33.3%) had imbalances in nutrition. Nineteen (31.6%) women were doing jobs in different public and private institutions, while 41(68.3%) had not got opportunity for jobs. Thirty-Three (55%) women had monthly income lessthan Rs.10,000/- per month and 27(45%) had Rs.10,000/- and above. Forty (66.6%) women were given importance and active participation in decision making, in children marriages. house-hold and in political process (vote casting) at all levels, while 20(33.3%) were not given importance in decision making of above matters. Forty -Three (71.6%) woman were given their right of inheritance / property. Fourteen (23.3%)women were forced to wear veil while going out of house. Forty (66.6%) woman admitted to have suffered from violence either psychological, physical or sexual in their life. Safe drinking water supply was available to 30 (50%) women, however sewage disposal, toilet facilities with in house were available to majority of the respondents. A total of 40 (66.6%) women were over all empowered. Conclusions: Women do havehuman rights as well. The results obtained from this study are encouraging but not up to the standards of International Human rights Principles, which are universal, inalienable; indivisible; interdependent and interrelated.