bluuebunny/crossref_metadata_2025 huggingface dataset:
STUDY OF OVARIAN TUMOR IN YOUNG GIRLS
Authors: TARIQ SAADIA , SOHAIL RUBINA
Published: September 2021

Objective: To analyze various clinical presentation and the surgical management of ovarian pathology in young girls ranges from 15-25 years. Design: Case series. Setting: Gynae Department 1, Lahore General Hospital Lahore. Period: From January 2008 to December 2009. Patients and Methods: All young girls in the age group mentioned above having an ovarian pathology and managed during study period were included. Age of patients, presenting symptoms, USG findings, surgical management and finally histological diagnosis were noted. Results: There were 20 cases with ovarian lesions. Most of patients presented at the age of 20-25 years (55%). Mass abdomen seen in (30%) cases, followed by pain abdomen in (20%). Lapratomy was done in most of cases and main aim was toward ovary sparing surgery as Cystectomy was done in (50%) cases and Oophorectomy was done in (30%) cases. 85% cases were benign on histology report and 15% were malignant. Conclusions: Ovarian tumors are rare in young age group. Benign lesions such as simple ovarian cysts are very common in this age. In young girls main interest is toward conservative and fertility sparing surgery.
DENGUE FEVER
Authors: ARSHAD IRFAN , MALIK FAYYAZ AHMED , HUSSAIN AAMIR , A.R.Shah Shahida
Published: September 2021

One of the major health hazards that has erupted in Pakistan within the recent past years and has caused loss of life of many young people is Dengue Fever. Objective: Main objective was to find clinico-pathologic parameters which are essentially associated with complications and contribute to the adverse outcome. Material & Methods: This prospective study was conducted on 106 seropositive cases of dengue fever. Patients were taken from Abbasi Shaheed Hospital, Karachi from June 2008 to March 2009. Results: The most common hematological abnormalities were thrombocytopenia and leucopenia. Platelets count below 50 × 103/ μL was seen in (78%) cases and 49 % patients had total white cell count below 4 ×103 /μL. Partial thromboplastin time was significantly prolonged in (26%) cases whereas prothrombin time was normal in all patients. Liver enzymes both Aspartate Aminotransferase (AST) and Alanine Amino-transferase were significantly elevated in (60%) patients. Blood urea nitrogen (BUN) and creatinine was deranged in (23%) patients. Conclusions: Fever was the most common clinical presentation( 86 % of the patients). Hematological parameters (low platelet count, low total leucocytes count, prolonged APTT and raised hematocrit) and biochemical parameters (raised aminotransferases, blood urea nitrogen) have strong association with the complications of dengue fever and hence are associated with the poor outcome of disease.
FALCIPARUM MALARIA
Authors: MEHDI SYED GHAZANFAR , NAQI NAEEM
Published: September 2021

Introduction: Quinine and quinidines remain the drugs of choice for chloroquine resistant Plasmodium falciparum malaria. In 1972, Chinese scientists discovered the antimalarial properties of a group of compounds from the qinghao plant (Artemisia annua) which have activity against all malaria causing parasites including multi-drug resistant strains of Plasmodium falciparum. Objective: To compare response to treatment between quinine and artemether in Plasmodium falciparum malaria. Design: Quasi-experimental study. Setting: Department of Medicine Pakistan Air Force Hospital Lahore. Period: 1st Jun 2008 to 1st Dec 2009. Patients: 80 consecutive adult patients with positive MP slide for Plasmodium falciparum malaria. Methods: Patients were randomly divided into two groups for treatment either with quinine or artemether. Results: Out of total 80 patients, 40 were given quinine and 40 were given artemether. Out of 40, 16 patients responded to quinine while 24 did not respond. The responders were 34.8% in case of quinine while 70.6% patients did not respond. Out of 40 patients treated with artemether, 30 responded while 10 did not. The responders were 65.2%while non responders were 29.4%.0n calculating the P-value from the chi-square it was found that difference in terms of response to the two treatment regimens was statistically significant.(P=.0022).Conclusion: The frequency of response in case of quinine was 34.8% while it was 65.2% in case of artemether. So based upon statistically significant difference (P=.0022) it is concluded that Artemether is a satisfactory alternative to Quinine for the treatment of falciparum malaria in adults.
THROMBOCYTOPENIA
Authors: HAYAT ATIF SITWAT , SIDDIQUI MOHAMMAD SAEED , SHAIKH NAILA , Ullah Muqeet
Published: September 2021

Background: Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. Methods: It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences (NIMS) Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Results: Out of 250 patients, 155(62%) were females and 95(38%) males with M:F ratio of 1:1.5. Mean age was 36±1.2 years (range 17-58 years). Out of 250, 175(70%) had thrombocytopenia (p<0.05) while 75(30%) had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121(48.4%), 41(16.4%) and 13(5.2%) respectively (p<0.05). Fever appeared to be most common symptom observed in all patients (100%) followed by vomiting and nausea (88%). Anemia was the commonest sign present (80%) during our study. Conclusions: We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection.
DIABETIC KETOACIDOSIS
Authors: HUSAIN SYED SHAJEE , JAVED MUHAMMAD RIZWAN , ALI SARA AHMAD
Published: September 2021

Objective: To determine the frequency of various precipitating factors for Diabetic Ketoacidosis (DKA) in patients with type 2 diabetes mellitus. Study Design, Setting & Duration: This was a prospective study carried out at Department of Medicine, Muhammad Medical College & Hospital Mirpurkhas, from February 2007 to February 2009. Patients & Methods: 100 patients with type 2 diabetes mellitus admitted with diabetic ketoacidosis (DKA) were analyzed to determine the precipitating factors. Results: Out of 100 patients 47 were males and their average age was 47 years (range=17-65) while 53 were females with an average age of 43 (range=14-58), among them 54 had various systemic infections, 18 were non-compliant to the treatments, 24 had other co-morbidities like chronic liver disease (n=8), stroke (n=7), chronic renal failure (n=5), sub-endocardial infarct (n=2) and acute pancreatitis (n=2) as precipitating factors while 4 had their first presentation of diabetes mellitus as diabetic ketoacidosis. A mortality of 14% was recorded in the study. Conclusion: Systemic infections, non-compliance to treatments and co-morbid conditions were the major precipitating factors for diabetic ketoacidosis.
PULMONARY TUBERCULOSIS
Authors: SHARIF NAVEED , AHMED NAZIR , HAMEED FAWAD , Rehan Nosheen , Khan Jawad
Published: September 2021

Objective: To study the age related radiological finding in pulmonary tuberculosis. Study design: A cross sectional study. Place and duration of study: From January 2009 to December 2009 pulmonary department of Bahawal Victoria Hospital Bahawal Pur. Patients and method: The cases diagnosed as pulmonary tuberculosis of either gender above age of 12 years were included in the study. Patients suffering from extra pulmonary tuberculosis, treatment failure, relapse, drug resistant tuberculosis and HIV sero-positive patients were excluded from the study. Patients were divided into groups according to the age. Group 1 consist of patients having age ≥ 50years while group 2 consist of patients having <50 years. Data was recorded on the Proforma and was analyzed statistically on SPSS 11. Results: this study consists of 106 patients and divided into two groups. It has been found that apical zone of lung involvement was more common in patients younger than 50 years while involvement of lower zone was more common in patients with age ≥50years. No significant difference was found regarding the involvement of middle zone, multiple zones and the type of lesions as the p-value was >0.05. Conclusions: the elderly patients with pulmonary tuberculosis have predominant involvement of lower zones. So, lower zone involvement of radiological lesions should be evaluated for pulmonary tuberculosis to start the treatment earlier and to minimize the risk of missing the diagnosis.
APPENDICECTOMY
Authors: RASHID ASIF ZAMAN , TARIQ MUHAMMAD
Published: September 2021

Objective: To evaluate the usefulness of invagination/burial of appendicular stump after removal of appendix. Design: A prospective, non randomized comparative study. Setting: CMH Kharian and PAF Hospital Mianwali. Period: 2005-2007. Patients and Methods: Three hundred patients were included in this study. Appendicectomy was performed through Lanz incision .After removal of the appendix stump was buried/ invaginated in 150 patients while it was not buried in other 150 patients. 198 patients were males and 102 patients were females. The youngest patient was 14 years old and the eldest was 55 years old. Perforated and gangrenous appendices were not included in this study. Results: There was hardly any difference in outcome of patients in both groups except that 10 patients in first group had longer hospital stay due to symptoms like more pain, fever and infection. Conclusion: Burial or otherwise of appendicular stump does not make much difference. It was concluded that there was no added benefit of invagination of appendicular stump rather it takes more operative time and at times it has negative implications too.
ELECTIVE MIDLINE LAPAROTOMY
Authors: SIRAJ ARSALAN , GILANI ATHAR ABBAS SHAH , DAR MUHAMMAD FAROOQ , Raziq Sohail
Published: September 2021

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.
NIGELLA SATIVA (KALONJI)
Authors: BURIRO MUHAMMAD ANWAR , TAYYAB MUHAMMAD , DITTA ALLAH
Published: September 2021

The increased level of LDL-c in the serum has a high risk and the increased serum HDL-c level has a low risk for the development of atherosclerosis. The effect of Nigella Sativa on levels of cholesterol fractions were determined in this study on rats. Methods: 24 albino rats of 08 weeks age having equal number of males and females were kept at optimum atmospheric condition. The blood samples were taken at the start and different control and experimental diets were given for 24 weeks. The experimental diets were added with Nigella Sativa as 30 mg/kg body weight. The blood samples were taken at the end of study. The blood samples drawn at the start and end of the study were estimated for serum cholesterol. The results of control and experimental groups were compared. Results: Total serum cholesterol in the control group showed increase from 8.3±3.30 to 13.96±9.3 at 24 weeks. The serum HDL cholesterol showed increase from 44.4±6.12 to 80.45±5.95 level at 24 weeks. The serum LDL cholesterol showed increase from 8.3±3.30 to 13.96±9.3 at 24 weeks. The total serum cholesterol in experimental group was increased from 76.9±6.5 to 117.5± 6.65 at 24 weeks. The serum HDL cholesterol levels was increased from 41.7±4.9 to 83.42±5.92 at 24 weeks as compared with control group. The LDL cholesterol levels were decreased from 12.7±6.9 to 8.5±7.8 at 24 weeks. Conclusions: This study shows significant decrease in serum low density lipoprotein cholesterol level, and increase in serum high density lipoprotein cholesterol levels.
SUPRACONDYLAR HUMERUS FRACTURES
Authors: SIAL NOOR AKBAR , RASHID ABID , YASIN AJMAL
Published: September 2021

Displaced Supracondylar fractures of the humerus in children are common injuries treated by orthopaedic surgeons. Objectives: To evaluate the role of open reduction and percutaneous crossed pin fixation in displayed supracondylar fractures and to design a simple and effective protocol for the treatment of these fractures. Design: Prospective. Setting: Independent Medical College Independent University Hospital Faisalabad. Period: From January 2009 to June 2010. Method: Fifty six cases with grade II and grade III Gartland Supracondylar humeral fractures were treated with open reduction through postereomedial approach and percutaneous crossed pin fixation with Kirschner wire and followed up for a minimum period of 1 year. Results: Patients were assessed on the basis of Flynn’s criteria there were 41 Excellent and12 good results Conclusions: It is concluded that open reduction and percutaneous crossed pin fixation is a sound and effective treatment for displayed supracondylar fractures with several advantages but requires careful judgment on the part of surgeon to avoid complications.
PREGNANCY AND FOOD
Authors: SHAHID AFSHAN , AHMED MAHMOOD , RASHID FARAH , Khan Mohammad Wasif , Rehman Mahmood-ur-
Published: September 2021

Objective: The aim of the study was to assess the existing beliefs and practices regarding food during pregnancy. Design: Cross-sectional study. Place and duration of study: The present study was conducted in Antenatal Clinic, Department of Gynecology and Obstetrics at Holy Family Hospital, Rawalpindi. This study was conducted in four months time from September 1st to December 31st, 2008. Patients and methods: Sample size was 189 pregnant females who were attending the Antenatal Clinic, Department of Gynecology and Obstetrics at Holy Family Hospital, Rawalpindi. This was calculated by computer software called Raosoft- a sample size calculator by keeping confidence level 95%, margin of error 5%, and response rate 86%. Simple Convenience Sampling technique was used. Results: 89% believed that there is an effect of food on pregnancy and 11% did not. Despite of high literacy rate (93%) there are certain strong food beliefs regarding pregnancy which have been practiced by pregnant ladies, which were effecting their food intake like hot, cold, badi and having difficult labour. Conclusions: All available resources for creating awareness among the masses regarding the importance of diet during pregnancy should be used properly by using all means of communication (especially mass media).
CHRONIC ANAL FISSURE
Authors: ALI MUHAMMAD , MIRZA TAHIR IQBAL , AKHTAR RIAZ
Published: September 2021

Objective: To compare lateral anal sphincterotomy (closed method) with anal dilatation in the management of primary chronic anal fissure. Study design: A prospective, comparative, interventional study. Place and duration: Department of Surgery Combined Military Hospital Kohat from Jan 2001 to Mar 2002.Materials and Methods: During the period, all patients with primary type of chronic anal fissure, who were above 12 years of age and were fit for surgery, were selected for study. They were divided into two groups for both surgical procedures in a randomized manner. After their respective surgical procedures patients were followed up for four weeks on weekly basis. The changes in signs and symptoms were thoroughly reassessed and noted in a separate proforma maintained for each patient for the purpose of comparison. Results: The total number of patients was 49 with an average age of 40 years. Male to female ratio was 7:1. In 44 (89.79%) patients the fissure was located posteriorly while in 5 (10.20%) patients it was located anteriorly. Closed lateral anal sphincterotomy (LAS) was done in 28 (57.14%) patients, of which 25 (51.02%) were males and 3 (6.12%) females. While anal dilatation (AD) was done in 21 (42.85%) patients, 18 (36.73%) males and 3 (6.12%) females. In all the patients in whom LAS was done, there was disappearance of all the symptoms and complete healing of ulcer. Those operated by AD, there was disappearance of all the symptoms and complete healing of ulcer in only 8 (38%) patients. Incontinence was present in 9 (18.36%) patients. Three (14.2%) patients had persistence of ulcer while one (4.76%) was having recurrence of ulcer.Conclusion: Lateral anal sphincterotomy, especially close method gives excellent results as compared to anal dilatation in terms of ulcer healing, disappearance of symptoms and lower rate of ulcer recurrence or incontinence.
LOOP ILEOSTOMY
Authors: SHER-UZ-ZAMAN MUHAMMAD , HAMEED FAWAD , ATIQ-UR-REHMAN SHEIKH , Khan Younis
Published: September 2021

Enteric perforation is a disastrous complication of untreated or poorly treated typhoid fever and unless treated by surgical method, it results in considerable morbidity and mortality. The purpose of this study to describe complications of ileostomy in patients of enteric perforation. Place & Duration of study: The study was conducted was in surgical units B-V hospital, Bahawalpur from 1st July 2008 to 30th June 2009. Material & Method: This was a descriptive case series study. 100 patients of both genders suffering from typhoid fever with perforation who underwent ileostomy were included the study. All the data was collected on pre-designed proforma. Results: Most of the patients were young with male to female ratio 1.6:1. Ileostomy was done in all the patients after cleaning the peritoneal cavity. Ileostomy was associated with diarrhea 20%, peristomal skin problems 22%. Other complications were bleeding in 3%,prolapsed in 5%, retraction in 4%, parastomal hernia in 5%, wound infection in 8%, intestinal obstruction in 5% patients, incisional hernia & psychological symptoms in 2% patients and stoma stenosis in one patient in our study. Two patients expired due the complication of ileostomy. Conclusions: Although ileostomy is not the most favored way of treatment of enteric perforation and it is associated with a number of complications and management problems, it is still a good option and life saving procedure in our setup where patients present very late with gross peritoneal contamination.
VENTRAL INCISIONAL HERNIAS
Authors: MAJID HAROON JAVAID , DAR HARUN MAJID , SHAFI MUHAMMAD , Javed Muhammad Arif
Published: September 2021

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. Objectives: To compare the outcome of two different methods of open repair of VIH (i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. Period: 11 years period (January 2000 – December 2010). Setting: Shaikh Zayed Hospital, Lahore. Patients & Methods: The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A (simple suture/Keel repair) while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients (0.93%). Conclusions: The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: SHUJA AWAIS , BASHIR ABID , RASHID ABID
Published: September 2021

Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitating hospital admission. Objective: To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity. Period: Jan 2008-2010. Setting: Department of Surgery, Independent University Hospital, Faisalabad. Study Design: Experimental study. Material & Methods: The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A (Surgery within 72 hrs of onset symptoms). Group B (surgery between 72hrs to 96 hours of onset of symptoms). Group C (surgery after 96 hours of onset of symptoms). Results: The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Mean hospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8&. The mean hospital stay and conversion rate had no significant difference. Conclusions: The timing of laparoscopic cholecystectomy has no significant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higher when surgery performed after 72 hours of onset of symptoms.
HEPATITIS
Authors: PHULPOTO JAVED AHMED , SHAIKH ALTAF AHMED , SAMO JAVED AKHTAR , Shaikh Abrar
Published: September 2021

Objective: To determine the frequency of co/super infection of hepatitis D in patients with hepatitis B related liver disorders. Study Design: Descriptive study. Place and Duration of Study: The hepatitis Centre Ghulam Mohammad Mahar Medical College Hospitals Sukkur & Khairpur, from January 2009 to December 2009. Methodology: All patient registered for HBV associated infections were selected. Blood was drawn from 200 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma (HCC) were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum by real time PCR. Descriptive statistics were used for frequency and mean determination. Results: The 129 patients finally selected for statistical analysis included 108 (84%) males and 21 (16%) females. The ages ranged from 6-68 years (mean=31.5 ± 12.39 years). There were 70 (54.2%) patients of non-cirrhotic, chronic hepatitis (CLD), 38 (29.4%) carriers, 12 (9.3%) cirrhotic and 9 (6.9%) hepatocellular carcinoma (HCC) patients. Among the 129 patients, 45 (34.9%) were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers. Conclusions: The frequency of co/super infection of hepatitis D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease (non-cirrhotics) and carriers.
SYSTEMIC LUPUS ERYTHEMATOSUS, FEMALE OF FERTILE AGE
Authors: IQBAL TEHSEEN , KARIRA KHEMOMAL A. , SHEIKH SHEHNAZ A.
Published: September 2021

Background: Systemic lupus erythematosus (SLE) is an important autoimmune disease and occurs when the body is mistakenly attacked by its own immune system. Prolactin acts as a cytokine and plays an important role in human immune response including autoimmune diseases. SLE is an immune complex mediated disease and is more common during pregnancy. Objective: Research is designed to analyze the level of serum prolactin in the pathogenesis of systemic lupus erythematosus and compared with estrogen in female of fertile age. Study Design: Observational Period: Setting: Study was carried out in the Department of Biochemistry, BMSI, in collaboration of ward-6 JPMC Karachi. Material and methods: Thirty five diagnosed cases of SLE and in addition 35 normal healthy controls from general population were included in the study. Serum levels of prolactin, estrogen, RA factor and ESR were estimated and correlated. Statistical analysis: The data was analyzed by using SPSS version 17. The student t-test & chi-square test was used the p-value <0.05 consider significant. Results: The results showed that patients suffering from SLE have highly significant (p<0.001) serum level of reproductive hormones prolactin and estrogen, in addition, significant changes in ESR indicate the infection when compared with control. Further, prolactin was negatively correlated with estrogen as well as with menarche while BMI have positively correlation with estrogen regardless of prolactin and menarche. Conclusions: Enhanced serum prolactin and estrogen changes in patients with systemic lupus erythematosus (SLE), may be used as a prognostic tool for autoimmune diseases.
DVT PROPHYLAXIS
Authors: SHEIKH MUHAMMAD SAJID , REHMAN MUHAMMAD FASIH UR
Published: September 2021

Objectives: To evaluate the effectiveness of LMWH prophylaxis for DVT in high risk patients after general surgery. Study design: Randomized controlled study. Setting: Surgical Unit-IV, District Head Quarters Hospital, Faisalabad. Period: From March 2009 to August 2009. Patients and Methods: Sixty patients in the LMWH group were given perioperative enoxaparin (Clexane) as prophylaxis while compression stockings were used in another control group comprised of 60 patients. At 5th postoperative day, Doppler study was performed to detect DVT in both groups. Categorical data were analyzed for significance using Chi square test through SPSS. Results: There were significant difference in age factor, history of DVT, Medical factor, surgical trauma factor and interpretation on the basis of points. However, there is non significant difference between LMWH group and control group for chemoprophylasis. Conclusions: LMWH administration is effective for the prevention of venous thromboembolism in high risk patients and its practice should be the standard of care in the practice of surgery.
PREPARING MEDICAL STUDENTS
Authors: ZAIDI NOSHEEN , AHMED MAHMOOD , SAIF SAIF UD DIN , Khan Wasif
Published: September 2021

Background: In Pakistan there are 3.3 Million child laborers without healthcare services and educational opportunities, which affect our social fabric. We report how structured ‘Service Experience’ helped broaden medical students understanding of social justice. Objective: To produce health professionals who are ready to work for a cause without voracity. Study design: A Cross sectional survey through a focal group discussion. Research question: Do opportunities for structured Service Learning help modify student’s perception of their role as doctors in society? Place of Study: Foundation University Medical College, Islamabad. Study Period: Fifteen months, from January 2008–April 2009. Methods: Fifteen students interviewed 700 child laborers using a piloted interview form during a fifteen months period. Focus group discussions were held with these students to discuss their experiences. Qualitative analysis of the discussion is reported. Results: Students empathized that children worked on a contractual basis averaging $1 per 10 hours with no meals. Parents encouraged them to earn money and they felt more satisfied pleasing them. Children didn’t attend school because of the school quality and fear of abuse. “Our exposure to child labor had been limited; this has taken us to the core of the issue. We now feel responsible as a physician and a leader to ensure ‘security of children in every respect’ as part of their health.” “We will avoid employing children at our homes and will council parents, trying to be role models for others.” “As future leaders we will propose measures including establishment of free quality educational systems with paid vocational tracks.” Conclusions: Service learning will inculcate empathy for the oppressed groups of the community and also develop a social and civic responsibility in medical students.
CATARACT SURGERY
Authors: CHAUDHRY MUHAMMAD MUMTAZ , JALIS MUHAMMAD MUBASHAR , NIAZI AFZAL KHAN
Published: September 2021

Purpose of study: To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Study Design: Retrospective. Period: 1st January 2001 to 31st December 2009. Setting: Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Materials and methods: Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Results: Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% (95 % CI). A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity (90%) and pain (75%) were the main presenting features in these cases.. There were 36 (72%) culture positive cases, with staphylococci (50%) being the most common organism found. Vitreous biopsy yielded positive results in 36 (72%) patients while negative results with no microbial growth was found in 14(28%) patients. There were 20 (40%) growths of coagulase negative staphylococci, 5 (10%) growths of streptococci, 8 (16%) growths of coagulase positive staphylococci, and 3 (6%) of gram negative organisms. The final visual outcome was recorded after one month. 8 (16%) patients achieved 6/12 or better, 26 (52%) patients achieved moderately good visual acuity 6/60 to 6/12, while 16 (32%) patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 (4%) patients had only perception of light while 1 (2%) patient had no perception of light and 1 (2%) patient had blind and painful eye who had to undergo evisceration. 6 (16%) patients achieved 6/12 or better visual acuity. Conclusions: The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis.
BURN PATIENTS
Authors: NAQVI ZULFIQAR ALI , KHARAL SALEEM. A. , AZIZ QAMAR
Published: September 2021

Objectives: To study the micro flora in wounds of the burn patients from three tertiary care medical hospitals in Karachi. Introduction: In burn patient infections arise from multiple sources and infect burn wounds by a variety of micro-organisms. Gram negative bacterial infection results from translocation from colon, further more burn patients are infected by Hospital acquired bacteria by various invasive and non invasive procedures. Period: July 2002 to December 2002. Setting: This study was conducted at the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Study Design: Observational study. Material & Methods: A retrospective study of fifty five patients with burn wound infection was carried out at burn units of Civil Hospital Karachi, National Institute of Child health Karachi and Abbasi Shaheed Hospital, Karachi. Patients who received burn injuries with clinical signs and symptoms of infection were included in this study. Results: In the present study 46(29%) isolates of P. aeruginosa were recovered, in which most strains were MDR and their sensitivity against Imipenem was 38 (78%). The over all prevalence of the Oxidase negative Gram negative coli form bacteria was more than 70%, in which the most prevalent organism belongs to Proteus Spp;(27%) follows the Enterobacter Spp;.(15.5%). Conclusions: Bacteria belongs with family Enterobacteriacae were more prevalent i.e. >70% while P. aeruginosa was individually more prevalent than any member of family Enterobacteriacae and was most resistant to multiple antibiotics than any other bacteria. Imipenem was the most effective drug against all gram negative bacteria follows the 4th. generation Cephalosporin Cefepime.
LUMBAR DISC FENESTRATION
Authors: REHMAN RIAZ UR , KHATTAK AZMATULLAH , ALAM WAQAR
Published: September 2021

Objectives: To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc. Study Design: Descriptive study. Setting: Department of neurosurgery of Hayatabad Medical Complex, Peshawar. Period: October 2008 to September 2010. Patients and Methods: All those patients were included in whom straight leg raising (SLR) sign was less than 60 degree and prolapsed L4-5 or L5-S1 disc on MRI. Patients with multiple level discs, previous history of spine surgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chest position under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day of discharge. Statistical analysis was performed with SPSS (version 10). Results: One hundred and nine patients were studied. Sixty were male and fifty nine were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The most common level of involvement was L 4 -L 5 (n=67) followed by L 5 -S 1 (n=42) . Sixty five patients had left sided symptoms while forty four had right sided. Majority of patients presented in Dennis pain scale 4 i.e. 66.97% (n=73). Twenty patients (18.36%) were in P3 and 16 patients (14.67%) were in Dennis pain scale 5. Complete pain relief (P1) , three weeks after disc excision ,was achieved in 90 (82.57%) patients .Fourteen patients(12.85%) were in P2 and five(4.58%) patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Conclusions: Surgical treatment provides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques.
TOTAL HIP ARTHROPLASTY
Authors: DASTGIR NABEEL , SADDIQE A. , MCCABE J. P.
Published: September 2021

Dislocation after total hip arthroplasty is part of spectrum ranging from neck impingement to subluxation before frank dislocation occurs. Objectives: To assess various parameters as potential risk factors for postoperative hip dislocation. Setting: Department of Orthopaedics in Merlin Park Regional Hospital, Galway Period: 5 years Study Design: Observational Material and Methods: In our study we reviewed 1096 patients who underwent primary total hip arthroplasty in a consecutive period of five years. We assessed various parameters as potential risk factors for dislocation. Results: During this period 16 (1.45 %) patients dislocated their hips. According to our study the Important factors that led to these dislocations were Retroverted cup (5 cases), trochanteric malunion/ avulsion (5 cases), Epilepsy (1 cases), Confusion/ Dementia (2 cases) Parkinsonism (2 cases). Abduction angle was found to be greater than 50 degrees in 8 cases. Conclusion: Familiarity with the risk factors assists in prevention and dictates aspects requiring further assessment, when dislocation occurs. Protection of the hip by bracing should be considered following revision surgery but is of questionable use in primary cases.
UNSTABLE FRACTURE OF RADIUS AND ULNA
Authors: ALAM WAQAR , SHAH FAAIZ ALI , DURRANI ZAFAR , Askar Zahid , Khan Muhammad Ayaz , Hayat Sikandar
Published: September 2021

Objectives: To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Study Design: Descriptive study. Period: 27/03/2009 to 26/03/2010. Setting: Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. Patients and Methods: All patients were admitted from OPD . Children less than 16 years with Unstable Radius- Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. Results: A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Conclusions: Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures.
PYKNODYSOSTOSIS
Authors: ODHIAMBO A. , MOSHY JEREMIAH , OTIENO W , Simon EN , Chindia ML
Published: September 2021

Pyknodysostosis (PKD), also called Maroteaux-Lamy disease or Toulouse-Lautrec syndrome is a rare osteosclerosing skeletal disorder that has an autosomal recessive trait. It is characterized by short stature, brachycephaly, short stubby fingers, open cranial sutures and fontanelles, diffuse osteosclerosis with attendant multiple fractures of long bones and osteomyelitis of the jaw; but with rare visceral manifestations. In this article we present three cases of PKD with diverse classical clinico-radiological features. Worldwide PKD have been reported in 9-months to 55 years but remarkably, we have presented amongst the youngest diagnosed cases, at 8months with visceral manifestations. Understanding early and delayed clinic-radiological manifestations of PKD is very important as accurate diagnosis of PKD avoid misdiagnosing it as hydrocephalous, cleidocranial dysostosis and osteopetrosis as the conditions may resemble each other clinically and radiologically.
LATERAL INTERNAL SPHINCTEROTOMY
Authors: JAHAN SHAZIA , ATEEQ MUHAMMAD
Published: September 2021

Objective: To observe the prevalence of anal fissure, and outcome of open lateral internal sphincterotomy in terms of symptomatic relief, fissure healing and complications of procedure in female population. Study Design: Cross sectional, Prospective interventional. Setting & Duration: Surgical Unit DHQ (Teaching) Hospital Rawalpindi, Women Medical Complex Sialkot over a period of seven years from 2003 to 2010. Methodology: Female Patients with chronic anal fissure with history of failed conservative treatment were included in the study after taking informed consent. All patients were evaluated and managed by consultant General Surgeon and were subjected to open lateral internal sphincterotomy (LIS). Results: Two hundred and seventy three female patients of mean age of 39.5 years with chronic anal fissure and history of failed / noncompliance to conservative treatment were enrolled in this study. All patients underwent open lateral internal anal sphincterotomy. Post operatively had excellent recovery, were ambulant on same day. Minor complications were noted in 44 patients (0.16%). Moderate pain at operation site was the commonest complication seen in 32 patients (0.11%). No major complication like permanent incontinence of flatus and feces or recurrence was reported in any of the patients. Conclusions: Lateral internal sphincterotomy remains an effective treatment for chronic anal fissure in the hands of experienced surgeon with highest patient satisfaction, and should be considered as the first line therapy in chronic and resistant / recurrent acute anal fissures.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: BHURGRI MUHAMMAD RAHIM , RAJPUT MUHAMMAD JAWAID , MUHAMMAD SYED RAZI
Published: September 2021

There is a continued debate on fate of spilled bile with gallstones during laparoscopic cholecystectomy, so we felt that the outcome needs further evaluation in detail. Although laparoscopic cholecystectomy become increasingly popular, but it is associated with a slightly higher chances of injury to biliary tree and perforation of gallbladder with spillage of bile only or with gallstones. Objectives: (1) To evaluate fate of spilled bile with gallstones during laparoscopic cholecystectomy. (2) To assess various possible outcomes. (3) Suggestions to prevent these and their management. Design of study: Prospective study. Setting: Surgical unit of Muhammad Medical College Hospital, Mirpurkhas. Period: February 2008 to April 2011. Data source: Total 100 patients who underwent elective laparoscopic cholecystectomy were included. Age, sex, duration of operation, operative findings, duration of hospital stay and post-op complications were recorded in proforma and analyzed on SSP version 10. Material and method: The patients who underwent cholecystectomy, and had intra-operative spillage were shortlisted, included in this study and followed up. Short-term follow-up was based on OPD visits for 2 to 3 weeks postoperatively, and long-term follow-up was achieved by regular OPD visits or telephone conversation in patients at a mean of 1.4 years (range 2 to 39 months).all minor or major complications were recorded in preformed proforma. Results: A total of 100 patients underwent laparoscopic cholecystectomy. Among the patients who underwent elective laparoscopic cholecystectomy the incidence of Iatrogenic perforation of the gallbladder is around 40%, of whom about 22% had spillage of only bile and 18% in whom spillage of both bile and gallstones. Conclusions: It is concluded that laparoscopic cholecystectomy with gall bladder perforation along and spillage of bile and stones took longer operative time than intact gall bladder. We suggest that attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure. In our study, we revealed that no harm is caused by retained gallstones during laparoscopic cholecystectomy after long term followup by evaluation.
THORACIC TRAUMA
Authors: KESIEME E B , OCHELI E F , KESIEME C N , Kaduru C P
Published: September 2021

Objective: To assess the pattern of thoracic trauma in two semi urban university hospitals in Nigeria, to determine the injuries associated with thoracic trauma, its management and outcome in a setting of small thoracic units and limited intensive care unit facilities. Study Design: Observational Method: The hospital records of 142 patients who sustained thoracic trauma between September 2007 and September 2010 were reviewed. The mode of injury, specific intrathoracic trauma, associated injuries, management and outcome were analyzed. Results: Eighty-two percent (82%) of patients were males and 73% of patients were above 40 years. Blunt thoracic trauma accounted for 77% of thoracic injuries. Road Traffic Accident (RTA) was the commonest cause of Blunt Chest Trauma (90%) while Gunshot injuries constituted the commonest cause of Penetrating Chest Trauma (73%). The commonest specific thoracic injuries were Rib fractures and Haemopneumothorax. Extremity injuries were the commonest associated extrathoracic injuries. Mechanical ventilatory assistance was indicated in 8.5% of patients. Only 1.4% of patients had delayed thoracotomy on account of clotted haemothorax and Empyema Thoracis. 2.8% of patients had Laparotomy for repair of Traumatic Diaphragmatic hernia. Others were managed conservatively. The mortality rate was 9.9%. Mortality was mainly among patients who required mechanical ventilatory support and those with associated severe extra thoracic injuries. Most of the patients were discharged before 20 days on admission. Conclusions: The incidence of chest trauma can be reduced by minimizing the frequency of road traffic accidents, abating violence and improving security. Most patients that sustain thoracic trauma can be managed conservatively. Mortality usually occurs in patients with associated severe extrathoracic trauma and those who require ventilatory support. Improving Intensive care unit facilities and training more trauma/thoracic surgeons and intensivists in the developing countries will help to reduce the mortality rate of chest trauma.
UROLITHIASIS
Authors: SIDDIQUI EJAZ HUSSAIN , SIDDIQUI SAAD , MUNIM ABDUL , Shah Noreen
Published: September 2021

Objectives: (1)To assess the common presenting features of urolithiasis. (2) To assess the role of Ultrasonography in its evaluation. Design: Cross sectional study. Setting: Khyber X rays, Khyber Medical Centre, Peshawar. Period: March 2010 to June 2010. Material and Methods: Data from patients presenting with urolithiasis for an ultrasound examination was analyzed for presenting complaints and ultrasound findings according to objectives of the study. Results: A total of 210 cases of urolithiasis were analyzed. The age wise categorization included pediatric population (9.5%), adult population (82.4%) and geriatric population (8.1%). Pain was the most common presenting complaint in all three age groups. Kidney was the most common site for renal calculi followed by ureter, bladder and urethra in descending order. Accompanying dysuria was present in 20% cases. Mild hydronephrosis was noted in 44.8%. Statistically significant difference was present between ultrasound findings in geriatric population and overall results. Conclusions: Urolithiasis continues to be a major cause of morbidity among population of all age groups. Overall trend of Ultrasonographic findings was applicable to pediatric and adult population. There has been significant difference of ultrasound findings among geriatric population from normal trend.