bluuebunny/crossref_metadata_2025 huggingface dataset:
The Political Economy of Industrial Development in Thailand
Authors: Chen Shangmao
Published: June 2016

Since the 1990s, governments around the world have emphasized the core concepts of globalization. Many governments initiated a series of political policies regarding liberalization and privatization in response to the inevitable phenomenon. In Southeast Asia, Thailand participated in the development as well by reconstructing its financial system to allow greater foreign capital for investments. Unfortunately, the importance of prudential regulations was underestimated, and the neglect thereafter caused the Asian Financial Crisis which initially occurred in Thailand on the second of June, 1997. The Thai government received 17.2 billion US dollars from the International Monetary Fund (IMF) to stabilize its domestic situation and implemented structural reform to minimize losses from the crisis. Meanwhile, different voices regarding the policies for globalization were expressed. These opinions mainly referred to regionalization/ regionalism and localization/ localism. This study discusses how the Thai state transformed under globalization from three industries: the Telecommunication industry, the Automobile industry, and the Cultural Creative industry. This article observes that Thailand turned to take regionalization and localization into consideration, which in turn demanded the state to increase domestic autonomy and capacity. The findings also suggest that cooperation with other governments in the region to accelerate economic recovery from the crisis was inevitable. However, political instability and close state-business relations continue to make the future of Thailand uncertain.
Erratum to "The Mandala Culture of Anarchy: The Pre-Colonial Southeast Asian International Society"
Authors: Journal of ASEAN Studies Editorial
Published: June 2016

Throughout the years, study on pre-colonial Southeast Asian international relations has not garnered major attention because it had long been seen as an integral part of the China-centred tribute system. There is a need to provide greater understanding of the uniqueness of the international system as different regions have different ontologies to comprehend its dynamics and structures. This paper contributes to the pre-colonial Southeast Asian literature by examining the interplay that had existed between pre-colonial Southeast Asian empires and the hierarchical East Asian international society, in particular during the 13th-16th Century. The paper argues that Southeast Asian international relations in pre-colonial time were characterized by complex political structures with the influence of Mandala values. In that structural context, the Majapahit Empire, one of the biggest empires at that time had its own constitutional structures of an international society, albeit still sought close relations with China.
Indonesia’s Response in the South China Sea Disputes: A comparative analysis of the Soeharto and the post-Soeharto era
Authors: Aplianta Derry
Published: June 2016

Before it developed into a dispute among China and Southeast Asian nations, the South China Sea has been disputed long before it became what it is today. The post-World War II era brought a fresh start to a new chapter of dispute, as China, Taiwan, Vietnam, the Philippines, Malaysia, and Brunei Darussalam laid their claims one by one. This study contends that under Suharto’s iron fist rule, Indonesia’s interest to the South China Sea dispute grew from maintaining Indonesia’s territorial integrity to maintaining domestic stability. The former took shape after being threatened by China’s map which claimed a part of the former’s territorial waters, while the later grew in through establishing deeper trade cooperation with China. Despite the half-hearted normalization with China, Indonesia managed to establish a track-two forum for parties involved in the South China Sea dispute, which is later proven to be instrumental. Under President Yudhoyono, Indonesia gradually played its initial role from a passive into an active honest broker, which brought improvements to the process. This research attempts to show that constraint to Indonesia’s role in the South China Sea dispute originates from both the ideological and historical factors. Indonesia’s long-running ideological constraints set its priorities to its interest to the dispute, while its foreign policy doctrine serves as a pragmatic means to achieve its goals of interests. Indonesia’s past relationship with China also played a part in influencing Indonesia’s response which later evolved as the relations went through ups and downs. Moreover, the unclear integration process of ASEAN sets the task of the honest broker became a one-country-show for Indonesia.
Women on the Steering Wheel: Identifying the Potentials of Women in Improving the Protection of Indonesian Women Migrant Workers
Authors: Yazid Sylvia , Dewi Elisabeth
Published: June 2016

This paper is based on a research that looked into the potentials of women as stakeholders in improving the protection of Indonesian women migrant workers abroad. It was designed based on the assumptions that an identification of the potentials of women at various levels and in various institutions may positively contribute to the efforts of finding solutions for the problems faced by women migrant workers and that rather than being seen merely as victims, women should be seen as actors who can actively participate in addressing the problems. This paper analyzes efforts made by a number of Indonesian women who are publicly recognized for their works in promoting the protection of Indonesian women migrant workers, both as state and non-state actors in the context of policy making. The focus is on how these women perceive the extend to which their efforts have been able to influence the policy making process. The discussion also includes how the women responded to the challenges and opportunities that they encounter as part of their learning process. The data for this paper was gathered through interviews with six prominent woman figures who are known for their work on the issue of women migrant workers. While confirming that as actors outside the government these women have made efforts to influence the policy making process, this paper showcases that the actual impact of their efforts is highly determined by the policy environment.
Global Indonesian Diaspora: How many are there and where are they?
Authors: Muhidin Salut , Utomo Ariane
Published: June 2016

In the last few years, there is an increasing interest in connecting Indonesian diaspora around the world in order to assist in the national development. A recent event called “Congress of Indonesian Diaspora” held by Indonesian Diaspora Network (IDN) in Jakarta has been conducted to focus on this issue. Nevertheless, there is still little known about the actual size and composition of the global Indonesian diaspora. This paper attempts to contribute to fill in this gap by analysing migration patterns and several specific demographic factors among Indonesian diaspora as part of the largest global community. The paper will also explore the potential impacts of Indonesian diaspora could play in Indonesian development.
Arthritis in inflammatory bowel disease
Authors: Shaukat Aadil , Shaukat Aamir , Shaukat Asim , Aadil Kanwal , Aamir Hooria , Khan Tahir Qadeer
Published: June 2016

Inflammatory bowel disease is a systemic disorder with intestinal and extra-intestinal features. Arthritis is a well recognized extra intestinal manifestation. Spondylitis, sacroiliiatis are the common involvement with IBD. NSAIDs are generally recommended in the treatment with caution due to its potential of flaring up the gastrointestinal symptoms. Sulphasalazine, methotraxate, aziothioprine and anti TNF alpha agents are licensed for treatment of arthritis in IBD. This is a Review Article
Hypocalcemia and nutritional rickets in children: common etiological factors
Authors: Khan Humayun Iqbal , Abdullah Awais , Kazi Mohammad Yaqub , Afzal Muhammad Faheem
Published: June 2016

Backgroud: Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. Objective: To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Study design: Cross sectional analytical study. Place and duration of study: This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. Patients and methods: 120 patients (2 months to 60 months) who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile (serum calcium, phosphate and alkaline phosphatase) and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. Results:: The study group comprised of 120 children (72 boys & 48 girls) ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 & 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Conclusion: Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints.
A phase ii study of doxorubicin, vincristine, cyclophosphamide, prednisolone (CHOP) chemotherapy with intathecal (IT) methotrexate and prophylactic cranial irradiation in a patients with high grade non Hodgkin`s lymphoma (NHL)
Authors: Rahman Ehsanur , , Shaharyar , Alauddin Zafar , Shabbir Khalid , Hafeez Mohammad
Published: June 2016

Objective: The objective of this phase II study was to evaluate the efficacy and toxicity of (CHOP) chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation in patients with high-grade Non Hodgkin`s lymphoma. Method: From January 2002 to December 2002 tewenty consecutive patients with histopathologically and immunohistochemically confirmed high grade NHL with Ann Arbor stage III & IV were enrolled. ECOG performance status of 0 or 1 was required. Written informed consent was obtained from all patients. Patients with symptomatic meningeal or brain involvement were excluded from the study. Cyclophosphamide 750 mg /m2, vincristine 1.4 mg / m2 (maximum 2 mg), doxorubicin 50 mg / m2 was given I/V on D1 and prednisolone 100 mg PO was given from D1 - D5. Cycles were repeated after every 21 days. Intrathecal methotrexate was given at a dose of 12 mg once during 3rd week, twice weekly on 5th & 6th week and once during 7th week. A total dose of 1800 cGy was given to whole brain in 10 fraction s with a daily tumor dose of 180 cGy using a Cobalt 60. Common Toxicity Criteria was used for evaluation of toxicity and WHO criteria for response evaluation. Result: All 20 patients were able to complete the planned therapy. Grade IV neutropenia was observed in 45% (9/20) of patients. Episodes of febrile neutropenia were seen in 20%(4/20). Grade II diarrhea was seen in 25%(05/20). 20%(4/20) had grade II cutaneous toxicity. No immediate radiation related toxicity was seen except grade II nausea and vomiting. Overall response was found in 75%(15/20) of patients, CR in 60%(12/20) and PR in 15%(03/20). 15%(03/20) patients showed stable disease and 10%(02/20) had progressive disease. Conclusion: This combined modality treatment of CHOP chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation has been feasible and effective with acceptable toxicity in this group of patients with high-grade Non Hodgkin`s lymphoma.
Does nitric oxide inhalation need to be reassessed?
Authors: Dahiyat Khalid A
Published: June 2016

Background: Inhaled nitric oxide is a drug which has been given FDA approval in 1999 but was not found prior to approval to be safe for use in premature neonates. Aim: To review and assess the studies which was done prior to its approval in order to find out what evidences the approval by the FDA was based on. Methods: A thorough search of the electronic data-base, Medline, Embase, Cinahl, Google. Conclusion: The use of this drug in treatment of the Pulmonary hypertension in premature babies is still contraversial and hold a serious untoward effects on the health, it should only used as the last ditch.
Blood culture and sensitivity pattern in Neonotology unit of Children Hospital Lahore
Authors: Butt Tayyaba Khawar , Rathore Ahsan Waheed , Farooqi Rehan , Zafar Aizza , Shah Azher Abbas
Published: June 2016

Objectives: To identify spectrum of organisms causing neonatal sepsis and the sensitivity pattern against commonly used antibiotics. Study design: Prospective descriptive study. Material and method: Blood samples were taken from all neonates with clinical suspicion of sepsis before start of antibiotics and sent for culture by standard method. The data obtained from January 2004 to June 2004 was analyzed and results were tabulated. Results: A total of 1900 blood samples were taken. Cultures were positive in 524 samples (27.6%). E Coli was the most common organism found (31.67%) followed by Staph Epidermidis (24.80%), Klebsiella (19.08%) and Pseudomonas (14.69%). Amikacin was the most effective drug followed by Co-Amoxi Clav, Ciprofloxacin, Imipenem and Ceftazidime in that order. Gram positive and gram negative organisms showed a high degree of resistance against Ampicillin and Gentamycin respectively. Conclusion: Neonatal sepsis is one of the leading causes of morbidity and mortality. Gram negative organ isms are the major cause of neonatal sepsis in NNU of Children Hospital. In this study these organisms showed resistance against commonly used antibiotics (Ampicillin, Gentamycin and Cefotaxime). There is a need to modify already existing protocol in NNU of Children Hospital.
Clinicopathologic features of epithelial ovarian cancer
Authors: Asif Fatima , Sattar Ambreen , . Shaharyar
Published: June 2016

Objectives: This retrospective study was conducted at the Clinical Oncology Department of Mayo Hospital with the objectives to find out the frequency of different clinicopathologic features and to see the pattern of treatment and its outcome. Patients and methods: From 2000 to 2004, 375 patients were seen at the Department of Clinical Oncology, Mayo hospital, Lahore. A proforma was designed to document the age, parity, histopathology, stage, grade, clinical features, and family history. The information was obtained from the medical record section. Stage was assigned according to FIGO staging system. All patients with histopathologically proven epithelial ovarian cancer were included. Results: Epithelial ovarian cancer constituted 8.4 % of all female cancers. The median age at presentation was 51 years (range, 21-75 years). All patients were symptomatic before the diagnosis, with ascites being the most common single manifestation (38.4 %) and in patients with multiple signs and symptoms abdominal sym ptoms were most commonly seen (71.5 %). Median pre operative CA125 level was 218 U/ml. ).Optimal cytoreduction was seen in 36.5 % only, and 63.5% patients presented after sub-optimal cytoreduction. Majority of the patients (82.7%) presented in late stages (III & IV) and only 17.3 % in early stages (I&II). Most common histopathologic type of invasive cancer was serous cystadenocarcinoma , seen in 247(72.4%) patients. Endometrioid tumors were seen in very few (3.8 % ).High grade tumors were the most common. Most women were multiparous and only 16.5% were nulliparous. Post operative treatment primarily included cisplatin based combination chemotherapy. One hundred and twenty seven patients were re treated for recurrent or residual disease and 68 were referred for secondary cytoreduction and were given second line therapy subsequently. Conclusion: Epithelial ovarian cancer is not a silent disease, most patients are symptomatic and present in an advanced stage. In majority of the patients optimal cytoreduction is not achieved. Cystadenocarcinoma is the predominant histology and the endometrioid variety is seen only in few.
Primary repair vs colostomy in colonic injuries - a two year experience at Lahore General Hospital and Mayo Hospital, Lahore
Authors: Haq Anwarul , Mumtaz Fawad , Wahla Muhammad Zakria
Published: June 2016

The object of the study was to compare the results of primary repair in colonic injury with colostomy. 200 patients were selected, 100 being allocated to each group .All patients underwent laprotomy mostly indicated by peritoneal irritation. Most of the injuries were of the transverse colon. 22 patients underwent into exteriorization of the repaired part. Right hemicolectomy and ileocolic anastomosis was done in 30 patients. A significant morbidity occurred from wound sepsis, abdominal abscess formation and postoperative pulmonary complications. 22 patients suffered from burst abdomen and 10 developed faecal fistulas. 4 patients died. Prolonged mean hospital stay and more incidences of postoperative complications occurred in colostomy group. This shows that primary repair of colonic injuries should be done in selected cases instead of colostomy in each case.
Renal transplant complications, role of resistive index on Color Doppler ultrasound
Authors: Qureshi Afshan , Batool Sadaf , Shaukat Asim , Khan Tahir Qadeer , Ahmad Khawaja Khurshid , Anjum Muhammad Nawaz
Published: June 2016

We evaluated 50 patients who had renal transplants and were sent for Doppler Ultrasound for complications, after the transplant procedure. Ages of the patients ranged from 20 to 65 years, 39 were male and 11 were female. In inclusions only first month post op patients were included and only those patients were considered who had some sort of complications on ultrasound at some stage of the follow up.Following complications were noticed: Diminished corticomedullary demarcations, increased echogenicity with raised R I (20 pt). Perinephric collections other than haematoma (13 pt). Perinephric haematoma (06 pt). Obstructed transplanted kidney ( 05 pt). Diminished arterial vascularity of the kidney (04 pt) Renal vein thrombosis (02 pt). RI was found to be raised in increased echogenicity, obstructed hydronephrotic kidney, diminished arterial supply and was disturbed in RVT.
The effects of reducing the exposure time of Mitomycin C in glaucoma surgery
Authors: Butt Nadeem Hafeez , Hye Abdul , Ayub Muhammad Hammad , Akhtar Saleem , Jahangir Samina
Published: June 2016

Topical application of mitomycin C has significantly increased the success rate of trabeculectomy. However the optimum exposure time of mitomycin C to the filtration site is not known. . The purpose of this study was to determine whether adequate post-operative control of IOP and a lower incidence of post operative complications can be achieved by using mitomycin-C for a shorter period of time during trabeculectomy, performed in high risk glaucoma patients. Methods: Twenty eyes of patients of glaucoma, who were considered to be at high risk for failure because of their young age, previous ocular surgery like cataract extraction and trabeculectomy, inflammatory glaucoma, high myopia and prolonged anti-glaucoma medication, underwent trabeculectomy with topical application of 0.2mg/ml concentration of mitomycin C for three minutes. They were case matched with a group of same number of eyes of high risk glaucoma patients who received same concentration of drug for 5 minutes. Results: Twelve months after surg ery, the mean pre-operative IOP decreased from 29.9mmHg to a post-operative level of 16.05mmHg in 3 minutes group, with a success rate of 85%, and from 29.35mmHg to 16.55mmHg in 5 minutes group, with the same success rate of 85%. The incidence of complications was higher in 5 minutes group, when total number of complications was compared. ( p value< 0.05) Ocular hypotony developed in 3 (15%) eyes in 5 minutes group, and none in 3 minutes group. No patient developed hypotony related maculopathy in either group. Other complications like hyphema, post-operative uveitis, and conjunctival wound leakage were managed conservatively. Conclusion: The present study supports the conclusion of previous studies that mitomycin C is highly effective drug when used in association with trabeculectomy, and when used in concentration of 0.2mg/ml for three minutes is as effective in controlling post-operative IOP as is five minutes exposure time of the same concentration. Further, emphasizing that the shorter exposure of the drug is associated with lesser incidence of vision threatening complications.
Comparative study between Bupivacaine infiltration in inguinal hernia and intravenous narcotic analgesia a multicenteric study
Authors: Wahla Muhammad Zakria , Haq Anwarul , Mumtaz Fawad
Published: June 2016

The object of the study was to assess the pain relief after Bupivacaine infiltration in the wound in the patients following hernioraphy and to compare it with patients who received narcotic analgesia. 400 patients were selected, 200 being allocated to each group. Pain was compared according to pain scale and mobility of the patients post operatively. After the first 6 hours patients who received Bupivacaine were mobilized earlier as compared to 2nd group. This shows that long acting local anesthesia can be used in a day care surgery.
Efficacy of Fine Needle Aspiration (FNA) Cytology in Differentiating Malignant and Benign Ovarian Cysts
Authors: Anwar Shaila , Shami Nabeela , Asif Shaheena
Published: June 2016

This study was carried out to determine the diagnostic efficacy of fine needle aspiration cytology between neoplastic and non neoplastic ovarian cysts and to verify the cytological diagnosis of aspirated fluid with histology of excised cyst. This was carried out at the Department of Obstetrics & Gynaecology, Ghurki Trust Teaching Hospital, Lahore from February 2003 to February 2005. It was an analytic study. A total number of 55 patients were included in the study. They were selected on the basis of ultrasonographic examination and having unilocular and non septate ovarian cysts. Ultrasound guided aspiration of cysts was done followed by excision. The cytology of fluid was correlated with histology of excised cyst. Results: Follicular cysts were seen in the highest percentage followed by haemorrhagic luteal cysts, serous cyst adenomas and serous cyst adenocarcinomas. Conclusion: Ultrasound guided fine needle aspiration of ovarian cysts is a feasible alternative to surgery for benign cysts of the ovary.
Assessment of clinical teaching /training program in medicine among the medical students
Authors: Shahzad Aamir , Salam Tanvir Us , Majrooh Mohammad Ashraf , Haque Israr Ul , Zafar Shamail , Ali I Kashif M
Published: June 2016

A student`s analysis of teaching / curriculum designing is important for proper educational planning. The study was conducted to evaluate the clinical training in subject of medicine with mutual collaboration of Foundation University Medical College Rawalpindi (FUMC) and Allama Iqbal Medical College (AIMC) Lahore. Total 151 students were interviewed out of those 74 were interview in FUMC Rawalpindi and 77 in AIMC Lahore. To get the feedback of clinical training in undergraduate students a simple questionnaire was distributed during the clinical attachments of final year students. The results showed 55% students were satisfied with duration of clinical rotation while 48.3% of the students thought, instead of rotation to all units, continuous stay in one unit would be a better idea; but marked variation in teaching standards and level of enthusiasm among teachers forces them to opt for the former to benefit from all teachers. Only 31 percent of students were satisfied with the level of commitment shown by senior faculty members and 21.8 percent thought that topics were adequately covered during clinical rotations. Ward tests were not rated very high as a reliable tool of their assessment and 60% felt it failed to assess them thoroughly.
A medical audit on management protocol of Diabetic Ketoacidosis in EMW
Authors: Chaudhary Umair Javaid , Abaidullah Sajid , Zaheer Jawad , Razzaq Anjum , Niaz Zafar , Hassan Mumtaz
Published: June 2016

A retrospective medical audit was conducted on patients admitted in East Medical Ward from January 2004 to July 2005 with a diagnosis of diabetic ketoacidosis. There were 44 patients included in this audit. Patients who had initial blood sugar level more than 250mg/dl and later found to have negative urinary ketones were excluded from the audit. Data was collected on a predesigned proforma and was analysed by the programme SPSS version 10. Results: We found that mean age of the patients was 35.39 18.26 years including 21 (47.7%) males and 23 (52.3%) females. Fourteen (31.8%) patients had their first presentation as diabetic ketoacidosis where as rest of the patients were known diabetics including 56.8% diabetic for less than 10 years and 11.4% diabetic for more than 10 years. Blood sugar level of all the patients was checked at presentation and none of them had blood sugar level less than 250mg/dl and record was missing for 3 patients. Urinary ketones of 44 patients were found to be positive with a max.no. 20 (45.5%) having 4+ ketones where as 3 had their record missing. We found that out of 44 patients arterial blood gases record of 36 (81.8%) patients was available ( mean pH = 7.0786,mean pCO2 = 22.231, mean HCO3 = 12.867) and 8 (18.2%) had their record missing. Serum electrolytes investigation record showed that 11 (25%) patients had their record missing for serum Na+ and K+. Rest of the patients had their record available in which serum Na+ ranged from 131 to 151 mEq/L where as serum K+ values showed that only 1(2.3%) patient had hyperkalemia (serum K+ >5.5) and 4(9.1%) had hypokalemia (serum K+ <3.5).
Parafalcine Subdural Empyema-A Rare Entity
Authors: Ahmad Manzoor , Farooq Umar , Chawla Naveed , Din Moinud , , Nadeem
Published: June 2016

Subdural empyema (SDE) is a significant cause of neurological morbidity and mortality. It should be recognized early and treated as an emergency. Although convexity subdural empyema is not so uncommon but parafalcine subdural empyema is quite rare. A recent case of parafalcine subdural empyema managed at Prince Abdullah Bin Abdulaziz Hospital, Bisha (KSA) is discussed. The epidemiology, pathophysiology, bacteriology, clinical features, radiographic findings and treatment of this life-threatening entity are reviewed
Bilateral III pouch branchial fistula
Authors: Rauf Asad , Dar Sajjid , Saleem Muhammad , Asad Naila , Ahmad Muneer , Qureshi Asif
Published: June 2016

An eight year old female was admitted via OPD with bilateral discharging sinuses. The ostium of the sinuses were at the anterior border of clavicular attachment of sternomastoid. There was H/O off and on whitish discharge, mucoid in consistency coming out from these external openings since last 6 years. It was not associated with any other complaint. There was no H/O respiratory infections, abscess formation, thyroiditis or swallowing difficulties associated with this. According to the location of external openings diagnosis of bilateral III pouch branchial fistula was made. Routine lab investigations showed normal profile. Fistulogram was attempted which was unsuccessful. Both the fistulous tracts were explored under general anaesthesia. The fistulous tract on left side was more developed as compared to the right. The left tract was extending upto the pyriform fossa and the right tract extended upto thyrohyoid membrane. Both tracts were completely excised. Postoperative recovery was uneventful. Clear liquids were permitted on the same day. Patient was discharged on second postoperative day and stitches were removed on fifth postoperative day. There were no complications on subsequent follow up for three months.
Recent advancement in the management of Chemotherapy-induced nausea and vomiting
Authors: Heda Ashish A , Khan Sohil Ahmed , P Puranik , Rodrigues Gabriel
Published: June 2016

The etiology, assessment and the pharmacotherapy of patients with Chemotherapy induced nausea and vomiting are reviewed. In the clinical practice of oncology, adverse drug reactions due to chemotherapy have become almost synonymous with the treatment themselves. The low therapeutic index of chemotherapy and the predictable and common adverse events with cancer treatments means that these events are seen as an un-avoidable component of treatment. Supportive care therapies are critical to the physical and emotional well being of the patient with cancer, which increases the chance, that chemotherapy and radiation can be administered at the optimal dose and on schedule. Approximately 70% to 80% of patients who receive chemotherapy; experience nausea and vomiting (N&V), which can disrupt their lives in numerous ways. The emetogenicity of the chemotherapy regimen greatly affects the patient`s risk for developing chemotherapy-induced nausea and vomiting (CINV). In addition to established and emerging pharmaco logical approaches to managing CINV, many complementary and integrated modalities may be the options. Progress in CINV management must include a better understanding of its etiology and focus on prevention. This is a review article.
Early diagnosis and misdiagnosis of Glaucoma
Authors: Sabir Ghulam
Published: June 2016

Aim: To recognize and draw a line between glaucomatous and non glaucomatous patients at very early stage. Objects: Such silent dangerous ocular problem must be recognized and treated at very initial stage to avoid subsequent complications. Diagnosis: History and all the parameters including intraocular pressure, vision, visual fields and fundus examination were evaluated for diagnosis. Method of study: The study was done at General Hospital and Services Hospital Lahore from 1987 to early 1991. All the patients over the age of 40 year whether coming for first time or already on antiglaucoma treatment were evaluated thoroughly. Patients were examined by senior colleagues also. Results: Total 180 patients were included in study, 120 males 60 females. They were divided into four groups. Group I and II were diagnosed early and included 120 patients with no complications. Group-III and IV were misdiagnosed and included 60 patients. Discussion Until and unless, special care is taken to focus on the diagnosis, it is usually missed with many complications. It is only the casual behaviour of treating physician who considers the patient`s complaint lightly and examines them superficially. Conclusion: Although misdiagnosed cases are relatively less than truly misdiagnosed cases of glaucoma yet they form an important fraction of patients who may go blind within coming years. It is therefore necessary to diagnose such patients at very early stage. The surgeon should take special interest to diagnose such patients. One should not hesitate to consult senior colleagues in doubtful cases. Proper counseling for non cooperative patients is very necessary.
Clinical presentations, diagnosis and pattern of intestinal tuberculosis, our experience, Nishtar Hospital Multan, Pakistan
Authors: Aziz Muzaffar , Jamal Nasir , Farid Muhammad Ikram , Aziz Muzammil
Published: June 2016

Objective: To discuss clinical presentations, diagnosis and pattern of intestinal tuberculosis of the patients presenting in surgical department. Design. Retrospective study. Place and duration of study. Nishtar Hospital Multan, Pakistan during the period of January 2002 to August 2004. Patients and methods. 109 diagnosed cases of intestinal tuberculosis were included in this study. Patients with intercurrent illness and patients proved to have other diagnosis after full work up were excluded from the study. A detailed history and full physical examination of all patients was recorded. Later on various investigations, operative findings were also noted. Results. The ages of patients were in range of 12-54 years. Male to female ratio was approximately 1:2. Clinical presentation was quite variable ranging from abdominal pain present in 100 patients (91.74%) to weight loss noted in 54 patients (49.54%). Endoscopic biopsy and PCR analysis were most useful in diagnosing intestinal tuberculosis in elective ca ses. Strictures of the small bowel were commonest pattern noted. Past history of pulmonary tuberculosis was present in 8 patients (7.33%) while 18 patients (16.51%) had previous history of intestinal tuberculosis. 35 patients (32.11%) had positive family history of tuberculosis. 18.34% of the patients had secondary tuberculosis. Conclusion. Intestinal tuberculosis is a common disease in third decade in the developing countries. Females are more affected than males. Primary tuberculosis is more common than secondary tuberculosis. Intestinal tuberculosis may present with a variety of abdominal symptoms and signs. Endoscopy and PCR analysis can be considered as reliable investigation in elective cases. Strictures, mass abdomen and intestinal perforation are the most common pattern observed.
Mortality and morbidity of 118 cases of acute pyogenic meningitis in paediatrics age group
Authors: Kakar Bashir Ahmed , Ahmed Sultan , Kakar Raz Mohammad
Published: June 2016

One hundred eighteen cases of acute pyogenic meningitis were admitted in the department of paediatrics Liaquat Medical college Hospitals Jamshoro/Hydrabad during one year period with a prevalence of 1.57% of total admissions. Thirty one were neonates and 87 were of post neonatal age group. Gram negative micro-organisms responsible for (66/118) 55.93% of cases with high fatality rate, whereas E.coli was responsible 13/31 (41.93%) in neonates with fatality rate of 58.33% (7/12). In post neonatal period streptococcus pneumoniae responsible for 31/878 cases with fatality rate of 44% ( 11/25 ), and H.influenzae prevalence was 17.24% with fatality rate of 28% (7/25) and Niseria meningitidis was responsible for 28.73% (25/87) cases with fatality rate of 8% (2/25). The overall fatality rate ( mortality + morbidity ) was 31.35% (37/118) various factors responsible for fatality are poor nutritional status, delay in referring the cases and to start of optimal therapy, lack of prompt laboratory aids for identifi cation and sensitivity of micro-organisms, the modified clinical pictures as a result of inadequate treatment before admission.
Postprandial gall bladder contraction seen under ultrasound to rule out non functioning gall bladder in patients of flatulent dyspepsia
Authors: Anwaar Rubina
Published: June 2016

Thirty patients with flatulent dyspepsia selected. Ultrasound examination pre and postprandial done. 26 had normal postprandial gall bladder contraction. 4 patients found to be having non functional gall bladder as it did not show postprandial contraction. They were advised to have oral cholecystography and one of these 4 patients was found to have stone impacted in neck of gall bladder.
Clinical efficacy of 0.2% glyceryl trinitrate ointment for anal fissures
Authors: Salman Shaista , Cheema Nusrat Rasool
Published: June 2016

Objective To validate the clinical efficacy of 0.2% glyceryl trinitrate ointment, a nitric oxide donor, in the management of anal fissures. Patients and methods: A prospective clinical study conducted on consecutive patients with anal fissures presented to the surgical clinic of Jinnah Hospital and Allama Iqbal Medical College Complex Lahore. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. All subjects were followed-up until they were pronounced cured or treatment terminated. Results: 121 patients comprised this study group. 6 cases were lost to follow-up and 109 (94.7%) of the remaining 115 subjects were cured. Of those cured, 13 (11.3%) presented with acute and 102 (88.7%) chronic fissures. There were 98 male and 17 female patients with median age of 41 years (range, 14-70 years). Complete symptomatic relief w as achieved in all patients within one month of therapy. Treatment had to be terminated in 6 (5.2%) patients: 5 (4.3%) experienced intolerable adverse effects and 1 (0.8%) patient failed to respond. All these cases were successfully treated with lateral internal sphincterotomy. There was no change of continence in this series. Conclusion: Glyceryl trinitrate ointment produces healing of the anal fissures and adequate symptomatic relief and should be considered as the first line treatment for anal fissures.
Prognostic value of initial Glasgow Coma Score in comatosed patients on medical floor
Authors: Nadeem Muhammad Arif , Irfan Khadija , Waheed Khawaja A Irfan
Published: June 2016

Objective: An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score (GCS) with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. Methods: A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery (discharge), death, and referral or self discharge (by attendants) against medical advice. Results: The outcome of 248 patients (90.84%) was established i.e. 152 (61.29%) were discharged after recovery and 96 (38.71%) died. The remaining 25 (09.16%) patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category ( score 3-5) there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category (12-15), 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. Conclusion: The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients.
Dr. Elisabeth Kubler-Ross stages of dying and phenomenology of grief
Authors: Mahmood Kaiser
Published: June 2016

Birth and death are both natural events but the emotional impact and the personal meanings of these events are vastly different. Birth may be anticipated with excitement and optimism, while the reality of death may be avoided and been denied. Elisabeth Kubler-Ross has been a pioneer in arousing popular and medical interest in the subject of death and dying. A physician who worked with dying patients and encouraged them to talk about themselves and their feelings toward their impending death. She found that most of the patients she had contact with welcomed the opportunity to speak openly about their conditions. After speaking with some 500 terminally ill patients, Kubler-Ross proposed that there were five stages in coming to terms with death: denial, anger, bargaining, depression and acceptance. This is a review article.
Diagnosis and management of urinary incontinence in older patient
Authors: Abbas Mazhar , Khan Arshad A , Ashraf Asma , U Haq E , Yousuf Ahmed A , A Shiekh I , A Malik , Khan Adnan I
Published: June 2016

Objective: To review the various causes of urinary incontinence (UI) in elderly patients and to outline a therapeutic approach to the clinical management of UI. Data sources: Online search of MEDLINE and additional references selected from the articles found during the search. Study selection: All peer-reviewed articles and review articles listed on MEDLINE published between 1966 and 2006. Key search terms included urinary incontinence, geriatric, aging, pelvic floor rehabilitation and indwelling catheter. Date extraction: Articles with clinical relevance to the geriatric population were selected based on the robustness of the study and reviews. If applicable, data from studies of healthier or younger populations was extrapolated to the elderly population examined in the reviews. Data synthesis: UI is a common occurrence among older adults treated in rehabilitation settings. The causes of UI in the elderly vary, including transient causes, established pathologic states of the urinary tract, and systemat ic multifactorial influences. Both behavioral and pharmacologic management strategies can successfully be implemented for UI, even in the frail elderly. Conclusion: UI can be effectively investigated and treated by rehabilitation practitioners by following a simple, stepwise approach.
Presentation of gallbladder carcinoma and its surgical management
Authors: Waqar Tariq , Ahmed Rasheed
Published: June 2016

Objective:- To study the mode of presentation, age and sex distribution, socio-economic status and evaluation of various surgical methods adopted for treatment of localized and advanced gallbladder carcinoma. Design:- It was a prospective type of study. Place and duration of study: This study was conducted in the Department of Surgery Nishtar Hospital, Multan from January 2004 to June 2005. Patients and methods: Twenty five patients of all ages and both sex were taken from all surgical units. On the basis of history, examination and laboratory investigations they were suspected of having gallbladder cancer. All the patients were operated and were divided into three groups on the basis of operative findings and stage of disease. Results:- There were 4 males and 21 female with a male to female ratio of 1:5. Presenting feature in decreasing order of frequency were; pain in right hypochondrium in 88%, nausea and vomiting in 60%, weight loss in 40%, jaundice in 28%, anorexia in 28%, mass in right hypochondriu m in 24%, pruritis in 20%, fever in 12% and ascites in 4% patients. Preoperative diagnosis of carcinoma of gallbladder was possible in 12 (48%) patients with the help of ultrasound and CT scan but all were of advanced age of disease. Gall stone were the most important etiological factor in 20 (80%) patients, obesity was found in 7 (28%) and chronic typhoid infection in 2 (8%) patients. All patients were operated. Simple cholecystecytomy was done in 4 patients of stage I and II. Extended cholecystectomy done in 6 patients of stage III. Laparotomy and biopsy of the mass and/or palliative surgery for drainage of bile was done in 15 cases of stage IV and V disease. Adenocarcinoma was the most common histological type found in 22 (88%) cases. Conclusion:- Gallstone are the most important etiological factor in gall bladder carcinoma.
Clinical response with antibiotics of 37 cases of acute pyogenic meningitis in Pediatrics (from 3- 12 years)
Authors: Kakar Behram , Kakar Bashir Ahmed , Durrani Asmat
Published: June 2016

Over a period of one year 37 confirmed cases of acute pyogenic meningitis by latex agglutination method were admitted in department of paediatrics, Liaquat Medical College Hospitals (LMCH) Jamshoro Hyadrabad, Sindh. These patients were treated with various antibiotics with the result that ampicillin plus chloromycetin is in combination as is effective as cephalosporin up to the age of 4 years and up to 12 years ampicillin as ampicillin plus chloromycetin which is standard treatment.
Study of frequency and responsible factors for post stroke depression in stroke patients coming to Mayo Hospital Lahore
Authors: Ch Umair Javaid , Osman Salman S , Iqtadar Somia , Zafar Waleed , Shakil Sana , Zahoor Zunaira , Akram Javed
Published: June 2016

Post stroke depression develops as a complication after stroke and impedes the recovery process. Different factors responsible for the development of depression include severity of paralysis, low functional and socioeconomic status and duration of stroke. Our objective was to find out the frequency and responsible factors for PSD in patients presenting to Mayo Hospital Lahore. In a descriptive design 174 patients were studied in out door clinics of Mayo Hospital Lahore. Depression was diagnosed on the basis of DSM IV and severity of stroke was evaluated on the basis of Barthel Index. Results showed that 37.9 % of patients had post stroke depression and majority of patients with PSD came with in first 3 months after stroke. We also found that there is a linear relationship (R2 = 0.844) between severity of stroke and PSD. Hence we concluded that PSD developed in almost one third of patients of stroke, is associated with duration and severity of stroke, developing more commonly with in first 3 months.
Complications of acute diarrhea in malnourished children
Authors: Mahmood Rashid , Khalid Yahya , Iqbal Syed Mjavid , Masood Tahir
Published: June 2016

In a developing country like Pakistan malnutrition is a serious health problem. Diarrheal diseases and malnutrition are inter-related. Hence it is worth studying not only diarrhea itself but also the incidence of acute diarrheal complications in malnourished children. A total of 150 malnourished children with acute diarrhea, 50 patients in each 1st, 2nd and 3rd degree of malnutrition were included in the study to see the frequency of complications. Their ages ranged from 1 month to 4 years. Majority of the patients (44.68%) were between 6 months and 1 year. The incidence of complications was highest in the youngest age group (1 month to 1 year). The majority of the complications like acidosis, shock and septicemia were seen in children with 3rd degree malnutrition. Metabolic and electrolyte derangements were seen again in majority of the patients with 3rd degree malnutrition. The duration of hospital stay was directly related to the degree of malnutrition.