bluuebunny/crossref_metadata_2025 huggingface dataset:
MYOCARDIAL INFARCTION IN DIABETICS
Authors: ALI LIAQAT , ABID ABDUL REHMAN , AHMED IMTIAZ , Niaz Nusrat , Rehman Tahira Abdul , Azhar Muhammad
Published: September 2021

Objective: To analyze the influence of diabetes mellitus on circadian rhythm affecting the onset of acute ST elevation myocardial infarction. Design: Observational study. Period: February to August 2010. Setting: Faisalabad Institute of Cardiology, Faisalabad. Materials and methods: Three hundred and seven consecutive patients who fulfilled the inclusion and exclusion criteria and presented with first MI were studied. All patients were divided into four groups according to the 6:00 hours interval of the day (Circadian rhythm). Group I comprised of patients presenting with onset of symptoms between 0-6 hours, Group II 6:01 to 12:00 hours, Group III 12:01 to 18:00 hours and Group IV 18:01 to 24:00 hours. Data was analyzed for variations within groups. Results: Two peaks of onset of symptoms were observed, first between 0-6 hours 144 (33.9%) patients and the second between 6:01 to 12:00 hours 87 (28.3%) and a non significant association was observed in time of onset of acute myocardial infarction P = 0.082. The trough was evening time 12:01 to 18:00 hours where only 63 (20.5%) patients had acute myocardial infarction. Mean age of study population was 56 ± 12.7 years. Mean age was similar in all the four groups P = 0.155. There were 228 (74.3%) males, 79 (25.5%) females. The circadian morning peak of MI symptom onset was attenuated in patients with diabetes as Group IV consisted of higher number 24 (37.5%) of diabetics followed by group I 23 (34.7%). Overall group II had the maximum number of hypertensive patients 41 (47.1%) as compared to other groups. Obesity was observed in 55 (18%) with similar number of patients in all groups P = 0.492. Majority of patients 117 (38.1%) presented between 4-8 hours after the onset of symptoms. Overall 170 (55.4%) patients had anterior wall myocardial infarction followed by inferior wall myocardial infarction in 82 (26.7%) patients. Conclusions: Our study demonstrates that the circadian morning peak of MI symptom onset was attenuated in patients with diabetes, suggesting a role of autonomic dysfunction. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to differences in the duration of diabetes.
TORTURE INJURIES
Authors: RAJA KHURRAM SOHAIL , ARSHAD HUMAIRA , MANZUR FARIDA
Published: September 2021

Objective: To examine the different type of injuries after police torture. Design: Torture study. Setting: Office of District Standing Medical Board, in DHQ Hospital Faisalabad. Period: From 1.1.2009 to 31.12.2009. Material & Methods: A study of 300 victims of alleged police torture examined by the District Standing Medical Board (DSMB) Faisalabad. Most of the victims at the time of examination were showing visible evidence of Physical trauma. Victims were males. Examination was conducted on the directions of judicial magistrates and District & Session Judge Faisalabad. Conclusion: A wide range of different types of injuries was observed on various parts of the body. Blunt trauma was most frequent. Psychological element of torture was also seen in some victims.
ALLERGIC RHINITIS
Authors: GILL MUHAMMAD ZAHID RAFIQ , AYUBI SALAHUDDIN
Published: September 2021

Introduction: Allergic rhinitis is one of the most common ENT diseases in Faisalabad. The affects of topical steroids on nasal mucosal environment has not been studied reliably. Objectives: To see the affects of topical steroids on symptom score and mucociliary clearance in Allergic Rhinitis. Rationale: To see whether symptom score change with change in mucociliary clearance after topical application of steroids. Study design: A quasi-experimental study. Setting: ENT Unit, Madina Teaching Hospital, Faisalabad ( a tertiary care hospital). Subjects: (sample, sampling technique): Non-probability convenience sampling. Fifty patients in total. Intervention: Saccharine with dye: india ink (Indigocarmine) application on anterior end of inferior turbinate to check mucociliary clearance. Methods (Main outcome measures): To assess change in mucociliary clearance time and symptom score (total as well as individual) before and after application of steroid at one, three and six months in patients having allergic rhinitis. Each nasal symptom was scored as zero to 3 on a severity scale (absent-mild-moderatesevere). Results: Patients were tested for nasal mucociliary clearance and symptom score before and after application of steroid. The results showed statistically significant difference in these groups. Conclusions: 1.Topical steroids modify the nasal mucosal environment in terms of mucociliary clearance and thus affects the patients quality of life in terms of allergic rhinitis symptom score 2. More long term follow up and wider studies are required to study the definite affects of steroids on nasal mucosa.
HEAD AND NECK RECONSTRUCTION
Authors: KHAN FIRDOUS , SHAH SYED ASIF , HAMEED HIFSA , Khan Naji ullah
Published: September 2021

Background: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. Objective: To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Patients and Methods: Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Results: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (25 patients); oropharynx/ hypopharynx, (7 patients); and neck or face (5 patients). Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients (67.59%) had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. Conclusions: The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed.
URINARY RETENTION DUE TO LABIAL FUSION
Authors: FAKHERI TARAVAT , SAEIDIBOROJENI HAMIDREZA , JALILIAN NASRIN , Keshavarzi Farahnaz
Published: September 2021

This report describes a 74 year old woman with urinary symptoms progressing to complete anuria with dense labial adhesions.This condition is mostly reported in pediatric age group but few reports addressed this condition in postmenopause.
BREAST SELF EXAMINATION
Authors: PARVANI ZEHRA
Published: September 2021

Aim: The purpose of this systemic review is to explore the literature on breast self examination and on breast awareness. Objectives: To evaluate the importance of breast awareness. (1) To prove breast awareness is a an effective strategy for health promotion. (2) To clarify the difference between breast awareness and breast self examination. (3) To critique self breast examination as an effective method for screening breast cancers. Methodology: To review the literature supporting breast self examination and breast awareness Medline, CINAHL, Pubmed, Science Direct and Cochrane Databases were used. The key words “breast awareness”, “difference” and “breast self examination” were used in conjunction with “breast cancer”, “breast screening” and “health promotion” to search the recent articles of last 5 years from 2005 to 2010. Conclusions: It was concluded through the literature support that breast self-examination does not reduce breast cancer mortality whereas; breast awareness provides women with some knowledge about the breasts to fight breast disease and to reduce morbidity but not to reduce the mortality.
IATROGENIC NOCERE
Authors: AKHTAR NAJAM
Published: September 2021

Abstract.
HNPCC
Authors: TUNIO MUTAHIR A. , HASHMI ALTAF , MOHSIN REHAN , Sultan Gohar
Published: September 2021

Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common form of hereditary bowel cancer. Multiple generations are affected with colorectal cancer at relatively young age, between 25 and 45 years. Objective: To investigate the frequency of HNPCC in Pakistani population, due to the high incidence of colorectal cancer in younger Pakistani adults and prevalence of consanguinity in this region conducted this study. Period: November 2008 and January 2010. Methodology: Ninty histopathologically confirmed colorectal cancer patients between 12- 50 years and their families were interviewed using a detailed questionaire. The questions about family history of colorectal cancer, history of other cancers, age at diagnosis and consanguinity were asked. The pedigrees were drawn for all families based on given information. Hospital records were also reviewed to confirm cancers reported in relatives. Amsterdam criteria was used to label a family as HNPCC. Results: Seventeen patients (18.9%) had one or more first or second degree relatives under age 50 years with colorectal cancers suggestive of HNPCC. Another 15 patients (16.7%) had first or second degree relatives with a family history of other extra-colonic cancers including ovarian, breast, endometrium, lung, parotid, brain and bladder cancer. Of these 30 patients (33.3%) reported that their parents were first degree cousins. Conclusions: 1. High frequency of HNPCC is seen in Pakistani population. 2. Higher proportion of colorectal cancer is seen in young Pakistanis. Strong prevalence of consanguineous marriages could be important factors for HNPCC occurrence in Pakistan. Future studies with large sample size along with genetic testing and screening programmes are warranted.
ACUTE PANCREATITIS
Authors: BHOPAL FAISAL G. , AZHAR FARYAL , MAHMOOD SHAHID , Iqbal Muhammed
Published: September 2021

Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2-3 days1. Setting: A study was conducted in RGH (Now BBH). Period: January, 1997 to January, 2001. All patients with abdominal pain and having a serum amylase level of five times the normal range, were included in the study. 72 patients were admitted. 29 (40.2%) were males and 42 (59.7%) were females. Male to female ratio was 2:3. The age of the patients ranged from 7 years to 85 years (average age 40 years). Disease severity was assessed according to Ranson’s criteria. They were managed in a general surgical ward or intensive care unit when indicated. Development of complications and their management done were recorded. Patients stayed in the hospital from 1-21 days with an average period of 8.59 days. 32 (44.44%) recovered uneventfully without any complication while 40 (55.55%) patients developed either local or systemic complications. Overall 10 (13.88%) patients died early in the course of disease i.e. within one week. All of them were above 55 years of age, 6 of them were females and 4 of them were males, mortality ratio for female to male was 3:2. Purpose of study: (1) To study the morbidity and mortality in patients of acute pancreatitis. (2) To evaluate the management of acute pancreatitis in a general surgical unit. Conclusions: Management of mild acute pancreatitis is simple, it needs only supportive treatment. However, the management of severe acute pancreatitis is complex. Mortality is high and the treatment requires individualized approach regarding timing of surgery and choice of technique.
FINE NEEDLE ASPIRATION CYTOLOGY
Authors: BHATTI SHER UZ ZAMAN , MALOOK SAIF UL , TARIQ M , Zulqurnain Ali
Published: September 2021

Introduction: Goiter is a common problem in southern Punjab and thyroid surgery is frequently performed in surgical units of BVH Bahawalpur. Fine Needle Aspiration Cytology is the investigation of choice in detection of carcinoma thyroid. It is simple and quick to perform and can be readily repeated. Objectives: The aim of the study was to find out the diagnostic accuracy of FNAC in thyroid nodules. Study Design: Cross sectional study. Period: June 2009 to November 2009. Setting: Department of Surgery, BVH Bahawalpur. Methods: Fifty patients of goiter of age ranging from 16to60 years, irrespective of gender, presenting with a thyroid nodule and undergoing surgery were included in the study at Department of Surgery, BVH Bahawalpur. Information of each patient was collected on a structural Performa and then analyzed on SPSS to assess the sensitivity and specificity of the FNAC. Results: the sensitivity and specificity of FNAC was 72.2% and 97.8% respectively. Conclusions: FNAC should be performed in all cases of thyroid nodules because of its high sensitivity and specificity to diagnose the benign as well as the malignant lesions of thyroid.
CORONARY ARTERY BY PASS GRAFTING
Authors: NAQVI AJMAL HASAN , MALIK AMBER , RASOOL FAIZ , Khan Zafar
Published: September 2021

Background: Several studies have suggested superiority of tight glycaemic control in reducing the incidence of surgical site infection and mortality after cardiac surgery. Objective: To compare the frequency of post operative surgical site infections after CABG in patients with tight glycamic control and those with standard glycamic control. Setting: Shaikh Zayed Hospital, Lahore. Period: June 2008 to March 2010. Methods: Total of 496 patients were included, they were randomized to tight glycaemic control group (TGC ,n =248) or standard control group(SC, n=248).In TGC group blood glucose was maintained between 90 – 130 mg/dl, while in SC group blood glucose was maintained between 131- 190mg/dl for 48 hours post surgery. Results were prospectively evaluated. Results: Demographic and surgical data was similar in both groups. Patients in TGC group showed significant reduction in post operative superficial sternal wound infection (4 vs 12 , p < 0.05) , deep sternal wound infection (1 vs 7, p <0.05) and leg wound infection ( 2vs 9, p<0.05).There was also non significant reduction in the incidence of post operative mediastinitis (1 vs 3), new myocardial infarction ( 2 vs 3),and atrial fibrillation (10 vs 12). Mortality was equal in both groups (1 in each). Conclusions: Significant reduction in SSI was observed in TGC group and no change was seen in other morbidities and short term mortality in the study.
MYOCARDIAL INFARCTION
Authors: ALI LIAQAT , ABID ABDUL REHMAN , AHMED JAHANGIR , Niaz Nusrat , Rehman Tahira Abdul , Azhar Muhammad
Published: September 2021

Objective: To determine clinical predictors of in-hospital complications in patients presenting with acute ST elevation myocardial infarction. Design: Descriptive Study. Period: from October 2010 to January 2011. Setting: Faisalabad Institute of Cardiology, Faisalabad.. Materials and methods: A total 342 patients with AMI were recruited in this study. All patients presenting with acute ST elevation myocardial infarction and fulfilling inclusion and exclusion criteria were included in the study. A full history was taken, particularly age, sex, occupation, address, history of smoking, diabetes mellitus, hypertension, ischemic heart disease and family history of ischemic heart disease. Primary end point was death while secondary end point were patients who had mechanical, ischemic or electrical complications or all of them. Results: Mean age of the study population was 56.3±12.7 years. There were 255(74.6%) males and 87(25.4%) females. There were 103(30.1%) diabetics, 137(40.1%) hypertensive and 174(50.9%) smokers. Family history of IHD was present in 34(9.9%). Obesity was observed in 60(17.5%). Dyslipidemia was observed in 45(13.2%). Majority of patients 123(36%) presented between 4-8 hours after the onset of symptoms. Only 72(21.1%) patients presented to the hospital within 4 hours of onset of symptoms. Overall 194(56.7%) patients had anterior wall myocardial infarction followed by Inferior wall myocardial infarction 84(24.6%) patients. Streptokinase therapy for thrombolysis was given to 236(69%) patients. Overall in-hospital mortality was 28(8.2%). Most frequent in-hospital complication was cardiogenic shock occurring in 38(11.1%) followed by Ischemic complications (Post MI angina and Re-MI) 37(10.8%), heart failure in 37(10.8%) and 1st and 2nd degree AV blocks in 36(10.5%) patients. In-hospital mortality was most significantly associated with site of MI i.e. anterior wall myocardial infarction (X2=28.88, p=0.0001) followed by patients not receiving Streptokinase therapy (X2=18, p=0.001), Age (X2=10.13, p=0.006). Site of MI had the highest Contingency Coefficient value of 0.279 followed by Streptokinase therapy 0.195 and age 0.170. Conclusions: Cardiogenic shock was the most frequent complication. Major predictors of in-hospital mortality were anterior wall myocardial infarction, patients not receiving streptokinase therapy and old age.
HYPERTENSION
Authors: ARSHI SHAHANA , BADSHAH MAZHAR , NAZ FARRAH , Naheed Fakhra , Nisa Fasih-un-
Published: September 2021

ABSTRACT…Objective: To evaluate association of hypertension with central obesity in low to middle socioeconomic population. Study design: Descriptive study. Setting: OPD, Filter Clinic. Pakistan Institute of Medical Sciences. Islamabad. Period: June to September 2008. Methods: This study was carried out on 85 patients with history of hypertension. Out of total patients, 27 were males and 58 were females. The ages of the all patients were between 20 to 70 years. Parameters recorded included history, blood pressure, weight, height, waist circumference and hip circumference. The secondary causes were ruled out on the basis of history and physical examination. Data and results were analyzed in SPSS. Results: Out of 85 patients, 74 including 21 males and 53 females had increased Waist Hip Ratio (WHR), 66 including 14 males and 61 females had increased Waist Circumference (WC), while the Body Mass Index (BMI) of 33 including 6 males & 27 females were found obese. It also showed that the females are more prone to obesity. The age group between 41-60 years was most effected. The results indicates that waist hip ratio is the most common indicator of obesity in patients with essential hypertension as compare to waist circumference and body mass index. Conclusions: Hypertension is associated with central obesity in low to middle socioeconomic status.
METABOLIC SYNDROME
Authors: SANDHU GHAZANFAR ALI , IQBAL SHAHID , BILAL AHMED , Rana Mohammad Mohsin , Abdullah Rehan , Qureshi Faraz Saeed
Published: September 2021

Objective: To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction (MI). Design: Cross –sectional, observational, multi center study. Place and duration: Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Materials and Method: Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Results: Out of 690 patients, 420(60.86%) were male and 270(39.14%) were females with average age 55.90±10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar (42%) levels. Conclusions: Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction.
PREVALENCE OF TUBERCUOSIS IN JAIL
Authors: IQBAL JAVED , MALIK ALTAF HUSSAIN , SHAHID KHALIL AHMED
Published: September 2021

Objective: To determine the prevalence of tuberculosis in prisoners of jail. Design: Descriptive study. Place and duration of study: Central Jail Bahawalpur, all prisoners who were jailed in prison were included. It comprises prisoners of ten years (from 1999). Patient and Method: The study population comprised of 2552 prisoners, 2540 were males and 12 were females. The important variables included symptoms of patients (cough, fever, hemoptysis), age, duration of stay in jail and radiological features seen on chest X Ray. Data was analyzed on SPSS. Results: There were 2540 males and 12 females. Forty-six patients had tuberculosis (1.80%) with mean age 37 ± 12.07 years and their mean stay in jail was 802 ± 1118 days. Among prisoners diagnosed as tuberculosis 39 (85%) had cough and hemoptysis was present in 10 (21.73%) of tuberculosis patients along with cough. Chest X Ray showed 22 (48%) had cavitations and bronchiectasis on chest x ray. Upper lobe alveolar infiltrates were found in 19 (41%) of cases while pleural effusion was present in 5 (11%) of tuberculosis patients. Conclusions: The study revealed that tuberculosis exists in jail of South Punjab Pakistan thus represents an important screening site for TB.
URINARY TRACT INFECTION
Authors: BALOCH GHULAM HUSSAIN , JAFFERY MUKHTIAR HUSSAIN , MADHUDAS CHANDRA , Devrajani Bikha Ram , Shah Syed Zulfiquar Ali
Published: September 2021

Objective: To determine the frequency and pattern of urinary tract infection in patients with diabetes mellitus. Design: Descriptive case series study. Period: February 2009 to July 2009. Setting: Department of medicine at Liaquat University Hospital). Patients and methods: All patients ≥18 years of age, of either gender were known diabetes for ≥ 2 years duration. The infection was labeled when >5/hpf leukocyte in urine and growth of organism on urine for C/S. The blood sugar and hemoglobin A1C (HbA1C) was also advised to evaluate the status of their diabetes i.e. control or poorly control. Result: During study period total 150 diabetic patients were evaluated for urinary tract infection, of which 92(61%) had UTI. Out of ninety two 80(87%) had diabetes type 2 and 12(13%) were diabetes type 1. The female gender was predominant. The mean ± SD for age of patients with type 2 and type 1 diabetes mellitus was 53.52±10.74 and 20.77±1.65 whereas the mean random blood sugar level in patients with type 2 and 1 diabetes was 232.85±5.87 and 288.99 ± 7.87. The mean ± SD for duration of diabetes type 2 and 1 was 4.77±2.31 and 2.56±1.42. The isolated microorganism were Staphylococcus aureus, Escherichia coli, Proteus, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae and C.albicans. Conclusions: The urinary tract infection is more prevalent in patients with diabetes mellitus.
BREAST FEEDING
Authors: AGHA FARAH , ALI HABIBA SHARAF
Published: September 2021

Objective: To identify the factors, causing the early termination of breast feeding i.e. from birth to six months of age. Design: A cross sectional study. Setting: Outpatient Department of Ziauddin Medical University, Kemari Campus, Karachi. Period: June 2008 to December. 2008. Methods: A structured questionnaire was put to mothers of children up to two years of age attending the outpatient department of pediatrics. Results: Significant associations existed between the early termination of breast feeding and family income, family structure (nuclear vs. extended), mode of delivery ,delayed in initiation of breast feeding early weaning and antenatal counseling with a p-value of <0.05. Conclusions: Provision of adequate prenatal counseling, early initiation, proper economical and environmental support, backup and encouragement are key factors associated with prolonged breast feeding among women.
VIOLENCE AGAINST WOMEN
Authors: QASIM ALTAF PERVEZ , SULEHRI MUHAMMAD ANWER
Published: September 2021

Background: Violence against women is an important public health problem. It has global significance regarding violation of human rights. Violence is an important risk factor related to ill health of women, having far reaching consequences affecting physical, social, mental and reproductive health of the victims. Objectives: To study the various types of interpersonal violence against women and find out the magnitude of physical violence and sexual assault among the victims. Study Design: A descriptive hospital record based study. Setting & Duration: The study was conducted from January to December 2005 in casualty out patient department of Allied Hospital, Punjab Medical College (PMC), Faisalabad. Methodology: Total 286 cases of violence, who reported for medico-legal examination during calendar year 2005, were included in the study. The cases of physical violence / sexual assault were examined in detail. Findings were tabulated and analyzed. Results: Among total 286 cases, 221 (77%) victims were married, and commonly involved age group was 21–30 years accounting for 82 (28.68%) victims. Blunt trauma was sustained by 193 (67.50%) victims, sharp edged weapon affected 17 (6.0%) cases, firearm bears the responsibility in 13 (4.54%) victims, a mix pattern of injuries by sharp / blunt objects was observed in 8(2.80%) females and (1.75%) women were said to be burnt. Forty-three (15%) cases were reported as victims of alleged sexual assault with peak incidence during 2nd decade of life in age group 11–20 years involving 23 (53.5%) cases. Among total 43 cases of sexual assault, 27 (63%) victims belonged to rural areas. Twenty Eight (65%) unmarried girls were subjected to sexual assault. In 43 sexual assault victims, semen was detected in 28 (65%) cases, 13 (30%) cases were negative; whereas reports of 2 (5%) cases were not available in the record. Conclusions: The cases of physical violence are common in Faisalabad and incidence of sexual assault is higher in rural areas more commonly affecting the unmarried young girls. There is need to attend this public health problem with concrete efforts to stop the violence against women & reduce the incidence of sexual assaults.
OPEN REDUCTION AND K-WIRE FIXATION OF DISPLACED UNSTABLE LATERAL CONDYLE FRACTURES OF THE HUMERUS IN CHILDREN
Authors: SIAL NOOR AKBAR , IQBAL MUHAMMAD JAVAID , SHAUKAT MUHAMMAD KALEEM
Published: September 2021

Background: Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. Objective: To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Design: Prospective. Setting: Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. Period: From January 2008 to December 2010. Method: In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Results: Excellent to good results were observed in all the12 patients presenting at 1–4 weeks post injury. In 5 patients presenting at 5–8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Conclusions: Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate.
FLUID VOLUME MEASUREMENT
Authors: DANISH KHALID FAROOQ , KHAN REHAN AHMAD
Published: September 2021

Objectives: (1) To measure the difference between the actual and observed volumes of fluids as measured by the commercially available drainage bags. (2) To find out reliability of fluid volume measurements as observed in commercially available drainage bags. Settings: Surgical Unit II, IIMCT Railway Hospital, Rawalpindi. Study design: Descriptive. Materials & methods: Commercially available drainage bags were used to observe the volume of fluid contained in it. The fluid (tap water) was introduced in the bag with a 50 cc syringe in 50 cc increments starting from 50 cc to 1050 cc. and the difference between observed volume and actual volumes were recorded. Data was analyzed with SPSS. Results: A total of twenty-one observations were made in 02 different commercially available urine bags. Major differences were found in the observed and measured volume with minimum difference of 50 -230 ml and maximum difference of 200-520ml. Conclusions: Significant differences were found between the actual volumes and the volumes observed by the marks on the drainage bags. It is noted that the observed value of the fluid volume contained in a drainage bag is highly unreliable and should not be used for clinical decision making.
RETINITIS PIGMENTOSA
Authors: ALAM MOHAMMAD , ISHAQ MOHAMMAD
Published: September 2021

Objective: To review clinical presentations and associations in patients suffering from Retinitis Pigmentosa. Design: Descriptive study. Period: January 2005 to December 2009. Setting: KTH Peshawar, DHQ Hospital Karak and Group of Teaching Hospital Bannu. Materials and Methods: A proper performa was made for documentation of patients. After informed consent, history was taken properly. Ocular examination regarding visual status, anterior and posterior segment examination with direct, indirect ophthalmoscope and slit lamp bimicroscopy was done. IOP was checked with applanation tonometer. For systemic examination and associations opinion of physician was asked if needed. Results: Total 83 patients were examined out of which 49(59.03%) were male and 34(40.96%) were female. Regarding age factor 1(1.20%) patients were in age group up to 10 years, 3(3.61%) in age group 11 to 20 years, 12(14.45%) in age group 21 to 30 years, 21(25.30%) in age group 31 to 40 years, 27 (32.53%) in age group 41 to 50 years, 12(14.45%) in age group 51 to 60 years, and 7(8.43%) patients were in age group 61 to 70 years. In 79(95.18%) patients there was family history of R.P while in 4 (4.81%) patients no family history was present. All the patients have involvement of both eyes. 61(73.49%) patients presented with complaints of night blindness, 56(67.46%) patients with defect in visual acuity with range from 6/9 to perception of light, out of which 24 patients had refractive error and 32 patients had no refractive error. 21(25.30%) patients presented with field defect. Fundoscopy revealed, bone spicule pigments configuration in 83(100%) patients, attenuated blood vessels in 23(27.71%) patients and, waxy pallor disc in 12(14.45%) patients. Regarding associations, in systemic association group 82(98.79%) patients had no association while 1(1.20%) patients had bardet biedle syndrome. In ocular association group 24(28.91%) patients had myopia, 14(16.86%) patients had cataract. Primary open angle glaucoma was present in 3(3.61%) patients while 2(2.40%) had cystoid macular oedema. Keratoconus was present in 1(1.20%) patients. Conclusions: Retinitis Pigmentosa is a grave disease with irreversible loss of visual functions. Mostly it is bilateral. Severity increases with age. Familial onset is more.
PATIENT SATISFACTION AND MERGING OF SMALL HOSPITAL
Authors: JABBAR NAVEED , MALIK LAMEES MAHMOOD , HAMEED SHAHID , Ch. Aftab Ahmed
Published: September 2021

Background: The first merging of small hospitals into a large one came into existence in January 2005 in county Louth. As a result the surgical departments of Louth county hospital Dundalk and Our lady of Lourdes hospital Drogheda Ireland were combined. Two hospitals are at less than half an hour drive and situated North-eastern region of Ireland. Objectives: To assess the impact of joining two departments of surgery in two different hospitals along with the patient’s reaction after such arrangements were made. Design: review of literature. Setting: Louth County Hospital Dundalk Ireland. Period: One year Methods: Following review of literature it was decided to explore the experience of patients who were treated in Louth County Hospital Dundalk one year after merging of two departments of surgery. Randomly 20% of patients treated in Louth County Hospital were included in a telephone survey. These patients were under care of all consultant surgeons. The patients were asked about their experience in Louth hospital. Also impact of joining surgical departments on waiting list was explored. Results: Out of 1310 patients, 20 % of patients treated in Louth Hospitals were included in the survey. The age of the patients varied from 15 to 67 years. 57 % of the patients were female and the remainders were males. It was found that 93.5% of patients were happy to travel to Dundalk and 96.5% were satisfied with the facilities there as well. Furthermore 96% said that they would be happy to have surgery in Dundalk if they ever needed it in the future. 6% of patients were dissatisfied with services in Louth County Hospital, Dundalk. Conclusions: The improvement of quality processes in healthcare is of constant concern to communities throughout the world. The results have clearly demonstrated that restructuring of services can work well and be acceptable to patients once hospitals are prepared with relevant resources in place.
EFFECTS OF NIGELLA SATIVA AND SUNFLOWER OIL DIET ON WEIGHT OF ALBINO RATS
Authors: BURIRO MUHAMMAD ANWAR , TAYYAB MUHAMMAD , DTTTA ALLAH
Published: September 2021

Objective: To study the effects of nigella sativa and sunflower oil on weight of albino rats. Study Design: Experimental study. Period: 1996 to 1997. Setting: PGMI, Lahore. Material & Methods: A study was conducted to determine the effects of nigella sativa and sunflower oil diet intake on body weight in albino rats. Fifty six albino rats with equal number of males and females were selected for the study, they were divided into four different groups, Control groups I and III were given diet (20%), high fat diet supplemented with bile salt (1% colic acid) and antithyroid drug (0.5% propylthiouracil).The experimental group II and IV were given the above diets with supplemented nigella sativa. The high fat diet when given at different intervals increased the body weight as compared to baseline level. Results: The high fat diet when given at different intervals increased the body weight as compared to baseline level. The high fat diet with propylthiouracil and bile salt also increased the body weight and the increase was more as compared to previous groups. The supplements of nigella sativa in the groups decreased body weight significantly as compared to the control groups, which was significantly increased in all the experimental groups as compared to the control groups. Conclusions: These observation confirm that nigella sativa decreased body weight. The above effects will be beneficial for patient with obesity. On the basis of these findings conclusions are made, that nigella sativa has got body weight reducing effects. Both nigella sativa and sunflower oil have got low atherogenic index (TC/HDL) and may be recommended in hyperlipidaemic obese patients or normal individuals. Nigella sativa has got weight reducing potential thus affecting obesity and may indirectly prevent atherosclerosis. Nigella sativa is curative remedy for all diseases except death, is the saying of our Holy Prophet Hazrat Muhammad Sallallaho Alaihe Wasalam.
TEMPOROMANDIBULAR JOINT ANKYLOSIS
Authors: RATHORE EHSAN , RATHORE ALTHAF HUSSAIN
Published: September 2021

Temporomandibular joint (TMJ) ankylosis is a distressing and disabling disorder due to fibrous or osseous adhesions between the bony components of the joint1. It not only causes the inability to open the month but also alters the eating habits, speech ability, and cause malocclusion, facial disfigurement and psychological disorders2. The main cause is trauma in the childhood3. The treatment is early and aggressive surgical operation4. So many surgical procedures have been described but no one has been proven entirely satisfactory5.
SKIN CLOSURE IN LAPAROTOMY
Authors: SHABBIR GHULAM , AMER M. SUHAIL , RASHID MUHAMMAD UMAIR
Published: September 2021

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Design and Duration: Quasi experimental study from September, 2006 to March, 2007. Setting: Surgical floor of Allied Hospital, (Punjab Medical College) Faisalabad. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Results: Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients (group A) were left open and closed on 4th day while that of next thirty patients (group B) closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence (16.66 %). Four belonged to group A(13.33%) and six belonged to group B(20 %) (p<0.05). In advancing age the infection rate was significantly high in the same group (p <0.01). Regarding hospital stay of patients of two groups the difference was statistically significant. Group A (mean=7.77, std. dev=2.029 and std. error of mean=0.370). Group B (mean=10.30, std. dev=4.822 and std. error of mean=0.880). Regarding age the difference was not statistically significant between two groups. Group A (mean 30.47, std. dev=10.099 and std error of mean=1.844). The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. Conclusions: No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care.
CHRONIC ANAL FISSURE
Authors: HUSSAIN ABID , NAHEED KISHWAR
Published: September 2021

Objective: To determine the role of chemical syphincterotomy as non surgical management of chronic anal fissure. Study Design: Descriptive. Setting: This study was conducted at Margalla teaching Hospital and United Medical center .Rawalpndi. Period: 1½ years. Patients & Methods: This study included 70 patients of either sex. A personal bio data and detailed history of dietary and bowel habits were registered. Topical 0.2% GTN (Gylciryltrinitrate) was applied to anal verge 2 times per day for the period of two months and its effects were noted. Result: 58 patients (83%) got symptomatic relief and 12 patients (17%) did not get improvement. Conclusions: Chemical syphincterotomy heals majority of the fissure . Topical 0.2% GNT ointment is widely used as a first line treatment in U.K . It is generally accepted as an effective treatment for chronic fissure .
HEMORRHOIDECTOMY VS RUBBER BAND
Authors: DILAWAIZ MUHAMMAD , RASHID ABID , BASHIR MUHAMMAD ABID
Published: September 2021

Objectives: To compare open hemorrhoidectomy and Rubber Band Ligation (RBL) in the management of 2nd and 3rd degree hemorrhoids in terms post operative and hospital stay. Design: Experiential Randomized Control Trial. Setting: Department of surgery, Allied Hospital and Independent University Hospital Faisalabad. Period: Dec 2008 to May 2009. Patients & Methods: 100 consecutive patients with second and third degree hemorrhoids were randomly divided into two groups. Group A (50 patients) were operated by open hemorrhoidectomy (Milligan morgan technique) while in group B (50 patients) rubber band ligations was performed. Open hemorrhoidectomy was performed under spinal anesthesia while rubber bands were applied with local xylocaine gel using Barron’s rubber band ligator. All the three hemorrhoids were ligated in single session. Results: Average hospital stay was 24 hours in patient operated by open hemorrhoidectomy as compared to one hour in rubber band ligation. 60% patients in group A developed moderate to severe pain requiring I/V morphine derivatives while 40% developed mild pain and treated with NSAIDS. In group B only 20% patients developed moderate pain and were dealt with I/M diclofenac sodium. Eightyeight percent patients in group A and 60% patients in group B developed mild to moderate bleeding in first postoperative week, which was self limiting. 6 patients developed severe bleeding after hemorrhoidectomy requiring blood transfusion. During six month follow up, two patients (4%) of open hemorrhoidectomy and 3 patients (6%) of RBL presented with recurrence and respective procedures were repeated. Conclusions: Rubber band ligation is safe, quick, economical and effective method for the treatment of 2nd and 3rd degree hemorrhoids.
SECOND TRIMESTER PREGNANCY
Authors: HEMLATA DR , NISA QAMAR-UR- , SOLANGI RUBINA , Rathi Suresh Kumar , Ullah Habib
Published: September 2021

Objective: To compare clinical efficacy and side effects of oral misoprotol with vaginal misoprostol for termination of second trimester pregnancy. Design: Interventional Quasi experimental. Setting: Gynae Unit III, Liaquat University Hospital, Hyderabad. Period: 1st March 2006 to 31st August 2006. Methodology: Sixty patients were selected with thirty in each group i.e thirty for oral route (group A) and thirty for vaginal route(group B). The patients included in this study were those having singleton pregnancy with gestational age between 12 to 26 weeks requiring termination of pregnancy. A dose of 100ug to 200ug was used with maximum of 1200ug in each group of patients. Results: The subjects of either group were similar with respect to mean age, height, weight, parity, gestational age and pre induction Bishop Score. The success rate in group A was 94.4% as compared to group B was 86.8%. intra uterine death was the commonest indication in both groups found in 46.7% women of vaginal misoprostol group and 50% women of oral misoprostol group. Surgical evacuation was needed in 36.7% women of oral misoprostol group and 16.7% women of vaginal misoprostol group. Conclusions: The present study shows misoprostol to be effective for mid trimester abortions, both orally and vaginally, the later route is preferable because it requires lesser doses and produces a shorter induction – abortion interval. However safety data are needed to guide the route choice and well designed studies are necessary.
PREGNANT WOMEN WITH LOW BMI (<19)
Authors: UROOJ UZMA , BAQAI SHEHLA , ANSARI ASMA
Published: September 2021

Introduction: A strong relationship between maternal weight and birth weight has been demonstrated consistently and low maternal weight is considered as a preventable risk factor for low birth weight. Objectives: To determine the frequency of preterm labour and fetal outcome in terms of low birth weight in pregnant women with low body mass index < 19. Study Design: Descriptive case series. Setting: Outpatient Department of Obstetrics and Gynaecology, Combined Military Hospital, Quetta, a tertiary care hospital. Duration of study: Six months from 01-05-2009 to 01-11-2009. Subjects and methods: Total 114 pregnant women at 16 weeks of gestational age with singleton pregnancy reporting to obstetrics and Gynaecology Department Combined Military Hospital, Quetta were selected. Results: Mean age was observed 27.6±3.9 year. Out of total 114 patients, 15 (13.1%) belonged to <37 weeks of gestation while 99 (86.9%) patients had >37 weeks gestation. Mean gestational age observed 38.5±4.1. Out of 15 preterm deliveries, 10 (66.7%) had uterine contractions >4/10 min 5 and (33.3%) patients had Cervical dilatation >2cm. Out of 114 patients, 12 (10.5%) cases had fetal weight <2.5 kg and while remaining 102 cases (89.5%) had fetal weight 2.5-4 Kg. Conclusions: In conclusion, this study demonstrates that low BMI is associated with preterm delivery and low birth weight babies.
CHRONIC TENNIS ELBOW
Authors: SHAH FAAIZ ALI , KHAN HAZIQDAD , ULLAH KIFAYAT
Published: September 2021

Objectives: To evaluate the results of autologous blood injection as a treatment for chronic tennis elbow (Lateral Epicondylitis). Study Design: Descriptive case- series. Setting and Duration: Orthopaedic Surgery Unit Mardan Medical Complex Teaching hospital Bacha Khan Medical College Mardan KPK, from April 2010 to June 2011. Methodology: A total of 22 patients with tennis elbow (lateral epicondylitis) were injected with 2 mL of autologous blood under the extensor carpi radialis brevis in the Out-Patient Department (OPD). Patients rated their pain on a Visual Analogue Scale(VAS) scale of 0 to 10 with 0 representing no pain and 10 the worst pain they had ever experienced, and categorized themselves according to Nirschl score(1-7). After the procedure pain rating and Nirschl score were recorded every 3rd week for a minimum of 6 months. If pain relief was not relieved entirely 6 weeks after the autologous blood injection a repeat injection was offered to the patient. Results: Seventeen patients (77.2%) received one injection of autologous blood and had resulted in lowering their mean pre-injection pain score and Nirschl sore of 6.2 and 6 to 0.1 and 1.1 post-injection respectively. Five patients (22.7%) received two injections and their average pre-injection pain score of 6.8 and Nirschl score of 6.2 were lowered to 0.2 and 1 respectively. Conclusions: Autolgous blood injection is an effective way to treat patients of chronic tennis elbow as demonstrated by decrease in pain and fall in Nirschl score and we therefore recommend it as a first line treatment for chronic tennis elbow.