bluuebunny/crossref_metadata_2025 huggingface dataset:
RECURRENT ETHMOIDAL POLYPI
Authors: SAEED MUHAMMAD , MIAN FAROOQ AHMED
Published: September 2021

The management of recurrent ethmoidal polypi is an important issue.This study was carried out to compare the results of various surgical modalities which are used for recurrent ethmoidalpolypi. Design: Prospective study. Setting Department of ENT Allied Hospital Faisalabad. Period: From Jan 2001 toDec 2003. Material & Methods: Total 150 patients suffering from recurrent ethmoidal polypi 102 males (68%) and 48females (32%) between 05 years to 90 years of age. The highest incidence was seen during fourth decade of life(27%). The incidence of recurrent ethmoidal polypi was 50 cases per year. The majority of cases were admitted throughout patient department (67%). The highest incidence of patients was seen during the months of March and August(12%). The majority of patients were belonging to poor class (62%). The most common presenting symptom was nasalobstruction (95%). The most common associated disease in patients with recurrent ethmoidal polypi was deflectednasal septum (52%). Nasal polypectomy was carried out in majority of patients (34%). The success rate was highestwith external ethmoidectomy (97%) and lowest with simple nasal polypectomy (75%). Many surgical modalities areavailable for the treatment of recurrent ethmoidal polypi, every procedure has got its own success and complicationrate therefore it is suggested finally that when a surgical modality is adopted it should be based upon patient history,investigations, extent and severity of disease, more over regular follow up of the disease is required to control thedisease.
POSTERIOR URETHRAL VALVES
Authors: MALIKQ MUHAMAMD AKRAM , SIAL SAFDAR H. JAVED , IQBAL ZAHID , Ahmad Munir
Published: September 2021

Posterior urethral valves are the most common cause of mechanical infravesical obstruction in children. The disorder has a broad spectrum of severity and the patients could developcomplications on the long term, even after valves ablation. Objective: To record the various clinical presentations ofPUV and audit our experience in management of PUV and its various complications. Study design: Prospective studySetting: Department of Urology Allied Hospital Faisalabad. Period: From 01-01-2001 to 31-07-2004. Material &Methods: All male patients (children, infants & neonates) presented with various symptoms and signs of PUV wereincluded in the study. Detailed history & clinical examination was performed in each case. Diagnosis was confirmedby micturating Cystourethrogram. Posterior urethral valves were ablated in all patients by electric hook. The period offollow-up was 06 months. Results: Total number of patients were 32. Age of presentation was 40 days to 27 years.Majority 14(44%) of patients presented with urinary retention.13 (41%). Patients presented with dribbling of urine andpoor stream. 07(22%) had associated vesicouretral reflux. Vesicostomy was performed in one patient and one patienthad to be dialyzed. Complications occurred in 13 (14%) patients. Most common were urinary tract infections in 10 (31%)patients. One patient went into End stage renal disease. Conclusions: Valve ablation is the mainstay of treatmentof post urethral valves. Prenatal and postnatal factors like renal dysplasia and UTI have their role in final outcome.Drainage by feeding tube and Vesicostomy improves the outcome.
PREVALENCE OF HBV, HCV AND HIV IN BLOOD DONORS AT LIAQUETPUR
Authors: KHAN MUHAMMAD AYUB , Ashraf Muhammad , REHMAN ABDUL , Ali Azam , ASHRAF MUHAMMAD , Ditta Allah
Published: September 2021

Objective: To know the prevalence of hepatitis B, hepatitis C and HIV.Design: Observational cross sectional study. Setting: Blood Transfusion Center Tehsil Headquarter HospitalLiaquetpur. Subjects and Methods: The data of blood donors from 2001 to 2003. Results: Total blood donors studiedwere 1426. The prevalence for hepatitis B was 5.96% (CL 4.84%-7.32%) It was 0.07% (CL <0.01% - 0.44%) for HCVand zero for HIV. The prevalence of HBV in males was 6.03% (CL 4.87%-7.45%) while 5.05% (CL 1.91%-11.63%) infemales (p=0. 6917). The prevalence in 17-20 years age group was 6.4% (CL 3.92%-10.23%), 5.81% (CL 4.6%-7.33%)in 21-40 years age group and in 41-60 years age group it was 4.35% (CL 1.33%-28.19%) [p=0.9029]. Conclusion:Hepatitis B is common, hepatitis C is an uncommon health problem while HIV is not present in this area.
THE PASSIVE CASE DETECTION OF MALARIA AT TEHSIL LIAQUETPUR
Authors: REHMAN ABDUL
Published: September 2021

Introduction: The purpose of this study is to compare the role of thedoctors and the medical technicians/ dispensers in passive case detection (PCD) of malaria.Design: This is a nonrandomized clinical trial. Material and Methods: The PCD slides data of Malaria Control Programme Laboratory atTehsil Headquarter Hospital Liaquetpur from 2001 to 2004 was divided into group A and Group B depending onwhether the slides were advised by the doctors or the medical technicians/dispensers. P value less than 0.05 was takenas significant. Results: The slide positivity rate (%) of Group A vs. Group B was 17.11 vs. 5.64 (p<0.0001) in 2001,9.35 vs. 3.17 (p<0.0001) in 2002, 5.76 vs. 1.61 (p<0.0001) in 2003 and 5.74 vs. 1.33 (p<0.0001) in 2004. Thefalciparum rate (%) of group A vs. group B was 2.59 vs. 0.46 (p<0.0001) in 2001, 2.06 vs. 1.15 (p=0.0342) in 2002,0.3 vs. 00 (p= 0.0767) in 2003 and 0.31 vs. 00 (p=0.1276) in 2004. Conclusion: The performance of doctors groupwas better than those of medical technicians/dispensers group
ARTERIAL HYPERTENSION-NON INVASIVE DIAGNOSIS
Authors: ADAMEK MILAN
Published: September 2021

Aims & Objectives: This study was designated to find andto characterize similarities andf differencies between two groups of patiens. One group were patients with establishedarterial hypertension / AH / and the second one were patients with new diagnosis of AH or who have so called highnormal blood pressure / BP / or who had randomly found elevated blood pressure once time in their history but,therefore they had normal BP on check examinations, they were left without treatment. The main goal of the study wasto show that the groups are similar in important parameters, which may be of clinical importance / decision abouttreatment / and to find which of the non invasive examinations, with exception of classical BP measurements, may stillplay the important role in setting the diagnosis of AH in early stage of the disease. And the second main goal of thestudy was to show that measurement of BP under basal conditions may sometimes be insufficient for decision makingif the patient is hypertonic or not. Methods: Following methods and measurements were used to obtain necessaryparameters – arterial blood pressure measurement, echocardiographic examination to obtain values as left ventriculardiameter in systole and diastole, interventricular septum and posterior wall thickness in systole and diastole, ejectionfraction - Teichholz, interventricular septum and posterior wall excursions, left atrial diameter, measurement of speedof aortic ejection, E/A index, isovolumic relaxation time, carotid myointimal thickening, carotid pulse velocity, time topeak of carotid upstroke and ambulatory blood pressure and electrocardiogram monitoring, measurement of bloodpressure reaction on exercise stress testing and in recovery period post exercise and double product.
PROLIFERATIVE VITREORETINOPATHY
Authors: NAQVI SYED ABID HASSAN , SHEHZAD SOHAIL , ZAFAR OMAR
Published: September 2021

Objective: The objective of study to assess the success of pars planavitrectomy with use of silicone Oil for internal tamponade in traumatic rhegmatogenous R D with severe PVR. Setting& Period: This study was carried out in department of Ophthalmology Military Hospital Rawalpindi. Material &Methods: Fifteen cases with severe proliferative vitreoretinopathy (PVR Grade C, according to up dated retina SocietyClassification of 1991) was included in study. All the patients had traumatic rhegmatogenous retinal detachment withhistory of blunt ocular trauma, without globe rupture, outcome of the treatment was assessed by post operativeanatomical and physiological success. Results: Anatomical success was encouraging in-spite of advance disease andtechnically difficult and complicated intra-ocular maneuvers.
HOOKWORM INFECTION
Authors: ANJUM MUGHEES
Published: September 2021

Objectives: To find out prevalence rate of hookworm infection in a rural community of Pakistan. Tofind out whether a significant correlation exists between hookworm infection and haemoglobin. This study “Correlationof hookworm infection and haemoglobin” was conducted in rural population of Mustafaabad (Iulliani) located in DistrictKasur. (Pakistan). By a stratified random sampling 1010 male adult subjects were selected from the above locality. 253i.e. 25.05% were found hookworm positive. Samples of stool and blood were collected. A thorough study on 253hookworm positive subjects was carried out for calculation of haemoglobin levels and intensity of hookworm infectionin terms of number of ova per gram of faeces. Haemoglobin levels were estimated by cyanomethaemoglobin methodand quantitative estimation of hookworm ova in stool was carried out by stoll’s modified egg counting technique. Theresults of the study showed statistically significant relationship between haemoglobin level and No. of hookworm ovaper gram of faces.(r = -- 0.876) for 253 hookworm positive cases, which reflects a high degree of negative correlation.
DIAGNOSTIC ROLE OF ENDOSCOPY
Authors: JAVED MASOOD , Muhammad Dilshad , AMIN KHALID , Abbas Shahid , HUSAIN AAMIR
Published: September 2021

Objectives: To see the usefulness of Endoscopy in patients with variousgastrointestinal manifestations. Design: Prospective study. Setting: Department of medicine and gastroenterologyAllied Hospital Faisalabad Period: January 2005 to July 2005, Material & Methods: This study was conducted on 500patients presented to us with various gastrointestinal manifestations of either sex and between 13-70 years. Results:260 patients were Males and 237 were Females. Most common indication was epigastric pain. 60.4% of the patientshad organic lesion. Endoscopy was maximally positive in inpatients (91.86%). Most common lesion was in stomach i.e.gastritis. Collectively ulcerative lesions came out to be 27.30%. Conclusion: Diagnostic yield of Endoscopy isundoubtedly very high if the patient selection is done in a meticulous way.
OPEN PROSTATECTOMY
Authors: IQBAL JAVAID , GULZAR MUHAMMAD REHMAN , AFZAL MUHAMMAD , Ahmed Irshad
Published: September 2021

Objectives: To study the morbidity of open prostatectomy. To assessthe frequency of complications after open prostatectomy. Study design: Descriptive cross sectional. Setting: SurgicalUnit-IV, DHQ Hospital, Faisalabad. Duration: 01-01-2003 to 31-12-2003 (One Year). Subjects: Patients of bladderoutlet obstruction due to benign prostatic hyperplasia (PBH) were operated by open surgery (Transvesical or retropubicprostatectomy). Results: Open prostatectomy was performed in 54 cases. In 38 cases, suprapubic transvesicalprostatectomy was performed, while in 6 cases, retropubic prostatectomy was done. Our youngest patient was 42 yearsold and oldest 90 years. Mean age was 62 years. In our study, the most common complications were wound associatedseen in 7(12.96%) cases. They included cellulites in 3(5.56%) cases, stitch abscess in 1(1.85%) cases, seroma in1(1.85%) cases, and abscess in 2(3.70%) cases. Other complications were bleeding in the form of reactionaryhaemorrhage/clot retention in 2(3.70%) cases and secondary haemorrhage in 3(5.56%) cases. Urinary fistula was seenin 5(9.26%) cases while retrograde ejaculation in 6(11.11%) cases, stricture urethra in 3(5.56%) cases, urinaryincontinence in 4(7.41%) cases and urinary tract infection in 5(9.26%) cases. Epididimo-orchitis, deep vein thrombosisand osteitis pubis were not seen in our study. The average duration of hospital stay was 6 days. Most cases weredischarged within five days of operation, while stitches were removed on the eighth postoperative day. Conclusions:The morbidity of open prostatectomy is higher than transurethral resection (TURP), as TURP is better procedure dueto lower complication rate, short hospital stay, cost effectiveness and better tolerated by old and unfit patients,presenting with small fibrotic prostate. Open prostatectomy is still a good option for BPH where TURP facilities are notavailable.
REFRACTORY KERATITIS IN HOT CLIMATE
Authors: DAR ASAD JAMAL , AHMED HASEEB , HANIF M.KASHIF , Yasin Ubaid Ullah
Published: September 2021

This article presents patients with unilateral painful red eye refractory torecommended standard treatment regimes in which staining, culture and sensitivity reports were inconclusive. Onocular examination hazy cornea with central corneal abscess was common in all cases. Corneal biopsy was reservedfor cases with inconclusive laboratory reports as well as poor response to standard treatment regime. The formerrevealed fungal hyphae in all cases. Patients mentioned had general predisposition e.g. diabetes mellitus, hot climate(Multan) as well as predisposing factors such as contact lenses, dry eye syndrome, poor ocular hygiene, agriculturalbackground were more prone to fungal keratitis, hence better diagnosed and confirmed early by contemplating cornealbiopsy.
HETEROTOPIC PREGNANCY
Authors: AKTHAR FARKHUNDA
Published: September 2021

A rare case of simultaneous tubal pregnancy and intrauterine pregnancy is discussed. Patient hadan atypical presentation of abdominal pain and a abnormal uterine bleeding but no period of amenorrhea. On clinicalexamination there was suspicion of ectopic gestation but ultrasonography revealed early intrauterine pregnancy alongwith luteal cyst. Because of increase severity of pain she was reviewed again. Repeat sonography findings wereconsistent with heterotopic which was confirmed by laparotomy and histopathology.
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
Authors: AHMED FAROOQ
Published: September 2021

Objectives: .To assess the safety, potential efficacy, morbidity andmortality of a small tidal volume mechanical ventilation strategy designed to reduce stretch induced lung injury in ARDS.Design: A prospective interventional experimental Setting: CMH Rawalpindi:..Period: .1st Sept 2001 to 30th June2002. Material & Methods: ARDS is a disease associated with high rate of mortality. It was a prospective interventionalexperimental study of 50 patients who underwent ventilatory support at intensive care unit of a tertiary care teachinghospital Combined Military Hospital Rawalpindi. Results: In both the Traditional Tidal Volume(TTV) and Small TidalVolume (STV) groups 15 of 26 patients [58%] achieved Reversal of Respiratory Failure (RRF). Of the patients whoachieved RRF, the mean number of days on positive pressure ventilation were 11.9±1.9 and 11.3 ± 2.2 days for theTV and STV patients respectively [not significant]. The mean number of days from the first day that weaning from MVwas allowed (when FI 02 was <or= 0.50 and PEEP was <or= 5) to RRF was 5.2 ±1.1 and 5.1 ±1.0 in the TTV and STVgroups respectively [p= .94] .Mortality before hospital discharge was 46% in the TTV group and 50 % in the STV group.Conclusion The sample size was too small to discern small treatment effects. The differences in tidal volumes andplateau pressures were modest or reduced tidal volume ventilation is not beneficial.
HAND INFECTIONS
Authors: NASIR ABDUL
Published: September 2021

Hand infections are the prime cause of loss of working hours for manualworkers and housewives. The objective was to study different types of hand infections, infecting organisms and to findout different residual complications. This prospective study was carried out at C.M.H., Peshawar from March 1, 2000to March 1, 2003. All patients above 12 years were included in the study. Diabetics, immunosuppressed patients, drugaddicts, and patients on steroid or cytotoxic therapy, were excluded from the study. Other exclusion criteria were crushinjuries, burns, compound fractures and skin lacerations. The diagnosis of hand infection was based on history,physical and roentgenographic examinations of the hand. All the patients were put on Cloxacillin & Gentacin and theiraffected hands were elevated. In cases of suppuration, surgical drainage was done & pus was sent for C/S. Earlyphysiotherapy was instituted & residual complications were recorded..Relative frequencies of different types of handinfections in 176 cases included Paronychia (22.16%), Cellulitis (21.02%), Felon (19.32%), Proximal & Middle VolarSpace infection (16.48%), web space infection (14.77%), Thenar Space Abscess (3.41%) and midpalmar abscess1.70%). Frequencies of hand infections in adolescents, young, middle and elderly patients were 14.77%, 52.84%, 25%and 7.39% respectively. There was no significant difference in frequencies of hand infection amongst males andfemales. The percentages of right hand and left hand involvement were 57.38% and 42.61% respectively. The ratiobetween manual workers and other patients of hand infections was 2.5:1. Staphylococcus aureus was detected as asingle offending organism in most of the cultures(62.59%) and stiffness was the leading complication(14.20%). Thefrequency of complications was significantly more in elderly patients (53.28%) but there was no significant differenceof complications amongst males and females.
THE HYSTERIA
Authors: MAQSOOD NIAZ , AHMAD ISHTIAQ , ALI WAJID , Rehman Wajeh ur , Niaz Naima
Published: September 2021

Objectives: To find out the sociodemographic characteristics ofconversion disorders and to find if there is any difference between the presenting symptoms of rural and urbanpopulation. Design: A non-probability, purposive, hospital based sample. Place and Duration of Study: Psychiatrydepartment of Victoria Hospital Bahawalpur, from February 2004 to April 2005. Patients and Method: A sample of 100-patients was collected. Both sexes were included. DSM-IV criteria for conversion disorder were applied for diagnosisof all these patients. Informed consent was taken for inclusion in the study. Patients suffering from concurrent physicaldisorders were excluded. The first author (NM.) using a semi-structured pro-forma interviewed all these patients. Thesociodemographic characteristics and the clinical profile were collected. Statistical analysis was made with the statisticalpackage for windows, SPSS (version –10). The applied method for group comparison was chi square- test. Results:The mean age of patients from the urban area was 24.26±7.25 years, as compared to 22.15±7.49 years for thepatients from the rural area. Most of the patients were females and were married. Majority of the patients from the urbanas well as from the rural area were uneducated and from the lower socio-economic class. The onset of illness wastypically acute and sudden, with precipitating life event. Majority of the patients had family history of the illness and comorbidpsychiatric disorders. The presenting symptoms were either sensory, motor, mixed symptoms and psuedoseizures.The presenting symptoms of patient from both urban (p value of 0.008), and rural area (P value =0.013), werestatistically significant. There were no statistically significant association between the presenting symptoms and thearea of living. The p values of the entire chi square tests were greater than (0.05). Conclusion: Prompt elimination ofthe symptoms of conversion disorder is important to prevent secondary gains from reinforcing it and causing it to persistor reoccur. Psychiatric services need to be developed and updated for the provision of prompt and efficient treatment,for the patients with these chronic and sometimes disabling conversion disorders.
DOCTORS NEED ENHANCED ONCOLOGY KNOWLEDGE
Authors: PARVEZ TARIQ , PARVEZ BABAR , BEHANI AMAL
Published: September 2021

Objective: To assess oncology knowledge among doctors, andsuggestions to improve. Design: Cross sectional analytical study. Place and duration of study: This study was carriedout in the Department of Oncology, King Fahad Hospital, Madina Munawra, KSA and was completed in 8 months fromNovember 2004 to June 2005. Subjects and Methods: Series of five lectures were delivered on different subjects ofoncology. Participants were asked to answer an MCQ type questionnaire, which was structured regarding the contentof the lecture, before the lecture and after the lecture. Comparison was made by simple percentage calculation andstatistical analysis, student’s t-test. Result: Knowledge of the doctors rose from average 37% to 74% after the lecture.Conclusion: Doctors need enhanced knowledge in oncology and simple lecturing can make an improvement
PROLONGED NEUROMUSCULAR BLOCKADE
Authors: ASGHAR SOHAIL , BOOTA MOHAMMAD
Published: September 2021

We are presenting a case of prolonged neuromuscular blockade afteremergency cesarean section. A 34 years old, young lady with no previous history of any systemic illness includingneuromuscular disorder reported in the operation t heatre for cesarean section. She was offered standard protocol forgeneral anaesthesia using thiopentone sodium i/v for induction, suxamethonium i/v for intubation, and pancuroniumbromide i/v for intra-operative relaxation. Intra-operative analgesia was obtained with nalbuphine i/v (after delivery ofchild). Ampicillin and gentamicin i/v were used as prophylactic antibiotics. The patient failed to regain spontaneousbreathing effort after a lapse of two hours since the last dose of pancuronium bromide. Laboratory investigationsincluding complete blood picture, urea, creatinine, electrolytes (calcium, sodium, potassium) revealed anemia andsevere hypocalcemia. She was given fresh whole blood and calcium gluconate intravenously, in addition to othersupportive measures like ventilatory support using SIMV mode of ventilation with 40% O2. Patient started regainingbreathing effort after about 12 hours and was extubated after about 15 hours of artificial ventilation with little residualneuromuscular blocking effect. She was kept in the ICU for the next 24 hours for observation and was discharged fromICU the next day with full recovery. Conclusion Patient probably suffered from the interaction between gentamicin andpancuronium bromide, that was further potentiated by hypocalcemia and anaemia. She was given supportive care alongwith replacement of calcium, and anaemia was corrected by fresh whole blood transfusion. Patient recovereduneventfully and was discharged from ICU the next day.
UTERINE TORSION IN TWIN PREGNANCY
Authors: MASOOD MUHAMMAD SAJJAD , QUDDUSI HUMA , AKHTAR MUHAMMAD SAMEE , DIN NASEER-UD-
Published: September 2021

A young married women in her 3rd ongoing pregnancy, having no alive issuepresented at 37+ weeks with labour pains. Cesarean section was planned because of twin pregnancy and past badobstetrical history. During operation, the uterus was found to have rotated to 180 degree to the right. A transverseincision was made on posterior wall of uterus to deliver babies. After suturing the incision site, the uterus wasrepositioned in right place. This paper presents a case of torsion of gravid uterus in which the delivery and repositioningof the uterus was successful.
CANCER PATIENTS
Authors: SABZWARI MOHAMMAD JAWAID , Riaz Muhammad , AHMAD MUKHTAR , Umair Muhammad , MAJEED MUHAMMAD TAHIR
Published: September 2021

In the world cancer is one of the leading causes of death. Most cancerswhen detected early, can be potentially cured. Thus early laboratory diagnosis of cancer has great importance inmanagement. The tumor markers are one of the methods of cancer management in use today. Objectives: Tocompare serum sialic acid (SA) and carcinoembryonic antigen (CEA) as tumor markers in different cancer patients.Study Design: Prospective study Setting: Shaikh Zayed Medical Complex, Lahore. Material and Methods: Onehundred and fifty three (153) documented different cancer patients were studied to compare between serum sialic acidand carcinoembryonic antigen as a tumor marker along with fifty controls of matched sex and age distribution between30-85 years. The sialic acid was estimated by colorimetric procedure and carcinoembryonic antigen by EnzymeImmunoassay. Results: The results revealed that mean levels of sialic acid and CEA in cancer patients weresignificantly higher (p<0.05) as compared to controls, considering all malignancies together, or carcinoma,hematological malignancies and sarcoma alone. Statistical analysis showed sialic acid to be more sensitive (p<0.05)than CEA in detection of cancer. Conclusion: Sialic acid was seen to be a good diagnostic indicator as compared toCEA in most cancer patients.
AUGMENTATION RHINOPLASTY
Authors: SAEED MUHAMMAD , MIAN FAROOQ AHMAD
Published: September 2021

To study merits and demerits of graft materials used for augmentation rhinoplasty.Design: Prospective. Settings: Study carried in the department of ENT Allied Hospital Faisalabad. Period: From Jan2001 to Dec 2002. Material and Method: The majority of patients were admitted through ENT out patient department.The data was collected on the basis of history, physical examination, investigations, photography, management andfollow up. Results: Total 30 patients 20 males (67%) and 10 females (33%). The majority of patients were from 3rddecade of life (53%). The duration of deformity in majority of patients was with in 2 years (73%). Majority of patientswere belonged to the lower class (60%). In many of the patients indication for augmentation rhinoplasty was cosmesis(100%). In 50% patients autologous iliac crest bone graft was used. The etiological factor for saddle deformity inmajority of cases was trauma (67%). The donors site morbidity was 32% as compared to other complications. Overallsuccess rate was 90%. Conclusion: The autologous cartilage has many advantages over autologous iliac crest bonegraft while performing augmentation rhinoplasty
HYPERTHYROIDISM
Authors: SULTAN MUHAMMAD , QAISAR MUHAMMAD ALI , AKHTAR M. SAEED
Published: September 2021

Objective: Thyroid eye disease presents a special challenge to the ophthalmologists withpathogenetic enigma & therapeutic dilemma. The objective of the study is to determine the frequency of mode ofophthalmic manifestation of thyrotoxicosis, rating of all components of “NOSPECS” classification system and todetermine the relative magnitude of low & high index orbitopathies. Design: Cross sectional study. Setting: Thedepartment of ophthalmology Allied Hospital / Punjab Medical College (PMC) & Punjab Institute of Nuclear medicine(PINUM) Faisalabad. Period: From 1 Apr 2004 to 31 st st March.2005. Material & Methods: 100 patients of all age &sex, after having diagnosed as thyrotoxic on the basis of positive laboratory investigations were subjected to a plannedocular examination according to the given protocol. An ophthalmopathy index scoring system was adopted to tabulatethe results. Results: Among 100 thyrotoxic patients, 72 were female & 28 were male with male to female ratio 1:26.The over all mean age was 36.59 ±13.81 years with 77 % of cases lying between 21-50 year of age. Orbitopathy wasfound in 74 % of thyrotoxic patients with relative distribution of eyelid retraction 56 %, soft tissue involvement 38 %,Proptoses 16%, restrictive myopathy 11%, corneal involvement 13 % and sight loss due to optic neuropathy 7 %. Thereis more occurrence of low index orbitopathy 83 % as compared to high index orbitopathy i.e 17 %. Conclusion: Theoccurrence of dysthyroid orbitopathy is not essentially present in all hyper thyroid patients. Only 3 out of 4 develop it.The frequency of manifestation of various eye lesions in descending order is eyelid retraction, soft tissue involvement,Proptosis, corneal involvement, myopathy & vision loss. Low index orbitopathy is more common & males are at morerisk of developing orbitopathy than females.
TYPE 2 DIABETICS
Authors: RANA MOHAMMAD MOHSIN , BASHIR MUHAMMAD BADAR , AKHTAR MUHAMMAD SAEED , Rehman Abaid-ur-
Published: September 2021

Introduction: The combination of hypertension, dyslipedemia, centralobesity with insulin resistance or hyperinsulinemia or glucose intolerance has been termed the "Metabolic Syndrome."This syndrome is a powerful determinant for cardiovascular disease. Presence of one risk factor mandates search forother factors. Hypertension and obesity and smoking are assessed clinically while Hyperglycemia and dyslipedemiaare detected by lab screening. Objective: To detect the other component of metabolic syndrome in type 2 diabetics.Design of study: Observational study. Setting: At Al-Shifa Metabolic Center, Faisalabad. Study Period: FromJanuary 2005 to June 2006 Materials And Methods: All patients with type2 diabetes mellitus were assessed forhypertension, central obesity and fasting serum cholesterol to define the different components of the MetabolicSyndrome. on diabetics presenting for routine consultancy. Results. A total of 8300 labeled type2 diabetics wereenrolled. Random blood sugar, blood pressure and central obesity by waist hip ratio were assessed and appointmentwas given for complimentary screening of fasting serum cholesterol and triglyceroid level. Only 2656 presented forscreening of lipids and only this group was evaluated further. 92% of patients were between 30-70 years of age. 8%were above the age of 70. There were 39% males and 61% females, 39% of diabetics had hypertension, 60% werecentrally obese, 69% had fasting serum cholesterol level above 150 mg/dL and 49% had fasting serum triglyceride levelabove 150mg/dl. Conclusion. Diabetes Mellitus, obesity, especially the central type, hypertension and dyslipedemiaare metabolically linked together. All of these are clustered together quiet frequently. These are well-established riskfactors for coronary heart disease, the major cause of mortality. Treating hyperglycemia alone in diabetics does notprotect coronaries. All of the risk factors shall be defined and treated together in every patient at risk of CHD. Treatingobesity is beneficial in glycemic, lipemic and hypertension control.
SCREENING FOR HEPATITIS B & C
Authors: HAIDER MUHAMMAD ZAHEER , Malik Aamir Mehmood , AHMAD NASEEM , Javed Mamoona , YASRAB MUHAMMAD
Published: September 2021

Viral hepatitis (HBV &HCV)one of the single most important cause of chronic liverdisease in Pakistan and World Wide is now spreadingbeyond endemic dimensions. Number of patients withhepatitis being received for elective and emergencyprocedures has increased tremendously. Thus healthcare providers especially operation theater staff hassignificantly increased risks of infectivity along withfurther transmission of the disease, if preoperativelyscreening and standard precautions are not followedstrictly. This makes the preoperative screening forhepatitis B & C one of the most important investigationsso that standard precautions can be taken to avoidfurther hazards of disease
CRIMEAN-CONGO HAEMORRHAGIC FEVER (CCHF) IN BALOCHISTAN
Authors: PIRKANI GHULAM SARWAR , JOGEZAI ESSA KHAN , ILYAS MANSOOR
Published: September 2021

Crimean-Congo Haemorrhagic Fever (CCHF) is a zoonotic disease causedby the bite of infected ticks, widely distributed in Asia and endemic in northern and western areas of Pakistan. InPakistan first human outbreak reported from Rawalpindi in 1976. In Balochistan first outbreak occured in 1987. Sincethan every year outbreaks of CCHF occur in northern parts of Balochistan. We are reporting our experience in detail,of these outbreaks and information about clinical picture, treatment and preventive measures for CCHF. cases
POLYCYSTIC KIDNEY DISEASE
Authors: MALIK MUHAMMAD AKRAM , IQBAL ZAHID , AHMED MUNIR
Published: September 2021

Objectives: (1) To document various clinical presentation of disease. (2) To assess family members.(3) To audit our experience of management of this disease. Study Design: Prospective study. Period: 01-01-2001to 31-12-2004. Material & Methods: All patients presented with ADPKD were included in the study. Detailed history,clinical examination was performed in each case. Pain was managed by NSAIDS and USG was done in each case.Urinary tract infection was treated with antibiotics according to culture sensitivity. Blood pressure was managed by ACEinhibitors. Stones were treated with URS, ±DJ stents and ESWL. Patients with ESRD were offered renal replacementtherapy in the form of haemodialysis and renal transplant. Results: Total number of patients was 19. Male 10 and 9Female. Age ranges from 32-65 years. Pain abdomen and flank was main presenting complaint in 95% patients. Fever& renal stones were present in 10(53%) and 08(42%) of patients respectively. Extra renal manifestations were presentin 02(11%) of patients. 06 patients progressed to ESRD. 03 patients died due to ESRD. Parents of 04 patients hadADPKD. Majority 10(52%) could not be evaluated. 06 Patients (21%) had their sisters and brothers involved withADPKD. DJ Stenting and ESWL was the only surgical management done. Conclusion: ADPKD is hereditary disorder.No cure is possible. Management of this disease by medication and surgery only slows the progress of renal failure.Counseling should be done to avoid cousin marriage in affected families. Chromosome analysis facilities should beavailable to affected families free of cost for early detection of disease.
COLD THYROID NODULE
Authors: WAQAR TARIQ , ALI NAWAB
Published: September 2021

Objectives: To determine the diagnostic potential of FNAC. Study Design:Comparative diagnostic procedure study. Place and Duration: Surgical outdoor and surgical unit-I Nishtar HospitalMultan during December 2003 to November 2004. Patients and Methods: Study was carried out on 50 patients ofeither sex, above the age of 15 years and who had cold thyroid nodule. These patients were subjected to FNAC. Thefindings of FNAC were adopted as a guide for their further management. Results: 50 patients, on FNAC 8 patients(16%) had cystic nodules, 30 patients (60%) had benign solid nodules, 4 patients (8%) had malignant disease while8 patients (16%) had cytology indeterminate or suspicious for malignancy. Out of 8 patients with cystic nodules, whichwere aspirated. Three patients had no recurrence while 5 patients who had blood stained aspirate had lobectomyfollowed by histopathology showing benign lesions. Out of 30 patients with benign solid nodule, 26 (88.88%) hadsurgery. Seventeen patients (65.4%) had lobectomy while 9 patients had STT. 12 patients having malignant andindeterminate or suspicious cytology had near-total thyroidectomy. Four patients proved to have papillary carcinomaand 2 patients folicular carcinoma, 3 patients had follicular adenoma and 3 had colloid nodular goiter. The diagnosticspecificity of FNAC in cold thyroid nodule in this study was 90%. There were 8% false positive and 0% false negativeresults. Conclusion: The fine needle aspiration cytology proved to be a reliable method for the preoperative diagnosisof cold thyroid nodule and better planning of their management.
NEODYMIUM: YAG;
Authors: NIAZI MUHAMMAD KHIZAR
Published: September 2021

Objective: To evaluate the incidence of posterior capsule opacificationafter phacoemulsification, between acrylic and polymethylmethacrylate intraocular lenses, by comparing their YAG lasercapsulotomy rates. Design: It was a randomized clinical trial. Place and duration of study: Department ofOphthalmology, Military Hospital Rawalpindi, between March 2002-04. Patients and Methods: One hundred and fivepatients were randomized to receive either a foldable acrylic lens (fifty-two cases), or rigid polymethylmethacrylate lens(fifty-three cases) following phacoemulsification for cataracts. Postoperatively their visual acuities were recorded alongwith the presence of posterior capsular opacification. Laser capsulotomy was performed if the eyes had lost 2 or morelines of visual acuity. Results: The visual acuity loss at six months in the PMMA group was greater than that in theacrylic group (p< 0.001,Chi-square test).65% cases exhibiting PCO in the Polymethylmethacrylate group developedit within the first six months, whereas in the acrylic group the development of posterior capsular opacification was seeneighteen months after surgery in 60% cases. Nd: YAG laser capsulotomy was performed in 28% of cases in the PMMAgroup compared to 6% in the AcrySof group (p < 0.005). Conclusion: Acrylic intraocular lenses is associated with lessincidence of posterior capsular opacification and with a significantly reduced rate of YAG laser capsulotomy comparedwith Polymethylmethacrylate lenses.
ADOLESCENT AGE GROUP
Authors: KHAKWANI MEHNAZ , TARIQ NABILA , ZAIDI HASAN IMRAN
Published: September 2021

Introduction: Puberty in girls is the phase of transition from childto mature woman. Menarche is the first menstrual period at puberty. The individual then becomes functionally capableof reproduction. Normally, it is a coherent process involving estrogen production, increased somatic growth anddevelopment of secondary sexual characteristics. Objective: To investigate the normal menstrual cycles and menstrualdisorders in adolescent age group. Study design: Population based survey. Setting: Study was conducted in thevarious schools of Multan city. Material and Methods: 500 school going girls. Results: The pattern of menstrualbleeding among Pakistani girls. Majority of the (i.e. 170 (34%) girls had normal pattern of bleeding. The day of heaviestflow was day 2 i.e. 292(49%) followed by day 1 i.e. 192(38.4%) of the cases. Menorrhagia as revealed by passage ofclots was present in 65(13%) of the cases. Majority of girls had their cycle duration between 28-30 days. More than85% of girls used home made pads during periods. Majority 156(48.4%) of girls had dysmenorrhoea for 1st and 2nd dayof the cycle. Dysmenorrhoea was found to be present in 322(64.4%) of the girls. About half of subjects developeddysmenorrhoea with the onset of menarche and about quarter started having dysmenorrhoea 3 months after menarche.Minority of the girls received education or information regarding periods prior to menarche. The majority was educatedeither with or after the menarche. Majority of subjects belonged to middle socio-economic status. Majority of girls hadregular periods since menarche. Majority of the remaining had irregular periods for sometimes due to anovulatorycycles which were spontaneously normalized. Those girls who had irregular periods, in majority of cases the irregularitywas corrected spontaneously after 3 months probably favouring earlier anovulatory cycles. Premenstrual symptomswere complained by 258(51.6%) of the girls. Majority 248(49.6%) of girls took menstruation as normal change of life.In majority 248(62.5%) of cases the mother and elder sister provided the information. Out of 500 girls, 397(79.4%) girlswere either informed or educated about periods.
EPIDURAL CATHETERS
Authors: TARAR HUMAYUN MUNIR , RAZA SHAUKAT , FARIDI MANZOOR AHMED , Raza Hasan
Published: September 2021

Objectives: 1) To determine if an alcoholic solution of 0.5% chlorhexidineis more effective than an aqueous solution of 10% povidone-iodine in reducing skin colonization associated with epiduralcatheter placement. 2) To determine the above two solutions is more effective in reducing epidural catheter tip bacterialcolonization. Design: Randomized observational study. Setting: Department of Anaesthesiology in Combined MilitaryHospital, Rawalpindi. Period: April 2001 to September 2001. Material and Methods: One hundred adults who wereplanned to receive epidural analgesia using epidural catheter for postoperative pain relief were randomly divided intotwo groups, one to receive an aqueous solution of 10% povidone iodine and the other to receive chlorhexidine ascutaneous antiseptic before catheter insertion. The insertion sites were cultured qualitatively just before epiduralcatheter removal. After their removal, the catheter tips were quantitatively cultured. Catheters were classified ascolonized when their tips yielded 1,000 or more colony forming units/ml in cultures. Results: A total of 100 patients wereincluded in the trial, 96 were evaluable. Overall among 96 catheters 32 catheter insertion sites showed positivebacteriological cultures, 20 in povidone iodine group and 12 in chlorhexidine group (p value 0.03). Cultures of cathetertips in the chlorhexidine group were significantly less to yield microorganism on removal (five events) than were cathetertips in the povidone iodine group (15 events ) p value 0.002. The bacterial species isolated from culture of catheter tipswere coagulase negative staphylococci in 19 cases and Enterococcus faecalis in one case. Six, out of the 20 catheterstips were considered as colonized, catheter colonization occurred less frequently when chlorhexidine was used for skinpreparation (1 events) than when povidone iodine was used (5 event) p value 0.001. Conclusion: An alcoholic solutionof 0.5% chlorhexidine is more effective than an aqueous solution of 10% povidone-iodine in reducing skin colonizationassociated with epidural catheter placement, moreover it is also more effective in reducing epidural catheter tip bacterialcolonization.
BLIND NASOTRACHEAL INTUBATION
Authors: CHEEMA ZAHID MEHMOOD , ZAKARIA MANZAR , MALIK NOMAN ALI
Published: September 2021

Objective: Blind Nasotracheal Intubation (BNI) can be undertaken aftermuscle relaxation with Inj. Succinylcholine or under deep inhalational anesthesia. The objective of study was todetermine the preferred one of these 2 techniques of BNI. Design: Prospective, randomized study. Place andDuration of Study: PNS SHIFA, Karachi and AFID, Rawalpindi from May 2002 to April 2005. Subjects and Methods:Sixty patients between 10 - 40 years of age presenting for elective surgery in whom BNI was required due to limitedor no mouth opening were enrolled through convenient sampling. Patients were randomly divided into two groups:WMR (n=30) or NMR (n=30) to undergo BNI after relaxation with Succinylcholine or under inhalational anesthesia with2% Halothane, respectively. A red rubber nasal endotracheal tube (cuffed and un cuffed in adults and childrenrespectively) was used. Results: The frequency of successful BNI in WMR group was 100% and significantly higher(P=0.03) than in the NMR group (86%). Time to succeed was significantly less in the WMR group 2±0.9 minutes versus3.4±2.0 in the NMR group. There was no statistically significant difference of occurrence of adverse events in the twogroups. Conclusion: BNI with Succinylcholine produced a higher success rate. This technique can decrease failureto intubate, we speculate that it may, therefore, increase patient safety.
RISK FACTORS ASSOCIATED WITH NEONATAL HYPOGLYCEMIA
Authors: LODHI MUNIR AKMAL , SHABBIR GHULAM , SHAH NASIR ALI
Published: September 2021

Objectives: Recurrent episodes of neonatal hypoglycemia are strongly associated with long termphysical and neuro-developmental deficits. (1) Moreover in neonates hypoglycemia can be overlooked as it may havenonspecific symptoms only. (2) This study was therefore carried out to analyse the risk factors associated with neonatalhypoglycemia and to evaluate the risk factors which have predictive value in its diagnosis. .Design: Based case controlstudy. Period: Six months from January 2005 to June 2005. Setting CMH Pano Aqil. Material and Methods: 385newborns were studied. Newborns of both civilians as well as military personnel were included in the study. 11newborns were excluded. Out of remaining 347 patients 101 were found to be hypoglycemia. Five risk factors (low birthweight, Birth Asphyxia, Neonatal sepsis, Meconeum aspiration syndrome delayed feeding ) strongly and independentlypredicated the risk of hypoglycemia. Results: The most common associated risk factor was low birth weight (47.47%)followed by delayed feeding (46.29%). Blood sampling for glucose estimation was done at birth / admission at 6 hours,12 hours, 24 hours and 48 hours. Test was initially performed by glucometer, the reading which were confirmed bylaboratory testing in border line case. Conclusions: In neonates with associated risk factors it is cost affective to carryout blood glucose levels at the time of birth and follow up readings taken as indicated by clinical progress later on.
ANEMIA DURING ANTENATAL PERIOD;
Authors: KHAN ZAHID MASOOD , SHOAIB MAHWISH , KHALID MAHWISH
Published: September 2021

Anemia is a common deficiency disorder in females of Pakistan during their reproductive bodies. Objectives: To evaluate anemia in pregnant women, to study prevalence type and management of anemia. Design: Prospective study. Setting; Jinnah Teaching Hospital Lahore. Period: From01.01.2004 to30.04 2004. Material & Method There were 100 females having two age groups 18-35 years and 36-50 years. Proper history with special emphasis on age, parity and symptoms were taken. Antenatal anemia was evaluated on the basis of history, clinical signs, symptoms and complete blood counts. Results: Iron deficiency anemia (80%) was found to be most common disorder. Urban and rural split depicts 60% and 40% respectively. The 25% subjected had mild anemia and 15% were asymptomatic. Standard treatment was advised according to severity of anemia. In country like Pakistan, Health Education is imperative and is necessarily needed to address this issue which is important for the outcome of any pregnancy.
PREGNANCY INDUCED HYPERTENSION;
Authors: ASLAM ADEEL , TALAT WASIMA , ASLAM ANEEL
Published: September 2021

Objective: To assess the stress response in severe pregnancy induced hypertensive patients on different drug regimen during preoperative and postoperative period. Sample size: 40 patients. Study Design: Comparative study. Place: CMH Kharian and WT Obgyne (Pvt) Ltd.Multan. Duration: June 2004 to January 2005. Patients and Methods: 40 patients of severe pregnancyinduced hypertensives were induced in this study. 20 patients were placed on a single standard antihypertensivei.e. alpha methyldopa and 20 were put on a combination of alpha methyldopa with long actingnifedipine or amlodipine. Both these groups underwent caesarean section. The stress response in both thesegroups was carefully analyzed and compared with a special note on any untoward effect on the mother orfetus. Results: The results from this trial clearly demonstrated that patients on combined drug therapyshowed better stress response during perioperative and postoperative period. Conclusion: In severe PIHpatients undergoing caesarean section good feto-maternal outcome was obtained on combinationantihypertensive drug therapy as compared to patients receiving single anti-hypertensive drug.
LATENT PULMONARY TUBERCULOSIS
Authors: SHIRAZ MOHAMMAD ATIF , KHAN ABDULLAH
Published: September 2021

Objective: To assess the prevalence of latent pulmonary tuberculosis (TB) in young adults males on MMR screening. Design: Descriptive study Place and duration of study: The study was carried out at Combined Military Hospital Kohat from January 2004 to August 2005. Material and Methods: A total of 4000 freshly inducted recruits aged between 18-23 years were subjected to MMR using an Odalka camera. Individuals with suspicious findings had a standard chest radiograph taken and on confirmation of findings they were inoculated with tuberculin and readings of Mantoux test were recorded. Results: Out of 4000 MMR films, 2.15% were judged suspicious and standard chest radiographs were taken. 1.2% showedfeatures suggestive of pulmonary TB. 0.175% showed non-tuberculous pulmonary findings and 0.05% showed cardiac lesions. 0.725 % chest radiographs were normal. 1.2 % suspected cases of pulmonary TB were investigated further with Mantoux test. 0.745% had strongly positive Mantoux test and were labeled as latent pulmonary TB. Conclusions: Pulmonary TB is a major health issue in our country. There is a highprevalence of latent pulmonary TB in our asymptomatic adult population. MMR is an effective and cheap method of early detection and should be considered for mass screening of our younger population on a larger scale.