bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous aspirin administration in patients of myocardial infraction during their hospital stay - a clinic audit
Authors: Ali Hammad , Ali Ahmed
Published: June 2016

This audit was performed to check whether all patients suffering from myocardial infarction have received aspirin in dose of 160 - 325 mg during their stay in the medical ward in Mayo hospital Lahore. Objectives: The audit was performed to assess the application of ACC/AHA guidelines for management of patients with acute MI regarding administration of aspirin in a dose of 160-325 mg daily during their stay in the hospital. Criteria of audit: A dose of 160-325 mg of aspirin should be continued indefinitely daily after an attack of MI7. Standard of audit: All patients who have been diagnosed to have acute myocardial infarction should receive 160- 325 mg of aspirin daily during hospital stay and continuously thereafter. Material and methods: A retrospective audit was conducted in medical ward in Mayo hospital, Lahore in which notes of patients who were admitted with a diagnosis of acute myocardial infarction from 1st Jan 2005 to 31st August 2005 were studied. Results: We found that patients included in this audit had a mean age of 56 years +/- 13.55 out of which 45 patients 84% were discharged, 2% were discharged on request, 4 % were shifted to CCU, 6% left against medical advice and 2% expired. We found out that out of 45 cases only 24.4 % of cases were given aspirin in the recommended dose of 160- 325 mg daily, 40 % of patients received only 75 mg aspirin daily, while 33.3 % of them got 150mg daily and 2.2 % of patients did not receive aspirin during their stay in the hospital.
Third nerve paralysis due to cranial metastasis of prostate tumor
Authors: Qamar Rao Muhammad Rashad , Mansoor Qasim , T Majeed
Published: June 2016

A 90 years old man presented with outward deviated right eye with droopy lid. These symptoms were developed over a period of two weeks and there was no pain behind the eye. There was no previous history of Diabetes mellitus, hypertension etc. He had a treatment for adenocarcinoma of prostate six years ago. On examination his best-corrected visual acuity was 6/60 in each eye. There was right complete third nerve paralysis with pupil involvement. Anterior segment examination showed nucleosclerotic changes on both sides. Posterior segment examination showed ARMD (dry type) in both eyes. Intraocular pressure and discs were normal. Contrast enhanced MR scan brain revealed a destructive mass at the base of skull at petrous apex on the right side extending forward to orbital apex on the same side. Total body bone scan also showed multiple metastatic lesions. Patient was referred to oncology unit for further management
Difficulties encountered at Cesarean section
Authors: Nisa. Meherun
Published: June 2016

Objective: To evaluate common difficulties encountered by the trainee registrars at C/Section. Design: An observational study. Place and Duration of Study: The Department of Gynae and Obstetrics Unit-II SIMS/Services Hospital, Lahore from 16th February to 16th September 2005. Patients and methods: One hundred cases of C/Section both emergency and elective were included. Almost all were done by trainee registrars and supervised by Senior Registrars. Common difficulties faced by trainees at C/Section were noted. Results: Out of 100, 59 were elective and 41 were emergency C/Sections. All were lower uterine segment C/Sections done on term or near term pregnancies. The commonest indication was previous scar (69) while 31 were primary C/Sections. The major problems encountered included difficulty to approach lower uterine segment due to adhesions formation (45), difficulty in delivering the baby from uterus (39) and the problem faced while securing haemostasis (31). One problem not directly related to C/Section noted was pricks to the surgeons in Hepatitis B & C positive patients. Three cases were noted leading to frustration and depression in the involved doctors.
Day case Laparoscopic Cholecystectomy
Authors: Rathore Munir Ahmad , Mansha Muhammad , M G Brown
Published: June 2016

Background: Day case laparoscopic cholecystectomy (DC-LC) is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the initial experience of DC-LC at the unit. Patients & methods: Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis (pneumatic compression and enoxaparin), per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up (86% overall). Results: Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 43y. There were two conversions. The direct admission rate (DAR) was 26/164 (14%). The indication for direct admission included observation alone (7/26), wound pain (6/26), nausea (3/26), suction drain (2/26) and operation in the afternoon (2/26). Six (3.6%) required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and anot her with an injury to CBD. One had post-op mild pancreatitis and three had wound pain and bruising. Conclusion DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis
Prevalence of risk factors of primary 3rd degree malnutrition in children under 5 years of age; admitted in Services Hospital, Lahore
Authors: Rana Muhammad Nasir , Kazi Muhammad Yaqoob , Nasir Ambreen , Hussain Amjad
Published: June 2016

Objective: To determine the prevalence of risk factors of primary 3rd degree malnutrition in children under 5 years of age. Design: Hospital based descriptive study. Place & duration of study: Department of Pediatrics, SIMS/Services Hospital, Lahore, from July 2005 to December 2005. Materials and methods: A total of 200 children were included in study, from 2 months to 5 years of age. All had 3rd degree malnutrition according to modified Gomez Classification. Risk factors included were; Fresh (Cow) milk feeding, mixed feeding, delayed weaning, more than 2 children under 5, large family size (>5 children), partial vaccination, no vaccination, working mother, un-employed factors, twin delivery. Results: Risk factors identified were as follows: Mixed feeding 85.5% (n=171), more than 2 children under 5 was 84.5% (n=169), delayed weaning 74% (n=148), only fresh milk 70% (n=140), large family size (>5 children) 69% (n=138), partial vaccination 66.5% (n=133), working mother 24% (n=48), unemployed father 13.5% (n=27) and twin deliveries 3.5% (n=7). Conclusion: Most of the risk factors are preventable just by counseling and motivation o f parents. Malnutrition can be avoided without causing financial burden on family.
Primary post partum hemorrhage after vaginal birth: an analysis of risk factors
Authors: Akhtar Yasmeen , Chohan Mohammad Arshad
Published: June 2016

Objective: - To analyze the risk factors for primary post partum Haemorrhage. Settings: - Gynae/Obstetrics-Unit I Lady Willingdon Hospital Lahore. Study Design: - Observational Analytical study. Duration: - One year Ist January 2005 to 31 December 2005. Materials/Methods:-It was an observational analytical study in which the data about patients was collected with the help of proformas. Conclusion:- Uterine atony due to various underlying risk factors is the major cause of post partum Haemorrhage. If these factors are identified and treated accordingly then a lot of mothers can be saved.
Peripartum cardiomyopathy presenting to cardiology department of Mayo Hospital, Lahore
Authors: Muhammad Zil , Nadeem Muhammad Arif , Hussain Irshad
Published: June 2016

Cardiac failure occurring in last trimester of pregnancy or within one to six months after delivery in a woman without a history of heart disease and with no cause for heart failure other than pregnancy is termed as peripartum cardiomyopathy. To determine fetomaternal morbidity and mortality in women presenting with peripartum cardiomyopathy, we did an open non-randomized observational descriptive study at Department of Cardiology Mayo Hospital, Lahore from January 2004 to Oct 2005. The women referred from Lady Willingdon and Lady Aitchison Hospitals to Cardiology Department of Mayo Hospital during last trimester and after delivery for work up of heart failure were included. Twenty five women presented with heart failure due to peripartum cardiomyopathy were included in this study, 40% in last trimester, 40% within one month and 20% within 4 month after delivery. The mean age was 35 + 5 years. Out of these 2 (8%) were primiparous, 13 (52%) were multiparous and 10 (40%) were grandmultipara. Ten (40%) were booked and 15 (60%) were nonbooked for antenatal care. Twenty (40%) patients were diagnosed for the first time and 5 (20%) had recurrence. Based on NYHA classification 20% were in class I, 40% class II, 20% class III and 20% in class IV. The patients were on standard medical treatment. All patients reviewed at follow up after 1, 6, and 12 months. No maternal mortality occurred. Antenatal ward admission was required for 32% women due to obstetric reasons and 8% due to cardiac cause. Five had spontaneous labor and 5 inductions were done for obstetric reasons: poor biophysical profile, previous caesarean section, uncontrolled diabetes, breech presentation and fetal distress. Three babies have intrauterine growth retardation. On echocardiography mean ejection fraction was 20-25% with global hypokinesia, 5 patients had clot in LV apex, 10 had whiff of mitral regurgitation and tricuspid regurgitation. We conclude that peripartum cardiomyopathy has high morbidity and mortality. Women are very much receptive about c ontraception in the immediate post partum period, therefore counseling of the patient and their family should be done to reduce maternal mortality.
Complications of Streptokinase during infusion in acute myocardial infarction
Authors: Bilal Haroon , Niaz Zafar , Shah Zahid Hussain , Razzaq Anjum , Ahsen Waseem , Saleem Asim , Hasan Mumtaz
Published: June 2016

Background: Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Material & Methods: Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Study design: Comparative / interventional Results: Post SK changes in blood pressure were significant (p= 0.011). There was post SK hypotension in 48 (24%) and post SK hypertension in 20 (10%) patients. Allergic reaction was present in 4 (2%) only (p=0.044). Arrhythmias were significantly less prominent in SK group (p=0.000). Post SK bleeding occurred in 3 (1.5%) only (p=0.082). 37 patients died (18.5%) in total, out of which 5 (2.55) patients died in SK group and 32 in control group (p=0.000). CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan (p= 0.31). Conclusions: Early administration of SK lowers in-hospital mortality (p= 0.00 0). Major complications during SK therapy are Hypotension (p= 0.011), Arrhythmias (p= 0.000), Allergic reactions (p= 0.044)
Common determinants of Ca breast - a case control study in Lahore
Authors: Mahmood Shahid , Rana Tasneem Fatima , Ahmad Maaz
Published: June 2016

Background Ca breast is commonest malignancy in females all over the world and 2nd leading cause of death in females. In Pakistan, it is more common in young age (incidence in 30-39 years) contrary to west (over 65years). Genetics ,use of oral hormonal contraceptives, prolonged hormonal replacement therapy, environmental hazards and parity are also considered to play an important role in causation of ca. breast .This morbidity pattern of young age in Pakistan is a real concern for the health care planners and providers. Objectives:-To know the etiological factors in the area, to formulate a public awareness programme for reduction in mortality and morbidity due to breast cancer in Pakistan Study design:-Case Control Study. Place and duration of the study: - Mayo and INMOL hospitals. Jan-June, 2005.Respondants and methods:-Pre- tested questionnaire was used to interview the cases and control groups Results:-Ca breast is significantly more in married, young age, with 3 or more children, breast feeding moth ers. Conclusion: - Early marriages environmental hazards, genetic predisposition and hormonal imbalance are the most important suspected causes. Cancer awareness and screening programme with community participation are the best feasible approaches for rectification of the situation.
Acute Epididymo-orchitis - is empirical therapy for chlamydia trachomatis justified?
Authors: Khan Muhammad Safdar , Farroq Muhammad , Qayyum Arif , Mannan Abdul , Tasneem Riaz A
Published: June 2016

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20`s. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 (43%) patients and in only 12 (14%) of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis.
Prevalence of pre-menstrual syndrome in young girls
Authors: Akmal Noreen , Akhtar Naseem , Raana Gul E , Attique Rubina
Published: June 2016

Prevalence of pre-menstrual syndrome(PMS) was determined in 100 girls in age group 16-22 years, belonging to a medical college. Out of total 66.66% had PMS. Major complaints were aches & pains, pre-menstrual dysmenorrhoea and mood swings.
Assessment of diastolic dysfunction in hypertensive patients and its association with left ventricular mass index
Authors: Siddique Tahir , B Sulehria S , Javed Fauzia , Qureshi Irshad Hussain , Riaz Muhammad Kashif
Published: June 2016

Objective: Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. Place of Study: East Medical and Cardiology wards of Mayo Hospital Lahore. Study Design: A descriptive cross-sectional study. Patients and Methods: 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students `t` tests. Results: The percentage of left ventricular hypertrophy (LVH) was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. Conclusion: 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age.
Chemical composition of urinary stones in Rahim Yar Khan and adjacent districts of Sindh and Baluchistan
Authors: Hakeem Abdul , Tariq Muhammad , Bari Mehboob , Abbas Muhammad Hassan , Anwar Muhammad
Published: June 2016

Aim: To find out the constituents of the urinary stones, so that preventive measures would be taken against recurrence. Patients and methods: A total No. of 200 consecutive patients with upper urinary tract calculi, that were operated in the urology and general surgical wards of Sh. Zayed Hospital Rahim Yar Khan were included in the study. In addition to Rahim Yar Khan the patients also came from adjacent districts of Sindh and Baluchistan. Qualitative Chemical analysis was carried out using Merchognost (Germany) urinary calculi analysis kit. All the tests were performed according to the instruction of manufacturers of the kit. Results: Stone samples were collected from 200 patients, out of these 138 (69%) were male and 62 (31%) of patients were female with male to female ratio 2.2:1 age range was between 9-72 years. Results of stone analysis indicate that calcium oxalate is the most common ingredient found in 100% of the stone samples. In 83% of patients it was found mixed with other varieties of stones while in 17% samples it was seen in pure form. Uric acid was the second most common ingredient seen in 73% of patients mixe d with calcium oxalate and magnesium ammonium phosphate but it was not found as pure form. Magnesium Ammonium phosphate found in 13% of stones samples in mixed form only, not as isolated stone.
Surgical management of pericardial diseases
Authors: Bilal Aamir , M Salim , Nishtar Salman , Nishtar Tahira , Nabi Muhammad Shoaib , Majeed Farhan , S Hassan
Published: June 2016

Tuberculosis and purulent pericarditis are the most common causes of pericardial effusion and constriction. Chronic constrictive pericarditis is a chronic inflammatory process that involves both fibrous and serous layers of the pericardium and leads to pericardial thickening and compression of the ventricles. The resultant impairment in diastolic filling reduces cardiac function. Pericardiectomy remains the treatment of choice for chronic constriction. A review of 72 cases at department of Cardiothoracic Surgery, Lady Reading Hospital is presented. There was a mortality of 12% and a morbidity of 20%. Forty seven of the 72 cases were tuberculous. The surgical excision of pericardium remains the only available curative treatment for constrictive pericarditis, while open pericardial drainage is required for cardiac tamponade resulting from pericardial effusion.
Frequency of Hepatitis C in admitted patients of Department of Obstetrics & Gynaecology, Ghurki Trust Teaching Hospital, Lahore
Authors: Akhtar Ambreen , Talib Waseem , Shami Nabeela , Anwar Shaila
Published: June 2016

Objective: To assess the frequency of hepatitis C in admitted patients of department of obstetrics and gynaecology Ghurki trust teaching hospital, Lahore. Design: Descriptive study Place and duration of study: This study was conducted on patients admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore from 1st January 2005 to 31st December 2005. Patients and methods: A total of 1569 patients of age between 20 to 70 years were admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore and were screened for anti-HCV antibodies by 3rd generation ELISA. All positive patients were asked about previous history of jaundice, surgery, blood transfusion, multiple injections and dental procedures. Results: Out of 1569 patients 107 were found to be anti-HCV positive. Mean age of patients was 34.5 years. Frequency of anti-HCV was maximum (38.3%) in 31-40 years age group and in gynaecology patients (12.5%). Previous history of multiple injections and dai handling were the most commonly associated factors. Co-existent hepatitis B and C was found in only 2 (1.8%) patients. Conclusion: Hepatitis C is becoming an alarmingly common problem in the area of Ghurki Trust Teaching Hospital, Lahore. Its modes of transmission need to be properly evaluated for its control and prevention.
Maternal (oral) hydration increases amniotic fluid volume
Authors: Umber Aneela
Published: June 2016

Objective:To determine the effect of maternal (oral) hydration on amniotic fluid volume in patients with third trimester oligohydramnios. Design: Interventional study. Place and Duration of Study: Department of Obs & Gynae Unit III, Sir Ganga Ram Hospital, Lahore from May 2002 to October 2002. Patients and Methods: Twenty five women with third trimester oligohydramnios (AFI ?5.0cm) and twenty five controls with normal amniotic fluid volume (AFI 8-24 cm) were prospectively recruited for this study. Maternal urine specific gravity and amniotic fluid index were determined before and after maternal hydration by asking them to drink 2 L of water in 2-4 hours before repeat amniotic fluid index and recorded on printed proformas. Results: Hydration increased amniotic fluid volume in women with oligohydramnios (mean change in amniotic fluid index 4.3 cm, 95% confidence interval 4.02 to 5.06; P value <0.001); as well as in women with normal fluid volume (mean change in Amniotic fluid index 2.7 cm, 95% confidence interval 2.23 to 3.21; P value <0.01). However, percentage increase in mean AFI was 58.6% in the oligohydramnios group, which was significantly greater (P value <0.05) than the percentage increase of 28.4% in control group. Hydration was associated with decrease in urine specific gravity in both groups. Conclusion: Maternal (oral) hydration increases AFV in women with oligohydramnios as well as in women with normal AFV and may be beneficial in the management of oligohydramnios.
A study of complications related with colostomy closure
Authors: Haq Anwarul , Butt Hasnat Ahmad , Ahmad Ashfaq
Published: June 2016

Objective: To determine the complications associated with colostomy closure following a suggested protocol and then compare the incidence with recent reported literature and to suggest measures for reduction of morbidity and mortality associated with colostomy closure. Study design: This study is based on a review of all the patients undergoing colostomy closure from August 1995 to September 1997 in East Surgical Ward, Mayo Hospital, Lahore. Material and methods: This prospective clinical study was carried out in the East Surgical Ward, Mayo Hospital, Lahore. A total of 32 patients belong to either sex who underwent colostomy closure following emergency colostomy were included in this study. Patients under 12 years of age were not included as these were managed in Paediatric Surgery Department of Mayo Hospital, Lahore. Time interval between construction and closure of colostomy was three months and all the patients were fit for anaesthesia. Pre-operative barium enema was done prior to admission to check a ny distal pathology like stricture or leakage. In only two cases strictures were found, and these patients were excluded from study. All patients were admitted through the outpatient department three days before operation, and a special proforma was filled for each patient. A detailed history was taken to find the time and indication for colostomy. A short note was made about the state of other injuries and site of colostomy. A thorough examination was performed to find the state of colostomy, type of colostomy and fitness of the patient. Results: A total of 32 patients were included in this study. Of these 26(81.2%) were male and 6 (18.7%) patients were female. 21(65.6%) were with loop colostomy, 7(21.8%) end colostomy with mucus fistula and 4(12.5%) were with end colostomy with Hartmann`s pouch. Penetrating injury of the colons is the most common etiology for colostomy at the initial operation. 15(46.8%) were made in the transverse colon, 13(40.6%) were made in the left colon and 4(12.5%) were made in the right colon. Conclusion: It has been concluded in this study that the most common indication for colostomy construction in Pakistan is the penetrating injury of abdomen. Young males are more commonly suffered from firearm injuries of abdomen. Loopogram should be done before colostomy closure especially in non-traumatic cases.
Pattern of injuries in trauma patients presenting in Accident and Emergency Department of Jinnah Hospital, Lahore
Authors: Ali Kamran , Arain Ghulam Mustafa , Masood Ahmad Sohail , M Aslam
Published: June 2016

Objective: To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. Design: A prospective descriptive epidemiological study. Place and duration of study: Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. Subjects and methods: The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head & neck, thorax and perineum. Then frequency of different types of trauma was determined. Results: During this period (1st April2005 to 30th September 2005), 111`413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients (30%) had blunt trauma, 134(2.86%) had penetrating firearms injury, 2433(51.99%) had penetrating sharp injury an d 709 patients (15.15%) had crush injury. Most patients got upper limb, lower limb, head & neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients (71.36%) got only minor surgery like stitching under local anaesthesia and 468 patients (10%) had no surgery at all. 872 patients (18.63%) underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Conclusion: Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies.
Octreotride in acute pancreatitis - have it or not?
Authors: Rafi Yaseen , Akram Behzad , Saqib Mudassara , Muhammad Ghulam , Muhammad Yar
Published: June 2016

The study was conducted in the Department of Surgery, Mayo Hospital, Lahore from March 2003 to January 2006. The objective of the study was to see the beneficial effects of Octreotride in acute pancreatitis. Thirty five patients who were diagnosed as acute pancreatitis were divided in two groups. In group A (controlled) Octreotride was given in a dose of 100?gm t.i.d subcutaneously for 7-10 days along with other measures. In group B (uncontrolled) patient were managed without Octreotride. Patients were evaluated in terms of abscess formation, haemorrhage, pseudocyst formation and mortality or uneventful recovery in both groups. No beneficial effect of Octreotride was observed in controlled group as compared to uncontrolled group. So we don`t recommend the routine use of Octreotride in patients with acute pancreatitis.
Comparison of Snodgross and para-meatal based flap technique for hypospadiasis
Authors: S A H Jaffry , Iqbal Naveed , Nazir Muhammad , Tarrar Khuda Dad
Published: June 2016

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.
Post thyroidectomy hypocalcaemia - an audit of 100 cases
Authors: Ahmad Ashfaq , Khan Hassan Muhammad , Chaudhry Nadia , Qureshi Ahmad Uzair , T A Shah
Published: June 2016

Purpose of our study is to compare the incidence of hypocalcaemia after total, near total or subtotal thyroidectomy for benign multinodular goitre. One hundred consecutive thyroidectomies performed for euthyroid benign multinodular goitre at West surgical unit, Mayo hospital, Lahore Pakistan, were included in the study. Mean age of patients was 33 (range 14 to 60) years. Preoperative serum calcium level ranged from 7.7 to 10.0 with an average of 8.8mg/dl. 34 patients had total thyroidectomy, 31 had near total thyroidectomy, 28 had subtotal thyroidectomy and 7 had lobectomy & isthmusectomy. Consultants performed 46 thyroidectomies, while senior registrars and residents performed 52 and 2 thyroidectomies respectively. 28 patients developed clinical features of hypocalcaemia.8 out of 31 patients who had near total thyroidectomy developed hypocalcaemia (25.8%). Out of 34 total thyroidectomies, 11 patients had hypocalcaemia (32.3%). In 28 patients who had subtotal thyroidectomy, 7 developed hypocalcaemia (25%) . 2 out of 7 lobectomy & isthmusectomy patients also required treatment for hypocalcaemia (28.5%). Hypocalcaemia developed within 48 hours of surgery in 53% of our patients. Incidence of hypocalcaemia among patients operated by consultants was 23.9 % (11 out of 46), while among patients operated by senior registrars and residents 17 out of 54 developed hypocalcaemia i.e. 31.5%. Average postoperative duration of hospital stay was 5.42 days in hypocalcaemic patients (range 2-17 days) and it was 2.77 days in normocalcaemic patients (range 1-6 days). We conclude that post thyroidectomy hypocalcaemia is a complication with significant morbidity. The incidence of this complication can be reduced by meticulous surgical technique with special emphasis on haemostasis. Identification and preservation of well vascularized parathyroid glands must be attempted in every thyroidectomy.
Comparison of maternal complication in elective vs. emergency Cesarean section
Authors: Ashraf Razia , Gul Asma , Bashir , Aliya , Tajammal Arif
Published: June 2016

Objective: To compare the maternal complication in elective vs emergency caesarean section. Design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Lahore General Hospital, Lahore Patients and methods: The study was conducted from August 2004 to August 2005. During this period all women underwent elective or emergency caesarean section included. Results: A total of 920 caesarean sections were performed, 770 were emergency and 150 were elective. Intraoperative and postoperative complications were 76, 70 in emergency and 6 in elective group. Postoperative complications were 120, 110 in emergency and 10 in elective cases. Conclusion: In emergency caesarean section maternal mortality and morbidity is high.
Changes in O2 saturation during inhalational induction of anesthesia in children - a comparison between halothane & isoflurane
Authors: M Younas , Zia Ashraf , Ch Tahir , Hussain Riaz , Galani Tafoorul Islam
Published: June 2016

Objective: To study the change in O2 saturation during induction of anaesthesia in children. A comparison between Halothane and Isoflurane. Study design: Prospective comparative study. Place and duration of study: Department of anaesthesia Services Hospital Lahore. Patient and methods: This study was conducted in 2004 on 70 children irrespective of sex age range 1-10 year. Results: A total 70 children were studied 35 in each group. The result showed that halothane is a better inhalational induction agent then isoflurane. Conclusion: Halothane is better than isoflurane for inhalational induction in children.
Hepatic trauma: effects of delay in presentation
Authors: Butt Hasnat Ahmad , Zahur Saquib , Haq Anwar Ul
Published: June 2016

Objective: Hepatic trauma carries a substantial amount of morbidity & mortality. Purpose of study: The purpose of the study is to study the effects of delay in initiation of management of patients suffering from hepatic trauma. Design: Prospective study. Place & duration: The study was carried out in the Department of Surgery, Mayo Hospital Lahore from the year 1995-1997. Patient & methods: 57 patients were included in this study. They were operated and different methods of repair were employed. Results: 57 patients were studied. 50 were males, 7 were females. They belonged to an age range of 12-62 years. 55.7% patients suffered from blunt trauma while the rest of the cases were of penetrating injury. Over 50% of the patients presented within 4 hours of injury. All of the patients were operated and there findings noted. Different types of haemostatic measure were employed. There were ten mortalities in this study. Conclusions: Early presentation to the hospital of hepatic trauma cases, has a good impact o n the ultimate outcome of the patients.
Positive viral markers of hepatitis B+C in patients admitted in medical ward for different diseases
Authors: Mehboob Fatima , Masud Shahroona , Yar Malik Hafiz Muhammad
Published: June 2016

Background:-A retrospective observational study held in Medical Ward of Sheikh Zayed Hospital Rahim Yar Khan. Object: To look for positive viral markers of Hepatitis B+C as a coincidental finding in patients admitted in Medical Ward for diseases other than the acute or chronic liver problem. Methods: The investigation record of patients admitted from 1st January to 30th April 2006 was thoroughly analyzed and picked up those cases which were incidentally discovered as HBs Ag and anti HCV positive. Results: Patients were categorized as HCV +ve, HBs Ag +ve both +ve and both negative and their significance was determined by SPSS. Conclusion: Coincidence of Hepatitis B and C in admitted cases indicates that the problem is widespread in the community and the screening facilities must be provided at lower levels to start timely management.
Esophageal dilatation as palliation for irresectable carcinoma esophagus
Authors: Nadeem Asif , Bilal Aamir , Nabi Muhammad Shoaib , Aslam Viqar , Afridi Kamal , Hussain Shafqat
Published: June 2016

Background: The primary therapeutic goals in patients with advanced oesophageal malignancy are the re-introduction of an enteral diet and early discharge. The endoscopic dilation has been proposed as an alternative technique for palliation in patients not suitable for surgery. Aim: To review our experience with oesophageal dilation for the palliation of malignant oesphageal obstruction. Methodology: A retrospective review was conducted of the notes of all patients who underwent palliative oesophageal dilation in our unit. Result: 100 patients (age range 30-90years) underwent oesophageal dilation for malignant oesophageal obstruction 48% of patients had obstruction at lower one third of esophagus. Median survival was 6 weeks (range 1week to 03 months). Successful dilation was possible in 70% of cases. During follow up 20% returned to solid diet, 50% required a soft diet and 30% were unable to tolerate any enteral nutrition. Conclusion: The use of oesophageal dilation achieves, good palliation allowing earl y discharge from hospital, re-introduction of an enteral diet.
Vesico vaginal fistula: prevention is possible
Authors: Khanum Zohra , Akram Humaira
Published: June 2016

A prospective study was conducted at Lady Willingdon hospital Lahore from Jan,2002 to Dec, 2004. During the mentioned period 22 patients were admitted with the diagnosis of urinary tract fistula. Among these most of the patients (i.e, 45%) were young belonging to age group 20-30 years. According to the causes 72 % were due to obstetrical causes, 23% due to surgical causes and 5 % were due to malignant. Regarding to the location of the fistula 14% were juxtauretheral,28% low vaginal, 35% mid vaginal,09% high vaginal and 14% were vault fistulae.Out of 22 patients first surgical repair failure occurred in four patients.
Medical and socioeconomic aspects of road traffic accidents
Authors: Afridi Hakim Khan , Khichi Zawar H , Aziz Khalid
Published: June 2016

Road traffic accidents leave medical and social repercussions on families and individuals involved. Moreover, it is saddening that the most vulnerable are from the youth and middle age groups. This deprives the society of much needed and precious human resources. Hence, the mean which was originally designed to serve mankind has become a means of destruction, cause of disability and sometimes death. The medical profession has to assume a key role not only in the management of the injured, but also in the prevention of accidents and road safety measures. In order to reduce the incidence of road accidents it is important to establish an efficient organizational set-up, highlight the role of mass-transit, periodic checkup of the vehicle for its road worthiness and education of masses with the hope that they will adhere to the rules while on road.
Colonic injuries; is primary repair a safe option?
Authors: Khan Intesarur Rashid , Irshad Khalid , Shafiq Muhammad Akmal , Khan Bahzad Akram , Cuahdhry Abdul Majeed
Published: June 2016

Objectives: This study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of large gut injuries .Materials and methods: :80 patients, presenting in emergency between Jan. 2004 and December 2005, were selected out of which 63 were males and 17 were females. Colonic injuries were divided into five categories and were dealt accordingly. Inclusion criteria: All colonic injuries presenting to emergency in study period except. Exclusion criteria: Injuries requiring ileocolic anastomosis, repair and proximal fecal diversion and distal colonic injuries requiring Hartmann`s procedure.
Association and Outcome of the Primary Repair of Obstetric Perineal Injuries
Authors: Saba Naseem , Sultana Anwar , Afridi Mehnaz
Published: June 2016

Objectives: To study the association and outcome of the primary repair obstetric perineal injures. Design:  Cross sectional study. Methods:  Patients presenting with third and fourth degree tears were included, factors associated with injures were studied. Primary repair was performed and outcome was looked after three months of repair. Results:  Sixty Four (64) patients were studied in 18 months 59% were having their first pregnancy. Instrumental deliveries an macrosomia are strong associations. Primary repair with end to end approximation was done which was successful. Conclusion:  Prevention is important Mediolateral episiotomy and skill of instrumental deliveries can minimize the risk of obstetrics perineal injures. Key Words:  erineal tears, feacal incontinence, instrumental deliveries, mediolateral episiotomy.
Etiology, Presentation and Management of Liver Abscesses at the Children’s Hospital Lahore
Authors: Cheema Huma Arshad , Saeed Anjum
Published: June 2016

Background:  Liver abscess is a common problem among children. The purpose of this study is to describe the etiology, different management strategies and outcome of children with liver abscess in Children’s Hospital Lahore. Patients and Methods:  This study included 38 children with liver abscess seen during two-year period, from September 2004 to September 2006 at the Children’s Hospital and Institute of Child Health, Lahore. Diagnosis was made on history, examination and investigations. Ultrasound and CT scan were the main diagnostic tools. Results:  Out of 38 patients, 33 children underwent aspiration and remaining 5 were managed conservatively.  Eight aspirates yielded positive culture for various organisms. Three patients were positive for E.Coli, 2 for Staph Aureus, and 1 each case of Klebsiella and Pseudomonas. One patient had multiple micro-abscesses and was also positive for typhidot IgM. Another patient was positive for acid fast mycobacterium tuberculosis. All patients recovered from their abscesses. There was no mortality reported. Conclusions:  In our pediatric population, liver abscess are mostly caused by pyogenic organisms. Amebic etiology was not proven in any case. Majority of liver abscesses can be satisfactorily treated by aspiration and /or percutaneous image guided drainage with satisfactory outcome. Key Words:  Liver abscess, children.
Seroprevalence of Surrogate Markers for Hepatitis B, Hepatitis C and HIV in Healthy Blood Donors at Shaikh Zayed Medical Complex, Lahore
Authors: Shah Shahida Amjed Riaz , Ehsan Ayesha
Published: June 2016

Introduction: This project was aimed to determine the seropositivity status for Hepatitis B surface antigen (HBsAg), antiHepatitis C (HCV) antibodies and antibodies to Human Immune Deficiency Virus (HIV) I and II in healthy blood donorsdonating blood at Shaikh Zayed Hospital Lahore.Material and Methods: The relevant data was collected during a period of 28 months from 1st January 2006 till 31st March2008. It was a cross sectional study which entailed screening of 60719 healthy donors. The donors were aged between 16years to 45 years. There were 93.43% males and 6.57% females.Results: The seroprevalence of Anti HCV antibodies was 3.870%; for HBsAg it was 1.407%; for HIV antibodies it was0.00658%. Our study demonstrated a higher seropositivity for HIV in healthy donor population than all of the previousreports except one with which it matched precisely. HBsAg showed a definite downwards inclination when compared withsimilar previous studies carried out in the last 7 years. Seroprevalence of anti HCV antibody was found to be similar whencompared with previous studies and demonstrated a higher trend in large cities with a multiethnic population.Key Words: MeSH: Blood donors, seroprevalence, HbsAg, antiHCV, HIV.
Clinical Pattern of Urinary Stone Disease in Our Setting
Authors: Memon Jan Muhammad , Athar M. Amin , Akhund Anwar Ali
Published: June 2016

Objectives: To study the basic clinical pattern of urinary stone disease in our setting.Study design: Descriptive study.Setting: Department of surgery of Nawabshah Medical College Nawabshah over a period of 4 years between August 2003to August 2007.Subjects: A total of 257 urolith patients with different stone burden enrolled in the study.Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. Thediagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .Allpatients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stonelocation, clinical presentation and operative procedures.Results: Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The ageranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 yearswhile lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116(45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi (Table 2). The commonest clinicalpresentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tractinfection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outletobstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patientshad asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84(32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%)nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2(0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients.Conclusion: Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part ofSindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalitiesare out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need oftoday’s medical practice.Keywords: Urinary calculi, Clinical profile, Open stone surgery.