bluuebunny/crossref_metadata_2025 huggingface dataset:
SURGICAL APPARELS
Authors: KISHWAR FARZANA , KHAN FILZA ZAFAR , KALSOOM SAMINA , ALAM SHAHZAD , Sohail Mohd. Tariq
Published: September 2021

Background: Around the world, majority of the public and private sector hospitals are using reusable gowns and scrubs whereas only a few hospitals are using disposable ones. Protection during surgery is very important both for the patient as well as for the surgeon. The reasons are not only hygienic but also creating a barrier so that the bacteria and the viruses do not transfer from patient to doctor and vice versa. The surgical gowns have been in use for many decades. With the advancements in the field of manufacturing (weaving and finishing), the quality of gowns has been improving over the period of time. In Pakistan, there is no awareness yet regarding the construction of surgical apparels viz. surgical gowns and scrubs so no standards are being followed as such during the manufacturing (weaving & finishing) of surgical apparels. For effective barrier function of surgical gowns and scrubs, it is necessary for them to comply with certain standards in terms of physical characteristics viz. mass per unit area, number of threads per unit length, tensile strength etc. The idea behind this study was to evaluate the physical characteristics of surgical gowns and scrubs currently being used in different public sector hospitals of Lahore. After which, necessary guidelines can be formulated and proposed to the concerned departments of various hospitals, in the light of which they can design some specifications and select appropriate materials for surgical apparels in future. Objectives: 1). To evaluate the physical characteristics of surgical apparels (gowns & scrubs) currently being used in different public sector hospitals of Lahore. 2). Comparison of results with existing/available performance requirements. Study design: Experimental study design. Period: April 2010-June 2010. Materials and Methods: Samples of fabric used for making surgical gowns and scrubs were collected from different hospitals of Lahore and evaluated for different fabric properties viz. mass per unit area, construction analysis (number of threads per unit length) and tensile properties in accordance with EN and ISO standards, in standard atmosphere for testing textiles. Results and Conclusions: The results obtained were compared with the available international standards and limited research studies done in the area of surgical apparels yet. It was found that none of the samples collected meet the minimal requirements available yet. So, there is a dire need of some minimal criteria of surgical apparels for the safety of the patients as well as of the health care personnel.
RIGID BRONCHOSCOPY
Authors: TAHIR MUHAMMAD , BHATTI MUHAMMAD ALI , ABDULLAH AMEER
Published: September 2021

Objectives: To evaluate foreign bodies in tracheobronchial tree and effectiveness of the therapeutic use of rigid bronchoscopy in a tertiary care setting. Study Design: Descriptive study. Place and duration of study. This study was carried out at Department of ENT and Head and Neck Surgery, Combined Military Hospital, Rawalpindi from June 2006 to June 2010. Patients and methods: This descriptive study was designed to evaluate the foreign bodies in tracheobronchial tree & effectiveness of the use of rigid bronchoscopy in a tertiary care setting. Sixty two patients underwent initial evaluation by ENT consultants and senior registrars followed by management with rigid bronchoscopy. Results: The most commonly affected age group was under 4 years. Male to female ratio was 3:1. Right main bronchus was affected in 51.61% cases. Most of the foreign bodies removed were organic in nature in 90.32% cases. The success rate for removal with rigid bronchoscopy was achieved in 98.39% cases, with fewer complications and no mortality Conclusions: It may be concluded from this study that early diagnosis & management is essential to prevent morbidity & mortality associated with foreign bodies. Rigid bronchoscopy is the most effective procedure for the removal of foreign bodies in tracheobronchial tree.
TRACHEAL INTUBATION
Authors: ALI LIAQUAT , BOOTA MUHAMMAD , KHURSHID TASSADAQ , Shafique Waseem
Published: September 2021

Introduction: Haemodynamic response to direct laryngoscopy and tracheal intubation has always been concern especially in cardiac patients. The use of fiberoptic bronchoscope for endotracheal tube placement may reduce the haemodynamic changes associated with intubation. Objectives: To compare haemodynamic changes (pulse and mean arterial pressure) following tracheal intubation, using direct laryngoscopic technique with fiberoptic bronchoscopic technique. Study Design: Randomized Controlled Trial (RCT). Settings and Duration: Department of Anaesthesiology, Intensive Care and Pain management Military hospital Rawalpindi. The study was of six months duration starting from April 2008 to October 2008. Subject and Methods: ASA-I and II patients (n=160) undergoing surgery meeting the inclusion and exclusion criteria.Informed consent was taken from all the patients undergoing the study. Patients were divided in two groups. Patients assigned to Group A got endotracheal intubation through direct laryngoscopic technique and Group B through fiberoptic bronchoscopic technique after induction of general anaesthesia. Pulse and Mean arterial pressure were recorded before induction of anaesthesia and three minutes after the intubation. Results: One hundred and sixty patients were studied. Eighty patients intubated through direct laryngoscopy (Group A) and eighty patients intubated through fiberoptic bronchoscope and it was observed that fiberoptic bronchoscopic intubation is haemodynamically safer as compared to conventional laryngoscopic intubation. Conclusion: The study concluded that bronchoscopic intubation provides better haemodynamic stability than direct laryngoscopic intubation.
POST OPERATIVE ANALGESIA FOLLOWING OPEN CHOLECYSTECTOMY
Authors: AHMED SAJJAD , KHAN RAHEEL AZHAR , KHURSHID TASSADAQ , Boota Muhammad , Ishaque Muhammad , Waseem Syed Hafiz Majid
Published: September 2021

Introduction: Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Design: Quasi Experimental study. Period: Jan2010 to June 2010. Setting: Military Hospital Rawalpindi. Material and methods: This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Sampling technique: Purposive (non probability) sampling. Result: Patient who received intermittent boluses (group B) required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Conclusions: Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125 % bupivacain.
HEPATIC CIRRHOSIS
Authors: TANWEER SALMA , PERVEZ TARIQ , TASEER IJAZ-UL-HAQUE , Khan Abdul Qadir , Arshad Muhammad
Published: September 2021

Objective: To see the association of platelet count, splenomegaly and development of oesophageal varices. Study Design: Observational study. Duration of study: One year from January 2010 to December 2010. Setting: Gastroenterology Department, Medical Unit III, Nishtar Hospital Multan. Methodology: One hundred ten cirrhotic patients were included. The record of these patients was scrutinized and data collected was entered and analyzed through SPSS 11. The patients were divided into three groups according to platelet count. Group I with platelet count less than 50000/mm3, group II with platelet count of 50000 to 100000/mm3 and group III with platelet count of 100000 to 150000/mm3. Similarly patients were also divided into three groups according to splenic size. Group I with splenic size 11 – 13 cm, group II with splenic size 13–16 cm and group III splenic size more than 16 cm. In each group presence of esophageal varices along with grading was noted. Results: The age of the patients varied from 15 to 80 years and mean age was 48.55 ± 13.88 years. Sixty five (59.1 %) were male and 45 (40.9%) were female. The hemoglobin level of these patients varied from 6.0 to 14.3 gm/100 ml with mean level of 9.23 ± 2.11gm/100ml. The platelet count varied from 22000 to 385000/mm3. The splenic size varied from 9 to 18 cm with mean of 12.53 ± 2.14 cm. Esophageal varices were detected in 102 cases. Seventeen cases were of grade I varices, 25 cases were of grade II varices, 40 cases were in grade III varices and 4 cases were in grade IV varices. Maximum number of grade-III (22 patients) and grade IV (3patients) esophageal varices occurred in patients having platelet count less than 50000/mm3. As the splenic size increases the grade of esophageal varices also increases. Maximum number of esophageal varices occur in grade II (25) followed by grade-III (37) in patients with splenic size in the range of 13 to 16 cm. Conclusions: A low platelet count and large splenic size are good non-invasive predictors of esophageal varices. These parameters can also accurately assess the presence of large varices. So a patient of cirrhosis with low platelet count and large spleen has an increased diagnostic yield of esophageal varices on upper GI endoscopy.
HBA1c
Authors: YAHYA K.M. , IQBAL KHALID , YAHYA HUMA
Published: September 2021

Background: Type-2 DM is an epidemic globally and is the major heath problem. Public awareness has lead to increased screening and treatments. But unfortunately, control is very poor overall. People get treatment but do not check the advantages of treatment. Objectives: To see the success and accuracy of treatment of DM, this study was conducted. Diabetic control was assessed by HBA1C level. Design: Prospective study. Setting: Department of Medicine OPD of All major Hospitals Faisalabad. Period: From 01-03-2009 to 14-05-2009. Methods: This multicentric was carried out in different hospitals of Faisalabad. Total of 67 patients of both sexes and different age groups with Type-2 DM were evaluated for primary goal of control of DM by measuring HBA1C with point of care (POC) technology. Various secondary features ware also noted. Results: Total n = 67 males = 38 females = 29. Study revealed a poor control in all patients. Mean HBA1C in male was 85% and in female 87%. There were differences in HBA1C as regards to level of education, socio-economic status but there was no difference with regard to truncal obesity & type of transport used. Conclusions: DM control was very poor in all groups with respect to age, sex, and type of treatment. This is a matter of concern both to the patient and their attending physicians. Poor control has far reaching implications to the patients, society, and the family.
THYROID DYSFUNCTION
Authors: ABDELLA ABDELMULA M. , MODAWE GAD ALLAH
Published: September 2021

Objectives: Studies on relation between serum lipids and thyroid dysfunction are numerous but, on the whole, desultory and inconclusive. The aim of this study was to investigate the concentration of serum triglyceride, cholesterol and cholesterol profile in Sudanese patient with thyroid dysfunction. Design: A case control study. Period: April 2008 to June 2009. Setting: Khartoum, Omdurman and Ibrahim Malik teaching Hospital, Khartoum State. Material and Methods: 200 Sudanese patients with thyroid dysfunction (hypothyroidism 100, hyperthyroidism 100) was compared with 100 healthy subjects as control group . Serum samples was taken and cholesterol, triglyceride, LDL and HDL levels were analyzed using colorimetric methods. Results: The mean ±SD serum triglyceride, total cholesterol, HDL and LDL in normal case respectively were 63.3±8.5, 163±6, mg/dl 44.3±3.7 mg/dl, 78.8±8 mg/dl. Among hypothyroidism, the mean ±SD serum total cholesterol, LDL, HDL respectively were 213.9±31.8 mg/dl, 38.5±3.5 mg/dl, 123.8±27.4 mg/dl and also among hyperthyroidism the mean ±SD serum triglyceride, total cholesterol, HDL and LDL respectively were 55.2±6.1mg/dl,152±11.5 mg/dl, 40.7±1.3 mg/dl and 76.1±9.7 mg/dl. Serum level of triglyceride, total cholesterol, and LDL is significantly elevated in hypothyroidism patients when compared with their control group (P<0.05). these changes in lipids profile among hypothyrodism patients are reversed upon thyroxine (T4) replacement therapy(p < 0.05). Conclusions: This study conclude that, the hypothyroidism causes significant increases of serum triglyceride, total Cholestrol, and LDL, with slight decreases in HDL level. In contrast thyroid replacement therapy reversed these changes.
STATUS OF HEPATITIS C VIRUS (HCV) INFECTION
Authors: NAEEM MUHAMMAD , AHMAD AMEER , QAISAR IMRAN , Ahmad Fiaz
Published: September 2021

Objective: To know the status of hepatitis C virus (HCV) infection in children admitted in Pediatric ward of Bahawal Victoria Hospital Bahawalpur. Study design: Cross-sectional descriptive study. Place and duration of study: Pediatric unit-1 Bahawal Victoria Hospital Bahawalpur over a period of 2 months and 15 days. Material and methods: This study was conducted over 500 children admitted in children ward-1 of Bahawal Victoria Hospital Bahawalpur. Children of 1-15 years of age were included in the study. The blood samples of these children were taken at the time of admission and serum was tested for HCV with ICT method and later on confirmed by ELISA. Children having HCV infection were tested for SGPT level. Different risk factors for transmission of HCV infection were also studied. Results: Out of 500 children 43 were HCV positive by ICT method. Out of these 43 ICT positive children 38 were confirmed by ELISA. In this way 7.6% children were found positive for HCV. In 23 cases (60.5%) SGPT was raised (>40). Statistically significant risk factors for transmission of HCV infection found in this study were past history of blood transfusion and history of injections in past. Conclusions: HCV infection is quite common in children. Safe blood transfusions and use of disposable and sterilized syringes is important for prevention of this infection.
PIOGLITAZONE VS GLIMEPIRIDE
Authors: RAHIM AMENA , SHAHZAD AMIR
Published: September 2021

Objectives: To compare the improvement in renal function tests (RFTs) of type 2 diabetic patients who were taking glimeperide alone and this drug in combination with piogliatzone and pioglitazone alone. Data source: Data was analyzed using ANOVA. P < 0.05 was taken as significant. Study Design: Randomized prospective study. Setting: This study was conducted in the diabetic clinic of Fauji Foundation hospital Rawalpindi and the tests were analyzed in the Biochemistry Lab of Islamic International Medical College Rawalpindi. Duration of study: 12 weeks. Materials & Methods: Blood glucose levels were determined by glucose oxidase method (globe marketing GD Italy), HbA1c by Microlab 200, urea/creatinine /uric acid by Selectra E & micro albumin by Spin colour. Results: No significant differences were observed for the variables of hemoglobin A1c, uric acid and urinary albumin P >0.05. Significant decreases were observed in the levels of fasting plasma glucose, urea and creatinine P< 0.05. Conclusions: In patients with type 2 diabetes pioglitazone and the combinations of glimepiride with pioglitazone produced significant improvements in measures of glycemic control and RFTs.
DOUBLE LUMEN CATHETERS
Authors: AKRAM MATEEN , ABBAS GHULAM
Published: September 2021

Objective: To measure recirculation by Urea based Method in double lumen catheters in patients undergoing hemodialysis. Design: Cross sectional study. Place and duration of study: Hemodialysis unit of Nephrology department of Shaikh Zayed Hospital, Lahore, and Quaid- i-Azam Medical College Bahawalpur for period of eight months from October 2007 to May 2008. Patients and methods: Total 125 adult patients selected with Non probability purposive sampling technique in which hemodialysis were done through double lumen catheter, were studied for recirculation. Access recirculation by urea based method with three sample technique was calculated from following formula; Percentage Recirculation= Systemic (S) – Arterial (A)/ systemic – Venous (V) x 100. Results: Out of 125 patients 53 (42%) were males, whereas 72 (58%) were females. Their mean age was 43.4 ± 15.7 years. Percentage recirculation by urea based method was 10.3± 6.64 with range from 3.6 to 24.8. Conclusions: Our results have shown the upper limit of acceptable recirculation (10.3± 6.6) through double lumen catheter. Central venous catheter remains an important temporary access and in some cases the only achievable access for the patients. This recirculation should be considered when measuring adequacy level in these patients.
IRON DEFICIENCY ANEMIA
Authors: IRSHAD GHAZALA , JAFRI SAGHIR AHMAD , KOUSAR SAMINA , Ali Irshad
Published: September 2021

Anemia is very common especially in developing countries and in Pakistan 70-80% of pregnant population is suffering from iron deficiency anemia. Ferritin is intracellular globular iron storage protein. The low level of ferritin indicates lack of iron that may lead to anemia and its high values may indicate iron overload. Objective: To determine the incidence of anemia on the basis of ferritin in three socioeconomic groups i.e. poor, middle and upper class and in three trimesters of pregnancy. Materials & Methods: Total 45 pregnant females were selected and divided in three categories of poor, middle, and upper class based on their socioeconomic status. Serum ferritin levels were measured by ELISA method. Results & Conclusions: Total mean serum ferritin (ng/ml) level were found to be 18.5± 3.5, 14.6± 3.0, 14.7± 3.6 in first, second and third trimesters respectively. Serum ferritin was very low in all three socioeconomic groups and it was lowest in poor class as compare to middle and upper class. It was concluded that serum ferritin is a good and reliable marker for detection of iron deficiency anemia during pregnancy as compared to hemoglobin.
ABDOMINAL PREGNANCY
Authors: ARA SARWAT , AWAIS NADIA
Published: September 2021

Abdominal pregnancy is a rare complication with maternal and even higher perinatal mortality. Objective: To alert physicians and sonologists about features of abdominal pregnancy. To promote awareness about this potentially lethal condition. Study Design: Observational case series. Period: 2000 to 2007. Setting: Department of Gynecology & Obstetrics, Allied Hospital, Faisalabad. Material & Methods: This study was conducted at department of Gynecology & Obstetrics, Allied Hospital, Faisalabad. Eight cases were done during the period 2000 to 2007. There demographic features including age, gestational age, ultrasound findings, operative findings and outcome were noticed. Results: The mean age was 30.125 years (range 23-38). The recorded mean gestational age was 20.62 (range 10-37 wks). Out of 8 cases, 6 patients are more than 25 years age. Four patients (50%) were primi gravida. Maximum parity was of 3. Our 50% of patients were having either one or two abortions. The abdominal pregnancy presents in variable fashion with acute abdominal pain (100%), fainting attacks (25%), shock (25%) and rarely with PIH, fetal distress and loss of fetal movements. Abdominal ultrasound was helpful in diagnosis but not conclusive always. The fetal diagnosis was confirmed per operatively. On laparotomy the placenta was attached to different parts of abdomen as following. Abdominal pregnancy is potentially fetal for mother and fetus. The maternal mortality is 12.5% (1/8). The fetus had 100% Mortality (8/8). Conclusions: Abdominal pregnancy is a rare occurrence but is challenging diagnostically and therapeutically. Awareness of this condition is very important in reducing the associated morbidity and mortality.
OBESITY
Authors: QURESHI FARHEEN UMAR , HUSSAIN JAWAD , SAQIB ANWAR SAOOD
Published: September 2021

Background: The problem of overweight and obesity is not confined only to developed countries but is also widely prevalent in developing countries. The study under report relates to determining prevalence of obesity and overweight in adolescent school boys. Objective: The objective of this study was to assess the prevalence of overweight and obesity in boys of public and private secondary schools, Faisalabad, and to relate it with their dietary style and physical activity. Study Design: Cross sectional and institutional based study. Methods: A total of 600 school boys of different age groups from the classes 6th to 10th were randomly selected and included for anthropometric measurements to categorize them into normal, overweight and obese individual. Their diet pattern and physical activity records were taken to correlate it with the obesity level. Results: The collected data revealed that 423 (70.5%) boys were normal. Whereas 98 (16.3%) were found to be overweight. Out of these, 72 (24.0%) were from private schools; while 26 (8.7%) were from government schools. Only 6 (2.0%) fell into obese category, and all belonged to private schools. No one was found to be obese in government schools. Mean ± SD weights (kg) in government and private school boys were 50.93 ± 7.18 and 56.34 ± 11.94, respectively whereas mean ± SD heights (m) of government and private schools boys were found to be 1.55 ± 6.64 and 1.56 ± 7.92 respectively. The data was statistically analyzed which exhibited significant relation with weight and BMI value. Conclusions: The prevalence of overweight was significantly higher in boys who ate junk foods and spent more time in watching television and sitting before computers. The findings of this study was found in agreement with certain earlier studies that revealed prevalence of obesity is to be on the increase among the private school boys of the area. It is, therefore, emphasized that regular physical exercise, regulated television viewing, doing household activities, balanced diet and healthy eating habits should be motivated in school children to ensure control of overweight and obesity, in this class of children.
SERVICES AND PRACTICES OF HEALTH CARE PROVIDERS IN A RURAL AREA OF FAISALABAD.
Authors: SARWAR GHULAM , MANZUR FARIDA , HAMID IMTIAZ
Published: September 2021

Objectives: (1) To determine the mode of services being rendered and practices done by the health care providers of the study area. (2) To identify various socio-demographic factors about the health care providers. A health care provider provides preventive, curative, rehabilitative and spiritual health services to the community. Health care is being provided by not only the registered and qualified doctors, but also by non-qualified non-registered and inexperienced persons in Pakistan. Methodology: A total of 57 health care providers from the union council 42 area in district Faisalabad were included. A pre-tested questionnaire to know about the services and practices of the individuals was served upon them to collect the relevant data. Design: Cross-sectional study. Setting: Union council 42 area in district Faisalabad. Period: 2008. Results: Out of 57, 30 (52.63%) were males and 27 (47.37%) were females. Most of them, 18 (31.6%) were above 49 years of age. 51 (89.47%) were practicing in the private; whereas, only 2(3.51%) in the public sector. Most of the individuals, 21 (36.8%) were LHW and only 2(3.5%) were doctors or medical assistants; 3(5.3%) were dispensers, 9(15.8%) were hakeems and 7 (12.3%) homeopaths. Most of them, 40(70.2%) were matriculates and 14(24.6%) graduates. Only 20 (35.1%) were having certificates and 11(19.3%) were diploma holders. Further, only 2(11.76%) out of 57 were registered with PM&DC and Punjab Medical Faculty. 30 (52.6%) individuals were rendering curative and only 5 (8.8%) preventive services. None of the health care providers was rendering laboratory, x-ray or ultrasound services. Most of the individuals, 36 (63.2%) were practicing allopathy and 7(12.3%) homeopathy way of treatment. Further, most of the professionals, 45 (78.95%) were not doing any surgery. As regards sterilization, the most 8(66.7%) were practicing boiling of instruments. Most of them 47 (82.45%) were giving injections to the patients, however, using disposable syringes, and 27(57.4%) were disposing of the syringes by cutting the needles to dump. 20 (42.55%) were referring their patients to DHQ Hospital and 47 (82.46%) were keeping the record. Conclusions: Qualified medical professionals were scarce in the locality. However, allopathic system of medicine was being widely practiced. Only LHWs were providing curative services with proper training to deliver first aid services.
TESTICULAR TORSION OF UNDESCENDED TESTIS IN A CHILD
Authors: AHMAD MAQSOOD , AHMAD MUMTAZ , SAQIB MUHAMMAD
Published: September 2021

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.
HETEROTOPIC PREGNANCY IN NATURAL CONCEPTION
Authors: MUSSART NAZIA , QURESHI SAIMA , ROOHI MAHNAAZ
Published: September 2021

Case Report
MENTAL RETARDATION
Authors: KHATTAK NAUREEN ASLAM , KHAN MUZAMMIL AHMAD , RAZA ABIDA
Published: September 2021

Mental retardation, also termed as learning impairment or cognitive dysfunction, is a serious manifestation of nervous system. The defining features of mental retardation are low or subaverage intellectual functioning (Intelligence quotient<70), impairment in at least two of the adaptive skills (e.g communication ability, self care, self guidance, reading, writing ability, etc) before 18 year of age1. Molecular cytogenetics is the study of genetic disorders using advanced technologies combined with cytogenetic and molecular methodologies2. Molecular diagnosis has equal importance as clinical diagnosis in mental retardation and day by day new advancement in these methodologies are being introduced by molecular cytogeneticists. The promising achievement of molecular cytogenetic techniques is the genetic counseling of high risk pregnancies. The current mini-survey of literature discusses an overview of these techniques employed to investigate deletion, duplication, inversion and translocation of chromosomes associated with mental retardation.
SPONTANEOUS BACTERIAL PERITONITIS
Authors: AHMAD MUKHTAR , MUMTAZ MOHAMMAD , MUGHAL AAMIR ABBAS , Ali Ameer Abbas , Iqbal Javed
Published: September 2021

Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. Objectives: (1) To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. (2) To examine the resistance against various antibiotics. Period: 6 months. Setting: Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Materials and Methods: Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean + S.D and qualitative variables, were recorded as frequencies and percentages. Results: Out of 80 patients with suspected SBP 38(47.5%) were culture positive while 42(52.5%) were culture negative. Among these 14(36.84%) showed gram positive growth and 20(52.63%) gram negative growth while 4(10.52%) showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone & augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36(95%) followed by cefoperazone 35(92%). Conclusions: Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome.
COLORECTAL CARCINOMA
Authors: GUL AYAZ , ALAM SYED IFTIKHAR , ASLAM RASHID , Alam Waqar
Published: September 2021

Objective: Colorectal cancer is the second commonest cause of death in the world. Its incidence in young patients is on rise. Objective: To determine the common types of colorectal carcinoma in patients below 40 years of age presenting to tertiary care level hospital. Study Design: Descriptive study Setting: It was carried out at Surgical Department, KTH, Peshawar Period: January 2007 to January 2008. Materials and methods: Total of 50 patients younger than forty years of age with colorectal cancer were included in study for the determination of histologic types. Results: There were 66% males and 34% were females. The commonest affected age group was 31-35 years old having 46% cases. On history 86% patients complained of altered bowel habits and on clinical examination anemia was present in 72% patients. Left and right sided tumors were found in 70% and 30% patients respectively. Adenocarcinoma was the commonest type found in 94% cases followed by lymphoma (4%). Conclusions: The incidence in young age group (≤ 39 years) was highest There was slight male preponderance. Adenocarcinoma was the commonest tumor.
PERCUTANEOUS NEPHROLITHOTOMY
Authors: HUSAIN IMRAN , TAHIR MUHAMMAD MUZAMMIL , ASHRAF SHAHZAD , Khan Muhammad Usman
Published: September 2021

Purpose: We compared postoperative outcome of conventional large bore percutaneous nephrolithotomy (PCNL) with small bore and tubeless percutaneous ephrolithotomy (PCNL). Study Design: prospective randomized trial. Period: August 2008-2009 Setting: Shaikh Zayed Hospital Lahore. Materials and Methods: The study included 90 patients randomized in three groups. Group. 1 included 30 patients who underwent conventional PCNL with large bore 16 fr nephrostomy tube, Group2 included 30 patients, PCNL with small bore 10 fr nephrostomy tube, and Group3 included 30 patients who had tubeless PCNL. Comparison was made in the terms of analgesia requirement, fever, duration of urinary leak and hospital stay. Results: In Group 1 analgesia requirement ranged from 40-70mg mean 50mg, in Group II, it was 30-60mg with mean 47.3mg while in Group III, The requirement of analgesia was 10-50mg with mean 21.1mg, p<0.005. Hospital stay was between 4 to 7days, mean 5.7days in group I while in group II, stay was between 3 to 5 days, mean 4.3days and in group III, it was between 1 to 4 days, mean 3.17days, p <0.005. Twelve patients had fever in group I, In group II, eleven patients while in group III, five patients developed fever, p <0.005. Leakage of urine from site of wound in group I was observed between 0 to 5 days while in group II leakage was between 0 to 4 days, and the leakage period reduced in group III from 0 to 2 days p <0.005. Conclusions: Tubeless PCNL is associated with the least postoperative pain. urinary leakage, fever and hospital stay, it’s a good option after an uncomplicated percutaneous renal procedure
ABNORMAL UTERINE BLEEDING
Authors: ARA SARWAT , ROOHI MAHNAZ
Published: September 2021

Background: Abnormal uterine bleeding is one of the most frequent conditions in gynecology. Hysteroscope & plastic devices for outdoor endometrial biopsy are gaining popularity but in our setup traditional dilatation and curettage play significant role in diagnosis of abnormal uterine bleeding. Objective: To detect different histopathological findings in abnormal uterine bleeding by conventional dilatation and curettage. Design: Descriptive Period: From December 2002 to March 2005.Setting: Department of obstetric & gynecology Unit-I Allied Hospital, Faisalabad, under the guidance of Professor Mahnaz Roohi. Results: 161 patients with abnormal uterine bleeding divided into adolescent, reproductive and peri-menopausal age groups. Maximum 59.02% patients with abnormal uterine bleeding were perimenopausal. Menorrhagia 49.06% was commonest bleeding pattern. Histopathological reports revealed 62.11% dysfunctional uterine bleeding, 21.73% organic lesions and 16.16% pregnancy complications. Complications occurred only in 0.62%.Conclusion: Dilatation and curettage is a safe & successful procedure for detecting intrauterine pathologies in abnormal uterine bleeding.
VAGINAL DISCHARGE
Authors: SHAIKH SHAHIDA , SHAIKH SALEEM AKHTER , MAGSI INAYAT
Published: September 2021

Objective: To observe the results of syndromic management in women living in IDPs camps complaining of chronic vaginal discharge. Design: Descriptive study. Setting: Medical Camps at Larkana set by Chandka Medical College Hospital for Internally Displaced Persons (IDPs) due to floods. Period: 1st September 2010 to 31st December 2010. Material and Methods: Total 200 symptomatic patients aged from 20 to 50 years suffering from chronic vaginal discharge having history of more than 6 months duration were included in the study. Asymptomatic as well as pregnant women and patients with abnormal cervix and having abnormal growth on cervix were excluded from the study. A detailed history and examination (including speculum and vaginal) was done and a proforma was filled. All these patients were given empirical treatment recommended by WHO as syndromic management consisting of stat doses of antifungal along with antibiotics, where no laboratory tests are required before treatment. Results: Next to vaginal discharge which was main symptom in all patients, the other symptoms like dusparunia, dysuria, itching ,lower abdomen pain and low backache was reported 9%, 16%, 20%, 24% and 31% respectively. Also 8% patients reported post coital bleeding. All patients were married and the mean age of the patients was 28+0.2 years and 15% of them were over 40 years. Mean parity was 4±1.Vaginal infection improved in 65% of the patients excellently with a first line single course of antibiotic and percentage raised up to 88% with second course. 19(9.5%) patients couldn’t be followed as they left that camp and 5(2.5%) patients who did not improve with two courses of antibiotics had big cervical erosions, referred to nearby tertiary care hospital for further management. Conclusions: IDPs live in poor conditions in camps without basic facilities and where it is difficult to perform bedside tests like microscopy, Potassium Hydroxide, wet mount films and tests for Sexually transmitted diseases like Chlamydia and gonorrhea are not available, syndromic management there is a rational way of treating cases of chronic vaginal discharge to get quicker response in such desperate women.
POSTPARTUM HAEMORRHAGE
Authors: ISHAQ TEHNIYAT , AMIN SAID , KHATTAK ISHAQ
Published: September 2021

Objective: To determine the frequency, risk factors and existing practice for the management of massive primary postpartum hemorrhage (PPH). Study design: Retrospective cross-sectional study. Setting: Department of Obstetrics & Gynaecology at Kuwait Teaching Hospital, Peshawar. Materials and methods: this study was performed from June 2008 to June 2010. Women who developed massive primary PPH after admission or were admitted with it, were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum hemorrhage, supportive medical and surgical intervention. Data was entered in the pre-structured proforma. Estimates of blood loss were made on history, visual parameters and patient’s condition. All the data was analyzed by using statistical computer soft ware SPSS 6. Results: During the study period total number of obstetrical admissions were 2944. Forty nine out of 2769 (1.76%) deliveries, developed massive primary PPH. The highest frequency of massive primary PPH was observed in grand multiparous patients. Uterine atony was the most common cause of the complication. Birth attendants other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Seventy five percent patients,(36/49) who had massive PPH, delivered vaginally. High dependency unit (HDU) was required in 12% (6/49) of women. Only one caesarian hysterectomy was done. There was one maternal mortality. Blood transfusions were required in 82% (40/49) of the patients. Conclusions: Postpartum hemorrhage can be a preventable condition if early identification and timely management of this complication and its risk factors is observed. Uterine atony is the leading cause of immediate PPH. The main risk factors for PPH due to uterine atony are high parity, a large fetus, multiple fetuses, hydramnios, or past history of PPH. Determining the frequency, risk factors and management of primary postpartum hemorrhage will help design stepwise protocols for prevention and management of primary PPH in our setup.
ORTHODONTIC PATIENTS
Authors: KHAN RANA MODASSIR SHAMSHER , TARIQ ALI SAAD
Published: September 2021

Objectives: To find out the prevalence of malocclusion in patients visiting orthodontic department of Lahore medical and dental college (LMDC). Study Design: It is a cross sectional study. Place of study: Orthodontic department, Lahore medical and dental College. Lahore. Material and methods: Malocclusion was clinically examined by using Angle’s classification in 1143 patients (708 girls and 435 boys). Results: Class I malocclusion was found in 23.27% of the total sample. Class II malocclusion was found in 53.19% and Class III malocclusion in 8.66% of sample. No statistically significant differences were found in distribution of malocclusion between males and females. Conclusions: The study revealed that Class II malocclusion predominated among patients visiting orthodontic department of LMDC.
ORTHOPEDIC INJURIES AMONG ELDERLY PERSONS
Authors: MALIK MUHAMMAD RAZZAQ , AZEEM MUHAMMAD , IQBAL MUHAMMAD ZAFAR
Published: September 2021

Background: Pakistan is experiencing a rise in its elderly population leading to increase burden of orthopedic injuries. With meager resources and a poor understanding of elderly health problems; Pakistan faces many challenges in caring for its elderly population. Objectives: The objectives of this study were to, “Assess the frequency of orthopedic injuries among elderly persons and the associated risk factors at Sheikh Zayed Medical College/ Hospital Rahim Yar Khan”. Study design and duration: This was an analytical observational study conducted among the elderly patients above the age of 60 years, admitted in the Orthopedic Department of Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Methodology: The data was collected regarding the frequency, causes and pattern of orthopedic injuries in elderly patients admitted in the Orthopedic Department of Sheikh Zayed Hospital / Medical College Rahim Yar Khan. The data regarding age, sex, education, occupation, geographical origin, and mechanism of injury were obtained by questionnaire. The data was analyzed on SPSS version 16. Results: There were total 1589 patients admitted in the Orthopedic Unit during the study period. The elderly persons above the age of 60 years were 291(18.31%). There were 184(63.24%) males and 107(36.76%) females. The average age was 64.52 years in urban residents and 66.34 years in rural residents’ patients. Among the frequency of injuries, the femoral neck and inter-trochanter region were most commonly involved. The proportion of injuries in males it was 44.02% and in females it was higher that was 49.53%. The majority (68.29%) of the elderly persons was dependent and was not satisfied with socio-economic condition and status in the family (p < 0.000). Conclusions: Elderly patients who have experienced trauma are at increased risk of subsequent injury. Interventions to reduce the likelihood of trauma recurrence should focus on those with chronic illnesses and functional impairments.
HEALTH SEEKING BEHAVIOR OF THE PEOPLE
Authors: SIDDIQUI M. SAEED , SIDDIQUI M. KHALID , SOHAG AIJAZ AHMAD
Published: September 2021

Objectives: The aims and objectives were, to know about the approach of people towards seeking medical advice with different options of healers, to observe thinking, feeling and various actions of people including level of self medication, and to know perception of people regarding various practices done by the healers. Data Source: People living in urban slum areas of Karachi. Design of Study: Cross sectional Study. Setting: Karachi. Period: July to October 2008. Subjects and Methods: It was Knowledge, attitudes and practices (KAP) study carried out on a sample of 300 permanent household members aged ≥ 16 years of middle and poor class living in urban slum areas of Karachi. Results: The mean age of the study participants was 38.27 with standard deviation of 17.57. 182 (61 %) were male while 118(39 %) were female. Out of 300 study participants (n=300) 260 (86.6 %) consult allopathic healers including 169 (56.33 %) MBBS general practitioners and 91 (30.3 % ) non qualified or quacks,25 (8.3 %) consult homeopaths, 11 ( 3.6 % ) Hakims, and only 4 (1.33 % )consult faith healers (P < 0.05).148 (49.33 %), participants belong to middle class group, while 152 (50.66 % ) were from poor class. 50 % study participants do self medication at home prior to consultation for heath. Conclusions: Health seeking behavior is a complex phenomenon in developing countries like Pakistan where poverty overrides all other factors in decision of selecting a healer. It is recommended that people should be educated in choosing a healer which should be a qualified one.
PAPILLO-INCISAL DISTANCE
Authors: SALEEM TAYYABA , AHMAD TARIQ ZAMAN
Published: September 2021

Objectives: To compare the influence of various arch forms on papillo-incisal distance PID (distance between posterior limit of the incisive papilla and the most prominent contour of the labial surface of maxillary central incisors). Study design: Descriptive study. Place and duration of study: Department of Prosthodontics, Lahore Medical and Dental College, Lahore, Pakistan, from October 2004-December 2005 & May2010-September2010. Methodology: A total of 250 subjects, 125 male and 125 female were included. Theme of evaluation was incisive papilla maxillary central incisor distance and arch form. Normal healthy subjects with symmetrical arches and all teeth present except third molars were included. Subjects with malformed teeth, periodontal problems, orthodontic treatment or restorations on the labial tooth surfaces were excluded. Data was analyzed in SPSS 16 package by applying t test and ANOVA, with p≤0.05 as cut off point for statistical significance. Results: The mean PID was 12.02mm SD±1.5. Among the subjects 82% had ovoid, 7% had tapering and 11% had squarish arches. Conclusions: Mean PID 12.02mm SD±1.5is suggested for artificial central incisors replacement. There is higher presentation of ovoid arches with a strong influence of arch forms (p-value <0.02) and a weak influence of gender (p-value <0.489) on PID.
LIPID ALTERATION
Authors: ABDELSALAM KAMAL ELDIN AHMED , SHARWANI MANAHIL ALI , TAHA SHAZA SALIH
Published: September 2021

Objective: determine serum lipid profile in diabetic and obese non-diabetic patients. Materials: 300 subjects comprising three groups, the first group included 100 diabetic patients (non-obese) with duration of diabetes over 5 years, the second group (obese) included 100 obese subjects (non-diabetic) with duration of obesity over 5 years, and the third group (control) included 100 healthy subjects. Methods: Lipid profile on the serum was performed with an auto analyzer using standard methods. Study design and period: Prospective Analytical Cross Sectional Study conducted in period from September 2006 to January 2008. Results: A significant (p value<0.05) increase in lipid profile results of diabetic and obese patients comparing to control while HDL-C showed significant decreasing. The cholesterol is significantly increased in females than males in diabetic patients, while the triglycerides are significantly decreased in diabetic females. The parameters showed insignificant variations between males and females in obese patients. Conclusions: In comparison to control group, DM & obese groups showed significantly increase in TG, TC, and LDL-C, but significantly decrease in HDL-C. Females showed significant increasing in TC and significant decreasing in DM group, while in obese group females showed insignificant decreasing in TG and TC.
ARTERIAL BLOOD pH
Authors: AHMED SHAFAQ , JANJUA SARFRAZ , ALI HAMID
Published: September 2021

Background: Arterial blood gas analysis is the most commonly performed investigation in intensive care unit(ICU) as the changes in acid-base balance are common in critically ill patients. Changes in pH are directly related to severity of disease. Keeping in view our clinical experience and literature search, we assume that patients whose pH is less than 7 at any time in the course of disease carries poor prognosis. Design: Quasi experimental study. Setting: ICUs of Combined Military Hospital Rawalpindi and Combined Military Hospital Multan. Period: From 1st Jan 2006 to 6th Aug 2007 and 7th Aug 2007 to 31st May 2010 respectively. Material and Methods: All the patients having pH less than 7 at any time in the course of disease were considered and patient having otherwise fair state of health before recent insult were included. Moribund terminally ill patient were excluded. Results: All the thirty patients needed intubation and ventilation except one who remained conscious despite having pH. 6.95. Twenty two patients (73.4%) died and eight patients (26.6%) survived. All patients who survived were diabetic except one having tracheal stenosis. All patients who died were non diabetic. Only one non diabetic patient was among the survivor. Survival among diabetic patient as group was 100%(7/7). Conclusions: Patients having pH below 7 at any time in the course of disease carry poor prognosis especially if they are non diabetic. Diabetic has best prognosis. However it is a small study of thirty cases only, further multi centre studies are needed to demonstrate the co-relation of pH with prognosis prediction.