bluuebunny/crossref_metadata_2025 huggingface dataset:
INTRA-ABDOMINAL PATHOLOGIES
Authors: AHMAD MALIK GULZAR , ANSARI MUHAMMAD SAJID , HUSSAIN CHOUDHARY SHAHID , Hussain Sabir
Published: September 2021

Objectives: To evaluate relative frequency, reasons, avoidable responsible factors and outcomes of relaparotomy. StudyDesign: Observational case series study Setting: Department of Surgery Unit III BVH Bahawalpur Duration: From 01-9-2009 to 31-8-2010Patients and Methods: All the patients who presented in surgical outdoor, indoor and casualty department with severe intra-abdominalpathologies after primary laparotomies referred from low level, secondary care and tertiary care hospital and underwent relaparotomy electivelyor on demand were included in the study. Retrospectively their demographic characteristics, initial diagnosis with surgical information of primarylaparotomy, factors and outcomes after relaparotomies were analyzed statistically. Results: A total 54 patients were included in the study withmale to female ratio of 1:2. Mean age of the study group was 30.91±12.5 years. Relative frequency of relaparotomy was 5.6%. Common centerof referral was low level hospital 66.7%.Most common indication of relaparotomy was peritonitis in 52%. Most common complication ofrelaparotomy was wound infection 74%. Avoidable factors responsible for relaparotomies were found to be surgery at low level hospitals(77.3%) and by nonqualified surgeons (72.1%). Conclusions: The rate of relaparotomy is very high because of unsupervised primary surgeryin institutions and surgery by unqualified operators in private sector. Many of these are avoidable. In addition to decreasing the complicationrate, primary surgery performed at tertiary care hospitals would decrease need for patients to undergo re-exploration.
PROGNOSIS OF ACUTE FULMINANT HEPATIC FAILURE
Authors: PHULPOTO JAVED AHMED
Published: September 2021

Acute fulminant hepatic failure (ALF) is a medical emergency and associated with high mortality rate. Its etiology showsconsiderable geographical variations. The viral causes are the most common in our region, [whilst acetaminophen (Paracetamol) inducedhepatotoxicity forms the most common precipitant in many developed countries]. Objective: To assess the causes and prognosis of acutefulminant hepatic failure in patients attending medical unit I, Ghulam Mohammad Mahar Medical college hospital, Sukkur. Study Design: Across-sectional study. Place of Study: Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Duration of Study: FromJanuary 2010 to July 2011. Methodology: A total one hundred twenty (120) patients of ALF were studied during the study period to evaluate thecauses and prognosis. Those patients who were admitted during the study period were included in the study. The selected patients presentedwith jaundice and hepatic encephalopathy of varying grades. Results: Almost all the cases the causative agents were viruses. Among these,the hepatitis E virus (HEV) was the top most causative agent followed by hepatitis B Virus (HBV) in this study. Despite good effort ofconservative treatment, the mortality rate was 77.5%. The mortality rate was higher in grade-III and grade-IV encephalopathy patients,whereas the prognosis is better in grade-1 and grade-II encephalopathy patients.
SLEEP DISORDERS
Authors: NAZANIN RAZAZIAN , MANSOUR REZAEI
Published: September 2021

Background: It has been estimated that 20% of adults and children have sleep disorder symptoms and signs. Sleep disordersremain largely undiagnosed in the general population. Increasing evidence suggests that sleep alterations could favor subsequent depressionand behavioral disturbances. Aim of the study: Regarding high prevalence of sleep disorders in the general population and their effect onmental and physical functions, this study was aimed to assess the prevalence of sleep disorders among medical students in KermanshahUniversity of Medical Sciences. Methods: Assessment of sleep disorders was done by Global Sleep Assessment Questionnaire (GSAQ). Inthis descriptive study, frequency of insomnia, daytime sleepiness, non-idiopathic insomnia, obstructive sleep apnea, restless leg syndrome andparoxysmal leg movement, nightmares, sleep walking and a sense of depression or anxiety was calculated. Results: A total number of 393medical students, 151 male and 242 female, were recruited. One or more kinds of sleep disorders have been reported by 254 persons (64%).The most frequent disorder was non-idiopathic insomnia (50.9%). Frequency of idiopathic insomnia was 29.5%. Prevalence of daytimesleepiness was 21.4%. The least frequent disorder was sleep walking (1.5%). Subjective sense of anxiety or depression was reported by 109persons (27.7%). Only 39 (9.9%) of the respondents had no disorder. Conclusion: Our findings suggest that sleep disorders are frequent inour studied population of medical students. More education about sleep disorders, sleep hygiene, and management of a life style whichnecessarily includes shift work and long hours of study, may lead to improved sleep patterns in medical students.
LACTOFERRIN LEVELS IN MOTHER’S MILK
Authors: HUSAIN NAQVI SYED QAISER , KHAN MOHAMMAD SHIRAZ , SIYAL ALI AKBAR , Sehto Mir Muhammad , Qazi Riaz Ahmed , Bux Shaikh Rasool , Ali Akhund Anwar
Published: September 2021

Objective: This study was aimed to see the significance of Lactoferrin in human breast milk among lactating mothers of healthyand sick babies. Place and duration: This study was conducted at pathology and paediatrics departments of Peoples University of Medical andHealth Sciences Nawabshah, Shaheed Benazirabad between Jan 2011 to Dec 2011. Design: Cross sectional study. Method: Lactoferrinlevels in breast milk of 356 mothers of healthy babies were estimated and similarly lactoferrin levels in breast milk of 318 lactating mothers ofsick babies were estimated & these results were analyzed. Results: the mean lactoferrin level in breast milk of 356 lactating mothers of healthybabies was 9.37 mg/ml and the mean lactoferrin level in breast milk of 318 mothers nursing sick babies was 3.73mg/ml. Conclusions: There isdecrease in lactoferrin levels of lactating mothers of sick babies in their mature milk, which could account for the susceptibility of their babies toinfection.
HAEMORRHOIDS
Authors: ABBASSI MUJEEB REHMAN , SHAIKH UBEDULLAH , SANGRASI AHMED KHAN
Published: September 2021

Objective: The objectives of the study are to compare the outcome of the Doppler Guided Haemorrhoidal Artery Ligation andopen Haemorrhoidectomy in 2nd & 3rd Degree Haemorrhoids. Study design: Comparative study. Place and duration of study: Study wascarried out at the General Surgical Department at Liaquat University Hospital, Jamshoro & private hospital Hyderabad from 2008 – 2009.Methodology: Study consisted of 50 patients of diagnosed cases of heamorrhoid. Patients were divided in two groups. In Group A Standardopen Haemorrhoidectomy and Group B we used Doppler Guided Haemorrhoidal artery ligation. Detailed history was taken from all the patientswith special regard to the bleeding per rectum or some thing coming out during defecation and Clinical examination of anal canal DRE andProctoscopy was done. Results: In both groups male were 37 (74%) and female 13 (26%) with male: Female Ratio of 2:8:1. Age ranging from20 to 60 years in both group, mean ages of patients were 38.28 + 10.355 years. 3rd degree haemorrhoid 31(62%) while 2nd degree 19(38%).Complications were mild to moderate pain 24(96%) patients in DG – HAL group while moderate to severe pain 23(92%) in excisionalheamorrhoidectomy group. Anal stenosis in 2(8%), patients, anal fissure 1(4%) patients and feacal incontinence 1(4%) patients were observedonly in excisional heamorrhoidectomy. Recurrence occurred in one case (4%) in each group. Conclusions: DG – HAL procedure has a low rateof complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period thanExcisional heamorrhoidectomy procedure.
OLECRANON FRACTURE
Authors: INAM Muhammad , SATAR ABDUL , HASSAN WAQAR , Saeed Mohammad , Arif Mohammad
Published: September 2021

Objective: The objective of the study is to assess the clinical and radiological outcome after tension band wiring of olecranonfractures. Design: Descriptive study. Setting: Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar. Period:July 2007 to June 2010. Materials and Methods: 29 consecutive patients of either sex with age above 20 years, having olecranon fracture.Fracture osteosynthesis was achieved with the insertion of two parallel 1.8 mm Kirschner wires from the tip of the olecranon and an 18 gaugewire in a figure of eight fashion. Then functional outcome is evaluated with Mayo Elbow Performance score (MEPS) while radiological outcomeis evaluated with standard radiographs. Results: Out of 29 patients, male were 19(65.5%) while female were 10(34.5%). Minimum age was 20,maximum 80 and average age was 47.5 years. There were 7(24.1%) patients with type A, 6(20.7%) type B, 9(31%) type C, 6(20.7%) type E and1(3.4%) with Schatzker type F fracture. Mayo Elbow Performance Score was Excellent in 13(44.8%), Good in 10(34.5%), Fair in 4(13.6%) andPoor in 2(6.9%) patients. There were 10(34.5%) complications including prominent wire in 3(10.3%), osteoarthritis in 1(3.4%), broken skin in3(10.3%), irritation of skin in 1(3.4%), erythema in 1(3.4%) and serous discharge in 1 (3.4%) patient. There was no non union recorded in thisstudy. Conclusions: Olecranon fractures heal well in most instances achieving recovery of normal function in more than 95% of patients.Functional outcome is dependent on fracture severity, length of immobilization, and patient factors.
BREECH PRESENTATION
Authors: IRSHAD RAO SHAHID , SIDDIQ SHAZIA , REHMAN RABIA
Published: September 2021

Objective: To determine the frequency of breech presentation at term. Design: Cross sectional study. Setting: Department ofObstetrics and Gynaecoogy, Unit-III, Nishtar Hospital, Multan. Period: June 2010 to May 2011 Material and methods: This study was carriedout in women with the age group 0-40 years. Breech presentation at term (37-41 completed weeks). Results: The frequency of breechpresentation at term was found to be 6.2%. 91% (215) of the patients were delivered by caesarean section and 9% (20) were delivered vaginally.Placenta previa and multiple pregnancy 8.51% each, congenital anomalies 4.25% and in 16.17% of the patients, no obvious cause was found.Conclusion: It is concluded from the study that the frequency of the breech presentation at term increased.
HDV INFECTION IN HBV INFECTED INDIVIDUALS
Authors: SHABIR SHAIKH GHULAM , ALI SOOMRO AKBAR , AHMED SHAIKH NISAR , Murtaza Pathan Ghulam , Majeed Chhutto Abdul , Ahmed Shaikh Zameer
Published: September 2021

Objective: To determine the status of HDV infection in HBV infected individuals at Larkana. Duration & place of study: This is alaboratory based retrospective study conducted at Molecular Laboratory HPCP-CMI Central laboratory CMC Hospital City block Larkana fromOctober 2010 to September 2011. Material & methods: During the study period all the serum samples in which the HBV DNA was qualitativelydetected werefurther processed for HDV RNA detection by the method of Real time PCR. Result: During the study period a total of 1564 HBVDNA detected serum samples were processed for HDV RNA detection. The males were 1078 (69.0%) and females 486 (31.0%). The age wereranged between 15 to 73 years. Out of the 1564 HBV DNA detected serum samples, the HDV RNA was detected in 865 (55.31%) and notdetected in 699 (44.69%) individuals. Conclusions: This study showed 55.3% HDV infection in the HBV infected patient. Hence, to formulatethe treatment option and to predict the response of treatment it is necessary that every HBV infected case should be processed for HDV RNAdetection.
PDPH BY USING SAME GAUGE OF NEEDLES
Authors: KHAN M.ASGHAR , HANIF M. DANISH , IQBAL M.RASHID
Published: September 2021

There is increase incidence of Lower Segment Caesarian section (LSCS) being performed under sub-arachnoid block (SAB)because it is relatively safe. One of the complications of SAB is Post Dural Puncture Headache (PDPH) which is very distressing to the patient.Objective: To observe the incidence of PDPH by using two different types of spinal needle of 25 gauge in females undergoing LSCS underSAB. Currently, in our setup 25G cutting (quincke) spinal needle is routinely used. Study design: Randomized controlled trial. Setting:Department of Anesthesia, Officers Family Hospital, Rawalpindi Cantt. Duration of study: 6 months from 15 February 2011 to 15 July 2011.Material and Method: 100 pregnant patients undergoing elective CD under spinal anaesthesia were randomized into two groups A & B. GroupA received SAB with 25G Quincke needle; Group B- received SAB with 25G pencil-point needle. Follow up was done upto 72 hours after thesurgery. Data obtained through study was analysed through computer software SPSS version 12. Quantitative variables like age, weight andheight are presented as mean and standard deviation. The frequency of PDPH was qualitatively analysed in percentage. The frequency ofPDPH was compared between two groups with the application of Chi-square as test of significance at P- value<0.05. Results: It was found thatthe incidence of PDPH with Quincke (cutting tip) needle was significantly higher (7.%) as compared to pencil point needle (0%). Conclusion:pencil-point spinal needle is associated with lesser incidence of PDPH and should be preferred to Quincke needle to achieve SAB in patientsundergoing LSCS.
MULLERIAN DUCT ANOMALIES;
Authors: ARA SARWAT , ALI TASNEEM
Published: September 2021

Background: Müllerian duct anomalies (MDAs) occur with an incidence estimated to be 4.3%. A unicornuate uterus with orwithout a rudimentary horn; is a type of mullerian duct abnormality with a frequency of 0.4%. Rudimentary horn pregnancies are rare obstetriccomplication and may cause difficulty in diagnosis and subsequent management. Objective: To alert about Mullerian duct abnormalitiesespecially unicornuate uterus with or without rudimentary horn. Design: Case series. Setting: Study was conducted in the department ofGynecology and obstetrics unit1, Allied Hospital Faisalabad. Duration of study: Cases detected during September 2006-0ctober 2011.Subjects and methods: All admitted cases of MDA whether obstetric or gynecological were included. We calculated cases of unicornuateUterus with or without rudimentary horn, also included cases of rudimentary horn pregnancy with or without rupture. Results: There were120cases of MDA out of which 8 (6.6%) were of unicornuate uterus. Out of 8 unicornuate uteri, 7/8 (87.5%) were with rudimentary horn and1/8(12.5%) without rudimentary horn. Left rudimentary horn in 4/8 patient (50%), right in 3/8 (37.5%) without horn1/8 (12.5%).Out of 7 rudimentaryhorn 1/7 gynecologic and 6/7 were obstetric, 5/7 (71.42%) ruptured in second trimester, and1/7 (14.28%) term pregnancy. In 1/7 (14.28%) hornnot removed because tubal ligation was done. Unilateral renal agenesis was present in 3/8 patient (37.5 %). Ovaries were preserved in 3/7patients (66%). Conclusions: There must be high index of suspicion for Mullerian duct abnormalities especially rudimentary horn for achievinggood success in diagnosis and management.
DENGUE HEMORRHAGIC FEVER / DENGUE SHOCK SYNDROME
Authors: RASHID AMIR , IQBAL KHAN HUMAYUN , UR-RASOOL NADEEM-
Published: September 2021

Objective: To study the clinical spectrum of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) in childrenadmitted in a tertiary care center during 2011 dengue epidemic in Lahore. Setting: This study was conducted in department of PediatricsLahore General Hospital (LGH) / Postgraduate Medical Institute (PGMI) Lahore, Pakistan. Design: Retrospective descriptive study. Period: 1stAugust to 31st October 2011. Method: All the children (<18 years) with clinical features of Dengue Hemorrhagic Fever and Dengue shockSyndrome (DHF/DSS) admitted to the Pediatric ward Lahore General Hospital, Lahore during the period of 1st August to 31st October 2011were enrolled in the study. The clinical manifestation were recorded on a standard questionnaire form. Clinically DHF/DSS cases wereconfirmed in the laboratory by different investigations. All the patient were diagnosed, managed and discharged according to WHO protocol.Results: A total of 254 patients were admitted in the ward labeled as dengue fever (DF) clinically. Out of these 142(55.9 %) were confirmed byserology. Of 254 DF cases 37(14.57%) were labeled as DHF and 02(0.79%) as DSS on their clinical manifestations and fulfilling the WHOcriteria. 55% were male and 45%females. Common symptoms were fever seen in 100%, headache 71.79% and vomiting seen in 58.97% of thecases. The most common bleeding manifestations were epistaxis seen in 69.23% of the cases. Positive IgM was noted in 53.9% and IgG in36.6% cases. A decrease in platelet count and increase in Heamatocrit ( Hct) during stay in ward was noted. Out of 39 patients only one patientexpired (2.56%).
RECONSTRUCTION OF NASAL ALAR DEFECT;
Authors: WAHID FAZAL I , KHAN ADIL , AHMAD KHAN IFTIKHAR
Published: September 2021

Objective: To assess the outcome of nasolabial flap for ala plasty in patients with alar defect. Design: Descriptive study.Setting: Department of E.N.T, Head & Neck Surgery Postgraduate Medical Institute (PGMI) Lady Reading Hospital (LRH) Peshawar. Period:January 2006 to December 2007. Material & Methods: In this study we included 35 patients. A detailed history and thorough physicalexamination regarding general condition of the patient and specifically E.N.T of the patient with emphasis on the alar soft tissue deformity, bothfrom cosmetic and functional aspect was recorded on preformed proforma. Pre-operative and post-operative photographs were taken aftertaking written consent from all the patients. All procedures were carried out under local infiltrative anesthesia and were covered by intravenousprophylactic antibiotics. These patients were followed at one month, six month and one year intervals. Result: Our study included 35 patients ofnasal ala plasty with superiorly based nasolabial flap. Out of 35 patients 26 (74.29%) were males and 9 (25.71%) were female with female tomale ratio of 1:2.8. Males dominated nasal deformity as males are more exposed to trauma. Average age in males was 47 years (range 24-70years) and in females it was 48.5 years (range 27-70 years). The patients presented with nasal alar deformity in the age range from 25 to 70years, while 19 patients (54.28%) presented during 31 to 50 years of age. Trauma was dominated (n=28, 80%) among the causative factors foralar soft tissue loss in these 35 patients. Twenty-eight (80.00%) patients were fully satisfied both cosmetically and functionally, 04 patients(11.42%) were partially satisfied only cosmetically and 03 patients (8.57%) were not satisfied with their nasal cosmetic improvement andfunctional results. Conclusions: Nasal ala plasty with superiorly based nasolabial flap provide good cosmetic result with minimalcomplications.
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY;
Authors: HUSSAIN RAJPAR ZAKIR , PARYANI JAI PAL , REHMAN MEMON SHAFIQUE-UR- , Abdullah Aziz , Shaikh Ubedullah
Published: September 2021

Objective: To determine the efficacy of Alpha blocker as adjunctive medical therapy , which increases the stone clearance afterextracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Design: Quasi Experimental study. Setting: Department of Urology,Liaquat National Hospital, Karachi. Period: September 2010 to March 2011. Materials & Method: Ultrasound guided Dornier Alpha Impactlithotripter was used for shock wave lithotripsy. Study was carried out on 60 patients who underwent single session of ESWL for renal calculus.Patients were divided in two groups, Group A (n=30) received conventional treatment and Group B (n=30) received Alpha-1 Blocker in additionto conventional treatment. All patients were evaluated with X-ray and Ultrasound (KUB) after 2 weeks and repeated at the end of month. Failureis defined as unsuccessful expulsion after 4 weeks and patient desire to remove the stone before day 30. Result: Out of 60 patients, 45(75%)were males and 15(257%) were females with male to female ratio was 3:1. The average age of the patients was found 36.32 ± 14.8 (Rangingfrom 15 to 75) years. Complete clearance was achieved in 76.7% of those receiving Alpha-1 Blocker and in 46.7% of controls at 1 month (P =0.001). This difference was statistically significant. Conclusions: The results of my study demonstrate that Alpha-1 Blocker therapy, as anadjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equallysafe.
CHRONIC OSTEOMYELITIS;
Authors: ALI SHAH FAAIZ , KHAN ZAHIR , ALI WAHID , Ali Durrani Zulfiqar
Published: September 2021

Objectives: To determine the causative organism of long bone chronic osteomylitis through culture of the sequestrum. Studydesign: Descriptive case series. Setting and duration: Orthopaedic Surgery Unit, Mardan Medical Complex Teaching hospital, Bacha KhanMedical College, Mardan, KPK, Pakistan from September 2011 to April 2012. Methodology: Twenty five patients with radiologically provenchronic osteomyelitis of long bones who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot, decubitusulcers, and infected implant. At least one specimen of sequestrum was taken from each individual and subjected to complete microbiologicanalysis. Results: Staphylococcus aureus was the most frequently found organism (n=11, 44%), followed by Enterobacteriaceae (n=5, 20%),coagulase-negative staphylococci (n=3,12%) Escherichia coli (n=2, 8%) P aeruginosa (n=1, 4%), Streptococcus species (n=1, 4%) and nogrowth (n=2, 8%).More than one microorganism was isolated in two (8%) patients. Conclusions: Staphylococcus aureus was the mostcommon organism isolated. Sequestrum culture provides accurate identification of causative bacteria.
HYPOALBUMINEMIA;
Authors: ASIF Muhammad , MUSTAFA GHULAM , HAQUE TASEER IJAZ-UL-
Published: September 2021

Objective: To determine the frequency of low voltage ECG in hypoalbuminemic patients. Study Design: Descriptive crosssectionalstudy. Setting: Nishtar Hospital Multan. Duration of study: April 2010 to September 2010. Sampling technique: Non-probabilitypurposive sampling. Methodology: One hundred and fifty patients of hypoalbuminemia were registered after taking informed consent forparticipation. Serum albumin was done in all the cases. All the patients under went ECG. QRS wave amplitude was measured from standard 12leads ECG’s using clippers and magnifying glass within 24 hours of test for serum albumin. All information were entered in a specially designedproforma. Data entered and analyzed through SPSS-11. Results: One hundred and fifty patients of hypoalbuminemia were included in thestudy. The age range was 18-90 years with mean of 47.28± 21.80 years. There were 87 male and 63 female patients. Sixty eight (45.33%)patients with hypoalbuminemia developed low voltage ECG. Among them 37 (54.41%) were male and 31 (45.58%) female. Liver dysfunction,renal dysfunction, malnutrition and pre-eclampsia were common causes of hypoalbuminemia and present in 47 (31.33%) ,35(23.33%),15(10.00%) and 7(4.66%) of patients respectively. Conclusions: Low voltage ECG can be seen in hypoalbuminemia. So while interpretinglow voltage ECG, the physician should keep in mind the hypoalbuminemia as one of the causes and should detect it first rather thanundertaking sophisticated and unnecessary expensive investigations to rule out cardiac pathology.
LEUKEMIA;
Authors: KALSOOM MISS , DEEBA KHAN Farah , NOREEN MISS SONIA , Javed M. Zaigham
Published: September 2021

The present work was undertaken to analyze qualitatively the serum electrolyte (K+, Na+, Mg2+, PO43- and Cl-) levels byphotometric analysis in cancer patients as compared to non-cancer individuals. An understanding of the mechanisms involved in diseasepathogenesis is paramount for prevention and treatment in cancer patients. Material and Methods: Total 120 blood samples were collected foranalysis randomly which were divided into two groups as A (leukemia patients) and B (normal individuals) having 60 in each. Both of thesegroups were further sub-divided (20 each) into three age groups (20-35, 36-50 and 51-70) A1, B1, A2, B2, A3, B3 respectively. Results: Asignificant (p<0.05) increase in serum K+ level (hyperkalemia) was observed in cancer patients as compared to normal individuals having a nonsignificant (P>0.05) interaction with the age limits. However a significant decrease (P<0.05) in the levels of Mg2+, PO43- and Cl- (hypomagnesia,h pophosphatemia and hypochloridemia respectively) was recorded in group B as compared to group A having independency of age limits.Conclusion: Low serum Na+ (hyponatremia) was observed in Group B3 as compared to Group A3 (51-70) except the age limits (20-35 and 36-50) which showed a non significant interaction with this decreased level of sodium. The data was statistically analyzed by ANOVA and a highlysignificant (P< 0.05) difference was obtained between both of the groups.
CARDIOVASCULAR HEALTH KNOWLEDGE OF PATIENT ATTENDANTS IN SOUTHERN OF IRAN, SHIRAZ
Authors: CHOHEDRI ABDUL HAMEED , MASJEDI MANSOUR , EGHBAL MOHAMMAD HOSSEIN
Published: September 2021

Background : Knowledge about coronary artery disease and it’s risk factors is a very important factor in prevention of ischemicheart disease. The aim of this study was to investigate knowledge of patient attendants about coronary artery disease and its risk factors insouthern of Iran; Shiraz. Design: Cross sectional study. Setting: Shiraz University of Medical Sciences. Materials and Methods: 800 patientattendants (persons accompanying patients) selected randomly and divided into two groups (study and control) each including 400 patientattendants. Face to face interview was done and knowledge was measured by correct answers to our standard questionnaire. Results: Themedian knowledge score was 6.89 for study group and was 2.82 for control group out of a possible maximum of 15. Majority of respondents instudy group could identify up to three risk factors for coronary artery disease, but in control group could identify only one risk factor. About 5.8%in study group and 37.5% in control group were not able to identify even a single risk factor for coronary artery disease. Conclusions:According to our results there is a big gap in knowledge about coronary artery disease and it’s risk factors in our population. It means that moreeducational programs are needed to prevent the increasing rate of coronary artery disease.
INTRA-OPERATIVE HYPOTENSION;
Authors: KHAN MUHAMMAD ASGHAR , SHUJAAT SABIHA , IQBAL MUHAMMAD RASHID , Hanif Muhammad Danish , Ahmed Aijaz
Published: September 2021

Objective: To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuingtheir routine dose of angiotensin system inhibitor therapy before surgery. Study design: Cross-sectional study. Setting: Department ofAnaesthesiology, Combined Military Hospital, Quetta. Duration of study: One year from 20-08-2010 to 19-08-2011. Subjects and methods:Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for atleast 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Results: Mean age of the patients was 47.70±8.47years. Out of 92 patients, 38 patients (41.3%) were male while remaining 54 patients (58.7%) were female. Distribution of cases by hypotensionafter induction of anesthesia shows, hypotension at 30 minute in 55 patients (59.8%) and hypotension at 60 minute in 37 patients (40.2%). Outof 55 hypotensive patients (at 30 minute) 17 patients (30.9%) had mild hypotension, 32 patients (58.2%) had moderate hypotension and 6patients (10.9%) had severe hypotension. Out of 37 hypotensive patients (at 60 minute) 8 patients (21.6%) had mild hypotension, 25 patients(67.6%) had moderate hypotension and 4 patients (10.8%) had severe hypotension. Conclusions: Hypertensive patients continuing theirroutine angiotensin system inhibitors therapy (<10 hr preoperative) have a variable risk of developing moderate hypotension within 30 minutesafter induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy.
AFP SURVEILLANCE;
Authors: KHAN HAMZULLAH , AFRIDI SARFARAZ KHAN , ISLAM OBAID UL
Published: September 2021

Objectives: To determine the status of the AFP surveillance system at Mohmand agency FATA in a sense to improve thesensitivity of the system in 2012. Design: Retrospective study. Setting: Mohmand agency FATA. Period: Jan-Dec 2011. Methodology: Therelevant information were recorded from the Rec files of these cases in accordance to the objectives of the study. Results: A total of 25 caseswere reported in 2011 in Mohmand agency as AFP cases. Eleven were females (44%) and 14(56%) were males. The age range of thesepatients were from 6 months to 14 years of age. Mean age with SD was 37.12+33 months. Four cases were confirmed polio type 1 wild typecases. The frequency of cases reported from various tehsils were: safi (36%), Pindialy and ekka ghund, Halimzai 16%, Prang ghar andambar4%, and Khweze/baizai 8%. Fourteen (56% cases) reported as urgent cases. Majority of the cases (28%) were injection neuritis, 20%cases diagnosed as traumatic neuritis, 4% as Guillain barre syndrome, and 8% as meningitis. 16 cases were cross reported from otheragencies and the remaining from the agency itself. Ghallani AHQ Hospital, RHC Ekka ghund and Mechany BHU are main diagnostic andreferral centers for AFP in the agency. The lab results reported 4 cases with P1 wild type virus. Conclusions: We have at time a bit weaksurveillance system for AFP and the agency being a part of FATA and its security volatile situation, all makes it more suitable for the polio virusto circulate. There is low level of awareness and stigma associated with Polio vaccines which is alarming for public health workers. The crossreported cases ration is more which shows bit weak catch up at station level.
LOCAL FLAPS AND SPLIT;
Authors: ISHAQ IRFAN , AHMAD AWAIS , QADIR FYYAZ GHULAM
Published: September 2021

Background: Two point discrimination (TPD).is the minimum distance between two stimulus points on the skin, which areperceived as distinct points, Among the two types of TPD i.e., static and dynamic, static two-point discrimination (STPD) is commonly used todetermine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two point discrimination incontrast to s-plit thickness skin grafts (STSG). Objective: The objective of this study was to determine the frequency of sensory deficit in termsof TPD in STSG and local flaps for soft tissue defects of fingers after three months. Study design: It was a Quasi experimental study. Settings:Patients admitted in the indoor of Plastic surgery department, Services Hospital Lahore. Period: February 2009 to January 2010. Material andMethods: Thirty five patients underwent local flap coverage and other thirty five underwent split thickness skin grafting for soft tissue defects offingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. Results: The sensory deficit observed at the end of12th week post operatively was in 8.6% of the patients with local flap coverage (3 patients) and 45.7% of those with STSG (16 patients).Patients with no sensory deficit were 91.4% (32 patients) in the local flap coverage and 54.3% (19 patients) in the STSG at 12th week of followup. The relative ratio of sensory deficit in local flaps and STSG was 5 (>2). Conclusions: The results of this study show that Local flaps arebetter options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.
CORONARY ARTERY DISEASE IN THE ELDERLY
Authors: ASLAM KHATTAK ZAHOOR , Khan MUHAMMAD QAISER , SHARIF KHAN HAMID , Islam Zafar Ul
Published: September 2021

Objective: The objective of our study is to assess the severity of coronary artery disease in the elderly and predict the safetyoutcome of coronary angiography. Study design: A cross sectional observational study. Setting: AFIC/NIHD Rawalpindi. Period: February2011 and August 2011. Method: The study population included 100 elderly patients (age>60years) undergoing coronary angiography.Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailedangiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronaryarteries (>50% for the left main coronary artery). We attempted to quantify the “severity of CAD” by ascertaining the prevalence of high-riskcoronary anatomy (HRCA, defined as >50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease).More than 70% stenosis in more than one coronary artery was considered as severe coronary artery disease. Results: Our study cohortcomprised of 100 consecutive subjects 82 (82.0%) men and 18 (18.0%) women with a mean age of 78.6 years (Range 70 years - 94 years). 77patients (77.0%) had severe coronary artery disease; 50 with triple vessel coronary artery disease (TVCAD) 1 with TVCAD with Left Main StemDisease, 26 had double coronary artery disease (DVCAD). 12 patients (12.0%) had moderate coronary artery disease with single vesselinvolvement (SVCAD), 6 patients (6.0%) had subcritical coronary artery disease with < 60 % stenosis in any of the vessel while only 5 patients(5%) had a normal coronary angiogram. Conclusions: Patients of elderly age group have more severe CAD and coronary angiography is arelatively safe procedure.
REAL TIME PCR;
Authors: RAZA ABIDA , A KHATTAK NAUREEN
Published: September 2021

In recent years, real-time PCR has come forward as a robust and widely used molecular technique in clinical and biologicalsettings. Although it can detect very minute quantities of target nucleic acid, but quantification of specific nucleic acids is not an easy task.Accurate and precise quantification is hampered by a number of factors that may include assay development and validation, fluorophoresselection, handling during sample preparation, storage, reaction procedures, and batch analysis conditions. Even minor variations aresignificantly magnified by the exponential nature of this technique. Current review gives an insight of the advantages, limitations, assaychemistries, quantitation parameters, and quality control issues related to this technology. Moreover it will also highlight the utilization of Realtime PCR in clinical oncology, virology, microbiology, and gene expression studies.
NEONATAL TETANUS
Authors: ZAFAR FAUZIA , RASHEED JAVARIA , GHAFFAR HAFIZ ABDUL
Published: September 2021

Objective: To determine the prevalence of neonatal tetanus and frequency of factor leading to neonatal tetanus in patientsvisiting to Nishtar Hospital, Multan and comparing this data with the past since 2002. Duration: January 2009 to December 2011. StudyDesign: Descriptive study (cross-sectional). Results: In this study 64 patients with neonatal tetanus were observed over a period of 03 yearsfrom January 2009 to December 2011. The ages of babies were from 3-28 days. Mean age was 7.89 + 1.23 days the total number of cases rosesignificantly from 0.8% of total admission in 2002 to 1.71% in 2011. The commonest risk factor was delivery of baby conducted at home (100%).2nd commonest factor was non immunized mothers, 95% of mothers were non immunized against tetanus in pregnancy. 5% were eitherpartially immunized (received one dose of T.T) or showed vaccine failure despite 2 doses of immunization. In 80% of the cases there wereunskilled birth attendants who conducted deliveries. Among tools which were used to cut umbilical cord, blades were 45% knives were 30%,and scissors were 25%. Ghee application on cord was found to be present in 30% of the cases. While Surma applied on cord was 40%. As far assex is concerned, 45% cases were females and 55% cases were males. Majority (70%) of cases were of normal birth weight (>2.5kg) while30% cases were of low birth weight (<2.5kg). Inability to take feed/lock jaw (95%), and fits (96%) were the two most common symptoms. Otherless common symptoms were fever (70%) and generalized stiffness (85%). All the patients were born at home by spontaneous vaginal delivery.Conclusions: The number of neonatal tetanus cases are increasing progressively despite the claims of wide coverage of Tetanus ToxoidVaccination of female population by EPI. In our setup the factors which lead to Neonatal Tetanus are; non immunization of mothers duringpregnancy, home delivery, delivery by non skilled birth attendants, application of ghee/surma on umbilical cord and cutting of umbilical cord byunsterilized tools (scissors, kitchen knife, blade). If proper immunization antenatal care and hygienic delivery practices are followed and allthese factors are overcome, disease can be controlled and mortality can be reduced.
ANAL FISSURE;
Authors: ALI SHAUKAT , KHAN MUHAMMAD AZIM , NIZAMI SHAHID MANSOOR
Published: September 2021

Objective: To know the outcome of treatment of chronic anal fissure. Setting: Nishtar Hospital, Multan. Period: January 2011 toJune 2011. Material and methods: A total of 100 patients attending surgical OPD were included in the study. Results: Out of 100 patients, 73(73%) were male and 27 (27%) were female patients. Majority of the patients were from the age group 31-40 years. At posterior midline fissurein ano was present in 91 (91%) patients and at the anterior midline it was in 9 (9%). Pain defecation was seen in all patients, constipation in 95(95%) patients whereas bleeding from rectum in 72 (72%) patients. Conclusions: It is concluded that in patients with chronic anal fissure,chemical sphincterotomy with topical nifedipine ointment is a non-invasive and effective modality.
MATERNAL MORBIDITY AND MORTALITY;
Authors: JABEEN SALMA , MEHMOOD CH. SOHAIL , FARIDI SARWAT , Ahmed Afzaal
Published: September 2021

Objective: To assess the demographic features of unsafe abortion and associated maternal morbidity and mortality, andavailability of post abortion care. Study Design: A Case-Series. Place and Duration of Study: The study was carried out in Gynae Unit-1 ofBahawal Victoria Hospital (BVH), Bahawalpur from 1st January 2009 to 31st December 2009. Material and Methods: Patients admitted withcomplicated unsafe abortion were evaluated regarding age, parity, marital status, educational status, socio-economic status, indication ofabortion, qualification of abortionist and method used for abortion, contraceptive usage, immediate complications and death rate in abortionseekers. Descriptive statistics were used for describing variable. Results: 119 patients were admitted with unsafe abortion. The mean age was28.5 years. 90.8% women were married, 59.6% multiparous, 21% got secondary and higher education, 62 belonged to poor socio-economicstatus. In 72% cases unsafe abortion was done during 1st trimester and 80% of women had previous history of unsafe abortion, 95%approached unqualified / semi skilled abortion providers who used instrumentation in 53% cases. The most common reason for abortion wasmultiparity (48%),& poor socio-economic status (19%), only 26.5% were using some kind of contraception. Most common complications werecontinued ongoing haemorrhage (incomplete abortion in 44%), followed by septic complications in 25% of cases and trauma to urogenital tract(22%) which also involved gut in 6% of cases. 2.5% patients reached in very critical stage & could not survived. Post abortion care provided toall patients of which 22% managed conservatively & 78% managed surgically. Contraception services offered to all but 24% refused themtotally. Conclusions: Unsafe abortion constitutes a major threat to health and lives of women. Most of them are multiparous, married at peak oftheir reproductive life and belong to poor economic status. The associated immediate morbidity is much higher than mortality in terms ofcontinued haemorrhage, sepsis, and trauma. The study focused on the need of post abortion care and easy accessibility to contraception toimprove quality of life.
FRACTURES IN CHILDREN;
Authors: - KIFAYATULLAH , DAD KHAN HAZIQ , ALI SHAH FAAIZ
Published: September 2021

Introduction: The epidemiology of orthopedic and traumatic disorders is as important as that of communicable diseases andas that of surgical audit. Some sort of surveillance system is essential for this purpose. Design: A retrospective study. Period: Jan 2001 to June2006: Setting: Orthopedic unit at THQ Hospital Tangi. Results: The population of adults and children less than 16 years in the populationstudied is 57% versus 43%, while the fracture rates were 40% and 60% respectively. In children under 16 years fractures of the radius and ulnawere the most common followed by fractures of the distal end of the humerus i.e. 45.93% and 33.40% respectively in the upper limb injuries.Discussion: Comprehensive data regarding orthopedic disorders are few5. Studies of specific injuries and specific age related disorders areeven more limited. Fractures rates vary across a country and similarly it is variable in different seasons13.
MILLENNIUM DEVELOPMENT GOALS;
Authors: SULEHRI MUHAMMAD ANWAR
Published: September 2021

Background: The Maternal mortality rate in Pakistan remains unacceptably high Objectives: To study the awareness ofimmunization and breast feeding and the utilization of family-planning methods by the women of rural districts of Punjab, Pakistan. StudyDesign: A Cross-sectional study. Setting: The study was conducted in Vehari and Chakwal districts of Punjab, Pakistan. Period: May-July2010. Methodology: A total of 100 women were included in the study. Data was collected, cleaned, tabulated and analyzed. Results: Amongthe hundred sampled women 58 (58%) were educated, and the commonly involved age group in the sample was 21-30 year accounting for59% of the women. Among these 61% of the women have visited a family planning center, while the contraceptive prevalence rate (CRP) IS39%. Thirty eight (54%) out of the 70 multi-parous women have given birth with an interval of approximately 2 years. Only 6 (8.75%) have anoptimum (safe) interval of 3 years. Among the total 90 child bearing women 74(82.22%) have got vaccinated their children, 46 (62.16%) ofthese are completely vaccinated according to the information obtained from the EPI vaccination cards. Among the 13(17.56%) who haven’tvaccinated their children 10 (62.5%) complained of lack of awareness regarding the importance of vaccination. Five (31.25%) complained ofinaccessibility to the BHU. Out of the 90 interviewed women 61 (67.7%) were vaccinated with tetanus toxiod during pregnancy. 82 (82%)women are aware of the benefits of breast feeding. 88(97.7%) out of total 90 child bearing women have breast fed their children with thepercentage decreasing to 83.33% after 6-11 months of age and only 39(43.33%) counting breast till 1.5-2year (optimum age) of age.53(58.88%) started weaning their child between 6-11 months of age. Direct causes of Neonatal Deaths were, 30% birth asphyxia and injuries,35% due to infections (tetanus, sepsis , pneumonia, diarrhea), 20% due to complication of pre-maturity, 5% congenital anomalies and 20% dueto other causes. Conclusions: There’s a need for mass education regarding EPI and it’s compliance so that the target set under MDGs isachieved. Though women of the rural areas are aware of the advantages of breast feeding there is a lot of variation in the duration that thechildren are breast fed and weaned, so there is a need for the provision of standardized nutritional to the mothers by the health workers.
PROPARACAINE;
Authors: SALEEM MUHAMMAD IMRAN , SALEEM MUHAMMAD FARHAN , ARSHAD MUHAMMAD
Published: September 2021

Objective: To evaluate the efficacy of proparacaine 0.5% as a topical anesthetic in pterygium surgery. Study Design: Quasi-Experimental study. Place and Duration: Eye Unit-II, Bahawal Victoria Hospital, Bahawalpur, from December 2010 to April 2011.Methodology: Thirty patients affected by primary pterygium underwent pterygium excision under topical anesthesia using proparacaine 0.5%eye drops. Pterygium excision was performed along with dissection of the degenerative conjunctival tissue, scraping of the corneal surface withsurgical blade No.15, meticulous dissection of the underlying Tenon's capsule, preparation of a free conjunctival graft from the superotemporalsector of healthy conjunctiva, and positioning of this graft to the area of bare sclera using 6/0 vicryl suture. Computer software SPSS (version10) was used to analyze the data. Results were considered statistically significant at p<0.05. Results: It was possible to perform all theprocedure under topical anesthesia using 0.5% Proparacaine eye drops without a need of supplemental subconjunctival or peribulbaranesthesia. Pain reported by the patients, recorded by a Visual Analog Scale (VAS) with 0-4 grades, and was mild to moderate during the entiresurgical procedure. Conclusions: Topical proparacaine 0.5% is a safe and effective anesthetic in pterygium surgery. The long lastinganesthesia with this agent permits performing the surgical procedure with low pain felt by the patients with a resultant low surgical invasivity anda short duration of surgery.
EFFECTS OF TRIBULUS TERRESTERIS;
Authors: JABBAR Abdul , NAZIR ABIRA , IQBAL ANSARI NAVEED , Javed Farooq , Janjua Khalid Mahmood
Published: September 2021

Objective: The objective of this study was to find the effects of herbal extract of tribulus terristris on the urine output andelectrolytes in rabbits and to find a herbal remedy for fluid and electrolyte abnormalities. Study design: Descriptive. Setting: Department ofPharmacology and Therapeutics, Post Graduate Medical Institute, Lahore. Period: The duration of study was for two weeks (in 2003). Materialand methods: Sixteen rabbits of mixed breed were purchased locally and kept in the animal house of Postgraduate Medical Institute, Lahorefor a week for acclimatization before starting the experiment. Twelve hours light and dark cycle was maintained. They were fed on grass, grain,seasonal vegetables and water adlibitum. Animals were weighed for calculation of dosage of herb.
SEPTICEMIA;
Authors: TEHSEEN SAEMA , WAHEED AFIFA , SHAMI NABEELA
Published: September 2021

Induced Miscarriage is defined as the elective termination of pregnancy before 24 weeks of gestation. Objectives: To determinethe frequency of sepsis associated with induced Miscarriage. Study Design: Cross-sectional survey. Setting: Department of Obstetrics andGynaecology, Unit-II, Ghurki Trust Teaching Hospital, Lahore. Duration of Study: Six months from 25-12-08 to 24-06-09. Materials andMethods: Total 110 cases were taken. Complete history including parity and mode of admission was taken. All information was recorded onspecially designed proforma. Results: A large number of patients turned out to be para 3-4 i.e. 87 (79%), 15 cases (13.7%) had the paritybetween 5-7 and only 8 cases (7.3%) were para 1-2 (Table-I).On analyzing the mode of admission it was found that 50 (45.4%) patients wereadmitted through out-patient department. 60 cases (54.6%) were admitted through emergency (Table-II). Finally the frequency of sepsisamongst women presenting with Miscarriage was calculated and it was found to be 25 (22.7%). 85 (77.3%) cases did not show any evidence ofsepsis (Table-III). Conclusions: Illegal Miscarriages are a major contribution to septic morbidity leading to a large number of maternal deathswhich is a dilemma in under developed countries like ours. Better public awareness and access to contraceptive measures has a definite role toplay in improving the outcome.