bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of Laparoscopic Cholecystectomy: 5 years experience in a University Hospital
Authors: Guraya Salman Yousuf , Khairy Gamal Eldin A , Murshid Khalid Rida
Published: June 2016

All patients, who underwent laparoscopic cholecystectomy for cholelithiasis, from September 1998 to September 2003 were retrospectively reviewed. There were 549 patients and out of those, 507 were female and 42 male subjects. The age ranged from 17-71 years for females and 18-69 years for male patients: median age 41.4 years. 476(86.7%) cases presented with chronic cholecystitis, 63(11.4%) acute cholecystitis, 6(1%) mucocele of the gallbladder and 2(0.4%) had empyema of the gallbladder. Sixteen cases were converted to open cholecystectomy (conversion rate of 2.9%) with a success rate of 97% for laparoscopic cholecystectomy. The reasons for conversion were found to be 8(1.4%) difficult dissection, 4(0.7%) bleeding from cystic artery, 2(0.3%) suspected duodenal injury, 1(0.1%) suspected colonic injury and 1(0.1%) Mirizzi`s syndrome. Postoperative hospital stay ranged from 1-13 days (mean 1.23). Atelactasis was reported to be the most frequent complication found in 9(1.6%) patients followed by deep vein thrombosis and subumbilical wound infection noted in 6(1%) cases each (P<0.00). Four patients had common bile duct injury and one case sustained common hepatic duct injury. All these patients had successful Roux-en-Y hepaticojejunostomy. There was no mortality in this series. Laparoscopic cholecystectomy is a safe and feasible procedure and should be the first line of treatment for symptomatic cholelithiasis.
DCR Local anesthesia (A new technique)
Authors: Sahaf Imran Akram
Published: June 2016

In DCR local anesthesia achieves dual purpose. Firstly, it helps in anesthesia. Secondly, Adrenaline added to the anesthetic agent creates decongestion, which helps in an avascular operation field. The old technique involves an injection of large amount of anesthetic agent, which can result in lignocaine reaction, and adrenaline associated problems. In the new technique only 1.5-2.0 ml of local anesthetic agent is injected which is highly safe and effective. There is also minimal distortion of local anatomy. In this study, two hundred and sixty five patients were given local anesthesia with new technique. Only six needed to have their anesthesia repeated, sixteen had a persistent ooze. No one had adrenaline related problems. This technique is a safe and effective way of providing anesthesia for DCR.
Risk of recurrence of preterm Premature Rupture of Membranes in subsequent pregnancies
Authors: Malik Aysha
Published: June 2016

The study was designed to estimate the risk of recurrence of preterm premature rupture of membranes in subsequent pregnancies. 121 patients with idiopathic PROM were followed up over two or more subsequent pregnancies and the problem recurred in 39 patients, for a rate of 32.2%. Various demographic data and characteristics of the index pregnancies were compared to identify a sub-group of patients at higher risk of recurrence in an attempt to prevent problem of prematurity.
Lateral internal sphincterotomy V/S anal dilatation
Authors: Zahra Farogh , Majid Abdul , Waheed Muhammad , Chohan Shabbir
Published: June 2016

Objective: To compare the two surgical procedures performed for the treatment of fissure in ano. Design: Clinical trial Setting: Surgical Unit-III, Sir Ganga Ram Hospital, Lahore. Subjects and Methods: Sixty female patients coming to the out door and emergency department of Sir Ganga Ram Hospital, were included in the study. Thirty patients had oper lateral internal sphincterotomy (LIS) and 30 had anal dilatation (AD). Results: LIS was associated with remarkably to incidence of post operative complications. The patients undergoing AD had more pain and bleeding per rectum in the postoperative period. Anal incontinence was seen in 59.6% of patients, prolapse of haemorrhoids in 40% and recurrence in 6,6%) operated for AD, while the corresponding figures for LIS were 6.6%, 10% & 0% respectively (p<0.05). Conclusion: LIS is a superior procedure to AD for the surgical treatment of fissure in ano. LIS should be adopted as a procedure of choice in uncomplicated fissure in ano.
Surgical management of simple Vesicovaginal fistulae
Authors: Mubeen Rana Muhammad , Naheed Farhat , Ashraf Rashid , Mallk Aftab All
Published: June 2016

Objective: Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital (F.G.S.H.); Islamabad, from February 2002 to January 2004. Patients and Methods: Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 (72.7%) patients while transabdominal repair was adopted in 3 (27.3%) patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. Results: The majority of fistulae (10 (90.9%)) were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One (9.1x) patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 (100%) cases of VVFs while in 6 (75x) of 8 (100%) cases through transvaginal route. To describe an overall result, 9 (81.8%) vesicovaginal fistulae were successfully repaired at first attempt. Conclusion: Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage.
Causes and outcome of suicidal cases presented to a medical ward
Authors: Shoaib Sara , Nadeem Muhammad Arif , Khan Zafar Ullah
Published: June 2016

Suicide is one of the leading causes of death in world but its causes and methods may vary. We enrolled patients who presented to the emergency with attempted suicide. The end point was death, discharge or leaving the hospital against medical advice. The study was designed to know the modes of committing suicide and underlying causes. Of the total 107 patients, who presented to the emergency 59 (55%) were males and 48 (45%) were females. Most common poison ingested was wheat pill in 35 (33.3%) patients followed by bleach/bathroom cleaner in 27 (25.7%), benzodiazepines in 20 (19%) and a small proportion of patients had copper sulfate, organophosphorus compounds, rat pills, lice powder, dettol and varnish. Two patients presented after hanging. Twenty eight (26%) patients died, just after reaching hospital and 10 had permanent disability. For suicide the most common poisons used were those that were easily available and without any ban on their sale. So general awareness should be created among masses about them and legal restrictions should be imposed on their sale.
Post operative maternal consequences of Cesarean Section
Authors: Khaliq Alia , Mehmood Hina , Zakia Ayesha Ibrahim
Published: June 2016

Objective: The objective of this study was to analyze Post-operative complication following Caesarean section and to find out the factors which can reduce maternal morbidity associated with Caesarean section. Study Design: Descriptive observational study conducted from September 2004 - February 2005. (6 month) in department of Obstetrics & Gynaecology, Lahore General Hospital, Lahore. Result: Total number of Births during this period were 2025 total number of Caesarean section were 597 (29.48%) out of which emergency Caesarean section were 518(86.7%) and elective were 79(13.2%). The Post-operative complication rate was (67.7%). The different complications encountered in post-operative period were anemia 58.86%, febrile morbidity 22.2%, endometritis 13.8%, urinary tract infection 10.6%, respiratory tract infection account for 7.4%, paralytic illeus 1.2%, wound infection 7.9%, postpartum haemorrhage (Primary or Secondary) 4,9%, one patient had strong suspicion of pulmonary embolism, sever headache due to postdural puncture was found in 3 patients. Other Anaesthesia complication and bladder injury incidence was about 0.74%. 2 maternal deaths occurred one due to sever postpartum haemorrhage and 2nd due to pulmonary embolism. Conclusion: Anemia and infectious morbidity was most common cause of morbidity following Caesarean section: regular antenatal care, good surgical techniques, antibiotic prophylaxis, proper aseptic measures, patient`s education and counseling can all work to reduce postoperative complications.
Thromboembolism in patients with Myocarditis
Authors: Sadiq Masood , Rathore Ahsan Waheed , Younis Mohammad , Haider Najam , Masud Farad , Rehman Asifur
Published: June 2016

Background: Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis (December 1999- Nov 04) of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and Methods: The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Results: Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 4 years. Systemic embolism was the presenting feature in 28 (6.9%) patients (Group A); while another 17 (4.2%) developed it during the hospital stay (Group B). Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction (EF) for those with vs. those without thrombo-embolism was 17.5 5.5 vs. 20.0 6.9 (p = 0.08). The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group.
Pregnancy in a patient with acute Porphyria
Authors: Tur Razia Eisha , Shaikh Muddassir Muhammad , Malik Samia
Published: June 2016

A 27 years old female was diagnosed to have acute intermittent porphyria in 1997. In 2002 she became pregnant. The first trimester was uneventful obstetrically but the duration, frequency and severity of porphyria attacks increased. As the pregnancy advanced to second trimester the condition of patient deteriorated. The symptoms were continuous with no period of relief. In the third trimester she became increasingly irritable and dyspnoeic, and developed facial edema, muscle weakness, and fecal and urinary incontinence. At 33 weeks of gestation USG showed absent liquor and decreased fetal movements; S/D (systolic diastolic ratio) was increased (>4.3). Elective Cesarean-section was performed at 33 weeks. Her condition settled in one week. Porphyria is an uncommon disorder. It affects women more frequently than men. Not only it has adverse effects on pregnancy but the frequency of porphyria attacks also increases during pregnancy. We herewith present a case report of a female with acute intermittent porphyria who conceived.
Analysis of maternal complications in cesarean section
Authors: Naz Farhat , Bagum Altaf
Published: June 2016

This interventional quasi experimental study was carried out at Gynaecology Department, Jinnah Hospital Lahore to determine frequency, indications of emergency and elective caesarean sections and to establish a comparison of maternal complications. During one year period July 2003-june 2004 total birth were 3932.955 women underwent caesarean section which makes the rate of 24.3% in our unit. Out of 955, 713(74.6%) were emergency and 242(25.4%) were elective caesarean sections. Common indications in emergency group were fetal distress (26.21%), repeat section (18.9%), failed progress of labour (14.3%) and malpresention (13%). In elective group repeat section (48.7%), malpresentation (17.3%), cephalopelvic disproportion (10.8%) antepartum haemorrhage (8.3%) were common indications. 490(93.2%) patients in emergency group required blood transfusions mainly due to anemia and 36(6.8%) patients in elective group were transfused mainly due to placenta previa.54 women faced intraoperative complications.54(93.1%) belong to emergency group and 4(6.89%) belong to elective group. caesarean hysterectomy were done in 6 patients in emergency group. post operative complications were encountered in 162 patients.150(92.6%) were from emergency and 12(7.4%) were from elective group. Infective morbidity constituted the major post operative problem.
In-hospital mortality of acute myocardial infarction in patients with and without renal dysfunction
Authors: Abid Abdul Rehman , Mohyuddin Muhammad Tahir , Ali Liaqat , Naveed Muhammad Shahid , Mallick Nadeem Hayat
Published: June 2016

Objective: To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Setting: Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. Study design: It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. Results: After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642(64.2%) while female patients were 358(35.8%). Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51(12%) in Group I patients, 46(16.6%) in Group II patients, 36(22%) in Group III patients, 35(27.7%) in Group IV patients and 5(35.7%) in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 (CI 2.2-12.1), moderate renal insufficiency OR 4.1 (CI 2.3-7.2) and mild renal insufficiency OR 1.9(CI 1.1-3.1) with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20(4.7%) patients in Group I, 17(6.1%) patients in Group II, 15(9.4%) patients in Group III, 16(12.6%) patients in Group IV and 4(28.6%) patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Conclusion: Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients.
Informed consent and medical ethics
Authors: Mahmood Kaiser
Published: June 2016

Medical ethics has a very long history and it investigates ethical issues arising in medicine and health care provision by applying the principles of moral philosophy. The ancient ethical codes were often expressed in the form of oaths. The best known medical oath in the western tradition is the Oath of Hippocrates and often regarded as the very foundation of Western medical ethics. The Hippocratic School produced a large body of writings on medicine, science and ethics. In the ensuing centuries the principles of Christian humanism dominated the practice of medicine. Towards the end of 18th century the role of physicians in dealing with disease in individuals as well as population groups led to the drafting codes of professional conduct. Changing attitudes of society and the major advances in medical science at the beginning of the 20th centuries led to recognition of the need for modification of the Hippocratic Oath. This need was met by the Declaration of Geneva, formulated by the World Medical Association in 1947, supplemented by Declaration on particular aspects of medical ethics. Now, the advanced medical technologies or revolutionary developments in the biomedical sciences as well as in clinical medicine and its communication to the public has led to a growing need for the medical professional to be fully aware of society`s views on various developments. This, no doubt, enables ethical guidelines to reflect and safeguard the interests and wellbeing of patients.
Glycopeptide sensitivity patterns in Staphylococci isolated from clinical specimens in a Tertiary Care Hospital
Authors: Majeed Muhammad Tahir , Izhar Mateen
Published: June 2016

Staphylococci are among the most important and common human pathogens worldwide. Their resistance to antibiotics is increasing. The glycopeptide antibiotics (vancomycin and teicoplanin) are the last resort to treat serious infections caused by these bacteria. During the last decade the strains of staphylococci have developed intermediate levels of resistance to teicoplanin and vancomycin. The objective of this study was to establish the prevalence glycopeptide resistance among clinical isolates of staphylococci in Shaikh Zayed Hospital, Lahore, and comparison of antimicrobial sensitivities of vancomycin and teicoplanin among these isolates. 75 (Seventy five) consecutive staphylococci isolated from clinical specimens received in the laboratory were collected and their sensitivity to antibiotics was tested by National Committee for Clinical Laboratory Standards (NCCLS) disk diffusion method. Results show that all staphylococci were sensitive to the glycopeptide antibiotics. This indicates that no high-level resistance to glycopeptide antibiotics in these organisms is present in our hospital. However, the emerging resistance in staphylococci against these drugs worldwide necessitates strict surveillance of these organisms, institution of effective infection control policies and judicious use of antibiotics.
A comparison of airway maintenance by cuffed Oropharyngeal airway (COPA) and laryngeal mask airway (LMA) in spontaneously breathing adult patients
Authors: Zia Ashraf , Chaudhry Tahir , Hussain Riaz , Ghalani Tafoorul Islam
Published: June 2016

In this study total hundred patients wee included. Fifty (group I) were subjected to COPA device for airway maintenance and in other fifty (group II) LMA was used. In this study first attempt successful insertion rate in group I was 90% while in group II it was 94%. However statistical analysis showed no significant different in both groups. Regarding maneuvers needed to maintain smooth breathing in group I head tilt was used in 2 %. It is significantly high in group I than in group II. Laboured breathing was seen in 6% in group I while 2% in group II. There was no significant difference in both groups. According to this study LMA is better in all respect as it is easier to insert and better fit in.
Pattern of upper gastrointestinal bleeding at Rahim Yar Khan
Authors: Chaudhary Abdul Waheed , Tabassum Hassan Mahmood , Chaudhary Muhammad Anwar
Published: June 2016

Design: It is a Prospective Observational case series. Place and Duration of Study: The study was conducted at Sheikh Zayed Hospital/Hamza Medicare Rahim Yar Khan, between January 1997 and December 2004. Patients and Methods; Consecutive 892 patients presenting with significant gastrointestinal bleeding, between January 1997 and December 2004 were recruited in this study. Source of active bleeding was defined by endoscopy. Results: Esophageal variceal bleed was the main finding 580, followed by gastric erosions 133 patients, Esophageal Ulcer 65, duodenal ulcer 61, bleeding gastric ulcer (26), Mallory Weiss Tear 21 and Osler Weber Rendu Syndrome/AV malformation 06 only. Conclusion: Esophageal varices are-real problem within our area but the scope has changed in the western world. Variations in disease pattern from time to time require the periodic studies to be aware of the current underlying mechanism of the ailments in the area of work. Total reliance on literature may consume local resources.
Epidural analgesia in labor in relation to the rate of instrumental deliveries
Authors: Javed Lubna , Salick Anbrin , Faruqi Naheed Jamal
Published: June 2016

Aims & Objectives: To study the effect of epidural analgesia (EA) in labour on the rate of instrumental deliveries Study Design: Clinical Trial / Case Control study. Study Settings: Labour ward of Jinnah Hospital, Lahore during one year period from July 2002 to June 2003. Patients and Methods: One hundred women in labor at term were divided into two equal groups. Group-I comprised of those women who were provided with epidural analgesia while group-II consisted of those women who had labour without the block. The anesthetist provided epidural analgesia using 0.125% bupivacaine and the obstetrician or midwife gave intermittent top-ups. Main Outcome Measures: The main outcome measures were the effect of epidural analgesia on the duration of second stage of labor and the rate of instrumental deliveries. The data was collected on a pre-designed proforma and was analyzed on computer software (SPSS). Ratio and proportions were calculated and Chi-square test was used to check significant association between the groups. P<.05 was considered statistically significant. Results: Gestational age, gravidity, duration of first stage of labour, and fetal outcome were comparable between the two groups. There was prolongation of second stage of labour (P < 0.05). 30% of the parturient in the group with epidural analgesia had second stage of <1 hour while there were 84 % of women in the control group who had second stage of <1 hour. 66% of the women in group I (EA) had duration of second stage of 1-2hours while in group-II 16% of women delivered in the same period. 4% of the women in the study group had second stage of >2hours while there was none (0.0%) who took >2hours in the control group. There was an increased rate of instrumental deliveries in patients with epidural analgesia (P<0.05). 40% of women had instrumental deliveries in the study group as compared to 10 % in the control group. Patient satisfaction was excellent among parturient given EA, 94 % of the parturient being very satisfied. Conclusion: Epidural analgesia along with an experienced anesthetist, a dedicated obstetrician and a trained midwife can convert the painful labour into a less stressful event. Although it prolongs the second stage of labour and increases the rate of instrumental deliveries yet its advantages of pain free labour, better psychological outcome and no significant complications outweigh these drawbacks.
Complications of repair of incisional hernia using polypropylene mesh
Authors: Waqar Tariq , Aslam Haji Sohail
Published: June 2016

Objective:- To find out frequency and type of complications after repair of incisional hernia using polypropylene mesh. Design:- It is a descriptive type of study. Place and duration of study:- This study was conducted in surgical Unit-I and Surgical Unit II Nishtar Hospital Multan from March 2003 to February 2005. Patients and method: After admission of the patient a detailed history, thorough physical examination was done and a proforma filled containing information about previous operation. Investigations like complete blood examination, complete Urine examination, random blood sugar level, X-ray chest, ultrasound were performed and patients put on the operation list. Polypropylene mesh placed in retromuscular plane and patients were observed for complications. Results:- Male to female ratio was 1:1.85. Age varied from 14-70 years. 32 patients (80%) were between the age of 31-60 years. 6 patients (15%) were between the age of 20-30 years 2 patients (5%) were between the age of 61-70 years. The approximate time interval between the initial operation and appearance of hernia, predominantly in all 40 patients was within first year following surgery, in fact 27 patients developed incisional hernia within first 3 months, incidence decreased gradually over subsequent years. The most common presentation was protusion of abdomen in all patients (100%) followed by vague abdominal discomfort in 36 patients (90%) and dragging pain at hernia site in 16 patients (40%). All patients underwent repair of incisional hernia using polypropylene mesh which was placed in retromuscular preperitoneal position. Complications occurred were wound infection in 4 patients (10%), serum collection in 2 patients (5%), prolonged ileus in 2 patients (5%), sinus formation in only 1 (2.5%), hernia recurrence in 1 patient (2.5%). There was no mortality in study. Patients were followed up at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Conclusion:- Mesh repair was found very effective method of dealing with incisional hernia.
Feeding practices among the infants presenting with acute diarrhea
Authors: Mahmood Rashid , Khurshid Asim , Iqbal Syed Mohammad Javed , Khan Malik Muhammad Nazir
Published: June 2016

Introduction: To study various feeding practices in children who present with acute watery diarrhea. The objective of the study was not only to study the feeding patterns but also draw an association between different feeding patterns and acute diarrheal episodes. Setting: Outdoor and indoor unit of Department of Paediatrics Jinnah Hospital affiliated with Allama Iqbal Medical College Lahore. Subject: Two hundred and fifty patients with acute watery diarrhea of less then 14 days between the ages of 1 month to 1 year were included in the study. Methods: It was a case control cross sectional study. The data related to 250 patients was collected. The required information was obtained from mother/ attendant of the infant in the questionnaire. All the questionnaire were filled by the doctors. Results: The majority of the infants with acute diarrhea were between 4 months to 1 year 195 (78%). Forty two (17%) were exclusively breastfed while 78 (31 %) exclusively bottle-fed. Fifty five (22%) had both breast feeding as well as bottle feeding. A large number of mothers 112 (44.8%) gave the reason of insufficient milk for the baby. Conclusion: Majority of the infants with acute diarrhea episodes were between 8 and 12 months when either breast milk is being replaced by bottle milk or improper weaning practices are being used. A large number of infants with acute diarrhea were either mixed fed or bottle fed. Because of increased mixed and bottle feeding there is high incidence of diarrhea in our community.
Profile of Medicolegal cases at Jinnah Hospital Lahore
Authors: Tajammul Neelam , Chaudhry Tajammul Hussain , Hanif Shahid , Bhatti Muhammad Amjad
Published: June 2016

Aims of study: 1) To physically equip accident / emergency department of Jinnah Hospital for the management of medico legal cases on scientific grounds 2) To Study the age group and the type of weapon involved 3) To create awareness amongst the social workers, law enforcement agencies and medical personnel about the management of such cases. 4) To suggest appropriate measures to reduce the incidence of these emergencies. Subjects and Methods: Two hundred and fifteen cases of medicolegal nature were collected. These cases visited the Accident /Emergency Department of Jinnah Hospital Lahore during the first six months of the year 2000 (January to June). A specialized proforma was designed to record the age, sex, and type of weapon inflicting injuries. Results: Out of these 213 cases 182 (85.44%) were male and 31 (14.56%) were female. Majority of the patients were within the age groups of 11-30 year of age (62.91%). 92 (43.19%) patients were injured because of the blunt weapon, 57 (26.76%) because of the firearms, 38 (17.85%) suffered injuries in road traffic accidents, 23 (10.80%) because of sharp edged weapons and 3(1.40%) patients because of the bums.
Diagnosis of enlarged thyroid - an analysis of 250 cases
Authors: Imran Ambreem A , Majid Sarosh , Khan Saeed Akhtar
Published: June 2016

Thyroid enlargement is a common problem faced both by clinicians and histopathologists. In an effort to determine the incidence of its various causes in our population, 250 cases were analyzed. There was a marked female preponderance (M:F ratio 1:3.8). Multinodular goiter was the commonest final diagnosis whereas 4 cases showed malignant thyroid neoplasms. Microscopic examination remained the golden path to the final diagnosis. The results as well as the relative efficacy of the various diagnostic modalities are discussed.
Outcome of patients of Subarachnoid Hemorrhage due to ruptured anterior communicating artery aneurysm after surgical clipping
Authors: Vohra Anjum Habib , Ahmed Mubasher
Published: June 2016

This prospective study was done to determine the outcome of subarachnoid haemorrhage (SAH) due to ruptured anterior communicating artery ( a Corn) aneurysm in 8 consecutive patients after craniotomy and clipping of the aneurysm. The study was conducted at Mayo Hospital, Lahore from September 1999 to January 2002. All patients presented with history and examination suggestive of SAH had CT scan brain as first radiological investigation. Patients of SAH were graded clinically according to Hung and Hess scale. After confirmation of diagnosis of SAH, four vessels cerebral angiography was done to localize site of aneurysm in patiens of Hunt and Hess grade I, II and III or after they improved to at least grade III. Craniotomy and clipping of aneursm was done only in patients with Hunt & Hess grade I, II and III. Maximum patients presented during 6th decade i.e., 38%. Male to female ratio was 6:2. Hunt & Hess grade I, II and III was observed in 5,2 and 1 patients respectively. Outcome was assessed according to G lasgow Outcome Scale (GOS). Good outcome was present in 75% patients and moderate disability in 25%.
The prevalence & age distribution of ovarian cysts
Authors: Khanum Zohra , Rehman Amanur
Published: June 2016

A prospective study conducted at Lady Willingdon Hospital LHR over two years for prevalence & age distribution of ovarian cyst. According to study 85% ovarian cyst were benign, 13 % cyst were malignant while 2% were borderline malignant. The commonest histopathological type was serous cystadenoma. Only age was not the determining factor for the type of the ovarian cyst.
Management of patients with esophageal artesia with or without tracheoesophageal fistula, a 7 years experience
Authors: Khan Kifayat , Bilal Aamir , Nishter Tahira , Nabi Muhammad Shoaib , Cheema Salim Saleem Shehzad
Published: June 2016

Objective: To see the short term outcome in patients treated for esophageal artesia with or without tracheo-esophageal fistula in our setup. Design: Descriptive and retrospective. Place and Duration: Department of Paediatric Surgery & Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 1998 to December 2004 with duration of 7 years. Materials and Methods: After diagnosis, patients were put on broad-spectrum intravenous antibiotics, intravenous fluids, vitamin K injection and throat suction in a normothermic environment. Diagnosis was established mainly on clinical grounds and supported by passing a big size nasogastric suction tube (size 10 Fr) through the mouth into the esophagus and taking a plain X-ray chest of the patient. After adequate preparation, through a right thoracotomy in 5th intercostals space, fistula repair and esophageal anastomosis was performed extrapleurally in patients with tracheoesophageal fistula while gastrostomy and ce rvical esophagostomy was performed in patients with pure esophageal atresia. Transanastomotic tube was passed as a nasogastric tube size 10 to act as a stent and later on used for tube feeding. Results: A total of 60 patients with esophageal artesia with or without tracheoesophageal fist ula were admitted. There were 40 males and 20 females. Age ranged from 1-7 days. Weight of the newborn patients was in the range of 2 - 3Kg. Four patients had cyanotic congenital heart disease, two were with imperforate anus and two with spina bifida. All patients had some form of bronchopneumonia due to aspiration of upper pouch contents out of whom 30 patients had severe pneumonia. Six patients left the hospital against medical advice and 6 patients died before operation. Forty-eight patients were operated. Esophagostomy and astrostomy was performed for pure esophageal atresia (10 Patients), while in 38 patients, a right thoracotomy in the 5" inter costal space with fistula ligation & esophageal anastomosis was performed. Three out of ten patients with pure esophageal atresia died, while eighteen patients with tracheoesophageal fistula died after surgery. Twenty-seven out of total 48 patients survived and were discharged to home after an average hospital stay of 7 days after surgery. Eleven patients were s een in follow up and treated accordingly. Conclusion: This study shows that majority of these patients presented late because of improper referral system.
Does sweeping of membranes in nulliparous women reduce the need for formal induction of labor?
Authors: Mehmood Hina , Bashir Alia
Published: June 2016

Objective: To evaluate the effectiveness of sweeping of the membranes in nulliparous women to reduce the need for a formal induction of labor. Design: A randomized controlled clinical trial. Place and duration of study: The study was conducted in the Gynae unit 1 of Jinnah Hospital Complex. Lahore, from April 2001to March 2003. Patients and methods: 100 nulliparous women attending the antenatal clinic at 39 weeks of gestation were randomly allocated for the study. 50 women were randomized to sweeping of membranes and 50 to control group. Their outcome measures in terms of proportion of women achieving spontaneous labor, duration of labor and bishop score at the time of admission to the hospital were assessed. Results: Spontaneous labor occurred more often in the sweeping of the membranes group than in the control group (38/50(76%) vs. 19/50(38%) P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labo r ward (25/50 (49%) vs. 8/50 (16%) P = 0.005. Women allocated to sweeping showed a trend towards having a shorter randomization-delivery interval: 9.4 days vs. 10.6 days in the controls P = 0.087. The need for induction of labor was significantly reduced in those women who underwent sweeping (11% vs26% P = 0.004). Conclusion: Sweeping of membranes in nulliparous women at 39weeks of gestation significantly decreases the number that will reach 41 weeks of gestation.
Management of post burn contracture of neck
Authors: Afzal Muhammad , Iqbal Javaid , Sajid Muhammad , Gulzar Muhammad Rehman , Bashir Mustehsan
Published: June 2016

Study Design: It is a prospective analytical study. Place and durations: Subjects & methods: 43 patients admitted during JAN 2001 to DEC 2002 who presented with severe functional (25 patients) of cosmetic impairment (27 patients). We selected 4 different options to manage the patients. (1) Release of/or excision + thigh grafts (2) Release of/or excision + wolfm (3)Thick therish + local flap (4) Musculocutaneous flap. Results: Out of 43 patients 27 were females and 16 were male and the age varies from 4-45 years. Out of 28 patients a (1) 25 given satisfactory and excellent results, and 5 out of Six patients a (2) and 4 out of 5 with (3) gave excellent results. To evaluate the outcome of different options for the management of PBNC we are presenting our 2 years experience of PBNC Neck in 43 patients from January 2001 to December 2002 who were admitted through surgical outdoor of Teaching Hospitals of PMC, Faisalabad. In our set up most of the patients presented with severe functional (25 patients) and cosmetic impairments (27 patients out of 43) because of late presentation, delayed treatment, poverty and lack of proper medical facilities. We selected 4 different options to manage these patients accordingly i.e. (1) release or and excision of contracture and thick split skin graft, (2) release or and excision of contracture and full thickness skin graft, (3) thick split skin graft and local flap, (4) musculocutaneous flap, giving satisfactory to excellent results in 25 out of 28 patients, 5 out of 6 patients and 4 out of 5 patients respectively. Thick split skin grafting after release or/and excision of contracture with strict advice of wearing cervical neck collar remained our mainstay of treatment because it was one of the best practical options to deal with severe PBC Neck while other options being reserved for difficult and recurrent cases. Conclusion: Thick split skin grafting is an easy, cost effective, reliable and compliant to the patient. Furthermore thick split skin grafting is a simple procedure whi ch may be carried out by any general surgeon with reserve for referred for the difficult cases.
In situ Piezoelectric ESWL for ureteric calculi
Authors: Shahzad Mohammad , Mubeen Rana Muhammad , Anwar Khursheed
Published: June 2016

Objective: To assess in situ Piezoelectric ESWL for ureteric calculi, avoiding false positive results arising from the spontaneous passage of small stones and also to evaluate the efficiency of the EDAP LT02 Lithotriptor for insitu ESWL treatment of ureteric calculi. Study Design: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor. Place & Duration of Study: patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, coming to Urology department of Pakistan Institute of Medical Sciences (PIMS), Islamabad, as out door patients. Patients and methods: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, Seventy two patients, 60 males and 12 females, with mean age of 39.6 years, presenting with solitary ureteric calculus were treated using EDAP LT 02 Piezoelectric Lithotriptor, lo calization with fluoroscopy. No regional or general anesthesia given. Results: After 3 months follow-up, of the 72 ureteric calculi cases, 60(83.3%) were successfully fragmented and ureter was stone free in 54 patients (75.1%) after insitu ESWL alone. The mean duration of stone clearance was 50 days (SD +11.58). Sixteen patients required one session only, 28 patients required 2 sessions and twelve patients required three and more than three sessions. Stone location was 28 upper ureteric, 18 middle and 26 in lower ureter. Stone size varied from 7mm.to 17mm. in longest diameter. The average number of session, 1.5 for upper ureteric stone, 1.8 for mid and lower ureteric stones. Stone clearance for upper ureteric calculus was 85.7%, for mid ureteric 66.7% & for lower ureteric 69%, the overall stone clearance was 75%. Conclusion: In situ piezoelectric ESWL is safe, simple and effective technique for treating ureteric calculi. The site and size of the stone affects the success rate.
Radiology - bone trauma - Qisas & Diyat law
Authors: Tajammul Neelam , Hussain Tajamul , Hanif Shahid , Mohdin Tariq , Zahid Lftikhar Ahmad
Published: June 2016

Objectives: - To assess the Role of Radiology in finalizing the medicolegal certification (living) with particular emphasis to bone trauma according to law of hurt in Pakistan. Setting: Department of Radiology, Mayo Hospital, Lahore Duration: 26-03-1995 to 8-09-1996 (26th of March 1995 to 8th of September 1996). Material and Method: - 168 patients of medicolegal nature refered for Radialogical assessment. The Protocol for identification of the cases was strictly observed. Request for Xrays was thoroughly scrutinized by the Radiologist on duty. Relevant Xrays were conducted observed and granted opinion. The information was collected from Police Record Medicolegal certificate, Xrays, opinion of Radiologist, treatment and operation notes. Specialized Performa was designed for this Purpose and variable were noted. Results: Total number of cases were 168. A large percentage was of males 156 (92.85%). Mean age in the case of males was about 32 years and in females 33 years. 131 (77.97%) of the cases were positi ve for radiological assessment (like shadows of metallic densities and fractures). There were total 132 fractures of the various bones of the cases. Fractures due to blunt weapon were in 95 cases (71.96%) and due to fire arm in 37 (22.03%). Maximum involved area was lower limbs 73 Fractures (55.4%) and minimum involvement was of lumbo sacral region 5 fractures (3.8%). Types of fractures (with displacement, Comminuted and without displacement) were noted. Maximum number of fractures were with displacement 73 (55.4%) and minimum were comminuted 27 (24.45%). Conclusion: - Radiology is the most suited specialty for medicolegal certification. Its importance is enhanced after the implementation of Qisas & Diyat Law. Radiology center with qualified and trained staff in medicolegal work must be attached to each medicolegal center. Males are the victim in very large percentage of the cases and that to in productive age group.
Frequency of Hepatitis C infection in diabetes mellitus
Authors: Qazi Masroor A , M Fayyaz , Muhyuddin Hyuddin Ch G , Jamil Aftab , A H Malik , A I Gardezi , Bukhari Mh
Published: June 2016

Place and duration of study: The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Background: Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. Objectives: To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. Designs: A cross-sectionalObservational-descriptive analytic study. Subjects and Methods: A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection .They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay (ELISA-3) which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence(rural or urban) Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Results: Among a total of 250 patients, 120 (48%) were male and 130 (52%) were female. Two hundred and forty-four (97.6%) patients were of type-II DM and 06 (2.4%) patients were of type-I DM. 22 (8.8%) patients were on insulin therapy while 228 (91.2%) were on oral hypoglycemic agents. Anti-HCV test was positive in 69 (27.6%) diabetic patients as compared to blood donors 41 (0.62%). In anti-HCV positive group, longer duration of diabetic mellitus (15yrs 15.94%), poor control of diabetic mellitus(87%), insulin therapy(17.39%) hypertension(91.3%) and nephropathy(94.2%) were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Conclusion: Hepatitis C infection is common in diabetic patients as compared to control group (27.6% vs 0.62%). Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy.
First feed given to the new born babies - a survey in an urban community of Lahore
Authors: Fatima Tahira , Mahmood Rana Sajid , Ahmad Maaz
Published: June 2016

Background: Pakistan being 7th populous country is facing a high Neonatal Mortality Rate and it is reported that acute gastroenteritis is one of the major factor to this high Neonatal Mortality Rate. Avoiding colostrums and giving some prelacteal feed are contributory factors for gastroenteritis. Which ultimately leads to high Neonatal Mortality Rate.Objectives:-To study the first feed practice adopted by lactating mothers in a community in Lahore. Study design. Cross sectional community based survey. Place and duration of the study:- Dubhi mandi near old Anarkali Lahore from January 2002 to June 2002. Respondants and methods: - 180 mothers who delivered in the previous year were listed and interviewed on structured pre tested questionnaire. Results: 32% mothers feed colostrums, and 68% started with other items like honey 27%, ghutti 18%, Araq 8%, water & sugar 4%, cow and formula milk 12%. Out of (122) those who did not started with colostrums, 59% done it intentionally under the influence of family traditions /taboos of either avoiding colostrums being a stale food or to get the first feed by a person of good fortune, 31% missed by ignorance and 10% due to medical reasons. Out of 58 `mothers who started with costume 45% were motivated by health professionals, 39% by relatives/friends and 20% by media. Conclusion: It is conclude that still prelacteal feed is common practice. It is also observed that people change this practice under the guidance of health professionals . So situation can be improved by increasing liaison of pregnant mothers with health professionals ,who should continuously motivate the mother during pregnancy and delivery, to start with colostrums with in half hour of delivery.
Neonatal jaundice and glucose-6-phosphate dehydrogenase deficiency
Authors: Rasheed Sohail , Hayee Abdul , Lodhi Yasmeen , Ahmed Rafi
Published: June 2016

One hundred new born males babies aged 7 days and above were included in this study. These were divided into two groups — Group I included G6PD normal subjects and Group II included G6PD deficient subjects. Total bilirubin and G6PD enzyme levels were done by commercially available kits. Results were analysed by using students `t` test and level of significance was done. A significant increase in total bilirubin level was observed in infants of G6PD deficiency, Erythrocyte G6PD level is significantly decreased in 06% of infants born with neonatal jaundice.