bluuebunny/crossref_metadata_2025 huggingface dataset:
HEPATITIS C
Authors: AHMED WAHEED , ZAIDI SYED BADSHAH HUSSAIN , ZAKARIA MANZAR
Published: September 2021

Objectives: To determine the frequency of thrombocytopenia and its manifestations in patients with Chronic Hepatitis C Virusinfection treated with interferon and ribavirin. Data Source: In door and out door patients. Design of Study: Case series. Setting and Periodof Study: Department of Medicine PNS Shifa Hospital Karachi, from 1s t August 2006 to 1s t July 2007. Materials and Methods: A Proformawas designed to enter the data of 100 patients fulfilling the inclusion criteria included in the study. Adult patients between the ages of 18 and50 years of both gender were selected. Presence of anti HCV antibodies, elevated serum alanine transaminase, a positive polymerase chainreaction for hepatitis C ribonucleic acid and compensated liver disease were prerequisites. All patients were treated with combination ofinterferon and ribavirin. Blood counts, alanine transaminase and prothrombin time were done at baseline and at 2,4 & 8 weeks intervals afterstarting interferon. A drop in platelets count below 100,000/cmm was taken as interferon induced thrombocytopenia. Results: In our studythrombocytopenia occurred in 11 % patients. Grade 3 thrombocytopenia (platelet counts < 50,000) occurred in 01 patient out of hundred in whichthere was severe gum bleeding and purpura so antiviral treatment was discontinued. Grade 2 thrombocytopenia (platelet counts between 50,000- 75,000) was observed in 03% patients but there were no bleeding episodes, 50% reduction dose was done in these patients. Grade 1thrombocytopenia (platelet counts between 75,000-100,000) was noticed in 07% patients but there were no bleeding manifestations and dosereduction was not done. Conclusion: Combination therapy is well tolerated, however, it can cause life threatening complications like bleedingepisodes in a few patients. Bleeding complications and manifestations as a result of thrombocytopenia are uncommon.
CONGENITAL ANOMALIES IN NEWBORN
Authors: TARIQ SAADIA
Published: September 2021

Objective: To determine congenital anomalies in newborn and associated maternal risk factors. Design: Cross sectionalobservational study. Setting: Department of Gynecology & Obstetrics unit 1 Lahore General Hospital Lahore. Period: From Jan 2007—Dec2007. Patients & methods: All the women who have given birth to babies with congenital abnormalities were recorded. Diagnosis of neonatalcongenital anomalies was based on clinical evaluation of newborn by experienced neonatologist. Results: During the study period, 2872patients delivered, of which 48 had congenitally malformed babies, makes the prevalence of 16 per 1000 births. Congenital anomalies weremost commonly 52.26% seen in the 21-30 years. The most frequent associated risk factor was history of consanguineous marriage in 45.83%.Neural tube defects were found to be commonest type of anomaly. Among the most frequent neural tube defect was hydrocephalus andanencephaly. Conclusion: The commonest associated risk factor was consanguineous marriage the frequency of which may be reduced bycreating awareness regarding the avoidance of consanguineous marriages. NTD were the most prevalent anomaly detected and early prenataldiagnosis is helpful in decreasing the indirect prevalence of perinatal mortality by offering early termination.
CONGENITAL MALFORMATIONS
Authors: HASAN SHAMAMA , ULLAH AMEEN , FARRUKH HUMA , Sadiq Nadeem
Published: September 2021

Objective: To determine frequency, pattern of distribution of congenital malformations in newborn. Design: Cross-sectionalobservational study. Place and Duration of study: Study was carried out in the Department of neonatology, Military Hospital Rawalpindi duringthe period of January 2008 to Dec 2008. Patients and methods: All the newborns were examined and mothers were interviewed. Baby'santenatal record was also noted and recorded in a Performa. Antenatal ultrasonography record was also recorded. Any internal malformationwas also noted. Babies who were found to have any malformations were screened for the congenital malformations. Screening was done withlatest laboratory tests , radiological evidences and chromosomal studies for suspected trisomies. Result: Congenital anomalies were notedin a Performa. Neural tube defect (NTD) was found to be the commonest type of anomaly. Among the most frequent NTD were hydrocephalusand menigomyelocele. Following that were the cardiac anomalies and genitourinary tract anomalies. Trisomy 21 was detected in two of thebabies while one newborn had trisomy 13. Conclusion: NTD were the most prevalent anomaly detected and early prenatal diagnosis is helpfulin decreasing the indirect prevalence of perinatal mortality by offering early termination. Folic acid supplementation should be advocated beforeconception
HOSPITAL ACQUIRED INFECTIONS
Authors: QAYYUM SHAZIA , WAQAS BUSHRA , SATTAR ABDUL
Published: September 2021

Nosocomial infections may be defined as the infections which develop within hospital. There are different types of  microorganisms which are involved along with other agents for the spread of these infections. Knowledge about the spread and prevention of these infections is the basic step for control. Hospital staff especially the doctors should be aware about the precautions to control the spread of there infections. Objectives: To assess the knowledge of doctors about hospital acquired infections and its prevention. Study designs: descriptive study Settings and period: In surgical unit of Allied Hospital Faisalabad from 15th June 2006 15th July 2006. Materials and methods: Study population was consisted on 71 doctors including Consultants, Medical Officers and House Officers. Data was collected with the help of questionnaires. Results: Results showed that majority of doctors were aware about nosocomial infections (N.I) but have weakknowledge about their routes of transmission and common types of N.I. Conclusions: The study revealed that doctors have sufficient knowledge regarding N.I and its prevention but certain weakness were observed.
POST OPERATIVE WOUND INFECTION
Authors: IJAZ AAMIR , AMER M. SUHAIL
Published: September 2021

Background: The use of antibiotic prophylaxis during Lichtenstein inguinal hernia surgery is controversial, and no definitive guidelines are available in literature. Objective: To determine effects of prophylactic antibiotics in reducing the frequency of postoperative wound infection in Lichtenstein hernia repair. Study Design: Case control study. Setting: Surgical Unit II, Allied Hospital, Faisalabad.Duration: One year, between January 2007 and December 2007. Methods: Patients undergoing unilateral, primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.0 g intravenous Cefazolin before the incision or an equal volume of placebo. Wound infection was defined according to the criteria of Centers for Disease Control and recorded. Results wereassessed using chi-square test. Results: 100 patients were included in the study. Minimum age of patients in this study was 20 and maximum 75 years with a mean of 44.06 in group A and 44.84 in group B. The total number of wound infections was 7 (7%); 2 (4%) in the antibiotic prophylaxis group and 5 (10%) in the placebo group. Statistical analysis showed no significant difference in the number of wound infections inboth groups (p value=0.240). Conclusions: We conclude that in Lichtenstein inguinal hernia repair routine use of prophylactic antibiotics is not needed, as it does not significantly reduce the postoperative wound infection rates.
HOSPITAL ACQUIRED INFECTIONS
Authors: QAYYUM SHAZIA , Waqas BUSHRA , SATTAR ABDUL
Published: September 2021

Nosocomial infections may be defined as the infections which develop within hospital. There are different types of microorganisms which are involved along with other agents for the spread of these infections. Knowledge about the spread and prevention of these infections is the basic step for control. Hospital staff especially the doctors should be aware about the precautions to control the spread of there infections. Objectives: To assess the knowledge of doctors about hospital acquired infections and its prevention. Study designs: descriptive study Settings and period: In surgical unit of Allied Hospital Faisalabad from 15th June 2006 15th July 2006. Materials and methods: Study population was consisted on 71 doctors including Consultants, Medical Officers and House Officers. Data was collected with the help of questionnaires. Results: Results showed that majority of doctors were aware about nosocomial infections (N.I) but have weak knowledge about their routes of transmission and common types of N.I. Conclusions: The study revealed that doctors have sufficient knowledge regarding N.I and its prevention but certain weakness were observed.
HER 2 NEU METASTATIC BREAST CANCER;
Authors: HAFEEZ MUHAMMAD , Usman Ahmed , SHAHARYAR Mr. , Ahmad Kafait , ZIKRYA MANZER
Published: September 2021

Objective: To evaluate the efficacy and toxicity of low dose sequential docetaxel-capecitabine chemotherapy as first line treatment of HER 2 negative metastatic breast cancer (MBC). Design: Experimental Study, Clinical Trial. Setting: Three different oncology centers, collaborating under the Cancer Research Group Pakistan. Period: From June 2006 to December 2007. Methods: Female breast cancer patients with visceral or visceral and bone metastases and a KPS > 70 were eligible. Results: 38 patients were enrolled. Median agewas 49 years (Range 32-70). With docetaxel treatment, CR was seen in 06 (16%) patients and PR in 20 (53%) with an overall response rate of 69%. Stable disease was seen in 10 (26%) and PD in 02 (05%). Four out of six complete responses were in patients with liver metastases. Thirty six patients received capecitabine. Thirty were evaluable for response. Capecitabine added one CR (3.33%) and six partial responses (20%).Two patients (6.67 %) who had a partial response to docetaxel relapsed during capecitabine treatment. As a result at the completion of the therapy CR was seen in 07 patients (18.42%), PR in 23 patients (60.53%) with SD and PD in, 4 patients (10.53%) each. An overall RR of 78.94 % was seen. Median time to progression was 10.9 months (range, 3-22 months) and at a median follow up time of 24 months (range, 16 -34months) 13 patients have died with an overall survival probability of docetaxel –capecitabine sequential therapy of 0.68. Significant docetaxel specific grade 3/4 toxicities included neutropenia and diarrhea in 14 (36.84%) and 03 (07.89%) respectively. Febrile neutropenia was seen in 06 (15.79%). Capecitabine specific significant grade 3 toxicities included hand-foot syndrome in three patients (8.33%) and diarrhea in 2(5.56%). Stomatitis, dermatitis, fatigue was seen in one patient (2.78 %) each. Conclusions: This treatment schedule of low dose sequential docetaxel - capecitabine is an effective first line treatment of HER 2 negative MBC that provides good overall response rate, manageable toxicity and improved survival.
RETAINED FOREIGN BODIES
Authors: QAMAR SHEHZAD AHMAD , IDREES TAHIR , JAMIL MUNAWAR , Sobia Humaira
Published: September 2021

Objectives: (1) To look into clinical presentations of intra-abdominal foreign bodies; (2) To document surgical procedure performed. (3) To see measures for prevention. Design: Observational case series. Setting: Bahawal Victoria Hospital Bahawalpur. Period: From 1.06.07 to 31.5.08. Patient & Methods: Eleven patients with retained having intra-abdominal foreign body were treated. Relevant history, clinical examination and necessary investigations were done. Exploratory laparotomy was done in 10 cases to remove the foreign body and in one case foreign body passed from the rectum without laparotomy. Results: Out of 11 cases, 54.54% are males and 45.45% were females. Operated in emergency 81.81% and elective 18.18%. 90.91% were operated in periphery and 9.09% in the tertiary care centre. Clinical presentations were intestinal obstruction (27.27%), intraabdominal abscess (13.18%), Discharging sinus (18.18%), mass abdomen (18.18%),entero cutaneous fistula (9.09%), peritonitis (9.09%). Exploratory laparotomy was done in 90.91%, to remove the foreign body and in 1 case passed per rectum. Conclusions: Retained foreign bodies presented as intestinal obstruction, abscess, sinus fistula mass, or peritonitis. It is avoidable iatrogenic surgical complication, mostly found in operations done in emergency and at peripheral hospitals. Exploratory laparotomy remains the mainstay of treatment to remove the intra-abdominal foreign body. Surgeon should be vigilant to avoid mishap by check on counting, tucking sponge, blackboard counting, examining abdomen, screening in suspicious case and claim for radio-opaque sponges.Referral system needs improvements for in time adequate treatment.
HIRSCHSPRUNG’S DISEASE
Authors: IQBAL MUHAMMAD ZAFAR , Azam Hammad , JAHANGIR MUHAMMAD , Tahir Muhammad , ANWAR MUHAMMAD , Irum Shumaila
Published: September 2021

Introduction: Hirschsprung’s Disease is one of the most common congenital anomalies that Pediatric Surgeons manage. In spite of the various modifications of pull through procedures available, the long term functional results are less than ideal. However, Modified Duhamel Procedure is one which has relatively good functional results and that is the reason we have selected this procedure for Hirschsprung’s disease in Sheikh Zayed Hospital, Rahim Yar Khan. Objectives: To evaluate the outcome of patients after Modified Duhamel Procedure for Hirschsprung’s Disease. Design: This is case series study. Settings: Department of Pediatric Surgery Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: Seventeen cases were studied over a period of two year i.e. from November 2006 to December, 2008. Material and Method: Seventeen (17) cases from both sexes were operated for Hirschsprung’s Disease over a period of one year and Modified Duhamel Procedure was adopted for all these cases. All patients were diagnosed cases of rectosigmoidal aganglionosis and follow up was done over a period of one year according to a comprehensive Proforma. Four parameters like normal stool evacuation, abdominal distension, soiling and stool incontinence were followed and then the results were compared with other national and international studies. Results: Fever 19.4% (n=04), wound infection 19.4% (n=04), vomiting 9.52% (n=02), abdominal distension 4.76% (n=01), and bleeding per rectum 4.76% (n=01), were the immediate post operative complications. Fourteen patients (82.35%), used to pass stool once daily. Abdominal distension was observed occasionally in six patients (28.57%). Soiling was seen in five patients (29.41%). Out of Seventeen, stool incontinence was seen in only three patients (17.64%). Conclusion: Modified Duhamel Procedure with the help of linear cutter stapler device is quite safe, easy and less time consuming. Infact Modified Duhamel is a procedure of choice for Hirschsprung’s Disease.
INTESTINAL ANASTOMOSIS
Authors: AHMAD KHAN RANA ASRAR , Dilawaiz Mohammad , HAMEED FAKHAR , Akram Ch. Mohammad , AHMED BASHIR
Published: September 2021

Objective: To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Study Design : Prospective comparative study. Period & Setting: Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. Materials and Methods: The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis anddouble layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage/. Results: Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant (p<.001) while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively (p<.001). Leakage rate was double (12%) in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Conclusion: Anastomosis usinga single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis.
AETIOLOGY OF PANCYTOPENIA
Authors: TARIQ MOHAMMAD , BASRI RABIA , KHAN NAJI ULLAH , Amin Said
Published: September 2021

Background: Pancytopenia is a reduction in the number of each type of peripheral blood cell. Therefore the role of bone marrow examintion in diagnosis of pancytopenia is important to know etiology of pancytopenia. The objective of the study was to know the aetiology of pancytopenia. Methods: This descriptive (Cross sectional) study was carried out in Khyber teaching hospital. Fifty patients with pancytopenia were included in the study from 1st January 2008 to 30th October 2008. Full blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. Statistical packages for social science (SPSS.11) was used to analyze data. Results: Out of 50 patients, 36% were of aplastic anaemia, 16% megaloblastic anaemia, 14% myelodysplastic syndrome and 12% acute lymphoblastic leukemia (ALL), Hypersplenism in 10%, 4% non Hodgkin lymphoma (NHL) and 4% multiple myeloma, 2% each of acute myeloblastic leukemia and chronic myelocytic leukemia. All of these disorders were common in male as compared to female. Conclusions: Aplastic anaemia was the commonest cause of pancytopenia followed by megaloblastic anemia and myelodysplastic syndrome in our study.
DIABETIC RETINOPATHY
Authors: SHAIKH NAUMAN AYUB , AHMAD FAROOQ
Published: September 2021

Introduction: 15 percent of the snakes are poisonous and present a potential life threatening risk to human lives. Objectives: (1) To review the demographic, epidemiological, clinical and laboratory findings of 48 patients of snake bite treated in a field hospital. (2) To evaluate the treatment and outcome of these patients. Design: A retrospective study. Setting: Field hospital in rural Sindh. Period: From January 2002 to December 2003. Material & Methods: All patients diagnosed with snake bite had first aid treatment by a either a nursing staff close to the place of bite or by a quack and later on transferred to field hospital. The first aid treatment consisted of pain relief (injectable diclofenac, oral acetaminophen), application of bandage or tourniquet proximal to the bite, antihistamine (oral or injectable chlorpheniramine) anti- inflammatory (injection hydrocortisone) and immobilization of the affected limb with a splint. Results: We are treated 48 patients with snake bite. There were 45(94%) male patients and 3(6%) female patients. Age range was 18 to 56 years with a mean age of 29.8 years. 35(73%) patients suffered from snake bite between the months of May and September. The timing of the bite was also peculiar with 36(75%) patients bitten between 8pm and 8am whereas only 12(25%) patients during other times of the day. 38(79%) patients gave history of seeing the snake themselves and 10(21%) patients were not able to see the snake mainly because of darkness. Conclusion It should be remembered that not all snakes are poisonous and that they are more afraid of humans than we are of them. Psychological effects of the bite are at times more devastating than the clinical effects, therefore patient reassurance forms part of the treatment.
RELATIONSHIP OF BRAIN NATRIURETIC PEPTIDE WITH SERUM LIPIDS AND BODY MASS INDEX IN HEALTHY ADULT MALES
Authors: JABEEN MEH , Murad Shah , FURQAN MOHAMMAD , Hassan Zulfiqar-ul- , TURAB MOHSIN , Mahmood Ghazi
Published: September 2021

Prevalence of morbid obesity has increased dramatically world wide during past three decades. BNP a cardiac lipolytic hormone is found to be decreased in obese hypertensive and heart failure patients. Increasing values of BMI are associated with dyslipidemia. Objective: To find out the relationship of BNP with increasing values of BMI and individual serum lipid fractions in apparently healthy adult males. Study Design: Observational, cross-sectional study. Setting: Department of Physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Material & Methods: Study included 85 adult males, aged between 20-60 years. All were nonsmokers, non- diabetic, having no other chronic illness and not taking any lipid lowering therapy. Study participants were evaluated for lipid profile and divided into three groups for the calculated BMI values according to WHO and International Obesity Task Force. Brain NatriureticPeptide was assayed by AxSym technology. Results: Brain Natriuretic Peptide developed a negative correlation with BMI, total and LDLcholesterol and a positive relation with HDL-cholesterol and triglycerides. Conclusions: This study concluded that Brain Natriuretic Peptide is negatively related with increasing values of BMI and degree of dyslipidemia in apparently healthy adult males.
EXCLUSIVE BREAST FEEDING
Authors: ASLAM SOHAIL , AKRAM FAROOQ , SULTAN MEHBOOB
Published: September 2021

Objective To study the duration and factors influencing exclusive breast feeding practice. Design: A cross sectional descriptive study Setting: A primary care hospital Gilgit, northern area of Pakistan. Period: Ten months from March 2007 to December 2007. Material & Method This study include 125 mothers with mean age of 24.3 years (SD 4.8),37% were illiterate while only 14% were matriculate or above among 125 babies (male 61%: female 39%). Results Out of total 125, eighty one (64.8%) babies were exclusively breast fed (EBF) for first six months of life and only five(4%) infants were not given breast milk at all . among 76 male infants ,52 (68.4%) were EBF for six months in comparison to 29 female (59.2%) out of 49. among 36 first born infants only 15 (41.7%) were EBF for six months in comparison to 66 (74.2%)out of 89 not first born(p<0.05). Conclusion: Exclusive breast feeding for complete 6 months is still not routinely practised by most of mothers and first born are deprived of this right in majority lower socioeconomic group and illiterate mothers are more likelyto breast feed, gender bias was also observed as a significantly high percentage of male babies were observed to be breast fed as compared to females. More efforts are required by health depart. And NGO’s to promote good breast feeding practices in our setup.
MATERNAL MORTALITY 2007-2008
Authors: SHAIKH AISHA ABDULLAH , SABOOHI SADIA , MEMON RUBINA A D
Published: September 2021

Objectives: To analyse the maternal mortality with its causes and possible contributing risk factors at Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Setting: This study was carried out at Gynae / Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from Jan-2007 to Dec-2008. Study Design: Descriptive case series study. Subjects and Methods: This study was conducted by analysing the death records of all maternal deaths who died over a period of two (02) years from Jan 2007 to Dec 2008. Thedemographic record included age, parity, booking status and education. The cause of death and possible contributing factors were evaluated. Results: 48 mothers died during this period making Maternal Mortality Ratio (MMR) of 1578/ 100,000 live births. Direct causes contributed to 79% (38) of maternal deaths while 21% (10) were due to indirect causes. The major causes of deaths were eclampsia 27% (13), haemorrhage33% (11), Sepsis 21% (10), Obstructed labour 8% (4). Among indirect causes, hepatic encethalopathy, anemia and renal failure were observed. Conclusions: Eclampsia, haemorrhage and Sepsis are still the major killers. Factors which need urgent improvement include education, antenatal booking, early diagnosis and referrals to tertiary care centers.
PRIMARY POSTPARTUM HAEMORRHAGE
Authors: RASHEED NUZHAT , MALIK MOEEN AKHTAR , NASIM NOREEN
Published: September 2021

Objective: To compare the effectiveness of Misoprostol with syntocinon in the prophylaxis of primary post partum haemorrhage during the management of 3rd stage of labour. Design: Experimental study. Setting: Department of Obstetrics & Gynaecology Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Patients and Methods: Pregnant patient with term pregnancy in labour were admitted in labour room. After confirmation that the patient is in labour, they were randomly divided in two groups A & B with 50 patients in each group. 600 ug oral Misoprostol was given to patients in group A and 10 units I/V Syntocinon were given to patients in group B at the time of delivery of anterior shoulder of the baby. Amount of blood loss was observed and all the information were recorded and entered in predesigned proforma. Results:Amongst the 100 pregnant patients the mean age was 28.86 + 2.94 and mean parity of patients was 3.94. 57% of patients were presented with labour pains only and 27% presented with both labour pain and leaking liquor. In 59 patients duration of labour was between 2-12 hours. Total 9 patients develop PPH in both groups, three patients from Misoprostol group and six patients from syntocinon group. PPH was mild to moderate and settled down with other uterotonic drugs none of the patient required surgical intervention. Development of minor side effect was relatively high in Misoprostol group i.e. 10% such as nausea, vomiting while 4% in syntocinon group. Shivering and mild pyrexia was 12% in Misoprostol group while 5% in syntocinon group. Conclusion: In this study effectiveness of both syntocinon & Misoprostol has been found comparable Misoprostol being slightly more effective than syntocinon in managing 3rd stage of labour also prophylacticaly and it also has fewer minor side effects with no serious danger to life. It does not need skilled personnel for its use.
INTERTROCHANTERIC FRACTURE OF FEMUR
Authors: KHAN NAJI ULLAH , Khan Mohammad Ayaz , ASKAR ZAHID , Hakeem Awal , AHMED ISRAR , Ullah Faheem , Durrani Zafar
Published: September 2021

Background: Intertrochanteric (IT) fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. Objectives: To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. Design: A descriptive observational study Setting: Department of Orthopaedic Khyber Teaching Hospital, Peshawar.Period: From 7th Jan 2008 to 7th Jan 2009. Material and Methods: 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw (DHS) was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. Results: We studied 113 Patients of intertrochanteric (IT) fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven (47.0%) patients were male and 53 (53.0%) were female. Postoperatively seven patients (7%) suffered from infections, 3 (3.0 %) patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 (3.0%) patients, 2 (2.0%) patients developed non union of the fracture site, 1 (1.0%) patient develop varus deformity. Seven (7.0%) patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 (77.0%) healed without complications. Conclusion It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur.
DEPRESSION AND DRUG NON- ADHERENCE
Authors: AKHUNZADA WAJID ALI , RAHMAN RAZA UR , DOGAR IMTIAZ AHMAD , Maqsood Niaz
Published: September 2021

Objectives: To determine the different levels of drug non-adherence in patients suffering from Depression. Design: A casecontrolled study. Place and Duration of Study: Hayatabad Medical Complex Peshawar, From February 2008 to August 2008. Patients and Method: 50-Cases were selected from the out patient department with the DSM-IV diagnosis of major depressive disorder, 50- non psychotic patients were selected as controls. Both sexes were included. The basic socio-demographic characteristics and the clinical profile of all the patients were collected. The level of drug non-adherence was recorded at week 4, week 8 and week 12. SPSS version 15 was used for statistical analysis. The applied method for group comparison was the Chi-square test. Results: The age in mean was 33.78 ± 11.30 for the sample and 30.65 ± 9.40 for control group. 38% of these patients were males and 62% females. 58% were married and uneducated from lowersocio-economical class. 70% of the study group and 59% of control group received treatment. The rates of non adherence were statistically not significant at week 4. However, at week 8 and week 12 the rates of non adherence were statistically significant with the p values of less than (0.001) respectively. Discussion: Rates of non-adherence with psychotropic / antidepressants are difficult to summarize because they varywith setting, diagnosis, severity of illness and type of adherence difficulties. Drug non-adherence is a serious clinical problem and it has direct effects on illness management and prognosis. Conclusions: The available evidence suggests that the outcome for patients who vary medication doses without consulting a professional is poor.
CT GUIDED TRANSTHORACIC NEEDLE ASPIRATION BIOPSY
Authors: SHAUKAT ASIM , SHAUKAT AAMIR
Published: September 2021

Objectives: To analyze the rate of Pneumothorax after CT guided TNAB of lung masses , and correlating it with the size of the lesion. Design: Descriptive study. Setting: Department of Radiology Mayo Hospital, Lahore. Period: From June 2002 to April 2003, Patients and method: Seventy patients underwent CT guided FNA of the chest masses. Results: Out of Seventy, 18 patients i.e.; 26 % developed Pneumothorax. Lesion less than 1 cm , out of 6 patients 3 developed pneumothorax ( 50 %), lesions 1-2 cm 5 out of 11 developedpneumothorax(45%), lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax ( 35%), lesions between 3-4 cm 2 out of 8 developed pneumothorax (25%), lesion sized 4-5 cm 1 out of 15 developed pneumothorax (6%), and lesion with more than 5 cm size 1 out of 16 developed pneumothorax ( 6%) . Conclusion: The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Massesincreases as the size of the lesion decreases.
SHOULDICE VERSUS LICHTENSTEIN REPAIR
Authors: AWAN WASEEM SADIQ , GULZAR MUHAMMAD REHMAN , ARAIN GHULAM MUSTAFA , Younus Raza
Published: September 2021

Objective: To compare the results of tissue based Shouldice repair with the Lichtenstein tension free repair of inguinal hernia. Design: A prospective randomized controlled trial. Period: From Jan 2004 to Dec 2006. Setting: Surgical Unit-II, Allama Iqbal Medical College / Jinnah Hospital Lahore, Pakistan. Patients & Methods: A total of 156 patients were included in this study were equally divided into two groups. Results: The mean age was 45 years. After a follow up of upto 2 years there was significant difference in the recurrence rate. It was 5% in the Shouldice group and 1.28 %in the Lichtenstein group. Similarly chronic pain was also much higher i.e. 5% in the Shouldice group compared to 1.28% in Lichtenstein Group. The rate of hematoma and seroma formation was the same (1.28%) in both groups, however infection was seen slightly more in Lichtenstein repair (3.84%) as compared to Shouldice repair (2.56%). Conclusion: Tension free Lichtenstein technique was found to be superior to the tissue based Shouldice repair with respect to post operative complications and recurrence.
INTRAPERITONEAL MESH PLASTY
Authors: MALIK FAKHAR ILYAS , MIRZA TAHIR IQBAL
Published: September 2021

Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various Modalities of Repair have been advocated but the overall results still remain disappointing. Objective: To evaluate in incisional Hernias the efficacy and safety of Intraperitoneal mesh repair with conventional Polypropylene Mesh. Setting: In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. Period: From January 2000 to January 2007. Materials & Methods: 90 cases of Incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with Co morbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and Ischemic Heart Disease etc: were also included if there was no other contraindications for Surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. Results: In our series of 90 patients, Females (92.22%, n= 83) outnumbered males (7.77%, n=7) and the highest incidence was in the 4th decade of life in females and the 3rd decade of life in males. Gynecological operations accounted for 61.44% (n=51) of the index operations. 77.7% (n=70) ofpatients had a BMI >30. Co morbid Conditions were present in 36.66% (n=33) of patients. The polypropylene mesh placed Intra peritoneal varied from 15×7.5 cm to 30×20 cm. The mean operating time was 60±20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80±10 minutes. 85.55% patients (n=77) attended our follow-up, ranging from 12 months to five years.Method of follow-up in outpatients department (OPD)/Clinics: 71.11%(n=64), by telephonic conversation: 12.22%(n=11). 14.44% (n=13) were lost in follow up. All patients in followup had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Conclusions:Historically intraperitoneal Mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for Incisional hernias, especially in difficult cases and with patients having co morbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience.
MANAGEMENT OF GASTRIC CARCINOMA
Authors: AWAN SAIF UD DIN , QADRI ANJUM A , MAQSOOD M ANSAR , Awan Ayesha Naureen
Published: September 2021

Objective: (1) To find the best treatment modality for carcinoma stomach. Design: Case series study. Setting: Combined Military Hospital Rawalpindi. Period: From January 1996 to December 1999. Patients and methods: 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. Results: The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia,respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients wereselected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died oftumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. Conclusions: It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factoris smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidityand mortality.
POSTOPERATIVE NAUSEA AND VOMITING (PONV)
Authors: ALI ZULFIQAR , AHMAD TANVEER , AHMAD IRSHAD , Rehan A G
Published: September 2021

Objective: To evaluate the effect of preoperative single dose injection dexamethasone for prevention of PONV in patients undergoing laparoscopic cholecystectomy and comparing it with normal saline (placebo). Design: Experimental RCT study. Place and duration of study: The study was conducted at Madina Teaching hospital, University Medical & Dental College, Faisalabad from January, 2008 to October 2009. Materials and Methods: After approval from the hospital ethical committee, 200 patients with ASA I & II were included in the study. We divided the patients into two groups; group I received preoperative dexamethasone (8mg) and the group II received normal saline (placebo) 90 minutes before the surgery. Patients were observed for any episodes of nausea or vomiting, need for rescue antiemetics, and complete responses in the postoperative period. The complete response was defined as no nausea, no vomiting, and no ant emetic medicationduring a 24-h postoperative period. This was also the primary efficacy end point of the study. The data was analyzed using Pearson’s Chi square test with P < 0.05 taken as significant. Results: Nineteen patients (19%) in the dexamethasone group reported nausea, compared with 43 (43%) in placebo group (p<0.05). Eight patients (8%) in the dexamethasone group reported vomiting and twenty two patients (22%) in theplacebo group reported vomiting (P <0.05). In group I, thirteen patients (13%) asked for rescue anti-emetic where as in group II (placebo group) thirty six patients (36%) asked for rescue anti-emetic (p<0.05). Seventy three patients (73%) in the dexamethasone group showed a complete response, compared with 35 (35%) in placebo group (p<0.05). Conclusion: We concluded that preoperative dexamethasone (8mg) reducesthe incidence of PONV as compared to placebo. As it is a cheap, freely available drug causing no complications, it should be used in otherwise fit selected patients undergoing laparoscopic cholecystctomy.
CONTROL OF POST-SURGICAL PAIN
Authors: MANSOURI ALI MIR , FARZI FARNOUSH , KHALKHALIRAD SHIRIN , Haryalchi Katayoon , Sediginejad Abas
Published: September 2021

Introduction: There are many complications for patients with post cesarean section relative pain. So it delays in discharging or increasing in hospital stay. The objective of this study was a comparison between Tramadol and Meperidine according to pain relief or other possible complications in post cesarean section pain control. Materials and Methods: This study was a double blind clinical trial. It arranged for 240 parturients who scheduled for emergency cesarean section with pain after surgery in spite of spinal anesthesia. All patients were in ASA class I. They were divided randomly in two groups .Meperidine (M) and Tramadol (T) groups with 120 patients in each group. After beginning of pain in post anesthesia care unit (VAS> or = 4), in group (T) tramadol 1.5 mg/kg and in group (M) meperidine  .5 mg/kg were injected intravenously. Apart from pain, other drug complications such as shivering, blood pressure changes, itching, nausea and vomiting, drowsiness were recorded one and two hours after injection. Data were analyzed by chi-square test. Results: Relative frequency rate (RFR) of 50% decrease in pain score one hour after intravenous injection was 56.7% in group (T) and 69.2% in group (M) ( P = 0.054). RFR for respiratory depression after one hour was 5.8% in (M) group and 0 in (T) group (P = 0.007). RFR for nausea after one hour was 39.2% in (T) group and 23.3% in (M) group (P = 0.008). RFR for vomiting after one hour was 23.3% in (T) group and 13.3% in (M) group (P= 0.045). RFR for drowsiness after one hour was 25% in (M) group and 3.3% in (T) group (P=0.007). There was no statistically significant relationship after 2nd hour for pain relief, nausea, vomiting and drowsiness between two groups. There was no difference between two groups in RFR for shivering, blood pressurechanges and itching in both two groups. Conclusion: This study illustrates both remedies Meperidine and Tramadol which were effective for pain relief and shivering after cesarean section. But according to high incidence of nausea and vomiting with Tramadol and more analgesic effects of Meperidine than Tramadol, administration of Meperidine is better than Tramadol after cesarean section for pain control.
CHRONIC SUPPURATIVE OTITIS MEDIA
Authors: LODHI MUNIR , AZIZ KAMRAN , MUNIR TEHMINA , Lodhi Hamza
Published: September 2021

Objective: The aim of the study was to determine the most prevalent organisms in chronic otitis media in children and their susceptibility to various antibimicrobials so that an appropriate empiric antibiotic can be started promptly while awaiting the results of the culture and sensitivity. Design: Prospective observational study. Place and Duration of Study: The study was conducted at Combined Military Hospital Lahore from Jan 2006 to Dec 2007. Subject and Methods: A total of 156 patients less than 15 years of age who were having discharge from one or both ears for at least 1 week with tympanic membrane perforation were included in the study.A sample of the ear discharge was collected on the swab and cultured on appropriate media. The Gram positive organisms were identified on the basis of Gram staining, catalase and coagulase test, the Gram negative organisms were identified by API 20e. A total of 156 patients were included in the study of which 96(61.5%) were males and 59(37.8%) were females. The organisms isolated were Staphylococcus aureus in 79(50.6%), Pseudomonas aeruginosa in 45 (28.8%) patients and Proteus mirabilis 17 (10.9%), Escherichia coli, Acinetobacter sp and streptocci were isolated in occasional patients. Staphylococcus aureus was the commonest organism isolated followed by Pseudomonas aeruginosa and Proteusmirabilis Fifty four. (34.6%)of Staphylococcus aureus were sensitive to gentamicin, fifty two (33.3%) to ciprofloxacin and 42 (26.9%)% to both ciprofloxacin and gentarnicin. Among the Pseudomonas aeruginosa isolates 40 (25.6%) were sensitive to gentarnicin, 27(17.3%) to ciprofloxacin and 22 (14.1%) to both ciprofloxacin and gentarnicin. Out of 156 patients 91(58.3%) had isolates which were sensitive to ciprofloxacin and 62(39.7%) were resistant to it. One hundred fourteen patients (73.1%)had isolates which were sensitive to gentamicin whereas 33(21.2%) were resistant. Similarly 35 isolates (22.4%) were sensitive to ulphamethoxazole/trimethoprim whereas 66(42.3%) were resistant. Among Proteus mirabilis isolates 12 were sensitive to gentamicin, 11 were sensitive to ciprofloxacin and 11 were sensitive to both ciprofloxacin and gentamicin. Conclusion: Ciprofoxacin ear drops can be recommended to be given empirically in children with chronic discharging ears. The initial therapy can be modified and appropriate therapy started if the result of the culture and sensitivity report shows the isolate to be resistant to the antibiotic started empirically.
PREVALENCE OF H. PYLORI
Authors: JAVED MASOOD , AMIN KHALID , MUHAMMAD DILSHAD , Husain Aamir , Mahmood Nasir
Published: September 2021

Background: Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA & UK and 5:1 in Pakistan1,2,3. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place toresist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid – No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H.pylori -No ulcer4,5, as over90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected byH.Pylori6. Aim of the study was to evaluate the prevalence of H.pylori among Duodenal ulcer patients at Faisalabad District and its suburbs. Study Design: Descriptive Study. Period: From Mar 2008 to Oct 2008. Materials and Methods: 50 patients (40 Males, 10 Females) belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H.Pylori status with the help of unease test and histological examination of biopsy specimen. Results: Epigastric pain was the most frequent symptom 90%. (46 out of 50 patients). 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recordedin age group IV (46—55 years). Maximum number of patients was skilled workers (35 out of 50) 70%. 80 % of the patients belonged to lower and middle class. Percentage of H.pylori positivity was 89.1 % and 84.34 %. Conclusions: Acceptance of contributory role and high prevalence rate of H.pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPIs which is cost effectiveand alter the course of the disease.
MALARIAL PARASITES SPECIES
Authors: SOOMRO FAROOQ RAHMAN , PATHAN GHULAM MURTAZA , BAJAJ DOULAT , Kakar Juma Khan
Published: September 2021

To determine the pattern of malarial parasites species in Jacobabad District Sindh. Design: A retrospective observational study.Setting: This study was conducted at District Malarial control Centre Jacobabad with collaboration of pathology Department C.M.C Larkanaand Leishmaniasis / Mosquito Zoology Lab: University of Balochistan Quetta. Period: One year 2005. Patients & Methods: During the studyperiod blood smears were prepared from the suspected cases of malaria. The suspected cases with fever referred from various areas ofJacobabad District by General Practitioners, Basic Health Units, Rural Health Centres and Taluka Hospital were included in the study forconformation of malaria. The parasites were identified by using Giemsa stained thick and thin smears. Results: During the study period total of58,989 blood smears were examined irrespective of age and sex and were conformed for malarial parasites, giving over all positivity rate of0.91% (540 cases). Plasmodium falciparum was identified in 154 (28.52%) and Plasmodium vivax in 386 (71.48%) cases. Conclusions: Thepositive cases for malarial parasites were 0.91% and Plasmodium vivax found as most predominant species in the region.