bluuebunny/crossref_metadata_2025 huggingface dataset:
JAIL POPULATION
Authors: NAFEES MUHAMMAD , AHMED ISHTIAQ , JAFFERI GHAZALA
Published: September 2021

Objective: The infections with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are common among prisoners but such data are sparse from Pakistan; hence in this study, we evaluated the sero-prevalence of these three infections among Jail inmates. Design: Cross-sectional survey. Setting: Central Jail, Lahore. Period: May to November 2009. Methodology: Investigate the seroprevalence of HBV, HCV and HIV infections among the random population of sentenced inmates of Central Jail, Lahore. We examined 3062 jail inmates, 396 of them were females and 2666 males. Majority of the inmates were Pakistani national (97.06 %). All collected blood samples were tested for HIV antibodies, HBsAg, and anti-HCV antibodies with one step chromatographic immunoassay. Results: Seroprevalence rate of HCV, HBV and HIV infections was 15.31%, 3.46 % and 1.79 % respectively. Overall prevalence of these infections in the jail inmates was 20.57 % and 18.77 % of them were positive for markers of viral hepatitis B/C. Conclusions: We evaluated that jail inmates in Pakistan had a high incidence of HCV, HBV and HIV infections. Regular testing is required to identify infected prisoners and refer them for appropriate treatment. In addition, general disease prevention efforts are needed to minimize transmission of these viral infections in this subpopulation, before and after release.
LIVER BIOPSY
Authors: SIDDIQI FUAD AHMAD , KITCHLEW RIZWANA , HASHMI ASIF
Published: September 2021

Objective: To study the safety and efficacy of Surecut needle in obtaining the liver tissue by percutaneous liver biopsy. Design: Single centered prospective hospital based study. Place and duration of study: Department of Internal medicine (Unit-1) & Family ward, Combined military hospital Lahore for more than one year from August 2002 to March 2004. Materials and Methods: One hundred and fifty patients of either gender having asymptomatic hepatitis C carrier state, healthy blood donors, with positive HCV-PCR were included in study. The patients liver biopsy was done with Surecut needle 16G with patient breath suspended in expiration from the periphery of right lobe of liver. Result: Majority of patients, 135 ( 90% ) were male and 15 (10%) were female. The mean age was 30.3 years with range of 25-55years. In 146(97.31%)patients successful biopsy was done while the biopsy was non-diagnostic in 4(2.69%) patients. Mean core length of liver tissue obtained was Mean+sd(1.2+0.42cm) and histopathologic diagnosis was made in 97.31% cases. Total number of attempts were 1-2. In 99% single attempt was done. No major complications related to procedure was seen. Conclusions: liver biopsy with Surecut needle is safe and effective in establishing the diagnosis of Chronic hepatitis.
DROPPED NUCLEUS DURING PHACOEMULSIFICATION
Authors: AHMAD FAHEEM , HAIDER SYED ALI
Published: September 2021

Introduction: The increasing popularity of phacoemulsificalion in restoring good visual acuity has also led to an increase in the incidence of its complications like nucleus drop during the procedure. Proper management of such patients not only reduces intravitreal lens fragments related complications but also significantly improves the visual acuity. Objectives: To evaluate the clinical features of the eye with retained Intravitreal lens fragments after the phacoemulsification surgery. We also aimed to investigate the incidence of cystoid macular edema, retinal detachment, suprachoridal hemorrhage and any other complication in patients after pars plana vitrectomy for retained intravitreal lens fragments. Setting: This study was carried out at the department of ophthalmology, Lahore General Hospital, Lahore. Period: The duration of study was one year 17-05-2004 to 28-04-2005. Study Design: Descriptive prospective. Material & Methods: The reported frequency of dislocated lens material at 0.3% is quiet low. Despite LGH being a referral center for retinal diseases, dropped nuclei and nuclear fragments constitute a very small fraction of the referred cases. Therefore the study was limited to 15 cases only so that it could be completed within specified period. Results: 15 eyes having retained lens matter after phacoemulsification surgery were included. Aphakia was present in 10(66.75%) patients. 5 (33.4%) patients were pseudophakic. Raised intraocular pressure was found in 11 (73.4%) patients, cornea! edema in 7 (46.7%), uveitis in 6 (40%) patients. Two (13.4%) patients had retinal detachment at presentation. The range of visual acuity way perception and projection of light to counting fingers in 9 eyes (60%), 2/60-6/60 in 5 eyes (33.4%). 6/24 in 1 (6.64%) eye preoperatively. After vitrectomy, range of visual acuity was 6/9 to 6/18 in 9 patients (60%) and 6/24-6/60 in 6 patients (40%). The comparison of pre-operative visual acuity and that of last follow-up showed p<0.01 (statistically highly significant). Intraocular pressure was raised in only 2 patients (13.3%). No patient developed retinal detachment. Cystoid macular edema was found in only 2 patients (13.4%).No patient developed significant intraocular inflammation after vitrectomy. Conclusions: Patients having retained intravitreal lens fragments presented with raised intraocular pressure, reduced visual acuity, uveitis and retinal detachment. In such patients combined pars plana vitrectomy and secondary intraocular lens implantation reduced the risk of postoperative complications including secondary glaucoma, uveilis and helped in restoration of useful visual acuity.
TOXICITY OF ISONIAZID (INH);
Authors: BHURGRI GHULAM RASOOL , KORIJO HUSSAIN BUX , IMRAN RATHORE MUHAMMAD , QAZI Muhammad Ali
Published: September 2021

Objective: To compare the untoward effects of isoniazid (inh) and placebo as an anti-tuberculosis therapy in tuberculosispatients. Study Design: Prospective study. Setting: Free T.B Clinic, Muhammad Medical College Hospital Mirpurkhas Sindh. Period: June2007 to Dec 2007. Patients, Method and Results: Patients were selected with filling of consent forms from free T.B Clinic. Prospective study ofadverse effects of INH Isoniazid in tuberculosis treatment. Conclusions: It is concluded like other anti-biotics, Isoniazid must be carefully,mentioned in combination therapy of Anti-Tuberculosis Therapy. The major side effects are those giving rise to serious health hazards, requirediscontinuation of the drug and referral to chest physician.
APPENDICECTOMY;
Authors: SARWAR KHAN JAHANGIR , FAROOQ UMAR , HASSAN HAMID
Published: September 2021

Objective: The objective of this study was to compare length of hospital stay, pain scores and the rate of wound infectionsbetween laparoscopic and open appendectomy. Design: Randomized Controlled trial. Place and Duration of study: This study wasconducted in surgical unit I Holy Family hospital, Rawalpindi from 1st June 2009 to 31st May 2010. Patients and methods: The patients weredivided into open and laparoscopy groups and their age, sex, time of discharge, pain scores and wound infection rates were compared andanalyzed. Results: Total of 160 patients were included in the study, 80 in each group. There were 58% male and 42% female patients. Mean agewas 22.78 years (±6.2).Post operative pain scores were significantly less in the laparoscopic group (p<0.05). The length of hospital stay in opengroup was 35.10 hrs (±5.4) hours and in the laparoscopic group was 38.70(4.8) hrs with a p value of 0.592.Wound infection was 0.037% in openand 0.025% in the laparoscopic group. Conclusions: Laparoscopic appendectomy is superior in terms of less morbidity and shorter postoperative hospital stay in the setting of an overworked tertiary care surgical floor of a Pakistani hospital.
EUTHANASIA;
Authors: KHAN Ayesha , HUSSAIN MEHWISH , HASAN SYEDA MISBAH
Published: September 2021

Objective: To assess the perception towards euthanasia among Pakistani medical students and practitioners. Methods: Thisdescriptive study was conducted at Dow Medical College and Civil Hospital, Karachi, Pakistan. Data was collected by a self administeredquestionnaire, consisted of case history of a cancer patient and questions regarding end of life issues. Results: Students were less likely toapprove euthanasia as a murder than doctors. Large number of participants considered it as an unethical act. The decision of patients’ right todie was more discouraged by the students than doctors. Though, both students and doctors were strongly disagreed to perform euthanasia infuture. The legalization of euthanasia in Pakistan was favored by 15.4% of practitioners, compared with 10.4% of students. Nearly half of theparticipants stated that they would not trust doctors if euthanasia become legal in Pakistan. Conclusions: Medical practitioners were foundmore in favor of euthanasia, its practice and legalization in Pakistan. This study gave insight for elaborating opinions towards euthanasia byPakistan.
ABNORMAL CERVICAL SMEAR;
Authors: WAHEED AFIFA , IJAZ SOFIA
Published: September 2021

Objective: To evaluate the colposcopic findings and biopsy results in patients with abnormal cervical smear reports. Studydesign: Interventional-Quasi experimental study. Setting: Department of Obstetrics and Gynecology, Unit-I, Services Hospital, Lahore.Period: Six months (June 21, 2007 to December 20, 2007). Material and Methods: Fifty patients were included according to inclusion criteria.Results: Mean age of the patients was found to be 32.8±7.3. Maximum patients were > para 4. 44% pap smears were with grade-II dyskaryosis.41 patients were found with acetowhite area, their biopsy findings showed 24.5% CIN-II cases. Same results were found in iodine negativeareas and biopsy in mosaic pattern showed 25% cases. Conclusions: Cervical cancer is a cause of morbidity and mortality amonggynecological malignancies, but with the help of non invasive technique like colposcopy it can be detected in its earlier stages where definitivecure is possible.
LATENT TUBERCULOSIS;
Authors: IQBAL JAVED , HUSSAIN MALIK ALTAF , JAMIL Aftab
Published: September 2021

Objectives: To assess the degree to which Latent Tuberculosis exist among long–term inmates in jail. Study Design:Prospective Cohort Analytic Experimental Quantitative Data. Setting and Period: Jails at Bahawalpur between 2009-2010. Methods: Wemonitored the Mountex Test of prisoners within 48 to 72 h and those who were 10 mm or more were considered positive and for HIV positive 5mm criteria were set to declare positive. Group 1-who were in jail for more than a year and those, Group- 2-who were in jail for less than onemonth. Data was collected on a proforma. Each prisoner had thorough clinical examination with detailed clinical history and Chest X-ray.Inclusion Criteria: 1. All those prisoners who never had tuberculosis in past. 2. All those prisoners who were not on Anti Tuberculous Therapy.3. All those prisoner whose chest x ray was normal and had no symptoms of tuberculosis. Exclusion Criteria: 1. All those who had tuberculosisin past or were on antituberculous treatment currently. 2. All those who were having chronic cough. Results: Total number of prisoners in group1 were 298 and number of prisoners in group 2 were 128. Latent tuberculosis was found in total of 31(10.40%) of prisoners in group 1 and noneof prisoners in group 2 were having latent tuberculosis. Conclusions: Jail inmates for more than 1 year did show more numbers of latenttuberculosis patients than the new inmates. These results suggest that the close contacts harbor the live tubercle bacilli and in future they mayconvert into active cases.
POSITIVE END EXPIRATORY PRESSURE (PEEP);
Authors: RAZZAQUE Usman , AZHAR RAHEEL , KHURSHID TASSADAQ , Zaeem Khalid , Majid Syed
Published: September 2021

Introduction: Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain uniquephysiological problems. These include placing (lateral decubitus position) in order to obtain optimal access for most operations on lungs, pleura,esophagus, and great vessels, opening the chest wall (open pneumothorax) and one lung ventilation anaesthesia. One lung ventilationanaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that rangesfrom 15% to 40% leading to increase in ventilation perfusion (V/Q) mismatch thus causing hypoxia and or hypoxemia. An optimal level ofpositive end expiratory pressure of 5cmH O when added to dependent lung is known to improve arterial oxygenation and improve ventilator 2efficiency. Objectives: To compare different values of positive end expiratory pressure (PEEP) during one lung ventilation, for its effects onblood arterial oxygenation and carbon dioxide levels. Study Design: Randomized controlled trial (RCT). Setting: Conducted in surgical Unit-IIIand Department of anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi. Duration of study with dates: Ten months from25-12-2008 to 01-10-2009, Additional quantum of Data was collected from 01-01-2011 to 25-01-2011. Subjects and methods: The patientswere divided into two equal groups of 100 patients each, by random allocation of patients to either in-group A (subjected to zero PEEP) or group-B (subjected to PEEP 5cm of water). Results: At induction and start of two lung ventilation 14 (14.0%) of the patients from group-A and 16(16.0%) from group-B had normal PaCO . At initiation of one lung ventilation 25 (25.0%) of the patients from group-A and 80 (80.0%) from group- 2B had normal PaO . At initiation of one lung ventilation 26 (26.0%) of the patients from group-A and 80 (80.0%) from group-B had normal PaCO 2 2with p <0.001. At end of procedure one lung ventilation 30 (30.0%) of the patients from group-A and 90 (90.0%) from group-B had normal PaO . 2At end of procedure one lung ventilation 32 (32.0%) of the patients from group-A and 91 (91.0%) from group-B had normal PaCO . 2Conclusions: The execution of one-lung ventilation still constitutes a challenge in clinical and surgical practice.
HELICOBACTER PYLORI & HEPATIC ENCEPHALOPATHY;
Authors: LIAQUAT JAHANGIR , KAZI IFTIKHAR , AHMED MUKHTIAR , Yousfani Akber Hussain , Kumar Raj
Published: September 2021

Introduction: Hepatic encephalopathy is a common and serious complication affecting patients with liver disease. Helicobacterpylori bacterium is postulated to be involved in worsening of this condition via its potential to create ammonia within the gastrointestinal tract.Objective: The objective of this study was to determine the frequency of H pylori infection in cirrhotic patients who were suffering from hepaticencephalopathy. Design: Case series study. Setting: Medical Unit-IV of Liaquat University Hospital, Hyderabad. Period: January to July 2010.Methodology: Methodology: Every confirmed case of cirrhosis of liver who presented with acute confusional state, and loss of consciousnessto the emergency department of hospital was considered for enrollment in the study. The presence of hepatic encephalopathy was confirmedand its severity grading was done clinically. Subsequently H pylori serological tests were done on every patient and a cut off value of 200:1antibody titer was considered as positive. Primary outcome variable was presence or absence of H pylori antibody titer. Results: A total of 115patients were selected, 69 (60%) were males and 46 (40%) were females. The mean age of patients was 49.36 years with a SD of 7.8. Antibodyto H pylori was present in 83 (72.17%) patients, whereas it was absent in 32 (27.83%). Two out of ten patients (20%) who were in Grade I hepaticencephalopathy showed a positive test for H pylori antibody. In Grade II hepatic encephalopathy 17 out of 19 patients (89.47%) were havingpositive H pylori antibody, in grade III 29 out of 34 (85.29%) and grade IV 35 out of 52 patients (67.3%) were having the antibody to H pylori.Conclusions: Further studies are warranted to evaluate the arguments for and against the role of H pylori in the pathogenesis of hepaticencephalopathy.
GINGIVAL HEALTH
Authors: NASIR NOMAAN , ALI SARAH , HAYAT YAWAR , Bashir Ulfat
Published: September 2021

Objectives: The location of crown margins is very important for the health of periodontal tissues. This study was designed toevaluate the gingival health of teeth before and six months after tooth crowning. Design: Cross sectional study. Setting: Islamic InternationalDental Hospital. Period: March 2010 to June 2011. Method: 50 patients were selected from the out patient department. Who were advisedcrowns for replacement of lost tooth structure and data was collected before and six months after crown insertion. Papillary Bleeding Index (PBI)was used to evaluate periodontal health. All recorded data was entered in computer and was statistically analyzed using SPSS version 17 dataanalyzer and comparisons were performed using chi square test. Results: Results showed that patients inserted with crowns had signs ofperiodontal disease. ( p value = 0.03). Conclusions: It may be concluded from the study that sub gingival crown margins have detrimental effecton gingival health.
PREGNANCY;
Authors: TAHIRA TASNIM , TAHIR SUMERA
Published: September 2021

Objective: To determine pregnancy outcome in patients presenting with heart disease during pregnancy and labour. Design:Descriptive study. Place & Duration of study: This study was conducted in Gynae Unit-I, Allied Hospital affiliated with Punjab Medical College,Faisalabad, during a period of 2 years from January 2009 to December 2010. Materials & Methods: This study included 74 patients whopresented with congenital or acquired heart disease during pregnancy or labour. Patients were evaluated for their cardiovascular status bycardiologist. Relevant investigations done to assess maternal and fetal condition. Results: 50 patients (67.6%) were in age group 20-25 years.Congenital heart disease was present in 8 (1.8%) patients while acquired heart disease was present in 66 patients (98.2%). 52 patients (70.3%)achieved term delivery, while 8 patients (10.8%) had spontaneous miscarriage and 14 patients (18.9%) had preterm delivery. 50 patients (76%)had live birth with normal birth weight, 12 patients (18%) had fetuses which were small for gestational age (SGA), 2 patients (3%) had stillbirthand 2 patients (3%) had early neonatal death due to prematurity. Conclusions: Heart disease in pregnancy is a high risk condition.Multidisciplinary approach should be adopted in the management of cardiac patient to achieve good obstetric and fetal outcome.
ANTHROPOMETRIC MEASUREMENTS;
Authors: ASHRAF SOHAIL , RAHMAN ARSHALOOZ J. , ABBAS KASHIF
Published: September 2021

Background: Determination of anthropometric measurements, especially of birth weight of newborn in first few days after birthis important for the assessment of neonatal nutritional status, gestational maturity, and prediction of early neonatal death. Objectives: (1) Todetermine the mean birth weight, mean birth length and mean head-circumference. (2) To seek association between income of the family andmean birth weight. Study Design: Analytical cross-sectional study. Setting & Period: This study was done in the pediatric department of LiaquatNational Hospital from March 2003 to September 2003. Materials and methods: One hundred full terms, normal, singleton newborn babieswere included and birth weight, length and head circumference were taken within 72 hours of birth. Results: Overall mean birth weight was2.890 kg, mean birth length 48.245cm and mean head circumference was 34.232 cm.The % of LBW babies was 13. The mean birth weight ofbabies belonging to group A (born to families with income >5000 Rs/mth) was 3.044 Kg and that of group B (born to families with income <5000Rs/mth) was 2.736 Kg. Group A had 8 % LBW babies whereas group B had 18 %. Mean birth weight, length and head circumference of boys was2.961Kg, 48.776 cm and 34.316 cm respectively. Mean birth weight, length and head circumference of girls was 2.788 Kg, 47.480 cm and34.109 cm respectively. Conclusions: Community based studies should be conducted from time to time in order to develop our own populationdata.
GESTATIONAL TROPHOBLASTIC DISEASES;
Authors: HASSAN SYED MEHMOOD , HASHM SHOAIB NAYYER I , AYAZ BUSHRA , Rashid Lodhi Faisal , Sohail Kanwal
Published: September 2021

Objective: The study was carried out to evaluate the frequency and types of gestational. Trophoblastic diseases (GTD) inendometrial curettings received for histopathology examination. Data Source: Pathology Department, Shifa Naval Hospital Karachi. Design ofStudy: It was a Retrospective Descriptive Observational study. Setting: Department of Pathology, Pakistan Naval Ship; Shifa Naval HospitalKarachi. Period: From 2009 till 2010. Material & Methods: A total of 170 cases of endometrial curettage were examined. All specimensreceived with a diagnosis of product of conceptions (POC) or with the clinical suspicion of a gestational trophoblastic disease were included.Results: It was observed that partial mole identified in 57.1 % cases followed by complete mole 21.4%, choriocarcinoma 14.2% and placentalsite Trophoblastic disease 7.1% cases. Nearly half of the cases were diagnosed as having a gestational trophoblastic disease; these were fromthe age groups of 26-30 years followed by 21-25 years. Conclusions: Hydatidiform mole is the commonest gestational trophoblastic disease.Most complete moles are detected clinically but partial moles are misdiagnosed as abortions therefore all cases of abortions should be sent forhistopathological examinations.
RECURRENT MALIGNANT PHYLLODES TUMOUR:
Authors: KUMAR U MAHESH , BR YELIKAR
Published: September 2021

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ENGLISH LANGUAGE PROFICIENCY;
Authors: SARFRAZ KHAN JUNAID , TABASUM SAIMA , MUKHTAR OSAMA , Bano Tahira , Iqbal Maryam
Published: September 2021

Introduction: Each year, more than 30,000 students sit in the Government sponsored Entrance Test conducted by University ofHealth Sciences, Lahore for admission in Public and Private Medical & Dental Institutes of Punjab, Pakistan. Objective: In this study, we haveembarked to seek the relationship of the performance of students in the English component of the test and their sciences components scoresand how this English-Science relationship varies amongst the developed and underdeveloped districts of Punjab, Pakistan. Period: Threeyears from 2008 to 2010. Methodology: The sciences components scores of the candidates in MCAT, their scores in English portion in the testand their demographic variables were entered into Statistical Package for Social Sciences (SPSS) v.16. Parametric tests were applied.Results: Nearly 14% of the question paper tests proficiency of the candidates in the English Grammar. The students from thesocioeconomically challenged districts scored less marks in English component as well as in the sciences component of Entrance Test whencompared with the scores of the students of more developed districts (p<0.05). The difference in the mean marks of English and Sciencescomponents of the test when adjusted for weightage was higher in the socioeconomically developed districts (p<0.05). A steady improvementfrom 2008 to 2010 in the scores obtained by candidates in English component of the Entrance Test was observed (p<0.05). Conclusions: Foradmission in Medical and Dental Colleges in Punjab, candidates scoring more than 60% marks in their Higher Secondary School CertificateBoard Examination, have to sit in a uniform Entrance Test in which from the year 2008-2009, candidates from socioeconomically low districtshave performed poorly in both English component and sciences components of test in comparison to the candidates from more developeddistricts. The comparatively lower score is more significant in sciences components of test. The lower scores of the less developed districts,candidates can not therefore be attributed to their low proficiency in the English language but rather to a lower general educational performance.
HEPATITIS ‘C’;
Authors: MEHMOOD KHAN MUZAFFAR , TAHIR Muhammad , RAZA Mohsin , BHATTI Muhammad Ali , Khokar Muhammad Riaz
Published: September 2021

Objective: The objective of this study was to determine association of Interferon-Ribavarin therapy with hearing loss in patientssuffering from Hepatitis ‘C’. Study Design: Quasi-experimental study. Place and Duration: Otolaryngology Department Combined MilitaryHospital Rawalpindi from 09 June 2006 to 08 June 2007. Patients and Methods: Consenting sixty patients of Hepatitis C divided into two equalgroups of 30 each, (group A receiving Interferon-Ribavarin therapy and group B, not receiving it) during the study period fitting the inclusioncriteria were selected. Pure Tone Audiometery including both air and bone conduction performed as base line data at commencement oftherapy and then at the end of therapy (after six months) . Patients were sampled by Convenience (non-probability) technique. Results: Thenumber of patients who were found to have defined hearing loss was 06 (20%) in Group A (n=30) and 05(16.67%) in Group B (n=30). Chi Squaretest was applied which showed a p-value of 0.739 which is highly insignificant. Conclusions: Interferon-Ribavarin Therapy does not have asignificant association with hearing loss in patients of Hepatitis ‘C’.
VITAMIN D DEFICIENCY;
Authors: ASLAM MUHAMMAD , MASOOD ZAHID , SATTAR Abdul , Qudsia Maria
Published: September 2021

Objective: To study the Prevalence of Vitamin D deficiency in pregnant women. Study Design: A Cross-sectional analyticalstudy through convenient sampling technique. Setting and duration: At a private Clinic located at East Canal Road Faisalabad, from March2011 to June 2011. Material and method: The study included consecutive 61 pregnant women of reproductive age and non-pregnant womenwere excluded. Blood samples were taken in morning i.e. overnight fasting samples, by venepuncture by disposable syringes sample weretaken and samples were stored at -20 degree centigrade till they were analyzed. Our interest was in age and serum Vitamin D 3 levels. Results:Out of 61 pregnant women results showed that 87.0% pregnant women were having Vitamin D deficiency, 10.0% were having Vitamin Dinsufficiency, 3.0% had Vitamin D sufficiency and none shows Vitamin D intoxication. Vitamin D deficiency was more prevalent in pregnantwomen of younger age group. Furthermore prevalence was higher among the pregnant mothers with high parity. Moreover, 65% women werenot exposed to sunlight properly, 60% women had muscle cramps and bony aches. 90% women never were tested for tested Vitamin D levelsbefore. Conclusions: Prevalence of Vitamin D deficiency is significant in pregnant women. It is also important for its effects on various organsand systems of body as well as on pregnancy and neonate. The different aspects of study led to conclusion to emphasize that Health educationbe imparted to pregnant women and their families in terms of diet, proper sunlight exposure and taking Vitamin D supplements in pregnancy. It isthus recommended to perform Vitamin D levels in every pregnant woman.
HYSTERECTOMY
Authors: IKRAM M. , JABEEN SHAZIA , SAEED M.
Published: September 2021

Abdominal hysterectomy, the procedure by which almost 90% of hysterectomies are currently being done. Laparoscopicassisted vaginal hysterectomy has been introduced as an alternative to abdominal hysterectomy, and is thought to allow a more rapid return tonormal activity. Laparoscopic assisted vaginal hysterectomy has less postoperative morbidity and quicker recovery than abdominalhysterectomy. Objective: To compare the laparoscopic assisted vaginal hysterectomy with total abdominal hysterectomy in term of operativetime, per operative blood loss and post-operative wound infection. Study Design: Randomized trial. Setting: This study was carried out in thedepartment of obstetrics and gynaecology, Shaikh Zayed Hospital, Lahore. Period: Six months (15th September, 2008 to 15th March 2009).Patients and methods: Eighty patients fulfilling the inclusion criteria were selected for this study. Patients were equally divided in two groups;group A (laparoscopic assisted vaginal hysterectomy) and group B (total abdominal hysterectomy). Operative time (in minutes), blood loss (inml) as estimated and post-operative wound infection was assessed by presence or absence of wound discharge, redness and edema aroundthe incision on 3rd, 5th and 7th post-operative day. Results: The mean ages of women in group A was 49.13+4.26 and 45.68+4.54 years ingroup B. The maximum number of parity between 3-4 was 19 in group A and 20 in group B. Mean weights of cases in group A was 65.60+10.45kilograms and 70.77+15.59 kilograms in groups B. The per-operative time in group A was 105.13+6.55 minutes and 83.38+14.82 minutes ingroup B. The mean blood loss in group A was 178.0+43.51 ml and 228.25+72.49 ml in group B. The wound discharge was not found in group A,while in group B, 4 cases (10%) on 3rd post-operative day, 6 cases (15%) on 5th post-operative day and 11 cases 27.5% on 7th post-operative.Conclusions: Laparoscopic assisted vaginal hysterectomy has a quicker post-operative recovery but at the expense of a bit long duration ofsurgery. Laparoscopic vaginal assisted hysterectomy is a feasible option in a selected group of patients who would otherwise require anabdominal hysterectomy. The drug requirement to control pain and level of pain experienced by patients were also significantly less.
SCLEROTHERAPY VERSUS RUBBER BAND LIGATION;
Authors: JEHAN SHAZIA , ALI MAHMMOD , ATEEQ Muhammad , Bhopal Faisal .G.
Published: September 2021

Objective: To compare the outcome of two different procedures of non operative treatment of uncomplicated second degreehemorrhoids in terms of efficacy and patients compliance. Study Design: Prospective interventional. Controlled Phase II clinical trial. Setting& Duration: Surgical Unit DHQ (Teaching) Hospital Rawalpindi from 10th September 2004 to 20th May 2006. Methodology: Regardless ofage and sex, first hundred patients attending the out patients department of surgical unit, DHQ( Teaching) Hospital , Rawalpindi withuncomplicated second degree hemorrhoids after informed consent were enrolled in the trial. Patients were divided into two treatment groupsA&B with 50 patients in each by random draw sampling. Patients in Group A were subjected to injection sclerotherapy (SCL) whereas of GroupB, Rubber band ligation (RBL) was performed. Results: One hundred patients of mean age of 42.24 years with uncomplicated second degreehemorrhoids with standard deviation of + 13.63 years were enrolled in this study. Out of total one hundred patients, 62 were male and 38 werefemale. The major indications of treatment were bleeding per rectum and prolapse. Patients in Group A were subjected to Injectionsclerotherapy (SCL) and of Group B , Rubber band ligation (RBL) was performed. In Group A , 28 patients (56%) were symptoms free after 4-6weeks with single session of SCL , 16 patients (32%) required additional second session at eight week and 6 patients (12%) required thirdsession at 12 weeks respectively due to persistence of symptoms. In Group B , 44 patients (88%) were symptom free after four weeks withsingle session of RBL, while 6 patients (12%) required second session at 10 weeks to become symptom free. At 12 month follow-up 46 patients(92%) remain symptomfree and 4 patients (8%) had recurrence of symptoms in Group A and rubber band ligation was performed. All thepatients of Group B (RBL) remained symptom free. (P value=0.041). Conclusions: Rubber band ligation is a safe, effective, economical nonoperative treatment option for second degree uncomplicated hemorrhoids with good patients compliance.
SEMEN pH;
Authors: MWAKYOMA HENRY. A. , MAGOROSA ERICK. P.
Published: September 2021

Background: Male infertility is a frequent reproductive health problem in the world. It is usually related to abnormal spermproduction or function and these abnormalities can occur anywhere in the production of sperm including hormonal regulation, storage andtransport of sperm. Various factors are known to be responsible for seminal fluid abnormalities. Usually the first step in evaluating for maleinfertility is semen analysis. Setting: The study was conducted at Muhimbili National Hospital mainly in the department of Pathology laboratory,cytology unit. Study design: The study was a hospital based cross-sectional type. Objective: To determine semen pH in patients presenting withinfertility complains and relate how pH of seminal fluid and other semen parameters influence each other. Material and methods: Beforesemen collection, patients were instructed to abstain from sexual intercourse for a minimum of 48 hours to 7 days and collect semen bymasturbation and transport it to the laboratory through shirt pocket. Semen was to reach the laboratory for examination in not more than onehour from time of collection. Semen was examined macroscopically for volume, colour, viscosity and pH by using a pH meter (Consort C830)followed by microscopic examination which included motility of spermatozoa and sperm count by using Neuber counting chamber. The smearwas made on glass slides, fixed in 95% ethyl alcohol for 30 minutes then stained by using Papanicolaou’s staining technique and then analyzedmicroscopically for morphological examination. Results: In the analysis of the influence of semen parameters on semen pH, there wasdecrease in seminal fluid pH with age whereby as age increased the pH of seminal fluid decreased.. The general trend observed was that thepH of seminal fluid tended to decrease with an increase in the days of abstinence. pH tended to decrease with an increase of seminal fluidvolume. The pH of seminal fluid also increased with an increase in viscosity (Hyperviscosity >Hypoviscosity). The pH of seminal fluid in patientswith less than 50% forward progressive movement of spermatozoa was higher when compared to those with more than 50% forwardprogressive movement. pH had an influence on the motility of spermatozoa. Conclusions and recommendation: pH and other parameterstended to have an influence each other during seminal analysis in our study. There is a variation of pH in different parts of the World according tothe studies done. It is recommended that pH should be included during seminal analysis because our study has shown that it affects most of theseminal fluid parameters in and contribute to the problem of infertility.
ECTOPIC PREGNANCY;
Authors: ALI ROBINA , AFZAL Uzma
Published: September 2021

Objectives: To assess the effectiveness of systemic methotrexate for treatment of unruptured ectopic pregnancy. Introduction:Ectopic Pregnancy is pregnancy that occurs in any location other than the uterus. 95% to 98% are tubal ectopics, but the number of ovarian,abdominal and cervical implantations is rising as does the number of heterotopic pregnancies. Study Design: Prospective experimental study.Setting: DHQ Hospital affiliated with Punjab Medical College Faisalabad. Period: Jan-2009 to Dec-2009. Patient & Method: A total of 45women were admitted with diagnosis of extrauterine pregnancy. But only 10 women fulfilled the criteria for medical management. Out of these80% patients required no surgical intervention. However 20% needed surgery. 60% patients suffered from lower abdominal or pelvic pain. 20%required 2nd dose of methotrexate. Average ß-hCG resolution time was 35 days. Conclusions: With early diagnosis and proper selectioncriteria adoption, medical treatment of ectopic pregnancy with systemic methotrexate is an effective and safe alternative to surgicalinterventions.
LOW DOSE HEPARIN;
Authors: NAEEM ABID , JABBAR TAHIRA
Published: September 2021

Objective: To evaluate the therapeutic benefit of low dose heparin in cerebral venous thrombosis, occurring during period ofperpeurum. Study design: Descriptive study. Setting: Department of Medicine DHQ Hospital Mirpur (Department of Obs/Gynae DHQ HospitalMirpur(AK). Period: January 2010 to November 2011. Method: This study was carried on 100 patients with history of postpartum cerebralvenous thrombosis. Out of which 48 on heparin and 52 formed the control group. The ages of all patients were between 20 to 30 years.Parameter recorded included history. Blood pressure.,the diagnosis was supported by cranial computed tomography. The secondary causeswere ruled out on the basis of history and physical examination. The data and results were analyzed in SPSS. Results: Out of 48 patients inheparin group 30 with non-heamorrhage lesion and 18 with haemorrhagic infarction). 52 in control group. 34 non-haemorriagic lesion and 18with haemorragic infarct .in non-haemorrhagic CVT, there is no death in heparin group as compared to 5 deaths in control group. In patients withhaemorriagic lesions, there were 5 deaths in heparin group as compared to 7 deaths in the control group. Heparin faed better than the controlgroup, both in patients with haemorrhagic as well as non-haemorrhagic lesions. Conclusions: Low molecular weight (LMWH) at low doses issafe and effective for both non-haemorrhage and haemorrhgic infarct of postpartum cvt with regard to recovery and outcome as compared tocontrol group.
DENOSUMAB:
Authors: TIKOO DEEPIKA , MEENAKSHI GUPTA
Published: September 2021

Osteoporosis is the most common metabolic bone disease in developed countries. One of its major problems is the long termmorbidity and poor quality of life of patients. Receptor activator of nuclear factor-kB, its ligand and osteoprotegrin pathway plays an importantrole in bone remodeling. Receptor activator of nuclear factor-kB interacts with receptor activator of nuclear factor-kB ligand leading to activationof osteoclasts. Denosumab, a fully monoclonal antibody to receptor activator of nuclear factor-kB ligand prevents its binding to receptoractivator of nuclear factor-kB and can effectively suppress the bone loss in osteoporosis. Various clinical studies have shown that Denosumabhas good efficacy in decreasing bone resorption and has a favourable safety profile also.
LUMBOTOMY;
Authors: NAWAZ BHATTI AHMAD , DIN AWAN SAIF UD
Published: September 2021

Background: Urolithasis is a common urological ailment since antiquity. Treatment of urolithasis has witnessed a revolutionarychange with the advent of minimally invasive endoscopic techniques. However in developing countries very few cases of the renal stonedisease are being treated using minimally invasive techniques and vast majority are still being managed with open surgery. Objectives: Theobjective of the study was to compare the two incisions used for renal and proximal ureter access, and find out which was better in our set up.Methods: We carried out a study at our center, comprising of 50 cases of solitary renal stones, to compare the traditional oblique lumbar (OL)incision with dorsal lumbotomy (DL). Patients included in the study were with a BMI of less than 30, all ages, having single large stone of renal /proximal ureter, extra renal pelvis, no previous surgery on the ipsi-lateral side. Results: The study revealed that the lumbotomy incision is betterthan the traditional lumbar oblique incision in terms of surgery time, post operative pain, early return to work and cosmetically accepted scar.Conclusions: After analyzing the data we came to the conclusion that the lumbotomy incision was superior to the oblique lumbar incision inselected cases and we recommend that it should be used specially in centers where facilities for endoscopic/minimally invasive managementare not available.
HEMORRHAGIC AND ISCHEMIC STROKE;
Authors: ARSHI SHAHANA , NAHEED FAKHRA , BADSHAH MAZHAR , Naz Farrah , Un-Nisa Fasih-
Published: September 2021

Objective: To compare frequency of ischemic stroke with that of hemorrhagic stroke in hypertensive patients presenting withstroke at Pakistan Institute of Medical Sciences, Islamabad. Study Design: A cross-sectional study. Place and duration: Department ofNeurology, Pakistan Institute of Medical Sciences, Islamabad from 17th July to 17th October 2010. Patients and Methods: One hundredconsecutive hypertensive patients with stroke were analysed for this study. Results: Total of 100 cases, 52 cases were of ischemic stroke. Outof this, 50% had left middle cerebral artery, 42.30% right middle cerebral artery, 3.85% anterior cerebral artery and 3.85% posterior cerebralartery involved. 48 cases had haemorrhagic stroke. The cerebellum was involved in 2.08%, 2.08% had left anterior lobe involved. Pons and rightparietal lobe was involved in 2.08% respectively. SAH in 12.50%, left basal ganglia in 29.17% and right basal ganglia was involved in 43.76%.Conclusions: The reported results suggest that in hypertensive patients the frequency of ischemic stroke is greater than hemorrhagic stroke.
DENTAL CARIES;
Authors: BADAR Samina , CHANNAR SALEEM , BHUTTA NOUMAN , Arshad Saima
Published: September 2021

Objective: To find out the prevalence and determinants of dental caries among patients attending dental OPD. Design:Descriptive Cross sectional study. Place & Duration: Dental out Patient Department, Bahawal Victoria Hospital and period was August tillNovember, 2010. Methodology: Data was collected with the help of predesigned Questionnaire. A Convenient sample of 05 eligiblerespondents was examined on daily basis till completion of sample size. Caries was assessed by using DMFT scale. Analysis of data wascarried out with the help of computer SPSS version 11. Chi square test was used to see the association between different variables,(brushing atnight, daily brushing, sugary food intake) define the variables. The level of significance was taken as p<.05. Results: Among study population(52%) were male and (53%) were urban dwellers. Dental caries was present in 97% of the patients & DMFT Score increased with increase inage. Commonly associated habits (with carries) included lack of daily brushing of teeth (P<.01), lack of brushing at night (p<.001), and dailyintake of sweets (p<.005). Conclusions: Frequency of dental caries was high with advancing age. Significant relationship of Dental Caries wasfound with oral hygiene and surgery foods.
SCARRED UTERUS;
Authors: PERVEEN SAIMA , HASNAIN ALI ZUL
Published: September 2021

Objective: To study frequency of Scarred Uterus in placenta praevia. Design: Descriptive observational study. Place andDuration Of Study: December 2008-December 2009 Holy family Hospital Rawalpindi. Patients and Methods: 50 patients with placentapraevia presented to Holy Family Hospital Gynae and Obs unit II during this period. All patients either admitted through emergency or Gynaeoutpatient department were included. Results: The mean age of patients with placenta Praevia was 29.04 year with (SD =5.11).The meangestational age was 34.6 weeks and (SD = 2.7). Fourteen (28%) patients were gravida 2 and 13(26%) were primigravida. Fifteen (30%) patientswere para 1 & 14 (28%) were para 0. Painless vaginal bleeding was the presenting complaint in 38(76%) patients, whereas 12(24%) patientswere diagnosed on routine ultrasonography. Nine (18%) cases underwent spontanouse vertex delivery and 41 (82%) cases were delivered bycaesarean section. Placenta Praevia type 1 in 7 (14%) cases. Placenta Praevia type 2 in 20 (40%) cases, type 3 in 14 (28%) cases, type 4 in 9(18%) cases . Previous history of scarred uterus was found in 16 (32%) cases .Post partum haemorrhage occurred in 13 (26%) cases.caesarean hysterectomy in 5 (10%) cases. Conclusions: A scarred uterus leads to increase frequency of Placenta Praevia, scarring of uteruscan be reduced by keeping the caesarean section rate within reasonable limits and instead of doing surgical evacuation of retained products ofconception, suction and evacuation by suction canula.
SUPRACONDYLAR FRACTURE OF HUMERUS;
Authors: ANWAR WASIM , SIRAJ Mohammad , RAHMAN NOOR , Iqbal Malik Javed , Ahmad Israr , Khan Mohammad Asghar , Kashif Salik
Published: September 2021

Objectives: To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction andpercutaneous pinning. Material and Methods: This prospective study of 50 patients who presented with displaced supracondylar fracture ofhumerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar overperiod from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperativereduction was assessed by Baumann angle. All patients were followed for one year. Results: Mean age of the patients was 7.02 years± 2.25 SD. Loss of Baumann angle in injured side was range from 2O to 8O. Loss of carrying angle in injured side was range from 3O to 9O. WhenBaumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 ± 2.22 SDand 4.320 ± 1.52 SD respectively. Using Flynn’s criteria 36 (72%) patients out of 50 patients with carrying-angle loss considered to be excellentresults and 14(28%) good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Conclusions: Baumannangle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylarhumeral fractures in children.
REAMED TIBIAL INTERLOCK NAILING;
Authors: INAM Muhammad , ARIF Muhammad , SATTAR ABDUL
Published: September 2021

Objective: The objective is to measure preoperative and postoperative compartment pressure in reamed tibial interlock nailingusing Whitesides infusion technique. Duration: This study is carried out from September 2007 to August 2008 Setting: Department ofOrthopedic and Spine Surgery of Hayatabad Medical Complex Peshawar Material and Methods: Thirty consecutive patients that werecandidates for closed reamed interlock nailing of the tibia and there compartment pressure were measured preoperatively and postoperativelyby Whiteside infusion technique. Results: Average age of patient was 35 years. Male were 26(86.66%) and female were 4(13.34%). Therewere 12(40%) type A and 18(60%) type B fractures according to Orthopedic Trauma Association (OTA) AO classification. Twenty seven (90%)factures were due to motor vehicle accident and 3(10%) were due to fall. The minimum preoperative pressure in superficial posteriorcompartment was 7 millimeter of mercury (mm Hg), deep posterior compartment was 10 mm Hg, anterior compartment was 10 mm Hg, lateralcompartment was 10 mm Hg while maximum pressure in was 25, 25, 25 and 25 mm Hg respectively. The maximum post operative pressure insuperficial posterior compartment was 10 mm Hg minimum and 25 mm Hg maximum, deep posterior compartment was 15 and 28 , anteriorcompartment was 15 and 30 and in lateral compartment was 10 mm Hg minimum and 30 mm Hg maximum. The minimum diastolic bloodpressure was 65 and maximum was 90 mm Hg. Conclusions: Compartment pressure measurement by Whitesides’ infusion technique is asimple and effective method for monitoring the intracompartmental pressure. It avoids unnecessary fasciotomy that has an extra morbidity interms of infection and skin coverage.
DEPRESSION;
Authors: AKHTAR SAEED , AKRAM Bushra , YASMEEN AZRA
Published: September 2021

Objective: Prevalence of Depression in patients presenting with Alcohol and Drug addiction. Place & duration of study: Thestudy was conducted in the Department of Psychiatry & Behavioural Sciences, Bahawal Victoria Hospital & Quaid-e-Azam Medical College,Bahawalpur from March, 2009 to May, 2009. Subjects & methods: The sample consisted of 50 in-patients (Male 46, Female 4) with Alcohol &Drug addiction. They were interviewed and results were analysed from the entries in a Performa and Hamilton Rating Scale for Depression.Results: Majority of the patients were male (92%), age group majority (74%) were between 21-40 years. Depression was found in 23(46%)patients, 14(28%) had severe depression and 9(18%) had mild to moderate depression. Conclusions: Significant numbers of patients ofalcohol and drug addiction have depression as co-morbidity, which can have important implications in the aetiology and prognosis. So everypatient seeking treatment for alcohol and drug addiction should be assessed for depression and we should develop a protocol to treatdepression in these patients.