bluuebunny/crossref_metadata_2025 huggingface dataset:
CHILD LABORERS
Authors: ZAIDI NOSHEEN , SAIF SAIF-UD-DIN , AHMED MAHMOOD , Khan Wasif
Published: September 2021

Background: In Pakistan there are about 3.3 Million unprotected child laborers. They are constantly exposed to all kinds of dangers and abuse intimidating the future of the country. These child laborers are without the basic necessities of life including food, shelter, schooling and healthcare services, which has devastating effects on our socio-economic fabric. It is quite imperative to comprehend and unveil the perilous picture of the working conditions of child laborers and the abuse inflicted upon them at such an impressionable age. Design: Cross sectional study. Setting: Rawalpindi city including workshops, shops and streets of Rawalpindi. Period: January 2008–Dec 2008. Objective: To assess the presence of any Verbal, Physical and Sexual abuse among the child laborers at Rawalpindi city. Results: Out of the total sample of 700 study subjects 315 (45%) of the Child laborers reported being abused whereas 385 (55%) reported no abuse. Out of the fraction which reported to be abused the break up is as follows. 214 (67.9%) reported verbal abuse, 75 (23.8%) reported Physical abuse and 25 (7.9%) reported sexual abuse. Conclusions: This study concluded that the child laborers are open to the elements of the adversities that come along with their work environment. The government should be urged to take necessary steps to trim down the abuse against child laborers and its frightening effects on their families, society and nation at large by constituting strict laws and ensuring their speedy implementation.
CHILD LABOR
Authors: AHMAD MUHAMMAD HASNAYN , MOHSIN JIBRAN , JAVED HASSAN , Mustafa Ghulam , Khan Asim Mumtaz , Mahmood Shahid
Published: September 2021

Background: Child Labor is any kind of work that harms or exploits the children in some way (physically, mentally, morally or blocking access to education). Child labor is quite common in Pakistan, and is still ignored; which depicts the society's attitudes towards child care. Child labor is an ethical dilemma and special attention must be given to this issue. Objective: To determine the factors responsible for child labor in Shadman Market Lahore. Study design: Descriptive, Cross sectional. Place and duration: Shadman Colony Lahore, July-August 2010. Methodology: Structured Pretested questionnaire was used to asses the factors responsible for child labor. Results: Large family size, low income per capita and parental illiteracy were shown to be responsible for child labor. Conclusion: Family size, income per capita and patrental education has a large scale effect on child labor.Key words:- Child labor, Family size, income per capita, parental education.
JERVELL AND LANGE-NIELSEN SYNDROME
Authors: ANWER AMMAR , SHAKEEL ALI , IKRAM M. HAMAYUN , Zaman Shahroona Masud
Published: September 2021

Objective: This study was carried out to find out the prevalence of Jervell and Lange Nielsen Syndrome (JLNS) in deaf school children for impaired hearing and to correlate this with consanguineous marriages. Setup: Schools for deaf and dumb children and Sheikh Zayed Medical College, Rahim Yar Khan. Design: Cross sectional, case control study. Period: 2006 - 2007. Methods: Electrocardiographs (ECG’s) of 114 congenitally deaf school children (ages 4-20 years) and also of 23 healthy children with normal hearing function of same age group were recorded. The corrected QT (QTc) interval of all 137 ECGs was evaluated by Bazett’s formula. Mean QTc of healthy children was taken as reference of normal QTc interval. The deaf children with normal QTc were labeled as control group. Patients with long QTc were further evaluated for JLNS by applying Schwartz’s criteria. We also calculated the relationship of the positive cases to consanguineous marriages. Results: We found that 28 deaf children out of 114 cases had QTc intervals longer than 0.44 seconds. This interval was significantly longer [P=0.008] than the QT interval in control group. As per Schwartz’s criteria, 15 out of 28 LQTs cases scored high points (3.5 to 5.5). The presence of consanguineous marriage was 100% in first pedigree of these 28 children. Conclusions: JLNS (an alarming arrhythmic disease associated with congenital deafness) is significantly present (24.6%) in Rahim Yar Khan’s deaf school children. The presence of cousin marriage was 100% in first pedigree of these children.
REFRACTIVE ERRORS
Authors: ALAM MOHAMMAD , FAREED MOHAMMAD
Published: September 2021

Objective: To know the profile of refractive errors in school age children in DHQ Hospital Karak and group of teaching Hospitals Bannu. Setting: DHQ Hospital Karak and group of Teaching hospitals Bannu. Period: Two years study from August 2007 to August 2009. Design: Descriptive study. Materials & Methods: A work up proforma was prepared for record of children. School age children with age range from 5 to 15 years who attended the eye OPD were documented and informed consents were taken from children and their parents. They were screened for refractive errors with retinoscopy. In some children cycloplegic refraction was done.Fundoscopy was also done to exclude any lesion causing visual impairment in some children .Refractive errors was noted as spherical equivalent of myopia and hypermetropia in children who had both spherical and cylindrical error while in those children who had only cylindrical error were assigned as astigmatism .Children with any organic lesion in cornea lens and fundi were excluded from study. Results: Total 2680 school age children with age range from 5 to 15 years were examined out of which 1560(58.20%) were male and 1120(41.8%) were female.1688(62.98%) children were emmetropic while 992(37.01%) had refractive error .Spherical equivalent of myopia was present in 541(54.53%) while that of hypermetropia in 360 (36.29%)children. Astigmatism was present in 91(9.17%) children. Conclusions: Refractive error is a common ocular disorder affecting school age children. Myopia is more common followed by hypermetropia. Therefore routine careful visual check up in school age children should be carried out.
NITINOL STENTS
Authors: HUSSAIN SAJJAD , KHAN QAISER
Published: September 2021

Stents deployed in the carotid arteries cause significant geometric changes in the vessels, influencing the flexibility and torsion characteristics of the vessels, which are aggravated by the high degree of mobility in this area of the body. The influence of these physical characteristics on carotid blood flow could influence the long term performance of the deployed stents. Objectives: To evaluate the geometric changes in the carotid arteries after deployment of self expanding nitinol stents. Settings: AFIC-NIHD. Period: November 2003 to August 2008. Material & methods: 45 cases of carotid artery stenting (CAS) done. We selected cases where the stenting to the internal carotid artery (ICA) had been done across the bifurcation of the common carotid artery (CCA) with self expanding nitinol stents, and when DICOM videos that had pre and post stenting images in the same imaging projection were available for analysis. Based on the inclusion criteria 21 videos were selected and deemed fit for taking measurements. The measurement system proposed by Berkefeld et al which involved the measurement of the CCA-ICA (common carotid artery –internal carotid artery) angle and ICA-offset was used. These variables were measured using onscreen measuring software which can measure linear distances and angles after appropriate calibration for each image. Results: We did not find any significant changes in the ICA-offset; significant changes in the CCA-ICA angle were noted.
POST TRAUMATIC SUB ARACHNOID HEMORRHAGE
Authors: ISMAEEL UMAR , MAHMOOD SHAHID , ALI ZULFIQAR , Aslam Muhammad Sikandar
Published: September 2021

Objective: To study the effect of Nimodipine on headache associated with post traumatic sub arachanoid hemorrhage. Study Design: prospective study Setting: This study was conducted at the Department of Neurosurgery & General Surgery, District Headquarters Hospital Rawalpindi. Period: 6 months Methods: 60 Patients from both genders, undergoing hospital admissions that fulfill the inclusion criteria were included in the study. Results: 12 patients were lost due to poor patient follow up. Of the remaining 48 patients, 29 (60.4%) patients suffered road side accidents, 12 (25%) had assaults and 7(14.6%) had fall. The patients were classified according to Hunt and Hess and Fischer Grading. 34 patients had grade 1 and 14 had grade 2 injuries according Hunt and Hess classification. 31 had grade 1 injuries and 17 had grade 2 injuries according to Fischer Grading. The mean age was 34.02 years with a range of 4 to 71. The mean interval since trauma & admission were 1.4 hour. The patient score on the visual analog pain scale before treatment had a mean of 4.46. The patient score on visual analog scale after treatment was 2.33 and P-value was calculated to be <0.001. Conclusions: The above results signify that Nimodipine should be prescribed to patients with Grade 1 and 2 post traumatic sub arachanoid hemorrhage. Headache was considerably reduced after the use of nimodipine.
MYOCARDIAL INFARCTION
Authors: AHMAD SHIEKH NADEEM , HASAN SYED SAUD , SALAT MUHAMMAD YOUSUF
Published: September 2021

Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. Objective: To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. Study design: To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. Place & duration of study: The study was conducted at national institute of cardiovascular diseases (NICVD) of Pakistan, Karachi. Subject and Methods: All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECG recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Results: Streptokinase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124+ 3.32 and 112+3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant (P<0.001). The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80+ 2.70 and 72+1.91 before and after the Streptokinase therapy’s, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69 % respectively. The P values were highly significant (P<0.001). Conclusions: Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis
LUMBAR DISCECTOMY
Authors: SMAIJA M.SHAHID , ATIQ-UR-REHMAN SHEIKH , KHIZAR ASFA
Published: September 2021

Background: Discectomy is the standard treatment for lumber disc disease. Fenestration operations involved lot of tissue dissection and so the complications. Instead the endoscopic discectomy involved less tissue dissection but limited exposure. Objectives: The objectives of this study were to compare the outcome of endoscopic discectomy and fenestration discectomy interms of relieve from symptoms and complications. Study Design: Analytic study. Place and duration of study: Neurosurgical unit Bahawal Victoria hospital Bahawalpur, from Feb 2010 to Aug 2010. Patients and Methods: Forty cases fulfilling the inclusion criteria were selected. Efficacy of procedure was determined by improvement in Denis pain scale, Macnab’s criteria and straight leg raising (SLR) improvement. Results: Forty patients divided in two equal groups. Patients of group A underwent fenestration and Group B endoscopic discectomy.60%of patients had left sciatica while 40% of patients had right sciatica. According to Denis pain scale 10% patients had moderate pain, 30% had severe pain and 60% had constant pain. Straight leg raising test showed, 50% patients had less than 30O SLR, 30%patients showed SLR of 31̊ to 40̊ and 20%patients had SLR more than 40O. MRI findings were disc bulging, protrusion and rupture. Considering SLR, Denis pain scale and Mcnabs criteria of pain control there was no clinical difference found between the two operative procedures except in two patients in group B when open discectomy had to be performed. Conclusions: MED is a safe and effective mode of treatment for low back pain in patients with lumbar disc herniation.
LOCAL ANALGESIA
Authors: ZAEEM KHALID , KHAN RAHEEL AZHAR , BHATTI ABDUL HAMEED
Published: September 2021

Objective: To compare the analgesic effect of commercially available premixed injection of lignocaine 2% and adrenaline in 1:100,000 dilution with that of freshly prepared solution by mixing adrenaline in suitable quantity to 2% plain lignocaine just before the time of injection for tooth extraction in patients of dental caries. Design: Descriptive Interventional Study. Place and Duration: Armed Forces Institute of Dentistry (AFID) Rawalpindi from March 2006 to August 2006. Patients and Methods: A total of 50 patients of dental caries, who were scheduled for tooth extraction, were divided into 2 groups of 25 each. Group A was provided analgesia with commercially available premixed injection of lignocaine and adrenaline and group B was provided analgesia with freshly prepared solution of plain lignocaine and adrenaline. Results: In group A, good quality analgesia sufficient enough for tooth extraction, was achieved in 19 patients whereas in group B good quality analgesia was achieved in 23 patients. Conclusions: Freshly prepared mixture of plain lignocaine and adrenaline gives better analgesic effect than that of commercially available solution of lignocaine with adrenaline.
DENGUE INFECTION
Authors: HAYAT ATIF SITWAT , SHAIKH NAILA , BALOCH GHULAM HUSSAIN
Published: September 2021

Background: Dengue fever (DF) has emerged as a major public health problem across the world in terms of health cost, morbidity and mortality. Objective: The objective of our study was to determine frequency of seropositive dengue virus infection by using enzyme immunoassay (EIA) test in patients with probable dengue infection at a tertiary care hospital of Hyderabad. Design: This crosssectional, observative , hospital-based study. Setting: Liaquat University Hospital Hyderabad. Period: 1st June 2010 to 31st December 2010. Methods: Patients presenting with acute febrile illness (i.e. documented fever of > 38˚C), skin rashes with or without bleeding manifestations (petechiae, epistaxis, hematemesis, menorrhagia or malena) plus cytopenias (leucopenia and / or thrombocytopenia) on peripheral smear examination, were evaluated for probable dengue virus infection. Serologic diagnosis has been carried out by using enzyme immunoassay (EIA) test with differential detection of IgM and IgG. Results: Out of 340 cases who fulfilled WHO criteria of probable dengue fever, 152(44.70%) were enzyme immunoassay (EIA) test reactive, while 188(55.29%) EIA non-reactive. The primary dengue infection was found in 102(67.10%) patients and secondary infection in 50(32.89%). Among both groups, males were predominantly affected. Majority of patients were hospitalized during the month of October. In addition, large number of patients aged between 13-35 years. Only two patients expired due to dengue shock syndrome and they were suffering from secondary dengue infection. Case fatality rate was 0.3% in our study. Conclusions: On conclusion, early detection of primary and secondary dengue virus infections via enzyme immunoassay (EIA) being important, as it is simple and rapid diagnostic tool having high sensitivity. This is especially valuable in alleviating psychological fear, disease-progression and mortality associated with dengue fever epidemics.
GASTROESOPHAGEAL REFLUX DISEASE
Authors: WARRAICH ABDUL RAZZAQ , RAFFAD DR. , SIDDIQ CHAUDHRY MUHAMMAD , Iqbal Zaheer , Khokhar Mohammad Saeed
Published: September 2021

Objective: To find the frequency of H pylori infection among the patients of gastroesophgeal reflex disease. Study design: Descriptive study. Setting: Department of Medicine, Unit-I, Services Hospital, Lahore. Subject & method: One hundred patients with gastroesophageal reflux disease (GERD) were included in this study. For detection and confirmation of helicobacter pylori, endoscopy with antral biopsy was done. Specimens were sent for histopathology, and rapid urease test was performed. Main outcome measures: Frequency of H pylori infection, frequency of regurgitation, dysphagia, nausea, vomiting and haemetemesis. Results: 100 patients who fulfilled the inclusion criteria were taken. There were 65 males and 35 females respectively. Their age ranged from 18 to 48 years. 39 (39%) patients were between 29-38 years while 23 (23%) were of 39-48 years. There were 38 (38%) patients between 18-28 years. The mean age of the patients was 31.79±7.56. 40 (40%) were found to be H. pylori positive on biopsy and rapid urease test, while 60 (60%) were H. pylori negative. The most common recorded symptom was chest pain/retrosternal burning (90%). Regurgitation (65%) and nausea (55%) were other common symptoms. Dysphagia and water-brash were present in 40% each. Vomiting (30%), abdominal pain (25%) and cough (20%) were the other symptoms. The least common symptom was haemetemesis (5%). Conclusions: A causal relationship between GERD and H. pylori infection could not be established. Therefore, routine H. pylori eradication in the treatment of patients with GERD is not recommended.
ATTITUDE AND KNOWLEDGE OF MOTHERS
Authors: SHUKR FURQAN , ALI SALMAN , YASMEEN ALMAS
Published: September 2021

Objective: The study explores attitudes and knowledge of mothers Thalassaemia Major children. Design: Cross sectional study. Setting: Thalassaemia center Military Hospital Rawalpindi. Period: The study was conducted from the 1st to the 30th August, 2011. Subjects and Methods: Fifty mothers were interviewed about the frequency of their child’s blood transfusion and thalassaemia related complications, as well as their educational status, the education status of their husband, monthly household income, attitudes and knowledge about premarital screening, antenatal testing, and genetic inheritance of thalassaemia and complications resulting from multiple transfusions. Results: Mean age of thalassaemia patients was 9.5±5.5 years and 29(58%) were males and 21( 42%) were females. Mean transfusion was 1.6±0.7 per month. Majority (52%) had stunted growth. 58 % of mothers were aware that premarital counseling could prevent disease. 60 % were aware that antenatal testing is available, and 40 % had undergone CVS for antenatal testing. Awareness about inheritance and hazards of blood transfusion was directly linked to maternal and paternal education (P values 0.08 and 0.05 respectively). Majority 30 (60 %) of mothers, irrespective of educational status, agreed that premarital screening should be mandatory. Conclusion: To improve patient awareness, instructional videos and audio lectures should be added to pamphlets already in circulation. Additional Facilities for premarital screening and counseling should be made available.
ACUTE EPIGLOTTITIS IN ADULTS
Authors: ALMERIE S.
Published: September 2021

Most clinicians would be aware of this disease, which is rare in children but even rarer in adult.
CARPAL TUNNEL SYNDROME
Authors: SUBHAN MOHAMMAD , SHAH FARIDULLAH , TARIQ Mohammad , Ali Shah Iftekhar , Ul Haq Najeeb , Ul Haq Anwar
Published: September 2021

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The symptoms of CTS include pain,paraesthesia and hypoesthesia in the hand, in the area innervated by the median nerve, and often occurs or worsens during the night or earlymorning, waking the patient up. Physical examination and nerve conduction studies are used to diagnose this condition. Early diagnosis andtreatment of CTS are important because any delay can cause irreversible median nerve damage. Objective: To highlight the role of physicalexamination and nerve conduction study in the diagnosis of CTS. Setting: Kuwait teaching Hospital Peshawar. Period: June 2008 to June2010. Methods: Fifty patients of carpal tunnel syndrome were studied. All patients who reported numbness and/or tingling in the median nervedistribution in the hands at least twice weekly during the preceding four weeks were enrolled to undergo clinical examination and nerveconduction tests. Following the clinical examination the symptomatic persons underwent bilateral nerve conduction tests. Results: Out of thesetwelve patients were males and thirty eight were females with a ratio of 1:3.1. The age range was between 20 to 60 years. CTS was bilateral in 22patients (44%), right-sided in 23(46%) patients and left-sided in 5(10%) patients. Conclusions: In addition to the clinical presentation,electrophysiology has been proposed as the standard of care for diagnosing CTS with a recommendation that it should be performed in allcases.
EFFECT OF CAPTOPRIL
Authors: E-FARAN MISS GULL- , ZIA MUHAMMAD ANJUM , ASLAM NIGHAT
Published: September 2021

Objectives: (1) To investigate the inhibitory effect of Captopril on level of glycation (in vivo). (2) To study glycation inhibition invivo. Study design: Case study. Period: Sep. 2006 to March. 2008. One year seven months. Setting: Department of Biochemistry Universityof Agriculture, Faisalabad. Methods: Different parameters like fluorescence, total proteins, TBA (thiobarbituric acid) method, periodateborohydride assay were used to check the effect of inhibitor on glycation. Thirty two combinations were made and all these combinations wereplaced at 37̊C, at same time for five weeks. 3mL of blood sample was drawn after 1st, 3rd and 5th week of incubation to perform the experimentsfor glycation and glycation inhibition. Along with the same temperature (37̊C), different combinations of glucose and inhibitor were used.Results: Effective concentration of inhibitor helped to decrease the level of glycation. All concentrations of glucose (G , G and G ) showed 1 2 3glycation with protein. The inhibitor Captopril (all concentrations) showed variations in inhibition of glycation at one temperature (37̊C) withdifferent parameters (Fluorescence, TBA and Periodate) but the most effective concentration of inhibitors at each condition is I (1mM) but I (10 3 1mM) and I (5 mM) were also equally effective after I . Periodate borohydride Assay is more effective for glycation determination than 2 3thiobarbituric acid assay. Conclusions: Captopril can be used as glycation inhibitor in future. As it enhances the activity of transketolase, it canproduce 3DG compound which can block the AGEs. However, more experimentations should be done on animal or on large scale before itsapplication in diabetic patients.
CONVENTIONAL AND ATYPICAL ANTIPSYCHOTICS;
Authors: AKHTAR NAJAM , HUSSAIN RANA MOWADAT
Published: September 2021

Objective: The objective of the study was to compare changes in fasting blood glucose and serum cholesterol levels followinginitiation of conventional and atypical antipsychotics in patients of psychosis. Study Design: An Interventional Comparative design was used.Place and Duration of Study: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi from August 2007 to August2008. Patients and Methods: A total of 110 patients were assigned to treatment with haloperidol (n=35), risperidone (n=36) and olanzapine(n=39). Fasting blood glucose and serum cholesterol levels were recorded at baseline and subsequently repeated at 02nd week, 06th week and08th week of treatment. In all the subjects, all the blood samples were drawn as a fasting sample in early morning. Results: ANOVA analysesindicated that changes in mean fasting glucose and cholesterol levels reached significance in period 2 (from 2nd week to 6th week) but not inperiod 1 (from 0 to 2nd week) and period 3 (from 6th week to 8th week). The increase in mean fasting glucose and cholesterol levels over timereached statistical significance in the olanzapine group after 6 weeks. No significant change in glucose was detected in the haloperidol andrisperidone groups. Conclusions: There is a higher risk of hyperglycemia and hypercholesterolemia with olanzapine treatment as compared torisperidone and haloperidol in the study population. These changes appear between 2 to 6 weeks after starting treatment.
EPITHELIAL OVARIAN CANCER;
Authors: SAEED SARAH , AKRAM MOHAMMAD
Published: September 2021

Background: Epithelial ovarian cancer is the most common cancer of gynaecologic origin in Pakistani women. It ranks amongthe ten most common cancers in our women. Despite being commonly encountered, information regarding the clinicopathological features islacking. Objective: To study the clinical and pathological features of epithelial ovarian cancer in our patients. Study Design: Retrospective study.Setting: Department of Medical Oncology, Jinnah Hospital Lahore. Period: Jan 01,2001 to Dec 31, 2002. Patients and methods: All patientswith histological or cytological diagnosis of epithelial ovarian cancer regardless of stage were included in the study. Information was obtainedfrom medical records which were reviewed thoroughly. Blood samples for analysis of BRCA mutations were sent to University of Toronto,Sunnybrook & Women’s College Health Sciences Centre, Toronto, Canada. Results: 75 patients were accrued. Mean age of the patients was47 years. The well defined risk factors such as nulliparity, lack of lactation, early menarche and late menopause were not present in the majorityof our patients. One striking feature was the number of patients with family history of cancer (18.7%). Majority were first degree relatives of thepatients and most had ovarian or breast cancer. BRCA1 and BRCA2 were seen in nine (12%) of the patients. Clinical presentation and histologicfeatures were similar to American and European patients, the only difference was that a large number (88%) of our patients presented withadvanced (stage III or IV) disease. Conclusions: Epithelial ovarian cancer manifests itself in a younger population of our women. Higherfrequency of positive family history was another striking feature of Pakistani patients.
MINOR DEGREE PLACENTA PRAEVIA;
Authors: SHAHEEN TALAT , BANO ISLAM
Published: September 2021

Objective: To find out the mode of delivery when the distance of placenta edge to internal os is more than 2 cm and less than 5cm i.e minor degree placenta praevia. Study Design: Descriptive Study. Place and Duration of Study: The study was done at CombinedMilitary Hospital Rawalpindi and Military Hospital Rawalpindi from January 2005 to January 2006. Patient and Methods: A total of 100 patientsadmitted in obstretic ward were selected according to the inclusion and exclusion criteria by convenience sampling. Patients with ante partumhaemorrhage after 34 weeks admitted, resuscitated and then investigated by blood tests and transvaginal ultrasound. Only patients withplacental edge to internal os distance of more than 2 cm were selected for study. Booked patients of placenta praevia type 1 and type 2 of morethan 37 weeks after bishop scoring and cervical ripening were delivered vaginally by ARM and Oxytocin. Results: In our study, out of selectedpatients 100 patients of placenta praevia type 1 and type 2 were selected, results of these patients were (a) 63% patients were deliveredvaginally. (b) 37% of patients were delivered by caesarean section. (c) 46% of patients with para 4 had placenta praevia as compared toprimigravida who had placenta praevia 15%. (d) 59 % of deliveries occurred at 34-36 years of gestation while 41% of deliveries were occurred atgestation of >36 years. Conclusions: Patients with placental edge more then 2 cm should be given a trial of vaginal delivery instead of goingstraight away to caesarean section.
METACARPAL AND PHALANGEAL LENGTHENING OF THE HAND;
Authors: KHAN FIRDOUS , KHAN NAJIULLAH , SHAH ASIF
Published: September 2021

Objectives: To present our experience of distraction osteogenesis in Metacarpal and Phalangeal lengthening of the hand andanalyze the factors which influence the period of healing. Design: Experimental study. Period: December 2008 to April 2011. Setting:Department of Plastic and Reconstructive Surgery, Khyber Teaching Hospital, Peshawar. The patients were admitted through out-patientdepartment and detailed history, clinical examination and necessary investigations were carried out. Informed consent was taken. Distractionhas been performed in six metacarpal bones and four phalangeal bones in nine patients. The age ranged from 3 to 59 years. All the digits hadtraumatic amputations. The injury was in the right hand (dominant) in 6 patients and in the left hand in 3 patients. An isolated injury to the thumbwas seen in 4 patients, while in the remaining patients other fingers had been injured. All patients were operated by the same surgeon usingsimilar lengthening technique. Patients were followed regularly and assessed for bone lengthening by clinical and radiological methods.Results: The achieved elongation of the metacarpal bones varied from 26 mm to 30 mm (average 27.66 mm), and of the digital phalanges from10 mm to 17 mm (average 13.5 mm). Average healing time was 2.05 months (range from 1.8 – 2.5). Average healing index was 0.75 month/cm(range from 0.65 – 0.88). Complications observed were pin tract infection (3 cases), necrosis of free grafted skin (2 cases), delayedspontaneous bone union (2 cases) and volar angulation (1 case). Webplasty was performed in all cases. Strength of pinch improved by anaverage of 37% and that of grasp by 48% compared to the preoperative values. All patients were able to pick up a paper and a cup of water.Conclusions: Distraction osteogenesis is a successful and reliable method for the lengthening of short metacarpals and phalanges. However,severe complications such as stiffness, angulation, subluxation of the MCP joint and delayed union or non-union are associated with thisprocedure. To avoid these complications, we suggest protection of the periosteum, refraining from distraction rates of more than 2×0.25 mm/dayand, if possible, avoid lengthening a bone by more than 40% or not more than 20 mm of the preoperative bone length.
LAPAROSCOPY;
Authors: MUSSARAT NAZIA , QURESHI SIAMA , SHUJA AWAIS , Roohi Mehnaaz
Published: September 2021

Introduction: Diagnostic Laparoscopy is considered to be the gold standard for the evaluation of the pelvis and is considered asafe procedure. Diagnostic Laparoscopy is a technique in the routine investigation and treatment of infertility as well as other gynecologicalproblems. Objectives: To determine, Laparoscopic findings in different gynecological conditions, different causes of infertility andcomplications of laparoscopy Design: Retrospective, descriptive study. Material And Methods: We reviewed case records of all patients whounderwent laparoscopy for their different Gynecological problems. Data were collected from patient case records in a data entry sheet Results:In our study a total of Thirty patients under went laparoscopy for investigation of different gynecological problems. There were 17 patients whohave primary infertility and 6 have secondary infertility while 7 presented with Lower abdominal pain. In our study the leading cause of primaryinfertility was Polycystic Ovarian Disease(29%).Other causes were bilateral tubal blockade (23.53 %) ,17% has PID and fibroid uteri, While onepatients shown Endometriosis as well as one patient had no obvious pathology.(5.88 %).On laparoscopic examination of secondaryinfertility 50% shown Tubal blocked while 16.67 shown Fibroid uterus and PID.One patient had normal pelvic findings(16.67). Regardingpatients presented with pain lower abdomen 57.15% has ovarian cyst,28.58% has Ectopic pregnancy while one case(14.29%) had hetrotropicpregnancy. In 24 patients had no complication and recovery was smooth. laparoscopy had to be converted into Laparotomy due to significanthemorrhage in two patient and wound infection was observed in two patients. One patient presented with post operative fever and onepresented with abdominal pain. Conclusions: Laparoscopy is a valuable diagnostic tool for females in different gynecological problems. Thebenefit of the laparoscopy to open surgery include less pain, less scarring, less disability and quicker recovery.
DETERMINANTS OF PREFERENCE OF HOMEOPATHIC TREATMENT TO ALLOPATHIC TREATMENT
Authors: ANJUM MUGHEES , CHANNER MUHAMMAD SALEEM , SHAHID KHALIL AHMED
Published: September 2021

Introduction: This study was conducted to find out determinants of preference of homeopathic treatment to allopathic one.Objectives: To determine factors influencing people’s attitude towards homeopathic treatment. Study Design: This was an descriptive crosssectional epidemiological study. Setting: At homeopathic clinics situated at Zenana Hospital road Bahawalpur Period: 1st July 2010 to 30th Nov2010. Subjects & Methods: Tool of data collection was preformed questionnaire which was used to collect relevant information. The informedconsent was taken. Eighty subjects were included in the study. Results: Out of total respondents, 87% preferred homeopathic treatment andonly 12.5% preferred allopathic treatment. This high utilization was attributed to high efficacy, low cost, better taste, less side effects and familytrend. Conclusions: People at Bahawalpur prefer homeopathic treatment to the allopathic one.
SEVERE ACUTE MATERNAL MORBIDITY;
Authors: CHOUDRY ABEERA , AFSHEEN AFEERA , CHOUDRY HUMAIRA , Saleem Uzma , Yasir Naureen
Published: September 2021

Objective: To determine the frequency and pattern of severe obstetric morbidity and mortality. Design: Cross sectional study.Period: 1st Oct 2005 to 30th Sep 2007. Setting: Military Hospital Rawalpindi. Methods: Cases of severe acute maternal morbidity and maternalmortality were collected and comparisons made of disease profile, organ system dysfunction, parity, mode of delivery, whether incidentoccurred at home or in the hospital and also whether patient was booked or unbooked. Results: One hundred and ten cases of Severe AcuteMaternal Mortality (SAMM) and eleven cases of maternal mortality were identified. More maternal deaths occurred in patients who had notbooked themselves for antenatal care. The four most frequent cases of severe morbidity were: hypertension 36 (32%), haemorrhage 32 (29%),anemia 16 (14%), sepsis12 (10%) in this order. The four causes of deaths were: sepsis 4 (36%), hypertension 4(36%), amniotic fluid embolism2(18.% ), haemorrhage 01(10%). There were statistically significant number of patients in mortality arm of sepsis group (p=0.01) In patients withSAMM there was a higher percentage of patients undergoing caesarean sections in haemorrhage and hypertension arm compared tobackground rate of 35%. Multi organ failure, cerebral and respiratory system involvement was linked to both SAMM and morbidity. Maternalmortality index was highest for sepsis (25%), and lowest for haemorrhage (3%) with hypertension intermediate in position (10%). Conclusions:A review of Severe Acute Maternal Morbidity offers a non threatening stimulus for improving quality of care. Comparison of Severe acutematernal morbidity with maternal death gives a different disease pattern and shows that different factors operate in each condition. Thereforeboth reviews complement each other.
FREQUENCY OF FEMORAL FRACTURES;
Authors: ADNAN RANA MUHAMMAD , ZIA Muhammad Irfan , AMIN JAHANZAIB , Khan Rafya , Ahmed Saleem , Danish Khalid F.
Published: September 2021

Background: To compare the frequency of various types of fractures of femur in patients less than and more than 40 years ofage in a tertiary care hospital. Design: Descriptive cross-sectional study. Setting: Emergency department. Period: January 2009 to April 2011.Method: A total of 1756 patients were divided into two groups with respect to age. Then they were further categorized according to the part offemur involved, and compared in both age groups. Results: The study was conducted on a total number of 1756 patients over a period of 2 yearsfrom 2009 to 2011. 51.1% patients were less than 40 years of age and 48.9% patients were more than 40 years of age. In patients more than 40years of age, pertrochanteric fracture was most common (86.40%). In patients less than 40 years of age, mid shaft of femur was most commonregion involved (87.02%). Conclusions: The incidence of proximal femur fractures is high in elderly patients because of several factors likeosteoporosis, visual impairment and cognitive disability. Whereas incidence of fractures of mid-shaft of femur is more common in youngpatients.
FREQUENCY OF HEPATOCELLULAR CARCINOMA IN CIRRHOSIS
Authors: AMIN SAID , SHABBIER GHULAM , UL HAQ ANWAR , Wazir Muhammad Noor
Published: September 2021

Objective: To find the frequency of hepatocellular carcinoma in cirrhotic patients of our population. Design: Prospectiveobservational study. Setting: Medical A Unit Hayat Abad Medical Complex Peshawar. Period: 1st January 2010 to 31st July 2011. Material &methods: All patients were screened for presence of Hepatocellular carcinoma (HCC) by performing Alpha fetoprotein and ultra sound (U/S)abdomen. Contrast enhanced computed tomography scan (CT) of abdomen was done in selective cases. European Association for the Studyof Liver Diseases (EASLD) Noninvasive criteria (limited to patients with underlying cirrhosis) was used for diagnosis of HCC i.e. Two coincidentimaging techniques that identify a focal lesion more than 2 cm showing arterial hypervascularization or one imaging modality that identifies afocal lesion more than 2 cm in diameter showing arterial hypervascularization and serum AFP levels greater than 400 ng/Ml. Results: A total of370 patients cirrhotic patients were enrolled in this study. Thirty nine patients (10.5%) were diagnosed as having HCC. Male patients were 30(77%) and 9(23%) were female. Mean age was 49.2% (range 18 to 72 years). Abdominal discomfort was predominant symptom present in 94%patients, followed by anorexia present in 90% patients, abdominal distension in 76%, weight loss in 62%, jaundice was present in 46% patients,altered mental status was notice in 36% patients and history of upper gastrointestinal (GI) bleed and malena was extracted from 26% patients.Ultrasound abdomen and CT abdomen showed unifocal lesion in 48.7% patients, multifocal lesion in 30.7% patients and massive lesion in20.5% patients. Alpha fetoprotein ranged from 45ng/dl to 630ng/dl. Hepatitis C (HCV) was the commonest cause present in 51% patients,Hepatitis B (HBV) in 15.3% patients and HBV and HCV co-infection in 10.25% patients, history of alcoholism was revealed in 5% patients and in2.5% patients alcoholism was present along with HCV and HBV each, while in 10% cases the cause of cirrhosis remained unknown.Conclusions: Hepatocellular carcinoma is the most common primary hepatic tumor and one of the most common cancers worldwide. It isconcluded that HCC is more common in males compared to female cirrhotic patients. Hepatitis C followed by HBV are the leading causes ofHCC related cirrhosis in local Population of Khyber pakhtoonkhwa.
SCABIES;
Authors: SAQIB MUNAZZA , ULLAH AFRIDI ITAAT , ALI ANSER , Jahangir Muhammad
Published: September 2021

Scabies is a common health problem worldwide. Most treatment modalities available are topical. Among them 5% Permethrin isthe most effective scabicide with few side effects. Limiting factors are its high cost, cumbersome application and emerging resistance.Ivermectin is the only oral scabicide available. It is effective, inexpensive and easy to use drug with no known drug interactions and limited sideeffects. Objective of study: To compare the safety of topical Permethrin and oral Ivermectin in treatment of scabies. Study design: Quasiexperimentalstudy. Setting: Department of dermatology Jinnah Hospital, Lahore. Subjects: 120 patients were enrolled and were randomlydivided in 2 groups of 60 each. Duration:- 12-02-07 to 31-01-08. Non funded study (As ivermectin was not available in Pakistan during the studyperiod, it was imported from India as tablet Ivecop 12 mg). Methods: Topical Permethrin and oral Ivermectin were used in groups A and Brespectively. Patients were examined and certain investigations were carried out before dug administration, and at day 7 and day 14 to evaluatethe safety of both drugs on the basis of appearing of side effects and change in baseline investigations. Results: In both groups, equal numberof patients experienced side effects (n=15). In group A, side effects observed were burning (n=8), contact dermatitis (n=4) and stinging (n=3). Ingroup B, we observed muscular pain (n=5), nausea (n=5), headache (n=2) and others (n=3). Significant rise of hepatic enzymes was noticed inonly 1 patient of group B which improved on next follow up. Conclusions: We found no statistically significant difference regarding safety of usebetween permethrin and ivermectin.
DENTAL CARIES;
Authors: BADAR SAMINA , CHANNAR SALEEM , BHUTTA NOUMAN , Arshad Saima
Published: September 2021

Objective: To find out the prevalence and determinants of dental carries 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, sugar rich food). 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 in age. Commonlyassociated habits (with carries) included lack of daily brushing of teeth (P<.01), lack of brushing at night (p<.001), and daily intake of sweets(p<.005). Conclusions: Frequency of dental caries was high with advancing age. There was significant relationship with oral Hygiene, Sugarrich food and dental caries.
BILATERAL ADDUCTOR ABCESS FOLLOWING GRION INJURY
Authors: DASTGIR NABEEL , KHALID BUTT KAMRAN , AHMED KHAN RIZWAN
Published: September 2021

Pubic pain is a common symptom in athletes and in soccer players.Its cause can be difficult to determine. We report a case in a14-year-old boy who presented with bilateral adductor muscle abcesses following a trivial injury to the groin. The etiology, radiological findingsand treatment, along with literature review are discussed. Introduction: The main causes of pubic pain after sports are thought to be sportsrelated microtrauma to the pubic rami or symphysis and lesions of the oblique, rectus or adductor muscles or their tendons1,2. Osteitis pubisrefers to a painful inflammation of the periosteum, bone, cartilage and ligamentous structures of the anterior half of the pelvis. Pubicosteomyelitis is an uncommon entity, accounting for less than 1% of all cases of Heamatogenous osteomyelitis. We report a case of bilateraladductor muscle abcess six week after a trivial injury in sports.
DIABETIC FOOT;
Authors: BALOCH G. M. KHAN , QURESHI KHALID HUSSAIN , BHATTI ASIM
Published: September 2021

Objective: Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was toevaluate the surgical management in diabetic foot patients presenting with different grades of infection. Design: Descriptive study. Place andduration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December2010. Patients and methods: A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgicaloutpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years andwere of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete bloodexaminations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesionswere raded according to Wagner classification and appropriate medical and surgical treatment carried out. Results: This study was carried outon 120 diabetic patients, out of which ninety six (80.0%) were male and twenty four (20%) were female. Male to female ratio was 4:1. Majority ofthe patients (n=66) were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,.Patients were grouped into five grades according to the severity of infection. Twenty six (21.6%) patients were managed with antibiotics anddressings, thirteen (10.8%) patients needed debridement and skin grafting while eighty-one needed amputations of different types.Staphylococcus aureus was the commonest organism isolated. Conclusions: Majority of the diabetic foot lesions were in grade II to V. Lessergrade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades neededamputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus andwound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity
DIABETES MELLITUS;
Authors: AZIZ MUHAMMAD SHAHID
Published: September 2021

Objective: To determine the prevalence of Diabetes mellitus in patients of hepatitis C virus infection. Design: Prospective andobservational study. Setting: Medical Wards at Combined Military Hospital Jhelum. Period: 1st November 2009 to 31st October 2010. Method:100 cases of HCV positive on Elisa method were inducted. All cases were segregated into different states of liver disorders and were screenedfor Blood Sugar level, for one year. So as to observe the frequency of Diabetes Mellitus among HCV positive patients. Diabetes mellitus wasconsidered to be present if patients were already on diabetes treatment or fasting or random blood sugar indicated diabetes mellitus accordingto standard criteria. Results: One hundred patients were studied. Fifty five (55 %) were males and forty five (45 %) were females. The agesranged from 15 to 71 years (Mean 44.24). Out of these 100 patients, total of 28 (28%) had diabetes mellitus. Out of 100 patients, 82 patients hadchronic hepatitis C virus infection without cirrhosis and 22 (26.4 %) of these had diabetes. Twenty two patients with chronic hepatitis C, who haddiabetes mellitus, twenty (90.9 %) were non-insulin dependent diabetics and two (9.1 %) were insulin dependent. Total of 18 patients hadcirrhosis and out of these 6 patients (33.33 %) had diabetes mellitus. Six patients with cirrhosis all had non-insulin dependent diabetes mellitus.Conclusions: Patient with chronic hepatitis C virus infection and cirrhosis secondary to hepatitis C virus infection have strong association withdiabetes mellitus and great majority of them are non-insulin dependent diabetics.
SITUS INVERSUS;
Authors: SHARMA RAVIKANT , AGNIHOTRI GAURAV
Published: September 2021

An unusual case of situs inversus was observed during routine postmortem of a 60 year old male subject at Government medicalcollege, Amritsar, Punjab, India. On the right side the common carotid artery was found to be absent. The right external carotid artery arosedirectly from the arch of aorta. The left internal carotid artery had a wide diameter and bifurcated . The right subdivision crossed overcompensating for absent right internal carotid artery. The compensation of absent internal carotid artery in situs inversus makes present caseunique and such variation has thus far never been reported in literature.The ontogeny and clinical implications of the variation have beendiscussed.