bluuebunny/crossref_metadata_2025 huggingface dataset:
HEPATITIS B VIRUS INFECTION AND ITS ASSOCIATED RISK FACTORS;
Authors: SIDDIQI GHULAM MUJTABA , NAEEM MANZOOR A , KHURSHID M ADIL , Altaf Jafary Zafar , Anwer Khursheed
Published: September 2021

Objective: The present study was carried out to screen for prevalence of Hepatitis B Virus (HBV) infection and its associatedrisk factors in patients presenting for various complaints at a tertiary care hospital. Study design: Cross-sectional descriptive study. Place &Duration: Nawaz Sharif social security Hospital, Multan Road Lahore from January 2008 through December, 2009. Materials & Methods: Atotal of 15403 patients, aged 14 to 60 years, belonging to low socio-economic group were screened for Hepatitis B surface antigen (HbsAg)during the study period. Relevant information was obtained through a pre-designed questionnaire prepared in accordance with the objectivesof the study. Patient’s serum was tested qualitatively for HbsAg by rapid immunochromatographic technique (ICT devices, Accurate, USA)according to the manufacturer’s instructions.All sera showing reactivity were then confirmed with Enzyme Linked Immunosorbent Assay(ELISA). Results: HbsAg positivity was found in 488 (3.16%) patients of the screened population. Associated risk factors were: therapeuticinjections (25.0%), shaving from community barbers (15.98%), blood or blood product transfusions (10.04%), HbsAg positive sexual partners(7.99%), dental treatment (6.96%), past surgical history (4.91%), occupational exposure (3.07%), pricking nose/ears (3.07%), H/ohemodialysis (2.04%) and medical endoscopy (1.02%). 5.94% cases revealed no risk factor whereas 13.93% cases had multiple risk factors.Conclusions: A high prevalence of known etiological risk factors for HBV infection in the HBV positive patients documented in our studyshould not go without serious concern. Public awareness programs should be launched through mass media to discourage the malpracticesrelated to risk factors.
PORTO-SYSTEMIC ENCEPHALOPATHY (PSE);
Authors: HAYAT ATIF SITWAT , BAWANY MOHAMMAD ADNAN , NAZ SILAWAT FURRUKH , Memon Mohammad Akber
Published: September 2021

Background: Porto-systemic encephalopathy (PSE) is a common medical emergency at our settings due to increasedprevalence of chronic liver disease. Objective: To determine frequency of common precipitating factors in patients having porto-systemicencephalopathy (PSE) at tertiary care settings in Hyderabad. Study design: Descriptive case series study. Setting: Department of MedicineIsra University Hospital Hyderabad. Period: 1st April 2011 to 31st December 2011. Methods: A total 100 patients manifesting clinical featuresof PSE were included in this study by non-probability convenience sampling. The data was evaluated in statistical program SPSS version 16.Results: As 100 patients with PSE were enrolled in the current study, out of these 96 patients have precipitating factors involved while only 4patients have no such factors. Out of these 96 patients, 36 patients have only single risk factor found while in 64 cases multiple factors wereimplicated. Constipation, infections (except SBP) and renal impairment were noted in 36%, 24% and 22% respectively. Conclusions:Constipation, infections (except SBP) and renal impairment were the most common precipitating factors of porto-systemic encephalopathy inour study. Hence priority should be given to them in terms of hospital funds, medicines and human efforts.
VACUUM EXTRACTION AND FORCEPS DELIVERIES;
Authors: NAZ Shabnam , MEMON IRUM , SOOMRO SHOAIBUNISA , Parveen Rehana
Published: September 2021

Objective: To compare the maternal and neonatal morbidity between vacuum extraction versus forceps vaginal delivery. Studydesign: Quasi-experimental study. Period: January 2009 to December 2010. Setting: Department of Obstetrics and Gynecology CMC,SMBBMU Larkana. Methodology: All patients delivered by forceps or vacuum with singleton pregnancy were included, the patient withmultiple gestation, breech presentation and gestational age less than 34 weeks were excluded. Data collected in pre-set Proforma include typeof instrument used, indication of instrumental delivery, maternal and neonatal complications of procedure. Data was analyzed; frequency andpercentage will be calculated for maternal age, gestational age, and degree of perineal and cervical tears. .chi-square test was applied tocompare the degree of neonatal and maternal complications. P-value less than 0.05 taken as significant. Results: Total 9, 5600 deliveries wereconducted, among them assisted vaginal deliveries were169 making the frequency of 2.66%, among which 96 have forceps and 64 wereventouse vaginal deliveries. Majority of women were primigravida. In infants of less than 37 weeks of gestation the use of forceps wassignificantly more common, delay in second stage of labor was the most common indication for vacuum extraction while fetal distress was morecommon reason for forceps delivery. Severe birth canal injuries (third and fourth degree perineal tears) and procedure related blood loss ofmore than 500 ml was significantly more common in forceps delivery group. Cephalhaematoma, neonatal jaundice and severe caputsuccedanum at discharge were more seen in vacuum deliveries, but facial injuries were more common after forceps delivery. Intracranialhemorrhage was identified in two infants born by vacuum extraction and none in forceps group. Two infants delivered by vacuum extractionexpired, one due to respiratory distress and other due to intracranial hemorrhage, and one of the infants delivered by forceps expired due tomeconium aspiration syndrome (MAS). Conclusions: Each instrument has its own merits and demerits .Maternal and neonatal outcomedepends on indications of instruments, patient selection and skill of operator. We conclude that forceps delivery is more associated withmaternal genital tract trauma and vacuum delivery is associated with more neonatal complications. So it is the choice of obstetrician to selectthe proper instruments . We also suggest that obstetricians learn these skills not on patients but in a skill laboratory using models.
FREQUENCY OF HYPONATREMIA
Authors: AHMAD AMEER , HUSSAIN SADIQ , FAYYAZ AYESHA
Published: September 2021

Introduction: Acute diarrhea is defined as passage of three or more stools in a day, of consistency softer than usual for thechild, or one watery stool. Acute diarrhea is the major cause of morbidity and mortality in developing countries. It accounts for approximately25% of total admissions in children ward and causes mortality of 5-10% in community. As dehydration is the main complication of diarrhea,treatment focuses upon rehydration through fluid replacement. Oral Rehydration solution (ORS) is the recommended treatment in children withacute diarrhea and some dehydration. Now WHO has recommended Low Osmolarity ORS which contains less sodium and glucose thanstandard ORS. One of the side effect of use of ORS solution with reduced sodium level is the development of hyponatremia ( i.e. serum sodiumlevel less than 130 meq/L) in some of children with acute diarrhea and results in adverse clinical events. Objective: To determine thefrequency of hyponatremia in children taking low osmolarity ORS for management of acute diarrhea with some dehydration. Study design:Descriptive case series. Place and Duration of Study: Study was conducted in Department of Pediatrics, Children ward-2 Bahawal VictoriaHospital Bahawal Pur and Department of Pathology Quaid-e-Azam medical college Bahawal Pur from 7th August 2010 to 22nd September2010. Subjects and methods: Total 32 children with age between 3 months to 60 months with acute diarrhoea and some dehydration withnormal initial serum sodium were included. An informed consent was taken from the parents to include their children in the study. Proforma wasfilled at the time of admission and after 4 hours. Blood sample was taken to measure serum sodium level. Criteria of hyponatreima was serumsodium level below 130 meq/l after giving low osmolarity ORS at a dose of 75 ml/kg to drink. Results: A total of 32 children with acute diarrheawere included in study with age ranging from 3 months to 60 months. Male to female ratio was 1.1:1. Hyponatremia was seen in 2 (6.3%) ofpatients. Conclusions: The risk of hyponatremia in patients treated with the low osmolarity ORS was minimal.
ROOT CANAL TREATMENT;
Authors: - FAISAL , SHAH SANA , KUMAR NARESH , Ali Syed Abrar , Inayat Nadia
Published: September 2021

Objective: To determine the frequency of root canal treatment in endodontic department of dental colleges of Karachi. StudyDesign: Cross-sectional study. Place and duration of study: Department of endodontics, Sir Syed Dental College & Hospital, Karachi from1st May 2011 to 31st August 2011. Material and Methods: Of the 400 teeth from 370 individuals (age range 12-50 years) were endodonticallytreated during four months by faculty members and postgraduate residents enrolled in a specialisation programme in department ofEndodontics. All patients were examined clinically and radiographically. For each case, information was collected in specifically designedproforma including location of the affected tooth, age and gender and reasons for endodontic treatment. Results: Of the 400 treated teeth, 225(56.25%) were mandibular and 175 (43.75%) were maxillary teeth. 236 teeth (59.0%) were from females and 164 (41.0%) from males.Significant differences were found between the maxillary and mandibular arch. Molars and premolars required significantly more frequentendodontic treatment than canines and incisors as revealed in fig.1. The most frequently treated tooth was the mandibular right first molar(9.12%) followed by the mandibular left first molar (7.07%). The mandibular first molar was the most common tooth to undergo endodonticprocedure than maxillary first molar. The most frequently diagnosed pathosis was irreversible pulpitis (44%), pulp necrosis (22%), retreatmentendodontic (17%), elective RCTs (10%) traumatic exposures were (7%) as shown in fig. II. Conclusions: Irreversible pulpitis was the mostfrequent cause of root canal treatment followed by pulp necrosis. Teeth of females required more endodontic treatment than males. The mostfrequent root canals were carried out in mandibular molars than maxillary molars.
RITUAL CIRCUMCISION;
Authors: NIAZI SIKANDER
Published: September 2021

Objective: To compare the results of one of the most commonly performed surgical procedure in Pakistan i.e. ritual circumcisionby using Bone cutter or Sinus forceps methods, in term of complications. Design: Comparative study. Setting: CMH Rawalpindi. Period: June2009 to Dec2010. Material and methods: After thorough physical examination with normal haemoglobin, BT (bleeding time) and CT (clottingtime), 200 neonates and young infants with age ranging from two weeks to three months ,were included and two equal groups were made.Results: There was no significant difference in terms of bleeding , local infection etc between two methods but the cosmetic appearance wasmore satisfactory in Sinus forceps method. Conclusions: Both methods proved to be safe at this age but Sinus forceps method is better thanthe Bone cutter in term of cosmetic appearance.
DENGUE FEVER;
Authors: BAIG SHAHBAZ , SATTAR ABDUL , AHMAD SHAHBAZ
Published: September 2021

Dengue infection is one of the most common mosquito borne viral diseases of public health significance. It has been identifiedas a clinical entity since 1780. Dengue is caused by viruses that are small enveloped viruses and are members of the family Flaviviridae genusFlavivirus. It is a vector borne disease and is a global health threat. In Pakistan first epidemic was reported in 1994 and since then cases arereported every years. This year dengue infection raised the number of patients and increased the deaths. Objectives: To assess theknowledge, attitude and practices of the people regarding Dengue fever. Study Design: Cross Sectional Study. Setting: Aziz Bhatti Town,Lahore. Duration of Study: One Month. Material and methods: Convenient sampling. The investigator himself collected the information fromthe sample under study. First of all, an informed consent was obtained from the respondent under study and secrecy of the information wasensured. Data was entered and cleaned using Epi Data version 3. Data was analyzed using Epi info version 3.5.1. Results: Out of 41respondent families only 2.4% did not hear about dengue fever while 97.6% respondents were well aware of the dengue fever. 80.5% wereaware of high grade fever in dengue fever, 73.2% were aware of associated body aches. 92.7% were aware that dengue fever is preventable.95.1% were using mats, coils & repellents while 2.4% were using smoke of wet wood.36.6% were covering the water containers. 75.6% werekeeping environment dry and clean.68.3% were having opinion that they will consult GP in case of illness.85.4% told that TV/Radio were thesource of above mentioned knowledge while 9.8% doctor and 4.9% got information through newspapers. only 4.9% respondents were havingopinion that government had sprayed for dengue fever.7.3% families experienced the patient of dengue fever in their family. Conclusions: Inthis study the results are the almost same with little variations as found in other studies. The knowledge, attitude and practice are the almostsame in every studies with little variation. Majority of the families were well aware of dengue fever.
CAUDAL ANALGESIA IN CHILDREN;
Authors: AMER MUHAMMAD , UL MALOOK MUHAMMAD SAIF , UZ ZAMAN MUHAMMAD SHER
Published: September 2021

Background: Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration oftramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine andbupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Setting: Department of Anesthesia andIntensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. Period: 01-12-2010 to 30-11-2011. Methods: Eighty children, aged between 2 to12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into twogroups A and B. Group A (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine and Group B (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine with 1mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and sideeffects were noted and analyzed. Results: Patients in both groups were comparable for age and weight. It was observed that the meanduration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours (p<0.05). Nausea and vomiting waspresent in 20% (n=8) patients in group A, while in group B, 27.5% (n=11) had nausea and vomiting in the post operative period (p<0.05). None ofthe patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. Conclusions: Theaddition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in thepostoperative period compared to bupivacaine alone.
TRIPLE ASSESSMENT
Authors: NIAZ MARYAM ISHRAT , FAROOQ OMER , HAIDER TIRMAZI FARHAN
Published: September 2021

Objectives: To determine the efficacy of triple assessment in diagnosis of malignant breast lumps in female patients taking corebiopsy as a gold standard. Setting: Breast Clinic, Unit-III, Department of Surgery, Nishtar Hospital, Multan. Period: October 2007 to March2008. Material & Methods: A total 0f 100 patients of breast lump, above the age of 14 years, having palpable lump of any size in breast wereselected according to inclusion criteria. Results: Out of 100 patients included in the study most of the patients were in the age group 45-54years i.e. 46 (46%) followed by 32 (32%) in the age group 35-44 years. According to occupation 67 (67%) were house wives, 13 (13%) wereteachers and 5 (5%) were nurses. In 48 (48%) patients the lump size was 2 cm, 35 (35%) patients had lump size from, 2-4 cm while in 17 (17%)patients lump size was > 4 cm. Presenting symptoms like lump was present in 50 (50%) patients, pain alone 25(25%) patients, discharge in 20(20%) patients and discharge with pain in 5 (5%). Lymph node status like grade-0 was seen in 60 (60%) patients, grade-1 in 21 (21%) patients,grade-2 in 15 (15%) patients and grade-3 in 4 (4%) patients. Conclusions: Triple assessment is a valuable tool for an accurate non surgicaldiagnosis of breast lump, allows assessment of breast cancer patient for conservative and neo-adjuvant primary treatment before surgicaltreatment.
CONCEPT MAPPING;
Authors: SARFRAZ KHAN Junaid
Published: September 2021

The explanations of different concepts of learning are called theories and approaches towards the learning process. Thedifference of concepts is based on interpretations of learning rather than the definition of learning. Five major learning theories: behaviorists,humanists, cognitivists, social cognitivists and constructivists exist, which explore the process of learning. In this paper, the concept maps of allthese theories will be discussed separately. The overarching linkages between the theories shown in the concept maps will also be explained.
BURNS IN CHILDREN;
Authors: MANSOOR S. HAROON , EL-HARRAZIN MOHAMED MAHMOUD
Published: September 2021

Burns are among the most devastating of all home injuries with formidable sequelae ranging from considerable physicaldisability to emotional and mental trauma. Patients of burn require prolonged hospitalization resulting into considerable financial burden onpatient as well as the state. Treatment of burns can be made cost effective by early excision and grafting of the burned areas. A randomizedcontrolled study was conducted to evaluate the efficacy of early versus delayed excision and skin grafting in pediatric burns. Out of 80 burnedchildren, 30 underwent early excision and grafting whereas 50 were treated with delayed excision and grafting. Mean percent graft take was96.67 in early and 88.40 in delayed group. Over all post operative complications like minor graft rejection was found in 26% cases of early and48% of delayed group whereas major graft rejection was found in 14% of delayed group only. Post operative contractures developed in 8% ofdelayed group. Mean hospital stay was 13.66 and 37.46 days for early and delayed excision and grafting respectively. Early excision andgrafting in pediatric burns is a superior and cost effective to delayed excision and grafting in terms of post operative complications, cosmesisand hospital stay.
ACUTE PANCREATITIS IN PREGNANCY
Authors: CHAUDHRY SHAMA , HUSSAIN RUBINA
Published: September 2021

Acute pancreatitis during pregnancy is rarely encountered and can have a high maternal mortality and fetal loss. We report herea case of a 35-year-old woman para 1+0 previous 1LSCS at 32 weeks of gestation. She had laparotomy at 29 weeks of gestation due to torsionof dermoid cyst in this pregnancy. Now she was presented with, severe epigastric pain, vomiting and pedal edema. Investigation revealedhyperamylasemia and leukocytosis, hypokalemia, hypocalcaemia. The patient was kept on conservative management, antibiotics, analgesics& intravenous fluids.Pancreatitis resolved & she delivered at 38 weeks by caesarean section.
CERVICAL SMEAR
Authors: ALTAF SAMINA , SAJJAD MADIHA , QAYYUM SHAZIA
Published: September 2021

Objective: To review cervical smear results in women of reproductive age group. Study design: Descriptive study. Place andduration of study: This study was carried out at the pathology department, Railway hospital, Islamic International Medical College Trust.Rawalpindi, from Jan 2007-Dec 2010. Materials and methods: A total of four hundred and seventy seven cervical smears were included in thestudy. Inclusion criteria was females of reproductive age group. Smears from postmenopausal women and those who had hysterectomy wereexcluded from the study. The cervical smear was taken using modified Ayres wooden spatula, or plastic spatula, to collect endocervical sample.The slides prepared were immediately fixed in 95% ethyl alcohol, and were subsequently stained by the recommended procedure of Papstaining. After staining, the slides were mounted with Canada balsam and finally reported by the cytopathologist according to the BethesdaSystem. Results: Four hundred and seventy seven patients were included in the study. Most of the patients belonged to low socio economicstatus. The cytological examination of the smears showed inflammatory changes in 33% (n=159) cases, normal smears/ no positive finding in25% (n= 118) cases, while reactive changes were seen in 2% (n= 10). Dysplastic changes were seen in 2 %( n= 10), while unsatisfactory/Inadequate samples were reported in 38 %( n=182) cases.
EFFECTIVE LECTURE DELIVERY;
Authors: ANJUM AFTAB , SAEED RIZWAN , BAJWA MUHAMMAD ASLAM
Published: September 2021

Objectives: To assess the perceptions of medical students regarding characteristics of effective delivery of lectures. To makesuggestions to promote active listening during lecture. To give recommendations regarding organization of lecture. Data Source: Primary datacollected by administration of Structured Questionnaire. Design of study: Descriptive Cross-sectional. Setting: University Medical College,University of Lahore. Period: August to September 2011. Materials and methods: The study population comprised of 580 students studyingat University Medical College of University of Lahore. The study sample was comprised of 123 students, 63 male and 62 female. The samplewas determined by using non-probability convenience sampling technique. The study variables included socio-economic demographic andcharacteristic related to teaching skills and delivery of lectures. Results: The most important effective lecture delivery characteristics noted bythe respondents of this study in order of were prior knowledge of the topic (87.8%), subject knowledge (82.9%), basic lecturing skills (77.2%),organization of the lecture (76.5%) and clarity (74%) of the lecturer regarding the underlying concepts. Majority of respondents reported theonset of boredom 20 minutes after the beginning of the lecture (37.4%) and during last 20 minutes (41.5%) in a lecture spanning over 60minutes. The majority of respondents (78%) felt that they are motivated by the lecture. Conclusions: The most frequent characteristic requiredfor effective teaching was prior knowledge of topic by students before the delivery. This study concludes promoting the friendly atmosphereduring the delivery of the lecture.
RATIO OF HEIGHT TO STERNOMENTAL DISTANCE;
Authors: FARZI FARNOUSH , MIRMANSOURI ALI , FORGHANPARAST KAMBIZ , Abdolahzade Mehrsima , Shafai Ahmadreza
Published: September 2021

Background: Preoperative evaluation is important in predicting the risk of difficult airway management. Ratio of height tosternomental distance is a new test for predicting difficult laryngoscopy. Design: Analytical cross – sectional study. Setting: Guilan Universityof Medical Sciences, Rash-Iran. Period: 1st Oct, 2009 to 30th Dec, 2010. Methods: 470 consecutive patients scheduled for elective surgeryundergoing general anesthesia and requiring endotracheal intubation. The tests that were used to predict difficult laryngoscopy included:mouth opening range, body mass index (BMI), thyromental distance, sternomental distance, and neck movement range, ratio of height tothyromental distance, ratio of height to sternomental distance and assessment of oropharyngeal view by modified Mallampati classification.After general anesthesia, glottic visualization was assessed during laryngoscopy using Cormack and Lehane classification. Multivariateanalysis and 95 percent confidence interval with SPSS 14 statistical package were used to compare the results of study. Results: Neckmovement range≤80 degrees had the highest sensitivity and specificity. Then Mallampati class 3 or 4 and RHSMD ≥ 12.5 were valuablerespectively. Odds ratio (95 percent confidence interval) of the neck movement range ≤ 80 ̊, Mallampati class 3 or 4, RHSMD ≥ 12.5 andRHTMD ≥ 23.5 were 17.7(9.57 – 49.76), 12.28 (7.6 – 47.04), 12.22 (22.8 – 76.6), 9.35 (2.29 – 10.52),5.6 (0.88 – 0.89), 3.78 (0.022 – 0.595)respectively. RHSMD had the least false negative value. Cut off point of RHSMD ≥ 12.5 and RHTMD ≥ 23.5 was not different between menand women. Conclusions: RHSMD is a useful and valuable clinical screening test for predicting difficult laryngoscopy.
EARLY PREGNANCY TERMINATION;
Authors: ULLAH NABILA ATA , ULLAH HANIA ATA
Published: September 2021

Objective: To determine the effectiveness and safety of elective termination of pregnancies from 56 days gestational age 2ndtrimester in which ingestion of 20 mg tamoxifen for 4 days was followed by oral administration of 1 or 2 days of 800 μg misoprostol. Design: Aclinical trial. Setting: Department of Obstetrics and Gynaecology, Nishtar Hospital, and Private setup, Multan. Period: January 2009 toJanuary 2010. Material and methods: A total of 50 patients were included in the trial on outdoor basis. Results: Of the 17 subjects with agestational age between 50 and 56 days, 15 (88.2%) aborted their pregnancies. The mean duration of uterine bleeding in the group of womenwho aborted their pregnancies was 8.1 days with a range of 1-34 days. Conclusions: In conclusion, the regimen of oral tamoxifen followed byoral administration of misoprostol was found to be an effective and rapid method to electively terminate early gestation of 8 weeks duration orless with no serious side effects.
ACUTE AND CHRONIC IMMOBILIZATION STRESS;
Authors: JUNJUA BASHIR AHMAD
Published: September 2021

Objective: The purpose of this article is to compare the morphological changes induced by acute immobilization with thoseproduced by chronic immobilization, in vermal cerebellar cortex of young male sprague dawley rats. Study design: Experimental study.Setting: Department of Anatomy CPSP Regional Centre, Islamabad. Period: 2005 to 2007. Material and method: A total of 120 young maleSprague Dawley rats were taken and divided equally in two groups for acute and chronic immobilization stress. Both these groups were dividedfurther into two subgroups (n=30 in each) control acute, experimental acute, control chronic and experimental chronic. ‘Experimental acute’group Ib was kept in restrainer for 24 hours continuously while ‘experimental chronic’ group IIb was kept in restrainer for 2 hours daily forfourteen days, one rat per restrainer separately. Hematoxylin and Eosin stained sections were studied under light microscope to record thedata. Results of experimental acute group were compared with those of experimental chronic’. Data was analyzed by SSPS version 10.Results: Insignificant increase in thickness of vermal cerebellar cortex and molecular layer was found in both acute and chronically stressedrats; but comparatively more in group Ib, however minimal non significant change in granular layer was seen in both experimental groups.Conclusions: Immobilization stress can cause the neuronal injury. Acute stress tends to produce more severe effects on brain cortical tissueas compared with chronic stress. The reason for occurrence of less severe effects under chronic stress is probably due to role of thephenomena of adaptation.
TOE TO THUMB TRANSFER
Authors: AZEEM Muhammad , AHMED CHEEMA TAHSEEN , IQBAL MUHAMMAD ZAFAR
Published: September 2021

Introduction: Thumb is the most important part of human hand both functionally and cosmetically. The reconstruction of lostthumb is always challenging for the surgeons. Objectives: The aim of study is to evaluate the results of micro – vascular reconstruction ofthumb by toe transfer. Place and duration of study: B. Victoria hospital Bahawalpur from January 1998 to December 2008. Material andmethod: Both male and female patients who presented to the orthopedic Department with traumatic amputation of thumb were included in thestudy. Results: All ten thumbs survived with minor complication as for as functionally and cosmetically are assessed. Dominant hand wasinvolved in eight cases. Conclusions: Results of Microvascular reconstruction are much better as compared to conventional methods. This issingle stage procedure and early rehabilitation of hand is possible. Cosmetically and functionally this is far superior to conventional methods.
EPIDURAL ANAESTHESIA;
Authors: ALI CHOUDRY AMJAD , AZHAR KHAN RAHEEL , IQBAL AMJAD , Khurshid Tasadaq
Published: September 2021

Objective: To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamicchanges and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epiduralanaesthesia. Study design: Quasi experimental study. Place and duration of study: Combined Military Hospital Rawalpindi from 15 October2007 to 15 April 2008. Methodology: American Society of Anaesthesiology (ASA) physical status (PS) I and II patient of either genderundergoing un-complicated open cholecystectomy were randomly divided into two groups, group A (n=30) received general anaesthesia (GA)and group B (n=29) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for peri-operative haemodynamicchanges, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups andobtain P-value. P-value of less than 0.05 was considered significant. Results: 9 out of 30 patients (30%) of group “A” (general anaesthesia) and4 out of 29 patients (13.79%) in group “B” (epidural anaesthesia) had vomiting. Shivering was seen in 3 out of 30 (10%) in group “A” (generalanaesthesia) and 1 out of 29 (3.44%) patient in group “B” (epidural anaesthesia). Urinary retention was seen in 1 out of 30 (3.33%) in group “A”(general anaesthesia) and 8 out of 29 (27.5%) in group “B” (epidural anaesthesia). Urinary retention was relieved by psychotherapy. None ofthe patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility (passage of flatus andstart of oral sips). In group “A” (general anaesthesia) 6 patients (20%) started oral sips in first post operative day, 16 patients (53.33%) onsecond post operative day, 8 patients (26.66%) in third post operative day. In the group “B” (epidural anaesthesia) 13 patients (44.8%) startedoral sips on first post operative day, 15 (51.72%) on second post operative day and one patient (3.44%) on third post operative day. Regardingthe length of hospital stay 17 patient (56.66%) of group “A” (general anaesthesia) were discharge by third post operative day and 22 patient(75.77) were discharge by third post operative day in group “B” (epidural anaesthesia). Conclusions: The use of intra-operative epiduralanaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomitingin patients under going open cholecystectomy.
PSEUDOANEURYSMS IN INTRAVENOUS DRUG ABUSERS
Authors: IMTIAZ NAUMAN , AHMED RIZVI SYED TAOKEER , HASHMI JAVAID SAJJAD , Iqbal Muhammad Rashid
Published: September 2021

Background: Intravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. Thesepseudoaneurysms (false aneurysms) are prone to rupture, leading to profuse hemorrhage and death. Objective: To evaluatepseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Design: Descriptive study.Place and duration of study: Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore.January 2006 to September 2010. Subjects and methods: All cases of pseudoaneurysms in intravenous drug addicts who presented to asingle vascular surgeon, between 1st January 2006 and 30th September 2010, were evaluated for site, mode of presentation, treatment andthe outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vesseland debridement. All cases were referred to psychiatrist for management of drug addiction. Results: Total 12 cases of pseudoaneurysms dueto IV drug abuse were included in our study. Arteries affected included 9(75%) common femoral arteries (CFA). In 3(25%) cases, both commonfemoral artery and vein were involved with arteriovenous fistula between them. There was 1(8.3%) pseudoaneurysm each of external iliacartery, superficial femoral artery and brachial artery. Nine cases (75%) presented with recurrent hemorrhage from a swelling while in 3(25%)cases there was swelling with no history of hemorrhage. In 7(58.3%) cases, repair/grafting, while in 5(41.6%) cases ligation and debridementwas done. There was seroma formation in 1(8.3%) case after excision and grafting. In none of the cases, in which artery was ligated, critical limbischaemia occurred. Conclusions: Common femoral artery is the most frequent site of pseudoaneurysms in IV drug abuse. In those caseswhere vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life savingprocedure but a safe option also.
RENAL INVOLVEMENT IN ACUTE GASTROENTERITIS;
Authors: ILYAS BAIG MIRZA MUHAMMAD , TARIF NAUMAN , RANDHAWA FAWAD AHMAD
Published: September 2021

Objective: Acute renal failure is one of the important complications of acute gastroenteritis. Early intervention and proper fluidreplacement may lessen this risk. We conducted this observational study to see the renal involvement and its outcome in patients with acutegastroenteritis. Design: Observational study. Setting: This study was done in three different hospitals which are tertiary care and teachinghospitals. Period: May 2009 to September 2009. Material and Method: A total of 200 patients were included in this study who presented withacute gastroenteritis. All patients were assessed properly for their clinical examination and laboratory tests including renal functions,electrolytes and other routine tests were done and evaluated. These patients were treated either in Emergency department or indoordepartments. Only those patients were included in our study who met our inclusion criteria which was set before conducting study. Results: Atotal of 200 patients were included in our study, among them 160 were male patients and 40 were female patients. At presentation 32 (16%)patients had deranged renal functions, 18 (09%) patients had urea in range of 50-100mg/dL and creatinine in the range of 1.4-2.0mg/dL. 10(05%) patients had urea in range of 101-150mg/dL and creatinine 2.1-3.5mg/dL. 04 (02%) patients had urea in range of 151-200mg/dL andcreatinine 3.6-7.0mg/dL. 12 patients were received in hypovolemic shock at presentation. After one week of follow up most of these patientsimproved but 04 patients were deteriorated and put on renal replacement therapy. Patients who had their renal functions in normal range weredischarged from hospital and follow up of all these patients were continued for 6 months. It was observed that those patients which presentedlate had more chances of renal involvement. Conclusions: Early referral and timely management with fluids and antimicrobials may reducerisk of renal failure in patients with acute gastroenteritis.
ECLAMPSIA;
Authors: ASHRAF SAIMA , SARWAR SAFIA
Published: September 2021

Objective: The objective of this study was to determine the perinatal outcome in patients with eclampsia. Study design:Descriptive study. Settings: Department of obstetrics and gynecology Nishtar Hospital Multan. Subject and Methods: Two hundred and sixtyfour pregnant ladies admitted in labor ward of Nishtar Hospital Multan diagnosed as eclampsia fulfilling the inclusion criteria were selected. Nonprobability purposive sampling technique was used. All information like prematurity, intrauterine death, stillbirth, low birth weight, admission toneonatal intensive care unit(NICU) and early neonatal death was recorded on a specifically designed proforma. For perinatal complicationsladies were followed for 7 days. Data were entered and analyzed by SPSS-11. Results: Out of 6183 admissions 231(3.73%) were eclamptic.Majority of the patients 157(67.96%) were primigravida, 118(51.08%) were in groups 21-30 years. There were 117(50.61%) uneducatedpatients and 157(67.96%) patients belonged to poor socioeconomic conditions. Only 63(27.27%) were booked cases. Most of the patients132(57.14%) were diagnosed at gestation less than 37 weeks and 120(51.94%) patients delivered vaginally. Prematurity was the mostfrequent complication i.e in 131(56.70%) patients observed and 147(63.63%) neonates required admission to NICU due to various reasons.There were 13(5.62%) intrauterine deaths, 29(12.55%) stillbirths and 21(9.09%) early neonatal deaths. Conclusions: Eclampsia is still amajor threat to the pregnant ladies in our institution and a major cause of perinatal morbidity and mortality. It is mostly preventable by earlydiagnosis and management of pre eclampsia and hypertensive disease. As stillbirth, prematurity and birth asphyxia are the most importantcauses of perinatal loss, so in eclampsia early referral of patients, better obstetric management, early resuscitative measures and goodneonatal care facilities can improve the perinatal outcome.
DIABETES MELLITUS PREDICTION;
Authors: KHAN SIKANDAR HAYAT , BOKHARI SYED AOWN RAZA , IJAZ AAMIR , Ali Mohammad Zafar , Masood Umair , Hanif Muhammad Shahzad , Khan Muhammad Junaid
Published: September 2021

ABSTRACT… Background: The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis ofdiabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalitiesassociated with diabetes mellitus, so a consideration comes in for their utilization as a marker to support diabetes mellitus. Objective: (1)To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose (2). To predict diagnosis of diabetes mellitus usingabove serum markers. Design: Cross-sectional analysis, descriptive study. Place and duration of study: This study was carried outbetween Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. Subjects and methods: Atotal of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjectswere grouped as having normal glucose tolerance (NGT), impaired fasting glucose (IFG), and newly diagnosed diabetes mellitus (NDDM).A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase (ALT) were made in the above groups tomeasure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results offasting blood glucose through pearson’s correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and twomathematical models [{Factor-I=FBG (mmol/L) + triglycerides (mmol/L)} and {Factor-II=FBG (mmol/L) + triglycerides (mmol/L) +total cholesterol (mmol/L)}] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. Results:The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [{Triglycerides: NGT =1.91, IFG=2.10,NDDM= 2.75, p=0.003} {total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056} {ALT:NGT=28.47, IFG=27.95,NDDM=25.78, p=0.846}]. Most correlation was found between serum triglycerides and fasting blood glucose (r2=0.235, p<0.001);while serum total cholesterol and ALT showed lesser correlations {(total cholesterol:r2= 0.172, P=0.007), (ALT:r2= 0.010,p=0.877)}. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, thefactors incorporating lipids and glucose had the highest overall diagnostic efficiency. Conclusions: Triglycerides and total cholesterollevels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion oftriglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus.
POSTOPERATIVE ANALGESIA;
Authors: SAMEE ASMA , TAHIR M. SHAFIQUE , KHAN NADEEM AHMAD , Masood Muhammad , Yousaf Muhammad , Waris Salman
Published: September 2021

Objective: To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinalhernia repair. Setting: Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. Period: August 2008 to May 2009.Material and methods: A total of 100 children aged between 2-5 years were included in the study. Results: The duration of analgesiawas significantly prolonged in group-A patients (P=0.001). A low frequency of postoperative vomiting was observed in both groups i.e.10% in group-A and 6.7% in group-B (P=0.64). No respiratory depression, flushing and pruritis were observed. Conclusions: Low dosecombination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effectivepostoperative analgesia with minimal side effects.
PEAK EXPIRATORY FLOW RATE;
Authors: AYYAZ SALMAN , MUSHTAQ M. AZAM , KHAN SHAKEEL AHMED
Published: September 2021

Objective: To ascertain the effects of cotton dust on the peak expiratory flow of cotton mill workers in comparison with thehealthy controls who never exposure to the cotton dust. Setting: Outpatient Department of Pulmonology, Nishtar Hospital, Multan.Period: August 2011 to March 2012. Material and methods: A total of 200 male subjects (100 healthy controls and 100 cotton millworkers) who strictly met the inclusion criteria were selected from the OPD. Results: The peak expiratory flow rate (PEFR) (L/min) ofcotton mill workers was significantly lower as compared to the control subjects and this impairment was directly proportional to theduration of exposure to the cotton dust in the mail. Conclusions: It was concluded from the study that the peak expiratory flow rate wasdecreased in the cotton mill workers.
VALSALVA MANOUEVRE;
Authors: KHAN MUHAMMAD KHALID AZAM , FAIZ SHAHID BIN , RAFIQUE ATIF
Published: September 2021

Objective: To assess the efficacy of Valsalva maneuver in the treatment of Eustachian catarrh. Study design: QuasiExperimental Study. Place and duration of study: Frontier corp Hospital (Quetta) and Sheikh Khalifa Bin Zayad Al Nahyan Hospital(Muzzafarabad) from December 2010 to May 2011. Patients and methods: Total of sixty patients of Eustachian catarrh were randomlyassigned to two treatment groups. Group A was given Antibiotics, Antihistamine, systemic and nasal decongestants and group B wasadvised Valsalva maneuver in addition to the above mention treatment. Relief in aural fullness (assessed through tympanometry) andhearing improvement (assessed through audiometry) were compared between these two groups at the end of three weeks of treatment.Results: Audiogram done after three weeks of treatment showed statistically significant hearing and middle ear pressure improvement(assessed through audiogram and tympanogram respectively) in group B.
ECLAMPSIA;
Authors: AKHTAR YASMEEN
Published: September 2021

Introduction: Hypertensive disorders during the pregnancy are seen in 5- 8% of cases. The worst form is eclampsia,associated with fits or convulsions. It is a rare event in developed countries. Eclampsia can not only lead to maternal mortalities but alsocause maternal morbidities. Lot of studies have been done about different aspects of this disease. This study aims to see the maternalmorbidities, mortalities but also to dig down the underlying parameters, which are responsible for them. They include Personal, Social,Educational, Medical and National problems. Objectives: (1) To compare the Fetomaternal outcome and complication in low risk andeclamptic patients. (2) To find out the underlying parameters or variables associated with this catastrophy. Study design: It is aDescriptive Study. Settings: Lady Aitchinson Hospital, Obstetrics/Gynecology Unit 1, Lahore, Pakistan. It is a teaching, tertiary carecentre affiliated with King Edward Medical University which is a well known all over the Asia. Duration: 1st Jan 2008 to 31st Dec 2010.Subjects and methods: 10557 patients presented in emergency room for Obstetrical causes.1200 patients had one or the other form ofhypertensive disorders.400 patients with Eclampsia presented with hypertension, fits and generalized body swelling. The patients whofulfilled the inclusion criteria were included in the study. Results: According to the results it is seen that maternal mortality is higher inEclampsia as compared to low risk (p=0.01)The maternal morbidities are also higher than normal low risk population (p=0.011).Perinatal outcome is again better in low risk than high risk group (p=0.099) .It was observed that illiteracy, poor socioeconomic status,lack of awareness about health facilities, poor arrangement at Basic Health units of villages, delayed decision making, delay in referraland management are the underlying variables and pitfalls which have to be addressed. Conclusions: It is concluded from this study thatalthough Eclampsia is a major killer and an uphill battle, but the measures can be taken at missed & neglected parameters, responsible forthe condition, to reduce the maternal morbidity and morality.
VITAMIN-D DEFICIENCY DURING PREGNANCY;
Authors: SOHAIL SUMBUL , RASHID SHAISTA
Published: September 2021

Objective: To find out the frequency of vitamin-D deficiency during pregnancy by using Serum 25 hydroxy vitamin-D3 leveland to evaluate the risk factors associated with low level of vitamin-D. Study Design: Cross Sectional Study. Setting: Gynae and obstetricunit II in Abbasi Shaheed Hospital Karachi. Period: February 2011 to July 2011. Material and methods: Design: All patients with historyof chronic renal disease, liver disorder, PIH, GDM, twin gestation, anti tuberculous treatment and antiepileptic treatment with excluded.Data was collected by predesigned proforma through personal interview. Result: This study showed 49 cases (98%) of primigravidawere vitamin-D deficiency. The highest low level was in 15-25 years of age. The mean concentration of 25bOH vitamin-D 3 was 10.30ng/ml.60 % of women had severe vitamin-D deficiency with level of 25 OH vitamin-D3 was lessthan 10ng/ml. Risk factors associated withlow level of vitamin-D3 included dietary deficiency , lack of sun exposure and practicing veil. Conclusions: Pregnant women includingprimigravida in Pakistan are at risk of vitamin-D deficiency. 25 (OH) assay should be used as an aid in assessment of vitamin-D deficiencyduring pregnancy so that proper correction can be achieved. Women who are deficient in vitamin-D should be counseled regardingmaternal and neonatal risk, a balanced diet ,limited sun exposure and compliance of vitamin-D supplement to ensure normal maternal andfetal outcome. Every women should provided by vitamin-D supplement prior to pregnancy.