bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Saturated Hydraulic Conductivity during Infiltration Test with the Aid of ERT and Level‐Set Method
Authors: Chou Ting-Kuei , Chouteau Michel , Dubé Jean-Sébastien
Published: June 2016

Core Ideas

A new technique for estimating the saturated hydraulic conductivity is developed.

It uses a combination of hydrogeophysical and numerical methods.

Electrical resistivity tomography and the instantaneous profile method are used.

The technique is validated using simple and complex numerical hydrogeological models.

Many hydrogeological and geophysical tools have been developed to determine subsoil properties, but they are often limited by sparse datasets and by the portability of the method from one site to another and often underestimate the complexity of the medium. We present a saturated hydraulic conductivity (Ks) estimation scheme, named the KES method, based on hydrogeophysical and numerical methods. The targeted medium of investigation is an unsaturated and heterogeneous soil. Estimation of Ks is accomplished by estimating the position of the wetting front and the distribution and velocity of flow lines during an infiltration test. Using numerical modeling, Ks is determined by minimizing the velocity difference between the measured flow lines and the modeled flow lines. Surface and buried electrodes are used as part of the electrical resistivity survey in determining the position of the wetting front. An instantaneous profile method is used to determine the water retention curve of the medium. The KES method has been tested and validated using data produced from simple and more complex geological models from published case studies. We obtained good reconstruction of the saturated hydraulic conductivity. We have found that the estimated value of Ks in log scale has a mean error <2.5%. Error increases along the boundaries of different hydrofacies.
Biota toxicity to herbicide Paraquat in Brazilian Northeast littoral reservoirs: need for a biomonitoring program for watershed management
Authors: Barbosa José Etham de Lucena , Watanabe Takako , Coler Robert Anthony , Paz Ronilson José da
Published: June 2016

We present the original results of set of toxicity tests of the herbicide Paraquat, used in sugar cane fields, and the cultivation of pineapple and, Eucalyptus, on zooplankton and benthos organisms from reservoirs of the Brazilian Northeast Littoral Zone. We demonstrate that Macrobrachium amazonicum (prawn), Pomacea lineata (snail) and Daphnia similis (cladoceran) are several orders of magnitude more sensitive than test organisms (aquatic insects, amphipods, and cladocerans) classically used in temperate regions. Combining typical herbicide application data together with rainfall and water level seasonality of Gramame Reservoir, we emphasize highly fluctuation patterns of toxicity for the other reservoirs in the region. Therefore, they urge the enforcement of management policies based on the implementation of a watershed-scaled biomonitoring program using the here employed test organisms. Reservoirs of the Brazilian Northeast was deteriorating (eutrophication, pollution; including frequent cyanobacteria blooming, often toxic), and multi-use management, particularly to meet the water drinking demand of rural and urban populations, is now a crucial need. The suggestion of implementing a biomonitoring program based on toxicity tests of particularly sensitive organisms are then more appropriate than a costly large-scale high technology program. The use of locally dominant organisms instead of temperate standards is essential. The demonstrated high sensitivity of Daphnia species to Paraquat may well explain why rotifers often dominate the zooplankton in reservoirs of this region, as herbicides and pesticides are widely as well as intensively used in the Northeast Semi-Arid Regions (e.g. Agreste and Sertão).
Surgical treatment of chest wall tumors (resection and reconstruction) A six years experience
Authors: Nabi Muhammad Shoaib , Bilal Aamir , Khan Fareed Ahmad , A Ijaz , O A Rana , A,Khalil A Randahawa F , H Raza , S Hn Sindhu , U Farooq , F Jawed , K Farooq , A Sheeraz , H H Ansari
Published: June 2016

Background: Chest wall resection and reconstruction remains one of the most challenging areas of Thoracic & Plastic Surgery. The purpose of this study is to report our 6-year experience with chest wall resections and reconstructions. Methods: A retrospective review of 36 patients who had chest wall resections from 1998 to 2003 was performed. Result: Patient demographics included tobacco abuse, hypertension, diabetes mellitus, niswar abuse, coronary artery disease, chronic obstructive pulmonary disease, and HCV +ve. Surgical indications included chest wall tumors, and lung cancer involving the chest wall. The mean number of ribs resected was 4±2 ribs. Thirty four patients underwent chest wall resections. Two patients underwent right upper lobectomy along with chest wall resections. Immediate closure was performed in all 36 patients. Primary repair without the use of reconstructive techniques was possible in 9 patients. Synthetic chest wall reconstruction was performed using Prolene mesh, Marlex mesh, methyl methacrylate sandwich, and polytetrafluoroethylene. Flaps utilized for soft tissue coverage were pedicled flaps (2 patients). Mean postoperative length of stay was 14±12 days. Mean intensive care unit stay was 5+4 days. In-hospital and 30-day survival was 100%. Conclusions: Chest wall resection with reconstruction can be performed as a safe, effective one-stage surgical procedure for a variety of major chest wall defects.
Changing patterns in the management of Colonic Trauma
Authors: Nadeem Nighat , Aslam Muhammad Nadeem , Chaudhary Abdul Majeed
Published: June 2016

Recent prospective studies have recommended primary repair for all colonic trauma. We evaluate the changing patterns given these recommendations and assess our results of primary repair. This prospective study was conducted on 63 patients with colonic trauma received over a year from July 2000 to June 2001. Morbidity was defined as failure of a primary repair, abscess, fistula, wound dehiscence, sepsis, and organ failure. Primary repairs were performed in 28 patients and colostomy was done in 35 patients. Prolonged mean hospital stay and more incidences of postoperative complications occurred in colostomy group. It was therefore, concluded that primary repair of colon should be adapted as a standard procedure. Colostomy should be reserved for patients with a prolonged delay to surgery, severe blood loss, and gross faecal contamination or associated with multiple organ injuries.
Clinical Audit of hysterectomies
Authors: KEMU Annals , Zahid Bushra , Tayyeb Rakhshanda
Published: June 2016

This descriptive study was carried out at Gynae unit II Sir Ganga Ram Hospital, Lahore from lst January 2004 to 3151 December 2004. All patients who underwent hysterectomy due to various gynaecological reasons were evaluated; objective was to determine frequency of different types of hysterectomies, indications and correlation with age and parity. During the study period 78 hysterectomies were performed out of which 77%. Were abdominal. Vaginal route was opted in 23% of cases and all patients were having uterovaginal prolapse of various degrees. Fibroid uterus was the commonest indication of abdominal hysterectomies (55%) followed by dysfunctional uterine bleeding (25%). Majority of cases of fibroid were in low parity group and prolapse was observed in women of high parity. About 70% of hysterectomies were performed in patients above 40 years of age and about 67% were para three and above. Overall there was positive trend of hysterectomies with increasing age and parity. Medical management of many conditions can be a good alternative provided there is earlier consultation from trained professionals about gynaecological problems, ultimately decreasing the rate of hysterectomies.
Delay in presentation of acute ischemic stroke in Lahore General Hospital, Lahore
Authors: Basharat Rafiq A , Mirza Kamran Rashid , Qamar Muhammad Yousuf
Published: June 2016

Objectives: To find out the time interval from onset of the symptoms to admission in the hospital of patients suffering from acute ischemic stroke, in order to assess the feasibility of thrombolytic therapy in Lahore General Hospital. Design: Hospital-based, prospective and observational study Setting: Lahore General Hospital Lahore. Duration: Six months from January - June 2004. Patients: Seventy two patients with acute ischemic stroke diagnosed on basis of clinical findings and CT scan. Methods: Patients o f a cute ischemic stroke including cerebral infarct, T IA, venous infarct and lacunar infarct were diagnosed on basis of clinical history, examination and CT scan and enrolled in the study. Data was collected on a Performa. Time taken by patients to reach hospital after onset of symptoms, distance of patients` residences from hospital, education level of patients and time required to do a CT scan after arrival of patient in hospital were studied. Results: 54.2% were male and mean age of patients was 60 years. 58 patients had cerebral infarction, TIA`s and venous infarction were 8 and 6 respectively. Delay in presentation was divided in three groups. Within three hours (hrs) 15 (21%) patients arrived. 54 and 18 patients arrived in 3-- 24 hrs group and >24 firs group. Mean distance was roughly 44 km. Mean distance for 0-3hrs, 3-24hrs and >24hrs group was 14, 35, and 85 Km respectively. Average time required to do CT scan was nine hours after arrival of patient in emergency department. Sixty-five percent of patients coming were illiterate. Conclusion: Majority of the patients with ischemic stroke present late to. emergency department. Many factors including distance from hospital, illiteracy, non-availability of ambulance services responsible for it. Evaluation-of patients and provision of urgent CT scan is required. in hospitals.
Causes of postmenopausal bleeding in our population
Authors: Hassan Sibte , Yaqub Uzma , Yusuf Ahmad Wasim
Published: June 2016

Objective: To evaluate common causes of postmenopausal bleeding in our population. Study design: Observational Analytical study. Settings: Department of Obstetrics & Gynaecology unit II Lady Willingdon Hospital Lahore from June 2000 to May 2002. Materials & methods: Hysteroscopically directed endometrial biopsies were taken from 100 cases of postmenopausal bleeding and were sent for histopathology. The data was collected with the help of Performa which was filled for every patient. Results: In our part of world, Atrophic Endometrium is the commonest cause of Postmenopausal Bleeding (PMB). Next common being Endometrial Hyperplasias. Out of malignant causes, Carcinoma Cervix is the commonest. Conclusion: Postmenopausal bleeding (PMB) should be taken seriously; no matter how less the bleeding is and malignant causes should be ruled out.
Obstetric outcome of cases referred to a Tertiary Care Hospital after trial of labor
Authors: Zahid Bushra , Khawaja Nuzhat , Tayyb Rakshanda
Published: June 2016

Childbirth is a natural process but with its` inherent risk of complications. Skilled birth attendant can provide timely emergency obstetrics services. Objective of this study was to analyze fetomaternal outcome of cases referred to our hospital after trial of labour and to identify factors, which could prevent adverse obstetric outcome. This study was conducted at Obstetrics & Gynae Unit II Sir Ganga Ram hospital, Lahore. One hundred patients who were admitted through emergency after trial of labour by TBA, LHV or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of hundred patients in study group 49 were Primigravida while 10 were grandmulti. About 90% of patients never had any antenatal checkup. Maximum patients (94%) were under care of TBA & LHV. 54 patients had already prolong labour out of which 38 cases were of obstructed labour. Five patients had ruptured uterus. 49 patients were delivered by caesarean section while 29 had forceps delivery. Laparotomy was carried out in four patients due to ruptured uterus out of which two had hysterectomy. There was one maternal death due to ruptured uterus. Post partum hemorrhage occurred in ten patients, while 12 had puerperal pyrexia. Regarding perinatal outcome there were 23 stillbirths, while 45 had Apgar score below 5 at five minutes. Ten babies died in first 12 hours. This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution.
Secondary hyperparathyroidism in association with malnutrition - inflammation complex syndrome in chronic hemodialysis
Authors: Nasri Hamid , Baradaran Azar
Published: June 2016

To found the association of high PTH levels with some indexes of malnutrition-inflammation complex syndrome (MICS), a study was carried out a group of maintenance hemodialysis patients(MHPs) consisting of nondiabetic and diabetic patients. Intact serum PTH (iPTH) and serum C-reactive protein(CRP), serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), serum cholesterol (chol)and serum triglyceride (Tg) were measured .Body mass index (BMI) was also calculated . Total patients were 36(f=15 m=21), consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. The mean patient`s age was 44(17) years. The value of serum iPTH of total HD patients was 434455 (median:309)pg/nd, the value of serum iPTH of diabetic and nondiabetic-dialysis patients were 201277(median:41) and 537483(median:340)pg/ml respectively. In this study we found a near significant positive correlation of serum iPTH with serum CRP, a significant inverse correlation of serum iPTH with BMI and a near significant positive correlation of serum ALP with Logarithm of CRP, a significant positive correlation of serum phosphorus with serum CRP and also a significant inverse correlation of serum phosphorus with BMI were found. A near significant inverse correlation of serum cholestrol with serum phosphorus as well as a near significant inverse correlation of serum cholestrol with serum CRP were existed too. When patients with iPTH below than 200 pg/ml were deleted, the correlation of iPTH with CRP was positive (r =0.42, p =0.085) and when patients with iPTH more than 500pg/ml were deleted, this correlation was found to be negative(r = -0.42, p =0.047), means that a low iPTH values is an index of malnutrition while higher values is associated with inflammation, Further attention needs to better control of hyperphosphatemia and maintaining the iPTH levels 1.5 times of normal to avoid the sides effects of secondary hyperparathyroidism.
Magnitude of vitamin A deficiency in poor communities of the four selected districts of Punjab using - (rapid assessment technique)
Authors: Shah Raza Ali , Qureshi Muhammad Babar , Khan Asad Alam
Published: June 2016

To determine the prevalence and associated factors responsible for vitamin A deficiency (VAD), a survey was carried out in the 21 selected villages of the 4 selected districts of Punjab, using a rapid assessment technique in July-August 1998. A total of 1526 pre-school going children from 6 months to 6 years were examined for Night Blindness (XN), Bitot`s Spots (X1B) and Corneal Scars (XS). Prevalence of VAD came as 6.4% (97 cases), out of which 0.8% (12 cases) were of XN, 5.4% (82 cases) were of X1B and 0.2% (3 cases) were of XS. Male to female ratio was 3:1. Sixty four percent of VAD occurred between ages 4 to 6 years having weights between 15 to 17 kg, which was below the recommended weights. The reason for malnourishment was that majority of VAD cases had diarrhea. Other factors responsible for high prevalence were poor socioeconomic conditions, increased number of children per household, lack of mother`s education, low monthly family income, lack of proper breast-feeding, and inadequate usage of vitamin A rich items, like milk and milk products, liver, fish, eggs and mangoes. The reason for not consuming vitamin A rich food was cost of items. The biggest barrier responsible for VAD was poverty. Thus, vitamin A deficiency is a significant major public health problem in the poor communities of Punjab.
Trans-symphyseal urethroplasty in children
Authors: Mansur Haroon , Ahmed Sarfraz , Tallat Nabeela , Qureshi Muhammad Ashraf Iqbal
Published: June 2016

Post traumatic posterior urethral strictures were managed by trans-symphyseal urethroplasty in 11 male patients of pediatric age group. The aim of the study was to evaluate the results of the technique in patients who underwent multiple unsuccessful procedures in the past. Two(18.2%) patients were 3-5 years old, 3 (27.3%) were between 6 and 8 years, 1 (9.1 %)was 10 years old whereas 5(45.5%) were 12-14 years of age. The length of the strictures varied from 1-3cm. Repair was performed after excising the stricture and anastomosing the spatulated urethral ends with interrupted sutures of 5/0 vicryl over a Foley`s catheter. Post operative follow up showed incontinence in 1(9.1%) case and prolonged urinary tract infection in 4(36.4%) cases. Postoperative stricture was not noted in only one of them at I year follow up. The authors recommend that trans-symphyseal urethroplasty is a satisfactory procedure for the treatment of posterior urethral strictures in children as it provides excellent approach and visualization with minimal post operative complications.
Spinal arteriovenous malformations: surgical outcome
Authors: Mahmood Khalid , Sarwar Afaq , Vohra Anjum Habib
Published: June 2016

Spinal arteriovenous malformations are relatively rare, being one tenth as common as cerebral AVMs and one tenth as common as primary spinal neoplasms. The aim of this retrospective study was to see distribution of this disease in spinal cord and analyse outcome of surgical treatment in our set-up. 5 patients with neurologic deficit due to spinal AVMs were operated upon from March 2000 to Feb 2005. Age ranged from 25-45 years with mean of 35 years. There were 2 females and 3 males with sex ratio of 1:1.5 respectively. Spinal AVMs were categorized as one of 4 types based on pattern of arterial and venous supply. We found that 60% (3 cases) in our series were intradural AVMs while 40% (2 cases) were dural type. We conclude that glomus variety of intradural AVMs was the commonest. The commonest presentation was acute spinal dysfunction and paraparesis. Selective spinal angiography can be negative in spinal AVMs, (20%) in our series, in which CT angiography provided clue to the feeding vessels.
Ilioinguinal neurectomy in open inguinal hernia mesh repair
Authors: Naseem Mirza Muhammad Khalid , Hameed Fakhar , Sheikh Muhammad Sajid , Bashir Mustehsan
Published: June 2016

Objectives: To evaluate the long-term impact of ilioinguinal neurectomy on the incidence of postoperative neuralgia and paraesthesia following the tension free Lichtenstein`s hernia repair. Study design: Case Descriptive Study. Place and duration of study: DHQ Hospital, Faisalabad (January 2003 - January 2005). Patients and methods: A total of 200 patients having unilateral inguinal hernia were included in the study. After a detailed history, patients were subjected to standard Lichtenstein inguinal hernioplasty. All patients underwent elective ilioinguinal neurectomy at the time of hernioplasty. Postoperative pain and paraesthesia were recorded and categorized on a mild, moderate or severe scale. Patients were followed 1 month, 6month and 1 year postoperatively. Results: The incidence of chronic pain was 9% at 1 month & 6% at 6 months and 1 year postoperatively. None of the patients developed severe persistent pain in inguinal region. The incidence of post operative paraesthesia showed a continuous decli ne. It was 32% at 1 month, 24% at 6 month and 19% at 1 year of follow up. The paraesthesia was never severe or bothersome at the end of the follow up period. Conclusion:Routine ilioinguinal neurectomy significantly reduces the chronic post-hernioplasty inguinal pain. Moreover it is safe to perform & well tolerated by the patients.
Is there any relationship of age & sex to the etiology and outcome of medical coma?
Authors: Nadeem Muhammad Arif , Irfan Khadija , Waheed Kh A Irfan , Waseein Tariq
Published: June 2016

As the diseases behave differently in males and females and even in different age groups, particular attention was made to classify and observe the distribution of various causes of coma according to age and sex of the patient in order to formulate our indigenous database for future reference. We studied the coma etiology with particular reference to the age and sex of the patient, and the outcome. All the 517 (312 male {60.35%} and 205 female {39.65%}) patients were divided into 7 groups according to decades from age 12 to 80 years. Patients older than 40 years predominated (318 {61.5%}). Metabolic coma was predominant cause in almost all age groups. Structural coma was increasing progressively with the age. Poisonings were the common cause in patients under 30, representing 35.85% of all comas in the age group 12-20, and 33.70% in the group from 21-30 years. In the next two decades (31-50 years), hepatic and renal failure predominated making up more than half of all causes. Leading causes among males we re poisonings (69 cases), hemorrhagic CVA (48 cases), ischemic CVA (24 cases), renal failure (28 cases) and hepatic coma (35 cases). Similarly among females causal distribution revealed renal failure (34 cases), followed by hepatic coma (29 cases), and hemorrhagic CVA (26 cases). Out of the 476 (92%) patients whose outcome could be determined 297 (57.4%) were discharged after recovery and 179 (34.6%) died. Eighty out of 205 female patients died (39%), while 99 out of 312 males had a fatal outcome (31.7%). We conclude that coma etiology has a significant effect on prognosis, while such significance could not be assigned to age or sex.
Delayed presentation and its effects on the prognosis of acute appendicitis
Authors: Waqar, Tariq , Riaz Irfan
Published: June 2016

Objective: To identify the causes of delay in the presentation of the cases of acute appendicitis and its effects on the prognosis. Study design: It was descriptive type of study. Place & duration of study: The study was conducted in Department of Surgery, Nishtar Hospital Multan in one year from February 2004 to January 2005. Patients & methods: The 50 patients of all ages and both sexes were taken from surgical wards of the hospital. They were presented with signs & symptoms of disease for more than 48 hours, but otherwise healthy i.e. not having any other serious illness. The patients were diagnosed as cases of acute appendicitis after history, examination, investigations and operation. Results: There were 4(8%) patients who did not take any treatment. Patients who took the treatment but wrongly diagnosed were 36(72%). Out of these 36 patients, 12(24%) patients were treated by the quacks, in 7(14%) the diagnosis was gastroenteritis, 11(22%) patients took antibiotics and analgesics from the start of the symptoms and in the remaining 6(12%) the presentation of the patients was not typical. 10 patients (20%) were diagnosed as acute appendicitis but they refused for appendicectomy. Out of these 50 cases 24(48%) were complicated. Overall perforation rate was 30%. Patient presenting with gangrenous appendicitis were about 6%. Appendicular mass formation was found in 4% cases. Patients presenting with generalized peritonitis were 6%. Appendicular abscess formation was in 2% cases. The duration of hospitalization was 3 days in uncomplicated cases, while in complicated cases it was 6.5 days. Conclusion: The high rate of complications of appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is the result of patient`s delay in seeking medical attention.
Diaphragmatic injuries, a retrospective analysis of 50 patients
Authors: Bilal Amer , M Salim , Nishtar Tahira , Nabi Shoaib , M Muslim , Ahmed Manzoor , Ali, Gohar , Cheema Shehzad
Published: June 2016

Objective:: This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment of diaphragmatic injuries in our trauma patients. Design:: An observational descriptive study. Place and duration of study:: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 2001 to April 2005. Subjects and methods: In this retrospective study, 50 patients admitted to our department with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment, modality, morbidity and mortality. Results: The average age of patients was 32 years. There were 35 (70%) male and 15 (30%0 female patients, 38 (76%) of these patients sustained blunt and 12 (24%) had penetrating chest injury. The diaphragmatic injury was right sided in 4 and left sided in 46 patients. Thirty nine (78%) patients presented in respiratory distress within 48 hours of in jury while 11 (22%) presented with bowel obstructive symptoms months and years after injury. A chest x-ray on admission suggested the diagnosis in 70% of the cases while chest ultrasonography and contrast studies were required in others. Surgery was emergent in 35 (70%), semi-emergent in 9 (18%) and effective in 6 (12%) cases. Surgical approaches were left thoracotomy (40 patients), left thoracolaprotomy (6 patients) and right thoracotomy (4 patients). The diaphragmatic repair was achieved by direct suture in 45 cases while prolene Mesh was required in 5 cases. The mortality rate was 6% (n = 3). Recurrence occurred in one (2%), wound infection in 3 (6%), pleural, space, problem in 1 and chest infection in 2 (4%) patients. Conclusion: A high index of suspicion and early surgical treatment determine the successful management of traumatic diaphragmatic injury with or without the herniation of abdominal organs. The surgical approach is individualized. We prefer the thoracic approach adding laporotomy when necess ary.
Management of pediatric Temporomandibular joint ankylosis: use of costochondral rib graft with interpositional temporalis myofacial flap
Authors: Akhtar Muhammad Usman , Shah Adnan Ali , Abbas Iram
Published: June 2016

Background: The posttraumatic ankylosis of the temporomandibular joint (TMJ) is frequently seen in children in Pakistan. The factors which favour in the development of this condition are; the children exhibit much more liability to emergency management, greater difficulty in clinical and radiological examination, state of mixed dentition, faster rate of healing, non-availability of specialists and low socioeconomic status of the patient. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. Method: All patients were presented at Punjab Dental and Children Complex Hospitals Lahore. Twenty-three children (age 1 to 15years) with 28 joints underwent costochondral arthroplasty with interpositional temporalis myofacial flap, out of which 6 were of re-ankylosis after surgery at other centres. The costochondral graft was fixed by tripod screws with remaining ramus condylar unit. The surgery was planned after caref ul examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. Results: The surgical protocol is used to achieve the desirable interincisal jaw opening (>30mm) that was also the postoperative criteria for successful surgery. Five patients with bilateral ankylosis were operated and one patient with additional ipsilateral coronoidectomy. Less than 30mm interincisal opening was considered as unsatisfactory jaw opening. The overall success rate was 96% with only one patient was observed with less than 30mm opening. The lateral and protrusive jaw movements were assessed as excellent, good and poor. The immediate postoperative complications were transient. Conclusion: The ankylosis develops mainly after damage to mandibular condyles or TMJ at a growing age. Results with the procedure were encouraging without noticeable complications during an average follow up of one year.
Laparoscopy versus laparotomy in the treatment of benign ovarian cyst
Authors: Akram Humaira , Lodhi Sohail Khurshid , Rana Tabinda
Published: June 2016

Objective: To compare laparoscopy with laparotomy in the treatment of benign ovarian cyst in women under 40 years of age. Design: Experimental. Place and duration of study: The study was conducted over a period of one and half year from June 2003 to Nov 2004 in Obstetrics & Gynaecology Department, Unit-III, Lady Willingdon Hospital, Lahore. Subjects & Methods: The sixty consecutive patients of benign ovarian cysts who required surgical treatment underwent either Laparoscopy(group I). or laparotomy (group II). The laparoscopic fenestration, aspiration and cystectomies were performed in group I (30 patients). However, ovarian cystectomies, salpingo-oophorectomy and oophorectomy were performed by laparotomy in group II (30 patients). Results: The comparison was done with respect to duration of surgery intra-operative blood loss, time of mobilization, duration of hospital stay and amount of analgesia used, time to return to normal activity. The amount of analgesics used, time of mobilization, duration of hosp ital stay and time to return to normal activity was less (P<0.05) in Laparoscopy as compared to Laparotomy. There was statistically no significant difference in the duration of surgery, blood loss and post operative morbidity (P>0.05). Conclusion: With appropriate preoperative evaluation, laparoscopic surgery is safe and effective in treating benign ovarian cyst in women under 40 years of age where the risk of malignancy is low. It is associated with early mobilization, less use of analgesia, shorter hospital stay.
Free radial artery as an alternate conduit in CABG
Authors: Waheed Abdul , Shabaz Ahmed , Khan Junaid Fayyaz , Tufail Zafar
Published: June 2016

Objective: This study was under taken to explore the potential of the Free Radial Graft as a safe efficient and suitable alternative conduit in coronary artery bypass grafting incase of in availability of the more established conduits like the IMA and Great Saphenous Vein graft especially in redo surgery. Method: This prospective randomized single center trial was conducted on three groups of patients under going CABG. The study was conducted from 1st January 1999 to December 2002.The first group A (n=15 with mean age of 47.05±8.35years) Radial artery was used for grafting in Right and Left sided grafts except the LAD. In the second group B (n=15 with a mean age of 54.80±11.14 years) Great Saphenous Vein was used for grafting in Right and Left sided grafts except the LAD. In the third group C (n=20 with a mean age of 55.93± 11.14 years) IMA was only grafted to LAD. Proximal ends of both the GSV and the Radial Artery were anastomosed to the Aorta. All patients were male . Follow up was done in these patien ts both by non invasive and invasive methods such as ETT , Thallium scan , Angiography. Comparison was mainly done between the Radial artery and the Great Saphenous Vein taking as granted that the IMA g the best graft for the LAD in all cases. Results: IMA was always applied to LAD in all patients in the three groups. In group (A) Radial Artery was grafted to RCA in 5 (33.3%) pts. Diagonal in 4 (26.7%)pts. Obtuse Marginal 12(80%) pts. And PDA 3 (20%) pts. In group (B) Great Saphenous Vein was grafted to RCA in 6(40%)pts. Circumflex 1(6.7%)pts. Diagonals 2 (13.3%) pts. Obtuse marginals 6 (40%) pts. And on PDA 4(20%) pts. All patients were regularly followed up for 18 months to 24 months. Post operative angina was reported in 2 (13.3%)pts. in group A and 5(33.3%) pts. In group B (p=0549). ETT was done in all these pts. Was positive in 1(6.7%) in group A and 2 (13.3%) in group B (p=0.309). Thallium scan was done in all the study population and was found positive in 4 (26.7%) in group A and 5 (33.3%) in group B Patients(p=0.265). Coronary angiograms were done on 10 patients out of each group. In group A the grafts were patent in 9 patients (90%). In the group B the grafts were found patent in 8 (86%) patients.(p=0.543). Moderate Graft stenosis was found in 01 patient in group B and none in group A (p=0.35). Totally blocked grafts were found in 01 patients in each group (p=1.00).
Type 2 diabetes in children: etiology, epidemiology, management and prevention
Authors: Dahiyat Khaledal
Published: June 2016

Background:Type 2 diabetes in children is a new epidemic which should be alarmed to its seriousness, so as to be taken care of by the medical care providers. Aim: Review of type 2 diabetes in children regarding the etiology, epidemiology, management and prevention. Methods: Thorough search was done through the electronic data-bases : Medline, Embase, Cinahl. Handsearch of diabetes related journal. Conclusion: Prevention of obesity and instituting physical activity protocols at school and home since early age is the cornerstone in facing this disease, children at risk should be recognised and followed up for long period of time
Comparison of lipid profile in thrombotic and hemorrhagic stroke patients
Authors: Sulehria Sohail Bashir , Asrar Anser , Qureshi. Irshad Hussain
Published: June 2016

Objective: To compare lipid profile in thrombotic and haemorrhagic stroke patients. Place of Study: All general medical and neurology wards of Mayo Hospital Lahore. Patients and Methods: Study was conducted in 40 consecutive patients of stroke admitted in hospital. Serum lipid (total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio) were estimated in all selected patients within 7 days of onset of stroke and findings were entered on study proforma specifically designed for this purpose and analyzed statistically by student`s "t" test. Results: Out of 40 patients included in the study, 22(55%) were suffering from thrombotic stroke while 18(45%) suffered from haemorragic stroke. The difference in the values of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio was not statistically significant between the two groups of patients. Conclusion: It is concluded that serum lipids i.e., total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio does not have any differential effect in the causation of thrombotic or haemorrhagic strokes.
Complications associated with splenectomy in thalassemia
Authors: Zahra Farogh , Ashraf Muhammad , Aslam Muhammad , Deen Qaim , Mannan Javeria
Published: June 2016

Aims and Objectives: The study aims at investigating the complications associated with splenectomy in thalassemic patients Study Design: It was a prospective clinical study. Materials and Method: Sixty Splenectomies were preformed electively after pre-operative preparation in Sir Ganga Ram Hospital, Lahore during the year Jan 2003 to Sep 2005. Results: Complications were categorized into per-operative, early post-operative and late complications. The frequency of per-operative complications was 3%, early post-operative complications were 10% and late complications were 1.6%. Interpretation and Conclusion: The rate of complications has decreased markedly as the patients are well prepared and improved post operative carp has also reduced the post-operative complications. With good perioperative management, splenectomy in children with massive splenomegaly is both safe and effective.
Intrauterine growth restriction: antenatal diagnosis and fetal outcome
Authors: Amin Lubna , Asif Shaheena
Published: June 2016

The following study was conducted in the Department of Obstetrics and Gynecology Jinnah hospital Lahore to identify women with risk factors for IUGR (Intrauterine growth restriction: Antenatal diagnosis and foetal outcome.)on clinical assessment and ultrasound and to co -relate antenatal diagnosis with fetal outcome. Fifty (50) patients were picked on basis of risk factor. Fourteen (28%) had SFH less than expected for gestation. Eleven (22%) had hypertension, Nine (18%) had previous history of SGA babies. Other risk factors were diabetes mellitus, pre-pregnancy weight less than 50 kg and smoking. On ultrasound 18 (39.63%) of patients were diagnosed as IUGR while 28 (60.48%) were diagnosed as non IUGR. Among IUGR babies 66.24% had asymmetrical while 33.76% had symmetrical IUGR. 39.53% babies were suspected of IUGR on SFH, and 28% of IUGR babies were suspected on ultrasound, as outcome measure 25% of babies had birth weight less than 10th percentile after delivery. It was concluded that for antenatal diagn osis of IUGR sonographic assessment is more precise than clinical assessment.
Functional outcome of ischemic stroke in diabetics
Authors: Fayyaz Mohammad , Ali Qazi Masroor , Chaudhary Ghulam Mohyuddin , Hameed Abdul , Bukhari Aftab Jamil Mh
Published: June 2016

Objective: Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Study Design: Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. Patients and methods: 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct (lacunar/cerebral). Results: Out of 132 ischemic stroke patients 36 (27%) were diabetics and 96 were nondiabetics. Hjipertension was present in 83 (62%). Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics (16.6% Vs 9.3% p<0.05). Disability was also more frequent in diabetics (25% Vs 13.5% p<0.05). In diabetic group good recovery (8.8% Vs 12.5%) as well as partial recovery (50% Vs 64.5%) was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths (15.3% Vs 7% p<0.05) and disability (15.3% Vs 10.7% p<0.05) than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality (20.8% Vs 11.8% p<0.05) as well as disability (33.3% Vs 15.2% p<0.05). Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality (17.6% Vs 9.8% p<0.05) as well as disability (26.4% Vs 14.2% p<0.05). Conclusion: Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome.
Assessing the impacts of water on industry–the case of Asia Pacific Breweries (APB)
Authors: Leusder Christian
Published: June 2016

Industrial water use accounts for 22% of global water consumption and for as much as 60% in high-income countries. Thus, it is a considerable factor when dealing with global water issues. This paper assesses the impacts of water on the brewing industry using the case example Asia Pacific Breweries (APB). By deriving a true cost of water (TCW) via a three-step approach involving (1) desalination, (2) secondary treatment and (3) reclamation, it reflects all water-related risks from physical availability to reputational, environmental, and legal risks in the context of a value-based management framework that embeds sustainability in the company's operational conduct. An excel-based sensitivity model takes into consideration all relevant drivers allowing for a detailed cost breakdown for each of the three steps. The resulting transparency of what drives the TCW yielded that the main components are energy, carbon, and capital costs. As derivatives on all three components exist, they were used to feign a hypothetical water option by replicating its pay-off as a weighted average of energy and carbon derivatives. At APB water accounted for merely 0.4% of total operating costs, but drove 335 times its cost in revenues. The resulting biomass from secondary treatment was also considered for energy recovery through anaerobic digestion and thermal hydrolysis. As a result, secondary treatment energy costs were subsequently reduced by 56%. As a result, the application of discriminatory pricing for industrial end-users of water was, therefore, concluded a viable option. Still, the demand-price elasticity of the company's products needs to be considered when applying said option to avoid the passing on of costs to consumers. A practical approach is considered involving a revenues per m3 of water over the TCW metric to determine the extent of discriminatory pricing and temporary tax breaks to avoid the passing on of costs to consumers.
An analysis of ground water quality in a water stressed urban centre: a case of Gweru city, Zimbabwe
Authors: Mukanga C. , Chitata T. , Mudereri B. T.
Published: June 2016

Ground water quality conformance to the World Health Organisation standards for drinking water was carried out and inferred to the health risks associated with use of such quality of water. Water samples were collected thrice a month, from nine boreholes, over a period of twelve months and analysed for physical, chemical and biological parameters. Chemical parameters were tested using UV-Vis photometry. Physical parameters were measured using HI9829 waterproof portable logging multi-parameter meter and biological parameters were determined using the Minimal Media ONRG-MUG test and the Membrane Filtration Method (MF). Results shows that total hardness and Fe concentration were above limit in 78% and 56% of the sampled boreholes, respectively. pH, EC, Ca, Cl, Fl, Mn, Mg and Turbidity were within the acceptable WHO limits. Of the sampled boreholes, 67% were not conforming to the Escherichia coli loads recommended for drinking water. Parametric correlations showed strong and significant correlations between chlorides and fluorides (r = 0.68; p < 0.05), Nitrates and Sulphates (r = 0.78; p < 0.05). There is need to treat borehole water to eliminate E. coli and reduce nitrates and total hardness. Furthermore, analysis and monitoring systems to determine temporal variability and health risks, respectively, needs to be put in place.
Cost benefit assessment of a novel thermal stripping – acid absorption process for ammonia recovery from anaerobically digested dairy manure
Authors: Anwar Sohaib Waseem , Tao Wendong
Published: June 2016

Thermal stripping – acid absorption is a novel technology recently developed to recover ammonia as marketable ammonium sulfate granules from anaerobic digester effluent. Taking a large-size dairy farm in New York State, USA, as an example, this study evaluates the costs and benefits of ammonia recovery from a recirculation line of mesophilic anaerobic digesters. Option 1 is the baseline without ammonia recovery. Option 2 is to draw digester effluent at 28% of the liquid manure loading rate, heat to 101 °C for ammonia recovery, and return the ammonia-recovered dairy manure to the digesters. Under option 2, the returned hot manure eliminates the need to heat the digesters. Option 3 is similar to Option 2, but the recirculation rate is only 14% of the manure loading rate. In this case, additional heating is needed for the digesters. Engineering unit cost and revenue models are developed for the thermal stripping – acid absorption process. Options 2 and 3 have benefit/cost ratios of 1.90 and 1.86, respectively. Option 2 produces greater net present value (NPV) ($1.34 million) than Option 2 ($0.72 million), while Option 1 yields a negative NPV (−$0.23 million). Ammonia recovery on this farm can create 1.5–3 jobs. Labor costs account for 62–70% of the total operating costs. Option 2 can generate a benefit of $0.018/L manure digestate or $0.50/d/cow. Any uncertainties relating to NPV and benefit/cost ratio are mainly associated with the sale price of ammonium sulfate and hourly wage rate.
Sustainable stormwater management in Yinchuan New Town
Authors: Ramírez José Ignacio , Qi Kong , Xiaobo Liu
Published: June 2016

In Yinchuan, China, a new urban area is planned for 160,000 inhabitants, in the vicinity of the Yellow River and close to a valuable natural landscape. To achieve sustainable development, an approach integrating urban planning, transport, energy, solid waste and water resources management is necessary. In order to achieve this, the SimbioCity approach was applied, where resource use and pollutant loads are reduced by creating cycles in which materials and water are recycled to the largest possible extent. In this context, the stormwater system is an important component. The objectives for the planned stormwater system in Yinchuan New City were to reduce flood risk and introduce stormwater purification, to maintain or improve water quality in the existing water bodies. A Sustainable Urban Drainage System approach was proposed and applied, during configuration and design of the new town's infrastructure. This proved both successful and cost effective.
Application of SAC254 measurement for the assessment of micropollutant removal in the adsorptive treatment stage of a municipal wastewater treatment plant
Authors: Rößler Annette , Metzger Steffen
Published: June 2016

In 2010, the Mannheim wastewater treatment plant was expanded with an adsorptive treatment stage to remove organic micropollutants (OMPs). Differences in the removal efficiencies of the OMPs investigated were determined over four years of operation by applying different powdered activated carbon (PAC) products and a constant volume-proportional dosing of 10 mg PAC/L. Possible influences on the removal efficiency are discussed here on the basis of the data obtained, exemplified for the analgesic diclofenac. The analyses show that the removal efficiency is influenced significantly by the spectral absorption coefficient (SAC) of the biologically treated wastewater at a wavelength of 254 nm (SAC254). Therefore, in order to ensure the constant treatment performance desired, the dosage of PAC should be adjusted to the measured SAC254 values. Moreover, as the SAC254 reduction correlates with the removal efficiency of OMPs, the additional determination of its reduction allows indirect control of the actual removal performance achieved. The SAC254 reduction can also be used for targeted control of the PAC dosage.
Phenols, flame retardants and phthalates in water and wastewater – a global problem
Authors: Ayanda Olushola Sunday , Olutona Godwin Oladele , Olumayede Emmanuel G. , Akintayo Cecilia O. , Ximba Bhekumusa J.
Published: June 2016

Organic pollutants in water and wastewater have been causing serious environmental problems. The arbitrary discharge of wastewater by industries, and handling, use, and disposal constitute a means by which phenols, flame retardants (FRs), phthalates (PAEs) and other toxic organic pollutants enter the ecosystem. Moreover, these organic pollutants are not completely removed during treatment processes and might be degraded into highly toxic derivatives, which has led to their occurrence in the environment. Phenols, FRs and PAEs are thus highly toxic, carcinogenic and mutagenic, and are capable of disrupting the endocrine system. Therefore, investigation to understand the sources, pathways, behavior, toxicity and exposure to phenols, FRs and PAEs in the environment is necessary. Formation of different by-products makes it difficult to compare the efficacy of the treatment processes, most especially when other organic matters are present. Hence, high levels of phenols, FRs and PAEs removal could be attained with in-line combined treatment processes.