bluuebunny/crossref_metadata_2025 huggingface dataset:
OTOMYCOSIS
Authors: MALIK MUHAMMAD FAHIM , ZIA RASHID , AKRAM SAJJAD
Published: September 2021

b j e c t i v e s : To determine the efficacy of tincture mertheolate in otomycosis. Design: An experimental study. Setting:Department of ENT Allama Iqbal Medical College/ Jinnah Hospital, Lahore. Period: From Dec. 2007 to April 2008. Patients & M e t h o d s A totalof 60 patients of symptomatic otomycosis were investigated prospectively. Aural swabs were collected on first, 7th and 14th day and examined,by direct microscopy of external auditory canal and culture for fungi. Of these 60 patients found to be having pure fungal infection were takenup for mycological and therapeutic study. Results Fungi belonging to Aspergillus were isolated in 57(95%) patients of which Aspergillus nigerwas the commonest isolated in 34(56.6%) patients followed by Aspergillus flavus in 21(35%) and Aspergillus fumigates in 2(3.33). Candidaspecies in 2(3.3%) and Mucor in 1 (1.6%) of patients. The patients were of all age groups but majority were between 21 and 30 years and themale to female ratio was equal. No patient had fungal infection elsewhere in the body. The patients were called for regular follow-up for threeweeks. In 30 cases tincture mertheolate was applied as topical antifungal agent after cleaning the external auditory canal, in 17 patient'sclotrimazole and in rest of the 13 patients miconazole was used. On 7th day, only 8 (13.3%) patients grew fungi in culture. They becamesymptom free on 14th day and no fungal material could be seen on otoscopy, direct microscopy or culture. Tincture mertheolate was found tobe most effective in these patients.
OSTEOPOROSIS
Authors: HAQ IRSHAD UL , MASOOD ZAHID
Published: September 2021

Objectives: To Study the prevalence of osteoporosis among post menopausal women in the Faisalabad city and comparethat with other developed and developing countries. S t u d y Design: A Cross Sectional Study. Place and Duration of Study: Medina TeachingHospital Faisalabad and Al Bari Hospital Faisalabad from February 2008 to April 2008. Patients and Methods: A total of 300 post menopausalwomen were included after valid consent and observing inclusion and exclusion criteria. Quantitative Ultrasound Device (QUO) that is BMDwas assessed from the heel of each participant. T-Scores were obtained and WHO classification was followed. A scale was used to assessthe Body Mass Index measuring height and weight. Data collection sheet having structured questions was used for checklist for obtainingpertinent information. Results: Out of 300 post menopausal women overall prevalence of Osteoporosis (OP) was 20%. Further, 44% wereOsteopenic. Results were comparable with other countries as well. Conclusion: Osteoporosis (OP) is not uncommon in our country. It shouldbe considered as a Public Health Problem. Early screening and prompt treatment can prevent the heavy cost on fracture managements. InPakistan, even in Asia Key data is not available to convince Policy makers that OP is a serious burden on population and to invest in preventionis the better option. Health Education is imperative for target population.
RISK FACTORS FOR HEPATITIS C VIRUS
Authors: KHAWAJA NUZHAT PARVEEN , LATIF FARZANA , HUSSAIN UZMA , Rehman Rakhshanda
Published: September 2021

Objective: To find out risk factors for hepatitis C infection in obstetric patients in a teaching hospital. Study Design -Observational study. Place and Duration At Sir Ganga Ram Hospital, Lahore during a period of one year. Subjects and Methods -Casesof hepatitis C infection, diagnosed on the basis of screening for antibodies for Hepatitis C were included in the study. A proforma was designedand details of each case including maternal demographics and associated risk factors were entered. Result Fifty three obstetric patients werepositive for Hepatitis C virus antibodies in one year of study period. Majority of women were among 25-29 years of age, belong to lowsocioeconomic status, illiterate and among parity range of 2-5. Previous history of surgical procedures was in 66% of subjects while 62% hadhistory of injections. Ear piercing in unsterilized conditions by non skilled person was also present in significant number (43%) while 17% hadhistory of blood transfusions. Conclusion: Hepatitis C infection is linked to surgical procedures, injections and ear piercing in this study.However, to identify all associated maternal risk factors, larger studies at multiple centres will be required and strategies should be made toprevent its' transmission.
DERMOID CYST OF OVAR
Authors: RASHID FARHAT , AMJAD NAZIA
Published: September 2021

The patient was a 23 years unbooked primigravida who presented through emergency with the history of gestationalamenorrhea of 12 weeks and acute pain in the left iliac fossa for the last 3 hours. Urgent ultrasound revealed viable pregnancy of 12 weeksalong with a large left ovarian cyst of heterogenous echogenicity. A diagnosis of torsion of right ovarian cyst was made and immediatelaparotomy was done after counseling of the family and preparing the patient. Per-operatively, it was found that left ovarian cyst had undergonetorsion. Histopathology confirmed the diagnosis of dermoid cyst.
BRAIN DEATH CRITERIA
Authors: HUSSAIN IFTIKHAR
Published: September 2021

Snake bite is an important cause of mortality and morbidity. It is estimated that each year snake bite is responsible for 30,000 to 40,000 deaths world wide1. Most snake bites are innocuous and are delivered by non poisonous species. There are 15% of the more than 3000 species of snakes, which are considered dangerous to humans2. The family Viperidae (Pit vipers) is the largest family of venomous snakes
DIABETES FOOT
Authors: RATHORE ALTAF HUSSAIN
Published: September 2021

Diabetes mellitus (D.M) is emerging as world’s biggest Health problem and is increasing at an alarming rate. It May be due to longevity of age, obesity, change of life style and unhealthy diet. It is estimated that 177 million people of the world or 5% of the world adult population is suffering from DM and 1 in 10 death in the people between 35 to 64 years of age is due to DM1. Pakistan is at 8"‘ number in the world in prevalence of DM2.
INGUINAL HERNIOPLASTY
Authors: AMER MUHAMMAD SUHAIL , ASHRAF MUHAMMAD
Published: September 2021

Introduction: Chronic pain following inguinal hernia repair is becoming a significant clinical problem, involving increased numberof patients and surgeons. Much controversy exists regarding treatment. Elective division of the nerves has been proposed to reduce the riskof chronic post operative pain. O b j e c t i v e s : To evaluate the effectiveness of elective neurectomy during open hernia mesh repair, in reducingpostoperativ pain. Materials a n d m e t h o d s : Settings: All patients admitted in SUN department of surgery, Allied Hospital Faisalabad wereincluded in study. Study was started after the approval of synopsis on with inguinal hernia 2n d Feb, 2007 to Aug, 2007.100 patients of inguinalhernias were divided into 2 groups, 50 in each group i.e. group A & group B. The last patient was registered in the first week of July,convenience nonprobability sampling was used for location of patients in two groups. Results: On day one the pain was assessed in the twogroups i.e. Group A and group B (convenience non probability sampling technique used for patient grouping).It was found to be absent in 24/50(48 %) and 18/50 (36 %), mild in 10/50 (20 %) and 12/50 (24 %), it was moderate in10/50 (20 %) and 10/50 (20 %) and was severe in 6/50(12%) and 10/50 (20%) in the two groups respectively. One week after operation, in groups A and B, respectively, pain assessed with the useof the 4-point verbal scale was absent in 45 patients (90%) and 37 patients (74%), mild in 3/50 (6%) and 4/50 (8%), moderate in 2/50 (4%) and6/50 (12%), and severe in none and 3/50 (6%). Postoperative pain was not correlated with the presence of preoperative pain, and no correlationwas evidenced in the 2 subgroups. One month after operation, follow-up visits were performed in group A patients and group B patients. Inparticular, pain was absent in 46/50 (92%) patients in group A and 41/50 (82%) patients in group B. It was mild in 2 (6%) and 6/50 (12 %),moderate in 2/50 (4%) and 2/50 (4 %) none of the patients with elective neurectomy had pain at follow up of one month and 1 (2 %)one patientwithout elective neurectomy had pain. The numbness was assessed by checking sense of touch around the operated area. The difference foundbetween the 2 groups with respect to the presence of numbness was 15/50 (30 %) and 7/50 (14%) in the two groups i.e. group A and groupB respectively at day 1 and 12/50 (24%) and 7/50 (14%) at follow up of one week and it was 5/50 (10%) and 2/50(4%) at one month in the twogroups. C o n c l u s i o n s : When performing lichtenstein inguinal hernia repair, routine ilioinguinal, iliohypogastric and genital branch ofgenitofemoral nerves neurectomy is a reasonable option.
AMOEBIC LIVER ABSCES
Authors: ZEESHAN SAQIB , Masood Aqsa , CHUGHTAI JEHANZEB , Nabi Saad un , TAHIR AKHTAR ALI
Published: September 2021

Background: Amoebic Liver Abscess (ALA) is a serious problem in Pakistan. Its management includes antimicrobial drugs, needleaspiration and surgical drainage. Objective: To determine if amoebic liver abscess can be treated conservatively or requires needle aspirationas well in selected cases. Design: a prospective hospital based study Setting: Nishtar Hospital Multan. Period: 18 months. Methods: Thirtysix consecutive adult patients with a right lobe liver abscess were included. All patients received metronidazole 800mg orally for 10-14 daysand were clinically observed. Patients who did not show any clinical improvement in 96 hours had an ultrasound guided needle aspirationperformed. Results & conclusion: Patients having an ALA less than 10 cm in size respond to medical treatment. If patients continue to havetoxic symptoms, needle aspiration should be performed. Most patients having ALA of >10 cm will end up having a needle aspiration but shouldbe given a trial of medical managemen
AGRICULTURAL MACHINES INJURIES
Authors: AKRAM MUHAMMAD , NAZIM MUHAMMAD , GULZAR MUHAMMAD REHMAN , Iqbal Javed
Published: September 2021

O b j e c t i v e s : (1) To determine the extent of agricultural injuries in term of their site, severity, management and type ofagriculture machine. (2) To determine the techniques that can decrease the morbidity and mortality caused by agricultural injuries. S t u dyd e s i g n : Descriptive study. S e t t i n g : This study was conducted in surgical department of Allied & DHQ hospital Faisalabad. P e r i o d : January2007 to December 2007. Material a n d M e t h o d s : This descriptive study was performed in 40 consecutive patients in surgical departmentDHQ/Allied hospital Faisalabad during Jan.2007 to Dec.2007.AII people who got agricultural injuries were included. People who got traumaticinjuries other than agricultural machines were excluded. All injuries were noted with respect to the age and sex of the patient, site, size, andseverity of injury, and type of agricultural machine. Management was done accordingly. Result: Out of 40 cases, 34 [85%] were male and06[15%] were female. In 25 cases [67.5%] fodder cutter were involved. In 10 cases[25%]pinching machines [gears, belt, chain machines] wereinvolved .03 cases [7.5%]run over by machine. 02 cases [05%]by harvesting machines In 30 cases[75%]upper limb was involved. In 05 [12.5%]cases scalp injuries were noted. In 02 cases [05%] genitalia were avulsed. In 03cases [7.5%] lower limb was involved. Injuries range from simplelacerations, degloving injuries, tendons &vessels injuries &finally amputations. C o n c l u s i o n : Mostly young male population is involved inagricultural machine injuries. Morbidity of .agricultural machine injuries can be reduced by modifying design of agriculture machines, by trainingfarm workers & by their proper treatment.
URETERAL STENTING
Authors: MIRZA ZAHOOR IQBAL , NAQVI M. ALI
Published: September 2021

O b j e c t i v e : To assess the need for routine ureteral stenting after ureteroscopic lithotripsy. D e s i g n : Prospective interventionalstudy. D u r a t i o n a n d p l a c e of s t u d y : Study was carried out between November 2006 to march 2009 at C.M.H Peshawar and C.M.H Lahore.Patients a n d m e t h o d s : A total of 100 patients were equally randomized into stented and non-stented group. All these patients under wentureteroscopy and lithotripsy. The inclusion criteria was stone 6 to 10 mm.Those patients with large stones, previous surgery or ESWL wereexcluded.8.9 Fr rigid ureteroscope was used with pneumatic lithotripter and 4.7 to 6 Fr double pigtail catheter was placed in stented group for02 weeks. No ureteral dilator was used and stones were fragmented and no extraction device was used. A complete urine analysis, x-ray KUBand USG were performed before and after operation in each patient. Pain score and lower urinary tract symptoms were recorded at the timeof admission and three days after the operation. R e s u l t s : Regarding post-operative pain no statistically significant difference was noted betweenthe two groups (p < 0.5). The stone free rate was 100% with hydronephrosis resolved equally in both groups. 20 patients(40%) in stented groupcomplained of at least two irritative bladder symptoms and only 05 patients (10%) in the non-stented group experienced bladder discomfort.There was no significant difference in patients reported Haematuria in either group. Two patients in each group developed urinary tract infectionC o n c l u s i o n : All those patients who were with out a stent after uncomplicated ureteroscopic lithotripsy have similar renal function recovery andsatisfactory pain reduction and with less irritative symptoms as compared to those with stent. We suggest that it is not necessary to place aureteral stent in every case after ureteroscopic lithotripsy for stones smaller than 01 cm.
DIAGNOSTIC UPPER GASTROINTESTINAL ENDOSCOP
Authors: MAHMOOD KHALID , Khan Hamzullah , DIN ZIA-U- , Mohammad Riaz , SAEEDI MOHAMMAD ILYAS , Kamal Mustafa
Published: September 2021

O b j e c t i v e : To evaluate Oesophagogastroduedensocopy (OGD) in term of it's indications and endoscopic findings. Design:Retrospective, audit.Place a n d d u r a t i o n of t h e study: Medical "C" unit, Department of Medicine Government Lady Reading Hospital PostGraduate Medical Institute Khyber Medical University Peshawar from July 2002 to June 2007. S u b j e c t s a n d M e t h o d s : Adult patients whounderwent upper gastrointestinal (Gl) endoscopies during the last 5 years period were included in the study. The procedure was performedas per the standard protocol with diagnosis based on established criteria. Results: A total of 2282 were scoped, 53.3% (n=1216) were femaleand 46.7% (n=1066) male. The mean age of the study population was 43.75 Standard Deviation (SD) +18.00. Dyspepsia (54.5%), upper Glbleed (12.3%), recurrent vomiting (11.1%), and dysphagia (7.8%) accounted for the common indications of the procedure. Endoscopy wasnormal in 16.4% (n=374) of patients. Amongst the others (n=1908) single endoscopic diagnosis was made in 91 % of the patients and in theremaining 9% of patients combination of lesions were seen. The endoscopic findings included gastritis and duodenitis alone or in combination(29.4%), oesophagitis (13.9 %), duodenal ulcer (6.6%), gastric ulcer (7.4%), oesophageal varices (3.7%) and growth oesophagus (2.9 %).Gastric ulcer was more common than duodenal ulcer. C o n c l u s i o n : Upper Gl endoscopy is safe and an excellent diagnostic modality with highdiagnostic yield. Dyspepsia, upper Gl bleed, recurrent vomiting and dysphagia are the commonest indication for OGD. Gastro-duodenitis,oesophagitis, peptic ulcer disease, oesophageal varices and growth oesophagus are the common endoscopic diagnosis.
DIABETES MELLITUS
Authors: BILAL AHMED , Shaheen Muqqadas , QURESHI FRAZ SAEED , Iqbal Touseef , IQBAL MUHAMMAD IRFAN , Khan Sadia , Fazal Muhammad Owais , Saeed Usama
Published: September 2021

O b j e c t i v e : To estimate the prevalence of diabetes, high total cholesterol, obesity, smoking and physical activity in urbanpopulation of Faisalabad. R e s e a r c h d e s i g n and m e t h o d s : The project was limited to population based screening for above mentionedvariables using WHO criteria. Study was conducted by holding numerous screening camps in different urban areas over the course of two years.People age 20 years or above were included in the study. Total 5349 people, 58%males (3102) and 42% females (2247) were screened fordiabetes and high blood cholesterol. Body mass index was calculated by measuring height in meter square and weight in kilograms. Peoplewere interviewed for smoking and physical activity and relevant data was entered in the designed proforma. R e s u l t s : Within the chosen agerange, total prevalence of diabetes was 16% and among them 11 % were previously diagnosed and 5% were unaware of their diabetes (newlydiagnosed). Cholesterol was high (>200 mg/dl) in 48 % males and 34% females. 9.2 % of the males were found to be obese (BMI>30) incomparison to 14.3 % of females whereas 36.26% of males and 36.84 % of females were overweight (BMI > 25 to 29.9 kg/m2). The prevalenceof smoking was 38.8% in males and 1.2 % in females respectively. In daily routines only 6.8 % of the males were doing the physical exercise(30 minutes exercise five days a week or equivalent) whereas among females it was 1.9 %. C o n c l u s i o n : Diabetes and metabolic syndromein adults is now a global health problem, and the population of developing countries like Pakistan are facing this menace especially in the urbanareas where it is on the rise with each passing day.
COUPLING AGENTS
Authors: JAVED EJAZ AHMED , SULTAN MUHAMMD
Published: September 2021

Objectives: To find out the uses of commercially available clear lubricant eye gel as coupling agent and compare it with 2.5 %methylcellulose in various procedures as 1. In Goldmann triple mirror for gonioscopy 2. In Abraham lens for Nd-YAG laser capsulotomy andiridotomy 3. In Area centralis lens for Grid laser photocoagulation 4. In Wide field lens for scatter or panretinal photocoagulation. S t u dyDesigmProspective Comparative Study. Setting: Diagnostic and research Department of Ophthalmology, Allied Hospital, PMC, Faisalabad.Period:From 1s t July 2008 to 31s t December 2008.Material a n d Patients:Eighty patients, divided into two groups as each group having fortypatients (40 eyes). One drop of topical anesthetic "Alcaine" proparacain hydrochloride was instilled twice in the eye, 5 minutes before startingthe procedure. We used hydroxyprophyl methylcellulose 0.3 % gel in the half of the patients eyes and used traditionally formulatedhydroxypropyl methylcellulose 2.5% in the other half of the patients eyes and the findings were compared with each other. R e s u l t s : 2.5 %methylcellulose was used in 40 eyes during Gonioscopy, Yag-laser iridotomy, Yag-laser capsulotomy and photocoagulation and was comparedwith 0.3 % hydroxypropyl methylcellulose gel in the same procedures in 40 other eyes. Post procedures clarity of view, comfort, irrigation ofsolution remants, redness and stinging sensation were compared with the both coupling agents. The 0.3% gel showed good results.
METASTATIC RENAL CELL CARCINOMA
Authors: HASANZADEH MALIHE , OMEDE ABBAS ALI , MOHAJERI TARANEH
Published: September 2021

Background: Approximately 30% of patients with renal cell carcinoma present with metastatic disease at the time of diagnosis.Metastasis of renal cell carcinoma to the vagina is rare. Case: A 61 year-old female presented with a vaginal lesion, which was excised anddiagnosed as metastatic clear cell carcinoma. A workup further is done. Radiological studies revealed a left renal mass; A subsequentnephrectomy confirmed renal cell carcinoma. Conclusion: Renal cell carcinoma must be in the differential diagnosis of a vaginal clear cellneoplasm in a postmenopausal woman.
PENILE CANCER
Authors: TUNIO MUTAHIR ALI , RAFI MANSOOR , HASHMI ALTAF HUSSAIN
Published: September 2021

Carcinoma of the penis has a well documented metastatic pattern, regional lymph nodes being the predominant site ofinvolvement. Distant metastasis is extremely rare, with a reported incidence of 1-10%. Skin metastasis is even rarer and three cases ofmetastasis to the skin have been reported previously worldwide. We present a case of carcinoma of the penis metastasizing to the skin of trunk.
PSEUDO PAPILLARY TUMOUR OF PANCREAS
Authors: SOOMRO QURATULAIN , Soomro Hafeez , MUHAMMAD KHAN , Khatoon Sardar , SHAIKH ABDUL SAMAD , Chandio Akhtar Ali
Published: September 2021

During 05 years period from January 2003 to December 2007,45 cases of Ca. Pancreas were reported to LINAR and only onecase of Pseudo Papillary Tumour of Pancreas is registered. It is a rare, low malignant potential pancreatic tumour. It has unknown pathogenesisand found in young females. We report a case of 24 years old female, who presented with pain in abdomen and low grade fever of 07 monthsduration. Lepratomy and excisional biopsy was done. H/P came as Pseudo Papillary Tumour of Pancreas. At presentation no any L.N. werefound enlarged. Like other malignant pancreatic tumours, this neoplasm does not metastasize. Its definitive treatment is complete surgicalremoval, no any role of chemotherapy because it doesn't metastasized, limited role of radiotherapy in local invasive tumour or in residual mass.
MACROMOLECULES AND PHARMACY
Authors: IQBAL ZAFAR , ZAFAR TASNEEM
Published: September 2021

Curiosity is the nature of man and availability of chance favor the prepared mind to explore the hidden things in the universe.One thought, observation or experience is based for the others. Chemistry is mother of the different disciplines. Macromolecules (carbohydrates,proteins, lipids etc), substitution of different group (R=Alklyl, Aryl etc) in their molecules changes their therapeutic efficacy and pharmacokinetics.Stereoisomerism in macromolecules structures, role of liposome's in penetration of drugs in cosmetics, percentage yield and antibiotics fromnatural moulds plays an important and significant role in pharmacy. The object is to find out a relationship between curiosity, macromoleculesand pharmacy which might be able to clear the concept about mechanism of action of drugs, discovery of the new drugs and to understandpharmacological and adverse effects of drugs. This might be helpful in therapeutic management, follow up and better health care of patientsin future
UNILATERAL SPINAL ANAESTHESIA
Authors: ASLAM MUHAMMAD
Published: September 2021

Objectives: To see the effects of adding pethidine to intrathecal bupivacaine on duration of post operative analgesia inpatients undergoing hip surgery. Design: A randomized placebo controlled observational study. Setting C M H Multan: Period: From March2006 to April 2007. Patient and Methods: A total of 90 male patients of age 60-75 years of comparable weight and height and ASAstatus II, III were selected. Patients were divided into two groups, group A and group B. Each group consisted of 45 patients. All patients wereassessed pre operatively a day before surgery and were briefed about the procedure. Results: All the patients were prepared before givingspinal anaesthesia. Patients in Group- A were given a mixture 01 ml of 0.75 bupivacaine and 0.2 ml of normal saline in lateral decubitus positionwith operating side down by using 23 G spinal needle. Patients in Group-B were given a mixture of 01 ml of 0.75 % bupivacaine and 0.2 mlof inj. pethidine 10mg in lateral decubitus position with operating side down by using 23 G spinal needle. All the patients were kept in lateraldecubitus position for 10 minutes to achieve unilateral block. Intra operative adverse effects like hypotension, nausea, vomiting, pruritis anddelayed respiratory depression and effective duration of post operative analgesia was recorded. Conclusion Addition of 10 mg pethidine tointrathecal hyperbaric bupivacaine is associated with prolonged postoperative analgesia and minimal side effects like hypotension, pruritis, anddelayed respiratory depression. However incidence of nausea and vomiting was much more
POSTOPERATIVE NEURALGIA
Authors: ALI ZULFIQAR , REHAN AG. , RASHID ZAKRYIA
Published: September 2021

Objective: To evaluate paresthesia following routine ilioinguinal nerve excision compared to nerve preservation in patientsundergoing anterior inguinal hernioraphy. Design: prospective experimental study. Place and duration of study: The study was conductedat Madina Teaching hospital, University Medical & Dental College, Faisalabad from July 01,2005 to June 30,2007. Patients and methods:Two hundred and eighteen patients were operated for their inguinal hernias. Ilio-inguinal nerve preservation (n=96) and nerve excision (n=122)was performed on alternative operation days. All patients were contacted and data was collected on incidence and duration of postoperativeparesthesia. Comparison was made by x2 analysis. Results: The patients with routine neurectomy were similar to the group without neurectomybased on mean age (68 ± 14 vs. 58 ± 18 years). The incidence of postoperative paresthesia was not significantly higher in the neurectomygroup versus the nerve preservation group at 1 month: 15% versus 4% (P = 0.078); 6 months: 11% versus 5% (P = 0.107); 1 year: 09% versus05% (P = 0.303); (Table 2). In patients with postoperative paresthesia, mean severity scores on a visual analog scale (0-10) were lower in theneurectomy group versus nerve preservation group at 1 month (2.6 ± 2.0 vs. 5.2 ± 0.0) and at 6 month (2.4 ± 2.0 vs. 5.2 ± 0.0) but similar inthe neurectomy and nerve preservation patients at 1 year (2.2 ± 1.8 vs. 3.8 ± 0.0) (Table 3). Conclusion: There is a trend towards increasedincidence of subjective paresthesia in patients undergoing routine neurectomy at 1 month, but there is no significant increase at any other endpoint in time. When performing anterior inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option
MULTI NODULAR GOITER
Authors: AKBAR SYED ALI , Qasim Mohammad , AHMED NAZIR , Khan Zar , ALI JOHAR , Afridi Nazar Mohammad
Published: September 2021

Objective: I. To determine the frequency of malignancy in multi nodular goiter. II. To determine the histopathological types.Design: This is a prospective study. Setting: Surgical department of Foundation Hospital Rawalpindi and associated Teaching Hospital ofFrontier Medical College Abbottabad. Period: Aug. 2002 to Aug. 2007. Patients and Methods. One hundred patients with Multi nodular wereincluded in this study. Patient with diffuse goiter, solitary nodules, patient operated somewhere else and suspected cases of malignancy wereexcluded from the study. Tissue were sent to Armed Force Institute for histopathological examination. Patients were followed for 2 weeks aftersurgery with histopathological report, all the preoperative and postoperative findings were recorded in detail. Data was analyzed byusingSPSS 14. Results. Majority of patients studied, belonged to Azad Kashmir and Gilgit which are among the known endemic regions for goitrein Pakistan and other from Chakwal and Jhelum. Histopathology revealed 96 (96%) patients with multi nodular goiter, 3 (3%) papillary carcinomaand 1 (1 %) Follicular carcinoma. Conclusions: Multinodularity of the goitre should not be considered as low risk of malignancy and delay forsurgical intervention. Changes in the size of gland, the appearance of new and hard nodules or cervical lymphadenopathy may indicatemalignant change and prompt indication for surgery.
WOUND INFECTION
Authors: HUSSAIN UZMA , SAEED AFSHAN , LATIF FARZANA
Published: September 2021

Objective: To evaluate the effects of the anaemia in wound infection after cesarean section. Design: Prospective study. Setting:Department of Obstetric-Gynaecology in Sir Ganga Ram Hospital / Fatima Jinnah Medical College Lahore. Period: Sep 2008 to Sep 2009.Patients and Methods: The study comprises of 100 pregnant women with moderate to severe anaemia. Selected cases underwent cesareansection due to different indications. The rate and frequency of wound infection was observed in all these women. Results were analysed andtabulated. Results: 100 cases with moderate to severe anaemia who underwent cesarean section were included. Moderate aneamia wasrecognized in 55% of cases and 19% with severe anaemia. Wound discharge was seen in 44 % of cases and wound dehiscence was foundin 56 % cases. Culture was positive in 41 % patients and majority of these were unbooked. Non elective cesarean delivery was performed in99% of cases. Conclusion: The rate of wound infection was very high in moderate to severely anemic women who underwent non elective/ emergency cesarean section.
COLONIC INJURIES
Authors: ZAHUR SAQUIB , BUTT HASNAT AHMAD
Published: September 2021

Objectives: To determine the effectiveness of primary repair of colonic injuries and its comparison with the traditionalcolostomy or exteriorization. Methods: The study was performed in Mayo hospital Lahore. Of the initial 114 patients 63 patients with colonicinjuries were selected and divided into 2 groups. After resuscitation these patients were operated. Both methods of treatment of colonic injurieswere employed in different patients. Results were tabulated and a comparison of primary repair vs colostomy was done. Results: Recoveryof patients undergoing primary repair was comparable with those having colostomy done. Only one major complication of leak occurred in theprimary repair group. Abdominal dehiscence occurred in the colostomy group. Average hospital stay of 9 days in the primary repair group wassignificant and far less, than 22 days in colostomy group. Conclusion: Under controlled circumstances primary repair of colonic injuries appearsto be a good mode of treatment.
RISING CAESAREAN SECTION RATE
Authors: CHOUDRY ABEERA , AFSHEEN AFEERA , Malik Ayesha , NAUSHEEN JAVERIA , Masood Saima
Published: September 2021

Objective: Compare indications for caesarean section in Military Hospital Rawalpindi in the year 1999 with the year 2005, sixyears apart, with an aim to identify areas where caesarean section rates could be decreased. Study design: Prospective Survey of caesareansection using information provided by doctors/midwives entering data in labour ward /theater registers. Methods: The study was designed asa process evaluation. Indication for caesarean section, parity, previous caesarean section, emergency / elective, labour / pre labour, presenceof previous caesarean section scar, induced or spontaneous labour were noted. Data was plotted into 2 separate classifications and indicationscompared across the 2 years 1999 versus 2005. Statistical significance was calculated and value of <0.05 was considered significant. Results:Overall section rates rose from 16.9% to 34.6% which showed almost doubling of rates in a span of 6 years. The chief contributors to risingrates were as follows. Caesarean section rate rose from 132 (2.2%) to 355 (4.6%) for previous one Caesarean section (p<0.001), from 172(2.9%) to 383 (5% )for previous >1 caesarean (p<0.001), that for nullipara increased from 203 (3.3%) to 632 (8.3%), prelabour or induced labour(p<0.001) and for dystocia from 150(2.5%) to 490 (6.4%) which was again significant (p<0.001) . Increase in section rate for antepartumhaemorrhage, diabetes, previous infertility and intrauterine growth restriction was insignificant. Conclusion : A decrease in the number ofcaesarean sections may be achieved by reducing the number of primary caesarean section and/or encouraging more patients to take a trialof scar. A decrease in induction rates may also lead to lowering of caesarean section rates.
PRETERM LABOUR
Authors: LATIF FARZANA , BANO BUSHRA , HUSSAIN UZMA
Published: September 2021

Objective: To compare the efficacy of Glyecryl trinitrate patch for prolonging gestation for more than 48 hours, 7 days or upto 37 weeks of gestation with Salbutamol in preterm labour. Study Design: Compartive descriptive study. Setting: Fatima Memorial HospitalLahore. Period: Dec 2003 to Jan 2005. Patients & Methods: The study was carried out on 60 pregnant patients admitted in hospital with thesymptoms and signs of preterm labour. The results were statistically analyzed using SPSS version 8.0. Results: Two groups (TransdermalGlyceryl Trinitrate group and Salbutamol) comprising 30 patients each were made. In Glyceryl Trinitrate group, transdermal patch was appliedand in Salbutamol group,. Intravenous infusion titrated according to frequency, duration and intensity of uterine contractions. All the patientsin each group were evaluated for prolongation of gestation for 48 hours till 37th week of gestation. The mean prolongation of pregnancy was26 days in GTN group and 32 days in Salbutamol group. The decrease in frequency of uterine contractions by 67.51 ± 7.74% in first 48 hoursof applying transdermal Glyceryl Trinitrate patch and by 80.14 ± 8.43 % in Salbutamol group which was statistically significant. Conclusion:Trinitrate appears to be a safe, well tolerated and non-invasive but less effectives method of suppressing uterine contraction in preterm labouras compared to Salbutamol.
CHRONIC HYPERTENSION
Authors: ASHOUR TARIQ HELAL
Published: September 2021

Background: Hypertension is an important risk factor for cardiovascular morbidity and mortality. Myocardial infarction, andstrokes, which are complications of hypertension, predominantly occur due to thrombosis of arterioles leading to ischemia and infarcts. NOsuppression leads to hypertension associated with haemostatic changes that may endanger life. Material and methods: Rats were randomlydivided into 2 groups equal in number, each contain 20 rats. Group (A) a control group given distillate water and Group (B) hypertension inducedgroup receiving NG-nitro-L-arginine methyl ester (L-NAME) for induction of hypertension. Results: Group 2 showed significant increases of meanblood pressure, plasma fibrinogen levels, significant reduction in mean values of percentages of platelets aggregation, significant increase inmean values of Plasminogen Activator Inhibitor-1 Antigen (PAI-1 antigen), significant increase in mean values of thromin-antithrombin complex(TAT)) and significant increase in mean values of soluble glycoprotein V (sGPV). In contrast, platelets counts showed insignificant changesin its mean values. Conclusion: The present study demonstrates, the increase in plasma fibrinogen levels, fibrinolysis activities as indicatedby increase in plasminogen Activator lnhibitor-1 Antigen (PAI-1 antigen), and systemic plasma thrombin which is detected by increases of meanplasma levels of thromin-antithrombin complex (TAT)) and soluble glycoprotein V (sGPV). Meanwhile decrease in nitric oxide in chronichypertension produces slight decrease in platelets count and aggregation.
CHLOROQUINE-RESISTANT PLASMODIUM FALCIPARUM
Authors: KHOHARO HAJI KHAN , QURESHI F ATI MA , ANSARI SHUAIB , Javed Rizwan
Published: September 2021

Objective: The study was conducted to determine the frequency of Chloroquine-resistant Plasmodium falciparum. Subjects& Methods: This was a descriptive case series study conducted at Muhammad Medical College Mirpurkhas & Liaquat University HospitalHyderabad/ Jamshoro, from January 2007 to December 2007. Total 160 patients with acute attack of fever were selected & studied who fulfilledthe inclusion criteria. The WHO extended test was done by giving 25 mg/kg body weight of Chloroquine base over 3 days. The interpretationof the test was done as per criteria laid down by WHO. Results: Out of one hundred sixty, 110 (68.75%) were males and 50 (31.25%) werefemales with ratio of 2.2:1. The age range 16-45 years with mean 28±12 years. Seventy one patients (44.375%) were Chloroquine sensitive.Chloroquine-resistance (CQR) Rl, Rll & both Rl Rll noted were 28.125%, 15.645% & 43.75% respectively. The CQR- R III was not observedin our study. Conclusions: In view of this situation, more organized and thorough studies must be conducted to elucidate the epidemiology,geographic-distribution & degree of Chloroquine resistance. And the local strategies be made to overcome this problem and to assess the needfor changing the first line drug.
SERUM VITAMIN D DEFICIENCY, A NEW EPIDEMIC
Authors: BILAL AHMED , Irian Muhammad , FAZAL MUHAMMAD OWAIS , Khan Sadia , QURESHI FRAZ SAEED , Saeed Abdullah Bin , Shaheen Muqqadas
Published: September 2021

Introduction: Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkalinephasphatase cannot predict underlying vitamin D deficiency. Objectives: 1. To determine the frequency of vitamin D deficiency in outpatientprivate clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation ofits deficiency to the serum calcium, alkaline phosphate and phosphate levels. Study design: Descriptive study. Setting: One of the local privateclinic. Materials and Methods: 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or bodyaches or not, were included in this study. The duration of study was 7 months from June to December 2008. Results: The study showed amongtotal 33% (n=264) were male and 67% (n=536) were female. 33 patients (4.1 %) were below age of 20 years, 364 patients (45.2%) were havingage between 20-40 years, 252 (31.5%) were between 41 -60 years, 143 (17.8%) were between 61 -80 years and only 8 patients (1 %) were above80years. Over all vitamin D present in sufficient amount (>30 ng/ml) in only 4 patients (0.5%), reaming patients (n=796,99.5%) were deficientin vitamin D were further divided into those who were having deficiency (serum level <20 ng/ml) (n=636, 79%) and insufficiency (serum levelbetween 21-29 ng/ml) (n=160,20%). All the deficient patients were having normal serum calcium and phosphate levels and only 33 patientswere having modestly raised serum alkaline phosphate. Among the sample only 318 (39.7%) were having bone or body aches as a presentingfeature while remaining 482 (60.3%) were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level(p-value=0.201), however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year(p-value<0.001). Conclusions: Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting youngpopulation. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health.
SYMPTOMATOLOGY IN THE INTERNAL MEDICINE WARDS
Authors: EL-MAHD EL-MAHDI EL-BADWI , Khan Kaniz Rasul , GAZZAZ ZOHAIR JAMIL , Farooq Mian Usman , DHAFAR KHALID OBEID
Published: September 2021

Objective: This study had been conducted to highlight the pattern of presenting complaints of the patients admitted in internalmedicine wards of a tertiary care hospital. Design: This observational study was conducted in internal medicine wards of Alnoor SpecialistHospital, Makkah, Saudi Arabia, from 31 -08-2004 to 14-10-2004. Methodology: The data had been collected retrospectively from the files andconsisted of demography, wards allocations, duration of stay, and frequency as well as duration of symptoms at the time of presentation. Datawas analyzed by SPSS version 16 and p<0.05 was considered as significant. Results: Out of total 103 subjects, majority 21 (20.4%) belongedto age group 65-74years. Saudis 75(73%) as well as males 59(58%) predominated. Saudis were older and stayed longer than non-saudis (55.5vs. 45.8years; p<0.05) and (9.3 vs. 6.3days; p<0.05), respectively. Most frequent symptom was fever while 41.2% symptoms had history of2-7days. Only 3.9% patients presented with >6 types of complaints. Diseases of the circulatory system were more prominent (16.5%). Morethan two third patients improved (75.7%) while 9.7% died. Conclusion: Maximum patients were within 65 to 74yrs of age. Saudis were olderand stayed longer than non-Saudis. Fever was the commonest presenting complaint. Minimum patients presented with >6 complaints anddiseases of the circulatory system predominated. A few died but most of them improved.
CONGENITAL HEART DISEASE
Authors: MANZOOR IRAM , DAUD SEEMA , HASHMI NOREEN RAHAT
Published: September 2021

Objective: To assess the parental knowledge and myths related to etiology of congenital heart disease. Design: A crosssectional descriptive study. Place and Duration of Study: Out patient department, indoor and echocardiography rooms of Children Hospitaland Institute of Child Health (CH & ICH) Lahore, in two weeks of October, 2007. Patients and Methods: Convenient sampling technique wasused to recruit 299 children between 1 month and 14 years of age, suffering from congenital heart disease. Cases of rheumatic fever andassociated congestive cardiac failure were excluded from the study group. A structured questionnaire was used to interview parents of the studygroup. Descriptive statistics was determined in terms of percentages. Results: Out of total 299 patients included in this study, 132 were in theage group of 1 -5 years (44%), with the mean age 1.86 years ± 0.886 SD. 200 were males (67 %) and 99 were females (33%). The respondentsincluded 71% mothers and 27% fathers. Ventricular septal defect (VSD) was the most common disease encountered in 128 children (43%).Regarding the causes of congenital cardiac defects, parents blamed cousin marriage (41%), inheritance (26%), increased maternal age(16%), maternal smoking(16%) and paternal smoking (39%). Other responses included evil spirits, moon and sun eclipses and bad wishes/evileye. 57% of the respondents said that there is no relationship between gender and congenital cardiac malformation and 85% respondentsbelieved that there is no relation with the food taken in pregnancy and subsequent cardiac defects. High Salt intake was considered as anassociated factor by 47 (15%) of the respondents. Naming the cause of cardiac malformations, 41% of the parents said drugs taken inpregnancy, 13% of the respondents blamed alcohol, cocaine and opium intake. Among parents, 73% were aware of the fact that maternal healthis important for disease causation in neonates but could not name any particular disease. Conclusion: The parents of those children, who havecongenital malformation, have different myths and fallacies associated with disease causation. Adequate health education strategies shouldbe adopted towards mass dissemination of information in the community about this important issue.
VACCINE REFUSAL
Authors: SHUKR REHMAN INAYAT , Sahi Nabeel , ALI SALMAN , Sattar Sumatra , MANZOOR FAREEDA
Published: September 2021

.Objective: To evaluate the pattern and reasons of reluctance/ refusal to polio vaccination with an aim to gain insights and learnlessons during Polio campaign. Setting: Polio campaign days during 2009 in Muzaffar Garah district between January to April 2009. Studydesign: Cross sectional survey. Material and Methods: Survey done during intensive polio days during the three campaigns this year bydetailed interview with parents, senior members of the family regarding reluctance to administer oral polio drops in the Muzaffar Garah district.Reasons and frequency of reluctance were documented. After counseling the WHO team managed to convince part of the reluctant population.The data was once again collected from the unconvinced population of parents who declined till the end. Results: During the survey there were404 reluctant parents.236(58%) of these were convinced and the remaining stayed unvaccinated despite counseling. Amongst the group thatshowed initial reluctance. 132(32.5%) refused to cooperate due to religious misconceptions. Of the confirmed deniers 116(69%) belonged toa conservative religious group The most easy to convince group was the group demanding monitory benefits for cooperating in Polio campaign13(7%). Conclusion: People refuse Polio vaccination due to misinformation /misconception especially on religious grounds. The die hardrefusals were mostly linked to religious reasons. Education of religious leaders is the way forward to drive Polio to extinction.
SUPERFICIAL CERVICAL SWELLING IN CHILDREN
Authors: SHEIKH MUHAMMAD SALEEM , AKHTAR MASOOD , SHEIKH MUHAMMAD AMIN
Published: September 2021

Fine needle aspiration cytology (FNAC) is commonly used first line diagnostic test for palpable cervical swelling by ENT and Head & Neck surgeon. Objective: To analyze the diagnostic importance of FNAC by knowing its sensitivity and specificity in children having palpable cervical swelling. Design: Prospective study. Setting: Department of ENT and Head Neck Surgery QAMC, Bahawalpur. Period: July 2006 to June 2007. Material And Methods: 82 cases of superficial cervical swelling with ages between 5 and 12 years were selected. Most of them were of poor socioeconomic class. All underwent FNAC for diagnosis and results were analyzed after comparing with histopathology examinations. Results: Out of 432 total patients (of all ages) who attended the ENT department during the study period, only 82 were selected for the research which fulfilled the inclusion criteria. These were 5-12 years old, both sexes, 47 boys (57.3%) and 35 girls (42.75%). Sixty eight (83%) patients had benign diseases while 14 patients (17%) had malignant lesions. Out of the 68 benign lesion (44.11%) were reaction hyperplasia (non specific inflammation), followed by tuberculous lymphadenitis (38.23%), cystic masses (5.88%), benign tumours (4.4 %) and nodular goiter (7.35%). Out of 14 malignant lesions, 6 (42.85%) had Hodgkin's Lymphoma, 2 (14.28 %) had Non Hodgkin's Lymphoma, 3(21.42% ) patients had squamous cell carcinoma and 1 (7.14%) patient each of rhabdomyosarcoma, undifferentiated carcinoma and pleomorphic adenoma. In our study sensitivity and specificity of FNAC to diagnose the malignant lesion was 85.7% and 89.7% respectively. Accuracy of FNAC in our study was 89.0%. Conclusion: FNAC is highly helpful to diagnose the pathology of cervical swelling in children. It has high rate of sensitivity, specificity and accuracy to diagnose the malignancy in these lesions. Proper and specific sampling needs complete cooperation of the child and sedation may be necessary for this. Expertise is required for FNAC reporting.
COLLOID CYST OF THE THIRD VENTRICLE
Authors: ASHRAF NAVEED , AZEEMI MUHAMMAD AKMAL , SAJJAD FAUZIA , Ghouri Asma
Published: September 2021

Objectives: Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler.Objectives: (1) to assess the extent of excision (2) to assess the morbid anatomy of the colloid cyst (3) to assess the risk of complications (4) to assess the functional outcome. Period: Eight years (Jul 2001-June 2009) Materials and Methods: Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Results: Total removal was achieved in 10 (66.7%) cases. In 5 (33.3%) patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two (13.3%) patients developed meningitis one week postoperatively and one diedsubsequently. Nine (60%) patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five (33.3%) of the total patients required ventriculoperitoneal shunt for obstructivey drocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Conclusions: Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure.