bluuebunny/crossref_metadata_2025 huggingface dataset:
LAPAROSCOPIC CHOLECYSTECTOMY;
Authors: MEMON, AYAZ AHMED , IQBAL, PERVEZ , JAMALI, KHAWAR SAEED , Shaikh Ubedullah , Qureshi Abdul Waqar Ahmed
Published: September 2021

Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performinglaparoscopic cholecystectomy and lead to conversion. Study Design: Prospective analysis study. Place and Duration of study: Thisstudy was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011to July 2012. Methodology: This study consisted of one hundred & forty six patients with gallstone disease. All patients had full clinicalexamination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly.Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and forassessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was notattempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acutepancreatitis, obstructive jaundice and unfit patients for general anesthesia. Results: Out of 146 patients included in this study 133 werefemale (91%) and 13 male (9%); with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings wereadhesions in calot's triangle 24(16.43%) cases, severe & tight adhesions around gallbladder and calot's triangle 21(14.38%) cases,obscured anatomy in calot's triangle 17(11.64%) cases, intrahepatic gallbladder 11(7.53%) cases, adhesions around gallbladder26(17.80%) cases, empyema 13(8.90%) cases, mucocele 9(6.16%) and anatomical variation 14(9.58%) cases. We observed out of 21patients who had Severe & tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopiccholecystectomy in 11(52.38%) cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variationalso lead to performing difficult laparoscopic cholecystectomy in 6(35.29%) and 5(35.71%) cases respectively. Four (2.73%) cases outof 146 had to be converted to the open cholecystectomy procedure. Conclusions: We conclude our study revealed that variousperoperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot'striangle, severe & tight adhesions around gallbladder and obscured anatomy in calot's triangle.
PERTROCHANTERIC FRACTURE FEMUR;
Authors: SIAL, NOOR AKBAR , MAHMOOD, NASIR
Published: September 2021

Background: Pertrochanteric fracture is common in elderly population. The dynamic hip screw is widely accepted in thetreatment of P/T fractures of the proximal femur. Objective: The purpose of this study was to assess radiological and clinical union inelderly patients after operative treatment of a pertrochanteric femoral fracture with DHS. Design: A prospective study. Setting:Orthopaedic surgery department of Independent Medical College Faisalabad. Study Period: Between July 2009 and June 2012. Method:The study group included 22 males and 51 females aged 50-95 years following pertrochanteric fracture femur either stable or unstable.Relevant history and x-rays were taken. We followed the inclusion and exclusion criteria. All patients were operated on routine operationlist under image intensifier after necessary investigations and fitness for anaesthesia. All the cases were treated by closed/openreduction and a dynamic hip screw (DHS) was inserted by a standard technique. An outpatient follow-up with x-ray check-ups wascarried out at one-month, 3months, 6 months and after 1year intervals to assess union and walking ability as outcome measures.Results: 73 cases were included in study 22 males and 51 females.66 fractures (90%) healed at an average of 12 weeks postoperatively(range 8-28 weeks). There were 4 patients (5.47%) requiring further surgical intervention. No obvious shortening of more than 1.6 cmwas noted compared to the contra lateral normal limb. Our results suggest that fixation with DHS may allow a faster post-operativerestoration of walking ability. Mortality upto1 year 11(15.06%).Further 6(8.22%) patients were lost to follow up. Conclusion: It isconcluded that the Dynamic Hip Screw is safe, suitable and reliable fixation.
PERIPHERAL ARTERIAL DISEASE (PAD);
Authors: MAHMOOD QAISER , SIDDIQUE NASREEN , QAISER AFFAN
Published: September 2021

Objectives: (1) To determine the frequency of PAD in diabetic patients. (2) To compare the frequency of PAD in diabeticstaking different treatment modalities. Design: Observational Cross-sectional study. Setting: Diabetic Research Centre Nishtar HospitalMultan. Period: Dec. 2010 to Dec.2011. Material and method: Four hundred and forty three (443) consecutive diabetic patients wereincluded in the study .History, Clinical Examination, Blood Sampling, HBA1C and Doppler’s studies for ABI were carried out. Grading ofseverity of PAD was done on the basis of ABI. Results: A total of 443 diabetic patients were screened for PAD by ABI. Out of 443 diabeticpatients 346(78.1%) were males and 97(21.9%) were females. 332(74.9%) patients were in age group 35-45 years, having normal ABI.111(25.1%) patients were in age group of 45-55 years having abnormal ABI. So on the basis of ABI the frequency of PAD was found25.1%. Among 111 diabetic patients with abnormal ABI 97(87.4%) have mild to moderate PAD while 14(12.6%) have severe PAD.Patients with severe PAD were in age group 55 and above and they have longer duration of diabetes. Out of 111 diabetic patients withabnormal ABI 87(78.4%) were males and 24(21.6%) were females indicating disease predominance in males. PAD was more common inpatients who were on Oral hypoglycemic agents Conclusions: The study demonstrates a high prevalence of PAD among people with type2 diabetes mellitus. This needs to be appropriately evaluated by the medical professionals.
RURAL SURGERY;
Authors: SUHAIL MUHAMMAD ALI , LAL BHAMAR , PARYANI JAI PAL , Shaikh Ubedullah
Published: September 2021

objective: To study the pattern of Urological & Non-Urological cases and their management at rural hospital. StudyDesign: descriptive and case series study. Place and Duration of Study: All surgical patients managed at civil hospital Mithi, from 3rdJune 2009 to 3rd June 2012. Methodology: In this study 4657 patients were enrolled. All patients presented with symptoms suggestingsurgical disease and managed as surgical cases were included in the study. These patients were either admitted via outpatientdepartment (OPD), emergency department or operated as OPD cases. The patients who received 1st aid medication and referred totertiary care were not included. The variables noted and analyzed were patient's demographic data, provisional and final diagnosis,disease pattern, presentation, mode of admission, mode of treatment, nature of operation, complications and final outcome. All the datawas analyzed by SPSS version-16 on computer. Results: During three year study period, 4657 patients were managed eitherconservatively or operated upon. Out of total, 2591(55.6%) were emergency and 2066(44.36%) were elective admissions. The malefemale ratio was 4:1 .The mean age of patients was 36.5 Years. Urinary tract diseases were responsible for 1638 (35.17%), alimentarytract diseases 1242 (26.6%), trauma 932 (20.01 %), soft tissue infections 546 (26.9%),superficial lumps 367 (18.13%) admission.Most common operative procedures for urinary tract diseases 409 (20.20%), soft tissue infections 546 (26.9%). superficial lumps367(18.13%), alimentary tract diseases (15.06%) 305, trauma (soft tissue repair and fractures 14.9 %( 303), were major bulk foroperations. Regarding procedures Abscesses incision and drainage in 197 (22.6%) patients, cystolithotomy in 153(17.6%),Hernioraphy (130) 14.9%, appendecectomy 105 (12.09%),haemorrhoidectomy 51(5.8%),breast abscess 38 (4.3%) breastlump(fibroadenoma) 25 (3.6%), hydrocele23 (2.6%), Ureterolithotomy 22 (2.5%) laparotomy 15 (1.7%), pyelolithotomy12, (1.3%)fissure in ano 13, (1.4%) undecended testis 12 (1.3%) Orchidectomy11 (1.3%) and abscesses psoas, perinal, scrotal 13 (1.4%), 18(2.07%) , 12 (1.3%) respectively. Conclusions: The concluded that the most common cause of seeking surgical care at back ward ruralTharparker was urinary tract diseases. Presence of surgical specialist at remote and back ward region Tharparker is candle in thedark.Main reason of patient referral to tertiary care was deficient in skill medical and surgical professionals, paramedic staff and medicalequipments.
HELICOBACTER PYLORI;
Authors: NASEER FAIZA , JAVED FATIMA , IRSHAD IRUM
Published: September 2021

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BREECH PRESENTATION AT TERM;
Authors: MUKHTAR, BUSHRA , KHAN BUSHRA , RASHEED NUZHAT
Published: September 2021

Objective: To compare the fetal outcome of elective cesarean section with elective vaginal birth for Term Breechpresentation in terms of APGAR Score, Respiratory Distress Syndrome, Admission in Neonatology Unit and Neonatal mortality. Design:Quasi experimental study. Setting: Department of Obstetrics & Gynaecololgy Bahawal Victoria Hospital, Bahawalpur. Methods: Total 120cases were included in the study divided into two groups, each having 60 fulfilling the inclusion criteria. Group 'A' had those who deliveredby planned cesarean and Group 'B' comprised those having planned vaginal delivery. Results: It was found that neonatal mortality was3.33 in vaginal and 0 in cesarean group. Mean APGAR Score at 1 and 5 minute was 8.47 and 9.53 in vaginal and 8.58 and 9.62 incesarean group. RDS was more in cesarean (5) than vaginal group (1.6). Admission in Neonatalogy Unit was more in vaginally deliveredgroup (8.33) as compared to the cesarean section group (5). Conclusion: Planned cesarean delivery in breech presentation at term isassociated with a reduction in neonatal mortality and morbidity as compared to the planned vaginal birth.
MODY GENES;
Authors: KANWAL ATTIYA , FAZAL SAHAR , ASGHAR SOHAIL , Naeem Muhammad
Published: September 2021

Objective: Genetic screening of Maturity Onset Diabetes of the Young (MODY) genes has not been performed in Pakistanso far; albeit MODY genes have been noticed in local population. A relevant research will help to establish a scheme for identification andtreatment of MODY. Data Source: The data source for the subgroup discovery was retrieved from PubMed. Study Design: Family affectedby MODY were contacted personaly for descriptive study. The family history was obtained from the representative members of the familyand pedigree was drawn. Setting: The extensive clinical examination of both patients and their unaffected normal relatives was carried outby expert clinician. Period: Specific primers for region of interest in genomic DNA were designed at the IBGE Islamabad using Primer3during last quarter of 2011. Materials & Methods: Mutation detection was performed followed by pattern discovery using subgroupddiscovery technique. Results: Unidentified MODY genes facilitating the cause of a specific diabetes in European population may play acentral role for diabetes characterized by autosomal dominant transmission in Pakistani population. Exclusion study indicates that there isno linkage to the known loci of MODY. Similarly genetic screening results suggest that no mutation is indicated in this examined family inMODY genes. Conclusion: There may be some environmental factors involved in causing this disease in this family; otherwise thisdisease is due to mutation in other reported MODY genes which are not screened in this study. Subgroup discovery results point out thatall the reported MODY genes have association among themselves revealing 580 patterns.
RECONSTRUCTION OF HIND FOOT DEFECTS;
Authors: ASLAM MUHAMMAD RIZWAN , KHAN AIZAZ SALEEM , PASHA IBRAHIM FAROOQ , Taj Rizwan Ullah
Published: September 2021

BACKGROUND: Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. Weshare here a simple and practical protocol (working solution) to select the most suitable method for soft tissue coverage of hind footdefects, customizable for every patient. METHODS: We carried out this study, in our department on 75 cases from March 2009 to May2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy,Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury (isolated or combined), ifcombined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimalwound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VACtherapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medialplantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. RESULTS: All patients had satisfactory and stablereconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss,peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. CONCLUSION: The simplified protocolfollowed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniqueswill vary from time to time from one surgeon to another depending upon his or her experience and liking.
FIRST DEGREE HEMORRHOIDS;
Authors: KHAN MUHAMMAD YUNAS , ALAM SYED IFTIKHAR , JAN QUTIB ALAM , Rehman Ata-ur-
Published: September 2021

Traditionally the treatment of Ist, 2nd and 3rd degree haemorrhoids is conservative management with fibre rich diet andbetter defecation discipline. If symptoms prevail then there are a wide range of treatment modalities. OBJECTIVE: to evaluate the efficacyof injection Sclerotherapy for First degree haemorrhoids using 5% Phenol in Almond oil. MATERIAL AND METHODS: This case seriesstudy was conducted on 83 patients with first degree piles in Surgical-C unit, Department of Surgery, Khyber Teaching Hospital Peshawarfrom 01/09/2010 till 01/03/2011. After Informed consent, injection Sclerotherapy with 1-2ml of 5% Phenol in Almond oil was injected inthe sub mucosal plane of each pile case above the dentate line. Patients were reviewed at 3 weeks interval for bleeding per rectum foreffectiveness of the procedure. RESULTS: A total of 83 patients with first degree haemorrhoids included in the study out of which 62(74.7%) were male and 21 (25.03%) were female with M: F=2.99:1. Average age 41.1 years+0.1 SD with range 20-60 years. Efficacywas observed in 68 (81.83%) patients where 15 (18.07%) patients showed no results. CONCLUSION: Injection sclerotherapy is simple,convenient and effective outdoor procedure for first degree haemorrhoids.
CHRONIC KIDNEY DISEASE;
Authors: ASIF MUHAMMAD , AKRAM MUHAMMAD , ULLAH ATIF
Published: September 2021

Introduction: Chronic kidney disease (CKD) is defined as kidney damage or glomerular filtration rate <60ml/min/1.73mfor 3 months or more, irrespective of cause. Objective: To measure glomerular filtration rate, free thyroxin, thyrotrophin in chronic kidneydisease patients and to find out the correlation between glomerular filtration rate, free thyroxin and thyrotrphin in these patients. StudyDesign: Cross sectional analytical study. Setting: Post Graduate Medical Institute (PGMI), Lahore General Hospital (LGH) Lahore. Period:6 months (Nov 2011 to April 2012). Material and Methods: Sixty five patients were included in the study. Serum Creatinine, TSH and FreeT4 were measured; Thyroid function tests TSH, FT4 were measured in these chronic kidney disease patients through enzyme linkedimmunosorbant assay method. GFR was calculated through Cock-croft-Gualt formula and the relevant data was entered in a predesignedProforma. Results: In the study total 65 chronic kidney disease patients were taken. Out of which thirty six (55.4%) were male and twentynine (44.6%) were female. Thirty five (53.8%) CKD patients whose TSH levels were above the normal limit while in the remaining patientsthe TSH values were in the normal range. Eight patients (12.3%) out of sixty five patients in whom FT4 values were below the normal limitwhile in the remaining fifty seven patients (87.6%) FT4 values were within the reference range. Those eight patients whose FT4 wasbelow the normal value, their TSH values were above the normal value too. Thirty five patients, whose TSH levels were above the normal2 limit, their mean age was 50.60± 11.95, mean serum creatinine was 4.73± 2.94 mg/dl, mean GFR was 22.17± 12.48 ml/min/1.73m ,mean TSH was 6.68± 0.87 mIU/L and mean FT4 was 0.97± 0.35 ng/dl. The p-value of TSH was < 0.001 and FT4 was < 0.05 incomparing with normal. Glomerular filtrations rate with TSH and FT4 the co-efficient of correlation (r) value for 35 patients to be – 0.713and 0.47 for TSH and FT4 respectively. Their p- values were 0.000 and 0.004 respectively, and p < 0.001 collectively. This was found tobe statistically significant. Linear regression line was obtained between GFR and TSH and GFR and FT4 in CKD patients. Conclusions:From these correlation studies I concluded that the chronic kidney disease is associated with biochemical thyroid dysfunctions causingmost commonly subclinical hypothyroidism.
PAPILLARY THYROID CARCINOMA;
Authors: SIDDIQUE FAIZA , AHMAD AHSEN NAZIR , AHMAD ASHFAQ , Ahsan Naveed , Gauhar Tooba Mehmud , Azim Khawaja Muhammad
Published: September 2021

At Mayo Hospital Lahore, from August 2010 to April 2011. Objective: was to determine the frequency of multifocalityamong all cases presented with papillary thyroid carcinoma (PTC) planned to undergo total thyroidectomy (TT). Material & Methods:Data of all patients of PTC was collected from inpatient department of East Surgical ward. All the patients underwent total thyroidectomyby same team of consultant surgeons. Results: A total of 35 patients of PTC with mean age of 37.94 years were included. Multifocaltumor was found in 31.4%. Out of them, 72.7% were females and 27.3% males. This case series showed that a multifocality is highlyprevalent in PTC and total thyroidectomy should be done as the treatment for PTC, to eliminate the additional tumor foci in thyroid glandand prevent its recurrence.
CESAREAN SECTION;
Authors: - QAMARUNISSA , - FKHARUNISSA
Published: September 2021

Study Design: Descriptive observational. Setting: The study was conducted in Gynaecological /Obstetrics department ofIsra University Hospital Hyderabad. Duration of study: One year from from1st April 2010 to 1st March 2011. Results: The total numbersof deliveries were 1522 out of them 551 (36.20%) were cesarean section while 971 (63.79%) were normal vaginal deliveries. Regardingthe age group majority of cases were 241(43.73%) belongs to 31 to 40 years. In our study majority of cases i.e. 328(59.52%) weremultigravida while 389(70.59%) cases belongs to low socioeconomic and 422(79.88%) were unbooked. Regarding indications most ofthe cesarean section were performed due to obstructed labour and main complication was found after cesarean section was PPH whilefetal complication was early neonatal death. Conclusions: The rate of cesarean section in our study was high. The commonest indicationof cesarean section was obstructed labour and majority of the patients belongs to low socioeconomic and were unbooked. Commoncomplication was PPH, fever from maternal side while fetal complication was early neonatal death.
MOLAR ECTOPIC PREGNANCY;
Authors: CHAUDHARY SHAMA , JANGDA IQRA , HUSSAIN RUBINA
Published: September 2021

Ectopic molar pregnancy is a rare occurrence. Clinical diagnosis of a molar pregnancy is difficult but histopathology is thegold standard for diagnosis. The management of ectopic molar pregnancies consists of surgically removing the conceptus, follow up &chemotherapy, if required. We are reporting a case report of a 35-year-old married, nulliparous woman, admitted in emergency with a 6-week history of amenorrhea, severe abdominal pain & an episode of fainting at home. Per abdominal examination revealed tendernessover the right iliac fossa, with guarding & rigidity. Diagnosis of ruptured ectopic pregnancy was made.Emergency laparotomy was done.Histopathological examination, showed tubal ectopic pregnancy with partial hydatidiform mole & a separate corpus luteal cyst.She wasfollowed up with serial beta hCG which became normal within 1 month. Although ectopic molar pregnancy is a rare entity but all ectopicpregnancies should be examined histologically to rule out presence of gestational trophoblastic disease to plan follow-up accordingly inorder to avoid persistent gestational trophoblastic disease which has a chance of malignant conversion.The prognosis of ectopic molarpregnancies is the same as for other forms of gestational trophoblastic disease.
ENDOGENOUS DEPRESSION;
Authors: SULTAN JAHANGIR , AFZAL TARIQ , JABEEN KOKAB
Published: September 2021

Objective: The aim of this study to determine the levels of Total triiodothyronine (T3) in patients with first episode ofEndogenous depression (prior to medical treatment) and in matched controls. Setting: Punjab Institute of Mental Health. Period: BetweenJan. and Dec.2011. Material & Methods: 100 newly diagnosed depressive patients in the age range of 18-65 years were included in thestudy. 60 healthy controls were taken from dermatological clinic. Total triiodothyronine (T3) was estimated using enzyme - immunoassay. The results obtained were analyzed using Statistical package of social sciences, Version 7.0 (SPSS 7.0). Results: No significantdifference in levels of Total triiodothyronine (T3) was found in depressive patients and control. Conclusions: Lower levels of T3 indepressive patients could lead to subclinical hypothyroidism and refractiveness. Therefore, thyroid profile in refractive patients issuggested.
BACKACHE IN PREGNANCY;
Authors: SHAHZAD NADEEM , ASLAM FARHAT , MALIK AISHA , HANIF ASIF
Published: September 2021

Introduction: Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant womenworldwide. Objectives: To find an association between backache and pregnancy with respect to obesity and to evaluate the effect ofphysiotherapy for relief of pain. Methodology: This longitudinal observational & randomized control study was conducted on pregnantfemales for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients (BMI>29.9) and non obese patients (BMI<29.9). All information was recorded on a Performa that was later entered and analyzed usingSPSS-11.5. Results: The mean age of all patients was 33.67±6.73 years with overall average gestational age of 27.47±5.19 weeks.Flexed posture was observed in 90(60%) patients and 60(40%) had very bad sitting habit. There were 80 (53.3%) obese and 70 (46.7%)non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine.st Most females reported that pain started during the 1 trimester (110) but only 40 females reported that they developed pain in the 2ndtrimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 (33%) patients who had severebackache while 100 (66.7%) had worse possible pain which was regressed to no pain in 140(93.3%) patients at final follow up visit andonly 10 (6.7%) had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant.Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. Conclusions: Weconclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also,more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapycan be recommended as the first line treatment for pregnant females.
Clinical Manifestations of Goldenhar Syndrome
Authors: NIAZI FUAD AHMAD KHAN , KHAN ABDUL MUNIM , NIAZI MANAL , Niazi Muhammad Afzal Khan
Published: September 2021

Goldenhar syndrome is a congenital disorder with diverse clinical presentation. This case series describes variousclinical manifestations of Goldenhar Syndrome. Materials and Methods: 11 patients at least two of the described features of Goldenharsyndrome were randomly included in the study to form a case series. Clinical data of all these subjects was documented, described inpercentages and analyzed. Results: Out of the 11 patients studied, 6 were females and 5 males. Mean age was 7.3 years (ranging from 1year to 23 years). 7 (63.6%) patients had a limbal dermoid, 6 (54.5%) patient had mandibular hypoplasia, whereas only 3(27.3%)presented with hemifacial microsomia. Spinal defects and polydactyly were present in (36.4%) patients each. There was one patient (9%)who had both microphthalmia and lid coloboma in addition to limbal dermoid. Similarly, renal defect (atrophic kidney), cleft upper lip andpalate and CNS defect (7th nerve palsy) were present in one patient (9%) each. None of our patients had either cardiac or GIT defect.Conclusions: In our study we were able to document the variable manifestations of Goldenhar syndrome with their frequencies. Thisknowledge base will help us in planning treatment and assistance strategies or these patients.
FISTULA IN ANO;
Authors: MEMON AMIR IQBAL , HUSSAIN ASIM , SHER GUL , Ishaq Muhammad
Published: September 2021

Objective: This study was planned to find out the clinical presentation and postoperative outcome of different surgicalprocedure in low type in low fistula in Ano. Design: Prospective observational study. Place and duration of the study: Study wasconducted in teaching hospital setting at LUMHS Jamshoro, Zia ud Din Teaching Hospital Karachi and DHQ JMC Teaching HospitalCharsadda. Liaquat University in Surgical Unit-I Jamshoro from May 2010 to June 2012. Patients Methods: One seventy cases of lowtype fistula in Ano with single external opening, irrespective of age and sex admitted in surgical unit-I, were examined. Mean age was 37years, patient’s rages from (15-60 years). Patients having high type fistula in ano identified pre and per operatively excluded from thestudy. A detailed history physical examination including local examination of anorectum focusing on the level of internal opening.Investigation like fistulogram done in selected case. Fistulectomy and fistulotomy performed in all these cases and patient followed upminimum upto the 6 months time. Results: Maximum Number of cases were seen in 3rd,4th, decade of life 50 (29.6%) and 64 (37%)respectively. Mean age was 37 ranges from 15 to 60 years. Out of 172 patients 142 (85.7%) male and 24 (14.3%) female. Male to femaleratio was 6.1:1. Majority of patients one forty two (82%) presented with discharge. Discharge along with swelling in 132 (76.7%).Hundred twelve (65%) underwent fistulectomy, 38 (22%) of the patients got fistulotomy and (12%) of patients underwent fistulectomyalong with haemorrhoidectomy and fissurectomy. A total of 72 (41.4%) patients experience different post operative, surgical andanesthetic complications. Conclusions: Incidence of low type fistula in ano is higher in 3rd and 4th decade of life. The disease was foundmore common in male, discharge, pain, itching are common symptoms of low type fistula in ano. In low type fistula in ano fistulotomy issafe procedure. Post operative complications can be prevented by careful treatment efforts.
ESOPHAGEAL VARICES;
Authors: AYUB AHSAN
Published: September 2021

Bleeding from esophageal varices is associated with high morbidity and mortality. It is currently recommended that allpatients with liver cirrhosis undergo upper gastrointestinal endoscopy to identify those who have esophageal varices. This approachleads to unnecessary endoscopies. There is need to evaluate clinical, laboratory and imaging parameters that may predict the presence ofesophageal varices and help select patients for endoscopy. Objective: Identify hematological, biochemical and ultasonographicpredictors of oesophageal varices in patients of cirrhosis. Study design: Cross sectional Descriptive study. Setting: Department ofGeneral Medicine and Gastroenterology unit 1, Services Hospital, Lahore. Duration of study: 6 months (April 01, 2007 – September 30,2007). Sample size: Study was done on One hundred patients who had established cirrhosis with oesophageal varices. Results: Majority(77%) were male who had evidence of esophageal varices. Hematemesis was the presenting complaint in 75% of patients and majority(83%) had clinically palpable spleen. Esophageal varices were present in 75% of patents who had platelet count <100, 000. In patientswho had portal vein diameter of >20mm 41% had evidence of esophageal varices. Splenic measurement of >13cm was associated withmaximum number of cases of esophageal varices i.e 82%. Conclusion: It is concluded from the study that male gender, clinically palpablespleen, low platelet count, portal vein diameter and splenic measurement can be used as non invasive parameters to predict esophagealvarices reducing the need of unnecessary endoscopies.
UTERINE RUPTURE;
Authors: MADHUDAR CHANDRA , GHORI AMBREEN , KHURSHID FARKHUNDA , Shah Syed Zulfiquar Ali , Devrajani Tarachand
Published: September 2021

objective: To evaluate frequency, maternal morbidity and mortality in patients with uterine rupture at Gynae Unit -II of civilHospital Hyderabad. Study design: Prospective descriptive study. Study setting: Department of Obstetrics and Gynecology, unit-IILiaquat University Hospital Hyderabad Sindh Pakistan; from 1st October 2010 to 31st March 2011. Subjects and methods: All thepatients diagnosed as case of uterine rupture was taken as study subject. Data was collected in a pre-designed porforma. Variableanalyzed were frequency, demographic characters, maternal morbidity and mortality. Results: During the study, 34 patients out of 1400deliveries presented with uterine rupture resulting in a frequency of 2.42%or 1: 41deliveries. 64.7%(22) patients were between 26 to 35years age and 67.64%(23) were multipara.26.47%(9) presented with extension of tears, 17.6%(6) with shock,20.5%(7) with septicemiaand 20.5%(7) with wound infection. Conclusions: Uterine rupture is yet a common obstetrical emergency in our area. The significantmorbidity and mortality deserves our special attention by a collaborative approach. Regular ante natal checkups, careful selection ofpatients for vaginal delivery, vigilantly monitoring during labor with smooth switch over to operative delivery can reduce this drasticobstetrical complication.
HYPOTENSION AFTER SPINAL ANAESTHESIA;
Authors: ALI AIJAZ , HAMID SHMYLA , HUSSAIN, RAJA MUSHTAQ , Iqbal, M. Rashid , Abidi Raza Ali
Published: September 2021

Objective: Aim of the study is to compare the efficacy of Ephedrine and Phenylephrine for treatment of hypotension afterspinal anaesthesia for elective caesarean section. Study design: Randomized Clinical Trial. Setting: Operation theatre Department ofAnaesthesiology, Combined Military Hospital Quetta. Duration of study: Six month from 16th Sep 2011 to 15th March 2012. Materialand Method: Seventy women undergoing LSCS for singleton pregnancy under spinal anesthesia were randomly assigned in group A andB (35 in each group). All patients preloaded with Lactated Ringer’s solution 15ml/kg body weight 10 minutes before administration ofspinal anaesthesia. Mean Arterial Pressure (MAP) was recorded before administration of spinal anaesthesia considered as Base-lineMAP and then at 1 Minute, 3 minutes & at 5 minutes after administration of spinal anaesthesia. When hypotension developed (MAP falls>20% from base line), intravenous single dose of ephedrine administered in group A patients, while in group B, Phenylephrine was given.Blood pressure was recorded after 1 minute following drug administration and up to 3 minutes at 1 minute interval. Patient handed over forprocedure after 10 minutes of spinal block. The SPSS version 13 was applied to the data. Mean and standard deviation were computed fornumerical variables like age, weight, height, systolic blood pressure, Diastolic blood pressure, and Mean Arterial pressure; whereasfrequency and percentages were employed to assess the categorical variable like efficacy. Chi-square test was used to compare theefficacy of intravenous bolus of ephedrine and phenylephrine. Statistical significance was taken at p<0.05. Results: There wassignificant difference in the efficacy of both the drugs, in the treatment of maternal hypotension. 74.29% were successfully treated ingroup “A” with a single dose of Ephedrine, as compared to group B where 51.43% were successfully treated with a single dose ofPhenylephrine. (p-value = 0.048). Conclusions: Intravenous ephedrine has more efficacy than phenylephrine in the treatment ofmaternal hypotension after spinal anesthesia for elective cesarean section.
POLYCYSTIC OVARIAN SYNDROME;
Authors: SHUKAR-UD-DIN SHAZIA , ASIM SADAF AHMED , RABIA SYEDA , Tabassum Rumina , Razzaque Aisha
Published: September 2021

Background: Polycystic ovarian syndrome is a common disease among the women in reproductive age group and morecommon in South Asian women. Clinical presentations include menstrual disorders, subfertility, obesity,hirsutism, acne vulgaris andacanthosis. Objectives: The objective of study was to investigate co relation between acne and polycystic ovaries and its relation tomenstrual irregularity. Methodology: A total of 56women were enrolled in the study from Outpatient Department of Obs&Gynae andDermatology, Dow University Hosptial, Ojha campus by convenient sampling. It was cross sectional study, conducted from July 2012 toNovember 2012.Verbal consent was taken. Sociodemographic information,Anthropometric measurement (height, weight, BMI) andacne severity with affected area, menstrual irregularities were administered on pre designed questionnaire.Pelvic ultrasound forpolycystic ovaries and serum LH, FSH in follicular phase of menstrual cycle (2nd day) advised from Dow Radiology and Dow Labrespectively. Results: A total of56 patients of PCOS were enrolled during five month period. The mean age of patient was 21.1+_SD0.994. Frequency of acne was 32 (57.1%).The mean BMI was 19.66 +_SD 4.54. Face was the commonest area involved in 24 (42.9%).menstrual irregularity was found in 50 (89.4%) women. There was no statistically significant relation seen between acne andoligomenorrhea. (X2 = 0.55 , P = 0.45). It was also determined that there was no co relation seen between the acne and serumtestosterone level calculated by independent sample t test.(P = 0.17) but statistically significant association seen between severity ofacne and serum LH/FSH ratio. (t test =3.28, p= 0.004) Conclusion: Acne was found in 32 (57.1%) women with PCOS. The study resultsrevealed a significant association seen between severity of acne and serum LH/FSH ratio. Relation between acne and serum testosteronelevel was statistically insignificant.
MENORRHAGIA;
Authors: ZIA FARZANA , BHAYANI SHAHZEEM , HUSSAIN RUBINA
Published: September 2021

Factor VII deficiency is a rare, autosomal recessive coagulopathy that becomes symptomatic in the form of a hemorrhagicsyndrome characterized by severe life threatening bleeding. This may present in young women as severe anemia due to bleeding pervaginum. We report one such case of a 12 year old girl who presented at the gynecology outpatient department with complaints of severemenorrhagia at menarche. Her past history was consistent with episodes of profuse epistaxis and bleeding from gums. Her completeblood count showed severe anemia. Upon further investigation her prothrombin time was prolonged but her APTT was normal which wasindicative of Factor VII deficiency and was confirmed by serum assays of Factor VII. It is important to diagnose this disorder earlier in orderto avoid long term complications especially in women who may suffer from severe life threatening hemorrhage during menses orrecurrent miscarriages during pregnancy. Therefore, our patient was transfused with packed cells and fresh frozen plasma immediatelyand started on low dose oestrogen and progesterone pill along with tranexemic acid to control her symptoms.
ALCOHOLIC INTOXICATION;
Authors: ILYAS NASIM , RAHIM KASHIF , MURTAZA SALEEM , Nadeem Sidrah
Published: September 2021

Objective: To assess the epidemiology of Alcohol consumption in Tehsil Hassan Abdal, district Attock, Punjab, Pakistan.Material and Method: The Medico legal cases record from 2009 – 2011 were studied for alcohol cases at Civil Hospital Hassan Abdal.Results: In the selected medico legal cases alcohol consumption was surprisingly reported only in male gender. Conclusion: Theinvolvement of younger males in alcohol consumption was found to be predominant. The trend of alcohol consumption was noted amongboth urban as well as rural population, with more urban cases as compared to rural.
HYDATID CYST;
Authors: MEMON FARZANA , SITWAT ATIF , MEMON JAWAID HUSSAIN
Published: September 2021

Background: Ecchino coccosis or hydatid cyst disease is a common parasitic disease that is known to affect bothhumans and animals and is an important health problem in poorly developed countries. Objectives: In this histopathological retrospectivestudy, we aimed to evaluate hydatid cyst disease occurring at different sites of body and were diagnosed during last fifteen years inpathology department, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro from January 1996 to December 2010.Study Design: Descriptive retrospective study. Materials: A total of 80 cases of hydatid cyst disease of different organs diagnosed atpathology department LUMHS Jamshoro and retrieved from Histopathological record. Results: Out of these 80 cases, 56 cases (70%)were of liver, 8 (10%) of lung, 5 (6.25%) of ovary. 01 case (1.2%) thyroid, 02 cases (2.5%) submandibular region and 8 (10%) eachoccurring at thigh, forearm, palm, cheek and fronto-temporal region. Majority of cases seen in females and M/F ratio of 1:3.6 and with agerange of 8-65 years. More than 50% of cases were seen between 30-65 years of age. Conclusion: Hydatid cyst of liver was mostcommon site followed by lung. But it can also be included in differential diagnosis of solitary cystic lesions of ovary and thyroid as well.
INFLUENCE OF TOURNIQUET APPLICATION;
Authors: ASLAM, FARHEEN , SHAUKAT ASTHMA , ALI, ZAKIR , Arain, Tariq M
Published: September 2021

Objective: The objective of the study was to determine the mean change in selected chemical analytes with and withoutapplication of tourniquet. Data source: Blood samples were collected from all persons irrespective of age and gender visiting pathologylaboratory, Quaid-e-Azam Medical College, Bahawalpur. Study design: The study was a Quasi experimental study. Setting: The studywas carried out in Pathology Laboratory, Quaid-e-Azam Medical College, Bahawalpur on Selectra XL and Easy lyte. Period: October 2011to April 2012. Subject and method: Blood samples were taken from both arms of 265 volunteer with one difference that standardizedexternal pressure of 60 mm Hg was applied by using a sphygmomanometer for one minute on one arm and on other arm blood samplewas collected without application of tourniquet. Results: Samples with tourniquet application showed statistically significant meanincrease in serum concentration of protein (p =0.001), cholesterol (p=0.03), calcium (p =0.007) and potassium (p=0.0001). Themean concentration of serum sodium and chloride showed no statistically significant change after one minute of tourniquet application.Conclusions: The tourniquet application of one minute influence certain laboratory parameters, so its use should be kept to a minimum.
TUBERCULOUS PATIENTS;
Authors: AZIZ NASIR , MAHMOOD HAMID , RIAZ HASHIM , Mahmood Zahid , Qadir Akhtar Murad , Munir Muhammad , Tayyab Muhammad
Published: September 2021

Objective: This study was designed to analyze the BCG vaccination status and compare the immune globulins levels in thehousehold contacts of tuberculous patients with non contacts of unexposed healthy peoples. Place: Gulab Devi Hospital, Post GraduateMedical Institute and Defense Housing Authority Lahore. Study design: Cross sectional study. Materials and Methods: Investigationslike ESR were done and the sera of 200 persons included in the study were tested for anti tuberculous antibodies by ELISA. BCGvaccination present or absent and scars were positive or negative in both groups were included. Results: The combined serologicalpositivity of the household contacts was 65.8% and for non-contacts was 34.1%. BCG scars were mostly absent in the householdcontacts as well as in non-contacts; But statistically IgG and IgA were present significantly by higher number in the household contacts ascompared to non-contacts, where as no significant difference in the IgM levels. These immunoglobulins status were compared with BCGscars in both study and control groups. The results were analyzed by SPSS version 14. Conclusions: Household contacts of tuberculosispatients are more susceptible to tuberculosis as compared to the non-contacts, as shown by positive and negative status ofantituberculous antibodies in the house hold contacts. More over BCG vaccination has no significant role in humoral evaluation.
VESICOVAGINAL FISTULA;
Authors: PERVEEN SAIMA
Published: September 2021

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CORTICOSTERIOD;
Authors: IQBAL SYED TALAT , BATOOL ZAINAB
Published: September 2021

Introduction: Indoor patients in hospitals frequently use corticosteriods for different indications. As the number of drugs inprescriptions increases, the risk of drug-drug interactions increases. This study deals with the frequent use and drug-drug ofcorticosteriods. Objective: The present study was designed to determine the frequency of use of corticosteriods in indoor patients andthe resulting drug-drug interactions. Study design: 270 Prescriptions of indoor patients from different wards of Aziz Bhatti Shahidteaching hospital Gujrat were collected randomly over the period of three months. These prescriptions were subjected to a drug-druginteraction software based analysis. The results were collected analysed and presented in the form of tables. Period: The patient chartscontaining prescriptions included in this study were collected over the period of three months. Material and Method: The software namedTHE MEDICAL LETTER ADVERSE DRUG INTERACTION PROGRAM was selected for finding the drug-drug interactions in randomlyselected indoor patient charts. Moreover, the frequency of use of corticosteriods was determined by simply counting the prescriptionscontaining corticosteriods out of total prescriptions and its percentage was found. Results: 29.25% patient charts were includingcorticosteriods in their prescriptions. Percentage of corticosteriod drug interactions found was 25.55%. Conclusions: Frequent use ofcorticosteriods in indoor patients can increase the risk of drug-drug interactions that should be monitored regularly.
EXCESSIVE CALCIFICATION OF PLACENTA;
Authors: GOSWAMI PUSHPA , MEMON SAMREEN , CHANNA MUHAMMAD ASLAM , Rathi Hemlata
Published: September 2021

Objective: To examine the morphological change due to excessive calcification of placenta of pregnancies complicated bypregnancy induced hypertension (PIH) and placental Abruption and its relation with fetal outcome. Study design: Case control type ofstudy. Place and duration: This study was conducted from June 2008 to July 2009 at the department of Anatomy of Liaquat University ofMedical & Health Sciences Jamshoro. Material and Methods: One hundred twenty placentae were collected from labor room andgynecology operation theatre of Liaquat University Hospital. Forty placentae from parturients that had pregnancy induced hypertension(PIH), forty from parturient having placental abruption & forty placentae of normal pregnancy (Control Group). Age of all parturients isbetween 17 to 32 years. Fetal outcome and data was recorded. Weight and diameter of Placentae were measured. Approximately five cmpiece of placenta was taken and processed for histological study. Results: The weight of placenta in control group were 450 to 650 gmwith a mean weight of 526.25± 8.414 gm and their diameter from 19 to 24 cm with a mean of 21.225±0.2148cm. In PIH group weight ofplacenta was from 200 to 550gm with a mean weight of 432.25 ± 11.889gm and their diameter ranges from 10 to 16cms with amean14.208 ± 0.1914cm. In placental abruption group the weight of placenta ranges from 180 to 400 gm with a mean weight of 284.88±9.084 gms and diameter ranges from 10 to 14cms with mean 13.070 ± 0.2504 cm. The difference in weight and diameter of placentain PIH and abruptio placentae was found statistically significant when compared with weight and diameter of normal placentae. Theweight of new born babies in control group was 1.8 kg to 3.6 kg mean weight of 2.790± 0.0689kg. In PIH group, the fetal weight was 1.4kg to 3.0 kg with a mean weight of 2.195 ±0.0703kg. In abruptio placentae group, the weight of new born baby ranges from 1.0 kg to2.8kg with a mean weight of 1.898 ± 0.0660 kg. Conclusions: Fetal outcome in cases of PIH and in abruptio placentae was poor ascompared to control group.
TORSION OF RIGHT UN-DESCENDED TESTIS;
Authors: Khalid Muhammad
Published: September 2021

A case of 14 months old child with history of uncorrected right cryptorchidism isreported here who presented with right inguinal abscess after 7 days of right groin pain.. Agenitourinary examination was performed, which revealed that his right inguinal region wasswollen and fluctuant, that was 5 cm in greatest dimension. No testicle was palpable in the rightipsilateral hemiscrotum. An ultrasound examination of the inguinal area revealed aheterogeneous testicle, with no blood flow on Doppler examination. Incision and drainageconfirmed torsion of the right undescended gangrenous testis. After. Incision and drainage andorchiectomy patient showed un-eventful recovery
ORAL HEALTH;
Authors: Ali Sarah , Ijaz Samra
Published: September 2021

Introduction: It has been now established beyond doubt that dental diseases arethe most common cause of human suffering. It is due to the impact of these diseases and humansuffering that World Health Organization has included Oral Health as one of the indicators forhealth of individual. The National Oral Health survey clearly indicates that oral diseases burdenthe people of Pakistan and there is lack of perception of needs or absence of tooth ache thatcauses a delay in seeking dental treatment. The survey also shows that preventive services arerare and there is lack of oral health education , preventive practices and lack of dental healthpromotional programs in Pakistan. There is no study at national level to reflect the extent ofawareness regarding oral health in population. The present study was conducted with theobjective of evaluating the extent of knowledge regarding oral health among patients visitingIslamic International Dental Hospital (IIDH). Materials and Methods: 200 patients visiting IIDHwere randomly selected in this cross sectional study that was conducted from May to July 2013.Out of these 80 were male and 120 were female. The age range of patients was from 15 to 60years. None of the patient had any psychological or motor dysfunction which could inhibit theperception and performance of oral hygiene measures. All the patients were educated andensured of anonymity. A multiple choice questionnaire was designed and distributed amongparticipants. The questionnaire included 13 questions with different responses andpredetermined answers. The data thus collected was compiled, analyzed using SPSS version 17and interpreted. In order to summarize the awareness level, responses were scored from 0-13based on the number of correct responses. The extent of awareness was graded on a three scaleparameter which was poor, fair and good. Results were expressed in terms of percentage.Results: The results showed that only 4% of the patients scored good while 43%% and 53%scored fair and poor awareness respectively. Conclusions: The study concluded that the level ofawareness regarding oral health is limited among patients visiting IIDH.