bluuebunny/crossref_metadata_2025 huggingface dataset:
FETO-MATERNAL OUTCOME;
Authors: QURESHI AYESHA ZAHOOR , RAO SHAHID , SIDDIQUE SHAZIA
Published: September 2021

Objective: To compare the effects of epidural analgesia and parenteral nalbuphine in labouring women with term pregnancieson feto-maternal outcome. Study Design: Randomized controlled trial Setting: It was carried out in the Labour Room, Nishtar Hospital, MultanPeriod: From June 2009 to December 2009. Material and methods: A total of 60 patients were included in the study. Patients were divided intotwo groups, having 30 patients in each group. Results: In group-A, pain control was much better and satisfactory (VAS=00-1), duration of labourwas slightly prolonged and instrumental delivery was more common. Low Apgar score and birth asphyxia were seen in group-B. No babydeveloped RDS in both groups. Conclusions: Feto-maternal outcome is much better in women having epidural analgesia with bupivacaine ascompared to women having intramascular nalbuphine.
THROMBOPROPHYLAXIS;
Authors: NABEEL NAUSHEEN , FAHIM FAUZIA , ABDUL HALIM TALHA
Published: September 2021

Maternal obesity (body mass index, BMI≥30kg/m²) is a global health problem. Significant evidence is available that it is directlyassociated with an increased risk of venous thromboembolic events in pregnancy and puerperium. Objective: This study aims to assess ourcurrent management protocols for thromboprophylaxis and to improve them according to guidelines recommended by The Royal College ofObstetricians and Gynecologists (RCOG). Design: Retrospective study. Period: September 2005 to December 2006. Method: In this study wedid a retrospective first audit cycle to evaluate the existing thromboprophylaxis management in women with high BMI (≥30) in our hospital.The aim was to check our compliance with RCOG recommendations and to introduce change in accordance with RCOG guidelines. Results:In first loop of audit cycle 120 pregnant women with BMI of more than 30 were evaluated.52 (43.3%) of them had no objective assessment doneduring antenatal period with no instructions regarding thromboprophylaxis. 3 of these patients developed Deep vein thrombosis (DVT).Change in practice was introduced based on findings of first loop of audit. In re-audit 120 pregnant women were reviewed with BMI of ≥30.Ninety eight(81.6%) women received Thromboprophylaxis, 22 (18.3%) did not receive thromboprophylaxis, none of them had any thromboticor embolic complications. Conclusions: Detailed objective assessment of obese pregnant women for thromboprophylaxis should beimplemented in our clinical practice according to the recommendations of NICE and RCOG guidelines.
TOCOTRIENOLS;
Authors: SHAHID Uzma , AHMED BUTT SHADAB , SHAUKAT FARHEEN
Published: September 2021

Objective: To evaluate the effect of tocotrienols on intimal thickening in ascending aorta of cholesterol-fed rabbits. StudyDesign: Randomized control trial. Place and duration of study: The Anatomy department of Army Medical College, Rawalpindi, from March2009 to February 2010. Material and Methods: Thirty, male, New Zealand white rabbits were randomly divided into three equal groups. Group-I was fed normal lab diet for six weeks. For the similar period, group-II & III were given 2% high cholesterol diet. However, group-III diet was alsosupplemented with tocotrienols (6 mg/kg body weight/day). By the end of study, aorta was removed from each animal. Cross sections fromascending aorta were processed and embedded in paraffin. Light microscopic examination was performed in H & E and Verhoeff elastic stainedslides. Results: Tunica intima in group-I appeared as single layer of squamous endothelial cells, lying on a thin layer of loose connective tissue.High cholesterol diet in group-II induced marked atherosclerotic changes which were characterized by extensive intimal thickening with raisedfatty streaks, pools of extracellular lipids, proliferation of smooth muscles and deposition of connective tissue matrix. Intimal thickening was alsoobserved in group-III, but lesions were of lesser degree than group-II (P<0.05). Histomorphometric analysis revealed significantly (P<0.001)higher thickness of intima in group-II and in group-III when either was compared with group-I. However, thickness of intima was 35% lesser(P<0.05) in group-III than group-II. Conclusions: Tocotrienols has significant potential in suppressing the intimal thickening of aorta incholesterol-fed rabbits.
BREAST DISEASES;
Authors: AHMED SHAIKH NASEER , DIN UJJHN IKRAM-UD- , CHANG FARZANA , Rajput Jawaid Aqeel
Published: September 2021

Breast lump is the common complaint of women in clinics, which includes the second leading cause of cancer deaths in women.Objective: The study was conducted to know the pattern of female breast diseases in our setup at Hyderabad / Jamshoro. Design: Adescriptive Study. Setting: Liaquat University of Medical and Health Sciences, Jamshoro. Material & Methods: Descriptive study Setting: Itwas conducted in the department of pathology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: Ten years from January2001 to December 2010. Results: Total of 2693 breast biopsies and mastectomies specimen included in this study, of which 278(10.32%)fibrocystic changes, 507(18.83%) inflammatory, 983(36.5%) benign and 889(33.01%) malignant. Conclusions: Benign Breast disease;fibroadenoma was the most common lesion. Infiltrating ductal carcinomas were next frequent, which reached hospital at late stage of disease.
POSTPARTUM HEMORRHAGE;
Authors: ALI ROBINA , HINA FARZANA
Published: September 2021

Introduction: Worldwide PPH remains one of the most common cause of maternal mortality and is largely preventable maternaldeaths mainly in low income countries. 80% of it occurs due to uterine atony and uterotonics can decrease the risk of uterine atony. Misoprostolhas powerful uterotonic effect because it is well absorbed and has potential to be used more widely than would be possible with injectableuterotonics alone. Objective: The objective of this study is to compare efficacy of misoprostol with ergometrine in cesarean delivery formanagement of PPH. Study Design: Randomized controlled trial. Duration of study: The duration of study was six months from 1/1/2010 to30th/6/2010. Setting: Department of Gynae and obstetrics, DHQ hospital, Faisalabad. Subjects and methods: All patients fulfilling inclusioncriteria were included in study and before cesarean section Hb was carried out and Patients were divided into two groups, GP , and GP . GP 1 2 1was given 800 ug MP per rectal just before starting cesarean Section and GP was given intravenous ergometrine at delivery of head or anterior 2shoulder. Blood loss was measured objectively after delivery of the baby with help of standard size kidney tray of 500cc and post operative Hbwas Carried out on 3rd post operative day. Results: 187 Patients were randomly allocated in GP and GP each. In GP , misoprostol was given 1 2 1800 μg per rectal just before starting cesarean section and 13 patients (7%) out of 187 have blood loss more than 500ml measured by standardsize kidney tray while in GP intravenous ergometrine was given at delivery of the head and in this group 25 patients (13.5%) out of 187 had 2blood loss more than 500ml, so misoprostol was found to be a better uterotonic than ergometrine for prevention of PPH. On the third postoperative day Hb was carried out and in GP 13 patients (7%) out of 187 had their Hb less than 9 g/dl while in GP 25 patients (13.5%) had Hb less 1 2than 9 g/d1. Conclusions: Mp is stable, cost effective and easily administrable drug and was found to be comparatively more powerfuluterotonic than ergometrine for preventing uterine atony.
OUTCOME OF STRICTUROPLASTY IN PATIENTS WITH INTESTINAL TUBERCULOSIS
Authors: BALOCH G. M. KHAN , HUSSAIN QURESHI KHALID , BHATTI ASIM
Published: September 2021

Introduction: Abdominal TB is one of the most prevalent forms of extra-pulmonary disease and is prevalent all over the world.Gastrointestinal involvement had been reported to be 55-90%. This study aimed to determine the outcome of stricturoplasty in patients withintestinal tuberculosis. Objective: To determine the outcome of stricturoplasty in patients with intestinal tuberculosis. Study Design:Descriptive case series. Setting: Department of General Surgery, Nishtar Hospital Multan. Duration with dates: Three years from January2009 to December 2011. Subjects & Methods: 120 patients of intestinal TB, who presented with intestinal obstruction in emergency and withsigns and symptoms of intestinal TB in outdoor patient department were selected. History of contact, family history of tuberculosis,immunization, past history of tuberculosis was taken. Diagnosis was confirmed by histopathology. Laparatomy was done in all cases andstricturoplasty was performed. Patients were followed up during hospitalization. Postoperative complications were noted. All information wererecorded on a proforma. Results: Out of 120 patients, 56.7% were male and 43.3% were female having age between 14 to 70 years. Mainpresenting symptoms were pain abdomen, vomiting, distension of abdomen, weight loss, anorexia and low grade fever with sweats. Maincomplications after stricturoplasty were chest infection 40(33.3%), wound dehiscence in 16(13.3%), leakage in 12(10%), recurrence in20(16.7%), scar pigmentation in 12(10%), keloid in 12(10%) patients and herniation in 8(6.7%) patients. Conclusions: Stricturoplasty is a safe,simple and easy operation, particularly useful at small peripheral hospitals with limited staff and resources.
ANTIHISTAMINES
Authors: GUPTA MEENAKSHI , SHARMA GEETA , SINGH JATINDER , Krishan Pal Rana Arun Gopal , Gupta Vinay
Published: September 2021

Objectives: Allergic rhinitis impairs social life, but it is not known whether quality of life may be improved when patient are treatedwith H 1 blockers. The present study evaluated the comparative efficacy and safety of cetirizine, loratidine and astemizole in patients of allergicrhinitis. Material &Methods: The design was open, randomized, parallel group comparison of three active treatment groups over a six weekperiod. Sixty patients of either sex in the age group of 16 – 45 years, suffering from allergic rhinitis were selected randomly. The effect ofcetirizine, loratidine and astemizole were observed on various parameters i.e., sneezing, nasal obstruction, watering of eyes, sedation andoverall well being of the patients over a period of six weeks. The Visual Analogue Scale (VAS) was utilized as a quantitative measure of symptomrelief. Results: An improvement in patient's discomfort as assessed by VAS was observed in all treatment groups, with cetirizine 10mg dailybeing significantly more effective than loratidine 10mg and astemizole 10mg. Cetirizine resulted in a significant reduction in sneezing and nasalobstruction as compared to loratidine and astemizole (p<0.05). Cetirizine and loratidine both were equally efficacious in relieving watering ofeyes but cetirizine as well as loratidine were more efficacious as compared to astemizole (p<0.05). Sedation was found to be maximum withcetirizine followed by astemizole and loratidine over six weeks of study period. Conclusion: Cetirizine has been found to be most effective inrelieving the symptoms of allergic rhinitis followed by loratidine and astemizole and it can also improve quality of life for patients with allergicrhinitis.
ECTOPIC PARTIAL MOLE;
Authors: SHARAF ALI HABIBA
Published: September 2021

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INTRAMEDULLARY INTERLOCKING NAILING WITHOUT IMAGE INTENSIFIER AND ORTHO TABLE
Authors: AHMED ORFI FAYYAZ , MAJEED SHAHID , ASLAM MUSHAHID , Siddique M Khalid
Published: September 2021

Interlocking nails are the gold standard treatment of fractures of shaft of long bones of lower limbs. It is also frequently performedfor most of the humerus fractures. The procedure is commonly performed using an image intensifier and orthotable. These are expensive andare not readily available in peripheral/field hospitals especially in resource – poor countries. Design: Retrospective study. Setting: FieldHospital Muzaffarabad and Combined Hospital Kharian. Period: Sep 2007 to July 2011. Patients & Methods: 138 consecutive cases offractures of femur, tibia and humerus shafts fixed with I/M I/L Nails in a field hospital. Reduction was achieved by open method in 87 (96.66%)cases of femur, 24 (60%) case of tibia and 5(62.5%) of humerus. Results: There were 34 females and 100 males’ ratio 1:2.94. All the cases wereadults with mean age 38.2 years and range was 16-78 years. Bones fixed were femur (90) 65.21%, tibia (40) 28.21%, and humerus (8) 5.70%.Fracture line was transverse in 104 (75.3%) and communited 10 (7.2%). Fractures were closed 112 (81.2%) and 26 (18.8%) of case. Recentfractures were 122 (88.4%) and old non united 16 (11.6%). Mean follow up period was 06 months - range 3 months to 1 ½ years. Complicationswere failure to achieve distal interlocking 6 cases, infection 3 cases. Union time averaged 3.5 months. Conclusions: It is therefore concludedthat I/M I/L nailing can be done without image and traction table.
STRESS IN MEDICAL EDUCATORS
Authors: DAUD SEEMA , KASHIF ROOTABA , SHUJA HAJRA
Published: September 2021

Background: Workplace or occupational stress are harmful physical and emotional responses that occur when there is anapparent mismatch between what doctors are trained for and what they are required to do. Data on workplace stress experienced by medicaleducators is scarce. Objective: To asses stress in medical educators and its job related predictors. Setting:Lahore Medical & Dental College(LMDC), Lahore and its affiliated Ghurki Trust Teaching Hospital (GTTH). Period: Three months, between January and March2009.Methods:A cross sectional survey was conducted. A structured questionnaire for background information and Workplace Stress Scale(WSS) were the data collection tools to survey 110 medical educators. Data was recorded and analyzed in SPSS 16. Chi Square test with p ≤0.05 as the cut- off point was applied for statistical significance. Results: Stress was present in 94% of respondents, with 21% having severestress. Age had statistically significant bearing on stress status (p=0.02), severity of stress (p=0.04), designation (p= <0.001) and monthlyearnings (p= <0.001). Main workplace stressors included inadequate control (96%), difficulty in expressing opinions (70%), unsafe workingconditions (66%), work overload and un-realistic deadlines (62%) and job pressures interfering with life (59%). Workplace motivators includedfull utilization of skills and ability for 97% (p=<0.001) and recognition or reward for good performance for 84% (p=0.06). Conclusions: Medicaleducators at LMDC, especially at junior level, reported high levels of both frequency and intensity of stress which need to be controlled.Autonomy and reward for good performance were motivational for our respondents.
ULTRASONOGRAPHY IN OBSTRUCTIVE JAUNDICE
Authors: AFZAL KIANI ASMA , JAVAID RANA HASSAN , GHAFFAR ABDUL , Khan Shamrez
Published: September 2021

Objective: To evaluate the validity of ultrasonography in patients who have obstructive jaundice. Design: Descriptive study.Place and duration of study: The study was carried out from September 2006 to May 2008 in department of Radiology Combined MilitaryHospital Quetta. Patients and Methods: A total of 30 patients; 14 male and 16 female underwent operation for obstructive jaundice. All of themhad preoperative ultrasonography. The site and nature of biliary obstruction were noted and the accuracy was determined with per-operativefindings / histological diagnosis as gold standard. Results: The cause of obstructive jaundice identified by ultrasonography with reasonablesensitivity of 90% and specificity of 90% for choledocholithiasis and sensitivity of 55.5% and specificity of 95.2% for pancreatic head tumours.Conclusions: Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and showsreasonable sensitivity and specificity to identify causes of obstruction in obstructive jaundice.
MUSCULOSKELETAL INJURIES BY BONE SETTERS
Authors: DASTGIR NABEEL , KHALID BUTT KAMRAN , NABEEL NAUSHEEN
Published: September 2021

Objective: To highlight, evaluate and analyze the complications associated with the treatment of fractures, joint dislocations andlimb deformities by bone setters in a suburban population of district Kasoor. Study Design: Prospective descriptive study. Setting: This studywas conducted at the Department of Trauma & Orthopaedics, Central Park. Medical College based at Bhatti International Teaching Hospital,Kasoor. Methods: This was a six month prospective study involving eighty six (86) consecutive patients presenting with complications related totreatment of their musculoskeletal injuries by bone setters. Results: Eighty six patients with complications associated with previous treatmentby bone setters were seen 62.7 (%) were male while 37.2 (%) were female. The age range from 4 months to 76 years (mean 34 years). Out ofeighty six patients, 15(17.4 %) patients had non union, 21 (24.4%) had malunion, 9 (10.4%) had avascular necrosis, 15(17.4%) had chronicosteomyelitis, 4(4.6%) patients had gangrene, 8(9.3%) had contractures, 2(2.3%) had persistent dislocations, 4 (4.6%) had Leg ulcers and8(9.3%) had wound infections. The major reasons for going to bone setters were the perceived low cost of treatment (45%), pressure and advicefrom the elders and friends (38%), fear of surgery (5%) and assumption of faster healing by the bone setters (12%).The methods used by thebone setters include splintage, bandage, plaster, stretching, massage and suturing. Conclusions: Bone setters create very difficult problemsfor orthopaedic surgeons. Many patients develop complications and loose their limbs due to inappropriate treatments. Awareness programesregarding inadequate treatment given by bone setters are necessary and their Patronization should be discouraged to avoid these types ofcomplications.
HELICOBACTER PYLORI IN NASAL POLYPOSIS
Authors: KHADEMI BIJAN , Azar Pira Negar , Ashraf Mohammad Javad , Chohedri Abdul Hameed
Published: September 2021

Background: Nasal polyposis is an inflammatory condition of unknown etiology. Recently concern regarding GER orHelicobacter pylori as a possible pathologic cause of nasal polyps has been increasing. The present study was planned to investigate thepresence of Helicobacter Pylor in Nassal polyps by PCR , rapid Urease test and serology. Design: Case control study. Setting: ENT ward ofShiraz, Khalilli Hospital, Iran. Period: April 2006 to March 2008. Materials and Methods: 37 patients with nasal polyps who had undergonenasal endoscopic sinus surgery and 38 control subjects who had undergone septoplasty and turbinectomy. Biopsy specimens of nasal polypsand inferior turbinates were assessed by PCR and Rapid Urease test. Blood sample of both study and control subjects were evaluated for antiH.pylori Ig G by ELISA. HP status was regarded as positive, if 2 tests were positive. Results: Seropositivity was more common in the patientswith nasal polyps (72.97%) than in the control patients (31.57%) (P-value= 0.000) RUT was positive in 9 (24.3%) of 37 patients with nasalpolyps, but was not positive in control group (P-value= 0.001). only 3 of (8.1%) of 37 patients with nasal polyps were positive for both RUT andELISA (P-value =0.115). PCR was negative in all patients and controls. Conclusions: Polypoid tissue can be colonized by some other agentscontaining a urease enzyme other than Helicobacer Pylori. So, result of RUT can be false positive, and addition test may be performed. In theour study by using PCR , we were not able to confirm presence of Helicobacter pylori in the nasal polyps. However, further epidemiologic studiesusing different and specific diagnostic tests with control of documented GER is recommended.
CONGENITAL TALIPES EQUINOVARUS
Authors: IMRAN KHAN Muhammad , AYAZ KHAN MUHAMMAD , SALMAN Muhammad , Hassan Raza
Published: September 2021

Objectives: To determine the functional outcome of one stage posteromedial release in congenital clubfoot in terms offunctional and radiological assessment. Methodology: Forty five patients having clubfoot deformity were included in the study. Fifteen patientshad bilateral deformities. The outcome was evaluated by functionally assessing the foot in the last review visit (at the end of 14thweek ofsurgery) using the rating system of McKay, which has ten categories and has a maximum score of 180 points. It rates the outcome as excellent,good, fair, poor and failure (Fig-1). Radiological assessment is made by measuring various angles on anteroposterior and lateral radiograph ofthe foot with gonometer at 3,6,10 and 14 weeks after release (Table-II). . The values of talocalcaneal angle (measured during every visit) on APand lateral views will be summated to yield talocalcaneal index, and an index of >40 degree was taken as normal. Results: Forty five patientsincluded in the study with clubfoot deformity. Out of these patients, 33 (73.33%) were males and 12 (26.66%) were females (table-I). They weregraded according to the McKay rating system. In this short term follow up of one year, the following results were observed. Thirty-nine (65%)patients had excellent results, 11 (18.33%) patients had good results, 3 (5%) patients had fair results and 7 (11.66%) patients had poor results(Fig-1). No case can be labeled as failure. Conclusions: Mild to moderated clubfoot deformities can be successfully treated in children up tofive years of age by one stage postero-medial release.
DIABETIC FOOT INFECTIONS
Authors: GUL AYAZ , IQBAL JAVID , AFRIDI ZIA UDDIN
Published: September 2021

Objective: The objective of this study is to know the frequency of methicillin resistant Staphylococcus aureus and its antibioticsensitivity in diabetic foot infections in our setup. Design: Cross sectional descriptive study. Setting: Surgical Department, Khyber TeachingHospital, Peshawar. Period: January 2008 to January 2010. Materials and Methods: A total of 84 patients, including 64 males and 20 females.Patient's identity, age, gender and the bacterial isolate on culture and sensitivity report were noted on a standardized proforma and analyzed onSPSS version 16.0. Patients of 18 years and both gender with type I & II Diabetes mellitus, diabetic foot ulcers of Wagner Classification SystemGrade 1 to 5 of 3 weeks duration, with infection and with no evidence of healing were enrolled in the study. Results: The overall mean age ofpatients was 60.8 years + 6.5SD with 9.2 + 0.5% HbA1c level. Frequency of methicillin resistant Staphylococcus aureus was 28.57%. Methicillinsensitive Staphylococcal aureus (51.19%), Pseudomonas aeruginosa (48.80%) and Escherichia coli (46.42%) were the common organismcultured. Methicillin resistant Staphylococcus aureus showed 100% sensitivity to Vancomicin, Linezolid, Meropenem, Imepenem andPipracillin/tazobactam. Conclusions: There is an alarming trend of increase in methicillin resistant Staphylococcus aureus because ofindiscriminate use of antibiotics in our set up which should be discouraged and a detailed knowledge of bacterial susceptibility to antimicrobialagents is necessary.
PERIPHERAL ARTERIAL DISEASE
Authors: HAYAT ATIF SITWAT , BAWANY MOHAMMAD ADNAN , HUSSAIN BALOCH GHULAM , Shaikh NAILA
Published: September 2021

Background: The increase in prevalence of type 2 diabetes and its complications is alarming. The incidence of diabetic footulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries.This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiarycare settings in Abbottabad. Methods: This was a prospective descriptive study-being conducted at Northern Institue of Medical Sciences(NIMS) and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer thanten days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation ofperipheral arterial pulses in the lower limbs. Ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle to that in the arm.Peripheral arterial disease (PAD) was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severeaccording to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American DiabetesAssociation. Results: A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age ofstudy subjects was 53.68±9.51 years. There were 33 (39.75%) males and 50 (60.24%) females with M to F ratio of 1:1.51. Mean duration ofdiabetes was 13.67±5.80 years (ranging from 9-23 years). Majority 57 (68.67%) of our patients were obese having poor glycemic control.Peripheral arterial disease has been found in 35(42.16%) patients, out of them 18(51.42%) had mild PAD as their ABI values remained between0.70-0.90, 15(42.85%) had moderate PAD due to their ABI values between 0.50-0.69 and 2 (5.71%) had severe PAD as their ABI values liebelow 0.49. Conclusions: Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial diseasein type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients.
SCURVY
Authors: RASHID AMIR , AHMED FARHAN , IQBAL KHAN HUMAYUN
Published: September 2021

Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. It is extremely rare in industrialized socities but stillexists in higher risk groups including economically disadvantaged populations with poor nutrition. We are reporting a case of 4 year old Asadwho presented to our department with this condition.
SELF MEDICATION PRACTICES
Authors: BAIG SHAHBAZ
Published: September 2021

Introduction: Obtaining and consuming drugs without the advice of physician either for diagnosis, prescription or surveillanceis called Self medication. Self medication has been a natural tendency of mankind at all times to relief their discomfort. Objectives: To assessthe self medication practices and the factors influencing self medication practices among the people living in Ghulam Mohammad Abad,Faisalabad. Study design: A Descriptive Cross -Sectional Study. Setting: Population of Ghulam Mohammad Abad, largest colony ofFaisalabad. Material & methods: By simple random technique a sample of 369 people living in Ghulam Mohammad Abad were selected. A pre-tested questionnaire was filled by interviewing each individual. Results: Prevalence of self medication found in study group was 61.20%. Anincrease pattern of self medication practices were found in the younger age group (15-35 years) which were 64.8 %. Self medication practicewas found more in male (64.5%) as compared to female (58.5%). The unmarried persons as compared to married were involved 8% more in selfmedication. Similarly 11% increase pattern of self medication was observed amongst the respondents belonging to nuclear family (66.9%) ascompared to extended type of family status (55.9%). There were 13.60% more practices of self medication in urban population (64.2%) ascompared to rural (50.6%) and self medication was observed in illiterate (50.4%) and in matric level education (62.3%) and persons havingeducation above matric (74.4%). The prevalence of self medication was more among skilled labor (75.9%) as compared to (54.9%) in unskilledlabor. Conclusions: An increase pattern of self medication practices were found in the younger age group. As for as the gender is concerned itis more in the male as compared to female. Unmarried persons as compared to married persons were involved more in self medication. It ismore in persons belonging to nuclear family status and also more in urban population as compared to rural population. Furthermore uneducatedand respondents having education up to matric are more involve in self-medication practice. Advice of person selling medicine at medical storewere having more affect on self medication. No reason for the use of drugs and un–affordability are also the determinants of increased selfmedication.
PERIODONTAL TISSUE DESTRUCTION
Authors: ALI SARAH , NASIR NOMAAN , AHMED BRIG® KABIR
Published: September 2021

Introduction: Periodontal diseases are the most common inflammatory diseases affecting the oral tissues. Objectives: Thisstudy was conducted to determine the extent of destruction of periodontal tissues in patients visiting Islamic International Dental Hospital (IIDH)and also to compare different variables e.g. age, brushing, plaque, calculus, recession, BOP, systemic diseases etc with periodontaldestruction. Design: Cross sectional study. Setting: Department of Periodontology Islamic International Dental Hospital, Islamabad. Period:November 2011 to December 2011. Materials: 80 patients 52 males and 28 females were randomly selected. A questionnaire was designedand two house officers were calibrated and trained in filling the questionnaire and examining the patient in department of Periodontology ofIslamic International Dental Hospital. Results: The results show that 25% of the patients were healthy with no loss of supporting structures. 30%of the patients had early periodontal destruction, 28% of patients had moderate periodontitis and 17% were having advanced periodontaldestruction. Periodontal destruction was more in males as compared to females and periodontal destruction increased with increasing age.Conclusions: It may be concluded from the study that prevalence of periodontitis increases with advancement of age.
GIANT HYDRONEPHROSIS
Authors: AHMED SHAIKH NISAR , SHABIR SHEIKH GHULAM , AHMED LARIK SHABIR , Iqbal Muhammad , Hussain MALIK
Published: September 2021

Objective: To study the clinical presentation and management of giant hydronephrosis. Setting: Civil Hospital Dadu andUrology Department SMBBMU Larkana. Period: March 2004 to march 2011. Patients and methods: 28 Patient with giant hydronephrosistreated. 18(64.3%) patients had unilateral and 2(7.1%)had bilateral pelvi ureteric junction obstruction, 4(14.3%) had ureteric stones andremaining 4(14.3%) had multiple renal stones. All patients were treated with definitive surgery ie pyeloplasty, nephroplication, ureterolithotomy,extended pyelolithotomy and nephrectomy. Six (21.4%) patients had elevated blood urea and serum creatinine level so initially treated bypercutaneous nephrostomy and ureteric cathetrization. Result: 10 out of 28 cases of giant hydronephrosis showed improvement in the functionand drainage as well as pelvi-calyceal system dilatation while 18 patients going for nephrectomy. Conclusions: Early referral and interventionis necessary for giant hydronephrosis to prevent infection and deterioration of renal function.
METHANOLIC EXTRACT
Authors: AHMED Usman , ASADULLAH MUHAMMAD , AHMED S. I. , Ilyas Hafiz Muhammad
Published: September 2021

Purpose of Study: The aim of this study is to look at the plant based such compounds that are known to have hepatoprotectivepotential. With above perspective, the study has been planned to see the hepatoprotective potential. To see hepatoprotective effect on theenzyme levels and histopathology. With the help of this study, some new hepatoprotective compound may be discovered which will help indeveloping an effective medicine. Material & Methods: The extract of Melia azedarch’s flower was screened for hepato protective effect. Albinorats were administered with carbon tetra chloride (CCl4) for inducing liver damage. Results: The effect of the extract was evaluated bymeasuring the liver enzymes like SGPT, Alkaline Phosphatase, Bilirubin and Gamma-GT in the serum. In the extract treated animals, there wassignificant decrease in liver enzyme levels. This observation leads to the conclusion that Melia flower extract possesses hepato protectiveactivity. The hepato protective activity of the methanolic extract was compared with standard Poly herbal formulation named Jigrine CL.Conclusion: In our study, we found the extract of Melia Azedarach (Flowers) has strong hepatoprotective activity.
LAPAROSCOPIC ASSISTED RIGHT HEMICOLECTOMY
Authors: REHMAN EHSAN UR , ALI KAMRAN , AVAIS SHAHZAD , Mustafa Ghulam , Rashid Masood
Published: September 2021

Objective: To assess the outcome of laparoscopic assisted right hemicolectomy in benign diseases like tuberculosis. Studydesign: Prospective observational study. Setting: Surgical unit –I of Jinnah Hospital Lahore. Period: Jan 2009 and June 2010. Material andMethods: This study included a series of twenty patients with preoperative clinical diagnosis of ileocecal tuberculosis. A three trocar techniquewas used to perform laparoscopic right hemi colectomy and anastomosis was performed outside the abdomen by extending the supraumbilicalincision. Results: Data of 20 patients who underwent laparoscopic assisted right hemicolectomy was analyzed. Mean age of the patients was27.5 years with male to female ratio 4:1 (Table-I). There was zero conversion(0%) to open surgery and no intra-operative complications(0%)were observed. Average hospital stay was 5.8 days. No patient had to be re operated. On histopathology of specimen final diagnosis was 95%ileo cecal tuberculosis and one patient (5%) turned out to be having lymphoma (Table-III). Conclusions: The laparoscopic colon surgery canproduce excellent results in selected patients of abdominal tuberculosis. Advantages of laparoscopic over open surgery include lesspostoperative pain, short-term postoperative ileus, earlier return to daily activity.
ULTRASONOGRAPHY, X-RAY AND INTRAVENOUS UROGRAPHY (IVU)
Authors: SHEIKH MUHAMMAD ASIF , PANSOTA MUDASSAR SAEED , RASOOL MUMTAZ , Tabassum Shafqat Ali , Saleem Muhammad Shahzad
Published: September 2021

Objectives: To know the sensitivity and specificity of ultrasound with plain abdominal film (X-ray KUB) compared to IVU inevaluation of renal colic. To develop a protocol for investigations of renal colic. Design of study: Experimental. Setting: Department of Urologyand Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur. Period: From July 2010 to December2011. Materials & Methods: The number of cases for the study were one hundred and fifty. Patients of either sex of age range from 10 to 50years with suspected urinary tract stone disease, PUJ obstruction and stricture ureterovesical junction were included in this study. Whilepatients of age <10years, renal failure and with history of hypersensitivity to contrast media were excluded from the study. After routineinvestigations, ultrasonography, plain X-ray KUB and IVU were performed in every patient at radiology department, Bahawal Victoria hospital,Bahawalpur. Results: The mean age of patients was 41.14±1.30 years. The ratio of male to female was 2.8:1. Presenting complaints ofpatients were flank pain. Maximum duration of complaint was 5-6 years. USG + X-ray KUB findings were obstructing renal stone, ureteric stoneand PUJO in 97(64.67%), 25(16.67%) and 28(18.67%) patients respectively. While on IVU, obstructing renal stone, PUJO and ureteric stonewas found in 87(58%), 31(20.67%) and 32(21.33%) patients respectively. Conclusions: This study shows that ultrasonography and plain X-rayabdomen (KUB) is sufficient for the diagnosis of renal disease presenting with renal colic.
HEMODIALYSIS
Authors: NAWAZ BHATTI AHMAD , DIN AWAN SAIF UD , ANWAR ASIYA
Published: September 2021

Background: Chronic renal failure / End stage renal disease is not only a medical illness but it also has wide ranging effects onthe patient and his family. Objectives: The objective of the study was to evaluate socio-economic impact of hemodialysis on patientsundergoing dialysis Setting: DHQ Teaching Hospital, Sargodha. Study Design: Cross sectional survey. Methods: The study was carried outa at our dialysis center. All 60 patients who were on dialysis schedule were included in the study. A structured questionnaire for socioeconomicimpact of dialysis was employed to collect the required data. by a third party i.e. a teacher and students of departments of Social Work,University of Sargodha, who were not involved in any part of the patient’s management, to avoid Physician bias and free expression by thepatients. Data was collected on questionnaire and analyzed. Results: A total of 60 patients were interviewed with male to female ratio of 3:1.Average age was 45.92 years. Sixty five percent lived in joint family. Majority of the patients had hypertension as the cause of renal failure. HCVwas positive in fifty five percent. Eighty percent patients were started on dialysis with a central venous access catheter. Sixty one percent weresatisfied by the behavior of their families while, fifty three percent said that the society showed sympathy towards them. Only thirty one percentwere satisfied with their life. About half the patients had economic stress. Forty one percent said that they have become isolated. Fifty onepercent were depressed. Fifteen percent were not satisfied with the attitude of nursing staff while ten percent patients by that of the doctors.Twenty five percent were not satisfied by the quality of medicine provided by NGO. Conclusions: Hemodialysis for ESRD is an expensiveendeavor. No government can cope with the ever increasing number of patients with ESRD. Community participation in terms of social groupsand financial assistance is an important factor to help this group of ailing population.
INCIDENTAL APPENDECTOMY
Authors: AHMAD MUMTAZ , AHMAD MAQSOOD
Published: September 2021

Objective: To determine the benefits of incidental appendectomy during abdominal hysterectomy in terms of post-operativecomplications and cost of operation. Duration: (5 years) 2003 to 2008. Design: Retrospective study. Methodology: 171patients who did (n:73) or did not (n: 98) undergo elective incidental appendectomy at the time of uncomplicated total abdominal hysterectomy from 2003 to 2008 atthree different hospitals by a single surgeon. The data was obtained about age, operation time, hospital stay, postoperative complications like(fever, wound infection, abscess formation, wound collection, wound dehiscence). Post-operative follow up was done for 5 years. Data wasanalyzed with chi square test using SPSS 16. Results: Seventy three incidental appendectomies were performed in this study of 171 patients(43%). The procedure was most commonly performed with total abdominal hysterectomy. Bilateral salpingo oophorectomy was performed in27 (16%) while unilateral in 13 cases (7.6%). Histopathology was done in 114 cases of uterus (70%), all the ovarian samples (100%), and 14 ofappendixes (19%). Only 06 appendixes out of 14 were reported inflamed (42.8%). Sixteen patients (16.3%) out of remaining 98 patientsreported for appendectomy within 3 to 5 years following TAH. P value <0.05 was considered significant and results of both groups werecompared with mean and P value. Conclusions: The data from current study and review of literature affirms incidental removal of theappendix. The two groups are comparable to each other in all parameters and perforation. The decision to perform an elective coincidentalappendectomy at the time of an unrelated gynecologic surgical procedure should be based on individual clinical scenarios and patientcharacteristics and preferences.
TEACHING METHODOLOGIES;
Authors: MUKHTAR Fatima , HASHMI NOREEN , RAUF MUHAMMAD ALI , Anzar Amna , Islam Butt Khurram , Ahmed Moneeb , Abbas Kumail
Published: September 2021

Objective: To determine preferences of medical students for modes of teaching, qualities of a good teacher and assessmenttechniques in medical education. Design: A descriptive cross-sectional study. Setting: Lahore Medical and Dental College, Lahore. Period:January 2011. Material & Methods: All students of third and fourth year MBBS classes were included in the study (n=127). A pre-testedquestionnaire was used for data collection. A 7-point Likert scale ranging from 1(strongly disagree) to 7(strongly agree) was used to determinestudent’s preferences of teaching styles. The data was recorded using SPSS version 16.0. Descriptive statistics were computed. Results: Thepreferred teaching methods for basic science subjects were skills laboratory 88(70%), followed by problem based learning 70(55%) andinteractive lectures 65(51%). The same teaching methods i.e. skills laboratory 101(80%), problem based learning 89(70%) and interactivelectures 79(62%) were also popular for the teaching of clinical science subjects. The least preferred teaching method for both basic 51(40%)and clinical 58(46%) sciences was didactic lectures. The desirable quality of a good teacher was reported as teaching skills 111(87%) and thepreferred assessment technique was found to be multiple choice questions 90(71%). Conclusions: Students prefer the student centredteaching styles as opposed to the traditional approach. Good teaching skill is the most desirable quality of a teacher and most students like to beassessed by multiple choice questions.
DOG BITES;
Authors: BAJWA MUHAMMAD ASLAM , MANZOOR SHAHEENA , Ahmed Aftab
Published: September 2021

Every day, 25–30 new cases of dog bites are treated at the civil hospital in Karachi. In absence of accurate number of rabiesdeaths, Infectious Disease Society of Pakistan suggests there are around 2000–5000 rabies deaths per year2. The estimated prevalence ofdog bites in Punjab is 0.03%, but no such estimate is available for Lahore3. Objective & Method: A community-based survey was carried out toassess the burden, determinants and public services available for dog bites in Lahore district, Pakistan. Results & Discussion: Theprevalence of dog bites in the study population was 21.3%. The most common site of bites was the legs (68.4%), followed by the abdomen ortrunk (12.1%), and hands or arms (5.6%). Among respondents to an exit interview administered to clients seeking care from an antirabiescentre, the most frequent age group of victims of dog bites was 16–60 years (53.4%). The majority of respondents had been bitten by stray dogs(63), while 47 respondents were bitten by their own or others’ pet dogs. Six respondents reported bites from rabid dogs. One hundred andseven (107) respondents said they had received vaccination at dog-bite centres; 89% of respondents confirmed the availability of vaccine,while 74.1% respondents said that they did not pay fees for services. Conclusions: The life-time prevalence of dog bites among respondentswas 21.3%. The most frequent age group of victims of dog bites was 16–60 years. Both stray and pet dogs had bitten the victims.
CONTRACEPTIVE METHODS;
Authors: SHAHBAZ TAZEEM , MEHMOOD SADIA , UL HAQ FAHIM
Published: September 2021

Objective: To estimate the knowledge, prevalence and factors associated with practice of modern contraceptive methodsamong currently married males of reproductive age group (20-49years) in soldier bazaar Karachi Pakistan. Period and Setting: The study wascarried out in Karachi in 2010 in area of soldier bazaar. Methods: In person interviews were carried out with150 males (Aged 20-49) fromdifferent areas of Soldier Bazaar which were taken randomly. Data was collected regarding socio-demographic features, reproductive profile,family size, knowledge, and practices of family planning services and reasons for non-use of contraception. Results: The half of respondentshas knowledge about condom (52%), IUCD (44.6%), Oral pills (43.7%), injection (41.3%) and tubal ligation (32.6%). Knowledge aboutwithdrawal and male sterilization (vasectomy) which are male contraceptive methods is low. Only 19.3% respondents know about all themethods and another 9.3% do not know about any method.32% respondents showed willingness to undergo vasectomy as compared to 68%who are not willing for the procedure.8% of the respondents use some of family planning methods 30% of respondents (and their wives) did notuse any contraceptive method because they want more children. Surprisingly 3.5% respondents among non-users did not know about thefamily planning methods. Educational level has shown direct relationship with knowledge and practice of family planning. Conclusions:Prevalence of male contraceptive methods along with knowledge of other methods is found very low and has direct relation with attitude andpractice of family planning, not only among themselves but also on the adoption of contraceptive measures of their wives.
NON –TRAUMATIC LOWER EXTREMITY AMPUTATIONS IN DIABETICS
Authors: ATEEQ Muhammad , BASHIR ABID , JEHAN SHAZIA
Published: September 2021

Objective: The purpose of this study was to estimate the prevalence of non -traumatic lower extremity amputations in diabetic inperipheral teaching hospital catchment area. Study Design: Prospective, Cross sectional, Interventional. Setting: Surgical Unit II. Aziz BhattiShaheed (Teaching) Hospital. Nawaz Sharif medical College, University of the Gujrat. Study Period: February 1, 2011 to January 31, 2012.Results: A total of 132 patient were subjected to non traumatic lower extremity amputation were enrolled in this study out of which 89 (67.42%)were diabetic, followed by non specific infections n=39 (23.48) Out of 89 total diabetic patients 53 (40.15%) patients were female whereas 36(27.27%) were male. Both major and minor non traumatic lower extremity amputation rate was more in female diabetic patients than malediabetics. Conclusions: The prevalence of non –traumatic below knee amputations at an early age is high in our diabetic patients, especially infemale population. By improving primary health care service regarding foot care awareness in diabetics appears to be the main way to reducethe amputation rate.
INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);
Authors: ASGHER Muhammad , GHAURI ASIM , ABDULLAH MUHAMMAD , Abassi Tariq
Published: September 2021

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.