bluuebunny/crossref_metadata_2025 huggingface dataset:
UNRESECTABLE HEAD AND NECK CARCINOMAS
Authors: MASUD AHMAD IJAZ , MAHMOOD QAISER , SIDDIQUE NASREEN
Published: September 2021

Introduction: Cancers of the head and neck are estimated to be the most prevalent cancers in the world. Data from various cancer centers of Pakistan reveal that epithelial head and neck cancer is one of the most frequent cancers varying from 12 to 25% of the total new patients seenannually. Objectives: To see the effect of concomitant chemo-radiotherapy on the survival of patient, to assess the toxicity of different treatment arms and the effect of age, sex and bulk or tumour on survival and compare the literature. Setting: Radiotherapy Department, Nishtar Hospital, Multan. Duration: 2 years. Material and Methods: Sample Size: 200 patients. Results: Out of 130 patients, 83 were males and theremaining 47 were females. The male to female ratio being 1.8:1. The mean age of the patients included in the study was 52 years, range being 22-80 years. The patients of head and neck cancer in the trial had different sites of involvement. In the trial the patients presented with various symptoms such as pain, swelling, ulcer, bleeding, dysphagia, dyspnea, hoarseness of voice and nasal obstruction etc. No patient had early stage disease. All the patients in the trial had the experience of nausea and vomiting, it was more marked in patients having radiotherapy; either alone or in concomitant with chemotherapy. The patients having concomitant chemo-radiotherapy i.e. group-C also had diarrhoea as a side effect. The effect on the liver function test was more pronounced in patients of group-A. The renal function was seen to alter more in patients receiving chemotherapy with cisplatin, whether as induction or as a concomitant to radiotherapy. Conclusion: Concomitant chemo-radiotherapy in locally advanced, unresectable head and neck carcinoma is statistically superior to induction chemotherapy followed by radiotherapy and the standard radiotherapy alone.
CAESAREAN VERUS VAGINAL DELIVERY IN THE MANAGEMENT OF ECLAMPSIA.
Authors: FARHAT RAHILA , ROOHI MAHNAAZ
Published: September 2021

Objective: To compare the results of vaginal delivery and caesarean section in the management of eclampsia in terms of maternal, fetal, morbidity and mortality. Study Design: This is a comparative study. Setting: It was carried in Gynae Unit I of Allied Hospital, Faisalabad, Period: From August 1999 till required sample was complete. Material and Methods: Hundred patients presenting to labour room with history of fits and hypertension were included in the study. Patients were divided into two groups. Group A included those patients under going L.S.C.S Group B included those undergoing vaginal delivery. Diagnosis was made on history examination and laboratory findings. Results: It was seen that maternal morbidity and mortality was low in patients undergoing vaginal delivery. There was no mortality in group B whereas in patients who had undergone L.S.C.S 6 expired. The need for ventilatory support was increased in group A (12 patients landed in ICU because of delayed recovery from anaesthesia). In group B no one needed ventilatory support. Those patients undergoing LSCS required more time to attain consciousness as compared to those undergoing vaginal delivery. Those undergoing LSCS required antihypertensive drugs for longer duration as compared to other group. The duration of hospital stay was decreased in patients of vaginal delivery. Conclusion: According to study carried out in Allied Hospital showed a decrease in maternal morbidity and mortality in patients undergoing vaginal delivery.
TRACHEA! INTUBATION
Authors: CHOHEDRI ABDUL HAMEED , AZEMATI SIMIN , GHAFFARI SINA
Published: September 2021

Background: Administration of remifentanil followed by thiopental provides adequate conditions for tracheal intubation without muscle relaxants. However, controversy still remains on the best dose of remifentanil. Objectives: To identify the optimum dose of remifentanil in which the best intubating conditions could be achieved. Design: prospective randomized double biind clinical trial Period: From June 2004 to November 2005. Material & Methods: In a randomized, double blind study, 90 ASA I or II patients were randomly divided into three equal groups (n=30). Intubatingcondition and hemodynamic changes were assessed after injection of remifentanil 2.0 pg/kg (group A), 3.0 (jg/kg (group B) and 4.0 (jg/kg (group C). This was followed by thiopental 5mg/kg. Ninety seconds after administration of the hypnotic agent, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, satisfactory, fair or unsatisfactory on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff. Hemodynamic changes were recorded at baseline, 1 min after induction, 1, 3 and 5 minutes after intubation. Results: Excellent intubating conditions were observed in 13.3% (n= 4), 46.7%(n=14), 83.3% (n=25) of patients in Groups A, B and C, respectively. Overall conditions at intubation were significantly (P<0.05) higher with 4pg/kg remifentanil compared with other doses. Conclusion: Intubation conditions were best when using thiopental 5 mg/kg combined with remifentanil at 4 mg/kg and no muscle relaxant.
A LAPRATOMY FOR MISSED IUCD
Authors: ATA NABEELA , KHAN ATA ULLAH , AHMED EJAZ
Published: September 2021

The intrauterine device is an effective long acting methodof contraception, which is perhaps under rated indeveloped world. It results in a local inflammatoryreaction within the cavity of the uterus, which probably,acting through tubal and uterine fluid, interferes with theviability of both sperm and eggs1. It also inhibitsimplantation. Inert devices are no longer recommended,like lippe’s loop. Modern copper containing devices arelicensed for use over 5 (Nova T380) to Copper T380years, after a woman reaches 40 the device need not bechanged and can be removed. One year after the lastmenstrual period copper IUDS consisting of a plasticframe with wire round the stem and some cases coppercaps on arms. The surface area of the copperdetermines the life span and efficacy of the device2. Aframe less IUD gynafix composes six copper beadsthreaded to hold them all in place and the sting has aknot at the proximal end which is embedded, using aspecial insenter into myometerium, anchoring it in place.A levonorgestrel releasing device has been licensed in1995under the trade name of Mirena
COMPUTERIZED AXIAL TOMOGRAPHY
Authors: HAFIZ AMRAN , MASOOD NAVEED , HUSSAIN FAYYAZ
Published: September 2021

Objectives: to evaluate the clinical safety, effectiveness, efficacy andpotential side effects of sedation in pediatric patients undergoing computerized tomography by intrarectal thiopentoneand to compare this technique with general anaesthesia for computerized tomography in paediatric patients. StudyDesign: Interventional and analytical / comparative study. Place and duration of study: The study was carried outin Radiology department Combined Military Hospital Rawalpindi over a period of 1 year from Jan 2003 to Jan 2004.Material and Methods: Sixty children below 5 years of age were selected by nonprobability convenience samplingand divided into 2 groups A and B, each comprising of 30 children .Group A was sedated by thiopentone sodium thatwas administered rectally and group B received general anaesthesia with a uniform technique. Results: in group Aquality of sedation was judged to be adequate in 26 out of 30 patients (86.6%). Another 2 were sedated but requiredmild restraint like reposition of the neck leaving 2 with inadequate sedation or an overall failure rate of 6.66%.In groupB the success rate was 100% with no observation of any complication. Conclusion: rectally administered thiopentalis a safe and effective sedative for paediatric patients requiring CT scanning in the presence of anaesthesiologist andthe failure rate is very low. General anaesthesia makes CT scan more successful with minimal adverse events.
FINE NEEDLE ASPIRATION CYTOLOGY
Authors: BARI ABDUL , Mirza Dr. Jamil Ahmed , WADOOD AHSAL-UL- , QASIM KHAWAJA FAROOQ
Published: September 2021

Introduction: Lymph nodes are frequently enlarged in children in a widespectrum of diseases, some are of great concern while others are trivial from clinical or diagnostic point of view.Objectives: To evaluate the diagnostic role of fine needle aspiration cytology in lymphadenopathy in pediatric agegroup. Period: Jan 2001 to Aug 2005. Material & Methods: The material was obtained by FNA from children of theregion, stained with H & E, Papaniculau, giemsa and Z.N Stain. History, physical examination and other pertinentclinicopathological parameters were noted before the FNA procedure. The biopsy material where available wassubsequently correlated with FNA diagnosis. Results: A total number of 120 cases were included in the study. Out ofthese 64 were females and 56 were males. Out of non malignant cases the most common diagnosis in our cases wasreactive lymphadenitis. Conclusions: Fine needle aspiration cytology is a reliable easy and economic technique ofdiagnosis. It should particularly be adopted in children to avoid unnecessary step of surgery and mental trauma as fairlyaccurate cytodiagnosis is possible especially when majority of the cases of lymphadenopathy are inflammatory innature.
ACUTE PYOGENIC MENINGITIS
Authors: KAKAR BASHIR AHMAD , TAREEN ESSA KHAN , BARI ABDUL , Kakar Raz Muhammad
Published: September 2021

118 cases of acute pyogenic meningitis were admitted in the department of Paediatrics LiaquatMedical College, Hospitals Jamshoro/ Hyderabad in one year period with prevalence of 1.57% of the total admissions.After selecting the cases on clinical ground we proceeded further to confirm the diagnosis by cerebrospinal fluidcytochemical analysis, gram staining,, culture and sensitivity and detection of the antigen of micro-organism by latexagglutination test.
MALIGNANCY IN BREAST LUMPS
Authors: NIAZ M. MUTTAHHAR ASIM
Published: September 2021

Objective:(i) To assess the frequency ofmalignancy in patients presenting with breast lumps. (ii)To find the age related frequency of malignancy in these cases.Design Observational study. Setting: Department of General Surgery, Combined Military Hospital Lahore. Period:From Jan 1998 and Jan 2000. Patients and methods: All patients presenting with breast lumps were included in thestudy. All patients had FNAC of the lump. Patients with signs or suspicion of malignancy were subjected to core needleor excisional biopsy and pathologic diagnosis confirmed. Cases proven malignant on FNAC and showing signs ofmalignancy under went mastectomy, followed by histopathological diagnosis. Non-diagnostic smears were repeatedor subjected to biopsy of the lesion. Cases of suspicious smears also underwent biopsy for histopathological diagnosis.Results: 277 patients with breast lumps managed at CMH Lahore were studied. 24.2% were diagnosed as having amalignant lump. Mean age in the present study is 32.96yrs for benign and 51.81yrs for malignant breast lumps.Conclusions: Frequency of breast cancer in breast lumps was 24.2% in the total cases in the study, almost one in 4female patients coming to a surgical clinic with breast lumps can have a malignant breast lump. Breast cancerfrequency is negligible under the age of 30 yrs. The probability of diagnosing of a breast lumps as malignant is 1 in 3in 31-40 yrs age group, 2 in 5 in 41-50 yrs age group, and more than 1 in 2 thereafter. There is a greater frequencyin younger age group in the population in our study as compared to international studies.
WOMEN EMPOWERMENT & FERTILITY BEHAVIOUR
Authors: BADAR SAMINA , Shahid Misbah , MANZOOR SHAHEENA , Yasmeen Seema , Chaudhary Mohammad Anwar
Published: September 2021

Objective: To find out the relationship, if any, between womenempowerment and their fertility behaviour. Design: A cross sectional descriptive study. Place & duration of study:The study was conducted in selected area of Bahawalpur City. The data was collected from March to June 2003.Subjects & methods: A total number of 872 households were selected by systematic random selection from upper,middle and lower class. Data was collected from eligible respondent (currently married women of reproductive agegroup 15-49 year having at least one child of 3 years age) through a pre-designed questionnaire. Independent variableempowerment of women was calculated by giving score to education, occupation and autonomy at micro level.Dependent variables (fertility and use of contraception) were assessed for significance by applying chi square test.Results: 41.9% high empowered women were in the opinion that birth of a male child did not provide security (p<.001).A strong positive association between level of empowerment and contraception use (P<.001). There is inverserelationship between women empowerment and number of children (<.001). Conclusion: There is strong inverserelationship between women empowerment and fertility while positive association exist with contraceptive use.
ESOPHAGEAL VARICES
Authors: AHMAD MAQSOOD , IRFAN MUHAMMAD , AKHTAR MUHAMMAD SAEED , Hashmi Zahid Yasin
Published: September 2021

A comparative trial was conducted to study the relative efficacy ofendoscopic injection sclerotherapy versus endoscopic injection sclerotherapy plus octreotide with reference to acutecontrol of bleeding esophageal varices and early re-bleeding. A total of 58 patients equally divided in two groups wereincluded in this study. Bleeding was controlled in 90% patients in both the groups. In group1 there were 20(68.96%)males and18(62%) males in group 2. The mean age of the patients under study was 50.62 &50.55 in group 1& 2respectively. The major proportion of patients was in Child Class B, which comprised of 42(72.41%) in total. ChildClass C was excluded out of study. Twenty-two (75.86%) patients in group 1 were in Child Class B and 7(24%) werein Child Class A & in group 2 there were 20 (68.96%) patients in Child Class B and 21% were in Class A. Etiology ofcirrhosis was HCV in 41(70.86%) and HBV in 9(15.5%) and other etiologies in remaining patients. In, group 1,HCVrelated cirrhosis was seen in 20 (68.96%) and in group 2, this was responsible for cirrhosis in 21(70.68%) of patients.Patients suffering from HBV related cirrhosis were 5(17.42%) in first group and 4(13.79%) in second group 2. Relativelyless number of patients in group 2, had rebleeding in first week of their in-hospital follow-up i.e. 5 versus 8 patients.Average number of blood transfusions per patient was 3.86 piants in group 1and 2.45 piants in group 2. The meanduration of Hospital stay was 8.52 days in group 1 and 7.45 days in group 2. Procedure related complications and inhospital outcome was almost comparable in two groups. The most common complication was hepatic encephalopathy.Combining endoscopic therapy with one of the vasoactive agents reduces the chances of early re-bleeding and needfor number of blood transfusions and duration of hospital stay.
INTESTINAL OBSTRUCTION
Authors: MAHMOOD KHALID , AHMED SHAHBAZ , HAMEED SAJID , Ali Liaquat
Published: September 2021

Objective: To identify the various causes of intestinal obstruction ininfants. Design: Retrospective study. Period: July 1995 to March 2007. Setting: Department of Paediatric Surgery,Allied Hospital, Faisalabad. Patients and Methods: The record of all infants who presented with intestinal obstructionduring the study period was reviewed. Results: Two hundred infants presented with intestinal obstruction. It was thecommonest cause for admission (57%) from the emergency department and constituted 8.2% of the infants operatedin the unit. They were predominantly males. Average duration of symptoms was 3 days. Common causes wereintussusception (46.5%), adhesions (16%), bands (13.5%) and incarcerated inguinal hernia (8%). Wound infection(12%) and wound dehiscence (6%) were the common complications. Mortality rate was 5%. Conclusion: Intestinalobstruction is seen frequently in infants and is associated with significant morbidity. Early recognition and prompttreatment are needed.
THYROID MALIGNANCY
Authors: WASEER MUHAMMAD HUSSAIN , IQBAL JAVAID , RANDHAWA SAJID REHMAN
Published: September 2021

Objectives: (1). Audit of our one year experience of management of thyroidcarcinoma in accordance with latest approved guidelines. (2) To point-out high risks of malignancy in population withthyroid diseases. Design: Prospective study. Setting: Surgical Unit-IV of DHQ Hospital Faisalabad with cooperationof Department of Pathology, Punjab Medical Collage, Faisalabad. Period: From 2000– 2001. Patients & method. Allpatients irrespective of age and sex with suspicious of thyroid malignancy were included in this study . Out of total 56patients of thyroid diseases 13 cases were proved thyroid carcinoma on histopathology. Results: Carcinoma of thyroidwas found more common in females. Papillary carcinoma was found in early age group. Follicular carcinoma was foundin younger age group. All patients with anaplastic carcinoma were above, the age of 50 years. Total thyroidectomy wasfound the treatment of choice for the management of carcinoma thyroid. Modified neck dissection was done in selectedcases. We offered lobectomy for one patient with young age with 1.5cm lesion in one lobe. Most patients were placedon TSH suppression thyroxine therapy. Postoperative follow– up was done for one year. The most important prognosticfactor was age of patient, size, type and extent of tumor. Another important factor was the treatment of the diseaseoffered to the patient. Conclusions: Screening programme at least in goitrous areas should be done to detectmalignancy at early stage and then early management should be offered in hope of good survival and least morbidity.
PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY
Authors: AHMAD AJAZ , IMRAN SHAHID , ABID ABDUL REHMAN , Mallick Nadeem Hayat
Published: September 2021

Objective: To compare the clinical, echocardiographic and angiographicvariables after PTMC in patients of mitral stenosis having echo score < 8 and $ 8. Place of study: Cardiology wardand echocardiography department of the Punjab Institute of Cardiology, Lahore. Duration of study: The study wasconducted from 15 of January 2006 till 30 th th of July 2006.Study Design: It was a comparative study. Materials &Methods Two hundred consecutive patients of mitral stenosis undergoing PTMC were studied. Patients were dividedin to two groups. Group I consisted of patient having echo score <8, while Group II contained patients having echo score$8. Results:The immediate clinical follow-up of 200 patients who underwent PTMC procedure was studied. Patientswere divided into 2 groups, Echo-Sc <8 (n=136) and Echo-Sc$8 (n=64). PTMC resulted in an increase in mitral valvearea from 1.0±0.3 to 2.0±0.6 cm2 in patients with Echo-Sc<8 and from 0.8±0.3 to 1.6±0.6 cm2 in patients with Echo-Sc$8 (P<0.0001). Procedural success was 83.5% for the overall group, with patients with Echo-Sc <8 having a higherprocedural success (93.4% versus 62.5%; P<0.0001). Thirty three (16.5%) patients had unsuccessful procedures.There was 1(0.5%) in-hospital death. Severe post- PTMC MR ($3 grade) occurred in 19(9.4%) patients, with grade IIIin 12 (6%) and grade IV in 7(3.5%). Emergent MVR was required in 3(1.5%) of 200 patients. Pericardial tamponadeoccurred in 2(1%) patients. Thromboembolic events (stroke) occurred in 2(1%) patients in the overall population. Finally1(0.5%) patient developed complete atrioventricular block. Conclusions: Patients with echo score less than 8 havea favourable outcome in terms of procedural success and post procedure complications as compared to patients withecho score $8.
ESSENTIAL HYPERTENSION
Authors: ASHRAF IMRAN , Khan Imran , KAMIL NOOR , Mannan Abdul , Razi Muhammad Shamaun
Published: September 2021

Background: Hypertension and type 2 diabetes mellitus also tend to coexist.The goal of antihypertensive therapy should consist of reducing cardiovascular morbidity and mortality associated withhypertension by a strategy focused on lowering blood pressure while minimizing the impact on other associatedcardiovascular risk factors like diabetes mellitus. Objectives: To observe and compare any change in serum glucosein patients with newly diagnosed essential hypertension with Atenolol and Amlodipine. Setting: Department ofPharmacology and Therapeutics, Basic Medical Science Institute (BMSI), Jinnah Post Graduate Medical Centre(JPMC), Karachi. Period: 12 weeks (90 days) Methods: Patients with newly diagnosed essential hypertension (N=70)were enrolled in this study and were divided into two groups, each comprised of 35 patients and were given tabletAtenolol 50/100mg once daily and tablet Amlodipine 5/10 mg once daily respectively for 90 days. Fasting Blood glucosewas measured on day of inclusion i.e. day 0, day 45 and day 90. At each fortnightly visit, blood pressure was recorded.Results: Atenolol raised mean blood glucose levels from baseline levels of 91.82±1.34 mg/dl to 99.73±1.33 mg/dl onday 90 (P<0.001) while Amlodipine had no significant effect on blood glucose level (P= N.S). Conclusion: Atenololmay not be a good choice for essential hypertensive patient with type 2 diabetes mellitus as it is found to impair the normal glucose metabolism. Long term clinical trials in diabetic patients are needed to confirm the observation of thepresent study.
HOSPITALS
Authors: BHATTI MUHAMMAD AYAZ , Rashid Farah , ZULFIQAR KOMEL , Haq Mirza Inamul , ALI MOAZZAM
Published: September 2021

Objectives: To know the amount of total waste generated in the hospital daily,to know the types of waste and the amount of infectious waste generated daily, and to know about knowledge andattitude of the health care workers, doctors nurses and sanitary staff about hospital waste. Setting: The study areais the Pakistan Railway Hospital a tertiary level care Hospital consisting of 380 beds and all the essential Departments.Study Period: the study was conducted from June 2006 to September 2006. Material and methods: study design:This was a cross sectional study Single tertiary level care hospital was studied due to limitation of time and resources.Data collection: Data was collected by using structured questionnaire and weighing of one day (24 hours) waste fromall the units. Other relevant data was collected by structured interviews, meetings, discussions. Results: wastegenerated in twenty four hours is 229.75 Kg. The average waste generated per patient per day is 1.05 Kg, the quantityof infectious waste generated is 104.8 Kg i.e. 0.478 Kg per patient per day. Quantity of waste generated in order ofmaximum to minimum waste was Gynae/Obs 1.29Kg, Paediatrics1.15Kg, Surgery 1.13 followed by Orthopaedics0.80Kg, ENT 0.71 Medicine 0.48 and ophthalmology 0.4Kg all per bed per day. The responses show that all thecategories of hospital workers are nearly not having the proper knowledge about the hazards and therefore unable togive suggestion or solution of the problem. Conclusion: Health care waste management in Railway Hospital is in badshape. The general awareness on the subject is very much lacking both by the producers as well as handlers of waste.There is acute need for training and sensitization of managers, staff and sanitary staff for safe disposal of waste.
FREQUENCY OF HELMET USE AMONG MOTORCYCLE RIDERS IN RAWALPINDI
Authors: MUMTAZ BABAR , Ahmed Mahmood , KHAN MUHAMMAD HUSSAIN , Mahmood Ayesha , KHAN MOHAMMAD WASIF
Published: September 2021

Objective: To find the frequence of helmet use as a safety tool andto investigate how many of the motorcyclists are aware of the beneficial effects of using a helmet. Design: A crosssectional study. Place and Duration of Study: In Community Medicine Department of Foundation University MedicalCollege, Rawalpindi from March 2007 to September 2007. Material and Methods: A total of 1000 questionnaires wererandomly distributed among motorcyclists during visits to Lalkurti, Saddar and Karchi chowk in Rawalpindi. Inclusioncriteria included those motor bike rider volunteering to participate in the study.44 responses were invalid and the totalvalid responses were therefore 956. No incentive was offered for participation in the study and no individual follow- upwas possible. Results: From a total sample size of 956 riders 541 were putting on a helmet and 415 were without thehelmet. The frequence of helmet use was therefore 56.6% and that the use non user is 43.4%. A bog majority i.e 80.7%of the respondents left that use of helmet while riding a motorbike should be mandatory while only 19.3% left that itshould be the discretion of the riders.57.6% of the riders left that in case of pillion riding both the riders should put onthe helmet while 42.4% did not support the idea. Conclusion: The study implies that we need to enact and enforcepolicy intervention for mandatory use of helmet, effective traffic law enforcement and imparting awareness among ourmasses especially the younger generation to reduce Road Traffic Accidents. Print and electronic media should beutilize extensively to disseminate basic traffic knowledge at all levels of the society.
MALNUTRITION
Authors: BADAR SAMINA , Yasmeen Seema , CHANNER M. IMRAN SALEEM , CHANNER MUHAMMAD SALEEM
Published: September 2021

Objective: To find-out the determinants of malnutrition in children between sixmonths to five years age in Bahawalpur. Study Design: This was an observational descriptive cross – sectional study.Setting: At Paediatric Medicine out – patient department in Bahawal Victoria Hospital, Bahawalpur.. Period: From Feb.2005 to March 2007.Subjects: Eleven hundred children with malnutrition having ages six months to five years. Mainoutcome measures. Determinants of malnutrition in children under – 5 in Bahawalpur. Results: This study consistsof 1100 sick children between the ages six months to five years brought by their parents (mother) to the PediatricMedicine out-patient department in Bahawal Victoria Hospital, Bahawalpur. Only the children with malnutrition(undernutrition) were included in the study population. Mothers of these children were interviewed and clinicalexamination of each child was carried-out to find-out the causes of malnutrition in them. According to Gome’sclassification, 39.45% of them had first degree malnutrition, 37.10%, second degree and 23.45%, third degreemalnutrition. Conclusion: The major causes of malnutrition found in our study population included: Illiteracy; food –fads; poverty; lack of breast-feeding; improper weaning; diarrhea and respiratory diseases. All these factors werestatistically significant.
BILIARY TRACT SURGERY
Authors: ALI UMAR , SHAH M. YUSUF , QINGYONG PAN CHENG'EN MA , Lian Yu
Published: September 2021

Surgical complication after biliary tract injury are serious complications of Hepatobiliary surgery. Theincidence of iatrogenic bile duct injuries has increased significantly since the number of cholecystectomy operationshave increased, laparoscopic cholecystectomy became the "gold standard", mini-cholecystectomy established for thetreatment of cholelithiasis. Intraoperative hemorrhage can be life-threatening or may lead the death. The common usesof laparoscopic cholecystectomy and mini-cholecystectomy have made the young surgeons less familiar with opencholecystectomy procedure and the approaches to manage the biliary tract injuries. Uncommonly the patient had toundergo hepatic transplantation secondary to biliary tract surgery with several vessel injuries or biliary cirrhosis.Postoperative bile leakage can be managed by effective drainage as soon as possible. These complications uncommonwith the expert surgeons, but common with comparatively inexperienced surgeons. There is no substitute of experienceand caution in biliary surgery for optimization technique.
ULNAR NERVE
Authors: QAISAR SYED SAEED , HANIF SAQUIB
Published: September 2021

Objective: To determine the etiology of ulnar nerve compression acrossthe elbow.Design: Retrospective and descriptive. Setting: At AFIRM Rawalpindi. Period: From Jan 2000 to Jan 2004.Material & Methods: 267 cases of Ulnar Nerve Compression at elbow diagnosed after electro-physiological studieswere selected. Most of the patients with a variety of complaints were referred to Rehabilitation Medical Department,Rawalpindi (AFIRM) for diagnostic evaluation (NCS/EMG) and management. Results: Out of 267 patients 210(78.65%)were males and 57(21%) were females. The mean age was 35 yrs (Range 9-67yrs). Most of the patients 180(67.41%)had left sided Ulnar nerve compression at elbow where as 87(32.59%) suffered on Right side. The most commonmode of presentation were paraesthesia 234(88%), pain 166(44%) and weakness of intrinsic hand muscles 104(27%).Electro-physiological evaluation shows prevalence of occupational 121(45%) and traumatic 51(21%) causes.Conclusion: Management of Ulnar never compression must include a comprehensive rehabilitation program thatshould focus on postural correction and workstation modification along with pharmacological and surgical advice
NEONATAL RESUSCITATION
Authors: FEROZE FAHEEM , MASOOD NAVEED , KHUWAJA AMIN , Malik Fakhar Ilyas
Published: September 2021

Background: The key to success in newborn resuscitation is theknowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process.The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube (ETT) or Face Mask (FM),both of these techniques require expertise and are associated with high rates of failure. Hence a third potential optionhas been suggested to overcome these problems. Objectives: To evaluate the efficacy of Laryngeal Mask Airway(LMA) in neonatal resuscitation and artificial ventilation and to compare it with that of ETT and FM. To evaluate LMA’sefficiency in situation where endotracheal intubation and facemask ventilation is difficult or not possible. Design: A Noninterventional, analytical / comparative study Setting: Combined Military Hospital Rawalpindi. Period: 20 weeks (1stJanuary 2002 to 31 May 2002). Subjects: A group of 75 neonates born with C-Section were selected on the basis ofnon-probability convenience sampling. They were subdivided into three sub gps with 25 neonates in each sub gp.Interventions; 75 neonates born after C-Section, were divided into sub gps i.e. A, B, and C containing a no of 25neonates in each gp. They were ventilated with ETT, FM and LMA respectively. These newborn babies had an Apgarscore < 4. They were resuscitated using a fix protocol. The efficacy of ventilation with either technique was evaluatedin terms of placement and ventilation. Results: The LMA emerged, as a valuable and better option in newbornresuscitation. Moreover, it was a successful tool in situations where endotracheal intubation and facemask ventilationwas difficult or impossible. Conclusion: The LMA is a potential valuable adjunct for the management of neonatalairway.
EARLY LAPAROSCOPIC CHOLECYSTECTOMY;
Authors: HINDUJA THAKUR K. , SHAIKH SHER MOHAMMAD , JALBANi MALICK HUSSAIN , Shaikh Nisar Ahmed , Soomro Ishaque
Published: September 2021

To assess the clinical out come of laparoscopic Cholecystectomyfor management of acute cholecystitis and to evaluate its safety, frequency of complications. Design: Observationalstudy. Setting: Surgical Units II and III Of Chandka Medical College Hospital Larkana.. Period: From 01.09.2003 upto 31.12.2007 Patients & Methods: A total of 100 consecutive cases of, acute cholecystitis confirmed subsequentlyby abdominal ultrasound scanning, who were admitted for early laparoscopic cholecystectomy. Results: There wasfemale preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients werereceived with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24(24%),Empyma 8(8%), Contracted 10(10%), Perforated 5(5%) and Gangrenous GB in 4(4%) while 49(49%) have acutecholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50minutes. No mortality was reported in this series. Conclusion: Emergency / early cholecystectomy is reliable and safemodality cost effective, and timely surgery with modern conception in themanagement of acute cholecysttitis, becauseof accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Choleshould be preferred technique now days for the treatment of acute cholecystitis at our Institute.
EARLY DIAGNOSIS OF HYPERTENSION WITH MOLECULAR GENETIC TECHNIQUES
Authors: RIAZ SABA , ALVI FARRAKH MEHMOOD , HASNAIN SHAHIDA
Published: September 2021

Objective: To standardize the molecular techniques for early diagnosisof genes of hypertension. Methodology and Results: These techniques include extraction of DNA in which weextracted DNA by manual method with results of high yield, less purity and it was more time consuming. On theother hand with kit (Fermentas) method yield was low with high purity and less time consuming. The purity of DNAwas checked by spectrophotometer by using DNA/RNA ratio. Conditions for diagnosis was optimized for specificDNA sequence by using primers for genes Agt and Ace. Restriction digestion was done with the amplified productwith restriction enzymes Lwel and Nco1 the result was found negative with no polymorphism. Single strandedconformational polymorphism (SSCP) was performed which is more efficient method of obtaining information aboutlevel of polymorphism with in anonymous nuclear loci than the restriction enzyme protocol. SSCP is also morespecific because it gives idea which specific portion of gene is highly polymorphic. The result was again negative.Conclusion: This preliminary study of molecular analysis optimized the conditions for detection of polymorphism ofcandidate genes associated with hypertension. Following the same standardized conditions this is possible that wecan study and diagnose thousands of hypertensive patients. This is very much helpful for future planning of personswho are prone to hypertension due to family history.
CHRONIC LOW BACK PAIN;
Authors: IFTIKHAR ADNAN
Published: September 2021

,,,
AN UNUSUAL PRESENTATION OF PELVIC TUBERCULOSIS;
Authors: CHAUDHRY RAHILA FARHAT , ROOHI MAHNAAZ ROOH
Published: September 2021

Tuberculosis is highly prevalent in developing countries like Pakistan and should be considered inthe differential diagnosis of patients with pelvic mass, ascites and raised serum CA 125 levels. A case of pelvictuberculosis with markedly raised serum CA 125 levels and initial diagnosis of ovarian tumour was made.
URO-DYNAMIC EVALUATION
Authors: JANJUA SAQUIB HANIF , MEHMOOD TARIQ , YASMIN REHANA , GiLL Zaheer Ahmad , Rathore M. Farooq Azam , Hasan Maqsood UI , Niazi Pervaiz Hasan Khan , Butt Aamir Waheed
Published: September 2021

Objective: To describe the pattern of Urodynamic evaluation at ArmedForces Institute of Rehab Medicine, Rawalpindi. Study Design: Descriptive study. Materials and Methods: This studywas conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Instituteof Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, andpresenting complaints whereas results were formulated according to Classification of voiding disorders by Internationalsociety of Incontinence. Data was analyzed using statistical package forSocial Science version 10. Results: In all (466)patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency (61%) andincontinence (52%) were the most common presenting complaints, 158(34%) had spinal cord injuries, 58 were casesof myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152(33%) hadhyperactive bladders, 110(24%) had a contractile/hypo-contractile bladders, 104(22%) had stress incontinence and56(12%) cases had normal results. Conclusion: Urodynamics helps in diagnosis of potentially life threatening urinaryproblems. The availability of this equipment and trained staff must be encouraged at tertiary care hospital. Moreresearch is required in this regard in Pakistan, which shall help in formulating better management protocols in future
Modelling and optimization of drying rate and quality parameters of foam mat dried mango powder
Authors: Christiana Alami Adamade  , Joshua Olanrewaju Olaoye
Published: September 2021

A study on modeling and optimization of foam mat drying of ripe mango was carried out, three levels of whipping durations (5 min, 10 min and 15 min, three levels of Egg white albumen powder concentrations as foaming agent (6% (w/w), 12%(w/w) and 18% (w/w)), three levels of Xanthan gum concentration as foam stabilizing agent (0.02%, 0.04% and 0.06%)and three levels of air drying temperature (50°C, 60°C and 70 °C) as input parameters were used. Design Expert 6.06 version was used to design the experiment in order to get all possible combinations of durations and concentrations. After washing and deseeding all samples of fresh mango, the pulp was foamed using egg white powder and liquid as foaming agent, the was stabilized by using xantham gum at different concentrations. The foamed products were all dried at 50°C, 60°C and 70 °C respectively in an instrumented cabinet dryer. The following output parameters were modeled and optimized with Design Expert 6.0.6 version: drying rate, vitamin C, beta carotene, crude protein, crude fibre, fat content, ash content, moisture content, carbohydrate and total soluble sugar. Ten (10) model equations, one for each of the output parameters were developed, and checked for adequacy and validity. All developed model equations were found to present functional relationships between input and output parameters. Hence, all developed model equations can be used as reliable tools for estimating, predicting and conducting analysis of the process. Best optimized results were selected base on the one that is most desirable. One of the ways of explaining optimization is that, it is the process of getting the values of input parameters that will either maximize or minimize the output parameters, drying rate (maximized), vitamin C (maximized), beta carotene (maximized), crude protein (maximized), crude fibre (maximized), fat (maximized), ash content (maximized), moisture content (minimized), carbohydrate (maximized), total soluble sugar (maximized) and moisture ratio (minimized).
Viral load and antibody levels in patients with COVID-19
Authors: Iva Christova  , Iva Trifonova  , Teodora Gladnishka  , Elena Dragusheva  , Georgi Popov  , Vladislava Ivanova
Published: September 2021

Relations between viral load, antibody levels and COVID-19 severity are not well studied and results from such investigations are controversial. In this study, we investigated kinetics of viral load and antibody responses to SARS-CoV-2 in 20 patients with COVID-19 and analysed the association with disease severity. The patients were followed on weekly basis within the first month after the onset and then once per month for the next 4 months. Serum samples were tested for IgA, IgM, and IgG antibodies against SARS-CoV-2 using ELISA tests. SARS-CoV-2 viral load in nasopharyngeal swabs was measured by quantitative Realtime RT-PCR. For vast majority of the patients, the viral loads were at their highest levels at presentation and then declined gradually. Despite development of specific antibody response 7-11 days after the onset of COVID-19, SARS-CoV-2 RNA was still detected in nasopharyngeal swabs of most of the patients. There was no direct link between viral load and severity of COVID-19: some of mild and some of severe cases started with a high viral load. There was a relationship between the time from the onset of the disease and the viral load: the highest viral load was in the first days. In more severe cases, there was a tendency for slower reduction in viral load and longer detection of SARS-CoV-2 virus. Levels of the specific antibodies increased earlier and to higher levels and were present for longer time in patients with more severe manifestations of COVID-19 than in those with milder disease.
A market analysis of beef cattle: Study in North Sulawesi Province - Indonesia
Authors: Erwin Wantasen  , Jein R Leke  , Sintya JK Umboh
Published: September 2021

The aim of the study was to analyze marketing channel, marketing margin, and marketing efficiency of in North Sulawesi, Indonesia. The research was conducted in two cities, such as City of Manado and Tomohon, and one regency, such as Regency of Minahasa, as the trade center of cattle in North Sulawesi province. There were 120 respondents, consisting of 100 farmers, 10 livestock brokers or intermediaries, 5 collecting traders (business scale of 20-30 cattle), and 5 end user or end consumer of live beef cattle, business consumer, and owner or user of abattoirs as well as beef distributors in North Sulawesi. The determining of respondents was snowball sampling starting with information of farmers as owner or user of abattoirs or slaughterhouse as well as both business and end users or end consumers of beef cattle. Analysis of marketing channel was performed by descriptively qualitative analysis via interview to marketing agencies and farmers of beef cattle, likewise with the analysis of marketing margin and marketing efficiency. The result of study showed marketing channel of beef cattle from farmers in North Sulawesi consists of two channels, such as via livestock brokers or intermediaries and through collecting wholesalers. the marketing margin of live beef cattle in North Sulawesi was large enough as of IDR 8,400,000, where the biggest marketing margin was on end users or business consumers. The market of beef cattle in North Sulawesi tends efficient due to the equal profit share and share of marketing cost in each marketing agency.
Detailed GIS mapping of communities of plants with conservation status and defining the touristic zones in the group "Kanarata and Quarry Drenaka" of the protected area "Pobiti Kamani" (Northeastern Bulgaria)
Authors: Stoyan Vergiev
Published: September 2021

The aims of the present study were: 1) to perform a detailed mapping of the distribution of conservationally significant (endemic, vulnerable, endangered and protected) plant species in the group "Kanarata and Quarry Drenaka" of the protected area "Pobiti Kamani" for 2020 yr in GIS environment; 2) based on the overlap of the distribution sites of plant species, to determine the "hot spots" of plant biodiversity, access to which should be limited in order to protect them and at the same time to identify areas with no or low concentration of conservationally important species in order to trace and mark the tourist paths in the protected area. In order to investigate the distribution of six plant communities, a detailed GIS mapping was performed. As a result of the study, detailed distribution maps of investigated species communities in Central Group were drawn. Special attention is paid to the zones where two or more communities were overlapped. The identification of the areas with concentration of conservation-significant species and localization of "hot spots" is crucial for protection management of the group "Kanarata and Quarry Drenaka" of the protected area "Pobiti Kamani". The model of "hot spots" and the model of overlapping are applicable and in combination with detailed distribution maps are fundamental for more successful protection and conservation. The suggested touristic zones with lack of conservation species can be used to trace and to construct environmentally friendly tourist trail and paths without destroying and harming the species, their habitats, and the aesthetic and recreational value of the landscapes.
Mengungkap Makna Biaya Haul Nyai Ageng Putri Ayu Kukusan (Studi Etnometodologi)
Authors: Ukamah Syaiful , Tumirin Tumirin
Published: September 2021

This study aims to uncover the meaning of the cost of Haul Nyai Ageng Putri Ayu Kukusan in Gresik Regency. This research was conducted at the Secretariat located on Jl Sunan Prapen II Klangonan, Gresik Regency. The method is qualitative with the Ethnomethodology approach. Data were collected through interviews with three informants and observed the actions of informants on the implementation of the Haul Nyai Ageng Putri Ayu Kukusan in Gresik District. The conclusion of this research is the Klangonan community in Gresik Regency has a perspective of the meaning of costs incurred, namely as Ukhuwah Islamiyah, because Ukhuwah Islamiyah is a form of love, as a form of friendship, as a form of building history, and as a form of gratitude.
Regular las emociones: Biopolítica y educación emocional
Authors: Alegre Daniel Andrés
Published: September 2021

En el contexto actual de avances a nivel mundial de gobiernos neoliberales que buscan imponer sus lógicas en todos los ámbitos de lo público, se torna necesario emplear herramientas teóricas que nos permitan oponer resistencias a esos intentos de captura. En este sentido, este texto analiza la propuesta pedagógica denominada educación emocional impulsada por distintas instituciones y partidos de diversos signos políticos en Argentina y el mundo. Para ello se emplean categorías propuestas por Michel Foucault en sus cursos del Collège de France, especialmente las ligadas al concepto de Biopolítica, como son: población, seguridad, gobierno, etc. El objetivo de este texto es situar a la educación emocional como uno de los dispositivos de seguridad descritos por el filósofo francés en tanto que tiene como finalidad producir sujetos-ciudadanos autorregulados y emocionalmente competentes que no representen riesgos ni amenazas, es decir, que sean productivos.
Análisis de la filosofía crítica en “La ideología alemana” de Marx y Engels
Authors: Aguilar Gerardo Adrián
Published: September 2021

 Lo obra “La ideología alemana” de los autores Marx y Engels es relevante por su potencial descriptivo de lo real en términos de crítica. Filosóficamente, en términos de problematizaciones en el campo de la filosofía, constituye un quiebre, pues implica una profunda revisión de los postulados de idealismo y del materialismo.

El tema a abordar en el siguiente trabajo está centrado en la lateralidad del concepto de filosofía que percibimos en la obra, que se presenta como crítica, como una filosofía negativa, pero dejando entrever que introduce su concepto filosófico como análisis de los supuestos, para ello se pondrá a la luz la crítica a filosofía hegeliana y como al mismo momento presentan su concepto de filosofía.

Seguidamente desde el análisis de Michel Foucault se intentará poner de manifiesto una técnica de interpretación basada en la sospecha del lenguaje, para exponer y favorecer una correcta hermenéutica sobre esta filosofía crítica adoptada, posteriormente acercarle al lector como debe ser estudiada la historia y plasmar lo que propone Marx con respecto a ella.

Por último, entender las complejidades de la sociedad desde esta visión filosófica como práctica para conocer las diversidades contemporáneas bajo una interpretación de Enrique Dussel.

La finalidad del trabajo es apropiarnos de lo escrito por Marx y Engels, lo que fundamentan en su línea de pensamiento criticando el conocimiento existente, exponer una técnica para interpretarlos, dejar claro su concepto de filosofía y contrastarlo contemporáneamente.

Hobsbawm afirma sobre Marx: “… el reconocido padre fundador (con Durkheim y Max Weber) del pensamiento moderno sobre la sociedad.” (Hobsbawm, 2011, p. 21)
Conciencia, subjetivación y lucha. Análisis del concepto de lenguaje en La ideología alemana
Authors: Rodriguez Néstor Emanuel Maximiliano
Published: September 2021

 El presente artículo pretende abordar la cuestión del “lenguaje” en La ideología alemana, su relación con la conciencia y la importancia de estos (lenguaje y conciencia) a la hora de hablar del proceso de subjetivación de la clase obrera en el sistema capitalista, planteando así al lenguaje como puente entre un sujeto y otro para 1) la satisfacción de sus necesidades materiales y 2) la subjetivación de cada uno de estos. Por otro lado, se trata también la problemática de la lucha existente entre el proletariado y la burguesía por adueñarse del signo y las consecuencias que se sucederían según cuál de estas clases sociales logre el dominio de la palabra y sus significaciones.