bluuebunny/crossref_metadata_2025 huggingface dataset:
HEPATOTOXICITY OF ATT
Authors: NIAZI GHULAM ABBAS KHAN , ARSHAD ABDUL REHMAN , ZAKARIA MANZAR , Ahmed Waqar , Sheen Irfan Najam
Published: September 2021

Objectives: To determine the frequency of hepatotoxicity with standard ATT. Study design: Descriptive. Setting: Department of Medicine, Combined Military Hospital Lahore. Period: Feb 2007 to April 2008. Materials & methods: 250 patients aged 18 years or greater having pulmonary TB were selected through non-probability convenience sampling technique. All patients were given four drugs for two monthsindoors, followed by two drugs for four months in outdoor. Symptoms suggestive of hepatotoxicity were enquired from the patients regularly. Serum bilirubin and ALT were measured on monthly basis and finally on completion of therapy. Hepatotoxicity was defined as a five fold rise in serum ALT. In patients developing hepatotoxicity, treatment was modified accordingly. Results: This study was done on 189 male and 61female patients (total: 250). Hepatotoxicity developed in 13 (5.2%) patients, mostly during the initial phase of treatment (84.6% incidence during the first month). Risk factors included: age (4 out of 156 young patients and 9 out of 94 older patients; p: 0.016) and nutritional status (8 malnourished patients and 5 well nourished patients; p: 0.031). Hepatotoxicity was not related to the gender (9 males and 4 females; p: 0.585) orthe results of baseline sputum smears (7 out of 102 smear positive cases and six out of 148 smear negative cases; p: 0.064). Conclusions: Hepatotoxicity with ATT is fairly common, especially in the elderly, malnourished patients and during the initial phase of treatment.
FREQUENCY OF HCV AND MEAN AGE
Authors: KAKAKHEL S. MEHTABULLAH , TARIQ MOHAMMAD , Haroon Mohammad , REHMAN SADEEQ-UR-
Published: September 2021

Objectives: To know the frequency of HCV in patients with cirrhosis and to know the mean age of patients with cirrhosis. Design: A descriptive study. Setting: Medical Unit Khyber Teaching Hospital Peshawar Period: From Jan 2007 to Jan 2008. Materials & Methods: 100 consecutive cirrhotic patients or those with signs and symptoms of cirrhosis, admitted to the medical units. They were either known cirrhotic orhaving signs and symptoms of chronic liver disease and diagnosed as cirrhotic during their stay in the hospital on the basis of ultrasound findings. The routine investigations including liver function test (LFTs), prothrombin time (PT), activated partial thromboplastin time (APTT), serum albumin were carried out in all patients. Ultrasound was the main tool for the diagnosis of cirrhosis liver. The hepatitis C virus (HCV) statuswas diagnosed by detecting Anti HCV Antibodies by enzyme linked immunosorbent assay (ELISA). Polymerase chain reaction (PCR) for HCV RNA was done only in affording patients. Results: The overall frequency of HCV was 52 in 100 patients. Out of these 52 HCV positive patients, PCR for HCV RNA was positive in 20 patients (38.15%) and the rest of the patients were not able to afford the est. Out of 52 HCV positive patients the number of male were more (1.8:1) as compared to female. The age of the patients ranged from 45-65 years, the majority being from 45 to 65 years with the mean age of 52 years. The stratification of risk factors was not the objective of this study. However, a note was made of exposure to various risk factors. Most of the patients had the history of receiving injections in the past from quacks. Conclusion: It is concluded that chronic HCV infection is the commonest cause of cirrhosis leading to chronic ill health, great economic burden on family and health care system and mortality. As there is no treatment for cirrhosis so prevention, early detection of HCV infection and prompt treatment of HCV infected patients will undoubtedly lead to a decrease in morbidity and mortality from this silent epidemic.
CIRCULATING LEUKOCYTES
Authors: AKHUND ISRAR AHMED , ALVI IRSHAD ALI , BHURGRI GHULAM RASOOL , Qureshi Muhammad Ali , Khoharo Haji Khan
Published: September 2021

Objective: Evaluating circulating leukocytes in acute mental stress & relation with coronary artery disease. Design: Descriptive study Setting: Muhammad Medical College Mirpurkhas, Duration: from March 2007 to August 2007. Methods: Two hundred young healthy adults were studied for stress experiment. Venous blood samples were drawn before and after stress for estimation of leukocyte counts. Values were presented as mean ±standard error of mean (SEM). Results: The difference in Pre and during stress results of variables were TLC = - 4630.85 ± 140.65, N % = -11.8 ± 0.36, L% = 4.03 ± 0.14, M %= 5.48 ± 0.37, E % = 1.18 ± 0.07, B % = 1.11 ± 0.022. Highly significant p-values (≤ 0.001) were found among various parameters, in both groups of subjects. Conclusion: An increase in the number of circulating leukocytes was an important unexpected observation that was noted. We suggest that the real life stress induced leukocytes changes may warrant further investigation about its relation with the coronary artery disease (CAD).
IMPACT OF DISSECTION
Authors: IQBAL KHADIJA
Published: September 2021

Background: Teaching of anatomy is based on cadaver dissection. Islamic values regarding permission of dead body use for learning purpose and recent introduction of Problem based learning has led to false belief that dissection is of no more help in understanding Anatomy. Objective: To access the views of post and under graduate students whether dissection sessions done at undergraduate level have helped them in better understanding anatomy. Methods: Questionnaires were distributed among 60 postgraduate medical students and 60 undergraduate students. The questionnaire comprised questions relating to experience of dissection for postgraduate students who have done dissection during their undergraduate classes. Results: There was a statistically significant % of students who found dissection beneficial for post graduation. Conclusion: Dissection should be a part of study in medical schools.
CAESAREAN SECTION
Authors: ALI HABIBA SHARAF , SALEEM NEELOFER , AGHA FARAH
Published: September 2021

Objective: To determine what surgical techniques are used by obstetricians in Pakistan for caesarean section operations and to compare it with the recommendation, proposal and guidelines of Royal College of Obstetrician and Gynecologist (RCOG) and Cochrane Reviews. Methods: A questionnaire was set up regarding surgical technique used during caesarean section and one hundred obstetricians were part of study. Setting: Hospitals in two large cities of Pakistan i.e. Karachi and Rawalpindi were requested to fill them. Period: Jan 2009 to June 2009. Result: Substantial and remarkable and difference noted in the practice of caesarean section among the obstetricians. Certain practices and procedures performed by our obstetrician are same as proved to be beneficial and valuable based on evidence and recommended by the RCOG and Cochrane Data on pregnancy. Conclusion: We observed that our obstetricians follow different surgical techniques for performing caesarean section. Some of the techniques follow recommendations by RCOG and provide to effective and beneficial by cochrane data.
OVARIAN DERMOID CYST
Authors: HASANZADEH MALIHE , TABARE SHAMILA , MIRZAEAN SARA
Published: September 2021

Objective: Mature teratoma is the most common germ cell tumor(and the most common tumor) of the ovary,composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare. Case report: A 72 years-old woman admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a Right ovarian mass (15×15 cm) thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. Conclusion: Infection of a mature teratoma is a relatively uncommon event. However, based on our case and others, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever.
CONGENITAL DIAPHRAGMATIC HERNIA
Authors: ABDOLLAHZADEH MEHRSIMA , FARZI FARNOUSH , GHORBANI MOHAMMAD HOSSEIN , Far Sasan Bozorgi
Published: September 2021

We report a case of late-presenting congenital diaphragmatic hernia (CDH) in a three-month-old male infant presenting to the pediatric hospital with attacks of cough and cyanosis .Although CDH is usually manifested on the first day of life, there are a number of case reports of late-presenting CDH usually presenting with respiratory or gastrointestinal symptoms. In this case report, we have focused on the anesthetic management of late-presenting CDH. Text: Congenital diaphragmatic hernia is usually manifested on the first days of life as respiratory distress and a scaphoid abdomen. The abnormality is herniation of the abdominal viscera through a defect in the diaphragm, most commonly the foramen of Bochdalek on the left side1. These infants often have a dramatic presentation3, in contrast, late onset or late- presenting CDHs present outside the neonatal period with variable signs and symptoms4. We describe a case of late-presenting CDH that referred to the pediatric hospital with attacks of cough and cyanosis.
AMEBIC LIVER ABSCESS
Authors: AHMAD KHAN RANA ASRAR , HAMEED FAKHAR , BASHIR M. BADAR , Rana Mohamad Mohsin , Mazhar Hamed Raza
Published: September 2021

Amoebic liver abscess is a common infection in third world countries like ours due to poor sanitary arrangements. It presents with severe pain and high grade fever and if not diagnosed and treated promptly, may lead to complications and mortality. Objectives: To estimate the incidence, need for aspiration and treatment outcome. Design: Case series study. Setting: At respective consultations centers in Faisalabad. Period: From 1st, January, 2007 to 31st December 2008. Patients and Methods: All patients suspected of the diagnosis of liver abscess whether presenting to physicians or surgeon were referred for ultrasonography for the confirmation of the diagnosis. Basic biodata, coexisting medical or surgical diseases and relevant investigation were recorded, and patient was assessed for the need to aspirate the abscess. After initial treatment patients were reassessed for the need to aspirate the abscess on third, tenth and twentieth day both clinically and ultrasonically. Results: We had 188 cases in the study. There were 128(68 %) males and 60 (32%) females. Majority, 156 (76.6%), of the abscesses were single, 40(21%) had double and 4 (2%) had three abscesses.166 (83%) were situated in the right lobe, 28(15%) in the left lobe and 4 (2%) had abscess in both lobes. 16 (9%) were aspirated at presentation due to their size or position. Only 4 (2%) were aspirated at firstfollow-up on third day due to non resolution of pain or fever or increase in size. All the patients who were not lost from follow up responded to standard treatment of metronidazole. Discussion: Amoebic liver abscess is a common diagnosis in our setup. Patients presents with right upper quadrant pain and fever. Clinical background and ultrasonogram give a reasonable suggestion about amoebic etiology. If initial aspirationis not indicated due to size larger than 5cm. or proximity to surface or nonresolution of symptoms or lesion in left lobe, conservative treatment with oral or intravenous metronidazole is successful.
AMEBIC LIVER ABSCESS
Authors: AHMAD KHAN RANA ASRAR , Hameed FAKHAR , BASHIR M. BADAR , Rana Mohamad Mohsin , Mazhar Hamed Raza
Published: September 2021

Amoebic liver abscess is a common infection in third world countries like ours due to poor sanitary arrangements. It presents with severe pain and high grade fever and if not diagnosed and treated promptly, may lead to complications and mortality. Objectives: To estimate the incidence, need for aspiration and treatment outcome. Design: Case series study. Setting: At respective consultations centers inFaisalabad. Period: From 1st, January, 2007 to 31st December 2008. Patients and Methods: All patients suspected of the diagnosis of liver abscess whether presenting to physicians or surgeon were referred for ultrasonography for the confirmation of the diagnosis. Basic biodata, coexisting medical or surgical diseases and relevant investigation were recorded, and patient was assessed for the need to aspirate the abscess. After initial treatment patients were reassessed for the need to aspirate the abscess on third, tenth and twentieth day both clinically and ultrasonically. Results: We had 188 cases in the study. There were 128(68 %) males and 60 (32%) females. Majority, 156 (76.6%), of the abscesses were single, 40(21%) had double and 4 (2%) had three abscesses.166 (83%) were situated in the right lobe, 28(15%) in the left lobe and 4 (2%) had abscess in both lobes. 16 (9%) were aspirated at presentation due to their size or position. Only 4 (2%) were aspirated at first follow-up on third day due to non resolution of pain or fever or increase in size. All the patients who were not lost from follow up responded to standard treatment of metronidazole. Discussion: Amoebic liver abscess is a common diagnosis in our setup. Patients presents with right upper quadrant pain and fever. Clinical background and ultrasonogram give a reasonable suggestion about amoebic etiology. If initial aspiration is not indicated due to size larger than 5cm. or proximity to surface or nonresolution of symptoms or lesion in left lobe, conservative treatment with oral or intravenous metronidazole is successful.
INTESTINAL TUBERCULOSIS
Authors: NIAZ KHURRAM , ASHRAF MUHAMMAD
Published: September 2021

Objective: To find out the effective diagnostic algorithm (clinical features and investigations) for intestinal tuberculosis. Design: A retrospective study. Place and Duration of Study: B.V. Hospital Bahawalpur, June 2007 -2009. Patients and Methods: 100 cases of diagnosed abdominal tuberculosis were included in the study. Demographic variables, symptomology, investigations and management detail were recorded from the hospital record of surgical department of B.V. Hospital Bahawalpur. Results: Out of 100 diagnosed cases of intestinal T.B, 55 patients were male. 62 patients were bellow 30 years. Most Common presentation was obstruction (29 %), peritonitis (18%) Abdominal distention (20%) and Abdominal Mass (15%), Histopathology (97%) and laparoscopy (82%) were most sensitive. Operative procedure were right Hemicolectomy (26%), resection Anastomosis (23%), stricturoplasty (13%0, Ileostomy (9%), adhesiolysis (17%). Conservativelymanaged patients on anti-tuberculous therapy (ATT) were (12%). Wound infection and dehiscence (12%) were the common complications. Four patients died. Conclusions: All patients with prolonged history of weight loss, vague health and non specific abdominal symptoms and those who are under consideration for intestinal tuberculosis should follow the protocol comprising histopathology (laparoscopic/ USG guided /open), complemented by the diagnostic laparoscopy and radiological studies.
HELICOBACTER PYLORI INFECTION
Authors: IMANZADEH FARID , IMANZADEH AMIR , SAYYARI ALI AKBAR , Yeganeh Mehrnosh , Javaherizadeh Hazhir , Hatamian Bizhan
Published: September 2021

Introduction: In most individuals H. Pylori is acquired early in the life (before 5 years). H. Pylori infection is more common in the third world countries, where about 90% of adults may be infected. Helicobacter pylori is one of the suspected causes of halitosis in children. Objectives: To evaluate the relationship of helicobacter pylori and halitosis. Patients and Material: 33 patients with chief complaint of halitosis included in our study. Halitosis was evaluated as a subjective symptom in this study. Careful history was obtained. All patients underwent physical examination in order to rule out sinusitis, otitis, and possible cause of halitosis. 67 patients without halitosis were selected as control group. All patients were aged 4-17 years old. Urea Breath Test was done for all patients. UBT has >95% sensitivity and specifity for diagnosis of H.pylori infection. Chi-square test and Yate’s corrected x2 was used to analyzes finding. Epi-info ver 6 were used. Results: In the case groups 7 patients had H. pylori infection and 26 patients had not. In the control group 18 patients had H.pylori infection and 49 patients had not halitosis (P=0.53). Conclusions: There is no significant differences between case and control group. In this study we did not find relationship between H.pylori infection and halitosis.
ULTRASONOGRAPHY
Authors: YASIN MALIK AMJAD , NASREEN GHAZALA , ALI SIKANDAR
Published: September 2021

Acute appendicitis is a diagnostic dilemma in young female patients. Ultrasonography has an important role in making preoperative diagnosis and ruling out other gynecological pathologies in women. Objectives: (1) To determine the diagnostic accuracy of ultrasonography for acute appendicitis. (2) To compare it with impression, in female patients. Design: Cross-sectional comparative study. Setting: Female Surgical department. Combined Hospital, Rawalpindi. Period: Mar 2006 - Jun 2008. Patients and Methods: 214 consecutive female patients presenting with pain right lower abdomen were enrolled. The patients were assessed clinically. Blood complete picture and urine analysis was carried out in all patients. Ultrasonography was performed by radiologist with 7.5 MMz short-focused high-resolution probes. Patients were operated upon and appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. Results: Ultrasound supported the diagnosis of acute appendicitis in 163 (76.2%) patients. In ultrasound with positive findings, patients 161 (98.8%) had inflamed appendices on histopathology and 2 (1.2%) had normal appendices. The over all sensitivity of ultrasonography was 81.3% and specificity was 87.5%. Diagnostic accuracy of ultrasonography was 81.8%. The over all sensitivity of surgeon’s clinical impression remained81.8% and specificity was 62.5%. Diagnostic accuracy of ultrasonography was 81.8%. Conclusions: Ultrasound should be the initial diagnostic modality in females presenting with right lower abdominal pain. It is highly specific, effectively rules out other pathologies and helps in minimizing the avoidable surgical trauma.
CHRONIC HEPATITIS C
Authors: ALI SHAUKAT , SHAHZAD SYED KHURRAM , SLEHRIA ATIQ UR REHMAN
Published: September 2021

Objectives: To know efficacy of combination of standard interferon α2b and ribavirin in chronic hepatitis C. Design: Prospective and analytical. Setting: CMH Bahawalpur. Period: Nov 2008 to Dec 2009. Materials and methods: A total of 126 patients, 104 males and 22 females, fulfilling inclusion and exclusion criteria were started combination treatment. Of these, 110 (87.3%) completed the treatment while 16 (12.7%) patients could not complete the treatment so they were dropped out of this study. Patients were started on  nterferon α2b in a dose of three million units sub-cutaneous (s/c) thrice a week along with daily Ribavirin 1000 milligram (mg) and 1200 mg orally for patients weighing less or more than 75 kilogram (kg) respectively. The primary outcomes, normalization of ALT and undetectable HCV-RNA by PCR, were determined at end of three and six months of treatment. Results: From Nov 2008 to Dec 2009, a total of 110 patients were treated with combination of Interferon α2b and Ribavirin for 24 weeks. Sixty eight patients (62%), 52 males and 12 females showed “end of treatment response” (ETR). Conclusions: Results of the study show effectiveness of the combination therapy of standard interferon and ribavirin for Chronic Hepatitis C. Results of this study are comparable to local and international studies.
PATTERN OF PROSTATIC DISEASE
Authors: HAMEED SADIA , MALIK AKRAM , BILAL SAIRA , DOGAR SHAHID RIAZ , ASLAM SHAZIA
Published: September 2021

Objectives: Analysis of the pattern of prostatic disease in Faisalabad. Design of Study: Case series study. Setting: Department of Pathology, University Medical and Dental College (UM&DC) and Meezan Laboratory (ML). Period: Duration of the study is three years. Methods and Materials: All prostatic specimens presenting to the Pathology department at the UM&DC and ML for histopathology were included. Results: During this period 540 prostatic biopsies were examined. The mean age of the patients was 67 years. Out of these 467(86.5%) were benign, 2 (0.3%) had prostatic intraepithelial neoplasia and 71 (13.5%) were malignant. All the cases of malignancies were adenocarcinomas. Most of them were well differentiated (Gleason’s score 2-4). The highest incidence of hyperplasia and malignancy occurred between 60-70 years of age. Conclusions: The incidence of prostatic cancer is on the rise and measures should be taken for early detection.
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Authors: ASHRAF HAFIZ SHAHZAD , HUSSAIN NADIR , HYDER IMRAN , Khan Mohammad Usman
Published: September 2021

Aim and Objectives: (1) To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. (2) To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Study Design: Analytical case series study. Material and Methods: Fifty patients of either sex below the age fourteen (14 years) having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Results: Out of the fifty patients, 40 (80%) were males and 10 (20%) females with male to female ratio of 4.1. The age range of patients was 2-14 years (mean ± SD 9.24±3.48 years). Thirty three patients (66%) had renal stones, 7 (14%) ureteric and 10 patients (20%) had bladder stones. Single successful treatment session was noted in 22 patients (44%), 18 patients (36%) received two sessions and 10 patients (20%) required three sessions for successful stone fragmentation.Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients (42%) felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients (34%), impacted stone in five (10%), ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients(40%) developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics.
FNAC OF THYROID NODULE
Authors: TARIQ MUHAMMAD , IQBAL MUHAMMAD ZAFAR , ALI MUHAMMAD ZULIFQAR , CH MUHAMMAD ANWAR , KHAN RAO SULMAN , IRUM SHUMAILA
Published: September 2021

Introduction: Clinically, solitary thyroid nodules are common, being present in up to 50% of the elderly population. The majority are benign with thyroid cancer representing an uncommon clinical problem. If euthyroid, then fine needle biopsy provides direct specific information about the cytology of the nodule from which the histology can be inferred. Objectives: To determine the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of solitary thyroid nodule and to avoid unnecessary surgery. Material and Method: Setting: This study was conducted in the Department of Surgery, Sheikh Zayed Medical College/ hospital Rahim Yar Khan. Duration of Study: September 2008 to August 2009 (one year). Sample Size: Fifty patients were included in the study. Study design: Prospective analytical study. Results: The results obtained were compared with histopathology and efficacy of FNAC was checked by calculating sensitivity, specificity, positive predictive value and negative predictive value. Out of 50 cases, FNAC showed 43 cases as benign and 7 cases as malignant lesions, while histopathological examination revealed 42 benign and 8 malignant lesions. FNAC was able to correctly pick 41 benign lesions, while 2 cases of benign lesion turned out to be malignant on histopathology (False negative).Out of total 8 cases which turned out to be malignant onhistopathology, FNAC was able to pick 6 cases, while one benign lesion was misdiagnosed as malignant (false positive). The analysis of study showed a sensitivity of 75% and specificity 97.6% of FNAC in detecting malignancy in solitary thyroid nodule. Conclusions: This study concluded that FNAC is highly effective in detecting thyroid malignancy in solitary thyroid nodule with a sensitivity of 75% and specificity of97.6%.
MESH REPAIR
Authors: HUSSAIN ABID , IMRAN ASIF
Published: September 2021

Objectives: To determine the outcome of mesh repair in the patients undergoing inguinal hernia surgery. Setting: Margala Teaching Hospital Rawalpindi. Duration: June 2006 to June 2008Study Design: Quasi experimental. Patients & Methods: This study included the 50 male patients underwent open mesh repair. In the long term follow up, recurrence of the disease and wound infection were noted. Patients were consecutively selected. Results: Recurrence of hernia was observed in one out of 50 patients. Rest of the patients were alright. Conclusions: The mesh repair has low recurrence rate, it is tension free and is easily learned.
LUMBER DISCITIS
Authors: AHMAD MUMTAZ , YASIN MUHAMMAD
Published: September 2021

Objectives: To study the occurrence of discitis after lumber disc surgery and its management. Study Design: Observational study. Setting: Department of Neurosurgery QAMC/ BVH Bahawalpur. Period: April 2006 to May 2009. Patients and Methods: This study includes 400 patients who underwent standard laminectomy procedure for disc excision. Patients presenting with backache and leg pain were thoroughly investigated. For the confirmation of herniated disc MRI or lumber route myelography were performed. All patients underwent either fenestration, hemilaminectomy or complete laminectomy for disc excision. Patients were followed for two weeks to three years after surgery. The diagnosis of discitis was on clinical grounds but this condition was confirmed by heamatological examination i.e. ESR, complete blood count, C-reactive protein and radiological examination i.e. MRI, CT and plain X-rays. Results: Eighteen (4.5%) patients out of four hundred patients developed disitis after surgery. Initially all patients were managed conservatively i-e. with complete bed rest and antibiotics .Fifteen (83.33%) patients responded well to this treatment but three (16.67%) patients did not improve and were subjected to surgery. Conclusions: Discitis after lumber disc surgery is rare. Discitis should be considered in any patient who develops severe backache,leg pain and muscles spasms after one to four weeks of lumber disc surgery especially accompanied with fever , raised ESR and elevated C-reactive proteins..A definitive diagnosis is essential for appropriate therapy of discitis.
TRACHEAL STENOSIS SURGERY
Authors: AHMED SHAFAQ , JANJUA SARFRAZ
Published: September 2021

Objective: To highlight the problems and solutions in airways management in patients with tracheal stenosis undergoing surgical interventions and to highlight the alternative methods of airway control where high frequency ventilatory facility is not available. Study Design: Case series study. Place and Duration: Combined Military Hospital Rawalpindi from 1st Jan 2004 to 30th June 2007. Patients and Methods: Twenty nine patients of both sex and all age groups presenting with difficulty in breathing due to tracheal stenosis undergoing surgical intervention on trachea have been included. All the patients were managed under general anaesthesia. Nasogastric tube 10 Fr, suction catheter, laryngeal mask airway or mask ventilation was used for initial ventilation where conventional endotracheal tube of even smallest size did not work. Results: Small size endotracheal tube were used in twenty four patients. Difficulty was faced in five patients. In these patients endotracheal tube of smallest size available could not be passed and we had to provide ventilation by innovative measures like nasogastric tube 10Fr in one, suction catheter 10Fr in two, laryngeal mask airway in one and mask ventilation in one. There was no mortality. Conclusions: Adequate ventilation during tracheal stenosis surgery can be very difficult in some cases. Therefore a thorough understanding, a tier of flexible plans and a variety of ventilating means should be arranged before administering anaesthesia.Nasogastric tube 10Fr or suction catheter of similar size are suitable alternative if facility for high frequency ventilation is not available.
POLYHYDRAMNIOS
Authors: TARIQ SAADIA , CHEEMA SADIA , AHMAD ADEELA , Tarique Naela
Published: September 2021

Polyhydramnios is though an uncommon problem but very distressing for patient. Objectives: To locate the causative factors and neonatal outcome in polyhydramnios. Design: Case series. Setting: Department of Obstetrics and Gynaecology unit 1, Lahore General Hospital, Lahore. Period: From January 2004- December 2005. Subjects and Methods: Total 82 diagnosed cases of polyhydramnios in 3rd trimester were included in this study. Results: According to the results of this study polyhydramnios can occur in primigravida as well asmultigravida. Causative factor are mainly idiopathic after which the most important is fetal defects. Diabetes is also associated finding with polyhydramnios in 26.8% cases. The impact of polyhydramnios on neonatal outcome is that most of the babies were born without any significant effect. There were only 26 babies (31.5%) in which anomalies were present and neural tube defects were common. Conclusions: Idiopathicpolyhydramnio being the most common type. Improved prenatal and antenatal screening and early detection of congenital anomalies may help to minimize the morbidity of the patient.
VAGINAL BIRTH AFTER CAESAREAN SECTION
Authors: KASHIF SUNBAL , MANSOOR MALAHAT , TARIQ RUBINA , Tahira Tayyaba
Published: September 2021

Introduction: Vaginal birth after caesarean section is currently the preferred method of delivery for pregnant women who had previous one lower segment caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risks associated with VBAC. Objectives: To evaluate conditions which can achieve successful vaginal birth after one caesarean section. Study Design: Cross-sectional analytic study. Setting: Department of Obstetrics and Gynaecology, Unit-I, Services Hospital, Lahore. Duration of Study with Dates: Study was carried out over a period of six months from 08-06-2006 to 07-12-2006. Subjects and Methods: One hundred pregnant women meeting inclusion criteria were included. During trial of labour patients were closely monitored by vital signs, fetal cardiac activity, lower abdominal pain and tenderness, fetal distress, vaginal bleeding and loss of presenting part. Results: Mean age of the patients was 34.27 + 6.45. According to distribution of cases by parity, maximum number i.e 64 (64.0%) was P 3-6. 79 patients (79.0%) had prior vaginal delivery. Maximum 41.0% patients were due to fetal distress while in 28% indication for previous caesarean were breech presentation. In 71% patient membranes were intact while 29.0% patients presented with per vaginal leaking. 51.0% had dilatation between 3-4cm. VBAC was more successful in patients 58.0% with favourable Bishop score. Conclusions: BMI <20, prior vaginal delivery, non-recurrent indication for previous caesarean, spontaneous onset of labour, cervical dilatation or favourable Bishop score, weight of baby < 3.5kg predict an individual’s likelihood of successful VBAC.
MULLERIAN DUCT ANOMALIES
Authors: TAHIRA TASNIM
Published: September 2021

Aim: The aim of this study was to analyze various presentations of mullerian duct anomalies & to determine its impact on reproductive outcome. Setting: Gynae Unit 1, Allied Hospital, PMC Faisalabad. Period: from 01-06-2007 to 31-12-2008. Design: Case Series Methods: A total of 40 patients were included in study. Their detailed history & examination was done. Relevant investigations TVS, IVU & MRI were done to diagnose mullerian duct malformations. Results: 16 patients (40%) presented with obstructive genital tract malformation while 8 patients (20%) presented with absence of uterus and vagina. Among those who presented in pregnancy, malpresentation (15%) was the commonest presentation. Conclusion: Obstructive anomalies of genital tract are commonest among mullerian duct malformations and are mostly diagnosed at puberty. Other uterine malformations may remain asymptomatic & may have both normal and adverse pregnancy outcome.
MATERNAL MORTALITY
Authors: JABEEN SALMA , ZAMAN BUSHRA S , AHMED AFZAAL , BHATTI SHER-UZ-ZAMAN
Published: September 2021

Objectives: To estimate maternal mortality ratio (MMR), obstetrical causes and determinants of maternal mortality. Study Design: A descriptive study. Place & Duration of Study: The study was conducted in Obstetrics & Gynaecology Department at Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College, Bahawalpur. This was a 3 years study conducted from January 2006 to December 2008. Patients & Methods: All direct and indirect maternal deaths during pregnancy, labor and perpeurium were included. The patients who expired after arrival were analyzed on specially designed Performa from their hospital records and questions asking from their attendants. The reason for admission, condition at arrival, cause of death and possible factors responsible for death were identified. The other information including age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospital was recorded on Performa and analyzed by SPSS version 11. Results: There were a total of 21501 deliveries and 19462 live births with 2039 peri-natal moralities. Total 133 maternal deaths occurred during last 3 consecutive years revealed MMR 683 per 100000 live births. Majority of the women who died were un-booked (91%). The highest maternal mortality age group was 20-30 years in which 54.2% deaths were observed. Out of 133 maternal deaths, 21% were primigravida. Obstetrical hemorrhage (44.4%) was the most frequent cause followed by hypertensive disorders (21.8%) & sepsis (15%). There were 33.8% of patients who were brought at compromised stage and 52.6% brought critical, only 13.5% died were stable at the time of arrival at hospital. Conclusions: Obstetrical haemorrhage was the leading cause of maternal deaths. Thisdreadful cause is preventable and manageable if steps are taken in time during antenatal period for risk detection and in postnatal period. Community awareness, training of traditional birth attendants to recognize the severity of disease and importance of being in time and improving referral can reduce the maternal deaths.
IRON DEFICIENCY ANEMIA
Authors: SABAH SHEZADI , RAMZAN MUSARAT , FATIMA IRUM
Published: September 2021

To determine the frequency of different causes of iron deficiency anemia in female patients of reproductive age group. 2) To determine the association between lack of balanced diet and iron deficiency anemia. Design: cross-sectional analytical study. Setting: Federal government services hospital, Islamabad. Period: From July 2008 to November 2008. Material and Methods: The study included female patients of reproductive age group i.e. 15-49 years of age having hemoglobin less than 11.5g/dl. The sampling technique was purposive. The data was analyzed using Microsoft excel 2000 and SPSS 10.0. Pearson correlation coefficient was used to determine the direction of relationship between total nutritional score and level of hemoglobin; student’s t-test was used to determine the significance of association. A pvalue of less than 0.05 was considered significant. Results: A positive correlation was observed between total nutritional score and level of hemoglobin (r = 0.402, p-value = 0.008). Correlation between animal protein and level of hemoglobin was 0.438 (p-value = 0.004) while between plant protein and level of hemoglobin was 0.211 (p-value = 0.179). Conclusions: It is concluded that there is a definite role of nutritional deprivation in the development of iron deficiency anemia. Lack of balanced diet especially protein group has much stronger association with thistype of anemia. Animal protein as compared to plant protein has strong association with the development of iron deficiency anemia.
REASONS FOR SELECTION OF NURSING PROFESSION IN PAKISTAN
Authors: MANZOOR IRAM , DAUD SEEMA , HASHMI NOREEN RAHAT , Zafar Madeeha , Khan Maham , Zafar Javaria , Babar Sharyar
Published: September 2021

Nursing is the backbone of health care delivery system. There are various factors which influence the choice of selecting nursing as profession. Objectives: (1) To find out the socio demographic profile of nurses working at Ghurki Trust Teaching Hospital (GTTH) Lahore. (2) To explore the reasons for selection of this profession. Study design: A cross sectional descriptive study. Duration of study: From October 2009 to January 2010. Setting: GTTH, Lahore. Subjects and Methods: All the nurses working in Ghurki Trust Teaching Hospital, Lahore are included in this study and their responses are obtained with a self administered questionnaire. Results: A total of 77 nurses participated in our study. The age distribution of these nurses has shown that a large number of nurses, 49 (63.6%) belonged to age group between 20 to 30 years.There were 26 (33.8%) nurses who had done B. Sc nursing. About 72 nurses (93.5%) have monthly income more than Rs.10,000. Majority of them, 48 (62.3%) are unmarried. 41 (53.2%) of the nurses selected this profession due to their own personal interest, 15 nurses (19.5%) selected this profession due to their parental influence. 12 nurses (15.6%) selected this profession for serving humanity. 9(11.7%) selected thisprofession to support their family. Approximately 25 nurses (32.5%) said that there are other family members working in the same profession. It was noted that out of these 25 nurses, 10 (40%) had their sisters in the same profession. Conclusions: Nursing forms the backbone of health care delivery system of a country. Decision makers in health sector need to understand that human resource development. Particularly Nursingrequires revolutionary changes. As Public health policy makers, it is imperative that we investigate the reasons for selection of nursing profession to attract and retain these important partners in health care provision.
FEMALE VICTIMS OF SEXUAL VIOLENCE
Authors: PARVEEN HUMAIRA , NADEEM SHIRZA , ASLAM MUHAMMAD , Sohail Khurram
Published: September 2021

Objectives: To ascertain the incidence of sexual violence in Faisalabad city and to analyze the data with respect to demographics, presentation and pattern of physical injuries and evidence collection from victims of sexual violence. Method: This cross sectional study was conducted on 93 alleged victims of sexual violence at the medico legal clinics in Allied hospital. DHQ hospital & Government General Hospital in Faisalabad city in year 2008. Results: 51.6% cases belonged to age group between 10-19 years and 63.45% were unmarried. In 59.1% cases the offender was previously known to the victim and in 31.18% cases two or more persons were involved in the act. There was more than 15 days delay of presentation to the hospital in 36.56% cases. In 13.98% cases non genital injuries and sign of struggle were present on the body of the victim while only 7.53% cases presented with genital injuries. In 80.64% cases the swabs sent to chemical examiner were positive for semen. Conclusions: The incidence of sexual violence is on the rise in Faisalabad city. Sexual violence was frequently seen in unmarried young females with late presentation due to social stigma. Sexual violence was associated with genital as well as non genital injuries. There should be clear guidelines regarding evidence collection and these should be disseminated and implemented nationally.
RED CELL TRANSFUSION
Authors: NAEEM MOHAMMAD ABDUL , NIWAZ AZHAR
Published: September 2021

Objective: The purpose of this study was to determine and quantify those factors that anesthetist’s use when deciding to transfuse blood in operating room. Setting: CMH abbottabad Period: Nov to Dec 2008 Design: Survey report. Patients and Methods: Prospective cross-sectional descriptive from operation theatre of Combined Military Hospital Abbottabad a tertiary care hospital. With consent from the local ethics committee, an audit was carried out using a questionnaire designed to examine some of the factors that could be important in the decision-making process surrounding blood transfusion during intermediate and major surgery. Anesthetists were asked to fill in the audit forms and to indicate whether they were going to give blood or not. Fifty two audit forms, completed during intermediate or major surgery, wereanalyzed to determine the strengths of certain factors in the decision-making process related to transfusion. Result: Fifty one forms had a satisfactorily complete data set with hemoglobin concentrations Hb between 6.6 and 15.0 g/dL. This study demonstrates that, of the physiological factors, the hemoglobin concentration was the most important factor used for red cell transfusion, and the presence of ongoing bleeding an important contextual factor. Peer pressure to transfuse became apparent at a [Hb] of about 8.5 g/dL. Conclusion: The patients were transfused at the average Hb value of 10.8 g/dL. This average Hb of transfused patients is much higher than current Hb trigger thresholds of 7.0–8.0 g/dL.
OBSTETRIC OUTCOMES
Authors: YASMEEN FOUZIA , SHAMI NABEELA , TALIB WASEEM
Published: September 2021

Objectives: To compare obstetric outcomes in the pregnancy subsequent to still birth with that following live birth in first pregnancy. Data Source: Medline data base. Study Design: Prospective cohort study. Setting: Ghurki Trust Teaching Hospital Lahore. Materials & Methods: The study included women who delivered a stillbirth between 2005 - 2007(exposed cohort). A group of women with live birth (unexposed cohort) was matched for delivery within the same year, maternal age (+/- 3 years), parity (+/- 1). In 2009, the charts of these women were examined for subsequent pregnancies. Main outcome measures Maternal and neonatal outcomes in the second pregnancy, pre eclampsia, placental abruption, labour induction, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth. Results: The exposed cohort group B (n =50) was at increased risk of preeclampsia (44% versus 28%, p value = 0.001<0.05) and placental abruption (20% versus 2%) and malpresentation (18% versus 4%). labour induction (20% versus 8%) instrumental delivery (16%versus 8%) and emergency caesarean (40%versus 16%); and prematurity (62%versus 26%, p value = 0.001<0.05), low birthweight (86% versus 54%, p value = 0.000<0.05) and stillbirths (6% versus 2%, p value = 0.489>0.05) of the infant as compared with the unexposed cohort group A (n =50). Conclusions: Majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a highrisk group with an increased incidence of adverse maternal and neonatal outcomes.
ECTOPIC PREGNANCY
Authors: ABBAS AFROZA , AKRAM H.
Published: September 2021

Objective: To find out the causative factors for rising rate of ectopic pregnancy in young women at periphery. Design: Descriptive study. Place and Duration of Study: Maula Bakhsh Teaching Hospital ( Obstetrical and gynaecological unit) Sargodha , from January 2008 – December 2008. Patients and Methods: All patients who were presented in labour room emergency and gynaecological out patients department with confirmed diagnosis of ectopic pregnancy on USG were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation and management. Results: Frequency of ectopic pregnancy was too high in our study compared to international studies. Majority of patients were young and nullipara. Leading risk factor is pelvic inflammatory disease due to septic induced abortion. 92% of patients had acute presentation. Conclusions: Rising rate of ectopic pregnancy was found in young, nulliparous women secondary to pelvic inflammatory disease. The frequency can be reduced by awareness of reproductive health care, liberal contraceptive utilization, acceptable adequate planned family. Early diagnosis and timely referral may be helpful in treating the patients prior to tubal rupture with decreased morbidity and mortality.
ADENEXAL CYSTS
Authors: RIAZ TEHREEN , JABEEN SARWAT , TALIB WASEEM , Shami Nabeela
Published: September 2021

Objectives: (1) To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. (2) To determine the relationship of age with type of ovarian tumour. (3) To categorize the management of these cases according to the intra-operative findings. (4) To analyze the occurrence of various histopathological types of tumour. Date Source: Medline Study Design: Single centered prospective descriptive study of 150 cases. Place and Duration of Study: Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to,31st December 2006. Subject and method: 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Results: Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain (53%) followed by menstrual disturbances (30%), abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Conclusions: Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management.