bluuebunny/crossref_metadata_2025 huggingface dataset:
PLACENTA PERCRETA WITH HAEMATURIA
Authors: ARA SARWAT
Published: September 2021

Placenta percreta with urinary bladder invasion is a rare but potentially lethal condition with a high mortality rate. A 28 years old woman, gravida three para two with previous 2 cesarean deliveries, at 30 weeks of gestation, was admitted with frank haematuria. The diagnosis of placenta percreta with involvement of urinary bladder was confirmed. An emergency cesarean section and obstetric hysterectomy was performed and urinary bladder was repaired.
APPENDICULAR MASS
Authors: ALI SARDAR , RAFIQUE HAFIZ MUHAMMED
Published: September 2021

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 toNovember 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying student Chi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.
POST OPERATIVE WOUND INFECTION
Authors: IJAZ AAMIR , AMER SUHAIL
Published: September 2021

Background: The use of antibiotic prophylaxis during Lichtenstein inguinal hernia surgery is controversial, and no definitive guidelines are available in literature. Objective: To determine effects of prophylactic antibiotics in reducing the frequency of postoperative wound infection in Lichtenstein hernia repair. Study Design: Case control study. Setting: Surgical Unit II, Allied Hospital, Faisalabad. Duration: One year, between January 2007 and December 2007. Methods: Patients undergoing unilateral, primary inguinal hernia repairelectively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.0 g intravenous Cefazolin before the incision or an equal volume of placebo. Wound infection was defined according to the criteria of Centers for Disease Control and recorded. Results were assessed using chi-square test. Results: 100 patients were included in the study. Minimum age of patients in this study was 20 and maximum 75 years with a mean of 44.06 in group A and 44.84 in group B. The total number of wound infections was 7 (7%); 2 (4%) in the antibiotic prophylaxis group and 5 (10%) in the placebo group. Statistical analysis showed no significant difference in the number of wound infections in both groups (p value=0.240). Conclusions: We conclude that in Lichtenstein inguinal hernia repair routine use of prophylactic antibiotics is not needed, as it does not significantly reduce the postoperative wound infection rates.
APPENDICULAR MASS
Authors: ALI SARDAR , RAFIQUE HAFIZ MUHAMMED
Published: September 2021

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 to November 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying studentChi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.
ACUTE CHOLECYSTITIS
Authors: CH TARIQ HASSAN , ALI ASGHAR , JAMIL MUNAWAR
Published: September 2021

Introduction: Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. Objective: To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Setting: Department of Surgery Bahawal Victoria Hospital Bahawalpur. Duration of Study: Two year study from December 2007 to December 2009. Subject and Methods: Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by intervalcholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. Results: The mean age of the patients in group A was 42.2 + 10.7 years and in group B was 42.2+ 10.7 years. The Male to female ratio was 1:4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1.8days and in group B was 3.8+ 1.4 days. The mean total hospital stayin group A was 6.5 + 1.7 days and in group B was 10.2 + 1.3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1(3.3%) injury to biliary tree, 4(13.3%) wound infection,1(3.3%) wound haematoma, 3 (10%) seroma and 1(3.3%) wound dehiscence. While in group B there were 1(3.3%) injury to biliary tree, 3(10%) wound infection,2 (6.7%) wound haematoma, 2(6.7%) & no patient of wound dehiscence. Conclusion: Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery.
OPEN CHOLECYSTECTOMY
Authors: KASHIF ALI , FEROZE FAHEEM , KAZI WAQAS AHMAD
Published: September 2021

Background: Postoperative nausea and vomiting (PONV) are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. Objectives: To compare the frequency of PONV in patients treated with propofol and metoclopramide. Study Design: Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months (01st July to 31st December 2004). Materials and Methods: 182 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit (PACU) were selected by non probability convenience sampling and were equally divided into two groups. Group ‘A’ received propofol (0.5 mg/kg) while group ‘B’ received metoclopramide (0.2 mg/kg). Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron (4mg). Results: In group “A”,18 patients responded to intervention (60%) whereas 26 (86.66%) patients gave a positive response in group “B” (p 0.020). More patients who received propofol needed the rescue medication (40%) than those who received metoclopramide (13.33%) (p 0.020). Conclusion: Metoclopramide is a better option for managing PONV than propofol.
ACUTE PANCREATITIS
Authors: TARAR NASIM AFZAL , HAIDAR IRFAN ZAFAR , IQBAL AZHAR , Hassan Maqsood ul
Published: September 2021

Objectives: To determine whether in our setup the Modified Glasgow Scoring System is still an accurate marker for the assessment of severity in acute pancreatitis. Study Design: Observational study. Settings: Surgical Unit, CMH Peshawar. Period: January 2005 to January 2008. Material and Methods: It is an observational study of 50 male and female patients between ages of 15-75 years (Mean 43.3). Male to female ratio was 1:1.3. They were graded mild, moderate and severe using the 8 variables/ markers of Modified Glasgow Scoring System. Exclusion from this study were the patients with acute pancreatitis who were treated at the same institution but not admitted to the surgical ICU, those admitted after inter institutional transfer for tertiary care and patients admitted as sick transfer from other hospitals after 24 hours. Results: On the basis of variables in the Modified Glasgow scoring system (Imrie), 18 patients were predicted with the severe outcome, but only 15 (83%) cases had an actual severe outcome. Whereas 3 cases (17%) did not follow the prediction and behaved as moderate pancreatitis. Similarly, 16 cases predicted as moderate pancreatitis, 14 (88%) followed the prediction and only 2 (12%) cases behaved as mild cases.16 cases were predicted mild, but 13 (81%) followed the prediction and only 3 (19%) switched to moderately severe group. Thus theoverall accuracy of Modified Glasgow Scoring System was found in 42 (84%) cases. Bililary pathology remained the main aetiological factor. Two of the variables were significantly deranged in severe cases. These were age over 50(4 cases), and WBC count > 20x 109/l (12 cases). Hospital stay varied between 4-21 days (Mean 9 days). Conclusion: The Modified Glasgow Scoring System remains a valid predicting systemfor the outcome in patients with acute pancreatitis. It is simple, easy to apply with good predictive value and can be used in all hospital settings.
GYNAECOMASTIA
Authors: SHABBIR ASIYA , REHAN TARIQ MAHMOOD , Hussain Jaffery SHAHID , Baig Muhammad Ubaidullah
Published: September 2021

Objectives: To determine the causative factors and management of Gynaecomastia. Study Design: Observational case series study. Place and Duration of Study: Surgical Unit-1 Bahawal Victoria Hospital Bahawalpur, from 1st January 200 till 31st December 2007. Patient and Methods: Thirty male patients having breast swelling were included in this study. Relevant history was obtained. Appropriate physical examination was performed. Necessary investigations were done and after making a diagnosis appropriate treatment was done. A total of 30 patients were studied in the study period of 18 months. Those male patients who were having breast lesion other than benign enlargement (e.g. Ca. Breast, Breast/Abscess) were not included in the study. Necessary investigations were done. Subcutaneous Mastectomy was performed. Results: The most common age group developing gynaecomastia was of 20-30 years (60%). Bilateral gynaecomastia was observed in 76.66% and unilateral gynaecomastia in 23.33%. Idiopathic gynaecomastia was observed in 73.33% cases. Medical treatment was given with tamoxifen 10mg twice a day for the period of three months in 6 case (20%) and this remained effective in 5 case (83.33%). Subcutaneous mastectomy was performed in 17 cases (56.66%). Post-operative complications were seen in 4 cases (23.52%), the most common complication being wound hematoma in 2 cases (11.76%). Most of the patients (88.9%) were fully satisfied with the results of subcutaneous mastectomy. Conclusion: Gynaecomastia is the most common benign lesion of the male breast. As far as physiological gynaecomastia is concerned, patients should be observed for at least 2 years from the onset of their condition. In most of the cases spontaneous resolution occurs. Surgical treatment should be planned in whom spontaneous resolution does not occur. Surgery remains the mainstay of therapy and is frequently indicated for psychological and cosmetic reasons.
PROSTATE CANCER
Authors: MWAKYOMA H A , MAGANDI J L
Published: September 2021

Objectives: To correlate histopathological grades of prostate cancer by Gleason’s scoring system and pretreatment PSA levels in patients with prostate cancer. Study Design: A prospective longitudinal study. Setting: Muhimbili National Hospital in the Departments of Histopathology and Morbid anatomy, Surgery and Biochemistry. Study Period: 15 months (from November 2006 to March 2008). Patients and Methods: Tissues were obtained from 131 cases of Transurethral Trucut biopsy and were formalin fixed and paraffin-embedded for diagnosis. The prostatic tumours were diagnosed and assigned Gleason’s histopathological grades and scores using Haematoxylin and Eosin (H&E) stained sections. Blood for PSA assay was analyzed by a method based on the immunoradiometric principle in which two monoclonal antibodies are directed against two different epitopes of PSA molecule. Results: During the period of study, 113 patients were diagnosed to have carcinoma of the prostate. The mean age at diagnosis was 68 years. The predominant histological type was adenocarcinoma (99.1%). The majority (45.1%) had moderately differentiated adenocarcinoma. Sixty one percent (61%) of patients had Gleason’s score of 5-7 and 81.5% of patients had significant elevation of pretreatment PSA of > 20.0 ng/ml. There was a positive correlation between Gleason’s score and pretreatment PSA levels in patients with Prostate cancer (r = +0.6) and was statistically significant (P< 0.05). Conclusions: It is known that the intermediate (5-7) Gleason’s score prostatic cancers are highly unpredictable in their clinical aggressiveness. This limitation is of particular importance as the majority of the tumours (76%) in our study fell into this intermediate category. Thus, predicting the biological potential of the majority of prostatic cancers in asymptomatic patients based upon histology alone is problematic. The combination of pretreatment PSA levels which correlated well with Gleason’s score in our study will be helpful in planning the choice of therapy in most patients with prostatic cancer in order to improve the prognosis.
LIVE RENAL DONORS
Authors: ASHRAF HAFIZ SHAHZAD , Ahmed Shafique , HYDER IMRAN , Ijaz Mubashir , KHAN MOHAMMAD USMAN
Published: September 2021

Objectives: To compare the findings of helical computed tomographic angiography and intra-operative findings in live related donors. To evaluate the accuracy of helical computed tomography with advanced 3D techniques in depicting the renal vasculature, parenchymal and anatomy of collecting system. Setting: Sheikh Zayed Post Graduate Medical Institute and National Institute of kidney diseases Lahore. Material and Method: Between June 2006 to May 2009 eighty potential donors underwent CT angiogram as a part of theirpreoperative workup. We retrospectively studied the CT angiogram and compared the finding with the surgical findings. The results were reviewed with radiologists to determine the discrepancy in discordant cases. Results: The accuracy of CT angiography was 93.40% to predict number of vessels. Five arteries and one vein was missed, this disconcordant comprised 7.59% during initial CT interpretation. The overallconcordance between CT angiography and operative findings in delineating the arterial anatomy was found in 74(93.67%) and venous in 78 (98.73%) donors. All CT scans demonstrated normal collecting system except one, which showed a dilated right pelvicalical system and ureter. Simple renal cysts about the size of 2-4 cm were found in the four left kidneys. CT scan supplied additional important anatomical informationincluding kidney size and the presence of nephrolithiasis. Conclusion: Helical CT angiography is very specific for arterial and venous anatomy as well as other anatomical and functional details. It provides all the information required by a surgeon. It can become the single imaging modality for preoperative assessment of potential donors in place of conventional angiography and intravenous urography. CT angiography isminimally invasive and cost effective.
ACUTE MYOCARDIAL INFARCTION
Authors: HUSSAIN ZAFAR , TANVIR ZAFAR HUSSAIN , AHMAD AFTAB
Published: September 2021

Background:- Magnesium, the second most abundant intracellular cation have several critically important roles in human body. In addition to energy production and maintenance of electrolyte balance, magnesium (Mg++) is essential for normal neuromuscular function, excitation contraction coupling maintenance of vessel tone, blood coagulation as well as Ca++ and K+ transport across the plasma membrane.Study Design: Case control study. Material and Methods:- A total of 125 subjects enrolled for this study, 88 were AMI patients having their first episode. 37 subjects were taken as control group. These patients were classified into three groups depending on the age of the subjects. Aims and objectives:- To find out serum magnesium and electrolyte levels in AMI patients at presentation to Emergency Department. Discussion:-Hypomagnesaemia is a common clinical finding in cases of acute myocardial infarction at their presentation to the emergency department of Punjab Institute of Cardiology, Lahore. It is very critical as ventricular tachyarrythmias cardiac arrest, sudden cardiac death, re-infarction are the usual outcome. Conclusion:-There is Hypomagnessemia (P<0.001) in all the subgroups while for Na+ and K+ (P>0.05). Our result explains thecontribution of hypomagnesaemia as a minor risk factor for AMI. Therefore it is suggested that serum magnesium should be estimated in each case of AMI patient. Importance may be given to Mg++ supplementation where needed. The dosage should not be empirical but be based on individual patient requirement.
SNAKE BITE
Authors: BUTT KAMRAN ZAHEER , ANWAR FAHEEM , RIZWAN MOHAMMAD
Published: September 2021

Introduction: 15 percent of the snakes are poisonous and present a potential life threatening risk to human lives. Objectives: (1) To review the demographic, epidemiological, clinical and laboratory findings of 48 patients of snake bite treated in a field hospital. (2) To evaluate the treatment and outcome of these patients. Design: A retrospective study. Setting: Field hospital in rural Sindh. Period: From January 2002 to December 2003. Material & Methods: All patients diagnosed with snake bite had first aid treatment by a either a nursing staff close to the place of bite or by a quack and later on transferred to field hospital. The first aid treatment consisted of pain relief (injectable diclofenac, oral acetaminophen), application of bandage or tourniquet proximal to the bite, antihistamine (oral or injectable chlorpheniramine) anti- inflammatory (injection hydrocortisone) and immobilization of the affected limb with a splint. Results: We are treated 48 patients with snake bite. There were 45(94%) male patients and 3(6%) female patients. Age range was 18 to 56 years with a mean age of 29.8 years. 35(73%) patients suffered from snake bite between the months of May and September. The timing of the bite was also peculiar with 36(75%) patients bitten between 8pm and 8am whereas only 12(25%) patients during other times of the day. 38(79%) patients gave history of seeing the snake themselves and 10(21%) patients were not able to see the snake mainly because of darkness. Conclusion It should be remembered that not all snakes are poisonous and that they are more afraid of humans than we are of them. Psychological effects of the bite are at times more devastating than the clinical effects, therefore patient reassurance forms part of the treatment.
VERAPAMIL AND LOPERAMIDE
Authors: UNAR MANZOOR AHMED , JALBANI GULSHAN ARA , WAGAN MAHBOOB AHMED , Shah Shaheen
Published: September 2021

Background: In smooth muscle cells, an increase in cytosolic free calcium concentration is an essential step for the cells to contract. The increase in calcium concentration occurs by influx from the extra cellular medium through calcium ion channels. Calcium channels have potential role in regulation of motility in gastrointestinal tract so there is growing interest in calcium channel blockers as a potential pharmacological approach to the treatment of various gastrointestinal motor disorders. In this study we evaluate the inhibitory effects of verapamil on spontaneous contractions of isolated guinea pig ileum and compare them with inhibitory effects of loperamide. Materials and Methods: Isolated intestinal segments of sixteen guinea pigs were used in this study. Serial dilutions (10-18 - 10-3 gm/ml) of loperamide and verapamil were administered; effects observed and recorded by 7B Grass Polygraph machine. Results: We observed that at lower concentrations, loperamide showed more inhibitory effects than verapamil while at higher concentrations (10-4 and 10-3 gm/ml) verapamil showed more inhibitory effects than loperamide on the contractions of isolated guinea pig ileum. Conclusion: This study gave us a clue that verapamil found a potent inhibitor of small intestinal contractions as loperamide. However one can presume further that calcium channel blocker verapamil acting on calcium channel receptor on GIT will be developed with more specific effects on smooth muscle of intestinal tract.
SERUM MAGNESIUM LEVEL
Authors: ZAFAR SADIA , AYESHA HINA , BUTT ASGHAR , Malik Bushra Abdul
Published: September 2021

Objectives: To evaluate serum magnesium level in children with 3rd degree malnutrition and to compare these values with healthy children. Study Design: Cross sectional comparative study. Setting and Duration: Pediatric Department of Allied Hospital Faisalabad from Oct. 2003 to Nov. 2004. Subjects: Cases: 60 children of age six month to five year having weight < 60% of that for age. Control: 60 healthy children of age six month to five year having weight > 80% of that for age. Methods: Both cases & controls were selected from indoor & outdoor through simple random sampling. Detailed history & examination was done and S/Mg level were measured by atomic absorption spectrophotometer. Data was analyzed with the help of SPSS by applying T test and was presented by frequency tables. Results: The cases showed decreased S/Mg level (1.11+/- 0.24 mg/dl) as compared to controls (2.01+/- 0.78mg/dl).S/Mg levels were also decreased in cases with height < 80 % of that for age (0.98+/-0.5mg/dl) as compared to controls having height > 90 % of that for age. S/Mg levels were markedly low in cases who had low albumin level (0.98+/- 0.05 mg/dl) and those children who presented with persistent diarrhea (0.96+/-0.12mg/dl) Conclusion: S/Mg levels were decreased in children with PEM as compared to those with age and sex matched control. This decrease in S/Mglevels was marked in those cases who had decrease serum albumin level and persistent diarrhea.
MISSED ABORTION
Authors: KHAN IKRAMULLAH , TIAR IK , SHEZADI NOREEN
Published: September 2021

Objective: To compare the effectiveness of extra-amniotic cervical catheter and vaginal misoprostol as a cervical priming agent prior to surgical evacuation in first trimester missed abortions. Design: Randomized clinical trial. Setting: At lady Willingdon hospital gynecology unit 1 from 1st March 2008 to 28th February 2009. Methods: 100 patients with diagnosis of missed abortions of up to 12 weeks + 6 days were studied. The primigravida were included. They were divided in two groups. In group. A (50) patients 400 microgram (2 tablet ) misoprostol were placed high up in posterior vaginal fornix while in group B (50) patients extra-amniotic. Foleys catheter was placed aseptically 6 hour before surgical intervention as priming agent. Exclusion criteria: All multigravida, patients sensitive to prostaglandin, and with disturbed coagulation were excluded. Main Outcome Measures: The main out comes are 1, cervical dilatation and effacement 2,complications like fever, pain lower abdomen, headache and vomiting 3, amount of bleeding in ml after application of agent. Results: Cervical catheter proved to be good cervical priming agent comparable to misoprostol. Cervical dilatation was significantly better in misoprostol (> 10 mm 44%, > 8mm 30%, > 5mm 20%) as compared to Foleys group (>10 mm 24%, > 8mm 38%, > 5mm 20%) while in 3 (6%) dose of misoprostol was repeated and in 10 (20%) patient in Foleys group has no effect. The side effects occurred in both groups but systemic effects were more in misoprostol, pain lower abdomen 42% VS 46%, backache 18% VS 26%, fever 10% VS nil, headache 16% VS nil and no side effect 14% VS28%) as compared to Foleys catheter. Systemic effects were absent in Foleys catheter due to inert nature. Bleeding occurred in all patientswith misoprostol while it was absent in 48% cases in Foleys group (>60ml 42% VS 8%, <40ml 32% VS 14% < 20ml 26% VS 30%). 48% cases had no bleeding in Foleys group. Conclusion: Cervical catheter proved to be good priming agent due to lesser systemic side effects as compared to misoprostol.
VAGINAL DELIVERY VERSUS CESAREAN SECTION
Authors: ZAMAN BUSHRA SHER , Zulqarnain Ali , QAMAR RASHAD , Saleem Anza , SIDDIQUE SUMERA
Published: September 2021

Objective: It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Design: Cross-sectional comparative study. Place and Duration of Study: Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. Patients and Method: The study was carried out on all Primigravida with breech presentation reported through emergency in labour deliveredvaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. Results: It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 incesarean group. Respiratory distress syndrome is more in cesarean (4.4%) than vaginal group (2.2%). Observed neonatal trauma is more in vaginal group (6.7%) than cesarean section (2.2%). Conclusion: Neonatal morbidity appears to be more in vaginal breech delivery than cesarean section for Primigravida with breech presentation at term.
ELECTIVE CAESAREAN SECTION
Authors: KAUSAR ROBINA , YASMEEN LUBNA
Published: September 2021

Objective: To compare short antibiotic prophylaxis versus prolonged antibiotic regime in terms of morbidity control of infection in patients undergoing elective caesarean section. Study Design and Settings: It was a experimental study done in Gynae/Obs unit I Holy Family Hospital Rawalpindi over a period of one year. Patients and Methods: Total of 200 patients selected randomly were admitted in antenatal ward for elective caesarean section. All these booked patients with age less then 40 years, gestational age of > 38 weeks, Hb >10g/dl, with no signs of genitourinary or respiratory tract infection were included in the study. These patients were divided in two groups with 100 patients in each group. In group I, short antibiotic prophylaxis in form of three doses of injectable antibiotic was given. In group II prolonged antibiotic regime wasgiven as 5 days course. Augmentin was chosen as it has proven efficacy and good coverage for microorganisms of urogential tract and skin. Injection Augmentin was given in dose of 1.2g (1g Amoxycillin + 200mg clavulanic acid) I/V x BD. All operation were performed by transverse lower segment caesarean section by registrars and consultants. Anaesthesia used was mostly spinal and more than 80% of the patients were having body mass index of <30. These patients were followed in postnatal ward for post operative infectious morbidity till discharge. Data collected through proformas was entered in computer and analyzed using SPSS. Result: Over all post operative infectious morbidity in group I was 29% and in group II 30% (p = 0.877). Post operative fever in group I was 09% and group II 08% (p = 0.800), while frequency of endometritiswas found to be same in both groups which was 03%. No case of chest infection was recorded in both groups. Only 5% patients in group I and 4% patients in group II were reported to have urinary tract infection (p = 0.733). The most common complication found during study was wound infection, the rate being 12% in group I and 15% in group II (p = 0.535). So the overall results showed no statistically significant differencebetween two groups. Conclusion: Short antibiotic prophylaxis is as effective as prolonged antibiotic regimen. As it is cost effective and most of our patients come from low socio economic class, so this short antibiotic prophylaxis should be recommended routinely for all elective caesarean sections.
RUPTURED UTERUS
Authors: AKHTAR YASMEEN
Published: September 2021

Objective: To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with other colleagues of the specialty. Study design: Case series descriptive study. Settings: Gynae /Obstetrics Unit -I Lady Willingdon Hospital Lahore. Study Duration: Five years i.e Ist May 2004 to 30th April 2009. Material and Methods: Obstetric patients who presented with ruptured uteri. Results: Results showed that risk factor for ruptured uteri include cesarean sections (61.11%), grand multiparty (16.6%), Instrumentaldeliveries (4.44%) and undetected perforation (1.11%). Conclusion: Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus.
EPIDURAL ANAESTHESIA
Authors: RIAZ AZMAT , MALIK HAMID SAEED , YASIN BILAL
Published: September 2021

Objectives: To compare the benefits and adverse effects of three different drug combinations when used for single-shot epidural anaesthesia for day-case arthroscopy. Design of Study: Prospective, random, double-blind study. Setting: A 250 bedded secondary care hospital. Period: From October 2005 to Feb 2007. Material and Methods: We studied 75 adult male patients, aged between 23 to 63 years, weight <100 kg, ASA physical status I or II undergoing elective knee arthroscopy as day-case procedure. Patients were randomly divided into three groups ( 25 patients in each group) and single-shot epidural anaesthesia was performed using a total of 20 ml epidural lignocaine 2% (Group 1) bupivacaine 0.5% (Group 2) or a mixture containing lignocaine 2% and bupivacaine 0.5%, 10 ml each (Group 3). Results: Time to achieve maximum height (in minutes) was similar in group-1 and group-3 (10±4 and 11±2), but it was significantly longer in group-2 (20±3). Block time was comparable in group-2 and 3 (130±25 and 118±37) but it was significantly shorter in group-1 (60±20). Post-operative discharge time was longest in the group-2, and comparable in group-1 and 3.The incidence of complications like bradycardia, hypotension, nausea and vomiting were more in group-2 and less in group-1 and group-3. Inadequate anaesthesia was more in group-1 and least in other two groups.Four patients of group-1 needed rescue analgesia and two from same group needed general anaesthesia as compared to none in group-2 and group-3. In 4-point patient satisfaction scale, maximum patients from Group-3 rated it perfect while most patients from group-1 were not satisfied with the quality of anaesthesia. Conclusions: The results of our study show that a 50-50 mixture of lignocaine and bupivacaine withfentanyl 50 μg when used for single-shot epidural anaesthesia for day case knee arthroscopy, provides better quality of analgesia, with fewer incidences of side effects and more patient satisfaction as compared to lignocaine or bupivacaine alone.
CLAVICLE FRACTURES
Authors: HAIDER IRFAN ZAFAR , KHAN TAHIR AHMAD , KHAN TAHIR AHMAD
Published: September 2021

Objective: To emphasize upon the frequency of fractures of clavicle due to indirect blunt trauma caused by road traffic accidents and falls from heights and their sequalae. Design: Observational descriptive study. Place and Duration of Study: Combined Military Hospital Bannu during a period of two years from June 2003 to May 2005. Patients and Methods: Patients included in the study were the trauma patients brought to Combined Military Hospital Bannu during a civil –military conflict in tribal areas of North and South  aziristan . Patients had sustained multiple injuries mostly due to road traffic accidents in hilly terrain , falls from heights and combat scuffles. Out of these trauma victims, 746 patients fractures of the clavicle were grouped, analyzed, treated with standard treatment methods and patients were followed up for the varying periods of time. Results: Out of 746 patients treated at our hospital, 84 were having fracture of clavicle(10.8%). 53 patients (63.1%) with clavicle fracture had fracture involving middle third of the clavicle , 20 patients (23.8%)had fracture of lateral third, and 11patients (13.1%) had fractures involving medial third of the clavicle. Conclusion: Clavicle is a bone which is at risk of fracture in cases of indirect blunt traumabecause the first human reaction in any violence or assault is to protect oneself by using the upper limbs. Its peculiar development and anatomical shape makes it vulnerable to fracture in most physical insults. However , it usually unites by conservative methods and even considerable non-union does not significantly affect function.
DERMATOLOGICAL DISORDERS
Authors: DOGAR IMTIAZ AHMAD , MAN M. ARIF , BAJWA ASMA , Bhatti Aysha , Naseem Shazia , Kausar Sumaira
Published: September 2021

Objectives: The study aimed to determine the prevalence and risk factors of Depression and Anxiety in indoor Patients of Dermatology Department. Types of study: cross sectional study. Place and Duration of study: The study was conducted at in door Department of Dermatology, D.H.Q Hospital Faisalabad from August 2006 to October 2006. Patients & Methods: A total of 77 diagnosed dermatological patients, (21males and 56 females) were selected by using non-probability convenient sampling. Hospital Anxiety andDepression Scale and DSM –IV-TR criteria for depression and anxiety were used to evaluate the patients. QOL-BREF was administered. Results were also correlated with patient’s demographics. Result: Out of 77 Patients who were enrolled in a study, 52 % of subjects reported psychiatric co-morbidity regarding anxiety and depression according to DSM-IV-TR, HADS, anxiety and depression score was 12.75 (±4.33)and 11.18 (±4.51) respectively. A strong co-relation of HADS anxiety and HADS depression was found with the DSM-IV- TR diagnosis respectively. The strong negative association was found with the education, monthly income and socio-economic status respectively. Conclusion: The study shows high Prevalence of Depression and Anxiety in Patients having dermatological disorder. The findings also highlight the importance of recognizing dermatological disease related psychiatric problems. Through training, dermatologists can identify psychiatry morbidity and play their role in early detection, management and referrals of complicated cases of these co- morbid conditions. In this way better quality of care can be assured.
MULTI-DETECTOR CT FINDINGS IN ABDOMINAL TUBERCULOSIS
Authors: SHAUKAT AAMIR , SHAUKAT ASIM
Published: September 2021

Objective: To know the findings of MDCT in cases of Abdominal Tuberculosis. Patients and Methods: Fifty eight patients with suspicion of abdominal tuberculosis were scanned and the findings were evaluated. All the patients received IV and oral contrast. The patients were referred from the medical and surgical departments of Shalamar Hospital, Lahore. Toshiba 4 Slice Aquilion was used for scanning. Theexclusion criterion was patients on Anti tuberculous drugs and urogenital tuberculosis. Results Following 6 findings were observed in 47 abnormal scans, Out of other 11 scans 9 had other diseases like diverticulitis, Appendicitis and Bowel Lymphoma. 2 were normal. Close medical and Surgical follow up was obtained in all cases. Ascites = 35, Omental / Mesenteric Thickening / Involving = 27, Small Bowel wall thickening =07, Large bowel wall thickening including Caecal wall thickening = 06, Abdominal Lymphadenopathy= 26, Solid Organ Involvement, Liver=01, Spleen=02. Conclusion: Ascites was the most common finding in Patients with Abdominal Tuberculosis and Involvement of liver being the least common finding amongst the group.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: KHAN JAHANGIR SARWAR , IQBAL MOHAMMAD , HASAN HAMID
Published: September 2021

Objective: To determine the frequency of common bile duct (CBD) injury in laparoscopic cholecystectomy in our settings, in my last 500 cases, after going through the learning curve associated CBD injuries. Design: Descriptive study. Place and Duration of Study: Surgical Unit-I, Rawalpindi General Hospital and the author’s Surgical Clinics from January 2003 to December 2008. Patients and Methods: Five hundred patients undergoing laparoscopic cholecystectomy by the same surgeon were included. The important variables included demographic data, intra operative time and findings, frequency of CBD injury and post operative hospital stay. Results: There were 419(83.8%) females and 81(16.2%) males with mean age 45.04±11.03 years. 294(58.8% )patients had chronic cholecystitis with Cholelithiasis and were admitted through Out Patient Department whereas 206(41.2%) were admitted through Accident and Emergency Department with acutecholecystitis. Abdominal ultrasound showed multiple calculi in 351(70.2%) patients and 149(29.8%) patients had single calculus preoperatively. Empyema was found in 97(19.4%) cases whereas adhesions were present in 182( 36.4%) patients. In our study frequency of CBD injury was 1%. Mean operating time was 35 minutes. 96.8 % of the patients were discharged within 48 hrs of operation. Conclusion: LaparoscopicCholecystectomy in our set up proved to be a safe procedure, having frequency of CBD injury of only 1% and a short hospital stay 493(96.8% )being discharged in less than 2 days.
PREVENTION OF PAIN ON PROPOFOL INJECTION
Authors: MAHMOOD IMRAN , YASMINE MUSARRAT
Published: September 2021

ABSTRACT… Background: Propofol is wonderful drug for short duration procedures. However, pain on injection of propofol, which has been reported to occur in 28-90% of patients, is a major drawback to its use. Different methods have been used to decrease this pain but intravenous lignocaine is most commonly used pretreatment. Period:................... Methods: A comparative, randomized, double blind study was undertaken to compare the efficacy of three drugs for prevention of pain on propofol injection on induction of  anaesthesia. 100 patients of ASA status 1 and 2 posted for General Surgery were allocated randomly in four groups of 25 each, using computer- generated table of random numbers. Venous occlusion was made with tourniquet for one minute. The study drug intravenous lignocaine 1% 2ml (group1), Ketamine 10mg(group2), Dexamethasone 4mg in 2ml (group 3) or normal saline 2ml (group 4) was administered over 10 seconds according to random number. There after occlusion was released and intravenous propofol was given. After the first 25% of propofol given, patients were asked for intensity of pain they experienced.Conclusion: It was concluded that Lignocaine, Ketamine and Dexamethasone significantly reduces the pain induced by Propofol injection pain as compared to Placebo but there is no difference in efficacy for prevention of pain among these three groups Key words: Propofol, pain, intravenous injection.Results: Lignocaine, Ketamine and Dexamethasone significantly reduces the pain on propofol injection in comparison to placebo, but there was no significant difference in pain score among groups 1, 2, 3. There was no significant difference in recall of pain among groups 1, 2, and 3. Although there was significant difference between placebo group and other three groups
CATHETER RELATED BLADDER DISCOMFORT
Authors: CHOHEDRI ABDUL HAMEED , SHIRAZI MEHDI , HOSSEIN EGHBAL
Published: September 2021

Introduction: Bladder discomfort is a common side effect after surgical procedures that involve either extensive bladder dissection or prolonged postoperative catheter drainage. Various treatments have been tried with varying degrees of success for managing this adverse effect. In this study we compared the efficacy of ketamine and tolterodine in prevention of catheter induced bladder discomfort. Patients and Methods: Three hundred patients who were scheduled for open prostatectomy or transurethral resection of prostate (TURP) were randomized into three groups. The first group received placebo, the second one received tolterodine before operation, and the third group received ketamine250ìg/kg IV, just before the anesthesia induction. Bladder discomfort was assessed by anesthesiologist who was unaware ofthe type of medication. The assessment was done on arrival in the post anesthesia care unit (PACU) and then at 0, 1, 2 and 6 hours after patient’s consciousness. Severity of discomfort was recorded as none, mild, moderate, or severe. The absence or presence of adverse effects were recorded. The data were analyzed using SPSS and Pearson chi-squared and ANOVA tests were applied for further statistical evaluations.Results: Both the incidence rate of bladder discomfort and its severity in the control group was significantly higher compared with ketamine and tolterodine groups (P< 0.001). Comparing the ketamine and tolterodine groups, tolterodine had lead to lesser degree of bladder discomfort at 0, 1, 2 hours, while ketamine was more effective at 6 hours. Conclusions: Pretreatment with either ketamine or tolterodine is effective indecreasing the incidence and severity of catheter related bladder discomfort in patients under going open prostatectomy or TURP.
CATARACT
Authors: SYED SARFRAZ HUSAIN , ARIF MUHAMMAD , SULTAN DR. MUHAMMAD
Published: September 2021

Objective: To observe the tendency of corticosteroids to raise the intraocular pressure after prolonged use of 0.1% dexamethasone eye drops during post operative period of cataract extraction. Study Design: Observational study. Period: From August 2008 to December 2009. Subjects and Setting: In the study 50 patients were included. These patients had age related cataract in one or both eyes. The IOP of every patient was measured preoperatively with the help of Goldman applanation tonometer. After cataract extraction, every patient received 0.1% dexamethasone eye drops four times a day for one month. The IOP was measured fortnightly. Setting: Department of Ophthalmology, Allied Hospital, Faisalabad and the clinics of the authors. Results: Topical administration of 0.1% Dexamethasone Eye Drops ,four times a day for one month after age related cataract extraction caused elevation of intraocular pressure more than 21 mm Hg in 8% of general population.
CONTROL OF HYPERTENSION
Authors: BHURGRI GHULAM RASOOL , KOREJO HUSSAIN BUX , QURESHI MUHAMMAD ALI , Kumar Raj , Aamir Nasrullah
Published: September 2021

Objective: To compare the efficacy and tolerability of Losartan and Atenolol in alone and combination in treatment of hypertension. Study Design: Comparative study. Setting: Medical out patients department of Jinnah Postgraduate Medical Centre Karachi from January 2007 to June 2007. Methods: There were 60 patients previously untreated with mild and moderate essential hypertensions were registered for study. The selected patients were divided into three groups. Group A was given atenolol, Group B was given Losartan, and Group C was given both drugs. The target blood pressure was 120-140/80-90 mmHg. There were 42 males and 18 females with age range 25-65 years. Results: The mean baseline score of groups A, B and C were showed systolic blood pressure 182±19, 174 ± 20 and 168 ± 12 respectively. The diastolic blood pressure was 104.5±11, 102.5±9 and 104.5±10 respectively. The difference in mean systolic and diastolic blood pressure was not significant statistically as P = 0.06 and 0.76 respectively. After 4 months of treatment with atenolol, systolic blood pressure decreased to 147±17, and diastolic blood pressure fell to 87±4. Losartan decreased systolic blood pressure 138±13 and diastolic blood pressure 87±4 in 4 months of treatment. The combined therapy decreased systolic blood pressure 115±4.6 and diastolic blood pressure 75±4.7. The effect of treatments on systolic and diastolic blood pressure was significantly different as (p < 0.001) and ( p = 0.036) respectively. Side effects observed in 2 (10%) patients from group C, 8 (40%) in group A and 4 (20%) in group B. Combination therapy proved more effective in controlling hypertension than mono therapy and also fewer side effects. Patients showed better control on combination therapy as compared to mono therapy. Losartan proved a little better in controlling hypertension then atenolol and was more expensive. Conclusion: Patients showed better results with combination therapy for hypertension compared to individual drug.