bluuebunny/crossref_metadata_2025 huggingface dataset:
VAGINAL SONOGRAPHY a HYSTEROSCOPY
Authors: ASGHARNIA MASOMEH , Tabar Zahra Mohammad , MEHRAFZA MARZIEH , Shakiba Mary am , OUDI MONA , Nikpuri Zahra , Nikpuri Zahra
Published: September 2021

B a c k g r o u n d : Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. A i m : To evaluatethe consistency of hysteroscopy based on a histopathological report from endometrial specimens for intrauterine disorders. Materials andMethods: This is a cross-sectional study. The study included 115 infertile patients. All were admitted for investigation of infertile women beforeassisted reproduction in Mehr infertility institute between 2006 and 2007 hysteroscopy, and histological evaluation of endometrial biopsyperformed.We compared the efficacy of hysteroscopy in the diagnosis of benign intrauterine pathology in infertile women in whom the diagnosiswas confirmed by histologic studies. The women had a complete evaluation with preoperative hysteroscopy, and histological analysis of uterinecavity specimens. Sensitivity, specificity, predictive and negative predictive values were calculated for hysteroscopy considering the histologicalstudy as 100%. Results: Sensitivity and specificity of sonography in diagnosing the polyp were stated 81 % and 64% respectively. Sensitivityand specificity of hysteroscopy showed of polyps revealed 85% and 84% respectively. The results indicated that Sensitivity and specificity ofsonography in diagnosing the myoma were 25% and 98% respectively. Sensitivity and specificity of hysteroscopy in diagnosing the myomawere expressed 50% and 93% respectively. C o n c l u s i o n : Hysteroscopy is a safe and rapid direct visualisation of the uterine cavity. We believeit should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.
"PROM"
Authors: YASMIN SHAKILA , FATIMA NAHEED , SAEED SHAZIA
Published: September 2021

Objective: To assess and compare the number of subjects in both groups (Study and comparison), who went into active labourwithin 24 hours and to compare the various complications (maternal & fetal) in both groups. Study Design: Quasi experimental. Sampling Technique: Convenience sampling. Sample Size & Setting: A total of 100 pregnant women presenting with history of leaking amniotic fluid at term (>37 wks) to labour ward of obstetrics and Gynaecology unit, Bahawal Victoria Hospital, Bahawalpur were included in the study. Material & Method: The pregnant women fulfilling the inclusion criteria were enrolled as our study subjects. Rupture of membranes was confirmed by nitrazine test.Thepatients were randomized into two groups (50 women in study and 50 in comparison group). In study group, 50 (Ligm of misoprostol was givenorally after initial assessment of mother and fetus. The dose was repeated 4 hourly, if there was no uterine activity. The number of patients going into active labour and delivering within 24 hours were noted. Different complications (maternal & fetal) faced during all procedure were also recorded and managed. In comparison group, patients were managed were also recorded and managed. In comparison group, patients were managed conservatively for 24 hours. Like in study group, number of patients gong into active labour and delivering with in 24 hours were noted. Different maternal & fetal complications occurring in this group were also recorded and managed. Results: A total of 100 Pregnant women were included in the study. The sample size (100 patients with PROM at term) was completed in 5 months. During that period over all 1105 deliveries were conducted, so the incidence of PROM at term in the study was 9.4%. It was observed in the study group, that all the patients (100%) went into active labour and 96% were delivered within 24 hours of PROM. While in comparison group 72% patients went into active labour and only 62% were delivered within 24 hours of PROM. The results showed that in study group 36 patients went into active labour with only one dose of oral misoprostol, 9 patients required 2 doses and 5 patients required 3 doses of oral misoprostol for going into active labour. When maternal complications were compared in both groups, 92% patients in study group had no complication while only 8% patients had to face different complications. In comparison group 86% had no complication and in 14% patients different complications occurred. Regarding fetal complications 4% fetus/neonates had to face different complications in each group. In current study there was no significant difference in the mode of delivery between the two groups. Conclusion: It was concluded that active management of pre labour rupture of membrances at term with oral misoprostol is a better option than the expectant management. Oral misoprostol in dose of 50 jugm is an effective agent for cervical ripening and induction of labour in PROM at term as significantly high percentage of patients delivered within 24 hours with no increase in maternal and fetal complications.
MATERNAL MORTALITY
Authors: KHAN SADIA , USMANI ASMA TANVEER , IFTIKHAR NAILA
Published: September 2021

Objective: The women residing in a developing country have 200 times greater risk of suffering from pregnancy and childbirthrelated mortality compared with the women of a developed country. To investigate relevant causes and the determinants of maternal mortalitythrough conducting scientific clinical studies. Methodologies: We conducted a prospective study of maternal deaths in the obstetrics andgynaecology unit of RGH for one year. Period: January 2007 to December 2007. We investigated the socio-demographic variables - includingage, parity, socio-economic status and literacy - along with the social behavior towards the antenatal. We designed standardized data collectingforms to collect data from the confidential hospital notes of the patients. The collected medical data of the patients proved useful in analyzingthe underlying causes and the risk factors behind direct and indirect maternal mortalities. Results: In our unit, we have recorded 28 maternaldeaths during the study period. 24 (86%) deaths are due to the direct causes and 4 (14%) are due to the indirect causes. The leading directcauses are hemorrhage 9 (37.5%), eclampsia 7 (29%), septicemia 5 (21%) and anaesthesia complications 2 (8%). Similarly, the distributionof indirect causes is: blood transfusion reactions 2 (50 %), hepatic failure 2 (50 %), Consequently, crude maternal mortality rate can beextrapolated at 645 per 100,000 maternities and maternal mortality ratio at 659 per 100,000 live births. The socio demographics of the deadmothers are: 16 (57%) patients in the age group of 25-35 years, 13 (52%) are multiparas (G2-G4) and 10 (36%) are grandmulti para i.e. G5and above. Moreover, 13 (46%) of them expired at term. The majority of them is illiterate and belongs to lower socio-economic group. 14 (42%)mothers have not received antenatal care and just 4 (15%) of them have received antenatal care from RGH or other hospital. 23 (92%) patientshave been suffering from anemia and we received 15 (54%) of them in a critical state with the hospital stay of less than 12 hours. C o n c l u s i o n :In our study hemorrhage and hypertensive disorders of pregnancy are the leading causes of maternal deaths. We argue that most of thesematernal deaths could have been possibly avoided by periodic interventions during the pregnancy, child birth and the postpartum period.
POSTDATE PREGNANCIES
Authors: RASHID MADIHA , HALEEM SHAMAILA , CHEEMA SADIA
Published: September 2021

Objective: The study was designed to determine the fetomaternal morbidity and mortality in post date pregnancies and tocalculate various modes of delivery in post date pregnancies in our set up. Study design: Non interventional descriptive study. Setting: GyneaUnit- III Services Hospital, Lahore. Material and methods: The data was collected with the help of Proforma which was filled for every patientdelivered at 40 weeks of gestation or above. The proforma included all points relevant to study. Results: The rate of meconium staining of liquor,fetal distress and caesarean section (C-section) increased significantly after 40 weeks gestation. Conclusion: The study shows that morechances of meconium staining, fetal distress and macrosomia in Post date patients. The study further shows that the induction and operativedeliveries are more common mode of deliveries in post date patients.
TREACHEROUS OVARIAN TUMOURS
Authors: RASHID FARHAT , AMJAD NAZIA
Published: September 2021

A 47 years old P7 AO presented with history of gradually increasing abdominal mass and menorrhagia for the last six months.Pelvic ultrasound showed enlarged uterus with multiple fibroids of varying sizes with bilateral, large ovarian tumours with solid elements andhypoehoic thick fluid with septations. CT scan also confirmed same findings. Staging Laparotomy was performed which confirmed the findingsof ultrasound and CT scan. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done along with peritoneal washings forcytology. Histopathology showed uterine fibroids, simple endometrial hyperplasia and Bilateral Mucinous cyst Adenomas of ovary with noevidence of malignancy.
SCURVY
Authors: KHALID MALIK M.
Published: September 2021

Hypervitaminosis and hypovitaminosis occur in children in our country mainly due to socioeconomic reasons. Most commonbeing the rickets due to vitamin D deficiency, however scurvy is also not uncommon and radiological changes suggestive of scurvy areoccasionally seen. Three cases of scurvy are presented here, between one and three years of age, showing typical radiological changesespecially in knees. Good history, physical examination and quality X-rays are essential for making diagnosis of scurvy.
ACUTE CHOLECYSTITIS
Authors: LODH MUHAMMAD FAISAL BILAL , KANWAL SUMERA , AKRAM MUHAMMAD
Published: September 2021

Laparoscopic cholecystectomy has been accepted as the treatment of choice for symptomatic gallstones. Its efficacy and timingin cases of acute cholecystitis is still under debate. This study was undertaken to evaluate our experience with early cholecystectomy as a safe,effective treatment of acute cholecystitis. M a t e r i a l s a n d m e t h o d s : Record of all the patients who had undergone laparoscopic cholecystectomy for the diagnosis of acute cholecystitis was reviewed. Patients were divided into two groups on the bases of onset of symptoms to surgical intervention: less than 72 hours in the early group (n = 15) and more than 72 hours in the late group (n = 25). Results: Conversion to openprocedure was insignificantly less (3 out of 15 in early group and 8 out Of 25 in late group) (20% versus 32%) in the early treated patients (pvalue0.411). Furthermore, the operative time (75 versus 95 minutes) postoperative hospitalization (2 versus 4 days) and total hospital stay (4versus 6 days) were significantly reduced in patients undergoing early laparoscopic cholecystectomy. C o n c l u s i o n : Laparoscopiccholecystectomy is a safe, effective technique for acute cholecystitis in experienced hands with lower conversion rate, shorter operative timeand reduced hospitalization.
COLORECTAL CANCER
Authors: AKRAM MUHAMMAD , IQBAL JAVAID , AMER WASIM
Published: September 2021

There is paucity of data on epidemiology and survival in colorectal cancer from developing countries. O b j e c t i v e s : To determineoverall survival and its predictive factors. S e t t i n g : Department of Oncology Jinnah Hospital Lahore. P e r i o d : From July 1997 to Dec2007.Methods: 73 patients were analyzed. Patient demographic data including age, sex, socio-economic status, pre-treatment CEA levels,Duke's stage, site of tumor (colon, rectum) and complete tumor resectability were recorded. Univariate analysis by chi-square and multivariateanalysis were performed by Cox Regression Model to evaluate the predictors of survival. SPSS v 13.0 was used for statistical analysis. Kaplan-Meier estimate was used to calculate survival. R e s u l t s : Median age of our patients was 45 years. Male to female ratio was 1:1.2. Completesurgical resection could be performed in only 48 (68.5%) patients. Majority (70%) patients had Duke C and D. Overall survivals at 36 monthswas 53 % and was 90% for Duke A and B, while it was 61% and 26% for Duke's C and D respectively. Females had a better survival rate of74% as compared to males with a survival of 36%. Patients with proximal colon tumors had survival of 73% as compared to 37% in rectal/rectosigmoidgroup. Patients with high pre-treatment CEA had poor survival 39%. Only 25% patients with unresectable tumors were alive at 36months compared to 67% in patients with resectable tumors. Conclusion: Significant predictive factors for improved survival were female gender,early disease, patients with proximal colon tumors, low pre-treatment CEA levels and complete tumor resection.
RISK FACTORS;
Authors: ANWER SHAHNAZ , KHAN MUHAMMAD YOUNIS , REHMAN SHEIKH ATIQ-UR-
Published: September 2021

O b j e c t i v e : To determine the risk factors associated with hepatitis B and C carriers versus healthy pregnant women. Materiala n d M e t h o d s : It was a single center based, cross sectional comparative study, conducted at Gynae ward II, B-V hospital Bahawalpur. Durationof study was from March to August 2008.100 patients were enrolled in the two groups, 50 HbsAg/Anti HCV positive women (cases) to comparewith 50 healthy women (controls) match for parity. The data were recorded on a proforma. R e s u l t s : 100 pregnant women were enrolled. Sixtyeight (68.0%) were aged 25 years or less with a mean age ± S.D of 24.62 ± 3.40. Ten (20%) women had HBV and 40(80%) were HCV positive.The risk factors were compared between the two groups by uni-variate and multivariate analysis which showed that history of dental treatment,blood transfusion, surgery, parenteral treatment and jaundice were significant risk factors for hepatitis B and C carrier status. C o n c l u s i o n :There appears to be a strong co-relation of history of blood transfusion and dental treatment with HbsAg/ Anti HCV carrier state in pregnantwomen. The anti HCV seropositivity was appreciably high (80%) as compared to HbsAg (20%) in carrier pregnant women.
FEBRILE CONVULSIONS IN CHILDREN
Authors: BIBI SURRIYA , AHMAD MAQBOOL , AJID AYESHAS
Published: September 2021

O b j e c t i v e s : (i) To know about the knowledge, attitude and practices of parents of children with febrile convulsions, (ii) To provideadequate information of relationship between fever and febrile convulsions and its usual good prognosis. D e s i g n : Descriptive study. S e t t i n g :It was conducted at Pediatric Department of Madina Teaching Hospital Sargodha Road Faisalabad. P e r i o d : Two years period from January2007-2009. M A T E R I A L A N D M E T H O D S : 150 parents and their children with febrile convulsions were included in the study. Diagnosis wasmade on the basis of a history of a convulsion in the child with a febrile illness. Cases were excluded when there was doubt about theoccurrence of convulsions, or if the child previously had convulsions due to any other cause, or if the physical examination or laboratoryparameters suggested any other etiology for the convulsions. LP was done in case of first time febrile fits. A pretested questionnaire comprisingof 12 questions was used for the study. Data was presented through frequency table. Statistical test of significance was Chi-square test. Thedata was analyzed with the help of SPSS computer program EQS 10 N. R e s u l t s : in the study 83 parents (59.3%) could not recognize theconvulsion; 127 parents (90.7%) did not carry out any intervention prior to getting the child to the hospital. 109 (77.9%) parents did not knowthe facts that the convulsion can occur due to fever. For 56 (40%) of the parents every subsequent episode of fever was like a nightmare. Only21 parents (15%) had thermometer at home and 28 (20%) knew the normal range of body temperature. Correct preventive measures wereknown to only 41 (29.2%). C o n c l u s i o n s : Parental fear of fever and febrile convulsion is a major problem with negative consequences affectingdaily family life. The most common immediate effect of the convulsion on the parents was fear of death and insomnia and fear of braindamage.
CHRONIC RENAL FAILUR
Authors: SULEHRI MUHAMMAD ANWAR , SHEIKH NIAZ MUHAMMAD
Published: September 2021

Objective: To find the effect of diabetes mellitus on the development of Chronic renal failure (CRF). S t u d y D e s i g n : DescriptiveCross-sectional study S e t t i n g : Allied Hospital, Faisalabad. P e r i o d : From May 2008 to June 2008. Materials & M e t h o d s : Forty-Five patientsof CRF were selected for study by convenient method technique from admitted patients in dialysis unit of Allied Hospital Faisalabad. R e s u l t s :In our study, out of 45 patients of CRF, 25 (55.6%) were found to be diabetic. The effect of diabetes on the development CRF was highest inage group of 71-85 years that was 100%. In this study diabetes mellitus was found to be more prevalent among married CRF patients (62%)as compared to unmarried patients among whom it was (17%). Among the male CRF patients 54% were diabetic, while among the female CRFpatients 57% were diabetic. C o n c l u s i o n : Percentage of CRF patients having diabetes mellitus was 55.6%. From the above results it isconcluded that effect of diabetes mellitus on the development of CRF increases with age. Diabetes mellitus was found to be more prevalentamong female CRF patients and also among the married CRF patients. The development of Chronic renal failure can be prevented by earlydiagnosis and treatment of diabetes mellitus.
GLOMERULOSCLEROSIS
Authors: ZAFAR TASNEEM , IQBAL ZAFAR
Published: September 2021

Objective: Objective is to determine the changes in lipids and lipoproteins in patients with glomerulosclerosis and healthy controls.Place and Duration: Department of Biochemistry, Frontier Medical College, Abbottabad with the collaboration of Nephrology Unit, AyoubMedical Complex, Abbottabad. April, 2006 February 2007. Material and Methods: Study includes 50 subjects out of which 25 adult patients(18 males, 7 females; age range 20-50 years) with glomerulosclerosis were selected from Nephrology Unit of Ayoub Medical Complex,Abbottabad. Apparently, 25 clinically healthy volunteers of similar age, sex, body mass index (BMI), and socio-economic status as that ofpatients, were selected from various areas of Abbottabad, as controls. Serum triacylglycerols, serum total cholesterol, and HDL-cholesterollevels were measured by kit method. LDL-cholesterol was calculated according to the Friedewald formula17. Serum VLDL-cholesterol ascalculated according to the formula proposed by Wilson cited by Delongi18 The results were expressed as mean ± standard error of mean.Statistical analysis was done using student's test. Results: Distribution of 25 patients and 25 controls, according to age is made. Male subjectswith glomerulosclerosis were greater in number than female, with male to female ratio of 1.85:1. Comparison of serum TGs, TC, HDL-c, LDL-c,VLDL-c, and HDL-c, LDL-c ratio. The mean values of TAGs, TC, HDL-c, LDL-c, VLDL-c, and ratio of HDL-c, vs. LDL-c of patients were observedsignificantly high (P<0.001), when compared to controls. In addition significant low values (P<0.001) of HDL-c in patients were also observedwhen compared to healthy controls. Conclusion: It is concluded that the results of this study provide evidence for raised lipids and lipoproteinslevels, which is invariable feature of nephritic syndrome with glomerulosclerosis. It is suggested that the patients with nephriticglomerulosclerosis should be assessed and managed to avoid potential of accelerating the development of coronary artery disease andincreasing risk of renal failure. Hopefully earlier intervention might decrease higher morbidity and mortality.
PR0P0F0L VS. THIOPENTAL NA
Authors: FARZI FARNOUSH , Oudi Mona , MEHRAFZA MARZIEH , Tabar Zahra Mohammad , MIRMANSOURI ALI , Hoseeini Ahmad
Published: September 2021

O b j e c t i v e : The aim of this study was to compare the side effects, fertilization rate and pregnancy rate (PR) and duration ofrecovery between Propofol and Thiopental Na after ICSI-vaginal retrieval of oocyte in ART cycle. D e s i g n : This study was a prospective,randomized clinical trial Materials and M e t h o d s : Ninety eight ASA(American Society of Anesthesiologist) physical status I and II womenparticipating in an intracytoplasmic sperm injection) ICSI) program were assessed. All of the patients underwent general anesthesia inductionwith Propofol and Thiopental Na. The first group (49cycles) received 2-2.5mg/kg of Propofol, and the second group (49cycles) received 5mg/kgThiopental during transvaginal oocyte retrieval. An informed consent form was obtained for each patients treatment. Variables under studyincluded: female age, cause and duration of infertiIity^postoperative nausea and vomiting(PONV), heamodynamic changes, mean number ofoocyte retrieved, oocyte metaphase II, embryo cleaved, embryo transferred, embryo quality and pregnancy rate(PR)and duration recovery.Statistical analysis was carried out by using SPSS.10 software and statistical test of T-test and chi-square. R e s u l t s : The PR in Propofol groupwas 18(36.7%) and in Thiopental Na group was 19(38.8%) with no significant differences the mean duration of infertility and weight weren'tstatistically significant. The mean number of oocyte retrieved (metaphase II), embryo cleaved, embryo transferred and embryo quality weren'tsignificant between the two groups. The incidence of nausea in Propofol group in comparison with Thiopental Na group was lower withsignificant differences. The incidence of vomiting between two groups was statistically significant (46.9% vs.28.6% respectively)(P<0.05).between two groups. Duration of recovery in Propofol group was 15+/_3min and in Thiopental Na group was 25+/_5 min that was statisticallysignificant(P<0.05). C o n c l u s i o n s : Propofol offered lower incidence of post operative nausea and vomiting and a quick recovery from anesthesia without any adverse effect on pregnancy outcome. These findings showed that Propofol was a good alternative for Thiopental Na in short timeoperation, like ICSI -vaginal retrieval of oocytes.
EXAMINATION STRESS
Authors: IQBAL ZAFAR , ZAFAR TASNEEM
Published: September 2021

O b j e c t i v e : 1: To examine the effects of examination stress in young adult male and female medical students on cardiovascularsystem and thyroid gland (i.e. thyroid hormones; T3,T4).2:To find out whether the responses are sex dependent or not. S e t t i n g : Departmentof Biochemistry NMC Multan (1997-1998). Patients a n d m e t h o d : Examination stress was studied in 28 young female and 21 young malevolunteer medical students, 0.5 hour before Biochemistry examination (stress condition), at 10-12 a.m. and about six weeks after examination(control condition) at the same time in the year 1997. Estimation of Thyroxine (T4) and Triiodothyronine (T3) and T3 /T4 was done in patientsand control subjects. R e s u l t s : There were no differences in body mass index of male and female groups in control and stress group.Subsequent analysis between two sexes showed that males subjects had significantly higher systolic (124.7±40.1 mmHg) and diastolic bloodpressure (76.56±2.48 mmHg). Heart rate (84.6±2.63) increases in stress condition, in both sexes, but in males the increasing of heart rate ismore than in females. Whereas females had higher respiratory frequency in stress condition, as compared to males. The levels of T3 in femalestress group were higher than male stress group but statistically not significant. The mean values of T4 were highly significant in female stressgroup than in male stress group. C o n c l u s i o n s : Stress responses to examination are different between two sexes. The differences in responsesto examination stress between male and female showed a greater increase in systolic and diastolic blood pressure, heart rate, respiratory rateand also thyroid hormones in response to stress. It is suggested that as the examination is a stressful condition and different effects of stresson male and female medical students should be considered. The clinical presentation is palpitations, tremors, nervousness, apathy, fatigue,thirst, and emotional un-stability is due to the increase of thyroid hormones. Students are guided to remain relaxed, as neurotransmitters andhormones are released which may effect the overall performance of the students. Further study may be down to find out the effects of stresson other systems of the body which may be helpful in future to avoid the poor mental health status during the examination.
HYPERPLASTIC THYROID G1AND
Authors: HUSSAIN ANWAAR , DIN SAIF-U- , AKHTAR KHALID MEHMOOD , Kaukab Nabeela
Published: September 2021

Aim and Objective: The study was conducted to see the vascular and follicular changes induced by dexamethasone (syntheticcorticosteroid) during involution of hyperplastic thyroid gland in albino rats. Study Design: A comparative histological study done in PostGraduate Medical Institute Lahore in 1998 Procedure: 54 adult rats were taken and divided at random into two control groups having 27 ratsand experimental groups containing 27 rats. Control group was given normal diet along with 2 microgram of Potassium iodide intraperitonealyfor 21 days while experimental groups further subdivided into group A having 3 rats and group B and C containing 12 rats each. All theexperimental groups were treated with Thiourea for 21 days. Group A was sacrificed on day 22 after withdrawal of thiourea. Group B was givenPotassium iodide intraperitonealy after stoppage of TU on day 21 and were sacrificed on days 22,26,30 and 50 in 4 sub groups (B1-B4) tostudy the involution process. Group C was injected dexamethasone from 22 to 50 days after withdrawal of TU and sacrificed on same daysin 4 subgroups (C1-C4) as sub groups B. Results: The results of experimental group. A showed increase in thyroid and relative tissue weight.Histologically this group exhibited significant increase in stromal congestion with tall follicular cells lining the small sized follicles having scantycolloid. The results of experimental groups B and C demonstrated increase in thyroid and relative tissue weight but microscopically subgroupsB revealed early and complete involution whereas subgroups C showed significantly persistent hyperplastic changes in the form of stromalcongestion, vessels wall remained well defined and tall follicular cells lining small empty follicles. Conclusion: It was concluded thatdexamehasone did retain hyperplastic changes during involution evident by stromal congestion and small sized regular follicle lined by tallfollicular cells, so it should be carefully used in thyroid diseases.
CT SCAN
Authors: REHMAN ABDUL , SHEIKH MOHAMMAD AMIN , WARAICH MUSTANSAR MAHMOOD
Published: September 2021

Objective: To study the diagnostic value of basal enhancement on computed tomography (CT scan) in differentiating tuberculous(TBM) from pyogenic (PM) meningitis. Design: Retrospective case control study. Setting: The Pediatric department in collaboration with thedepartment of Radiology and Diagnostic imaging of Bahawal Victoria hospital, Bahawalpur. Methods: The reports of CT scan (contrast) donewithin 5 days of admission of children 4 month to14 years of age with a diagnosis of either TBM (case group) or PM (control group) wereanalyzed for the basal enhancement. Results: The sensitivity, specificity, PPV and NPV of basal enhancement in the diagnosis of TBM was0.97,1,1 and 0.95 respectively. Conclusions: The presence of the basal enhancement on CT scan can effectively distinguish TBM from PM.
ECLAMPSIA
Authors: YOUSUF FARHANA , HAIDER AMBREEN , HAIDER GULFAREEN , Muhammad Nasirudin
Published: September 2021

Objectives: The purpose of our study was to find the outcome, frequency, maternal morbidity and perinatal outcome due toeclampsia in our set up. Design: Descriptive study. Place and Duration of Study: This study was conducted in the department of obstetricsand gynae from 1 st January 2007 to 1 st January 2008, in Gynecology & obstetric department: unit 1 of Liaquat University hospital Hyderabad.Patients and Methods: Total 39 patient's who had eclampsia were included in this study while other obstetric patient's who had no eclampsiawere excluded from the study. After an informed consent information was recorded on predesigned proforma regarding maternal age, parity,duration of pregnancy, B.P at admission, mode of delivery, maternal morbidity and perinatal outcome. Results were analyzed through computersoftware programme SPSS version 11 and percentages were used to describe the data. Results: Total 1415 deliveries were conducted duringthe study period. Out of these, 39 patients had eclampsia. So the frequency of eclampsia was 2.7%. Majority of patient's i.e. 15(38.4%) wereless than 20 years .Out of 39 patient's, 32(82.0%) patient's were primigravida while 4(10.2%) were multigravida and 3(7.6%) patient's weregrandmultigravida. Majority of the patient's i.e. 28(71.7%) were unbooked. 18(46.1%) patient's had fit during antenatal period, 14(35.8%)patient's had fit in postpartum period one case with eclampsia was received on 6th postnatal day. Serious maternal morbidity was pulmonaryedema seen in 6(15.3%) HELLP Syndrome in 3 (7.6%) and acute renal failure in 4(10.2%) patient's. Regarding perinatal outcome, 28(71.7%)babies were born alive, out of these 11 (39.2%) were died in early neonatal period.8 (20.5%) babies born, were still birth while 3(7.6%) weremacerated IUD. Conclusion: In our study majority of patient's who developed eclampsia were young and primigravida. Major maternalmorbidity was pulmonary edema, chest infection and acute renal failure. Perinatal mortality was also high.
INTRAUTERINE GROWTH RESTRICTION
Authors: CHOUDRY ABEERA , Anwar Amhreen , KHAN SUMAIRA , Shukr Rian , HAFEEZ HUMAIRA
Published: September 2021

O b j e c t i v e : To compare fetal outcome in normal umbilical artery Doppler findings to abnormal umbilical artery Doppler findingsin pregnant women with fetal growth restriction.Main o u t c o m e m e a s u r e s : Umbilical artery Doppler studies, apgar score at 1 minute and apgarscore at 5 minutes after delivery.Study D e s i g n : Cross-sectional, comparative study. Setting: Department of Obstetrics and Gynaecology,Military Hospital and Combined Military Hospital, Rawalpindi. From Jan 2005 to Jan2007.Methods: Patients with fetal growth restriction between28 to 37 weeks of pregnancy were selected, in whom diagnosis was confirmed by ultrasonography. All patients were followed up with umbilicalartery Doppler studies. The study group consisted of 48 women (group I), where the umbilical artery waveform was compromised. The outcomein these was compared with an equal number of controls, where growth restricted fetuses had normal Doppler waveforms (group II). R e s u l t s:The mean age of patients in group I was 26.9 years and in group II was 28.6 years. Fetuses with abnormal umbilical artery Doppler findingshad higher incidence of maternal gestational hypertension and oligohydramnios. Rate of emergency cesarean section for fetal distress wasalso higher in this group. Growth restricted babies with abnormal umbilical artery Doppler waveforms had lower apgar scores. In babies withnormal Doppler studies, 91.6% had apgar score above 7 at 5 minutes after birth. In babies with raised Rl 78.1%, in babies with abscent enddiastolic flow 54.5% and in babies with Reversed end diastolic only 20% had apgar score above 7 at five minutes after birth. The differencewas statistically significant (P=0.001 (.Conclusion: Umbilical artery velocimetry can distinguish the group of growth restricted fetuses at riskof poor apgar. Growth restricted fetuses with normal Doppler studies are at a lower risk than those with abnormal Doppler findings in terms ofpoor apgar score.
SECONDARY ADDOMINAL PREGNANCY
Authors: TARA SARWA
Published: September 2021

Secondary abdominal pregnancy is a rare form of ectopic pregnancy. A 21 weeks viable secondary abdominal pregnancyafter tubal rupture has been found at laparotomy. The case is reported because of its rarity.
HYPERPLASTIC THYROID GLAND
Authors: HUSSAIN ANWAAR , Kaukab Nabeela , DIN SAIF-U- , Ismail Muhammad Ismail , AKHTAR KHALID MEHMOOD
Published: September 2021

Aim and Objective: The study was conducted to see the effects of dexamethasone (synthetic corticosteroid) on involution ofhyperplastic thyroid gland in albino rats, and to evaluate its uses in thyroid diseases. Study Design: Comparative histological study done inPostgraduate Medical Institute Lahore in 1998. Materials and methods: 54 adult male rats were taken and divided at random into control grouphaving 27 rats and experimental groups containing 27 rats. Control group was given normal diet along with 2 microgram of Potassium iodidefor 21 days while experimental groups further subdivided into group A having 3 rats and group B and C containing 12 rats each. All theexperimental groups were treated with Thiourea. Group A was sacrificed on day 22 after withdrawal of thiourea. Group B was given Potassiumiodide after stoppage of thiourea on day 21 and were sacrificed on days 22, 26, 30 and 50 in 4 sub groups (B1- B4). Group C was injectedDexamethasone daily from day 22 to day 50 and sacrificed on same days in 4 subgroups (C1-C2) to study involution process. Results:Histologically experimental group A exhibited significant increase in width and length of follicular cells lining the small sized follicles havingscanty colloid. The results of experimental subgroups B revealed early and complete involution whereas subgroups C showed significantlypersistent hyperplastic changes in the form of tall follicular cells lining small empty follicles. Conclusion: Thus it was concluded thatdexamehasone did retain hyperplastic changes during involution process, so steroid should consciously be used in thyroid diseases.
PROSTATIC HYPERPLASIA
Authors: MALIK MASUD , Iqbal Zahid , AHMED NISAR , Manan Abdul , RAZA MOHAMMAD , Chugta Mohammad Nawaz i
Published: September 2021

Aims and objects. To asses the efficacy, safety and complication of TUEVP on the basis of subjective and objective parametersand to establish an alternative procedure in our setup. Material and Methods: The study was conducted at Urology Department ServicesHospital Lahore over a period of four years (I996-2000). A total 50 patients suffering from Bladder outflow symptoms due to BPH were selectedfor the study. The TUEVP done by standard technique. Results: The mean age was 64.16 with standard deviation of 7.86 years. The meanoperating time in TUEVP was 20.6. Mean volume of irrigating fluid during the procedure was 8.28. Few patients require blood transfusion couldbe shorter resection time and less bleeding during TUEVP. Mean preoperative serum sodium was 138.8 mEq/1. After TUEVP mean changesin serum sodium was 1.1 mEq/1. Post operative mean volume of irrigant used was 11.12 liters. In TUEVP no patients developed significanthaemorrhage during first 24 hours. Mean estimated cost of operation was Rs.4160/. Early complication rate like clot retention occurs in 4% andfever occurs (4%) while haemorrhage, TURP syndrome , retention of urine and DVT not reported. Late post operative complication includedsecondary infection( 4%), Epididymoorchitis( 4%), U.T.I in (12%), Retrograde ejaculation (24%) and stricture urethra( 4%) patients. The meansymptomatic improvement in IPSS Score was 12.76 after two weeks, 8.72 after three month. Peak flow rate increased 13.4 ml/s after two weeksand 14.44 ml/s after three months. Conclusion: TUEVP is the effective and safe procedure with fewer complication and better recovery in oursetup but required clinical trials to different urological centers to established its long term efficacy and safety.
INGUINAL HERNIA REPAIR
Authors: AVIAS SHAHZAD , REHMAN E. , ZAKIR M. , Rashid Masood
Published: September 2021

Objective: To evaluate early results of laparoscopic repair of inguinal hernia by totally extraperitoneal approach (TEP) performed.Setting: At Surgical unit III, Jinnah hospital Lahore. Period: From August 2005 to July2008. Methods: 97 patients over the age of 30 yearsunderwent TEP repair of their inguinal hernia. Post operative assessment of the patients included pain score assessment and analgesiarequirement, along with ability to walk upright comfortably, time taken to return to normal activity and early complications like seroma,haematoma, infection etc. Results: Post-operative pain assessment at 8 hours after surgery showed 43(44.3%) patients required extraanalgesia while 24 hours after surgery only 13(13.4%) patients required extra analgesia. Mean operative time was 95 min (range 55-130min)for unilateral hernia. However, as experience increased with TEP repair, mean operating time decreased to 75mins in the second half of thecases. 21(20.6%) patients at 24hrs and 51(52.6%) patients at 48hrs could walk upright without any help. Median period for return to normalactivity at domestic level was 5days (range 3-23).Incidence of early complications is shown in table-Ill. Conclusion: Our results of TEPlaparoscopic hernia repair are comparable to European experience in terms of postoperative pain, mobility of patient and rehabilitation, as wellas early complications.
COVERAGE OF EXPOSED TIBIA
Authors: SHAH TAJAMMAL ABBAS , LATIF USMAN , REHMAN QUDDUS-UR-
Published: September 2021

The alarming rise in road traffic accident has resulted in increased incidence of degloving lower limb injuries requiring some sortof cover for exposed bones e.g tibia. Objective: To study and compare the rate of wound infection & decreased morbidity in degloving injuriesof lower limb following early bone coverage by various surgical methods of bone coverage. Design: Comparative, prospective study, Place& duration of study. Allied Hospital SU II Faisalabad. Period: From January 2002 to October 2004. Material & Methods: Thirty (30) patientsdivided into four groups, muscle & musculocutaneous flaps for 15 patients, local rotational flaps for 05 patients, cross leg flaps & decorticationfor 05 patients. The patients in each group were divided unequally because of unavailability of patients. Patients were also examinedpostoperatively for 06 weeks. Results: The patients underwent surgery for degloving injury of leg. Most of them were young malesbetween 5-45 years of age resulting mainly from different types of accidents. 2 out of 15(13.3%) patients having, musculocutaneous flapsdeveloped wound infection. 1 out of 5(20%) with local rotational flaps, 2 out of 5 (40%) with cross leg flaps & 3 out of 5(60%) with decorticationdeveloped wound infection. 14 out of 15(93.3%) patients with muscle & musculocutaneous flaps while 4 out of 5(80%) with local rotational flapsrecovered within 3 weeks. Patients with cross leg flaps recovered after one month while patients with decortication recovered after forty fivedays. 13 out of 15 regained full function (86%) with muscle & musculocutaneous flaps while patients having local rotational flaps regained 100%full function. 4 out of 5(80%) regained full function with cross leg flaps & 1 out of 5(20%) regained full function with decortication. Conclusions:Muscle & musculocutaneous flaps for exposed tibia is safe and effective method of treatment having low rate of wound infection with widercoverage & decreased morbidity.
INGUINAL HERNIA
Authors: REHMAN QUDDUS-UR- , LATIF USMAN , SHAH TAJAMMAL ABBAS
Published: September 2021

Objectives: To compare the rate of wound infection, recurrence and haematoma formation following Darn & Lichtenstein repair.Design: Prospective, comparative study. Place & Duration: Surgical Unit-ll, Allied Hospital, Faisalabad. Period: One year study from 15-01-2003 to 15-01-2004. Patients & Methods: Total of 50 male patients between 16-60 years of age having right sided, left sided and bilateralinguinal hernias were divided by odd and even numbers into two groups, each group consisting of 25 patients. In 1s t group of patients,Lichtenstein repair was done. While in 2n d group, Darn repair of posterior inguinal wall was performed. Patients were examined postoperativelyfor wound infection, haematoma formation & recurrence. Most of them presented with reducible inguinal hernias (84%) while others withirreducible inguinal hernias (16%). Results: Wound infection and hematoma formation were not observed in any patient in case of Lichtensteinrepair. Wound infection was not observed in any patient and hematoma formation in two patients in case of Darn repair. Recurrence occurredin one patient with Darn repair while non was observed in case of Lichtenstein repair. Conclusion: Lichtenstein repair (mesh repair) of inguinalhernia is safe & has less rate of recurrence and haematoma formation.
EPICARDIAL PACING
Authors: PARVEZ ZAHID , CHAUDHARY FARID AHMAD , NAZQVI AJMAL HASAN , Saeed Muniza
Published: September 2021

Placement of epicardial wires on the right atrial and right ventricle surfaces is a routine practice in cardiac surgery. These pacingelectrodes are used for invasive pacing of the myocardium for a variety of emergent and elective conditions postoperatively. There is uncertaintyin actual practice about the optimum time for their removal, and practice varies widely between different institutions. Objectives: To determine thetime related efficacy of these pacing electrodes after cardiac surgery, to find out the optimum time of their removal. Period: July 2008 toOctober 2008. Patients & Methods: 47 patients those underwent coronary artery bypass surgery were prospectively enrolled and evaluatedwith standard 12 lead ECG and ventricle pacing threshold immediately after surgery and on the 5t h postoperative day. The patients were dividedinto two subgroups according to their left ventricle ejection fraction ( > 40% verses < 40%). Results: There was significant difference in theeffective pacing threshold in groupl and 2 on immediate post operative period and on day 5. (P = 0.002 and P = 0.02 respectively) The sensingthreshold immediately after operation and on 5t h post operative day also differed significantly (P = 0.009 in group 1 and 0.02 in group 2) Theeffective VVI* pacing was lost in 17 patients (40.5%) on the 5t h post operative day and comparison of effective pacing threshold in the twogroups showed no significant difference during the same period of time (P = NS). "Ventrculo-ventrical inhibition. Conclusions: The epicardialpacing wires have little usefulness after the fifth postoperative day and should be removed by this time. In addition postoperative pacingthreshold was not affected by the decreased left ventricular function.
ACUTE RENAL COLIC
Authors: NAQVI MUHAMMAD ALI , MIRZA Zl
Published: September 2021

Objective: To compare the efficacy of Nelbuphine hydrochloride (opioid) and Diclofenac Sodium (NSAID) in management of Acuterenal pain. Design: Prospective non-randomized quasi experimental study. Setting: This study was conducted in Emergency department (ED)of Combined Military Hospital, Lahore. Period: From 1st April 2008 to 31 July 2009. Patients and Method: A Total of 100 patients presentingin emergency department with a clinical diagnosis of renal and Ureteric colic were studied. They were randomly divided in to equal andcomparable groups, Group A & B. Severity of pain was assessed using a Visual Analogue scale (VAS). Group A was treated with IntravenousNelbuphine 10mg and group B was given intramuscular Diclofenac Sodium 75mg. Assessment of Pain relief, both onset and complete responsewas assessed in both groups. In addition to the pain relief, side effects like Nausea, vomiting, respiratory depression, drowsiness and injectionsite pain were also assessed. Results: Nelbuphine was found significantly superior (p=0.05) to Diclofenac, both for time of onset of pain reliefand complete pain relief. Moreover less patients required rescue analgesia in Group A (p=0.05). Only one patient treated with Group A hadrespiratory depression which was statistically insignificant (p=0.05). There was a 3.5% increase in Nausea and vomiting in Nelbuphine treatedpatients. Conclusion: Nelbuphine is a safe and rapid acting Opioid with few side effects. It should be preferred over Diclofenac sodium intreatment of Acute Renal pain.
FIREARM WOUNDS
Authors: HAIDER RIZVI SYED IJLAL , Sohail Khurram , ASLAM MUHAMMAD , Arshad Humaira
Published: September 2021

Objectives: To study the different changes occurring at cellular level in firearm injuries from near to distant shots. StudyDesign: A prospective Study. Place and Duration of Study: Khyber Teaching Hospital Peshawar and B.V Hospital Bahawalpur. Material &Methods: Bodies presenting for autopsy within 12 hours after firearm injury were included. Wounds expressing maximum details were selectedfor study. Tissue samples were taken from wounds and preserved in 10% formalin. Sections were taken and slides were stained with HarrisHaemotoxylin. Olympus P-6 was used for photography and Nikon ( FE-2 body) for gross and microscopic photography. Results: Themorphology at cellular level was variable according to the distance of fire. Marked distortion and streaming of nuclei was more pronounced andevident in close contact wounds. However changes were less pronounced with the increasing distance. Section of exit lesion reveled splittingbetween dermis and epithelium. Further in this study rifle fire fatalities were maximum (53.33%) and distant shot fatalities were predominant(73.33%.). Conclusion: Microscopy can also be used as an additional tool to differentiate between entry and exit wounds and for estimatingrange of fire.
PANCYTOPENIA
Authors: JALBANI AZIZULLAH , Gurbakhs Kouro Mai , ANSARI IMDAD ALI , Chutto Mumtaz , SHAH AFTAB HUSSAIN , Solangi Ghulam Akbar
Published: September 2021

Introduction: Pancytopenia is said to exist in an adult when the hemoglobin level is less than 13.5gm/dl in males and 1 l.5gm/dlin females, white cell count less than 4xl09IL and platelet count less than 150x109/L1. The causes of pancytopenia are aplastic anemia, subleukemicleukemia, myelodysplasia2 multiple myeloma, nutritional deficiencies leading to megaloblastic anemia, hypersplenism, paroxysmalnocturnal hemoglobinuria, AIDS, infections such as miliary tuberculosis, leishmaniasis, brucellosis etc. Objectives: To determine the frequencyof various causes of pancytopenia in gender at Chandka Medical College, Larkana. Study design: Cross Sectional Study. Setting: OPD &Medical Ward-ll, Chandka Medical College Hospital Larkana. Duration with dates: 01 years study from February 2007 to February 2008.Subject and methods: Patients of either sex, who attended medical ward-ll of Chandka Medical College Hospital Larkana, either as inpatientor out patient department, from February 2007 to February 2008 and fulfilled the inclusion criteria, were included in this study. Pancytopeniawas considered as hemoglobin value less than 13.5gm/dl in males or 11.5gm/dl in females, a white cell count less than 4x109/L and Plateletscount less than 150x109/L. Patients of less than 12 years and pregnant females were excluded from the study. Result: Out of 40 patients, 29(72.5%) were males and 11 (27.5%) were females. Female to male ratio was 1:2.6. The mean ages of males were 29.10 ± 16.46 years whereasof females 36.14 ± 15.6 years (P = 0.22). Aplastic anemia was the most common pathology encountered and was diagnosed in 13 cases(31.5%), followed by hypersplenism 09 (22.9%), Megaloblastic anemia 06 (15%) and hodgkin's lymphoma in 04 (10%) cases. Other lesscommon causes detected were multiple myeloma 02 (5%), drug induced 02 (5%) and malaria, milliary tuberculosis, myelodysplastic syndrome,hemophagocytic syndrome was 01 (2.5%) case in each. Conclusion: We concluded that aplastic anemia was the most common cause in ourpatients and more than 2/3rd patients were young males. We think the causes of aplastic anemia in this study may be misuse of drugs, kushtas,exposure to chemicals and viral infections.