bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERARM BLOOD PRESSURE
Authors: Faraz Ahmad , Zubair Ujala , Choudry Usama Khalid , Siddiqa Iram Aamir , Naeem Ushna , Zafar Fasih
Published: September 2021

Interarm blood pressure difference is linked to various peripheral arterial diseaseand thus occupies great significance in vascular medicine. Due to various physiological&pathological changes vessels suffer with hardening that produces measurable inter armblood pressure difference. Less than one in 5 physicians is interested in measuring bloodpressure in both arms. Objectives: to study the interarm blood pressure difference amongmedical students and its association with age, gender, BMI. Study Design: Cross-sectionalstudy. Setting: Karachi. Period: September 2015 to November 2015. Methodology: Data wascollected from 305 individuals, Blood pressure was measured by designated technician withstudents in sitting position with at least 5 minutes of rest, among healthy nonsmokers medicalstudents of DUHS. Results: Mean weight of individuals was 57.4+- 12.9 kg. Mean height wasfound to be 164.6+-9.5 mm of Hg. Mean BMI of individuals was 21.0 +-3.78 kg/m2. Mean rightarm systolic blood pressure was found to be 102.9+-13.4 mm of Hg. Mean right arm diastolicpressure was found to be 64.1+-12.8 mm of Hg. Mean left arm systolic blood pressure wasfound to be 101.8 +-13.0 mm of Hg. Mean left arm diastolic blood pressure was found tobe 64.4+-12.9 mm of Hg. Mean interarm systolic blood pressure was found to be 7.4+-7.6mm of Hg. Mean interarm diastolic blood pressure difference was found to be 8.6+-8.5 mmof Hg. Conclusions: Regular measurement of blood pressure in both arms and assessmentof interarm blood pressure difference can lead to a new era where vascular events can bediagnosed at an earlier stage and thus treated earlier
IRON DEFICIENCY ANEMIA
Authors: Farrukh Ghazala Masood , Hasan Zainab , Ikram Samar , Tariq Batha
Published: September 2021

Globally about two billion people suffer from anemia of various types amongstwhich Iron Deficiency Anemia (IDA) is the most prevalent type. According to National NutritionSurvey of Pakistan 2011 (NNS), 50.4 % of non-pregnant females suffer from IDA, despite thefact that a variety of low cost, indigenous food sources of iron are available, affordable andaccessible in Pakistan. IDA is a risk factor for complications of pregnancy and low birth weightbaby and is also an independent cause of morbidity and mortality in all ages. Therefore thisstudy was conducted to determine the dietary patterns of iron intake in females of reproductiveage group who had IDA without any other known cause. Study Design: A cross sectionalstudy. Setting: Three tertiary care centers of Ziauddin Hospital located at Clifton, Kemari andNorth Nazimabad. Methods: Reproductive age females suffering from IDA according to theirCBC profile within three months prior to the study were selected through purposive sampling.Females taking iron supplements or with any known cause of iron deficiency were excluded.Total of 141 eligible and consenting IDA patients filled a 7 Day dietary recall questionnaireto determine the iron intake of indigenously available iron rich foods and blood sample wascollected for hematological profiles and iron studies. Results: Mean iron intake was 6.41 ±4.39 mg/day. Median heme and non heme iron intake was 8.0 mg and 28.0 mg per week,respectively. 52.4% of our study population had moderate IDA, 38.2% had pica for one or moresubstance and almost all suffered from one or more symptoms of iron deficiency. Majority ofthe population was consuming non-heme sources of iron. Conclusion: The iron consumptionfrom indigenous dietary sources is very low and contributes significantly to development of IDA.Increasing awareness regarding signs and symptoms of IDA and common dietary sources ofiron will contribute to screening, early diagnosis and correction of the iron deficit thus promotinghealth and preventing complications.
CHRONIC KIDNEY DISEASE
Authors: Shafi Salman Tahir , Saleem Mohammad , Abdullah Wajid , Anjum Roshina , Shafi Tahir
Published: September 2021

Diabetes Mellitus and Hypertension are leading causes of chronic kidneydisease (CKD). There is limited data on frequency of retinopathy attributed to diabetes mellitusor hypertension in CKD patients in local population. Objective: to determine the frequency ofdiabetic and hypertensive retinopathy in patients with CKD not on hemodialysis or peritonealdialysis. Study Design: Cross Sectional. Setting: Nephorology ward at Sharif Medical CityHospital. Period: 6 Month. Methods: All patients between ages of 20-80 years with CKD notpreviously on renal replacement therapy (hemodialysis or peritoneal dialysis) who were admittedto nephrology ward at tertiary care facility over a 6 month period were included. Fundoscopicexamination was performed by a qualified ophthalmologist after dilating pupils. Results: A totalof 124 patients were included in the study. Stage V CKD was present in 85.7%. Diabetes Mellituswas present in 84 patients (67.7%). Of these patients, 39 (46.4%) had diabetic retinopathy. Nonproliferativediabetic retinopathy, proliferative diabetic retinopathy and macular edema werefound in 27 (69.1%), 4 (10.2%) and 9 (23.1%) patients respectively. Hypertensive retinopathywas present in 51 (49.5%) out of 103 (83%) hypertensive patients. Of these patients, 16 (31.3%)had grade I, 21 (41.2%) had grade II, 11 (21.6%) had grade III and 3 (5.8%) had grade IVhypertensive retinopathy. Conclusion: A significant proportion of patients with advanced CKDhave retinopathy. Patients with CKD and diabetes or hypertension should be encouraged toundergo a complete eye examination
KEINBOCK’S DISEASE
Authors: Shah Faaiz Ali , Alam Waqar , Hayat Sikandar , Ahmed Ashfaq , Ahmad Saeed , Javed Shahzad , Aziz Amer
Published: September 2021

Objectives: To evaluate the functional and radiological outcome of metaphysealcore decompression of distal radius for treating Keinbock’s disease. Study Design: Descriptivecase series. Place and Duration: Orthopaedic A Unit Lady Reading Hospital Peshawar andGhurki Trust Teaching Hospital, Lahore and District Headquater Hospital Temargarah LowerDir from January 2014 to June 2016. Material and Methods: Patients of all ages and bothgender with pain and restricted wrist motion and radiologically diagnosed Lichtman’s stageI, II and III (A) were included in the study. Metaphyseal core decompression of distal radiuswas performed in the included subjects and patients were followed fortnightly for two monthsand then monthly for at least one year. At each visit pain was assessed with Visual AnalogueScale (VAS), wrist flexion and extension measured with goniometer and Stahl index with x raywrist. Results: A total of eleven patients including 9(81.8%) males and 2(18.1%) females with\mean age 31.2 years (range 24 to 42 years) were included in the study. Lichtman’s stage Ipatients were 2(18.1%), stage II were 6(54.5%) while stage III (A) patients were 3(27.2%).Postoperatively complete pain relief was achieved (VAS 0) for all stage I and II and most stage III (A)patients (90.9%, n=10) while mild pain (VAS 1) was reported in one (9%) patient of stage III (A)disease at final visit. Normal wrist flexion and extension was achieved in all stage I and II andmost of stage III (A) patients (90.9%). Only one (9 %) patient of stage III (A) could not achieveadequate wrist mobility at last follow up. Pre and post op Stahl index remained the same for allstages. No complication was reported. Conclusion: Metaphyseal core decompression of distalradius results in excellent functional outcome in majority patients and should be the treatmentof choice for early Keinbock’s disease (stage I’II and III (A).
A RARE SALIVARY DUCT PAROTID TUMOR
Authors: Ashraf Muhammad Hasham , Azim Asad , Waseem Talat , Azim Khawaja M.
Published: September 2021

Salivary Duct Carcinoma is a rare but highly aggressive tumor of the parotidgland. This tumor histologically shares the features of invasive duct cell carcinoma of breast.Here we present a case of such an advanced T4aN2M0 tumor involving overlying skin and levelI and II lymph nodes which was managed by radical conservative parotidectomy followed byfree radial forearm flap. Patient postoperatively received chemo radiation and is recurrence freeover a period of two years. We also give a brief account of literature review regarding SalivaryDuct Carcinoma and its management.
MATERNAL MORBIDITY
Authors: Shaikh Sumera , Wassan Kiran
Published: September 2021

Objective … To determine the frequency of maternal morbidity in patients withmajor degree of placenta previa in a previously scarred uterus. Study Design: Descriptivestudy. Setting: Department of Obstetrics and Gynecology Liquat University of medical andHealth Sciences, Jamshoro. Period: April 1st 2012 to Sep 30th 2012. Methods: The data wascollected on pre-designed pro-forma by the researcher. Tools and techniques were analyzedthrough SPSS version 15. Results The Following results were drawn by the study: Themean age of enrolled participants was 32.5±4.7 years, mean parity was 3.8±1.4 and meangestational age was 34.7±2.9 weeks. The frequency of morbidly adherent placenta was 23.7%,postpartum hemorrhage 21.9%, blood transfusion >4 47.2% and cesarean hystrectomy was12.3% cases. Conclusions: It is concluded from this study that morbidly adherent placenta was23.7%, postpartum hemorrhage 21.9%, blood transfusion >4 47.2% and cesarean hystrectomywas 12.3% cases.
46 XY DISORDER
Authors: Najeeb Muhammad Naveed , Malik Sadiq Hussain , Salam  Sehgal Sheikh Khurram , Malik Ameer Ahmad , Mehmood Saqib
Published: September 2021

Objectives: The Disorders of Sex Development are classified as 46, XY DSD,46, XX DSD and Chromosomal DSD according to the chromosomal constitution of the affectedpersons. 46, XY DSD is further classified into Androgen Synthetic Defect, Androgen InsensitivitySyndrome Gonadal Dysgenesis, 5-Alpha Reductase Deficiency, Persistent Mullerian DuctSyndrome and Isolated Hypospadias according to the pathophysiology of the disease. Theaim of present study was to classify 46, XY patients into their subclasses on the basis of theirhormonal profile and physical examination. Study Design: Observational descriptive study.Setting: Biochemistry Department University of Health Sciences for Karyotyping and Geneticassessment, and its allied institution Biochemistry Department Quaid-e-Azam Medical CollegeBahawalpur for hormonal analysis, along with Pediatric Medicine Departments of Quaid-e-AzamMedical College / Bahawal Victoria Hospital Bahawalpur for collection of Sample and clinicalassessments. Period: June 2015 to December 2015. Study Design: Observational descriptivestudy. Material and Methods: 53 patients with 46, XY DSD were recruited. Complete clinicalhistory and data of each patient was recorded in the research proforma. Genitals examinedfor the phallus length and size, position of urinary meatus, palpation of gonads and shape ofthe labioscrotal folds. Ultrasonography examination of each patient was performed to look forundescended testes and for the presence of either male or female internal reproductive organs.Results: Base line levels of serum Testosterone Dihydrotestosterone Luteinizing hormone,Follicle stimulating hormone, 17-OH-Progesteron and Anti-mullerian hormones were measuredby ELISA technique. Testosterone and DHT were measured again after hCG stimulation. Onthe basis of physical examination, ultrasonographic findings and hormonal profile diagnosisof the types of 46, XY DSD was possible in 27 (51%) of patients. Androgen synthesis defect asa cause of 46, XY DSD was diagnosed in 7(13%) patients, Androgen insensitivity syndrome in6(11%) patients, 5-Alpha reductase deficiency in 3(6%) patients, Gonadal Dysgenesis in 3 (6%),Persistent Mullerian Duct Syndrome in 3(6%) and Isolated Hypospadias in 2 (4%) patients.There were 26 (49%) patients which remain undiagnosed with the algorithm of diagnosis usedin the present study.
SEIZURES
Authors: Shaikh Tariq Zaffar , Yousfani Akbar , Memon Iqbal Ahmed , Ali Memon Hamid Nawaz , Ahmed Zaheer , Ali Shah Syed Zulfiquar
Published: September 2021

Objective: To evaluate the clinical, electroencephalogram (EEG) and computedtomography (CT) scan study of seizures. Study Design: Cross sectional study. Period:Six months study. Setting: Liaquat University Hospital Hyderabad. Patients and methods:All patients of more than 18 years of age, either gender had seizures for the first time wererecruited and included in the study. The data was analyzed in SPSS 16 and the frequency andpercentage was calculated. Results: During six months study period total 50 patients wereevaluated for seizures, of which 35 (70%) male and 15(30%) were females, majority of thepatients 30(60%) were belonged to urban population while the means age ±SD for overallpopulation was 38.97±7.87 whereas it was 37.76±5.65 and 40.23±6.83 in male and femalepopulation respectively. Twenty subjects (40%) had partial seizures while 30 (60%) had generalseizures while the EEG and CT scan abnormalities was observed in 35 (70%) and 32 (64%)patients respectively. Regarding etiology the 20(40%) subjects were idiopathic, tuberculoma wasobserved in 9(18%) patients and cerebral infarct / hemorrhage in 8(16%) subjects respectively.Conclusion: It is concluded that abnormal EEG supportive to confirm the diagnosis of seizures.CT scan was abnormal in 64% of patients revealing structural abnormalities. Majority of caseswere idiopathic although tuberculosis, cerebral infarct / hemorrhage and brain tumors werepredominant etiological factors.
HYPERBARIC OXYGEN THERAPY (HBOT)
Authors: Sadiq Imran , Ramzan Muhammad , Al Sharari Naseer Bashir , Oufi Yousaf al , Khan Omar
Published: September 2021

The role of steroids in the treatment of Bell’s palsy is well known provided patientspresent within 72hrs of symptoms onset. If patients present late or with severe Bell’s palsythe effect of steroids or other treatment modalities is not yet clear. Aim of this study was toevaluate the effect of HBOT along with oral steroids in treatment of such patients. Setting:Diving department at Armed Forces Hospital King Abdul Aziz Naval Base Jubail, Kingdom ofSaudi Arabia (KSA). Period: January 2010 to Dec. 2015. Methods: Bell’s palsy patients ofage 13 years and above were treated with steroids & HBOT. Prednisolone 60mg was givenorally for one week to all patients & those patients who could tolerate HBOT were selected fortreatment with Hyperbaric Oxygen in a closed chamber at 2.5 ATA, 90 minutes a day and fivedays a week. HBOT was continued till complete recovery or up to 20 sessions before declaringpartial recovery or failure. Assessment was done by physician using House-Brackmanngrading system for Facial nerve dysfunction. Patients were followed up to 3 months beforedeclaring partial recovery or treatment failure. Results: Treatment was started on 125 patientsbut 15 patients could not tolerate HBOT due to ear pain (10 patients) or high blood pressure(5 patients) in the HBOT chamber whereas 10 patients did not show up for follow up so only100 patients completed the treatment. Out of 100, 22(22%) patients had mild (grade I to II), 40patients (40%) had moderate (grade III to IV) and 38 patients (38%) had severe (grade V to VI)Bell’s palsy. Majority of patients (85%) presented after 72hrs of symptoms onset. At 3 monthsof follow up 90% (n=90) patients had full recovery whereas 10% (n=10) patients had partialrecovery. Severity of disease (OR 0.125, CI 0.025---0.6255, p =0.00595) and time between onsetof symptoms and start of treatment >2weeks (OR 0.0966 CI 0.0187---0.4987, p=0.00280) werestatistically significant. Conclusion: Combination of Hyperbaric Oxygen therapy and steroids is
MYASTHENIA GRAVIS
Authors: Ahmed Raheel , Kumar Sunil , Awais Mr. , Hayat Atif Sitwat
Published: September 2021

Objectives: To determine the frequency of different clinical features of myastheniagravis in patients presenting to a tertiary care hospital, Karachi. Study Design: Cross sectionalstudy. Setting: Neurology ward, JPMC, Karachi. Period: 23rd January 2013 to 22nd July 2013.Patients and Methods: A total of 71 diagnosed patients of Myasthenia Gravis (MG) betweenthe age 15 and 70 years were recruited. Structured questionnaire was used to collect the dataregarding most common clinical manifestations of MG. Data were entered and analyzed inSPSS version 17. Chi-Square test was used as test of significance. Results: Mean age + S.Dof patients was 34.11 ± 10.42 years. The mean ± SD of duration of symptoms among thesepatients was 5.23 ± 3.52 months. Most of the patients (21%) belong to age between 21 to30 years. Regarding clinical features in these patients of myasthenia gravis it was noted thatptosis and diplopia were most common symptoms, 62% and 54.9%, respectively. Conclusion:Myasthenia gravis, a chronic neuromuscular disorder leads to various degrees of neurologicdysfunction which manifest as different clinical features. The current study found that ocularsymptoms are commonest presenting features.
FREQUENCY AND OUTCOME OF RIGHT VENTRICULAR INFARCT
Authors: Siddique Munir , Hussain Shahadat , Ahmed Shafique
Published: September 2021

Objectives: To determine the frequency and outcome of right ventricular infarct inpatients with inferior wall myocardial infarction during hospital stay. Study Design: Descriptivecase series. Place and duration of study: The study was carried out in cardiology department ofBahawal Victoria Hospital Bahawalpur from 13th January 2013 to 12th July 2014. Methodology:A total of 145 patients of inferior wall myocardial infarction were enrolled. Right sided ECG wasrecorded to detect RV infarction in V4R lead. Patients with RV infarction were followed for highdegree AV block and in hospital mortality till discharge. Results: A total of 145 patients wereincluded in the study. Mean age of patients was 53.54 11.3 years. Out of 145 patients, 84(57.93%) were male and 61 (42.07%) were female. Out of 145 patients, 51(35.17%) patientshad right ventricular infarct. In 51 patients with right ventricular infarct, 5 (9.8%) patients expiredwhile 20 (39.2%) had 3rd degree AV blocks. Conclusion: Patients with inferior myocardialinfarction who also have right ventricular myocardial involvement are at increased risk of deathand 3rd degree (complete) AV block.
PRE-ECLAMPTIC AND NORMOTENSIVE PREGNANCIES
Authors: Akram Muhammad , Nadeem Muhammad Faisal , Anwar Ashba , Memon Fareen Anwar , Shafiq Muhammad Imtiaz , Memon Ali Raza
Published: September 2021

Background: Pre-eclampsia along with its consequences is one of the primarydriver of maternal morbidity and horribleness. Despite the availability of magnificent literature,the onset of pre-eclampsia has yet not been fully understood. Objectives: To compare the serumcalcium level among pre-eclampsia and the normal women during pregnancy. Patients andMethods: Study Design: Hospital based case control study. Setting: Gynecology Departmentof Jinnah Hospital Lahore. Period: 1st July 2014 to 31 December 2014. The study groups consistof the 30 pre-eclamptic subjects and women with normal pregnancies. The serum calciumlevel of the subjects under this study was determined using standard colorimetric analyzer.Results: The results of our study determined that serum calcium level among the pre-eclampticand the normotensive pregnant women was statistically significantly lower as compared to thenormal pregnant women. Conclusion: The findings of current work are statistically significantto establish that concentration of serum calcium among pre-eclamptic subjects is lower than inthe normotensive women during pregnancy.
CERVICAL DISEASES
Authors: Lakhwani Mumtu Bai , Yasir Rozina , Amjad Anila , Ali Zain
Published: September 2021

Objectives: The aim of our study is to compare the efficacies of Pap smearcytology, colposcopy and histopathology, in diagnosis of cervical diseases. Study Design:Cross sectional cohort study. Period: One year from June 2013 to June 2014. Setting:Tertiary care hospital in Karachi, Pakistan. Method: The patient population n=145 consistedof women ranging from age 18 to 80 years old, who had come to the outpatient clinics for avariety of symptoms. Pap smear, colposcopy and histopathology was done for women who hadsymptoms like recurrent vaginal discharge, postcoital bleeding and other diseases of the cervix.Findings were noted on a proforma and all the patients signed a duly informed consent. Datawas analyzed using SPSS version 23. Results: The mean age was 45 +/- 9 years (between24 – 75 years), the parity was 5 +/- 4, normal colposcopy findings were found in n= 66 women,while abnormal findings were found in n=79 women. In the abnormal colposcopic finding groupn=63 had abnormal histopathology (p<0.001) abnormal histopathology was found in n=11women who had normal colposcopic findings (16.67% false negative), the calculated sensitivityand specificity of colposcopy was determined to be 86% and 79%. For pap smear abnormalitywas found in n= 49 patients, out of which n=29 had abnormal findings on histopathology aswell. And for colposcopy and pap smear out of n= 78 patients who had abnormal colposcopicfindings, abnormal pap smear was found in only n= 28 patients. And out of those who hadnormal colposcopy n= 67, n= 21 had abnormal pap smear (False positivity of 31.34%) similarlyout of those who had normal pap smear n= 96, n= 44 had abnormal histopathology (falsenegativity of 45.83%). The calculated sensitivity and specificity of pap smear was 38.8% and71.8% respectively. Conclusion: We have concluded that there is a strong correlation betweenfindings of colposcopy and histopathological diagnosis, but when it comes to the diagnosismade by pap smear and colposcopy and pap smear and histopathology the correlation is weakand not consistent.
PHACOEMULSIFICATION
Authors: Ahmad Faheem , Iqbal Syeda Iqra
Published: September 2021

Introduction: Any opacity in crystalline clear lens that may or maynot impaired vision is called cataract. According to maturity of cataract it may beimmature, mature or hypermature. When a patient develop cataract than there isno significant medical treatment for cataract. Surgery is the treatment of choice forcataract. Phacoemulsification (phaco), a modification of ECCE, has found worldwidepopularity in last two decades. Objectives: To find out visual acuity and complicationsof phacoemulsification in patients operated by senior surgeon during learning curve.Study Design: Descriptive case series. Settings: Department of OphthalmologyIndependent University Hospital, Faisalabad. Period: One year from 01-04-2014to 31-03-2015. Data Collection Methods: Patients coming through the OPD ofthe eye department who fulfilled the inclusion criteria were enrolled and informedconsent was taken from all patients. Results: In this study 100 eyes had undergonePhacoemulsification with IOL under Local anesthesia during study period. The meanage of patients was 57.50 years (range 30-85 years). Regarding the visual acuity inoperated eyes, 80 eyes ( 80 %) had a BCVA of 6/6-6/12, 12 eyes (12 %) had a BCVA of6/18 to 6/36 and 6 eyes (6 %) had a BCVA of 6/60 to CF. While only 2 percent Patienthad visual acuity less than Counting finger(CF). Discussion: During phaco training,the author was taught in stepwise about various stages of phaco and then authorpractice single part every stage of phaco multiple times to be master in every step ofphaco under supervision of an experienced ophthalmologist. Due to learning of phacostep-by-step leads to good surgical outcomes and least complication rates. Afterlearning the phaco basic training, the author started to perform phacoemulsification inIndependent University Hospital Faisal Abad under the supervision of an experiencedophthalmologist followed by independently performing phacoemulsification.Conclusion: Surgeon experienced in ophthalmic surgery along with adequatephacoemulsification training leads to a good visual outcome with minimum peroperativeand post-operative complications.
OVARIAN TUMORS
Authors: Asghar Umair , Qadir Abdul , Bajwa Affan Zia , Bhagwani Anil Roy , Saad Shazia , Waheed Iqra
Published: September 2021

Introduction: Ovarian cancers are the most common and fatal malignanciesin females. In Pakistan the incidence of ovarian cancer is increasing. The evidence regardingthe extent of problem is scarce in local population. Objective: To study clinico-pathologicalcharacteristics of ovarian tumors in females presenting in a tertiary care setup. Study Design:Cross sectional survey. Setting: Department of Pathology, Liaquat National Hospital, Karachi.Methods: There were total n=29 patients diagnosed with ovarian tumors. Women with primaryovarian tumors were identified and clinical, radiological and pathological records were assessed.Frequency of different types of pathologies were identified among these women. Results: Meanage was 48.55±13.20years. There were n= 10 benign, n=6 borderline and n=13 malignantcases. Most common presenting complaint was abdominal pain and abdominal distension.Papillary Serous Carcinoma were most common benign (n=8) and malignant tumors (n=6). Atthe time of presentation, malignant lesions already had attained a size of 15.5 cm with ascitesn=7, mets to bowel in n=7 cases. Mortality was 30% in patients with malignancy while rests ofthe patients were lost to follow-up. Conclusion: Ovarian cancers are well known for being mostlethal of gynecological malignancies. At the time of presentation these tumors already attain asignificant size and metastasis. Further studies are warranted in this aspect.
APPENDICULAR MASS AND ABSCESS
Authors: Yousfani Zubair Ahmed , Laghari Ahsan Ali , Atta Jabeen , Khurram M. Siddique , Bano Roohi , Durran Jamrose , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency of appendicular mass (tumour) andabscess at tertiary care teaching hospital. Study Design: Cross sectional descriptive study.Period: One year. Setting: Department of Surgery at Liaquat University Hospital Hyderabad /Jamshoro, a tertiary care teaching hospital. Patients and Methods: All the patients presentedwith pain in right iliac fossa were recruited for the study. The detail history was taken; clinicalexamination was done, while all the baseline and specific investigations were advised accordinglyto explore the appendicular lump / abscess whereas the data was saved and analyzed inSPSS version 16 and the consideration for significance was p-value ≤0.05. Results: Duringone year study period total fifty patients were presented as appendicular mass and abscess,seventy percent appendicular mass presented with fever and 60% presented with vomiting.Regarding appendicular abscess 90% presented with fever and 30% presented with vomiting.The appendicular mass and appendicular abscess was identified in 32 (64%) and 18 (36%)cases with male population predominance. Out of thirty two patients of appendicular masswere managed surgically i.e. 16 cases were underwent for surgery immediately whereas restof the 16 subjects were managed by Oschner Scherren regime and later date appendicectomywas performed. All 18 cases of appendicular abscess were managed by antibiotics drainageand these cases of appendicular abscess were nominated for interval appendicectomy6-8 weeks later due to recurrent appendicitis. Conclusion: The appendicular mass andappendicular abscess are common disorders and the management tools varies accordinglyfrom early appendectomy, conservative conventional management to interval appendectomywhile the extraperitoneal drainage and interval appendectomy are useful tool for patients withappendicular abscess
GIANT INGUINAL HERNIA
Authors: Memon Muhammad Anwer , Pathan Mohammad Rafique , Bux Karim
Published: September 2021

Objectives: To determine the complications and their management in patientswith giant inguinal hernia. Place and Duration of Study: This study was carried out in inSurgical Unit-IV, Liaquat University Hospital Jamshoro, from October 2013 to December 2015.Methodology: This study consisted of 30 patients of giant inguinoscrotal hernias. DetailedHistory was taken from all the patients with special regard to the inguinoscrotal swelling.Detailed Clinical examination of the patient was done .Site of swelling was especially examinedfor assessment of three grades. Grade–I means hernia reaching upto middle of thigh, Grade-IImeans inguinoscrotal contents reaching upto knee joint and Grade-III means contents goingbelow knee level. All data was entered in a specified proforma designed for this purpose.Inclusion criteria were all diagnosed patients of giant inguinoscrotal hernia on the basis ofhistory, clinical examination were included in this study. Exclusion criteria included patientsunfit for surgery, patients below age of 12 years, patients with severe co-morbidity and morbidobese patients. Results: 30 patients included in this study. There was wide variation of ageranging from a minimum of 30 years to 70 years , mean age was 46.28+7.20 years. The patientspresented with more common in right side 21(70%) cases and left side 9(30%) cases. Patientspresented with grade-I 11(36.66%) cases, grade-II 9(30%) cases, grade-III 7(23.33%) cases andgrade IV 3(10%) cases. Giant inguinal hernia were operated Orchidectomy and hernioplasty12(40%) cases, followed by Debulkation of contents and hernioplasty 9(30%) cases andGradual Pneumoperitoneum and hernioplasty 4(13.33%) cases. Complications seen in thisstudy was Respiratory in 3(10%) patients, Abdominal compartmental syndrome in 1(3.33%)patients, Paralytic Ileus in 2(6.66%) patients and Wound Infections in 4(13.33%). Conclusion:In conclusion our study revealed it is commonly to live in our population due to ignorance ofhernia poverty in remote areas and lack of knowledge of disease complications.
PILONIDAL SINUS
Authors: Ramzan Muhammad , Mirza Muhammad Khalid , Ali Muhammad Arif
Published: September 2021

Objectives: To prospectively evaluate the results of modified Karydakisprocedure with subcuticular skin closure in presacral pilonidal sinus disease patients. Design:Prospective cohort study. Setting: Armed Forces Hospital Dhahran. Period: Jan.2007 and Jan2013 were prospectively followed for 2 & ½ yrs. Methodology: 243 patients having pilonidalsinus disease who underwent surgery by modified Karydakis technique with subcuticular skinclosure. They were evaluated for age, sex, BMI, duration of symptoms, hospital stay, morbidity,recurrence and cosmetic satisfaction. The patients having acute pilonidal sinus abscess wereexcluded from the study. Results: Out of 243 patients, 230 were males and 13 females with amean age and BMI of 24.7, 26.3, 29.4 and 30.8 respectively. The most common symptom wasseropurulent discharge from the sacrococcygeal area. 232 (95.5%) patients completed theirfollow up whereas 11 (4.53%) patients (5 females and 6 males) could not be traced in follow upcalls after 3 months. 22/243 patients (9%) had minor wound related complications like minorwound infection, partial wound or skin disruption and seroma formation. There were only 3(1.23%) recurrences (2 males and 1 female). All patients were fully satisfied with the cosmeticresult. Conclusion: Karydakis asymmetrical flap closure using subcuticular skin closure is asimple technique which gives best outcome in terms of morbidity and Cosmesis.
NEURLOGICAL OUTCOME OF GLIOMAS
Authors: Khalid Muhammad , Raina Umer Farooq , Ahmad Ejaz , Zaman Khaleeq UZ
Published: September 2021

Background: Mostly Primary brain tumors are derived from neuroglial cells,neuronal or primitive bipotential precursors or neuroepithelial cells and they are calledgliomas. These comprise of 45-65% of intracranial tumors. We aimed to conduct a studyto determine the neurological outcome of patients with gliomas on the basis of karnofskyscore who are managed with craniotomy and excision of tumor. Study Design: Descriptivecase series. Setting: Neurosurgery Department, PIMS, Islamabad. Patients reporting to OPDaccident and emergency department and those admitted to neurosurgery unit or referred fromother units were enrolled. Period: July 2014 to April 2015 in duration of ten months. Methods:140 gliomas patients which were diagnosed on CT/MRI with contrast. Patients with low gradeglioma, those with post radiation necrosis diagnosed on MRI and MR spectroscopy brain,children having glioma and those gliomas patients having co-morbidities were excluded fromthis study. The outcome of this study was determined as neurological outcome of patientswith glioma according to karnofsky score after craniotomy plus excision of tumor. Results:The patients’ average ages were 37.4 + 11.2 years. Male gender was in dominance with83 (59.2%) cases compared to 57 (40.7%) females. Of the total 140 patients of gliomas, 24(17.1%) had neurological deficit. The mean Karnofsky score was 70.0 + 10.0 before surgeryand after surgery it improved to 90.0 + 10.0 and this difference in mean karnofsky scorebetween before and after surgery was found statistically significant (p-value = 0.001). Themean Glasgow coma scale was 12.0 + 2.0 before surgery and 14.0 + 1.0 post operatively.Post operatively it was observed that, of the 24 patients with neurological deficit, 18 (75.0%)improved completely whereas 6 (25.0%) patients could not improve. Conclusion. There isa significant improvement in nuerological outcome which is measure through the karnofskyscore of gliomas patients whose undergoing craniotomy and excision of tumor.
URETERIC CALCULI
Authors: Noreen Afshan , Javed Azhar Mehmood , Zahoor Maria , Shakir Afshan , Bodla Maria Afzal , Saleem Neelum
Published: September 2021

Objectives: The objective was to determine accuracy of ultrasound in thediagnosis of ureteric calculi confirmed on non-contrast Computed Tomography amongpatients with acute ureteric colic. Study Design: Cross-sectional study. Setting: EmergencyDepartment of Nishtar Hospital, Multan. Period: 11-07-2012 to 10-01-2013. Materials andMethods: 100 consecutive patients presenting with acute severe ureteric colic and fulfillingthe inclusion and exclusion criteria were enrolled for the study from the emergency departmentof Nishtar Hospital Multan. Ultrasonography was done in all patients and USG findings wererecorded for the presence or absence of hyperechoic shadows in the ureteric. All the patientsunderwent CT scan to confirm or refute the findings of Ultrasonography. Result: Mean age ofthe patients was 37.85 + 12.60 years. Males were 53 (53%) while females were 47 (47%). Meanduration of pain before presentation was 14.81 + 6.20 hours. Mean severity of pain on visualanalogue scale was 9.40 + 0.8. Overall 79 patients were diagnosed as having ureteric calculi.Ultrasonography detected the ureteric stone in 75 patients and was all found to have stoneon CT scan and represented true positives. Among 25 patients in whom ultrasound did notdemonstrate any stone, 4 were found to have ureteric stone on CT scan thus representing falsenegative whereas 21 (84%) were confirmed on CT scan not to have any stone, thus representingTrue negatives. The sensitivity of USG for detection of ureteric stone was found to be 94.9%,the specificity was 100%, and positive predictive value was 100% while negative predictivevalue was 84% .There was no significant effect of age or gender on the accuracy of ultrasound.Conclusion: Ultrasonography is a readily available, non-invasive and reliable investigation inpatients presenting with acute flank pain to diagnose ureteric stones with a specificity of 100%and a sensitivity approaching 95%. Thus it is recommended that it should be used routinely forthe evaluation of patients presenting with acute flank pain.
TYPE D PERSONALITY
Authors: Saleem Shemaila , Saleem Tamkeen , Waheed Qazi
Published: September 2021

Introduction: The prevalence of cardiovascular disease (CVD) is escalatingspeedily in the developing world including Pakistan. CVD is considered to be one of the leadingcauses of deaths in near future. The CVD is believed to be associated with personality factorsand the researches continue to refine the key elements predisposing cardiovascular disease.The objective of the study was to explore the construct of a Type A behavior pattern and Type Dpersonality in patients with cardiovascular disease and healthy controls. Settings: CardiologyOPD of the hospitals in Rawalpindi and Islamabad. Methods: The psychometric tools used tomeasure these constructs are the Type A behavior pattern scale (TABP), Type D personality Scale(DS14) and Revised Ways of Coping Questionnaire (WCS-R). 100 patients with cardiovasculardisease having coronary heart disease and myocardial infarction were compared with 100healthy controls in terms of relevant aspects of their cardiovascular functioning. Traditionalemphasis has been that Type A is a predictor of CVD. Results: The study results indicatethat the Type D is a better predictor of cardiovascular heart disease as compared to Type A.Furthermore, the results indicate that frequency of Type A and Type D is more prevalent in CVDpatients than in the healthy controls. Conclusion: Making an allowance for the high frequencyof Type A and Type D personality in cardiovascular disease, controlling the behavior patternscan be useful for prevention of risk as well as for creating better management of CVD patients.
ANEMIA
Authors: Naeem Abid , Kouser Robina , Mahmood Arshid
Published: September 2021

Iron, folate and B12 deficiencies are the common throughout in the world.National survey 2011 conducted in Pakistan revealed; nutrition anemia is 50.5% in womenof child bearing age and 51% in pregnant women. Iron, folate, and B12 can be correctedby oral/, injectable and dietary supplementation however it takes 3-6 months treatment. Thepatients are symptomatic in moderate to severe anemia. Erythropoietin injection stimulateerythropoiesis in bone marrow and addition of iron ,folate B12 , improve heamoglobin up to10g/dl after 04 weeks therapy .There is immediate symptomatic improvement and it avoidsmultiple blood transfusion. Objectives: To determine the efficacy of erythropoietin in correctionof heamoglobin along with supplementation of iron, folate, and B12 for a period of 04 weeks.Period: January 2015-December 2015. Study Design: A prospective descriptive study. Placeof Study: Mohi-Ud-Din Teaching Hospital Mirpur AJK. Results: Among 110 selected male andfemale patients, (age ranging 20-50 years), after erythropoietin injection plus iron,folateB12supplementation, the reticulocytes and heamoglobin increased from 1.2 to11% and 4.5 to 10.5g/dl respectively after 04 weeks therapy. Conclusion: Erythropoietin injection plus iron, folate,B12 supplementation is an effective way of erythropoiesis for correction of anemia after 04weeks therapy. This immediately improved symptoms &sign of anemia thus avoiding the needof repeated blood transfusion.
CYTOMEGALOVIRUS INFECTION
Authors: Mahmood Khalid , Hashmi Abid Ali , Hanif Muhammad Umair
Published: September 2021

Cytomegalovirus can cause lifelong latency and reactivates when the patientbecome immunocompromised and can cause severe complications. Patients on hemodialysisare on risk of CMV infection due to multiple blood transfusions and impaired immunity. Serologyof the patient does not detect the latent infection. Objectives: To check the frequency ofcytomegalovirus (CMV) infection in patients on hemodialysis. Design: Observational study.Setting: Gulab Devi Chest Hospital & Lahore General Hospital Lahore. Period: six month.Material and Methods: 31 patients that were on hemodialysis were enrolled in this study. CMVDNA detection was done from the peripheral blood with consent from the patients. The 222bpband corresponding to the size marker and positive control was considered as positive. Thedata was analyzed using SPSS version 20.0. Results: Age, gender and socioeconomic statushad no association with CMV infection. No patient was found positive for CMV DNA. Serumcreatinine levels were significantly associated with the duration on dialysis. Hypertension anddiabetes were diagnosed as major co-morbidities. In this study none of the sample testedpositive for CMV DNA. Conclusions: There is a need to conduct large population based studyto establish the sero-prevalance of CMV infection in Pakistani population as no description isavailable yet. Furthermore, the blood should be screened for CMV viremia or antibodies prior totransfusion to rule out risks associated with reactivation of latent infection in critically ill patients.
PYOMYOSITIS;
Authors: Khan Samiullah , Khan Muhammad Ayaz , Iqbal Javed , Saleem Sana
Published: September 2021

Pyomyositis is a common health problem with significant complications andmorbidity. Surgical drainage and Antibiotic treatment is the mainstay of its treatment. Properculture and sensitivity of etiological bacteria is crucial for successful treatment of Pyomyositis.Objectives: To determine the frequency of Pyomyositis and its common bacteria with theirantibiotics sensitivity among children presenting with highly suspected clinical features.Design: Cross sectional descriptive study. Setting: Department of Orthopedics and Trauma,Khyber Teaching Hospital, Peshawar. Period: 12 months from19th July, 2012 to 18th July, 2013.Materials and Methods: 156 patients presented with highly suspected clinical features ofPyomyositis were examined clinically and were investigated by Ultra sound and CBC. Thosepatients who were having Pyomyositis, pus samples were taken for culture and sensitivity testand the data was analyzed by Statistical Package for Social Sciences (SPSS) version 10.0.Results: There were147 (94.23%) patients having Pyomyositis out of 156 patients. On cultureand sensitivity test, 87 (59.18%) have positive growth while 60 (40.82%) have no growth. Themost common bacteria isolated was Staphylococcus aureus55 (63.21%) followed by E. coli 10(11.49%), Pseudomonas Aeruginosa 7 (8.04%), and Streptococcus Pyogenes 5 (5.74%). Allisolated bacteria showed more than 95% and 90% sensitivity to Vancomycinand and Fusidicacid respectively while all bacteria showed maximum resistance to Penicillin i.e. more than35%. Conclusion: Prompt diagnosis of pyomyositis in highly suspected patients, detection ofits etiological bacteria and their antibiotic sensitivity tests are very important for the treatmentof Pyomyositis.
CARCINOMA OF CAECUM;
Authors: Atta Jabeen , Dalwani Abdul Ghafoor , Yousfani Zubair Ahmed , Khurram M. Siddique , Bano Roohi , Durrani Jamrose , Ali Shah Syed Zulfiquar
Published: September 2021

Objectives: To determine the frequency, clinical presentation and managementstrategies for carcinoma of caecum among pathologies in right iliac fossa excludinggynaecological disorders at Liaquat university hospital Hyderabad / Jamshoro. Study Design:Cross sectional multi-disciplinary study. Period: Thirty months. Setting: Liaquat UniversityHospital Hyderabad / Jamshoro. Patients and Methods: All the patients presented with GIsymptoms, intestinal obstruction, and appendicitis or had mass in the right iliac fossa wereselected and recruited and further evaluated for existence of carcinoma of caecum andpreceded for management strategies. The data was analyzed in SPSS 16 and the frequencyand percentage was calculated and the level of significance was p-value ≤0.05. Results: Total50 patients were diagnosed as caecum cancer during thirty months study period. The cancerof caecum was common in older age group. The mean age ± SD for whole population andmale as well as female gender was 67.53±6.98, 66.32±8.75 and 65.34±5.96 and of fifty cases,thirty two (64%) were males and eighteen (36%) were females respectively. The commonpresentation identified was mass in right iliac fossa in 28 patients (p=0.03) while the commonoperative procedure performed was ileotransverse anastomosis with right hemicolectomy in 34patients which is non-significant in relation to age (p=0.7) whereas it was significant in contextto gender (p=0.04) respectively. Conclusion: The common presentations for carcinoma ofcaecum detected was right iliac fossa mass while the predominant age, gender and operativeprocedure performed were seventy plus years, male gender population and Ileotransverseanastamosis with right hemicolectomy.
INTERACTIVE SESSIONS;
Authors: Batool Hijab , Mumtaz Asim , Chughtai A.S
Published: September 2021

Objectives: To compare the perception of students about two different teachingmethods in the subject of pathology at Central Park Medical College Lahore. Background:In medical education, it becomes essential to adopt an approach of teaching and learningthat is best suited to the undergraduate medical students. Many studies have revealed thatsmall group discussions lead to an improved and active learning as compared to conventionaldidactic lectures. Hence, new research is required to identify the preferences and needs of themedical students in relation to their daily learning activities. Study Design: Cross sectionalstudy. Setting: Central Park Medical Lahore. Materials and methods: Comparative analysisof lectures and SGD was done via a feedback performa which was distributed among third(n=105) and fourth year (n=114) MBBS students during a small group discussion session.The students were explained about the purpose of study and 20 minutes were given to fillthe performa. Feedback performa comprised of selecting the preferred method of teaching insubject of Pathology at Central Park Medical Lahore. Results: The study revealed that studentswere satisfied with the current teaching pattern in pathology. 68.9% of the participants preferredSGDs over lectures as the ideal teaching modality in Pathology. According to 47.9% of thestudents the appropriate time for a single lecture of Pathology should be 30 minutes. 55.2%of the participants suggested discussion as the most helpful method of teaching during anSGD. Conclusion: The findings of this study revealed that students preferred SGD as the mosthelpful method of learning in subject of pathology. SGD of the topics which had been coveredin the comprehensive lectures in the same week lead to a better understanding of the topicresulting in an improved and active learning of the students.
BILE DUCT INJURIES;
Authors: Tagar Muhammad Paryal , Jamali Khawar Saeed , Abbasi Mujeeb Rehman , Tagar Sarang
Published: September 2021

Objectives: Determine the frequency of bile duct injuries during open andlaparoscopic cholecystectomy procedures. Study Design: Prospective Observational Study.Place and Duration of Study: This study was conducted at surgical department of multiplehospitals and compares the results Civil Hospital Naushahro Feroze, Liaquat University HospitalJamshoro and Civil Hospital Karachi and NaushahroFeroze, August 2014 to December 2015.Methods: All 320 patients were equally divided for open cholecystectomy and Laparoscopiccholecystectomy. Demographic profile and detailed Clinical examination were recorded. Allpatients were evaluated for Cholelithiasis underwent preoperative investigations. All patientswere resuscitated and optimized before intervention. Inclusion criteria were diagnosed caseof gallstones, age > 20 years and both gender selected for open cholecystectomy andLaparoscopic cholecystectomy and assessed the frequency of bile duct injury during bothprocedures. Exclusion criteria were of carcinoma of gall bladder, stone in CBD and obstructivejaundice. Chi square test was applied for p-value. Results: 320 cases of gallstone wereundertaken for operative laparoscopic cholecystectomy and open cholecystectomy procedure.Most of the patients were 208(65%) female, male to female ratio were 1:7.2. Gall stonecommonly reported in 3rd and 4th decade 186(58.13%) cases in between 36-50 years. The meanage was 39.8+5.90years. Abdominal ultrasound revealed that multiple stone 253(79.1%) casesas compared to single stone. Other common findings of thick wall gallbladder139 (43.44%)cases while ultrasonologist reported impacted gallbladder stone in 23(7.19%) cases. Commonbile duct injury more occur in open procedure 24(7.5%) cases as compared to laparoscopiccholecystectomy 15 (4.7%) cases and Chi square test was applied for p-value <0.001.Conclusion: The Laparoscopic procedure has decreased rate of complications and bile ductinjury day by day due to improved learning curve.