bluuebunny/crossref_metadata_2025 huggingface dataset:
FIBEROPTIC BRONCHOSCOPY
Authors: HUSSAIN AAMIR , Nagra Hanif , AMIN KHALID , Zakria Muhammad , JAVED MASOOD
Published: September 2021

O b j e c t i v e s : To demonstrate the usefulness of Bronchoscopy as a diagnostic tool in various pulmonary disorders. D e s i g n :Prospective study. Setting: Nawaz Medicare Hospital Faisalabad. Period: June 2004 to December 2007. Materials & M e t h o d s : This studywas conducted on 52 patients, 37 were male & 15 were female. Their ages ranged from 26 to 85 years. These patients who under wentBronchoscopy were either suspected cases of bronchogenic carcinoma or had difficult to treat un-resolving pneumonias. Endobronchialbiopsies and bronchial aspirates were obtained. R e s u l t s : In the patients suspected of bronchogenic tumor 66.67% patients turned out tobe positive on endobronchial biopsies. Bronchial aspirates were diagnostic in 73.32% cases of un-resolving pneumonias. The commonestsymptoms in patients under going Bronchoscopy were haemoptysis and cough. C o n c l u s i o n : Bronchoscopy is very useful in the diagnosisof suspected cases of bronchogenic carcinoma. Bronchial aspirates are helpful in the diagnosis of un-resolving pneumonias.
DRY EYE SYNDROME
Authors: MALIK TAHIR MUMTAZ , NAQVI SYED ABID HASSAN , SHAHID MUHAMMAD
Published: September 2021

Objective: To determine the frequency of dry eye syndrome in adult patients. Study Design: A descriptive study. Setting:Eye Department Military Hospital Rawalpindi. Period: From June 2004 to December 2004. Patients and methods: A total of hundredpatients were randomly selected from the daily OPD at eye department, MH Rawalpindi. They were tested for the presence of dry eyesyndrome by Rose Bengal staining, Schirmer tear strip measurements and Tear film break up time. Results: A total of 67 males and 33females were recruited. Out of these 10 males and 6 females were found to be having dry eye syndrome. Mean patient age was34.3±1.3years (range 20-60 years). Conclusion: The frequency of dry eye syndrome in adult patients attending the eye clinic of MilitaryHospital Rawalpindi is 16%.
CPD
Authors: TAHIR M. SHUJA
Published: September 2021

It is an international problem to keep the doctors up to date and competent in practice. Continuing professional development is developmentof the person as a whole. It is development of goal oriented individuals. Its focus is on planned changes (good changes) towards a bettersociety. Its objectives are to provide most up to date and state of art services in various specialized fields of health care system.
LEARNING STYLES
Authors: DANISH KHALID FAROOQ , AWAN AZRA SAEED
Published: September 2021

O b j e c t i v e s : 1. To study the prevalence of learning styles in intermediate level students in Rawalpindi according to Kolb'sLearning Style Inventory. 2. To study the correlation of learning styles with career choices of intermediate level students in Rawalpindi. 3.To compare the results of the study with the learning styles of clinical students of a medical college. D e s i g n : Cross sectional. Descriptive.M e t h o d s : The study was done on the intermediate level students of Government Colleges in Rawalpindi. It included the Pre-Medical, Pre-Engineering and Humanities students. All students were given a questionnaire based on Kolb's learning style inventory, and responsescollected. Instructions to fill the questionnaire were given verbally to all students. Each student was also instructed to present three careerchoices in order of priority. Data was collected. Results: Prevalence of different learning styles in medical students and intermediate levelstudents is shown in table-l and table-ll respectively. C o n c l u s i o n s : The prevalence and pattern of learning styles of intermediate levellearners and medical students is different. Majority of intermediate level learners have the converger learning styles in contrast with themedical students in whom accommodators are in overwhelming majority. Most learners choosing "Doctor" as their preferred career amongintermediate level learners were of assimilator style, followed by convergers. Accommodators were on third place in choosing "Doctor" aspreferred career. The most preferred career among intermediate level learner was "Teacher".
HEPATITIS C
Authors: TARIQ FAQIR MUHAMMAD , AHMAD IRSHAD , SUBHANI HABIB , Haq Irshad Ul
Published: September 2021

I n t r o d u c t i o n : Hepatitis C is a RNA virus isolated in 1988 but still not cultured in the laboratory. Hepatitis-C infection is aserious global public health issue, WHO estimates worlds 3 % population is HCV positive. Pakistan is also facing the huge burden of thisdisease. Accurate prevalence information for hepatitis C infection is scant in Pakistan. Few population based studies are available, the mostcomprehensive being that of Luby et al which after testing a representative sample from a population of 150,000 in Hafizabad, Pakistanfound an overall sero-prevalence of 6%. This increased to 30% with increasing age. They also found sero-prevalence of 16% in householdmembers of HCV infected cases. Aslam et al reported a population prevalence of 16% from Lahore and 23.8% in Gujranwala. In our studypublished in Medical Forum showed prevalence of HCV antibodies in population attending our department of ophthalmology is 27.06%.There is no data from Pakistan about prevalence of hepatitis C in Paramedical staff. It appears that paramedical staff is at higher risk ofcontracting this infection as they are exposed to multiple risk factors like needle stick injuries. Little is known about the prevalence of HepatitisC in this group of population. The objective of our study was to assess the perceived increased incidence of Hepatitis C in this group ofpopulation. M e t h o d s & Materials:This is a retrospective audit of the data from the records kept by clinical laboratory of University MedicalCollege, Faisalabad. All paramedical staff members were invited for HCV antibody test on 13.1.2007 to 20.1.2007.Any staff member workingin those days was included in the study. Persons on holidays or did not give free informed consent was excluded from the study. Serumof blood samples were analyzed by EXCEL a one step test device for the qualitative detection of antibodies to Hepatitis C virus in serumor plasma by trained professional. This test has a relative sensitivity of 96.8%, relative specificity 99% and accuracy 98.9% as comparedto HCV EIA test. Statistical analysis was performed by SPSS system.Results: A total 80 staff members were working in the hospital at thattime, 61 attended for the test (F: 31, M: 30). We found 7 (11.4%) were HCV positive and 54 (88.52%) were HCV negative including 2 weeklypositive. Among HCV positive 4 (6.55%) were male and 3 (4.91 %) were females. Age distribution was 17 - 75 years with mean age 32.51years. Among HCV positive 3 were analyzed by ELISA technique. 2 weekly positive by EXCEL were negative by ELISA and 1 positive byEXCEL was positive by ELISA. C o n c l u s i o n : Paramedical staff is perhaps not at higher risk of contracting HCV infection. However morestudies are required to further assess this finding.
INSULIN DEPENDENT DIABETES MELLITUS
Authors: KHURSHID MUHAMMAD USMAN , ALV I MANSOOR-UL-HASSAN
Published: September 2021

A i m s & O b j e c t i v e s : To test the hypothesis that an increased plasma concentration of sialic acid, a marker of the acutephaseresponse, is related to the presence of diabetic retinopathy in type 1 diabetes mellitus or Insulin Dependant Diabetes Mellitus (IDDM).R e s e a r c h D e s i g n a n d M e t h o d s : We investigated the relationship between plasma sialic acid concentration and diabetic retinopathy in across-sectional survey of 1,369 people with type 1 diabetes. Subjects were participants in the IDDM Complications Study, which involveddiabetic centers of four different hospitals in Lahore. Results: There was a significantly increasing trend of plasma sialic acid with severityof retinopathy (P < 0.001 in men) and with degree of urinary albumin excretion (P < 0.001 men, P < 0.01 women). Elevated plasma sialicacid concentrations were also associated with several risk factors for diabetic vascular disease: diabetes duration, HbAlc, plasma triglycerideand cholesterol concentrations, waist-to-hip ratio, hypertension and smoking (in men), and low physical exercise (in women). In multiplelogistic regression analysis, plasma sialic acid was independently related to proliferative retinopathy and urinary albumin excretion rate inmen. Conclusions: We concluded that an elevated plasma sialic concentration is strongly related to the presence of microvascularcomplications in type 1 diabetes with retinopathy and nephropathy. Further study of acute-phase response markers and mediators asindicators or predictors of diabetic microvascular complications is therefore justified.
MALIGNANT LUNG TUMORS
Authors: KHAN RAO SAAD ALI , DIN RAFI UD
Published: September 2021

O b j e c t i v e : To determine sensitivity and specificity of bronchial wash cytology in diagnosis of malignant lung tumors, withhistopathology as gold standard. D e s i g n : Validation study of bronchial wash cytology as a screening procedure. S e t t i n g : Pulmonologyunit,Department of Medicine, Military Hospital Rawalpindi. D u r a t i o n : Six months (from Nov 2004 to May 2005) Patients a n d m e t h o d s:Hundred indoor patients of either gender with clinical suspicion of lung tumors were included in this study by convenience non probabilitysampling. Transbronchial biopsies of the lesions were done and samples of tissues were collected for histopathological examination. Tenml of reaspirated isotonic saline was sent for bronchial wash cytology examination. R e s u l t s : Out of 100 patients histopathologicalexamination confirmed malignancy in 75 (75%), whereas cytology could detect malignancy in 58 (58%). Thus bronchial wash cytology hada sensitivity of 77.33% and a specificity of 100%. Conclusion: Pulmonary wash cytology has good sensitivity and specificity but yields lessinformation as compared to biopsy. It is particularly useful in patients where the latter is contraindicated or the required expertise is notavailable.
CORONARY ARTERY DISEASE
Authors: MUHAMMAD FIDA , Mallick, Nadeem Hayat , ABID ABDUL REHMAN , AHMAD AJAZ , Imran Shahid
Published: September 2021

Objectives: This study was designed to evaluate the pattern of clinical presentation, risk factors and angiographic findingsin young males presenting with acute myocardial infarction (AMI).Materials and methodsThis cross-sectional descriptive study wasconducted at the Cardiology Department, Punjab Institute of Cardiology, Lahore from May 2005 till February 2006. After fulfilling the inclusioncriteria 200 male patients <40 years with coronary artery disease (CAD) were studied. Results: Mean age of the study population was31.5±9.2 years with an age range of 31 to 40 years. Most common risk factor was smoking present in 60% patients. Family history ofischemic heart disease (IHD) was present in 44.5% patients, hyperlipidemia in 35.5% patients, hypertension in 25.5% and diabetes mellitusin 17.5% of patients.Common mode of clinical presentation was AMI 42.5% patients. Left anterior descending (LAD) was diseased in 73.5%,followed by Left Circumflex (LCx) 51% and Right Coronary Artery (RCA) in 39% patients. Left Main Stem (LMS) disease occurred in 9.5%patients. Good left ventricular (LV) systolic function was observed in 38%, moderate LV systolic function in 34% and poor LV systolic functionin 14.5% patients. Conclusion: Patients with premature coronary artery disease have unheralded acute onset of symptoms. Smoking isthe most common risk factor. Young patients have single vessel CAD with frequent involvement of LAD and commonly have good leftventricular systolic function.
IRON DEFICIENCY ANEMIA
Authors: AHMED SHAHEEN , Ali Salman , FAREED NAEEM , Sultan Mehboob , SADIQ NADEEM , Khurshid Umar
Published: September 2021

t r o d u c t i o n : The adherence to treatment of iron deficiency anemia often is poor in both developed and developingcountries. The current standard therapy is oral ferrous sulfate administered 3 times daily. It is possible that adherence would improve witha single-dose daily treatment regimen. O b j e c t i v e s : To compare single versus thrice daily ferrous sulfate for treatment of iron deficiencyanemia in young children. D e s i g n : Quasi experimental study Setting: Children Department Military Hospital Rawalpindi. P e r i o d : From (01Jan- to31 Mar 05 and 03 Jul to 02 Oct 05) Subjects and Methods: Total 250 patients of iron deficiency anemia (hemoglobin values: 7.0to 9.9 gm/dl and serum ferritin values: 10 ng/ml or less) were identified. Children divided into two groups and matched on the basis of age;and gender. One group (n = 125) received ferrous sulfate once daily and the control group (n = 125) received ferrous sulfate thrice dailyat a total dose of 6 mg/kg/day of elemental iron for 2 months. Hemoglobin and serum ferritin values were measured as baseline and at theend of the study. R e s u l t s : Successful treatment of anemia (target hemoglobin > 10 gm/dl) occurred in 81.42 % of the single dose and in79.83 % of thrice daily dose groups and the side effects were minimal between the two groups. Conclusion: A single versus a 3 times dailydose of ferrous sulfate resulted in a similar rate of successful treatment of iron deficiency anemia, without significant side effects.
WOUND DEHISCENCE
Authors: AFZAL MUHAMMAD , AHMED MUSTARSHED , SHEIKH MUHAMMAD SAJID
Published: September 2021

Introduction: Exploratory laparotomy is a common procedure performed at the surgical floor, mainly in emergency. The need for exploration ranges from cases of abdominal trauma to those of preexisting abdominal ailments. Wound dehiscence, either partial or complete does occur after laparotomy and a number of studies have been performed to find out its frequency after laparotomy and to pin point the factors responsible for this complication. This study is designed to find out the frequency of wound dehiscence after exploratory laparotomy. Also it will compare frequency of wound dehiscence in trauma cases verses cases of abdominal pathology. O b j e c t i v e s : (1) To work out frequency of wound dehiscence after exploratory laparotomy. (2) To know the differential frequency of wound dehiscence after acute abdominal trauma compared with those having preceding underlying pathology and were explored. S t u d y D e s i g n : It was a prospective observational study. Settings: Surgical units Allied Hospital, Faisalabad department of surgery. S a m p l e Size: 200 patients operated in emergency and elective lists for abdominal exploration. S a m p l i n g t e c h n i q u e : Non probability (convenience). E x c l u s i o n criteria: (1) Children less than 10 years (2) Sub costal incision (3) Pfennensteil incision (4) Morrison's' incision (5) Grid iron incision and; (6) Incisions to explore the kidney were excluded. (7) Those patients who expired in emergency just after exploration. Inclusion criteria: All patients above 10 years opened by midline laparotomy incision. R e s u l t s : Out of 200 patients, 20 got wound dehiscence. It included 7 from Group I and 13 from Group 2. C o n c l u s i o n : Improved surgical technique, early arrival in hospital and control of infection can bring the incidence of wound dehiscence after exploratory laparotomy down to a level comparable to international figures.
HERNIOPLASTY
Authors: BILALL MUHAMMAD FAISAL , AKRAM MUHAMMAD , KANWAL SUMERA , Iqbal Jawaid
Published: September 2021

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repairedusing open suture, open mesh or laparoscopic mesh techniques. O b j e c t i v e s : To examine the results of open mesh repair using "sublaytechnique" of hernioplasty. Setting: Surgical Unit-I, Department of Surgery at Allied Hospital, a tertiary care teaching hospital affiliated withPunjab Medical College, Faisalabad. Patient & M e t h o d s : Sixty patients (male:16, female:44) were operated for incisional hernia. Openmesh repair was done. Polypropylene mesh was placed over closed posterior rectus sheath layer and over the rectus abdominis, wereavailable. Anterior rectus sheath was closed in front of the implanted mesh. All the patients received injectable third generation cephalosporinfor 48hrs postoperatively. Postoperative recovery in terms of seroma formation, wound infection, intraabdominal adhesions leading tointestinal obstruction, enterocutaneous fistula formation and recurrence were the main factors noted and analyzed statistically. Results:Mean postoperative hospital stay was 03 days. Only one patient developed wound infection. None of the patients developed seromaformation, intestinal obstruction or enterocutaneous fistula. Maximum follow up till this study is 14 months. No recurrence has been reportedso far. C o n c l u s i o n s : Open mesh repair using "sublay technique" does not carry risk of enterocutaneous fistula, carries low risk of seromaformation and wound infection. Proper technique is not associated with recurrence.
LUMP BREAST
Authors: QASIM MUHAMMAD , AKBAR SYED ALI , ALI JOHAR , Mustafa Saima
Published: September 2021

B a c k g r o u n d : Lump breast is a fairly common presenting complaint for which patient seeks medical advice and becomesanxious about the diagnosis. Fine needle aspiration cytology (FNAC) for the diagnosis of lump breast has been proved as a simple, rapidand economical Procedure. The present study was done to evaluate the diagnostic accuracy of fine lump breast in our set-up comparedwith open biopsy. M e t h o d s : The study was conducted in surgical department of Nishtar Hospital Multan and Frontier Medical CollegeAbbottabad. One hundred female patients with lump breast were selected for the study and their medical history was recorded. The agerange was 15- 65 years. All of the patients under went FNAC of the lump breast followed by open biopsy for comparison. R e s u l t s : Theresults reveal that this study shows a sensitivity of 87.5% for FNAC to pick malignant lesions and specificity of 82.4% while over all diagnosticaccuracy 84%. C o n c l u s i o n s : Fine needle aspiration cytology is safe, easy, cheap and accurate procedure. Its sensitivity and specificityis fairly high and is a good alternative to open biopsy. FNAC should be routinely used and open biopsy should be performed in doubtfulcases only.
DISTAL HYPOSPADIAS
Authors: IQBAL MUHAMMAD , Ahmed Tufail , AHMED NISAR , . Amanullah Amanullah , RASHEED ABDUL , Malik Masud , Hussain Malik
Published: September 2021

Objective: To assess the efficacy, safety and complication of Barcat_Redman urethroplasty technique in the managementof distal hypospadias. Place of S t u d y : Prospective study was completed at Urology Department, Services Hospital Lahore and larkana from1998 to 2007. Material a n d M e t h o d s : Fifty patients of distal hypospadias were selected from the Urology Department of Services HospitalLahore and Larkana for Barcat_Redman urethroplasty technique. R e s u l t s : Age of the patients range from 5 to 25 years, the mean age was11 years. Forty (80%) patients belonged to urban areas while 10(20%) were of rural areas.AII the patients presented with dystopia ofexternal urethral meatus and chordee (ventral curvature) while 25 (50%) presented wih misdirected stream, 3(5%) spraying of urine and3(5%) narrow stream . The subcoronal type of distal hypospadias was commonly seen in our study, forty (80%) patients had subcoronaland 10 (20%) distal penile urethral opening. Following barcat-redman technique 35(70%) patients had good result and 8(16%) patients weredeclared as fair result while 4 (14%) decleared failure. The overall morbidity rate was 30% while hospital stay was 3 days. C o n c l u s i o n :Barcat-Redman urethroplasty technique is simple, less time consuming and has better success rate for the management of Distalhypospadias.
TERMINATION OF PREGNANCY
Authors: HUSSAIN UZMA , LATIF FARZANA , AKHTER TEHSEEN
Published: September 2021

O b j e c t i v e : To compare the efficacy of vaginal misoprostal with that of sublingual misoprostol in 2n d trimester of pregnancyby comparing the induction-expulsion interval between two groups of patients induced with vaginal and sublingual misoprostol. S t u dyd e s i g n : Interventional, quasi experimental study. Settings: Obstetrics & Gynaecology Unit 1, Sir Ganga Ram Hospital, Lahore. Durationof s t u d y : Thirteen months from October 2006 to November 2007. S u b j e c t s a n d M e t h o d s : Sixty women at 12-26 weeks of gestation whichwere selected for termination of pregnancy were assigned into two groups. Thirty women received sublingual misoprostol and thirty womenreceived vaginal misoprostol. Dosage regimen was tablet Misoprostol 200fjg 4 hours apart till expulsion of fetus (maximum 5 doses). Mainoutcome measures were: 1. Induction-expulsion intervals 2. Maternal side effects 3. Fever 4. Nausea/vomiting 5.Diarrhea. R e s u l t s : Meaninduction-expulsion interval in vaginal group was 11.8±8.3 hours and in the sublingual group was 12.8±8.5 hours. Percentage of completeexpulsion was 53.3% in both groups. Cases of failed induction in vaginal group were 10% and in sublingual group were 13.3%. One case(3.3%) of fever and two cases (6.6%) of vomiting were observed in sublingual group and one case (3.3%) of vomiting was observed invaginal group. C o n c l u s i o n : Both routes appear to be equally efficacious for mid trimester pregnancy termination, without significant sideeffects.
NEURAL TUBE DEFECTS
Authors: RASHEED NUZHAT , AHMED MUNIR , YAR HAFIZ MUHAMMAD
Published: September 2021

O b j e c t i v e : To know the frequency of NTD among total births in teaching Hospital Rahim Yar Khan and to know thepossible causes of neural tube defects in area of Rahim Yar Khan D e s i g n : Prospective study Setting: Department of Obstetrics andGynaecology Sheikh Zayed Medical College/Hospital Rahim Yar Khan P e r i o d : One year from November 2006 to October 2007. Patients& M e t h o d s : All pregnant mothers were registered in the study but only those were selected who were diagnosed during pregnancy or afterdelivery as a case of NTD. Results: Out of 6701 live births, a total of 52 cases were diagnosed as NTD. The information was collected bytaking history along with ultrasound findings and biochemical tests. The incidence came out is 7-8/1000 live births. The maternal mean agewas 28.9 years and more common in primigravida i.e. 33% and 30% were grand multigravida. 75.3% of women belonged to low incomegroup, and were not taking proper balanced diet. 80% lived in Joint family and 96.2% females were house wives. 96% cases of NTD weredetected by ultrasound at mean gestation of 21.66 wks. The most common NTD was anencephaly found in 67% of cases, spina bifida 29%and encephalocele was found only in 4% of cases. The male; female ratio was 2:3.74% of women had Hb level less then 10gm/dl and in20 women the type of anaemia was macrocytic- hypochromic. C o n c l u s i o n : Low socio-economic status, poverty and poor dietary habitsmay be factors for higher incidence of neural tube defects. Our study provides new data for the health care providers to improve healthfacilities and their utilization and iron and folic acid supplementation targeted to all women of child bearing age to prevent neural tube defects.
TESTICULAR MORPHOLOGY
Authors: ZAREEN NUSRAT
Published: September 2021

Objective: To study the effects of mobile phone induced Electromagnetic fields (EMFs) on testis of young mice. Settings: Department of Anatomy, College of Physicians and Surgeons Pakistan, Regional Centre, Islamabad. Period: January to June, 2008. Study Design: Experimental animal study. Materials & Methods: This study was conducted on two groups of young BALB-c (6 weeks of age) purchased from National Institute of Health Islamabad. These animals were divided into two groups control and treated, each consisting of twenty animals. The treated group was exposed for one month to mobile phone induced EMFs by placing a mobile phone in the floor of the cage. This phone was rung upon from any other line or cell phone twice daily for 15 minutes. The control group was kept under identical conditions except for mobile phone on the cage floor. Results and observations: Histological comparison of testis of the both group animals showed a significant increase, in the number of tubules with sperms in the lumen, increased sub capsular congestion of vessels, presence of vacuolation and giant cells in germinal epithelium and abnormal cells in the lumen of seminiferous tubules of the treated group. Conclusion: The results indicate altered testicular morphology of the EMFs exposed mice.
ULTRASOUND SCAN
Authors: SABIH DURR-E- , Ali Farooq , ALIKHAN AAMIR , Sajid Khan Mohammad , JEHANGIR WAQAS
Published: September 2021

O b j e c t i v e : To assess the infective potential of ultrasound gel and probes when used in a routine manner on ambulatorypatients with intact skin. At our institute, ultrasound probes are wiped with a non-sterile absorbent paper towel after each patient. The probesbecome dry and clean in social terms but we were unsure if they also became bacteriologically decontaminated after wiping clean. We alsowished to ascertain the intrinsic infective potential of ultrasound gel. Materials a n d m e t h o d s : Bacteriological samples were taken from probesurface (after wiping it clean as per our protocol); gel dispensing bottles; and the gel jars that contain the gel in bulk. A total of 61 sampleswere cultured, out of these 13 were jar samples that were acquired daily on 13 days, 10 from gel bottles and 38 from probe surface (27before beginning ultrasound, 11 after ending the day's work). Probe surface samples were collected on sterile cotton wipes dipped in sterilenutrient broth; bottle and jar samples were collected by sterile nickel loops and cultured on commercially available nutrient agar. Colonieswere counted at 24 and 48 hours. R e s u l t s : The results show bacterial contamination in all (10/10) gel bottle samples, 7% pre-scan probesurface wipes (2/27) and 27.3% (3/11) on post scan wipes. Gel Jar samples were sterile on the first 3 days and then progressively showedgreater colony counts. This showed that the gel is initially sterile but is apparently contaminated from air and it serves as growth mediumfor bacteria. C o n c l u s i o n : We conclude that the highest contamination is observed in gel bottle samples (100%). The lowest contaminationwas observed from wiped probe samples. This was probably due to repeated cleaning of probes by the operators. Gel jar samples havethe second highest contamination but the initial samples showed no growth. The ultrasound gels probably contain no or little antibacterialagent and the gel serves as a growth medium for bacteria.
HEAT STROKE WITH DIARETES INSIPIDUS
Authors: AZIZ MUHAMMAD SHAHID
Published: September 2021

A young soldier 20 years of age was brought with 02hour history of sudden loss of consciousness associatedwith high grade fever while working in the field for severalhours in hot and humid weather in month of August.There was no history of head trauma.
SCHWANNOMA OF THE CERVICAL SYMPATHETIC CHAIN
Authors: SHISHEGAR MAHMOOD , Chohedri A. H. , MOSAVI SEYED ALI , Ashraf Mohammad Javad , HOSSEINI SEYED HOSSEIN DASTGHEIB
Published: September 2021

Schwannomas are benign, slow-growing tumors that arise from Schwann cells of the nerve sheath. Those originatingfrom the sympathetic cervical chain are extremely rare and usually presents as an asymptomatic neck mass. Here we report a case ofschwannoma of the cervical sympathetic chain in a 32-year-old man who had asymptomatic neck mass for 6 months. But it appearedpulsatile due to the anterior displacement of carotid sheath by the mass and thus mimics a carotid body tumor. As discussed in this reportCT scan with contrast is enough for ruling out paraganglioma and imposing extra expense for MRI and angiography is unnecessary .Theonly rare complication encountered after surgery was Horner's syndrome, which required no treatment.
BREAST CANCER
Authors: MALIK MUNIZA QAYYUM , Malik Asima , RASHEED SHAHEEN , Afzal Hurriat , KHURSHID RUKHSHAN
Published: September 2021

Objective: To assess the alterations of serum cholesterol, liver and bone enzyme with breast cancer patient taking tamoxifenwith different hormaonal status. S t u d y Design: Experimental study. Period: April to September, 2006 (24 weeks). Setting: The study wascarried out on serum samples that were obtained from out department of Oncology, Sir Ganga Ram Hospital of Lahore. Materials a n d M e t h o d :The study included 68 (serum specimen) of breast cancer patients. These patients were different stages of menstruation (postmenarche,perimenopausal and post menopausal). Clinical history and provisional diagnosis were also noted. Results: These patients (68 women) withbreast cancer were divided into three major groups; (1) Postmenarche patient, (2) perimenopausal (3) post menopausal status. It is observedthat the level of serum cholesterol, ALT and serum alkaline phosphatase in post menarche women were within the normal limits. While womenin perimenopausal and post menopausal age groups, had increased level of serum cholesterol (P<0.01) and alkaline phosphatase. Level ofALT however was observed on border line. C o n c l u s i o n s : It is therefore concluded that tamoxifen either prevents or shows no effect on thebone and liver function as well as on cholesterol in postmenarche patients. While in case of perimenopausal and postmenopausal breast cancerpatients who received tamoxifen, it may induce increase in cholesterol level and bone resorption, which may be due to decreased level ofestrogen. However, further research is needed to reach better conclusions.
ACUTE APPENDICITIS IN PREGNANCY
Authors: HABIB LUBNA , MIRZA MASOOM RAZA
Published: September 2021

Objective: To determine the maternal and foetal outcome among the cases of acute appendicitis during pregnancy. D e s i g n :Prospective Study. Setting: Aga Khan Hospital for Women, Kutyana Memon Hospital and Hamdard University Hospital, where authors work.Period: From June 2004 to May 2008. Material a n d M e t h o d s : A total of 21 pregnant females who presented with right sided abdominal painwith clinical diagnosis of acute appendicitis were managed during this study period. All patients were admitted and managed by both surgeonand obstetrician. Detailed 'clinical history and physical examination was performed and all patients were investigated by complete blood picture,urine analysis and ultrasonography of abdomen and pelvis. Appendicectomy was performed through Grid Iron incision. Macroscopic appearanceof appendices and other operative findings were recorded and all specimens were sent for histopathology. All the patients were followed uptill the out come of pregnancy. Results: Twenty one patients were managed during this study period and out of these 21,13 patients wereprimigravida and 8 were multigravida. At presentation most of the patients were in their second trimester of pregnancy. Acute appendicitis wasconfirmed by histopathologically in 16 out of 17 patients with inflamed looking appendices (negative appendicectomy rate was 23.80%). Foetalloss occurred in 2 patients (9.52%) and both were in their second trimester of pregnancy. One patient gave birth to a baby who had low birthweight (4.76%) and one patient who was operated in third trimester had premature labour (4.76%) three weeks prior to expected date.Remaining 17 patients delivered at term without any consequences. Two patients developed wound infection which responded to wound careand antibiotics. C o n c l u s i o n : Acute appendicitis is the commonest cause of acute abdomen during pregnancy. A timely decision and aprofessional liaison among obstetrician and surgeon are key factors for a better outcome.
DUCKETT URETHROPLASTY
Authors: IQBAL MUHAMMAD , Ahmed Tufail , AHMED NISAR , Amanullah Amanullah , RASHEED ABDUL , Malik Masud , Hussain Malik , Manan Abdul
Published: September 2021

Objective. To assess the efficacy, safety and complication of Duckett urethroplasty technique in the management of distalhypospadias. Design: Prospective study. Setting: At Urology Department, Services Hospital Lahore and larkana. Period: From 1998 to 2007.Material and Methods. Fifty patients of distal hypospadias were selected from the Urology Department^ services hospital lahore and larkanafor duckett urethroplasty technique. Results: Age of the patients ranged from 5 to 22 years. The mean age was 10 years, forty (80%) patientsbelonged to urban areas while 10(20%) were of rural areas.AII the patients presented with dystopia of external urethral meatus and chordee(ventral curvature). 25 (50%) presented wih misdirected stream, spraying of urine 3(5%) and narrow stream 3(5%). The subcoronal type of distalhypospadias was commonly seen in our study. Forty (80%) patients had subcoronal and 10 (20%) distal penile urethral opening. All the patientswere had distal type of hypospadias associated with chordee. Following duckett technique 32(64%) patients had good result and 10(20%)patients have fair result while 8(16%) were decleared as a failed cases. Conclusion. There is still no operative procedure,which can be labelledas ideal operation for hypospadias.however duckett technique have lower success rate but statistically insignificant as compared to otherprocedures.
COMMINUTED FRACTURES OF SHAFT OF FEMUR
Authors: MAHMOOD TARIQ , CHEEMA ARSHAD ALI , YASIN AJMAL , Chaudhary Rasul Ahmad
Published: September 2021

Comminuted fracture shaft of the femur is a common entity faced by orthopaedic surgeon. Road traffic accidents are the majorcause of these comminuted fractures. But with increase in violence, gun shots are also causing these fractures frequently. Objectives: To seeand compare the result of intramedullary interlocking nailing and biological plating in terms of infection rate, union rate and to assess the othercomplications. Design: Prospective study Setting: Department of Orthopedic Surgery Allied Hospital Faisalabad. Period: From Sept 2001 toSept 2003. Patients & M e t h o d s : Forty comminuted fractures of femur were managed .twenty by bridge plating and twenty by interlockingnailing. Results: Results were compared with reference to healing time, infection rate, operating time and hospital stay and was comparableto other studies. Conclusions: Closed interlocked intra-medullary nailing is an excellent method for treating comminuted femoral shaft fracture.But requires expensive equipment and more expertise. Bridge plating require no special instrumentations and can be done at periphery withless facilities available.
CIRCULATING MONOCYTES
Authors: ASHOUR TARIQ HELAL , TELMESAN ABDUL WAHAB M A
Published: September 2021

Objective: This study was conducted to measure Monocytes HLA-DR expression in neonatal sepsis in comparison to otherdiseases with systemic inflammation and high risk of infection (respiratory distress syndrome "RDS" and prenatal asphyxia) and this may behelpful in early diagnosis of infection and therapeutic intervention. M e t h o d s : This study was carried out on 2007 and it conducted on 38 sickneonates, 22 with proven sepsis diagnosed clinically and by positive blood culture and 16 (8 had RDS and 8 had prenatal asphyxia) withpossible infection i.e. they had 2 or fewer clinical signs of sepsis and negative blood culture. Those Patients with possible infection were followedup (for 48 h). Seven out of the 8 RDS Babies developed sepsis as evidenced clinically and by positive blood culture and they considered aspatients with early sepsis at the time of admission. Forty healthy age and sex matched newborns were studied as controls. All Babies weresubjected to complete blood count (CBC), C-reactive protein (CRP) and flow cytometeric determination of HLA-DR expression on monocytes.Results: Neonates with proven sepsis and those with early sepsis (7/8 of RDS) had significantly lower HLA-DR% {15.9+7.8 and 11.4±5.9respectively) than controls (61.0±20.6). HLA-DR% was reduced below the lowest cut off values in all septicemic neonates (neonates with provenand those with early sepsis). At the time of admission CRP was positive in 91 % of neonates with proven sepsis and in only 57% of the neonatesof early sepsis. In addition, there was no significant difference between HLA-DR percent in neonates with prenatal asphyxia when comparedto control group. Monocytes HLA-DR% had higher sensitivity, specificity, positive and negative predictive values (100%, 85%, 87.5% and 100%respectively) compared to CRP (57.1%, 77.8%, 66.7%, 70% respectively) for neonatal sepsis at its early stages before evident clinical andlaboratory diagnosis. C o n c l u s i o n : HLA-DR % expression on monocytes is a sensitive test for both diagnosis of neonatal sepsis and its earlystage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensivecare units
HEPATOCELLULAR CARCINOMA
Authors: AMER WASIM , MAJROOH MUHAMMAD ASHRAF , AKRAM MUHAMMAD
Published: September 2021

Introduction: Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world.Characteristics of our population suffering from HCC are not known, this study aims to present epidemiological, clinical and laboratorycharacteristics of HCC patients..Design: A retrospective study. Setting: At Jinnah hospital, Lahore. Period: 36 months. Material & m e t h o dsHCC was diagnosed according to the guide lines given by EASL-2000. The data was later analyzed by SPSS13. Results. A total of 34 patientswere included in the study. Majority patients were male 21(80%) and belonged to urban setting (21). Pain abdomen 21(61.8%) and Ascites22(64.7%) were the commonest presentations. 15(44%) patients were suffering from HCV and 12 (35.3%) were negative for both HCV & HBV,while 9 out of these were also not alcoholic. Most of the patients had symptoms present for 1 -6 (76%) months and majority presented in eitherstage III or IV (91 %), none of the patient presented in stage I. Most the patients 25(73.5%) had tumor size larger than 5 cm at presentation andsimilarly 20 (59%) had more than one lesions at presentation, stage of tumor was positively associated (p <0.02) with number of tumor lesions.Conclusion. HCC does occur in a cirrhotic background but a good number of patients were not cirrhotic and need to be investigated furtherfor other possible dietary risk factors. Pain and abdominal distension in a cirrhotic patient should be addressed to immediately so as to diagnoseHCC at an earlier stage.
VIBRIO CHOLERAE
Authors: BABAR AMIR MOHAMMAD , Mengal Mohammad Hanif , KAPOOR CHANDI , Pirkani Ghulam Sarwar , IQBAL MOHAMMAD
Published: September 2021

b j e c t i v e : To isolate the etiological agent of diarrheal outbreak, identification, antibiogram of isolated bacteria. P a t i e n t s a ndM e t h o d s : Stool samples from patients and water samples from reservoir of water collected in transport media. Culture and sensitivity test wereperformed in Microbiology Laboratory of Bolan Medical Complex Hospital Quetta. The isolated strain was confirmed by National Institute ofHealth Laboratory Islamabad and Agha Khan University hospital laboratory Karachi. The outbreak was controlled by preventive measures.R e s u l t s : More than five thousand people affected in the outbreak, including all age and both sexes. Twenty three deaths (0.4%) occurred inthis outbreak. The stool samples from patients and from 5 water reservoir tanks collected for analysis of etiological agent responsible for theoutbreak. The stool and water samples revealed isolation of Vibrio cholerae Inaba, El Tor, which was sensitive to Ampicillin, Ciprofloxacin,Tetracycline, Doxycyline and intermediate to Choloramphenicol and Erythromycin. Resistant to Nalidixic Acid Polymaxin B, and Cotrimaxazole.C o n c l u s i o n : The Vibrio cholerae Inaba, El Tor was the causative agent of this outbreak and the first outbreak which occurred inBalochistan due to Vibrio cholerae Inaba, El Tor.
ACUTE ANAL FISSURESMOKING PATTERNS
Authors: HASHMI NOREEN RAHAT , Maqsood Khalid , DAUD SEEMA , Saleem Shezad , MANZOOR IRAM , Javaid Usman
Published: September 2021

Objective: To determine the smoking patterns of medical students of 4th year MBBS. Design: A cross-sectional survey. Setting:Lahore Medical and Dental College (LMDC), Lahore, Pakistan. P e r i o d : From November to December 2006. M e t h o d o l o g y : The 50 medicalstudents of 4th year MBBS, who were current smokers. A structured questionnaire was used to collect the data. Descriptive statistics wasdetermined in terms of percentages. Results: In present study, 48% students started smoking between 14-17 years of age, 34% started tosmoke between ages 18-21 years and 18% of them had been smoking for past 4-6 yrs. Main reason to commence smoking included curiosity(27%), need to look glamorous (22%), peer pressure (16%) and stress relieving (10%). When probed about numbers of cigarettes smoked daily,the response of majority was that 32% of students admitted to smoking 1 -5 cigarettes, similar number admitted to smoking 6-10 cigarettes, and30% of students smoked more than 20 cigarettes. Among the respondents, 41 % had a brother who was a smoker and 37% had a father whowas a smoker. More than half the respondents (58%) said that their parents were unaware of their smoking habit. Regarding awareness aboutthe medical hazards of smoking, 31% of students named cancer, 29% mentioned heart disease, 18% were familiar with COPD and only 7%referred to stroke. The main concerns of respondents regarding smoking were fear of being discovered by their parents (22%), psychologicaldependence (20%) and physical dependence (18%). Only 50% of students tried to quit smoking, using hypnosis and substitutes like nicotinegum and nicotine patches. Conclusion: Tobacco smoking among medical students is alarming. These findings not only raise concerns for thefuture health of our medical students but also their credibility and effectiveness as health promoters for population at large.
TRIGEMINAL NEURALGIA
Authors: ARSHAD MUHAMMAD
Published: September 2021

Design: A retrospective study of 40 cases of Trigeminal Neuralgia who were treated surgically ( by MVD, micro-vasculardecompression). Place & Duration: Department of Neurosurgery Quaid-I-Azam Medical College/Bahawal Victoria Hospital Bahawalpur duringfour (4) year period from January 2003 to December 2006.These patients were resistant to medical treatment so MVD was performed. MethodsTotal number of patients is (40) forty. In 10 patients CT scan brain and especially for posterior fossa was performed before surgery to rule outany suspected tumour pathology. In the remaining 30 cases no MRI or CT scanning of brain was done before surgery and diagnosis ofTrigeminal Neuralgia was made on clinical grounds. Results: Posterior fossa was opened by standard right or left retro-mastoid approachdepending upon the side of pain. In 27 out of 40 cases the superior cerebellar artery (SCA) was the offending vessel. In 5 cases, only the veinwas the cause of pain. In 2 cases, vein and artery, both were the offending vessels. In 2 cases, only arachnoidal adhesions were the causeof pain. And in 4 cases, after opening the posterior fossa it was found that cause of pain is a tumour of trigeminal nerve (3 cases) or meningioma(1 case) of cerebellopontine angle. C o n c l u s i o n : From these operative findings of tumours in the posterior fossa in cases of TrigeminalNeuralgia, it is concluded that all the patients suffering from Trigeminal Neuralgia should be screened with MRI prior to surgery to rule out anytumour pathology as a cause of Trigeminal Neuralgia, so that proper preparations be made before surgical intervention.
CATARACT
Authors: HAQ QAMAR-UL-
Published: September 2021

Objective: To assess the surgical results for cataract management versus the leading free eye camps to conclude the trendof cataract management and the postoperative complication frequency in Faisalabad to create orientation about cataract management infocused community. Study Design: Retrospective study. Setting: At DHQ and Allied Hospitals Faisalabad Period: From January 2008 toOctober 2008.Subject Total cataract operations conducted in two free eye camps arranged twice a year in March and October 2008 were noted.Data for postoperative complications were recorded from the said teaching hospitals and the doctors providing the follow up services for campsurgery. Statistical analysis of data was made by using SPSS. Results: It was depicted from the data that postoperative results were betterin case of teaching hospitals as compared to free eye camp
GLAUCOMA CAPSULARE
Authors: FIRDOUS MUHAMMAD
Published: September 2021

Purpose of Study: To emphasize the role of filtration surgery in the treatment of glaucoma capsulare. Moreover the studyalso highlights the importance of thorough ocular examination and diagnosis as the condition is likely to be missed. Material, M e t h o d s andResults: This study was conducted to find out the results of filtration surgery (trabeculectomy) in such cases. Forty cases with pseudoexfoliationglaucoma presenting in the Dept of Ophthalmology PAF Hospital Mushaf Sargodha were included. These patients were initially treated withtopical medications for three months. Thirty cases that showed poor response to drugs were operated upon and a trabeculectomy wasperformed. Postoperative pressure readings were recorded twice weekly for the first two months and then once monthly for four months. Aftera follow-up of six months, twenty five cases (83.33%) were effectively controlled without any added medications whereas five cases (16.67%)required addition of a single drug to achieve the desired effect. Conclusion: The response to medical treatment is generally not satisfactoryand surgery has to be undertaken as a final resort. Trabeculectomy is the safe and effective operation in glaucoma capsulare (pseudoexfoliationglaucoma).
RAISED INTRAOCULAR PRESSURE
Authors: SAEED MUHAMMAD KAMRAN , Ljaz Umar , AMEEN SAMEER SHAHID , Hanif Kashif , IBRAHIM MUHAMMAD TAHIR
Published: September 2021

Objective: To measure the rise in intraocular pressure after neodymium:yttrium-aluminum-garnet (Nd:YAG) Laser capsulotomyin pseudophakic patients aged 50 years and above. STUDY DESIGN: Prospective study. Duration of Study: Study was done from May 2005to Dec 2005. (Eight months duration) Settings: Eye department Military Hospital Rawalpindi. Material a n d M e t h o d s : A total of 100 patients,presenting in Eye department, Military Hospital Rawalpindi, fulfilling inclusion and exclusion criteria were included. With a minimum numberof bursts of 3.6 mj / shot energy level with Nd: YAG laser, a 3 to 4 mm hole in the posterior capsule was created. The intraocular pressure wasmeasured 1 hour, 3 hours, 1 day and 1 week after the laser. Results: The rise in intraocular pressure was noticed in 6 (6%) patients afterNd:YAG laser capsulotomy. Five out of six patients had fibrous type of posterior capsular opacification while one patient had Elschnig's pearl.Male to female Ratio was 7:3. C o n c l u s i o n : Our findings suggest that the rise in intraocular pressure is an infrequent complication of Nd:YAGLaser capsulotomy.