bluuebunny/crossref_metadata_2025 huggingface dataset:
CHEMICAL INJURIES TO EYES
Authors: AHMED NOMAN NAZIR
Published: September 2021

Objective: To find out the chemical agents responsible for eye injuries,assess magnitude of the problem and resultant visual outcomes in our dependent population. Design: Observationalstudy. Place and Duration of Study: Eye department, CMH, Hyderabad from Jan 2004 to Dec 2005. Patients andMethods: Thirty five patients of all ages who presented with history of chemical injury to eyes during a period of twoyears were included in this study. Patients with co-morbidity of eyes were not included. Cases were studied to find outcausative chemical agents and their nature, sex distribution, cause and place of the incident, duration of exposure (timeelapsed between chemical injury and copious irrigation at the time of presentation) and effect on visual function.Results: Chemical injuries sustained by 47 eyes of 35 patients were analyzed. All of them were accidental and mostlymales were affected at their workplace. Nearly one third of the times 12(34.29%) both eyes were affected and23(65.71%) cases were unilaterally affected. 30(85.72%) patients presented within first two hours of the injury.3(8.57%) presented within 12 hours and 2(5.72%) presented within 24 hours. Severity of injury was grade I in mosteyes i.e. 37(78.73%) and grade II in 10(21.27%). None was found to have grade III or IV injury. Immediate irrigationwas reported in 29(82.86%) cases. The visual prognosis for eyes that received immediate irrigation was significantlyimproved. 27(77.14%) cases were caused by alkalis and 8(22.86%) were due to acids. 26(74.28%) of the cases weredue to lime. A visual acuity of 6/6 was achieved in 40(85.10%) eyes at follow up after 01 week. 7(14.89%) eyesdeveloped corneal haze of varying degree resulting in BCVA of 6/9 to 6/18. Eye protection was not used in any of the35(100%) cases. 1(2.13%) eye developed cataract during follow up period and needed to be operated upon for visualrehabilitation. Conclusion: All ocular chemical injuries resulted from accidents; at work or at home and none resultedfrom assault. Most of the injured persons needed to be hospitalized on an average for 03 days. Lime was found to bethe major culprit and was found to be used extensively for painting purposes. Visual outcome correlated with severityof injury at initial presentation.
FNAC IN THE MANAGEMENT OF SOLITARY THYROID NODULE
Authors: RAZA SOHAIL , RAZA HAMAD , SAEED ZAHID , Ahmed Mubasher
Published: September 2021

Objective: To determine the significant role of FNAC upon other diagnosticmodalities in pre-operative investigations of patients presenting with solitary thyroid nodules and to compare the postoperative histopathological results with the results of FNAC. Design: A Comparative study. Place and Duration ofStudy: Department of Surgery Combined Military Hospital Quetta and Combined Military Hospital Rawalpindi fromDecember 1999 to December 2001. Patients and Methods: In this study 46 patients with solitary thyroid nodule werestudied. Only 2 patients were toxic while remaining 44 were with euthyroid. In this study only one case was suspectedto be malignant clinically out of 5 malignant cases. All 46 patients under went thyroid scanning, ultrasound examinationand fine needle aspiration biopsy and the diagnostic accuracy was assessed. Results: 36 patients (78.26%) wereoperated while 10(21.73%) were managed conservatively. There were 5(10.86%) malignant nodules while 41(89.13%)were benign. All the 5 cases with malignancy were with ‘cold’ nodules on scan as most of others, while ‘solid’ onultrasound examination and so were most of other benign nodules. All cases diagnosed malignant pre-operatively onFNAC, proved to be malignant on histopathology after surgery and the others diagnosed as benign on FNAC provedto be benign. Conclusion: This study shows that conventional investigations for evaluation of solitary thyroid nodulesare inaccurate in identifying the malignant from the benign nodules and their routine use in such patients should beabandoned, while the use of FNAC should be encouraged more in our hospitals as this technique is with high degreeof sensitivity and specificity, cost effective and safe.
SPINAL ANAESTHESIA
Authors: RAZA SHAUKAT , TARAR HUMAYUN MUNIR
Published: September 2021

Objectives: To investigate the effects of adding pethidine with intrathecalbupivacaine, in patients having elective Caesarian section under spinal anaesthesia. Design: A prospectiverandomized double blind study. Setting: Department of Anaesthesiology in Combined Military Hospital, RawalpindiPeriod : 15 June 2002 to 15 October 2002. Material th th and Methods: One hundred patients received intrathecalinjection of 0.5 % bupivacaine 2.0 ml plus either normal saline 0.2 ml (control group) or 0.2 ml 5% pethidine equivalentto 10mg of the drug (pethidine group). Duration of effective analgesia (defined as the time duration from the intrathecalinjection to first patient demand of analgesia) was recorded. Other variables recorded were Hypotension (defined aswhen systolic blood pressure drops to less than 90 mm of Hg or a decrease of 25% from base line blood pressure),pruritis and occurrence of nausea and vomiting. Results: The duration of effective analgesia was greater in thepethidine group (mean 238.70 minutes) compared with control group (mean 120.88 minutes), this difference wasstatistically significant with p<0.05. Hypotension was more common in the pethidine group 70% compared to 52% inthe control group (P=0.06), while pruritis occurred in 20 % patients of Pethidine group compared to only 6% of controlgroup (p=0.038). Nausea and vomiting were also common in pethidine group (52% vs. 10%) with a p value of 0.001.Conclusion: Addition of 10 mg of pethidine to 2 ml of 0.5% bupivacaine results in significant rise in early postoperativeanalgesia but at a cost of higher rate of side effects.
HEMORRHOIDS
Authors: MAJID ABDUL , MALIK ASAD MAHMUD , BUTT MOHAMMAD QASIM
Published: September 2021

Objective: To evaluate the therapeutic results of rubber band ligation inhemorrhoidal disease. Design:. Prospective case series with a minimum follow up of six months. Place and durationof study: At surgical out door department of Combined Military Hospital Rawalpindi from January 2002 to July 2003.Patients and methods: One hundred patients with 1st and 2nd degree hemorrhoids were treated by rubber band ligationand injection scelerothrapy in two groups “A” and “B” with 50 patients in each group respectively. They were followedup for six months and therapeutic effects were assessed by improvement in symptom severity score, post procedurecomplications and number of off days from work. Results: In group “A” 38(76%) patients were cured, 7(14%) showedimprovement and 5(10%) showed no improvement. While in group “B” 25(50%) patients were cured, 13(26%) showedimprovement and 12(24%) showed no improvement. In group “A” complications occurred in 15 patients and in group“B” complications occurred in 27 patients, however no serious and life threatening complications were seen. Conclusion:Rubber band ligation is a rapid, safe, effective and economical method of treating 1st and 2nd degree Hemorrhoids inout door
PAUWEL'S OSTEOTOMY AND OSEOSYNTHESIS
Authors: ASGHAR MUHAMMAD , TARIQ MUKHTAR AHMED , SHAFEE MUHAMMAD
Published: September 2021

Introduction:- Fracture neck of femur is one of serious injuries encountered in orthopaedic trauma management. It can result from trivial trauma in elderly but are usually the result of high-energy trauma in the younger age group. Objective- To evaluate the results of Pauwel's osteotomy and oseosynthesis in patients with non union of femoral neck fractures. Setting Orthopaedic Unit, Nishtar Hospital, Multan. Duration 1989-1998. Material and methods Sample size 30 patients. Results: 30 cases of neglected fracture neck of femur treated. 5 patients were treated first with traction where greater trochanter migrated a way up to bring it down to the proper level. Then osteotomy was done. In 25 cases Pauwels' osteotomy was primarily done and fixed with 120 degree osteotomy plate. Follow up period ranged from 7 months to 2 and half years. Patients were assessed for reduction of the fracture site in according to alignment index by Garden for union of the fracture and range of mobility and pain relief in follow up period. Conclusion:- This is a reliable method of dealing with nonunion of the fracture neck of the femur in young adults.
RUBBER BANB LIGATION
Authors: AWAIZ DIL , MURTAZA GHULAM , RASHEED ABID , Rehman Quddus-ur- , Hussain Riaz
Published: September 2021

Objectives: To find out the post-operative complications of rubber band ligation in 2nd and 3rd degree of hemorrhoids. Design: A descriptive study. Place and Duration of study: An eighteen month study with 2 months follow up (from January 2002 to June 2003), conducted in the department of surgery, Allied Hospital Faisalabad. Patients and Methods: 50 patients were selected (from OPD) in this study. We included all patients with uncomplicated, primary 2nd and 3rd degree hemorrhoids, above 12 years of age and having no co morbid disorders like diabetes, hypertension and bleeding disorders. With patient in the knee elbow or left lateral position (depending upon the choice of patient) digital rectal examination (ORE)was carried out after lubricating the finger with xylocaine jelly. Proctoscopy was done with lubricated proctoscope and exact sites of hemorrhoids localized. The hemorrhoids were ligated one by one. We did triple ligation on a single session. Results: Out of 50 patients, 21(42%) patients were suffering from 2nd degree hemorrhoids, while 29(58%) patients were having 3rd degree. 42(84%) patients were fully cured, 3(6%) developed mild pain, 1(2%) developed severe pain and 2(6%) suffered from mild bleeding while 2(6%) patients developed moderate bleeding. Conclusion: Rubber band ligation is an effective method for treating 2nd or 3rd degree hemorrhoids with no significant post-operative complications.
POLY TRANSFUSED THALASSAEMIA PATIENTS
Authors: KAPOOR CHANDI , HANIF MUHAMMAD , IQBAL MUHAMMAD
Published: September 2021

Objective: To find out prevalence of Malarial Parasite, human immunodeficiency virus, hepatitis B and C virus in polytransfused thalassaemia patients and in apparently healthy blood donors, Design; Prospective Study. Setting: Thalassaemia Care Centre, Bolan Medical Complex Hospital, Quetta, Period: From Jan 2006 to April 2006, Material & Method: A total of 150 multitransfused patients of p, thalassaemia major and 150 normal blood donors were included in this study, Results; Thirty percent thalassaemia patients were positive for anti HCV, 14% for HBsAg and 0,7% for antiHIV antibodies, There was a significant trend in the increase in prevalence of viral markers along with the increase in the number of transfusions, Eight percent positivity for HBsAg, 0% for anti HIV and 2% for anti HCV antibodies were found among blood donors, No Malarial parasite was found on smear in both patient and donors group, Conclusion: The results of this study raise an alarm to existence of a significant risk of transfusion transmitted diseases in our setup.
KARTAGENER SYNDROME
Authors: AMIN KHALID , JAVED MASOOD , HUSAIN AAMIR , Abbas Shahid , Raza Abid
Published: September 2021

We are reporting a case of Kartagener syndrome in a 19 year old young male, who presented to uswith chronic sinusitis, bronchiectasis and dextrocardia.
NEONATAL SEIZURES
Authors: AFTAB RUSHDA
Published: September 2021

Introduction: Seizures in the neonates are quite different from those in older children and adults,whereas seizures in preterm differ from those of term infant. Neonatal seizures are poorly organized and at timesinconspicuous, they also differ in origin from those of older children as they frequently arise in subcortical areas whilein older children they arise from cortex. Objective: To find out the frequency of seizures and determine the frequencyof various types of neonatal seizures among newborns admitted to Nishtar Hospital, Multan. Material and Methods:Setting: Pediatric Unit-I, Nishtar Hospital, Multan. Duration: From May 1998 to December 2000. Sample size:200cases. Results: Out of these 200 cases, 162(81%) were male and 38(19%) were female. Among the babies withseizures, 163(81.5%) were full term, 25(12.5%) were preterm and 12(6%) were post-term. In relation to time ofpresentation, 40(40%) patients presented within 24 hours, while 65(32.5%) within 72 hours of birth and remaining55(27.5%) patients after 72 hours of birth. Among the etiological factors noted there were 100(50%) patients with birthasphyxia, 40(20%) with infections, 30(15%) with metabolic problems, 18(9%) with intra-cranial hemorrhage and 6(3%)patients had kernicterus. Cerebral malformations were noticed in 4(2%) cases and 2(1%) patients were diagnosed aspyridoxine dependency. Regarding the type of seizures multi focal clonic seizures occurred in 100(50%) cases,generalized tonic seizures in 56(28%) cases and subtle and focal clonic seizures in 22(11%) each. Sixty one 30.5%)patients died during their hospital stay. Conclusion: Neonatal seizures indicate significant underlying disease.Recognition of etiology is often helpful in prognosis and treatment.
HCV INFECTED PATIENTS
Authors: IQBAL SAJJAD
Published: September 2021

Objectives: To assess the prevalence of different hepatitis C virus (HCV)major genotypes and subtypes in HCV infected patients. Design: A cohort prospective study. Place and Duration:At Shalamar Hospital Lahore, From Dec 2002 to Dec 2005. Patients and methods: 1652 patients, 697 females and955 males infected with hepatitis C virus confirmed by ELISA were included in the present study for the analysis of HCVgenotypes. Infection was reconfirmed by HCV RNA detection with qualitative PCR. Gentyping was done with multiplexPCR using type specific primers. Results: Among 1652 genotyping was done with multiplex 3 was seen most common1220 (73.85%). Second and third common genotypes were 2 and 1 , 154 (9.33%) and 80 (4.84%) respectively followedby genotype 4 which was 41 (2.84%). In this study 106 (6.42%) cases remained unclassified and mentioned asuntypable. In 51(3.09%) cases more than one genotype was seen which reported as mixed genotypes. Conclusion:Patients with chronic liver disease due to hepatitis C virus infection in this part of Pakistan had predominantly HCVgenotype 3 but the presence of genotype 1 and 4 could not be excluded. So before therapy genotyping must be takenunder consideration.
LARYNGEAL CANCER
Authors: AKHTAR NAEEM , KHAN BABAR RAFIQUE , TIRMIZEY MUHAMMAD ALI , Hanif Muhammad
Published: September 2021

Laryngeal cancer remained the most common malignant tumourof the head and neck despite an increase in the tumours of the oral cavity and oropharynx in the past two decades.However, it is the malignancy which has a high cure rate if diagnosed early and treated correctly. Objective: Toanalyse the results of treatment offered to laryngeal cancer patients. Design: Prospective study. Setting: Departmentof ENT and Head & Neck Surgery Unit-II Allied Hospital Faisalabad. Study Period: Nov 2003 to Oct 2005. Materialand Methods: 50 cases of laryngeal cancer were selected at random who presented with hoarseness and /orrespiratory distress in the out patient department. Majority of these patients were smokers. All these 50 cases wereanalysed from treatment point of view. Results: Out of 50 cases of laryngeal cancer, 12 patients (24%) presented withsupra-glottic growth. Only one patient (02%) involved the sub-glottic region. The trans-glottic growth was noted in 16patients (32%). We had to perform emergency tracheostomy in 19 patients (38%). 16 patients (32%) underwent totallaryngectomy as the primary mode of treatment. 18 patients (36%) were referred to oncology department for primarytherapeutic radiotherapy. Salvage total laryngectomy after primary radiotherapy failure was offered to 7 patients (14%).It was noted that recurrence of the lesion was more in those patients who received primary radiotherapy, 9(18%)showed recurrence in case of primary radiotherapy while 5(10%) showed the recurrence after total laryngectomy.Conclusion: Early diagnosis of laryngeal cancer pays a lot of dividends and makes the difference between life anddeath. Therefore more emphasis should be made on early diagnosis.
RUPTURE OF RUDIMENTARY HORN OF UTERUS AT 16 WEEKS OF GESTATION
Authors: ALI ROBINA , ROOHI DR. MAHNAAZ
Published: September 2021

Rupture of gravid uterus is a rare but serious obstetric complication. Rupture in primigravida in firstor second trimester generally occurs in mullerian anomalies. A 24-year-old, primigravida, at 16 weeks gestationpresented with dull, lower abdominal pain, and tachycardia. She underwent D&C for the presumptive diagnosis ofmissed abortion few days’ back. Chronic ectopic pregnancy was diagnosed on the basis of history & examination, andher laparotomy was planned. Upon laparotomy, right-sided ruptured ectopic pregnancy in rudimentary horn ofunicornuate uterus was found & ruptured horn was excised. The patient had uneventful recovery.
SCIATIC NERVE
Authors: JABBAR ABDUL , NAQVI ANJUM , HAIDER MUMTAZ
Published: September 2021

Objective: To determine the number, size, somatotopy and segmental distribution of HRP labeledmotor and sensory neurons forming sciatic nerve in albino rat by using HRP technique. To fined out the distribution ofneurons in sciatic nerve in albino rat in spinal cord from L3S1. The average number, size and segmental distribution ofmotor and sensory neurons were localized by HRP method of tracing neuronal connections. The motor neurons formingSCN ranged 10-60 microns and extended between the caudal part of L3 and rostral part of SI spinal segment. Theyoccupied PPL, PL, C and aL subgroups. The peak frequency distribution of motor neurons was observed in L4-L6spinal segment in SCN. The labeled sensory neurons whose peripheral process run in SCN were localized in L3-S1ipsilateral Dorsal Root Ganglia (DRG). No somatotopic organization of the cells was found in the DRG. The cells weredistributed throughout the ganglia without forming groups. The somal diameters of sensory neurons forming SCNmeasured between 14-58 microns.
INTUSSUSCEPTION
Authors: HAMEED SAJID , AHMAD SHAHBAZ , MAHMOOD KHALID , Ali Liaquat
Published: September 2021

Objective: To review our results of management and compare them withother published series. Design: Retrospective study. Period: July 1995 to June 2006. Setting: Department ofPaediatric Surgery, Allied Hospital, Faisalabad. Patients and Methods: The record of all patients was reviewed.Results: A total of 102 patients were managed during this period. They were predominantly males. Eighty four percentwere under 1 year while more than half under 6 months. Two thirds four of the cases presented between the monthsof March and August. Intussusception was preceded by a about of acute gastroenteries in over one third of the cases.Mean duration of symptoms before presentation was 72 hours. All cases except one, underwent surgical exploration.At operation resection and anastomosis had to be done in nearly 60%. Wound infection (12%) and wound dehiscence(2%) were the major complications. Mortality rate was 8%. Conclusion: The management of intussusception in oursetting is unsatisfactory when compared to the international standards. A high index of suspicion leading to earlycoupled with an inprocement in the management standards is needed.
VENTRICULAR TACHYCARDIA
Authors: GILANI MUHAMMAD SHAH , Khan Abrar Ahmad , SATTAR ABDUL , Khan Arif Rahim , MAHMOOD QAISER
Published: September 2021

Introduction: Frequent or complex patterns of ventricular ectopic activity,whether occurring during routine activity or induced by exercise, are often a marker for serious heart disease and aharbinger of sudden death. The detection of such arrhythmias is thus an important responsibility of the physician.Objective: To find the prevalence, associated characteristics and prognostic significance of exercise induced nonsustainedVT in a representative population. Material and Methods: Setting: Nishtar Hospital, Multan. Sample size:1000 patients. Duration: Two years. Study design: Descriptive, analytical study. Sampling Technique: Convenientprobability sampling done. Results: Ten subjects, 7 men and 3 women, with exercise induced VT were identified,representing 1.1% of those tested; only 1 was young than 65 years. All episodes of VT were asymptomatic and nonsustained.In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runsof VT were present in 4 subjects. Two subjects had exercise induced ST segment depression, but subsequent exercisethallium scintigraphic results were negative in each. Compared with a group of age and sex matched control subjects,those with asymptomatic, non-sustained VT displayed no difference in exercise duration, maximal heart rate, or theprevalence of coronary risk factors or exercise induced ischemia as measured by electrocardiography and thalliumscintigrahy. Over a mean follow period of 2 years, no subject has developed symptoms of heart disease or experiencedsyncope or sudden death. Thus, exercise induced VT in apparently healthy subjects occurs almost exclusively in theelderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portendincreased cardiovascular morbidity or mortality rates over a 2 year period of observation. Conclusion: Exerciseinduced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomaticruns of 3 to 6 beats usually near peak exercise, and does not show increased cardiovascular morbidity or mortalityrates over a 2 year period of observation.
INFERTILE FEMALE
Authors: TALIB WASEEM , HAFEEZ MAIMOONA , IKRAM MOHAMMAD , Saeed Mohammad
Published: September 2021

Objective: To highlight the role of laparoscopy in the diagnosis andmanagement of problems related to infertility. Design: Retrospective, descriptive study. Place & Duration: Departmentof Obstetrics & Gynaecology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore between 1stJanuary 2003 to December 2003. Patients & Methods: Forty three women were selected for laparoscopy, 25 havingprimary infertility and 18 having secondary infertility. Results: Laparoscopy diagnosed significant number of previouslyundiagnosed (unexplained) cases. In laparoscopy multiple procedures like laparoscopic ovarian diathermy,adhesiolysis, cauterization of endometriotic spots, and removal of endometriomas, salpingostomy and cauterizationof fibroids can be performed in women with primary as well as secondary infertility while having minimal complications,short hospital stay and no mortality. Conclusion: Laparoscopy is a valuable diagnostic tool for female infertility.Laparoscopy is less invasive and more convenient.
ACUTE SEVERE ASTHMA
Authors: KOHISTANI TEHSEEN ASHRAF
Published: September 2021

Objective: To compare the improvement in peak expiratory flow rate (PEFR) of patients presentingto the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy.a) Salbutamol nebulization. b) Salbutamol plus Ipratropium bromide nebulization. c) To compare the hospital admissionrates in the above mentioned two treatment groups. Design: A comparative study. Place and Duration of Study:Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Material and Methods: Sixty adult asthmatic patients with peakexpiratory flow rate (PEFR) less than 200 liters per minute were randomly assigned to nebulization treatment withsalbutamol (5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes) or the same salbutamol regimen plusipratropium bromide (0.5 mg). The primary end point was change in PEFR. The PEFR was measured at 30 minutes,60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups wasexamined as secondary end point. Results: The increase in PEFR over time was significantly greater in combinedipratropium plus salbutamol group (p = 0.01) also the proportion of admitted patients was less in combined salbutamolplus ipratropium bromide group 4/30 vs 11/30, p = 0.036. Conclusion: The data suggested that combined iratropiumbromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initialmanagement of patients who present with acute severe asthma.
SENTINEL LYMPH NODE
Authors: HAMEED SADIA , RIAZ SABIHA , HUSSAIN ARIF
Published: September 2021

Objective: To assess the efficacy of a localization technique for thesentinel lymph node in patients with early breast carcinoma using 1% isosulphan blue. Study Design: Prospective studyPlace and Duration: Departments of Pathology, Punjab Medical College Faisalabad and Sheikh Zayed Hospital,Lahore and Departments of Surgery, Allied & DHQ Hospitals, Faisalabad from July 2002 – June 2003. Patients andMethods: 1% Isosulphan blue was used to identify the sentinel node in cases of early (T1 & T2) breast cancer. Thedye was injected just before the incision was made. The area was massaged. Mastectomy was done. The sentinel nodewas identified by following the blue track to the first coloured lymph node. This was removed and submitted separatelyfor histopathology along with the mastectomy specimen. Results: The procedure was performed in 95 cases. SLNwere identified in 80 (84%) patients. The mean age was 43.99 years. Majority of the tumours were located in the rightbreast in the upper outer quadrant. One SLN was identified in 93%, 2 in 3% and 3 were noted in 4% of the cases.Conclusion: Injection of 1% isosulphan blue around the tumour is an effective method for isolation of the SLN inselected cases. It saves the patient of the side effects of axillary clearance in node negative cases.
ABDOMINAL HYSTERECTOMY
Authors: TAHIRA TASNIM , QURESHI SAIMA , ROOHI MAHNAZ
Published: September 2021

Objective:(1)To audit cases of abdominal hysterectomy performed by post graduate tainees. (2) Toevaluate mortality and morbidity rate. Study Design: An observational Study. Setting: Department of Obstetrics andgynaecology, Allied Hospital Faisalabad. Period: From 01-01-2005 to 30-06-2006. Material & Methods:120 casesof abdominal hysterectomies done for non obstetric and benign gynaecological conditions were selected for study.Results: The most common indications for hysterectomy was DUB (43.3%). Overall intra operative complicationsdeveloped in 5 patients (4.1%). Post operative complications developed in 9 patients (7.5%). The mean duration ofhospital stay was 5.5 days. No case of death was recorded in the study. Conclusion: This study demonstrates thatabdominal hysterectomy can be safely done even during the learning curve of the post graduate trainees with the lowcomplication rate, shorter hospital stay and without significant mortality.
WEGENER GRANULOMATOSIS
Authors: QURESHI NAUSHEEN
Published: September 2021

Objective: To highlight the different clinical features, parameters of diagnosis and to see the effectof chemotherapy and steroids on this disease. Setting: Department of Otolaryngology Head & Neck Surgery JinnahHospital Lahore. Period: From Dec 1998 to July 2001.Methods: Five cases of Wegener Granulomatosis were studiedduring the study period. Three patients had limited disease while two patients had generalized disease with renalinvolvement. All patients were started on azathiopurine (2mg/Kg/day) or cyclophoshamide (1-2mg/km/day) along withsteroids. After a months time the dose of steroid was reduced to alternate day. Weekly monitoring of white blood cellcount with urine examination for RBCs or protein casts was done. Any patient with haematuria or TLC reduced to lessthan 3500 were immediately taken off from cyclophoshamide and azathiopurine was started. Patients having classicdisease , dose of cyclophoshamide had to be increased from two to four milligram / per Kilogram per day to achievea good response. The response to treatment was measured by noticing the resolution of pulmonary infiltrates reducedESR and negative C-ANCA. Results: We found nasal symptoms like nasal obstruction and epistaxis to be the mostcommon symptom followed by fever, cough and deafness. Crusting, granulations and occasional perforation wereusually found on nasal examination. Conductive deafness wasmost common ear finding. History, clinical examination,ESR, C-ANCA and a representative biopsy were all essential in diagnosing this condition. Azathiopurine andcyclophosphamidewere the main chemotherapeutic agents used with prednisone to cause remission in all our patientsexcept one who died two weeks after having been admitted in our institution. Surprisingly in contrast to the normalcause of high mortality reported in international literature in this disease to be renal failure, our patient died due torespiratory failure. Four out of five patients went into remission a year after regular treatment with this regime. Themajor complications occurring during hospital stay and their treatment were nausea, vomiting, sudden fall of TLC, andoral thrush. Conclusion: The common presentation of patient with Wegner’s Granulomatosis is of upper respiratorytract symptoms like nasal obstruction and epistaxis followed by lower respiratory symptoms like cough, fever andHaemoptysis. A representative biopsy with positive C-ANCA and high ESR are hallmarks of diagnosing this condition.The most effective medical regime till today is cyclophosphamide and azathiopurine with alternate day prednisone forinducing remission.
EXCIMER LASER
Authors: MOQEET M. ABDUL , BUTT IMRAN AZAM
Published: September 2021

Objectives: To evaluate the efficacy and safety of excimer laserphotorefractive keratectomy for myopia in Pakistani people. Design: Prospective study. Setting: At Al-Shifa Trust EyeHospital Rawalpindi. Period: October, 1995 and Febrauray, 1996. Material & Methods: The study group of thirteenpatients, comprises of 25 eyes, with refractive error ranging from -1.50 to -3.50 D.S (diopters sphere) and less than-1.50 D.C (diopters cylinder).Results: Thirteen eyes (52%) lost to follow up after three months. Only twelve eyes (48%)could be reviewed at six months after photorefractive keratectomy. At one month, eleven eyes (44%) and at threemonths, eight eyes (32%) were hypermetropic within +0.25 to +1.00 diopters of spherical equivalent .At six months onlythree eyes (25%) had hypermetropia within +0.25 to +1.00 diopters spherical equivalent. None of the eyes had anykind of astigmatism more than 1.00 diopter. No over correction of more than +1.00 diopter of spherical equivalent wasobserved in any case. At one month, three months and six months after photo-refractive keratectomy, 88%, 80% and100% eyes had 6/6 visual acuity respectively, without any optical aid. Hundred percent of the eyes showed completehealing of the epithelium on third post operative day. Moderate to severe postoperative pain was experienced by everyone for three days with gradual reduction in intensity. Only one eye (8.33%) had grade 1 haze at six months. Restsof the eyes were clear .No vision threatening complications occurred. Despite the short term follow up, photorefractivekeratectomy appears to be an effective and safe procedure with good predictability for the correction of low myopia.Conclusion: Despite relatively short term follow up of the study; photo refractive keratectomy (PRK) appears to be safeand quite predictable procedure for correction of low myopia.
SYNDESMOSIS FIXATION IN BIMALLEOLAR WEBER C ANKLE FRACTURES;
Authors: RAO SAJID EJAZ , MUZAMMIL SOHAIL , KHAN ABDUL HAFEEZ
Published: September 2021

Objective: To study the influence of size of screws for syndesmosis fixationin bimalleolar Weber C ankle fracture. Design: A prospective randomised controlled clinical trial. Place and Durationof Study: Orthopaedic Department at Combined Military Hospital Malir. Period: From October 2002 to September2005. Patients and Methods: 17 consecutive young active patients with Weber type C bimalleolar ankle fractureshaving syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups.1 2 In group I (n = 9) 3.5mm small fragment and in group II (n =8) 4.5mm large fragment AO cortical screws were usedfor syndesmotic fixation. All patients were followed up for 12 months. Fracture healing or loss of reduction ofsyndesmosis was taken as the study end point. Hardware loosening or breakage and need for hardware removal werethe outcome measures. Subjective and objective assessment with Olerud-Molander Ankle (OMA) scores , range of 1motion and radiographic criteria was done. Results: Loss of reduction was not seen in any patient in both groups.Comparing two groups using paired sample t-test, there was no difference in screw loosening and breakage (p values> 0.05). We did not find a statistically significant difference between range of motion (p = 1.08) and OMA score (p-value= 0.805). Conclusion: Size of the syndesmotic screw does not appear to influence healing of syndesmotic injury.Screw loosening, which can result in reduced range of ankle motion postoperatively was more common in smallerscrew group though the difference was not significant.
VACUUM EXTRACTION AND FORCEPS DELIVERIES;
Authors: ISLAM ALIYA , KHAN AISHA HANIF , MURTAZA JAVARIA NOSHEEN
Published: September 2021

Objective: To compare the maternal and neonatal complications after instrumental deliveries.Design: Prospective study. Setting: At MH Rawalpindi. Period: Six months from April 15, 2006 to October 14, 2006.Results: Total 96 instrumental deliveries were carried out; of which 46 were ventouse and 50 were forceps deliveries.58% of forceps deliveries were carried out in nulliparous and 42% in mulitparous patients as compared to 61% ofventouse deliveries in nulliparous and 39% in multiparous patients. Fetal distress was indication in 68% of forcepsdeliveries and 61% ventouse deliveries. Prolong second stage (>1 hr) was the second commonest indication i.e., in18% of forceps deliveries and 13% of ventouse deliveries. Success rate was 90% in ventouse and 97% in forcepsdeliveries. Extension of episiotomy was more likely to occur with ventouse deliveries and third degree perineal tearoccurred more with forceps deliveries. 14 babies were admitted to NICU and 90% of them were due to meconiumstaining. There was only one intrapartum death in the ventouse delivery group and that was due to intrapartumasphyxia. Conclusion: Forceps are more likely to be used in primigravidas and less likely to fail. Most commonindication of instrumental deliveries is fetal distress followed by prolonged second stage. Cephalhaematoma andjaundice are more common in ventouse deliveries. Extension of episiotomy and low apgar score at one minute is morelikely to occur with ventouse deliveries where as third degree perineal tear and subconjuctival haemorrhage are morelikely to occur in forceps deliveries
STROKE;
Authors: AKBAR MUHAMMAD AFTAB , AWAN MONA MUNIR , HAIDER SYED AFTAB , Choudhry Ghulam Mohy-Ud-Din
Published: September 2021

Objective: (1) To finding the frequency of various electrocardiographic abnormalities in sufferers ofacute stroke (2) Comparing the ischemic and hemorrhagic stroke in this perspective. Study design: Observational.Place and duration of study: Emergency department of Nishtar Hospital, Multan from April 2003 to August 2005.Patients and methods: Two hundred patients of acute stroke who presented within 48 hours of the onset ofneurological symptoms, were included in the study, irrespective of the comorbid conditions like hypertension, diabetesmellitus, valvular heart disease, coronary artery disease and cardiomyopathy. Results: Majority of the patients hadischemic stroke. ECG changes due to variation in heart rate, rhythm ischemia, QTc prolongation and left ventricularhypertrophy were frequent findings in sufferes of acute stroke. Except atrial fibrillation and left ventricular hypertrophythese changes were more or less similar in two types of stroke. Conclusion: A variety of electrocardiographicabnormalities can be found in sufferers of acute stroke. Except atrial fibrillation and left ventricular hypertrophy, therefrequency is more or less similar whatever the type of stroke may be.
PREGNANCY RELATED ACUTE RENAL FAILURE
Authors: SHAIKH QURBAN ALI , SHAIKH NISAR AHMED , SOOMRO AKBAR ALI , Shaikh Ghulam Shabir , Shaikh Abdul Rasheed
Published: September 2021

Introduction: Acute renal failure (ARF) during pregnancy is rareevent and continues to be common in developing countries. Period: 1998-2005. Setting: Nephro-urology unit atChandka Medical College, Larkana. Study Design: Retrospective study. Patients & Methods: 294 cases of AcuteRenal Failure were treated. Among these cases, 72 (24.5%) were pregnancy related in origin. All of these patients wereknown to be previously healthy. Results: Pregnancy related Acute Renal Failure was associated with, post partumhemorrhage was in 20(27.7%), intra uterine death in 20(27.7%) antipartum hemorrhage was 18(25%), preeclampsiaeclampsia in 8(11.11%) and septic abortion and puerperal sepsis in6(8.3%). Among these patients 65(90.3%) requireddialysis therapy because of moderate to severe azotemia. 35(48.61%) patients recovered normal function. 30(46.15%)developed irreversible renal function. Conclusion: Early reorganization of this disorder, improvement of health infrastructure, antenatal health care and intensive supportive therapy, can reduce maternal and fetal mortality and morbidity.
CORONARY ARTERY ANOMALIES;
Authors: KHAN MUHAMMAD QAISER , NURI MASUD UL HASSAN , IRFAN MUHAMMAD , Raza Afsar , Abbas Shahid
Published: September 2021

Introduction: Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the generalpopulation . The incidence of various coronary anomalies and associated clinical, angiographic and hemodynamic 1findings have been cited in several internationally published clinical series . To compare our experience with 4-8previously reported studies, we have reviewed clinical and angiographic findings for 50 adult patients with coronaryartery anomalies. Patients and Methods: We surveyed the records of 5050 consecutive adult patients who hadundergone coronary angiography.Setting: Armed Forces Institute of Cardiology and National Institute of Heart Disease(AFIC/NIHD) Rawalpindi. Period: 1 Jan 2004 and 30 April 2005, and identified 50 adults with various coronary artery st thanomalies. Results: 5050 reports were reviewed and 50 (0.9%) coronary artery anomalies were identified in 50patients. Different anomalies identified are; both coronary arteries from right sinus of Valsalva (RSV)-(n = 1), bothcoronary arteries arising from the left coronary sinus (n = 4), single coronary arteries (n = 2), LCx from RSV/RCA (n=6),anterior descending artery arising from the right coronary sinus (n = 1), coronary artery fistulae (n = 4), separated originof anterior descending and left circumflex coronary arteries (n = 25), and separate origin of conus/ RV branch (n = 7).The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, and anterior in theanterior descending arteries. Conclusions: We conclude that adult congenital anomalies of the coronary arteries arenot uncommon finding in a tertiary care cardiac center. Separate origin of LAD and LCx from LSV and left circumflexcoronary artery arising from RSV/RCA are the most frequently diagnosed anomalies.
NEONATAL BILIARY ATRESIA
Authors: KIBRIA REHAN-E- , SAFDAR AQEEL
Published: September 2021

. Bilrary atresia continues to emanate controversy & despair among Physicians & patients alike. Withthe development of liver transplant and new techniques a new insight in NBA surgical care has come forth. Thiscondition is the most common cause of persistently direct (conjugated) hyper bilirubinemia in the first 03 month of life.Kasai portoenterostomy & liver transplantation battle to become todays leading therapy. The main focus of attentionhowever remains that the results after portoenterostomy are decided by the promptness of the initial workup & referralto surgery. More then 80% of babies with NBA have satisfactory bile flow after hepatic portoenterostomy if theprocedure is done before 8th week of life.
LEFT VENTRICULAR EJECTION FRACTION AFTER ACUTE MYOCARDIAL INFARCTION.
Authors: ATHER HAFIZ MUGHEES
Published: September 2021

Objective: (1). To measure and compare Left Ventricular EjectionFraction (LVEF) after acute anterior wall and inferiorwall myocardial Infarction and correlate LVEF with clinical findingsin the patients. (2) To see prevalence of Left Ventricular Failure (LVF) after AMI. Design: Prospective observationalechocardiography based study.Setting: Sheikh Zayed Hospital Lahore. Period: From 2001 to 2002. A total of 60 (sixty)patients of (anterior or inferior) Acute Myocardial infarction (AMI) were included in the study. Patients were divided intwo groups on the basis of anterior myocardial wall MI (AWMI) or inferior myocardial wall MI (IWMI). Echocardiographywas done on all cases and ejection fraction was calculated by applying Simpson’s Rule and patients were examinedat the same time to see the presence of signs of left ventricular failure (LVF). (LVEF) was correlated with the findingsof LVF in these patients. Results: In patients with LVF mean ejection fraction (EF) was 37.13 with standard deviation(SD) of 8.4 %. In patients without failure the mean EF was 56.29% with SD of 3.75. In 30 patients of IWMI, mean EFwas 54.93% with SD of 6.86. In 30 patients of AWMI it was 46.07% with SD of 11.72. In all 60 patients minimum EFwas 30% and maximum was 60% with a mean of 50.50 with SD of 10.52. In AWMI, 53% patients had signs of leftventricular failure. In patients of IWMI, 13.3% had signs of LVF. Conclusions: AWMI causes more decrease in LVEF.LVF is more commonly associated with AWMI than IWMI. There is statistically significant difference in LVEF of patientswith and without LVF.
SIALIC ACID AS A PREDICTOR OF TYPE 2 DIABETES MELLITUS
Authors: KHURSHID M. USMAN , US IBRAHIM
Published: September 2021

Inflammatory markers predict type 2 diabetes. Gestational Diabetes Mellitus(GDM) predicts type 2 diabetes. Objective: To examine the association of inflammatory markers with GDM, weinvestigated total sialic acid (TSA) in women with and without previous GDM.Design & methods:All women with GDMand a random sample of women from diabetic center of SirGanga Ram Hospital, Lahore were taken after an interview,an oral glucose tolerance test and anthropometry were performed. A total of 46 women with and 50 women withoutprevious GDM completed the protocol. Results: Mean TSA was significantly higher in women with (71.8±11.1 mg/dl)than without (67.5±9.8 mg/dl) previous GDM (P< 0.05). In a linear regression model, TSA was 4 mg/dl (P< 0.05) higherin women with previous GDM, after adjustment for BMI and fasting insulin sensitivity. In a similar model, current 2-hplasma glucose levels were associated with higher TSA levels after adjustment for waist-to-hip ratio and the log oftriglycerides. TSA was strongly correlated with individual components and aggregates (r = 0.55, P< 0.001) of themetabolic syndrome. Conclusions: Increased TSA levels are associated with previous GDM and are strongly linkedto the metabolic syndrome. These findings in young women suggest that a chronic mild systemic inflammatory responseis an early feature of the metabolic syndrome and that GDM may be a window for its investigation.
HISTORY OF THYROID SURGERY
Authors: SHUJA AWAIS
Published: September 2021

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SPILLED GALL STONE DURING LAPCHOLE;
Authors: ASSARIAN ABDOLALI , CRONIN MICHAEL , THOMAS PAUL R
Published: September 2021

Spillage of gallstones has been reported during 7% of laparoscopiccholecystectomies. When associated with infected bile, this can cause intra-abdominal abscess formation resistant tosimple drainage. In these cases laparotomy is usually indicated. We found few previous reports of percutaneousgallstone removal from the abdominal cavity, one of which used lithotripsy for stone extraction. We describe anothersuccessful case of percutaneous intra-abdominal gallstone removal using lithotripsy.
Ranking of cadmium low amount measurement systems according to economic, environmental, and functional indicators using ELECTRE analytical method
Authors: Benyamin Chahkandi , Mohammad Gheibi , Amir Takhtravan
Published: September 2021

Cadmium is one of the transition metals, known by the scientific name Cd. One of its main characteristics is the high toxicity, even in very little amounts. Cadmium is often released through industrial effluents, pesticides, chemical fertilizers, and the burning of fossil fuels. Since the presence of cadmium ions in the living organisms’ body, especially humans, can cause serious damage to the liver and pancreas, and also because its role in causing cancer has been proven, measuring very low amounts of this metal is of high importance. In the first step, this study has reviewed and analyzed common laboratory methods for measuring small amounts of cadmium. Then, according to economic, environmental, feasibility, speed, and accuracy factors, all available methods were evaluated using the ELECTRE technique. The results showed that the extraction methods using Dowex Optipore V-493 resin and extraction system in Triton X-114 surfactant, placed in the first and second positions.
Behavior evaluation of freundlich and langmuir isotherms in cadmium preconcentration using solid phase extraction method for linear and nonlinear numerical computational patterns
Authors: Benyamin Chahkandi , Mohammad Gheibi , Amir Takhtravan
Published: September 2021

Cadmium is naturally present in the mineral cadmium sulfide which is a rare form of this element and the highest amount of cadmium is obtained from the extraction process of other minerals such as lead, copper and zinc. The release of this metal into the environment leads to widespread epidemiological effects. Therefore, measuring small amounts of this metal is also of particular importance. Small amount measuring methods of this metal are such as,preconcentration using solid phase extraction system using adsorbents. The main part of the preconcentration process is achieved by adsorption processes. In this study, the behavior of Freundlich and Langmuir adsorption isotherms for the capacity of TMON and IMNM adsorbents in cadmium adsorption has been evaluated by Power and Rational statistical distributions. At the end of the study, the constant coefficients of the Freundlich and Langmuir models were compared in both linear and non-linear modes. The results showed; the linearization method for the Kf coefficient of the Freundlich isotherm can cause errors equal to 41.6% in TMON adsorbent and 39.3% in IMNM adsorbent. Also, in parameter b, errors of 66.66% are obtained in TMON adsorbent and 32.45% in IMNM adsorbent.
Investigation of snow load reduction in the industrial sheds roof design with photovoltaic systems by mathematical modelling, solar system evaluation, X-steel simulation and thermodynamic practices
Authors: Nasim Ghadami , Bita Deravian , Behzad `Deravian , Amir Takhtravan , Seyed Mohammad Khatibi , Mohammad Gheibi
Published: September 2021

Since snow load is one of the loads of designing the industrial shed roof, this research presents a new system to reduce the industrial sheds roof design. In this system, sensitive units of moisture and temperature, which can be adjusted with different areas, are installed on the shed’s roof. The mechanism of system is that the sensors in the units detect the presence of snow on the shed roof and send an order to connect electricity to the elements; therefore, the snow on the roof melts by the heat generated. In this system, solar panels are used to supply electricity. As with the help of this mechanism, snow does not remain on the roof, it is possible to eliminate the snow load in the calculations of the shed and apply at least the live load of the sixth regulation (Due to having a one-story shed, minimum live load applied and it used only for the foundation design of the structure.), this issue will create an economic plan in shed designing. According to the study conducted in this research, it is shown that the dimensions of the sheet beam used in the shed are reduced, which will significantly reduce the cost of construction and installation to some extent. In the following, two samples of sheds with a span of 20 meters in the presence of snow and the absence of snow in the software were modelled, and the results were compared with each other.