bluuebunny/crossref_metadata_2025 huggingface dataset:
ROLE OF MULTIPARITY IN BIRTH DEFECTS.
Authors: Jawad Shahbano , Haq Ikram Ul , Cheema Muhammad Rafique
Published: August 2021

Objectives: To study role of parity in the occurrence of congenital malformationsin neonates delivered at various hospitals in Lahore. Study Design: Descriptive cross sectionalstudy design was used. Setting: Muhammad Akram Teaching and Research Hospital, SocialSecurity Hospital Manga Mandi and Maternity Center at Raiwind Road, Lahore. Period: Threemonths, Jan to March 2017. Materials and Methodology: Mothers of 100 malformed neonateswere taken as sample. A questionnaire data collection tool was developed and the mothers wereinterviewed about their age, total number of children, and any history of abortion, miscarriagesand complications in pregnancy. Questionnaire was pretested before the data collection.Statistical package for social sciences (SPSS) version 20 was used for entry, compilation andanalysis of data. Results: Out of 100 subjects, 76 mothers were multiparous and 24 wereprimiparous. Out of these 76(100%) multiparous mothers, 45(59%) were above 30 years of age,21(28%) were between 18 and 30years while 10(13%) were below 18.The neonates of these76 mothers were assessed for the type of anomaly having 28(37%) GIT anomalies, while thosewith CVS, musculoskeletal, urogenital and facial defects were 15(20%), 9(12%), 18(23%) and6(8%) respectively. Conclusion: This study suggests that multiparty has an important role in thedevelopment of congenital malformations. The number of Urogenital, GIT and CVS anomalieswas significantly higher than Facial and Neural Tube defects.
CAROTID ARTERY STENOSIS
Authors: Khattak Muhammad Ishaq , Khan Faramoz , Fida Zahid , Zar Adnan
Published: August 2021

Objectives: The objective of this study is to determine the frequency of carotidartery atherosclerosis using color Doppler ultrasound in ischemic stroke patients. StudyDesign: Cross-sectional study. Period: July 2015 to June 2016. Setting: Khyber TeachingHospital, Peshawar. Method: Doppler ultrasonography was done to assess carotid artery statusin patients diagnosed with cerebral infarction. Results: Data comprised of 174 ischemic strokepatients between ages 37-95 years. 111 were males whereas 63 were males. Mean age wasfound to be 64.03±11.71 years. Doppler ultrasound revealed carotid artery atherosclerosis in52.3% (n=91) patients with 57% males and 34% females. Right carotid artery involvement wasfound in 28 patients and left carotid artery involvment in 38 patients. Both carotid arteries wereinvolved in 25 patients. Conclusion: We have concluded that carotid artery atherosclerosis is anindependent predictor for future vascular events. Our study reports carotif artery atherosclerosisin 52.3% patients with ischemic stroke.
TONSILLECTOMY;
Authors: Iqbal Muhammad , Kumar Dileep , Ansari Noor Alam
Published: August 2021

Objective: To compare the effectiveness of dissection and diathermytonsillectomy in children and adults. Study Design: Comparative, interventional study.Setting: ENT Department of Peoples University of Medical and Health Sciences (For women)Nawabshah (SBA). Period: January 2009 to December 2011. Methods: 100 Patients of bothgenders, age ranging between 6 to 35 years, divided in two equal half as groups A and Baccording to surgical procedures were included in study. In group A, Electro diathermytonsillectomy was done, while in group B dissection tonsillectomy was applied. Results: Ingroup A, Electro diathermy tonsillectomy group, postoperative moderate to severe pain, thickslough oedema referred otalgia and haemorrhage was seen. 07 Patients developed secondaryhaemorrhage while in group B postoperative mild to moderate pain was seen. Only 02 Patientsdeveloped secondary haemorrhage in group B. Conclusion: Dissection Tonsillectomy is thebest procedure in children and adults till yet.
VARICOCELE;
Authors: Abbas Muhammad Wseem , Kamal Mustafa , Murtaza Ghulam
Published: August 2021

Objectives: To compare frequency of complications in open surgery versuslaparoscopic surgical management of varicocele among adolescents at a tertiary care hospital.Study Design: Randomized controlled trial (RCT) study. Setting: Unit-I Department of GeneralSurgery, Nishtar Medical College and Hospital, Multan. Period: January 2014 to February 2015.Material and methods: Group A was managed by open surgery while group B patients hadundergone laparoscopic management. All data were analyzed by SPSS – 20. Results: A totalof 100 patients with varicocele were taken. Mean age of our study cases was 26.59 ± 5.54years. Mean duration of surgery was 33.16 ± 5.97 minutes. Mean hospital stay in our studywas 45.60 ± 12.53 minutes. Mean duration of disease was 5.31 ± 1.41 months. Of these 100study cases, 19 (19%) were obese. Post-operative complications were noted in 32 (32%) ofour study cases. Recurrence was noted in 19(19%) of our study cases, hydrocele formationin 10 (10%) and wound infection was noted in only 03 (3%) of our study cases. Conclusion:Our study results conclude that laparoscopic management of varicocele is safe, efficient, costeffective and reliable procedure. Complications are significantly less than that of open surgery.Laparoscopic management is associated with significantly less duration of surgery and shorterhospital stays than that of open surgery. By using laparoscopic technique we can decreasemorbidities among targeted population which will provide relief to the suffering families as wellas be helpful for hospital authorities in terms of short hospital stays leading to less investments.
BIOPHYSICAL PROFILE;
Authors: Zafar Sardar Alfareed , Mehdi Anjum , Noor Shagufta , Javed Naureen
Published: August 2021

Objectives: To determine the diagnostic accuracy of biophysical profile in pretermfetuses with intrauterine growth restriction for diagnosis of birth asphyxia. Study Design: Crosssectionalstudy. Settings: Department of Radiology / Obstetrics & Gynaecology FaisalabadMedical University, Faisalabad and affiliated Hospitals. Duration of Study: The study wascarried out for a period of one calendar year, 1st January, 2016 to 31st December, 2016. Material& Methods: Total 105 patients admitted through OPD and emergency fulfilling the criteria wereincluded in this study. Results: In our study, 63.81% (n=67) were between 18-30 years and36.19% (n=38) were between 31-35 years of age, mean+sd was calculated as 27.52+4.69years diagnostic accuracy of biophysical profile in preterm fetuses with intrauterine growthrestriction for diagnosis of birth asphyxia while keeping Apgar score as gold standard wasrecorded, it shows 34.29% (n=36) true positive, 7.61%(n=8) had false negative, 6.67%(n=7)false positive and 51.43%(n=54) had true negative. Sensitivity, specificity, and diagnosticaccuracy rate were calculated as 81.82% 88.52% and 85.71% respectively. Conclusion:Higher diagnostic accuracy of biophysical profile in preterm fetuses with intrauterine growthrestriction for diagnosis of birth asphyxia. It is recommended that these high risk patients mustbe screened in their antenatal period for diagnosis of birth asphyxia so that proper treatmentprotocols may be followed.
HYPERTENSIVE HEMORRHAGIC STROKE;
Authors: Rehman Fazal ur , Idrees Sikander , Hashim Muhammad , Hashmi Syed Maroof
Published: August 2021

Objectives: The aim of our study is to evaluate the use of intracranial pressuremonitoring as a predictor of neurological deterioration in patients with hemorrhagic stroke andevaluate the relationship of continuous intracranial pressure monitoring with warning signsof brain herniation and hematoma enlargement in our setup. Study Design: Randomizedcontrolled trial. Period: 02 years duration from June 2014 to June 2016. Setting: Tertiary CareHospital in Karachi Pakistan. Method: Patients in group A had continuous monitoring of theintracranial pressures by having an implant device placed under general anesthesia. Bothgroups were given the required treatment as per guideline, including blood pressure reduction,diuretic and mannitol as per requirement. Both the groups were assessed clinically after every8 hours in the initial three days and then every day till no deterioration were observed for 5 days(pupils, reflexes, extremity test etc) and a repeat CT scan was performed at 24 hours after theonset of initial stroke. While in the control group pressures were monitored using neurologicalsigns and clinical measurements, and the dose of mannitol was adjusted accordingly. Theoutcome was assessed within 1 month duration from the onset of hemorrhagic stroke, and theparameters used were hematoma progression and herniation of the brain. Results: The patientpopulation consisted of n= 100 patients, who presented to our hospital with a primary diagnosisof hemorrhagic stroke, as confirmed by CT scan. The patient population was divided into twogroups using a random number generator, group A consisted of the patients who underwentintracranial pressure monitoring and had n= 52 patients, while group B consisted of the controlgroup (no objective ICP measurement) and had n= 48 patients in the group. The incidence ofenlargement of the hematoma in group A was n= 16 (30.76%) and in the control group was n=18 (37.5%). And when it comes to brain herniation n= 6 (11.53%) patients developed it in theICP monitoring group and n= 10 (20.833%) developed it in the control group respectively. Wefound that the mortality rate in our study population was n= 4 (7.69%) in ICP monitoring groupand n= 5 (10.41%) in the control group having a p value of 0.04, the neurological outcome in thetwo groups also had statistically significant differences, having a p value of 0.03. Conclusion: Inour study we found a lower incidence of secondary brain herniation in patients who underwentcontinuous intracranial pressure monitoring as compared to control group, furthermore thesepatients had better neurological outcomes.
POST ISOMETRIC HAMSTRING STRETCHING;
Authors: Islam Farooq , Arshad Kanwal , Arif Muhammad Asim , Bashir Muhammad Salman
Published: August 2021

Objectives: Muscles and skeleton work together if any human being wants toroam around. If muscles and joint move to their full range then a free and purposeful action isachieved and goal is met for which movement was performed. If movement abnormality is seenthen its underlying cause can be tight muscle especially the hamstring in the lower extremity.Tight hamstring is quite common in normal individuals. This tightness is not desirable andneeds to be treated particularly when somebody needs to perform full range of motion withoutany difficulty. There are numerous choices to achieve this purpose. Different researchers usedifferent choices according to their own thinking. The main theme underlying this researchis to find out evidence based treatment option to treat the tight hamstring group. StudyDesign: randomized controlled trial. Place and Duration: different football clubs of Lahorefrom March 2015 to June 2015. Methodology: For this research two groups of football playerswere utilized. One group was selected for post isometric relaxation technique alone whileother group received a combination therapy containing post isometric relaxation and crossfrictional massage. Result: the p-value for the group 1 was 0.51 while for group 2 was 0.000.Conclusion: After conducting this research a conclusion was drawn that a combination ofpost isometric relaxation and cross frictional massage showed better results in releasing thetightness of hamstring than alone therapy. So a combination therapy comprising post isometricrelaxation and cross frictional massage was a better choice to treat tight hamstring.
PRE-DIABETES;
Authors: Khan Rabnawaz , Khan Sundus , Gul Sumbul , Kanwal Shamsa , Samin Ariz , Ahmed Ashfaq
Published: August 2021

Objectives: To determine the prevalence of pre diabetes in students of AyubMedical College and associated risk factors. Study Design: Prospective study. Period: Jan2016 to Jun 2016. Setting: Ayub Medical College. Materials and Methodology: 130 studentsparticipated after simple random sampling technique. Different variables were studied andinitially were entered on a pre-formed proforma and then SPSS 17.0 version were used for dataanalysis. Results: 15(11.54%) of the students were suffering from pre diabetes. Among them11(8.46%) were males while 4(3.07%) were females. 50 (38.46%) students had a positive familyhistory of diabetes whereas 80 (61.54%) had no family history. 111(85.38%) of the studentsin study were non-smokers and Only 40(30.77%) students were doing regular exercise.Conclusion: A significant prevalence of pre-diabetes in young adults is a matter of concerntherefore all young adults need to be targeted for screening of pre diabetes and lifestylemodification.
PNEMOTHORAX;
Authors: Haider Syed Aftab , Sultan Atqua , Salma Zaira , Waris Salman , Yousaf Muhammad
Published: August 2021

Objectives: To determine the incidence and outcomes of pneumothorax incritically ill patients admitted in intensive care unit (ICU). Study Design: Retrospective study.Setting: Intensive care unit of Nishtar Hospital Multan. Period: 1 July, 2016 to 31 Dec, 2016.Methods: Included analysis of 300 patients. Patients of all age groups and gender were includedin this analysis. We reviewed their clinical records regarding age, gender, incidence and type ofpneumothorax, pneumothorax episodes and its causes. Diagnosis of pneumothorax was basedon clinical examination and plain chest X-rays of patients. Results: Pneumothorax occurred onlyin 26 (8.7%) patients. Out of these 26 patients, there were 3 (1.0%) patients in whom spontaneouspneumothorax occurred and in remaining 23 (7.7%) patients pneumothorax was iatrogenic innature. There was significantly higher rate of mortality in patients who developed pneumothorax38.46%versus 3.2% in patients without pneumothorax (p-value <0.001). Duration of ICU staywas also significantly prolonged in pneumothorax patients 11.4 days versus only 6.2 daysin patients without pneumothorax (p-value <0.001). Patients with iatrogenic pneumothorax,mortality occurred in 5 (83.3%) patients in whom pneumothorax occurred due to mechanicalventilation, 1 (33.3%) in patients with central venous catheter insertion, 2 (22.3%) in patients withpericardiocentesis and 2 (40.0%) in patients with thoracentesis. Conclusion: Pneumothorax isassociated with a very high mortality and increased length of ICU stay. Mortality rate is higherin pneumothorax due to mechanical ventilation (barotrauma) as compared to other procedurerelated pneumothoraxes.
AMNIOTIC FLUID ASSESSMENT;
Authors: Ali Amjad , Shoukat Marium , Bashir Muhammad Usman , Danyal Ahmed
Published: August 2021

Objectives: To assess amniotic fluid volume in second and third trimester ofpregnancy in Pakistani population. Period: Three months. Setting: Talha ultrasound, Multan.Material and Methods: I have started my work by collecting data from the month of November,2015 to February, 2016. The machines which have been used for data collection were Xarioand Z-5 ultrasound Doppler machines with transabdominal (3.5-5MHz) probes. A group of 100Pakistani married female patients of different age groups was included. These patients werehaving normal criteria of second and third trimester (14-40 weeks gestational age). Results:100 married female patients were selected having different age group. There were no significantdifference found in the means of large pocket volume and four pocket volumes of second andthird trimester of pregnancy. Conclusion: Ultrasound plays an important role in assessment ofamniotic fluid volume. If there is one unit change in large pocket volume (LPV) than four pocketvolume (FPV) will change by 2.37 and 2.146 in second and third trimester, respectively.
ANAL FISSURE;
Authors: Bukhari Syeda Tooba , Rehman Sheikh Atiq-ur- , Abdullah Muhammad Shoaib , Bukhari Syed Talha , Iqbal Javid
Published: August 2021

Objectives: To compare the effectiveness of 2% Diltiazem ointment with 0.2%Glyceryl trinitrate ointment. Place & period: The study was conducted in surgical units,Bahawal Vicotria Hospital, Bahawalpur, Pakistan from 01-01-2016 to 31-12-2016. Material &Method: In this prospective comparative study, 160 patients with anal fissure were equally&randomly divided in two group A (received 2%diltiazem ointment) & group B (received 0.2%Glyceryl trinitrate ointment). The ointment had to be applied to anal verge twice daily for 6-8weeks. Assessment was done at 2nd, 4th & 6th weekends for fissure healing, pain relief & sideeffects. Results: Complete fissure healing was observed in 80%of patients in group A & 70% ingroup B (P<0.15). Pain response was good & was fairly similar in both the groups. Headacheoccurred in 5% in group A & 20% in group B (P<0.002). Mean time taken for healing of fissurein group A was 5.5±0.28 weeks & in group B was 5.8±0.32 weeks (P< 0.237). Recurrence ratewas 7.5% in group A & 17.5% in group B. Conclusion: Topical Diltiazem is preferred to topicalGlyceryl trinitrate in the treatment of acute & chronic fissure, because it is associated with a fewside effects.
STROKE;
Authors: Imran Mehr , Arslan Muhammad , Fiaz Muhammad Umair , Khalid Ayesha
Published: August 2021

Objectives: To determine the frequency of common factors leading to stroke inyoung local population. Study Design: It is Descriptive Cross-Sectional study. Setting: Medicalfloor, DHQ, Hospital, Faisalabad. Period of Study: 6 Months, September, 2016 to February,2017. Methodology: A total of 150 diagnosed cases of stoke between 18-40 years of age ofeither gender were enrolled in this trial. We excluded all those cases with recurrent historyof cerebrovascular accidents, space occupying lesion, head injury, hypoglycemia, transientischemic attack, CNS infection. We used CT brain showing either infarct or hemorrhage. Aftera detailed history from patient/relative including the common factors of stroke, all patientsundergoing thorough physical examination, CT/MRI Scan brain, lipid profile and fasting bloodglucose measurement to rule out the presence/absence of hypertension, smoking, Dyslipidemiaand diabetes mellitus being the common risk factors. Results: Age distribution shows 38%(n=57) were between 18-30 years while 62% (n=93) between 31-40 years, mean+sd wascalculated as 35.21+6.47 years. (Table-I) Gender distribution shows 64% (n=96) male and36% (n=54) females. (Table-II). Frequency of common factors leading to stroke in young adultsreveals hypertension in 60.67% (n=91), diabetes mellitus in 41.33% (n=62), smoking in 31.33%(n=47) and dyslipidemia in 23.33% (n=35). Conclusion: The results of the study conclude thatamong common factors hypertension, smoking, dyslipidemia and diabetes mellitus are theleading causes of stroke and these factors are modifiable and by controlling on these factors,the frequency of stroke in young adults may be avoided.
HEMORRHOIDECTOMY;
Authors: Ahmed Shibber , Ahmad Ishtiaq , Amjid Humayun , Furqan Aamir
Published: August 2021

Objectives: Is to compare outcomes in terms of mean post-operative pain andhospital stay between stapled versus conventional hemorrhoidectomy. Hypothesis: There isa difference in mean post-operative pain and hospital stay between stapled and conventionalhemorrhoidectomy, stapled technique is better than conventional technique. Study Design:Randomized control trial. Setting: Department of General Surgery Bakhtawar Amin MemorialHospital Multan. Period: February 2016 February 2017. Methodology: A total number of 60patients enrolled in the study, both genders. Statistical software SPSS ver.23 was used toanalyze the data. Mean and SD were calculated and presented for numerical variables likeduration of hemorrhoids, age and pain score while frequencies and percentage were calculatedand presented for categorical variables like ender and grade of hemorrhoids. Independent t-testand chi square test were applied to see effect modification. P value ≤0.05 was considered assignificant. Results: Total number of 60 (100%) patients in the study, 32 (53.3%) were maleand 28 (46.7 %) were female. Mean hospital stay in group A was 1.63 ± 0.71 and in groupB means duration of hospital stay was 1.73 ± 0.74. A P value was 0.001. On stratification ofdata it is concluded that in group A 9 patients have no pain 6 have mild and 6 have moderatepain and 5 patients have severe pain, similarly in group B, 3 patients have no pain 2 have mildpain 1 have moderate pain and no patient have severe pain. P value for male patients was2.65. Conclusion: This study confirms that stapled hemorrhoidectomy is associated with lesspostoperative pain with no effect of age and gender on outcome.
TETRALOGY OF FALLOT IN ADULT;
Authors: Chaudhry Abid Rafiq , Tageldeine Mohammad , Al Mesnid Abdulrahman Abdulaziz
Published: August 2021

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease inchildren but occurs rarely in adults. The extent of cyanosis depends on the balance of systemicand pulmonary vascular resistance, which depends on the severity of right ventricular outletobstruction.3 The more severe the obstruction, the more blood flows into the left side causingdesaturation and cyanosis. The survival rate of patients who receive surgical full correction isabout 86% at 32 years follow-up and 85% at 36 years follow up.
THE BETTER SURGICAL OPTION FOR CHRONIC CHOLECYSTITITS;
Authors: Ali Adan , Mahboob Akhtar , Hassan Hasnat , Chaudhry Shabbir H.
Published: August 2021

Introduction: Laparoscopic cholecystectomy is a standard and widely usedprocedure in the treatment of chronic cholecystitis for quite a long time now but there is a recentdevelopment in technique because of advent of harmonic scalpel (HS). Thus this study wasconducted with an objective to compare frequency of post-operative complications in patientsundergoing laparoscopic cholecystectomy by conventional versus harmonic technique. DataSource: Primary data based on patients presenting with chronic cholecystitis to the surgicaldepartment at tertiary care hospital. Study Design: Randomized Control Trial. Study Setting:The study was conducted in surgical unit-I, Jinnah Hospital Lahore. Duration of Study:Study was conducted in duration of one year i.e. January 2015 to December 2015. Subjects& Methods: After approval from the hospital ethical review board, 400 patients of either sexwith age from 16 to 60 years and a diagnosis of chronic cholecystitis were included usingpurposive non-probability sampling technique. They were then randomly assigned to eitherconventional or harmonic group for laparoscopic cholecystectomy using lottery method ata ratio 1:1. . Information regarding their demographic characteristics and frequency of gallbladder perforation during surgery along with readmission in patients was noted in a structuredproforma and data was analyzed using SPSS version 21.0. Results: The mean age of patientswas 48.19 ± 6.484 years with about 156 (39%) male patients while 244 patients (61%) werefemale. About 15 (7.5%) patients in harmonic group and 16 (8%) patients in conventionalgroup of laparoscopic cholecystectomy had gall bladder perforation during the procedurewhile 20 (10%) patients of harmonic group and 27 (13.5%) patients in conventional group werereadmitted. On application of chi square test it was seen that the differences were statisticallyinsignificant in both groups for the complications related to the procedure. Conclusion: It canbe concluded from this study that both treatments are equally effective in terms of gall bladderperforation and rate of readmission. Thus, any of the techniques can be selected without muchfear of complications depending upon the health care facility and financial constraints of healthsystem in a resource depleted developing country.
FIB-4 INDEX:
Authors: Shaikh Fida Hussain , Zeb Shaista , Siddiqui Kashif Aziz , Ghori Muhammad Aamir , Memon Muhammad Sadik , Zaki Madiha
Published: August 2021

Objectives: To assess the diagnostic validity of FIB-4 for predicting hepaticfibrosis in patients of chronic hepatitis C genotype 3. Study Design: Cross-sectional study.Setting: Department of Gastroenterology and Hepatology, Isra University Hospital, Hyderabadthrough convenient sampling. Period: June 2013 to June 2014. Methods: Diagnostic validity ofFIB-4 index for predicting hepatic fibrosis was determined by measuring sensitivity, specificity,positive productive, negative predictive value, and compared these parameters with liverbiopsy. The liver histology was determined by METAVIR score. Results: A total 115 patientswere enrolled with mean and SD of age was 39.6 ± 9.3 years. Dividing FIB-4 index into threecategories as <1.45, 1.45 - 3.25, and >3.25; by using the Obuchowski method the AUROC was0.93 (with 95% CI 0.91, 0.95). When dividing the FIB-4 index in to three categories as <1.45,1.45 - <2.25 and >2.25; the AUROC by using Obuchowski method was 0.87 (with 95% CI 0.83,0.91). Similarly for the diagnosis of Cirrhosis (F = 4 METAVIR) on the predictive value of thenon-invasive test FIB-4 while using Obuchowski method the AUROC was 0.85 (with 95% CI0.83, 0.87). Conclusion: The FIB-4 index is a simple, inexpensive, non-invasive, and a quicktest for predicting liver fibrosis in patients of chronic Hepatitis C genotype 3.
PULMONARY ARTERY AND AORTIC DIAMETERS;
Authors: Nasrullah Faran , Mahmood Rashid , Hameedi Shahlisa
Published: August 2021

Objectives: To measure pulmonary artery and aortic calibers, and calculatingmain pulmonary artery to ascending aorta ratio in healthy children, to verify the adult ratio of1:1. Study Design: Observational study. Place and duration of study: Radiology Department,Combined Military Hospital, Peshawar from 15 July 2015 to 14 July 2016. Methodology:Chest CT cans of 283 healthy children, with no history or predisposing causes of pulmonaryhypertension, performed between July 2015 and July 2016, were retrospectively studied.Diameters of pulmonary artery and aorta were measured on CT chest, at the level of bifurcationof the main pulmonary artery, and the ratio of pulmonary artery to ascending aorta wascalculated. Results: The average diameter of the main pulmonary artery, right pulmonary arteryand left pulmonary artery were 19 mm, 12.1 mm and 12.2 mm respectively. The diameter of theascending aorta was determined to be 12.2 mm and descending aorta was 13.67 mm. Ratio ofthe main pulmonary artery to ascending aorta was 1.06, which was higher than the adult ration,usually taken as <0.9. Conclusion: The measurement criteria devised for early detection ofpulmonary hypertension have different set of values when considering pediatric population ascompared to adults. Main pulmonary artery to ascending aorta ratio is significantly higher inhealthy children of all ages as compared to adults. CT scan is an excellent minimally invasivemodality in evaluation of the mediastinal vasculature.
OSTEOARTHRITIS OF THE HIP JOINT;
Authors: Jabbar Faisal Abdul , Shah Rehana Ali
Published: August 2021

Objectives: The aim of our study is to determine the surgical outcome andrates of complication in patients undergoing surgical treatment for osteoarthritis of the hip jointwith total hip arthroplasty and compare it with hip resurfacing procedures. Study Design: Aprospective cohort study. Period: Five years duration from January 2011 to December 2016.Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: The study populationconsisted of n= 170 patients (n= 110 patients undergoing cementless THA and n=60 patientsundergoing hip resurfacing procedures). The inclusion criteria was all the patients who came toour outpatient clinic, with unilateral or bilateral osteoarthritis (grade 3,4) of the hip joint requiringsurgical treatment, were fit for surgery and gave informed consent to participate in the study.All the procedures were done by the same team of surgeons at the same institute in seriesunder general anesthesia. Data was collected in a pre-designed proforma. Postoperatively thepatients were restricted to a reduction of weight bearing by half for the first six weeks, andwere involved in physiotherapy till discharge from the hospital. The patients from both groupsreceived the same thromboembolic and infection prophylaxis. Data was analyzed using IBMSPSS version 22. Results: In our study we found that the rates of reoperation had statisticallysignificant differences, being n= 5 in THA group and n=9 in resurfacing group having a pvalue of 0.019. In the resurfacing group n= 4 patients had fractures of the femoral neck. All therevision surgeries were undertaken utilizing the posterolateral approach, n= 2 patients wererevised utilizing cementless femoral stems while n=2 were revised utilizing cemented femoralstem, n= 5 patients were revised to total hip arthroplasty procedure on account of asepticloosening. No dislocations were observed after the revision surgical procedures. There wasno statistically significant difference in the total rates of complications among the two groups,having a p value of 0.44. The pre-operative Harris hip scores were similar in the two groupshaving a p value of 0.2. Conclusion: According to the results of our study the outcome in theboth the cementless total hip arthroplasty and hip resurfacing procedure are similar in termsof implant survival and clinical results however rate of complication is higher in the patientsundergoing hip resurfacing technique and needed revision surgeries. The patients undergoinghip resurfacing had better mobility post operatively, and hence this consideration is to be madeduring patient selection, as hip resurfacing is preferred by younger patients due to its higherfunctional outcomes.
DIABETES MELLITUS;
Authors: Ashraf Muhammad Aizaz , Shamshad Talha , Abbas Muhammad Waseem , Asghar Naveed , Bin Arshad Muhammad Umer , Shafique Nouman , Javaid Rukhsar , Mustafa Nigah e , Asghar Saira , Mushtaq Sana
Published: August 2021

Objectives: Diabetes Mellitus being a major issue faced by developingcountries like Pakistan. Non-adherence is a major issue in achieving a desired therapeuticgoal. This study aims at determining relation with the drug non-adherence associated with thetreatment regime, treatment satisfaction and educational status of the person. Study Design:This was a cross sectional study. Place and Duration: This study was done at the Diabetesclinic, Nishtar hospital, Multan. Total 242 diabetic patients were studied over a period of 10months. Methodology: The inclusion criteria was set as patients who have been diagnosedwith Diabetes Type II and had been on oral hypoglycemic medications for about last 5 monthsor more. Those patients who were diagnosed with Type I diabetes and Type II diabetesless than 5 months were not included in the study. Also those patients who were on Insulintherapy were also excluded. Socio-demographic data was obtained along with therapy typeand educational status. Drug adherence level was studied with the 8-item Morisky (MMAS-8). Treatment satisfaction was studied with the help of treatment satisfaction questionnaire formedication. The data was analyzed on the SPSS version 23 with significant p-value <0.05.Results: Among 242 patients 152(62.81%) were females and 90(37.19%) were males. Meanage of the patients were 47.68±15.13 years. Patients on combination therapy were (n=134,55.3%) and on monotherapy were (n=108, 44.6%). Mean adherence score was 5.4±1.1.Themean for four domains of Treatment Satisfaction Questionnaire for Medication(TSQM) were:effectiveness= 66.93±15.27, side effects=32.09±26.91, convenience =62.59±14.49 andsatisfaction= 65.49±16.13.Non-adherence was found to be associated with age, illiteracy,side-effects, satisfaction and convenience (p<0.05). Conclusion: Non-adherence must beovercome in patients to achieve appropriate glucose levels. Significant factors affecting theadherence levels were Illiteracy, Side effects, convenience and satisfaction of the patient. Publicawareness campaigns and regular clinic visits should be encouraged. Drugs having lower sideeffects,higher satisfaction levels and combined generics for once daily dosing having greaterconvenience should be used.
PERSISTENT BRADYCARDIA;
Authors: Abbas Shahid , Fatima Sehar , Hameed Naeem , Qasim Muhammad
Published: August 2021

Objectives: To determine the outcome in patients with bradycardia afterdiscontinuation of rate slowing drugs in terms of frequency of persistent bradycardia. StudyDesign: Descriptive study. Setting: Faisalabad Institute of Cardiology, Cardiology Department.Period: 2013-2014. Materials and Methods: Pulse and ECG were used to identify the patientsand after obtaining informed consent, total 95 patients of bradycardia were included fromemergency. Patients with persistent bradycardia were noted after 5 days of discontinuationof culprit drug. Results: Among total 95 patients, 46(48.4%) were male and 49(51.6%) werefemale. Patients with rate limiting drugs include β blockers 79(75.8%), CCBs 19(20%) anddigoxin 4(4.2%). Patients presented to hospital have sinus bradycardia 3(3.2%), 2nd degreeAV block 19(20%) and 3rd degree AV block 73(76.8%). After 5 days of discontinuation ofculprit drug, bradycardia persisted in 32(69.6%) male, 37(75.5%) female patients with sinusbradycardia persisted in 1(33.3%), 2nd degree AV block in 7(36.8%) and 3rd degree AV blockin 61(83.6%). Conclusion: In majority of patient on rate slowing drug, bradycardia persistedafter discontinuation of these drugs. Bradycardia was not truly drug induced, but it was due tounderlying conducting system disease which was unmasked by rate slowing drugs.
HYPONATREMIA;
Authors: Javid Riaz Ahmed , Ghafoor Ayesha , Ahmed Ifrah
Published: August 2021

Objectives: To find out the frequency of hyponatremia in cases of hepaticencephalopathy. Study Design: Cross-sectional study. Setting: Department of Medicine DGKhan Hospital, DG Khan. Period: July 2016 to December 2016. Material and Methods: Total80 patients with hepatic encephalopathy either male or female were selected for this study.Hyponatremia was assessed in these selected patients. Results: Mean age of the patientswas 38.34 ± 11.140 years. Hyponatremia was found in 31 (39%) patients. Hyponatremia wasnoted in 13 (41.94%) patients of age group 18-36 years and 18 (36.73%) patients of age group37-55 years. Statistically insignificant association of hyponatremia with age was seen with pvalue 0.6467. Hyponatremia was found in 21 (40.38%) male patients and 10 (35.71%) femalepatients. But the difference of frequency of hyponatremia between male and female patients wasstatistically insignificant with p value 0.8109. Conclusion: Results of this study showed a higherpercentage of hyponatremia in patients with HE. Male were more victim of HE as compared tofemale but insignificant association of hyponatremia with gender is noted. Findings of presentstudy showed that there is insignificant association of hyponatremia with grade of HE, socioeconomicstatus, area of residence and age.
FREQUENCY OF DISLIPIDEMIA.
Authors: Shani Muhammad Adrees , Ather Hafiz Mughees , Nagra Muhammad Hanif , Aamer Muhammad
Published: August 2021

Background: Lipid lowering therapy in documented Coronary artery diseaseis considered secondary prevention and lipid levels have significant influence on CAD Deathrates. Objectives: To find out the frequency of dyslipidemia in patients of ischemic heart diseasepatients and to compare the results with international studies. Study Design: A descriptive caseseries study was carried out. Setting: The study was done in Medical Unit-II and CCU of AlliedHospital Faisalabad. For 6 months from 15march 2016 to 15 September 2016. Subjects: 50patients diagnosed to have angina pectoris and ischemic heart disease patients were included.and all 50 Patients were on routine diet and were asked not to take anything overnight. Bloodsample (5cc) was taken in all 50 patients with overnight fasting and blood sample were sent toAllied Hospital Laboratory immediately for analysis of (Triglycerides, total cholesterol, LDL andHDL). Reagents used were those of: “Merck Diagnostia Germany” Triglycerides were measuredby ready to use reagent-using enzymatic splitting with lipoprotein lipase and quinoneimine asindicator. Total cholesterol, HDL and LDL were measured by “CHOD PAP METHOD” using readyto use reagents. Methods: Diagnosis was made on the basis of history, clinical examination andECG findings. The history included chest pain, palpitation, sweating and shortness of breath.Ischemic heart disease patients’. ECG criteria were ST segment depression, T-wave flatteningand inversion. All patients were subjected to fasting lipid profile. Results: Out of 50 patients,30 were males and 20 were females. The frequency of dyslipidemia was 60% in patients ofangina pectoris and ischemic heart disease patients. Triglycerides were elevated in 56 %. Malewere 40% and females 16% and P value regarding gender distribution was 0.063; significantone indicating that there is a definitive relation between gender and hypertriglyceridemia. Totalcholesterol was elevated in 20%. Males were 12% and females were 8%. And P value regardingsex distribution was 1.00. LDL was elevated in only 4%. HDL was also elevated in 4% of thecases. Conclusion: Present study concluded that dyslipidemia is common in angina pectorisand ischemic heart disease patients especially males and all patients of angina pectoris must bescreened for dyslipidemia as early as possible and should be treated aggressively to minimizethe risk of further complication of angina pectoris.
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY;
Authors: Ahmed Iftekhar , Farooq Muhammad , Qureshi Abdul Mannan , Saeed Muhammad , Rehman Sami Ur
Published: August 2021

Background: Urolithiasis is a common ailment that costs billions of Dollars everyyear. Recurrent urinary tract obstruction or urolithiasis may stimulate the fibrogenic flow, whichis responsible for the definite functional loss of renal parenchyma. In the few past years, themanagement of urinary calculi undertook a remarkable modification. Open surgery for stonesis nearly replaced by minimal or non-invasive operative procedures like ureterorenoscopy,percutaneous nephrolitholapaxy and extracorporeal shock wave lithotripsy (ESWL). StudyDesign: Randomized Controlled Trial. Setting: Department of Urology Services HospitalLahore. Duration of Study: 1st January -30th December 2016. Material and methods: Thecomparative study of 60 cases through Non probability convenient sampling was conducted toevaluate the outcome of ESWL in patients with single lithiasis of lower pole calyx with differentinfundibulopelvic angles as measured on pre-treatment IVU. Results: The mean age of all thepatients was 33.70±10.72 years. Out of 60 Patients 32(53.3%) were males while 28(46.7%)were females with 1.14 male to female ratio. In group A, the mean LIPA was 78.83±4.71o andin group B, was 100.53±5.73o. The overall mean LIPA of the patients was 89.68±12.11o.Stoneclearance was noted in 39 (65%) patients. 15 patients (38.46%) and 24 patients (61.53%) ingroup A and B respectively. p-value=0.015. After ESWL stone clearance was more in patientshaving IPA ≥ 90°as compared to IPA 70-90o. Conclusion: Stone clearance is significantlyhigher with IPA>90o as compared to IPA70-90o.In future now we are able to implement the useof IPA>90o instead of using <90o that is more successful in achieving stone clearance.
DIABETIC MOTHERS;
Authors: Chohan Muhammad Nadeem , Ahmed Imran , Dass Deve , Shamim Samina
Published: August 2021

Objectives: To compare the frequency of macrosomia and hypoglycemiain neonates born to Pre-gestational diabetic mothers having controlled versus uncontrolleddiabetes during pregnancy at Liaquat National Hospital Karachi. Study Design: DescriptiveCross-Sectional Study. Place and duration of Study: Ante-natal Clinic, Labor Room and PostNatal Unit of Pediatric Department, Liaquat National Hospital Karachi, from October 2013 toMarch 2014 over 376 neonates. Methodology: This study was carried out on 376 cases atante-natal clinic, labor room and Post-natal ward. Her pregnancy record Checked for controlof blood sugar level and brief history taken. Neonatal capillary blood taken at 30 minutes afterbirth to check the blood glucose level. Neonatal birth weight taken immediately after birth andplotted on growth chart for the assessment of macrosomia. Results: Mean age of the patientswas 35.37 years, male prevalence was found higher, and that is 57.40%. Mean gestationalage was 37.22 weeks. Mean duration of diabetes was 3.77 years. There were 57.70 patientswith controlled diabetes. Frequency of hypoglycemia was found in 21.50% patients, whilemacrosomia was found in 36.20% patients. Conclusion: The frequency of hypoglycemia andmacrosomia in infants of diabetic mother was 21.5% and 36.50% respectively. There was asignificant difference in the frequency of macrosomia and hypoglycemia in infants of diabeticmothers among well controlled versus uncontrolled diabetics.
POLYHYDRAMNIOS;
Authors: Qadir Maimoona , Amir Sohail
Published: August 2021

Background: Polyhydramnios is an obstetrical condition associated withsignificant perinatal and maternal morbidity and mortality. Although it is uncommon conditionbut a source of much discomfort to the patient. Objectives: To determine the maternal andfetal outcome of Polyhydramnios. Study Design: Descriptive cross sectional study. Setting:Gynaecology and Obstetrics Department of Khyber Teaching Hospital, Peshawar. Period: 1stJanuary 2016 to 31st December 2016. Methodology: All the cases diagnosed as polyhydramniosaccording to amniotic fluid index in four pockets, in women of any age or parity after 20 weeksgestation were included. Results: Incidence of polyhydramnios was 1.8%.170(61%) caseswere in age range of 31- 40 years and 137(49%) were multigravidas. 162(58%) cases had mildpolyhydramnios. Pre ecclampsia was the commonest maternal condition associated in 42(15%)cases followed by anemia in 39(13.97%) and diabetes in 28(10%) cases. Complications thatoccurred as a result were preterm labor in 33(11.8%), premature rupture of membranes in28(10%) and malpresentation in 22(7.88%) cases. Commonest fetal congenital anomaly wasanencephaly in 36(13%), hydrocephaly in 15(5.3%) and cleft lip and palate in 13(4.6%) cases.Out of 279 feti, 42(15%) were intrauterine deaths and 28(10%) were stillborns. Conclusion:Early diagnosis, timely referral, termination if needed and good management in labor toavoid complications are keys to deal with a polyhydramnios patient. Antenatal care should beemphasized amongst the women and families.
SURGICAL SITE INFECTION;
Authors: Hussain Syed Muhammad Asar , Janjua Saadat Ali , Fareed Amna , Ahmad Asrar , Saleem Irum
Published: August 2021

Objectives: To compare the frequency of surgical site infection after primaryand delayed primary wound closure in dirty abdominal wounds. Study Design: Randomizedcontrolled trial. Duration and Setting: This study was carried out over a period of six monthsfrom 07-02-2014 to 06-08-2014 in the department of surgery combined military hospital Quetta.Methodology: A total of 190 patients were included in this study. wound was observed fordevelopment of surgical site infection post operatively within seven days by the assignedinvestigator who was unaware of the wound study design. surgical site infection was assessedusing Southampton wound grading. Results: Mean age of the patients was 30.89±10.38 and32.74±9.52 in group A and B, respectively. in group-A, 73 patients (76.8%) and in group-B 66patients (69.5%) were male while 22 patients (23.2%) of group-A and 29 patients (30.5%) ingroup-B were female.in group-A surgical site infection was observed in 29 patients (30.5%)and in group-B 12 patients (12.6%) were having surgical site infection. statistically significantdifference was found between two groups (p=0.003). Conclusion: The frequency of surgicalsite infection was significantly lower after delayed primary closure of dirty wounds as comparedto primary closure.
CARDAIC SURGERY;
Authors: Hashmi Junaid Zia , Hashmi Kanza Zia , Zaheer Faisal , Hussain Zaigham , Mustafa Kashif
Published: August 2021

Objectives: To identify the risk factors of delayed extubation after cardiac surgery.Study Design: Observational study. Setting: Cardiac surgery in CPE Institute of Cardiology.Period: 2 months from November-2016 to March-2017. Methods: Eighty-one (81) patients whounderwent cardiac surgery. In ICU we recorded extubation time of all patients. Patients withextubation time <6 hours after labelled as early extubation group and those with extubationtime >6 hours were labelled as delayed extubation group. We recorded their preoperative riskfactors and operative variables of surgery to identify the risk factors that leads to late extubationafter cardiac surgery (CS). Results: Prevalence of diabetes was significantly high in patientswith delayed extubation. There were 42.3% diabetic patients with delayed extubation and only12.7% diabetic patients with early extubation (p-value 0.003). Total pump time, cross clamptime and type of operation were similar between the groups. Cardiovascular instability wasthe most common cause of delayed extubation that occurred in 9 patients, reduced level ofconsciousness in 9 patients, post-op bleeding in 6 patients, while hypoxemia and increasedrespiratory rate occurred in 1, 1 patient respectively. Conclusion: Diabetes Mellitus is anindependent risk factor of delayed extubation after cardiac surgery. Cardiovascular instability,reduced level of consciousness and post-operative bleeding after surgery are the main factorsthat leads to delayed extubation after CS.
PREVALENCE OF BLEEDING GUMS;
Authors: Akram Ruksana , Khan Mian Azizullah
Published: August 2021

Objectives: To evaluate the prevalence of bleeding gums in association withoral health practices. Study Design: Descriptive cross sectional. Setting: Main DiagnosticDepartment NID, Multan, Pakistan. Materials and Methods: Period: 1st January 2017 to 31stMarch 2017. 1000 patients of either gender or age who came to main diagnostic department,NID, Multan, Pakistan for treatment purpose. A Questionnaire was designed. After gettingconsent, questions were asked and clinical examination was done to assess the frequency,accuracy of brushing technique, prevalence of calculus deposition and bleeding gums. Patientswere asked about the devices they used for oral Hygiene practices. Result: Result showed thatout of total sample 92.3% of patients were Brushing. 90% of them were using improper Brushingtechnique. 81.4% showed calculus deposits and 40.6% bleeding gums. Higher prevalence ofbleeding gums and calculus deposits were in 26-30years old age groups and 21-25 years oldindividuals respectively. 92% of the patient with bleeding gums had associated calculus.98%of patients with bleeding gums had improper brushing technique.98% of the patients withcalculus had improper brushing technique.1.2% of the patients were flossing. Conclusion:Improper brushing technique is the main factor for calculus deposits that is the leading causefor bleeding gums.
HUMERAL DIAPHYSEAL FRACTURE;
Authors: Sarwar Farhan , Saeed Hafiz Salman , Iqbal Sajjad , Fayyaz Iqra
Published: August 2021

Objectives: To determine the outcome of close reduction and conservativemanagement in closed humeral diaphyseal fracture in terms of normal union and delayedunion. Study design: Descriptive case series. Setting: Orthopedic Department of Allied andDHQ Hospital Faisalabad. Duration of study: 15th December 2012 to 15th December 2014.Material & Methods: 170 patients with mean age of 36.68 ± 14.16 including 98 (57.6%)males and 72 (42.4%) females falling in inclusion criteria were managed conservatively withthe technique i.e. application of u-shaped plaster slab initially for 3 weeks then replaced byhumeral brace (Sarmiento) uptil 12 weeks. Results: 170 patients with mean age of 36.68 ±14.16 including 98 (57.6%) males and 72 (42.4%) female patient. Simple transverse fractureswere 103 (66.47%), spiral fractures 31 (18.23%) and oblique fractures 36 (15.30%). Unionwas achieved in 158 patients (92.94%), 12 patients (7.05%) progress to delayed union. Meanhealing time was 10 weeks ± 1.81 with a range of 7 to 15 weeks. Conclusion: When choosingconservative methods close reduction and conservative management initially with u-slab ofplaster of paris later replaced by humeral brace (Sarmiento) is the treatment of choice becauseof low complication but very high success rates.