bluuebunny/crossref_metadata_2025 huggingface dataset:
ANEMIA IN PREGNANCY
Authors: TASEER IJAZ-UL-HAQUE , SAFDAR SOHAIL , MIRBAHAR AHSANULLAH , AWAN ZARA
Published: September 2021

Objective: To see frequency of anemia and its related risk factors in pregnant women in an under developed area of Southern Punjab. Study design: Descriptive study. Setting: Ante natal outpatient clinic Tehsil Headquarter Hospital Kabirwala (Khanewal). Duration of the study: October2006 to March 2007. Sampling technique: Non-probability purposive. Methodology: Two hundred and fifty pregnant ladies attending ante natal outpatient clinic at Tehsil Headquarter Hospital Kabirwala (Khanewal) irrespective of reproductive age, socio economic, educational and residential status were included in this study. After taking consent a pre-designed proforma was filled in. Hemoglobin level was checked. Subjects were categorized according to the hemoglobin levels into mild (10.0-10.9 g /dl), moderate (8.0-9.9 g/dl) and severe (< 8.0 g/dl) anemia. Results: Two hundred and fifty pregnant women were studied. Mean age of the pregnant women was 28.28 ± 5.20 years. Out of these 250 pregnant women, 138 (55.2%) were anemic and out of these 83 (60.14 %) were moderately anemic while 55 (39.86 %) had mild anemia and none of these had sever anemia. Among participating pregnant women, 28 (11.2 %) were in 1st trimester, 85 (34 %) in 2nd trimester and 137 (54.8%) were in the 3rd trimester. Anemia was observed in 10 (35.71 %) women in first trimester, 35 (41.18%) in 2nd trimester and 93 (67.88 %) in 3rd trimester. One hundred and thirty two women were from rural background, out of these, 83 (62.88%) were anemic. Seventy were uneducated and out of these, 58 (82.88%) were anemic while 180 women were educated and of these 81 (45 %) were anemic. Ninety five (38 %) were having poor dietary habits and out of these, 78 (82.10 %) were anemic. One hundred eight pregnant ladies were not taking any iron supplement, out these 83 (76.85 %) were anemic while 142 (56.8 %) pregnant ladies were taking iron supplements, out of these 55 (38.73 %) were anemic. Twenty one pregnant women were with gravida more than 6 and out of these 19 (90.47 %) were anemic, of these 11 (57.89 %) had moderate anemia while 8 (42.10 %) were mildly anemic. Conclusions: The results of present study showed high frequency of anemia in the targeted population. Anemia was related with poor dietary habits especially poor iron intake. Anemia was more related with multi gravidity.
PREGNANCY
Authors: AKHTAR AMBREEN , TALIB WASEEM
Published: September 2021

Aims and Objectives: To evaluate whether serial monitoring of fetuses beyond 40 weeks with biophysical profile and non-stress test improves the fetal outcome in terms of morbidity and mortality determined by APGAR score at 5 minutes, presence of meconium in liquor, weight of baby and admission of neonate in nursery and to compare the maternal morbidity associated with prolonged pregnancy, labour induction and mode of delivery in the study and control group. Materials and Methods: It is a prospective controlled study conducted in the department of obstetrics and gynaecology Ghurki Trust Teaching Hospital, Lahore from 1st September 2007 to 31st August 2009. 200 patients at 40 weeks of pregnancy matching the inclusion criteria were enrolled for the study. They were divided into a study and a control group consisting of 100 patients each. Patients in the study group were subjected to fetal monitoring in the form of cardiotocography (CTG) and biophysical profile (BPP) while those in the control group were evaluated clinically and by kick count chart (KCC). The outcome of the two groups beyond 40 weeks was compared with each other. Results: The percentage of patients reaching 42 weeks was 4 in each group. The rest went into spontaneous labour, were induced or had emergency caesarean sections due to various reasons. The difference between the rest of the parameters like maternal morbidity, mode of delivery, fetal APGAR score and admission in neonatal intensive care unit (NICU) between the two groups were not statistically different. Conclusions: After 40 weeks of gestation fetal monitoring should be started with proper counseling of the patient, clinical assessment and fetal kick chart. NST and biophysical profile should be used selectively in patients with sluggish fetal movement or suspected reduced liquor clinically. All patients who reach 42 weeks must be induced.
BREAST FEEDING
Authors: ISLAM ALIYA , KHAN NUSRAT AJAB , NAILA USMA
Published: September 2021

Objective: To study the causative factors responsible for avoidance of Breast Feeding in post-partum women attending the post-natal OPD in MH Rawalpindi. Design: Comparative cross sectional study. Setting: Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from all the Pakistan dealing with other ranks of Pak Army. Duration: Nine months (From 01.01.2007 to 1.10.2007). Materials and Methods: Study was done on 1000 patients at post-natal Gynae OPD. Patients were divided into two groups of 500 each. Those patients who were exclusively breast feeding their babies were included in group-II while group-I included those patients who were not breast feeding their babies at all. Patients demographic data was entered on questionnaire and factors involved were interpreted. The most important causative factor responsible for avoidance of breast feeding in group-I were noted down. The mothers in group-II were enquired about that problem. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. Results: The study showed that as compared to group-II causative factors involved in avoidance of breast feeding in group-I were pain at operated site 148, working women 38, Sick baby 26,Cracked nipples and mastitis 59, Breast abscess 4, Social Myths 58, Multiple Births 2, Inverted Nipples 5 and failure of proper counseling 160. Conclusions: Most of the factors responsible for avoidance of breast feeding are preventable and treatable. General population should be educated regarding the benefits of breast feeding in the mother and baby. Thus reducing mortality rate in woman and infants.
PRIMARY POSTPARTUM HEMORRHAGE
Authors: ZAMAN BUSHRA SHER , SHER-UZ-ZAMAN MUHAMMAD , SIDDIQUE SUMERA
Published: September 2021

Objective: It is to compare efficacy of Oral Misoprostol with intravenous oxytocin in the management of primary post partum hemorrhage. Design: Quasi experimental study. Place and Duration of Study: Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 1st December, 2006 to 1st December, 2007. Patients and Method: The study was conducted on 90 patients who went into post partum hemorrhage during the study period. Cases were divided into two groups each having 45 patients fulfilling the inclusion criteria. Group ‘A’ had those who received oral misoprostol 600μg and group ‘B’ those who received 5 UNITS intravenous oxytocin. The variables analyzed were failure of drug, time taken to control bleeding and side effects of drugs. Students t-test was used for comparison between means and chi-square test for comparison between percentages. Significance was taken at P<0.05. Results: It was noted that failure rate of oral misoprostol was 11.1% and that of oxytocin was 22.2%. Mean time taken to control bleeding by misoprostol was 16.6 minutes and 1.311 minutes by intravenous oxytocin. Side effects was observed in 35.5% cases of misoprostol group and 2.22% cases of oxytocin group. Conclusion: The time taken to control bleeding and side effect profile is more better in intravenous oxytocin as compared to oral misoprostol in the menagemnt of primary postpartum hemorrhage, but number of patients responded to oral misoprostol are more, so it can be used as in combination of oxytocin where oxytocin alone failed to work.
HYSTERECTOMIES
Authors: NISA QAMAR-UR- , ULLAH HABIB , SHAIKH TANWEER AHMED , Hemlata Miss , Memon Fatima , Memon Zehra
Published: September 2021

Objective: To audit indications and histopathological diagnosis of hysterectomies performed at Muhammad Medical College hospital, Mirpurkhas. Study Design: Retrospective study. Place and Duration of Study: Department of Obstetrics and Gynaecology and Department of Pathology, Muhammad Medical College Hospital, Mirpurkhas Sindh from January to December 2008. Methodology: Data regarding symptoms and indications of hysterectomies performed during this year were collected from files and patient records. Histopathological reports of those patients were collected from department of pathology. The results were analyzed by percentages. Results: A total of 145 hysterectomies were performed in 2008. Mean age of patients was 45years ranging from 35-60 years and parity ranges from 4 – 10. Most common presenting complaints were excessive menstrual blood loss in 97(67%) patients, followed by some thing coming out of vagina 28(19%). Most common pre-operative diagnosis of fibroid was made in 44 (33%) followed by uterovaginal prolapse in 28(19%) and dysfunctional uterine bleeding (DUB) in 18(12%) of patients. Regarding histopathological diagnosis chronic cervicitis was the most commonly diagnosed pathology in 45 (31%) followed by fibroid in 25(17%) cases. Conclusions: A yearly audit should be conducted in every institute to collect data and to analyze the pattern of indication and lesions found on histopathological examination.
HEPATITIS 'B' AND 'C'
Authors: IQBAL MUHAMMAD ZAFAR , AZEEM MUHAMMAD , MALIK MUHAMMAD RAZZAQ
Published: September 2021

Background: Hepatitis B and C is a global problem. The prevalence of hepatitis B and C in orthopedic patients is quite high with the common risk factors: previous history of surgery or blood transfusion. Objectives: The objectives of this study were to, "Find out the prevalence of Hepatitis B and C and their risk factors in patients admitted in Orthopedic Unit of Sheikh Zayed Medical College Hospital Rahim Yar Khan.”. Design & Duration: This was a prospective cohort study. The duration was from July 2009 to December 2009. Patients and Methods: This study was conducted in Orthopedic Department of Sheikh Zayed Medical College Hospital Rahim Yar Khan. Patients of either sex and of all ages who were undergoing orthopedic surgery were included in the study. All patients underwent screening for Hepatitis-B and Hepatitis-C and confirmed by Elisa method in positive patients. Data regarding age, sex, HBV, HCV was noted and analyzed by SPSS version 14. Results: Among 745 patients. 581 (77.98%) were male and 164 (22.02%) were female. Hepatitis B and C was present in 165 (22.15) patients. Out of these positive cases 125 (75.76%) were suffering from hepatitis C and 36 (21.81%) were suffering from hepatitis B, and 4 (2.43%) patients were positive for both HBV & HCV. Among the predisposing factors previous history of surgery was positive in 39 patients; history of blood transfusion in 27 patients, dental procedure was in 17 patients’ and 123 patients having injection therapy in the past. Conclusions: All the patients who need surgery should be properly screened for HBV and HCV. It is also necessary that separate operation theaters and instruments should be used for HBV and HCV positive cases.
HYPOGLYCEMIA
Authors: SANDHU GHAZANFAR ALI , RANA MOHAMMAD MOHSIN , BASHIR M. BADAR , Akthar Saeed , Rehman Abedur
Published: September 2021

Hypoglycemic symptoms are a very common experience for diabetics ranging from an innocent increased appetite to dreadful unconsciousness. This study was designed to assess the patient’s awareness about the symptoms, experience of individual symptoms and their ability to recognize and to respond accordingly. Materials and Methods: All diabetic patients were assessed for the awareness of different symptoms of hypoglycemia, their experience of individual symptoms in last six months and ability of the patient and family members to recognize and to respond accordingly to these symptoms on a prescribed proforma with the help of trained staff. Results: We had 1260 new cases of DM during the study period with valid diagnosis and taking either sulphonylurea or Insulin who were enrolled in the study. 280 patients had no idea of the symptoms. 564 patients knew no more than three symptoms. Palpitation and sweating were the most commonly known 80% and experienced 65% symptoms. Hunger and epigastric discomfort were the next best known 73% and experienced 58% symptoms. Loss of consciousness was the next in the list in terms of knowledge 52% and experience 23%. Coldness of body 28%, severe weakness 24%, blurred vision 12%, abnormal behavior 12% and altered consciousness 6% were the next in the list of experience. Early morning headache, night terror and frequent awakening were the least known 3% and recognized1% symptoms. Abnormal behavior and altered consciousness were not known to any patient as a symptom. Of those who knew or experienced the symptoms, eating anything available was the most common response, only 35% responded by eating rapidly available food items like sugar, honey, candies, beverages, fruit juice or jams. 3% of patients even resorted to taking diet colas initially and only later took other food after waiting for some time. In the event of patient getting unconscious, 80% of the times attendants did not consider hypoglycemia initially at home at first such experience. Discussion: Patient must be properly educated about these symptoms before prescribing these agents and shall be repeatedly evaluated at each visit. Failing to recognize early and mild symptoms may lead to a terrifying experience.
THYROGLOSSAL SINUS
Authors: SAEED MUHAMMAD
Published: September 2021

Objective: To assess demographic and anatomical features of thyroglossal sinus. Design: Descriptive. Setting: ENT department Allied Hospital Faisalabad. Period: From Jan 2005 to June 2010. Material and Methods: The patients were admitted through ENT out patient department. The data was collected on the basis of history, physical examination, investigations, management and follow up. Results: Total 60 patients 35 males (58%) and 25 females (42%). The majority of patients were from second decade of life 28 (47%). The most common location of thyroglossal sinus was thyrohyoid 55 (92%). The etiology of of thyroglossal sinus in majority of cases was iatrogenic 50 (83%). The common clinical presentation was discharging sinus in the neck 60 (100%). The histological diagnosis in all the cases was benign 60 (100%).All the patients were managed by Sistrunks operation 60 (100%).The recurrence was seen in 4 cases (07%). The incidence of thyroid carcinoma was 00%. Overall success rate was 93%. Conclusions: The prevalence of thyroglossal sinus is quite considerable. The majority of cases are iatrogenic which means that more awareness is required about diagnosis and proper management of thyroglossal cyst. The incision and drainage of thyroglossal cyst should be avoided to prevent the development of thyroglossal sinus. In all the cases the specimen should be sent for histopathology to rule out the thyroid carcinoma.
APPENDECTOMY
Authors: ALI ZULFIQAR , AHMAD TANVEER , AHMAD IRSHAD , Amir Muhammad Suhail , Rehan AG
Published: September 2021

Objective: The aim of this study was to compare the outcomes and morbidities of laparoscopic appendicectomy (LA) and open appendicectomy (OA) in patients with acute appendicitis. Design: Interventional study. Setting: The study was conducted at Madina Teaching Hospital, University Medical & Dental College, Faisalabad. Period: From June 2007 to August 2009. Materials and Methods: The study group consisted of two hundred patients suffering from acute appendicitis. One hundred patients underwent LA and one hundred patients underwent OA. Comparison was based on operating time, complications, requirements for postoperative analgesia, time until resumption to regular diet, hospital stay, and return to full activity in days. Comparisons were made between continuous variables using Student’s t test of the means and were made between proportions using Fischer’s exact or chi-square testing where appropriate. Statistical significance was taken to be a p value of .05 or less. Results: Of the hundred patients, five patients (5%) had the procedure converted to open surgery. The rate of infection was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (2 days after LA, 5 days after OA, P < 0.05) than after OA. The operating time was shorter {OA: 25 min (median), LA: 30 min (median), P > .05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. Conclusion: LA is associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.
MORPHOLOGY OF GRAFTED TENDON
Authors: JAFRI SHAHZADA M.H , QADRI ANJUM ANWAR , SHAHZAD KHUBAIB , Bukhari Mulazim Hussain
Published: September 2021

This is the first research done to explore the morphologic changes in two stage tendon grafting as compared to one stage tendon grafting. AIMS: To compare morphology of grafted tendons with and with out first stage silicon rubber rod implantation. STUDY DESIGN: Comparative experimental study. PERIOD: 1994-2007. MATERIAL AND METHODS: 30 patients were included in this study. They was divided into 3 groups. Group 1 underwent 2 stage tendon grafting group 3 was used as control morphological study of tendons. RESULTS: Group 1 (1-stage) tendon grafting showed degeneration and fibrous reaction as morphological changes. Group 2. (2 Stage) appeared as normal tendons morphologically. CONCLUSION: This study concludes that instead of direct tendon grafting, two stage tendon grafting is recommended.
GALLBLADDER CARCINOMA;
Authors: KHAN AHMAD HASSAN , GORAYA SAIFULLAH , RASHID HAROON-UR-
Published: September 2021

Objective: Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. A suspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Design: Descriptive study. Place & Duration of study: District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. Patients & Methods: 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. Results: A total of 200 cases were studied (161 females, 39 males; M: F ratio 1:4). The mean age was 45 years (range 28-74 years). The most common presenting complaint was pain right hypochondrium with nausea and vomiting (85%).The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients (1%), Wound Infection in 3 patients (1.5%) and death in one case (0.5%). The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Conclusions: Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols.
PERFORATED PEPTIC ULCER
Authors: KHAN SIKANDER HAYAT , INAM UL HAQ MIRZA , AZIZ SHAHZAD AKHTAR
Published: September 2021

Objectives: To evaluate the epidemiology of peptic ulcer perforation in Armed Forces and further management / outcome of the patients. Methods: Data of 36 patients with perforated peptic ulcer collected. This data was analyzed on SPSS 13. Period and Setting: CMH Rawalpindi from Jan 1979 to July 1981, Jan 1985 to Dec 1987 and Jan 2001 to Dec 2003. Results: Out of 36 patients 35 were male and only one was female. Twenty four (67%) were between 31-50 years. No past history was taken from eight (22%) patients. Thirty four (94%) patients presented with duodenal perforation. Twenty patients (55%) had rigidity all over abdomen and peristalsis were present in ten (28%) patients who reported within twelve hours. Seventy eight (78%) were diagnosed by history and simple radiological examination. All the patients were treated by laparotomy (simple closure with omental patch). Post operative complications occur in ten (28%) patients and mortality rate was 8%. Conclusion: Predominantly the peptic ulcer perforation occurs between 30-50 years of age. The incidence reduces with succeeding years of study. Post operative complications were less in younger age group .Early diagnosis can be made easily by taking good history and performing simple radiological examination.
SUPRATROCHLEAR FORAMEN
Authors: MAHAJAN ANUPAMA
Published: September 2021

Introduction: The knowledge of the presence of STF in a humerus may be important for preoperative planning for treatment of supracondylar fractures. Objectives: Focused on the STF which is an important variation in the distal end of the humerus. Material and Method: The material consisted of 100 humeri of known sex taken from the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. 36 pairs of male humeri and 14 pairs of female humeri were taken. Results: The supracondylar foramen is seen in 26% of total humeri. It was present more in the females as compared to males and more frequently on the left side than on the right side. The translucent septum is found more frequently in the males than in females and more frequently on the right side than the left side. Conclusions: The anatomical knowledge of STF may be beneficial for anthropologists, orthopaedic surgeons, and radiologists in day-to-day clinical practice.
LATERAL EPICONDYLITIS
Authors: CHOUDHARY KHAULA ASHRAF , RATHORE M. FAROOQ AZAM , HANIF SAQUIB , RASHID MAQSOOD UL HASAN
Published: September 2021

Objectives: To find out effectiveness of steroid injection for early management of lateral epicondylitis. Data Source: One hundred and twenty Patients of both genders presenting with unilateral lateral epicondylitis of less than two weeks duration reporting at Outpatient Department at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi. Design of Study: Quasi experimental study. Setting: Out patient department of Armed Forces Institute of Rehabilitation Medicine, which is the largest rehabilitation facility in the country at present offering a multidisciplinary approach in the management of disability and musculoskeletal disorders17. Period: 01 yrs. Results: Both groups had sixty cases each with a mean age of 35.1 ± 6.22 and 36.08 ± 5.98 respectively. There were 54(45 %) males and 66(55%) females. At four weeks and three months follow up assessments there was significant improvement in pain relief and pain free grip strength in the Group A(steroids) as compared to Group B (NSAIDs). Conclusions: Local steroid injection is an effective treatment with an advantage over nonsteroidal anti-inflammatory drugs (Diclofenac). It results in a rapid and better relief of symptoms, which is sustained over a period of three months.
SERUM MAGNESIUM AND HYPERTENSION
Authors: MAHERI WALI MUHAMMAD , ISHAQ MUHAMMAD , AKHUND ISRAR AHMED , Sabir Muhammad
Published: September 2021

Background: Despite advances in the prevention and treatment of hypertension over the past decade, hypertension remains an important public health challenge. Recent efforts to reduce the prevalence of hypertension have been focused on non-pharmacologic means, specifically diet. An increased intake of magnesium has been shown in some but not all studies to reduce blood pressure in patients with hypertension. Decreased Serum magnesium levels are associated with development of hypertension. Aims: This study was planned to investigate relation of serum magnesium with blood pressure in patients with mild uncomplicated hypertension. Subjects & Methods: Study was conducted at LUMHS hospital Jamshoro and DHQ hospital charsadda for the period of six months. Fifty known cases of uncomplicated mild hypertensive patients were selected, same number of healthy controls were also examined. Results: When results were summed up and test parameters were compared, it was seen that no significant differences were found in serum magnesium levels among both groups, when compared statistically. Conclusion: Finally we conclude that no relation of magnesium with hypertension was observed. Suggestions: Much more work on wide scale population may be needed to clarify the idea.
PARANASAL SINUSES AND NASAL CAVITY
Authors: MALIK TAYYABA GUL , FAROOQ KHALID , RASHID ANJUM
Published: September 2021

Objectives: To describe the clinical and neuro-radiological patterns of orbital invasion by the sino-nasal diseases. Study Design: Descriptive, Retrospective study. Period: 2004 to 2009. Subjects and Methods: We retrospectively reviewed fifty four cases of nasal and paranasal sinus diseases invading the orbit. The medical charts were analyzed. The data considered for the study was age, sex, ocular presentation and associated systemic problems of the patients. The neuro-radiological results were correlated with the clinical picture. Results: The age range was from 6 to 85 years (mean 45.5). Male to female ratio was 3.5: 1. The initial clinical presentation was Proptosis (66.66%), disturbance of vision (25.9%), ophthalmoplegia (11.11%), diplopia (9.26%) and ptosis (9.26%). 79.63% patients had inflammatory etiology and 20.4% had neoplastic lesions in the nasal and paranasal sinuses extending into the orbit.
CARCINOMA CAECUM
Authors: TUNIO MUTAHIR ALI , RAFI MANSOOR , HASHMI ALTAF HUSSAIN
Published: September 2021

Most of patients with colorectal carcinoma end up with colostomies and ileostomies. Different complications are described pertinent to ileostomies. We are presenting a very rare presentation of ileostomy, the metastasis from mucinous adenocarcinoma of caecum, without ileostomy dysfunction, local bleeding as presenting complaint along with a ileostomy growth.
LISTERIA PERITONITIS
Authors: AZIZ FAHAD , PENUPOLU SUDHEER , DODI SUJATHA , Grigoriu Adriana
Published: September 2021

One case of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients is reported. In our case, the listeris was isolated from ascites from the asictic fluid. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The sulfamethoxazole trimethoprim is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.
BREAST FEEDING
Authors: KAZMI TAHSEEN , SHAH BEENISH , HAQ MASOOD UL , Husain Syed Shahjee , Zehra Tabbasum
Published: September 2021

Introduction: Breast feeding provides complete and balanced nutrition to the baby. The survey done in 1995 by health ministry, Pakistan reported that although 94 % of the children were ever breastfed, only less than 16 % of the children were exclusively breastfed. Objective: To assess the knowledge, attitude and practices regarding breastfeeding among undergraduate students of medical colleges of Karachi. Materials and Methods: Data Source: Female medical students from Clinical and preclinical years. Study Design: Cross sectional study. Setting: Liaquat National Medical College (LNMC) and Sir Syed College of Medical Sciences (SSCMS), Karachi. Period of study: 3 months. Material and Methods: Total 222 female students filled a multiple choice semi-structured questionnaire. Results: Out of total 222 female students 32.9% were in pre-clinical group while 67.1% were in clinical group. It was observed that educational level of the student was strongly associated with the knowledge regarding initiation of breastfeeding and age till which exclusive breastfeeding should be continued (p=0.000). Clinical group had more knowledge regarding colostrums as compare to the pre-clinical group (p=0.000). Conclusions: A significant difference was found between preclinical and clinical students regarding the knowledge of breastfeeding. In this study most students were from clinical level of undergraduate medical education which made them more aware regarding the significance of breastfeeding.
PRETERM LABOUR
Authors: WAHEED AFIFA , SHAMI NABEELA
Published: September 2021

Objective: To determine the effectiveness of transdermal patch of glyceryl trinitrate as tocolytic agent. Study design: Interventional- Quasi experimental study. Setting: Department of Obstetrics and Gynecology Unit- 1, Services hospital, Lahore. Duration with dates: One year (February 10, 2006 – February 10, 2007). Sample size: Fifty pregnant women with preterm labour were included in the study. Results: 54% of pregnant women were between G2 – G4. Majority (48%) of the women presented between 31 – 34 weeks of gestation. 46% of pregnant women had bishop score of 4 or more. 64% of patients found to have no risk factor for preterm labour. Majority (86%) responded after application of second patch (10 mg glyceryl trinitrate patch). 84% had no side effects. Local skin reaction (10%) and headache (4%) observed in few patients. 58% of pregnant women delivered after 48 hours and 78% of them delivered vaginally which was statically significant and majority of babies delivered weight more than 1.5 kg and with good Apgar score. Conclusions: It is concluded from the study that glyceryl trinitrate is a safer tocolytic, which has simple method of application; rapid onset of action with low cost, low risk from side effects and it does not require intensive monitoring.
INDUCTION OF LABOUR
Authors: NASREEN GHAZALA , YASIN MALIK AMJAD , CHOUDRY ABEERA
Published: September 2021

Objective: To determine the efficacy and safety of stepwise oral misoprostol with vaginal misoprostol for cervical ripening for induction of labour. Study design: Interventional Quasi - Experimental study. Setting and duration: The study was of 15 months (April to 30 June) duration conducted at Obstetrics and Gynaecology department Military Hospital Rawalpindi. Subjects and methods: 100 females between 37-42 weeks of gestation were randomly divided into two groups 1and 2. Patients in group -1 assigned to the stepwise oral misoprostol arm received 50 μg initially followed by 100 μg every 04 hours upto maximum 04 doses ; group-2 assigned to the vaginal misoprostol arm received 25 μg every 04 hours up to maximum 04 doses. Subsequent doses of misoprostol were withheld if adequate uterine activity (≥3 contractions in 10 minutes) or a Bishop score ≥ 8 had been achieved, or active labour had begun. The main outcomes were the interval from first misoprostol dose to delivery and mode of delivery. Patients were also monitored for adverse events. Results: There was no difference in the average interval from the first dose of misoprostol to delivery in the oral (21.1 ± 7.9 hrs) and vaginal (21.5 ±11.0 hrs, p = NS) misoprostol groups. 9 patients in the oral group (18%) and 16 patients in the vaginal group (32%) underwent caesarean section (p<0.05). There were no significant differences in the occurrence of tachysystole, hypertonus, hyperstimulation or neonatal outcome between two groups. Conclusions: Oral misoprostol appears to be as effective as vaginal misoprostol for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, and is associated with a lower cesarean section rate.
INFERTILITY
Authors: KAUSAR ROBINA , YASMEEN LUBNA , JABBAR TAHIRA , Imran Faiqa
Published: September 2021

Objective: To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Study Design: Observational analytical study. Period: June 2009 to June 2010. Methods: In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in our study, 74% (2/3 rd) patients were less than 30 years of age and 26% (1/3rd ) were between 30 – 40 yrs of age. Primary infertility was seen also in 2/3rd of patients (73% ) and secondary infertility in remaining 1/3rd (27%) of patients. Polycystic ovary (PCO) was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown (unexplained infertility). on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day (12.41 day) of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8 % of patients refused further treatment and 4 % did not report back. Conclusions: Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients.
INDUCTION OF LABOR
Authors: JABBAR TAHIRA , FAISAL SHAMAILA , IMRAN FAIQA , Kauser Robina
Published: September 2021

background: Labor can be induced through a myriad of ways. The aim of this study was to compare the effectiveness of the intracervical Foley balloon catheter and intra vaginal 3 mg prostaglandin E2 tablet(s) in preinduction cervical ripening at term. Methods: Prospective analytic study of a cohort of 280 women selected through non probability sampling admitted in Obstetrics units, in two private hospitals one at Rawalpindi and the other at Mirpur (Azad Kashmir), from January 2009 to March 2010. All women were randomized to receive an intracervical Foley catheter or prostaglandin E2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. Results: There were no differences in mean Bishop Scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean ± S.D.) after ripening were 6.6±0.81 and 6.7±0.86 for the Foley catheter and prostaglandin groups, respectively (P=0.54). The prostaglandin group showed a statistically shorter induction to delivery time compared with the Foley catheter (16.5±2.2 and 20.51±3.89 h, respectively (P<0.01). Both the groups showed no statistically significant difference between the occurrences of spontaneous vaginal delivery. Labor was established in 72% cases of cervical Foley group. On the other hand induction occurred in 76% cases in prostaglandin group. There was no statistical difference between the need of oxytocin infusion for labor augmentation between the two groups and fetal distress was equally frequent in both the groups. Conclusions: Foley catheter was as effective as Prostaglandin E-2 at term for induction of labor with additional advantage of being cheaper, readily available and had no systemic side effects.
TRANSVERSE LIE
Authors: ALI ROBINA , ABRAR AISHA
Published: September 2021

Transverse lie is dangerous not only to fetus but may endanger the life of mother if timely intervention is not done. Good antenatal care is of tremendous importance for proper management of transverse lie. Objectives: 1). To determine the predisposing factors to transverse lie. 2). To find out maternal and perinatal outcome in transverse lie. Facts were analyzed to find out the avoidable factors which make the maternal and perinatal outcome worse. Setting: Gynae and obstetric unit-II DHQ Hospital Faisalabad. Study Design: It was a descriptive study. Duration: Six months from 15th September, 2006 to 15th March, 2007. Materials and methods: Sixty cases of transverse lie were included in this study. These sixty patients were analyzed in great details, regarding predisposing factors, clinical features, intrapartum and postpartum management including the maternal and perinatal outcome. Results: Predisposing factors were found in 42% of the primpara but in only 34% of the multipara. The mode of delivery was surgical and lower segment caesarean section was undertaken in 80% of cases. Maternal outcome in order of frequency were difficult surgery in 23.3%, obstructed Labour in 15%, delayed recovery from anaesthesia in 3.3% and uterine rupture in 1.6%. Fetal outcome in order of frequency were intrauterine death in 18.3%, hand prolapse in 20% and cord prolapse in 8.9%. Conclusions: Known predisposing factors to transverse lie withstand a closer and more accurate assessment of their incidence. The maternal and perinatal outcome can be improved by early diagnosis during antenatal care and hospital delivery, without any delay.
BLOOD TRANSFUSION
Authors: SOOMRO REHMATULLAH , JAVED MUHAMMAD RIZWAN , ALI SARA AHMAD
Published: September 2021

Objective: To evaluate Blood Ordering and Transfusion ratios for elective surgical procedures. Study Design, Setting & Duration: This was a prospective study carried out at Muhammad Medical College Hospital Mirpurkhas from January 2007 to December 2007. Patients & Methods: A total of 1032 patients were included, both male & female. All patients who underwent elective surgical procedures in Surgical Unit, Muhammad Medical College hospital, Mirpurkhas from January 2007 to December 2007 were included in this study. Blood units cross matched and units transfused intra-operatively and post-operatively were recorded apart from patient demography and hepatitis profile. Results: A total of 1032 patients underwent elective surgical procedures during the study period. Total 1500 blood units arranged, among these only 74 units of blood were transfused. This means only 4.9% of blood was utilized while 95.1% of blood was not utilized. Cross-match to transfusion ratio (C/T) = 20.27, Transfusion probability (Tp) = 7.1 and Transfusion index (Ti) = 0.07. Conclusion: For elective surgical procedures, there is no need for routine cross matching of blood. However, one must confirm the availability of blood for Hepatitis B and Hepatitis C reactive patients, and for cases, where the bleeding is inevitable like transvesical / transurethral removal of prostate.
LAPAROSCOPIC APPENDICECTOMY
Authors: JABBAR NAVEED , KHAN M. ZAFAR , CH. AFTAB AHMED
Published: September 2021

Objective: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show that the use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk of infection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. Study Design: Descriptive Study. Period: Oct 2009 to Jun 2010. Setting: Shalamar Hospital, Lahore. Materials and Methods: Over a period of 9 months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct and cystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at one week and six weeks after discharge from hospital. Results: There was no clinical evidence of surgical site infection or leak from appendicular stump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was 4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. Conclusions: This study shows that clips can be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is very convenient, an easy, safe, and cost-effective procedure.
URINARY TRACT STONE DISEASE
Authors: ISHAQ MUHAMMAD , AKHUND ISRAR AHMED , LAGHARI MAULA BUX , Sabir Muhammad
Published: September 2021

Aims & Objectives: Geographical variation in the rates of kidney stones has been observed for many years. Pakistan is situated in stone belt. Calculus diseases is endemic in Pakistan, perhaps the incidence in Pakistan is highest in the world. Purpose: To evaluate etiology and biochemical risk factors (inorganic phosphate) in the Peshawar. Subjects & Methods: Study was conducted at LHR and Hayatabad Hospitals of Peshawar for the period of nine months. Two hundred patients and same number of controls were selected. Results: The mean value of mean inorganic phosphate in non stone formers were less than that of stone formers. The mean of urinary inorganic phosphate excretion in stone formers was greater than that of non-stone formers. Conclusions: We conclude that inorganic phosphate is an independent risk factor for renal stone formation.
URETHRAL CATHETERIZATION
Authors: MEHMOOD SHAHID , FAROUK KHALID , QADEER ZEESHAN , Nadeem Iram Batool
Published: September 2021

Objectives: (1) To assess the theoretical and practical knowledge of young doctors about urethral catheterization. (2) To evaluate the experience and level of confidence of young doctors regarding the urethral catheterization in various tertiary care centers of Rawalpindi and Islamabad. Period: Sep 2009 to Feb 2010. Setting: Tertiary Care Centre, Fauji Foundation Hospital, Rawalpindi. Subjects and methods: A questionnaire was distributed among 400 young doctors working as interns in various tertiary care teaching hospitals of Rawalpindi and Islamabad. We obtained the information about observation, assistance, performance and knowledge of young doctors about urethral catheterization. Results: Questionnaire was distributed to about 400 young doctors working as interns in different teaching hospitals of Rawalpindi and Islamabad. Among the 400 doctors, 20 (5%) doctors never observed the male urethral catheterization and 35 (8.75%) doctors never observed female urethral catheterization. While among these 400 doctors 159 (38.75%) doctors never assisted male urethral catheterization and 175 (43.75%) doctors never assisted female urethral catheterization. Moreover 205 (51.25%) doctors never performed the male urethral catheterization and 185 (46.25%) doctors never performed female urethral catheterization. Conclusions: Training of young doctors about UC is not adequate. There is a need to train the young interns properly on this aspect. A senior resident or registrar of department should demonstrate the procedure in front of young interns before they are allowed to practice and first few catheterizations should be supervised by senior residents. Other alternate is the use of manikens for training of house officers.
TYPHOID FEVER
Authors: HAYAT ATIF SITWAT , SHAIKH NAILA , SHAH SYED IQBAL AHMED
Published: September 2021

Background: Typhoid fever is widely recognized as a major public health problem in developing countries. A simple, reliable and rapid diagnostic test is needed for clinicians especially in areas where laboratory services are limited. Objective: To evaluate sensitivity and specificity of typhidot (IgM), a serological test to identify IgM antibodies against salmonella typhi. Study Design: This was a prospective study. Setting: Northern Institute of Medical Sciences (NIMS) and Ayub Teaching Hospital Abbottabad. Period: 1st November 2009 to 31st August 2010. Methods: A total of 100 patients with clinically suspected typhoid fever were studied and divided into three main groups as A, B and C, with definite typhoid fever, typhoid suspects plus non-typhoidal illnesses and healthy controls respectively. Blood culture and typhidot (IgM) tests were conducted for all subjects included in the study. The validity of typhidot (IgM) test has been evaluated by determining the sensitivity, specificity, positive and negative predictive values. Results: In our study, majority (75%) were males and (25%) females with M to F ratio of 3:1. The mean age of study group was 26.31±11.8 (SD) years. Among 100 clinically diagnosed typhoid fever patients, 19 had positive blood culture for S.typhi and 71 were typhidot (IgM) positive. Out of 19 culture positive patients, 18 (94.73%) were true typhidot (IgM) positive, which was also falsely positive in 05 (20.83%) among 24 non- typhoidal febrile controls. None of the healthy controls was positive for typhoid (IgM) test. The sensitivity, specificity, negative and positive predictive values of typhidot (IgM) test using blood culture as gold standard were 94.73%, 90%, 97.72% and 78.26% respectively for patients having typhoid fever. Conclusions: Typhidot (IgM) test is a simple, reliable, rapid and valid diagnostic tool for typhoid fever especially in areas where laboratory services are limited.
DIABETIC PATIENTS
Authors: SHAIKH ZULFIQAR ALI , SHAIKH MUHAMMAD ZAMAN , ALI GHULAM
Published: September 2021

Objective: To assess awareness about the role of lifestyle changes in the management of diabetes among diabetics. Patients and Methods: Settings: Diabetic clinics of Jinnah Postgraduate Medical Centre and Kidney Centre. Karachi. Study Period: From April 7, 2008 to August 31, 2008. Study Design: Cross Sectional. Sampling Technique: Convenient. Sample Size: 200 diabetic patients. Results: A total of 200 diabetics were interviewed. Their mean age was 48.8 years. Of these 92 (46%) were males and 108 (54%) were females. Diabetes was under control of 38% and 57% were taking regular treatment. Education sessions were attended by only 11%, counseling for lifestyle modification was done with 16%, 30% followed diet chart and 18% of the study participants were doing regular / irregular exercise. Majority of them (68%) needed social and family support to cop up the disease. Conclusions: There was a lack of awareness about the role of lifestyle changes in the management of diabetes among these diabetic patients. There is a need of health education programs for diabetics and general public.