Rawal Medical Journal

Publications
Objective: To explore the specificity and sensitivity of clinical and intraoperative findings in comparison with histopathology of specimens in cases diagnosed as acute appendicitis and under going appendicectomy Method: This retrospective cross sectional observational study was based on a review of the histopathological reports of appendicectomy specimens submitted for histopathology examination in Holy Family Hospital, Rawalpindi from May 2006 to April 2007. Data were analyzed by SPSS version 13. Results: A total of 1016 specimens were received. Fifty-one percent specimens came from females and 49 % from males. The median age was 22 years. Fifty-six percent specimens showed acute appendicitis, 27% were normal appendices, 6% had fecolith and 4% showed oxyuriasis. In total, 26.8% patients had normal appendix with 18.4% males and 34.6% females (p<0.001; OR 2.35). Conclusions: Overall negative appendicectomy (NA) rate was 27% and was significantly higher in females as compared to male patients.
 
Objective: The aim of this study was to determine the hemoglobin value of Jordanian subjects over 40 years who live in Amman and its surrounding areas. Methods: A prospective survey of the level of hemoglobin (Hb) was carried out in a randomly selected 526 Jordanian subjects (57.8% women) over the age of 40, who attended the outpatient medical clinic in Queen Alia Military Hospital over a one year interval period. Place of residence, smoking status, blood pressure measurement and blood sugar estimation was taken into consideration. Results: There were 304 women and 222 men. The mean Hb level was 13.56±1.32g/dl in women and 15.06±1.42g/dl in men (p<0.001). In men, Hb levels did not differ in regard to place of residency, but women of rural origin had significantly lower Hb levels than other women (p<0.001). Women under age 50 had significantly (p<0.001) lower Hb levels than older women. Smokers had significantly higher Hb levels than non-smokers (p<0.002) and there was weak correlation with numbers of cigarettes smoked (men rs=0.07, p=0.07; women rs=0.14, p<0.001). Nineteen subjects (3.6%) were found to be anemic (Hb < 11.5g/dl in women or < 12.5g/dl in men). Conclusions: The mean hemoglobin level in Jordanian adults at around 600-1025 m altitude was 13.56±1.32g/dl in women and 15.06±1.42g/dl in men.
 
Objective: To evaluate the etiology, perioperative management and outcome of surgery in cases of tracheal stenosis. Methods: This was a retrospective analysis of patients with tracheal stenosis who underwent tracheal resection with anastomosis from January 2000 to December 2010. Results: Ten patients, aged between 15 to 53 years old (mean of 34.4 years) were included. Post intubation injury was the major cause of tracheal stenosis (n=8), followed by external laryngeal trauma (n=2). Using the Cotton-Myer classification, 60% of patients had Grade III stenosis whilst 40% had Grade IV stenosis. Intravenous corticosteroids were given 24 hours before extubation. Four patients were well post-operatively without complications. The most common complication in the other patients was granulation tissue at the anastomosis region (n=3), vocal cord paresis (n=2) and one restenosis (n=1). Four of these patients underwent examination under anesthesia with removal of granulation tissue and/or laser dilatation. However, 2 cases needed Shian Lee operation and required T-tube until present. The success rate for tracheal resection and anastomosis is taken as the number of patients successfully decannulated, which was 80%. Conclusion: Tracheal resection with end-to-end anatomosis was a successful procedure for cervical tracheal stenosis, with low mortality and few complications related to it.
 
Objective To determine the incidence of various complications of laparoscopic cholecystectomy (LC). Patients and Methods This observational case series study was conducted at Sukkur Blood Bank Hospital Sukkur, GMC Teaching Hospital Sukkur and Red Crescent Hospital Sukkur from January 2004 to December 2010. It comprised of 1100 cases. All had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent LC, whether successful or converted, were included in this study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma. Results The average age was 47.63 years while male to female ratio 1:4.6. The weight ranged from 41 to 127 kg (mean 64 kg). Main complications observed were hemorrhage (3.18%), bile duct injury (0.27%), retained CBD stones (0.18%), bile leakage (1.19%) and gut injury (0.09%). Minor complications included gallbladder perforation (9.82%), spilled stones (3.9%), sub umbilical wound infection (1.6%) and illeus (1.3%). Overall conversion rate was 2.9%. Conclusion The morbidity and mortality of LC are remarkably low. Incidence of complication is very low and less than open cholecystectomy, which makes this procedure safe, effective and procedure of choice for gallbladder disease.
 
Short saphenous vein diameter and its relation to reflux (n=128).
Objective The aim of the study is to assess various reflux sites in patients with varicose veins by using duplex scan. Patients and Methods This prospective observational study was done at Department of Diagnostic Radiology, Holy Family Hospital, Rawalpindi in collaboration with Department of Surgery, Social Security Hospital, Islamabad from January 2007 to December 2010. All the patients diagnosed as having varicose veins by the surgeon and referred to the department of radiology underwent duplex scanning of the venous system of the affected lower limb. The patients having recurrent varicose veins, history of limb trauma, previous venous surgery, sclerotherapy, and deep venous thrombosis were excluded from the study. The long and short saphenous systems were assessed, together with the deep veins and perforators along the medial aspect of the thigh and calf. Reflux was defined by retrograde flow lasting longer than 0.5 s after manual calf compression. Results A total of 128 lower limbs of 114 patients were included in the study. 71 (62.28%) were males and 43 (37.72%) were females. Mean age was 44.67 years (range 22-63). Mean age of male was 42.06 years and that of females was 48.53 years. Of the 128 lower limbs assessed, 68 were right, 60 were left and 14 patients had bilateral varicose veins. Isolated sapheno-femoral junction incompetence was found in 46 (35.9%) cases whereas isolated sapheno-popliteal junction incompetence was seen in 30 (23.4%) patients, 32 (25%) had both sapheno-femoral and sapheno-popliteal incompetence. Conclusion Saphenofemoral junction was the most common site of reflux in the varicose veins. As colour duplex scan is non-invasive, repeatable, and readily accepted by the patients, it should be the investigation of choice for patients presenting with varicose veins.
 
We present a case of FB ingestion that mimicked a neoplasm whereby a 58-year-old gentleman with a history of near fatal accident 14 years ago, complains of foreign body sensation in the throat for 4 months. Flexible laryngoscopy revealed a smooth surfaced bulge at the right lateral pharyngeal wall, pushing the right aryepiglottic fold and arytenoid medially obscuring the right vocal fold. Biopsy twice via direct laryngoscopy reported as no evidence of malignancy Imaging findings revealed a heterogenous enhancing mass of the lower oropharynx and hypopharynx extending from C2-C7 levels. Within the center of this mass, lay a slightly curvilinear structure returning hypointense signal at both T1- and T2- weighted sequences, highly suggestive of a FB. On third laryngoscopy, a broken denture was found hidden inferior to the mass, partly embedded at the posterior pharyngeal wall.
 
Objective To analyze characteristics of patients with bomb blast head injuries in a tertiary care hospital of Khyber Pukhtoonkhwa, Pakistan. Patients and Methods This observational study was conducted at the department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from January 2009 to December 2010. We included all the patients with bomb blast head injuries who were hospitalized, irrespective of their age and gender, and excluded those patients who died before hospitalization. Results Out of a total of 2052 bomb blast victims treated in Lady Reading Hospital, 154 patients had head trauma. Out of these 154 patients, 131 (85.1%) were male with the age range from 2 months to 70 years. Common age groups affected were 2nd and 3rd decades (24% and 29% respectively) of life. 14 % of these patients had severe head injuries. Frontal lobes (31.17%) and temporal lobes (24.67%) of the brain were commonly affected. The common complications were neurodeficit (52%), wound infection (13.6%), cerebrospinal fluid leak (9.1%), epilepsy (5.8%) and post traumatic hydrocephalous (3.3%). Mortality rate was 11.7%. Conclusion Significant number of hospitalized patients exposed to explosion had head injuries. Young males were mainly affected. Frontal and temporal lobes of the brain were the common sites of injury. Mortality rate in the hospitalized head injured patients was 11.7%. The common complications in surviving patients were neurodeficit and wound infections.
 
Objective To evaluate the frequency of complications of ileostomy. Patients and Methods This descriptive study was conducted on 180 patients at surgical units of Chandka Medical College Hospital, Larkana from August 2004 to February 2008. Patients of ileostomies performed for various pathologies including enteric perforation, intestinal obstruction, abdominal tuberculosis and abdominal trauma were enrolled. Preoperative preparation, investigations, operative findings and post operative complications were noted. Result A total of 180 patients were evaluated. Age ranged between 12-65 years (mean 29+13.31years). Male to female ratio was 1:1.22. 93(51.6%) patients were of enteric perforation followed by 49(27.2%) of intestinal obstruction, 20 (11.1%) of abdominal tuberculosis and 18(10%) of abdominal trauma. 72 (40%) patients developed variable complications; of which 38(21.1%) developed skin excoriation, 12(6.6%) retraction, 8(4.4%) stenosis, 8(4.4%) stomal prolapse, 3(1.6%) peristomal sepsis, 2(1.1%) ischemia and one(0.5%) bleeding. Mortality rate was zero. Conclusion Complications of ileostomy are common and most of them are manageable conservatively.
 
Objective: To assess acceptance of vaccination against Coronavirus by nursing students of Mosul City. Methodology: This quantitative cross-sectional study collected data by using questionnaires from 215 students of College of Nursing, University of Mosul, Iraq from September 20 to December 20, 2021. All respondents were 18 – 30 years old. Results: Age of students was 20 to 26 years, (mean22.34 1.76). Almost two-thirds of respondents (70%) agreed that the nursing student should be vaccinated against Covid 19. Conclusion: The acceptability rate was significantly high among females. Higher acceptability of COVID-19 vaccination among nursing students was related with their age group and stage of study.
 
Objective: To evaluate the anxiety and depression in medical students due to COVID-19 in Sindh, Pakistan. Methodology: This cross-sectional study was conducted on students of medical and dental colleges throughout the province of Sindh, including the public sector and private sector medical colleges. Anxiety and depression were assessed by generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9). Data were analyzed by SPSS version 26. Results: A total of 1445 medical students participated in the study. The average age of the students was 21.87±3.16 years. Various levels of anxiety and depression, ranging from mild to severe, were observed in 78.1% and 76.9% of students, respectively. Conclusion: Anxiety and depression most commonly affect medical students even in reasonable condition. In the current situation of the pandemic, they are overstressed, and the prevalence of anxiety and depression relatively increased significantly.
 
We report a case of extensive myocardial calcification in a 19 years old male. This rare condition is associated with metastatic deposition, infarction or other endocrine disorders and in this patient, with childhood history of living in a farm may have been caused by some type of infection. (Rawal Med J 2008;33:260-261).
 
Objective: To determine the age-specific interrelation between body mass index (BMI) and other obesity related indicators and to determine age and gender-differences of anthropometric characteristics in the Pakistani children aged 2-19 years. Methodology: Anthropometric measurements included height, weight and body circumferences and their derived indices BMI, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) were taken from a cross-sectional sample of 10782 Pakistani children, aged 2-19 years during March to June, 2016. The data were analyzed using descriptive statistics, independent t-test and the Pearson correlation co-efficient. Results: BMI had a strongest positive and significant correlation with mid-upper arm circumference (MUAC) in all age-groups of boys and girls. BMI had weakest correlation with WHR in all age-groups for both genders. The mean comparisons between both genders showed that boys had a higher mean value in various agegroups than those of girls had with few exceptions. Conclusion: There was considerable interrelationship among different anthropometric measures in boys and girls of aged 2 to 19 years. However, the MUAC had strong positive correlation with BMI in both genders and MUAC therefore, could be proposed as a simple and easy index to discriminate children and adolescent with elevated BMI.
 
Objective To compare the maximal infusion rate of FMS 2000 fluid warmer on various intravenous catheters and fluids. Methods This study was performed on 4th February 2011 in operation room, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea. 0.9% sodium chloride (NS), Ringer's lactate (RL), and 6% hydroxylethyl starch 130/0.4 (HES) were applied to FMS 2000 fluid warmer. After FMS 2000 was equipped with one kind of fluid, 16 types of catheter including double lumen catheter were connected to the end of line. We accelerated infusion rate to 750ml/min under 300mmHg of pressure limit. Maximal infusion rate under 300mmHg was measured three times. Maximum value of maximal infusion rate was compared. Results 7-, 8.5F rapid infusion catheter (RIC) resulted in rate of 750ml/min in NS, RL and HES group. Other catheters did not exceed 750ml/min. Maximal infusion rate of NS and RL was faster than HES in all kinds of catheter except RIC. There was no statistically significant difference Conclusion Maximal infusion rate of HES is slower than NS and RL in ordinary sized venous catheter using FMS 2000. NS and RL had no difference in maximal infusion rate.
 
Objective: To find how common weight gain was among Mosul University students during the Iraqi quarantine in 2020. Methodology: In this quantitative cross-sectional study, data were gathered using an electronic version of an Arabic-language questionnaire form from the 1st of September to 1st December 2021. We recorded demographic characteristics, eating habits and weight before and during the pandemic. Results: Out of 1688 students, 67% were males. Age of 40.17% was between 21 – 23 years. We found that 41% had same appetite and 54% had same number of meals per day and 57.6% had no extra activities. There is a significant value of age groups and gender with all forms of BMI. Conclusion: This study concluded that the there was a big difference of BMI during quarantine with a significant values of age groups and gender with all forms of BMI.
 
Objective: To assess the frequency of metabolic syndrome (MS) and its constituents in a sample of Pakistani obese patients. Methodology: In this descriptive and cross- sectional study, we used a sample of 300 patients from Khyber Teaching Hospital, Peshawar, Pakistan from April 2016 to November 2016. They were randomly selected and their mean age was between 15 and 25 years. The variables obtained included BMI, both systolic and diastolic blood pressure, cholesterol, fasting blood glucose, triglyceride levels, LDL- cholesterol, HDL- cholesterol, waist to hip ratio, waist circumference and insulin resistance. Results: Of the 300 patients, the frequency of MS was 20%. There were no significant differences in the frequency of developing MS between the genders. The order of frequency of the components as observed was as follows; abdominal obesity was 88%, high triglyceride level was 85%, males were 40%, 40% of the sampled population resided in the urban area. Meanwhile, 35% of the patients had hypertension while only 5% had hyperglycemia. The frequency of developing MS was 70 times higher in patients with high triglyceride levels in their when compared to those with normal levels. Conclusion: The frequency of MS and its components in Pakistani adolescent patients is high. The high levels of triglyceride and a sedentary lifestyle profoundly contributed to MS. Moreover, the findings signify the importance of early treatment and prevention of obesity in working toward reducing the rate of diabetes mellitus type 2; as glucose intolerance had a strong relationship with the components of MS, and cardiovascular diseases such coronary artery disease.
 
Objective: To assess Anxiety & Depression in 3rdyear MBBS students of CMH Lahore Medical College. Methodology: This cross-sectional descriptive study was conducted at CMH Lahore Medical College in April 2014 on 3rd year MBBS students and included 110 students of 3rd year MBBS selected conveniently. Diagnostic instruments like Hospital Anxiety & Depression Scale (HAD Scale) English version was used for data collection. Results: Out of 110 students, 55 (50%) were males and 55 (50%) females. Mean age was 21 years. 36 (32.7%) were suffering from anxiety, from which, 16 (44%) were male 20 (56%) were female. 12 (10.9%) were suffering from depression, out of which, 6 (50%) were male and 6 (50%) were female. Conclusion: Anxiety was present predominantly in female students, where as depression was equally distributed in both the genders. Future research should move on from simple cross-sectional studies to better-quality longitudinal work, which can identify both predictors for and outcomes of poor mental health in medical students.
 
Maternal weight gain and maternal mean fat consumption.  
Neonatal weight and maternal daily lipid consumption.  
Mean Maternal total energy and nutrient intake and birth weight of full term neonates. 
Objective To determine effects of maternal macronutrient intake in 3rd trimester of normal pregnancy on the maternal weight gain and neonatal birth weight of full term neonates. Patients and Methods The study was conducted from April, 2007 to November 2007 at Gynecology and Obstetrics Unit of Pakistan Institute of Medical Sciences, Islamabad. This hospital based Descriptive study was carried out on pregnant women registered at 26 weeks of pregnancy by employing consecutive (non-probability) sampling technique. Dietary history was taken by a semi structured Food Frequency questionnaire and 24 hours dietary recall at the time of registration. Written informed consent was obtained. Results Mean energy and protein consumption of the pregnant women was 2168.89 Kcal/day and 65.71 g/day respectively in the last trimester of pregnancy. Fat and carbohydrate intake was 73.26 g/day and 306.14 g/day respectively. Maternal energy intake more than the National Recommended Dietary Allowance (RDA) for Pakistan showed a highly significant (P = 0.007) increase in the birth weight of the neonates but no increase was seen (P = 0.93) in the maternal weekly weight gain. Maternal fat consumption had a significant positive relation with both the neonatal birth weight (P = 0.005) as well as maternal weekly weight gain (P = 0.03) but carbohydrate consumption was only significantly related to maternal weight gain (P = 0.01). Conclusion This study suggests a strong role of maternal diet during pregnancy for optimal newborn weight.
 
Objective: To evaluate our experience with laparoscopic total extra-peritoneal (TEP) inguinal herniorrhaphy in terms of full recovery, return to work, complications and recurrence rate. Duration: From 1st January 2007 to 31st December 2010. Setting: Surgical Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Patients and Methods: We retrospectively studied a consecutive series of patients who underwent laparoscopic TEP repair of inguinal hernia at our unit. The study consisted of fifty eight patients and total extra-peritoneal (TEP) approach was used in all patients. Results: All 58 patients were male with a mean age of 46 years (range 25 to 67 years) at the time of operation. During the study period, 69 laparoscopic inguinal hernia repairs were performed in 58 patients. Bilateral hernia repair was done in 11 patients (19%). Of the 69 procedures; seven repairs (12%) were done for recurrent hernias. In 20% of the patients the procedure was completed as a day case surgery. A mean follow up of six months was obtained for 46 patients (79%). Minor complications occurred in 32% of patients, whereas major complication occurred in two patients who developed recurrence in the immediate post operative period. The median time to normal physical activity was 8-11 days for unilateral and 11-16 days for bilateral hernia repair. Conclusion: Laparoscopic TEP herniorrhaphy is a good alternative to open hernia repair. However further studies are needed to strengthen this conclusion.
 
Objective: To assess the prevalence of hypomagnesaemia and its co-occurrence with other diseases in children aged 6-60 months admitted to Children's Hospital and Institute of Child Health, Multan (CH&ICH Multan). Methodology: This prospective observational study was conducted in Nutrition Stabilization Center at Children's Hospital and Institute of Child Health, Multan from May 2019 to January 2020. A total number of 384 malnourished children aged 6-60 months were included in the study. The nutritional status of children was accessed according to WHO criteria as weight for height or length <-3SD or mid upper arm circumference <11.5 cm and presence of severe signs of wasting and bilateral edema. For data analysis SPSS version 20 was used. Results: Out of 384 children, 163(42.45%) had hypomagnesaemia. The mean age was 18.4±2.8. Male to female ratio was 1.21:1 with 96(58.89%) male and 67 (41.11 %) f e m a l e h a d hypomagnesaemia. We found that 62(38.04%) hypomagnesaemia children belonged to age group 12-24 years. Most children, 121(31.51%) were aged 12-24 months and 282(73.44%) belonged to very poor socio-economic status. Conclusion: Hypomagnesaemia was very common among hospitalized children which can cause many complications that increases the mortality rate and hospital stay.
 
Dermojet.
Before treatment.
After treatment.
Objective: To determine the efficacy of intralesional triamcinolone acetonide in alopecia areata by Dermojet. Methodology: This study was a case series and conducted in Dermatology department, Abbasi Shaheed Hospital, Karachi, Pakistan from February 6, 2014 to August 6, 2014. Clinically diagnosed, 100 cases of alopecia areata aged 15 to 50 years were included via non probability consecutive sampling. Intralesional triamcinolone acetonide was given via Dermojet at monthly intervals for 3 months. The response was recorded at each visit by the appearance of hairs in alopecia patches. The efficacy was taken as positive if more than 50% of the patch showed growth of hairs with reduction in size of the patch, as measured by Vernier Caliper. Results: The mean age was 30.84±9.97 years (range 15 to 50). Out of 100 patients, 44 were male and 56 female. Only 19 patients had a positive family history. The mean duration of disease was 6.88±4.90 months. 86 patients had 1-3 patches and 14 patients had 4-6 patches while mean size of the patch was 4.33±1.72 cm. 75 patients achieved efficacy and 25 patients did not. Conclusion: The efficacy of intralesional triamcinolone acetonide in alopecia areata patches via Dermojet device was high. It may be utilized in future for treatment of alopecia areata.
 
Objective: To review the frequency and determinants of malpresentation in singleton pregnancy at out institution. Methodology: This retrospective cross-sectional study was conducted based on hospital records of the patients admitted and delivered at Gynecology and Obstetrics Department, Ayub Teaching Hospital (ATH)Abbottabad, Pakistan in a specific time period. Data was collected on a specifically designed pro forma and was analyzed with SPSS version 16. Results: The commonest malpresentation was breech (85.8%) followed by transeverse (8.7%), brow (2.4%), compound (2%) and face presentation (1.2%). Highest frequency (93) of all types of malpresentation was observed in primigravida; breech being the highest (82). Conclusion: The changing trends in the abnormal presentation need further study. Awareness programs regarding maternal and child health in periphery and effective antenatal medical services should be provided for early detection and timely management of malpresentation.
 
Splenic pedicle after Fig 2. Splenic infarction. torsion.
Wandering spleen is a rare clinical entity characterized by abnormal spleen position due to its long vascular pedicle. Congenital maldevelopment and acquired laxity of the splenic's ligaments due to processes such as trauma, pregnancy and connective tissue disease are two known causes of this condition. The most common presenting symptoms are abdominal pain, abdominal mass and acute abdomen. Treatment options depend on the presenting condition. We will present a case of torsion of wandering spleen treated by splenectomy in our hospital.
 
Objectives: To determine frequency and the reasons of conversion laparoscopic procedure into open surgery. Methodology: This prospective cross sectional study was conducted in department of surgery, Khyber Teaching Hospital, Peshawar, Pakistan from January 2015 to July 2016. A sample of 200 patients was selected by using non probability convenient sampling technique. Complicated cases, which were difficult to handle by laparoscope were converted to open surgery after diagnoses were made while rests of cases were managed by laparoscopy at same time. Data were analyzed by SPSS version 16. Results: Out of 200 patients, 135(67.5%) were males, 65(32.5%) females, 76(38%) from urban while 124(62%) from rural area. Mean age was 35±11 years (range 15-85). 41(20.5%) were diabetics, 36(18%) were hypertensive while 26(13%) were smokers. Diagnosis was made successfully in all patients in whom acute appendicitis was most frequent (74.5%) followed by perforated duodenum in 6.5% of cases. In 22(11%) of cases the laparoscopy was converted into open procedure. The reasons of conversion in case of acute appendicitis were advance adhesions (25.75%), severe inflammation (35.25%) and bleeding in 34% of patients. Conclusion: About one tenth of laparoscopic procedures were converted into open procedures. Reasons of conversion of laparoscopic procedures into open surgery in case of acute abdomen were adhesions, previous abdominal surgeries, severity and time of presentation of perforations, severe inflammation, severe bleeding and difficulties in visualization of anatomy.
 
Objective: To determine the most significant factors in clinical and laboratory investigations that can help in pointing presence or absence of serious surgical condition. Methods: It's a retrospective analysis of 210 patients who were admitted to Prince Rashid Ben Al-Hassan hospital, lrbid, Jordan as a case of acute abdominal pain from January 2008 to January 2009. Results: Out of 210 patients, 127 were female and 83 male. The ages ranged from 15 to 65 year. One hundred and four patients (49.5% of total) were diagnosed to have acute surgical pathology. Of these, 49 (47.1%) had acute appendicitis where appendectomy done. Seventy one (33.8% of total) were labeled to have acute non specific abdominal pain. Nausea and vomiting presented in 72.1% of patients who have acute surgical pathology followed by localized tenderness or guarding in (70.2%), leukocytosis (62.5%) and tachycardia in 54.8% of patients. Conclusion: Nausea and vomiting, localized tenderness or guarding, leukocytosis, and tachycardia were associated with significant pathology. Patients without these variables were unlikely to have significant pathology requiring further active medical or surgical intervention.
 
Objective: To evaluate the endoscopic findings in children to help identify the diverse causes of chronic abdominal pain in them and thus assist in their management. Methodology: A retrospective review of 28 children referred to the pediatric gastrointestinal clinic in Prince Ali Hospital in AL-Karak with chronic or recurrent abdominal pain was conducted from August 2011 to August 2012. Complete blood count, kidney function test, liver function test, erythrocyte sedimentation rate (ESR), urine analysis and culture, stool analysis and abdominal ultrasound were done in all patients. Upper gastrointestinal endoscopy was performed in all children in whom above investigations were normal. Results: Out of 28 of children, 16 were female and 12 male, with a mean age of 8.5 years (range 3-14). The most common gross endoscopic finding was antral hyperemia that was noticed in 13 (46.4%) patients. Among them, H. pylori associated active chronic gastritis was the commonest histopathological finding seen in 10 (77%) patients, followed by chronic gastritis in 3 (23%) patients. Four (14%) patients showed duodenal erosion. Stomach nodularity was seen in four patients, three of them have H. pylori chronic active gastritis; 3 (75%) on biopsy report and the other one was normal. Two patients revealed loss of normal esophageal vascularity and two other showed multiple esophageal nodule. The last three patients (10%) were normal grossly but one of them had H. pylori active chronic gastritis. Conclusion: Performance of upper gastrointestinal endoscopy in patients with recurrent or chronic abdominal pain is a highly efficient and safe procedure to identify organic causes and assist in their management.
 
A descriptive cross sectional study conducted in Pakistan Ordnance Factory hospital Wah Cantt. Frequency of giardiais is studied in school age children who have minimum three episodes of abdominal pain in a period of three months that is interfering with their daily activities. This frequency is found to be 14.4 % among a sample of 328 patients. The percentage of cases using boiled drinking water is also determined that is found to be 7.9% among 328 patients.
 
Objective To evaluate the role of abdominal sonography in the diagnosis of acute appendicitis. Method This was a descriptive study and was conducted in the Cantonment General Hospital Rawalpindifrom May 2006 to December 2007. A total of 170 patients presenting with a clinical diagnosis of acute appendicitis, irrespective of age and gender, were included in the study. All had an ultrasonography by the graded compression technique. Histopathology was used to compare the clinical and sonographic judgment. Results Out of 170 patients, 118 patients were histologically confirmed acute appendicitis. Ultrasonography suggested 100 out of 118 (85%) patients positive for acute appendicitis. It was normal in 46 out of 52 (88.4%) patients of negative appendicectomies. It gave a false negative result six cases. Sensitivity of sonography was 85% and specificity was 86%. Conclusions The data supports a positive role for sonography in the diagnosis of acute appendicitis. Its role in male adults and children is encouraging, while in female adults ultrasonography has more false negative results. (Rawal Med J 2009;34: 138-140).
 
Objective: To study the clinical indication and common pathologies identified on specimen, and complications associated with this procedure. Methodology: This prospective observational study was carried out at Department of Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur (Shaheed Muhtarama Banazir Bhutto Medical University Larkana Sindh, Pakistan) during one year period from 1st May 2010 to 30th April 2011. All abdominal hysterectomies performed during this period were studied for the following variables: The primary clinical indication, the histological diagnosis and complications associated with this procedure. Data was collected on pre-designed Performa and analyzed on SPSS version 15. Results: Total number of patients admitted during study period were 5580. Of these, 2280 (40.86%) had the gynecological problems, of these 2280 patients, 820 (35.96%) required surgery. Two hundred ninety women underwent major surgery which included elective abdominal hysterectomy in 150 (51.72%) patient. Peak age incidence was in 35-60 years. In 97% cases indication were for benign conditions. Menstrual disorders were the major clinical indication of hysterectomy while uterus leiomyoma were the common pathology confirmed. There was no mortality associated with the procedure. Conclusion: Menstrual disturbance was leading indication of hysterectomy and leiomyoma was the commonest pathology found on hysterectomy specimen.
 
Objective: This study was aimed at evaluating the prevalence of Abdominal Aortic Aneurysm (AAA) in men older than 50 years with a complaint of low back pain, employing MRI technique Patients and Methods: In a cross-sectional study, 600 men older than 50 years with low back pain evaluated by MRI were assessed during a 12-month period. A diameter of abdominal aorta more than 3 cm was considered as aneurysm. Patients were divided in two groups: group A without an evidence of lumbar disc herniation on MRI (300 patients); and group B with lumbar disc herniation (300 patients). History of smoking was determined in all patients. Results: Mean age was 60.05±8.81 (50-84) years. Positive history of previous or current smoking was found in 185 (30.8%) patients. AAA was detected in 7 (1.2%) patients, 3.2% and 0.2% of smokers and non-smokers, respectively (p=0.004, OR=13.9). There were 5 (1.7%) and 2 (0.7%) cases with AAA in groups A and B, respectively (p=0.287). In group B, 1% and 0.5% of patients with and without a positive history of smoking had AAA, respectively (p>0.05). Conclusion: This study showed that the prevalence of AAA in elderly men with low back pain is similar to their counterparts without a complaint of low back pain. On the other hand, smoking was a risk factor for AAA. Screening of AAA in men older than 50 years with low back pain who smoke may be advisable. (Rawal Med J 2009;34:1-3).
 
Objective: To determine the safety of vaginal delivery among cardiac pregnant women as compared to lower segment cesarean section (LSCS) at our institution. Methodology: This case-control study was conducted at the Departments of Obstetrics & Gynecology, Yusra Medical & Dental College, Islamabad, Pakistan from January 2008 to December 2009. A total of 176 pregnant women were included through purposive sampling technique and interviewed by using pre-tested structured questionnaire. 86 pregnant women were taken as cases who had acquired or congenital cardiac diseases and 90 pregnant women as controls without cardiac problems. Data was collected on demographic features, obstetrical and medical evaluation. Results: Out of 86 cardiac pregnant women, 62 (72%) had spontaneous vaginal delivery (SVD) and 24 (28%) underwent LSCS either due to obstetrical or cardiac reasons. In control group, out of 90 non-cardiac pregnant women, 78 (87%) had SVD and 12 (13%) had LSCS. In cardiac pregnant women, with SVDs only 2 (3.2%) had primary post partum hemorrhage (PPH) of milder degree, which was treated with uterine bimanual massage. While LSCS in the cardiac pregnant women, 7 (24%) pregnant women had primary PPH out of which 3 were treated with simple measure like infusion Syntocinon, Misoprostol rectally, while 1 patient required blood transfusion and one patient had to undergo hysterectomy due to uncontrollable hemorrhage while 1 patient had secondary PPH and was treated by antibiotics and blood transfusion. Conclusion: It is concluded that vaginal delivery is the safest and preferred route of delivery in pregnant women with cardiac diseases.
 
Objective: To determine the sonographic differential diagnosis of abdominal masses among children visiting The Children's Hospital and Institute of Child Health, Lahore, Pakistan. Methodology: A cross-sectional, descriptive study was conducted at the Radiology Department of The Children's Hospital, Lahore. Data of 188 patients was collected through a convenient sampling technique via self-structured questionnaire. All the children upto the age of 18 years coming with abdominal masses from August 2017- January 2018 were included. Data were analyzed by SPSS version 24. Results: Majority of the children were between 6-12 years of age. Overall mean age was 5.35+4.40 years. Majority 116(61.7%) of the children were males and females were 72(38.3%). M:F was 1.6:1. Hydronephrosis was the most common abdominal mass seen in 37(19.7%) patients, followed by Lymphoma 36(19.2%), Wilms' Tumor 21(11.2%), Liver Abscess 16(8.5%), Neuroblastoma 11(5.8%), Pseudo-Pancreatic Cyst 11(5.8%) and Choledocal Cyst 11(5.8%). Most common clinical presentations were abdominal distention 79(42.0%), pain abdomen 52(27.7%) and fever 22(11.7%). Conclusions: Pediatric abdominal masses were more common in males. Majority of the tumors were noted in children between 6-12 years of age. Majority of the masses had features of benign lesion on ultrasound. Renal masses were the most common presenting in almost all age groups being most common in Neonates. Hydronephrosis was the most common diagnosis followed by Lymphoma, Wilms’ Tumour, Liver Abscess, Neuroblastoma, Pseudo-Pancreatic Cyst and Choledocal Cyst.
 
Objectives: To evaluate the diagnostic value of ultrasound in detecting intraabdominal injuries in patients with blunt abdominal trauma. Patients and Methods: The study was conducted in the department of radiology, Combined Military Hospital Lahore, from 13th September 2006 to 29th September 2007. A total of 70 patients with blunt abdominal trauma were included. They all underwent Ultrasonography (US) followed by Computed Tomographic (CT) scan of abdomen. Sensitivity, specificity, positive and negative predictive values and accuracy of US in detecting intraabdominal injury were calculated keeping CT findings as gold standard. The cases in which laparotomy was performed; the surgical findings were taken as the standard. Results: US examinations were positive in 34 patients. Of these, US showed free fluid in 18 (52.9%), and abdominal organ injury in 12 (35.3%) and only abdominal organ injury in 4 (11.8%). True-positive findings were seen in 28 (82.35%) of these on CT and/or laparotomy. There were two false negative cases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US in detecting intraabdominal injury were 93.3%, 85.0%, 82.3%, 94.4% and 88.5%, respectively. Conclusion: Ultrasonography has high diagnostic performance in the screening of patients with blunt abdominal trauma.
 
Objective: To assess the success rate of trans-abdominal repair of vesico-vaginal and uretero-vaginal fistulae. Methodology: This prospective descriptive study was conducted in the Departments of Surgery, Gynecology and Urology, Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Pakistan from August 2009 to July 2012. A total 27 patients of vesicovaginal fistulae (VVF) and Uretero-Vaginal fistulae were included in the study. All patients had supra-trigonal multiple or single VVF and were repaired by the abdominal approach. The outcome of the procedure and post-operative complications were recorded. Results: Thirteen patients had single supra-trigonal, three had multiple VVF. Three had vesico-uterine and four had uretero-vaginal fistulae. All were operated by abdominal approach successfully. Pelvic surgery (abdominal hystrectomy/LSCS) was the major cause of VVF, accounting for 66.66% (18 patients), while in remaining 33.33% (9 patients) the obstructed and prolonged labor were the cause. All fistulae healed successfully with minor leaking in 2 (7.4%) patients which settled spontaneously. One patient developed post-operative adhesions (small bowel obstruction) and was explored and adhesiolysis was done. Three (11.11%) patients developed post-operative wound infection and healed by dressing. Conclusion: Trans abdominal is an excellent approach for supra-trigonal, vesico-uterine and uretero-vaginal types of fistulae.
 
Objective:To describe the pattern of visceral injuries in penetrating trauma patients, their association with entry wounds and to observe the outcome of patients after surgical intervention. Methodology: This study included 79 patients with abdominal trauma who presented in the Accident and Emergency department of Civil Hospital, Karachi, Pakistan and underwent exploratory laparotomy from October 2011 to April 2013. A proforma was used to document patient's demography, findings and final outcome. Results: 42.7% patients were in the age group of 21 to 30 years. 76 (96.2%) were male and 3 were female. Most entry wounds were found on ventral abdominal wall (57%), involving the left upper quadrant in 31.6% patients. Intra-abdominal injuries, included liver (n=14, 17.7%), spleen (n =12,15.2%), kidney (n=4, 5.1%), pancreas (n=4, 5.1%), stomach (n=12, 15.2%), small bowel (n=34, 43%) and large bowel (n=35, 44.3%). 41 patients have multiple organ injury. Associated injuries were present in 50.6% cases. Postoperative complication included wound infection in 30.4%, wound dehiscence in 6.3%, abdominal sepsis in 3.8% and mortality in 8 (10.1%) patients. Average hospital stay was 8 days. Conclusion: This study has highlighted the pattern of visceral injuries that can be predictable in firearm trauma patients even before exploration. The entry wound, clinical stability and the surface area of visceral organs are the major determinants in predicting pattern of visceral involvement.
 
Objective: To determine frequency of knee osteoarthritis (OA) and its association with hip abductor muscle strength and difficulty during ascending and descending stairs among osteoarthritis patients. Methodology: This cross sectional study was conducted on 167 female patients presenting with knee OA in different hospitals of Lahore. We used a standard knee osteoarthritis-linked health assessment survey, WOMAC Osteoarthritis Index. Muscular strength of hip abductors was investigated using manual muscle testing grading system. Data were analyzed using SPSS 21. Results: Mean age of patients was 58.33+8.836 year (range 45-82). We found 91(54.5%) patients had left knee, 63(37.7%) right knee and 13(7.8%) had bilateral knee OA. Positive association was seen between knee OA with difficulty while climbing stairways (p=0.018) and also with strength of hip abductors (p=0.001). However, no significant association existed between OA of knee and difficulty while moving down stairs (p=0.073). Conclusion: The knee OA was frequent among female patients. There was positive association between knee OA and difficulty while ascending staircase but no significant relation exist between OA of knee and trouble during going down steps. An association between knee OA and strength of hip abductor muscles was found, which showed that in knee OA, hip abductors i.e., gluteus medius were more prone to weakness as compared to others hip muscles in this study.
 
Objectives: To determine knowledge, attitude and practice of medical students and interns towards research, to identify factors affecting research knowledge and to improve research knowledge among a group of new graduates through a research methodology educational intervention course. Methodology: Both cross- sectional study and intervention educational program were conducted in King Abdulaziz University, Jeddah in 2012. A total of 260 medical students and interns were selected using multistage stratified random sample. A pre-constructed, confidential, validated, self-administered questionnaire inquiring about research knowledge, attitudes and practice was used. A Pre-test and Post-Test were implemented among 33 new graduates. Results: The cross-sectional study revealed that knowledge about research was generally low. Study participants who received research training and conducted researches had significantly higher knowledge score compared to others (p<0.05). Positive research attitude was present. Regarding practice, 38.1 % of medical students and interns participated in researches and 5.8 % published a scientific paper. Marked improvement of mean knowledge score occurred after the educational program (p<0.001). Conclusions: Low knowledge, positive attitudes and fair practice prevailed from the cross-sectional part. Intervention program was successful in improving research knowledge.
 
We present a rare case of aberrant hepatic artery in a 40-year-oid male with a history of chronic cholecystitis. During laparoscopic surgery, the artery found to pass anterior to the body the gallbladder and bifurcating anterior to the gallbladder body. The surgery was uneventful. We present this anomaly of the rare condition of aberrant right hepatic artery which should be in mind during laparoscopic cholecystectomy, because inadverant injury could lead to massive bleeding and increase co morbidities.
 
Objective: To correlate results of Transvaginal sonography with those of hysteroscopy and biopsy in abnormal uterine bleeding to estimate the accuracy and analytical values of non-invasive transvaginal sonography in abnormal uterine bleeding. Methodology: This cross-sectional Study was carried out at BMCH, Quetta, Balochistan, Pakistan from March 2013 to February 2014 and included 200 patients of abnormal uterine bleeding. Exclusion criteria were pregnancy, virginity, local bleeding of perineal or vaginal origin. Hysteroscopy and biopsy and Transvaginal Ultrasound (TVS) were performed in all. Result: The most common type of bleeding was found to be menorrhagia in 39% while the least common type was postmenopausal bleeding in 9%. Mean endometrial thickness was 11.64 mm and it was noted that at less than 14mm thickness no serious pathology was found. Sensitivity of TVS for endometrial hyperplasia was found to be 66.66% while specificity was 100%. Positive analytical value was 100% while negative value was 100%. Overall sensitivity calculated for TVS was 94.44%, specificity 98.55%, PPV was 81.93% and NPV 98.55%. Conclusion: Sensitivity and specificity of TVS were lower than hysteroscopy and biopsy but the difference was not significant. TVS can be used as first line investigation while hysteroscopy and biopsy may be left for cases of high risk or in those cases where some positive findings could be found on TVS.
 
Objective To evaluate the frequency of abnormal urine routine examination (RE) in order to justify the clinician's frequent requests and use of test either as diagnostic aid to confirm provisional clinical diagnosis or a tool for accidental diagnosis. Material and Methods A total of 2000 urine samples received from 1st Sept 2008 to 10th May 2009 were processed in Raazi Diagnostics Pathology Laboratory, Rawalpindi. They were examined for proteins, glucose and blood using Combur-10 urine test strips (Roche) and leucocytes using light microscope. The tests with one or more above mentioned abnormal findings were labeled as Positive. Results Out of 2000 samples*39.8% showed positive results. Pyuria was seen in 25.8%*glycosuria in 7.8%*proteinuria in 7.1% and hematuria in18.35% cases. Tests with positive physicochemical findings were 26.2% and tests with both leucocytes and positive physicochemical findings were 12.25%. 23.7% samples were from male patients*out of which 34% were positive. 76.3% samples were from females*out of which 41.6% were positive. Pyuria was found more in females (29.9%) while hematuria was higher in males (20.9%). 942 (47.1%) samples were received in the morning, 707 (35.4%) in the evening and 351(17.5%) during the night. Pyuria (30.4%) was detected more in evening and proteinuria (18.8%) more in night shifts. The frequency of positive samples increased with age*more so in physico-chemical than microscopic aspect. The price of urine R.E in private sector laboratory is Rs 50-150/test. The cost of 2000 tests is estimated at Rs 100000- 300000*out of which Rs 40,000-120,000 were for positive tests and Rs 60,000-180,000 for negative tests. Conclusions The detection of abnormal findings in urine was 39.8% Urine RE test indicates fairly satisfactory diagnostic yield. Pyuria was the commonest abnormality seen especially in females. The research and better strategies are needed to improve diagnostic yield in children. The guidance of patients and health care professionals to improve current practices of sample collection and examination can yield more positive results. The clinician should order lab investigations after conscientious justifications.
 
Objective: To find the frequency of microalbuminemia in type II diabetic patients and to determine the frequency of different abnormalities of lipid profile in Type II diabetic patients with and without microalbuminuria. Methodology: Total 344 patients of type-11 diabetes mellitus of both genders between the age of 35-70 years were enrolled in the study from Lahore General Hospital, Lahore, Pakistan. Blood sample for lipid profile was collected after 12 hours of fasting and spot mid stream early morning urine sample was collected in laboratory for microalbuminuria detection. Results: Out of 344 cases, 151 (43.90%) were male and 193 (56.10%) were females with male to female ratio of 2:1. 132 (38.37%) cases were between 35-50 years of age while 212 (61.63%) between 51-70 years of age (mean 53.18+9.32). Frequency of microalbuminuria was recorded in 32.56% (n=112) cases. Out of 112 cases of microalbuminuria, Hypertriglyceridemia was seen in 98 (87.5%) cases, increased LDL-C in 102 (91%) while decreased HDL-C was found in 95 (84.8%) cases (p=0.000). Out of 232 cases of without microalbuminuria, hypertriglyceridemia was found in 143 (61%) cases, increased LDL-C in 151 (65%) and decreased HDL-C was seen in 169 (72.8%) cases. Frequency of microalbuminuria was seen more in age group of 51-75 years (n=65) with disease duration of more than 3 years (n=71), HbA1c ?6 (n=69) and BMI more than 30. Conclusion: The frequency ofhypertriglyceridemia, increased LDL-C and decreased HDL-C is higher in type II diabetic patients with microalbuminuria as compare to patients without microalbuminuria and is dependent on advanced age, duration of disease and BMI.
 
Objectives: To evaluate various abnormalities of semen and assess azoospermia in Sukkur region of Sindh. Methods: Five hundred seven semen samples were analyzed. They were either advised by their clinicians, consultants or out of their self-awareness of semen analysis. Individuals using the facilities available in laboratory for this purpose opted either for masturbation or intercourse. These fresh samples were kept at 37°C for 1/2 an hour for liquefaction. Semen samples were examined within 1 hour. Results: Out of 507 samples, these were age groups: 15-24, n=85, 25-34, n=302, 35-44, n=101, 45-54, n=15, and 55-onwards, (n=4. Various abnormal shapes of spermatozoa were observed and small round headed with short tailed (29%), small-round headed with long tailed (16.56%) and small round headed with short and long tailed spermatozoa (37.28%) were recorded. Predominant abnormal forms of spermatozoa were of small round headed with short and long tailed (n=122) were observed. The total percentage of azoospermia was 17% and major age group affected was (25-34) followed by age group (35-44) and (15-24). Conclusion: It was concluded that 17% of individuals tested were affected by azoospermia. Efforts are to be focused on the determination of the factors causing variations in sperm cells, low count and azoospermia in developing countries.
 
Objective: To compare the conduction abnormalities between anterior and inferior myocardial infarction. Methodology: This study was conducted from 1st January 2011 to 30th June 2011 in Cardiology Department, Lady Reading Hospital, Peshawar. Patients who presented with acute myocardial infarction were included in the study. Patients having renal failure, hypokalemia, hyperkalemia, history of valve replacement, coronary artery bypass graft and those who were using beta blockers, digoxin or calcium channel blockers were excluded from the study. Results: Out of of 600 patients, 309 had acute anterior myocardial infarction and remaining had acute inferior myocardial infarction and 70% were male. Mean age was 58.8±12.5 years. Conduction abnormalities were seen in 12.16% patients. Amongst patients with Ant Ml, 3.5% developed atrioventricular blocks and 7.1% intraventricular conduction defects. In inferior Ml, 11.3% were atrioventricular and 2.4% were intraventricular conduction defects. Conclusion: Conduction abnormalities are common findings in acute myocardial infarction. Intraventricular conduction abnormalities are more common in anterior Ml and atrioventricular conduction abnormalities are more common in inferior Ml.
 
Objectives: To evaluate the hematological derangements associated with malaria and response to treatment in children. Methodology: It was a retrospective cross- sectional study using convenience sampling, carried out in the Pediatrics and Pathology departments, Madina Teaching Hospital, Faisalabad, Pakistan from November 2012 to October 2013. All children up to age 16 years, who were suffering from malaria, were included in the study. Results: Out of 104 children, 66 (63.5%) were male and 38 (36.5%) were female. Anemia was found in 58 (55.8%) children. Clinically, Splenomegaly was present in 75 (72.1%) of patients (p=0.04). Thrombocytopenia (platelets count <150,000/μL) was found in 82 (78.8%) of children (p=0.001). Most of the patient (91.5%) responded to 4 doses of chloroquine (CQ) and only 8.5% were CQ resistant. Conclusion: In an acute febrile illness with marked thrombocytopenia, P. vivax malaria should be kept as a differential diagnosis.
 
Objectives: To unfold any relationship of ABO blood groups to medical diseases and personality traits. Methodology: This cross sectional study was carried out in the Medicine Department of Fauji Foundation Hospital, Rawalpindi Pakistan from May 2016 to September 2016 and 75 individuals were included. The Tube method involving both forward and reverse blood typing was used to determine the blood groups of the individuals. They were asked about the existing medical illnesses and available records were also checked prior to labeling the patients with a particular ailment. Five personality traits were evaluated. The relationship of ABO blood group with medical diseases and personality traits was studied by Contingency Coefficient. The independent predictors of ailments and personality traits were analyzed by regression analysis. Results: The commonest blood group was B+ive; physical illness was allergic rhinitis and personality trait was opened to gain new experiences. ABO blood groups didn’t show any association with medical illnesses (p>0.05). We found no association of blood groups with personality traits (p>0.05). Blood group was not an independent predictor of medical ailments and personality traits (p>0.05) but age was found to be predictor of ailments (p<0.05). Conclusion: No association of ABO blood group with medical illnesses and personality traits was found in this study.
 
Objective: To determine the frequency, demographics, type of abortionist, method used, and morbidity associated with complicated cases of unsafe abortion admitted to a tertiary care hospital. Methodology: This descriptive study was conducted over a period of two years from 1st January 2010 to 31st December 2012 at the department of Gynecology, SMBBMU Larkana, Pakistan. All patients who had the history of induced abortion of <22 weeks of gestation, terminated outside our hospital were admitted. The information recorded included drmo graphics, reason for opting abortion, place of abortion and expertise of the person who carried out the procedure and its subsequent morbidity. After evaluation, and primary resuscitation, theywere managed according to their morbid condition. Data were analyzed using SPSS version 20. Results:During the study period, total number of admissions were 4952, and among them 452 were cases of abortion. Out of these, 60 had induced abortion making the frequency of 0.605% (6 per 1000 per year) of all the gynecological admissions and 6.63% (66 peri 000 per year) of all the cases of abortion. Mean age of patients was 33.5±4.1year. 48(80%) patients belonged to poor socioeconomic class and 58(96.7%) were illiterate. Abortion was induced by Dai (33.3%), Doctor (33.3%), Lady health visitor (LVH) (26.7%) and Traditional birth attendant (6.7%). Methods used were Dilatation and evacuation (55%) and oral misoprostol (45%). Bleeding per vaginum was the most common complication affecting 35(58.3%) patientsfollowed by sepsis and uterine perforation. Conclusion:Induced abortion is a menace resulting in significant maternal morbidity, affecting 6 per 1000 of all gynecological admissions per year. These abortions were mainly induced by Dais and LHVs.Bleeding per vaginum was the most common presenting feature of induced abortion.
 
Objective To determine maternal and fetal morbidity with abruptio placentae and its outcome in these patients. Patients and Methods This cross-sectional study was conducted in the department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from February 2007 to January 2009. After ruling out other causes of antepartum hemorrhage, 50 patients of abruptio placentae after 20 weeks gestation admitted to labor ward were included in the study. Various maternal and fetal complications were noted. Results Only 10 (20%) patients were booked at JPMC for delivery and remaining 40 (80%) patients were non-booked and were admitted through emergency. Anemia was found in 22 (44%) patients, renal failure in 3 (6%) and disseminated intravascular coagulopathy in 5 (10%) patients. In 3 (6%) patients abruption had occurred in previous pregnancy. Hypertension was the most common associated risk factor found in 44% patients. Anemia, multiparity and advanced maternal age was also strongly associated with abruption. Placental abruption was more common in age group 31-40 years and grandmultipara (>P5). Forty (80%) patients had vaginal deliveries while in 10 (20%) patients caesarean section was performed; out of these one had caesarean hysterectomy due to life threatening PPH. Couvelaire uterus were found in 3 (6%) patients and PPH occurred in 14 (28%) patients. 70% patients received blood transfusion with quantity ranging between 1-5 pints, FFP ranging between 0-6 pints. No maternal death was seen. Out of 50 births, 18 (36%) babies were born alive, 25 (50%) babies were stillbirths and early neonatal death occurred in 7 (14%). Perinatal mortality was 64%. Conclusion Placental abruption can result in significant morbidity in both mother and fetus.
 
Objective: To determine the frequency of anemia and need for blood transfusion in patients of placental abruption. Methodology: This prospective cross sectional study was conducted at Department of Obstetrics & Gynecology for a period of 15 months from September 2010 to December 2011. All pregnant ladies who presented with Abruptio Placentae were included by completing a proforma for each patient. After confirming the diagnosis, the blood of these patients was sent to laboratory for hemoglobin level, blood group and other routine investigations. According to hemoglobin level and the amount of bleeding, the number of blood units required by each patient was recorded. The data was analyzed on SPSS v 15. Results: 100 patients suffering from placental abruption were studied. 83% ladies were anemic and 61 were moderate to severely anemic. 98% received blood transfusion and 91% received 1-4 units of blood. Conclusion: Majority of patients presenting with placental abruption were found to be anemic and required multiple blood transfusions. The association between anemia and placental abruption is well documented, however, it needs to be established whether anemia leads to abruption or anemia is the consequence of abruption.
 
Objective: To determine the effects of placental abruption on the mode of delivery, whether vaginal or abdominal, primary PPH and baby's weight. Patients and Methods: This descriptive studyincluded 25 pregnant patients with APH whose clinical diagnosis was placental abruption. Placenta was examined after delivery and labeled as less than 50% abruption, or more than 50%. Mode of delivery, occurence of primary PPH and weight of baby were recorded. All patient were followed till time of discharge. Results: Out of 25 women, vaginal delivery occured in 64% and abdominal delivery in 36%. Primary PPH occured in 32%, and 28% babies had weight below 2.5kg. But 16% babies had early neonatal death (ENND). No maternal mortality occured. Conclusion: Placental abruption had a profound impact on both maternal and perinatal complication including DIC, couvelaire uterus, severe birth asphyxia and perinatal death.
 
Lymphocytic mastitis is an uncommon fibro- inflammatory breast disease, found in association with some auto-immune disorder e.g Type 1 diabetes, rheumatoid arthritis, Sjogren's syndrome etc. I am reporting a rare case of was normal, but the right breast was swollen, skin red and warm with lymphocytic mastitis in a 25 year old Indonesian patient with involvement of one breast and having no known under lying risk factors.
 
Objective: To review our experience in treatment of breast abscess by using needle aspiration under antibiotic cover. Methodology: This descriptive case series study was conducted from January 2012 to December 2012 at Department of Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan. A total of 64 female patients with breast abscess up to 5 cm in size were included in the study. Aspiration was done by using 14 G needle in OPD. Patients were followed up after one week and further aspirations were performed, if deemed necessary. Results: Mean age was 23 years, 89% patients were lactating and only 11% non-lactating. Commonest presenting symptom was painful swelling (100%) followed by fever (18%). 25% were cured with single aspiration, 51.56% required a second aspiration and 18.75% needed multiple aspirations (p=0.001). Incision & drainage was done in 4.68% cases, who failed to respond to multiple aspirations. Conclusion: Needle aspiration under antibiotic cover is an effective way of treating smaller breast abscesses with less discomfort and low morbidity.
 
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  • Asian Institute of Medicine, Science and Technology
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  • American University of the Caribbean School of Medicine, St Maarten
Tariq Wahab Khanzada
  • Rustaq Hospital
Abdul Samad
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