JFJMC Current Issue

Journal of Fatima Jinnah Medical College

Vol. 11, Issue 1, Jan-March 2017


Association of CRP Level with The Outcome in Patients with Cerebrovasular Accidents: A Case-Control Study

 MUHAMMED ADNAN ASLAM, SARDAR FAKHAR IMAM, FAHEEM SAEED, AHSAN NAUMAN

1Assistant Professor Neurology, Fatima Jinnah Medical University Lahore. 2Professor of Medicine, Vice Chancellor, Fatima Jinnah Medical University Lahore. 3Assistant Professor Neurology, Fatima Jinnah Medical University Lahore. 4Professor of Neurology, Lahore General Hospital Lahore

Corresponding Author: Dr Muhammad Adnan Aslam, Assistant Professor Neurology, FJMU / Sir Ganga Ram Hospital Lahore. Email: dradnan.aslam@yahoo.com, Contact: 03216388979

 ABSTRACT

Introduction: Cerbrovascular Accidents (CVA’s) are a major burden over the society with highly associated mortality as well as mortality. Therefore it is important to find the markers which may help us in order to determine its prognosis.

Objective: To determine the mortality rate and frequency of poor outcome among patients presenting with CVA along with the relation to higher and normal CRP levels obtained within 24 hours of the start of symptoms

Material and Methods: This case-control study was conducted at Neurology department of Sir Ganga Ram Hospital/ Fatima Jinnah Medical University, Lahore. Total duration of study was 18 months, from January, 2015 to June, 2016. All the patients with CVA presenting in Emergency department of the hospital within 24 hours of start of symptoms were included in the study. Patients underwent CT scan to confirm the diagnosis of CVA. Their blood sample of 3 ml quantity was obtained for CRP levels. According to CRP level, they were dichotomized into 2 groups: ≥6 mg/L (Cases); <6 mg/L (Controls). They were re-assessed after 3 months of presentation using modified Rankin Scale (mRS) for morbidity and the mortality. All data were analyzed by SPSS version 20.

Results: A total of 235 patients were included in the study. They were dichotomized into two groups according to CRP level and 156 patients were in control while 79 patients were in case group. The mean age of patients was found as 63.9 ± 10.9 years and 66.19 ± 12.01 years in both groups. The mRS score was assessed at 3- months follow up and it was found that the mortality occurred among 29 patients (18.5%) in patients in Cases group while in 9 patients (11.3%) in Control group (P = 0.156). Also poor outcome was found in 76 patients (48.7%) in Cases while in 26 patients (32.9%) in Control group (P = 0.020). Odd’s Ratio was calculated for poor outcome in both groups and it was found as 1.937 (1.101, 3.406) and 1.776 (0.795, 3.963) for mRS>2 and mortality respectively.

Conclusion: We conclude that CRP level is an easily available test and if it is higher than normal in patients with CVA, it is associated with poor outcome and higher mortality. So we may use this test routinely in order to predict the morbidity of the disease.

 Keywords: Cerbrovascular Accident; Ischemic stroke; intracerebral hemorrhage; C-reactive protein; Outcome

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Evaluation of Complications in Children after Liver Transplantation: A Single Centre Study

1MUHAMMAD ARSHAD ALVI, 2IQTADAR SEERAT

1Assistant Consultant, Paediatric Gastroenterology, Hepatology & Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia, 2Consultant Paediatric Gastroenterology, Hepatology & Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia

Correspondence: Dr Muhammad Arshad Alvi, Assistant Consultant, Paediatric Gastroenterology, Hepatology & Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia. Contact No: 00966556255467 Email: alviarsh@gmail.com

ABSTRACT

Objective: To evaluate complications in children after liver transplantation so an early referral and appropriate management could be instituted to improve the late outcome.

Study Design: Retrospective observational study.

Place and Duration of Study: The study was carried out at the Department of Pediatric Gastroenterology, Hepatology & Nutrition, KFSH&RC, Jeddah, Kingdom of Saudi Arabia. The data between 1/10/2006 and 1/10/216 was included and analysed.

Materials and Methods:

Sample Size: 15 patients fulfilled the criteria of selection and were recruited in the study.

Sampling Technique: The data was collected from the hospital’s electronic records: power chart system.

Data Collection Procedure: A spread sheet was designed to collect data regarding demographics, primary diagnosis, long-term morbidity such as drug related complications, viral and bacterial infections, recurrence of cholestasis and primary disease, lympho-proliferative disease and graft versus host disease.

Data presentation: The data was presented in percentages and frequencies in the form of charts and a table.

Results: Among 15 children 12 were males, male to female ratio was 4:1. The median age at liver transplant was 2.5 years. Eight patients (53%) had either one or more episodes of bacterial infections, in the form of UTI, Sepsis, and throat infection. Five children (34%) developed EBV infection and 3 (20%) had CMV infection. Hypomagnesaemia was found in 14 (93%) children, while hyperphosphataemia and hypophosphatemia were noted in 9 (60%) and 5(33%) children respectively. Three (20%) children developed renal failure. Two (13%) children had recurrence of cholestasis, 1 (7%) child developed biliary stricture and another (17%) had chronic rejection. Only one child expired and the overall survival rate was 93%.

Conclusion: Infections and drugs related electrolyte abnormalities were the most common complications noted in children, 6 months after liver transplantation. With early detection and appropriate management, majority of complications could be detected and managed, which would have an impact on the long term survival.

Key Words: Liver transplantation, Complications, Infections, Drugs, Electrolytes

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Genesis of Low Backache in Young Adults

BASMA KHAN,1 TASHHIR RANA2, SAMAN CH3, SHAHID WAHEED4

1Associate Professor, Radiology Department, FJMU/SGRH, Lahore, 2Professor of Radiology & HOD, Sharif City Medical & Dental College, Lahore.3Assistant Professor, Radiology Dept, FJMU/SGRH, Lahore.4Professor of Radiology & HOD, FJMU/SGRH, Lahore.

Correspondence Author:- Dr. Basma Khan, Associate Professor of Radiology, FJMU/SGRH, Lahore.

Email:basmakhan60@hotmail.com 

ABSTRACT

Objective: To establish relevance between low back pain and transitional vertebra at lumbosacral junction.

Research Design: was qualitative, descriptive and cross sectional.

Setting: The study was conducted at the Department of Diagnostic Radiology, Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore in collaboration with the Departments of Orthopedics, Neurology, Medicine and Neurosurgery of the same hospital who were referring patients with backache for X-Rays.

Duration: Study period was six months from Nov 2015 to April 2016.

Sample Size and Selection: First 200 patients referred to Radiology Department during the study period with the presenting complaint of low backache and advised MRI.

Sampling Technique: Random/ Non Probability and convenient sampling.

Materials and Methods: Patients referred to the Radiology Department for X Ray Lumbosacral spine and MRI. These young adults had presenting complains of  with low backache referring to one of the legs, restricted body movements first with activity and later at rest, numbness and foot drop.  Bony changes and normal variants such as sacralisation and changes occurring in the visualized spine secondary to this variation were first documented on digital X- Rays taken at right angles to one another mostly as frontal and lateral of the lumbosacral spine. The patients were then referred for MRI Lumbosacral Spine, which confirmed not only the bony but also associated soft tissue abnormalities as well.

Results: The results of our study showed that sacralisation is a very common finding and manifests in the form of early degenerative changes in the Lumbosacral spine.

Conclusion: Identification of a transitional vertebra is important in young adults as it is a common cause of low backache.

 Key words: Spondylosis, sacralisation, MRI.

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Awareness and Practice of Blood Donation Among Medical Students of AIMC/FJMU

 1MUHAMMAD IMRAN, 2SHABAHAT ALI, 3KHURRAM SHAHZAD, 4BILAL HASSAN, 5AISHA FAROOQ,6SYED SHERAZZAIDI,7MUHAMMAD MUSTANSAR

1MBBS,FCPS-I(Medicine), 2Medical Officer SGRH, 34th Year MBBS Student AIMC, 44th Year MBBS Student AIMC, 5PGR FJMU/SGRH, 63rd Year MBBS Student AIMC, 7Assistant Professor of Biochemistry FJMU/SGRH, Lahore.

Correspondence Author: Dr. Muhammad Imran, MBBS, FCPS-I, Email: iemran512@gmail.com

ABSTRACT

Background: The level of awareness and practice concerning blood donation among the medical students is important to be understood as they are projected to convey the information to the general population about the need of voluntary blood donation.

Aims and Objective: The evaluation of knowledge level and practice about blood donation amongst medical students of Allama Iqbal Medical College and Fatima Jinnah Medical University, Lahore.

Study Design: Cross sectional study.

Study Setting: Study was performed among the students of AllamaIqbal Medical College, affiliated with Jinnah Hospital, Lahore. and Fatima Jinnah Medical University, affiliated with Sir Ganga Ram Hospital Lahore.

Duration of Study: 3 September to 8 December, 2016.

Sample Size: 550 Medical Students.

Sampling Technique: Sampling Technique used was non probability convenient technique.

Results: There were550 respondents,162 males and 388 females. Among 162males 94(58%) were donor and68(41.9%) didn’t donate blood. Among 388 females 44 (11.3%) were donor and 344(88.7%) didn’t donate blood. Causes: for not donating the blood were, weakness (23.8%),fear of needle prick (5.6%) , fear of blood borne diseases (5.3%), fright of becoming fat (3.3%) and no proper reason (37.5%).There was no note worthy dissimilarity in awareness amongst males and females, but blood donation practices were found to be markedly higher in males.

Conclusion: Blood donation compaigns and seminars are not enough to motivate them to donate blood, Collaborative awareness sessions may be arranged to strength then practice of blood donation.

Key words: Blood donation, Awareness, Practice, Medical students

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Frequency and Antimicrobial Sensitivity Spectrum of Bacterial Pathogens Responsible for Neonatal Sepsisat Sir Ganga Raam Hospital, Lahore

 1JAVARIA ABDUL JABBAR,2KOKAB JABEEN, 3JAVERIA GUL

1Postgraduate Resident Histopathology, Fatima Jinnah Medical University, Lahore.2Assistant Professor, Microbiology, Fatima Jinnah Medical University, Lahore.3Senior Demonstrator, Microbiology, Fatima Jinnah Medical University, Lahore.

Correspondence: Dr. Javaria Abdul Jabbar, House number 366-DD, Phase IV, Defence Housing Authority, Lahore. Cell: +92-304-4093636, E-mail id: javarya_81@hotmail.com

 ABSTRACT

Background: Neonatal sepsis is a life threatening problem in neonates which is one of the major contributor of neonatal mortality especially in developing countries.The aim of our study is to enlist the organisms predominantly responsible for neonatal sepsis in our hospital and todeterminetheirantimicrobialspectrumofsensitivity. Surveillance should be conducted shortly apart (every 3-6 months) to update the causative organisms and their sensitivity spectrum in particular localities.The administration of organism specific antibiotics will be helpful in decreasing the number of multidrug resistant strains which are spreading due to the administration of broad spectrum antibiotics, being given to patients on empirical grounds.

Aims & Objective: The aim of our study is to determine the bacterial pathogens commonly responsible for neonatal sepsis in our setup and to determine their antimicrobial spectrum of sensitivity. This will help us deciding which antibiotic should be administered empirically to the patients presenting to us with neonatal sepsis, when a culture report is awaited.

Study Design:Cross-sectional observational study.

Setting:Microbiology Laboratory of Fatima Jinnah Medical University, Lahore.

Duration of Study:1st August 2015 to 29th February 2016, (six months).

Subjects and Methods: Study was conducted on342blood culturesamples. These sampleswereculturedandafter confirmingtheoffendingagentitsantimicrobialsusceptibilitypatternwasalso determined.

Results:Outof342bloodculturesamplesreceived,117werepositiveforgrowth.Of117 positivecultures,37samples(32%)showgrowthofCitrobacterspecies,20(17%)ofStaphylococcus aureusand17(15%)ofKlebsiellaspecies.

Conclusion: Thecommonest organism responsible for sepsis in neonates in our setup is Citrobacterspecies, secondmostcommonbeing StaphylococcusaureusandthirdoneisKlebsiella species.

Key words:Neonatal Sepsis, Blood culture, Citrobacterspecies, Staphylococcus aureus, Klebsiellaspecies, Multidrugresistance.

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Determinants of Smoking Among Adolescents (14 -19 Years) in UC Maingri District Narowal

 1HUMAIRA ZAREEN, 2SAADIA SHAHZAD, 3SHAFIQUE JAVAID

Assist. Prof, MCH Dept, IPH Lahore,Assist.Prof, Community Medicine Dept,Shalamar Medical and Dental College Lahore, SMO RHC Shakkargarrah.

Corespondence Author: Dr. SaadiaShahzad, Assist. Prof Community Medicine Dept, Shalamar Medical and Dental College, Lahore Contact No: 03214767918. Email: saadiazahur@live.com

ABSTRACT

Background: Smokingis an important public healthproblem of the present time. It is responsible for high disease burden and mortality among all age groups. Adolescents are rapidly growing and developing young children into adults and get easily indulge into smoking. Many factors contribute to start smoking in adolescent period.

Aims &Objectives: To find out the prevalence of smoking among adolescents aged 14-19 years; to identify the factors responsible for smoking; and to find out association between smoking and various factors among adolescents.

Methodology: Study Design: Cross-sectional survey.

Study Setting: Union Council Maingri, Tehsil Shakargarh, District Narowal.

Study Duration:- One month.

Study Population: All the adolescents living in the union council Maingri.

Sample Size: 300 adolescents aged 14-19 years were selected as study participant by simple random method.

Results: Three-hundred adolescents were selected as study participants.Their mean age and SD was 16.63 ± 1.80years. 27.0% adolescents were smokers. Among 22 adolescents who were not attending school, 21 (95.5%) were smokers. Among 72 adolescents who were working, 58 (80.6%) were smokers. Among 135 adolescents whose fathers were smokers, 67 (49.6%) were smokers. Among 37 adolescents whose brothers were smokers, 28 (75.7%) were smokers. Among 62 adolescents whose friends were smokers, 59 (95.2%) were also smokers.Results showed significant association between adolescents smoking behavior and their schooling, working outside homes, parental and family smoking, smoking of friends and number of friends.

Conclusion:Smoking of family members and friends had great influence on adolescents. Parents and teachers should play their significant roles in preventing adolescents from smoking through health education.

Keywords:Smoking, adolescent, cigarette, prevalence, risk factors.

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Drotaverine for Acceleration of Labour with Reduced Incidence of Caerserean Section and No Postpartum Haemorrhage

 

1NADIA SABEEN, 2FARZANA LATIF,3AQUILA FAZIL

1Senior Registrar LGH, 2Associate Prof. AMC/PGMI/ LGH, 3Assistant Professor FJMU/SGRH, Lahore).

Corresponding Author:- Dr. Nadia Sabeen, House No 52 Block H Model Town Lahore.

Mobile No: 03354063625

ABSTRACT

Aims & Objectives: To compare the outcome in labouring patients receiving drotaverine versus control group.

Setting: Department of Obs & Gynae Unit-III Services Hospital, Lahore. Study Design: Randomized controlled drug trial.

Sampling Technique: Simple Random sampling.Duration of Study:12-10-14 to 11-04-15

Subjects and Methods: A total of 200 patients (100 in each group) were included in the study. group-A was given 40mg of intravenous drotaverine in first stage of labour during active phase and its effect was assessed by calculating the time in minutes to reach the full dilatation of cervix while group-B did not receive any drug and used as control group. The dose was repeated after 2 hours, if the rate of dilatation of cervix was less than 1cm/hr in primigravida and 1.5cm/hr in multigravida. Patients were monitored in postnatal period in first 24 hours for postpartum haemorrhage in both the groups as per operational definitions. Results were recorded on spss version for final analysis.

Results: patients were ranged between 20-40 years of age. Mean age of the patients was 22.51±4.70 and 26.20±4.55 years in group-A and B, respectively. Mean gestational age was 39.35±1.08 weeks in group-A and 39.59±0.99 weeks in group-B. Postpartum haemorrhage was occurred in 13 patients (13.0%) of group-A and 14 patients (14.0%) of group-B. In group-A, 93 patients (93.0%) and in group-B, 76 patients (76.0%) vaginal delivery performed while in 7 patients (7.0%) of group-A and in 24 patients (24.0%) of group-B caesarean section was carried out. There was statistically significant difference between the two groups (p=0.001). In group-A 56 ladies (56.0%) and in group-B 51 ladies (51.0%) were primigravida while 44 ladies (44.0%) in group-A and 49 ladies (49.0%) in group-B were multigravida. Mean duration of first stage of labour was 206.80±24.45 and 308.40±48.69 in group-A and B, respectively (p<0.001). Stratification with regard to parity was carried out.

Conclusion: In Conclusion, The Use Of Drotaverine Hydrochloride During The active phase of first Stage Of Labor Is safe And Effective In Accelerating Labour. Its timely Administration during first stage of labour helps in  faster and smooth progress Of Labor With faster Cervical Dilatation  and minimal side effects.

Key words: Acceleration of Labour, Drotaverine, Caesarean Section

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A Evaluation of Gastrointestinal Causes of Recurrent Abdominal Pain in Children 

1IQTADAR SEERAT,2 MUHAMMAD ARSHAD ALVI

1Consultant Paediatric Gastroenterology, Hepatology & Nutrition, KFSH&RC, Jeddah, Saudi Arabia, 2Assistant Consultant, Paediatric Gastroenterology, Hepatology & Nutrition, KFSH&RC, Jeddah, Saudi Arabia.

Correspondence: Dr Iqtadar Seerat, Consultant Paediatric Gastroenterology, Hepatology & Nutrition, KFSH&RC, Jeddah, Saudi Arabia. Contact No: 00966559629265. Email: iseerat@hotmail.com

 ABSTRACT

Aims &Objective: To evaluate GIaetiology of recurrent abdominal pain in children with and without alarm symptoms

Study Design: Retrospective study.

Place and Duration of Study: This retrospective study was conducted for the time period starting from February, 2016- February, 2017 at the department of Paediatric Gastroenterology, Hepatology& Nutrition, KFSH&RC, Jeddah, Saudi Arabia.

Materials and Methods: 25 children were recruited in this study with history of recurrent abdominal pain. Out of 25 there were 17 children with alarm symptoms and 8 without alarm symptoms. The referrals were made from different specialities of our department and also from a number of local hospitals outside Jeddah.

Results: Out of 17 patients with RAP and alarm symptoms there were 3 cases (17.5%) of reflux oesophagitis, 1 case (5.8%) of eosinophilicoesophagitis, 10 cases (59%) of Crohn’s disease, 1 case (5.8%) of chronic gastritis and2 cases (11.7%) of irritable bowel syndrome were diagnosed. In 8 children without alarm symptoms there were 2 cases (25%) of H.Pylori gastritis, 2 cases (25%) of Crohn’s disease and 1 case (12.5%) of coeliac disease. The diagnosis of irritable bowel syndrome was made in rest of 3 patients (37.5%).

Conclusion: Majority of children with alarm symptoms were diagnosed with organic diseases. Children with ongoing recurrent abdominal pain without alarm symptoms were also found to have organic causes. Therefore children of recurrent abdominal pain even without alarm symptoms should also be investigated and managed by Paediatric gastroenterology team due to high prevalence of underlying organic diseases to avoid any delay.

 Key Words: Recurrent abdominal pain (RAP), alarm symptoms, organic causes, Non-organic causes

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The Outcome of Surgery for Vascular Injuries in Major Limb Trauma

 1AHSAN NASIM,2 MUHAMMAD NASIR, 3ALIA BASHIR

Designation/Department Address. Associate Professor Surgical unit 1 Jinnah hospital/AIMC

Correspondence Author: Dr. Ahsan Nasim, Associate Professor Surgery, Surgical Unit.1, Jinnah hospital/AIMC Lahore. Phone.03004251992, Email. ahsannasim@yahoo.com

 

ABSTRACT

The incidence of vascular injuries of extremities is scaling new heights in Pakistan. This substantial vascular surgical profile of general surgery demands significant knowledge and skill to manage traumatic vascular injuries.

Aims & Objectives:

  1. To record the mode of presentation of acute peripheral vascular injuries in limb trauma patients admitted through Accident and Emergency Department, Jinnah Hospital, Lahore.
  2. To evaluate and analyze the outcome of various types of vascular repair carried out for such injuries.
  3. Comparison of results with international data.

Study Design: Prospective analytical and observational study.

Setting: Conducted in Surgical Unit-I, Jinnah Hospital, Lahore

Period: From January 2015 to January 2016.

Methodology: A total of 31 limb trauma patients with associated acute vascular injuries were managed.

Results: 30 patients were male and one was female with mean age of 27 years. Major limb trauma associated with vascular injuries were caused by firearm in 19 (61.2%) cases, stab in 3 (9.6%) and blunt trauma in 9(29%).Arterial bleeding from the wound was the commonest presentation in 15 (48.3%) then deficient distal pulses in 13 (41.9%). Upper limb was involved in 15(48.3%) cases and lower limb in 16 (51.6%)cases. 27 (87%) patients had arterialinjuries,4(12.9%) isolated venous and 8 (25.8%) had associated venous lesions. Axillary artery was the most common vessel injured in 7 (22.5%) cases. Autogenous saphenous vein graft was interposed in 17 (62.9%)patients, 6 (22.2%) had endtoend repair and 4 (14.81%) had lateral repair of injured artery. Lateral venorrhaphy was done in 7 (22.58%) venous injuries. 6 (19.3%) developed postoperative wound infection, 6(30%) out of 20fasciotomy wound infection and 5 (16.1%) got distal limb edema. Amputation and mortality rates were 3.22% each.

Conclusion: Timely surgical intervention, regular use of interposition vein graft and low threshold for fasciotomy gave better results. Time is the decisive feature for final outcome of vascular surgery.

Key Words: Major limb trauma, vascular injury

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Frequency of Postpartum Haemorrhage with Intravenous TranexamicAcid versus Placebo in Females Undergoing Caesarean Section at Term

1QURATULAIN ABBAS, 2FARZANA LATIF

1PGR, Obs & Gynae PGMI/AMC/LGH, Lahore, 2Associate Professor PGMI/AMC/LGH, Lahore.

Correspondence: Dr. Farzana Latif, House no.305 Z, phase 3,DHA,LahoreCell no. 03004474649

E-mail:drhammada@yahoo.com.

 ABSTRACT

Background:Obstetrichaemorrhage is an important cause of maternal death and serious morbidity worldwide. Postpartum haemorrhage (PPH) can be prevented by a number of pharmacological agents and surgical procedures which can be use variedly. Among the pharmacological agents Tranexamic acid (TXA) is one of the most important drug that is used to prevent PPH. Thisstudy has been conducted to compare frequency of postpartum haemorrhage with intravenous Tranexamic acid versus placebo in females undergoing caesarean section at term.

Objectives: To compare the frequency of postpartum haemorrhage with intravenous Tranexamic acid versus placebo in females undergoing caesarean section at term.

Methodology:This trail was carried out at Department of Obstetrics and Gynaecology, unit1, Lahore General Hospital, Lahore. The study was conducted after six months of approval of synopsis. Non-probability purposive technique of sampling was used for this study. Total 120 patients were recruited. Demographic details (name, age, gestational age) were obtained. Then, lottery method was used to divide patients randomly in two groups.The patients were given 1 gm. of intravenous Tranexamic acid in group T. Tranexamic acid was prepared in 20 ml of 5% dextroseby the addition of 1 gm (10 ml) of Tranexamic acid.In group P, placebo was given. Distilled water (10 ml) was added in 20 ml of 5% dextrose to prepare placebo. The injection was given 10 minutes before skin incision. Then females underwent caesarean section. After surgery, patients were shifted to ward and were followed-up there for 2 hours postpartum for assessment of blood loss. If blood loss was ≥500 ml, then PPH was labeled (as per operational definition). Both groups were compared by using chi-square test taking p-value ≤0.05 as significant. Frequency was calculated for parity. Data was stratified for age, parity and BMI to address the effect modifiers. Post-stratification Chi-square Test was used in order to check the significance. P-value <0.05 was taken as significant.

Study Design:Randomized Controlled Trial.

Setting:Department of Obstetrics and Gynaecology, unit 1, PGMI / Lahore General Hospital, Lahore.

Duration:Six months after approval of synopsis (18th June, 2015 to 18thDecember, 2015).

Sample Size:Total 120 cases were studied in two groups; Each group consist of 60 cases and it is calculated with 80% power of test, 5% level of significance and taking expected percentage of PPH i.e. 10% with TXA and 28% with placebo in females undergoing caesarean section at term.

Results: In this study 63 (52.5%) women who underwent C-Section have blood loss <500 ml, among these 40 patients were from TXA group and 23 patients were from placebo group .In 57 (47.5 %) women postoperative blood loss was >500ml, among these 17 patients were from TXA group and 40 patients belongto placebo group. The study results show that postpartum hemorrhage was significantly less with TXA than placebo (14% versus 33%) respectively, P<0.05. Statistically, two groups were significant different in terms of PPH (p-value=0.000). My hypothesis was clearly accepted according to results that there are less chances of postpartum haemorrhage with intravenous Tranexamic acid as compared to placebo in females undergoing caesarean section at term.

Conclusion:Our study results concluded that the postpartum hemorrhage was significantly reduced with Tranexamic acid in comparison with placebo (14% versus 33%respectively).

 Keywords:PPH, C-Section at term, Tranexamicacid,postpartum blood loss

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A Study on The Risk Factors of Chronic Kidney Disease Amongst Patients of Jinnah Hospital Lahore

1MUHAMMAD IMRAN, 2BILAL HASSAN, 3KHURRAM SHAHZAD, 4AISHA FAROOQ, 5MUHAMMAD MUSTANSAR

1MBBS,FCPS-I (Medicine), 24thYear MBBS Student AIMC, 34th Year MBBS Student AIMC, 4PGR FJMU/SGRH, 5Assistant Professor of Biochemistry FJMU/SGRH, Lahore.

Correspondence Author: Dr. Muhammad Imran, MBBS, FCPS-I, Email: iemran512@gmail.com

ABSTRACT

Background: Chronic Kidney disease(CKD) is an important cause of morbidity worldwide, and the prevalence is increasing. Hypertension, diabetes, obesity and age are amongst the most important risk factors.

AIMS &OBJECTIVE:To study the socio-demographic and clinical factors in the patients of CKD, and to find which is the most frequent factor associated with CKD.

Study Design: This is a cross sectional study.

Setting:The 4 medical units and the nephrology ward of Jinnah Hospital, Lahore along with the nephrology outpatient department.

Duration of Study:April to May 2016.

Sample Size:80 patients.

Type of Sampling:Non-random purposive sampling

Results: the frequency of hypertensives in the CKD patients was 68.3%,diabetes was present in 46%, 56% of the population was male, 53% had a history of using traditional alternative medicine (Specifically Hakeem Medications). The mean age of the population was 44.3+ 16.5.

Conclusions: Hypertension is the most frequent risk factor found in the CKD patients. However, its control is not upto the mark. Strategies should be employed to control hypertension and diabetes to prevent further progression of disease in this country where there are insufficient medical services.

Keywords: chronic kidney disease, risk factors, hypertension, diabetes

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Abnormalities of Renal and Lipid Profile in Patients with Thyroid Dysfunction and its Implications

ARIF MALIK1, MUHAMMAD ABDUL BASIT ASHRAF1, AHMAD SALEEM2, WAHEED JAMEEL2, MAHRUKH SAGEER1, SHAHZAD AHMAD3, RABIA RASOOL1, GULSHAN PARVEEN1, SULAYMAN WAQUAR1, AYESHA ZAHID1, QURAT-UL-AIN1

1Institute of Molecular Biology and Biotechnology, University of Lahore,2Department of Physiology, Allama Iqbal Medical College, Lahore-Pakistan,3FMH College of Medicine and Dentistry, Lahore-Pakistan

Corresponding author: Dr. Arif Malik, Institute of Molecular Biology and Biotechnology, University of Lahore. Email:arifuaf@yahoo.com. Cell: 0321-8448196

ABSTRACT

Background: Lipid and renal profile is markedly influenced by thyroid disorders; however, the relationship among them has not been analyzed in detail in human.

Methodology: The blood samples of thirty each hyperthyroid, hypothyroid patientand sex-matched clinically apparently healthy individuals were recruited for the present study. TG, LDL, HDL, total cholesterol, creatinine, urea and uric acid were determined with commercial kits.

Results: The results of the present study show that the lipid profile in the patients of hypothyroidism and hyperthyroidism differed significantly. The levels of TCh, TG and LDL were higher (189.45±6.83 mg/dl, 188.67±8.35 mg/dl and 98.27±5.87 mg/dl) in hypothyroid patients as compared to hyperthyroid group (244.39±5.26 mg/dl, 207.52±5.26 mg/dl and 107.56±2.76 mg/dl respectively). Renal profile of hypothyroidism and hyperthyroidism also differed significantly for creatinine, uric acid and urea. Higher levels of urea, uric acid and creatinine were recorded in hypothyroid patients (94.57±2.77 mg/dl, 8.10±0.28 mg/dl and 2.16±0.38mg/dl) in contrast to hyperthyroid group (87.63±1.98 mg/dl, 7.60±0.19 mg/dl and 1.07±0.16 mg/dl respectively) as compared to control.

Conclusion: The present study demonstrated that patients with hyperthyroidism had increased levels of TCh and LDL as compared to patients of hypothyroidism. Increased lipid contents remain associated with cardiovascular diseases hence the risk of cardiovascular and renal diseases remain higher in the patients with thyroid disorder.

Keywords: Thyroid disorders, cardiovascular disease, renal dysfunction, lipid profile, renal profile

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Rate and Frequency of Indications for Caesarean Section (CS) in A Tertiary Care Hospital

1ARJUMAND IFTIKHAR, 2LAMIA YOUSAF, 3YOUSAF LATIF KHAN

1Assistant professor 2Assistant professor 3Professor of Obstetrics & Gynaecology, Hameed Latif Hospital, Lahore. Department of Obs.& Gynaecology, Arif Memorial Teaching Hospital, Lahore.

ABSTRACT

Objective: To determine the rate of caesarean sections (CS) and frequency of their various indications.

Study Design: Cross-sectional study.

Setting: Department of Obstetrics and Gynaecology, Units 1 and 2, Arif Memorial Teaching Hospital (AMTH), Lahore.

Duration: One year, from 1st January 2014 to 31st December 2014.

Methods: All deliveries at gestational age 28 weeks and greater in the hospital during 2014 were included. Data were taken from labour room and theatre registers. Patients’ hospital number,booking status, parity, date of delivery, type of delivery and indications of emergency and elective caesarean sections were recorded.

Results: All deliveries at gestational age 28 weeks and greater in the hospital during 2014 were included. Out of 1100, Multigravidae were 55.1% (606), whereas primigravidae were 44.9% (494). 62.4% (686) were caesareans (CS) and 37.6% (414) were vaginal deliveries. 94.92% (393) were spontaneous vaginal deliveries, 2.41% (10) vaginal births after caesarean (VBACs), 1.93% (8) were assisted breech deliveries (ABDs), 0.48% (2) vacuum deliveries and 0.24% (1) outlet forceps delivery. Out of 686 CS, 62.24% (427) were emergency CS (Em CS) and 37.76% (259) were elective CS (El CS).

Conclusion: Currently AMTH has a high CS rate of 62.4%. If quality of vaginal deliveries is improved and CS in primigravidae is avoided as far as possible ,the number of ElCS can be eventually decreased. Health policy makers and managers should collaborate in designing strategies to improve expertise of dais and general practitioners and improve awareness in population to curtail the number of high risk cases with multiple indications referred for EmCS.

Keywords: pregnancy, caesarean section, indications of CS, delivery, tertiary care hospital.

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