Vol. 10, Issue. 3, July to September 2016

Journal of Fatima Jinnah Medical College, Lahore.

July to September  2016 Vol. 10, Issue No. 3

Prevalence of Non-Motor Symptoms in Parkinson’s Disease Patients


1Assistant Professor of Neurology FJMU/SGRH, 2Vice Chancellor/Professor of Medicine FJMU/SGRH, 3Professor of Physiology FJMU, 4Professor of Neurology AMC/PGMI/LGH, Lahore.

Correspondence Author: Dr. Muhammad Adnan Aslam, Assistant Professor Department of Neurology Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore. Email: dradnan.aslam@yahoo.com


Introduction: Parkinson’s disease (PD) is common neurological illness of geriatric population having cardinal motor features like bradykinesia, asymmetrical resting tremors and rigidity. However it is also associated with certain non-motor symptoms (NMS) which are considered as part of PD. NMS may include urinary symptoms, forgetfulness, gastrointestinal symptoms and skin manifestations and many more with variable frequency and intensity.

Objective: The main objective of study was to find frequency of NMS among patients of PD already taking medications for it.

Material and Methods: This cross-sectional study was done at Neurology department, Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore (FJMU/SGRH) over duration of 1 year from July, 2015 to June, 2016. All the patients already diagnosed with PD and taking treatment for it, were enrolled in study. The Demographic details were assessed. They were specifically asked for NMS by a questionnaire formulated by authors. All the data were analyzed through SPSS version 20.

Results: A total 131 patients were recruited in the study. The mean age of patients was calculated as 58.87 ± 9.45 years. Most of the patients in this study were males which were 64.1% (n=84). The most common symptom found in this study was impaired concentration among 78 participants (59.5%) followed by Sialorrhea in 74 patients (56.4%) , unexplained pain in 69 patients (52.6%), Nocturia (54.1%), urinary urgency (51.1%) and Hyposmia (46.5%). Other NMS symptoms were present with lower frequencies.

Conclusion: We conclude that NMS are quite prevalent in patients with PD in our setup , hence they must be specially taken care when dealing with PD. We also need to educate our patients regarding the presence of these symptoms and physicians to manage them promptly.

 Keywords: Parkinson’s disease; Non-motor; symptoms; Cardinal


Hypocalcaemia in  Postoperative Patients Following Total Thyroidectomy


1Professor/Head of Department Surgery Unit I, Pro-Vice Chancellor FJMU/SGRH, 2Assistant Professor Surgical Unit I FJMU/SGRH, 3Assistant Professor Surgical Unit I FJMU/SGRH, 4Post Graduate Resident FJMU/SGRH, Lahore. 5Consultant Histopathology’s

Correspondence:- Dr. Absar Nazir, Assistant Professor Surgical Unit I FJMU/SGRH, Lahore.

Email Address:- Abbsar71@hotmail.com.


Introduction: Hypocalcaemia is one of the most common and severe complication seen in patients after total thyroidectomy. Reported incidence of hypocalcaemia is 20-30%. Multiple factors are enlisted causing post-operative hypocalcaemia. This study evaluated the occurrence of hypocalcaemia in patients after total thyroidectomy.

Objectives: To identify the frequency of hypocalcaemia and the factors leading to Hypocalcaemia in

Patients undergoing total thyroidectomy

Study Design:            Descriptive Case Series

Place & Duration: we conduct this study in surgical department of Sir Ganga Ram Hospital, Lahore

From March, 2014 to February, 2016

Methodology: All Patients with total thyroidectomy and were above 15years were included in our study

There routine investigation and serum calcium level were done pre operatively and postoperatively serum

calcium level checked after 6,12,24,and 36hours .

Results: Out of 200 patients, Hypocalcaemia occurred in 102 patients. 62 (60.78%) patient developed

hypocalcaemia after first 24 hours while by that time total 86 (84.31%) patient had developed


Conclusion: Frequency of hypocalcaemia after total thyroidectomy was 51%, with most cases found to be

hypocalcaemia after first 24 hours emphasizing the significance of Serum Calcium level during that period.

Keywords: Total thyroidectomy, Hypocalcaemia, Parathyroid hormone.


Congenital Chloride Diarrhoea In Relation With Renal Complications


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

Correspondence: Dr Iqtadar Seerat, Consultant Paediatric Gastroenterology, Hepatology & Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia.

Contact No: 00966559629265 Email: iseerat@hotmail.com


Objective: To assess the significance of early detection of renal complications in children with congenital chloride diarrhoea.

Study Design: Retrospective study.

Place and Duration of Study: This study was done for the time period from March, 2003- September, 2016 in the department of Paediatric Gastroenterology, Hepatology & Nutrition, KFSH&RC, Jeddah.

Materials & Methods: This retrospective study was carried out for the time period starting from March, 2003- September, 2016 for 19 confirmed cases of congenital chloride diarrhoea at KFSH&RC, Jeddah.

Results: Out of19 cases we found 13(68.4%) patients with renal abnormalities. We found 2 cases (15.3%) with end stage renal disease, 3 cases (23%) of nephrocalcinosis, 7 cases (53.8%) with increased echogenicity of both kidneys and 1 case (7.6%) of renal stones.

Conclusion: We conclude that by increasing the level of understanding of disease and keeping good compliance with daily medications, the renal complications could be prevented to improve the outcome.

Key Words: Congenital chloride diarrhoea (CLD), renal complications, compliance, outcome.


Prevalence of Myopia and Peripheral Retinal Degeneration in Medical Students of Fatima Jinnah Medical University


1Professor Ophthalmology FJMU/SGHR, 2Senior Registrar Ophthalmology SGRH, 3Postgraduate Resident FJMU/SGRH, Lahore 4 Assistant Professor Ophthalmology FJMU/SGRH, 5Postgraduate Resident Ophthalmology FJMU/SGRH, Lahore.

Correspondence Author:-Huma Kayani, Professor of Ophthalmology FJMU/SGHR, Lahore.


Introduction: Prevalence of refractive error especially myopia in medical students is high. Documented data pertaining to this question this is not well surveyed in medical students of Pakistan.

Objective: The present study will aim to determine the prevalence rate of myopia in medical students of female medical university in Pakistan.

Study design: Cross sectional, observational study

Materials and Methods: 250 female medical students of 4th year Fatima Jinnah Medical University were evaluated for myopia and dilated fundus examination to rule out peripheral retinal degeneration associated with myopia. All students’ myopic refractive error was assessed using retinoscope and auto-refractometer. Refractive errors have been further categorized according to the Diopteric power. Pupil dilation done with help of tropicamide and retinal examination with indirect ophthalmoscopy and non-contact lens slit lamp biomicroscopy.

Results: Out of 250 medical students, 153 (61.2%) were Myopes. Further subdivision showed 105 (68.63%) as low myopes, 44 (28.76%) as moderate and 4(2.61%) as high myopes. Genetic influence of either or both parents was found in 110 (71.9%) 0f myopes. Peripheral retinal degeneration was found in 33 (21.6%) eyes with retinal breaks in 5 (3.2%) eyes.

Conclusion: Prevalence of myopia is high in medical students and they are more prone to developing early peripheral retinal degeneration.

Key words: myopia, peripheral retina degeneration


Study of Insulin Resistance in Male and Female Diabetics


1Professor of Biochemistry AIMC, Lahore, 2Assistant Professor of Biochemistry, AIMC/SKP, 3Assistant Professor of Biochemistry, AIMC/SKP, 2Assistant Professor of Biochemistry FJMU, Lahore.

Correspondence Author:- Prof. Dr. M Zamir Ahmad, Professor of Biochemistry AIMC, Lahore.


Objectives: To determine the insulin resistance in diabetic type 2 males and females in the fasting state in the population of Lahore, Pakistan.

Methods: The study group comprised of 122 individuals (49 males and 73 females), who were > 30 years old. Parameters, serum glucose and serum insulin levels were estimated in fasting state and based on those, the insulin resistance indices (IRI) was calculated by HOMA-IR 1 in the total sample population, in males and in females separately.

Results: The study group had increased average levels of serum glucose (10.008 + 0.326 mmol/L) and insulin resistance indices (5.370 + 0.396) when compared with the normal adult population. There was no difference based on gender. IRI was significantly different based on groups of W/ht in males. On the other hand, the correlations of all the clinical parameters with their respective serum glucose, serum insulin and IRI were strongly positive (r > 0.8) and highly significant (p value < 0.001) irrespective of gender status and parameter type.

Conclusion: The results for anova could mean that the fat distribution only in males is responsible for metabolic derangements; though the results for correlation show no discrimination based on gender.

 Key words , hyperglycemia, hyperinsulinemia. insulin resistance ,diabetic type 2


Bacterial Meningitis in Children in a Tertiary Care Hospital in South Punjab: A Retrospective Analysis of Clinical and Laboratory Features


1Assistant Professor Pathology Nishtar Medical College Multan. 2Associate Professor Pathology Nishtar Medical College Multan.

Correspondence:- Dr. Asghar Javaid, Associate Professor Pathology Nishtar Medical College Multan.


Background: In children, meningitis is still in the ten common causes of death in many countries. Bacterial meningitis has high incidence of mortality in childhood. Both clinical evaluation and the use of laboratory investigations are important tools in finding cause of bacterial meningitis .

Objective: The purpose of the research is to study the demographic features, yield of gram staining, the incidence and etiology of bacterial meningitis in children of ≥ 2 months to ≤14 years during a 1 year period, from October 2013 to September 2014, in Department of Pediatrics, Nishtar Hospital Multan & in Pathology Department Nishtar Medical College Multan.

Methods: Diagnosis of bacterial meningitis was mainly based on criteria published by the World Health Organization (WHO) .Children having history of intake of antibiotic in the last 5 days which can cross the blood brain barrier and children with tuberculosis meningitis were excluded. The patients were evaluated according to their sex, age, clinical features and pathogenic microorganisms. Patients were divided in three age groups. CSF was collected by lumbar puncture in ward and biochemistry, microscopy , gram staining and bacteriological culture was performed in pathology department .Statistical analysis of data was done by using Microsoft Excel, and SPSS 16.

Results: A total of 130 patients (2.53% of the total admissions) were included in the study. Male patients were 76(58.5%) and 54 (41.5%) patients were female. Out of 130, 54(41.5%) patients were in the age group of ≥2 months-1 year, 40(30.8%) in the group of 1-5 years and 36(27.7%) in group of 5-14 years. 72.3% children were below 5 years in our study . Gram staining was positive in 74(56.9%) cases and negative in 56(43.1%). The most common clinical symptoms was fever and headache and the least was vomiting .The CSF cultures were positive in 60(46.2%) cases and negative in 70(53.8%).The three most common pathogens reported are Streptococcuspneumonia 26 (20%),Neisseriaemeningitidis 20 (15.4%) and Hemophilusinfluenzae b , 12 (9.2%).

Conclusion: Bacterial meningitis is still a very common serious infection in children below 5 years .The most common pathogen involved in the etiology of bacterial meningitis was Streptococcus pneumoniae. The yield of gram staining and culture though comparable with the national studies but lower than reported internationally.

Keywords: Children; Bacterial Meningitis


Complications Risk with Ivanissevich’s Technique for Varicocele Treatment 2 Years’ Experience in Sir Ganga Ram Hospital, Lahore


1Assistant Professor Surgical Unit I FJMU/SGRH, 2Professor/Head of Department Surgery Unit I, Pro-Vice Chancellor FJMU/SGRH, 3Assistant Professor Surgical Unit I FJMU/SGRH, 4Post Graduate Resident FJMU/SGRH, Lahore. 5Consultant Histopathology.

Correspondence:- Dr. Absar Nazir, Assistant Professor Surgical Unit I FJMU/SGRH, Lahore.

Email Address:- Abbsar71@hotmail.com.


Background: Ivanissevich’s procedure is commonly practiced. However it was observed that the complication rate seen in this procedure was quite high then other techniques like Paloma or with laparoscopy..

Objective: We conducted this study to high light complication rate observed in Ivanissevich”s Procedure and discourage this procedure for varicocele treatment.

Methodology: We conducted this study in surgical department of SIR GANGA RAM HOSPITAL LAHORE and 120 patients were included in it, over a period of two years from march 2014 to feb 2016.All the patients selected were having Left Sided Varicocele and we follow up these patients over the period of 6 months. C

Results: Over a period of two years, 102 patients were operated (Ivanissevich”s procedure) for grade II Varicocele .there age ranges between 13 to 45 years with mean of 25.5 years.13patients (13%) developed scrotal edema which settled within ten days, post-operative hematomas observed in 6 patients(6%) and recurrence was the most common complication which was seen in 17 patients(17%).only one patient had testicular atrophy.

Conclusion: Ivanissevich’s procedure has considerable complications then other available procedures like Paloma and Larorscopic Varicocelectomy.

Key Words: Varicocele, Paloma, Hematoma, Hydocele Testicular atrophy.


Accuracy of Lelli Test in Diagnosing Anterior Cruciate Ligament Tear taking Arthroscopy as Gold Standard


Department of Orthopedics, Sir Ganga Ram Hospital, Lahore.

Correspondence to: Dr. Saif-ur-Rehman, Post-Graduate Resident, Orthopedic Department, Sir Ganga Ram Hospital Lahore. Email: drsrehman@outlook.com


Objective: To determine the accuracy of Lelli test in diagnosing anterior cruciate ligament tear taking arthroscopy as gold standard.

Design: It was a cross-sectional survey.

Place and Duration of Study: This study was conducted in the Department of Orthopedics, Sir Ganga Ram Hospital, Lahore from December 2015 to November 2016.

Patients and Methods: 60 consecutive patients presenting in the outpatient department of Orthopedic Surgery Sir Ganga Ram Hospital, Lahore with suspected ACL tear were included in this study. Lelli test was performed in all these patients and the ACL tear was later confirmed upon arthroscopy which was taken as gold standard. A written informed consent was taken from every patient.

Results: There were 52 male and 8 female patients in the study group with a male to female ratio of 6.5:1. The mean age was 28±6.1 years. ACL tear was suspected in 32 patients on a positive Lelli test while actual tear was confirmed in 34 patients on arthroscopy. When cross-tabulated, there were 31 true positive, 1 false positive, 3 false negative and 25 true negative cases on Lelli test. It yielded 91.18% sensitivity, 96.15% specificity and 93.33% accuracy with positive and negative predictive value of 96.88% and 89.29% respectively for Lelli test taking arthroscopy as gold standard.

Conclusion: In the present study, Lelli test was found to be a reliable clinical test for diagnosing ACL tear with sensitivity and specificity superior to conventional clinical methods in current practice.

 Keywords: Anterior Cruciate Ligament Tear, Lelli Test, Diagnostic Accuracy


Rate of Retinal Re-Detachment Following Phacoemulsification and Silicone Oil Removal


1Professor OF Ophthalmology FJMU/SGHR, 2Postgraduate Resident FJMU/SGRH, 3Assistant Professor Ophthalmology FJMU/SGRH,4Senior Registrar Ophthalmology SGRH,

Correspondence Author:-Dr. Huma Kayani, Professor Ophthalmology FJMU/SGHR, Lahore.


Background: Silicone oil injection is a common internal tamponading agent used in retinal attachment surgeries. However it can result in ocular complications like cataract, glaucoma and keratopathy. As soon as retina gains stability it is advisable to remove oil form vitreous cavity. The objective of the study is to evaluate the rate of retinal re-detachment following combined phacoemulsification, intraocular lens implantation and silicone oil removal.

Study Design: prospective, interventional

Methods: 20 eyes of 20 patients with previous history of retinal detachment surgery (pars plana vitrectomy and silicone oil 1000 cst) were operated again once the retina was anatomically stable mean 9±2 SD months after previous retinal surgery. Phacoemulsification with foldable hydrophobic intraocular lens with silicone oil removal using Alcon Accurus Vitrectomy oil ejection system via 23 or 25 gauge pars plan approach was used. Patients were followed up on day 1, 1 month and 6 months postoperative and assessed for visual improvement plus retinal re detachment. Visual acuity, intraocular pressure, anterior and posterior examination using slit lamp and indirect ophthalmoscope was done on each visit. All surgeries (1st and 2nd) were done at single tertiary hospital of Lahore by one surgeon.

Results: 60% males and 40% females in the study group with mean age of 41±15 years. The interval between the two surgeries was 8 to 12 months with mean of 9±2 SD. Visual acuity improvement of at least 2 lines was recorded in majority of patients at the end of last (6 month) follow-up. Temporary hypotony was recorded in first post op day with mean of 11.8±4.5 from pre-op pressure of 17.2±2.4 mmHg which was significant reduction with p-value <0.001. This regained to normal within a few days. Temporary Choroidal detachment 10% and vitreous hemorrhage 15% observed which improved without squeal. No re-detachment was seen in 6 month follow up period.

Conclusion: combined surgical technique (phacoemulsification with silicone oil removal) is a good alternative saving patients from third surgery for cataract extraction. The author believes that due to better surgical machines, instruments, surgical skills and early surgical intervention the rate of retinal detachment following silicone oil has reduced and has better visual results.

Key Words:  Phacoemulsification, silicone oil, rhematogenous retinal detachment, traction retinal detachment, proliferative vitreoretinopathy PVR


Laparoscopic Management of Ectopic Pregnancy


Department of Obstetrics & Gynaecology Hameed Latif Hospital, Lahore, Pakistan

Correspondence Author: Dr Fauzia Anjum, Assistant Professor of Obs & Gynae, Rashid Latif Medical College/Hameed Latif Hospital Lahore. Email:drfauzia83@gmail.com


Background: Laparoscopic management of gynaecological conditions is gaining popularity due to reduced morbidity and shorter hospital stay as well as for better cosmetic outcomes than open surgery. Although laparoscopic intervention is not a new technique for management of ectopic pregnancy in advanced countries; it is still not as common in Pakistan.

Methods: All cases of ectopic pregnancy presenting at Hameed Latif Hospital from 1st Jan 2015 to 31st Jan 2016 were enrolled in this study. Brief history and clinical findings were noted. Trans-vaginal ultrasound and relevant laboratory tests were performed and patients were managed with laparoscopic approach. Findings on laparoscopy were noted and appropriate interventions were undertaken. Any complications identified per-operatively or before discharge from the hospital were also noted. Data were entered in and analysed with SPSS version 21 for windows.

Results: Mean age was 29.2 yrs (SD±5.29), 22(75.9%) patients did not have any past surgical

history while other 7 (24.1%) had LSCS previously. Lower abdominal pain was the most frequent presenting symptom found in 27 (93.1%) patients. Mean systolic BP was 108mmHg (SD±11.67) with a range of 80 to 130 mmHg. Abdominal tenderness was present on abdominal examination in 20(69%) patients. Laparoscopic surgery was an emergency procedure in 23(79%) cases and elective in the rest (21%). Salpingectomy was the most common procedure performed in 14 (48.3%) patients; other procedures included salpingostomy, milking and others. Blood transfusion was required in 11 (37.9%) patients and there were no post-operative complications. No patient required laparotomy and in all patients diagnosis was found to be correct.

Conclusion: Laparoscopic management of ectopic pregnancy is a safe technique with low morbidity rates.

Key Words: Amenorrhea LaparoscopyEctopic pregnancy Salpingectomy


Outcome of Stapled Haemorrhoidectomy, A Systematic Review


1Registrar Surgical Unit I, Sir Ganga Ram Hospital, Lahore. 2Senior Registrar Surgical Unit I, Sir Ganga Ram Hospital, Lahore. 3Assistant Professor Surgical Unit I, Sir Ganga Ram Hospital, Lahore. Professor Surgical Unit I, Sir Ganga Ram Hospital, Lahore.

Correspondence: email: docruxana@gmail.com. Cell: 004917629413830


Objective: The objective of this study is to see the outcome of stapled technique of haemorrhoidectomy in terms of operative time and complications like urinary retention and perineal infection.

Study Design: Descriptive case series

Setting: Department of General Surgery, Unit-I, Sir Ganga Ram Hospital, Lahore.

Duration of Study: Six months from 23-May-2011 to 22-December-2011.

Subjects and Methods: Two hundreds of patients fulfilling the criteria of study were included in the study. All patients underwent stapled haemorrhoidectomy. They were followed up during early postoperative period i.e. first day after surgery, in first week and at 15 days. Postoperative complications like urinary retention and perineal infection were seen, operative time was noted. Other variable i.e. postoperative bleeding (it is the bleeding with bowel movements during first and second week postoperatively) was also noted.

Results: Mean age of patients in study was 46.1±7.9 years. There were 112 (56%) male and 88 (44%) female patients. The mean operative time of the patients was 23.2±3.9 minutes. Postoperative urinary retention was found in 6 (3%) patients. Perineal infection was found in 7 (3.5%) patients and postoperative bleeding was found in 9 (4.5%) patients at 7th postoperative day. No complication was found in any patient at 15th postoperative day.

Conclusion: It was concluded from this study that stapled technique of haemorrhoidectomy reduced the operative time and postoperative complications like urinary retention, perineal infection and postoperative bleeding.

Key Words: Stapled haemorrhoidectomy, postoperative complications, urinary retention, perineal infection, postoperative bleeding.


Comparion of Effectiveness of Nifedipine with Progesterone Depot and Nifedipine Alone for Tocolysis in Preterm Labour


1Assistant Professor Department of Gynaecology FJMU/SGHR, 2Professor/Head of Gynaecology, FJMU/SGRH, 3 Women Medical Officer, SGRH, Lahore.

Correspondence to: Dr. Kanwal Nosheen Assistant Professor Department of Gynaecology FJMU/SGHR, Lahore.


Many tocolytic agents are used to suppress preterm uterine contractions. These include: beta-agonists, calcium channel blockers, prostaglandin synthetase inhibitors, nitric oxide donars, oxytocin receptor antagonists. Among these the calcium channel blockers specifically nifedipine is constantly gaining importance due to its more effectiveness and lesser side effects as compared to the other drugs. In high risk pregnancies, Progesterones had also shown efficacy in reducing the incidence of recurrent preterm delivery . In this study the effectiveness of nifedipine with progesterone depot and nifedipine alone in the tocolysis of preterm labour was compared.

Objectives: To determine the efficacy of nifedipine alone (group-A) and nifedipine with progesterone depot (group-B) for tocolysis of preterm labour.

Study design: Randomized controlled trial

Setting: Obstetrics and Gynaecology unit-III, Sir Ganga Ram Hospital, Lahore.

Duration of study with dates: This study was conducted over period of six months from June 2015 to December 2015.

Subjects and Methods: The study was conducted on 92 patients; i-e: 46 in each group at gestational age of 28-36weeks.

Results: Age range in the study was from 18 to 35 years with mean age of 20.04 ± 5.12yaers. Majority of the patients 40 (43.48%) were between 18 to 25 years of age. The gestational age was from 28 to 36 weeks with mean age of 33.56 ± 2.23 weeks. Majority of the patients 51 (55.43%0were between > 32 to 36 weeks of gestation. Mean parity in group-A was 2.34±1.51 while in group-B was 2.46±1.39.There was cessation of uterine contractions till 48 hours in 22 (47.83%) and no cessation in 24 (52.17%) patients in group-A, nifedipine only ; while in group-B ,nifedipine with progesterone depot, it was seen in 33 (71.74%) and 13 (28.26%) patients respectively. So, efficacy was 47.83% in group-A and 71.74% in group-B with p-value of 0.019.

Conclusion: Through this study it was concluded that nifedipine with progesterone depot was more effective in cessation of preterm uterine contractions as compared to oral nifedipine alone. So, it is recommended that nifedipine with progesterone depot should be used as a first line agent to inhibit the uterine contractions in preterm labour. Thus some benefit can be achieved by prolongation of preganacy , by accelerating fetal lung maturity through administration of corticosteroids. And this would help fetomaternal outcome and reduce the complications related to prematurity .


Keywords: Prematurity, tocolytics, uterine contractions, respiratory distress syndrome.


Dengue Awareness: A Community Survey


1Medical Officer Sir Ganga Ram Hospital, Lahore. 2Medical Officer Sir Ganga Ram Hospital, Lahore, 3Post Graduate Resident,4Assistant Professor AIMC/SKP,

Correspondence Author:- Dr. Memoona Tahir, Women Medical Officer Sir Ganga Ram Hospital, Lahore.



Objectives: To determine the presence of potential indoor breeding sites, to determine the extent of knowingness about dengue and preventive services provided.

Results: Out of 199 respondents, 85.4% knew about Dengue out of which 52.8% regarded it to be a viral disease. Majority had gutter covers among all breeding sites 70.4%. 58.8% had AC and its water leakage and 54.8% had solid waste in the form of tins, shoppers, bottle caps. The commonly used repellant was anti-mosquito spray 39.2% and coils 18.6%. Household cases of Dengue during the last year outbreak were 54.8% and 61.3% in neighborhood. 39.7% respondents were facilitated by the Indoor spraying by the Health team whereas 73.9% had outdoor spraying done by the Health Team. 34.7% respondents reported that recent filling of holes and depressions has been done. The major source of awareness among the respondents is due to Media 94.9%, family and friends 90.9% and doctors 27.6%.

Conclusions: Majority of the people have a good knowledge about Dengue and its transmission which can be either due to greater proportion of educated people in the sample or mass media campaigns since last year outbreak. Still many potential breeding sites have been kept in the houses which are not checked.

Keywords: Aedes aegypti , dengue hemorrhagic fever ,potential breeding sites,global pandemic.


Reasons of Cancellation of Elective Surgical Operations on The Day of Surgery at Sir Ganga Ram Hospital, Lahore


1Assistant Professor Surgery FJMU/SGRH, 2Assistant Professor Surgery, FJMU/ SGRH, 3Associate Professor Surgery, FJMU/SGRH Lahore.

Correspondence Author:- Dr Nadia Farooq Assistant Professor Department of Surgery, Sir Ganga Ram Hospital, Lahore. E.mail:drnadfq@gmail.com


Background: Cancellation of elective operations is a noteable dilemma in many hospitals. Late cancellation of operation affect not only hospital resources but causes emotional disturbance in patients as well.

Objective: To find out the incidence and causes for late cancellation of elective operations.

Study Design: It is a prospective observational study.

Method and material: This prospective observational, hospital based study was conducted in one of the surgical department of Sir Ganga Ram Hospital Lahore for a period of one year from 2nd Jan, 2015 to 3rd Jan 2016.Data was collected of all the patients whose operations were cancelled on intended day of operation and reasons for cancellation were noted on specially designed proforma.

Result: A total of 1440 pts were operated on elective operation list. Eighty four cases were postponed. Cancellation rate was found to be 5.8% mostly due to medical reason (41.7%), followed by shortage of time (25%),blood not arranged (9.5%), strikes (7.1%), administrative reason(6%,) patient restrain (6%), patient not prepared (3.6%) and change of plan(1.2%) respectively.

Conclusion: Most of reasons are avoidable.

KEY WORDS: Elective operations, late cancellation.


Thyroid Surgery with Small Incision


Assistant Professor Surgical Unit I FJMU/SGRH, Professor/Head of Department Surgery Unit I, Pro-Vice Chancellor FJMU/SGRH, Assistant Professor Surgical Unit I FJMU/SGRH, Post Graduate Resident FJMU/SGRH, Lahore. Consultant Histopathologist.

Correspondence: -Dr. Absar Nazir, Assistant Professor Surgical Unit I FJMU/SGRH, Lahore.

Cell: – 03214458511, Email Address:-Abbsar71@hotmail.com.


Introduction: Kochker neck incision has been gold standard for the thyroid surgery, which is given transversely 2 cm above the sternal notch and 8-12cm in length. In late nineties minimal invasive techniques gained popularity, one of them is by giving small [3-5cm] midline incision. . We conducted a prospective study toassess the outcome thyroid surgery with smaller incision and factors influencing the incision length.

Method: The study group comprised of 39 patients underwent thyroid surgery with minimal incision, between March 2014 to February 2016 in surgical department of Sir Ganga Ram Hospital Lahore. All patients were operated by same surgical team.

Results: Out of 39pts, 9 patients were male and 30 patients were female. In 16 patients total thyroidectomy was performed and hemi thyroidectomy in 23 patients. Mean length of incision for total thyroidectomy was 4.5cm and 3.6cm in total thyroidectomy. Length of the incision mainly influence by the volume of thyroid tissue, other factors which play minor role are neck circumference and gender.

Conclusion: In our study ,using an anterior small-incision, minimal complication rates ,good cosmoses obtained and more postoperative comfort place this thyroidectomy technique higher than other. Both physician’s and patient’s satisfaction may be achieved with careful patient selection.

Keywords: Total thyroidectomy, minimal invasive thyroidectomy (MIT).


Outcome of The Endoscopic Repair in Groin Hernias: An Experience of 100 Total Extraperitoneal (Tep) Repairs in Terms of Operative Time, Hospital Stay & Post Operative Pain


1Assistant Professor Department of Surgery KEMU/Mayo Hospital, 2Senior Registrar Department of Gynecology, 3Medical Officer Department of Surgery, 4Professor of Surgery Mayo Hospital, Lahore. 5Professor of Surgery AIMC/Jinnah Hospital, Lahore.

Correspondence Author:- Dr. Somer Masood, Assistant Professor of Surgery KEMU/Mayo Hospital, Lahore.


Background: Groin hernia surgery is the most commonly performed surgery done by surgeons all over the globe.. Although many different techniques are practiced for this but still there is no consensus on the most suitable technique., Recurrences and chronic pain postoperatively is the most common complication in inguinal hernia repair after Lichtenstein’s technique. To reduce postoperative chronic pain, the use of total extra peritoneal placed mesh has been suggested.

Materials and Methods: This study included 100 consecutive inguinal hernia repairs were done by using the Total Extraperitoneal (TEP) technique between April 2014 and October 2015. The, primary endpoint was the early recurrence and the secondary endpoints were the operative time, hospital stay and post-operative pain on 4 weeks follow-up after surgery.

Results: All of the 100 Patients were male with the average age of 42.50, SD ±15.94 years. Early recurrence was noted in only 10 patients (10%) who were assessed clinically at the follow up of the patient at 4th week post-operatively. Mean hospital stay in all the patients post-operatively was found to be as 1.267 days SD ±0.225. Mean operative time of the TEP procedure was found to be 46.68, SD ±10.60 while the mean VAS score at 4th week postoperatively was noted as 3.72, SD ±1.478.

Conclusions:The Laparoscopic Total extra peritoneal mesh repair (TEP) is safe, feasible and effective technique. With this approach, there is reduced early recurrence, operative time, less pain in the post-operative period and the hospital stay.

Key words: Total extra peritoneal, Mesh hernioplasty.


Outcome of Everted End-To-End Urethroplasty in Traumatic Bulbar and Membranous Urethral Stricture


1Associate Professor of Urology , Lahore General Hospital / PGMI / AMC Lahore , 2Professor of Urology & Head Department of Urology , Lahore General Hospital / PGMI / AMC Lahore , 3Assistant Professor of Urology , Lahore General Hospital / PGMI / AMC Lahore , 4Resident of Urology , Lahore General Hospital / PGMI Lahore, 5Resident of Urology , Lahore General Hospital / PGMI Lahore, 6 Professor of Urology , Bahawalpur Medical & Dental College , Bahawalpur.

Correspondence Author: Kamran Zaidi , Assistant Professor of Urology , Lahore General Hospital / PGMI / AMC Lahore. Email : drkamranzaidi@yahoo.com , Contact # +92-333-4257695


Objective: Objective of this study is to determine the result of everted end to end urethroplasty in those patients who have traumatic bulbar and membranous urethral stricture.

Methods: The conducted place of this study was the department of Urology, Lahore General Hospital, Lahore for a duration of one year from 01-01-2012 to 31-12-2012. The included patients were 30 in number in the study. A single surgical team performed the procedure and Uroflowmetry and subjective evaluation was done on 2nd week, 1st month and 4th month and 12th month post operatively.

Results: 24.43±12.39 years were labeled as mean age of patients. The findings of retrograde and Antigrade Urethrogram were that the stricture at bulbo membranous junction was in 2 patients and the blind stricture at bulbar level was in 28 patients. 6.83±4.25 months were the average interval between the initial injury and urethroplasty. Mean length of the stricture was 1.83±0.63 cm after operation. On follow up of 2 weeks after operation, 15 patients were having subjective grading of 1 and 2 respectively (50 % in each). After 1 month of operation, grade 1 was reported in 23 patients (76.67%) and Grade-2 and Grade-3 subjective grading were present in 2 patients (6.67%) in each. 22 patients (73.34%) had 1 Uroflowmetry grading and 8 patients (26.67%) had 2 Uroflowmetry grade after 14 days of operation. After the follow up of 1 month, grade-1 was present in 19 patients (63.34%), Grade 2 was in 6 patients (20%) and Grade-3 Uroflowmetery was present in 2 patients (6.67%). Only 24 patients (80%) had presentation of grade-1 subjective improvement symptom and uroflowmetry at 4th month and 1 year after operation. The recurrence of stricture at follow up of 1 month was in 3 patients (10%) and at follow up of 4 month another 3 patients (10%) developed recurrent stricture in whom Internal Optical Urethrotomy (IOU) was subjected. Among the 6 patients (20%) of stricture recurrence, single IOU was enough for 2 patients (6.67%), 3 patients (10%) improved with 2 times IOU having 3 months interval and perineal urethroplasty was ultimately performed in 1 patient (3.34%) after repeated IOU. Failure was considered if IOU was repeated along with other intervention.

Conclusion: The treatment of choice for short traumatic bulbar and membranous urethral strictures is everted end-to-end urethroplasty having approximate 100% cure rates with minimum complications


Correlation of P53 Expression with Histological Grade and Histological Type of Invasive Breast Carcinoma


1Assistant professor of Pathology, CMH Medical College, Lahore, 2Professor of Pathology, SIMS, Lahore, 3Associate Professor of Pathology, PGMI, Lahore.

Correspondence Author: Dr. Tayaba Javed, Assistant Professor of Pathology, CMH Medical College, Lahore.


Objective: To evaluate expression of P53 in different types of breast CA and correlate it with different grades of invasive ductal CA.

Study design: It is a descriptive study

Place and duration of study: Pathology Department, Post Graduate Medical Institute (PGMI) from 2nd January 2014 to 3rd January 2015.

Material & Methods: A total of 71 specimens diagnosed with invasive breast carcinoma in all surgical specimens (excisional biopsy, incisional biopsies mastectomies) were included in the study. P53 immunohistochemical staining was applied on all the cases. DAKO FLEX monoclonal mouse anti human P53 protein kit was used. P53 staining was done on 4mm sections and interpreted under the microscope. Typing and grading of carcinoma was done according to WHO classification and P53 expression was observed in different types and grades of breast carcinoma. Statistical package for social sciences 20 Data was used for analysis. Qualitative expression was presented in the form of frequency and percentage.

Results: From 71 patients, all 09 cases of grade I carcinoma were P53 negative, 22 cases of grade II carcinoma were P53 negative whereas 12 cases were positive. Among 22 cases of grade III breast carcinoma, 16 were P53 positive while 06 were negative. P53 showed different expression in different types of breast carcinoma. P53 positivity was seen in 28 of 65 cases while rest (37) was negative for it. Mucinous carcinoma showed positivity in 50% of the cases (one was positive and one was negative). Similar results were seen in invasive lobular carcinoma as seening mucinous carcinoma. P53 showed 100% positivity in poorly differentiated (1/1) and metaplastic carcinoma (1/1).

Conclusion: P53 positive expression is a poor prognostic marker. It is seen more frequently in carcinoma with poor prognosis and less frequently in carcinomas with better prognosis.

 Key Words Invasive breast CA, p53, histological grade, Histological type


Diagnostic Accuracy of Doppler Ultrasound in Detecting Tumor Thrombus in Inferior Vena Cava (IVC) in Renal Cell Carcinoma


1Assistant Professor Radiology PGMI/LGH, 2Post Graduate Resident PGMI/LGH,33rd Year MBBS Student CMH, Professor of Radiology AMC/PGMI/LGH, Lahore.

Correspondence Author:- Dr. Nighat Haroon Khan, Assistant Professor Department of Radiology PGMI/LGH, Lahore.


Objectives: To determine diagnostic accuracy of Doppler Ultrasound in detecting inferior vena cava tumor thrombus in cases presenting with renal cell carcinoma taking histopathology as gold standard.

Materials and Method: After informed consent, a total of 125 renal cell carcinoma patients were included in the study. Patients’ demographic data was entered in proforma in each case.

Setting: The study was conducted at the Department of Diagnostic Radiology Lahore General Hospital, for a period of six months from 21-05-2014 to 20-11-2014 , Lahore.

Research Design: Qualitative , descriptive and cross sectional.

Sampling Technique: Convenient/Non probability sampling. All patients underwent Doppler ultrasound to assess the involvement of the inferior vena cava by tumor thrombi. Tumour specimen was sent to hospital pathology department for its histopathological analysis. The results of Doppler ultrasound were conpared with the findings of histopathology as gold standard.

Results: The mean age of subjects was 46.80±17.01 years. In this study 73 (58.4%) patients were male and 52 (41.6%) were female. Color Doppler Ultrasound revealed that out of total 125 patients, 91 (72.8%) had positive findings while 34 (27.2%) had negative findings, whereas, according to the results of the histopathology 90 (72.0%) patients showed a positive result while 35 (28.0%) had a negative result. Setting histopathology as a gold standard, the overall diagnostic accuracy of Color Doppler Ultrasound came out to be 91.2% The sensitivity was 94.44% and specificity 82.86% of Color Doppler Ultrasound. The negative and positive predictive values were found as 93.41% and 85.29% respectively.

Conclusion: Diagnostic accuracy of Doppler ultrasound is high (sensitivity =94.44% and Specificity = 82.86%) in detecting tumor thrombus in inferior vena cava in cases of renal cell carcinoma by taking histopathological findings as gold standard. Due to good diagnostic accuracy of Coloured Doppler ultrasound it can be used as a preferred investigation to CT scan for accurate diagnosis.

Keywords: Thrombus, renal cell carcinoma, Doppler ultrasound


A Brief Overview of Clinico-Pathological Indicators of Breast Carcinoma


1Assistant professor of Pathology, CMH Medical College, Lahore, 2Professor of Pathology, SIMS, Lahore, 3Associate Professor of Pathology, PGMI, Lahore.

Correspondence Author:- Dr. Tayaba Javed, Assistant Professor of Pathology, CMH Medical College, Lahore.


Breast cancer has been rated as the 2nd most frequent type of malignancy. As regards being a cause of death, breast malignancy is ranked fifth in order. The occurrence of breast cancer in underdeveloped countries was low when compared with economically developed world. Mode of presentation varies a lot in breast carcinoma. Pain, palpable lump, knobbly bumpy breast and nipple discharge are the typical presenting modes. In 80 % of cases the most common presentation is a swelling. Pain is a nonspecific symptom regarding carcinomas. A lump is noticed when it is at least 2 cm in size. Other modes of presentation include certain changes in skin color such as redness, and orange peel like appearance (peau d orange), without the presence of lump. Sometimes a delay in diagnosis occurs as it is treated as an inflammation. Female gender is the most crucial risk factor for breast malignancy. 41 to 50 year is the peak age of breast carcinoma, occasionally at 25 years and less than 5% occur in women in age range of 70 to 80 years. Genetic makeup and women with increased estrogen levels like early menarche and late menopause also form a contributory factor. This study focuses on above mentioned clinical parameters, a few risk factors and histomorphological indicators and following formula was used {n = Z2P (1-P)} d2 Women diagnosed with invasive breast carcinoma in surgical specimens like excisional biopsies, incisional biopsies and mastectomies were included in this study and patients with recurrent breast carcinomas who have been receiving treatment line chemotherapy, radiotherapy and hormonal therapy were excluded from this study. This study showed that 55.8% cases left side was involved and in 44.1% cases right sided involvement was seen, 22.5% has breast carcinoma in their first step related while 10% has second step relative breast carcinoma and exposure of radiation was observed in 8%. The main presenting complaints were lump in breast, and skin changes (mentioned above). This study showed that lump in breast was the most common presenting complaint while nipple discharge was the second most frequent, female gender can be rendered a risk factor. The age decade which poses greatest risk was 41 to 50 years. There were cases in less than 30 and under 80 decades as well. Invasive ductal carcinoma was the most common type.

Key Words: Breast Lump, Invasive ductal carcinoma, Metastatic


Haemodynamic Changes During Laparoscopic Cholecystectomy Under Sevoflurane Anaesthesia


Assistant Professor Department of Anaesthesiology, FJMU/SGRH, Lahore.

Correspondence: Dr. Waqar Azim, Assistant Professor Anaesthesiology, FJMU/SGRH, Lahore.

Email: drazim3@hotmail.com


Aims & Objectives: The objective of the study is to determine the effect of sevoflurane on the haemodynamic changes during laparoscopic cholecystectomy.

Methods: In this study total 160 cases were selected. Induction of anaesthesia was done with Thiopentone Na and intubation, with cuffed endotracheal tube, using succinylcholine I/V. Anaesthesia was maintained with Nitrous oxide (66%) in Oxygen and Sevoflurane at 1 MAC. Changes in heart rate and blood pressure were noted during surgery.

Conclusion: Sevoflurane provided good operating conditions throughout the procedure. It provides a safe and effective intraoperative control of cardiovascular homeostasis.

 Keywords: Cholecystectomy, Laparoscopic, Haemodynamics, Sevoflurane.