Vol. 7, Issue 3, JUL – SEPT 2013

EDITORIAL

Diarrhea: Why Children Are Still Dying and What Can Be Done

 AYESHA ARIF

Head of Department of Pediatrics, Fatima Jinnah Medical College / Sir Ganga Ram Hospital, Lahore

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Safe Motherhood: Morbidity and Mortality Associated with Unsafe Termination of Pregnancy

 KHOLA YOUSAF, KIREN KHURSHID MALIK, MARIAM MALIK

 ABSTRACT

Objective: To determine the morbidity and mortality associated with unsafe termination of pregnancy.

Material and Methods: A cross sectional descriptive study was conducted in the Department of Obstetrics and Gynaecology at Sir Ganga Ram Hospital, Lahore from January 2008 to March 2014. A total of 139 patients who presented with history of termination of pregnancy with instruments were included in the study. Data regarding their socio demographic features, reason for termination of pregnancy, nature of provider/facility, complications and treatment were collected and analysed.

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Clinico-etiolological Study of Hoarseness in 100 Patients

 AZHAR HAMEED, BAKHT AZIZ, MOHIBULLAH MUSHWANI, SAJID IQBAL SHEIKH

Department of ENT & Head and Neck Surgery, Unit-I, Mayo Hospital/King Edward Medical University, Lahore

Correspondence: Dr. Bakht Aziz, House # 2, Sector-DD, Phase-4, DHA, Lahore. Email: bakhtaziz@gmail.com

 ABSTRACT

Objective: To evaluate the role of FLEXIBLE FIBER OPTIC NASOPHARYNGOSCOPE /LARYNGOSCOPE in diagnosis of etiology of hoarseness.

Setting: ENT Unit-1 Mayo Hospital, King Edward Medical University (KEMU), and Lahore Period: From Sep 2012 to March 2013.

Material and Methods: Patients were admitted through ENT outpatient department. The data was collected on the basis of history, physical examination, investigations, flexible fiber optic nasopharngoscopy /Laryngoscopy, findings, management and follow up through standard questionnaire.

Background: Hoarseness is a common symptom among patients who present to tertiary care hospitals . Patients with hoarseness are often referred for nasolaryngoscopy for evaluation to exclude serious conditions as laryngeal cancer.

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Incidence and Presentation of Molar Pregnancy at Bahawal Victoria Hospital, Bahawalpur

TASNEEM AKHTAR, ASLAM MEHMOOD MALIK, NOREEN AKMAL, NAILA IHSAN

For Correspondence: Dr. Tasneem Akhtar, Assistant Professor, Department of Obstetrics and Gynaecology Unit II, Quaid e Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur

Email: dr.tasneemakhtar@yahoo.com, 03333005666

ABSTRACT

Background: Molar pregnancy is the most common form of gestational trophoblastic neoplasia.  Incidence of molar pregnancy varies globally and appears to be higher in south east Asia. The objective of this study was to find out the incidence and presentation of molar pregnancy at Bahawal Victoria Hospital Bahawalpur.

Patients and Methods: A 6 year retrospective, descriptive study conducted at Gynae Unit-II of Bahawal Victoria Hospital, Bahawalpur, from 1st January 2007 to 31st December 2012. Diagnosis of molar pregnancy was made on the basis of history, physical examination and investigations. The incidence and mode of clinical presentation was noted.

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Positive Predictive Value of Abnormal Cardiotocography Trace During Labour for Poor Fetal Outcome

ASMA MAHMOOD, KOKAB ZAI, ASIA PARVEN

1PGR Sir Ganga Ram Hospital, 2Senior Registrar AV Siena Medical College, 3Senior Registrar Sir Ganga Ram Hospital, Lahore

ABSTRACT

Objective: To determine the positive predictive value of abnormal cardiotocography (CTG) trace during labour for poor fetal outcome.

Study design: Cross sectional

Duration of Study: Six months from 24 ‐05‐2011 till 24‐12‐2011

Setting: Study was carried out in the department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital, Lahore.

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RBC Parameters in Patients of Systemic Lupus Erythematosus Report of 75 Cases from Lahore, Pakistan

ASMA MUNIR, MONA AZIZ, MANAAL AFZAAL, muhammad usman, ATIYA MAHBOOB

1Consultant haematologist, 2Associate professor of Hematology Shaikh Zayed FPGMI Lahore, 3Senior registrar of Dermatology, Shaikh Zayed FPGMI Lahore, 4Trainee Registrar, Dept of Nephrology, Shaikh Zayed FPGMI Lahore, 5Professor of Dermatology, Shaikh Zayed FPGMI Lahore.

For correspondence: Dr. Asma Munir, 200-D, DHA-EME, Lahore. Pakistan. Email: gemini_twinz01@hotmail.com

ABSTRACT

Background: Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that may virtually affect every organ in the body. It is characterized by the production of a variety of autoantibodies. Haematological manifestations of SLE are diverse. Anemia is the major haematologic manifestations of SLE .

Objectives: To determine the various RBC parameters in patients of Systemic Lupus Erythematosus . Design: Prospective, cross sectional.

Place and duration of study: Department of Haematology, PGMI/Shaikh Zayed Hospital, Lahore from May 2011 to April 2012.

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Assessment of awareness, attitude and practices regarding dietary iodine in pregnant women: a cross sectional survey

MUHAMMAD LUQMAN FARRUKH NAGI1, TEHSEEN HAIDER KAZMI2, SADIA IRSHAD LEGHARI3, SANA NAZ4

Department of Community Medicine, Assistant Professor Shalamar Medical & Dental College, Lahore 1, Professor Shalamar Medical & Dental College,Lahore2, Demonstrator Shalamar Medical & Dental College, Lahore 3 , Statistician, Shalamar Medical & Dental College,Lahore4

 ABSTRACT

Context: Iodine deficiency can impair brain development both in natal and post natal life. There is high prevalence (52%) of iodine deficiency among women of reproductive age in urban areas.

Aims: The purpose of this study is to explore knowledge, prevalent attitude and practices about Iodine consumption in pregnant females of a local community in Lahore, Pakistan.

Settings and Design: Crosssectional study based on non-probability convenient sampling technique. Pregnant women (n=400) of any age have been targeted to respond for the survey.

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The Role of Prophylactic Theophylline in Prevention of Acute Renal Failure in Neonates Exposed to Asphyxia

 IFTIKHAR EJAZ, AFTAB ANWAR, ASMA MUSHTAQ, FATIMA ZEESHAN, IQRA WAHEED

Correspondence: Dr. Iftikhar Ejaz, Associate Professor Paediatrics & Paediatric Nephrologist, Children’s Hospital & ICH, Ferozepur Road, Lahore. E-mail: driftikharijaz777@gmail.com, Cell: 0302-8420335

 ABSTRACT

Background: Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine metabolite leads to a fall in glomerular filtration rate (GFR) and filtration fraction (FF). This might be inhibited by the nonspecific adenosine receptor antagonist, theophylline.

Objective: To determine the efficacy of prophylactic theophylline in prevention of acute renal failure in term neonates exposed to perinatal asphyxia.

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Frequency of Nutritional Rickets in Children and Association with Iron Deficiency Anemia

 IFTIKHAR EJAZ, AMNA AHMED, SUMAYYA AFTAB, IQRA WAHEED , ATTIA BARI

Correspondence: Dr. Iftikhar Ejaz, Associate Professor Paediatrics & Paediatric Nephrologist, Children’s Hospital & ICH, Ferozepur Road, Lahore. E-mail: driftikharijaz777@gmail.com, Cell: 0302-8420335

 ABSTRACT

Background: Nutritional rickets is a prevalent problem in developing countries. Despite extensive research the exact prevalence in Pakistan could not be found. Vitamin D deficiency is widespread throughout the world and is associated with rickets in children and iron deficiency anemia (IDA).

Objectives: Objectives of this study were to determine the frequency of nutritional rickets in children aged 6months to 5years and to determine the frequency of IDA in children with nutritional rickets.

Materials and Methods: This cross sectional study was conducted in the Children’s Hospital, Lahore for 6 months. 300 children were included in the study through non probability purposive sampling technique. Informed consent and demographic information of child were taken from parents / guardian. Biochemical profile , x-ray wrist , hemoglobin, MCV and ferritin levels were done to assess rickets.

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Patterns of Anemia in patients of Systemic Lupus Erythematosus Study of 75 cases from Lahore, Pakistan

ASMA MUNIR, Mona Aziz, muhammad usman, MANAAL AFZAAL, ATiYA MAHBOOB

1Consultant haematologist, 2Associate professor of Hematology, Shaikh Zayed FPGMI Lahore, 3Trainee Registrar, Dept of Nephrology, Shaikh Zayed FPGMI Lahore, 4Senior registrar of Dermatology, Shaikh Zayed FPGMI Lahore, 5Professor of Dermatology, Shaikh Zayed FPGMI, Lahore.

For correspondence: Dr. Asma Munir, 200-D, DHA-EME, Lahore. Pakistan. Email: gemini_twinz01@hotmail.com

ABSTRACT

Objectives: To determine the frequency and types of anaemia in patients of Systemic Lupus Erythematosus (SLE).

Design: Cross sectional survey.

Place and duration of study: Department of Haematology, PGMI/Shaikh Zayed Hospital, Lahore from May 2011 to April 2012.

Patients and Methods:  Seventy five diagnosed cases of SLE presenting to the in- and out-patient departments of Shaikh Zayed Medical Complex Lahore, fulfilling the inclusion criteria were included in the study. Written informed consent was taken. Patients were investigated in Haematology and Biochemistry Laboratories, Shaikh Zayed Medical Complex, Lahore. All collected information was entered into SPSS version 17.0 and analyzed using its statistical package.

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Outcome of Lymph Node Biopsy in Gulab Devi Chest Hospital

HAMID HASSSAN*, ZAHEER AKHTAR**, GHULAM SHABBIR PERVAIZ***, ASIF HANIF****

* Cardiothoracic Surgeon & MS Gulab Devi Chest Hospital, **Assistant Prof Pulmonolgy Gulab Devi PGMI Lahore, ***Thoracic Surgeon Gulab Devi Chest Hospital, **** Head of Biostatic Department Gulab Devi PGMI Lahore

ABSTRACT

Background: Lymph node biopsy is a diagnostic procedure done in lymphadenopathy. Lymphadenopathy is an abnormal increase in size of lymph nodes which may be due to infection, inflammation, malignancyand many other diseases.

Objective: To see the histopathological outcome of lymph node biopsy and to see the sensitivity and specificity of lymph node biopsy in Tuberculosis and malignancy.

Methods: 212 patients with lymph node enlargement who had lymph node biopsies at the Gulab Devi hospital Lahore in 2012. The clinical parameters age, fever, and weight loss were measured at initial examination. Fine needle aspiration cytology was done in all patients. The patients were divided into 4 groups 1st Tuberculous, 2nd cancerous, 3rd specific reactive hyperplasia and 4th one is tuberculous abscess. These groups were compared based on patient’s clinical parameters. Biopsies were taken from different area of cervical, supraclavicalar, axillaries, and submendibular and mediastinal lymph nodes depending upon area involved

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Cheiloscopy–A Deterministic Tool for Forensic Sex Determination

MARIAM ARIF1, M. KHALID CHAUDHARY2, M. MAQSOOD3

Department of Forensic Medicine & Toxicology , Assistant Professor FMH College of Medicine and Dentistry, Lahore1; Professor FMH College of Medicine and Dentistry, Lahore2; Associate Professor Shalamar Medical & Dental College, Lahore3

Corresponding Author: Dr. Mariam Arif, Assistant Professor, Forensic Medicine & Toxicology Department FMH College of Medicine & Dentistry, E-mail: kemc51@yahoo.com

 ABSTRACT

Introduction: Establishment of personal identity in forensic science involves chiefly determination of sex, race, age and stature .If the sex of an individual is known, it can be helpful to exclude a large number of suspects from the investigation. Cheiloscopy is an upcoming tool for determination of sex of an individual.

Objective: The aim of the study was to determine whether cheiloscopy behold the potential for determination of sex.

Materials and Method: The study was conducted on 100 students, 50 males and 50 females belonging to the age group of 18-23 years. Lip prints were recorded by applying lipstick and then transparent cellophane tape to the lips which was then stuck to a white bond paper. They were studied and classified by two separate examiners. The results were statistically analyzed using percentages and applying Chi – square test for goodness of fit to see the difference in types in the two sexes .

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Association of Thrombocytopenia with Chronic Liver Disease Due to Hepatitis-C

RANA AATIF SIDDIQUE, MUHAMMAD SAIF UL MALOOK, RANA AAMIR DIWAN

Department of Medicine, Civil Hospital, Bahawalpur, Department of Surgery, Civil Hospital, Bahawalpur,

Department of Community Medicine, DG Khan Medical College, DG Khan

Correspondence: Dr Muhammad Saif ul Malook, Room No 24, Doctors Lodge BVH Bahawalpur. Phone: 0321 7329599, Email: malook@gmail.com

ABSTRACT

Introduction: Patients with Chronic Liver Disease (CLD) including advanced fibrosis and cirrhosis commonly experience thrombocytopenia. Thrombocytopenia associated with chronic liver disease has been reported in 15–70% of patients with advanced fibrosis and portal hypertension, depending on the stage of disease. Thrombocytopenia may be caused by Hepatitis C virus (HCV) directly, or it may result from Iinterferon based anti-viral therapy that affects platelet number or function, either directly or by suppression of thrombopoiesis in the bone marrow.

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Effect of Analagesic Dose of Ketamine on Intraoperative Propofol Requirement and Postoperative Pain Relief After Diagnostic Gynaecological Laparoscopy

MOTSIM SHERAZ, MUHAMMAD AHMAD KHAN, KHAWAJA RASHID HAFEEZ

ABSTRACT

Background: Analgesic dose of ketamine given at induction reduces usage of propofol intraoperatively and requirement of opioid analgesic drugs postoperatively.

Patients and Methods: Hundred patients were randomly allocated to two equal groups: saline or ketamine. It was a double blind study. Patients in both groups received premedication with midazolam and induction with propofol. Patients in ketamine group received 0.25 mg/kg ketamine at induction while the other group received saline. Anaesthesia was maintained with propofol infusion @ 6 mg/kg/min in both groups and additional boluses of propofol were used to deepen anaesthesia when required. Total amount of propofol used was noted at the end of procedure. Total amount of analgesic drug tramadol was also noted in the postoperative area at the time of discharge of patient.

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Pulmonary Tuberculosis in Household Contacts of Pulmonary Tuberculosis Patients Registered in Dots Implemented Tertiary Care Setting

AAMIR NAZIR, EJAZ MAHMOOD AHMAD QUERISHI, JALEES KHALID KHAN, ARSHAD MEHMOOD MINHAS, ZULIFQAR-UL-HUSSAIN

1Government Model Chest Clinic, Sir Ganga Ram Hospital Lahore, 2Institute of Public Health Lahore, 3KEMU, Lahore, 4AIMC, Lahore

ABSTRACT

Introduction: Household contacts of pulmonary tuberculosis cases are the most risky group for tuberculosis infection /disease and are the easiest group to detect tuberculosis cases.

Objectives: This study was undertaken to describe the frequency distribution of active pulmonary tuberculosis in household contact of patients with active pulmonary tuberculosis

Setting and study design: This descriptive observational study was carried out in chest clinic of Sir Ganga Ram Hospital Lahore.

Patients and Method:  Contacts aged >15 years of patients registered for treatment of tuberculosis at Model Chest Clinic, Sir Gangaram Hospital, Lahore were included in the study. The patients were asked to provide three sputum specimens two spot and one morning. Demographic features like age, sex and history of the disease were collected on a standardized questionnaire. Sputum smear microscopy for AFB was carried out at Model Chest Clinic by Zeihl-neelsen method.

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Pulmonary Congenital Cystic Adenomatoid Malformation: A Rare Congenital Abnormality in Adults. Case Report and Review of Literature

HADI MUTAIRI, IRFAN KHAN FOZAN ALDULAIJAN, SARAH ALAJMI, AMEERA S BILHARETH, ZAHRA ALHAJI, IKRAM UL HAQ CHAUDHRY

Division of Thoracic Surgery, King Fahad Specialist Hospital, P.O. Box 15215, Dammam 314111, Saudi Arabia

Corresponding Author. Ikram Chaudhry, drihc@hotmail.co.uk

ABSTRACT

Congenital cystic adenomatoid malformation (CCAM) of the lungs also known as congenital pulmonary airway malformation (CPAM) is rarely encountered in adults. We herein report two cases of CCAM in adult patients. A 24-year-old healthy female chest xray performed as pre employment health screening showed a lesion in the right lung upper zone.

Computed tomography of thorax (CT) confirmed a mass in right lung upper zone. Second case is a 28-years-old male who presented with recurrent respiratory tract infections not responding to anti-microbial therapy. The CT scan of thorax showed a mass in left lung upper zone. Bothe cases were treated successfully by surgical resection. Histopathology reports of both cases were consistent with congenital cyst adenomatoid malformation.

Key words: Congenital cystic adenomatoid, malformation, malignancy, respiratory tract infection, surgery

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A Rare Case of Dysphagia Caused by Tracheal Diverticulum

 IKRAM CHAUDHRY, HADI MUTAIRI, WEJDAN MANAH, MUSSARAT AFZAL, IMTIAZ KHURSHID

Division of Thoracic Surgery, Chest Medicine, Anesthesia, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Correspondence to: Dr.Ikram Chaudhry, Division of thoracic surgery, King Fahad Specialist hospital, PO Box 15215, Dammam SA 31444, Saudi Arabia; email: drihc@hotmail.co.uk

ABSTRACT

Tracheal diverticulm is a rare benign disease also called paratracheal air cyst.

Often they are asymptomatic and are discovered incidentally on endoscopic or radiological examination of the chest. Common symptoms are recurrent respiratory tract infections, cough, and rarely dysphagia. Herein we report a rare case of dysphagia caused by tracheal diverticulum. CT scan of neck revealed a large tracheal diverticulum probably compressing the oesophagus. After diverticulectomy, the patients swallowing returned back to normal.

Key words: Dysphagia, Tracheal, Diverticulum, Barium swallow, Surgery.

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