Vol. 8, Issue 2, APR – JUN 2014

EDITORIAL

Changing The Landscape —Transformation Brought About by Medical Imaging at the Turn of the Millennium

SHAHID WAHEED*, BASMA KHAN**

*Associate Professor & Head of Radiology Department, FJMC/SGRH, Lahore, **Assistant Professor Department of Radiology FJMC/SGRH Lahore

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Frequency and Relationship of Polycystic Ovarian Syndrome with Hirsutism

RABAIL JAVED1, FARKHANDA GHAFOOR2, ATIYA MAHBOOB3, HINA ZUBAIR4, ASMA MUNIR5, MUHAMMAD ASIM 6, SHAFIQUE AHMAD7

1Research Officer, PMRC, NHRC, Sheikh Zayed Medical Complex Lahore, 2Senior Research Officer/Centre Incharge PMRC, NHRC,Sheikh Zayed Medical Complex, Lahore, 3Professor and Head, Department of Dermatology, Sheikh Zayed Medical Complex, Lahore, 4Department of Gynecology, Benazir Medical College, MirPur, Kashmir, 5Demonstrator, Department of Haematology, Sheikh Zayed Medical Complex, Lahore, 6Statistician, PMRC, NHRC, Sheikh Zayed Medical Complex Lahore, 7Professor & Head of Department of Radiology, Sheikh Zayed Medical Complex, Lahore

ABSTRACT

Objectives: To estimate the frequency and relation of polycystic ovarian syndrome (PCOS) with hirsutism in normal and hirsute females.

Study Design: Cross-sectional analytical study.

Place and Duration: Department of Dermatology, Radiology and Immunoassay Laboratory at NHRC, Sheikh Zayed Medical Complex, Lahore from Dec 2008 – Dec 2009.

Patients and Methods: Clinically confirmed 50 hirsutes and 50 normal females aged between 14-20 years were included in the study while those with virilism, post menopausal, menopause cushing syndrome were excluded. Informed consent was obtained from eligible participants and demographic information was recorded in a study proforma. Ultrasound was done for polycystic ovaries (PCO) and adrenal hyperplasia. PCOS was further confirmed in accordance with revised Rotterdam definitions 2003 and its criteria. A modified Ferriman-Gallwey (FG) score was used to determine the severity of hirsutism. Five milliliters of fasting blood was drawn, serum separated and stored at -20ºC, for analysis of luteinizong hormone and follicular stimulating hormone ratio (LH: FSH), free testosterone, dihydrotestosterone (DHT), cortisol and alanine transferase (ALT).

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Thyroid Dysfunction in Chronic Hepatitis C Patients Treated with Pegylated Interferon Alpha 2a and Ribavirin Combination Therapy and its Predisposing Factors

1MUHAMMAD KHURRAM SALEEM, 2MUHAMMAD KASHIF, 3ANIQA ANSER, 4TASHIA MALIK, 5ARIF MAHMOOD SIDDIQUI

1MBBS, FCPS (Medicine), MRCP (UK), MRCPS (Glasgow), Assistant Professor of Medicine CMH Lahore Medical College, Combined Military, Hospital Lahore, 2MBBS, Registrar Medical Unit II, Jinnah Hospital Lahore, calmkashif@gmail.com Mobile No: 03334227290, 3MBBS, Registrar Medical Unit II, Jinnah Hospital Lahore, aniqaanser@yahoo.com Mobile No: 03346617567, 4MBBS, Registrar Medical Unit II, Jinnah Hospital Lahore, Mobile No: 03214609603, 5MBBS, MRCP (UK), FRCP (London), FRCP (Glasgow), FRCP (Edinburg), Professor & Head of Department Medical Unit II, Jinnah Hospital Lahore, rdsidiqi@gmail.com Mobile No: 03334232211

Correspondence: Dr Muhammad Khurram Saleem, drkhurram_77@yahoo.com Mobile No: 03334822143

 ABSTRACT

Background: Pakistan carries one of the world’s highest burdens of the chronic hepatitis C and mortality due to liver failure. Chronic hepatitis C is treated with pegylated interferon alpha and ribavirin combination therapy. Changes in the thyroid function are common side effects of this antiviral treatment. Interferon alpha treatment can induce thyroid dysfunction in 2.5% to 20% of the treated patients.

Study Design: Descriptive case series

Methods: This study was conducted in Medical Unit II, Jinnah hospital Lahore from April 2013 to September 2013 and 220 chronic hepatitis C patients were included in this study. They were started on pegylated interferon and ribavin combination therapy for 6 months. Thyroid stimulating hormone (TSH) levels were measured at the start and after completion of this therapy. Factors leading to thyroid dysfunction including female gender, HCV genotype and smoking were also recorded in these patients.

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Frequency and Factors Leading to Recurrent Laryngeal Nerve (RLN) Injury during Thyroid Surgery

GUL ZARIN KHAN, FAROGH ZAHRA, IMTIAZ HUSSAIN, NISAR AHMAD KHAN, AMIR ZAMAN KHAN

1Registrar Surgical Unit I, 2Assistant Professor, Surgical Unit I, 3Registrar Surgical Unit I, 4Registrar Surgical Unit I, 5Professor & Head  of Department Fatima Jinnah Medical College/ Sir Ganga Ram Hospital, Lahore.

Correspondence: email: dr_gulzarin@hotmail.com. Cell no.: +923462880801

 ABSTRACT

Objectives: The objectives of this study were to determine the frequency and to assess the factors leading to Recurrent Laryngeal Nerve (RLN) injury during thyroid surgery at a tertiary care hospital.

Study Design: Descriptive case series.

Setting: Surgical Unit-I, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore.

Subject and Methods: Four hundreds and seventy patients were included in this study. Patients with pre-existing RLN injury and those with concomitant parathyroid pathology were excluded from the study. RLN injury was documented by post-operative finding of absent vocal cord movement on direct laryngoscopy by the anesthetist at the time of extubation.

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Single Versus Double Layer Anastomosis of Small Intestine. A Prospective Study at Lahore General Hospital Lahore, Pakistan

1SHAFQAT ULLAH, 2HASAN ASKARI, 3MUHAMMAD IBRAR HUSSAIN, 4MUHAMMAD ZAHID, 5MOHAMMAD IQBAL

1Resident Surgery, 2Assistant Professor of Surgery, Postgraduate Medical Institute/Lahore General Hospital Lahore, 3Assistant Professor of Surgery, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia, 4Associate Professor of Surgery, Postgraduate Medical Institute/ Lahore General Hospital Lahore, 5Professor of Surgery, Allama Iqbal Medical College Lahore

Corresponding Author: Dr Hasan Askari (Email: hasanaskari55@hotmail.com), Cell: 0300-8446300

ABSTRACT

Objectives: To compare the outcome of single layer interrupted with conventional double layer small bowel anastomosis in terms of anastomotic leak, operative time and length of hospital stay.

Patients and Methods: This prospective comparative study was conducted in Surgical Unit-II, Postgraduate Medical Institute at Lahore General Hospital, Lahore over a period of six months from December 2009 to June 2010. A total of 100 adult patients, requiring small bowel anastomosis were considered eligible for enrolment in  study. They were randomized to have either a single layer interrupted extra-mucosal anastomosis (Group A) or conventional double layer anastomosis (Group B). Anastomotic leak, time required to complete the anastomosis and hospital stay in both the groups were main outcome measures.

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Histological Study of Lungs in Rats Exposed to Chloroquine During Intrauterine life”

ALIYA ZAHID1, TAQUAYYA S ABIDI2

1Associate Professor Anatomy AIMC ,Lahore, 2Ex Professor of Anatomy, KEMU, Lahore

Address for Correspondence: Dr Aliya Zahid, draliyaimtiaz@gmail.com, 27 A1 Johar Town Lahore

ABSTRACT

Aims and Objectives: A study was carried out to see the effects of chloroquine on the lungs of rats exposed to chloroquine during their intrauterine life.

Type of Study : Descriptive cross sectional study

Materials and Methods: In this study, 12 pregnant female albino rats were used and divided in 4 groups, A (control) and B,C and D (experimental). Total gestational period in rats ranges from 20-22 days which in this study was divided into three trimesters of seven days each. Oral dose of chloroquine 700mg/kg body weight was given to group B in first trimester (day1 to day 7), group C in 2nd trimester (day 8 to day 14) and group D in third trimester (day 15 to term). After the control and experimental groups had delivered, their offsprings were selected at random (about 5/adult rat). On day 5 after birth, lungs were then dissected out, processed, blocks were made, cut and mounted. Sections were stained with haemotoxylin and eosin stains.

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Evaluation of Friedwald’ and Anandaraja’ formulae Against Direct Estimation of LDL in Fasting Samples Received in Aga Khan Multan Stat Lab

 ASGHAR JAVAID1, FAREED ZAFAR2

1Assistant Professor of Microbiology, Nishtar Medical College, Multan, 2Professor / Head of Department Obs. & Gynaecology, FJMC/SGRH, Lahore

Correspondence: Dr. Asghar Javaid, Assistant Professor, Department of Pathology, Nishtar Medical College and Hospital, Multan. Email: asgharmicro@hotmail.com

 ABSTRACT

Objective: To compare the Friedewald and Anandaraja’s formulae with direct homogeneous assay for serum low density lipoprotein cholesterol (LDL-C) levels estimation.

Place and Duration of Study: A retrospective study was conducted from July 2012 to December 2012 at Multan Stat Laboratory of Aga Khan University Hospital

Method: The study assessed 1459 blood samples from out-patients of either gender sent to the Collection centers of Aga Khan university hospital, from southern Punjab for measurement of total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C)’ VLDL and triglyceride (TG) levels. Total cholesterol, high-density lipoprotein cholesterol, TG and LDL-C were measured on Hitachi 902 chemistry analyzer (Roche). 68(4.66%) specimens with TG > 450mg/dl were excluded from further analysis .LDL-C levels were also calculated by Friedewald formula (FF) and Anandaraja’s formula in1391 samples. The mean± SD (mg/dl) LDL-C levels were calculated for three methods. The percentage difference (%ΔLDL) defined as calculated LDL-C minus D-LDL-C compared to the direct measurement was calculated using the following formula: %Δcalculated LDL-C = [(calculated LDL-C)-(DLDL- C)]/D-LDL-C*100.(26).Linear regression analyses was done using Microsoft Excel 2007 to assess the regression and correlations between three methods.

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Hematological Profile in Patients with Dengue Fever: Report of 47 Patients in 2010

ASMA MUNIR1, MONA AZIZ2, MUHAMMAD ONEEB SALEEMI3, ATIYA MAHBOOB4, RABAIL JAVED5

1Consultant haematologist, 2Professor, Department of Haematology, Shaikh Zayed FPGMI, Lahore, 3Demonstrator, Department of Anatomy, King Edward Medical University, Lahore, 4Professor, Department of Dermatology, Shaikh Zayed FPGMI, Lahore.5 Research Officer at PMRC/ NHRC, Sheikh Zayed FPGMI, Lahore.

Correspondence: Dr Asma Munir, gemini_twinz01@hotmail.com

ABSTRACT

Background: Dengue fever is one of the major causes of morbidity and mortality in tropical and sub-tropical countries. The routine haematological examination is an important investigation for the diagnosis and proper management of such patients.

Objective: To evaluate haematological changes in patients with dengue fever.

Design: Prospective, follow-up study.

Place and duration of study: Department of Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore from 3rd Oct 2010 to 20th Nov 2010.

Patients and Methods: Forty-seven serologically confirmed, admitted cases were evaluated for age, gender and haematological changes.

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Prevalence of Hepatitis ‘B’ in Apparently Suspected Individuals of Southern Punjab by Highly Sensitive Electro-chemiluminescence Immunoassay (ECLIA)

 ASGHAR JAVAID1, FAREED ZAFAR2

1Assistant Professor of Microbiology, Nishtar Medical College, Multan, 2Professor / Head of Department Obs. & Gynaecology, FJMC/SGRH, Lahore

 ABSTRACT

Background: The prevalence of hepatitis B virus (HBV) infection is increasing worldwide . This study was aimed to assess the prevalence of HBsAg among suspected patients for hepatitis by community doctors attending collection centers of Aga Khan University Hospital’s clinical laboratory Karachi in Southern Punjab.

Place and Duration: A retrospective study was conducted from January 2011 to June 2011 at Multan Stat Laboratory of Aga Khan University Hospital.

Methods: A total of 2819 suspected patients were received at collection centers and included in this study. The screening was performed in Aga Khan Multan Stat Lab by using the Elecsys HBsAg 11 assay kit on Cobas e 411 immunoassay analyzer. Data was entered and analyzed using SPSS version 16 statistical package.

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Apgar Score in Term Pregnancies with Isolated Oligohydramnios

1SALEHA ANWER, 2BUSHRA BANO, 3TASHHIR RANA, 4ALIA NASEER UD DIN

1WMO Department of Gynecology Unit IV SGRH, 2Senior Registrar Gynecology Unit IV SGRH, 3Assistant Professor Department of Radiology FJMC/SGRH, 4Senior Registrar Gynecology Unit IV SGRH, Lahore

Correspondence Author: Dr. Bushra Bano Senior Registrar Sir Ganga Ram Hospital, Lahore.

 ABSTRACT

Oligohydramnios is defined as amniotic fluid index (AFI) < 5th centile for the gestational age. AFI < 5cm or maximum vertical pocket devoid of umbilical cord or fetal limbs measures < 30cm, in the presence of intact membrane. It is well established that oligohydramnios is associated with a high risk of adverse perinatal outcomes, On the other hand, oligohydramnios is a poor predictor for adverse outcome and leads to un-necessary inductions and followed by increased caesarean sections rate.

Objective: To determine the frequency of adverse perinatal outcome in pregnancies with isolated oligohydramnios at term.

Study design:  Case Series.

Settings: The study was carried out in the Department of Obstetrics & Gynaecology unit IV, Sir Ganga Ram Hospital, Lahore.

Duration of Study: From 30th September 2012 to 29th March 2013

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Assessment of Accuracy of Death Certification in Teaching Hospital in A Developing Country

MARIAM ARIF1, SYED HAMAD RASOOL2, MUSHTAQ AHMED3

Assistant Professor Forensic Medicine & Toxicology Department FMH College of Medicine and Dentistry, Lahore1; Senior Registrar Surgical Unit IV Services Hospital, Lahore 2 ; Assistant Professor Forensic Medicine & Toxicology Department , Nishtar Medical College, Multan3

Corresponding Author: Dr. Mariam Arif, Assistant Professor, e-mail: kemc51@yahoo.com

 ABSTRACT

Introduction: Death certification is largely random and fragmented in most developing countries.

Objective: This study is done to evaluate errors in medical & non-medical part and to determine causes of errors of cause of death.

Material and Method: Two hundred and twenty death certificates were randomly selected that have been issued from November 2013 to April 2014 for the deceased who were admitted in Services Hospital, Lahore. A predetermined error grading scale was used to assess the accuracy and completeness of selected death certificates. Causes of errors were analyzed and confirmed after detailed scrutiny of the medical section of death certificates. Data was statistically analyzed using SPSS version 20.

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Menstrual Irregularities and its Awareness in the Students of Sir Syed Medical College for Girls Karachi

1ANISA KAMAL, 2SONIA NAQVI, 3FAREED ZAFAR, 4EMAN KHALID, 5HASSAN FATIMA JAFFERY

1Assistant Professor obstetric and gynaecology Sir Syed Hospital, Email: anisakamal5@gmail.com, Cell # 0321 3820895, 2Associate Professor Obstetrics and gynaecology Sir Syed Hospital, Cell # 0300 8248208, Email: sonia_naqvi@hotmail.com, 3Professor / Head of obstetric and gynaecology Department, FJMC / SGRH, Lahore, 4House Officer Sir Syed Hospital, Cell # 0336 2547251, 5Head of Department Obstetrics and Gynaecology Sir Syed Hospital

Correspondence Dr. Anisa Kamal, 1Assistant Professor obstetric and gynaecology Sir Syed Hospital, Email: anisakamal5@gmail.com, Cell # 0321 3820895

ABSTRACT

Objective: To assess the Menstrual Irregularities and its awareness in students of Sir Syed Medical College for girls in Karachi.

Study Design: It was an analytical cross sectional study.

Place And Duration: The study was carried out on students of Sir Syed Medical College for Girls from August 2012 – January 2013.

Material and Methods: A total of 240 students were included in the study. A detail Proforma was given to them after a verbal consent acquired from the authorities of the ethical committee. Moreover all individual were quierd in centered confidential to reduce influence from other people. Information was collected in both Urdu and English but proforma was filled in English. A data collection form with respect to age, demographic data, history of menstrual cycle, interval of days, Dysmenorrhea, flow pattern, family history, comorbidities were collected. Biochemical evaluation was also analysed.

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Frequency of Left Ventricular Thrombus after Acute Anterior Wall Myocardial Infarction

AHMAD HASAN, ZEESHAN GHOUS, JAHANGIR GHAFOOR, ZUBAIR AKRAM

Department of Cardiology, Jinnah Hospital, Lahore

Correspondance to: ahnmalik@hotmail.com. Ph. No# 03214937381

 ABSTRACT

Background: Acute myocardial infarction (MI) is one of the leading causes of mortality and morbidity associated with cardiovascular diseases. Left ventricular thrombous (LVT) is one of the important complications of myocardial infarction. LVT significantly increases the morbidity and mortality associated with MI. The embolic complications of LVT include stroke, vital organs infarct and limb ischemia. In this study we tried to find out the frequency of LVT in our population at 48 hours and at 1 week after acute MI. This would help us in better understanding of this potential life threatening complication of MI in our population.

Objective: The objective of the study is to determine the frequency of left ventricular thrombus after acute anterior wall myocardial infarction at 48 hours after MI and at 1week in those patients that didn’t have LV thrombus at initial assessment at 48hours.

Study Design: It was a descriptive case series.

Setting: The Study was conducted in CCU, cardiology department Jinnah Hospital Lahore.

Sample Selection: All patients of both genders with age range of 25-85 years, of acute anterior wall ST-elevation myocardial infarction (excluding old infarct patients, patients already having thrombus, contraindications to thrombolytic therapy) from May 2013 to Sep 2013 were selected.

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In Trauma; Patient’s Ignorance of Fasting causes delay in Surgical Management”

SYED MOHSIN ALI, IRFAN SAJID KHAN, HADI MUTAIRI, FOZAN ALDULAIJAN, IKRAM UL HAQ CHAUDHRY

Corresponding Author: Syed Mohsin Ali, mohsinali2@hotmail.com, King Fahad Specialist Hospital Dammam Kingdom of Saudi Arabia

ABSTRACT

Background: Ignorance of fasting after acute injury, prior to emergency surgery may cause significant delay in treatment. The aim of this study was to find out the awareness and understanding of “fasting” for anaesthesia after injury.

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Botulinum Toxin Injection Versus Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Randomized Trial

1ABDUL NASIR, 2MOHAMMAD ZAHID, 3HASAN ASKRI, 4MUHAMMAD IBRAR HUSSAIN, 5FAROOQ AHMAD, 6MOHAMMAD IQBAL

1Resident Surgery, 2Associate Professor of Surgery, 3Assistant Professor of Surgery, Postgraduate Medical Institute/Lahore General Hospital Lahore, 4Assistant Professor of Surgery, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia, 5Assistant Professor of Surgery, Services Institute of Medical Sciences Lahore, 6Professor of Surgery, Allam Iqbal Medical College, Lahore

Corresponding Author: Dr. Mohammad Zahid (Email: drzahid_ch11@hotmail.com)

 ABSTRACT

Objective: The objective of the study was to compare the outcome of botulinum toxin injection (BTI) and lateral internal sphincterotomy (LIS) for chronic anal fissure (CAF) in terms of efficacy and complications of both the procedures.

Patients and Methods: This prospective randomized trial was conducted in the Department of Surgery; Unit II Post-Graduate Medical Institution / Lahore General Hospital, Lahore over a period of one year. One hundred and thirty adult patients with CAF were randomized to have either Botulinum toxin injection (group A) or lateral internal sphincterotomy (group B). The outcome was measured in terms of pain relief, healing rate, recurrence of fissure and procedure related complications. Patients were followed up for 6 months.

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Comparison of two analgesic doses of Ketamine on haemodynamic response to surgical incision

KHAWAJA RASHID HAFEEZ, MOTSIM SHERAZ, MUHAMMAD AHMAD KHAN, SHAMILA ATHAR SIDDIQUI

ABSTRACT

Background: Surgical procedures stimulate patient’s haemodynamic system and bring about significant clinical changes in heart rate (H. R)  and systolic blood pressure (SBP).  These variables can be used to assess depth of anesthesia. Tachycardia is strongly linked to sympathetic stimulation along with concomitant rise in blood pressure and may cause decompensation in patients with heart failure. Various drugs are used to control likelihood of these responses by use of anaelgesics. This study was conducted to compare haemodynamic response with two doses of Ketamine to surgical incision.

Material and Methods: Sixty Patients were randomly divided into two groups using random numbers table. Group A received ketamine 0.25 mg/Kg whereas group B received ketamine 0.5mg/kg. After setting up the monitors, first value of HR and SBP were taken as baseline value. Propofol 1% in a dose of 2 mg/kg and rocuronium in a dose of 0.6 mg/kg were given I/V for induction in both groups and maintained on sevoflurane. Intravenous ketamine was given according to the assigned group.HR and SBP were recorded before induction as the baseline values, before the administration of ketamine, every minute after ketamine till the surgical incision (SI) and the following five minutes; then at ten and twenty minutes after SI. Percentage change in HR and SBP from the baseline will be calculated for all the readings following administration of ketamine.pdf


An Analysis of Frequency and Histopatohologies of Gestational Trophoblastic Neoplasia at Tertiary Care Hospital Peshawar, Khyber Pukhtoonkhwa (KPK)

SHANDANA BAWAR, TANVEER SHAFQAT, SONIA RAFIQ, SANODIA AFRIDI, REHANA RAHIM

Department of Obstetrics & Gynecology, Lady Reading Hospital, Peshawar, Pakistan

Correspondence: Dr. Shandana Bawar, e-mail: shandanabawar@hotmail.com

 ABSTRACT

Background: Gestational trophoblastic disease (GTD) encompasses pregnancy related disorders arising from abnormal trophoblast tissue. It consists of premalignant conditions, complete and partial hydatidiform mole and malignant conditions that include invasive mole, choriocarcinoma, placental site trophoblastic tissue and rare epitheliod trophoblastic tumors. The malignant conditions collectively are termed as gestational trophoblastic neoplasia (GTN) or persistent trophoblastic disease (PTD).

Objective: To determine the frequency and histopathology of gestational trophoblastic neoplasia, its clinical presentation and management options of this malignant condition.

Subjects and Methods: The study was a prospective study conducted at Gynae B Unit, PGMI Lady Reading Hospital, Peshawar from October 2010 to October 2013. Inclusion criterion was, all the patients with history of irregular vaginal bleeding following molar pregnancy, miscarriages, ectopic or term pregnancy or irregular PV bleeding after repeated evacuations, with raised serum beta human chorionic gonadotropin (βhCG). They were evaluated with transvaginal ultrasound, chest x-r ay and Full blood count. After confirmation of molar pregnancy patients were registered, underwent suction evacuation and were counseled regarding disease and disease complications, with stress on contraception with barrier methods and 2 weekly follow up with serum βhCG from same laboratory. Patient’s contact number and home address was taken for sending reminders of follow-up. On follow- up if patient was symptomatic for hemorrhage, pain abdomen, respiratory distress, raised or static serum βhCG, patient was readmitted and further evaluation was done for Gestational trophoblastic neoplasia with full blood count, liver function tests, renal function tests, MRI pelvis, CT chest. Patient was scored to low risk i.e. <6 and high risk >6, according to prognostic FIGO scoring. Low risk patients were started on single agent methotrexate/Folinic acid (MTX/FA) and high risk patients were treated in collaboration with clinical oncologist for commencement of multiagent chemotherapy, usually EMA/CO.

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Maternal and Fetal Outcome Where Three Doses of Prostaglandin E2 were Used for Induction of Labour

SHAHZADI SAIMA HUSSAIN, SEMI FAYYAZ

Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar

Correspondence: Dr. Shahzadi Saima Hussain, e-mail :maple9894@yahoo.com

 ABSTRACT

Objective: To assess maternal and fetal outcomes where three doses of vaginal prostaglandins (PGE2) are used for induction of labour.

Subjects and Methods: This study was Retrospective cohort study conducted in Gynae B unit LRH from 1st January 2013 till 28th February 2014. A total of 708 patients had induction of labour with prostaglandin E2, among them 65 women had received three doses of vaginal PGE2 (3mg tablet or 2mg gel) for induction of labour. The clinical record of these 65 patients was further analyzed. Primary outcomes included mode of delivery, frequency of hyperstimulation of uterus, postpartum haemorrhage (PPH), and fetal outcome was observed in terms of Apgar score.

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Unusual Presentations of Extrapulmonary Tuberculosis

  1. AQEEL UR REHMAN,1 USMAN JAVED IQBAL,2 ZAHEER AKHTAR3

1Assistant professor & DMS Gulab Devi Chest Hospital, 2Demonstrator Cardiac Perfusion GDPGMI, MPH*, 3Associate Professor Pulmonology Gulab Devi PGMI & Chest Hospital

ABSTRACT

Objective: To describe the unusual sites of extra-pulmonary tuberculosis (EPTB) cases in a tertiary care hospital in a high burden tuberculosis country.

Methodology: A cross sectional study of 100 cases was conducted at Gulab Devi Chest Hospital. All cases diagnosed and treated as EPTB (on the basis of histopathology & culture sensitivity) between January 2013 & December 2013 were included. Data was retrieved from medical records on demographics, clinical, laboratory and treatment outcome status.

Results: A total of 100 patients being treated were included in the study. Mean age was 38.8 years. An overall male predominance was observed. Most common unusual presentations of EPTB by number of cases were of multiple abscesses following sinusitis and epididymitis.

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Carotid Artery Stenosis in Non-Alcoholic Fatty Liver Disease: A Tertiary Care Hospital Experience

UMAR FAROOQ DAR1, WASEEM IQBAL2, NASIB ULLAH SHAH3, MUHAMMAD MAJID4, MUHAMMAD AAMIR USMAN5, NAVEED IQBAL6

1Department of Infectious Diseases, Institute of Public Health Lahore, 2Department of Medicine Unit II, Lahore General Hospital Lahore, 3Department of Medicine Sandeman Provincial Hospital Bolan Medical College Quetta, 4-6Department of Medicine, Jinnah Hospital Lahore,

For correspondence: Dr. Umar Farooq Dar, e-mail: umardar84@gmail.com

 ABSTRACT

Objective: To determine the frequency of carotid artery stenosis in non-alcoholic fatty liver disease (NAFLD).

Subjects and Methods: This descriptive cross sectional study was carried out on 175 patients with ultrasonic diagnosis of NAFLD. All patients were screened by carotid Doppler scan and in case of a peak systolic velocity greater than 100cm/sec, patient was labeled as having carotid artery stenosis.

Results: The mean age of patients of NAFLD was 42.4±9.3 years. Frequency of carotid artery stenosis (CAS) came out about 12.6% among all patients. Hypercholesterolemia was found significantly associated with CAS in NAFLD patients while age, sex and BMI more than 30 kg/m2 was not significantly different in patients with and without carotid artery stenosis.

Conclusion: The frequency of CAS is quite high (12.6%) so we should screen all patients of NAFLD for CAS.

Keywords: Carotid artery stenosis, Nonalcoholic fatty liver disease, Atherosclerosis

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Iatrogenic Pneumomediastinum: A Case Report and Review of Litrature Conservative Management an Option

 IKRAM UL HAQ CHAUDHRY, HADI MUTAIRI, FOZAN ALDULAIJAN, IMTIAZ KHURSHID

Department of Thoracic Surgery and Pulmonary Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia

Correspondence: Imtiaz Khurshid, MD, Consultant Pulmonologist, King Fahad Specialist Hospital, PO Box 15215, Dammam 31444, Saudi Arabia, e-mail: imtiaz.khurshid@kfsh.med.sa

ABSTRACT

Pneumomediastinum and subcutaneous emphysema are unusual complications of upper aerodigestive tract intrumentation.Currently there are no established guidelines for management of pneumomediastinum. We report two cases of pneumomediastinum due to oesophageal rupture and tracheal tear after endoscopy. Both cases were managed conservatively with favorable outcome.

Key Words: Endoscopy, pneumomediastinum, oesophagus, trachea, conservative management.

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CORRIGENDUM

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