Vol. 8, Issue 3, JUL – SEPT 2014


Breaking New Ground; Arthroscopic Surgery, Its Potential and Use in Pakistan


1Professor / Head of Orthopedics Department FJMC/SGRH, 2PGRs Orthopedics Surgery FJMC/SGRH, 3PGRs Orthopedics Surgery FJMC/SGHR, Lahore


Adequacy of Dialysis Among Patients on Thrice Weekly Hemodialysis: Are we Reaching Minimum Standards?


Department of Nephrology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore.

Correspondence to : Dr. Rabia farooq, PGR Nephrology, Department of Nephrology, Medical Unit-1, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore. Email: rabiafarooq75@hotmail.com. Cell: +923124987276


Background: Severe chronic kidney disease requires renal replacement therapy in shape of Dialysis or Transplant. An adequately treated Hemodialysis (HD) patient is physically active, well nourished, not anemic, and not hypertensive with a maintained quality of life and life expectancy that is not inferior to that of healthy subjects. Worldwide the minimum standards of adequate HD are thrice weekly dialysis; single pool Kt/V (spKt/V) of 1.2 per dialysis and Urea reduction ratio (URR) of 65%.

Objective: The objective of the study is to determine the frequency of adequacy of dialysis among patients on thrice weekly dialysis in a tertiary care hospital.

Methodology: A descriptive case series study was conducted in dialysis center of Sir Ganga Ram Hospital for Six month period on Sample size of 72 patients who were receiving thrice weekly hemodialysis. URR and sKt/V were measured as markers of adequacy of dialysis along with other variables like Hemoglobin, Serum Calcium and Serum Phosphorus.


Outcome Comparison of Terlipressin and Octreotide in Patients Having Severe Gastrointestinal Bleed Due to Portal Hypertension


1PG Resident of Medicine / Gastroenterology, King Edward Medical University, 2Associate Prof. of Medicine, King Edward Medical University, 3Chief Orthopedic Surgeon, Police and Services Hospital, MD, Health Foundation Peshawar, 4Assist. Prof. Biostatistics: Gulab Devi Post Graduate Medical institute, Lahore, 5Statistical Assistant: Mayo Hospital Lahore.

Corresponding Author: Jibran Umar Ayub: PG resident of Medicine / Gastroenterology: King Edward Medical University, Cell # 03339227301, Email ID: jibranumar@yahoo.com


Objective: The aim of the study is to compare hyponatremia as a complication of treatment with terlipressin and octreotide in patients having severe gastrointestinal bleed due to portal hypertension.

Materials and Methods: This randomized controlled trial was conducted at Department Of Medicine Mayo hospital, King Edward Medical University Lahore. 60 patients were divided into two groups randomly by taking 30 patients in Group-A who received Terlipressin 1 mg 6 hourly and same no. of patients in Group-B who received Octreotide 50 microgram per hour IV infusion both for 5 days. Daily electrolyte monitoring was done to see the Hyponatremia as the complication of the treatment.


Frequency of Hypotension after Subarachnoid Block for Elective C-Section: A Comparison Between Prophylactic Intramuscular Ephedrine and Phenylephrine


1Senior Registrar Anaesthesia Department, Sir Ganga Ram Hospital, 2Registrar, Surgical Unit 1, Sir Ganga Ram Hospital, Assistant Professor 3Professor Anaesthesia Department, S.G. Ram Hospital, Lahore

Correspondence: email: drsalirehman@gmail.com. Cell No.: +923214759638


Objectives: To compare the frequency of hypotension after giving prophylactic intramuscular ephedrine and intramuscular phenylephrine in parturients undergoing elective caesarean-section in subarachnoid block.

Study Design: Randomized Controlled Trial.

Setting: Department of Anaesthesia, Sir Ganga Ram Hospital, Lahore.

Subjects and methods: A total of 270 cases (135 in each group) were included in this study, group-A received intramuscular ephedrine and group-B received intramuscular phenylephrine.

Results: Mean age was 26.15±5.27 and 26.53±5.23 in group-A and group-B, respectively. Frequency of hypotension in group-A was found to be 47 patients (34.8%) and in group-B frequency of hypotension was found to be 68 patients (50.4%). Difference was statistically significant between two groups (P=0.013). ASA-I status was in 77.8% and 74.0% in group-A and B, respectively. Similarly, ASA-II status was found in 22.2% patients of group-A and 26.0% of group-B.


Evaluation of The Efficiency of Immunization Services at A Primary Health Care Centre of a Squatter Settlement in Karachi

Research work was done at Ziauddin University, Karachi


*Department for Educational Development, Aga Khan University, Karachi, **Department of Community Medicine, Shalamar Medical & Dental College, Lahore, *** Department of Medical Education, King Saud Bin Abdul Aziz University, Saudi Arabia

Correspondence to: Tahseen Kazmi, Professor & Head, Department of Community Medicine, Shalamar Medical & Dental College, Lahore Pakistan. Telephone: 0333-2144068, 0423-6818604, 0423-6852658.

Email: tahseenkazmi@gmail.com


Background: According to the WHO and UNICEF only 73% of the target children in Pakistan receive all antigens up to the third dose of Diphtheria-Tetanus-Pertussis vaccine and the vaccine wastage rate is estimated to be 50% around the world as reported by World Health Organization. The objective of this study was to find out the efficiency of Expanded Programme on Immunization programme at the primary health care level at a health centre run by a private university in a squatter settlement.

Methods: This cross-sectional survey was conducted from April to June 2008. The vaccination data used in the study was obtained through record documents for the period of January 2007 to June 2008 and interviews from the staff of the center. Estimated dropout rates and efficient use of vaccine vials were the main outcome variables.

Results: The estimated dropout rate for Measles vaccine was 38.8%. The vaccine wastage rates were calculated using vaccine usage records from the period of January 2007 till June 2008. The wastage rates were the highest for Bacillus Calmette Guérin vaccine (35.9%) followed by Measles vaccine (29.4%) and the lowest for Diphtheria-Tetanus-Pertussis and Hepatitis B vaccines (3.9%).


Chest X-Ray Findings in Sputum Positive Tuberculosis Patients


1Associate Prof. Pulmonology Gulab Devi Hospital 2Demonstrator Cardiac Perfusion, MPH. 3Cardiothoracic surgeon & MS Gulab Devi Hospital

*Correspondence: sh.usmanjavediqbal@gmail.com, Postgraduate Medical Institute, Gulab Devi Hospital


Aim & Objective: To see the spectrum of chest X-ray abnormalities in sputum positive T.B patients.

Methodology: In this descriptive cross sectional study a total of 120 patients aged 16-80 years of either sex, with sputum positive smear were taken from the Pulmonary Tuberculosis department of Gulab Devi Chest Hospital, whose chest X-rays were interpreted to see the suspicion of PTB and related spectrum of abnormalities on chest X-rays.

Results: Mean age of our patients was 40.7±16.8 years with male to female ratio of 1:1.4. Bilateral lung was involved in 62 (51.7%) patients and 58 (48.3%) patients have unilateral involvement of lung in chest X-rays. 68 (56.67%) patients had Infiltrative shadows. Cavitatory lesions were present in 49 (40.83%) cases and only 3 (2.5%) patients had non-cavitatory lesions on chest X-rays. Opacity or consolidation was seen in 41 (34.1%) cases while abnormalities in terms of pleural effusion or pneumothorax was seen in only 18 (15%) cases in CXR.


Morphometric Analysis of Nose of Adult Female


Correspondence to Dr. Muhammad Naeem, Department of ENT and Head & Neck Surgery Unit – I, Mayo Hospital, Lahore affiliated with King Edward Medical University, Lahore.

Email: drnaeem_ent@outlook.com


Objectives: To determine the mean values of different morphometric measurements from nose of females in study population and to explore the variations in its size and shape.

Study: Cross sectional Study

Place of Study: This study was conducted in the department of ENT Unit – I, Mayo Hospital, Lahore associated with King Edward Medical University, Lahore.

Material and Methods: A total of 100 female patients visiting ENT Department, Mayo Hospital, Lahore were randomly selected and recruited for the study. Surface measurements were taken directly from the nose of all subjects included in the study, by inch tape. Each variable was measured twice in centimeters and degrees by the same investigator. Demographic profile and relevant data was recorded in a standard performa. Mean of different morphometric values of nose of female were taken.

Results: Mean age of patient was 31.97±12.32 year. Minimum and maximum age was 16 and 60 years. Mean length of dorsum of nose 4.74±0.31cm. Mean nasal width was 3.79±0.28cm. Mean distance between alar crease and tip of nose was 2.43±0.23cm. Mean distance between alar crease and vertical line over upper lip and nasal tip and level of upper lip was 1.00±0.13 and 1.42±0.22cm. Mean nasal root width was 1.41±0.16cm. Naso frontal and naso labial angle was 148.750±6.25 and 109.530±9.35. Mean SM distance was 4.05±0.30cm.

 Key Words: Morphometric, Anthropometry, Nose measurements.


Delayed Facial Nerve Paralysis After Tympanomastoidectomy. Incidence, Aetiology and Prognosis


Department of ENT, Fatima Jinnah Medical College / Sir Ganga Ram Hospital, Lahore.

Correspondence: Dr Tahir Rashid MCPS, FCPS, Assistant Professor ENT, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore. Email: Tahir1964@hotmail.com.


Background: Facial nerve paralysis is a well known complication of tympanomastoid surgery. In certain cases facial nerve is paralyzed without any injury a few days after surgery, known as Delayed Facial Nerve (DFN) palsy. It can occur two weeks after surgery. A retrospective study was conducted at ENT Unit –II, Fatima Jinnah Medical College / Sir Ganga Ram Hospital ( FJMC/SGRH), Lahore, to document frequency of, etiological factors and long term prognosis.

Material and Methods: The study period spanned over six years (May 2008 – May 2014) during which a total of 350 patients underwent tympanomastoid surgery. Three patients (0.85%) were identified as having delayed facial nerve paralysis. Those patients were clinically assessed and their medical records were reviewed. Tympanomastoid surgery included Cortical, modified radical, radical mastoidectomy and atticotomy.

Results: There were only 3 cases of delayed facial palsy after tympanomastoid surgery (0.85%). Examination under microscope showed pus in mastoid cavities in two patients who developed facial palsy on day nine and day ten; while the third patient who developed facial palsy on day five had a clean mastoid cavity except the exposed facial nerve in horizontal segment. Appropriate management with antibiotics alongwith steroids in two patients having infection proved effective. While in third patient, the mastoid pack was removed and steroids alongwith prophylactic antibiotics were given resulting in recovery.

Conclusion: The incidence of delayed facial nerve palsy (DFP) after Tympanomastoid surgery is low. The appropriate management & follow up is essential. The overall prognosis for delayed facial nerve palsy (DFP) in such cases is good.

Key words: Facial paralysis, Tympanomastoidectomy, mastoid pack.


Awareness of HIV/AIDS in Pregnant Women


Services Hospital Lahore (SIMS)

Correspondence: sofiatabassam@gmail.com


Introduction: The human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) pandemic continues its deadly assault in different parts of the world. Over 20 million people have died since the first case of AIDS was identified in 1981.

Objectives: Aim of this study was to determine the increase in percentage of cases having correct response regarding knowledge of HIV/AIDS after counseling session. It was conducted in Services Hospital Lahore (SIMS), Gynaecology Unit 2, antenatal clinic in 6 months of period.

Results: Most of the patients between 26-30 years i.e. 38%(n=114), mean, frequency of pre-counseling knowledge of HIV/AIDS was in 22.33% (n=67) and after counseling session knowledge of HIV/AIDS was again evaluated which was recorded in 88%(n=264) while frequency of increase percentage of cases having correct response regarding HIV/AIDS after counseling was recorded 62.33% (n=197) by subtracting 88%(n=264) after counseling session from 22.33%(n=67) pre-counseling knowledge.

Conclusion: It was concluded that after counseling session regarding knowledge of HIV/AIDS, a significant increase in percentage of cases having correct response is achieved and this type of counseling at antenatal clinic is useful for the protection from morbidity.

Key Words: HIV/AIDS, knowledge, counseling session, correct response


Presentation and Management of Malignant Tumors of Thyroid Gland in ESW Mayo Hospital, Lahore


For Correspondence: Dr Tooba Mahmud Gauhar, Senior Registrar, East Surgical Ward, Mayo Hospital, Lahore. Email: angel.july17@gmail.com, Tel no: 0333-4369461


Objective: To review the cases of malignant tumors of thyroid gland in respect to their presentations, histological types and its management.

Materials and Methods: A total of 194 cases of malignant tumors of thyroid gland operated from 2006 to 2013 in East Surgical ward, Mayo hospital , Lahore are reviewed. The distribution of histological types, presenting symptoms and outcome of treatment are discussed.

Results: Out of 194 cases, 71.1% were females and 28.9% were males. 88.6% were euthyroid, 9.2% were hypothyroid and 2% were hyperthyroid. 40.2% presented with a solitary nodule, 58.5% with multinodular goiter and 31.9% with goiter along with cervical lymphadenopathy. 3.6% had hoarseness and fixed unilateral vocal cords. 87.6% were primary tumors and 12.3% were recurrent tumors. 64.3% were Papillary carcinoma, 30.3% were Follicular carcinoma, 3.7% were anaplastic carcinoma and 3.2% were medullary carcinoma. 31.4% underwent lobectomy and isthmusectomy followed by completion thyroidectomy, 27.8% had total thyroidectomy, 29.3% had total thyroidectomy and unilateral block neck dissection, 5.1% had total thyroidectomy and bilateral block neck dissection, 2% had subtotal thyroidectomy, 0.05 % had isthmusectomy, 1.03% had Sistrunk’s operation followed by total thyroidectomy and 0.05% had suprahyoid neck dissection.

Conclusion: Female preponderance was found in our study in carcinoma thyroid. Papillary carcinoma was the commonest cancer type found followed by Follicular carcinoma. Both commonest types of cancers if treated in time and adequately can result in good patient’s survival.


Gynaecological Encounters in Surgical Emergency


1,3Senior Registrar, Surgical Unit-III, Sir Ganga Ram Hospital, Lahore

2Professor and Head of Department South Surgical Ward, King Edward Medical University, Lahore.

4Post-graduate Resident, Surgical Unit-III, Sir Ganga Ram Hospital, Lahore


Introduction: Female patients presenting in surgical emergency department often have an underlying gynaecological cause. The most common causes are ovarian pathologies such as cyst rupture or torsion, small gut perforation, gut adhesion and ureteric or urinary bladder injuries. These conditions may clinically resemble certain surgical causes of acute abdomen. Sometimes the diagnosis may only be confirmed per-operatively.

Methodology: A total of 79 females who were operated during the six months study period at the surgical emergency department of Sir Ganga Ram Hospital, Lahore, for some gynaecological pathology were included in the study. Routine laboratory and clinical investigations were conducted in all cases. The clinical history and diagnosis were recorded.

Results: The age range for patients was 15 to 47 years (mean age 29.20 + 7.2). Sixty-three patients (79.7%) were married and 16 (20.3%) were unmarried. Among these patients, 21.5% were nulliparous, 38% were primiparous and 40.5% were multiparous. The most common symptoms were nausea and vomiting (68.4%), peritonitis (63.3%) and fever (50.6%). Shock was observed only in 6 patients (7.5%). The most common etiology was ileal perforation (22.8%), rupture or torsion of ovarian cyst (20.3%) and adhesion of gut with uterus or ovaries (17.7%). Mortality was observed in 3 (3.3%) patients.

Conclusion: Gynaecological conditions requiring surgical management are commonly encountered on surgical emergency floor. The post-graduate trainees working in surgical and gynaecological emergencies must be trained to deal with such emergencies.

Keywords: gynaecological encounters, surgical emergency, acute abdomen.


Evaluation of Thyroid Hormone Profile in Patients with Suspected Thyroid Dysfunction in Southern Punjab


1Assistant Professor of Microbiology, Nishtar Medical college Multan. 2Professor/Head of Gynecology FJMC/SGRH Lahore

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


Background Objective: To assess T3, T4 &TSH levels and prevalence of thyroid disorders in the suspected patients received at collection centers of Aga Khan Lab in Southern Punjab districts.

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

Methods: 1784 suspected patients were evaluated for thyroid hormonal assay-tri iodo thyronine (T3), tetra iodo thyronine (T4) and thyroid stimulating hormone (TSH) by using cobas kits on Cobas e 411 immunoassay auto analyzer using electrochemiluminescence immunoassay(ECLIA) technique.

Results: Out of total one thousand seven hundred and eighty four cases of suspected individuals,472 (26.45%) were males and 1312(73.54%) were females. Out of total ,518(29.03%)subjects including139 (26.83%) males and (73.16%) 379 females showed thyroid dysfunction with male to female ratio 1:2.73. Of these 1784 cases, 357 (20.01%) were in age group of < 20 years, 1189 (66.65%) were in 21-54 years, and 238 (13.34%) were in age group of > 55 years. . Most common thyroid disorder found was hyperthyroidism (14.18 ) followed by hypothyroidism (6.73%) which was followed by subclinical hyperthyroidism (4.87%) and subclinical hypothyroidism (3.25%) .

Conclusion: The prevalence of thyroid dysfunction was very high (29.03 %) with hyperthyroidism (14.18%) being most common. Females were more affected.

Keywords: T3, T4, TSH, Hyperthyroidism, Hypothyroidism


Surgical Excision of Intradural Extra Medullary Spinal Tumors; Review of Outcome and Complications


Department of Neurosurgery (PGMI) Shaikh Zayed Hospital, Lahore


Objectives: Intradural extra medullary (IDEM) tumors of the spinal cord are most common benign lesions. Surgical decompression and resection, though challenging, benefits the patient significantly.

Methods: The authors performed a retrospective review of forty three patients with IDEM lesions, who presented to the Department of Neurosurgery Shaikh Zayed Hospital Lahore from June 2006 to March 2014. All patients were clinically evaluated for preoperative neurological status and investigated with MRI without and with contrast. Postoperative complications were assessed along with the neurological status till the patients last follow up. Other complications including CSF leakage, requiring lumbar drainage and infections were also noted.

Results: There were forty three patients with a mean age of 40 years. Complete resection was achieved in 38 (88.3%) patients and subtotal resection in 5 (11.6%) patients. Majority of the patients (41 out of 43) showed improvement (95%). Thirty eight patients were ambulatory post resection.

Conclusion: IDEM lesions pose significant challenge for surgical resection. However if complete resection is achieved, the results, as evident by the functional recovery, are gratifying.

Key words: Spine, Tumor, Intradural, Extramedullary, Resection Outcome


Prevalence of Hepatitis ‘C’ in Apparently Suspected Individuals of Southern Punjab by Highly Sensitive Chemiluminescence Immunoassay


1Assistant Professor of Microbiology, Nishtar Medical college Multan, 2Professor/Head of Obstirict & Gynaeology FJMC/SGRH Lahore


Background: The prevalence of hepatitis C virus (HCV) infection is increasing worldwide .Hepatitis C virus (HCV) infections accounts for substantial proportions of the world wide liver disease. This study was aimed to assess the prevalence of Anti-HCV 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 3341 suspected patients were received at collection centers and included in this study. The screening was performed by using the Elecsys Anti-HCV II assay kit on Cobas e 411 immunoassay analyzer. Data were entered and analyzed using SPSS version 16 statistical package.

Results: From the total of 3341 suspected hepatitis patients, 2045 (61.20%) were males and 1296 (38.80%) were females. Anti-HCV was found reactive in 1002 (29.99%) borderline 20 (0.59%) and non-reactive in 2319 (69.42%). Out of the total individuals, 589 (17.63%) males and 413 (12.36%) females were Anti-HCV reactive. . . The overall seroprevalence was found to be 29.99%. LODHRAN (70%), VEHARI (49.55%), KHANEWAL (44%) and BAHAWALNAGER (37.7%) are most affected districts for HCV infection.

Conclusion: The overall prevalence of HCV is alarming high. Males were more affected. It is required to prevent the disease by giving education to the health personal as well as to general population.

Keywords: Hepatitis C virus, Prevalence, Southern Punjab


Etiologic Spectrum and Clinical Features of Pancytopenia: A Hematological Study in a Tertiary Care Hospital at Quetta


1Department of Haematology, Bolan Medical College Quetta, 2Department of Pathology, Mohi-Ud-Din Islamic Medical College (MIMC) Mirpur, Azad Jammu & Kashmir

Correspondence: Dr. Zahid Masood, Email:drzahidbmc9@gmail.com


Objective: To determine the clinical profile, etiological spectrum and bone marrow findings of patients presenting with pancytopenia.

Patients and Methods: This was the cross sectional observational study conducted in the Department of Pathology, Hematology Section, Bolan Medical Complex, Teaching Hospital Quetta spanning over a period of five years from January 2009 to January 2014. Four hundred and two patients fulfilled the criteria of pancytopenia. Routine complete blood count (CBC), peripheral blood smear (PBS) and bone marrow aspirations (BMAs) done on all patients. Bone marrow trephine biopsies (BMTBs) were done where needed. These procedures were performed according to standard methods. SPSS-11 was used to analyze the data.

Results: Out of 402 patients 32.8% were of megaloblostosis, 25.4% hypocellular marrow, 11.4% normocellular marrow, 5.2% acute lymphoblastic leukemia (ALL) and visceral leishmaniasis (VL) each, 4.5% mixed deficiency anemia (MDA), 0.8% acute myeloid leukemia (AML), malaria 2.7%, idiopathic thrombocytopenic purpra (ITP) 2.8 and 1.5% hypersplenism. Male to female ratio was 1.4:1. The commonest presenting complaint was pallor (69.52%), fever (27.20%) bleeding manifestations (15.6%), bleeding with fever (9.9%) and others.

Conclusion: Complete blood count, peripheral blood smear and bone marrow aspiration and in some cases bone marrow trephine biopsies are of paramount importance in diagnosing patients with pancytopenia. As a large number of pancytopenic patients are having benign and reversible causes, an early and prompt diagnosis is mandatory for the purpose of making appropriate therapeutic decisions.

Key words: Pancytopenia, Etiologic Break-up, Bone marrow examination


Vesical Stone Around Migrated Intrauterine Contraceptive Device (IUCD)

  1. A. SHAH1, H. ZAHID*2, F. A. ZAEEM3, A. SAJJAD4, S. FIAZ5, M. SAEED6

Department of Urology, Sir Ganga Ram Hospital, Lahore, Pakistan

Author Information: 1Professor Urology FJMC/SGRH, 2PGR Surgery SGRH, 3PGR/MO Urology SGRH, 4HO Urology SGRH, 5HO Urology SGRH, 6HO Urology SGRH, Lahore.

Correspondence Author: Dr Hassaan Zahid, Post Graduate Registrar, Gen Surgery, Sir Ganga Ram Hospital, Lahore. Email: sunnyzahid123@hotmail.com


Intrauterine contraceptive devices (IUCDs) are now becoming one of the most popular reversible methods of contraception. It is so because of its high efficacy and low cost. Although it is safe but may cause some serious complications as uterine perforation. We present two cases of missing IUCD, in which there was migration into the urinary bladder and calculus around that. Both were managed endoscopically without any complication, at Department of Urology, Sir Ganga Ram Hospital, Lahore.

Key words: IUCDs, Vesical Stone, Contraception