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Objective: To create a nomogram based on urine volume and flow of males without lower urinary tract symptoms., Methods: The prospective, cross-sectional study was conducted at the Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, from November 1, 2020, to October 31, 2022, and comprised healthy young males without lower urinary tract dysfunction who were recruited from the hospital as well as a large textile mill. They were asked to void on their normal desire. Uroflowmetry was done to determine maximum flow rate, average flow rate, and void volume values. A best-fit regression model was used to formulate uroflowmetry nomogram using average and maximum urine flow rate over voided volume. The sample size was calculated using PASS 2020 Power Analysis and Sample Size Software (2020). NCSS, LLC. Kaysville, Utah, USA. The database was developed on NCSS 2020 Statistical Software (2020). NCSS, LLC. Kaysville, Utah, USA for the data analysis., Results: Of the 468 male subjects enrolled, data was analysed related to 432(92.3%). The mean age was 25.59±4.32 years. Mean maximum flow rate, average flow rate and void volume were 25.28±8.70mL/s, 14.77±4.79mL/s and 405.48±163.86mL, respectively. The association of age was noted with maximum flow rate (r=0.1435, p=0.004), average flow rate (r=0.1135, p=0.004) and void volume (r=0.0619, p=0.004). The best-fitted model for maximum and average flow rate was subsequently developed which was statistically significant (p<0.05)., Conclusions: The nomograms developed could reliably predict the maximal flow rate in young Pakistani men.

Objectives: To compare the efficacy of mycophenolate mofetil with intravenous cyclophosphamideas induction therapy in lupus nephritis., Methods: The observational, prospecrive, cohort study was conducted at the Rheumatology Department of Fatima Memorial Hospital, Lahore, Pakistan, from July 2016 to June 2019, and comprised lupus nephritis patients. For induction therapy, the patients were assigned at the discretion of the treating rheumatologist to mycophenolate mofetil group MMF, and intravenous cyclophosphamide group CYC. The latter group was further divided into NIH subgroup that received the therapy as per the protocol of the National Institutes of Health, and ELNT subgroup which recived the therapy as per the Euro Lupus Nephritis Trial protocol. Maintenance therapy in all groups was mycophenolate mofetil. Tacrolimus was added in case of non-response. The outcome was the achievement of complete renal response at 6, 12 and 24 months. Data was analysed using SPSS 26., Results: Of the 131 patients, 126(96.2%) were females. The overall mean age was 27±7.7 years. There were 58(44.2%) patients in group MMF and 73(55.7%) in group CYC, which had subgroup NIH 46(63%) and subgrpup ELNT 27(37%). The complete renal response rates at 6, 12, and 24 months were 22 (43.1%), 35 (71.4%), and 40(83.3%) for group MMF; 5(12.5%), 9(22%) and 24 (58.5%) for subgroup NIH, and 6(26.1%), 8(36.4%) and 14(63.6%) for subgroup ELNT. Group MMF outcomes were significantly better than the rest (p<0.05)., Conclusions: Mycophenolate mofetil induction therapy was more effective than intraveenous cyclophosphamide in terms of achieving remission at 6, 12 and 24 months.

Objective: To determine the current trends in complete denture education in undergraduate dental colleges., Methods: The survey-based study was conducted in April and May 2020 at undergraduate dental colleges of Pakistan, and comprised heads of the Prosthodontics Department at all dental colleges across Pakistan having at least one batch of final year dental students. Data was collected using an online predesigned questionnaire that explored theoretical and practical teaching patterns of complete denture prosthodontics in the undergraduate years, and the materials and practices of students when constructing complete dentures in the clinics. The participants were given the option of choosing more than one option where needed. Data was analysed using SPSS 23., Results: Of the 49 subjects approached, 40(81.6%) returned the forms duly filled; 11(27.5%) from public-sector institutions and 29(72.5%) from the private sector. There were 26(65%) institutions which required that their undergraduate students fabricate 2-4 conventional complete dentures. In all 40(100%) colleges, faculty gave live clinical demonstrations before students fabricated conventional complete dentures in the outpatient departments. Teaching strategy included small group discussions in 25(62.5%) institutions. Green stick 40(100%), zinc oxide eugenol 40(100%) and impression compound 39(97.2%) were the materials of choice for various steps of impression making. In all the 40(100%) institutions, students fabricated conventional complete dentures during their prosthodontics rotation. Immediate, copy and overdentures were constructed by students in 8(20%), 3(7.5%) and 8(20%) institutions, respectively., Conclusion: Majority of the dental schools used similar impression materials and techniques for fabricating conventional complete dentures. Didactic teaching of conventional and unconventional complete dentures was being carried out at a huge majority of the dental institutions studied.

Objectives: To evaluate the effect of laparoscopic sleeve gastrectomy on vitamin D status, parathyroid hormone,serum calcium and the effectiveness of vitamin D supplementation., Method: The prospective study was conducted at the General Surgery Department of Kafrelsheikh University Hospital, Egypt, in November 2019, and comprised morbidly obese patients of either gender who were managed with laparoscopic sleeve gastrectomy. Serum levels of vitamin D, calcium and parathyroid hormone were assessed at baseline and at 6 and 12 months after the surgery. All subjects were given 400 IU/day of vitamin D. If the level of vitamin D was <30ng/ml, further doses of calcifediol 200,000 IU were added every two weeks. Data was analysed using SPSS 22., Results: Of the 40 patients, 28(70%) were females and 12(30%) were males. The overall mean age was 33.9±10.8, mean weight was 136±18.29kg and mean body massindex was 50±4.9kg/m2 . The mean operative time was 64.5±13.6 minutes, and the mean hospitalstay was 1.8±1.1 days. There wassignificant reduction in body massindex values after the surgery (p<0.05). Vitamin D level was 19.2±3.2 ng/ml at baseline, which rose to 21.4±2.7 ng/ml at 6 months and 26.6±2.8 ng/ml at 12 months post-surgery (p<0.05). Preoperative parathyroid hormone level was 58.3±7.8 pg/ml , which went down to 48.6±7.4 pg/ml at 6 months, and 41.3±6.5 pg/ml at 12 months postoperatively (p<0.05). The mean serum calcium level at baseline was 9±0.4mg/dL, which rose to 9.2 ±0.3mg/dL and 9.5±0.4 mg/dL at 6 and 12 months post-surgery (p<0.05)., Conclusions: Low vitamin D complications could be decreased postoperatively by administering vitamin D as a routine treatment. Postoperative monitoring of vitamin D, parathyroid hormone and serum calcium levels is essential.

Objectives: To evaluate the effect of self-care guidelines on improving menopausal urogenital symptoms., Method: The quasi-experimental study was conducted from September 2018 to February 2019 at the outpatient clinic at the maternity hospital of Ain Shams University, Egypt, and comprised menopausal women reporting urogenitalsymptoms. The participants were divided into 10 equal groups and were subjected to 30-minute theoretical and practicalself-care sessions 3 times per week for 4 weeks. Data was collected using interviews, Day-to-Day Impact of Vaginal Aging questionnaire and Urinary Incontinence Questionnaire. Data was collected at baseline, immediately after the intervention and after 3 monthsfrom the first evaluation. The collected data were statistically analysed using the statistical package forsocialscience (SPSS version 20), percentage (%), the arithmetic mean (),standard deviation (SD), and chi-square (X2 & P-value) were calculated., Results: Of the 120 women with mean age 48.03±3.04 years (range: 45-50 years), 72(60%) had secondary education, 109(90.8%) were married, 44(36.7%) were working in an office and 7(55.8%) were housewives. The mean age at menopause was 46.57±2.33 years (range: 42-50 years). Urogenital symptoms post-intervention reduced significantly (p<0.05)., Conclusions: Self-care intervention had a significant impact in terms of improving menopausal urogenitalsymptoms.

Objectives: To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia., Method: The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24., Results: Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively., Conclusions: Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.

Objectives: To evaluate Hem-o-Lok polymer clips' feasibility, safety and cost-effectiveness in controlling the splenic pedicle during paediatric laparoscopic splenectomy., Method: The prospective study was conducted from May 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised children of either gender aged <18 years who had benign haematological diseases and were indicated for laparoscopic splenectomy. During the procedure, Hem-o-Lok clips were used for controlling the splenic pedicle. Patients were encouraged to ambulate the same day, and the drain was removed 24hours postoperatively. The cases were followed up for three months postoperatively., Results: Of the 23 subjects, 11(47.8%) were boys and 12(52.2%) were girls. The overall mean age was 8.74±3.44 years (range: 4-15 years). There were 6(26%) cases of spherocytosis, 1(4.3%) immune thrombocytopenic purpura and 16(69.6%) with thalassemia major. The mean operative time was 93.43±29.87 minutes(range: 65-180 minutes). There was no conversion to open splenectomy and no mortality. There were 2(8.7%) cases of minor and 1(4.3%) of major intraoperative bleeding. All the 3(100%) cases were controlled laparoscopically. No postoperative bleeding occurred and no cases required postoperative blood transfusion., Conclusions: Controlling both the splenic artery and vein using Hem-o-Lok clips was found to be feasible, safe and cost-effective.

Cardiac rhabdomyoma is the most common primary cardiac tumour and is considered to be a hamartoma of developing embryonic cardiac myocytes. It is commonly seen in tuberous sclerosis. The size and location of the tumour is the surrogate determinant of the risk of haemodynamic compromise. Pericardial rhabdomyoma is very rare and tends to follow the inherent natural history of spontaneous regression. We present cases of two foetuses diagnosed with large pericardial rhabdomyoma and no haemodynamic consequences.

Objectives: To assess knowledge, attitude and practice of medical and paramedical staff about cervical cancer as well as its screening and prevention., Methods: The descriptive cross-sectional study was conducted at the Jinnah Post-graduate Medical Centre, Karachi, from March 1 to August 30, 2019, and comprised women medical and paramedical staff randomly selected from different specialties. Data was collected using a structured questionnaire. Data was analysed using SPSS 20., Results: Of the 347 participants 144(41.5%) were nurses and 203(58.5%) were doctors. The overall mean age was 26.22±6.38 years. Of the total, 108(30%) respondents were married and 239(68%) were single. Overall, 239(68.8%) were well aware of Pap smear being the screening test; 85(24.5%) were aware of the true guidelines to repeat the test; 152(43.8%) had an idea of the exact use of visual Inspection with acetic acid; 61(17.6%) had got a Pap smear done; and 156(45%) thought they were at risk of developing carcinoma cervix. The common risk factors identified were multiple sexual partners 254(73.2%), age at first sexual intercourse 160(46%), smoking 131(37.8%), foul-smelling discharge 221(63.7%), and post-coital bleeding 231(66.6%)., Conclusions: Cervical cancer prevalence is rising due to inadequate knowledge and awareness among healthcare personals. Improvement can be brought by regular use of Pap smear.

Objective: To provide evidence about the susceptibility of anti-malarial drugs, and to identify the clinical features of the disease in children., Methods: The prospective observational comparative study was conducted at the Dongola Specialist Hospital, Dunqulah, Sudan, from February 2016 to February 2017, and comprised children aged <16 years with bodyweight >5kg who had malaria. The subjects were enrolled into group 1, which received treatment based on physician's discretion, and group 2, which received treatment in accordance with the national guidelines. The follow-up was conducted on days 3, 7 and 14 to identify cases as early treatment failure, late treatment failure, or treatment success. Data were analysed in terms of frequencies and percentages using statistical analysis software R version 3.1.2., Results: Of the 120 children, 60(50%) were in each of the two groups. Overall, 63(52.5%) were aged 1-6 years, 66(55%) were males, and 42(35%) were exposed to malaria for the first time. Post-treatment test was negative for all 120(100%) the subjects in both the groups. showing no inter-group difference., Conclusion: Although resistance to combination therapy was not detected, it remains extremely important to remain vigilant for the emergence of resistance in the future.

The objectives of this study were to find out the frequency of anxiety and depression in medical students and various coping mechanisms adopted by them to identify the coping trends and to stress the need of equipping these students with positive coping tools to deal with anxiety and depression. A cross-sectional, questionnaire-based observational study was conducted on a population of 500 medical students of Federal Medical and Dental College, Islamabad. The duration of the study was three months. By using the WHO sample size calculator, taking the confidence level 95%, anticipated population proportion 70% and absolute precision required 7%, the sample size was calculated at 165. The samples were collected by non-probability consecutive sampling via a questionnaire. In the study, two instruments were used: 1) Aga Khan University Anxiety and Depression Scale (AKUADS), and 2) Brief Cope Inventory. Self-administered questionnaires were filled by the students and the data collected from these questionnaires was analysed on SPSS version 19. Out of the sample size of 165 (98 female, 67 male) students, excluding 12 students with previous history of mental and physical illness, the prevalence of depressed students found after calculating their scores according to the Aga Khan Anxiety and Depression Scale (AKUADS score ≥19) was 95 (57.57%). The most used positive coping mechanisms by these students were religion (5.55±1.91), acceptance (5.28±1.56), planning (5.27±1.58) and active coping (4.85±1.45). The most used negative coping mechanisms were self-blame (5.52±1.83), self-distraction (5.29±1.56), and venting (4.67±1.49). The high presence of negative coping mechanisms indicates the urgency of the need for proper counselling and guidance of medical students about dealing correctly with anxiety and depression.

Objective: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender., Methods: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23., Results: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001)., Conclusions: The prevalence of overactive bladder was found to be low when assessed with strict application.

Objective: The study aimed to document the impact of interpersonal communication (IPC) activities on increasing volume of family planning clients, new users, long term contraceptive uptake, post-partum, and post abortion family planning uptake at the associated health facilities of the Sabz Sitara Network., Methodology: A comparative secondary analysis of retrospective programme service delivery data from two groups of providers was performed. The exposure variable is defined as receipt of IPC. The six outcome variables are volume of: family planning (FP) clients, FP clients less < 25 years, intra-uterine device (IUD) insertions, post-partum FP clients (PPFP), users, and post-abortion FP (PAFP) clients., Results: The increase in client volume in IPC supported providers is significant for all the FP outcomes when adjusted for provider qualification and location. The adjusted model shows a significant increase of 10 more FP clients, 2 more youth clients and IUD insertions each, 3 more new users, and 1 more client for post abortion services., Conclusions: The IPC intervention has a positive and significant impact on increasing client volume for all related FP outcomes at the associated provider facilities. Location and qualification of providers seem to moderate the impact. Considering qualification, and geo-social demographics of the area to tweak intervention intensity and design will help amplify the associated beneficial outcomes and minimize underperformance. To maximize return on investment, subsequent evaluations should help determine the ideal time frame required to achieve and sustain the positive results.

Objective: To design and implement a career guidance programme for medical students, and to evaluate its effectiveness., Methods: The quasi-experimental single-group study was conducted at the College of Medicine, Jouf University, Sakaka, Saudi Arabia, during the 2018-19 academic year. A modified Medical Career Development Inventory covering 5 areas was used to assess how much students' thinking or planning had improved after implementing the designed career guidance programme following Kern's 6 steps for course design. This was done through focussed group discussions. In the second phase, a comprehensive sample comprising 4th and 5th year male and female medical students was enrolled to assess their readiness, planning and choice of specialties, and to compare the same variables post-intervention. Data was analysed using SPSS 22., Results: There were 50 students in the first phase; 30(60%) males and 20(40%) females. In phase II, there were 82 subjects; 47(57.3%) males and 35(42.7%) females. Pre-intervention mean result was 2.60±0.29 which increased post-intervention to 3.16±0.20 (p=0.018), suggesting an improved degree of vocational development., Conclusions: The career guidance programme significantly improved degree of vocational development and readiness to cope with developmental tasks encountered throughout a physician's career.

Objective: To determine the reasons that motivated students to seek admission in dental colleges, and to assess differences in the reasons between students studying in private and public dental colleges., Methods: The cross-sectional analytical study was conducted at two public-sector and four privatesector dental colleges in Karachi from June to September, 2018, and comprised students of first to final year of studies. Data was collected using a self-administered questionnaire. Students were asked to mark all reasons that they considered had been an influencing factor on their decision to opt for dentistry. Data was analysed using SPSS 21., Results: Of the 900 forms distributed, 814(90.4%) were collected with complete data; 182(22.4%) males and 632(77.6%) females. The overall mean age was 20.8±1.3 years. Of the total, 324(39.8%) students were from the public sector, while 490(60.2%) were at private colleges. A statistically significant difference was noted in professional and personal reasons cited by the two groups of students (p<0.05)., Conclusions: It is of utmost importance that students shall be very clear regarding their expectations from a career to minimise chances of abandoning it midway or being professionally dissatisfied even after completing a degree.

Objective: To explore the satisfaction and perception of medical students towards simulation-based learning approach. ., Methods: The cross-sectional study was conducted at the College of Medicine, Jouf University, Sakaka, Saudi Arabia, in 2018, and comprised medical students of either gender in preclinical and clinical years who were exposed to simulation-based learning. A reliable questionnaire was used to collect data, and it was scored on a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied). Overall satisfaction level was graded on a scale ranging 6-10 (6 = sufficient; 10 = excellent). Data was analysed using SPSS 20., Results: Of the 400 students approached, 230(56%) responded. Of them, 198(86%) were from the preclinical years and 32(14%) were from the clinical years. Students from all years were satisfied with instructors' cooperation 191(83%), organization of skills 179(78%), clear intended learning outcomes 189(82%), updated knowledge 179 (78%) . The deficiencies cited were lack of proper training rooms 40/230(17.40), shortage of training times 80/230(34.50%), inadequate facilities 52/230(22.6%) of students were satisfied. Overall satisfaction was graded by 170(73.9%) students as >6 and there was a significant difference between satisfaction scores of preclinical and clinical years (p=0.001)., Conclusions: Most students were satisfied that simulation-based learning improved their clinical skills, ability to retain learning materials, clinical decision-making and communication skills with patients.

Haemangioendotheliomas (HAE), although rare but are the most common parotid gland tumours in children. We report a 4-month-old girl who presented with a progressively enlarging right sided facial swelling overlying the angle of the mandible. An Ultrasound of the lesion and a computed tomography (CT) scan of the head and neck was carried out which revealed a large lesion within the right parotid gland. CT scan further demonstrated a direct communication with the right external carotid artery and external jugular vein. Considering the clinical course and radiological findings, there was sufficient evidence to avoid any invasive testing. Due to the self-limiting nature of the disease, patient was managed expectantly.

Objectives: To explore postpartum depression as a predictor of suicidal ideation and to find if perceived social support had a moderator effect in this scenario among new mothers with hearing loss., Methods: The descriptive cross-sectional study was conducted from March to September 2018 in Lahore, Islamabad, Rawalpindi, Gujrat, Gujranwala, Jhelum and Sialkot Cities of Pakistan. New mothers with hearing loss (HL) and those without hearing loss were recruited from maternity clinics 2 to 6 weeks after the delivery. Standardised tools were used to measure postpartum depression, perceived social support and suicidal ideation among the subjects. Data was analysed using SPSS 21., Results: Of the 547subjects, 272(49.7%) were those with hearing loss and 275(50.3%) were without hearing loss. Odd ratio showed that mothers with hearing loss were 1.97 times more likely to exhibit postpartum depression compared to those without hearing loss, whereas participants with HL were 1.08 times more likely to be at risk of having suicidal behaviours compared to those without hearing loss. On the other hand, those without hearing loss were 0.97 times higher on social support. Postpartum depression was a positive predictor (p<0.001) whereas perceived social support negatively (p<0.001) predicted the suicidal ideation of new mothers with hearing loss. The interaction of postpartum depression and perceived social support negatively affected (<0.001) suicidal behaviour., Conclusions: Perceived social support appeared to lower the probability of postpartum depression and suicidal ideation among mothers with hearing loss.

Allgrove syndrome is a rare autosomal recessive syndrome of unknown prevalence. The first case of Allgrove syndrome was reported in 1978 by Allgrove. It is characterized by triad of achalasia, alacrima and adrenal hypoplasia. There are also associated autonomic and neurological manifestations. We report the case of a 7 years old boy being treated for achalasia cardia, presented with fits and altered sensorium which on further investigations was found to be due to adrenal insensitivity (Raised ACTH level, low Cortisol level, and normal Aldosterone and Renin ratio). He also had undiagnosed alacrima since birth, mild degree of hearing loss and autonomic instability in the form of episodic hypertension.

Objective: To evaluate the association of bone mass density with chronic backache., Methods: The case-control observational study was conducted at Bone Mass Density Assessment Unit, Liaquat University of Medical & Health Sciences Jamshoro from January 2011 to December 2013. Adult patients of either gender having chronic backache were studied alongside subjects without backache who served as the control group. Bone mass density of all patients was measured at the lumbar spine (L1-L4) and hip using a dual-energy X-ray absorptiometry scan. Association of chronic backache with age, gender, body mass index and bone mass density was assessed by performing multiple regression analysis., Results: Of the 482 subjects in the study, 162(33.6%) were cases and 320(66.3%) were the controls. Overall age range was 20-78 years with a mean of 48.5±12.36. The mean age of the controls was 38.87±13.55, while for the cases it was 36.26±9.41. Bone mass density in the cases was significantly low compared to the controls (p-0.028)., Conclusions: Severity of chronic backache could be predicted by low bone mass density.

Human papilloma viruses (HPV), members of the papillomaviridae family, infects squamous epithelial cells of cevix, lower genitalia, and oral cavity. The association of HPV with oropharyngeal carcinogenesis is well documented.The incidence of oral cancer ranks second in Karachi South in both genders according to World Health Organization (WHO) statistics. This is attributed to the popularity of chewable tobacco products among the general population. Studies on Gutka-eaters in a set population of Karachi showed high frequency of HPV (17%) and high prevalence of HPV in squamous cell carcinoma in Pakistani patients (68%). The exposure of oral mucosa to chewable tobacco causes abrasions making it susceptible to HPV. This review strives to summarise the role of HPV in chewable tobacco-related precancerous and cancerous lesions. The literature of about a decade was retrieved from Google and pubMed with the under mentioned key words. It was found that the use of chewable tobacco products, especially Gutka, may increase the risk of oral squamous cell carcinoma (OSCC).

Objective: To study cardiotoxicities, especially bradycardia in cancer patients treated with 5-Fluouracil and 5-Fluouracil based chemotherapy regimens in Pakistani population., Methods: Data was extracted from the medical records of all diagnosed cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Center registered between January 2002 and December 2004 receiving 5- Fluouracil based chemotherapy regimens. The data was analysed retrospectively, including electrocardiogram and cardiac markers. Pearson's Correlation coefficient was calculated to see any possible correlation between 5-Fluouracil alone and 5-Fluouracil based regimens and cardiotoxicity, and other variables., Results: Symptomatic cardiotoxicity was observed in 60 (19.93%) out of 301 patients whose cases were part of the study. Bradycardia was the most common cardiotoxicity and was observed in 36 (11.96%) patients. Nine (2.99%) mortalities were also observed. The incidence of cardiotoxicity was not significantly different between the patients with and without pre-existing cardiovascular disease (p = 0.095) and having negative correlation - 0.305. Cardiotoxicities were more common with Continuous Infusion (CI) of 5-Fluouracil, radiotherapy concurrent with 5-Fluouracil and when 5-Fluouracil was used in combination with Cisplatinum (CDDP)., Conclusion: Cardiotoxicities were more prevalent when 5-Fluouracil was used along with concurrent radiotherapy and with Cisplatinum and when administered in continuous infusion pattern. Hence, 5-Fluouracil and 5-Fluouracil based chemotherapy regimens cause cardiotoxicities, especially bradycardia, in a significant number of cancer patients in Pakistani population.

Objective: To compare the antibiotic therapy with the absence of antibiotic therapy in reducing post-tonsillectomy morbidities, Methods: The quasi-experimental study was conducted at the Aga Khan University Hospital, Karachi, from November 2006 to September 2007. It involved 60 patients fulfilling the criteria for recurrent tonsillitis who were divided in two groups based on the different practice of two sets of surgeons. In one group antibiotics were used, while in the other group, no antibiotic was given. Patients filled a questionnaire about pain, post-operative bleeding, day of normal diet intake, day of normal activity and any consultation received during the first postoperative week. The data collected was analyzed using SPSS version 16., Results: There were 60 patients who were divided in two groups of 30 each on the basis of purposive sampling technique. Mean age was 21.43 +/- 8.3 years. Of the total, 55% were male and 45% were female. Post-operative pain was comparable between the two groups. Four patients had secondary haemorrhage--three in the antibiotic group, and one in the non-antibiotic group. Mean day of normal activities and normal diet intake was almost the same in both groups. Unscheduled hospital visits were 6.9% in the antibiotic group, and 3.3% in the non-antibiotic group., Conclusion: The study showed that antibiotics did not have any significant impact in reducing the post-tonsillectomy morbidities.

Objective: To review the role of angioembolization in the control of intractable epistaxis at our institution., Methods: A retrospective review of the charts of the patients between Jan 2001 to June 2010 at Aga Khan University Hospital, Karachi was done. All patients who underwent angioembolization for intractable epistaxis were included in the study. Patients with nasal or nasopharyngeal mass were excluded. Data was analyzed by using SPSS version 16., Results: Total numbers of the patients were 16. Fourteen (87.5%) patients were male and 2 (12.5%) were female with mean age 51.2 +/- 12.922 years (range 26-71 years). In 11 (68.75%) patients there were no associated risk factors for epistaxis, 3(18.75%) patients had uncontrolled hypertension, 1 (6.25%) patient had road traffic accident and 1 (6.25%) patient had bleeding after nasal surgery. All patients were initially treated by anterior and posterior nasal packing for 48 to 72 hours. Angioembolization successfully controlled epistaxis in all 16 (100%) patients initially. However, in 2 (12.5%) cases embolization had to be repeated; in 1 patient on the same day and in another patient after one month of initial procedure. The average length of stay after angioembolization was 1.9 +/- 0.854 days. No major or permanent complication was observed. Two (12.5%) patients developed minor complications (1 patient experienced facial pain for 7 days and another patient developed haematoma at the site of femoral artery)., Conclusion: Angioembolization is a safe and effective treatment option for intractable epistaxis.

Aorto-pulmonary window is a relatively rare congenital cardiac malformation with an overall incidence of 0.1%. Pulmonary hypertension develops quickly if the lesion is left untreated hence early surgical intervention is warranted after diagnosis. The surgery for correction of APW has evolved over years, currently an open repair on cardiopulmonary bypass (CPB) with a single patch technique yields good results. Mortality is affected by association of pulmonary hypertension and other cardiac malformations. We present a case of an infant with a large type II APW with a relatively low pulmonary vascular resistance. Hospital stay was complicated because of pulmonary arterial disease making it an important reason for correction in the first few months of life.

Implantation of cardiac pacemakers has been practiced for at least five decades with continuous developments of the hardware. The invention of dual chamber pacemakers has initiated a debate concerning its superiority over single chamber ventricular pacemakers. Throughout the world, surgeons have been using dual chambered permanent pacemakers with successful follow ups. However, Pakistan has not yet taken the advantage of such pacemaker devices till now. We report three cases that underwent a dual chamber permanent pacemaker implantation for the first time in children less than 8 kg with successful follow ups.

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies.

Objectives: To determine the effect of clear liquor and meconium stained liquor on mode of delivery, and to evaluate neonatal outcome., Methods: It was a Cross sectional analytical study, conducted in the department of Obstetrics and Gynaecology, Shaikh Zyed Federal Postgraduate Medical Institute/Hospital, Lahore and Shaikh Zaid Women Hospital Larkana, from April 2006 to March 2007. Two hundred and fifty patients from Larkana and 250 patients from Lahore in clear liquor group were included in the study. Similarly 125 patients from each city, that is 250 patients which had meconium stained liquor were included in group 2. The subjects with meconium stained amniotic fluid and clear amniotic fluid were registered as group 1 and 2. The socio demographic information, fertility history and gestational age of subjects were recorded. The investigations and information regarding mode of delivery and duration of labour were also noted. All babies delivered were attended by paediatricians., Results: In this study 500 cases with clear liquor and 250 cases of meconium stained liquor were selected from two cities, Lahore and Larkana. Out of these 55 (22%) patients had grade I meconium stained liquor, 140 (56%) patients and 55 (22%) patients had grade II and grade III meconium stained liquor respectively. The mode of delivery is significantly affected by meconium staining of liquor. The effect of meconium stained liquor was significant on time of delivery. There were 40 (16%) post date deliveries in meconium stained liquor as compared to 1% in subjects with clear liquor. The effect of meconium staining of liquor was significant on Apgar score, neonatal admission, meconium aspiration syndrome and neonatal deaths., Conclusion: Meconium stained amniotic fluid (MSAF), is associated with increased neonatal morbidity and mortality. Caesarean sections were performed twice as frequently in women presenting with MSAF.

Objective: To find the prevalence of malignant pathology in women with postmenopausal bleeding (PMB)., Methods: An observational cross section study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College and Hospital Nawabshah from 1st January 2006 to 31st December 2006. All patients with a typical history of post-menopausal bleeding were evaluated under anaesthesia and diagnostic dilatation and curettage was done for histopathological assessment of endometrial lining. Cervical biopsy was taken in selected patients., Results: Total 50 patients were included. Benign lesion was found in 24 (48%) cases, followed by malignant pathology in 15 (30%), premalignant lesion was responsible for PMB in 7 (14%) cases, while pathology remained undetermined in 4 (8%) patients., Conclusion: Malignancy has an important role in the etiology of PMB which needs a careful evaluation. This study showed a high prevalence of malignant disorders (30%) with carcinoma of cervix and endometrium having an equal contribution. Multiparity was the most significant factor for carcinoma of endometrium.

Objective: To assess gastrointestinal symptoms among depressed patients presenting in an outpatient psychiatric clinic., Methods: All consecutive and consenting cases of depressive disorder presenting to the clinic from Jan' 02 to Dec' 05 were inducted in the study. A descriptive study was carried out in a clinical setting at the Neuro-Spinal Medical Institute, Karachi, Pakistan. The assessment was based on detailed history, physical examination, mental state examination and filling of semi structured proforma designed for this purpose. For diagnostic purpose WHO classification ICD-10 criteria was used., Results: A total of 1165 (Male: 56%, Female: 43.2%) patients were assessed. The age ranged from 6 to 90 years for male and 5 to 80 for females with p-value of 0.001. Majority were married. Their educational status revealed that 20.4% of males and 45.1% females were illiterate. The most frequently reported gastrointestinal symptom was decreased appetite (67.7%) followed by constipation (57.7%) and diarrhoea (42.3%). Other reported symptoms included abdominal pain, vomiting, gas, indigestion and nausea in order of frequency. In males 13.7% and 12.7% females had suffered for > 10 years before seeking psychiatric consultation. Surprisingly, about 26.3% of the patients had previously pursued alternative modes of treatment (homeopathic, faith healers and hakeems)., Conclusion: Somatic symptoms manifesting as gastrointestinal symptoms are common in patients with depressive disorder. Awareness about such an association is essential and will be useful for primary care physicians and gastroenterologists for establishing early diagnosis and management, thus avoiding unnecessary investigations in patients with poor resources.

Objective: To assess the efficacy and preparedness of the pre-hospital and hospital emergency medical systems and post graduate trainees in the city to deal with a massive terrorist strike., Methods: A cross-sectional survey of postgraduate trainees was conducted at Jinnah Postgraduate Medical Center and Civil Hospital Karachi from 21st July 2007 to 24th July 2007, to evaluate the preparedness and self identified deficiencies of doctors involved in massive trauma casualty management. To assess the pre-hospital care in Karachi, structured telephonic interviews were conducted of administrators of two private run charity based ambulance services., Results: Out of the 90 respondents questioned regarding a self assessment of their training, only 3 (3.3%) of them were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed Hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures are available in the ambulances., Conclusion: With an increasing number of terrorist attacks in the country, massive influx of casualties in a relatively short time span has become a regular feature of the Pakistani hospital system. Lack of adequate training at pre-hospital and in hospital levels may translate into increasing morbidities and mortalities. It is imperative that training of junior doctors and paramedical staff be conducted regularly and an effective regional communication base established for efficient interdepartmental coordination.

A twelve years old female patient presented with headache off and on and disparity between upper and lower limb pressures. On the basis of history, physical examination and magnetic resonance angiography, the patient was diagnosed as mid aortic syndrome and planned for elective aorto aortic bypass graft surgery through left thoracotomy. Double lumen endotracheal tube was placed for lung isolation and episodes of hypertension during proximal and distal cross clamp were controlled with sodium nitropruside infusion (SNP). Extra pleural catheter was put in at the end of surgery before chest wall closure for postoperative pain control. Both upper and lower limb pressures were monitored in the cardiac intensive care unit (CICU) and over a period of twenty four hours, gradient gradually reduced to 10 mm Hg.

Objective: To establish intrauterine diagnosis of thalassaemia major in couples with thalassaemia trait by chorionic villous sampling., Methods: A total of 60 couples with children suffering from transfusion dependent beta-thalassaemia or couples who were known carriers of beta-thalassaemia were included in this study. The standard procedure was followed for the collection of samples which was finally transferred in appropriate medium to Armed Forces Institute of Pathology Rawalpindi for detection of thalassaemia mutation., Results: After DNA analysis of the submitted samples, no thalassaemia mutation was detected in the foetus in 24 cases. In 8 cases foetus were heterozygote for thalassaemia having a single mutation. In 28 cases, foetus were homozygous for beta-thalassaemia., Conclusion: Appropriate and extensive screening, accurate detection and counseling of at risk couples, along with antenatal diagnosis is a promising strategy for the reduction of mortality and morbidity from thalassaemia in countries where it is prevalent. Based on these results, it can be concluded that prenatal diagnosis of beta-thalassaemia for prevention can be done using chorionic villous sampling.

Objective: To observe if phenylephrine mixed with propofol can attenuate hypotensive effects of propofol during induction of anaesthesia., Methods: A total number of 135 adult ASA-I and ASA-II patients were divided into three groups. (Group A, B and C). All patients were induced with propofol 2.5 mg per kg. In Group A (control group) patients received propofol mixed with 2cc of 0.9% normal saline. Group B (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 25 microg/cc (total 50 microg); Group C (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 50 microg/cc (total 100 microg). Haemodynamic variables like systolic, diastolic, mean arterial blood pressure and heart rate were noted. Hypotension was defined as 20% decrease in baseline systolic blood pressure recorded before induction of anaesthesia., Results: Phenylephrine in a dose of 100 micrograms attenuated the drop in systolic blood pressure. However phenylephrine in a dose 50 micrograms did not effectively prevent anticipated drop in SBP., Conclusion: Phenylephrine in doses of 100 micrograms effectively attenuates anticipated hypotension upon induction of general anaesthesia with propofol.

Eales' disease is an idiopathic retinal vasculitis common in Saudi Arabia effecting young adults, usually men. This chronic disorder is extremely difficult to treat. Treatment modalities in current practice are oral steroids, panretinal photocoagulation and pars plana vitrectomy. One eye of a diagnosed patient with Eales' disease at Vitreoretinal Clinics, Department Of Ophthalmology, Military Hospital, Rawalpindi was administered intravitreal triamcinolone. Preoperative and one month post operative fluorescein fundus angiograms were performed. The post-operative fluorescein fundus angiogram showed decreased perivascular leakage of the fluorescein dye as compared to the preoperative fluorescein fundus angiogram. Our report validated a similar report from the Indo-Pak subcontinent. Intravitreal triamcinolone appears to be a promising treatment modality for retinal vasculitis.

Objective: To evaluate various histo-pathological features in endometrial curettings of patients complaining of menstrual irregularities with excessive blood loss and correlating them with clinical presentations., Methods: A total of 260 endometrial curettings were obtained by Dilatation and Curettage done at the Department of Gynecology and Obstetrics, Railway Hospital, Rawalpindi. All the preserved specimens were processed under standard conditions at the Pathology Department, Islamic International Medical College (IIMC). The sections were studied after staining with Haematoxylin and Eosin stain., Results: The patients presented with menorrhagia in 51.9%, metrorrhagia in 35.4%, polymenorrhoea in 9.2% and polymenorrhagia in 3.5% cases. History of hormonal intake was observed in 0.66% patients. Menstrual disorders were most common in 41-50 years age group accounting for 48% cases. Pathology was diagnosed in 40% of endometrial biopsies. The endometrial lesions included endometrial hyperplasia (24.7%), chronic nonspecific endometritis (13%), endometrial polyp (1.2%), pill pattern endometrium (2.3%) atrophic endometrium (0.8%) menopausal pattern endometrium, squamous metaplasia, squamous cell carcinoma and chorioncarcinoma (0.4% each)., Conclusion: The dilatation and curettage was found to be an appropriate approach with a good diagnostic yield. Fortunately frequency of endometrial malignancy appeared to be very low. Endometrial hyperplasia was the leading causes of excessive menstrual bleeding.

Objective: To determine the commonest cause of genitourinary fistulae and evaluate the experience of the surgical management. The study was carried out at the Urology Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi., Methods: Twenty two patients were operated including 14 of Vesicovaginal Fistula (WF), and 8 of Ureterovaginal Fistula (UVF). In one patient of WF fistula was extending up to proximal urethra. Out of 14 WF cases, 9 patients underwent transvaginal repairs, 1 extraperitoneal transvesical repair and 1 transperitoneal repair. Three urinary diversions including 1 Mitrofanoff and 2 ileal conduits were also made. Ureteroneocystostomy was done in cases of UVF with adjuvant procedures in 3 cases including Psoas Hitch in 1 and Boari's flap in 2 patients., Results: The mean age was 35 (range 21-50) years. WF due to obstetric causes was seen in 71.4% patients while 28.6% developed WF secondary to gynaecological procedures. Majority of (91%) WF were repaired successfully in the first attempt in patients subjected to the procedure (78.6% cases of WF). There was only one recurrence in transvaginal repair, which was successfully treated with extraperitoneal transvesical approach in second attempt, thus augmenting the success rate to 100%. However 3 (21.4%) cases of WF required urinary diversion as there was complete loss of sphincter mechanism in one case, in which fistula was extending up to the urethra, and in two cases of complex WF with complete loss of posterior bladder wall surrounded by extensive scarring. All cases of UVF were successfully treated with ureteroneocystostomy alone or with adjuvant procedure in 37.5% cases., Conclusion: Uncomplicated WF can be successful repaired transvaginally by refreshing the fistulous edges without excising it. Transabdominal route should be reserved for complicated WF. Ureteroneocystostomy with antireflux mechanism with or without adjuvant procedure is the treatment of choice for UVF resulting from complete transaction or ligation of ureter.