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Objective: To determine the association of age and parity with gestational hypertension. Study Design: Case-control study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital, Sibi Pakistan, from Oct 2020 to Sep 2021. Methodology: A total of two hundred and sixty-eight (n=268) patients (134 controls and 134 cases) were included in this study. Data about age, parity, economic status and education status was recorded. Two consecutive readings of blood pressure were recorded in siting position, 4 hours apart, and the second reading was entered on the proforma. Results: Mean age of the patients was 28.10±5.61 years and 28.99±6.29 years in cases and controls, respectively. Mean gestational age was 38.46±1.02 weeks in cases and 38.04±1.00 weeks in controls. In cases, primigravida were 88(65.7%) and multigravida were 46(34.3%) and in controls 58(43.3%) were primigravida and 46(56.7%) were multigravida. Odds ratio was 2.50(95% CI: 1.53-4.10), p value was <0.001. In cases, 111 women (82.8%) were from young age group and 23 women (17.2%) belonged to advanced age group. In controls 94 women (70.2%) were of young age group while 40 women (29.8%) belonged to advanced age group (p value was 0.013). Conclusion: Primigravidae and women of younger age seem to have association with pregnancy induced hypertension. [ABSTRACT FROM AUTHOR]

Objective: To compare percutaneous A1 pulley release and steroid injection in terms of mean pain score in trigger digit. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthopedic Department Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2018. Methodology: Patients with trigger finger diagnosed clinically in Out Patient Department meeting inclusion and exclusion criteria were included in the study. Patients were randomly allocated to Group A & B by lottery method. Group A had percutaneous release of A1 pulley using a surgical blade 11, after preparation of the skin and injection of 1ml 2% plain Lidocaine. Group B had injection with corticosteroid. Both procedures were carried out in Out Patient Department under strict aseptic measures. Visual analogue score at start and end of the study was recorded. Results: A total of 185 patients were included in this study, 122(66%) were males and females were 63(34%). The mean age of patient was 37.80±11.80 years with range from 15-60 years. Mean score of Group A was 39.16±12.22 years and the mean age Group B was 38.93±10.98 years. 56(30.3%) patient had mild visual analogue score, 96 (51.9%) had moderate visual analogue, 33 (17.8%) had severe visual analogue. Conclusion: Percutaneous release was found better option for the treatment of the trigger digit with a high success rate. Surgery should be reserved only for cases refractory to steroid injection technique. Keywords: Per cutaneous release of A1 Pulley, Trigger Digit, visual analogue score. [ABSTRACT FROM AUTHOR]

Objective: To assess the increased frequency of serum C-peptide levels in patients of colorectal carcinoma. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jul 2018 to Jan 2019. Methodology: A total of 100 cases of colorectal carcinoma were enrolled. Blood samples were obtained to assess C-peptide level. The C-peptide serum concentrations were deliberate through the Cobas 6000 by using the electro-chemi-luminescence immunoassay (ECLIA) method. If level of C-peptide was >2 pmol/mL, then it was noted. Results: The mean age of all patients was 58.3 ± 5.4 years. There was a total of 136 (68%) females and 64 (32%) were males. The mean BMI of patients was 28.96 ± 12.31 kg/m². The family history of colorectal carcinoma was positive in 6 (6%) cases. The mean C-peptide level was 4.55 ± 2.37 pmol/L. There were 33 (33%) patients with raised C-peptide level while 67 (67%) had normal c-peptide level. Conclusion: It is concluded that increased C-peptide level is high in patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of rifaximin in reducing the frequency of recurrence of hepatic encephalopathy among patients with liver cirrhosis. Study Design: Descriptive case series. Place and Duration of Study: Outpatient department of Combined Military Hospital Peshawar from Jan to Jun 2017. Methodology: We included one hundred patients of either gender having liver cirrhosis with child Pugh B or C class with at least two previous episodes of hepatic encephalopathy. Patients were followed for six months to have any recurrence of hepatic encephalopathy. Conventional group was defined as having standard regimen including lactulose. Rifaximin treatment was defined as a 550mg BD daily dosing along with standard prescription. Results: Fifty patients were on conventional treatment to prevent recurrence of hepatic encephalopathy while 50 patients were using rifaximin in addition to standard prescription. The average age of 54.8 ± 6.1 years with 58% male patients and 48% in child-pugh B class. Thirty (30%) patients developed hepatic encephalopathy among the study population. 14 patients with recurrence belong to rifaximin group while 16 were on conventional treatment (p-value >0.05) showing a non-significant difference. Post stratification revealed only age as a significant predictor of recurrence of hepatic encephalopathy in our study population (p<0.05). Conclusion: Frequency of hepatic encephalopathy is similar in conventional treatment with Lactulose over six months of follow up as compared with rifaximin. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of proteus mirabilis infections in patients of rheumatoid arthritis. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jul 2018 to Jan 2019. Methodology: A total of 100 cases of rheumatoid arthritis with urinary tract infection were enrolled. Freshly voided urine samples were obtained and sent to the pathology lab. The serotypes of proteus mirabilis were evaluated by enzyme-linked immunosorbent assay (ELISA) and immunoblotting and presence of proteus mirabilis was noted. Results: A total of 100 cases of rheumatoid arthritis with urinary tract infection were recruited. The mean age of patients was 61.22 ± 10.18 years. There were total 67 (67%) females and 33 (33%) were males. About 79 (79%) patients had sedentary lifestyle while 21 (21%) had active lifestyle. There were 41 (41%) patients had positive urine culture with proteus mirabilis while 59 (59%) had other organism involved in urine infection. Conclusion: The high frequency of proteus mirabilis infection has been detected and the frequency was of females with complaint of urinary tract infection was high. [ABSTRACT FROM AUTHOR]

Objective: To compare I-gel and Endotracheal tube for peak airway pressure during general anesthesia in pediatric inguinal hernia surgeries Study Design: Quasi experimental study. Place and Duration of Study: Anesthesia/surgical department, Pak Emirates Military Hospital Rawalpindi, Pakistan Jun to Nov 2021. Methodology: A Quasi experimental study was conducted on 250 children. Patients were randomly assigned into two groups. Group-A received the I-gel after induction with sedative agents while Group-B received the Endotracheal tube with routine induction and muscle paralysis. Peak airway pressure was monitored by the consultant anesthetist on anesthesia workstation throughout the surgery. Results: Out of 250 pediatric patients undergoing hernia repair randomized into two groups, 136(54.4%) were categorized into Group-A and 114(45.6%) were categorized into Group-B. Mean age of patients in our study was 3.35±2.454 years. 159(63.6%) children included in the study were male while 91(36.4%) were female. Out of 250, 202(80.8%) patients had normal peak airway pressure during the surgery while 48(19.2%) had raised pressure during the surgery. Use of Endotracheal tube was found statistically significantly associated with raised peak airway pressure during the surgery (p-value<0.05). Conclusion: Use of I-gel was found better in relation to maintenance of peak airways pressure as compared to Endotracheal tube in pediatric patients undergoing hernia repair under general anesthesia. [ABSTRACT FROM AUTHOR]

Objective: To compare preoperative Ketamine nebulization versus saline nebulization in reducing the frequency and severity of sore throat postoperatively. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Bahawalpur Pakistan, from Jan to Jun 2022. Methodology: A total of 120 patients (60 in each group) with different surgeries filling the inclusion criteria were considered in the study. Adult patients of 20-60 years with ASA class 1-2 who were planned for elective surgery of less than 2 hours were included. Group-A patients underwent nebulization with Ketamine while in Group-B nebulization was done with normal saline. Results: A total of patients included were 120 (60 each group). Twenty-eight (23.3%) patients developed Post-Operative Sore Throat at some time after extubation. The frequency of Post-Operative Sore Throat with Ketamine was 13.3% and with saline it was 33.3%. Twenty (71.42%) patients of Post-Operative Sore Throat developed sore throat at 2 hours after extubation, of which 15 patients belong to Saline Group (p-value 0.01). Twenty-one patients of Post-Operative Sore Throat had mild sore throat of which 14 patients were of Saline Group (p-value 0.006). Conclusion: Ketamine nebulization postoperatively leads to reduced frequency and severity of Post-Operative Sore Throat in early post-operative period in patients in which endotracheal intubation was done for GA. [ABSTRACT FROM AUTHOR]

Objective: To calculate the surgical outcomes of different approaches of tympanoplasty type 1 in terms of air bone gap closure, wound healing, and postoperative pain. Study Design: Prospective cross-sectional study. Place and Duration of Study: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan from Jun 2018 to May 2020. Methodology: Size of sample was 75 patients divided into three groups. Consent was obtained from all the patients included in study. After proper evaluation and relevant investigation pre- and post-operative PTA was performed. Tympanoplasty type-1 was performed by the same surgeon by the three approaches following established otological surgical protocol. Collected data was entered in SPSS-25 for analysis. Results: All 75 patients were divided into three equal groups. Male were 55 (73.3%), females were 20 (26.7%). Male: female ratio was 2.7:1. Majority of patients presented in 2nd and 3rd decades of life 31 (41.33%) and 28 (37.33%) respectively. Preoperative mean ± SD, ABG in groups A, B and C were 37.60 ± 11.28 dB, 37 ± 9.68 dB and 31.80 ± 12.40 dB, respectively. No significant difference was found amongst the three groups regarding pre-operative and post-operative ABG (p=0.85 and p=0.4), respectively. Mean ± SD, wound healing time in Groups A, B and C were 1.00 ± 0.00, 1.80 ± 0.40 and 1.76 ± 0.43 respectively with p=0.0001 and similarly postoperative pain with p=0.001. The wound healing time and post-operative was statistically better (p<0.05) in group A (Transmeatal approach) than other groups. Conclusion: Although wound healing time and post-operative pain were significantly minimum in transmeatal approach for tympanoplasty, but overall success rate of tympanoplasty was not statistically significant among these three approaches. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019. Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II & GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test. Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061). Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of elevated serum uric acid levels in patients with coronary artery disease, association of hyperuricemia with severity of coronary artery disease, gender, age, hypertension, and diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Internal Medicine department, Combined Military Hospital Multan, from Nov 2015 to May 2016. Methodology: One hundred and fifty patients with coronary artery disease were selected consecutively and admitted for coronary angiography. Serum uric acid levels were evaluated after eight hours fasting by photometric technique having normal reference range of 3.5-6.7 mg/dL. Coronary angiography was performed and Gensini score computed. To compare mean Gensini score between normouricemic and hyperuricemic population, student's t-test was applied. Results: A total of 150 study cases (mean age: 54.4 ± 8.5 years), 101 (67.3%) were male while 49 (32.7%) were female. Diabetes mellitus was present in 43 (28.7%) of cases and hypertension was present in 65 (43.3%). Hyperuricemia was noted in 58 (38.7%) of cases. The mean Gensini score in hyperuricemic patients was significantly higher (40.31 ± 14.64) compared to patients with normal serum uric acid levels (25.02 ± 10.94) (p<0.001). The frequency of hyperuricemia was significantly higher in males, patients ≤60 years of age, and patients with diabetes mellitus (p<0.001, p=0.001 and p=0.001). No significant asso-ciation with hypertension was observed (p=0.314). Conclusion: Frequency of 38.7% for hyperuricemia was noted in our study among patients with coronary artery disease. Hyperuricemia was significantly associated with higher Gensini score, male gender, younger age, and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of hyponatremia in acute cerebrovascular accidents and explore the relationship of hyponatremia with age, gender, type, and duration of cerebrovascular accidents. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Internal Medicine, Combined Military Hospital Peshawar, from Dec 2016 to Jun 2017. Methodology: In this study, a total of 127 patients with acute cerebrovascular accidents i.e. within 12 hours of onset were enrolled. Serum sodium levels were evaluated at the initial presentation of the patient at the emergency department after confirmation of cerebrovascular accidents following clinical evaluation and computed tomography scan of brain without contrast. Results: In this study, the mean age was 46 ± 8.7 years. Seventy-four (58%) patients were males while 53 (42%) patients were females. Eighty-six (68%) patients had ischemic cerebrovascular accidents while 41 (32%) patients had hemorrhagic cerebrovascular accidents. Thirty-eight (30%) patients had hyponatremia. Stratification of hyponatremia with age, gender, duration of cerebrovascular accidents, and the type of cerebrovascular accidents showed statistically insignificant correlation with p-value >0.05. Conclusion: The frequency of hyponatremia in our cohort of acute cerebrovascular accidents patients was 30%. There was no association between hyponatremia and age, gender, type, or duration of cerebrovascular accidents. Monitoring of serum sodium levels must be done in all patients who are admitted with a cerebrovascular accidents. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiology and clinical profile of chronic liver disease in children presenting at Pak Emirates Military Hospital Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted at the Department of Pediatrics, Pak Emirates Military Hospital Rawalpindi, from Sep 2015 to Sep 2016. Methodology: After informed written consent, 84 consecutive children diagnosed of chronic liver disease were included in the study and demographic features, presentation and underlying etiology. Results: There were 43 (51.2%) male and 41 (48.8%) female children with a mean age of 46.62 ± 46.89 months. Frequent presenting complaints were jaundice (32.1%) persistent neonatal jaundice (29.8%), abdominal distension (27.4%). Hepatosplenomegaly was the frequent presentation of children with glycogen storage disease while persistent neonatal jaundice was associated with biliary atresia and neonatal hepatitis. Wilson disease presented with neurological symptoms. Glycogen storage disease and biliary atresia were the most frequent underlying etiologies recorded in 15 (17.9%) children. The frequency of Wilsons disease was significantly higher among children aged between 5-10 years. Conclusion: The frequent clinical presentations of children with chronic liver disease were jaundice, abdominal distension and hepatosplenomegaly. Glycogen Storage Disorders, Biliary atresia and Wilsons Disease and were the most frequently encountered etiologies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of needle assisted laparoscopic repair (NALR) of inguinal hernias in children. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pediatric surgery, Pak Emirates Military Hospital, Rawalpindi, from Aug 2017 to Apr 2018. Material and Methods: A total of 50 patients were included in the study. All the patients were diagnosed with inguinal hernias on the basis of history given by parents and clinical examination. All patients underwent NALR of inguinal hernias after preoperative workup and informed written consent. Pneumoperitoneum was created in all cases by open method. Transumblical 3mm port was used for telescope along with a single 3mm port in lower abdomen for grasping forceps. Internal inguinal ring was closed by transfixing it with a loop suture using 22 G spinal needle and 2/0 prolene suture. Operative time and presence of contralateral processus vaginalis was noted. Patients were followed up at four weeks and three months for postoperative complications. Results: Age of the patients ranged from 12 years, Mean ± SD was calculated as 40.36 ± 37.74. Regarding inguinal hernia site, n=17 (34%) have right sided hernia, n=13 (26%) have left sided hernia while bilateral hernia were present in n=20 (40%), 9 patients (18%) were found to have occult patent processus vaginalis peroperatively. Mean operative time ranged from 9 minutes to 25 minutes with Mean ± SD calculated as 15.94 ± 5.30. All operations were completed laparoscopically without need of conversion to open herniotomy. There were no intraoperative complications; No case of matachronous contralateral inguinal herniaor hydrocele formation and wound related complications during follow up at 4 weeks and 3 months. Conclusion: LNAR of inguinal hernias in children is an effective, quick and safe technique which can be easily learnt due to its simplicity to perform. This technique can be employed in both male and female pediatric population with promising results. One main advantage is the ability to pick up the occult patent internal ring which can be repaired in the single stage to prevent the development of metachronous inguinal hernia in the later age. [ABSTRACT FROM AUTHOR]

Objective: To compare per-operative normal saline wound irrigation prior to closure with conventional simple wound closure without irrigation in terms of development of surgical site infection (SSI) in clean contaminated wounds. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Combined Military Hospital Dera Nawab Sahib, from Nov 2014 to Nov 2016. Material and Methods: Group A and group B had 355 patients each. Group A was subjected to per-operative surgical wound irrigation with 300 ml of normal saline prior to skin closure while group B was subjected to conventional simple closure of surgical wound without any kind of wound irrigation. Development of postoperative SSI was checked till 30th post-operative day (POD). A p-value <0.05 was considered statistically significant. Results: Postoperative SSI was comparatively less in group A (4.5%) as compared to group B (10.2%) which was statistically significant (p 0.004). Conclusion: Per-operative surgical wound irrigation was found superior to conventional simple wound closure in terms of development of SSI in clean contaminated cases. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate of intrauterine balloon tamponade versus B Lynch suture in the management of severe postpartum hemorrhage. Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in department of Obstetrics and Gynaecology, Combined Military Hospital, Bahawalpur, from Jan 2017 to Jun 2017. Materials and Methods: A total of 104 patients with severe postpartum hemorrhage, 20 to 35 years of age of gestational age 36-42 weeks were included in the study. Patients with genital tract trauma, retained products of conception, ruptured uterus and any bleeding disorderwere excluded. Then selected patients were placed randomly into group A (intrauterine balloon tamponade) & group B (B Lynch suture) by using lottery method. Outcome variables like control of bleeding within 15 minutes after procedure (success rate) was noted. Results: The mean age of women in group A was 27.69 ± 3.68 years and in group B was 27.60 ± 3.65 years. The mean gestational age in group A was 39.98 ± 1.57 weeks and in group B was 40.04 ± 1.68 weeks. Success was 67.31% in group A (intrauterine balloon tamponade) and 88.46% in group B (B Lynch suture) with p-value of 0.009, showing statistically significant difference between the two groups. Conclusion: This study concluded that success rate (stoppage of bleeding within 15 minutes) of B Lynch suture is better as compared to intrauterine balloon tamponade in the management of severe postpartum hemorrhage and should be used as first line procedure in controlling severe PPH. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of ondansetron with a combination of ondansetron and dexamethasone after elective laparoscopic cholecystectomy in terms of postoperative nausea and vomiting. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2014 to Mar 2015. Materials and Methods: Two hundred and twenty two patients fulfilling the inclusion criteria were selected for study and divided into two groups of 111 each. Group A was given ondansetron while group B was given combination of ondansetron and dexamethasone at induction of general anesthesia. Patients of both groups were observed at 24 hours postoperatively for nausea and vomiting. Results: Sixty six patients in group A had nausea as compared to 50 patients in group B (p-value 0.03), 46 patients in group A had vomiting as compared to 19 patients in group B (p-value <0.001), showing statistically significant difference between the two groups. Conclusion: Postoperative nausea and vomiting is significantly lower in ondansetron and dexamethasone combination group as compared to ondansetron alone group after elective laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: To conduct a five-year bibliometric analysis of Pakistan Armed Forces Medical Journal from 2011 to 2015. Study Design: Retrospective secondary data analysis. Place and Duration of Study: Department of General Surgery, Combined Military Hospital Bahawalpur. Material and Methods: The data of all publications excluding editorials and letters to editor published in Pakistan Armed Forces Medical Journal (PAFMJ) from 2011 to 2015 was downloaded from the Journal website and analyzed in terms of bibliometric parameters. Results: Total number of research documents from 2011 to 2015 was 749, comprising of 648 original articles, 13 review articles and 88 case reports. The number of publications per year ranged from 130 to 186. Three-author contributions ranked the highest with 214 publications (28.57%). Most of the publications have an average of 11-20 citations (n=394, 52.60%). Pathology should have been further classified remained the most popular medical specialty with 83 publications (11.08%). Conclusion: The issue numbers per year for PAFMJ and have been gradually increased over time. Original articles are the main type of papers for this journal. The publication is open for all fields of medical and dental sciences. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of 0.2% brimonidine eye drops on control of intraocular pressure following Neodymium: Yttrium-Aluminum-Garnet (Nd: YAG) laser posterior capsulotomy. Study Design: Quasi experimental study. Place and Duration of Study: Study was conducted in department of Ophthalmology, Combined Military Hospital Peshawar of six months duration from Oct 2013 to Mar 2014. Material and Methods: A total of 182 patients were included in this study. One drop of 0.2% brimonidine one hour prior to laser treatment was instilled in the eyes of patients. Cornea was anaesthetized with topical 0.5% proparacaine hydrochloride. "Ocular instruments ® Abraham Capsulotomy YAG contact lens" was used along with Q-switched Zeiss VISULAS YAG III (Nd: YAG) laser system to make a hole of 3-4mm in the posterior capsule using minimum amount of total laser energy. Data were analyzed using SPSS version 15.0. Mean and standard deviation was calculated for numeric variables like age and intraocular pressure at different occasions. Frequency and percentage was calculated for categoric variable i.e. gender. Efficacy was stratified among age and gender to see effect modifiers. Results: The mean age of participants was 63.3 ± 7.7 years. Out of 182 patients, 109 (59.9%) were male while remaining 73 patients (40.1%) were female. Brimonidine 0.2% eye drops proved effective in 162 patients (89.0%). Stratification of age and sex with regard to efficacy of 0.2% brimonidine eye drops was carried out. Conclusion: The use of 0.2% brimonidine has been proven effective to counteract the IOP increase following Nd: YAG laser capsulotomy in this study. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of serum IgA anti-tissue transglutaminase antibody in the diagnosis of celiac disease taking histopathology as gold standard. Study Design: Cross-sectional survey. Place and Duration of Study: This study was conducted at the department of Pediatrics, Military Hospital Rawalpindi from April 2015 to July 2016. Patients and Methods: Ninety-five consecutive children presenting with suspicion of celiac disease were included in this study after taking written informed consent. A predesigned proforma was used to record patient's demographic details. Anti-tTG level of =25 U/ml was taken as diagnostic of celiac disease while results of histopathology on endoscopic biopsy were taken as gold standard. Results: The mean age of the patients was 6.48 ± 3.20 years and majority (n=53, 55.8%) of the children were aged between 5 to 10 years. The serum anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Taking a cut-off value of =25 U/ml for anti-tTG, 81 (85.3%) children were suspected of celiac disease. Histopathology of endoscopic biopsy confirmed celiac disease in 68 (71.6%) children with 62 true positive, 19 false positive, 6 false negative and 8 true negative cases. It yielded 91.18% sensitivity, 29.63% specificity and 73.68% accuracy for anti-tTG (=25 U/ml) in the diagnosis of celiac disease with positive and negative predictive values of 76.54% and 57.14% respectively. Conclusion: IgA anti-tissue transglutaminase antibody (=25 U/ml) was found to be highly sensitive test for the detection of celiac disease in children. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital Quetta, from 1st August 2014 to 30th April 2015. Material and Methods: A total of 60 patients were included in this study and were divided into two groups of 30 each. Patients in group A underwent open appendectomy with closure of peritoneum while patients in group B had non-closure of peritoneum during the same procedure. Post-operatively, pain severity was assessed on visual analogue scale (VAS) numeric pain distress scale. On presence of VAS numeric pain distress scale between 5 to 7, intramuscular (IM) diclofenac sodium was given and on score >7, intravascular (IV) tramadol was given. The final outcome was measured at day 0 and day 1. Results: Pain score and analgesic requirements were significantly less in non-closure group than closure group on day 0 and day 1, showing statistically significant difference between the two groups. Conclusion: Mean post-operative analgesic requirement is significantly less in non-closure group as compared to closure group during open appendectomy. [ABSTRACT FROM AUTHOR]

Objective: To compare age, gender, and bacteria isolated from urine cultures with antibiotic resistance patterns. Study Design: Cross-sectional study. Place and Duration of Study: Surgery and Pathology Department Combined Military Hospital, Bannu Pakistan, from Jan 2023 to Apr 2024. Methodology: Three hundred and eighty-six patients aged 1 to 80 years with urinary tract infection symptoms were included. Patients having recurrent urinary tract infections, immunocompromised patients already taking antibiotics, and those with multiple co-morbid conditions were excluded. Urine cultures were evaluated, and the sensitivity/resistance pattern was compared with gender, age, and bacteria isolated in positive cases. Results: Forty-six samples were culture positive (11.9%). Escherichia coli was the most frequently isolated organism, obtained from 32 samples (69.6%), while Pseudomonas aeruginosa was isolated from 8 samples (17.4%), Klebsiella pneumoniae from 4(8.7%), Enterobacter from 1(2.2%) and Serratia liquefaciens from 1(2.2%) sample. Resistance to Ampicillin was found in 30 samples (88.2%), Amoxicillin/Clavulanic acid 24(85.7%), Ciprofloxacin 23(74.2%), Ceftriaxone 18(69.2%), Levofloxacin 10(66.7%), Co-trimoxazole 21 samples (65.6%), Cefepime 9(36%), Gentamicin 7(33.3%), Meropenem 10(27%), Piperacillin/Tazobactum 3(14.3%), Fosfomycin 4(13.8%), Amikacin 4(10.5%), and Nitrofurantoin 3 samples (7.5%) respectively. No statistically significant difference was found for gender, age, or type of bacteria with antibiotic sensitivity/resistance profiles (p>0.05). Conclusion: Urinary tract bacteria resist most prescribed antibiotics, including Ampicillin, Amoxicillin/Clavulanic acid, Ciprofloxacin, Levofloxacin, Ceftriaxone, and Co-trimoxazole. [ABSTRACT FROM AUTHOR]

Objective: To compare laparoscopic and conventional open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection (SSI). Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Quetta from 6th Jun 2010 to 1st Sep 2011 and Combined Military Hospital, Multan, Pakistan from 2nd Sep 2011 to 5th Jun 2012 over a period of 2 years. Patients and Methods: A total of 417 patients underwent appendectomy during this period. 137 patients underwent laparoscopic appendectomy (group A) while 280 patients had open appendectomy (group B). The sample includes all patients who were operated upon, between the time-span of June 2010 to September 2011. A chi square-test was performed to compare the data for statistical significance. Results: Mean operative time for group A was 79.21 ± 23.42 minutes whereas in group B, the mean operative time was 41.49 ± 20.86 minutes. Group A patients had a shorter hospital, l stay (3.6 ± 1 day) but in group B, it was (5.2 ± 3 days). Seven patients (5.1%) developed surgical site infection (SSI) in group A and 34 patients (12.14%) developed postoperative SSI in group B (p < 0.05). Conclusion: Laparoscopic appendectomy is superior to open appendectomy because of shorter hospital stay and lesser post-operative SSI, but requires longer operative time. [ABSTRACT FROM AUTHOR]