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Objective: To compare the postoperative outcomes while using direct true lumen approach versus conventional cannulation approach in management of acute type-A aortic dissection patients. Study Design: Randomized Clinical Trial. Setting: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi. Period: 1st June 2022 to 31st December 2022. Methods: A total of 22 patients age more than 18 years who presented in CMH Emergency Department with acute type A aortic dissection were included in this study. In group A (11 patients) were managed with direct true lumen cannulation while in group B (11 patients) were managed with conventional (axillary/femoral) cannulation. In both groups intra-operative parameters like procedure time, mean time of cardiopulmonary bypass, cross clamp and circulatory arrest time were measured. In both groups, outcome was measured in terms of occurrence of multi-organ failure, acute kidney injury, arrhythmias on ECG and in-hospital mortality. Data was analyzed using SPSS 26. Results: Mean age of our patients were 43.36±2.16yrs in group A while 43.36±2.94yrs in group B. Male gender predominates in both groups (gp A-81.8% & gp B-90.9%). We found no difference of statistical significance between two groups in terms of various intra-operative parameters like mean duration of procedure in group A was 428.15min and in group B was 427.36 min. Similarly mean circulatory arrest time was 31 min in group A and 29.09 min in group B. Patients in "direct true lumen cannulation" group had significantly shorter duration of intubation. In terms of post-operative outcomes, multi-organ failure occurred in 1 (9.09%) patient in group A while it occurred in 3(27.27%) patients in group B. In hospital mortality occurred in 2(18%) patients in group A as compared to 4(36%) in group B. So better results were observed in "direct true lumen cannulation" group as compared to "conventional (axillary/femoral) cannulation" group. Conclusion: In our study, acute type-A aortic dissection patients who had undergone direct true lumen cannulation during operative management showed better post-operative outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the use of electrocautery and scalpel dissection while performing modified radical mastectomy in terms of frequency of seroma formation. Study Design: Randomized Clinical Trial. Setting: Department of Surgery, Fauji Foundation Hospital, Rawalpindi. Period: 19-06-2019 to 22-06-2022. Material & Methods: A total of one hundred (n=100) female patients between age 22-60 years, who underwent modified radical mastectomy for breast carcinoma were enrolled in the study and randomized into two groups. Electrocautery dissection was performed in group A while patient in group B will undergo Scalpel dissection. Outcome was measured in terms of seroma formation at 7th day postoperatively. Results: Mean age of patients in our study was 42.39 years and standard deviation 8.26. At day 7 after the surgery, mean drain volume was 39.77 ml in our patients. Seroma formation was observed in a total of 14(28%) patients in group A (electrocautery) and 8(16%) patients in group B (Scalpel). Conclusion: Frequency of seroma formation was significantly lower with scalpel dissection as compared to those with electrocautery dissection after MRM. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the T2DM patients' reasons for refusing insulin therapy and their initial barriers to use insulin. Study Design: Cross-sectional Observational study. Setting: Primary Outpatient Health Care Center Karachi. Period: 15th October 2022 to 15th January 2023. Material & Methods: Total 800 diagnosed patients of type-II diabetes mellitus having HbA1c level about 7.0% were included in study, participants were interviewed and necessary data and their response against insulin was recorded on designed questionnaire. Results: Total 800 number of patients were enrolled in study, 434 were female (54.25%) while 366 were male (45.75%) participants. The average age of total patients was 45.6±10.5. Study reported that 28.5% patients mentioned that its painful procedure. 25% patients were unaware about insulin, 15% mentioned that it is difficult to self-inject, 10.5% lack of technical person or medical staff that can inject over there, 7.5% patients believe that insulin is last resort of treatment, 5% needle phobia, 4.5% reluctant due to un affordability of insulin, 3% insulin would be addictive, and 1% patients with religious restriction was reported. Conclusion: Study explore many reason that are mainly influencing use of exogenous insulin for the treatment of diabetes mellitus. Insulin therapy is painful procedure consideration have been recorded more common while other factors unawareness about insulin, needle phobia, lack of technical people in home specially in backward areas and insulin is last resort of treatment beliefs are also major important factors reported during study. [ABSTRACT FROM AUTHOR]

Objective: To estimate the psychological and sociodemographic correlates of delayed discharge of patients undergoing Elective Laparoscopic Cholecystectomy. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital. Period: July 2019 and June 2022. Material & Methods: The study comprised reviewing medical records of 160 patients who underwent daycare cholecystectomy. It was noticed from patients’ medical records that patients were carefully selected for daycare surgery. Patients with comorbidities, previous upper intraabdominal surgery, ultrasound findings of thickened gallbladder wall > 5mm were not offered day care surgery. For data collection a Performa was designed based on literature review. To assess psychological state, we applied Hospital anxiety and depression scale in Urdu. Descriptive statistics were calculated for the sociodemographic variables, mean and standard deviation was found for continuous variables and frequency percentages for categorical variables. Results: One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. In LS group, the postoperative stay range was 2 –19. Observation of postoperative fever (n = 3), surgery-related causes postoperative pain (n= 6), delayed oral diet = 1, retained abdominal drain = 4, and postoperative complications (n= 3). Bowel injury (n = 2) and septicemia (n = 1) were serious postoperative consequences resulting in more prolonged hospital stay. PONV (n = 2), medical causes (n = 3), and patient preference (n = 7) were among the reasons for the prolonged hospital stay. Conclusion: While our study has a few limitations; it is a retrospective review with nonrandomized patient selection and a smaller sample size, we have established safety of day case laparoscopic cholecystectomy in select group of patients. Patients’ personal satisfaction was the most common reason for their overnight admission after day case LC which was because of number of sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objective: To understand and recognise why some patients leave the medical facility against physicians medical advice as it has clear significance in identifying those at risk and planning interventions for them beforehand. Study Design: Exploratory Research. Setting: Department of Psychiatry, Gujranwala Medical Collage/ Teaching Hospital. Period: September 2018 to September 2019. Material & Methods: The record included 73 cases that left against medical advice. Results: Highest ratios of variables present in the patients who left AMA were educational level of patients up to matriculation (34.2%), unemployment (54.8%), primary diagnosis of schizophrenia (20.5%), residence in Gujranwala (57.5%), attending physician's residence up to 2 years (27.4%), and non availability of attendants (16.4%). Conclusion: Knowing what variables perpetuates the patient's need to leave against medical advice can help in taking preliminary measures to prevent it. [ABSTRACT FROM AUTHOR]

Objective: To find out the prevalence and risk factors of systemic hypertension. Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: July 2020 to June 2021. Material & Methods: A total of 298 children of both gender aged 4-12 years, visiting pediatric outpatient department of the study institution were enrolled. A child was labeled as normotensive if blood pressure (BP) measurement was below 90th percentile, pre-hypertensive if BP between 90th to 95th percentile and hypertensive if BP more than 95th percentile. The data was analyzed using SPSS version 26.0. Results: In a total of 298 children, 171(57.4%) were male. Overall, mean age was found to be 7.6+2.1 years while 159 (53.4%) were below 7 years of age. Majority of the children, 166 (55.7%) belonged to rural areas of residence. Family history of hypertension was noted in 150 (50.3%) children. Hypertension was found in 56 (18.8%) children, pre-hypertension in 9 (3.0%) while remaining 233 (78.2%) children were normotensive. Age less than 7 years (p=0.0023), overweight/obesity (p=0.0026) or family history of hypertension (p=0.0118) were found to have significant association with hypertension. Conclusion: High prevalence of systemic hypertension was noted in children. Younger age, high body mass index and family history of hypertension were found to be significantly associated with hypertension. [ABSTRACT FROM AUTHOR]

Objective: To find out efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN). Study Design: Observational study. Setting: Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: May 2020 to April 2021. Material & Methods: A total of 22 neonates of both genders with diagnosis of PPHN were enrolled during the study period. Demographic characteristic along with information about perinatal and postnatal characteristics were recorded among all neonates at the time of admission. X-ray chest were asked. Oral sildenafil was administered as 2mg/kg per dose thrice a day to all study cases and continued till extubation. Outcome was recorded on the basis of difference in FiO2 need after initiating sildenafil, time required to get ventilator off or mortality. Results: Out of a total of 22 neonates, 13 (59.1%) were male. Majority of the neonates, 15 (68.2%) were term newborns. Mode of delivery was lower segment cesarean section in 17 (77.3%) cases. APGAR score at 5 minutes was between 7 to 10 in 13 (59.1%) newborns. There were 13 (59.1%) newborns who required immediate resuscitation following birth. Meconium aspiration syndrome was the commonest associated condition found among 8 (36.4%) neonates. As per echocardiographic findings, 13 (59.1%) neonates had severe PPHN, 5 (22.7%) moderate and 4 (18.2%) mild. Mean oxygenation index at the time of admission was noted to be 46+14. Inotropic support was administered to 19 (86.4%) cases. Mean length of neonatal intensive care unit was 15+5 days. Mortality was reported among 10 (45.4%) neonates. Conclusion: Oral sildenafil was found to be a promising option for the treatment of neonates having PPHN. Oral sildenafil was found to successfully improve oxygenation among neonates having PPHN. [ABSTRACT FROM AUTHOR]

Objective: To find out the effectiveness of prophylactic parenteral paracetamol to minimize rates of ductus patency among preterm infants. Study Design: Case-control study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: March 2020 to February 2021. Material & Methods: A total of 70 neonates (35 cases and 35 controls) having gestational age less than or equal to 34 weeks were enrolled. All 35 cases were administered prophylactic parenteral paracetamol as 20 mg per kg stat and 7.5 mg per kg 6 hourly for 1st 3 days of life while all controls were given no drugs. Echocardiography was performed in all 70 neonates after 1st three post-natal days to identify PDA. Data was analyzed using SPSS 26.0. Results: In a total of 70 neonates, 37 (52.9%) were male and 33 (47.1%) female. Overall, mean gestational age was noted to be 32.1+1.47 weeks while mean body weight was recorded to be 1424.6+229.7 grams. There were 6 neonates (17.1%) among cases who were found to have PDA in comparison to 23 (65.7%) in controls (p<0.0001). Four (11.4%) neonates died in case group in comparison to 7 (20.0%) among controls (p=0.3245). Mean duration of hospitalization was recorded to be 20.52+8.2 days in case group in comparison to 24.81+4.6 days among controls (p=0.0088). Conclusion: Prophylactic parenteral paracetamol was found to prevent ductus patency among preterm neonates. In comparison to controls, duration of hospital stay was significantly short among neonates who were administered prophylactic parenteral paracetamol. [ABSTRACT FROM AUTHOR]

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed. [ABSTRACT FROM AUTHOR]

Objective: To find out pattern along with age and gender wise distribution of congenital heart disease (CHD). Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Narowal. Period: January 2019 to February 2020. Material & Methods: During the study period, a total of 151 children aged between 1 month to 15 years as confirmed case of CHD according to echocardiography were enrolled for this study. Gender, age categories, area of residence and types of CHDs were represented as frequency and percentages. Patients with different types of CHDs were distributed between both gender and different age categories. SPSS version 26.0 was used to handle and analyze all study related data. Results: During the study period, a total of 151 confirmed cases of CHD were enrolled. There were 82 (54.3%) male and 69 (45.7%) female representing a male to female ratio of 1.2:1. Most of the cases were aged less than 1 year. There were 118 (78.1%) children below 1 year of age while 22 (14.6%) between 1 to 5 years of age and 11 (7.3%) above 5 years of age. Ventricular septal defect (VSD) and ASD were noted to be the most frequent types of acyanotic heart lesions in 41 (27.2%) and 29 (19.2%) cases respectively whereas TOF was the most frequent type of cyanotic heart lesion in 23 (15.2%) cases. Conclusion: VSD followed by ASD and TOF were noted to be the most frequent types of CHD. [ABSTRACT FROM AUTHOR]

Objectives: To compare the tissue based Desarda repair with Lichtenstein mesh technique for inguinal hernia in terms of operation time, hospital stay, return to normal activities, cost and post-operative complications such as seroma formation, surgical site infection and recurrence. Study Design: Randomized Controlled trial. Setting: Department of General Surgery Hayatabad Medical Complex, Peshawar, Pakistan. Period: June 2017 to June 2019. Material & Methods: Total of 150 male patients were selected using Non probability consecutive sampling technique. Patients were randomized into two groups using lottery method. 75 patients in group A underwent hernia repair with Desarda no mesh technique and 75 patients in group B underwent hernia repair by performing Lichtenstein mesh technique. Patients were followed up after 2 weeks, 1 month, 3 months, 6 months and 1 year. Results: The mean age of Desarda group was 44.59±10.58 years while it was 44.44±10.30 years in the Lichtenstein group (P=0.932).Mean Operative time was less for Desarda repair (42.08 ± 3.42 min) when compared to Lichtenstein repair (49.01 ± 4.77min) (p=0.000). The average hospital stay after Desarda repair was 2.08±0.27 days and after Lichtenstein repair it was 3.00±0.40 days (p=0.000). After Desarda procedure the average duration to return to work was 11.10±2.32 days while it was 13.92±2.24 days in Lichtenstein procedure (p<0.0001). The total cost of the operation was (Rs 3893±293) in Desarda group and (Rs 7844±175) in the Lichtenstein group (p=0.000). When compared for observed postoperative complications like seroma, wound infection and recurrence in both groups all the p-values were > 0.05 and were non-significant statistically. Conclusion: In comparison to Lichtenstein mesh repair, Desarda technique is cost effective, easy to learn, patients have less hospital stay, less chances of postoperative complications and early return to basic physical activities. [ABSTRACT FROM AUTHOR]

Needle Stick Injury (NSI) is a percutaneous piercing wound typically dealing with sharps. Needle stick injuries are the most common health care workers issue worldwide. The causes include various factors like type and design of needle, recapping activity, handling/ transferring specimens, collision between HCWs or sharps, during clean-up, manipulating needles in patient line related work, passing/handling devices or failure to dispose of the needle in puncture proof containers. NSIs may transmit other bacterial, fungal, or viral infections, including blastomycosis, cryptococcosis, diphtheria, herpes, malaria, mycobacteriosis, spotted fever and syphilis. Objectives: To determine frequency of needle stick injury among health care workers. Study Design: Cross-sectional study. Setting: District Headquarter Hospital Layyah. Period: Jan to March 2019. Material & Methods: Sample size was 161. A structured pre-tested questionnaire containing both open and close-ended questions was administered during the period of Jan-March 2019. Results: Out of 161 participants, 114 (70.8%) reported having a needle stick injury at least once during their clinical practice and the frequency of NSIs was significantly higher among nurses (76.7%) as compared to Doctors (50%), Laboratory staff (45.5%) and waste handlers (70.8 %). Conclusion: Study concludes that in absence of the routine collection of accurate data on NSIs, small studies have been useful in highlighting which groups of HCWs are most at risk from NSIs. [ABSTRACT FROM AUTHOR]

Objectives: Our study aims to determine the frequency of progressive hemorrhagic injury as observed on the CT scan from the initial scan performed at the time of presentation to a subsequent one in the 12 hours after the initial scan. Study Design: The type of study is a prospective observational case series. Setting: At Tertiary Care Hospital in Karachi, Pakistan. Period: 3 months from June 2018 to August 2018. Materials & Methods: All patients over 18 years of age who presented to the Accident and Emergency Department of the hospital with traumatic brain injury and had a CT scan performed within four hours of the injury were included in the study. A predesigned proforma was used to note down patient findings. CT scan findings were classified as subdural hematoma (SDH), intraparenchymal contusion (IPC) extradural hematoma (EDH) and subarachnoid hemorrhage (SAH). A repeat CT scan was performed twelve hours after the initial CT scan. Data were analyzed using IBM SPSS version 20.0, mean and frequencies were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Results: Of the n= 110 patients in our study 79 were males and 31 were female, the mean age of the patients was 34.25 years. The Glasgow Coma Scale scores at the time of arrival were between thirteen and fifteen for n= 33 (30%) of the patients, between nine and twelve for n= 54 (49.09%) of the patients, less than and equal to eight for n= 23 (20.90%) of the patients. Subarachnoid hemorrhage was present in n= 32 (29.09%) patients, intraparenchymal hematoma was present in n= 42 (38.18%) of the patients, while subdural hematoma and epidural hematoma was present in n= 14 (12.72%) and n= 22 (20%) of the patients respectively. Progressive hemorrhagic injury was found in n= 66 (60%) of the patients, while in n= 11 (10%) of the patients there was resolution of the lesion and n= 33 (33%) of the patients showed no observable changes in the repeat CT scan. Finally, our results indicate that of the 110 patients in our study PHI was seen in n= 17 (53.12%) patients with SAH, n= 18 (81.81%) patients of EDH, n= 5 (35.71%) patients of SDH and n= 26 (61.90%) patients of IPC respectively. Conclusion: According to the results of our study PHI is observed in 60% of the patients with a traumatic brain injury observed within the initial 12 hours after injury, and epidural hematoma and intraparenchymal contusions had the highest incidences of PHI among all the different types of traumatic brain injuries. [ABSTRACT FROM AUTHOR]

Diabetes is a very prevalent problem in Pakistan. Depression along with diabetes affects not only quality of life but compliance and management of patient. Various studies have found high prevalence of depression among T2DM depression. In our study we shall determine the prevalence of depression among T2DM patients in Pakistan. The objective of this study was to find out the prevalence of depression in Type2 diabetes mellitus patients. Study Design: Cross-sectional study. Setting: Jinnah Post Graduate Medical Centre Karachi. Period: May 2017 to December 2017. Materials and Methods: The patients with a diagnosis of type 2 diabetes above age 30 years (Male= 50 (30.1%) Female=116 (69.9%) Total=66 Patients), were recruited after informed consent. Type 2 diabetes mellitus patients both male and female above age 30 were included in the study. Results: Mean PHQ- Score is 10.83±5.6. 81.9% had PHQ Score > 4. According to PHQ-9 scale, 18.1% (n=30) had no depression, 26.5% (n=44) had moderately severe depression and 3.6% (n=6) had severe depression. In our study females had more severe depression in comparison with male (5.2% vs. 0%). Conclusion: Depression is very common in Pakistan among Type 2 Diabetic patients. Antidepressant has key role to break the vicious cycle of depression and type2 diabetes mellitus diabetes. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine the short term effects of energy drinks on the cardiovascular system and physical performance of healthy adult male medical students. Study Design: Experimental study. Place and Duration of Study: This study was conducted at the Physiology departments of CMH Multan Institute of Medical Sciences, Multan and Continental Medical College, Lahore from February 2017 to April 2017. Subjects and Methods: Sixty eight healthy, adult, male medical students participated in this study. Each day, heart rates and blood pressures of 3 to 4 students were measured and then the tests of physical performance (hand grip test and 300 meter run test) were performed ("pre-test" measurements). After that, each student drank 250 mL of a standard energy drink and then rested for about 30 minutes, after which post-test measurements were recorded in the same way. Changes in various parameters, before and after the consumption of energy drink were compared using the student's t-test. Results: The cardiac parameters (heart rate & blood pressure) of the students increased significantly after using the energy drink (p-value < 0.05). Mean±SD hand grip of the students increased from 44.97±3.96 Kg to 45.14±3.99 Kg after consuming the energy drink, but this increase was not significant (p-value = 0.667). Similarly, the mean±SD time of "300 meter run test" decreased from 68.28±3.40 seconds to 67.93±4.47 seconds after the consumption of the energy drink, but this was also non-significant (p-value = 0.448). Conclusion: We observed significant increase in heart rate and blood pressure of the study subjects, while no significant enhancement was seen in the physical performance of healthy adult male medical students, 30 minutes after consuming the energy drinks. [ABSTRACT FROM AUTHOR]

Objectives: To improved motor learning in spastic cerebral palsy children and reinforce weak movement patterns and to discourage overactive ones. To reduce the spasticity with different Bobath physical therapy techniques and control body posture as well as body movements. Study Design: A case series. Place and Duration of Study: Madina Teaching Hospital (The University of Faisalabad) Faisalabad, Pakistan. Period: The duration of the study was 3 months March 2013 to May 2013. Patients & Methods: A total 13 patients, aged 2-10 years of spastic CP were randomly selected. Effects of treatment were measured and data were collected by using non-probability convenience sampling technique. All children were tested thrice once completion of first month, then end of second month and then completion of therapy at the end of third month. Results: The result revealed that grading of spasticity from 1st to 3rd months of study was measured mean and standard deviations as follow, 1.62±0.87 to 0.85±0.80, CV% 53.75 to 95.24% and variance 0.93 to 0.89. The gross motor learning of 5 conditions that was Lying & rolling, Sitting, Crawling & kneeling, Standing, Walking & running and Overall % from first month to third month was measured as follow, Lying & rolling 41.48±30.36 to 44.49±31.90 P-value 0.000, Sitting 47.18±37.59 to 49.74±38.11 P-value 0.000, Crawling & kneeling 26.74±27.11 to 29.49±29.17 P-value 0.000, Standing 12.43±16.25 to 14.20±17.53 P-value 0.000, Walking & running 9.08±12.75 to 10.47±13.79 P-value 0.000 and Overall % 27.38±23.46 to 29.68±24.85 P-value 0.000. Conclusion: The Bobath techniques (neurodevelopment treatment) on gross motor learning are very effective and do play an important role in cerebral palsy children. [ABSTRACT FROM AUTHOR]

Background and Objectives: To analyze the functional outcome of open door laminoplasty (ODL) for the treatment of Cervical Ossified Posterior Longitudinal Ligament (OPLL). Study Design: Case series study. Setting: Civil Hospital Karachi. Period: 05 years, 2013 to 2017. Material & Methods: 18 patients (15 Male, 3 Female) underwent ODL for cervical OPLL, over a period of 5 years. Pre-operative & post-operative degree of myelopathy was assessed using Nurick grading score. Patients with Nurick grade > 2 were included in study. MRI compatible titanium micro plates & screws were used. Instability was assessed by X-ray Cervical Spine obtained 6 weeks post-operatively. Results: Mean age of presentation was 52 years. 2 to 3 levels were involved in most cases. Mean operative time was 2 hours 30 minutes. Following Nurick grading 94.4% (n=17) improved by grade 1 or more, while in only 5.6% (n=1) it remained same. No instability or kyphotic deformity was seen on follow up X-rays. Conclusion: ODL is a safe & effective procedure for the treatment of multiple level OPLL. It can avoid complications related to the anterior approach (like unintentional durotomy & spinal cord injury) and diminished the possibility of instability & kyphotic deformity associated with laminectomy alone. [ABSTRACT FROM AUTHOR]

Objectives: Study objectives were devised to assess perceptions of women regarding importance of folic acid intake, to evaluate role of healthcare providers in counseling of women for folic acid intake, to find out association between perceptions of women with folic acid intake practices and with counseling of healthcare providers. Study Design: A cross sectional survey. Setting: Gynecology and Obstetrics Wards and OPDs of Tertiary Care and Teaching Hospitals of District Rawalpindi. Period: July-December 2016. Methodology: Study participants were approached by using convenient sampling technique and sample size was of 271 women of reproductive age. attending gynecology and obstetrics wards and OPDs of tertiary care and teaching hospitals of district Rawalpindi. After obtaining consent from institutional review board, an interview-based questionnaire was used as data collection tool. Results: Out of 271 women of childbearing age, 60% perceived the importance of folic acid intake in diet. The highest counseling contribution was from doctors (57.6%) while evaluation of role of healthcare providers was done regarding counseling. Those who had perceived importance of folic acid had a significant better intake (p = 0.03). There was a significant association between role of healthcare providers and perceptions (p = 0.02). Conclusion: Majority of women perceived importance of folic acid intake and doctors were playing a significant role in counseling of women regarding folic acid intake during pregnancy. Folic acid intake practices were significantly influenced by women's own perceptions and role of healthcare providers was a very important factor to direct perceptions of women. [ABSTRACT FROM AUTHOR]

Background: It is defined as fracture in which fractured fragment is elevated above the level of the intact skull. Objectives: To assess the outcome of patients with delayed repair of compound depressed fractures. Study Design: Retrospective comparative cross sectional study. Setting: Civil Hospital, Karachi, Pakistan. Period: 01-01-2015 to 31-12-2016. Methodology: Sample size was calculated and sampling technique was non probability. Data was recorded from patients files to computer and analyzed on SPSS version 21. Results: The mean age of study participants was 21 years ± 5. There were 14 (77.7%) male and 4 (22.2%) female patients in our study. The maximum time from injury to intervention was 84 hours. Most patients presented to the emergency department with compound depressed fractures due to fall or hit by blunt object (40%) followed by road traffic accidents (33.3%) and assault (26.7%). Most common location of the compound depressed fracture was frontal bone involving right side of the skull. All the patients were successfully managed with satisfactory outcome without any major complications. Conclusion: The authors conclude that repair of depressed compound fractures in adults, if managed properly shows good outcome with less complications even with delay of 6 hours to 84 hours from injury to intervention. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to analyze the postoperative visual status in patients with suprasellar tumors with preexisting preoperative visual deficit after surgical resection. Study Design: Comparative cross section study. Setting: Civil Hospital Karachi. Period: March 2013 to August 2016. Methods: A total of 107 patients with suprasellar tumors with preoperative visual deficit who were operated. Either via transsphenoidal (43) or transcranial (64) approaches, were included in this case series. Sixty six patients had pituitary adenomas, 24 had craniopharyngiomas, 13 had meningiomas, 3 had chordomas and 1 had epidermoid cyst. Twenty five patients had uniocular visual deficit and 82 had binocular. Visual acuity was recorded preoperatively, postoperatively at discharge and at four weeks follow-up. Results: Postoperatively 46% of eyes improved, while 34.4% and 19.6% remained same and deteriorated respectively. Patients underwent transsphenoidal technique got significant 65% improvement, and those who underwent transcranial had 37.5% improvement (p-valve=0.005). Pituitary adenomas showed the greatest visual improvement of 65% (p-value=0.000), followed by craniopharyngiomas (33.5%) and meningiomas (7.6%). In total 52 patients (48.6%) showed improvement in vision and the visual acuity of remaining 55 (51.4%) did not improve. Conclusion: Patients experience significant benefit in vision after decompressive surgery for suprasellar tumors, especially those who have pituitary adenoma and who undergo transsphenoidal technique. [ABSTRACT FROM AUTHOR]

Context: Colloid cyst is a rare tumour of the brain that has a good outcome upon surgical removal. Aims: We present the outcome of surgical management of colloid cyst at our setup based on the experience of last ten years. Study Design, Setting and Period: The type of study is a retrospective review of cases of third ventricular colloid cyst operated at the Department of Neurosurgery, Civil Hospital Karachi, Pakistan, from January 2005 to December 2015. Methods and Material: The patient's data including the clinical records, radiographic data, operative and follow up notes were studied. The patient population was divided into groups based upon the size of the cyst. The surgical approaches utilized were the transfrontal transventricular and transcallosal approach. All the patients also underwent a series of tests to determine the function of the somatosensory, motor and memory functions both pre and post operatively and upon follow up. Statistical analysis used: Data was analyzed using SPSS version 23. Mean and standard deviation was used for continuous variables, while frequency and percentage was used for categorical variables. Results: The study population n= 60 patient, n= 36 males and n= 24 females. The size distribution of the cyst was, n= 4 (6.66%) were less than 1.5cm, n=47 (78.33%) were 1.5-3cm and n=9 (15%) were >3cm. Headache was the most common presenting complaint. Papilledema was observed in 71.66% of the patients, while memory changes were observed in 8.33% of the patients. The surgical excision of the cyst was performed in n= 52, patients while ventriculoperitoneal shunt was performed in n= 8 patients. Conclusions: According to the results of our study the transcallosal approach, is a safe technique, in which the neurological damage is limited due to minimal callosotomy and manoeuvring of the fornix. [ABSTRACT FROM AUTHOR]

Cranioplasty is the surgical repair of a bone deformity of the skull. Autologous bone grafts are preferred more since the cranial bone flaps will not be subject to rejection by the host and they lower the entry of foreign materials into the body. Preservation of cranial bone flaps is done in numerous ways, namely cryopreservation after a decompressive craniectomy, intracorporeal preservation and cranioplasty with subcutaneously preserved autologous bone grafts. The method of preserving cranial bone flaps using cryopreservation has many advantages; it is a safe, simple and an effective method for autologous bone grafts. The cryopreservation is also associated with higher infection rates and bone resorption as complications when compared to intracorporeal preservation. Intracoporeal preservation technique has many advantages, particularly that this surgery is easy, safe and cost-effective. The duration of the operation is short. The autologous bone flaps are not subject to rejection and there is no need for intra-operative bone shaping. Therefore on the basis of review of literature authors concluded that intracorporeal preservation is better than cryopreservation of cranial bone flaps, in terms of efficacy and complications. [ABSTRACT FROM AUTHOR]

Objectives: To assess knowledge and attitude of young doctors serving in Tertiary care Hospitals regarding the IPV intervention and polio eradication campaign. Study Design: A cross sectional descriptive study. Setting: Five Tertiary Care Hospitals in Rawalpindi and Islamabad. Period: Oct 2015-Nov 2015. Methods: Proportionate random sampling technique was used to select a sample of 100 doctors working in pediatrics wards and out patients departments (OPD). After taking informed consent the data was collected using a standardized Questionnaire to measure level of awareness among this cohort of Health care providers. Data were entered and analyzed using SPSS version 21. Baseline distinctiveness (demographic) was summarized by descriptive statistics. The statistical inference was drawn using Chi square test, p value of ≤ 0.05 was considered as significant. Results The study sample comprised of 47 males and 53 females. Mean age of participants was 29.8 ± 5.7. There were 15% House Officers, 45% Post Graduate Trainees, 30% Medical Officers and 10% consultants in the sample. Majority of doctors (65%) expressed disinterest and doubt about polio immunization while 40% suggested focus on sanitation and health promotion before immunization. Among the participants only 29% had attended polio surveillance training workshop in last 2 years and participated in polio National Immunization days. There was no significant association between knowledge about IPV and years of experience(χ² =2.68, p= 0.433). Conclusion: This study suggests that there was inadequate knowledge of doctors in tertiary care hospitals regarding IPV and polio eradication efforts in Pakistan. [ABSTRACT FROM AUTHOR]

Objectives: To compare serum uric acid levels in different stages of diabetic nephropathy. Study Design: Descriptive analytical study. Setting: University of Health Science Lahore. Period: February 2010 to January 2011. Subjects and methods: A sample size of 195 diabetic subjects. They were divided among normoalbuminuric, microalbuminuric and macroalbuminuric groups, according to their daily urinary albumin excretion rate (AER), with 65 patients in each group. Their glomerular filtration rate (GFR), daily AER and serum uric acid was evaluated by conducting tests on serum and urine samples. Statistics: Kruskal- Wallis test and Mann-Whitney U test were used to observe differences of medians in different groups. P value less than 0.05 was taken statistically significant. Results: There was majority of males in microalbuminuric and macroalbuminuric groups while females were more in number in normoalbuminuric group. Significant differences were found in serum urea concentration, serum creatinine concentration, serum uric acid concentration, glomerular filtration rate, urinary creatinine concentration, urine flow rate, daily albumin excretion rate and urinary albumin concentration among the three groups. Urinary creatinine concentration and glomerular filtration rate were in the highest ranges in normoalbuminuric group and in the lowest ranges in macroalbuminuric group. While rest of the parameters (ie. age, duration of diabetes, serum urea concentration, serum creatinine concentration, urine flow rate, daily AER , urinary albumin concentration and serum uric acid concentration) were in the lowest ranges in normoalbuminuric group and in the highest ranges in macroalbuminuric group. There was significant increase serum uric acid levels in advancing stages of diabetic nephropathy. p <0.05 was taken statistically significant. Conclusion: It is concluded that serum uric acid increases with the advancing stages of diabetic nephropathy. Progressive decline in glomerular filtration rate and gradual rise in serum creatinine level occurs throughout the course of diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study is to determine the prevalence of post operative intracranial infection rate, at Civil Hospital Karachi, Pakistan. Study Design: Retrospective analysis of cases of craniotomy, studying the files of patients who had the procedure done. Setting: Neurosurgical Department at Civil Hospital Karachi Pakistan. Period: Ten years period (2005 to 2015). Method: To determine the incidence and factors associated with infection a sub group analysis was done in all those patients in whom the intracranial infection was caused by a cranial surgery. Patients who were administered antibiotics for the treatment of infection were not included also those who were treated for wound infection without intracranial involvement. Data was analyzed using SPSS version 20. Results: A total of 5800 cranial surgical procedures were performed by a team of 30 neurosurgeons and residents. And a total n= 116 (2%) procedures were done due to post operative infection on a total of n= 70 patients. N= 37 patients were male and n= 33 patients were female, the median age of patients was 50 years and the age range was from 2 to 75 years. The procedures were performed as elective procedures in n= 56 (80%) patients and as an emergency case in n= 14 (20%) patients. The most common organism was methicillin sensitive staphylococcus aureus, and the most surgeries who were found to have a high incidence of post operative infection for craniotomies done for removal of a tumor. Conclusion: The postoperative infection is one of the most important complications of cranial surgical procedures and required immediate attention and treatment, even after taking all the precautionary measures to ensure sterility a small number of patients still develop severe infection needing reoperation for removal of debris and pus. [ABSTRACT FROM AUTHOR]

Background: Tibia is the most commonly fractured bone because of its structure and position. Tibial fractures are increasing with time to time and hence the morbidity and mortality are increasing despite proper public health efforts. There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. Therefore, epidemiological assessment is crucial for fracture. The purpose of this study was to provide upto- date information about patients baseline demographics, distribution of fracture classification, trauma mechanism and to formulate the preventive measures. Study Design: Retrospective study. Setting: Emergency or OPD at Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: 1st January 2011 to 31st December 2015. Material and methods: Any type of diaphyseal tibial fracture. The data were taken from hospital database and include clinical, epidemiological and radiological records. The results were analyzed using SPSS 20. Results: A total of 2120 patients were included in the study. 1980(93.4%) were male and 140 (6.6%) were females. Male to females ratio were 14.14:1 with mean age of 33.28 ± 21.02. Between 0-20 years, 519(24.5%) of patients were admitted, 1021(48.2%) of patients were between 21-40 years, 467(22.0%) were between 41-60 years and only 113(5.33%) were above 60 years. Type A2 in 444(20.9%) were the most common pattern of fracture found. The traumas were most common in months of May, June and July and Motorbike accidents were the main cause. The mid shaft of tibia is the most commonly fractured i-e 1038 (49.0%) followed by distal part i-e 611(28.8%) and the least is the proximal i-e 471(22.22%). Conclusion: This study shows AO-type 4A2 was the most common fracture type, representing 20.9% of all tibial shaft fractures. The individuals between 21-40 years were mostly affected and the motorbike accidents were found the main cause for such traumas. [ABSTRACT FROM AUTHOR]

Introduction: Malaria is second most life threatening disease in the world. It shows highest morbidity rate among serious illness including tuberculosis etc. Pakistan is at high risk of this disease giving very rise high frequency of Malaria victims in rural areas of Federally Administered Tribal Areas (FATA) of Pakistan. Due to its severe epidemics in specific regions they are termed as malarious areas of a country. Objectives: Main purpose of the study was to find out prevalence (p-value) of malaria in local community of FR Bannu region visited to basic health clinics. Study Design: In current survey based epidemiological descriptive study, we analyzed valuable data of malaria epidemic and its prevalence in selected areas of FATA (FR Bannu) region in Khyber Pakhtunkhwa via questionnaire & personal interaction. Study Period: The study was conducted in the months of June 2014 to August 2014. Material & Methods: Followed questionnaire against gender, age, seasonal, area & specie wise protocol survey. Results: Results showed (P > 0.05) ranging variables including high number of plasmodium vivax strain over plasmodium falciparum, gender comparison was dominant by male against females, age wise effect of pathogenic strain upon infants and old aged peoples, seasonal occurrence and its prevalence was less in cold months and in start of summer season where the data of rural areas was at its peak risk. Conclusion: It is concluded that pregnant ladies and infants are at high risk in such areas, so more care and control programs for malaria eradication are needed in selected areas of Pakistan. [ABSTRACT FROM AUTHOR]

Objectives: To examine the awareness regarding HIV/AID and sexual behaviour among long distance truck drivers (LDTDs) in Bahawalpur division. Study design: A cross sectional population study. Setting: Three districts (Bahawalpur, Bahawalnagar and RYK). Data: Sample of size of 120 LDTDs is taken by using convenient sampling technique. Methods: Descriptive and inferential analysis carried out. Results: Every 6 out of 10 LDTDs have heard aboutHIV/AIDS and believed that sexual intercourse is a major mode of its transmission. The use of condom before sex is seldom among truckers. Exactly half of LDTDs have only one sexual partner while nearly quarter (23.3%) of the respondents currently having two sexual partners. Over half (54.2%) of truckers made payment for sex with commercial sex workers (CSWs) and only 3.3% did so with their helper/conductor. Two models are executed separately to explore the association of trucker’s knowledge about HIV/AIDS (Model 1) and those who paid for sex (Model 2). Pearson chi-square analysis exhibits that respondents having age group 25-30 year, those with native of Punjabi language, those who manage to earn more than 15,000 Pakistani rupees per month, those having secondary level of schooling and those watching TV has higher knowledge regarding HIV/AIDS. LDTDs with age thirty years and over, Saraiki speaking, monthly income less than 10,000, illiterate, unmarried, watching TV and remain away from home during current trip a week are found to be more prone to pay for sex to CSW. Conclusions: The awareness of HIV/AIDS and knowledge of its transmission through sexual contact is high among LDTDs but still public health strategies are needed to promote the knowledge of all possible transmission modes of HIV/AIDS and use of condom before sex, ultimately to improve health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to uncover the trend regarding knowledge about sexually transmitted infections (STIs) among Pakistani women of reproductive age 15-49 as well as evaluating the socio demographic differentials associated with STIs knowledge. Design: The secondary data sets are used of Pakistan demographic and health survey (PDHS) of ever married women with sample size 10023and 13558.Period: PDHS 2006-07 and PDHS 2012-13. Setting: The national institute of population studies done this survey with the technical support from ICF International and Pakistan bureau of statistics and the USAID supported the financially. Methods: Descriptive frame work along withbivariate analysis was performed to understand the trend regarding STIs knowledge and evaluate the significant socio demographic factors respectively. Results: The awareness regarding STIs and knowledge to use always condom during sex to reduce the risk of getting HIV/AIDSafter equating the two PDHS has improved over time just by 3.85% and 6.50% respectively in PDHS-2012-13 compared to PDHS 2006-07. Early age group (15-19) women have sufficient lack of knowledge about STIs. Urban has more knowledge regarding STIs compared to rural. Education, wealth index and media awareness have positive association with STIs knowledge. Conclusions: Socio demographic differentials such as age, education, location and geographical area of residence, media access, wealth index and women occupation are found to be statistically highly significant with respect to sexually transmitted infections knowledge. These statistical outcomes will enhance the capability in disease management and control. [ABSTRACT FROM AUTHOR]

Objectives: To uncover the trend regarding TB knowledge and perception of its transmission as well as underlining the socio demographics aspects associated with TB cure among the reproductive venerable women. Methods: Quantitative frame work along with inferential analysis have been carried out by using the Pakistan Demographic and Health Survey 2006-07 and 2012-13 of ever married women. Results: Trend regarding TB awareness and its cure and treatment have been changed over time by 4.31% and 4.49% respectively in PDHS 2012 compared to PDHS 2006. Whereas an adequate knowledge of TB transmission thought air when coughing and sneezing remain constant after equating the two surveys. To understand the functional relationship of variables multinomial logistic regression analysis was carried out separately for PDHS 2006 and PDHS 2012. Two models revealed that early reproductive age group 15-19 of ever married women believed that TB cannot be curable compared to their counterparts upper age groups 45-49. Illiterate ever married women are more pronounced [OR=5.38 and OR=10.30] that TB is an incurable infectious disease compared to women having higher educational degree in PDHS 2006 and PDHS 2012 respectively. Location and geographical area of residence, wealth index, and media exposure have positive association about TB knowledge of cure and treatment. Conclusion: Although the awareness level improved but it still needs to launch some massive and wide-ranging awareness programme regarding an adequate knowledge of various diffusion modes of tuberculosis by utilizing all media modes predominantly television. Potential struggles are obligatory where the subordinate literacy rate and limited health care settings meticulousness in remote areas, so that the illness and death due toTB can be minimized. [ABSTRACT FROM AUTHOR]

Objective: To determine the trend of road traffic accidents (RTAs) and forecasting their incidence is an emerging to take safety measures so that general public health related morbidity and mortality can be minimized. Setting: The data for present study has been taken from Pakistan bureau of statistics (statistics House). Period: January 2002-2003 to December 2011-2012. Methods: A set of eleven curve fitting models namely linear, quadratic, cubic, logarithmic, inverse, exponential growth model, logistics-curve, and compound models were carried out for prediction. Results: Under the descriptive analysis, the annual average number of fatal and non-fatal accidents is 43.3% and 56.7% respectively. In provinces Punjab contributes to a high rate of total number of accidents, while Khyber Pakhtunkhwa, Sindh and Baluchistan placed second, third and fourth respectively. Under the curve fitting estimation, the cubic model was selected for predicting the annual traffic road accident for all categories i.e. (i) Total Number of Accident (ii) Fatal Accident (iii) Non-Fatal Accident (iv) Killed People (v) Injured People and (vi) The Number of Vehicle Involved. Rising trend in all categories are expected in Pakistan. Conclusions: The traffic road accident is expected to rise in Pakistan. [ABSTRACT FROM AUTHOR]

Globally 35 million people were living with HIV in 2013 whereas around 78 million people have been infected since the start of the epidemic and 39 million people have died of AIDS- related illness. Objectives: To examine the factors associated with HIV/AIDS awareness of ever married men and women age 15-49. Design: The secondary data sets are used of Pakistan demographic and health survey (PDHS) of ever married men and women with sample size 3134 and 13558. Period: PDHS 2012-13. Setting: The national institute of population studies done this survey with the technical support from ICF International and Pakistan bureau of statistics and the USAID supported the financially. Methods: Bivariate and binary logistic regression analysis has been carried out to evaluate the significant socio demographic factors. Results: Every 7 out of 10 ever married men have heard about AIDS, while the situation is much critical for ever married women, 6 out of 10 have not heard about HIV/AIDS. Generally finding revealed that almost both of the respondents have misconception regarding HIV/AIDS transmission. Two binary logistic regression models are executed one for ever married man and other for ever married women. Two models revealed that early age groups have less knowledge about HIV/AIDS; urban has more knowledge compared to rural. Education level, media assess and wealth index have positive association regarding to HIV/AIDS awareness. Conclusions: Socio-demographic aspects such as age, education, place of residence and access to media TV, radio and newspaper, wealth index and occupation are found to be significant varied systematically with the awareness of HIV/AIDS. These statistical outcomes will enhance the capability in disease management and control. [ABSTRACT FROM AUTHOR]

Poliomyelitis is a highly infectious disease but preventable by effective vaccines. Children under five year of age affected by this disease as a result a permanent paralysis. Objectives: To uncover the trend of infant polio immunization coverage through modeling is a significant concern to formulate an adequate vaccination strategies and program after the outbreak of new cases of polio in a recent year in Pakistan. Design: The reported data of monthly infant polio immunization coverage to National Institute of Health, Islamabad, Pakistan from January 2008 to July 2013 for the present study has been taken from Pakistan bureau of statistics with total time series entities 67. National Institute of Health, Islamabad took the record of per month number of doses administered ( 0-11 months )children by the registered health centre in pakistan. Period: January 2008 - July 2013. Setting: Pakistan bureau of statistics (Statistics House) Methods: A set of various short term time series forecasting models namely Box-Jenkins, single moving average, double moving average, single parameter exponential smoothing, brown, Holts and winter models were carried out to expose the infant polio immunization coverage trend. Results: Among the several forecasting models ARIMA models are chosen due to lower measure of forecast errors namely root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE). ARIMA (2,1,1), ARIMA (1,0,2), ARIMA (0,1,2) and ARIMA (2,1,1) models are established as an adequate models for the prediction of OPV-0, OPV-1, OPV-2 and OPV-3 respectively. Conclusions: With the exception of OPV-1 the infant polio immunization coverage is expected to rise in Pakistan. [ABSTRACT FROM AUTHOR]

Objectives: Effective implementation of mathematical and statistical models maximizes the likelihood of understanding the trajectory, level and pattern of incurable diseases and their therapies, so that precise demand strategies for costly lifesaving therapies for future, resource allocation and timely intervention could be ensured, a significant concern for less developed countries like Pakistan. Methods: The record of monthly number of patients on lifesaving anti-Retroviral Therapy for more than 18 HIV treatment centers in Pakistan was acquired for the period January 2011 to July 2013.A set of eleven curve fitting models namely linear, quadratic, cubic, logarithmic, inverse ,exponential growth model, logistics-curve and compound models was carried out for prediction. Results: After the execution of various curve fitting models by taking the ANOVA approach along with coefficient of determination and the forecast accuracy measures namely, mean percentage error (MAPE), mean absolute error (MAE) and mean square error (MSE) in the selection of final efficient model. Cubic model was selected for forecasting the monthly anti-retroviral therapy cases for all categories i.e. overall, male female and children. On the basis of final selected model 3% increment is expected number of paticuts on anti-retroviral therapy annually in HIV treatment center in all Pakistan. Male patients are expected to increase 14% who will get lifesaving anti-retroviral therapies. While the annually expected reduction of 17% and 42% in female and children cases taking anti-retroviral therapy is expcted in future respectively. Conclusions: The overall number of people on anti-retroviral therapy are expected to increase in Pakistan. Males are expected to have greater risk as compared to female and children in Pakistan. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was planned to observe the bioavailability and disposition kinetics of amoxicillin in adult rabbits (irrespective of sex) under healthy and dehydrated conditions. Design: Comparative. Place and duration of study: The study was conducted at the department of pharmacology, University of Veterinary and Animal Sciences, Lahore from April 2013 to October 2013. Methodology: Initially all rabbits were weighed and their packed cell volume (PCV) and other biochemical parameters were observed under normal conditions. Bioavailability and disposition kinetics of amoxicillin (10mg/kg body weight) were studied in normal rabbits following oral and intravenous route of drug administration. After 10 days washout period, these rabbits were made dehydrated by keeping the animals off water but not food. The animals with 10% decrease in body weight were declared dehydrated. Their parameters were again measured. Treated rabbits were administered amoxicillin orally and intravenously (10mg/kg body weight). Samples were drawn at prescribed time. Amoxicillin was assessed in plasma by using microbiological assay method. Plasma concentration was analyzed using non compartmental method. Results: The water deprived or dehydrated rabbits showed a significant increase in the packed cell volume, blood glucose and plasma globulins as compared to the normal rabbits. However, there was a significant (p<0.05 & p<0.01) decrease in body weight, total proteins, albumins and albumin globulin ratio of the dehydrated rabbits. The peak plasma concentration, volume of distribution and rate constant of elimination was lower in the dehydrated rabbits as compared to the normal rabbits. The plasma concentration of amoxicillin after intravenous administration in dehydrated rabbits had a significant (p<0.05 & p<0.01) larger area under curve, area under 1st moment curve, a longer half life and a larger mean residence time. Conclusions: The study in the dehydrated rabbits indicated the need of modification of dosage regimen. [ABSTRACT FROM AUTHOR]

Objective: To assess the radiological and functional outcome of external fixator in the treatment of intar-articular fractures of distal radius. Study design: Descriptive case series. Place and duration of study: Orthopaedic unit District Headquarter Hospital Temargarha Lower Dir from March 2013 to March 2014. Material and methods: Twenty five patients of intra-articular fracture distal radius fulfilling the inclusion criteria were treated with AO external fixator by ligamentotaxis. Preoperative and postoperative radiograph measurements were taken of radial inclination, radial tilt, and radial length, and fractures were classified according to the AO system. The fixator was removed after 6-8 week and functional assessment was done using Gartland and Werely point system at monthly interval for six months. Results: Eighteen male (72%) and 7(28%) females mean age 43.1 years with intra-articular distal radius fractures were treated with external fixator. Preoperative mean radial inclination(10.5 degree) radial tilt(29 degrees dorsal) and radial length(6.3 mm) were reported postoperatively as 18.8 degrees,8 degrees volar and 10 mm respectively at final follow up visit. The functional evaluation by Gartland and Werley's point system reported excellent (60% patients) ,good(20%) and fair(12%) at final follow up visit. One (4%) patient could not achieve union while one (4%) malunion was reported. Conclusions: Bridging external fixator(static) yields excellent radiological and functional results in majority of intra-articular distal radius fractures. [ABSTRACT FROM AUTHOR]