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Objective: To know the gender difference in the autoimmune profile that is anti TPO antibodies and thyroid profile in patients with hypothyroidism and in euthyroid controls. Study Design: Case Control study. Settings: Medical Out Door Department of Bahawal Victoria Hospital, Bahawalpur. Period: 01/09/2018 to 31/08/2019. Material & Methods: Case control study that was conducted after taking ethical approval from hospital ethical committee. After taking informed consent data was entered on a predesigned questionnaire and 5 ml of venous blood was taken for thyroid profile and anti TPO antibodies. Study population was selected by nonprobability sampling. A total 128 patients in which 69 in the hypothyroid group A and 69 in euthyroid control group were added. Results: Most of the anti TPO positive hypothyroid participants were females but TSH value was more in males. All euthyroid anti TPO participants were females. Female hypothyroid patients were young compared to males. Conclusion: Autoimmune thyroid disorders are more common in females, autoimmunity appears before biochemical failure of thyroid.

Objectives: To see the detrimental effects of arsenic kushta (kushta-e-Sammulfur) induced toxicity in wistar rats. Study Design: Experimental Study. Setting: Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore. Period: 02nd June 2016 to 30th September 2016. Material & Methods: This experimental study was conducted on a total of 48 wistar rats, each weighing approximately, 200-300grams. These rats were then randomly divided into four groups each of them comprising of 12 rats. Group I was taken as a control group which was given flour pellets. Group II was given a single dose of 180 mg/kg of arsenic kushta for 2 weeks, whereas Groups III was given 150 mg/kg of arsenic kushta only for 12 weeks and Group IV was also given dose of 150 mg/kg of arsenic kushta along with 75mg of Bovine Serum Albumin for 12 weeks. Histopathological changes were then seen in the germinal epithelium, stages of spermatogenesis and insterstitium of testes of rats. Results: Changes in germinal epithelium, stages of spermatogenesis and interstitium were seen in all the above groups except group 1 which was the control group. Maximum changes were seen in groups C and D which were given high doses of arsenic kushta along with injection of bovine serum albumin. Conclusion: Arsenic kushta preparation of kushta-e-Summulfur causes testicular toxicity in wistar rats and have similar toxic effects in human beings.

Objective: To determine different causes of portal hypertension in children. Study Design: Cross Sectional study. Setting: Department of Pediatric Medicine, Department of Pediatric Gastroenterology and Department of Medical Emergency, The Children’s Hospital and Institute of Child Health, Multan. Period: 3rd April 2019 to 2nd October 2019. Material & Methods: A total of 71 children presenting with portal hypertension aged 1 month to 15 years of either gender were included. Newborns or children with congenital heart diseases were excluded. Patient samples were collected for complete blood counts and liver function tests, Ultrasound Abdomen and color Doppler ultrasonography were done for portal vein pressure to determine various causes of portal hypertension. Results: Overall, mean age was 9.00 ± 3.64 years. Out of the 71 patients, 51 (71.83%) were male and 20 (28.17%) were females. Different causes of portal hypertension were portal vein thrombosis in 48 (67.61%), liver cirrhosis in 14 (19.72%) and biliary atresia in 9 (12.68%) children. Conclusion: Among children having portal hypertension, portal vein thrombosis was noted to be the commonest cause followed by liver cirrhosis and biliary atresia.

Objective: To find the probable role of Homocysteine as a prognostic indicator for women with Pregnancy-Induced Hypertension and comparison of Homocysteine Levels in Normal Versus pre-eclamptic women. Study Design: Cross Sectional Comparative study. Setting: Gynecology Unit of Lahore General Hospital, Lahore. Period: May 2017 to Oct 2017. Material & Methods: Thirty four consented pre-eclamptic pregnant women with age range 29 to 35 years were included in the study. 20 age matched pregnant women with no history of any clinical problem were taken as controls. A questionnaire based on age, obstetric details including detail of gravida, family history etc was filled by both subjects and controls. Anthropometric parameters were noted based on height and weight. Blood sample of both patients and controls was drawn for estimation of blood urea, serum creatinine, and homocysteine. Results: Mean age of women was 31 year with BMI 27.0 Kg/m2. Levels of serum homocysteine were significantly more women with pre-eclampsia in comparison with cases of controls. However the values of blood urea and serum creatinine were insignificantly high in pre-eclamptic women in comparison with their controls. Conclusion: Serum homocysteine as a biomarker may help to find out its additive importance in the prediction of pre-eclampsia and the severity of its related complications.

Objectives: To evaluate electrolytes levels in patients suffering from iron deficiency anemia and to compare it with patients without anemia. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology, Sahiwal Medical College Sahiwal. Period: November, 2019 to May, 2020. Material & Methods: After taking informed consent, five milliliter of blood was drawn from each patient. Blood sample was analyzed for electrolytes, complete blood counts and serum ferritin levels. Results were compared in normal and iron deficiency anemic groups. Results: A total of 287 clinically anemic suspects including 181 (63.0%) female and 106 (37.0%) male with mean age of patients as 36.11±12.23 were included in this study. A total of 205 (71.4%) of the suspects had anemia whereas frequency of anemia remained higher among females (78.5%) as compared to males (59.5%) in this study. On the basis of serum ferritin levels a total of 178 (62.0%) patients had iron deficiency. Mean values of Sodium (130.41±0.59) and Bicarbonate (24.10±0.31) remained low while mean Potassium (4.33±0.07) and Chloride (103.93±0.47) levels of Iron Deficiency Anemia (IDA) group remained high as compared to non-anemic group. Conclusion: Levels of sodium and bicarbonate are found to be on the lower side while potassium and chloride remained on higher side in patients with Iron deficiency Anemia in this study. Thus these findings indicate close monitoring of electrolytes to evade impediments during management of patients.

Objectives: Multiple organ dysfunction syndrome (MODS) is commonly encountered by pediatricians in Pediatric Intensive care Units (PICUs) among critically ill children. This study was done to find out the frequency of MODS in children admitted at PICU. Study Design: Case series. Setting: Department of Pediatrics Medicine, The Children’s hospital and the Institute of Child Health, Multan. Period: From May to November 2019. Material & Methods: Variables recorded for each case included age, gender, residential status, maternal education, height, weight and BMI. Venous blood sample was sent to the hospital pathology laboratory for baseline investigations to diagnose MODS. Results: Of these 101 study cases, majority, 61 (60.4 %) were male, 51 (50.5 %) belonged to rural areas, 74 (73.3%) from middle income families and 72 (71.3%) mothers of admitted children were illiterate. Overall mean age was 3.62 ± 1.95 years while mean body mass index was 24.85 ± 2.20 kg/m.2 Mean duration of PICU stay was 4.31 ± 3.39 day and 69 (68.3 %) had duration of PICU stay up to 5 days. Of these 101 study cases, multiple organ dysfunction was noted in 33 (32.7%). Conclusion: High Frequency of MOD was observed among children admitted to PICU. MODS was found to have association with male gender, residential status as rural, maternal education status as illiterate, obesity and duration of PICU of more than 5 days.

Objectives: To study the early outcomes of mitral valve replacement with a mechanical prosthesis is patients with rheumatic mitral valvular disease. Study Design: Retrospective Observational study. Setting: Punjab Institute of Cardiology, Lahore and Rawalpindi Institute of Cardiology, Rawalpindi. Period: From August 2014 to August 2017. Material & Methods: Consecutive patients who underwent mitral valve replacement for a rheumatic pathology were included in the study. Patients undergoing a redo surgery, those with concomitant aortic valve intervention, coronary artery bypass grafting and emergency procedures were excluded from the study. Results: Of the 104 patients included in the study, 58 (56.2%) were female patients. The mean age of the patients was 35 ± 12.36 years (median 33 years). Sixty (58.5%) had hypertension and 22 (21.28%) had diabetes. Mitral valve stenosis was the main pathology in 84 (81.25%). Severe pulmonary hypertension was recorded in 15 (15%) patients. The mean preoperative Tricuspid Valve Pressure Gradient (TVPG) was 55.33 ± 18.35 mmHg. The mean cross clamp time was 45.33 ± 12.32 minutes. The postoperative tricuspid valve pressure gradient came down to 31.5 ± 12.21 mmHg. No patients had acute renal injury, pulmonary complications or re-exploration for bleeding. Perioperative mortality was 4 (3.75%). Conclusion: Rheumatic valvular disease is still prevalent in our part of the world. Most of the patients with rheumatic heart disease will end up with replacement of the valve. Replacement with a mechanical prosthesis has favorable early outcomes.

Objectives: This study was done to compare calcium hydroxide (Ca(OH)2) and chlorhexidine (CHX) in relieving interappointment pain, in addition to observe influence of gender and age. Study Design: Randomized Control trial. Setting: Department of Operative Dentistry, Fatima Memorial Hospital, Lahore. Period: 3rd October 2016 to 20th May 2017. Material & Methods: 100 subjects were divided into 2 groups of 50, group A (Ca(OH)2) and group B (CHX). Information was recorded regarding the gender, age, intracanal medicament used, VAS pain scores of preoperative pain, 24 hours, 48 hours and on the 4th day of placing medicament. Change in pain scores was assessed as the main outcome variable. Results: VAS score mean difference for both medicaments was significant for 24 hours, 48 hours and 4th day (p < 0.0005. CHX medicament decreased pain more as compared to Ca(OH)2. Age had no significant effect on VAS score decrease but females had significant decrease in pain (p=0.04). Conclusion: CHX decreased the mean interappointment pain score more as compared to Ca(OH)2.

Objective: To determine the frequency of anemia and its causative risk factors in patients attending the gynecology outpatient department of Nishtar Medical University and Hospital. Study Design: Cross sectional study. Setting: Gynecology Outpatient Department attendees of Nishtar Medical University and Hospital. Period: 1st September to 31st December 2019. Material & Methods: Total 361 females between 19-49 years of age were enrolled and included those patients who consented to be tested for blood hemoglobin estimation. Their brief history was taken after proper consent according to predesigned proforma to rule out the risk factors. Patients with chronic kidney disease, chronic lung diseases and liver diseases were excluded. Blood test was done by obtaining the blood sample by finger prick method. Hemoglobin analysis was performed by portable Hemocueanalyser. Frequency of anemia, severity of anemia and their stratification was performed against the risk factors like age, educational status, socioeconomic status, status of pregnancy, parity and contraception were obtained to rule the causative factors. Anemia was defined per standard criteria as hemoglobin less than 11gm/dl. Results: Majority of patients 65% were between 19-35 years of age and 34% were 36-49years of age. Frequency of pregnant patients and non-pregnant patients was 63.4% and 36.6%. Frequency of anemia was 56.8%, mean hemoglobin 10.48±1.18 with mild, moderate and severe anemia were 36.8%, 17.2% and 2.8%. Majority of females 82.9%, never went to school and had primary education, 71.70% belong to very poor and poor socioeconomic status, 79.02% were multipara and 81.95% never and infrequently practiced the contraceptive methods. Conclusion: Frequency of anemia is very high in females presenting to tertiary care hospital being more common in younger age group. Frequent pregnancies, poor socioeconomic status and low level of educational attainment were the major determinants of anemia in females.

Objectives: To assess histological spectrum of endometrial lesions in abnormal uterine bleeding at a tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Pathology, Multan Medical & Dental College, Multan and Faisalabad Medical University, Faisalabad. Period: January, 2019 to December, 2019. Material & Methods: Using non – probability purposive sampling technique. Results: A total of 238 ladies presenting with abnormal uterine bleeding were registered in our study. Mean age of these patients with AUB was 47.25 ± 5.57 years (ranging 21 years to 59 years), 158 (66.4%) were aged more than 45 years. Eighty five (35.7%) were from rural areas while 153 (64.3%) from urban areas. Of these 238 females, 162 (68.1%) were illiterate and 76 (31.9%) were literate. Majority of patients i.e. 218 (91.6%) were married and mean duration of illness was 5.28 ± 3.89 months while 169 (71%) presented within 6 months of illness. Histopathological pattern revealed Proliferative phase endometrium was observed in 69 (29%), endometrial hyperplasia in 59 (24.8%), chronic endometritis in 40 (16.8%), secretory phase in 40 (16.8 %), atrophic endometrium in 30 (12.6%) and endometrial polyps in 10 (4.2%). Conclusion: Histological pattern revealed proliferative endometrium was commonest followed by hyperplasia, secretory phase and chronic endometrium in our study. Disordered proliferative endometrium was commonly observed in married females and those having duration of symptoms more than 6 months. Hyperplasia was more frequent in older patients who were married. Secretory phase was significantly more common in patients with prolonged disease and chronic endometritis was associated with marital status and prolonged disease duration.

Infertility is global health issue. Male factor contribute to infertility in more than half of sub fertile couples. Their diagnosis is easy by simple test of husband semen analysis. This study has been designed to know the contribution of male factor and frequency of abnormalities of semen in infertile couple. Objectives: To determine the frequency of male factor in infertile couple and to evaluate the different abnormalities in semen. Study Design: Descriptive study. Setting: Department of Obstetrics and Gynecology in Nishtar Hospital Multan. Period: From January 2019 to June 2019. Material & Methods: Study started after taking approval from hospital ethical committee. Study included 200 subfertile couples after informed consent attending the outpatient department. The partner of female attending the fertility clinic between ages 20-40 were selected. History taken from female partner regarding age, duration of subfertility, type of subfertility any drug intake and medical illness of male. Result: Among 200 couples 64(32%) had abnormal semen parameters.24 had oligospermia. Eight had azoospermia and 60 had asthenospermia. 20 patients had teratospermia. Conclusion: Male factor is significant contributor of infertility therefore awareness is needed in order to engage more males partner in evaluation and management of infertility.

Objectives: To determine the frequency of pre-eclampsia among pregnant ladies with abnormal uterine artery Doppler at 22- 24 weeks of gestation at a tertiary care hospital. Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynecology, Nishtar Medical University / Hospital Multan. Period: All the women (n=160) with abnormal uterine artery from 01-07-2018 to 30-06-2019 were included. Material & Methods: The pulsatility index (PI) of uterine artery Doppler was taken by taking average of 3 consecutive waveforms to determine the abnormal uterine artery Doppler. These study cases were followed till delivery to document pre-eclampsia. Results: Of these 160 study cases, 89 (55.6 %) had gestational age up to 23 weeks while 71 (44.4 %) had gestational age more than 23 weeks having mean age of 25.44 ± 4.77 years. Of these 160 pregnant ladies with abnormal uterine artery Doppler, 72 (45.0 %) were resident of rural areas and 88 (55.0 %) were resident of urban areas and family history of pre-eclampsia was 42 (26.3%). Previous history of pre-eclampsia was noted in 41 (25.6%). Mean parity was 2.24 ± 1.06 and 113 (70.6%) had parity up to 3. Mean gravidity of our study cases was 3.87 ± 1.16 and 89 (55.6%) had gravidity up to 4. Obesity was present in 30 (18.8 %) having mean body mass index 25.23 ± 1.92 kg/m2. Mean interpregnancy interval was 14.19 ± 6.82 months and 83 (51.9 %) had interpregnancy interval more than 1 year and pre-eclampsia was noted in 125 (78.1%). Conclusion: Very high frequency of pre-eclampsia was noted in our study in pregnant women presenting with abnormal uterine artery Doppler at 22 – 24 weeks of gestation. Pre-eclampsia was significantly associated with age, family history of pre-eclampsia, previous history of pre-eclampsia and interpregnancy interval.

Syncope occurs as a result of cerebral hypoperfusion. Various neuroendocrine hormones have some role in the pathogenesis of Syncope. Current study was conducted to determine the role of Angiotensin II in pathophysiology of vasovagal syncope (VVS) and Postural tachycardia syndrome (POTS). Study Design: Cross sectional analytical study. Setting: Islamic International Medical College, Rawalpindi and in Electrophysiology department (AFIC). Period: April 2017 to April 2018. Material and Methods: Sample size of this study was comprises of 80 subjects, having 35 cases of VVS and POTS each and 10 controls were also taken. Cases were collected on the basis of Head up tilt test (HUT) result and on their previous history of syncope, then their blood samples were collected and stored. Hormonal analysis of Angiotensin II was performed by ELISA technique. SPSS statistics 21 was used to evaluate result by applying ANOVA test. p value of < 0.05 was considered significant. Result: Analysis of Angiotensin II concentration in Postural tachycardia syndrome, Vasovagal and control group was found 170.93 ± 118.59 pg/ml, 152.16 ± 91.40 pg/ml and 136.93 ± 43.18 pg/ml respectively. In statistical analysis p value was 0.570 which is insignificant. Conclusion: It is concluded that Angiotensin II exerts role in the pathophysiology of VVS and POTS as shown by the difference in the value of Angiotensin II in VVS, POTS and in control group.

The objective of this study was to compare the mean residual pain after cemented versus uncemented hemiarthroplasty of hip. Study Design: Randomized Controlled Trial. Setting: Orthopaedic Department, Allied Hospital, Faisalabad. Period: September 2016 to October 2017. Materials and Methods: Total 150 patients were admitted in orthopedic Department of Allied Hospital Faisalabad according to inclusion & exclusion criteria. After taking informed written consent, all patients were divided into two groups randomly. Cementedhemiarthroplasty was done in Group A patients and uncemented hemiarthroplasty was done in group B patient. All procedures were done by surgeon who has minimum 5yrs post fellowship experience. Monthly Follow up was done and residual pain was noticed at the end of 6th month. All the data was analyzed by using SPSS version 20.0. Results: In this study, in Group-A the patients between 65-75 years of age were 57.33% (n=43) and between 76-85 of age were 42.67% (n=32). In Group B the patients between 65-75 years of age were 56%(n=42) and between 76-85 years were 44% (n=33). The mean+sd was calculated and it is 73.49+4.99 years in Group-A patients and 73.73+4.74 years in Group-B patients. In Group A, males were 61.33% (n=46) and female were 38.67% (n=29). In Group B, males were 57.33% (n=43) and female were 42.67% (n=32). When we compared the residual pain after cemented versus uncemented hemiarthroplasty of the hip, it shows 1.69+0.35 in Group-A patients and 2.62+0.30 in Group-B patients. When we calculated p-value it was 0.0001 showing a significantdifference. Conclusion: It is concluded that residual pain in cemented hemiarthroplasty is lower than uncemented hemiarthroplasty.

Introduction: Dengue can indicate a diverse clinical spectrum. The intensity ofhepatic involvement in patients, with dengue infection varies from soft injury to severe injury bymeans of jaundice and liver cell failure. Even if liver is not a most important objective limb, liverinvolvement is a renowned aspect. Objectives: The objective of this study was to assess liverinvolvement in dengue patients upto 12 years of age. Study Design: The study was Prospectiveobservational. Place and Duration of Study: Study was conducted in children ward, PaediatricDepartment, Holy Family Hospital Rawalpindi from August 2014 to October 2015. Methods:Upto 12 years of age, all suspected dengue children patients were screened and solitaryserologically established cases by dengue IgM capture ELISA were incorporated in the studyafter taking written permission from the parents of the patients. Patients were categorizedaccording to GCP dengue guidelines into dengue fever (DF), dengue hemorrhagic fever (DHF)and dengue shock syndrome (DSS). Results: Among 146 children, 78 were in the group of DF,35 were in the group of DHF and 33 were in the group of DSS. Most children (70 %) were above5 years. Fever was the leading illness followed by body aches, hepatomegly, rashes, edema,headache, petechiae, hepatic tenderness, pain in abdomen, vomiting, mucosal bleed andjaundice. Children with DSS have more liver involvement. Hepatomegaly and thickening of gallbladder was maximum in children with DSS and can be an indication of severe illness. Serumbilirubin, serum albumin, liver enzymes like ALT, AST and ALP were considerably elevated inchildren with DSS as compare to other two groups. 32 patients out of 33 with DSS had liverinvolvement. Conclusion: Dengue fever has become a main health issues at the moment inPakistan. Hepatic association in dengue in children has high fatality rate and spectrum variesfrom jaundice to rise of liver enzymes.

Objectives: To determine the outcome of close reduction and conservativemanagement in closed humeral diaphyseal fracture in terms of normal union and delayedunion. Study design: Descriptive case series. Setting: Orthopedic Department of Allied andDHQ Hospital Faisalabad. Duration of study: 15th December 2012 to 15th December 2014.Material & Methods: 170 patients with mean age of 36.68 ± 14.16 including 98 (57.6%)males and 72 (42.4%) females falling in inclusion criteria were managed conservatively withthe technique i.e. application of u-shaped plaster slab initially for 3 weeks then replaced byhumeral brace (Sarmiento) uptil 12 weeks. Results: 170 patients with mean age of 36.68 ±14.16 including 98 (57.6%) males and 72 (42.4%) female patient. Simple transverse fractureswere 103 (66.47%), spiral fractures 31 (18.23%) and oblique fractures 36 (15.30%). Unionwas achieved in 158 patients (92.94%), 12 patients (7.05%) progress to delayed union. Meanhealing time was 10 weeks ± 1.81 with a range of 7 to 15 weeks. Conclusion: When choosingconservative methods close reduction and conservative management initially with u-slab ofplaster of paris later replaced by humeral brace (Sarmiento) is the treatment of choice becauseof low complication but very high success rates.

Introduction: Subarachnoid block has been in practice for below umbilicalsurgery more than 110 years.1 in recent era all over the world most of cesarean sections arebeing done under subarachnoid block because of high mortality rate associated with generalanesthesia due to failed intubation and aspiration pneumonia. Objectives: To compare theefficacy of phenylephrine versus ephedrine in the treatment of hypotension during cesareansection under subarachnoid block. Study Design: Randomized control trial. Setting:Department of Anesthesiology Nishter Hospital Multan. Period: March 2014 to August 2014.Materials and Methods: A total 80 patients included in the study and patients were divided intotwo equal groups. Phenylephrine group (P group) and Ephedrine group (E group), 40 patientsin each. Results: A total of 80 (100%) patients included in the study. As concern to the age ofpatients, mean age in group E was 30.50 and standard deviation was 5.383, similarly in groupP mean age was 30.75 and SD was 5.921. As concern to the efficacy in group E, 7 were havinggood efficacy and 33 were have poor efficacy. In group P 30 had good efficacy and 10 hadpoor efficacy. P=0.000 a significant value. Conclusion: Phenylephrine is more effective thanephedrine for the treatment of hypotension due to subarachnoid block during cesarean section.

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarovmethod in patients undergoing Girdle stone procedure in terms of pain relief and limb lengthdiscrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedicand Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore.Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow upfor next one year after the procedure. Materials and Methods: Forty five patients having hipjoint problems were included. The radiographs would include plain radiographs of the pelvisin neutral and single limb standing position and the femur of involved side to assess the pelvicobliquity. Surgery was performed in the supine position under spinal anesthesia. A proximalfemoral osteotomy was performed at the level of ischial tuberosity. The other distal femoralosteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomieswere then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/dayfor lengthening. Results: There were 30 male patients and 15 were female patients with maleto female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among allpatients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion:By using the Ilizarov technique, we could prevent the valgus effects created by the valgusextension osteotomy while achieving lengthening of the femur through the distal osteotomy inthe femur. It is an excellent technique for those patients who are not fit for total hip replacement.

Objectives: To evaluate the management of tibial diaphyseal fractures treated byPOP cast versus intramedullary nailing in terms of time of union. Design of study: Randomizedcontrolled trials. Setting: Department of Orthopaedic, Allied / DHQ Hospital, Faisalabad.Duration of Study: Six months (01-08-2013 to 31-01-2014). Materials and Methods: 80patients fulfilling the inclusion and exclusion criteria were included in the study. After laboratoryand radiological assessment, the patients in Group 1 were treated by long leg cast. The patientsin Group 2 were treated with intramedullary interlocking nail. The patients were followed on OPDbasis. Results: 80 patients divided into 2 groups. Each group had 40 patients. Mean age ofpatients was 30.99 ±8.092 years. There were total of 65% males and 35% females in this study.According to geometry of fractures simple transverse fractures were 47.5%, spiral fractureswere 17.5%, oblique fractures were 25% and segmental fractures were 10%. There were 71.25%closed fracture and 28.75% type l open fractures. Mean time of union was 23.86 ± 5.48 weeks ingroup 1 while in group 2, mean time of union was 18.35 ± 4.12 weeks. P-value was 0.001 whichis statistically significant. Conclusion: It is concluded that reamed intramedullary interlockingnailing is a good mode of internal fixation comparing with conservative management of closereduction and POP cast in both close and type I open fractures in terms of union.

Introduction: Psychological stress activate two axes: Hypothalamic- Pituitary-Adrenal axis and Sympathoadrenal axis leading to production of cortisol and catecholamines.Autonomic disturbances in the body can be evaluated by estimating heart rate variability.Study Design: Cross sectional study. Setting: Islamic International Medical College. Period:June 2014 to December 2014. Materials and Methods: Subjects were labeled as stress andcontrol on basis of DASS questionnaire proforma. Morning Cortisol level of all the subjectswas measured by quantitative ELISA method. Heart rate variability recording of all the subjectswas done. Results: Low frequency in absolute and normalized unit and low to high frequencyratio was significantly higher in stressed group, compared to control (p≤ .05, p ≤ .001, pp ≤.001 respectively). High frequency in normalized was significantly lower in stressed subjects,compared to control (p ≤ .001). Cortisol level was significantly higher in the stressed group incomparison with control (p ≤ .05). Conclusion: Stress can lead to increase morning cortisollevel and can cause autonomic disturbances which can be evaluated by measuring heart ratevariability.

Background: Central nervous system (CNS) tuberculosis constitutes 6% of alltuberculosis cases and tuberculous meningitis (TBM) is the most serious manifestation. Despiteeffective anti-tuberculous medicines, 20-50% of tuberculous patients die and significant numberof patients have neurological deficits. Failure to initiate anti-tuberculous therapy in the earlystages of the disease may lead to significant morbidity and mortality. Setting: MW-1, MW-III andMW-IV of Bahawal Victoria hospital Bahawalpur. Methods: All patients of tuberculous meningitisdiagnosed on the basis of the clinical criteria and cerebrospinal fluid examination (WBC ≥15,predominant lymphocytes and sugar level ≤40 mg/dl) were included in the study. Age, gender,and GCS level of the patients were recorded. Every patient was observed for mortality withintwo weeks after admission (within ward or enquired on mobile phone if patient was dischargedearly). Results: A total of 73 patients were included in the study. The mean age of patientswas 36.71 years with standard deviation of 17.161 years. Out of 73 patients, 31 (42.47%)patients were male and 42 (57.53%) were female. Out of 73 patients, 12 (16.44%) patients oftuberculous meningitis had mortality while 61 (83.56%) patients had no mortality. Conclusion:Tuberculous meningitis is a chronic illness with relatively high mortality and morbidity. Low levelof consciousness on admission to hospital is an important predictor for mortality.

Objectives: To evaluate the protective effects of combination of extracts of Oleaeuropeae and Ginkgo biloba in response to hematological toxicosis induced by DOX. Designof study: Animal experimental study. Setting: Dow University of Health Sciences. Period: 2month. Materials & methods: The extracts of Olea europeae and Ginkgo biloba were preparedby using standard Soxhlet apparatus and then they were mixed together in 1:1 ratio. EighteenMale Wistar rats were incorporated in the study and divided in 3 groups: T* (control group: 2ml 0.9 % NS), TP0 (DOX group: 15 mg/kg/week) and TP1 (extract of Olea europeae & Ginkgobiloba + DOX: 200 + 15 mg/kg/week). All animals receive drugs by intra-peritoneal route. On57th day blood was withdrawn by cardiac puncture and preserved for analysis. Hematologicalprofile includes CBC and Platelet count. Results: Hematological analysis reveals that theanimals which receive Doxorubicin had low levels of Hemoglobin, RBCs, Leukocytes,Neutrophils, Eosinophils, Monocytes, Lymphocytes and Platelets when compared to controlgroup. The levels of Hb and RBCs were low but it is not evident of anemia. Neutrophil andPlatelet were drastically low, which shows presence of Neutropenia and Thrombocytopenia.The treated group animals had shown positive elevation in the levels of CBC and Platelet count.Conclusions: On the basis of hematological report it is concluded that combination of extractsof Olea europeae and Ginkgo biloba can prevent the toxicosis effects of Doxorubicin.

Objectives: Oxaliplatin causes hematological toxicities in clinical setting whichlimits its efficacy. The aim of this study is to investigate the therapeutic effects of Andrographispaniculata against hematological toxicity caused by oxaliplatin. Study design: Experimentalanimal study. Period: Study takes 8 month from March 2015 to Oct 2015. Setting: Dow universityanimal house. Method: Wistar albino male rats, divided into 3 equals groups (n=6): GroupN* was a control group (0.9% normal saline), Group NP0 was Oxaliplatin treated group andGroup NP1 was prophylactically treated with Andrographis paniculata followed by Oxaliplatinin order to assess the protective effects of Andrographis paniculata against the hematologictoxicity caused by Oxaliplatin. Results: Prophylactic treatment with Andrographis paniculata(NP1) significantly increases the levels of platelets and neutrophile count compared with thestandard (NP0) (p

Static I /M I/L Nailing is considered to be the gold standard for fixing mid-shaftfractures of long bones. Flexible nails or plates are used in children for internal fixation of suchfractures to avoid damage to epiphysis. Nailing is done under image intensifier using orthotable.These prerequisites are not available in all peripheral hospitals especially in a resourceconstrained country like Pakistan. A technique was evolved to do static I/M I/L Nailing withoutimage and ortho-table while working under such conditions at MASH at CMH Muzaffarabad.The results were compared with the procedure done under image by the same surgeon.Study Design: Retrospective comparative study. Settings: Field Hospital (MASH) at CMHMuzaffarabad, CMH Kharian, CMH Malir and CMH Nowshera. Period of Study: Sep 2007 toMarch 2016. Material and Method: 165 cases of fracture femur, tibia and humerus were fixedwith static I/M I/L Nailing without image intensifier while 148 cases of fractures of these bonesfixed under image using ortho -table by the same surgeon were included in the study. Results:A minimum follow-up of 06 months was done and observations made regarding estimatedblood loss, average time of operation (including anesthesia), and fracture healing time, weightbearing, early and late complications. Results are compared in two groups. Conclusion: I/M I/LNailing for long bones fractures can be done without image intensifier11 or any intra-operativeX-rays.4 Ortho-table is also not essential. Technique is simple. Opening the fracture site is notrequired in most of the cases. Minimal access is used when fracture site opening is required. Itdoes not compromise any principle for internal fixation. Distal interlocking screws are appliedwithout making a cortical window and their position is doubly confirmed intra-operatively bya simple technique (not mentioned in literature before this study). There are no added risksinvolved12 and results are comparable to the procedure done using image intensifier and orthotable.

Background: Shoulder impingement syndrome is umbrella term that covers rotator cuff syndrome, tendinitis of muscles of rotator cuff and bursitis in shoulder region. Usually this syndrome is treated conservatively. The treatment options are corticosteroid injections, medical treatment and physical therapy, of which, the most common are injection therapy and physical therapy. Injection therapy is carried out by orthopedic surgeons. However, which treatment is most effective in terms of symptoms relieving and cost effectiveness, yet conflicting. Study Design: Randomized Controlled Trial. Setting: Independent University Hospital, Faisalabad. Period: 1stJuly 2017 to 30thJune 2018. Methods: Comparing effects of two treatments for shoulder impingement syndrome; sub armorial steroid injection, the control group and manual physical therapy, the treatment group. Primary outcomes were Shoulder Pain and Disability Index (SPADI), to measure endpoint differences. Secondary outcomes included changes in Global Rating of Change (GRC) scale and Numeric Pain Rating Scale (NPRS) scores. Trial was conducted in one clinical setup. The collected data was analyzed by Statistical Package of Social Sciences (SPSS 20.00). Results: At baseline of group physical therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At post treatment of group injection therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At follow up of group injection therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At follow up of treatment physical therapy all patients mild level of pain, at numeric rating pain scale. Conclusion: Injection therapy treatment is more effective in improving shoulder impingement syndrome in terms of pain and function than that of physical therapy treatment.

Objectives: To compare lateral versus posterior approach in the management of supracondylar fractures of humerus in children in terms of functional outcome. Study Design: Retrospective Comparative study. Place and Duration of Study: This retrospective study was carried out over a period of seven years from Oct 2009 to Oct 2016, at Combined Military Hospitals Kharian, Malir and Nowshera. Patients and Methods: All the children having supracondylar fracture (Gartland Type-II and III) who underwent surgical intervention either by posterior or lateral approach were included in the study. In Group-A children operated by posterior approach were placed while in Group-B children were operated by posterior approach. They were followed up in OPD after 6 months. The final functional and cosmetic outcome was assessed by using Flynn’s criteria. Data was analysed by using SPSS version -20. A p-value of less than 0.05 was considered as statistically significant. Results: A total of 104 cases were operated during this study period. Fifty-four cases were done by posterior approach (Group-A), while 50 cases were operated by lateral approach (Group-B). In Group-A the mean age was 6.1 years while in Group-B, mean age was 6.6 years. In Group-A the male to female ratio was 72:28 while in Group-B it was 64:36. The mean weight in Group-A was 19.81Kgs (SD: ±4.53) while in Group-B it was 20.44 Kgs (SD:± 3.97). The mean operative time in Group-A was 36.30 minutes (SD: ±3.32) and in Group-B it was 23.58 minutes (SD: ±2.12). The functional outcome at six months follow-up was excellent in 35 (65%), good in 8 (15%), fair in 7 (13%) and poor in 4(7%) cases in Group-A while in Group-B it was excellent in 35 (70%), good in 10 (20%), fair in 4 (8%) and poor in only one case (2%). This difference was not significant at a p-value of 0.441. Conclusion: Though lateral approach required less operative time but there was no statistically significant difference from the posterior approach comparing the functional outcome in the management of paediatric supracondylar fractures of humerus.

Morbidity and mortality due to community acquired pneumonia has beenincreased in our country. Children and old age patients are mostly effected due to communityacquired pneumonia Study design: Cross sectional study. Setting: Patients hospitalized forCommunity acquired pneumonia in four different hospitals located at different areas werestudied. Period: Three years period from August 2011 to August 2014. Objectives: To assessdemographic profile, pneumonia severity index and length of stay of community acquiredpneumonia patients hospitalized at different hospitals in Karachi. Method: 800 patients bothmale and females patients were included in this study. Results: It was found that 480 (60%)were males and 320 (40%) were females, males were significantly more frequent (c2=0.48,p˂0.05) than the females patients. There was a significance difference in numbers of differentage group patients. According to the age distribution, there were 222(27.75%) from 1-5 years,which was the highest among the patients and there were 44(5.5%) from 81-90 years of agegroup patients, which was least among the different age group patients. According to thecomorbidity most of the patients were found without comorbidity there were 456(57%) patientspossess no comorbidity. Patients with comorbidity were 344(43%), and comorbidity was foundin patients with hypertension were 131(16.4%) and patients with diabetes were 105(13.1%) thesewere the two most commonly comorbidity disease found. According to the socioeconomicstatus (SES) status there were 482(60.25%) patients from lower SES class, 270(33.8%) patientfrom middle SES class and 54(6.8%) patients from high Socioeconomic class. patient with lowSES were much higher at hospital C and hospital D.(c2=127.88,p˂0.05). CAP is more frequentin married patients, married patients status were much higher at hospital C and hospital D(c2=60.31, p˂0.05). According to the PSI segregation there were 424(53%) patients from PSIclass I, 168(21%) were from PSI class II, 128(16%) patients were from PSI class III, 44(5.5%)were from class IV and 36(4.5%) were from PSI class V. Mean length of stay (LOS) was greaterat hospital C and D as compare to other two hospitals. Conclusion: CAP is frequent amongmales, low socio-economic, hypertensive individuals and patients from 1-5 years of age. Theshortest mean length found was 3.6days at hospital A and the longest mean length of stayfound was 7.6 days at hospital D.

Introduction: Coronary artery bypass surgery is associated with post-operativecomplications like, atelactasis, pneumonia, plural effusion, pulmonary edema which effect onpost operative oxygenation of patient resulting in delayed recovery and prolong hospital stay.Materials and method: A total of 170 patients included in the study. Study Design: Randomizedcontrol trial. Setting: Department of Cardiac Surgery, Chaudary Pervaiz Elahi Institute ofCardiology Multan. Period: January 2016 to June 2016. Objective: To Compare postoperativeoxygenation outcomes in patients undergoing CABG with and without pre-operative spirometry.Results: Oxygenation variables pre-operative mean PO2 and SD in C group was 93.27 ± 5.04and in I group 97.29 ± 2.31. Similarly pre-operative PCO2 in C group was 41.73 ± 3.22 and in Igroup was 38.78 ± 2.99. Mean A-a gradient and SD in C group was 7.42 ± 1.70 and in I group4.56 ± 1.11. At the time of shifting from theater mean PO2 in C group was 91.22 ± 4.64 andin I group was 98.20 ± 2.00, similarly mean PCO2 and SD in C group was 43.18 ± 3.47 andin I group 39.65 ± 1.15. Mean A-a gradient and SD in C group was 8.02 ± 1.30 and in I group3.87 ± 0.88. After four hours mean PO2 and SD in C group was 92.00 ± 5.05 and in I group99.04 ± 1.15. Mean PCO2 after four hours in C group was 42.34 ± 4.08 and in I group 37.29 ±2.93. As concerned to A-a gradient mean and SD was 7.12 ± 1.70 and in I group 5.84 ± 1.92.Conclusion: Preoperative incentive spirometry have improved postoperative oxygenation andreduce the incidence of postoperative complications following CABG.

This study was carried out to check the efficacy of external fixators as comparedto conservative management in treating fracture shaft of femur in children from 2 to 8 years.Fracture shaft of femur in this age group are usually managed with traction for 2-3 weeksfollowed by hip spicca of 3-4 weeks. It is difficult to achieve good reduction by traction. Thisis not well tolerated by children. Hospital stay is prolonged. Perenial hygiene is difficult andpressure sores are common. LLD (limb length discrepancy), knee stiffness and gait changesare the long term complications associated with conservative management.6 We managed 31cases of fracture shaft of femur in 30 children from the age of 2-8 years with external fixators(ex-fix) and compared the results with 24 cases of fracture femur managed with traction andhip spicca. Study design: Prospective study. Tertiary care hospitals of military at Muzaffarabad,Kharian and Malir. Period: Sep 2008 to Mar 2015. Material & Methods: Informed consent wasobtained. Children from 2 to 8 years were included in this study. AO External fixator with 3.5mm shanze screws was used with 2 screws on each side of fracture. External fixators wereremoved after 8 weeks in most (>90%) of the cases. Patients were discharged on 1st postopday. Results: Observations were made during hospital period and then fortnightly and aminimum follow up of 6 months was done. Union was assessed clinically and on X-rays (3surfaces union). Observations made regarding reduction achieved, complications of procedureand compliance of children. Any LLD, knee stiffness and gait abnormality were noted during the6 months of follow up and compared with 24 cases managed conservatively (control group).

Objectives: To determine the prevalence of prelacteal feeding among mothers ofPakistan and to find out the various concepts behind this practice and fundamentally to establishthe association of prelacteal feeding with breastfeeding outcomes. Background: In Pakistan,many efforts have been done to emphasize the nutritional importance and adequacy of breastmilk for the newborns. Despite such efforts, it has been witnessed on multiple occasions thatprior to the commencement of breastfeeding, prelacteal feeds are introduced by the mothers totheir young ones. Prelacteal feed (PLF) are food supplements that are given to newborns orally.Design: Qualitative, descriptive, cross sectional Survey. Setting: The Lady Dufferin Hospital(LDH) and Jinnah Medical College hospital (JMCH). Methods: Study includes 400 Mothersincluding young mothers and data was collected with use of a pre-assessed authenticatedquestionnaire. Results: A large group of, both educated and uneducated, mothers knew aboutPLF administration (90.5%). Out of these, 70% mothers routinely give prelacteal feeds, withreadymade ghutti and honey being the most widely used supplements, 19.5% and 37.2%respectively .However their reasons for doing so differed significantly. Family tradition (27.8%)and religious credence (21.8%) are the most popular reasons for practicing prelacteal feeding.The other minor reasons are breast milk insufficiency, prevention of dehydration, hypoglycaemia,preparation of the gastrointestinal tract for digestion and to quench thirst. However, majorityof the subjects were aware of the benefits of breastfeeding and 99% mothers breastfed theirchildren. Conclusions: Regardless of the fact that mothers understand the significance ofbreast milk, most mothers routinely and unnecessarily give prelacteal feeds. Therefore, mothersshould be discouraged for the unsafely administration of prelacteal feeds and re-emphasizedabout the importance and nutritional adequecy of breastfeeding.

Introduction:Laboratory is a base of developing teaching and scientific research,also a place of training practical and innovation ability.A robust laboratory experience is a very important part of a high-quality course of instruction in every subject for students interested in research and education. Therefore, a laboratory’s physical design and layout must support and optimize investigation and synthesis of ideas and materials.Objectives:The main objective of biosafety instruction is to guarantee safe practices among specialists in research about labs.Study Design: Review Article. Study Period: June 2017 to December 2017.Setting:Riphah International University, Lahore. Material and Methods: This review article was written to enhance the awareness of biosafety among the students and the professionals. A literature review was done for this study through searching original articles, reviews, case studies and different websites. After analyzing the literature, important aspects of biosafety were highlighted and conclusion was drawn.Results and Conclusion:Regardless of a few instructive workshops by the Pakistan Biological Safety Association (PBSA), consistence with safe practices among researchers stays low. The hazard for research facility authorities working with exceedingly risky operators ought to be limited through preparing and adherence to stringent security conventions and standard working techniques.

Introduction: Fractures of upper end of femur are generally applied sometraction pre- peratively. Traditionally either skin or skeletal traction is applied. In this study weapplied traction via POP Boot with a T behind ankle in 354 cases of fracture upper end of femurduring pre-operative management and the results were compared with those of skin and skeletaltraction. Objectives: To see whether effective pre-op traction can be applied via POP Boot inupper femur fractures and what are the complications and cost effectiveness as comparedto skin and skeletal traction. Study: In 354 patients POP Boot was applied and 3 kg trationapplied to the injured limb with fracture femur while in 50 cases skin traction and in another 50cases skeletal traction was applied. Design: It’s a randomized prospective double blind study.Settings: Study was carried out in tertiary care hospitals including combined military hospitalsof Rawalpindi, Muzaffarabad and Kharian. Period: Study was conducted between the periods of10 Sep 2003 to 20 Sep 2012 (9 years and 10 days). Methods: All patients have either simple orcommunited fracture of upper end of femur. All patients were adults and received same amountof analgaesia. 3 kg traction was applied as standard in all cases. All patients were operated fortheir fracture femur within 2 to 10 days of applying traction. Results: Results were compared interms of pain control, reduction achieved, rotational control, and discomfort during applicationof tration, complications, and cost effectiveness and compared with standard skin and skeletaltractions. Conclusion: POP Boot traction is an easily applied, effective and cost effective way oftraction which has very low rate of complications and should be used for pre-op traction in alladult cases with upper femur fracture.

Knee pain due to injury is a common presentation in orthopedic outpatientdepartment. X-rays, MRI and arthroscopy are the basic investigation tools when meniscoligametousinjury is suspected. If MRI is normal usually arthroscopy is withheld. In this studywe analyzed the arthroscopic findings of such cases in which X rays and MRI were normalor near normal. Objectives: 1- To find out knee injuries in patients with painful knees. 2- Tofind out any other pathology of knee joint. Design: It’s a retrospective study in which 42 suchcases were analyzed who underwent arthroscopy with a normal or near normal MRI. Setting:This study includes cases done at CMH Rawalpindi, Muzaffarabad, Kharian and Malir. Periodincludes May 2005 to August 2014. A total number of 209 arthroscopies were done by thesame orthopedic surgeon. Results: Out of 42 cases 31 were males while 11 were females.Mean age was 31.4 years (range 18-54 years).In all cases arthroscopy was done by the sameorthopedic surgeon within 6 weeks of MRI. MRI films were reported by a qualified radiologist. Inall cases there was a strong clinical suspicion of menisco-ligamentous injury while X-rays andMRI were near normal or normal. Out of 42 cases in 36 (85.7%) cases, one or more findingswere detected on arthroscopy which were not picked by MRI. Conclusions: It is concludedthat if a menisco-ligamentous injury is strongly suspected in a knee on clinical examination,arthroscopic evaluation should not be denied to a patient even if X-rays and MRI are normal.

Crossed testicular ectopia (CTE) is a rare congenital anomaly14. It is also knownas transverse testicular ectopia (TTE). In this condition both testis descend/migrate towardsthe same hemi-scrotum. About 100 cases have been reported so far. It may be associatedwith other congenital anomalies which include persistent Mullerian Duct Syndrome, truehermaphroditism, pseudo-hermaphroditism, inguinal hernia, hypospadias and scrotalanomalies. We are reporting one such case in 6 years old boy who presented to CMH Malir inMarch 2014 with left inguinal hernia and per-operatively found to have right testis in left inguinalcanal. Left testis had descended into left upper scrotum. Vasa were tethered together in upperportion by fibrous tissue. Right testis and vas was separated, mobilized extra-peritonially anddone in right scrotum (ipsilateral). Left orchiopexy was done in left scrotum. Hernia repair wasthen preformed. Post-op u/s scan was done to detect any other associated pathology whichwas negative. In most of the published reports diagnosis was made per-operatively as was thecase in this patient.