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Objective: To compare the frequency of haemorrhage after tonsillectomy as a day care procedure versus tonsillectomy as a one day procedure., Methods: A comparative study was conducted at the Department of ENT and Head and Neck Surgery, Shifa International Hospital, Islamabad from January 2003 to December 2007. The sample consisted of 400 patients, divided into two groups, One group was kept in the hospital for eight hours and was labeled as the daycare group while other group was kept admitted for 23 hours stay (overnight) and was labeled as the one day group. Patients with nasal pathology, bleeding diathesis and less than 4 years of age were excluded. Patients were followed up post operatively on 7th and 14th day and were inquired about any bleeding episode from the mouth during stay at home. The data was analysed at SPSS 13., Results: Post tonsillectomy haemorrhage was seen in 10 patients (2.5%), 4 (2%) occurred in day care group while 6 (3%) in one day group. All were secondary haemorrhages. Chi square test showed no significant difference in haemorrhages between the two groups., Conclusions: Tonsillectomy can safely be done as a daycare procedure as there is no significant difference of post operative haemorrhage between daycare and one day admission.

Objective: To analyze the patients' perspective of the process of informed consent in a tertiary care hospital setting., Methods: A cross sectional survey was carried out at a tertiary care teaching hospital Islamabad and 200 patients were included who responded to the questionnaire. The study extended from March to May 2008. Patients were interviewed by trained personnel. Patients undergoing emergency surgery, minors and medical professionals were excluded form the study. Data was entered and frequencies and percentages were analyzed on SPSS 14., Results: A total of 98% of patients admitted that informed consent was taken, however, only 81 (40.5%) patients understood the information provided. Patients reporting that their decision to proceed with surgery was actually influenced by other people including the treating doctor numbered 112 (56%). Only 58 (29%) signed their own consent form, the rest of them were signed by relatives. Only 96 (48%) patients admitted having been informed about possible complications of surgery as against 156 (78%) who were informed of sequelae of not having the surgery done. Signatures taken by the paramedics were 138 (69%). Despite a poor understanding of the process of informed consent, 187 (93.5%) still felt satisfied with the process of informed consent., Conclusion: There is a lack of proper understanding by the population and inadequate system of informed consent in our setting. However, majority of the people still feel satisfied with the information provided. There is a unique family system where decision-making is shared within the family.

Primary cutaneous and subcutaneous aspergillosis is a rare entity and usually occurs secondary to systemic or disseminated aspergillosis. We describe a unique case of primary aspergillosis of the cheek in a 45-year-old male without any evidence of disseminated aspergillosis and recognizable trauma or surgical procedure in the area of cheek.

The DNA sequence of Kringle-2 and serine protease domains of the human tissue plasminogen activator (reteplase, K2S) was PCR amplified. This product was then cloned into the expression vector pET15b plasmid. The presence of the insert was confirmed by restriction digestion, PCR and determination of the nucleotide sequence. By using isopropyl beta-D thiogalactopyranoside (IPTG), reteplase was induced in E. coli BL21 cells and analyzed using polyacrylamide gel electrophoresis (PAGE).