Showing papers in "Journal of Ayub Medical College Abbottabad in 2006"

Characteristics of dengue fever in a large public hospital, Jeddah, Saudi Arabia.

Abstract: Background: This study aims to determine demographic, clinical and laboratory profile along with disease outcome of all confirmed cases of dengue fever (DF) and dengue hemorrhagic fever (DHF) admitted in King Abdulaziz Hospital & Oncology Center, Jeddah, Saudi Arabia. We also want to highlight the significance of implementing a well targeted community based disease prevention program. Methods: All patients admitted from May 2004 till April 2005 with a suspected diagnosis of DF and DHF were followed. All cases confirmed by a positive serology (IgM alone or IgM and IgG) to dengue fever were studied in detail to determine age, gender, ethnicity, monthly distribution, clinical and laboratory profile. Results: A total of 80 patients were admitted with a suspected diagnosis of DF. Among these, 39 (48.75%) patients were confirmed by positive serology to have the disease. Male to female ratio was 3.3:1. Their ages ranged from 2 to 60 years with a mean of 27.6 + 11.2. Twelve patients were Saudis, while the rest were non-Saudis coming from different countries in Asia, Africa and Middle East. Maximum number of patients (48.72%) was seen in the summer months of June, July and August. Commonest presentation was fever (100%), headache (48.72%), myalgias (66.7%) and vomiting (25.64%). Rash, hemorrhagic manifestations and positive tourniquet test were relatively uncommon. Only two patients fulfilled WHO criteria of DHF. Main hematological abnormalities were thrombocytopenia (79.49%) and leucopenia (48.72%). Significant elevation of PTT was observed in 25.64% of patients. Abnormal liver function tests with high transaminases were seen in about 66.7% of patients, whereas 33.33% of patients had significantly elevated creatine kinase. All patients improved clinically with improvement of chemical and hematological parameters. None of the patients died in this series. Conclusion: DF continues to be a significant health problem in Western region of Saudi Arabia. Large number of pilgrims coming from disease endemic areas all over the world facilitates the continued introduction of dengue virus with different strains. Fortunately there has been no serious outbreak of dengue fever in recent years. A sharp vigilance is required by concerned authorities to prevent and minimize any future outbreak. It is extremely important to implement and maintain an effective, sustainable and community based disease prevention program. Key Words: Dengue fever, Dengue hemorrhagic Fever, Headache, Rash, Thrombocytopenia

Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan.

Abstract: Background: The stigma attached to mental illness in the West is now well recognised. There is however, only limited information available on this topic from the developing countries. Measurement of stigma among medical students and doctors is straightforward to carry out allowing targeted work to educate doctors in countries with few resources. This study was carried out to assess the attitude of medical students and doctors, attending medical colleges in Lahore, Pakistan. Methods: A survey was circulated among the medical students and the doctors of the three medical colleges in Lahore, Pakistan. 294 (59%) of the 500 survey forms sent out were returned. Results: Just over half of the respondents held negative attitudes towards people with schizophrenia, depression, drug and alcohol disorders. However, most had favourable views of the recovery and treatability of the mental disorders. Conclusions: The views held by the medical students and the doctors in Lahore, Pakistan are broadly similar to the opinions expressed by the medical students and doctors in the UK.

Acute renal failure associated with malaria.

Abstract: Background: Malaria has protean clinical manifestations and acute renal failure (ARF) is one of its serious complications and could be life threatening. This study was carried out to describe the clinical characteristics and factors associated with adverse out come in patients with malarialacute renal failure. Materials and Methods : Data of 46 Patients with ARF and smear positive malaria was analyzed further among all cases of ARF presented to us at Nephrology department of Jinnah Postgraduate Medical Centre, Karachi from January 2003 to December 2004.Results were expressed as mean, standard deviation and range. Results: Among 237 patients with ARF of diverse etiology, 46(19.4%) developed ARF due to falciparum malaria. The male to female ratio was 3.6:1. Oliguria was seen in 76.09% on admission, and 78.26% required dialysis. In addition to ARF, most of the patients had at least one other manifestation of severe malaria. 35(76.06%) patients recovered completely while 11(23.91%) died in early dialysis. Prolonged disease duration, severe ARF, cerebral malaria, hyperbilirubinaemia, and disseminated intravascular coagulopathy (DIC) were poor prognostic factors. Conclusion : Falciparum malaria associated with ARF is a life threatening condition, but early presentation and intervention with appropriate anti-malarial and dialysis therapy is associated with improved survival and recovery of renal function. Early dialysis treatment in patients with severe falcipaum malaria and signs of deteriorating renal function is recommended. Key words: Acute renal failure , malaria, falciparum malaria, haemodialysis .

Fine needle aspiration cytology of thyroid nodule: diagnostic accuracy and pitfalls

Abstract: Objective : To evaluate the utility of FNAC in patients with Thyroid Nodule. Methods : Records of all patients treated surgically for thyroid nodule(s) at Aga Khan University Hospital from January 2000 to December 2004 were reviewed. The patients who had pre operative FNAC as first line of the evaluation and the final post operative histopathology report available were included in the study. Results: 125 patients (90 female 35 male) had thyroid surgery. The cytological diagnosis was made according to following categories: Benign, Follicular lesion, Malignant and Inadequate sampling. Among 63 “Benign cases”, 57 were benign and 6 turned out to be malignant. Among 44 cases from “Follicular group”, 31 were benign and 13 were malignant. Out of 15 patients from “Malignant” group, 14 were malignant and 1 was benign. Among three patients from the “Inadequate sampling group”, 2 turned out to be benign and one was malignant. The overall results showed a sensitivity of 98%, specificity of 70%, and positive predictive value of 91%, negative predictive value of 93% and diagnostic accuracy of 91%. Conclusion: We conclude that FNAC is an invaluable and minimally invasive procedure for pre operative assessment of patients with a thyroid nodule in our setting as well. FNAC has high sensitivity in picking up malignancy in thyroid and also has high diagnostic accuracy in the evaluation of thyroid nodules. Keywords : Thyroid – FNAC - Histopathology

Persistence of anti-HBs antibody and immunological memory in children vaccinated with hepatitis B vaccine at birth.

Abstract: Aims: Vaccination with the hepatitis B surface antigen (HBsAg) induces protective levels of antibody (anti-HBs = 10 IU/L) in majority of vaccinees. It has been shown that the levels of anti-HBs antibody do wane after vaccination. The aim of this study was to evaluate the persistence of anti-HBs antibodies in healthy Iranian children at 10 years after primary vaccination and the response to a booster dose using recombinant hepatitis B vaccine. Materials and Methods: Blood samples were collected from 146 healthy 10-11 years old children who received primary course of Hepatitis B vaccine at 0, 1.5 and 9 months of age. The sera were tested for anti-HBs, antibody to Hepatitis B core antigen (anti-HBc) and HBsAg by ELISA technique. A single booster dose of recombinant hepatitis B vaccine was administered intramuscularly to a total of 94 children, whose anti-HBs antibody was less than 50 IU/L (70 children with anti-HBs <10 IU/L and 24 subjects with anti-HBs 10-50 IU/L). The sera of children were re-tested for anti-HBs antibody levels at 4 weeks after booster vaccination. Results: At 10 years after primary vaccination 70/146 (47.9%) of children had protective levels of antibody with geometric mean titer (GMT) of 68.12 IU/ml. All children were negative for HBsAg, although anti-HBc antibody was positive in 11 (7.5%) of children. In the 94 subjects who received the booster dose the seroprotection and the GMT of anti-HBs antibody were 25.5% and 9.58 IU/L at pre-booster time and rose to 95.75% and 575.6 IU/L after the booster vaccination, respectively. Seroprotection rates and mean titer of antibody similarly expressed in males and females. Conclusion: The results of present study showed that at 10 years after primary vaccination with recombinant HB vaccine, 47.9% of the children had protective levels of anti-HBs antibody. Moreover we have demonstrated an anamnestic response to booster vaccination that confirms the persistence of an effective immunological memory in vaccinees. Key words : Children, Hepatitis B vaccine, Anti-HBs antibody, Immunologic memory, Booster vaccination.

Prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern karachi, pakistan

Abstract: Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan’s largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all participants at the examination site. Our main outcome measure was diabetic retinopathy, which was classified as non-proliferative diabetic retinopathy (NPDR), severe NPDR, and proliferative diabetic retinopathy (PDR). Our grading was based on clinical examination. Results: A total of 912 subjects were screened for diabetes mellitus. Of these, 160(17.5%) had diabetes- 1.8% had type I diabetes and 15.9% had type II diabetes. One hundred and eight individuals visited the hospital for ophthalmic examination. Of them, 15.7% had diabetic retinopathy. The prevalence of diabetic retinopathy was higher among individuals with type I diabetes, with greater duration of diabetes, and among women. The commonest form of diabetic retinopathy was non-proliferative (76.5% [mild: 35.3 %, moderate: 29.4 %, and severe: 11.8 %]), followed by maculopathy (17.6 %) and proliferative diabetic retinopathy (5.9 %). Conclusion: More systematic and population-based research is needed to estimate the prevalence of and identify risk factors for diabetic retinopathy in Pakistan. Key words: diabetic retinopathy, prevalence, Karachi, Pakistan

Management of ectopic pregnancy: a two-year study.

Abstract: Background: Ectopic pregnancy is the most important cause of maternal mortality and morbidity in the first trimester. Over the past few decades, the management of ectopic pregnancy has been revolutionized; various modalities of treatment are currently in practice. The purpose of this study was to determine the frequency of these modes of treatment of ectopic pregnancy and their outcome. Methods: Fifty two patients diagnosed to have ectopic pregnancy at MCH Center unit II in the year 2004 and 2005 were included in the study. A cross-sectional analytical study was done. Four modes of treatment were given according to patient’s condition, ultrasound findings and s-hCG levels; these were laparotomy, operative laparoscopy, methotrexate injection and conservative management. The outcome measures included success of each treatment modality, need for second mode of treatment in each group and duration of hospital stay. Results: A total number of 52 patients with ectopic pregnancy were identified and studied. The rate of ectopic pregnancy was 1:100 deliveries. Emergency laparotomy was performed in 30 (57.9%) women, 15 (28.8%) received methotrexate injection. Seven women (13.3%) were managed conservatively and operative laparoscopy was not used as primary treatment in any of the patient. All cases of laparotomy did not require any further procedure. Twelve out of fifteen (80%) cases of medical treatment were successful while one (6.7%) proceeded to emergency laparotomy, one (6.7%) to operative laparoscopy and one (6.7%) to laparoscopy preceding laparotomy. Five out of seven patients (71.4%) on conservative treatment did not require any further intervention while two (28.6%) of them resolved with methotrexate injection. The duration of hospital stay in laparotomy, medically treated and conservatively managed groups was 6.5, 5.9 and 1.7 days respectively. Conclusion: In the institutional setting ectopic pregnancy accounted for 1% of total deliveries. More than half of all women with ectopic pregnancy presented with acute abdomen and required emergency laparotomy. About 40% women could be managed with non-surgical modalities with 80% success for methotrexate injection and 71% for conservative treatment in the present study. Keywords : Ectopic pregnancy, methotrexate, laparoscopy.

Frequency of hypertension in stroke patients presenting at ayub teaching hospital

Abstract: Background; Stroke is a frequent medical problem occurring in patients with hypertension and other risk factors. The objective of this study was to find the frequency of hypertension as important risk factor in stroke patients presenting at Medical 'B' unit of Ayub Teaching Hospital, Abbottabad from November 2003 to January 2005. Methods: Patients who clinically presented with features of stroke and then confirmed on C.T scan were included in this study. Other underlying risk factors were diabetes mellitus, smoking, cardiovascular disease and dyslipidemia. Result: Hypertension was found to be the most common risk factor in current study. Out of 91 cases, 51 (56.04%) were suffering from hypertension. Thirty five patients were male and sixteen patients were female. Peak stroke prone age was 61-70 years in males and 51-60 years in females. Conclusion: Hypertension is the leading risk factor of stroke. It is therefore essential to detect and treat hypertension at its outset Keywords: Stroke, Hypertension, Risk factors, CT scan

Adult intussusception – a surgical dilemma

Abstract: Background: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30–1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. Methods: The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. Results: All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. “Target lesion” and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Conclusion: Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical. Key words: Adult Intussusception

Precipitating factors of hepatic encephalopathy: experience at pakistan institute of medical sciences islamabad.

Abstract: Background: Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad. Methods: Fifty admitted patients with acute or chronic liver diseases complicating to hepatic encephalopathy were probed into for precipitating factors, based on history, clinical examination and laboratory methods from September 2005 to December 2005. The associated biochemical laboratory data analysis and prognostic stratification through Child’s Pugh classification was also done. Results: Infection (44%), gastrointestinal bleeding (38%) and constipation (38%), stood out as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume paracentesis were least common factors. Most patients were in grade III (52%), and grade IV (22%), of hepatic encephalopathy. Other common associations were ascites (64%), Child’s class C (62%), hyponatremia (50%), low haemoglobin (70%), hepatitis C (62%), and high mortality rate (30%). Conclusion: Infection, gastrointestinal bleeding and constipation being the most important precipitating factors must be prevented and hospital funds, medicines and human efforts should lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also includes effective control measures against rising cases of hepatitis C, as it is the leading cause of liver cirrhosis in Pakistan. Key Words: Hepatic Encephalopathy, Liver cirrhosis, precipitating factors.

Abruptio placentae and its complications at Ayub Teaching Hospital Abbottabad.

Abstract: Background: Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern. Methods: The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation, presenting with ante partum haemorrhage during the study period. Patients underwent a complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer. Results: A total of 53 cases of abruptio placentae were recorded out of 1194 cases (4.4%) admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000 deliveries. Induction of labour was required in 27 (50.9%) cases, while caesarean section was performed in 16 (30.2%) cases. Major complications were intra uterine fetal demise (31/53, 58.5%), fetal distress (8/22 live births, 36.4%) and post partum haemorrhage, which occurred in 10 (18.9%) cases. Conclusions: A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality. Key Words: Abruptio placentae, ante partum haemorrhage, perinatal mortality.

Analysis of homicidal deaths in Peshawar, Pakistan.

Abstract: Background: Homicide is one of the oldest crimes in human civilization. For every person who dies as a result of homicide, many more are injured. A study of the patterns of homicide in a society is one of the first steps in developing strategies to prevent it. This study was conducted at the department of Forensic Medicine Khyber Medical College, Peshawar, to know the patterns of homicide, taking it as the first step in the prevention of this crime. Methods: This study includes 520 cases of homicide out of the total of 662 medico-legal autopsies conducted at Khyber Medical College, Peshawar, during the year 2002. The cases have been labeled as homicide on the basis of autopsy and police inquest. Results: The homicide rate for Peshawar during the period under study was 22.9/100,000. Males constituted 86.15% of the victims. 32% of the victims were in their third decade of life. Firearms were the causative agent in 86% of the cases. Chest was the primarily targeted area of the body. The highest number of homicides occurred in the month of November. Conclusions: The homicide rate is alarmingly high in Peshawar as is the use of firearms. This is something that should be seriously looked at by the policy makers

Homicidal deaths by firearms in Peshawar: an autopsy study.

Abstract: Background: Medico legal autopsies can be valuable sources of information about the distribution of causes of reported deaths, particularly in homicidal cases. The present study provides information regarding the homicidal deaths due to firearm injuries in the district of Peshawar, NWFP, Pakistan. Methodology: This descriptive study was conducted over the period of the year 2004. Data were collected from the autopsy records of the Department of Forensic Medicine, Khyber Medical College Peshawar and included all reported unnatural deaths from urban and rural areas of district Peshawar on whom autopsies were conducted in the department. Results: Homicidal deaths constituted 77.7% (492/633) of all autopsies for the year 2004. Of 492 homicidal deaths, a vast majority of 452 (91.87%) were caused by firearm injuries. Among these, the male to female ratio was 5.5:1. The most common firearm weapon (418/452, 92.5%) were high velocity rifled weapons (Kalashnikov, rifles, pistols), followed by low velocity rifled weapons (18/452, 3.98%) and shotguns (16/452, 3.54%). A total of 956 injuries were found in various body areas, giving an average of over two injuries per person. The head, face and neck sustained the highest injuries (257, 26.9%), followed by the chest (248, 25.9%) and abdomen (149, 15.6%); the extremities, buttocks and genitalia together sustained 302 (31.6%) injuries. Conclusion: The vast majority of reported homicides in Peshawar are caused by firearm injuries, which bring up issues related to possession of firearms and changes in cultural attitudes towards use of firearms, if a decrease in firearm-related homicides is desired. Key Words: Firearms, Homicide, Autopsy.

Attitude of the university students and teachers towards mentally ill, in lahore, pakistan

Abstract: Background: Although, much is known about the attitudes and beliefs people hold towards mental illness in the west, no such work has been done in the developing countries. It is difficult to measure the attitudes of the general public in developing countries due to differences in terminology and concepts of the illness. However, majority of educated people in the developing countries can recognise common psychiatric disorders by their western names. We therefore, decided to measure attitudes of university students and teachers in Lahore, Pakistan. This study was carried out to assess the attitude of university students and teachers in Lahore, Pakistan. Methods: A survey form was circulated among the university students and the teachers in Lahore, Pakistan. Of the 300 survey forms 194 were returned. Results: Majority of the respondents held negative attitudes towards people with schizophrenia, depression and drug and alcohol disorders. Conclusions: The views held by the university teachers and students reveal negative attitudes towards mentally ill. Attitudes of those who knew someone with mental illness were similar to those who did not.

Clinical features and outcome of cerebral abscess in congenital heart disease

Abstract: Background: Cerebral abscess is a serious life threatening complication of several diseases. The objective of this study was to look at the clinical profile, microbiology and outcome of children with cerebral abscess having an underlying congenital heart disease as compared to other predisposing conditions. Methods: Thirty children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was 5.6±4.4 years. Results: The duration of illness at the time of admission was 17.6±24.6 days. Typically patients presented with fever, vomiting, headache and seizures. The predisposing conditions found were cyanotic congenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%) and no underlying cause was found in 5 (17%) children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcus milleri group (52%). Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6 children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5. Conclusion: B rain abscess is a serious infection with poor outcome if diagnosed late. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosis should be low particularly in children with a predisposing condition like cyanotic congenital heart disease. Key words: Brain abscess, cyanotic congenital heart disease

Granulomatous mastitis: a review of 14 cases.

Abstract: Background : Tuberculosis of breast is a rare entity and may be confused with carcinoma of the breast. We present a case series of 14 patients with granulomatous mastitis, seen over a seven-year period from a cancer centre in Lahore, Pakistan. Methods : The cases were retrieved using electronically coded records and clinical, radiological and pathological data reviewed. Cases with a histologic diagnosis of granulomatous mastitis were included. Results : Granulomatous mastitis was seen at a frequency of 0.37% of the 3768 patients seen with breast diseases (3722 women; 46 men) during this time period. The average age at presentation was 40.7 years [range 14- 65 years]. The most common presentation was a lump in the upper outer quadrant of the breast. Mammography showed a range of appearances. Diagnosis was obtained via fine needle aspiration (10 cases), core biopsy (2 cases) and excision (2 cases). Acid-fast bacilli were seen in five out of the 14 patients. Ten out of 14 patients completed treatment at our centre with satisfactory response. Conclusions : Granulomatous mastits is an uncommon disease and typically presents with a lump in the breast. The diagnosis can be established by fine needle cytology in the majority of cases. Acid-fast bacilli are seen a minority of the cases. Key words : granulomatous inflammation, mastitis, breast, tuberculosis, Pakistan.

Comparative study of Mathieu and Snodgrass repair for anterior hypospadias.

Abstract: Background: This study was carried out to compare the operative time and rate of complications of Mathieu and Snodgrass procedures for the repair of primary anterior hypospadias. Methods: This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from March 2003 to Feb 2005. We managed 90 patients with primary anterior hypospadias. Children between 2 years to 12 years were included in the study. Those who had previous repair were excluded from the study. Only those patients were selected who never had their hypospadias repaired. Those with significant chordee were also excluded from the study. Patients were divided into two groups. Group I had Mathieu repair and Group II had Tubularized Incised Plate (TIP) urethroplasty (Snodgrass procedure). Stent was kept patent by frequent irrigation. Operative time was calculated for both the procedures separately. Patients were followed for subsequent complications. Results: A total of 90 cases were studied. Mathieu repair was performed in 45 patients and tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) in the rest of 45 patients. Cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus. Meatal stenosis and wound breakdown was equal in each group whereas urocutaneous fistula and proximal urethral stricture were seen more frequently in Mathieu group. Keywords: A nterior hypospadias, Mathieu repair, Tubularized Incised Plate urethroplasty (TIP), Snodgrass procedure

Applications and complications of polyurethane stenting in urology.

Abstract: Background: As surgeons working in a developing country, we decided to review our experience with polyurethane stents instead of the more expensive ones on common urological procedures and analyzing our experience with respect to their usefulness versus their problems and outcome. Methods: This stusy was carried out at Armed Forces Institute of Urology, Rawalpindi and Combined Military Hospital, Kharian Cantonment, Pakistan through March 2002 through May 2004. During this period 342 of patients were operated requiring stent and 220 patients out of these had polyurethane as stent material for different urological operations. Results: Among the 220 patients who underwent polyurethane stenting, early complications included fever, infection, voiding symptoms while stent migration, encrustation and stent stiffness was encountered as later complications. Conclusion: The benefits of Polyurethane stents are its strength, versatility and low cost. Poor biodurability and biocompatibility only limit its use; these are reasonably effective in our setup but should only be used for short duration. Key words: Urology Stents, Polyurethane, Complications.

Etiology of strokes and hemiplegia in children presenting at ayub teaching hospital, abbottabad

Abstract: Background: Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. Methods: This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005.All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. Results: The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. Conclusions: Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad. Key words: Cerebrovascular Accident, Children, Hemiplegia, Intracranial infections

Evaluation of aetiology and efficacy of management protocol of epistaxis.

Abstract: Background: Epistaxis is one of the commonest medical emergencies. It affects all age groups and both sexes. The cause may be local or systemic but in majority it is spontaneous and idiopathic. Trauma is considered to be a major aetiological factor. Various treatment protocols are utilized to control epistaxis derpending upon the type, severity and cause of bleeding. Methods: This descriptive study was designed to evaluate the aetiology and efficacy of management protocol of epistaxis in a tertiary care setting. 313 patients underwent prospective evaluation by consultant and non-consultant doctors with considerable experience in Ear, Nose & Throat (ENT) emergencies management. Standard principles were followed in the management. Results: This study demonstrated a bimodal distribution with incidence peaks in below 25 years & above 50 years of age. Males were affected twice more than the females (2.15:1.04). Anterior nasal bleeding was noted in majority of the patients. Anterior nasal packing was the most effective method of controlling anterior epistaxis. While posterior bleeding was controlled by posterior nasal packing with Foley’s catheter. The most common cause was found to be trauma, followed by hypertension. Conclusion: It may be concluded from this study that epistaxis is the m ost common ENT emergency, affecting all age groups. It has a bimodal age presentation and affects males twice more than females. Anterior bleeding is more common than posterior bleeding. Epistaxis may be controlled with chemical/electro-cautery if the bleeding point is visible. In case of failure to localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively control majority of epistaxis. Foley’s catheter is a good option that can be used for posterior nasal packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there is mucosal ooze. Key words: Epistaxis, Nasal packing, Foley’s catheter.

Urothelial neoplasia of the urinary bladder--comparison of interobserver variability for WHO Classification 1972 with WHO/ISUP Consensus Classification 1998.

Abstract: Background: Classification of urothelial bladder tumours is an important factor in the treatment and prognosis of these lesions. Over the years many classifications have been proposed for this purpose. The objective of this study was to classify urothelial neoplasms of the urinary bladder using the latest WHO/ ISUP Consensus Classification 1998 and WHO Classification 1972 and compare the two regarding interobserver variability. Methods : This study included 100 consecutive biopsy specimens of urothelial neoplasms of the urinary bladder diagnosed at the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. These were classified according to WHO Classification 1972 and WHO/ISUP Consensus Classification 1998 by 2 groups of pathologists independently. The tumour categories for WHO classification 1972; papilloma, and transitional cell carcinoma (TCC) grades I, II and III were compared with the WHO/ISUP Consensus Classification entities of papilloma, papillary neoplasm of low malignant potential, low grade and high grade papillary carcinomas. Kappa statistics were used to evaluate interobserver variability. Chi square test was used to calculate significance. Results : There was agreement on 80 tumours between the two groups of histopathologists when using WHO classification 1972 while there was agreement on 95 tumours using WHO/ISUP consensus classification. The value of Kappa for WHO Classification was 0.68 (good agreement) whereas for WHO/ISUP Consensus Classification it was 0.91 (excellent agreement). The difference between the two systems was statistically significant (p<0.001). Kappa values were less for benign and borderline lesions using both systems. Conclusions: WHO/ISUP Consensus Classification 1998 showed less interobserver variability than WHO Classification 1972 in the evaluation of bladder tumours . It was found easier to apply by both groups. There was less agreement on the benign and borderline lesions using both the classifications. Key Words : Transitional cell carcinoma, Urinary bladder neoplasms, Urothelial neoplasia.

Peripheral blood-based polymerase chain reaction in diagnosis of pulmonary tuberculosis.

Abstract: Armed Forces Institute of Pathology, Rawalpindi Background. The rapid diagnosis of infectious diseases, particularly those that represent a public health problem, like tuberculosis, is a challenging problem. By using nucleic acid amplification techniques like PCR, one may be able to diagnose, the disease on the day of arrival of specimen in the laboratory. For diagnosis of tuberculosis by direct methods like PCR, specimens from site of infection are required. In certain cases it is difficult to get the specimens from site of infection and in such situations; some researchers have tried to detect the DNA of Mycobacterium tuberculosis complex from blood of these patients. The purposive of this study is to determine the diagnostic efficacy of peripheral blood-based polymerase chain reaction for diagnosis of pulmonary tuberculosis. Methods. This was a simple descriptive study, carried out in Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2004 to Dec 2004. Sputum and blood samples were collected from 96 suspected patients of pulmonary tuberculosis. Sputum samples processed for ZN staining and AFB culture (gold standard) and blood samples processed for PCR. Results. Out of 96 cases, 60 (62.5%) were culture positive. PCR was positive in 14 (14.5%). AFB smear positive were 34 (35.4%). The overall sensitivity and specificity of the PCR assay was 20% and 94.4% respectively and the positive and negative predictive values were 85.71% and 41.46% respectively. The overall efficiency of the test was 47.91%. Conclusion. Due to low sensitivity; a negative PCR assay does not rule the disease. However, this test may be helpful in cases where specimens from the site of infection are not available.

Effectiveness of routine urine analysis of patient attending rural health centers in Abbottabad.

Abstract: Background: Renal diseases may be discovered accidentally during routine urinalysis. This study was done to see the significance of urinalysis and study the magnitude of abnormal urinalysis in patients with no symptoms of renal disease. Methods: From 15 th February to 16 th March 2005, a total of 1000 samples of urine were collected from the patients attending three rural health centers of Abbottabad. Dipstick Method was used for urinalysis. Results: there were 600 males and 400 female patients. The age ranged from 1 to 55 years. Proteinuria was present in 2.3%, hematuria in 4.8 % patients, pyuria in 10.2% and glycosuria in 2% patients. Conclusion: In our setup routine urine analysis should be performed in all patients to identify the presence of unrecognized renal diseases which may benefit from simple therapeutic measures. Keywords: Urine, urinalysis, Proteinuria

Significance of immunohistochemistry in accurate characterization of malignant tumors.

Abstract: Background: To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. Methods: A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. Results and Conclusions: Out of the 20,000 biopsies, 6534 (32.67%) were neoplastic. 4726 neoplasms (72.33%) were malignant, and 1808 (27.67%) were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin’s lymphomas, 97.94% of Hodgkin’s lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively. Key Words: Malignant tumours, Karachi, Immunochemistry

Migrating foreign body in the thyroid gland, an unusual case.

Abstract: We report an unusual case of an ingested foreign body in 26 year old female that perforated the esophagus and penetrated the thyroid gland. A neck exploration was done to remove the foreign body. Keywords: Foreign body, Thyroid gland, perforated esophagus

Giant multiple intra-abdominal hydatid cysts.

Abstract: Hydatid disease is endemic in the cattle grazing areas particularly Australia, New-Zealand, Middle East, India, Africa, South America and Turkey 1 . It is a parasitic infection caused by the cestode tapeworm Echinoccocus granulosus. The dogs are the definitive host and the adult worms are found in their small intestine. Humans get infected either by contact with the definitive host or by consuming vegetables and water contaminated with the hydatid ova 2 . In humans the hydatid disease commonly involves the liver (75%) and the lungs (15%). The remaining (10-15%) of the cases include the other regions of the body 1 . The disseminated intra-peritoneal hydatid disease is a very rare finding 1 . We report such a presentation wherein the abdominal cavity is seen to contain multiple hydatid cysts.

Malaria in children: Study of 160 cases at a private clinic in Mansehra.

Abstract: Background: This Study was conducted in a private clinic to report frequency, presentation and management of malaria in children presenting with fever. Methods: 160 Children of age varying from 42 days to 15 years were included in this study, during a period of 1999-2004. Results & Conclusions: Malaria was confirmed in 154 cases, including 114 male and 46 female children. In 6 cases malarial parasite was not seen on microscopic examination of their blood films. 142 cases were found to be suffering from vivax and 12 were suffering from falciparum malaria. Most of the cases were treated with amodiaquine and some of them were treated with other antimalarial drugs. Keywords: Malaria, Children

Comparison of frequency of wound infection: open vs laparoscopic cholecystectomy.

Abstract: Background: The objective of this quasi experimental study was to compare the frequency of wound infection between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) conducted in Surgical Unit IV, Jinnah Hospital Lahore from June 2005 to January 2006. Methods: 100 patients undergoing elective cholecystectomy for symptomatic gallstones were studied. The patients were allocated in the two groups of 50 each by simple random technique. Group-I underwent OC and Group-II underwent LC. The patients were then followed up for four weeks to pick up signs of wound infection. In case of infection, the degree of infection and the remedial measures done were documented and the results analysed. Results: In LC group there was only one case of Class- II wound infection i.e. 2%. In case of OC there were three cases of wound infection i.e. 6%. Out of these, two were of Class-III and one of Class-II. Conclusion: While there was no wound infection in cases of chronic Cholecystitis in both groups, the frequency of wound infection was three times as common in OC as compared to LC in Acute Cholecystitis / Empyema. Key words: Open cholecystectomy (OC), Laparoscopic Cholecystectomy (LC), Wound infection.

Survey of changes in complete blood count and red cell indices of whole blood incubated in vitro at different temperatures up to 48 hours.

Abstract: Background: Complete blood count (CBC) is one of the most common and conventional blood test that physicians usually request. However the results of this test are affected by different factors such as, the temperature and duration of incubation, therefore the aim of this survey was to evaluate the effect of temperature and time of incubation on CBC, red blood cells (RBC) indices and white blood cells (WBC) differential count. Methods: In a cross-sectional study, blood samples were taken from 30 healthy medical students of Rafsanjan University (15 males and 15 females). The samples divided into three parts; CBC were done on the samples up to 48 hours incubation at temperature of 25, 30, and 37 0 C at the time of sampling, and after 2, 8, 24 and 48 hours. Data were statistically analyzed and the following results were obtained. Results: RBC count, hematocrit, MCH, percent of monocytes and eosinophils were constant in different temperatures, WBC count, MCHC, hemoglobin, platelets count, the percent of lymphocytes and neutrophils were constant up to 24 hours and then tend to increase with increasing temperature except lymphocytes percent that tend to decrease. MCV decreased with increasing temperature up to 8 hours and then significantly increased (from 83.89 to 87.50 fmol/l, p<0.001). WBC, hematocrit, MCV, platelets count, and neutrophils’ percent tend to increase by the time of incubation, but RBC count, MCHC, lymphocytes’ percent decreased. Hemoglobin, MCH, and the percent of monocytes and eosinophils were constant. Conclusion: The finding of this survey showed that some of CBC parameters can be changed with the incubation, therefore it is better to do the CBC test after blood taking as soon as possible. Key Words: CBC, RBC Indices, Temperature of storage, Time of storage

Determinants of bottle use amongst economically disadvantaged mothers.

Abstract: Background: There is documented evidence of increased risk of infant mortality in formula fed infants versus breast fed babies. The hazards of bottle use for infant feeding, especially in underprivileged communities, are also well known. As the issue of bottle use is directly related to childhood survival and mortality, there is legislation against propagation of bottle-feeding in Pakistan. Methods: Objectives: To obtain information about determinants of bottle use for infant feeding in a low-income periurban community. Design: Community based cross-sectional study. Results: 150 mothers with infants up to one year of age were included in the study period from October 03 to March 04. Out of these 102 mothers were found using bottle for infant with or without breast-feeding. The tendency to use the bottle increased in relation to child’s increasing age. Only 17% of the infants under the age of 3 months were offered bottle, it was 69% between 4 to 6 months and it increased to 76%.in infants from 7 months to 1 year. The attributes associated with increased bottle use were mother’s older age, illiteracy and increased parity. Conclusion: Bottle use is a public health issue in poor and illiterate mothers of developing countries. While, in Pakistan, laws are enacted against its propagation, we need community-based strategies to bring about a socio-cultural shift in the growing prevalence of bottle use found in the study. Key words: Infant feeding in developing countries, bottle use, breast milk substitute.