Prevalence of contraceptive practices in married women of Nainsukh village near Lahore

Overpopulation is one of the biggest problems faced globally by many developing countries which include Pakistan as well. Pakistan is the seventh most populous country of the world. By 2050 Pakistan will be ranked as the fourth largest nation of the world and its population will grow to 285 million. This study was planned to evaluate the prevalence of contraceptive use in a semi urban area Nainsukh near Lahore, Pakistan and to find out the major factors playing role in selection of contraceptive method. The contraceptive prevalence rate was 35.2% among married females of Nainsukh. It was observed that the most common method used by couples was condom used by 11.70% of the respondents. OCP were used by 4.6%, IUCD by 6.5%. Tubal ligation was opted by 4.6% of the participants. Major source of information was family planning center for 24.8% and friends gave this information to 14.98% of the women. Mother in law 5.9%, dai 9.1%, media 7.8% were other sources. Mean duration of use of contraceptive method was reported to be 2.45 +/- 1.81 years. The most common reason of not using any contraceptive method was lack of awareness 29% and religious beliefs 23%. Approximately 58.3% of the clients were getting contraception facilities from private sector. Source of supply was lady doctor for 6.2% and LHW by 5.2%. About 5.5% of the females reported abortion as a choice to be used for contraception and only 4.2% were aware of emergency contraceptive methods

Ondansetron versus combined dexamethasone and metoclopramide in prevention of nausea and vomiting after laparoscopic cholecystectomy

To compare the efficacy of combined metoclopramide and dexamethasone with ondansetron in preventing nausea and vomiting after laparoscopic cholecystectomy. Randomized controlled trial. Surgical Unit I Combined Military Hospital Rawalpindi, from 1[st] June 2010 to 3[rd] January 2011. A total of 120 patients were observed for 24 hours after elective laparoscopic cholecystectomy for nausea and vomiting and divided into two groups of 60 patients each. Nausea and vomiting was rated by the patients according to a three point scale [O=no nausea and vomiting, 1= nausea, 2= retching or vomiting]. Early postoperative nausea and vomiting was not present in 31[51.7%] patients of group 1 and 40[66.7%] of group 2 [score = 0]. In 11[18.3%] patients of group 1 and 12 [20.0%] of group 2 only nausea was present [score = 1], while 18[30.0%] patients in group 1 and [13.3%] in group 2 scored 2.The late postoperative nausea and vomiting was not present in 21[35.0%] patients in group 1 and 37[61.7%] in group II [score = 0]. In 28 [46.7%] patients in group 1 and 22[36.7%] in group 2 nausea was present [score = 1] while 11[18.3%] patients of group 1 and 1[1.7%] in group 2 scored 2. Ondansetron was effective as compared to combined metoclopramide and dexamethasone in prevention of post-laparoscopic cholecystectomy nausea and vomiting

unique presentation of unexploded ordnance in a patient

Rocket injuries in the war are common,but the retained unexploded rocket injury is quite rare and uncommon. We report an unusual case of unexploded rocket in knee area that required removal with unique safety measures, so as to prevent patient from potentially catastrophic situation

Utility of medium thickness plantar skin grafts in palmar defects

To assess the utility of medium thickness plantar skin grafts in palmar defects. Case series. Department of Plastic Surgery Combined Military Hospital, Peshawar, from January 2006 to February 2009. Total 16 patients with palmar defects resulting from post-burn contractures, syndactyly release and tumor resection were included. All patients were treated with release of contractures and excision of scar tissue. Post release the palmar defects were covered primarily using medium thickness plantar skin graft from foot instep. First dressing was changed after two weeks with advice to splint the fingers for six months. Donor site was covered with calcium sodium alginate dressing which was removed after two weeks. Graft was assessed with regards to rate of graft take, colour and texture match, recurrence of contracture, mobility of the graft and the nature of donor site healing. All the patients operated had a complete take of the medium thickness plantar skin grafts, which were judged by their epithelialisation. The color match and the texture match were excellent. Three patients had mild infection at recipient site which healed with debridement and dressings. Hypertrophic scarring and mild hyper pigmentation at the donor site was seen in 4 cases but ultimately all wounds healed completely by the end of three months. In our study the excellent color, texture match and the functional advantages offered by the medium thickness plantar graft far exceeded the expected outcome of conventional techniques

Bilateral inferior thyroid artery ligation and transient hypocalcaemia: a comparison of two surgical techniques

To compare the frequency of hypocalcaemia in thyroid surgery after ligation of inferior thyroid artery trunk and ligation of Inferior thyroid artery branches at gland surface. Quasi experimental comparative study. Department of Surgery, Combined Military Hospital Rawalpindi, from February 2008 to August 2008. The patients were assigned to two equal groups, Group 'A' and Group 'B'. Estimation of serum calcium [Ca] levels was done before surgery in both the groups. In group 'A' patients underwent thyroid surgery with ligation of inferior thyroid artery [ITA] trunk, while in group 'B' terminal branches of ITA were ligated on gland capsule. Following the surgery serum calcium levels was measured 6 hours after surgery. Afterwards levels of serum calcium were checked daily for three days. The two groups were compared for the frequency of transient hypocalcaemia. Four patients in group A [13.3%] developed transient hypocalcaemia [serum corrected Ca < 2.0mmol], while in group B three patients [10%] developed transient hypocalcaemia. Fishers Exact test was applied and this difference was found statistically insignificant at p=1.0. Over all frequency of transient hypocalcaemia in this study was 11.6%. Ligation of ITA trunk does not increase the risk of hypocalcaemia in thyroid surgery.

Accuracy of modified alvarado score in diagnosis of acute appendicitis in adults

To measure the accuracy of Modified Alvarado Score [MAS] in diagnosing suspected patients of acute appendicitis having MAS of 7 or above. Validation study. Surgical Departments of Combined Military Hospital [CMH] and Military Hospital [MH] Rawalpindi from April 2006 April 2007. This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated. Postoperatively appendices of all the patients were sent for histopathological examination of their results regarding presence of absence of acute appendicitis were then compared with MAS of there patients. The data was analyzed by using SPSS version 10.0. Statistical analysis showed that MAS of 7 or more has sensitivity of 88.885, specificity of 71.42%, Positive Predictive Value 88.88% and Negative Predictive Value 71.4%. Accuracy of MAS was 84%. MAS 7 or above is a reliable indicator of acute appendicitis clinically in adults. The number of negative appendicectomies can be reduced by using MAS in clinical practice

Comparative analysis of alvarado and teicher scores in the diagnosis of acute appendicitis

To compare the efficacy of Alvarado and Teicher scores in the diagnosis of acute appendicitis, using postoperative histopathology as gold standard. Comparative, cross sectional study. Department of surgery, Combined Military Hospital Rawalpindi, from 22nd June 2006 to 26th February 2007. Hundred cases of clinically diagnosed/suspected of acute appendicitis were included in the study by convenience [non-probability] sampling. Selected patients were graded according to Alvarado and Teicher scores, and underwent appendicectomy. All appendicectomy specimens were sent for histopathology reporting. A 2 x 2 table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the scoring systems. Using Alvarado and Teicher scores, a sensitivity of 95% and 89.55%, specificity of 69.69% and 66.66%, positive predictive value of 86.48% and 85.71%, negative predictive value of 88.46% and 76.66%, negative appendicectomy rate of 13.5% and 15.49% and diagnostic efficacy of 87% and 83% were found, respectively. Alvarado score has better diagnostic accuracy as compared to Teicher score in the diagnosis of acute appendicitis

Solitary thyroid nodule, frequency of malignancy at combined military hospital Rawalpindi

To determine frequency of malignancy in solitary thyroid nodule. Case-series study. The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi, from April 2002 till April 2003. Sixty patients with clinical solitary thyroid nodule fulfilled the selection criteria and were included in the study. Thyroid function tests, ultrasonography and thyroid scanning was done. Finally FNAC and histopathology were done in all the operated cases and record was evaluated. Out of 60 cases studied, 8 [13.33%] were found to have malignant lesions. The remaining 52 [86.67%] cases had benign pathology. Male patients with solitary thyroid nodule showed a higher incidence of malignancy 17.65% as compared to females 11.63%, Maximum malignant cases [50%] were found between the ages of 31 to 40 years. Papillary carcinoma was the most common malignancy [50%] found in our study. The incidence of malignancy in solitary thyroid nodule is quite high [13.33%]. So people should be educated to attend thyroid clinics for early diagnosis and adequate treatment

Comparison of simultaneous and sequential repair of bilateral inguinal

Comparison of morbidity and short term complications of simultaneous bilateral inguinal hernia repair with sequential repair of bilateral inguinal hernia. Quasi-experimental study. Surgical department of CMH Rawalpindi from 19-8-2005 to 11-6-2006. In the study 50 patients underwent inguinal hernia repair, 25 underwent simultaneous bilateral repair [Group I] while the other 25 patients underwent sequential repairs with a variable time duration in between [Group II]. Results were recorded on a pre designed proforma. The number of days spent in the hospital by patients in group I was significantly less [4.8 days] than patients in group II [9.6 days]. The need for narcotic analgesics was also significantly increased in group II patients [19 as compared to 8]. The post operative complications were comparable in both the groups [6 in group I and 9 in group II]. A tension free technique allows bilateral inguinal hernias to be repaired during one operation with similar outcomes as unilateral tension free repair and less hospital stay than sequential repair