Effects of exercises on pregnancy related low back pain: a quasi experimental study

Objective: To evaluate the effect of therapeutic exercises on pregnancy related low back pain in a tertiary care hospital of Karachi

Material and Methods: This was a quasi-experimental study with non-probability convenience sampling technique. Study was carried out at Liaquat National Hospital Karachi. Patients were divided into two groups [Experimental and Control]. Inclusion criteria were age <30 years, 2nd and 3rd trimester, stable medical status and those who gave the informed consent. Exclusion were pregnancy induced hypertension [>140/90mmHg], Cardiac disease, diabetes mellitus, persistent vaginal bleeding, history of miscarriages, decreased foetal movement. Data was collected through assessment Modified Oswestry Low back pain disability questionnaire. SPSS version 23.0 was used to analyze the data

Results: A total of 30 samples were selected for the study. There were 15 respondents in experimental while 15 in control group. Disability levels were found to be significantly decreased after post treatment in experimental group with P-value= 0.002. It was seen that number of patients was increased from 1[6.7%] to 6[40%] in minimal disability group whereas crippled back pain group in pre-treatment group was totally shifted towards minimal or moderate pain 3[20.0%] and no case was seen in post-treatment

Conclusion: Low back pain in pregnancy can disturb daily life routine but exercise therapy and proper counselling will lead stress free life to female in gestation. After post treatment in experimental group showed decrease in pain as compare to control group who were not provided any exercise therapy. Working women in experimental group also showed decrease by crippled back pain to moderate pain after exercise. So in the end researcher suggest that physiotherapy exercises play a vital role in reducing Low Back Pelvic Pain [LBPP] during pregnancy

Post operative wound infection in uncomplicated Laparoscopic Cholecystectomy with and without a drain

Objective: To compare the frequency of wound infection with and without subhepatic drain in patient's undergoing laparoscopic cholecystectomy

Study Design: Randomized controlled trial

Place and Duration of Study: Study was carried out at department of Surgery, Combined Military Hospital [CMH] Lahore, from Nov 2014 to Apr 2015 over a period of six months

Material and Methods: This study included a total of 140 patients [70 in each group]. In group A, a drain was placed in subhepatic space after laparoscopic cholecystectomy and no drain was placed in group Bafter laparoscopic cholecystectomy

Results: In our study, out of 140 patients [70 in each group], patients in the age range of 20-50 years were 61.43 Percent [n=43] in group-A and 57.14 Percent [n=40] in group-B while those in the age range of 51-70 years were 38.57 Percent [n=27] in group-A and 42.86 Percent [n=30] in group-B. Mean +/- SD was found to be 46.34 +/- 7.54 and 46.23 +/- 10.34 years respectively. About 28.57 Percent [n=20] in group-A and 22.86 Percent [n=16] in group-B were male while 71.43 Percent [n=50] in group-A and 77.14 Percent [n=54] in group-B were females. Wound infection was compared in both groups which showed that 18.57 Percent [n=13] in group-A and 7.14 Percent [n=5] in group-B had wound infection. A p-value was calculated as 0.04 which was significant

Conclusion: We concluded that the frequency of wound infection with subhepatic drain in patients undergoing laparoscopic cholecystectomy was found significantly higher when it was compared to cases without drain

Qualitative versus quantitative PCR in establishing response to chronic hepatitis C treatment with sofosbuvir

Objective: To determine the change in rapid virological response for chronic hepatitis C by qualitative PCR testing after treatment with sofosbuvir

Study Design: A descriptive study

Place and Duration of Study: Memon Medical Institute Hospital, Karachi, from January to September 2016

Methodology: The study population consisted of patients above 18 years, till 80 years of age, of both genders, having chronic infection with HCV. Patients included were treatment-naive, non-responders or relapsers; and among these categories, both cirrhotic and non-cirrhotic patients were included. Initially, genotyping and quantitative PCR test was done, one at the start of treatment then at 4 weeks that is till rapid virological response [RVR] was elicited. Qualitative testing was compared by Chi-square with quantitative assays simultaneously to check sensitivity by qualitative testing

Results: Out of 106 patients, the mean age of the patients was 46.40 +/- 14 years. There were 39 [36.8%] males and 67 [63.2%] females. One hundred [94.3%] were infected with genotype 3. One hundred and five [99.05%] patients responded to sofosbuvir with successful achievement of RVR after 4 weeks. One patient did not achieve RVR [0.94%]. The sensitivity of qualitative test was 99%

Conclusion: Qualitative analysis is a cost-effective and sensitive method in patients treated with sofosbuvir for confirming RVR, especially in developing countries where patients are self-paying with significant financial constraints

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells reported in an asymptomatic patient: a rare case and literature review

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UC-OGC) is a rare and poorly described pancreatic malignancy. It is comprised of mononuclear, pleomorphic, and undifferentiated cells as well as osteoclast-like giant cells (OGC's). It constitutes less than 1% of pancreatic non-endocrine neoplasia and is twice as likely to occur in females as in males. Its histopathologic properties remain poorly understood. It is suspected that UC-OGC is of epithelial origin that can then transition to mesenchymal elements. As part of this study, we describe a case of a malignant pancreatic neoplasm that was discovered in a 69-year old patient as an incidental finding. We also provide an overview of previously published data to highlight UC-OGC's clinical and pathologic features.

Surgical management of thyroid diseases: an experience at sandeman [Provincial] Hospital, Quetta

Objective: To evaluate the surgical management of thyroid disease

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Otorhinolaryngology and Head and Neck Surgery Department Sandeman [Provincial] Hospital, Quetta from March 2014 to May, 2016

Materials and Methods: This study included 43 patients of thyroid disease of the afore-said period. Medical records of patients were reviewed retrospectively and results were analyzed

Results: The mean age of the patients was 34.95 +/- 11.97 [S.D] years and male to female ratio was 1:7.6.The benign lesions were 88.63% and malignant lesions were 11.63%. Simple multi nodular goiter was 39.53% and was most common cause of thyroid enlargement. Near total thyroidectomy was performed in 34.88% and total thyroidectomy in 30.23%. Other procedures performed were lobectomy with isthmusectomy [27.91%], subtotal thyroidectomy [4.65%] and total thyroidectomy with central compartment lymph node dissection [2.33]. The overall complication rate was 16.29%. Hypocalcemia was most frequent complication followed by recurrent laryngeal nerve palsy

Conclusion: Thyroid disorders are more common in females. Simple multinodular goiter is the most frequent cause of thyroid enlargement. Near total thyroidectomy seems to be optimal procedure for benign thyroid lesions while total thyroidectomy for malignant lesions. Hypoparathyroirdism and recurrent laryngeal nerve palsy are common complications

Evaluation of the chemical composition of essential oil of Thuja occidentalis leaves grown in Peshawar, Pakistan by gas chromatography mass spectrometry

Essential oil extracted from the fresh leaves of Thuja occidentalis were evaluated for its chemical composition employing GC-MS. Total of twenty nine components were identified and determined quantitatively using the area normalization procedure. Alpha-pinene and [+]-4-carene were found in high amount with a percentage concentration of 54.78 and 11.28 respectively. Other compounds which yielded appreciable amounts are: alpha-cedrol [6.87%], terpinolene [5.88%], p-menth-1-en-8-ol acetate [5.21%], beta-myrcene [4.04%], beta-pinene [2.26%], germacrene D [1.72%], sabinene [1.65%] and D-Limonene [1.62%]

Gas chromatography coupled with mass spectrometric characterization of Curcuma longa: protection against pathogenic microbes and lipid peroxidation in rat's tissue homogenate

The present study was designed to investigate the mineral content and antimicrobial activity of Curcuma Longa extracts and its essential oil. We also determined the lipid peroxidation inhibition activity of the ethanolic extract against sodium nitroprusside [SNP] induced thiobarbituric acid reactive species [TBARS] formation in rat's brain, kidney and liver homogenates. Major constituents of essential oil identified by gas chromatography and mass spectrometry [GCMS] were beta-sesquiphellandrene [38.69%], alpha-curcumene [18.44%] and p-mentha-1,4 [8]-diene [16.29%]. Atomic absorption spectroscopy [AAS] was used for the quantitative estimation of Calcium [Ca], Magnesium [Mg], Iron [Fe], Copper [Cu], Zinc [Zn], Chromium [Cr], Nickel [Ni] and Manganese [Mn]. The extract showed highest Mg [49.4mg/l] concentration followed by Ca [35.42mg/l] and Fe [1.27mg/l]. Our data revealed that the ethanolic extract of Curcuma Longa at 1-10 mg/kg significantly inhibited TBARS production in all tested homogenates. Crude extracts and essential oil were tested against three gram positive bacteria i.e. Bacillus subtilis, Bacillus atrophoeus, Staphylococcus aureus, six gram negative bacteria i.e. Escherichia coli, Klebsiella pneumonias, Salmonella typhi, Pseudomonas aeruginosa, Erwinia carotovora, Agrobacterium tumefaciens and one fungal strain namely Candida albicans by disc diffusion assay. Essential oil showed highest anti-microbial activity as compared to the crude extracts. The present study confirms the significant antimicrobial and antioxidant potential of the studied plant, which can be considered as a diet supplement for a variety of oxidative stress induced or infectious diseases

Aetiology of epistaxis: a retrospective study of 87 cases at Bolan medical complex hospital, Quetta

To objective of this study was to describe the aetiology of epistaxis. Retrospective, descriptive study. This study was carried out at the Department of Otorhinolaryngology and Head and Neck Surgery, Bolan Medical Complex Hospital, Quetta from December 2011 to December 2013. This study included 87 patients of epistaxis of the afore-said period. Medical records of patients were reviewed retrospectively and results were analyzed. The mean age of the patients was 26.70 +/- 18.10 [SD] years and male to female ratio was 2:1.Trauma [32.18%] was the commonest cause of epistaxis, followed by idiopathic group [22.99%] and hypertension [14.94%]. Other causes were nasal and nasopharyngeal tumours [10.34%], inflammatory diseases of nose and sinuses [8.05%], blood dyscrasias [6.90%] and miscellaneous causes [4.60%] which included one case of aspirin induced epistaxis, one case of hereditary hemorrhagic telangiectasia, one patient of typhoid fever and one case of liver cirrhosis. Nasal trauma is the most common cause of epistaxis. Idiopathic group is the second in which exact cause of epistaxis is not known, followed by hypertension, while other causes are rare

Frequency of behavioural features among insomniac patients

Background: Insomnia may affect daytime quality of life and have different behavioral symptoms among patients

Objective: To determine the frequency of behavioral and demographic features among insomniac patients

Patients and Methods: A cross sectional study was conducted on patients from southern Punjab, who were insomniac and taking medications from Psychiatric Ward, Nishtar Hospital Multan, from 1[st] January 2010 to 31[st] January, 2011. Data was collected from 417 insomniac patients. A questionnaire was administered targeting insomnia criteria. Confidentiality of information taken was ensured. The data was entered and analyzed by SPSS version 15

Results: A total of 417 patients participated in the study. The age range was 10-80 years, with 52% females, 272 insomniac patients out of 417 [65.2%] were anorexic. 225 [54%] cases were the eldest, among insomnia patients, following were the youngest who were 116 [28%] and the least were in between the eldest and the youngest who were 75 [18%]. 284 [68%] patients complained about the uncontrolled level of anger with destructive behavior

Conclusion: Anorexia, uncontrolled anger, restlessness was found in insomnia. Females, illiterate and elder members of family were more insomniac

Clinical profile, conventional surgical approaches and the outcome of the surgery in juvenile nasopharyngeal angiofibroma

To study the clinical profile of angiofibroma, various conventional surgical approaches and the outcome of surgery. Prospective, analytical study. This study was conducted at the Department of Otorhinolaryngology and Head and Neck Surgery, Bolan Medical Complex Hospital, Quetta from January2008 to December2012. This study included 31 patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. All patients were treated by conventional surgical approaches following Fisch staging system. Twenty one [21] patients were operated by lateral rhinotomy approach, Three [3] patients by transpalatal approach, five [5] patients by Weber-Fergusson approach and two [2] by Mid-facial degloving approach. The patients were followed up for a period of three [3] years for any recurrence. All patients were male with mean age 15.61 +/- 2.64 years. The patients presented with recurrent epistaxis, nasal obstruction and nasopharyngeal mass apart from other symptoms and signs. Majority of the patients [80.64%] came with stage II and IIIA disease. Lateral rhinotomy approach was used in majority of cases [67.74%]. Recurrence was observed in 5 cases [16.12%]. Recurrence rate was less [one out of 2leases] with lateral rhinotomy approach in comparison with other approaches. In transpalatal route recurrence was observed in two [2] cases out of three [3] cases, while in Weber-Fergusson approach it was one out of five [5] and in Mid-facial degloving it was one out of two [2] cases. Juvenile nasopharyngeal angiofibroma is a disease of male adolescents. The patient most commonly presents with recurrent epistaxis and nasal blockage with nasopharyngeal mass. Surgery is the treatment of choice. Lateral rhinotomy approach gives an excellent exposure for most of these tumours with less chance of recurrence

Role of oral and topical nasal steroids in prevention of ethmoidal nasal polyp recurrence after intranasal polypectomy: a comparative study of 64 cases

To study the effect of oral and intranasal topical corticosteroids on nasal, polyp recurrence after intranasal polypectomy. Perspective, comparative. This study was conducted out in ENT and Head and Neck Surgery Department, Bolan Medical Complex Hospital, Quetta, from March 2010 to March 2013. Sixty four patients of both sexes with diagnosis of ethmoidal nasal polyp underwent intranasal polypectomy. Then patients were divided into two groups, Group-A and Group-B. There were 32 patients in each group. In group-A the patients received oral and intranasal topical steroids postoperatively while in group-B patients did not receive oral and intranasal topical steroids. Both groups were followed-up for any recurrence of polyps at interval of 3, 6 and 12 months. Recurrence rates in group-A were 6.25%, 12.5% and 21.87%, while the recurrence rates in group-B were 12.5%, 28.12% and 43.75% at interval of 3, 6 and 12 months. A postoperative short course of oral steroids followed by topical nasal steroid spray after intranasal polypectomy can reduce the recurrence rate of ethmoidal nasal polyps significantly

Missed vascular injuries: presentation and outcome

Objective: To describe the different presentation, diagnostic evaluation, management and outcome of complications of missed vascular injuries. Study Design: A case series. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Combined Military Hospital, Kharian Cantt, from June 2009 to June 2012

Methodology: All the patients with vascular injuries missed at the time of causative trauma who reported during this study period were included. Patients presented with acute vascular injuries and iatrogenic aneurysm at the vascular anastomosis site were excluded. All cases were evaluated with either CT or conventional angiography and managed with various open vascular surgical techniques and their results were assessed

Results: Twenty eight patients with missed vascular injury underwent various vascular repairs. Age of patients ranged from 16 to 78 years [mean = 33.7 +/- 15.4 years]. Male to female ratio was 6:1. Twelve [42.8%] patients presented with pseudoaneurysm alone, 10 [35.7%] with traumatic arteriovenous fistulae, 4 [14.3%] with post-traumatic thrombosis and occlusion and 2 [7.1%] with pseudoaneurysm and hemorrhage. Penetrating injuries were the commonest cause in 19 [67.8%]. The time interval between injury and presentation in hospital ranged from 2 to 1300 weeks [mean 228 weeks]. Lower limb vessels were affected in 20 [71.4%], the upper limb in 5 [17.8%] and neck vessels in 3 [10.7%]. Superficial femoral artery was the most frequently involved artery in 9 [32.1%] cases. Interposition reverse autogenous saphenous vein graft was most common type of repair in all types of missed vascular injuries. One [3.5%] patient had amputation after secondary hemorrhage

Conclusion: Low velocity penetrating trauma was the common cause of missed vascular injury. Pseudoaneurysm was the most common presentation

Randomized clinical trial comparing local anesthesia with spinal anesthesia for intestinal stoma reversal

Objective: to compare the outcome of local anesthesia versus spinal anesthesia in intestinal stoma reversal

Material and Methods: it was randomized clinical trial with 64 patients, undergoing reversal of ileostomies and colostomies. Procedure was performed either under local anesthesia plus sedation [n=32] or spinal anesthesia [n=32]. The duration of the operation, conversion or supplementation of the anesthetic technique, time spent in the post-anesthesia recovery room, postoperative complications and length of hospital stay were analyzed

Results: duration of operation and time spent in post-operative recovery room was less in patients operated under local anesthesia. Conversion to general anesthesia was only needed in spinal anesthesia group. Post-operative complications were less in local anesthesia group. Mean length of hospital stay was almost equal in both groups

Conclusion: intestinal stoma reversal under local anesthesia and sedation is safe and more effective than same procedure under spinal anesthesia

Pulmonary function abnormalities in patients with metabolic syndrome

A cross sectional survey was conducted to evaluate for any deterioration in lung functions in patients having characteristics of metabolic syndrome. In a medical camp, study participants underwent blood pressure measurement, blood glucose and total cholesterol testing, anthropometry and waist circumference. A total of 42 non smoker subjects including 28 [66.6%] males and 14 [33.3%] females who were suffering from metabolic syndrome underwent spirometry using American Thoracic Society/European Respiratory Society [ATS/ERS] criteria. Out of 28 [66.6%] males, 19 [67.85%] had spirogram within normal limits, while 9 [32.14%] had abnormalities in pulmonary function testing including reduced PEF, FVC, FEV1 and FEF25-75, while out of 12 females, 7 [58.33%] had spirogram having all parameters within normal limits, while 5 [41.66%] had considerable spirometric abnormalities. Non smoker patients with metabolic syndrome have considerable abnormalities on pulmonary function testing which may have implications on their future respiratory health. Further larger studies for pulmonary functions evaluation are required in obese population

Neonatal sepsis - its determinants and outcome among newborns admitted in neonatal intensive care unit [NICU], Liaquat university hospital Hyderabad

Neonatal sepsis is a life threatening emergency and is one of the commonest causes of neonatal mortality in developing countries. It is very difficult to diagnose because of multiple risk factors and non specific clinical signs. To assess frequency of neonatal sepsis and to identify its determinants and outcomes among newborns. Hospital based descriptive cross sectional study. This study was conducted at Neonatal Intensive Care Unit, Liaquat University Hospital Hyderabad from 1[st] July 2011-31[st] October 2011. The data was collected through questionnaire based interviews from duty doctors regarding health status of neonates along with laboratory investigation reports. The criteria for the case diagnosis was maternal history, newborns' clinical findings and laboratory diagnostic work up including blood culture, blood cell counts and C-reactive proteins. The results were analyzed by using SPSS version 16 for various socio-demographic variables and for the outcome of the disease. Among total 236 newborns admitted in NICU, 115 neonates [48.7%] were diagnosed as neonatal sepsis. Gender of new borne was not related with occurrence of neonatal sepsis, but males were at greater risk of developing sepsis from nosocomial infection. [p= 0.04]. Strong association was also seen for neonates who were low birth weight [p= 0.01], had maternal peripartum history [p=0.01], and family's poor socio-economic background [p=0.02]. Neonatal sepsis was frequent presentation of the new borne admitted in NICU; it was associated with wide variety of risk factors

Effects of harassment on health of women prisoners at a prison in Pakistan

Pakistan ranks 125th out of 169 countries on the Gender Development Index [GDI] and has high prevalence rates of violence against women. The objective of this original research was to determine the frequencies and identify patterns of harassment among women in a prison of Karachi. It was a cross sectional survey conducted from 1st April 2011 to 31st June 2011 of all women incarcerated at Karachi Central Prison. A total of 70 women prisoners were present in the prison at the time of the study. However, only 38 women prisoners consented to provide respective information. Women prisoners were interviewed on a pretested questionnaire after obtaining necessary ethical approval from the authorities. Study results indicate the frequency of harassment in the women prison Karachi was 21%. It was predominant in

Knowledge of family physicians about the fundamental diagnostic modality for chronic obstructive pulmonary disease

The adequate knowledge of primary health practitioners about spirometry being the best test for the diagnosis of chronic obstructive pulmonary disease [COPD] is essential because of high prevalence and sustained global rise in COPD population

Methods: A cross-sectional survey of family physicians by a questionnaire [data interpretation] was conducted to assess the existing status of knowledge about the spirometric diagnosis for COPD. This was undertaken on the occasion of two scientific presentations as well as by directly approaching them at their clinics

Results: A total of 150 questionnaires were given and 148 were returned with a response rate of 98.66%. Sixty three participants [42.56 %] selected the correct answer [spirometry: FEV1, FVC and FEV1/VC ratio] while 57.44% opted for the wrong answers for COPD diagnostic strategy given in the clinical scenario. More senior family physicians [P- value 0.076] and more educated physicians [P- value 0.022] had a better knowledge regarding the correct answer of performing spirometry

Conclusion: There is inadequate knowledge among family physicians about the fundamental diagnostic modality [spirometry] of COPD

Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group

Knowledge regarding the transmission of hepatitis-B, hepatitis-C virus infection and HIV among patients attending medical outpatient department at Nishtar hospital, Multan

To assess the level of knowledge regarding the transmission of hepatitis-B, hepatitis-C and HIV among the patients of medical outpatient department, Nishtar Hospital, Multan. Patients attending Medical outpatient department, Nishtar Hospital, Multan were interviewed in this cross-sectional study for the assessment of knowledge regarding the spread of Hepatitis B, Hepatitis C and .HIV. A total of 350 patients attending medical outpatient department were interviewed. Of these participants, 208 [59.4%] were males and 142 [40.6%] were females. Mean age of the participants was 35.15 +/- 6.57 years. Three [0.85%] were familiar with only hepatitis B, Three [0.85%] with only hepatitis C and 3 [0.85%] with only HIV and 290 [82.8%] were familiar with all three diseases while 51[14.5%] were unfamiliar with these diseases. Two hundred and sixty eight [16.6%] participants were knowing that these diseases could be transmitted by syringes while 265 [75.7%] by needles. Two hundred sixty one [74.6%] were knowing that these could be spread by the transfusion of contaminated blood, 217 [62%] knew that these could be spread by dental procedure with contaminated instruments, 233 [66.6%] reported that by unsafe sex, 169 [48.3%] by tattooing, 196 [56%] by ear/nose piercing, 261 [74.6%] by infected razors and 198 [56.6%] knew that these could be transmitted by mother to newborns. Knowledge regarding the spread of hepatitis B, C and HIV was found to be low in our study population which emphasizes the need for strong awareness campaigns and programs to address this issue

Changing frequency of hepatitis-B and hepatitis-C positive cases among blood donors screened in blood bank at Nishtar hospital, Multan

To determine the change in frequency of Hepatitis-C and B in blood donors presented for screening at blood bank of Nishtar Hospital, Multan. This cross sectional, descriptive hospital based study was carried out in Community Medicine Department, Nishtar Medical College, Multan in collaboration with the Blood Bank at Nishtar Hospital, Multan. A total of 300 donors were screened for hepatitis-B and hepatitis-C during the month of June 2009. Among 300 blood donors screened for hepatitis-B and hepatitis-C, 92.7% were males while females were only 7.3%. Among all blood donors screened, 6% were found hepatitis-B positive and 5.3% were found hepatitis-C positive. Hepatitis-B and hepatitis-C are increasing at an alarming rate in Multan and the surrounding areas. Aggressive measures are needed for control this epidemic