Factors Associated with Early Adverse Events after Coronary Artery Bypass Grafting Subsequent to Percutaneous Coronary Intervention

BACKGROUND: A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. METHODS: The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to December 2014. Patients who previously underwent PCI (n=38) were compared to patients who did not (n=122). Preoperative, operative, and early in-hospital postoperative data were analyzed. The end points of the study were in-hospital mortality and postoperative major adverse events. RESULTS: Non-significant differences were found between the study groups regarding preoperative demographic data, risk factors, left ventricular ejection fraction, New York Heart Association class, EuroSCORE, the presence of left main disease, reoperation for bleeding, postoperative acute myocardial infarction, a neurological deficit, need for renal dialysis, hospital stay, and in-hospital mortality. The average time from PCI to CABG was 13.9±5.4 years. The previous PCI group exhibited a significantly larger proportion of patients who experienced in-hospital major adverse events (15.8% vs. 2.5%, p=0.002). On multivariate analysis, only previous PCI was found to be a significant predictor of major adverse events (odds ratio, 0.16; 95% confidence interval, 0.03 to 0.71; p=0.01). CONCLUSION: Previous PCI was found to have a significant effect on the incidence of early major adverse events after CABG. Further large-scale and long-term studies are recommended.

Firearm fatalities in rural setting: autopsy based study at tehsil headquarter hospital

Objectives: Present study was conducted to find out the incidence, pattern and demographic characteristics of the victims died of firearm injuries brought for Medico legal Autopsy at Tehsil Headquarter Hospital located in the suburbs of Punjab, Pakistan and to study the parameters of age, gender, number and site of injuries on the body of those victims

Study Design: Descriptive study Place and Duration of Study: This study was carried out at Tehsil Headquarter Hospital Gojra, District Toba Tek Singh, Punjab Pakistan during the period of two years i.e. 1[st] January 2009 to 31[st] December, 2010

Materials and Methods: All the victims of unnatural deaths brought for Medico legal Autopsy to Government Eye-cum General Hospital [Tehsil Headquarter Hospital] Gojra District Toba Tek Singh were studied in detail

The finding were tabulated, analyzed and compared with those of other studies conducted in different areas of Pakistan as well as other countries

Results: Out of the total 110 unnatural deaths, 83 [75.45%] were males and 27 [24.55%] females. Sixty five victims of age range 21-40 years constituted 59.09% of the death toll followed by 14 [12.73%] and 13 [11.82%] cases belonging to 2[nd] and 5[th] decades of life respectively. Firearms remained the most common modality to kill 52 [47.27%] victims including 42 [80.77%] males and 10 [19.23%] females giving a male to female ratio of 4:1. Out of the total 52 victims of firearms, 67.30% belonged to rural areas while 32.70% were residents of suburbs. Thirty four victims of firearms, with the age range of 21-40 years constituted the death toll of 65.38%. The most common site of injury was neck and chest involving 57.70% victims

The fatal firearm injuries on the head were noted in 17.30% dead bodies whereas extremities were involved only in 7.70% cases

Conclusion: The young males aged between 21-40 years were commonly involved in the fatalities resulting from firearms in rural setting belonging to Tehsil Gojra of Punjab. The situation is alarming and eye opener for the law enforcing agencies

To prevent such killings, there should be combined effort from all sections of the society

Appropriate steps should be taken for control of the extremism, socio-economical development of the area and proper employment facility for the youth. Concrete efforts for prevention need to be initiated through implementation of the rule of law, strict control on the firearms, as well as education and awareness among rural / urban population

Study of the cases of sexual assault; reported at a tertiary care hospital in bahawalpur

Objectives: The present study was undertaken with objectives to study the socio-demographic and medico-legal characteristics in victims of sexual assault reporting for medico legal examination at tertiary care hospital at Bahawalpur

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out in the Department of Accident and Emergency of a tertiary care hospital at Bahawalpur front I[st] January, 2013 to 31[st] December, 2014

Materials and Methods: This study was conducted on 87 cases of sexual assault received in the Department of Accident and Emergency of Bahawal Victoria Hospital, Bahawalpur during the calendar years 2013 and 2014. The details pertaining to sodo-demographic factors such as age, marital status, residential background, and profession of the victim, time interval between the incidence and medico-legal examination and associated physical / genital injuries sustained by the victims wene also recorded- The results of the different specimens sent to the forensic science laboratory for fiuther examination were collected and tabulated on a self designed Performa. Results: The study revealed that incidence of sexual assault was common in urban citizens as compared to the rural areas. The most vulnerable age group was 11-20 years involving 36[41.38%] cases followed by those belonging to 3[rd] decade of life involving 30[34.48%] victims. Of the total 87 cases of alleged sexual assault, 35[40.23%] were students whereas 55 [63.22%] were unmarried

As regard the time interval between sexual assault and examination, 20[22.99%]victims presented themselves for medico legal examinationwithin24 hours of the incidence. Hymen was found tom/iuptured with old tears in 72[82,76%] cases and fresh tear was noticed in 15[17.24%] victims whereas no Virgo intacta was found among all sexual assault cases. Vaginal swabs were found stained with spermatozoa in 56[64.36%] cases and on naked eye examination; the clothes of 22[25.29%]victims were stained with semen. Conclusion: The most vulnerable age group affected by the sexual violence in Bahawalpur belonged to 11 -20 years and majority unmarried. Rape and Sexual Assault is imderreported crime due to social stigma. A joint effort by law enforcing agencies. Judiciary and civil society should be made in collaboration of electronic and print media to eliminate the sexual violence from the community. The study may help to enhance awareness among public and implement the strategies to make the society a safe place for females particularly the unmarried younger age group

Emerging trend of self harm by using 'kala pathar' hair dye [paraphenylene diamine]: an epidemiological study

Background: Poisoning due to Hair dye containing Paraphenylene diamine, famous with local name of 'Kala Pathar' is an emerging way of self harm in developing countries. The substance produces toxic effects if ingested or when applied locally including angioedema, respiratory distress, rhabdomyolysis, acute renal failure and hepatic necrosis

Objective: To study the demographic profile, clinical manifestations and outcome of the victims of 'Kala Pathar' hair dye [PPD] poisoning. Study Design, Setting and Duration: Prospective study was carried out in Bahawal Victoria Hospital, Bahawalpur [a tertiary care health institution] for the period from 1[st] January 2016 to 10[th] March 2016

Methodology: The study conducted in 109 patients of Paraphenylene diamine poisoning admitted in B.V. Hospital Bahawalpur, through Accident and Emergency Department with history of ingestion of Kala Pathar hair dye. The patients were treated conservatively and tracheostomy was done as life saving measure in all cases having acute cervicofacial and laryngeal oedema. The patients were grouped according to the age, gender, clinical presentation and final outcome. The data cleaned, analyzed and results were expressed in tables and charts

Results: Out of the total109 patients, 12[11%] were male and 97[89%] females. Majority 91 [83.48%] victim belonged to the age range of 11-30 years involving 83[76.15%] females and 26[23.85%] males. One hundred and four [95.41%] patients were of lower socioeconomic class and rural dwellers. Suicidal intention was reported in all 109 [100%] cases who developed cervicofacial oedema associated with dysponea and strider and emergency tracheostomy was done in all those victims. Eighty Six[78.90%] patients were discharged in good condition and 23[21.10%] expired due to complications of Paraphenylene diamine poisoning. Of those 23 fatalities, 19[82.60%] were females and 4[17.40%] males

Conclusion: 'Kala Pathar' Paraphenylene diamine poisoning is more common in females of younger age group belonging to rural areas and associated with high mortality. The cases could be managed by early diagnosis and prompt actions for supportive treatment because no specific antidote is available. As burden of such cases has been increasing, there is dire need for bringing awareness among the public regarding the toxic effects of hair dye [PPD]. It is suggested that sale of 'Kala Pathar' should be legally restricted by the concerned authorities

Penile squamous cell carcinoma involving corpus cavernosum in a circumcised male - a case report

Background: Penile carcinoma is an uncommon condition, accounting for less than 1% of all male cancers. It typically presents as a superficial lesion involving the Glans and Penile Shaft. Risk factors for penile carcinoma include phimosis, human papilloma virus infection and tobacco smoking. The spread of the tumor to the loco-regional lymph nodes is the most relevant prognostic factor

Case Presentation: The current case report is about a 65 years old male who presented with non-healing ulcer involving glans and shaft of penis for two months. Examination of Perineum revealed an ulcer of size about 3 cm in length involving glans and distal penile shaft, with eaten up most of glans surface. Wedge biopsy histopathology report showed moderately differentiated Squamous cell carcinoma of the penis involving sub-epithelial tissue with lympho-vascular invasion and involvement of corpora cavernosa. CT-Scan abdomen with IV contrast showed no evidence of metastasis or lymphadenopathy. So partial penectomy was planned and carried out subsequently

Conclusion: Although squamous cell carcinoma of the penis a rare disease, mainly affecting the elderly population but all the penile ulcers not responding to medial therapy must be evaluated for malignancy. Most of these cases remain neglected because of inadequate evaluation and investigation by the local doctors which leads to late presentation. Due to these circumstances the patients have already metastatic disease at presentation. So, it is required to educate local doctors as well as general population to create proper awareness of this disease

In vitro comparative study of two different bleaching agents on micro-hardness dental enamel

Objective: To evaluate the effect of home-use bleaching agent containing 16% Carbamide Peroxide [CP] and in-office bleaching agent containing 38% Hydrogen Peroxide [HP] on enamel micro-hardness

Study Design: An in vitro experimental study

Place and Duration of Study: Department of Operative Dentistry and Science of Dental Materials at Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and Material Engineering Department of NED University of Engineering and Technology, Karachi, from July to December 2014

Methodology: A total of 90 enamel slabs from 45 sound human 3rd molar were randomly divided into 3 groups. Each group contained 30 specimens [n=30]. Group 1 was kept in artificial saliva at 37[degree]C in incubator during the whole experiment. However, Groups 2 and 3 were treated with power whitening gel and tooth whitening pen respectively. After bleaching session, specimens were thoroughly rinsed with deionized water again for 10 seconds and then stored in artificial saliva at 37[degree]C in incubator. Artificial saliva was changed after every 2 days. The Vickers hardness tester [Wolpert 402 MVD, Germany] was adjusted to a load of 0.1 kg [100 gm] and dwell time of 5 seconds. Three Vickers were performed on each specimen using a hardness tester according to the ISO 6507-3:1998 specification. Micro-hardness measurements were performed before and after bleaching at day 1, 7 and 14

Results: In the control group, the baseline micro-hardness was 181.1 +/- 9.3 which was reduced after the storage on day 1, 7 and 14 [p = 0.104]. In Group 2, baseline micro-hardness was 180.4 +/- 10.1 which was reduced to 179.79 +/- 10.0 units after day 1. Whereas, on day 7 and 14, the values of micro-hardness were 179.8 +/- 10 and 179.7 +/- 10.29, respectively [p=0.091]. Furthermore, the baseline micro-hardness in Group 3 was 174.0 +/- 22.9 units which was reduced to 173 +/- 23 on day 1, 170 +/- 30 on day 7 and 173 +/- 23 on day 14 [p = 0.256]. The statistically insignificant difference was found among micro-hardness values of different bleaching agents [p = 0.118]

Conclusion: Bleaching with 38% Hydrogen Peroxide [HP] and 16% Carbamide Peroxide [CP] resulted in insignificant effect on surface micro-hardness of enamel

Epidemiology and Pattern of Fascicular Block Following ST-Elevated Acute Myocardial Infarction.

Aim: The aim of the study was to observe the epidemiology and pattern of fascicular block following ST elevated acute myocardial infarction (AMI). Background: Fascicular block following S-T elevated acute myocardial infarction is often seen in CCU. It predicts poorer in-hospital outcome and signifies underlying extensive myocardial damage with jeopardized conducting system. Materials and Method: This one year prospective observational study was carried out among the S-T elevated AMI patients in the CCU of NICVD during the period of January 2004 to December 2004. Hundred consecutive patients of first attack of AMI with or without fascicular block were included in this study. The patients suffering from congenital heart disease, cardiomyopathy, valvular heart disease and the patients having permanent pacemaker or preexisting syndrome were excluded from the study. Case selection was done with the help of history, physical examination, twelve leads surface ECG and echocardiography. Results: The mean age of the studied patients was 54.2±10.0 years. Highest percentage (38%) was in the age group 51-60 years. The mean age of male Patients was 51.0±9.9 years. Analysis reveals that the mean age of the female patients was significantly higher than the male patients. Among the studied patients, highest percentage had history of smoking 67% followed by hypertension (39%), diabetes mellitus (39%) etc. Among the studied patients 66% had anterior MI and 34% had inferior MI. Highest percentage of patients presented with isolated RBBB (54.0%), followed by LBBB (18%), bi-fascicular (16.0%), tri-fascicular block (8.0%) and isolated LAHB (4.0%). Among the patients with anterior MI, highest percentage presented with RBBB (42.4%) followed by bi-fascicular block (24.2%), LBBB (15.2%) and LAHB (6%) whereas with inferior MI, 76.5 percentage had RBBB followed by LBBB (23.5%). Conclusion: In this study majority of the patients were male. Most of the patients were in the age group 50-60 years. Number of anterior MI was higher (66%) than inferior MI (34%). Anterior MI showed highest incidence of fascicular block than inferior MI which is statistically significant. Among the fascicular blocks, RBBB was the highest (54.0%) and next common fascicular block was LBBB, least common was LAHB. Left posterior hemi-block was not found in this study. Statistical variation among the different types of fascicular blocks observed in this study was significant. Smoking was the most important risk factor. So, fascicular blocks following acute MI are more prone to develop complications than acute MI without fascicular block. Message is that patient with fascicular blocks following acute MI needs special care and treatment.

Use of box simulators for improving intraoperative laparoscopic skills: an essential tool for the surgeon in training

To compare the improvement of intraoperative laparoscopic skills by measuring GOALS score between residents who have undergone simulator training with those who have not received any simulator training. A randomized controlled trial. Department of Surgery, Services Hospital, Lahore, from August 2013 to February 2014. Thirty residents belonging to year 1, 2 and 3 were included in the study. They were randomly divided into 2 groups. Both groups had a baseline evaluation with GOALS score while performing dissection of gallbladder from liver bed during laparoscopic cholecystectomy. Group-A underwent formal training on simulators whereas group-B did not receive any formal training on simulators. After 6 months, a repeat evaluation was done again by measuring GOALS score while performing gallbladder dissection. Baseline GOALS scores of both the groups were similar. Group-A baseline score was 7.66 +/- 0.93 and group-B score was 7.46 +/- 1.04 [p = 0.585]. However repeat scores for group-A showed a significant improvement [an increase of 7.16 +/- 1.48 to 14.76 +/- 1.67, p < 0.001] from baseline scores. Residents in group-B improved their scores by 2.30 +/- 0.99 to 9.76 +/- 0.79 [p < 0.001]. When inter group comparison was done the second score of group-A was significantly higher than that of group-B [14.76 +/- 1.67 vs. 9.76 +/- 0.79, p < 0.001]. Inter-rater reliability was moderately significant [Kappa 0.540]. Training on laparoscopic simulators results in significant improvement of intraoperative laparoscopic skills

Forgotten DJ stents; a misery to the patients

Background: DJ Stents have been in use since long for the management of ureteral obstruction. The obstruction may be due to stone, stricture, PUJ Obstruction etc. DJ Stents if kept for long time are associated with different complications like, blockage, break, migration, encrustation, stone formation etc. These long stayed DJ Stents need additional procedures for their removal like, URS, PCNL, and Pyelolithotomy etc

Objectives: i] to analyze the data retrospectively to see the number of patients having forgotten DJ Stents. ii] to see the level of awareness of patients regarding their DJ removal

Study Design: retrospective study

Place and duration of study: Urology Department, Allied Hospital, Faisalabad from Jan 2011 to Dec 2014

Materials and Methods: record of patients of forgotten DJ Stents for 4 years

Results: during 4 years period 35 patients were found to have forgotten DJ Stents and maximum duration of forgotten DJ Stents was 14 years. 41.66% patients in first group [indwell time 3- 12months] were having encrustations. Overall 11/35 [31.42%] needed litholopaxy for their DJ removal and 24/35 [68.57%] needed URS and it was successful in 22/24 patients. One patient needed PCNL and one had pyelolithotomy for their removal

Conclusion: patients should be stressed / counseled properly regarding its removal by telling its complication. Thread attached to the DJ stent may be left outside external urethral meatus. It must be properly documented in discharge slip. A register must be maintained to keep record of these patients and it should have their address and phone number so that they should be reminded of about their DJ removal well in time

Role of intravenous urography and ultrasonography in the management of vesicovaginal fistula [VVF]

Background: It has been a matter of great controversy whether the sonography [USG] and intravenous urography [IVU] both are mandatory for the evaluation of hydronephrosis and hydro ureter in female patients having urinary fistulae. So we planned to conduct a study on this subject

Objectives: To compare the sensitivity of IVU and USG in showing the degree of Hydro nephrosis and hydro ureter in the patients having VVF

Study Design: Prospective study

Place and Duration of Study: Department of Urology Punjab Medical College /Allied Hospital Faisalabad from January 2013 to October 2014

Methodology: Thirty consecutive female patients suffering from urinary incontinence who presented in outpatient department and were diagnosed to have VVF were taken for study. Patients with urge incontinence, patients with malignancy, patients who underwent surgery or received radiation were excluded from this study. Informed consent for study purpose and surgery were taken. USG and IVU were done in every patients to find the hydronephrosis or hydro ureter

Results: Twenty seven out of thirty patients who had not hydronephrosis on USG, they also had not hydronephrosis or hydro ureter on IVU, while only three patients had hydronephrosis on USG had also hydronephrosis on IVU

Conclusion: This study concluded that USG and IVU have almost equal sensitivity in finding hydro nephrosis or hydro ureter in patients having VVF. Therefore, any one of them can suffice to find out hydronephrosis. IVU is an invasive procedure and have the risk of reaction to contrast material and exposure to radiations. USG is cost effective, non-invasive and hence can be used in place of IVU

Percutaneous nephrolithotomy [PCNL]: comparison of tubeless versus conventional method in terms of hospital stay and duration of operation

Introduction: Percutaneous Nephrolithotomy [PCNL] is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of PCNL

Objective: To compare the outcome of conventional percutaneous nephrolithotomy with postoperative PCN tube versus tubeless Percutaneous Nephrolithotomy, in terms of duration of surgery and postoperative hospital stay

Study Design: Randomized control trial

Setting: Urology Department Punjab Medical College / Allied Hospital Faisalabad

Materials and Methods: Sixty patients were taken with non probability consecutive sampling technique. They were divided into group A[n=30] with conventional PCNL having postoperative nephrostomy tube and group B[n=30] with tubeless PCNL by computer generated random number table. They were compared in terms of duration of surgery and post operative hospital stay

Results: Age distribution of total patients ranged from 15 to 77 years, mean age was 35.07 +/- 15.89. Mean duration of postoperative hospital stay was 6.2 +/- 0.81and 4.07 +/- 1.2 days [p-value=00001] in group A and group B respectively. The operating time was 80 to 145, minutes, mean time 110.17 +/- 15.87 in group A. In group B, operating time was between 65 to 140 minutes mean time 95.18 +/- 22.43

Conclusion: Tubeless PCNL reduces duration of surgery and postoperative hospital stay significantly as compared to conventional PCNL with postoperative nephrostomy tube

Outcome of intracorporeal cystolithotripsy in children

Objectives: To evaluate the success and complications of intracorporeal cystolithotripsy in children

Design: It was prospective and descriptive study

Place and duration of study: Study was conducted in Department of Urology Allied Hospital, [PMC] Faisalabad from January 2011 to December 2012

Patients and Methods: Total number of 40 patients with vesical stone

Results: Children with average age of 7.23 years were included in study. Stones were completely removed in [90%] patients. Perforation occurred in 2.5% patients, 5% patients required redo intracorporeal cystolithotripsy due to stone impaction in urethra. 2.5% Patients needed open vesicolithotomy due to bleeding

Conclusion: Intracorporeal cystolithotripsy with pneumatic lithoclast is a safe and valid procedure for management of vesical calculi in children

Communication skills training of undergraduates

To assess the adequacy or deficiency of relevant communication skills needed in clinical practice among students of King Edward Medical University and identify the need of developing curriculum for communication skills. Sequential mixed method design using survey questionnaire and in-depth interviews. King Edward Medical University, Lahore, from March - September 2010. Final year students consented to participate in the survey questionnaire regarding communication skills needed in clinical practice selected on the basis of random stratified sampling technique. The questioned aspects include communication skills, supervised training, breaking bad news, counselling and written communication skills. In the second qualitative phase, volunteers who had passed final year were selected on the basis of non-probability purposive sampling technique for recording in-depth interviews. Qualitative data was analyzed with content analysis after identifying themes and trends from the data. Only 20% students had clarity of communication skills training, 28% believed that their learning was supervised, 20% believed training was structured, 28% were confident about handling difficult situations, 15% could effectively break bad news, and 22% were confident in written communication skills. In the interviews 70% felt that their peers had average skills in handling difficult situations like breaking bad news and counselling, 60% believed that communication skills program was non-existent and 100% agreed that patient turnover is a strength for the institute and structured training would improve their communication skills performance. The communication skills of the studied group were inadequate to address special situations. This presses need for developing a communication skills training program

Crossing vessels as a cause of pelvi-ureteric Junction [PUJ] obstruction

Foetal hydronephrosis is commonly caused bycongenital pelviureteric Junction [PUJ] obstruction.It is either due to nerve deficiency or due to intrinsicmuscular defect at PUJ or it may be due to lowerpolar aberrant crossing vessel just compressing thePUJ. The purpose of this study is to see thecontribution of crossing vessels in causing the PUJobstruction

Aims and objectives: [1] to find thecontribution of crossing vessels in causing PUJobstruction on naked eye examinationperoperatively, [2] To histologicaly verify the causeof PUJ obstruction in cases of crossing vesselscompressing the pelvi-ureteric junction [PUJ]

Patients and methods: 27 cases of Congenital PUJobstruction were taken during four year period whowere candidatesfor operation. All underwent Anderson HynesPyeloplasty and specimen of PUJ with narrowsegment below it was taken and preserved in 10%formalin. The specimen was sent to histopathologistalong with other specimens where PUJ obstructionwas not caused by crossing vessels for nervedetection by S-100 immunohistochemistry and forhistopathological examination

Results: Five out of27 cases of PUJ obstruction were caused by crossingvessels and in these five cases, four [80%] werehaving normal histology showing that crossingvessels were the cause of PUJ obstruction merelycompressing the PUJ mechanically

Vesicovaginal fistula, causative factors and outcome of surgical management: an experience at PMC/allied hospital Faisalabad

Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up

Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad

Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted

Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively

Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results

Effect of different irradiation times on microhardness and depth of cure of a nanocomposite resin

To determine the microhardness and depth of cure of nanocomposite using different irradiation times on both upper and lower surfaces of composite material. In-vitro experimental study design. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and NED University of Engineering and Technology, Karachi, from March to May 2010. Total 120 cylinder shaped specimens; 60 specimens for depth of cure test and 60 specimens for micro hardness test were fabricated using A3 shade of nanocomposite [Filtek Z350 XT, 3M ESPE]. For each irradiation time four groups were made [Group 1 = 20s] [Group 2 = 30s], [Group 3 = 40s] and [Group 4 = 60s]. For each group fifteen specimens were used. The resin was placed and polymerized into a cylindrical plastic mold. Depth of cure was measured by using micrometer. Micro Vickers hardness was measured on both top and bottom surfaces. SPSS-16.0 was used for statistical analysis. There was statistically significant difference in the depth of cure between all groups showing the highest value in group 4 [p < 0.001]. For hardness on top surface, there was a statistically significant difference in between groups 1 and 2 [p=0.001], groups 1 and 3 [p < 0.001], groups 1 and 4 [p < 0.001] There was no statistically significant difference between groups 2 and 3, groups 2 and 4 and in between groups 3 and 4. For hardness on bottom surface, there was statistically significant difference in between all groups showing the highest value in group 4 [p < 0.001]. Depth of cure and hardness was increased by increasing irradiation time. Hardness on the top surface was higher than bottom surface values

Outcome of anastomotic urethroplasty for stricture urethra

To evaluate the outcome of end-to-end urethroplasty for stricture urethra and need for ancillary procedures. Prospective, study was carried out in Department of Urology Allied Hospital Faisalabad from Oct, 2007 to April, 2010 to see the outcome for anastomotic urethroplasty in 40 patients. Simple perineal urethroplasty was done in 30 patients. Perineal urethroplasty with separation of corporal bodies was done in 06 patients and inferior pubectomy was required in 02 patients according to indication. Age, length of stricture and ancillary techniques required during reconstruction were combined. Success was considered when there was no need for redo anastmosis, IOU or patient was cured by dilatation. Out of 40 patients that underwent end-to-end urethroplasty, 35 [87.5%] were successful. Simple perineal urethroplasty showed a success rate of 93.75%. Perineal urethroplasty with separation of corporal bodies had a success rate of 66.66%. Patients in which inferior pubectomy was required had success rate of 50%. End-to-end urethroplasty is an excellent option for treatment of stricture urethra and majority of failures occurs in children and those having very proximal membranoprostatic urethral strictures

Application of an external fixator to the open diaphyseal fractures of femur

The study on 30 cases of open diaphyseal femoral fractures has been done between January 2008 to November 2008 on patients coming to Orthopaedics Department at Bolan Medical complex Hospital Quetta attached to Bolan Medical College, Quetta. It is a prospective study, which includes 30 patients with open diaphyseal fractures of femur. They were operated after stabilization of general condition using external fixator. It is a valuable clinical treatment option, providing surgeons with the spatial relationship of tissues both statically and dynamically via minimally, technique. The study shows union occurred in 24, 80% cases. There was an established non-union in 06 [20%] cases. All were Type III-A and III-B. The average time of union was from 8-20 weeks. The overall incidence of deep infection was 38% and was limited to type III-A and III-B. Pin crack infection was seen in 36% and was controlled with standard management. The average hospital stat was 15 days On the basis of this study it is evident that treatment by external fixator is very satisfactory, cost effective and there are no major complications and can be used with full confidence. Above all good results can be achieved by aggressive and repeated debridement, irrigation and early soft tissue coverage of the-bone

Fixation of distal femoral fractures in adults by dynamic condylar screw

To analyze the role of Dynamic Condylar Screw and the early functional outcome and complications associated with surgical management of Distal Femoral Fractures in Adult using DCS in our circumstances. This descriptive study was carried out in Orthopaedics Department Bolan Medical Complex Hospital Quetta from March 2007 to April 2008. The study included management of 25 cases of Distal Femoral Fractures treated by Dynamic Condylar Screw. These fracture are complex injuries, which are often unstable and comminuted. Despite advances in surgical Technique and improvement in implant, treatment of Distal Femoral Fractures remains a challenge in many situation, if not treated correctly may lead to permanent disability. There were 25 cases selected, 23 males and 2 females with in average age of 32.2 years, ranging from 20 years to 60 years. The cause of injury was high-energy trauma in majority of cases. These were of A1, A2, A3, and C1 and C2 type fractures. 21 out of 25 cases gained knee flexion more than 90°. The limb shortening of 2cm was noted in 03 cases, in 20 patients fractures united in 10-12 weeks. Bone graft was used in 05 cases. The average follow up was about 10 months. At the end of the study results shows that DCS is a good method of treating closed type, A1, A2, A3, C1 and C2 fractures. DCS provides rigid fixation and good purchase in Osteoporotic bone. Early mobilization prevents knee stiffness

Homeless in Dhaka: Violence, Sexual Harassment, and Drug-abuse.

Bangladesh has experienced one of the highest urban population growth rates (around 7% per year) over the past three decades. Dhaka, the capital city, attracts approximately 320,000 migrants from rural areas every year. The city is unable to provide shelter, food, education, healthcare, and employment for its rapidly- expanding population. An estimated 3.4 million people live in the overcrowded slums of Dhaka, and many more live in public spaces lacking the most basic shelter. While a small but growing body of research describes the lives of people who live in urban informal settlements or slums, very little research describes the population with no housing at all. Anecdotally, the homeless population in Dhaka is known to face extortion, erratic unemployment, exposure to violence, and sexual harassment and to engage in high-risk behaviours. However, this has not been systematically documented. This cross-sectional, descriptive study was conducted to better understand the challenges in the lives of the homeless population in 11 areas of Dhaka during a 13-month period from June 2007 to June 2008. A modified cluster-sampling method was used for selecting 32 clusters of 14 female and male respondents, for a sample of 896. In addition to sociodemographic details, this paper focuses specifically on violence, drug-abuse, and sexual harassment. The findings showed that physical assaults among the homeless, particularly among women, were a regular phenomenon. Eighty-three percent of female respondents (n=372) were assaulted by their husbands, station masters, and male police officers. They were subjected to lewd gestures, unwelcome advances, and rape. Male respondents reported being physically assaulted while trying to collect food, fighting over space, or while stealing, by police officers, miscreants, or other homeless people. Sixty-nine percent of the male respondents (n=309) used locally-available drugs, such as marijuana and heroin, and two-thirds of injecting drug-users shared needles. The study determined that the homeless are not highly mobile but tend to congregate in clusters night after night. Income-generating activities, targeted education, gender-friendly community police programmes, shelters and crises centres, and greater community involvement are suggested as policy and programmatic interventions to raise the quality of life of this population. In addition, there is a need to reduce high rates of urban migration, a priority for Bangladesh.