Linking fish and crustacean taxonomic composition with seasonal contrasts in the soft-bottom intertidal zone / Ligação da composição taxonômica de peixes e crustáceos com contrastes sazonais na zona intertidal de fundo macio

Abstract The primary objective of this study was to investigate the seasonal fish and crustacean variations concerning taxonomic composition, species richness, and diversity in sandy beach habitat. For this purpose, we investigated the Sonmiani Hor lagoon area during four distinct seasons, i.e., northeast (NE) monsoon, pre-monsoon, south-west (SW) monsoon, and post-monsoon for one year. During each haul, the net was pulled about 100m along the beach in 0.5m depth. The results showed a strong linear correlation between the diversity index and equitability in fishes (r = 0.978). The diversity index was strong negatively correlated with the abundance and biomass (r = -0.978, -0.972, respectively). The physical attributes like sea surface water temperature and salinity showed a strong negative effect on species assemblages (r = -0.981 and -0.943, respectively). The mean air and water temperature illustrated approximately 3°C difference during NE and pre-monsoon seasons. However, salinity, pH, and electrical conductivity did not show any significant seasonal variabilities. Under the ecological indices, the fish species displayed higher diversity (H' = 3.19) during SW monsoon, whereas the lowest diversity was observed during pre-monsoon (H' = 1.58). The equitability and species richness, however, remained more noticeable during SW monsoon (J' = 0.81). The total number of individuals of fish and crustaceans reached 4799 with 3813 fish individuals and 986 individuals of crustaceans. A total of 27 families of fish while five crustacean families comprising of 30 genera and 38 fish species while ten genera and 17 species of crustaceans were recorded. Liza subviridis displayed the highest abundance among the sampled fish species. In conclusion, fish species constituted a significant part of the coastal fauna in the study area. The seasonal variations displayed distinct variations in fish species composition and diversity.

Resumo O objetivo principal deste estudo foi investigar as variações sazonais de peixes e crustáceos em relação à composição taxonômica, riqueza de espécies e diversidade no habitat de praias arenosas. Para esse fim, investigamos a área da lagoa Sonmiani Hor durante quatro estações distintas, ou seja, monção nordeste (NE), pré-monção, monção sudoeste (SW) e pós-monção, por um ano. Durante cada transporte, a rede foi puxada cerca de 100 m ao longo da praia, a 0,5 m de profundidade. Os resultados mostraram uma forte correlação linear entre o índice de diversidade e a equitabilidade de peixes (r = 0,978). O índice de diversidade apresentou forte correlação negativa com a abundância e a biomassa (r = -0,978 e -0,972, respectivamente). Os atributos físicos, como temperatura da água da superfície do mar e salinidade, apresentaram forte efeito negativo sobre o conjunto de espécies (r = -0,981 e -0,943, respectivamente). A temperatura média do ar e da água teve uma diferença de aproximadamente 3 °C durante a monção NE e a pré-monção. No entanto, salinidade, pH e condutividade elétrica não apresentaram variabilidade sazonal significativa. A respeito dos índices ecológicos, as espécies de peixes apresentaram maior diversidade (H' = 3,19) durante a monção SW, enquanto a menor diversidade observada foi na pré-monção (H' = 1,58). A equitabilidade e a riqueza de espécies, no entanto, permaneceram mais perceptíveis durante a monção SW (J' = 0,81). O número total de peixes e crustáceos foi de 4.799, com 3.813 peixes e 986 crustáceos. Foram registradas 27 famílias de peixes e 5 famílias de crustáceos, com 30 gêneros e 38 espécies de peixes, além de 10 gêneros e 17 espécies de crustáceos. Liza subviridis apresentou a maior abundância entre as espécies de peixes amostradas. Em conclusão, as espécies de peixes constituíram uma parte significativa da fauna costeira na área de estudo. As variações sazonais apresentaram variações distintas na composição e diversidade das espécies de peixes.

Poverty-associated emerging infection of Cystic Echinococcosis in population of Northern Pakistan: A hospital based study

@#Cystic Echinococcosis (CE) is one of the most important zoonotic parasitic diseases in human, livestock, and wildlife globally. The prevalence of CE depends upon human behavioral risk factors, the diversity and ecology of animal host interactions and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. It is a neglected, economic and socio-cultural problem in Pakistan. The available data about the incidence of CE is very limited and no extensive study has been reported in Pakistan. The current study was aimed to analyze the hospital reported cases of CE and the associated risk factors related to the incidence of CE. The hospital-based data of CE for the time period of January 2012-December 2017 was collected from Islamabad, Rawalpindi and Peshawar. The data covered demographic characteristics including age, gender, and cyst localization of infected individuals and socioeconomic determinants. The data was analyzed based upon different risk factors along with the different socioeconomic parameters that has an important impact on the distribution of disease. A total of 228 cases were presented in the selected hospitals of different cities during the study period. Out of total 228 patients, 59.21% were males and 40.78% were females (P<0.001). Most infections have been recorded in young adults (>20-30) showing 22.8% of total infected individuals followed by children (0-10) showing 10.5% (n=24), respectively (P<0.001). Liver was the most vulnerable organ (58.77%, n=134) followed by lungs (14.47%, n=33) (P<0.001). The infection was higher among rural communities (84.2%) than urban (12.8%) (P<0.001). Socioeconomic and demographic factors had an important impact on the intensity of disease (P<0.001). The occurrence of cases in children and young adults was an important finding as it indicated an active transmission of the parasite in Pakistan along with the poverty index. Emergence of echinococcosis in Pakistan showed that emerging health issues in Pakistan could bring the disease to limelight for future research. This finding, together with the fact that 1 hospital reported 214 cases over 6 years 325 underlines the need for a program for prevention/control of this disease in Pakistan. The timely measure needs to be taken to hamper the disease development and establishment. In order to control the disease, complete surveillance should be done which in turn weighs down the disease progress.

Estimation of serum matrix metalloproteinases among patients of oral squamous cell carcinoma

Objective: To estimate the serum levels of matrix metalloproteinases in oral squamous cell carcinoma patients and in healthy subjects

Methods: In this observational study, biopsy diagnosed oral squamous cell carcinoma patients [n= 38] were recruited from Mayo Hospital, Lahore during 2016 to 2017. Age and gender matched Controls [n= 38] were also included. Venous blood sample of each participant was drawn, serum separated and the levels of matrix metalloproteinases were measured by multiplex ELISA

Results: Serum levels of MMP-1, -8, -10, -12 and -13 in OSCC patients showed statistically significant increase as compared to control group [p < 0.01]. The MMP-12 predicted the presence of OSCC with highest AUC of 0.836 [95% CI [0.733 to 0.911]] for sensitivity and specificity of 80% and 78.9%, respectively for a cut-off value of 16.13 pg/ml

Conclusions: MMP-12 has been found to have significant sensitivity and specificity to qualify as a diagnostic biomarker

Prevalence of hydatidosis in livestocks in Chakwal District of Pakistan

Background:Hydatidosis is a zoonotic parasitic disease and a serious human and animal health problem in many endemic areas of the world. It is caused by the tapeworm parasite of Echinococcus granulosus sensu lato. This parasite is endemic in the neighboring countries like China, Iran and India. There are limited studies on CE in Pakistan.Methods:This study primarily aimed to determine the prevalence of hydatidosis in slaughtered livestocks in Chakwal district (Chakwal, Bhaun, Kallar kahar, Choa saidan shah and Balkasar) from June to December 2015. The livestocks were inspected after slaughtering and the ages, breeds and organ wise prevalence were recorded.Results:A total of 6 095 animals (sheep, goat, buffaloes and cattle) of different genders, ages and breeds were inspected after slaughtering. Overall prevalence was 8.55% (88/1 045) in sheep followed by 8.42% (88/1 045), 6.90% (4/58), 2.99% (138/4 608) in cattle, buffaloes and goats, respectively. Liver wise prevalence was 7.75%, 6.90%, 0.06%, 1.30% in cattle, buffaloes, goats and sheep, respectively while lung wise prevalence was 7.55%, 0.67%, 0.00%, 0.00%, in sheep, cattle, buffaloes and goats, respectively. Male (9.50%) were more infected than female (1.96%) in all hosts. Breed wise prevalence was higher in desi breed of cattle followed by crossbreed and other breeds. In goats, teddhi breed was more infected then beetal while in sheep Afghani breed was more infected than the others. Cattle of 6-9 years groups were more infected than 0-3 and 3-6 years age groups. Buffaloes of the only age group of 6-9 years were infected while in goat and sheep 3-6 years were more infected than 0-3 years. According to the statistical analysis there was a significant difference (P<0.05) in prevalence of hydatidosis when ages, genders and organs were compared.Conclusion:The hydatidosis is a serious parasitic problem in the study area for livestocks. The disease should be monitored on regular basis in other areas of Pakistan and future studies should be carried out to explore the real prevalence in Pakistan.

Linking fish and crustacean taxonomic composition with seasonal contrasts in the soft-bottom intertidal zone

Abstract The primary objective of this study was to investigate the seasonal fish and crustacean variations concerning taxonomic composition, species richness, and diversity in sandy beach habitat. For this purpose, we investigated the Sonmiani Hor lagoon area during four distinct seasons, i.e., northeast (NE) monsoon, pre-monsoon, south-west (SW) monsoon, and post-monsoon for one year. During each haul, the net was pulled about 100m along the beach in 0.5m depth. The results showed a strong linear correlation between the diversity index and equitability in fishes (r = 0.978). The diversity index was strong negatively correlated with the abundance and biomass (r = -0.978, -0.972, respectively). The physical attributes like sea surface water temperature and salinity showed a strong negative effect on species assemblages (r = -0.981 and -0.943, respectively). The mean air and water temperature illustrated approximately 3°C difference during NE and pre-monsoon seasons. However, salinity, pH, and electrical conductivity did not show any significant seasonal variabilities. Under the ecological indices, the fish species displayed higher diversity (H = 3.19) during SW monsoon, whereas the lowest diversity was observed during pre-monsoon (H = 1.58). The equitability and species richness, however, remained more noticeable during SW monsoon (J = 0.81). The total number of individuals of fish and crustaceans reached 4799 with 3813 fish individuals and 986 individuals of crustaceans. A total of 27 families of fish while five crustacean families comprising of 30 genera and 38 fish species while ten genera and 17 species of crustaceans were recorded. Liza subviridis displayed the highest abundance among the sampled fish species. In conclusion, fish species constituted a significant part of the coastal fauna in the study area. The seasonal variations displayed distinct variations in fish species composition and diversity.

Resumo O objetivo principal deste estudo foi investigar as variações sazonais de peixes e crustáceos em relação à composição taxonômica, riqueza de espécies e diversidade no habitat de praias arenosas. Para esse fim, investigamos a área da lagoa Sonmiani Hor durante quatro estações distintas, ou seja, monção nordeste (NE), pré-monção, monção sudoeste (SW) e pós-monção, por um ano. Durante cada transporte, a rede foi puxada cerca de 100 m ao longo da praia, a 0,5 m de profundidade. Os resultados mostraram uma forte correlação linear entre o índice de diversidade e a equitabilidade de peixes (r = 0,978). O índice de diversidade apresentou forte correlação negativa com a abundância e a biomassa (r = -0,978 e -0,972, respectivamente). Os atributos físicos, como temperatura da água da superfície do mar e salinidade, apresentaram forte efeito negativo sobre o conjunto de espécies (r = -0,981 e -0,943, respectivamente). A temperatura média do ar e da água teve uma diferença de aproximadamente 3 °C durante a monção NE e a pré-monção. No entanto, salinidade, pH e condutividade elétrica não apresentaram variabilidade sazonal significativa. A respeito dos índices ecológicos, as espécies de peixes apresentaram maior diversidade (H = 3,19) durante a monção SW, enquanto a menor diversidade observada foi na pré-monção (H = 1,58). A equitabilidade e a riqueza de espécies, no entanto, permaneceram mais perceptíveis durante a monção SW (J = 0,81). O número total de peixes e crustáceos foi de 4.799, com 3.813 peixes e 986 crustáceos. Foram registradas 27 famílias de peixes e 5 famílias de crustáceos, com 30 gêneros e 38 espécies de peixes, além de 10 gêneros e 17 espécies de crustáceos. Liza subviridis apresentou a maior abundância entre as espécies de peixes amostradas. Em conclusão, as espécies de peixes constituíram uma parte significativa da fauna costeira na área de estudo. As variações sazonais apresentaram variações distintas na composição e diversidade das espécies de peixes.

Role of laparoscopy in evaluation of abdominal pain

Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain

Study Design: Prospective study

Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013

Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21

Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20-70 years with mean age of 50 +/- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 [29.09%] patients, cholecystitis with biliary sludge in 14 [12.72%], pelvic inflammatory disease in 12 [10.90%], ovarian cyst in 11[10%], adhesions in 10[9.09%], intestinal tuberculosis in 8 [7.27%], mesenteric lymphadenitis in 7 [6.36%], lymphoma in 4 [3.63%], ectopic pregnancy in 3 [2.7%], CA gallbladder in 2 [1.81%], meckels diverticulum in 2 [1.81%], endometriosis in 2 [1.81%] and crohns disease in 1 [0.9%] patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed

Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations

Supervisors' perspective on electronic logbook system for postgraduate medical residents of CPSP

Objective: To find out the perspective of the supervisors about the role of electronic logbook [E-Logbook] of College of Physicians and Surgeons, Pakistan [CPSP] in monitoring the training of postgraduate medical residents of CPSP

Study Design: Descriptive cross-sectional study

Place and Duration of Study: College of Physicians and Surgeons Pakistan [CPSP], Karachi, from May to October 2015

Methodology: An electronic computer-based questionnaire designed in Hypertext Preprocessor [PHP] language was distributed to the registered CPSP supervisors through the e-log system. The questionnaire comprised of seven close ended questions. The data were entered and analyzed by SPSS version 20. Descriptive statistics were determined

Results: A total of 1,825 supervisors responded to the questionnaire. Fifteen hundred and ninety-eight [87.6%] supervisors gave regular feedback for their trainees, 88.2% considered it a better monitoring tool than conventional logbook, 92.5% responded that e-logbook helped in the regular assessment of the trainees, 87.8% believe that quality of training will improve after introduction of e-logbook, 89.2% found e-logbook useful in implementation of outcome-based learning and 88.4% considered e-logbook user-friendly. The main reasons for not providing regular feedback included the supervisors not familiar to e-logbook interface, internet access problems, and busy schedules of supervisors

Conclusion: There was a wide acceptability of the e-log system among the supervisors with positive perception about its usefulness. The common reasons that hinder the provision of regular feedback include not being familiar to e-log interface, internet access problem, busy schedule and some consider using e-logbook a cumbersome task. These reasons can be alleviated to provide a better training monitoring system for the residents

Effect of academic environment on physical and psychological health in elementary students

Objective: To explore physical and psychological effects of academic environment on elementary school pupil

Methods: A sample size of this study 1200. Students of all the Government and private schools of Lahore, Punjab, Pakistan, were included in our population of pupil of age 6-11 years studying in elementary schools. Pupil studying in morning school. Data was collected through a structured questionnaire and questionnaires were filled by the respondents in the presence of researcher

Results: It is evident that 93.6% Govt. School students lift bags heavier than recommend 5 kg while in private schools it is 86.1%. Overall 89.8% students carry bag weights heavier than recommend than 10% of body weight. Only 16.66% of Govt. schools students have normal BMI and 83.21% have abnormal BMI while in private schools 31.25% individuals have normal BMI. It may be attributed to better financial conditions and better educational environment in private schools

Conclusions: The study concludes that too much study time and excessive stress is causing physical and psychological changes in children. Due to lack of healthy educational environment students are suffering from emotional distress and physical stress

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: UAE Tertiary Care Hospital Initial Experience.

Aim: To study efficacy of Laparoscopic Sleeve Gastrectomy (LSG) for morbid obesity as a measure of weight reduction over a period of one year from May 2011 – 2012. Materials and Methods: Morbidly obese patients (n=109) referred from clinics with primary problem of obesity and consequent co-morbidities underwent the procedure LSG during a period of one year. The data included; demographics, weight of patients/BMI, Comorbid conditions, preoperative work up, indications for surgery, length of hospital stay, duration of surgery, postoperative complication and reduction of weight at 3 weeks, 3, 6 and 12 months. Results: Out of 109 patients, 94 (86%) are below 40 years of age, reflecting high prevalence of obesity in the younger population in UAE. As per gender, 67 (61.5%) are female and 42 (38.5%) male. Preoperatively, mean weight is 121±16 kg; 68 (62.4%) patients have BMI 40-50 kg/m2 and 41 (37.6%) of 35-40 kg/m2, 12 (11%) patients are diabetics (DM), 9 (8.3%) hypertensive (HTN), 12 (11%) have symptoms of Gastritis, 3 (2.8%) have shown Clo test +ve., 7 (6.4%) complaining Knee Joint pain, 3 (2.8%) with Backache, 2 (1.8%) patients are diagnosed cases of gastroesophageal reflux disease (GERD), though 58 (53.2%) have no comorbidities. Among those 107 (98.2%) patients are referred to dietitian. All patients underwent laparoscopic sleeve gastrectomy (LSG). Postoperatively, 104 (95.4%) patients were without any complication. 1 (0.9%) patient has bleeding while 4 (3.7%) has minor issues (nausea, vomiting) and there was no leak in this group of patients. On follow up, there was a significant weight loss and improvement of comorbidities: At 3 weeks post op, the mean weight was 113±16 kg, at 3 months 103±13 kg, at 6 months 92±12 kg and at 1 year 82±10 kg. Complete resolution of Diabetes Mellitus (DM) observed in 7 (58.33%) out of 12 patients and improvement in 5 (41.55%). Complete resolution of hypertension (HTN) in 5 (55.55) and improvement in 4 (44.44). Gastritis completely resolved in 10 (83.33) and improved in 2 (16.66). The patients who had knee joint pain and backache, all improved. Conclusion: LSG has clearly proven its efficacy for morbid obesity in term of weight reduction and consequent co-morbidities. It’s gaining popular in community being an acceptable and safe procedure.

CPSP/HSE postgraduate overseas rotational programme: residents' perspective

Objective: to get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme

Study Design: mixed methods qualitative research study

Place and Duration of Study: CPSP, Regional Office, Lahore, in June 2015

Methodology: it is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed

Results: the mean age of residents was 29.9 +/- 1.1 years, 7 [21.2%] were females and 24 [72.7%] respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making [mean score of 3.3 +/- 1.2] and enhanced professionalism [mean score of 3.6 +/- 1.1]. They disagreed that training has polished their procedural skills [mean score 2.4 +/- 1.2]. The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules

Conclusion: residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues

Bile duct injuries and outcomes: a retrospective medical record review

Objective: To report on our experience of cholecystectomy associated bile duct injuries and observe factors influencing outcomes

Study Design: Simple descriptive study

Place and Duration of Study: Surgical unit IV, Military Hospital [MH] Rawalpindi, over a period of seven years from 01-01-2005 to 1-12-2012

Material and Methods: Eighty eight patients who underwent repair of bile duct injuries during this period were included in this study. Patients referred from class 'W and 'C' hospitals to our institute were also included

Results: Fifteen immediate repairs [0-72 hours] post cholecystectomy, forty eight intermediate repairs [72hrs-6wks] and twenty five late repairs [> 6 wks] were performed [table-1]. Short term morbidity was higher in patients with upper biliary tract injury [p=.04].The most common long-term complication was biliary stricture, which occurred in 28 patients [31.8%]. Patients with bile duct injuries [BDIs] repaired in intermediate period were more prone to develop stricture of biliary tree than those repaired in immediate or late period [p=.03] [table 3]. Long term morbidity was also higher in patients who presented with bile contamination of peritoneum [p=.03] and had sustained complex biliary tract injuries [E4/E5] [p=.03].The overall morbidity and mortality rate was 31% and 3% respectively

Conclusion: We observed that complex hilar injury, presence of intra-abdominal bile and timing of BDI repair is an important predictor of long-term outcome. Injuries repaired in early [0-72hrs] or late period [>6wks] were less likely to develop biliary stricture as compared to injuries repaired in intermediate period [72hrs-6wks]. Moreover complex hilar injuries and intra-abdominal bile at presentation increases the possibility for development of late biliary stricture

Mortality prediction in patients admitted in surgical intensive care unit by using APACHE IV

Objective: To predict the mortality by the mean Acute Physiology and Chronic Health Evaluation [APACHE] IV score of all the patients admitted in a Surgical Intensive Care Unit [ICU] and comparing the score of the survivors and non-survivors

Study Design: Descriptive study

Place and Duration of Study: Surgical Intensive Care Unit, Mayo Hospital, Lahore, from June 2013 to November 2014

Methodology: All adult patients admitted in the Surgical ICU were included in this study. The demographics and other data of the patients were recorded. The APACHE IV scores of all patients were calculated at the time of admission. The scores of the survivors and the non-survivors were compared for prediction of survival and mortality

Results: The age of these patients ranged from 13 to 70 [mean 38.39] years with 86 [55.48%] males and 69 [44.52%] females. The mean APACHE IV score of these patients was 34.96 +/- 14.93 ranging from 11 to 63 years. Eighty-three [53.55%] patients survived and 72 [46.45%] died. With respect to gender, 41 [47.67%] males out of 86 and 31 [44.92%] females out of 69 did not survive. The mortality increased with an increase in APACHE IV score and all the patients with score more than 39 did not survive

Conclusion: The predicted mortality can be assessed by APACHE IV score, so it is good for application among the surgical ICU patients

Spectrum of diseases in acute intestinal obstruction

To determine the etiological spectrum of acute intestinal obstruction in our clinical setup Military Hospital Rawalpindi. Descriptive study. Surgical department of Military Hospital, Rawalpindi from Jul 2012 to Jul 2013, over a period of about 1 year. A total of 120 patients with acute mechanical intestinal obstruction who underwent laparotomy were included in our study while those with non-mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study. All the patients were selected by non-probability purposive sampling technique. Emergency laparotomy was done and operative findings were recorded. A total of 120 patients with mechanical intestinal obstruction were included in this study out of which 93 [69.17%] were female and remaining 27 [30.83%] were males. Male to female ratio was 1:2.24. Age range of patients was 22-85 years. Out of 120 patients operated for acute intestinal obstruction post-op adhesions were found in 37 [30.83%] patients followed by intestinal tuberculosis in 23 [19.17%] patients, obstructed inguinal hernias in 13 [10.83%], gut malignancies in 15 [12.5%], Meckel's diverticulum with bands in 7 [5.83%], volvulus in 7 [5.83%], perforated appendix in 6 [5%], intussusception in 2 [1.7%], inflammatory bands in 5 [4.17%], trichobezoar and faecal impaction in 2 [1.7%] while in 3 [2.5%] patients no definite cause was found. Post-op adhesions are the commonest cause of mechanical intestinal obstruction in our setup followed by intestinal tuberculosis as second most common clinical pattern of presentation

Comparison of case based learning with conventional teaching-students' perspective

To compare case based learning with conventional teaching from student's perspective. Cross sectional comparative study. Army Medical College, Rawalpindi from May 2012 to November 2012. A closed ended self-administered questionnaire with twelve questions was prepared and distributed to 427 students of 2[nd] to final year MBBS classes. The responses to the questions were dichotomous either in favour of case based learning or conventional teaching. It included both the genders and all the categories of students from 17 to 23 years of age. Duly filled questionnaires were returned by 397 respondents which were included in the study. Univariate analysis of each question was performed by applying Binomial exact test. Reliability was determined through internal consistency by applying Cronbach's alpha test. A total of 294 [74%] male and 103 [26%] female students with mean age of 19.83 +/- 1.41 years participated in the study. Difference in frequency of respondents was significant for all the questions [p-value < 0.05] except question number 1 and 2. Value of Cronbach's alpha was 0.83 showing high reliability. Case based learning is a preferred instructional strategy as compared to conventional teaching from students' perspective

E-Log system in monitoring of residency program: trainees' perspective

To record residents' perspective about the utility of newly introduced E-Log system at the College of Physicians and Surgeons Pakistan [CPSP]. Sequential mixed method design using survey questionnaire and in-depth interviews. CPSP, Regional Center, Lahore, from March to June 2014. Data was collected from registered trainees through a web-based survey questionnaire on a scale of 1 to 7 about the utility of E-log system. In-depth interviews were conducted with 7 students using non-probability purposive sampling. The interviews were tape recorded and subsequently transcribed. Quantitative data was analyzed using SPSS version 20 and qualitative data was analyzed using content analysis by identifying themes and patterns. A total of 4399 responses were received. Motivation was 4.61 +/- 1.98; 4.33 +/- 2.00 remained acknowledgment of control of one's training by the new system. Ease of use got a mean score of 4.56 +/- 2.15. The overall acceptance of the students regarding E-Log system was high. Scheduling IT workshop at the start of training will add to the student satisfaction regarding utility of E-Log system

role of nanotechnology in fuel cells and renewable energy

Nanotechnology deals with the study and manipulation of matter at minute scales of the order of less than 1mm in length, and is a leading research topic among scientists and engineers. This study discusses the contributions that nanotechnology has to offer in the context of renewable energy. Focus is mainly on improvements in efficiency, feasibility and supply of renewable energy resources. Specific emphasis is placed on hydrogen technologies. Considerable growth is being witnessed in the rene- wable energy industry. Climate change, triggered by greenhouse gas emissions, and consequent changes in public opinion, and pressure have all resulted in renewed interest in renewable energy sources. Only certain specific areas of renewable energy technologies, such as material strength and its physical properties, are influenced by nanotechnology as there are no alternative means of achieving the desired thermochemical/electrochemical efficiencies than through the use of nano-scale technologies

Laparoscopic cholecystectomy: a clinical practice audit

To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Prospective study. Surgical department Military Hospital from Jul 2011-Dec 2013. A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone panereatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients' demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 k 10.456 years, 447% patients presented with the clinical features of acute cholecystitis, 540 [52.94%] with chronic cholecystitis and 23 [2.28%] with acute panaeatitis. Mean 1 operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 [3.6%] patients were converted to open cholecystectomy. Post-operative complications occur in only 122 [12%] patients. 938 [92%] patients were discharged within 48 hours. of surgery. Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non-complicated gallstone disease

Near total thyroidectomy; role of drain

To evaluate the role of surgical drains in near total thyroidectomy. It was a Randomized clinical trial conducted at department of surgery, DHQ teaching Hospital, Dera Ghazi Khan from Jun 2012 to May 2013. Patients were randomized into two groups by lottery method. Group A were those in which drains were placed and Group B patient were operated and no drains were placed. Inclusion criteria included all patients presenting for near total thyroidectomy for benign diseases. Those with massive goiters or nodules larger than 6 cm were excluded. 40patients were enrolled in the study. Complications, length of hospital stay, and overall cost were evaluated. In the Group B [no drain group], there was 03 days mean hospital stay with no increase in postoperative complications like swelling. While Group A [drain group] mean hospital stay was 06 days. Thyroid surgery without the use of a drain decreases the length of hospital stay, with no increase in patient morbidity. The overall cost is significantly reduced

Intralesional bleomycin sclerotherapy: an effective treatment of cystic hygroma in children

To study the outcome of intralesional sclerotherapy with injection Bleomycin in cystic hygroma in children. A case series. The department of Pediatric Surgery at Military Hospital, Rawalpindi, Pakistan from Jan 2011 to Dec 2012. All patients with peripheral cystic hygroma [CH] presenting to us, were enrolled in the study. The cyst was aspirated in the operation theater under sedation. Injection bleomycin 0.5 mg /kg diluted in 10-15 cc of distilled water was injected in the cyst at multiple sites. Injection was repeated after every month depending upon the response. A total of 30 patients reported to the department with superficial cystic hygroma, 12 were males [40%] and 18 were females [60%], age ranged from 15 days to 8 years. Cervico-facial was the most common site. Results were assessed in terms of excellent [complete resolution], good [> 50% reduction in size] and poor [< 50% reduction in size]. In 2 patients, complete resolution was achieved after maximum seven shots of intra-lesional bleomycin injections [IBI], while 18/30 [60%] resolved after single dose. Twenty seven patients [90%] resolved completely, 2 [6.6%] had good response, 1 [3.3%] showed poor response. Minor complications were noted which were treated by symptomatic treatment. No major side effects or recurrence were noted in maximum 2 years follow up. Intralesional bleomycin sclerotherapy is safe and effective as primary treatment in cystic hygroma

Subcutaneous versus subcutaneous and intraperitoneal local anaesthetic in the management of post appendicectomy pain

To compare the efficacy of subcutaneous only and combined subcutaneous and peritoneal infiltration of 0.5% bupivacaine during appendicectomy for the management of early post operative pain. Randomized controlled study. Department of Surgery, CMH Kohat from 13[th] December 2007 to 20[th] December 2008. Sixty patients of acute appendicitis, divided into two groups of 30 each, were included in the study. Group A was given 0.5% bupivacaine subcutaneously, whereas group B was given the anaesthetic subcutaneously as well as intraperitoneally during appendectomy. In group A, 24 [80%] were VAS [visual analogue scoring] 3 [uncomfortable] and 6 [20%] were VAS 2 [mild pain] whereas in study group B, 11 [36.6%] were VAS 3, 19 [63.3%] were VAS 2 and 19 [63.3%] were VAS 2 during 1st 12 hrs postoperatively [p=0.001]. In 12-24 hrs post operatively, 15 [50%] patients were VAS 3 in group A and same number was VAS 2 and in group B, only 3 [10%] were in VAS 3 and 27 [90%] were VAS 2 [p=0.001]. A combination of subcutaneous and peritoneal infiltration with bupivacaine is superior in relieving post appendectomy pain so patients require less dosage of analgesics in early post operative period along with early mobilization