A Study of Two-field, Three-field, and Four-field Techniques using Rainbow and Thermoluminescent Dosimetry for Radiotherapy Treatment of Cervix Cancer

The aim of the present study is to investigate the rectal dose during three different radiotherapy techniques of dosimeter cervicalcancer. The study was carried out using a Anderson Rando female phantom. The thermoluminescent dosimetry (TLD) capsulesand detectors of rainbow dosimeter were employed for rectal and target volume dose determination. Several techniques ofexternal beam radiation therapy such as two field (AP-PA), three field, and four field with equal applied dose were planned.During application of different radiotherapy techniques, the maximum dose received by rectum is due to the two-field technique.The results of two dosimetry types were compared with each other. The mean and standard deviation values of two field, threefield, and four field for rectum are 1.97 ± 0.01, 1.68 ± 0.026, and 1.35 ± 0.05, respectively, whereas the mean and standarddeviation values of two field, three field, and four field for cervix are 2.03 ± 0.01, 1.98 ± 0.02 and 1.92 ± 0.01, respectively. Theresults were evaluated by the paired t-test. The P values calculated from data are as follows: Two field, cervix, P = 0.02; threefield, cervix, P = 0.0016; and four field, cervix, P = 0.0026, demonstrates that four field significantly reduces the rectum dose.This study showed that using TLD and rainbow dosimetry during radiotherapy could have a useful role as a predictor of choosingappropriate technique for preventing future rectal complications. Dose limitation to the rectum could possibly be achieved byusing three-field and four-field techniques with equal tumor dose while maintaining a high dose to the tumor.

Association of patent ductus arteriosus (PDA) with prematurity and low birth weight neonates

Background: Patent ductus arteriosus (PDA) is a major morbidity encountered in preterm neonates, especially in babies less than 28 weeks gestation or 1000g. It may close spontaneously in preterm neonates; however, failure to close spontaneously in preterm neonates results in significant mortality and morbidity in them.Methods: This prospective study was conducted in a tertiary care hospital in north India over a period of one year. The study cohort consisted of preterm, newborn babies admitted in the hospital with gestational age less than 37weeks and birth weight <2500g.Results: In this study total number of patients admitted during the study were 2930. Out of these preterm low birth weight neonates were 432. Among preterm low birth weight neonates admitted, 132 neonates were excluded as per exclusion criteria. Patent ductus arteriosus was detected in 56 among the 300 neonates giving an overall incidence of patent ductus arteriosus 18.6%, the incidence of patent ductus arteriosus was 56.2% for neonates weighing less than 1000gm, 24.7% for neonates weighing between 1000-1499g, 11.6% for neonates weighing between 1500-1999g and 5.6% for the neonates weighing between 2000-2499g.Conclusions: Thus, incidence of patent ductus arteriosus was inversely proportional to gestational age and birth. Data also suggest that immaturity is the major determinant of the persistent patency of ductus arteriosus.

Causes of acute renal failure: an etiological perspective study

Objective: To look into the causes of acute renal failure in this area so that preventive strategy can be designed

Study Design: Observational study

Place and Duration of Study: This study was carried out in Medical Outdoors, District Teaching Hospitals, Ghazi Khan Medical College, DG Khan and Khairpur Medical College, Khairpur Mir's from June 2013 to May 2014

Materials and Methods: A total of 100 patients of acute renal failure were included in the study

Results: There were 64 [64%] males and 36 [36%] females with ratio of 1.7:1. 60% patients in the younger age group and age range was 10-70 years. Nausea and vomiting were commonest symptoms in 92% of the patients while 88% patients were oliguric. All patients had tachycardia while 38% had volume over load. Blood urea was more than 100 mg/100 ml in 92% of patients. ARF because of pure medical reasons were seen in 48% of patients while surgical and pregnancy related problems were found in 26% each

Conclusion: Early referral, identification and treatment of pre-renal factor, good perinatal care and cautious therapeutic decisions can substantially bring down the incidence of acute renal failure

Overt thyroid dysfunction during treatment of hepatitis c patients with interferon and ribavirin

Objective: To find out the thyroid dysfunctions during treatment hepatitis C patients with Interferon and Ribavirin

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out at the Teaching Hospital, Ghazi Khan Medical College, DG Khan from April 2015 to January 2016

Patients and Methods: Fifty patients of chronic HCV were enrolled

Results: Out of 50 treated patients 35 were female and 15 were male. Fifteen [15%] patients developed thyroid dysfunction and out of these 15 patients [11 female [73.3%] and 4 male [26.7%]].Ten [66.6%] out of 15 patients developed hypothyroidism and 5[33.3%] out of 15 patients developed hyperthyroidism. Seven [70%] out of 10 patients who developed hypothyroidism needed levothyroxine therapy. Two [40%] out of 5 patients who developed hyperthyroidism needed carbimazol therapy for their symptoms and disease control. All patients completed hepatitis C treatment with combined Peg-Interferon Alpha-2a and Ribavirin therapy

Conclusion: The involvement between thyroid dysfunction in hepatitis C individuals and management with IFN- alphaandRIBA

Balanced diet; balanced life

Objective: Non-pharmacological intervention to manage the health by healthy balanced diet and life style modifications

Study Design: Randomized Cross sectional Study

Place and Duration: Pakistan Council of Scientific and Industrial Research [PCSIR] laboratory Karachi from March 2012 to June 2013

Material and Methods: In this study, 210 volunteers were included [137 male and 73 female] aged between 25-60 years. The study was conducted with the questionnaire being filled at PCSIR labs, Karachi. The study period included from March to May 2012. One year later the same group of volunteers were re-examined from March to June 2013, who managed to alter the diet and life style for one year. The questionnaire was filled by an expert well versed in collecting the data from the patients who attended the OPD at PCSIR labs

Results: The results indicate that a lot of people in our population lead a sedentary life style and do not take part in physical activity which leads to health problems due to comparatively less energy / calories expenditure

Conclusion: Efforts should be made globally to create a public awareness and provide healthy environment to the people about pursuing healthy lifestyles. Several life style behaviors may influence to maintain energy balance over long term. The primary approach for achieving weight loss is lifestyle changes which includes reduced intake of calories and increase in physical activity. Regular, moderate intensity physical activity enhances long term weight maintenance and balance between energy input and output

Allgrove (Triple A) Syndrome: A Case Report from the Kashmir Valley

Allgrove (Triple A) syndrome is a rare autosomal recessive disorder characterized by cardinal features of adrenal insufficiency due to adrenocorticotropic hormone (ACTH) resistance, achalasia, and alacrimia. It is frequently associated with neurological manifestations like polyneuropathy. Since its first description by Allgrove in 1978, approximately 100 cases have been reported in the literature. Here we report an 18-year-old boy diagnosed as having Allgrove syndrome, with ACTH resistant adrenal insufficiency, achalasia, alacrimia, and severe motor polyneuropathy. Alacrimia was the earliest feature evident at the age of 8 years. He presented with achalasia and adrenal insufficiency at 12 and 18 years respectively and developed neurological symptoms in the form of severe muscle wasting at the age of 15 years. Patients with Allgrove syndrome usually manifest adrenal insufficiency and achalasia during first decade of life. Our patient manifested adrenal insufficiency and achalasia in the second decade and manifested neurological dysfunction before adrenal dysfunction.

Inter-arch tooth size discrepancy among different sagittal malocclusion groups and its clinical implications

The relationship of the mesiodistal widths of the maxillary and mandibular teeth influences the optimal final occlusion, overbite and overjet. The aim of this study was to compare inter-arch tooth size ratios among different malocclusion groups and to determine the percentage of clinically significant cases [outside two SD from the Bolton's mean] in each malocclusion group. Pretreatment records of 110 patients belonging to different malocclusion groups [Class I = 40, Class II = 40, Class III = 30] were evaluated for Bolton's anterior, overall and posterior ratios. Angle's classification system was used to assign cases into different malocclusion groups. No significant difference was found in anterior, posterior and overall Bolton's ratios among the three malocclusion groups. Forty percent of the entire sample had clinically significant discrepancy in anterior ratio, while 14.54% patients had discrepancy in overall ratios. In Class I malocclusion group, 37.5% patients had anterior ratios and 20% had overall ratios discrepancy outside 2 SD from Bolton's mean. In Class II group, 35% patients had anterior ratios and 12.5% had overall ratios outside this range. In Class III malocclusion group, 50% patients had anterior and 10% patients had overall ratio discrepancies outside 2 SD from Bolton's means. No significant difference was found between males and females when the three ratios were compared between the two genders in individual malocclusion groups as well as in the entire sample

Papillary thyroid carcinoma; the frequency of multifocality in patients undergoing total thyroidectomy

At Mayo Hospital Lahore, from August 2010 to April 2011. Was to determine the frequency of multifocality among all cases presented with papillary thyroid carcinoma [PTC] planned to undergo total thyroidectomy [TT]. Data of all patients of PTC was collected from inpatient department of East Surgical ward. All the patients underwent total thyroidectomy by same team of consultant surgeons. A total of 35 patients of PTC with mean age of 37.94 years were included. Multifocal tumor was found in 31.4%. Out of them, 72.7% were females and 27.3% males. This case series showed that a multifocality is highly prevalent in PTC and total thyroidectomy should be done as the treatment for PTC, to eliminate the additional tumor foci in thyroid gland and prevent its recurrence

Incidence of bacteria resistance to bacteria resistance antibiotics in hospitals

To study the incidence of Bacteria resistance to antibiotics in hospitals. Experimental study. This study was conducted at Shaheena Jamil Teaching Hospital Abbotabad and Islam Teaching Hospital Sialkot from 1[st] January 2012 to 30[th] April 2013. 100 cases of Bacteria resistance to antibiotics in hospital patients were selected by doing culture and sensivity test in labs of Shaheena Jamil hospital Abbottabad and Islam teaching hospital Sialkot. Bacteria resistant to Penciline was the most highest, 147 cases [36.75%] and the lowest incidence of bacteria resistant to Levofloxin, 20 cases [05%] as shown in table No.l. The incidence of bacteria resistant to antibiotics with relation to age was maximum at 1-10 years, 15 cases [3.75%] and maximum in age group 21-30 years, 105 cases [25.75%] as shown in table No.2. The incidence of bacteria resistant to antibiotics in females were, 207 cases [51.75%] and in male, 193 cases [48.25%] as shown in table No.3. The incidence of bacteria resistant to antibiotics was the highest in office servants and factory workers, 54 cases [13.50%] and 53 cases [13.25%] respectively and the lowest in students, 20 cases [05%] as shown in table No.4. The incidence of bacteria resistant to antibiotics was highest in middle class of peoples, 189 cases [47.25%], 159 cases [39.75%] in low socio-economic group of peoples and 52 cases in high gentry, 52 cases [13%] as shown in table No.5. The incidence of bacteria resistant to antibiotics was more in peoples living in rural area, 221 cases [55.25%] as compared to peoples living in urban area. 179 cases [44.75%] as shown in table No.6. The incidence of Bacteria resistance to antibiotics was rising day by day misuse of antibiotics, therefore the use of antibiotics should be only by a qualified doctor prescription

Incidence of Hepatitis A, B and C with relation to age, sex, occupation, socio economic status, and urban or rural area of Hazara division and district Sialkot

To study the incidence of Hepatitis A, B and C with relation to age, sex, occupation, socio economic status, medical and surgical treatment, blade used for shaving and urban or rural area of Hazara division and district Sialkot. Original study. This study was conducted at Shaheena Jamil Teaching Hospital Abbotabad and Islam Teaching Hospital Sialkot from 1[st] January 2010 to 30[th] April 2013. 300 cases of Hepatitis A, B and C were randomly selected from the patients attending to OPD and emergency of Shaheena Jamil Teaching Hospital Abbotabad and Islam Teaching Hospital Sialkot and their peripheral districts. Results are shown in Table No. 1 to Table No. 9. The sanitary conditions of drinking water should be improve. The medical and paramedical staff should take care against syringe needle prick, surgical knife cut and blood transfusion. In barber shop during hair cutting and clean shave the blade should be new one and not reused. The sexual contact should be restricted to the life partner. The dental surgery is also one toll for Hepatitis spread. The aggravating factors such as occupation and socio economic status, medical and surgical treatment, blade used for shaving, surgical instruments, syringe, blood transfusion dentistry instruments should be free of infection and sanitary conditions should be improved

Incidence of tuberculosis with relation to age, sex, occupation, socio economic status and urban or rural area of Hazara division and district Sialkot

To study the incidence of tuberculosis in patients with relation to age, sex, occupation, socio economic status, medical and surgical treatment, blade used for shaving and urban or rural area of Hazara division and district Sialkot. Original study. This study was conducted at Shaheena Jamil Teaching Hospital Abbotabad and Islam Teaching Hospital Sialkot from 1[st] January 2010 to 30[th] April 2013. 500 cases of tuberculosis were randomly selected from the patients attending to OPD and emergency of Shaheena Jamil Teaching Hospital Abbotabad and Islam Teaching Hospital Sialkot and their peripheral districts. Results are shown in Table No. 1 to Table No. 5. The maximum incidence of tuberculoses was in age group [31-40 years] and 23.4%. The incidence of tuberculoses was in age group 71-80 years [08%] which was minimum with relation to age group as shown in Table No. 1. There was more incidence of tuberculosis [55.4%] in women as compared to men [44.6%] because men have more resistance against tuberculosis as compared to women as shown in Table No. 2. As shown in Table No. 3 the victims of tuberculosis were maximum in laborer [23%] and factory workers [22.2%] and minimum incidence of tuberculosis was found [1.6%] in house wives as compared to other groups of people. There was maximum incidence of tuberculosis in low socio economic group of people [65.4%] in middle class of people and 2.8% in high gentry as shown in Table No. 4. Which was minimum as compared to other groups of people. As shown in Table No. 5 there was 42.6% incidence of tuberculosis as compared to rural area 57.4%

Incidence of anemia in pregnancy. A randomized study at PMC hospital Nawabshah

In this part of the world anemia is one of the major public health problems especially in pregnant women. In our country the most important cause of anemia is poor diet repeated pregnancies and lack of awareness about contraception. Anemia can easily be managed with well nourish diet, with supplements of iron folic acid and multivitamin tablets. In our areas socio-economic problem is one of the causes which can be cope with help of Government and Non- Governmental Organizations by providing iron tablets and iron fortified foods to the population as a prophylaxis. To improve their health, pregnant women should regularly visit the clinics of Obs and Gynae and follow instructions of attending doctors and practice birth spacing in between the pregnancies. To determine the incidence of anemia in pregnant women in different socioeconomic classes in rural areas. Cross-sectional observational study. This study was conducted at the Department of Gynae and Obs, Peoples Medical College Nawabshah, and Sindh Pakistan from 1[st] March 2009to 30[th] June 2009. 850 pregnant ladies were included in the study who came to attend the antenatal clinic; where their history and clinical examination were recorded on a Performa. The ladies were divided into three socioeconomic classes, the higher, middle and lower class. 3ml of blood sample was taken from all the ladies for hemoglobin estimation and other necessary Lab test. A total number of 850 participants were included in this study, out of those 329 pregnant women were having hemoglobin [Hb] below 9 gm/dl, declared as anemic, the incidence as observed was 38.77% and the highest incidence was found in lower socioeconomic class. It can be concluded from this study that anemia is one of the major problem in pregnant women of rural areas. The incidence observed was 38.77% which was least [0.6%] in higher class and was highest [60.2%] in lower socioeconomic class

Efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children

To compare the efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children presenting at CMH Murree. Randomized control trail [RCT] Departments of Paediatrics and Pathology CMH Murree from August 2009 to March 2010. Forty one children diagnosed with iron deficiency anemia on the basis of hemoglobin, red cell indices and morphology and serum iron levels were included. Patients were randomized into two groups with group I of 18 receiving oral ferrous sulphate and group II of 23 receiving parenteral iron sorbitol therapy. Response was assessed by reticulocyte count at 1 week, change in hemoglobin, MCV and serum iron levels at 4 weeks post treatment. The reticulocyte response at 1 week time was significantly more with intramuscular iron as compared to oral iron. Mean hemoglobin change and serum iron level increase were also significantly more with intramuscular iron therapy. Mean MCV level change was insignificant between the two modalities. Parenteral intramuscular iron sorbitol treatment with better compliance shows early improved responses in children with iron deficiency anemia as compared to oral ferrous sulphate therapy and should be used as a preferred modality for treatment

Orthodontic treatment outcome assessment using peer assessment rating [PAR] index

The crosssectional study was carried out to determine the degree of improvement in malocclusion after orthodontic treatment provided at the Aga Khan University Hospital [AKUH], Karachi, and to find out which malocclusion showed a marked reduction in PAR score after orthodontic treatment. It was conducted from March 2007 to April, 2007. This study evaluated the last 50 consecutively finished orthodontic cases using PAR index. The material consisted of pre- and post treatment casts and orthodontic files. Pre- and post-treatment PAR score was calculated for each patient. All patients who received complete orthodontic treatment at this hospital and whose good quality records were available were included in the study. Re-treatment cases and patients transferred out of hospital were excluded. Records of 50 patients [38 females and 12 males] were evaluated for PAR score. The mean reduction in the PAR score was 24 points [91.95%]. The number of patients in 'greatly improved' category was 30 [60%], in 'improved' category 19 [38%] and in 'worse/no different' category 1 [2%]. Statistically significant correlation was found between percentage PAR score reduction and pretreatment PAR score. A significantly higher orthodontic treatment standard was achieved. The mean reduction in PAR score was almost 92%. The percentage of patients in 'Greatly improved' category was 60%. A significant correlation [p<0.001] was found between pre-treatment PAR score and percentage reduction in PAR score

LAP V/S Open Cholecystectomy: A Prospective Study of 800 Patients.

As the number of surgeons performing laparoscopic cholecystectomy(LC), a rigorous evaluation of the safety of LC is waranted. It is essential to determine the extent of the difference in morbidity and mortality when compared with open cholecystectomy(OC). To compare the complications occurring in the patients undergoing L.C as compared to those undergoing open cholecystectomy. In a study conducted over a period of 8 years, 400 patients who underwent LC were compared to 400 patients who had undergone OC. The two groups were compared with respect to complication (severity grade 1-4), hospital stay and time required to return to work. (using the student ‘t’ test). The overall complication rate in both the groups was 4.8%. In LC group, the rate of grade 1, grade 2a and grade 2b complications were 2.3%, 0.3% and 2.3% respectively and in OC group it was 4%, 0% and 0.8% respectively. It means that grade 1 complications were 1.89 times higher in open cholecystectomy group as compared to LC group and grade 2b complications are 3.04 times higher in LC group as compared to OC group, though the variations are insignificant statistically. There was 0% mortality in both the groups. Postoperative hospital stay and time taken to return to work were less with LC group. Laparoscopic and open cholecystectomy were found to be comparable procedures in terms of complication for the treatment of gall stone disease and LC has not been associated with any increase in untoward events.

Esophageal cancer in Kashmir [India]: an enigma for researchers

About 90% of esophageal cancers worldwide are Squamous Cell Carcinomas [SCC], mostly occurring in defined high-incidence areas of low and middle-resource countries. Historically, the highest incidences are reported in regions of Central Asia. One such region is Kashmir Valley in Northern India. In this review, we summarize a large body of epidemiological, toxicological and observational information on occurrence, dietary patterns and lifestyles to discuss factors that may be involved in the etiology of SCC in Kashmir Valley. To date, no single factor can be identified as the main cause of the excess incidence of SCC as compared to other regions of India. Three main components emerge as important factors: a societal component with poor, rural lifestyle and general deprivation, status in particular in vitamins and oligoelements; a lifestyle component with the use of copper utensil in cooking, the consumption of spicy, deep fried foodstuffs, and the drinking of hot salty tea; and an environmental component with exposure to high levels of dietary nitrosamines from diverse sources. Overall, these three components are similar to the general pattern of factors that have been involved in causing SCC in other high-incidence area in the so-called "esophageal cancer belt", namely in central China [Cixian, Lixian] and in Northern Iran [Golestan]. Further comparative studies between these regions are needed to identify the contributions of these various components

Courveilhier Baumgarten syndrome: a rare syndrome revisited

A 25 year old male had presented with history of abdominal distension of 20 days duration and on examination he had prominent abdominal vein and a venous hum with Ascites. He had no history of altered sensorium, melena. The clinical scenario was suggestive of Cruveilhier Baumgarten syndrome

Central venous pressure line; complications in surgical cases

To study the frequency of complications of central venous pressure line. Descriptive observational study. This study was carried out in surgical ward and intensive care unit of Fauji Foundation hospital Rawalpindi and Frontier Medical College Abbottabad. From 2003-2007. One hundred consecutive surgical patients needing central venous line insertion above 14 years of age were included in the study. Patients under 14 years of age, with central venous line in situ at the time of admission, with thoracic trauma, chronic obstructive pulmonary disease, burns involving upper chest and neck areas, cardiovascular disease and bleeding disorders were excluded from this study. 100 cases were included in the study with the range of age between 16-82 years. There were 76% female and 24% male. Out of these 100 cases 40 were suffering from malignancy, 20 were suffering from intestinal obstruction, 10 were with peritonitis and 30 cases were having miscellaneous disorders. Rate of complications of central venous line was 30% in this study. Rate of infection was 20%, rate of misplacement of catheter was 8% and rate of pneumothorax was 2% infection is the most common complication of the central venous line insertion followed by misplacement of catheter and pneumothorax, so it is important to take specific measures to minimize these complications

The Effect of Smoking Habits on Different Histological Types of Lung Cancer in Kashmir.

A prospective study was conducted with the aim to determine the effect of smoking habits on different histological types of lung cancer. A total of 100 patients that included 91 males and 9 females with histological documentation of lung cancer were enrolled in the study. A detailed history was taken in each case that revealed active smokers 90%. Of which cigarette smokers were 40%, Hooka and Bidi smokers 17.7% and 5.6% of cases respectively. We also observed lung cancer was more common among farmers 34% who were active hooka smokers. Squamous cell carcinoma was the main histological type of lung cancer associated with all types of smoking habits.