Tree species composition, growing stock and biomass carbon dynamics of the major timber species in Hindu Kush regions of Pakistan

Abstract Using inventory data, this study evaluates the species composition, growing stock volume (GSV), and biomass carbon (BMC) of the five major timber species in the sub-tropical, and temperate/sub-alpine regions of Pakistan. It was found that the stem density varies between 50 and 221 trees ha -1, with a mean of 142 trees ha-1 (13.68 million trees for entire forest area). Among the species, Pinus wallichiana showed a high species composition (27.80%) followed by Picea smithiana (24.64%). The GSV was found in the range of 67.81 to 425.94 m3 ha-1, with a total GSV value of 20.68 million m3 for the entire region. Similarly, The BMC ranged from 27.04 to 169.86 Mg ha-1, with a mean BMC value of 86.80 Mg ha-1. The total amount of stored carbon was found at 8.69 million tons for a total of 95842 ha of commercially managed forest. Furthermore, the correlation analysis between the basal area (BA) and GSV and BMC showed that BA is the best predictor of GSV and BMC. The findings provide insights to the policy makers and forest managers regarding the sustainable commercial forest management as well as forest carbon management in the recent global carbon management for climate change mitigation.

Resumo Usando dados de inventário, este estudo avaliou a composição de espécies, volume de estoque crescente (GSV) e carbono de biomassa (BMC) das cinco principais espécies madeireiras nas regiões subtropicais e temperadas/subalpinas do Paquistão. Constatou-se que a densidade do caule variou entre 50 e 221 árvores ha-1, com média de 142 árvores ha-1 (13,68 milhões de árvores para toda a área florestal). Entre as espécies, Pinus wallichiana apresentou alta composição de espécies (27,80%), seguida de Picea smithiana (24,64%). O GSV foi encontrado na faixa de 67,81 a 425,94 m3 ha-1, com um valor total de 20,68 milhões de m3 para toda a região. Da mesma forma, o BMC variou de 27,04 a 169,86 mg ha-1, com valor médio de 86,80 mg ha-1. A quantidade total de carbono armazenado foi de 8,69 milhões de toneladas para um total de 95.842 ha de floresta manejada comercialmente. Além disso, a análise de correlação entre área basal (BA), GSV e BMC mostrou que BA é o melhor preditor de GSV e BMC. As descobertas fornecem insights para os formuladores de políticas e gestores florestais sobre o manejo florestal comercial sustentável, bem como o manejo florestal de carbono no recente gerenciamento global de carbono para a mitigação das mudanças climáticas.

Tree species composition, growing stock and biomass carbon dynamics of the major timber species in Hindu Kush regions of Pakistan / Composição de espécies de árvores, estoque em crescimento e dinâmica de biomassa de carbono das principais espécies madeireiras nas regiões de Indocuche no Paquistão

Using inventory data, this study evaluates the species composition, growing stock volume (GSV), and biomass carbon (BMC) of the five major timber species in the sub-tropical, and temperate/sub-alpine regions of Pakistan. It was found that the stem density varies between 50 and 221 trees ha -1, with a mean of 142 trees ha-1 (13.68 million trees for entire forest area). Among the species, Pinus wallichiana showed a high species composition (27.80%) followed by Picea smithiana (24.64%). The GSV was found in the range of 67.81 to 425.94 m3 ha-1, with a total GSV value of 20.68 million m3 for the entire region. Similarly, The BMC ranged from 27.04 to 169.86 Mg ha-1, with a mean BMC value of 86.80 Mg ha-1. The total amount of stored carbon was found at 8.69 million tons for a total of 95842 ha of commercially managed forest. Furthermore, the correlation analysis between the basal area (BA) and GSV and BMC showed that BA is the best predictor of GSV and BMC. The findings provide insights to the policy makers and forest managers regarding the sustainable commercial forest management as well as forest carbon management in the recent global carbon management for climate change mitigation.

Usando dados de inventário, este estudo avaliou a composição de espécies, volume de estoque crescente (GSV) e carbono de biomassa (BMC) das cinco principais espécies madeireiras nas regiões subtropicais e temperadas/subalpinas do Paquistão. Constatou-se que a densidade do caule variou entre 50 e 221 árvores ha-1, com média de 142 árvores ha-1 (13,68 milhões de árvores para toda a área florestal). Entre as espécies, Pinus wallichiana apresentou alta composição de espécies (27,80%), seguida de Picea smithiana (24,64%). O GSV foi encontrado na faixa de 67,81 a 425,94 m3 ha-1, com um valor total de 20,68 milhões de m3 para toda a região. Da mesma forma, o BMC variou de 27,04 a 169,86 mg ha-1, com valor médio de 86,80 mg ha-1. A quantidade total de carbono armazenado foi de 8,69 milhões de toneladas para um total de 95.842 ha de floresta manejada comercialmente. Além disso, a análise de correlação entre área basal (BA), GSV e BMC mostrou que BA é o melhor preditor de GSV e BMC. As descobertas fornecem insights para os formuladores de políticas e gestores florestais sobre o manejo florestal comercial sustentável, bem como o manejo florestal de carbono no recente gerenciamento global de carbono para a mitigação das mudanças climáticas.

Echocardiographic Wall Motion Abnormalities in Hypertensive Patients with Electrocardiographic Left Ventricular Hypertrophy

Background: During the cardiac cycle with the effect on cardiac function, Echocardiographic wall motion abnormalities are kinetic alterations in the cardiac wall motion. It can be characterized as per their grades and their distribution pattern like segmental or global. It can be attributed to a coronary territory or follow a non-coronary distribution. Aim of the study: The aim of the study was to evaluate the patterns of echocardiographic wall motion abnormalities among hypertensive patients with electrocardiographic left ventricular hypertrophy.Material & Methods:This was prospective observational study which was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2020 to January 2021. In total 76 hypertensive patients with electrocardiographic left ventricular hypertrophy were included as the study subjects for this study. This study was approved by the ethical committee of the mentioned hospital. A predesigned questioner was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 23 programs as per necessity.Results:In this study, in analyzing the status of wall motion abnormalities (WMA) among the participants we observed that, 22% of the patients were with segmental wall motion abnormalities, 18% were with global dysfunction and 59% were fully free from any type of WMA. Among patients with global dysfunctions, 71% were with mild and 12% were with moderate-to-severe dysfunction whereas this ratio was 47:24 in segmental abnormality patients. On the other hand, in analyzing the severity and location of patients with segmental WMA we observed that 47%, 24%, 53%, 41%, 18%, 24%, 29%, 47%, 35%, 53% and 41% were with mild dysfunction, moderate-to-severe dysfunction, inferior wall dysfunction, antero-septal dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction respectively.Conclusion:In this study, majority of the participants were found free from any type of wall motion abnormality. ‘Mild dysfunction’, inferior wall dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction are found as some more frequent dysfunctions among patients with WMA.

Three point fixation is superior to two point fixation technique for zygomatic complex fracture

Background:Isolated zygomatic or malar bone fractures are second most common fracture among facial skeletal injuries. It has been reported that three point fixation is appropriate for isolated zygomaticbone fracture. The objective of current study was to compare the mean difference in terms of malar height outcome by using different fixation techniques (two point and three point)in patients with zygomatic complex fracture.Methods:This randomized controlled trial was conducted at Department of Oral and Maxillofacial Surgery, MMDC, Multan, during a period of six months from 1st June 2017 to 30th November 2017. A total 182 patients of both genders were included in this study. Two point fixation techniques were used in Group-A patients. While 3 point fixation was used in Group-B patients. After 6 weeks follow-up, patients were assessed for malar height. Outcome was measured by comparing the mean difference of pre and postoperative malar height of both techniques. Data were analyzed using computer program SPSS-21. P≤0.05 was taken as significant in all analysis.Results:Among patients in two pointfixation group, the mean malar height was 67.55±2.98 mm and in three pointfixation group, meansmalar height was 71.55±2.36 mm. The difference of malar height among two treatments was highly significant with p<0.01. Conclusions: Using three point fixation results better as compared to two point fixations in terms of malar height outcome

Biochemical changes in subjects with fatty liver: Is there a link?

Objective:To evaluate the biochemical markers including serum triglycerides, ALT, and fasting plasma glucose in detection of fatty liver disease

Methodology:This cross-sectional analysis was carried out at the department of radiology and pathology, PNS Rahat hospital,Karachi between March-2010 to February-2011.Sixty-two subjects with an ultrasonographic diagnosis of fatty liver were compared with thirty-seven subjects with normal ultrasound for fatty liver, after excluding all other abnormalities on history and examination. The comparison included measurement of biochemical abnormalities including fasting blood glucose, triglycerides, total cholesterol and alanine transaminase [ALT]

Results:The results of fasting blood glucose[[Fatty liver group=7.06 +/- 3.51mmol/L][Without fatty liver disease=5.12 +/- 0.56 mmol/L] [p = 0.002]], serum triglycerides [[Fatty liver group=2.56 +/- 1.33 mmol/L ] [Without fatty liver disease=1.68 +/- 0.97 mmol/L ] [p = 0.001]] and ALT[[Fatty liver group=36.37 +/- 18.12 IU/L] [Without fatty liver disease=28.15 +/- 13.95 IU/L] [p = 0.026]] were significantly higher in subjects with fatty liver disease. The Receiver Operating Curve [ROC] analysis showed fasting blood glucose and serum triglycerides to have the most area under the curve [AUC] as 0.747 [95% CI: 0.647-0.847] and 0.731[95% CI: 0.622-0.840]; while the other parameters have AUCs as: Serum ALT-0.650 [95% CI: 0.532-0.767] and total cholesterol-0.509 [95% CI: 0.389-0.629]

Conclusion: Hyperglycemia and hypertriglyceridemia are associated with an ultrasonographic diagnosis of fatty liver. Raised transaminase levels in subjects with fatty liver disease also suggest underlying hepatocyte damage

Mitral valve replacement in systemic lupus erythematosus associated Libman-Sacks endocarditis

Libman-Sacks endocarditis, first discovered in 1924, is a cardiac manifestation of systemic lupus erythematosus [SLE]. Valvular involvement has been associated with SLE and antiphospholipid syndrome [APS]. Mitral valve, especially its posterior leaflet, is most commonly involved. We report a case of a 34 year old woman with antiphospholipid antibody syndrome and SLE, who presented with mitral valve regurgitation. The patient underwent a prosthetic mitral valve replacement, with no followup complications. We suggest mechanical valve replacement employment in the management of mitral regurgitation in Libman- Sacks endocarditis, in view of the recent medical literature and our own case report

Resection of posterior mediastinal tumors by video assisted thoracic surgery

This case report illustrates successful Video Assisted Thoracic Surgery [VATS] performed on a 45-year-old woman and 52-year-old man presenting with a mass in left and right paravertebral space on the CT scan respectively. VATS has many benefits over traditional open operation [thoracotomy], resulting in less pain and shorten recovery time. However, VATS has higher equipment cost but when an experienced surgeon performs the surgery, better outcomes are achieved. VATS is not common in Pakistan's surgical setup as it is an expensive method of eradicating mediastinal pathologies and not every patient undergoes VATS. The primary objective of presenting these cases is to promote the use of VATS specifically for removal of posterior mediastinal tumors and improve the surgical outcomes

Strangulated paraesophageal hiatus hernia: a case report

Strangulation of hiatus hernia is a rare event and difficult to diagnose in emergency. We are reporting a case of 14 year old girl who was diagnosed sliding hiatus hernia since childhood but due to delayed treatment presented in emergency with perforation of stomach and generalized peritonitis. She was treated successfully

Massive retroperitoneal mass - giant schawanoma

Schwannoma are usually solitary, slow growing, and non-aggressive neoplasms usually found in head and neck region. Retroperitoneal Schawanoma especially large sized are rare and difficult to diagnose clinically. We are discussing a 43 years old lady, who presented with huge reteroperitoneal mass of left side, treated successfully

Characteristics and in Hospital Clinical Outcome of Patients with Non St-Segment Elevation Myocardial Infarction with Chronic Kidney Disease.

Background: Nearly 40% of patients presenting with Non ST-Segment Elevation Myocardial Infarction (NSTEMI) have Chronic Kidney Disease (CKD). CKD is a powerful predictor of adverse events among NSTEMI patients. The purpose of the present study was to evaluate the in-hospital outcome of patients with Chronic Kidney Disease presenting with Non ST-Segment Elevation Myocardial Infarction. Methods: In this prospective observational study a total of 128 patients with NSTEMI were enrolled. They were divided equally in group I (NSTEMI with CKD) and group II (NSTEMI with normal renal function) on the basis of estimated glomerular filtration rate. Patients were considered to have CKD if he/she had documented history of CKD or estimated glomerular filtration rate <60 mL/min/1.73 m². Presence of inhospital complications was identified. Results: Patients with CKD were significantly older, with a greater prevalence of hypertension, diabetes mellitus, lower left ventricular ejection fraction, and lower haemoglobin level compared with those without CKD. CKD patients had more atypical presentation during admission. In-hospital complications were significantly higher in CKD patients presenting with NSTEMI. Conclusion: CKD strongly predicts adverse in-hospital outcome among NSTEMI patients.

Effect of bleaching on shear bond strength of orthodontic brackets

The purpose of this in vitro study was to determine the effect of bleaching on shear bond strength of orthodontic brackets. This randomized control trial was performed over a period of 6 months in the department of orthodontics, de,Montmorency College of Dentistry, Lahore. A total of one hundred and forty extracted premolar teeth were included which were further divided into two groups. Group A was assigned as control group without bleaching and Group B as study group with bleaching. The teeth in both groups were embedded individually in acrylic placed in rubber moulds using a mounting jig so that the labial surfaces would be parallel to the applied force during the shear test. Group B was bleached with Pola office advanced tooth whitening system and were stored in a solution of 0.9% saline till they were bonded. The bonding process for both groups was then performed in a standard manner. After bonding bracket was properly positioned on its respective tooth. An occluso-gingival load was applied to the bracket producing a shear force at the bracket tooth interface using a computerized shear bonding testing machine. The results showed that there was no statistically significant difference between the shear bond strength of unbleached teeth and that of bleached teeth following a two weeks interval after bleaching

Role of newspapers in health policy making in Punjab

This paper looks at the role of newspapers in health policy making in Punjab, the largest province of Pakistan in terms of population, with nearly 56% of the country's entire population. For the inclusive progress of socio-economic facet of the general public, government should give top priority to the investment in the health sector. Health is the second biggest public sector when it comes to physical infrastructure and human capital in Punjab. Health sector of Punjab is faced with numerous anomalies and the government has been undertaking reforms with intervals. Announcement of health policy is an important initiation for government's plan for the advancement of health sector, in this regard how the media and in case of this study, newspapers, impact health policy making. Newspapers provide a channel which is used by the policy makers to make promises and deliver intentions. Public's Feedback is an essential part of this process and is under investigation in this study. Newspapers can set the direction for public's welfare by covering a specific matter and overlooking the other. With regard to this function of the newspapers this research endeavors to discover the role newspapers in health policy making by adopting the technique of content analysis of four sampled newspapers for the period of six months

Diagnostic accuracy of saline hysterosonography in cases of abnormal uterine bleeding

To evaluate diagnostic accuracy of saline hysterosonography in diagnosing endometrial hyperplasia taking histopathology as gold standard. Validation study. Radiology Department MH/CMH Rawalpindi form 10th July 2006 to 10th January 2007. Fifty cases of Abnormal Uterine Bleeding comprising both pre and post menopausal patients were included. They were selected on non probability convenience sampling technique. Saline hysterosonography was conducted in the Radiology Department and results compared with histopathological findings. Among 50 patients who underwent saline hysterosonography, 40 patients were diagnosed to have positive findings while 10 did not show any abnormality on saline hysterosonography. Of the 10 patients whose endometrium did not show any abnormality on saline hysterosonography, 8 were found to be normal on histopathology and 2 cases showed abnormality. One case was of endometrial hyperplasia and the other showed a benign endocervical polyp which was missed on saline hysterosonography. This showed that Saline hysterosonography has a sensitivity of 94.7%, specificity of 66.7%, and an overall diagnostic accuracy of 88%. Saline hysterosonography is highly accurate in the diagnosis of endometrial pathologies. It is cost effective, well tolerated by patients and can be performed as an outpatient procedure

Rare Case of Ruptured Sinus of Valsalva: Ruptured Into Left Ventricular Cavity.

Rupture sinus of Valsalva is a relatively rare condition. We report a rare case of ruptured left sinus of valsalva with aneurysm, presenting with acute left ventricular failure. Transthoracic echocardiography showed an aneurysmal dilatation of the base of interventricular septum and part of the aortic root and a marked turbulent flow from the aortic root to the left ventricle with a continuous systolodiastolic shunting. The patient underwent successful repair of ruptured sinus of valsulva with closure of fistula. During Ventriculotomy the defect was repaired using pledgeted 5/ 0 prolene interrupted sutures and pericardial patch.

Pheochromocytoma with hypertensive crisis due to glucocorticoid administration: a case report and review of the literature.

We report a patient who presented with single episode of severe hypertension after intramuscular injection of betamethasone which was given to treat acute exacerbation of bronchial asthma. Episode of severe arterial hypertension was associated with pulmonary edema, acute renal failure and hyperkalemia. Further evaluation by appropriate diagnostic tests revealed that the patient is a case of phaechoromocytoma. This neoplasm was excised successfully and the patient is presently asymptomatic.We believe that this episode was initiated by glucocorticoid injection.

Management of congenital club foot

Aims and Objectives: To determine the effectiveness of Ponseti technique with the kite method in the management of congenital club foot

Study Design: It was a prospective interventional study

Place and Duration of Study: The study was conducted in the department of Orthopedic Surgery Foundation University Medical College and Fauji Foundation Hospital Rawalpindi from 1st October 2009 to 31st June 2010

Results: Total of 46 patients with grade 2 deformity was included in the study who meets the inclusion criteria. Patients were randomly divided into two groups of 23 each. Majority of the patients [65%] were between 05-09 weeks of age. The mean age was recorded as 7.7 weeks with S.D of 5.21. TEV is a predominantly male's disease as 65% patients in this study were males, while 35% were females in group-A. Similarly in group-B, males were 78% and 22% were female. Outcome of both the procedures was recorded at three months follow up. In group-A success rate was recorded 74% as compared to group-B in which 87% patients were found in satisfactory range with more than 25 passive range of dorsiflexion at ankle joint

Conclusion: Conservative Ponseti method is the best option for the management of Congenital Talipes Equino Varus [clubfoot] for grade 2 deformity, when starts early. This not only corrects the deformity, preventing surgical intervention but also lessens the financial burden over the parents as well as on the health system

Acute abdomen cases presenting at Fauji Foundation Hospital, Rawalpindi

To study the common causes of acute abdomen at Fauji Foundation Hospital, Rawalpindi, Study Design: Descriptive study. This Study was conducted at the Department of Surgery, Fauji Foundation Hospital, Rawalpindi from December 13, 2009 to February 22, 2011. A total of 840 patients who presented with acute abdominal pain and were admitted from the emergency department of Fauji Foundation Hospital, Rawalpindi from December, 2009 to February, 2011 were included in the study. The data of the 840 male and female patients was collected on the Patient Performa and then transferred to the data sheet IV of SPSS 10. The results were analyzed by calculating the frequencies of acute abdomen causes. The most frequent cause was non specific abdominal pain [38.7%] followed by acute cholecystitis [7.7%] and acute appendicitis [6.8%]. Total exploratory laparotomies done were 204 [24.3%] while 498 [59.3%] patients were managed conservatively with ultrasound abdomen and pain medication. Non specific pain was found to be the most common cause of acute abdomen followed by acute cholecystitis and acute appendicitis. The diagnostic accuracy can be enhanced especially in females of child bearing age by the use of ultrasonography and selective diagnostic laparoscopy

Frequency of ventricular arrhythmias during first 24 hours of acute myocardial infarction in patient thrombolysed with streptokinase

To assess the frequency of ventricular arrhythmias during first 24 hours complicating first episode of Acute Myocardial Infarction in patients thrombolysed with Streptokinase. Cross-sectional, prospective, observational and qualitative study. This study was conducted at Sialkot Medical Complex for six months from March 2010 to August 2010. 200 consecutive patients with acute myocardial infarction who received Streptokinase were assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the time of admission was done. Arrhythmias from the cardiac monitor's memory noted and documented. Ventricular arrhythmias studied were ventricular fibrillation [VF], sustained ventricular tachycardia, accelerated idioventricular rhythm, non-sustained ventricular tachycardia and premature ventricular beats > 10 beats per hour. Findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Reperfusion arrhythmias were observed in 20% of the patients [40/200] in first 24 hours after thrombolytic therapy presenting with first acute myocardial infarction. All the patients included in the study showed the ECG criteria of STEMI and positive quantitatively Troponin T test. Inferior wall MI was the most common type of acute MI. All the patients received IV Streptokinase as thrombolytic agent. The patients with sustained VT [33%] received cardioversion and IV amiodarone. Non-sustained VT were managed by observation only [77%]. A total of 35 patients survived in first 24 hours, five died. Reperfusing arrhythmias are commonly observed in first 24 hours after Streptokinase therapy for acute myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires observation only but sustained ventricular arrhythmias [VF, VT] can be life-threatening and therefore must be considered for treatment, Electrical cardioversion is preferred over pharmacological treatment in case of sustained ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently

Relationship of C · reactive protein with essential hypertension at 1st presentation and effect of antihypertensive treatment on micro inflammation

Objective: to determine the relationship of C- reactive protein with essential hypertension at 1st presentation and effect of angiotensin-11 receptor blockade on micro-inflammation

Material and Methods: twenty healthy controls and forty patients of stage 1 and stage 2 essential hypertension diagnosed at their 1st presentation at outpatient department of Services Hospital Lahore was studied. Blood of all patients was checked for CRP at 1st presentation and at the end of twelve weeks. Patients were divided in two groups A and B, group A received valsartan 80 to 160 mg per day and group B received amlodipine 5 to 20 mg per day. None of the patients required additional antihypertensive therapy

Results: the mean change in hsCRP was 0.09 mg/L among those allocated to amlodipine compared with 0.08 mg/L among those allocated to valsartan. When the means of hsCRP were compared in three groups, it was found that initial hsCRP levels were high in hypertensive group and after twelve week treatment with antihypertensive medicines there was significant drop in hsCRP levels [p<0.05]. Within the groups neither amlodipine nor valsartan showed the individual benefit on each other [p>0.05], both of them were equally effective in reducing hsCRP. No relationship was observed between hsCRP change and change of blood pressure

Conclusion: it is concluded that C-reactive protein is high in hypertensive patients and adequate control of blood pressure is required to prevent the vasculature from atherosclerotic damage

Co relation of thyroid function test with the clinical presentation

To correlate the biochemical thyroid profile with the clinical presentation of the patient and decision about the time of surgery. It is an analytical cross sectional study. This study was carried out in the Department of Surgery, Fauji Foundation Hospital, Rawalpindi from 1[st] January 2010 to 31[st] March 2011 Thirty patients were included in this study after taking consent and approval from the ethical committee of the hospital. All of them were females. Age ranges between 13 to 45 with mean of 22.26 years. These patients presented with a swelling in front of neck with or without signs of hypothyroidism or hyperthyroidism. Trial of 6 to 12 months given to every patient to bring the TFT's within normal range. Only those patients were included in the study who took the medicines regularly. Mode of presentation was out door department of Fauji Foundation Hospital Rawalpindi. Patients were examined clinically by surgeon and anesthetist for risk assessment. Routine laboratory investigations including thyroid function test were requested and analyzed by operating surgeon. TFT's were co-related with the clinical signs and symptoms of the patients. Patients were divided into two groups. Group one includes clinically euthyroid patients with TFT's within normal range. Group two again include clinically euthyroid patients but abnormal TFT's. A total of 30 patients were included in this study. All of them were females and clinically euthyroid. Mode of presentation was the outdoor patient department of Fauji Foundation hospital. Presenting complaint was swelling in front of neck. 23 out of 30 patients [66.6%] had normal TFT's and clinically euthyroid. 7 out of 30 Patients [33.3%] shows variation between their thyroid profile and clinical presentation. Sub or near total thyroidectomy was done in all the patients. Recovery was un-eventful. Operation on thyroid gland is a major undertaking and decision should be taken by senior surgeon. Ideally TFT's should be within normal range as well as patient should be euthyroid clinically in order to avoid post operative complications. In those cases where patient is clinically euthyroid but biochemically status is either hyper or hypo thyroid, surgery can be done after clinical trial of at least six months with thyroxin or anti thyroid drugs with a view to bring the TFT's within normal range. We can conclude that although the biochemical profile of the patients with thyroid disease is important but in country like Pakistan where thyroid hormonal assay is not easily available the surgery can be done by careful clinical assessment, keeping in view compliance of patient, regularity of taking medicine, clinical status and side effects of medical treatment