Analysis of Estrogen receptor [ER] and Progestrone receptor [PR] expression in surface Epithelial Tumors of Ovary and its correlation with their clinical stage

Objective: To evaluate ER and PR expression in epithelial ovarian cancers [EOC] and to determine its association with clinical stage

Study Design: Cross sectional study

Place and Duration of Study: Histopathology department, Armed Forces Institute of Pathology [AFIP] Rawalpindi, from Mar to Oct 2017

Material and Methods: A total of thirty three [n=33] histologically confirmed EOCs were analyzed. ER and PR expression status was assessed by immunohistochemistry using Allred scoring system and was compared with the clinical stage defined by The International Federation of Gynecology and Obstetrics [FIGO] staging system

Results: A total of thirty three [n=33] females were enrolled. Mean age of the study females was 50.8 +/- 12.9 years. Most frequent histologic type was serous carcinoma [SC] 60.6 percent [n=20] followed by mucinous carcinoma [MC] 15.2 percent [n=5], endometrioid carcinoma [EC] 9.1 percent [n=3], clear cell carcinoma [CC] 9.1 percent [n=3], Brenner tumor [MBT] 3 percent [n=1] and seromucinous carcinoma [SMC] 3 percent [n=1]. Most patients were in clinical stage I 61 percent [n=20] followed by stage II 24 percent, [n=8] and stage III 15 percent [n=5]. Among SC, 90.0 percent [n=18/20] were ER and 65 percent [n=13/20] were PR-positive. All MC and CC were ER/PR negative. Two of the three ECs were ER and one was PR-positive. Higher percentage of stage I tumors exhibited ER 65 percent [n=13/20] and PR 45 percent [n=9/20] positive status [p>0.5]. The correlation was very weak positive between clinical stages and both ER and PR scores [Allred] r=0.11 and 0.15 respectively p>0.05

Conclusion: Higher percentages of stage I tumors exhibited ER and PR positive status yet not statistically significant from stage II/III. Estimation of ER and PR receptor status may help to select the women with ovarian malignancy for hormonal therapy, which is more likely to improve the response rate

Comparison of functional outcome in Mayo Elbow performance score in Olecranon Fractures after treatment with Tension band wiring and locking compression plate

Objective: To compare mean change in the Mayo Elbow Performance Score in olecranon fracture after treatment with tension band wiring and locking compression plate

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Orthopaedics, Benazir Bhutto Hospital Rawalpindi, from Aug 2015 to Aug 2016

Material and Methods: Sixty patients were included in the study. Patients were divided into two groups, A and B. For group A, Locking compression plate while in group B tension band wiring was used. Follow-up was carried out at the end of 1st week and then at the end of 6th week post-operatively. Functional outcome was assessed by mean change in Mayo Elbow Performance Score

Results: Mean age in the study was 43.62 +/- 12.187 years. There were 32 [53 percent] male patients and 28 [47 percent] female patients, while 34 [57 percent] patients had Mayo IIB fractures and 26 [43 percent] had mayo IIA fractures. Twenty five patients [42 percent] belonged to ASA class II while 35 [58 percent] belonged to ASA class I. Twenty Six patients [43 percent] presented within 24 hours of the injury while 34 [57 percent] presented within 48 hours. Mean change in the Mayo Elbow Performance Score in TBW group was 8.77 +/- 3.54 versus 10.63 +/- 3.479 for the LCP group [p=0.044]

Conclusion: Locking Compression plate is superior to Tension Band Wiring in patients with olecranon fracture in terms of Mayo Elbow Performance Score

Mega cisterna magna diagnostic dilemma

Objective: To determine the frequency of isolated mega cisterna magna [MCM] in Saudi population, compare the accuracy of fetal ultrasound with postnatal neuro-imaging, report the associated central nervous system [CNS] anomalies on postnatal neuro-imaging

Study Design: Retrospective study

Place and Duration of Study: King Fahad Armed Forces Hospital Jeddah Saudi Arabia from Jan 2007 to July 2011

Material and Methods: This was a retrospective study conducted at King Fahad Arrmed Forces Hospital Jeddah, Saudi Arabia. We included all reported cases of fetal mega cisterna magna from January 2007 till July 2011. Ante-natal and postnatal records and neuro-imaging studies of all the cases were reviewed and documented on the database. Neurological assessment was done by Pediatric Neurology Consultant at an average age of 8 months of life

Results: MCM was diagnosed in 26 [0.12%] on fetal scans [15 male and 11 females]. Post natal scans were available for 20/26 [77%] and 6/26 [23%] cases were missing. Of the 20 post natal scans, 12 [60%] scans were normal and 8 [40%] scans were abnormal. The following abnormalities were detected: 3 [37.5%] cerebellar hypoplasia, 2 [25%] partial dysgenesis of corpus callosum, 2 [25%] cases were confirmed as MCM and 1 [12.5%] arachnoid cyst. Neuro-developmental assessment was reported as normal in 50% of the cases with associated CNS anomalies

Conclusion: The association of MCM with major CNS anomalies is significant in this study population. Post natal neuro-imaging confirmation is required for all fetuses with mega cisterna magna on fetal sonography

To determine the comparative values of lipid profile between ischemic and hemorrhagic stroke

Objectives: To determine the relationship of total cholesterol, HDL-C and their ratio among ischemic and hemorrhagic stroke

Study Design: An observational prospective comparative study

Place and duration: This research work was carried out from 1[st] June 2014 to 31[st] December 2014 at department of medicine Bahawal Victoria Hospital Bahawalpur

Methedology: Hundred patients between 30 to 90 years of age, who were admitted by the department of general medicine BVH Bahawalpur with first ever stroke and verified by CT scan brain, were included in the study. Patients who had history of coronary heart disease or lipid lowering drugs, neurological deficits secondary to epilepsy, infective or metastatic disorder, or pre-existing severe cognitive disorder were excluded from this study. A detailed history and physical examination details along with fasting lipid profile were collected from patient records in the hospital medical department. Mean values of quantitative data were presented as mean SD [standard deviation].Frequency percentage of total cholesterol, high density lipoproteins and triglycerides in both groups of ischemic and hemorrhagic stroke, were determined and compared using proportion test for any significant difference taking p-value of < 0.05 as significant

Results: Quantitative data of CVA, comprising [50 each of ischemic and hemorrhagic cases] was analyzed. Mean age of presentation was 56 years. In 50 ischemic patients mean total cholesterol was raised above normal reference range. It was 218.30 +/- 79mg/dl in ischemic stroke while it was 194 +/- 26.7mg/dl in hemorrhagic cases and it was highly significant at P value of < 0.001.The mean HDL concentration was 33.10 -7.33 in patients of ischemic stroke while it was 39.02-4.22 in hemorrhagic cases with p value of o.oo2 [highly significant]. Serum triglycerides levels turned out to be normal in both groups

Conclusion: Hypercholesterolemia and low HDLC was seen significantly in ischemic CVA group as compared to hemorrhagic counterpart

Bedside ultrasonography: a useful tool for traumatic pneumothorax

Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax

Study Design: Analytical study

Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015

Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard

Results: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33% and 54.76%, respectively and specificity of 100% for both modalities

Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk

Hospital waste management plan at bahawal victoria hospital, bahawalpur

Objective: To describe hospital waste management plan in our setting for primary to tertiary hospitals and to make it environmental friendly with respect staff safety

Study Design: Observational / cross sectional study

Place and Duration of Study: This study was carried out at Bahawal Victoria Hospital, Bahawalpur from May to August 2015

Materials and Methods: This study carried out as an assignment for the course of Environmental and Occupational Health point of view. Data has been collected from the staff of the BV Hospital and the Quaid-e-Azam Medical College, Bahawalpur as our study subjects. The purpose of this paper is to outline the hospital waste management plan in our setting from primary to tertiary hospitals in a comprehensive way to put forward suggestions for further improvement

Results: Among the hospital staff particularly doctors were not aware of any hospital waste management protocol/plan. Similarly nobody form the hospital staff recalled any training program or such activity to be performed in their respective wards or departments since ever. Just the concerned nursing staff had sort of interaction with the sanitary workers and the sweepers engage in their routine hospital cleaning process supervised by the sanitary inspectors. As such no health facilities had properly implemented any hospital waste management plan in accordance to expected standard and practices; just routine maintenance of the hospital cleanliness is being carried out and the wastes were collected and moved to the point of transportation or being transported direct to its disposal point

Conclusion: There is need to develop Hospital Waste Management policy and plan for institutions along with its allocation of appropriate funds. Hosp Waste disposal standard operating procedures in a way that such model can be implemented anywhere by little modification as per need assessment basis in all of our healthcare settings

Pattern of presentation of mandibular condylar fractures in relation with known risk factors

Mandibular fractures are one of the most common fractures of facial bones. Parasymphysis is the most common site followed by condylar and subcondylar areas of the mandible. A descriptive study was carried out at Department of Oral and Maxillofacidl Surgery, King Edward Medical University I Mayo Hospital, Lahore from 27th September 2011 to 26th September 2012. The study was carried out on forty patients with mandibular condylar fractures. The fractures were classified according to the Spiessl and Schroll classification system. Objective of this study was to describe pattern of presentation of mandibular condylar fractures and to evaluate factors leading to mandibular condylar fractures in a tertiary care hospital. 32 [80%] were males and 8 [20%] females. The age ranged from 1% to 65 years with mean of 26 years [SD +/- 16.90]. Road traffic accidents including motor bike, auto-rickshaw and car accidents were found to be predominant risk factors [15 patients - 37.5%]. Type II fractures [low neck displacement] comprised the highest proportion - 16 out of 48 fractures [33.3%]

Road traffic accidents and falls were the leading risk factors for mandibular condylar fractures identified in this study. Type II fractures were seen to be the most frequent variant of condylar fracture. It was noted that no specific pattern of condylar fracture was associated with any specific risk factors

Eruption time of premolars in children at urban schools of Lahore, Pakistan

The purpose of this study was to ascertain mean eruption ages of premolars in local school children and to compare with other population groups. cross sectional study. This study was conducted in the Deptt. Of Oral Maxillofacial Surgery, KEMU,Lahore from 17.12.2009 to 17.12.2010. The mean eruption ages of permanent teeth were derived from a cross sectional study of 4000 public and private schools children in Lahore with ages ranged 8-13 years. Children were from all classes of socioeconomic status. Sample was examined in good torchlight and emergence through the gingivae was noted. Maxillary premolars erupted earlier than the mandibular ones in both genders. The mean sequence of eruption in upper and lower arch was P[1], P[2]. Maxillary 1[st] premolar was the first tooth to erupt in boys and girls; whereas mandibular 2[nd] premolar was the last one. [1] The premolars erupted slightly earlier than the standards used in our practice of text books. [2] Maxillary premolars erupted earlier than mandibular premolars. [3] Local standards should be applied while planning preventive and interceptive orthodontic measures and treatment modalities in other specialties

survey to assess the food habits of school going children from high socioeconomic background

Objectives: To assess food habits of school going children from a high socio-economic background, Establish food frequency of commercially available foods and to determine the risk factors and to suggest the way to control these risk factors

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at the Department of Community Medicine, Al-tibri Medical College, Isra University, Karachi from 31stMay to 30thJuly, 2015

Materials and Methods: This survey was carried out on 200 students age of 6-12 years enrolled in KAS school belong to high socioeconomic group, randomly selected for interviews through an administrated structured food frequency questionnaire. This survey was conducted in three days during 8am to 3pm. All students who visited the health office for any reason were asked to participate in the study

Results: The mean age of respondents was 12.7 +/- 3.7 years. Thirty-nine reported missing at least one meal a day. Averagely the students consumed 4.2meals per day. Most frequently missed meal was evening tea/snack [n=17], followed by midday snack [n=12]. Few students reported missing lunch [n=3] or dinner [n=2] during the week

Conclusion: Students need to be encouraged to take healthy foods, by creating opportunities for better choices. Health education strategies can be effective implemented in a school setting through innovate means can ensure better outcomes

Oral squamous cell carcinoma; clinico-pathological parameters and AgNOR status in grading

The aim of this study was to evaluate clinico-pathological parameters and the status of argyrophilic nucleolar organizer regions stain in various histological grades of oral squamous cell carcinoma. A cross sectional study was conducted on fifty cases of oral squamous cell carcinoma. The specimen were collected from the department of Oral and Maxillofacial Surgery and processed for hematoxylin and eosin stain and AgNOR stain Pathology Laboratory, King Edward Medical University Lahore. Bidi smoking is associated with oral squamous cell carcinoma. The AgNOR [mAgNOR and pAgNOR] status was significantly low in well differentiated and moderately differentiated compared to poorly differentiated oral squamous cell carcinoma [p =0.001]. AgNOR size in poorly differentiated was significantly higher than the AgNOR size in well differentiated oral squamous cell carcinoma. Similarly the distribution of AgNOR in moderately and poorly differentiated oral squamous cell carcinoma was significantly high. The AgNORs index was significantly high in poorly differentiated squamous cell carcinoma as compared to well differentiated and moderately differentiated squamous cell carcinoma. The use of AgNORs stain is easy, valid and reliable method to assess the histological grading of oral squamous cell carcinoma and should be used to predict the prognosis of patients

Utilization of nasolabial flap for reconstruction of oral cavity defects

Objective of this study was to highlight the utilization of nasolabial flap for reconstruction of oral cavity defects. The study revealed the results of 21 nasolabial flaps in 14 patients over the period of two and a half year. The patients presented at the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore from November 2009 to November 2011 and at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital Lahore from May 2012 to October 2012. In 08[57.14%] patients the defects were secondary to Oral Submucous Fibrosis of buccal mucosae; 03[21.43%] patients were with biopsy proven Squamous Cell Carcinoma of the oral cavity and in 02[14.28%] patients flap was used to cover the post traumatic oro-antral defects secondary to firearm and machine injuries to the maxilla. One patient [7.14%] had the defect after resection of the cystic lesion of the maxilla. Uneventful flap healing was observed in 20[95.24%] and partial flap loss occurred in only 01[4.76%]. It was concluded that the nasolabial flap is a reliable and minimally traumatic local flap for reconstruction of small-to-medium sized oral cavity defects with predictable functional and good aesthetic results

Comparison of post operative complications in mandibular angle fractures treated by single versus two miniplates

The ojective of this study was to compare the complications [infection and non union] when fractures through the angle of the mandible are treated with a single noncompression miniplate versus 2 noncompression miniplates. 300 patients were randomly divided in two groups, 150 patients in each. Group A was treated by single non compression miniplate plate at superior borber of angle of mandible using intraoral approach. Group B was treated by two noncompression plates one at superior border as in group A, and other plate at lower border using extra oral approach. Patients were assessed for infection and non union on 21st, 45th and 60th days after the procedure. Mean age of patients in Group-A was 35.87 +/- 1.90 and in Group-B mean age of patients was 31.30 +/- 3.45 years respectively. Gender distribution showed that there were 241 [80.34%] [Group-A=124, Group-B=117] male and 59 [19.67%] female patients [Group-A=26, Group-B=33]. There were 10[6.67%] patients in Group-A and 22[14.67%] patients in Group-B who got infection at fracture site at 21st day.. At 45th day 6 [4%] patients in Group-A and 17[11.33%] patients in Group-B had infection. At 60th day infection was present in 10 [6.67%] patients and in Group-A only 2 patients had infection. This study shows that there are less chances of Infection when the patients are treated with one miniplate as compared to two miniplates for the treatment of displaced mandibular angle fractures

Acute appendicitis mean platelet volume

Objectives: To study mean platelet volume [MPV] in acute appendicitis and its correlation with leukocyte count

Study Design: Case control study

Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2013 to February 2014

Subjects and Methods: Subjects with clinical suspicion of acute appendicitis were selected according inclusion and exclusion criteria. A sample of 49 acute appendicitis patients and 37 controls were studied. The Blood samples were collected in sodium citrate vacutainers and processed on Sysmex KX 21 analyzers. The main analysis was the comparison of the difference of MPV between acute appendicitis and controls. Data was analyzed on SPSS version 21.0 by student's t-test, Chi-square test and Pearson's correlation [r] was used to evaluate association of MPV with platelet counts and leukocytes. A p-value of

Results: The mean platelet volume and leukocytes were significantly elevated in patients with acute appendicitis. MPV and leukocytosis in controls and cases were noted as 7.93 +/- 2.1 vs. 9.10 +/- 2.9fl [p=0.0001] and 6980 +/- 120 vs. 13980 +/- 340 micro L[-1] respectively. MPV was positively correlated with leukocytosis [r=0.419] [p=0.0001], while Platelets showed a negative correlation

Conclusion: Elevated MPV and leukocytosis are observed in acute appendicitis. MPV may be exploited for clinical diagnosis of acute appendicitis but in a proper clinical context along with leukocytosis

Evaluation of nacked eye single tube red cell osmotic fragility test for screening of beta thalassaemia trait

The study aimed to evaluate the validity and significance of Nacked Eye Single Tube Red cell Osmotic Fragility Test [NESTROFT] for screening of beta thalassaemia trait [BTT] to reduce the incidence of birth of thalassaemic child in community. Cross sectional study. This study was conducted at Diagnostic and Research Lab in Pathology Department of Peoples University of Medical Health Sciences [PUMHSW] at Shaheed Benazirabad from January 2013 to December, 2013. Total 504 subjects comprising 303 [60.3%] females and 201[39.7%] males with age ranging between 5 and 48 years and male to female ratio 1:1.5 were selected for this study. The family history of thalassaemia and history of cousin marriages were noted. EDTA anti-coagulated whole blood samples were collected for on-site NESTROFT testing, and later tested for Complete Blood Count [CBC] and serum Ferritin concentration at Diagnostic and Research Laboratory of Pathology Deptt. PUMHS. Screening for BTT was done on Naked Eye Single Tube Red cell Osmotic Fragility Test [NESTROFT] with 0.36% freshly prepared saline. The diagnosis of BTT was confirmed on automated Hemoglobin Electrophoresis at cellulose acetate alkaline pH. Red cell indices [automated Hematology cell counter cell-tac alpha] were assessed along with peripheral smear morphology [Leishman's stained slides] as enhanced tool for BTT case finding. Out of total 504 subjects 201 married women and 101 married men with their mean age [26.5 +/- 21.5] years were selected. In this study, female to male ratio was 1.5:1 and among the total 302 married subjects, ratio of cousin marriages [60.4%] was noted. Neither any women were pregnant nor there was history of thalassaemia in their families. The laboratory parameters such as the mean values of hemoglobin g/dl. RBC count millions/cmm, PCV%, MCV fl, MCH pg, MCHC g/dI among these subjects respectively were 11.9 g/dl, 4.5 millions/cram, 82 fi, 38.7%, 26.9 pg, 33.2 g/dl. Out of 504 samples, NESTROFT was positive in 21[4.1%] and negative in 483 [95.9%]. Out of all NESTROFT positive cases 15 [71.4%] were true positive confirmed on the hemoglobin electrophoresis with increased hemoglobin A2 level above 3.5 and remaining 6[28.6%] were false positive. Only 4 [1%] cases were false negative, then sensitivity, specificity, positive and negative predictive values and efficiency of NESTROFT were calculated 87%, 86%, 71%, 99% and 99.9 respectively. The NESTROFT is a valuable, cost effective screening test for beta thalassaemia trait

Prevalence and antibiotic susceptibility of methicillin resistant Staphylococcus aureus and Acinetobacter baumannii in clinical samples from intensive care unit patients in a tertiary care hospital at Peshawar [Pakistan]

Multi-drug resistance in Staphylococcus aureus and Acinetobacter baumannii [A baumannii] can cause a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis etc., which can lead to substantial morbidity and mortality, particularly in the ICU settings. These organisms have been shown to be increasingly resistant to a large group of antibiotics, especially [3-lactam antibiotics. The aim of the present study was to determine the prevalence and antibiotic susceptibility of methicillin resistant Staphylococcus aureus [MRSA] and A baumannii in patients admitted in Intensive Care Units [ICUs] of a tertiary care hospital in Peshawar, Pakistan. A total of 518 bacterial isolates were collected from different ICUs during die period from 1st November 2012 to 30 November 2013. Media, reagents and kits used for bacterial culture and analysis included blood agar, MacConkey's agar, mannitol salt agar, DNAase and Api Biomerieux 10s [France]. Antibiotic cefoxitin was used to check whether strains of Staphylococcus aureus were methicillin resistant or sensitive. The antibiotic susceptibility testing was performed by Mueller Hinton agar [MHA] by disc diffusion method. Out of a total of 518 cultures obtained, 42[8.1%] were MRSA positive and 33[6.37%] were positive for A baumannii. Vancomycin [40[95.23%]] and minocycline [33[78.57%]] were the most effective drugs against MRSA, while colistin [33 [100%]] and minocycline [20 [60.6%]] were the most effective against A baumannii. There is an increased frequency of multi-drug resistant Staphylococcus aureus and Acinetobacter baumannii [A baumannii] among patients in the ICU setting which calls for continuous surveillance to determine prevalence and effective antibiotic susceptibility of these bacteria

Comparison of the stylet and the gum elastic bougie in tracheal intubation in a simulated difficult airway

To compare the stylet and the gum elastic bougie in tracheal intubation of a simulated difficult airway. Randomized control trial. The study was conducted in Main Operation Theatre at Rehman Medical Institute, Peshawar from June 2009 to June 2010.6 patients, ASA grades I and II, undergoing elective surgical procedures requiring tracheal intubation were randomly divided in two groups. Difficult intubation scenario was simulated by applying a rigid Philadelphia collar in both groups. Patients in Group-A were intubated with a stylet and patients in Group-B were intubated using a gum elastic bougie. Both groups were then compared in terms of overall success in intubation, and number of intubation attempts. Statistical analysis was done by applying Chi-Square test and Students' T- test. Among the patients of Group-A, only 71.4% patients were successfully intubated using a stylet while 100% patients in Group-B were successfully intubated using a bougie. In the simulated difficult airway, tracheal intubation using a gum-elastic bougie has a higher success rate when compared to stylet assisted intubation and should be preferred in a difficult intubation scenario

Traumatic brain injury: experience at divisional headquarter teaching hospital, Mirpur, AJK

Traumatic brain injury is one of the leading causes of morbidity, mortality and severe economic loss; especially in the patients who are in productive years of life. The objective of our study was to find out the etiological pattern and distribution of traumatic brain injury at Mirpur, Azad Kashmir. Prospective study. This study was carried out at surgical wards at DHQ hospital, Mirpur from Nov 2012 to April 2013. In this study epidemiological and clinical data of all the patients with traumatic brain injury admitted in surgical wards at DHQ hospital, Mirpur were included. A total of 309 patients with traumatic brain injury were admitted. The age range was between 3 years to 80 years. The mean age was 23.8 years. The most commonly affected age group was between 25-30 years [89.3%]. Males were predominant [81.9%]. Students involved constituted 44.7% of patients. Commonest mode of trauma was pedestrians hit by motorized vehicles [70%] followed by physical assaults [15.9%]. Majority of the patients [88.3%] were from local district and 70.2% reached the hospital within two hours of trauma. 46.6% of the patients had a GCS of 13-15 on arrival. 3.9% had subdural hematoma while 1% of patients had skull fractures and intracerebral bleeds. Overall mortality was 5.8%. Road traffic accidents are the leading cause of traumatic brain injury affecting the young population at Mirpur and led to 5.9% mortality and 9.5% total dependency in the affected population. Better traffic control system and awareness can reduce the incidence of traumatic brain injuries

Diabetics and their diseases, what do they know? Assessing knowledge level among diabetic patients

Limb loss is one of the most devastating complications of Diabetes mellitus. Prevention is possible only with a well educated patient. We set out to assess patient education by physicians and foot care awareness in patients attending our DHQ Hospital. Descriptive study. This study was carried out at the DHQ Hospital, Mirpur, Azad Kashmir from 01.12.2012 to 30.03.2013. This was a descriptive study involving 311 patients attending DHQ Hospital, Mirpur, Azad Kashmir. The patients were chosen by convenience sampling. The patients could be either type 1 or type 2 diabetics. A total of 18 multiple-choice questions were used. Patients less than 40 years were excluded from the study. 314 patients were enrolled in the study. 37.62% of patients were aged 40 to 50 years. Females comprised 52.41% of the patients. 49.52% of patients were illiterate. About a third of patients [31.51%] visited their doctor weekly or fortnightly. A size-able number of patients [39.55%] had never or rarely been guided about life style changes by their doctors. 68.17% of patients had never or rarely been guided about diabetic complications. Only 23.15% patients were aware about foot care. Pearson Chi-Square values were highly significant P<0.0001 for education and foot care awareness. Patient education by physicians is almost non-existent in Pakistan and needs to be improved. Improving literacy will improve patient foot care awareness

Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries; a review of 47 cases

Background: Firearm injuries cause significant morbidity and mortality among its victims. The type and extent of tissue damage vary from simple small size wound to a large soft tissue or skeletal defect. The selection of the appropriate surgical technique is as important as the timing because incorrect selection or improper application of surgical techniques may also lead to infection, sequestration, wound dehiscence, graft rejection, facial deformity and subsequent re-visional operations

Objective: The present study, carried out at Oral and Maxillofacial Surgery department, King Edward Medical University/ Mayo Hospital, Lahore, was aimed at highlighting the frequency of Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries

Study design: Descriptive case series

Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital, Lahore, from November 2010 to November 2012; including 6 months follow up

Patients and methods: The study was conducted on 47 patients. All patients suffered gunshot injuries to the mandible and had soft and hard tissue defects at a single site. Patients ranged in age from 17 to 54 years with a mean age of 32.31 years. Males dominated in the study and were n=37 and females n=10. All patients were treated definitively in the first operation by addressing the hard and soft tissue defects

Results: All had single site fracture with angle of the mandible being most common 27 [57.44%]. For reconstruction of soft tissue defect local advancement by undermining and primary closure was carried out in 35 [74.47%] patients, buccal pad of fat in 4 [8.51%] patient, deltopectoral flap in 5 [10.64%] patients and skin graft in 3 [6.38%] patient. For hard tissue reconstruction, nonvascularized bone graft was given in all cases i.e. n=47 [100%]. Iliac crest bone graft was given in 34 [72.34%] patients, rib graft in 6 [12.77%] patients and symphyseal outer cortex bone graft in 7 [14.89%] patients. Post-operative complications were noted in terms of infection, plate exposure, plate fracture and malocclusion which appeared to be 9 [19.1%], 5 [10.6%], 2 [4.3%], 5 [10.6%] respectively

Conclusion: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary definitive hard and soft tissue management can be considered in patients suffering from gunshot injuries to the mandible. Although post-operative complications can result at higher rates in such injuries yet properly selected surgical techniques and post-operative infection control can produce excellent desired esthetic and functional results