Seasonal Influence on Postoperative Complications after Total Knee Arthroplasty

PURPOSE: This study is aimed at investigating whether inpatient complications and surgical site infections (SSIs) occurred more commonly in patients undergoing total knee arthroplasty (TKA) during the summer season. MATERIALS AND METHODS: A total of 725 patients who underwent unilateral or bilateral TKA were included in this study. A total of 241 patients (33.2%) underwent TKA between May and August. Our outcomes of interest were the incidence of postoperative complications and length of stay. RESULTS: May–August surgeries were associated with a higher risk of postoperative inpatient complications (p=0.003). May–August surgeries (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18 to 3.85), postoperative transfusion (OR, 2.46; 95% CI, 1.43 to 4.26), postoperative special care unit stay (OR, 4.68; 95% CI, 1.99 to 11.0) and chronic kidney disease (OR, 3.27; 95% CI, 1.15 to 9.28) were associated with a higher odds of developing inpatient complications. No association was present between summer surgeries and SSIs (p=0.486). CONCLUSIONS: The results of this study show that overall complication rates following TKA exhibit a seasonal trend, with a peak during the summer months. These results may have some implication in clinical practice and stricter approaches to hospital guidelines during the summer months.

Role of percutaneous cholecystostomy tube placement in the management of acute calculus cholecystitis in high risk patients

Objective: To evaluate the utility of percutaneous cholecystostomy tube in patients with acute calculus cholecystitis, who are considered unfit for immediate surgery. Study Design: Observational study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2014

Methodology: All adult patients who underwent percutaneous cholecystostomy tube placement for acute calculous cholecystitis were included. These patients were divided into two groups for further analysis. Group-I consisted those who had interval cholecystectomy after tube placement and Group-II were those who had no further treatment. Recurrence of symptoms, infections and operation related complications were noted

Results: Sixty-five patients met the inclusion criteria. Mean age was 58.5 years. Forty-four patients [67.7%] were males. Forty-three patients underwent interval cholecystectomy [Group-I] and 22 did not [Group-II]. Mean operative time was 134.9 +57.8 minutes. Five [11.6%] patients were converted to open cholecystectomy, two [4.6%] developed CBD injury, and seven [16.2%] developed surgical site infection. In Group-II, three patients [13.6%] developed recurrence of symptoms and 19 [86.4%] remained symptom-free. Catheter related problems occurred in four [18%] patients. Mean follow-up was 19 +8 months

Conclusion: Percutaneous cholecystostomy is a good alternative for patients unfit to undergo immediate surgery. Recurrence of symptoms after tube removal are in a low range; therefore, it can be considered a definitive management for high risk patients. Laparoscopic cholecystectomy after tube placement becomes technically challenging

Knowledge of nursing students regarding housing characteristics and its evaluation

Objective The purpose of this research study is to assess the knowledge of housing characteristics and associated health problems in nursing students of Dow University of Health Sciences [DUHS]. Moreover, nursing students' knowledge about housing condition and public health risks were also analyzed

Methodology The study was conducted at Institute of Nursing, DUHS, Karachi. In 2012, 90 nursing students were asked to participate in this study with their consents. A teaching session was conducted as a part of this study that lasted for two hours. At the end of teaching session students were requested to fill out the questionnaire about their housing condition and health related problems along with a feedback of the session

Results The study highlighted that on average, participants had been living in the same housing for the last one year, with median and inter-quartile range of 12 and 16 months respectively. Twelve participants [13%] mentioned that they had suffered from diarrhea or vomiting during last three months, and 7.6% participants reported that their housing conditions were affecting their respiratory health. A large number of participants [89.1%] and [87.2%] did not find any visible mold in their house/hostel or kitchen respectively. Almost 61% and 80% participants reported about the mechanical ventilation and window in the bathroom respectively

Conclusion Reduction in dampness results in improvement of various health symptoms. House dust mite can be controlled through constant mechanical ventilation. The majority of the participants showed willingness towards such seminars and discussions for their future classes

Carotid intima media thickness percentiles for Pakistani population

Carotid artery intima media thickness estimation is a well-established way of cardio vascular disease evaluation. The purpose of this cross-sectional study was to develop normal carotid intima media thickness percentile values for a Pakistani cohort. Data was collected at the Departments of Radiology and Family Medicine, The Aga Khan University Hospital, Karachi, from April 2014 to August 2015. High frequency ultrasound of carotid was done in 257 patients [97 male [38%], 160 female [62%]] without any known carotid artery disease. Reference ranges [90% range between 5th and 95th centiles] were constructed for each common carotid and internal carotid artery measurement and displayed in graph form. The mean difference was found in left common carotid artery [0.55 +/- 0.13] and left internal carotid artery thickness [0.50 +/- 0.10] significant at p=0.031 and p=0.014, respectively. The IMT percentile graphs developed in this study for internal and common carotid arteries are exclusive for this population and can be used to assess vascular health from ultrasound measurements

Viral hepatitis c in thalassaemia: determination of antibody hcv frequency in mutitransfused thalassaemia patients

Background: Thalassemias are a group of genetic blood diseases. These patients are blood transfusion dependent because of genetic inability to produce hemoglobin according to body needs. Due to repeated transfusions, these patients are vulnerable to HCV, HBV and HIV like blood transmitted diseases. The purpose of this study is to determine post transfusion HCV frequency in these patients

Objective: To assess prevalence of antibody HCV in multi-transfused Thalassaemia patients. Study Setting: The study was conducted at Thalassaemia Center, DHQ Hospital Faisalabad located in Central Punjab, Pakistan. The record of the Thalassemia children registered in this center during 1[st] Jan 2012 to 31[st] Dec 2014 was reviewed. Study Design

Methodology: A descriptive cross sectional study was conducted on 416 Thalassemia children registered in Thalassemia Center DHQ Hospital Faisalabad. Out of these 379 children were included while 37 excluded due to incomplete record. The demographic data, blood transfusion history and lab tests details were taken from patient files. The HCV diagnostic laboratory techniques used were Rapid manual, confirmed by Enzyme Linked Immunosorbent Assay [ELIZA]

Results: Out of 379 Thalassemia patients, HCV positive found were 123 [32.45%]. The study population age was in range of 1- 19years while age range of HCV affected group was 5-19 years. Out of total 379, male were 235 [62%] and female were 144 [38%] while in total 123 HCV affected group 82 [66.67%] were male and 41 [33.33%] female. In total of 379 Thalassemic children having multiple transfusions, 123 [32.45%] were HCV +ve. Among 353 Thalassemic children having positive blood groups, 111 [31.44%] were HCV +ve while 12 [46.15%] were HCV +ve in 26 children with negative blood groups. Among 235 male, 82 [34.89%] were HCV +ve and 41 [28.47%] HCV +ve in 144 female children. Hepatomegaly was 75% in HCV +ve while 65% in HCV -ve groups. The splenomegaly was almost 80% in all groups

Conclusion: Despite use of screened blood transfusions in this center, still there is alarming proportion of HCV affected blood receiving patients. In this study Antibody HCV prevalence was higher [46.15%] in Thalassemic children with negative blood groups than [31.44%] positive group children. In total HCV +ve patients, 2/3 [66.67%] were male and 1/3 [33.33%] female group. This study warrants attention to improve HCV diagnostic and instrument sterilization techniques to minimize the risk of HCV infection

Roads traffic accidents: an epidemiological study of road traffic accidents in tertiary care hospital

Background: Road Traffic Accident [RTA] is growing public issue and fall among four top causes of mortality and morbidity. Many people [of all age groups], die daily during playing in streets or travelling on roads. Main causes of these accidents are lack of driving skills, distracted and prolonged driving, use of intoxicants, use of mobile phone during driving, defective roads, over loading and inadequate government administrative structure. These accidents are predictable and largely preventable through multi-disciplinary coherent strategies

Objective: To study epidemiological factors, compliance with traffic rules and pattern of accidental injuries

Methods: This study is descriptive cross sectional, carried out at DHQ Hospital Faisalabad. The data was obtained from patients of RTA arriving at Accident and Emergency Department [Trauma Center], from 1[st] January 2016 to 30[th] June2016. During this period 583 patients of RTA were reported to this center. The study variables were socio demographic, human, environmental and time factors. Statistical analysis was done in percentages, linear / logarithmic trends and chi-square test to know strength of association between these variables

Results: Among total 583 RTA cases, male victims were 449 [77.02%] and female 134 [22.98%]. Majority of cases 256[43.91%] were in age group of 15-29 years. Victims of RTA from rural areas were 194 [33.28%] while 389 [66.72%] were from urban / sub-urban areas. People from low economical strata were 198 [33.96%], moderate 310 [53.17%] and victims with illiteracy level were 135 [23.16%] and having education up to school were 304 [52.14%]. Human factor, cell phone user were 29 [4.97%]. Victims observing traffic rules were 93 [15.95%] while only 17 [30.19%] practiced PPM. Human factor regarding casual attitudes was observed in 47 [8.06%] cases. Maximum accidents occurred during office/school and market opening / closing timings i.e. 08-00 to 12-00 hours, 180 [30.87%] with fatality 27 [04.63% of this time events and 24.12% of total fatality] and 12-00 to 16-00 hours 136 [23.33%] with 4.29% fatality of total events and 22.32% of total fatality]. Fatality was maximum during evening, 35 [6.00%] of evening RTA's and 31.25% of total fatality. Environmental factors, worst weather was observed in 35 RTA's [6.00%], narrow and repairable roads shared in 69 cases [11.84%] while in old repairable vehicles were 17 [2.92%]. RTA in two wheeler vehicles/one wheeler were 271+59=330 [56.60%], in auto rickshaw [three wheeler] 106 [18.18%] and in pedestrian 85 [14.58%]. Pattern of head injury was found in 72 RTA's [12.35%] while limb injuries 76 [13.04%]. Mortality occurred in 112 [19.21%] cases while mild to severe morbidity was observed in 471 [80.79%] cases

Conclusion: This study concluded that male youth shared major portion of RTA victims. Morbidity and mortality was high in riders of two wheelers and in persons having head injuries. All the contributory factors were largely preventable through multi-pronged approach

Biomonitoring of Toxic Effects of Pesticides in Occupationally Exposed Individuals

BACKGROUND: Workers in pesticide manufacturing industries are constantly exposed to pesticides. Genetic biomonitoring provides an early identification of potential cancer and genetic diseases in exposed populations. The objectives of this biomonitoring study were to assess DNA damage through comet assay in blood samples collected from industry workers and compare these results with those of classical analytical techniques used for complete blood count analysis. METHODS: Samples from controls (n = 20) and exposed workers (n = 38) from an industrial area in Multan, Pakistan, were subjected to various tests. Malathion residues in blood samples were measured by gas chromatography. RESULTS: The exposed workers who were employed in the pesticide manufacturing industry for a longer period (i.e., 13-25 years) had significantly higher DNA tail length (7.04 μm) than the controls (0.94 μm). Workers in the exposed group also had higher white blood cell and red blood cell counts, and lower levels of mean corpuscular hemoglobin (MCH), MCH concentration, and mean corpuscular volume in comparison with normal levels for these parameters. Malathion was not detected in the control group. However, in the exposed group, 72% of whole blood samples had malathion with a mean value of 0.14 mg/L (range 0.01-0.31 mg/L). CONCLUSION: We found a strong correlation (R2 = 0.91) between DNA damage in terms of tail length and malathion concentration in blood. Intensive efforts and trainings are thus required to build awareness about safety practices and to change industrial workers' attitude to prevent harmful environmental and anthropogenic effects.

CT pelvis in children; should we routinely scan pelvis for wilms tumor and hepatoblastoma? Implications for imaging protocol development

Wilms tumor and hepatoblastoma are the most common intra-abdominal solid organ childhood tumors. CT examination is one of the routinely performed procedures in hospitals for children with these tumors inspite of high radiation exposure associated with CT scans. Sixty patients [Wilms tumor = 45, hepatoblastoma = 16] were evaluated retrospectively. Higher proportion [44.4%] of metastatic disease was identified at presentation in the Wilms tumor subset as compared to hepatoblastoma [6.3%] [p=0.006]. Metastatic disease was noted in 6 patients having Wilms tumor on follow-up while it was also low in hepatoblastoma which was noted in only 2 patients [p > 0.05]. No significant difference was identified in pelvic extension of disease at presentation in both studied population [p > 0.05]. Pelvic metastasis was noted in 1 patient only with Wilms tumor on follow-up while no pelvic metastasis was seen in the hepatoblastoma patients [p-value > 0.05]

Learning preferences; teaching medical faculty

Introduction: This study has focused to know the learning preferences among faculty considering different methodologies and considering about CME to improve healthcare

Objectives: To identify the gaps in knowledge regarding CME in medical faculty of Lahore and to see the awareness of the CME among them

Study Design: This is a cross-sectional study of medical faculty in Lahore

Settings: Three hospitals in Lahore are included from both private/ public sectors. Period: It was conducted over a period of 2 months from JULY, 2014 to August, 2014

Methods: A questionnaire comprising of 21 questions was distributed at random for data collection among doctors having done post graduation

Results: Most of the faculty members who attended CME found it as useful tool for improving the knowledge and techniques for better patient care

Conclusions: Majority teachers are not interested in CME and do not participate and ask for some incentives

Job satisfaction of physicians and teachers; regular verses contract basis jobs

Objectives: To determine the level of job satisfaction of physicians and teachers having regular jobs and those having contract based jobs and to compare level of job satisfaction between these types of jobs and between the two professions

Study design: Cross sectional study

Duration and place of study: This study was conducted with teachers and physicians recruited at different schools, colleges and hospitals of Faisalabad in six months from October, 2008 to March 2009

Subjects and methods: A sample of 200 participants, 100 physicians [50 regular and 50 on contract basis] from public hospitals and 100 teachers [50 regular and 50 on contract] from public schools and colleges was drawn through purposive convenient sampling technique

Result: In overall profession wise analysis teachers scored higher on job satisfaction scale [m=131.98] than physicians [m=126.98]. Personals having regular jobs had lower job satisfaction [m=128.52] than professionals have contract jobs [m=130.45]

Conclusion: Contract based jobs carry higher levels of job satisfaction for employees than the regular based jobs

Tuberculosis management; how well do our medical practitioners know in Lahore Hospitals?

Background: Medical practitioners are the main source of health care for patients in Pakistan due to their availability at all times. Limited information is available related to the management of Tuberculosis [TB] among the practitioners

Study Design: Cross sectional study

Setting: Through stratified random sampling among the practitioners of Lahore, Punjab

Period: May 2014 to August 2014

Methods: They were presented with a questionnaire and their answers examined according to the international designed strategy for TB management

Results: TB management has a positive relationship with experience, awareness, source of awareness and continuing medical education and a negative relationship with qualification. 95 % of doctors agreed to go for further investigation but only 40% knew that 2 sputum samples were required for proper diagnosis. Only 32% doctors knew TB resistant drugs were to be given in drug resistant cases

Conclusion: Most doctors in Pakistan lack sufficient knowledge regarding tuberculosis management and prompt measures shall be taken to improve it

Lack of association between MTHFR gene polymorphisms and response to methotrexate treatment in Pakistani patients with rheumatoid arthritis

Methylenetetrahydrofolate reductase [MTHFR] gene polymorphisms have been reported to be associated with response to methotrexate [MTX] in certain populations of patients with rheumatoid arthritis [RA]. This study aims at investigating any relationship of two single nucleotide polymorphisms [SNPs] in MTHFR gene, C677T and A1298C with response to therapy with MTX in Pakistani RA patients. Allelic frequencies of the two polymorphisms [C677T and A1298C] were determined in 67 RA patients [9 males and 58 females; mean age 42.87 +/- 13.5 years] who had previously participated in a prospective clinical trial. Fifty-one patients had received MTX and were followed up for response up to 6 months. Genotyping of the two MTHFR polymorphisms was carried out using PCR-RFLP, while fasting concentration of plasma homocysteine was determined using a kit method. Twenty-eight patients were found to be "good responders", while twenty-three were [poor responders]. MTHFR 1298C and MTHFR 677T alleles' frequencies in [good responders] were not different from frequencies in [poor responders] [0.574 vs. 0.521; p=0.6 and 0.197 vs. 0.196; p=0.75, respectively]. Plasma homocysteine levels in female RA patients were significantly higher compared to general population in Karachi [13.1 +/- 6.7 micromol/1 vs. 11.4 +/- 5.3 micromol/1; p<0.00l]. MTHFR C677T and A1298C polymorphisms are not associated with response to MTX in a population of Pakistani RA patients

Knowledge, attitude and practice [KAP] of dengue fever in adult semi-Urban and rural population of central Punjab Pakistan

Objective: to assess Knowledge, Attitude and preventive measures practiced by semi-urban / rural adult population of central Punjab regarding dengue fever

Study setting: independent University Hospital Faisalabad located in semi urban area of Jinnah Town [District Faisalabad] was selected for this study

Study Design: a cross sectional Descriptive study was conducted among the adult patients and their attendants from semi-urban/rural area attending OPD IUH

Study Population: adult patients/their attendants aged 18 years and above from both sexes and from all economical strata attending OPD of IUH were asked to take part in the study

Materials and Methods: Inclusive criteria: participant should be residing in Jinnah Town Faisalabad for the last one year

Sample Size: 550 adult individuals were taken by convenient sampling from the OPD patients and their attendants of IUH as a representative sample of total population of Jinnah Town. 95% confidence interval, 5% sampling error, assumption of 50% knowledge and attitude prevalence and 15% non-response rate were decided prior to study

Results: 550 individuals were enrolled for study, 50 participants decline to continue study. Analysis showed that 83.8% participants have adequate knowledge about vector, 38.6% know about dengue fever, 83.2% have good attitude about dengue fever, 86.6% participants use some of the preventive measures to protect themselves from mosquito

Conclusion: more Awareness Campaigns regarding dengue fever are still needed in rural area to have adequate level of KAP to control and prevent dengue fever epidemics. Due to low literacy level, there is gap between knowledge and practices. Health services in rural areas are insufficient, understaffed and un-accessible due to lack of roads/transport indicating differential allocation of resources for rural areas

Appraisal of Hepatitis-B and Hepatitis-C prevalence

Objective: to asses prevalence of HBV and HCV among healthy blood donors

Study Setting: Blood Transfusion Services Center DHQ Hospital Faisalabad. [Blood donation record of blood donors]

Study Design: retrospective review of blood donation record of blood donors, who attended this center from 1[st] Jan 2014 to 31[st] Dec 2014

Materials and Methods: the blood donation record of 32028 persons was reviewed who visited BTSC DHQ Hospital Faisalabad for donation of blood. The donors were selected according to International donor selection criteria. All the blood donors were screened for HBV and HCV by "Rapid Method."

Results: review and analysis of blood donation record of 32028 screened blood donors showed that 11.16% blood donors were female [ n= 3574 ] and 88.84% were male [n=28454].Among total, 609 blood donors were HBV positive i.e.1.90% and 2724 were HCV positive i.e. 8.50%

Conclusion: this study concluded that the prevalence of HBV and HCV among healthy blood donors of this area, HBV to be in low endemic group [<2 %] while HCV in high endemic group [>8%]. Female donors are proportionately less than male donors

Tuberculosis; patients knowledge, attitude and perceptions

Tuberculosis is one of the major public health problems in Pakistan. Pakistan ranks fifth amongst TB high-burden countries worldwide and accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. To describe knowledge, attitudes, and perceptions among the patients of pulmonary tuberculosis about their disease attending outpatient department at independent university hospital Faisalabad. A descriptive cross-sectional study. August to September 2014. Out patients department at Independent University Hospital Faisalabad. A total of 197 patients from OPD. Systematic random sampling technique. After an informed consent a pretested questionnaire were used to collect the information from the patient. SPSS-17were used to calculate the frequencies and percentages. Out of 197 respondents were 55.3% [109] male, 44.7% [88] female and 63% [125] were earning below 10000 rupees per month. As for as knowledge is concerned 50% of the patients viewed that TB is transmitted through contact with the patients having tuberculosis, 83%labelled cough of long duration as commonest sign, 60% viewed that it can be prevented by avoiding contact with patients, 57% labeled healthcare staff as their source of information, 65.9% perceived TB as an infectious disease, 55% stress as cause of disease, 85% as not curable disease. Poor knowledge and false perceptions are the main constrain in the control of TB in Pakistan

Research productivity; evaluation among faculty members at dow university of health sciences karachi

Research training at higher education level for clinical and teaching staff is important and there are methods to introduce research culture in employees at clinical and teaching departmental level. Objectives: To recognize and quantify the research productivity status of teaching and clinical faculty of [DUHS] Dow University of Health Sciences Karachi before and after its establishment in 2003. Design: Non experimental cross sectional study. Period: 1st October 2012 to 1st February 2013.. Setting: Medical college Karachi. Subjects and method: Students of third semester were applied to sort out the ten years record from 1998 to 2008 of all researches conducted by faculty of Dow University of Health Sciences, published in international and national journals by using different online search engines. Research Output was measured in terms of the increase in the number of publications and quality of publications before and after the launch of Dow University. Data was entered in Microsoft office excel version 2007 and analyzed it in statistical package for social sciences [SPSS] version 17; person chi-square was applied to test the statistical significance at 95% confidence interval. Results: Data of total 594 researches was found out between the years1998 to 2008, 175[29.5%] researches were published before the foundation of Dow university of Health sciences Karachi [2003] while 419[70.5] researches were produced after 173[45.6%] research papers were published in indexed journals before, "whereas" 206[54.4%] were published in indexed journal after 2003. Original research articles were 152 [31%] before 2003, which rose to 339 [69%]. Publications of article types such as case reports, case series, and short communication, editorials and review articles also increased to 80 from 23 after establishment of Dow University. Conclusions: From a total of 594 faculty researches o published in indexed and non indexed journals between the years 1998 and 2008; there was a significant increase in production after establishment of Dow university of Health Sciences Hence it is confidently reported that due to establishment of research committees after the founding, there is a promotion and facilitation of research activities among faculty members.

Association of HIV with drug dependence; socio-demographic characteristics of substance abusers inclusive of HIV positive admitted in model drug abuse and treatment center, DHQ hospital, Faisalabad, Pakistan

This study was undertaken with an objective of collecting basic data to assess the extent and variety of drug abuse in patients presenting to the model drug abuse and treatment center, DHQ hospital, Fsd as per social and demographic circumstances. cross sectional study. The study was conducted in the indoor Department of Model Drug Abuse Treatment Center of Department of Psychiatry and Behavioral Sciences, DHQ Hospital, Faisalabad from Jan-2014 to March-2014. 80 patients dependent on different drugs participated in this study through purposive convenient sampling technique. Personal, Social, and Demographic variables were recorded on a demographic sheet. The results were obtained by using SPSS 17. Descriptive statistics showed that 31 patients [38.8%] were HIV positive. Most of the patients were males [97.5 %], between 30 to 35 years of age [28.8%], married [61.3%], lived in urban areas [55%], illiterate [32.5%], had primary level education [21.3%], or middle level education [22.5%]. 51.3 % patients were laborers. As illiteracy, low education, unemployment, labor as profession, and peer pressure are the key features of drug abusers. So, parents, health professionals, and state personals should take these as risk factors and focus upon these population segments to spread awareness and take measures of control to minimize the incidence of substance abuse

Sinonasal polyposis and fungus: a growing relationship

To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226[69.75%] and out of them, 102[45.13%] were males and 124[54.86%] were females with a P value of 0.039. The mean age was 25.95 +/- 9.32 [15-45] years for the patient with fungus. Aspergillus was the commonest organism found. Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found

Effect of locally administered ciliary neurotrophic factor on the survival of transected and repaired adult sheep facial nerve

To determine whether the administration of Ciliary Neurotrophic Factor [CNTF] at the site of repaired facial nerve enhances regeneration in the adult sheep model. Ten adult sheep were divided into 2 groups: control and study group [CNTF group]. In the CNTF group, the buccal branch of the facial nerve was transected and then repaired by epineural sutures. CNTF was injected over the left depressor labii maxillaris muscle in the vicinity of the transected and repaired nerve for 28 days under local anesthesia. In the CNTF group, the sheep were again anesthetized after nine months and the site of facial nerve repair was exposed. Detailed electrophysiological, tension experiments and morphometric studies were carried out and then analyzed statistically. The skin CV min, refractory period, Jitter and tension parameters were marginally raised in the CNTF group than the control but the difference was statistically insignificant between the two groups. Morphometric indices also did not show any significant changes in the CNTF group. CNTF has no profound effect on neuronal regeneration of adult sheep animal model

Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM] and maternal death at tertiary health care centre

Pakistan stands second in the world s rating of highest stillbirth rate. This gives an emergency call to authorities involved in maternity health care of Pakistan to take serious and quick steps to address the problem. Retrospective observational study at tertiary health care centre to see frequency and risk factors for stillbirth in cases of severe acute maternal morbidity [SAMM] and maternal death over period from January 2008 till Jan 2010. High stillbirth rate 438 /1000 was found in the study group as compared to still birth rate of 74 /1000 in rest of the deliveries during the same period. Data analysis by using multivariate regression for variables after adjusting for co variable showed significant association [p value < .05] with still births of following factors grand multipara [adjusted OR 1.887 Cl 1.156-3.081] primigravida [adjusted OR 1.623 Cl -1.023-2.573] low education [adjusted OR 19.378 Cl- 2.586-145.208] lack of standard antenatal [care Non booked [adjusted OR 10.101 Cl 3.847-26.518] referred cases [OR 5.879 Cl 2.166-15.954]] preterm deliveries [adjusted OR 2.994 Cl 1.512-5.931] and vaginal deliveries 1.986 [Cl 1.351-2.920] whereas uterine rupture [adjusted OR 4.003 Cl 1.647-9.729] prepartum haemorrhage [adjusted OR 3.617 Cl 1.756-7.451] and hypertension [adjusted OR 3.298 Cl 2.040- 5.330]were significant obstetric risk factors. Audit of SAMM and maternal death with emphasis on risk factors of still birth would help to find strategies to reduce preventable causes of stillbirth .This would be important relatively quick contribution to efforts of achieving MDG 4