Medical thoracoscopy in evaluation of undiagnosed pleural effusion

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

Oxidative stress and antioxidant vitamins in cataract patients

Background: In Pakistan age related vision disturbances are mainly due to cataract. Various studies have reported relationship of ocular lesion with senile changes and diabetes mellitus resulting in reduced quality of life due to vision. Oxidative stress is an important factor in the process of cataractogenesis. The pathogenesis of the cataract may involve decreased activity of antioxidant scavenging system which includes non-enzymatic natural antioxidants as biomolecules such as carotenoids and vitamins. So, it is planned to investigate the level of serum antioxidant vitamins in diabetic cataract patients and in non-diabetic cataract patients.Methods: The study was conducted at Biochemistry department, Al-Tibri Medical College Karachi from October 2016 to October 2017. Ninety pre diagnosed cataract patients were selected from Al-Ibrahim Eye Hospital Karachi 40 normal control subjects were selected from the same population with same socioeconomic group. The demographic data was analyzed. The random blood sugar, antioxidant vitamins (C, A and E) and malondialdehyde were analyzed in the blood sample of control and cataract patients. The data was analyzed by SPSS version 20.Results: There was no significant difference in the level of vitamin C, A, E and MDA between diabetic and non-diabetic cataract patients, but the blood levels of vitamins of control are higher as compared to the cataract patients. The level of MDA is significantly high in cataract patients as compared to control. Antioxidant vitamin E was negatively correlated with serum malondialdehyde in cataract patients.Conclusions: It is concluded that in diabetic and non-diabetic cataract low level of serum antioxidant vitamins may be a contributory factor for cataractogenesis.

Casos nuevos de tuberculosis y análisis de la tendencia de la enfermedad en el municipio de Santiago de Cuba / New cases of tuberculosis and analysis of the disease tendency in Santiago de Cuba municipality

Se realizó un estudio descriptivo y transversal para caracterizar la población de pacientes con tuberculosis del municipio de Santiago de Cuba, durante los trienios 2008-2010 y 20142016, así como el análisis gráfico de la tendencia de la enfermedad. La población estuvo conformada por 101 casos nuevos con diagnóstico confirmado. Se calcularon las tasas de incidencia y la diferencia porcentual de tasas. Se estimaron porcentajes superiores de afectados en las edades jóvenes e intermedias de la vida (25-34 y 35-44 años) con 21,8 y 22,8 por ciento en el primer trienio, así como 20,7 y 18,2 por ciento en el segundo, respectivamente; aunque en ambos periodos, los mayores riesgos se desplazaron hacia las edades más envejecidas. En ambos trienios predominó el sexo masculino (79,2 y 77,9 por ciento, respectivamente), así como los riesgos de enfermar superiores en el primero con 11,3 casos por cada 100 mil habitantes de dicho sexo. La tendencia de la enfermedad exhibió una progresiva disminución de los pacientes, aunque de forma lenta e irregular

A descriptive and cross-sectional study to characterize the population of patients with tuberculosis in Santiago de Cuba municipality, was carried out during 2008-2010 and 2014-2016, as well as the graphic analysis of the disease tendency. The population was formed by 101 new cases with confirmed diagnosis. The incidence rates and the rates percentage difference were calculated. Higher percentages of affected patients in the young and intermediate ages of life were considered (25-34 and 35-44 years) with 21.8 and 22.8 percent in the first triennium, as well as 20.7 and 18.2 percent in the second, respectively; although in both periods, the highest risks moved toward the most aged. In both trienniums the male sex prevailed (79.2 and 77.9 percent, respectively), as well as the risks of getting sick were higher in the first one with 11.3 cases every 100 thousand inhabitants of this sex. The disease tendency showed a progressive decrease of the patients, although in a slow and irregular way

Frequency of post obturation pain by using ibuprofen and ibuprofen/dexamethasone infiltration in single visit root canal treatment cases

Background: Pain after root canal treatment is a challenging problem for the operative dentists over the last few years. The development of pain is dependent on the intensity of tissue damage. Inflammation is characterized by a series of vascular events in response to tissue injury. The release of mediators is responsible for much of the pain. The rationale of this study is to use NSAIDs alone or in combination with dexamethasone to reduce post treatment swelling and pain following endodontic therapy. The objective of the study was to compare the frequency of post obturation pain by using ibuprofen or ibuprofen/ dexamethasone infiltration in single visit endodontic cases.Methods: This study was carried out in the Operative Dentistry, Department (AFID), Rawalpindi, Pakistan from December 2015 to May 2016 after approval from the Institutional Ethical Review Board. After an informed consent, 128 patients fulfilling inclusion criteria were divided in to two equal groups. In Group A, after root canal treatment, an additional single shot local infiltration of 0.5 mg dexamethasone was given in periapical area. Both the patient groups were prescribed ibuprofen 400 mg three times a day. Patient’s pain response was recorded after 24 hours of treatment, using visual analogue scale. Data was analyzed using SPSS version 17.Results: After 24 hours, 6 (9.4%) patients showed the pain in group A while 16 (25.0%) patients complained of pain in group B.Conclusions: The results of this study showed, group A showed less postoperative pain as compared to group B where only ibuprofen was given.

Outcome of bipolar hemi arthoroplasty: analysis of using lateral and posteriolateral approach

Objective: To find the outcome of bipolar hemiarthroplasty using posteriolateral and lateral approaches

Study design: Descriptive case series

Place and Duration of study: Departments of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2016

Methodology: Patients of either sex and of age above 40 year, who presented in Emergency Department with femoral neck fractures, were included in the study. Data included basic demorgraphic profile, Harris hip scoring, duration of surgery, hospital stay and blood loss

Results: A total of 200 patients were included in the study. There were 77 [38.5%] males and 133 [61.5%] females. Male to female ratio was 0.58:1 with mean age of 58.2 +/- 6.02 year. Mean follow up was 14.2 +/- 2.5 months. In 134 [67.0%] patients there was history of fall, 41 [20.5%] presented with fracture after low energy vehicle accident, 20 [10.0%] presented after high energy vehicle accident. Duration of surgery and blood loss were less in posteriolateral approach. The complication rate and Harris hip scoring was similar in both the approaches

Conclusions: Outcome of surgery in terms of infection, mobility and pain as well as dislocations were similar in both the approaches. The posterior approach was superior in terms of short duration of surgery and less blood loss

Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules

Objective: To determine diagnostic accuracy of sonographic criteria in differentiating benign from malignant solid thyroid nodule by using new sonographic classification system

Study Design: Cross sectional validation study

Place and Duration of Study: Department of Radiology, Combined Military Hospital Multan from Oct 2014 to Mar 2015

Material and Methods: A total of 150 consecutive cases of either sex ranging in age from 19-60 years with palpable thyroid nodules referred for diagnostic workup were subjected to ultrasound [US] examination for assessment of solid thyroid nodules and it was followed by US-guided fine-needle aspiration [FNA] of all solid thyroid nodules. Each of the biopsied nodule was subsequently placed into one of five categories on the basis of sonographic features i.e. [malignant] [suspicious for malignancy] [borderline] probably benign] and [benign]. Evaluation of accuracy of sonographic diagnosis for solid thyroid nodule was done by comparing results of fine needle aspiration biopsy [FNAB]

Results: The mean age of the patients [n=150] was 42.34 +/- 4.78 years; seventy three percent [n=109] were females and twenty seven percent [n=41] were males. Frequency of thyroid nodules [on FNAB as gold standard] was revealed as 20.7% [n=31] malignant and 79.3% [n=119] benign, accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, keeping FNAB as gold standard showed 18.7% [n=28] true positive, 4.7% [n=7] false positive, 2% [n=3] false negative and 74.6% [n=112] true negative

Ultrasound finding has sensitivity of 90.3%, specificity of 94.12% and diagnostic accuracy of 93.3%

Conclusion: Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, while keeping FNAB as gold standard was high and is recommended for diagnosis of malignant solid thyroid nodules

Biosynthesis, characterization and antimicrobial action of silver nanoparticles from root bark extract of Berberis lycium Royle

Various biological methods are being recognized for the fabrication of silver nanoparticles, which are used in several fields. The phytosynthesis of nanoparticles came out as a cost effective and enviro-friendly approach. When root bark extract of Berberis lycium was treated with silver ions, they reduced to silver nanoparticles, which were spherical, crystalline, size ranged from 10-100nm and capped by biomolecules. Synthesized silver nanoparticles were characterized by UV-visible spectroscopy, Scanning Electron Microscopy [SEM], Energy Dispersive X-ray Spectroscopy [EDX], Transmission Electron Microscopy [TEM], X-Ray Diffraction [XRD] and Fourier Transform Infra Red Spectroscopy [FTIR]. The plant mediated synthesized silver nanoparticles showed pronounced antimicrobial activities against both Gram negative bacteria [Escherichia coli, Klebseilla pneumoniae, Pseudomonas aeruginosa] and Gram positive bacteria [Staphylococcus aureus and Bacillus subtilis]. The plant mediated process proved to be non-toxic and low cost contender as reducing agent for synthesizing stable silver nanoparticles

Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan

Objective: To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management

Method: We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups

Results: After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices [p < 0.001]. Health care and sanitary workers in intervention group scored statistically significantly higher [p < 0.001]

Conclusion: Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings

Success rate of vitapex as an obturating material in primary molars

The aim of this study was to determine the success rate of Vitapex as an obturating material for primary teeth. A total of 50 patients with non-vital necrotic pulp of lower primary molars were selected. They were treated with contemporary treatment ofpulpectomy. After disinfections of canals, obturation was done with Vitapex and restoration of tooth was done. Clinical and radiographic examination was done at one, two and three month intervals. The teeth were evaluated for pain,, tenderness to percussion, swelling, presence of radiolucency. Results showed out of 50 patients, 24 were females and 26 were males. Age of patients ranged from 5 years to 10 years with a mean value of 7.2 and standard deviation +/- 1.6. Success rate of Vitapex was 88% [44 patients] and 12% [6 patients] cases were in failure. It was concluded that 88% success rate of Vitapex®, showed promising results to save a restorable primary tooth until its normal exfoliation

Acute myocardial infarction; a comparative study to assess the angiographic changes in diabetic and non diabetic patients

To compare the angiographic findings in patients with acute myocardial infarction [AMI] and compare it with diabetic and non-diabetic patients admitted in the cardiology department of LUHMS. Descriptive analytical study. Department of cardiology at Liaquat University of Medical and Health Sciences [LUMHS] Hospital, Hyderabad. Periods of 1[st] June 2012 to 31[st] July 2013. All patients with AMI and had diabetes mellitus and age eighteen or more than eighteen years both male and female were included after taking informed consent. Out of 297 patients diagnosed as AMI, 195 [65.65%] patients had acute ST elevation Myocardial Infarction and 102 [34.35%] patients had acute non ST elevation myocardial infarction. Among 297 patients, 190 [64%] patients were non-diabetic and 107 [36%] patients were diabetic. Diabetic patients were older, more often males, but prevalence of smoking was less marked. Coronary angiographic findings among patients with AMI and diabetics revealed three vessels disease. Older patients with male predominance presented with AMI and had diabetes mellitus were found to have three vessels disease in coronary angiography

Flexible fiberoptic naso-pharyngo-laryngoscopy: indications and outcome

Objective: To find the indications and outcome of flexible fiberoptic naso-pharyngo-laryngoscopy in ENT practice

Study design: Case series

Place and Duration of study: Department of E.N.T. and Head Neck surgery, Liaquat University Hospital Hyderabad, from February 2013 to January 2015

Methodology: All patients with upper airway problems in whom flexible fiberoptic naso-pharyngolaryngoscopy [FFONPL] performed were included

Results: A total of 437 patients were included in this study. There were 228 [52.2%] males and 209 [47.8%] females. The age range was from 8 year to 80 year with mean age of 45.87 year. It was performed for diagnostic purpose in 351[80.3%] patients having voice and swallowing problems. It was possible to identify structural etiology in all cases. It was used in follow up of 73 patients for residual disease who had chemo radiotherapy for different tumors. Of these, in 54 [73.97%] patients the airway was patent to allow the removal of tracheostomy tubes. In 13 cases it was used to facilitate passage of nasotracheal tube in patients with ankylosis of temporomandibular joint. It was successful in 12 cases

Conclusion: FFONPL is an effective and safe tool for various ENT related pathologies

Gartland type III supracondylar fracture humerus; surgical management

Objectives: the purpose of present study is: 1. To know the results of surgical intervention of Garland type III fracture Humerus in children.2. To know the early and late complication of surgical intervention

Study Design: prospective interventional study

Setting: department of Orthopedic Unit-II, Civil Hospital Karachi

Period: February 2010 to January 2012

Methods: 200 male and female patients with Gartland type III supracondylar fracture of humerus presenting within 24 hour of injury, with age limit varying between 1- 12 years were included in our study. The anteroposterior and lateral view X-rays were taken and evaluated for displacement and angulation, medial/ lateral displacement and angulation and rotation of distal fragment. After all aseptic measures, patient under general anesthesia, through posterior approach skin was incised, subcutaneous tissue dissected along the line of incision. Triceps apponeurosis was splitted and interposed soft tissue was released and fracture reduced and fixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateral view and an angle of 30 degree - 40 degree in A/P view. Wound closed in layers, aseptic dressing applied and well-padded back slab with elbow in appropriate angle of flexion was applied and pulses were checked. Postoperatively the hand was held elevated. Plaster of parries black slab was removed after four weeks; the wires were removed after six weeks. The follow-up ranged from 3 to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteria for assessing the results were based on healing period, anatomical appearance, function and radiographic appearance

Results: excellent results according to Mitchell-Adam's criteria were observed in 60%. [120/200] cases, good results were observed in 27% [54/200] cases. Overall excellent to good results were observed in 87% of cases

Conclusion: it is concluded that outcome of surgical treatment of supracondylar fractures of humerus [Gartland type III] fixed with medial and lateral placement of k- wires were excellent to good and it achieves stable fixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injuries were decreased as compared to closed reduction and percutaneous k-wiring. As this method is techinically easy, less demanding and effective for stabilization and can be applied for patients with these fractures

Burden of head and neck cancers in Kamrup urban district cancer registry of Assam, India: a retrospective study.

Background: Head and Neck cancers are basically squamous cell carcinomas. It is the fifth most common cancer and the sixth most common cause of cancer mortality in the world. Incidence of cancer as a whole for all sites is fourth highest in Kamrup Urban District (KUD) in males (AAR 185.2) and second highest (AAR 156.3) in females out of all Population Based Cancer Registries (PBCR) in India. Incidence of head and neck cancers in KUD is quite high both nationally and internationally. This retrospective study was carried out to assess the incidence pattern of head and neck cancers in Kamrup Urban District of Assam, India for the period of 2009-2011. Methods: Cancer is not notifiable in India, so method of collecting information on cancer was active in PBCR Guwahati. A total of 4416 cases were registered during the three years (1st January 2009- 31st December 2011) of which 2508 were male and 1908 female. Statistical analysis used: Age Adjusted Rate (AAR), Crude Rate (CR) and Population pyramids are provided by NCRP-ICMR. Results: The relative proportion of head and neck cancers of total cancer cases registered in KUD constitutes 26% (654/2508) and 12% (225/1908) in male and female respectively. In males cancer of hypopharynx (AAR 14.7) was most common followed by tongue (AAR 9.4) and mouth (AAR 7.7). In females cancer of mouth (AAR 7.6) is most common followed by cancer of tongue (AAR 3.2). Conclusion: The pattern and incidence of various head and neck cancers is of utmost importance for primary prevention and early detection to adequately manage these cancers comprehensively in the community.

Cutaneous manifestations of systemic lupus erythematosus - an experience from Bahawal-Victoria Hospital, Bahawalpur

To document the frequency of cutaneous manifestation of systemic lupus erythematosus [SLE]. It was a case-series collected from Dermatology Department and all four Medical Units of Bahawal-Victoria Teaching Hospital of Quaid-e-Azam Medical, Bahawalpur. A total of 100 patients with diagnosis of SLE and fulfilling the inclusion criteria were included in the study. All the patients were evaluated for the cutaneous manifestations of SLE. All the information was collected in a specially designed proforma and analyzed with the help of SPSS version 10. The mean age of the patients was 25.97 +/- 4.64 years. 92% patients were female and 8% were male. Out of 100 patients, 85% patient presented with cutaneous manifestations. Photosensitivity was seen in 40 [40%] patients, discoid rash in 35 [35%], malar rash in 25 [25%], and oral ulcers in 24 [24%]. SLE is predominantly seen among female patients of young age. Photosensitivity is most common presentation, followed by discoid rash

Food behaviors and youth obesity in Pakistan / Tendências alimentar e a obesidade juventude no Paquistão

The epidemic of obesity took off from about 1980 and in almost all countries has been rising inexorably ever since. Only in 1997 did world health organization accept that this was a major public health problem. It is also becoming an important public health problem among Pakistani children due to changes in life style and other factors. The increasing prevalence of childhood obesity and its concomitant health risks justify widespread efforts toward prevention. A Cross-sectional study was conducted to elaborate the various types of foods and change in eating behavior leading to abnormal weight gain among the youth. A total of 504 male and female students of class six to ten were selected through simple random sampling. Anthropometric measurements were done with calibrated instruments using the age and sex specific BMI cut off points according to World Health Organization growth reference. Results showed significant proportion of girls (86%) and boys (85%) had abnormal waist to hip ratio. The determinants of the obesity lie within the rapid changes in food intake behavior and lifestyle patterns which had a clear and significant impact on the prevalence of obesity in youth of Pakistan.

A epidemia de obesidade decolou de 1980, e em quase todos os países aumentou inexoravelmente o número de obsessos desde então. Apenas em 1997, a Organização Mundial da Saúde aceitou que este era um problema de saúde pública. Também está se tornando um importante problema de saúde pública entre crianças paquistanesas pelas mudanças no estilo de vida e outros fatores. O aumento da prevalência da obesidade infantil e seus riscos de saúde concomitante em justificar esforços generalizados para a prevenção. Um estudo transversal foi conduzido para a elaboração dos vários tipos de alimentos e a mudança no comportamento alimentar levando ao ganho de peso anormal entre os jovens. Um total de 504 estudantes do sexo masculino e feminino da classe 6-10 foram selecionados através de amostragem aleatória simples. Medidas antropométricas foram realizadas com instrumentos calibrados usando a idade e o sexo IMC específicos cortado pontos de acordo com Mundial de referência de crescimento Organização Mundial de Saúde. Os resultados mostraram significativa proporção de meninas (86%) e meninos (85%) com cintura anormal ao quadril. Os determinantes da obesidade encontram-se nas rápidas mudanças no comportamento de consumo alimentar e os padrões de estilo de vida que teve um impacto claro e significativo sobre a prevalência de obesidade em jovens do Paquistão.

Comparision of excision and primary [midline] closure with karydakis technique in the surgical treatment of pilonidal sinus

Pilonidal sinus is a common anorectal problem that occurs in the cleavage between the buttocks [natal cleft] and causes discomfort and embarrassment and absence from work for the sufferers. It typically affects young men and women. Numerous surgical procedures have been described but treatment failure and disease recurrence is common leading to considerable morbidity in these otherwise healthy patients

Objective: To compare the effectiveness of excision and primary closure with Karadykis Technique of cleft closure in the surgical treatment of pilonidal sinus

Materials and Methods: Setting: Department of Surgery, Ch. Rahmat Ali Memorial Hospital, Township, Lahore. Study Duration: 3 years [Jan 2009 to Dec 2011]

Sample Size: 40 patients, 20 in each group

Inclusion Criteria: All adult males and females with clinical diagnosis of chronic pilonidal sinus

Exclusion Criteria: Recurrent pilonidal sinus disease, acute pilonidal abscess

Results: Out of 40 patients, 35 [87.5%] were males and 5 [12.5%] were females. Age range was 16 to 35 years with mean age of 25.5 years. Group A consisted of 20 patients who underwent Excision and Primary closure while group B had 20 patients who underwent Karydakis Technique of cleft closure. The postoperative complications encountered in Group A were post operative pain, wound infection, numbness at the site of surgery and recurrence while in Group B, complications included post operative pain, hematoma/seroma formation, wound infection, wound dehiscence, numbness at the site of surgery and recurrence

Conclusion: Karadykis procedure is better than excision and primary midline closure in terms of less postoperative complications, reduced hospital stay and recurrence rate

New single use supraglottic airway device with non-inflatable cuff and gastric tube channel

To assess ventilatory characteristics and airway complications associated with the use of I-gel in patients undergoing gynaecological surgeries. Experimental study. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, Karachi, from July 2008 to June 2009. One hundred adult female patients aged 15 - 75 years, ASA-I and II scheduled for elective gynaecologic surgical procedures under general anaesthesia with controlled ventilation were included in this study. After insertion of device, ease of insertion, time of insertion, peak airway pressure, leak pressure were noted. After proper placement of device, gastric tube was also passed in every patient. Pharyngolaryngeal morbidities [sore throat, dysphagia, dysphonia, neck pain and coughing at 1 hour and 24 hours postoperatively] were also noted. I-gel was inserted in the first attempt in 92% patients while second attempt was required in 8% of patients. Average time of insertion was 9.68 +/- 2.69 seconds. Average leak pressure of 22.48 +/- 2.07 cm H[2]O. After removal of I-gel no blood staining was found on any device. Coughing was noted in 6% patients after removal of device and mild sore throat was noted in only one patient after 24 hours of surgery. I-gel is a simple and easy to use supraglottic airway device. Its insertion do not require laryngoscopy and airway can be maintained in very short time in adult female patients

Local dexamethasone infiltration after dental implant placement - a comparative study

Objective of this study was to evaluate the efficacy of the co-administered dexamethasone and diclofinac potassium in controlling pain and swelling after dental implant surgery. The study was done in the PN Dental Centre [PNDC], PNS Shifa hospital Karachi from Aug 2009 to Dec 2010. It was a cross sectional comparative study. One hundred patients were selected in this study and divided into two equal groups, A and B of 50 patients each. In group A only Diclofinac potassium was given and in group B patients intraoral infusion of Dexamethasone was given along with Diclofinac potassium. In Group B patients reported good control over pain and swelling in first 24hours as compared to the group A

functional ectopic vaginal anus: a rare clinical entity

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises. She improved within a month with Wexner score of zero

Childhood circumcision, indications and complications

Circumcision is the most commonly performed operation in males worldwide and is an integral part of several religions like Islam and Judaism. Medical indications of circumcision are a few. Circumcision is contraindicated in a number of congenital penile disorders, including hypospadias, epispadias, chordee, buried penis and micropenis. Various techniques are available for performing circumcision. Complications include haemorrhage, infection, and meatal injury resulting in stenosis, removal of incorrect amount of skin, penile injury, urethral injury and painful scarring. However many of these complications can be prevented by using precise surgical techniques, meticulous asepsis and haemostasis

Objectives: To note indications, age of children and complications developing after circumcision

Patients and Methods: The study was conducted in the Surgical Department of Ch. Rahmat Ali Memorial Hospital, Township, Lahore, from Jan 2009 to Dec 2011. A total of 1000 cases were included in the study

Results: 860 [86%] children had circumcision performed in the surgical department and 140[14%] were referred to our unit after circumcision performed by quacks, barbers and general practitioners, after developing some complications. Ritual [religious] circumcision was done in 936 [93.6%]. 64 [6.4%] had medical indications. Out of 936, 815 [87%] were Muslims and 121 [13%] were non Muslims. 64 [6.4%] children were circumcised because of medical indications, mainly phimosis and paraphimosis. 140 [14%] children were referred to our unit because of complications, mainly bleeding in 34 [24%], infection in 20 [14.2%], under circumcision in 85 [60.7%] and excessive removal of skin in 1 [0.7%] child. The only complication which occurred in children operated in the hospital was infection in 6 [0.7%]children. Ages of the children were: Less than 1 month- 208 [20.8%] 1 to 12 months- 655 [65.5%] 1to 5 years- 110 [11%] More than 5 years- 27 [2.7%]