Thyroid surgery: drain versus no drain

To compare patients undergoing thyroid surgery without the placement of a drain versus patients undergoing surgery with placement of drain; in terms of hospital stay, operative pain score, amount of fluid collection in the neck and postoperative complications. This study was conducted at surgical unit, Naseer Teaching Hospital, Peshawar from January 2010 to July 2014. Important variables of the study were duration of hospital stay, post operative pain score, amount of fluid collection in the wound as detected on ultrasound and postoperative complications. Visual Analogue scale was used to assess postoperative pain on completion of 24 hours. All the patients were subjected to ultrasound of the neck on the 1st post-operative day. The data was entered on a proforma and analyzed on SPSS 21. The study included 68 patients; being grouped in to two groups the group with drain showed no difference demographically from the group in which drain was not placed post operatively. Mean postoperative pain score 24 hours after surgery was 60.87 +/- 7.06 SD in the drain group and 41.19 +/- 4.18 SD in no drain group [p value < 0.05]. Mean duration of hospital stay was 3.63 days +/- 0.707 SD in drain group and 1.19 days +/- 2.145 SD in no drain group [p value <0.05]. "Drain less" Thyroidectomy causes less discomfort, short hospital stay and does not increase the risk of post operative complications. Drains should be used only in selected cases of Thyroidectomy

Surgical site infection; in-vitro anti-bacterial activity of different brands of ceftriaxone against bacteria commonly implicated in surgical site infection and their cost effectiveness

Ceftriaxone is used in wide range of day to day microbial infections in clinical practice3. Despite the incumbent drug regulating authority in Pakistan, there is scanty literature comparing the anti-microbial efficacy of different available br and s of ceftriaxone. Objectives: To know the in-vitro activity of various br and s of ceftriaxone against bacteria most commonly isolated from surgical site infection [SSI]. A comparison of five days cost of these br and s will also be done. Design: Experimental study. Period: Feb 2013 to Aug 2013 Setting: Surgical "C" unit Lady Reading Hospital [LRH] in collaboration with departments of pharmacology Khyber Girls Medical College [KGMC] and microbiology department of Lady Reading Hospital Peshawar. Material and Methods: Isolates of five bacteria i.e. Staphylococcus aureus, Proteus mirabilis, Escherischia coli, enterobacter Spp, and Klebsiella pneumoniae, found sensitive to ceftriaxone were grown on 50 slops each and the zone of inhibition was checked for each of the ten br and s of ceftriaxone. Results: The zones of inhibitions of different br and s of ceftriaxone against the above mentioned bacteria were not significantly different. The cost of therapy was significantly different for ten br and s. Conclusions: Various br and s of ceftriaxone of variable cost had no influence on their activity against bacteria involved in SSI.

morphological study of celiac, superior mesenteric and inferior mesenteric arteries in atherosclerosis

Depolymerisation of acid-mucopolysaccharides results in the loss of metachormasia of the ground substance followed by visible fibre crumbling, complete dissolution and replacement by lipid droplets and cholesterol. The objective of this study was to assess the distribution of different atherosclerotic lesions in celiac, superior mesenteric and inferior mesenteric arteries relation to age and sex. A prospective descriptive observation study was conducted at Mortuary of King Edward Medical University Lahore, and Department of Pathology Allama Iqbal Medical College Lahore. A total of 30 human autopsies were carried out. Celiac, Superior mesenteric and inferior mesenteric arteries were taken out and opened length-wise. One to four areas of tissue were taken from each artery for histological examination. Slides were prepared from each paraffin block. Sections were stained with haematoxylin and eosin. Special stains were performed on sections to display each component of atherosclerosis. The fibrolipid plaques were seen in 6 cases. The complicated lesions were present in 5 cases. Of these, 4 showed ulceration and 1 showed thrombus formation. The calcified lesions were observed in 5 cases. The morphological changes in media and elastica were present in 4 cases. In superior mesenteric artery fatty streaks were present in 8 cases. The fibrolipid plaques were confirmed in 5 cases. Three cases showed ulceration, 1 case showed intimal vascularisation, haemorrhage, and thrombus formation. The calcified lesions were present in 2 cases. The morphological changes in media and elastica were seen in 4 cases in anterior mesenteric artery. Fatty streaks were present in 8 cases. The fibrolipid plaques were grossly observed in 6 cases. The complicated lesions were present in 4 cases; of these, 3 cases showed ulceration, and 1 showed intimal vascularisation and haemorrhage along with thrombus formation. The calcified lesions were present in 3 cases. The morphological changes in media and elastica were present in 4 cases. This data indicates the incidence of ischemic changes in abdominal viscera due to atherosclerotic narrowing.

Morphology and incidence of atherosclerotic lesions in subclavian arteries - a human autopsy study

To assess different morphological categories of atherosclerotic lesions and their incidence in relation to age and sex in our population. Prospective descriptive observational study. This study was conducted at Mortuary of King Edward Medical University Lahore and Department of Pathology Allama Iqbal Medical College Lahore and completed in one and a half year from. A total of 30 human autopsies were carried out at random. The age range was between 8 and 85 years. Right and Left subclavian arteries were taken out from dead bodies. They were opened lengthwise. One to four areas of tissue were taken from each artery in all cases. Section were prepared from paraffin blocks. They were stain with Haematoxylin and Eosin stain. Special stains were also performed to differentiate all the components of atherosclerotic lesions. The fibrolipid plaques were seen in l3 cases in the right subclavian artery and I3 cases in left subclavian artery. The complicated lesions were seen in 8 cases in the right subclavian artery and 9 cases in the left subclavian artery. 6 of these 8 cases showed ulceration in the right subclavian artery and 2 showed intimal vascularization and haemorrhage alongwith thrombus formation. In the left subclavian artery the ulceration was seen in 7 cases and intimal vascularization and haemorrhage in 2 cases along with thrombus formation. The calcified lesions were present in 7 cases in the right subclavian artery and 8 cases in the left subclavian artery. The morphological changes in media and elastics were seen in 7 cases in right subclavian artery and 8 cases in left subclavian artery. In this study different atherosclerotic lesions are categorized and their relation to age and sex is appreciated in our population. This study is although is preliminary but gives basic and useful data about the incidence of ischemic changes in upper limbs due to raised atherosclerotic lesions in subclavian arteries

morphological study of renal arteries in atherosclerosis - a human autopsy study

To assess the different morphological changes in atherosclerotic lesions in renal arteries in relation to age and sex. Prospective descriptive observational study. Mortuary of King Edward medical University and mayo hospital, Lahore, Pakistan. Duration of study was one and a half year. A total of one hundred and thirty human autopsies were carried out during this study. Ninety were males and forty females. The age range was between 8 and 85 years. The autopsies were done left renal arteries were taken out artery for histological examination. Tissue processing was done. On the average 7-8 slides were prepared from each block by taking ribbons of tissues. The paraffin sections were stained using Haematoxylin and Eosin stain, Curtis's picro-ponceau stain, verhoeff's elastic tissue stain, von kossa's staining technique, periodic acid Schiff [PAS] reaction, Toludine blue stain and peral's Prussian blue stain. The fibrolipid plaques were seen in 32 of the 39 cases seen on gross appearance in the right renal artery and 20 of the 24 cases seen on gross appearance in the renal artery. The complicated lesions were present in 15 cases in the right renal artery and 11 cases in the left renal artery. In the right 12 cases showed ulceration, 3 cases showed intimal vascularization and haemorrhage, whereas 2 of these cases also showed thrombus formation. In the left renal artery there were 8 cases showing ulceration, 3 cases showed intimal vascularization and haemorrhage and one of theses also showed thrombus formation. The calcified lesions were seen in 9 case in the right renal artery and 7 cases in the left artery. The morphological changes in the media and elastic were in 11 cases in right renal artery and 7 cases in left renal artery. Incidence of fibro-lipid plaques complicated and calcified lesion are quite high in both renal arteries. The relative high incidence of raised lesions in Right renal arteries may be due to more length, lower position and its position across the inferior vanacava

morphological study of common carotid arteries in atherosclerosis

Objective: to review the pattern of atherosclerosis in common carotid arteries

Material and Methods: the pattern of atherosclerotic lesions was studied in common carotid arteries in 30 human autopsy cases, This study was conducted in the mortuary of King Edward Medical College, Lahore. Both the right and left carotids of all 30 cadavers were opened and reviewed both grossly and microscopically

Results: the fatty streaks were present in 10 cases in the right common carotid artery and 10 cases in the left common carotid artery. The fibro lipid plaques were seen in 9 cases in the right common carotid artery and 9 cases in the left common carotid artery. The complicated lesions were present in 5 cases in the right common carotid artery and 6 cases in the left common carotid artery. In the right common carotid artery 4 cases showed ulceration and one case showed intimal vascularization and haemorrhage along with thrombus formation. In the left common carotid artery 4 cases showed ulceration and 2 showed intimal vascularization and haemorrhage along with thrombus formation. The calcified lesions were seen in 4 cases in the right common carotid artery and 5 cases in the left common carotid artery. The morphological changes in media and elastic were present in 6 cases in the right common carotid artery and 7 cases in left common carotid artery

Conclusion: this study shows that raised atherosclerotic lesions are reasonably common in our population and stresses the need to conduct larger studies to comment on the relationship with age and sex

Atherosclerotic lesions in relation to occupational physical activity-a human autopsy study

To assess the severity of different atherosclerotic lesions in relation to occupational physical activity in our population. Prospective descriptive observational study. Mortuary of King Edward Medical University Lahore and Department of Pathology Allama Iqbal Medical College Lahore. The duration of study was completed in one and a half year. A total of 130 human autopsies were carried out at random. The age range was between 8 and 85 years. Heart, aorta coronary arteries and renal arteries were collected from dead bodies. One to four areas of tissue were taken from aorta and each arteries in all cases. Sections were prepared from paraffin blocks. These were stained with Haematoxylin and Eosin stain. Special stain were also performed to differentiate all the components of atherosclerotic lesions. The fatty streaks were present in a predominant number of cases in Grade-II and Grade-Ill than in Grade-I physically activity cases. The fibrolipid plaques, complicated and classified lesions were seen predominantly in Grade-I than in Grade-II and Grade-Ill physically active cases on percentage basis. In this study the severity of different atherosclerotic lesions is noted in Grade-I, Grade-II and Grade-Ill physically active subjects according to their occupational activities. This basic data gives indication and guideline for prevention and control of atherosclerotic process by increasing physical activity in life style of our population

Atherosclerotic lesions in cigarette smokers and hukka smokers: a comparative human autopsy study

To assess the different morphological types of atherosclerotic lesions in cigarette smokers and Hukka smokers in our population. This descriptive study was conducted at the mortuary of King Edward Medical University Lahore and Department of Pathology Allama Iqbal Medical College Lahore from June 2007 to July 2009. Heart, aorta coronary arteries and renal arteries were collected from dead bodies. One to four areas of tissue were taken from aorta and each artery in all cases. Sections were prepared from paraffin blocks. These were stained with Haematoxylin and Eosin stain. Special stains were also performed to differentiate all the components of atherosclerotic lesions. A total of 130 human autopsies were carried out in this study. Out of these, 84 were smokers [62 cigarette and 22 hukka smokers]. The analysis was carried out on these 84 cases. The mean age of smokers was 48.63 +/- 16.079. Fibrolipid plaques and complicated/ calcified lesions were seen in predominantly more cases in cigarette smokers, than hukka smokers in aorta, coronary arteries and renal arteries. This study shows distribution of different atherosclerotic lesions in cigarette smokers and hukka smokers in our population. The raised atherosclerotic involvement in cigarette smokers as compared to hukka smokers is evident from the results

Effect of fixed orthodontic apliances on the salivary pH

To assess the influence of fixed orthodontic appliances on the salivary pH. Randomized controlled trial. Department of Orthodontics, Armed Forces Institute of Dentistry in collaboration with the Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from 10th September 2007 to 06th November 2008. Sixty Subjects [11 males and 49 females] with age ranging 13-20 years were randomly selected and divided into a control and an experimental group of 30 each. Study involved analysis of salivary samples. A proforma indicating salivary levels of pH at T1 [pre treatment] and at T2 [after 4 months] with the differences between T1 and T2 was prepared for each subject. In experimental group salivary pH depicted a statistically significant decrease between T1 and T2. These changes in control group were insignificant. Fixed orthodontic appliances [FOAs] tend to influence oral environment by lowering salivary pH towards acidic side

Atherosclerotic lesions in hypertensive subjects -a human autosy study

To assess the incidence and severity of atherosclerotic lesions in hypertensive subjects in our population. Prospective descriptive observational study. Mortuary of Forensic Department, King Edward Medical University Lahore and Pathology Department of Allama Iqbal Medical College Lahore. This study was completed in one and a half year. A total of 130 human autopsies were carried out in the mortuary of King Edward Medical University Lahore. Heart, aorta and its major branches were collected. History was taken from the close relative of deceased for hypertension. One to four areas of tissue were taken for each artery and aorta for histological examination. The section were stained with Haemotoxylin and Eosin stain. Different special stains were also performed on all cases to differentiate different components of atherosclerotic lesions. The fibrolipid plaques, complicated lesions and calcified lesions were present in a predominant number of cases in aorta and its major branches, except the fibrolipid plaques were less dominant in the right coronary artery, the complicated lesions were seen less frequently in the right coronary artery and the left renal artery and the calcified lesions were observed less dominantly in the thoracic aorta, anterior descending branch and circumflex branch of left coronary, innominate artery, coelic artery, superior mesenteric artery, inferior mesenteric artery and renal arteries. The calcified lesions were absent in the right coronary artery. This study although preliminary but basic and observational in nature indicates the considerable severity of raised atherosclerotic lesions in hypertensive subjects in our population

Atherosclerosis in relation to diabetes mellitus

To access the relationship of different categories of atherosclerotic lesions to diabetes mellitus and also in relation to age and sex. Prospective, Randomized and Comparative Study. Forensic Medicine and Toxicology Department, KEMU and AIMC, Lahore from April 2006 to Dec. 2007. 130 autopsies were performed the age range was 8 to 85 years. The autopsies were done at random. Heart, aorta and its major branches were collected from dead bodies. The history of diabetes mellitus was taken from the close relatives of the deceased. The processing of cases was done in the Pathology Department of AIMC, Lahore. The slides were stained by haematoxline and eosin. Special stains also performed, The fatty streaks were present in predominant number of cases in aorta and its major branches except in the right coronary artery where they were seen less dominantly. The fibrolipid plaques, complicated and calcified lesions were present in a predominant number of cases in aorta and its major branches except the calcified lesions were present less dominantly in the thoracic aorta circumflex branch and renal arteries. The complicated lesions were not seen in the right coronary artery and calcified lesions were absent in the right coronary artery, innominate artery and superior mesenteric artery in diabetics. In the study it was concluded that there is definite relationship between diabetes mellitus and different categories of atherosclerotic lesions. The age and sex relationship of atheroscleroses is also well indicated in this study

Atherosclerosis in relation to fat penniculus [obesity] between xiphoid and umbilicus

It has been shown that possible influence of body weight is more evident for coronary than aortic atherosclerosis; and more in men than women. Coronary heart disease due to obesity in males becomes significant when body mass index [BMI] exceeds 30 [30% overweight] and does not affect the life expectancy particularly in women. This study was conducted to asses the relation of thickness of fat penniculus [obesity] between xiphoid and umbilicus to different atherosclerotic lesions; and to collect basic data about age and sex distribution of this relation. It was prospective descriptive study and conducted at mortuary of King Edward Medical University, and Department of Pathology, Allama Iqbal Medical College, Lahore. A total of 130 human autopsies were carried out in one-and-a-half year of study duration. The ages of the deceased ranged between 8 and 85 years. Heart aorta and its major branches were included in this study. In addition, fat penniculus between xiphoid and umbilicus was measured and atherosclerosis lesions were categorised and correlated with this parameter. Haematoxylin and Eosin, and different special stains were done in Pathology Department of Allama Iqbal Medical College, Lahore to asses to severity of atherosclerosis lesions. The fatty streaks were present in predominantly more cases with Fat Penniculus <20 mm than in asses with Fat Penniculus <10 mm and <30 mm. The fibrolipid plaques, complicated and calcified lesions were present in a dominant number of cases with Fat Penniculus <30 mm on percentage basis. Raised lesions were seen more frequently in cases with Fat Penniculus 20 mm to <30 mm than in cases with Fat Penniculus <10 mm and <20 mm thickness

Prevalence of class II malocclusions in Pakistani sample - a study

The aim of this study was to determine the frequency of Class II malocclusion in seven different age groups in a local sample of patients seeking orthodontic treatment. Data for the study were retrieved from the patient's orthodontic records who sought orthodontic treatment at Armed Forces Institute of Dentistry [AFID] during the period of Oct 1999 through May 2008. A total of 1348 patients were screened. All the subjects had full complement of permanent teeth up to second molars. The patients with the history of previous orthodontic treatment, extractions of permanent teeth other than 3rd molars, mixed dentition, congenital malformations like Cleft lip or/ and palate and systemic diseases were excluded from the study. Assigning the subjects to various occlusal traits was based purely on clinical examination, study casts in centric occlusion, facial photographs and lateral cephalograms assessment. An overall prevalence of class II malocclusions within the selected sample was found to be 41%, with a male to female ratio of 1: 2.6. The three categories of Angle Class II malocclusion depicted a prevalence of 29.9% for Class II/1, 0.7% for Class II/2 and 10.4% for Class II subdivisions. All the three groups of Class II malocclusions reflected higher female ratios, presumably because of the higher number of female gender seeking orthodontic treatment in Pakistan

Frequency of dental anomalies in various malocclusions in orthodontic patients

The aim of this study was to determine the frequency of different dental anomalies in different malocclusion groups of patients seeking orthodontic treatment. This study was carried out at the Orthodontic Department of Armed Forces Institute of Dentistry [AFID], Rawalpindi. Data for the study were collected from the pretreatment diagnostic records of patients who reported at the department for orthodontic treatment from June 2003 to June 2009. A total of 503 patients of both gender [158 male, 345 female] with mean age 15.89+3.03 years [range, 11-22 years] were evaluated for study. All the subjects were in permanent dentition and had pretreatment diagnostic records were included in the study. Patients with syndromes, severe medical histories, impacted third molars, extraction of any permanent tooth, or trauma to any tooth before orthodontic treatment were excluded from the study. It was found that 55.3% of patients [n=503] had at least one dental anomaly. Agenesis [missing tooth or teeth] was the most common [24.9%], followed by ectopic eruption 21.3%, impaction 7.8% [canine] and supernumerary teeth 1.4%. The rate of tooth agenesis was higher in female than in males. No statistically significant correlations were found between dental anomaly and type of malocclusion. A remarkably high rate of dental anomalies was recorded. Dental anomalies reflected higher frequency in females, presumably because of the higher number of female gender seeking orthodontic treatment in Pakistan

Orthodontic uprighting of impacted mandibular permanent second molar - a case report

Due to the change in the life style and eating habits, impactions of teeth are on the increase. Mandibular 3[rd] molars and at times second molars are not the exceptions. They pose not only a big challenge to an oral surgeon but also provides a golden opportunity to the treating orthodontist by leveling and aligning it, thus enabling the dental occlusion to become stabilized and integrated in a much more balanced and harmonized manlier. Mandibular second molar plays a major role not only in function but also as a reinforcing anchor in orthodontics. Its significance is of paramount importance. Maximum efforts are to be exercised in saving and conserving this tooth in the oral cavity. Oral surgery should be the last resort in the treatment modalities. It should be undertaken only, when the orthodontic treatment fails due to the difficult spatial relationship of the tooth and is jeopardizing survival of the vital neighboring anatomical structures. A case report of a young girl with mesioangularly impacted left second mandibular molar is presented. Both 1[st] and 3[rd] molars of the ipsilateral side were present and fully erupted. The impacted tooth was managed orthodontically and no surgical intervention was resorted to minimize invasive procedures

Prevalence of class III malocclusion in an orthodontically referred Pakistani population

To assess the prevalence of Class III malocclusions in all military and civilian patients seeking orthodontic treatment at Armed Forces Institute of Dentistry, so as to strategize treatment planning on a priority and individualized basis. A total of 1348 patients referred to the department of Orthodontics ..AFID from Oct 1999 through June 2008 were both clinically and cephalometrically screened for this study. Out of a final sample size of 1185, comprising 375 [31.6%] males and 810 [a 4% females, [11.1%] patients exhibited Class III malocclusion. Class III was found in 51 males and 80 females only. Males exhibited a higher frequency 13.6% as compared to females 9.9%. Frequency of Class III malocclusion in our sample is higher than those of Caucasians, Africans and Asians of Middle East. It is however compatible to Turkish and Japanese populations, but lesser than Koreans