Potential risk factors for congenital malformations in neonates: a case series study in two tertiary care hospital of Lahore city

Objective: 1.To Study the potential risk factors for congenital malformations in neonates admitted at two tertiary care hospitals of public sector in Lahore city. 2.To find out the frequency of systems affected in congenital anomalies

Methods: It was a "case series" study conducted at Children hospital and Services hospital Lahore. All the congenital malformations from 1st April to 30th April, 2013, in neonates admitted in these institutions were included in the study. Mothers of 40 cases of congenital malformations were interviewed after taking verbal consent, using self-administered, pre-tested questionnaire. Data was analyzed by using SPSS version 14

Results: The frequency of cousin marriages in parents with congenitally malformed children was considerably high i.e. 65%. Majority of mothers i.e. 62.5% were below metric, 87.5% belonged to low income group, 62.5% did not made an increase in diet during pregnancy, 35% suffered from stress during pregnancy and 30% had previous abortion. The number of anomalies of urogenital system and GIT were higher with frequency of 45% and 30% respectively with a cumulative frequency of 75%

Conclusion: The frequency of congenital malformations was considerably higher among parents with consanguinity, in low income groups, mother's education less than metric and paternal age greater than 30 years. The number of anomalies of urogenital system and GIT were higher in our subjects with frequency of 45% and 30% respectively with a cumulative frequency of 75%

Sarcasm of quality and efficiency: an evaluation of inpatient bed utilization in services hospital Lahore Pakistan

Objective: to determine inpatient bed utilization in the Pediatrics Ward of Services Hospital, Lahore as average daily census and Bed Occupancy Rate

Methods: a cross sectional study was conducted in the Pediatrics Medicine Ward of Services Hospital Lahore which is a tertiary care hospital attached with Services Institute of Medical Sciences Lahore, Pakistan. A 'midnight census' was conducted by 4th year MBBS, Medical Students for the children admitted from 6 to 12 May, 2015. The data for inpatient service utilization was analyzed for estimation of average daily census and bed occupancy rate

Results: the average daily census was 69 patients per day and the Bed Occupancy Rate was found to be 137.7%. This rate was higher than 100% that shows the over-utilization of beds leading to quality compromise for the provided services

Conclusion: high bed occupancy rate indicates a scarcity of beds in the Pediatric Ward which highlights a disparity between the supply and demands of pediatric medical services. A change in policy and increase in number of beds would help provision of quality health services to the children

Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment

To identify the frequency of anomalies associated with chest deformity in physical fit male candidates reporting for military recruitment. Observational. Department of Thoracic Surgery, CMH Rawalpindi from 1[st] Jan 2008 to 31 Dec 2011. Normal healthy physically fit young adolescents being recruited for army were scrolled and those exhibiting chest deformity were isolated and subjected to evaluation. Convenience sampling was carried out. All cadidates of chest wall deformity thereafter underwent a thorough physical checkup, pulmonary function tests and echocardiography. A total of 3735 candidates of chest deformity reported at our center for evaluation over this duration. Single deformity patients 3380 [90.5%], mixed deformity patients 355 [95%]. We found that none of the candidates had any derangement of the lung function tests or electrocardiographic abnormality despite their deformity. However echocardiography detected an abnormality in 161 [4.3%] individuals who were otherwise asymptomatic. Chest deformity should be excluded before physical tests, in all the male candidates reporting for enrolment. If slightest of doubt exists that a candidate has chest deformity then he should be evaluated with echocardiography to exclude cardiac abnormality. Although the associated frequency is only 4.3% but this can subsequently result in a grave event like death

Solitary pulmonary nodule a rare case

A middle aged man presented with a solitary pulmonary nodule. He had a diagnostic dilemma as the CT guided FNAC was inconclusive. The frozen section exam reported it to be malignant so a lobectomy was performed for this lesion. The final histopathology report confirmed it to be a very rare tumor of extra skeletal synovial sarcoma

Assessment of determinants of decrease in tendency for breast feeding in Mothers Visiting Services Hospital Lahore

Objective: assesment of the determinants of decrease in tendency for breast feeding among mothers visiting Gynae and Peads OPD of Services Hospital Lahore

Material and Methods: this was a cross sectional, descriptive study, carried out at Services Hospital, Lahore. Study duration was 3 months from June 2014 to August 2014. Study population included all mothers before menopause in Gynae and Paeds OPD of Services Hospital Lahore. A predesigned structured questionnaire was used to collect data from mothers. Data was entered, cleaned and analyzed using SPSS version 16. Consent was obtained on the form beforehand

Results: breastfeeding practices were more in the mothers who had knowledge about benefits of breastfeeding. The percentage of women having knowledge of benefits had increased tendency to start breastfeed their child within 30 minutes of birth and to continue it for 2 years. Mothers who had breastfeeding as a family tradition were provided with more suitable environment which led to increased tendency for breast feeding. On contrary the mothers who we're not provided with a suitable environment and did not have breastfeeding as family tradition had decreased tendency to breast feed their children. Mothers who were in good health condition had increased tendency to breastfed their children. Breast feeding practice in women who did not consider breastfeeding as old fashion and did not think breast feeding to affect their figure was more than the mothers who preferred top feeding as a fashion. The breastfeeding practice in women who had a good health status i.e. did not have systemic disease ,breast abnormality and felt healthy after breast feeding is more than the mothers who had poor health status

Conclusion: from the results it was concluded that lack of knowledge about benefits of breastfeeding, misconceptions about taboos regarding breastfeeding affecting figure and is an old fashioned practice, poor health status of mothers, increased work load on the part of mothers and lack of suitable environment to breastfeed led to decrease in tendency for breastfeeding

Assessement of musculoskeletal manifestation in diabetic patients visiting diabetic clinic of services hospital, Lahore

Objective: to determine the frequency of musculoskeletal manifestations in diabetic patients and to examine the possible predictors for its development

Material and Methods: we performed a cross sectional study from 1 April 2013 to 31 June 2013 to evaluate the musculoskeletal manifestations in diabetic patients at Diabetic Management Center of Services Hospital Lahore, Pakistan. Base line variables were examined to determine the association of musculoskeletal manifestations. Analysis was carried out using Statistical package for Social Sciences [SPSS version 20]

Results: 100 patients were included; 34% had musculoskeletal manifestations. Of these 34 patients 29 [85%] were type 2 DM. The most common manifestations were adhesive capsulitis [n=13], carpal tunnel syndrome [n=12] and muscle atrophy [n=9]. A significant association was found between gender [p=0.041], overweight [p=0.021] and neuropathy

Conclusion: musculoskeletal manifestations are recognized in diabetic patients. Physicians should consider examining the particular regions in the joints of shoulders and hands during their routine visits

Assessment of cases of congenital cataract in patients admitted in hospitals of Lahore

Objective: to observe the different patterns of congenital cataract in children and to determine the age at which maximum cases are reported

Material and Methods: descriptive cross sectional .Study was conducted on patients of congenital cataract in different hospitals of Lahore and Study duration was 03 months. All participants were selected by non-probability purposive sampling technique. Parents of patients of congenital cataract were interviewed after taking verbal consent using questionnaire method. Data was analyzed using SPSS

Results: in this study 30 cases of congenital cataract were examined age ranging from 0-8 years in the four hospitals of Lahore. Majority [70%] of the cases of congenital cataract are reported up to age 4 years. Out of 30 cases of congenital cataract 56% are male and 43% are female. Majority [83.3%] of cases are reported with bilateral congenital Cataract. Nystagmus and squint as associated symptoms are present in majority [63.3%] cases. Hereditary trait regarding congenital cataract is observed in 46.7% of cases. Maternal rubella infection as a cause of congenital cataract is reported in majority [73.3%] of cases. Congenital cataract in associated with metabolic disorders is reported in 26. 7% of cases. Majority of patients [73.3%] are having lamellar pattern

Conclusion: most patients are reported up to the age of 4 years. Males are predominantly affected. Maternal rubella is found to be commonest cause. Most of cases are with bilateral presentation. Majority of cases have lamellar pattern

Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses

To determine the sensitivity and specificity of endoscopic ultrasound [EUS] guided fine needle aspiration cytology [FNAC] in the evaluation of pancreatic masses. Analytical study. Department of Pathology, Shaukat Khanum Cancer Hospital and Research Centre, from January 2006 to June 2011. Patients of either gender aged above 18 years who underwent EUS guided FNAC of pancreatic masses detected on abdominal CT, were included in the study. Biphasic abdominal CT scans were carried out for all the patients, followed by EUS guided FNAC. All material aspirated for cytologic evaluation was assessed for sample adequacy on-site, followed by formal examination for diagnostic purposes. The mean age of patients tested was 58.94 +/- 12.84 years with age ranging from 23 to 78 years. Regarding gender 23/42 [54.76%] patients were male and 19/42 [45.24%] were female. Out of 42 cases, 27 [64%] cases were diagnosed as adenocarcinoma, 4 [9.5%] as benign, 4 [9.5%] as mucinous cystic neoplasm, 2 [4.7%] as chronic pancreatitis, 2 [4.7%] as non-diagnostic, 2 [4.7%] as atypical cells seen and 1 [2.38%] as non-Hodgkin's lymphoma. The results were in full concordance with radiologic findings. EUS guided FNA is an excellent procedure for evaluation of pancreatic masses. The overall sensitivity of this procedure is 89% and the specificity is 67%

Video assisted thoracoscopic surgery [VATS] lung biopsy for non-responsive patients of interstitial lung disease [ILD]

To study the results of VATS [Video Assisted Thoracoscopic Surgery] Lung Biopsy in Interstitial Lung Disease [ILD] case series. Department of Thoracic Surgery, CMH Rawalpindi from Jan 2009 to Mar 2010. All those patients of ILD [Interstitial Lung Disease] were included who failed to improve after a period of observation including those on empiric therapy, all patients in which BAL [Bronchoalveolar Lavage] and TBLB [Transbronchial Lung biopsy] was inconclusive and all those patients fit to undergo thoracoscopic surgery. Patients excluded were elderly patients, those with systemic disorders frequently associated with ILD and those with known neoplasm likely to have lymphangitic dissemination. We used three thoracoscopic ports, all biopsies were sent for histopathology examination, single chest tube was placed in all cases and it was removed once the airleak ceased. All complications encountered were noted. Fourteen patients were registered during study period. Biopsy showed that 9 had ILD, and 5 did not have ILD. Only complication was a prolonged airleak for 2 days in 2 patients. No mortality was encountered. Thoracoscopic surgical biopsy can be accomplished safely in most cases where there is a diagnostic dilema for interstitial lung disease

Management of primary spontaneous pneumothorax by video assisted thoracoscopic surgery [VATS]

To evaluate the outcome of treatment of primary spontaneous pneumothorax by VATS. Case Series. Dept. of thoracic Surgery Combined Military Hospital Rawalpindi between April 2007 to Dec 2009. This study included 20 patients with primary spontaneous pneumothorax who were treated by VATS apical stapling and pleural abrasion/ pleurectomy. All patients were operated under one lung ventilation. Three ports of 10mm were used and apical stappling / bullectomy was done with linear cutting stapler [ethicon, autosuture]. This was combined with pleural abrasion/ pleurectomy, Chest was drained via a single chest tube. We had 21 procedures on 20 patients. There were 18 males and 2 females [9:1]. Mean age was 26.4 years. Indications included persistent air leak 7, recurrent attack 12, contralateral recurrence 1 and professional hazard 1. Mean hospital stay was 3.2 days. Complications included minor port site infection 5, intercostals neuralgia 3, delayed lung expansion 2 cases and persistent apical space in 1 case. There is no recurrence. VATS was a reliable approach for managing primary spontaneous pneumothorax with low morbidity