A comparative study of the effect of health insurance on women's use of health facility delivery: Evidence from demographic health survey in Benin Republic

Studies in the Benin Republic have identified contextual factors that determine health facility delivery among women of reproductive age. However, it is not certain if the same set of factors predicts facility delivery for women who enrolled in health insurance and those who did not. The study seeks to compare the determinants of health facility delivery for mothers under health insurance and those that are not in the Benin Republic. The study used data for 33,078 women of reproductive age, drawn from the most recent Benin demographic and health survey (2017-18). The characteristics of the women were described using simple proportions and frequency. Binary Logistic regression was used to examine determinants of health facility delivery for both groups of women. The result showed that only 0.7% of the women were under health insurance coverage. The prevalence of health facility delivery was high in the enrolled group but not in the unenrolled group (98.3% vs. 87.8%). The uniform determinants of health facility delivery across the two groups were household wealth, education, employment, land/house ownership, media exposure, a minimum of four antenatal contacts, and place of residence. To improve the coverage of health facility delivery, a multi-pronged approach should be used to improve household socioeconomic status, encourage media use among women, expand education opportunities for women, and specifically target rural women in Benin. (Afr J Reprod Health 2022; 26[6]:104-115).

Intestinal spirocheteosis in a patient with celiac disease

A young girl presented to us with recurrent diarrhea along with a history of 5 kg weight loss in one year. On examination, she appeared pale, while her laboratory reports showed a low hemoglobin, mean corpuscular volume [MCV] and serum albumin. Her erythrocyte sedimentation rate [ESR] was slightly raised with her iron profile suggestive of iron deficiency anemia. Viral markers, human immunodeficiency virus [HIV] serology along with thyroid profile were all unremarkable. There was no history of tuberculosis, and purified protein derivative [PPD] skin test was also negative. Computed tomography [CT] abdomen showed thickening of the terminal ileum with multiple enlarged lymph nodes. An esophagogastroduodenoscopy [EGD] along with colonoscopy was done. Multiple biopsies were taken, which were suggestive of sprue along with intestinal spirochetosis. Her tissue transglutaminase [TTG] was negative while deamidated gliadin peptide [DGP] was positive. She was kept on gluten-free diet and started on tablet metronidazole. This case shows that intestinal spirochetosis should be kept in mind in patients belonging to lower socio-economic status, who present with chronic diarrhea symptoms

Effects of anterior chamber depth and axial length on corneal endothelial cell density after phacoemulsification

Objective: To evaluate mean decrease in Corneal Endothelial cell Density [CED] after phacoemulsification in patients with different Anterior Chamber Depths [ACDs] and Axial Lengths [ALs]

Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. One hundred eyes of 90 patients, scheduled to undergo phacoemulsification surgery, were included. AL and ACD of each patient were calculated preoperatively using IOL Master. Cataracts were classified according toLens Opacities Classification System III [LOCS III] giving nuclear opalescence [NO] grades on slit lamp examination and only patients with grades NO2 and NO3 were included.Eyes were divided into two groups according to ACD and AL: Group-I: ACD 2.0mm - 3 mm and AL 22mm - 23.5mm; Group-II: ACD 3.1 mm -4.0 mm and AL 23.6mm - 25mm. CED measurements were done preoperatively and 2 month postoperatively using specular microscopy. The difference in CED change [Endothelial Cell Loss] between the two groups after surgery was analyzed using SPSS, v 22; IBM Corporation, Armonk, NY

Results: Differences in gender, laterality, age and preoperative CED between two groups were not significant. Difference in postoperative CED was also not significant, however difference in mean change and mean frequency change in CED between two groups was found to be statistically significant

Conclusion: ACD and AL affect the CED during phacoemulsification and Intraocular Lens[IOL] implantation and can be considered as risk factors of peroperative endothelial cell loss

Germ cell tumor and Takotsubo Cardiomyopathy: A treatment dilemma

Germ cell tumors [GCT] are uncommon malignancies in adult males and comprise less than 1% of male cancers. Due to highly curative nature and productive life years gained after treatment; reduction of chemotherapy related toxicities becomes vital. Cisplatin is the backbone of GCT chemotherapy, and is related to myocardial injury, thromboembolism and vasculitis. Though it should not be replaced with Carboplatin, however in certain circumstances, its use maybe unsafe; especially in cases when patient have prior myocardial infarction. We report a case of Takotsubo cardiomyopathy [TCM] secondary to GCT diagnosis in a young male. This patient presented withsymptoms of myocardial infarction however, coronary angiography was normal and a diagnosis of TCM was made. Though, it is rare but a unique challenge, as whether Cisplatin use would be safe in this particular scenario? On one hand patient had stress related myocardial injurywhile he was also at risk of further Cisplatin induced complications.There are no clear cut guidelines, so after informed consent his treatment regimen was modified to EC [Etoposide/Carboplatin] instead of EP [Etoposide/Cisplatin]. Patient has completed 4.6 years of follow-up without any evidence of relapse. We suggest informed decisions and to weigh the pros and cons of using an inferior regimen, in order to achieve same long term prognosis while preventing any acute complications,in younger patients with curable cancers

Hepatic Sarcodosis presenting as portal hypertension in a young boy

A 13-year-old boy, known case renal stone disease came with the complaints of abdominal pain along with low grade fever. On examination, hepatosplenomegaly was noted while his lab reports showed a low hemoglobulin with a raised ESR. His blood and urine cultures showed no growth. Viral markers, autoimmune profile, C and p ANCA were all negative apart from a raised serum IgG level. Ultrasound abdomen showed a hyperechoic liver with an enlarged spleen along with splenic varices and minimum ascites. Ultrasound hepatic doppler was normal. Serum AFP levels were normal while workup for Wilson's disease was negative. Fibroscan showed F4 fibosis. CT scan abdomen showed an enlarged left lobe of the liver along with an enlarged spleen. His EGD revealed varices. So liver biopsy was done that was suggestive of chronic granulomatous disease with ZN stain testing negative for TB.PPD, urine for AFB were both negative. Serum ACE levels were raised. He started ATT therapy but his condition did not improve. So, on the suspicion of hepatic sarcoidosis, he started on steroids and had a drastic improvement in his condition

use of Karnofsky Performance Status [KPS] as a predictor of 3 month post discharge mortality in cirrhotic patients

Aim: Is Karnofsky Performance Status [KPS] a predictor of 3 month post discharge mortality in cirrhotic patients?

Background: Cirrhotic patients often experience an abrupt decline in their health, which often leads to frequent hospitalization and can cause morbidity and mortality. Various models are currently used to predict mortality in cirrhotics however these have their limitations. The Karnofsky Performance Status [KPS] being one of the oldest performance status scales, is a health care provider - administered assessment that has been validated to predict mortality across the elderly and in the chronic disease populations

Methods: We used the KPS performance status scale to envisage short-term mortality in cirrhotic and HCC patients who survive to be discharged from hospital

Results: Our study showed that KPS one week post-discharge, child pugh score, hospital stay, international normalized ratio, serum albumin, total bilirubin and serum creatinine showed statistical significance on univariate analysis. On multivariate analysis, KPS was found to be statistical significant predictor of 3-month mortality

Conclusion: Hence KPS can be utilized to identify cirrhotic patients at risk of 3-month post discharge mortality

Role of Pancreatic Stent placement in prevention of post Endoscopic retrograde Cholangiopancreatography Pancreatitis: experience at a tertiary care hospital in Pakistan

Objective: To determine the frequency of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis [PEP] in patients who underwent prophylactic pancreatic duct stenting

Study Design: Descriptive case series

Place and Duration of Study: This descriptive case series was conducted at the department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Jul 2017 to Feb 2018

Material and Methods: One hundred and twenty consecutive patients were enrolled after they met inclusion and exclusion criteria. Endoscopic Retrograde Cholangiopancreatography Pancreatitis [ERCP] was performed by Olympus duodeno scope [TJF Q180V] by an endoscopist having at least 3 years experience of performingindependent ERCPs. An additional 4, 6, or 7cm long 5FrGeenen[registration sign] pancreatic plastic stent [Cook Medical] was placed in all cases where pancreatic duct was accidentally cannulated. Primary outcome variable was post ERCP pancreatitis. Data was recorded on a pre-designed proforma and analyzed by SPSS version 21.0

Results: Out of total 120 cases, PEP was found in 4 [3.3 percent] patients. All the 4 patients had mild pancreatitis

Conclusion: PEP is not an uncommon complication following ERCP. The rate of PEP appears to be lower with prophylactic pancreatic duct stenting

Anti-Microbial potential of Panacea [Nigella Sativa]

Background: In the existing scenario, increasing drug cost, toxic effects and drug resistance or the main motivating factors for researchers to exploit the natural bioactive sources for safe and natural therapeutic as an alternative to antibiotics

Objectives: The main objective of the study is to find out the antimicrobial potential, its spectrum and magnitude in N.sativa

Study Design: Experimental/in vitro study

Duration: September, 2016 - February, 2017

Settings: Different departments [of School of Pharmacy, Pathology and Bio-chemistry of UM and DC], The University of Faisalabad

Methodology: Antibiotics assay is performed by using the disc diffusion methods. N.sativa extracts are prepared and from these sensitivity discs are prepared. Standard size inoculum is also prepared. Then by using standard disc diffusion method the zones of inhibitions produced by N.sativa extracts are measured and recorded in mm and is compared with positive and negative controls

Results: Spice extract tested against test organisms revealed antimicrobial potency with diameter of zone of inhibition [27.17+/-0.98mm - 31.33+/-0.21mm] while positive control manifested zone of inhibition [19.33+/-0.21 - 29.17+/-0.17mm]. Ethanol extracts prepared by Soxhlet apparatus showed better results compared with extracts prepared by simple maceration process. Furthermore, overall ethanol extracts showed better results compared with the aqueous extracts

Conclusion: This study revealed the presence of natural bioactive compound[s] in N.sativa with highly significant broad spectrum antibacterial potential, even against multi resistant pathogens

To evaluate the efficacy and safety of CofNovex plus [EMA] syrup

The cough and cold are very widespread conditions and a common purpose for advice in general practice. Utmost often the sign and symptoms of cough are produced by acute viral airway infection and the course is frequently benign. But it can be converted into bacterial super-infection and can cause acute bronchitis. Herbal medicines are used to treat symptoms of the cough and cold, and among these medicines Ivy leaf is used to treat mucous discharge and irritation in throat due to the cough and cold. In addition to synthetic substances such as acetylcysteine, carbocisteins, ambroxol and bromhexine, herbal medicines contain saponins, which are used in these indications. Not just Ivy, but also the marshmallow and mustard seeds used for these indications. This clinical trial was conducted in 220 patients, in which 110 receive the CofNovex plus European Medicines Agency [EMA] syrup and 110 receive the placebo. The age range of patients was 3 years to above 15 years. The sample paired t-test was applied to evaluate the significant level. CofNovex plus [EMA] syrup was very effective in treating cough and cold symptoms. The new treatment CofNovex plus [EMA] syrup was safe and well tolerated in patient at given specific age group

Histopathological pattern of glomerular lesions on percutaneous renal biopsy in proteinuric patients

Objective: To determine the histopathological pattern of glomerular lesions on per-cutaneous renal biopsy in patients presenting with proteinuria

Study Design: Cross-sectional descriptive study

Place and Duration of Study: Department of Medicine, Combined Military Hospital Peshawar, from Aug 2012 to May 2015

Material and Methods: From the adult patients undergoing renal biopsy for various indications in our department, we selected a cohort of 200 patients who had proteinuria of >/= 1 gram/24 hours on presentation. A percutaneous renal biopsy was performed in these patients and the specimens were subjected to histopathology and immunofluorescence studies. The results of biopsy findings were considered along with other clinical and laboratory data to reach conclusive clinico-histopathological diagnoses of various glomerular diseases

Results: Most patients with proteinuria [91%, n=182] have glomerular disease. Among glomerular diseases, primary ones are more common [69.8%] than secondary disorders [26.9%]. In our study cohort, focal segmental glomerulosclerosis is the most common diagnosis [23%], while lupus nephritisis the most common secondary glomerular disorder [7%]. Other common glomerular disorders are membranous nephropathy [12%], IgA nephropathy [9%], and post-infectious glomerulonephritis [6%]

Conclusion: Glomerular disease is common in patients presenting with proteinuria. Its histopathological pattern appears similar to that mentioned in many other studies of the region

Pharmacokinetic behavior of montelukast in indigenous healthy male volunteers

Aim of present study was to investigate the pharmacokinetic behavior of Montelukast in the healthy male volunteers under indigenous conditions. One tablet of montelukast 10 mg was administered in each subject and blood at different time intervals. Concentration of montelukast in plasma samples was analyzed by high performance liquid chromatography method to calculate pharmacokinetic parameters. The plasma concentration of montelukast was in the range of 1.31-1.76 micro g/mL at 0.5-12 hours with C[max] value of 1.59+/-0.16 micro g/mL at 3.71+/-0.64 hours. These values of plasma drug concentrations were above the minimum effective concentration of montelukast during the entire study hours. Absorption and elimination half-lives of the montelukast were evaluated as 2.52+/-0.54 hours and 2.63+/-0.35 hours, respectively. The volume of distribution and total body clearance of montelukast were investigated as 0.34+/-0.01 L/kg and 0.01+/-0.00 L/hr/kg, respectively. The pharmacokinetic parameters i.e. Cmax, AUC, t1/2, Vd and ClB of montelukast calculated in present study were found different as compared to that of the previous literature values which was due to genetic and environmental variation

Outcome of end-stage renal disease patients with advanced uremia and acidemia

Objective: To determine the outcome of End-Stage Renal Disease [ESRD] patients presenting with advanced uremia and acidemia requiring hemodialysis and adverse events seen within 72 hours of admission

Study Design: Cross-sectional study

Place and Duration of Study: Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from October 2010 to March 2011

Methodology: ESRD patients with advanced uremia and acidemia were included in the study. History, physical examination, complete blood count, serum urea, creatinine, electrolytes, arterial blood gases analysis, and ultrasound of kidneys were done in each patient. Adverse events and outcome were recorded for the next 72 hours. Data was analyzed by SPSS version [10]. Mean value and standard deviation of quantitative measurements were calculated and statistical significance computed by t-test. A p-value

Results: Out of the 194 ESRD patients [mean age 46.54 +/- 14.07 years], 28 [14%] expired and 166 [86%] survived within 72 hours of admission. Hypotension requiring inotropic support was the commonest adverse event observed in 40 [20.6%] cases followed by fits in 31 [16%]; and 25 [12.9%] patients required ventilatory support. Mortality was high in patients above 50 years of age. There was no statistically significant difference between two genders regarding adverse events and mortality

Conclusion: The morbidity and mortality of patients with ESRD are serious concerns. Early referral of patients with ESRD, before they develop severe acidosis, can prevent significant morbidity and mortality

Comparison of pain score after giving diclofenac sodium versus nalbuphine in patients undergoing ESWL: our experience in SIMS/ SHL

Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques

Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013

Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated

Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05

Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain

Traumatic arteriovenous fistula-A late complication of vascular injuries

Objective: To evaluate the causes, site, duration between the time of injury and presentation and management of traumatic arteriovenous fistula [AVF]

Study Design: A descriptive study

Place and Duration of study: Department of vascular surgery at Combined Military Hospital Rawalpindi from March 2010 to Dec 2011 and Combined Military Hospital Kharian Cantt from Jan 2012 to March 2014

Material and Methods: All the cases of traumatic AVF fistula which reported during this study period were included. Congenital arteriovenous [AV] malformations and fistula for hemodialysis access were excluded from this study. All the cases were evaluated with computerized tomography [CT] angiography or conventional angiography and managed with various open vascular surgical techniques and their results were assessed

Results: Fourteen patients of traumatic AV fistula underwent various open vascular repairs. Age of patients ranged from 16 to 75 years with average age of 34.3 +/- 14.5 years. Male to female ratio was 3.6:1. Penetrating injuries were the commonest cause i.e. 11 [78.6%]. Time interval between injury and presentation in hospital ranged from 4 months to 25 years with average time interval 4.3 years. Lower limb vessels were affected in 10 [71.4%] the upper limb in 1 [7.1%] and neck vessels in 2 [14.3%] and 1 [7.1%] case of post appendectomy AVF between inferior epigastric artery and adjacent vein. Superficial femoral artery and vein was the most frequently involved vessels i.e. 7 [50%] cases

Conclusion: Low velocity penetrating vascular trauma was the commonest cause of traumatic AV fistula. Lower extremities were the most frequently involved site. In most of the cases traumatic AV fistula presents late with its complications. Surgical intervention includes the excision of fistula and restores the continuity of the involved artery and vein with interposition reverse autogenous vein graft or prosthetic graft

Effect of serum albumin on outcome of stroke in children at tertiary care hospital

Objective: the objectives of this study were to determine the frequency of favorable outcome of stroke in children presenting at tertiary care hospital and to compare the mean serum albumin levels in children with favorable and unfavorable outcome of stroke in tertiary care hospital

Methods: two hundred children in the age range of 1-14 years, meeting the inclusion and exclusion criteria were registered from pediatric and neurology department of Children Hospital and ICH Lahore. Informed consent was taken from their parents to include them in the study. Demographic information [name, age, sex, address] was collected. Serum albumin was sent to biochemistry lab of the hospital at the time of admission. Outcome of the stroke was determined by Modified Rankin Scale at the time of discharge and death in case and observed data was recorded on a specially designed proforma [attached]

Results: in our study, out of 200 cases, 40% [n=80] cases were between 1-7 years of age, 60% [n=120] cases were between 8-14 years of age, mean +/-sd was calculated as 7.75+/-3.49 years, 56% [n=1 12] cases were male, 44% [n=88] cases were females. Frequency of favorable outcome of stroke in children with stroke presenting in tertiary care hospital was calculated as 42.5% [n=85] while 57.5% [n=115] had unfavorable outcome. Comparison of mean serum albumin levels in children with favorable and unfavorable outcome of stroke in tertiary care hospital showed, 3.13+/-0.19g/dl in favorable outcome while 1.79+/-0.18g/dl in unfavorable outcome and p value was calculated as 0.0001 which shows a significant difference between mean serum albumin levels in favorable and unfavorable outcome of stroke

Conclusion: we concluded that most of the pediatric stroke patients have unfavorable outcome and comparatively less patients have favorable outcome of stroke. Also, the mean serum albumin level in children with favorable outcome is higher and it is significantly lower in children with unfavorable outcome of stroke in tertiary care hospital. So higher the serum albumin in pediatric stroke patient one can expect good outcome of stroke

Renal colic patient; comparison of un-enhanced helical computed tomography, intravenous urography and ultrasound + Plain X-Ray"

To compare Un-enhanced Helical Computed Tomography [UHCT], Ultrasonography [US] + Plain X-Ray and Intravenous Urography [IVU] in the evaluation of patients with suspected renal colic. In 70 patients with renal colic US, plain X-ray, IVU and UHCT were performed to demonstrate urinary stones and other relevant pathologies. Patients were then followed-up to stone passage or removal, and the course of clinical symptoms were noted. 57 patients had ureteral stones based on stone passage or removal. 13 patients did not have ureteral stones based on failure to recover a stone, disappearance of symptoms, and diagnosis unrelated to stone disease. Un-enhanced helical computed tomography was found to be the most useful method in the demonstration of ureteral stones with a sensitivity of 97%. Reformatted images clearly depicted the intraureteral location of stones in most cases. Spiral UHCT showed renal calculi in 15 patients, USG + KUB in 12 and IVU in 9 patients. Non-contrast axial and reformatted spiral CT [UHCT] images were found superior to USG + KUB and IVU in the depiction of ureteral and renal calculi. Reformatted images offer a good alternative to IVU in problematic cases

Effects of L-carnitine; on skeletal muscle of rabbit

L-carnitine [L-car] is a trimethylated amino acid required for the transformation of long chain free fatty acids into acylcarnitine and their subsequent transport into the mitochondrial matrix. It enhances the fatty acid oxidation for energy thus delaying the skeletal muscle fatigue. Objectives of this study were to determine effect of L-carnitine supplementation on skeletal muscle lactate after fatigue, to observe effect of L-carnitine supplementation on force of contraction in skeletal muscle and to estimate the time to onset of fatigue after L-carnitine supplementation. In control group, the rabbit sedated and soleus muscle was excised, Homogenized and centrifuged. Supernatant collected, was mixed with reagents of lactate test kit. Absorbance of light was read with the help of spectrophotometer and readings were noted. In experimental group, L-carnitine was given in a dose of 80mg / kg. The period of administration was two weeks. Soleus muscle was excised after giving the last dose of L-carnitine. Lactate level was measured by using lactate test kit [Randox®]. Readings for lactate measurement were noted after fatigue in both groups. Statistically significant results [p <0.05] were found in all three variables. Data was analyzed by applying [t] test in IBM SPSS Statistics - 20 software. L -carnitine delays the onset of fatigue of skeletal muscle. This was the stated alternative hypothesis

Preparation, biodistribution and scintigraphic evaluation of [99m]Tc-lincomycin

A complex of lincomycin was synthesized with technetium-99m. The synthesis was carried out by using SnCl[2].2H[2]O as reducing agent and ascorbic acid as stabilizer. The effect of various parameters such as amount of ligand/reducing agent, pH value and reaction time on radio labeling process was studied. The characterization of the [99m]Tc-Lincomycin was performed by HPLC and electrophoresis Biodistribution studies were carried out by analyzing the model of bacterial infectious rats [Sprague-Dawley]. The uptake of infectious lesions at different time interval was also studied by using scintigraphic technique. The complex showed effective target to non-target ratio for various inflammatory or infectious lesions. The [99m]Tc-Lincomycin effective binding to living bacteria and could be used successfully as an infection imaging agent

Dynamization versus static antegrade intramedullary interlocking nail in femoral shaft fractures

Objective: to compare the primary dynamic interlocking technique with static interlocking method for femoral shaft fractures in terms of bony union

Study design: quasi experimental study

Place and Duration of study: department of Orthopaedic Surgery, Ziauddin University Hospital Karachi, from March 2012 to August 2013

Methodology: all patients with closed femoral shaft fractures were treated by closed reamed intramedullary [IM] interlocking nail. They were divided into two equal groups. Group I [Dynamization group] patients underwent primary dynamization and in Group II [Static group] patients the static nail was used. Both groups were divided into subgroups on the bases of post reduction intrafragmental gap less than or more than 3mm on x-ray.The surgical procedure and postoperative protocols were same for both the groups, with the exception of interlocking mode. The outcome was measured using Thorensen clinical criteria. Bony union, time of union, delayed union, nonunion, implant breakage and leg shortening were recorded

Results: a total of 64 patients were included, 32 in each group. Mean time of union was same in dynamic group and static group with post reduction intrafragmental fracture gap < 3mm. In the dynamic group with post reduction intrafragmental fracture gap=3mm, one case of nonunion was noted. In static group two cases of delayed union and one case of nonunion were noted in sub group with post reduction intrafragmental fracture gap=3mm

Conclusion: dynamization significantly shortened the mean time to union in femoral shaft fracture with intrafragmental gap =3mm, though it did not significantly affect the union rate of the femoral shaft fractures as compared to static close intramedullary interlocking nailing

Frequency of pruritic dermatoses among pregnant women

Objective To determine the frequency of pruritic dermatoses among pregnant women.

Methods This, cross-sectional study was conducted at Obstetrics out-patient department, Bahawal- Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, over a period of 6 months in 238 Pregnant women of age ranging from 20 to 40 years. Following specific pruritic dermatoses of pregnancy were searched and recorded on pre-designed proforma and analyzed: pemphigoid gestationis, polymorphic eruption of pregnancy, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, eczema in pregnancy and pruritic folliculitis of pregnancy.

Results Among 238 pregnant women, 14 [5.9%] presented with pruritic dermatosis of pregnancy while in rest of 224 [94.1%] patients no specific dermatosis of pregnancy was found. Out of those 14 patients, polymorphic eruption of pregnancy was seen in 5 [35.7%] patients, eczema in pregnancy in 4 [28.6%], pemphigoid gestationis in 2 [14.3%], prurigo of pregnancy in 1 [7.1%], intrahepatic cholestasis of pregnancy in 1 [7.1%] and pruritic folliculitis of pregnancy in 1 [7.1%] patient. The dermatoses of pregnancy was detected in 5 [35.7%] patients in the age group 20-25 years, 4 [28.6%] patients of age group of 26-30 years, 2 [14.3%] patients of age group of 31-35 years and 3 [21.4%] patients of age group of 36-40 years of age.

Conclusion Pruritic dermatoses of pregnancy are not uncommon among pregnant women and should be considered while evaluating pregnant women. Polymorphic eruption of pregnancy is most frequent pruritic dermatosis of pregnancy, followed by eczema of pregnancy.