[en] Objective: To determine the frequency of splenic injury after blunt trauma abdomen and common types of trauma leading to it. Study Settings: Surgical Department, Lady Reading Hospital, Peshawar. Study Design: Descriptive (cross sectional) study. Duration: From July, 2015 to December, 2016. Material and Methods: A total of 240 patients above 14 years of age and of both genders presenting with blunt trauma abdomen in Out Patient Department or Emergency department were included in the study. After history and clinical examination, Ultrasound or CT scan abdomen was used as diagnostic tool for splenic injury. Splenic injury detected on exploratory laparotomy for blunt abdominal trauma were noted and once detected the patients was carefully checked for detection of types of trauma leading to spleen injury like road traffic accident, fall from height, assault and industrial accident. Data was recorded in pre designed proforma and analyzed by using SPSS version 20. Results: A total of 240 patients were studied. Mean age was 30 years with SD+-2.13. Seventy five percent patients were male while 25 percent patients were female. 14(6 percent) patients had splenic injury in which 6(42 percent) patients had road traffic accident, 5(36 percent) had industrial accident, 2(14 percent) patients had fall from height and 1(8 percent) patient had assault. Conclusion: The commonest causes of splenic injury in blunt abdominal trauma were road traffic accident and industrial accidents. Early diagnosis is the key for proper management and survival of the patients. Road traffic accident and industrial accident are preventable causes and can be minimized by following rules of traffic and industry. (author)

[en] Cervical cancer is the condition which has a long latency period from premalignant to malignant stage. Human papilloma virus (HPV) is the most common cause of cervical cancer in sexually active woman. Th e objective of our study was to assess and compare the awareness of HPV and its vaccine, uptake and the associated barriers among medical, dental and nursing students of Jinnah medical and dental college of Karachi. Material and Methods: Th is cross-sectional study was conducted from August - November, 2016. Data was collected after taking informed and written consent in a structured questionnaire through interview. Total 455 students were selected via convenient sampling. Data analysis was performed on SPSS version 25.0. Results: In general, male students showed better understanding of HPV infection and vaccine than female students. Most of the participants (79.4% male and 51.7% female) were well aware about the virus. But only 38.2% male and 22.3% female students knew about the availability of HPV Vaccine. Th e level of Vaccine uptake among the students was even lower and only 13 out of 455 respondents had actually taken up the HPV Vaccine however, majority of the students (64% males and 60% females) showed willingness to get vaccinated if they get a chance. Moreover, unawareness about the disease and vaccine were identified as the chief barrier and most students agreed upon the need of conducting awareness programs on HPV infection and vaccine. Conclusion: Th is study reveals insufficiency in awareness regarding HPV and its vaccinations which is recognized as a profound barrier in our community. Fortunately, ca cervix is preventable by vaccine but in order to get maximum benefit knowledge of health professionals about the disease and its prevention should be amplified through medical education programs, conference and media (author)

[en] Introduction: Construction of a gastrointestinal stoma is a frequently performed surgical procedure. The rationale for a temporary loop ileostomy is to provide de-functioning in case of a potentially dangerous anastomotic complication with an obvious risk for mortality. Although formation of de-functioning loop Ileostomy is usually a straight forward procedure, there is an appreciable complication rate. Most of the complications seen after ileostomy are due to advanced pathology and relative in-experience of the residents in emergency situation. Objectives: The main objectives of the study were to see the nature and rate of complications of ileostomy construction and to develop a strategy to prevent these complications and how to deal with them. Main outcome measures: Morbidity and mortality of patients within 03 months of the procedure or till the reversal of ileostomy was performed. Study design: It was a descriptive Study. Setting: Surgical B ward, Khyber Teaching Hospital, Peshawar. Subjects: 106 patients who underwent general surgical operations with construction of an ileostomy were included in the study. Material and Methods: 106 patients selected by consecutive sampling were included in the study. The study was conducted from August 2016-July 2017 which included 106 patients and data was collected from the Surgical “B” unit of Khyber Teaching Hospital, Peshawar. Results: The results obtained showed that the most common complication was high stoma output (28.30%), skin excoriation (25.48%). Other complications included stoma prolapse, stoma retraction, parastomal hernia, bleeding, parastomal fistula, electrolytes imbalance, stenosis, and parastomalverices. Conclusion: It is concluded that Ileostomy should be properly fashioned in order to decrease the morbidity and mortality by properly trained surgeons. (author)

[en] To determine the prevalance of various hematological disorders in district Peshawar by using bone marrow aspirate and biopsy. Material and Methods: The study is a retrospective descriptive cross sectional study. It is conducted in Khyber Teaching Hospital, Peshawar. This study carried out from January 2016 to December 2016. Cases whose records were complete regarding the age, gender and bone marrow diagnosis were included in the study. Cases whose records were incomplete and were having aspirate specimens with inadequate material were excluded from the study. All the data of patients diagnosed with certain hematological disorders during the study period was retrieved and studied. The diagnoses were noted and results were drawn accordingly. Results: The mean age of the study population was 30.7±7, with range of 1.5 -60 years. 63(45%) cases were males, while 76(55%) cases were females. Out of 139 patients, about 30 (21.7%) cases were diagnosed as having leukemias. This was followed by megaloblastic anemia which was seen in 26(18.8%) cases, idiopathic Thrombocytopenic purpura which was seen in about 26 patients (18.8%) cases and hemolytic anemia in 17(12.3%) cases. Metastatc infiltration, eshmeniasis and paroxysmal nocturnal hemoglobinuria were seen in 2(1.4%) cases each. Malaria and myelofibrosis was seen in 1(0.7%) cases each. Conclusion: Leukemia was the commonest malignant hematological disorder in Peshawar. This was followed by megaloblastic anemia, which was commonest non hematological disorder in our region. Bone marrow aspirate and biopsy are important diagnostic tools to reach to final. (author)

[en] Objective: To assess the outcome of percutaneous needle tenotomy in the treatment of resistant lateral epicondylitis Study design: Descriptive study Place and duration of study: Outpatient Department (OPD) of Orthopedics and Trauma Qazi Hussain Ahmad Medical Complex Nowshera and Private clinics in Kohat, KPK, Pakistan from January 2016 to December 2017. Materials and Methods: 20 patients with resistant lateral epicondylitis meeting the inclusion criteria were enrolled in the study. Each patient underwent percutaneous needle tenotomy of the common extensor tendon with 18G hypodermic needle under local anesthesia. Pre-procedure and post-procedure assessment at 12 weeks was doneusing VAS pain score and Nirschl stage. Results: Out of 20 patients, 16(80 percent) patients were females and 4(20 percent) were males. Average age of the patients was 40.75 years+- 8.03SD. In 17(85 percent) patients, right elbow was involved while in 3(15 percent) patients, left elbow was involved. Most of the patients (15, 75 percent) were in the age range of 30-50 years. Mean duration of symptoms was 31.85 weeks+-4.88SD. At 12 weeks, mean VAS pain score decreased from 8.05+-1.36SD to 1.35+-2.22SD while mean Nirschl stage decreased from 6.15+-0.85SD to 0.95+-1.63SD. There was statistically significant decrease in VAS pain score and Nirschl stage at 12 weeks (p-value <0.001). Treatment was successful in 70 percent (14) of patients (VAS pain score<- 2). Temporary pain at tenotomy site was reported by 2 (10 percent) patients. No case of hematoma formation or infection was reported. No patient was lost to follow up. Conclusion: Percutaneous needle tenotomy for resistant lateral epicondylitis is easy, safe, effective and minimally invasive procedure which can be done at outpatient department. We recommend long-term comparative study to confirm our results. (author)

[en] To find out the different types of Parotid tumours in out setup and their prevalence in different age groups. All patients admitted with Parotid swellings, irrespective of age and sex. The detailed data of the patients was collected and analyzed. A total of 27 patients, 15 males and 12 females, with ages ranging from 15 to 65 years were included in the study. Most of the patients were in the 31-50 years of age group. Pleomorphic adenoma was the commonest benign tumour with an incidence of 66.6%, while Mucoepidermoid Carcinoma with an incidence of 11.11% was the most common malignant tumour. Parotid gland is the principal site of salivary gland tumours. Males are affected more and Pleomorphic adenoma is the most common benign and Mucoepidermoid carcinoma the most common malignant tumour. (author)

[en] Objective: The aim of the study was to determine the efficacy and safety of Desarda repair technique of inguinal hernia in terms of recurrence and other complications especially pain. Material and Methods: Th e descriptive cross-sectional study was conducted in the Department of Surgery at Khyber Teaching Hospital, Peshawar, Pakistan for a period of fifteen months. 55 male patients with age more than 14 years who presented with an inguinal hernia on either side were operated after taking an informed consent. Data was collected on a set performa and analyzed on SPSS 20. Results: A total of 55 male patients with inguinal hernia were operated. The mean operative time was 42.82 minutes. The maximum pain score of 6 on first post-operative day was observed only in 1(1.8percent) patient. There was nil pain score at tenth post-operative day in 43(78.2 percent) patients. The wound grade on tenth post-operative day came out to be 0 in 52(94.5 percent) patients. No acute complications were reported in 51(92.7 percent) patients. Mild scrotal swelling was reported only in 3(5.5 percent) patients. No recurrence was observed after a maximum follow up of one year. Conclusion: Desarda tissue based inguinal hernia repair is a viable, safe and a more economical alternative to mesh techniques. (author)

[en] Objectives:To evaluate the role of prophylactic gastrojejunostomy in preventing late gastric outlet obstruction in patients with advanced periampullary tumors. Material and Methods:Th is case series study was conducted at Surgical “D” ward of Khyber Teaching Hospital Peshawar from January 2014 to December 2017 and included 33 patients with advanced unresectable periampullary carcinoma. They underwent prophylactic retrocolicgastrojejunostomy alone or in combination with a biliodigestive procedure. Patients with resectable tumors and those with previous history of gastric surgery were excluded from this study. Results: Out of these patients 20 patients were males and 13were females with mean age of 59.78 ± 5.97. All patients underwent ultrasound and CT scan and 10 patients had pre-op ERCP. Retrocolic-gastrojejunostomy was performed after the tumor was found unresectable. Wound infection was the commonest complication which occurred in 7 patients, common in those with co-morbidities. Biliary leakage occurred in 5 patients, 3 of these patients had pre-operative biliary intervention. Post-operative cholangitis occurred in 3 patients while 4 patients had minor leak from the drain site which improved with conservative management. Four patients developed urinary tract infection, while three patients had signs of delayed gastric emptying which responded to conservative treatment. The mean hospital stay was 8.09+-3.39 days and there was no mortality and no patient developed gastric outlet obstruction during the minimum follow up period of 2 months. Conclusion: Prophylactic gastrojejunostomy in patients with unresectable peri-ampullary tumor is a safe procedure with negligible morbidity and mortality and significantly decreases the risk of late gastric outlet obstruction. (author)

[en] Objectives: To determine the knowledge and awareness of HIV/AIDS among medical, dental and nursing students of health care institution in Karachi - Pakistan.Study design: Descriptive cross-sectional study. Place and Duration: This survey was conducted in the Liaquat College of Medicine and Dentistry, Karachi. The survey was initiated on the 30 November,2018 and was concluded on the 20th January, 2019. Method and Materials: A total of 230 questionnaires were distributed among the first-year students of all the three disciplines. Approximately 187 filled questionnaires were obtained of which 165 questionnaires were found to be properly filled and were considered as valid. A questionnaire was used to evaluate the knowledge and awareness of HIV/AIDS. Results: According to the results attained 75 percent of the participants have knowledge of the spread of disease and from the study it can be said that majority of students tend to have basic knowledge of HIV/AIDS.The students of nursing discipline are the ones that do not have proper level of knowledge and awareness. Conclusions:Overall knowledge and awareness of medical and dental students about HIV/AIDS communicability and route of transmission is adequate but students of nursing discipline are the ones that do not have proper level of knowledge and awareness. Nursing students must be made aware and should understand the importance of treating HIV/AIDS patients. (author)

[en] Objectives: To compare effectiveness of low-dose bupivacaine-fentanyl versus conventional dose of bupivacaine in parturients undergoing cesarean section and the frequency of hypotension in two regimens. Study design: Randomized clinical study Place and duration of study: Anesthesiology Department and Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, from July to December 2019. Material and methods: 52-women undergoing cesarean section were randomly allocated into two groups; 26-patients in group-A were given 10 mg bupivacaine, and 26 in group-B, 5 mg bupivacaine-25μg fentanyl. Blood pressure (BP) and heart rate were recorded. Intra-operative pain assessment was done using visual analog scale (VAS). Duration of effective analgesia was taken from the time of intra-thecal injection to a VAS score ≥4. Systolic BP (SBP)<20% of preoperative value was labelled as hypotension. Data was analyzed with SPSS 19. Results: Mean age was 26.19±4.31 years. There was no significant difference among age, weight, height and ASA of patients in two groups (p=0.65, 0.052, 0.19, and 0.39, respectively). Mean baseline SBP, diastolic blood pressure (DBP), and heart rate were not significantly different. Men final SBP was significantly different (p = 0.006), while no significant difference was seen in DBP and heart rate and duration of surgery (p=0.23, 0.42, 0.23, respectively). The duration of analgesia was more prolonged in group-B (p<0.001), and hypotension was significantly higher in group-A (p=0.005). Conclusion: Low-dose intra-thecal bupivacaine and fentanyl provides more effective spinal anesthesia for cesarean section with less hypotensive episodes. (author)