FREQUENCY OF CAROTID ATHEROSCLEROSIS IN CEREBRAL INFARCTION

Objective: To know the frequency of carotid atherosclerosis in ischaemic stroke patients in our population using color Doppler ultrasound. Methodology: This is an observational study conducted in the department of Medicine Nishtar Hospital, Multan. All the patients admitted during this duration with CT scan proof of stroke were included in the study. Risk factors in all these patients were stratified. Doppler ultrasound was performed on all patients with ischaemic stroke according to the study protocol. Results: A total of 100 patients were included in this study over a period of five months. 66% of these were having cerebral infarction. Hypertension (72%), diabetes (35%), smoking (29%) and obesity (20%) were the common risk factors. The frequency of significant carotid atherosclerosis in acute ischaemic stroke patients was 21%. Conclusion: Carotid atherosclerosis is one of the most important indicators, predictors as well as an independent risk factor in the development of ischaemic stroke. KEY WORDS: Carotid, Atherosclerosis, Doppler ultrasound

EFFICACY OF INTRAVENOUS ACETAMINOPHEN VERSUS KETAMINE FOR POSTOPERATIVE PAIN AFTER ABDOMINAL HYSTERECTOMY

Objective; To determine the efficacy of intravenous acetaminophen versus ketamine for postoperative pain after abdominal hysterectomy. Material and Methods; A total of 114 women undergoing abdominal hysterectomy were taken in this study. The study was conducted from June 2017 to May 2018 at department of Anesthesiology, Nishtar Hospital, Multan. Results; Our study comprised of 114 ladies undergoing abdominal hysterectomy, mean age of the study cases was 54.13 ± 6.89 years (with minimum age of the patients was 39 years while maximum age was 68 years). Majority of our study cases i.e. 92 (80.7 %) had parity more than 3 and American Society of Anesthesiology (ASA) score level 1 in 93 (81.6%). Sixty one (53.1%) belonged to rural areas, while mean duration of surgery was 72.80 ± 11.32 minutes. Mean BMI level in our study cases was noted to be 23.98 ±4.17 Kg/m2 and obesity was present in 34 (29.8%) of our study cases. Efficacy was noted in 60 (52.6 %) of our study cases. Efficacy was 73.7% study cases in group A while 18 (31.6%) in group B (p=0.000). Conclusion; Our study results support the use of intravenous acetaminophen (IVA) for pain management in patients undergoing abdominal hysterectomy compared with ketamine. Intravenous acetaminophen is safe, reliable and effective for the pain management in postoperative abdominal hysterectomy patients which was associated with shorter hospital stay and cost effective for the suffering families. No adverse reactions were noted in this study with the use of intravenous acetaminophen. Keywords; Intravenous acetaminophen, Ketamine, Abdominal Hysterectomy.

Management of intercondylar femur fracture with distal femur locking compression plate: outcome analysis of 72 cases

Background: Supra-condylar and inter-condylar fractures of the distal femur account for 7% of all femoral fractures and have always been difficult to treat and regaining full knee function is often difficult. The purpose of this study is to evaluate the functional outcome, fracture healing, complications of distal femoral intercondylar fractures managed by locking compression plate.Methods: Total 72 patients of intercondylar femur fracture were operated by ORIF with distal femur-locking compression plate via the standard swashbuckler approach. The functional outcomes were analyzed using modified hospital for special surgery scoring system.Results: Muller type C2 fracture was the most common fracture type with 50 out of 72 patients. The average range of motion achieved was about 99.03°±24.73° (Closed fractures =105.83°±19.41°and open fractures = 89.50°±28.36°). There was also a significant difference in the duration of operative time, 84.28±18.32 minutes for closed fractures and 98.46±22.47 minutes for open fractures. The average duration for radiological union was 14.52±2.21 weeks for closed and 17.20±2.44 weeks for open fractures. The average knee score was 80.13±13.38 using modified Hospital for Special Surgery score.Conclusions: Closed fractures have a higher range of motion and a better knee score compared to open fractures, supporting the fact that soft tissue compromise also affects range of motion and post-op rehabilitation of the limb. The outcome seems to correlate with the nature of injury i.e. high vs low velocity, type of fracture, anatomic reduction, associated injuries, time elapsed since injury to fixation and the stability of fixation

HETEROTIC ESTIMATION AND ADAPTABILITY OF TOMATO HYBRIDS FOR FRUIT YIELD AND ITS RELATED TRAITS IN PAKISTAN.

Current study is emphasizing on the estimation of heterosis for different yield attributing traits and adaptability of tomato hybrids. It was performed in the research area of VCRP, HRI, NARC Islamabad during 2018-2019. Crossing was completed among six parents followed by line × tester. The analyzed data depicted significant differences (P ≤ 0.01) among all the characters.Due to desirable high negative heterotic values hybrids Peto-86 × Nagina and Riograndi × Roma were found suitable for breeding early maturing hybrids. For plant height maximum positive heterosis was observed in Riograndi × Nagina, for no. of cluster/plant in Naqeeb × Roma, for traits like flower cluster-1, fruit cluster-1, fruit length & width and single fruit weight in Naqeeb × Continental while for yield Riograndi × Continental showed maximum heterosis. Therefore among 9 tested hybrids Naqeeb × Continental was found to be highly preferable and recommended for utilization in different breeding programmes

Outcome of Patients Treated with Oral Sofosbuvir and Ribavirin: One Year Follow up Experience

Objective: The aim of this study was to evaluate the efficacy and safety of sofosbuvir plus ribavirin therapy and prevalence of hepatitis C relapses.Methodology: A descriptive case series study was planned and executed for the evaluation efficacy, safety and relapsers of among HCV patients treated with sofosbuvir plus ribavirin. One hundred patients were enrolled after careful monitoring of inclusion criteria. PCR, LFTs, CP, RFTs, Serum albumin and ultrasound performed in all patients and they were given 400mg of sofosbuvir and 1000mg of Ribavarin. There was no dropout of haemoglobin and ALT was normalized in both groups.Results: 69% male and 31% females between January 2014 to March 2017. All patients were naive having genotype 3 and average age in males being 33.3 years whilst in females being 51.61 years. At one-month post treatment, 87.09% females and 78.265% males achieved RVR while ETR was 83.87% in females and 86.95% in males. Treatment related adverse effects were myalgias, insomnia and flu like symptoms which need symptomatic treatment. After 3 months of follow up, SVR was observed to be 90.32% in females and 88.405% in males. However, subsequent follow up of 1 patients revealed a relapse rate of 12.9% in females and 8.69% in males after achieving SVR.Conclusion: The combination of sofosbuvir and ribavarin is safe and effective treatment for genotype 3 (GT3) non cirrhotic patient

Cutaneous Squamous Cell Carcinoma, an Immunohistological Analysis

Background: To detect the presence of keratin in apparently non-keratinizing squamous cell carcinomas by immunoperoxidase staining. This is important because keratinizing tumours are less radiosensitive and non-keratinizing are more radio responsive. Methods: This prospective study was conducted at King Edward Medical College and Post Graduate Medical Institute, Lahore over six months, A total of 45 patients suffering from squamous cell carcinomas of skin were included in the study.Both H and E and immunoperoxidase stainings were performed. Positive and negative controls were set up. The results of both types of staining were compared for each case. Results: Four groups were identified. Nineteen cases showed obvious keratinization on both H and E and immunoperoxidase staining.Eight cases had doubtful keratinization on H and E but showed more obvious keratinization on immunoperoxidase staining. Seven cases were non-keratinizing on H and E staining but revealed keratin on immunoperoxidase analysis.Eleven cases were non-keratinizing on H and E as well as on immunoperoxidase analysis. Conclusion: Immunohistological technique can help us in revising and modifying our H and E impression of a squamous cell carcinoma. It can help us in better diagnosis of squamous cell cancers on basis of keratinizatio

Role of metastasectomy and chemotherapy in carcinoma of uterine cervix

Squamous cell carcinoma of uterine cervix is potentially a curable disease; however, many patients treated with definitive chemoradiotherapy develop distant metastases, with few of them having a single metastatic deposit. There are no guidelines for the treatment of patients with oligometastatic cervical cancer.We present a case of a patient with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB squamous cell carcinoma of uterine cervix. She was successfully treated with concurrent chemoradiotherapy with definitive intent. One year later, she developed a solitary pulmonary nodule for which she underwent resection followed by chemotherapy. She is free of any local or distant disease at 5 years of regular follow-up

Incidental renal cell carcinoma in pelvic malignancies

Simultaneous diagnosis of renal cell carcinoma with pelvic malignancies is rare but a well-documented phenomenon. It is not uncommon to have incidental renal masses on imaging done for investigating other tumors. There are no established guidelines for the treatment of patients with dual malignancies. The management of such patients is challenging and requires a multidisciplinary approach. We present a series of three cases with a diagnosed pelvic malignancy but further workup revealed a kidney tumor. Both the malignancies were evaluated individually and diagnosed as two different primary neoplastic lesions. This case series examines each distinct patient\u27s presentation, discusses the diagnosis, and compares and contrasts the findings while discussing the literature on this topic