Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among m... more Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among most common causes of blunt splenic trauma. In 1970s, postsplenectomy complications were published by some authors, revealing the high mortality and morbidity related to overwhelming postsplenectomy infection (OPSI). Therefore, conservative management for splenic trauma was accepted as treatment of choice in all the patients to decrease mortality due to OPSI. Therefore, NOM of traumatic splenic injury has now been accepted as standard treatment of choice for all AAST grade I, II and III, whereas this was not found safe in higher grades of splenic trauma. Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma. Results: Out of all studied parameters grade of injury, contrast blush on CT scan, grade of hemoperitoneum showed statistical significance with p value<0.001, however gender, age, mode of injury, showed no s...
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Mar 1, 2022
Aims: Settings: To study role of Laparoscopy in treating Pediatric Inguinal Hernia and Hydrocele.... more Aims: Settings: To study role of Laparoscopy in treating Pediatric Inguinal Hernia and Hydrocele. Department of Surgery, Government Medical College Srinagar. A prospective observational study involving 43 children who underwent la Materials and Methods: paroscopic repair of inguinal hernia / hydrocele over a period of 2 years in our tertiary care institute. T Results: here were 57 children enrolled but only 43 patients were included for the study. Age ranged from 7 month to 12 years. There were 38 boys and 5 girls in the study group. There were 32 unilateral and 11 bilateral cases. Among unilateral 26 were on the right side and 6 on the left side. 54 hernia / hydrocele / open DIR were treated laparoscopically. IPSI for unilateral, SEAL for bilateral cases among boys and LIHIL technique was performed in girls. There were no signicant differences among various techniques performed with respect to hospital stay, post operative analgesia requirement but difference was signicant for higher complication rates in SEAL. Also the difference was found to be signicant when compared unilateral versus bilateral cases for operative time and post operative return to activity. Absorbable suture material was used in all cases and there were no recurrences seen during a mean follow up period of 16.5 months. Laparoscopic treatment of pediatric inguinal hernia/hydrocele/Open DIR i Conclusions: s a safe and effective approach. We found a very low rate of complications which were all minor in nature and were managed conservatively. There were no recurrences thus making laparoscopic herniotomy a potentially gold standard approach in the near future but the ideal/gold standard laparoscopic technique for pediatric inguinal hernia appears yet to be achieved.
Background: Blunt abdominal trauma is the most common cause of splenic injury and spleen is the m... more Background: Blunt abdominal trauma is the most common cause of splenic injury and spleen is the most common organ injured in trauma patients both in children and adults. Abdomino-pelvic ultrasound is very efcient radiological investigation in the diagnosis of splenic injuries; it can detect intraperitoneal hemorrhage, splenic capsular tears, and the vascularity of the spleen. Moreover, computed tomography (CT) scan is investigation of choice in hemodynamically stable.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury. However, even patients with CT scan nding of “blush on CT”, indicating higher grades of injury, if hemodynamically stable stil...
Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountere... more Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountered in any general surgical outdoor worldwide especially in fertile females who are obese and in their 4th or 5th decade of life. One of the complications can be gallbladder perforation, although can be a sequel to acalcular cholecystitis. In India, incidence of Gall bladder perforation is estimated to be around 4%. There has been a marked increase in the incidence of the gallstone in the West during the past century. Material and Methods: The aim of our study was to highlight the Etiopathogenesis, Diagnosis, Management and Complications of gall bladder perforations. Results: In our study 35 patients were studied ageing between 25-80 years of age with a mean age of 54.3+14.53 years. Majority of our study patients i.e. 13 (37.1%) aged >60 years. Type 2 GB perforation was seen in 30 (85.7%) patients, followed by Type 1 in 3 (86% patients while as 2 (5.7%) patients were found to have Type ...
Background: Advanced ventilation technologies require critical nursing management to facilitate p... more Background: Advanced ventilation technologies require critical nursing management to facilitate patientcare. The nursing workforce in the intensive care units (ICUs) should have basic knowledge and understanding of the ventilator and its mechanics to recognise adverse events and improve the care quality. Methods: A pre-experimental study using an educational intervention was conducted in the ICUs at a tertiary care hospital, was conducted to assess the baseline knowledge of nursing staff about ventilator mechanics and respiratory physiology, and to identify the effectiveness of the module and teaching sessions on their knowledge score. A self-administered and structured questionnaire was used to collect data. A self-developed educational module was used as an intervention. Descriptive analysis was reported for demographic characteristics; paired t-test was conducted to identify difference in mean scores before and after intervention; and stratified analysis was also performed. Resul...
We present a review article on adrenal glands, with a special reference to their anatomy, physiol... more We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.
Journal of Evidence Based Medicine and Healthcare, 2021
BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries resul... more BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries result in damage to the skin by electrical, chemical, thermal or radiation energies or a combination of them, by far the most common being the thermal injuries. However, most burn injuries are preventable and hence need preventive strategies. Outcome is dependent on various factors. The focus of this study is to provide an overview of various factors and clinical presentation of burn injury and their correlation of these various factors with outcome of burn injury. METHODS A retrospective facility-based document review analytical study was conducted on 215 patients admitted in the emergency (burn ward) department of Government Medical College and Hospital, Srinagar, Kashmir from September 2019 to September 2020. RESULTS In our study, out of total 215 hospitalized burn patients, 101 (47 %) were female and 114 (53 %) were males. In 103 (47.9 %) patients, burn injury was caused by scald burn, ka...
Objectives: This study compared efficacy of two methods of placental delivery at the time of cesa... more Objectives: This study compared efficacy of two methods of placental delivery at the time of cesarean section that is spontaneous and manual removal of placenta in terms of excessive blood loss during caesarean. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at the department of Gynaecology and Obstetrics, Combined Military Hospital Multan, from Nov 2016 to Apr 2017. Methodology: Participants having similar demographic and clinical characteristics, were selected and divided into 2 groups. Group A underwent removal of placenta spontaneously, while group B underwent manual removal of placenta. The total amount of blood suctioned and sponges soaked during surgery were noted whereas, haemoglobin level at 6 hours post-operatively was noted for difference of ≥2 gm/dl as significant. Results: In our study, mean maternal age and mean gestational age of study population was 26.77 ± 3.47 years and 36.96 ± 1.44 weeks respectively. Significant bloo...
Quantification of soil organic carbon (SOC) stocks in different land uses holds vital significanc... more Quantification of soil organic carbon (SOC) stocks in different land uses holds vital significance because of its implications regarding carbon sequestration as the largest terrestrial carbon pool. The current study was conducted to quantify and compare SOC stocks in forest land, agricultural land, and barren land-use categories in the subtropical ecosystems of the Himalayan foothills in Kashmir. Results showed the highest SOC value in the forest soil (75 ± 11.1 Mg C ha−1) followed by agricultural soil (58 ± 7.0 Mg C ha−1) and barren land (44 ± 6.5 Mg C ha−1). SOC stocks in different land uses showed broad variations with values as high as 106 ± 11.3 Mg C ha−1 (forest soils) and as low as 14.1 ± 7.1 Mg C ha−1 (barren land). The forest SOC values responded significantly to species composition with the highest values in Pinus roxburghii Sarg. pure stands as compared with broad leaved forests. Multivariate ordination analyses revealed that the variations in SOC stocks were significantl...
Objectives: To identify and assess the risk factor for transmission of HBV and HCV in pregnantlad... more Objectives: To identify and assess the risk factor for transmission of HBV and HCV in pregnantladies and perinatal outcome, presenting to obstetric OPD at CMH Lahore. Design: Case control study. Setting:Combined Military Hospital Lahore. Period: From May 2003 to April 2004. Patients and Methods: All the patientspresenting to obstetrical OPD during one year were randomly screened for both hepatitis B and C using ELISA.Perinatal outcome was compared with control group. The risk factors for HBV and HCV were studied in 30 patients,who were positive for either HBV or HCV. A detailed history was taken followed by a questionnaire and screening forHBV and HCV. The results were compared with control group who were negative for hepatitis B and C but had samesocioeconomic back ground and similar living conditions (wives and soldiers). Results: In the study group 20 patientsgave history of surgical operation or dental procedure. These surgical operations included major or minor operations.In co...
Abstract Quantification of carbon stocks is critical to evaluate the potential of an ecosystem to... more Abstract Quantification of carbon stocks is critical to evaluate the potential of an ecosystem to mitigate the impact of global climate change in the REDD + scenario. Present research project was designed to gauge the sequestered carbon in Chir Pine (Pinus roxburghii) dominated forests in the foothills of the western Himalayan region of Kashmir which constitute a significant regional carbon pool. The study outcomes revealed an average carbon stock value of 94.3 Mg/ha from which 68 Mg/ha was shared by soil organic carbon (SOC); whereas average biomass carbon share was 26.3 Mg/ha. P. roxburghii was the most noteworthy species containing an average carbon stock value of 5.93 Mg/ha followed by Quercus incana (3.59 Mg/ha) and Olea cuspidata (2.26 Mg/ha). Average forest biomass was chronicled as 52.5 Mg/ha from which tree biomass was 49.34 Mg/ha. Shrub and herb biomass contributed 1.95 and 0.53 Mg/ha correspondingly whereas the Leaf litter and deadwood necromass produced an average of 0.67 Mg/ha. Ordination analysis revealed that the forest carbon stocks were significantly influenced by the species composition, structural attributes as well as anthropogenic disturbances. Current study has resulted in generating a standard baseline dataset of the regional carbon stocks with diverse implications for sustainable carbon management in REDD + perspective.
We present a review article on adrenal glands, with a special reference to their anatomy, physiol... more We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.
Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing num... more Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing number of patients. In this study, we determined the various reasons for conversion of laparoscopic cholecystectomy in our setup.Methods: This was a descriptive study, conducted at Government Medical College Srinagar, Frommay 2015 to June 2017. The study included 450patients with symptomatic cholelithiasis, who underwent laparoscopic cholecystectomy. All patients were operated by experienced laparoscopic surgeons with experience of more than 300 Laparoscopic cholecystectomies. Cases that required conversion from laparoscopic to open surgery were analyzed and the factors possible for such conversion were studied.Results: The mean age of patients was 45.6 years and male to female ratio 1:3.8. The mean operating time was 49 minutes and average hospital stay was 2 days. Out of 450 patients, 26(5.8%) required open conversion. Factors responsible for open conversion were dense adhesions in 12(2.7...
Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In p... more Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No pati...
Journal of Liaquat University of Medical & Health Sciences, 2019
Aim: To determine the frequency of morbidly adherent placenta and it's associated maternal outcom... more Aim: To determine the frequency of morbidly adherent placenta and it's associated maternal outcomes. Methods:The descriptive cross-sectional study was carried out on 180 pregnant women with age between 15 to 45 years, carrying singleton pregnancy, having previous uterine scar due to cesarean section. The study was conducted in CMH Hospital, Multan from January-2018 to OCT-2019. Maternal outcomes in-terms of intra and post-operative complications such as need for blood transfusion, bladder repair, emergency hysterectomy, ICU admission, surgical site infections, and mortality was main study outcome. Results:Mean age of women was 31.28±3.58 years. MAP was diagnosed in 17(9.44%) women, out of which placenta increta was presented in 11 (6.1%) cases, placenta accreta vera in 4(2.2%) and percereta in 2(1.1%) cases. Mean gestational age in women in MAP was 34.62±2.78 weeks. Most common complication was bleeding requiring blood transfusion occurred in 76.5% cases, emergency hysterectomy was needed in 76.47% cases, bladder repair in 11.7% cases and 35.2% cases required admission in ICU. Mortality occurred in 2(11.8%) women with MAP. Conclusion: Morbidly adherent placenta is a common presentation among patients with previous scar. Bleeding is the commonest complication in these patients, many of these patients require admission in ICU. These patients also have higher mortality rate.
Overgrazing in the fragile Himalayan alpine grassland ecosystems is a major cause of substantial ... more Overgrazing in the fragile Himalayan alpine grassland ecosystems is a major cause of substantial loss of soil organic carbon (SOC). The current study was conducted to analyze the effects of grazing on SOC in seven alpine grasslands of Kashmir. SOC was found to be greatly influenced by severe grazing and varied between 43.1 and 120 Mg/ha. Average SOC was found to be 70.5 Mg/ha; it was 90.6 Mg/ha in non-grazed areas (NGAs) and 50.4 Mg/ha in highly grazed areas (HGAs). The highest value of SOC was 139.1 Mg/ha (in NGA) whereas the lowest was 30.3 Mg/ha (HGA). An average of 1632.7 domestic animals reserved by 278 households were recorded per site. The study determined that an increased herd size results in a decreased SOC level. Grazing regime was a countering factor for SOC at all study sites and caused SOC loss of up to 103.3 Mg/ha. Besides intensive grazing, SOC was also found to be influenced by site physiognomy and microclimatic variations. Grazing management is urgently needed in the Western Himalayan alpine grasslands to enhance SOC levels.
to 15 th June 2015. Subjects & Methodology: Where sample size was calculated using WHO sample siz... more to 15 th June 2015. Subjects & Methodology: Where sample size was calculated using WHO sample size calculator using expected proportion of intrauterine growth restriction p= 4%. 11 163 pregnant women of 20-40 year of age with uterine fibroid of ≥3cm on ultrasound were included in this study. Patients of endometriosis and hypertension were excluded. An obstetrical ultrasonography was done to confirm singleton pregnancy, size of uterine fibroid and to confirm gestational age. Patients were monitored until delivery and complications were recorded. Preterm labour was defined as dilation of the cervix <4cm with the presence of uterine contractions of ≥ 4 per hour of 30 seconds duration with intensity to effect progressive effacement, assessed by vaginal examination. Malpresentation was defined as a presentation in which baby's bottom or feet, instead of head, are in position relative to the maternal pelvis by ultrasound and IUGR was defined as fetal weight below the 10th percentile and fetal abdominal circumference below the 10th percentile on ultrasound. Results: Age range in this study was from 20 to 40 years with mean age of 32.773±1.99 years, mean gestational age 34.730±2.44 weeks, fibroid size 5.736±1.51cm, duration of complain 5.018±1.41 months, height 1.561±0.11 meters, mean weight 73.619±13.66 Kg and mean BMI was 28.607±3.106 Kg/m 2. Majority of the patients were from 31-40 year group (89%). Preterm labour was seen in 15.3% patients, malpresentation was 7.4% and IUGR was seen in 6.1% patients. Conclusion: Our study conclude that, most common complication of uterine fibroids during pregnancy was preterm labour followed by malpresentation and IUGR.
Background: In spite of the wide range of intestinal anastomotic techniques, surgeons are still n... more Background: In spite of the wide range of intestinal anastomotic techniques, surgeons are still not so confident with colorectal anastomosis. Invention of surgical staplers has provided some procedural advantages and sense of security to surgeons as well as to patients, in respect to sphincter-saving procedures and thereby improving the quality of life. Outcome measures of applying these devices should be evaluated to see its efficacy and cost-effectiveness over conventional handsewn technique in treatment plan. The result of such comparative study may help surgeons to improve results of their technique. The aim of this prospective study is to observe the results of using stapler in comparison to handsewn colorectal anastomosis. Patients and Methods: A total of 60 patients were selected, of which 30 underwent “stapled” and 30 underwent “handsewn” anastomosis. The two groups were compared on the following points (i) mean operating time (min), (ii) resumption of oral feeding, (iii) wound infection rate, (iv) anastomotic leak rate, (v) duration of hospital stay and return to work in days. The procedures were evaluated and presented. Results: The stapling procedure took shorter operative time compared to the handsewn anastomosis with a mean of 123 ± 21.1 min and 161.5 ± 27.8 min respectively (P < 0.001). Oral feeding was started earlier in patients who underwent stapler anastomosis 4.0 ± 1.0 days, as compared to handsewn anastomosis 5.0 ± 0.83 days (P value = 0.001). There was no significant difference between the two groups in postoperative hospital stay; it was 7.8 ± 1.76 days and in controls group it was 8.1 ± 2.12 (P > 0.0137). Conclusion: Application of the stapler in treating lower gastrointestinal malignancies demonstrated better effects in terms of mean operating time, resumption of oral feeds, and hospital stay.
Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. U... more Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. Unfortunately, the coverage of child vaccination in Pakistan is poor resulting in unnecessary yet preventable deaths. This study investigated the determinants and reasons for not vaccinating children in Pakistan. Materials and Methods: The study used the Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002 data. Demographic, distance to health facility, poverty status, literacy and education, and location of residence were used as determinants of nonimmunization of children. Descriptive statistics including frequency distribution, proportions for categorical variables and mean for continuous variables, and logistic regression analysis were done using the Stata 11.0. Results: Almost 7.73% children in Pakistan were never immunized. More than 87.4% of these lived in the rural areas. Prevalence of nonimmunization was highest in Balochistan compared to other provinces. Large households appeared to have increased risk of a child not being vaccinated. Moreover, low literacy and education of the head of the household and the spouse was also associated with low vaccination coverage. Distance from the health facility was found to be another factor related to nonimmunization of children. Increase in per capita income significantly decreased the risk of missing vaccinations. Conclusions: Prevention and immunization programs should focus more on high-risk regions such as Balochistan and rural areas. Literacy, education, and economic status were among the other significant factors associated with low vaccination rates, which need a special focus in the public policy to achieve the target of a healthy society.
Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among m... more Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among most common causes of blunt splenic trauma. In 1970s, postsplenectomy complications were published by some authors, revealing the high mortality and morbidity related to overwhelming postsplenectomy infection (OPSI). Therefore, conservative management for splenic trauma was accepted as treatment of choice in all the patients to decrease mortality due to OPSI. Therefore, NOM of traumatic splenic injury has now been accepted as standard treatment of choice for all AAST grade I, II and III, whereas this was not found safe in higher grades of splenic trauma. Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma. Results: Out of all studied parameters grade of injury, contrast blush on CT scan, grade of hemoperitoneum showed statistical significance with p value<0.001, however gender, age, mode of injury, showed no s...
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Mar 1, 2022
Aims: Settings: To study role of Laparoscopy in treating Pediatric Inguinal Hernia and Hydrocele.... more Aims: Settings: To study role of Laparoscopy in treating Pediatric Inguinal Hernia and Hydrocele. Department of Surgery, Government Medical College Srinagar. A prospective observational study involving 43 children who underwent la Materials and Methods: paroscopic repair of inguinal hernia / hydrocele over a period of 2 years in our tertiary care institute. T Results: here were 57 children enrolled but only 43 patients were included for the study. Age ranged from 7 month to 12 years. There were 38 boys and 5 girls in the study group. There were 32 unilateral and 11 bilateral cases. Among unilateral 26 were on the right side and 6 on the left side. 54 hernia / hydrocele / open DIR were treated laparoscopically. IPSI for unilateral, SEAL for bilateral cases among boys and LIHIL technique was performed in girls. There were no signicant differences among various techniques performed with respect to hospital stay, post operative analgesia requirement but difference was signicant for higher complication rates in SEAL. Also the difference was found to be signicant when compared unilateral versus bilateral cases for operative time and post operative return to activity. Absorbable suture material was used in all cases and there were no recurrences seen during a mean follow up period of 16.5 months. Laparoscopic treatment of pediatric inguinal hernia/hydrocele/Open DIR i Conclusions: s a safe and effective approach. We found a very low rate of complications which were all minor in nature and were managed conservatively. There were no recurrences thus making laparoscopic herniotomy a potentially gold standard approach in the near future but the ideal/gold standard laparoscopic technique for pediatric inguinal hernia appears yet to be achieved.
Background: Blunt abdominal trauma is the most common cause of splenic injury and spleen is the m... more Background: Blunt abdominal trauma is the most common cause of splenic injury and spleen is the most common organ injured in trauma patients both in children and adults. Abdomino-pelvic ultrasound is very efcient radiological investigation in the diagnosis of splenic injuries; it can detect intraperitoneal hemorrhage, splenic capsular tears, and the vascularity of the spleen. Moreover, computed tomography (CT) scan is investigation of choice in hemodynamically stable.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury.CT also guides the surgeon towards management of injuries, and maintaining the low threshold for surgical intervention in correlation with hemodynamic unstable patient with traumatic splenic injury. However, even patients with CT scan nding of “blush on CT”, indicating higher grades of injury, if hemodynamically stable stil...
Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountere... more Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountered in any general surgical outdoor worldwide especially in fertile females who are obese and in their 4th or 5th decade of life. One of the complications can be gallbladder perforation, although can be a sequel to acalcular cholecystitis. In India, incidence of Gall bladder perforation is estimated to be around 4%. There has been a marked increase in the incidence of the gallstone in the West during the past century. Material and Methods: The aim of our study was to highlight the Etiopathogenesis, Diagnosis, Management and Complications of gall bladder perforations. Results: In our study 35 patients were studied ageing between 25-80 years of age with a mean age of 54.3+14.53 years. Majority of our study patients i.e. 13 (37.1%) aged >60 years. Type 2 GB perforation was seen in 30 (85.7%) patients, followed by Type 1 in 3 (86% patients while as 2 (5.7%) patients were found to have Type ...
Background: Advanced ventilation technologies require critical nursing management to facilitate p... more Background: Advanced ventilation technologies require critical nursing management to facilitate patientcare. The nursing workforce in the intensive care units (ICUs) should have basic knowledge and understanding of the ventilator and its mechanics to recognise adverse events and improve the care quality. Methods: A pre-experimental study using an educational intervention was conducted in the ICUs at a tertiary care hospital, was conducted to assess the baseline knowledge of nursing staff about ventilator mechanics and respiratory physiology, and to identify the effectiveness of the module and teaching sessions on their knowledge score. A self-administered and structured questionnaire was used to collect data. A self-developed educational module was used as an intervention. Descriptive analysis was reported for demographic characteristics; paired t-test was conducted to identify difference in mean scores before and after intervention; and stratified analysis was also performed. Resul...
We present a review article on adrenal glands, with a special reference to their anatomy, physiol... more We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.
Journal of Evidence Based Medicine and Healthcare, 2021
BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries resul... more BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries result in damage to the skin by electrical, chemical, thermal or radiation energies or a combination of them, by far the most common being the thermal injuries. However, most burn injuries are preventable and hence need preventive strategies. Outcome is dependent on various factors. The focus of this study is to provide an overview of various factors and clinical presentation of burn injury and their correlation of these various factors with outcome of burn injury. METHODS A retrospective facility-based document review analytical study was conducted on 215 patients admitted in the emergency (burn ward) department of Government Medical College and Hospital, Srinagar, Kashmir from September 2019 to September 2020. RESULTS In our study, out of total 215 hospitalized burn patients, 101 (47 %) were female and 114 (53 %) were males. In 103 (47.9 %) patients, burn injury was caused by scald burn, ka...
Objectives: This study compared efficacy of two methods of placental delivery at the time of cesa... more Objectives: This study compared efficacy of two methods of placental delivery at the time of cesarean section that is spontaneous and manual removal of placenta in terms of excessive blood loss during caesarean. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at the department of Gynaecology and Obstetrics, Combined Military Hospital Multan, from Nov 2016 to Apr 2017. Methodology: Participants having similar demographic and clinical characteristics, were selected and divided into 2 groups. Group A underwent removal of placenta spontaneously, while group B underwent manual removal of placenta. The total amount of blood suctioned and sponges soaked during surgery were noted whereas, haemoglobin level at 6 hours post-operatively was noted for difference of ≥2 gm/dl as significant. Results: In our study, mean maternal age and mean gestational age of study population was 26.77 ± 3.47 years and 36.96 ± 1.44 weeks respectively. Significant bloo...
Quantification of soil organic carbon (SOC) stocks in different land uses holds vital significanc... more Quantification of soil organic carbon (SOC) stocks in different land uses holds vital significance because of its implications regarding carbon sequestration as the largest terrestrial carbon pool. The current study was conducted to quantify and compare SOC stocks in forest land, agricultural land, and barren land-use categories in the subtropical ecosystems of the Himalayan foothills in Kashmir. Results showed the highest SOC value in the forest soil (75 ± 11.1 Mg C ha−1) followed by agricultural soil (58 ± 7.0 Mg C ha−1) and barren land (44 ± 6.5 Mg C ha−1). SOC stocks in different land uses showed broad variations with values as high as 106 ± 11.3 Mg C ha−1 (forest soils) and as low as 14.1 ± 7.1 Mg C ha−1 (barren land). The forest SOC values responded significantly to species composition with the highest values in Pinus roxburghii Sarg. pure stands as compared with broad leaved forests. Multivariate ordination analyses revealed that the variations in SOC stocks were significantl...
Objectives: To identify and assess the risk factor for transmission of HBV and HCV in pregnantlad... more Objectives: To identify and assess the risk factor for transmission of HBV and HCV in pregnantladies and perinatal outcome, presenting to obstetric OPD at CMH Lahore. Design: Case control study. Setting:Combined Military Hospital Lahore. Period: From May 2003 to April 2004. Patients and Methods: All the patientspresenting to obstetrical OPD during one year were randomly screened for both hepatitis B and C using ELISA.Perinatal outcome was compared with control group. The risk factors for HBV and HCV were studied in 30 patients,who were positive for either HBV or HCV. A detailed history was taken followed by a questionnaire and screening forHBV and HCV. The results were compared with control group who were negative for hepatitis B and C but had samesocioeconomic back ground and similar living conditions (wives and soldiers). Results: In the study group 20 patientsgave history of surgical operation or dental procedure. These surgical operations included major or minor operations.In co...
Abstract Quantification of carbon stocks is critical to evaluate the potential of an ecosystem to... more Abstract Quantification of carbon stocks is critical to evaluate the potential of an ecosystem to mitigate the impact of global climate change in the REDD + scenario. Present research project was designed to gauge the sequestered carbon in Chir Pine (Pinus roxburghii) dominated forests in the foothills of the western Himalayan region of Kashmir which constitute a significant regional carbon pool. The study outcomes revealed an average carbon stock value of 94.3 Mg/ha from which 68 Mg/ha was shared by soil organic carbon (SOC); whereas average biomass carbon share was 26.3 Mg/ha. P. roxburghii was the most noteworthy species containing an average carbon stock value of 5.93 Mg/ha followed by Quercus incana (3.59 Mg/ha) and Olea cuspidata (2.26 Mg/ha). Average forest biomass was chronicled as 52.5 Mg/ha from which tree biomass was 49.34 Mg/ha. Shrub and herb biomass contributed 1.95 and 0.53 Mg/ha correspondingly whereas the Leaf litter and deadwood necromass produced an average of 0.67 Mg/ha. Ordination analysis revealed that the forest carbon stocks were significantly influenced by the species composition, structural attributes as well as anthropogenic disturbances. Current study has resulted in generating a standard baseline dataset of the regional carbon stocks with diverse implications for sustainable carbon management in REDD + perspective.
We present a review article on adrenal glands, with a special reference to their anatomy, physiol... more We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.
Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing num... more Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing number of patients. In this study, we determined the various reasons for conversion of laparoscopic cholecystectomy in our setup.Methods: This was a descriptive study, conducted at Government Medical College Srinagar, Frommay 2015 to June 2017. The study included 450patients with symptomatic cholelithiasis, who underwent laparoscopic cholecystectomy. All patients were operated by experienced laparoscopic surgeons with experience of more than 300 Laparoscopic cholecystectomies. Cases that required conversion from laparoscopic to open surgery were analyzed and the factors possible for such conversion were studied.Results: The mean age of patients was 45.6 years and male to female ratio 1:3.8. The mean operating time was 49 minutes and average hospital stay was 2 days. Out of 450 patients, 26(5.8%) required open conversion. Factors responsible for open conversion were dense adhesions in 12(2.7...
Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In p... more Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No pati...
Journal of Liaquat University of Medical & Health Sciences, 2019
Aim: To determine the frequency of morbidly adherent placenta and it's associated maternal outcom... more Aim: To determine the frequency of morbidly adherent placenta and it's associated maternal outcomes. Methods:The descriptive cross-sectional study was carried out on 180 pregnant women with age between 15 to 45 years, carrying singleton pregnancy, having previous uterine scar due to cesarean section. The study was conducted in CMH Hospital, Multan from January-2018 to OCT-2019. Maternal outcomes in-terms of intra and post-operative complications such as need for blood transfusion, bladder repair, emergency hysterectomy, ICU admission, surgical site infections, and mortality was main study outcome. Results:Mean age of women was 31.28±3.58 years. MAP was diagnosed in 17(9.44%) women, out of which placenta increta was presented in 11 (6.1%) cases, placenta accreta vera in 4(2.2%) and percereta in 2(1.1%) cases. Mean gestational age in women in MAP was 34.62±2.78 weeks. Most common complication was bleeding requiring blood transfusion occurred in 76.5% cases, emergency hysterectomy was needed in 76.47% cases, bladder repair in 11.7% cases and 35.2% cases required admission in ICU. Mortality occurred in 2(11.8%) women with MAP. Conclusion: Morbidly adherent placenta is a common presentation among patients with previous scar. Bleeding is the commonest complication in these patients, many of these patients require admission in ICU. These patients also have higher mortality rate.
Overgrazing in the fragile Himalayan alpine grassland ecosystems is a major cause of substantial ... more Overgrazing in the fragile Himalayan alpine grassland ecosystems is a major cause of substantial loss of soil organic carbon (SOC). The current study was conducted to analyze the effects of grazing on SOC in seven alpine grasslands of Kashmir. SOC was found to be greatly influenced by severe grazing and varied between 43.1 and 120 Mg/ha. Average SOC was found to be 70.5 Mg/ha; it was 90.6 Mg/ha in non-grazed areas (NGAs) and 50.4 Mg/ha in highly grazed areas (HGAs). The highest value of SOC was 139.1 Mg/ha (in NGA) whereas the lowest was 30.3 Mg/ha (HGA). An average of 1632.7 domestic animals reserved by 278 households were recorded per site. The study determined that an increased herd size results in a decreased SOC level. Grazing regime was a countering factor for SOC at all study sites and caused SOC loss of up to 103.3 Mg/ha. Besides intensive grazing, SOC was also found to be influenced by site physiognomy and microclimatic variations. Grazing management is urgently needed in the Western Himalayan alpine grasslands to enhance SOC levels.
to 15 th June 2015. Subjects & Methodology: Where sample size was calculated using WHO sample siz... more to 15 th June 2015. Subjects & Methodology: Where sample size was calculated using WHO sample size calculator using expected proportion of intrauterine growth restriction p= 4%. 11 163 pregnant women of 20-40 year of age with uterine fibroid of ≥3cm on ultrasound were included in this study. Patients of endometriosis and hypertension were excluded. An obstetrical ultrasonography was done to confirm singleton pregnancy, size of uterine fibroid and to confirm gestational age. Patients were monitored until delivery and complications were recorded. Preterm labour was defined as dilation of the cervix <4cm with the presence of uterine contractions of ≥ 4 per hour of 30 seconds duration with intensity to effect progressive effacement, assessed by vaginal examination. Malpresentation was defined as a presentation in which baby's bottom or feet, instead of head, are in position relative to the maternal pelvis by ultrasound and IUGR was defined as fetal weight below the 10th percentile and fetal abdominal circumference below the 10th percentile on ultrasound. Results: Age range in this study was from 20 to 40 years with mean age of 32.773±1.99 years, mean gestational age 34.730±2.44 weeks, fibroid size 5.736±1.51cm, duration of complain 5.018±1.41 months, height 1.561±0.11 meters, mean weight 73.619±13.66 Kg and mean BMI was 28.607±3.106 Kg/m 2. Majority of the patients were from 31-40 year group (89%). Preterm labour was seen in 15.3% patients, malpresentation was 7.4% and IUGR was seen in 6.1% patients. Conclusion: Our study conclude that, most common complication of uterine fibroids during pregnancy was preterm labour followed by malpresentation and IUGR.
Background: In spite of the wide range of intestinal anastomotic techniques, surgeons are still n... more Background: In spite of the wide range of intestinal anastomotic techniques, surgeons are still not so confident with colorectal anastomosis. Invention of surgical staplers has provided some procedural advantages and sense of security to surgeons as well as to patients, in respect to sphincter-saving procedures and thereby improving the quality of life. Outcome measures of applying these devices should be evaluated to see its efficacy and cost-effectiveness over conventional handsewn technique in treatment plan. The result of such comparative study may help surgeons to improve results of their technique. The aim of this prospective study is to observe the results of using stapler in comparison to handsewn colorectal anastomosis. Patients and Methods: A total of 60 patients were selected, of which 30 underwent “stapled” and 30 underwent “handsewn” anastomosis. The two groups were compared on the following points (i) mean operating time (min), (ii) resumption of oral feeding, (iii) wound infection rate, (iv) anastomotic leak rate, (v) duration of hospital stay and return to work in days. The procedures were evaluated and presented. Results: The stapling procedure took shorter operative time compared to the handsewn anastomosis with a mean of 123 ± 21.1 min and 161.5 ± 27.8 min respectively (P < 0.001). Oral feeding was started earlier in patients who underwent stapler anastomosis 4.0 ± 1.0 days, as compared to handsewn anastomosis 5.0 ± 0.83 days (P value = 0.001). There was no significant difference between the two groups in postoperative hospital stay; it was 7.8 ± 1.76 days and in controls group it was 8.1 ± 2.12 (P > 0.0137). Conclusion: Application of the stapler in treating lower gastrointestinal malignancies demonstrated better effects in terms of mean operating time, resumption of oral feeds, and hospital stay.
Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. U... more Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. Unfortunately, the coverage of child vaccination in Pakistan is poor resulting in unnecessary yet preventable deaths. This study investigated the determinants and reasons for not vaccinating children in Pakistan. Materials and Methods: The study used the Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002 data. Demographic, distance to health facility, poverty status, literacy and education, and location of residence were used as determinants of nonimmunization of children. Descriptive statistics including frequency distribution, proportions for categorical variables and mean for continuous variables, and logistic regression analysis were done using the Stata 11.0. Results: Almost 7.73% children in Pakistan were never immunized. More than 87.4% of these lived in the rural areas. Prevalence of nonimmunization was highest in Balochistan compared to other provinces. Large households appeared to have increased risk of a child not being vaccinated. Moreover, low literacy and education of the head of the household and the spouse was also associated with low vaccination coverage. Distance from the health facility was found to be another factor related to nonimmunization of children. Increase in per capita income significantly decreased the risk of missing vaccinations. Conclusions: Prevention and immunization programs should focus more on high-risk regions such as Balochistan and rural areas. Literacy, education, and economic status were among the other significant factors associated with low vaccination rates, which need a special focus in the public policy to achieve the target of a healthy society.
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