FUNGAL RHINO SINUSITIS DURING COVID-19 ERA

Fungal rhino sinusitis is a life threating, aggressive, angioinvasive infection caused by a group of fungai called mucormycetes and aspergillus as well1. Spores of these fungai are present in the soil, air decaying material and animal dungs. They are inhaled and swallowed to cause infection. It affects mainly immune compromised patients like uncontrolled diabetes (fungus grows and flourish at high sugar level), organ transplant individuals and patients on long term steroid therapy2. Apart from the Covid-19 the fungal infection is not contagious.

Thalassemia & Covid-19 In Khyber Pakhtunkhwa (KP) Pakistan

Thalassemia is a preventable hereditary disorder,each of the parent must be autosomal recessive tohave a child with serious symptoms of the majordisease. Thalassemia occurs due to abnormal ordeficient Hemoglobin (an iron containing proteins)in Red Blood cells. Depending upon the type ofproteins involved, there are two types ofThalassemia, aThalassemia and (3 Thalassemia 12

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It is well known that, medical teachers and supervisors are involved in teaching process with under graduate and postgraduate students

Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

Efficacy of Condom Balloon Tamponade in Management of Primary Postpartum Hemorrhage

Background: Primary postpartum hemorrhage has a significant effect on maternal morbidity and mortality. Proper treatment andin time management of the patient have showed to decrease this morbidity and mortality a lot.Objective: The objective of our study is to find out the efficacy of balloon tamponade in the management of primarypostpartum hemorrhage.Material and Method: This study was conducted in Saidu group of teaching hospital, swat from 1st august 2018 to 31st July2019. All the patient with Primary postpartum hemorrhage were included in the study. All patients were first managed bymedical therapy and when the medial therapy failed then balloon catheter tamponade were introduced and patients werenoticed for stoppage of bleeding within few minutes.Result: Mean age was 27.04±5.42 years. 72 patients failed from medical therapy which was managed by condom tamponade.The response rate of condom tamponade in these 72 patient was 69 (95.83%) while 3 (4.17%) did not respond. There was nosignificant effect of age, gravida on the response rate of Balloon tamponade.Conclusion: The response rate to Balloon Catheter tamponade is high in patient with Primary postpartum hemorrhage due touterine atony. It should be tried before preceding to other Surgical management like Be-lynch, uterine artery ligation orhysterectomy in cases of medical therapy failure.Key Words: primary postpartum hemorrhage, Medical Management, Condom catheter, Response rate.

Child Perception Questionnaire for Oral Symptoms of Hypodontia Children

Background: The congenital absence of one or more deciduous or permanent teeth is called hypodontia. It is the most prevalentcongenital dental abnormality. Hypodontia could be caused by a number of genetic and environmental factors.Objectives: The aim of the current study was to find out the impact of hypodontia on oral health and quality of life of children.Material and Methods: A cross sectional comparative study was carried out on 40 patients suffering from hypodontia and 40healthy controls in the outpatient department of Nishtar institute of dentistry, Multan. Patients and healthy controls were selected bynon-probability convenient sampling technique without any gender discrimination. Age of the selected patients and controls was11-14 years. Oral health was checked by using dental examination instruments. Urdu Proformas were used for betterunderstanding of children.Results: Mean age of the study subjects was 11.9 (± 0.94) years with range of 11 to 14 years. There was 36 (45%) male and 44(55%) female. In our study, maxillary lateral incisor was the most commonly missing tooth. Out of 40 patients suffering fromhypodontia, about 37 (92.5%) patients presented with poor oral health, 38 (95%) patients were affected by their condition and31(77.5%) patients were dissatisfied from their appearance.Conclusion: Hypodontia had great impact on the quality of life of the children. Patients presented with poor oral health and werehighly dissatisfied from their condition.Keywords: Hypodontia, oral health, quality of life

A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain.

Back ground: Lumbar spinal stenosis (LSS) is a common cause of morbidity in elderly patients due to degenerative changes ofspine. Different surgical procedures have been proposed including open lumbar laminectomy and other less invasivedecompressive procedures to minimize soft tissue damage and lessen the post-operative complication. So we conducted thisstudy to find more appropriate and less invasive procedure.Objective: To compare mean post-operative back pain score in patients with lumbar spinal stenosis undergoing bilateraldecompression via unilateral approach versus classic laminectomy.Material and Methods: This randomized control trial was carried out in department of neurosurgery, Saidu Teaching HospitalSharif Swat from April 2018 to October 2018.Atotal of 60 patients having confirmed degenerative lumbar spine stenosis with painscore of >5 on Visual Analogue Score (VAS) presenting in outpatient department were included in the study. Patients not willing forthe study and fulfilling the set exclusion criteria were excluded. Patients were divided in two groups randomly on basis of lotterymethod. Written informed consent was taken and VAS at presentation of all patients was recorded. In group Apatient underwentbilateral decompression via unilateral approach. In-group B patient underwent classic laminectomy. Pain evaluation in both groupsvia Visual Analogue Scoring was recorded before surgery and at 1month post-operative follow-up. Follow up was advised at a 2weeks interval and final outcome was measured at 1 month post operatively. Data collected was analyzed through SPSS 22.Results: In our study the mean age of the patients was 59.12±12.88 years, the male to female ratio was 0.9:1. Statistically highlysignificant difference was found between the study groups with pain at 1st month i.e. p-value=0.000.Conclusion: The bilateral decompression via unilateral approach had significantly reduced post-operative pain as compared toclassic laminectomy in patients with LSS.Key words: pain, classic laminectomy, bilateral decompression, unilateral approach, lumbar spinal Stenosis

Frequency and Histopathological variants of Leiomyoma in Uterine Specimens in a Tertiary Care Hospital.

Background: Leiomyoma is the commonest benign smooth muscle tumor of uterus. It also occur in other organs like gall bladder,skin, gasterointestinal tract etc. Leiomyosarcoma is a rare malignant counter part of leiomyoma.Objective: To see the frequency of histopathological variants of leiomyomas in uterine specimens in Southern District ofKhyber Pakhtunkhwa Pakistan.Material and Methods: This descriptive study was conducted in Department of Pathology, Bannu Medical College Bannu incollaboration with Government and Private Hospitals of the Southern District of KPK. The duration of study was seven years fromJanuary 2011 to December 2017. A total of 210 specimen of leiomyoma were included in this study. Inclusion criteria was allbiopsies of uterine leiomyomas of any age. Exclusion criteria wa autolysed and insufficient biopsy specimen. All biopsies werefixed over night in 10% buffered formalin, processed for histopathological slides preparation. Finally slides were prepared, labeledand reported by Histopathologist. . All the data was analysed in Statistical Package for Social Sciences (SPSS) version 20 forfrequency with percentages and mean with standard deviation.Results: In this study of 210 leiomyoma cases, the age range was from 25- 65 years. The commonest age group was 36-45 yearsfollowed by 25-35 years. The frequency of leiomyoma was 21.5% amongst the total uterine biopsy specimen. Histologically theusual leiomyoma was comprising of 176(83.80%) followed by hyalinised leiomyoma 11 (5.23%), myxoid leiomyoma 09(4.28%),lipoleiomyoma 05 (2.38%), cellular leiomyoma 04 (1.90%), shwannian leiomyoma 03 (1.42%) and one each of symplastic andangioleiomyoma 01(0.47%).Conclusin: Leiomyoma which is the commonest benign smooth muscle tumor of uterus have a number of histological variants. Inthis study usuall leiomyoma was the commonest variant followed by hyalinized leiomyoma, myxoid leiomyoma and lipoleiomyoma.It is important to separate various types of leiomyoma on histology to avoid confusion of misdiagnosis.Key WordsS: Histopathology. Fibroids. Leiomyoma variants. Hysterectomy. Myomectomy.

Correlation of Human Epidermal Growth Factor Receptor (Her2-neu) Marker with the Grades of Urothelial Carcinoma

Background: Urothelial carcinoma is the common carcinoma of urothelium. Its incidence is high in developed countries but itsoccurrence is increasing in developing countries like Pakistan with mortality rate of 3.8/100,000 in males and 1/100,000 in females.HER2 is a member of the human epidermal growth factor receptor (HER/EGFR/ERBB) family.Amplification or over-expression ofthis oncogene has been shown to play an important role in the development and progression urothelial carcinoma.Objective: To evaluate the relationship between HER2/NEU expression and grades of urothelial carcinoma bladderMaterial and Methods: This was a cross-sectional descriptive study for the period of six months from January to June, 2017conducted at Pathology section Rehman Medical Institute Peshawar. After approval from university Ethical board 63 cases wereselected by purposive sampling.The Tissue samples from diagnosed cases of urothelial carcinoma of urinary bladder were included.Cases of urothelial carcinoma from other sites were excluded. Paraffin embedded tissue blocks were cut and sections stained byH&E to evaluate histopathological features and tumor grades. Immunohistochemical expression of HER2 was determinedapplying standard techniques of immunohistochemistry.Results: Out of total 63 cases, 47 were males and 16 were female with a mean age of 60.7 years (range 14-90 years). There were38 High grade, 23 Low grade and 2 cases of PUNLMP. 36 cases were positive for HER2 expression in which 26(72.2%) were Highgrade, 9(25%) of Low grade and 1(2.7%) of PUNLMP. High grade was more common in HER2 positive cases and this relationshipwas significant (p<.05). Among positive 36 cases, 19 cases of +3 score were High grade, 05 in Low grade and 01 in PUNLMP whilescore 2+ was in 07 cases of High grade and 04 were in Low grade. The relationship of HER2 score was not significantly related tograde of tumor (p>.05)Conclusion: HER2 is highly expressed in high grades of urothelial carcinoma bladder and this relationship between HER2expression and tumor grades is statistically significant.Keywords: HER2, Urothelial carcinoma, Grades, Immunohistochemistry

Foetal Neuro-Protection-Role of Magnesium Sulphate

Foetal Neuro-Protection-Role of Magnesium Sulphate