Combined Military Hospital Lahore Research Articles

Trends of Different Gynaecological Cancers at Combined Military Hospital Lahore; An Overview of Last Five Years

Objective: To observe trends of gynaecological malignancies at Combined Military Hospital Lahore.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jan 2015 to Dec 2019.
 Methodology: Data was retrieved from patient admission and discharge notes and their records at the pathology department. Variables like trends of gynaecological malignancies, mean age, common presenting complaint, and common malignancy with histopathology type were collected.
 Results: A total of 107 patients were selected from 2015-2019. Commonest malignancy observed was carcinoma endometrium 51 (47.6%) followed by carcinoma ovary 32 (29.9%), and gestational trophoblastic disease 17 (15.8%), carcinoma cervix 6(5.6%) with one case of carcinoma vulva (0.9%). The common presentation was postmenopausal bleeding 27 (25.2%). Among endometrial carcinoma, adenocarcinoma was the common histopathological type (92.1%). The mean age observed with carcinoma endometrium was 46.9 ± 9 years, ranging from 45-65 years.
 Conclusion: Endometrial malignancy was the commonest malignancy observed in our study. Most patients presented with postmenopausal bleeding. Trends of different gynaecological malignancies were reviewed.

Ewing Sarcoma of Chest Wall: Analysis of 19 Patients

Objective: To share the short and long term outcomes of the patients having Ewing Sarcoma of the chest wall.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Thoracic Departments of Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan from Jan 2010 to Jun 2020.
 Methodology: In total, 19 patients were enrolled. Inclusion criteria were physiologically fit patients for one-lung ventilation with proven true-cut histopathology. Exclusion criteria were poor performance status and non-compliance to chemotherapy.
 Results: Out of 19 cases, 13 males (68.42%) and six females (31.58%) patients. The age range was from 8 to 29 years, with a mean age of 17.6 + 4.16 years. The most common symptom was palpable mass 19, followed by chest pain 8 and one patient presented with fungating mass. All patients showed partial response to neo-adjuvant chemotherapy as per RECIST criteria. Following resection and confirmation of negative margins, primary reconstruction was done. The soft tissue coverage was provided using Latissimus Dorsi Muscle Flap in 16 Cases (84.21%) and in 03 patients (15.79%) Rectus Abdominis muscle was used. Post operatively, less than 02 blood transfusions were needed in six patients. There was no post-operative ventilatory support required, and mortality was zero.
 Conclusion: Ewing Sarcoma of the chest wall is a rare tumour in the adult population. An excellent outcome can be achieved through early diagnosis, meticulous surgical technique and good teamwork in a multi-disciplinary setting.

Awareness of Medical Professionals about Common Disinfectants in a Tertiary Care Hospital Against Corona Virus

Objective: To assess the working knowledge of health care workers (HCW) regarding the appropriate use of disinfectants against Coronavirus in hospital care settings using a questionnaire.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital Lahore, Pakistan, from Apr 2020.
 Methodology: Two hundred health care workers were consecutively selected and divided into two groups, irrespective of gender. Each participant had to fill a structured proforma containing twenty-five close-ended questions.
 Result: Group-1 participants were 126 (63%) and group 2 participants were 74 (37%). 117 (92.8%) group-1 participants were 20–30 years of age and degree holders while 40 (54%) group-2 participants were 31-40 years old and diploma holders. Significant awareness (p<0.001) regarding disinfectants was observed in group-1 (102 81%); all the degree holders were well aware of disinfectants and required less training. In contrast, in group-2, 44 (59%) were fully aware of disinfectants; the rest did not qualify and needed proper training. Participants with a good educational status and work experience of >10 years were the high achievers in both groups.
 Conclusion: This study revealed that majority of the participants knew about the correct usage of disinfectants and they were fully prepared to handle the ongoing pandemic. Another finding was that awareness was directly related to relevant education, prolonged work experience and age

Alteration of Coagulation Profile in Malaria Patients and its Correlation with The Degree of Parasitemia

Objective: To determine the alteration of coagulation profile (PT, APTT, D-dimers) in malaria patients and its correlation with the degree of Parasitemia.Study Design: Cross-sectional study.
 Place and Duration of Study: Pathology department of Combined Military Hospital Lahore, from Jan to July 2018.
 Methodology: A total of 92 patients were included in the study. The malarial parasite was identified using thick and thin smears. Hemoglobin, Red blood cell, White blood Count, Prothrombin Time, Activated Partial Thromboplastin Time, and Ddimer levels were measured using automated analyzers Sysmex KX-21 and CA-600. 
 Results: The mean age of the patients was 23.35 ± 14.4 years with 53 (57.6%) males and 39 (42.4%) females. Plasmodium falciparum was identified as the causative species in 33 (35.9%) of the cases, 59 (64.1%) cases were caused by Plasmodium vivax. Based on parasitic load, 50 (54.3%) patients were found to have a mild degree of parasitemia whereas 26 (28.3%) had moderate and 16 (17.4%) had severe parasitemia. A significant association was found between the degree of parasitemia and coagulation parameters.
 Conclusion: Partial thromboplastin time, activated partial thromboplastin time and D-dimer levels were positively correlated with the degree of parasitemia specifically in plasmodium falciparum as compared to the other species. Therefore, special care should be exercised in patients having an underlying inherited bleeding disorder and a strict prevention protocol should be made.

An analysis of breakthrough seizures and related factors in paediatric epilepsy patients.

To determine the frequency of breakthrough seizures among paediatric patients suffering from epilepsy, and factors related to the precipitation of these seizures. The cross-sectional study was conducted from July 1, 2018, to July 1, 2020, at the Combined Military Hospital Lahore and the Military Hospital, Rawalpindi, Pakistan, and comprised children of either gender aged 2-12 years diagnosed with any type of epilepsy presenting at the children outpatient department. Diagnosis of epilepsy was established by either a consultant adult neurophysician or a consultant paediatrician. The presence of breakthrough seizures was assessed by obtaining detailed history from the patient and the primary caregiver. Socio-demographic profile, duration of epilepsy and poly-pharmacy were noted. Data was analysed using SPSS 23. Of the 450 subjects, 259(57.6%) were boys and 191(42.4%) were girls. The overall mean age was 6.353±4.732 years. The presence of breakthrough seizures was noted in 227(50.4%) subjects. Children with young age, with low family income, and those in need of poly-pharmacy showed significantly higher odds for breakthrough seizures (p<0.05). The incidence of breakthrough seizures in epileptic children was high despite the anticonvulsant agents that were previously effective in controlling seizures.

Quality of Life of Melasma Patients in Pakistan

Objective: To assess the quality of life in Pakistani melasma patients.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Dermatology, Combined Military Hospital Lahore, from Oct 2020 to May 2021.&#x0D; Methodology: The study was conducted on 126 adult patients of both genders by non-probability, consecutive sampling technique. Melasma severity was assessed by 'melasma area severity index (MASI) and quality of life impairment by 'dermatology life quality index (DLQI).&#x0D; Results: A total of 126 patients participated in the study, out of which 85.7% were females, and 14.3% were males. Mean MASI score was 12.21 ± 6.87, and mean DLQI score was 8.22 ± 7.46. Male patients had higher MASI scores and statistically signifycant DLQI than female patients (p=0.016). Employed people and those from the higher socio-economic group showed a more significant impairment of their quality of life.&#x0D; Conclusion: There was moderate impairment of quality of life in melasma patients. Healthcare givers need to recognize the effect of melasma on mental health while counselling patients and devising management strategies.

Review of Level III Maternal Care in The Patients of Placenta Previa and Its Optimal Outcome: One-Year Experience at Combined Military Hospital Lahore

Objective: To review the cases of placenta previa with its optimal outcome, presented at Combined Military Hospital Lahore.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jul 2018 to Jun 2019.&#x0D; Methodology: Total forty-six women, with singleton pregnancy and cephalic presentation were included. Women with placental abruption, having some local cause of antepartum haemorrhage, bleeding disorders, with severe medical disorder were excluded. Doppler ultrasound and MRI pelvis were performed to confirm the placenta previa and morbid adhered placenta (MAP).&#x0D; Results: Mean age of patients was 31.6 ± 3.5 years. Risk factors like previous scar and curettage was observed in 41 (89.1%) and 15(32.6%) patients respectively. On antenatal examination, placenta previa was diagnosed in 38 patients. Obstetrical hysterectomy was performed in 30 (65.2%) cases whereas lower segment caesarean was performed in 16 (34.7%) cases.&#x0D; Conclusion: Placenta previa is leading cause of maternal morbidity and mortality. Tremendous increase in the cesarean section rate is responsible for increased frequency of abnormally implanted placenta and such cases should be managed at tertiary care hospital to get optimal outcome.

COMPARISON OF THE EFFICACY OF TOTAL LARYNGEAL ANESTHESIA AND SIMPLE LOCAL ANESTHESIA DURING AWAKE FIBEROPTIC BRONCHOSCOPY

Objective: To compare the efficacy of total laryngeal anesthesia and simple local anesthesia during awake fiberoptic bronchoscopy.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Pulmonology, Combined Military Hospital Lahore, from Jan to Jul 2020.&#x0D; Methodology: A total of 70 patients, who were undergoing fiberoptic bronchoscopy were divided into two groups. Group-I patients were given topical anesthesia with 2% Lignocaine while group-II patients, in addition to topical Lignocaine, had 2% Lignocaine injected into bilateral internal laryngeal nerves for total laryngeal anesthesia. Assessment of efficacy of anesthesia was evaluated by Reasoner scale.&#x0D; Results: In group-I, 26 (74.28%) patients showed mild or moderate cough and gagging during stage-1. Fifteen (42.85%) patients showed moderate cough and gagging that interfered with the procedure during stage-2 and 19 (54.28%) patients showed mild cough or gagging that did not interfere with the procedure in stage-3. In group-II, 17 (48.57%) patients exhibited mild cough or gagging during stage-1. Sixteen (45.71%) exhibited mild cough or gagging that did not interfere with the procedure during stage-2 with all the patients showing either no cough or mild cough and gagging that did not interfere with the procedure during stage-3. More patients of group-II 32 (91.42%) agreed to a repeat test if required medically as compared to group-I 28 (80%).&#x0D; Conclusion: Patients undergoing fiberoptic bronchoscopy who underwent total laryngeal anesthesia and sedation, in addition to topical anesthesia experienced less cough and gagging than those receiving only local anesthesia.

DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients.&#x0D; Study Design: Cross-sectional diagnostic accuracy study.&#x0D; Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020.&#x0D; Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded.&#x0D; Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879).&#x0D; Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

FREQUENCY OF BONE EROSION ON COMPUTERIZED TOMOGRAPGHY SCAN IN ALLERGIC FUNGAL RHINOSINUSITIS

Objective: To analyze the frequency and sites of bone erosion on computerized tomograghy scan in Allergic Fungal Rhinosinustis in Pakistan.&#x0D; Study Design: Retrospective observational study.&#x0D; Place and Duration of Study: Department of ENT, Combined Military Hospital Lahore, Malir Karachi and Rawalpindi, from Jan 2010 to Dec 2019.&#x0D; Methodology: Total 230 cases of Allergic Fungal Rhinosinusitis were screened, out of which 85 patients having bone erosions on computerized tomograpghy scan were included in the study. Bone erosion in different paranasal sinuses and their sub sites were evaluated. Depending upon the number of bone erosion, patients were divided into three categories as mild, moderate and severe. Those having erosion at a single site were labelled as mild, those with two sub sites of erosion as moderate and those with more than two subsites of erosion were labelled as severe cases.&#x0D; Results: Detailed evaluation of computerized tomography scan of paranasal sinuses revealed bone erosion in 85/230 (36.9%) cases. Mean affected age was 23.96 ± 12.71 years. There were 52 (61.1%) males and 33 (38.9%) females. Ethmoid sinus was the most commonly involved sinus to have bone erosions 55 (38.19%) followed by maxillary sinus 38 (26.38%) then sphenoid sinus 27 (18.75%) and lastly frontal sinus 24 (16.6%). Out of 85 patients 48 (56.1%) were having mild, 22 (25.8%) moderate and 15 (17.6%) had severe disease.&#x0D; Conclusion: Allergic Fungal Rhinosinusitis has high frequency of bone erosion. Computerized tomography scan is an important and effective investigation in finding these bony erosions and ethmoid sinus is the.....

DISSERTATION WRITING: AN ANALYSIS OF VARIOUS BARRIERS TO ITS SUCCESS IN PROMOTING RESEARCH CULTURE IN PAKISTAN

Objective: To identify evidence of success or otherwise of measures like dissertation to promote high quality medical research in the students undergoing postgraduate specialty training despite of many efforts, the quality of medical research in the country remains in turmoil and unrest prevails in the medical community as well.&#x0D; Study Design: Cross-sectional survey.&#x0D; Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jan 2017 to Dec 2018.&#x0D; Methodology: This study was conducted by using Google forms, interviewing the college’s affiliates, which include supervisors, fresh graduates and current trainees using a structured questionnaire, to get an idea of the participants’ view regarding magnitude of the problem, its causes and possible solution.&#x0D; Results: A total of 94 participants responded to the online questionnaire. Among these, 34 (36%) fell in the age group 29-34 years, followed by 19 (20.2%) in the age group 35-40 years. Among the participants, 56 (59.6%) were females. Sixty-six (74%) participants agreed that dissertation writing was not an effective tool in promoting research culture in the country.&#x0D; Conclusion: The current system of Dissertation-writing is not efficient in promoting research skills of the postgraduate trainees and systemic improvements are urgently needed, which would also brighten the image of medical education in the country.

INCIDENCE OF RECURRENT LARYNGEAL NERVE PALSY IN CERVICAL ANASTOMOSIS AFTER ESOPHAGECTOMY FOR CARCINOMA ESOPHAGUS

Objective: To study the incidence of Recurrent Laryngeal Nerve Palsy (RLNP) in cervical anastomosis after esophagectomy for carcinoma of the esophagus.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration of Study: Military Hospital’s Thoracic surgery departments, Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan, from Jan 2010 to Sep 2020.&#x0D; Methodology: Designated proformas were used to collect data. Histopathologically proven, operable cases of carcinoma esophagus with normal phonation were included, all of which underwent cervical anastomosis. All cases of benign pathologies and per-operative macroscopically advanced loco-regional disease were excluded. Recurrent laryngeal nerve (RLN) was identified in all cases and follow-up of 6 months for recovery period was executed.&#x0D; Results: 220 cases were included out of which 121 (55%) were males while 99 (45%) females. The age range was 14-81 years (mean is 38.7 ± 16.78). Out of 29 (13.6%) cases underwent minimally invasive esophagectomy (MIE) while thoracophreno laparotomy was performed in 100 (45.4%) cases, McKeown in 46 (20.9%) and Trans-hiatal esophagectomy (THE) in 45 (20.4%) patients. Recurrent Laryngeal Nerve Palsy was found in 19 patients (8.6%), tracheal injury in 3 (1.3%) and bronchial injury in 1 (0.4%) patient. Recurrent Laryngeal Nerve Palsy was transient in 14 cases and permanent damage persisted in 5 patients.&#x0D; Conclusion: Recurrent Laryngeal Nerve Palsy after esophagectomy is related to increased morbidity due to respiratory complications. With Sharp dissection technique, adequate surgical skill and equipment, the incidence of Recurrent Laryngeal Nerve Palsy can be decreased. In our study, it is less............

MYRINGOTOMY FOR THE TREATMENT OF OTITIS MEDIA WITH EFFUSION; A COMPARISON IN THE OUTCOME WITH AND WITHOUT GROMMET INSERTION

Objective: To compare the outcome of myringotomy with and without grommet insertion in the patients of otitis media with effusion in terms of improvement of hearing in a one-month follow-up.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Pakistan Airforce Hospital Jacobabad and Combined Military Hospital Lahore Pakistan, from Jan to Dec 2020.&#x0D; Methodology: A total of 28 patients aged 4-12 years diagnosed to have conductive hearing loss due to otitis media with effusion not responding to medical treatment were included. Non probability convenience sampling was done. Children aged less than 4 years and above 12 years were not included in the study. They were randomly divided into two groups of 14 patients each using lottery method. Group A underwent myringotomy alone whereas group B underwent myringotomy with grommet insertion. Patients in both groups also underwent adenoidectomy on case-to-case basis. Both groups were compared in terms of improvement in hearing post operatively in a one-month follow-up.&#x0D; Results: There was statistically significant reduction in air bone gap at the end of follow up period as compared to preoperative air bone gap in group B (p=0.007). In group A there was statistically significant reduction in air bone gap at one week (p=0.002) however this improvement was not maintained at 4 weeks (p=0.386).&#x0D; Conclusion: Myringotomy with grommet insertion had significantly more patients with improved hearing as compared to myringotomy alone after one month.

ASSOCIATION OF TYPE 2 DIABETES MELLITUS WITH ABO AND RH BLOOD GROUP

Objective: To find out the association of type 2 diabetes mellitus with ABO and Rh blood groups.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Department of Haematology, Combined Military Hospital Lahore, from Jul to Dec 2020.&#x0D; Methodology: A total 179 patients with type 2 diabetes mellitus and 50 healthy individuals were inducted into the study. Five (5ml) blood from the patients was taken via clean aseptic venipuncture in a tube containing EDTA. HbA1C was generated through automated analyzer Cobas c501 and blood grouping was carried out using tube method by an experienced technician.&#x0D; Results: A total of 179 (77.8%) individuals with diabetes mellitus type 2 and 50 (21.7%) healthy cases were inducted into the study as a control group. A statistically significant difference was observed with blood group B being the most prevalent among them (p=0.001). There was a greater frequency of Rh-negative blood group in patients having diabetes mellitus type 2 as compared to the control group.&#x0D; Conclusion: There is a strong association found between ABO and Rh blood group with diabetes mellitus type 2. Blood group B negative was the most common among the patients having diabetes mellitus type 2. Blood group O positive showed the least association.

SPECTRUM OF HISTOPATHOLOGICAL PATTERNS OF DUODENAL BIOPSIES IN PATIENTS WITH UNEXPLAINED ANAEMIA AND CHRONIC DIARRHEA AND THEIR CORRELATION WITH ENDOSCOPIC FINDINGS AND SEROLOGICAL MARKERS

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020.&#x0D; Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease.&#x0D; Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level &gt;100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease.&#x0D; Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.

DETERMINATION OF DIAGNOSTIC ACCURACY OF BIOCHEMICAL PARAMETERS (CRP, LDH & FERRITIN) IN THE DIAGNOSIS OF COVID-19 IN SUSPECTED COVID CASES

Objective: To determine the diagnostic accuracy of the Lactate Dehydrogenase, C-Reactive Protein and Ferritin in suspected patients of COVID-19.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Pathology department of Combined Military Hospital Lahore in the month of May 2020.&#x0D; Methodology: We included 101 adult (&gt;18 years) symptomatic suspected COVID-19 patients of both genders. Children, pregnant women and asymptomatic patients were excluded from study. Age, gender and results of Reverse Transcriptase Polymerase Chain Reaction, Lactate Dehydrogenase, C-Reactive Protein, ferritin were recorded.&#x0D; Results: Lactate Dehydrodenase had highest sensitivity (75%) with positive predictive value of 71.6% and diagnostic accuracy of 65.3% among three biochemical parameters studied. Receiver Operator Characteristic curve was studied. Area under curve of Lactate Dehydrogenase (AUC=0.65) and Ferritin (AUC=0.59) reflected their ability to prognosticate the presence of COVID19 disease. However, C-Reactive Protein (AUC=0.42) appeared to be a poor predictor of the disease.&#x0D; Conclusion: Raised serum Lactate Dehydrogenase (&gt;490 U/L) and Ferritin (&gt;152 ng/L) levels can be used to predict the Reverse Transcriptase Polymerase Chain Reaction positivity for COVID-19 in the population of suspected patients of COVID19. However, C-Reactive Protein is a poor predictor of COVID-19.

SUDDEN CARDIAC DEATH: VULNERABILITY OF ATHEROSCLEROTIC PLAQUE IN CORONARY ARTERIES

Objective: To assess the vulnerability of atherosclerotic plaque in coronary arteries of individuals dying of ischemic heart disease.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Histopathology department, Combined Military Hospital Lahore, from Nov 2016 to Nov 2017.&#x0D; Methodology: A total of 43 cases were taken in the study. The Autopsy specimens from the bodies of people dying suddenly of ischemic heart disease were taken into the study. Tissues showing autolytic changes and patients dying with coronary artery disease after corrective procedure like stenting and bypass were excluded.&#x0D; Results: Out of 43 cases, 35 (81.4%) cases were positive for cluster of differentiation 68 (CD 68), 34 (79%) cases were positive for cluster of differentiation 105 (CD 105) &amp; 36 (83.6) cases were positive for nuclear factor kappa-light-chain-enhancer of activated B cells (NF-Kb).&#x0D; Conclusion: People who had died of ischemic heart disease have more vulnerable plaque in their coronary arteries as compared to the people who had died of non-ischemic cause. Early recognition of the un-ruptured plaque is important for the treatment strategies.

EARLY VERSUS DELAYED ORAL INTAKE IN PATIENTS AFTER CESAREAN SECTION UNDER REGIONAL ANESTHESIA

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018.&#x0D; Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water) &lt;5 hours after cesarean section and in group 2, patients received sips of water 8 hours following surgery. Bowel motility was assessed after surgery on hourly basis. Data about time interval to first bowel movement and ileus were noted.&#x0D; Results: Mean age of patients was 32.329 ± 3.44 years and 33.051 ± 3.64 years in group 1 and 2 respectively. Mean gestational age and body mass index was 38.50 ± 0.93 weeks and 29.824 ± 4.97 kg/m2 in group-1 versus 37.937 ± 0.98 weeks and 27.779 ± 2.81 kg/m2 in group 2. Mean duration of surgery was 47.096 ± 6.65 minutes in group-1 and 47.647 ± 8.76 minutes in group 2. Ileus was seen in 17% patients in group-1 and 34.1% in group-2 (p&lt;0.001). Mean time interval for first bowel movement was 8.323 ± 1.20 hours in group-1 and 13.034 ± 2.54 hours in group 2 (p&lt;0.001).&#x0D; Conclusion: Early feeding after an uncomplicated cesarean section has reduced rate of ileus symptoms and mean time interval for bowel......

Variceal Hemorrhage as the Commonest Cause of Presentation with Acute Upper Gastrointestinal Bleeding: A Paradigm Shift

Background: Upper gastrointestinal bleeding, a life-threatening condition, is a common presentation of the emergency room visits. Objective: To determine the frequencies of various causes of acute upper gastrointestinal bleeding (AUGIB) amongst the patients presenting at emergency department with upper gastrointestinal bleed mandating urgent esophagogastroduodenoscopy (OGD). Study Design: It is a retrospective observational study. Settings: Department of Gastroenterology, Combined Military Hospital Lahore, Pakistan. Duration: 12 months from January 2019 to December 2019. Methods: All the patients who presented to emergency department with AUGIB and were referred for endoscopy after initial resuscitation were included in study. Their record was reviewed including the epidemiologic data, history, clinical details and endoscopic findings. Patients who had routine, non-urgent OGD to screen for varices or anemia, were excluded from the study. Results: Records of 270 patients, aged between 18-96 years were analyzed, 206(76.3%) were males and 64 (23.7%) were females. The most common finding was esophageal varices (26.0%) followed by gastritis (20.7%). Esophageal varices were found more frequently in males (76.1%) as compared to females (23.9%). Conclusion: This study strengthened the hypothesis that bleeding due to variceal hemorrhage is now actually the leading cause for AUGIB, mandating inclusion of medical treatment for variceal bleed in treatment protocol of all upper GI bleeds in the emergency assessment room, pending OGD.

Prevalence of Depression, Anxiety and Stress in Medical Students, interns and residents in Pakistan

Aim: To assess prevalence of Depression, Anxiety, Stress in medical students, interns, and residents in Pakistan Study design: Cross-sectional Survey (Questionnaire) based study. Place and duration of study: This study was conducted at Combined Military Hospital Lahore Medical College from March 2020 to May 2020. Results: 104 participants were included in the study. There was female predominance 58(55.8%), and the mean age was 23.55±1.42. The overall mean score of depression and anxiety was 21.2±12.67 and 15.7±10.67 respectively and most prevalent in third and fourth-year residents. The mean stress score was 13.7, 10. 27. Twenty-eight (26.9%) of the overall participants had extremely severe depression, 36 (34.6 %) had extremely severe anxiety and 13(12.5%) had severe stress. Doctors studying and practicing in the private sector have a higher DASS21 score (p = &lt; 0.006) Conclusion: Multiple factors have been found to contribute to the poor mental health of health care workers, including financial trouble, sleep deprivation, abuse from colleagues, high expectations, female gender, broken relationships, and substance misuse. Keywords: Anxiety Disorders, Depression, Medical, Mental Health Problem Solving, Psychological Distress,