Health Sciences Jamshoro Research Articles

Vitamin D and diabetic retinopathy in above 40 years old patients; Study of Tertiary Eye Care Hospital Jamshoro.

Objective: To estimate the relationship between serum level 25-hydroxyvitamin (25 (OH) D) and diabetic retinopathy (DR) in type 2 diabetic elders. Study Design: Prospective, Observational study. Setting: Institute of Ophthalmology, Liaquat University of Medical & Health Sciences Jamshoro. Period: July 2020 to September 2021. Material & Methods: After completing the clinical examination, all participants were sent to the laboratory to investigate the blood level of Vitamin D (Vita D), glycated hemoglobin, glucose fasting/random; and urea and creatinine. For statistical analysis, the Statistical Package for Social Sciences (SPSS) version 20 was used. The serum level of 25 (OH) D was assessed with logistic regression analysis to evaluate the relationship with diabetic retinopathy. Results: Collected blood variables indicated that the mean level of Vita D was lower in subjects with proliferative Diabetic Retinopathy (PDR) and Non-PDR (NPDR) as compared to No DR (NDR) (14.10 ± 1.20, 21.10 ± 1.91, 23.29 ± 2.10

Bowel Preparations for Colonoscopy: Current Medical Practices in Pakistani Hospital Settings

Aim: To evaluate the quality of bowel preparations concerning the Boston Bowel Preparation Score (BBPS) and to analyze the administration, ease, palatability, and side effects of practices. Study design: Cross-sectional study Place and Duration: this study was conducted in Liaquat University of Medical and Health Sciences Jamshoro from October 2021 to March 2022 Methodology: The present study incorporated 132 patients who visited the hospital for a colonoscopy. Patients above 18 years of age were included, whereas patients with surgical procedures were excluded from the study. Participants were evaluated through pre-designed proforma for demography, dietary recommendations, side effects, procedure indications, bowel preparations, and patient ease of the bowel preparations. BBPS was used to access the bowel preparation. A score ≥ 5 was regarded as satisfactory. Results: Out of 132 patients, 73 (55.3%) were males. Seventy-one (53.8%) patients received Polyethylene glycol-based bowl preparation, and sixty-one (46.2%) patients received sodium phosphate-based preparation. Chronic constipation was the most typical cause of colonoscopy. Common side effects were vomiting (12.1%), nausea (1.5%), and bloating (3%). More than half of them responded that the preparations were palatable. A satisfaction rate of 80.3% was observed in patients with both preparations. BBPS of above five was observed in 109 (82.6%) patients. Conclusion: Polyethylene glycol and sodium phosphate preparations have been widely used in clinical practices for cleansing the colon. Sodium phosphate-based preparation was found more effective. Keywords: Bowel cleansing agents, Colonoscopy, Endoscopy, Polyethylene Glycol, Sodium phosphate.

Prevalence Of Hypothyroidism in Esrd Patients with Maintenance Hemodialysis

The kidney affects “the thyroid gland causing various derangements in its function whenever the kidney is impaired, even with a minor imperfection in its job, and this makes dialysis patients more prone to thyroid disorders with subsequent increase in mortality and morbidity. Objective: To determine the frequency of hypothyroidism in ESRD patients who are on maintenance hemodialysis. Methods: A descriptive cross-sectional study was conducted at Department of Nephrology, Liaquat University of Medical and Health Sciences Jamshoro”, upon a sample of 140 patients having age between 18 to 70 years presented with end stage renal disease with 3 months or more of maintenance hemodialysis were consecutively enrolled. Investigations was advised for TSH levels, T3, T4. The presence of hypothyroidism along with baseline and clinical characteristics were noted. Results: Of 140 patients, the mean age of the sample was 62.31± 9.78 years. Majority of the sample were males as compared to females, i.e., 93 (66.4%) and 47 (33.6%). History of thyroid disorder was observed in 83 (59.3%) patients. Comorbidity showed that type 2 diabetes mellitus was observed in 65 (46.4%) and hypertension in 77 (55%) patients. The mean TSH, T3 and T4 level was found to be 4.67± 0.20, 0.97± 0.37, and 5.33± 0.69 respectively. Frequency of hypothyroidism was found to be 53 (37.9%) patients. Conclusion: A considerably higher number of patients were presented with hypothyroidism in “ESRD patients who are on maintenance hemodialysis.

Repair of Bilateral Inguinal Hernia in Children with a Single Cosmetic Incision. Our Experience in Tertiary Care Center

Aim: To evaluate the advantages/benefits of a single cosmetic incision approach for the repair of bilateral inguinal hernia in children. Study design: A cross-sectional study Place and Duration of study: Pediatric surgery department, Liaquat University of Medical & Health Sciences Jamshoro from February 2017 and June 2022 Methodology: Bilateral inguinal herniorrhaphies were performed on a total of 178 children and infants who received treatment in succession. A single, transverse, 2.5-cm long suprapubic incision was performed in 89 (50%) of the patients, and the Scarpa fascia was punctured using cautery. The external ring was located and opened after retracting the wound, and the ilioinguinal nerve was safeguarded. After testicular vascular and sac separation from vas deference, the hernial sac is delicately Trans ligated with 3-0 Vicryl (Ethicon), closed was the external oblique aponeurosis. The wound was then retracted to the opposite side and treated there using the same technique. Results: Ages ranged from 3 months to 11 years at the time of operation (average, 29.8 months). 56.93% of the patients—96—were under the age of one, with 51 of them—28.65%—being under the age of six months. 48 patients were 1 to 5 years old, and 24 were over the age of 5. The average operating time was 8–10 minutes shorter than it had been in the past for children who had undergone bilateral inguinal incisions, which typically took 30–40 minutes. The visual look and overall outcomes have pleased the patients and parents. There haven't been any recurrences so yet. Conclusion: In order to improve therapeutic impact and lower the risk of complications and recurrence, we develop a single incision method for bilateral inguinal herniorrhaphies. Depending on the availability of a paediatric surgeon with the necessary experience and skills, a single incision technique for treating a child's bilateral inguinal hernia is practical, safe, and can be provided to patients. Keywords: single incision approach, inguinal herniorrhaphies, children, cosmetics

Compare of the Frequency of Instrument Fracture of Endodontic File Using Rotary Pro Tapers and HY Flex Series

Objective: To compare the frequency of instrument fracture of endodontic file using Rotary Pro Tapers and EDM Hy Flex series. Study Design & Setting: This experimental in vitro study was conducted at Institute of Dentistry Liaquat University of Medical and Health Sciences Jamshoro. Subjects and Methods: Data was prospectively collected from extracted human teeth. A total of 66 canals were included. Simple descriptive statistics were used to present demographic data, along with frequency and percentages to present qualitative variables. It was decided to perform a post-stratification chi square test taking a p-value of less than 0.05 as significant. Results: A total of 66 canals (33 each endodontic file using Rotary Pro Tapers and EDM Hy Flex series) were included. Mean endodontic file in group A and B was 1.28±0.14 mm and 0.58±0.08 mm. Comparison of instrument separation in endodontic file using Rotary Pro Tapers and Hy Flex series showed separation of 09 (27.3%) and 02 (6.1%) respectively. Conclusion: Based on the results of this study, Protaper files generated much more stress than EDM Hy Flex files, but comparisons of instrument separation between the two instruments showed that the latter performed better overall. Keywords: Root canal treatment, Endodontic file, Rotary Pro Tapers and Rotary EDM Hy Flex.

Association between Raised Serum Lactate Dehydrogenase and Hypertensive Disorders of Pregnancy

Objective: To determine the association between raised serum lactate dehydrogenase (LDH) and hypertensive disorders of pregnancy.
 Material and Methods: This case control study was conducted in the department of Obstetrics and Gynecology, at Liaquat University of Medical and health Sciences Jamshoro, Hyderabad, for a period of six months from July 2021 to December 2021. All the pregnancy hypertensive disorder women as cases and normotensive women as control of ages between 18 and 45 years with gestational age >28 weeks, irrespective of parity and booking stratus were included. Under aseptic conditions, from each woman of both groups around a 2 ml venous blood sample was taken (before treatment) for the assessment of serum LDH levels. Serum LDH levels more than 280 U/L was considered as raised. All the informations were noted on predesigned proforma by the researcher herself. SPSS version 26 was used for the data analysis.
 Results: A total of 100 cases were included, particularly 50 women having hypertensive disorders of pregnancy and 50 normotensive pregnant women were studied. The overall mean age of the female’s was 25.76+5.39 years and average BMI was 32.7+2.02 kg/m2. Out of all 65.0% were primiparous. Most of the females 76.0% were poor socioeconomically. LDH was raised among 62.0% of the women with hypertensive disorders of pregnancy and it was normal among all normotensive pregnant women. Average serum LDH level was significantly higher in cases as compared to the controls (0.001).
 Conclusion: Raised serum lactate dehydrogenase (LDH) was observed to be significantly linked to hypertensive disorders of pregnancy. Careful monitoring of serum LDH concentrations during pregnancy in high-risk cases may play a role in early detection and treatment to decrease the morbidity and mortality.

Home Quarantine Among COVID Positive Health Professionals: A Cross-Sectional Study From Hyderabad Pakistan

Objective: To determine the preference for home quarantine and its reasons among health professionals during the COVID-19 pandemic.
 Study Design: Cross-sectional study.
 Place and Duration: Department of Obstetrics/Gynecology, Liaquat University of Medical and Health Sciences Jamshoro, and other affiliated hospitals with LUMHS, from Apr to Sep 2021.
 Methodology: Eighty home-quarantined health professionals (HPs) at our institute following the exposure to confirm COVID-19 cases were included. A pre-designed questionnaire was used to analyze its reliability using Cronbach's alpha value in SPSS after completing the home quarantine period and analyzed.
 Results: We enrolled 80 health professionals. 43 (53.8%) were PG Trainees, followed by consultant (20%), doctors (20.0%), nurses (6.2%), and technicians (6.9%). The mean quarantined period was 15.72 ± 6.15 days (7-20 days). Doctors, PG trainees, and nurses perceived a greater level of irritability than the other health professionals. We found an association between irritability and advanced age, confinement, and being single. Generally, PG Trainee revealed higher physical activity (p= <0.001). Physical activity was significantly lower among respondents who were unmarried (p= 0.004).
 Conclusion: Increased satisfaction and a more homelike environment, less aggravation of symptoms, and a mild level of depression and anxiety among health care professionals were associated with home quarantine measures during the COVID19 pandemic.

Comparison of Corticosteroids Versus Platelet-Rich Plasma for the Treatment of Plantar Fasciitis: A longitudinal Study

Aim: To compare the effectiveness of corticosteroids therapy and platelet-rich plasma (PRP) therapy for the treatment of plantar fasciitis. Study design: A longitudinal study Place and Duration: This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro Pakistan from June 2020 to June 2021 Methodology: A total of 120 participants were considered in the study. Participants were divided into two groups. Both groups consisted of 60 patients each. One group was treated with corticosteroids injection (n=60) and the other was treated with PRP (n=60). All the participants were assessed clinically at the time of induction of treatment, after six weeks of the treatment, and after six months of the treatment. The clinical assessment included the visual analog pain scale (VAS), Roles and Maudsley scoring, and the American Foot & Ankle Society (FAS). Results: A significant improvement in plantar fascia thickness, VAS, and AFAS was observed after the injection was given to the participants of both groups. The mean AFAS of the PRP group at 6th week was 84.6±4.8 and in the sixth month, it was 90.4±2.9. The value of AFAS of the corticosteroid group at 6th week was 75.3±4.7 and it was 80.1±4.2 in the sixth month. The mean value of VAS in the PRP group at the 6th week was 2.5±1 and at the 6th month was 1±0.7. Likewise, the value of VAS in the corticosteroid group at 6th week was 4±1.2 and at 6th week was 2.7±0.8. There were no complications in both groups. Conclusion: The corticosteroids injection and PRP injection have the same effectivity for the treatment of plantar fasciitis. Keywords: Plantar Fasciitis, PRP, Corticosteroids

Comparison Between Open Shouldice Versus Laparoscopic Unilateral Inguinal Hernia Repair: A Randomized Controlled Trial

Aim: To compare the outcomes of laparoscopic Inguinal hernia repair and open Inguinal hernia Shouldice repair. Study design: A randomized controlled trial Place and duration: This study was conducted at Liaquat University of Medical Health Sciences Jamshoro, Pakistan from April 2020 to April 2021. Methodology: In this study comparison of a laparoscopic and open procedure was done. A total of 124 patients were included in the study. A total of 64 patients underwent a Laparoscopic Transabdominal Pre Peritoneal (TAPP) Inguinal Hernia Mesh Repair and 60 patients underwent the Shouldice technique of hernia repair which is an open surgical Non Mesh Technique. The measured Variable were Early Complication, Return to work, Duration of analgesia requirement and Reoccurrence Rate. The data were analyzed using IBM SPSS version 26. Results: The rate of complications in both groups was similar. Patients who underwent the laparoscopic procedure mean duration to return back to work was 12 days. On the other hand, those who had the Shouldice procedure mean duration was 17 days return back to work. The mean duration of analgesia intake after a laparoscopic procedure was 2.2 days and after a Shouldice procedure was 2.8 days. Recurrence of the hernia was reported by 3 (4.69%) patients who underwent the laparoscopic procedure and 2 (3.33%) patients who underwent the open procedure. Conclusion: The laparoscopic procedure is a better procedure than the open procedure of primary unilateral hernia repair in terms of early recovery, return to work and postoperative pain. Keywords: Laparoscopy, hernia repair, Shouldice procedure

To Access the Clinical Outcomes at Three Months amongst Patients Presenting with Acute De-Compensated Heart Failure

Aim: To determine the 3-month clinical outcome in patients with acute decompensated heart failure (ADHF). Study Design: A cross-sectional descriptive study. Place and Duration: This study was conducted at Cardiology department of Liaquat University of Medical and Health Sciences Jamshoro for six-months duration from July 2021 to December 2021. Methodology: Patients with acute de-compensated heart failure (ADHF) were involved and followed for the consequences in the form of worsening functional class, re-admission and mortality. The exercise test was performed according to the modified Bruce protocol on treadmill, with incessant on-line respiratory gas. The slope of the association between CO2 production (VCO) ventilation (VE) was evaluated by computer graphical analysis (VE / VCO2 slope). Results: 79(54.1%) of 146 patients were male. Patients' age ranged from 15 to 85 years, and the mean age was 52.10 ± 19.54 years. The patients were alienated into four age groups. Overall, 94(64.4%) of patients showed adverse clinical outcomes at three months of follow-up. Overall readmission rates were 16.7% higher in patients 51-70 years of age. Deterioration in the functional class occurred in 32.9%, less frequently in 14.6% of patients in 71-85 years of age. Mortality was found in 16.4% of patients and 37.5% of patients aged 71-90 years in the three-month follow-up. Conclusions: During the three-month follow-up period, readmissions for acute decompensated heart failure were significantly higher at a younger age, while functional class deterioration and mortality were higher at an older age. Keywords: Rehospitalization, Acute decompensated heart failure, Mortality and Functional class.

Variation in White Blood Cell Differential Fluorescence Scattergram: A Clue for Automated Malaria Diagnosis

Background: Malaria is an arthropod-borne disease caused by Plasmodium. Malaria is a significant public health challenge with about 3.3 billion human lives at risk in 97 countries with two hundred million estimated malaria cases and 600,000 fatalities. Timely diagnosis can prevent disease spread, loss of human lives, and its harmful impact on the economy therefore malaria diagnosis by automated hematology analyzer is of great value. Objective: To assess identification of scattergram abnormalities in malaria samples and to compare its performance with Microscopy, RDTs & PCR. Study Design: Descriptive and cross-sectional study Place and Duration of Study: Department of Pathology, Liaquat University of Medical & Health Sciences Jamshoro, 06 months from May 2020 to October 2020. Methodology: Eighty seven malaria suspected samples were included. CBC performed on Sysmex XN1000i followed by Microscopy of thin blood film, RDTs by using STANDARDTM Q Malaria P.f/Pan Ag Test, DNA extracted by QIAamp DNA mini kit, PCR performed by GenoAmp Real-time qPCR Malaria. Results: The median age of patients was 24+13.93 years. WDF Scattergram abnormalities were observed in 95.4 %of samples with sensitivity of 97.6% and specificity of 100% respectively. PPV was 100% and NPV was 99.8%. 96.4% of patients were malaria positive by microscopy. ICT was positive in 96.6% of samples while PCR confirmed plasmodium presence in 97.7% samples. Conclusion: Automated hematology analyzer provides high sensitivity and specificity for malaria diagnosis. The Sysmex XN-1000i can detect certain abnormalities in WDF scattergrams in malaria patients. As a result, the appearance of an abnormal WDF scattergram in a patient with a history of febrile illness, aids the pathologist in confirming a malaria diagnosis. Keywords: Malaria, Plasmodium Vivax, Plasmodium Falciparum, WDF scattergram, ICT, RT qPCR

Clinical Characteristics and Outcome of Arteriovenous Fistula among Patients Undergoing Haemodialysis with end Stage Renal Disease

Objective: To determine the clinical characteristics and failure rate of arteriovenous fistula (AVF) among patients undergoing haemodialysis with end stage renal disease. Methodology: This was a cross-sectional study, done at department of urology at Bilawal Medical College for Boys, Liaquat University of Medial and Health Sciences Jamshoro Pakistan, with time duration of eleven months from April 2021 to February 2022. All the patients with age of more than 20 years, both genders, end stage renal disease and undergoing haemodialysis were included. The optimal site for fistula development was determined after taking blood pressure and completing the Allen test. Vascular diameter, intravascular thrombosis, arterial wall atherosclerosis, and the opening of arterial inflow and venous outflow access were all assessed during the procedure. End- to- side and side-to-side arteriovenous fistula were established if there were no contraindication. The patients were discharged after establishing the fistula's patency and experiencing the thrill. The patient's fistula patency and hemodialysis performance were assessed till six weeks. All the information was documented in the self-made proforma. SPSS version 26 was used for the data analysis. Results: A total of 100 cases were studied, most of the cases (49.0%) were more than 50 years old and males were most common 71.0%. Out of all, 59(59.0%) cases were diabetics and hypertensive. According to the site of arteriovenous fistulae (AVF), Left radio cephalic AVF was31.0%, left brachio cephalic AVF was 40.0%, left brachio basilic AVF 24.0%, right radio cephalic AVF 03.0%, right Brachio cephalic AVF 1.0% and right brachio basilic AVF 1.0%. At 6th week follow-up arteriovenous fistula was observed successfully functional in 91.0% cases, while 5.0% arteriovenous fistula were burst and in 3.0% it was failed, while one patient was died during this six-weeks follow-up. Conclusion: For haemodialysis, the arteriovenous fistula was observed to be the best and preferable option with higher functioning rate, noninvasive and lower complicated. Keywords: Renal failure, AVF, function, failure

Clinical Presentation of Patients of Carcinoma of Rectum and Different Modalites of Treatment

Objectives: To determine the clinical presentation of patients of Carcinoma of Rectum and Different modalities of treatment.
 Methodology: This was a Prospective observational study conducted in from May 2019 to April 2021 at Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro, Sindh, Pakistan. The study comprises 50 patients. All were admitted from Outpatient Department (OPD). All patients were evaluated fully after history & Clinical examinations Digital Rectal Examination (DRE) with Proctoscope and specific investigations of, Stool DR, Fecal occult blood, ultra sound of abdomen and pelvis, Sigmoidoscopy, Colonoscopy with biopsy, Barium enema, C T Scan of Abdomen, chest & pelvis, MRI Abdomen &Pelvis, PECT Scan, Anorectal or Endoluminal Ultra sound, Tumor Marker CEA, Monoclonal Antibodies, LDH level, LFT for liver. and X- Ray chest PA view. Complete blood picture (CBC) Blood urea, sugar, serum electrolyte, HBSAG, HCV, & HIV, COVID -19, LFT, PT, APTT, INR and ECG for fitness purpose and general assessment.
 Results: In this study 50 patients of carcinoma of Rectum were reported. The maximum number of patients were in age group between 12 to 80 years. Out of 50 patient, 15 patients were presented with Altered Bowel habit (Constipation and Diarrhea) & Spurious Morning Diarrhea , 13 patients were presented with Altered Bowel habit (Constipation & Diarrhea) Spurious Morning Diarrhea ,With Bleeding per rectum. Out of 50 patients 15 patients were diagnosed stage 1 ,13 patients were diagnosed stage 11, 9 patients were diagnosed stage 111, 13 patients were diagnosed stage 1V. Out of 50 patients 28 patients were treated with anterior resection, 15 patients initially treated with New adjuvant therapy followed by patients were treated APR with TME, immunotherapy, gene therapy. 4 patients were treated initially diversion colostomy, then Neo adjuvant therapy, 3 patients were treated laparotomy, colostomy, hart men procedure, Chemo radio therapy, Immunotherapy, Gene therapy.
 Conclusion: Carcinoma of Rectum is a common problem all over the world. Patients of carcinoma rectum can present diarrhea, constipation, bleeding per rectum, spurious morning diarrhea if not diagnose, and treat the patient in early stage, patients live style will be complicated.

An Autopsy Study of Cases of Death Due to Poisoning

Objective: To describe the socio-demographic profile of deaths due to poisoning and to assess frequency of poisoning deaths, among the autopsies Design of the Study: Descriptive cross sectional study. Study Settings: The study was conducted at Department of Forensic Medicine and Toxicology Liaquat University of Medical and Health Sciences Jamshoro Sindh from January 2021 to December 2021. Material and Methods: The present study was carried out in the Department of Forensic Medicine from. During this period, 313 autopsies were conducted, out of which, majority of cases were poisoning deaths. Among them 100 cases of Poisoning deaths were selected for the study based on purposive sampling and Chemical Analysis Report. Results of the Study: The most common poisons encountered in this study were OP compound (55 - 50%) and Phosphide ions (33 - 30%). Congestion (24 – 21.81%) and pulmonary edema (19 – 17.27%) was the most common findings in the lungs in cases of OP compound poisoning; whereas, pulmonary hemorrhage (12– 10.90%) and congestion (11– 10%) was the most common findings in the lungs in cases of Phosphide ion poisoning. Necrosis (16– 14.54%) and sinusoidal dilatation (14– 12.72%) was the most common findings in the liver in cases of OP compound poisoning; whereas, necrosis (21– 19.09%) and fatty change (09 – 8.18%) were the most common findings in the liver in cases of Phosphide ion poisoning. Conclusion: The most common form of poison taken by this research cases is organophosphorus pesticides. Males are more likely to be poisoned than females. In both rural and urban communities, married people outnumbered single people. Based on the information provided by the police and families of the deceased, the suspected type of poison in the majority of the victims remained unclear prior to autopsy. Keywords: Poisoning, Autopsies, Forensic Medicine

Magnitude of Prevelance of Refractive Errors in School-age Children: A Cross-sectional Study

Aim: To determine the frequency of refractive errors in school-age children.
 Study Design: Cross-sectional study.
 Place and duration: Two Government and two Private schools of Hyderabad Sindh, screened by the institute of ophthalmology at Liaquat University of Medical and Health Sciences Jamshoro, from January 2021 to June 2021.
 Methodology: Schools and students were selected by stratified random method; a total of four hundred students were screened in four schools. From class one to class ten, 10 students were selected from each class. Prior written permission was obtained from parents. External ocular examination, visual acuity, pinhole test, autorefraction, and fundus examination were done and recorded on proforma along with the information regarding age, sex, family history, and parent’s education. The data was entered and analyzed by SPSS version 22.
 Results: In government schools 27 students out of 200 had refractive errors, myopia was present in 15 (55.55%) students, hypermetropia in 7 (25.93%) students and astigmatism in 5 (18.52%) students, while in private schools 25 students had refractive errors. Myopia was present in 16 (64%) students, hypermetropia in 7 (28%) students and astigmatism in 2 (8%) students. Myopia and astigmatism were more prevalent in female sex being 8.1% and 2% respectively, while in males it was 6.4% and 1.4% cases. In this study, no significant refractive error difference was found between government and private sector schools.
 Conclusion: In our study, the prevalence of refractive errors was 13% (52) out of 400 students. Refractive errors are the most common and easily treatable causes of decreased vision in school-aged children. It is recommended that visual acuity be checked prior to admission to school because refractive errors can be easily corrected with glasses. If it is treated in time, the child can be prevented from amblyopia and squint.

Pattern of Injuries in Genito-Anal Area in Cases of Sexual Assault: A Cross Sectional Study

Aim: To determine the pattern of injuries in the genito-anal area in cases of sexual assault
 Study Design: Cross-sectional study
 Place and Duration: This study was conducted at Liaquat University of Medical and Health sciences Jamshoro, Pakistan from June 2020 to July 2021
 Methodology: A total of 96 victims of assault, who survived rape, were incorporated. The victims were from all groups of ages. All the patients considered in this study were both male and female. All of them had reported the case to the police and community.
 Results: There were 84.5% cases of penile-anal penetration, 76% of penile-oral penetrate and 48% of assault victims presented with ano-genital bleeding. Most of the cases of sexual assault considered in this study were not completely investigated previously.
 Conclusion: The study concludes that the most common pattern of injury after sexual assault was penile-anal penetration. Penile-oral penetration was the second most common injury. Nothing can undo whatever a sexual assault victim has to go through but catching and punishing the perpetrator is a necessary step. Genital injuries are not proof of a sexual assault. A sexual assault does not necessarily leave the genital area injured.

Comparison between Modified Triangular Flap and Envelop Flap Techniques for Surgical Removal of Impacted Mandibular Third Molar

Objective: To compare postoperative outcomes in surgical extraction of mandibular third molar with envelop flap versus modified triangular flap.
 Setting & Duration: Oral & Maxillofacial Surgery Unit at Faculty of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Study period was from January 2021 to December 2021.
 Subject and Methods: A set of 60 individuals were sequentially assigned 30 to the Group A envelop flap and 30 to the Group B modified triangular flap for surgical removal of the mandibular third molar tooth. The demographic and clinical parameters was identified and recorded in proforma. The discomfort, swelling, and restricted mouth opening linked with an impacted mandibular third tooth are all assessed prior to surgery. The flap pattern employed for the extraction of the impacted lower third molar tooth, pain, and mouth opening was all reported on the proforma at the end of the procedure. On the seventh postoperative day, each patient was evaluated again.
 Results: - The average age of patients in group A was 29.77±7.17 years and 28.20±6.28 years in group B. Mean pain score was significantly low in group A as compare to group B [0.87±0.86 vs. 2.93±0.87 p=0.0005]. Mean mouth opening was significantly high in group A than group B [12.86±3.59 vs. 6.12±1.67; p=0.0005].
 Conclusion: In comparison to the envelope flap, the modified triangular flap was more effective when considering the postoperative periodontal state of the surrounding third molar and the dehiscence after wound recovery.

Antidepressant and Anxiolytic Effect of Tramadol as Compared to Imipramine, in Acute and Chronic Dosage in Rats

Objective: To assess the anti-depressant and anxiolytic effect of tramadol as compared to imipramine (approved antidepressant) in acute and chronic doses in rats.Methodology: This observational experimental animal study was carried out from December 2020 to February 2021 at Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro in collaboration with Agricultural University, Tandojam. Forty- eight healthy male rats housed at Animal House Sindh, Agricultural University, Tandojam after due approval from institutional ethical review board. The 48 rats were categorized into 3 equal groups of 16 each: Group A for Normal saline (0.9% NaCl) 15ml/kg, Group B for Imipramine 15 mg/kg and Group C for Tramadol 15 mg/kg. Each group was further subdivided into two groups namely acute A1, B1, C1 and chronic A2, B2, C2 and evaluated for anti-depressant and anxiety activity using forced swim test and elevated plus maze test. The data obtained was analyzed using SPSS. 22.0.Results: Tramadol acted to significantly reduce the mean duration of immobility as compared to the control (P<0.001). Resolution of immobility due to tramadol was insignificant when compared to imipramine. Likewise, the swimming periods in the tramadol and imipramine groups were significantly longer than the control group (<0.001), but almost equal in both tramadol and imipramine groups, showcasing that tramadol has antidepressant activity at par with imipramine (p value >0.05).Conclusion: Tramadol exhibits significant acute and chronic antidepressant and anxiolytic effects in rats when compared to imipramine and controls.

Impact of Mode of Delivery on the Neonatal and Maternal Outcomes: A Cross-Sectional Study

Aim: To assess the impact of mode of delivery on the neonatal and maternal outcomes Study design: A cross-sectional study Place and Duration: This study was conducted at BMC Liaquat University of Medical Health Sciences Jamshoro Pakistan from February 2020 to February 2021. Methodology: The patients were divided into two groups and each group included 178 women. One group had undergone cesarean section and the other group had undergone normal vaginal delivery, and different maternal and neonatal outcomes were assessed including trauma, significant loss of blood, Apgar score, puerperal febrile morbidity, wound infection, and cord pH. Results: The study observed a higher rate of puerperal febrile morbidity and wound infections present in C-section. Similarly, blood loss was also significant in C-sections. However, neonatal complications were low and non-significant between the two groups. Conclusion: The study observed that increased maternal morbidity is associated with C-sections and women must be informed properly before making a choice of delivery. Keywords: Women, vaginal delivery, C-sections, morbidity

Frequency of Clinical Symptoms in Post Cholecystectomy Syndrome Patients our Hospital Experience: A Cross-Sectional Study

Aim: To determine the frequency of different clinical symptoms in (PCS) Post Cholecystectomy Syndrome patients, at a secondary care facility Study Design: A cross-sectional study Place and Duration: This study was conducted at Liaquat University of Medical Health Sciences Jamshoro, Pakistan from May 2020 May 2021. Methodology: For the purpose of this study, 100 patients were selected. Only those individuals were selected who qualified against an inclusion criterion which was set based on the patients’ history of cholecystectomy. For this purpose, a questionnaire was made. The patients that were selected had to go through CT (computed tomography) scans and sonographic tests. Blood testing was also done and sera were prepared for in-depth laboratory tests. Data from the research were analyzed by using SPSS version 19. Results: Most common clinical symptom after post-surgery was right upper quadrant pain (114 patients). Epigastric discomfort was present in 97 patients. Fever was third in line (73 patients) with jaundice being fourth (23 patients). Abdominal tenderness (19 patients) was followed by bile leakage (7 patients), fluid in the peritoneal region (19 patients), CBD dilation (39 patients), recurrent stone in CBD (12 patients), retained stone in CBD (19 patients), dysfunctioning of Oddi sphincter (37 patients) and remnants of the cystic duct stump was present in 41 patients. Conclusion: The results of this study show that post cholecystectomy symptoms and conditions vary among patients and all of them need to be kept in while proposing proper follow-up treatment Keywords: post cholecystectomy syndrome, bile leak, sonography, CT scan