King Edward Medical University Research Articles

Elucidation of resistance acquisition between various genera of gram-negative bacteria

The antimicrobial agents have the potential to maintain the selective pressure on bacteria. Bacteria can alter various mechanisms for survival under selective pressure. Thus, the bacteria acquire resistance through conjugation from co-existing bacteria during antimicrobial stress. The study was designed experimentally to investigate the acquired resistance on the basis of time against different genera of gram-negative bacteria. The study was conducted at the Department of Pathology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan. E coli strain was sensitive to Ciprofloxacin and Pseudomonas aeruginosa strain was resistant to Ciprofloxacin. The macro broth dilution technique was used to verify the susceptibility of E. coli and P. aeruginosa. 0.5 MacFarland standard solution of E. coli and P. aeruginosa were mixed and kept at the sub-minimal inhibitory concentration (0.781 µg/ml) of Ciprofloxacin for 28 days. MIC of Ciprofloxacin was measured against E. coli at weekly basis. It was observed that the Ciprofloxacin MIC against E. coli after 7, 14, 21 and 28 days were <01 µg/ml, <01 µg/ml, <04 µg/ml and <25 µg/ml respectively. In conclusion, E. coli acquires resistance from P. aeruginosa under selective pressure of sub-minimal concentration of antibiotic Ciprofloxacin in 28 days.

Impact of antibiotic withdrawal and starvation conditions on plasmid elimination and consequent loss of resistance.

To assess resistance-loss due to plasmid elimination under experimental conditions, including withdrawal of antibiotics and administration of starvation conditions. The experimental study was conducted at the Department of Pathology, King Edward Medical University, Lahore, Pakistan, from July to December 2019. A single sensitive clinical isolate of escherichia coli, showing resistance towards ampicillin was collected and separately sub-cultured in three different culture broths: tryptic soya broth, minimal broth and control broth for a period of one month under standard laboratory conditions. Minimum inhibitory concentrations of the strains were calculated after every seven days to check antibiotic susceptibility. Minimum inhibitory concentrations of the initial escherichia coli strain measured on Day 1 was 6mg/mL and it became sensitive after continual sub-culturing in the absence of antibiotics in 21 days. Due to starvation conditions, the bacterial strain exhibited sensitivity to an even lower antibiotic concentration of 1.5mg/mL on the 28th day. Bacterial growth inhibition zones determined by disc diffusion method using an ampicillin disc of 10µg/mL showed no zone of inhibition. Provision of starvation conditions and withdrawal of antibiotic allowed the escherichia coli strain to exhibit gradual loss of resistance over a period of time.

Awareness of Augmentative and Alternative Communication among Final Semester Students of SLP

The ability to communicate with words is one of a person's distinguishing characteristics. People who have lost their ability to talk are unable to communicate effectively for whatever reason. The acquisition (AAC) approach was implemented as a viable alternative for assisting these individuals. Objective: To find out awareness of augmentative and alternative communication among final semester students of SLP. Methods: The cross-sectional study was conducted in seven major institutes of Lahore (University Of Lahore, Riphah International University, King Edward Medical University, School Of Allied Health Sciences, Fatima Memorial Hospital, Punjab University, NUR International University). Final semester students of BS or MS program in SLP were included in the study. The research employed the convenient sampling methodology and standardized questionnaire was used having 26 questions, with responses obtained through an online form and survey. SPSS17 was used to analyze data collected from 50 respondents. Results: Overall awareness was calculated of respondents regarding Augmentative and Alternative communication. Results indicated that 32(65.71%) of final semester students of speech language pathology have adequate knowledge about AAC technology, 10(18.40%) did not significant knowledge about AAC technology while 8(15.89%) totally unfamiliar about AAC technology. Conclusion: After analysis it was concluded that majority of students had awareness of AAC. Most of Lacking was seen in students who did not have good academic exposure and did not practice with patient of AAC.

Outcome Assessment of Comparison between Surgical Decompression versus Local Corticosteroid Injection in Carpal Tunnel Syndrome

Aim: To evaluate the effectiveness of surgical decompression versus local corticosteroids for carpal tunnel syndrome in improving clinical outcome and to determine the length of symptom relief Study Design: This was a comparative, longitudinal and interventional study. Place and duration of study: OPD and A&E department of Orthopedics Surgery and Traumatology (DOST) Unit I, King Edward Medical University/ Mayo Hospital Lahore. duration of study was 1 year after approval of synopsis. Methodology: Cases of carpel tunnel syndrome with age 18 years and above were included. The diagnosis of carpel tunnel syndrome was based on general physical examination, nerve conduction studies and additional radiological test.). A total 64 patients were selected randomly. They were divided into two groups. GROUP “A” was treated by surgical decompression. Group “B” was treated by local corticosteroids. They were follow up at 3 months, 6 months and 1 year. All the procedures were done by single surgical team. Outcome measuring tools symptom severity scale(CTS) and functional status scale (CTS) were used. Results: In group A and B the mean age of patients was 45.44±8.39 and 47.22±9.72 years respectively. Mean symptoms severity scale in group-A was higher when compared to group-B at 3 months, 6 month and 1 year with p-value < 0.05. Moreover mean functional severity scale was also improved in group-A when compared to group-B at 3 month, 6 month and 1 year with p-value < 0.05. Conclusion: Through this study we conclude that surgical decompression of carpal tunnel versus local corticosteroid injection in terms of clinical outcome improvement and to assess the length of symptomatic relief. Keywords Hand surgery, carpel tunnel syndrome, conservative treatment, steroid injection, surgical decompression

Frequency, Pattern and Management of Dog Bite injuries in Children in a Developing Country

Aims: To collect and analyze data regarding frequency, pattern, and management of dog bite injuries in children so that it can be reported to health authorities to launch preventive measures plan against dog bite trauma in children and make sure availability of immunoglobulin and vaccine in proper quantity at proper place to prevent its misuse and expiry. Study design: Observational descriptive study. Setting: Department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore. Duration of study: One year from January 2018 to December 2018. Methods: All patients with dog bite injuries admitted through emergency in department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore were included in the study. Demographic data regarding age, gender, mechanism and severity of dog bite trauma and management recorded on detailed Performa. Results: During one year period a total of 445 patients with dog bite injuries presented in pediatric surgical emergency. Out of these 37.8% patients were admitted and 62.2% patients with minor injury were discharged on same day after proper wound management and vaccination in emergency department. Majority were males and most common age at presentation was from 4-8 years. Conclusion: As dog bite injuries are preventable so there is need to give education to children and families about preventive measures against dog bite injuries and proper treatment like immunoglobulin and vaccination. Keywords: Dog bite trauma, children, Frequency, management

Frequency, Etiology and Presenting Complaints Associated With Zygomatic Complex Fractures

Aim: To investigate the etiology, gender distribution and presenting complaints associated with zygomatic fractures Method: This cross sectional study was done in Oral and Maxillofacial Surgery Department of King Edward Medical University from April to D3ecember 2019. Patient data was collected from OPD and analysed with SPSS. Results: We analyzed the data of 162 patients with zygomatic bone fracture. Out of this 148 were male and 14 were females. There were bilateral cases, more affecting right side of face and affecting left side of face. The most common etiology was road traffic accident followed by interpersonal violence and occupational injuries. When we consider presenting complaints 87 patients came with difficulty in chewing, 45 with limited mouth opening, 23 with depressed malar eminence and only 7 patients with nerve paraesthesia. Conclusion: Considering the geographic and cultural indices of the evaluated population, it can be concluded that the patients gender and trauma causes significantly affect the prevalence of zygomatic bone fracture Keywords: Zygomatic bone, nerve paraesthesia, limited mouth opening

An audit of foeticide, neonaticide and infanticide: A retrospective study in the Department of Forensic Medicine, King Edward Medical University, Lahore.

The deliberate killing of a foetus in the womb, or a child from the first 24 h of birth to one month of age, or within the first year of life, is called foeticide, neonaticide and infanticide, respectively. Socioeconomic stress, mental illness, gender selection, shame or fear of punishment of adultery or illegitimacy, grudge and jealousy with parents and negligent delivery by dai are major causative factors in such cases. This is a retrospective, descriptive, observational study, and the sample pool consisted of 35 cases. Foeticide cases were 42.9% of the total and the same percentage of cases were neonaticides, while 14.3% of cases were of infanticide. The male-to-female ratio was 1.26:1 and the major cause of death was head injury. The study shows a prevalence of foeticide and neonaticide as compared to infanticide. It also displays the prevalence of males in overall cases and a higher number of unknown cases in our setting.

Frequency of Leukoerythroblastic Picture and Hematological Parameters in COVID-19 Patients and Association With Disease Severity

Introduction: Patients infected by COVID-19 can present with severe lung damage and acute respiratory distress syndrome (ARDS) and have a significant mortality risk involving all body system such as cardiovascular (CVS), gastrointestinal (GIT), neurological (CNS), immune system and haemopoietic system.
 Aims & Objectives: To determine frequency of Leukoerythroblastic picture, compare complete blood counts and cell ratios (NLR, PLR, LMR) of positive COVID-19 patients with suspected COVID-19 patients and their association with severity as stratified by mode of admission and clinical status.
 Place and duration of study: King Edward Medical University, Mayo Hospital Lahore from December 2020 to January 2021.
 Material &Methods: 75 RT-PCR confirmed COVID-19 and 75 suspected patients of both genders and aged above 18 years were included. Severity was classified by mode of admission and patient status. CBC samples of all patients were analyzed for counts, differential and LE picture on Sysmex XE-1000 automatic blood analyzer. NLR, LMR and PLR were calculated in both groups. Peripheral smear findings were noted for leukoerythroblastic picture in all patients.Data was analyzed using SPSS version 25, p value ?0.05 was considered significant.
 Results: Each group consist of equal (75) number of patients with male predominance. Mean age of patient in confirmed and suspected groups were 58±14 and 61±15 respectively in both groups. Majority were admitted in HDU and ICU compared to isolated wards (P: .000). Frequency of LE picture in both groups was (2.7%) (P:0.12) by Chi-square. Mean± SD were determined, of hematological parameters and ratios in confirmed and suspected groups. ANC (P:0.022), ALC (P:0.032), NLR (P:0.002) were significantly different when compared in both groups.
 Median (IQR) of Hb (p: 0.05), WBC (P: 0.000), platelet (P: 0.008), ANC (P: 0.000), NLR (P: 0.000), LMR (P: 0.016)
 were significantly correlated with severity, when analyzed by independent-sample Kruskal Wallis Test.
 Conclusion: Leukoerythroblastic picture is not associated with severity in COVID-19. Neutrophil to lymphocyte ratio is important prognostic factor in suspected and confirmed COVID-19 patients.

Comparison between Bilateral Internal Mammary Artery Graft and LIMAG in Patients Undergoing CA Bypass Grafting

Background: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over Left internal mammary artery for coronary artery bypass grafting (CABG). However, there are still uncertainties about which surgical approach is the best one to use with BIMA grafting. Objective: To compare Bilateral Internal Mammary Artery (BIMA) Grafting with Left Internal Mammary Artery (LIMA) Grafting during Coronary Artery Bypass Grafting (CABG) in terms of early mortality and sternal wound infections. Materials & Methods Randomized: control trialtechnique enrolled. The study was conducted at the Cardiac Surgery Department, King Edward Medical University (KEMU), Mayo Hospital Lahore Results: Total 96patients undergoing CABG were included in this study. Patients were randomly divided into 2 groups; each group contains 48 patients. Group A included patients having Left IMA to LAD; second and third graft by Great Saphenous Vein and Group B included patients having Bilateral Internal Mammary Arteries with Left IMA to LAD or OM and Right IMA to RCA, LAD or Ramus Intermedius. The superficial and deep sternal wound infections was recorded along with the different risk factors including diabetes, obesity, hypertension, smoking and use of inotropes intra-operatively and post operatively. The incision site over the sternum was being evaluated on daily basis throughout the stay of the patients (from 5–8 days). Diagnosis of Sternal infections was based on the presence of positive cultures, dehiscence of the sternum incision, fever, redness pain, and infected (purulent) secretions. Sternal instability and discharge, ventilation time, length of ICU stay, chest drainage, re-exploration and length of hospital stay was also recorded. Results:Not any of the patients included in these two treatment groups suffered from mortality (LIMA: 0%, BIMA: 0%). Deep sternal wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] and superficial wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] did not show any statistically significant association towards both grafts type. Patients who underwent BIMA grafting suffered from higher in hospital stay as compared to patients who underwent LIMAgrafting. i.e. [LIMA: 7.02 & BIMA: 8.02, P value = 0.000] Conclusion: Results of the study showed no significant difference for deep sternal wound infection and superficial wound infection between the two grafts BIMA and LIMA. However, patients who underwent BIMA grafting had significantly higher hospital stay as compared to patients who underwent LIMA grafting. Keywords: Bilateral, Internal, Mammary Artery, Grafting, Left, Internal Mammary Artery, Coronary Artery, Bypass, Grafting, Mortality, Sternal wound infections.

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement.
 Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1st, 2018 to October 30th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant.
 Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001).
 Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

To Assess the Renal Functions and Common Risk Factors of its Impairment in A Group of General Population

Background: In Pakistan more than 25 million people are suffering from kidney diseases. Kidney damage can be detected at earlier stage by simple laboratory tests like renal function tests, proteinuria and estimated Glomerular Filtration Rate (GFR). Objective: To assess renal functions and common risk factors of its impairment in a group of general population on world kidney day 2018. Materials and Methods: It is a descriptive study conducted in Central Diagnostic Laboratory, Mayo Hospital/ King Edward Medical University (KEMU), Lahore It was carried out on 158 Healthy subjects without history of renal disease. All collected data was entered and analyzed by using Statistical package for social sciences (SPSS version 20). Results: 85(54%) were males and 73(46%) females. Mean + SD age was 44.3 ±13.9 years. 50(32%) were hypertensive, 30(19%) were hyperglycemic, 28(18%) had proteinuria, 30(19%) had Hyperuricemia and 18(12%) had increased creatinine levels. Mean ± SD glucose, creatinine and uric acid levels were 130± 30, 1.2± 0.7 and 4.5± 1.3 mg/dl respectively. Conclusion: Screening of subjects without renal known disease with diagnosed hypertension, diabetes or hyperuricemia as risk factors for CKD is required. 18 undiagnosed cases of CKD were identified in this survey. Keywords: risk factors, CKD, Renal function test.

Initial Psychological Response of Various Population Groups to COVID-19 Pandemic: A Cross Sectional Study

Introduction: The corona virus pandemic has brought with it psychological problems like anxiety, stress, and depression. Research studies are urgently required to generate data that would help formulate strategies to manage the ensuing psychiatric and psychological maladies at societal level.
 Aims & Objectives: The aim of our study is to better comprehend the initial psychological response of society to COVID-19 outbreak though a survey.
 Place and duration of study: This cross-sectional study was conducted in King Edward Medical University, Lahore from April 2020 to October 2020.
 Material & Methods: An online questionnaire comprising of 20 items including the Zung self-rating Anxiety Scale (SAS) was disseminated to three fifty (350) participants. Two hundred and seventy-one (n=271) responses were received. Collected data was entered and analyzed using the SPSS software version 20. Categorical variables were presented as frequencies and percentages. Relationships between categorical variables were tested by Chi square test. Regression analysis was conducted to investigate the effect of various variables on total stress score. A p-value of <0.05 was considered significant.
 Results: It was revealed that 85.2% of the respondents reported minimal psychological impact, 14.8% had mild to moderate anxiety levels and 0.4% reported marked to severe anxiety. The impact was 2.5 times greater in subjects belonging to lower socioeconomic status (p=0.02).
 Conclusion: Population belonging to lower socioeconomic class is more vulnerable to be impacted by psychological disturbances due to the pandemic owing to economic losses that are magnified in the population with fragile earning sources.

Determination of Postmortem Interval by Estimating CSF Proteins Concentration after Death, by Dye Binding Method at a Tertiary Care Hospital in Lahore, Pakistan

Introduction: Postmortem interval (PMI) is the time lapse between death of a person and its postmortem examination i.e. autopsy. Estimating the postmortem interval (PMI) is an imperative perspective of forensic medicine.
 Aims & Objectives: This study was conducted to see the impact of CSF protein estimation on determination of PMI.
 Place and duration of study: It was an observational correlational study, conducted for one year at Department of Forensic Medicine, King Edward Medical University Lahore.
 Material & Methods: A total of 119 cadavers were included in this study. Chemicals used were disodium molybdate, pyrogallol, succinic acid. The minimum detectable concentration of total proteins in CSF with dye binding method using pyrogallol red was determined as 0.022g/l. Two ml of CSF was taken from each cadaver. Clear, colorless samples were taken in test tubes. Turbid and blood contained samples were not included in study. Protein concentration was determined using photospectrometry. Statistical analysis was done by SPSS-23. Quantitative variables like age were presented as mean ± SD. Qualitative variables like gender were presented as frequency and percentages. For comparison between PMI and CSF proteins concentration correlation was applied.
 Results: Males accounted for majority of our subjects. The mean value of proteins in CSF was 219.91± 113.121 mg/dl. The most common PMI was 11 to 20 hours. CSF proteins increased gradually over 72 hours after death. The results of present study showed a significant positive correlation between time of death and CSF proteins concentration after death.
 Conclusion: It is observed that as a whole protein concentration increased with increasing time of death. Hence, CSF protein concentration can be used in estimating time since death.

HISTOLOGICAL CONSEQUENCES OF CONSUMPTION OF ENERGY DRINK ON RENAL TUBULES

Objective: To investigate the outcomes of energy drink on renal tubules of albino rats.
 Study Design: Laboratory-based experimental study.
 Place and Duration of Study: King Edward Medical University, Lahore from Aug 2018 to Dec 2019.
 Methodology: Group A and B were experimental groups received 1.5ml/kg and 2.2ml/kg body weight of energy drink, respectively. Group C received 1ml/kg body weight of distilled water. Comparison among groups was made by applying One-Way ANOVA for quantitative variables. Tukey’ test was used for post hoc analysis. For qualitative variables, chi-square test was applied to make comparison among groups
 Results: The mean initial and final weight of animals was around 152.7 ± 5.3g and 171.9 ± 5.1g, respectively. The mean paired kidney weight, relative tissue weight index, length and width of kidneys for all three groups were found insignificant. Microscopic examination showed tubular vacuolization in groups A and B showing p-value of 0.027.
 Conclusion: Consumption of energy drinks results in histopathological injury of epithelial cells of renal tubules.

Feedback of Certificate in Medical Teaching Programme at King Edward Medical University Lahore

Background: The concept of feedback is central to medical education. There is gradual shift from sandwich feedback to Pendleton feedback which is learner centred. Pragmatic worldview was proposed in this study. Certificate in Medical Teaching (CMT) programme was initiated at King Edward Medical University (KEMU) Lahore since 2019.The study objective was to improve learning outcome. Methods: Mixed Method research design was chosen, out of all mixed method procedures “Convergent parallel mixed method design” was followed collecting simultaneously quantitative and qualitative data, then results were analysed and compared separately. This study was carried out from 01-06-2020 to 31-03-2021 at King Edward Medical University Lahore. Sample size of 43 participants from CMT (Certificate in Medical Teaching) Batch 1 and 2 took part in this study. Doctors from clinical side, demonstrators and personnel of Allied health sciences attended this course. A predesigned proforma designed on google form was sent to each participant via e-mail.. Results: Quantitative data collected was interpreted as percentages and in form of tables and presented as pie charts. Qualitative data collected was analysed by segregating data into codes. Corresponding themes were made of each code and presented in tabular form. Conclusion: On the basis of feedback and mixed method approach, it can be concluded that certificate in medical teaching is a new teaching program at king Edward Medical University Lahore which can serve as basis to start master’s degree at this institution. Keywords: Feedback, medical teaching, KEMU

Study of Association of Demographic Variables with Types of Burns Presenting in a Tertiary Care Medicolegal Clinic

Background: In day to day life every human whether young or the old happens to deal or face the fire sources or any relevant entity. Great research is available in all the regions of the world and generous emphasis had been delivered widely. Though the advantages of the energy sources outweighs its disadvantages if dealt with proper care but accidents do happen in this process. The study focuses on the association of the demographic variables like age, gender, marital status and level of education. Aim: To observe the association of demographic variables with types of the burns. Methods: A total of 250 victims of burns presenting in the Medicolegal Clinic of King Edward Medical University Lahore/ Emergency of Mayo Hospital Lahore expanded over a period of several months from December 2017 to August 2018. Results: A grossly significant association of the age, gender, occupation and level of education of the victims of burns with types of different burns i.e. scalds, dry flame burns, chemical burns and electrical burns was observed with a 0.000 p value. A little lower significance of marital status of with a p value of 0.036 was observed when compared to different types of burns. Keywords: Scalds, Dry flame, Chemical, Electrical, Burns, Age, Gender, Marital Status, Occupation

Study of Age and Gender Predilections amongst the Victims of Burns of Domestic Violence

Background: Human life from conception till death needs some sources of energy or heating mechanism to advance from a day to another in the process of livelihood. From innocent infants falling victims to fires, toddlers to scalds, youth to vitriolage and elders to enmity of a variety of sources or to their own debilitation bring them close to the fire source let them fell a prey to burns. Aim: To observe the age and gender predilections amongst the victims of burns Methods: The study was carried out among 250 victims of burns presented from December 2017 to August 2018 and reported in the Accident and Emergency Department of Mayo Hospital Lahore and filtered in Medicolegal Clinic of King Edward Medical University Lahore. Results: The study revealed maximum involvement of pediatric and geriatric age groups falling victim to burn incidents. In an analysis as a whole almost 84% victims were belonging to these two extremes of ages. Gender disparity showed a slight difference of just 10% showing female preponderance being exposed to burns. Keywords: Burns, Age, Gender, Variation, Disparity

Zero Balance versus Conventional Hemofiltration-Impact on Renal Function and Blood Conservation in Adult Valvular

Aim: To compare conventional ultrafiltration (CUF) with zero-balanced ultrafiltration (Z-BUF) in the patients having valvular heart surgery. Methods: This cross-sectional mono-centered retrospective study was designed. The data of total 471 patients were reviewed during March 2018 to February 2020, only 98 patients fitted in the inclusion criteria and were divided into two groups with 47(47.95%) patients received CUF, while 51 (52.04%) patients were administered with Z-BUF at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore, Pakistan. Statistical analysis was done using SPSS version 25. The early postoperative clinical outcomes included, renal function as primary outcome and hemodynamics stability of the patients as secondary outcome. Results: Renal functions in terms of serum creatinine (1.1 vs. 1.3mg/dL; P < 0.010) and creatinine clearance ratio (81.51vs. 67.3mL/min; P < 0.01) were improved in the patients having Z-BUF compared with CUF. Urine output was almost double in the Z-BUF cohort compared with the CUF. The hemofiltration technique had no impact on the secondary outcomes as amount of the blood loss and number of patients required blood transfusion were similar (P > 0.05) in our cohort. Conclusion: Z-BUF appeared to be better hemofiltration method than CUF during CPB when assessed in terms of renal protection without hemodynamic status in patients undergoing valvular heart surgeries in our population. Keywords: Cardiopulmonary bypass, Ultrafiltration, Renal injury, Hemoglobin, Blood transfusion

Study of Sexual Dimorphism in the Closure of Sagittal Suture – A Postmortem Study

Background: Performing identity is a prime task in medicolegal and postmortem examinations. Age is the first parameter that has to be determined followed by sex. There are several techniques through which sex can be determined. As well there are different anatomical, physiological and pathological parameters determination of sex. Aim: To determine the sexual dimorphism in the cranial sagittal suture closure macroscopically. Methods: All the cases for this purpose had been selected from those brought for autopsy in the Department of Forensic Medicine and Toxicology, King Edward Medical University Lahore during the year 2016. Results: The statistical analysis revealed early closure in males than in females both ectocranially and endocranially with advancing age in the sagittal suture of cranial vault. The p value was found significant being less than 0.05 thereby establishing the fact that sexual dimorphism in the cranial sagittal suture exists. Conclusion: Conclusively the determination of sex is possible from the pattern of Cranial Sutures closure on autopsy table. Key words: Sex, Sagittal, Suture, Cranial

Morphometric study of vertebral artery groove in dry human cervical vertebra in Pakistani population

Introduction: Vertebral artery passes through vertebral artery groove present on the posterior arch of atlas; free movement of which is required during rotation of the neck. This artery can be compressed if the vertebral groove is converted into arcuate foramina due to the projection of bony ponticuli over the grove. This compression can cause vertebra-basilar insufficiency, headache, or neck-shoulder pain of unknown origin. Objective: This study aims to provide data regarding vertebral artery groove and its morphology to help surgeons and clinicians in the local Pakistani population as no data is available in this population. Materials and Methods: A total of sixty adult dry human atlas vertebrae were taken from the Anatomy museum of King Edward medical university. Quantitative and qualitative data were taken for analysis. Quantitative data include the distance of medial and lateral edges of vertebral artery groove from the midline of the posterior arch, the distance of the medial edge of foramen transversarium from the midline, the thickness of vertebral artery groove and its dimensions at medial and lateral entrance points. Qualitative data includes the type of bridging over the vertebral artery groove. Data were analyzed and the mean was taken.Results: Mean distance of the medial edge of vertebral artery groove from midline was found to be 13.32 ± 3.25 and 13.72 ± 2.82 mm on right and left sides respectively while the mean distance of the lateral edge of vertebral artery groove from midline was 22.31 ± 3.47 on the right side and 22.29 ± 2.98 on the left side. The mean of total thickness found was 3.84 ± 0.66 mm on right and 3.57 ± 1.14 mm on left. Morphology showed that 3.33% of the Pakistani population has complete arcuate foramina, 40% partial bridging, and 56.67% absent bridging. Conclusion: Findings of this study can be helpful for neurosurgeons during procedures requiring exposure of the posterior arch of the atlas so that damage to a vertebral artery can be prevented.