King Edward Medical University Lahore Research Articles

A Randomized Controlled Trial Comparing Injection Polidocanol, with Injection 50% D/W in Rectal Prolapse

Background: Rectal prolapse manifests as the protrusion of the rectal mucosa through the anal opening. There can be partial or full thickness prolapse. It usually occurs before 4 years of age. Rectal prolapse in childhood tends to affect both males and females equally. Aim: To compare Inj. Polidocanol with Inj 50% D/W in rectal prolapsed in this randomized controlled trial. Methods: The study was conducted in the pediatric surgical ward of Mayo Hospital & King Edward Medical University Lahore, after receiving approval from the Hospital's Ethical Committee. There were 60 patients rectal prolapse with 30 patients in each group. Polidocanol was used in group A while 50%dextrose water was used in group B. The procedure was performed under general anesthesia. In the postoperative period children were observed for early complications like fever, anaphylaxis, diarrhea, hemorrhage, pain while defecating, mucosal edema and constipation. Results were analyzed with SPSS. Results: Out of 60, 36 were male while 24 were female. Group A included 16 male and 14 females whereas group B had 20 males and 10 female children. Mean age was 5.35years with SD of 2.7 and ranging from youngest child of 8 months till eldest of 12 years. In group A mean age was 5.44 while mean age of group B was 5.26 years. All 30 patients in group A were relieved of their symptoms after single session of Polidocanol so giving 100% of success rate while 28 patients (93.33%) in group B were relieved of their symptoms while 2(6.66%) patients developed recurrence with no significant difference. The complications observed in the study were post-operative constipation in 3(10%) patients in group A, however no patient developed postoperative stricture, infection or adverse drug reaction. In group B no patient developed any post-operative complication. Practical Implication: This comparative study helps us to find more effective and better drug available as a sclerosing agent to treat rectal prolapse in pediatric population. It’s also cost effective and with fewer side effects and easily available. Conclusion: In conclusion, injection sclerotherapy using polidocanol emerges as an equally successful procedure for managing RP in children. This medication demonstrates enhanced efficacy, safety, and accessibility. The process is not only less time-consuming but also entails minimal complications. Keywords: Rectal Prolapse Manifests, Protrusion, Mucosa, Chronic Constipation, Hirschsprung’s Disease,

Comparison of Treatment Outcome of the Effectiveness of Isometric Exercises as Compared to General Exercises with Cervical Spine Mobilization in The Management of Chronic Non Specific Neck Pain

The purpose of this study was to evaluate the “effectiveness of isometric exercises as compared to general exercises along with cervical spinal mobilization to reduce pain, disability and to increase range of motion in chronic non-specific neck pain”For this randomized controlled experiment total 32 patients (16 in each group) with chronic non-specific neck pain were recruited from physiotherapy Ward Mayo Hospital Lahore, Department of Physiotherapy King Edward Medical University Lahore between October, 2019 and March, 2020. Simple randomization method was used to assign participants into isometric exercise group and general exercise with cervical spine mobilization group. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises with cervical mobilization group performed active range of movement exercises for all neck movements. Patients in both groups received 4 supervised treatment sessions per week for 6 weeks. Visual Analogue Scale (VAS), Neck disability index Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 6 weeks.Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001for isometric exercise group, p = 0.05 for general exercises group and p= <0.001 for range of movement. However, mean improvements in post intervention VAS score and Neck disability index Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non- specific neck pain however; isometric exercises are clinically more effective than general exercises with cervical spine mobilization.

Morphometric Measurement of Distance of Nutrient Foramen from Proximal, Distal Ends and Circumferential Diameter at the level of Nutrient Foramen in dry adult Humerii

Objective: To analyse the morphometric measurements of different parameters of adult dry humerii bones with reference to its clinical importance in different surgical conditions. Bones were available in the department of Anatomy, King Edward Medical University Lahore Pakistan. Methods: Across sectional morphometric study which was done from 1st March 2021 to 30th April 2021 in the department of anatomy by having 60 dry humerii. Bones which were not in good condition or damaged by any means were excluded from study. Different parameters like maximum length of humerus, distance of nutrient foramina from the different ends of humerus and the circumferential diameter of shaft at the level of nutrient foramen were also noted. The number, distance and site of nutrient foramina were noted macroscopically by using a vernier caliper, measuring scale and metallic wire. Ethical clearance was taken from Ethical review board of King Edward medical university. Results: The number of right sided humerii were 31 and the number of left humerii were 29. The number of nutrient foramen varies in right and left side. On the right side the number of nutrient foramina were more as compared to the left side. Out of total right sided; 9 humerii were having double nutrient foramen and out of total left sided humerii ; the double nutrient foramen was found in only 1. When it compared to this study, the results for total length of humerus between right and left side it showed no significant difference as p-value was 0.311. But when it compared to the diameter between the two groups it showed the significant difference as p-value is < 0.05. Conclusion: It is concluded that variations in the morphometry of humerus was present in current study. Such as humerus can have more than one nutrient foramen. Single nutrient foramen is mostly seen in both sides of humerii. Although there was no difference seen in the size and location of foramina and no statistical difference was found between maximum length of right and left humerii. But this study will add further knowledge of humerus into literature regarding variations in its morphology present in local population. This knowledge will also help clinicians during any type of reconstructive bone surgery.

Factors Influencing the Pursuit of Legal Rights by Burn Victims of Domestic Violence

Background: The decision to report domestic violence incidents, including burns, can be complex and influenced by various factors such as lack of confidence in police, delay in delivery of the just and social factors like that of fear, shame, and a belief that the family might be disturbed. Understandingthis trend is crucial in developing effective strategies to support and protect survivors. In matters of domestic violence of burns the victims fear to register the case in police station or any health facility. Aim: To understand the factors responsible for the failure of registering their burn incident as medicolegal issue. Methodology: Study was carried out among the victims of burns of domestic violence in the catchment area of May Hospital Lahore.The population of study comprises of urban and rural populations. The study sample comprised of 450 unfortunate victims of domestic burns for one whole year of 2018 from January to December brought in the Medicolegal Clinic of the King Edward Medical University Lahore. The data was collected on a predesigned questionnaire after due approval from Ethical Review Committee and Institutional Review Board. Results: The study results revealed that literacy level play a pivotal role in registering the incident of domestic violence a matter of legal concern being significant with a p value as 0.029. The social factors like that of confidence in the local police, the delay of the justice system and physical or emotional disturbance of the family if the fight for a legal battle in criminal domestic burn incident was found grossly significant with p value as 0.000 being very valid in growing economies. Conclusion: The study was found conclusive that literacy level and social factors like that of confidence in local law enforcement agencies, delay in delivery of the justice and family issues are the most vital social factors hindering to fight a legal battle in domestic burn incidents. Keywords: Burns, Domestic Violence, Legal Rights, Law Enforcement, Medicolegal Burns, Justice System

An Observational Study on the Early Stages of the Covid-19 Pandemic in Pakistan

Bachground: The coronavirus disease 2019 (COVID-19) pandemic, which started on February 26, 2020 in city of karachi, spread quickly throughout Pakistan. Material and Method: The design of this study was a observational study design and this study was conducted at king Edward medical University Lahore. More than 6,200 persons were afflicted by the illness in the first seven weeks, and there were more than 111 documented fatalities. Many problems arise if we contrast the COVID-19 tragedies in Pakistan with those in nations like China, Iran, and the European Union. The geography of the nation, poverty, poor literacy rates, environmental circumstances, sanitary conditions, and dietary habits are only a few of the difficulties we face in containing this epidemic. Although there are terrible circumstances in each of these areas, Pakistan's COVID-19 epidemic was slower than that of other developing nations. Results: The impact of COVID-19 appears to be lessened by Pakistan's humid hot temperature, early reaction to COVID-19, population immune system, BCG vaccination, and the proportion of young individuals. In this essay, we explore the COVID-19 pandemic outbreak in China, Iran, and Pakistan and present its day-to-day changes. We outline the COVID-19 structure and how it compares to SARS-COV and SARS-COV2. The use of Remdesivir (an adenosine analogue used against RNA viruses), Chloroquine (a widely used anti-malarial drug), convalescent plasma, neutralising antibodies targeting the ACE-2 receptor, and an ACE-2-like molecule that might bind to the S protein of the coronavirus are also covered in terms of treatment options and their drawbacks. Also covered are the effects of COVID-19 on Pakistan's economy and government relief measures. Conclusion: In conclusion, it may be said that the support systems in place may not be sufficient to stop the spread of the virus. Even with the meagre assistance offered, it is weaker for rural places where the virus's effects may be severe than in the nation's cities. Further research is required as the epidemic develops to better understand governmental efforts to contain the virus and its effects across the nation. Keywords: Coronavirus COVID-19 Pakistan Pandemic Outbreak

Role of Apparels in Burns due to Domestic Violence – A tool for assessing Degree of Burns

Background: Human life is subject to certain environmental, cultural and ethnic origin factors. Based upon the above facts loose and tight variety of clothing/apparel are commonly used. Fire and flames are an integral part of human life on the other hand and accidents do occur in natural course of history. In such accidents type of apparel one might be wearing play a great role in degree or severity of burns. Association and assessments need to be established in this regard. Methods: The study has been conducted on 250 cases of dry flame burns in AED of Mayo Hospital Lahore/Medicolegal Clinic of King Edward Medical University Lahore for a period of nine months in 2017-18. The population of 250 cases were selected through convenient non-probability purposive sampling technique. The study descriptive cross-sectional study design was applied to the above population selected for the study. Results: Our study revealed1.6% females were involved more than males in the burn incident during the period of study. A wide majority up to 70% used Shalwar and Kameez of loose wearable category as per culture of the country in comparison to the relatively tight clothing of Trousers and Pantaloons variety. A grossly significant role has been established with a p value of 0.024 that loose variety of apparel are responsible for causing greater degree of damage in burns as compared to that of tight variety of apparel worn at the time of incidence. Conclusion: The study concludes that wearing relatively short apparels or of tight i.e. Trousers and Pantaloons variety can be safe, protective and a healthy habit during cooking, working in fire burning vicinity like that of industry, hotels, restaurants and winter outdoor activities. The loose variety hereafter referred as Shalwarand Kameezvariety of cultural apparels can be dangerous and even life threatening when it involves higher percentages of burns. Keywords: Burns, Apparel, Clothing, Degree of Burns

An Autopsy based unaided Eye Study of Lambdoid Suture of Skull– the Science of Forensic Estimation of Age

Background: The criminal investigation starts at crime scene and ends in the laboratory. The most vital of which is mortuary where the postmortem examination of the deceased is carried out to answer the questions of interest in that investigatory menu. Aim: Unaided eye estimation of age from the lambdoid suture of skull on autopsy. Methods: The subjects under study were taken from mortuary of the department of Forensic Medicine and Toxicology in the King Edward Medical University Lahore during the year 2016. The targeted population for study was the draining are of the mortuary of King Edward Medical College having designated police station. A pretested questionnaire was used to collect the calculated sample among the research population as a research method. A non-probability convenient consecutive sampling technique was applied to collect the data. The comparative descriptive study design was utilized to analyze the results. Results: The study revealed that among the targeted population a higher percentage more than third of the sample size were adolescents of age between 21 – 30 years being 35% followed by elderlies of age between 41 – 50 years amount to 20%. The research depicted that age can be determined from degree of closure of lambdoid suture in the dead body on the autopsy table with closure taking place earlier in males as compared to that of females. Conclusion: This study concludes that it is possible to estimate age from the degree of lambdoid suture closure of the deceased skull vault during the postmortem examination. Keywords: Age, Lambdoid, Suture, Autopsy, Cranial, Post-mortem Examination, Skull

Haematological and Clinical Findings Especially Third Space Fluid Accumulation Observed in Major Dengue Outbreaks of Pakistan

Introduction: Dengue fever is a mosquito-borne disease caused by the bite of female aedes mosquito. It is a flavivirus and belongs to the family of arboviruses. According to WHO estimate about 50 million people are afflicted with dengue each year. The outbreak of dengue fever has serious implications on public health and should be dealt efficiently.
 Aims & Objectives: The purpose of this study was to observe the haematological parameters, frequency of third space fluid accumulation (TSFA) and its association with these parameters so that this fatal complication can be detected early to improve patient management.
 Place and duration of study: It was a cross-sectional study conducted in Haematology Department KEMU, in collaboration with Dengue Unit, Mayo Hospital Lahore between December 2021 to February 2022.
 Material & Methods: This was a cross-sectional study conducted at Hematology Department King Edward Medical University Lahore. The patients of dengue fever diagnosed on serology were included in our study. The complete blood counts, ALT and third space fluid accumulation on radiological examination was noted in all patients. The data was analyzed using SPSS version 20 and association among the variables was seen.
 Results: Total 200 patients were included with mean age 35.03 ± 15 years and male to female ratio of 2.07:1. TSFA was seen in (60) 30% patients, and showed positive correlation with increased hematocrit, low platelet count, increased lymphocyte, and monocyte count. The results were compared with previous outbreaks in 2008 and 2012.
 Conclusion: Haematological parameters are helpful in disease monitoring and predicting the development of complications especially third space fluid accumulation which has high mortality rate. Early follow-up of haematological findings with clinical correlation can help to prevent the disease complications and increase overall survival.

The efficacy of zinc as an adjuvant therapy in the treatment of severe pneumonia in children between 2 months to 2 years of age.

Objective: To compare the efficacy of zinc as an adjuvant therapy in the treatment of severe pneumonia in children between 2 months to 2 years of age. Study Design: Case Control study. Setting: Department of Paediatrics, Mayo Hospital Lahore. Period: 20 February 2019 to 20 August 2019. Material & Methods: After approval of Institutional Review board of King Edward Medical University Lahore Pakistan total 200 cases were selected by Consecutive (non probability) sampling and were divided into 2 groups each containing 100 cases. Group A children were given 20 mg elemental zinc per day plus Ampicillin plus cloxacillin while Group B patients were given only on Ampicillin plus cloxacillin. Mean + Standard deviation were calculated for continuous variables like age, base line zinc level and duration of fever. Post stratification chi square test was applied in which P value ≤0.05 will be considered as significant value. Results: Mean Age was recorded as 09 Months ± 5.54 in Group A while in Group B it was recorded as 12 Months ± 6.47. In Group A, 56 (56%) infants showed improvement who were administered zinc while 44 (44%) did not. Similarly, in Group B, 38 (38%) infant patients showed improvement who were not administered zinc whereas 62 (62%) did not show any improvement. This improvement was statistically significant P Value = 0.010. Conclusion: This study revealed a statistically significant efficacy estimate for zinc in the resolution of severe pneumonia.

Relationship of Nottingham Prognostic Index with prognostic parameters of breast carcinoma

Background: Breast cancer (BC) is the commonest malignancy in the female and it is gaining its significance due to worldwide rising incidence. It is also important due to 2.5% higher incidence in Pakistan as compared to neighbouring countries. Nottingham prognostic index (NPI) is an important prognostic factor of BC. It provides information about survival and morbidity. There are significant variations in different studies. Aim: To carry out current study relating NPI with various histopathological parameters of BC. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 137 cases of breast carcinoma were included. Information about age, grade, primary tumor size, axillary lymph node status and stage was entered in the pre designed proforma. NPI was calculated as 0.2xtumor size(cm)+lymph node grade. NPI was scored as excellent, good, moderate and poor and its correlation was calculated against primary tumor size, lymph node grade, tumor grade and stage. Results: We studied 137 cases of breast carcinoma with mean age 49.32±11.64 years. Mean NPI was 5.4±1.4 with range of 2.4 to 9.4. NPI scores in poor 65(47.4%) and moderate 61(44.5%) groups were significantly high as compared to good 10(7.3%) and excellent scores 1(0.7%). Most of the cases of poor NPI were in p T3 and p T4 whereas this was p T2 with moderate score. Poor score of NPI was significant in grade 3 which is in contrast to moderate score where grade 2 dominated the picture. Correlation of NPI with LNG was in favor of LNG 1 with good and moderate scores while LNG3 dominated in the poor group. In stage III, 49 cases (35.8%) were seen with poor score of NPI. Conclusion: NPI is an important prognostic parameter and it can be studied with different histopathological parameters to see correlation between them. In the current study majority of the cases of NPI scored at poor and moderate levels. Correlation coefficient was linear, strong and positive especially with LNG. Mean NPI has ascending correlation with these parameters. Thus NPI can be used as a prognostic indicator when comparing with histopathological parameters of BC. Keywords: Breast cancer, NPI, tumor grade, tumor stage, LNG

Frequency of Thyroid Lesions at Pathology Department of King Edward Medical University Lahore

Background: Thyroid gland is notorious for carrying commonest endocrine pathologies and also for commonest endocrine malignancy. It is the 5th most common cancer in human beings. This makes to carry out current study to get insight of frequency of thyroid lesions at tertiary care level. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 1601 cases were included. Information about age, sex and diagnosis was entered in the pre designed proforma. SPSS version 22 was used for data analysis. Descriptive analysis was done and the results were presented as frequencies, percentages and ratios. The results were then studied against local and international data. Results: This study revealed non neoplastic and neoplastic lesions as 1323 (82.63%) and 278 (17.37%) respectively. Bulk of the lesions 61.6% were between the age bracket of 20-39 years. Mean±SD for age was 34.22±11.42 years. Female to male ratio(F:M) was in favour of females as 9.81:1. Among the non neoplastic lesions, MNG 1151(87%) was a dominant lesion followed by TH 82(6%). LT 29(2.19%) and HT 26(1.96%) were other important lesions. F:M ratio was 10.80:1. Neoplastic lesions were divided into benign 178(64%) and malignant tumors 100(36%). FA was the leading benign neoplasm 164(59%). Rest of the benign tumors shared a minor fraction except HCA 12(4.31%). Among the malignant category, Papillary carcinoma 69(24.82%) dominated over MC 12(4.31%). FC 7(2.51%) and AC 6(2.15%) were other significant findings. F:M ratio in malignancy was 3.16:1 which was significantly lower than 13.83:1 in benign tumors. Conclusion: MNG is the dominant lesion among the non neoplastic lesions while in the neoplastic category FA was leading as benign neoplasm. Papillary carcinoma turned out to be the commonest malignant tumor. Major share of all the lesions were seen between 20-39 years. Keywords: MNG, Papillary carcinoma, Follicular adenoma, neoplastic lesions

Accuracy of GeneXpert in Diagnosis of Smear Negative Tuberculosis: A Cross-Sectional Study

Objective: This study was aimed to compare the diagnostic accuracy of GeneXpert in smear negative as compared to smear positive pulmonary tuberculosis patients.
 Methods: This comparative cross sectional study was undertaken at Health Research Institute (National Institute of Health) TB Research Centre, Pulmonology King Edward Medical University Lahore, Pakistan. A total of 101 patients in each smear negative and positive groups were included. After taking the informed consent a predesigned questionnaire was used to collect the data.
 Results: A total of 202 patients consisting of 94 (46.5%) male and 108 (53.5%) females with mean age of patients as 39.83±18.14 years were included in this study. Highest proportion of 45% patients remained to be in age range of 18-35 years. Culture presented the highest accuracy of 96.1% with sensitivity, specificity and positive predictive value of 95.9%, 100%, and 100% respectively while GeneXpert remained to be 94.6%, 94.9%, 80%, and 99.5% respectively in this study.
 Conclusion: Accuracy of GeneXpert is excellent in diagnosis of smear positive pulmonary tuberculosis patients and very well in diagnosing smear negative pulmonary TB patients and a great addition in early and definite diagnosis of TB and keeps the ability to confirm around 75% smear negative pulmonary tuberculosis.

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.

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

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

Audit of the Wheat Pill Cases at Medicolegal Clinic Mayo Hospital Lahore

Objective: To determine the audit of wheat pill cases at medicolegal clinic of Mayo Hospital Lahore.
 Materials and Methods: This descriptive study was conducted at Department of Forensic Medicine and Toxicology (medicolegal clinic), King Edward Medical University Lahore. This audit was of 9 months from September 2020 to May 2021. Patients presented at emergency department with attempt of wheat pills poisoning of all age groups and both genders were included. Cases were diagnosis via history of wheat pills consumption by the relatives. All the cases were given primary recovery and were shifted to the Intensive Care Unit (ICU). Data was collected on monthly basis form September 2020 to May 2021. All the data was collected via study proforma.
 Results: Total 49 wheat pill cases were observed during 9 months, their mean age was 29.26±12.68 years. Out of all 51.0% were males and 49.0% were females. Labourer males and housewives were most common 34.7% and 40.8% respectively. Frequency of wheat pill cases were high in months of September, October and May. At the time of admission 59.2% cases were seen conscious, 36.7% were semiconscious and 4.1% were unconscious. Out of all 59.2% were died.
 Conclusion: This study observed that the wheat pills are highly toxic with the quick and high mortality rate. Strict legislations are recommended to the sale control of these pills all over the country.

Gross Anatomical Variations of Cystic Duct: A Cadaveric Study

Aim: To determine the frequency of anatomical variations of cystic duct. Study design: Descriptive Case Study Place and duration of study: Anatomy Department of King Edward Medical University Lahore and duration of study was from August 2018 to December 2019. Methodology: The dissection of 43 cadavers was done and extra hepatic biliary tract was explored. The length of cystic duct and site of insertion of cystic duct in common hepatic duct was noted. The length of cystic duct <1 cm was taken as short cystic duct and >4cm as long cystic duct. The insertion of cystic duct near porta hepatis is high insertion and near duodenum is low insertion. Results: The mean length of cystic duct was 2.67±0.71 cm. Out of 43 cadavers 2(4.7%) of cadavers had short cystic duct. 41(95.3%) of cadavers had normal length of cystic duct. There was no cadaver observed with long cystic duct. Out of 43 cadavers 39(90.7%) of cadavers had mid insertion of cystic duct, 4(9.3%) of cadavers with high insertion of cystic duct and no cadaver with low insertion. Conclusion: The most common anatomical variation of cystic duct is high insertion of cystic duct 9.3%. Keywords: Anatomical variations, cystic duct, cholecystectomy.

FACULTY PERSPECTIVE ABOUT DIFFICULTIES IN IMPLEMENTATION OF NEWLY INTRODUCED INTEGRATED CURRICULUM FOR BASIC SCIENCES IN KING EDWARD MEDICAL UNIVERSITY

Objective: To explore the perceptions of basic sciences faculty about the integrated curriculum.
 Study Design: Sequential mixed method study.
 Place and Duration of Study: King Edward Medical University Lahore, from Oct to Dec 2017.
 Methodology: A 15-item survey was utilized as quantitative information collection device that gave the numerical depiction of the patterns, views or conclusions of the participants. In-depth interviews were done after survey as a tool of qualitative data collection to investigate beliefs and explore the attitudes.
 Results: All ninety three faculty members of basic sciences in medical college were contacted and survey response rate was 96.77% (90/93). 97% of faculty members had awareness about curricular integration; but majority (56%) had concerns about its appropriate implementation. Majority agreed that integration was beneficial for students‟ learning. They were satisfied with its design and relevance. Major considerations were correct implementation and lack of coaching in adopting new teaching methods and educational approaches.
 Conclusion: Curriculum integration is useful and essential in student‟s learning but training is necessary in its planning and execution. Current negative perceptions need to be addressed through further research.