Changing trends in the etiology and management of vesicovaginal fistula.

Vesicovaginal fistula has remained a scourge and of public health importance, causing significant morbidity, and psychological and social problems to the patient. Continuous wetness, odor and discomfort cause serious social issues. The diagnosis has been traditionally based on clinical evaluation, dye testing, cystoscopic examination and contrast studies.

A Case of Pediatric Post-Traumatic Stress Disorder Presenting as Attention Deficit Hyperactivity Disorder: A Case Report.

In the past few years, there has been increased recognition that children, who have faced traumatic incidences, can develop post-traumatic stress disorder (PTSD), just like in adults. We present a case of PTSD in a 6-year-old child who endured three surgical procedures because he was suffering from a congenital cranial stenosis (Pfeiffer) syndrome. Because of repetitive painful episodes, resulting from the syndrome, and then post-surgical complications, the child developed behavioral outbursts, hypervigilence, concentration problems, and irritability.

First chikungunya outbreak in Pakistan: a trail of viral attacks.

Despite explicit warning from the National Institute of Health, Pakistan experienced its first chikungunya outbreak in the metropolis of Karachi. We underscore the attention of health authorities and healthcare professionals towards contributing factors associated with this outbreak and the measures required to combat this viral disease.

Pattern and profile of electric burn injury cases at a Burn centre.

Background: Electrical burns are quite different from thermal and chemical burns. This study is from a centre which deals with job related electric burn injuries alone and thus can give a pure account of the electric burns and discuss the related peculiarities. Study aims to highlight the differences in the mechanism of electric burn injury, its mode of presentation, morbidity, complications and thus the treatment strategies as compared to rest of the burn injuries.

Review-Medicinal plants and management of Diabetes Mellitus: A review.

Diabetes is a metabolic disorder characterized by chronic hyperglycemia and associated with dysfunction and failure of various body organs. Alarming increase in prevalence rate has made this disorder a major health problem globally. The available treatment modalities are not sufficient to combat diabetes and associated complications.

Comparison of the learning of two notations: A pilot study.

Introduction: MICAP is a new notation in which the teeth are indicated by letters (I-incisor, C-canine, P-premolar, M-molar) and numbers [1,2,3] which are written superscript and subscript on the relevant letters. FDI tooth notation is a two digit system where one digit shows quadrant and the second one shows the tooth of the quadrant. This study aimed to compare the short term retention of knowledge of two notation systems (FDI two digit system and MICAP notation) by lecture method.

Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study.

Background: Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies.

Methods: A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality.

Glomus tumours: Outcome based on tumour location in hand.

Objective: To determine the clinical outcome of patients with glomus tumour in nail matrix and nail bed that were excised with transungual approach.

Methods: The case series was conducted at the Allied and District Headquarter Hospital, Faisalabad, Pakistan,from January 2012 to June 2014, and comprised patients with glomus tumour at finger tipswhose diagnosis was confirmed with biopsy results. Variables noted were the location of the tumour in the nail i.

Factors affecting functional outcome after lower extremity amputation.

Background: More than 100,000 major lower extremity amputations -- amputations at the metatarsal, below-knee or above-knee level -- are performed yearly in the United States. Despite improvements in long-term outcome, operative mortality following such amputations has remained stable at 9% to 10% over the last 20 years. Several predictors for functional outcome of amputee patients are mentioned in the literature.

Postoperative range of motion and stability after anterior cruciate ligament reconstruction using quadrupled hamstring autograft.

Background: The incidence of anterior cruciate ligament (ACL) tear is increasing, especially in young active adults. Various surgical options like bone-patellar tendon-bone graft and hamstring autograft have been the focus of evaluation and comparison in various aspects, each having specific advantages and demerits. We are increasingly using and analysing quadrupled hamstring autograft for ACL reconstruction.

Clinic based biopsy vs. theatre biopsy of bone and soft tissue extremity tumours: comparable diagnostic modalities.

Objective: To compare the diagnostic accuracy of clinic-based biopsy versus theatre biopsy against final histopathology in patients presenting with extremity tumours.

Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients who underwent biopsy procedure of extremity tumours from January 2008 to December 2011. Data regarding socio-demographic status, disease-related and procedure-related variables were collected from the files.

Clinic-based biopsy with a small curette: is it a reliable and safe option in extremity tumours?

Objective: To establish the diagnostic accuracy and safety of clinic-based biopsy done with a small curette.

Methods: The retrospective study was conducted at Aga Khan University Hospital Karachi and comprised data of patients who underwent biopsy procedure of extremity tumours in clinic under local anaesthesia from July 2009 to June 2012. Patients who underwent the procedure in operating room under general anaesthesia were excluded and so were those with insufficient or missing information, or those who had the final procedure done elsewhere.

K Wire fixation of supra-condylar humerus fractures in children. Is ulnar nerve at risk?

Objective: To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographic alignment was also targeted.

Methods: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of paediatric patients who underwent closed reduction and percutaneous pin fixation for the treatment of displaced extension type supracondylar fractures of the humerus between July 2007 and June 2012.

Floating knee injuries: postoperative complications and outcome.

Objective: To evaluatepost-operative complications and functional outcome of floating knee injuries using Karlstrom\'s criteria.

Methods: The prospective randomised study was conducted at Allied Hospital, Faisalabad, Pakistan, from November 2013 to October2014, and comprised patients of either gender. The injuries were classified using Fraser classification.

Short term evaluation of total hip arthroplasty; our experience at tertiary care center.

Background: Total hip arthroplasty is a common and successful treatment for osteoarthritis of the hip. Demographic trends in Pakistan suggest a significant increase in the demand for total hip replacement surgery.

Objectives: The current study was planned to assess the outcome of THA at our centre in terms of pain relief and functional improvement by using pre and postoperative HHS.

Outcome of open reduction internal fixation with cross K-wires for supracondylar fracture of humerus in terms of Flynn's criteria in children.

Objective: To determine the outcome of open reduction and internal fixation of supracondylar fracture of humerus in children using Flynn\'s criteria.

Methods: The quasi-experimentalstudy was conducted at Punjab Medical College/Allied Hospital, Faisalabad, Pakistan from July 2012 to June 2014and comprised children aged between 5 and 12 years with supracondylar fracture of humerus presenting within one week of the fracture. Post-surgery follow-up included clinical assessment and measurement of carrying angle on radiographs.

Effectiveness of ilizarov frame fixation on functional outcome in aseptic tibial gap non-union.

Objective: The Objective of the study is to evaluate the effect of Ilizarov frame fixation on functional outcome in aseptic tibial gap non-union cases.

Methods: In this clinical study, 15 cases of post-traumatic aseptic tibial gap non-union were selected in department of orthopedics, Allied Hospital Faisalabad, Punjab Pakistan, during years 2013-2014. After blood analysis and clinical assessment, the aseptic gap nonunion cases underwent ilizarov frame fixation for their problem.

Clinical outcome of patients with isolated tibial shaft fractures treated with S.I.G.N interlock nails in terms of surgical site infection and radiological bone healing on follow up.

Objective: To determine the clinical outcome of patients with isolated tibial shaft fractures treated with Surgical Implant Generation Network interlock nails.

Methods: The observational study was conducted from January 2010 to October 2014 at Allied Hospital, Faisalabad, Pakistan, and comprised in-patient charts. The Surgical Implant Generation Network Fracture Care Online Database was also screened for patients' data to be included in the study.

Local recurrence of giant cell tumour of bone after intralesional treatment with and without adjuvant therapy, a single institution case series.

Background: Giant cell tumour (GCT) of bone is generally a benign tumour composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but non-sclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes.

Giant Pleomorphic Adenoma of the Parotid Gland.

Salivary gland tumours are a relatively rare entity. Pleomorphic adenoma is the most common amongst these, comprising 60 - 70% of all parotid tumours. Pleomorphic adenomas are benign and tend to increase in size slowly.

High frequency and poor prognosis of late childhood BCR-ABL-positive and MLL-AF4-positive ALL define the need for advanced molecular diagnostics and improved therapeutic strategies in pediatric B-ALL in Pakistan.

Background: Fusion oncogenes (FOs) resulting from chromosomal abnormalities have an important role in leukemogenesis in pediatric B cell acute lymphoblastic leukemia (ALL). The most common FOs are BCR-ABL, MLL-AF4, ETV6-RUNX1, and TCF3-PBX1, all of which have important prognostic and drug selection implications. Moreover, frequencies of FOs have ethnic variations.

Status of oxidant, antioxidantand serum enzymes in thalassaemic children receiving multiple blood transfusions.

Objective: To determine the levels of oxidant, antioxidant and serum enzymes in thalassaemic children receiving multiple blood transfusions.

Methods: The case-control study was done from February to August 2012, and comprised thalassaemic children receiving multiple blood transfusions at Allied Hospital, Ali Zeb Foundation, and the Thalassaemia Centre in Hilal-e-Ahmar Hospital, Faisalabad, Pakistan. Healthy subjects were also screened for any related disease condition that could prejudice the results.